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Subretinal implantation of a carrier for retinal pigment epithelium in minipigs
Straňák, Zbyněk ; Kuchynka, Pavel (advisor) ; Mahelková, Gabriela (referee) ; Rusňák, Štěpán (referee)
Age-related macular degeneration (AMD) is the leading cause of practical blindness in developed countries. AMD is one of many retinal diseases that arise from the absence and/or dysfunction of the retinal pigment epithelium (RPE). There are two main types of VPMD (wet and dry), which differ in etiopathogenesis and ophthalmological findings. To date, therapy is only possible for the wet form of AMD, where neovascularization permeating from the choroid and subsequent oozing or bleeding in the subretinal space with deterioration of rod and cone cells and other neuronal cells occurs. Neovascularization can be partially prevented by repeated intra-vitreal applications of anti-VEGF agents. Without treatment, the result is a disciform retinal scar and irreversible visual impairment. A current trend in the treatment of AMD is the attempt to introduce innovative surgical procedures that have the potential to improve severe ophthalmic morbidity, particularly in non-responders to pharmacological therapy. The aim of this study was to evaluate the success rate and optimize a surgical procedure that allows for controlled and safe transplantation of RPE cells. The success of transplantation of RPE cells in the form of an epithelium that acts as a selective barrier immediately after transplantation is dependent on the...
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Indicators of systemic inflammation in spontaneous and instrumental delivery. Influence on neonatal concentrations of inflammatory markers.
Šibíková, Michaela ; Janota, Jan (advisor) ; Bayer, Milan (referee) ; Straňák, Zbyněk (referee)
8 ABSTRACT The inflammatory process, associated with endothelium activation, is one of the possible mechanisms of the initiation of spontaneous delivery. The mode of delivery may affect the concentrations of inflammatory molecules and microvesicles produced by endothelial cells. These biomarkes might be used to detect neonatal pathologies. The aim of our study was to assess endothelial biomarkers in cord and neonatal blood following different modes of delivery: i.e. spontaneus vaginal delivery and elective cesarean section. The study group consisted of neonates and their mothers after uncomplicated pregnancy and spontaneous vaginal delivery (spontaneous group) and after elective caesarean section (elective group). The patient samples were taken from the cord blood and from the peripheral venous blood of the newborns between 48- 72 hours of life. Soluble biomarkers were measured using a multiplex immunoassay based on the Luminex® xMAP platform. The concentration of microvesicles and surface antigen-specific microvesicles was determined by flow cytometry. We found significantly increased concentrations of cord blood soluble endothelial markers and cell-membrane derived endothelium specific microvesicles after spontaneous vaginal delivery compared to elective cesarean section. Irrespective of the delivery mode...
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How to decrease severe hospital acquired infection in newborns admitted to NICU
Bořkovcová, Tereza ; Straňák, Zbyněk (advisor)
With the rapid development of science and technology and related advances in medical care, pediatricians are, respectively, neonatologové, to save less and still nezralejší newborn. To care for critically ill newborns often (premature low gestational age or congenital defects) are inherently large number of invasive diagnostic and therapeutic procedures, bringing a number of risks as nosocomial infections (in Anglo-Saxon literature referred to as NI = nosocomial infection, HAI = Hospital-Acquired infection or healthcare-associated infection). These are today high time contributor to perinatal morbidity and mortality. And not only that. Extension of stay in NICU newborns increases additional risk of hospital infections, prolong suffering, and suffering newborns and families themselves, and not increase the extent cost of hospital care. As is clear from the conclusions various international studies, regular and consistent compliance often quite elementary hygiene habits (such as hand washing and disinfection of medical and parents before any contact with the newborn, disinfection stethoscope, etc..), can prevent the emergence of nosocomial infections or at least substantially reduce this risk.
