This work "Is assisted reproduction a therapy for infertility?" deals with methods of assisted reproduction. The aim is not only to elucidate its techniques but also to open some difficult ethical questions. This work shows why we cannot regard assisted reproduction as a legitimite treatment for infertility and suggests alternative procedures. The first chapter is about the individual human life seen from the perspective of various sciences. The second chapter is about causes of infertility and about possibilities of its treatment. The third chapter deals with various methods of artificial reproduction. The following chapter is about ethical challenges related to these methods. The fifth chapter presents the standpoint of the magisterium of the Catholic Church. The final chapter tries to see fertility and parenthood from a larger perspective: the principal alternatives are substitute family care and spiritual parenthood. Keywords methods of assisted reproduction, infertility, parenthood, substitute family care, spiritual fertility

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Osteochondral defects comprise cartilage and bone tissue in the joint region and create challenges for orthopedic surgery, also because intrinsic regeneration capacities of the articular cartilage are limited. Furthermore, tissue layer-specific characteristics regarding cell types, mechanical properties and biochemical composition need to be considered. Research questions: In this work, concepts were developed which allow mimicking of osteochondral interfacial layers in a patient-individual and zonally specified manner by 3D extrusion (bio)printing. This feature of patient specificity was proven on different levels within this project: Besides the option for application of patient-own, expanded stem cells or chondrocytes within a scaffold to support regeneration and neo-tissue formation, a workflow was implemented which enables the consideration of magnetic resonance imaging (MRI) data and zonal geometry of the defect. With the materials suitable to achieve this design and a bioprinting-compatible process, the impact of such a system on embedded cells was investigated. A zonally structured, partly mineralized construct was evaluated regarding its capability to allow or support chondrogenesis of primary human chondrocytes (hChon). Furthermore, a strategy based on core-shell bioprinting technology was developed which allows simultaneous embedding of different cell types in a zonally defined distribution with a targeted effect by incorporated growth factors while reducing the off-target effects that would be expected when applied homogeneously via the surrounding medium. In addition, hybrid multi-material scaffolds were developed to adjust the stiffness of these systems. Materials and methods: To define design and patient-specific requirements for an osteochondral implant, an anonymized MRI dataset of a patient with osteochondritis dissecans (OCD) was used. The main constituent of the developed fabrication system was a bioink based on 3% alginate and 9% methylcellulose (algMC) with hChon. Laponite was added to alg-MC-based inks in order to control the release of differentiation factors for a sustained delivery in multi-zonal osteochondral constructs. A printable calcium phosphate cement (CPC) was used as a mineral phase. For the bioprinting process, multi-channel extrusion was applied for an alternating printing of hChon-laden algMC and CPC in order to mimic a zone of mineralized cartilage. Cell fate was investigated on biochemical and gene expression level. A coaxial extrusion module was applied for the co-extrusion of a bioink (shell) – algMC or plasma-functionalized algMC loaded with hChon or human pre-osteoblasts (hOB), respectively – and a biomaterial ink (core) doped with the corresponding growth factors TGF-β3 or BMP-2 as central target-specific factor depot. By melt electrowriting technology (MEW), additional scaffolds from polycaprolactone (PCL) microfibers with a freely adjustable fiber structure were generated. To trigger the mechanical stiffness of cell-laden hydrogels, these scaffolds were manually added to the bioprinting process as an extra support. Results: Suggested strategies of 3D extrusion (bio)printing for clinically relevant dimensions (Publication I)were successfully applied on algMC-based inks, bioinks and CPC to generate multi-material cell-laden constructs of an individual, patient-specific