[Differences in the elastic work of breathing of the pulmonary parenchyma in patients with bronchial asthma and COPD].

AIM: To determine and compare the work of breathing to overcome elastic resistance (Ael) in patients with bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) with similar changes in the elastic properties of the parenchyma in the same settings of ventilation disorders (grade 1). MATERIALS AND METHODS: Differences in the manifestations of similar changes in the elastic properties of the lungs in patients with BA and COPD were evaluated. To identify differences, a comparative study was conducted on Аel overcome in BA patients with positive bronchodilator (with salbutamol) and bronchoconstrictor (with methacholine) tests, with reduced and preserved bronchial conductance (groups 1 and 2, respectively), and in COPD patients with negative bronchodilator and bronchoconstrictor tests (group 3). All study patients showed a grade 1 lung ventilation disorder (a decrease in the one-second forced expiratory volume by 15-35%). The results were compared with each other and with the control group (group 4, healthy non-smokers). All study patients were comparable by age and sex. The respiration mechanics was studied using simultaneous registration of spirogram and transpulmonary pressure, and the parameters of bronchial conductance and ventilation were determined using body plethysmopressography using the Jager software and hardware system. RESULTS AND CONCLUSION: In COPD patients, Ael was significantly increased (p>0.05), whereas in both BA groups, it was unchanged. Increased elastic work of breathing in patients with COPD may be associated with the involvement of certain types of contractile elements, which are preserved in patients with BA at the initial stages of the disease.

[The Role of Reactive Oxygen Species in the Pathogenesis of Adipocyte Dysfunction in Metabolic Syndrome. Prospects of Pharmacological Correction].

It is established that oxidative stress induces insulin resistance of adipocytes, increases secretion leptin, IL-6, TNF-α by adipocytes. Adiponectin secretion by adipocytes is reduced after the action of reactive oxygen species. Metabolic syndrome contributes to oxidative stress in adipose tissue, on the one hand due to the activation of production of reactive oxygen species by adipocyte NADPH-oxidase, and on the other hand by reducing the antioxidant defense adipocytes. It is found that obesity itself can induce oxidative stress. Chronic stress, glucocorticoids, mineralocorticoids, angiotensin-II, TNF-α play an important role in the pathogenesis of oxidative stress of adipocytes. Metformin remains the cure for the treatment of insulin resistance. The positive results in the treatment of metabolic syndrome by losartan were obtained. Antioxidants and flavonoids exhibit a positive impact on the course of the experimental metabolic syndrome.

[Effect of atorvastatin on pro-inflammatory status (in vivo and in vitro) in patients with essential hypertension and metabolic syndrome].

AIM: To study effect of atorvastatin on spontaneous production of cytokines and reactive oxygen species by mononuclear leukocytes of blood of hypertensive patients with metabolic syndrome in vivo and in vitro. MATERIAL AND METHODS: We conducted an 8-week open prospective study on 36 patients with essential stage II hypertension associated with metabolic syndrome. Along with examination made in specialized cardiological clinic we assessed spontaneous production of cytokines and reactive oxygen species by blood mononuclear leukocytes during therapy with atorvastatin (in vivo). Dynamics of these parameters under the influence of atorvastatin on suspension of mononuclear leukocytes was also assessed in vitro. RESULTS: Therapy with atorvastatin (20 to 40 mg/day) facilitated reduction of serum concentration of acute phase proteins (C-reactive protein and neopterin) and decrease of spontaneous production by blood mononuclear leukocytes of proinflammatory cytokines (interleukin [IL]-1ß, IL-6 and tumor necrosis factor [TNF]-α) and reactive oxygen species. Dynamics of cytokine concentrations in supernatants of mononuclear leukocytes obtained after incubation of the cells with atorvastatin in vitro confirmed the assumption of direct inhibitory effect of this drug on spontaneous production of some proinflammatory cytokines (IL-6 and monocyte chemotactic protein-1). Absence of significant lowering of concentrations of other proinflammatory cytokines (IL-1ß and TNF-α) and expression of reactive oxygen species in vitro evidenced for complex indirect effect of therapy with atorvastatin on their production.

