Measles in Czech population with varying vaccination rates in 2018-2019: clinical and laboratory differences between vaccinated and unvaccinated individuals and their relevance to clinical practice.

BACKGROUND AND OBJECTIVES: In a highly vaccinated population, an increasing number of previously vaccinated measles cases can be expected. The aim of this study was to assess the effect of vaccination on the clinical course and immune response in relation to the current measles case definition. METHODS: The presence of fever, catarrhal symptoms, exanthema and complications, and specific IgM and IgG positivity were assessed in all 230 patients and compared in 193 patients with known vaccination status, divided into measles-containing vaccine (MCV) groups: MCV0 (85 patients), MCV1 (25 patients) and MCV2 (83 patients). RESULTS: Statistically significant differences between groups were found for catarrhal symptoms.Conjunctivitis and rhinitis were significantly less frequent in the MCV2 group (47% and 54%) compared to MCV0 (80% and 80%), p < 0.001 and p = 0.002 respectively. Typical exanthema was present in 74 (87%) MCV0 and 56 (67%) MCV2 patients, p = 0.005. Complications were most common in the MCV0 group (29%). ECDC clinical case criteria were met in 81 (95%) MCV0, 18 (72%) MCV1 and 59 (71%) MCV2 patients, p < 0.001. IgM were positive in 64 (83%) MCV0, 14 (74%) MCV1 and 36 (67%) MCV2 patients, differences were not statistically significant. There were highly significant differences in IgG between MCV0 and both vaccinated groups (p < 0.001). CONCLUSIONS: A redefinition of the clinical case classification is essential to better capture modified measles and to raise awareness among healthcare workers of the differences in measles in vaccinated patients.

Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis.

Background: Epidemiological data are crucial to monitoring progress towards the 2030 Hepatitis C Virus (HCV) elimination targets. Our aim was to estimate the prevalence of chronic HCV infection (cHCV) in the European Union (EU)/European Economic Area (EEA) countries in 2019. Methods: Multi-parameter evidence synthesis (MPES) was used to produce national estimates of cHCV defined as: π = πrecρrec + πexρex + πnonρnon; πrec, πex, and πnon represent cHCV prevalence among recent people who inject drugs (PWID), ex-PWID, and non-PWID, respectively, while ρrec, ρex, and ρnon represent the proportions of these groups in the population. Information sources included the European Centre for Disease Prevention and Control (ECDC) national operational contact points (NCPs) and prevalence database, the European Monitoring Centre for Drugs and Drug Addiction databases, and the published literature. Findings: The cHCV prevalence in 29 of 30 EU/EEA countries in 2019 was 0.50% [95% Credible Interval (CrI): 0.46%, 0.55%]. The highest cHCV prevalence was observed in the eastern EU/EEA (0.88%; 95% CrI: 0.81%, 0.94%). At least 35.76% (95% CrI: 33.07%, 38.60%) of the overall cHCV prevalence in EU/EEA countries was associated with injecting drugs. Interpretation: Using MPES and collaborating with ECDC NCPs, we estimated the prevalence of cHCV in the EU/EEA to be low. Some areas experience higher cHCV prevalence while a third of prevalent cHCV infections was attributed to PWID. Further efforts are needed to scale up prevention measures and the diagnosis and treatment of infected individuals, especially in the east of the EU/EEA and among PWID. Funding: ECDC.

Major ions in Central European precipitation - Insight into changes in NO3-/SO42-, NH4+/NO3- and NH4+/SO42- ratios over the last four decades.

