[Diagnostic significance of clinical and laboratory indices in predicting non-alcoholic fatty liver disease during screening studies].

AIM: To study the significance of clinical and laboratory non-invasive indexes along with the insulin resistance index when carrying out diagnostic assessment of non-alcoholic fatty liver disease (NAFLD) during screening examinations. MATERIALS AND METHODS: The study involved 348 employees working at oil-production enterprises. An ultrasound scanning of the liver was carried out to assess the criteria of NAFLD. The following indexes were calculated: fatty liver index (FLI), hepatic steatosis index (HSI), lipid accumulation products (LAP), and homeostasis model assessment of insulin resistance (HOMA1-IR). The prognostic significance of these indexes in relation to the probability of NAFLD diagnosis based on ultrasound data was studied using single-factor and multi-factor logistic regression models followed by ROC-analysis. RESULTS: The FLI, HSI, and HOMA1-IR indexes in single-factor logistic regression models showed a high statistical significance when carrying out diagnostic assessment the NAFLD with good model calibration capability. The percentage of correct binary classification regards the presence/absence of NAFLD amounted to 82.4% for FLI, 79.7% for HSI, and 72.7% for HOMA1-IR (p0.001). According to the ROC-analysis, the area under the curve (AUC) by the NAFLD diagnostic assessment was 0.917 (95% CI 0.8890.945); 0.880 (95% CI 0.8460.915) and 0.849 (95% CI 0.7640.934), respectively. The multi-factor logistic regression model with the inclusion of FLI and HOMA1-IR 72.7% enabled us to achieve the correct binary classification in terms of NAFLD in 84.2% of cases. When it comes to the ROC-analysis, considering the probabilities predicted in the multi-factor logistic model as the test variable and NAFLD in ultrasound examination as the state variable, it was possible to set the value of AUC 0.933 (95% CI 0.8820.985). CONCLUSION: The studied clinical and laboratory indexes (FLI, HSI, HOMA1-IR) have a high diagnostic significance regarding NAFLD diagnosed using ultrasonographic criteria. The application of the proposed two-factor logistics model makes it possible to predict the presence of NAFLD when examining a large number of patients, without involving additional ultrasound diagnostics specialists in order to use medical resources rationally.

[Prognostic significance of arterial stiffness parameters in the identification of very high-risk patients].

Over the past few decades, much attention has been paid to the study of the properties of the vascular wall and its role in predicting cardiovascular events. The testing of new indicators characterizing cardiovascular risk is being actively conducted. The study included 288 men aged 40 to 60 years (mean age 51.6 ± 6.2 years). Among the examined 133 people belonged to the category of very high cardiovascular risk (they suffered myocardial infarction for no more than 5 years before inclusion in the study), and 155 patients did not have a history of cardiovascular complications. Using the Fukuda denshi VS-1500 VaSera sphygmograph, a cardio-ankle vascular index (CAVI) and augmentation index (AI) were obtained. A model of multivariate logistic regression was constructed for the probability of assigning the patient to a group of very high risk, as well as ROC analysis. The study demonstrated the statistically significant role of CAVI in predicting the assignment of patients to a group of very high cardiovascular risk (after myocardial infarction). An increase in the odds ratio of assigning a patient to this group with an increase in CAVI per unit is 1.417. According to the results of ROC analysis, the prognostic role of CAVI (AUC 0.70) is slightly inferior to age (AUC 0.75), but exceeds AI (AUC 0.641). The share of variability in the probability of classifying patients as a very high risk group from the influence of the studied factors is 31%. The overall quality of the predictive model can be rated as good (AUC = 0.77).

[Informativity of Indicators of the Arterial Wall Stiffness for Screening Studies].

OBJECTIVE: comparative assessment of informativity of parameters of arterial wall stiffness - the cardio-ankle vascular index (CAVI), the augmentation index (AI) - for solution of problems of screening patients being under threat of realization of complex impact of metabolic syndrome (MS) and elevated vessel wall stiffness, both creators and markers of high risk of severe cardiovascular complications. MATERIALS AND METHODS: We examined mining industry employees (n=206) with cardiac risk factors (arterial hypertension, abdominal obesity, and smoking). Comparative group comprised 75 employees of the same enterprise without above-mentioned risk factors. Studies of arterial wall stiffness included determination of CAVI and AI. The sensitivity, specifcity and accuracy of the screening method were calculated. RESULTS: CAVI and AI parameters had different sensitivity, specifcity and accuracy for identifying patients at risk of cardiovascular complications. AI was 2 times more sensitive than CAVI during examination of patients with only clinical and anamnestic cardiovascular risk markers and patients with clinical-anamnestic and laboratory risk markers. Specifcity of AI was lower than specifcity of CAVI and atained only 34.4% in patients with clinical-anamnestic and laboratory risk factors. At the same time, specifcity of CAVI in these patients reached 86.2%. Accuracy of AI for screening study was 1.4 times higher than that of CAVI in patients with only clinical-anamnestic risk markers, and 1.6 times higher in patients with both clinical-anamnestic and laboratory risk markers. Moreover, after comparing patient groups with individually high and normal CAVI and AI, we found the differences in metabolic laboratory risk factors (glucose, total cholesterol, triglycerides and the Atherogenic Index) only for AI. CONCLUSION: Parameters of arterial stiffness have different informative value for screening of patients with clinical-anamnestic or laboratory risk factors. AI compared with CAVI is 2 times more sensitive and 1.6 times more accurate but has lower specifcity for risk factor screening among patients being under threat of realization of complex impact of MS and elevated vessel wall stiffness.

Analysis of the Role of Carriership of Polymorphic Genotypes of ESR1, eNOS, and APOE4 Genes in the Development of Arterial Hypertension in Men.

We studied the role of the carrier status for polymorphic loci of genes encoding estrogen receptors (ESR1), endothelial NO synthase (eNOS), and apolipoprotein E (APOE4) and products of their expression nitrogen oxide (NO) and apolipoprotein (ApoE) in the development of arterial hypertension in men. Conventionally healthy volunteers and 149 men with clinical manifestations of stage I-II arterial hypertension were examined. In men with arterial hypertension, the frequency of minor allele A of ESR1 gene was higher (27.5 vs. 9.5% in the reference group; χ2=4.43, p=0.04). The level of NO in the peripheral blood was also higher in the main group (χ2=3.93, p=0.047). The increase in NO concentration did not depend on the presence of polymorphic genotypes (GG and GT) of eNOS gene, but the decrease in ApoE level in blood serum was associated with TC genotype of APOE4 gene (p=0.04). Our results suggest that minor allele A of ESR1 gene is associated with the development of arterial hypertension in men. Reduced content of ApoE in blood serum of men with arterial hypertension was associated with APOE4 gene polymorphism. However, increased level of NO did not depend on polymorphic genotypes GG and GT of eNOS gene. These polymorphisms are of specific interest as additional markers of genetic predisposition to the development of arterial hypertension in middle-age men.

[Arterial bed stiffness in patients with different cardiovascular risk factors]. / Zhestkost' arterial'nogo rusla u patsientov s razlichnymi faktorami riska razvitiya serdechno-sosudistykh zabolevanii.

AIM: To investigate the specific features of changes in the arterial wall stiffness (AWS) parameters obtained by sphygmomanometry in patients with different risk factors (RFs) for cardiovascular events (CVEs). MATERIALS AND METHODS: A total of 208 mining enterprise workers who had cardiovascular RFs, such as hypertension, abdominal obesity, and smoking, were examined. A comparison group consisted of 75 workers of this enterprise who had no these RFs. AWS was examined using a VaSera VS-1500 (Fukuda Denshi, Japan) to determine CAVI, ABI, UT, %МАР, AI, tb, and tba. RESULTS: The group of patients with a combination of RFs versus the comparison group showed a statistically significant prevalence of virtually all sphygmomanometric indices characterizing AWS, which is suggestive of a less favorable long-term prognosis in this category of patients. CONCLUSION: The patients having abnormal AWS parameters should be included in a group at risk for cardiovascular diseases and CVEs and their existing RFs be further assessed in detail for a preventive purpose. It is appropriate to incorporate volumetric sphygmomanometry in screening examination programs.

Formation of metabolic syndrome as a risk factor of circulatory diseases in drivers.

The authors considered systemic approaches to disclosing factors that promote metabolic syndrome formation and associated risk of ciculatory system diseases in drivers. Examination covered drivers with metabolic syndrome and without it. Findings are that metabolic disorders developing in drivers are occupationally conditioned. Length of service can determine cases numbers of cardiovascular disorders, diabetes mellitus manifestations, more frequent combination of hyperglycemia and/or hyper-, dyslipidemia with abdominal obesity. The drivers with length of service over 15 years, aged over 35, demonstrated arterial hypertension in 35% of cases, postinfarction cardiosclerosis in 43% of cases, disorders of cardiac rhythm and conductivity in 55% of cases, and the number increases with length of service and reaches 80% of total examinees number by 55 years of age. Diabetes mellitus was diagnosed in 37% of cases (in 75% of the workers first diagnosed) with over 20 years of service, average age of 50 years.

On occupational fitness examination of workers exposed to occupational hazards after coronary artery bypass grafting.

Myocardium revascularization in coronary heart disease patients is one of the most important treatment modalities. Considerable improvement of somatic state after surgery for IHD is seen in 82-83% of patients in average, whereas only hardly more than a half return to occupational activity without decrease in preoperative level of qualification and performance. In occupational therapy and industrial medicine clinic with FBSI <>, examination covered 68 workers of Perm' area enterprises, derected for occupational fitness study after coronary artery bypass grafting and 100 workers at various terms after myocardium infarction, with verified IHD. Risk factors evaluation demonstrated that after coronary artery bypass grafting 75% of patients are motivated to maintain healthy lifestyle and compliance to treatment over 5 years; positive changes in a year according to functional study were seen in 75% of cases; level of blood pressure in office 127.8±9.4 mm Hg; dyslipidemia, hypercholesterolemia remain in 11.7% of cases. At first stage, criteria of permit-to-work are: decrease in functional class of chronic cardiac failure to 0-II degrees from initial one; absence of exertional stenocardia or exertional stenocardia less than II degree, absence of ventricular arrhythmias of high grade.

[Forecasting a risk of occupationally related diseases in workers engaged into titanium-magnesium production].

Workers of titanium and magnesium production, under occupational exposure to complex of chemical (chlorine, hydrochloride, sulfur dioxide) and physical factors (industrial noise, work hardiness), have arterial hypertension as occupationally related disease, when length of service over 15 years (EF = 71,5%), and nasopharyngitis for length of service over 10 years (EF = 65%). Arterial hypertension risk is mostly associated with increased industrial noise level (F = 1621; R2 0.95; p < 0,001; noise 70,1 dB). Mathematic modelling of nasopharyngitis development probability demonstrated dependence of concentration of chlorine, hydrochloride, sulfur dioxide, chlorine and hydrochloride combination (F = 37-281; R2 = 0,37-0,73; p < 0.001; chlorine 0,63 mg/m3). Complex of parameters (leucocytosis, eosinophilia, increased IgA level), activated cellular immunity (increased CD 16+56+, CD3+CD25+) and absolute phagocytosis characterized nonspecific inflammatory reaction, immunity tension as a response to a complex of chemical factors of titanium and magnesium production. Markers of endoihelial dysfunction and cardiovascular risk (uric acid, VEGF, homocystein, LDLP) and stress marker (cortisol) demonstrate potential effect of occupational factors on vascular wall, metabolic processes and central nervous system, with involvement of

[State of vegetative nervous system in workers engaged into multiple shifts work with night shifts].

Occupational activity with night shifts and length of service over 5 years is characterized by prevalent sympathetic influence on cardiac activity, vagosympathetic interaction index (LF/HF) is considerably higher than in workers with lower length of service and 1.5 times exceeding upper normal value. VLF indicator exceeds physiologic normal value due to increased activity of ergotropic and humoral metabolic mechanisms of cardiac rhythm regulation. Sympathetic regulation activity level (LF parameter) is also reliably higher than in workers with lower length of service (p = 0.024). Parasympathetic regulation activity level (HF parameter) is below normal value - that indicates decreased influence of parasympathetic vegetative system on cardiac activity (depression of defence mechanisms). Comparative analysis of vegetative regulation spectrum at rest, in accordance with length of service, demonstrated the most marked changes in workers with length of service over 5 years: lower total spectral capacity (TP, msz), lower share of high-frequency waves (HF, %), increase of average vagosympathetic interaction index (LF/HF) and higher share of very low waves (VLF, %) in the spectrum structure. Ihe data prove intensified ergotropic, humoral, sympathetic influences on cardiac activity and, as a result, higher risk of dysmetabolic processes and cardiovascular diseases.

[Prevention of circulatory system diseases in underground mining workers].

The article covers results of preventive measures in workers engaged into underground mining. Those measures are aimed to prevent occupationally mediated health disorders resulting in circulatory diseases. The prophylaxis was proven effective on premorbid condition--that was demonstrated in reliable decrease of cause-effect relationship intensity for health disorders in workers subjected to prophylactic measures. Transitory disablement morbidity due to cicrulatory system diseases decreased. Situational modelling of risk changes for the studied group demonstrated changes of diseases risk under medical prophylactic measures. After the prophylaxis, the risk demonstrated 3.1 times decrease.

[Problems of occupational fitness conclusion on periodic medical examination].

Additional examination in Occupational Pathology Center are economic loss both for employer and employee, as the employee receives payment for those days when in the examination. Analysis of over 600 cases of occupational fitness examination in Occupational Pathology Center according to referrals given by medical institutions providing periodic medical examination shows that in most cases the conclusion was possible during periodic medical examination. Difficulties in conclusion on workers' fitness for occupation during periodic medical examination, according to our viewpoint, result not from limited diagnostic facilities for adequate examination and unfitness disclosure, but from lack of information in primary medical documentation and inadequacy of occupational factor and work characteristics presented by employer to actual working conditions.

[Treatment of occupational neurosensory deafness and noises in internal ear].

Neurosensory deafness treatment can be effective only after removal of specific etiologic factor--exposure toindustrial noise, that necessitates change of work and occupation, i.e. occupational disablement. Search for effective, complex methods to treat and prevent neurosensory deafness in patients exposed to occupational noise remains topical problem in otorhinolaryngology and occupational therapy. The article presents a method of treatment and prevention of neurosensory deafness in patients exposed to occupational noise; demonstrates its efficiency. Combination of medical therapy and physical therapy improves function of conductive pathways of hearing analyser, enables adequate rehabilitation of hearing in workers--that was confirmed by audiologic and neurofunctional parameters. The method is inexpensive, can be operative in medical stations at enterprises.

[Considering risk factors of arterial hypertension in workers exposed to occupational hazards, according to results of periodic medical examinations].

The article covers prevalence of risk factors concerning cardiovascular diseases and health disorders in workers due to occupational hazards of textile production, criteria for early diagnosis of arterial hypertension. To prevent arterial hypertension and its progress into severe cardiovascular diseases in the workers, the authors necessitated complex of medical and preventive measures.

[Features of early stages of cardiovascular continuum in workers engaged in oil-extracting enterprise].

The authors present data on metabolic disorders and vascular state in workers of oil extracting enterprise, exposed to complex of occupational hazards (noise, work hardiness, chemical factors). Major role among chemical hazards is played by aromatic hydrocarbons. In clinical and epidemiologic studies, arterial hypertension was reliably more frequent in a group of oil extraction workers. Findings are that oil extraction workers, when compared to the reference group, demonstrate more marked metabolic disorders (dyslipidemia with increased total cholesterol and low density lipoproteins, hyperuricemia, hyperglicemia, increased lipids peroxidation) with endothelial dysfunction. These changes are associated with remodelling of arterial wall, that at early stages involves thickening intima-media complex. That leads to hardness and arteriosclerosis of arteries.