[State of the hepatobiliary system on the data of ultrasonic examination in children and adolescents with overweight and obesity].

Currently, a stable increase in the incidence of overweight and obesity is noted, this fact leads to an elevation in comorbidity with them. The relevance of the study is due to the involvement of the hepatobiliary system in the development of metabolic dysfunction and the formation of non-alcoholic fatty liver disease in the future. The aim of the research was to study the effect of overweight and obesity in children and adolescents on the state of the hepatobiliary system on the basis of ultrasound examination. Material and methods. A single-center retrospective comparative study was conducted. The main group consisted of 112 children and adolescents with Z-score body mass index (BMI) above +1SD, the comparison group consisted of 264 persons with a BMI from -2 to +1SD aged 5-17 years. An analysis of the results of anthropometric, including the assessment of BMI, ultrasound and biochemical studies was carried out. Results. The Z-score of BMI corresponding to overweight was recorded in 54 (13.8%) examined persons, and obesity - in 58 (14.8%) patients. In children of the main group, an increase in the size of the liver was recorded 3.6 fold more often, diffuse changes in the liver were revealed 32.4 fold more often, an increase in the volume of the gallbladder - 2.1 fold, signs of excessive aerocolia - 3.3 fold more often (p<0.001). In children with overweight and obesity, the level of triglycerides (p=0.003), low-density lipoprotein cholesterol (p=0.035), glucose (p=0.012), C-reactive protein (p=0.011), malon dyalldehyde (p=0.012), the activity of alaninaminotransferase (p<0.001) and alkaline phosphatase (p=0.001) were statistically significant, with a significantly lower level of high-density lipoprotein cholesterol (p<0.001). Statistically significant logistic models of the probability of an increase in the linear dimensions of the liver, diffuse changes, an increase in the volume of the gallbladder, the presence of excessive aerocolia signs from the Z-score BMI value were obtained. The Nigelkirk determination coefficient was 0.34, 0.17, 0.11 and 0.10 c.u. respectively. Conclusion. The contribution of overweight and obesity to the increase in the linear dimensions of the liver and the volume of the gallbladder, the formation of diffuse changes and excessive aerocolia according to the ultrasound examination was 10-34%.

[Substantiating reference values of active anterior rhinomanometry in children aged 4-14]. / Obosnovanie referensnykh znachenii perednei aktivnoi rinomanometrii u detei v vozraste 4­14 let.

RELEVANCE: Objective diagnostics of nasal breathing disorders in children is a vital issue given frequent inconsistency between patients' subjective feelings and actual nasal patency. Active anterior rhinomanometry (AAR) is an objective procedure and the golden standard for nasal breathing evaluation. But still, there are no actual data in literature on relevant criteria used to evaluate nasal breathing in children. OBJECTIVE: To determine reference values for indicators evaluated by active anterior rhinomanometry in Caucasian children aged 4-14 based on statistical data. MATERIAL AND METHODS: Overall, we examined 659 healthy children of both sexes who were divided into 7 groups as per their height. All children included into our research underwent AAR according to the conventional procedure. AAR indicators (Summary Flow left, Summary Flow right, Summary Flow, Summary Resistance left, Summary Resistance right and Summary Resistance Flow) are given as median (Me) and values of 2.5, 25, 75, and 97.5 percentiles. RESULTS: We determined direct moderate, significant and strong correlations between summary speed of the flow and resistance in both nasal passages and separate speeds of the flow and right and left resistance in inhalation and exhalation (r=0.46-0.98, p<0.001). We also established weak correlations between AAR indicators and age (r= -0.08-0.11), and between ARR indicators and height (r= -0.07-0.15). Reference values for AAR indicators were successfully determined. CONCLUSIONS: AAR indicators are likely to be determined bearing a child's height in mind. Determined reference intervals can be applied in clinical practice.

[Peculiarities of disorders in physical development of children consuming drinking water with increased nitrate content].

