By Q. Mortis. University of North Carolina at Chapel Hill. 2019.
The internal synchro- Chrononutrition nization provided by circadian clocks may be altered by Chronotherapy many factors discount nizagara 50 mg mastercard, one of which is aging order nizagara 100mg without a prescription. During aging purchase nizagara 100mg without prescription, any disturbance or imbalance in the Chronobiological relationship between the circadian and homeostatic systems + balance may lead to the impairment of numerous physiological processes generic nizagara 100 mg mastercard. The vast major- all compounds with powerful antioxidant properties [23, ity of studies have focused on examining the homeostatic 29, 47]. The administration of tryptophan increases the regulation of the quantity and quality of food ingested. Tem- ulatory, anti-infammatory, and chronobiotic properties [50 poral aspects of this regulation have been far less studied 52]. Since these are functions with a circadian rhythmicity, they Knowledgeofthenatureandfunctionofbiological deteriorate during aging with the weakening of overt circa- rhythms is of practical as well as theoretical interest. Tat meal timing has major efects on refected in the growing number of applications of chronobi- thebodyhasledtotheconvictionthat,inchoosingfood,it ology published in the recent health sciences literature. One is not only convenient to consider its nutritional value, but such novel area of research is chronopharmacology. This is also its capacity to promote or hinder the normal functioning focused on the design and evaluation of drug delivery systems of the circadian cycles control systems (Table 1). In humans, that release a bioactive agent at a rhythm matching the bio- alterations have been detected in the overall expression of logical requirements of the treatment of a given disease . Compared drugs in order to synchronize the rhythms in disease activity with a control diet high in carbohydrates and low in fat, with the efcacy of a particular drug, thus allowing for its a very low carbohydrate, fat-rich diet has been found to optimal efcacy in the patient. However, the evidence on whether carbohydrates positively impact sleep quality is not completely consistent, since consuming carbohydrate mealswithhighorlowglycaemicloadsseemsnottoafect 3. Basis of Chrononutrition: Health Benefits any polysomnographically determined sleep index . Feeding behaviour is the frst element to nutrients can entrain the circadian rhythm, diet design must 4 Oxidative Medicine and Cellular Longevity Table 1: Examples of antioxidant requirements according to chrononutrition principles. Tese ideas can the modulation of the immune and infammatory systems, be subsumed under the concept of chrononutrition. This helping to prevent infectious and infammatory diseases in concept refects that it is not only the content of food, the elderly . Finally, in 1997 the most signifcant phenol butalsothetimeofingestionandtheinteractionsofits in red wine, trans-resveratrol, was shown to prevent carcino- nutritional components which naturally contribute to the genesis in mice . Since then, this phytochemical has been proper functioning of the circadian system. Harmans free radical theory of aging posits that specifc health benefts of resveratrol range from 5 mg to oxidized macromolecules accumulate with age, resulting in 5 g, and some have considered additional compounds with decreased function and shortened life span . A major critical limitation reduction of oxidative stress has been found to be associated of most of the clinical research on resveratrol has been the with prolongation of life expectancy in many organisms [58 lack of trials examining the longer-term health efects of this 60]. Teexampleswehavebriefydiscussedaboveare oxidative stress, thereby strengthening the bodys antioxidant just a few of the more than several thousands of bioactive defences, can reduce the rate of aging and the risk of age- compounds that have been identifed in foodstufs from all associated diseases . Few of them have taken The possibility that mammalian life span could be signif- into account the chrononutritional properties responsible for icantly extended by diet modifcation was frst demonstrated the efectiveness of such compounds. In humans, the type inarodentstudypublishedbyMcCayandcoworkersin of food (macronutrient) is a temporally controlled variable. This seminal experiment showed that life span can be Once the nutrient enters the bloodstream, it may resemble extended by diet restriction without malnutrition, as opposed the behaviour of a drug. It is thus subject to the principles of to diet restriction with malnutrition which can have the chronopharmacology, the most important of which is that the opposite efect . Not only diet