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The Influence of Selective Ventilation on the Concentration of Antibiotics in Lung Tissue - Microdialysis Study
Děrgel, Martin ; Manďák, Jiří (advisor) ; Šantavý, Petr (referee) ; Brát, Radim (referee)
Mini-invasive surgical techniques are currently replacing the standard open techniques. The advantages of these techniques consist of minimal surgical stress (small surgical wounds, integrity of the rib cage, better wound healing, and shorter time spent on mechanical ventilation), quicker convalescence periods and a return to ordinary life. The delicate and precise operating techniques in mini-invasive procedures require long- term preparation and training of the whole surgical team and a good visualization of the operation field with the aid of specialized surgical and optical instruments. In cardiac surgical patients, selected surgical techniques are carried out via a thoracotomy incision, preferably with selective ventilation, i.e., "one lung ventilation" with a collapsed lung allowing for better visualization. This method assures comfort to the operating surgeon, albeit this can lead to complications such as atelectasis and pneumonia. The administration of antibiotics minimizes the perioperative infection risk before every invasive cardiac procedure. Interstitial microdialysis is the preferred method to ascertain if the administered prophylactic antibiotic penetrates the pulmonary tissue. Microdialysis is a mini-invasive method that monitors exogenic and endogenic molecules in the extracellular...
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Effect of continuous blood flow on cerebrovascular perfusion and hemocoagulation in patients with implantable left ventricular assist device
Koňařík, Miroslav ; Szárszoi, Ondrej (advisor) ; Ošťádal, Petr (referee) ; Brát, Radim (referee)
Implantation of left ventricular assist devices (LVADs) is an integral treatment modality in patients with heart failure. In most cases, it refers to a machine which generates continuous blood flow with reduced pulse pressures. The effect of reduced pulsatility on organ function, such as homeostatic regulatory mechanisms is still unknown. The goal of our study was to understand whether continuous blood flow generated by mechanical support devices affects cerebrovascular regulatory mechanisms (study A), and whether or not hemocoagulation is affected in regard to complications relating to hemocompatibility (study B). Study A utilized finger plethysmography and TCD ultrasonography to detect possible changes in static cerebral auto-regulation when compared to a range of rotations per minute (rpm) of the LVAD, which served as a model for either accentuation or reduction in residual arterial pulsatility. Study B divided patients with implanted LVADs based on the incidence of selected thrombophilic mutations. Both groups of patients were placed on individualized anticoagulation protocols. The results were focused on the incidence of thromboembolic and hemorrhagic complications, and eventual morbidity/mortality of the patient. Our findings did not confirm disruption to static cerebral auto-regulation,...
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Changes in Expression of Membrane Molecules CD200R, CD95, CD95L, and Soluble CD200R Regulating inflammatory Responses in Patients Undergoing Cardiac Surgery
Holmannová, Drahomíra ; Krejsek, Jan (advisor) ; Brát, Radim (referee) ; Turánek, Jaroslav (referee)
Cardiac surgery is known to initiate a complex physiological response with the immune system activation (SIRS), neurohormonal response, metabolic changes, coagulopathies etc. SIRS is triggered by tissue injury, myocardial ischemia, reperfusion, use of anaesthesia, cardioplegia, extracorporeal circuit etc. Excessive immune system activation is associated with progression of SIRS, life-threatening multi-organ dysfunction (MOD), and increased morbidity/mortality in the postoperative period. The immune system response is regulated and terminated by both cellular and humoral regulatory and inhibitory mechanisms including changes in expression of in our study monitored molecules: CD200/CD200R, sCD200R and CD95/CD95L. Methods: The study included the measurement the expression of CD95, CD95L, CD200R, and sCD200R molecules in granulocyte and monocyte populations in blood samples of 30 patients who underwent heart surgery using CPB. Samples collected before surgery, after surgery, and in the postoperative period (1st , 3rd , 7th day) were analysed by flow cytometry and sCD200R by ELISA. Results: We discovered a significant increase in the percentage of granulocytes expressing inhibitory molecule CD200R (from 5% to 17.8%) instantly after surgery. It might be presumed that these cells are less susceptible to...
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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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Changes in Expression of Membrane Molecules CD200R, CD95, CD95L, and Soluble CD200R Regulating inflammatory Responses in Patients Undergoing Cardiac Surgery
Holmannová, Drahomíra ; Krejsek, Jan (advisor) ; Brát, Radim (referee) ; Turánek, Jaroslav (referee)
Cardiac surgery is known to initiate a complex physiological response with the immune system activation (SIRS), neurohormonal response, metabolic changes, coagulopathies etc. SIRS is triggered by tissue injury, myocardial ischemia, reperfusion, use of anaesthesia, cardioplegia, extracorporeal circuit etc. Excessive immune system activation is associated with progression of SIRS, life-threatening multi-organ dysfunction (MOD), and increased morbidity/mortality in the postoperative period. The immune system response is regulated and terminated by both cellular and humoral regulatory and inhibitory mechanisms including changes in expression of in our study monitored molecules: CD200/CD200R, sCD200R and CD95/CD95L. Methods: The study included the measurement the expression of CD95, CD95L, CD200R, and sCD200R molecules in granulocyte and monocyte populations in blood samples of 30 patients who underwent heart surgery using CPB. Samples collected before surgery, after surgery, and in the postoperative period (1st , 3rd , 7th day) were analysed by flow cytometry and sCD200R by ELISA. Results: We discovered a significant increase in the percentage of granulocytes expressing inhibitory molecule CD200R (from 5% to 17.8%) instantly after surgery. It might be presumed that these cells are less susceptible to...
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