[Risk factors for carbohydrate metabolism disorders from a chronobiological position].

steady increase in the prevalence of carbohydrate metabolism disorders is closely related to overweight and obesity. Obesity is associated with a sedentary lifestyle, poor diet, sleep disturbance, which can lead to dysfunction of circadian rhythms with a decrease in the production of the hormone melatonin. The aim of the study is to clarify the most significant risk factors for carbohydrate metabolism disorders in obese patients from the standpoint of chronobiology. Material and methods. The retrospective study involved 120 patients with obesity (body mass index 31.35±3.80 kg/m2) with early disorders of carbohydrate metabolism (EDCM), type 2 diabetes mellitus (T2DM) and without disorders of carbohydrate metabolism (n=40 in each group). The age of the patients was 40-69 years, of which 75% were women and 25% were men. The patients' food diaries (for 24 hours) and Horne-Ostberg tests were analyzed. Fasting glucose, glycated hemoglobin, leptin, insulin were determined in the venous blood plasma; the insulin resistance index (HOMA-IR) was calculated, anthropometric indicators, basal body temperature (BT) were measured. Results and discussion. Patients of all groups were comparable in age, sex, BMI. The patients had an irrational distribution of the amount of calories consumed during the day, frequent meals, and a tendency to late breakfast (9:30-10:00 h) and dinner (19:00-20:00). In all 3 groups, leptin and insulin resistance was determined. In patients with DM2 leptin and insulin deficiency was revealed, which was confirmed by the presence of negative correlations between insulin concentration and energy consumption (r=-0.817, p<0.001) and carbohydrates intake (r=-0.299, p<0.001), as well as between carbohydrate intake and leptin concentration (r=-0.221, p<0.01) and HOMA-IR (r=-0.257, p<0.005). The duration of sleep averaged 7±1 h per day, and bedtime using artificial illumination, on average, varied in the range of 22:00-23:30, which can lead to circadian mismatch, with the progression of insulin resistance. The decrease in the amplitude of the BT circadian rhythm in patients with EDCM and T2DM, as well as the presence of an inverse correlation between BT and energy consumption (r=-0.531, p<0.0001) and fat intake (r=-0.533, p<0.0001), and a positive correlation between BT and protein consumption (r=0.533, p<0.0001), may indicate the involvement of melatonin in the development and progression of disorders of carbohydrate metabolism. Conclusion. The most significant risk factors for the development of disorders of carbohydrate metabolism, accompanied by circadian dysfunction in the surveyed, include irrational distribution of the energy value of food during the day, frequent meals, late breakfast and dinner; shifting the time of going to bed, shortening the duration of sleep, exposure to artificial lighting in the evening.

Platelet Chemiluminescence during Physical Exercise of Various Intensity.

Generation of ROS (including free radicals) in rat platelets during physical exercises of different intensities was evaluated by the chemiluminescent method. The acute or chronic submaximal exercises increased the platelet chemiluminescence by 2.5-3.0 times. In the control, platelet activation with physiological aggregant ADP enhanced their chemiluminescence by 7.5 times. Addition of ADP to platelets isolated from animals subjected to exercise of any intensity increased chemiluminescence by 4-5 times. In a trained organism, functional reserve of the platelets is preserved during long-term physical exercise of any intensity, but is exhausted after acute physical exercise. Thus, intensive physical exercises enhanced the hemostatic potential of the blood, which is associated with the risk of thrombohemorrhagic complications, especially in acute or submaximal long-term exercises.

[Group preventive consulting influence on body mass correction and nutrition disorders. 5-year prospective survey].

The aim of the work was to analyze education technologies efficacy using group methods of prevention (body mass correction school) in patients with overweight and obesity, living in Extreme North, according to a 5-year prospective survey. 181 Extreme North alien inhabitants have been investigated (23.2% men, 76.8% women) with overweight and obesity. 144 of them were surveyed during 5 years. Age median was 37 (29-49) years, including men - 33 (29-43) and women - 39.5 (27.5-48) (p=0.123). All participants were divided into 2 groups depending on preventive group education compliance. Group 1 received brief recommendations for the inspection, Group 2 was trained with the group of preventive counseling. Within 3 months of surveillance target body mass reduction was achieved by 11.3% of patients of the group 1 and 31.5% of patients of the group 2 (p=0.0018). By the end of the first year these parameters proved to be 7% and 16.4% (p=0.0453). After that there was no significant difference between groups, although about 5-6% of responders kept the achieved target of BM reduction even in group 1. Group prevention consulting is associated with short time reduction of such risk factors prevalence as low physical activity (from 86.3 to 61.1% during 3 months, p<0.005), insufficient fruits and vegetables consumption and violation of macro- and micronutrient composition of the daily diet. It is also accompanied with lower cumulative proportion of patients without all metabolic syndrome components (Cox's F-Test: F=2.61; p=0.0178) and a significant reduction of percent of patients having SCORE-risk >5% (p=0.0461) after 5 years of surveillance. Thus, group preventive consulting raises awareness of patients about their health status, leads to daily meal ratio impairment reduction, decreases prevalence of obesity and low physical activity in short time period and reduces MS - risk. During 3 months after consulting body mass reduction (of 5% or more) was observed in 30% of patients. Achieved result is stable within following 12 months in less than 16% of patients. In the longer term, education is accompanied by a decrease in MS risk and some reduction in SCORE-risk.

Personified strategy for the correction of cardiometabolic risk factors in the alien population of the Arctic.

Aim. To estimate the efficacy and prognostic value of individual consulting in Far North inhabitants during a 5 year survey. Materials and methods. 125 patients with metabolic syndrome were included in the study (24.8% women, 24.8% men, age median 45 years (39-48); p > 0.05). All the participants were divided into 2 groups dependence on the consulting frequency in the framework of the non-surgical body mass reduction programs (group 1 - single consulting, group 2 - repeated consultings in 12 months). Results. Individual consulting of patients with MS within 3 months after the onset of the study allowed the target body mass to be achieved in 50% of the patients in association with the reduction of atherogenic lipid fractions (p < 0,05), insulin resistance (p < 0,05), inflammation markers, hemostasis disorders markers (p < 0,05) and decrease in the number of patients with behavioral risk factors. Repeated educational module increased the relative probability 1,9 (95% CI 1,03-3,6) and odds ratio - 2.4 (95% CI 1,01-5,4) of body mass maintenance within 24 months and also reduced the risk of type 2 DM development (Cox's F-Test: F = 2,7; p = 0,041) and atherogenicity of lipid profile after 5 year observations. Conclusion. Our results proves the necessity of active utilization of educational modules at least as often as once a year. For the successful use of these modules based at outpatient facilities of the Far North it is necessary to include a dietologist in the staff of prophylactic departments which encounters difficulty under the modern funding mode.

[Proinflammatory cytokine levels depending on the stage of hepatic fibrosis in patients with metabolic syndrome and non-alcoholic fatty liver disease].

AIM: To study levels of systemic inflammation markers and plasminogen activator inhibitor-1 (PAL-1) in patients with metabolic syndrome (MS) and establish their relationship with the progress of selected stages of non-alcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS: 129 patients aged 18-59 yr with abdominal obesity and MS underwent elastometry for the assessment of the degree of fibrosis depending on concomitant metabolic disorders and measurement of proinflammatory cytokine levels. RESULTS: Disorders of carbohydrate metabolism in MS patients are associated with the high levels of systemic inflammation markers (CRP, TNF-α, IL-6) and a two-fold rise in the PAI-1 level. The progress of fibrosis is associated with the increase of cytokine levels. CONCLUSION: Patients with MS and NAFLD associated with disorders of carbohydrate metabolism need to be examined by elastometry for the detection of fibrosis with simultaneous measurement of IL-6 and PAI-1 levels as cardiovascular risk factors.

[A course of acute respiratory virus infections in patients with metabolic syndrome].

