Tunable Coupling Architecture for Fixed-Frequency Transmon Superconducting Qubits.

Implementation of high-fidelity 2-qubit operations is a key ingredient for scalable quantum error correction. In superconducting qubit architectures, tunable buses have been explored as a means to higher-fidelity gates. However, these buses introduce new pathways for leakage. Here we present a modified tunable bus architecture appropriate for fixed-frequency qubits in which the adiabaticity restrictions on gate speed are reduced. We characterize this coupler on a range of 2-qubit devices, achieving a maximum gate fidelity of 99.85%. We further show the calibration is stable over one day.

[Outcomes of Revisions of the Acetabular Component of THA with Paprosky Type 3a and 3b Defects Using Tantalum Trabecular Metal Implants 2-10 Years Postoperatively]. / Výsledky revizí acetabulární komponenty TEP kycle s defekty Paprosky 3a a 3b pomocí trabecular metal tantalových implantátu 2­10 let po operaci.

PURPOSE OF THE STUDY Tantallum trabecular metal implants (Trabecular Metal Technology - TMT) considerably changed the acetabular reconstruction options in revision surgeries with extensive bone defects and distorted pelvic ring integrity. The purpose of this study is to ascertain the short-term to medium-term outcomes of acetabular reconstruction through TMT implants in patients with Paprosky type 3a and 3b acetabular defects and in case of pelvic discontinuity. MATERIAL AND METHODS The prospective monocentric study included patients in whom the revision of acetabular components in total hip arthroplasty was performed, the acetabular defect was classified as Paprosky 3a and higher, a TMT implant was used for reconstruction, and the follow-up period was at least 2 years after surgery. In total, 87 patients who had met the inclusion criteria were operated on and followed-up. The patients in the study group underwent a clinical examination, an X-ray and also an assessment using the Harris hip score. Moreover, the patients were asked about their satisfaction with the surgical outcome, their willingness to undergo the same procedure again in case of difficulties, and they were also asked to rate the outcome in percentage term and by assigning grades. Also, an analysis of the reasons for revision and subsequent complications was carried out. Implant integration and its migration were evaluated on an X-ray. RESULTS 32 men and 55 women were subjects to evaluation, with a balanced number of operated sides (44:43 in favour of the right side). One-stage procedures prevailed, which were performed in a total of 74 cases, while two-stage revisions were performed in 13 cases in the study group. In three patients (3.5%) pelvic discontinuity was diagnosed, 69 patients (79%) suffered from Paprosky 3a defect and 15 patients (17%) from Paprosky 3b defect. The first patients underwent surgery in 2009 and the mean follow-up period in the study group was 48 months. In 1 patient the TMT implant was removed for infectious complications, in the remaining part of the group the TMT implant was fully integrated with no signs of loosening or migration in the monitored period. In the assessment using the Harris hip score, the mean score of 80.4 (range 36-99) was achieved. When assessing the satisfaction with the surgical outcome, the mean value achieved was 94.4%, and the mean assigned grade was 1.26 (on a school grading scale). DISCUSSION Extensive bone defects and pelvic discontinuity represent an issue in revisions of the acetabular component in total hip arthroplasty. There are several options how to address these conditions. State-of-the-art TMT implants thanks to their shortterm and medium-term outcomes appear as one of the most beneficial option with a low failure rate both in our study group and in published papers. CONCLUSIONS Evaluation of this monocentric prospective study reveals encouraging short-term and medium-term outcomes of the use of TMT implants in managing extensive acetabular bone defects of Paprosky 3a and 3b type and supports their further introduction into practice at our department. Key words: total hip arthroplasty (THA), revision implantation, TMT implant.

[Treatment of Acute Periprosthetic Infections with DAIR (Debridement, Antibiotics and Implant Retention) - Success Rate and Risk Factors of Failure]. / Lécba akutních periprotetických infekcí postupem DAIR (debridement, antibiotics and implant retention) ­ úspesnost a rizikové faktory selhání.