shape. With the use of flexible and reversible software solutions, MRI data from an OCD patient were utilized for the design and later fabrication of a bi-zonal implant (Publication II). The resulting implant showed a suitable geometry fitting into a model of the lesioned femoral condyles fabricated by stereolithography. For surgical fixation of such a potential implant, an individual implantation adapter was developed. The same materials processable via multi-channel printing were compatible with bioprinting of hChon isolated from the femoral head of human hip arthroplasty patients. The majority of cells survived the printing process and cultivation conditions in monophasic scaffolds consisting of cell-laden algMC, and in biphasic scaffolds with a zonally separated or interwoven mineral zone of calcium phosphate cement. Cells in both setups, representing plain articular cartilage and calcified cartilage, were able to re-differentiate and demonstrated the characteristic ECM marker production and gene expression. The calcium-deficient CPC led to a decrease of calcium ions and an initial increase of phosphate ions in the surrounding medium. In the presence of the CPC phase, chondrogenesis was enhanced (Publication III). The core-shell bioprinting concept allowed the spatially defined differentiation of cells (hChon or hOB), encapsulated in a bioink extruded as shell compartment, adjacent to a respective factor-loaded core depot with specific differentiation factors. The biomaterial inks for the core depot were successfully adjusted regarding viscosity and release kinetics by addition of nanoclay (Laponite) nanoparticles. Optical coherence tomography (OCT) was introduced as a tool to monitor the coaxial strand pattern and the location of embedded cells in a contactless manner. The applied inks allowed adjustment of release properties of components such as growth factors BMP-2 and TGF-β3. In hChon, characteristic genes such as collagen 2 or aggrecan were upregulated, while hOB were able to express the typical genes ALP, BGLAP and IBSP. Although both incorporated differentiation factors also demonstrated enhancing effects on both compartments, respectively, the induced adverse effects of hypertrophy in the cartilage zone and collagen 2 expression in the bone zone were successfully prevented. This was done by applying the factors with a sustained release via a Laponite-supported ink as the core depots, instead of homogeneously supplementing the surrounding cell culture medium (Publication IV). By adding PCL microfiber mesh scaffolds, fabricated by MEW, with a decreasing fiber density from 1000 to 250 µm, the Young’s modulus of the algMC scaffolds increased from 10 kPa to more than 50 kPa. The resulting hybrid scaffolds were proven cytocompatible; bioprinted hChon reacted to this hybrid algMC structure with a PCL density of 750 µm with an improved release of sulphated glycosaminoglycans (Publication V). Conclusions: A fully integrated approach for a multiphasic implant design, embedding of primary cells and simultaneous application of respective growth factors was realized by 3D extrusion (bio)printing. Concepts for bioprinting of mineralized cartilage based on algMC and CPC and for local factor delivery in osteochondral tissue substitutes by core-shell bioprinting were developed. The presented approaches allow an adjustable zonal design and full control over spatial differentiation and fate of bioprinted cells. The versatility of this modular system allows addition of further features as demonstrated for the combination with PCL microfiber scaffolds to adjust mechanical properties of the cartilage zone. Another option can be the mechanical stimulation of magnetically deformable algMC-magnetite scaffolds. These valuable insights for the field will serve as basis for further applications in vitro and in vivo. They might open up new research directions with a potential translation to other material combinations and other tissue defect types.:Table of Contents List of abbreviations List of figures Legal note 1. Introduction 1.1 The osteochondral interface – function, anatomy and histology 1.2 Pathology of cartilage and osteochondral tissue 1.3 State of the art: treatment of cartilage defects and osteochondral defects 1.4 Tissue engineering for osteochondral regeneration 1.5 Biomedical additive manufacturing and bioprinting 1.6 Hydrogels for bioprinting 1.7 Multi-component and multiphasic strategies to