Jiri Charvat

Comparison of Soybean Oil- and Olive Oil-based Lipid Emulsions on Hepatobiliary Function and Serum Triacylglycerols Level during Realimentation

This study compared the effects of soybean oil- versus olive oil-based lipid emulsions on hepatobiliary function and serum triacylglycerols in patients who required transient parenteral nutrition support for significant weight loss. Patients who received a parenteral ready-to-use industry admixture including either soybean oil- (n = 10) or olive oil-based lipid emulsion (n = 11) for 2 weeks were retrospectively analysed. Cholestatic and cytolytic enzymes, conjugated bilirubin and serum triacylglycerols were sampled before and 1 day after completing parenteral nutrition support. Significant deterioration of cholestatic enzymes occurred in five patients in the soybean oil group and in one in the olive oil group. Serum triacylglycerols significantly deteriorated in seven patients in the soybean oil group and in one patient in the olive oil group. No differences were recorded for cytolytic enzyme abnormalities. In conclusion, the olive oil-based emulsion induced abnormalities of cholestatic enzymes and serum triacylglycerols significantly less frequently than the soybean oil-based emulsion.

The association of masked hypertension in treated type 2 diabetic patients with carotid artery IMT

OBJECTIVES To evaluate the association of masked hypertension (MH) in treated type 2 diabetic patients without history of cardiovascular disease with carotid artery target organ damage. METHODS Sixty-four type 2 diabetic patients treated for hypertension with office BP below 140/90 mm Hg were examined by 24-h BP monitoring and carotid sonography. MH was diagnosed if daily mean ambulatory BP was >or=135/85 mm Hg. The association of MH with carotid artery parameters was evaluated. RESULTS The average age of patients was 62+/-5 years. Twenty-four patients had MH (37.5%). Carotid artery IMT was 0.74+/-0.08 mm in patients with MH and 0.69+/-0.06 mm without MH (p=0.03). The distensibility of common carotid artery was 0.24+/-0.07 mmHg(-1) in patients with MH and 0.29+/-0.1mm Hg(-1) without MH (p=0.14). After adjustment for age, gender, smoking, duration of diabetes, BMI and clinic blood pressure (BP) values the association of MH with carotid artery IMT was sustained. CONCLUSION Masked hypertension in treated type 2 diabetic patients is associated with carotid artery IMT.

Changes in the plasma amino acid profile in anorexia nervosa.

We evaluated and measured by high performance liquid chromatography the plasma amino acid levels in 11 female patients with anorexia nervosa during a period of significant loss of body weight, compared with 11 healthy age-matched controls. Total amino acid and total branched-chain amino acid levels were similar in both groups, however significantly higher levels of glycine and ornithine were found in anorexia nervosa patients, as well as significantly lower levels of leucine, tyrosine and lysine compared with controls. The glycine/valine and phenylalanine/tyrosine ratios were significantly higher in anorexia nervosa patients than in control subjects. The levels and ratios of other amino acids were within the normal range, with no significant differences between the two groups. Changes in the plasma amino acid profile in anorexia nervosa patients can be explained by chronic severe malnutrition and prolonged stress.

Common carotid artery intima-media thickness is not increased but distensibility is reduced in normotensive patients with type 2 diabetes compared with control subjects.

This study evaluated carotid artery parameters in normotensive patients with type 2 diabetes compared with non-diabetic control subjects. Using a high-resolution B-mode ultrasound scanner, common carotid artery intima-media thickness (IMT) and carotid tree atheroma thickness were measured in 82 patients with type 2 diabetes and 41 controls. The distensibility of the common carotid artery was calculated using the Reneman equation. Distensibility was significantly decreased and atheroma thickness was significantly increased in the diabetes group. There was no significant difference in IMT between the two groups. Stepwise linear regression analysis revealed an association between common carotid artery distensibility and post-ischaemic dilatation of the brachial artery (a measure of endothelial function), body mass index and diabetes duration in patients with type 2 diabetes. In conclusion, common carotid artery IMT in normotensive patients with type 2 diabetes is comparable to that of control subjects, whereas atheroma thickness is higher and arterial stiffness more pronounced in those with type 2 diabetes, indicating the existence of atherosclerotic changes in normotensive type 2 diabetes patients.

The Association between Left Ventricular Diastolic Function and a Mild-to-Moderate Decrease in Glomerular Filtration Rate in Patients with Type 2 Diabetes Mellitus

This prospective study evaluated the relationship between echocardiography parameters of left ventricular (LV) diastolic function and mild-to-moderate renal function impairment in 82 patients with type 2 diabetes mellitus. The mean age of the patients was 61.1 years. A significant correlation was found between estimated glomerular filtration rate (eGFR) and the ratio of peak velocity of early transmitral flow (E) to peak velocity of early diastolic mitral annular motion (E′). Cluster analysis revealed two subgroups of patients with different E′ values but comparable eGFRs. The correlation between eGFR and E/E′ was significant in 38 patients with E′ ≤ 7.1 cm/s, but not significant in 44 patients with E′ > 7.1 cm/s. The results suggest that the deterioration of LV relaxation (E′) represents the underlying condition for the association between mild-to-moderate renal function impairment and the non-invasive parameter of LV end-diastolic pressure (E/E′), in patients with type 2 diabetes without any previous cardiovascular event and with well-controlled blood pressure.

Plasma Adrenomedullin and Subclinical Cardiorenal Syndrome in Patients with Type 2 Diabetes Mellitus

OBJECTIVE: To evaluate whether plasma adrenomedullin is involved in the previously reported significant inverse correlation between left ventricular (LV) end-diastolic pressure (peak velocity of early transmitral flow/peak velocity of early diastolic mitral annular motion ratio [E/E′]) and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes mellitus, mild-to-moderate renal function impairment and LV relaxation impairment (E′ ≤ 7.1 cm/s). METHODS: Plasma adrenomedullin concentration, E/E′ and eGFR were assessed in 82 patients with type 2 diabetes. RESULTS: Plasma adrenomedullin concentration was positively correlated with eGFR in patients with or without LV relaxation impairment, and inversely correlated with E/E′ in patients with LV relaxation impairment. Multivariate linear regression analysis supported a role for plasma adrenomedullin in the association between E/E′ and eGFR. CONCLUSION: These results support the hypothesis that adrenomedullin modulates the interaction between the heart and kidneys in early subclinical cardiorenal syndrome in patients with type 2 diabetes mellitus.

The Impact of Early Diastolic Myocardial Relaxation on the other Parameters of Diastolic Function and Association of Tissue Doppler Parameters of Diastolic Function with Diabetes Compensation and Duration in Type 2 Diabetic Patients

This study assessed the impact of tissue Doppler derived myocardial early diastolic relaxation velocity (Em) on the other parameters of diastolic function (preload dependent transmitral early diastolic velocity [E], tissue Doppler derived myocardial late diastolic velocity [Am], preload dependent transmitral late diastolic velocity [A]) and evaluated the correlation of these parameters with selected clinical variables in type 2 diabetic patients. Using tissue Doppler echocardiography, 82 type 2 diabetic patients were evaluated, divided into two equal groups of Em < 7.5 cm/s or ≥ 7.5 cm/s. Patients with Em < 7.5 cm/s had significantly lower E/A and Em/Am, and higher E/Em values. Multilinear regression showed a negative correlation between Em and glycated haemoglobin (HbA1c) and duration of diabetes, a negative correlation of Em/Am with age, duration of diabetes and HbA1c, and a positive correlation of E/Em with age, duration of diabetes and use of diuretics. The E/A ratio only correlated negatively with age. It is concluded that Em is a reliable parameter of diastolic function, and that the tissue Doppler parameters of diastolic function are associated with diabetes compensation and diabetes duration.

Effects of high-tone external muscle stimulation on renal function in healthy volunteers.

OBJECTIVE AND DESIGN Hightone external muscle stimulation (HTEMS) ameliorates pain and discomfort of patients with polyneuropathy. Since some patients reported about an urge to urinate during these treatments, the potential effects of HTEMS application on renal function were investigated. For this purpose in healthy subjects, we analyzed in the current study the acute effects of electrotherapy on parameters of renal function. INTERVENTIONS 24 healthy volunteers (14 women and 10 men), mean age 26 ± 4 years, were enrolled. The protocol was composed of a run-in period, a pre-treatment period, the active HTEMS treatment period of both lower extremities and the post-treatment period. The duration of each period was 60 min. Urine collection and blood samples were taken at the beginning and end of each period. To achieve a sufficient diuresis, the fluid intake was adapted to the amount of diuresis. Parameters of renal function included diuresis, glomerular filtration rate (endogenous creatinine clearance) and absolute and fractional sodium excretion. Moreover blood pressure and heart rate were monitored. RESULTS HTEMS led to a significant increase of creatinine clearance and fractional sodium excretion which was limited to the active treatment period. CONCLUSION These findings show for the first time that HTEMS can transiently increase glomerular filtration rate associated with a decreased tubular sodium reabsorption. The underlying mechanisms are to be elucidated.

Circulating Serum Matrix Metalloproteinase-3 and Metalloproteinase-9 Are Not Associated with Echocardiographic Parameters of Diastolic Function in Asymptomatic Type 2 Diabetic Patients

Serum concentrations of matrix metalloproteinase (MMP) 3 and MMP9 were evaluated in 82 asymptomatic type 2 diabetes mellitus patients without cardiovascular complications and in 41 non-diabetic control subjects. In the asymptomatic diabetic patients, the correlations of these concentrations with diabetes duration, selected biochemical parameters such as glycated haemoglobin (HbA1c), and echocardiographic parameters of diastolic function were also assessed. Pulsed and tissue Doppler echocardiography was performed in the two groups. Mean ± SD age was 61 ± 6 years for the asymptomatic diabetic patients and 61 ± 5 years for controls. Mean ± SD concentrations of MMP3 and MMP9 were significantly higher in the asymptomatic diabetic patients (67.5 ± 10.4 and 77.8 ± 28.8 μg/l, respectively) than in controls (47.2 ± 6.1 and 51.1 ± 13.7 μg/l, respectively). In the asymptomatic diabetic patients, MMP3 correlated only with albuminuria (r = 0.341) and MMP9 only with HbA1c (r = 0.262); neither MMP was correlated with echocardiographic parameters of diastolic function. Thus, in asymptomatic type 2 diabetic patients without cardiovascular complications, serum MMP3 and MMP9 were elevated, MMP9 was associated with HbA1c and MMP3 was associated with albuminuria, however, MMP3 and MMP9 were not associated with echocardiographic parameters of diastolic function.

The incidence of symptomatic upper limb venous thrombosis associated with midline catheter: Prospective observation:

Aim: The evaluation of the incidence of symptomatic upper limb venous thrombosis (ULVT) associated with midline catheters in patients admitted to the hospital. Methods: The frequency of symptomatic ULVT diagnosed in a group of patients with midline catheters confirmed by sonographic examination in hospitalised patients at Faculty Hospital over the period of 1 year. Results: Four hundred thirty-nine midline catheters were inserted in 430 patients (250 women and 180 men) during year 2015. Nine patients had two midline catheters. The average age of the patient was 68 years (range: 19–96 years). The median time of midline catheter introduction into a vein was 10 days (range: 1–112 days). Symptomatic thrombosis was diagnosed in 20 patients (4.5%), 3.3/1000 catheter days. It was associated with gender (male) and midline insertion in the cephalic vein. Conclusion: The risk of upper limb symptomatic thrombosis associated with midline catheters during a stay in the hospital should be taken into consideration when indicating optimal venous access.