Multi-level control
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Autoři v práci popisují své IGleté zkušenosti s léčbou nitrobřišních neorgánových abscesu pomocí cílené perkutánní drenáže tenkým katétrem 5,5 F (n = 18) a pomocí jednorázové nebo opakované evakuační punkce tenkou jehlou 20 G (n = 30) prováděných pod sonografickou kontrolou u 48 osob. Popisovaná metoda jednorázové nebo opakované evakuační punkce a perkutánní drenáže byla úspěšná v 69 % pripadů (33 osob). Z 15 osob s neúspěšným výsledkem zemřelo 6 nemocných (12,5 %) po následné chirurgické drenáží v sepsi pod obrazem multiorgánového selhání. Na rozdíl od perkutánních drenáží širokými katétry nebyla v hodnoceném souboru zaznamenána Žádná závažná nebo letální komplikace v souvislosti s výkonem, v 6 případech (7 %) všech aspiračnich punkci a perkutánních drenáží byly zaznamenány pouze nezávazné komplikace. Dosažená úspěšnost se pohybovala na dolní hranici literárně uváděné úspěšnosti perkutánní drenáže s širšími katétry, výskyt závažných komplikací v souvislosti s touto metodikou byl na rozdíl od perkutánní drenáže s širšími katétry v hodnoceném souboru nulový.
The authors describe their 16 years of experience in the therapy of intra-abdominal extra-organ abscesses performed by means of a directed percutaneous drainage with the use of a thin catheter 5.5 F (n = 18) or by means of a single or repeated evacuation puncture by a thin needle 20 G (n = 30), which have been done under an ultrasonographic control in 48 persons. The described method of the single or repeated evacuation puncture and percutaneous drainage was successful in 69% of cases (33 persons). From the 15 other patients, six persons (12.5%) died after a subsequent surgical drainage for sepsis under the picture of a multi-organ failure. In contrast to the percutaneous drainage by wide catheters, no serious or lethal complications were detected in connection with the intervention, in 6 cases (7%) there were only insignificant complications. The success of the intervention was on the lower level of percutaneous drainage interventions, performed with wider catheters, described in literature. In contrast to percutaneous drainage with wider catheters, serious complications connected with this method were absent.
- MeSH
- břišní absces etiologie terapie ultrasonografie MeSH
- drenáž metody MeSH
- intervenční ultrasonografie metody přístrojové vybavení využití MeSH
- lidé MeSH
- punkce metody MeSH
- výsledek terapie MeSH
- zaváděcí katétry MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
... Control measures -- Section 6. Features of important foodborne diseases -- -- Annex 1. ... ... Outbreak control meeting: draft agenda -- Annex 3. ... ... Planning and preparation 4 -- 2.1 General 4 -- 2.2 Outbreak control team 4 -- 2.3 Record keeping 6 -- ... ... Control measures 47 -- 5.1 General 47 -- 5.2 Control of source 47 -- 5.3 Control of transmission 50 - ... ... Outbreak control meeting: draft agenda 103 -- 3. Examples of outbreak investigation forms 104 -- 4. ...
vi, 146 s. : il., tab. ; 30 cm
- MeSH
- enterobakteriální infekce epidemiologie prevence a kontrola MeSH
- epidemický výskyt choroby MeSH
- gastrointestinální nemoci prevence a kontrola MeSH
- kontaminace potravin prevence a kontrola MeSH
- nemoci přenášené potravou prevence a kontrola MeSH
- Konspekt
- Hygiena. Lidské zdraví
- NLK Obory
- epidemiologie
- gastroenterologie
- NLK Publikační typ
- publikace WHO
Cieľ práce: Dokázať, že pri výrazne nehomogénnej distribúcii plynov v ťažko patologicky postihnutých pľúcach je možné viachladinovou UVP zlepšiť distribúciu plynov do pomalých bronchoalveolárnych kompartmentov bez rizikovej zmeny objemového zaťaženia rýchlych kompartmentov. Autor realizoval softvérový matematický model viackompartmentných nehomogénne postihnutých pľúc, ktoré „ventiloval“ novým spôsobom UVP – tzv. trojhladinovou ventiláciou. Viachladinovú ventiláciu definuje ako spôsob (modifikáciu) UVP, pričom základnú hladinu ventilácie tvorí ventilačný režim CMV, PCV, alebo PS (ASB) a nadstavbu, tzv. ventiláciu na pozadí tvorí hladina PEEPh (PEEP high) s meniteľnou frekvenciou a trvaním prechodu medzi jednotlivými hladinami PEEPh/PEEP. Názov a sídlo pracoviska: Oddelenie anestéziológie a intenzívnej medicíny. Materiál a metodika:Viachladinová ventilácia na 3 tlakových úrovniach realizovaná matematickým modelom ako kombinácia tlakovo kontrolovanej ventilácie (PCV) a dvoch úrovní PEEP a (PEEPh). Výsledky: Pri porovnávaní jednohladinovej UVP v režime PC s tzv. trojhladinovou ventiláciou ako kombináciou PC+PEEPh/PEEP autor zistil, že plnenie pomalých kompartmentov sa na modeli výrazne zlepšilo, a to rádove o 50–60 % oproti východzej hodnote. Tento rozdiel v absolútnom vyjadrení u obštrukčných kompartmentov dosahuje 2 až 10-násobok objemu, respektive 1,2–3-násobné zvýšenie MV v kompartmentoch k4 a k5. Záver: Matematickým modelom sa dá preukázať, že aplikácia tzv. trojhladinovej UVP môže viesť k výrazným zmenám v distribúcii plynov v nehomogénne patologickým procesom postihnutom pľúcnom parenchýme. Matematický model si vyžiada klinické overenie, aby boli zodpovedané otázky účinnosti tejto modifikácie UVP.
Objective: Considering the issues of intermittent positive pressure ventilation (IPPV) in non-homogenous pathological lung processes, the author built a mathematical model of tri-compartment non-homogenously injured lungs ventilated with a new mode of IPPV – multi-level ventilation. The author defines multi-level ventilation as a type (modification) of IPPV consisting of background ventilation using the CMV, PCV or PS (ASB) ventilation mode and an added level called “on-background ventilation“ consisting of multiple levels of PEEPh (PEEP high) with variable frequency and duration of transition between individual levels of PEEP. The objective was to prove whether in cases of considerably non-homogenous gas distribution in acute pathological disorders of the lungs it is possible to improve gas distribution into slow broncho-alveolar compartments while only minimally or not at all increasing the volume load of the fast compartments by using the multi-level IPPV. Setting: Department of Anaesthesiology and Intensive Care Unit. Materials and methods: Multi-level ventilation on three pressure levels was carried out by a mathematical model as a combination of pressure-controlled ventilation (PCV) and two levels of PEEP: PEEP (constant) and PEEPh (PEEP high). Results: Comparing single-level IPPV in the PCV mode with the tri-level ventilation (PCV+PEEPh/PEEP), the author found that the loading of the slow compartments in the model was considerably improved by as much as 50–60% in comparison to the baseline value. This difference, in absolute figures, reached as much as a 2–10 times increase in volume, or a 1.2–3 times increase in minute ventilation in compartments k4 and k5. Conclusions: The mathematical model proves that the application of multi-level IPPV can achieve considerable changes in gas distribution in the lung parenchyma affected by a non-homogenous pathological process. The mathematical model requires further verification in the clinical setting to answer questions regarding its efficacy.
Cyanobacteria Synechococcus sp. PCC 7942 and Synechocystis sp. PCC 6803 show similar changes in the metabolic response to changed CO2 conditions but exhibit significant differences at the transcriptomic level. This study employs a systems biology approach to investigate the difference in metabolic regulation of Synechococcus sp. PCC 7942 and Synechocystis sp. PCC 6803. Presented multi-level kinetic model for Synechocystis sp. PCC 6803 is a new approach integrating and analysing metabolomic, transcriptomic and fluxomics data obtained under high and ambient CO2 levels. Modelling analysis revealed that higher number of different isozymes in Synechocystis 6803 improves homeostatic stability of several metabolites, especially 3PGA by 275%, against changes in gene expression, compared to Synechococcus sp. PCC 7942. Furthermore, both cyanobacteria have the same amount of phosphoglycerate mutases but Synechocystis 6803 exhibits only ~20% differences in their mRNA levels after shifts from high to ambient CO2 level, in comparison to ~500% differences in the case of Synechococcus sp. PCC 7942. These and other data imply that the biochemical control dominates over transcriptional regulation in Synechocystis 6803 to acclimate central carbon metabolism in the environment of variable inorganic carbon availability without extra cost carried by large changes in the proteome.
- MeSH
- metabolismus MeSH
- metabolomika MeSH
- oxid uhličitý metabolismus MeSH
- regulace genové exprese enzymů * MeSH
- regulace genové exprese u bakterií * MeSH
- stanovení celkové genové exprese MeSH
- Synechococcus genetika metabolismus MeSH
- Synechocystis genetika metabolismus MeSH
- systémová biologie MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Anterior cervical plate fixation is an approved surgical technique for cervical spine stabilization in the presence of anterior cervical instability. Rigid plate design with screws rigidly locked to the plate is widely used and is thought to provide a better fixation for the treated spinal segment than a dynamic design in which the screws may slide when the graft is settling. Recent biomechanical studies showed that dynamic anterior plates provide a better graft loading possibly leading to accelerated spinal fusion with a lower incidence of implant complications. This, however, was investigated in vitro and does not necessarily mean to be the case in vivo, as well. Thus, the two major aspects of this study were to compare the speed of bone fusion and the rate of implant complications using either rigid- or dynamic plates. The study design is prospective, randomized, controlled, and multi-centric, having been approved by respective ethic committees of all participating sites. One hundred and thirty-two patients were included in this study and randomly assigned to one of the two groups, both undergoing routine level-1- or level-2 anterior cervical discectomy with autograft fusion receiving either a dynamic plate with screws being locked in ap - position (ABC, Aesculap, Germany), or a rigid plate (CSLP, Synthes, Switzerland). Segmental mobility and implant complications were compared after 3- and 6 months, respectively. All measurements were performed by an independent radiologist. Mobility results after 6 months were available for 77 patients (43 ABC/34 CSLP). Mean segmental mobility for the ABC group was 1.7 mm at the time of discharge, 1.4 mm after 3 months, and 0.8 mm after 6 months. For the CSLP- group the measurements were 1.0, 1.8, and 1.7 mm, respectively. The differences of mean segmental mobility were statistically significant between both groups after 6 months (P = 0.02). Four patients of the CSLP-group demonstrated surgical hardware complications, whereas no implant complications were observed within the ABC-group (P = 0.0375). Dynamic plate designs provided a faster fusion of the cervical spine compared with rigid plate designs after prior spinal surgery. Moreover, the rate of implant complications was lower within the group of patients receiving a dynamic plate. These interim results refer to a follow-up period of 6 months after prior spinal surgery. Further investigations will be performed 2 years postoperatively.
- MeSH
- fúze páteře metody MeSH
- kostní destičky MeSH
- krční obratle patologie radiografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- neúspěšná terapie MeSH
- prospektivní studie MeSH
- studie případů a kontrol MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
Case-control study data of 637 multidrug resistance TB patients, successfully completed treatment course with first line anti-TB drugs plus pyrazinamide, revealed main medical and social factors of the disease recurrence. All patients were treated 4 or 5 months in clinic under standardized directly observed regimes and 18-24 months in out-patient surveillance. Relapse development was noted in 21 cases and significantly more often appeared in patients living alone and aged 30 to 40 years old.
- Klíčová slova
- case-control study,
- MeSH
- antituberkulotika terapeutické užití MeSH
- dospělí MeSH
- lidé MeSH
- multirezistentní tuberkulóza * terapie MeSH
- Mycobacterium tuberculosis účinky léků MeSH
- recidiva MeSH
- společenská třída MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
BACKGROUND: Patients suffering from functional neurological disorder (FND) experience disabling neurological symptoms not caused by an underlying classical neurological disease (such as stroke or multiple sclerosis). The diagnosis is made based on reliable positive clinical signs, but clinicians often require additional time- and cost consuming medical tests and examinations. Resting-state functional connectivity (RS FC) showed its potential as an imaging-based adjunctive biomarker to help distinguish patients from healthy controls and could represent a "rule-in" procedure to assist in the diagnostic process. However, the use of RS FC depends on its applicability in a multi-centre setting, which is particularly susceptible to inter-scanner variability. The aim of this study was to test the robustness of a classification approach based on RS FC in a multi-centre setting. METHODS: This study aimed to distinguish 86 FND patients from 86 healthy controls acquired in four different centres using a multivariate machine learning approach based on whole-brain resting-state functional connectivity. First, previously published results were replicated in each centre individually (intra-centre cross-validation) and its robustness across inter-scanner variability was assessed by pooling all the data (pooled cross-validation). Second, we evaluated the generalizability of the method by using data from each centre once as a test set, and the data from the remaining centres as a training set (inter-centre cross-validation). RESULTS: FND patients were successfully distinguished from healthy controls in the replication step (accuracy of 74%) as well as in each individual additional centre (accuracies of 73%, 71% and 70%). The pooled cross validation confirmed that the classifier was robust with an accuracy of 72%. The results survived post-hoc adjustment for anxiety, depression, psychotropic medication intake, and symptom severity. The most discriminant features involved the angular- and supramarginal gyri, sensorimotor cortex, cingular- and insular cortex, and hippocampal regions. The inter-centre validation step did not exceed chance level (accuracy below 50%). CONCLUSIONS: The results demonstrate the applicability of RS FC to correctly distinguish FND patients from healthy controls in different centres and its robustness against inter-scanner variability. In order to generalize its use across different centres and aim for clinical application, future studies should work towards optimization of acquisition parameters and include neurological and psychiatric control groups presenting with similar symptoms.
- MeSH
- konverzní poruchy * diagnostické zobrazování patofyziologie MeSH
- lidé MeSH
- magnetická rezonanční tomografie * metody MeSH
- mozek * diagnostické zobrazování patofyziologie MeSH
- reprodukovatelnost výsledků MeSH
- studie případů a kontrol MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: The mitochondrial metabolism has been associated with pancreatic ductal adenocarcinoma (PDAC) risk. Recent evidence also suggests the involvement of the genetic variability of the mitochondrial function in several traits involved in PDAC etiology. However, a systematic investigation of the genetic variability of mitochondrial genome (mtSNP) and of all the nuclear genes involved in its functioning (n-mtSNPs) has never been reported. METHODS: We conducted a two-phase association study of mtSNPs and n-mtSNPs to assess their effect on PDAC risk. We analyzed 35,297 n-mtSNPs and 101 mtSNPs in up to 55,870 individuals (12,884 PDAC cases and 42,986 controls). In addition, we also conducted a gene-based analysis on 1,588 genes involved in mitochondrial metabolism using Multi-marker Analysis of GenoMic Annotation (MAGMA) software. RESULTS: In the discovery phase, we identified 49 n-mtSNPs and no mtSNPs associated with PDAC risk (P < 0.05). In the second phase, none of the findings were replicated. In the gene-level analysis, we observed that three genes (TERT, SUGCT, and SURF1) involved in the mitochondrial metabolism showed an association below the Bonferroni-corrected threshold of statistical significance (P = 0.05/1588 = 3.1 × 10-5). CONCLUSIONS: Even though the mitochondrial metabolism might be involved in PDAC etiology, our results, obtained in a study with one of the largest sample sizes to date, show that neither n-mtSNPs nor mtSNPs are associated with PDAC risk. IMPACT: This large case-control study does not support a role of the genetic variability of the mitochondrial function in PDAC risk.
- MeSH
- duktální karcinom slinivky břišní genetika metabolismus MeSH
- genetická variace MeSH
- genom mitochondriální MeSH
- jednonukleotidový polymorfismus MeSH
- lidé MeSH
- mitochondrie metabolismus MeSH
- nádory slinivky břišní genetika metabolismus MeSH
- studie případů a kontrol MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
... Nevsimal, Petr -- 13 -- 14\'\" Conference of the EFTC -- Examining the impact of individual and program level ... ... factors on therapeutic process: a multi-dimensional framework of treatment engagement 50 -- Papamalis ...
1st ed. 90 s. : il. ; 21 cm
- MeSH
- kongresy jako téma MeSH
- kontrola léčiv a omamných látek MeSH
- programy národního zdraví MeSH
- rehabilitace metody trendy MeSH
- Publikační typ
- abstrakt z konference MeSH
- programy MeSH
- Geografické názvy
- Česká republika MeSH
- Konspekt
- Farmacie. Farmakologie
- NLK Obory
- rehabilitační a fyzikální medicína
- farmacie a farmakologie
Background Abnormal findings at brain MRI in patients with neurologic Wilson disease (WD) are characterized by signal intensity changes and cerebral atrophy. T2 signal hypointensities and atrophy are largely irreversible with treatment; their relationship with permanent disability has not been systematically investigated. Purpose To investigate associations of regional brain atrophy and iron accumulation at MRI with clinical severity in participants with neurologic WD who are undergoing long-term anti-copper treatment. Materials and Methods Participants with WD and controls were compared in a prospective study performed from 2015 to 2019. MRI at 3.0 T included three-dimensional T1-weighted and six-echo multigradient-echo pulse sequences for morphometry and quantitative susceptibility mapping, respectively. Neurologic severity was assessed with the Unified WD Rating Scale (UWDRS). Automated multi-atlas segmentation pipeline with dual contrast (susceptibility and T1) was used for the calculation of volumes and mean susceptibilities in deep gray matter nuclei. Additionally, whole-brain analysis using deformation and surface-based morphometry was performed. Least absolute shrinkage and selection operator regression was used to assess the association of regional volumes and susceptibilities with the UWDRS score. Results Twenty-nine participants with WD (mean age, 47 years ± 9 [standard deviation]; 15 women) and 26 controls (mean age, 45 years ± 12; 14 women) were evaluated. Whole-brain analysis demonstrated atrophy of the deep gray matter nuclei, brainstem, internal capsule, motor cortex and corticospinal pathway, and visual cortex and optic radiation in participants with WD (P < .05 at voxel level, corrected for family-wise error). The UWDRS score was negatively correlated with volumes of putamen (r = -0.63, P < .001), red nucleus (r = -0.58, P = .001), globus pallidus (r = -0.53, P = .003), and substantia nigra (r = -0.50, P = .006) but not with susceptibilities. Only the putaminal volume was identified as a stable factor associated with the UWDRS score (R2 = 0.38, P < .001) using least absolute shrinkage and selection operator regression. Conclusion Individuals with Wilson disease (WD) had widespread brain atrophy most pronounced in the central structures. The putaminal volume was associated with the Unified WD Rating Scale score and can be used as a surrogate imaging marker of clinical severity. © RSNA, 2021 Supplemental material is available for this article. See also the editorial by Du and Bydder in this issue.
- MeSH
- atrofie MeSH
- hepatolentikulární degenerace diagnostické zobrazování farmakoterapie metabolismus patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- mozek diagnostické zobrazování metabolismus patologie MeSH
- prospektivní studie MeSH
- studie případů a kontrol MeSH
- stupeň závažnosti nemoci MeSH
- železo metabolismus MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH