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Sera collected from healthy individuals from the general population in the Czech Republic during repeated cross-sectional surveys were analyzed. Samples collected in the same six districts in two time periods, 1978-1989 and 2001, were compared. The study subjects were divided into six age categories between 10 and 59 years. Overall, 434 samples from 1978-1989 and 270 samples from 2001 were screened for Anaplasma phagocytophilum (AP) and Borrelia burgdorferi sensu lato (BB). The anti-AP positivity rates were 13.1% and 11.5% in the first and second period, respectively, and did not differ significantly between the periods (P = 0.559). The anti-BB antibodies were detected in 33.9% and 14.8% of study subjects, respectively. The positivity rates were significantly lower in the second period (P<0.001). No considerable changes were observed in the sex distribution of positive findings between the two periods. The highest positivity rates of anti-AP antibodies were found in the 10-14 year age group: 16.0% in 1978-1989 and 16.7% in 2001. The age distribution of the anti-AP antibody positivity rates did not change substantially (P = 0.872). In 1978-1989, the lowest anti-BB antibody positivity rate (26.7%) was found in the 10-14 year age group, with a gradual increase with age to 41.1% in 50-59 year-olds. In 2001, the positivity rate in the 10-14 year age group was 26.2% and was not significantly different from that in the first period (P = 0.955). However, the positivity rates in the older age groups 15-59 years decreased significantly (P<0.001) and varied between 8.3% and 15.1%.

Tick-borne encephalitis (TBE) is a serious acute neuroinfection of humans caused by a tick-borne flavivirus. The disease is typically seasonal, linked to the host-seeking activity of Ixodes ricinus (predominantly nymphs), the principal European tick vector species. To address the need for accurate risk predictions of contracting TBE, data on 4,044 TBE cases reported in the Czech Republic during 2001-2006 were compared with questing activity of I. ricinus nymphs monitored weekly at a defined location for the same 6-year period. A time shift of 21 days between infected tick bite and recorded disease onset provided the optimal model for comparing the number of cases of TBE with numbers of questing nymphs. Mean annual distribution of TBE cases and tick counts showed a similar bimodal distribution. Significantly, the ratio of TBE cases to questing nymphs was highest in the summer-autumn period even though the number of questing nymphs peaked in the spring-summer period. However, this pattern changed during a period of extreme meteorological events of flooding and abnormally high temperatures, indicating that changes in climate affect the incidence of TBE. Previous studies failed to link human behavior with changes in incidence of TBE but showed extrinsic temperature impacts arbovirus replication. Hence, we hypothesize the apparent discrepancy between peak nymphal tick activity and greatest risk of contracting TBE is due to the effect of temperature on virus replication in the tick vector. Relative proportions of questing nymphs and the numbers of weeks in which they were found were greater in summer-autumn compared with spring-summer at near-ground temperatures >5°C and at standard day and weekly average temperatures of >15°C. Thus, during the summer-autumn period, the virus dose in infected tick bites is likely greater owing to increased virus replication at higher microclimatic temperatures, consequently increasing the relative risk of contracting TBE per summer-autumn tick bite. The data support the use of weather-based forecasts of tick attack risk (based on daytime ambient temperature) supplemented with weekly average temperature (as a proxy for virus replication) to provide much-needed real-time forecasts of TBE risk.

Background: Lyme borreliosis (LB) and tick-borne encephalitis (TBE) are two vector-borne diseases transmitted by ticks. Both diseases are endemic and have been reported in all regions of the Czech Republic including urban agglomerations, but in varying proportions. Because of the natural conditions in the border areas, the risk of infection is also high for travelers from the neighboring countries such as Austria, Germany, Poland, and Slovakia., Materials and Methods: To gain more information on the epidemiology of LB and TBE in the last decade, we analyzed national surveillance data from 2007 to 2016., Results: Incidence of LB in the Czech Republic was 37.3/100,000 population and year (27.6 - 46.1/100,000). Incidence of TBE incidence was 5.7/100,000 (3.4-8.2/100,000) and declined although the trend was not significant (p = 0.155). Difference between the incidences of LB and TBE was increasing in time. Overall male-to-female ratio was 0.84 and 1.51 for LB and TBE, respectively. The age-specific incidences of both infections have a typical two-peak shape, with the first peak in the age group 5-9 years for LB and 15-19 years for TBE. The second peak for both LB and TBE is in the age group 55-64 years. TBE poses a considerable risk to children < 15 years. Among 39,074 cases of LB, the most common clinical manifestations were erythema migrants 62.1% and Lyme neuroborreliosis 25.1%. All 5969 TBE cases manifested itself by affecting nervous system, namely meningo-encephalitis 47.9%, meningoencephalomyelitis 21.8% and meningitis 19.8%., Conclusions: The data evidence the high chance risk of infection with LB and TBE in the Czech Republic. The incidence of both infections shows a bimodal distribution during the year. LB cases are five to six times as frequent as TBE cases. Over the last years, the incidence of LB has remained roughly stable while TBE has shown a downward trend. The present study is unique in allowing the comparison of the incidence rates of LB and TBE over time and space.

The COPHES/DEMOCOPHES twin project was performed in 2011-2012 in 17 European countries to harmonize all steps of the human biomonitoring survey. Urinary cadmium, cotinine, phthalate metabolites, and hair mercury were measured in children (N = 120, 6-11 years) and their mothers of reproductive age, living in urban or rural areas. Cadmium in mothers' and children's urine was detected at a geometric mean (GM) concentration 0.227 and 0.109 μg/L, respectively; 95th percentile (P95) was 0.655 and 0.280 μg/L in mothers and children, respectively. No age-related, education-related, or urban versus rural differences were observed within the frame of each population group. Cadmium urinary level in mothers was about twofold compared with children. Higher levels were obtained in all smoking mothers but not in occasionally smoking or mothers and children exposed to environmental tobacco smoke (ETS). Mercury values in mothers were significantly higher in urban than in rural populations but not in children. GM and P95 for mercury in children's hair were 0.098 and 0.439 μg/g and in mothers' hair were 0.155 and 0.570 μg/g. Concentrations for mercury in the Czech samples were lower than European average. Hair mercury increased significantly with consumption of fish or seafood and with number of amalgam tooth fillings (in children). A positive association was found with family educational level. No influence of age was observed. Urinary cadmium and hair mercury levels were lower than health-based guidelines with one exception. High levels of urinary cotinine were found in the 12 smoking mothers (GM approximately 500 μg/L); lower levels in occasionally smoking mothers, N = 11 (34.5 μg/L). The mean cotinine levels in nonsmoking mothers who reported daily exposure to ETS was 10.7 μg/L. A similar mean value (10.8 μg/L) was obtained in six children who had daily exposure to ETS. In children without exposure to ETS, the mean cotinine level was 1.39 μg/L urine. Cotinine in the urine of children demonstrates limited protection of the Czech children against exposure to ETS.

Study Objective: The objective was to analyse and evaluate a cohort of Lyme borreliosis (LB) patients with neuroborreliosis (LNB) hospitalised in the Czech Republic in 2003-2013., Material and Methods: Data analysed in this study were obtained from the National Register of Hospitalised Patients, which is a nationwide population register maintained at the Institute of Health Information and Statistics of the Czech Republic. Data collection from all departments of bed care establishments are regularly processed every year. Registration of basic hospitalisation diagnoses is performed in accordance with the 10th revision of the International Classification of Diseases (ICD-10). The study cohort consisted of 23,631 patients with clinically and laboratory confirmed LB hospitalised between 2003 and 2013., Results: Nervous system involvement, i. e. LNB (ICD-10 codes G00-G99) was recorded in 27.1% (6,392) of LB patients. Hospital admissions for LB exhibited a slight downward trend with year-on-year fluctuations over the study period. In contrast, LNB showed an upward trend with slight year-on-year fluctuations (345-779 cases) (p = 0.003). Overall, 6,392 persons, 3,220 males and 3,172 females, were diagnosed with LNB over the 11-year study period. Some patients presented with multiple concomitant neurological symptoms. Overall, 6,392 hospitalised patients were diagnosed with 8,168 diseases of the nervous system. The most common diagnoses were facial nerve disorders (21.1%), meningitis (18.3%), polyneuropathies (13.6%), encephalitis, myelitis, and encephalomyelitis (11.3%), and nerve root and plexus disorders (4.9%). The average age of male and female patients hospitalised with LNB was 44.4 and 44.7 years, respectively. It varied significantly between the ICD-10 code groups (p < 0.001) from 38.0 to 63.0 years. The relative incidence of LB by five-year age group showed the first peak at the age of 5-9, followed by a considerable drop at the age of 20-24 and then by another higher peak at the age of 55-59 (the hospitalisation rate ratio comparing the peaks in the adults and children was 1.78). For LNB, the second peak shifted to the age of 65 to 74 years and was similar to the peak in children age groups (hospitalisation rate ratio of 0.95). The distribution of hospital admissions for LNB by month of admission showed the highest numbers of admissions in July and September and the lowest numbers of admissions in December and April. The length of hospital stay was significantly higher (mean of 12.4 days and median of 13 days) in LNB patients (p < 0.001) than in other LB patients (mean of 10.3 days and median of 10 days)., Conclusion: The basic prerequisite for reliable diagnosis of LNB is a multidisciplinary collaboration of highly experienced neurologists, infection disease specialists, and microbiologists. The cohort of 6,392 patients hospitalised for LNB was analysed by gender, length of hospital stay, and month of hospital admission. The study found LNB cases to occur in all age groups. LNB diagnosis performed in accordance with the ICD-10 enables valid comparison between neurological outcomes of LB patients at both the national and international levels.