restriction, but also dietary time of day infuences both benefcial and unwanted efects. This is particularly the case in combating a variety of disorders and diseases in which there is an elevated production of free radicals . The antioxidant efects of these compounds have been demonstrated both in animal models and in humans. This augmentation was positively correlated with increases in Time of the day serum antioxidant capacity in both rats (Rattus norvegicus, a nocturnal animal) and ringdove (Streptopelia risoria,a Melatonin diurnal animal) and in both young and old age groups. Blacklines infammatory cytokines, especially in the old animals, by represent normal circadian patterns of melatonin and serotonin downregulating the levels of proinfammatory cytokines and secretion, while grey lines show a disturbed pattern due to aging upregulating those of anti-infammatory cytokines . Aging beverage may be attributed to the high melatonin content is a complex process. It is related to circadian rhythm disrup- of the Jerte Valley cherry, although the involvement of other tion with the resulting sleep disturbances andotherphys- antioxidants, such as polyphenols, cannot be ruled out. Tese include Given these results with animal models, tests were con- impaired nutrient absorption [94, 95], immunosenescence ducted with humans. It was found that both a diet enriched , decreased hormone levels , and neuronal death with Jerte Valley cherries and the ingestion of a Jerte Valley [100, 101]. The age-associated disruption in the sleep/wake cherry-based nutraceutical product improve the antioxidant rhythm has been linked to the conventional decline in status of young, middle-aged, and elderly individuals [31, 89]. It may be cor- Particularly noteworthy was that not only the substantial rected by supplementation with melatonin or with foodstufs amount of melatonin, serotonin , and tryptophan  rich in melatonin (or in melatonins precursors). In this contained in these Jerte Valley cherries, but also the timing respect, Bravo et al. The lunchtime consumption of cherries or sumed twice a day (at breakfast and supper). Hence, or decreased brain serotonin concentration, is associated together with the ingestion of cherries (or the cherry-based with several age-related pathologies . In this sense, product) at supper time, this boosts the total nighttime the consumption of the aforementioned Jerte Valley cherry circulating melatonin levels [31, 91]. Tese interventions product was efective in diminishing cortisol levels in young, succeeded in improving the subjects antioxidant status. The mechanism is Most importantly, both of these nutritional interventions via enhancement of the brain serotonin functions that are showed sleep-promoting and mood-enhancing actions in the involved in the adaptation to stress [105, 106]. The explana- tion may be that while energy requirements decrease with References advancing age, nutritional requirements increase because of the greater demand for maintenance of the functionality of  J. Concluding Remarks role of oxidative stress in the aging process, TeScientifcWorld- Journal,vol. Tan, Melatonin in relation to the strong and weak to turn its attention to the development of nutraceutical versions of the free radical theory of aging, Advances in medical products. Miquel, Envejecimiento celular y molecular: teoras del envejecimiento, in Manual de Geriatra,F. Yankner,Neuralmechanisms the demonstration that the implementation of these chrono- of ageing and cognitive decline, Nature,vol. Knudsen,Oxidativestress commonly experiences progressive deterioration in phys- associated with exercise, psychological stress and life-style iological functions and metabolic processes. Garrido, Aging and stress: past hypotheses, present efects on sleep quality and antioxidant status in the elderly. Mukhtar, Cancer chemoprevention natural instruments with which to prevent or delay the onset through dietary antioxidants: progress and promise, Antioxi- of common age-related diseases. Liu, Health benefts of fruit and vegetables are from addi- trition have so far focused their attention on small groups tive and synergistic combinations of phytochemicals, American ofthepopulationwithnomarkedhealthproblems. Esquinca-Ramos, Crono- ical efects of melatonin: role of melatonin receptors and signal biologa. Madrid, An introduction to chronobiology, in Chrono- most versatile biological signal? Smolensky, Biological clocks and shif work: circadian dysregulation and potential long-term efects, Cancer  M. Barriga, Physiological concentrations of melatonin and corticosterone afect phagocytosis and oxidative metabolism of  R. Rodriguez, Melatonin and aging: in vitro efect of young antioxidant enzymes: a signifcant role for melatonin, Journal andmatureringdovephysiologicalconcentrationsofmelatonin of Pineal Research,vol. Tan, Melatonin in sleep-wake cycles, Journal of the American Geriatrics Society, walnuts: infuence on levels of melatonin and total antioxidant vol. Liu, Health benefts of phytochemicals in whole fruits, Assessment of the potential role of tryptophan as the precursor in Nutritional Health: Strategies For Disease Prevention,N. Rodrguez, Circadian levels of serotonin in plasma and legium Antropologicum,vol. Galli, The role of antioxidants in the Mediter- Clinical Pharmacology and Toxicology,vol.
The mucous membranes consist of non-keratinized discount 50 mg nizagara visa, stratifed epithe- lium with relatively homogeneous expression of desmoglein 3 with only minimal expres- sion of desmoglein 1 order 50 mg nizagara. In the skin desmoglein 1 occurs mainly in the subcorneal epider- mis buy nizagara 25mg online, and less ofen in the suprabasal epidermis cheap nizagara 50mg without a prescription, while desmoglein 3 is expressed mainly in the basal and suprabasal layers. Tus, antibodies to desmoglein 3 in pemphigus vulgaris mainly cause suprabasal loss of adhesion of the non-keratinized mucosal epithelium. In pemphigus foliaceus, antibodies to desmoglein 1 cause a superfcial, subcorneal blistering of the skin but not the mucous membranes (Fig. In addition, patients with pemphigus vulgaris occasionally have autoantibodies to other desmosomal adhesion molecules, e. It is possible that in a signifcant portion of pemphigus patients serum testing would show 3 Autoimmune Bullous Skin Disorders 37 IgG reactivity with cholinergic receptors of epidermal keratinocytes; two acetylcholine re- ceptors have been described as potential autoantigens in pemphigus: pemphaxin, an an- nexin homologue which binds acetylcholine, and alpha 9 acetylcholine receptor (Nguyen et al. The role of these autoantibodies in the pathogenesis of pemphigus vulgaris re- mains unclear. The precise mechanism of loss of adhesion afer binding of desmoglein-specifc anti- bodies has not been completely elucidated (Amagai et al. In vitro tests show that binding of pemphigus antibodies to epidermal keratinocytes leads to rapid but transitory infux of Ca2+ ions which probably disrupts signal transduction of the adhesion molecules. Tere may also be local activation of proteases such as plasminogen activator and phos- pholipase C, possibly leading to proteolytic cleavage of the extracellular portion of the des- moglein. The effect of IgG antibodies to desmoglein 1 and 3 on epidermal adhesion is shown in the mucous membranes and skin (modified after Amagai, 2003). The isoforms of desmoglein, desmoglein 1 and 3, are expressed in different amounts in the basal and apical layers of the cutaneous and mucosal epidermis. Function- ally, there may be desmoglein compensation that has not been inactivated by autoantibody binding. The clinical manifestation (pemphigus foliaceus, or cutaneous or mucocutaneous variants of pemphigus vulgaris) correlates with the autoantibody profile. Intraepidermal neutrophilic dermatosis type Clinical presentation The diferent pemphigus variants may be distinguished based on their respective clinical features, the site of intra-epidermal blistering, and their characteristic antibody profles (Tab. In about 80% of patients, pemphigus vulgaris initially presents with faccid blisters or erosions on the mucous membranes, especially on the oral mucosa (Fig. A study by Hale and Bystryn reported that symptoms afecting the larynx or nasal mucosa were com- mon complaints in patients with pemphigus vulgaris (Hale and Bystryn, 2001). Out of a total of 53 pemphigus vulgaris patients included in the study, 26 (49%) reported either laryngeal and/or nasal symptoms. Biopsies taken from the lesions show changes characteristic of pemphigus vulgaris on histology and under direct immu- nofuorescence (Calka et al. Exanthematous appearance of flaccid blisters on the back (a) with subsequent development of large erosions (positive for Nikolskys I sign) on clinically normal appearing skin (b, right shoulder) one patient had duodenitis. Crusty erosions and non-scarring alopecia on the scalp (a, b) 3 Autoimmune Bullous Skin Disorders 41 Fig. The resulting disorder, known as neo- natal pemphigus, manifests clinically on newborn skin as exanthematous, crust-covered erosions that can persist for a few weeks (due to the half-life of maternal autoantibodies). Pemphigus vegetans is a variant of pemphigus vulgaris that occurs on intertriginous ar- eas such as the axillae and the groin region; clinical presentation consists of blisters and secondary pustules that have a tendency to form verruciform or papillomatous vegeta- tions (Fig. As in pemphigus vulgaris, both variants of pemphigus vegetans involve autoantibody