Acute responses of hepatic fat content to consuming fat, glucose and fructose alone and in combination in non-obese non-diabetic individuals with non-alcoholic fatty liver disease.

We have recently demonstrated that a high-fat load can induce immediate increase in hepatic fat content (HFC) and that such an effect can be modified differently by co-administration of fructose or glucose in healthy subjects. Therefore, we addressed the question how consumption of these nutrients affects changes in HFC in subjects with non-alcoholic fatty liver disease (NAFLD). Eight male non-obese non-diabetic patients with NAFLD underwent 6 experiments each lasting 8 hours: 1. fasting, 2. high-fat load (150 g of fat (dairy cream) at time 0), 3. glucose (three doses of 50 g at 0, 2, and 4 hours), 4. high-fat load with three doses of 50 g of glucose, 5. fructose (three doses of 50 g at 0, 2, and 4 hours), 6. high-fat load with three doses of 50 g of fructose. HFC was measured using magnetic resonance spectroscopy prior to meal administration and 3 and 6 hours later. Plasma triglycerides, non-esterified fatty acids, glucose and insulin were monitored throughout each experiment. HFC increased by 10.4 ± 6.9% six hours after a high-fat load and by 15.2 ± 12.5% after high-fat load with fructose. When co-administering glucose with fat, HFC rose only transiently to return to baseline at 6 hours. Importantly, NAFLD subjects accumulated almost five times more fat in their livers than healthy subjects with normal HFC. Consumption of a high-fat load results in fat accumulation in the liver of NAFLD patients. Fat accumulation after a fat load is diminished by glucose but not fructose co-administration.

Clinical and (31)P magnetic resonance spectroscopy characterization of patients with critical limb ischemia before and after autologous cell therapy.

Autologous cell therapy (ACT) is a new treatment method for diabetic patients with critical limb ischemia (CLI) not eligible for standard revascularization. After intramuscular injection of bone marrow-derived mononuclear cells local arteriogenesis in the ischemic tissue occurs. Studies assessing visualization of this therapeutic vasculogenesis after ACT by novel imaging techniques are lacking. The aim of our study was to assess the effect of ACT on possible metabolic changes and perfusion of critically ischemic limbs using (31)P magnetic resonance spectroscopy ( (31)P MRS) and its possible correlation with changes of transcutaneous oxygen pressure (TcPO(2)). Twenty-one patients with diabetes and no-option CLI treated by ACT in our foot clinic over 8 years were included in the study. TcPO(2) as well as rest (phosphocreatine, adenosine triphosphate and inorganic phosphate) and dynamic (mitochondrial capacity and phosphocreatine recovery time) (31)P-MRS parameters were evaluated at baseline and 3 months after cell treatment. TcPO(2) increased significantly after 3 months compared with baseline (from 22.4±8.2 to 37.6±13.3 mm Hg, p=0.0002). Rest and dynamic (31)P MRS parameters were not significantly different after ACT in comparison with baseline values. Our study showed a significant increase of TcPO(2) on the dorsum of the foot after ACT. We did not observe any changes of rest or dynamic (31)P MRS parameters in the area of the proximal calf where the cell suspension has been injected into.

Consciousness and general anaesthesia: a recent view.

An explanation of consciousness is one of the major unsolved problems of modern science. The modern view of consciousness arose in the nineteenth century; the view presumed that mental activity correlates with distinct physical states. Is the problem of consciousness real? Crick and Koch made a tentative assumption that all different aspects of consciousness (pain, seeing, thinking, emotion, self-consciousness) are connected by a basic common mechanism. The next step towards understanding involved the neuronal theories of consciousness (correlates of consciousness), often referred as the NNC (neural correlates of consciousness). Many neuroscientists presume that consciousness must have a neuronal correlate. The neuroscience of anaesthesia can be defined as studying the effect of anaesthetic agents on consciousness and the preconsciousness brain mechanisms of cognitive function. Some of these mechanisms, such as recognition of the novel stimuli, are still present in deep anaesthesia, during continuous suppression. Anaesthesia is not "an all or nothing" phenomenon and consciousness awareness with explicit memory represents only one part of the spectrum of cognitive functions. The introduction of safe general anaesthesia represents one of the most important, although under-appreciated, advances in modern surgery. There is some difficulty in defining the term "consciousness" in relation to the anaesthetic state. The difference in brain activity between those under anaesthesia and those not under any such influence.

Differences in muscle metabolism in patients with type I diabetes - influence of gender and nephropathy studied by (31)P MR spectroscopy.

