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Gender differences in myocardial apoptosis of the patients after heart tranplantation.
Smetana, Michal ; Szárszoi, Ondrej (advisor) ; Brát, Radim (referee) ; Neckář, Jan (referee)
Gender differences in myocardial apoptosis of the patients after heart transplantation Background: Many functions of the cardiovascular apparatus are influenced by gender. The aim of our study was to find out the sensitivity to perioperative ischemia of the donor female and male myocardium; and determine how the organism affects the donor myocardium of the other sex after heart transplantation (detection of apoptosis), and whether the investigated biomarkers can predict primary graft dysfunction (PGD). Methods: The research was divided into three prospective studies. The Study 1 included 81 patients undergoing heart transplantation from September 2010 to January 2013. Patients were divided into two groups according to male allograft and female allograft. In order to prove myocardial necrosis the high-sensitive cardiac troponin T (hs-cTnT) method was used. Apoptosis was determined by immunohistochemical detection of caspase-3, Bcl-2, and by the TUNEL method. The Study 2 includeded 58 patients divided into four groups according to gender; both of the recipient and the donor. Apoptosis (caspase-3, Bcl-2, TUNEL) was analysed in these groups during the two-year follow-up. Into Study 3 64 patients were involved. We investigated the relationship in between these biomarkers and the development of PGD after...
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Cardiac ischemic tolerance in rats subjected to adaptation to chronic hypoxia and physical exercise: the role of TNF-alpha.
Svatoňová, Anna ; Neckář, Jan (advisor) ; Maxová, Hana (referee) ; Szárszoi, Ondrej (referee)
Cardiovascular diseases represent the most important health risk factors because they are responsible for more than 50% of total mortality. Among them, the ischemic heart disease is leading cause of mortality. From the whole spectrum of different cardioprotective phenomena we have selected: 1) adaptation to chronic normobaric hypoxia (CNH) as the traditional experimental model in our laboratory area and 2) protective effect of exercise which in recent years represents promising and clinically relevant protective mechanism. The whole thesis is based on two studies. Aim of the first study was to characterize the expression of the main pro-inflammatory cytokine, TNF-α, in hearts of rats adapted to CNH. Chronic TNF-α inhibition by infliximab was used for discovering of certain role of TNF-α in CNH. We showed that increased myocardial level of TNF-α during adaptation to CNH was contributed via its receptor TNFR2 and nuclear factor κB-dependent activation of protective redox signalling with increased antioxidant defence. This adaptive pathway participates on the infarct size-limiting effect of CNH. Aim of the second study was find out whether exercise training and CNH could play synergy in cardiac protection in rats model. We reported that CNH and exercise reduced infarct size but their combination...
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Pulmonary hypertension
Chovanec, Milan ; Herget, Jan (advisor) ; Szárszoi, Ondrej (referee) ; Lindner, Jaroslav (referee)
4 Abstract Hypercapnia could be used in the treatment of critically ill patients with chronic hypoxia (cardio - pulmonary failure) as a prevention against the development of hypoxic pulmonary hypertension. This work showed the reason based on the observed difference between patients with chronic obstructive pulmonary disease and high altitude dwellers. Both groups have similar levels of oxygen saturation of haemoglobin, high altitude residents have no hypercapnia compared to patients with chronic obstructive pulmonary disease but hypercapnic sea level patients have less severe lung hypertension than mountain residents. Mortality of people with diagnosed pulmonary arterial hypertension is closely associated with right ventricle hemodynamic function (pulmonary arterial pressure, right atrial pressure and cardiac index). Recently, the therapy that has been used for pulmonary arterial hypertension has consisted of three main targets; firstly: endothelin receptor blockers, secondly: prostacycline and its analogues, thirdly: PDE-5 inhibitors in order to increase the concentration of endogenous NO and its mutual combination. Unfortunately, it is clear that the recent clinical therapy of pulmonary arterial hypertension is extremely expensive, with minimal or no effect on right ventricle hemodynamic function. In...
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Percutanous electrogastrography, principle and posibilities of clinical application in abdominal surgery
Fraško, Roman ; Krška, Zdeněk (advisor) ; Maršálek, Petr (referee) ; Szárszoi, Ondrej (referee)
Author of this dissertation presentation discuss in the begining definition and historical consequences of origin and consecutive evolution of the method of percutaneous electrogastrography. Intimately is described physiology, anatomy, embryology and function of gastrointestinal tract with special interest on construction and function of the stomach. Next to this author analyses current knowledge about location and function of the gastric pace setter. The technique of used perctutaneous electrogastrography equipmentt is described. In the second part results of original studies monitoring restoration of peristalsis in perioperative period at patients after open and laparoscopic cholecystectomy and laparoscopic non-adjustable gastric banding are discussed. Furthermore results of EGG measurement of patients with mechanic, vascular and paralytic intestinal obstruction are presented in correlation with plasma levels of interleukin 1β, interleukin-6, procalcitonin and C-reactive protein. Key words: Percutanous electrogastrography, laparoscopic cholecystectomy, laparoscopic gastric bandage, inflammatory mediators, intestinal obstruction.
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Oxygen consumption in awake cardiac surgical patients
Pořízka, Michal ; Stříteský, Martin (advisor) ; Szárszoi, Ondrej (referee) ; Šetina, Marek (referee)
OBJECTIVES: Standard blood flow rates for cardiopulmonary bypass have been assumed to be the same for awake cardiac surgery with thoracic epidural anesthesia as for general anesthesia. However, compared to general anesthesia, awake cardiac surgery with epidural anesthesia may be associated with higher oxygen consumption due to missing effect of general anesthetics. This may result in insufficient oxygen delivery and lactic acidosis when standard blood flow rates were used. The primary aim of our study was to investigate if standard blood flow rates are adequate in awake cardiac surgery. The secondary aim was to evaluate postoperative clinical outcomes of patients undergoing awake cardiac surgery. METHODS: Forty-seven patients undergoing elective on-pump cardiac surgery were assigned to receive either epidural (Group TEA, n=17), combined (Group TEA-GA, n=15) or general (Group GA, n=15) anesthesia. To monitor adequacy of standard blood flow rates, arterial lactate, acid base parameters, central venous and jugular bulb saturation were measured at six time points during in all groups. Blood flow rates were adjusted when needed. Subsequently, early and late postoperative outcome data including hospital and 3-year mortality was recorded and compared among the study groups RESULTS: No lactic acidosis has...
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The role of nitric oxide in cardioprotection induced by chronic hypoxia
Mandíková, Petra ; Neckář, Jan (advisor) ; Szárszoi, Ondrej (referee)
The aim of present project was to uncover the effect of pharmacological increase in acute and chronic nitric oxide (NO) production on cardioprotective effect of chronic hypoxia. We studied the effect of NO donor molsidomine on hemodynamic conditions and ischemia - induced myocardium injury. Male Wistar rats were exposed to continual hypoxia in a normobaric chamber (10 % O2, 4 weeks). Rats received molsidomine either chronically (15 mg/kg/day) in drinking water or acutely (10 mg/kg) in saline infused 30 min before ischemia. Control rats were kept under normoxia and treated in a corresponding manner. Adaptation to chronic hypoxia resulted in development of pulmonary hypertension. Chronic treatment with molsidomine slightly reduced these consequences of chronic hypoxia but it had no effect on increased cardiac ischemic tolerance in chronically hypoxic rats. On the other hand acute treatment with molsidomine significantly reduced infarct size and increased the number of arrhythmias in both normoxic and chronically hypoxic animals. In conclusion, our data suggests that acute increase in availability of NO is cardioprotective in both normoxic and chronically hypoxic rats contrary to its chronic increase which seems to have no protective contribution.
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