[The effectiveness of eradication therapy of the 1st line of Helicobacter pylori infection in patients with type 2 diabetes mellitus].

AIM: Evaluation of the efficacy and safety of eradication therapy of infection Helicobacter pylori in patients with H. pylori- associated pathology of the upper gastrointestinal tract and concomitant type 2 diabetes mellitus (DM). MATERIALS AND METHODS: The prospective randomized study involving 180 patients (87 men and 93 women) with H. pylori- associated pathology of the upper gastrointestinal tract was carried out. The patients were divided into four groups of 45 people: 1 patients without diabetes who received the classic triple eradication therapy; 2 patients with type 2 DM who received the classic triple eradication therapy; 3 patients without DM who underwent quadrotherapy with bismuth preparations; 4 patients with type 2 DM who underwent quadrotherapy with bismuth preparations. Eradication therapy was carried out for 14 days. Evaluation of the effectiveness of eradication using a breath test was carried out 4 weeks after completion of the course of treatment. Eradication success was assessed separately for ITT and PP analyzes. RESULTS: The effectiveness of classical triple eradication therapy in patients with concomitant type 2 DM is 64.4% in the ITT group and 69.05% in the PP: quadrotherapy 73.34 and 80.49%, respectively. The effectiveness of first line eradication therapy is higher in patients without DM compared with groups of patients with concomitant type 2 DM: ITT 83.33%, PP 88.23% and ITT 68.89%, PP 74.70%, respectively. The incidence of side effects in patients with type 2 DM: with the use of classical triple therapy 22.23%, quadrotherapy 31.12%. CONCLUSION: The data of the study of the efficacy and safety of line I eradication therapy make it possible to recommend the four-component therapy based on bismuth for use in clinical practice, especially in patients with DM.

[The study of microcirculation and tissue metabolism as early diagnostic criteria for the risk of diabetic foot development].

AIM: To assess the state of the microvasculature, tissue metabolism and its reserve capabilities for the purpose of early intervention for the prevention of diabetic foot syndrome. MATERIALS AND METHODS: Thirty patients were examined. The patients were divided into three groups depending on the hypoglycemic therapy (metformin, empagliflozin, dapagliflozin). The comparison group consisted of 12 volunteers who did not have carbohydrate metabolism disorders. RESULTS: It was found: the HbA1c indicator significantly decreased in all three groups; significant dynamics in the state of the microvasculature was not observed in any of the three groups; in all groups, there was an improvement in tissue metabolism, however, in this case, no significant dynamics were observed in any of the 3 groups, which indicates the need for provocative tests. CONCLUSION: For this purpose, the authors recommend the method of combined use of laser Doppler flowmetry and laser fluorescence spectroscopy. This technique allows diagnosing the state of the microvasculature and tissue metabolism and its reserve capabilities, using thermal and cold tests.

[Estrogen metabolism, lifetime methylation disorders, and breast cancer].

Oncogenesis can be caused by an increase in the activity of genes responsible for initiating tumor growth in stem or progenitor cells, as well as a reduction in the functioning of suppressor genes. Endogenous estrogen exposure is associated with an increased risk of breast cancer in both pre- and postmenopausal women. The most important step in the understanding of the pathogenesis of breast cancer was the development of the theory of the switching of estrogen's effect from hormonal to genotoxic, in which the main culprits of carcinogenesis are not chemical metabolites of estrogens, but their derivatives, corresponding to chemical procarcinogens according to their damaging characteristics. The origin of these substances and the formation of estrogen genotoxicity lies in the disruption of the inactivation process of catechol estrogens in methylation reactions. The main epigenetic modification of the human genome is the methylation of cell DNA molecules. DNA methylation does not alter the primary sequence of nucleotides, but is necessary for the functional suppression of certain genes. The phenomenon of hypomethylation-hypermethylation underlies the long-term silencing of various genes, including tumor suppressor genes. Nutrition and a lifestyle associated with smoking and the consumption of excessive quantities of alcohol determine estrogen metabolism and the availability of methyl groups in the body, as well as epigenetic changes in the DNA of the genome. The assessment of individual risk of breast cancer on the basis of an assay for the expression and methylation of the COMT gene responsible for estrogen metabolism seems relevant.