AIM: To determine specific features of a course of acute respiratory viral infections (ARVI) and changes in immunological status in patients with metabolic syndrome (MS). MATERIAL AND METHODS: Body mass index (BMI), waist circumference, levels of cholesterol, lipoproteins, triglycerides, cytokines and immunoglobulins were measured and glucose tolerance test was made in 120 patients with MS. Registration of ARVI during a year was verified by the presence of antigens in immunofluorescence reaction. RESULTS: MS patients have obesity of an abdominal type and immunoresistance. Concentration of proinflammatory cytokines and leukocyte count in blood increased proportionally to an increase in fat tissue mass, immunoglobulins content went down. ARVI in most evident MS were characterized by a sluggish and areactive onset, longer course, more frequent respiratory and cardiovascular complications. CONCLUSION: MS is a factor of risk of a sluggish and complicated course of ARVI.

[Search for an optimal therapy of patients with atrial fibrillation (results of many years of comparison of three treatment strategies).]. / Poisk optimal'noi terapii bol'nykh s fibrilliatsiei predserdii (rezul'taty mnogoletnego sravneniia trekh strategii lecheniia).

Patients with nonrheumatic atrial fibrillation (n=465, mean age 59.4+/-3.8 years) received controlled therapy for 7.4+/-1.6 years. Group 1 comprised 306 patients with paroxysmal and persistent atrial fibrillation who after restoration of sinus rhythm received antiarrhythmic therapy aimed at prevention of recurrences and repetitive cardioversions. Group 2 consisted of 67 similar patients who did not receive continuous antiarrhythmic therapy. Therapy of patients with persistent atrial fibrillation (group 3, n=92) included heart rate slowing drugs and anticoagulants. Group 1 was characterized by lowest rate of complications and all cause mortality, and best quality of life. There were more nonfatal strokes in group 2. All cause mortality in group 2 was 15% (p<0.05). Highest rate of nonfatal strokes, and deaths due to chronic heart failure was observed in group 3. All cause mortality in this group was 22.8% (p<0.001 vs group 1).

[Characteristics of lipid profile in blood plasma of patients with metabolic syndrome and manifest disorder of carbohydrate metabolism]. / Osobennosti lipidnogo profilia plazmy krovi u bol'nykh s metabolicheskim sindromom i manifestnym narusheniem uglevodnogo obmena.

AIM: To study specific features of lipid plasm profile in patients with metabolic syndrome (MS) and manifest disorder of carbohydrate metabolism (CM) as well as their relationships with clinical symptoms of MS. MATERIALS AND METHODS: Contents of lipids and apolipoproteins of plasm was measured on an empty stomach in 30 patients (18 females and 12 males) with MS and manifest disorder of CM (diabetes mellitus type 2 at the stage of good and satisfactory compensation of CM without terminal complications). RESULTS: The patients were found to have a subnormal level of HDLP cholesterol, high levels of total cholesterol, LDLP cholesterol and LP alpha. Hypertriglyceridemia occurred only in 31.4% patients (TG < 200 mg/dl). Mean TG level was 173.69 +/- 21.52 mg/dl. TG and diastolic arterial pressure, fasting glycemia and waist circumference significantly correlated. If the WC/TC was 1.0 and higher, the antiatherogenic plasm factor--HDLP cholesterol--significantly lowered. Positive correlation existed between TG and total cholesterol, LDLP cholesterol, apoB, LDLP cholesterol/HDLP cholesterol, apoB/apoA1, while negative correlation was seen between TG and HDLP cholesterol levels. Patients with hypertriglyceridemia had significantly higher levels of total cholesterol, LDLP cholesterol, apoB, apoB/apoA1. CONCLUSION: Plasm levels of TG most significantly reflect severity of basic clinical manifestations of MS: abdominal obesity, arterial hypertension, CM compensation. The presence of hypertriglyceridemia in MS patients can be considered as an indicator of high atherogenic potential of plasm.

[Systemic lupus erythematosus and sepsis]. / Sistemnaia krasnaia volchanka i sepsis.

Features of clinical course and symptoms of systemic lupus erythematosus are analysed in SLE patients with sepsis (n = 11) which was defined as a systemic inflammatory reaction to verified infection with polyorganic insufficiency. Statistic analysis was made with the program MS Excel 7.0. Sepsis, activating factors, antibacterial and immunosuppressive therapy are discussed. Outcomes are described. Differential diagnosis with paraneoplastic syndrome is illustrated.