Knowledge of precipitation composition is important, among other things, to reveal changes in atmospheric chemistry. Here we present the long-term time trends in ratios of major ions in precipitation, namely nitrate to sulphate (NO3-/SO42-), ammonium to sulphate (NH4+/SO42-) and ammonium to nitrate (NH4+/NO3-). For this we explore the long-term time series recorded by the Czech Hydrometeorological Institute at eight monitoring sites situated in urban, rural and mountain regions of the Czech Republic between 1980 and 2020. To that end, we use innovative Bayesian inference with the Integrated Nested Laplace Approximation (INLA) computational method appropriate for investigating complicated large-scale data. Our results indicated: (i) increasing NO3-/SO42- ratio in precipitation over time and distinct seasonal behaviour with higher values in winter and lower values in summer, (ii) increasing NH4+/SO42- ratio in precipitation and distinct seasonal behaviour with higher values in summer and lower values in winter and (iii) relatively stable NH4+/NO3- ratio in precipitation with a mild recent increase and distinct seasonal behaviour with higher values in summer and lower values in winter. This behaviour pattern holds true for all the sites analysed, irrespective of their geographical position, altitude or environment. Though explored in detail rarely, the ion ratios are important to study as they reflect changes in atmospheric chemistry, mirroring changes in emissions and meteorology and suggesting changing impacts on ecosystems and the environment.

Clinical and molecular genetic analysis of cytologically uncertain thyroid nodules in patients with thyroid disease.

BACKGROUND: The current requirement is to establish the preoperative diagnosis accurately as possible and to achieve an adequate extent of surgery. The aim of this study was to define the preoperative clinical and molecular genetic risks of malignancy in indeterminate thyroid nodules (Bethesda III and IV) and to determine their impact on the surgical strategy. METHODS: Prospectively retrospective analysis of 287 patients provided the basis of preoperative laboratory examination, sonographic stratification of malignancy risks and cytological findings. Molecular tests focused on pathogenic variants of genes associated with thyroid oncogenesis in cytologically indeterminate nodules (Bethesda III and IV). The evaluation included clinical risk factors: positive family history, radiation exposure and growth in size and/or number of nodules. RESULTS: Preoperative FNAB detected 52 cytologically indeterminate nodules (28.7%) out of 181 patients. Postoperative histopathological examination revealed malignancy in 12 cases (23.7%) and there was no significant difference between Bethesda III and IV categories (P=0.517). Clinical risk factors for malignancy were found in 32 patients (61.5%) and the presence of at least one of them resulted in a clearly higher incidence of malignancy than their absence (31.3% vs. 10.0%, respectively). Pathogenic variants of genes were detected in 12/49 patients in Bethesda III and IV, and in 4 cases (33.3%) thyroid carcinoma was revealed. The rate of malignancies was substantially higher in patients with pathogenic variants than in those without (33.3% vs. 16.2%, respectively). CONCLUSIONS: Our experience implies that molecular genetic testing is one of several decision factors. We will continue to monitor and enlarge our patient cohort to obtain long-term follow-up data.

Stigmatization and discrimination of people living with HIV in the Czech Republic: a pilot study.

OBJECTIVES: HIV positivity diagnosis is often accompanied by stigmatization and discrimination, even in developed societies. The aim of the study was to obtain current information on the quality of life of people living with HIV in the Czech Republic, to assess the level and perception of stigmatization and discrimination, and to identify existing problems of people living with HIV concerning health services, family and the public. METHODS: Data for the pilot study were collected by convenience sampling between 2021 and 2022. Respondents were recruited from residents of Czech nationality and foreigners living with HIV in the Czech Republic who participated in an ECDC online questionnaire study or attended a convalescent stay for people living with HIV. Likert scales were used to capture key opinions, attitudes and beliefs of respondents. Data were processed using descriptive analysis. RESULTS: The study involved 42 people living with HIV. A total of 77% of the respondents reported that they had learned to live with their HIV-positive status, but 21% admitted to having low self-esteem due to their status. A total of 81% of the respondents had disclosed their HIV-positive status to someone outside of the healthcare setting, however, 40% of the respondents found it difficult to do so. Assault or threats from a sexual partner were reported by 17% of the respondents. A total of 27% of the respondents admitted having been denied or suspended health care, 44% reported inappropriate comments from healthcare workers, and 32% of the respondents avoided visiting the healthcare facility. Alarmingly, 41% of the respondents had been refused dental care at some point in the past because of their HIV-positive status. CONCLUSIONS: Although the study presents only limited findings due to the small number of respondents, it is clear that stigmatization and discrimination of people living with HIV exists in the Czech society. It brings the risk of loss of motivation and involvement of people living with HIV in working together with healthcare providers on their treatment. There is a clear need for a larger study to identify the causes of stigmatization and to find ways to prevent it.

