[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.

[Obesity and atherosclerosis--what's the link?]. / Co spojuje obezitu a aterosklerózu?

Obesity, primarily abdominal obesity, is a significant risk factor for symptomatic atherosclerosis. Atherosclerotic vascular changes and the pandemic of obesity are connected with the civilization process, in particular with diet modification and shortage of exercise and physical effort. The clinically defined metabolic syndrome is the most prominent atherosclerotic risk factor based on adipose tissue dysfunction producing low grade inflammation and endothelial dysfunction.

[Abdominal obesity]. / Abdominální obezita.

The examination of fat tissue distribution has considerably refined the relationship between obesity and the overall and cardiovascular mortality. The identification of the abdominal (central) obesity by the waist circumference measurement is easy accessible and should become the obligatory part of any physical examination. Abdominal (central) obesity is a mandatory component for the diagnosis of the metabolic syndrome, and represents major risk factor of cardiovascular mortality.

[The effect of treatment with fenofibrate on the risk profile of patients with metabolic syndrome and mixed dyslipidemia treated on an outpatient basis]. / VIiv lécby fenofibrátem na rizikový profil nemocných s metabolickým syndromem a smísenou dyslipidemií lécených ambulantne.

The study has shown that patients with metabolic syndrome and typical dyslipidemia treated on an outpatient basis by general practitioners or specialists are those whose anamneses include IHD or diabetes and who are very often indicated for combined statin-fibrate therapy. Fenofibrate therapy combined with a single lifestyle intervention in the form of individual interview resulted in the following improvement of the risk profile of the above patients: significant decrease in body weight and waist circumference, decrease in blood pressure and fasting glycemia; improvement of typical dyslipidemia in 90% of patients, however, only 30% of patients achieved the target TG levels below 1.7 mmol/l and the HDL-cholesterol levels above 1.3 mmol/l and 1 mmol/l in women and men, respectively. A total of 60% of patients no longer met the criteria for MS after 6 months of therapy. However, LDL-cholesterol and total cholesterol levels in patients with IHD or with diabetes were very unsatisfactory; only 6% of patients had achieved the recommended level of target LDL-cholesterol below 2.5 mmol/l before the intervention, i.e. 94% of the patient sample was indicated for statin therapy. 86% of patients with LDL-cholesterol above 2.5 mmol/l remained in our patient sample after non-pharmacological and pharmacological fibrate therapy. The results show that combined statin--fibrate therapy would be the best therapy for patients with IHD or diabetes who meet the MS criteria and whose typical dyslipidemia is expressed.

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.

[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.

Risk calculation of type 2 diabetes.

The paper presents an analysis of the risk of developing Type 2 diabetes according to family history and anthropometric variables. The age of diabetes onset was analysed in 2024 diabetics. We obtained several groups according to family history. In each group taken separately, the data describing the cumulative percentage of diabetes onset was fitted by logistic curve F(x) = p1/(1 + p2*p3((x/10)-p4)). Comparing these curves we see that cumulative age-dependent risk increases from the group of randomly chosen persons through the group of first degree relatives to the children of diabetics. The highest risk of diabetes onset is determined by the curve representing the group of known diabetics. Another analysis was performed in a different group of 390 obese subjects (34 diabetics among them). Male diabetics had significantly higher body mass index (BMI) and weight than male non-diabetics. Female diabetics showed significantly higher weight, body mass index, waist to hip ratio (WHR) and age than female non-diabetics. Elimination of factors with randomization and matching showed a complicated relationship between diabetes, age and anthropometric variables. Using stepwise logistic regression we obtained the model for prediction of diabetes risk based on age, BMI, WHR: probability of diabetes = exp(u)/(1 + exp(u)), where u = -13.9 + 0.05431*age + 6.789*WHR + 0.07881*BMI for obese women, u = -11.84 + 10.01*WHR for obese men. In conclusion, genetic factors are the most important and can be exactly quantified in Type 2 diabetes. The importance of anthropometric variables for prediction of diabetes risk is also presented.

Two endocrinological anniversaries.

In 2004, the First Faculty of Medicine will commemorate two significant anniversaries related to the small, yet important field of endocrinology. On January 31, 2004 it has been twenty years since the death of the founder of the discipline in this country, professor Josef Charvát (6.8.1897 - 31.1.1984). The occasion was marked by the Dean of the First Faculty of Medicine, by the Prorector of Charles University and by the President of the Czech Academy of Science who jointly unveiled a memorial plaque dedicated to the founder-of Czech endocrinology placed on at the house in Ostrovní Street, where professor Charvát lived and died. During the brief ceremony, short quotes were read from the works of professor Charvát by the famous Czech actor Radovan Lukavský and a speech was delivered by professor Vratislav Schreiber, the most notable of professor Charvat's students. On June 29, 2004, professor Schreiber himself, still full of vigour celebrated his 80th birthday. That day, too, is a significant anniversary in the history of Czech endocrinology.

[Clinical significance of the quantification of obesity. The Quetelet index and its use]. / Klinický význam kvantifikace otylosti. Queteletuv index a jeho pouzívání.

The degree of obesity, ie. the quantity of excessive stored adipose tissue, affects substantially morbidity and mortality on cardiovascular, metabolic, and other diseases. While the quantity of an adipose tissue is practically impossible to determine, it is necessary to use the body weight, adjusted for the stature. The Quetelet's index (body mass index, BMI) is the best one from height-weight indices. Values of BMI define categories of normal weight, overweight, and obesity, which have different importance of their health implications and therapeutical approaches.

[Energy metabolism in obesity]. / Energetický metabolismus u obezity.

The regulation of energy metabolism in obesity may differ from normal condition in several respects. The synthesis of lipids may be enhanced due to a greater production of insulin, estrogens and cortisol and to a lack of dehydroepiandrosterone. Lipolysis is reduced in obese subjects by a decreased secretion of catecholamines, growth hormone, adipsin and cachectin. Inadequate intake of food and stress modify the T3/rT3 ratio. Oxidative phosphorylation and the production of ATP is modified, thermogenesis decreases due to a reduced synthesis of thermogenin. A decreased activity of substrate cycles and of the Na-K ATPase, is expected. Most of these disorders are normalized in post-obese patients. Many common drugs interfere with energy metabolism, namely those used in psychiatry and all hormones and their antagonists mentioned above and used for a long time. Obesity should not be considered as a simple result of overeating and lack of physical activity.

[Texture analysis of ultrasonograms--a new method in the diagnosis of thyroid diseases?]. / Analýza textury ultrasonogramu--nová kvalita v diagnostice tyreopatií?

Ultrasonography is a generally accepted method for diagnosing both the diffuse and focal (nodal) lesions of the thyroid gland. The main limit of this method is the restricted ability of the human eye to analyse all information included. Moreover, the proportion of subjectivity when evaluating the picture is greater than with other imaging methods. Computer texture analysis in combination with automatic classification may prove a potent tool that could enable--immediately after the standard examination--to assign the finding to a particular type of diffuse disorder, with an accuracy of up to 100 percent. From a variety of procedures, which we have tested until now, the best results were obtained with a combination of spatial, co-occurrence and systematically constructed features, selected by a method that is based on the magnitude of classification error. From several tested ways of classification the Bayes's classificator in combination with the criterion of majority was found to be the best approach.

[The effect of a low-energy protein diet in short-term ambulatory treatment of obese women]. / Ucinnost nízkoenergetické bílkovinné diety v krátkodobém ambulantním podáváni u obézních zen.

Fourteen obese women (BMI 37.2 +/- 7.3) were treated with a very low energy diet containing 1555 kJ (370 kcal) for 14 days. Weight loss occurred in all cases (4.2-10.7 kg, mean 6.46 +/- 1.68 kg), although usual weight-reducing regimens have not succeeded before. There were no complications and results of usual biochemical tests did not change. Body mass index and concentrations of serum total cholesterol decreased significantly, insulin levels fell in the first and fourth hour of a glucose tolerance test. Also serum triiodothyronine concentrations declined significantly but not below the lower limit of normal results. We concluded that short-term very low energy diet treatment enable a safe decline of excessive body mass in out-patients, including those resistant to usual reducing diets.

[Changes in IGF-I levels and its binding proteins in diabetes mellitus and obesity]. / Zmeny koncentrací IGF-I a jeho vazebných proteinu u diabetes mellitus a obezity.

BACKGROUND: The system of IGF-I and its binding proteins is a complex system with many physiological functions including metabolic regulations. Present study was aimed to describe changes of its particular components in patients with type 1 and type 2 diabetic patients and patients with obesity. METHODS AND RESULTS: We examined 21 patients with obesity, 13 patients with type 2 and 22 with type 1 diabetes in comparison with 16 age matched healthy controls. We performed clinical examination and estimation of serum concentrations of IGF-I, free-IGF-I, IGFBP-1, -2, -3 and -6, insulin, C-peptide and fasting glucose. Patients with obesity featured by decreased IGF-I (p < 0.05), free-IGF-I (p < 0.05), IGFBP-1 (p < 0.01) and IGFBP-3 (p < 0.05) serum levels. Type 2 diabetes were associated with a decline of IGF-I (p < 0.05) and IGFBP-2 (p < 0.05) serum levels. Type 1 diabetes was characterised by typical decrease in IGF-I (p < 0.05), free-IGF-I (p < 0.01) and IGFBP-3 (p < 0.01) serum levels as well as by increase in IGFBP-1 (p < 0.01) serum levels. Type 2 diabetic patients had lover IGFBP-2 and higher IGFBP-1 and IGFBP-6 levels than obese subjects. CONCLUSIONS: The study showed a changes in the system of IGF-1 and its binding proteins associated with studied metabolic diseases that confirm active participations of this system in carbohydrate metabolism regulation.

[Changes in serum levels of IGF-I and its binding proteins and their relation to microcirculation in obese patients]. / Zmeny sérových hladin IGF-I a jeho vazebných proteinu u obézních pacientu a jejich vztah k funkci mikrocirkulace.

The IGF-I system and its binding proteins participate in the pathogenesis of vascular affections under various pathological conditions. The mechanism and mode of its action were however not elucidated in details so far and views on its role are controversial. The objective of the study was to assess the relationship of this system and the blood flow in the microcirculation in obese patients. The authors examined 21 obese patients (BMI 39.7 +/- 7.3 kg/m2) and a group of healthy volunteers. They examined: serum concentrations of total IGF-I, free IGF-I, IGFBP-1,-2,-3, and -6, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides as well as the intimomedial thickness of the common carotid arteries and parameters of blood flow in the microcirculation, evaluated by a laser-Doppler examination. In obese patients there were significantly lower serum concentrations of IGF-I and free-IGF I (p < 0.05) as compared with the control group. Comparison of the function of the microcirculation revealed in obese patients, as compared with the control group, a lower percentage increase of perfusion after occlusion (PORH%, p < 0.05) and after heating (TH%, p < 0.05) and a slower onset of thermal hyperaemia (THmax/t, p < 0.05). In the control group serum concentrations of free-IGF-I correlated inversely with the maximum perfusion after heat induced hyperaemia (THmax (r = -0.54, p < 0.02) and the rate of onset of hyperaemia after heating (THmax/t) (r = 0.51, p < 0.02). In the group of obese patients serum concentrations of free-IGF-I correlated inversely with the maximum perfusion after heat induced hyperaemia (THmax) (r = -0.55, p < 0.02), and IGFBP-3 concentrations correlated inversely with maximum hyperaemia after occlusion (PORGmax) (r = -0.57, p < 0.01). The results suggest that the function of the microcirculation in obese subjects is affected. The activity of the IGF-I system and its binding proteins is related to the affected function of the microcirculation and a negative part is played particularly by serum concentrations of free IGF-I. The negative effect of IGFBP-3 on the function of the microcirculation is surprising.