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Background: Currently, most available data on the medication adherence of patients with chronic heart failure are based on indirect methods. We examined the level of adherence to medical therapy using a direct method - serum drug level testing. Methods: We carried out a prospective single-centre registry of patients with chronic heart failure (LEVEL-CHF registry), in whom we analysed serum levels of the medications prescribed for the treatment of heart failure: angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists. We labelled a patient as non-adherent if at least one serum level of a prescribed drug was unmeasurable (below the detection limit). Patients with all tested drugs identifiable in serum were labelled as adherent. We enrolled 274 patients (208 men and 66 women) mean age 62 years. Results: 82.5% of patients were adherent and 17.5% non-adherent to prescribed medications. 3.6% were completely non-adherent without any detectable drugs in serum. Patients aged

Patients with clinically node-positive bladder cancer were historically considered to have uniformly poor prognosis and were frequently treated with palliative chemotherapy (CHT) only. Although retrospective data show that long-term survival with combined treatment (surgery + CHT) is possible in one-third of these patients, consensus on a treatment algorithm is still lacking. The aim of the study is to compare the efficacy of different treatment modalities based on data from a population-based cancer registry.The study comprises 661 patients identified from the Czech National Cancer Registry (1996-2015) with cTanyN1-3M0 bladder cancer; 195 were treated with CHT alone, 234 underwent radical cystectomy alone (RC), and 232 received a combination of RC and perioperative CHT (RC + CHT). Multivariate Cox proportional hazard regression analyses were used to evaluate the effectiveness of various treatments.The 5-year OS for CHT alone, RC alone, and RC + CHT were 21.7% (95% confidence interval [CI], 15.4%-28.0%), 12.1% (95% CI, 7.4%-16.7%), and 25.4% (95% CI, 18.9%-31.9%), respectively (P .001). The median survivals were 17, 10, and 23 months, respectively. In multivariate analysis, age 60 years (hazard ratio, 1.29; 95% CI, 1.06-1.56; P = .011) and clinical stage cT3-4 (hazard ratio, 1.39; 95% CI, 1.12-1.71; P = .002) were negative predictors of survival. When compared with CHT, RC + CHT reduced the risk of overall mortality by 21% (P = .044).Approximately one-quarter of clinically node-positive patients may achieve long-term survival with combined treatment integrating RC and perioperative CHT. The overall survival of patients is significantly improved with a multimodal approach in comparison to CHT alone.

Isolated retroperitoneal recurrence (IRR) in renal cancer patients after radical nephrectomy (RN) is a rare event and poses a therapeutic dilemma. We evaluated oncologic outcomes in surgically treated patients with IRR and established prognostic factors associated with survival. The benefit of metastasis-directed therapy (MDT) in those with clinical progression after extirpation of IRR was assessed.This was a retrospective single-institutional study in which 60 renal cancer patients after previous RN underwent surgery for suspicion of IRR within the period of 2004-2019; in 55 of them, RCC recurrence was histologically confirmed. No patient had distant metastatic disease at the time of IRR diagnosis. In cases of clinical progression after IRR surgery, MDT (metastasectomy, stereotactic radiotherapy) was selectively used. Kaplan-Meier curves were used to estimate survival outcomes. Univariable and multivariable Cox proportional hazards regression analyses were used to evaluate associations between clinicopathological parameters and cancer-specific survival.Median age at IRR diagnosis was 64 years (range 23-81). IRR was diagnosed at a median of 42 months (IQR 19-99) after RN. Surgical complications of grade 3-5 after IRR extirpation were rare (7%). Median follow-up time was 50 months (IQR 19-80). Five-year recurrence-free survival and cancer-specific survival rates were 32% and 66%, respectively. Radiographic progression was observed in 34 (62%) patients at a median of 11 months after IRR surgery, out of which 22 patients (40%) underwent MDT. When compared with 12 patients without MDT, the MDT patients had a prolonged median time to systemic treatment of 58 (vs. 16 months), and median cancer-specific survival of 88 (vs. 46 months). Upon multivariable analysis, the interval from nephrectomy ≤12 months (HR 7.77), tumour grade 3-4 (HR 13.24) and female sex (HR 7.42) were determined to be independent prognostic factors of cancer-related mortality.Aggressive surgical therapy of IRR is feasible with relatively low morbidity. More than half of the patients experience long-term survival. The interval from nephrectomy to IRR less than 12 months, tumour grade 3-4 and female sex were negative prognostic predictors. In the case of progression, metastasis-directed therapy may prolong the interval to initiation of systemic treatment.

BackgroundTo evaluate in-hospital and long-term mortality of patients with acute coronary syndromes (ACS) not having selective coronary angiography (CAG) during hospitalization and to analyze the reasons for conservative approach.Methods and patientsA single-centre retrospective study using registry data. Over the period from January 2005 to April 2009, a total of 193 ACS patients did not have in-hospital CAG. Fifty-five (28.5%) patients had recent CAG (within the last 12 months) or the procedure was planned after discharge (invasive group “I”). In 138 (71.5%) patients, CAG was not considered at all (conservative approach, group “C”). These subgroups were compared in terms of in-hospital parameters and long-term mortality.ResultsST-segment elevation myocardial infarction (STEMI) was diagnosed in 50 (25.9%) patients. The most frequent reasons for not performing CAG included serious comorbidities affecting the prognosis (22%) and pharmacological stabilization in very old individuals with non-STEMI (21%). One in ten (11%) patients died before the CAG was performed, the same proportion of patients refused to have CAG or had a long ischaemia time (STEMI subgroup). A temporary contraindication to CAG was found in 8%, a recent CAG finding not suitable for revascularization in 8%, while a limiting neurological disease was present in 6% of patients. In-hospital mortality was 30.1%, being higher in Group C (34.1% vs. 20.0%; p=0.049), 6-year mortality was as high as 78.8%, also with higher rates in Group C (86.2% vs. 60.2%; p

Little is known about the role of adipokines in the pathogenesis of coronary artery disease in young patients. The aims of this study were to compare serum levels of adipokines and expression of adipokines in peripheral blood leukocytes in patients with premature coronary artery disease (CAD), metabolic syndrome and healthy individuals.Sixty-five patients with premature CAD (men 18-45years old and women 18-55years old) formed the study group. The control groups were 75 patients with metabolic syndrome and 50 healthy individuals. For each group, RNA expression in peripheral blood leukocytes was determined for 24 different adipokines and 11 adipokines were examined in serum.In individuals with CAD, serum visfatin levels were significantly higher than in metabolic syndrome and healthy controls (2.3 vs. 1.6 vs. 0.7µg/L, P0.001) while both omentin-1 (92.9 vs. 587.0 vs. 552.3µg/L, P0.001) and ZAG2 (45.5 vs. 72.5 vs. 77.1mg/L, P0.001) levels were lower. The receiver operating curve (ROC) analysis for testing the validity of these adipokines in the diagnosis of CAD compared to control groups provided the following areas under the curve (AUC): omentin-1 AUC 0.97 (cut-off ≤222µg/L), ZAG2 AUC 0.89 (cut-off ≤51.7mg/L) and visfatin AUC 0.74 (cut-off ≥1.0µg/L) (P0.001 in all cases). Visfatin and omentin-1 serum levels did not differ between the acute phase of myocardial infarction and the chronic phase of CAD. In patients with CAD, we found no significant relation between mRNA expression and adipokine concentration.Serum omentin-1, visfatin and ZAG2 could serve as biomarkers of premature CAD in young apparently healthy people.

IntroductionThe assessment of B-type natriuretic peptide (BNP) plasma levels is not only useful for the differential diagnosis of acute dyspnea, but also for the prognostic stratification of patients with heart failure. However, available studies that have addressed monitoring of hospitalized patients are burdened with significant limitations: (1) measurement of plasma BNP levels only at admission or at discharge, (2) lack of details regarding the cause of heart failure, and (3) small sample size. Therefore, we conducted a prospective study of all patients presenting to our hospital with acutely decompensated chronic systolic heart failure.AimTo determine the importance of admission and discharge values of BNP and its changes during hospitalization for identification of patients with acutely decompensated chronic systolic heart failure at higher risk of unfavorable course of the disease.MethodsA prospective monocentric study determining plasma BNP levels at admission and at discharge in patients hospitalized for acutely decompensated chronic systolic heart failure. Patients: 130 consecutive patients, 77% men, mean age 70 years, body mass index (BMI) 27.8kg/m2; etiology of chronic heart failure—65.9% ischemic heart disease, 29.5% dilated cardiomyopathy, 4.6% others; signs and symptoms at admission—peripheral edema 58.9%, pulmonary rates 88.3%, orthopnea 53.1%, median of admission BNP 1101pg/ml, median of discharge BNP 650pg/ml, median left ventricular ejection fraction 26.5%, average length of hospitalization 9 days.ResultsDuring the follow-up (mean 15 months) the total mortality rate reached almost 40% and the annual mortality of our cohort was 29%. The most common causes of death included progression of heart failure and acute coronary syndromes. To evaluate the long-term risk of mortality, we used time-dependent ROC curves for the definition of cut-off values of BNP at admission and discharge. The relationship of BNP levels and the survival of patients was assessed using the hazard ratio (HR) calculated by the Cox proportional hazards model. BNPs at admission and at discharge with a cut-off value of 1699pg/ml and 434.5pg/ml are significant prognostic factors for patients hospitalized for acutely decompensated chronic systolic heart failure with a HR 2.79 and 3.29, respectively. During the follow-up, more than half of the patients required readmission to the hospital. The most common reasons for rehospitalization were cardiovascular causes.ConclusionBNP levels at admission and at discharge are an important predictive factor of survival in patients with acutely decompensated chronic systolic heart failure.

Mutations in the TNFRSF13B gene, encoding TACI, have been found in common variable immunodefi- ciency (CVID) and selective IgA deficient (IgAD) patients, but only the association with CVID seems to be significant. In this study, Czech CVID, IgAD and primary hypo/dysgammaglobulinemic (HG/DG) patients were screened for all TNFRSF13B sequence variants. The TNFRSF13B gene was mutated in 4/70 CVID patients (5.7%), 9/161 IgAD patients (5.6%), 1/17 HG/DG patient (5.9%) and none of 195 controls. Eight different mutations were detected, including the most frequent p.C104R and p.A181E mutations as well as 1 novel missense mutation, p.R189K. A significant association of TNFRSF13B gene mutations was observed in both CVID (p = 0.01) and IgAD (p = 0.002) Czech patients. However, when combined with all published data, only the association with CVID remained significant compared with the controls (9.9% vs. 3.2%, p < 10^6), while statistical significance disappeared for IgAD (5.7% vs. 3.2%, p = 0.145). The silent mutation p.P97P was shown to be associated significantly with CVID compared with the controls in both Czech patients (allele frequency 4.3% vs. 0.2%, p = 0.01) and in connection with the published data (5.1% vs. 1.8%, p = 0.003). The relevance of some TNFRSF13B gene variants remains unclear and needs to be elu- cidated in future studies.

Objectives The aim of this study was to determine whether the atherogenic index of plasma (AIP = log[triglycerides/HDL-cholesterol]) differs in heterozygous familial hypercholesterolemia (FH) patients with and without a history of cardiovascular disease (CVD). Design and methods A total of 555 FH patients with known mutations in the LDL receptor or the apolipoprotein B gene, of whom 53 had a history of CVD (CVD + group), were retrospectively analyzed. Results Compared to patients without CVD (CVD − group), CVD + patients showed significantly higher fasting LDL-cholesterol, triglycerides and AIP as well as lower HDL-cholesterol. After both adjustment for age and diabetes and using analysis based on age and sex matched groups, only the increase in triglycerides and AIP in the CVD + vs. the CVD − group remained significant. Conclusion The results of the present study indicate that AIP, which reflects the presence of atherogenic small LDL and small HDL particles, may be connected to the risk of CVD in FH patients.

The effect of previous long-term hypertension on mortality in acute heart failure (HF), regardless of blood pressure values, has not been well studied.Acute Heart Failure Database (AHEAD) - Czech HF registry enrolled 4153 consecutive patients with acute HF. We excluded severe forms (cardiogenic shock, pulmonary oedema, right HF) and analysed 2421 patients with known presence or absence of previous hypertension. Demographic, clinical and laboratory profile, treatment and mortality rates were assessed and predictors of outcome were identified.Patients with previous hypertension (71.5%) were older, more of female gender, with worse pre-hospitalisation NYHA class, increased incidence of co-morbidities and higher left ventricular ejection fraction (LVEF). Although in-hospital mortality was similar in both cohorts (2.6%), survival at 1, 2 and 3-year was worse in the hypertensive group (75.6%, 65.9% and 58.7% vs. 80.7%, 74.2% and 69.8%; P0.001). Nevertheless, hypertension was not associated with mortality in multivariate analysis and stronger predictors of outcome were identified (P0.05): new-onset acute HF [hazard ratio (HR) 0.62] and increased body mass index (HR 0.68) proved to have a protective role. Advanced age (HR 1.86), diabetes (HR 1.45), lower LVEF (HR 1.28) and admission blood pressure (HR 1.54), elevated serum creatinine (HR 1.63), hyponatremia (HR 1.77) and anaemia (HR 1.40) were associated with worse survival.Antecedent hypertension is frequent in patients with acute HF and contributes to organ and vascular impairment. However its presence has no independent influence on short- and medium-term mortality, which is influenced by other related co-morbidities.

Negative pressure wound therapy (NPWT) is an evidence-based therapy for the treatment of chronic and acute wounds. The application of specific dressing kits with the NPWT unit enables physiological processes in the wound that support healing especially by promoting wound bed preparation and managing high levels of exudate. The aim of NPWT is to close the wound faster by reducing complications like sepsis, wound recurrence, which reduce wound healing and may lead to amputation. The duration of the therapy depends on the therapeutic aims, wound pathology and the presence of co-morbidities. The aim of this study was to evaluate the efficiency and effectiveness of two different topical negative pressure devices. We analysed results of 70 patients suffering from wound healing disorders treated with KCI (VAC®) as well as by Hartmann (Vivano®) negative pressure wound therapy devices between 2008 and 2012.

was used for a detailed evaluation of the LV segments by all the applied methods. The mean LVEF in the total study population was 34.3±4.8%, the mean LV enddiastolic and endsystolic volume were 282±94 resp. 184±67 ml respectively. Description of all parameters in the whole dataset is depicted in Table 1. In 1471 LV segments (92%) echocardiographic image quality allowed assessment of segmental function with STE. Among the 1471 segments with adequate image quality tracking of acoustic markers, segmental analysis of ceCMR indicated 76–100% DE in 189 segments. Analysis of rest perfusion SPECT imaging indicated QREST 3 in 164 segments and QREST 4 in 92 segments. Based DE findings, SLSmax analysis allowed distinction of segments with a transmural scar and totally non-viable myocardium (DEN75%) from segments with a non-transmural, potentially ischemic or morphologically normal myocardium. Performing receiver operating curve (ROC) analysis for the distinction of transmural scarred myocardium from all other segments in the whole LV, the area under curve (AUC) was 0.866. The ROC analysis yielded a cut-off value of −5.3% for SLSmax with a sensitivity of 83.1%, specificity of 84.8% to identify segments with non-viable myocardium presence on ceCMR. Odds ratios and ROC analysis results of given model with a SLSmax cut-off value −5.3% for DEN75% prediction are depicted in Table 2. A statistically significant difference (AUC 0.866 vs. 0.822 for SLSmax resp. QREST, p=0.036) in accuracy of predicting a segmental DEN75%, was achieved as a result of higher accuracy of STE in comparison with QREST in the right coronary artery (RCA) perfusion territory (AUC 0.75 vs. 0.893 for QREST resp. SLSmax ,p b0.001). A QREST perfusion score 3–4 discriminated between segments with potentially viable myocardium and segments with DEN75% with a sensitivity of 86.2% and specificity of 66.3%.

High-dose therapy and autologous transplantation in poor prognosis patients with diffuse large B-cell lymphoma in first remission. Survival analysis.