Abstract Background Safety of protamine administration after catheter ablation of atrial fibrillation (AF) using pulse-field system has not been previously described in a prospective randomized trial. Methods Consecutive patients with paroxysmal, persistent or long-standing persistent AF undergoing catheter ablation of AF using Farapulse system were randomly assigned in 1:1 ratio for protamine administration before sheaths removal. All vascular punctions were navigated using a direct ultrasound control. Right femoral vein was used for FaraDrive (16 F) sheath and left femoral vein for ICE (11 F) and decapolar diagnostic catheter (7 F). All sheaths were removed immediately at the end of procedure with subsequent local haemostasis with figure-of-eight suture. Primary endpoint was early and late access site complications. Secondary endpoints were significant bleeding, thromboembolic events and duration of hospital stay. Results 428 consecutive patients were enlisted into the study (213 in protamine group; 215 in control group). Baseline and procedural characteristics were similar between both groups. ACT before venous sheath removal was higher in patients not receiving protamine (330.1 ± 38.6 vs. 189.3 ± 44.7 seconds, P < 0.001). There were no significant differences in both primary and secondary endpoints between both groups: groin hematoma (5 vs 5; p = NS); there were no thromboembolic complications in both groups and no significant differences of hospital stay duration. Conclusion Protamine administration after atrial fibrillation ablation using Farapulse system is not necessary when using ultrasound navigated vascular access and haemostasis with figure of eight suture.

Abstract Background Simple, cheap wearables for long-term ECG monitoring with automatic analysis of all measurements using a bespoke artificial intelligence (AI) are scarce. Annotated single-lead ECG data from a chest-belt are missing. Methods We have developed a complex software environment to acquire raw ECG data from the Polar H10 chest-belt, and a bespoke, original AI to detect artifacts, QRS complexes and the presence of atrial fibrillation (AF) from chest-belt recordings. Original manually annotated ECG recordings from real patients from cardiology departments using the chest-belt and a public MIT-BIH database as reference were used for validation. Results QRS determination by AI (version Q4/23) in evaluating MIT-BIH database of ECG samples had a 97.67 % sensitivity and a 97.73 % positive predictive value. AF in MIT-BIH database was detected by AI with 90.31 % sensitivity and 92.09 % positive predictive value. To assess AI accuracy in ECG from a chest-belt, 150 consecutive measurements using Polar H10 chest-belt (215 hours of ECG recordings in total) from individual patients were included in the analysis. Patients were not limited in any physical activity during measurements. 7.15 % of the length of all recordings (15.4 hours) was assessed as noise by AI and excluded from the analysis. AF lasting longer than 30 seconds was present in 14 of 150 (9.3 %) manually evaluated recordings. QRS determination by AI in evaluating manually annotated chest-belt data had 99.76 % sensitivity and 99.74 % positive predictive value. AF in manually annotated chest-belt data was detected by AI with 92.86 % sensitivity and 100 % positive predictive value. Conclusion A chest-belt can be used to reliably detect QRS complexes and the presence of atrial fibrillation with high accuracy when using a bespoke artificial intelligence for the evaluation. Commonly available devices capable of long ECG measurements could be used for patient-empowered screening for important arrhythmias.Atrial fibrillation on chest-belt ECG

Abstract Background Atrial fibrillation (AF) and related atrial tachycardias (ATs) are common arrhythmias in patients with pulmonary hypertension (PH). They are currently assessed in a multicentre randomized trial investigating extensive radiofrequency catheter ablation of the arrhythmogenic substrate on top of selective ablation of clinical arrhythmia alone. Purpose Irrespective of the randomization scheme, we compared clinical and procedural characteristics in patients with AF versus those with right-sided ATs. Methods Out of 74 patients with combined post- and pre-capillary or isolated pre-capillary PH, two study subgroups were composed: AF group included 40 patients and AT group included 31 patients: 24 with typical atrial flutter (AFL) and 7 with other right-sided ATs (2 upper loop reentry ATs, 2 focal ATs from coronary sinus ostium, 1 focal AT from terminal crest, and 2 polymorphic ATs from high right atrium). Three patients with inducible AV nodal reentrant tachycardia were excluded from this analysis. Biatrial electroanatomic mapping was performed in all patients. The data are presented as medians (interquartile range) and compared by the Mann-Whitney U test. Results The clinical and procedural characteristics of AF and AT groups are shown in Table. Cycle length (CL) of both induced and spontaneous AFL was 302 (267; 324) ms. Non-CTI-dependent ATs had CL 425 (350; 480) ms. In patients with AF, the dominant CL was 183 (152; 221) and 191 (154; 210) ms in right and left atrial appendage, respectively. In the whole cohort, pulmonary vein isolation was done in 49 (66%), left atrial substrate ablated in 23 (31%), cavotricuspid isthmus block achieved in 46 (62%), superior vena cava isolation completed in 28 (39%), intercaval line ablated in 26 (36%), and right atrial substrate or focal activity ablated in 8 (11%) cases. The procedure was technically successful in 72 (97%) patients. Conclusion Patients with right-sided ATs had expectedly more dilated right atrium. This was not, however, associated with a higher prevalence of right atrial low-voltage areas. Left atrial electroanatomic remodelling in AF patients was concordant with that frequently observed in non-PH patients with AF. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic.

