Metabolický syndrom (MetS) představuje komplexní soubor různých metabolických poruch, které zahrnují abdominální obezitu, poruchu lipidů, zvýšený krevní tlak a zvýšenou glykemii nalačno a které ve vzájemné interakci představují významné rizikové faktory pro řadu onemocnění, včetně onemocnění močového traktu. Řada dokladů naznačuje, že MetS a jeho individuální komponenty predisponují nejen ke vzniku maligních onemocnění, jakými jsou karcinom ledvin, prostaty, ureteru či močového měchýře, ale také dalších onemocnění urologického charakteru, jakými jsou urolitiáza, benigní hypertrofie prostaty, mužský hypogonadismus či erektilní dysfunkce. Některé patofyziologické mechanismy či paradoxní nálezy nejsou v současnosti dostatečně objasněny a vyžadující další výzkum. Z klinického hlediska je důležitý poznatek, že pro úspěšnou prevenci a řešení řady urologických onemocnění může být často potřebná taková mezioborová spolupráce, která povede k léčbě a úpravě predisponujících rizikových metabolických faktorů vedoucích ke vzniku těchto onemocnění.

Metabolic syndrome (MetS) is a complex unit of various metabolic disorders, inclu­ding abdominal obesity, dyslipidemia, elevated blood pressure and increased fasting glycemia, which act in mutual interplay as important risk factors for multiple diseases, including disorders of urinary tract. Increasing body of evidence suggest that MetS and its individual components predispose not only to the development of malignant tumors notably carcinoma of kidney, prostate, ureter or urinary bladder but also to the development of other urological diseases, such as urolithiasis, benign prostate hypertrophy, male hypogonadism or erectile dysfunction. Some patophysiological mechanisms or paradoxal findings are not currently sufficiently understood and require further research. From a clinical point of view it is important to respect the fact, that for successfull prevention and management of multiple urological disorders an increased interdisciplinary cooperation aimed to treat and decrease predisposing risk metabolic factors is required.

Úvod: Mnohé štúdie a metaanalýzy preukázali, že telemonitorovanie krvného tlaku ako aj iných faktorov metabolického syndrómu môže zlepšiť ich manažment. Avšak mnoho pacientov nevyužíva telemonitorovanie kvôli osobným, technologickým a iným bariéram. Cieľom tejto štúdie bolo zistenie aké sú perspektívy a prekážky telemonitoringu lipitenzie na Slovensku z pohľadu pacienta. Metódy: Táto štúdia bola realizovaná ako dotazníková a mala za cieľ osloviť 2 545 pacientov. Dotazník pozostával z častí zameraných na osobné charakteristiky pacienta, návyky z hľadiska merania krvného tlaku (TK), na využívanie smart-technológií, ich predpokladané prínosy a prekážky z hľadiska pacienta ako aj na znalosť lipidového profilu a kardiovaskulárneho rizika samotným pacientom. Výsledky: Celkovo sme získali 252 odpovedí od pacientov (9,9 %). Z celkového počtu opýtaných má arteriálnu hypertenziu 67,4 %, kým nefarmakologickú terapiu užíva 7,9 %. Denne si TK meria len 21,2 % hypertonikov, signifikantne vyšší počet mužov ako žien (p = 0,011) a najčastejšie si meria TK veková kategória 31–45 rokov. Až 19,4 % využíva nositeľné zariadenia a 6,3 % tlakomery prepojené s aplikáciou. Signifikantne častejšie smart-technológie využíva kategória 31–45-ročných (p = 0,01). Závažné prekážky využitia smart-technológií neboli identifikované, väčšina si vyžadovala funkciu vzdialených konzultácií, úpravy liekov a jednoduché užívateľské rozhranie. Väčšina pacientov nevie svoju hodnotu LDL-cholesterolu a až 45,7 % tých čo vie, malo zvýšené hladiny. Záver: Celkovo prevláda záujem o využitie metód telemedicíny krvného tlaku, pri jej implementácii na Slovensku bude však nutná spolupráca pacienta a lekára.

Introduction: Numerous studies and meta-analyses have demonstrated that telemonitoring of blood pressure and other factors of metabolic syndrome can improve their management. However, many patients do not use telemonitoring due to personal, technological, and healthcare barriers. The aim of this study was to identify the perspectives and barriers to telemonitoring of lipid levels in Slovakia from the patient’s point of view. Methods: This study was conducted as a questionnaire-based survey targeting 2,545 patients. The questionnaire consisted of sections focused on patients’ personal characteristics, habits regarding blood pressure measurement, the use of smart technologies, their perceived benefits and barriers, as well as the patients’ knowledge of their lipid profile and cardiovascular risk. Results: A total of 252 responses were obtained (9.9 % response rate). Among the respondents, 67.4 % had hypertension, while 7.9 % were on non-pharmacological therapy. Only 21.2 % of hypertensive patients measured their blood pressure daily, with a significantly higher proportion of men compared to women (p = 0.011), and the most frequent blood pressure monitoring was observed in the 31–45 age group. A total of 19.4 % used wearable devices, and 6.3 % used blood pressure monitors connected to an app. Smart technology use was significantly more common in the 31–45 age group (p = 0.01). No severe barriers to the use of smart technologies were identified; most patients required features such as remote consultations, medication adjustments, and user-friendly interfaces. The majority of patients were unaware of their LDL-C values, and 45.7 % of those who were aware had elevated levels. Conclusion: There is a prevailing interest in implementing telemedicine methods for blood pressure monitoring. However, collaboration between patients and physicians will be necessary for its successful implementation in Slovakia.

• MeSH
• Digital Health MeSH
• Dyslipidemias prevention & control   MeSH
• Hypertension * epidemiology   prevention & control   MeSH
• Humans MeSH
• Blood Pressure Determination methods   MeSH
• Surveys and Questionnaires MeSH
• Heart Disease Risk Factors MeSH
• Statistics as Topic MeSH
• Telemedicine * methods   MeSH
• Check Tag
• Humans MeSH
• Geographicals
• Slovakia MeSH

Pulse Wave Velocity (PWV) is widely used to assess arterial elasticity and is an independent risk factor for cardiovascular disease, but it is influenced by multiple factors. Objective is to assess the impact of blood pressure and heart rate on PWV. Twenty healthy young individuals were enlisted as subjects. Real-time blood pressure monitoring was performed by non-invasive continuous blood pressure measuring instrument during the detection of subjects' carotid PWV. During real-time blood pressure monitoring, exercise load caused fluctuations in blood pressure and heart rate, and PWV changes of each subject under different blood pressure and heart rate conditions were recorded simultaneously. Among the 20 subjects, PWV was associated with blood pressure in four subjects and heart rate in one subject. PWV increased with rising blood pressure when the systolic pressure fluctuation range was >=30mmHg, diastolic pressure fluctuation range was >=18mmHg, and mean arterial pressure fluctuation range was >=20mmHg. PWV increased with rising heart rate, when the heart rate fluctuation range was >30 beats/min. Blood pressure and heart rate have some influence on PWV. However, the fluctuation range of blood pressure and heart rate should reach a certain value, the impact is significant. Keywords: Pulse wave velocity, Blood pressure, Heart rate.

• MeSH
• Pulse Wave Analysis * methods   MeSH
• Adult MeSH
• Blood Pressure * physiology   MeSH
• Humans MeSH
• Blood Pressure Determination methods   MeSH
• Young Adult MeSH
• Heart Rate * physiology   MeSH
• Vascular Stiffness physiology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Kontext: Endotelová dysfunkce (ED) je jedním z hlavních mechanismů rozvoje různých kardiovaskulárních onemocnění. Endotelová dysfunkce je spojena s obezitou a hypertenzí, což se odráží v nízkých hodnotách průtokem stimulované dilatace tepny (flow-mediated dilatation, FMD) a vysokých hodnotách endotelinu-1 (ET-1) u dospělých osob a starších. Méně se ví o hodnotách uvedených dvou parametrů u adolescentů. Cílem této studie bylo srovnat hodnoty FMD a ET-1 obézních adolescentů s hypertenzí, obézních adolescentů bez hypertenze a u adolescentů s normální tělesnou hmotností. Metoda: Celkem 72 indonéských adolescentů průměrného věku 195 (178–217) měsíců, převážně chlapců (61 %), bylo zařazeno do tří následujících skupin: obezita s hypertenzí (n = 21), obezita bez hypertenze (n = 19) a bez obezity a bez hypertenze (n = 32). Hodnota FMD se měřila na pažní tepně po vyvinutí zvýšeného systolického tlaku na předloktí po dobu pěti minut. Hodnoty ET-1 se měřily metodou ELISA v sendvičovém uspořádání. Výsledek: Medián hodnoty ET-1 byl 42 (2,4–384) pg/ml. Mezi skupinami však nebyly nalezeny žádné významné rozdíly v hodnotách ET-1 (p 0,269). I když byly hodnoty FMD podle deskriptivní analýzy vyšší u zdravých adolescentů, nebyly zjištěny žádné statisticky významné rozdíly (p 0,159) v hodnotách FMD ve skupinách obezita s hypertenzí (9,1 ± 5 %), obezita bez hypertenze (8,3 ± 3,1 %) a bez obezity a bez hypertenze (10,9 ± 6,2 %). Srovnání hodnot ET-1 mezi skupinami s ED a bez ED (mezní hodnota FMD 7,1 %) nevykázalo žádné rozdíly (p 0,77). Navíc hodnoty ET-1 nekorelovaly statisticky významně s hodnotami FMD (p 0,66, r –0.053). Závěr: U indonéských adolescentů s obezitou a hypertenzí, obezitou bez hypertenze a s normální tělesnou hmotností a bez hypertenze nebyly zjištěny žádné rozdíly v hodnotách ET-1 a FMD. Korelace mezi ET-1 a FMD není u adolescentů statisticky významná.

Background: Endothelial dysfunction (ED) is one of the major mechanisms in various cardiovascular dis- eases. ED is associated with obesity and hypertension, which is reflected by low flow-mediated dilatation (FMD) value and high endothelin-1 (ET-1) level in adults or older. However, their value in adolescents is less known. This study aims to compare the FMD and ET-1 between obesity with hypertension, obesity without hypertension, and normal adolescents. Method: A total of 72 Indonesian adolescents with a mean age of 195 (178-217) months and dominated by males (61%) were classified into the three following groups obesity with hypertension (n = 21), obesity with- out hypertension (n = 19), and normal (n = 32) adolescents. FMD was measured using the brachial artery by previously applied supra systolic pressure in the forearm in 5 minutes. ET-1 was measured by Sandwich ELISA. Results: The median ET-1 level was 42 (2.4-384) pg/mL. However, there are no significant differences in ET-1 levels between all groups (p 0.269). Although FMD values are descriptively higher in normal adolescents, however, there are no statistical differences (p 0.159) in FMD values between obese with hypertension (9.1 ± 5%), obese without hypertension (8.3 ± 3.1%), and normal (10.9 ± 6.2%) groups. Comparison of ET-1 levels between groups with ED and without ED (FMD cut-off 7.1%) showed no differences (p 0.77) among them. In addition, ET-1 was not significantly correlated with FMD (p 0.66, r -0.053). Conclusion: There are no differences in ET-1 and FMD values between obesity with hypertension, obesity without hypertension, and normal Indonesian adolescents. The correlation between ET-1 and FMD is not significant in adolescents.

• MeSH
• Brachial Artery pathology   MeSH
• Dilatation, Pathologic etiology   blood   MeSH
• Endothelium physiopathology   MeSH
• Endothelin-1 * blood   MeSH
• Hypertension complications   blood   MeSH
• Humans MeSH
• Adolescent MeSH
• Pediatric Obesity * complications   blood   MeSH
• Statistics as Topic MeSH
• Check Tag
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Clinical Study MeSH
• Research Support, Non-U.S. Gov't MeSH

Obstructive sleep apnea increases morbidity and mortality risks. The most common treatment is continuous positive airway pressure, with nasal mask usage being important, but not always optimal. While most research on treatment adherence focuses on the patient, the bed partner's involvement may be detrimental. Our study aim is to obtain a European-wide picture of the bed partner's attitude and support towards continuous positive airway pressure therapy, including effects on relationship satisfaction and intimacy. The English translation of a German bed partner questionnaire, assessing relationship satisfaction and three major components (general attitude, perceived mask looks, intimacy effects) was distributed within the European Sleep Apnea Database Network and translated in participating countries' local language. Data were collected for 2 years. In total, 10 European countries (13 sleep centres) participated with 1546 questionnaires. Overall, 91% of bed partners had a positive attitude towards continuous positive airway pressure therapy, 86% perceived mask looks not negative, 64% stated no negative intimacy effects. More specifically, 71% mentioned improved sleep quality, 68% supported nightly device usage. For 41% of bed partners, relationship satisfaction increased (no change for 47%). These results were significantly more pronounced in Eastern/Southern Europe compared with Middle Europe, especially regarding intimacy effects. However, increased continuous positive airway pressure therapy length affected attitude negatively. These results provide necessary information to improve treatment strategies by including educational couple-focused approaches. Among others, we revealed that negative intimacy effects are not considered a barrier to continuous positive airway pressure adherence. These results may inspire more research identifying regional gaps with need for treatment adjustments.

• MeSH
• Adult MeSH
• Interpersonal Relations MeSH
• Middle Aged MeSH
• Humans MeSH
• Sleep Apnea, Obstructive * therapy   psychology   MeSH
• Personal Satisfaction * MeSH
• Perception MeSH
• Surveys and Questionnaires MeSH
• Aged MeSH
• Sexual Partners psychology   MeSH
• Continuous Positive Airway Pressure * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe MeSH

Aim: The supply of medical aids and training in their use are essential for home mechanically ventilated (HMV) children and their parents. Design: A qualitative interview study was performed to gain deeper insights into parents' views and to derive sound recommendations for designing this form of care with the most common need for multiple medical aids (devices and accessories). Methods: Twelve problem-centred interviews were conducted with parents of children receiving HMV and subjected to qualitative content analysis. Results: Parents found ventilation-specific medical devices and accessories to be generally reliable, but not always well designed for children or well selected. Parents also identified challenges and problems regarding structural, procedural and personal aspects of the supply of medical aids. In particular, deficits in task performance and cooperation between stakeholders and involved healthcare institutions became apparent. When parents or home care nurses lacked competence in using the technology, unsafe situations easily arose. Conclusion: The study highlighted the need for further developments in the supply of ventilation-associated medical aids. Furthermore, the need for qualified professionals and for educational strategies to promote safety amongst parents as users of medical aids in home care became clear.

• MeSH
• Home Nursing * methods   MeSH
• Qualitative Research MeSH
• Humans MeSH
• Caregivers psychology   MeSH
• Child Care * methods   MeSH
• Parents psychology   MeSH
• Social Support psychology   MeSH
• Positive-Pressure Respiration * methods   nursing   instrumentation   MeSH
• Patient Education as Topic methods   MeSH
• Health Facilities supply & distribution   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

Nitric oxide (NO)-stimulated cyclic guanosine monophosphate (cGMP) is a key regulator of cardiovascular health, as NO-cGMP signalling is impaired in diseases like pulmonary hypertension, heart failure and chronic kidney disease. The development of NO-independent sGC stimulators and activators provide a novel therapeutic option to restore altered NO signalling. sGC stimulators have been already approved for the treatment of pulmonary arterial hypertension (PAH), chronic thromboembolic pulmonary hypertension (CTEPH), and chronic heart failure (HFrEF), while sGC activators are currently in phase-2 clinical trials for CKD. The best characterized effect of increased cGMP via the NO-sGC-cGMP pathway is vasodilation. However, to date, none of the sGC agonists are in development for hypertension (HTN). According to WHO, the global prevalence of uncontrolled HTN continues to rise, contributing significantly to cardiovascular mortality. While there are effective antihypertensive treatments, many patients require multiple drugs, and some remain resistant to all therapies. Thus, in addition to improved diagnosis and lifestyle changes, new pharmacological strategies remain in high demand. In this review we explore the potential of sGC stimulators and activators as novel antihypertensive agents, starting with the overview of NO-sGC-cGMP signalling, followed by potential mechanisms by which the increase in cGMP may regulate vascular tone and BP. These effects may encompass not only acute vasodilation, but also mid-term and chronic effects, such as the regulation of salt and water balance, as well as mitigation of vascular ageing and remodelling. The main section summarizes the preclinical and clinical evidence supporting the BP-lowering efficacy of sGC agonists.

• MeSH
• Guanylyl Cyclase C Agonists therapeutic use   pharmacology   MeSH
• Enzyme Activators therapeutic use   pharmacology   MeSH
• Antihypertensive Agents * therapeutic use   pharmacology   MeSH
• Cyclic GMP * metabolism   MeSH
• Hypertension * drug therapy   physiopathology   MeSH
• Humans MeSH
• Nitric Oxide metabolism   MeSH
• Soluble Guanylyl Cyclase * metabolism   MeSH
• Signal Transduction drug effects   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

AIMS: Retinoids participate in multiple key processes in the human body e.g., vision, cell differentiation and embryonic development. There is growing evidence of the relationship between retinol, its active metabolite- all-trans retinoic acid (ATRA) - and several pancreatic disorders. Although low levels of ATRA in pancreatic ductal adenocarcinoma (PDAC) tissue have been reported, data on serum levels of ATRA in PDAC is still limited. The aim of our work was to determine serum concentrations of retinol and ATRA in patients with PDAC, type-2 diabetes mellitus (T2DM), chronic pancreatitis (CHP) and healthy controls. METHODS: High performance liquid chromatography with UV detection (HPLC) was used to measure serum levels of retinol and ATRA in 246 patients with different stages of PDAC, T2DM, CHP and healthy controls. RESULTS: We found a significant decrease in the retinol concentration in PDAC (0.44+/-0.18 mg/L) compared to T2DM (0.65+/-0.19 mg/L, P<0.001), CHP (0.60+/-0.18 mg/L, P< 0.001) and healthy controls (0.61+/-0.15 mg/L, P<0.001), significant decrease of ATRA levels in PDAC (1.14+/-0.49 ug/L) compared to T2DM (1.37+/-0.56 ug/L, P<0.001) and healthy controls(1.43+/-0.55 ug/L, P<0.001). Differences between early stages (I+II) of PDAC and non-carcinoma groups were not significant. We describe correlations between retinol, prealbumin and transferrin, and correlation of ATRA and IGFBP-2. CONCLUSION: Significant decrease in retinol and ATRA levels in PDAC compared to T2DM, healthy individuals and/or CHP supports existing evidence of the role of retinoids in PDAC. However, neither ATRA nor retinol are suitable for detection of early PDAC. Correlation of ATRA levels and IGFBP-2 provides new information about a possible IGF and retinol relationship.

• MeSH
• Pancreatitis, Chronic * metabolism   blood   MeSH
• Diabetes Mellitus, Type 2 * metabolism   MeSH
• Adult MeSH
• Carcinoma, Pancreatic Ductal metabolism   MeSH
• Middle Aged MeSH
• Humans MeSH
• Pancreatic Neoplasms * metabolism   blood   MeSH
• Aged MeSH
• Case-Control Studies MeSH
• Tretinoin * metabolism   blood   MeSH
• Vitamin A * blood   metabolism   MeSH
• Chromatography, High Pressure Liquid MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Major depressive disorder (MDD) is a mental illness with a high worldwide prevalence and suboptimal pharmacological treatment, which necessitates the development of novel, more efficacious MDD medication. Nuclear magnetic resonance (NMR) can non-invasively provide insight into the neurochemical state of the brain using proton magnetic resonance spectroscopy (1H MRS), and an assessment of regional cerebral blood flow (rCBF) by perfusion imaging. These methods may provide valuable in vivo markers of the pathological processes underlying MDD. METHODS: This study examined the effects of the chronic antidepressant medication, citalopram, in a well-validated MDD model induced by bilateral olfactory bulbectomy (OB) in rats. 1H MRS was utilized to assess key metabolite ratios in the dorsal hippocampus and sensorimotor cortex bilaterally, and arterial spin labelling was employed to estimate rCBF in several additional brain regions. RESULTS: The 1H MRS data results suggest lower hippocampal Cho/tCr and lower cortical NAA/tCr levels as a characteristic of the OB phenotype. Spectroscopy revealed lower hippocampal Tau/tCr in citalopram-treated rats, indicating a potentially deleterious effect of the drug. However, the significant OB model-citalopram treatment interaction was observed using 1H MRS in hippocampal mI/tCr, Glx/tCr and Gln/tCr, indicating differential treatment effects in the OB and control groups. The perfusion data revealed higher rCBF in the whole brain, hippocampus and thalamus in the OB rats, while citalopram appeared to normalise it without affecting the control group. CONCLUSION: Collectively, 1H MRS and rCBF approaches demonstrated their capacity to capture an OB-induced phenotype and chronic antidepressant treatment effect in multiple brain regions.

• MeSH
• Olfactory Bulb metabolism   surgery   drug effects   MeSH
• Citalopram * pharmacology   MeSH
• Depression drug therapy   metabolism   MeSH
• Depressive Disorder, Major drug therapy   metabolism   MeSH
• Hippocampus metabolism   drug effects   MeSH
• Rats MeSH
• Magnetic Resonance Spectroscopy methods   MeSH
• Disease Models, Animal * MeSH
• Brain * metabolism   drug effects   MeSH
• Cerebrovascular Circulation * drug effects   MeSH
• Rats, Sprague-Dawley MeSH
• Proton Magnetic Resonance Spectroscopy MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

Úvod: Arteria profunda femoris (APF) je důležitou tepnou, která v případě postižení arteria femoralis superficialis (AFS) zabezpečuje perfuzi tkání dolní končetiny přes tzv. kolaterální řečiště. Izolovaná angiochirurgická rekonstrukce, plastika APF (profundoplastika), je ve vědecké literatuře diskutovaným tématem, co se týče významu kolaterálního řečiště a jeho přínosu ke zlepšení klinického stavu pacienta. Cílem projektu je zhodnotit dopad izolované profundoplastiky na zlepšení prokrvení dolní končetiny, a tím přispět v rozhodovacím procesu indikace tohoto typu výkonu. Metodika: Do této prospektivní monocentrické studie byli zahrnuti pacienti se symptomatickou ischemickou chorobou dolních končetin (ICHDK) ve stadiu klaudikačních potíží, klidových bolestí nebo s tkáňovým defektem hodnoceným dle Rutherfordovy klasifikace stupněm 1 až 5. Kritériem pro zařazení byla významná stenóza APF s konkomitantním uzávěrem AFS a insuficientním výtokem pro bypass. S odstupem jednoho a šesti měsíců od výkonu byly hodnoceny změny klaudikačního intervalu, Rutherfordova klasifikace a přítomnost chronické končetinu ohrožující ischemie (CLTI). Měření transkutánní tenze kyslíku (TcpO 2 ) bylo využito k objektivizaci úrovně perfuze a oxygenace tkání. Výsledky: V průběhu dvou let byla profundoplastika provedena u 45 pacientů – u 23 pacientů klaudikantů a 22 pacientů s CLTI (9 s klidovou bolestí, 13 s ischemickým defektem). Ve skupině klaudikantů došlo k prodloužení klaudikačního intervalu ze 128 m před operací na 505 m po šesti měsících od revaskularizace. Ve skupině CLTI došlo k signifikantnímu zlepšení a vymizení klidových bolestí u všech pacientů, což bylo objektivizováno zlepšením TcpO 2 na bérci o 52 % na hodnotu 52 mm Hg a na dorzu chodidla o 143 % na hodnotu 35,8 mm Hg. Ovlivnění osudu těžších forem CLTI jenom izolovanou profundoplastikou je již obtížnější úkol a i tak došlo ke zhojení akrálního ischemického defektu u 61,5 % pacientů s přežitím bez potřeby amputace (amputation free survival) po šesti měsících 76 %, kdy tři pacienti v průběhu sledování podstoupili vysokou amputaci ve stehně. U pacientů s defektem byl pooperačně také pozorován nárůst hodnot TcpO 2 , kdy na bérci a nártu došlo k 1,3- a 1,6násobnému zvýšení hodnot (na 43 mm Hg, resp. 27 mm Hg). Závěr: Profundoplastika jako izolovaná procedura revaskularizace pacientů s ICHDK je nadále metodou volby u selektivní skupiny pacientů. Dle naší studie je nejefektivnější k léčbě klidových bolestí nebo k prodloužení klaudikačního intervalu, ale může přispět i k hojení menších akrálních defektů. V literatuře absentující konsenzus na tzv. TcpO 2 threshold pro hojení defektů byl naší studií pozorován při hodnotě 27 mm Hg, resp. 35,8 mm Hg pro vymizení klidových bolestí.

