Serum levels of matrix metalloproteinases 2 and 9 in patients with acute myocardial infarction.

The myocardial extracellular matrix plays an important role in maintaining the structural and functional integrity of the heart and is centrally involved in post-myocardial infarction repair processes. We analysed some genetic and proteomic aspects that could play an important role in the development of myocardial infarction. Matrix metalloproteinases are enzymes that contribute strongly to the degradation of extracellular matrix components. In this study the serological levels of MMP-2 and MMP-9 were investigated using immunological testing in 34 patients with myocardial infarction and 34 matched control subjects. The serum levels of MMPs were determined by ELISA. Changes in serum levels were characterized within 24 h and after 6 months post myocardial infarction. Significantly higher levels of MMP-2 (299.47 ± 117.61 ng/ml) and MMP-9 (93.56 ± 53.74 ng/ml) were determined in patients with myocardial infarction compared to the controls, in both cases P < 0.001. MMP-9 levels decreased significantly in the 6 months after cardiac event, whereas the levels of MMP-2 were almost equal to the post-infarction ones. While comparing the results from four patients that died of cardiovascular cause within 6 months we found significantly higher MMP-2 (435.00 ± 55.83 ng/ml, P = 0.003) and MMP-9 (166.25 ± 41.07 ng/ml, P = 0.018) values. Microarray analysis was used to determine the gene expression of selected genes for MMPs and their regulators from peripheral blood. The selected genes did not show satisfactory results that could have a potential implication for diagnostics of tissue degeneration.

Serum levels of matrix metalloproteinases 2 and 9 and TGFBR2 gene screening in patients with ascending aortic dilatation.

Development of ascending aortic dilatation (AAD) in about 10 % of patients operated for aortic valve disease (AVD) is probably based on intrinsic pathology of the aortic wall. This may involve an abnormality in the process of extracellular matrix remodelling. The present study evaluated the serum levels of specific metalloproteinases (MMP-2 and MMP-9) and investigated the gene for transforming growth factor receptor 2 (TGFBR2) in 28 patients with AVD associated with AAD (mean age 60.6 years), in 29 patients (68.9 years) with AVD without AAD, and in 30 healthy controls (45.3 years). The serum levels of MMPs were determined by ELISA. Further, we focused on genetic screening of the TGFBR2 gene. Plasma MMP-2 concentrations were significantly higher in the groups of patients compared to the controls: median 1315.0 (mean 1265.2 ± SD 391.3) in AVD with AAD, 1240.0 (1327.8 ± 352.5) in AVD without AAD versus 902.5 (872.3 ± 166.2) ng/ml in the healthy controls, in both cases P < 0.001. The serum levels of MMP-9 were significantly higher in AVD with AAD patients [107.0 (202.3 ± 313.0)] and in AVD without AAD patients [107.0 (185.8 ± 264.3)] compared to the healthy controls [14.5 (21.2 ± 24.8) ng/ml], in both cases P < 0.001. No significant correlation was observed between plasma MMP-2 and MMP-9 and ascending aorta diameter. Genetic screening did not reveal any variation in the TGFBR2 gene in the patients. Measurement of MMP levels is a simple and relatively rapid laboratory test that could be used as a biochemical indicator when evaluated in combination with imaging techniques.

[Pilot register of acute myocardial infarction--a 5-year evaluation of quality of care in non-PCI hospitals]. / Pilotní registr akutního infarktu myokardu--hodnocení kvality péce v non-PCI nemocnicích v prubehu 5 let.

INTRODUCTION: The aim of this research was to describe (demographic data and cardiovascular disease risk factors) a non-selected patient population with acute myocardial infarction and to evaluate the applied diagnostic and therapeutic approaches. PATIENTS AND METHODS: Data on 3,184 cases of acute myocardial infarction from non-PCI hospitals in Cáslav, Chrudim, Jindrichuv Hradec, Kutná Hora, Písek and Znojmo were entered in a pilot register between 2003 and 2007. RESULTS: ST elevation myocardial infarctions represented 28.5% of registered cases; primary reperfusion was indicated in 68.3% of these cases. Coronarography was indicated in 43.8% of patients in the non-ST elevation myocardial infarction subgroup. When evaluating pharmacotherapy administered during the first 24 hours following admission, a statistically significant increase in pharmacotherapy administration over the 5 years of register existence was observed (the most apparent for clopidrogel--increase from 24.6% to 63.3%). Analysis of medication recommended for use at discharge also revealed significant increase in administration of the recommended medication over the 5 years in all evaluated drug groups--the most significant, once again, for thienopyridines (increase from 34.9% to 49.6%). In-hospital mortality decreased over the 5 years from 15.2% in 2003 to 8.0% in 2007. CONCLUSION: The 5-year evaluation of diagnostic and therapeutic approaches applied in patients with acute myocardial infarction in non-PCI hospitals confirmed improvement in care provided, specifically improved adherence to pharmacotherapy as well as interventional treatment guidelines pertinent to this patient group. Together with increased quality of care, we observed a decline in in-hospital mortality of patients with acute myocardial infarction.

Semantic interoperability in Czech healthcare environment supported by HL7 version 3.

OBJECTIVES: The data interchange in the Czech healthcare environment is mostly based on national standards. This paper describes a utilization of international standards and nomenclatures for building a pilot semantic interoperability platform (SIP) that would serve to exchange information among electronic health record systems (EHR-Ss) in Czech healthcare. The work was performed by the national research project of the "Information Society" program. METHODS: At the beginning of the project a set of requirements the SIP should meet was formulated. Several communication standards (openEHR, HL7 v3, DICOM) were analyzed and HL7 v3 was selected to exchange health records in our solution. Two systems were included in our pilot environment: WinMedicalc 2000 and ADAMEKj EHR. RESULTS: HL7-based local information models were created to describe the information content of both systems. The concepts from our original information models were mapped to coding systems supported by HL7 (LOINC, SNOMED CT and ICD-10) and the data exchange via HL7 v3 messages was implemented and tested by querying patient administration data. As a gateway between local EHR systems and the HL7 message-based infrastructure, a configurable HL7 Broker was developed. CONCLUSIONS: A nationwide implementation of a full-scale SIP based on HL7 v3 would include adopting and translating appropriate international coding systems and nomenclatures, and developing implementation guidelines facilitating the migration from national standards to international ones. Our pilot study showed that our approach is feasible but it would demand a huge effort to fully integrate the Czech healthcare system into the European e-health context.

Voice-supported electronic health record for temporomandibular joint disorders.

OBJECTIVES: To identify support of structured data entry for an electronic health record application in temporomandibular joint disorders. METHODS: The methods of structuring information in dentistry are described and the interactive DentCross component is introduced. A system of structured voice-supported data entry in electronic health record on several real cases in the field of dentistry is performed. The connection of this component to the MUDRLite electronic health record is described. RESULTS: The use of DentVoice, an application which consists of the electronic health record MUDRLite and the voice-controlled interactive component DentCross, to collect dental information required by temporomandibular joint disorders is shown. CONCLUSIONS: The DentVoice application with the DentCross component showed the practical ability of the temporomandibular joint disorder treatment support.

Overdenture - implants versus teeth - quality of life and objective therapy evaluation.

An overdenture is a complete or removable partial denture that has one or more tooth roots or implants to provide a support. The study compares two types of prosthodontic treatment - overdenture supported by remained own teeth with ball attachments and that held by implants. The cohort of 35 patients (recall from 1 to 5 years) was evaluated. When subjectively and objectively assessed no significant difference between both groups was observed.

Forensic dentistry--identification from the dentist's point of view.

The paper deals with an identification of missing persons based on a dental documentation. The procedure of the identification is presented in two case reports with a new possibility of electronic imaging called Dental Cross in comparison with classical dental documentation, which is officially used for identification of the missing persons by Interpol.

Electronic health record for forensic dentistry.

OBJECTIVES: To identify support of structured data entry for electronic health record application in forensic dentistry. METHODS: The methods of structuring information in dentistry are described and validation of structured data entry in electronic health records for forensic dentistry is performed on several real cases with the interactive DentCross component. The connection of this component to MUDR and MUDRLite electronic health records is described. RESULTS: The use of the electronic health record MUDRLite and the interactive DentCross component to collect dental information required by standardized Disaster Victim Identification Form by Interpol for possible victim identification is shown. CONCLUSIONS: The analysis of structured data entry for dentistry using the DentCross component connected to an electronic health record showed the practical ability of the DentCross component to deliver a real service to dental care and the ability to support the identification of a person in forensic dentistry.

The Framingham risk function underestimated absolute coronary heart disease risk in Czech men.

OBJECTIVES: The aim was to validate the Framingham coronary heart disease (CHD) risk function with the formula by Wilson et al. (1998) in Czech men. METHODS: The validation was performed within the 20-year primary prevention study of atherosclerotic risk factors (STULONG) including 1417 middle-aged men from the Czech Republic (Prague). A total of 646 men examined in 1979-1988, and followed-up for ten years, were included into the validation study. The calibration and discrimination ability of the Framingham risk function in the Czech population were explored. RESULTS: The estimated 10-year risk of CHD by the Framingham risk function was 12.8% in 646 men, significantly higher than the observed risk (16.4 %), p = 0.013. The trend in the 10-year incidence of CHD was significantly increasing with quintiles of the estimated risk, p < 0.001. After the recalibration of the Framingham risk function, there was an insignificant difference between the estimated (18.2%) and observed (16.4%) risks of CHD, p = 0.320. The Framingham risk function classified men into those with and without CHD in the 10-year period with accuracy over 60%. CONCLUSIONS: Unlike some validation studies from Western Europe, the Framingham risk function significantly underestimated the 10-year CHD risk in the Czech Republic. In agreement with these studies, the incidence of CHD was significantly increasing across quintiles of the estimated risk.

[Prolactin response to stress in patients with systemic lupus erythematodes (SLE), rheumatoid arthritis (RA) and in healthy controls]. / Stresová odezva prolaktinu u nemocnych se systémovým lupus erythematodes (SLE), revmatoidní artritidou (RA) a u zdravých kontrol.

Prolactin is a one of the stress hormones, like the growth hormone, ACTH, cortisol and catecholamins. Among its wide range of functions is the important role of controlling the immune response which is, unlike in the case of cortisol, of stimulatory nature. For this activity, it is monitored as a factor influencing the progress and course of autoimmune diseases. The authors of the paper monitored prolactin response to stress in a normal stress situation, i.e. blood collection. A significant difference was detected between the levels of prolactin in 3 successive blood collections in 30 minute intervals (P < 0.001). Prolactin responded by a prompt increase in the serum level, followed by a relatively fast linear decrease. There was no difference in the response between the SLE and RA patient groups and the healthy population. Therefore we conclude that this is a normal reaction of the organism because acute response to stress in patients with autoimmune diseases is the same as in healthy persons.

Triangulation applied to Jan H. van Bemmel.

OBJECTIVE: To describe the person of Jan H. van Bemmel from different points of view. METHOD: Triangulation. RESULTS AND CONCLUSIONS: Jan H. van Bemmel successfully contributed to research and education in medical informatics. He inspired a lot of people in The Netherlands and internationally.

Biomedical informatics research and education at the EuroMISE Center.

OBJECTIVES: In the paper we described the partial achievements reached by the EuroMISE Center in research and higher education, supporting better healthcare in future information society. METHODS: Through the research cooperation, the EuroMISE Centre suggests publicly available tools and methods that allow the application of new technologies for various healthcare organizations and citizens, with a special focus on the national environment of the Czech Republic. It provides a platform for a greater level of research cooperation with the usage of the most up-to-date information and communication technologies and a wide spectrum of clinical and genetic data and knowledge. RESULTS: Results of research and higher education of the EuroMISE Centre in the field of Biomedical Informatics are described in outputs of national and European projects. Further results have been published and/or presented at national and international meetings and incorporated in education and healthcare practice. CONCLUSIONS: The long-term effect of postgraduate doctoral education in the field of biomedical informatics consists in the rapid increase of scientists that are needed in the Czech Republic to reach the goals of information society in health care. The multidisciplinary research at the EuroMISE Center moves towards direct usage in the informational support of diagnostics and therapy, mining of the medical databases, and in the customization of healthcare based on the clinical and genetic profile of a patient.

[Intrapartal fetal monitoring, sensitivity and specificity of methods]. / Intrapartální fetální monitoring, senzitivita a specificita metod.

OBJECTIVE: To evaluated sensitivity and specificity of presently used methods for intrapartal monitoring (CTG, FpO2 a STAN S-21) and their mutual comparison. TYPE OF STUDY: A prospective study. SETTING: Gynecological-Obstetrical Clinic, 1st Medical Faculty, Charles University and general Teaching Hospital, Prague. METHOD: In 114 pregnant women with high-risk or pathological course of pregnancy the authors evaluated the capability of individual methods to predict intrapartal hypoxia, determined on the basis of postnatal evaluation of parameters observed (Apgar score in 1st minute, pH from umbilical artery, lactate levels in fetal blood, base excess (BE) and postpartum condition of fetus evaluated by a neonatologist). Each method was categorized according to its importance. The quality of individual methods was evaluated by means of their sensitivity and specificity as well as by the area under ROC (Receiver Operating Characteristic), i.e. AUC (Area under Curve). A similar or different prediction of the condition of the newborn by these individual methods was evaluated by the McNamara test of symmetry. In 50 deliveries performed by Cesarean section and 24 forceps deliveries the authors evaluated postnatal pH from umbilical artery and evaluation by Chi-square test. The women in childbed were infused with a tocolytic drug (hexoprenalin) before Cesarean section. All tests were performed at 5% level of significance. RESULTS: Low level of Apgar score in the 1st minute and less) always indicated CTG, but also a large proportion of normal newborns. STAN, in contrast, well indicates all newborns with a normal point evaluation. The best balanced evaluation of the newborns is provided by FpO2 and there was a significant difference between CTG and FpO2. In evaluating pH from the umbilical artery (pH < 7.20), TCG proved to be most sensitive again but displayed low specificity. STAN was the best predictor of newborns with normal pH. In evaluating high levels of lactate (> 3.7mmol/L) and BE (> -10) and related demonstration of metabolic acidosis STAN proved to be the best predictor. The condition of the newborn evaluated by a neonatologist immediately after birth (medium or heavy depression) was best predicted by FpO2. In deliveries performed by Cesarean section and after the administration of tocolysis the postnatal pH was higher then in forceps deliveries without acute tocolysis. The occurrence of emergencies in the course of a pathological delivery in individual methods is as follows: CTG, FpO2 and STAN. CONCLUSION: Even though CTG displays a very low specificity, this method should not be rejected, since it draws attention of the obstetrician very early to the possibility of developing hypoxia. FpO2 or STAN gives more precision to the situation and demarcates a correct moment for ending the delivery for the indication of fetus hypoxia intra partum. STAN is the best predictor for conditions of developing metabolic acidosis, evaluated postnatally by the level of lactate and BE in fetal blood.