activity against desmoglein 3 and desmoglein 1 (Tab. Histological analysis shows eosinophilic spongiosis without marked acantholysis; circulating antibodies to desmoglein 1 and desmoglein 3 may be identifed (Tab. Differential diagnosis Table 3 lists important diferential diagnoses in pemphigus vulgaris. Stanley and Amagai reported that a staphy- logenic exotoxin, as a serine protease, is able to proteolytically cleave the extracellular do- mains of desmoglein 1 (Stanley and Amagai, 2006). This leads to superfcial loss of adhesion in the epidermis, with a clinical appearance resembling that of pemphigus foliaceus. He- reditary bullous skin disorders should also be considered which involve defects in cutane- ous adhesion molecules which are also a target structure of circulating autoantibodies in ac- quired bullous autoimmune skin disorders (Tab. First and foremost, however, diferen- tial diagnosis should rule out other pemphigus disorders. In chronic disease, the erosions may spread, covering large areas and contributing via secondary pyoderma and catabolic metabolism to the morbidity and mor- tality associated with the disease. In rare cases there are also autoantibodies to intracellular, desmosomal plaque proteins (see Tab. In endemic variants in Brazil, Tunisia, and other regions in northern Africa, patients also have IgG autoantibodies to desmoglein 1 (Warren et al. The superfcial erosions and accompanying erythema and hyperkerato- sis mainly afect the trunk and sun-exposed areas of the skin, sometimes resembling cuta- neous lupus erythematosus (Gomi et al. Antibodies to des- moglein 1 and possibly other desmosomal antigens may be identifed; ofen there are also antinuclear antibodies (Gomi et al. Pemphigus seborrheicus is a very superfcial variant of pemphigus foliaceus with exten- sive erythematous plaques and erosions on seborrheic areas (Fig. The clinical appearance, usually polymorphous with faccid or taut blisters on the upper trunk or with multiforme-like, extensive erythema with epidermolysis, can sometimes re- semble toxic-epidermal necrolysis (Lyell syndrome). This relatively rare disease is ofen as- 3 Autoimmune Bullous Skin Disorders 47 A B Fig. Intraepidermal, neutrophilic dermatosis with flaccid pustules covering the entire trunk (a), subcorneal pustulosis with an anular ar- rangement of erythematous plaques on the back (b) with corresponding histopathological correlates sociated with B-cell lymphoma or other malignant hematological disorders and may pre- cede clinical manifestation of cancer. Unlike other pemphigus disorders, loss of adhesion of the lung epithelium can also occur (obliterating bronchiolitis); on endobronchial biopsy typical intraepidermal acantholysis of the bronchial epithelium is seen. IgG anti- bodies to a 170 kD antigen which was recently been identifed as the protease inhibitor al- pha-2 macro-globuline-like-1 (Schepens et al, 2010) have a high diagnostic value in con- frming clinical diagnosis. In rare instances erosions on the oral mucosa may also occur as seen in pemphi- gus vulgaris. Antibodies are usually identifed against desmoglein 1 and less ofen against desmoglein 3 (see Tab. IgA pemphigus IgA pemphigus is characterized clinically by pustules that have a tendency to coalesce, forming anular lesions that are more strongly pronounced at the periphery (Fig. IgA pemphigus is also associated with benign and malignant monoclonal IgA gammopathies and gastrointestinal disorders. Direct immunofuores- cence studies show intercellular IgA deposits in the epidermis, but no IgG deposits. Massive, hemorrhagic erosions on the skin of the face (a), erosive stomatitis with fibrin coating (b), IgG and / or IgA deposits intercellularly in the epidermis and at the dermoepidermal junction zone (c) 3 Autoimmune Bullous Skin Disorders 49 Fig. Beginning with clinical appearance, in addi- tion to guiding histology, direct and indirect immunofluorescence studies also play a key role in diagnosis; immunoserological testing can be used to confirm the diagnosis or for prelimi- nary diagnosis of disease course direct immunofuorescence studies show circulating IgA antibodies in about 50% of pa- tients. Tere are two immunopathological sub-forms: intraepidermal neutrophilic disease which is generally associated with IgA antibodies to desmoglein 1 or 3 (Fig. Clin- ically, both variants are characterized by fragile blisters or pustules on an erythematous, scaly background. Diagnosis Diagnosis of pemphigus vulgaris is based on clinical presentation, histology, and direct and indirect immunofuorescence (Fig. It is advisable to select recent, intact blisters for performing a biopsy, ensuring that surrounding perilesional tissue is also included. The tis- sue is fxed in formalin for histological analysis, while for