Microvascular Reactivity and Endothelial Function in Type 2 Diabetic Patients with Hyperlipidemia Treated with Simvastatin: 3-year Follow-up.

Aim of this study was to evaluate microvascular reactivity (MVR) by laser Doppler flowmetry in Type 2 diabetes mellitus (T2DM) with hyperlipidemia during three years of simvastatin treatment. Additionally, markers of endothelium and fibrinolysis were evaluated. Twenty patients with T2DM and hyperlipidemia were treated with 20 mg of simvastatin daily for 3 months, treatment was then interrupted for 3 months (wash-out) and again started and maintained continually up to total of 36 months of follow-up. Maximal perfusion (max), velocity of perfusion increase (max/t) and percent increase of perfusion compared to baseline (%) was measured during post-occlusive reactive hyperemia (PORH) and thermal hyperemia (TH). VCAM-1, ICAM-1, E-selectin and P-selectin were used as markers of endothelium, tissue plasminogen activator (tPA) and its inhibitor (PAI-1) as markers of fibrinolysis. Baseline MVR in diabetic patients was comparable to controls. MVR decreased at months 3, 12, and 36 compared to baseline (PORHmax 26+/-12, 35+/-17, 26+/-11 vs. 56+/-30 PU, p<0.05, THmax 67+/-19, 81+/-37, 58+/-24 vs. 134+/-70 PU, p<0.01, PORHmax/t 2.0+/-1.4, 2.8+/-1.7, 1.9+/-1.3 vs. 7.7+/-7.4 PU/s, p<0.05, THmax/t 1.1+/-0.6, 1.0+/-0.4, 0.7+/-0.4 vs. 1.5+/-0.7 PU/s, p<0.05.

Inflammatory response in patients undergoing hip surgery due to osteoarthrosis or different types of hip fractures.

OBJECTIVE: Hip surgery represents a major intervention associated with significant inflammatory response. The objective of our study was to compare markers of systemic inflammation and soluble adhesive molecules in patients undergoing elective hip replacement to those with hip fracture either intracapsular (IC) or extracapsular (EC). DESIGN: We included 65 consecutive patients undergoing hip surgery--17 patients with elective hip replacement (EL group), 29 patients with EC fracture (EC group) and 11 patients with IC fracture (IC group). Fibrinogen (FBG), orosomucoid (ORM), C-reactive protein (CRP), transferrin (TRF) and white blood cells count (WBC), sP-selectin, sE-selectin, and soluble intercellular adhesion molecule-1 (sICAM-1) were measured before surgery 4h, 48h, and 7 days after surgery. RESULTS: IC patients had preoperatively highest values of inflammatory markers including FBG, CRP, ORM, WBC and lowest values of TRF, as compared to intermediate values found in EC and lowest values in EL groups. The surgery has led in all three subgroups to significant elevation in CRP, ORM and decrease in TRF. In IC group, the subsequent recovery of inflammatory markers was very slow. We noted a significant suppression of sP-selectin and sE-selectin values in all subgroups after surgery. The decrease of sE-selectin but not of sP-selectin correlated with changes in hemoglobin and blood transfusions' administration. CONCLUSIONS: Hip surgery is associated with significant inflammatory reaction. In patients with hip fractures, inflammatory markers are elevated already preoperatively, more so in IC than in EC fractures. The unexpected observation of a significant postoperative decrease in sE-selectin and sP-selectin will require further research for elucidation.

[Thrombophilia in pregnancy--physiology and pathophysiology of hemocoagulation changes during normal and pathological gravidity]. / Trombofilie v tehotenství--fyziologie a patofyziologie hemokoagulacních zmen v normální gravidite a pri nekterých patologických tehotenských stavech.

Venous thromboembolism belongs to most feared complications in pregnancy. It is the leading cause of illness and even death during pregnancy and puerperium. Thrombophilias--acquired or inherited, manifest often during pregnancy and puerperium. These risk states could endanger normal pregnancy by increasing the probability of the first or recurrent thromboembolic incident and adverse obstetric events (pregnancy loss, pre-eclampsia, intrauterine growth restriction, placental abruption).

[Thrombotic complications of sepsis and their pharmacological prophylaxis]. / Trombotické komplikace pri sepsi a jejich farmakologická profylaxe.

Patients with severe sepsis are at increased risk for developing thrombembolic phenomena. This article aims to clarify the association between systemic inflammation activation and coagulation, pathogenesis of coagulation abnormalities during severe sepsis. The article reviews incidence and deep venous thrombosis risk factors among these patients and summarizes recent evidence-based guidelines for deep venous thrombosis prophylaxis.

Control of gene expression by FNR-like proteins in facultatively anaerobic bacteria.

Facultatively anaerobic bacteria are able to adapt to many different growth conditions. Their capability to change their metabolism optimally is often ensured by FNR-like proteins. The FNR protein of Escherichia coli functions as the main regulator during the aerobic-to-anaerobic switch. Low oxygen tensions activate this protein which is expressed constitutively and is inactive under aerobic conditions. The active form is dimeric and contains a [4Fe-4S]2+ cluster. The direct dissociation of the cluster to the [2Fe-2S]2+ cluster by the effect of oxygen leads to destabilization of the FNR dimer and to loss of its activity. The active FNR induces the expression of many anaerobic genes; the set comprises over 100 of controlled genes. Many other bacteria contain one or more FNR analogues. All these proteins form the FNR family of regulatory proteins. Properties of these proteins are very distinct, sometimes even among representatives of different strains of the same bacterial species. FNR-like proteins together with other regulators (e.g., two-component system ArcBA, nitrate-sensing system NarXL, etc.) control a complicated network of modulons that is characteristic for every species or even strain and enables fine tuning of gene expression.