Fiberoptička trahealna intubacija na budno i rizična ekstubacija u bolesnika s očekivanim otežanim dišnim putom zbog post-traumatske ankiloze temporomandibularnih zglobova

In this case report we present successful airway management in a patient with predicted difficult airway using the Difficult Airway Society guidelines. Our patient presented with recurrence of severely reduced mouth opening due to post-traumatic bilateral temporomandibular ankylosis, and was scheduled for surgical resection of the mandibular articular processes. Awake fiberoptic intubation was planned. After light sedation and thorough topicalization of the nasal cavity the flexible optic bronchoscope was successfully navigated into the trachea with ‘spray-as-you-go’ technique and the endotracheal tube was railroaded over it. After a two-point check of the endotracheal tube placement the patient was put under anesthesia. The surgery was uneventful. Finally, a plan with surgeons for safe extubation was made and the patient was extubated uneventfully on the next day using the airway exchange catheter in the intensive care unit.U ovom prikazu slučaja opisujemo uspješno zbrinjavanje dišnoga puta u bolesnika s predviđenim otežanim dišnim putom primjenjujući smjernice koje je izdalo Difficult Airway Society. Bolesnik se prezentirao otežanim otvaranjem usta posljedično obostranoj post-traumatskoj ankilozi temporomandibularnih zglobova. Planirana je budna fiberoptička intubacija za kiruršku resekciju obaju mandibularnih zglobnih nastavaka. Nakon lagane sedacije i temeljite topikalizacije nosne šupljine fleksibilni optički bronhoskop je uspješno navigiran u traheju tehnikom spray-as-you-go te je endotrahealni tubus postavljen preko njega. Nakon dvostruke provjere položaja endotrahealnog tubusa bolesnik je anestetiziran. Kirurški zahvat je protekao bez neočekivanih događaja. U dogovoru s operaterima primijenjen je plan za sigurnu ekstubaciju te je ona učinjena bez neočekivanih događaja dan kasnije primjenom tzv. katetera “izmjenjivača” u jedinici intenzivnog liječenja

Air quality in the German–Czech border region: A focus on harmful fractions of PM and ultrafine particles

A comprehensive air quality study has been carried out at two urban background sites in Annaberg-Buchholz (Germany) and Ústí nad Labem (Czech Republic) in the German–Czech border region between January 2012 and June 2014. Special attention was paid to quantify harmful fractions of particulate matter (PM) and ultrafine particle number concentration (UFP) from solid fuel combustion and vehicular traffic. Source type contributions of UFP were quantified by using the daily concentration courses of UFP and nitrogen oxide. Two different source apportionment techniques were used to quantify relative and absolute mass contributions: positive matrix factorization for total PM2.5 and elemental carbon in PM2.5 and chemical mass balance for total PM1 and organic carbon in PM1. Contributions from solid fuel combustion strongly differed between the non-heating period (April–September) and the heating period (October–March). Major sources of solid fuel combustion in this study were wood and domestic coal combustion, while the proportion of industrial coal combustion was low (<3%). In Ústí nad Labem combustion of domestic brown coal was the most important source of organic carbon ranging from 34% to 43%. Wood combustion was an important source of organic carbon in Annaberg-Buchholz throughout the year. Heavy metals and less volatile polycyclic aromatic hydrocarbons (PAH) in the accumulation mode were related to solid fuel combustion with enhanced concentrations during the heating period. In contrast, vehicular PAH emissions were allocated to the Aitken mode. Only in Ústí nad Labem a significant contribution of photochemical new particle formation (e.g. from sulfur dioxide) to UFP of almost 50% was observed during noontime. UFPs from traffic emissions (nucleation particles) and primary emitted soot particles dominated at both sites during the rest of the day. The methodology of a combined source apportionment of UFP and PM can be adapted to other regions of the world with similar problems of atmospheric pollution to calculate the relative risk in epidemiological health studies for different sub-fractions of PM and UFP. This will enhance the meaningfulness of published relative risks in health studies based on total PM and UFP number concentrations.

HEALTH CARE IN SLAVONIAN PROVINCE DURING THE 19th CENTURY

Zbog neposredne blizine s Osmanskim Carstvom, u Slavoniji je postojala stalna opasnost od ulaska brojnih zaraznih i nezaraznih bolesti. Dodatna su otegotna okolnost bili loši životni i higijenski uvjeti, siromaštvo, suše i poplave. Odlaskom Osmanlija krajem 17. stoljeća zdravstvenu skrb pružala je tek nekolicina brijača i ranarnika, koji su ostali živjeti u slavonskom Provincijalu. Zbog loše zdravstvene zaštite, carica i kraljica Marija Terezija 1770. donosi Opći zdravstveni zakon koji se primjenjivao na području cijele Habsburške Monarhije, uključujući i Slavoniju. Među ostalim, njime je predviđeno uvođenje formalnog obrazovanja za zdravstvene radnike, što je u konačnici rezultiralo stvaranjem kvalitetnijega medicinskog kadra. Usporedno s tim, šarlatanima se sve češće izricala zabrana rada. Nedostatak obrazovanih liječnika, stomatologa, primalja, ljekarnika i veterinara pokušalo se riješiti različitim mjerama kojima se poticalo njihovo školovanje i usavršavanje. Nakon stjecanja diplome ti su stručnjaci bili raspoređeni u bolnice, domove za starije i nemoćne osobe, domove za invalide i u druge zdravstvene ustanove u kojima se stanovnicima slavonskog Provincijala pružala zdravstvena skrb.Due to its proximity to the Ottoman Empire, Slavonia was constantly exposed to the threat of invasion by numerous infectious and non-infectious diseases. An additional aggravating circumstance was the poor living and hygienic conditions in Slavonia, poverty, droughts, and floods. After the withdrawal of the Ottomans at the end of the 17th century, medical care was provided only by a few barbers and ‘ranarniks’ (i.e., feldshers) who remained in the Slavonian province. Due to the poor medical care, in 1770, the Empress and Queen Maria Theresa issued the General Health Law, which applied to the entire Habsburg Monarchy, including Slavonia. Among other things, it provided for the introduction of formal training for health personnel, ultimately leading to a better quality medical workforce. At the same time, charlatans were increasingly prohibited from working. The shortage of trained physicians, dentists, midwives, pharmacists, and veterinarians was addressed through various measures to promote their education and training. After obtaining their diplomas, these professionals were employed in hospitals, old people’s homes, nursing homes, homes for people with disabilities, and other healthcare institutions where the inhabitants of the Slavonian province received medical care

Early Childhood Lower Respiratory Illness and Air Pollution

BackgroundFew studies of air pollutants address morbidity in preschool children. In this study we evaluated bronchitis in children from two Czech districts: Teplice, with high ambient air pollution, and Prachatice, characterized by lower exposures.ObjectivesOur goal was to examine rates of lower respiratory illnesses in preschool children in relation to ambient particles and hydrocarbons.MethodsAir monitoring for particulate matter 2 years of age, for PAHs compared with fine particles. Preschool-age children may be particularly vulnerable to air pollution–induced illnesses

Constitutive Overexpression of the OsNAS Gene Family Reveals Single-Gene Strategies for Effective Iron- and Zinc-Biofortification of Rice Endosperm

BACKGROUND: Rice is the primary source of food for billions of people in developing countries, yet the commonly consumed polished grain contains insufficient levels of the key micronutrients iron (Fe), zinc (Zn) and Vitamin A to meet daily dietary requirements. Experts estimate that a rice-based diet should contain 14.5 µg g−1 Fe in endosperm, the main constituent of polished grain, but breeding programs have failed to achieve even half of that value. Transgenic efforts to increase the Fe concentration of rice endosperm include expression of ferritin genes, nicotianamine synthase genes (NAS) or ferritin in conjunction with NAS genes, with results ranging from two-fold increases via single-gene approaches to six-fold increases via multi-gene approaches, yet no approach has reported 14.5 µg g−1 Fe in endosperm. METHODOLOGY/PRINCIPAL FINDINGS: Three populations of rice were generated to constitutively overexpress OsNAS1, OsNAS2 or OsNAS3, respectively. Nicotianamine, Fe and Zn concentrations were significantly increased in unpolished grain of all three of the overexpression populations, relative to controls, with the highest concentrations in the OsNAS2 and OsNAS3 overexpression populations. Selected lines from each population had at least 10 µg g−1 Fe in polished grain and two OsNAS2 overexpression lines had 14 and 19 µg g−1 Fe in polished grain, representing up to four-fold increases in Fe concentration. Two-fold increases of Zn concentration were also observed in the OsNAS2 population. Synchrotron X-ray fluorescence spectroscopy demonstrated that OsNAS2 overexpression leads to significant enrichment of Fe and Zn in phosphorus-free regions of rice endosperm. CONCLUSIONS: The OsNAS genes, particularly OsNAS2, show enormous potential for Fe and Zn biofortification of rice endosperm. The results demonstrate that rice cultivars overexpressing single rice OsNAS genes could provide a sustainable and genetically simple solution to Fe and Zn deficiency disorders affecting billions of people throughout the world.Alexander A. T. Johnson, Bianca Kyriacou, Damien L. Callahan, Lorraine Carruthers, James Stangoulis, Enzo Lombi and Mark Teste

