In einer prospektiven, randomisierten, doppelblinden, Placebo-kontrollierten Cross-over-Studie wurden hämodynamische und immunologische Effekte einer dreitägigen adjunktiven Therapie mit niedrig dosiertem Hydrocortison (HC) (100 mg Bolus + 10 mg/Stunde) bei 40 Patienten im septischen Schock untersucht. Die Therapie mit HC führte zum Anstieg des mittleren arteriellen Drucks und des systemischen Gefäßwiderstands sowie zur Reduktion des Herzzeitvolumens und der Herzfrequenz, die pulmonalvaskulären Widerstände blieben unverändert. Die Nitrit/Nitrat-Plasmaspiegel (Stickstoffmonoxid-Synthese) und der Katecholaminverbrauch nahmen ab. Die Immunreaktionen waren komplex: Abnahme proinflammatorischer (Interleukin-(IL)-6, 8) und antiinflammatorischer (IL-10, lösliche Tumor-Nekrosefaktor-Rezeptoren) Mediatoren, Anstieg proinflammatorischer Zytokine (IL-12 und Interferon-?), Reduktion der Endothel- (E-Selektin) und Granulozytenaktivierung (CD11b, CD64), Reduktion der T-Helfer- und Suppressorzellzahl und der eosinophilen und basophilen Granulozyen, die Monozytenzahl stieg an und die neutrophilen Granulozyten sowie die Gesamtleukozytenzahl blieben unverändert. Parameter der unspezifischen (Respiratory Burst, Phagozytose) und der spezifischen Immunreaktion (HLA-DR auf Monozyten, Antigenpräsentation) wurden nicht oder nicht wesentlich supprimiert, die Phagozytosefähigkeit von Monozyten nahm zu. Eine Beendigung der HC-Therapie führte zu ausgeprägten hämodynamischen und immunologischen Rebound-Phänomenen. Die Wirkung von niedrig dosiertem HC im septischen Schock kann daher als kreislaufstabilisierend und immunmodulatorisch charakterisiert werden, Zeichen einer ausgeprägten Immunsuppression fanden sich nicht. / In a prospective, double-blind, randomised, placebo-controlled cross-over study, hemodynamic and immune effects of a three-day adjunctive treatment with low doses of hydrocortisone (HC) (100 mg bolus followed by 10 mg per hour) were investigated in forty patients with septic shock. HC-therapy induced a rise of mean arterial pressure and systemic vascular resistance and a decline of cardiac index and heart rate without altering pulmonary vascular resistance. Both, nitrite/nitrate levels (nitric oxide formation) and cathecholamine requirement were reduced. Immune responses were complex and included: reduction of proinflammatory (interleukin-(IL)-6, 8) and antiinflammatory (IL-10, soluble tumor necrosis factor receptors) mediators, an increase of proinflammatory cytokines (IL-12 and interferon-?), a reduction of endothelial (E-selectin) and granulocyte activation (CD11b, CD64), and a decrease of T-helper and suppressor cells as well as eosinophil and basophil granulocytes; monocytes increased and total granulocyte and leukocyte counts remained unaltered. Parameters of innate (respiratory burst, phagocytosis) and adaptive immune responses (HLA-DR-expression on monocytes, antigen presentation) were not essentially affected, monocyte phagocytosis rather increased. HC-withdrawal induced marked hemodynamic and immunologic rebound effects. In conclusion, effects of low dose HC-therapy in septic shock is characterised by hemodynamic stabilisation and immunomodulation, without inducing severe immunosuppression.

Orofacial clefts are frequent congenital anomalies. A combination of genetic and environmental factors contributes to their formation. Orofacial clefts together with growth retardation belong among the indicators of embryo toxicity. This thesis is focused on the potential relationship between birth weight and orofacial clefts of newborns born in Czech Republic. The non-syndromic cleft lip, cleft lip and palate, isolated cleft palate and patients with Pierre-Robin sequence are discussed here. Evaluation of the relationship between the birth weight and orofacial clefts was performed on the base of statistical analysis. The differences were tested in children with different types of orofacial clefts and in cleft patients compared to healthy control. Statistical analysis of variance demonstrated that the type and severity of the cleft (unilateral/ bilateral) does not affect birth weight of newborns with orofacial clefts. Newborns with non-syndromic clefts had reduced birth weight in comparison to healthy controls. Cleft patients with Pierre-Robin sequence (syndromic form of cleft) did not differ in birth weight from healthy children. To verify the results obtained in patients with orofacial clefts that the birth weight is lower in these patients compared to control, two experiments on a chicken model...