Introduction: Profunda femoris artery (PFA) is an important artery that provides perfusion of the lower limb tissues via collateral circulation in case of superficial femoral artery (SFA) occlusion. Isolated angiovascular reconstruction, APF reconstruction (profundoplasty), is a debated topic in the scientific literature regard- ing the importance of collateral circulation and its contribution to improving the patient's clinical condi- tion. This project aims to evaluate the impact of isolated profundoplasty on the improvement of lower limb perfusion and thus to contribute to the decision-making process for the indication of this type of procedure. Methods: This prospective single-center study enrolled patients with peripheral artery disease (PAD) in the stage of claudication, rest pain or presence of tissue foot ulcer assessed according to Rutherford classification grade 1 to 5. Inclusion criteria were significant AFP stenosis with concomitant AFS closure and no distal runoff to the feet. Changes in claudication interval, Rutherford classification, and presence of chronic limb-threatening ischemia (CLTI) were assessed at one and six months after surgery. Transcutaneous oxygen tension (TcpO2 ) was measured to objectify the tissue perfusion and oxygenation level. Results: During two years, profundoplasty was performed in 45 patients, 23 claudicants, and 22 CLTI patients (9 with rest pain, 13 with foot ulcer). The claudicant group’s intermittent claudication interval was prolonged from average 128 metres (m) preoperatively to 505 m six months after revascularization. In the CLTI group, there was a significant improvement and disappearance of rest pain in all patients, which was objectified by an improvement in TcpO2 on the calf by 52% to 52 mmHg and on the dorsum of the foot by 143% to 35.8 mmHg. Controlling the fate of more severe forms of CLTI by isolated profundoplasty alone is already a more difficult task, and even so, healing of the acral ischemic defect occurred in 61.5% of patients with amputation free survival at six months of 76%, with three patients undergoing high amputation in the thigh during follow-up. Postoperatively, an increase in TcpO 2 values was also observed in patients with the foot ulcer, with 1.3 and 1.6 times increases in the tibia and calcaneus (to 43 mmHg and 27 mmHg, respectively). Conclusion: Profundoplasty as an isolated procedure for revascularization of patients with PAD remains the method of choice in a selective group of patients. Our study shows it is the most effective for treating rest pain. However, it may contribute to healing of smaller acral ulcers or prolong the claudication interval. The lack of consensus in the literature on the so-called TcpO2 threshold for defect healing was observed by our study at 27 mmHg and 35.8 mmHg for resolution of rest pain, respectively.

• Keywords
• profundoplastika,
• MeSH
• Chronic Limb-Threatening Ischemia * surgery   pathology   MeSH
• Lower Extremity surgery   blood supply   pathology   MeSH
• Intermittent Claudication surgery   etiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Prospective Studies MeSH
• Aged MeSH
• Statistics as Topic MeSH
• Blood Gas Monitoring, Transcutaneous methods   instrumentation   statistics & numerical data   MeSH
• Vascular Surgical Procedures * methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Clinical Study MeSH
• Research Support, Non-U.S. Gov't MeSH