[The physiological and biochemical methods of increasing of energy diffusion in vivo as a reaction of compensation under obesity.]

The article presents the analysis concerning main directions of physiological increasing of expenditure of energy in organism that probably can be used for prevention of obesity. First of all, it's increasing of physical load and activation of heat production at cold adaptation. In both cases the leading role belongs to skeletal muscles and consists in both implementation of biological function of locomotion and regulation of metabolism. At human biological reaction of adaptation to lower temperatures the most significant increasing of energy scattering in the form of heat is provided by cross-striated muscle fibers at the expense of contracticle function (thermo-regulation muscle tone and tremble) and increasing of uncoupling of oxidation and phosphorylation in mitochondria and also increasing of activity of cellular pumps: Na+, К+- ATPase and Ca-ATPase for compensation of increased passive "leakage" of ions. This occurrence is induced by action of nor-adrenaline and thyroid hormones and is accompanied by activation of hydrolysis of triglycerides and oxidation of released fatty acids in mitochondria. To develop biological reaction of cold adaptation and also prevention of obesity a proposal is made to implement both common procedures of tempering and short-time impact of ultra-low temperature in the conditions of specialized cryo-sauna.

[BASIC PHYSIOLOGICAL MECHANISMS OF HUMAN ADAPTATION TO COLD].

The article provides an overview of the literature that focuses on the main types of human adaptation to cold and mechanisms for increasing heat production. It is shown that the studies in recent years, aimed at studying the molecular mechanisms of adaptation to cold, confirmed the results of previous physiological studies have demonstrated that the major contribution to adaptive thermogenesis during cooling made by oxidative fibers in skeletal muscle (birds, marsupials, large placental and people) and brown adipose tissue (small placenta, especially rodents). The main sources of thermoregulatory heat generation are the contractile activity (thermoregulatory shivering and muscle tone), the uncoupling of oxidative phosphorylation and decrease in thermodynamic efficiency of the ATP-powered pumps (ATPase), which are induced by noradrenaline and thyroid hormones and accompanied by an increase in the consumption of oxygen and energy substrates. During long-term adaptation to cold the number and activity of mitochondria increase to provide enhanced ATP consumption.

[The becoming of function and metabolism of subcutaneous insulin-dependent adipocytes on stages of phylogenesis. The etiologic factor and pathogenesis of obesity as a pandemic].

The visceral fatty cells of omentum and insulin-depended subcutaneous adipocytes implement simultaneously three reactions: a) biological reaction of exotrophy - absorption of fatty acids in the form of non-polar triglycerides; b) active depositing of fatty acids in non-polar triglycerides and c) releasing of fatty acids in blood plasma only in the form of unesterified fatty acids. The single pool of intercellular medium is a little bit of the third world ocean that: a) was privatized by every entity in the moment of going out to dry land and in which b) as millions years in ocean before, continue to live cells. At the level of paracrin cenosis of cells regulation is worked out related to: a) a single pool of intercellular medium; b) local pools of medium; c) size (number of cells) and organs. Under obesity, increasing of number of insulin-depended subcutaneous adipocytes results in: a) increasing of volume of distal part of arterial channel; b) slowing down of bloodstream, biological reaction metabolism-micro-circulation is disturbing, O2 clearance decreases, excretion of catabolites is deranged; c) multiplicity of blood turnover in capillaries is decreased; d) implementation of biological functions of homeostasis, trophology, biological function of endoecology and adaptation are disordered. The compensation in vivo of biological reaction of metabolism-micro-circulation at obesity includes: a) decreasing of number of insulin-depended subcutaneous adipocytes; b) decreasing of volume of distal part of arterial channel and c) decreasing of volume of circulating blood. The decreasing of volume of blood in arterioles of muscular type occurs by means of activation of secretion of early in phylogenesis brain natriuretic peptide, then ventricle and atrium natriuretic peptide. In biological function of homeostasis, natriuretic peptides are synergists with action of humoral mediator of aldosterone. Jointly, they support constancy of parameters of single pool on intercellular medium: aldosterone is called to exclude pool's decreasing and natriuretic peptides to exclude its increasing.

[THE STRUCTURALLY AND FUNCTIONALLY DIFFERENT POOLS OF FAT TISSUE: INSULIN-INDEPENDENT VISCERAL CELLS, INSULIN-DEPENDENT SUBCUTANEOUS ADIPOCYTES AND BROWN CELLS OF THERMOGENESIS].

Three phylogenetically, morphological and functionally different pools of fatty cells are function in vivo according phylogenetic theory of general pathology. The first one is a phylogenetically early and limited in number of cells pool of visceral fatty cells of omentum and retro-peritoneal cellular tissue. The late in phylogenesis insulin renders no regulatory effect on visceral fatty cells. The visceral fatty cells deposit fatty acids in the form of triglycerides providing with energy substrates implementation of six biological functions: biological function of homeostasis and trophology, biological functions of endoecology and adaptation, function of continuation of species and cognitive biological function. The pathology of visceral fatty cells under alimentary overeating of physiological food develops metabolic syndrome. In the process of implementation of feedback mechanism visceral fatty cells secrete leptin. The second one is a later in phylogenesis, potentially larger in number of cells pool of insulin-dependent subcutaneous adipocytes. This pool, potentially unlimited in number of insulin-dependent subcutaneous adipocytes, is destined to provide with energy substrates produced by adenosine triphosphate only one biological function - a function of locomotion, motion at the expense of contraction of cross-striated skeletal myocytes. The characteristic of function of fatty acids is that they deposit fatty acids in the form of non-polar triglycerides in composition of lipoproteins under receptor endocytosis; release fatty acids only in form of into intercellular medium. The unesterified fatty acids are bound by lipid-transporting protein albumin. The main pathology of insulin-dependent subcutaneous adipocytes is obesity with expressed proliferation of insulin-dependent subcutaneous adipocytes. The insulin-dependent subcutaneous adipocytes synthesize adiponeсtin for implementing feedback mechanism. The third one is a pool of brown fatty cells. The physical chemical processes of oxidation and oxidative phosphorylation are uncoupled in mitochondria of these cells. The mitochondria of brown fatty cells mainly produce calories of heat energy. The brown fatty cells, functioning in warm-blooded animals, support constancy of temperature of body, biological function of homeostasis under winter sleep (period of hibernation) in animals and in the first weeks of post-natal life of Homo sapiens. Three pools of fatty tissue are developed from different sources.

PHYSIOLOGICAL MECHANISMS OF ADAPTATION TO COLD.

The literary review is devoted to human adaptation to cold and rehabilitation and therapeutic uses of cryosauna. Main physiological mechanisms of adaptation to cold are analyzed. It is shown that adaptation to polar latitudes increases primarily the risks of cardiovascular diseases, as well as disorders in the respiratory and peripheral nervous systems. At the same time, many investigators consider cold exposure as a promising method to combat obesity and to treat the metabolic syndrome. Cryosayna can be an experimental model for studying cold effects on human organism, developing procedures of adaptation to cold and evaluation of the adaptation reserve.

[Basic mechanisms of QRS voltage changes on ECG of healthy subjects during the exercise test].

Electrocardiography is the most commonly used technique for detection stress-induced myocardial ischemia. However, the sensitivity of ECG-criteria is not high. One of the major problem is the difficulty in differentiating ECG changes caused by various factors. The aim of this study was to evaluate the dependence of the QRS voltage changes during exercise on parameters of central hemodynamics, gender particularities and to reveal mechanisms causing these changes. To eliminate the effect of changes in cardiomyocytes transmembrane potentials under the influence of the neurotransmitters of the autonomic nervous system during stepwise increasing exercises and/or due to a lack of ATP results from inadequate myocardial blood flow only healthy subjects not older than 35 years were included in the study (7 men and 7 women) and only periods of ventricular depolarization (QRS complex on the ECG) were included in the analysis. We compared the changes of QRS waves during exercise sessions with two upper and one lower limbs in both men and women. The exercise load was twice bigger in exercise with one leg relative to exercise with two arms. Responses of heart rate and systolic arterial pressure were similar. Amplitude of S-wave in left chest leads significantly increased in both sessions without significant difference between augmentations in the sessions and in groups of men and women. Significant relationship between the S wave augmentation and the peak systolic arterial pressure were revealed. Furthermore, the QRS changes during the exercise with vertical and a horizontal torso position were compared to assess the impact of diastolic arterial pressure and displacement of the diaphragm and heart rotation due to increase of abdominal pressure during the last steps of exercise. The obtained results allow us to exclude the impact of the heart position and size changes, as well as the exercise load on S-wave changes and make a conclusion about the dependence of this parameter on the value of systolic blood pressure.

[Alteration of the QRS complex in electrocardiograms of healthy people in the course of test loading].

QRS amplitudes were analyzed in ECG records obtained from exercising healthy people to evaluate the sensitivity of QRS waves to exaggerated pulmonary ventilation, blood pressure (BP) and heart rate (HR). Seventeen normal subjects aged >35 years were involved in a series of three test loading sessions aimed to define QRS alterations caused by shifting and rotation of the heart, and changes in conductivity of thoracic organs and tissues as a consequence of a different respiration pattern. They also participated in a second series of three loading sessions aimed to trace QRS alterations stemming from changes in central hemodynamics (systolic and diastolic BP and HR). Both series demonstrated a reliable S-wave rise that did not relate to the heart rotation caused by the diaphragm displacement due to deep respiration and change in body positioning but correlated with increases in systolic BP. These observations could have been induced by growth of the transmural myocadial pressure produced by isovolumic contractions during heavy test loading.

[Effect of sex on informative power of various electrocardiographical criteria of left ventricular hypertrophy in patients with excessive body mass].

Aim of the study was to analyze dependence of various voltage parameters of QRS complex on increase of left ventricular myocardial mass (LVMM) in samples of men and women with excessive body mass or obesity. We included data from 223 patients with excessive body mass and diagnosis of stage I - II arterial hypertension. ECG was registered in 12 standard leads. Left ventricular hypertrophy (LVH) was certified if according to echoCG data LVMM exceeded 125 g/m2 in men and 110 g/m2 in women. Depending on sex and presence of LVH all patients were divided into 4 groups: M1 (men with LVH, n=74), M2 (men without LVH, n=74), W1 (women with LVH, n=55), anb W2 (women without LVH, n=20). We analyzed amplitudes of all waves of the QRS complex as well as Sokolow-Lyons voltage parameters and the Cornell index. The following intergroup differences were most significant: between groups M1 and M2 - in amplitudes of S waves in chest leads V3, V4; between groups W1 and W2 - in amplitudes of R-waves in limb leads I and aVL, and amplitudes of S-waves in lead III. Increases of the Cornell voltage index were observed both in men and women with LVH. The following criteria had greatest sensitivity at 95% specificity: in men - SV4 > 1,1 mV (34%) and RaVL+SV3 > 2,3 mV (32%); in women - RaVL > 0,8 mV (56%) and RI+SIII > 1,5 mV (56%). Informative power of electrocardiographical diagnosis of LVH can be augmented by the use of different voltage criteria in groups of men and women. In men most informative are chest leads (SV1 - V3, RaVL) while in women - limb leads (RI, RaVL, and SIII). The use of combination parameters RaVL+SV3 > 2,3 mV (in men) and RI+SIII > 1,5 mV (in women) allows to augment sensitivity with unchanged specificity. In patients with excessive body mass voltage the Sokolow-Lyons criterion is not informative. Most significant component of the Cornell voltage criterion in groups of men with excessive body mass is amplitude of SV3, in groups of women - amplitude of RaVL.

[Increased QRS voltage during dehydrating].

