Cardiorespiratory signals have long been treated as "noise" in functional magnetic resonance imaging (fMRI) research, with the goal of minimizing their impact to isolate neural activity. However, there is a growing recognition that these signals, once seen as confounding variables, provide valuable insights into brain function and overall health. This shift reflects the dynamic interaction between the cardiovascular, respiratory, and neural systems, which together support brain activity. In this review, we explore the role of cardiorespiratory dynamics-such as heart rate variability (HRV), respiratory sinus arrhythmia (RSA), and changes in blood flow, oxygenation, and carbon dioxide levels-embedded within fMRI signals. These physiological signals reflect critical aspects of neurovascular coupling and are influenced by factors such as physiological stress, breathing patterns, and age-related changes. We also discuss the complexities of distinguishing these signals from neuronal activity in fMRI data, given their significant contribution to signal variability and interactions with cerebrospinal fluid (CSF). Recognizing the influence of these cardiorespiratory dynamics is crucial for improving the interpretation of fMRI data, shedding light on heart-brain and respiratory-brain connections, and enhancing our understanding of circulation, oxygen delivery, and waste elimination within the brain.
The adaptive immune response critically hinges on the functionality of T cell receptors, governed by complex molecular mechanisms, including ubiquitination. In this study, we delved into the role of in T cell immunity, focusing on T cell-B cell conjugate formation and T cell activation. Using a CRISPR-Cas9 screening approach targeting deubiquitinases genes in Jurkat T cells, we identified BAP1 as a key positive regulator of T cell-B cell conjugate formation. Subsequent investigations into BAP1 knockout cells revealed impaired T cell activation, evidenced by decreased MAPK and NF-kB signaling pathways and reduced CD69 expression upon T cell receptor stimulation. Flow cytometry and qPCR analyses demonstrated that BAP1 deficiency leads to decreased surface expression of T cell receptor complex components and reduced mRNA levels of the co-stimulatory molecule CD28. Notably, the observed phenotypes associated with BAP1 knockout are specific to T cells and fully dependent on BAP1 catalytic activity. In-depth RNA-seq and mass spectrometry analyses further revealed that BAP1 deficiency induces broad mRNA and protein expression changes. Overall, our findings elucidate the vital role of BAP1 in T cell biology, especially in T cell-B cell conjugate formation and T cell activation, offering new insights and directions for future research in immune regulation.
- MeSH
- Lymphocyte Activation * immunology MeSH
- B-Lymphocytes * immunology metabolism MeSH
- Jurkat Cells MeSH
- Humans MeSH
- Tumor Suppressor Proteins * metabolism genetics MeSH
- Receptors, Antigen, T-Cell * metabolism MeSH
- Signal Transduction MeSH
- T-Lymphocytes * immunology metabolism MeSH
- Ubiquitin Thiolesterase * genetics metabolism deficiency MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
Charakter proudění krve může být důležitý faktor při formování cévní patologie. Komplexní chaotické proudění a turbulence v kritických místech jako jsou bifurkace, může vést k iritaci cévní stěny a nakonec ke stenóze či poškození stěny. Kritická místa mohou vzniknout i při endovaskulárních zákrocích (např. při stentování) nebo v oblasti anastomózy po transplantaci orgánů. Rychlost proudění krve a jeho charakter lze efektivně a neinvazivně měřit pomocí magnetické rezonance. Metoda fázového kontrastu (PC) je dobře etablovanou technikou, která umožňuje měřit rychlost relativně přesně. Tato metoda má však i své limitace (např. omezené prostorové rozlišení s ohledem na rozměr některých cév). Navíc v případě použití stentu je MR signál silně ovlivněn až potlačen v jeho nejbližším okolí a vnitřním lumen. Proto nemůže být rychlost relevantně měřena ve stentu nebo na jeho hranicích. Avšak pomocí matematického modelování proudění s hraničními hodnotami získanými mimo problematickou oblast (stent, oblast silných turbulencí) a se znalostí anatomické geometrie by mohla informace o charakteru proudění ve zmíněných kritických oblastech přispět k predikci vývoje cévní patologie.; Character of the blood flow can be important factor in for the formation of vessel pathology. Complex chaotic flow and turbulences in critical places like bifurcation can lead to vessel wall irritation and finally to stenosis or wall damage. Such critical places can also be created by endovascular treatment (e.g. by means of stenting) or in case of vessel anastomosis after organs transplantation (e.g. connection of the renal artery to iliac artery during kidney transplantation). Flow velocity and character can be efficiently and non-invasively measured using magnetic resonance imaging (MRI). Phase contrast (PC) MRI is well established method where flow velocity is coded into the MR signal phase and so the velocity can be measured relatively precisely. However, there are several limitations when using PC for “in-vivo” quantification (e.g. low spatial resolution in respect to vessel diameter). Moreover, in case when stent was used for the treatment, the MR signal is strongly influence or even suppressed by the presence of metallic net of the stent wall creating RF shielded volume inside the stent. Therefore, the flow cannot be measured directly in the stent or very close to its border. But proper mathematical model of the flow character based on initial conditions provided by MRI outside the stent could help to predict the impact of the flow phenomena on the future vessel disease development.
- Keywords
- MRI, MRI, stent, stenóza, kvantifikace průtoku, matematické modelování toku, endovaskulární zákrok, flow quantification, mathematical model of the flow, stenosis, stent, endovascular treatment,
- NML Publication type
- závěrečné zprávy o řešení grantu AZV MZ ČR
BACKGROUND: Cerebral air embolism (CAE) is an uncommon medical emergency with a potentially fatal course. We have retrospectively analyzed a set of patients treated with CAE at our comprehensive stroke center and a hyperbaric medicine center. An overview of the pathophysiology, causes, diagnosis, and treatment of CAE is provided. RESULTS: We retrospectively identified 11 patients with cerebral venous and arterial air emboli that highlight the diversity in etiologies, manifestations, and disease courses encountered clinically. Acute-onset stroke syndrome and a progressive impairment of consciousness were the two most common presentations in four patients each (36%). Two patients (18%) suffered from an acute-onset coma, and one (9%) was asymptomatic. Four patients (36%) were treated with hyperbaric oxygen therapy (HBTO), high-flow oxygen therapy without HBOT was started in two patients (18%), two patients (18%) were in critical care at the time of diagnosis and three (27%) received no additional treatment. CAE was fatal in five cases (46%), caused severe disability in two (18%), mild disability in three (27%), and a single patient had no lasting deficit (9%). CONCLUSION: Cerebral air embolism is a dangerous condition that necessitates high clinical vigilance. Due to its diverse presentation, the diagnosis can be missed or delayed in critically ill patients and result in long-lasting or fatal neurological complications. Preventative measures and a proper diagnostic and treatment approach reduce CAE's incidence and impact.
- Publication type
- Journal Article MeSH
PURPOSE OF REVIEW: This article offers an overview of recent randomized controlled trials (RCTs) testing the efficacy of veno-arterial extracorporeal membrane oxygenation (VA ECMO) and microaxial flow pump (mAFP) in treating cardiogenic shock, including findings from the DanGer shock trial. It summarizes the clinical implications and limitations of these studies and key decision-making considerations for cardiogenic shock device use. RECENT FINDINGS: Despite important limitations in all published RCTs, the routine use of VA ECMO for acute myocardial infarction related cardiogenic shock did not demonstrate benefit and should be reserved for selected patients with extreme forms of cardiogenic shock. Conversely, mAFP (Impella CP) appears promising for cardiogenic shock due to ST elevation myocardial infarction. A stepwise approach - initial mAFP use for cardiogenic shock with left ventricular failure, supplemented by VA ECMO if mAFP is inadequate or if severe right ventricular failure is present - may be preferable, but requires validation through RCTs. High complication rates in device arms underscore the need for careful patient selection, preventive strategies, education for centers and operators, and further research. SUMMARY: Recent trials offer insights into mechanical circulatory support in cardiogenic shock, but their real-world applicability is limited. Despite potential benefits, the use of VA ECMO and mAFP is associated with significant complication rates, emphasizing the need for personalized use.
The demographic profile of patients transitioning from chronic kidney disease to kidney replacement therapy is changing, with a higher prevalence of aging patients with multiple comorbidities such as diabetes mellitus and heart failure. Cardiovascular disease remains the leading cause of mortality in this population, exacerbated by the cardiovascular stress imposed by the HD procedure. The first year after transitioning to hemodialysis is associated with increased risks of hospitalization and mortality, particularly within the first 90-120 days, with greater vulnerability observed among the elderly. Based on data from clinics in Fresenius Medical Care Europe, Middle East, and Africa NephroCare, this review aims to optimize hemodialysis procedures to reduce mortality risk in stable incident and prevalent patients. It addresses critical aspects such as treatment duration, frequency, choice of dialysis membrane, dialysate composition, blood and dialysate flow rates, electrolyte composition, temperature control, target weight management, dialysis adequacy, and additional protocols, with a focus on mitigating prevalent intradialytic complications, particularly intradialytic hypotension prevention.
- Publication type
- Journal Article MeSH
- Review MeSH
Persistent infection with high-risk types of human papillomaviruses (HPV) is a major cause of cervical cancer, and an important factor in other malignancies, for example, head and neck cancer. Despite recent progress in screening and vaccination, the incidence and mortality are still relatively high, especially in low-income countries. The mortality and financial burden associated with the treatment could be decreased if a simple, rapid, and inexpensive technology for HPV testing becomes available, targeting individuals for further monitoring with increased risk of developing cancer. Commercial HPV tests available in the market are often relatively expensive, time-consuming, and require sophisticated instrumentation, which limits their more widespread utilization. To address these challenges, novel technologies are being implemented also for HPV diagnostics that include for example, isothermal amplification techniques, lateral flow assays, CRISPR-Cas-based systems, as well as microfluidics, paperfluidics and lab-on-a-chip devices, ideal for point-of-care testing in decentralized settings. In this review, we first evaluate current commercial HPV tests, followed by a description of advanced technologies, explanation of their principles, critical evaluation of their strengths and weaknesses, and suggestions for their possible implementation into medical diagnostics.
- MeSH
- Papillomavirus Infections * complications MeSH
- Humans MeSH
- Human Papillomavirus Viruses MeSH
- Uterine Cervical Neoplasms * MeSH
- Papillomaviridae genetics MeSH
- Technology MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Fyziologickou funkcí horních dýchacích cest je ohřát a zvlhčit vdechovaný vzduch. U pacientů na umělé plicní ventilaci je nutné tuto funkci nahradit. Součástí respirační péče je i užití pasivního (HME, heat and moisture exchanger) nebo aktivního ohřátí a zvlhčení vdechované směsi. V populaci neselektovaných kriticky nemocných nebyly v randomizovaných kontrolovaných studiích zjištěny rozdíly v klinickém výsledku mezi oběma těmito způsoby. Použití HME je technicky jednodušší způsob, který je preferovaný u pacientů bez respirační patologie, u kterých se předpokládá potřeba jen kratší umělé plicní ventilace (UPV); < 4 dny. U ostatních ventilovaných nemocných může být preferováno aktivní zvlhčení, protože HME buď naráží na limitace účinnosti (vysoké inspirační průtoky nebo hypotermie pacienta), životnosti (zanášení sekrety), nebo nežádoucí efekt zvýšení mrtvého prostoru (ARDS; acute respiratory distress syndrome). V článku jsou podrobně rozebrány fyzikální a fyziologické principy a dostupná experimentální a klinická data o různých způsobech zvlhčení v intenzivní péči. Je diskutována nejednotnost doporučení stran frekvence výměny filtrů, kde se zdá, že doporučení výrobců ne zcela reflektují rizika častějšího rozpojování okruhu a experimentální data zcela chybí. Kromě uceleného pohledu na tuto problematiku si článek klade za cíl poskytnout i konkrétní doporučení pro praxi.
The upper airway naturally warms and humidifies inspired air. For patients with artificial airways, this function is assumed by respiratory care devices, utilizing passive (HME, Heat and Moisture Exchangers) or active humidification. Despite no observed differences in clinical outcomes between these methods in randomised trials with critically ill patients, each has its particular benefits. HME, being technically simpler, is favoured in patients without respiratory pathologies, who are expected to be on only short-term mechanical ventilation (< 4 days). For other ventilated patients, active humidification might be more appropriate, especially when HME's efficacy is limited due to high inspiratory flow, patient hypothermia, contamination risk, or in patients sensitive to increased dead space, such as in ARDS. This paper explores the physiological principles, experimental findings, and clinical data regarding respiratory humidification in intensive care. It also highlights the disparity in recommendations on the frequency of filter changes. Manufacturers' guidelines often do not consider the risks associated with frequent circuit disconnection, and there is a noticeable absence of experimental data on this topic. This paper seeks to offer a holistic understanding of respiratory humidification in intensive care, coupled with actionable recommendations for clinical practice.
- Keywords
- HME, výměníky tepla a vlhkosti,
- MeSH
- Humans MeSH
- Critical Care * methods MeSH
- Risk MeSH
- Temperature MeSH
- Respiration, Artificial methods instrumentation MeSH
- Humidity MeSH
- Airway Management * history methods instrumentation MeSH
- Humidifiers MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Introduction: Thermoregulation is a complex process in the human body with the ability to maintain a constant optimal body temperature. Biochemical processes of the organism, as well as metabolic processes, are closely correlated with body temperature. Human temperature is determined by several laws, in particular metabolic production and heat flow between the organism and the environment. For the proper functioning of the organs in the human body, it is essential to maintain a constant optimum body temperature. This can be disturbed by inadequate internal and external factors and thermal discomfort can affect the patient's overall outcome. Aim: The aim of this study is to evaluate the development of body temperature in critically ill patients in the emergency department and its effect on overall patient outcome. Design: Quasi-experiment. Methods: Direct observation was performed, including measurement and analysis of body temperature in patients with serious condition in emergency admission. Data were collected in the emergency department of a teaching hospital with a trauma center status between March and December 2021. Statistical tests were evaluated at the level of statistical significance α=0.05. Results: The study population consisted of 274 (100%) patients. Most negative readings were recorded at the time of patient admission. During the course of treatment, there was a gradual adjustment of body temperature to the physiological limit. The resulting body temperature values were within the desired or expected parameters. In terms of a more detailed description, the most significant values were identified in patients with cardiac problems. Conclusions: Knowing the direction of body temperature skew can be considered beneficial. Early correction of pathological values can have a major effect on the overall outcome of the patient.
Téma bylo zpracováno formou diplomové práce, která se zabývá podpůrnými respiračními, ventilačními a neinvazivními technikami dechové podpory, které souvisejí s celosvětovou pandemií covidu-19, která v období 2020–2021 ovlivnila život mnoha lidí. Během pandemie se v nemocnicích rozšířila terapie vysokoprůtokovým nosním kyslíkem (HFNC –high-flow nasal cannul; high-flow) jakožto možná alternativa umělé plicní ventilace (UPV) u covid pozitivních pacientů. Práce se zabývá problematikou, zda HFNC může být alternativou UPV u covid pozitivních pacientů v intenzivní péči. Empirická část vyplývá z kvantitativních výzkumů. První výzkum byl zaměřen na sestry a jejich zkušenosti a znalosti s technikou HFNC, jejím principem a fungováním, a to prostřednictvím rozeslaných dotazníků. Druhý výzkum byl zpracován sběrem sekundárních dat za pomoci statistické analýzy. Ve druhém kvantitativním šetření bylo cílem znázornění ventilačních režimů u všech hospitalizovaných pacientů, kteří podstoupili terapii na UPV či HFNC, zjistit, zda je HFNC alternativou UPV u covid pozitivních pacientů a zda nedošlo k jejímu selhání během terapie.
The topic was explored through a master’s thesis that focuses on supportive respiratory, ventilatory, and non-invasive techniques of respiratory assistance related to the global covid-19 pandemic, which affected the lives of many people during the period of 2020–2021. During this pandemic, the use of high-flow nasal oxygen therapy (high-flow) proliferated in hospitals as a potential alternative to invasive mechanical ventilation for covid-positive patients. The thesis addresses the question of whether high-flow can serve as an alternative to invasive mechanical ventilation for covid-positive patients in intensive care. The empirical part is derived from quantitative research. The first study focused on nurses and their experiences and knowledge of the high-flow technique, its principles, and its functioning, through distributed questionnaires. The second study utilized secondary data collection and statistical analysis. In the second quantitative investigation, the goal was to depict ventilation strategies in all hospitalized patients who underwent therapy with either invasive mechanical ventilation or high-flow, to determine whether high-flow can serve as an alternative to invasive mechanical ventilation for covid-positive patients, and whether its failure occurred during the therapy.
