Signatures of the Optical Stark Effect on Entangled Photon Pairs from Resonantly Pumped Quantum Dots.

Two-photon resonant excitation of the biexciton-exciton cascade in a quantum dot generates highly polarization-entangled photon pairs in a near-deterministic way. However, the ultimate level of achievable entanglement is still debated. Here, we observe the impact of the laser-induced ac-Stark effect on the quantum dot emission spectra and on entanglement. For increasing pulse-duration-to-lifetime ratios and pump powers, decreasing values of concurrence are recorded. Nonetheless, additional contributions are still required to fully account for the observed below-unity concurrence.

Selection and characterisation of FVIII-specific single chain variable fragments.

The development of inhibitory anti-FVIII antibodies is currently the most severe complication in the treatment of haemophilia A patients. Inhibitor eradication can be achieved by immune tolerance induction (ITI). Recent findings suggest a correlation between the FVIII-specific IgG subclass distribution and the duration or outcome of ITI. To quantify FVIII-specific IgG subclasses in patients' plasma FVIII-specific IgG standards are required. Here, the isolation of FVIII-specific single chain variable fragments (scFvs) from synthetic phage display libraries and the characterisation of their FVIII domain specificity are described. The isolated scFv 1G10, which binds to the FVIII A2 domain, was cloned into the context of the four human IgG (hIgG) subclasses and expressed in mammalian cells. Purified 1G10-hIgG1, -hIgG2, -hIgG3 and -hIgG4 are used as standards to determine the absolute amounts and relative contribution of the different FVIII-specific IgG subclasses in future studies. The results from these studies will eventually add to understanding the role of the FVIII-specific IgG subclass distribution as prognostic factor for the outcome of ITI.

Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment.

The aim was to describe diaphragmatic behavior during postural limb activities and examine the ventilatory and stabilizing functions of the diaphragm. Thirty healthy subjects were examined in the supine position using a dynamic MRI system assessed simultaneously with specialized spirometric readings. The diaphragmatic excursions (DEs) were measured at three diaphragmatic points in the sagittal plane; the diaphragm positions (DPs) as related to a reference horizontal baseline were determined. Measurements were taken during tidal breathing (TB) and isometric flexion of upper or lower extremities against external resistance together with TB. Mean DE in both upper and lower postural limb activities was greater compared with the TB condition (P < 0.05), with the effect greater for lower limb activities. Inspiratory DPs in the upper and lower extremity activities were lower compared with TB alone (P < 0.01). Expiratory DP was lower only for lower extremity activities (P < 0.01). DP was most affected at the apex of the crescent and crural (posterior) portion of the diaphragm. DEs correlated strongly with tidal volume (Vt) in all conditions. Changes in DEs relative to the initial value were minimal for upper and lower extremities but were related to lower values of Vt (P < 0.03). Significant involvement of the diaphragm in the limb postural activities was found. Resulting DEs and DPs differed from the TB conditions, especially in lower extremity activities. The differences between the percent changes of DEs vs. Vt found for lower extremity activities were confirmed by both ventilatory and postural diaphragm recruitment in response to postural demands.

Analysis of diaphragm movement during tidal breathing and during its activation while breath holding using MRI synchronized with spirometry.

Using magnetic resonance imaging (MRI) in conjunction with synchronized spirometry we analyzed and compared diaphragm movement during tidal breathing and voluntary movement of the diaphragm while breath holding. Breathing cycles of 16 healthy subjects were examined using a dynamic sequence (77 slices in sagittal plane during 20 s, 1NSA, 240x256, TR4.48, TE2.24, FA90, TSE1, FOV 328). The amplitude of movement of the apex and dorsal costophrenic angle of the diaphragm were measured for two test conditions: tidal breathing and voluntary breath holding. The maximal inferior and superior positions of the diaphragm were subtracted from the corresponding positions during voluntary movements while breath holding. The average amplitude of inferio-superior movement of the diaphragm apex during tidal breathing was 27.3+/-10.2 mm (mean +/- SD), and during voluntary movement while breath holding was 32.5+/-16.2 mm. Movement of the costophrenic angle was 39+/-17.6 mm during tidal breathing and 45.5+/-21.2 mm during voluntary movement while breath holding. The inferior position of the diaphragm was lower in 11 of 16 subjects (68.75 %) and identical in 2 of 16 (12.5 %) subjects during voluntary movement compared to the breath holding. Pearson's correlation coefficient was used to demonstrate that movement of the costophrenic angle and apex of the diaphragm had a linear relationship in both examined situations (r=0.876). A correlation was found between the amplitude of diaphragm movement during tidal breathing and lung volume (r=0.876). The amplitude of movement of the diaphragm with or without breathing showed no correlation to each other (r=0.074). The movement during tidal breathing shows a correlation with the changes in lung volumes. Dynamic MRI demonstrated that individuals are capable of moving their diaphragm voluntarily, but the amplitude of movement differs from person to person. In this study, the movements of the diaphragm apex and the costophrenic angle were synchronous during voluntary movement of the diaphragm while breath holding. Although the sample is small, this study confirms that the function of the diaphragm is not only respiratory but also postural and can be voluntarily controlled.

[Autologous chondrocyte implantation in the treatment of cartilage lesions of ankle joint]. / Transplantace kultivovaných autologních chondrocytu hlezenného kloubu.

PURPOSE OF THE STUDY: The authors present the results of surgical treatment of talar dome cartilage defects. They used the transplantation of autologous cultured chondrocytes in the form of a solid chondral graft. MATERIAL AND METHODS: Patients with chondral lesions categorized as grades II to IV by the Anderson classification or as grades II to IV by the Berndt and Harty classification were indicated for this treatment. After preoperative MRI examination, a small sample of healthy cartilage was harvested arthroscopically from the non-weight-bearing area of the talus and was sent to the Tissue Bank in Brno for chondrocyte cultivation. After 28 to 42 days the cultured chondrocytes were formed into a solid chondral graft, implanted at the damaged site of the talar dome and fixed with fibrin glue (Tissucol). RESULTS: Between July 2003 and October 2005 five patients, three males and two females, were treated using this method. Their age ranged from 22 to 46 years. Follow-up was 6 to 24 months, with an average of 12.6 months, and the patients were examined by MRI at 2 weeks, 2 and 6 months and at 1 year. The clinical results were evaluated on the basis of the Mazur and Weber scoring systems. CONCLUSIONS: A significant improvement in clinical function of the ankle joint was achieved in three patients and the condition remained unchanged in one patient. In one patient, the surgical outcome was too recent for evaluation, but the MRI results indicated tendency to good incorporation of the graft.

[Effectiveness of teaching gerontology and geriatrics in students of the 1st Faculty of Medicine, Charles University in Prague]. / Efektivita výuky teoretické i klinické gerontologie u studentu 1. lékarské fakulty UK v Praze.

BACKGROUND: Increasing number of seniors in the society requires more university-degree educated professionals--health care professionals, social care workers and managers with basic exposure to and knowledge of gerontology and geriatrics. The aim of our paper was to evaluate the effectiveness of undergraduate training of gerontology and geriatrics among students of the 1st Faculty of Medicine, Charles University in Prague. METHODS AND RESULTS: To get information about knowledge of medical students and students of ergotherapy and physiotherapy and about their attitudes towards senior citizens we conducted a survey using two anonymous questionnaires prepared in our department and piloted earlier. The survey ran during the academic year 2004/2005. Students completed identical questionnaires twice, first time before the start of the clinical rotation and second time after the training end (n=134). Evaluation of knowledge and attitudes confirmed that one to two weeks clinical rotation at Department of Geriatrics was effective and increased knowledge of students in the topic trained. The percentage of correct answers in all three evaluated training programmes increased after the completion of the clinical rotation and reached 83% and more. From 134 participating students, 54.5 % appreciated life experience and wisdom of seniors they met, 98.4 % of students were satisfied with the training programme and 67.2 % of students reported that after training they changed their attitude towards senior population. CONCLUSIONS: Our survey confirmed that clinical training in geriatric medicine at 1st Faculty of Medicine, Charles University in Prague, prepared in agreement with current European recommendations is sufficiently effective and well accepted by the students. Therefore we recommend introduction of formal geriatric training for students in all medical faculties in the Czech Republic.

[Therapy of severe chondral defects of the patella by autologous chondrocyte implantation]. / Lécba hlubokých chondrálních defektu pately transplantací kultivovaných autologních chondrocytu.

PURPOSE OF THE STUDY: The aim of this study was to present the results of treatment of deep chondral defects of the patella by transplantation of a solid chondral graft formed by autologous cultured chondrocytes. MATERIAL AND METHODS: Indications for autologous chondrocyte implantation most frequently included acute trauma to the knee, particularly the patella, which resulted in a severe focal cartilage defect. The lesions were assessed on the basis of the Bessette and Hunter classification preoperatively, and on the Outerbridge classification during arthroscopy. A sample of healthy cartilage was harvested from a non-weight-bearing area of the trochlea femoris. After cultivation of chondrocytes for 28 to 42 days in the tissue bank, a solid chondral graft, prepared with the use of fibrin glue (Tissucol), was ready for implantation. RESULTS: Six patients, two males and four females (average age, 21.1 years; range, 13 to 39 years) were treated by this method in the period from July 2003 to October 2005. Follow-up ranged from 1 to 25 months, with an average of 18.5 months. The patients were examined postoperatively by magnetic resonance imaging (MRI) at 2 weeks, 2 and 6 months, and at 1 year. The clinical results were evaluated by the Meyers, the Tegner and the Lysholm knee scoring systems. Two of the six patients, in whom the follow-up period was shorter than 6 months, were not included in the evaluation. CONCLUSIONS: A significant improvement in knee function was recorded when the preoperative and final follow-up stages were compared, as well as on comparison with the healthy contralateral knee joint. MRI examination showed good graft incorporation in all patients.

[Drainage of pathologic fluid collections under CT guidance]. / Drenáze patologických kolekcí tekutin pod CT kontrolou.

During the period from January 2000 to November 2001 the authors performed in 98 patients 129 drainages of pathological fluid collections. In all instances the drainages were performed under CT control. In 80 patients the drain was placed in the area of the pleural cavity, in 47 in the area of the peritoneal cavity and in three patients the localization was different. For drainage they used catheters of the pigtail type size from 8F to 24 F, depending on the extent of the pathological collection, its depth, and nature of the drained contents. In 119 cases Seldinger's method was used, in 10 the tandem troacar method of placement of drainage catheters. The placement of the drainage catheter under CT control is a safe and effective method for removal of pathological fluid collection. In the authors' group successful drainage was proved in 71 of 84 (84.5%) patients followed up on a long-term basis.

[Percutaneous transluminal septal myocardial ablation in the treatment of hypertrophic obstructive cardiomyopathy: short-term study]. / Perkutánní transluminální septální myokardiální ablace v lécbe hypertrofické obstrukcní kardiomyopatie: krátkodobé sledování.

In 18 patients with symptomatic hypertrophic obstructive cardiomyopathy 18 procedures involving percutaneous transluminal myocardial ablation were performed. The patients were followed up for three months after the procedure. The mean intraventricular peak gradient declined during the intervention from 51 +/- 26 mm Hg to 11 +/- 12.2 mm Hg (p < 0.001). On average 2.7 +/- 1.1 ml ethanol were administered, as a rule into the first septal branch. The target artery was detected in 13 instances by means of myocardial contrast echocardiography and in five instances by haemodynamic investigation. In one instance the procedure was combined with subsequent balloon angioplasty of the ramus circumflexus. In one patient it was necessary to implant ex post a permanent pacemaker on account of AV bloc grade III. In one instance when myocardial contrast echocardiography was not used) infarsation not only of the basal interventricular septum occurred but also of the posterolateral left ventricular wall. During the three-month follow-up the incidence of stenocardias assessed according to CCS declined from grade 2.6 +/- 0.8 to 0.8 +/- 0.8 (p < 0.0001). Dyspnoea evaluated according to NYHA declined from grade 2.9 +/- 0.5 to 1.4 +/- 0.6 (p < 0.0001). The maximal intraventricular gradient evaluated by Doppler echocardiography declined from 57.2 +/- 42 mm Hg before the procedure to 19.7 +/- 12 mm Hg (p < 0.001). An identical gradient after stimulation with one dose of isosorbide dinitrate spray (1.25 mg) declined from 82.3 +/- 27 mm Hg to 25 +/- 6 mm Hg (p < 0.0001). The diastolic thickness of the IVS in the intervened segment declined from 21.2 +/- 3 mm to 14.7 +/- 2 mm (p < 0.0001). No significant change in the size of the left ventricle was recorded, nor in its ejection fraction and size of the left atrium. One patient died suddenly during the follow up period. Percutaneous transluminal septal myocardial ablation leads during short-term follow-up to a significant weakening of the basal segment of the interventricular septum, a decline of the intraventricular gradient and symptomatology of hypertrophic obstructive cardiomyopathy.

