The role of systemic inflammation in the pathogenesis of insulin resistance and metabolic syndrome in patients with chronic hepatitis C.

AIM: To determine the role of nonspecific inflammation in the formation of IR and metabolic syndrome in patients with chronic hepatitis C. MATERIALS AND METHODS: The study included 205 patients with CHC aged 18 to 69 years. Patients with CHC are randomized into two groups depending on the presence of IR: group 1 - patients with a HOMA index ≥2.77, which corresponded to IR (n=110); group 2 (n=95). The levels of serum iron, C-reactive protein (CRP), serum ferritin and adipose tissue hormones [leptin, resistin, adiponectin and tumor necrosis factor-α (TNF-α)] were additionally investigated. RESULTS: At all stages of development of IR, nonspecific inflammation was detected (according to ferritin, CRP and serum iron), increasing with increasing HOMA index [Homeostasis Model of Assessment - Insulin Resistance (HOMA-IR)] (Matthews D., 1985), metabolic syndrome and its components. In the analysis of indicators in patients with chronic hepatitis C with a body mass index <25 kg/m2, conjugacy of IR with low-intensity inflammation, high viral load and hypersecretion of TNF-α was detected. CONCLUSION: Given the high predictor role of CRP indicators in predicting IR, it should be used as a surrogate screening marker of IR in patients with chronic hepatitis C and should be actively treated for violations.

A novel highly selective ligand for separation of actinides and lanthanides in the nuclear fuel cycle. Experimental verification of the theoretical prediction.

We have predicted earlier by DFT simulation that tridentate O,N,O-donor cyclic dilactams (B) belonging to the family of pyridine-2,6-dicarboxamides are much more selective and efficient extractants for the separation of lanthanides and actinides than open-structure pyridine-2,6-dicarboxamides due to the higher degree of "ligand preorganization". In the present work, three new ligands of type (B) were synthesized. Extraction experiments showed that, in line with the data from DFT simulation, these ligands have 5-6-fold higher selectivity for the separation of an Am3+/Eu3+ pair and provide distribution coefficients D which are by three orders of magnitude higher than those for the related parent ligands with an open structure. Determination of the solvate numbers (SNs) for Eu3+ and Am3+ cations by slope analysis has shown that the stoichiometry of complexes, in the form of which these ions pass from the aqueous into the organic phase, depends to a considerable extent on the polarity of the organic solvent. Strongly polar solvents (ε > 20) extract these cations mainly in the form of 1 : 1 complexes LM(NO3)3 having according to the DFT simulation the largest dipole moments (µ = 18.6-19.7 D). The solvents of low polarity (ε ≤ 10) extract these cations mainly in the form of less polar 2 : 1 complexes L2M(NO3)3 (µ ≈ 1.6 D). For solvents of intermediate polarity fractional values of solvate numbers were obtained which indicates the coexistence of complexes LM(NO3)3 and L2M(NO3)3 in the organic phase.

[Insulin resistance and chronic hepatitis C]. / Insulinorezistentnost' i khronicheskii gepatit S.

AIM: To estimate the spread of insulin resistance (IR) in patients with chronic hepatitis C (CHC) and to define the role of IR in the development of hepatic steatosis (HS) and in the progression of liver fibrosis (LF), as well as the impact of IR on the results of antiviral therapy (AVT). SUBJECTS AND METHODS: A total of 211 patients with CHC were examined. A comparison group consisted of 75 patients with chronic hepatitis B (CHB). The patients were divided according to the presence and absence of IR and type 2 diabetes mellitus (DM). IR was analyzed in patients with CHC with a body mass index (BMI) of <25 kg/m2 and with the initial manifestations of LF. RESULTS: In the patients with CHC, IR without DM was 1.7-fold more common and type 2 DM was 2.6 times more frequently seen than in those with CHB. The highest biochemical activity, subclinical inflammation (as evaluated from ferritin and C-reactive protein levels), and an advanced LF stage were noted in the presence of IR and type DM. IR and type 2 DM were associated with metabolic syndrome and its individual components and with no response to AVT. When the BMI was <25 kg/m2, HS, inadequate 25(OH)D provision, an advanced LF stage, and slowly progressive inflammation were related to IR. In the presence of the initial manifestations of fibrosis, IR was associated with obesity, HS, 25(OH)D deficiency, a rise in C-reactive protein greater than 3 mg/l, and no response to AVT. CONCLUSION: The presence of IR in CHC patients with a BMI of <25 kg/m2 and with the initial manifestations of LF and the association of IR with HS and an advanced LF stage necessitate an examination of all patients with CHC in an effort to identify IR and to perform active therapy of detected abnormalities.

