[Metabolic surgery--the most effective diabetes treatment]. / Metabolická chirurgie--nejúcinnejsí lécba diabetu.

Bariatric operations resulting in a favourable metabolic effect--not only due to a reduction of excessive body weight--are known as metabolic surgery. Interventions into the digestive tract, especially the prevented contact of food with the duodenal and proximal jejunal lining and/or the effect of an insufficiently digested food on the jejunum, favourably affect incretin mechanisms. Thus, "resolution" of type 2 diabetes and discontinuation of antidiabetic medication can be achieved in as many as 95 percent of patients. Today, combined procedures (gastric bypass, biliopancreatic diversion) are indicated for diabetic subjects with severe obesity. The usefulness and indication of metabolic surgery for type 2 diabetics with less pronounced overweight have to be verified in prospective controlled studies.

[Dyslipidemia and obesity 2011. Similarities and differences]. / Dyslipidemie a obezita 2011. Jak spolu souvisejí a v cem se lisí.

We shall open our overview of issues related to obesity and hyperlipoproteinemia (HLP) or dyslipidemia with a notoriously known truth (that some are still reluctant to accept): HLP/DLP is not obesity. It is certainly not possible to put an equal sign between subcutaneous fat and the level of plasma lipids and lipoproteins. On the other hand, it is obvious that there is a number of connecting links between HLP/DLP and obesity. These associations on one side and differences on the other are the focus of this review paper. (1) HLP/DLP as well as obesity represent a group of high incidence metabolic diseases (gradually evolving from epidemic to pandemic) that affect several tens of percent of inhabitants. (2) Both HLP/DLP and obesity often occur concurrently, often as a result of unhealthy lifestyle. However, genetic factors are also been studies and it is possible that mutual predispositions for the development of both diseases will be identified. At present, it is only possible to conclude that obesity worsens lipid metabolism in genetically-determined HLP. (3) Both these metabolic diseases represent a risk factor for other pathologies, cardiovascular diseases are the most important common complication of both conditions (central type of obesity only). Concurrent presence of HDL/DLP and obesity is often linked to other diagnoses, such as type 2 diabetes mellitus (DM2T), hypertension, pro-coagulation or pro-inflammatory states; all as part of so called metabolic syndrome. (4) Patients with metabolic syndrome and, mainly, central obesity usually have typical dyslipidemia with reduced HDL-cholesterol (HDL-C) and sometimes hypertriglyceridaemia. Current treatment of HDL/DLP aims to first impact on the primary aim, i.e. LDL-cholesterol (LDL-C), and than influence HDL-C. (5) It seems that the therapeutic efforts in HLP/DLP and obesity will go in the same direction. I will skip the trivial (and difficult to accept by patients) dietary changes. Pharmacotherapy, however, (very scarce with respect to obesity) may bring positive effects on lipids and BMI. Metformin used to be considered as a drug that could improve lipid profile and lead to body weight reduction. Even though larger studies did not provide an unambiguous evidence for this, metformin keeps its position as a first line oral antidiabetic (not only) in patients with T2DM, HLP and obesity. Positive effect on lipids, mainly HDL-C is reported with pioglitazone. This drug, unlike other glitazones, does not bring body weight reduction but at least does not have a negative effect. Other antidiabetics with a positive effect on lipids and body weight include incretins, liraglutid in particular. Liraglutid importantly decreases triglyceride levels and has anorectic effect. Furthermore, metabolic effects of bariatric surgery should not be overlooked. Bariatric surgery brings weight reduction as well as it improves lipid profile and compensation of diabetes mellitus (DM). It should be mentioned here that bariatric surgery has been used for the treatment of HLP as early as 1980s. The results of the 25-year follow up within the POSCH study (ideal bypass indicated for HLP), presented in 2010, confirm a decrease in overall as well as cardiovascular mortality in an operated group, even though patients who did not undergo surgery were significantly more frequently treated with statins.

[Recommendations for the treatment of tobacco dependence]. / Doporucení pro lécbu závislosti na tabáku.

This first Czech version of guidelines formulated by the working group of mentioned medical associations is based on current literature and international guidelines. They are aimed mainly on clinical medicine and on incorporation of this treatment into the health care system according to WHO recommendations. They should serve to the treatment of tobacco dependence at any level: during any contact with the smoking patient (short intervention), in specialised centres or for the health care providers or health system itself.

Angiogenic factors are elevated in overweight and obese individuals.

BACKGROUND: Adipose tissue produces both vascular growth factors and inhibitors. Since obesity is associated with expansion of the capillary bed in regional adipose depots the balance between these factors may favor angiogenesis. OBJECTIVE: To investigate the relationship between body mass index and serum concentrations of vascular growth factors in human subjects. METHODS: Vascular endothelial growth factor (VEGF), VEGF-C, VEGF-D, soluble VEGF receptor-2 (sVEGFr2), hepatocyte growth factor (HGF), angiopoietin-2, angiogenin and endostatin concentrations were measured in serum collected from 58 lean (24 males, 34 female, mean BMI, 22.2+/-0.3) and 42 overweight and obese (16 males and 26 females, mean BMI, 33.5+/-1.2) subjects after an overnight fast. RESULTS: Sexual dimorphism was apparent in the serum concentrations of VEGF-C, VEFG-D and angiopoietin-2 with significantly higher levels in female compared to male subject. VEGF, VEGF-C, VEGF-D, soluble VEGF receptor-2, angiopoietin-2, angiogenin and endostatin but not HGF were significantly elevated in overweight and obese subjects. Positive correlations between BMI and the serum concentrations of VEGF-C, VEGF-D, sVEGF-R2, angiopoietin-2, angiogenin and endostatin were observed even after adjustment for gender and age. CONCLUSIONS: Increased levels of vascular growth factors as well as the angiogenesis inhibitor endostatin are present in overweight and obese subjects and may contribute to previously documented increased risk of metastatic disease in obese subjects with cancer.

Serum levels of antibodies to thyroid peroxidase correlate with quantitative descriptors of thyroid ultrasound images in patients with breast cancer.

The aim of the study was to compare the structural changes in ultrasound image of the thyroid tissue in 12 women with breast cancer (BC) and 8 women with colorectal cancer (CC). MATLAB software was used to analyse the digitised images. As quantitative descriptors of thyroid ultrasound images (QDTI) were used raw grey scale values of individual image pixels (RAW) and the optimal one-dimensional discriminative texture features (F2, F6, F7). The possible relations between QDTI and thyroid laboratory parameters were tested. In the BC group serum levels of antibodies to thyroid peroxidase negatively correlated with feature RAW (multiple regression, beta coefficient -0.75, p=0.004) and positively with feature F2 (multiple regression, beta coefficient 1.44, p=0.04). In the BC group RAW negatively correlated with serum levels of tumour marker CA 15-3 (Pearson's correlation coefficient, r=-0.714, p=0.00917). No such correlations were found in CC group. The correlations between QDTI and serum levels of antibodies to thyroid peroxidase in patients with BC show that the positivity of antibodies to thyroid peroxidase is probably accompanied with structural changes in the thyroid tissue.