AIM: To assess QRS voltage changes with lower total amount of biological fluids under ultrafiltration during hemodialysis. MATERIALS AND METHODS: The study included 14 patients with chronic renal failure. An average of 2.5 +/- 0.24 liters of fluid were removed during a session. 12-lead standard ECG was continuously recorded by means of a computer-aided cardiac recorder throughout the session of hemodialysis. Changes in the amplitude of QRS waves were analyzed in each lead. RESULTS: Elevated QRS voltage was most pronounced in the anterior chest leads (v1-v4). Moreover, the potentials corresponding to the propagation of a predominant excitation front over the cardiac surface facing both the anterior chest wall--QRS+ (R wave) and the posterior chest wall--ORS-(S or Q waves) increased in most cases. Voltage changes in these leads were observed in 90% of patients, the amplitude of the waves being increased by more than 0.5 mV. CONCLUSION: During dehydration, lower chest tissue electroconductivity may cause a considerable increase in QRS voltage. This should be kept in mind while analyzing ECG data during both a session of hemodialysis and antihypertensive therapy resulting in some fluid loss, as well as in the treatment of cardiac and renal failure, leading to diminished concomitant edemas.

[The problem of indexation of left ventricular myocardial mass by body size in obese patients].

AIM: To assess efficacy of different ECG-criteria of left ventricular myocardial hypertrophy (LVH) in hypertensive patients as regards body mass (obesity). MATERIAL AND METHOD: Data on 100 patients (42 males and 58 females, age 19-79 years) with diagnosis of hypertension of the first-second degree were analysed. ECG was registered in 12 leads. LVH was determined by ECG by the following criteria: Sokolov-Lion (S-L): Sv1+Rv5(v6) > 35 mm; Cornell voltage (Crn-V): R avL+Sv3 > 28 mm (> 20 mm for women); Cornell product (Crn-P). According to the body mass the patients were divided into 3 groups: with normal weight, overweight and obesity. Crn = P criterion was most sensitive in all the three groups. RESULTS: In the groups sensitivity of ECG criteria depends on several factors: on the method of indexation and on the gender and body mass index. CONCLUSION: Informative value of ECG criteria of LVH depends on the method of indexation and on the amount of the excessive body mass.

[Dynamics of ECG voltage in changing gravity].

Comparative analysis of the QRS voltage response to gravity variations was made using the data about 26 normal human subjects collected in parabolic flights (CNERS-AIRBUS A300 Zero-G, n=23; IL-76MD, n=3) and during the tilt test (head-up tilt at 70 degrees for a min and head-down tilt at-15 degrees for 5 min, n=14). Both the parabolic flights and provocative tilt tests affected R-amplitude in the Z lead. During the hypergravity episodes it was observed in 95% of cases with the mean gain of 16% and maximal--56%. On transition to the horizontal position, the Rz-amplitude showed a rise in each subject (16% on the average). In microgravity, the Rz-amplitude reduced in 95% of the observations. The voltage decline averaged 18% and reached 49% at the maximum. The head-down tilt was conducive to Rz reduction in 78% of observations averaging 2%. Analysis of the ECG records under changing gravity when blood redistribution developed within few seconds not enough for serious metabolic shifts still revealed QRS deviations associated exclusively with the physical factors, i.e., alteration in tissue conduction and distance to electrodes. Our findings can stand in good stead in evaluation of the dynamics of predictive ECG parameters during long-term experiments leading to changes as in tissue conduction, so metabolism.

[Electrocardiographic diagnosis of hypertrophy of the left ventricular myocardium in patients with arterial hypertension and overweight].

