Centrálna bolest je termín, ktorým sa oznacuje bolest zaprícinená primárnou léziou alebo dysfunkciou centrálneho nervového systému a patrí do skupiny neuropatických bolestí. V praxi býva casto prehliadnutá, hlavne v prípade koexistencie viacerých druhov bolesti. Casto býva tiež považovaná za bolest psychogénnu. Centrálnu bolest môžu zaprícinit všetky ochorenia mozgu a miechy. Najcastejšie sa vyskytuje u pacientov po cievnych mozgových príhodách, poškodení miechy a sclerosis multiplex. V tendencii vyvolat centrálnu bolest nie je dôležitá štruktúra ci rozsah lézie, ale jej lokalizácia. Objaví sa rovnako po léziách vznikajúcich náhle i vyvíjajúcich sa pomaly. Jej patogenéza je nejasná. Viacero teóorií je založených na princípe deaferentácie, abnormálnej hypersenzitivity poškodených vlákien a zmien v neurotransmisii. Možným mechanizmom je disociovaná porucha citlivosti. Centrálna bolest vzniká po urcitom casovom odstupe od vzniku lézie. Kvalita bolesti pocitovaná pacientom je rozmanitá. Najcastejšie ide o pálivú, pichavú, ci tlakovú bolest, ale rozsah pocitovaných kvalít bolesti je velký. Charakteristickou crtou je prítomnost viac ako jednej kvality bolesti u jedného pacienta. Intenzita bolesti je konštantná alebo menlivá. Zmeny sa objavujú spontánne alebo vplyvom vonkajších a vnútorných faktorov, ako sú kožné a viscerálne stimuly, pohyb tela, emócie a zmeny nálady. Centrálna bolest býva asociovaná s poruchami citlivosti, a to najmä termickej a algickej. Prakticky u všetkých pacientov s centrálnou bolestou sú prítomné somatosenzorické abnormity. Najcastejšie sa vyskytuje hyperalgézia, allodýnia a dyzestézia. Ostatné neurologické symptómy (poruchy hybnosti, koordinácie, zraku, sluchu, vestibulárnych a vyšších kortikálnych funkcií) môžu, ale nemusia byt prítomné. Liecba centrálnej bolesti je problematická, prognóza je zlá, úspechom je zmiernenie bolestí.

Central pain is a term used to describe pain initiated or caused by a primary lesion or dysfunction in the central nervous system and can be included under the broad term of „neuropatic pain“. It has often been overlooked, if several coexisting pains of an anusual nature exist. Not infrequently has central pain been thought to be of psychogenic origin. Almost any kind of lesion in the brain or spinal cord can cause central pain. The largest groups of patients are those with cerebrovascular lesions, multiple sclerosis and spinal cord injury. It seems probable that for the risk of causing central pain is not important the structure or size of the lesion, but the localisation of the lesion. Central pain develops both after rapidly developing lesions, as well as with slowly developing ones. There does not exist any consensus regarding the patogenesis of central pain. Several theories are based on the concept of deafferentation, abnormal hypersenzitivity of damaged fibers, generation of new receptors, and alterations in the central pattern of impulses. Possible underlying mechanism is dissociated sensory loss. Central pain frequently develops at an interval of weeks or months after the occurrence of the lesion. There is a great variation among central pain patients in the quality of pain. The most common are burning, aching and pressing, but the list of qualities described by patients is long. Almost all patients experience more than one pain qualities. Intensity of central pain ranges from low to extremely high is constant or may vary. These variations seems to occur spontaneously or under the influence of external and internal events, such as cutaneous and visceral stimuli, body movements, emotions and changes in mood. Central pain is associated with changes in sensibility to the temperature and pain. A wide spectrum of sensory abnormalities is found among patients with central pain. The most frequent are hyperesthesia, hyperalgesia and allodynia. The presence of other neurological symptoms (abnormalities in muscle function, coordination, vision, hearing, vestibular and higher cortical functions) have a great variations.

