[Avandia and avandamet in the treatment of patients with diabetes mellitus type 2: effects on secretion of some fat tissue hormones].

AIM: To study effects of avandia and its combination with metformine (avandamet) on secretion of fat tissue hormones. MATERIAL AND METHODS: The examination protocol for 42 patients with type 2 diabetes mellitus (DM) aged 62.4 +/- 7.7 years comprised tests for blood levels of leptin, soluble receptor to leptin, insulin, grelin, resistin and adiponectine. RESULTS: The treatment resulted in reduction of fasting glycemia from 10.69 +/- 2.54 to 8.42 +/- 1.73 mmol/l, of glycosilated hemoglobin--from 8.1 + 1.6 to 7.75%, immunoreactive insulin--from 19.1 +/- 8.3 to 12.0 +/- 6.5 mg/ml, grelin--from 21.7 +/- 14.6 to 17.3 +/- 13.7 mg/ml, leptin--from 40.3 +/- 24.2 to 26.9 +/- 15.4 mg/ml, soluble receptor to leptin--from 17.9 +/- 4.5 to 13.1 +/- 3.5 mg/ml. LDLP and HDLP cholesterol was high. CONCLUSION: Avandia and avandamet are effective antidiabetic drugs with a beneficial effect on secretion of fat tissue hormones.

[The role of the fat tissue and its hormones in the mechanisms of insulin resistance and the development of type 2 diabetes mellitus].

The fact that fat issue is an endocrine gland secreting several hormones participating in the pathogenesis of type 2 diabetes mellitus (DM2) is universally recognized. Fat issue secretes leptin, tumor necrosis factor alpha, resistin, adiponectin, interleukin-6, free fatty acids, visfatin, omentin, perilipin, and other substances that influence the condition of insulinoresistance, one of the main factors responsible for DM2. Subcutaneous fat and visceral depot fat tissue differ in the spectrum of hormones they produce; the list of these hormones is presented in the article. The presence of abdominal or visceral obesity is combined with significant insulinoresistance, which, in its turn, increases the risk of vascular complications of diabetes. The article also cover the participation of other mechanisms - insulin secretion defect, oxidation stress, low secretion of glucagon-like peptide 1, apoptosis, an increased quantity of amyloid and the fl-cell pull in the pancreatic island--in DM2 pathogenesis. The authors present data on the secretion of leptin, resistin, adiponectin, and tumor necrosis factor a, as well as the condition of the functional activity of beta-cells and the degree of insulinoresistance in 30 DM2 patients receiving dietotherapy.

[Lipid reducing and antioxidant action of mexicor in patients with diabetes mellitus type 2].

AIM: To study mexicor effects on functional activity of beta-cells, insulin resistance, lipid metabolism and lipid peroxidation in patients with diabetes mellitus (DM) type 2. MATERIAL AND METHODS: Twenty patients with DM type 2 participated in a double blind randomized trial of mexicor vs placebo. Before and after therapy the following parameters were studied: plasma glucose before meal, immunoreactive insulin, glycosilated hemoglobin, cholesterol, triglycerides, LDLP and HDLP cholesterol, malonic dialdehyde, dienic conjugates, superoxide dismutase, catalase, glutathione peroxidase and alpha-tocopherol. RESULTS: Mexicor significantly improved compensation of carbohydrate metabolism by glucose and glycosylated hemoglobin in the blood, insulin resistance value, lipid metabolism and lipid peroxidation in activation of antioxidant enzymes. CONCLUSION: Mexicor in therapy of DM type 2 improves carbohydrate and lipid metabolism, lipid peroxidation, activates antioxidant defence enzymes, functional activity of beta-cells, reduces insulin resistance.

Sulfonylureas induce cholesterol accumulation in cultured human intimal cells and macrophages.

Using primary cultures of human smooth muscle intimal cells and mouse peritoneal macrophages it was demonstrated that oral hypoglycemic agents, sulfonylurea derivatives, at concentrations 10(-5)-10(-4) mol/l caused significant (by 25%-60%) intracellular total cholesterol accumulation. This in vitro atherogenic effect was confirmed in an ex vivo model. Sera from Type 2 diabetic patients, taken after sulfonylurea administration, acquired the ability to induce cholesterol accumulation in cultured cells. This enhanced atherogenic effect of patients' sera was observed for the next 2-4 h following the treatment and corresponded well to the pharmacokinetic characteristics of the tested drugs. The results suggest that sulfonylureas may exert a direct atherogenic action at the level of arterial cells, by increasing intracellular cholesterol content.

