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The case report presents a case of an Afghan boy with multiple scrapie injuries to the trunk and the limbs resulting from the explosion of unidentified ammunition. The polytraumatized  patient was comprehensively and successfully treated in an international field surgical hospital within the framework of ISAF (International Security Assistance Force) - Afghanistan.

Ionizing radiation (IR) induces various types of damage in the cellular DNA, of which the most deleterious are double strand breaks. Double strand breaks lead to activation of signaling cascade aiming to repair the damage or to transiently or permanently arrest cell cycle, and/or induce cell death. In the case of high doses of ionizing radiation with a high dose-rate (0.5-1 Gy / min) where the cell repair capacity is insufficient, cell death often occurs in response to double-strand breaks. The response to the radiation exposure depends on many factors such as the cell type, its proliferation activity, and p53 status. In tumor cells, cell death is associated primarily with apoptosis or mitotic catastrophe. In normal fibroblasts, cells accumulate in the G1 phase of the cell cycle and so-called premature senescence occurs after irradiation.In cells with functional p53 protein an increase in the p21 protein (cell division inhibitor) and accumulation of the cells in the G1 phase occurs. In the case of very low-dose rate (LDR), this accumulation is transient; after DNA damage repair, the cells continue to divide. Upon irradiation with higher doses at a LDR, accumulation in the G1 phase is irreversible; p16 protein is upregulated and the status of premature senescence is induced.  The same dose of radiation administered at LDRs results in more senescence than after an acute exposure.In the case of the use of IR for the eradication of tumor cells, the status of these cells is important in terms of p53 and proliferation. About fifty percent of tumor cells do not possess p53 protein or are mutant, and after irradiation they accumulate in the G2 phase and repair the IR-induced damage (e.g. HL-60 cells). In HL-60 cells (p53^-/- human promyelocytic leukemia), G2 phase accumulation occurs during irradiation with low dose rate, and their radioresistance increases if the cells are irradiated in the G2-phase. When the dose-rate is very low, the cells enter the mitotic cycle during irradiation, and because cels in mitosis are highly radiosensitive, apoptosis is induced and thus their radiosensitivity increases as well.

The work describes system of preventive medical examinations in the Armed Forces of the Czech Republic, introduced in 1999, by comparison with preventive programs in civilian section. Detailed description of content of the examinations and anthropometric methods and news from 2017 shows advantages and disadvantages. Range of the examinations and problematics of participation of active soldiers are elaborated in discussion in cost-benefit ratio.

Department of Toxicology and Military Pharmacy has a long science history. During its existence, many Ph.D., PharmDr. or diploma thesis were originated here. In recent years, the Department is more open to young science interested people, expecially to secondary school students.

The 8^th Singapore International Symposium for Protection Against Toxic Substances (SISPAT) is a technical forum that aims to share the latest knowledge and technology with regards to defence against unconventional threats amongst scientists and operations managers (military and public health) from the academia, government and other relevant industries. Asymmetrical threats posed by the use of unconventional agents transcend international boundaries and is constantly evolving to circumvent existing defence measures. Henceforth, defence measures against CBRN threats must leverage on bilateral and multi-lateral cooperation to remain effective. The theme for the 8^th SISPAT, "Staying One Step Ahead of Evolving CBRNe Threats Through International Cooperation", reinforces the importance of continuing this tradition of information sharing, scientific exchange and close-knit interactions between international communities to counter such asymmetric threats.The Symposium will be held in conjunction with the 24^th edition of NCT CBRNe Asia and the 25^th edition of NCT eXplosive Asia.

The 8^th Singapore International Symposium for Protection Against Toxic Substances (SISPAT) is a technical forum that aims to share the latest knowledge and technology with regards to defence against unconventional threats amongst scientists and operations managers (military and public health) from the academia, government and other relevant industries. Asymmetrical threats posed by the use of unconventional agents transcend international boundaries and is constantly evolving to circumvent existing defence measures. Henceforth, defence measures against CBRN threats must leverage on bilateral and multi-lateral cooperation to remain effective. The theme for the 8th SISPAT, "Staying One Step Ahead of Evolving CBRNe Threats Through International Cooperation", reinforces the importance of continuing this tradition of information sharing, scientific exchange and close-knit interactions between international communities to counter such asymmetric threats.The Symposium will be held in conjunction with the 24^th edition of NCT CBRNe Asia and the 25^th edition of NCT eXplosive Asia.