Advanced technologies in stroke prevention

Moždani udar predstavlja značajan javnozdravstveni problem, a kontrola promjenjivih čimbenika rizika je bitna komponenta u njegovoj prevenciji. The Stroke Riskometer App je aplikacija za pametne telefone koja služi za identifikaciju rizičnih čimbenika i procjenu rizika. Istraživanja su pokazala da je primjenom telemedicine i prijenosnih uređaja moguće postići bolju kontrolu pojedinih rizičnih čimbenika. Svrha ovog preglednog rada je istražiti i prezentirati suvremene individualizirane metode detekcije i kontrole čimbenika rizika koji su dostupni u obliku prijenosnih uređaja poput pametnih satova i telefona. Dodatno, telestroke mreža je dio telemedicine koji služi povezivanju manjih bolnica sa većim centrima putem interneta kako bi se povećala dostupnost specijalističke skrbi za pacijente te uštedjelo vrijeme kod zbrinjavanja akutnog moždanog udara. Ona omogućuje preciznu procjenu kliniĉke slike te obradu radioloških snimki od strane stručnjaka koji onda usmjeravaju terapiju i daljnje zbrinjavanje akutno bolesnog pacijenta. Radiologija je jedno od najzanimljivijih područja za primjenu umjetne inteligencije u medicini. Pokazalo se da neuronske mreže mogu parirati radiolozima u analizi pojedinih slikovnih podataka, no njihova šira primjena tek je u ranim fazama razvoja. Bitnu ulogu u razvoju i implementaciji umjetne inteligencije imaju baze podataka iz čega proizlazi potreba za sustavnim prikupljanjem radioloških slikovnih podataka te nalaza, što bi u konačnici moglo omogućiti automatsku analizu neuroradioloških podataka. Time bi se ubrzao proces dijagnostike i usmjeravanja terapije pri akutnom moždanom udaru, kao i u ostalim hitnim stanjima.Stroke represents a significant public health issue and control of modifiable risk factors is an important component in its prevention. The Stroke Riskometer App is a smartphone application used for identification of risk factors and risk assessment. Research has shown that it is possible to achieve a better risk factor control by using telemedicine and wearable devices. The purpose of this review is to investigate and present advanced individualised methods for risk factor detection and control, that are available in the form of wearable devices such as smart watches or phones. Furthermore, telestroke network is a part of telemedicine used to connect smaller hospitals and bigger centers via the internet to achieve higher coverage of expert care for patients as well as to save time while treating acute stroke. It allows for precise assessment of clinical presentation and expert review of radiological scans, thus helping to direct therapy and further treatment of acutely ill patient. Radiology is one of the most interesting fields for deployment of artifical intelligence in medicine. It is shown that neural networks can compete with radiologists in analysing some imaging results, but their wider application is still in the early stages of development. Databases have an important role in development and implementation of artificial intelligence, therefore there is a need for systematic collection of radiological images and findings, which may allow for automatic analysis of neuroradiological images. That would make diagnosing and treating acute stroke, as well as other emergency conditions, faster