[Analysis of polymorphic variants of renin-angiotensin system genes in polymetabolic syndrome and non-insulin-dependent diabetes]. / Analiz polimorfnykh variantov genov renin-angiotenzinovoi sistemy pri polimetabolicheskom sindrome i insulin-nezavisimom sakharnom diabete.

Polymorphisms of the genes for angiotensin-converting enzyme (ACE) and angiotensinogen, the proteins of the renin-angiotensin system (RAS), were tested for association with the polymetabolic syndrome (PMS) and non-insulin-dependent diabetes mellitus (NIDDM) in the Moscow population. The insertional (I) allele and genotype II of the ACE gene proved to be associated with PMS. A significant difference in allele and genotype frequency distributions of the (CA)n microsatellite of the 3'-untranslated exon of the angiotensinogen gene was revealed between randomly sampled individuals and patients with PMS and IDDM from the Moscow population.

[Polymorphism of the angiotensin I-converting enzyme gene in diabetic retinopathy patients and type 2 diabetes mellitus patients with myocardial infarction]. / Polimorfizm gena angiotenzin I-prevrashchaiushchego fermenta u lits s diabeticheskoi retinopatiei i bol'nykh sakharnym diabetom tipa 2, perenesshikh infarkt miokarda.

The insertion/deletion polymorphism (I/D) of the angiotensin I-converting enzyme gene (ACE) was examined in type I diabetes mellitus patients (DM) with (n = 31), or without (n = 33) retinopathy, and in type 2 DM patients with either myocardial infarction (MI; n = 75), or with (n = 37), or without (n = 178) retinopathy. No association between the ACE gene and retinopathy in type 1 and type 2 DM patients was revealed. In the type 2 DM patients with MI, a statistically significant (P < 0.05) elevation of the D allele frequency (64%) compared to that without MI (55.3%), together with statistically nonsignificant prevalence of the DD homozygotes (41% versus 30.6%) was observed. Our data indicate that the D allele (RR 1.43) and DD genotype (RR 1.75) are risk factors for myocardial infarction in the type 2 DM patients.

[Association between insertion-deletion polymorphism of the angiotensin-converting enzyme gene and development of angiopathies in patients with non-insulin dependent diabetes mellitus from the Chuvash Republic]. / Assotsiatsiia mezhdu insertsionno-deletsionnym polimorfizmom gena angiotenzin-prevrashchaiushchego fermenta i razvitiem angiopatii u bol'nykh insulin-nezavisimym sakharnym diabetom iz respubliki Chuvashiia.

Insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE) gene was analyzed in patients with non-insulin-dependent diabetes mellitus (NIDDM) and in the control group consisting of healthy subjects. The insertion allele (I) and genotype II were found to be associated with NIDDM. The frequencies of diabetic retinopathy and nephropathy in NIDDM patients were not associated with this polymorphism. However, an association was found between the DD genotype of the ACE gene and diabetic angiopathy in lower extremities.

[Changes in carbohydrate metabolism in patients with tuberculosis]. / Izmeneniia uglevodnogo obmena u bol'nykh tuberkulezom.

The function of the pancreatic incretory apparatus was studied in 51 patients with primary active pulmonary tuberculosis by analysing the blood levels of immunoreactive insulin, C peptide and glucose before and after glucagon stimulation. A pronounced enhanced insulin secretion was found. At the same time signs of relative insulin deficiency appeared as persistent hyperglycemia and apparently delayed concentration peaks of immunoreactive insulin and C peptide. Prednisolone therapy caused a noticeable, but rapidly reversible aggravation of relative insulin deficiency. Relative insulin deficiency coupled with the higher secretory function of the pancreatic insular apparatus which decreased its functional reserves with increases in the disease duration is likely to underlie the more frequent development of severe diabetes mellitus in patients with pulmonary tuberculosis.

[Success of a parlodel test in the differential diagnosis of syndromes of disturbed prolactin secretion]. / Rezul'tativnost' proby s parlodelom v differentsial'noi diagnostike sindromov narushennoi sekretsii prolaktina.

Altogether 33 women with various forms of the syndrome of hyperprolactinemia (hypophyseal adenoma, idiopathic disorders of prolactin secretion--PL, and normoprolactinemic galactorrhea) and 6 controls were investigated. An acute parlodel test at a dose of 5 mg with subsequent determination of the blood levels of PL and TSH was performed in 2 and 4 h after drug administration. The most noticeable disorders in the dopaminergic regulation of pituitary activity were observed in pituitary adenomas which were characterized by a dramatically disturbed response of PL and TSH to parlodel. In hyperprolactinemia of nontumorous genesis PL and and TSH secretion in tests was also changed. The parlodel test seems to be a valuable method for differential diagnosis of the syndrome of disturbed PL secretion.

[Functional state of the sympathetic-adrenal system at the stages of developing late complications of diabetes mellitus]. / Funktsional'noe sostoianie simpatiko-adrenalovoi sistemy na étapakh formirovaniia pozdnikh oslozhnenii sakharnogo diabeta.

AIM: To study a functional state of the sympathico-adrenal system in patients with diabetes mellitus (DM) in developing late complications. MATERIAL AND METHODS: The study included 81 DM patients: free of late complications and diabetic autonomic neuropathy (DAN) (n = 24); with DAN (n = 6); with DAN and nonproliferative retinopathy (n = 8); with DAN and nephropathy stage 1-2; with DAN and diabetic retinopathy, sensory polyneuropathy (n = 23); with diabetic nephropathy stage 4 (n = 14). Blood levels of epinephrine, norepinephrine, dopamine were measured using liquid chromatography with electrochemical detection. A spectral analysis of the cardiac rhythm was made with application of the program "Mars". RESULTS: In patients with DM progression there was imbalance of autonomic nervous system, sympathetic hypertonicity, parasympathetic hypotonicity, subnormal power of the central regulatory contour. Dissociation was found between the degree of hypersympathicotonia and a fall of blood catecholamines concentration related to severity of the disease complications. CONCLUSION: Dissociation between sympathetic hypertonicity and low concentration of blood catecholamines is prognostically unfavourable and predicts development of arrhythmia and asystole. Augmentation of centralization of the systems regulating autonomic nervous system reflects tension of the regulatory systems and predicts disruption of adaptation.

[Regulatory mechanisms of insulin secretion from beta-cells]. / Reguliatornye mekhanizmy sekretsii insulina iz beta-kletki.

Two-step liberation of labelled calcium from beta-cells was shown to correlate with biphase secretion of insulin. Data on redistribution of calcium in the cells, its binding with calmodulin and participation of glucose metabolites in the insulin secretion are discussed.

[The role of the female sex hormones in the pathogenesis of catamenial epileptic seizures]. / Rol' zhenskikh polovykh gormonov v patogeneze katamenial'nykh épilepticheskikh pripadkov.

The paper presents the results of evaluation of gonadotropins and female steroids concentrations in 46 female epileptics on catamenia day 1, in the middle of follicular and lutein phases. The control consisted of 7 healthy females of the same age with favourable heredity and free of neuroendocrine diseases. Two groups of patients were distinguished: females with catamenial epileptic seizures and those with catamenia-independent seizures. It is shown that changes in the concentrations of female steroid sex hormones were unidirectional in both the groups with a tendency to deficient luteal phase and relative hyperestrogenemia in all the cycle phases. The involvement of insufficient activation produced by brain stem formation reticularis in pathogenesis of catamenial epilepsy in suggested. A pathogenetic approach to epilepsy treatment in females when hormonal status is considered and psychostimulators are used is proposed.

[Tonocardin in complex treatment of diabetes mellitus concurrent with hypertension]. / Tonokardin v kompleksnom lechenii sakharnogo diabeta, sochetaiushchegosia s gipertoniei.