[Analysis of cardiovascular safety of novel glucose-lowering medications].

In 2008 the Food and Drug Administration has revised approval process for new antidiabetic agents and introduced a requirement to demonstrate the cardiovascular safety in an international multicenter trial. Currently cardiovascular outcome trials of dipeptidyl peptidase-4 (DPP-4) inhibitors (SAVOR-TIMI53, EXAMINE and TECOS), sodium-glucose cotransporter 2 inhibitors (EMPAREG, CANVAS), glucagon-like peptide-1 receptor agonists (ELIXA, EXSCEL LEADER and SUSTAIN-6), ultralong-acting and insulin (DEVOTE) have been completed. The trials confirmed cardiovascular safety of these glucose-lowering medications, and in addition, EMPA-REG OUTCOME (empagliflozin), CANVAS (canagliflozin) and LEADER (liraglutide) have also demonstrated cardioprotective effect of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. These data led to the changes of clinical guidelines for the management of type 2 diabetes.

[Effect of dental implants with conditioned surface based on sodium hydroxide in patients with osteoporosis]. / Otsenka éffektivnosti primeneniia dental'nykh implantatov s konditsionirovannoi poverkhnost'iu na osnove gidroksida natriia u patsientov s osteoporozom.

The problem of improving the efficiency of implantological treatment of patients with osteoporosis (OP) today remains relevant due to the high frequency of postoperative complications. Among the main factors affecting the success of dental implant treatment, the nature of the implant surface is essential. Patients with adentia and OP especially relevant in use of dental implants with optimized surface, air conditioned component influencing bone remodelling. OBJECTIVE: Evaluation of the effectiveness of dental implants with a conditioned surface based on sodium hydroxide in men with osteoporosis. MATERIAL AND METHODS: The study included 60 men 54-65 years of age in need of dental implants of which 40 were diagnosed with OP. Patients with OP were divided into groups: I - 20 men without antiresorptive therapy; II - 20 men taking ibandronate 150 mg monthly, calcium and vitamin D (1000 mg/800 IU daily). The control group consisted of 20 men 54-65 years without OP. Microarchitectonics of the mandible was studied using cone-beam computed tomography and histomorphometry. Implants with bioactive surface based on sodium hydroxide (NaOH) were used. RESULTS: The results showed that the success of osseointegration is due to the qualitative parameters of the bone tissue of the perceived bed and the initial level of remodeling processes and does not depend on the conditioning of the implant surface NaOH. Comprehensive antiosteoporotic therapy with bisphosphonates and calcium supplementation with vitamin D leads to restoration of micro-alveolar part.

[Features of restoration of chewing efficiency in patients over 50 years with complete absence of teeth and alveolar bone atrophy.]

The base of osteoporosis is an imbalance of bone remodeling processes, with a predominance of the resorption phase that in the maxillofacial region is manifested by a partial and complete absence of teeth with a decrease in the volume of bone tissue of the jaws and a violation of its microarchitectonics. Atrophy of the alveolar bone reduces the degree of fixation of the removable prosthesis, can develop various diseases of the underlying mucosa. In this regard, the installation of dental implants as a support for removable orthopedic structures is relevant, however, in patients with osteoporosis, the risk of complications in the early and late postoperative period remains high to 44%. Objective: to improve the efficiency of dental implantation in patients with osteoporosis. 80 men over 50 years old with complete absence of teeth on the lower jaw with alveolar atrophy and osteoporosis were under observation. Carried out condition monitoring of the micro alveolar bone in patients with osteoporosis without a comprehensive antiosteoporotic therapy and in patients receiving ibandronate for 1 tablet (150 mg), 1 time a month with calcium 1 000 mg and vitamin D (cholecalciferol) 800 IU daily. It was found that taking antiresorptive therapy for 3 months improves the quality of the alveolar bone, increases the effectiveness of dental implantation in patients with complete absence of teeth and atrophy of the alveolar part.