The aim of the present study is to compare the prevalence of Borrelia burgdorferi sensu lato (s.l.) and Anaplasma phagocytophilum in questing ticks by using molecular methods from spring to autumn 2007. A total of 526 Ixodes ricinus ticks were collected from vegetation in three different sampling sites, representing an urban area (city park), a suburban area (village) and a natural montane habitat. The prevalence of B. burgdorferi s.l. was 17.3% (7.5% in males, 18.7% in females and 20.2% in nymphs), while 4.4% of ticks (13.1% of males, 3.7% of females and 1.6% of nymphs) tested positive for A. phagocytophilum. We found higher rates of Anaplasma infection in ticks from the urban area (8.6%) than from the suburban (0.8%) and natural (1.6%) habitats in the spring months. The prevalence of Borrelia infection in the urban park increased significantly from spring (14% in March) to autumn (50% in October). The Anaplasma positivity in the urban area in the autumn months (2.2%) was significantly lower than in the spring and summer months (9.6%). The prevalence of A. phagocytophilum was significantly higher in male ticks than in females and nymphs. For B. burgdorferi s.l., the inverse was true. We conclude that infection risks associated with the presence of Anaplasma and Borrelia in ticks in cities may be comparable to those in natural ecosystems or may be even higher. Our results indicate the need for the surveillance of tick-borne pathogens in urban areas., (Copyright © 2017 Elsevier GmbH. All rights reserved.)

Aim: To determine the prevalence of antibodies against hepatitis E virus in the general population of the Czech Republic of age 15 to 64, to analyse the age and sex distribution of these antibodies, and to evaluate the benefit of the immunoblot test for the confirmation of the specificity of the enzyme immunoassay (EIA) screening test., Material and Methods: Sera from the last available multipurpose serological survey conducted in 2001 were tested. Anti-HEV IgG was detected by the RecomWell HEV IgG EIA test (Mikrogen Diagnostik, Germany). The immunoblot assay RecomLine HEV IgG/IgM (Mikrogen Diagnostik, Germany) was used for confirmation., Results: Using the RecomWell IgG EIA test, anti-HEV IgG reactivity was found in 115 (6.7%) of 1715 sera. No significant difference in the anti-HEV IgG reactivity was found between men 58 (6.9%) and women 57 (6.6%). The prevalence of anti-HEV IgG increased with age from 3.5% in the age group 15-24 years to 16.8% in 55-64-year-olds., Conclusions: The prevalence of hepatitis E IgG antibodies determined in the serological survey in the age group 15-64 years was 6.7%. Recalculated for the general population of the Czech Republic, the prevalence was 8.6%. The prevalence of anti-HEV antibodies increased with age, reaching a peak of 16.8% in the age group 55-64 years. The prevalence was not significantly different between men and women. Using the immunoblot RecomLine IgG test for the confirmation of the specificity of the screening test in the seroprevalence study was not of clear benefit.

Aim: Human exposure to organic pollutants (some of them also called endocrine disruptors) can be associated with adverse metabolic health outcomes including type 2 diabetes. The goal of this study was to compare the urine levels of bisphenol A and phthalate metabolites in subgroups of patients with metabolic syndrome composed of patients with and without three important components of metabolic syndrome (hypertension, dyslipidemia and diabetes)., Methods: We have investigated 24 hr urine samples of 168 patients with metabolic syndrome from the Metabolic Outpatient Department of General University Hospital in Prague. Using standard metabolic syndrome criteria, we classified patients as dyslipidemic (n=87), hypertensive (n=96), and type 2 diabetic (n=58). Bisphenol A and 15 metabolites of phthalates were evaluated in relation to creatinine excretion. Samples were analysed with enzymatic cleavage of glucuronide using ultra-high-performance liquid chromatography-electrospray ionization tandem mass spectrometry in one laboratory with external quality control., Results: Four metabolites, mono-n-butyl phthalate, mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate, and mono-(2-ethyl-5-carboxypentyl) phthalate showed significantly higher levels in diabetic compared to non-diabetic patients (p<0.001, p=0.002, p=0.002, and p=0.005, respectively). The differences remained significant after adjustment to hypertension, dyslipidemia, age, and BMI. No difference was found between either the hypertensive and non-hypertensive or dyslipidemic and non-dyslipidemic patients. There was no significant relation of bisphenol A level to diabetes, hypertension, dyslipidemia, age, and BMI., Conclusions: Urine levels of four phthalate metabolites were significantly higher in type 2 diabetics independently on specified predictors. Phthalate levels can be in relation to beta cell dysfunction in type 2 diabetic patients but this study is not able to show if the relation is causal., (Copyright© by the National Institute of Public Health, Prague 2016)

Study Objective: Three years long research study (2011-2013) on population density of Ixodes ricinus and the infection rate of the pathogens that they transmit was conducted in four topographically distant areas in the Czech Republic. In the previous decade (2001-2010) thirteen loci with increased incidence of tick borne encephalitis cases were defined, suggesting the permanent interaction of human population with ticks and indicating the landmarks for study of the presence of other tick borne pathogens. The work program included the identification of existing spectrum of spirochetes from Borrelia burgdorferi sensu lato complex and the conditions of their occurrence and distribution., Material and Methods: In the areas of the Ústí nad Labem Region, Olomouc Region, South Bohemian Region, and Highlands Region, 600 m2 plots were selected in the local optimal I. ricinus habitats where tick flagging was performed every year in the spring-summer and autumn seasons of the tick questing activity. Collected adult ticks (1369 males and 1404 females) were individually screened for B. burgdorferi s. l. spirochets., Results: Spirochetes from B. burgdorferi s.l. complex were detected in all 13 studies sites in all altitudes from 280 to 1030 meters a. s. l. The total rate of infection was determined as 11.4% (males 10.4%, females 12.4%) with range limits from 1.4% (Ústí nad Labem in 2011) to 19.7% (South Bohemian Region, 2012).Genospecies were detected in various proportions and in different combinations: Borrelia afzelii, B. garinii, B. burgdorferi s. s., B. bavariensis, B. bissettii, B. valaisiana, B. spielmanii and B. lusitaniae. The three-year observation justifies the assumption that the regional differences in infectivity of I. ricinus are based on the character of the local biocenosis of the respective region. The dynamics of its seasonal changes, conditioned by climatic factors, determines the annual differences., Conclusion: Three of the medically most important Borrelia species formed a core group among all detected genospecies. B. afzelii was a dominated one (115 detections), followed by B. garinii (100) and by B. burgdorferi s.s. (19). Other genospecies were detected sporadically. However, the detection of B. bissettii should be emphasized due to the recently proven pathogenic effects of this genospecies and yet little-known sporadic expansion in the Czech Republic. The medical importance and distribution of other sporadically occurred genospecies is also discussed.Key words: Ixodes ricinus - Borrelia afzelii - B. garinii - B. burgdorferi s. s. - B. bavariensis - B. valaisiana - B. spielmanii - B. lusitaniae - B. bissettii - distribution - altitude - season - medical importance.

Aim To verify and compare the accuracies of mortality predictions in the Intensive Care Unit (ICU) of the Internal Clinic of Central Military Hospital in Prague, Czech Republic, using model APACHE II and the newer systems of the APACHE IV, SAPS 3 and MPMo III. Methods The data were collected retrospectively between 2011 and 2012, 1000 patients were evaluated. The assessment of the overall accuracy of the mortality predictions was performed using the standardized mortality ratio (SMR), and the calibration was assessed using the Lemeshow-Hosmer "goodness-of-fit" C statistic. Discrimination was evaluated using ROC curves based on calculations of the areas under the curve (AUCs). Results The APACHE II, SAPS 3, and MPMo III systems significantly overestimated the expected mortality, whereas the APACHE IV model led to correct estimations of the overall mortality. The discrimination capabilities of the models assessed according to the constructions of the ROC curves were evaluated as good, only the APACHE II was evaluated as satisfactory. The calibrations of all models were evaluated as unsatisfactory. Conclusion The best mortality estimation for the investigated population sample was provided by the APACHE IV system. The discrimination capabilities of all models for the studied population were satisfactory, but the calibration of all of the systems was unsatisfactory. The conclusions of our study are limited by the relatively small size of the investigated sample and the fact that this study was conducted at only a single site., (Copyright© by the Medical Assotiation of Zenica-Doboj Canton.)

Objectives: To track the trends in general health indicators and the prevalence of cardiovascular diseases (CVD), high blood pressure and elevated blood cholesterol in the middle-aged urban population in the Czech Republic in 1998-2010., Study Design: Cross-sectional study., Methods: The following data from the three-phase HELEN (HEalth - Lifestyle - ENvironment) study, a prevalence questionnaire survey, were analysed: data collected from 8214 subjects in phase I, 6107 subjects in phase II, and 4389 subjects in phase III. The study subjects were aged 45-54 years and the study period spanned from 1998 to 2010. The differences in the indicators between phases were evaluated by binary and ordinal logistic regression models at a significance level of 0.01., Results: Over the study period, a significant increase was observed in the proportion of respondents who self-rated their health as very good or good: from 46.6% to 51.0% in males (P = 0.006) and from 45.5% to 49.9% in females (P < 0.001). At the same time, the rates of respondents under long-term medical follow-up rose significantly from 36.3% to 44.3% (P < 0.001) and from 46.4% to 56.2% (P < 0.001), respectively. CVD prevalence did not change although the percentage of males and females with high blood pressure (from 29.3% to 36.6% and from 26.0% to 31.2%, respectively) and elevated total cholesterol (from 29.0% to 36.6% and from 27.3% to 32.4%, respectively) increased significantly., Conclusions: Self-rated health among the middle-aged population in the Czech Republic improved during the 1998-2010 period, but, at the same time, more people needed to be followed up for a disease. The proportions of respondents with hypertension and elevated blood cholesterol increased while the CVD rates did not vary significantly., (Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

The serum samples from the years 1970-1990 archived at the temperature of -20°C in the biobank primarily intended for serological survey performed in the CR since 1960 were pooled and analyzed for DDT, its metabolites, HCB, HCHs, and indicator PCB congeners using up-to-date GC/MS/MS methods to retrospectively assess health risks according to current health guidelines. Samples were pooled based on the decade of sampling, age, gender, and three geographical areas; in adults, one pooled samples consisted of ten and in children of twenty individual samples. Altogether 233 pooled samples were analyzed. For all organochlorine pesticides (OCPs), significant downward trends were observed in the period 1970-1990 (p<0.001). The levels of HCB exceeded the Biomonitoring Equivalent (BE) value. The hazard quotient (HQ) in Prague and Ostrava during the 1970s and 1980s was about 40 and in the 1990s it had dropped to about five. In Uherské Hradiště, the HQ in 1975 was one order of magnitude higher (about 170), and had decreased to approximately 12 by 1987. For both HCB and the DDT sum, the BE-related carcinogenic risk of actual concentrations in the past exceeded significantly the individually accepted cancer risk level of 10(-4). The levels of the main PCB congeners in the 1970s through 1990s revealed an upward time trend in all analyzed strata. The highest concentrations were found in the serum of residents from the hot-spot area Uherské Hradiště. Critical PCB sum concentration levels (700ng/g lipid for vulnerable population groups and 1800ng/g lipid for other population groups) were substantially exceeded with an increasing time trend. PCB sum had exceeded HBM II values of 7μg/L of serum since 1980 in all age strata. In conclusion, the body burden of the Czech general population relative to persistent organic pollutants (POPs) in the period 1970 through 1990 significantly exceeded currently existing health based limit values. The past exposure might adversely affect the health status of the Czech population., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

Incomplete stent apposition and uncovered struts are associated with a higher risk of stent thrombosis. No data exist on the process of neointimal coverage and late apposition status of the bioresorbable vascular scaffold (BVS) when implanted in the highly thrombogenic setting of ST-segment elevation acute myocardial infarction (STEMI). The aim of this study was to assess the serial changes in strut apposition and early neointimal coverage of the BVS using optical coherence tomography (OCT) in selected patients enrolled in the PRAGUE-19 study. Intracoronary OCT was performed in 50 patients at the end of primary percutaneous coronary intervention for acute STEMI. Repeated OCT of the implanted BVS was performed in 10 patients. Scaffold area, scaffold mean diameter and incomplete strut apposition (ISA) were compared between baseline and control OCT. Furthermore, strut neointimal coverage was assessed during the control OCT. Mean scaffold area and diameter did not change between the baseline and control OCT (8.59 vs. 9.06 mm(2); p = 0.129 and 3.31 vs. 3.37 mm; p = 0.202, respectively). Differences were observed in ISA between the baseline and control OCT (0.63 vs. 1.47 %; p < 0.05). We observed 83.1 % covered struts in eight patients in whom the control OCT was performed 4-6 weeks after BVS implantation, and 100 % covered struts in two patients 6 months after BVS implantation. Persistent strut apposition and early neointimal coverage were observed after biodegradable vascular scaffold implantation in patients with acute ST-segment elevation myocardial infarction.

Objective: The evaluation of multidisplinary care about HIV positive pregnant women in the Czech Republic., Design: Review., Settings: Gynekologicko-porodnická klinika 1. LF UK a Nemocnice na Bulovce, Praha., Methods: The vertical transmission of HIV infection from mother to fetus occurs most often during birth, still 1-2% of HIV-positive pregnant women will transfer the virus transplacenta. Due to careful screening for HIV during pregnancy, counselling, combination antiretroviral (cART) therapy, childbirth planning and its performance by C-section there appears a significant decrease of the virus transmission to the fetus, its occurrence is around 2%. If the HIV infection is detected in the context of screening for sexually transmitted infections (STIs), we begin with combined antiretroviral therapy (cART) depending on the level of viremia and CD4 as soon as possible. All HIV-positive pregnancies are tested for possible coinfection with hepatitis C. Since the first application of the antiretroviral treatment, the therapy is applies throughout the duration of the pregnancy. The labours of the HIV- positive women in the Czech Republic are scheduled. The primary choice is a caesarean section during the 38th week of pregnancy., Conclusion: From 1996-2014 the HIV positive status at 18 months of child age was confirmed in 4 cases in the Czech Republic. Three children were born to mothers whose HIV status was unknown at the time of the birth. Thanks to strict adherence to the interdisciplinary care, HIV positive woman have a chance to deliver a HIV-negative newborn and the risk of the transmission of the virus is significantly low.

Objectives: Minimally invasive surgery for atrial fibrillation (AF) has rapidly evolved recently. The long-term efficacy of most of these procedures is poorly known., Methods: Between 2006 and 2010, 38 drug-resistant, symptomatic patients with stand-alone AF underwent unilateral, thoracoscopic, off-pump ablation. The mean age was 60 ± 8.2 (range 42-75) years and the mean AF duration was 46 ± 62 (range 3-240) months. Sixteen patients (42%) had paroxysmal, 9 (24%) had persistent and 13 (34%) had long-standing persistent AF. A box lesion was created using a microwave (26 patients) or monopolar radiofrequency (12 patients) system. Patients were prospectively followed with repeat electrocardiograms (ECGs) and ECG Holters. Additional catheter ablation was offered to patients with recurrence of arrhythmia., Results: All procedures were completed as planned with one conversion to sternotomy, zero mortality and minimal in-hospital complications. The mean follow-up duration was 70 ± 19 (range 20-88) months. Arrhythmia-free survival rates after the procedure were 50, 44.4, 24.1 and 10.8% at 6, 12, 36 and 60 months, respectively, with most recurrences in the first 6 months. Twelve patients underwent additional catheter ablation(s); from the last intervention, 75% of them were in sinus rhythm (SR) with a mean follow-up of 31 ± 23 (range 4-86) months. Overall, at the end of follow-up, only 3 patients were still in SR without any arrhythmia recurrence. Major complications (cerebral, peripheral embolism or bleeding) occurred in 5 patients., Conclusions: Unilateral, thoracoscopic AF ablation is safe and technically feasible. However, the results of the microwave and monopolar radiofrequency devices were less than satisfactory, with a gradual decline in arrhythmia-free survival over a very long-term follow-up., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: Significant aortic stenosis (AS) is frequently associated with mitral regurgitation (MR) of varying degrees. We sought to assess the change in MR grade after the aortic valve procedure, to find predictors of MR improvement and finally to determine the prognostic impact of persistent MR., Methods: We retrospectively analyzed a group of 101 AS patients who underwent aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI) at our institution between January 2007 and March 2014 and who presented with MR grade 2 or higher on preoperative echocardiogram - 35 patients underwent an isolated AVR, 18 underwent TAVI, and the rest underwent a combined procedure, which included coronary artery bypass grafting. The mean follow-up was 28.5±21 months., Results: MR improved significantly after the procedures (2.4±0.5 vs. 1.9±0.9, p<0.001) and a decline in the severity of MR was observed regardless of etiology (degenerative/post-rheumatic, functional/ischemic, combined) without significant changes between groups (p=0.667). Downgrading of MR severity was associated with improvement in ejection fraction (p=0.021) and reduction in the size of cardiac chambers, especially the left atrium (left atrial diameter, p<0.001). None of the preoperatively evaluated factors (severity of AS, MR etiology, ejection fraction, cardiac chamber dimensions, coronary artery disease, and New York Heart Association functional class) was a significant predictor of MR improvement. Persistence of higher degrees of MR was associated with a more frequent need for cardiovascular hospitalization, while the survival rate 3 years after procedure was not affected (p=0.146)., Conclusions: In the majority of AS patients, an aortic valve procedure leads to reduction in coexistent MR. A significant decrease in the severity of MR in our study was observed regardless of etiology and preoperative grade of MR. Persistence of higher degrees of MR was associated with increased patient morbidity., (Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Study Objective: The aim of the three-year study (2011-2013) was to monitor population density of Ixodes ricinus ticks and its infection rate with the tick-borne encephalitis virus in areas with a high incidence of tick-borne encephalitis as reported in the previous decade 2001-2010. Such a comprehensive and long-term study based on existing epidemiolo-gical findings has not previously been conducted in Europe., Material and Methods: In the areas of the Ústí nad Labem Region, Olomouc Region, South Bohemian Region, and Highlands Region, 600 m2 plots were selected in the local optimal I. ricinus habitats where tick flagging was performed every year in the spring-summer and autumn seasons of the questing activity. In total, 18,721 I. ricinus ticks (1448 females, 1425 males, and 15,848 nymphs) were collected and investigated., Results and Conclusion: The results have shown that the differences in the infection rate of I. ricinus observed between regions are driven by variation in the density of the local I. ricinus populations which is influenced by the characteris-tics of the whole local biocenosis. The overall prevalence estimate of TBE virus in Ixodes ricinus ticks at the altitudes below 600 m a.s.l. was 0.096 % (95% CI 0.055-0.156) for nymphs, and 0.477 % (95% CI 0.272-0.773) for adults. The dynamics of the seasonal variation in I. ricinus populations, depending primarily on the climatic factors, are behind the interyear differences in the infection rate of ticks and, consequently, in the epidemiological situation of tick-borne encephalitis. The nymph to adult ratio was 5.5 on average but showed great interregional variability (from 10.3 in the Ústí nad Labem Region to 1.8 in the Highlands Region). It might be used in the future as one of the indicators of the composition of the local I. ricinus population and of the level of the circulation of tick-borne pathogens in zoonotic sphere and also for use in the health risk assessment in a given area. Despite the permanent expansion of ticks and tick-borne pathogens in higher altitudes the high risk limit for human infection with tick-borne encephalitis is 600 m a.s.l. in the Czech Republic.

