Utjecaj prijeoperacijske respiracijske rehabilitacije kod kardiokirurških bolesnika

The aim of the study was to evaluate the effects of preoperative respiratory rehabilitation on functional capacity, length of stay in intensive care unit (ICU), duration of mechanical ventilation (MV) and total hospitalization, as well as to estimate arterial blood gas (ABG) values in patients undergoing cardiac surgery. Nineteen patients were included in the randomized observational study, divided into two groups: group A (intervention) and B (control). Preoperative and postoperative rehabilitation was performed in group A, and only postoperative rehabilitation in group B. Rehabilitation was carried out according to a predefined protocol. We used ABG to evaluate respiratory function, two-minute walk test (2MWT) and sit-to-stand test to assess functional capacity. The following data were obtained from medical documentation: duration of MV, length of stay at ICU, occurrence of postoperative pulmonary complications, and length of total hospitalization in both groups. Significant between-group difference was found for the length of total hospitalization and duration of MV (p<0.05 both). Analysis of the mean values of 2MWT on the last day of hospitalization (p=0.005), sit-to-stand test before surgery (p=0.022) and on the last day of hospitalization (p=0.008) showed statistically significant differences. The length of hospital stay significantly correlated with preoperative rehabilitation in group A (r=0.885; p<0.0001). There was no difference in ABG parameters between the groups. The study showed that preoperative respiratory rehabilitation had an effect on reducing duration of MV and length of total hospitalization, and improved functional capacity.Cilj rada je bio procijeniti učinak prijeoperacijske respiracijske rehabilitacije na funkcionalni kapacitet, dužinu boravka u jedinici intenzivnog liječenja (JIL), trajanje mehaničke ventilacije (MV) i ukupnu hospitalizaciju te procijeniti vrijednosti plinske analize arterijske krvi (ABG) kod bolesnika podvrgnutih kardiokirurškim operacijama. U radomiziranu opservacijsku studiju bilo je uključeno 19 bolesnika podijeljenih u dvije skupine: skupina A (ispitivana) i B (kontrolna). Prijeoperacijska i poslijeoperacijska rehabilitacija provedena je u skupini A, a samo poslijeoperacijska rehabilitacija u skupini B. Rehabilitacija je provođena prema unaprijed utvrđenom protokolu. Rabili smo parametre ABG za procjenu respiracijske funkcije, a za procjenu funkcionalnog kapaciteta 2-minutni test hoda (2MWT) i sit-to-stand test. Sljedeći podaci prikupljeni su iz medicinske dokumentacije: dužina MV, dužina boravka u JIL, pojava komplikacija i dužina ukupne hospitalizacije. Nađena je značajna razlika između skupina za dužinu ukupne hospitalizacije (p<0,05) i dužinu MV (p<0,05). Analiza srednjih vrijednosti 2MWT posljednjeg dana hopitalizacije (p=0,005), sit-to-stand testa prije operacije (p=0,022) i posljednjeg dana hospitalizacije (p=0,008) između skupina pokazala je statistički značajnu razliku. Dužina hospitalizacije je značajno korelirala s prijeoperacijskom rehabilitacijom u skupini A (r=0,885; p<0,0001). Nije bilo razlike u parametrima ABG između skupina. Studija je pokazala da je prijeoperacijska respiracijska rehabilitacija utjecala na smanjenje dužine MV, dužinu trajanja ukupne hospitalizacije te na poboljšanje funkcionalnog kapaciteta

Quantitative morphometric analysis of the myenteric nervous plexus ganglion structures along the human digestive tract

Background/Aim. All the functions of the digestive system are controlled, guided and initiated by the autonomic nervous system. A special part of this system placed in the wall of the gastrointestinal tract is known as the enteric or metasympathetic nervous system. The aim of this study was to analyse myenteric nervous plexus in different parts of the digestive tract. Methods. We examined the myenteric nervous plexus of the esophagus, stomach, duodenum, jejunum, ileum, transverse colon and rectum in tissue samples taken from 30 cadavers of persons aged 20-84 years. After standard histological processing sections were stained with hematoxylineosin, cresyl violet (CV) and AgNO3 method. Multipurpose test system M42 was used in morphometric analysis. The results were analyzed by t-test and analysis of variance. Results. The number of neurons per cm2 surface was the lowest in the esophagus (2.045 ± 310.30) and the largest in the duodenum (65,511 ± 5,639). The statistical processing showed significant differences (p < 0.001) in the number of neurons between the esophagus and all other parts of the digestive tract. The maximal value of the average surface of the myenteric nervous plexus neurons was observed in the esophagus (588.93 ± 30.45 μm2) and the lowest in the stomach (296.46 ± 22.53 μm2). Conclusion. There are differences in the number of ganglion cells among different parts of the human digestive tract. The differences range from a few to several tens of thousands of neuron/cm2. The myenteric nervous plexus of the esophagus was characterized by a significantly smaller number of neurons but their bodies and nuclei are significantly larger compared to other parts of the digestive tract

Asymmetries in numerical density of pyramidal neurons in the fifth layer of the human posterior parietal cortex

Background/Aim. Both superior parietal lobule (SPL) of dorsolateral hemispheric surface and precuneus (PEC) of medial surface are the parts of posterior parietal cortex. The aim of this study was to determine the numerical density (NV) of pyramidal neurons in the layer V of SPL and PEC and their potential differences. Methods. From 20 (40 hemispheres) formaline fixed human brains (both sexes; 27- 65 years) tissue blocks from SPL and PEC from the left and right hemisphere were used. According to their size the brains were divided into two groups, the group I with the larger left (15 brains) and the group II with the larger right hemisphere (5 brains). Serial Nissl sections (5 μm) of the left and right SPL and PEC were used for stereological estimation of NV of the layer V pyramidal neurons. Results. NV of pyramidal neurons in the layer V in the left SPL of brains with larger left hemispheres was significantly higher than in the left SPL of brains with larger right hemisphere. Comparing sides in brains with larger left hemisphere, the left SPL had higher NV than the right one, and then the left PEC, and the right SPL had significantly higher NV than the right PEC. Comparing sides in brains with the larger right hemisphere, the left SPL had significantly higher NV than left PEC, but the right SPL had significantly higher NV than left SPL and the right PEC. Conclusion. Generally, there is an inverse relationship of NV between the medial and lateral areas of the human posterior parietal cortex. The obtained values were different between the brains with larger left and right hemispheres, as well as between the SPL and PEC. In all the comparisons the left SPL had the highest values of NV of pyramidal neurons in the layer V (4771.80 mm-3), except in brains with the larger right hemisphere

Razlika u aktivaciji c-fosa u hipokampalnim CA1 neuronima i granularnim neuronima gyrus dentatus-a kod jednokratne i ponovljene ishemije mozga pacova

We investigated the activation of c-fos early gene in the hippocampal region CA1 and gyrus dentatus in two groups of rats. The first group, exposed to global ischemia (during 10 minutes of occlusion of four vessels) was sacrificed 60 minutes after reperfusion, and the second group was first exposed to transient (3-4 minutes) ischemia (preconditioned or tolerant rats) and after 72 hours was again exposed to global ischemia in the same way as the first group. Immunohistochemistry for c-fos protein was performed using the avidin-biotin peroxidase method. Analysis of results included morphological, semiquantitative analysis and t-test of differences between GD and CA1 region of the hippocampus. Results showed a significantly more intense c-fos activation in GD than in the CA1 region in both groups, with global ischemia and preconditioned rats. This indicates different pattern of c-fos activation in investigated brain regions in relation to time factors, and also indicates a strong impact of ischemic preconditioning on c-fos activity in both investigated regions. Our results clearly show that in the future studies of c-fos activation in the brain a very careful experimental design related to the control of distinct regional and time effects needs to be performed.Istraživana je aktivacija ranog gena c-fos u CA1 regionu hipokampusa i u gyrus dentatus-u u dve grupe odraslih pacova. Jedna grupa je bila podvrgnuta globalnoj cerebralnoj ishemiji (tokom 10 minuta okluzije sva četiri krvna suda) i 60 minuta posle reperfuzije pacovi su bili žrtvovani. Druga grupa je bila prvo 3-4 minuta podvrgnuta tranzitornoj ishemiji (rezistentna grupa) i opet je posle 72 sata bila izložena globalnoj ishemiji na isti način kao i prva grupa. Imunohistohemijska analiza reakcije na c-fos protein je izvršena avidin - biotin metodom. Analiza rezultata obuhvatila je morfološku i semikvantitativnu analizu i t-test u izračunavanju značajnosti razlika u reaktivnosti između gyrus dentatus-a i CA1 regiona hipokampusa. Rezultati su u obe grupe pacova, kako posle globalne ishemije, tako i posle tranzitorne i potom globalne ishemije (rezistentna grupa), ukazali na signifikantno veću c-fos aktivaciju u gyrus dentatus-u nego u CA1 regionu. Takođe je u rezistentnoj grupi c-fos aktivacija bila mnogo slabija nego u grupi podvrgnutoj samo globalnoj ishemiji. Sve ovo ukazuje na različit tok procesa c-fos aktivacije u istraž ivanim regionima mozga i u različitim vremenskim fazama eksperimenta. Takođe je dokazan i jak uticaj ishemičkog prekondicioniranja na ovu aktivaciju u oba istraživana regiona. Iz naših rezultata proizlazi da buduće studije moraju biti pažljivo osmišljene, tako da budu kontrolisani regionalni i vremenski efekti. Tek takva istraživanja bi nas približila mogućem korišćenju uticaja aktivnosti c-fos gena u zaštiti moždanih struktura od efekata ishemije