[Role of circulating angiogenic factors in diabetic kidney disease].

This original article contains the authors own data on homeostasis of angiogenic growth factors (vascular endothelial growth factor - VEGF, angiopoietin 1 and 2 - Ang-1, Ang-2) in diabetic kidney disease. The aims of study were evaluation of alteration on serum concentration of circulating VEGF, Ang-l and Ang-2, and of their association with markers of renal damage (albuminuria, glomerular filtration rate) and anemia in patients with diabetes mellitus. We studied 78 patients type I diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Among this group 37patients had chronic kidney disease. The serum level of VEGF was elevated in T1DM patients and was associated with degree of proteinuria. The serum concentration of Ang-2 was higher in patients with chronic kidney disease (T1DM and T2DM), renal failure (T1DM), proteinuria and anemia (T2DM). Ang-2 strongly associated with albuminuria (T1DM and T2DM), glomerular filtration rate (T1DM) and hemoglobin (T2DM). Obtained results demonstrate that levels of VEGF and Ang-2 (but not Ang-1) are raised in patients with diabetic kidney disease and associated with markers of renal damage and anemia. These data indicate the presence of the disturbance of angiogenic growth factors (VEGF, Ang-2) homeostasis and activity in diabetic patients with chronic kidney disease.

[Early erythropoietin deficiency in diabetic kidney lesion].

AIM: To evaluate the renal production of erythropoietin (EPO) in relation to filtration function in patients with diabetic kidney lesion. SUBJECTS AND METHODS: The investigation enrolled 183 patients with types 1 and 2 diabetes mellitus (DM), of whom 128 were diagnosed as having diabetic kidney lesion. Serum EPO levels were measured by enzyme immunoassay. Patients who had a glomerular filtration rate (GFR) of below 15 ml/min/1.73 m2 and received erythropoiesis-stimulating agents were excluded from the investigation. RESULTS: The mean serum EPO levels in the patients with diabetic kidney lesion did not vary with the presence or absence of anemia, the degree of albuminuria, or GFR. A physiological inverse relationship was found between the level of EPO and that of hemoglobin in the blood of the patients with DM without kidney disease and in those with renal lesion and GFR > or = 60 ml/min/1.73 m2. The magnitude of the association of the values increased as GFR was higher. The level of EPO was found to be unassociated with hemoglobin in patients with GFR < 60 ml/min/1.73 m2. CONCLUSION: In the patients with diabetic kidney lesion, serum EPO concentrations did not depend on the stage of chronic kidney disease and the degree of albuminuria in spite of more severe anemia as renal failure progressed. These patients showed inadequate EPO production just in early diminished renal filtration function.

[Prevention of iodine deficiency diseases in pregnant and lactating women].

The objective of this work was to evaluate results of control epidemiological studies of iodine-deficiency condition in pregnant and breast-feeding women; the secondary objective was to develop standard prophylactic iodine dose schedule for these patients. The study included two groups of pregnant women treated either with a daily dose of 200 mcg potassium iodide (group 1, n=52) or with 300 mcg Kl/day (group 2, n=69). In all of them, blood TSH, free thyroxin and antithyroid peroxidase antibody levels were measured along with iodine excretion in urine. Thyroid volume was determined by ultrasound. Initially, median urinary iodine excretion in all the patients was 62.7 mcg/l. Three months after onset of the treatment with potassium iodide it significantly increased to 83.5 mcg/l and 1120.8 mcg/l in groups 1 and 2 respectively (p = 0.006 and 0.001). However, the desired level of >150 mcg/l was not achieved. Treatment with KI in the period of lactation within 2 months after delivery resulted in median urinary iodine excretion of = >100 mcg/l in 10.5% of the women in group 1. None of the patients in group 2 showed the required iodine concentration in the urine. It means that the minimal daily prophylactic dose of iodine for pregnant and lactating women should be 300 mg.

[The results of the "tiromobil" epidemiological trial of pregnant women in the Russian Federation].

AIM: To study structural and functional changes in the thyroid gland (TG) in pregnant women living in iodine-deficiency regions; to evaluate efficacy of prophylactic measures. MATERIAL AND METHODS: Random sample method was used for examination of 1090 pregnant women living in the regions with different iodine provision. All the participants were examined clinically, measurements were made of thyroid size, TTH, free T4, iodinuria. RESULTS: Iodine salt in household was used only by 17% women. Prophylaxis of iodine deficiency was conducted in 51% pregnant women. Thyroid alterations were detected in 27% examinees, diffuse goiter was diagnosed on the average in 17% pregnant women (in some regions 36%), nodular goiter--in 3.1%, focal goiter alterations of the thyroid--in 4.4%, symptoms of autoimmune thyroid disease--in 2.7%. ldoinuria varied with regions from 72.5 to 150 mcg/l. TTH and T4 levels were mainly normal. Isolated fall of T4 in trimester II and III was registered in 70% pregnant women, low TTH--in 4.4%. CONCLUSION: Most of the pregnant women in the regions studied were at risk of diseases associated with iodine deficiency. Prevention of iodine deficiency is not adequate.

