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This year marks the 20th anniversary of the launch of the chronic thromboembolic pulmonary hypertension (CTEPH) surgical treatment programme, which involves three departments of the Cardiac Centre of the General University Hospital in Prague. Diagnosis and decision-making on the type of treatment, including indication for surgical treatment, is carried out at the Centre. Other non-surgical treatments and long-term dispensary care are also available to patients. Over 500 patients with CTEPH have been operated on during the program's lifetime. Our Centre also concentrates on patients with other types of severe pulmonary hypertension who are indicated for various challenging surgical procedures, as they can be offered comprehensive perioperative care by experienced anaesthetists and intensivists. Anaesthesia and intensive postoperative care of patients indicated for pulmonary endarterectomy has certain specifics, which are based on the fact that patients undergoing this operation have right-sided heart failure with chronic low cardiac output, are significantly symptomatic, and have minimal circulatory and ventilatory reserves. In addition, they are at risk of developing several serious complications during the surgery and in the early postoperative period, which increase morbidity and mortality. This review work is based on twenty years of experience at our center, many of which have been materialized in independent original studies published in peer-reviewed journals. In addition to their practice, the authors draw on the experience of other European and international centers, many of which they have established useful collaborations with. The anaesthetic and intensive care procedures used have undergone many changes over the past twenty years and have been re-evaluated based on recommendations and experience, always to improve outcomes and reduce the rate of perioperative complications. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To compare clinical parameters and quality of life in patients with pulmonary arterial hypertension (PAH) at the time of diagnosis, at the time of LenusPro pump implantation and during intravenous treptostinil treatment. METHODS: Seven patients with severe PAH treated with intravenous treptostinil via implantable LenusPro pumps were evaluated, including NYHA classification, six-minute walking test, BNP and quality of life assessment using the EQ-5D-5L questionnaire before and after pump implantation. RESULTS: No significant changes were observed in NYHA class and six-minute walking distance test. There was however a significant improvement in the quality of life and a decrease in BNP levels. The mean EQ-5D- 5L index assessed during subcutaneous treptostinil treatment was significantly worse when compared to that assessed during its intravenous application (0.39 ± 0.24 vs 0.78 ± 0.28, p < 0.05); the same is true about the pain/discomfort dimension. Complications occurred, namely one nonfatal pneumothorax, one nonfatal hemothorax, and one event of nonfatal treptostinil intoxication after refilling. CONCLUSIONS: In patients who do not tolerate subcutaneous treptostinil treatment, the use of the LenusPro implantable pump results in a significant improvement in quality of life with an acceptable safety profile (Tab. 2, Fig. 2, Ref. 19). Text in PDF www.elis.sk. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The aim of this study was to analyse survival of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) hospitalized due to an acute right heart failure (ARHF) with emphasis on risk factors and effectiveness of treatment following current guidelines. METHODS: We retrospectively analysed 117 hospitalizations of 70 patients (59 PAH patients; 11 CTEPH patients, mean age 53.1 ± 16.77 years, 54% females) between 2004 and 2013. RESULTS: 96 cases were hospitalized at cardiology wards (CW) while 21 at intensive care unit (ICU). The overall hospital mortality was 12.8%, CW mortality was 4%, and ICU mortality was 52.4%. Higher risk of in-hospital mortality was associated with younger age, lower sodium levels, severe forms of PAH (heritable PAH, CTD-PAH) and need of PAH combination treatment. The one-year survival from the fi rst ARHF hospitalization was 67.6% (95% CI 57.1-80%), the two-year survival was 41.9% (95% CI 30.8-56.9%). The presence of ascites was a predictor of long-term mortality. CONCLUSIONS: Mortality in patients with PH and ARHF remains very high. Identification of its risk factors could be used as basis of risk-adapted therapy (Tab. 5, Fig. 2, Ref. 14). Text in PDF www.elis.sk. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To compare clinical parameters and quality of life in patients with pulmonary arterial hypertension (PAH) at the time of diagnosis, at the time of LenusPro pump implantation and during intravenous treptostinil treatment. METHODS: Seven patients with severe PAH treated with intravenous treptostinil via implantable LenusPro pumps were evaluated, including NYHA classification, six-minute walking test, BNP and quality of life assessment using the EQ-5D-5L questionnaire before and after pump implantation. RESULTS: No significant changes were observed in NYHA class and six-minute walking distance test. There was however a significant improvement in the quality of life and a decrease in BNP levels. The mean EQ-5D- 5L index assessed during subcutaneous treptostinil treatment was significantly worse when compared to that assessed during its intravenous application (0.39 ± 0.24 vs 0.78 ± 0.28, p < 0.05); the same is true about the pain/discomfort dimension. Complications occurred, namely one nonfatal pneumothorax, one nonfatal hemothorax, and one event of nonfatal treptostinil intoxication after refilling. CONCLUSIONS: In patients who do not tolerate subcutaneous treptostinil treatment, the use of the LenusPro implantable pump results in a significant improvement in quality of life with an acceptable safety profile (Tab. 2, Fig. 2, Ref. 19). [ABSTRACT FROM AUTHOR]

OBJECTIVES: The aim of this study was to analyse survival of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) hospitalized due to an acute right heart failure (ARHF) with emphasis on risk factors and effectiveness of treatment following current guidelines. METHODS: We retrospectively analysed 117 hospitalizations of 70 patients (59 PAH patients; 11 CTEPH patients, mean age 53.1 ± 16.77 years, 54% females) between 2004 and 2013. RESULTS: 96 cases were hospitalized at cardiology wards (CW) while 21 at intensive care unit (ICU). The overall hospital mortality was 12.8%, CW mortality was 4%, and ICU mortality was 52.4%. Higher risk of in-hospital mortality was associated with younger age, lower sodium levels, severe forms of PAH (heritable PAH, CTD-PAH) and need of PAH combination treatment. The one-year survival from the first ARHF hospitalization was 67.6% (95% CI 57.1-80%), the two-year survival was 41.9% (95% CI 30.8-56.9%). The presence of ascites was a predictor of long-term mortality. CONCLUSIONS: Mortality in patients with PH and ARHF remains very high. Identification of its risk factors could be used as basis of risk-adapted therapy (Tab. 5, Fig. 2, Ref. 14). Text in PDF www.elis.sk. [ABSTRACT FROM AUTHOR]

Interferons (IFNs) have proven antitumor activity against a variety of human malignancies, which may result, at least in part, from inhibition of angiogenesis. The objective of this study was to identify IFN-stimulated genes (ISGs) that played a role in mediation of angiogenic inhibition. IFN- was a more potent antiangiogenic agent compared to IFN-2b (80% versus 20%, respectively) and suggests that IFNs inhibited angiogenesis by preventing endothelial cell differentiation, and not by direct antiproliferative effects. To identify ISGs that were key inhibitors of angiogenesis, we utilized an in vitrofibrin gel angiogenic assay which closely recapitulated the in vivoprocesses of angiogenesis. DNA microarray analysis of IFN--treated endothelial cells in the fibrin gel assay identified 11 ISGs that were induced >10-fold during angiogenesis inhibition. Recombinant IP-10 inhibited angiogenesis in a dose-dependent fashion, but was a less effective inhibitor compared to IFN-, suggesting that additional ISGs are involved in inhibiting angiogenesis. ISG20 was upregulated by microarray analysis, but did not inhibit angiogenesis when overexpressed in human umbilical vein endothelial cells (HUVECs). However, a dominant negative mutant of ISG20 inhibited angiogenesis by 43%. Results suggest that IFN-induced angiogenic inhibition was likely mediated by multiple ISGs; our novel finding is that decreased exonuclease activity in HUVECs associated with expression of the ISG20 ExoII mutant inhibited angiogenesis. [ABSTRACT FROM AUTHOR]

Similar to electrical currents flowing through magnetic multilayers, thermal gradients applied across the barrier of a magnetic tunnel junction may induce pure spin-currents and generate ‘thermal’ spin-transfer torques large enough to induce magnetization dynamics in the free layer. In this study, we describe a novel experimental approach to observe spin-transfer torques induced by thermal gradients in magnetic multilayers by studying their ferromagnetic resonance response in microwave cavities. Utilizing this approach allows for measuring the magnetization dynamics on micron/nano-sized samples in open-circuit conditions, i.e. without the need of electrical contacts. We performed first experiments on magnetic tunnel junctions patterned into 6  ×  9 µm2 ellipses from Co2FeAl/MgO/CoFeB stacks. We conducted microresonator ferromagnetic resonance (FMR) under focused laser illumination to induce thermal gradients in the layer stack and compared them to measurements in which the sample was globally heated from the backside of the substrate. Moreover, we carried out broadband FMR measurements under global heating conditions on the same extended films the microstructures were later on prepared from. The results clearly demonstrate the effect of thermal spin-torque on the FMR response and thus show that the microresonator approach is well suited to investigate thermal spin-transfer-driven processes for small temperatures gradients, far below the gradients required for magnetic switching. [ABSTRACT FROM AUTHOR]