We often form intentions but have to postpone them until the appropriate situation for retrieval and execution has come, an ability also referred to as event-based prospective memory. After intention completion, our cognitive system has to deactivate no-more-relevant intention representations from memory to avoid interference with subsequent tasks. In everyday life, we frequently rely on these abilities also in stressful situations. Surprisingly, little is known about potential stress effects on these functions. Therefore, the present study aimed to examine the reliability of event-based prospective memory and of intention deactivation in conditions of acute psychosocial stress. To this aim, eighty-two participants underwent the Trier Social Stress Test, a standardized stress protocol, or a standardized control situation. Following this treatment, participants performed a computerized event-based prospective memory task with non-salient and focal prospective memory cues in order to assess prospective memory performance and deactivation of completed intentions. Although the stress group showed elevated levels of salivary cortisol as marker of a stress-related increase in hypothalamus-pituitary-adrenal axis activity throughout the cognitive testing period compared to the no-stress group, prospective memory performance and deactivation of completed intentions did not differ between groups. Findings indicate that cognitive control processes subserving intention retrieval and deactivation after completion may be mostly preserved even under conditions of acute stress.

Introduction: Sodium chloride supplementation in saltwasting congenital adrenal hyperplasia (CAH) is generally recommended in infants, but its implementation in routine care is very heterogeneous. Objective: To evaluate oral sodium chloride supplementation, growth, and hydrocortisone and fludrocortisone dose in infants with salt-wasting CAH due to 21-hydroxylase in 311 infants from the AQUAPE CAH database. Results: Of 358 patients with classic CAH born between 1999 and 2015, 311 patients had salt-wasting CAH (133 females, 178 males). Of these, 86 patients (27.7%) received oral sodium chloride supplementation in a mean dose of 0.9 ± 1.4 mmol/kg/day (excluding nutritional sodium content) during the first year of life. 225 patients (72.3%) were not treated with sodium chloride. The percentage of sodium chloride-supplemented patients rose from 15.2% in children born 1999–2004 to 37.5% in children born 2011–2015. Sodium chloride-supplemented and -unsupplemented infants did not significantly differ in hydrocortisone and fludrocortisone dose, target height-corrected height-SDS, and BMI-SDS during the first 2 years of life. Conclusion: In the AQUAPE CAH database, approximately one-third of infants with salt-wasting CAH receive sodium chloride supplementation. Sodium chloride supplementation is performed more frequently in recent years. However, salt supplementation had no influence on growth, daily fludrocortisone and hydrocortisone dose, and frequency of adrenal crisis.

We often form intentions but have to postpone them until the appropriate situation for retrieval and execution has come, an ability also referred to as event-based prospective memory. After intention completion, our cognitive system has to deactivate no-more-relevant intention representations from memory to avoid interference with subsequent tasks. In everyday life, we frequently rely on these abilities also in stressful situations. Surprisingly, little is known about potential stress effects on these functions. Therefore, the present study aimed to examine the reliability of event-based prospective memory and of intention deactivation in conditions of acute psychosocial stress. To this aim, eighty-two participants underwent the Trier Social Stress Test, a standardized stress protocol, or a standardized control situation. Following this treatment, participants performed a computerized event-based prospective memory task with non-salient and focal prospective memory cues in order to assess prospective memory performance and deactivation of completed intentions. Although the stress group showed elevated levels of salivary cortisol as marker of a stress-related increase in hypothalamus-pituitary-adrenal axis activity throughout the cognitive testing period compared to the no-stress group, prospective memory performance and deactivation of completed intentions did not differ between groups. Findings indicate that cognitive control processes subserving intention retrieval and deactivation after completion may be mostly preserved even under conditions of acute stress.