Každý operačný výkon predstavuje u pacienta určité riziko a možnosť vzniku pooperačných komplikácii, hoci ide o bežne vykonávanú operáciu. Najčastejšie sa komplikácie vyskytujú u obéznych pacientov, kedy aj z banálnej operácie môže pacient skončiť na oddelení poskytujúcom intenzívnu starostlivosť a bojovať tak o svoj život. U obéznych pacientov je poskytovanie intenzívnej starostlivosti náročnejšie, nakoľko je potrebné u nich saturovať všetky základné potreby od prijímania potravy cez hygienu až po vyprázdňovanie. Cieľom príspevku je predstaviť a opísať priebeh liečby a ošetrovateľskej starostlivosti u extrémne obéznej pacientky po cholecystektómii, ktorej stav si vyžadoval intenzívnu starostlivosť z dôvodu rozvíjajúcej sa sepsy v oblasti operačnej rany, kde bolo potrebné využitie inovatívnych liečebných postupov a metód pri jej hojení. Metodika: Pomocou kvalitatívneho výskumu formou kazuistiky, opisujeme zaujímavý prípad pacientky, ktorá si vyžadovala 95 dňovú hospitalizáciu na intenzívnom oddelení s ťažkou sepsou, kardiovaskulárnym zlyhávaním, nutnosťou umelej pľúcnej ventilácie (UVP), s využitím VAC systému (vacuum assisted closure) na hojenie rany, dekubitmi rôznych stupňov, infekčnou hnačkou a syndrómom závislosti od UVP. Výsledky: Pacientka preložená z chirurgickej jednotky intenzívnej starostlivosti (JIS) v poruche vedomia, s potrebou zabezpečenia dýchacích ciest, napojenia na UVP, potrebou vazopresorickej podpory, septickým stavom, rozpadom operačnej rany a potrebou korekcie glykémie inzulínom v lineárnom dávkovači. Po cirkulačnej stabilizácii pacientky na 13. deň hospitalizácie bol naložený chirurgom do operačnej rany VAC systém, ktorý sa v pravidelných intervaloch menil. Počas hospitalizácie stav pacientky komplikovaný vznikom dekubitov a Clostridioides difficile infection (CDI). U pacientky postupne vznikol syndróm závislosti na UVP, preto extubovaná až na 91. deň. Na 95. deň pacientka v stabilizovanom stave so zhojenými dekubitmi, preliečenou CDI infekciou a s VAC systémom preložená na oddelenie dlhodobo chorých. Aj banálna operácia môže skončiť bojom o život. U extrémne obéznych pacientov je riziko komplikácii vyššie, nakoľko trpia viacerými ochoreniami, ktoré spomaľujú proces hojenia rán a zároveň zvyšujú nároky na poskytovanú ošetrovateľskú starostlivosť vo všetkých oblastiach. Zachránený život však prevyšuje všetky nároky a je najväčšou odmenou pre celý personál oddelenia.
Every surgical procedure represents a certain risk and possibility of developing a patient. postoperative complications, although it is a commonly performed operation. Most often, complications occur in obese patients, when even a banal operation can cause a end up in an intensive care unit and fight for their lives. In obese patients, the provision of intensive care is more difficult, as it is necessary to restoreall basic needs from foodintake to hygiene to defecation. The aim of the paper is to present and describe the course of treatment and nursing care in an extremely obese cholecystectomy patient who secondition required intensive care for developing sepsis in the area of the surgical wound, as a result of which the wound It fell apart and it was necessary to use innovative treatments and methods to heal it. Methodology: Using qualitative research in the form of a case report, we describe an interesting the case of a patient who required 95 days of hospitalization in an intensive care unit with severe sepsis, cardiovascular failure, the need for artificial pulmonary ventilation (APV), using the VAC system (vacuum assisted closure) wound healing, pressure ulcers of varying degrees, infectious diarrhea and addictionsyndrome UVP. Results: Patient transferred from the surgical intensive care unit (ICU) in a disorder of consciousness, with a need securing the respiratory tract, connection to UVP, the need for vasopressor support, septic condition, disintegration of the surgical wound and the need for glucose correction with insulin in lineardispenser. After circulatory stabilization of the patient on the 13th day of hospitalization, loaded by the surgeoninto the surgical wound of the VAC system, which at regular intervals Changed. During hospitalization, the patient’s condition is complicated by the development of pressure ulcers and Clostridioides difficile infection (CDI). The patient gradually developed UVP dependence syndrome, so shewasextubated on day 91. At the 95. day a patient in a stablecondition with healed pressure ulcers, retreated CDI infection and with the VAC system transferred to the long-term care unit. Even a banal operation can end in a fight for life. In extremely obese patients, it is the risk of complications is higher, as they suffer from several diseases that slowdown the process of wound healing and at the sametimeincrease the demands on the nursing care provided in the allareas. However, a life saved exceed sall claims and is the grea test reward for the entire staff of the department.
