doc. Ing. Vratislav Fabián, Ph.D.

Objective: Pathophysiology explanations for functional movement disorders often assume a role for emotional hyperarousal. Pupillometry is a validated method for evaluation of emotional arousal by detecting changes in pupil size in response to emotional stimuli. In a case-control study design, we aimed to study objective and subjective emotional arousal using pupillometry and affective ratings. To assess attentional engagement by affective stimuli, we used videooculographic tracking of eye movement patterns (scanpath). Methods: Twenty-five female patients with functional movement disorders (mean age: 40.9 [SD 12.7] years) and 23 age matched healthy female controls participated in the study. Using infrared high-resolution eye-tracker, both pupil size and eye movement pattern in response to emotionally charged erotic, adventure, threat, victim, and neutral pictures were recorded along with subjective ratings of emotional valence and arousal of the presented pictures. Results: A between-group comparison showed significantly smaller pupil dilation to adventure stimuli compared to neutral stimuli in patients compared to controls (P < 0.004, bootstrap, uncorr., adj. η2 = 0.00). No significant difference in pupillary response to other stimuli and scanpath parameters was found between the groups. Patients rated significantly lower emotional arousal to erotic pictures than controls (P < 0.001, bootstrap, uncorr., adj. η2 = 0.09). Conclusion: This study did not find evidence of autonomous or subjective emotional hyperarousal. The mismatch between objective autonomic measures and subjective arousal ratings in patients is of pathophysiological interest and in line with recent findings of impaired interoception in functional movement disorders.

Úvod: Endovenózní laserová ablace (EVLA) je uznávaná alternativa chirurgické léčby varixů, ale optimální laserový generátor a jeho nastavení jsou předmětem diskuse. Účelem sdělení bylo korelovat klinické výsledky s teoretickou výhodou užití laserového diodového generátoru vlnové délky 1940 nm, který generuje záření s vysokou absorpcí tepla v tenké vrstvě koagulované tkáně. Metody: V období od 1/2010 do 12/2021 byla provedena EVLA celkem u 3529 konsekutivních pacientů s křečovými žilami a sonograficky prokázanou insuficiencí povrchových žil dolních končetin. Postupně jsme užívali tři typy laserových generátorů s vlnovou délkou 1064, 1470, resp. 1940 nm. Všichni pacienti byli prospektivně zařazeni do registru, absolvovali časnou pooperační kontrolu s objektivizací neprůchodnosti žilního segmentu a další kontroly v případě komplikací. Výsledky: Úspěšnost žilního uzávěru se u všech tří laserů nelišila (p=0,054) a přesáhla 98 %. Katetrizační metoda umožnila provést více ablací během jednoho výkonu s trendem 1,08, 1,31 a 1,62. V roce 2021 byl u laseru Tethys 1940 nm počet výkonů na pacienta 1,79. U tohoto laseru bylo, z důvodu vyššího absorpčního koeficientu záření pro vodu, možno snížit celkovou aplikovanou energii na polovinu (8 W, 50−80 J/cm). Pacienti po EVLA tímto laserem měli příznivější pooperační průběh, přestože bylo provedeno více ablací najednou. U 95,6 % pacientů byla provedena jen časná pooperační kontrola (p<0,001). Závěr: Studie prokázala, že všechny užité laserové generátory měly stejnou efektivitu, co se týče uzávěru žilního segmentu. Při užití diodového laseru vlnové délky 1940 nm bylo možno snížit výkon laseru na polovinu. Pacienti měli lepší pooperační průběh, přestože bylo provedeno více výkonů během jedné operace.

Czech physiologist Penaz tried to overcome limitations of invasive pulse-contour methods (PCM) in clinical applications by a non-invasive method (finger mounted BP cuff) for continuous arterial waveform detection and beat-to-beat analysis. This discovery resulted in significant interest in human physiology and non-invasive examination of hemodynamic parameters, however has limitations because of the distal BP recording using a volume-clamp method. Thus, we propose a validation of beat-to-beat signal analysis acquired by novel a brachial occlusion-cuff (suprasystolic) principle and signal obtained from Finapres during a forced expiratory effort against an obstructed airway (Valsalva maneuver). Twelve healthy adult subjects [2 females, age = (27.2±5.1) years] were in the upright siting position, breathe through the mouthpiece (simultaneously acquisition by brachial blood pressure monitor and Finapres) and at a defined time were asked to generate positive mouth pressure for 20 s (Valsalva). For the purpose of signal analysis, we proposed parameter a “Occlusion Cuff Index” (OCCI). The assumption about similarities between measured signals (suprasystolic brachial pulse waves amplitudes and Finapres’s MAP) were proved by averaged Pearson’s correlation coefficient (r=0.60,p<0.001). The averaged Pearson’s correlation coefficient for the comparative analysis of OCCI between methods was r=0.88,p<0.001. The average percent change of OCCI during maneuver: 8% increase, 19% decrease and percent change of max/min ratio is 35%. The investigation of brachial pulse waves measured by novel brachial blood pressure monitor shows positive correlation with Finapres and the parameter OCCI shows promise as an index, which could describe changes during beat-to-beat cardiac cycles.

Introduction: Tinnitus is an intrusive and chronic illness affecting a significant portion of the population, decreasing affected individuals’ quality of life and socioeconomic functioning. Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulatory method utilizing weak electrical currents to elicit short and long-term central nervous system changes. Several studies have proven its effect on tinnitus. We aimed to broaden the knowledge and provide data on the effect and its retention. Methods: In the randomized, double-blinded, sham-controlled trial, 39 patients (active n = 19, sham n = 20) underwent bifrontal tDCS (anode over right dorsolateral prefrontal cortex (DLPFC), cathode left DLPFC, current of 1.5 mA, 20 min, 6 sessions in 2 weeks). Tinnitus Functional Index (TFI), Iowa Tinnitus Handicap Questionnaire (ITHQ), Beck Anxiety Inventory (BAI), Zung Self-Rating Depression Scale (SDS), and WHO-Quality of Life-BREF were employed in 4 evaluation points, including the follow-ups of 6 weeks and 6 months. Results: We reached a delayed, significant long-term improvement (p < 0.05) in auditory difficulties associated with tinnitus and noticed it even after 6 months compared to placebo. We also reached a short-term, negative effect in the psychological domain of WHO-Quality of Life-BREF (p < 0.05). Not all subdomains of TFI and ITHQ reached statistical significance during the data analysis, even though specific positive trends were noticed. Conclusion: We proved partial, positive, long-term effects of tDCS on tinnitus and short-term, negative, transient effect on a specific aspect of the general quality of life. We expanded upon the results of previous trials and provided data concerning the longevity and the precise effect of multiple sessions, bifrontal DLPFC tDCS. Our sample size (n = 39) was limited, which might have contributed to the lesser statistical power of the analyzed items.

There are not many studies dealing with a comparison of the eye movements of individuals with dyslexia and developmental language disorder (DLD). The aim of this study is to compare the eye movements in the two most common language disorders, dyslexia and DLD and to consider their contribution to diagnostics. In the research the oculomotor test was administered to 60 children with the clinical diagnosis of dyslexia or DLD and 58 typically developing children (controls). The test included a prosaccadic task, antisaccadic task and a nonverbal sequential task with self-regulation of the pace. Controls could be singled out from other two clinical groups by means of the oculomotor imaging. Both of the clinical groups in comparison with the controls were characterized by worse overall performance. Through the employment of the oculomotor it was possible to differentiate between both of the clinical groups. The dyslexics had an overall worse oculomotor performance than the DLD group. The results of the study show that the oculomotor test has the potential to contribute to diagnostics of dyslexia and DLD and the screening of these disorders at pre-school age.

The standard ISO 81060–2:2018 allows the use of invasive blood pressure monitoring systems as reference gauges in clinical trials of automated non-invasive automated sphygmomanometers. The reference measuring system is subject to requirements for a maximum permissible error of ±2 mmHg, and the resonant frequency and damping coefficient must also be characterized. The 'catheter-sensor' system used in clinical practice only has defined parameters required by the standard for the chamber with the pressure sensor. The characteristic parameters of the whole measuring system cannot be defined even when the type of catheter used is known, because after every irrigation the system changes the values of its natural frequency (fn) and damping ratio (ζ). These parameters directly define the frequency response of the system, its resonant frequency and the damping coefficient. The characteristic parameters of the 'catheter-sensor' system were defined on the basis of an analysis of a second-order linear model and the measurement of the step response of the real system. Measurements have shown that repeated irrigation of the same 'catheter-sensor' system can change the value of the system’s natural frequency by tens of Hz. In well-irrigated systems, the accuracy required by the standard was met. The following values were determined for this system: fn = 38.8 Hz and ζ = 0.130. In the second case, when the system was probably affected by air bubble compliancy, the measurement accuracy was much lower. The discovered deviation was tens of mmHg. This system had fn = 6.5 Hz a ζ = 0.281.

Introduction: Endovenous Laser Ablation (EVLA) is a common alternative to surgical treatment of varicose veins. The aim of our study was to demonstrate that laser occlusion is durable, that we can treat all patients in a one day setting, even with veins >10mm in diameter, and that multiple EVLAs can be done at the same time. Methods: In the period from 1/2017 to 12/2019 EVLA was performed in a total of 1551 consecutive patients with varicose veins and ultrasonographically documented venous reflux. The mid-term results were evaluated in a group of patients operated from 1/2017 to 6/2017 (316 pts.). We compared a risk group that consisted of patients with veins >10mm in diameter (40 pts.) with a control group (the remaining 276 pts.). Patients with veins >10mm are traditionally considered as candidates for conventional surgery. Results: The catheter-based method enabled us to perform more ablations in one procedure. In 2019 we performed 1.44 EVLA procedures per patient. There was only one postoperative follow-up visit, indicating an uncomplicated postoperative course, in 87.5% of patients of the risk group. In the control group 100% of patients had only one follow-up visit including ultrasound examination, showing an uncomplicated postoperative course (p<0.001). There was no difference in the incidence of complications. Ultrasonographic follow-up was performed in the risk group. Veins larger in diameter revealed complete disintegration early, but at the end of the follow-up period (mean 33 ± 6 months) they disappeared completely. Conclusion: The study showed good mid-term results of EVLA of the saphenous vein in the outpatient setting and the feasibility of performing multiple ablations in a non-selected group of patients using local anaesthesia. Laser destruction of the vein was shown to be permanent. Perfect familiarity with the diagnostic procedure using ultrasonography and early patient follow-up are required to achieve reproducibility.

Purpose: The purpose of this study was to evaluate the relationship between the cuff pulsatility index and invasively determined arterial pulsatility in patients with a left ventricular assist device. Methods: Twenty-three patients with a left ventricular assist device with end-stage heart failure (six females: age = 65 ± 9 years; body mass index = 30.5 ± 3.7 kg m−2) were recruited for this study. Suprasystolic occlusions were performed on the upper arm of the patient’s dominant side, from which the cuff pressure waveform was obtained. Arterial blood pressure was obtained from the radial artery on the contralateral arm. Measurements were obtained in triplicate. The relationship between the cuff pressure and arterial blood pressure waveforms was assessed in the frequency-domain using coherence analysis. A mixed-effects approach was used to assess the relationship between cuff pulsatility index and invasively determined arterial pulsatility (i.e. pulse pressure). Results: The cuff pressure and arterial blood pressure waveforms demonstrated a high coherence up to the fifth harmonic of the cardiac frequency (heart rate). The cuff pulsatility index accurately tracked changes in arterial pulse pressure within a given patient across repeated measurements. Conclusions: The cuff pulsatility index shows promise as a non-invasive index for monitoring residual arterial pulsatility in patients with a left ventricular assist device across time.

Hemodiafiltration (HDF) adds convective elimination of middle molecules (MM), proportional to filtered volume (Vconv) on the top of diffusion-based elimination of small molecules (SM) by conventional hemodialysis (HD). Studies, both observational and randomized controlled ones, performed so far generally indicated positive impact of higher Vconv on all-cause mortality in HDF patients, although the magnitude of Vconv at which HDF becomes apparently superior to HD differed widely among the studies. Also the issue of a suitable anthropometric parameter by which the Vconv should be normalized has not yet been solved. Data from the ESHOL study seems to indicate that patient´s body surface area (BSA) could well be used for this—mortality was decreasing with increasing Vconv/BSA with a bottom plateau starting at about 15 L/m2. We have therefore devised a formula and a graph for determination of Vconv which fulfils the requirement Vconv/BSA= 15. Assuming maximum feasible and safe filtration fraction QF/QB= 0.3, the Vconv actually defines the necessary blood flow (QB) to reach Vconv/BSA= 15 as QB=15·BSA/(0.3·t) (t – session time). It is also possible to check what QB is needed in terms of sufficient diffusion-based transport (target Kt/V) and compare both QB values to see if adequate combined elimination of both SM and MM can be achieved at the same time and under what conditions, respectively.

We describe a case of a right-handed, 42-year-old, Caucasian female patient who manifested a set of unusual adverse effects during maintenance ultrabrief right-unilateral electroconvulsive therapy (ECT)—generalized myoclonic secondary seizure with lateralization nonresponsive to repeated intravenous diazepam application, deviation of the tongue and the head to the left, ping-pong gaze with nystagmoid jerks, postictal hypoactive confusion state lasting 15 minutes (with a total time to recovery 30 minutes), and likely Todd's paralysis after the procedure (subsided within 24 hours). These adverse effects led to a thorough clinical investigation and eventually the discovery of a brain tumor. In the article, we hypothesize about the possible interaction between the intracranial mass and ECT and provide a literature overview on the topic. Cases like this are likely underreported, and although several studies demonstrate that ECT can be applied safely to patients with an intracranial mass, this report demonstrates that brain tumor can interfere with ECT in an unpredictable way and have severe consequences (eg, unresponsiveness to diazepam when attempting to halt the seizure as our patient). Unusual symptoms after ECT, albeit reversible, such as in this case report, should be followed by a thorough neurological check-up to exclude any underlying organic pathology.

Cardiovascular disease is the most common cause of death in developed countries. Blood measurement is an integral part of the diagnosis of these diseases. With the development of oscillometric blood pressure monitors, the question of regular monitoring of their clinical accuracy (overall error) has arisen. This paper deals with the overall accuracy of two commercial tonometers (Hartmann Digital HG 160 comfort and HuBDIC HBP–1520), using two calibrated blood pressure simulators (Fluke BP Pump 2 and Fluke ProSim). Using the Wilcoxon rank-sum test, significant differences between the simulators have been proved for all measurements – both for SBP and DBP measurements and both for Hartmann Digital HG 160 and HuBDIC HBP–1520 tonometers (p < 0.001). Therefore, without the precise knowledge of the relationship between the blood pressure monitor and the simulator used, it is not appropriate to use simulators to determine the overall error. On the other hand, the tested devices had a very good repeatability of the measurements at all presets, with both simulators. From this point of view, it is suitable to use simulators to determine the stability of measurement by a given tonometer rather than its clinical accuracy.

INTRODUCTION: Catheter-Based Endovenous Laser Ablation (EVLA) is a commonly used alternative to surgical treatment of varicose veins. Recently, catheterization methods have proved to be methods of choice due to the preference of patients who value minimal invasiveness. Research of EVLA currently focuses on optimization of the procedure, which includes study of the benefits of the individual types of laser generators and the wavelengths used. In this observational study we compared our early results in a non-selected population of consecutive patients treated with two different types of lasers. METHODS: In the period from February 2010 to June 2017, EVLA was performed in a total of 1747 consecutive patients (74% were female) with venous reflux. The average vein width was 8.5 mm (525 mm). Our study sought to compare a more economical 1470nm diode laser (DL) generator (Velas 2, China) - used to operate on 630 patients - with a Nd-Yag crystal generator (Fotona - Slovenia) used in 1117 patients. All operations were performed using the same methodology, in an outpatient setting, in one specialized center. All procedures were completed in local tumescent anesthesia under peroperative ultrasound control. Postoperative sonography was performed in all patients. RESULTS: The results did not show a statistically significant difference in early closure rates (98.8% for Nd-Yag versus 99.8 for DL p-ns). Early recurrence was observed in 9 patients (15 vein segments) and managed successfully with early re-intervention and closure in all cases. The causes of incomplete closure included mainly the known risk factors (anticoagulation therapy, history of varicophlebitis). There was no correlation with larger venous diameter. In 6 patients, thrombus prolapse was observed in the deep femoral vein lumen. All cases were successfully cured after a week of low-molecular-weight heparin therapy. Only one case of low-risk pulmonary embolism was reported in a patient who failed to follow the regime recommendations. CONCLUSION: This evidence did not show a significant difference in closure reliability and the amount of complications of the endovenous laser ablation of large and small saphenous vein with a 1060nm Nd-Yag crystal compared to the more economical 1470nm diode laser generator.

Elektrokonvulzivní terapie (EKT) je biologická metoda léčby v psychiatrii, která byla poprvé v léčbě psychických obtíží aplikována před 80 lety. Její účinnost v léčbě řady závažných akutních duševních onemocnění nebyla dosud překonána. V současnosti se používá ve většině lůžkových psychiatrických zařízení v České republice. Za dobu užívání EKT došlo k výrazné modernizaci a modifikaci metody a v dnešní době je tato léčba bezpečná, s minimálním výskytem nežádoucích účinků. Navzdory tomu je stále spojena se značnou stigmatizací nejen u veřejnosti, ale i mezi lékaři. Poslední ucelená publikace o EKT vyšla před 20 lety, proto se autoři rozhodli zpracovat současné poznatky do souhrnné publikace. Cílem je obeznámit odborníky i širší veřejnost s podstatou a pravidly používání elektrokonvulzivní léčby. Úvodní teoretická část přináší informace o historii a vývoji EKT i o příčinách její stigmatizace. Popisuje mechanismus působení této metody, shrnuje poznatky o její účinnosti a srovnává její využívání v České republice a ve světě. Druhá část přináší praktické informace pro používání EKT v běžné praxi. Popisuje indikace a kontraindikace této terapie, věnuje se možným nežádoucím účinkům a možnostem jejich minimalizace. Přináší také poznatky o léčbě specifických skupin nemocných (seniorská populace, děti, těhotné ženy, pacienti s neurologickou diagnózou). Závěrem jsou zmíněny nové varianty EKT – udržovací a pokračovací – a vize léčebného užití v blízké budoucnosti.