Evaluation of the Completeness and Timeliness of the Infant Pertussis Surveillance System in the Czech Republic in 2015, 2017 and 2019.

Introduction: The completeness and timeliness of the pertussis questionnaire-based enhanced surveillance system (ESS) among infants and reported pertussis data within the electronic nationwide notification system (NNS) in the years 2015, 2017 and 2019 were evaluated in a pilot study. Methods: The completeness of the variables for demographic characteristics, date of symptom onset, hospitalisation and vaccination status were assessed in both systems. Timeliness of reporting in the NNS was analysed as the interval between symptom onset and a) the date of first specimen collection (diagnostic delay), and b) the date of the Regional Public Health Authority receiving notification (notification delay). Results: A total of 121 confirmed pertussis cases were reported to the NNS in the study years, while in the ESS a total of 104 confirmed cases were reported in infants. In both systems most cases were in the age group of one completed month of life (20% versus 23%) and males (55% versus 55%). The majority of cases were hospitalised (81% versus 85%) and unvaccinated (77% versus 78%). Within the NNS, the first dose of vaccine was reported in 13 cases, the second dose in 11, and third dose in three cases. Within the NNS, 100% completeness of following variables was found: symptom onset, week and region of reporting, age, gender and place of isolation. Median diagnostic delay was nine days. Median notification delay was 18 days. Conclusions: Data completeness was high in the NNS, except for lack of vaccination data in those eligible by age. Efforts to improve the completeness of laboratory-related variables and timeliness are essential. Based on the study results, the project of improving the ESS for infants will continue with regular evaluation.

Ambient ozone at a rural Central European site and its vertical concentration gradient close to the ground.

The representativeness of ambient air quality of an in situ measurement is key in the use and correct interpretation of the measured concentration values. Though the horizontal representativeness aspect is generally not neglected in air pollution studies, a detailed, high-resolution vertical distribution of ambient air pollutant concentrations is rarely addressed. The aim of this study is twofold: (i) to explore the vertical distribution of ground-level ozone (O3) concentrations measured at four heights above the ground-namely at 2, 8, 50, and 230 m-and (ii) to examine in detail the vertical O3 concentration gradient in air columns between 2 and 8, 8 and 50, and 50 and 230 m above the ground. We use the daily mean O3 concentrations measured continuously at the Kosetice station, representing the rural Central European background ambient air quality observed during 2015-2021. We use the semiparametric GAM (generalised additive model) approach (with complexity or roughness-penalised splines implementation) to analyse the data with sufficient flexibility. Our models for both O3 concentrations and O3 gradients use (additive) decomposition into annual trend and seasonality (plus an overall intercept). The seasonal and year-to-year patterns of the modelled O3 concentrations look very similar at first glance. Nevertheless, a more detailed look through O3 gradients shows that they differ substantially with respect to their seasonal and long-term dynamics. The vertical O3 concentration gradient in 2-230 m is not uniform but changes substantially with increasing height and shows by far the highest dynamics near the ground between 2 and 8 m, differing in both the seasonal and annual aspects for all the air columns inspected. We speculate that non-linear changes of both seasonal and annual components of vertical O3 gradients are due to atmospheric-terrestrial interactions and to meteorological factors, which we will explore in a future study.

The Safety Assessment of Cosmetic Perfumes by Using In Chemico and In Vitro Methods in Combination with GC-MS/MS Analysis.