BACKGROUND Our study aimed to evaluate incidence and mortality trends for childhood and adolescent cancers in the period 1994-2016 in the Czech Republic. MATERIAL AND METHODS Data on childhood cancers, which are recorded in the Czech National Cancer Registry, were validated using a clinical database of childhood cancer patients and combined with data from the National Register of Hospitalised Patients and with data from death certificates. These validated data were used to establish cancer incidence. Data from death certificates were used to evaluate long-term trends in mortality. Incidence and mortality trends were assessed by the average annual percentage change. RESULTS The age-standardised incidence trend for childhood cancers (i.e. those diagnosed in patients aged 0-19 years) showed a statistically significant slight long-term increase in the number of new cases, +0.5% annually on average (p < 0.01), more specifically an increase of +0.6% in girls and a statistically insignificant decrease of 0.1% in boys. In children aged 0-14 years, other malignant epithelial neoplasms and malignant melanomas showed the largest statistically significant average annual increase in incidence (+4.9%; p < 0.01), followed by central nervous system neoplasms (+1.3%; p < 0.05). Lymphomas, by contrast, showed a statistically significant average annual decrease in incidence in children aged 0-14 years (2.1%; p < 0.01). In adolescents aged 15-19 years, other malignant epithelial neoplasms and malignant melanomas also showed a statistically significant average annual increase in incidence (+5.2%; p < 0.01), followed by central nervous system neoplasms (+1.5%; p < 0.05). Mortality trends showed a statistically significant long-term decrease: on average, 5.1% annually in children aged 0-14 years (p < 0.01), and 3.7% annually in adolescents aged 15-19 years (p < 0.01). CONCLUSION Available data make it possible to analyse long-term trends in childhood cancer incidence and mortality.

The purpose of this study is to summarize incidence and trends in the pediatric cancer burden in the Czech Republic over the period 1994-2014. The recently established Childhood Cancer Registry was combined with retrospective data from the Czech National Cancer Registry to analyze the annual patterns of incidence and long-term trends of pediatric cancer patients aged 0-14 years diagnosed between 1994 and 2014. Malignancies were classified according to the International Classification of Childhood Cancer. The distribution of incidence was stratified according to gender, age at diagnosis, type of cancer and geographic area. Annual age-standardized rates were adjusted using the world standard population. Changes over time were quantified as the average annual percentage change. This analysis comprised records of 5,605 children diagnosed with cancer within the period 1994-2014, annually 267 records on average; the overall age-standardized average annual incidence rate was 169 cases per million. Boys were affected more frequently than girls: the M/F crude incidence ratio was 1.2:1. The highest incidence rates were observed for ICCC groups I (27.8%), III (21.8%), II (12.4%) and IV (7.8%); other groups formed 30.2%. There are significant differences in the geographic distribution of incidence between regions. A borderline statistically significant increase (0.6%) in the overall average annual percentage change was detected between 1994 and 2014 (95% CI: 0.01 to 1.12; p = 0.05). This study provides reliable recent information on trends in the incidence of childhood cancers in the Czech Republic.

V lednu 2014 bylo v CR zahajeno adresne zvani obcanů do programů screeningu zhoubných nadorů. Cilem tohoto sděleni je popsat metodiku zavedeneho systemu a prvni výsledky projektu. Pozvanky zasilaji svým klientům zdravotni pojisťovny, projekt je koordinovan Ministerstvem zdravotnictvi CR ve spolupraci se zastupci dotcených odborných spolecnosti (gynekologie, gastroenterologie, gastrointestinalni onkologie, radiodiagnostika, prakticke lekařstvi), zastupců zdravotnich pojisťoven a dalsich odborniků. Zvani jsou obcane, kteři se těchto organizovaných programů casneho zachytu dlouhodobě neucastni. Od ledna do zaři 2014 bylo na screeningova vysetřeni pozvano vice než 1,6 milionu pojistěnců, nejvice do screeningu kolorektalniho karcinomu. Z obcanů pozvaných v prvnich třech měsicich adresneho zvani se v obdobi leden–cerven 2014 zapojilo 8,2 % do screeningu karcinomu hrdla děložniho, 12,6 % do screeningu karcinomu prsu a 14,2 % do screeningu kolorektalniho karcinomu. Prvni výsledky potvrzuji funkcnost zavedeneho systemu a potencial pro navýseni pokryti screeningem v nasledujicich letech.

Czech cancer screening programmes feature a comprehensive multimodal information system which covers all the levels of assessment needed - population-based monitoring (Czech National Cancer Registry), monitoring of results in the diagnostic databases of centres, as well as the quantification of coverage and outputs of primary care according to the administrative data of health care payers. A system of personalised invitations to cancer screening programmes was launched in 2014, based on a stand-alone component of the information system which makes it possible to identify eligible clients in health care payers databases. The system was fully standardised and uniformly implemented in all health insurance companies; its functionalities also involve both continuous and retrospective assessment of the results of personalised invitation. The legislative framework in force will have to be applied and implemented for a more comprehensive and integrated employment of all involved data sources, i.e. cancer registries, screening registries, and administrative data. The system must be able to analyse de-identified individual records on clients participation in screening programmes, and thus to ensure an adequate analysis of performance indicators in compliance with international recommendations.

Breast, colorectal and cervical cancer screening programmes make it possible to decrease the population mortality rates of these diseases. How-ever, complex standards of the quality of care must be introduced and followed in order to maintain a favourable ratio between the benefits and risks arising from population-wide screening programmes. Such programmes should be organized and population-based, ensuring that quality control is performed at all levels. This review introduces the system of quality control in the Czech cancer screening programmes, and provides specific examples of performance indicators that are usable and/ or being used in these programmes. Cancer screening programmes in the Czech Republic are equipped with a comprehensive information background which involves monitoring of the cancer burden in the population, monitoring of the screening process based on clinical data, and monitoring of the screening process based on administrative data. In particular, the specific performance indicators describe the success rate of take up of the target population, ability of the screening test to reveal (sensitivity) or to exclude (specificity) the screened condition, correct employment of subsequent diagnostic methods or treatment of detected cancers or precancerous lesions where applicable. In the Czech breast cancer screening programme, these indicators are routinely used in order to monitor the individual centres; in both colorectal and cervical cancer screening programmes, these indicators are used to monitor the entire programme, whereas the system of quality control for individual centres is under continuous development. A project of personalized invitations was launched in 2014, and its results are regularly evaluated in cooperation with the Czech National Reference Centre and the Ministry of Health of the Czech Republic.

In January 2014, a programme of personalised invitations was launched in the Czech Republic, with the objective of inviting insured persons to cancer screening programmes; namely breast cancer screening and cervical cancer screening in women, and colorectal cancer screening both in women and men. This programme aims at strengthening the current cancer prevention programmes, and to increase the currently inadequate participation of the target population in these programmes; therefore, personalised invitations are sent to citizens who have not participated in these programmes for several years and therefore at risk of developing a serious disease. The project is coordinated by the Czech Ministry of Health in cooperation with the expert medical societies involved (gynaecology, gastroenterology, gastrointestinal oncology, diagnostic radiology, general practice), representatives of health care payers, and other experts nominated by the Minister of Health. All health care payers invite their clients (insured persons) to preventive check-ups, covering all examinations needed. The project has been realised with the assistance of financial resources from EU funds. This article describes the methodology of personalised invitations which has been implemented nationwide, its data background, and the first results of the project in the first half of 2014, when almost 1.3 million Czech citizens were invited.