Osteoid osteoma of olecranon process of ulna in subchondral location.

We present a case of a 15-year-old girl with osteoid osteoma in an unusual subchondral localization of the olecranon. Unspecific complaints and minimal X-ray findings at the onset of the disease led to an incorrect diagnosis and more than 2 years of inefficient treatment.

[Case-mix classification in post-acute and long-term care. Validation of Resource Utilization Groups III (RUG-III) in the Czech Republic]. / Case-mix klasifikace pro postakutní a dlouhodobou péci. Validizace Resource utilization groups III (RUG-III) v Ceské republice.

BACKGROUND: Czech facilities for non-acute, continuing care provide care for very heterogeneous group of residents with different clinical characteristics, care needs and resource use. The rate based funding of LTC doesn't reflect patient case-mix. Therefore, a case mix system RUG based on per diem resource use is being used abroad for rational and fair LTC funding. METHODS: The validity of RUG-III has been evaluated and its use for financing of LTC and geriatric care in CR examined. In a sample of 1162 residents from 18 institutions patients were assigned to one of 44 RUG-III groups regarding their clinical characteristics. Data were analyzed using analysis of variance with individual care time per patient per day as independent and RUG-III groups as dependent variables. Weighted means for each group (case-mix indexes, CMI) were calculated. RESULTS: The RUG-III system achieved 59% variance explanation of total per diem costs of nursing and therapy/rehabilitation care and meets criteria of clinical validity. The CMIs for individual groups span from 0.39 to 2.70 i.e. differences in resource use between groups were sevenfold. Resource use within groups was relatively homogeneous. CONCLUSIONS: The RUG-III represent a suitable case-mix system for nonacute institutional care in the Czech health care. Besides its use for payment incentives, RUG-III can be used in facility management, quality assurance process and for comparative analyses on national and international level.

Vitrectomy update for macular traction in ocular toxocariasis.

PURPOSE: To study the results of modern vitrectomy in traction and combined traction-rhegmatogenous retinal detachment involving the macula in cases of ocular toxocariasis. METHODS: This was a cohort study of patients seen in different institutions in the United States. Ten eyes of 10 patients were studied. Vitrectomy was performed in all eyes, combined with membrane removal, scleral buckle, fluid-gas exchange, silicone oil, or lensectomy in certain cases. The anatomic and visual results of surgery were reviewed. RESULTS: Ten eyes from 10 patients ranging in age from 2 to 33 years (median, 6 years) were reviewed. Follow-up ranged from 3 months to 8 years (median, 2 years). All eyes achieved macular attachment following surgery; vision improved in 5 (50%) eyes, and was unchanged in 5 (50%). Histologic specimens from six eyes were reviewed, and revealed combinations of fibrous tissue, eosinophils, plasma cells, lymphocytes, and giant cells. One specimen revealed an encysted Toxocara canis organism. CONCLUSION: Inflammation created in response to Toxocara larvae may lead to traction retinal detachment of the macula. Vitreoretinal surgery has a good chance of reattaching the macula and improving vision.

[Catheter therapy in patients with stable angina pectoris. Results of 662 coronary angioplasties]. / Katetrizacní lécba nemocných se stabilní anginou pectoris. Výsledky 662 koronárních angioplastik.