• MeSH
• bolest epidemiologie   farmakoterapie   patofyziologie   MeSH
• centrální nervový systém patofyziologie   patologie   MeSH
• poranění mozku MeSH
• senzorické prahy MeSH
• tractus spinothalamicus patofyziologie   MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• centrální generátory rytmu fyziologie   MeSH
• interneurony * fyziologie   MeSH
• konektom MeSH
• lidé MeSH
• Check Tag
• lidé MeSH

BACKGROUND: Bacterial resistance is considered a consequence of misuse or overuse of antibiotics. Dentistry significantly contributes to this increasing public health problem. The aim of this cross-sectional study was to examine the pattern of antibiotics prescribed by Croatian dentists in Zagreb area. METHODS: Out of 220 Doctors of Dental Medicine (DMDs) from Zagreb 110 responded to survey. Prior to the research an ethical approval was obtained. Participants were directly contacted. The questionnaire consisted of two parts: general data on DMDs and the part concerning indications, duration, type and dosage of antibiotic therapy. Data were processed using MS Excel and SPSS for Windows, Version 17.0. Statistical significance was tested by Fisher's exact test, chi-square test, Mann-Whitney U test and Spearman's rank correlation at the level of statistical significance p<0.05. RESULTS: During the period of two months, the doctors prescribed antibiotics to 1,500 patients, 690 (46%) were men and 810 (54%) women. The most often prescribed antibiotics were penicillin (72.5% of patients), represented mostly by amoxicillin in combination with clavulanic acid (57.6%). The most common indication for the prescribed antibiotics was periapical or periodontal abscess (44%). Definite clinical indication (71.2%) was stated as the most common reason for antibiotic prescription. Antibiotic therapy usually lasted 7 days (62.9%). The doctors prescribed daily doses of antibiotics according to the instructions for the use of specific drugs. CONCLUSION: The examined subjects prescribe antibiotics according to the curriculum taught at the School of Dental Medicine for majority of types, doses and duration of the treatments, although antibiotics over-prescription in cases without medical indication was observed. The national guidelines on antibiotic regimens are required in order to reduce unnecessary antibiotic use.

• MeSH
• antibakteriální látky aplikace a dávkování   terapeutické užití   MeSH
• bakteriální léková rezistence MeSH
• lidé středního věku MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• vzorové postupy ve stomatologii statistika a číselné údaje   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Chorvatsko MeSH

Background The aim of this project was to collect real-world evidence and describe treatment patterns for stage III non-small cell lung cancer in Central and Eastern Europe. Based on real-world evidence, an expert opinion was developed, and the unmet needs and quality indicators were identified. Patients and methods A systematic literature search and a multidisciplinary expert panel of 10 physicians from 7 countries used a modified Delphi process to identify quality indicators and unmet needs in patients with stage III non-small cell lung cancer. The profound questionnaire was used to characterize treatment patterns used for stage III non-small cell lung cancer, and a systematic review identified patterns in Central and Eastern Europe. The first questionnaire was completed by a group of medical oncologists, radiation oncologists and pneumologists. The panel of experts attended an in-person meeting to review the results of the questionnaire and to process a second round Delphi. An additional survey was then compiled and completed by the panel. Results A complete consensus was reached by the panel of experts on a set of evidence-based clinical recommendations. The experience-based questionnaire generated a highly variable map of treatment patterns within the region. A list of unmet needs and barriers to quality care were developed with near-unanimous consent of the panel of experts. Conclusions The current landscape of diagnostic and therapeutic approaches in Central and Eastern European countries is highly variable. We identified several significant barriers, mainly related to the availability of diagnostic and imaging methods and low rates of chemoradiotherapy with curative intention as initial treatment for unresectable stage III NSCLC.