add specific cues and features to bioprinted tissue models 1.8 Additive Manufacturing of patient-specific bone and cartilage substitutes 2. Aims of the thesis List of publications included in the thesis 3. Strategies for biofabrication of volumetric constructs with an individual shape (Publication I) Publication I: Review article 4. Workflow for an MRI-guided, bi-zonal implant design (Publication II) 41 Publication II: Article Publication II: Published supporting information 5. Chondrogenesis in 3D bioprinted constructs and its compatibility with a mineral phase (Publication III) Publication III: Article Publication III: Published supporting information 6. Concept for a zonally defined factor delivery (Publication IV) Publication IV: Article Publication IV: Published supporting information 7. Hybrid bioscaffolds for tailoring mechanical properties of cartilage tissue substitutes (Publication V) Publication V: Article 8. Discussion and outlook References SUMMARY ZUSAMMENFASSUNG Acknowledgements List of other publications (co-)authored by the candidate Scientific congress contributions during PhD phase Journal ranking in Journal Citations Report Appendix I – Erklärungen zur Eröffnung des Promotionsverfahrens Appendix 2 – Erklärung zur Einhaltung gesetzlicher Bestimmungen / Osteochondrale Defekte umfassen Knochen- und Knorpelgewebe innerhalb des betroffenen Gelenks und stellen die klinische Orthopädie vor Herausforderungen dar, auch da die intrinsische Regenerationsfähigkeit des Gelenkknorpels stark limitiert ist. Zudem sind in den zu unterscheidenden Gewebeschichten spezifische Charakteristika wie unterschiedliche Zelltypen, mechanische Eigenschaften und die biochemische Zusammensetzung zu berücksichtigen. Fragestellungen: In der vorliegenden Arbeit wurden Konzepte entwickelt, mit dem sich per 3D-Extrusions(bio)druck Gewebeschichten dieser osteochondralen Grenzschicht zonenspezifisch und patientenindividuell nachbilden lassen. Diese patientenindividuellen Merkmale wurden innerhalb des Projektes auf mehreren Ebenen nachgewiesen: Zum einen können patienteneigene Stammzellen oder Chondrozyten nach Vermehrung im Labor innerhalb einer Gerüststruktur (“Scaffold”) zur Unterstützung der Regeneration und Gewebeneubildung angewandt werden. Zum anderen wurde ein Workflow vorgestellt, der die Berücksichtigung einer individuellen, per Magnetresonanztomographie (MRT) detektierten, schichtweisen Geometrie einer Läsion erlaubt. Mit Hilfe von Materialien, die diese Formgebung ermöglichen, wurde in einem Biodruck-kompatiblen Prozess der Einfluss eines solchen Systems auf eingebettete Zellen untersucht: Ein zonal aufgebautes, teilweise mineralisiertes Konstrukt wurde hinsichtlich dessen Eignung, Chondrogenese humaner Knorpelzellen (hChon) zu ermöglichen oder zu unterstützen, evaluiert. Zudem wurde eine auf der Kern-Mantel-Biodrucktechnologie basierende Strategie entwickelt, die das Einbetten unterschiedlicher Zelltypen mit zonal definierter Verteilung kombiniert mit einem gezielten Effekt durch inkorporierte Wachstumsfaktoren. Hierbei sollten unerwünschte Nebeneffekte der im Kern dargebrachten Faktoren auf die jeweils andere Zellsorte, die man bei homogener Faktorengabe über das umgebende Medium erwarten würde, reduziert werden. Weiterhin sollte mittels hybrider Multi-Material-Scaffolds die Steifigkeit des Systems angepasst werden. Material und Methoden: Um ein Design und patientenindividuelle Anforderungen für ein osteochondrales Implantat zu definieren, wurde ein anonymisierter MRT-Datensatz eines Osteochondrosis dissecans(OCD)-Patienten genutzt. Hauptbestandteil des entwickelten Fabrikationssystems war eine Biotinte aus 3% Alginat und 9% Methylcellulose (algMC) mit hChon. Laponit wurde zu den auf algMC basierenden Tinten hinzugefügt, um die Freisetzung von Differenzierungsfaktoren zu kontrollieren und damit eine verzögerte Gabe in mehrschichtigen osteochondralen Konstrukten zu ermöglichen. Ein druckbarer Kalziumphosphatzement (CPC) wurde als Mineralphase genutzt. Im Biodruckprozess wurde der Mehrkanaldruck angewandt, um durch alternierende Extrusion von hChon-beladenem algMC und CPC die mineralisierte Knorpelschicht nachzubilden. Die Zellentwicklung wurde auf biochemischer Ebene und hinsichtlich der exprimierten Gene untersucht. Ein koaxiales Extrusionsmodul wurde zur Ko-Extrusion einer Biotinte (Mantel), bestehend aus algMC beladen mit hChon oder Plasma-funktionalisierter algMC beladen mit humanen Prä-Osteoblasten (hOB), und einer korrespondierenden faktorenbeladenen Biomaterialtinte (Kern) genutzt. Dieses zielspezifische Faktorendepot enthielt jeweils TGF-β3 oder BMP-2. Durch die Technik des Melt Electrowritings (MEW) wurden zusätzliche Scaffolds aus Polycaprolacton(PCL)-Mikrofasern mit einer justierbaren Faserstruktur generiert. Um die Steifigkeit von zellbeladenen Hydrogelen anzupassen, wurden diese Scaffolds als mechanischer Support manuell während des Biodruckprozesses eingebracht. Ergebnisse: Die zugrundeliegenden Strategien des 3D-Extrusions(bio)drucks in klinisch relevanten Dimensionen (Publikation I) wurden an algMC-basierten Tinten, Biotinten und CPC erfolgreich angewandt, um zellbeladene Konstrukte patientenindividueller Form aus mehreren Materialien zu generieren. Durch den Einsatz flexibler und reversibler Software-Lösungen, wurden MRT-Daten eines Patienten mit einem osteochondralen Defekt verwendet, um ein zweischichtiges Implantatdesign zu entwerfen und zu fertigen (Publikation II). Dieses Implantat wies eine adäquate Passgenauigkeit in einem Modell der Läsion in den Femurkondylen, hergestellt per Stereolithografie, auf. Zur chirurgischen Fixierung eines solchen potenziellen Implantats wurde ein individueller Adapter für einen chirurgischen Stößel entwickelt. Das gleiche Materialsystem, prozessierbar mittels Mehrkanaldrucks, erwies sich als kompatibel zum Biodruck von hChon, isoliert aus dem Femurkopf von Hüft-Totalendoprothese-Patienten. Die meisten der Zellen überlebten den Druckprozess und die Kultivierungsbedingungen in monophasigen Scaffolds bestehend aus zellbeladener algMC-Biotinte, sowie in biphasigen Scaffolds mit einer in einer getrennten Schicht verlaufenden oder verwobenen mineralisierten Zone aus CPC. Zellen waren in beiden Ansätzen, als monophasiger oberflächlichen Gelenkknorpel, sowie als kalzifizierte Knorpelschicht, in der Lage, sich zu redifferenzieren; sie zeigten die Expression charakteristischer Matrix-Komponenten und -Gene. Der Kalzium-defizitäre CPC führte zu einer Verminderung der Kalziumionenkonzentration und zu einem initialen Anstieg der Phosphationen im umgebenden Medium. In Gegenwart der CPC-Phase war die Chondrogenese verstärkt (Publikation III). Das Konzept des Kern-Mantel-Biodrucks ermöglichte die örtlich aufgelöste Differenzierung von Zellen (hChon oder hOB), eingebettet in eine Biotinte extrudiert als Mantel-Kompartment, in unmittelbarer Nähe zu einem entsprechenden Faktor-beladenen Depot mit spezifischen Differenzierungsfaktoren. Die Biomaterialtinten für das Kern-Depot wurden durch die Zugabe von Nanoclay(Laponit)-Nanopartikeln hinsichtlich Viskosität und Freisetzungskinetik erfolgreich angepasst. Optische Kohärenztomographie (OCT) wurde als eine zerstörungsfreie Methode zur Beobachtung des koaxialen Strangmusters und der Zellverteilung eingeführt. Die genutzten Tinten erlaubten die Adaption der Freisetzungskurven unterschiedlicher Moleküle wie der Wachstumsfaktoren BMP-2 und TGF-β3. In hChon war die Expression charakteristischer Gene wie Kollagen 2 oder Aggrecan verstärkt, während hOB die für die osteogene Differenzierung typischen Markergene ALP, BGLAP und IBSP exprimierten. Obwohl beide inkorporierten Faktoren auch verstärkende Effekte auf jeweils beide Kompartimente zeigten, konnte der induzierte unerwünschte Effekt der Hypertrophie innerhalb der Knorpelzone sowie die unerwünschte Kollagen Typ 2-Expression innerhalb der Knochenzone erfolgreich verhindert werden. Dies geschah, indem die Faktoren statt homogen über das umgebende Zellkulturmedium mittels Laponit-Tinte und daher freisetzungsverzögernd über die Kern-Depots dargereicht wurden (Publikation IV). Mittels der PCL-Mikrofaser-Gitter-Scaffolds, hergestellt per MEW, mit enger werdenden Fasernetzdichten von 1000 bis 250 µm konnte der E-Modul der algMC-Scaffolds von 10 kPa auf über 50 kPa erhöht werden. Die Zytokompatibilität der hybriden Scaffolds wurden nachgewiesen; auf die Struktur in hybriden algMC-Scaffolds mit einer PCL-Faserdiche von 750 µm reagierten biogedruckte hChon mit einer erhöhten Freisetzung von sulfatierten Glykosaminoglykanen (Publikation V). Schlussfolgerungen: Ein integrierter Ansatz für ein mehrphasiges Implantatdesign, das Einbetten von primären Zellen und die gleichzeitige Anwendung der entsprechenden Wachstumsfaktoren wurde mittels 3D-Extrusions(bio)druck realisiert. Konzepte zum Biodruck von mineralisiertem Knorpel basierend auf algMC und CPC und zur lokalen