[Gender-related risk of non-fatal stroke, myocardial infarction and blindness in the type 2 diabetic patients depend on the type of treatment].

The aim of present observational cross-sectional study was the estimation of the gender-related risk of non-fatal stroke, myocardial infarction and blindness in type 2 diabetics (T2D) depending on treatment in Ukraine. In Dec 2005 the data from 11 Ukrainian regions for all living T2D already included into the nationwide population-based diabetes register (start of creation Jan 2001) was extracted. Male/female relative risks (RRs) for non-fatal stroke, myocardial infarction and blindness were calculated in treatment groups: Diet only (DO) 7273/15901; oral antidiabetic drugs (OAD) 15109/ 33913; insulin (I) 5529/12462 male/female respectively. 95% confidence intervals were estimated using logarithmic transformation, chi-square test was used to compare the differences between groups. The higher prevalence of stroke among men was in those patients treated with OAD or DO:RRs = 1.38 (1.26-1.51) and 1.48 (1.25-1.76), respectively. The gender differences were absent among those treated with I:RR = 0.98 (0.87-1.10). An excess male risk of myocardial infarction was in persons treated with I:RR = 1.37 (1.21-1.55), though smaller than in those treated without I - male/female RRs: 2.18 (1.97-2.41) and 2.37 (1.99-2.86), respectively for OAD and DO (P<0.001 in both cases). The significantly increased female prevalence of blindness was in patients treated with I:RR = 0.80 (0.70-0.92). The latest is in accordance with our earlier results, which have demonstrated the raised prevalence of both low sight and proliferative retinopathy among the insulin-treated diabetic women. No sex-related differences in blindness prevalence were revealed in patients treated with OAD or DO. The gender risks of not-fatal stroke, myocardial infarction and blindness in T2D are significantly different depending on the fact of insulin treatment. Further research could clarify if it depends upon insulin-related hyperandrogenisation in T2D women.

[Heat production as a criterion of adrenergic regulation of metabolic processes of the myocardium]. / Teploproduktsiia kak kriterii adrenergicheskoi reguliatsii metabolicheskikh protsessov miokarda.

Bolus injection of adrenaline in coronary perfusion blood flow caused different-directed changes in coronary venous blood temperature. Directivity and myocardium heat production changes are determined by peculiarities of interactions between adrenergic and cholinergic mechanisms of cardiodynamics and myocardial metabolism regulation. Cholinergic blockade by atropine++ increases heat production and limits negative ino- and chronotropic components of cardiac adrenergic reactions. That increase is completely eliminated by subsequent obsidan blockade of beta-adrenoreceptors.

[A method of continuous registration of heat production of the heart]. / Sposob nepreryvnoi registratsii teploproduktsii serdtsa.

A new method of continuous registration of the cardiac heat production was developed for the quantitative assessment of the levels of metabolic processes in cardiac hemodynamic reactions. The method is based on the technique of coronary arteries catheterization and extracorporeal perfusion, coronary sinus catheterization with a special catheter equipped with miniature-temperature transducer and a device designed for transformation of blood temperature values into the electrical signals. The data on the changes in cardiac heat production during cardiovascular adrenergic reactions and in conditions of acute myocardial ischemia have been obtained. It has been shown that changes in myocardial heat production depend significantly on the direction of shifts in the cardiac function and associated alterations in the level of myocardial metabolic processes.

[Changes in the function and energy metabolism of the myocardium in experimental diabetes mellitus in dogs]. / Izmeneniia funktsii i énergeticheskogo obmena miokarda pri éksperimental'nom sakharnom diabete u sobak.

Coronary arteries, coronary sinus, heart cavities, and great vessels were catheterized in anesthetized dogs with alloxan diabetes. Cardiac contractility, coronary and systemic circulation, myocardial energy metabolism and acid-base balance were studied. It was shown that the alterations of the cardiac function occurred in experimental dogs with severe diabetes mellitus. They consisted of a decrease in cardiac and working outputs, ejection period, maximum velocity of the left ventricular contractions and an increase in the projection period. These dysfunctions were caused by the alterations of the myocardial energy metabolism and systemic changes in the acid-base balance.

[Changes in the adrenergic mechanisms regulating cardiac activity and coronary circulation in experimental diabetes mellitus]. / Izmeneniia adrenergicheskikh mekhanizmov reguliatsii deiatel'nosti serdtsa i koronarnogo krovoobrashcheniia pri éksperimental'nom sakharnom diabete.

The effect of hyperglycemia on adrenergic response of the heart and coronary vessels was examined, using an alloxan diabetes model, in an experimental study involving catheterization, extracorporal perfusion and coronary arterial resistance measurement in dogs with intact thoracic cavities. Experimental diabetes mellitus was shown to be associated with enhanced positively chronotropic--and weakened negatively chrono- and inotropic--cardiac response to catecholamines introduced into the perfusion flow. Adrenergic reactive dilatation of coronary vessels was first enhanced, and later weakened, as glycemia progressed. It is assumed that a disturbance of hormonal interrelations due to insulin deficiency may play a role in the mechanism of changed adrenergic response of the heart and coronary vessels in experimental diabetes mellitus.