immunofuorescence the plain specimen is frozen (e. The primary func- 3 tion of histology is to identify the level at which blistering is taking place and thus to clas- sify the disorder as belonging to the pemphigus group or distinguish it from subepider- mal blistering. Histologically, pemphigus vulgaris is characterized by intraepidermal loss of keratino- cyte adhesion, known as acantholysis. Typically, in the basement membrane zone there are basal keratinocytes attached to the foor of the blister. Occasionally an infammatory infl- trate is also seen which mainly consists of eosinophils forming clusters of infltrates in the epidermis. While suprabasal blistering is typical of pemphigus vulgaris, in pemphigus foliaceus blistering is more superfcial, with subcorneal blistering (Fig.
Determination of the production of superoxide radicals and hy drogen peroxide in mitochondria cheap nizagara 100 mg with visa. High protonic potential actuates a mechanism of production of reactive oxygen species in mitochondria generic 25mg nizagara fast delivery. Oxidative stress and stress-activated signaling pathways: a unifying hypothesis of type 2 diabetes purchase 100 mg nizagara fast delivery. Subcellular localization of human glyceralde hyde-3-phosphate dehydrogenase is independent of its glycolytic function nizagara 25mg generic. Hexosamines, insulin resistance, and the complications of diabe tes: current status. Uncoupling insulin signalling by serine/threonine phosphorylation: a molecular basis for insulin resistance. Targeting beta-cell function early in the course of therapy for type 2 diabetes mellitus. A lesson in metabolic regulation in spired by the glucokinase glucose sensor paradigm. Protein kinases, protein phosphorylation, and the regulation of insulin secretion from pancreatic beta-cells. Oxidative stress induces insulin resistance by activating the nuclear factor-kappa B pathway and disrupting normal subcellular distribution of phosphatidylinositol 3- kinase. Proposed mechanisms for the induction of in sulin resistance by oxidative stress. Relation between antioxidant enzyme gene expression and antioxidative defense status of insulin-producing cells. Glucose toxicity in beta-cells: type 2 diabetes, good radicals gone bad, and the glutathione connection. Activation of the hexosamine pathway leads to deterioration of pancreatic be ta-cell function through the induction of oxidative stress. Regulation of beta cell glucokinase by S-nitrosy lation and association with nitric oxide synthase. Glucose-induced changes in protein kinase C and ni tric oxide are prevented by vitamin E. Hyperglycemia-induced mitochondrial superoxide overproduction activates the hexosamine pathway and induces plasminogen activator inhibitor-1 expression by increasing Sp1 glycosylation. Hexosamine pathway is responsible for inhibition by diabetes of phenylephrine-induced inotropy. Vitamins D, C, and E in the prevention of type 2 diabetes mellitus: mod ulation of inflammation and oxidative stress. Biologic activity of carotenoids re lated to distinct membrane physicochemical interactions. Increased risk of non-insulin dependent diabetes mellitus at low plasma vitamin E concentrations: a four year follow up study in men. Low plas ma ascorbate levels in patients with type 2 diabetes mellitus consuming adequate di etary vitamin C. Advances in diabetes for the millennium: vitamins and oxidant stress in diabetes and its complications. Cardio-renal syndrome (or reno-cardiac syndrome, the prefix depending on the primary failing organ) is becoming increasingly recognised . Conventional treatment targeted at either syndrome generally reduces the onset or progression of the other . Pathogenesis of chronic kidney and cardiovascular disease The links It is, in fact, very difficult to separate these chronic diseases, because one is a complication of the other in many situations. Prevention and treatment of these diseases are major aims in health systems worldwide. However, no matter the cause, the progres sive structural changes that occur in the kidney are characteristically unifying . Alterations in the glomerulus include mesangial cell expansion and contraction of the glomerular tuft, fol lowed by a proliferation of connective tissue which leads to significant damage at this first point of the filtration barrier. Hypertension induces intimal and medial hypertrophy of the intrarenal arteries, leading to hypertensive nephropathy. This is followed by outer cortical glomerulosclerosis with lo cal tubular atrophy and interstitial fibrosis. Compensatory hypertrophy of the inner-cortical glomeruli results, leading to hyperfiltration injury and global glomerulosclerosis. The first two stages have normal, or slightly reduced kidney function but some indication of