PURPOSE OF THE STUDY Revision surgery with implant retention and exchange of mobile prosthetic parts is considered to be the method of first choice in acute periprosthetic infections with a stable endoprosthesis and good condition of soft tissues, where the symptoms did not last longer than 3 weeks. The aim of the study was to evaluate the long-term outcomes and to identify the factors affecting the success rate of this procedure. MATERIAL AND METHODS This unicentric retrospective study evaluated the results of 18 surgeries with implant retention performed at the Department of Orthopaedics of Ceské Budejovice Hospital in the period 2009-2016. The failure of the procedure was defined as the presence of at least one of the following criteria: removal or replacement of endoprosthesis within 2 years after the DAIR procedure, detection of the same pathogen during the DAIR procedure and in the later performed revision surgery, necessity of chronic suppressive antibiotic therapy, death related to periprosthetic infection. The cured patients were invited for a clinical check-up. The postoperative condition was assessed using the Knee Society Score and the Harris Hip Score. RESULTS The overall success rate of the procedure reached 61.1%. Hematogenic dissemination was the cause of periprosthetic infection in 13 followed-up cases (72.2%), with the average time after the implantation of 153.2 weeks. Treatment through the DAIR procedure was successful in 53.8%. Early postoperative complications were observed in 5 cases (27.8%), in 4 of which, i.e. 80%, they were successfully managed by a surgery with implant retention. The most frequently identified etiological agents were Staphylococcus aureus and Staphylococcus epidermidis strains. In primo-implanted endoprostheses the success rate reached 90.9% (in case of early postoperative infections even 100%), whereas surgeries in repeatedly operated joints were successful in 14.3% only. The mean value of the Knee Society Score in patients after a successful knee joint surgery was 81.2 of the maximum score of 100 (σ= 8.5), the Function Knee Society Score was 70 of 100 (σ= 34.6). In the case of the Harris Hip Score in patients after the hip replacement, the mean hip function score was 89.8 of the maximum of 100 (σ= 7.3). The patients with knee and hip joint endoprosthesis after the performed DAIR procedure were satisfied on average to the level of 82.5% and 90%, respectively, while 28.6% of patients experienced certain functional decline during daily activities. Postoperatively, 25% of patients reported continuing stronger pain as compared to the past medical history. No patient experienced any change in terms of a limited range of motion or decreased joint stability. DISCUSSION The overall success rate of the DAIR procedure of 61.1% corresponds with the values stated in the literature. A significantly higher success rate was achieved in early postoperative complications. This can be explained by a lower specificity in determining the actual pathogenesis of late periprosthetic infections and potentially longer lasting colonisation of endoprosthesis. The medical history of previous surgeries performed on the affected joints for septic arthritis or with a surgical instrument retention was identified as an important risk factor of failure of the subsequently performed DAIR procedure. Significant effects of pathogenicity of the detected agent or systemic comorbidities on the success rate of the procedure were not confirmed in our group. Successful performance of the DAIR procedure results in maintaining a very good function of endoprosthesis as well as subjective satisfaction of patients. CONCLUSIONS The DAIR technique is an ideal solution in correctly and early diagnosed acute periprosthetic infections. The results suggest that it is particularly appropriate in early postoperative infections of primary total joint replacements. Its indication in late periprosthetic infections, especially of repeatedly operated joints, shall be carefully considered. Key words:acute periprosthetic joint infections, PJI, DAIR, implant retention, risk factors, success rate.

[Economic Analysis of the Costs of Hospital Stay of Patients with Infection as a Complication of Total Replacements - Part 2: Total Hip Arthroplasty]. / Ekonomická analýza nákladu na hospitalizaci pacientu s infekcní komplikací totální náhrady - 2. cást: totální náhrada kycelního kloubu.

PURPOSE OF THE STUDY The study aims to quantify the costs of a hospital stay of patients with periprosthetic joint infection after total hip arthroplasty throughout the period of treatment. MATERIAL AND METHODS The group included patients who have been treated at our department for infection as a complication of total hip replacement since 1 January 2011, who have been provided with treatment (including complications) exclusively at the departments of Nemocnice Ceské Budejovice, a.s. and whose treatment can be considered completed in 2019. The patients were included in the study regardless of the type of infection and method of treatment. The group consisted of 36 patients (16 men and 20 women). There were 3 cases of early postoperative infection, 14 cases of late postoperative infection and 19 cases of hematogenous infection. The group includes 8 patients treated by a one-stage reimplantation, 19 patients managed by a two-stage reimplantation, 6 patients treated by a revision surgery with implant retention, and 3 patients in whom only the implant removal was possible. In selected patients, all the reported points for all the hospital stays and costs incurred on a separately charged material were ascertained and the final sum was compared with the reimbursement obtained by the hospital in the DRG system valid for the respective year of treatment. The total costs were analysed and also an analysis by type of infection and method of treatment was carried out. RESULTS The average costs of managing infection as a complication of total hip arthroplasty at our department amounted to CZK 320 065 (CZK 56 995 - CZK 953 614), the reimbursement in respect of the monitored cases in the DRG system equalled CZK 220 503 (CZK 89 149 - CZK 589 974). The aforementioned suggests that the average loss per treated patient is CZK 99 562 (CZK + 63 372 - CZK -428 499). DISCUSION Care associated with infections as a complication of total hip arthroplasty is very costly and these costs are not fully covered by the reimbursement from the health insurance companies. In the Czech Republic, these costs have not been quantified as yet, therefore it is only possible to compare the costs with international publications arriving at similar conclusions and with own monitoring of the costs of periprosthetic joint infections after total hip arthroplasty. The most economically efficient is the one-stage replacement which, however, is not suitable for all the patients, and the two-stage reimplantation continues to be the gold standard. In our study, the most expensive was found to be the treatment of periprosthetic joint infection after total hip arthroplasty, in which also the highest financial loss is reported. CONCLUSIONS Due to the very high costs of treatment for periprosthetic joint infections after total hip arthroplasty, it is necessary to exert maximum efforts to prevent periprosthetic joint infections and to consider a change in the method of financing, particularly in centres to which patients are referred from other centres in order to make this treatment economically viable. Key words:total hip arthroplasty, PJI - periprosthetic joint infection, economic analysis.

[Economic Analysis of the Costs of Hospital Stay of Patients with Infection as a Complication of Total Replacements - Part 1: Total Knee Arthroplasty]. / 1. cást: totální náhrada kolenního kloubu - 1. cást: totální náhrada kolenního kloubu.

PURPOSE OF THE STUDY The study aims to quantify the costs of a hospital stay of patients with total knee periprosthetic joint infection throughout the period of treatment. MATERIAL AND METHODS The group included patients who have been treated at our department for infection as a complication of total knee replacement since 1 January 2011, who have been provided with treatment (including complications) exclusively at the departments of Nemocnice Ceské Budejovice, a.s. and whose treatment can be considered completed in 2018. The patients were included in the study regardless of the type of infection and method of treatment. The group consisted of 24 patients (11 men and 13 women). There were 2 cases of early postoperative infection, 6 cases of late postoperative infection and 16 cases of hematogenous infection. The group includes 17 patients treated by a two-stage reimplantation, 6 patients treated by a revision surgery with implant retention, and 1 patient treated by a one-stage replacement. In selected patients, all the reported points for all the hospital stays and costs incurred on a separately charged material were ascertained and the final sum was compared with the reimbursement obtained by the hospital in the DRG system valid for the respective year of treatment. The total costs were analysed and moreover, an analysis by type of infection and method of treatment was carried out. RESULTS The average costs of managing infection as a complication of TKA in our department amounted to CZK 405 864 (CZK 66 768-CZK 181 17). The average cost of a two-stage revision was CZK 497 487, the cost of a revision surgery with original implant retention was CZK 175 312. The reimbursement in respect of the monitored cases in the DRG system equalled CZK 276 230 (CZK 40 943-CZK 848 401). The aforementioned suggests that the average loss per a treated patient is CZK 129 635 (CZK + 26 066Kc-CZK -332 774). DISCUSION Our study is in agreement with recent literature, when confirming that the care associated with infections as a complication of TKA is very costly (especially in case of a two-stage reimplantation) and also that this care is not fully covered by the health insurance company. The reimbursement made by the health insurance companies does not cover on average 1/3 of the costs of care for an infectious patient. Theoretically, the reasons behind the reduced reimbursement may be sanctions which, however, cannot be accepted in case of late hematogenous infections which constituted more than 50% in our group. CONCLUSIONS Our study presented the actual costs associated with the care of TKA infection. It makes sense that the most expensive is the two-stage reimplantation, which is nevertheless still considered to be the gold standard procedure in chronic TKA infection. High costs of therapy together with the requirement of expert care would justify the introduction of care provided by specialised centres. In this case, centralisation could result in a more efficient use of funds and improvement of the quality of provided care. Key words:total knee arthroplasty, PJI - periprostetic joint infection, economic analysis. ÚVOD.

Report From the American Society of Transplantation Conference on Donor Heart Selection in Adult Cardiac Transplantation in the United States.

Cardiac transplantation remains the only definitive treatment for end-stage heart failure. Transplantation rates are limited by a shortage of donor hearts. This shortage is magnified because many hearts are discarded because of strict selection criteria and concern for regulatory reprimand for less-than-optimal posttransplant outcomes. There is no standardized approach to donor selection despite proposals to liberalize acceptance criteria. A donor heart selection conference was organized to facilitate discussion and generate ideas for future research. The event was attended by 66 participants from 41 centers with considerable experience in cardiac donor selection. There were state-of-the-art presentations on donor selection, with subsequent breakout sessions on standardizing the process and increasing utilization of donor hearts. Participants debated misconceptions and established agreement on donor and recipient risk factors for donor selection and identified the components necessary for a future donor risk score. Ideas for future initiatives include modification of regulatory practices to consider extended criteria donors when evaluating outcomes and prospective studies aimed at identifying the factors leading to nonacceptance of available donor hearts. With agreement on the most important donor and recipient risk factors, it is anticipated that a consistent approach to donor selection will improve rates of heart transplantation.

Threshold Dynamics of a Semiconductor Single Atom Maser.

We demonstrate a single atom maser consisting of a semiconductor double quantum dot (DQD) that is embedded in a high-quality-factor microwave cavity. A finite bias drives the DQD out of equilibrium, resulting in sequential single electron tunneling and masing. We develop a dynamic tuning protocol that allows us to controllably increase the time-averaged repumping rate of the DQD at a fixed level detuning, and quantitatively study the transition through the masing threshold. We further examine the crossover from incoherent to coherent emission by measuring the photon statistics across the masing transition. The observed threshold behavior is in agreement with an existing single atom maser theory when small corrections from lead emission are taken into account.

[Endoprosthesis Infections - Guidelines for Antibiotic Therapy Common Guidelines of the Czech Society for Orthopaedics and Traumatology and the Society for Infectious Diseases of the Czech Medical Association of J. E. Purkyne]. / Infekce endoprotéz ­ doporucení antibiotické lécby Spolecné doporucení Ceské spolecnosti pro ortopedii a traumatologii a Spolecnosti infekcního lékarství Ceské lékarské spolecnosti J. E. Purkyne.

PURPOSE OF THE STUDY This study aims to articulate regional guidelines for curative and suppressive antibiotic therapy of total joint replacement infections. MATERIAL AND METHODS When developing the standard, used as source materials were the published foreign guidelines for antibiotic therapy of prosthetic joint infections, the analysis of resistance of bacterial strains conducted in the Hospital in Ceské Budejovice, a.s. and the assessment of strain resistance for the Czech Republic published by the European Antimicrobial Resistance Surveillance Network (EARS-Net). Considered was also the availability of individual antibiotics in the Czech Republic and restricted prescription according to the Summary of Product Characteristics as specified in the State Institute for Drug Control marketing authorisation. The expert group composed of orthopaedists, microbiologists and infectious disease specialists elaborated the basic antibiotic guideline for choosing an appropriate antibiotic/antifungal drug based on the usual susceptibility, its dose and dosage interval for initial and continuation therapy. The comments of individual specialists were gradually incorporated therein and in case of doubts majority rule was applied. The drafted document was sent for peer reviews to clinical orthopaedic, infectious disease and microbiological centres, whose comments were also incorporated and the finalised document was submitted for evaluation to specialised medical societies. RESULTS The outcome is the submitted guideline for antibiotic curative and suppressive therapy suitable for managing the prosthetic joint infections, which was approved by the committee of the Czech Society for Orthopaedics and Traumatology andthe Society for Infectious Diseases of the Czech Medical Association of J. E. Purkyne. DISCUSION Curative therapy of total joint replacement infections consists primarily in surgical treatment and has to be accompanied by adequate antibiotic therapy administered initially intravenously and later orally over a sufficient period of time. Bearing in mind the wide spectrum of pathogens that can cause infections of a joint replacement and their capacity to form a biofilm on foreign materials, the correct choice of an antibiotic, its dose and dosage interval are essential for successful treatment. Such standard should respect regional availability of antibiotics, regional pathogen resistance/susceptibility and ensure the achievement of sufficiently high concentrations at the requested location including anti-biofilm activity. CONCLUSIONS The submitted guideline is not the only treatment option for joint total replacement infections, but it makes the decisionmaking easier when treating these complications in the form of infections. The final choice of an antibiotic, its dose and duration of therapy shall be based on a critical assessment of results of microbiological (blood culture and molecular genetic) tests and reflect the patient s clinical condition. Since these are multidisciplinary issues, we consider useful for this guideline to be commented upon and approved by the committee of both the Society for Orthopaedics and Infectious Diseases so that it can become the starting point for treatment. Key words: total joint replacement infection, TEP, ATB, antibiotic therapy, consensus meeting, guideline.

Retransplant and Medical Therapy for Cardiac Allograft Vasculopathy: International Society for Heart and Lung Transplantation Registry Analysis.

