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Severity of portal hypertension is usually quantified by measuring the hepatic venous pressure gradient (HVPG). However, due to its invasiveness, alternative markers are being sought. Bile acids (BA), being synthesized, metabolized, and transported by the liver, seem to have the potential to serve as endogenous markers. The aim of the present study was to determine whether serum BA reflect the severity of portal hypertension.We correlated serum concentrations of individual BA with portal pressure (as HVPG) in an exploratory cohort of 21 cirrhotic patients with portal hypertension. The predictive potential of selected candidates was then confirmed in an independent validation cohort (n = 214). Additionally, nine previously published noninvasive markers were added to the stepwise logistic regression model to identify the most relevant ones, which were eventually used to create a prognostic index of portal hypertension.Serum levels of taurochenodeoxycholic acid (TCDCA) significantly correlated with HVPG and showed a high potential to predict clinically significant portal hypertension (HVPG ≥ 10 mm Hg: AUROC = 0.97 ± 0.06). This was confirmed in the validation cohort (AUROC = 0.96 ± 0.01). The predictive index (constructed based on AST/ALT, spleen diameter, and TCDCA concentration) was able to distinguish clinically significant portal hypertension with 95% sensitivity and 76% specificity.TCDCA seems to be a promising noninvasive marker of clinically significant portal hypertension. Its predictive potential may be further enhanced when it is combined with both the AST/ALT ratio and spleen diameter.

Summary: Introduction: Insulin resistance (IR) is a hallmark of non-alcoholic fatty liver disease (NAFLD), which has been associated with worse long-term survival and more frequent occurrence of chronic kidney disease (CKD) than in patients without NAFLD. The aim of our study was to evaluate the impact of NAFLD and IR on survival and renal function in patients after liver transplantation (LT). Methods: Our prospective study included 96 LT candidates who were observed after LT. We evaluated patient survival and occurrence of CKD (defined as estimated glomerular filtration [eGFR] ≤1.00 mL/s/1.73 m2 or overt proteinuria) 5 years after LT and at the end of follow-up. Clinical, laboratory, MR and elastographic evaluation before and 1 year after LT were performed as well as liver biopsy 1 year after LT. Results: Of the factors present 1 year after LT, higher ALT (P = 0.021), ALP (P = 0.012) and everolimus treatment (P = 0.025) increased the risk of death at the end of follow-up, borderline significance was found also for higher waist circumference (P = 0.058), AST (P = 0.059), HOMA-IR (P = 0.056) and presence of fibrosis stage ≥3 in biopsy (P = 0.055). In addition to the presence of CKD 1 year after LT (P

Introduction: Sarcopenia (severe muscle depletion) and myosteaosis (pathological fat accumulation in muscle) are frequent muscle abnormalities in patients with cirrhosis associated with unfavorable prognosis. The aim of our study was to evaluate the impact of sarcopenia and myosteatosis in liver transplant (LT) candidates in our center on the peritransplant course and patient and graft survival. Methods: This prospective study included adult LT candidates who underwent clinical and laboratory examination. The skeletal muscle index (SMI) at L3 level and radiodensity of psoas major muscle (PM-RA) were evaluated by CT. Results: Pretransplant sarcopenia was found in 49 of 103 patients (47.6%) and myosteatosis in 53 (51.5%) patients. Patients with sarcopenia had lower BMI, waist circumference, occurrence of hypertension and metabolic syndrome and lower triglyceride and C-peptide levels than patients without sarcopenia. Patients with myosteatosis had higher Child-Pugh score and lower HDL-cholesterol levels than patients without myosteatosis. Pretransplant SMI negatively correlated with the amount of blood transfusions given during LT and occurrence of biliary complications. Patients with myosteatosis had higher need for blood transfusions during LT and after LT, and higher number of surgical revisions. Occurrence of sarcopenia had no significant effect on patient and graft survival. Patients with myosteatosis had worse long-term survival than patients without myosteatosis, the graft survival did not differ. Conclusion: Sarcopenia and myosteatosis are frequent muscle abnormalities in LT candidates with negative impact on peritransplant course. Myosteatosis was associated with a worse long-term survival in our study. Key words: sarcopenia – myosteatosis – liver transplantation – prevalence – complications – survival

Tuky z mořských ryb a v nich obsažene omega3 polynenasycene dlouhořetězcove mastne kyseliny (EPA a DHA) maji zasadni vliv nejen na riziko srdecně cevnich onemocněni, ale take na kognitivni funkce. Testovali jsme ucinek do stravy přidaných 800 mg EPA a 1 200 mg DHA na den, obsažených v rybim oleji, na kognitivni funkce (memorovani, koordinace a soustředěni) intenzivně sportujicich chlapců (N = 169, věk 10-15 let). Intervenovana skupina konzumovala po dobu 6 měsiců 2 cajove lžicky oleje denně. Vsichni chlapci denně zapisovali jidelnicek a pravidelně podstupovali antropometricke analýzy pro vylouceni zasadnich změn ve stravovacich a pohybových zvyklostech. Studii dokoncilo celkem 121 chlapců (82 v intervenovane a 39 v kontrolni skupině). Přidani definovaneho množstvi EPA a DHA do stravy bylo verifikovano stanovenim omega3 indexu z kapilarni krve. Změny v omega3 indexu korelovaly s výsledky psychologickeho Bourdonova testu. Výsledky testu potvrdily statisticky významnou souvislost mezi hodnotou omega3 indexu s urovni kognitivnich funkci mladých sportovců (zlepseni o 63 % v intervenovane vs. o 43 % u kontrolni skupiny P = 0,0001; P = 0,007 po adjustaci na věk).

BACKGROUND Increased levels of plasma lipoproteins are among some of the modifiable risk factors for cardiovascular disease (CVD). Dietary changes and increased physical activity are the most powerful non-pharmacological interventions for achieving optimal plasma lipid levels. OBJECTIVES To investigate the effect of an intensive short-term lifestyle intervention on plasma lipid trajectories in overweight non-diabetic females. MATERIAL AND METHODS A total of 202 healthy overweight (body mass index (BMI) >27.5 kg/m2) females underwent an intensive short-term (ten-week) intervention (at least 4 units of one-hour exercise activity weekly at optimal energy intake) aimed at lowering body weight. Plasma lipid (total cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C), high-density-lipoprotein cholesterol (HDL-C), and triglycerides (TG)) levels were examined at baseline and every 2 weeks over the course of the ten-week intervention. RESULTS There was a significant decrease in BMI (Δ -4.7%, p < 0.001) and body weight (Δ -4.9%, p < 0.001) after the intervention. Positive changes (decreases) in TC (Δ -8%, p < 0.001), TG (Δ -9%, p < 0.001) and LDL-C (Δ -11%, p < 0.001) were observed immediately after 2 weeks, but levels did not decrease further thereafter. In contrast, HDL-C did not increase as expected: after 2 weeks of intervention, we observed a significant decrease of about 6% (p < 0.001) followed by a slow return to baseline values. But even after 10 weeks of intervention, HDL-C values had not reached the values detected at baseline. CONCLUSIONS In overweight females, HDL-C decreased after short-term intensive lifestyle intervention. To confirm the protective effect of increased physical activity, plasma lipids need to be examined over a longer time period.

Objective: The aim of this analysis was to analyze the presence of the most important cardiovascular (CV) risk factors and to discuss patterns of LDL cholesterol management in the population studied. Methods: We enrolled 961 males, average age of 42.9 ± 4.7, and 851 females, average age of 51.2 ± 3.6. Data on personal, pharmacological and family history, and laboratory examinations were collected. Cardiovascular (CV) risk was calculated using the Systematic Coronary Risk Evaluation (SCORE) algorithm with modifications according to the guidelines. Results: The distribution of CV risk in the observed cohort was as follows: 24% of the subjects had low, 51% moderate, 17% high and 8% very high risk. The percentage of patients who reached target values of LDL cholesterol was dramatically lower in the groups with very high (1%) and high (3%) risk than in the groups with moderate (14%) or low risk (59%). Dyslipidemia was newly identified in 20% of both sexes. Arterial hypertension was newly diagnosed in 8% of males and 5% of females, and type 2 diabetes mellitus was newly diagnosed in 3% of both the males and females. Dyslipidemia was present in 39% of males and 41% of females; arterial hypertension in 43% of males and 45% of females, and type 2 diabetes mellitus was diagnosed in 11% of the subjects of both sexes. 49% of males and 31% of females were overweight and 32% of both genders were obese. There were 36% of male smokers and 22% of female smokers. 48% of the participants were pharmacologically treated. Non-pharmacological treatment was recommended to 62% of male and to 65% of female participants. Pharmacological intervention was started in 53% of males and 51% of females. In both gender antihypertensive treatment with angiotensin-converting enzyme (ACE) inhibitors (29% of males and 27% of females) and lipid lowering therapy with a statin (28% of males, 27% of females) were the most commonly initiated treatments. In the subgroup of the 101 patients with LDL cholesterol levels > 5 mmol/L 56% were not treated with a statin. The analysis of relationship between the positive family history of any of the followed CV risks showed significant increases of the risk for arterial hypertension, type 2 diabetes mellitus and dyslipidemia. Conclusion: European guidelines suggest general screening for risk factors, including analysis of lipid profiles in the population of 40-year-old males and 50-year-old or postmenopausal women. Our study documents high prevalence and incidence of CV risk factors together with insufficient control of the risk factors in Czech patients of this age range. This finding suggests that preventive examinations should be undertaken earlier (e.g., in 30-year-old males and 40-year-old women). Exact timing of the preventive check-ups to yield the best cost-benefit ratio needs to be verified.

OBJECTIVE Respiratory alkalosis (RA) and dilutional hyperchloremic acidosis (DHA) are the most common acid-base balance (ABB) disorders in patients with liver cirrhosis. The aims of this study were to clarify whether RA develops in relation to DHA via respiratory compensation of metabolic acidosis and whether spironolactone in combination with low-dose furosemide - diuretics known to ameliorate DHA - positively affects RA in liver cirrhosis patients. MATERIALS AND METHODS 59 patients with advanced cirrhosis were divided into two groups. Group D consisted of individuals (urine sodium concentration (UNa+) > 20 mmol/L) who responded to combination therapy consisting of spironolactone and low-dose furosemide. The non-D group consisted of individuals (UNa+ ≤ 20 mmol/L) who either did not respond to the treatment or who were not administered it. In both groups, we examined serum and urine concentrations of electrolytes and ABB parameters, including SNa+-SCl- and SNa+/SCl- values. RESULTS In group D, we found a statistically significant relationship between pCO2 and SHCO3-: r = 0.756 (p < 0.001) and between pCO2 and SNa+-SCl-: r = 0.522 (p = 0.001). Neither Salb nor the corrected anion gap were associated with changes in SHCO3- or pCO2 values. Although SHCO3- values were normal, abnormal pCO2 values were observed in one third of group D patients. Based on multivariable analysis, SHCO3- proved to be a statistically significant influencing factor on pCO2 values. CONCLUSION DHA contributes to the development of RA in individuals with liver cirrhosis. Reducing DHA by means of effective diuretic therapy comprising spironolactone and furosemide has a beneficial effect on RA in such patients.

Kardiovaskularni onemocněni (KVO) jsou hlavni přicinou umrti v Ceske republice. Pokles umrtnosti na KVO, který je u nas pozorovan od roku 1985, může být způsoben poklesem incidence nebo letality. Letalita onemocněni souvisi předevsim s urovni lecebne pece, zatimco incidence KVO je ovlivněna rizikovým profilem obyvatelstva. Cilem teto prace bylo zjistit prevalenci zakladnich rizikových faktorů u reprezentativniho vzorku ceske populace. Metodika: Byl proveden 1% nahodný výběr vzorku populace deviti okresů Ceske republiky ve věku 25-64 let. Vysetřeni sestavalo z vyplněni standardniho dotazniku, ziskani zakladnich antropometrických udajů, opakovaneho měřeni krevniho tlaku a odběru krve. Výsledky: V obdobi 2015-2018 bylo vysetřeno celkem 2 621 osob (1 250 mužů, průměrný věk 48,3 ± 10,9 roku a 1 371 žen, průměrný věk 47,7 ± 11,0 roku; p < 0,001); respondence 44,8 %. Průměrna hodnota indexu tělesne hmotnosti (BMI) u nami vysetřene populace cinila 29,1 ± 4,8 kg/m2 u mužů a 27,15 ± 6,1 kg/m2 u žen (p < 0,001). Obezita byla zjistěna u 37,3 % mužů a 28,2 % žen. Mezi vysetřenými muži 24,8 % uvedlo, že jsou pravidelnými kuřaky, zatimco kouřeni u žen bylo zjistěno u 21,6 % (p < 0,001). Nalezli jsme vysokou prevalenci hypertenze (48,6 % u mužů a 32,4 % u žen; p < 0,001); 74,3 % hypertoniků vi o svem onemocněni, 61,5 % je medikamentozně leceno a pouze 33,9 % dosahuje cilových hodnot krevniho tlaku < 140/90 mm Hg. Průměrna hodnota celkoveho cholesterolu u nami vysetřene populace byla teměř identicka pro muže i ženy (muži 5,26 ± 1,03 mmol/l; ženy 5,28 ± 1,00 mmol/l). Hypolipidemiky bylo leceno 13,9 % mužů a 10,2 % žen (p < 0,001). Diabetes byl zjistěn u 8,2 % mužů a 4,6 % žen (p < 0,001). Prevalence vsech zakladnich rizikových faktorů výrazně narůstala s věkem u obou pohlavi (p pro trend < 0,001). Zavěr: U reprezentativniho nahodně vybraneho vzorku ceske populace středniho věku byla nalezena vysoka prevalence zakladnich rizikových faktorů kardiovaskularnich onemocněni, ktere jsou přicinou stale vysoke mortality z kardiovaskularnich přicin v Ceske republice. © 2020, CKS.

Uvod : Insulinova resistence (IR) ma velký význam v patogenezi nealkoholove tukove nemoci jater (NAFLD) a dalsich onemocněni. Udaje o prevalenci a vývoji IR u pacientů před a po transplantaci jater (LT) jsou omezene. Cilem nasi prospektivni studie bylo zhodnoceni prevalence a vývoje IR u pacientů před a v prvnich 2 letech po LT. Metody : U 77 pacientů zařazených na cekaci listinu k LT v obdobi 5/2015 až 4/2017 bylo před LT, 6M, 1R a 2R po LT provedeno klinicke a laboratorni vysetřeni a elastografie jater, 1 H MR spektroskopii byl stanoven obsah tuku v jatrech. V 1 a 2 letech po LT byla provedena necilena biopsie jater. Výsledky : IR definovanou jako HOMA-IR ≥ 3,0 mělo 26 pacientů (41,3 %) před LT, 16 pacientů (25,4 %) v 6M po LT, 22 pacientů (34,9 %) v 1R po LT a 29 pacientů (46,0 %) v 2R po LT (p=0,028 pro 2R vs 6M). Předtransplantacni IR korelovala s věkem, indikaci k LT a přitomnosti metabolickeho syndromu. IR hodnocena 2R po LT korelovala s přitomnosti metabolickeho syndromu, hypertenze, diabetu, BMI, GGT, s množstvim jaterniho tuku hodnoceným histologicky i 1 H MR spektroskopii, se stupněm balonove degenerace v biopsii a se stupněm fibrozy dle shear wave elastografie. Zavěr : Prevalence insulinove resistence je vysoka u pacientů před i po LT, významně stoupa s rostouci dobou od LT. Výskytu potransplantacni IR a souvisejicich faktorů je třeba věnovat maximalni peci.

Infections caused by Pseudomonas sp are difficult to resolve by antibiotics (ATBs) and local therapy. The aim of our pilot study was to assess the effect of different local agents—particularly acidifying solutions—on the healing of diabetic foot ulcers (DFUs), eradication of pathogens, and economic costs related to DFU therapy. In this case study, we monitored 32 DFU patients infected by Pseudomonas species. Patients were divided into 2 groups according to the local therapy provided: group 1 (n = 15)—modern local treatment; group 2 (n = 17)—acidifying antiseptic solutions. The study groups differed only with regard to ATB usage prior to enrolment in the study ( P = .004), but did not differ with regard to age, diabetes control, peripheral arterial disease, or microcirculation status. During the follow-up period, DFUs healed in 20% of cases in group 1, but there were no cases of healing in group 2 (NS). The length of ATB therapy, the number of new osteomyelitis, lower limb amputations, and the changes of DFUs status/proportions did not differ significantly between study groups. Pseudomonas was eradicated in 67% of cases in group 1 and in 65% of cases in group 2. The local treatment given to group 2 patients was associated with lower costs ( P < .0001). Conclusion. Acidifying agents had the same effect as modern healing agents on wound healing, the number of amputations, and the eradication of Pseudomonas. Moreover, therapy performed using acidifying solutions proved in our pilot study markedly cheaper.

Background Achieved education is the most consistent and powerful socioeconomic status index and the differences in cardiovascular mortality (CV) according to achieved education in the Czech Republic are over a long period among most pronounced in Europe. Higher prevalence of CV risk factors in less educated is the major factor behind their higher CV morbidity and mortality. Purpose To analyse the changes in prevalence and control of CV risk factors according to achieved education in general population and in patients with stable CHD and their impact on CV mortality. Methods Based on data of 15 590 persons from 7 cross sectional epidemiological surveys carried through the Czech MONICA and post-MONICA project in 1985–2018 in identical 6 districts of the Czech Republic (general population) and on data of 2129 patients from 5 independent descriptive surveys of the Czech EUROASPIRE study in 1995–2018 (patients with stable CHD) time trends of major CV risk factors and their control in respondents with basic, secondary and university education were compared. Results The persons from general population as well as patients with CHD with higher education had consistently lower BMI and lower prevalence of obesity, the differences increased in due time (p Conclusion CV risk gradient in general population and in CHD patients decreased with level of education achieved, was present during the whole analysed period and became more pronounced in the 2016–18 survey. The education based differences were more pronounced in factors influenced by lifestyle (BMI, smoking) and less in factors influenced also by medical therapies (blood pressure, cholesterol levels). The impact on CV mortality is to be expected more pronounced in general CV prevention and less in already treated population. Observation of healthy life style remains a basic problem in CV prevention, particularly in persons with elementary education. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Agency for Medical Research, Ministry of Health of the Czech Republic

Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases. Our objective has been to establish reference values for major functional and structural parameters of retinal microcirculation in a randomly selected urban population sample. A total of 398 randomly selected individuals from an urban population aged 25 to 65 years, resident in Pilsen, Czech Republic, were screened for major cardiovascular risk factors. Retinal microcirculation was assessed using scanning laser Doppler flowmetry (SLDF), with data evaluable in 343 patients. Of this number, complete data were available for 256 individuals free from manifest cardiovascular disease, diabetes and drug treatment for hypertension and/or dyslipidemia, constituting the reference value population. Juxtapapillary retinal capillary blood flow has increased significantly with age whereas vessel and luminal diameters have decreased. No sex differences in retinal microcirculation parameters have been found. Therefore, reference values for retinal microcirculation parameters have been established by age groups. Unattended automated office systolic BP, after adjusting for age, correlated significantly with wall-to-lumen ratio (WLR) and wall thickness (WT). Moreover, after adjusting for age and mean BP, a positive relationship has been found between carotid femoral pulse wave velocity and WT, WLR and wall cross-sectional area, indicating the interaction between micro- and macro-vasculature. In conclusion, our study is the first to provide reference values of retinal microcirculation parameters in a random Caucasian population sample. Our results have shown that, at the population level, the first structural changes in retinal microcirculation are those in lumen diameters. Of note, a close relationship between BP and vascular remodeling of retinal arterioles and between aortic stiffness and WLR of retinal arterioles suggests an interaction between micro- and macro-vasculature.

In our pilot study, we aimed to determine how many patients with the statin intolerance history referred to the specialized center for the diagnostics and treatment of lipoprotein metabolism disorders really suffer from a complete statin intolerance. The purpose of the study was to prove that complete statin intolerance is overestimated and overdiagnosed, and with the detailed knowledge of the issue and patient approach, it is possible to find an appropriate statin treatment for the most of patients. With the increasing number of statin users worldwide, the issue of statin intolerance has been a frequently discussed topic in recent years. There are many factors that play a role in the manifestation of statin intolerance (predisposing factors as age, sex, and some diseases), genetic factors leading to a different metabolism, drug-drug interactions, psychological reasons, and the negative influence of the mass media. However, it is estimated that true complete statin intolerance, defined by an intolerance of at least three statins at their usual lowest daily doses, occurs in approximately 3–6% of all statin users. In our pilot study, we conducted a retrospective analysis of 300 patients who were referred to the Center of Preventive Cardiology with a history of statin intolerance. During the follow-up treatment, 222 patients (74%) were able to use some statin (rosu-, atorva-, simva-, fluvastatin), and in 21% of the cases (63 patient), the target values according their CV risk level were even achieved. Only 78 patients (26%) were confirmed as being complete statin intolerant following a thorough therapeutic effort. The most tolerated statin was rosuvastatin.

Our aim was to determine the serum uric acid (SUA) levels associated with an increased risk of cardiovascular (CV) and all-cause death in the general adult population. We analyzed data obtained in two independent cross-sectional surveys performed in the Czech Republic in 2006-09 and 2015-18, involving 1% population random samples in nine districts, aged 25-64 years, stratified by age and gender. Ten-year mortality data were obtained in a cohort with examination in 2006-09. Final analyses included 3542 individuals (48.2% men) examined in 2006-09, and 2304 (47.4% men) examined in 2015-18. From a cohort examined in 2006-09, 122 men and 60 women were reported dead (33% and 27% from CV disease). In men, there was no association of baseline SUA levels with baseline SCORE category or 10-year mortality rates. In women, each 10 µmol/L increase in baseline SUA levels was associated with an increase in baseline SCORE category (P < .001). Receiver operating characteristic curve analyses in women identified the baseline SUA cutoff values discriminating: 1. between low/intermediate and high/very high SCORE categories (309 µmol/L), 2. CV mortality (325 µmol/L), and 3. all-cause mortality (298 µmol/L). After adjusting for confounders including SCORE, Cox regression analysis confirmed that the baseline SUA cutoffs of 309 µmol/L and 325 µmol/L were associated with 4-times (P = .010) and 6-times (P = .036) greater risk of CV mortality, whereas the cutoff of 298 µmol/L was associated with 87% greater risk of all-cause mortality (P = .025). In conclusion, the SUA cutoff value of 309 µmol/L identified women at high/very high SCORE category and was associated with 4-times greater risk of observed CV mortality over 10 years.

Purpose: Primary aldosteronism (PA) is considered the most common form of secondary hypertension, however, its prevalence, particularly in a general population, is still a matter of debate. The aim...

The purpose: To evaluate longitudinal trends in the prevalence of hyperuricaemia and chronic kidney disease (CKD) in Czech adults with and without arterial hypertension (HT).Materials and methods: Two independent cross-sectional surveys were performed in 2006-2009 and 2015-2018, each screening involving 1% population random sample of the general population of nine districts of the Czech Republic aged 25-64 years, stratified by age and gender. Hyperuricaemia was defined as serum uric acid ≥ 420 μmol/l in men, and ≥ 360 μmol/l in women. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73 m2 and/or albumin/creatinine ratio ≥ 3 mg/mmol.Results: Final analyses included 3504 individuals examined in 2006-2009, and 2309 in 2015-2018. The overall prevalence of hyperuricaemia increased from 16.4% to 25.2% in men (p < 0.001), and from 7.6% to 10.9% in women (p < 0.001), whereas the overall prevalence of CKD declined from 6.8% to 3.6% in men (p = 0.001), and from 7.6% to 4.8% in women (p < 0.001). There was no interaction between HT and hyperuricaemia in either gender; the increase in hyperuricaemia prevalence was observed both in hypertensive and normotensive adults and was accompanied by the increased prevalence of abdominal obesity. Contrarily, there was an interaction between HT and CKD in both men (p < 0.001) and women (p = 0.011); the CKD prevalence declined only in hypertensive individuals, specifically in those using antihypertensive medication and was accompanied by the increased use of renin-angiotensin-aldosterone system (RAS) inhibitors and calcium channel blockers (CCBs).Conclusions: Over the period of 10 years, the overall prevalence of hyperuricaemia increased, while the prevalence of CKD decreased. An increase in the prevalence of hyperuricaemia was observed both in hypertensive and normotensive individuals and was accompanied by an increase in the prevalence of abdominal obesity. A decline in the prevalence of CKD was only observed in hypertensive individuals and was accompanied by the increased use of RAS inhibitors and CCBs.

Cilem studie je ukazat anamnezu, klinický průběh a casnou i pozdni mortalitu 1 291 mužů středniho věku (< 65 roků) hospitalizovaných v letech 2006-2016 pro akutni infarkt myokardu. Vsichni nemocni přijati do 24 hodin (90 % pacientů) byli po přijezdu angiograficky vysetřeni; perkutanni koronarni intervence (PCI) infarktove tepny byla urgentně provedena u 85,4 % vsech nemocných, u 14,6 % byla před propustěnim provedena PCI dalsi neinfarktove tepny a u 7,7 % byl proveden v casnem pořadi aortokoronarni bypass (CABG). Primarni fibrilace komor se vyskytla u 8,6 % nemocných, kardiogenni sok u 5,1 %. Mortalita kardiogenniho soku dosahovala 53 %. V celem souboru byla 28denni mortalita 4,8 %, dalsi jednorocni mortalita (28 dni-1 rok) 1,7 %. Dlouhodoba mortalita celeho souboru byla sledovana do konce roku 2015. Dlouhodobou mortalitu nepřiznivě ovlivňuje věk, udaj o dřive prokazane ischemicke chorobě srdecni (PCI nebo CABG nebo dřive proběhlý infarkt myokardu [p < 0,040], nizka hodnota ejekcni frakce při přijeti [p < 0,001, EFLK < 35 %] a projevy srdecniho selhani v akutni fazi onemocněni [sok, Killip III, p < 0,001]). Jeden rok přežilo 1 158 nemocných a 918 z nich se (79,3 %) podařilo po roce ambulantně zkontrolovat. Nova nefatalni přihoda se vyskytla jen u osmi nemocných (0,9 %), anginu pectoris udavalo 54 mužů (5,9 %).Druhým cilem je ukazat změny v anamneze, klinickem obraze a mortalitě, ke kterým doslo u mužů v teto věkove kategorii v průběhu let 1970-2016. K analýze dat mužů tohoto věku byly použity udaje registru Světove zdravotnicke organizace (WHO) a registru Evropske kardiologicke spolecnosti (ESC) a dale byly použity vlastni soubory mužů ve věku do 65 let z let 1970-1977 (bez reperfuzni lecby), soubor z let 1991-1995 (trombolyticka era) a konecně soucasný soubor z let 2006-2016. Hospitalizacni (28denni) mortalita klesala z 15-16,6 % před reperfuzni lecbou na 8,7 % v eře trombolýzy až na konecných 4,8 % v letech 2006-2016. Stejně tak klesala mortalita do jednoho roku (28-365 dni) z 11,5 % na soucasných 1,6 %. K výrazným změnam dochazi tež v anamneze nemocných. Výskyt předchozi anginy klesal ze 42 % v letech 1970 na 24 % v eře převažujici trombolýzy až na soucasných 6,1 %. Podobně klesalo procento výskytu předchoziho srdecniho infarktu, z někdejsich 25-30 % na soucasných 9,6 %.Mensi výskyt anginoznich obtiži před přihodou a mensi výskyt předchoziho infarktu je způsoben nejen ucinnějsi medikaci a sekundarni prevenci, ale i soucasnou strategii revaskularizace u nemocných s anginou a strategii casne revaskularizace myokardu po koronarni přihodě. Na poklesu mortality pacientů hospitalizovaných pro akutni infarkt se tedy podili nejen casna rekanalizace infarktove tepny, ale i mensi výskyt předchoziho infarktu a lepsi stav koronarniho řecistě u pacientů s dřive diagnostikovanou anginou a dřive proběhlým infarktem.

Background & aims The rs738409 c.444C > G (p.I148M) polymorphism in PNPLA3 is a major factor predisposing to non-alcoholic fatty liver disease. The aim of the study was to clarify the impact of liver and extrahepatic expression of the PNPLA3 p.148M variant on liver graft steatosis after liver transplantation. Methods Fat content was assessed in liver biopsies from 176 transplant recipients. During a period of 4 ± 1 years after transplantation, 17 patients developed grade 3 steatosis, 14 patients grade 2 steatosis, 56 patients grade 1 steatosis, and 89 patients grade 0 steatosis. The influence of the recipient and donor rs738409 genotype and clinical and laboratory data on liver fat content were analyzed using ordinal logistic regression. Results The PNPLA3 rs738409 CC/CG/GG genotype frequencies, respectively, were 0.494/0.449/0.057 in the graft donors and 0.545/0.330/0.125 in the graft recipients. In the multivariate analysis, the presence of the PNPLA3 c.444G allele in donor (OR 1.62; 95%CI 1.12–2.33), post-transplant BMI (OR 1.14; 95%CI 1.07–1.22), diabetes mellitus (OR 1.99; 95%CI 1.22–3.22), and serum triglycerides (OR 1.40; 95%CI 1.11–1.76) were independent risk factors for increased liver graft fat content. Conclusions These data indicate that the liver expression of the PNPLA3 p.148M variant confers a genetic predisposition to liver graft steatosis along with nutritional status and diabetes.

Diabetic foot (DF) can develop in diabetic patients after organ transplantation (Tx) due to several factors including peripheral arterial disease (PAD), diabetic neuropathy and inappropriate DF prevention. Aim: To assess the occurrence of DF and associated risk factors in transplant patients. Methods: Fifty-seven diabetic patients were enrolled as part of this prospective study. All patients underwent organ Tx (01/2013-12/2015) and were followed up for minimum of 12 months up to a maximum of 50 months. Over the study period we evaluated DF incidence and identified a number of factors likely to influence DF development, including organ function, presence of late complications, PAD, history of DF, levels of physical activity before and after Tx, patient education and standards of DF prevention. Results: Active DF developed in 31.6% (18/57) of patients after organ Tx within 11 months on average (10.7 ± 8 months). The following factors significantly correlated with DF development: diabetes control (p = .0065), PAD (p2;p = .01), history of DF (p = .0031), deformities (p = .0021) and increased leisure-time physical activity (LTPA) before Tx (p = .037). However, based on logistic stepwise regression analysis, the only factors significantly associated with DF during the post-transplant period were: PAD, deformities and increased LTPA. Education was provided to patients periodically (2.6 ± 2.5 times) during the observation period. Although 94.7% of patients regularly inspected their feet (4.5 ± 2.9 times/week), only 26.3% of transplant patients used appropriate footwear. Conclusions: Incidence of DF was relatively high, affecting almost 1/3 of pancreas and kidney/pancreas recipients. The predominant risk factors were: presence of PAD, foot deformities and higher LTPA before Tx. Therefore, we recommend a programme involving more detailed vascular and physical examinations and more intensive education focusing on physical activity and DF prevention in at-risk patients before transplantation.

Since 2007, the year of their first widespread use, genome-wide association studies (GWAS) have become the “gold standard” for the detection of causal genes and polymorphisms in all fields of human medicine. Cardiovascular disease (CVD), one of the major causes of morbidity and mortality, is no exception. The first GWAS focused on hypercholesterolemia and dyslipidemia as the major CVD determinants. GWAS confirm the importance of most of the previously identified genes (e.g. APOE, APOB, LDL-R) and recognize the importance of new genetic determinants (e.g. within the CILP2 or SORT1 gene clusters). Nevertheless, the results of GWAS still require confirmation by independent studies, as interethnic and interpopulation variability of SNP effects have been reported. We analyzed an association between eight variants within seven through GWAs detected loci and plasma lipid values in the Czech post-MONICA population sample (N=2,559). We confirmed an association (all P

Zastoupeni a zřejmě i význam některých kardiovaskularnich rizikových faktorů se na populacni urovni měni. Cilem teto prace proto bylo popsat soucasný rizikový profil pacientů s akutnim koronarnim syndromem (AKS) a srovnat jej s populacnimi daty z identicke populace.Do studie bylo zahrnuto 946 mužů ve věku 28-65 let a 296 žen ve věku 30-70 let, kteři byli přijati na Kliniku kardiologie IKEM s diagnozou akutniho koronarniho syndromu v letech 2006-2013. Výskyt rizikových faktorů u nemocných byl srovnavan s výskytem rizikových faktorů u populacniho vzorku obyvatel odpovidajiciho věku, který byl vysetřen v ramci projektu Czech post-MONICA v letech 2006-2009. Ve srovnani s kontrolni skupinou 1 400 mužů a 1 016 žen měli nemocni castějsi výskyt vsech rizikových faktorů s výjimkou celkoveho cholesterolu. Muži i ženy s AKS měli obdobnou hodnotu celkoveho cholesterolu (muži 5,41 ± 1,16 mmol/l vs. 5,50 ± 1,08 mmol/l, NS, ženy 5,60 ± 1,25 mmol/l vs. 5,71 ± 1,01 mmol/l, NS), ale vyssi hodnotu LDL cholesterolu (muži 3,66 ± 1,05 mmol/l vs. 3,38 ± 0,93 mmol/l, p < 0,001, ženy 3,67 ± 1,17 mmol/l vs. 3,45 ± 0,91 mmol/l, p < 0,001) a nižsi hodnotu HDL cholesterolu (muži 1,14 ± 0,31 mmol/l vs. 1,28 ± 0,34 mmol/l, p < 0,001, ženy 1,32 ± 0,37 mmol/l vs. 1,60 ± 0,38 mmol/l, p < 0,001). Tyto rozdily jsou zachovany i při vylouceni pacientů a kontrolnich osob, ktere byly leceny statiny. Detailnějsi analýza lipidoveho spektra podle věkových skupin ukazala větsi rozdily mezi nemocnými a kontrolni skupinou v hodnotě LDL cholesterolu předevsim u mladsich pacientů, zatimco hodnoty HDL cholesterolu jsou nižsi ve vsech věkových skupinach. Poměr LDL/HDL cholesterolu tak zůstava u nemocných oproti kontrolam vyssi ve vsech věkových skupinach.Pozitivni rodinna anamneza (RA) předcasneho výskytu ischemicke choroby srdecni (ICHS) u rodiců byla u nemocných s AKS rovněž castějsi (muži 19,8 % vs. 13,9 %, p < 0,001, ženy 25,9 % vs. 18,4 %, p < 0,001) a větsi rozdily byly zaznamenany u mladsich pacientů. U pacientů s pozitivni rodinnou anamnezou se AKS manifestoval v casnějsim věku a věkový rozdil se zvýraznil, pokud byla pozitivni RA spojena s kouřenim nebo hypertenzi. Muži s AKS a pozitivni RA se od ostatnich nemocných lisili pouze vyssim podilem nizkých hodnot (< 1,0 mmol/l) HDL cholesterolu (55,5 % vs. 45,0 %, p < 0,05 mmol/l) a vyssim BMI (29,27 ± 4,79 vs. 28,49 ± 4,29 kg/m2, p < 0,05).Hodnota celkoveho cholesterolu se v soucasne populaci nejevi jako rizikový faktor akutniho koronarniho syndromu. Jako největsi riziko se jevi kouřeni a nizka hodnota HDL cholesterolu, resp. vyssi poměr LDL/HDL cholesterolu. U mladsich osob se jako rizikový faktor navic uplatňuji pozitivni rodinna anamneza předcasneho výskytu ICHS a vyssi hodnota LDL cholesterolu.

BACKGROUND The rs58542926 polymorphism in transmembrane 6 superfamily member 2 (TM6SF2) is a genetic factor predisposing to nonalcoholic fatty liver disease. We aimed to explore the effect of recipient and donor TM6SF2 rs58542926 genotypes on liver graft fat content after liver transplantation. METHODS Steatosis was evaluated in liver biopsies from 268 adult recipients. The influence of recipient and donor TM6SF2 genotypes, patatin-like phospholipase domain-containing 3 (PNPLA3) rs738409 genotypes, and nongenetic factors on the steatosis grade assessed 6-30 months after transplantation was analyzed by ordinal logistic regression. RESULTS The presence of the TM6SF2 c.499A allele in the donor (P = 0.014), PNPLA3 c.444G allele in the donor (P < 0.001), posttransplant body mass index (P < 0.001), and serum triglycerides (P = 0.047) independently predicted increased liver fat content on multivariable analysis, whereas noncirrhotic liver disease, as an indication for liver transplantation, was associated with lower risk of steatosis (P = 0.003). The effects of the donor TM6SF2 A and PNPLA3 G alleles were additive, with an odds ratio of 4.90 (95% confidence interval, 2.01-13.00; P < 0.001), when both minor alleles were present compared with an odds ratio of 2.22 (95% confidence interval, 1.42-3.61; P = 0.002) when only one of these alleles was present. CONCLUSIONS The donor TM6SF2 c.499A allele is an independent risk factor of liver graft steatosis after liver transplantation that is additive to the effects of donor PNPLA3 c.444G allele.

Infections caused by Pseudomonas sp are difficult to resolve by antibiotics (ATBs) and local therapy. The aim of our pilot study was to assess the effect of different local agents-particularly acidifying solutions-on the healing of diabetic foot ulcers (DFUs), eradication of pathogens, and economic costs related to DFU therapy. In this case study, we monitored 32 DFU patients infected by

Background: Hypertension is the most prevalent major independent risk factor for developing coronary heart disease (CHD). The present analysis aimed to assess blood pressure (BP) distribution and factors associated with insufficient BP control in coronary patients from 24 countries participating in the European Society of Cardiology (ESC) EURoObservational Research Programme (EORP) EUROASPIRE IV survey. Methods: EUROASPIRE IV is a cross-sectional study conducted in 2012-2013 in patients aged 80 years or less hospitalized for CHD with a follow-up visit at a median of 16 months later. Logistic regression analysis was applied to confirm factors associated with BP control defined as less than 140/90 mmHg for nondiabetic patients and less than 140/85 mmHg for diabetic patients. Results: A total of 7998 patients (response rate, 48.7%) attended the follow-up visit. Complete data were available in 7653 participants (mean age 62.5 +/- 9.6 years). The BP goal was achieved in 57.6%. Patients failing to achieve the BP goal were older, had higher BMI, had more often a history of coronary artery bypass grafting (CABG) and reported diabetes more frequently. Logistic regression confirmed the following independent significant predictors of not achieving the BP goal: a history of diabetes [odds ratio (OR) 1.75], obesity (OR 1.70 vs. normal BMI), overweight (OR 1.28 vs. normal BMI), age at least 65 years (OR 1.53) and CABG as the index event (OR 1.26 vs. acute MI). Conclusion: EUROASPIRE IV found insufficient BP control in a large proportion of patients with stable CHD, with diabetes, increased BMI, older age and CABG as the index event being independent predictors of poor BP control.

Objective. Off-loading is one of the crucial components of diabetic foot (DF) therapy. However, there remains a paucity of studies on the most suitable off-loading for DF patients under postoperative care. The aim of our study was to evaluate the effect of different protective off-loading devices on healing and postoperative complications in DF patients following limb preservation surgery. Methods. This observational study comprised 127 DF patients. All enrolled patients had undergone foot surgery and were off-loaded empirically as follows: wheelchair+removable contact splint (RCS) (group R: 29.2%), wheelchair only (group W: 48%), and wheelchair+removable prefabricated device (group WP: 22.8%). We compared the primary (e.g., the number of healed patients, healing time, and duration of antibiotic (ATB) therapy) and secondary outcomes (e.g., number of reamputations and number and duration of rehospitalizations) with regard to the operation regions across all study groups. Results. The lowest number of postoperative complications (number of reamputations: p=0.028; rehospitalizations: p=0.0085; and major amputations: p=0.02) was in group R compared to groups W and WP. There was a strong trend toward a higher percentage of healed patients (78.4% vs. 55.7% and 65.5%; p=0.068) over a shorter duration (13.7 vs. 16.5 and 20.3 weeks; p=0.055) in the R group, as well. Furthermore, our subanalysis revealed better primary outcomes in patients operated in the midfoot and better secondary outcomes in patients after forefoot surgery—odds ratios favouring the R group included healing at 2.5 (95% CI, 1.04-6.15; p=0.037), reamputations at 0.32 (95% CI, 0.12-0.84; p=0.018), and rehospitalizations at 0.22 (95% CI, 0.08-0.58; p=0.0013). Conclusions. This observational study suggests that removable contact splint combined with a wheelchair is better than a wheelchair with or without removable off-loading device for accelerating wound healing after surgical procedures; it also minimises overall postoperative complications, reducing the number of reamputations by up to 77% and the number of rehospitalizations by up to 66%.

Posttransplant osteoporosis, which evolves from preexisting bone pathologies, represents a serious complication with deteriorating consequences. The aim of our study was to evaluate epidemiological data on bone mineral density (BMD) in subjects with type 1 diabetes (T1DM) in advanced stages of diabetic nephropathy indicated for simultaneous pancreas-kidney transplantation (SPK). We retrospectively compiled biochemical and densitometrical data from 177 patients with T1DM at CKD (chronic kidney disease) stages G4-G5 (115 men, 62 women, median age 40 yr, diabetes duration 23 yr) enrolled on waiting list for SPK for the first time between the years 2011 and 2016. MedianZ-scores were as follows: lumbar spine (LS): -0.8 [interquartile range -1.75 to 0.1]; total hip (TH): -1.2 [-1.75 to -0.6]; femoral neck (FN): -1.2 [-1.9 to -0.7]; and distal radius (DR): -0.8 [-1.4 to -0.1]. We noted a gender difference in LS, with worse results for men (-1.1 vs. -0.3) even after adjusting for BMI (body mass index) and glomerular filtration (p<0.001). Osteoporotic and osteopenic ranges (based onT-scores) for all major sites were 27.7% and 56.5%, respectively, with similar results across both genders. Women had a significantly higher proportion of normal BMD in LS than men (67.7 vs. 49.4%,p<0.05). Patients with T1DM at CKD stages G4-G5 exhibited serious BMD impairment despite their young age. Men surprisingly displayed lowerZ-scores and higher percentages of pathological BMD values in LS than women did. The introduction of adequate preventive measures during the advanced stages of diabetic nephropathy to prevent bone loss is recommended.

Cholesterol 7α- hydroxylase (CYP7A1) is the key regulatory enzyme of the classic bile acid biosynthetic pathway. Its activity is subjected to complex feedback regulation in order to maintain the bile acid pool (1,2). Enzyme activity has been shown to exhibit a distinct diurnal variation in rodents (3) and humans (4). The study in humans took advantage of the fact that CYP7A1 activity in the liver correlated with concentration of 7α-hydroxy-4-cholesten-3-one (C4) in plasma, which can be thus used as a reliable marker of CYP7A1 activity (5,6). The same authors demonstrated that there were two peaks in enzyme activity, the first at midday and the second around 10pm (4). In our previous study in healthy volunteers carried out between 7am and 10pm, we reproduced their findings for the midday peak (7). However, we noted that enzyme activity displayed very high inter-individual variability. Several polymorphisms have been identified in the regulatory regions of the CYP7A1 gene. One of these polymorphisms, -203A>C (rs3808607), has been shown to affect cholesterolemia and responsiveness of cholesterolemia to diet as well as drug treatment (8-13). The mechanisms involved have not yet been explained and it is still not clear whether this promoter polymorphism can also affect diurnal variation in enzyme activity. Therefore, in this case-control study, we investigated whether the course of CYP7A1 diurnal activity differed between homozygous young healthy male carriers of -203A and -203C alleles of the CYP7A1 gene. We also analyzed the effect of short-term chenodeoxycholic acid (CDCA) and cholestyramine (a bile acid sequestrant) treatments on CYP7A1 activity throughout the day. These drugs down-regulate and up-regulate CYP7A1 activity, respectively.

Background Compared with Western Europe, the decline in cardiovascular (CV) mortality has been delayed in former communist countries in Europe, including the Czech Republic. We have assessed longitudinal trends in major CV risk factors in the Czech Republic from 1985 to 2016/17, covering the transition from the totalitarian regime to democracy. Methods There were 7 independent cross-sectional surveys for major CV risk factors conducted in the Czech Republic in the same 6 country districts within the WHO MONICA Project (1985, 1988, 1992) and the Czech post-MONICA study (1997/98, 2000/01, 2007/08 and 2016/2017), including a total of 7,606 males and 8,050 females. The population samples were randomly selected (1%, aged 25–64 years). Results Over the period of 31/32 years, there was a significant decrease in the prevalence of smoking in males (from 45.0% to 23.9%; p < 0.001) and no change in females. BMI increased only in males. Systolic and diastolic blood pressure decreased significantly in both genders, while the prevalence of hypertension declined only in females. Awareness of hypertension, the proportion of individuals treated by antihypertensive drugs and consequently hypertension control improved in both genders. A substantial decrease in total cholesterol was seen in both sexes (males: from 6.21 ± 1.29 to 5.30 ± 1.05 mmol/L; p < 0.001; females: from 6.18 ± 1.26 to 5.31 ± 1.00 mmol/L; p < 0.001). Conclusions The significant improvement in most CV risk factors between 1985 and 2016/17 substantially contributed to the remarkable decrease in CV mortality in the Czech Republic.

Diabetic peripheral neuropathy (DPN) is a common complication of diabetes with potential severe consequences. Its pathogenesis involves hyperglycemia-linked mechanisms, which may include changes in the expression of neurotrophic growth factors. We analyzed the expression of 29 factors potentially related to nerve degeneration and regeneration in skin biopsies from 13 type 1 diabetic pancreas and kidney recipients with severe DPN including severe depletion of intraepidermal nerve fibers (IENF) in lower limb skin biopsies (group Tx1 1st examination). The investigation was repeated after a median 28-month period of normoglycemia achieved by pancreas transplantation (group Tx1 2nd examination). The same tests were performed in 13 stable normoglycemic pancreas and kidney recipients 6–12 years posttransplantation (group Tx2), in 12 matched healthy controls (group HC), and in 12 type 1 diabetic subjects without severe DPN (group DM). Compared to DM and HC groups, we found a significantly higher (p < 0.05–0.001) expression of NGF (nerve growth factor), NGFR (NGF receptor), NTRK1 (neurotrophic receptor tyrosine kinase 1), GDNF (glial cell-derived neurotrophic factor), GFRA1 (GDNF family receptor alpha 1), and GFAP (glial fibrillary acidic protein) in both transplant groups (Tx1 and Tx2). Enhanced expression of these factors was not normalized following the median 28-month period of normoglycemia (Tx1 2nd examination) and negatively correlated with IENF density and with electrophysiological indices of DPN (vibration perception threshold, electromyography, and autonomic tests). In contrast to our expectation, the expression of most of 29 selected factors related to neural regeneration was comparable in subjects with severe peripheral nerve fiber depletion and healthy controls and the expression of six factors was significantly upregulated. These findings may be important for better understanding the pathophysiology of nerve regeneration and for the development of intervention strategies.

The subclass of triglyceride-rich lipoproteins – remnant-like particles (RLP) seems to be strong and independent risk factor for cardiovascular disease. We evaluated the role of RLP and other risk factors (RF) with sonographically measured intima-media thickness of carotid arteries (IMT CCA) in a cohort of Czech population including women defined according to the time after menopause. We investigated relation of IMT CCA to age, weight, central obesity, plasma lipids including remnant-like particles cholesterol (RLP-C) and triglycerides (RLP-TG) in 136 men and 160 women. Using multiple linear regression analysis, significant association between IMT CCA and RLP-C was found in women 1-7 years after menopause. In the whole group of women, only age and fasting blood glucose were independently associated with IMT CCA. In men only age significantly correlated with IMT CCA. Significant decrease of all plasma lipids between 1988 and 1996 in men was detected, while in women significant increase in triglycerides and no change in non-HDL cholesterol was observed. RLP-C was the strongest independent RF for atherosclerosis in postmenopausal women but its association with IMT CCA was limited to several years after menopause. In conclusion, women changing reproductive status could be more sensitive to atherogenic impact of remnant lipoproteins.

Myocardial infarction (MI) is the leading cause of death in industrialized countries. All the traditional risk factors for MI are responsible for approximately 50 % of cases of MI cases. Attention therefore has recently focused on genetic variants that are not associated with conventional risk factors. One of them is the marker rs6922269, which has been suggested as a risk factor for development of MI in Western populations. We analyzed the relationship between rs6922269 variant on MTHFD1L gene and (i) risk of the acute coronary syndrome (ACS) in the Czech population and (ii) mortality in 7 years follow up. Rs6922269 (G>A) variant was analyzed (CR 99.3 % for patients and 98.0 % for controls) by PCR–RFLP in consecutively examined 1614 men and 503 women with ACS (age below 65 years) and in population-based controls––1191 men and 1368 women (aged up to 65 years). ANOVA and Chi square were used for statistical analysis. The genotype frequencies were almost identical (P = 0.87) in the ACS patients and in controls and no differences were observed, if males (P = 0.73) and females (P = 0.93) were analysed separately. In addition, rs6922269 polymorphism was not associated with the classical risk factors (dyslipidemia, hypertension, obesity, smoking, diabetes) in control population. Cardiovascular mortality was significantly higher in males, carriers of the AA genotype (P

Here we analyzed associations between muscles mass, total bone mineral content (BMC), lumbar spine bone density (BMD L1-L4) and serum or urine hormones in healthy peripubertal girls. Total BMC and areal BMD L1-L4, muscle mass and fat were measured by dual-energy X-ray absorptiometry (DXA). Muscle force (N) was estimated by a dynamometer. Circulating estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), 25-hydroxy vitamin D, parathyroid hormone (PTH), insulin-like growth factor 1 (IGF-1), leptin, osteocalcin, bone isoenzyme of alkaline phosphatase (bALP) and total calcium and phosphorus were quantified as the nocturnal melatonin and serotonin urinary excretion. Partial correlations adjusted for height, Tanner score and physical activity confirmed positive relationships between BMC or BMD L1-L4 (Z-score) and lean mass or fat. Furthermore, positive relationship was observed between BMC or BMD L1-L4 (Z-score) and serum leptin. After adjustment for Tanner score and physical activity, positive associations were observed between lean mass and IGF-1, leptin levels or muscle force. We proved positive relationships between bone mass and serum leptin in peripubertal girls.

Our previous study showed that a diet enriched with 400 g of carp per week improved plasma lipids in subjects after aortocoronary bypass (CABG). The aim of the present study is to determine whether the different carp farming systems have an impact on the effects of carp meat in secondary cardiovascular prevention. We examined 3 groups of patients after CABG over a 4-week period of spa treatment (108 persons, 73 males, 35 females, age over 60 years). We found no differences in baseline values of blood pressure or plasma lipids. The patients were given a standard spa diet (controls; N=36) or a diet enriched of 400 g of carp meat per week, enriched omega 3 (N=37) or cereal carp (N=35). Plasma lipid parameters were examined at start and after 4 weeks in a routine laboratory setting. Group consuming omega-3 carp showed the largest decline in total cholesterol, LDL cholesterol, triglycerides and an increase in HDL cholesterol (all p

Objective:To evaluate longitudinal trends and determinants of mean serum uric acid (SUA) levels in two representative Czech population surveys (2006–09 and 2015–18) and to determine the SUA levels associated with increased 10-year risk of cardiovascular (CV) death.Design and method:Two independent c

Objective:Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases.Our objective was to establish reference values for major functional and structural parameters of retinal microcirculation

Purpose Heart failure is associated with impaired endothelial function including peripheral vessels. A pulsatility decrement once continuous flow left ventricular assist device (CF-LVAD) implanted has been consistently corroborated as an additive factor further compromising peripheral vascular function in such patients. EndoPAT 2000 is a FDA approved, operator independent device for assessment of endothelial function allowing for serial examination of reactive hyperemia index (RHI; as a measure of endothelial responsiveness; cutoff Methods Thirty-two patients implanted with HeartMate3 LVAS (5 females; mean age 55±13.8 years, ischemic cardiomyopathy 43.75%) were longitudinally examined by EndoPAT 2000 prior to the procedure and subsequently at 3rd and 6th month after implantation. Results Mean RHI was substantially impaired and below the norm already at a baseline (1.33±0.63). Temporal analysis revealed highly significant worsening at 3rd (RHI = 0.5±0.64) and 6th (RHI = 0.67±0.59) month post implantation (both p Conclusion The study provides additional evidence on a negative effect of suppressed physiologic pulsatility amplitude in CF-LVAD patients. Despite restored central hemodynamics, peripheral vascular function after implantation is further compromised based on serial assessment by EndoPAT 2000. Our observations suggest that a novel feature of programmed artificial pulsatility in HeartMate3 does not provide a sufficient pulse amplitude to avert further progression of peripheral vascular dysfunction due to continuous flow circulatory pattern. Larger scale adverse events matched clinical trials are warranted.