The use of magnetic resonance spectroscopy for studying glucose metabolism

Magnetická rezonance spektroskopie (MRS) představuje neinvazivní metodu, která umožňuje in vivo sledovat metabolické pochody ve vybraných tkáních. Její aplikace v diabetologii představuje možnost mapovat metabolismus v cílových orgánech působení inzulinu a přispět tak k objasnění patofyziologie vzniku inzulinové rezistence. Dizertační práce je zaměřena na praktickou aplikaci fosforové (³¹P) a vodíkové (¹H) spektroskopie při vyšetření metabolismu kosterního svalu u osob s inzulinovou rezistencí nebo poruchou lačné glykémie a dále na vyšetření mozkové tkáně s pomocí ¹H MRS po navození hyperinzulinémie u diabetiků 1. typu a zdravých kontrol. Vyšetření byla provedena přístrojem Siemens Vision 1,5T; k hodnocení glukózového metabolismu a inzulinové senzitivity byla provedena vyšetření orálním glukózovým tolerančním testem a hyperinzulinovým euglykemickým clampem. Studie 1 byla zaměřena na hodnocení energetického metabolismu kosterního svalu (m. soleus) u potomků hypertoniků, u kterých byl v porovnání se zdravými kontrolami prokázán určitý stupeň inzulinové rezistence. Fosforová spektroskopie zde umožnila hodnotit koncentrace vybraných makroergních fosfátů (fosfokreatin, anorganický fosfát, adenosintrifosfát, fosfomonoestery a fosfodiestery). Koncentrace těchto látek v kosterním svalu byly u potomků...Magnetic resonance spectroscopy (MRS) is a noninvasive technique that enables to follow metabolic processes in selected tissues in vivo. Recently the attention has been focused on metabolic mapping in target organs of insulin action to describe the pathophysiology of insulin resistance. The aim of our study was to present the practical application of ³¹P (phosphorus) MRS and ¹H (proton) MRS in metabolic studies of skeletal muscle in insulin resistant subjects and in subjects with impaired fasting glucose. The third study was aimed to evaluate the brain metabolism with ¹H MRS in healthy controls and subjects with type 1 diabetes during hyperinsulinemia. ¹H and ³¹P MRS were performed using a MR Scanner Siemens Vision operating at 1,5 Tesla. To assess the parameters of glucose metabolism and insulin action oral glucose tolerance test and hyperinsulinemic euglycemic clamp were performed. The study 1 was aimed to evaluate the skeletal muscle (m. soleus) energetic metabolism in the offspring of hypertensive parents (OH) with a higher level of insulin resistance. The concentrations of selected high energy phosphates (phosphocreatine, inorganic phosphate, adenosintriphosphate, phosphomonoesters, phosphodiesters) were evaluated with ³¹P MRS. Their amount in OH was comparable to healthy controls. However we...Institut klinické a experimentální medicínyInstitute for Clinical and Experimental Medicine1. lékařská fakultaFirst Faculty of Medicin

Comparison of Educational System and Competence of Paramedics in the Czech Republic and Slovakia

Tématem této bakalářské práce je vzdělávací systém a kompetence zdravotnických záchranářů v České a Slovenské republice. Zabývá se zejména porovnáním studijního oboru a kompetencí Zdravotnických záchranářů v České a Slovenské republice. Práce je rozdělena na část teoretickou a část praktickou. V teoretické části je popsán vývoj zdravotnických záchranných služeb na území České a Slovenské republiky. Dále jsou popsaný vzdělávací systémy obou zemí, kompetence a uplatnění zdravotnických záchranářů v těchto zemích. Úkolem praktické části je získat potřebná data k problematice srovnání vzdělávacích systému a kompetencí oboru Zdravotnický záchranář v České a Slovenské republice.ObhájenoThe topic of this bachelor thesis is the educational system and competencies of paramedics in the Czech and Slovak Republics. It deals mainly with the comparison of the field of study and the competencies of paramedics in the Czech and Slovak Republics. The thesis is divided into a theoretical part and a practical part. The theoretical part describes the development of medical rescue services in the Czech and Slovak Republics. Further, the education systems of both countries, competencies and application of paramedics in these countries are described. The task of the practical part is to obtain the necessary data on the issue of comparison of educational systems and competencies of the paramedic branch in the Czech and Slovak Republics

The use of magnetic resonance spectroscopy for studying glucose metabolism

Magnetic resonance spectroscopy (MRS) is a noninvasive technique that enables to follow metabolic processes in selected tissues in vivo. Recently the attention has been focused on metabolic mapping in target organs of insulin action to describe the pathophysiology of insulin resistance. The aim of our study was to present the practical application of ³¹P (phosphorus) MRS and ¹H (proton) MRS in metabolic studies of skeletal muscle in insulin resistant subjects and in subjects with impaired fasting glucose. The third study was aimed to evaluate the brain metabolism with ¹H MRS in healthy controls and subjects with type 1 diabetes during hyperinsulinemia. ¹H and ³¹P MRS were performed using a MR Scanner Siemens Vision operating at 1,5 Tesla. To assess the parameters of glucose metabolism and insulin action oral glucose tolerance test and hyperinsulinemic euglycemic clamp were performed. The study 1 was aimed to evaluate the skeletal muscle (m. soleus) energetic metabolism in the offspring of hypertensive parents (OH) with a higher level of insulin resistance. The concentrations of selected high energy phosphates (phosphocreatine, inorganic phosphate, adenosintriphosphate, phosphomonoesters, phosphodiesters) were evaluated with ³¹P MRS. Their amount in OH was comparable to healthy controls. However we..

Retrospective Analysis of Bone Metabolism in Patients on Waiting List for Simultaneous Pancreas-Kidney Transplantation

Posttransplant osteoporosis, which evolves from preexisting bone pathologies, represents a serious complication with deteriorating consequences. The aim of our study was to evaluate epidemiological data on bone mineral density (BMD) in subjects with type 1 diabetes (T1DM) in advanced stages of diabetic nephropathy indicated for simultaneous pancreas-kidney transplantation (SPK). We retrospectively compiled biochemical and densitometrical data from 177 patients with T1DM at CKD (chronic kidney disease) stages G4-G5 (115 men, 62 women, median age 40 yr, diabetes duration 23 yr) enrolled on waiting list for SPK for the first time between the years 2011 and 2016. Median Z-scores were as follows: lumbar spine (LS): -0.8 [interquartile range -1.75 to 0.1]; total hip (TH): -1.2 [-1.75 to -0.6]; femoral neck (FN): -1.2 [-1.9 to -0.7]; and distal radius (DR): -0.8 [-1.4 to -0.1]. We noted a gender difference in LS, with worse results for men (-1.1 vs. -0.3) even after adjusting for BMI (body mass index) and glomerular filtration (p<0.001). Osteoporotic and osteopenic ranges (based on T-scores) for all major sites were 27.7% and 56.5%, respectively, with similar results across both genders. Women had a significantly higher proportion of normal BMD in LS than men (67.7 vs. 49.4%, p<0.05). Patients with T1DM at CKD stages G4-G5 exhibited serious BMD impairment despite their young age. Men surprisingly displayed lower Z-scores and higher percentages of pathological BMD values in LS than women did. The introduction of adequate preventive measures during the advanced stages of diabetic nephropathy to prevent bone loss is recommended