optimized protocol
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Náhle zlyhanie obličiek (NZO) na oddeleniach intenzívnej starostlivosti je stále závažným problémom s vysokou mortalitou. Doteraz používané preventívne postupy na zabránenie rozvoja NZO nepriniesli očakávané výsledky. Zistením, že u kriticky chorých pacientov je narušená autoregulácia prietoku krvi obličkami a prietok sa stáva závislým od stredného arteriálneho tlaku (MAP), sa otvorila nová možnosť ovplyvnenia NZO. Na našom pracovisku sme vychádzali z modifikovaného prístupu podľa Cordingley a Palazza, ktorý pozostával z 3 bodov: 1. Optimalizácia a niekedy maximalizácia efektívneho cirkulujúceho objemu krvi. 2. Udržanie alebo obnovenie diurézy pomocou kontinuálnej infúzie diuretík. 3. Udržanie dostatočne vysokého stredného arteriálneho tlaku kontinuálnou infúziou noradrenalinu. Tento postup sme aplikovali u 18-tich pacientov celkovo 19 krát. 18 krát sa nám podarilo zvýšiť diurézu. Pritom u 12-tich pacientov s dvoma zlyhávajúcimi orgánovými systémami tento postup stačil na postupnú úpravu renálnych funkcií. Len 1 pacient z tejto skupiny zomrel na ťažký akútny infarkt myokardu. Naproti tomu u 6-tich pacientov s minimálne 3-mi zlyhávajúcimi systémami bol tento postup účinný len u jedného pacienta. Ostatní 5-ti pacienti z tejto skupiny vyžadovali v ďalšom priebehu CAVVH, CAVVHD alebo HD. Všetci 5-ti pacienti zomreli.
The acute renal failure (ARF) remains still a serious problem with a high mortality rate in the ICU. All known approaches have failed in the attempt to prevent or treat ARF. Critically ill patients have impaired or absent autoregulation of renal blood flow. The renal blood flow depends in this case on a mean arterial pressure (MAP). In this way we can influence the course of ARF. In our work we used a modificated approach to ARF, from Cordingey and Palazzo. Our approach contained: 1. Reachment of optimal and sometimes of maximal effective intravascular circulating volume. 2. Sustain or increase diuresis with continual infusion of diuretics. 3. Sustain adequate MAP with continual infusion of noradrenalin. We applicated this approach 19 times with 18 pacients. 18 times we were able to increase diuresis. And this was satisfied to recover renal function in the group of 12 patients whom two organ systems have failed. Only one patient from this group died. On the other hand the same approach was satisfied to recover renal function only from one patient in the group of 6 patients where 3 and more organ systems have failed. The other 5 patients from this group required CVVH, CVVHD or HD in the next course of disease. All these 5 patients died.
- MeSH
- akutní poškození ledvin farmakoterapie mortalita MeSH
- diuréza MeSH
- dospělí MeSH
- hemodynamika MeSH
- kardiovaskulární nemoci chirurgie komplikace MeSH
- kritický stav farmakoterapie komplikace mortalita MeSH
- ledviny krevní zásobení patofyziologie účinky léků MeSH
- lidé středního věku MeSH
- lidé MeSH
- noradrenalin farmakologie terapeutické užití MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
Cardiac arrest continues to have poor survival in the United States. Recent studies have questioned current practice in resuscitation. Our emergency medical services system made significant changes to the adult cardiac arrest resuscitation protocol, including minimizing chest compression interruptions, increasing the ratio of compressions to ventilation, deemphasizing or delaying intubation, and advocating chest compressions before initial countershock. METHODS AND RESULTS: This retrospective observational cohort study reviewed all adult primary ventricular fibrillation and pulseless ventricular tachycardia cardiac arrests 36 months before and 12 months after the protocol change. Primary outcome was survival to discharge; secondary outcomes were return of spontaneous circulation and cerebral performance category. Survival of out-of-hospital arrest of presumed primary cardiac origin improved from 7.5% (82 of 1097) in the historical cohort to 13.9% (47 of 339) in the revised protocol cohort (odds ratio, 1.80; 95% confidence interval, 1.19 to 2.70). Similar increases in return of spontaneous circulation were achieved for the subset of witnessed cardiac arrest patients with initial rhythm of ventricular fibrillation from 37.8% (54 of 143) to 59.6% (34 of 57) (odds ratio, 2.44; 95% confidence interval, 1.24 to 4.80). Survival to hospital discharge also improved from an unadjusted survival rate of 22.4% (32 of 143) to 43.9% (25 of 57) (odds ratio, 2.71; 95% confidence interval, 1.34 to 1.59) with the protocol. Of the 25 survivors, 88% (n=22) had favorable cerebral performance categories on discharge. CONCLUSIONS: The changes to our prehospital protocol for adult cardiac arrest that optimized chest compressions and reduced disruptions increased the return of spontaneous circulation and survival to discharge in our patient population. These changes should be further evaluated for improving survival of out-of-hospital cardiac arrest patients.
- MeSH
- Americká kardiologická asociace MeSH
- analýza přežití MeSH
- časové faktory MeSH
- chronické poškození mozku etiologie prevence a kontrola MeSH
- dospělí MeSH
- elektrická defibrilace kontraindikace metody normy MeSH
- fibrilace komor epidemiologie komplikace MeSH
- insuflace MeSH
- intratracheální intubace metody normy MeSH
- kardiopulmonální resuscitace metody normy MeSH
- klinické protokoly MeSH
- lidé středního věku MeSH
- lidé MeSH
- masáž srdce MeSH
- oxygenoterapie kontraindikace metody mortalita MeSH
- retrospektivní studie MeSH
- senioři MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- srdeční zástava komplikace mortalita terapie MeSH
- urgentní zdravotnické služby metody normy MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
- Geografické názvy
- Kansas MeSH
- Spojené státy americké MeSH
Face transplantation introduces an unprecedented potential to restore form and function in patients with severe facial disfigurement. A successful face transplantation programme requires a sound research protocol, a solid infrastructure, expert personnel and adequate funding. There are only a few active face transplant programmes in the world and interest in the development of new such programmes continues to grow. After 2 years of working on the development of the face transplant programme, in 2009 the team at Brigham and Women's Hospital (BWH) performed the 2nd face transplant in the United States. Since then, the team has continued to evaluate several possible face transplant candidates and performed three additional facial transplants. These experiences have helped refine a highly effective multidisciplinary protocol that carries a patient through recruitment, informed consent, screening, preoperative planning, face transplantation surgery and postoperative long-term follow-up. The members of the BWH face transplantation team responsible for carrying out this protocol include a team leader, a programme manager/coordinator, clinical and rehabilitation specialists, social workers, bioethicists, nurses and administrative staff. The roles of each team member during the various stages of the face transplant process are presented here. Additional insight into the interaction between the face transplant team, the Institutional Review Board and the regional Organ Procurement Organization is given. The BWH team's experience has shown that true collaboration, creativity and a unique approach to each candidate translate into the optimal care of the face transplant patient both before and after surgery.
- MeSH
- interprofesionální vztahy MeSH
- klinické protokoly * MeSH
- lidé MeSH
- pooperační péče MeSH
- rejekce štěpu MeSH
- transplantace obličeje metody normy MeSH
- týmová péče o pacienty organizace a řízení MeSH
- výběr pacientů MeSH
- získávání tkání a orgánů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Research Support, U.S. Gov't, Non-P.H.S. MeSH
- Geografické názvy
- Boston MeSH
Úvod: Hypertrofické jizvy jsou nechtěným a mutilujícím následkem hlubokých popálenin, dále vystupňovány jsou u rozsáhlých popáleninových úrazů. Frakční CO2 laserová terapie je jednou z metod komplexní léčby hypertrofických jizev a používá se od roku 2007. Přestože její účinnost byla v klinické praxi objektivně prokázána, nebyly stanoveny optimální parametry nastavení. Pro hodnocení účinku laserové terapie se používají dříve navržené hodnotící nástroje, které dobře postihují kvalitu jizev, ale nedokáží postihnout specifické změny pro provedené laserové terapii. Materiál a metody: Frakční CO2 laserová terapie hypertrofických jizev je na Oddělení plastické a estetické chirurgie FN Olomouc prováděna od roku 2017; systematická studie účinků probíhala v letech 2019–2020. Celkem bylo léčeno 25 hypertrofických jizev u 13 pacientů, každá z jizev byla frakční CO2 laser terapií ošetřena více než jednou. Výsledky: Statistickou analýzou dat bylo detekováno statisticky významné zlepšení textury jizev a zlepšení celkového funkčního a estetického výsledku. U jizev, jejichž výška byla před zahájením laserové terapie vyšší než 2 mm, došlo k signifikantní redukci výšky pod 2 mm (62,5 % jizev). Korelační analýzou byla detekována statisticky signifikantní pozitivní korelace mezi energií laserového paprsku a redukcí rozsahu jizev prominujících nad nivó zdravého okolí. Frakční CO2 laserová terapie ukázala statisticky významnou účinnost při redukci rizik spojených s plnoformátovou CO2 laserovou terapií. Frakční ošetření bylo pacienty velmi dobře tolerováno, topická anestezie 5% gelem lidokainu byla dostatečná u 24 z 25 pacientů. Následné hojení probíhalo u všech pacientů bez komplikací. Závěr: Frakční CO2 laserovou terapií bylo dosaženo statisticky významného zlepšení textury a redukce výšky hypertrofických jizev a zlepšení celkového funkčního i estetického výsledku.
Introduction: Hypertrophic scars are an unwanted and mutilating consequence of deep burns, and are further exacerbated by extensive burn injuries. Fractional CO2 laser therapy is one of the methods for complex treatment of hypertrophic scars, it has been used since 2007 [1]. Although its effectiveness has been objectively proven in clinical practice, the optimal settings parameters have not been determined. To evaluate the effect of laser therapy, previously designed evaluation tools are used, which evaluate the quality of scars well, but fail to capture specific changes for the performed laser therapy. Material and methods: Fractional CO2 laser therapy of hypertrophic scars is performed at the Department of Plastic and Esthetic Surgery, University Hospital Olomouc, since 2017 and the systematic study took place in 2019–2020. In common, 25 hypertrophic scars were treated in 13 patients; each scar was treated by fractional CO2 laser therapy more than once. Results: Statistical analysis detected statistically significant improvement of the texture of the scars and the improvement of overall functional and esthetic result. We found significant reduction of the height under 2 mm (62,5% of scars) in scars with the height > 2 mm before the initiation of laser therapy. Correlation analysis detected a statistically significant positive correlation between the energy of laser beam and the reduction volume of the scar protruding above the niveau of healthy surrounding tissue. Fractional CO2 laser therapy showed statistically significant efficacy in the reduction of the risks associated with full-format CO2 laser-therapy. Fractional treatment was very well tolerated by the patients. Topical 5% lidocaine gel was effective in 24 out of 25 patients. Further healing was without complications in all patients. Conclusion: Fractional CO2 laser therapy has achieved statistically significant improvement of the texture and reduction of hypertrophic scars and overall improvement of functional and esthetic result in our study.
ERAS (enhanced recovery after surgery) představuje komplexní strategii zaměřenou na urychlení rekonvalescence, redukci komplikací a optimalizaci pooperační péče. Protokol ERAS se skládá z doporučení pro předoperační, perioperační a pooperační fázi péče o pacienty. Implementace ERAS protokolu přináší řadu benefitů, a to jak pro pacienty, tak pro zdravotnický systém. Zkracuje dobu hospitalizace, snižuje počet a závažnost pooperačních komplikací a zlepšuje kvalitu života pacientů. Tyto faktory vedou k úspoře nákladů na zdravotní péči a zefektivnění obratu pacientů na lůžkách (tzv. obložnost). Důsledné dodržování protokolu ERAS je klíčové pro dosažení optimálních výsledků. Komplexní strategie ERAS tak představuje historický zlom v perioperační péči a stává se nezbytným standardem v chirurgii jater a slinivky břišní.
ERAS (enhanced recovery after surgery) represents a comprehensive strategy aimed at expediting patient recovery, reducing complications, and optimizing postoperative care. The ERAS protocol encompasses recommendations for the preoperative, perioperative, and postoperative phases of patient care. Implementation of the ERAS protocol yields a multitude of benefits for both patients and the healthcare system. It shortens hospital stays, diminishes the number and severity of postoperative complications, and enhances patient’s quality of life. These factors contribute to healthcare cost savings and improved bed turnover efficiency. Rigorous adherence to the ERAS protocol is paramount to achieving optimal outcomes. The comprehensive ERAS strategy thus marks a paradigm shift in perioperative care and emerges as an indispensable standard in liver and pancreatic surgery.
PURPOSE: To assess the efficacy of the novel clinical formulation of fenretinide (LAU-7b) for the treatment of allergic asthma. To study the association between LAU-7b treatment in allergic asthma and the modulation of very long chain ceramides (VLCC). METHODS: We used two allergens (OVA and HDM) to induce asthma in mouse models and we established a treatment protocol with LAU-7b. The severity of allergic asthma reaction was quantified by measuring the airway resistance, quantifying lung inflammatory cell infiltration (Haematoxylin and eosin stain) and mucus production (Periodic acid Schiff satin). IgE levels were measured by ELISA. Immunophenotyping of T cells was done using Fluorescence-activated cell sorting (FACS) analysis. The analysis of the specific species of lipids and markers of oxidation was performed using mass spectrometry. RESULTS: Our data demonstrate that 10 mg/kg of LAU-7b was able to protect OVA- and HDM-challenged mice against increase in airway hyperresponsiveness, influx of inflammatory cells into the airways, and mucus production without affecting IgE levels. Treatment with LAU-7b significantly increased percentage of regulatory T cells and CD4+ IL-10-producing T cells and significantly decreased percentage of CD4+ IL-4-producing T cells. Our data also demonstrate a strong association between the improvement in the lung physiology and histology parameters and the drug-induced normalization of the aberrant distribution of ceramides in allergic mice. CONCLUSION: 9 days of 10 mg/kg of LAU-7b daily treatment protects the mice against allergen-induced asthma and restores VLCC levels in the lungs and plasma.
- MeSH
- alergeny imunologie MeSH
- bronchiální astma farmakoterapie imunologie metabolismus MeSH
- ceramidy metabolismus MeSH
- fenretinid terapeutické užití MeSH
- klinické protokoly MeSH
- methylcelulosa chemie MeSH
- modely nemocí na zvířatech MeSH
- myši MeSH
- ovalbumin imunologie MeSH
- příprava léků MeSH
- Pyroglyphidae imunologie MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- myši MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Hepatectomies play a crucial role in the multidisciplinary management of primary and secondary liver malignancies but are associated with significant risks, including 30-day mortality, morbidity, prolonged hospitalization, and increased resource utilization. Optimizing perioperative care remains a challenge; however, enhanced recovery programs have shown improved patient outcomes. The EUPEMEN (EUropean PErioperative MEdical Networking) protocol focuses on improving the perioperative management of liver resections through the establishment of interdisciplinary principles based on practical experience and theoretical frameworks from five European countries. This paper outlines the core elements of the EUPEMEN protocol, emphasizing strategies to minimize surgical stress, optimize perioperative care, and enhance postoperative recovery. The protocol is systematically designed to reduce postoperative mortality and morbidity, shorten hospital stays, and improve patient outcomes. The EUPEMEN guidelines address inconsistencies in surgical practice across Europe and are structured for implementation in various healthcare environments. "The protocol's approach is designed to support improvements in perioperative care standards in liver resections and may serve as a practical and efficient tool for healthcare professionals, pending further clinical validation. The EUPEMEN protocol offers a standardized, evidence-based framework to enhance perioperative management in hepatectomies. By integrating multidisciplinary principles, the main target is to eliminate complications, improve surgical outcomes, and promote faster recovery. Its implementation across diverse clinical settings may contribute to advancing perioperative care standards for liver resections in Europe.
- MeSH
- hepatektomie * metody normy MeSH
- klinické protokoly MeSH
- lidé MeSH
- nádory jater chirurgie MeSH
- perioperační péče * metody normy MeSH
- pooperační komplikace prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Evropa MeSH
Úvod: Zubní dřeň představuje relativně snadno dostupný zdroj mezenchymových kmenových buněk. Kmenové buňky ze zubní dřeně (KBZD) byly poprvé izolovány v roce 2000 a od té doby jsou intenzivně studovány. Cíl: Cílem studie bylo optimalizovat proces izolace KBZD, zejména zkrátit dobu, po kterou je zubní dřeň enzymaticky štěpena. U KBZD izolovaných novým postupem stanovit proliferační aktivitu, fenotyp, viabilitu a ověřit schopnost jejich diferenciace ve zralé buněčné typy – osteoblasty, chondroblasty a adipocyty. Materiály a metodika: Extrahovali jsme celkem pět stálých zubů a izolovali pět buněčných linií, které jsme kultivovali v modifikovaném kultivačním médiu (α-MEM) pro adultní mezenchymové progenitorové buňky, obohaceném o 2 % fetálního bovinního séra, růstové faktory, antibiotika, antimykotika, a doplněném o Insulin-Transferrin-Sodium-Selenium supplement. Pro stanovení viability, počtu a velikosti buněk jsme použili přístroje Vi-Cell analyzer a Z2-Counter. Fenotypová analýza byla provedena pomocí průtokového cytometru Cell Lab Quanta. Pro diferenciaci v chondroblasty, osteoblasty a adipocyty jsme použili komerčně dostupná diferenciační média. Průkaz diferenciace jsme dokazovali imunohistochemicky (osteokalcin a kolagen typu II) a histologickým barvením (modrý Massonův trichrom, barvení dle Kossy a olejová červeň). Výsledky: KBZD jsme kultivovali do 8. pasáže. Buňky dosáhly průměrně 47,8 ± 2,0 populačních zdvojení (angl. population doublings; PD). Průměrný čas potřebný pro zdvojení populace (angl. doubling time; DT), činil 39,2 ± 6,1 hodin. Po celou dobu kultivace byly buňky proliferačně aktivní. Průměrná viabilita v 2. pasáži byla 92,3 ± 1,5 % a v 8. pasáži 92,4 ± 1,4 %. Fenotypovou analýzou jsme prokázali vysokou expresi povrchových antigenů pro mezenchymové kmenové buňky (angl. cluster of differentiation; CD) CD13, CD29, CD44, CD90, pro tzv. „stromal associated“ znaky CD73, CD166, a naopak nízkou či nízce pozitivní expresi znaků CD31, CD34, CD45, typických pro endoteliální a hematopoetickou buněčnou řadu. KBZD se diferencovaly ve zralé buněčné typy, osteoblasty a chondroblasty. I přes proadipogenně silně působící médium buňky nediferencovaly v adipocyty. Závěr: Podařilo se nám optimalizovat izolační protokol pro KBZD tím, že jsme zkrátili dobu, po kterou je zubní dřeň enzymaticky štěpena. KBZD izolované touto metodou prokazovaly po celou dobu kultivace vysoký proliferační a diferenciační potenciál. Nezpozorovali jsme žádné známky spontánní diferenciace či degenerace. Právě pro vysokou proliferační aktivitu, široký diferenciační potenciál a snadnou dostupnost představují KBZD budoucnost v regenerativní medicíně.
Introduction: The dental pulp represents an easily accessible source of adult dental pulp stem cells (DPSCs). They were isolated for the first time in 2000 and since then many researchers have investigated and analysed their biological characteristics. Aim: The purpose of this study was to optimize the isolation protocol for DPSCs, namely to shorten the time of enzymatic digestion of the dental pulp, and to cultivate isolated DPSCs using this new approach, investigate their proliferation, phenotype, cell viability and determine their ability to differentiate into mature cells, chondroblasts, osteoblasts, and adipocytes. Materials and methods: Out of five extracted permanent teeth, we isolated five dental pulp stem cell lineages. They were cultivated in a modified cultivation media (α-MEM) for mesenchymal adult progenitor cells containing 2 % fetal bovine serum (FBS) and supplemented with growth factors, antibiotics, antimycotics and Insulin-Transferrin-Sodium-Selenium supplement (ITS). The cell viability, cell count and other properties were examined using a Vi-Cell analyzer and Z2-Counter. The phenotype analysis was performed using a flow cytometer Cell Lab Quanta. For differentiation in chondroblasts, osteoblasts and adipocytes, we used commercially available differentiation media. The evidence of differentiation was proved by the immunocytochemistry (osteocalcin and collagen type II) and histological staining (blue Masson's trichrome, von Koss stain and oil red). Results: We were able to cultivate DPSCs over 47.8 ± 2.0 population doublings (PD). The average population doubling time (DT) was 39.2 ± 6.1 hours. The average cell viability was 92.3 ± 1.5 % in the second passage and 92.4 ± 1.4 % in the eighth passage. DPSCs showed high positivity for mesenchymal stem cell markers (cluster of differentiation; CD) CD29, CD44, CD90 and for stromal associated markers CD13, CD73, CD166 and negative expression or low positivity for hematopoietic markers CD34, CD45 and for CD31. DPSCs differentiated into osteoblasts and chondroblasts. Even after the exposition of the strong adipogenic medium they did not show any signs of differentiation into adipocytes. Conclusion: We have successfully optimized the isolation protocol for DPSCs by shortening the time of enzymatic digestion of the dental pulp. DPSCs isolated using the new method demonstrated the high proliferation and differentiation potential throughout long-term cultivation. We did not observe any signs of spontaneous differentiation or cell degeneration. DPSCs seems to be the promising future for a regenerative and reparative medicine thanks to their remarkable high proliferative potential and ability to differentiate into many mature cell populations.
Due to limitations in commercial diagnostic methods, this study aimed to develop a reliable real-time polymerase chain reaction (Rt-PCR) assay for early diagnosis of brucellosis. Optimization of the Rt-PCR method was performed on serum samples spiked by Brucella melitensis with different densities ranging from 101 to 108 colony-forming units (cfu)/mL; each density was prepared in ten samples. The limit of detection was investigated by using Thermo DNA extraction kit with Maxima SYBR Green Rt-PCR and two TaqMan probe-based Rt-PCR protocols performed by QuantiTect and TEMPase multiplex PCR master mixes in two thermal cyclers, which were Rotor-Gene and Bio-Rad. The validation of the optimized protocol was carried on 20 brucellosis-negative samples and 20 samples spiked with B. melitensis by using a combination of Thermo DNA extraction kit with TEMPase PCR master mix. SYBR Green Rt-PCR yielded positive results on all samples having ≥ 104 cfu/mL of B. melitensis in both thermal cyclers. Its limit of detection was 112 DNA copies per reaction. The positivity of both probe-based Rt-PCR protocols was 100% and 80% on the samples having 103 cfu/mL and 102 cfu/mL of B. melitensis, respectively. The limit of detection of probe-based protocols was defined as 4 DNA copies per reaction. The optimized Rt-PCR protocol showed high-level accuracy, precision, specificity, and sensitivity, each having a rate of 100%. The current study indicated that the TaqMan probe-based Rt-PCR protocol optimized and validated with serum samples can be reliably used for early diagnosis of brucellosis.