Faktorengabe in osteochondralen Gewebeersatzstrukturen per Kern-Mantel-Druck wurden entwickelt. Die vorgestellten Ansätze erlauben ein vielseitig adaptierbares, zonales Design, die volle Kontrolle über die örtliche Differenzierung sowie die Reifung der biogedruckten Zellen. Die Vielseitigkeit des modularen Systems ermöglicht zudem das Hinzufügen weiterer Merkmale, was anhand des Einbringens von PCL-Mikrofaser-Scaffolds zur Justierung der mechanischen Eigenschaften der Knorpelzone demonstriert wurde. Eine weitere Option stellt die mechanische Stimulation magnetisch verformbarer algMC-Magnetit-Scaffolds dar. Die wertvollen Erkenntnisse werden als Basis für weitere Anwendungen in vitro sowie in vivo dienen können. All dies kann neue Möglichkeiten und Forschungsrichtungen eröffnen und ist in vielerlei Hinsicht übertragbar auf weitere Materialkombinationen, sowie verschiedene Defekt- und Gewebearten.:Table of Contents List of abbreviations List of figures Legal note 1. Introduction 1.1 The osteochondral interface – function, anatomy and histology 1.2 Pathology of cartilage and osteochondral tissue 1.3 State of the art: treatment of cartilage defects and osteochondral defects 1.4 Tissue engineering for osteochondral regeneration 1.5 Biomedical additive manufacturing and bioprinting 1.6 Hydrogels for bioprinting 1.7 Multi-component and multiphasic strategies to add specific cues and features to bioprinted tissue models 1.8 Additive Manufacturing of patient-specific bone and cartilage substitutes 2. Aims of the thesis List of publications included in the thesis 3. Strategies for biofabrication of volumetric constructs with an individual shape (Publication I) Publication I: Review article 4. Workflow for an MRI-guided, bi-zonal implant design (Publication II) 41 Publication II: Article Publication II: Published supporting information 5. Chondrogenesis in 3D bioprinted constructs and its compatibility with a mineral phase (Publication III) Publication III: Article Publication III: Published supporting information 6. Concept for a zonally defined factor delivery (Publication IV) Publication IV: Article Publication IV: Published supporting information 7. Hybrid bioscaffolds for tailoring mechanical properties of cartilage tissue substitutes (Publication V) Publication V: Article 8. Discussion and outlook References SUMMARY ZUSAMMENFASSUNG Acknowledgements List of other publications (co-)authored by the candidate Scientific congress contributions during PhD phase Journal ranking in Journal Citations Report Appendix I – Erklärungen zur Eröffnung des Promotionsverfahrens Appendix 2 – Erklärung zur Einhaltung gesetzlicher Bestimmungen

Summaries in Afrikaans and English / Text in Afrikaans / In the recent decision in Kellerman v South African Transport Services 1993 4 SA 872 (C) a claim for the loss of the use of a thing not utilised in the production of income was apparently allowed for the first time in South African law. A number of strict requirements were however set for such a claim. For a considerable time a claim has been recognised in English and German law even where a substitute was not hired and where the article was used for pleasure purposes. It is submitted that this should also be the position in South African law because the loss of the use of a thing per se has an independent value. It is further submitted that the interest on capital value method (as per English law) can be used as starting-point in the determination of quantum. A degree of flexibility is necessary to ensure fairness and equity. / In die onlangse beslissing in Kellerman v South African Transport Services 1993 4 SA 872 (K) is daar klaarblyklik die eerste maal in die Suid-Afrikaanse reg 'n eis om skadevergoeding weens gebruiksverlies van 'n saak wat nie in die produksie van inkomste gebruik is nie erken. Die hof stel egter 'n aantal streng vereistes vir so 'n eis. 'n Eis word al 'n geruime tyd in die Engelse en Duitse reg erken selfs waar 'n substituut nie gehuur is nie en waar sake bloot vir plesierdoeleindes gebruik is. Daar word submitteer dat dit ook die posisie in die Suid-Afrikaanse reg behoort te wees aangesien gebruiksverlies opsigself 'n selfstandige waarde het. Dit word verder aangevoer dat die rente-op-kapitaalwaarde-metode (soos in die Engelse reg) gebruik kan word as 'n uitgangspunt by kwantumbepaling. Ter wille van redelikheid en billikheid behoort die maatstaf 'n mate van buigsaamheid te he. / Private Law / LL. M.

Pour le comblement d'une perte de tissu, la greffe reste une méthode usitée en chirurgie osseuse mais une lacune importante conduit à l'emploi de matériaux artificiels. Alternative aux implants métalliques, les substituts osseux biocéramiques ont une efficacité insuffisante dans de nombreuses indications : problème d'intégration d'un volume important, résistance inadéquate à long terme, faible bioréactivité. Doper ces biocéramiques est une voie intéressante mais nombre de dopants ont abouti à des effets cytotoxiques voire à la dégradation des propriétés mécaniques. Le magnésium a été étudié comme dopant de l'hydroxyapatite pour des faibles teneurs, apportant des améliorations sans affecter la biocompatibilité. Cependant, les fortes teneurs et l'optimisation de la synthèse d'une biocéramique dopée ont été peu étudiées. Nous avons étudié et optimisé la synthèse d’hydroxyapatite par la méthode de précipitation aqueuse pour un dopage au magnésium de 1, 2, 5 et 10 % en masse. Caractérisations physicochimiques (DRX, MEB, densité), biologiques (cytotoxicité) et mécaniques (microdureté, élasticité) ont été menées (poudres ou pastilles frittées ou non). Nous avons montré l'apparition de TCP à partir de 2 % Mg, la densité des échantillons diminuant quand la teneur croît. Le dopage accroît la microdureté et le module d’Young. Aucune cytotoxicité n'a été révélée mais une importante baisse d’activité cellulaire a été remarquée pour 10 % de magnésium. Une légère augmentation a été observée pour 1 %. L'aptitude à la mise en forme a été appréciée via le coulage d'une réplique d'un implant intervertébral. Le dopage d'HA à 1 % Mg s'avère être à tout point de vue le compromis optimal. / For the filling of a loss of tissue, the graft is a current process in bone surgery, but a significant deficiency leads to the use of artificial materials. Alternative to metallic implants, bone substitutes bioceramics have insufficient efficacy in many indications: problem of integrating a large volume, inadequate long-term resistance, low bioreactivity. Doping these bioceramics is an interesting way but many of dopants have conducted to cytotoxic effects or to the degradation of mechanical properties. Magnesium has been studied as a dopant of hydroxyapatite for low contents, improving thebioceramic without affecting its biocompatibility. However, high contents and the optimization of the synthesis of such a doped bioceramic have been little studied. We investigated and optimized the synthesis of hydroxyapatite by the aqueousprecipitation process for magnesium doping of 1, 2, 5 and 10 wt%. Physico-chemical (XRD, SEM, density), biological (cytotoxicity) and mechanical (microhardness, elasticity) characterizations were conducted (on powders or pellets sintered or not). We have shown the occurrence of TCP from 2% Mg, the density of samples decreasing when the content grows. The doping increases the microhardness and the Young’s modulus. No cytotoxicity was revealed but a significant decrease in cellular activity was noted for 10% magnesium. A slight increase was observed for 1%. The ability to form an implant was assessed via the slip casting of a replica of an intervertebral implant. Doping HA to 1% Mg was found to be at any point of view the optimum composition.

Specifics of alternative family care institutions The Keywords: Substitute Family Care Adoption Foster care Constitutional Education Children's Home Chances for the Future Abstract: The purpose of this thesis is to describe the specifics of individual foster care institutions. The thesis consists of two parts. The theoretical part illustrates the history adoption and foster care. Moreover various forms of alternative family care will be described adoption, foster care, guardianship, institutional care or facilities for children requiring immediate assistance. The practical part deals with the children's homes. It describes Children's Home in Horšovský Týn. It also addresses the potential consequences of constitutional education and the effect of project Chances for Future on careers of children from children's homes. Powered by TCPDF (www.tcpdf.org)

TITLE Transformation of Children's homes into a new type of facilities ABSTRACT The aim of this study is to map the evolution and current state of the system of care for children and families at risk in the Czech Republic and the Slovak Republic, the educational-psychological perspective on the issue and to outline a vision for the future development. It is based on literature review particularly in the fields of work with children and families at risk, social pedagogy, developmental psychology, historical and current system of care for children at risk in our country and the Slovak Republic. The study contains knowledge of the author's experience in residential care and the first year experience in pilot project which aims to transform children's home into the facility providing support and field services for families at risk. The purpose of the practical part of the paper is to prove feasibility of the proposal using the case reports of children placed in children's home. KEYWORDS Child at risk, substitute family care, institutional care, the transformation of institutional care, remediation of a family.

