BACKGROUND: Modulation of the cardiac autonomic nervous system (ANS) is a promising adjuvant therapy in the treatment of atrial fibrillation (AF). In pre-clinical models, pulsed field (PF) energy has the advantage of selectively ablating the epicardial ganglionated plexi (GP) that govern the ANS. This study aims to demonstrate the feasibility and safety of epicardial ablation of the GPs with PF during cardiac surgery with a primary efficacy outcome of prolongation of the atrial effective refractory period (AERP). METHODS: In a single-arm, prospective analysis, patients with or without a history of AF underwent epicardial GP ablation with PF during coronary artery bypass grafting (CABG). AERP was determined immediately pre- and post- GP ablation to assess cardiac ANS function. Holter monitors were performed to determine rhythm status and heart rate variability (HRV) at baseline and at 1-month post-procedure. RESULTS: Of 24 patients, 23 (96%) received the full ablation protocol. No device-related adverse effects were noted. GP ablation resulted in a 20.7 ± 19.9% extension in AERP (P < 0.001). Post-operative AF was observed in 7 (29%) patients. Holter monitoring demonstrated an increase in mean heart rate (74.0 ± 8.7 vs. 80.6 ± 12.3, P = 0.01). There were no significant changes in HRV. There were no study-related complications. CONCLUSIONS: This study demonstrates the safety and feasibility of epicardial ablation of the GP using PF to modulate the ANS during cardiac surgery. Large, randomized analyses are necessary to determine whether epicardial PF ablation can offer a meaningful impact on the cardiac ANS and reduce AF. TRIAL REGISTRATION: Clinical trial registration: NCT04775264.

• MeSH
• Electrocardiography, Ambulatory MeSH
• Electroporation * methods   MeSH
• Atrial Fibrillation * surgery   MeSH
• Ganglia, Autonomic * surgery   MeSH
• Catheter Ablation * methods   MeSH
• Coronary Artery Bypass * methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Pericardium * surgery   innervation   MeSH
• Prospective Studies MeSH
• Aged MeSH
• Feasibility Studies MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Study MeSH

Východisko: Společnost všeobecného lékařství ČLS JEP periodicky monitoruje názory občanů na vybrané aspekty problematiky zdravotnictví a zdravého způsobu života. Tato publikace navazuje na předchozí výstupy průzkumů provedených v letech 2015 až 2024. Cíl a metody: Cílem výzkumu bylo zjistit, jaké jsou názory občanů na vybrané součásti práce všeobecných praktických lékařů (VPL) a na zdravotní systém a jejich úlohu v něm. K provedení reprezentativního sociologického výzkumu názorů občanů byla v ČR zvolena metoda řízeného rozhovoru tazatele s respondentem (face-to-face), realizovaná profesionální agenturou. Statistické zpracování dat bylo provedeno programem SASD 1.5.8 (Statistická analýza sociálních dat). Závěry výzkumu jsou reprezentativní pro občany ČR z hlediska jejich pohlaví, věku a regionu. Výsledky: Občané ČR jsou ve většině případů s péčí a časem, který jim věnuje v průběhu jejich návštěvy praktický lékař, spokojeni, negativní stanovisko zaujímá jen malá část (6,8 %) z nich. Největší spokojenost s péčí praktického lékaře a časem, který jim věnuje, se vrátila na úroveň let 2018–2020, tj. na úroveň před pandemií covid-19. Lze rovněž konstatovat, že občané ČR jsou s prací zdravotní sestry v ordinaci jejich praktického lékaře spokojeni, negativní stanovisko zaujímá též jen malá část (5,4 %) z nich. Občané vnímají týmové praxe pozitivně, i když (56,9 %) preferuje, aby je vždy ošetřoval jen „jejich“ praktický lékař, což lze zabezpečit v rámci objednávkového systému. V oblasti preventivní péče jsou stále v ČR významné rezervy a jen cca 50 % občanů na ní aktivně participuje. Silnou se ukazuje do budoucna kombinace aktivit VPL a vlastní motivace občanů na zlepšení zdraví. Prevenci jako významnou ke zlepšení svého zdraví hodnotí 80 % respondentů a 75,4 % respondentů by respektovalo rady na změnu životního stylu od VPL nebo lékaře specialisty v rámci preventivní péče. Jen necelá 1/3 (30,8 %) občanů míní, že zdravým životním stylem žije, téměř ½ (48,0 %) občanů se domnívá, že zdravým životním stylem žije občas. Občané se domnívají, že největším rizikem, které je ohrožuje, je nedostatek pohybu (27,0 %), dalších 23,7 % respondentů označilo jako největší riziko špatné stravování, 20,0 % občanů považuje za největší riziko stres na pracovišti a 19,8 % nedostatek spánku. Nejmenším rizikem je dle mínění dotázaných stres doma (označilo 9,5 % respondentů). Výsledky budou využity v rámci připravovaných plánovaných změn v preventivní péči u VPL v ČR.

Býma S, Javorská K, Halata D, Borský P. Citizens’ opinions on some aspects of the activities of general practitioners 2024 Background: The Czech Society of General Practitioners (CSPG) periodically monitors citizens’ opinions on selected aspects of healthcare and healthy lifestyle issues. This publication follows up on previous results of surveys conducted in 2015–2024. Aim and methods: The aim of the research was to find out what citizens’ opinions are on selected parts of the work of general practitioners (GPs) and on the healthcare system and their role in it. To conduct a representative sociological survey of citizens’ opinions in the Czech Republic, the method of controlled interview between the interviewer and the respondent (face-to-face), implemented by a professional agency, was chosen. Statistical data processing was performed using the SASD 1.5.8 program (Statistical Analysis of Social Data). The conclusions of the research are representative of citizens of the Czech Republic in terms of their gender, age and region. Results: Citizens of the Czech Republic are in most cases satisfied with the care and time that a general practitioner devotes to them during their visit, and only a small part (6.8%) of them have a negative opinion. The highest satisfaction with the care of a general practitioner and the time they devote to them has returned to the level of 2018–2020, i.e. to the level before the covid-19 pandemic. It can also be stated that citizens of the Czech Republic are satisfied with the work of a nurse in their general practitioner’s office, and only a small part (5.4%) of them also have a negative opinion. Citizens perceive team practices positively, although (56.9%) prefer that they are always treated only by“their” general practitioner, which can be ensured within the framework of an ordering system. There are still significant reserves in the Czech Republic in the area of preventive care and only about 50% of citizens actively participate in it. The combination of VPL activities and citizens’ own motivation to improve their health is proving to be strong in the future. 80% of respondents rate prevention as important for improving their health and 75.4% of respondents would respect advice on lifestyle changes from a VPL or a specialist doctor as part of preventive care. Just under 1/3 (30.8%) of citizens believe that they live a healthy lifestyle, almost ½ (48.0%) of citizens believe that they live a healthy lifestyle occasionally. Citizens believe that the greatest risk that threatens them is lack of exercise (27.0%), another 23.7% of respondents identified poor nutrition as the greatest risk, 20.0% of citizens consider stress at work to be the greatest risk, and 19.8% lack of sleep. According to the respondents, the least risk is stress at home (indicated by 9.5% of respondents). The results will be used within the framework of the planned changes in preventive care for primary health care in the Czech Republic.

AIMS: The aim of this study was to evaluate the association of serum neurofilament heavy chain (sNfH) and chitinase 3-like 1 (sCHI3L1) with treatment response and disease activity in multiple sclerosis (MS). METHODS: This single-center, prospective, observational cohort study was conducted at the MS Centre, University Hospital Ostrava, Czech Republic, from May 2020 to August 2023. sNfH and sCHI3L1 were determined using ELISA. A mixed-effects linear model with a log-transformed outcome variable was applied. RESULTS: We analyzed 459 samples from 57 people with MS. Patients were sampled an average of 8.05 times during 21.9 months of follow-up. Those experiencing a relapse at sampling had a sNfH concentration 50 % higher than those in remission (exp(β) 1.5, 95 % CI 1.15-1.96). A longer duration of treatment was associated with lower sNfH (exp(β) 0.95, 95 % CI 0.94-0.96). Patients switched from low- to high-efficacy disease-modifying therapies (DMTs) had higher sNfH than patients treated with low-efficacy DMTs only (exp(β) 1.95, 95 % CI 1.35-2.81). Higher sCHI3L1 was associated with older age (exp(β) 1.01, 95 % CI 1.00-1.02) and longer DMT use (exp(β) 1.01, 95 % CI 1.00-1.02). sCHI3L1 values were not associated with relapse at the time of sampling, renal function, sex, or type of DMT. CONCLUSION: In contrast to sCHI3L1, sNfH may be a potential biomarker for monitoring treatment response and confirming clinical relapse in MS. Further research is needed to determine the long-term dynamics of sNfH and develop related treatment strategies.