structural deficit in two samples at least 90 days apart. Stages 3-5 are considered the most concerning, with Stage 3 now being sub-classified into Stages 3a and b because of their diagnostic impor tance. Common themes for causality are oxidative stress and inflammation, be they local or systemic. Left ventricular hypertrophy and myocardial fibrosis also predispose to an increase in electric excitability and ventricular arrhythmias . These ob servations have sparked added interest in the mechanisms of the chronic diseases, and in ways to target these mechanisms with additional therapies, such as antioxidants. Inflammation and chronic kidney and cardiovascular disease The circulating nature of many inflammatory mediators such as cytokines, and inflammato ry or immune cells, indicates that the immune system can act as a mediator of kidney-heart cross-talk and may be involved in the reciprocal dysfunction that is encountered commonly in the cardio-renal syndromes. There are many links with visceral obesity and with increased secretion of inflammatory mediators seen in visceral fat . Proinflam matory cytokines are produced by adipocytes, and also cells in the adipose stroma. The links with oxidative stress as an endogenous driver of the chronic diseases become immedi ately obvious when one admits the close association between oxidative stress and inflamma tion. The characteristics of dyslipidaemia (elevated serum triglycerides, elevated low- density lipoprotein cholesterol, and/or low high-density lipoprotein cholesterol) are also often seen in obese patients and these are all recognized as risk factors for atherosclerosis. An improved understanding of the precise mo lecular mechanisms by which chronic inflammation modifies disease is required before the full implications of its presence, including links with persistent oxidative stress as a cause of chronic disease can be realized. Oxidative stress arises from alterations in the oxidation-reduction balance of cells. The simple oxidant imbalance theory has now grown to incor porate the various crucial pathways and cell metabolism that are also controlled by the in terplay between oxidants and antioxidants [23-27]. The rationale for antioxidant therapies lies in restoring imbalances in the redox environment of cells. Agreement on the role of oxidative stress in the pathogenesis of chronic disease is, however, not complete. Oxidants are involved in highly conserved basic physiological processes and are effectors of their downstream pathways [41, 42]. The specific mechanisms for oxidative stress are difficult to define because of the rapidity of oxidant signalling . For example, protein tyrosine phosphatases are major targets for oxidant signalling since they contain the amino acid residue cysteine that is highly susceptible to oxidative modification . This may indicate the induction of free radicals in response to receptor ac tivation by a cognate ligand in a process that is similar to phosphorylation cascades of intra cellular signalling. However, adequate lev els of both are likely to be vital for normal cell function. There is no evidence to indicate that glutathione synthesis occurs within mitochondria, however the mitochondria have their own distinct pool of glutathione required for the formation of Gpx . Many of these proteins are known to interact with each other, forming re dox networks that have come under investigation for their contribution to dysfunctional oxidant pathways. Mitochondrial-specific isoforms of these proteins also exist and include Grx2, Grx5, Trx2 and Prx3 [52-54], which may be more critical for cell survival compared to their cystolic counterparts . Intracellular synthesis of glutathione from amino acid derivatives (glycine, glutamic acid and cysteine) accounts for the majority of cellular glutathione compared with extracellular glutathione uptake . Oxidative stress and transcriptional control The role of oxidative stress in upstream transcriptional gene regulation is becoming increas ingly recognised. Not only does this provide insight into the physiological role of oxidative stress, but presents regulatory systems that are possibly prone to deregulation.