Cardiac retransplantation for heart transplant recipients with advanced cardiac allograft vasculopathy (CAV) remains controversial. The International Society for Heart and Lung Transplantation Registry was used to examine survival in adult heart recipients with CAV who were retransplanted (ReTx) or managed medically (MM). Recipients transplanted between 1995 and 2010 who developed CAV and were either retransplanted within 2 years of CAV diagnosis (ReTx) or alive at ≥2 years after CAV diagnosis, managed medically (MM), without retransplant, constituted the study groups. Donor, recipient, transplant characteristics and long-term survival were compared. The population included 65 patients in ReTx and 4530 in MM. During a median follow-up of 4 years, there were 24 deaths in ReTx, and 1466 in MM. Survival was comparable at 9 years (55% in ReTx and 51% in MM; p = 0.88). Subgroup comparison suggested survival benefit for retransplant versus MM in patients who developed systolic graft dysfunction. Adjusted predictors for 2-year mortality were diagnosis of CAV in the early era and longer time since CAV diagnosis following primary transplant. Retransplant was not an independent predictor in the model. Challenges associated with retransplantation as well as improved CAV treatment options support the current consensus recommendation limiting retransplant to highly selected patients with CAV.

Multicenter Analysis of Immune Biomarkers and Heart Transplant Outcomes: Results of the Clinical Trials in Organ Transplantation-05 Study.

Identification of biomarkers that assess posttransplant risk is needed to improve long-term outcomes following heart transplantation. The Clinical Trials in Organ Transplantation (CTOT)-05 protocol was an observational, multicenter, cohort study of 200 heart transplant recipients followed for the first posttransplant year. The primary endpoint was a composite of death, graft loss/retransplantation, biopsy-proven acute rejection (BPAR), and cardiac allograft vasculopathy (CAV) as defined by intravascular ultrasound (IVUS). We serially measured anti-HLA- and auto-antibodies, angiogenic proteins, peripheral blood allo-reactivity, and peripheral blood gene expression patterns. We correlated assay results and clinical characteristics with the composite endpoint and its components. The composite endpoint was associated with older donor allografts (p < 0.03) and with recipient anti-HLA antibody (p < 0.04). Recipient CMV-negativity (regardless of donor status) was associated with BPAR (p < 0.001), and increases in plasma vascular endothelial growth factor-C (OR 20; 95%CI:1.9-218) combined with decreases in endothelin-1 (OR 0.14; 95%CI:0.02-0.97) associated with CAV. The remaining biomarkers showed no relationships with the study endpoints. While suboptimal endpoint definitions and lower than anticipated event rates were identified as potential study limitations, the results of this multicenter study do not yet support routine use of the selected assays as noninvasive approaches to detect BPAR and/or CAV following heart transplantation.

Sisyphus Thermalization of Photons in a Cavity-Coupled Double Quantum Dot.

We investigate the nonclassical states of light that emerge in a microwave resonator coupled to a periodically driven electron in a nanowire double quantum dot (DQD). Under certain drive configurations, we find that the resonator approaches a thermal state at the temperature of the surrounding substrate with a chemical potential given by a harmonic of the drive frequency. Away from these thermal regions we find regions of gain and loss, where the system can lase, or regions where the DQD acts as a single-photon source. These effects are observable in current devices and have broad utility for quantum optics with microwave photons.

[Use of Patient Specific Instruments at Total Knee Arthroplasty. One-Year Results of a Prospective Randomised Study]. / Pacient Specific Instruments (PSI) pri implantaci TEP kolenního kloubu - rocní výsledky prospektivní randomizované studie.

