[Changes in metabolic parameters and glomerular filtration rate in patients with morbid obesity after bariatric surgery].

AIM: To study the effect of weight loss in the short term after bariatric surgery (BO) on metabolic parameters and glomerular filtration rate (GFR) in patients with morbid obesity. MATERIALS AND METHODS: We studied 40 adult (over 18 years) patients with morbid obesity who underwent bariatric surgery. Metabolic indices and calculated GFR according to the CKD-EPI formula in patients before and after bariatric surgery were compared. RESULTS: In the whole group of operated patients, the average body mass index (BMI) after surgery decreased from 45.8 to 30.5 kg/m2. In 11 (92%) patients with impaired carbohydrate metabolism, remission of diabetes mellitus was achieved and sugar-lowering drugs were canceled. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, there is a tendency towards a decrease in GFR, probably due to a decrease in hyperfiltration. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, a statistically significant increase in the level of GFR was noted. The greater metabolic efficacy of combined operations (mini-gastric bypass, biliopancreatic diversion) in relation to the correction of carbohydrate and fat metabolism was revealed. CONCLUSION: Obesity is a modifiable risk factor for decreased kidney function and the progression of chronic kidney disease. Bariatric surgery is an effective treatment for morbid obesity. The study proved the positive effect of weight loss after BO on renal function, including by improving the course of diseases associated with obesity.

[One-anastomosis gastric bypass with a short limb]. / Zheludochnoe shuntirovanie s odnim anastomozom na korotkoi petle.

OBJECTIVE: To develop an acceptable method of surgical treatment of patients with obesity grade 1 and 2 in accordance with the following criteria: high safety, no risk or minimal risk of intestinal malabsorption, no limitations for postoperative gastrointestinal examination, no need for organ resection and surgical reversibility in case of necessity. MATERIAL AND METHODS: In accordance with the above-mentioned criteria, we have modified OAGB (one-anastomosis gastric bypass). A gastric tube was formed from a lesser curvature using 33Fr stomach catheter with a length of at least 25 cm. Manual retrogastric retrocolic anastomosis in «end-to-side¼ fashion was performed within 20 cm from the ligament of Treitz. This type of anastomosis made it possible to preserve gastric tube length as much as possible that reduces the risk of jejunogastroesophageal reflux. RESULTS: There were 16 patients (15 females and 1 male) aged 23-48 years for the period from June 2019 till March 2020. Mean weight of patients was 86.12 kg (range 62-124). Mean BMI was 35.15 kg/m2 (ranged 21.96-39.62). In 6 months after surgery, all patients achieved normal BMI. Man BMI dropped to 23.8 kg/m2. Minimal excessive weight loss was 81.8%, maximal excessive weight loss - 125%. Control esophagogastroduodenoscopy was performed in 5 patients after 6 months and later. During retrograde duodenoscopy, we visualized major duodenal papilla in all cases using a flexible endoscope with standard optic system. CONCLUSION: The proposed modification of one-anastomosis gastric bypass with a short limb is a safe and effective procedure in bariatric surgery. This surgery ensures postoperative diagnostic and therapeutic endoscopic procedures in all parts of stomach and duodenum. This method could be recommended for surgical treatment of patients with obesity grade 1 and 2 after additional clinical trials and analysis of long-term results.

Role of MicroRNAs in the Regulation of Subcutaneous White Adipose Tissue in Individuals With Obesity and Without Type 2 Diabetes.

Obesity is a high-risk factor for such comorbidities as cardiovascular disease, several types of cancer, and type 2 diabetes; however not all individuals with obesity have such complications. Approximately 20% of individuals with obesity are metabolically healthy. This study focused on differences between obese individuals with and without type 2 diabetes (T2D+ and T2D-, respectively) on the transcriptome level. Subjects included were 35 T2D- patients with obesity and 35 T2D+ patients with obesity with the same body mass index (BMI). The study was based on the transcription analysis of mRNA and microRNAs (miRs) by RNAseq. In the first step, we performed RNAseq of miRs, in the second step, we analyzed only those mRNA, which appeared targets for significant miRs from the first step. All RNAseq results were validated by qPCR. There were seven miRs differently expressed with adjusted p-value <0.1, which were confirmed by qPCR. Five among them: miR-204-5p, miR125b-5p, miR-125a-5p, miR320a, miR-99b-were upregulated in T2D+ patients with obesity, while only two miRs, miR-23b-3p, and miR197-3p, were increased in T2D- patients with obesity. These seven miRs target two groups of genes: matrix metalloproteinases and TGFß signal pathway genes. According to the results of transcriptome analysis, the main difference between T2D+ and T2D- patients with obesity was in adipogenesis and fibrosis regulation by matrix metalloproteinases and SMAD4-RUNX2 signal cascade. Based on the data about transcription profiles of both groups, we suggested that the process of fibrosis in T2D+ patients with obesity is more pronounced than in T2D- patients with obesity.

