Cholesterol level correlate with disability score in patients with relapsing-remitting form of multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is an autoimmune disease characterised by demyelination. There are many environmental factors that can affect the progression of this disease. It is necessary to better understand the impact of these factors in MS pathogenesis and progression. OBJECTIVE: Present study investigates the relationship of total cholesterol serum levels and other parameters contributing to cardiovascular risk - homocysteine and serum lipid parameters (triglycerides, HDL, LDL) - with the progression of MS (EDSS score). METHODS: The study involved 169 patients diagnosed with MS. Total homocysteine levels were measured by high-performance liquid chromatography. Serum lipid parameters were measured with enzymatic kits. RESULTS: There was no difference observed between homocysteine levels in MS patients and controls. Dyslipidaemia seems to be associated with MS progression, particularly in women with relapsing-remitting form of MS. CONCLUSION: Positive correlation of total and LDL cholesterol with disability score in patients with relapsing-remitting form of MS suggests that lipid parameters could have a negative effect on the disease progression.

Influence of some mineral ions on lipid peroxidation in vitro.

Recently, a growing interest has been recorded in mineral content of mammalian diet, which might impair their development. Focused on the topic, we studied the effect of Al3+, Si4+, Sr2+ and Na2S on the intensity of malondialdehyde (MDA) production in vitro. MDA, as one of oxidative stress markers, was determined in rat brain homogenates in the conditions of lipid peroxidation (LP) activated by iron ions and ascorbate. Our results showed a significant increase in lipid peroxidation after addition of aluminium ions. We assume a probable impact of Al3+ on active or regulatory centres of antioxidant enzymes, resulting in the reduction of their antioxidant functions. The addition to Si4+ or Na2S to samples with Al3+ significantly decreased Fe2+-activated LP. We can explain the influence of Na2S by the formation of insoluble complexes with iron. Similarly, the effect of Si4+ can be related to the production of aluminium-silicon complexes. In our view, an optimal ratio of aluminium and silicon ions (or aluminium ions and Na2S) in the diet might have beneficial effects on brain functions.

Effect of mineral water from Trencianske Teplice (drinkable source, drill SB-3) on lipid peroxidation in vitro.

Influence of mineral water from Trencianske Teplice (drinkable source) on lipid peroxidation processes was determined in model situations under in vitro conditions using the brain tissue. The central nervous system was selected because it is especially sensitive to the radical-induced damage. In addition, there is a high content of polyunsaturated fatty acids in the brain which has a low antioxidant capacity and is relatively rich in iron ions--enhancers of lipid peroxidation processes. We present the inhibitory effect of the mineral water on the intensity of lipid peroxidation in the presence of iron ions. We assume that some component or combination of more components of the mineral water may act as chelators of iron ions.

[Natriuretic peptides in patients with aortic stenosis]. / Nátriuretické peptidy pri aortovej stenóze.

INTRODUCTION: The aim of this research was to, in patients with severe (tight) aortic stenosis (AoS), evaluate a) an association between clinical and some haemodynamic characteristics and natriuretic peptides (ANP, BNP) concentrations and b) usefulness of these hormones in the decision making on the next therapeutic steps. METHODS: Echocardiography and 6-minut exertion walking test were performed in 23 consecutive patients (12 men, 11 women; age 67 +/- 7 years) and 20 controls together with ANP and BNP measurements from three plasma samples before, immediately after and 20 minutes after the exertion test. RESULTS: There was high inter-individual variability in the ANP and BNP concentrations in patients with AoS. All ANP and BNP were significantly higher than in the controls (ANP 1, 2, 3, p < 0.001; BNP 1, 2, 3, p < 0.001). Only the ANP levels increased significantly after the exercise (ANP 1 vs. ANP 2 = 0.011; ANP 2 vs. ANP 3 p = 0.037). We identified significant correlations between aortic peak gradient and BNP 1, 2 (r = 0.821, p < 0.001) and ANP 1, with BNP correlations being stronger. We did not find any correlations with aortic valve area and the left ventricle mass. The hormone levels were non-significantly increased depending on NYHA classification. Exercise did not improve validity ofANP and BNP measurement. Their values had high sensitivity but low specificity in detecting critical AoS. CONCLUSION: ANP and mainly BNP helped to exclude severe AoS but they were not useful in detecting lower, orderline gradients. We did not prove ANP and BNP to be significant factors in decision making about the timing of AoS surgery.

[Characteristics and the prognosis of patients with acute heart failure in current clinical practice]. / Charakteristiky a osud pacientov s akútnym srdcovým zlyhávaním v aktuálnej klinickej praxi.

PURPOSE: Analysis of predefined characteristics and outcomes in a non-selected population of patients hospitalized for acute heart failure (AHF) in Slovakia. METHODS: We conducted a nationwide prospective multicenter survey with 860 consecutive patients enrolled in 11 hospitals throughout Slovakia--two centres with a non-stop catheterization service, two central and 7 regional hospitals. Relevant data of 78 characteristics in 9 categories were collected during 3 months (between 1 May 2009 and 31 July 2009). There was a specific form designed for this survey. Collected data were then transferred into the electronic database and statistically analysed. RESULTS: Mean age was 72 years, 81% of patients were in NYHA class III/IV (52% male). The majority of patients were admitted with decompensated heart failure (68.4%), frequency of cardiogenic shock was 0.3%. New-onset AHF (AHF de novo) was diagnosed in 31.1%, of which 20.8% was due to acute coronary syndromes. Coronary heart disease was the predominant primary aetiology of AHF (67%), followed by almost equally represented hypertension (10.5%), valvular disease (10%) and dilated cardiomyopathy (9%). Hypertension was referred as the most frequent comorbidity (82%), followed by atrial fibrillation (48%), diabetes mellitus (42%), history of renal failure (31%) and with anaemia at admission (38%). Rales were the dominant physical sign (69.9%). Systolic blood pressure greater than 140 mm Hg was present in 37.8% and QRS length > 120 ms in 21.4% of patients. Preserved left ventricular ejection fraction (> or = 40%) was observed in 57% out of 70% documented cases in the whole survey. 23.3% of patients had a history of coronary angiography. 84.3% of patients received intravenous treatment, diuretics, nitrates and inotropes were given to 82.2%, 18% and 6%, respectively. The number of patients with cardiac resynchronization therapy (CRT), with or without defibrillator function, was 0.9%. Mean length of stay was 9.2 days and in-hospital mortality was 9.1%. At discharge, 76% of patients were on angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), 62% were using beta-blockers (BB), however the doses of drugs were lower then recommended values. CONCLUSIONS: Results of the survey are comparable with other observational studies, surveys and large registries. Although the percentage of patients with ACE-I/ARB and BB at discharge seems promising, there is still area for improvement in AHF patients health care.

K(+)-p-nitrophenylphosphatase activity in rat brain and liver.

K(+)-p-nitrophenylphosphatase (K(+)pNPPase) is the enzyme, which is considered to be involved in K(+)-dependent hydrolysis of the phosphoenzyme in the reaction cycle of Na(+), K(+)ATPase. The aim of our present study was to characterize some features of K(+)pNPPase in homogenates of the rat brain and liver. We determined p-nitrophenylphosphatase (pNPPase) activity in the presence of various ion combinations (Mg(2+)+ K(+), Mg(2+), K(+)). We found a higher total pNPPase activity in the brain (0.8+/-0.079 nkat/mg protein) than in the liver (0.08+/-0.01 nkat/mg protein). Contrary to the liver, the main part of the total brain activity was K(+)-dependent. The activity of K(+)pNPPase was significantly higher in cerebral cortex homogenates (0.86+/-0.073 nkat/mg protein) in comparison to those of the whole brain (0.57+/-0.075 nkat/mg protein). The specific K(+)pNPPase activity was two times higher in the isolated pellet fraction (0.911+/-0.07 nkat/mg protein), rich in synaptosomes, compared to the whole brain homogenate (0.57+/-0.075 nkat/mg protein). Our results demonstrate the high activity of K(+)pNPPase in the brain tissue and its distribution mainly into the pellet fraction, what might indicate a possible role of K(+)pNPPase in specific structures of the brain, e.g. in synaptosomes.

Multi-vessel stenting during primary percutaneous coronary intervention for acute myocardial infarction. A single-center experience.

BACKGROUND: Recanalization of the culprit lesion is the main goal of primary angioplasty for acute ST-segment elevation myocardial infarction (STEMI). Patients presenting with acute myocardial infarction and multivessel disease are, therefore, usually subjected to staged procedures, with the primary percutaneous coronary intervention (PCI) confined to recanalization of the infarct-related artery (IRA). Theoretically at least, early relief of stenoses of non-infarct-related arteries could promote collateral circulation, which could help to limit the infarct size. However, the safety and feasibility of such an approach has not been adequately established. METHODS: In this single-center prospective study we examined 73 consecutive patients who had an acute STEMI and at least one or more lesions > or = 70% in a major epicardial vessel other than the infarct-related artery. In the first 28 patients, forming the multi-vessel (MV) PCI group, all lesions were treated during the primary procedure. In the following 45 patients, forming the culprit-only (CO) PCI group, only the culprit lesion was treated during the initial procedure, followed by either planned-staged or ischemia-driven revascularization of the non-culprit lesions. Fluoroscopy time and contrast dye amount were compared between both groups, and patients were followed up for one year for major adverse cardiac events (MACE) and other significant clinical events. RESULTS: The two groups were well balanced in terms of clinical characteristics, number of diseased vessels and angiographic characteristics of the culprit lesion. In the MV-PCI group, 2.51 lesions per patient were treated using 2.96 +/- 1.34 stents (1.00 lesions and 1.76 +/- 1.17 stents in the CO-PCI group, both p < 0.001). The fluoroscopy time increased from 10.3 (7.2-16.9) min in the CO-PCI group to 12.5 (8.5-19.3) min in the MV-PCI group (p = 0.22), and the amount of contrast used from 200 (180-250) ml to 250 (200-300) ml, respectively (p = 0.16). Peak CK and CK-MB were significantly lower in patients of the MV-PCI group (843 +/- 845 and 135 +/- 125 vs 1652 +/- 1550 and 207 +/- 155 U/l, p < 0.001 and 0.01, respectively). Similar rates of major adverse cardiac events at one year were observed in the two groups (24% and 28% in multi-vessel and culprit treatment groups, p = 0.73). The incidence of new revascularization in both infarct- and non-infarct-related arteries was also similar (24% and 28%, respectively, p = 0.73). CONCLUSION: We may state from this limited experience that a multi-vessel stenting approach for patients with acute STEMI and multi-vessel disease is feasible and probably safe during routine clinical practice. Our data suggest that this approach may help to limit the infarct size. However, larger studies, perhaps using drug-eluting stents, are still needed to further evaluate the safety and efficiency of this procedure, and whether it is associated with a lower need of subsequent revascularization and lower costs.

Natriuretic peptides and endothelin-1 in patients undergoing coronary artery bypass grafting.

Off-pump coronary artery bypass grafting (CABG) is an alternative to conventional CABG using cardiopulmonary bypass. Off-pump technique reduces the complications of CABG performed with extracorporeal circulatory assistance (Lancey et al. 2000; Mack et al. 2004a,b). The object of this study was to compare peri- and postoperative time courses of vasoactive peptides - atrial natriuretic poptide (ANP), brain natriuretic poptide (BNP) and endothelin-1 (ET-1) in off-pump versus on-pump CABG. 22 patients, who underwent on-pump (group A, n = 11) or off-pump CABG (group B, n = 11) were studied. The peri- and postoperative time courses of plasma ANP and BNP were similar in both groups. A statistically significant difference between ET-1 plasma level 2 h after surgery in the group A and ET-1 plasma level 2 h after surgery in the group B (2.46 + or - 1.14 pg/ml/Ht versus 0.74 + or - 0.09 pg/ml/Ht, p < 0.0001) was found. Different CABG techniques were not associated with significant changes in peri- and postoperative plasma ANP and BNP. By contrast, plasma ET-1 significantly rose in the group A 2 h after surgery, indicating endothelial damage.

Trends in risk factors and etiology of 606 cases of infective endocarditis over 23 years (1984-2006) in slovakia.

The aim of this study was to assess trends in risk factors, etiology, outcome and treatment strategies for endocarditis over 23 years in Slovakia. A prospective survey of 606 cases of infective endocarditis (IE) was conducted from 1984-2006. Rheumatic fever as well as previous dental surgery showed decreasing trends within the last 23 years. Also embolic complications of IE declined along with increasing rates of surgically treated patients. No significant changes in etiology were detected apart from the fact that culture-negative endocarditis increased from 10.7% to 55.4% between 1998-2001. Surgically treated patients increased from 22.7% (1984-1990) to 50.1% (2002-2006) and mortality dramatically decreased from 26.7% (1984-1990) to 5.3% (2002-2006). Staphylococcus aureus and coagulase-negative staphylococci were the leading causes (22.4% - 48%) followed by viridans streptococci (12.2%-18.2%) were a relatively stable trend over 23 years of IE in Slovakia.

[Surgical treatment of abdominal aortic aneurysms in severe ischemic coronary disease]. / Operacná liecba aneuryziem abdominálnej aorty pri závaznej ischemickej chorobe srdca.

BACKGROUND: The abdominal aortic aneurysm (AAA) is one of the most serious problems of vascular surgery and general medicine, as well. Endovascular methods of treatment have been developing very rapidly, however, the conventional treatment of the AAA still predominates. The results of operative treatment have been influenced besides the delayed diagnostics of the AAA resulting in a high rate of ruptured AAA by the high comorbidity of the AAA patients population. The accentuation of the proper preoperative and perioperative management of patients could therefore significantly influence the results of the surgery. MAIN PURPOSE AND STARTING POINTS: Striking difference between the mortality of elective and emergent surgery of AAA has been unchanged despite the intensive effort of many centers. One of the main factors of mortality is the concomitant serious coronary heart disease (CHD), predominantly the acute myocardial infarction (MI). The paper analyses the possibilities to improve the results of AAA surgery by means of the patients selection and effective preparation before the elective surgery. The risk factors and concomitant diseases of patients suffering from the AAA, the elective and emergent surgery ratio and the operative mortality are referred. The results of surgical treatment before and after accepting the modern CHD management algorithm are compared. METHODS: The present study is a retrospective analysis of the data of 343 consecutive patients with AAA operated on during the 20-years period from 1 January 1979 to 31 December 1998. The 1st group of 249 patients operated on during the 18-years period from 1. January 1979 to 31 December 1996 was not subjected to special attention concerning the CHD and was compared with the 2nd group of 93 patients operated on from 1 January 1997 to 31 December 1998. In this group of patients special attention was focused on the improvement of surgical techniques, intensive care and comprehensive diagnostics, evaluation and proper management of the concomitant CHD. RESULTS: The mortality rate of the elective surgery in the 1st group was 5.5%, in the 2nd group decreased to 3.6%, the difference was not statistically significant. Evident improvement of the results was apparent in emergency operations for ruptured AAA. The mortality rate in the 1st group of 76% dropped to 40% in the 2nd group (p < 0.05). The improved policy in the management has lead to statistically significant decrease of the MI incidence in the perioperative period (87.2% to 28.5%, p < 0.001). CONCLUSION: The improved diagnostics, selection of patients with special concern to the CHD and management of the patients before surgery, improved surgical techniques and intensive care lead to evident improvement of the results in the surgical management of the AAA. This fact is confirmed by improved results of the 2nd group of patients because of improved CHD management algorithm. (Tab. 5, Fig. 1, Ref. 35.)

The effect of the new oral hypoglycemic agent A-4166 on glucose turnover in the high fat diet-induced and/or in the hereditary insulin resistance of rats.

A-4166, a phenylalanine derivative, is a hypoglycemic agent, which has been shown to improve blood glucose levels mainly due to the rapid and short term stimulation of insulin release. Nevertheless, a possible extrapancreatic action of A-4166 has not yet been investigated. Therefore, insulin action (euglycemic hyperinsulinemic 6.4 mU.kg-1.min-1 clamp plus 3H-2-deoxyglucose tracer administration) was studied after 3 weeks on either standard (BD) or high fat (HF) diet in normal control (C) or in hereditary insulin resistant (hHTg) rats which were given a single dose of A-4166 (10 mg per kg BW, i.v.) 60 min after clamp commencement. HF feeding reduced the glucose infusion rate (GIR) required to maintain euglycemia to about 50% of C (p < 0.001). In hHTg rats, HF did not further pronounce the pre-existing decrease of GIR of hHTg animals fed BD. A-4166 changed GIR neither in C, nor in the hHTg group. The estimated glucose disposal (Rd) (C-BD: 32.3 +/- 1.9 vs C-HF: 25.5 +/- 1.9 mg.kg-1.min-1, p < 0.001) and glucose metabolic index (Rg') in skeletal muscles (Q. femoris: C-BD: 25.6 +/- 1.5 vs C-HF: 12.3 +/- 1.1 mmol.100 g-1.min-1, p < 0.001) were reduced by HF in control rats but were not restored by a concomitant bolus of A-4166. Nevertheless, in hHTg rats fed the HF diet a single dose of A-4166 brought back their Rd (hHTg-HF: 23.5 +/- 1.3 vs hHTg-HF plus A-4166: 31.0 +/- 3.5 p < 0.03) and Rg' (Soleus muscle: hHTg-HF: 29.2 +/- 3.2 vs hHTg-HF plus A-4166: 41.3 +/- 4.0) to values of the control group on BD. In summary, a) a single bolus administration of A-4166 to the control or to the insulin resistant hHTg rats, fed either the BD or HF diets, did not abolish the reduction of GIR required to maintain euglycemia during hyperinsulinemic clamps; b) nevertheless, A-4166 caused a significant increase of the estimated plasma glucose disposal (Rd) and skeletal muscle glucose metabolic index (Rg') of hHTG rats fed the HF diet; c) we suggest that A-4166 may have an extrapancreatic action but this needs to be proven using a long-term administration plan of A-4166.

HPLC method for measurement of purine nucleotide degradation products in cerebrospinal fluid.

We describe a convenient method for the separation and quantification of xanthine, hypoxanthine, and uric acid in 20 microL of cerebrospinal fluid (CSF) with use of HPLC and ultraviolet detection. The analysis is performed on a Sepharon SGX C18 column and the elution system consists of potassium phosphate buffer, pH 5.1, with 20 mL/L methanol. The lower limit of detection was 4 pmol for hypoxanthine and xanthine and 6 pmol for uric acid. Analytical recoveries of purine metabolites ranged from 98.6% to 102.9%. The intra- and interassay CVs were <3%. The applicability of the method is illustrated with the determination of micromolar concentrations of xanthine, hypoxanthine, and uric acid in CSF samples obtained from 113 patients with various neurological disorders.

Mycoplasma-virus contacts, budding and scars remaining in the membranes of Acholeplasma laidlawii and its virus.

Various stages of virus and mycoplasma budding indicated that both virus and, most probably some mycoplasma progeny developed by budding. Besides this alternative, binary fission was the mode of mycoplasma reproduction. Mycoplasma-virus and mycoplasma-mycoplasma connections by stems were observed. Circular scars, 40-80 nm in diameter, often in groups, were left in the membrane of mycoplasmas by the budding bodies. cytoplasmic structures seen in cross-fraction are presented. a relatively small number of globular virus-like bodies, not identical with MV-Lg-L 172, were observed budding from mycoplasma cells in the non-infected host culture.

Membrane structures of Acholeplasma laidlawii and its virus.

The main types of ultrastructures found in the freeze-fracture faces of Acholeplasma laidlawii S 2 and its virus MV-Lg-L 172 were (1) particles 7-19 nm in diameter, mostly located in the convex cytoplasmic fracture faces. (2) small bulges or aggregates, 13-25 nm in diameter, which occupied only limited areas of both inner and outer fracture faces of some mycoplasmas, (3) numerous tiny grains and/or spikes 2-6 nm in diameter, protruding from a finely structured background, especially in the outer concave mycoplasmal fracture faces, and (4) linear structures, most probably fibrils and thicker filaments, both in the fracture faces and around mycoplasmas and viruses and connected with them. There was a high degree of structural similarity between mycoplasmal and viral membranes: no obvious significant difference was found.

Glycine in the central nervous system in experimental allergic encephalomyelitis.

The content of glycine, a possibly inhibitory neurotransmitter was studied in central nervous system of guinea pigs with experimental allergic encephalomyelitis (EAE). The glycine level was increased in spinal cord, but not in the brain of animals with EAE. The greatest increase in glycine concentration was in lumbosacral cord, and at the time of appearance of clinical signs of diseases. The results are discussed in terms of possible connection between the changes of glycine concentration and clinical signs of EAE.