Aims: Early clinical results after implantation of bioresorbable vascular scaffolds (BVS) in ST-elevation myocardial infarction (STEMI) are encouraging, but long-term data are missing. This study evaluates long-term outcome in STEMI patients with implanted BVS., Methods and Results: The PRAGUE-19 study is an academic study enrolling consecutive STEMI patients with the intention to implant BVS. A total of 580 STEMI patients were screened between December 2012 and March 2015; 117 patients fulfilled entry criteria and BVS was successfully implanted in 114 (97%) of them. The primary combined clinical endpoint (death, reinfarction or target vessel revascularisation) occurred in 11.5% during the mean follow-up period of 730±275 days with overall mortality of 4.4%. Definite scaffold thrombosis occurred in two patients in the early phase after BVS implantation; there was no late thrombosis. Quantitative coronary angiography (10 patients) at three years demonstrated late lumen loss of 0.2±0.33 mm and optical coherence tomography showed minimal lumen area of 5.3±1.37 mm2 and neointimal hyperplasia area of 2.9±0.48 mm2. BVS struts were still visible at three years and 99.4% of them were well apposed and covered., Conclusions: Encouraging clinical and imaging results after BVS implantation in STEMI patients persist during long-term follow-up.

We introduce CEval software (downloadable for free at echmet.natur.cuni.cz) that was developed for quicker and easier electrophoregram evaluation and further data processing in (affinity) capillary electrophoresis. This software allows for automatic peak detection and evaluation of common peak parameters, such as its migration time, area, width etc. Additionally, the software includes a nonlinear regression engine that performs peak fitting with the Haarhoff-van der Linde (HVL) function, including automated initial guess of the HVL function parameters. HVL is a fundamental peak-shape function in electrophoresis, based on which the correct effective mobility of the analyte represented by the peak is evaluated. Effective mobilities of an analyte at various concentrations of a selector can be further stored and plotted in an affinity CE mode. Consequently, the mobility of the free analyte, μA, mobility of the analyte-selector complex, μAS, and the apparent complexation constant, K('), are first guessed automatically from the linearized data plots and subsequently estimated by the means of nonlinear regression. An option that allows two complexation dependencies to be fitted at once is especially convenient for enantioseparations. Statistical processing of these data is also included, which allowed us to: i) express the 95% confidence intervals for the μA, μAS and K(') least-squares estimates, ii) do hypothesis testing on the estimated parameters for the first time. We demonstrate the benefits of the CEval software by inspecting complexation of tryptophan methyl ester with two cyclodextrins, neutral heptakis(2,6-di-O-methyl)-β-CD and charged heptakis(6-O-sulfo)-β-CD., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Introduction: Calcific aortic valve stenosis (CAVS) is a serious clinical problem. The strongest predictor of CAVS progression is the amount of calcium in the aortic valve. The pathogenesis of CAVS is largely consistent with the pathogenesis of atherosclerosis; however, about 50% of patients with CAVS do not exhibit significant atherosclerosis. Cardiovascular calcification is currently considered an actively regulated process, in which the important role is attributed to the RANKL/RANK/OPG (receptor activator of nuclear factor κB ligand/RANK/osteoprotegerin) axis. We measured OPG levels in the tissue of calcified, stenotic aortic valves in relation to the presence or absence of coronary artery disease (CAD)., Materials and Methods: Aortic valve samples were collected from 105 patients with calcified, mainly severe aortic stenosis, who were divided into two groups according to the presence of CAD. In Group A (n=44), there were normal coronary artery findings, while in Group B (n=61), there was angiographically demonstrated >50% stenosis of at least one coronary artery. The control Group C (n=21) consisted of patients without aortic stenosis and with normal angiographic findings on coronary arteries., Results: The highest tissue concentrations of OPG [median (pmol/L), 25th-75th percentile] were found in Group A [6.95, 3.96-18.37], which was significantly different compared to the other two groups (P=.026 and .001, respectively). The levels of OPG in Group B [4.15, 2.47-9.16] and in Group C [2.25, 1.01-5.08] did not differ significantly (P=.078); however, the lowest concentrations of OPG were found in Group C. Neither age nor gender in our study had effect on tissue levels of OPG (P=.994 for gender; P=.848 for age)., Conclusion: Calcified and narrowed aortic valves, compared to the normal valves, were accompanied by a change in tissue concentrations of OPG, which is, in addition, dependent on the presence or absence of CAD. The highest tissue concentrations of OPG in our work were found in patients with significant aortic stenosis without concomitant CAD., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: In the Czech Republic, two-dose immunization against mumps achieves 98% coverage. The routine reporting detects mumps cases, clinical complications, and hospital admissions in unvaccinated but also in vaccinated individuals. Using surveillance data of patients with mumps we assessed the effectiveness of mumps vaccination on mumps clinical complications and hospitalization need. We also investigated the effect of the time since immunization., Methods: We analysed data on incident mumps cases reported to the Czech national surveillance system in 2007-2012. Using a logistic regression model with adjustment for age, sex, year of onset, and the administrative region, the association between vaccination and the most frequent mumps complications and hospitalization was evaluated. The adjusted odds ratios (ORa) for mumps complications were compared between the vaccinated and non-vaccinated groups, reflecting the vaccine effectiveness (VEa) computed as VEa = (1-ORa) × 100. We estimated the risk of mumps complications by the time from vaccination., Results: From total of 9663 mumps analysed cases 5600 (58%) occurred in males. The mean age at the disease onset was 17.3, median 16 years. Ninety percent of the study patients had no complications, while 1.6% developed meningitis, 0.2% encephalitis, and 0.6% pancreatitis. Mumps orchitis occurred in 659 (11.8%) male cases. In total, 1192 (12.3%) patients required hospitalization. Two doses of vaccine received by 81.8% cases significantly reduced the risk of hospitalization: ORa 0.29 (95% CI: 0.24, 0.35). Two doses showed statistically significant VEa 64% (95% CI: 46, 79) for meningitis, 93% (95% CI: 66, 98) for encephalitis in all cases, and 72% (95% CI: 64, 78) for orchitis in males. Vaccine effectiveness for orchitis declined from 81 to 74% and 56% in the most affected age groups 10-14, 15-19, and 20-24 years, respectively. Among 7850 two-dose recipients, the rate of complications rose from below 1 to 16% in categories up to 6 years and 24 and more years after the second dose, respectively., Conclusions: This study demonstrates a significant preventive effect of two-dose vaccination against mumps complications (orchitis, meningitis, or encephalitis) and hospitalization for mumps. The risk of complications increases with time interval from vaccination. Teenagers and young adults were the most affected age groups.

The aim of our study was to find out the optimal conditions for short-term storage of cerebrospinal fluid (CSF) samples for direct diagnosis of Lyme disease. A mixture of Borrelia-negative CSFs spiked with a defined amount of cultured Borrelia garinii was used. Borrelia stability was investigated over 7 days at four different temperatures [room temperature (RT), +4, -20 and -70 °C]. Quantitative changes in CSF Borrelia were measured by quantitative PCR (qPCR), and morphological changes in the spirochetes were observed by transmission electron microscopy (TEM). These qPCR results were statistically evaluated. We found +4 °C to be an optimal temperature for short-term storage of CSF samples intended for TEM observation. There was no significant difference between the temperatures tested in the average quantity of Borrelia measured by qPCR. On the contrary, electron optical diagnosis of frozen samples and samples stored at RT showed destructive morphological changes and decreased spirochete counts. Our results show that optimal conditions for the pre-analytical phase of investigation of one type of material can differ depending on the diagnostic method employed.

