Coexistence and management of abdominal aortic aneurysm and coronary artery disease

Background: Abdominal aortic aneurysm (AAA) and coronary atherosclerosis share common risk factors. In this study, a single-center management experience of patients with a coexistence of AAA and coronary artery disease (CAD) is presented.Methods: 271 consecutive patients who underwent elective AAA repair were reviewed. Coronary imaging in 118 patients was considered suitable for exploration of AAA coexistence with CAD.Results: Significant coronary stenosis (> 70%) were found in 65.3% of patients. History of cardiac revascularization was present in 26.3% of patients, myocardial infarction (MI) in 31.4%, and 39.8% had both. In a subgroup analysis, prior history of percutaneous coronary intervention (PCI) (OR = 6.9, 95% CI 2.6–18.2, p < 0.001) and patients’ age (OR = 1.1, 95% CI 1.0–1.2, p = 0.007) were independent predictors of significant coronary stenosis. Only 52.0% (40/77) of patients with significant coronary stenosis underwent immediate coronary revascularization prior to aneurysm repair: PCI in 32 cases (4 drug-eluting stents and 27 bare metal stents), coronary artery bypass graft in 8 cases. Patients undergoing revascularization prior to surgery had longer mean time from coronary imaging to AAA repair (123.6 vs. 58.1 days, p < 0.001). Patients undergoing coronary artery evaluation prior to AAA repair had shorter median hospitalization (7 [2–70] vs. 7 [3–181] days, p = 0.007) and intensive care unit stay (1 [0–9] vs. 1 [0–70] days, p = 0.014) and also had a lower rate of major adverse cardiovascular events or multiple organ failure (0% vs. 3.9%, p = 0.035). A total of 11.0% of patients had coronary artery aneurysms.Conclusions: Patients with AAA might benefit from an early coronary artery evaluation strategy

Novel Venetin-1 nanoparticle from earthworm coelomic fluid as a promising agent for the treatment of non-small cell lung cancer

The present research shows the antitumor activity of a protein-polysaccharide complex Venetin-1 obtained from the coelomic fluid of Dendrobaena veneta earthworms against A549 cancer cells. The investigations are a continuation of experiments on the antitumor activity of coelomic fluid obtained from this species. The Venetin-1 nanoparticle was obtained after thermal treatment of the coelomic fluid, separation from coelomocytes, filtration, and lyophilization. The preparation showed a selective effect on cancer cells, whereas normal cells were unaffected. Venetin-1 was effective against the lung cancer cells at doses of 31.3 and 62.5 µg/ml, and the results were imaged using light microscopy and scanning electron microscopy (SEM). The cells died mainly via the apoptosis pathway. Necrotic cells appeared sporadically in the microscopic view. SEM imaging revealed complete destruction of the A549 cells after the incubation with Venetin-1. The atomic force microscopy (AFM) analyses showed changes in the topography, peak force error images, and Young’s modulus (elasticity) of the A549 cells after the incubation with Venetin-1. The transmission electron cryomicroscopy (Cryo-TEM) analysis indicated a polymeric nature of the analyzed preparation. The samples of Venetin-1 showed a very homogeneous size profile with the microparticle size of approximately 58.23 nm. A significant decrease in Venetin-1 binding to sphingomyelin was observed. Venetin-1 lost its pore-forming activity or deactivation of the pore-forming activity occurred. This confirms the absence of hemolytic capacity of Venetin-1 towards red blood cells. The conducted analyses show the suitability of the obtained complex for biomedical research. The next step will consist in analyses of the effect of Venetin-1 on the immune system in mice

The evaluation of vasculature in post-mortem angio-computed tomography for anatomy research purposes: method description based on celiac trunk analysis

Background: Anatomical research based on deceased body specimens is a time-consuming process that requires a great deal of skill and time to perform correctly. Three-dimensional medical image analysis is an excellent tool for anatomic evaluation, but it often includes patients with comorbidities in the study group, which can skew the results. The purpose of this study was to develop and evaluate methods for anatomic research based on postmortem contrast-enhanced computed tomography angiography 3D reconstruction of the celiac trunk. Materials and methods: Postmortem contrast-enhanced computed tomography angiography of 105 (28.6% female, age 50.8±18.7) decedents without abdominal trauma or tumor was analyzed. The abdominal portion of the aorta and the celiac trunk with its branches were reconstructed and evaluated. The type of celiac trunk was evaluated. The results were analyzed. Results: The celiac trunk, splenic artery, and common hepatic artery were visualized in all cases. The left gastric artery was visible in 97.1% of cases. The dorsal pancreatic artery was visualized in 61.0% of cases. The most common type of celiac trunk was 1 (88.6%), and the rarest types were 2, 3, and 6 (1.0%). We observed 4 morphologies of the truncus celiacus that did not fit the classification presented previously. Conclusions: This study has demonstrated that three-dimensional reconstruction of postmortem contrast-enhanced computed tomography is an excellent tool for performing accurate morphometric analyzes for anatomic research purposes. This method can serve as a source for anatomic studies in the healthy population

Superior mesenteric artery clinical classification and morphometrical analysis

Background: The superior mesenteric artery is one of the most important arteries in the abdominal cavity, which is of great clinical importance, especially in surgical procedures and fatal ischemic complications. The aim of this study was to develop a clinical classification of the superior mesenteric artery. Materials and methods: Postmortem contrast-enhanced computed tomography of 104 (29.8% female, age 50.7±18.7) human bodies were analyzed. Based on anatomic predisposition to ischemic and iatrogenic complications, a three-tiered clinical classification of the superior mesenteric artery was developed. Type 0 was defined as standard risk for ischemic and iatrogenic complications. Type 1 was defined as increased thromboembolic risk with decreased risk of iatrogenic bleeding, and type 2 was defined as decreased ischemic risk with increased risk of iatrogenic bleeding. The supply area of the superior mesenteric artery was divided into 4 regions: pancreas, caecum, ascending colon, and transverse colon. Results: Type 0 (standard risk) was found in 62.5% of cases. Type 1 was most frequently observed in the ascending colon region (15.4%). Type 2 was most frequently observed in the pancreatic region (17.3%). Regarding type, most abnormalities were found in the region of the ascending colon (18.3%), pancreas region (17.3%), and transverse colon (16.3%). Conclusions: The proposed clinical classification of SMA links anatomic variations in morphology with their clinical significance. A simple, three-level classification can be easily applied in daily practice and serve as a great support for preoperative evaluation and recognition of patients at risk of iatrogenic or thromboembolic complications

Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease : implications for patient management and healthcare resource utilization

Introduction: Invasive coronary angiography (CAG), the ‘gold standard’ in coronary artery disease (CAD) diagnosis, requires hospitalization, is not risk-free, and engages considerable healthcare resources. Aim: To assess recent (throught out 10 years) evolution of ‘significant’ (≥ 50% stenosis(es)) CAD prevalence in subjects undergoing CAG for CAD diagnosis in a high-volume tertiary referral center. Material and methods: Anonymized medical records were compared from the last vs. the first 2-years of the decade (June 2007 to May 2018). Referrals for suspected CAD were 2067 of 4522 hospitalizations (45.7%) and 1755 of 5196 (33.8%) respectively (p < 0.001). Results: The median patient age (64 vs. 68 years) and the prevalence of heart failure (24.1% vs. 42.2%) increased significantly (p < 0.001). The CAG atherosclerotic lesions, for all stenosis categories (< 50%; ≥ 50%; ≥ 70%; occlusion(s)), were significantly more prevalent in men. The proportion of subjects with any atherosclerosis on CAG increased (80.7% vs. 77.6%, p = 0.015). However, in the absence of any gross change in, for instance, the fraction of women (40.4% vs. 41.8%), the proportion of CAGs with significant CAD (lesion(s) ≥ 50%) decreased from 55.2% in 2007/2008 to below 1 in every 2 angiograms (48.9%) in 2017/2018 (p < 0.001). This unexpected finding occurred consistently across nearly all CAG referral categories. Conclusions: Despite more advanced age and a higher proportion of subjects with ‘any’ coronary atherosclerosis on CAG, the likelihood of a ‘negative’ angiogram (lesion(s) < 50%; no further evaluation/intervention) has increased significantly over the last decade. The exact nature of this phenomenon requires further investigation, particularly as a reverse trend would be expected with the growing role (and current high penetration) of contemporary non-invasive diagnostic tools to rule out significant CAD

Systémový pohled na založení společnosti s ručením omezeným

Import 14/11/2007Prezenční545 - Institut ekonomiky a systémů řízen

Comparison of the Insolvency Proceedings in the Czech Republic and Selected Foreign Countries

Import 30/10/2012Diplomové práce je zaměřena na rozdíly mezi insolvenčním řízením v ČR a vybraných státech EU. První část se zabývá insolvenčním řízením v ČR. Druhá část analyzuje insolvenci v zahraničí a insolvenci z pohledu nařízení Evropské Komise. V poslední části jsou vyhodnoceny rozdíly, aktuální srovnání dat za rok 2011, zneužívání insolvenčního práva, návrhy na zlepšení prvků insolvence atd.The thesis is focused on analyzing the differences between insolvency proceedings in the Czech Republic and selected EU countries. The first chapter deals with insolvency proceedings in Czech republic. The second part is aimed on foreign insolvency proceedings and EU council regulation on insolcency proceedings. The last part analyzes differences, the actual comparison of the number of insolvencies for the year 2011, abuse of insolvency laws, proposals for improving insolvency elements etc.117 - Katedra účetnictvívelmi dobř