Animal testing has been prohibited for the safety assessment of cosmetic ingredients or finished products. Thus, alternative non-animal methods, followed by confirmatory clinical studies on human volunteers, should be used as the sole legally acceptable approach within the EU. The safety assessment of cosmetic products requires the involvement of multiple scientific disciplines, including analytical chemistry and biomedicine, as well as in chemico, in vitro and in silico toxicology. Recent data suggest that fragrance components may exert multiple adverse biological effects, e.g. cytotoxicity, skin sensitisation, (photo)genotoxicity, mutagenicity, reprotoxicity and endocrine disruption. Therefore, a pilot study was conducted with selected samples of fragrance-based products, such as deodorant, eau de toilette and eau de parfum, with the aim of integrating results from a number of alternative non-animal methods suitable for the detection of the following toxicological endpoints: cytotoxicity (with 3T3 Balb/c fibroblasts); skin sensitisation potential (in chemico method, DPRA); skin sensitisation potential (LuSens in vitro method, based on human keratinocytes); genotoxicity potential (in vitro Comet assay with 3T3 Balb/c cells); and endocrine disruption (in vitro YES/YAS assay). The presence of twenty-four specific known allergens in the products was determined by using GC-MS/MS. The strategies for estimation of the NOAEL of a mixture of allergens, which were proposed by the Scientific Committee on Consumer Products in their 'Opinion on Tea tree oil' document and by the Norwegian Food Safety Authority in their 'Risk Profile of Tea tree oil' report, were used as models for the NOAEL estimation of the mixtures of allergens that were identified in the individual samples tested in this study.

Vaccination against influenza in pregnant women in a maternity hospital in the Czech Republic in the season 2020-2021.

OBJECTIVES: Pregnant women are among the priority groups to receive influenza vaccines in the Czech Republic since 2011, data on vaccination coverage are not yet available. The aim of the study was to determine the influenza vaccination coverage (IVC) and provide source data for further activities. METHODS: A prospective observational study was performed in a large maternity hospital in Prague. The self-completed questionnaire was distributed to 5,475 pregnant women between September 1, 2020 and August 31, 2021. Questions included maternal sociodemographic characteristics, influenza vaccination status and sources of maternal vaccination recommendations during pregnancy. RESULTS: A total of 4,617 completed questionnaires have been analysed. The median age of study participants (N = 4,592) was 33 years (range: 18-51 years). The majority (69.7%) of women had completed their university education, most women were childless (58.5%) or had one child (32.5%) before the start of the study. Less than 2% of women reported being vaccinated against influenza during their pregnancy (1.5%; 95% CI, 1.1-1.9%). Only 21% of women knew that it's possible to get vaccinated against influenza during pregnancy. Participants considered influenza vaccination in pregnancy as important (3.3%), useful (41.1%) and useless (44.4%). Out of 959 pregnant women who had information about influenza vaccination during pregnancy, only 6.9% were vaccinated, while among those who did not have this information, 0.1% were vaccinated during pregnancy (p < 0.001). The most frequent source of information was Internet, then media and a general practitioner. CONCLUSIONS: The IVC during pregnancy in our study was extremely low. In order to improve IVC among pregnant women, it is necessary to increase awareness of recommendations and vaccination options among the public and professionals and incorporating vaccination recommendation in routine antenatal practice.

Detection of persistent low IgG avidity-an interpretative problem in the diagnosis of acute toxoplasmosis.

OBJECTIVES: For the proper diagnosis of toxoplasmosis it is essential to determine the stage of the infection, for which the most preferred method is IgG avidity test. The avidity index (AI) should initially be low (AI≤0.3) in the acute phase and increase during the infection. However, persistent low avidity can occur in patients with latent toxoplasmosis, which can complicate the interpretation of the results. The aim of the study is to explain the causes of this phenomenon. METHODOLOGY: A retrospective study was carried out with 717 serum samples collected from 442 patients from the categories of pregnant and non-pregnant women, men, and newborns + infants (age < 0.5 year). The trends of AI kinetics were evaluated in repeatedly examined patients. The frequency of cases with low avidity was compared in individual categories of patients and in groups of people with acute and non-acute toxoplasmosis. RESULTS: The proportion of patients with initially low avidity was 42.1% in the acute toxoplasmosis group while it was 13.0% in the non-acute groups. In uninfected newborns with anti-Toxoplasma antibodies transmitted from the mother, a decrease in IgG avidity levels over time was observed, resulting in 29.2% of samples showing low (improper) avidity. While the dynamics of IgG avidity and the frequency of cases of improperly low avidity were similar in men and pregnant and non-pregnant women, the category of newborns and infants differed substantially for these indicators. CONCLUSIONS: Due to acceptable specificity and negative predictive value, high avidity can rule out acute toxoplasmosis, but moderate sensitivity complicates the possibility of its confirmation. The results of the avidity test must be interpreted in the context of the results of other methods.

Carbosilane ruthenium metallodendrimer as alternative anti-cancer drug carrier in triple negative breast cancer mouse model: A preliminary study.

The carbosilane metallodendrimer G1-[[NCPh(o-N)Ru(η6- p-cymene)Cl]Cl]4 (CRD13), based on an arene Ru(II) complex coordinated to imino-pyridine surface groups, has been conjugated with anti-cancer drugs. Ruthenium in the positively-charged dendrimer structure allows this nanoparticle to be considered as an anticancer drug carrier, made more efficient because ruthenium has anticancer properties. The ability of CRD13 to form complexes with Doxorubicin (DOX), 5-Fluorouracil (5-Fu), and Methotrexate (MTX) has been evaluated using zeta potential measurement, transmission electron microscopy (TEM) and computer simulation. The results show that it forms stable nanocomplexes with all those drugs, enhancing their effectiveness against MDA-MB-231 cancer cells. In vivo tests indicate that the CRD13/DOX system caused a decrease of tumor weight in mice with triple negative breast cancer. However, the tumors were most visibly reduced when naked dendrimers were injected.

Monitoring the vaccination of pregnant women against pertussis - single-centre one-year study in the Czech Republic.

OBJECTIVES: This observational study aimed to analyse data from big maternity hospital, determine the vaccination coverage and provide source information for further activities. BACKGROUND: Although vaccination of pregnant women against pertussis is recommended in the Czech Republic, data on vaccination coverage are not available. METHODS: The self-completed questionnaire was distributed to 5,475 pregnant women in the maternity hospital between 2020 and 2021. Questionnaires collected mother's sociodemographic characteristics, pertussis vaccination status and sources of recommendations for vaccinations during pregnancy. RESULTS: A total of 4,617 completed questionnaires were analysed. Pertussis vaccination coverage during pregnancy was 1.6 % (95% confidence interval, 1.3-2.0 %). Only 12.5 % of women knew about the possibility of being vaccinated against pertussis during pregnancy. Women considered pertussis vaccination in pregnancy as important (12.9 %), useful (49.1 %) and useless (24.0 %). Of 579 pregnant women who had information about pertussis vaccination during pregnancy, only 12.1 % were vaccinated, while among those who did not have this information, 0.1% were vaccinated during pregnancy (p < 0.001). The most frequent source of information was Internet, then a general practitioner. CONCLUSION: It is necessary to raise awareness of recommendations for pregnancy vaccination among public and professionals, to emphasize the benefits of such vaccination in order to increase the vaccination coverage (Tab. 3, Ref. 31). Text in PDF www.elis.sk Keywords: pertussis, whooping cough, pregnancy, vaccination, health knowledge, prevention.

Changes in cognitive function after thoracoscopic and catheter ablation for atrial fibrillation.

