INTRODUCTION: The subject of this study was the creation of a new type of laboratory walking stress test for the Special Forces of the Army of the Czech Republic. This study developed a test model that has been validated in practice and that reflects the fact that the performance of endurance without and with a load varies considerably. Especially, if we focus on operators, as their activities are always performed with loads/full gear (equipment, weapons, equipment, etc.). MATERIALS AND METHODS: 24 men/operators from the Special Forces of the Army of the Czech Republic volunteered for this study. The maximal exercise test/spiroergometry was designed to include performance at a load of 55 kg/121 lb, a constant speed of 5.3 km/h, and an increase in incline angle of 1 degree after each elapsed minute. The test was performed on a treadmill under standard time, location, and temperature conditions. During the test, the following values were recorded: VO2 = oxygen consumption indicating the intensity of the exercise was monitored, VO2/kg = oxygen consumption converted to body weight, VO2/HR = pulse oxygen (the amount of oxygen converted in one heartbeat), HR = heart rate, VE = ventilation, volume of air exhaled in 1 min, breathe frequency (BF) = respiratory rate in 1 min. RESULTS: Out of the total number of 24 respondents, the study found these mean values of variables. The variable mapping the oxygen consumption, which indicates the intensity of VO2 loading, was 3.8, with the lowest value being 3.2 and the highest being 4.5. After converting oxygen consumption to bodyweight, VO2/kg was 46, the lowest value of 38.8, and the highest 53.0 were measured for this variable. Pulse oxygen, i.e., the amount of oxygen calculated per heart contraction VO2/HR, was 20.5, the lowest value 16.0, and the highest 26.0. The average HR heart rate was 183.5, with the lowest value being recorded at 164 and the highest value is 205. Ventilation, i.e., the amount of exhaled air per minute in VE, was measured at 144.9, the lowest value was 114.7, and the highest was 176.6. The BF in 1 min was 58.5, the lowest value 35, and the highest 70. The mean time load was 10:20 min, the shortest test length was 7:25 min, and the longest was 13:23 min. These values correspond to the degree of inclination of the ascent, i.e., the mean value was 10 degrees, the smallest achieved slope was 7 degrees, and the largest 13 degrees. CONCLUSION: The designed weighted walking test proved to be fully functional and effective in measurement. The further established protocol corresponds to the requirements of the current needs of the Special Forces of the Army of the Czech Republic. Last but not least, the walking stress test is applied for the external and internal selection and screening of operators. Data obtained from testing were used to develop deployment requirements for patrol/nuclear combat missions.

• MeSH
• chůze MeSH
• cvičení * fyziologie   MeSH
• kyslík MeSH
• lidé MeSH
• spotřeba kyslíku * fyziologie   MeSH
• srdeční frekvence MeSH
• zátěžový test MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

INTRODUCTION: A deeper understanding of personality specifics in military personnel may increase the efficacy of health care professionals in this field. Changes in modern warfare require army officers to make decisions in complicated situations with increasing levels of autonomy. Character is traditionally regarded as a key quality in these dynamics. However, it remains unclear which character strengths are conducive to effective leadership in the military. The present study aims at mapping Czech Army cadets' and professional soldiers' perceptions of the character strengths of those officers, who they consider the best they served under. The study also examined how these perceptions vary across soldiers at different stages of their careers and how much they overlap with the same soldiers' ratings of their own strengths. In addition, a regression analysis, to outline combinations of strengths for various aspects of character-based leadership, was performed. MATERIALS AND METHODS: Respondents (N = 199) were recruited from three different subpopulations of the Czech Army-serving members of two reconnaissance units (N = 38), and 1st (N = 81) and 5th (N = 80) year cadets at the University of Defense. They rated the character strengths of chosen officers and themselves on the Character Strengths Leadership Inventory and the Values in Action Inventory of Strengths Revised. This study was approved by the units' commanding officer and the representatives of the University of Defense. RESULTS: Subordinates rated honesty, leadership, perspective, teamwork, fairness, creativity, love of learning, and zest highest in their chosen officers. These officers' mean profiles strongly correlated in all the three groups (rs = .82-.86). The mean correlation between officers' and respondents' self-reported strengths was not strong (rs = .18). Multiple regression models of the perception of an officer's success, success of their team, them as a leadership example, and them as having a good character, most frequently, involved fairness, honesty, kindness, and social intelligence, while forgiveness was negatively associated with these parameters. CONCLUSIONS: The present study achieved its aims. First, it suggests the officers' character strengths that tend to be most valued by their subordinates among Czech Army cadets and soldiers serving in reconnaissance units. Second, the strong overlap of best officers' character profiles in all groups suggests that this perception may remain stable throughout a soldier's career. Third, the relationship between chosen officers' and respondents' self-reported strengths was negligible, suggesting that the perception of officer's strengths may not be an individual's projection. Fourth, regression models of character-based leadership proposed a combination of character strengths that may contribute to the officer's perceived efficacy. Compared to other studies, the sample included both cadets and military professionals with a proportional number of females being included. These results imply that health care practitioners working with military clients may benefit from the acknowledgment of their specific character strengths, most notably honesty and fairness, while providing care to this population.

