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lmportance of epicardial fat in heart diseases: new mechanism of action and their therapeutic implication
Matloch, Zdeněk ; Haluzík, Martin (advisor) ; Maruna, Pavel (referee) ; Lipš, Michal (referee)
It was documented earlier that epicardial fat is a source of pro-inflammatory mediators under basal conditions (Mazurek, Zhang et al. 2003, Baker, Silva et al. 2006). It was also found that during cardiac surgery there is an increased expression of mRNA for pro- inflammatory cytokines in both epicardial and subcutaneous adipose tissue (Kremen, Dolinkova et al. 2006). During advanced heart failure, an inflammation of adipose tissue and resistance to adiponectin was also discovered (Khan, Kato et al. 2012). As part of the project, we tested the hypothesis that changes in levels of pro-inflammatory and anti-inflammatory cytokines, including their expression in adipose, muscle and heart tissue, as well as changes in insulin resistance and lipid profile parameters, are dependent on the type of underlying disease of patients, either the presence of CAD or valve degeneration. The aim of our project was to investigate metabolic changes in various fat tissues, insulin resistance, pro-inflammatory and anti-inflammatory cytokines plasmatic levels and their mRNA expressions in patients with coronary artery disease (CAD) undergoing either elective coronary artery bypass surgery (CABG) or isolated valve replacement. Our patients underwent several blood tests and measurements like anthropometric, biochemical, and...
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New trends in perioperative monitoring and glycaemic control.
Lipš, Michal ; Kunstýř, Jan (advisor) ; Bešík, Josef (referee) ; Beneš, Jan (referee)
Glycaemic control in critically ill patients has been a topic of considerable attention for the past 20 years. In literature and at scientific meetings, there have been ongoing debates regarding the efficacy of glycaemic control in these patients with frequently entirely opposite opinions. These range from a strict invasive approach with target glycaemia 4-6 mmol/l to a liberal approach tolerating even values higher than 12 mmol/l. In the preview of this PhD thesis we have analysed so far published literature and describe the reasons for this inconsistency. According to the results of recent studies, the most significant efficacy of tight glycaemic control has been observed in cardiac surgical patients. If we consider the concept of tight glycaemic control as efficient strategy, there are three important questions remaining unanswered as follow. Does the specific algorithm-protocol play a key part in the concept of tight glycaemic control alongside the knowledge and skills of nursing staff in safe and efficient blood glucose control? What is the ideal timing of starting the strategy of tight glycaemic control (TGC) in cardiac surgical patient? And is there any benefit in outcome respect to mortality or morbidity? Do we have any more safe and efficient option or add-on to standard perioperative...
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