Coronary angioplasty supplemented by implantation of a stent has become a standard therapeutic method in patients with stable angina pectoris. The authors analyzed the spectrum of patients indicated for this treatment, its successfulness and complications of catheterizations. In the course of a two-year period the authors implemented 662 catheterizations in 602 patients with stable angina. 58% patients indicated for coronary angioplasty on account of stable angina had a history of myocardial Q infarction, 93% had angina grade II or III according to CCS. Affection of one artery was diagnosed in 56% patients, complete revascularization was achieved in 59% of the operations. The clinical rate of success of catheterization was 97% in stenoses of the coronary arteries and 61% in coronary occlusions. In 57% of the treated lesions a coronary stent was implanted. Serious clinical complications developed in 1% of the interventions, none of the patients died. Catheterization treatment of stable angina is very successful and safe.

[Percutaneous localization and marking of small solitary pulmonary nodules in CT imaging before video thoracoscopy surgery]. / Perkutánní lokalizace a znacení solitárních malých plicních uzlu pod CT kontrolou pred videotorakoskopickou operací.

BACKGROUND: The localization of small lung nodules by palpation is not possible when videothoracoscopic surgery is performed. Transparietal fine needle biopsy is frequently not successful in small lung nodules. METHODS AND RESULTS: The authors describe their experiences with percutaneous CT controlled marking of small lung parenchyma around small lung nodules by patent blue and contrast medium mixture. The method was used in 7 patients with nodule size from 7 mm to 25 mm. In all patients the surgeon was able to localize the nodule. Operation followed localization as soon as possible, the interval was from 60 to 120 minutes. Four of 7 nodules were benign, 3 nodules were malignant. CONCLUSIONS: New method of marking of small lung nodules makes a minimal invasive operation possible. The operation stress is lower and the time of hospitalization is shorter.

[The effect of disability of the aged patient on the level of caregiving burden by the family]. / Vliv zdravotního postizení starého pacienta na stupen pecovatelské záteze rodiny.

BACKGROUND: A growing number of dependent elderly people is cared for at home by family members. However, long-term caregiving may become an intolerable strain for some families and lead to failure of family care. The aim of the study was to examine if level of physical and mental disability of the patient influences the extent of perceived caregiver burden representing risk factor for negative outcome. METHODS AND RESULTS: 128 elderly patients with disability and dependency (37 men, 91 women, average age 79.9 +/- 6.9 yrs) and 128 their primary caregivers, mostly family members (28.9% men, 71.1% women) were evaluated. Functional status of care recipient was assessed by means of Barthel ADL Index (mean = 70.9 +/- 26.5), IADL Test (mean = 31.4 +/- 23.5) and Mini-Mental State Exam, MMSE (mean = 20.4 +/- 6.5). Average score of Caregiver Burden Interview (CBI) was 34.7 +/- 18.8. According to CBI, 40.6% of caregivers were found under high or even extremely hig level of stress. Level of perceived burden correlated significantly with physical and mental disability level, in decreasing order for IADL, ADL and MMSE (rs = 0.582-0.708, p < 0.001). CONCLUSIONS: Caregiver burden of family caregivers is significantly related to the level of functioning and cognitive impairment of care recipient, particularly to his/her ability to perform instrumental activities. Functional decline of elderly patient represents a risk factor which contributes to negative caregiving outcome and institutional placement.

[Urinary and fecal incontinence in geriatric facilities in the Czech Republic]. / Inkontinence moci a stolice v geriatrických zarízeních v Ceské Republice.

BACKGROUND: Incontinence represents one of the common problems in long-term care geriatric facilities and nursing homes. However, in the Czech Republic data on prevalence, severity and incontinence-associated factors for nursing home residents are not available. The aim of the study was to report the prevalence of urinary (UI) and bowel incontinence (BI) in different geriatric facilities and to identify factors positively associated with incontinence. METHODS AND RESULTS: In a sample of 1162 residents of 18 long-term care facilities UI has been found in 684 residents (63.3%). Health and social care facilities did not differ significantly (60.7 vs 65.6%). Of the incontinent 294 residents (27.2%) suffered from permanent/daily incontinence, 390 (36.1%) from occasional transitory UI. Prevalence of BI reached 54.4%, as well as double incontinence (45.9%). Cognitive impairment, self-care ADL and/or mobility dependency and bed rest are factors significantly associated with UI (for all P < 0.001). However, age, gender and urinary tract infection did not reach the statistical significance (P = 0.280-0.069). Risk adjustment/stratification for UI revealed the prevalence of 33.0% in the low risk group. In the high risk group (high ADL dependency and severe cognitive impairment) the prevalence came up to 96.0%. CONCLUSIONS: Our study presents the first results focused on incontinence problem in long-term care geriatric institutions in the Czech Republic. High prevalence of this condition makes incontinence an important medical, nursing and economical yet neglected problem.

