Morphological and functional changes in microvasculature and endomysium in human atrial myocardium with atrial fibrillation

This doctorial thesis was focused on morphological and functional changes in microvasculature and endomysium in human atrial myocardium with atrial fibrillation. Atrial fibrillation (AF) is one of the most common arrhythmias in the clinical practice and it is associated with an increase in mortality risk that is strongly related with old age. Its pathogenesis is still not sufficiently explored. One of the generally recognized factors contributing to the initiation and maintenance of atrial fibrillation is structural remodeling of the myocardium. Structural remodeling is reflected by changes that affect both atrial cardiomyocytes as well as endomysium. We analyzed atrial biopsies obtained from patients undergoing bypass or mitral valve surgery. The patients had a regular sinus rhythm or were suffering from AF. Immunohistochemistry was used to visualize collagen I, collagen III, elastin, desmin, smooth muscle actin and VEGF in the atrial samples.To detect capillaries UEA-lectin was used. For detection of different types of immune cells the following markers were detected immunohistochemically: CD45 as a pan- leukocyte marker, CD3 for T-lymphocytes, CD68 for monocyte/macrophages, mast cell tryptase for mast cells and DC-SIGN for immature dendritic cells. Our results document that in patients...Tato disertační práce byla zaměřena na morfologické a funkční změny kapilárního řečiště a endomysia v lidském atriálním myokardu při fibrilaci síní. Fibrilace síní (FS) je jednou z nejčastějších arytmií, se kterou se setkáváme v klinické praxi, je spojena se zvýšeným rizikem úmrtnosti a silně souvisí se stářím. Její patogeneze stále není dostatečně prozkoumána. Jeden ze známých faktorů přispívajících k udržení FS je strukturální přestavba myokardu. Strukturální remodelace se projevuje jednak změnami samotných síňových kardiomyocytů, ale také změnami v endomysiu. Studovali jsme síňové biopsie získané od pacientů kteří podstoupili aorto-koronární bypass nebo operaci mitrální chlopně. Pacienti měli pravidelný sinusový rytmus nebo fibrilaci síní. Imunohistochemie byla použita k vizualizaci kolagenu I, kolagenu III, elastinu, desminu, aktinu hladkého svalstva a VEGF ve vzorcích síní. Pro detekci kapilár byl použit UEA-lektin. Pro detekci různých typů imunitních buněk byly imunohistochemicky detekovány následující markery: CD45 jako marker panleukocytů, CD3 pro T-lymfocyty, CD68 pro monocyty/makrofágy, tryptáza z žírných buněk pro žírné buňky a DC-SIGN pro nezralé dendritické buňky. Naše výsledky dokumentují, že u pacientů podstupujících operaci na otevřeném srdci lze nalézt variabilní hladinu ECM...Ústav histologie a embryologie 1. LF UKInstitute of Histology and Embryology First Faculty of Medicine Charles UniversityFirst Faculty of Medicine1. lékařská fakult

withdrawn 2017 hrs ehra ecas aphrs solaece expert consensus statement on catheter and surgical ablation of atrial fibrillation

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Morphological and functional changes in microvasculature and endomysium in human atrial myocardium with atrial fibrillation

This doctorial thesis was focused on morphological and functional changes in microvasculature and endomysium in human atrial myocardium with atrial fibrillation. Atrial fibrillation (AF) is one of the most common arrhythmias in the clinical practice and it is associated with an increase in mortality risk that is strongly related with old age. Its pathogenesis is still not sufficiently explored. One of the generally recognized factors contributing to the initiation and maintenance of atrial fibrillation is structural remodeling of the myocardium. Structural remodeling is reflected by changes that affect both atrial cardiomyocytes as well as endomysium. We analyzed atrial biopsies obtained from patients undergoing bypass or mitral valve surgery. The patients had a regular sinus rhythm or were suffering from AF. Immunohistochemistry was used to visualize collagen I, collagen III, elastin, desmin, smooth muscle actin and VEGF in the atrial samples.To detect capillaries UEA-lectin was used. For detection of different types of immune cells the following markers were detected immunohistochemically: CD45 as a pan- leukocyte marker, CD3 for T-lymphocytes, CD68 for monocyte/macrophages, mast cell tryptase for mast cells and DC-SIGN for immature dendritic cells. Our results document that in patients..

MODELS OF MULTYCRITERIAL STEP BY STEP CHOICE DECISIONS, THEIR USE IN THE SUGAR INDUSTRY

Summary. Optimal control of existing systems can be reduced to the problem of multi-criteria step by step choice of effective solutions in discrete systems. Their structure can be described as a directed graph with a given vector weights in its arches. The problem of choice can be reduced to the problem of search of optimal ways on the graph. Available methods of search are used only for linear systems whose structure is described by acyclic graphs. Nonlinear structures contain branches and/or return process streams. The methods of multi-criteria step by step choice are not applicable for them. To solve such problems we propose the model of decomposition of a graph that describes the structure of the system, into acyclic subgraphs and the synthesis model of effective integrated ways. The latter will be implemented by the consistent integration of their fragments i.e. effective ways found in acyclic subgraphs, and narrowing down through the choice function by taking into account the conditions of the system integrity. Further on, the article dwells upon a numerical realization of decomposition model and synthesis of integrated solutions. The proposed models were tested on the example of optimization of crystallization process in the sugar industry. The task was to select from a variety of possible control actions some set of alternatives, optimal in 3 additive performance criteria. At each stage of the process the appropriate control actions were selected and graph options of control actions with the given its arches quantitative estimates of the efficiency criteria was developed. As a result of application of the developed models numerous effective integrated ways, consisting of 38 options were received. Each such decision was corresponding to the option value of control impacts on the stages of the process

New Algorithm for Conservative Treatment of Patients with Keratoconus

The purpose of our study was to substantiate and evaluate the effectiveness of the conservative method of treating keratoconus in the early stages of the development of the disease. Patients and methods. The study of the effectiveness of the proposed method for the conservative treatment of keratoconus was performed on clinical material obtained by monitoring 39 patients (75 eyes) with a diagnosis of keratoconus stage I–III for at least 10 years. Every 4–6 months, all patients underwent an ophthalmological examination — visometry, autorefractometry, keratometry, keratotopography, pachymetry, biomicroscopy. Along with the study of the ophthalmic status of the patients, cardiointervalography was performed before starting conservative treatment. The assessment of vegetative homeostasis was performed using the Mustang-Diagnost device of the Technika company (Russia). Results. All patients observed by us were matched with corneal or corneoscleral gas-permeable contact lenses of various models and manufacturers. According to cardiointervalography, in 97 % of our patients vegetative dysfunction was determined, while in 85 % and all examined, a significant predominance of sympatheticotonic neurotrophic regulatory processes was determined. At the first stage of the conservative treatment of keratoconus pharmacological agents were selected. They potentiate cholinergic neurotrophic regulatory effects and activate aerobic processes in the tissues of the eyeball. The next step was the potentiation of sympathicotonic (ergotropic) neurotrophic regulatory processes. Treatment was carried out during the entire observation period, alternating complexes of preparations for 60 days. An increase in diopter strength along the steep meridian was noted in patients with keratoconus of all stages. In the group of patients with stage I keratoconus in 4 eyes out of 16, in patients with stage II disease in 7 eyes out of 35, in stage III patients in 7 eyes out of 24. Opposite, a study of the KISA % index in all observed patients showed a decrease in the coefficient values. Conclusions. The combination of therapeutic factors into tonic (trophotropic, anabolic) and phase (ergotropic, catabolic) regulatory blocks, taking into account their mutual neurodynamic synergism and in accordance with the phase nature of biorhythmogenesis of reparative processes, makes it possible to prevent the progression of keratoconus. The use of the treatment complex developed by us, which includes therapeutic treatment and correction with rigid gas-permeable contact lenses, corrects metabolic disorders and stabilizes collagen synthesis, which makes it possible to lay off the surgical treatment of patients with keratoconus

Quantification of Analgesic and Anti-Inflammatory Lipid Mediators in Long-Term Cryopreserved and Freeze-Dried Preserved Human Amniotic Membrane

The aim of this study was to compare concentrations of endogenous N-acylethanolamine (NAE) lipid mediators—palmitoylethanolamide (PEA), oleoylethanolamide (OEA), and anandamide (AEA)—in fresh, decontaminated, cryopreserved, and freeze-dried amniotic membrane (AM) allografts, thereby determining whether AM’s analgesic and anti-inflammatory efficiency related to NAEs persists during storage. The concentrations of NAEs were measured using ultra-high-performance liquid chromatography–tandem mass spectrometry. Indirect fluorescent immunohistochemistry was used to detect the PEA PPAR-α receptor. The concentrations of PEA, OEA, and AEA were significantly higher after decontamination. A significant decrease was found in cryopreserved AM compared to decontaminated tissue for PEA but not for OEA and AEA. However, significantly higher values for all NAEs were detected in cryopreserved samples compared to fresh tissue before decontamination. The freeze-dried AM had similar values to decontaminated AM with no statistically significant difference. The nuclear staining of the PPAR-α receptor was clearly visible in all specimens. The stability of NAEs in AM after cryopreservation was demonstrated under tissue bank storage conditions. However, a significant decrease, but still higher concentration of PEA compared to fresh not decontaminated tissue, was found in cryopreserved, but not freeze-dried, AM. Results indicate that NAEs persist during storage in levels sufficient for the analgesic and anti-inflammatory effects. This means that cryopreserved AM allografts released for transplant purposes before the expected expiration (usually 3–5 years) will still show a strong analgesic effect. The same situation was confirmed for AM lyophilized after one year of storage. This work thus contributed to the clarification of the analgesic effect of NAEs in AM allografts

Bioptic Study of Left and Right Atrial Interstitium in Cardiac Patients with and without Atrial Fibrillation: Interatrial but Not Rhythm-Based Differences.

One of the generally recognized factors contributing to the initiation and maintenance of atrial fibrillation (AF) is structural remodeling of the myocardium that affects both atrial cardiomyocytes as well as interstitium. The goal of this study was to characterize morphologically and functionally interstitium of atria in patients with AF or in sinus rhythm (SR) who were indicated to heart surgery. Patient population consisted of 46 subjects (19 with long-term persistent AF, and 27 in SR) undergoing coronary bypass or valve surgery. Peroperative bioptic samples of the left and the right atria were examined using immunohistochemistry to visualize and quantify collagen I, collagen III, elastin, desmin, smooth muscle actin, endothelium and Vascular Endothelial Growth Factor (VEGF). The content of interstitial elastin, collagen I, and collagen III in atrial tissue was similar in AF and SR groups. However, the right atrium was more than twofold more abundant in elastin as compared with the left atrium and similar difference was found for collagen I and III. The right atrium showed also higher VEGF expression and lower microvascular density as compared to the left atrium. No significant changes in atrial extracellular matrix fiber content, microvascular density and angiogenic signaling, attributable to AF, were found in this cohort of patients with structural heart disease. This finding suggests that interstitial fibrosis and other morphological changes in atrial tissue are rather linked to structural heart disease than to AF per se. Significant regional differences in interstitial structure between right and left atrium is a novel observation that deserves further investigation