Comparison of FK 506, mycophenolate mofetil, and aminoguanidine effects on delay of corneal allograft rejection in an experimental model of low-risk and high-risk keratoplasty.

The purpose of our study was to compare the effectiveness of immunosuppressive drugs on the prevention of allograft rejection in a murine model of low-risk and high-risk keratoplasty. The therapy included FK 506 (tacrolimus; 0.2 mg/kg), mycophenolate mofetil (30 mg/kg), aminoguanidine (0.1 g/kg), and combination of FK506 + mycophenolate mofetil or FK506 + aminoguanidine. The results obtained from the Gray's survival model stratified according to the type of subjects suggest that a major rejection risk reduction was achieved using FK506; good results also were obtained for mycophenolate mofetil. Although the point estimates of both the survival and relative risk of rejection suggest a deferred effect of the combination FK506 + mycophenolate mofetil, this finding did not prove statistically significant.

[Primary prevention of ischemic heart disease in middle-aged men living in Prague: results of twenty-year research]. / Primární prevence ischemické choroby srdecní u muzu stredního veku v Praze: výsledky dvacetiletého sledování.

INTRODUCTION: Ischemic Heart Disease (IHD) represents the most frequent cause of mortality and morbidity in the Czech Republic. The aim of this study is to analyze long-term mortality of cardiovascular disease (CVD), identify its predictors and verify the validity of Framingham risk function for Czech patients. DESIGN AND METHODS: The twenty-year study (STULONG) of primary prevention of risk factors of atherosclerosis in 1419 men aged 38 to 53 years living in Prague was started in 1975. RESULTS: CVD mortality analysis showed a higher risk of death for heavy smokers vs. non-smokers or light smokers (p < 0.0001), hypertensive patients vs. patients with normal blood pressure (p < 0.0001), men with hypercholesterolemia vs. men with normal cholesterol level (p = 0.0432), and a lower risk for university graduates vs. men with elementary education (p = 0.0006). Between 1980 and 1984, age-specific CVD mortality rates of men from STULONG study were higher (p = 0.0132) than national CVD mortality rates; between 1985 and 1994, they were insignificantly lower. Framingham risk function underestimated absolute ten-year risk of IHD in all risk quintiles (p < 0.0001) with discrimination of 63%. CONCLUSION: CVD mortality observed within STULONG study was significantly affected by known risk factors (hypertension, smoking, hypercholesterolemia, lower education); Framingham risk function underestimated absolute ten-year risk of IHD.

The new features of the ExaMe evaluation system and reliability of its fixed tests.

OBJECTIVES: The ExaMe system for the evaluation of targeted knowledge has been in development since 1998. The new features of the ExaMe system are introduced in this paper. Especially, the new three-layer architecture is described. Besides the system itself, the properties of fixed tests in the ExaMe system are studied. In special detail, the reliability of the fixed tests is discussed. The theory background is explained and some limitations of the reliability are pointed out. METHODS FOR ESTIMATION OF THE RELIABILITY: Three characteristics used for estimation of reliability of educational tests are discussed: Cronbach's alpha, standardized item alpha and split half coefficient. The relation between these characteristics and reliability and between characteristics themselves is investigated. In more detail, the properties of Cronbach's alpha, the characteristics mostly used for the estimation of reliability, are discussed. A confidence interval is introduced for the characteristics. RESULTS AND CONCLUSIONS: Since 2000, the serviceability of the ExaMe evaluation system as the supporting evaluation tool has been repeatedly shown at the courses of Ph.D. studies in biomedical informatics at Charles University in Prague. The ExaMe system also opens new possibilities for self-evaluation and distance learning, especially when connected with electronic books on the Internet. The estimation of reliability of tests contains some limitations. Keeping them in mind, we can still get some information about the quality of certain educational tests. Therefore, the estimation of reliability of the fixed tests is implemented in the ExaMe system.