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Antiphospholipid Antibodies and Their Significance in Thomboembolic Diseases
Hirmerová, Jana ; Filipovský, Jan (advisor) ; Roztočil, Karel (referee) ; Malý, Jaroslav (referee)
The diagnostic workup in patients with venous thromboembolism (VTE) consists of imaging methods as well as laboratory assays and concentrates not only on diagnostic and follow-up procedures but also on the evaluation of the possible cause of VTE event. In the absence of an obvious clinical provoking factor, occult malignancy or thrombophilic disorder should be searched for. From the practical point of view, the most relevant are those thrombophilic states that are associated with an increased risk of recurrence and may therefore play a role in the decision about the length of the anticoagulation therapy (usually with warfarin) following the event. However, the most common inherited thrombophilic disorders are associated with only mildly increased risk of VTE recurrence and their detection does not usually warrant prolonged warfarin therapy. Antiphospholipid syndrome (APS) is an acquired thrombophilic state with a significantly higher risk of VTE recurrence, especially after warfarin withdrawal. The laboratory diagnostics of APS consists of coagulation assays (detection of lupus anticoagulans) as well as serologic tests of antiphospholipid antibodies (APA). APAs are very heterogeneous and only some of them are considered "diagnostic" - anticardiolipin antibodies (ACA) and newly also antibodies...
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The influence of sertraline treatment on the metabolic and antropometric parameters in people with depression
Podlipný, Jiří ; Beran, Jiří (advisor) ; Filipovský, Jan (referee) ; Jirák, Roman (referee)
Introduction: Pharmacotherapy with antidepressants can cause a metabolic risk, can be neutral in terms of metabolism or can perform a metabolic benefit for the treated patients. Objective: The aim of the presented study is to assess the effects of long-term use of sertraline on the particular laboratory and anthropometric parameters in somaticaly healthy or compensated outpatients treated for unipolar depression. Methods: The study was performed in cooperation of Centre of Preventive Cardiology (CPC) of 2nd Department of Internal Medicine and Department of Psychiatry of Charles University in Prague, Faculty of Medicine in Plzeň (Pilsen) and University Hospital Plzeň, Czech Republic. A screening of risk factors in relation to the development of cardiovascular (CV) diseases and metabolic syndrom was carried out in 350 people from the cohort Pilsen Longitudinal Study III (PILS III) at CPC. The participants filled in a Czech version of the Zung Self-Rating Depression Scale (SDS) simultaneously with the screening. Those of them scoring up the threshold set for the suspicion of depression in SDS were invited to the department of psychiatry outpatient's office in order to undertake a psychiatric examination. There were 31 persons in total fulfilling the following criteria: (1) aduld patients diagnosed with...
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Interactive Influence of Genetic Effects and Effects of External Environment on Properties of Large Arteries in Relation to Sodium Management
Seidlerová, Jitka ; Filipovský, Jan (advisor) ; Widimský, Jiří (referee) ; Segers, Patrick (referee) ; Herijgers, Paul (referee)
In line with Guyton's work, the goal of our research was to explore in three European populations whether the properties of large arteries are associated with renal sodium handling, which itself changes with environmental factors and with variation in a large number of genes. Before engaging in the genetic analyses proper, we first studied the familial aggregation and the heritability of arterial properties. In all our analyses, we accounted for relatedness among participants and for covariables and confounders. In a first study, we compared the arterial characteristics and blood pressure (BP) in normotensive offspring of two normotensive parents (OFF/NT) and normotensive offspring, who had at least one hypertensive parent (OFF/HT). We measured peripheral pulse pressure (PPp) by conventional and 24-h ambulatory BP. A SphygmoCor device was used to determine the central (CAIx) and peripheral (PAIx) augmentation indexes, central pulse pressure (PPc), and aortic pulse wave velocity (aPWV). Compared with OFF/NT (n=59; 16 to 34 years of age), the OFF/HT (n=174; 17 to 40 years) had higher (0.14<P<0.0007) BP and PPp on conventional measurement (121/75 vs. 114/71 mm Hg and 46 vs. 42 mm Hg) as well as on 24-h ambulatory monitoring (118/70 vs. 114/67 mm Hg and 48 vs. 47 mm Hg). OFF/HT, compared with OFF/NT, also had...
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Examination methods of skin microcirculation in diabetes foot syndrome
Krčma, Michal ; Rušavý, Zdeněk (advisor) ; Filipovský, Jan (referee) ; Horký, Karel (referee) ; Prázný, Martin (referee)
Introduction: Since the mid 1980s, a lot of attention has been dedicated to the importance of microcirculation; a part of arterial bed including arterioles, precapillary sphincters, capillaries, venules and arteriovenous shunts. It is a structure of decisive importance for an organism; in its domain an exchange of blood gases and metabolic products takes place and it contributes to thermoregulation. Mediation of vasomotor reaction and vasoarterial reflex maintaining a stable hydrostatic pressure is also an important function. Microcirculation is for its dimensions (capillary diameter approx. 5 x 10-5 mm2, blood flow velocity around 0.4 mm.s-1) relatively difficult to access for more detailed examination, yet its impairments are very severe and dominate in many metabolic disorders. Microcirculation impairment is crucial in diabetes mellitus, where arteriovenous shunts open at the expense of nutritive bed due to a loss of sympathetic tone in peripheral circulation in diabetic neuropathy (Netten, Houben). Blood flow is therefore seemingly sufficient, but the affected tissue undergoes ischemia (warm ischemia). To what extent hyperinsulinemia contributes to this effect is not yet clearly known, one of the possible explanations may be a stimulation of sympathetic activity. Not a few studies are dealing with...
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Šejda, Tomáš ; Poledne, Rudolf (advisor) ; Filipovský, Jan (referee) ; Češka, Richard (referee)
Based on the results of our study, we concluded that the degree of brachial artery flow endothelium-dependent dilatation is difficult to evaluate using predefined cut-off points as a single-measurement screening test to indicate endothelial dysfunction. On the contrary, the variation of endothelial function after a defined stimulus (dietary, medication) examined at a predefined interval using an identical protocol can help to assess enhanced or reduced efficacy of endothelium-dependent vasodilatation. In the next study, we demonstrated that a high-fat load applied at a single dose does not significantly affect brachial artery vasoreactivity in young, healthy volunteers after four weeks of low- and high-fat diets. In contrast with atherosclerosis, the effect of hypercholestrolemia on adhesive molecule levels has been a source of controversy. We demonstrated that 3-month therapy with fluvastatin does not decrease cICAM-1 levels despite normalization of cholesterol levels. The implication is cholesterol may not induce endothelial activation by the initial upregulation of this adhesive molecule. Endothelial dysfunction can be considered the initial, functionally relevant stage of atherosclerosis, demonstrable still before morphological changes. In patients with advanced obliterative atherosclerosis,...
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Risk factors for atherosclerosis and its potential pharmacological effects in patients with coronary artery disease and lower limb
Hromádka, Milan ; Filipovský, Jan (advisor) ; Piťha, Jan (referee) ; Šimon, Jaroslav (referee)
1 Statin therapy in patients with peripheral artery obstructive disease (PAOD) 1.1 Patients with lipid metabolism disorders Simvastatin therapy with the dose titration adjusted to the effect led to the prolongation of claudication interval and to the elevation of ankle-brachial pressure index, which was statistically significant at the interval of 18 months after starting the therapy. At the same time we observed normalization of lipid levels and the lowest levels of oxidative stress markers. Statin use was also associated with lowering homocysteine level. 1.2 Patients without lipid metabolism disorders - the influence on laboratory parameters and functional capacity In patients without lipid metabolism disorder, treated with simvastatin 20 mg daily, we noted an improvement, i.e. prolongation of claudication interval and elevation of ankle-brachial pressure index, while in the control group treated only with a diet we observed further deterioration of capacity. In the control group, the parameters of lipid metabolism were statistically significantly worse after six months and this trend remained even in further control visits with HDL cholesterol slightly lowering. In the simvastatin group, a statistically significant decrease of LDL occurred during several months as well as elevation of HDL...
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