52 research outputs found

    Przygotowanie pacjenta obci膮偶onego kardiologicznie do zabiegu chirurgicznego - rola lekarza rodzinnego. Cz臋艣膰 druga. Pacjent z zastawkow膮 wad膮 serca a operacja niekardiochirurgiczna

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    Zastawkowe choroby serca wyst臋puj膮 relatywnie cz臋sto, szczeg贸lnie w populacji os贸b w podesz艂ym wieku. Konieczno艣膰 przeprowadzenia zabiegu niekardiologicznego u takich pacjent贸w mo偶e stwarza膰 wiele problem贸w, a ponadto wi膮za膰 si臋 z podwy偶szonym ryzykiem powik艂a艅 sercowych. Najwy偶szy poziom ryzyka zgonu w okresie oko艂ooperacyjnym wyst臋puje u chorych ze zw臋偶eniem zastawki aortalnej, jednak uszkodzenie innych zastawek r贸wnie偶 mo偶e by膰 przyczyn膮 powik艂a艅. Autorzy przedstawili podstawowe elementy oceny pacjenta przez lekarza rodzinnego przed zabiegiem niekardiologicznym ze szczeg贸lnym zwr贸ceniem uwagi na ewentualn膮 obecno艣膰 wady zastawki, stopie艅 zaawansowania oraz profilaktyk臋 bakteryjnego zapalenia wsierdzia

    Przygotowanie pacjenta obci膮偶onego kardiologicznie do zabiegu chirurgicznego - rola lekarza rodzinnego. Cz臋艣膰 pierwsza - pacjent z chorob膮 niedokrwienn膮 serca a operacja niekardiochirurgiczna

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    W pracy przedstawiono obecne zalecenia dotycz膮ce przedoperacyjnej oceny uk艂adu kr膮偶enia u os贸b z chorob膮 niedokrwienn膮 serca. W niekt贸rych sytuacjach klinicznych, opr贸cz szczeg贸艂owego wywiadu, badania przedmiotowego i elektrokardiograficznego, konieczne bywa wykonanie bada艅 nieinwazyjnych oraz koronarografii. Autorzy zaprezentowali zasady przedoperacyjnej oceny ryzyka powik艂a艅 sercowych u pacjent贸w zagro偶onych zawa艂em serca lub zgonem sercowym w okresie oko艂ooperacyjnym. Wysoko艣膰 tego ryzyka zale偶y od rodzaju operacji (jej zakresu i trybu — pilny, planowy). Mo偶na je r贸wnie偶 okre艣li膰 na podstawie tak zwanych klinicznych wska藕nik贸w ryzyka. Niekt贸re sytuacje kliniczne (rozpoznana choroba wie艅cowa, stan po zawale serca, obecno艣膰 zastoinowej niewydolno艣ci serca, nadci艣nienia t臋tniczego czy cukrzycy itp.) warunkuj膮 poddanie chorego odpowiedniej diagnostyce, a tak偶e wdro偶enie zmniejszaj膮cej ryzyko optymalnej farmakoterapii

    Przygotowanie pacjenta obci膮偶onego kardiologicznie do zabiegu chirurgicznego - rola lekarza rodzinnego. Cz臋艣膰 trzecia. Pacjent z przewlek艂膮 niewydolno艣ci膮 serca a operacja niekardiochirurgiczna

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    Niewydolno艣膰 serca (HF, heart failure) jest jednym z g艂贸wnych czynnik贸w ryzyka oko艂ooperacyjnej 艣miertelno艣ci sercowej. Liczba wykonywanych zabieg贸w operacyjnych wzrasta wraz z wiekiem chorych. R贸wnocze艣nie zwi臋ksza si臋 cz臋sto艣膰 HF u pacjent贸w w podesz艂ym wieku. Pojawia si臋 zatem wa偶ny problem oszacowania wysoko艣ci ryzyka oko艂ooperacyjnego oraz okre艣lenia post臋powania z chorymi z tej grupy. Celem stratyfikacji ryzyka przed zabiegiem jest redukcja 艣miertelno艣ci i chorobowo艣ci. Dzi臋ki niej mo偶liwe jest r贸wnie偶 dostarczenie choremu dok艂adniejszych informacji o mo偶liwych powik艂aniach, aby jego zgoda na zabieg by艂a w pe艂ni 艣wiadoma. Zmniejszenie liczby powik艂a艅 oraz liczby wykonanych test贸w diagnostycznych przed zabiegiem mo偶e si臋 przyczyni膰 do znacznego zmniejszenia koszt贸w opieki medycznej. W pracy om贸wiono schemat wywiadu, badania przedmiotowego oraz zakres bada艅 dodatkowych, kt贸re nale偶y wykona膰 przed zabiegiem, oraz post臋powanie, kt贸re mo偶e prowadzi膰 do zmniejszenia ryzyka powik艂a艅 oko艂ooperacyjnych u pacjenta z przewlek艂膮 niewydolno艣ci膮 serca

    Limits to sustained energy intake. XXIII. Does heat dissipation capacity limit the energy budget of lactating bank voles?