[Disturbances of thyroid function after coronary angiography].

Frequency of thyroid gland functional disturbances after introduction of iodine-containing radiographic contrast agents during coronary angiography was studied in 146 patients, residents of the zone of borderline iodine deficit. Frequency of thyroid pathology was high at baseline (39%). Functional state of the thyroid gland was assessed before and 1, 3, 6, 12 months after investigation. During first month after coronary angiography there were several new cases of thyrotoxicosis and hypothyroidism, as well as deterioration of preexisting functional disturbances of the thyroid. Patients with baseline pathology and functional disturbances of thyroid gland before conduction of coronary angiography should be included into risk group of development of iodine induced states.

[Results of epidemiological surveys for iodine-deficiency diseases within the framework of the Thyromobile project].

In the Russian Federation, there are virtually all areas whose population is at risk for iodine-deficiency disorders. During 2003, we made epidemiological studies of iodine-deficiency disorders within the framework of the Thyromobile project supported by the pharmaceutical company "Nycomed"in 12 regions of the Russian Federation. A total of 2673 individuals were examined. According to the WHO recommendations, the study covered prepubescent children aged 8 to 11 years. It involved physical examination, thyroid ultrasound study, blood sampling for ioduria, intelligence test, and sodium chloride iodine assay. The findings indicated that the tension of goiter endemia corresponded to the level of iodine deficiency, which was in the range of mild iodine deficiency, in most regions other than some districts of the Volgograd, Astrakhan, Nizhni Novgorod regions where the median of ioduria in schoolchildren corresponded severe iodine deficiency. The studies indicated that the population's use ofiodinated salt is not up to the recommendations of international expert organizations. Intelligence tests revealed an 11-18% IQ decrease in children from virtually all study areas. According to the strategy of iodine deficiency control in the Russian Federation, it is advisable to use iodinated salt for mass prevention and drugs containing a physicological dose of iodine for group and individual prevention.

[The biochemical markers of bone metabolism in differential diagnosis of hematogenic osteomyelitis of foot bones and acute stage of diabetic osteoarthropathy]. / Biokhimicheskie markery kostnogo metabolizma v differentsial'noi diagnostike gematogennogo osteomielita kostei stopy i ostroi stadii diabeticheskoi osteoartropatii.

The determination of the level of leukocytes and ESR in 25 patients was shown to be of low informative value in differential diagnostics of destructive injuries of feet in patients with diabetes mellitus. An analysis of the biochemical markers of the bone remodeling has demonstrated high informative value of this method in differential diagnostics of acute stage of diabetic osteoarthropathy and osteomyelitis that allows to use it in complex examinations of osteomyelitis suspects.

Tissue transplantation as a compensation for deleterious effects of ageing, radiation, diabetes, and craniocerebral trauma.

The presence of blood-brain and blood-ocular barriers allows the transplantation of various biological tissues into the brain and the anterior eye chamber without acute immune rejection. Tissue grafting into the immuno-privileged areas (brain, anterior eye chamber) allows its long-term functioning without immuno-suppression. This method was shown to be effective in compensating for the deleterious effects of ageing, radiation, diabetes, and craniocerebral trauma.

[Kidney lesions in non-insulin dependent diabetes mellitus]. / Osobennosti porazheniia pochek pri insulinnezavisimom sakharnom diabete (SD II tipa).

Because little is known about disordered metabolism of uric acid as a pathogenetic mechanism of renal damage in non-insulin-dependent diabetes mellitus (NIDDM) it was studied in 75 NIDDM and 48 IDDM patients. Clinical examination of the patients included evaluation of purin metabolism according to serum uric acid, diurnal urine excretion, uric acid clearance. Hyperuricemia occurred more frequently in NIDDM. Positive correlation was observed between hyperuricosuria and the severity of diabetic nephropathy which was more pronounced in IDDM.

[Endemic goiter in Moscow and Moscow region]. / Sostoianie zobnoi éndemii v Moskve i Moskovskoi oblasti.

Goiter prevalence and iodine excretion levels were assessed in schoolchildren aged 9 and 13 in the city of Moscow (n = 91) and the Moscow region, 60 km East of Moscow (n = 92). Goiter prevalence was evaluated by ultrasonography. In Moscow it was found to be 31.1% among children aged 9 and 17.5% among those aged 13. The respective values in the Moscow region were 47.2 and 39.3%. Medium urinary iodine levels were 6.9 to 7.5 micrograms/dl in Moscow and 4.1 to 5.4 micrograms/dl in the region. According to modern criteria, iodine deficiency in Moscow may be regarded as mild and in the region as moderate. Control programs are urgently needed tc prevent development of iodine deficiency disorders.

[Determination of autoantibodies to pancreatic beta-cells, non-islet endocrine cells and fibroblasts in patients with newly detected diabetes mellitus]. / Opredelenie autoantitel k beta-kletkam podzheludochnoi zhelezy, neostrovkovym éndokrinnym kletkam i fibroblastam u bol'nykh s vpervye vyiavlennym sakharnym diabetom.

The clinical onset of insulin-dependent diabetes (IDD) is characterized by the onset of circulation of autoantibodies to beta-cells. Thirty-three newly detected IDD patients and 14 newly detected patients with noninsulin-dependent diabetes mellitus were examined for autoantibodies to antigen P 64-69, to surface antigen of islet cells, to thyrocyte microsomal fraction, thyroglobulin, hypophysis, fibroblasts; the levels of circulating immune complexes were measured as well. IDD debut was found associated with the appearance of antibodies to pancreatic islet cells, thyroid, thyroglobulin, hypophysis, fibroblasts, this indicating a polyclonal activation of the immunity system. A relationship was revealed between antifibroblast antibody and anti-islet-cell antibody. Antihypophyseal antibodies were detected in 43% of patients with noninsulin dependent diabetes. Nine per cent of IDD patients and 24% of patients with noninsulin dependent condition were negative in the tests.

[Levels of immunoreactive insulin in the pancreas and allograft to the anterior chamber of the eye in experimental diabetes]. / Soderzhanie immunoreaktivnogo insulina v podzheludochnoi zheleze i allotransplantate v peredniuiu kameru glaza pri éksperimental'nom diabete.

Transplantation of the embryonic pancreas to an immune privileged area (the anterior chamber of the eye) ensures considerable improvement of the condition of animals with alloxan diabetes. Some results concerning graft functioning for a long period of time and partial regeneration of insulin-producing tissue of the pancreas of operated on animals were obtained.

[Hypoinsulinemia, hyperglycemia and circulating antibodies to the islet cells during the development of streptozotocin diabetes in rats]. / Gipoinsulinemiia, giperglikemiia i tsirkuliruiushchie antitela k ostrovkovym kletkam pri razvitii streptozototsinovogo diabeta u krys.

The time course of metabolic parameters and islet cell surface antibodies (ICSA) in low-dose streptozotocin (STZ)-induced diabetes in rats was studied, a total STZ dose being 160 mg/kg body weight. Two-phase diabetes development was observed. Initial mild hypoinsulinemia and hyperglycemia turned to more severe diabetes after day 24 which was preceded by the first ICSA peak at day 13. The second ICSA peak occurred at day 35. The data obtained suggest that in this model of diabetes the toxic STZ effect induces both the diabetic syndrome and humoral autoimmunity to beta-cells, and the latter leads to further impairment of diabetes.

[The clinical x-ray characteristics of the soft tissues of the lower extremities in diabetics]. / Kliniko-rentgenologicheskaia kharakteristika miagkikh tkanei nizhnikh konechnostei u bol'nykh sakharnym diabetom.

The authors present the results of clinicoroentgenological and immunological investigations of the state of lower limb soft tissues in 117 patients with diabetes mellitus. Vascular wall calcification and soft tissue edema were noted practically in all the patients with a period of disease over 1 year. X-ray investigation permitted the detection of vascular lesion at early stages of complication development, in most of the patients even at the preclinical stage. A degree of lower limb vascular lesion is not related to a type of diabetes mellitus and the patients' age. There is direct correlation between the affection of the walls of medium size vessels and vessels of the fundus of the eye. The frequency and severity of lower limb vascular lesion, polyneuropathy and nephropathy grow significantly with an increase in a period of disease. A parallel decrease of immunoglobulins is noted. The affection of osseous tissue does not depend on a period of disease and shows insignificant correlation with a degree of vascular lesion.

[The insulin and proinsulin levels in patients with newly detected diabetes mellitus]. / Soderzhanie insulina i proinsulina u bol'nykh s vnov' vyiavlennym sakharnym diabetom.

Total immunoreactive insulin (IRI), proinsulin-like component, IRI, C-peptide and glucagon were determined in patients with newly detected diabetes mellitus and in healthy subjects on an empty stomach and after food testing. The results obtained have shown that a study of the serum total IRI composition combined with C-peptide determination during food testing can be used as a diagnostic test to define a type of diabetes mellitus.

[Functional activity of the insular apparatus of the pancreas in children with newly diagnosed diabetes mellitus]. / Funktsional'naia aktivnost' ostrovkovogo apparata podzheludochnoi zhelezy u detei s vpervye vyiavlennym sakharnym diabetom.

It has been shown that before insulin treatment children with diabetes mellitus diagnosed for the first time manifested heterogenous endogenous secretion of insulin, which did not correlate with the disease standing before diagnosis establishment.