[S-100B protein elevation in patients with the acute coronary syndrome after resuscitation is a predictor of adverse neurological prognosis]. / Elevace proteinu S-100B u pacientu s akutním koronárním syndromem po resuscitaci je prediktorem nepríznivé neurologické prognózy.

INTRODUCTION: The annual incidence of out-of-hospital cardiac arrest is around 90-190 cases per 100 000 inhabitants. The limiting factor for further prognosis of patients after out-of-hospital arrest is their neurological status. The S100B protein is mainly the nervous system cells product, its glial-specific and mostly expressed by astrocytes. It has been shown that after circulatory arrest its increased level correlates with the prognosis of patients. Work aims to determine the level of protein S100B in the group of patients with acute myocardial infarction without circulatory arrest, and compare it to the value in patients with acute myocardial infarction after out-of-hospital resuscitation. METHODS: 24 patients were evaluated after out-of-hospital resuscitation for the malignant arrhythmias during acute coronary syndrome (ACS). All patients were treated with mild therapeutic hypothermia. The control group consisted of 19 patients with ACS. The sample for the determination of S-100B was taken immediately on admission. Neurological status was evaluated according to the CPC scores (Cerebral Performance Categories) at discharge, patients were divided into 3 groups: CPC1 - good condition, CPC2 - moderate neurological disability, CPC3-5 - serious neurological impairment, coma or death. RESULTS: The values of protein S-100B fluctuated, in patients with no resuscitation, in range between 0.038 to 0.204 pg/ml. In patients after resuscitation without subsequent neurological disability (CPC 1) was range 0.077 to 0.817 pg/ml, in patients with moderate to severe neurological disability (CPC 2) was range 0.132-2.59 pg/ml, patients with severe neurological disabilities or deaths had S-100B levels from 0.70 to 8.53 pg/ml. According to ROC analysis we found the cut-off value for the S-100B. Cut-off value for probably a good neurological condition is < 0.23 pg/ml (specificity 93%, sensitivity 70%), and value testify for supposed severe neurological disability or death is > 1.64 pg/ml (specificity 95%, sensitivity 83%). CONCLUSION: Protein S-100B is one of the early and sensitive markers of severe brain damage in patients after cardiac arrest. Its early determination can help in prediction of patient neurological condition and help doctors to decide further action.

[Risk stratification in patients with Brugada syndrome]. / Stratifikace rizika u pacientu s Brugada syndromem.

Brugada syndrome (BrS), one of the most frequently diagnosed inherited arrhythmogenic syndromes, is responsible for more than 4% of all sudden deaths and at least 20% of sudden deaths in patients with structurally normal hearts. The sudden death is often the first symptom of BrS and appears most often already during the fourth decade of life of BrS patients. Implantation of cardioverter--defibrillator was proved to be the only effective treatment, i.e. prevention of the sudden death, in BrS. Thus, it is uniquely determined to be used in case of symptomatic BrS patients. On the contrary, the individual risk of life-threatening arrhythmias has to be thoroughly considered in case of asymptomatic BrS patients due to substantial side effects of implantation of cardioverter-defibrillator. This review first provides a summary of factors recommended for the risk stratification in BrS patients in 2005 including their support or rejection in the following studies. Subsequently, we focused on the most important risk factors newly suggested after 2005.

Logit and fuzzy models in data analysis: estimation of risk in cardiac patients.

The aim of this study was a comparison of risk stratification for death in patients after myocardial infarction (MI) and of risk stratification for malignant arrhythmias in patients with implantable cardioverter-defibrillator (ICD). The individual risk factors and more complex approaches were used, which take into account that a borderline between a risky and non-risky value of each predictor is not clear-cut (fuzzification of a critical value) and that individual risk factors have different weight (area under receiver operating curve - AUC or Sommers' D - Dxy). The risk factors were baroreflex sensitivity, ejection fraction and the number of ventricular premature complexes/hour on Holter monitoring. Those factors were evaluated separately and they were involved into logit model and fuzzy models (Fuzzy, Fuzzy-AUC, and Fuzzy-Dxy). Two groups of patients were examined: a) 308 patients 7-21 days after MI (23 patients died within period of 24 month); b) 53 patients with left ventricular dysfunction examined before implantation of ICD (7 patients with malignant arrhythmia and electric discharge within 11 month after implantation). Our results obtained in MI patients demonstrated that the application of logit and fuzzy models was superior over the risk stratification based on algorithm where the decision making is dependent on one parameter. In patients with implanted defibrillator only logit method yielded statistically significant result, but its reliability was doubtful because all other tests were statistically insignificant. We recommend evaluating the data not only by tests based on logit model but also by tests based on fuzzy models.

[The progress of autonomic parameters in patients after myocardial infarction with ST elevation]. / Vývoj autonomních parametru u pacientu po infarktu myokardu s ST elevacemi.

The patients after myocardial infarction with ST elevation (STEMI) are endangered by the development inception of autonomic dysfunction, decreased baroreflex sensitivity, decreased heart rate variability, and increased blood pressure variability as a result of increased sympathetic activity and/or decreased parasympathetic activity. Thanks to direct angioplasty and optimal pharmacotherapy of coronary artery disease and heart failure, we didn't found any significant changes of these parameters within a one-year follow-up, and mortality due to cardiac etiology was very low in this group. Autonomic dysfunction and negative left ventricular remodeling is related only to a small group of patients after STEMI, whose risk stratification will be difficult.

[Analysis and comparison of cohorts of patients with implantable cardioverter-defibrillator in primary and secondary prevention]. / Analýza a srovnání souboru nositelu implantabilního kardioverteru-defibrilátoru v primární a sekundární prevenci.

OBJECTIVE: The aim of this study was an analysis of patients with ICD implanted in primary prevention (PP) in long-term follow-up and comparison with data obtained in secondary prevention patients (SP). PATIENTS AND METHODS: We assessed 73 patients with PP ICD and 138 patients with SP ICD. Males were in majority with 88% in PP group and 78% in SP group. The average age was 63 years. Majority of patients suffered from coronary artery disease. The mean ejection fraction (LV EF) was 28% in PP patients and 38% in SP patients. The number of affected coronary arteries and medication were similar in both groups. We compared the occurrence of intercurrent diseases, malignant arrhythmias, inappropriate therapies, hospital readmissions and patients' survival. RESULTS: PP patients had lower LV EF ejection fraction (p < 0.001), higher number of revascularized arteries (p < 0.001) and lower occurrence of inappropriate therapies and arrhythmic storms (p < 0.001). There was higher number of patients with diabetes (p = 0.009), dyslipidemia (p < 0.001) and cerebral artery disease (p = 0.017) among those in PP group. Renal insufficiency was related to a higher risk of death. CONCLUSIONS: Patients with PP ICD implantation have lower LVEF, and more intercurrent diseases then patients with ICD implanted form SP reasons. Their myocardium is more often revascularized and the occurrence of inappropriate therapy is low. Arrhythmic storm is a typical feature of patients with ICD implanted in secondary prevention.

[Acute embolization into the veins in the splanchnic bed--an overview of current methods of diagnosis and therapies]. / Akutní embolizace do tepen splanchnického reciste--prehled soucasných diagnostických prístupu a terapie.

Acute mesentery artery embolization is a rare diagnosis. In case of late recognition the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Unfortunately, the symptoms do not often correlate with clinical findings. Plain X-ray of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the occluded artery. Papaverin vasodilatation and intravenous anticoagulation are also justifiable, catheter aspiration and stent implantation have also been challenged. Our review is to provide a detailed up-to-date information about the issue and is an extensive follow-up of our recently published case report [Superior mesentery artery embolization as a complication of the primary angioplasty solved by local thrombolysis. Vnitr Lék 2008; 54(9): 871-875].

[Hypertension in HIV positive patients]. / Hypertenze u HIV pozitivních pacientu.

Survival of HIV-positive patients on highly active antiretroviral therapy (HAART) has significantly improved. Although traditional heart complications of the infection such as pericarditis or myocarditis has become rather rare owing to the therapy, wide range of metabolic abnormalities have been described. We focused on the evaluation of prevalence of hypertension among HIV positive patients with respect to their high cardiovascular risk. We examined 40 HIV positive patients (28 males and 12 females) followed in AIDS center in Brno. All probands underwent 24-hour ambulatory blood pressure monitoring as a part of their cardiological examination. 40 age- and gender-matched healthy controls were recruited. We evaluated the average value of systolic (SBP) and diastolic (DBP) blood pressure as well as the average value of heart rate (HR) within 24 hours of monitoring. Following values were found in the group of healthy controls: SBP 124.1 +/- 8.6 mm Hg, DBP 71.6 +/- 6.9 mm Hg and HR 67.9 +/- 9.7/min. HIV positive patients presented with the following values: SBP 118.5 +/- 9.3 mm Hg, DBP 76.8 +/- 5.7 mm Hg a HR 78.6 +/- 9.7/min. All the differences were statistically significant at p < 0.05. We diagnosed 14 patients with hypertension defined as SBP higher than 125 mm Hg and/or DBP higher than 80 mm Hg in both of the groups. Prevalence of hypertension in HIV positive patients was comparable to that seen in healthy controls. HIV positive patients had lower SBP but higher DBP and HR.

[SIADH as only paraneoplastic cause of the small cell lung cancer]. / SIADH jako jediný paraneoplastický príznak malobunecného karcinomu plic: kazuistika.

62 years old patient was admitted to the hospital with weakness of lower extremities. Using laboratory examination, we found very severe hyponatrenaemia, hypochloraemia and hypotonia of blood plasma, because of SIADH. We searched for the cause of that syndrome and finally we found that the cause of that syndrome was small cell lung cancer with an expansion into the mediastinum and metastases into the skelet.

Baroreflex sensitivity in children, adolescents, and young adults with essential and white-coat hypertension.

UNLABELLED: Hypertension, which is a common cardiovascular disease in adults, could originate in childhood. The aim of the study was to show differences in baroreflex sensitivity and short-term blood-pressure variability between healthy and hypertensive children, adolescents and young adults, and those with white-coat effect with respect to obesity. We examined 54 subjects (11-21 years) who had repeatedly high causal blood pressure. Basing on 24-hour blood pressure monitoring, the subjects were divided into groups: 24 subjects with hypertension (Hy) and 30 subjects with white-coat effect (WhC). Hy and WhC subjects were compared with age-matched healthy controls in a ratio of 1 : 2 for both groups: 48 controls for hypertensive subjects (CoHy) and 60 for subjects with white-coat effect (CoWhC). Totally, 162 subjects were studied. Systolic blood pressure (SBP) and inter-beat intervals (IBI) were recorded in all subjects for 5 min (Finapres, metronome controlled breathing at a frequency of 0.33 Hz). The power spectra of SBP and IBI were calculated. Indices of baroreflex sensitivity (BRS [ms/mmHg] and BRSf [mHz/mmHg]) were determined by the cross-spectral method. The SBP variability was determined as SBP spectral power in the range of 10-second rhythm (SBP (0.1Hz)). The body mass index (BMI) was significantly higher in both Hy and WhC compared with their controls (Hy vs. CoHy; WhC vs. CoWhC: 24.6 +/- 6.0 kg/m (2) vs. 20.4 +/- 2.8 kg/m (2), p < 0.001; 23.2 +/- 5.9 kg/m (2) vs. 20.3 +/- 2.6 kg/m (2), p < 0.05). BRS was significantly decreased in both groups (Hy vs. CoHy; WhC vs. CoWhC: 6.0 +/- 2.7 ms/mmHg vs. 9.5 +/- 3.9 ms/mmHg, p < 0.001; 7.2 +/- 3.1 ms/mmHg vs. 10.9 +/- 6.2 ms/mmHg, p < 0.01), and BRSf as well (Hy vs. CoHy; WhC vs. CoWhC: 10.8 +/- 4.6 mHz/mmHg vs. 16.2 +/- 6.1 mHz/mmHg, p < 0.001; 13.0 +/- 4.9 mHz/mmHg vs. 18.3 +/- 8.7 mHz/mmHg, p < 0.01). The decrease of baroreflex sensitivity was linked with the increase in the variability of SBP (0.1Hz), which was significant in hypertensives only (Hy vs. CoHy; WhC vs. CoWhC: 142 +/- 96 mmHg (2)/Hz vs. 94 +/- 83 mmHg (2)/Hz, p < 0.01; 121 +/- 131 mmHg (2)/Hz vs. 107 +/- 98 mmHg (2)/Hz). CONCLUSION: The mild increase of BMI was associated with white-coat effect and a BRS and BRSf decrease. The greater increase of BMI was associated with hypertension and a deeper BRS and BRSf decrease. This greater decrease of BRS and BRSf in hypertensives was linked with the increased SBP-variability.

[Comparison of the prevalence of non-invasive risk markers of the sudden cardiac death in patients treated by thrombolysis and by percutaneous transluminal coronary angioplasty]. / Srovnání výskytu neinvazivních rizikových znaku náhlé srdecní smrti u nemocných lécených trombolýzou a prímou angioplastikou infarktové tepny.

BACKGROUND: Myocardial infarction survivors may develop a higher risk of sudden cardiac death. The risk markers: left ventricular ejection fraction, ventricular premature beats, late potentials on averaged ECG, baroreflex sensitivity and heart rate variability are used as non-invasive stratification markers. METHODS AND RESULTS: Occurrence of the autonomic and morphologic dysfunction risk markers in the myocardial infarction patients treated by thrombolysis and by primary percutaneous transluminal coronary angioplasty (PTCA) is compared. We studied a cohort of 48 acute myocardial infarction survivors treated by primary PTCA and 96 patients treated by thrombolysis. CONCLUSIONS: Patients treated by primary PTCA had significantly lower occurrence of premature ventricular beats and pathological parameters of the heart rate variability.

Radiative and nonradiative transitions in subchloroplast particles highly enriched in P-700.

Radiative and nonradiative processes were investigated in subchloroplast particles highly enriched in P-700 (1 P-700 to 10 chlorophyll molecules) according to the method of classical fluorescence and of photoacoustical spectroscopy. The envelope of fluorescence spectrum divided into three Gaussian bands and their quantum yields of fluorescence were calculated. Indpendently the quantum yield of fluorescence was determined from the spectral course of the photoacoustical signal. Finally, the estimate of the photochemical activity of P-700, based upon the measured fluorescence quantum yield and upon the measured nonradiative losses of excitation energy, was done.