High plasma levels of triglycerides (TG) are an independent risk factor in the development of cardiovascular disease, with about 50 % of the final levels being determined genetically. Apolipoprotein A5 ( APOA5 ) is the last discovered member of the apolipoprotein APOA1/C3/A4 gene cluster, found by comparative sequencing analysis. The importance of APOA5 gene for determination of plasma triglyceride levels has been suggested after development of transgenic and knock-out mice (transgenic mice displayed significantly reduced TG, whereas knock-out mice had high TG). In Czech population, alleles C-1131 and Trp19 are associated with elevated levels of plasma TG and higher risk of myocardial infarction development. These alleles also play some role in nutrigenetics and actigenetics of lifestyle interventions leading to the plasma cholesterol changes as well as in the pharmacogenetics of statin treatment. On the contrary, APOA5 mutations detected in Czech population did not show strict effect on plasma TG levels. Val153 → Met variant exhibit the sex-specific effect of HDL-cholesterol levels. The suggested roles of APOA5 variants in determination of the plasma remnant particles, plasma concentrations of C-reactive protein or some anthropometrical parameters were excluded., J. A. Hubáček ... [et al.]., and Obsahuje seznam literatury
The aim of this study was to assess the influence of regular daily consumption of white wine on oxidative stress and cardiovascular risk markers. Forty-two healthy male volunteers consumed 375 ml of white wine daily. Each participant provided three venous blood samples (before wine consumption, following the wine consumption period and again a month later). Levels of superoxide dismutase, glutathione peroxidase, reduced glutathione, total antioxidant capacity, total cholesterol, HDL-cholesterol, apolipoprotein A I, apolipoprotein B, triglycerides, paraoxonase 1, C-reactive protein, homocysteine, thiobarbituric acid reactive substances (TBARS) and advanced oxidation protein products (AOPP) were measured. Immediately following the month of white wine consumption there was a significant increase in HDL-cholesterol (p<0.0001), paraoxonase 1 (p<0.001), glutathione peroxidase (p<0.001) and reduced glutathione (p<0.01) levels, a decrease in superoxide dismutase activities (p<0.0001), and a decrease in oxidation protein products (p<0.001) and TBARS (p<0.05) concentrations. However, there was also a clear increase in homocysteine (p<0.0001) after a month of white wine consumption. The results of our non-placebo controlled trial suggest that regular daily white wine consumption is associated not only with both antioxidative and antiatherogenic effects but also with a potentially proatherogenic increase of homocysteine concentrations. and D. Rajdl, J. Racek, L. Trefil, K. Siala.
Prague hereditary hypercholesterolemic (PHHC) rat – rat strain crossbred from Wistar rats – is a model of hypercholesterolemia induced by dietary cholesterol. Importantly, no bile salts and/or antithyroid drugs need to be added to the diet together with cholesterol to induce hypercholesterolemia. PHHC rats have only modestly increased cholesterolemia when fed a standard chow and develop hypercholesterolem ia exceeding 5 mmol/l on 2 % cholesterol diet. Most of the cholesterol in hypercholesterolemic PHHC rats is found in VLDL that become enriched with cholesterol (VLDL-C/VLDL-TG ratio > 1.0). Concurrently, both IDL and LDL concentrations rise without any increase in HDL. PHHC rats do not markedly differ from Wistar rats in the activities of enzymes involved in intravascular remodelation of lipoproteins (lipoprotein and hepatic lipases and lecithin:cholesterol acyltransferase), LDL catabolism, cholesterol turnover rate and absorption of dietary cholesterol. The feeding rats with cholesterol diet results in development of fatty liver in spite of suppression of cholesterol synthesis. However, even though cholesterolemia in PHHC rats is comparable to human hypercholesterolemia, the PHHC rats do not develop atherosclerosis even after 6 months on 2 % cholesterol diet. Importantly, the crossbreeding experiments documented that hypercholesterolemia of PHHC rats is polygenic. To identify the genes that may be involved in pathogenesis of hypercholesterolemia in this strain, the studies of microarray gene expression in the liver of PHHC rats are currently in progress., J. Kovář ... [et al.]., and Obsahuje seznam literatury
Over the last decade, C-reactive protein concentration analyzed by the high sensitivity method (hsCRP) has been proven as a marker of premature atherosclerosis. Concentration exceeding 2 mg/l represents an increased individual risk of myocardial infarction and stroke but strict application of this borderline is complicated by relations of CRP concentrations to other risk factors of cardiovascular diseases. In a large 1 % representative sample of the Czech population, a positive relation of hsCRP to BMI, a waist circumference and triglyceride concentration was documented. Substantial sex differences were found in its relationship to age. Whereas it is continuously increasing in men, this increase appears in women only after menopause. A substantial decrease of body weight and visceral fat volume by increased physical activity is accompanied by significant decrease of hsCRP in young obese women. This decrease was not related to a change of interleukin-6 concentration, although it is supposed to regulate CRP production. CRP concentration is partly under genetic control as a higher concentration in young siblings of probands with proved coronary atherosclerosis was documented. The participation of genes related to lipoprotein metabolism (genes for apolipoprotein CI and apolipoprotein E) influence hsCRP concentrations. We hypothesized that an increased concentration of hsCRP represents a certain marker of proinflammatory status related to central obesity and triglyceride metabolism and it might be related to individual properties of monocytes in atherogenesis., R. Poledne ... [et al.]., and Obsahuje seznam literatury
Při dlouhodobém hladovění je nedostatečný přívod energie kompenzován z vlastních zdrojů organizmu. Zásoby glykogenu jsou rychle vyčerpány, produkce inzulínu klesá. Zpočátku slouží jako zdroj energie především bílkoviny, později jsou přednostně utilizovány tuky. V každém případě dochází však do určité míry k vyčerpání libové tělesné hmoty s vývojem deplece iontů, především uložených intracelulárně, t.j. fosfátů, kalia a magnézia. Jejich plazmatické hladiny zůstávají během malnutrice, díky uvolňování z buněk, v referenčních mezích. Deplece postihuje i významné metabolické kofaktory, kterými jsou stopové prvky a vitaminy, především thiamin. Po zahájení realimentace a přívodu glukózy se cukry stávají opět primárním zdrojem energie a katabolismus tuků a bílkovin klesá. Uvolňuje se sekrece inzulínu a při nástupu anabolismu se tok uvedených iontů obrací zpět do buněk. Může dojít k extrémnímu poklesu jejich plasmatických hladin a k akutnímu nedostatku thiaminu. V těžších případech vzniká realimentační syndrom (RS). V souvislosti s tím může dojít k závažným dysfunkcím řady orgánů, včetně srdečního selhání. Práce uvádí postupy doporučené pro rozpoznání rizika malnutrice i rizika vývoje RS. Jsou popsány jeho možné pestré klinické příznaky. Jsou uvedeny postupy klinického i laboratorního monitorování při zahájení realimentace u nemocných, kteří jsou v riziku vývoje RS. Dále jsou uvedeny postupy při úpravě iontových deplecí při manifestaci RS, jejich agresivita je vztahována k plasmatickým hodnotám fosfátu, kalia a magnézia., During long lasting starvation the insufficient supply of energy is compensated from own sources of organism. The store of glycogen is soon exhausted and the production of insulin decreases. During initial period the main source of energy used is all body protein. Later on lipids are preferred. However to some extent the lean body mass is always depleted. This depletion is accompanied by decreased intracellular pool of phosphates, potassium and magnesium. Thanks to gradual release from catabolic cells during malnutrition, their plasma levels remain in reference ranges for long time. The depletion affects also the important metabolic factors, such as the trace elements and vitamins, thiamine especially. During realimentation sugars become the main source of energy again and catabolism of fat and protein is interrupted. The restored secretion of insulin and start of anabolism turn the shift of the afore mentioned ions back into the cells. Their plasma levels as well as the levels of thiamine may extremely fall in short time. As consequence of these changes the refeeding syndrome (RS) may develop. The severe multiorgan dysfunction may develop including the cardiac failure. The paper presents the proceedings recommended for the malnutrition risk screening and also for the detection of risk of RS. The possible diverse clinical manifestations of this syndrome are presented. The article follows the description of clinical and laboratory monitoring at the start of realimentation in severely malnourished high risk patients. When RS is already diagnosed, the described corrections of ion dysbalances are sometimes aggressive, according to their plasma levels., Kazda A., Brodská, H., Novák F., Ševela S., and Literatura
Chronic heart failure has become a significant health problem. Cardiac surgery has an important role in the treatment of patients with heart failure. There are traditional surgical techniques in cardiac surgery – coronary revascularization, valve surgery, ventricular reconstructive surgery as well as new surgical techniques – cardiac support device (CorCap), mechanical circulatory support and resynchronization therapy. Cardiac surgery has a definitive role in the treatment algorithm for chronic heart failure., J. Pirk., and Obsahuje seznam literatury
Currently-used mechanical and biological heart valve prostheses have several disadvantages. Mechanical prostheses, based on carbon, metallic and polymeric components, require permanent anticoagulation treatment, and their usage often leads to adverse reactions, e.g. thromboembolic complications and endocarditis. Xenogenous and allogenous biological prostheses are associated with immune reaction, thrombosis and degeneration, and thus they have a high rate of reoperation. Biological prostheses of autologous origin, such as pulm onary autografts, often burden the patient with a complicated surgery and the risk of reoperation. Therefore, efforts are being made to prepare bioartificial heart valves with an autologous biological component by methods of tissue engineering. They should be biocompatible, durable, endowed with appropriate mechanical properties and able to grow with a child. For this purpose, scaffolds composed of synthetic materials, such as poly(lactic acid), poly(caprolactone), poly(4-hydroxybutyrate), hydrogels or natural polymers, e.g. collagen, elastin, fibrin or hyaluronic acid, have been seeded with autologous differentiated, progenitor or stem cells. Promising results have been obtained with nanostructured scaffolds, and also with cultivation in special dynamic bioreactors prior to implantation of the bioartificial grafts into an animal organism., E. Filová ... [et al.]., and Obsahuje seznam literatury
Bor a jeho sloučeniny byly zařazeny díky Nařízení Evropské komise č. 1907/2006 (REACH) do skupiny látek negativně ovlivňující reprodukci a vývoj plodu. To vyvolalo potřebu shrnout současné poznatky o jeho toxicitě a užití v medicíně během těhotenství a laktace. Akutní i chronická toxicita sloučenin boru je nízká. Otravy byly popsány jen ve výjimečných případech. Reprodukční toxicita zahrnuje v pokuse na zvířeti poškození spermatogenese a možnost vzniku vrozených vývojových vad obvykle za situace, kdy matka vykazuje známky toxického poškození. Práce rovněž shrnuje publikované klinické studie o vlivu kyseliny borité na vývoj plodu. Dle publikovaných výsledků studií nedosahuje expozice u člověka takových hodnot, aby k poškození reprodukce a plodu došlo. Protože užití jakéhokoli léku v těhotenství a laktaci musí být opodstatněné a profit musí převládat nad rizikem, shrnuje práce i studie, které se zabývají účinností kyseliny borité ve srovnání s jinými antimykotiky. Pro léčbu mykóz lze užít lokálně působící nystatin, případně klotrimazol, nebo mikonazol, výjimečně perorálně flukonazol v nízkých dávkách. Účinnost kyseliny borité je srovnatelná, případně vyšší, při léčbě rezistentních kmenů. Výhodou je i její nízká cena. Na závěr je třeba zdůraznit, že užití jakéhokoli přípravku během 1. trimestru by mělo být podloženo naléhavou potřebou léčby., The European Union Regulation REACH (No. 1907/2006) classified of boron and its compounds in the group adversely affecting reproduction and fetal development raised the need to to summarize findings about its toxicity and use in medicine during pregnancy and lactation. Acute and chronic toxicity of boron compounds is low. Intoxications were reported only in exceptional circumstances. In animals, reproductive toxicity includes the damage to spermatogenesis and the possibility of congenital defects usually in doses causing maternal toxicity. The work also summarizes the published clinical studies on the effect of boric acid on fetal development. According to the published results of studies, the human exposure does not reach of such values that the reproduction and fetal damage occurred. Since the use of any drug in pregnancy and lactation must be justified and profit must prevail over the risk, the work summarizes studies on the effect of boric acid as compared to other antifungal agents. Nystatin, clotrimazole, or miconazole, fluconazole can be used topically for the treatment of fungal infections, applied p.o. exceptionally in low doses, only. The effectiveness of boric acid is comparable or higher in resistant strains. Low price is an advantage. Finally, it should be emphasized that the use of any drug during the 1st trimester should be supported by the urgent need of treatment., Eva Maňáková, Lucie Hubičková Heringová, and Literatura