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Obstructive sleep apnoea (OSA) is associated with type 2 diabetes mellitus (T2DM). However, mechanisms mediating association between these two conditions remain unclear. This study investigated, whether the OSA-associated changes in adipose tissue lipolysis might contribute to impaired glucose homeostasis in patient with T2DM. Thirty-five matched subjects were recruited into three groups: T2DM + severe OSA (T2DM + OSA, n = 11), T2DM with mild/no OSA (T2DM, n = 10) and healthy controls (n = 14). Subcutaneous abdominal adipose tissue microdialysis assessed spontaneous, epinephrine- and isoprenaline-stimulated lipolysis. Glucose metabolism was assessed by intravenous glucose tolerance test. Spontaneous lipolysis was higher in the T2DM + OSA compared with the T2DM (60.34 ± 23.40 vs. 42.53 ± 10.16 μmol/L, p = 0.013), as well as epinephrine-stimulated lipolysis (236.84 ± 103.90 vs. 167.39 ± 52.17 µmol/L, p

Supplementary material. (DOCX 115 kb)

Later stages of secondary lymphedema are associated with the massive deposition of adipose tissue (AT). The factors driving lymphedema-associated AT (LAT) expansion in humans remain rather elusive. We hypothesized that LAT expansion could be based on alterations of metabolic, adipogenic, immune and/or angiogenic qualities of AT. AT samples were acquired from upper limbs of 11 women with unilateral breast cancer-related lymphedema and 11 healthy women without lymphedema. Additional control group of 11 female breast cancer survivors without lymphedema was used to assess systemic effects of lymphedema. AT was analysed for adipocyte size, lipolysis, angiogenesis, secretion of cytokines, immune and stem cell content and mRNA gene expression. Further, adipose precursors were isolated and tested for their proliferative and adipogenic capacity. The effect of undrained LAT- derived fluid on adipogenesis was also examined. Lymphedema did not have apparent systemic effect on metabolism and cytokine levels, but it was linked with higher lymphocyte numbers and altered levels of several miRNAs in blood. LAT showed higher basal lipolysis, (lymph)angiogenic capacity and secretion of inflammatory cytokines when compared to healthy AT. LAT contained more activated CD4+ T lymphocytes than healthy AT. mRNA levels of (lymph)angiogenic markers were deregulated in LAT and correlated with markers of lipolysis. In vitro, adipose cells derived from LAT did not differ in their proliferative, adipogenic, lipogenic and lipolytic potential from cells derived from healthy AT. Nevertheless, exposition of preadipocytes to LAT-derived fluid improved their adipogenic conversion when compared with the effect of serum. This study presents results of first complex analysis of LAT from upper limb of breast cancer survivors. Identified LAT alterations indicate a possible link between (lymph)angiogenesis and lipolysis. In addition, our in vitro results imply that AT expansion in lymphedema could be driven partially by exposition of adipose precursors to undrained LAT-derived fluid.

As not much is known about the prevalence and predictors of nutritional deficiencies among vegans in the Czech Republic, we evaluated whether supplement use and duration of adherence to the vegan diet are associated with the risk of cobalamin and iron deficiencies. Associations between self-reported supplementation and duration of vegan diet with biomarkers of cobalamin (serum cobalamin, holotranscobalamin, homocysteine, folate) and iron status (serum ferritin, iron binding capacity, transferrin and saturation of transferrin) were assessed by cross-sectional analyses of medical data from a clinical nutrition center. Data from 151 (72 females) adult vegans (age 18&ndash, 67 years), who were free of major chronic diseases and 85 (40 females) healthy non-vegans (age 21&ndash, 47 years) were analyzed. Overall, vegans had significantly lower cobalamin, hemoglobin and ferritin levels, but higher folate and MCV values compared to non-vegans. Vegans not using cobalamin supplements were at higher risk of low plasma cobalamin than regularly supplementing vegans (OR: 4.41, 95% CI 1.2&ndash, 16.16 for cobalamin, OR: 19.18, 95% CI 1.02&ndash, 359.42 for holotranscobalamin), whereas no significant differences in cobalamin status related to duration of the vegan diet were observed. Regularly supplementing vegans had similar levels of cobalamin/holotranscobalamin as non-vegans. Despite lower ferritin and hemoglobin levels, there was no indication of a higher risk of iron-deficiency among vegans. To conclude cobalamin deficiency risk depends on supplementation status and not on the duration of an exclusive vegan diet, which underlines the need to integrate cobalamin status monitoring and counselling on supplement use in routine clinical care in the Czech Republic.

Additional file 2. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents.

Additional file 1. WHO Trial Registration data set.

Background Aim of the study was to compare metabolic response of leg skeletal muscle during functional electrical stimulation-driven unloaded cycling (FES) to that seen during volitional supine cycling. Methods Fourteen healthy volunteers were exposed in random order to supine cycling, either volitional (10-25-50 W, 10 min) or FES assisted (unloaded, 10 min) in a crossover design. Whole body and leg muscle metabolism were assessed by indirect calorimetry with concomitant repeated measurements of femoral venous-arterial differences of blood gases, glucose, lactate and amino acids. Results Unloaded FES cycling, but not volitional exercise, led to a significant increase in across-leg lactate production (from -1.1±2.1 to 5.5±7.4 mmol/min, p

Nutritional Factors in Skeletal Muscle Insulin Resistance Development Jan Gojda Abstract Background. Diet composition ranks among etiological factors of insulin resistance (IR) and diabetes. Vegans, people consuming exclusively plant-based diet, have significantly lower prevalence of IR and thus represent a suitable model population for study of nutritional factors on IR development. Branched chain amino acids (BCAA) ranks among these factors. Aims and hypothesis. Aim of the observational study was to prove that vegans have better glucoregulatory functions and thus to validate "vegan vs. omnivore" model. Aim of the consecutive interventional study was to prove in this model that dietary intervention with BCAA leads to a group sepcific changes in the insulin function mesures. Methods. 11 vegans and 10 omnivorous controls were recruited in the observational study. Hyperinsulinemic euglycemic clamp (HEC) and muscle (SM) biopsies (amount of intramyocellular lipids (IMCL), mtDNA and the activity of citrate synthase (CS)) were performed. 8 vegans and 8 omnivores were consequently subjected to the intervention with 15 or 20 g of BCAA respectively. The examination was performed at the baseline, after the intervention and after 6 months wash-out period: anthropometry, HEC, arginine test, SM biopsy (CS, activity of...

Supplementary material. (DOCX 115 kb)

When they saw the sea horizon Messinští mast Genoese galleys, which came from the business offices in the Crimea, certainly had no idea that they proclaim the most shattering pandemic in the history of the continent, black Pandemic of death. The disease, which affected all corners of Europe, which itself has disappeared After four centuries as mysteriously as she appeared, and todaymany question marks hanging. The more we know about the Black Death, the less traditional truthsremain in the light of new evidence unshaken. Never in the history of Europe has not been witnessed such a drastic event. never was not affected by the pandemic of this magnitude. Within a few years and died half of Europe's population. Significantly changing the structure ofthe population in the rural and in cities. But what struck even more than the mass of the populationand what pomření caused a profound change in collective behavior and mentality ofsociety, was the fact that the epidemic erupted with varying intensity at regularintervals various parts of Europe and the plague and death became part ofeveryday life. For many past efforts have been devoted to the issue of the Black Death. The aim of this research is a compilation of available sources with a focus on new knowledge of the etiology, course medieval pandemic in the Czech...

Background. A plant-based diet, rich in dietary fiber, is associated with health benefits in glucose and lipid metabolism. Dietary fiber is an important substrate for gut microorganisms, by which it is metabolized into numerous compounds, many of which positively affect the metabolic phenotype of the host. Understanding the mechanisms behind these phenomena could lead to discovery of new approaches in the treatment and prevention of metabolic diseases. Objectives. This study aims to describe the relationship between dietary fiber intake, intestinal microbiome composition and function, and metabolic phenotype. In the first (observational) part, we investigated the mentioned parameters in two groups of healthy volunteers whose dietary habits differed in daily fiber intake. In the second (interventional) part, we described the dynamics of these parameters in response to an increase in daily fiber intake and we tried to identify markers predicting a favorable metabolic response. Methodology. Sixty-two vegans and 33 omnivores were included in the observational study. The following examinations were performed: anthropometry, nutritional record evaluation, blood sampling for serum metabolome analysis and evaluation of static parameters of glucose and lipid metabolism, oral glucose tolerance test (oGTT)...

Aims: The aim of this work was to determine whether a increased resting energy expenditure contributes to the nutritional risk for patients with pancreatic cancer. What the variability of resting energy expenditure is and whether it predicts weight loss. Another aim was to verify that lower protein-energy intake also has an impact on weight loss. Methods: Data for the diploma thesis were obtained from the project "Pancreatic Cancer: Metabolic Derangements Associated With Insulin Resistance", which takes place at the Department of Clinical Physiology of Metabolism at 2nd Department of internal medicine in the University Hospital Královské Vinohrady. The project includes 40 - 50 patients with pancreatic tumor resection per year. Data were collected from the beginning of December 2019 until the end of April 2020. The project is funded by the grant AZV NV19-01-00101. 10 consecutive patients (4 women and 6 men) with pancreatic cancer who had a complete dataset for analysis were selected for the research set for the diploma thesis. The patients underwent anthropometric examination, blood tests were taken, and indirect calorimetry was performed. Results: The first part of the research was focused on anthropometric parameters, parameters of nutritional status and the presence of cancer cachexia. The second...

Diabetic foot syndrome is a serious chronic complication of diabetes mellitus, caused by a number of factors such as neuropathy, angiopathy, infection, and above all, this syndrome is consequence of a poor diabetes compensation and cardiovascular risk factors. It is characterized by particularly impaired wound healing and a higher tendency to chronicity, which can often be a reason for disability of the patient. Nutrition plays a very important role in a patient hospitalized with diabetic foot syndrome, as adequate coverage of energy and nutritional needs is essential for successful treatment and healing of ulcers. The theoretical part of this diploma thesis first mentions diabetes mellitus, its basic characteristics and briefly describes the types of diabetes that are associated with diabetic foot syndrome. Acute and chronic complications of diabetes are also discussed, followed by a more extensive chapter on the diabetic foot syndrome itself. This is the very definition of the term, epidemiology, pathogenesis, classification, diagnosis, treatment and prevention of this syndrome. The last chapter deals briefly with general nutritional recommendations for diabetics and the nutritional status of patients in which they are most often found when they are admitted to hospital, which is malnutrition,...

Sleep apnea syndrome, or sleep apneic syndrome, is a serious illness that causes a high risk of cardiovascular disease development in patients. This disease is characterized by a breathless breathing disorder and falls into a class of disorder that accompanies sleep disturbances. Sleep apnea syndrome (SAS) affects 5-15% of the population, and 50-80% of patients with type 2 diabetes mellitus (T2DM) or severe obesity. SAS has a causal contribution to the development of disorders in glucose metabolism and T2DM. Diabetes mellitus type 2 is a complex metabolic disorder in which the organism is unable to process glucose as under normal physiological conditions due to a relative insulin deficiency and simultaneous peripheral insulin resistance. Insulin resistance is eventually compensated for by increased insulin secretion, which leads to the development of hyperglycemia after failure of this compensation. T2DM is very often associated with the presence of obesity, arterial hypertension, dyslipidemia and hyperuricemia. The aim of this study is to determine if the presence of SAS in non-diabetic subjects and patients with type 2 diabetes mellitus leads to disorders in the metabolism of fatty acids in the skeletal muscle. The results of the study contribute to the understanding of the molecular mechanisms...

in english This thesis deals with the impact of education on knowledge about diabetic diet and lifestyle changes of patients. The theoretical part is comprehensively discussed the issue of diabetes mellitus type 2 and its etiology, pathophysiology, epidemiology, diagnosis, complications and treatment. The research deals with finding the influence of different forms of education on the knowledge of type 2 diabetes, in aspect of complications, regime and dietary measures as an important part of diabetes treatment. The goal of the work was just a survey of knowledge among diabetics and evaluating the effectiveness of education. The data were collected through questionnaires that were distributed to patients personaly or left in the diabetes clinic of FNKV. The evaluation was conducted in the form of graphs and charts which suggest how respondents answered correctly, incorrectly or with one wrong answer, the number of specific answers to each of the options for the questions and forms of education affect the accuracy of answers. One of most important finding include that the best result is the highest efficiency achieved reeducation education (4.1% more correct answers than only one time education), in the form of written and oral (by 12% more correct answers than just oral and 21% than just writing)...

Cílem této bakalářské práce je přiblížit problematiku péče o terminálně nemocného. Toto téma jsem si vybrala záměrně už ve druhém ročníku kombinovaného studia na univerzitě. Při své profesi jsem se často setkávala s umírajícími a považovala jsem své znalosti a dovednosti v péči o ně za velmi uspokojivé. Že ten pohled byl spíše slepou profesní pýchou, mi ukázaly přednášky z etiky, filozofie a ošetřovatelství na fakultě. Rozhlédla jsem se a zjistila, že v kraji, kde žiji, není žádné zázemí pro kvalitní paliativní a hospicovou péči a lidé ani netuší, že mají na takovou péči právo. S několika dalšími zdravotníky jsme založili občanské sdružení Hospic pro Liberecký kraj. Díky naší činnosti se stala výstavba hospice jednou z priorit politických představitelů Libereckého kraje a informace o paliativní a hospicové péči se dostala do povědomí obyvatel. Abych získala co nejvíce praktických zkušeností, zúčastnila jsem se krátkodobých stáží v hospicových zařízeních v České republice a využila jsem možnost blíže se seznámit s poskytováním paliativní péče také v Anglii a ve Švýcarsku. Princip fungování zahraničního modelu péče zmiňuji v klinické části práce. Hospic je jen jednou částí v systému poskytování paliativní péče. Aby byla kvalitní paliativní péče skutečně dostupná každému, kdo ji potřebuje, musí se rozvinout...