BACKGROUND: Comparative data regarding the effect of percutaneous and thoracoscopic ablation of atrial fibrillation (AF) on cognitive function are very limited. The aim of the study was to determine and compare the effect of both types of ablations on patient cognitive functions in the mid-term. METHODS: Patients with AF indicated for ablation procedure were included. Forty-six patients underwent thoracoscopic, off-pump ablation using the COBRA Fusion radiofrequency system, followed by a catheter ablation three months afterward (Hybrid group). A comparative cohort of 53 AF patients underwent pulmonary vein isolation only (PVI group). Neuropsychological examinations were done before and nine months after the surgical or catheter ablation procedure. Neuropsychological testing comprised 13 subtests of seven domains, and the results were expressed as post-operative cognitive dysfunction (POCD) nine months after the procedure. RESULTS: Patients in both groups were similar with respect to the baseline clinical characteristics; only non-paroxysmal AF was more common in the hybrid group (98% vs. 34%). Major POCD was present in eight (17.4%) of hybrid patients versus three (5.7%) of PVI patients (p = 0.11), combined (major/minor) worsened cognitive decline was present in 10 (21.7%) hybrid patients versus three (5.6%) PVI patients (p = 0.034). On the other hand, combined (major/minor) improvement was present in 15 (32.6%) hybrid patients versus nine (16.9%) patients in the PVI group (p = 0.099). CONCLUSION: Hybrid ablation, a combination of thoracoscopic and percutaneous ablation, is associated with a higher risk of cognitive decline compared to sole percutaneous ablation.

Total thyroidectomy can still remain the method of choice in some Bethesda III cases.

BACKGROUND: The latest WHO classification of tumours of endocrine organs defines new units of borderline thyroid tumours (BTT). The aim of our study was to evaluate ultrasonographic and cytological features, mutation profile and surgery treatment in rare thyroid tumours. METHODS: An analysis of 8 BTT out of 487 patients, who underwent thyroid surgery between June 2016 and June 2020. The definitive diagnosis was made postoperatively by extensive histopathological examination. Molecular genetic analysis of genes associated with thyroid oncology (BRAF, HRAS, KRAS, NRAS, TERT, TP53, fused genes) were performed from one FNAB, and 7 formalin-fixed paraffin-embedded (FFPE) samples. RESULTS: BTT were found in a total of 8 patients (1.6%), with a predominance of men with respect to other operated patients. FNAB samples were classified in the Bethesda system as Bethesda I, Bethesda II and Bethesda III in one, four and three cases, respectively. Hemithyroidectomy and total thyroidectomy were performed equally in four patients. The histopathological diagnosis revealed non-invasive encapsulated follicular neoplasm with papillary-like nuclear features (NIFTP) in three patients, follicular tumour of uncertain malignant potential (FT-UMP) in three patients, well differentiated tumour of uncertain malignant potential (WDT-UMP) in one patient, and hyalinizing trabecular tumour (HTT) in one case. In NIFTP cases mutation in HRAS gene in one patient together with probable pathogenic variant in TP53 gene and in NRAS gene in two patients were detected. In HTT patient PAX8/GLIS3 fusion gene was detected. CONCLUSION: The surgical treatment of BTT is necessarily individual influenced by preoperative clinical, ultrasonographic, cytological and molecular genetic findings, and the presence of other comorbidities.

The nociceptive response during adult cardiac surgery measured by the qNOX index: A feasibility study.

BACKGROUND: Monitoring nociception during general anaesthesia remains a substantial challenge. The Conox monitor uses two EEG indices, the qCon and the qNox. The qNox refers to the probability that a nociceptive stimulation triggers a movement of the patient and the response probability of reaction to nociceptive stimulation. We decided to test the feasibility of monitoring the qNOX index during adult cardiac surgery and to investigate whether this index correlates with hemodynamic and hormonal signs of nociceptive stimulation. METHOD: We enrolled 19 patients undergoing elective cardiac surgery. These were randomised to 2 groups receiving different doses of sufentanil via target controlled infusion: group A (n=9) 0.25 ng/mL and group B (n=10) 0.75 ng/mL. All patients were maintained at the same depth of anaesthesia. We recorded the Conox monitor indices (qNOX, qCON, electromyographic), hemodynamic variables and plasmatic levels of cortisol and noradrenaline. RESULTS: There was significantly higher blood pressure (P=0.013) and plasmatic cortisol (P=0.003) in group A and a significant increase in plasmatic noradrenaline with increasing intensity of surgical stimulation in both groups: A (P=0.001), B (P=0.008). We found no significant corresponding changes in the qNOX index. There was a positive correlation between qNOX and hemodynamic signs of stimulation (P=0.012) and between the qNOX and EMG indices (P=0.013) after endotracheal intubation, but not later after EMG index dropped. CONCLUSION: Our results do not support the assumption that signs of nociceptive stimulation during adult cardiac surgery will be reflected by the qNOX index. This may be related to compounding of qNOX processing and use of muscle relaxants. Further investigation on this field is needed.

Partial upper sternotomy for aortic valve replacement provides similar mid-term outcomes as the full sternotomy.

Background: Minimally invasive aortic valve replacement via upper partial sternotomy (MiniAVR) provides very good short-term results and delivers certain advantages in the postoperative course. There is limited data regarding the mid-term mortality and morbidity following this minimally invasive surgery. Methods: We provide a retrospective analysis of the patients, undergoing MiniAVR versus full sternotomy (FS) for aortic valve replacement with biological prosthesis. As the primary combined end-point the combination of death, stroke, and rehospitalization within 3 years postoperatively was defined. Data have been collected from National Cardiac Surgery Registry and insurance companies. Results: Two hundred consecutive patients with aortic valve replacement (100 ministernotomy in MiniAVR group and 100 full sternotomy in FS group) with biological prosthesis were included in this study. Ministernotomy had longer cross-clamp and bypass times (median difference 6.5 min, P=0.005, and 8.5 min, P=0.002 respectively). Patients operated via upper partial sternotomy had a lower postoperative bleeding [300 mL (IQR, 290) vs. 365 mL (IQR, 207), P=0.031]. There was no difference in the 3-year mortality (14% vs. 11%, P=0.485). The mean number of readmission 3 years after surgery per capita was almost the same in both groups (1.65 vs. 1.60, P=0.836). Median time to the first readmission was longer in the MiniAVR group (difference 8.9 months). The incidence of combined end-point during 3 years postoperatively in both groups was not statistically different (P=0.148), as well as readmissions from cardio-vascular reasons (subhazard ratio 0.90, P=0.693). Conclusions: Upper partial sternotomy can be performed safely for aortic valve replacement, without increased risk of death, stroke or re-admission in 3 years postoperatively.

Adaptive Synthesis of Functional Amphiphilic Dendrons as a Novel Approach to Artificial Supramolecular Objects.

Supramolecular structures, such as micelles, liposomes, polymerosomes or dendrimerosomes, are widely studied and used as drug delivery systems. The behavior of amphiphilic building blocks strongly depends on their spatial distribution and shape of polar and nonpolar component. This report is focused on the development of new versatile synthetic protocols for amphiphilic carbosilane dendrons (amp-CS-DDNs) capable of self-assembly to regular micelles and other supramolecular objects. The presented strategy enables the fine modification of amphiphilic structure in several ways and also enables the facile connection of a desired functionality. DLS experiments demonstrated correlations between structural parameters of amp-CS-DDNs and the size of formed nanoparticles. For detailed information about the organization and spatial distribution of amp-CS-DDNs assemblies, computer simulation models were studied by using molecular dynamics in explicit water.

The reduced use of invasive procedures leads to a change of frequencies of prenatally detected chromosomal aberrations: population data from the years 2012-2016.

OBJECTIVE: The aim of the study was to analyze the results of screening for chromosomal aberrations in a population with a high rate of first-trimester screening and low rate of cell-free DNA testing. METHODS: The data were obtained from the National Registry of Congenital Anomalies of the Czech Republic. We calculated and compared the proportion of autosomal trisomies (Down, Edwards, and Patau syndrome) and of other chromosomal aberrations identified during prenatal diagnostics. RESULTS: We identified 3009 prenatally diagnosed cases of chromosomal aberrations in the 2012-2016 period. The number of major autosomal trisomies has increased from 329 cases (30.86 per 10,000 live births) in 2012 to 423 cases (37.41) in 2016 (p = 0.014). The numbers of other aberrations decreased from 246 cases (23.07 per 10,000) in 2012 to 217 cases (19.19) in 2016 (p = 0.017). The usage of invasive diagnostic procedures decreased from 1099.54 in 2012 to 622.73 in 2016 (per 10,000 live births). CONCLUSIONS: Our population-based study confirmed a decrease in prenatal detection of nonmajor chromosomal aberrations wherein a decrease of invasive testing occurred. With the introduction of cell-free DNA testing, further decrease of invasive procedures and detection of nonmajor aberrations may be expected.

Local fresh- and sea-water effects on fog occurrence.

Fog is an important atmospheric phenomenon highly relevant to ecosystems and/or the environment. Two essential prerequisites of fog formation are the presence of fog condensation nuclei and water in the atmosphere. The aim of our study was to examine in detail how fog occurrence is influenced by water areas in the immediate vicinity of the fog observation site. We have used as input data long-term observations on fog occurrence measured at 56 professional meteorological stations in Romania in 1981-2017 and GIS-derived information on water areas and on two topographical indices, TWI and TPI, in the neighbourhood of these stations. We formulated three alternative models of different complexity based on a semiparametric generalised additive logistic model for the probability of fog occurrence with potentially nonlinear, smooth effects modelled via penalised splines. A radius of 9 km appeared to be the most influential when considering the water area in a circle around the fog observation station. Based on our results, we concluded that (i) the water area in the vicinity of the station is a factor influencing fog occurrence, (ii) the water's effect differs according to water type (freshwater or seawater proximity), and (iii) GIS-derived topographical indices are informative for the explanation of fog occurrence and their inclusion enhanced the fit of the models substantially. Our findings, based on a reliable long-term data set of fog occurrence and recent GIS-derived data, explored by a relevant statistical approach will enhance further considerations related to fog formation and its environmental consequences.

Carbosilane Glycodendrimers for Anticancer Drug Delivery: Synthetic Route, Characterization, and Biological Effect of Glycodendrimer-Doxorubicin Complexes.

The complexity of drug delivery mechanisms calls for the development of new transport system designs. Here, we report a robust synthetic procedure toward stable glycodendrimer (glyco-DDM) series bearing glucose, galactose, and oligo(ethylene glycol)-modified galactose peripheral units. In vitro cytotoxicity assays showed exceptional biocompatibility of the glyco-DDMs. To demonstrate applicability in drug delivery, the anticancer agent doxorubicin (DOX) was encapsulated in the glyco-DDM structure. The anticancer activity of the resulting glyco-DDM/DOX complexes was evaluated on the noncancerous (BJ) and cancerous (MCF-7 and A2780) cell lines, revealing their promising generation- and concentration-dependent effect. The glyco-DDM/DOX complexes show gradual and pH-dependent DOX release profiles. Fluorescence spectra elucidated the encapsulation process. Confocal fluorescence microscopy demonstrated preferential cancer cell internalization of the glyco-DDM/DOX complexes. The conclusions were supported by computer modeling. Overall, our results are consistent with the assumption that novel glyco-DDMs and their drug complexes are very promising in drug delivery and related applications.