[Analysis of lipid plasma spectrum and basic parameters of red cell membranes in patients with metabolic syndrome and ischemic heart disease]. / Analiz lipidnogo spektra plazmy i osnovnykh parametrov kletochnykh membran éritrotsitov u bol'nykh s metabolicheskim sindromom i ishemicheskoi bolezn'iu.

Specific features of lipid plasma spectrum and principal parameters of red cell membranes are characterized in patients with metabolic syndrome (MS) and chronic stable ischemic heart disease (IHD). 109 patients with metabolic syndrome (diabetes mellitus type 2, arterial hypertension, abdominal obesity and dyslipidemia) were divided into 2 groups: with and without IHD. MS patients with IHD had marked defects of lipid metabolism with hypercholesterolemia, high levels of triglycerides, LDLP cholesterol, low level of HDLP cholesterol. Lipid plasma spectrum in MS patients with IHD vs those without coronary atherosclerosis was characterized by a significantly lower level of apo A1. In red cell membranes these patients had lower fractions of esterified cholesterol combined with high intensity of lipid peroxidation.

[Changes in clinical and laboratory findings on oxidation metabolism in lymphocyte membranes of rheumatoid arthritis patients on synchronous programmed intensive therapy]. / Dinamika kliniko-laboratornykh pokazetelei i parametrov okislitel'nogo metabolizma v membranakh limfotsitov u bol'nykh revmatoidnym artritom v protsesse provedeniia sinkhronnoi programnoi intensivnoi terapii.

The study of the effects of intensive treatment on activity of free-radical oxidation in lymphocyte membranes was conducted in 15 rheumatoid arthritis (RA) patients with systemic involvement, stage II-III activity who had failed previous basic therapy because of unefficiency or intolerance. The synchroneous programmed intensive therapy was performed in 3 stages. Stage 1: three sessions of plasmapheresis with 3 day intervals, synchronous introduction of 30 mg methotrexate and 500 mg methylprednisolone. Stage 2: the same procedures once a week for the following 3 weeks. Stage 3: a monthly intensive therapy for 3 months. After the end of stage 3 all the patients received methotrexate 7.5 mg weekly per os for 6 months. The above intensive therapy of RA patients had an antiinflammatory effect, changed peroxidation reactions in lymphocyte membranes by lowering the level of pro-oxidants and stimulation of antioxidant system. No positive changes in the lipid status occurred.

[Clinical and biochemical aspects of flixotide administration in patients with moderate bronchial asthma]. / Kliniko-biokhimicheskie aspekty primeneniia fliksotida u bol'nykh bronkhial'noi astmoi srednetiazhelogo techeniia.

AIM: To compare clinical, device and biochemical aspects of monotherapy with flixotide vs combination of flixotide with serevent in patients with moderate bronchial asthma (MBA). MATERIAL AND METHODS: 18 patients with MBA received flixotide and 18 MBA patients flixotide plus serevent for two weeks of lead-in and eight weeks of basic treatment. A special study was made of neutrophils which were examined for activity of LPO-antioxidants and phospholipid spectrum of membranes. RESULTS: There were similar changes in function of the system LPO-antioxidants and lipid structure in neutrophilic membranes of moderate BA patients of both the groups. CONCLUSION: Clinicobiochemical efficacy of mean doses of a new topic inhalation glucocorticoid flixotide alone or in combination with prolonged beta 2-adrenostimulator serevent is demonstrated. There were positive trends in metabolic processes in neurophilic membrane. Use of flixotide in combination with serevent is clinically preferable.

[Rationale-based nutrition as a factor of anemia prevention in pregnant women]. / Ratsional'noe pitanie kak faktor profilaktiki anemii u beremennykh zhenshchin.

Rational nutrition, based on properly arranged regimen including quantitative and qualitative distribution of the daily ration into meals is one of important elements in correction of anemia, endemic for the West Siberian region. Pregnant women should be referred to a group at risk of this disease; special nutrition standard, therapeutic and prophylactic rations should be created for them with due consideration for communal conditions, health status, and their actual nutrition.

