Pulmonary pathophysiology during circulatory support.

Úvod: Distenze levé komory srdeční a následně až vznik plicního edému jsou často diskutované komplikace veno-arteriální membránové oxygenace (VA ECMO) u pacientů s těžkým srdečním selháním. Cílem studie bylo na experimentálním modelu srdečního selhání sledovat vliv VA ECMO na distenzi levé komory, plicní hemodynamiku a akumulaci tekutin v plicích a navrhnout postup, jímž by bylo možné vzniku plicního edému předejít. Metodika: Experimenty probíhaly na prasečích modelech v celkové anestézii. Na modelu chronického srdečního selhání byly sledovány vlivy zvyšujícího se "afterloadu" na práci levé komory. Vliv zvyšujícího se "afterloadu" na objem tekutin v plicích byl pak sledován na modelu akutního ischemického srdečního selhání. K detekci změn objemu tekutin byla využita elektrická impedanční tomografie (EIT). EIT data byla analyzována fázovou a frekvenční filtrací tak, aby byl zahrnut pouze funkční region plic. V rámci studie byly porovnány i různé metody dekomprese levé komory při současném užití s VA ECMO. Výsledky: Postupné zvyšování průtoku mimotělní podporou VA ECMO vedlo u akutně i chronicky selhávající cirkulace ke zlepšení hemodynamických a oxygenačních parametrů. Vyšší průtoky VA ECMO však způsobily také významnou distenzi levé komory srdeční a zvýšení nároků na její práci. Navyšování...Introduction: Left-ventricular (LV) distension and consequent pulmonary congestion are complications frequently discussed in patients with severe LV dysfunction treated with veno- arterial extracorporeal membrane oxygenation (VA ECMO). The goal of this study was to describe the influence of high VA ECMO flows to LV distension, lung hemodynamics, and lung fluid accumulation. Methods of LV decompression were studied to prevent lung edema. Methods: In all experiments porcine models under general anesthesia were used. The effects of high extracorporeal blood flow (EBF) on LV heart work were assessed in a chronic heart failure model. The effects of LV afterload on lung fluid accumulation were evaluated by electrical impedance tomography (EIT) on acute heart failure models. Phase and frequency filtration and mathematical analysis were applied to the raw EIT data. Subsequently, mini- invasive techniques of LV decompression were evaluated for LV work. Results: The stepwise increases of VA ECMO flow improved both hemodynamic and oxygenation parameters. Nevertheless, it also caused distension and increased work of LV. The rise in EBF led to increased pulmonary capillary wedge pressure and lung fluid accumulation assessed by EIT in heart failure. The methods for LV decompression (Impella pump, atrial...Institute of Physiology First Faculty of Medicine Charles UniversityFyziologický ústav 1. LF UK1. lékařská fakultaFirst Faculty of Medicin

Pulmonary pathophysiology during circulatory support.

Introduction: Left-ventricular (LV) distension and consequent pulmonary congestion are complications frequently discussed in patients with severe LV dysfunction treated with veno- arterial extracorporeal membrane oxygenation (VA ECMO). The goal of this study was to describe the influence of high VA ECMO flows to LV distension, lung hemodynamics, and lung fluid accumulation. Methods of LV decompression were studied to prevent lung edema. Methods: In all experiments porcine models under general anesthesia were used. The effects of high extracorporeal blood flow (EBF) on LV heart work were assessed in a chronic heart failure model. The effects of LV afterload on lung fluid accumulation were evaluated by electrical impedance tomography (EIT) on acute heart failure models. Phase and frequency filtration and mathematical analysis were applied to the raw EIT data. Subsequently, mini- invasive techniques of LV decompression were evaluated for LV work. Results: The stepwise increases of VA ECMO flow improved both hemodynamic and oxygenation parameters. Nevertheless, it also caused distension and increased work of LV. The rise in EBF led to increased pulmonary capillary wedge pressure and lung fluid accumulation assessed by EIT in heart failure. The methods for LV decompression (Impella pump, atrial..

Septima Clark, školy pro občany a volební práva Afroameričanů

The aim of this paper is to analyze the Citizenship Schools and their achievements in the Civil Rights Movement. The introductory chapter provides some insight into the history of voting rights of women and African Americans in the United States of America. The theoretical part also provides information about Septima Clark's personal life and work. Then, earlier educational programs that served African Americans are described. The following practical section presents the establishment and achievements of the Citizenship Schools. The final chapter is based on the analysis of the goals, functionality, and successes of the Citizenship Schools with the Freedom Schools, and a comparison between the two.Předmětem této práce je analyzovat Citizenship Schools a jejich úspěchy v Afroamerickém hnutí za lidská práva. Úvodní kapitola podrobně popisuje historii volebního práva žen a Afroameričanů ve Spojených státech amerických. V krátkosti je představen také osobní život a práce Septimy Clark. V teoretické části jsou rovněž zmíněny dříve existující vzdělávací programy, které vznikly pro Afroameričany. Následující praktická část se zabývá založením a úspěchy Citizenship Schools. Podstatou závěrečné kapitoly je analýza cílů, fungování a úspěchů Citizenship Schools a Freedom Schools, a jejich vzájemné porovnání.Fakulta filozofick