• MeSH
• Biomarkers * blood   MeSH
• Adult MeSH
• Outcome Assessment, Health Care MeSH
• Immunologic Factors administration & dosage   pharmacology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Neurofilament Proteins * blood   MeSH
• Prospective Studies MeSH
• Chitinase-3-Like Protein 1 * blood   MeSH
• Multiple Sclerosis blood   drug therapy   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH

BACKGROUND: During the COVID-19 pandemic, the majority of patients received ambulatory treatment, highlighting the importance of primary health care (PHC). However, there is limited knowledge regarding PHC workload in Europe during this period. The utilization of COVID-19 PHC indicators could facilitate the efficient monitoring and coordination of the pandemic response. The objective of this study is to describe PHC indicators for disease surveillance and monitoring of COVID-19's impact in Europe. METHODS: Descriptive, cross-sectional study employing data obtained through a semi-structured ad hoc questionnaire, which was collectively agreed upon by all participants. The study encompasses PHC settings in 31 European countries from March 2020 to August 2021. Key-informants from each country answered the questionnaire. Main outcome: the identification of any indicator used to describe PHC COVID-19 activity. RESULTS: Out of the 31 countries surveyed, data on PHC information were obtained from 14. The principal indicators were: total number of cases within PHC (Belarus, Cyprus, Italy, Romania and Spain), number of follow-up cases (Croatia, Cyprus, Finland, Spain and Turkey), GP's COVID-19 tests referrals (Poland), proportion of COVID-19 cases among respiratory illnesses consultations (Norway and France), sick leaves issued by GPs (Romania and Spain) and examination and complementary tests (Cyprus). All COVID-19 cases were attended in PHC in Belarus and Italy. CONCLUSIONS: The COVID-19 pandemic exposes a crucial deficiency in preparedness for infectious diseases in European health systems highlighting the inconsistent recording of indicators within PHC organizations. PHC standardized indicators and public data accessibility are urgently needed, conforming the foundation for an effective European-level health services response framework against future pandemics.

• MeSH
• COVID-19 * epidemiology   MeSH
• Humans MeSH
• Cost of Illness MeSH
• Pandemics MeSH
• Primary Health Care MeSH
• Cross-Sectional Studies MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Cyprus MeSH

To understand the environmental determinants of physical activity (PA), precise spatial localization is crucial. This cross-sectional study focuses on the spatiotemporal distribution of PA among Czech adolescents (n = 171) using Global Positioning System loggers and accelerometers. The results showed that adolescents spent most of their time in sedentary behavior, with 57.2% and 58.5% of monitored time at home and school, respectively. The park and playground had the lowest proportion of sedentary behavior but also the lowest amount of moderate to vigorous PA (MVPA). However, when considering the time spent in each domain, the highest proportion of MVPA was seen in publicly accessible playgrounds (13.3% of the time). Chi-square analysis showed that the relative distribution of different PA intensities did not differ across spatial domains. Based on these results, the authors propose 2 key strategies for increasing MVPA in adolescents: Increase the time spent in activity-supportive environments, such as parks and playgrounds, and design techniques to increase MVPA at home and school settings.

• MeSH
• Accelerometry * MeSH
• Residence Characteristics MeSH
• Adolescent Behavior psychology   MeSH
• Exercise * MeSH
• Transportation methods   MeSH
• Geographic Information Systems * MeSH
• Play and Playthings MeSH
• Humans MeSH
• Adolescent MeSH
• Cross-Sectional Studies MeSH
• Sedentary Behavior * MeSH
• Schools MeSH
• Parks, Recreational MeSH
• Environment Design MeSH
• Check Tag
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

Research on the external physical load on elite youth soccer players during the weekly training microcycle in competitive periods and official matches is limited. The aims of this study were twofold: a) investigate possible differences in external physical load (PL) across player positions in U17 elite youth soccer players during official matches; b) determine the weekly training to match physical load ratio (WTMLr) across player positions. The sample included 20 outfield players from an elite soccer academy (mean age 15.94 ± 0.25 years) playing in four positions: central defender (CD), full-back (FB), central midfielder (CM) and Striker (S). Data were collected during the spring in-season period for 17 official matches played in a 4-3-3 game format. Indicators of external physical load monitored were: total distance (TD); total distance in high-speed running (HSR; > 16.1 km.h-1); total distance in sprint running (SPR; > 21.6 km.h-1); and relative physical load intensity (%HSR). The WTMLr was calculated for TD, HSR, SPR and %HSR as the ratio of the average weekly sum of training PL to the average sum of PL in an official match for a given players' position. Collectively, the training intensity during a one-week microcycle (%HSR in WTMLr) achieved only 76 % of match demands. CD performed significantly lower in all measured indicators of external PL during the official match than all other positions (p < 0.05; g > 0.80) except for TD in S. S achieved significantly higher SPR during official matches compared to CD (p < 0.05; g > 0.80), CM, and FB (g > 0.80). In contrast, CD reported higher WTMLr (medium-large effect size) in HSR and SPR indicators than all other positions. CM performed significantly higher %HSR in WTMLr than S and FB (p < 0.05; g > 0.80). Results revealed insufficient training intensity relative to match demands and, at the same time, weekly training PL did not meet match demands (especially in HSR and SPR) for players across the different positions. Therefore, practitioners should select appropriate training methods (drills and games) to ensure sufficient training intensity (HSR and SR metrics) and consider using the WTMLr, which can be used to help optimise and individualise training PL for different player positions.

• MeSH
• Running * MeSH
• Soccer * MeSH
• Geographic Information Systems MeSH
• Humans MeSH
• Adolescent MeSH
• Seasons MeSH
• Check Tag
• Humans MeSH
• Adolescent MeSH
• Publication type
• Journal Article MeSH

OBJECTIVES: The provision of primary health care was not interrupted during the coronavirus disease 2019 (COVID-19) pandemic in Czechia, although the capacity and resources of providers changed. We examined how the pandemic affected individual general practices throughout 2017-2021, focusing on differences between urban and rural practices. METHODS: We analysed data from the largest health insurance company in Czechia, which provides care to 4.5 million people (60% of the population). We evaluated the prescription volume, diabetes care procedures, and faecal immunochemical test (FIT) in preventive care and new pandemic-related procedures (remote consultations, testing, and vaccinations). For the spatial distribution of practices, we adapted the Organisation for Economic Cooperation and Development typology. RESULTS: We observed minimal declines in 2020 in the rate of prescribing (-1.0%) and diabetes care (-5.1%), with a rapid resumption in 2021, but a substantial decline in FIT (-17.8% in 2020) with slow resumption. Remote consultations were used by 94% of all practices regardless of location, with testing and vaccinations more commonly performed by rural general practitioners (GPs). CONCLUSIONS: Primary care in Czechia rose to the challenge of the COVID-19 pandemic, as shown by the finding that the volume of healthcare services provided through primary care did not decrease across most of the monitored parameters. This study also confirmed that rural GPs provide more care in-house, both in terms of prescribing and procedures performed in their practices. Future studies will need to focus on preventive care, which the pandemic has dampened in GP practices in Czechia.

• MeSH
• Early Detection of Cancer * statistics & numerical data   MeSH
• COVID-19 * epidemiology   prevention & control   MeSH
• Diabetes Mellitus * epidemiology   MeSH
• Colorectal Neoplasms * diagnosis   epidemiology   MeSH
• Practice Patterns, Physicians' * statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Professional Practice Location statistics & numerical data   MeSH
• Pandemics prevention & control   MeSH
• General Practitioners statistics & numerical data   MeSH
• Primary Health Care MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

The placenta plays a critical role in maternal-fetal nutrient transport and fetal protection against drugs. Creating physiological in vitro models to study these processes is crucial, but technically challenging. This study introduces an efficient cell model that mimics the human placental barrier using co-cultures of primary trophoblasts and primary human umbilical vein endothelial cells (HUVEC) on a Transwell®-based system. Monolayer formation was examined over 7 days by determining transepithelial electrical resistance (TEER), permeability of Lucifer yellow (LY) and inulin, localization of transport proteins at the trophoblast membrane (immunofluorescence), and syncytialization markers (RT-qPCR/ELISA). We analysed diffusion-based (caffeine/antipyrine) and transport-based (leucine/Rhodamine-123) processes to study the transfer of physiologically relevant compounds. The latter relies on the adequate localization and function of the amino-acid transporter LAT1 and the drug transporter P-glycoprotein (P-gp) which were studied by immunofluorescence microscopy and application of respective inhibitors (2-Amino-2-norbornanecarboxylic acid (BCH) for LAT1; cyclosporine-A for P-gp). The formation of functional monolayer(s) was confirmed by increasing TEER values, low LY transfer rates, minimal inulin leakage, and appropriate expression/release of syncytialization markers. These results were supported by microscopic monitoring of monolayer formation. LAT1 was identified on the apical and basal sides of the trophoblast monolayer, while P-gp was apically localized. Transport assays confirmed the inhibition of LAT1 by BCH, reducing both intracellular leucine levels and leucine transport to the basal compartment. Inhibiting P-gp with cyclosporine-A increased intracellular Rhodamine-123 concentrations. Our in vitro model mimics key aspects of the human placental barrier. It represents a powerful tool to study nutrient and drug transport mechanisms across the placenta, assisting in evaluating safer pregnancy therapies.

• MeSH
• Models, Biological MeSH
• Biological Transport MeSH
• Human Umbilical Vein Endothelial Cells * metabolism   MeSH
• Inulin metabolism   MeSH
• Isoquinolines MeSH
• Coculture Techniques MeSH
• Leucine metabolism   MeSH
• Humans MeSH
• Maternal-Fetal Exchange * MeSH
• ATP Binding Cassette Transporter, Subfamily B, Member 1 metabolism   MeSH
• Placenta * metabolism   MeSH
• Rhodamine 123 metabolism   MeSH
• Pregnancy MeSH
• Trophoblasts * metabolism   MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Background: In elite soccer, many teams routinely use positional games (PGs) in their practice sessions, striving to simulate competition situations, although some debate exists about the application's usefulness. Objective: The main aim of this descriptive study was to compare the physical demands among three different formats of PGs within the competitive profile. Methods: A descriptive study was conducted with 19 Argentinian professional soccer players (age 23.7 ± 4.7 years, body mass 73.6 ± 7.0 kg, height 177.2 ± 5.6 cm). External load was monitored by GPS (Catapult) during typical practice sessions with PGs designs (7 vs. 7 + 1 Floater [F], 9 vs. 9 + 2F + 2 goalkeepers [GK], 10 vs. 10 + 1F + 2GK) and during 10 official matches. Data on total distance (TD), player-load (PL), HILR (distance covered at speed > 14.9 km/h per minute), HSSL (distance covered at speed > 19.9 km/h per minute), number of runs during HILR and HSSL, very high-intensity accelerations (> 3.5 m/s2; VHIA) and decelerations (< -3.5 m/s2; VHID) and maximal speed (MS) were measured. In addition, rates of perceived exertion (RPE) were also monitored. Results: The mean values of TD and PL were similar to those of match status in every format. With respect to HILR and HSSL, the average values were significantly lower than those obtained in matches for 7 vs. 7 + 1F and 9 vs. 9 + 2F + 2GK formats (p < .001). The MS was the other variable in the study that differed notably from the values obtained during matches in each format (p < .001). The VHIA values were significantly higher than matches in 7 vs. 7 + 1F, while VHID presented statistical differences in both formats, 7 vs. 7 + 1F and 10 vs. 10 + 1F + 2GK. Regarding RPE, 10 vs. 10 + 1F + 2GK was the only format without statistical difference in comparison with matches (p < .001). Conclusions: The findings suggest that smaller-sized PGs could be used to stimulate intensity in terms of acceleration/deceleration demands, whereas larger-sized PGs are the optimum format to reach a similar performance in a competitive situation.

• MeSH
• Adult MeSH
• Soccer * MeSH
• Humans MeSH
• Professionalism MeSH
• Athletes MeSH
• Sports MeSH
• Physical Fitness * MeSH
• Team Sports MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Clinical Study MeSH

The aim of this study was to examine the differences in the weekly training load between starters and non-starters classified based on the match starting line-up, with respect to the playing position and a training day. Notably, 31 young adult soccer players (age: 18.79 ± 1.04 years) competing in the 3rd Czech division were monitored across the season. The weekly training load was measured using a GPS system as follows: total distance covered (TD), high-speed running distance (HSR), sprint running distance (SR), and acceleration and deceleration distance (ACDC). We found higher values in three out of four observed variables (HSR, SR, and ACDC, excluding TD) for starters compared to non-starters (p < 0.05), with small to moderate effect sizes (d = 0.40-0.49). Differences were observed especially in players who were fullbacks, offensive midfielders, and forwards. Moreover, the largest differences were found in training prior to a match day for HSR, SR, and ACDC (p < 0.05). Non-starters experienced lower weekly external loads in offensive player positions, predominantly in high-intensity variables, which are essential for their physical performance. It seems that non-starters may experience potential under-loading in the training process. Coaches and practitioners should be aware of this potential risk and find an appropriate method to compensate for load discrepancies, particularly in terms of high-intensity activities.

• Publication type
• Journal Article MeSH