[Quantitative EEG, basic disorders and smoking in etiopathogenetically different groups of paranoid-hallucinatory psychoses--an exploratory study]. / Quantitatives EEG, Basisstörungen und Rauchen bei ätiopathogenetisch differenten Gruppen paranoid-halluzinatorischer Psychosen--eine explorative Studie.

We performed an exploratory study of quantitative EEG in aetiopathogenetically different paranoid-hallucinatory psychoses divided into the following groups: a) patients with familial psychoses (n = 12), b) patients with neuropsychological deficits (n = 16), c) patients with alcohol and drug abuse (n = 22) and d) patients with so-called sporadic psychoses (n = 12). We found a significant reduction of relative alpha power in the group with neuropsychological deficits. In the group with familial psychosis there was a significant reduction of absolute delta power and a significant increase of relative beta power and dominant beta frequency, especially for the frontal leads. Patients with drug abuse showed a reduction of absolute beta power and an increase of absolute and relative theta power. The group with sporadic psychosis showed a significant slowing of the dominant beta frequency and a significant increase of the absolute power of fast alpha rhythms. The group with sporadic psychoses showed lowered scores for the paranoid-hallucinatory basic symptom factor. The group with neuropsychological deficits showed the most visceral-somatoform basic symptoms, the highest nicotine consumption, increased dyskinesias and more perinatal complications. This group also showed the highest level of neuroleptic and antiparkinson medication. All in all, the group with neuropsychological deficits showed a complex interaction of somatic-exogenic and medical-iatrogenic factors. Furthermore, there was a significant positive correlation between paranoid-hallucinatory basic symptoms and nicotine abuse and high frequency beta waves.

[Pulmonary alveolar microlithiasis]. / Plícní alveolární mikrolitiáza.

The authors present two of their own observations where, based on the clinical course of the disease and the X-ray finding, they diagnosed the condition as pulmonary alveolar microlithiasis. They present a review of the literature as regards new views on the pathogenesis, diagnosis and therapy of the condition. They evaluate the contribution of scintigraphy 99 mTc, bronchial lavage and X-ray methods with a high differentiating capacity (HRCT). As regards therapeutic possibilities, transplantation of the lungs should be considered in advanced stages of the disease.

[Diagnosis of pulmonary embolism and monitoring of post-embolic changes in the vessels using pulmonary digital subtraction angiography]. / Diagnostika plicní embolie a sledování postembolizacních zmen na cévách pomocí plicní digitální subtrakcní angiografie.

The group comprises 48 patients where digital subtraction angiography revealed embolization of the lungs. Forty-four of the patients were examined on account of clinical suspicion of embolism of the lungs, in the remaining four the examination was made on account of other indications. In four instances of 48 patients where we diagnosed or suspected embolism of the lungs DSA was also used to follow up the effect of heparinization and anti-aggregation therapy in relatively extensive findings revealed during the first examination. Based on their experience, the authors summarize angiographic pictures into four morphological types: perfusion defect, localized thinning and reduction of peripheral arterioles, sudden discontinuation of lobar and segmental arteries ("cut-off") and intraluminal defects in the contrast filling of arteries. The authors evaluate objectively the advantages and disadvantages of DSA and compare in the discussion the course of the examination, as well as the results with classical angiography, with perfusion and ventilation scan and try to find the correct place in the algorithm of visualization methods when embolism of the lungs is suspected. Based on the assembled experience, DSA of the lungs can be used as the first diagnostic method or after screening perfusion scan, if the latter is available immediately after development of complaints, as the second method. The authors analyze also the reasons of the relatively less frequent and very often late indication of this examination in this country.