In February 2016, the World Health Organization (WHO) declared the current Zika outbreak a Public Health Emergency of international concern. The Zika virus disease is caused by a virus (family Flaviviridae) transmitted by Aedes spp. mosquitoes. People with the Zika virus disease usually have symptoms that can include a low-grade fever, maculopapular rash, conjunctivitis, arthralgia, malaise, headache and retro-ocular headaches. Neurological and autoimmune complications have been described during the outbreaks in Polynesia and recently in Brazil. There are no licensed medical countermeasures - vaccines, therapies or preventive drugs available for the Zika virus infection and disease.

Sternutators are substances that irritate the nasal and respiratory passages and cause coughing, sneezing, lacrimation, and sometimes vomiting. They are organoarsenic compounds and some of them were used as warfare toxic gases in World War I, namely diphenylaminochloroarsine, diphenylchloroarsine, diphenylcyanarsine, and phenyldichloroarsine. The effect of these irritants is in principle non-lethal.

Aim: To describe effectiveness of orlistat and phentermine in soldiers of the Armed Forces of the Czech Republic.Methods: In ambulatory patients, some anthropometric and biochemical parameters were compared before administration with 120 mg of orlistat three times a day or 15 mg of phentermine once a day. The same parameters were compared after a three-month therapy. This group included 289 patients (238 males and 51 females) who were administered the same dose of orlistat or phentermine for the entire period of time.Results: Statistically significant weight loss in both genders, on average by 4.6 ± 4.2 kg in males and by 5.3 ± 4.3 kg in females, was observed in patients taking orlistat within three months. Statistically significant weight loss, on average by 6.5 ± 6.0 kg in males and by 5.2 ± 4.3 kg in females, was also observed in patients taking phentermine for the same period of time. As for monitored biochemical parameters, a decrease of total cholesterol, HDL cholesterol and glucose at a statistically significant level (p<0.05) was observed in the group of females, the same statistically significant decrease, but in triglycerides, was proved in the group of males. Then a decrease of total cholesterol and increase of HDL cholesterol at a statistically significant level (p<0.001) was observed in the group of males.Conclusion: We can state that in our patients we have proven a positive effect of orlistat or phentermine substitution on their weight reduction.

Organophosphorus compounds (OPCs) are a wide group of compounds both structurally and functionally. Each OPC has a unique toxicological profile. The exposure to this type of poison is not limited only to certain occupationally exposed people but also to children, women, pregnant women; all have chances to be exposed to this poison. During the recent past years it has been reported in many poison epidemiological studies and case reports that exposure of OPCs during pregnancy caused malformed fetuses, neural tube defect (NTD) and shortening of pregnancy. The literature for animal models reveals inconclusive evidence. The generalized view is that they are neither teratogenic nor embryotoxic. But it is not true. There is a lack of systematic study and scarcity of reports on the topic. The present study was undertaken to investigate the teratogenicity induced by organophosphorus compounds in different animal models by literature review. Literature was searched by Toxicology Data NetWork (TOXNET), Developmental and Reproductive Toxicology Database (DART), Toxicology Literature Online (TOXLINE), Hazardous Substances Data Bank (HSDB), Pubmed Central, Entrez-Pubmed, Science Direct, Directory Of Open Access Journal (DOAJ), Google Scholar and International Program on Chemical Safety (IPCS-INCHEM), Embase. The terms for literature search were teratogenicity, organophosphorus compounds; fetal toxicity, organophosphorus compounds; organophosphorus poisoning and pregnancy; organophosphorus poisoning and growth restriction; organophosphorus poisoning and IUGR; organophosphorus poisoning and reproduction; organophosphates and reproduction; pregnancy and organophosphates. The outcome of the study concludes that the work on teratogenicity induced by organophosphorus compounds was completely neglected, inconclusive, and only carried out on less than half of the OPCs available in the market. A more comprehensive and systemic study on the subject is clearly needed and its importance should not be ignored because more positive cases are being reported on the teratogenicity and embryotoxicity of OPCs.

Group of viral hemorrhagic fevers (VHF) present a range of disorders from relatively moderately serious to human life threatening entities whose mortality reaches high levels. There are classified as acute viral febrile diseases characterized by nausea, myalgia and fatigue, dominating with general alteration of vessel permeability and regulation. Symptoms of bleeding often occur, particularly in severe cases which are usually diffuse and present a symptom of general vessel injury rather than life-threatening condition.

Soldiers, particularly those involved in combat operations, are exposed to a continuous danger frequently resulting in various types of injuries, out of which the most common and serious is traumatic brain injury (TBI). Up to the second quarter of 2015, the Defense and Veterans Brain Injury Center has recorded 333,169 cases of active soldiers affected with TBI. TBI can be defined as an injury that results from external force to the head and causes an alternation of loss of consciousness. The key symptoms of TBI comprise physical problems, sensory impairments, behavioral changes, cognitive disorders, communication difficulties, and swallowing disorders. The purpose of this study is to review available studies on TBI among active military personnel with special focus on communication disorders. The methods applied for this study include a method of literature review of both clinical and review studies relevant for the researched issue in the acknowledged databases and a method of comparison and evaluation of their findings. The findings show that the research studies exploring communication disorders among the active military personnel are rare. In addition, earlier diagnosis of TBI is needed as well as a multidisciplinary team intervention approach to the treatment of TBI.

A report about experiences gained during a month internship at the Queen Astrid Military Hospital Burns Centre in Brussels, Belgium, in May 2015.

International terrorism becomes one of the most dangerous problems at the beginning of the 21^st century. Terrorist attacks have serious impact on politics, economy, military as well as security forces, international law and legislation, and psychological issues. International terrorism is legally characterised not only as a threat to the life and property of individuals, but also as a worldwide threat to human civilization, social order, international public order and values. The aim of this contribution is to specify the incidence of terrorist attacks from 1970 to 2013 in European countries and to characterise their imminent impact on the number of casualties. Furthermore, the contribution aims to specify the type of these attacks, weapons employed in them and numbers of casualties corresponding to various types of weapons. The analysis was based on data from databases and existing studies. The monitored period witnessed a slow but steady increase in the incidence of terrorist attacks in the EU countries without any significant changes. The types of weapons employed in these attacks did not change much, either.

In April 2005, an international advanced research workshop entitled, “Preparedness of Medical Systems: Guidelines for Mass-Casualty Situations” was convened in Haifa, Israel, under the auspices of NATO. Numerous specialists from various countries addressed the management of problems that arise during the hospital and pre-hospital phases of a medical response to mass-casualty situations, as well as the issue of preparedness for potential toxicological events. Methods for evaluating the quality of care provided during such situations were also discussed (1). In November 2009, the authors and their team organized the “NATO Advanced Training Course: Best Way of Training for Mass-Casualty Situations” for specialists from countries participating in the Partnership for Peace (PfP) and Mediterranean Dialogue (MD) programs; once again, the course was held in Haifa, Israel. The aim of the course was to inform its participants (all of whom were experienced protagonists in the field of emergency medical services and hospital management, or ministry of health officials, in their respective countries) about teaching and training methods for preparation for mass-casualty situations (2)...

The main goal of this reaserch is an evaluatin of mental stress. The level of stress was studied in a group of nurses that spent some time on the military missions, especially in Afghanistan.We used Meister questionary for evaluation of a stress level at work, in a civilian hospital in the Czech Republic and a military work place, during the mission.In conclusion, the goal of our reaserch is classification of a stress level during the nurses' deployment in foreign mission. Based on these results, some methods convenient for managing a higher level of stress were described and mechanisms of stress adaptation are discussed.

Healthcare is an industry that has a very strong position in economies and a relatively high share of GDP. It also includes the medical device industry. The aim of this paper is to analyse the potential of the market for medical devices in Europe. The starting point is the analysis of the external environment, describing the selected macroeconomic variables affecting aggregate demand and therefore the medical device industry in selected countries. The tool for strategic analysis of the European market is Porter's Five Forces model, where initial information is obtained from the analysis of economic indicators of the given industry, analysis of world databases data, analysis of documents dealing with studies of the medical device industry.The European market can be described as highly competitive, with a large number of small and medium-sized companies, stable innovative activity, which is significantly defined by the regulations by the competent authorities. Globally, this industry is predicted to grow.

Organophosphorus (OP) is a large group of compounds with a wide variety of applications. The group comprises insecticides, pesticides and nematicides etc. in addition to deadly poison OP warfare chemicals like sarin and tabun. Thousands of casualties have been reported globally each year by the unintentional and intentional use of OP compounds. Uses of deadly poison OP like sarin by terrorists groups and irresponsible regimens have been documented as well. The threat always exists. The mainstream therapy includes administration of atropine, pralidoxime and bezodiazepines in addition to general supportive measures. Despite this standard therapy, the mortality rates of OP poisoning are still high. Different approaches and methodologies have been postulated and introduced as an alternative to standard therapy but none could replace the existing standard therapy. The present short review examined the possibility of usage of antihistamines as alternate to atropine. Pros and cons have been discussed. The study suggests that some of the first generation antihistamines like promethazine and diphenhydramine may be effectively used as antidote for OP poisoning depending upon the degree of poisoning. They may have several advantages like inexpensive, systematically and centrally acting anticholinergic antihistamines, readily crosses blood-brain barrier, and large quantities of the drug exist in most hospitals and pharmacies, providing a reservoir in the event of a mass casualty event. However, further clinical studies and evidences are warranted.

Currently, Biomedicine is characterised by a growing need for processing large amounts of data in real time. This leads to new requirements for information and communication technologies (ICT). Cloud computing offers a solution to these requirements and provides a lot of advantages such as cost savings, elasticity and scalability of using ICT.The aim of this paper is to explore the concept of cloud computing. Firstly, the forms of cloud computing are described. Secondly, the potential benefits and limitations of Biomedicine technology are discussed. Finally, the current (present) situation of using this technology in Biomedicine in the Czech Republic from an economic point of view is analysed.

MAIN TOPICS: Influenza and new respiratory viral agents, Viral emerging infections, Viral congenital and neonatal infections, Viral blood born infections, Anthropozoonoses of viral origin, Viral gastroenteritis, Viruses and immunosuppressed host, Viral pathogenesis and immunity, Viral diagnosis, Viruses and oncogenesis, New antiviral agents, Strategies and progress in viral vaccines, Molecular epidemiology, Quality assurance in virology laboratory.

The Headquarters Joint Force Command (JFC) at Brunssum is an operational NATO headquarters located in that small town in the Limburg province of the Netherlands. The history of this HQ stems from 1967 when the Allied Forces Central Europe Command (AFCENT) was established there. In March 2000, HQ AFCENT stood down, and the new Regional Headquarters, Allied Forces Northern Europe (RHQ AFNORTH), assumed command of and responsibility for Northern Europe. As a result of the Prague Summit in November...

Anthrax is still a high threat biological agent, with historical precedence of potential terrorist use. While lack of human-to-human transmission may contain attacks in pockets, attacks can be multiple, coordinated and/or covert, therefore successful containment is heavily dependent on rapid identification after the smallest (possible) number of early cases, immediate and accurate statistical assessment of its geographic extent based on case histories, and a rapidly targeted prophylaxis strategy that considers both antibiotics and vaccine. Persistence of spores could lead to continued post-event threat, lack of guarantee that total decontamination has been achieved, fear of repeat attacks, concerns and disruptions to normal life, and tremendous loss to the economy. These considerations were among those that underpinned the recent 'Anthrax Counter Measures 2013' international conference held at the think-tank Royal United Services Institute, London, on 4 February 2013. Peer-reviewed abstracts of fifteen oral papers and nineteen posters presented in this conference are published as proceedings in this issue of the Military Medical Science Letters journal (ISSN 0372-7025). This meeting brought together academic, government and third sector organisations to debate key issues in anthrax counter measures under four themes: 'What might happen? How will we know? How to respond? What does the future look like?'. Topics explored include injectional anthrax (the latest and fourth mode of infection), inhalational anthrax (which drives biodefence considerations like animal models, emergency preparedness, etc.), the role of US government agencies post-Amerithrax attacks (especially the Animal Rule and Project BioShield, and the first licensed product raxibacumab), current and emerging trends in detection and diagnostics, etc. Discussions took place on how to accelerate products from laboratory to field, how to make the most out of the currently licensed antibiotics and vaccines, and how to bridge the gap between science and frontline response to anthrax. More efforts are needed to quantify the overall burden of the Amerithrax attacks, including the impact on tourism and business showdowns or diversions. This will enable governments to demonstrate value for taxpayer money and identify gaps through initiatives such as the annual preparedness index, shelf-life extension programmes, etc. Continued fiscal pressures could also encourage like-minded friendly governments to share resources and stockpiles, leading to other benefits such as increased resilience and cooperation.

The most complex topic is represented by operative treatment of type IV lesions of rotator cuff. Palliative arthroscopic resection of rotator cuff did not produce optimal results. We thus intend to evaluate the newly implemented surgical techniques at our department.Fifty-six patients with type IV rotator cuff lesions were treated surgically between October 2007 and December 2010. In 6 patients, combined operations had to be performed because of their pathology, and these were not included in detailed evaluation. The population selected for detailed evaluation of new surgical techniques included 50 patients (mean age: 59 years, range: 41-73 years). The patients were randomized into two subpopulations, each formed by 25 people. Both subpopulations can be considered representative and comparable.All operations were performed in the "beach-chair" position in general anesthesia or/and in interscalenic block. After type IV lesion was diagnosed, the prespecified surgical procedure followed - partial muscle transfer of subscapularis muscle tendon (Karas) or partial non-anatomic rotator cuff reconstruction (Burkhart). The results were evaluated after 6 months using the modified Constant Functional Score. The following parameters were assessed: sex, age, side of the operation, dominance of the limb, Constant Functional Score pre-operatively and post-operatively, subjective and objective evaluation, pain, activities, movement and muscle strength, Constant Score improvement, improvement in its individual items and subitems, pain pre-operatively and post-operatively.In older patients with type IV lesions, we have good experience with Karas method while in younger and more active patients, Burkhart method seems to be more useful.

Gyromitra esculenta (Persoon ex Fries) mushrooms have been responsible for severe intoxications and even deaths. Clinical data are characterized primarily by vomiting and diarrhea and after a while by jaundice, convulsions and coma. Other Gyromitra species which may be of concern are G. fastigiata and G. gigas; nevertheless, recent advances in chromatography, biochemistry and toxicology have established that other species within the Ascomycetes may also prove toxic. Their toxins, mainly gyromitrin (N-methyl-N-formyl-N-acetyl-hydrazone) and their higher homologues are converted in the milieu of human stomach into N-methyl-N-formylhydrazine (MFH), then into N-methylhydrazine (MH). The toxicity of these latter chemicals, which are mainly hepatotoxic and even carcinogenic, has been established through in vivo and in vitro experiments with cell cultures and biochemical systems. Considering the chemical structure and the reactivity of these natural compounds, chemical and biochemical mechanisms are defined in order to explain their intrinsic biological activity. These findings imply that consumption of G. esculenta could present a carcinogenic as well as an acutely toxic health hazard.

A 43-year-old man, injured during a factory explosion on January 4, 2010, was transported to the nearest hospital. Volume resuscitation started, subclavian vein cannulation, chest tube, and covering of burns were performed. The intubated and ventilated patient was transferred by helicopter to our hospital. The leading diagnoses were: haemorrhagic - traumatic and burns shock, haemoperitoneum, pneumothorax, subtotal amputation of the left distal crus/feet, burns over 40 % of the body surface, right calcaneus fracture etc. Preliminary circulatory stabilisation with discontinuation of norepinephrine infusion was achieved within 10 hours, by excessive positive fluid balance, which took three days (22, 10 and 9 litres). Preliminary blood lactate 7 mmol/l was normalised within 24 hours. Blood albumin level 15 g/l was tolerated without any artificial replacement. The second hit appeared on day 10, in a form of septic shock caused by Aspergillus fumigatus infection from the lacerated left lower limb. High-volume continuous haemodiafiltration because of hyperpyrexia was used, after the exarticulation in the left knee-joint. An excessive proteolysis (urea loss more than 1000 mmol/day) persisted 1.5 months, with energy expenditure over 2600 kcal/day. The patient underwent multiple surgical interventions. Metabolic support using combined parenteral and enteral nutrition was performed during the first month, enteral nutrition combined with food were consequently given for more than 3 months. The patient was hospitalised until April 26, 2010. These types of traumas are fully comparable with military battlefield environment injuries. Principles of war surgery (life and limb saving, damage control surgery) should be applied also in civilian environment, particularly in disaster situations.

The ability of three oximes (HI-6, trimedoxime, K203) to reduce cyclosarin-induced acute neurotoxic signs and symptoms was compared with the neuroprotective efficacy of two combinations of oximes (HI-6 + trimedoxime, HI-6 + K203) using a functional observational battery. Cyclosarin-induced neurotoxicity and the neuroprotective effects of HI-6, trimedoxime or K203 alone and HI-6 combined with trimedoxime or K203 in rats poisoned with cyclosarin at a sublethal dose (80 μg/kg i.m.; 70% of LD₅₀ value) were monitored by the functional observational battery at 24 hours and 7 days following cyclosarin challenge. The results indicate that all types of antidotal treatment are able to survive cyclosarin-poisoned rats 7 days following cyclosarin poisoning while one non-treated cyclosarin-poisoned rats died within 24 hours following cyclosarin challenge. All three oximes alone as well as both oxime mixtures combined with atropine were able to slightly decrease cyclosarin-induced neurotoxicity in the case of sublethal poisoning but they did not eliminate all cyclosarin-induced acute neurotoxic signs and symptoms. Their ability to reduce cyclosarin-induced acute neurotoxicity was almost the same regardless of type of antidotal treatment. Thus, the tested combinations of oximes were not able to increase the neuroprotective effectiveness of antidotal treatment of acute cyclosarin poisoning compared to the individual oximes.

Aim: Cytokinesis-block micronucleus (CBMN) assay and its comprehensive variant CBMN cytome assay are cytogenetic methods. CBMN is based on assessment of micronuclei in nucleated cells that have completed only one nuclear division. Besides micronuclei, CBMN cytome assay analyzes additional genotoxic (nucleoplasmic bridges and nuclear buds), cytostatic (nuclear division index), and cytotoxic (amount of necrotic and apoptotic cells) parameters. The aim of this study is to evaluate these parameters in human blood lymphocytes after in vitro irradiation and to assess its contribution to biodosimetry. Material and methods: Human blood from 6 donors was in vitro irradiated by 0, 1, 2, 3, 4, or 5 Gy and cultivated for 72 hours. Blood lymphocytes were stimulated with phytohemagglutinin and their cytokinesis was blocked by cytochalasin B. After cultivation, cultures were hypotonically treated, dropped onto glass slides and stained with Giemsa. Slides were evaluated by microscope. Results: We observed significantly increased amount of micronuclei, nucleoplasmic bridges, and nuclear buds measured in binucleated cells, significantly increased amount of micronuclei measured in mononucleated cells and significantly decreased nuclear division index after irradiation by 1, 2, 3, 4, and 5 Gy. Amount of death cells (apoptotic and necrotic) significantly increased after irradiation by 4 and 5 Gy. Conclusion: Although all parameters assessed by CBMN cytome assay have biodosimetric potential, practically feasible is only evaluation of micronuclei in binucleated cells. This parameter was used to construct in vitro linear-quadratic dose-response calibration curve which could be used as a biodosimetric tool for triage of radiation casualties.

The discipline of medical ethics is concerned with morality, moral obligations and the principles of proper professional conduct concerning the rights and duties of a physician himself, his patients and fellow practitioners, as well as his actions in the care of patients and in relation with their families. Its foundations lie in the philosophical traditions of Eastern and Western thought and have strongly shaped modern codes of conduct and conventions...