Energy Industry and Geopolitics – Influence on Emergency Electricity Supply

Článek shrnuje problematiku nouzového zásobování elektřinou v krizových situacích, která byla podrobně analyzována v rámci výzkumného projektu VD20072008A05 (2007-2008) v rámci programu bezpečnostního výzkumu Ministerstva vnitra. Výsledky řešení projektu byly využity při přípravě priorit českého předsednictví Radě EU a při přípravě podkladových studií pro tzv. Pačesovu komisi, a to zejména v oblasti energetické bezpečnosti. Energetickou bezpečnost nelze řešit bez analýzy geopolitického pozadí. Mírová spolupráce povede k rozšíření obnovitelných zdrojů energie, decentralizovaných zdrojů a k dálkovým přenosům elektřiny. Případný válečný konflikt o zbývající zdroje by měl charakter asymetrické gerilové války s útoky na kritickou infrastrukturu. V obou případech je třeba postupně měnit charakter současných energetických sítí. Přechod od pasivních k aktivním sítím je zásadním prvkem ochrany obyvatelstva nejen při zvládání rostoucího množství distribuovaných zdrojů a dopadů extrémních klimatických jevů typu Kyrill a Emma, ale i při zvládání krizových situací v případě teroristických útoků a guerillové války.The article summarises the problems of emergency electricity supply in crisis situations as analysed in the research project VD20072008A05 (2007-2008) in the framework of security research programme of Ministry of the Interior. Results of the projects were utilised in the preparation of priorities of Czech Republic in the period of presidency of the EU Council and in the preparation of working papers for socalled Pačes commission, especially in the area of energy security. Energy security cannot be solved without the analysis of geopolitical background. Peaceful cooperation will lead to the extension of renewable energy sources, decentralized sources and to long-distance transmission of electricity. A potential armed confl ict over remaining sources would have the character of asymmetric guerrilla war with attacks against critical infrastructure. In both the cases, it is necessary to change gradually the character of existing energy supply networks. Transition from passive to active networks is the fundamental element of population protection not only when dealing with the growing number of distributed sources and the impacts of extreme climatic events of the type of Kyrill and Emma, but also when coping with crisis situations in the case of terrorist attacks and guerrilla war

Zkušenosti s ochranou kritické infrastruktury v České republice

Příspěvek shrnuje praktickou zkušenost s ochranou kritické infrastruktury v ČR, zejména v oblasti energetických systémů. Po úvodních studiích vypracovaných krátce po útocích 11. září 2001 se CITYPLAN systematicky zapojil do koncepčních a výzkumných prací a trvale se věnuje rozvoji partnerství veřejného a soukromého (Public Private Partnership) s cílem zvýšení ochrany obyvatel. Výsledkem je zapojení krajských samospráv a energetických firem do diskuse a přípravy realizace ochrany KI. MPO v závěru roku 2006 podpořilo tyto aktivity grantem na pilotní projekt "Zvýšení odolnosti distribuční soustavy proti důsledkům dlouhodobého výpadku přenosové soustavy ČR s cílem zvýšení bezpečnosti obyvatel". V roce 2007 se rozhodlo podpořit i druhý - komplementární - projekt "Výzkum možnosti posílení startů ze tmy pro zvýšení spolehlivosti a odolnosti provozu elektrizační soustavy ČR"

Advanced technologies in stroke prevention

Moždani udar predstavlja značajan javnozdravstveni problem, a kontrola promjenjivih čimbenika rizika je bitna komponenta u njegovoj prevenciji. The Stroke Riskometer App je aplikacija za pametne telefone koja služi za identifikaciju rizičnih čimbenika i procjenu rizika. Istraživanja su pokazala da je primjenom telemedicine i prijenosnih uređaja moguće postići bolju kontrolu pojedinih rizičnih čimbenika. Svrha ovog preglednog rada je istražiti i prezentirati suvremene individualizirane metode detekcije i kontrole čimbenika rizika koji su dostupni u obliku prijenosnih uređaja poput pametnih satova i telefona. Dodatno, telestroke mreža je dio telemedicine koji služi povezivanju manjih bolnica sa većim centrima putem interneta kako bi se povećala dostupnost specijalističke skrbi za pacijente te uštedjelo vrijeme kod zbrinjavanja akutnog moždanog udara. Ona omogućuje preciznu procjenu kliniĉke slike te obradu radioloških snimki od strane stručnjaka koji onda usmjeravaju terapiju i daljnje zbrinjavanje akutno bolesnog pacijenta. Radiologija je jedno od najzanimljivijih područja za primjenu umjetne inteligencije u medicini. Pokazalo se da neuronske mreže mogu parirati radiolozima u analizi pojedinih slikovnih podataka, no njihova šira primjena tek je u ranim fazama razvoja. Bitnu ulogu u razvoju i implementaciji umjetne inteligencije imaju baze podataka iz čega proizlazi potreba za sustavnim prikupljanjem radioloških slikovnih podataka te nalaza, što bi u konačnici moglo omogućiti automatsku analizu neuroradioloških podataka. Time bi se ubrzao proces dijagnostike i usmjeravanja terapije pri akutnom moždanom udaru, kao i u ostalim hitnim stanjima.Stroke represents a significant public health issue and control of modifiable risk factors is an important component in its prevention. The Stroke Riskometer App is a smartphone application used for identification of risk factors and risk assessment. Research has shown that it is possible to achieve a better risk factor control by using telemedicine and wearable devices. The purpose of this review is to investigate and present advanced individualised methods for risk factor detection and control, that are available in the form of wearable devices such as smart watches or phones. Furthermore, telestroke network is a part of telemedicine used to connect smaller hospitals and bigger centers via the internet to achieve higher coverage of expert care for patients as well as to save time while treating acute stroke. It allows for precise assessment of clinical presentation and expert review of radiological scans, thus helping to direct therapy and further treatment of acutely ill patient. Radiology is one of the most interesting fields for deployment of artifical intelligence in medicine. It is shown that neural networks can compete with radiologists in analysing some imaging results, but their wider application is still in the early stages of development. Databases have an important role in development and implementation of artificial intelligence, therefore there is a need for systematic collection of radiological images and findings, which may allow for automatic analysis of neuroradiological images. That would make diagnosing and treating acute stroke, as well as other emergency conditions, faster

Advanced technologies in stroke prevention

Moždani udar predstavlja značajan javnozdravstveni problem, a kontrola promjenjivih čimbenika rizika je bitna komponenta u njegovoj prevenciji. The Stroke Riskometer App je aplikacija za pametne telefone koja služi za identifikaciju rizičnih čimbenika i procjenu rizika. Istraživanja su pokazala da je primjenom telemedicine i prijenosnih uređaja moguće postići bolju kontrolu pojedinih rizičnih čimbenika. Svrha ovog preglednog rada je istražiti i prezentirati suvremene individualizirane metode detekcije i kontrole čimbenika rizika koji su dostupni u obliku prijenosnih uređaja poput pametnih satova i telefona. Dodatno, telestroke mreža je dio telemedicine koji služi povezivanju manjih bolnica sa većim centrima putem interneta kako bi se povećala dostupnost specijalističke skrbi za pacijente te uštedjelo vrijeme kod zbrinjavanja akutnog moždanog udara. Ona omogućuje preciznu procjenu kliniĉke slike te obradu radioloških snimki od strane stručnjaka koji onda usmjeravaju terapiju i daljnje zbrinjavanje akutno bolesnog pacijenta. Radiologija je jedno od najzanimljivijih područja za primjenu umjetne inteligencije u medicini. Pokazalo se da neuronske mreže mogu parirati radiolozima u analizi pojedinih slikovnih podataka, no njihova šira primjena tek je u ranim fazama razvoja. Bitnu ulogu u razvoju i implementaciji umjetne inteligencije imaju baze podataka iz čega proizlazi potreba za sustavnim prikupljanjem radioloških slikovnih podataka te nalaza, što bi u konačnici moglo omogućiti automatsku analizu neuroradioloških podataka. Time bi se ubrzao proces dijagnostike i usmjeravanja terapije pri akutnom moždanom udaru, kao i u ostalim hitnim stanjima.Stroke represents a significant public health issue and control of modifiable risk factors is an important component in its prevention. The Stroke Riskometer App is a smartphone application used for identification of risk factors and risk assessment. Research has shown that it is possible to achieve a better risk factor control by using telemedicine and wearable devices. The purpose of this review is to investigate and present advanced individualised methods for risk factor detection and control, that are available in the form of wearable devices such as smart watches or phones. Furthermore, telestroke network is a part of telemedicine used to connect smaller hospitals and bigger centers via the internet to achieve higher coverage of expert care for patients as well as to save time while treating acute stroke. It allows for precise assessment of clinical presentation and expert review of radiological scans, thus helping to direct therapy and further treatment of acutely ill patient. Radiology is one of the most interesting fields for deployment of artifical intelligence in medicine. It is shown that neural networks can compete with radiologists in analysing some imaging results, but their wider application is still in the early stages of development. Databases have an important role in development and implementation of artificial intelligence, therefore there is a need for systematic collection of radiological images and findings, which may allow for automatic analysis of neuroradiological images. That would make diagnosing and treating acute stroke, as well as other emergency conditions, faster