The Diploma thesis is oriented into the area of a substitute family care in the Czech Republic. There are family functions disturbances in the respekt to the child specified in the first chapter, focusing mainly on those who most frequently, have an influence on a creation of so called "Infant social orphanage". The second chapter is dedicated to the possibilities of providing of substitute children nurture, mainly to single forms of substitute family care and theoretical recourses used for the optimal option of substitute child nurture. The content of the third chapter is a foster care (historical development, forms, infants indications, applicants motivation) and the newest type - the temporary foster care and its specifications compared to other forms of foster care. The fourth charter includes methodological recourses for an empirical research and thein interpretation. There are the Diploma Thesis findings and possibilities of further development of the substitute family care in the Czech Republic compiled in the fifth chapter.

Le bisphénol S (BPS) est largement utilisé comme substitut du Bisphénol A (BPA) et l’exposition humaine au BPS est désormais ubiquitaire. Or, le BPS, à l’instar du BPA, présente un potentiel perturbateur endocrinien, ce qui soulève la question du risque liée à une exposition fœtale au BPS pour la santé humaine. Dans ce contexte, l’objectif de cette thèse est d’évaluer l’exposition fœtale au BPS et de caractériser des biomarqueurs phénotypiques d’exposition fœtale et/ou d’effet du BPS à partir d’une signature stéroïdomique. Une étude toxicocinétique réalisée sur le modèle du fœtus ovin a montré que le transfert materno-fœtal du BPS est faible. Cependant, le BPS et son principal métabolite, le BPS glucuronide, sont lentement éliminés du compartiment fœtal en raison d’un passage placentaire fœto-maternel du BPS limité et de la faible vitesse de réactivation du BPSG en BPS. Il en résulte une exposition fœtale au BPS similaire à celle au BPA, lors d’exposition maternelle répétée. L’étude du transfert placentaire du BPS et du BPSG sur le modèle de placenta humain perfusé a conforté les résultats observés chez le mouton, avec des faibles transferts materno-fœtal et fœto-maternel du BPS, respectivement 10 et 3 fois inférieurs à ceux du BPA. L’exposition maternelle quotidienne au BPS au cours de la gestation chez la brebis n’a pas eu d’impact sur les voies de biosynthèse des androgènes dans l’unité materno-fœtoplacentaire pour les fœtus mâles. Bien que le potentiel d’exposition fœtale du BPS est similaire à celui du BPA, nous n’avons pas mis en évidence d’effets associés à cette exposition / Bisphenol S (BPS) is widely used as a substitute for Bisphenol A (BPA) and human exposure to BPS is now ubiquitous. However, BPS, like BPA, displays an endocrine disrupting potential, raising the issue of the risk of fetal exposure to BPS for human health. In this context, the objective of this thesis is to evaluate the fetal exposure to BPS and to characterize phenotypic biomarkers of fetal exposure and / or effect of BPS from a steroidal signature. A toxicokinetic study carried out on the model of the ovine fetus has shown that materno-fetal transfer of BPS is weak. However, BPS and its major metabolite, BPS glucuronide, are slowly eliminated from the fetal compartment due to the limited feto-maternal placental transfer of BPS and the low rate of reactivation of BPSG to BPS. This results in fetal exposure to BPS similar to BPA at repeated maternal exposure. The study of placental transfer of BPS and BPSG on the model of human perfused placenta reinforced the results observed in sheep, with low materno-fetal and feto-maternal transfers of BPS, respectively 10 and 3 times lower than those of BPA. Daily maternal exposure to BPS during pregnancy in ewes did not impact the androgen biosynthetic pathways in the materno-fetoplacental unit for male fetuses. Although the potential for fetal exposure of BPS is similar to that of BPA, we have not found any effects associated with this exposure.

Em procedimentos de regeneração óssea guiada (ROG) as membranas de colágeno são os materiais mais utilizados como barreira; porém, sua tendência ao colapso faz indispensável a utilização de materiais de suporte. Para este propósito, os xenoenxertos são substitutos ósseos considerados padrão-ouro, embora apresentem um período longo de reabsorção que impede grande formação do osso. Em contrapartida o ?-fosfato tricálcico (?-TCP) permite boa formação do osso, mas é reabsorvido rapidamente e fracassa quando precisa dar suporte à membrana. O alendronato, um bisfosfonato nitrogenado, é uma droga antirreabsortiva para o tratamento da osteoporose e outras doenças ósseas porque inibe a função dos osteoclastos. O plasma rico em fibrina (PRF) é um concentrado de fibrina sem adição de químicos que consegue estimular processos de cicatrização pelos fatores que fazem parte de sua composição. Neste estudo qualitativo de ROG em defeitos de 5 mm no osso parietal de ratos foi avaliado: 1) o efeito na formação óssea da administração local de 1g/ml de alendronato sódico adicionado a xenoenxerto porcino e a ?-TCP; 2) a adição local de alendronato e PRF a ?-TCP na possibilidade de diminuir a rápida reabsorção do material e impedir o colapso da membrana. Foram usados 100 ratos adultos Wistar distribuídos em 5 grupos (n=20): Xenoenxerto controle (XE-C); xenoenxerto adicionado com alendronato (XE-AL); ?-TCP controle (TCP-C); ?-TCP adicionado com alendronato (TCP-AL); e, ?-TCP adicionado com PRF (TCP-F). Em todos os grupos o enxerto foi coberto com membrana. Dois tempos de estudo de quatro e oito semanas foram considerados para cada grupo (n=10). Ao final de cada tempo, os animais foram sacrificados e as amostras foram fixadas, descalcificadas e processadas para seu estudo em microscopia de luz por meio de análise histológica, histoquímica TRAP e imuno-histoquímica para osteopontina (OPN). Os resultados mostraram maior formação do osso tanto para xenoenxerto como para ?-TCP quando foram adicionados com alendronato local, em ambos tempos de estudo. Nos grupos do ?-TCP a adição de alendronato local permitiu diminuir a reabsorção dos grânulos, melhorando o suporte à membrana ao final dos tempos de estudo; no entanto, no grupo do PRF a reabsorção foi maior e teve pouca formação de osso, provocando colapso da membrana. Adicionalmente, regiões de osso primário subjacentes à membrana de colágeno foram observadas em todos os grupos. / Collagen membranes are the most used materials as a barrier in guided bone regeneration (GBR) procedures; however, its tendency to collapse makes indispensable the use of support materials. For this purpose, xenografts, which are bone substitutes, although they have a long period of resorption that prevents large bone formation, are still considered the gold standard support material. In contrast, tricalcium ?-phosphate (?-TCP) allows good bone formation, but is rapidly reabsorbed and fails when it needs to support the membrane. Alendronate, a nitrogenated bisphosphonate, is an anti-resorptive drug for treatment of osteoporosis and other bone diseases because it inhibits the function of osteoclasts. Fibrin-rich plasma (FRP) is a fibrin concentrate with no added chemicals that can stimulate healing processes by the factors that are part of its composition. In this qualitative study of ROG in 5 mm defects in the rat parietal bone, was evaluated: 1) the effect on bone formation of local administration of 1g / ml sodium alendronate added to porcine xenograft and ?-TCP; 2) the local addition of alendronate and PRF to ?-TCP in the possibility of diminishing the rapid reabsorption of the material and preventing the collapse of the membrane. A 100 adult Wistar rats distributed in 5 groups was used (n = 20): Xenograft control (XE-C); xenograft added with alendronate (XE-AL); ?-TCP control (TCP-C); ?-TCP added with alendronate (TCP-AL); and, ?-TCP added with PRF (TCP-F). In all groups the graft was covered with membrane. Two study times of four and eight weeks were considered for each group (n = 10). At the end of each time, the animals were sacrificed and the samples were fixed, decalcified and processed for light microscopy by histological analysis, TRAP histochemistry and immunohistochemistry for osteopontin (OPN). Results showed higher bone formation for both xenograft and ?-TCP when added with local alendronate at both study times. In the ?-TCP groups the addition of local alendronate allowed to decrease grain resorption, improving membrane support at the end of the study times; however, in the PRF group the resorption was greater and had little bone formation, causing membrane collapse. In addition, primary bone formed in the underlying collagen membrane were observed in all groups.