The Benefit of Telemonitoring in the Prevention of Septic Shock in a Patient with Aggressive Non-Hodgkin’s Lymphoma

Telemonitoring is a great tool for vital signs monitoring in patients at high risk of severe life-threatening infections, such as haemato-oncological patients. As it can detect early symptoms of an infection, it allows early reaction and, therefore, can help prevent the progression of the infection into severe sepsis. We present a case report of a 69-year-old patient with aggressive non-Hodgkin lymphoma undergoing intensive immunochemotherapy. The treatment was complicated by two episodes of Gram-negative bacterial (G−) infection. During the first episode, the patient was admitted to the hospital only after developing septic shock with multiorgan dysfunction syndrome, which required vasopressor support and multiple broad-spectrum antibiotics and other antimicrobial therapy. Following this episode, the patient was enrolled in our telemonitoring project focusing on early detection of infections in high-risk haemato-oncological patients. The patient later developed another infection with G− bacteremia; however, thanks to the telemonitoring, he was admitted to the hospital within a few hours after developing (and detecting) fever. The therapy was initiated immediately, and the infection was successfully managed with first-choice antibiotics without any further complications. This case illustrates the importance of early detection of infection in high-risk patients, as well as the benefits of telemonitoring. Moreover, avoidance of septic shock and the consequent need for intensive care can significantly reduce healthcare costs

The effect of rework content addition on the microstructure and viscoelastic properties of processed cheese

The aim of this work was to add various amounts of rework (0.0 to 20.0% wt/wt) to processed cheeses with a dry matter content of 36% (wt/wt) and fat with a dry matter content of 45% (wt/wt). The effect of the rework addition on the viscoelastic properties and microstructure of the processed cheeses was observed. The addition of rework (in this case, to processed cheese with a spreadable consistency) in the amounts of 2.5, 5.0, and 10.0% (wt/wt) increased the firmness of the processed cheese. With the further addition of rework, the consistency of the processed cheeses no longer differed significantly. The conclusions obtained by the measurement of viscoelastic properties were supported by cryo-scanning electron microscopy, where fat droplets in samples with added rework of over 10.0% (wt/wt) were smaller than fat droplets in processed cheeses with lower additions of rework. © 2018 American Dairy Science AssociationCore; HMFL, High Magnetic Field Laboratory, Chinese Academy of Sciences; MEYS, Ministry of Education, Youth and ScienceTomas Bata University in Zlin, Czech Republic [IGA/FT/2018/003]; Ministry of Education, Youth and Sports of the Czech Republic (Czech-BioImaging, Prague, Czech Republic) [LM2015062

Rifampin-Releasing Triple-Layer Cross-Linked Fresh Water Fish Collagen Sponges as Wound Dressings

Objectives. Surgical wounds resulting from biofilm-producing microorganisms represent a major healthcare problem that requires new and innovative treatment methods. Rifampin is one of a small number of antibiotics that is able to penetrate such biofilms, and its local administration has the potential to serve as an ideal surgical site infection protection and/or treatment agent. This paper presents two types (homogeneous and sandwich structured) of rifampin-releasing carbodiimide-cross-linked fresh water fish collagen wound dressings. Methods. The dressings were prepared by means of the double-lyophilization method and sterilized via gamma irradiation so as to allow for testing in a form that is able to serve for direct clinical use. The mechanical properties were studied via the uniaxial tensile testing method. The in vivo rifampin-release properties were tested by means of a series of incubations in phosphate-buffered saline. The microbiological activity was tested against methicillin-resistant staphylococcus aureus (MRSA) employing disc diffusion tests, and the in vivo pharmacokinetics was tested using a rat model. A histological examination was conducted for the study of the biocompatibility of the dressings. Results. The sandwich-structured dressing demonstrated better mechanical properties due to its exhibiting ability to bear a higher load than the homogeneous sponges, a property that was further improved via the addition of rifampin. The sponges retarded the release of rifampin in vitro, which translated into at least 22 hours of rifampin release in the rat model. This was significantly longer than was achieved via the administration of a subcutaneous rifampin solution. Microbiological activity was proven by the results of the disc diffusion tests. Both sponges exhibited excellent biocompatibility as the cells penetrated into the scaffold, and virtually no signs of local irritation were observed. Conclusions. We present a novel rifampin-releasing sandwich-structured fresh water fish collagen wound dressing that has the potential to serve as an ideal surgical site infection protection and/or treatment agent