Peculiarities of physical development disorders in 334 children were examined in the course of comparative clinical-laboratory research; all these children consumed drinking water with various nitrates content (11.2±1.1 mg/l and up to 3.14 MPC, i.e. 141 mg/l), in a dose equal up to 9.0 mg/kg of body weight (RfD 1.6 mg/kg). A focus group consisted of 158 children aged from 3 to 10, a control group was made up of 176 children of the same age. Nitrates content in urine taken from children of focus group (49.22±11.69 mg/l) was 2.4 fold higher than the same parameter in control group (20.2±3.13 mg/l, р=0,001). Under exposure to nitrates consumed with drinking water endocrine system diseases were detected 1.7-2.1 fold more frequently, and physical development disorders, 2.5-4.3 fold more frequently, than in control group (р=0.02-0.05). We detected authentic correlation between nitrate excretion with urine and deviations in physical development in children consuming drinking water with nitrogenous compounds content which was higher than MPC; such deviations were ICD: Е44-Е46 - mild protein-energy malnutrition, Е34.4 - excessive height, Е67.8-Е66.0 - excessive nutrition, ОR=2.35, DI=1.22-4.53). Explained variance fraction amounted to 42-75% (R2=0.42-0.75; 64.9≤F≤162.3, р=0.001). Changes in thyroid gland volume were detected 2.4 fold more frequently, and changes in its structure 2.5 fold more frequently, in focus group than in control group (р=0.049). We determined statistically significant correlation between thyroidal disorders and nitrate content in urine (ОR=3.52; DI=1.73-7,0), with factor contribution level reaching 52% (R2=0.52; F=173.3; р=0.001). We detected that 34% of children from focus group had thyrotrophic hormone level 1.2 fold higher than physiological standard and the same parameter in control group (р=0.02). And also free thyroxin level was near age physiological standard in 23.4% of examined children which was 1.2 fold lower than in control group (p=0.05). The research revealed that methemoglobinemia with tissue respiration abnormalities and disorders in liver enzyme system functioning followed by protein-energy malnutrition (ICD: E44.1-E46), were the most relevant for younger children (under 6 years) and children suffering from functional gastrointestinal pathologies. As for older children (6-10 years) we observed mostly disorders in neuroendocrine regulation, thyroid gland, and antioxidant protection, in them together with somatic development potentiation and growth in weight-height parameters (ICD: Е66.0-Е67.8). It has been established that reduced thyroid supply, disorder of tissue respiration and antioxidant balance, and dysregulation of hypophysial-adrenal homeostasis section provide the basis for the formation of disturbances in physical development and endocrine pathology in children being under oral exposure to nitrates.

[Experience of using subcutaneous interstitial fluid for biomonitoring a dose load in workers of metallurgic industry].

Comparative envaluation of metals content of serum and subcutaneous interstitial fluid revealed that levels of chromium, manganese, arsenic, cadmium in these biologic media have no reliable differences (p = 0.056-0.907) but strong correlation (r = 0.52-0.93). Findings are that sorlie metals (nickel, copper, zinc, lead) contents of subcutaneous interstitial fluid have reliable differences in contents of serum and subcutaneous interstitial fluid., but these metals have strong correlations between their contents in the biologic media (r=0.43-0.72). Chances are that subcutaneous interstitial fluid is a promising medium for biomonitoring of dose load in metallurgic industry workers and enables to increase efficiency of measures reducing risk of occupational hazards influence on the worker's health.

[Thyroid state in workers of mechanical rubber production under complex exposure to occupational factors].

Complex study of thyroid gland covered workers engaged into mechanical rubber production, under exposure to complex of occupational factors. Chemical analytic study revealed 5.5 times excess of acrylonitrile content of expired air in examinees of the study group if compared to the reference group. Ultrasound examination data demonstrate structural changes in thyroid gland in 72% of the workers (diffuse changes and nodular masses). As early dysadaptation markers, findings are 1.3-1.7 times increased antibodies to TPO and higher TSH level. These disorders can indicate autoimmune processes in thyroid tissue and strain of compensatory adaptational mechanisms of pituitary-thyroid regulation.

[Lipid metabolism changes in population residing in area influenced by storage of ore-processing waste containing lead, cadmium and arsenic].

Clinical, laboratory and ultrasound examination covered features of lipid metabolism disorders in 137 adults and 170 children, neighbouring storage of ore-processing and extraction waste, in conditions of chronic exposure to metals from various sources (ambient air, water, foods). Findings are that children with higher serum levels of cadmium and arsenic (1.4-2.0 times vs. the reference group) demonstrated 2.2 times more frequent endocrine diseases, up to 2.7 times more frequent obesity related diseases, if compared to the reference group (OR = 2.74; DI = 1.05-7.14; p < 0.05). Chronic noncarcinogenous risk for endocrine system was characterized by jeopardy index (THI) 3.78 - unacceptable risk. With unacceptable risk due'to multi-source exposure to lead, cadmium and arsenic, the findings are: dysfunction of hypothalamus-pituitary-thyroid link, with activated free radical oxidation and accumulation of perioxidation products, depletion of antioxidant defence resources, disorders of neuromediator processes and lipid metabolism, with obesity formation (ICD: E67.8-66.0), mostly related to negative influence of arsenic (r = 0.37-0.59; p = 0.004-0.05).

[Genetically determined lipid metabolism disorders due to oral intake of technogenic hyperchlorination products].

The study covered genetically determined lipid metabolism disorders due to oral intake of technogenic hyperchlorination drinkable water products. Findings are that overweight and obese children in a main group appeared to have serum chloroform level 2.3 times higher than that in a reference group. In oral intake of hyperchlorination drinkable water products, the study revealed main genes having polymorphism associated with endocrine disorders: overweight and obesity--APOE, PPARG, HTR2A, characterizing antioxidant system state--SOD2 and detoxication--SULTA. Polymorphism of candidate genes HTR2A and SOD2 was characterized by increased occurrence of mutant homo-- and heterozygous genotype, relative risk of pathologic allele presence in population exceeded the refrence group values. Probability of increased serum serotonin and lower Cu/Zn in children with mutant homozygous genotype HTR2A and SOD2 is 1.2-1.3 times higher than in those with heterozygous and normal homozygous genotypes.

[Clinical and laboratory diagnostic criteria of chronic glomerular and tubulointerstitial kidney disorders associated with exposure to metals and oxygen organic compounds of technogenic origin].

Complex clinical, functional an laboratory examination of children living under unacceptable risk conditions due to aerogenous exposure to cadmium, chromium, lead and phenol revealed that kidney diseases associated with exposure to metals and phenol develop in children with genetic predisposition to disordered biotransformation of chemicals--polymorphism of genes CYPOX, RCYT 450, SULTA1 in homozygous and heterozygous variants. Increased levels of chemicals in blood causes microcirculation disorders in renal cortex, direct toxic effect in nephrons, suppresses activity of anitoxidant defense on cellular and systemic levels. The authors specified pathogenetically based complex of clinical and laboratory diagnostic markers of chronic kidney diseases associated with exposure to metals (cadmium, chromium, lead) and oxygen-containing (phenol) organic compounds.

[Development of lipids and carbohydrates metabolism disorders caused by drinkable water with high content of chlorine organic compounds].

Evaluation of effects caused by environmental peroral exposure to chlorine organic compounds revealed that individuals with AG variation of HTR2A gene are a community with increased sensitivity to chloroform and a risk group for lipid and carbohydrates metabolism disorders. Individual risk of endocrine disorders (ICD: E67.8 excessive nutrition and E66.0 obesity) in these individuals is higher than in general population exposed to chloroform at residence (HQ1.72). Serum serotonin level, that is functionally connected with HTR2A gene, is 1.3 times lower vs. the reference group value.