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Introduction: Patients with cardiogenic shock (CS) are at a high risk of developing infectious complications; however, their early detection is difficult, mainly due to a frequently occurring noninfectious inflammatory response, which accompanies an extensive myocardial infarction (MI) or a postcardiac arrest syndrome. The goal of our prospective study was to describe infectious complications in CS and the immune/inflammatory response based on a serial measurement of several blood-based inflammatory biomarkers. Methods: Eighty patients with CS were evaluated and their infections were monitored. Inflammatory markers (C-reactive protein, procalcitonin, pentraxin 3, presepsin) were measured seven times per week. The control groups consisted of 11 patients with ST segment elevation myocardial infarction without CS and without infection, and 22 patients in septic shock. Results: Infection was diagnosed in 46.3% of patients with CS; 16 patients developed an infection within 48 h. Respiratory infection was most common, occurring in 33 out of 37 patients. Infection was a significant or even the main reason of death only in 3.8% of all patients with CS, and we did not find statistically significant difference in 3-month mortality between group of patients with CS with and without infection. There was no statistically significant prolongation of the duration of mechanical ventilation associated with infection. Strong inflammatory response is often in patients with CS due to MI, but we found no significant difference in the course of the inflammatory response expressed by evaluated biomarkers in patients with CS with and without infection. We found a strong relationship between the elevated inflammatory markers (sampled at 12 h) and the 3-month mortality: the area under the curve of receiver operating characteristic ranged between 0.683 and 0.875. Conclusion: The prevalence of infection in patients with CS was 46.3%, and respiratory tract infections were the most common type. Infections did not prolong statistically significantly the duration of mechanical ventilation and did not increase the prevalence of hospital mortality in this high-risk CS population. CS due to acute myocardial infarction was accompanied by a strong and highly variable inflammatory response, but it did not reach the intensity of the inflammatory response observed in patients with septic shock. An extensive immune/inflammatory response in patients with CS is linked to a poor prognosis.

Objective Takotsubo syndrome (TS) is a heart condition characterised by a sudden transient left ventricular dysfunction; its pathophysiology is probably associated with elevated levels of catecholamines but the exact mechanism is not known as yet. Literature and clinical experience suggest that TS affects persons with various comorbidities. This pilot work aims to evaluate the frequency of comorbidities with potential pathological immune reactivity, and to evaluate the potential association between TS and hypersensitivity to metals assessed by LTT-MELISA (R). Methodology, Results A total of 24 patients (23 women, 1 man) with a history of TS attack and 27 healthy controls were evaluated. Hypersensitivity was evaluated by a lymphocyte transformation test (LTT-MELISA (R)); a questionnaire of environmental burden was used to select evaluated metals. A total of 19 patients (79%) had at least one condition that might potentially be associated with pathological immune reactivity (autoimmune thyroid disease, drug allergy, bronchial asthma, cancer, contact dermatitis, rheumatoid arthritis). Hypersensitivity to metals was identified significantly more frequently in TS patients than in healthy controls (positive reaction to at least one metal was identified in 95.8% of TS patients and in 59.3% of controls; p = 0.003); the difference was statistically significant for mercury (45.8% and 14.8%, respectively; p = 0.029). Conclusion Our work shows that conditions with pathological immune reactivity occur frequently in TS patients, and our data suggest a possible association between TS and hypersensitivity tometals (mercury in particular) evaluated by LTT-MELISA (R). We also suggest that apart from the triggering stress factor, potential existence of other serious conditions should be considered when taking medical history of TS patients.

Uvod a cil: Fosfolipaza A2 asociovana s lipoproteiny (Lp-PLA2) je biomarkerem zanětu specifickeho pro cevni složku. Lp-PLA2 hydrolýzou oxidovaných fosfatidylcholinů produkuje ucinne prozanětlive mediatory, ktere napomahaji vzniku nestability aterosklerotickeho platu. Předchozi prace prokazaly, že zvýsena hodnota Lp-PLA2 > 200-235 μg/l je nezavislým prediktorem zvýseneho kardiovaskularniho rizika i po adjustaci na tradicni rizikove faktory. Cilem prace je ve skupině stabilnich pacientů po STEMI stanovit koncentrace Lp-PLA2 a u casti pacientů s jeji zvýsenou hodnotou posoudit vliv navýseni davky statinů na koncentraci Lp-PLA2.Metodika: Celkem bylo vysetřeno 186 stabilnich pacientů po akutnim infarktu myokardu. Bylo vyhodnoceno lipidove spektrum a hodnoty Lp-PLA2. U pacientů s Lp-PLA2 > 200 μg/l byla intenzifikovana terapie statiny a po třech měsicich byl proveden kontrolni odběr lipidů a Lp-PLA2.Výsledky: Ve skupině 186 pacientů bylo po 12 měsicich od akutniho IM dosaženo celkoveho cholesterolu 200 μg/l, ve skupině pacientů s LDL cholesterolem < 2 mmol/l bylo celkem 14 % pacientů se zvýsenou hodnotou Lp-PLA2. Po zvýseni davky statinů doslo k významnemu poklesu jak celkoveho a LDL cholesterolu, tak i hodnoty Lp-PLA2. (286 vs. 229 μg/l; p = 0,02).Zavěr: Asi 7 % stabilnich pacientů po STEMI vykazuje zvýsene hodnoty Lp-PLA2 i přes dobře kontrolovanou koncentraci LDL cholesterolu. Intenzivnějsi terapie statiny vedla u těchto pacientů k významnemu sniženi Lp-PLA2.

This work presents the first results from the long-term experiment, which is focused on the impact of intensive rainfall and long period of drought on microbial activities in soil. Fifteen lysimeters were prepared in the area of our interest. This area is a protection zone of underground source of drinking water. These lysimeters were filed with topsoil and subsoil collected in this area and divided into two groups. These groups differ in fertilization and amount of water received during the growing season. Amount of microbial biomass and leaching of mineral nitrogen and phosphates were chosen as main indicators of microbial activities in soil. Content of mineral nitrogen and phosphates was measured in soil solution, which was collected from each lysimeters. Amount of microbial biomass was determined in soil samples that were taken from the lysimeters before and after the long period of drought and intensive rainfall., {"references":["P. C. Brookes, A. Landman, G. Pruden and D. S. 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Coronary artery disease (CAD) affects in lower percentage even younger individuals. This paper describes group of young patients aged 40 years or less with premature manifestation of CAD, including analysis of risk factors, severity of coronary arteries affection, management and follow-up lasting up to 7 years.There were 98 patients included retrospectively, in whom macroscopic affection of coronary arteries was diagnosed by coronary angiography within the years 2000-2007. 68 of the patients were indicated to coronary angiography urgently due to acute coronary syndrome (ACS), 44 of them due to acute myocardial infarction with ST elevations. The patients were called for further co-operation and 45 of them (45.9%) were re-examined completely and they will be observed prospectively. The results show overall good short-term prognosis of these patients and confirm importance of early invasive management and revascularisation. One-year mortality of the patients with ACS was 1.9%. 80% out of 45 completely re-examined patients have ejection fraction of left ventricle better than 50% and 84% ofthem is without any anginal symptoms. However, our results show inadequate secondary prevention in these patients. 15 patients (33%) still smoke, 20 (44%) is over-weighted. Only 22 patients (49%) had LDL-cholesterol level bellow 2.5 mmol/l and even only 15 patients (33%) had blood pressure below 130/80 mm Hg.Management of these basic risk factors should improve even the long-term prognosis of our patients.

Abnormal heterogeneity of myocardial electrophysiologic processes increases the risk of malignant arrhythmias. The aim of the studywas to assess changes ofrepolarization homogeneity in patients after acute myocardial infarction (MI) using morphological parameters obtained from long-term 12-lead electrocardiographic recordings.In the group of 200 patients (45 females, 155 males) a long-term (10 minutes supine) 12-lead electrocardiographic recording (SEER MC, GE Medical) was performed 48-72 hours after acute myocardial infarction. The following parameters were calculated using experimental software: total cosine R to T (TCRT) and Twave residuum (TWR). The results were correlated with Q wave evolution and left ventricular ejection fraction (LVEF).Distinguishing the MI type (Q vs nonQ) the following values were obtained: TCRT: 0.17 +/- 0.61 vs 0.16 +/- 0.49, p = 0.52, absolute TWR: 21,200 +/- 21,700 vs 25,700 +/- 29,300, p = 0.3, relative TWR: 0.0012 +/- 0.0017 vs 0.0017 +/- 0.0026, p = 0.28. Stratification according to LVEF (or = 40% vs40%) led to: TCRT: -0.03 +/- 0.66 vs 0.25 +/- 0.54, p = 0.01, absolute TWR: 29,700 +/- 32,400 vs 21,300 +/- 21,500, p = 0.14, relative TWR: 0.0021 +/- 0.0047 vs 0.0013 +/- 0.0021, p = 0.48.TCRT is a robust measurement of the spatial angle between the QRS complex and T wave loops which is related to LVEF. The results concerning TWR might indicate that this parameter is independent of LVEF, which needs to be confirmed in further analyses in a larger population.

Ventricular repolarization abnormalities are associated with increased risk of sudden cardiac death in patients after myocardial infarction. The aim of this study is to assess QT dynamicity - QT/RR relationship - in patients after myocardial infarction and its contribution to risk stratification of sudden cardiac death.In a group of patients with diagnosis of acute myocardial infarction a long term ECG recording was performed 48-72 hours after myocardial infarction (MARS Unity Workstation, GE Medical Information Technologies). Patients with unstable circulation, artificial pulmonary ventilation, left bundle brach block, atrial fibrillation and paced rhythm were excluded. Analysis of QT dynamicity was performed by QT Guard software (GE Medical Information Technologies). QT/RR relationship is expressed by linear regression as QT = = aRR + b where "a" is termed "slope".Assessment of QT dynamicity was possible in 215 ECG recordings. In 6-month follow-up 2 patients died and another was successfully resuscitated for primary ventricular fibrillation. Six-month mortality resp. mortality + resuscitation was 0.9 %, resp. 1.4 %. Therefore statistical evaluation was not possible. In the 3 mentioned individuals the slope values were 0.333, 0.249 and 0.342.Mortality of up-to-date-treated patients after myocardial infarction is low. Therefore, in such patients it is not possible to assess QT dynamicity as a risk factor in midterm follow-up. Limitation of the method is the necessity of substantial selection of patients elegible for analysis and dependance on necessary equipment.

In a total of 22 healthy women, the concentrations of vitamin A, retinol-binding protein (RBP), beta-carotene, vitamin E, pyridoxal-5'-phosphate (PLP), folic acid, vitamin B12, biotin and vitamin C as well as the activities of the erythrocytic enzymes, erythrocyte transketolase (ETK), erythrocyte glutathione reductase (EGR) and erythrocyte glutamate oxalacetate transaminase (EGOT) were measured and compared at delivery, 3-5 days post-partum (pp) and 5-10 weeks pp. The mean values indicated a post-partal increase of vitamin A, RBP and vitamins B12 and C; and a post-partal decrease of PLP, folic acid, biotin, vitamin E and beta-carotene. The basal activities ETK0 rose at the end of puerperium above the values measured at delivery, while EGOT0 were lower than at parturition. None of the women had an adequate biochemical vitamin status for all vitamins measured over all three investigations. The biochemical vitamin deficiency of biotin was found most often, followed by vitamins B12, B6, C, A, folic acid, B2, B1 and beta-carotene; vitamin E status was optimal in all women.

This study evaluates the need of vitamin E supplementation in very-low-birth-weight infants by long-term follow-up of plasma vitamin E status during the first 15 mo of life, with two different levels of supplementation. The subjects were 51 newborn infants with birth weights less than or equal to 1520 g. During hospitalization the infants were fed human milk. On the third day of life oral vitamin E supplementation of less than or equal to 10 mg/d was started in all infants. In addition, 23 infants selected at random were given intramuscular vitamin E (20 mg/kg/d) during the first 3 d. The data indicate that the 10 mg/d supplement resulted in an adequate plasma concentration of vitamin E. After cessation of supplementation at age 3 mo, the risk of low plasma vitamin E levels increased. Although intramuscular administration resulted in long-lasting increments in mean plasma vitamin E values, some later levels in these infants were marginal.

The annual incidence of out-of-hospital cardiac arrest is around 90-190 cases per 100 000 inhabitants. The limiting factor for further prognosis of patients after out-of-hospital arrest is their neurological status. The S100B protein is mainly the nervous system cells product, its glial-specific and mostly expressed by astrocytes. It has been shown that after circulatory arrest its increased level correlates with the prognosis of patients. Work aims to determine the level of protein S100B in the group of patients with acute myocardial infarction without circulatory arrest, and compare it to the value in patients with acute myocardial infarction after out-of-hospital resuscitation.24 patients were evaluated after out-of-hospital resuscitation for the malignant arrhythmias during acute coronary syndrome (ACS). All patients were treated with mild therapeutic hypothermia. The control group consisted of 19 patients with ACS. The sample for the determination of S-100B was taken immediately on admission. Neurological status was evaluated according to the CPC scores (Cerebral Performance Categories) at discharge, patients were divided into 3 groups: CPC1 - good condition, CPC2 - moderate neurological disability, CPC3-5 - serious neurological impairment, coma or death.The values of protein S-100B fluctuated, in patients with no resuscitation, in range between 0.038 to 0.204 pg/ml. In patients after resuscitation without subsequent neurological disability (CPC 1) was range 0.077 to 0.817 pg/ml, in patients with moderate to severe neurological disability (CPC 2) was range 0.132-2.59 pg/ml, patients with severe neurological disabilities or deaths had S-100B levels from 0.70 to 8.53 pg/ml. According to ROC analysis we found the cut-off value for the S-100B. Cut-off value for probably a good neurological condition is0.23 pg/ml (specificity 93%, sensitivity 70%), and value testify for supposed severe neurological disability or death is1.64 pg/ml (specificity 95%, sensitivity 83%).Protein S-100B is one of the early and sensitive markers of severe brain damage in patients after cardiac arrest. Its early determination can help in prediction of patient neurological condition and help doctors to decide further action.