Type I diabetes mellitus (DM1) is a complex disease with adverse effects on organs and tissues despite compensation by insulin treatment. The goal of our study was to study how kidney diseases change (31)P MR parameters of muscle metabolism in DM1 patients with respect to gender. 51 DM1 patients (19 m/14 f without and 13 m/5 f with nephropathy) and 26 (14 m/12 f) healthy volunteers were examined using (31)P magnetic resonance spectroscopy at 3T tomograph at rest, and during and after a calf muscle exercise. The exercise consisted of a six-minute plantar flexion using a pedal ergometer followed by a six-minute recovery. It is reflected by reduced relative beta-ATP and increased Pi and phosphodiester signals to phosphocreatine (PCr) at rest and prolongation of the PCr recovery time after the exercise. Measurement on healthy volunteers indicated differences between males and females in pH at the rest and after the exercise only. These differences between patients groups were not significant. We have proven that nephropathy affects the metabolism in diabetic patients and our results confirm significant difference between patients with and without nephropathy. Gender differences in pH were observed only between male and female healthy volunteers.

Influence of breathing on the measurement of lipids in the myocardium by ¹H MR spectroscopy.

The myocardium examination by MR spectroscopy is very challenging due to movements caused by the cardiac rhythm and breathing. The aim of the study was to investigate the influence of breathing on the quantitative measurement of lipid/water ratios in different groups of volunteers and different measuring protocols. We examined the lipid content of myocardium at 3T using the proton single voxel spectroscopy. Three protocols (free breathing, breath hold and the use of respiratory navigator) controlled by ECG were used for the examination of 42 adult volunteers including 14 free divers. Spectra were evaluated using jMRUI software. An average content of lipids in the healthy interventricular septum, gained by all protocols was equal to 0.6 %, which is in agreement with other published data. Based on the quality of examinations and the highest technical success, the best protocol seems to be the one containing a respiratory navigator since it is more acceptable by patients. Based on our results and the literature data we can conclude that MR spectroscopy is able to distinguish patients from controls only if their myocardial lipid content is higher than 1.6 % (mean value of lipids plus two standard deviations).

Possible extrapyramidal system degradation in Parkinson's disease.

Extrapyramidal system, a rich network of nerve and glial cells consists of subcortical and cortical grey matter. The system serves as an integrator of unaware, automatic, repeated, spontaneous, complicated and purposeful motor samples. Muscle tone regulation and its distribution is another decisive extrapyramidal function. This review article concerns to some degradation mechanisms in extrapyramidal system, as either the programmed cell death or apoptosis. The physiologic extracellular decreasing signals creating apoptosis (nerve growth factor--fall) are either genetically expressed or there are neuropathophysiologic processes that may activate pathways leading to apoptosis, namely oxidative stress, glutamate toxicity and calcium homeostasis disruption. The level of dopamine transporter expression (mRNA, methyl-phenyl-pyridinium) might determine the vulnerability of the nigral neurons to the Parkinsonian insult. The most common clinical picture of extrapyramidal disorder-Parkinson's disease-consists of an active dopamine cell death-apoptosis, which is partially programmed like as programmed cell death and partially accidentally installed chain of events. Without morphological criteria, biochemical indicators such as laddered DNA fragmentation pattern and/or the requirement for macromolecular synthesis merely suggest but do not provide unequivocal evidence for apoptosis. There are either genetic or acquired conditions creating unbalance of Bax/Bcl-2 families-proapoptotic and prooncogenic factors, respectively. The first Bax gene cooperates with other genes coding the new transmembrane proteins into the mitochondrial megapores determinating transition by means of death receptors. Bcl-2 codes prooncogenic mitoses and tissue proliferation. The neuroprotective hypothesis of the dopamine agonist action is a very attractive working hypothesis and some of its tenets are derived from the oxidative stress hypothesis for neurodegeneration, but this hypothesis is still controversial.

Four quantitative EMG methods and theirs individual parameter diagnostic value.

Quantitative electromyography (EMG) usage in daily clinical medicine can exclude the investigation results influencing by the electromyographer's subjective factor in needle EMG. The aim of our study was to compare the diagnostic efficiency of these quantitative EMG methods which have found some more consistent application in routine neurologic practice. We have investigated 35 healthy subjects and 59 patients with two basic types of neuromuscular disorders (neuropathies and myopathies) by means of four quantitative EMG methods: 1--modified Buchthal's low threshold MUAPs (motor unit action potentials) analysis; 2--interference EMG pattern Dorfman's and McGill's limited decomposition; 3--interference EMG pattern spectral analysis; 4--interference EMG pattern turns-amplitude analysis. In results analysis parameter's 95% confidence intervals were calculated by Campbell and Gardner and the difference between three subject groups (controls, neuropathies, myopathies) was evaluated by special multidimensional statistics (Hotelling T2 test) using simultaneously all tested parameters of four quantitative EMG methods. The modified Buchthal's low threshold MUAPs analysis was the most effective method in discovering neuropathy and myopathy with area as the best discriminating parameter. The diagnostic power in neuropathies may be increased using selected quantitative EMG methods or theirs individual parameters combinations. Several aspects of applyied quantitative EMG methods and aquired data statistical analysis are discussed.

[Selected parameters of lipoprotein metabolism in cerebrovascular diseases]. / Vybrané parametre metabolizmu lipoproteínov pri cerebrovaskulárnych ochoreniach.

In series of patients with stroke, selected by random (n = 68), mean age 62.44 +/- 9.12 years (range 39-82 yrs), there were 23 females (33.8%), mean age 65.43 +/- 10.11 yrs and 45 males (66.2%) mean age 60.8 +/- 8.3 yrs. Lp(a) reference values have been obtained from a group of 283 healthy individuals (age ranging from 15 to 65 years). The cholesterol, triacyglycerol, Apo B reference values come from the database of the Department of Clinical Biochemistry. There were 52 hypoxemic stroke patients in the whole observed group. Triacylglycerol serum level TAG < or = 2.89 mmol/l was observed in 47 cases (90.3%), the serum level TAG > 2.89 mmol/l was present in 5 cases (9.7%). The occurrence of TAG normal serum level was significantly more frequent than its pathologic increase (p < 0.001). Apolipoprotein Apo B < or = 1.67 g/l serum level was present in 41 (78.8%) and Apo B > 1.67 g/l in 11 (21.2%) cases (p < 0.001). Apo B < or = 1.67 g/l serum levels in 23 cases (82.1%) and Apo B > 1.67 g/l in 5 cases (18%) were observed among the stroke diabetes mellitus patients (n = 28)--statistic difference in 1/1000 level. In the total hypoxemic stroke group (n = 52), Lp(a) < or = 0.278 g/l was observed in 44 cases (84.6%), Lp(a) > 0.278 g/l serum level was present in 8 cases (15.4%)/ - p < 0.001. According to EASD consensus the serum level of Lp(a) = 0.278 g/l has been considered as "cut-off limit". Similar distribution of Lp(a) serum levels was observed in the diabetes mellitus stroke group (n = 28), the ischemic heart group (n = 54), the group with aortosclerosis (n = 16) and in the group with arterial hypertension (n = 50). Elevated TAG serum levels were not in correlation with the number of sites where atherosclerotic changes were proved by arteriography, ultrasound investigation e.g. in the extracranial brain supplying arteries. Elevated Lp(a) serum levels did not correlate with the stage of ischemic heart disease and they correlated with the stage of functional CNS defect in arterial hypertension and atherosclerosis. Metabolic disorders of lipoprotein and apolipoprotein, namely genomic transcription of lipoprotein seem to be more significant risk stroke factors, but, if they are present, they contribute to the occurrence of arteriosclerosis of some larger arteries. Elevated Lp(a) serum levels did not correlate with the stage of the heart ischemic disease and aortosclerosis, but they correlate with the stage of functional CNS defect due to arteriosclerosis and arterial hypertension, hence the increase in Lp(a) serum level as an indicator of arteriosclerotic evolution of cerebral arteries is significant. Our results, hence, do confirm a common supposition for Lp(a) serum level as an independent arteriosclerotic risk factor of the brain arteries. (Fig. 7, Tab. 1, Ref. 22.)

[Memory, awareness and learning in general anesthesia]. / Pamät, uvedomovaná bdelost a ucenie v celkovej anestézii.

Enough information concerning memory and other cognitive functions in total anesthesia is available in the literature. Some basic theories about neuronal mechanisms of memory and consciousness are known. An attempt trying to bridge the gap between psychological and biologic levels is the usage of anesthetics in pharmacologic tests enabling the study of their influence on awareness and memory in humans. With the help of this approach it is possible to inquire into the psychological mechanisms and to demonstrate the influence of anesthetics on them. 44 patients were included in the study, operated on in inhalation anesthesia. The effects of anesthesia on awareness, consciousness, learning and memory in our study sample were following: 1. No episode of awareness was observed during the study; 2. There was an improvement of the memory quotient (MQ) following total inhalation anesthesia (p < 0.05); 3. The pain threshold significantly decreased after anesthesia (p < 0.001); 4. There exists a learning mechanism in total anesthesia more efficient in the group of patients auditively learning pain related words (p < 0.05) comparing to the control group of patients auditively learning pain nonrelated words; 5. Statistical analysis of the number of remembered pain related words and pain nonrelated words revealed significantly higher number of words in the first group of pain related words (p < 0.001). (Tab. 3, fig. 6, Ref. 22.)

[Single-photon emission-computed tomography in the diagnosis of cerebrovascular diseases]. / Príspevok jednofotónovej emisnej pocítacovej tomografie k diagnostike cievnych ochorení mozgu.

BACKGROUND: SPECT-HM-PAO allows to detect the regional cerebral blood flow and total diminution of the brain perfusion still before morphological substrate evolution in CT scan, without invasive technologies. SEARCH GOAL: The authors have analyzed data obtained by SPECT-99mTc HM-PAO in the group of 46 patients suffering from cerebrovascular disorders and they have compared them with results aimed by CT scans. Both, the SPECT-99mTc HM-PAO and CT scan were performed within 48 hours or later after the onset of the stroke; some of CT scans were repeatedly performed. RESULTS: They discovered 40 positive and 6 negative SPECT-HM-PAO findings, 26 positive and 20 negative CT scans. SPECT investigation more frequently discovers circulatory failures in the clinically altered hemisphere than the CT scan does in a substrate; SPECT discloses hypoperfusion of the clinically unaltered hemisphere if silent hypoperfusion is present. The ipsilateral foci of CT substrates were significantly less frequently observed (p < 0.001) than some ipsilateral regional hypoperfusions. Not only the number, but also size and extent of hypoperfusional foci searched by SPECT are significantly higher and wider than the numbers and dimensions of substrates observed by CT (p < 0.001). CONCLUSION: CT scan diagnostic possibilities are restricted by the time factor (CT examinations performed within 48 hours since the onset of the stroke are significantly less frequently positive than those performed later-p < 0.001). SPECT examination has not such a limiting time factor (p > 0.05). MEANING: Hence SPECT-HM-PAO renders early, long lasting and wide information on the restriction of the overall and regional perfusion, independently of the fact as to whether the reduction of cerebral perfusion is, or is not going to result in ischemic necrosis and/or ischemic sclerosis. SPECT renders correlation of the perfusion disorder earlier, wider in space, and more frequently than the CT scan, and therefore it is a prerequisite to the disclosure of the mentioned silent focal blood flow reductions. (Graph 12, Fig. 3, Ref. 4.)

[Local immune defects--products of free oxygen radicals]. / Lokálne imunodefekty--produkty volných kyslíkových radikálov.

The discussion about the supporting task of four main active oxygen dependent mechanisms mediating and modulating immune signals was included in the work, along with the discussion on antioxidants influencing these mechanisms. The former include xanthine-oxidase, cyclooxygenase, lipoxygenase, aldehyde oxygenase metabolic chains. Currently, we are just beginning to realize that active oxygen and antioxidants can modulate the induction of physiological signals, and that these effects are not limited to the immune system. The effects of antioxidant treatment could represent neutralization of harmful radicals, albeit they can simply represent modulation of complex biochemical events which are essential parts of normal metabolism. Some natural antioxidants, e.g. alfa-to-copherol, ascorbic acid and beta-carotens are very good means of the primary prevention, but with acute failure of local antioxidants, they do not prevent the excessive production of proliferative inflammatory tissue. Tirilazad-mesylate has threefold beneficial influences: first as an inhibitor of the creation of oxygen radicals, second as a scavenger or quencher of free oxygen radicals, and finally in the arrangement of the defects in the phospholipid bilayer and possible receptors of macrophages, as well as T cells. The drug is suitable for active modulation of locally changed immune reactions and thus it rejects harmful proliferative inflammation in the subdural space. Until recently it has been eliminated by surgical procedure. The authors expel the thick (0.8 cm) subdural collection of the proliferative inflammatory product by tandem treatment which includes methylprednisolon+tirilazad-mesylate for three days, followed by fourteen days of methylprednisolon, which was gradually decreased in daily oral doses. This is a revolutionary change in the treatment of similar intracranial processes. (Fig. 4, Ref. 21.)

[Leber's hereditary optic nerve neuropathy]. / Leberova hereditárna neuropatia zrakového nervu.

The authors present a case report of 26 years old man with bilateral optic nerve neuropathy. Detection of heteroplasmic mutation of mitochondrial DNA at G3460A site confirmed the suspicion on Lebers hereditary optic nerve neuropathy (LHON). Genetic and environmental factors of the disease and various accompanying neurologic and other symptoms, which can together with the optic nerve defect participate in the development of of the LOHN clinical pattern are discussed. (Ref. 12.)

[Electrophysiologic analysis of subclinical disorders of muscle tonus in atherosclerosis and hypertension]. / Elektrofiziologicheskii analiz subklinicheskikh narushenii myshechnogo tonusa pri ateroskleroze i gipertonicheskoi bolezni.

A group of patients with atherosclerosis and essential hypertension without clinically manifested signs of cerebral involvement was examined. The methods used included somatosensory evoked potentials, the assessment of the brachial muscles tone by passive sinusoidal movements of the upper arm and the determination of the curves of the isometric activation of the leg muscles during the stimulation of the feet by tactile and painful stimuli. Subclinical impairments of the muscular tone were elucidated. Patients with bilateral changes of the muscle tone show a high risk of the development of encephalopathy; those with unilateral alterations are at risk of developing a cerebral impairment of the corresponding side.