N,N'-Dialkyl-N,N'-diaryl-1,10-phenanthroline-2,9-dicarboxamides as donor ligands for separation of rare earth elements with a high and unusual selectivity. DFT computational and experimental studies.

N,N'-Dialkyl-N,N'-diaryl-1,10-phenanthroline-2,9-dicarboxamides (IV) were predicted (DFT simulation) and then were proved experimentally to be efficient donor ligands with high and unusual selectivity for the extraction separation of lanthanides. Distribution coefficients D of lanthanide cations in two-phase aqueous solution-polar organic solvent decrease with increasing Ln(3+) atomic number. The selectivity factors SFLn1/Ln2 for adjacent lanthanide ions were found to be about 3.

[Use of a regional registry of chronic hepatitis patients to optimize antiviral therapy]. / Ispol'zovanie regional'nogo registra patsientov s khronicheskimi gepatitami v tselyakh optimizatsii protivovirusnoi terapii.

AIM: To determine the general characteristics of patients with chronic viral hepatitis C (CVHC) from the data of a registry of patients with viral hepatitis (VH) in the Stavropol Territory and to estimate possible predictors for the inefficiency of antiviral therapy (AVT) for treatment optimization. SUBJECTS AND METHODS: The results of examining and treating patients with CVHC were retrospectively analyzed from the data of the registry of HV patients in the Stavropol Territory in 2008-2013. RESULTS: The chronic hepatitis registry includes 1811 patients with CVHC; out of them there are 64% who have its virus genotype 1. According to the registry, there is cirrhosis in 244 (13.5%) patients, fibrosis (METAVIR F2-F3 in 724 (39.97%), and fibrosis (METAVIR F0-F1) in the remaining 843. Carbohydrate and fat metabolic disturbances (obesity, insulin resistance (IR), and diabetes mellitus (DM)) have been found in 615 (34%) patients; every three patients have gastrointestinal diseases and comorbidity is absent in 24% of the patients. The results of AVT were analyzed in 493 patients with CHC virus genotype 1. The analysis showed the most important predictors for the inefficiency of AVT; these included HOMA-IR >2, the presence of IR (HOMA-IR >2.77), and type 2 DM, as well as patient age over 45 years, male sex, a viral load of ≥6 log10 IU/ml, and liver fibrosis (METAVIR ≥F3). CONCLUSION: The analysis of VH morbidity in the Stavropol Territory, the making of a registry of patients with chronic VH, its columns of IR, body mass index, virologic response changes during therapy could clarify the actual need in AVT and improve activities in the prophylactic medical examination and treatment optimization in this patient group in the areas of this region.

[Clinical features of chronic hepatitis B in the presence of metabolic syndrome and insulin resistance].

AIM: To assess the relationship of different components of metabolic syndrome (MS), viral load, and HBeAg status to the risk for cirrhosis of the liver in patients with chronic hepatitis B (CHB). SUBJECTS AND METHODS: Fifty-three patients with CHB were examined according to the conventional criteria for patients with chronic hepatitis (the 2012 EASL guidelines). Analysis is made in relation to the degree of liver fibrosis (LF), the presence of MS, abdominal obesity, and insulin resistance (IR). RESULTS: MS was detected in 22.6% of the patients with CHB. The duration of the latter in MS was noted to be longer; the patients with MS were accordingly older than those without MS. The patients of this category were significantly more frequently observed to have type 2 diabetes mellitus (DM2), and IR, hepatic steatosis, and > 3 METAVIR scores for LF, and elevated activity of hepatic enzymes (alanine aminotransferase, aspartate aminotransferase). Marked LF was associated with a high viral load, obesity, DM2, patient age, and MS. The patients with MS showed a higher activity of hepatic enzymes than those with abdominal obesity without MS. CONCLUSION: The percentage of CHB patients with MS increases with disease duration and patient age. High viral load, disease duration, MS, obesity, and DM2 are associated with score >3 METAVIR scores for significant LF.

[Evaluation of seroconversion after vaccination of medical staff against HBV infection].

