V klinické praxi jsou používány dva přístupy k hodnocení acidobazického stavu organismu: tradiční (bicarbonate-centered), jenž je založen na Hendersonově-Hasselbalchově disociační rovnici kyseliny uhličité doplněné výpočtem aniontové mezery, a novější kvantitativní dle Stewarta-Fencla, který definuje tři nezávisle proměnné veličiny, jejichž změny určují pH. Jsou to: rozdíl mezi součtem nábojů nesených silnými kationty a silnými anionty plazmy (SID – strong ion difference: sníží-li se, vznikne acidóza a naopak), celková koncentrace slabých neprchavých kyselin ([Atot] – anorganický fosfát a albumin: sníží-li se, vznikne alkalóza a naopak) a pCO2. Dle tohoto přístupu jsou pH i hydrogenkarbonát tzv. závisle proměnné, jejichž koncentrace se mění tehdy a jen tehdy, když se změní nezávisle proměnné veličiny. Hlavní předností Stewartova-Fenclova přístupu je výpočet plazmatické koncentrace aniontů silných kyselin, které běžně nestanovujeme a na jejichž přítomnost usuzujeme při tradičním přístupu z aniontové mezery. Korekce hodnoty aniontové mezery na plazmatickou koncentraci albuminu zvyšuje její výpovědní hodnotu. Tato úprava přibližuje tradiční přístup k novějšímu Stewartovu-Fenclovu přístupu, který přesně vypočte množství silných aniontů tak, že aniontovou mezeru korigovanou na albumin dále upřesní podle plazmatické koncentrace fosfátů, kalcia a magnezia. To má význam zejména u kriticky nemocných v metabolickém rozvratu, kdy tradiční přístup vždy neodhalí přítomnost nestanovených aniontů silných kyselin. Posouzení rozdílu mezi sérovými koncentracemi natria a chloridů upozorní na poruchu acidobazické rovnováhy v důsledku odchylky SID.

Two approaches have been used in clinical evaluation the acid-base status: traditional (bicarbonate-centered) is based on the Henderson-Hasselbalch equation complemented by calculation of the anion gap, and more recent quantitative approach proposed by Stewart and Fencl. The latter method defines the three independent variables, which regulate pH. These include: the difference between the sum of charges carried by strong plasma cations and anions termed the strong ion difference – SID (decrease causes acidosis, and vice versa); the total concentration of the weak non-volatile acids − [Atot] (inorganic phosphate and albumin, decrease causes alkalosis and vice versa), and pCO2. According to this approach, pH and bicarbonate are dependent variables. Their concentrations change if and only if one or more independent variables are altered. The main advantage of the Stewart-Fencl approach is the calculation of the concentration of plasma acids, which are not routinely measured. In the traditional approach, their presence is inferred from the anion gap. The correction of the value of anion gap according to the serum albumin level increases the specificity. This correction brings traditional approach closer to the Stewart-Fencl method that precisely calculates unmeasured strong anions by further adjustment of the corrected anion gap according to the serum phosphate, calcium and magnesium levels. The precise calculation of unmeasured anions is important in critically ill patients with the metabolic breakdown, where the traditional approach may overlook the presence of unmeasured anions. Consideration of the sodium-chloride difference draws the attention to acid-base disturbance caused by change of the strong ion difference.

• Klíčová slova
• Stewartova-Fenclova teorie, silné anionty, hydrogenkarbonátový ion,
• MeSH
• acidobazická rovnováha fyziologie   MeSH
• acidóza diagnóza   MeSH
• anionty * MeSH
• biologické modely * MeSH
• chloridy krev   MeSH
• hydrogenuhličitany krev   MeSH
• ionty MeSH
• koncentrace vodíkových iontů MeSH
• lidé MeSH
• poruchy acidobazické rovnováhy * diagnóza   metabolismus   MeSH
• sérový albumin analýza   MeSH
• sodík krev   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

This study is focused on the issue of sport service validation in the fitness domain; it aims to propose a systematic procedure for evaluating the quality of services in the Czech fitness industry. Cross-cultural transfer and validation of the SERVQUAL method (Parasuraman, Zeithaml, Berry, 1988), which was originally validated for American customers, is discussed practically. The modified Czech version of the SERVQUAL questionnaire was the main tool of data collection in the market research of six fitness centers chosen randomly with a sum of 697 participants. Upon completion of data collection, the reliability of the model was repeatedly evaluated by means of SEM – Structural Equation Modelling. Based on the SEM results a hierarchical structured model was designed with a general factor and four factors corresponding to questionnaire subscales.