AIM: To study efficacy of different ECG criteria of hypertrophy of left ventricular myocardium (LVH) in hypertensive patients with reference to overweight and obesity. MATERIAL AND METHODS: The authors analyse data on 100 patients (42 males and 58 females) aged 19-79 with diagnosis of arterial hypertension stage I-II. ECG was conducted in 12 leads. LVH by ECG was determined according to the following criteria: Sokolov-Lyon (S-L): Sv1+Rv5(v6) > 35 mm; Cornell voltage (Crn V): R avL +Sv3 > 28 mm (> 20 mm for females; Cornell product (Crn P): (RavL+Sv3)xQRSduration > 2440 mm x ms (for females RavL+Sv3 amplitudes + 0.6 mm). To verify L VH by echoCG, the authors used threshold values of left ventricular myocardium mass index (LVMMI) 125 g/m(2) for males and 110 g/m(2) for females. LVMMI was calculated by two methods: LVMM to body surface area (BSA) 2) LVMM to BSA of an ideal figure of a relevant height. Depending on the BMI all the patients were divided into 3 groups: with normal weight (BMI under 25 kg/m2), with overweight (BMI between 25 and 30 kg/m(2)), with obesity (BMI over 30 kg/m(2)). RESULTS: Sensitivity of the criterion Crn-P was the highest. The S-L criterion had the least sensitivity (under 10%) in groups with overweight by more than 25 kg/m(2). In these groups sensitivity of all ECG criteria of L VH depends on some factors: on indexation of LVH by body size, gender and overweight. S-L criterion sensitivity is higher in subgroups of males irrespective of overweight and obesity. CONCLUSION: Informative value of LVH ECG criteria depends on the method of LVMM indexation by body size, overweight and gender of the patients.

[The differential diagnosis of the ECG changes in ischemic heart disease combined with arterial hypertension (the data from precordial mapping)]. / Differentsial'naia diagnostika izmenenii EKG pri ishemicheskoi bolezni serdtsa v sochetanii s arterial'noi gipertoniei (dannye prekordial'nogo kartirovaniia).

The authors have developed the algorithm for differential diagnosis of coronary heart disease associated with arterial hypertension. The algorithm was devised using the comparative data of precordial mapping made for 29 and 60 coronary disease patients with arterial hypertension and coronary stenosis without left ventricular myocardial cicatrices, hypertrophy and dilatation, respectively, as well as for 30 hypertensive subjects without coronary angiography signs of coronary stenosis, but with left ventricular hypertrophy established at echocardiography. Sixty normal subjects served as control. The algorithm sensitivity reached 70%, specificity 73%.

[The differential electrocardiographic diagnosis of dilated cardiomyopathy and ischemic heart disease (the data from precordial mapping)]. / Differentsial'naia élektrokardiograficheskaia diagnostika dilatatsionnoi kardiomiopatii i ishemicheskoi bolezni serdtsa (dannye prekordial'nogo kartirovaniia).

The authors suggest a new criterion for differential diagnosis according to the mapping of 35 ECG leads (PECG-35) in dilated cardiomyopathy (DCMP) and coronary heart disease (CHD). Analysis was made of 12 and 35 ECG leads in 120 patients. There were 60 cases of DCMP and 60 cases of CHD. According to the ECG-12 data the signs of focal cicatricial myocardial lesions were detectable in 34 cases of DCMP. According to echocardiography, the end diastolic size exceeded 5.9 cm in 23 CHD patients. The diagnostic algorithm was devised to distribute the patients into two groups. The algorithm consists in the following: 1) the sum of the areas of R waves is calculated in leads 6, 7, 13, 4, 20, 21 (+/- aR6-7I-IV parameter); 2) the sum of the areas of S waves is calculated in leads 22, 23, 24, 29, 30, 31 (sigma aS1-3V-VI parameter); 3) the parameter sigma aR6-7I-IV + sigma aS1-3V-VI is computed; 4) if sigma aR6-7I-IV + sigma aS1-3V-VI greater than 0.55 mB/s, the patient is diagnosed to have DCMP, if aR + aS less than 0.55 mB/s, the patient is diagnosed to have CHD. The sensitivity of the algorithm offered is 70-82%, with the specificity being 80%.