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    Acknowledgements We are grateful to our technicians and several students for their help during this study and for animal care. We thank Catherine Hambly and Peter Thompson for technical assistance for the isotope analysis for the DLW measurements. We thank Ulf Bauchinger for stimulating discussion and his comments, and two anonymous referees for comments on the manuscript. Funding This project was supported by grants from the Polish Ministry of Science and Higher Education [0595/B/P01/2011/40 to E.T.S. and 8167/B/P01/2011/40 to P.K.], and Jagiellonian University [DS/WBINOZ/INOS/757 to P.K.].Peer reviewedPublisher PD

    Age-related changes of physiological performance and survivorship of bank voles selected for high aerobic capacity

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    Variation in lifespans is an intriguing phenomenon, but how metabolic rate influence this variation remains unclear. High aerobic capacity can result in health benefits, but also in increased oxidative damage and accelerated ageing. We tested these contradictory predictions using bank voles (Myodes=Clethrionomys glareolus) from lines selected for high swim-induced aerobic metabolism (A), which had about 50% higher maximum metabolic rate and a higher basal and routine metabolic rates, than those from unselected control lines (C). We measured sprint speed (VSmax), forced-running maximum metabolic rate (VO_{2}run), maximum long-distance running speed (VLmax), running speed at VO_{2}run (VVO_{2}), and respiratory quotient at VO_{2}run (RQ) at three age classes (I: 3-5, II: 12-14, III: 17-19 months), and analysed survivorship. We asked if ageing, understood as the age-related decline of the performance traits, differs between the A and C lines. At age class I, voles from A lines had 19% higher VO_{2}run, and 12% higher VLmax, but tended to have 19% lower VSmax, than those from C lines. RQ was nearly 1.0 for both A and C lines. The pattern of age-related changes differed between the lines mainly between age classes I and II, but not in older animals. VSmax increased by 27% in A lines and by 10% in C lines between age class I and II, but between classes II and III, it increased by 16% in both selection directions. VO_{2}run decreased by 7% between age class I and II in A lines only, but in C lines it remained constant across all age classes. VLmax decreased by 8% and VVO_{2} by 12% between age classes II and III, but similarly in both selection directions. Mortality was higher in A than in C lines only between the age of 1 and 4 months. The only trait for which the changes in old animals differed between the lines was RQ. In A lines, RQ increased between age classes II and III, whereas in C lines such an increase occurred between age classes I and II. Thus, we did not find obvious effects of selection on the pattern of ageing. However, the physiological performance and mortality of bank voles remained surprisingly robust to ageing, at least until the age of 17-19 months, similar to the maximum lifespan under natural conditions. Therefore, it is possible that the selection could affect the pattern of ageing in even older individuals when symptoms of senility might be more profound

    Aortic dissection during pregnancy 鈥 obstetric perspective

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    The risk of vascular events during pregnancy is substantially increased. Beyond comparatively frequent vascular diseases, pregnancy may lead also to the development of exceptionally rare vascular events such as the aortic dissection and aortic rupture which are conceivably endangering life conditions. Women with the connective tissue disorders and with a family history of the aorta diseases are especially prone to the aortic complications which may also develop in the absence of these risk factors due to the pregnancy-induced structural changes of the aortic wall. The preconception counselling is vital for patients with aortopathies to assess the risk of the aortic dissection and to establish the most appropriate care plan including the surgical intervention. This review presents the management guidelines in patients with the aortic dissection risk during pregnancy

    Experimental evolution on a wild mammal species results in modifications of gut microbial communities

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    Comparative studies have shown that diet, life history, and phylogeny interact to determine microbial community structure across mammalian hosts. However, these studies are often confounded by numerous factors. Selection experiments offer unique opportunities to validate conclusions and test hypotheses generated by comparative studies. We used a replicated, 15-generation selection experiment on bank voles (Myodes glareolus) that have been selected for high swim-induced aerobic metabolism, predatory behavior toward crickets, and the ability to maintain body mass on a high-fiber, herbivorous diet. We predicted that selection on host performance, mimicking adaptive radiation, would result in distinct microbial signatures. We collected foregut and cecum samples from animals that were all fed the same nutrient-rich diet and had not been subjected to any performance tests. We conducted microbial inventories of gut contents by sequencing the V4 region of the 16S rRNA gene. We found no differences in cecal microbial community structure or diversity between control lines and the aerobic or predatory lines. However, the cecal chambers of voles selected for herbivorous capability harbored distinct microbial communities that exhibited higher diversity than control lines. The foregut communities of herbivorous-selected voles were also distinct from control lines. Overall, this experiment suggests that differences in microbial communities across herbivorous mammals may be evolved, and not solely driven by current diet or other transient factors

    Evolution of basal metabolic rate in bank voles from a multidirectional selection experiment

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    A major theme in evolutionary and ecological physiology of terrestrial vertebrates encompasses the factors underlying the evolution of endothermy in birds and mammals and interspecific variation of basal metabolic rate (BMR). Here, we applied the experimental evolution approach and compared BMR in lines of a wild rodent, the bank vole (Myodes glareolus), selected for 11 generations for: high swim-induced aerobic metabolism (A), ability to maintain body mass on a low-quality herbivorous diet (H) and intensity of predatory behaviour towards crickets (P). Four replicate lines were maintained for each of the selection directions and an unselected control (C). In comparison to C lines, A lines achieved a 49% higher maximum rate of oxygen consumption during swimming, H lines lost 1.3 g less mass in the test with low-quality diet and P lines attacked crickets five times more frequently. BMR was significantly higher in A lines than in C or H lines (60.8, 56.6 and 54.4 ml O2/h, respectively), and the values were intermediate in P lines (59.0 ml O2/h). Results of the selection experiment provide support for the hypothesis of a positive association between BMR and aerobic exercise performance, but not for the association of adaptation to herbivorous diet with either a high or low BMR
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