AIM: Carry out analysis of formation of immune response in vaccinated medical staff against viral hepatitis B, detect risk factors by lack of seroconversion after vaccination. MATERIALS AND METHODS: In medical staff (49 individuals) retrospective analysis of dynamics of antibody titers against HBsAg (aHBs) after vaccination in 1998-2011, data on objective status and main laboratory parameters based on medical documentation was carried out. RESULTS: Among vaccinated the lack of response (aHBs < 10 mIU/ml) was observed in 20.4%, weak response (aHBs > or = 10 mIU/ml, < 100 mIU/ml)--in 34.7% and full response (aHBs > or = 100 mIU/ml)--in 44.9% of staff. Age over 40 years, male gender, obesity and insulin-resistance were linked with ineffectiveness of vaccination. With aHBs < 100 mIU/ml titers the patients became seornegative within 3 years after the immunization. With aHBs > or = 100 mIU/ml titers the patients remained seropositive for 10 years. CONCLUSION: Age over 40 years, male gender, obesity and insulin-resistance are linked with lack of formation of seroconversion after vaccination against HBV infection. When immune response is weak early monitoring of HBV titers is necessary with the aim of timely execution of revaccination. When immune response is adequate, revaccination is possible in 10 years.

[The functional metabolic activity of the blood neutrophils in different clinical forms of brucellosis]. / Funktsional'no-metabolicheskaia aktivnost' neitrofilov krovi pri raznykh klinicheskikh formakh brutselleza.

The characteristics of the activity of alkaline phosphatase, nonspecific esterase, myeloperoxidase, lysosomal cation proteins, lipids have been determined in the cytochemical study of neutrophils in peripheral blood samples of 127 patients with acute, chronic, primary chronic brucellosis and osteochondrosis. It is expedient to use these characteristics as additional tests for the differential diagnostics of different clinical forms of brucellosis, as well as residual brucellosis and osteochondrosis.

[Hypophyseal gonadotropic function in gout]. / Gonadotropnaia funktsiia gipofiza pri podagre.

Gonadotropic function of hypophysis was studied in 109 patients with gout. Raised level of luteinizing hormone (LH) was found in men while women had decreased content of LH and follicle-stimulating hormone (FSH). Severe lesions of joins and kidneys were associated with suppressed FSH secretion. The authors consider correction of hormonal dysfunction in gout to be advisable. Certain correlative relations were established to exist between levels of gonadotropins, sex hormones and indices of purine metabolism.

[The clinico-pathogenetic aspects of sex dimorphism in gout]. / Kliniko-patogeneticheskie aspekty polovogo dimorfizma pri podagre.

The examination of 241 gout patients (207 males and 34 females) revealed a marked sexual dimorphism of the disease related to the articular and renal syndromes. Male gout is characterized by higher blood levels of uric acid and oxypurinole in reduced clearance of the latter, while in female gout there were hyperxanthinoxidasemia and hypo-cAMPemia. Unbalance of sex and gonadotropic hormones, which appeared multidirectional and dependent on the sex, was observed in males in the form of lower concentrations of blood testosterone and estradiol against elevated levels of progesterone and lutropin, in females manifested with hypoprogesteronemia and reduced gonadotropin.

[Analysis of early and late complications of the Duhamel and Soave operations in the treatment of developmental defects of the large intestine in children]. / Analiz rannikh i pozdnikh oslozhnenii operatsii Diuamelia i Soave pri lechenii porokov razvitiia tolstoi kishki u detei.

Under study were results of the surgical treatment of 306 patients with various defects of the colon (Hirschsprung's disease, dolichosigmoid, dolichocolon, primary megarectum). In 158 of the patients the Duhamel operation was used, 148 patients were operated on after Soave. Early postoperative complications were established in 13 patients (4.2%), late complications were found in 15 patients (4.9%). The character of the early and late complications was dependent on the kind and technique of the operation.

[Clinical picture and treatment of concealed penis in children]. / Klinika i lechenie skrytogo polovogo chlena u detei.

A method of surgical treatment of 47 patients with microphallus is described. There are two kinds of the surgical treatment of microphallus depending on its form. A new operative method is proposed for a dystopic form. Good long-term results were obtained.

[Polyps of the large intestine in children]. / Polipy tolstoi kishki u detei.

Polyps in the large intestine is a frequent disease in children. It is more often observed in boys than in girls aged 4 to 9. In most cases solitary polyps are observed (in 73,35%). Two-three polyps are met in 21,62% of cases. Polyposis is a rare disease--0,91%. The main symptom of polyps in children is hemorrhage from the anal orifice. The method of treatment is dependent on the amount, size, height of the situs and spread of the polyps. Dissection of polyps through the rectal speculum is used more frequently, rectoromanoscope is used in rarer cases (electroexcision and coagulation). Resection of the large intestine or colotomy and ablation of polyps can be successfully used in polyposis and high situs of polyps.