- MeSH
- Clostridioides difficile MeSH
- Surgical Wound Dehiscence nursing therapy MeSH
- Pressure Ulcer nursing therapy MeSH
- Wound Healing MeSH
- Obesity complications MeSH
- Critical Care Nursing MeSH
- Critical Care MeSH
- Pulmonary Ventilation MeSH
- Postoperative Complications nursing therapy MeSH
- Sepsis MeSH
- Negative-Pressure Wound Therapy MeSH
- Treatment Outcome MeSH
- Publication type
- Case Reports MeSH
Úvod: Akutní mastoiditida je hnisavý zánět sliznice mastoidních sklípků s rozpadem mezisklípkových kostěných sept. Je to nejčastější intratemporální zánětlivá komplikace středoušního zánětu u dětí. Včasná diagnostika a léčba jsou klíčové pro prevenci šíření zánětu ze spánkové kosti extraa intrakraniálně. Cíl práce: Cílem této retrospektivní studie je analyzovat případy akutní mastoiditidy u dětí na našem pracovišti. Studie se zaměřuje na vyhodnocení incidence akutní mastoiditidy u dětské populace, identifikaci hlavních etiologických agens odpovědných za tuto infekci a analýzu současných terapeutických přístupů, prevence a její afektivity. Materiál a metody: Formou retrospektivní studie byla zpracována data pacientů ošetřených a hospitalizovaných na dětském oddělení a na oddělení ORL KZ, a. s. – Nemocnice Děčín, o.z., v období 1. 1. 2015 – 1. 9. 2022 se stanovenou diagnózou akutní mastoiditida – H-700 dle MKN-10, vyhledáno pomocí nemocničního informačního systému. Výsledky: Do hodnoceného souboru bylo zahrnuto 23 pacientů. Sledovaní pacienti v souboru byli převážně ve věku 12–18 let. Nejméně dětí bylo ve věkové skupině do 6 let. Nejčetnějším původcem v uvedené studii byl Streptococcus pneumoniae se subtypy 3 a 8, na které, jak ukázala studie, vakcína Synflorix není účinná. Všem sledovaným pacientům byla nasazena empirická antibiotická terapie. Ve skupině případů od 12 do 18 let byla terapie antibiotiky zahájena v monoterapii. U mladších pacientů sestávala antibiotická terapie vždy z dvojkombinace antibiotik, jednalo se zejména o dvojkombinaci clindamycin + gentamycin. U 13 z 23 případů byla indikována chirurgická terapie. Ve většině případů se délka hospitalizace nezměnila v závislosti na věku, ani na etiologickém agens, či místě bydliště. Nebyla nalezena závislost mezi typem léčby akutní mastoiditidy a původcem onemocnění či ovlivněním sluchu. Závěr: V naší retrospektivní studii jsme zjistili, že incidence akutní mastoiditidy koreluje se všeobecně známou incidencí v rámci České republiky a celosvětovými daty. Studie prokazuje, že jako nejčastější patogen akutní mastoiditidy u dětí je identifikován Streptococcus pneumoniae. Analýza ukázala, že vakcína Prevenar 13 vykazuje lepší účinnost v prevenci akutní mastoiditidy ve srovnání s vakcínou Synflorix. Tyto výsledky naznačují, že přehodnocení používané vakcinační strategie by mohlo přispět k dalšímu snížení incidence akutní mastoiditidy. Lze konstatovat, že délka rekonvalescence a možné ovlivnění sluchu po léčbě akutní mastoiditidy nemusí záviset na typu mikrobiálního původce. Doporučujeme pokračovat v monitorování a hodnocení účinnosti vakcín a klinických přístupů ke zlepšení prevence a léčby této závažné komplikace středoušního zánětu.