• Klíčová slova
• kvalita služeb, SERVQUAL, Fit Index,
• MeSH
• analýza latentních tříd * MeSH
• fitness centrum * organizace a řízení   MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• statistika jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• hodnotící studie MeSH
• práce podpořená grantem MeSH

• MeSH
• klinické lékařství MeSH
• peritoneální nádory terapie   MeSH
• týmová péče o pacienty MeSH
• Publikační typ
• monografie MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• vnitřní lékařství
• onkologie

OBJECTIVES: Democracy-based medicine is a combination of evidence-based medicine (systematic review), expert assessment, and worldwide voting by physicians to express their opinions and self-reported practice via the Internet. The authors applied democracy-based medicine to key trials in critical care medicine. DESIGN AND SETTING: A systematic review of literature followed by web-based voting on findings of a consensus conference. PARTICIPANTS: A total of 555 clinicians from 61 countries. INTERVENTIONS: The authors performed a systematic literature review (via searching MEDLINE/PubMed, Scopus, and Embase) and selected all multicenter randomized clinical trials in critical care that reported a significant effect on survival and were endorsed by expert clinicians. Then they solicited voting and self-reported practice on such evidence via an interactive Internet questionnaire. Relationships among trial sample size, design, and respondents' agreement were investigated. The gap between agreement and use/avoidance and the influence of country origin on physicians' approach to interventions also were investigated. MEASUREMENTS AND MAIN RESULTS: According to 24 multicenter randomized controlled trials, 15 interventions affecting mortality were identified. Wide variabilities in both the level of agreement and reported practice among different interventions and countries were found. Moreover, agreement and reported practice often did not coincide. Finally, a positive correlation among agreement, trial sample size, and number of included centers was found. On the contrary, trial design did not influence clinicians' agreement. CONCLUSIONS: Physicians' clinical practice and agreement with the literature vary among different interventions and countries. The role of these interventions in affecting survival should be further investigated to reduce both the gap between evidence and clinical practice and transnational differences.

• MeSH
• internacionalita * MeSH
• kritický stav MeSH
• lékaři MeSH
• lidé MeSH
• medicína založená na důkazech metody   MeSH
• mortalita v nemocnicích * MeSH
• multicentrické studie jako téma statistika a číselné údaje   MeSH
• péče o pacienty v kritickém stavu metody   MeSH
• randomizované kontrolované studie jako téma statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• konsensus - konference MeSH

• Klíčová slova
• funkce hazardu, FLIPI, Follicular Lymphoma International Prognostic Index, overfitting,
• MeSH
• algoritmy MeSH
• analýza přežití MeSH
• Bayesova věta MeSH
• faktory vyvracející (epidemiologie) MeSH
• folikulární lymfom * MeSH
• lidé MeSH
• logistické modely MeSH
• metody pro podporu rozhodování MeSH
• neuronové sítě MeSH
• odds ratio MeSH
• pravděpodobnost MeSH
• prognóza * MeSH
• statistické modely MeSH
• statistika jako téma MeSH
• support vector machine MeSH
• Check Tag
• lidé MeSH