Low proliferative potential of adipose-derived stromal cells associates with hypertrophy and inflammation in subcutaneous and omental adipose tissue of patients with type 2 diabetes mellitus.

BACKGROUND: Obesity and type 2 diabetes mellitus (T2DM) are among the most important morbidity factors. In this study we tested the hypothesis that low proliferative potential of adipose derived stromal cells (ADSC) associates with reduced formation of new fat depots, excess accumulation of fat in the functional adipocytes and their hypertrophy, resulting in fat inflammation and insulin resistance. METHODS: We screened two groups of obese patients with or without T2DM, matched for BMI, age, and duration of obesity to test the hypothesis that hypertrophy and decreased renewal of adipocytes may underlie transition from obesity to T2DM. All patients were matched for carbohydrate metabolism (fasting blood glucose level, glycated hemoglobin, HOMA-IR index and M-index). The subcutaneous and omental fat tissue biopsies were obtained during bariatric surgery from obese individuals with or without T2DM. The morphology and immunophenotype of subcutaneous and omental fat was assessed in frozen tissue sections. ADSC were isolated from both types of fat tissue biopsies and screened for morphology, proliferative potential and inflammatory status. RESULTS: The non-diabetic patients had normal carbohydrate metabolism and moderate insulin resistance measured by HOMA-IR and hyperinsulinemic clamp (M-index), while T2DM patients were extremely insulin resistant by both indexes. The average size of diabetic adipocytes was higher than that of non-diabetic in both subcutaneous and omental fat tissues, indicating adipocyte hypertrophy in T2DM. Both these tissues contained higher level of macrophage infiltration and increased M1-like to M2-like ratio of macrophage subpopulations, suggesting increased fat inflammation in T2DM. This was confirmed by increased activatory phosphorylation of stress-induced JNK1/2 in diabetic ADSC. CONCLUSION: These results suggest that blunted proliferation and increased hypertrophy of diabetic ADSC may lead to reduced insulin sensitivity via increased inflammation mediated by M1 macrophages and JNK1/2 pathway.

[Cyanidin as endogenous chelator of metal ions in maize seedling roots].

The property of cyanidin complexation with different metal ions in maize seedlings roots was established using parameters of reflectance spectroscopy and colorimetry. The spectral criteria of pigment association with metals in vivo were evaluated.

[Dose effect of cyanidin interaction with lead ions in roots of maize seedlings].

The dose effect of cyanidin interaction with lead ions in maize seedling roots was established using reflectance spectroscopy and colorimetry. It was demonstrated basing on the regression analysis that changes of spectral parameters were related to enhanced complex formation when the metal concentration increases.

[Complexation of cyanidin with cadmium ions in solution].

The effect of complexation between cyanidin (extracted from maize seedling roots) and cadmium ions was established in solution on the basis of absorption spectroscopy and colorimetry data. Spectral parameters for identification of the pigment added to the metal has been established.

[Effect of beta-carotene accumulation on spectral parameters of microscopic fungi Blakeslea trispora biomass]. / Vplyv nakopychennia beta-karotynu na spektral'ni parametry biomasy mikroskopichnoho hryba Blakeslea trispora.

Parameters of reflectance spectra in visible region and colorimetry for Blakeslea trispora biomass with different content of beta-carotene were determined. Correlation level of pigment accumulation and spectral characteristics were revealed. It is established, that objective control of color characteristics for biomass is possible using measurement of colorimetric parameters.

[Laparoscopic surgery in tumor obstruction of the biliary tract]. / Laparoskopicheskaia khirurgiia pri opukholevoi obstruktsii zhelchnykh putei.

The article gives a detailed description of the technique of laparoscopic biliodigestive anastomoses in patients with advanced tumors of hepatopancreatoduodenal zone. The authors have an experience with 18 operations. They performed 14 cholecystoenteroanastomoses including 9 total laparoscopic operations and 5 operations through a combined approach--laparoscopy in combination with minilaparotomy. The authors believe that laparoscopic surgery is feasible and safe for treatment of these patients. The combined approach has financial advantages giving the possibility to save the disposable stapling devices.

[Endoscopic removal of the gallbladder mucosa after cholecystostomy]. / Endoskopicheskoe udalenie slizistoi obolochki zhelchnogo puzyria posle kholetsistostomii.

The authors have developed a new method of radical treatment of patients with acute obstructive cholecystitis after cholecystostomy. The endoscopic removal of the mucosa was proposed using hysteroresectoscope GYI-525-12 (Circon-ACM1). The method was used in 5 elderly patients with high anesthesia risk in whom surgical cholecystectomy was not possible. The removal of the mucosa resulted in the replacement of the gallbladder with the connective tissue giving the effect of radical operation.

[Video endoscopy of the residual cavity in hydatidectomy of the liver]. / Endovideoskopiia ostatochnoi polosti pri ékhinokokkéktomii pecheni.

Results of treatment of 162 patients with echinococcosis of the liver were analyzed. Traditional surgical treatment of these patients was followed by endovideoscopy of the residual cavity of the liver. During endovideoscopy of the residual cavities the remnants of the chitinous membranes and small daughter vesicles not noticed during the open stage of the operation were removed in 7.4% of the patients, in 25.9% of the patients cystobiliary fistulas were detected. The endovideoscopy considerably improves revision of the residual cavities of the liver and facilitates liquidation of cystobiliary fistulas which gives better results of the treatment of such patients.

Pneumoperitoneum risk prognosis and correction of venous circulation disturbances in laparoscopic surgery. A pilot study.

BACKGROUND: This study was initiated to find a method of determining the prognosis for possible changes in hemodynamic and respiratory parameters in patients with pneumoperitoneum (PP). METHODS: We devised a model for a pseudopneumoperitoneum (PPP), which is created by encircling the wide pneumochamber on the entire abdomen and inflating it to a preset pressure. To verify the prognostic possibilities of the proposed model, we studied the pneumotachygraphy parameters, noninvasive and invasive monitoring parameters of PPP after induction of anaesthesia, and venous circulation disturbances, as well as the medical effect of the intermittent sequential compression device. RESULTS: In healthy patients, the restrictive lung syndrome did not approach the risky limit. In patients >/=60 years old, this syndrome was very close to the limit. In a number of patients with serious cardiovascular and pulmonary pathology, the pressure of >10 mmHg was considered to be intolerable. Lung compliance, which was the parameter most sensitive to the increased intraabdominal pressure, was 47 +/- 10 at baseline, and 29 +/- 4 (p > 0.05) at both PPP and real PP (14 mmHg). CONCLUSIONS: The PPP model is quite similar to the real PP and can be used for preoperative prognosis in laparoscopic surgery. The elevated intraabdominal pressure results in a significant disturbance of venous blood flow in the lower extremities. The use of the device for peristaltic pneumomassage of the lower limbs is effective in correcting negative changes in venous hemodynamics in laparoscopic surgery.

[Lithogenic bile typing based on parameters of cluster analysis of IR-spectra]. / Tipizatsiia litogennoi zhelchi na osnove klasternogo analiza parametrov IK-spektrov.

Using cluster analysis of analytic strips optical densities the lithogenic bile heterogeneity has been confirmed and different types, possessing a distinction totality of spectral and biochemical figures has been revealed. This study demonstrated tendency in process of formation of gallstone in cholelithiasis.

Infrared spectra of bile, ionized, and conjugated bile acids. / Infrakrasnye spektry zhelchi, ionizirovannykh i kon''iugirovannykh zhelchnykh kislot.

The ionization and conjugation effect on infrared spectra of bile acids has been studied. The interpretation of spectra of native bile absorption in the infrared range was conducted with allowance for different types of functional groups oscillations.

[Treatment of peptic ulcer hemorrhage with leucine enkephalin analog dalargin]. / Lechenie iazvennykh gastroduodenal'nykh krovotechenii s primeneniem analoga leitsin--enkefalina-dalargina.

The article discusses treatment of 72 patients suffering from duodenal ulcer complicated by bleeding with the Soviet-made preparation Dalargin which is a synthetic analogue of leucine-enkephalin. The preparation was infused intravenously in a dose of 3 mg in physiological solution once daily. No other additional antiulcerative agents were give. The diagnosis was established on the basis of endoscopy. Dalargin led to cicatrization of the ulcers in 20.3 days in 60% of patient, obvious positive dynamics was noted in 32% of patients; in 8% of patients Dalargin proved ineffective. Basal hydrochloric acid secretion reduced by 56% during treatment.

[Spectrophotometric determination of the protein concentration in solutions]. / Spektrofotometricheskoe opredelenie kontsentratsii belka v rastvorakh.

The spectrophotometric methods for determination of protein concentration in solution are analysed. According to the given data it has been concluded that the method based on the measurement of difference in light absorption by protein solution at 235 and 280 nm is more accurate as compared with the method of absorption determination at 260 and 280 nm. The linear regression coefficient is used in calculation.