• MeSH
• charakter MeSH
• lidé MeSH
• ozbrojené síly * MeSH
• vedení války MeSH
• zpráva o sobě MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

The ongoing war in Ukraine presents unique challenges to prehospital medical care for wounded combatants and civilians. The purpose of this article is to identify, describe, and address gaps in prehospital care, casualty evacuation, and medical evacuation throughout Ukraine to share lessons for other providers. Observations and experiences of medical personnel were collected and analyzed, focusing on pain management, antibiotic use, patient assessment, mass casualty triage, blood loss, hypothermia, transport immobilization, and clinical governance. Gaps identified include limited access to pain management, lack of antibiotic guidance, inadequate patient assessment and triage, access to damage control resuscitation and blood, challenged transport immobilization practices, and challenges with clinical governance for both local and foreign providers. Improved prehospital care and casualty and medical evacuation in Ukraine are required, through increased use of empiric pain management, focused antibiotic guidance, enhanced patient assessment and triage in the form of training, access to prehospital blood, and better transport immobilization practices. A robust and active lessons learned program, trauma data capture, and quality improvement process is needed to reduce preventable morbidity and mortality in the war zone. The recommendations presented in this article serve as a starting point for improvements in prehospital care in Ukraine with potential to change prehospital training for the NATO alliance and other organizations operating in similar areas of conflict. Graphical Abstract.

• MeSH
• antibakteriální látky MeSH
• hromadné neštěstí * MeSH
• lidé MeSH
• resuscitace MeSH
• třídění pacientů MeSH
• urgentní zdravotnické služby * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Ukrajina MeSH

BACKGROUND: Nanofiber wound dressings remain the domain of in vitro studies. The purpose of our study was to verify the benefits of chitosan (CTS) and polylactide (PLA)-based nanofiber wound dressings on a porcine model of a naturally contaminated standardized wound and compare them with the conventional dressings, i.e., gauze and Inadine. MATERIAL AND METHODS: The study group included 32 pigs randomized into four homogeneous groups according to the wound dressing type. Standardized wounds were created on their backs, and wound dressings were regularly changed. We evaluated difficulty of handling individual dressing materials and macroscopic appearance of the wounds. Wound swabs were taken for bacteriological examination. Blood samples were obtained to determine blood count values and serum levels of acute phase proteins (serum amyloid A, C-reactive protein, and haptoglobin). The crucial point of the study was histological analysis. Microscopic evaluation was focused on the defect depth and tissue reactions, including formation of the fibrin exudate with neutrophil granulocytes, the layer of granulation and cellular connective tissue, and the reepithelialization. Statistical analysis was performed by using SPSS software. The analysis was based on the Kruskal-Wallis H test and Mann-Whitney U test followed by Bonferroni correction. Significance was set at P < .05. RESULTS: Macroscopic examination did not show any difference in wound healing among the groups. However, evaluation of histological findings demonstrated that PLA-based nanofiber dressing accelerated the proliferative (P = .025) and reepithelialization (P < .001) healing phases, while chitosan-based nanofiber dressing potentiated and accelerated the inflammatory phase (P = .006). No statistically significant changes were observed in the blood count or acute inflammatory phase proteins during the trial. Different dynamics were noted in serum amyloid A values in the group treated with PLA-based nanofiber dressing (P = .006). CONCLUSION: Based on the microscopic examination, we have documented a positive effect of nanofiber wound dressings on acceleration of individual phases of the healing process. Nanofiber wound dressings have a potential to become in future part of the common wound care practice.

• MeSH
• chitosan * farmakologie   terapeutické užití   MeSH
• hojení ran MeSH
• nanovlákna * terapeutické užití   MeSH
• obvazy MeSH
• prasata MeSH
• sérový amyloid A farmakologie   MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Hemobilia is a rare condition defined as bleeding in the biliary tract. The clinical presentation is variable. The typical manifestation consists of jaundice, upper gastrointestinal bleeding, and right upper quadrant abdominal pain. This set of symptoms is known as "Quincke's triad." It is present in only 22%-35% of cases. Post-traumatic hemobilia is an extraordinarily rare condition occurring in only 6% of the patients with hemobilia. In general, it occurs in less than 0.2% of patients with liver trauma. A delay in the development of bleeding after liver trauma is frequent. Early diagnosis is essential because massive bleeding into the biliary tract is a potentially life-threatening condition. We present a case of a patient with massive hemobilia developed 12 days after blunt abdominal trauma. Computed tomography angiography showed two pseudoaneurysms in hepatic segments V and VIII with contrast medium extravasation. We successfully performed digital subtraction angiography with selective transcatheter arterial embolization of the leaking segment VIII pseudoaneurysm. Embolization of the pseudoaneurysm in segment V was technically impracticable. Our article provides a review of the published literature focussing on the prevalence, diagnostics, and treatment of post-traumatic hemobilia.

• MeSH
• gastrointestinální krvácení MeSH
• hemobilie * etiologie   diagnóza   terapie   MeSH
• játra zranění   MeSH
• lidé MeSH
• nepravé aneurysma * MeSH
• tupá poranění * komplikace   MeSH
• žloutenka * etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

INTRODUCTION: The efficiency of front kick is related to the kicking technique. Thus, the aim of this study was to find the kinematic determinants of front kick dynamics across different performance and loading levels (no load to 45-kg load). MATERIALS AND METHODS: Twenty-four elite and sub-elite professional military personnel (26.8 ± 10.1 years, 84.2 ± 5.4 kg, 181.1 ± 6.4 cm) performed six front kicks into a force plate across five different loading conditions. Three-dimensional kinematics of the kicks was quantified and included velocity of the hip (Vhip), velocity of the knee (Vknee), velocity of the shoulder (Vshoulder), velocity of the foot (Vfoot), angular velocity of the knee (AVknee), and angular velocity of the hip (AVhip). RESULTS: The main kinematic differences between the two groups were that the sub-elite group had an increased kick time for all loading conditions (P < .001) and a lower Vfoot (P = .05) and a decreased Vhip and Vshoulder (P < .05) in the highest load condition. Vhip and AVhip were the best predictors (up to R2 = 0.58; P = .020) of peak force and impact force during no-load or loaded kicking at the elite level. Typical predictors of impulse in the elite group were AVhip, Vhip, and Vshoulder and those in the sub-elite group were AVknee and Vfoot. CONCLUSIONS: The kinematic variables provide good predictions of kicking dynamics; however, the best predictor varies with the loading conditions and performance levels. Hip motion is the main differentiating factor.

• MeSH
• biomechanika MeSH
• dolní končetina * MeSH
• kolenní kloub MeSH
• koleno * MeSH
• lidé MeSH
• noha (od hlezna dolů) MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION: Breastfeeding is a human biological norm that is widely acknowledged as the ideal form of nutrition for all infants. Human milk saves lives, improves long-term health for the both mother and infant, and significantly reduces health care-related costs. The American Academy of Pediatrics recommends exclusive breastfeeding for at least 6 months and thereafter to continue with breastfeeding, in addition to complimentary foods for at least 1 year or longer. The World Health Organization extends this recommendation to at least 2 years or beyond this age. MATERIALS AND METHODS: Multiple complex policies and directives would not be necessary if a federal law would entitle all new mothers to an adequate length of paid maternity leave and would protect parents during the time they personally care for their infants. Although a nationally mandated maternity leave is not available, the DoD should create a coherent global policy applicable to all active duty personnel across all branches of the U.S. Military. A global policy would govern positive change across all military branches and create consistent work conditions conducive for mothers to achieve their personal breastfeeding goals. In addition, a global policy would improve the military employees' health as well as maintain retention of military personnel. RESULTS: A comparison of the U.S. Armed Forces to the Czech Armed Forces shows that the individual breastfeeding policies and directives of the U.S. Military branches are certainly steps in the right direction to support breastfeeding military members. CONCLUSION: The well-documented evidence of long-term breastfeeding health benefits in addition to the economic benefits justifies such global military policy and would be a foundation to a national maternity leave policy, given that the USA is the only developed country without nationally mandated statutory entitlement to paid maternity leave.

• MeSH
• dítě MeSH
• kojenec MeSH
• kojení * MeSH
• lidé MeSH
• matky MeSH
• mzdy a přídavky MeSH
• ozbrojené síly * MeSH
• Světová zdravotnická organizace MeSH
• těhotenství MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION: Hypothermic ex-situ machine perfusion (MP) has been shown to be a promising alternative to static cold storage (SCS) for preservation of solid organs for transplantation and vascularized composite allotransplantation. Perfusion with blood-based perfusion solutions in austere environments is problematic due to their need for appropriate storage and short shelf life, making it impractical for military and emergency use. Acellular perfusion has been shown to be effective, but the ideal perfusate solution for MP of amputated limbs is yet to be determined. The purpose of this study is to evaluate the efficacy of alternative perfusate solutions, such as dextran-enriched Phoxilium, Steen, and Phoxilium in ex-vivo hypothermic MP of amputated limbs in a porcine model. MATERIALS AND METHODS: Amputated forelimbs from Yorkshire pigs (n = 8) were preserved either in SCS (n = 2) at 4°C for 12 hours or machine-perfused at 10°C for 12 hours with oxygenated perfusion solutions (n = 6) at a constant flow rate. The perfusates used include modified Steen-solution, Phoxilium (PHOX), or Phoxilium enriched with dextran-40 (PHODEX). The perfusate was exchanged after 1 and 6 hours of perfusion. Machine data were recorded continuously. Perfusate samples for clinical chemistry, blood gas analysis, and muscle biopsies were procured at specific timepoints and subsequently analyzed. In this semi in-vivo study, limb replantation has not been performed. RESULTS: After amputation, every limb was successfully transferred and connected to our perfusion device. The mean total ischemia time was 77.5 ± 5.24 minutes. The temperature of the perfusion solution was maintained at 10.18 ± 2.01°C, and perfusion pressure at 24.48 ± 10.72 mmHg. Limb weight increased by 3% in the SCS group, 36% in the PHODEX group, 25% in the Steen group, and 58% in the PHOX group after 12 hours. This increase was significant in the PHOX group compared with the SCS group. All perfusion groups showed a pressure increase of 10.99 mmHg over time due to edema. The levels of HIF-1a decreased over time in all groups except the Steen and the PHODEX group. The biomarkers of muscle injury in the perfusate samples, such as creatine kinase and lactate-dehydrogenase, showed a significant difference between groups, with highest values in the PHODEX group. No significant differences were found in the results of the blood gas analysis. CONCLUSION: With the exception of significantly higher levels of creatine kinase and lactate dehydrogenase, MP with dextran-enriched Phoxilium provides similar results as that of the commercially available perfusates such as Steen, without the need for cold storage, and at circa 5% of the cost of the Steen solution. Further large-scale replantation studies are necessary to evaluate the efficacy of dextran-enriched Phoxilium as an alternate perfusate solution.

• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Face transplantation was performed in a highly sensitized recipient with positive preoperative crossmatch and subsequent antibody-mediated rejection. The recipient was a 45-year-old female with extensive conventional reconstructions after chemical burns over the majority of the body. Residual quality of life and facial functions were poor. Levels of circulating anti-human leukocyte antigen (HLA) antibodies were high, and panel reactive antibody score was 98%. A potential donor was identified; however, with positive T and B cell flow crossmatches. The transplant team proceeded with face transplantation from this donor, under tailored immune suppression and with available salvage options. The operation was successful. Plasmapheresis and induction immune suppression (i.e., thymoglobulin followed by mycophenolate mofetil, tacrolimus, and steroids) were provided. Five days later, there was significant facial swelling, rising anti-HLA antibody titers, and unprecedented evidence of C4d deposits on skin. High doses of steroids and thymoglobulin were provided; however, rejection increased such that by day 19 it was diagnosed grade III in the BANFF scale. After stopping thymoglobulin because of serum sickness, combination therapy of plasmapheresis, eculizumab, bortezomib, and alemtuzumab was provided. HLA antibody levels decreased while swelling and redness improved. At 3 months, there were no longer signs of rejection on biopsy.

• Publikační typ
• časopisecké články MeSH