This diploma paper deals with the managed care in the world and in The Czech Republic. It focuses on forms of the managed care, weaker forms of this kind of financing health care - PPOs, POS, on accomplishments and negatives and it's compared with the other kind of financing. The situation is described in all insurence companies in Czech Republic especially in Česká průmyslová pojišťovna.

Lipopolysaccharides (LPS), major virulence determinants in Gram–negative bacteria, are responsible for many pathophysiological responses and can elicit strong immune responses. In order to better understand the role of LPS in host–pathogen interactions and elucidate the immunogenic properties of LPS outer core oligosaccharide, an all α–linked Escherichia coli R3 outer core pentasaccharide was first synthesized with a propyl amino linker at the reducing end. This oligosaccharide was also covalently conjugated to a carrier protein (CRM197) via the reducing end propyl amino linker. An immunological analysis demonstrated that this glycoconjugate can elicit specific anti-pentasaccharide antibodies with in vitro bactericidal activity. These findings will contribute to further exploring this pentasaccharide antigen as a vaccine candidate. Human milk oligosaccharides (HMOs) are a family of diverse unconjugated glycans that exist in human milk as one of the major components. Characterization, quantification and biofunctional studies of HMOs remain a big challenge due to their diversity and complexity. The accessibility of homogenous HMOs library is essential to solve these issues which have beset academia for several decades. In this study, an efficient chemoenzymatic strategy, namely Core Synthesis/Enzymatic Extension (CSEE), for rapid production of diverse HMOs was reported. Based on 3 versatile building blocks and 4 robust glycosyltransferases, a library of 31 HMOs were chemoenzymatically synthesized and characterized by MS and NMR. CSEE indeed provides a practical approach to harvest structurally defined HMOs for various applications. Glycoproteins are extremely important for all life on the planet. Glycoproteins play important roles in various biological processes. Increasing evidences demonstrate that glycosylation of proteins could improve stability of proteins by stabilizing their tertiary structure and protecting them from proteolysis. Besides, glycosylation of proteins could provide targeting effects through glycan-lectin interaction. Furthermore, carbohydrates play crucial roles in humoral immunity in that many sugar epitopes are identified as antigens for antibodies. Glycoprotein could boost strong T cells mediated intercellular immune responses because homogeneous antigens present on the surface of proteins by multivalent bonds. In this study, the three advantages of glycoproteins, namely stabilizing proteins, targeting effects and eliciting immunological response, were extensively explored by broad collaboration with other groups.

Background: Humanmilk oligosaccharides (HMOs) support and concurrently shape the neonatal immune system through various mechanisms. Thereby, they may contribute to lower incidence of infections in infants. However, there is limited evidence on the role of individual HMOs in the risk of otitis media (OM), as well as lower and upper respiratory tract infections (LRTI and URTI, respectively) in children up to 2 years. Objective: To investigate whether individual HMO concentrations measured at 6 weeks of lactation were associated with risk of OM, LRTI or URTI up to 2 years in breastfed infants. Associations with OM, LRTI and URTI were determined for the most prominent human milk oligosaccharides including 13 neutral, partly isomeric structures (trioses up to hexaoses), two acidic trioses, and lactose. Design: HMO measurements and physician reported data on infections were available from human milk samples collected at 6 weeks postpartum (n = 667). Associations of HMOs with infections were assessed in crude and adjusted models using modified Poisson regression. Results: Absolute concentrations (median [min, max], in g/L) of 2′-fucosyllactose (2′-FL) tended (p = 0.04) to be lower, while lacto-N-tetraose (LNT) was higher in the milk for infants with OM in the 1st year of life (p = 0.0046). In the milk of secretor mothers, LNT was significantly higher in the milk for infants with OM (RR [95% CI]: 0.98 [0.15, 2.60]) compared to infants without OM (RR [95% CI]: 0.76 [0.14, 2.90]) at 1 year (p = 0.0019). No statistically significant milk group differences and associations were observed for OM, LRTI, and URTI (p > 0.0031). Conclusion: Our findings suggest that neither prominent neutral individual HMOs (ranging from 2′-FL to LNDFHs) nor acidic human milk sialyllactoses or lactose are significantly associated with a reduced or increased risk of infections in infants up to 2 years of age. Further research is needed to determine whether specific HMOs could potentially reduce the incidence or alleviate the course of distinct infections in early life.