[The role of bioactive food additives in therapeutic and prophylactic nutrition]. / Rol' biologicheski akivnykh dobavok v lechebno-profilakticheskom pitanii.

The efficiency of therapeutic and prophylactic nutrition (TPN) is determined by its scientific basis. The diets should be created with consideration for pathogenetic mechanisms of the effects of occupational hazards, energy expenditures, ecology of the habitat, national features of nutrition, and unfavorable factors associated with the risk of the underlying and concomitant diseases. Use of bioactive food additives (BFA) essentially facilitated the development and utilization of TPN under conditions of hazardous production and unfavorable ecology. The technology of making a perspective BFA Vitagmal has been developed. Biomedical evaluation of this BFA was carried out: protein, carbohydrate, and mineral metabolism, morphology of organs and tissues in experimental animals fed Vitagmal, and its effects on clinical and physiological status of man were studied. The effect of BFA on the metabolism was studied in patients with metabolic alimentary obesity. The results demonstrated a pronounced health-fortifying antioxidant effect of Vitagmal, which had a favorable impact on cardiovascular and central nervous functions, stimulated the metabolic processes, had a slight "protective effect" in ethanol intoxication, and no side effects. This recommends Vitagmal for wide use in therapeutic and prophylactic medicine.

[Clinico-metabolic effects of biologically active phospholipid and pectin additives in patients with acute leukemia]. / Kliniko-metabolicheskie éffekty biologicheski aktivnykh dobavok fosfolipidnoi i pektinovoi prirody u bol'nykh ostrym leikozom.

Antioxidant and membranoprotective effect of biological active supplements of phospholipid and pectin nature in patients with acute leukosis during the clinical and laboratory remission period is indicated.

[Effectiveness of fenspiride in patients with chronic obstructive bronchitis]. / Effektivnost' fenspirida u bol'nykh khronicheskim obstruktivnym bronkhitom.

Patients with chronic obstructive pulmonary disease of moderate severity were investigated for two months for assessment of fenspiride activity. Examination of the patients (age 42.6 +/- 5.3) took place before and after fenspiride therapy. In comparison to the control group, fenspiride patients showed improvement of external respiration function: FEV 1, FVC, FEF 50-75, PEF increased. Dienic conjugates, malonic dialdehyde levels decreased, alpha-tocopherol in platelet membranes rose, functional activity of platelets fell. Side effects were rare and not serious. It is concluded that fenspiride has an antiinflammatory effect, reduces bronchoconstriction and depresses platelet aggregation, is well tolerated. Fenspiride is an effective drug for the treatment of moderate chronic obstructive bronchitis.

[Changes in lipid metabolism in platelet membranes in patients with ischemic heart disease following meals with animal and vegetable fats]. / Izmeneniia okiclitel'nogo metabolizma lipidov v membranakh trombotsitov u bol'nykh ishemicheskoi bolezn'iu serdtsa posle pishchevykh nagruzok zhivotnym i rastitel'nym zhirom.

AIM: To evaluate changes in oxidative lipid metabolism in platelet membranes by content of lipid peroxidation (LPO) products and antioxidant defense (AOD) activity in patients with stable chronic ischemic heart disease (IHD) after single intake of animal fat or vegetable oil. MATERIAL AND METHODS: 30 IHD patients with stable angina of effort functional class II-III and 30 healthy controls had a single meal with animal fat or vegetable oil. Before the meal and 6 hours after it tests were performed for LPO activity and AOD in platelet membranes. RESULTS: Patients with stable chronic IHD showed LPO activation and suppressed enzymatic and non-enzymatic AOD. Single animal fat or vegetable oil intake cause insignificant shifts in oxidative platelet metabolism in healthy controls while animal fat in IHD patients activates LPO and promotes accumulation of initial and end peroxidation products in platelet membranes. Vegetable fat in IHD patients suppresses enzyme AOD. CONCLUSION: Animal fat and vegetable oil as a single diet load have a prooxidant effect at the levels of platelet membranes in IHD patients but not in healthy persons.