UNLABELLED: PURPOSE OF THE STUDY The aim of this prospective study was to evaluate, at one year of follow-up, radiographic and clinical results of total knee arthroplasty (TKA) performed with use of Zimmer® Patient Specific Instruments (PSIs) which allow for planning and customising each patient's TKA. MATERIAL AND METHODS Of the patients with knee arthritis who were eligible for joint replacement, 23 were randomly selected and included in this study. There were 11 men and 12 women, with 11 right and 12 left knee joints. On the basis of pre-operative CT scans, PSI custom-made pin guides, which conformed to the individual patient's anatomy, were produced and then used in the THA surgery involving a NexGen (CR) system. All patients were examined before surgery and at 1 year after THA. The evaluation at a follow-up visit included standing full-length radiographs (antero-posterior and lateral), Knee Score results, range of motion (ROM), patient's satisfaction report, and post-operative complications. The X-ray views were examined for mechanical leg axis alignment, TKA alignment in antero-posterior and lateral projection and signs of potential loosening. RESULTS At 1 post-operative year, the average Knee Society Score (KSS) was 85.5 points and the average functional score was 82.6 point. The satisfaction rate was 94% and, on a school rating system, the average mark was 1.3. The average postoperative ROM value was 116°. All patients were willing to undergo the surgery again. The only complication was thrombosis in one patient. Radiographic findings of knee alignment were optimal in 18, correct (up to 3° deviation) in three and incorrect (above 3° deviation) in two patients. Radiographic signs of loosening were not recorded. DISCUSSION Correct knee alignment is one of the requirements for achieving a good TKA outcome. Various techniques are used to improve the total knee process (computer-aided surgery, customised guides). Zimmer Patient Specific Instruments provide advanced pre-operative planning and more accurate implant sizing and alignment. An experienced surgeon can achieve the same good results with conventional planning under standard conditions but the use of PSIs is clearly more beneficial in patients with extra-articular deformities and in patients in whom femoral intramedullary guides cannot be employed. To produce a custom-made pin guide requires a CT scan of the whole leg and is also associated with additional paperwork. The PSIs simplify the total knee process from start to finish and surgeons have complete flexibility to make fine-tuning adjustments during the procedure. CONCLUSIONS Zimmer Patient Specific Instruments allow for exact alignment of both the femoral and the tibial component in a TKA process. Under standard circumstances, clinical and radiographic outcomes are comparable with those of conventional planning. However, the use of PSIs is clearly more beneficial in patients with extra-articular deformities and in patients in whom femoral intramedullary guides cannot be employed. KEY WORDS: total knee arthroplasty, TKA, Patient Specific Instruments, PSIs.

[Lynch Syndrome -  the Pathologist's Diagnosis]. / Diagnóza Lynchova syndromu od patologa.

Lynch syndrome (formerly known as hereditary non-polyposis colorectal cancer) is the most com-mon hereditary colorectal cancer syndrome. The syndrome is caused by a germline mutation of one of the mismatch repair (MMR) genes responsible for DNA replication error repair. Impaired function of the proteins encoded by these genes leads to microsatellite instability (MSI), which is associated with increased incidence of neoplasms: mainly colorectal cancer. According to recent estimates, up to 5% of all colorectal cancers are associated with Lynch syndrome. Due to this relatively high frequency, familial occurence, absence of premorbid phenotype, and development of malignant tumors at a reproductive age, a correct diagnosis is important not only from an ethical but also from an economical point of view. Unfortunately, clinical means of diagnosis, namely, the revised Bethesda guidelines designed to detect patients suitable for genetic testing for Lynch syndrome, lack sufficient sensitivity. The methods associated with modern pathology are more sensitive than the clinical criteria used to detect patients suspected of having Lynch syndrome. Pathological diagnostics are based on direct or indirect detection of MSI. Indirect methods include analysis of morphological signs associated with MSI in histological samples from colorectal carcinoma patients and immunohistochemical investigation of MMR protein expression. To rule out sporadic cases caused by epigenetic inactivation of an MMR gene, molecular genetic investigation of the BRAF gene and methylation analysis of the MLH1 promoter are performed during diagnostic workup. A suspicion of Lynch syndrome based on the results of the methods mentioned above should be proven by detection of a germline mutation in an MMR gene in peripheral blood leukocytes.

Phonon-assisted gain in a semiconductor double quantum dot maser.

We develop a microscopic model for the recently demonstrated double-quantum-dot maser. In characterizing the gain of this device we find that, in addition to the direct stimulated emission of photons, there is a large contribution from the simultaneous emission of a photon and a phonon, i.e., the phonon sideband. We show that this phonon-assisted gain typically dominates the overall gain, which leads to masing. Recent experimental data are well fit with our model.

[The Effect of Tranexamic Acid on Blood Loss after Primary Unilateral Total Knee Arthroplasty. Prospective Single-Centre Study]. / Vliv podání kyseliny tranexamové na krevní ztráty po primární jednostranné náhrade kolenního kloubu - prospektivní studie.

PURPOSE OF THE STUDY: Tranexamic acid is an antifibrinolytic agent which blocks plasmin-mediated fibrin degradation. It is used in surgery to reduce intra-operative and post-operative blood loss. The aim of our study was to assess the effect of tranexamic acid administration on blood loss after elective primary unilateral total knee arthroplasty. MATERIAL AND METHODS: A total of 119 patients (50 men, 69 women) with an average age of 69.2 years were included. The patients were randomised into two groups: Group A received a single dose of tranexamic acid (Exacyl, 1.5 g i.v.) before the operation; Group B (control) did not receive any antifibrinolytic agent. All patients underwent surgery under spinal anaesthesia with a tourniquet applied to the operated leg. The intra-operative blood loss, post-operative blood loss based on drainage, pre- and post-operative levels of haemoglobin and haematocrit, and the number of administered blood transfusions were analysed. RESULTS: The administration of tranexamic acid led to a reduction in post-operative blood loss at all intervals tested, including the total blood loss (504 ± 214 vs 815 ± 231 ml; p < 0.001), and to reduced requirements for blood transfusion (1.18 ± 0.51 vs 1.54 ± 0.84 transfusion units; p < 0.05). A similar effect was observed in the subgroups of men and women; the total blood loss was higher in men than in women in both group B (non-significant) and group A (p < 0.05) patients. There was a gradual decline in haemoglobin and haematocrit levels during the post-operative period, with no significant differences between the two groups. Nor were there any differences in intra-operative blood losses either. No severe complications such as stroke, acute myocardial infarction or thromboembolic disease were recorded. DISCUSSION The administration of tranexamic acid before the application of a tourniquet resulted in reducing post-operative, but not intra-operative, blood losses in patients undergoing elective total knee arthroplasty. Transfusion requirements were reduced as well. CONCLUSIONS: Our study confirmed the efficacy and safety of tranexamic acid administration in relation to blood loss after total knee arthroplasty. In this indication, the administration is in accordance with the literature data.

Extreme harmonic generation in electrically driven spin resonance.

We report the observation of multiple harmonic generation in electric dipole spin resonance in an InAs nanowire double quantum dot. The harmonics display a remarkable detuning dependence: near the interdot charge transition as many as eight harmonics are observed, while at large detunings we only observe the fundamental spin resonance condition. The detuning dependence indicates that the observed harmonics may be due to Landau-Zener transition dynamics at anticrossings in the energy level spectrum.

Photon emission from a cavity-coupled double quantum dot.

We study a voltage biased InAs double quantum dot (DQD) that is coupled to a superconducting transmission line resonator. Inelastic tunneling in the DQD is mediated by electron phonon coupling and coupling to the cavity mode. We show that electronic transport through the DQD leads to photon emission from the cavity at a rate of 10 MHz. With a small cavity drive field, we observe a gain of up to 15 in the cavity transmission. Our results are analyzed in the context of existing theoretical models and suggest that it may be necessary to account for inelastic tunneling processes that proceed via simultaneous emission of a phonon and a photon.

[Minimally invasive anterolateral surgical approach for total hip arthroplasty: seven-year results]. / Náhrada kycelního kloubu MIS-AL technikou--sedmileté výsledky.

PURPOSE OF THE STUDY: To evaluate the results of using the minimally invasive surgical-anterolateral approach (MIS-AL) for total hip arthroplasty at 7-year follow-up. MATERIAL: A total of 188 patients operated on between January 2005 and March 2006 were invited to come for check-up. Of them, 132 had a complete follow-up including examination at one and 7 years post-operatively. Forty-seven patients did not respond, four had died and five underwent revision arthroplasty. The evaluation was based on the Harris Hip Score, percent and school markings and radiographic analysis. METHODS: The patient was operated on in the lateral position. A short incision (5 to 8 cm) was made above the junction of the greater trochanter and the anterior superior iliac spine. The hip was accessed through a natural separation between the gluteus medius and the tensor fasciae latae. After joint capsule resection, femoral elevators were applied and femoral neck osteotomies were performed. The first was done on the leg in an orthograde position and the other as well as femoral head extraction were carried out on the leg with the knee flexed 90 degrees and hip external rotation of 90 degrees. Using reamers and rasps, the bone of both the acetabulum and the femur was prepared for implantation of a cementless or cemented prosthesis. A standard antibiotic prophylaxis and an antithrombotic therapy were administered. The patients were allowed to walk with 30 kg of weight on the operated leg from the 2nd post-operative day; walking with full weight-bearing without external support was allowed in patients with cemented implants at 6 weeks and in those with cementless implants at 3 months after surgery. RESULTS: The group evaluated consisted of 69 men and 63 women, with an average age of 64.75 years at surgery. The average pre-operative Harris Hip Score was 46. At 7 years after surgery the average hip score increased to 89.125. Of the 132 patients, 128 were satisfied with the outcome; the average rating was 94% and the average school mark was 1.34. The outcome assessment by the same patients at 1 post-operative year included the average values of 90.55 for the hip score, and 97% and 1.17 for percent and school marking of satisfaction, respectively. Better outcomes were achieved in the patients with cementless hip replacement. DISCUSSION: Our results, which are in agreement with the published data, show that the results of mid-term assessment of MIS-AL procedures are not superior to those achieved by the conventional approach. Even well documented prospective randomised studies comparing minimally invasive and standard techniques have failed to report any advantages of one method over the other in any of the characteristics studied, which included haemoglobin levels, X-ray findings, patient mobilisation, length of hospital stay, pain intensity, and scoring system results (Harris Hip Score, McMaster University Osteoarthritis Index or Short Form-12). Many studies have focused on looking for characteristics of better early results after minimally invasive techniques but, so far, the findings have been comparable for both methods or are of no great importance. CONCLUSIONS: The minimally invasive technique for total hip replacement is no revolution in this field but is an alternative for a selected category of patients whose condition in the early post-operative period would benefit from less-invasive surgery. The MIS-AL approach does not replace the conventional total hip arthroplasty. It may play a role early after surgery but has no superior outcomes in the long-term post-operative period. In well indicated cases it is the method of choice with good mid-term results.