• MeSH
• delfská metoda MeSH
• dospělí MeSH
• konsensus MeSH
• lékařská praxe - způsoby provádění statistika a číselné údaje   MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• nádory plic epidemiologie   patologie   terapie   MeSH
• nemalobuněčný karcinom plic epidemiologie   patologie   terapie   MeSH
• průzkumy a dotazníky MeSH
• staging nádorů MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH
• východní Evropa MeSH

Robotická rehabilitace chůze, která náleží mezi pokročilé rehabilitační technologie, původně vznikla jako modifikace terapie chůze na běžícím pásu při odlehčení v závěsném systému. V současnosti je k dispozici řada systémů pracujících na základě různých principů vč. mobilních asistivních exoskeletů. Neurofyziologický podklad této terapie je založen na míšní autonomii (centrální generátory vzorů), plasticitě centrálního nervového systému a motorickém učení. Z hlediska medicíny založené na důkazech je přínos této terapie zatím nejasný. Jednoznačným kladem je ulehčení fyzické práce terapeuta. Indikace proto musí vycházet z racionální úvahy.

Robotic gait therapy, one of advanced rehabilitation technologies, original­ly evolved as a modification of the body weight-supported treadmill therapy. At present, a range of various systems based on dif­ferent principles is available, includ­ing mobile as­sistive exoskeletons. Neurophysiological es­sence of this therapy is based on the spinal cord autonomy (central pattern generators), plasticity of the central nervous system and motor learning. With respect to the evidence-based medicine, benefits of this therapy are still unclear; unambiguously positive is the reduced physical burden on a therapist. Indications must, therefore, be based on a rational consideration. Key words: robotics – central pattern generators – plasticity – motor learning The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.

• Klíčová slova
• centrální generátory vzorů, motorické učení, terapie chůze na běžícím pásu při odlehčení v závěsném systému, BWST, Body--Weight Supported Treadmill Therapy,
• MeSH
• centrální generátory rytmu MeSH
• cévní mozková příhoda MeSH
• chůze (způsob) * MeSH
• chůze fyziologie   MeSH
• design vybavení MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• neuroplasticita MeSH
• obnova funkce MeSH
• poranění míchy rehabilitace   MeSH
• rehabilitace po cévní mozkové příhodě MeSH
• rehabilitace metody   přístrojové vybavení   MeSH
• robotika * MeSH
• techniky fyzikální terapie * MeSH
• tělesná hmotnost MeSH
• terapie cvičením metody   pracovní síly   MeSH
• terminologie jako téma MeSH
• učení MeSH
• zatížení muskuloskeletálního systému MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• centrální nervový systém patologie   cytologie   MeSH
• nádory mozku patologie   klasifikace   MeSH
• nádory nervové tkáně diagnóza   MeSH
• nádory podle histologického typu MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• neurologie
• onkologie
• patologie
• NLK Publikační typ
• publikace WHO

The pacemaker (PCM) timing is a basic feature of the stimulation system. The device tries to bring the function of the heart with the conduction system disorder as close as possible to its original physiologically correct state. The main function of the PCM is a bradyarrhythmia therapy. Current devices are programmable and can adequately respond to any fluctuations in a heart rate from required values. Common parts of these devices are algorithms for the atrial tachycardias detection such as atrial fibrillation. The interpretation of a fast heart rate is affected by the pacemaker timing and different refractory intervals, especially in the case of tachycardias of lower frequencies. In this paper we discuss the effect of different atrial event frequencies to the adequate PCM response according to the timing behavior of the device. We prove our hypotheses by an experimental verification on the phantom of the pacemaker system by the in vitro method. The obtained results are compared with the case report from clinical practice. We set limit intervals for the detection of atrial tachycardias and verify the rate of the activation of the PCM program response for different frequencies. Finally, we discuss the behavior of cardiac implantable electronic devices (CIEDs) during the detection of signals of higher frequencies.

• MeSH
• biomedicínské technologie metody   MeSH
• biomedicínský výzkum MeSH
• centrální generátory rytmu anatomie a histologie   MeSH
• elektrofyziologické techniky kardiologické metody   přístrojové vybavení   MeSH
• kardiostimulace umělá metody   MeSH
• síňová ektopická tachykardie diagnostické zobrazování   prevence a kontrola   MeSH
• srdce patofyziologie   MeSH
• tachykardie * diagnostické zobrazování   prevence a kontrola   MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

OBJECTIVE: To evaluate the prevalence of spoke-wheel pattern and typical symptoms of focal nodular hyperplasia (FNH) by means of dynamic contrast-enhanced ultrasonography (CEUS) in relation to lesion size. METHODS: Twenty-eight patients were included in the trial, in whom, based on the CEUS, we raised suspicion of hypervascularized liver lesion; there were 30 lesions altogether. The final diagnosis of FNH was verified by means of CT, MRI or lesion biopsy. Majority of patients (26) were females, compared to 2 male, with average age of 33.3 years. Average lesion size was 45.6 mm. Besides the ultrasound examination, we used also "blood pool" ultrasound contrast agent of second generation, sulphur hexafluoride (BR1); we evaluated enhancement of the lesion until the late stage-within 5 min from application. RESULTS: In lesions larger than 3 cm (n=20), stellate vascular enhancement was found in 19 cases (95.0%) early in arterial phase. As for lesions smaller than 3 cm (n=10), spoke-wheel pattern was observed only in 3 cases (30%) and lesions smaller than 2 cm practically did not show this phenomenon at all (n=1; 17%). Generally, symptom of spoke-wheel pattern was observed in 22 cases, i.e. in 73.3%. In total, central scar was present in 63.3% (n=19) of cases. In lesions larger than 3 cm, it was present in 85.0% (n=17), in lesions smaller than 3 cm in 20% (n=2). CONCLUSION: Contrast-enhanced ultrasonography can be the final diagnostic method for FNH larger than 3 cm which has typical spoke-wheel vessel structure on CEUS. If this phenomenon is not present and the central scar is not visible, specific diagnosis of FNH cannot be based solely on CEUS findings.

• MeSH
• arterie ultrasonografie   MeSH
• dospělí MeSH
• endosonografie metody   MeSH
• fluorid sírový diagnostické užití   MeSH
• fokální nodulární hyperplazie ultrasonografie   MeSH
• játra ultrasonografie   MeSH
• kontrastní látky MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrobubliny MeSH
• mladiství MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

OBJECTIVES: The aim of the present study was to evaluate morphological MRI findings in histologically-proven central nervous system lymphoma (CNSL) at time of their first appearance, and to describe dynamic changes on repeat MRI before the diagnosis was histologically proven. METHODS: We retrospectively evaluated the MRI examinations of 74 patients with histologically-proven CNSL (10 secondary CNSL, 64 primary PCNSL; 10 immunocompromised, 54 immunocompetent). In 43 patients, we evaluated the evolution of CNSL on MRI before the diagnosis was proven. RESULTS: Primary CNSL was typically localized supratentorially (63%), with multiple (59%) or infiltrative (36%) lesions showing diffusion restriction (98%), often (87%) reaching the brain surface. In approximately 50% of patients, meningeal, ependymal or cranial nerve involvement was found. We detected significant differences in enhancement patterns between immunocompromised and immunocompetent patients; non-homogenous enhancement present in 50% of immunocompromised patients. We did not find any significant differences in MRI appearance between primary and secondary CNSL. Regression was evident after corticosteroid treatment in 52% of patients; however, in 16% of cases overall progression was observed. CONCLUSION: CNSL generally presents as an infiltrative lesion or multiple homogenously-enhancing lesions of the brain in contact with the brain surface. Involvement of the corpus callosum, cranial nerves, ependyma or meninges is common. No significant differences between primary and secondary CNSL were detected, however differences in enhancement type between immunocompromised and immunocompetent primary CNSL patients were found. We stress the variability of MRI findings in the course of the disease and also the variable response to corticotherapy.

• MeSH
• difuzní magnetická rezonance MeSH
• difúzní velkobuněčný B-lymfom diagnostické zobrazování   farmakoterapie   imunologie   MeSH
• dospělí MeSH
• hormony kůry nadledvin terapeutické užití   MeSH
• imunokompetence imunologie   MeSH
• imunokompromitovaný pacient imunologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfom diagnostické zobrazování   farmakoterapie   imunologie   MeSH
• magnetická rezonanční tomografie MeSH
• mladý dospělý MeSH
• nádory centrálního nervového systému diagnostické zobrazování   farmakoterapie   imunologie   MeSH
• nádory mozku diagnostické zobrazování   farmakoterapie   imunologie   MeSH
• progrese nemoci MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH