[Glucose, Lactate, NGAL and Coefficient of Energy Balance in Synovial Fluid in Patients with Hip and Knee Prosthetic Joint Infection]. / Stanovení hladiny glukózy, laktátu, NGAL a KEB ve výpotku u infekcí TEP kolen a kyclí.

PURPOSE OF THE STUDY Laboratory methods are central to prosthetic joint infection (PJI) diagnosis. Most research teams focus on detection of specific inflammatory markers, causative pathogens, or on assessment of the tissue response. This study sought to determine the optimal cut-off values and diagnostic performance of selected synovial markers in relation to the diagnosis of hip or knee PJI. The studied markers were synovial level of glucose, lactate, coefficient of energy balance (CEB) and NGAL (neutrophil gelatinase-associated lipocalin). MATERIAL AND METHODS This prospective study includes 89 patients who underwent revision total knee or hip arthroplasty for septic or aseptic reasons in the period from 2014 to 2017. Among these 89 patients, there are 2 cases of prosthetic hip infection, 22 cases of prosthetic knee infection, 31 aseptic revision total hip arthroplasties and 34 aseptic revision total knee arthroplasties. The diagnostic characteristics of the studied methods were set in relation to the reference standard, the 2013 MSIS (Musculoskeletal Infection Society) criteria. The cut-off values were calculated using the ROC (receiver operating characteristic curve) analysis. RESULTS The synovial glucose test is considered positive if the glucose level drops below 2.65 mmol/L. The area under the curve is 0.813, sensitivity 75.0%, specificity 83.1%. The synovial lactate test is considered positive if lactate level rises above 8.87 mmol/L. The area under the curve is 0.882, sensitivity 70.8%, specificity 95.4%. Synovial NGAL is considered positive if its level exceeds 998 µg/L. The area under the curve is 1.000, sensitivity 100.0%, specificity 100.0%. CEB is considered positive if its value is lower than +4.665. The area under the curve is 0.883, sensitivity 91.7% and specificity 69.8%. Combining of these tests with other synovial markers does not improve the diagnostic performance of the studied tests. CONCLUSIONS The glucose and lactate levels and CEB undoubtedly reflect the presence of an inflammatory process in a prosthetic joint. However, the diagnostic characteristics of these tests are not better than those of other modern diagnostic techniques. As opposed to these tests, synovial NGAL shows excellent diagnostic performance. Nonetheless, the potential of this method shall be verified on larger cohorts of patients. Key words: prosthetic joint infection, periprosthetic infection, total knee arthroplasty, total hip arthroplasty, diagnosis, glucose, lactate, CEB, NGAL.

Aspirin resistance measured by cationic propyl gallate platelet aggregometry and recurrent cardiovascular events during 4 years of follow-up.

BACKGROUND: Aspirin resistance appears to be an important prognostic factor in patients with coronary artery disease, yet there is no standardized method to measure it and limited data on its correlation to clinical outcomes. METHODS: In a prospective study we followed 103 patients (mean age 64 years) with acute coronary syndrome (ACS) without ST segment elevation who were treated with 100 mg of aspirin (ASA) daily. Optical platelet aggregometry using cationic propyl gallate (CPG) as an inductor was measured at ACS onset and after 3, 12, 24, 36, and 48 months. ASA responsiveness was defined both by the slope of the aggregation curve (<53%/min) and by spontaneous aggregation (<5%). The primary outcomes were the recurrence of ACS or stroke. RESULTS: Patients with ACS exhibited a greater prevalence of ASA resistance (55%) than healthy volunteers (4%; p<0.01). ASA resistance occurred more often in patients with type 2 diabetes, hypertriacylglycerolemia, and decreased HDL levels, and in smokers (p<0.05). A single assessment of platelet aggregometry was sufficient to identify ASA-resistant patients. During the 4-year follow-up, the patients with ASA resistance had an 88% incidence of recurrent cardiovascular events versus 46% for the patients without ASA resistance (p<0.01). In the subgroup with recurrent cardiovascular (CV) events, significantly more patients were ASA-resistant than in the subgroup without recurrent CV events (72% vs. 8%, p<0.01). CONCLUSION: ASA resistance measured by CPG-induced platelet aggregometry is more common among patients with ACS and some metabolic risk factors, and ASA-resistant patients have a significantly higher recurrence of cardiovascular events.

[Use of assessment of aggregation of thrombocytes induced by cationic propyl gallate to estimate recurrence of cardiovascular complications]. / Vyuzití stanovení agregability trombocytu po indukci kationickým propylgalátem v odhadu recidiv kardiovaskulárních komplikací.

INTRODUCTION: Recently resistance to an acetylsalicylic acid (ASA) administration has been a frequently mentioned problem. However, to identify ASA nonresponsive patients (ASA resistance) is difficult and common examination procedures can contain important preanalytic, analytic and postanalytic mistakes. Recently a possibility to use aggregometry after induction with cationic propyl gallate (CPG) has been discussed in this context; it's a robust, highly sensitive, and specific method for ASA resistance estimates. We asked ourselves following questions during our work: GOAL: a) Experience patients with acute coronary syndrome (ACS) ASA resistance more often than healthy volunteers?; b) Are aggregation values in both patients with different metabolic homeostasis disorders and patients with risk factors for atherosclerotic complications different?; c) Change results of measured aggregation induced by CPG in patients treated with identical ASA therapy during a several years long monitoring; respectively are patients assessed differently during the monitoring?; d) Is it possible to use one-shot aggregation assessment following CPG to estimate ASA resistance or is it necessary to repeat the examinations?; e) Is recurrence of ACS complications more frequent during two years of monitoring of patients with ACS history resistant to 100 mg doses of ASA per day? METHOD: 103 patients of an average age 69 were assessed. All of them suffered from ACS without ST segment elevations and were treated conservatively; in addition to it all of them were treated with 100 mg ASA/day. They were assessed at the onset of ACS and after 3, 12 and 24 months. The examination consisted of taking patient history, clinical examination, BMI determination, laboratory test for cholesterol, HDL, LDL, triacylglycerols, and glucose, and of an aggregation of thrombocytes assessment under standard conditions (spontaneous and after CPG induction). RESULTS AND CONCLUSION: a) ASA resistance is more frequent in patients with ACS compared to healthy volunteers (45% to 6%, p < 0.001). b) Patients with type II DM, smokers, patients with low HDL cholesterol levels or high triacylglycerols levels are ASA resistant more often (< 0.05). c) Results of measured aggregation of thrombocytes don't change during administration of the identical dose of 100 mg ASA/day during 2 years of monitoring. Respondents usually are assessed identically during monitoring (responsive/ASA nonresponsive). d) ASA resistance can be estimated from one-shot aggregation assessment following induction with CPG. e) Two years after diagnosing the ASA resistance a percentage of cardiovascular complications recurrence is higher in patients with history of ACS (p < 0.001). One-shot assessments of the CPG induced thrombocytes aggregation and the spontaneous aggregation are sensitive in 81% of patients with ACS history and specific in 100% of patients at risk of recurrence of cardiovascular complications. If these results are confirmed it could lead to a change in interventions in patients with ASA resistance proved by this method.

[First experience with the cobalt binding capacity (ACB) test in the diagnosis of acute coronary syndrome (a pilot study)]. / První zkusenosti se stanovením vazebné kapacity pro kobalt (ACB) v diagnostice akutního koronárního syndromu (pilotní studie).

INTRODUCTION: Commonly used laboratory markers of coronary damage in individuals with acute coronary syndrome (ACS) are not specific for myocardial ischemia and prove only irreversible myocardial damage. There have been concerns recently of a laboratory test able to distinguish sufficiently an individual with myocardial ischemia and typical IHD symptoms from patients without IHD. Since 1994 several works about cobalt binding capacity of albumin (ACB) have been published in which a unique diagnostic sensitivity and specificity of this test for estimations of the presence of myocardial ischemia has been described. In February 2003 this test was approved by FDA for making an early diagnosis of ACS. GOAL OF THE WORK: To verify a possibility to use ACB test for making an early diagnosis of ACS. METHOD: 98 individuals, patients of the Department of Internal Medicine of the hospital in Sternberk, hospitalised for suspicion of ACS but not indicated for direct PTCA, have been examined. Respondents with ACS diagnosis were examined via coronarography. All the respondents were examined for cTnI, myoglobin, and ACB immediately at the admission (0) and 2, 6, and 12 hours after admission. Cobalt binding capacity of albumin has been given in absorbance units. The group of respondents was subsequently divided into subgroups according to presence of ACS and subgroups of respondents with/without AMI. RESULTS: 55 respondents (56%) have been diagnosed with ACS. 16 respondents (16%) from them suffered from non-Q AMI and 39 respondents (40%) suffered from unstable AP (UAP). 43 respondents (44%) suffered from noncoronary sternal pain. Patients with ACS had ACB values significantly higher at admission and 2 and 6 hours after admission compared to respondents without ACS (0: 0.62 +/- 0.17 vs. 0.4 +/- 0.11, 2: 0.61 +/- 0.13 vs. 0.44 +/- 0.12, 6: 0.58 +/- 0.16 vs. 0.45 +/- 0.1, p < 0.01). In ACB dynamics monitoring in defined groups of respondents no significant differences have been identified among ACB values of individual takings. There were no significant differences in ACB values 12 hours after admission (0.53 +/- 0.12 vs. 0.44 +/- 0.16) in cut-off absorbance ACB 0.5 the diagnostic sensitivity at admission was 69% and specificity 89%, 2 hours later 87% and 71% and 6 hours after admission 64% and 69%. 12 hours after admission ACB assessment has not been possible to be used for ACS diagnosing (AUC of 0.55). First 2 hours after admission ACB test was more specific and sensitive for diagnosing ACS compared to cTnI test (0: AUC 0.83 vs. 0.61, p = 0.015, 2: AUC 0.87 vs. 0.71, p = 0.04). However, ACB test could not be used in respondents with ACS to distinguish between acute myocardial infarction and unstable angina pectoris (UAP) (AUC: ACB-0 0.51, ACB-2 0.56, ACB-6 0.51, ACB-12 0.57). CONCLUSION: ACB test is a quick, cheap and easy examination which is very specific and sensitive for early diagnosing of acute coronary syndrome without regard whether it is caused by UAP or AMI (up to 6 hours after admission) compared to commonly used markers. This test could significantly contribute to the next fate of a patient (diagnostic procedures, patient's prognosis).

[Personal experience with determination of NT-proBNP in clinical practice]. / Vlastní zkusenosti s vyuzitím stanovení NT-proBNP v klinické praxi.

INTRODUCTION AND OBJECTIVE: Recently in the literature information is found on estimation of natriuretic peptides in the differential diagnosis of dyspnoea. Because in the Czech Republic since the beginning of 2002 routine estimation of NT-proBNP is available (analyzer Elecsys 2010), the objective of our work was to find out whether it is possible to use in the everyday practice of a district hospital estimation of NT-proBNP to differentiate dyspnoea with affection of the heart muscle from other types of dyspnoea. METHOD: A group of 33 patients from the medical department of the Sternberk hospital was examined who attended on account of dyspnoea and lacked signs of acute coronary syndrome. All probands were diagnosed on the basis of defined criteria; according to the final diagnosis the patients were divided into three groups: group "LV" was formed by dyspnoic patients with organic affection of the left ventricle and signs of congestion in the lesser circulation, group "non-LV" was formed by patients where no organic affection of the left ventricle was found but other heart disease was present. Group "non-C" was formed by patients where a cardiac cause of dyspnoea was ruled out. In all patients on admission NT-proBNP was assessed. RESULTS: 33 probands were examined, 18 men and 15 women, mean age 74.5 years. 25 probands the dyspnoea was classified as dyspnoea with affection of one of the cardiac compartments [19 of them had signs of organic affection of the left ventricle (group "LV")]; in 6 probands no signs of organic left ventricular affection were found (group "Non-LV"). The remaining 8 patients had no signs of any disease of the heart muscle, valves, septa, endocardium and pericardium (group "Non-C). The baseline values of NTpro-BNP were closely associated with the NYHA classification (grade II--median 55.3 pmol/l (469 ng/l, grade III--median 399.3 pmol/l (3384 ng/l), grade IV--median 724.7 pmol/l (6294 ng/l), the differences were statistically significant, p < 0.05). The dyspnoic probands with concurrent affection of some cardiac compartment (groups "LV" and "Non-LV") had a NT-pro BNP concentration significantly higher than probands without affection of the heart (group "Non-C") (median 589.5 pmol (4996 ng/l as compared with 62.9 pmol/l (533 ng/l, p < 0.01). In the group of probands with heart disease probands with affections of the left ventricle (group "LV") had significantly higher NT-proBNP values than subjects without affection of the LV and without any heart disease (groups "Non-LV" and "Non-C") (median 670.6 pmol/l (5683 ng/l) as compared with 187.5 pmol/l (1589 ng/l), p < 0.01). In hospitalized probands after treatment along with improved cardiopulmonary compensation also a significant drop of NT pro-BNP occurred (median 303 pmol/l (3967.7 ng/l to 211 pmol/l (2561 ng/l), p < 0.05). When looking for associations between anamnestic, laboratory and clinical data we found that the value of NT-proBNP is associated with dyspnoea with cardiac affection (groups "LV" + "Non-LV", correlation coefficient 0.48), with the left ventricular ejection fraction (correlation coefficient 0.52) and the baseline NYHA classification (correlation coefficient 0.36). In the examined group we did not find an association between NT-proBNP and age, sex, diabetes mellitus, hypertension, the presence of atrial arrhythmias, aortal stenosis, or the width of the left atrium. When using as cut-off for NT-proBNP 59 pmol/l (500 ng/l), the sensitivity of NT-proBNP for dyspnoea with affection of the cardiac compartments was 92% and the specificity 67%. CONCLUSION: Assessment of NT-proBNP is an important diagnostic acid in the differential diagnosis of dyspnoea.

Application of cationic propyl gallate as inducer of thrombocyte aggregation for evaluation of effectiveness of antiaggregation therapy.

INTRODUCTION AND AIM OF THE STUDY: Acetylsalicylic acid (ASA) is one of basic preparations used in the therapy of cardiovascular diseases. Application of ASA leads to irreversible reduction of platelet aggregation. The aim of the present study was to verify monitoring of effectiveness of ASA therapy using the measurement of platelet aggregability in vitro after induction by cationic propyl gallate (CPG), which is considered to be a highly potent inducer of aggregation. METHODS: We examined a group of 27 healthy volunteers, divided into two subgroups (n = 19, n = 8). The first subgroup was examined for thrombocyte aggregation before and 24 hours after administration of 400 mg of ASA after induction by ADP, collagen, adrenalin and CPG. The second subgroup was examined for thrombocyte aggregation before and after a three-day administration of ASA in a dose of 100 mg/day. RESULTS AND CONCLUSION: In the group of 27 healthy volunteers we determined normal values of aggregability for individual inducers. Low stability of the used methods was proved (weak or insignificant correlation of results of the same method before and after administration of ASA). The most advantageous parameter for monitoring of effectiveness of 400 and 100 mg of ASA was CPG slope (paired t test, p < 0.00000002, resp. p < 0.001). The parameter of CPG slope we determined in both subgroups the cut-off value (< 53s), by means of which it is possible to discriminate probands according to ASA therapy (in contrast to other routinely used inducers). The obtained results indicate that measurement of thrombocyte aggregation after CPG induction reveals a significantly lower percentage of ASA non-responders ASA than after other inducers. Measurement of thrombocyte aggregation after CPG induction is predicted to be highly promising for monitoring the effectiveness of anti-aggregation therapy.

[Initial experience with use of cationic propyl gallate as an inducer of thrombocyte aggregation in evaluation of anti-aggregation therapy]. / První zkusenosti s vyuzitím kationického propylgallátu jako induktoru agregace trombocytu v hodnocení úcinnosti antiagregacní terapie.

INTRODUCTION AND OBJECTIVE: Acetylsalicylic acid (ASA) is one of the basic preparations which are used in the treatment of cardiovascular diseases. ASA administration leads to irreversible restriction of platelet aggregation. The objective of our work was to test possibilities of monitoring the effectiveness of ASA therapy by measuring the platelet aggregability in vitro after induction with cationic propyl gallate (CPG) which is considered a very potent aggregation inductor. METHOD: We examined a group of 27 healthy volunteers divided into two sub-groups (n = 19, n = 8). In the first sub-group the platelet aggregation was examined before and after 24 hours following ingestion of 400 mg ASA after induction with ADP, collagen, adrenaline and CPG. In the second sub-group the platelet aggregation was examined before and after three-day administration of ASA--100 mg/day. RESULTS AND CONCLUSION: In a group of 27 volunteers we assessed normal values of aggregation after different inductors. A low stability of the methods used was proved (low stability or insignificant correlation of results of the same method before and after ASA ingestion. The most useful parameter by means of which it was possible to monitor the effectiveness of administration of 400 or 100 mg ASA was the C/G slope (paired t-test, p < 0.0000002, and p < 0.001 resp.). In parameter CPG slope we were able to assess in both groups the cut-off value (< 53%/min.) by means of which it is possible to discriminate probands according to ASA therapy (contrary to the other commonly used inductors). From the results ensues that when assessing the thrombocyte aggregation after CPG induction we find a significantly lower percentage of so-called ASA non-respondents than after other inductors. We consider the use of assessment of thrombocyte aggregation after CPG induction when monitoring antiaggregation therapy a very promising procedure.

[Condition of the teeth and oral hygiene in medical students, stomatological branch, Palacky University Olomouc]. / Stav chrupu a hygieny dutiny ústní u studentu stomatologického smeru LFUP v Olomouci.

The paper deals with assessment of the cariosity of teeth, hygiene of the oral cavity, needs and quality of treatment in 126 dental medical students, Palacký University, Olomouc in the school year 1987/88. From the assembled results it may be concluded that the health consciousness of care of oral health even in groups of interested persons, as we may anticipate in dental the students is not reflected in their attitude to their own health. This is the more problematical as it may make us think that health education is not a sufficient impulse for medical students.

Contribution to the survey of epidemiological studies on industrial stomatology from available foreign literature. Part I.

The epidemiological studies on industrial stomatology are reviewed and the general characteristics of noxae and methodological approach to the examination of persons from hazard workplaces are described.

Contribution to the survey of epidemiological studies on industrial stomatology from available foreign literature. Part II.

The epidemiological studies from available foreign literature deal with statistical processing of results obtained from the examination of workers from hazard workplaces in light and heavy industries. The effect of chemical and biological noxae on teeth decay and mucosa of the oral cavity was studied in a series of workers divided according to sex, age, and duration of employment. The harmful effect of noxae was found on the incidence and course of periodontopathies and worsened oral hygiene. No correlation was observed between the type of noxa and teeth decay. Noxae affect negatively the whole organism.