Cardiovascular diseases are one of most frequent cause of morbidity and mortality in the world. There is an emerging need for integrated, non-invasive, and easy-to-use clinical tools to assess accurately cardiovascular system primarily in the preventative medicine. We present a novel design for a non-invasive pulse wave velocity (PWV) assessment method integrated in a single brachial blood pressure monitor allowing for up to 100 times more sensitive recording of the pressure pulsations based on a brachial occlusion-cuff (suprasystolic) principle. The monitor prototype with built-in proprietary method was validated with a gold standard reference technique SphygmoCor VX device. The blood pressure and PWV were assessed on twenty-five healthy individuals (9 women, age (37 ± 13) years) in a supine position at rest by a brachial cuff blood pressure monitor prototype, and immediately re-tested using a gold standard method. PWV using our BP monitor was (6.67 ± 0.96) m/s compared to PWV determined by SphygmoCor VX (6.15 ± 1.01) m/s. The correlation between methods using a Pearson’s correlation coefficient was r = 0.88 (p < 0.001). The study demonstrates the feasibility of using a single brachial cuff build-in technique for the assessment of the arterial stiffness from a single ambulatory blood pressure assessment.

The gold standard for noninvasive blood pressure (BP) measurement, the Doppler technique, does not provide systolic blood pressure (SBP) and diastolic blood pressure (DBP) and may limit therapy outcomes. To improve patient care, we tested specifically designed experimental BP (ExpBP) monitor and the Doppler technique by comparing noninvasive measures to the intraarterial (I-A) BP in 31 patients with end-stage heart failure (4 females) 2.6 ± 3.4 days post-LVAD implantation (20 HeartMate II and 11 HeartWare). Bland–Altman plots revealed that the ExpBP monitor overestimated mean arterial pressure (MAP) by 1.2 (4.8) mm Hg (mean difference [standard deviation]), whereas the Doppler by 6.7 (5.8) mm Hg. The ExpBP SBP was overestimated by 0.8 (6.1) mm Hg and DBP by 1.9 (5.3) mm Hg compared with the respective I-A pressures. Both techniques achieved similar measurement reliability. In the measurement “success rate” expressed as a frequency (percent) of readable BP values per measurement attempts, Doppler accomplished 100% vs. 97%, 97%, and 94% of successful detections of MAP, SBP, and DBP provided by the ExpBP monitor. The ExpBP monitor demonstrated higher accuracy in the MAP assessment than the Doppler in addition to providing SBP and DBP in majority of subjects. Improved BP control may help to mitigate related neurologic adverse event rates.

Kapitola se zabývá popisem technických parametrů elektrokonvulzivní terapie z hlediska bezpečnosti pacienta.

Pupil responses are known to indicate brain processes involved in perception, attention and decision-making. They can provide an accessible biomarker of human memory performance and cognitive states in general. Here we investigated changes in the pupil size during encoding and recall of word lists. Consistent patterns in the pupil response were found across and within distinct phases of the free recall task. The pupil was most constricted in the initial fixation phase and was gradually more dilated through the subsequent encoding, distractor and recall phases of the task, as the word items were maintained in memory. Within the final recall phase, retrieving memory for individual words was associated with pupil dilation in absence of visual stimulation. Words that were successfully recalled showed significant differences in pupil response during their encoding compared to those that were forgotten - the pupil was more constricted before and more dilated after the onset of word presentation. Our results suggest pupil size as a potential biomarker for probing and modulation of memory processing.

Introduction Catheter-based endovenous laser ablation (EVLA) is a widely used alternative to surgery and is slowly becoming a state of the art method in the treatment of varicose veins. In this observational study we sought to determine whether the method is safe and feasible in an unselected population of patients and if it can be used on more vein segments during one procedure. Methods and results From February 2010 to March 2016 EVLA was performed in 1209 venous segments in 1117 consecutive patients (74% women) with venous reflux. Mean diameter of ablated segments was 9.3 mm (range 5–25 mm). All procedures were performed on an out-patient basis using local tumescent anesthesia. Intraoperative sonographic guidance was mandatory. Early closure was successful in 98.8% of treated venous segments. Early non-closure occurred in 9 patients (15 treated segments) and all were successfully resolved by early re-EVLA. The causes of incomplete closure were mainly of technical character due to the learning period – low energy, non-closure of proximal tributaries, non-complete emptying of the vein during procedure. Non-closure was not related to diameter of the vein. In 6 patients the prolapse of the thrombus into the lumen of deep femoral vein was noted. The thrombus resolved after one week treatment with low molecular weight heparin. Low-risk pulmonary embolism was observed in one non-compliant patient. Conclusion EVLA of the greater saphenous vein, small saphenous vein and large tributaries in the treatment of symptomatic reflux is a flexible, safe, effective and reproducible method. The closure of venous segments was performed without limitation in venous diameter and amount of segments.

Systemic arterial blood pressure (BP) is one of the most important parameters of the cardiovascular system. An oscillometric NIBP monitor was specifically designed to measure oscillometric pulsations and mean arterial pressure (MAP) during inflation and deflation of the cuff. Nineteen healthy young (age 23.1±1.7 years; mean±SD) and 35 elderly (83.9±7.9 years; mean±SD) subjects were studied. Differential analysis of MAP during inflation and deflation show mean |ΔMAP|=2.9±2.6 mm Hg in the young group (mean±SD) and |ΔMAP|=6.3±5.2 mm Hg for seniors (mean±SD). There was a significant difference (p<0.05) in means of |ΔMAP| measured during cuff inflation and cuff deflation between both groups. In about 50% of elderly subjects |ΔMAP| was higher than 5 mm Hg. Potential clinical relevance of the method needs to be further evaluated.

Cardiac output (CO) assessment as a basic hemodynamic parameter has been of interest in exercise physiology, cardiology and anesthesiology. Non-invasive techniques available are technically challenging, and thus difficult to use outside of the clinical or laboratory setting. We propose a novel method of non-invasive CO assessment using a single upper arm cuff. The method uses the arterial pressure pulse wave signal acquired from the brachial artery during 20 second intervals of suprasystolic occlusion. This method was evaluated on a cohort of 12 healthy individuals (age of 27.7±5.4 years, 50% male) and compared to an established method for non-invasive CO assessment, the open circuit acetylene method (OpCirc) at rest, and during low- to - moderate intensity exercise. CO increased from rest to exercise (rest: 7.4±0.8 vs. 7.2±0.8; low: 9.8±1.8 vs. 9.9±2.0; moderate: 14.1±2.8 vs. 14.8±3.2 l/min) as assessed by the cuff-occlusion and OpCirc techniques, respectively. The average error of experimental technique compared to OpCirc was -0.25±1.02 l/min, Pearson's correlation coefficient of 0.96 (resting + exercise), and 0.21±0.42 l/min with Pearson's correlation coefficient of 0.87 (rest only). Bland-Altman analysis demonstrated good agreement between methods (within 95% boundaries) the reproducibility coefficient (RPC) = 0.84 l/min with R2=0.75 at rest and RPC=2 l/min with R2=0.92 at rest and during exercise, respectively. In comparison with an established method to quantify cardiac output, the cuff-occlusion method provides similar measures at rest and with light to moderate exercise. Thus we believe this method has the potential to be used as a new noninvasive method for use during exercise.

Text příspěvku je zaměřen na prezentaci vybraných výsledků a zkušeností získaných při řešení projektu Sledování očních pohybů pro diagnostiku v neurovědách č. TA01011138 podpořeného Technologickou agenturou ČR. Při řešení projektu byla vyvinuta potřebná technologie ke sledování očních pohybů, vznikla sada okulometrických testů a navrženou videookulografickou metodou bylo změřeno více než 350 žáků základních škol. Cílem provedeného experimentu bylo ověřit možnosti využití technologie ke sledování očních pohybů při diagnostice specifických vývojových poruch učení, a to zejména dyslexii. V následujícím textu je uveden popis použité technologie, navržené metody měření včetně okulometrických testů a získaných zkušenosti z provedeného experimentu s dětmi. Součástí textu jsou také vybrané výsledky měření ve vazbě na možnosti jejich využití v praxi.

Příspěvek je zaměřen na měření a zpracování hemodynamických parametrů k primárnímu screeningu aterosklerózy u pacientů napříč věkovým spektrem. Parametry kardiovaskulárního systému měříme pomocí neinvazivních metod široce uplatnitelných v klinické, ambulantní i domácí péči. Zpracované výsledky vycházejí z databáze více než 200 signálů nasbíraných během posledních 3 let. Příspěvek zahrnuje popis principů vyhodnocení pomocí několika metod, a navíc zmiňuje rizika chyb, kterých se dopouštíme při měření oscilometrickou metodou vlivem nedokonalosti použité manžety.

Exploring the emotions that can be induced by properly designed marketing communication messages is a modern and very interesting area of research in marketing. For measurements of the induced emotions various medical devices are used (eg, EEG, MRI, etc.) that can influence the natural behavior of the respondent in the course of the experiment. The following text aims to introduce the possibility of identifying other emotions that may be hidden in pupil size and its changes. An eye camera allows measurement of changes in pupil size depending on the projected visual stimulus. This paper presents the possibility of using eye cameras to identify the emotions that are demonstrated in an experiment carried out with known and unknown logos respectively.

This paper presents the design and realization of the hardware for measurement of hemodynamic parameters. The aim of the work has been to develop the hardware for sensing of biological signals such as the oscillometric pulsations in arm cuff and in wrist cuff, the photoplethysmography (PPG) signal and the electrocardiography (ECG) signal. The selection of signals allows a determination of selected hemodynamic parameters, which are important for primary screening of atherosclerosis, for example the pulse wave velocity (PWV) or the arterial stiffness index (ASI). The hardware is designed for measuring biological signals both during the increasing of pressure in the arm cuff and during the decreasing of the pressure. The measuring of oscillometric pulsations in the cuffs during the increasing of the pressure eliminates the artefacts caused by deformation of the arm tissues. The design and realization of the hardware is described in this paper. The paper includes the example of the measured signals and the short description of the initial signal database which has been created during verification of hardware. The paper presents the basic idea of primary screening of atherosclerosis using the selection of hemodynamic parameters in advance.

Tento příspěvek se zabývá možnostmi měření hemodynamických parametrů kardiovaskulárního systému neinvazivními metodami. První část je věnována teoretickému rozboru problematiky, metodice měření, zpracování signálů a jejich vyhodnocení. Je stručně popsáno několik parametrů, které jsou podstatné pro určení míry postižení cév aterosklerózou. Dále je čtenář stručně seznámen s návrhem vlastního zařízení a jeho konkrétní realizací v podobě funkčního vzorku na FEL ČVUT. Toto zařízení umožňuje synchronní měření všech potřebných biologických signálů, které jsou nezbytné pro vyhodnocení stavu kardiovaskulárního systému popsanými metodami a výzkum dalších signifikantních parametrů.

The eye tracking principles follow up the idea of pupil as a direct actuator. System of eye nerves is one of the closest to the brain, therefore its reaction time should be one of the shortest. Different methods are being used to measure eye movement, such as infrared-oculography, magneto-oculography, electro-oculography, or video oculography (VOG). Last method uses a camera device to capture images of eye movement. These images are analyzed afterwards, to determine trajectory of eye ball. Our research team has developed such device called I4Tracking®. This device contains high definition high speed digital camera with analyzing and visualizing software. The whole process of determination, where are people looking, uses simple mathematical and geometrical models connected into one complex solution. It starts with calibration before every measurement. It does not compute center of pupil, only tests if data needed for processing are valid. Different calibration method can reach better outputs in different environment. I4Tracking® has actually implemented two different methods based on 9 or 5 calibration points. 9 points method works as simple linearization process. New five point calibration is now being tested. It is based on mathematical model derived from 3D model of human head, eyeball and camera positions. Its theoretical preciseness is nearly 100%, but depends on sufficient number of prepared 3D simulations. At first point, black filled object is created from eye movement trajectory simulation. This picture is imported into Matlab to define x,y positions of each point. All coordinates are mapped to rectangle matrix afterwards. Detection algorithm finds only nearest neighbor by splitting space into two cells and coparing. Second stage is recording, which is realized by high speed camera capturing between 1 and 87 frames per second using 720x482 pixels resolution.

Exploring the emotions that can be induced by properly designed marketing communication messages is a modern and very interesting area of research in marketing. For measurements of the induced emotions various medical devices are used (eg, EEG, MRI, etc.) that can influence the natural behavior of the respondent in the course of the experiment. The following text aims to introduce the possibility of identifying other emotions that may be hidden in pupil size and its changes. An eye camera allows measurement of changes in pupil size depending on the projected visual stimulus. This paper presents the possibility of using eye cameras to identify the emotions that are demonstrated in an experiment carried out with known and unknown logos respectively.

Publikace popisuje zcela nové požadavky na přístrojové vybavení specializovaných lékařských ordinací a odpovídají požadavky na hygienické, metrologické, bezpečnostní i funkční kontroly těchto sofistikovaných zdravotnických prostředků. Dále jde uvedeny nové informační technologie, které nacházejí uplatnění v lékařské praxi, apod. Publikace vyšla jako příloha časopisů Intervenční a akutní kardilologie, Praktické lékařství, Medicína pro praxi, Interní medicína pro praxi,Pediatrie pro praxi, Urologie pro praxi, Neurologie pro praxi.

The paper presents the design and development of a signal database used for the determination of hemodynamic parameters. The signals from the database are used for the evaluation of new algorithms determining hemodynamic parameters. The signal database consists of synchronously obtained independent signals -- the records of oscillometric pulsations, the records of electrocardiograms (ECG) and the records of photoplethysmogram (PPG). Currently the signal database consists of signals from about 65 persons. The signals were recorded from persons in wide age range from 19 to 94 years. The signals were stored anonymously, but each set of signals was labeled by the ID number and the anamnestic data.

Our research is focused on two areas, namely on the heart rate variability (HRV) and on noninvasive continuous blood pressure estimation. In this paper, we describe relationships between HRV and both spontaneous and controlled respiration. In order to improve methods for continuous blood pressure estimation, the influence of averaging on correlation between pulse arrival time (PAT) and blood pressure is also studied.

Vision is among the most powerful sources of information provided by human senses. As much as 70 percent of stimuli come from the eyes and eye movements following the object of interest. The task of tracking eye movements in dependence on a visual stimulus is useful primarily in medical diagnosis and therapy, followed by scientific research and industry. The eye camera - the system I4Control(R) is a modern technical product enabling tracking eye movements and measuring of the size of the pupil. The supplementary computer application, I4Tracking(R), stimulates such movements visually, records them and evaluates the data collected.

The paper deals with the design of method for primary screening of atherosclerosis based on hemodynamic parameters. The method combines sensing of blood pressure using two-cuffs system with sensing of plethysmography and electro-cardiography signals. The designed method provides not only the measurement of blood pressure as a standard parameter of cardiovascular system, but also the measurement of several hemodynamic parameters such as pulse wave velocity (PWV) or arterial stiffness index (ASI). The design and realization of the device for measuring parameters given above are also described in the paper.

The focus of this paper is continuous non-invasive blood pressure monitoring. We used electrocardiography (ECG) and photoplethysmography (PPG) to compute pulse arrival time (PAT) between heart and finger. PAT was measured as the time difference between the R-peak of ECG and a characteristic point of PPG. We defined different characteristic points on PPG and compared their suitability for blood pressure estimation. Measurements were made on a group of 10 volunteers using an invasive blood pressure meter as reference. Generally, the best results were achieved when using time intervals from R-peak of ECG to the relative minimum preceding the rising edge of PPG. However, for some participants, differing parameters gave better results.

Dyslexie je vývojová porucha čtení, buď vrozená, nebo získaná poškozením mozku. Jedná se o omezenou schopnost naučit se číst navzdory normální inteligenci, dobrému tělesnému i duševnímu zdraví, přiměřené vzdělávací nabídce, motivaci a vyvíjenému úsilí dotyčného jedince. Je podmíněna poruchami v základních poznávacích schopnostech, přičemž jejich příčinou je nejčastěji dědičnost. Dále může být porucha způsobena změnami ve stavbě a funkci centrální nervové soustavy, které často vznikají v období těhotenství nebo kolem porodu, nedostatečným rozvojem některých psychických funkcí. U některých jedinců lze poruchu odstranit, u jiných přetrvává v určité podobě až do dospělosti. Podle statistik u 5-15 % populace může být diagnostikována určitá forma a míra specifické vývojové dyslexie. Jedná se tedy o velmi závažnou a rozšířenou poruchu, kterou je potřeba co nejdříve odhalit, abychom zabránili a předešli zbytečným psychickým újmám z pozdní diagnostiky.

The system I4Control(R) represents a novel type of computer periphery (an assistive technology), which enables handicapped people with various disabilities to control of a personal computer through movement of eyes or head. Since it emulates computer mouse, it provides its user by a unique chance to communicate with all installed SW applications by means of his/her eye movements. The system is based on the video-oculographic method of recording eye movements with a tiny camera, which catches up to the frame of spectacles. It is a simple, non-invasive and accurate method for monitoring eye movement. This solution does not require fixing the head.

We observed dependencies among blood pressure, pulse arrival time and pulse wave amplitude of photoplethysmogram in our studies. Measurements were made at the intensive care unit in Motol University Hospital in Prague and were compared with invasive blood pressure meter. The correlation coefficients between systolic or diastolic pressure and pulse arrival time achieved up to - 0.97, when averaging over 16 RR intervals. However, the range of the measured systolic and diastolic pressure is very low in some cases, and therefore we cannot do reliable conclusions. Correlations between pressure and amplitude of photoplethysmogram were still somewhat higher, however, a poor repeatability of such a measurement can be expected.

This chapter deals with various aids designed to compensate motor disabilities. Assistive technologies enable individuals with various physical disabilities to perform daily activities, help with communication, studying, work duties and/or leisure time activities. In essence, these technologies help their users to achieve a greater degree of independence and quality of life.

Podpůrnou nebo-li asistivní technologií můžeme nazvat jakýkoliv předmět, část zařízení nebo celý systém, který je využívaný na udržení nebo zlepšení funkční způsobilosti jednotlivců se zdravotním postižením. Jedná se o komplexní pojem zahrnující poruchy, choroby a omezení pohyblivosti nebo účasti na společenských aktivitách. Tyto technologie představují pomocný nástroj, který napomáhá při realizaci úkolů, které by byly bez této pomoci jinak těžko uskutečnitelné. Umožňují jednotlivcům se zdravotním postižením vykonávat každodenní aktivity, pomoci s komunikací, se studiem, pracovními povinnostmi nebo při rekreačních aktivitách. Ve své podstatě pomáhají klientům dosáhnout vyšší nezávislosti a kvality života.

Systém I4Control(R) je asistivní pomůckou, která handicapovanému uživateli umožňuje komunikovat s osobním počítačem prostřednictvím očních pohybů a tím mu zpřístupnit například veškeré informace a služby na Internetu. Aby systém I4Control(R) plně emuloval (nahrazoval) klasickou počítačovou myš, je doplněn o funkci pravého tlačítka. V základním menu má uživatel možnost zvolit tuto volbu, která ve většině aplikací vyvolá odpovídající kontextové menu.

Blood is carried from the heart to all parts of your body in vessels called arteries. Blood pressure is the force of the blood pushing against the walls of the arteries. Each time the heart beats (about 60 to 70 times a minute at rest), it pumps out blood into the arteries with different value of systolic pressure SP (highest blood pressure when the heart beats) and different value of diastolic pressure DP (lowest blood pressure when the heart relaxes) [3]. Values of SP and DP change during the whole day with dependence on person's physical and psychical activity.

Results obtained by the modern automatic blood pressure (BP) monitors using oscillometric method [5] are highly dependent on conditions of cardiovascular system of the monitored person. Especially, with people who suffer from cardiovascular diseases (e.g. aterosclerosis) the resulting values differ significantly from those measured by the traditional auscultation method. A reasonable solution for improvement of quality of oscillometric method could be a sophisticated intelligent BP measuring system which applies for evaluation of BP more complex approach taking into account the monitored person's condition of patient cardiovascular system (CS) i.e. the hemodynamic parameters of CS (e.g. heart rate, stroke volume, total peripheral resistance, systemic arterial compliance, pulse wave velocity, augmentnation index etc.). Such a system has to be based on appropriate models of the considered diseases which are validated on real life data.

This study compares accurancy of blood preasure measurement, which is measuremented by the commercial oscillometric monitor and by classic mercury sphygmomanometer.

Accuracy of measurement with the modern automatic blood pressure (BP) monitors using oscillometric method is highly depended on condition of cardiovascular system of the monitored person. Especially, with people who suffer from cardiovascular diseases (e.g. arteriosclerosis) the resulting accuracy is very different when compared to auscultation method. A reasonable solution for improvement of quality of oscillometric method could be an intelligent universal measuring system for evaluation of BP taking into account condition of patient cardiovascular system (CS) of monitored person i.e. the hemodynamics parameters of CS (e.g. heart rate, stroke volume, total peripheral resistance, systemic arterial compliance, pulse wave velocity, augmentnation index etc.).

This work introduces a new concept of supporting elderly at their homes. The whole framework is being developed under OLDES project: Older People's e-services at home. OLDES aims at developing a very low cost and easy to use entertainment and health care platform designed to ease the life of older people in their homes. The platform is based on a PC corresponding to Negroponte's paradigm of a € 100 device, giving the guarantee of an affordable system. OLDES provides: user entertainment services, through easy-to-access thematic channels and special interest forums supported by animators; and health care facilities based on established Internet and tele-care communication standards. As an example of OLDES platform implementation, two pilot projects are addressed: 100 clients pilot including 10 people with cardiological problems in Bologna, Italy and diabetes pilot in Prague, Czech Republic

Dlouhověkost je dnes ukazatelem civilizovanosti země. Zvyšující se životní úroveň, současná medicína a péče o vlastní zdraví jsou kreditem naší doby. S vyšším věkem se však objevují specifické zdravotní a sociální problémy. Starý člověk bývá často závislý na pomoci svého okolí, péče o něj mnohdy mění vztahy a úlohy jednotlivých členů rodiny či komunity [1]. Tato práce představuje nový koncept podpory starších lidí v prostředí domova. Celý program je zastřešen evropským projektem OLDES: Older People's e-services at home. Cílem projektu je vývoj nízkonákladového systému, který by usnadnil a obohatil život nejenom osamělým seniorům. Systém se skládá ze dvou hlavních částí: monitorovací a informační (zábavné).

Článek popisuje vznik, působení, hlavní směry výzkumu a vyučované předměty skupiny biomedicínského inženýrství na katedře fyziky ČVUT FEL

People do not copy just the randomness from the nature. It is the research area of the scientific field called Bionics. It aims to find solutions of the most variable problems in the nature, it observes living creatures/organisms and mimics their behaviour. Why it is the Mother Nature that improves its "developments" during thousands of years. Bionics is young and progressive science field that allows us to construct devices to support weakened organs supports or to build artificial organs. Since bionics is fast developing field it is important to choose the right tool for student education - elearning. The aim of our work is to create the hypertextbook with the multimedia components that clearly explain some topics from bionics. The information about a several courses is stored in an XML format which allows full availability of all informations from course.

Problematika provádění patřičných kontrol a revizí zdravotnických prostředků dle současné platné legislativy je zejména pro běžné provozovatele lékařských ordinací - lékaře - velmi vzdálená a nepřehledná. V následujícím článku je tedy kladen zvýšený důraz na popis této problematiky, seznámení čtenáře s aktuálním legislativním rámcem a prováděcími předpisy, a zejména pak s intervaly, v jakých se dané kontroly a revize mají provádět, kdo je smí vykonávat a jak mají vypadat doklady o jejich provedení.

Měření tlaku krve (TK) přístrojem, který využívá k vyhodnocení TK oscilometrické pulzace (OP), patří mezi nejoblíbenější metody automatického měření TK. Je však známým faktem, že mnoho současných oscilometrických měřidel má problémy s přesností měření. Zejména u osob trpících chorobami vaskulárního systému (např. arterioskleróza) či stavy, které kardiovaskulární stav přímo ovlivňují (např. těhotenství), se měření klasickou auskultační metodou s fonendoskopem a rtuťovým sfygmomanometrem značně rozchází s hodnotami naměřenými oscilometrickou metodou. Z tohoto důvodu se na Katedře kybernetiky ČVUT v Praze započalo s tvorbou databáze OP.

Měření krevního tlaku v ordinacích praktických lékařů, na klinikách a v nemocnicích patří mezi rutinní procedury. Zdravotnický personál je na tuto proceduru kvalitně vyškolen. Menší pozornost je však věnována výběru a péči o přístroj, se kterým se samotné měření tlaku provádí. Neznalost fyzikálních a technických parametrů přístrojů pro měření TK pak může vyústit v jejich nesprávné používání a zacházení s nimi. V článku je zaměřena pozornost na udržování dlouhodobé technické kvality tonometrů, čehož lze dosáhnout pravidelnými kontrolami tzv. metrologickým ověřením měřidla. Toto ověření je předepsáno ze zákona a provádí ho Český metrologický institut ČMI a autorizovaná metrologická střediska AMS. Pravidelné metrologické ověření tonometrů by tedy mělo být samozřejmostí této péče. Lze tak předejít případným pokutám či právním sporům, ale zejména je tím pro pacienty zajištěno měření TK na kvalitních a přesných přístrojích.

Neinvazivní měřidla tlaku krve jsou dle vyhlášky MPO 345/2002 Sb. měřidla stanovená k pravidelnému ověřování. Pokud jsou tato měřidla používána ve zdravotnických zařízeních, jsou to zcela bezpochyby měřidla, která slouží k ochraně lidského zdraví a je tedy vhodné, aby tato měřidla byla pravidelně kontrolována. Cílem tohoto článku je zamyslet se nad významem krevního tlaku, jeho vlivu na lidské zdraví a rozborem vlastních metod měření tlaku krve ukázat, že je vhodné ponechat tato měřidla mezi stanovenými. V článku je dále zhodnocen současný stav mezi těmito stanovenými měřidly v ČR a jsou zde popsány problémy, které v této oblasti nastaly vstupem České republiky do Evropské unie.

People do not copy just the randomness from the nature. It is the research area of the scientific field called Bionics. It aims to find solutions of the most variable problems in the nature, it observes living creatures/organisms and mimics their behaviour. Why it is the Mother Nature that improves its "developments" during thousands of years. Bionics is young and progressive science field that allows us to construct devices to support weakened organs supports or to build artificial organs. Since bionics is fast developing field it is important to choose the right tool for student education - e-learning. The aim of our work is to create the hypertextbook with the multimedia components that clearly explain some topics from bionics. The information about a several courses is stored in an XML format which allows full availability of all informations from course.

People do not copy just the randomness from the nature. It is the research area of the scientific field called Bionics. It aims to find solutions of the most variable problems in the nature, it observes living creatures/organisms and mimics their behaviour. Why it is the Mother Nature that improves its "developments" during thousands of years. Bionics is young and progressive science field that allows us to construct devices to support weakened organs supports or to build artificial organs. Since bionics is fast developing field it is important to choose the right tool for student education - e-learning. The aim of our work is to create the hypertextbook with the multimedia components that clearly explain some topics from bionics. The information about a several courses is stored in an XML format which allows full availability of all informations from course.

One of the most important things in the recent biomedical engineering sphere, which is characteristic of rapid increasing complexity of the medical electric equipments, is a high quality education of the expectant bioengineers. There is a big demand for modern teaching aids. The main aim of this project was to design and construct a set of modular blocks of a galvanic isolation (isolation components) for education in biopotential processing, especially in electrocardiography. The set of modules is derived from typical structure of the modern medical equipment. Demonstrative description of principles was the main goal of the design, nevertheless the standard safety requirements defined in technical standards EN 60601 were applied. The most modern products of the world's leading producers were used during the design and construction.

Bionika je relativně mladá vědní disciplína, která vznikla v 60. letech minulého století. Za její počátky je již ale možno pokládat pokusy Leonarda da Vinciho (1452 - 1519) o sestrojení letadla s pohyblivými křídly na základě pozorování letu netopýrů. Úkolem bioniky je hledat inspiraci u živých organismů a tu pak přetvořit tak, aby byla použitelná pro člověka. Bionika studuje možnosti využití poznatků o stavbě a funkcích živých systémů k řešení technických a technologických problémů. Na katedře kybernetiky má tento předmět dlouhodobou tradici a je vyučován jak v magisterském, tak i doktorském studiu. V předmětu Bionika jsou probírána taková témata, jako např. kardiostimulátory, umělá ledvina, kloubní náhrady, ale také systémy člověk stroj či virtuální realita v medicíně. Tato vědní disciplína se rozvíjí velice rychle a je tedy nutné tomuto trendu přizpůsobit i výuku studentů. Vhodným nástrojem pro podporu výuky se stávají současné informační technologie - multimediální kurzy.

The main aim was to design and construct a set of modular blocks for education in biopotencial processing, especially in electrocardiography. The designed set of moduls serves as an educational aid for Biomedical engineering subjects at FEE CTU and at FBMI CTU and at 1st School of Medicine, Charles University. The set of moduls is derived from typical structure of the modern medical equipment. Demonstrative description of principles was the main goal of the design, nevertheless the standard safety requirements defined in technical standards CSN EN 60601-X-XX were applied. The most modern products of the world's leading producers were used during the design and construction.

It is increasingly clear that the traditional way of measuring blood pressure in the clinic or office frequently produces numbers that grossly overestimate a patient's true blood pressure level. This effect is often caused by so called "white coat" syndrome. Nowadays, for this reason it becomes more popular so called home monitoring of blood pressure, that attenuates this effect. In the paper, there is described specially telemedicine system for monitoring of blood pressure. The system consists of blood monitor equipment which automatically reports results of up-to-date patient's measurements to the doctor's monitoring and decision support (MDS) system using wireless communication. The MDS system can make an evaluation for the doctor who can immediately intervene if necessary. Introduction of such a system in practice can bring considerable improvement in the treatment of hypertension.

It is increasingly clear that the traditional way of measuring blood pressure in the clinic or office frequently produces numbers that grossly overestimate a patient's true blood pressure level. This effect is often caused by so called "white coat" syndrome. Nowadays, for this reason it becomes more popular so called home monitoring of blood pressure, that attenuates this effect. In the paper, there is described specially telemedicine system for monitoring of blood pressure. The system consists of blood monitor equipment which automatically reports results of up-to-date patient's measurements to the doctor's monitoring and decision support (MDS) system using wireless communication. The MDS system can make an evaluation for the doctor who can immediately intervene if necessary. Introduction of such a system in practice can bring considerable improvement in the treatment of hypertension.

It is increasingly clear that the traditional way of measuring blood pressure in the clinic or office frequently produces numbers that grossly overestimate a patient's true blood pressure level. This effect is often caused by so called "white coat" syndrome. Nowadays, for this reason it becomes more popular so called home monitoring of blood pressure, that attenuates this effect. In the paper, there is described specially telemedicine system for monitoring of blood pressure. The system consists of blood monitor equipment which automatically reports results of up-to-date patient's measurements to the doctor's monitoring and decision support (MDS) system using wireless communication. The MDS system can make an evaluation for the doctor who can immediately intervene if necessary. Introduction of such a system in practice can bring considerable improvement in the treatment of hypertension.

Traditional way of measuring blood pressure (BP) in the clinic frequently produces numbers that overestimate patient's true blood pressure level. This effect is often caused by so called "white coat syndrome". New technologies offer means to introduce home monitoring of BP that attenuates this effect. In the contribution, there is described design of a special telemedical system for monitoring of BP. The system consists of BP monitor equipment which automatically reports results of up-to-date patient's measurements to the doctor's monitoring and decision support (MDS) system using wireless communication. The MDS system can make preliminary evaluation for the doctor.