INTRODUCTION:Severe sepsis is still associated with significant morbidity and mortality, which is however different, as well as its management, depending on the region. What is the situation in the Czech Republic and what is the character of patients with severe sepsis is currently not known. The aim of the project is to describe the processes of care, outcome and characteristics of patients with severe sepsis admitted to the intensive care department of the Czech Republic.METHODS:This is a multicentre and observational project with retrospective enrollment of patients who meet the criteria for severe sepsis before or within 24 hours after admission to selected intensive care units (ICU EPOSS).RESULTS:394 patients were analyzed. Median age at admission was 66 (56- 76) years, males predominated (58.9%) and the median APACHE II score on admission was 25 (19- 32). Patients were predominantly medical (56.9%) and most were secondary admitted from other ICU (53.6%). Meeting the criteria of severe sepsis was most frequently within the period (± 4 hours) of admission the EPOSS ICU (77.6%). Median total fluid intake during the first 24 hours was 6,680 (4,840- 9,450) ml. Most patients required mechanical ventilation (58.4%). Compliance with the resuscitation bundle of severe sepsis in our group was very good and was associated with lower mortality of patients. Most frequently, the EPOSS ICU length of stay (LOS) was 7 (3- 15) days and median hospital LOS was 13 (8- 28) days. Hospital mortality in our cohort was 35.8%.CONCLUSION:Introducing the project, which in its first stage obtained valuable and internationally comparable data about patients with severe sepsis admitted to the involved ICU in the Czech Republic.

Everolimus is an oral mTOR kinase inhibitor approved for the treatment of patients with metastatic renal cell carcinoma (mRCC) progressing during or after treatment with vascular endothelial growth factor (VEGF)-targeted agents. Using the national RENIS clinical registry, we have retrospectively analysed outcomes of patients treated for mRCC with everolimus. A total of 78 patients were evaluable. Median progression-free survival from the start of everolimus therapy was 7 months (95% confidence interval 2-12 months). Partial response or stable disease was achieved in 69% of patients. Treatment toxicity was predictable and serious adverse events occurred in only 6% of patients the most common being respiratory toxicity. Everolimus therapy provides significant clinical benefit for heavily pretreated mRCC patients after failure of VEGF-targeted therapy.

Registr monoklonalnich gamapatii představuje spolu s programem CRAB dva hlavni soucasne projekty Ceske myelomove skupiny. Důvodem pro jeho vytvořeni byla snaha o zahajeni prospektivniho sledovani dat nemocných s monoklonalnimi gamapatiemi z regionu středni a východni Evropy s cilem sledovani jejich incidence, využivani a efektu jednotlivých lecebných modalit vcetně výskytu nežadoucich přihod a toxicity. Jde o ambiciozni projekt i ve světovem měřitku, který by měl do budoucna vest k dalsimu zlepseni pece o nemocne.

The Czech Ophthalmologic Society (member of the Czech Medical Society of Jan Evangelista Purkyne) in collaboration with the Institute of Biostatistics and Analysis of the Masaryk University in Brno established a nation-wide information system for the follow-up of the epidemiology and treatment of the exsudative age-related macular degeneration (ARMD). The project named AMADEUS is a multi-centric, non-invasive, observation prospective study with the aim to improve the patients' treatment and to unify the criteria for the follow-up of the ARMD in the real clinical practice in the Czech Republic. The basic instrument of the whole project is a clinical register collecting parametric data from 9 specialized centers. Especially the project monitors the photodynamic therapy with Verteporfyrine (Visudyne) and treatment by anti-VEGF agents, or Pegaptanib (Macugen) and Ranibizumab (Lucentis). The project's protocol is trying to collect representative data about ARMD diagnosis and treatment; during regularly controls, the efficacy and safety of the treatment are followed-up.The data collecting does not influence the treatment strategy or the availability of chosen treatment for the patient. Since October 2008 until the end of the year 2009, the registry collected complex information about more than 1402 newly treated ARMD patients; out of them, in 582 cases the one-year follow-up period was regularly terminated. The available data shows well-considered indication of drugs indications by the doctors; the treated patients fulfill the indications criteria set by the scientific society. According to the data from the registry, in some treating centers the application schedule is not followed-up in some drugs (especially Pegaptanib); there is the possibility to improve the treatment. All the clinical centers participating in the AMADEUS registry will continue in the data collecting, which after a longer period of time will facilitate further treatment optimization and eliminating of the established imperfections. Further information about the project may be found at the web site: www.amadeus.registry.cz.