Introduction: Acute mastoiditis is a purulent inflammation of the mastoid mucosa with disintegration of the interstitial bone septa. It is the most common intratemporal inflammatory complication of otitis media in children. Early diagnosis and treatment are crucial to prevent the spread of inflammation from the temporal bone extraand intracranially. Aim of the study: The aim of this retrospective study is to analyze the cases of acute mastoiditis in children in our department. The study aims to evaluate the incidence of acute mastoiditis in the pediatric population, identify the main etiological agents responsible for this infection, and analyze current therapeutic approaches, prevention, and its effectiveness. Materials and methods: The data of patients treated and hospitalized in the children‘s ward and ENT department of KZ, a. s. – Hospital Děčín, o.z., from 1 January 2015 – 1 September 2022 with the diagnosis – acute mastoiditis – H-700 according to ICD-10, were searched using the hospital information system, and were processed in the form of a retrospective study. Results: 23 patients were included in the evaluated cohort. The study population was mainly aged 12–18 years. The smallest number of children were in the age group under 6 years. Streptococcus pneumoniae with subtypes 3 and 8 was the most frequent causative agent in the study, for which the Synflorix vaccine was shown to be ineffective. Empiric antibiotic therapy was administered to all patients studied. In the group of cases aged 12 to 18 years, antibiotic therapy was started in monotherapy. In younger patients, antibiotic therapy always consisted of a double combination of antibiotics, in particular Clindamycin and Gentamycin. Surgical therapy was indicated in 13 of 23 cases. In most cases, the length of hospital stay did not vary with age, etiologic agent, or place of residence. No dependence was found between the type of treatment for acute mastoiditis or the causative agent of the disease or the effect on hearing. Conclusion: In our retrospective study, we found that the incidence of acute mastoiditis correlates with the generally known incidence in the Czech Republic and global data.The study shows that Streptococcus pneumoniae is identified as the most common pathogen of acute mastoiditis in children. The analysis showed that the Prevenar 13 vaccine showed better efficacy in preventing acute mastoiditis compared to the Synflorix vaccine. These results suggest that reassessment of the vaccination strategy used could contribute to further reduction in the incidence of acute mastoiditis. It can be concluded that the length of recovery and possible impact on hearing after treatment of acute mastoiditis may not depend on the type of microbial agent. We recommend continued monitoring and evaluation of vaccine efficacy and clinical approaches to improve prevention and treatment of this serious complication of otitis media.
The disease currently known as frontotemporal dementia (FTD) has undergone a complex evolution from its first description by Arnold Pick and later by Alois Alzheimer, through the first clinicopathological criteria introduced by David Neary and David Mann, to its current nomenclatural perception as a complex clinicopathological entity. Currently, Frontotemporal lobar degeneration is viewed as a heterogeneous syndrome caused by progressive degeneration of the frontal and temporal lobes of the brain. Clinically, it can manifest as three syndromes of frontotemporal dementia (behavioral variant of FTD, progressive non-fluent aphasia and semantic dementia) but also as so-called "overlap" syndromes involving corticobasal degeneration and progressive supranuclear palsy. Its prevalence is about 10 % among all dementias and 40 % among dementias with onset between 45 and 65 years of age. The clinical manifestation of the different subtypes varies, the common denominator being behavioral disturbances and impairment of fatic, gnostic and executive functions. Mnestic and visuo-spatial functions, although preserved for a relatively long time, are superimposed by personality disintegration, fatic, gnostic and executive dysfunction. Compared with Alzheimer's disease, it generally has an earlier age of onset, a more rapid course and more devastating impairment of individual cognitive domains. FTD has a heritability of more than 30 % according to current knowledge. The main genes involved are MAPT, C9orf72 and GRN. More rarely affected genes are VCP, TDP-43, FUS and CHMP2B. In our article, we focus on the genetics of FTD and the clinic-genetic-pathological correlations. We also aim to provide a plastic picture of how individual mutations affect the molecular mechanisms of neurodegeneration.
- MeSH
- Epigenesis, Genetic genetics MeSH
- Frontotemporal Dementia * diagnosis genetics classification MeSH
- Genetic Testing methods MeSH
- Humans MeSH
- Primary Progressive Nonfluent Aphasia diagnosis genetics MeSH
- Progranulins genetics MeSH
- tau Proteins genetics MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Over the recent years, our understanding of the cell death machinery of mature erythrocytes has been greatly expanded. It resulted in the discovery of several regulated cell death (RCD) pathways in red blood cells. Apoptosis (eryptosis) and necroptosis of erythrocytes share certain features with their counterparts in nucleated cells, but they are also critically different in particular details. In this review article, we summarize the cell death subroutines in the erythroid precursors (apoptosis, necroptosis, and ferroptosis) in comparison to mature erythrocytes (eryptosis and erythronecroptosis) to highlight the consequences of organelle clearance and associated loss of multiple components of the cell death machinery upon erythrocyte maturation. Recent advances in understanding the role of erythrocyte RCDs in health and disease have expanded potential clinical applications of these lethal subroutines, emphasizing their contribution to the development of anemia, microthrombosis, and endothelial dysfunction, as well as their role as diagnostic biomarkers and markers of erythrocyte storage-induced lesions. Fas signaling and the functional caspase-8/caspase-3 system are not indispensable for eryptosis, but might be retained in mature erythrocytes to mediate the crosstalk between both erythrocyte-associated RCDs. The ability of erythrocytes to switch between eryptosis and necroptosis suggests that their cell death is not a simple unregulated mechanical disintegration, but a tightly controlled process. This allows investigation of eventual pharmacological interventions aimed at individual cell death subroutines of erythrocytes.
- MeSH
- Apoptosis MeSH
- Cell Death MeSH
- Eryptosis * MeSH
- Erythrocytes * metabolism cytology MeSH
- Ferroptosis MeSH
- Humans MeSH
- Necroptosis MeSH
- Regulated Cell Death MeSH
- Signal Transduction * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
OBJECTIVE: This research aims to design and evaluate an enteric-coated hard capsule dosage form for targeted delivery of biological materials, such as FMT (fecal microbiota transplant) or live microbes, to the distal parts of the GIT. The capsules are designed to be internally protected against destruction by hydrophilic filling during passage through the digestive tract. METHODS: Hard gelatin capsules and DRcapsTMcapsules based on HPMC and gellan were used to encapsulate a hydrophilic body temperature-liquefying gelatin hydrogel with caffeine or insoluble iron oxide mixture. Different combinations of polymers were tested for the internal (ethylcellulose, Eudragit® E, and polyvinyl acetate) and external (Eudragit® S, Acryl-EZE®, and cellacefate) coating. The external protects against the acidic gastric environment, while the internal protects against the liquid hydrophilic filling during passage. Coated capsules were evaluated using standard disintegration and modified dissolution methods for delayed-release dosage forms. RESULTS: Combining suitable internal (ethylcellulose 1.0 %) and external (Eudragit® S 20.0 %) coating of DRcapsTM capsules with the wiping and immersion method achieved colonic release times. While most coated capsules met the pharmaceutical requirements for delayed release, one combination stood out. Colonic times were indicated by the dissolution of soluble caffeine (during 120-720 min) measured by the dissolution method, and capsule rupture was indicated by the release of insoluble iron oxide (after 480 min) measured by the disintegration method. This promising result demonstrates the composition's suitability and potential to protect the content until it's released, inspiring hope for the future of colon-targeted delivery systems and its potential for the pharmaceutical and biomedical fields. CONCLUSION: Innovative and easy capsule coatings offer significant potential for targeted drugs, especially FMT water suspension, to the GIT, preferably the colon. The administration method is robust and not considerably affected by the quantity of internal or external coatings. It can be performed in regular laboratories without specialized individual and personalized treatment equipment, making it a practical and feasible method for drug delivery.
- MeSH
- Polysaccharides, Bacterial chemistry MeSH
- Biocompatible Materials chemistry MeSH
- Cellulose * chemistry analogs & derivatives MeSH
- Hypromellose Derivatives chemistry MeSH
- Hydrophobic and Hydrophilic Interactions * MeSH
- Hydrogels chemistry MeSH
- Caffeine chemistry administration & dosage MeSH
- Colon * metabolism MeSH
- Polymethacrylic Acids chemistry MeSH
- Drug Delivery Systems * methods MeSH
- Delayed-Action Preparations chemistry MeSH
- Polymers chemistry MeSH
- Polyvinyls chemistry MeSH
- Capsules * MeSH
- Drug Liberation * MeSH
- Gelatin * chemistry MeSH
- Ferric Compounds chemistry administration & dosage MeSH
- Publication type
- Journal Article MeSH
Ochrana člověka za mimořádných událostí je povinný vzdělávací obsah volně navazující na bývalou brannou výchovu, o jejímž obnovení se v kontextu událostí poslední doby opět diskutuje. Nabízí velmi širokou paletu témat, která lze zařadit nejen do výuky chemie, ale i jiných (nejen) přírodních věd. Velmi vhodné je např. zařazení do výuky jako (krátko či střednědobý) projekt zaměřený na téma radioaktivita a jaderné zbraně, které je pro žáky zajímavé. Pro realizaci projektu byla autory článku vytvořena pojmová mapa a návodné otázky, a také seznam doporučených zdrojů informací, které mohou učitelé a jejich žáci využít. Cílem projektu je nejen nabýt nové znalosti a vědomosti v souvislosti s tématem jaderných zbraní a radioaktivity, ale také získat ucelený přehled díky mezipředmětovému uspořádání.
Human protection in emergencies is a compulsory educational content in the Czech Republic loosely related to the former military education. It offers a very wide range of topics that can be included not only in chemistry education, but also in other (not only) natural sciences. For example, it is very suitable to include it as a (short- or medium-term) project focused on radioactivity and nuclear weapons, which is of interest to the students. For this purpose, we have created a concept map and guiding questions, as well as a list of recommended sources of information that teachers and their pupils can use. The aim of the project is not only to gain new knowledge and understanding, but also to gain holistic insight into the topic through cross-curricular educational approach.
- MeSH
- Radiation, Ionizing MeSH
- Nuclear Weapons MeSH
- Humans MeSH
- Radioactivity MeSH
- Education methods MeSH
- Teaching * MeSH
- Check Tag
- Humans MeSH
An ideal extracellular matrix (ECM) replacement scaffold in a three-dimensional cell (3D) culture should induce in vivo-like interactions between the ECM and cultured cells. Highly hydrophilic polyvinyl alcohol (PVA) nanofibers disintegrate upon contact with water, resulting in the loss of their fibrous morphology in cell cultures. This can be resolved by using chemical crosslinkers and post-crosslinking. A crosslinked, water-stable, porous, and optically transparent PVA nanofibrous membrane (NM) supports the 3D growth of various cell types. The binding of cells attached to the porous PVA NM is low, resulting in the aggregation of cultured cells in prolonged cultures. PVA NMs containing integrin-binding peptides of fibronectin and laminin were produced to retain the blended peptides as cell-binding substrates. These peptide-blended PVA NMs promote peptide-specific cell adherence and growth. Various cells, including epithelial cells, cultured on these PVA NMs form layers instead of cell aggregates and spheroids, and their growth patterns are similar to those of the cells cultured on an ECM-coated PVA NM. The peptide-retained PVA NMs are non-stimulatory to dendritic cells cultured on the membranes. These peptide-retaining PVA NMs can be used as an ECM replacement matrix by providing in vivo-like interactions between the matrix and cultured cells.
- Publication type
- Journal Article MeSH
1. vydání 823 stran : ilustrace (převážně barevné), mapy ; 24 cm
Publikace se zaměřuje na radiologickou fyziku, radioaktivitu a ionizující záření. určeno odborné veřejnosti.; Monografie zahrnuje všechny důležité oblasti radiologické fyziky, včetně jejího vývoje v historickém kontextu. Postupně probírá jednotlivé typy radioaktivní přeměny, jejich vlastnosti a základy interakcí ionizujícího záření s hmotou.
- MeSH
- Physics MeSH
- Radiation, Ionizing MeSH
- Radioactivity MeSH
- Radiology MeSH
- Publication type
- Monograph MeSH
- Conspectus
- Fyzikální stavba hmoty. Jaderná fyzika. Molekulární fyzika
- NML Fields
- fyzika, biofyzika
We have recently developed a model of pancreatic islet transplantation into a decellularized pancreatic tail in rats. As the pancreatic skeletons completely lack endothelial cells, we investigated the effect of co-transplantation of mesenchymal stem cells and endothelial cells to promote revascularization. Decellularized matrix of the pancreatic tail was prepared by perfusion with Triton X-100, sodium dodecyl sulfate and DNase solution. Isolated pancreatic islets were infused into the skeletons via the splenic vein either alone, together with adipose tissue-derived mesenchymal stem cells (adMSCs), or with a combination of adMSCs and rat endothelial cells (rat ECs). Repopulated skeletons were transplanted into the subcutaneous tissue and explanted 9 days later for histological examination. Possible immunomodulatory effects of rat adMSCs on the survival of highly immunogenic green protein-expressing human ECs were also tested after their transplantation beneath the renal capsule. The immunomodulatory effects of adMSCs were also tested in vitro using the Invitrogen Click-iT EdU system. In the presence of adMSCs, the proliferation of splenocytes as a response to phytohaemagglutinin A was reduced by 47% (the stimulation index decreased from 1.7 to 0.9, P = 0.008) and the reaction to human ECs was reduced by 58% (the stimulation index decreased from 1.6 to 0.7, P = 0.03). Histological examination of the explanted skeletons seeded only with the islets showed their partial disintegration and only a rare presence of CD31-positive cells. However, skeletons seeded with a combination of islets and adMSCs showed preserved islet morphology and rich vascularity. In contrast, the addition of syngeneic rat ECs resulted in islet-cell necrosis with only few endothelial cells present. Live green fluorescence-positive endothelial cells transplanted either alone or with adMSCs were not detected beneath the renal capsule. Though the adMSCs significantly reduced in vitro proliferation stimulated by either phytohaemagglutinin A or by xenogeneic human ECs, in vivo co-transplanted adMSCs did not suppress the post-transplant immune response to xenogeneic ECs. Even in the syngeneic model, ECs co-transplantation did not lead to sufficient vascularization in the transplant area. In contrast, islet co-transplantation together with adMSCs successfully promoted the revascularization of extracellular matrix in the subcutaneous tissue.
- MeSH
- Decellularized Extracellular Matrix MeSH
- Endothelial Cells MeSH
- Neovascularization, Physiologic * MeSH
- Rats MeSH
- Cells, Cultured MeSH
- Islets of Langerhans * immunology MeSH
- Humans MeSH
- Mesenchymal Stem Cells * MeSH
- Pancreas MeSH
- Islets of Langerhans Transplantation * methods MeSH
- Mesenchymal Stem Cell Transplantation * methods MeSH
- Adipose Tissue * cytology MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Humans MeSH
- Male MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
Daydreaming, a form of spontaneous and self-generated mental process, may lead to the disintegration of attention from the immediate external environment. In extreme cases, patients may develop maladaptive daydreaming comorbid with dissociation. The examination of dissociative alterations frequently occurs within the framework of complex cognitive processes. While dissociation may be a neurological and psychological dysfunction of integration, transient dissociative occurrences, i.e., momentary dissociation may signify a dynamic interplay between attentional division and orientation within the sensory cortex. Furthermore, previous studies have recorded the interactivity of attention by stimuli onset with P3 event-related potentials and the active suppression of distractor positivity. In this context, during auditory and visual mismatch negativity, the sensory cortex may interact with attentional orientation. Additionally, distractor positivity during task-relevant stimuli may play a crucial role in predicting momentary dissociation since sensory cortices share cerebral correlates with attentional fluctuations during mental imagery. Thus, this theoretical review investigated the cerebral activities associated with attentional orientation and may be extended to mindfulness. By integrating these findings, we aim to provide a comprehensive understanding of dissociative states which may lead to a resolution for dissociative psychopathology.
- MeSH
- Dissociative Disorders * physiopathology MeSH
- Electroencephalography methods MeSH
- Evoked Potentials physiology MeSH
- Humans MeSH
- Attention * physiology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH