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Aim. The CORD Study compared effectiveness and tolerability of losartan and ramipril in patients with arterial hypertension (AH).Material and methods. The study included two groups, A and B. In Group A (n=4016; mean age 62,6+11,6 years; 53,1% women), the patients with blood pressure (BP) 3 months were switched from ACE inhibitors to losartan. At baseline and 1, 3, 6, and 12 months later, BP, heart rate, and biochemical parameters were measured; general blood assay and electrocardiography (ECG) were also performed. In group B (n=3813; mean age 60,5+12,2 years; 50,5% women), the patients with BP >140/90 mm Hg and no previous ACE inhibitor or angiotensin receptor blocker (ARB) therapy were randomly administered either losartan (50 mg/d; n=1887) or ramipril (5 mg/d; n=1926).Results. Group A demonstrated a decrease in BP — from 147,4+14,8/87,7+9,3 to 139,7+11,8/83,0+9,3 mm Hg (p

Hemodialysis is a life-saving method for patients with acute and chronic kidney failure. This treatment requires sufficiently large and safe vascular access. Ensuring optimal vascular access is therefore a prerequisite and an integral part of the care of these patients. In addition to commonly known vascular approaches such as non-tunnelized or tunneled hemodialysis catheters and AV fistulas, less well-known methods are also available, such as a translumbar or directly surgically inserted hemodialysis catheter into the right atrium. However, these alternative approaches are the only, life-saving alternative for some patients. The ambition of this review article is to offer a comprehensive view of the available options for vascular access, the algorithm for its selection and solutions to the most common complications in clinical practice.

The brain is among the target organs of hypertension. Patients with hypertension have a higher risk of developing stroke as well as experiencing a decline in cognitive functions and dementia. Changes in the white matter and atrophy of the grey matter of the brain induced by high blood pressure develop insidiously since the onset of hypertension, even in young individuals. The effect of high blood pressure on the vessel wall cumulates in time; therefore, hypertension in younger people implies an increased risk of dementia in older age. Hypertension in young age cannot be considered a benign condition. Hypertension in middle age increases the risk of dementia by 61 %. Consistent and early hypertension control can reverse the adverse development towards dementia and lack of self-sufficiency in the patient. Data comparing individual antihypertensive drugs in terms of preventing dementia are scarce. However, renin angiotensin system blockers have been found to protect against Alzheimer's disease more than other classes of antihypertensive drugs. To achieve rapid and effective hypertension control, a combination of antihypertensive drugs is usually required. Using a fixed-dose triple combination of perindopril, indapamide, and amlodipine, blood pressure targets of < 130/80 mm Hg can be achieved within three months in 93 % of patients.

This study aimed to analyze the adaptive skills of children with intellectual disabilities in institutional care. We focused on communication, socialization, daily living skills and their relationship with risk factors, and institutional care. Our sample included 197 children aged 5−18 years (M = 12.8, SD = 2.97), 50% boys, with IQ < 85 placed in different types and lengths of stay in institutional care. There were 17% that presented with borderline intellectual functioning (IQ 84−87) and 83% that had intellect disabilities. Adaptive behavior (AB) was assessed by Vineland Adaptive Behavior Scale (VABS-3). The BIF and Mild ID groups did not differ in Socialization. The profile of adaptive behavior for BIF and Mild ID was Daily Living Skills > Communication > Socialization, and for Moderate and Severe ID, Socialization > Daily Living Skills > Communication. Longer institutional care was associated with lower competencies in AB. Gender differences were found, females overperformed males in Socialization, Daily Living Skills, and ABC score. Levels of ID, gender, length of stay in institutional care, and neonatal difficulties were significant predictors in the model which explain the 63% variance of AB. The practical implications of the results are discussed related to the assessment of ID, prevention, and care for institutionalized children.

Angiotensinogen (AGT) represents a key component of the renin-angiotensin-aldosterone system (RAAS). Polymorphisms in the 3' untranslated region (3'UTR) of the AGT gene may alter miRNA binding and cause disbalance in the RAAS. Within this study, we evaluated the possible association of AGT +11525C/A (rs7079) with the clinical characteristics of patients with coronary artery diseases (CAD). Selective coronarography was performed in 652 consecutive CAD patients. Clinical characteristics of the patients, together with peripheral blood samples for DNA isolation, were collected. The genotyping of rs7079 polymorphism was performed with TaqMan ® SNP Genotyping Assays. We observed that patients with the CC genotype were referred for coronarography at a younger age compared to those with the AA+CA genotypes (CC vs. AA+CA: 59.1 ± 9.64 vs. 60.91 ± 9.5 (years), p = 0.045). Moreover, according to the logistic regression model, patients with the CC genotype presented more often with restenosis than those with the CA genotype ( p = 0.0081). In conclusion, CC homozygotes for rs7079 present with CAD symptoms at a younger age compared with those with the AA+CA genotype, and they are more prone to present with restenosis compared with heterozygotes.

The case report is about a 68-years-old man who developed a weight loss and diabetes mellitus as early symptoms of pancreatic cancer several months before the diagnosis. Unfortunately, the diagnosis was made too late, at the stage of generalized disease, when symptomatic treatment was the only possible way. The aim of the article is to warn about this possible way of pancreatic cancer manifestation, because only the diagnosis determined in time, when the tumor is localized, allows its resection - the only curative treatment method. For this reason, it is necessary to consider the presence of pancreatic cancer in the case of an atypical manifestation of diabetes.

Objective: Currently available methods for endogenous cortisol monitoring in patients with hormonal insufficiency rely on measurements of plasma levels only at a single time point; thus, any kind of chronic exposure to cortisol is challenging to evaluate because it requires collecting samples at different time points. Hair cortisol levels acquired longitudinally better reflected chronic exposure (both cortisol synthesis and deposition) and may significantly contribute to better outcomes in glucocorticoid replacement therapies., Design: Twenty-two patients on cortisol substitution therapy were monitored for plasma, urinary, and hair cortisol levels for 18 months to determine whether hair cortisol may serve as a monitoring option for therapy setting and adjustment., Methods: Plasma and urinary cortisol levels were measured using standardized immunoassay methods, and segmented (∼1 cm) hair cortisol levels were monitored by liquid chromatography coupled to mass spectrometry. A log-normal model of the changes over time was proposed, and Bayesian statistics were used to compare plasma, urinary, and hair cortisol levels over 18 months., Results and Conclusions: Hair cortisol levels decreased over time in patients undergoing substitutional therapy. The residual variance of hair cortisol in comparison to plasma or urinary cortisol levels was much lower. Thus, longitudinal monitoring of hair cortisol levels could prove beneficial as a noninvasive tool to reduce the risk of overdosing and improve the overall patient health., Competing Interests: E. Bartečků declares a commercial relationship with Angelini S.p.A. in the form of honoraria. J. Juřica claims a commercial relationship with Krka, Leram, and Angelini in honoraria for consultations and lecturing. Other authors declare that they do not have any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Venous thromboembolism in children is rare, but the incidence has increased sharply during the last years. The standard of care for treating this disease consists of warfarin, unfractionated heparin, low-molecular-weight heparins and fondaparinux. Lately, the usage of rivaroxaban (direct oral anticoagulant) was officially approved. According to a recent study, treatment with rivaroxaban resulted in a similarly low recurrence risk and reduced thrombotic burden without increased risk of bleeding. The usage of direct oral anticoagulants could overcome the limitation of currently used care (mainly the necessity of regular laboratory monitoring and parenteral application) while providing similar efficacy and safety to treat venous thromboembolism in children.

Blockade of the renin angiotensin aldosterone system (RAAS) is currently considered to be the gold standard of antihypertensive therapy. ACE inhibitors and AT1-blockers are clinically the most relevant groups of RAAS blockers. Even though both drug groups block angiotensin II, ACE inhibitors typically reduce the degradation of bradykinin, which leads to the release of nitric oxide and prostaglandins with subsequent vasodilation. These differences in the mechanism of action can be of clinical relevance for hypertensive patients. Morbidity mortality studies of RAAS blockers have been reported in which ACE inhibitors, particularly perindopril, improved the overall survival in hypertensive patients. In the ONTARGET trial, a direct comparison of both drug groups yielded comparable results. Perindopril, which has been used in the clinical practice for more than 25 years, is a long-acting lipophilic angiotensin-converting enzyme inhibitor with a once-daily dosage schedule and a high affinity to tissue-converting enzyme. Its safety, efficacy, and very good tolerance have been shown in a number of studies. It is part of many fixed combinations which improve patient compliance and increase the effect of treatment of cardiovascular diseases.

The aim of this retrospective study is to evaluate our experience with diagnostic and therapeutic endoscopic retrograde cholangiopancreaticography (ERCP) in patients after choledochoduodenoanastomosis., Methods: The study took 20 years (November 1994 - December 2014). Three patients after choledochoduodenoanastomosis who had symptoms of biliary obstruction were retrospectively evaluated. In all cases, a standard therapeutic videolateroscope was used to perform ERCP., Patients and Results: We achieved ERCP in these 3 patients with choledochoduodenoanastomosis 100% cannulation success rate - 3 out of 3 patients. This was 100% success rate of diagnostic ERCP. In all of these patients, ERCP was found - both stenosis of the natural mouth of the Vater papilla, stenosis of choledochoduodenoanastomosis, and suprastenotic distal choledocholithiasis. In all patients with the above-described ERCP pathology, endoscopic treatment was initiated immediately after diagnostic ERCP, consisting of standard endoscopic papillotomy of the stenotic Vater papilla, balloon dilatation of choledochoduodenoanastomosis stenosis, and endoscopic extraction of suprastenotic distal choledocholithiasis. In total, therapeutic ERCP was completely successful in all 3 patients out of 3 (100%) who had initially started endoscopic treatment. There were no complications in our group of 3 patients., Conclusion: In ERCP in patients after choledochoduodenoanastomosis, we achieved 100% success of both diagnostic and therapeutic ERCP in all of our 3 patients.

The stomach resection according to Billroth I (B I) is very rarely done. The aim of this retrospective study is to evaluate our experience with diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients after stomach resection according to Billroth I. In patients with a condition after stomach resection according to B I, a study of the group of 20 years (November 1994 - December 2014) took place. Three patients were evaluated retrospectively after B I stomach resection with biliary obstruction. For the ERCP was used the Olympus therapeutic videotheroscop in all cases with the standard (as in normal anatomical situation). Cannulation success in diagnostic ERCP was achieved in 3 out of 3 patients - 100% success rate of ERC diagnosis. For all these 3 patients CDL was found in the ERCP. In addition, endoscopic treatment was performed immediately after ERCP diagnosis in all 3 patients with a CDL pathologic ERCP diagnosis, the initial endoscopic papillotomy (EPT) performed in the standard procedure (as in normal anatomy). Subsequently, endoscopic extraction of all CDL from hepatocholedocus to duodenum was performed. Overall the ERCP was completely successful in all 3 of the 3 (100% of 3) patients who initially started endoscopic therapy. There were no complications in our group of 3 patients. For ERCP in patients with BI stomach resection, we had 100% success rate of diagnostic and therapeutic ERCP in all of these patients (3 CDL patients).

Cardiovascular diseases (CVD) are still at the first place in the case of mortality in European countries. Consistent secondary prevention for CVD is very important aspect in the fight with this negative statistics. We consider antithrombotic treatment as a gold standard in secondary prevention for CVD . There are a lot of latest trials about this problematics. COMPASS trial targets the effectiveness of rivaroxaban in patients with CVD as a secondary prevention. The results of this trial are very positive about using rivaroxaban and acetylsalicylic acid together in effort to avoid progression or relapse of CVD.

Cardiac arrhythmias represent wide and heterogenic group of disturbances in the cardiac rhythm. Pathophysiology of individual arrhythmias is highly complex and dysfunction in ion channels/currents involved in generation or spreading of action potential is usually documented. Non-coding RNAs (ncRNAs) represent highly variable group of molecules regulating the heart expression program, including regulation of the expression of individual ion channels and intercellular connection proteins, e.g. connexins.Within this chapter, we will describe basic electrophysiological properties of the myocardium. We will focus on action potential generation and spreading in pacemaker and non-pacemaker cells, including description of individual ion channels (natrium, potassium and calcium) and their ncRNA-mediated regulation. Most of the studies have so far focused on microRNAs, thus, their regulatory function will be described into greater detail. Clinical consequences of altered ncRNA regulatory function will also be described together with potential future directions of the research in the field.

Several pathophysiological mechanisms have been proposed in the development of pregnancy complications, including endothelial dysfunction, an inflammatory pathway and oxidative stress. The aim of the present study was to evaluate the correlation between proinflammatory cytokines TNF-alpha, IL-6 and dual cytokine IL-10 in the mother's peripheral blood and systolic blood pressure, risk of preeclampsia and low birth weight in gestational diabetes (GDM). We observed 40 women with GDM divided into a gestational hypertension group (n=20) and comparison group (n=20) with normal blood pressure. We found a significant positive correlation between TNF-alpha; IL-6; IL-10 levels and systolic blood pressure (SBP) in the second trimester (p<0.001; p<0.001; p<0.001); the third trimester (p<0.001; p<0.001; p<0.05). We also proved correlations for diastolic blood pressure (DBP) during the second; third trimester (p<0.001; p<0.001; p<0.001); (p<0.001; p<0.001; p<0.0015). We demonstrated a statistically significant positive association between high TNF-alpha group and preeclampsia risk in the third trimester (p=0.04). We also determined the negative correlation in the second trimester between birth weight and TNF-alpha; IL-6, IL-10 levels (p<0.05; p<0.001; p<0.001). To conclude, our data highlight the importance of cytokines TNF-alpha, IL-6 and IL-10 in blood pressure regulation. In addition, high levels of TNF-alpha have been associated with increased risk of preeclampsia. We found a significant negative correlation between levels of TNF-alpha, IL-6, IL-10 and birth weight.

Aims: Unattended automated office blood pressure (uAutoOBP) has attracted more attention since SPRINT trial had been published. However, its long-term relationship to attended office blood pressure (AuscOBP) is not known., Material and Methods: Stable treated hypertensive subjects were examined in four Czech academic hypertension centers. All subjects attended four clinical visits three months apart. uAutoOBP was measured with the BP Tru device; AuscOBP was measured three times with auscultatory method by the physician. 24-hour ambulatory blood pressure monitoring (ABPM) was performed within one week from the second clinical visit., Results: Data on 112 subjects aged 65.6 ± 10.8 years with mean AuscOBP 128.2 ± 12.2/78.5 ± 10.3 mm Hg are reported. Across the four clinical visits, the uAutoOBP was by 10.1/3.7 mm Hg lower than AuscOBP and the mean difference was similar during all four visits (P≥.061). Both uAutoOBP and AuscOBP had similar intra-individual variability during study follow-up as demonstrated by similar intraclass correlation coefficients (ICC, for systolic ICC = 0.50, for diastolic ICC = 0.72). However, the intra-individual variability of the systolic AuscOBP and uAutoOBP difference was high as demonstrated by low ICCs for absolute (ICC = 0.17 [95%CI, 0.09 - 0.25]) and low κ coefficients for categorized differences (κ ≤ 0.16). The main determinant of AuscOBP-uAutoOBP difference was AuscOBP level. The AuscOBP-uAutoOBP difference was poor tool to identify hypertension control categories defined on the basis of AuscOBP and ABPM., Conclusions: Although mean AuscOBP-uAutoOBP differences were relatively similar across the four clinical visits, intra-individual variability of this difference was high. The AuscOBP-uAutoOBP difference was poor tool to identify hypertension control categories defined on the basis of AuscOBP and ABPM. Therefore, uAutoOBP cannot be used as a replacement for ABPM.

Aims: Unattended automated office blood pressure (uAutoOBP) may eliminate white-coat effect. In the present study, we studied its relationships to attended office blood pressure (BP) and ambulatory BP monitoring (ABPM)., Material and Methods: Stable treated hypertensive subjects were examined in four Czech academic hypertension centres. uAutoOBP was measured with the BP Tru device; attended BP was measured six times: three times with auscultatory method (AuscOBP) by the physician followed optionally by three oscillometric measurements (OscOBP). ABPM was performed within one week from the clinical visit., Results: Data on 172 subjects aged 63.7 ± 12.4 years with AuscOBP 127.6 ± 12.1/77.6 ± 10.0 mm Hg are reported. uAutoOBP was by 8.5 ± 9.0/3.0 ± 6.1 mm Hg lower than AuscOBP. The AuscOBP-uAutoOBP difference increased with the AuscOBP level and it did not depend on any other factor. OscOBP differed by 8.6 ± 8.6/1.9 ± 5.7 mm Hg from uAutoOBP. 24-hour mean BP was by 4.2 ± 12.1/3.5 ± 7.8 mm Hg lower than AuscOBP and by 4.3 ± 11.0/0.5 ± 6.9 mm Hg higher than uAutoOBP; the correlation coefficients of 24-hour mean BP with AuscOBP and with uAutoOBP did not differ (p for difference ≥.13). In the lowest BP group (systolic AuscOBP <120 mm Hg or diastolic AuscOBP <70 mm Hg), both AuscOBP and uAutoOBP were lower than 24-hour mean BP, while in the highest BP group (systolic AuscOBP ≥140 mm Hg or diastolic AuscOBP ≥90 mm Hg), they were higher., Conclusions: Compared to uAutoOBP, attended BP measurement gives higher values, both when measured with auscultatory or oscillometric method. Inter-individual variability of AutoOBP - uAuscOBP difference, as well of uAutoOBP - ABPM difference, is large. We did not prove that uAutoOBP would be associated to 24-hour ambulatory BP more closely than attended BP.

Axial spondyloarthritis (axSpA) is a common name for the non-radiographic form of the disease and radiographic axial spondyloarthritis, known as ankylosing spondylitis (AS). The disease is typically manifested at a young age, characterized by affection of axial skeleton, and in the most severe form can lead to complete ankylosis of the spine. Etiology of diseases have not yet been clarified, however, the genetic background, especially the binding to HLA-B27 antigen, is obvious. Clinical manifestations are dominated by chronic pain in the lower pain or buttocks that occurred in young age, in a large proportion of patients having the character of so-called inflammatory pain. In addition to the axial skeleton, axSpA there is also common affection of peripheral skeleton in the form of enthesitis, arthritis, and less often dactylitis. At present, enthesitis is considered as a hallmark of the entire spondyloarthritis group. Typical for axSpA is the frequent presence of extraskeletal manifestations in the form of uveitis, idiopathic intestinal inflammation and psoriasis. In the axSpA diagnosis, significant advances have been made in recent years in the field of imaging techniques. Magnetic resonance imaging can also identify the early stage of the disease before the development of structural lesions. Also, the newer concepts of the entire spondyloarthritis group, based on the 2009 ASAS (Assessment of SpondyloArthritis international Society) classification criteria, contributed to early diagnosis of the disease, and in particular to the underlying importance of association with HLA-B27 antigen and the presence of peripheral and non-articular manifestations. Non-steroidal anti-rheumatic drugs (NSAIDs) and TNFα blockers are effective axSpA therapy, which has been recently enhanced by interleukin 17 blockade (IL17).Key words: axial spondyloarthritis - biological treatment - enthesitis - extraarticular manifestations - magnetic resonance imaging - non-radiographic axial spondyloarthritis - sacroiliitis.

The human genome contains about 22 000 protein-coding genes that are transcribed to an even larger amount of messenger RNAs (mRNA). Interestingly, the results of the project ENCODE from 2012 show, that despite up to 90 % of our genome being actively transcribed, protein-coding mRNAs make up only 2-3 % of the total amount of the transcribed RNA. The rest of RNA transcripts is not translated to proteins and that is why they are referred to as "non-coding RNAs". Earlier the non-coding RNA was considered "the dark matter of genome", or "the junk", whose genes has accumulated in our DNA during the course of evolution. Today we already know that non-coding RNAs fulfil a variety of regulatory functions in our body - they intervene into epigenetic processes from chromatin remodelling to histone methylation, or into the transcription process itself, or even post-transcription processes. Long non-coding RNAs (lncRNA) are one of the classes of non-coding RNAs that have more than 200 nucleotides in length (non-coding RNAs with less than 200 nucleotides in length are called small non-coding RNAs). lncRNAs represent a widely varied and large group of molecules with diverse regulatory functions. We can identify them in all thinkable cell types or tissues, or even in an extracellular space, which includes blood, specifically plasma. Their levels change during the course of organogenesis, they are specific to different tissues and their changes also occur along with the development of different illnesses, including atherosclerosis. This review article aims to present lncRNAs problematics in general and then focuses on some of their specific representatives in relation to the process of atherosclerosis (i.e. we describe lncRNA involvement in the biology of endothelial cells, vascular smooth muscle cells or immune cells), and we further describe possible clinical potential of lncRNA, whether in diagnostics or therapy of atherosclerosis and its clinical manifestations.Key words: atherosclerosis - lincRNA - lncRNA - MALAT - MIAT.

Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis, classified into 2 subtypes - AIP type 1 and AIP type 2. We present a case of a 31-years-old female admitted to our institution with upper abdominal pain and obstructive jaundice. Endoscopic retrograde cholangiopancreatoscopy (ERCP) revealed stenosis of intrapancreatic distal bile duct. Diffuse parenchymal enlargement and typical features of AIP were shown by computed tomography (CT) and endoscopic ultrasonography (EUS). The patient´s serum IgG4 was elevated at 3.8 g/l (range 0.08-1.4 g/l). She was diagnosed with AIP type 1 and treated with prednisone (initial dose of 30 mg per day, then tapered by 5 mg/day every week). The maintenance dose of 5 mg per day was continued for 6 months. Despite clinical and radiological remission, serum levels of IgG4 remained elevated. The patient experienced disease relapse 25 months after first attack. Moreover, new finding of calcifications occured in pancreas. The relapse was managed with corticosteroids and maintenance immunosupression with azathioprin was started. Literature review on risk factor of relapse, long-term immunosupressive therapy indication and optimal follow-up of AIP type 1 patients are discussed.Key words: autoimmune pancreatitis type 1 - long-term follow-up - relapse - therapy.

Objective: To assess the diagnostic and therapeutic options in the care of patients with primary hyperparathyreosis in outpatient practice.Cohort and methods: The study included all the patients with primary hyperparathyroidism treated at the 2nd Internal Medicine Department, Masaryk University and the University Hospital of St. Anne in Brno in the period from Jan 1, 2008 to Dec 31, 2013. The sample consisted of 218 patients, including 41 men and 177 women. Patients with secondary hyperparathyroidism, especially patients with underlying hypovitaminosis D, renal insufficiency and those taking medications with possible effects on parathyroid hormone levels, have not been included in the study. A special attention was paid to differences between the normocalcaemic and hypercalcaemic patients. Ultrasound scanning was performed in all patients, while scintigraphy was indicated in patients who are considered for possible surgical treatment., Results: In the group of 218 patients, serum calcium levels at the baseline were pathologically elevated in 31 patients (14 %) and normal in 187 patients (86 %). One fifth of patients with normocalcaemic primary hyperparathyroidism developed long-term hypercalcaemia - within two years in two thirds of the patients from the onset of the disease and sporadically also after more than four years of follow-up. Parathyroid adenoma was found and removed in 30 hypercalcemic patients (in 97 % of all 31 hypercalcemic patients operated on) and in 2 normocalcemic patients (40 % of all 5 the normocalcemic patients operated on). Pharmacological treatment was administered to 22 patients, of which 9 patients received long-term treatment and 13 patients received pharmacotherapy only during the preoperative preparation for patients with very high serum calcium levels., Conclusion: The results support the opinion that primary hyperparathyroidism is a biphasic disease. The initial normocalcemic period is often asymptomatic or associated with symptoms of little importance. Severe complications, however, may already be present also in normocalcemic patients. The decision of when patients with normocalcemic primary hyperparathyroidism should be monitored and when initiation of treatment is needed should also require more detailed information.Key words: hypercalcaemia - hyperparathyroidism asymptomatic and primary - normocalcaemia - outpatient care - parathyroid hormone - surgery and pharmacotherapy.