[The new blood test bio-marker SEPT9 and colorectal carcinoma screening]. / Nový krevní test bio-markeru SEPT9 a screening kolorektálního karcinomu.

Due to its high incidence and mortality rates, the colorectal carcinoma represents a crucial medical issue. However, when it is detected in early stage there is high rate of successful treatment. Thats why, early stage cancer screening programmes were introduced into the clinical practice. They focus on the finding of hidden bleeding, using various laboratory techniques, sigmoidoscopy, and, primarily, colonoscopy. However, screening programmes have not yet reached the effect required. New techniques are therefore being developed, such as the detection of blood bio-markers. This group includes also methylated SEPT9 (mSEPT9) detection in blood. We applied this test on 57 patients; we divided the group into two parts. There were 33 asymptomatic individuals in the first group. In this group, we were got only one positive mSEPT9 result. The consequent colonoscopies were negative. The other group had 24 proven carcinomas. Of them, two had negative mSEPT9 results. The remaining in all 22 patients was tested mSEPT9 positive. After its efficiency is tested by further studies, this test may be used especially for patients with low compliance, as it only requires routine blood drawing.

[Relationship of acromial morphology and rotator cuff tears]. / Vztah tvaru akromia a ruptury rotátorové manzety.

PURPOSE OF THE STUDY: To evaluate the effect of acromial morphology, as assessed on radiographs, on rotator cuff tears. MATERIAL: A total of 200 patients surgically treated for shoulder disorders were enrolled. All were older than 40 years and had good quality shoulder radiographs. Two groups were composed: First, a clinical model group of 136 patients to be investigated for three parameters of rotator cuff injury that was divided into two subgroups. One included 68 patients, with an average age of 53.5 years, in whom surgery revealed no injury to the rotator cuff; the other subgroup of 68 patients, with an average age of 58 years, had a ruptured supraspinatus tendon. Subsequently, a control group of 64 patients (32 with rotator cuff injury and 32 without it) was used to verify the results of the model group. METHODS: Three parameters describing the acromion, i.e., acromion index (AI), lateral acromion angle and acromial slope, were measured on standard radiographs. Tangential antero-posterior and scapular "Y" (supraspinatus outlet) views were taken, the images were digitalised and evaluated using a TomoCon 3.0 Viewer programme, and the results of the two groups were statistically analysed and compared. RESULTS: The difference between the patients with rotator cuff injury and those without it was best shown, in both groups, by significant differences in the acromion index. This was true for both the men and women. The AI values for the patients with rotator cuff injury were 0.66 and 0.65 in the model and control groups, respectively. The same AI value of 0.76 was found for uninjured rotator cuffs in both groups. The two other parameters investigated did not appear to be of any significant validity for assessment of rotator cuff tears. DISCUSSION: The aetiology of injury to the rotator cuff has not been fully understood yet but, undoubtedly, the causes will be many. The shape of the acromion is regarded as one of the important factors. We agree with Nyffeler et al. that a lateral extension of the acromion is most often associated with rotator cuff tears and that the acromion index proposed by these authors is a good parameter to assess this morphological change. CONCLUSIONS: A lateral extension of the acromion plays an important role in the aetiology of degenerative tears of the supraspinatus tendon. The acromion index appears to be the best instrument for assessing this morphological change.