[Effect of insulin and beta-adrenergic blockaders on coronary circulation in response to hypoxia]. / Vliianie insulina i beta-adrenergicheskikh blokatorov na koronarnoe krovoobrashchenie v reaktsiiakh na gipoksiiu.

An experimental study in dogs with intact thoracic cavity under morphine-chloralose narcosis featured coronary catheterization, extracorporeal perfusion and resistography as well as catheterization of the heart cavities and the coronary sinus. Hemodynamic and respiratory parameters were recorded simultaneously. PO2, PCO2 and pH were measured in the inflowing and outflowing blood. The effect of insulin on circulatory response in acute hypoxic hypoxia was examined before and after obsidan block of beta-adrenoreactive systems. Insulin administered after the obsidan beta-adrenergic block was found to limit coronary dilatation and reduce myocardial oxygen consumption in a more pronounced measure. It is suggested that the effect of insulin on coronary dilatation is due to reduced myocardial oxygen consumption resulting from its action on the heart's beta-adrenergic systems.

[Effect of dopamine on coronary circulation]. / Vliianie dopamina na koronarnoe krovoobrashchenie.

The effect of dopamine on coronary and systemic circulation was examined in an experimental study on dogs using catheterization and extracorporeal perfusion of the bypassing branch of the left coronary artery, and simultaneous recording of heart's vascular resistance as well as cardio- and hemodynamic patterns. Dopamine introduced into coronary perfusion flow caused a dilatation of coronary vessels, a reflex drop in arterial blood pressure and peripheral vascular resistance, and changes in heart rate and intensity of cardiac contractions. Dopamine dosage should be about ten times as high to reproduce cardiodynamic and hemodynamic effects, comparable with the response to adrenaline and noradrenaline in terms of magnitude and pattern of development. Coronary vessels are dilated in two steps, through cholinergic activation and direct stimulation of beta-adrenoreactive systems. These two phases can be blocked by atropine and obsidan, respectively. After m-cholinergic and beta-adrenoreactive systems are blocked, dopamine produces a slight coronary vasoconstriction.

[Possible metabolic mechanisms of coronary circulatory disorder in an intact area of the left ventricle in experimental myocardial infarct]. / Vozmozhnye metabolicheskie mekhanizmy narusheniia koronarnogo krovoobrashcheniia v intaktnoi zone levogo zheludochka serdtsa pri éksperimental'nom infarkte miokarda.

In dogs with experimental myocardial infarction the anterior descending branch of the left coronary artery was ligated and 1, 2, 3, 5, and 10 days later its circumflex branch was catheterized and perfused, and coronary circulation in the intact myocardial zone, systemic hemodynamics, the AMP content and the activity of enzymes catalysing adenosine metabolism were studied. In the intact myocardial zone resistance increases in the coronary vessels and neurohumoral regulation is disturbed, the beta-adrenergic and cholinergic reactions of dilation are weakened, alpha-adrenergic pressor effect of catecholamines on the cardiac vessels is manifested, and adenosine metabolism is disturbed. Disorders of adenosine metabolism are regarded among the possible mechanisms of coronary circulatory disorders in the intact zone of the myocardium.

[Effect of insulin on coronary vessel adrenergic and cholinergic reactions]. / Vliianie insulina na adrenergicheskie i kholinergicheskie reaktsii koronarykh sosudov.

The effect of a single insulin injection on the reaction of the coronary vessels to adrenaline, noradrenaline, and acetylcholine was studied in experiments on dogs. Insulin induces a decrease of arterial pressure and of the resistance of the coronary and peripheral vessels reduces the reflex cholinergic and beta-adrenergic reactions of dilatation of the coronary vessels, and promotes alpha-adrenergic reactions in intracoronary administration of adrenaline and noradrenaline. Insulin also weakens the immediate cholinergic reactions of the coronary vessels in stimulation of the effector systems with acetylcholine.

[The dynamics of cardiac contraction in dogs with alloxan diabetes]. / Dinamika sokrashcheniia serdtsa pri alloksanovom diabete u sobak

Development of alloxan diabetes was accompanied in dogs by regular changes in the phasic structure of the cardiac contractions. Direction of the changes in the indices of phasic analysis in the groups of dogs with an average (up to 144.3 +/- 12.5 mg%) and marked (up to 258.0 +/- 22.8 mg%) increase in the blood sugar level was the same, but their expression increased with the elevation of hyperglycemia. In marked hyperglycemia there was established an increase (in comparison with normal values) of the index of myocardial tension, a shortening of the period of ejection, a decrease of the mechanical coefficient and of the intrasystolic index, this coinciding with the character of changes of the corresponding indices in the patients suffering from diabetes mellitus, depending on the severity of the disease. The data obtained pointed to the significant influence of metabolic changes (assessed by hyperglycemia level) on the contractile function of the heart.