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Prediction of intestinal damage in neonates with gastroschisis
Frýbová, Barbora ; Rygl, Michal (advisor) ; Pešl, Tomáš (referee) ; Straňák, Zbyněk (referee)
Prediction of intestinal damage in neonates with gastroschisis MUDr. Frýbová Barbora Objective: The aim of the study was to identify both prenatal ultrasonographic markers in fetuses and a biochemical marker in newborns with gastroschisis that predict postnatal outcome; to perform a new technique of defect closure by preformed silicone silo for gastroschisis and to evaluate long-term quality of life and somatic growth of patients with gastroschisis and compare them with the general population. Material and Methods: The analysis of 122 patients with gastroschisis operated on between 2004-2018 at the Department of Paediatric Surgery of University Hospital Motol in Prague was performed. In the retrospective-prospective study (97 patients) ultrasound findings at the 30th week of pregnancy and medical reports were statistically analyzed to identify independent prenatal ultrasonographic predictors of postnatal outcome. In the prospective study, new surgical technique of preformed silicone silo for gastroschisis to perform the stepwise defect reconstruction was used in four patients. In the prospective I-FABP study (53 patients), the urine was collected during the first 48 hours after surgery from neonates operated on for GS. Neonates with surgery that did not include gut mucosa served as controls for...
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Low Cardiac Output in Extremely Low Gestation Age Neonates and Intraventricular Haemorrhage
Miletín, Jan ; Straňák, Zbyněk (advisor) ; Bayer, Milan (referee) ; Zoban, Petr (referee)
This thesis is a commented monothematic collection of nine publications addressing cardiovascular assessment in preterm and term infants with a special focus on the immediate postnatal period. At the beginning, it provides a literature review of different modalities of Cardiac Output (CO) measurements in neonates, pathophysiology of Peri-intraventricular Haemorrhage (PIVH) in preterm infants and short review of the neonatal transition with some notes on role of the Patent Ductus Arteriosus (PDA). The main thesis is then divided into three logical parts. In the first and the main part, CO measurement possibilities in the neonatal period are reviewed and published with bioreactance identified as a novel emerging method of continuous CO assessment. The second study of this part is a prospective, observational cohort study in infants with a birth weight of less than 1250g. The CO was measured by bioreactance between 6 and 48 hours of age. Infants with PIVH and/or Necrotising Enterocolitis (NEC) had significantly lower CO compared to infants without these complications on day one of life. This low CO was then followed by a significant increase on day two of life. The third study is a prospective observational cohort study in near term and term infants undergoing Therapeutic Hypothermia (TH) for...
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Nanotechnology in the intensive care: Intravascular biocompatibility of carbon nanomaterials-effect of carbon nanotubes on blood platelets
Šemberová, Jana ; Straňák, Zbyněk (advisor) ; Dyr, Jan (referee) ; Hubálek Kalbáčová, Marie (referee)
Nanotechnology in the intensive care: Intravascular biocompatibility of carbon nanomaterials - effect of carbon nanotubes on blood platelets. EFFECT OF CARBON NANOTUBES ON BLOOD PLATELETS Carbon nanotubes (CNTs) are among the principal materials currently used in biomedical nanotechnologies. CNTs possess superior mechanical and chemical characteristics including enormous tensile strength, elasticity and conductivity. As a result they are very popular and attractive for use in various biomedical applications. Many of these applications may lead ultimately to contact of carbon nanomaterials and blood. Furthermore, CNTs may also be present intravascularly as a result of environmental or occupational exposure. Therefore, the investigation of the intravascular biocompatibility of CNTs is a critical safety issue. We studied the effects of structurally different purified CNT materials from different manufacturers on human platelets and compared their effects to amorphous carbon black nanoparticles (ACB), fullerene C60, fullerenol C60(OH)24 and NIST standard polystyrene nanobeads (PNBs). Using light transmission aggregometry of human platelet rich plasma, we found that various CNTs induce PLT aggregation and this occurs in a concentration dependent manner. In contrast to CNTs, ball-like shaped fullerene...
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Doppler parameters of myocardial dysfunction in very low birth weight infants
Širc, Jan ; Straňák, Zbyněk (advisor) ; Plavka, Richard (referee) ; Janota, Jan (referee)
Preterm neonate is exposed to significant hemodynamic changes after delivery. Cardiac and extracardiac shunts, especially ductus arteriosus, play an important role in this process. Failure of postnatal adaptation and persistent patent ductus arteriosus (PDA) may lead to cardiac overload and circulatory failure with hypoperfusion of vital organs and in turn adversely affect the short-term and long-term morbidity and mortality of these patients. Newborns with very low birth weight are at highest risk, however the possibilities for diagnosing circulatory failure in this patient group are limited. Clinical presentation and physical examination are nonspecific and involve subjective measures. Functional echocardiography provides information on systolic and diastolic heart function as well as the possibility to measure cardiac output and superior vena cava flow (SVC flow). Much of what is known about ventricular function pertains to systole rather than diastole. Near infrared spectroscopy provides another noninvasive method, enabling the measurement of tissue oxygenation including that of the brain. Cerebral oxygenation can be measured by placing the probe on the head of the neonate. Further possibility to help diagnose circulatory system failure are biochemical markers, commonly used in diagnosing...
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The importance of tissue oxygenation changes in monochorionic twins for predicting severe neonatal morbidity
Korček, Peter ; Straňák, Zbyněk (advisor) ; Bayer, Milan (referee) ; Janota, Jan (referee)
Despite improvements in perinatal outcome in recent decades, multiple pregnancies are associated with increased risk of complications including preterm birth, fetal growth restriction (FGR) and twin-twin transfusion syndrome (TTTS). Fetal circulatory disturbances and immature cerebral vasculature increase the risk for serious perinatal injury and adverse neurodevelopmental outcome in multiple births. Cerebral oxygenation (crSO2) monitoring using near-infrared spectroscopy (NIRS) is increasingly used in high-risk infants. However, limited data are available in twin preterm infants with respect to cerebral tissue perfusion. The aim of this project was to measure crSO2 using NIRS in preterm monochorionic and dichorionic twins during the first 72 hours of life and find out correlation between underlying fetal conditions and crSO2 development. We divided the study population into 4 subgroups based on major fetal pathology: donor (1) and recipient (2) monochorionic twins (with TTTS), selective FGR infants (3) and twins without fetal compromise (4). We observed significant variation in crSO2 among the subgroups using mixed model analysis. The recipient twins exhibited the lowest crSO2 throughout the study period, whereas the FGR and donor twins presented with the highest values. Nevertheless, we found no...
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Prediction of intestinal damage in neonates with gastroschisis
Frýbová, Barbora ; Rygl, Michal (advisor) ; Pešl, Tomáš (referee) ; Straňák, Zbyněk (referee)
Prediction of intestinal damage in neonates with gastroschisis MUDr. Frýbová Barbora Objective: The aim of the study was to identify both prenatal ultrasonographic markers in fetuses and a biochemical marker in newborns with gastroschisis that predict postnatal outcome; to perform a new technique of defect closure by preformed silicone silo for gastroschisis and to evaluate long-term quality of life and somatic growth of patients with gastroschisis and compare them with the general population. Material and Methods: The analysis of 122 patients with gastroschisis operated on between 2004-2018 at the Department of Paediatric Surgery of University Hospital Motol in Prague was performed. In the retrospective-prospective study (97 patients) ultrasound findings at the 30th week of pregnancy and medical reports were statistically analyzed to identify independent prenatal ultrasonographic predictors of postnatal outcome. In the prospective study, new surgical technique of preformed silicone silo for gastroschisis to perform the stepwise defect reconstruction was used in four patients. In the prospective I-FABP study (53 patients), the urine was collected during the first 48 hours after surgery from neonates operated on for GS. Neonates with surgery that did not include gut mucosa served as controls for...
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