Aim: The Ostrava region suffers from high levels of air pollution during winter inversions. We investigated the association between short-term elevations of air pollutant concentrations and worsening of respiratory problems, use of asthma medication and restriction of daily activities in asthmatic patients in Ostrava., Methods: One-hundred and forty-seven child and adolescent patients (aged 6-18 years) with a confirmed diagnosis of mild to moderate persistent asthma were included in the study. Participants' parents completed diaries covering the period of November 2013 to February 2014; this analysis included 18,228 person-days. Daily smoothed maps of outdoor concentrations of particulate matter (PM10), nitrogen dioxide (NO2) and sulphur dioxide (SO2) were constructed from routine monitoring data, and participants' daily exposures were estimated on the basis of time spent at home and at school. The associations between health outcomes and exposure to air pollutants were estimated using the multiple logistic regression method., Results: The odds ratios (OR) of the combined outcome for wheezing and/or difficulty in breathing, per 10 µg/m³ increase in the mean 24-h exposure were 1.07 (95% confidence interval 1.04-1.11) for PM10, 1.30 (1.18-1.44) for NO2, and 1.37 (1.18-1.59) for SO2. Additional inhaler use (in addition to usual medication) was also more frequent at higher air pollutant concentrations; the odds ratios per 10 µg/m³ increase in the mean 24-h exposure were 1.05 (1.02-1.07) for PM10, 1.19 (1.10-1.30) for NO2, and 1.26 (1.11-1.43) for SO2. Associations were less consistent for other health outcomes., Conclusions: These results suggest moderately strong associations between air pollutant concentrations and respiratory difficulties among asthmatic children and adolescents. More detailed analyses are required to confirm these preliminary findings., (Copyright© by the National Institute of Public Health, Prague 2015.)

Background: Abiotic conditions provide cues that drive tick questing activity. Defining these cues is critical in predicting biting risk, and in forecasting climate change impacts on tick populations. This is particularly important for Ixodes ricinus nymphs, the vector of numerous pathogens affecting humans., Methods: A 6-year study of the questing activity of I. ricinus was conducted in Central Bohemia, Czech Republic, from 2001 to 2006. Tick numbers were determined by weekly flagging the vegetation in a defined 600 m(2) field site. After capture, ticks were released back to where they were found. Concurrent temperature data and relative humidity were collected in the microhabitat and at a nearby meteorological station. Data were analysed by regression methods., Results: During 208 monitoring visits, a total of 21,623 ticks were recorded. Larvae, nymphs, and adults showed typical bimodal questing activity curves with major spring peaks and minor late summer or autumn peaks (mid-summer for males). Questing activity of nymphs and adults began with ~12 h of daylight and ceased at ~9 h daylight, at limiting temperatures close to freezing (in early spring and late autumn); questing occurred during ~70 % calendar year without cessation in summer. The co-occurrence of larvae and nymphs varied annually, ranging from 31 to 80 % of monitoring visits, and depended on the questing activity of larvae. Near-ground temperature, day length, and relative air humidity were all significant predictors of nymphal activity. For 70 % of records, near-ground temperatures measured in the microhabitat were 4-5 °C lower than those recorded by the nearby meteorological observatory, although they were strongly dependent. Inter-annual differences in seasonal numbers of nymphs reflected extreme weather events., Conclusions: Weather predictions (particularly for temperature) combined with daylight length, are good predictors of the initiation and cessation of I. ricinus nymph questing activity, and hence of the risk period to humans, in Central Europe. Co-occurrence data for larvae and nymphs support the notion of intrastadial rather than interstadial co-feeding pathogen transmission. Annual questing tick numbers recover quickly from the impact of extreme weather events.

Objective: Phthalates and their metabolites are classified as endocrine modulators. They affect the hormonal balance in both children and adults. The aim of this publication was to compare the urinary levels of phthalate metabolites in selected populations of the Czech Republic (CZ), Slovakia (SK), and Hungary (HU) in relation to the sources of phthalate exposure identified by means of questionnaire (personal care products, floor and wall coverings, plastic toys, and some kinds of foods)., Methods: Data were obtained through the twin projects COPHES (COnsortium to Perform Human biomonitoring on a European Scale) and DEMOCOPHES (DEMOnstration of a study to COordinate and Perform Human biomonitoring on a European Scale) from 2009 to 2012. The target groups were children aged 6-11 years old and their mothers up to 45 years of age. The metabolites of phthalates (monomethyl phthalate (MMP), monoethyl phthalate (MEP), monobenzyl phthalate (MBzP), mono-cyclohexyl phthalate (MCHP), mono-(2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (5OH-MEHP), and mono-(2-ethyl-5-oxohexyl) phthalate (5OXO-MEHP)) were analysed in first morning urine samples. After enzymatic glucuronide cleavage, the urine sample analyses were performed using ultra-high-performance liquid chromatography-electrospray ionization tandem mass spectrometry (UHPLC-ESI-MS/MS) in one laboratory that qualified in the External Quality Assessment exercises organised by COPHES., Results: Significant differences in phthalate exposure between countries were revealed for children only but not for mothers. The concentrations of 5-OH-MEHP (P<0.001), 5OXO-MEHP (P<0.001), and their sum (P<0.001) were the highest in SK compared to CZ and HU. The health based guidance values for the sum of DEHP metabolites 5-OH MEHP and 5OXO-MEHP established by the German Commission for biomonitoring of 300 µg/L and 500 µg/L for women adults and children, respectively, were only exceeded in one mother and three boys. A significant difference was also found for MEP (P=0.0149), with the highest concentrations detected in HU. In all countries, the increasing frequency of using personal care products significantly elevated the concentrations of MEP., Conclusion: Some differences were observed between countries in the concentrations of individual urinary phthalate metabolites in children. However, the questionnaire results give no direct explanation for the differences between the countries except the variation in using personal care products., (Copyright © 2014 Elsevier Inc. All rights reserved.)

In humans, toxoplasmosis mostly occurs as a latent infection, but in immunocompromised individuals, the agent may reactivate and cause severe to life-threatening disease. HIV positive individuals and transplant recipients, in particular hematopoietic stem cell transplant and heart transplant recipients, are at highest risk. The disease most often affects the central nervous system but can involve any organ. Because of the alteration of the immune response in these patients, the serodiagnosis is not reliable and direct detection of the causative agent is needed--namely by microscopy and DNA PCR. If inadequately treated or left untreated, toxoplasmosis generally has a fatal prognosis in immunocompromised patients and therefore, the treatment must be started as early and energetically as possible. The gold standard both in the treatment of reactivation and secondary prophylaxis is the pyrimethamine-sulfadiazine combination while co-trimoxazole can be used in the primary prophylaxis for high-risk patients.

Objective: Analysis of the prevalence of selected congenital anomalies in the Czech Republic in 1994-2009., Design: Retrospective epidemiological analysis of the postnatal and overall (including prenatally diagnosed cases) prevalence of congenital anomalies from the database of the National Registry of Congenital Anomalies of the Czech Republic., Material and Methods: Data from the National Registry of Congenital Anomalies (NRCA) maintained by the Institute of Health Information and Statistics of the Czech Republic (IHIS CR) were used. The analysis was carried out for the entire Czech Republic, based on the data from 1994 to 2009. Additional data on prenatally diagnosed anomalies were obtained from medical genetics centres and laboratories in the Czech Republic. This study analyzed the postnatal and overall (including prenatally diagnosed cases) prevalence of congenital anomalies. More detailed analysis was carried out for the following diagnoses: anencephaly, spina bifida, encephalocoele, congenital hydrocephalus, omphalocoele, gastroschisis, oesophageal atresia and stenosis, anorectal anomalies, and diaphragmatic hernia. Prevalence trends were analysed using Poisson regression., Results: In 2009, a total of 118 348 live births were recorded in the Czech Republic, 60 368 boys and 57 980 girls. Of this total, 4 653, i.e. 2 745 boys and 1 908 girls, were diagnosed with congenital anomalies. In 2007-2009, the total of life births with congenital anomalies ranged between 4.6 and 4.8 thousand per year. The respective ranges in this three-year period were in the order of 2.7 and 2.8 thousand per year for boys and 1.9 thousand per year for girls. The prevalence of postnatally diagnosed anencephaly was minimal, as most cases were diagnosed prenatally, and the data did not vary significantly. The prevalence of postnatally diagnosed cases remained at the same level. The effectiveness of the prenatal diagnosis of spina bifida increased and thus the prevalence of postnatally diagnosed cases decreased. The prevalence of prenatally diagnosed encephalocoele increased and that of postnatally diagnosed cases varied between years, with no clear trend. The prevalence of omphalocoele varied for both prenatally and postnatally diagnosed cases; nevertheless, the effectiveness of prenatal diagnosis of this defect increases. The prevalence of gastroschisis remained unchanged, but the number of live births with this diagnosis showed a non-significant upward trend. If the trend reflects the real situation, it could be a result of a changed approach to prenatal diagnosis due to advances in corrective surgery of this defect. The prevalence of live births with congenital hydrocephalus showed a downward trend in the second half of the period 1994-2009 thanks to the improved diagnosis. The prevalence rates of live births with congenital esophageal and anorectal anomalies were slightly increasing. The prevalence of congenital diaphragmatic hernia varied between years but the overall prevalence appeared to be slightly increasing., Conclusion: The prevalence of some congenital anomalies (spina bifida, omphalocoele, and congenital hydrocephalus) showed a downward trend over the study period 1994-2009, mainly as a result of effective prenatal diagnosis. The prevalence of other congenital anomalies such as anencephaly or encephalocoele remained unchanged in live births. As for anencephaly, postnatally diagnosed cases were rare as the prenatal diagnosis was close to 100 %. The trend in encephalocoele is explained by the low incidence of this diagnosis in the population. The third group of postnatally diagnosed congenital anomalies such as gastroschisis or esophageal and anorectal anomalies were on the rise. As for gastroschisis, the reason was the changed approach to prenatal diagnosis due to good prognosis of this operable defect. The prevalence of congenital esophageal and anorectal anomalies varied between years, with a slowly increasing trend, similarly to diaphragmatic hernia.

Study Objective: Serological diagnosis of epidemic mumps can be difficult in vaccinated persons, particularly due to the absence of specific IgM antibodies. The aim was to find whether adding the detection of IgA antibodies to the currently used routine serological diagnosis of mumps (detection of IgM and IgG antibodies in an acute serum sample) would make the serological diagnosis of mumps more effective in a population with a high vaccination coverage. At the same time, ELISA kits for the detection of early IgA and IgM antibodies against the mumps virus were compared and statistical analysis of the results was performed., Material and Methods: Sixty-four acute sera from patients with laboratory confirmed diagnosis of mumps were included in the study. Clinical specimens were collected at the onset of clinical symptoms. To test the sera, the MASTAZYME ELISA Mumps IgA kit (MAST DIAGNOSTICA, Germany) with the MASTSORB sorbent (RF and IgG) and Enzygnost Anti-Parotitis-Virus/IgM kit (Siemens, Germany) were used. A panel of 121 acute sera with no epidemiological link to mumps virus served as specificity controls for the IgA assay. The epidemiological data were derived from the EPIDAT system. The level of agreement was assessed using the McNemara test and Cohen's coefficient kappa. The Stata 9.2 software (Stata Corp LP, College Station, USA) was used for statistical analysis., Results: The detection of IgA and IgM antibodies against the mumps virus yielded concordant results in 50/64 acute sera, 32 positive and 18 negative, i.e. an agreement of 78.12 %. Of the remaining 14 samples, 13 were only IgA positive and one was only IgM positive. The controls showed non-specific IgA positivity in 5/121 samples which indicates a 96% specificity., Conclusion: The absence of specific IgM antibodies against mumps virus is relatively often seen in vaccinated indivi-duals; nevertheless, the test is routinely used in patients with suspected active infection. The test for IgA antibodies, which is not routinely performed, significantly increased the detection rate of the disease. Based on the results of the present study, it can be concluded that the combination of the anti-mumps IgM and IgA assays increased the effectiveness of the serological diagnosis at the onset of clinical symptoms from less than 52% to nearly 72%.

To determine changes in incidence of reactivation of Toxoplasma gondii infection, manifesting as toxoplasmic encephalitis, and to assess the immunological mechanisms controlling reactivation in HIV-infected patients, a Czech cohort of 502 HIV/T. gondii co-infected patients was followed for 2909·3 person-years. The incidence of toxoplasmic encephalitis between the periods before and after the introduction of combination antiretroviral therapy (cART) was compared. Toxoplasmic encephalitis was diagnosed in 21 patients. In those patients the geometric mean value of CD4+ T lymphocytes was 12·6 times lower than in patients with non-reactivated T. gondii infection but an additionally significant decline in CD8+ T lymphocytes (3·3-fold) and natural killer cells (4·3-fold) was observed. This confirms the significance of these parameters. A twelvefold decrease in Toxoplasma reactivation incidence (40·2 vs. 3·4/1000 person-years) between monitored periods was seen. In the cART era, Toxoplasma reactivation was observed only in patients with unrecognized HIV infection or refusing therapy.

Background: Nasal inflammation in allergic rhinitis enhances bronchial Th2 driven inflammation and development of asthma. We assessed bronchial inflammation induced by natural allergen exposure during pollen season in patients with pollinosis with or without asthma to show the intensity of inflammation in asthma and rhinitis and possible persistence of inflammation in periods without allergen exposure., Methods: Sputum was induced in 52 patients with seasonal allergic rhinitis without asthma, 38 patients with seasonal allergic rhinitis and seasonal asthma and 23 healthy volunteers. Sampling was performed 6-8 weeks before the expected beginning of symptoms, during symptomatic period and 6-8 weeks after the end of symptoms. Sputum ECP was measured by means of chemi-luminiscent immunometric assay and sputum cell counts were assessed by classical staining and immunocytochemistry., Results: Sputum eosinophils were on the whole higher in both asthma and rhinitis compared to controls (p<0.001, p=0.003). The rise of eosinophils during pollen season compared with values out of pollen season was significant in asthma (classical staining) (p=0.014) and slightly apparent in rhinitis (immunocytochemistry) (p=0.073). The seasonal rise of sputum ECP was observed only in rhinitis (p=0.006)., Conclusions: Inflammation of the lower airway in patients with allergic rhinitis with and without asthma has been confirmed by means of both sputum eosinophil count and sputum ECP level. Persistent inflammation of lower airway in periods without allergen exposure was proven in seasonal asthma. This may have implications for the therapy of seasonal allergic rhinitis with and without asthma in terms of promoting long-term anti-inflammatory treatment., (Copyright © 2013 SEICAP. Published by Elsevier Espana. All rights reserved.)

Rheumatoid arthritis is an autoimmunity leading to considerable impairment of quality of life. N-acetyl glucosamine (GlcNAc) has been described previously as a potent modulator of experimental arthritis in animal models and is used for osteoarthritis treatment in humans, praised for its lack of adverse effects. In this study we present a comprehensive immunological analysis of multivalent GlcNAc-terminated glycoconjugate (GC) application in the treatment of collagen-induced arthritis (CIA) and its clinical outcome. We used immunohistochemistry and FACS to describe conditions on the inflammation site. Systemic and clinical effects were evaluated by FACS, cytotoxicity assay, ELISA, cytometric bead array (CBA), RT-PCR and clinical scoring. We found reduced inflammatory infiltration, NKG2D expression on NK and suppression of T, B and antigen-presenting cells (APC) in the synovia. On the systemic level, GCs prevented the activation of monocyte- and B cell-derived APCs, the rise of TNF-α and IFN-γ levels, and subsequent type II collagen (CII)-specific IgG2a formation. Moreover, we detected an increase of anti-inflammatory IL-4 mRNA in the spleen. Similar to the synovia, the GCs caused a significant reduction of NKG2D-expressing NK cells in the spleen without influencing their lytic function. GCs effectively postponed the onset of arthritic symptoms, reduced their severity and in 18% (GN8P) and 31% (GN4C) of the cases completely prevented their appearance. Our data prove that GlcNAc glycoconjugates prevent the inflammatory response, involving proinflammatory cytokine rise, APC activation and NKG2D expression, leading to the attenuation of clinical symptoms. These results support the glycobiological approach to the treatment of collagen-induced arthritis/rheumatoid arthritis (CIA/RA) as a way of bringing new prospects for more effective therapeutic interventions., (© 2014 British Society for Immunology.)

Aims: Bioresorbable vascular scaffolds (BVSs) have been studied in chronic coronary artery disease, but not in acute ST-segment elevation myocardial infarction (STEMI). This prospective multicentre study analysed the feasibility and safety of BVS implantation during primary percutaneous coronary intervention (p-PCI) in STEMI., Methods and Results: Bioresorbable vascular scaffold implantation became the default strategy for all consecutive STEMI patients between 15 December 2012 and 30 August 2013. A total of 142 patients underwent p-PCI; 41 of them (28.9%) fulfilled the inclusion/exclusion criteria for BVS implantation. The BVS device success was 98%, thrombolysis in myocardial infarction 3 flow was restored in 95% of patients, and acute scaffold recoil was 9.7%. An optical coherence tomography (OCT) substudy (21 patients) demonstrated excellent procedural results with only a 1.1% rate of scaffold strut malapposition. Edge dissections were present in a 38% of patients, but were small and clinically silent. Reference vessel diameter measured by quantitative coronary angiography was significantly lower than that measured by OCT by 0.29 (±0.56) mm, P = 0.028. Clinical outcomes were compared between BVS group and Control group; the latter was formed by patients who had implanted metallic stent and were in Killip Class I or II. Combined clinical endpoint was defined as death, myocardial infarction, or target vessel revascularization. Event-free survival was the same in both groups; 95% for BVS and 93% for Control group, P = 0.674., Conclusion: Bioresorbable vascular scaffold implantation in acute STEMI is feasible and safe. The procedural results evaluated by angiography and OCT are excellent. The early clinical results are encouraging.

Background: The aim of this study was to compare human and animal skin irritation data with results of selected in vitro methods, including HET-CAM test, Neutral Red Release Assay, Neutral Red Uptake Assay and EpiOcular eye irritation test and with already existing data of eye irritation obtained from animal experiments., Methods: Chemicals employed in previous skin irritation validation studies and commercially available cosmetic formulations were subjected to further testing using in vitro methods Neutral Red Release (NRR) assay, Neutral Red Uptake (NRU) assay, HET-CAM test and EpiOcular assay., Results: The study revealed that skin irritants are not necessarily eye irritants; specifically volatile or solid materials may be misclassified. NRR assay provided false negative results in case of substances with fixative effect or not removable under standard washing procedure, emphasizing the role of microscopical evaluation as a crucial additional endpoint. Although overpredictive, HET-CAM test provided the lowest false negative rate. The most aggressive cosmetic formulation was correctly identified by EpiOcular assay, in accordance with NRU and NRR assays results, while HET-CAM test correctly identified the mildest formulation., Conclusions: Each of the in vitro methods is related to a specific endpoint of ocular irritation and provides only partial information on the mode of action of the tested material. Despite good reproducibility of individual in vitro assays, only the weight-of-evidence approach and results of multiple selected in vitro tests can allow for estimation of eye irritation hazard in vivo.

Background: The aim of this randomized study was to investigate the effect of seven-day high-dose atorvastatin therapy on the incidence of peri-procedural myocardial infarction (PMI) in patients receiving long-term statin therapy., Methods: The patients with stable angina receiving statin therapy and referred for percutaneous coronary intervention (PCI) were randomized (ratio 1:1) to a 7-day pre-treatment with atorvastatin of 80 mg daily and subsequent PCI (Atorvastatin group), or immediate PCI (Control group). The incidence of PMI was based on serum concentration of creatine kinase myocardial band (CK-MB) mass and troponin I (TnI), which were measured prior to and between 16 and 24h post PCI. The values were considered as positive if they were elevated ≥ 3 times the upper limit normal., Results: We randomized 202 patients (male 67%, 65.5 ± 9.2 years; 100 vs. 102 pts.). There were no significant differences in the baseline characteristics among the randomized groups. The incidence of PMI, based on post-interventional release of TnI and/or CK-MB mass was 15% in the Atorvastatin group vs. 14% in the Control group (p=0.80). One patient (3%) in Atorvastatin group suffered from MI between randomization and PCI., Conclusions: These results suggest that 7-day pre-PCI therapy with high-dose atorvastatin did not reduce the occurrence of PMI in patients receiving chronic statin therapy., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To determine the incidence and laboratory characteristics of primary Toxoplasma gondii infection in HIV-infected individuals., Methods: This retrospective study was conducted between 1988 and 2012 on a cohort of 1130 HIV-infected patients at the AIDS Center Prague. Toxoplasma serology, standard laboratory parameters, and health status were evaluated at 3-6-month intervals for all patients., Results: The total person-time of follow-up of patients at risk of Toxoplasma seroconversion was 3046.3 years; there were 14 primary T. gondii infections, yielding an incidence rate of 0.0046 (95% confidence interval 0.0027-0.0078). Most of the subjects were clinically asymptomatic, but in one case seroconversion was accompanied by transient cervical lymphadenopathy. The CD4+ T-lymphocyte count geometric mean increased from 418 (95% confidence interval 303-579) cells/μl before seroconversion to 501 (95% confidence interval 363-691) cells/μl after seroconversion (p = 0.004), while other parameters (CD8+ T-lymphocytes, natural killer cells, viral load, beta2-microglobulin, total immunoglobulins) remained unchanged. As compared to the control group, patients with primary toxoplasmosis had higher initial levels of total immunoglobulins IgA and IgG and a tendency to higher CD8+ T lymphocyte counts., Conclusions: Neither the incidence nor the course of the primary Toxoplasma infection was influenced by the immune status of the patients. Immune parameters of patients with primary Toxoplasma infection did not differ from those of the controls., (Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Background: Pneumococcal urinary antigen test is a valuable tool for diagnosing pneumococcal pneumonia and meningitis in adults. Its use in children is generally not accepted because of nonspecificity at this age. It is frequently positive in asymptomatic nasopharyngeal carriers. The aim of our study was to assess the age limit from which the test is no longer positive in asymptomatic healthy carriers., Methods: A total of 197 children aged 36-83 months attending 9 day care centers in Prague were enrolled during February and March 2010. Nasopharyngeal swab specimens were collected from each participant and selectively cultivated. The presence of pneumococcal antigen in urine was detected by BinaxNOW® S. pneumoniae kit., Results: Streptococcus pneumoniae was cultivated in 53.3 % of healthy children with the highest colonization rate (59.3 %) in children aged 48-59 months. The most frequently colonizing serotypes were: 19F, 23F, 3, 19A, 6B and 4. The presence of pneumococcal antigen in urine decreased with age from 39.0 % in 36-47 months to 17.9 % in 72-83 months old (p = 0.031). The antigen positivity was serotype-dependent and more frequent in nonvaccinated children., Conclusion: We demonstrated age-dependent linear decrease of pneumococcal antigen excretion into urine in healthy children. The positivity rate of the test in children aged 72-83 months was similar to that referred in healthy adults, irrespective of colonization. To confirm this age limit for use of this test in diagnostics of pneumococcal diseases, further study in school-age children is justified.

Aim: Analysis of the incidence of tick-borne encephalitis (TBE) in the Czech Republic (CR) in 2001-2011 in different administrative regions and municipalities with extended power (MEPs)., Material and Methods: Each TBE case reported to the EPIDAT system was matched to the respective MEP or Prague according to the place of residence. The annual TBE incidence was calculated per 100 000 permanent residents (mean) of each administrative region and MEP. The overall incidence, age-specific incidence, and average incidence by administrative region per year and per the eleven-year period were calculated., Results: In the study period, the highest TBE incidence rates were found in the Plzeň Region, South Bohemian Region, and Highlands Region, neighbouring with Germany and Austria. The overall TBE incidence in the CR had a slightly upward trend resulting from different subtrends in various administrative regions. The overall trend was most influenced by the most affected regions with opposite trends - the Highlands Region and the South Bohemian Region. The South Bohemian Region with the highest average incidence in the study period of 23.4/100 000 population also showed the maximum effect on the country-wide age-specific incidence due to the trend in the age--specific incidence, sharply rising to peak in the age group 60-64. As it had long been the region with the highest incidence in the Czech Republic, vaccination campaigns were organized repeatedly there, targeting high-risk areas and children. The vaccine coverage rate in school-age children in the last decade was about 50%. The analysis of age group trends showed no considerable increase in 0-14-year-olds in 2011, i.e. the year with the second highest TBE incidence ever reported in the CR, in contrast to 15 to 44-year-olds where the TBE incidence rates were three times as high. From this it can be inferred that the post-vaccination antibody level and its protective effect wane over years unless a booster dose is given. The incidence trend for TBE in 45-64-year-olds, i.e. the age group who lived life long inside or close to the most active TBE foci, suggests that the contact with the TBE virus does not induce protective herd immunity. The analysis of TBE incidence in the population of smaller administrative areas provides more detailed information. In six MEPs, the average TBE incidence over the 11-year period was more than 30/100 000, with a peak of 58/100 000., Conclusion: Although the most important epidemiological information for a disease with natural focality is the place of acquisition of infection, the long-term evaluation of TBE incidence according to the patients place of residence is also relevant. The data on TBE incidence in the population of 205 MEPs provide helpful information for campaigns to reduce the risk of TBE infection targeted to human behaviour in TBE natural foci and preventive measures, particularly vaccination. It cannot be excluded that residents of high-risk areas will continue risky behaviour even in the future.

Recent outbreaks of viral hepatitis A in non-endemic European countries and the potential outbreak risk in susceptible populations has led us to evaluate the clinical characteristics of children hospitalised with hepatitis A. Retrospective study included 118 children (68 boys and 50 girls) with the mean age of 8.5 years hospitalised at Hospital Na Bulovce in Prague from June 2008 to June 2009. The clinical course was symptomatic icteric in 57 (48.3 %) children, symptomatic anicteric in 23 (19.5 %), subclinical in 22 (18.6 %) and asymptomatic inapparent in 16 (13.6 %). The relapse of the disease occurred in three patients. There were no cases of fulminant hepatitis. The most frequent symptoms included jaundice (57 cases), abdominal pain/discomfort (38), vomiting (38), dark urine (37), subfebrility (29) and fever (25). Hepatic injury markers were substantially elevated in icteric patients, but moderate elevations were identified in anicteric and subclinical cases as well. Lower white blood cell and lymphocyte counts were independently associated with symptomatic and more severe clinical course. Active immunisation was provided to 22 patients, and as a post-exposure prophylaxis to 19 of them. The clinical course and laboratory parameters in vaccinated children were not significantly different from non-vaccinated children. The clinical course of hepatitis A was largely self-limiting and benign. Asymptomatic infections are frequent, representing risk for disease spread; however, they are associated with elevations of hepatic injury markers. The inclusion of significant proportion of asymptomatic cases that were identified and investigated only because of active epidemiological surveillance in the outbreak focus represents the particular asset of this study.

Purpose: Though numerous studies investigating ambient ozone (O(3)) effects on human health were published, such a study for Central Europe is still lacking. We have investigated the association between ozone (O(3)) levels and hospital admissions and mortality due to cardiovascular and respiratory diseases for Prague inhabitants for summer months (April-September) over the 5-year period 2002-2006. Our hypothesis was that ambient O(3) levels in Prague resulted in adverse health outcomes and were associated with increased mortality and hospital admissions., Methods: The effect of O(3) on mortality and hospital admissions was investigated using the negative binomial regression after controlling for the influence of meteorological factors (air temperature and relative humidity) and calendar effects (seasonal patterns, long-term trends and day of week)., Results: We found a statistically significant association between O(3) levels and daily mortality from respiratory diseases. Relative risk of 1.080 (95% CI: 1.031-1.132) was observed for mortality from respiratory diseases per 10 μg m(-3) increase in 1-day lagged daily mean O(3) concentration. No statistically significant association was detected between O(3) concentrations and daily mortality from all causes, daily mortality from cardiovascular diseases and hospital admissions for respiratory and cardiovascular diseases. The O(3) effects differed in men and women, nevertheless, the results were ambiguous with respect to used lag and O(3) metrics. No significant confounding effects of PM(10) on the investigated association were observed., Conclusions: O(3) exposure in Prague, though lower as compared to many other cities in Europe, is high enough to cause adverse health effects.

Surgical ablation procedure can restore sinus rhythm (SR) in patients with atrial fibrillation (AF) undergoing cardiac surgery. However, it is not known whether it has any impact on clinical outcomes. There is a need for a randomized trial with long-term follow-up to study the outcome of surgical ablation in patients with coronary and/or valve disease and AF. Patients are prospectively enrolled and randomized either to group A (cardiac surgery with left atrial ablation) or group B (cardiac surgery alone). The primary efficacy outcome is the SR presence (without any AF episode) during a 24-hour electrocardiogram after 1 year. The primary safety outcome is the combined end point of death, myocardial infarction, stroke, and renal failure at 30 days. Long-term outcomes are a composite of total mortality, stroke, bleeding, and heart failure at 1 and 5 years. We finished the enrollment with a total of 224 patients from 3 centers in 2 countries in December 2011. Currently, the incomplete 1-year data are available, and the patients who enrolled first will have their 5-year visits shortly. PRAGUE-12 is the largest study to be conducted so far comparing cardiac surgery with surgical ablation of AF to cardiac surgery without ablation in an unselected population of patients who are operated on for coronary and/or valve disease. Its long-term results will lead to a better recognition of ablation's potential clinical benefits., (© 2012 Wiley Periodicals, Inc.)

Aims: Surgical ablation procedure can restore sinus rhythm (SR) in patients with atrial fibrillation (AF) undergoing cardiac surgery. However, it is not known whether it has any impact on long-term clinical outcomes., Methods and Results: This multicentre study randomized 224 patients with AF scheduled for valve and/or coronary surgery: group A (left atrial surgical ablation, n = 117) vs. group B (no ablation, n = 107). The primary efficacy outcome was the SR presence (without any AF episode) during a 24 h electrocardiogram (ECG) after 1 year. The primary safety outcome was the combined endpoint of death/myocardial infarction/stroke/renal failure at 30 days. A Holter-ECG after 1 year revealed SR in 60.2% of group A patients vs. 35.5% in group B (P = 0.002). The combined safety endpoint at 30 days occurred in 10.3% (group A) vs. 14.7% (group B, P = 0.411). All-cause 1-year mortality was 16.2% (A) vs. 17.4% (B, P = 0.800). Stroke occurred in 2.7% (A) vs. 4.3% (B) patients (P = 0.319). No difference (A vs. B) in SR was found among patients with paroxysmal (61.9 vs. 58.3%) or persistent (72 vs. 50%) AF, but ablation significantly increased SR prevalence in patients with longstanding persistent AF (53.2 vs. 13.9%, P < 0.001)., Conclusion: Surgical ablation improves the likelihood of SR presence post-operatively without increasing peri-operative complications. However, the higher prevalence of SR did not translate to improved clinical outcomes at 1 year. Further follow-ups (e.g. 5-year) are warranted to show any potential clinical benefit which might occur later.

Pregnancy-associated plasma protein-A (PAPP-A) was studied as a marker of acute coronary syndrome (ACS). It has been shown that its levels are increased by heparin administration. Therefore, the aim of our study was to ascertain the diagnostic significance of PAPP-A in heparin-naïve patients and compare it with (TnI). We prospectively studied 67 heparin-naïve patients with acute chest pain. The patients were independently grouped according to the presence or absence of ACS. PAPP-A levels were significantly increased in ACS patients (8.6 vs. 7.3 mIU/l; P = 0.006) with high positive (95.7%) and lower negative predictive values (47.7%). In multivariate analysis, its levels were strongly predictive of a final diagnosis of ACS (OR 41.8; 95th CI 2.64-662.6; P = 0.008). The diagnostic significance of PAPP-A was not higher than TnI even within 6 h after the onset of chest pain [the area under the ROC curve (AUC) was 0.69 for PAPP-A and 0.91 for TnI, respectively; P = 0.08]. We observed no difference in the AUC in NSTE-ACS patients (0.73 for PAPP-A and 0.79 for TnI (P = 0.5)). PAPP-A levels were an independent predictor of ACS diagnosis in heparin-naïve patients. Its diagnostic significance was not higher than TnI even within a short period after the onset of chest pain. In troponin-negative NSTE-ACS patients, PAPP-A helped make the correct final diagnosis.

Introduction: Little is known about the prognosis of moderate versus critical carotid stenosis treated by carotid artery stenting (CAS)., Material and Methods: This was a retrospective analysis of a single-centre registry including 271 consecutive patients (69 ±9 years, 87% at high risk for surgery), in whom 308 procedures were performed. The study included both symptomatic (≥ 50% carotid artery stenosis) and asymptomatic (≥ 70% carotid artery stenosis) patients. The primary endpoint was the rate of adverse events during follow-up (range 1-48 months), defined as all-cause death or stroke., Results: We treated 115 critical and 193 moderate stenoses and implanted 318 stents (56% with closed cell design). Embolic protection systems were used in 296 cases (96%). The technical success rate was 98.2% in the critical stenoses group and 99% in the moderate group (NS). During follow-up, the incidence of the primary endpoint was 12.9% (13 pts) in the critical stenoses group and 14.7% (25 pts) in the moderate stenoses group (estimated 3-year freedom from death/stroke was 0.844 vs. 0.812; log-rank test p = 0.983). Left ventricular ejection fraction < 40%, significant contralateral carotid artery occlusion or stenosis and renal insufficiency were identified as significant predictors of the primary endpoint (p < 0.03)., Conclusions: Carotid artery stenting with embolic protection systems in patients at high risk for carotid endarterectomy is safe. Patients with initially moderate and critical stenoses have an identical mid-term prognosis with regard to death and stroke.

Introduction: The time course of pregnancy-associated plasma protein-A (PAPP-A) levels was studied at admission, immediately after percutaneous coronary intervention (PCI) and 1, 2, 4, 6, 12, 24 and 48 h after PCI in acute coronary syndrome with ST segment elevation (ACS-STE) to determine the impact of PCI, concomitant clinical complications and heparin administration., Material and Methods: Pregnancy-associated plasma protein-A serum levels, examined by the Kryptor(TM) system, were studied in 30 heparinized PCI ACS-STE patients, in 10 elective PCIs and 12 coronary angiographies with heparin, and in 5 patients with normal coronary angiogram without heparin., Results: Heparin caused a high PAPP-A increase in ACS-STE patients, in all patients with heparin without ACS and angiographic signs of significant atherosclerosis. This increase was directly associated with heparin dosage and activated clotting time (ACT) (r = 0.71, p = 0.0001) and inversely with the interval between heparin applications and time of serum sampling. It was followed by a rapid decrease within 1 to 2 h and return to normal levels in 10 to 12 h. In ACS-STE patients the decrease was significantly slower than in heparinized elective PCI and angiography patients. The PAPP-A increase was not significantly dependent on the length of PCI. Persistent increase after 24 h was associated in 4/7 patients with concomitant clinical complications., Conclusions: The diagnostic validity of PAPP-A can be verified only within the 1(st) h after clinical onset of ACS before heparin administration, the prognostic value in heparinized patients not earlier than 12 h after the last heparin application, if ACT is normal and serious clinical concomitant complications are eliminated.

The HLA-B*57:01 allele is associated with a hypersensitivity reaction to abacavir, and its prevalence varies in different populations. The aim of the study was to investigate HLA-B*57:01 prevalence in the Czech HIV-infected population. HLA-B*57:01 prevalence in our cohort was 5.33%, which is similar to the situation in other Central European countries.

Background: Carotid artery stenting (CAS) is the method of choice for carotid artery revascularization of patients at high risk for carotid endarterectomy. In this study, we compared the midterm results of CAS in patients with unilateral versus bilateral carotid artery disease., Methods and Results: This is a retrospective analysis of 1-year outcome of 273 consecutive patients in whom 342 CAS procedures were performed. The incidence of periprocedural transient ischemic attacks (TIAs) differed significantly (8% vs. 1%; p = 0.01) among patients with and without bilateral internal carotid disease, and a tendency to a lower occurrence of early adverse events (death, stroke, periprocedural TIA, periprocedural myocardial infarction) was subsequently shown (11% vs. 5%; p = 0.12). At 1-year follow-up, there was a high incidence of adverse events (death, stroke, periprocedural TIA, periprocedural myocardial infarction, restenosis) in patients with bilateral carotid artery disease (40% vs. 14%; p < 0.01), which was mainly driven by a higher incidence of death, periprocedural TIA, and restenosis (p ≤ 0.02 for all). According to multivariate analysis, the independent predictors of midterm adverse events were left ventricular dysfunction, male gender, bilateral carotid artery disease, renal insufficiency, cerebral symptoms within the last 6 months before the intervention, and low-density lipoprotein cholesterol level., Conclusions: At midterm follow-up, patients with bilateral carotid artery disease treated by CAS have significantly more adverse events than those with unilateral disease., (Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)