[The influence of amlodipine on transcapillary metabolism of oxygen during coronary heart disease with insulin resistance].

This three-week open uncontrolled study included 34 men (mean age 53.14+-1.19 yr) with coronary heart disease (CHD) and insulin resistance (HOMA >2. 77); it was designed to estimate effect of amlodipine on transcapillary oxygen metabolism (TCOM). Multivascular stenosing coronary atherosclerosis was managed by aortocoronary bypass surgery. Traditional methods applied in specialized cardiological clinics were supplemented by TCOM measurement using a PA-2 polarograph (Czech Rep.). Polarography revealed deterioration of TCOM parameters including permeability of hemocapillaries, adaptive reserves of the microcirculatory bed, and oxygen supply to the tissues. Amlodipine therapy demonstrated high antianginal potency of this drug and its ability to improve TCOM

[Pleiotropic effects of atorvastatin and dynamics of quality of life characteristics in patients with hypertensive disease and metabolic syndrome].

AIM: To study pleiotropic effects of atorvastatin during 8-week therapy of metabolic syndrome and estimate their relationship with dynamics of quality of life characteristics (QLC). MATERIAL AND METHODS: This 8-week study included 36 patients with stage II hypertensive disease associated with metabolic syndrome (MS). Comprehensive clinical, laboratory and instrumental examination was supplemented by QLC assessment using the MOS SF-36 questionnaire. RESULTS: 8-week therapy of stage II hypertensive disease associated with metabolic syndrome using individually selected doses of atorvastatin (20 to 40 mg/d) significantly reduced atherogenic cholesterol fraction and serum leptin levels; it had positive effect on carbohydrate and purine metabolism and safely maintained positive dynamics of subjective assessment of most points of the MOS SF-36 questionnaire.

[Prothrombotic state in patients with metabolic syndrome: an association with inflammation].

AIM: To comprehensively study hemostasis pathology and its association with the laboratory markers and mediators of inflammation in patients with metabolic syndrome (MS). SUBJECTS AND METHODS: One hundred and eleven patients with type 2 diabetes mellitus, who were diagnosed as having MS, were examined. Vascular-platelet and secondary hemostases and anticoagulant and fibrinolytic systems were evaluated, by performing the complete clinical, laboratory, and instrumental study accepted in a specialized endocrinology clinic. The blood concentrations of high-sensitivity C-reactive protein and proinflammatory cytokines were determined in all the patients with MS and control persons (n = 50). RESULTS: It was found that in patients with MS, hemostasis pathology that might be classified as the combined form of a prethrombotic state, which was caused by different types of a constellation of vascular-platelet and plasma hemostases, as well as physiological anticoagulant deficiency, was linked to the laboratory markers and mediators of subclinical inflammation. CONCLUSION: In the patients with MS, subclinical systemic inflammation is of substantial importance for the mechanisms of a prethrombotic state.

[Quality of life in patients with coronary heart disease associated with metabolic syndrome: results of factor analysis].

AIM: To identify the factors most substantially influencing the quality of life (QL) in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS), by using the principal component method. SUBJECTS AND METHODS: One hundred and two male patients (mean age 48.6 +/- 1.02 years) with CHD associated with MS, who had experienced large-focal myocardial infarction not earlier than 6 months before, were examined. Estimation of QL (EORTC QLQ CORE 30) and emotional-personal sphere (brief multifactorial personality questionnaire test and Spielberg's trait anxiety inventory) was made along with the complete clinical, laboratory, and instrumental examination accepted in specialized clinical practice of cardiology. RESULTS: A factor analysis of the variables obtained after a thorough examination of the patients could identify 4 common QL determinants, such as postinfarction cardiac remodeling, neurotization, obesity, and the degree of heart and coronary failure. CONCLUSION: MS in patients with CHD appreciably determines the total score of physical, emotional, and social well-being. In the cluster of MS components, obesity is a major factor that influences QL in patients who have sustained myocardial infarction.