Pulse wave analysis during supine rest may identify subjects with recurrent vasovagal syncope A B S T R A C T

In the present study, we studied whether analysis of the FAP (finger arterial pressure) waveform during supine rest discriminates subjects with recurrent VVS (vasovagal syncope) from healthy controls. Signal-averaged FAP waveforms (Finapres) were obtained in 32 head-up tilt-test-positive subjects with recurrent VVS (35 + − 13 years) and in 32 sex-and age-matched healthy controls. The DT (time delay) between the systolic and diastolic peaks of the FAP waveform was measured and large artery SI (stiffness index) was calculated as a ratio of body height and DT. VVS patients had significantly shorter DT compared with controls (303 + − 31 compared with 329 + − 18 ms; P < 0.001) and higher SI (5.79 + − 0.70 compared with 5.20 + − 0.36 m/s; P < 0.001). The differences were independent of heart rate and blood pressure. SI > 5.45 m/s identified subjects with syncope with a sensitivity of 72 % and a specificity of 84 %. Age-corrected DT (cDT = DT + age − 350) identified subjects with syncope with a sensitivity of 75 % and a specificity of 84 %. Combined use of cDT < 0 ms and SI > 5.45 m/s increased sensitivity and specificity to 81 % and 96 % respectively. The discriminative power of FAP descriptors improved further when younger subjects were excluded. In subjects aged > 30 years (median age), the combination of cDT and SI identified subjects with syncope with a sensitivity of 93 % and a specificity of 100 %. These results suggest that FAP descriptors during supine rest might be useful in the diagnosis of VVS in middle-aged subjects

Clinical Evaluation of Subcutaneous Lactate Measurement in Patients after Major Cardiac Surgery

Minimally invasive techniques to access subcutaneous adipose tissue for glucose monitoring are successfully applied in type1 diabetic and critically ill patients. During critical illness, the addition of a lactate sensor might enhance prognosis and early intervention. Our objective was to evaluate SAT as a site for lactate measurement in critically ill patients. In 40 patients after major cardiac surgery, arterial blood and SAT microdialysis samples were taken in hourly intervals. Lactate concentrations from SAT were prospectively calibrated to arterial blood. Analysis was based on comparison of absolute lactate concentrations (arterial blood vs. SAT) and on a 6-hour lactate trend analysis, to test whether changes of arterial lactate can be described by SAT lactate. Correlation between lactate readings from arterial blood vs. SAT was highly significant (r2 = 0.71, P < .001). Nevertheless, 42% of SAT lactate readings and 35% of the SAT lactate trends were not comparable to arterial blood. When a 6-hour stabilization period after catheter insertion was introduced, 5.5% of SAT readings and 41.6% of the SAT lactate trends remained incomparable to arterial blood. In conclusion, replacement of arterial blood lactate measurements by readings from SAT is associated with a substantial shortcoming in clinical predictability in patients after major cardiac surgery

Dynamicke testy, matematicke modely a prediktivni vypocty u diabetu a metabolickeho syndromu.

Diabetes and metabolic syndrome are very common diseases leading to atherosclerosis and other severe complication. Quantitative approach in research and clinical decision is necessary. Methods of mathematical modeling, regression analysis, cluster distance analysis and repeated measurement of parameters were used. Using of these methods led to following results: Model of protein glycation was realised with first order glycation kinetics. Model based consultation system for insulin therapy was developed. The model is able to adapt itself to o concrete patient and to improve individually the prediction of blood glucose level. Model can be used for insulin therapy consultation. Empiric risk was calculated for type 2 diabetes based on family history and somatometric data in Czech population. These results were found to correspond with German and English population. Predictive calculations were derived using multiple linear regression. Long term prediction of obesity treatment result can be calculated. Model based calculation of insulin sensitivity was used to identify the relationship between insulin and dehydroepiandrosterone level. 7beta-hydroxyisomere of dehydroepiandrosterone was found to be a component of metabolic syndrome. This result was supported by static and dynamic analysis. Model of ketone forming in obese was proposed. Insulin decrease was found to be most important factor in early betahydroxybutyrate forming. Cluster distance analysis was used to analysis the fixation of components of metabolic syndrome. Patients with metabolic syndrome were classified in two clusters. Relationship of metabolic syndrome components is changing during weight reduction. In 3 Czech districts odds ratio for diabetes in cancer was calculated: in colon cancer, pancreatic cancer, renal cancer, uterus and breast cancer. Odds ration for diabetes was found to be very high in Czech population. Colon cancer seems to have growing diabetes incidence from proximal to distal part of colon. Finally the quantitative approach to diabetes and metabolic syndrome was summarised and a review of computer approaches in diabetes was published.Summary in EnglishAvailable from STL, Prague, CZ / NTK - National Technical LibrarySIGLECZCzech Republi

No difference in hypertension prevalence in smokers, former smokers and non-smokers after adjusting for body mass index and age: a cross-sectional study from the Czech Republic, 2010

Background Several hypotheses suggest a temporary increase in blood pressure following smoking cessation. This may be the result of endocrine changes (e.g. alteration in adrenocorticotropic hormone and cortisol levels in post-cessation period) and/or post-cessation weight gain. Our aim was to identify factors that may be associated with the diagnosis of hypertension after quitting smoking. Methods In 2010, we conducted a cross-sectional survey in a sample of 2065 Czech adults, chosen by quota selection and representative according to age, gender, education, region of residence and the size of settlement, aged 18 to 94 years. We examined the association between age, gender, body mass index, smoking status, and education with the hypertension diagnosis in their personal history. Data were compiled and weighed by age categories. Statistical significance was measured by Pearson Chi-square test at the level of significance 95 %. Results Diagnosis of hypertension was reported in 461 (22 %) subjects, with no difference by gender. Based on univariate analysis, former smokers were more likely than non-smokers to be diagnosed for hypertension (OR 1.450 (1.110-1.900), p = 0.006). However, after adjusting for body mass index and age, the occurrence of hypertension diagnosis did not differ among non-smokers, smokers and former smokers (OR 0.760 for smokers, p = 0.082 and OR 1.020 for former smokers, p = 0.915). Conclusions We did not find any differences in hypertension diagnosis prevalence according to smoking status

Levels of retinol and retinoic acid in pancreatic cancer, type-2 diabetes and chronic pancreatitis

Aims. Retinoids participate in multiple key processes in the human body e.g., vision, cell differentiation and embryonic development. There is growing evidence of the relationship between retinol, its active metabolite- all-trans retinoic acid (ATRA) - and several pancreatic disorders. Although low levels of ATRA in pancreatic ductal adenocarcinoma (PDAC) tissue have been reported, data on serum levels of ATRA in PDAC is still limited. The aim of our work was to determine serum concentrations of retinol and ATRA in patients with PDAC, type-2 diabetes mellitus (T2DM), chronic pancreatitis (CHP) and healthy controls. Methods. High performance liquid chromatography with UV detection (HPLC) was used to measure serum levels of retinol and ATRA in 246 patients with different stages of PDAC, T2DM, CHP and healthy controls. Results. We found a significant decrease in the retinol concentration in PDAC (0.44+/-0.18 mg/L) compared to T2DM (0.65+/-0.19 mg/L, P&lt;0.001), CHP (0.60+/-0.18 mg/L, P&lt; 0.001) and healthy controls (0.61+/-0.15 mg/L, P&lt;0.001), significant decrease of ATRA levels in PDAC (1.14+/-0.49 ug/L) compared to T2DM (1.37+/-0.56 ug/L, P&lt;0.001) and healthy controls(1.43+/-0.55 ug/L, P&lt;0.001). Differences between early stages (I+II) of PDAC and non-carcinoma groups were not significant. We describe correlations between retinol, prealbumin and transferrin, and correlation of ATRA and IGFBP-2. Conclusion. Significant decrease in retinol and ATRA levels in PDAC compared to T2DM, healthy individuals and/or CHP supports existing evidence of the role of retinoids in PDAC. However, neither ATRA nor retinol are suitable for detection of early PDAC. Correlation of ATRA levels and IGFBP-2 provides new information about a possible IGF and retinol relationship