Metagenomic Analysis of Gingival Sulcus Microbiota and Pathogenesis of Periodontitis Associated with Type 2 Diabetes Mellitus.

Biofilm of the gingival sulcus from 22 patients with type 2 diabetes mellitus and periodontitis, 30 patients with periodontitis not complicated by diabetes mellitus (reference group), and 22 healthy volunteers without signs of gingival disease (control group) was studied by quantitative PCR. Quantitative analysis for the content of P. gingivalis, T. forsythia, A. ctinomycetemcomitans, T. denticola, P. intermedia, F. nucleatum/periodonticum, and P. endodontalis in the dental plaque was performed with a Dentoscreen kit. The presence of other bacterial groups was verified by metagenomic sequencing of the 16S rRNA gene to evaluate some specific features of the etiological factor for periodontitis in type 2 diabetes mellitus. Specimens of the Porphiromonadaceae and Fusobacteriaceae families were characterized by an extremely high incidence in combined pathology. The amount of Sphingobacteriaceae bacteria in the biofilm was shown to decrease significantly during periodontitis. Metagenomic analysis confirmed the pathogenic role of microbiota in combined pathology, as well as the hypothesis on a possible influence of periodontitis on the course and development of type 2 diabetes mellitus.

[All-Russian Consensus on Diagnosis and Treatment of Celiac Disease in Children and Adults]. / Vserossiiskii konsensus po diagnostike i lecheniyu tseliakii u detei i vzroslykh.

The paper presents the All-Russian consensus on the diagnosis and treatment of celiac disease in children and adults, which has been elaborated by leading experts, such as gastroenterologists and pediatricians of Russia on the basis of the existing Russian and international guidelines. The consensus approved at the 42nd Annual Scientific Session of the Central Research Institute of Gastroenterology on Principles of Evidence-Based Medicine into Clinical Practice (March 2-3, 2016). The consensus is intended for practitioners engaged in the management and treatment of patients with celiac disease. Evidence for the main provisions of the consensus was sought in electronic databases. In making recommendations, the main source was the publications included in the Cochrane Library, EMBASE, MEDLINE, and PubMed. The search depth was 10 years. Recommendations in the preliminary version were reviewed by independent experts. Voting was done by the Delphic polling system.

[C-REACTIVE PROTEIN AS AN INDICATOR OF RISK OF CARDIOVASCULAR COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND ITS CORRECTION].

The study included 74patients (22 men and 52 women) aged 48-75yr with type 2 diabetes mellitus (DM2). 62 (88,6%) of them had grade II hypertensive disease (grade II-III by the WHO/ISH-2010 classification), 46 (67%) presented with II- III class functional stable angina of effort, 7 patients survived myocardial infarction, two ones underwent coronary artery stenting. Patients of the main group (n=50) received oral hypoglycemic agents in combination with 1-exenatide (mimetic of glucagon-like peptide) in the form of two daily subcutaneous injections of 5 mcg for 1 month and 10 mcg during the next 5 months. Control patients (n=20) were given standard hypoglycemic therapy. Analysis of highly sensitive CRP demonstrated its increase to 3 mg/l and more in 72.8% of the patients that was responsible for the high risk of cardiovascular disorders. 22,8% of the patients had a CRP level 1,0-2,9 mg/l (moderate risk) and only in 4,2% it was lower than 1 mg/l (low risk). Six months of exenatide therapy resulted in normalization of glycemia, glycated hemoglobin and significant decrease of CRP level which suggested the improvement of the functional state of vascular endothelium due to reduction of chronic inflammation objectively reflected in the highly sensitive CRP level.

Crystallization of oral fluid components in patients with type 1 diabetes mellitus.

We systematized and described morphological criteria characterizing crystalline aggregates in mixed saliva from patients with type 1 diabetes mellitus.

Crystallization of oral fluid components in patients with type 2 diabetes mellitus.

Crystal aggregations of oral fluid from normal subjects and patients with type 2 diabetes mellitus were examined. Morphological signs characterizing crystal aggregations of salivary pools from patients with type 2 diabetes mellitus are described and classified.