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Introduction to Survival Analysis
Valenta, Zdeněk
Survival analysis is concerned with analyzing time-to-event data where the event of interest usually represents some type of “failure”. In clinical medicine, the event of interest may be e.g. death of a patient from well specified causes, autoimmune rejection of the graft by the transplant recipient or other type of graft failure in transplant studies. In certain situations, however, the true survival outcomes may not be observable, because we have observed a so called “censoring event” which prevented the event of interest from occurring. Such censoring event may represent, for instance, loss of a particular subject from follow-up, occurrence of administrative censoring, which typically takes place in clinical trials, or we may indeed observe other type of “failure”, e.g. death from fatal injuries rather than from cardiovascular causes which were of primary interest in a particular clinical trial. In this article we will stress the importance of a key assumption relating censoring process to survival outcomes and review principle univariate survival analysis methods for uncorrelated data. We will review popular models for analyzing univariate survival data, many of which enable us quantifying effect the prognostic variables independently exert on survival outcomes. Model examples will cover the classes of non-parametric, parametric and semi-parametric methods. We will also review underlying assumptions of individual models and stress the importance of using appropriate models in analyzing univariate time-to-event data.
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Drug policy - prices, settlements and participation
Davidová, Jana ; Solich, Jan (advisor) ; Foltán, Viliam (referee) ; Hartlová, Stanislava (referee)
ve Value in Health Participation on drug costs in the elderly in the Czech Republic Davidova, J.; Praznovcova, L.; Vlcek, J. In: Value in Health, Vol. 8 Issue 6 Page 615-A242, Supplement to ISPOR 8th Annual European Congress, Florence, Italy. November 2005 OBJECTIVES: Analysis of participation on drug costs in seniors in the Czech Republic in connection with seniors' social status (e.g. financial, household conditions). METHODS: Quota-sampled questionnaire-based interview with 450 respondents visiting pharmacy; Ratio men:women approximately 1:2; Age 60 years old and elder; 3 regions of the Czech Republic RESULTS: Most of respondents (60 %) live in households with their partners. Respondent's income was retirement pension in 80 %. Its average level was between 5001 and 7499CZK. Respondents used together 1651 medicines on physician's prescription in last four weeks. Overall co-payment for medicines was 31944CZK, e.g. 70CZK per patient. Only 27 % of respondents used fully reimbursed products. Respondents used together 273 OTC drugs in value of 12900CZK, e.g. 29CZK per patient. Average respondents spent on medicines 100CZK in last four weeks, e.g. between 2 and 1.3 % of their income. There were respondents, about 10 %, searching for the level of co-payment in several pharmacies and 8 % of respondents,...
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The system and the financing system of psychiatric care in the Czech Republic in the period 2010-2016
Křížová, Natálie ; Lukášová, Tereza (advisor) ; Bartůsková, Lucia (referee)
The bachelor thesis focuses on mental health, which is becoming a socio-economic problem these days. Since there is a constant prevalence of patients with mental illnesses and thus an increase of a burden in the economic system, this work explains the system of psychiatric care, which is crucial for the future development of mental health of Czech population. Based on the analysis of the issue it is evident that the effort to manage the care system to community care will do not contribute to the reduction of treatment costs, but on the other hand, will facilitate the accessibility to psychiatric facilities for patients. The funding of psychiatric care is not based on the national health system, which influences the direction of a large part of the funds for treatment in psychiatric hospitals.
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The possibilities of influencing walking stereotypes with botulinum toxin
Kolářová, Edita ; Angerová, Yvona (advisor) ; Pochylová, Barbora (referee)
Title: The possibilities of influencing walking stereotypes with botulinum toxin Abstract: The thesis is focused on finding opportunities to influence the walking stereotype of patients suffering from spasticity of the lower limbs by botulinum toxin. The aim of thesis is to compare the quality of walking stereotype of these patients before and after the application of botulinum toxin by using a standardized test intended to evaluate the walk and based on the results to evaluate the effect of botulinum toxin on the walking stereotype. While reading the theoretical part the reader is familiar with the basic concepts related to the problems such as spasticity, botulinum toxin and walking stereotype. The scales evaluating the muscle tone are subsequently described (The Modified Ashworth scale, The Tardieu Scale) and of course the scales evaluating the walking stereotype are also mentioned (Rancho Los Amigos Gait Analysis Form, Gait Assessment Rating Scale, Rivermead Visual Gait Assessment, Tinetti Balance And Gait Evaluation). Scales evaluating the walking stereotype are also described in detail at thesis, their pros and cons are highlighted and upon the preferences of the author, one of these scales is selected to be applied in the practical part. The practical part is composed of case studies of two patients...
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The effect of analgesics and their combination with neurotropic drugs on pain and brain mediators
Soukupová, Marie ; Kršiak, Miloslav (advisor) ; Farghali, Hassan (referee) ; Rokyta, Richard (referee)
The first aim was to investigate changes in analgesic efficacy of several analgesics in combination with selected drugs affecting nervous system after systemic administration. The second aim was to ascertain changes of levels of pain mediators in vivo in supraspinal brain structures (in periaqueductal gray matter, central amygdala, striatum) in pain and under the drug influence. The analgesic efficacy of combinations of analgesics with neurotropic drugs was investigated in the writhing test in mice. Interactions between analgesics and neurotropic drugs were evaluated by the isobolographic analysis, which enables to distinguish the supra-additive (synergistic) interactions from solely additive and sub-additive ones. A possible negative effect of neurotropic drugs on motor functions was determined in the rota-rod test in mice. Changes of levels of pain mediators in the brain during pain and under the drug influence in rats were measured by microdialysis in vivo coupled with a high performance liquid chromatography. A model of inflammatory pain induced by intraplantar injection of carrageenan and a model of neuropathic pain produced by a spared sciatic nerve injury model were used in rats. We evaluated pain in plantar and von Frey filament test. Our microdialysis experiments revealed that inflammatory pain...
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název v anglickém jazyce není uveden
Klusáčková, Pavlína ; Pelclová, Daniela (advisor) ; Hajduková, Zdeňka (referee) ; Vízek, Martin (referee)
Early diagnosis of occupational asthma is important especially for the prognosis of this disease. The confirmation of the diagnosis of occupational asthma is sometimes difficult using diagnostic methods available nowadays. That is why searching new methods is very important. Analysis of exhaled breath condensate (EBC) by liquid chromatography combined with mass spectrometry enables the separate detection of cysteinyl leukotrienes (LT) - LTC4, LTD4, LTE4; LTB4 and 8-isoprostane. If patients with occupational asthma and controls were compared, only LTC4 was significantly higher among all EBC parameters studied in asthmatics (despite corticosteroid treatment). This marker could be used in the future diagnostics. Monitoring of 24-hours variability of EBC parameters in patients, in whom occupational asthma is suspected, showed relatively high intraindividual and interindividual variation. It is evident therefore, that if only one daily measurement in asthmatics would be possible (which is common in articles of several authors), it should be collected in the same period of day in all persons. In negative bronchoprovocation tests significant changes of EBC parameters were not found. The evaluation of positive bronchoprovocation tests was limited by small number of patients, however in five persons from six, the...
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Molecular factors of artherogenesis in chronic kidney disease with experimental model of chronic inhibition of Nitric Oxide Synthesis and its Effect of HMG-CoA reductase inhibitoin
Lecian, Dalibor ; Matouš, Bohuslav (advisor) ; Tesař, Vladimír (referee) ; Zadražil, Josef (referee)
The experimental part of the thesis covered the markers involved in nitric oxide deficiency model in rats. The analogue of arginine N-nitro- L -arginine-methyl ester ( L -NAME) was used. L -NAME administration resulted in sustained elevation of BP, decreased GFR, and in higher albuminuria compared to control animals. The administration of hypolipidemic drug - atorvastatin to Wistar rats was studied. The statin used caused lower albuminuria and prevented decreases in GFR in L -NAME rats without having an impact on hypertension. CAV1 protein expression was similar in all groups of rats. In contrast, VEGF expression and RhoA activity was increased in L -NAME-treated animals, and normalized with coadministration of atorvastatin. Clinical part of the thesis focused on the analysis of markers of oxidative stress in obese and non-obese patients with CKD and after kidney transplantation. The patients with CKD had elevated serum concentrations of AGEs, sRAGE and ADMA with the maximal concentrations of AGEs in the patients on hemodialysis. The successful kidney transplantation decreases the AGEs, sRAGE and ADMA concentrations but not to normal value according to general population. Patients with obesity exhibited lower concentrations of sRAGE in CKD as a protective factor for cardiovascular disease. Concentrations of...
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Stress-strain analysis of arterial aneurysms
Tesařová, Petra ; Skácel, Pavel (referee) ; Burša, Jiří (advisor)
The diploma thesis is focused on the creation of the aneurysm finite element model and the making of the aneurysm wall stess-strain analysis using ANSYS software. The model of abdominal aortic aneurysm geometry starts from the CT scan of the particular patient. In the thesis there are compared two chosen constitutive models, each of them appears from different mechanical tests done on human arterial fibre samples. Furthermore, a limiting condition for aneurysm wall structure damage is expressed. On the basis of the results of stress calculation in the aneurysm wall and the limiting condition, the safety coefficient and rupture factors risk are worked out.
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Genetic Aspects of Sporadic Ovarian Cancer
Jančárková, Natalia ; Freitag, Pavel (advisor) ; Rokyta, Richard (referee) ; Kohoutová, Milada (referee)
58 9. SUMMARY Molecular biological parameters, including genetic alterations, present new and perspective direction in diagnostics, prediction of prognosis, monitoring and possible therapeutic approaches in oncological disease. The results presented have to do with the project, which is concentrated upon chromosomal rearrangements in ovarian and cervical cancer and their correlations with available parameters of both molecular biological and clinical characteristics. Sixty patients with ovarian cancer and twenty patients manifesting cervical cancer were included into the study. The histological type and grade, MIB-1 and p53 (using immunohistochemical method) were estimated by histopathologist. Both conventional karyotyping and molecular-cytogenetic methods (fluorescent in situ hybridization and comparative genomic hybridization) were applied to reveal chromosomal aberrations. The results were subjected to statistical evaluation, using analysis of variances and χ2 test. There were correlated parameters of quantitative and qualitative character - age, stage, histological type, grade, CA 125 before and after treatment, MIB-1, p53, surgical residuum, lymphadenectomy, response rate, chromosomal rearrangements. Analyses accomplished in ovarian cancer group revealed typical amplifications on chromosomes 1q, 3q and...
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Problems of renal tumours in patiens with terminal stadium of renal failure
Ürge, Tomáš ; Hora, Milan (advisor) ; Novák, Jaroslav (referee) ; Zachoval, Roman (referee) ; Morávek, Petr (referee)
Objective: Risk of renal carcinoma is minimal 10 x higher in group of patients in terminal stadium of renal failure (end stage kidney disease - ESKD). We have only some information about chromosomal changes in renal tubules, from which rise renal carcinoma, and about pathogenesis of renal carcinoma, which seems to be different from carcinoma in common population. Aim of the study: In clinical part we valorize characteristic signs of renal carcinoma in ESKD by using of statistic methods. In experimental part we can explain pathogenesis of this carcinoma by analysis of selective chromosomal aberations. Material, methods: In 2000 - 2007 were 184 patients with ESKD in care of transplant centre and nephrologic ambulation of Faculty hospital Plze_. In 15 patients we diagnose renal carcinoma. In this group we valorize: age, gender, causation of renal failure and dialysis duration. Age, gender and type of renal carcinoma we confront with carcinoma in common population. In experimental part we valorize numerical aberations in chromosome 7, 17 and Y of tubular epithelium using fluorescent hybridization in situ (FISH). Results: We have 15 patients in average age 55.7 ± 11.5 years, long of during dialyzation was 78 ± 54 months. We do not find dependence between causation of renal failure and genesis of renal...
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