[The use of non-linear methods of statistical analysis in the differential electrocardiographic diagnosis of hypertrophic cardiomyopathy (data from precordial mapping)]. / Ispol'zovanie metodov nelineinogo ctaticheskogo analiza v differentsial'noi élektrokardiograficheskoi diagnostike gipertroficheskoi kardiomiopatii (dannye prekordial'nogo kartirovaniia).

An algorithm was proposed to make a differential diagnosis of hypertrophic cardiomyopathy by precordial ECG mapping in 35 leads (PECG-35) of 82 patients with hypertrophic cardiomyopathy and 339 matched patients: those with isolated left and right ventricular hypertrophy, concurrent ventricular hypertrophy, those with coronary heart disease having scars of various sites and having no cicatricial myocardial changes, including those in the presence of left ventricular hypertrophy, as well as 98 healthy individuals. Computer-aided analysis of their mapping was used to calculate the area of Q, R, S, T waves and ST segment and the prolongation of QRS complex. ECG parameters were analyzed by using cluster and dispersion analyses and the kNN method. The cluster analysis of PECG-35 made it possible to divide all the data on hypertrophic cardiomyopathy into 2 groups. For each the complexes of PECG-35 parameters were identified, in whose range the kNN method differentiated hypertrophic cardiomyopathy with a broad spectrum of abnormalities at a high sensitivity of 67-75% and a specificity of 86-90%.

[Use of integral indicators of precordial mapping in differential diagnosis of focal-cicatricial lesions of the myocardium]. / Ispol'zovanie integral'nykh pokazatelei prekordial'noi kartogrammy v differentsial'noi diagnostike ochagovo-rubtsovogo porazheniia miokarda.

The paper proposes new criteria for differential diagnosis of myocardial "focal scarring" and "++pseudo-scarring" changes in various cardiac abnormalities and homogeneous morphological alterations in the ventricular complex on ECG (the QS, Qr-type abnormalities of the R line) by using the findings of 35 lead ECG mapping (PM-35). ECG-12 and PM-35 were analysed in 427 patients, including those with coronary heart disease (n-122), arterial hypertension and aortic malformations (n-130), dilated cardiomyopathy, congenital cardiac disease (n-175). Electrocardiographic signs of focal scarring lesions were revealed in all the cases with coronary heart disease and 66 with myocardial hypertrophy. The total value of ST segment depression and the sum of Q wave squares in three to five vertical mapping columns were found to be the most significant differential and diagnostic criterion. When scars and ++pseudo-scars were differentiated, a sensitivity of 75% was obtained at a specificity of 87%.

[Diagnosis of ischemic heart disease based on the data of precordial mapping]. / Diagnostika ishemicheskoi bolezni serdtsa po dannym prekordia'lnogo kartirovaniia.

To improve the efficiency of electrocardiographic diagnosis of coronary heart disease, a search for new meaningful ECG parameters has been carried out, using precordial mapping and automated analysis of the maps. The study included 95 coronary patients, whose diagnosis was verified by visual techniques (coronaroangiography and left ventriculography). ECG-12 showed no signs of past focal/scarry lesions in any of the patients, and detected ischemic changes in 23% only. A group of 95 normal subjects was taken as controls. A classifying function was constructed, using mathematical procedures, stepwise discriminant analysis in particular. Used for the diagnosis of coronary disease, it yielded an 83% sensitivity and an 85% specificity.

Diagnosis of ischaemic heart disease based on data of precordial mapping.

To increase the efficacy of electrocardiographic diagnosis of ischaemic heart disease (IHD), the authors searched for new ECG parameters using the method of precordial mapping and computer map analysis. The study was made in a group of 95 IHD patients, with diagnosis confirmed with the use of visual methods (coronary angiography and left ventriculography). On 12-lead ECG, the signs of focal cicatrization were found in none of examined patients, and ischaemic changes were present in 23% only. 98 practically healthy people were used as controls. With the aid of mathematical methods including the step-wise discriminant analysis, a classificatory function was construed enabling to increase the sensitivity of IHD diagnosis to 83% at an 85 percent specificity.