Four species of legless anguid lizard genus Anguis have been currently recognized: A. fragilis from western and central Europe, A. colchica from eastern Europe and western Asia, A. graeca from southern Balkans, and A. cephallonica from the Peloponnese. Slow worms from the Italian Peninsula have been considered conspecific with A. fragilis, despite the fact that the region served as an important speciation center for European flora and fauna, and included some Pleistocene glacial refugia. We used mitochondrial and nuclear DNA sequences to investigate the systematic and phylogenetic position of the Italian slow-worm populations and morphological analyses to test for phenotypic differentiation from A. fragilis from other parts of Europe. Our phylogenetic analyses revealed that Italian slow worms form a distinct deeply differentiated mtDNA clade, which presumably diverged during or shortly after the basal radiation within the genus Anguis. In addition, the specimens assigned to this clade bear distinct haplotypes in nuclear PRLR gene and show morphological differentiation from A. fragilis. Based on the differentiation in all three independent markers, we propose to assign the Italian clade species level under the name Anguis veronensisPollini, 1818. The newly recognized species is distributed throughout the Italian Peninsula to the Southern Alps and south-eastern France. We hypothesize that the Tertiary Alpine orogeny with subsequent vicariance might have played a role in differentiation of this species. The current genetic variability was later presumably shaped in multiple glacial refugia within the Italian Peninsula, with the first splitting event separating populations from the region of the Dolomite Mountains.

• MeSH
• Bayesova věta MeSH
• biologická evoluce * MeSH
• buněčné jádro genetika   MeSH
• fylogeneze * MeSH
• genetická variace MeSH
• haplotypy MeSH
• ještěři anatomie a histologie   klasifikace   genetika   MeSH
• mitochondriální DNA genetika   MeSH
• pravděpodobnostní funkce MeSH
• sekvenční analýza DNA MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Itálie MeSH

• MeSH
• biometrie MeSH
• statistika jako téma MeSH

• Konspekt
• Statistika
• NLK Obory
• statistika, zdravotnická statistika
• management, organizace a řízení zdravotnictví

Height to crown base (HCB) of a tree is an important variable often included as a predictor in various forest models that serve as the fundamental tools for decision-making in forestry. We developed spatially explicit and spatially inexplicit mixed-effects HCB models using measurements from a total 19,404 trees of Norway spruce (Picea abies (L.) Karst.) and European beech (Fagus sylvatica L.) on the permanent sample plots that are located across the Czech Republic. Variables describing site quality, stand density or competition, and species mixing effects were included into the HCB model with use of dominant height (HDOM), basal area of trees larger in diameters than a subject tree (BAL- spatially inexplicit measure) or Hegyi's competition index (HCI-spatially explicit measure), and basal area proportion of a species of interest (BAPOR), respectively. The parameters describing sample plot-level random effects were included into the HCB model by applying the mixed-effects modelling approach. Among several functional forms evaluated, the logistic function was found most suited to our data. The HCB model for Norway spruce was tested against the data originated from different inventory designs, but model for European beech was tested using partitioned dataset (a part of the main dataset). The variance heteroscedasticity in the residuals was substantially reduced through inclusion of a power variance function into the HCB model. The results showed that spatially explicit model described significantly a larger part of the HCB variations [R2adj = 0.86 (spruce), 0.85 (beech)] than its spatially inexplicit counterpart [R2adj = 0.84 (spruce), 0.83 (beech)]. The HCB increased with increasing competitive interactions described by tree-centered competition measure: BAL or HCI, and species mixing effects described by BAPOR. A test of the mixed-effects HCB model with the random effects estimated using at least four trees per sample plot in the validation data confirmed that the model was precise enough for the prediction of HCB for a range of site quality, tree size, stand density, and stand structure. We therefore recommend measuring of HCB on four randomly selected trees of a species of interest on each sample plot for localizing the mixed-effects model and predicting HCB of the remaining trees on the plot. Growth simulations can be made from the data that lack the values for either crown ratio or HCB using the HCB models.

• MeSH
• biologické modely * MeSH
• buk (rod) růst a vývoj   MeSH
• smrk růst a vývoj   MeSH
• Publikační typ
• časopisecké články MeSH
• validační studie MeSH

BACKGROUND: Sutherland et al. recently published the Practical Guidelines for high-sensitivity detection of paroxysmal nocturnal hemoglobinuria (PNH) clones by flow cytometry (FCM), containing concise protocols for PNH testing. METHODS: Using this approach, we studied the intra- and interlaboratory variability observed in a multicenter study in which fresh blood samples containing three clinically relevant PNH clone sizes within the granulocytic, monocytic, and red blood cell (RBC) populations were shipped to each participating center. RESULTS: Coefficients of variation (CVs) for precision/reproducibility analysis ranged from 0.01%/0.02% to 0.48%/0.45% (big clone), from 0.69%/1.52% to 4.24%/5.80% (small-intermediate clone), from 1.47%/3.91% to 15.01% /17.83% (minor clone) for PNH white blood cells (WBCs) and from 0.24%/0.48% to 1.76%/1.83% (big clone), from 0.80%/1.14% to 2.39%/4.45% (small-intermediate clone), from 1.09%/3.36% to 10.54%/10.23% (minor clone) for PNH RBCs, respectively. Linear regression analysis showed excellent performance correlation between centers (r > 0.99), Wilcoxon rank test revealed no statistically significant differences for PNH granulocytes, monocytes, and RBCs (P > 0.05%), Bland-Altman analysis demonstrated good performance agreement for all target PNH clones (mean bias ranging from -1.47 to 0.71). CONCLUSION: Our results demonstrate very good intra- and interlaboratory performance characteristics for both precision and reproducibility analyses and excellent correlation and agreement between centers for all target PNH clone sizes. Our data confirm the reliability and robustness of the recently published Practical Guidelines approach for high sensitivity PNH testing by flow cytometry and suggest that such an approach represents an excellent basis for standardization of PNH testing by flow cytometry.

• MeSH
• antigeny CD59 krev   MeSH
• erytrocyty patologie   MeSH
• leukocyty patologie   MeSH
• lidé MeSH
• paroxysmální hemoglobinurie diagnóza   patologie   MeSH
• počet leukocytů MeSH
• průtoková cytometrie * MeSH
• referenční standardy * MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVES: The study sought to evaluate the relationship between procedural volume and outcomes with radial and femoral approach. BACKGROUND: RIVAL (RadIal Vs. femorAL) was a randomized trial of radial versus femoral access for coronary angiography/intervention (N = 7,021), which overall did not show a difference in primary outcome of death, myocardial infarction, stroke, or non-coronary artery bypass graft major bleeding. METHODS: In pre-specified subgroup analyses, the hazard ratios for the primary outcome were compared among centers divided by tertiles and among individual operators. A multivariable Cox proportional hazards model was used to determine the independent effect of center and operator volumes after adjusting for other variables. RESULTS: In high-volume radial centers, the primary outcome was reduced with radial versus femoral access (hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.28 to 0.87) but not in intermediate- (HR: 1.23; 95% CI: 0.88 to 1.72) or low-volume centers (HR: 0.83; 95% CI: 0.52 to 1.31; interaction p = 0.021). High-volume centers enrolled a higher proportion of ST-segment elevation myocardial infarction (STEMI). After adjustment for STEMI, the benefit of radial access persisted at high-volume radial centers. There was no difference in the primary outcome between radial and femoral access by operator volume: high-volume operators (HR: 0.79; 95% CI: 0.48 to 1.28), intermediate (HR: 0.87; 95% CI: 0.60 to 1.27), and low (HR: 1.10; 95% CI: 0.74 to 1.65; interaction p = 0.536). However, in a multivariable model, overall center volume and radial center volume were independently associated with the primary outcome but not femoral center volume (overall percutaneous coronary intervention volume HR: 0.92, 95% CI: 0.88 to 0.96; radial volume HR: 0.88, 95% CI: 0.80 to 0.97; and femoral volume HR: 1.00, 95% CI: 0.94 to 1.07; p = 0.98). CONCLUSIONS: Procedural volume and expertise are important, particularly for radial percutaneous coronary intervention. (A Trial of Trans-radial Versus Trans-femoral Percutaneous Coronary Intervention [PCI] Access Site Approach in Patients With Unstable Angina or Myocardial Infarction Managed With an Invasive Strategy [RIVAL]; NCT01014273).

• MeSH
• akutní koronární syndrom radiografie   chirurgie   MeSH
• arteria femoralis MeSH
• arteria radialis MeSH
• koronární angiografie metody   využití   MeSH
• koronární angioplastika metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• periferní katetrizace metody   využití   MeSH
• prognóza MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH