[The structure of blood gut microbiota markers in athletes and their relationship with the diet].

It is known that under conditions of ultra-high physical activity and a specific diet, the state of the microbiota plays a significant role in maintaining the health, metabolic and energy status of athletes. The purpose of the study was to evaluate the composition of blood microbial markers in professional football players and physically active people and their correlation with diets in order to substantiate recommendations for their optimization. Material and methods. In a cross-sectional study a group of football players (n=24, 28±3 years old, body mass index - 22.5±1.0 kg/m2) who received a diet according to the training regimen, and a comparison group of physically active individuals (n=25, 34±5 years old, body mass index - 21.8±2.8 kg/m2) have been examined. The method of gas chromatography-mass spectrometry was used to analyze microbial markers of microbiome, mycobiome, virome and blood metabolome populations. Data on actual dietary intake were collected using food diaries for 3 days, followed by data processing with the Nutrium 2.13.0 nutritional computer program. For analysis, individual daily requirements for energy and macronutrients have been calculated based on the basal metabolic rate (according to the Mifflin-San Geor formula, taking into account anthropometric data), the coefficient of physical activity (groups IV and II, respectively). Results. The analysis of the athletes' diet, compared with individual requirements and with the recommendations of the International Society for Sports Nutrition (ISSN), revealed a lack of complex carbohydrates (5±1 instead of 6.1±0.3 g/kg body weight day), an excess of sugars (23±4 instead of <10% of kcal). These figures are significantly higher than the intake of similar nutrients in physically active people in the comparison group. In football players, compared with the comparison group, significant changes in microbial markers were found for Alcaligenes spp., Clostridium ramosum, Coryneform CDC-group XX, Staphylococcus epidermidis (p<0.001), known for their pro-inflammatory activity in the intestine, as well as for Lactobacillus spp. (p<0.001) performing a protective function. In addition, mycobiome markers were increased in athletes: Candida spp. (p<0.001), Aspergillus spp. (p<0.001), among which there are potential pathogens of mycoses. This was not observed in the comparison group. At the same time, an increase in the microbial markers of Alcaligenes spp., Coryneform CDC-group XX, Lactobacillus spp., Streptomyces spp., Candida spp. Micromycetes spp., containing campesterol in the cell wall, in football players positively correlated with a high calorie diet (p<0.001). A similar correlation of mycobiome markers (Micromycetes spp., containing sitosterol in the cell wall, ρ=0.346, p=0.015) was observed with an excess of easily digestible carbohydrates. Taking into account the data obtained, a correction of the diet have been proposed: increasing the consumption of carbohydrates to 7.3-7.5 g/kg of body weight/day by including bakery products from whole grain flour and cereals in the diet (up to 300-370 g/day), limiting simple sugars (up to 90-95 g/day). Conclusion. High physical activity leads to changes in the structure of blood microbial markers, including a shift towards an increase in potentially pathogenic fungi. Wherein, a predictive role is played by an imbalance of macronutrients in terms of quantitative and qualitative composition, an excess of simple sugars, and a lack of slowly digestible carbohydrates. To correct the diet, an additional inclusion in the diet of their main sources - products from cereals (cereals and bakery products) is proposed.

[CURRENT ISSUES IN THE CHOICE OF ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH METABOLIC SYNDROME AND RELATED NON-ALCOHOLIC FATTY LIVER DISEASE].

Widespread in clinical practice, comorbid conditions and diseases, among which is the high prevalence of metabolic syndrome (MS), determine the need for selection of the optimal pharmacotherapy. The presence of certain liver diseases, including nonalcoholic fatty liver disease (NAFLD), may interfere with the processes of transformation of drugs, the metabolism of which occurs in the liver, which has been proved by experimental investigations. The article deals with the rational choice of antihypertensive drugs as a whole, and angiotensin-converting enzyme (ACE) in particular in patients with metabolic syndrome and NAFLD. Particular attention is paid to the possibilities of certain ACE inhibitors and their pharmacological properties.

[NSAID GASTROPATHY IN PATIENTS WITH COMORBID DISEASES].

The widespread use in clinical practice of non-steroidal anti-inflammatory drugs (NSAIDs), largely due to the general trend towards an aging population and, as a consequence, increase the number of individuals with comorbid conditions and diseases, including the most common are diseases of the cardiovascular system, diseases of the joints and spine, requiring of therapy with, combining the anti-inflammatory and analgesic properties. However, NSAIDs not only have favorable effects, but have quite a wide range of adverse effects, an important place among which is NSAID-induced gastropathy. The article deals with the rational choice of NSAIDs in patients depending on the degree of cardiovascular risk and gastrointenstinalnogo, as well as the possibility of preventing NSAID-associated gastropathy. Particular attention is paid to the choice of individual NSAIDs with regard to their pharmacological properties.

[Clinico-economical aspects of application of trimetazidine MB in patients with chronic heart failure and cardiac rhythm disturbances].

AIM: To study clinical and pharmacoeconomical aspects of trimetazidine MD as a component of complex therapy of chronic heart failure (CHF) in patients with cardiac rhythm disturbances. MATERIAL AND METHODS: In 82 patients (67 men, 15 women, mean age 62.2+/-7.3 years) with II-III functional class (FC) of CHF we studied effect of addition of therapy with trimetazidine MB to standard therapy on CHF FC, parameters of Holter monitoring (HM) of ECG and treadmill test. In analysis of HM we considered number of isolated and paired ventricular extrasystoles (VE), episodes of nonsustained ventricular tachycardia (VT), duration of episodes of ST segment depression on 24-hour ECG. Pharmacoeconomical analysis of 2 therapy regimes was conducted by the method of calculation of cost/efficacy ratio for each parameter. Stabilization of state was achieved before study in all patients at the background of standard therapy with angiotensin converting enzyme inhibitors, cardiac glycosides, diuretics, beta-adrenoblockers. At the background of this therapy trimetazidine MB in the dose of 70 mg/day was added to 40 patients of group 1 while 42 patients of group 2 received standard therapy without trimetazidine MB. RESULTS: After 16 weeks of treatment CHF FC lowered 11% (<0.05) 10% (<0.05) in groups 1 and 2, respectively. According to data of HM numbers of VE decreased in group 1 by 57.6% (<0.05), in group 2 by 28.8% (<0.05), episodes of nonsustained VT--by 58.3% (<0,05) and 36.8% (<0.05), isolated VE--by 23.6% (>0.05) and 6.9% (>0.05), respectively. Duration of episodes of ST depression decreased 55.5% (<0.05) in group 1 and 23.3% (<0.05) in group 2. According to treadmill test maximal power of load in patients of group 1 rose 12.3% (<0.05), of group 2-6.7% (<0.05), total exercise duration rose 16.8% (<0.05) and 82% (<0.05), respectively. Cost/efficacy ratio expressed in roubles per 1% efficacy calculated for CHF FC was 2694 in group 1, 4095--in group 2; for maximal load power--2409 and 3667, respectively; for duration of episodes of ST segment depression--1665 and 1934, respectively; for dynamics of VE number--514 and 853, respectively. CONCLUSIONS: Supplementation of standard CHF therapy with therapy with metabolic cytoprotector trimetazidine MB allows to achieve more pronounced positive effect on CHF FC, exercise tolerance, and lowering of cardiac ectopic activity. Smallest cost efficacy ratio after addition of trimetazidine MB to standard therapy from pharmacoeconomical point of view evidence for advantages of this regime of therapy possessing smaller expenditures per unit of efficacy.

[Psycho-autonomic aspects in patients with gastroesophageal reflux disease, and functional esophageal disorders].

The subjects of the study were 79 patients (35 with functional esophageal disorders (FED), 24 with nonerosive reflux disease (NERD), and 20 with erosive reflux disease (ERD), who were selected on the basis of clinical complaints, 24-hour ph-study, and esophagogastroduodenoscopy. All the subjects were evaluated by means of clinical questionnaires and psychological tests: Beck depression test, Spielberg State-Trait Anxiety inventory (STAI), and Toronto alexithymia test (TAS). In FED and NERD patients vs. ERD patients the following abnormalities were observed more frequently: autonomic and functional somatic symptoms (apart from gastrointestinal tract (GIT) complaints) (p < 0.01), sleep disturbances (p < 0.01), fatigue (p < 0.01), eating behavior disorders (DEBQ) (p < 0.05), maternal overprotection in childhood (p < 0.05), psychophysioligical GIT reaction in childhood (p < 0.05), higher levels of state and trait anxiety (p < 0.05), and hypochondria (p < 0.05). The clinical symptom index (CSI) (the sum of stomach and bowel complaints to the sum of esophageal complaints ratio) was calculated. CSI in FED and NERD patients was 1.8, while CSI in ERD patients--0.1 (p < 0). Thus, compared to ERD patients, patients with FED and NERD were characterized by more pronounced emotional, motivational, and autonomic disorders. Besides, CSI demonstrated that the character of gastrointestinal dysfunction was more diffuse in NERD and FED and more local--in ERD patients.

[Psychophysiologic disorders in patients with functional disorders of upper sections of the gastrointestinal tract and with gastroesophageal reflux disease]. / Psikhovegetativnye narusheniia u bol'nykh s funktsional'nymi rasstroistvami verkhnikh otdelov zheludochno-kishechnogo trakta i gastroézofageal'noi refliuksnoi bolezn'iu.

The features of the psychovegetative status in patients with functional disorders of the esophagus and stomach (FD) and gastroesophageal reflux disease (GERD) are investigated. The methods included clinical, instrumental and psychometric examination. The patients of both groups had similar vegetative abnormalities and a tendency towards the growth of depression and anxiety parameters, did not differ in psychosocial factors, and had a wide range of psychovegetative abnormalities (PA). Lump in the throat, heartburn, epigastralgia (p < 0.01), depression, actual anxiety, alexitymia and vegetative disorders decreased in both groups (p < 0.05) after treatment with citalopram (20 mg per day) during 2 months. So PA are revealed in patients with FD and GERD, and citalopram reduces psychovegetative and GIT disorders.