H3: We suppose the patients with thyreopathy will show lower quality of life purchase nizagara 50 mg mastercard, less life satisfaction than the control group cheap nizagara 50mg with visa. H4: We suppose the patients with thyreopathy will experience more negative emotions (depression and anxiety) that the control group purchase 50 mg nizagara. It is known that especially anxiety and depression occur in patients with different diagnoses (e 50mg nizagara for sale. H5: We suppose the patients with thyreopathy will perceive higher social support compared to the healhy ones. With regard to the fact it is dealt with a planned operation mobilisation of patient social network and providing increased social support can be presupposed, and even from the side of medical staff. Differences between the ills and healthy ones have not been proved (Winsa et al, 1991; Yoshiuschi et al. Kukleta, 2001) research was an exception, were less support was shown in patients probably due to the reason the disease is developed with insufficient social support in an easier way. H6: We suppose that increase of resilience occurs in time within a half-year follow up in patients (growth of the sense for coherence and tendency to internal locus of control). The researches show that even if the sense for coherence can show itself as a stable trait, difficult life situations can change mans view of the world (Schnyder, 2000). After experiencing surgery (situation with less control) patients can gradually perceived a growth of the control over their lives (comp. H7: We suppose that the patients with thyreopathy will begin to choose effective coping strategies in time within a half-year follow up. Even earlier experience plays a specific role in managing and choice of coping strategy (comp. The patients could acquire more adaptive strategies of manageability with the help of coping with surgery and they could be stimulated to this by the contacts with doctors, and so on. Satisfaction and quality of life usually increases with decrease of health problems that we suppose after an operation (comp. H9: We suppose that decrease of negative emotions (depression and anxiety) occur in patients with thyreopathy within a half-year follow up. There should be less negative emotions with presupposed improvement of the health status due to the surgery (comp. H10: We suppose that decrease of perceived social support occur in patients with thyreopathy within a half-year follow up. After initial mobilisation of the social support (including medical staff) due to the surgery, there will be its decrease, when the surroundings begin to consider the patient as healthy, cured. With respect to these unexplored issues we have also been interested in answers to the following explorative questions: Q1: What are the differences in the observed variables among the patients with different thyreopathies? We regard comparison of such type a very interesting and we have not been informed on any similar researches. Q2: What is the composition of the key areas (life topics) in the framework of quality of life, what importance and satisfaction with individual areas patients with thyreopathy will mention within the follow up period and how it is going to be in the control group? It is necessary to await that disease, treatment effects the quality of life not only in its total height, but also concerning the composition and importance of individual areas (cues) and their satisfaction with them (Kivohlav, 2002). Connection of the quality of life with resilience and social support is described in the literature, on the contrary, stress and negative emotions should deteriorate it. A statistically significant difference between the patients and the control group has not been proved in average scores of the total sense of coherence. An significant difference of average scores have not been proved in scores between the patients and the control group, neither in comprehensibility, nor in manageability, or in meaningfulness. Statistically significant difference has not been proved in average scores of completely perceived social support between the experimental and control groups. Statistically significant difference has not been proved between the two groups in the social support from an important, not closely specified person, neither concerning the social support from friends. Statistically significant difference of averages has not been found out in patients and healthy persons in any of the coping strategies. An exception is a strategy of planning where it has been showed on the edge of statistical significance, respectively closely behind it, that it is used more frequently by the healthy respondents than the ills with thyreopathy. On the edge of statistical significance, respectively closely behind it, it is indicated that higher life satisfaction has been mentioned by the member of the control group that the patients. Statistically significant difference in average scores of depression has not been proved between the patients and the control group. Higher variance in locus of control on the edge of statistical significance has been found out in the patients compared with controls. Comparison of patients with thyreopathy to healthy population 294 Thyroid and Parathyroid Diseases New Insights into Some Old and Some New Issues Hypotheses H1 to H5 have been proved only partially (see Tab. The patients with thyreopathy, compared to the healthy persons, significantly perceive higher social support from the family, they are more anxious and on the edge of significance they are less satisfied with the life. Even other literature resources state that the disease causes the need for help (e. The healthy persons score significantly higher in locus of control and in coping strategy of planning on the edge of significance that is often regarded as an effective strategy. Differences between the patients and the healthy persons have not been found out in sense of coherence and depression. A paradox finding, that total higher quality of life is in patients compared to the healthy ones, has been explained in compliance with the quantitative data from the interviews. The patients have made an impression that they rather overestimated (idealised) the satisfaction evaluation in individual areas, especially within the period of hospitalisation, but also a little bit 3 months after it. As if due to the fact they have occurred in a difficult situation and they are to cope with it, they needed to see their life more positively and not to admit dissatisfaction with individual areas of life. Results graphically illustrated on the line segment of satisfaction level have been much more credible. Because the scale of life satisfaction requires holistic approach, but analytic assessment is necessary for the scale of total quality of life calculated from individual parts (comp. Statistically significant difference in average scores of the whole sense of coherence within the follow up period has not been proved. Statistically significant difference in average scores of manageability have not been proved, nor in the average scores of meaningfulness within the follow up period. The difference between the averages have been indicated on the edge of statistical significance and a significant linear growth (p < 0. Statistically significant difference in averages of perceived social support from an important, not specified person has not been proved in patients within the follow up period. A difference in averages, close to the edge of significance, appeared in patients during the follow up after the surgery, and on the edge of significance there was indicated a linear decrease in use of emotional social support. We have not found out any statistically significant differences in averages in other coping strategies within the follow up period. Statistically significant difference in averages of the life satisfaction level in the patients has not been found out during the follow up. On the edge of statistical significance, respectively close to it there has been indicated a significant difference in averages and a significant linear decrease of quality of life (p < 0. We have not proved a statistically significant difference of depression averages in patients during the follow up. A difference in average scores on the edge of statistical significance has been indicated and a statistically significant linear trend (p < 0. Hypothesis H10 has been confirmed, hypotheses H6 and H9 have been proved partially, hypotheses H7 and H8 have not been proved (see Tab. During the half-year follow up period there occurred significant decrease of anxiety in patients, an increase in comprehensibility and in the feeling of the control over the situation has been indicated on the edge of significance (comp. Our finding is in compliance with the fact that in managing a difficult situation a man at first tries to understand it (comprehensibility) (comp. A linear decrease in coping strategy of use of emotional social support was indicated in patients within the follow up, and a significant decrease was indicated in perceived social support from the family, apparently due to the fact the stress situation of operation passed. Total social support, support from friends and coping strategy of focus on and venting of emotions changed in a quadratic way at first, there was a significant decrease after 3 months, and a slight increase after 6 months after hospitalisation. Apparently it relates to the fact, the patient can feel himself isolated during the first 3 months after the surgery. Close to the edge of statistical significance a decrease in total quality of life was indicated in patients within the follow up, that relates to original overvaluation of life satisfaction with individual areas, but at the same time it can relate to the fact what was apparent in first interviews with them inappropriate expectations in relation to the medical intervention (they expected complete cure). Caption: means that the given variable was dealt with a linear increase means that the given variable was dealt with a linear decrease depicted curve illustrates course of a quadratic trend ed.