AIM: To examine the effect of the alpha 1-adrenoblocker tonocardin (doxazosin) on the course of arterial hypertension (AH) and on carbohydrate and lipid metabolism and insulin resistance in patients with type 2 diabetes mellitus (DM) concurrent with AH. MATERIALS AND METHODS: 18 patients with type 2 DM concurrent with AH, treated with tonocardin for at least 12 weeks were examined; the fasting glycemia, the levels of blood glycosylated hemoglobin, serum total cholesterol and triglycerides, and the degree of insulin resistance (intravenous insulin load or insulin tolerance test and the insulin resistance index estimated by the HOMA method) were determined. RESULTS: Tonocardin treatment lowered systolic BP (from 159 +/- 19.83 to 136.57 +/- 17.43 mm Hg; by 14.5%), diastolic BP (from 93.38 +/- 12.98 to 79.12 +/- 11.69 mm Hg; by 15.28%), fasting glycemia (from 9.32 +/- 1.61 to 7.05 +/- 1.51 mmole/l; by 24.36%), glycosylated hemoglobin Ai (from 9.63 +/- 1.86 to 8.59 +/- 0.98%; by 10.8%), total cholesterol (from 6.09 +/- 0.57 to 5.4 +/- 0.4 mmole/l; by 11.4%), triglycerides (from 2.11 +/- 0.57 to 1.88 +/- 0.52 mmole/l; by 11%), glycemia after 30-min insulin load (from 9.32 +/- 1.61 to 5.77 +/- 1.57; by 39% and from 7.05 +/- 1.51 to 4.2 +/- 1.25 mmole/l; by 44% at the beginning and end of the follow-up, respectively), insulin resistance index (from 9.87 +/- 2.45 to 6.57 +/- 1.99; by 33.5%). CONCLUSION: The findings suggest that tonocardin exerts an antihypertensive effect and positively affects carbohydrate and lipid metabolisms, and diminishes insulin resistance in patients with type 2 DM concurrent with AH.

[Status of the cardiovascular system in patients with subacute thyroiditis]. / Sostoianie serdechno-sosudistoi sistemy u bol'nykh podostrym tireoiditom.

In thirty patients with subacute thyroiditis the authors examined cardiovascular system with the use of the ECG as the most accessible and informative enough method. The clinical and ECG alterations were compared before and after the treatment with glucocorticoids. It was established that the patients with subacute thyroiditis had clinico-electrocardiographic alterations attesting to the presence of myocardiodystrophy. The alterations seen on the ECG mirrorred fully enough the impairment of the cardiovascular system. Myocardiodystrophies associated with subacute thyroiditis undergo reverse development as the remission of the underlying disease is attained as a result of specific therapy with glucocorticoids. This is confirmed by the electrocardiographic findings in the course of the treatment.

[Disordered Na+/H+ metabolism in the erythrocytes of patients with insulin-dependent diabetes mellitus]. / Narushenie Na+/H(+)-obmena v éritrotsitakh bol'nykh insulinzavisimym sakharnym diabetom.

Na+/H+ countertransport speed in red cells of insulin-dependent diabetes (IDDM) patients was studied. The rate of Na+/H+ exchange in diabetic erythrocytes did not differ statistically from the rate of such exchange in control erythrocytes. Statistically significant differences in the rates of Na+/H+ exchange in red cells of patients with and without angiopathies were not found either, though the above rate was higher in nephropathy patients compared to those with retinopathy. Statistically significant acceleration of the Na+/H+ exchange rate was found in red cells of patients with family history of IDDM compared to patients without hereditary predisposition. There was no correlation between the rate of Na+/H+ exchange and duration of diabetes mellitus. It is suggested that acceleration of Na+/H+ countertransport in red cells of different diabetic groups may be polyetiological.

[Recovery of the anticoagulation system function in patients with insulin-dependent diabetes by neutralization of the activity of diabetogenic factor]. / Vosstanovlenie funktsii protivosvertyvaiushchei sistemy u bol'nykh insulinzavisimym diabetom putem neitralizatsii v organizme aktivnosti estestvennogo diabetogennogo faktora.

Functions of the anticoagulation system were restored in patients with insulin-dependent diabetes after neutralization of the diabetogenic factor in blood of patients by repeated administration of heparin at low doses. Development of thrombosis was also prevented in these patients.

[The physical work capacity of diabetics during rehabilitative treatment]. / Fizicheskaia rabotosposobnost' bol'nykh sakharnym diabetom v protsesse reabilitatsionnogo lecheniia.

Work fitness was assessed in 120 patients with diabetes mellitus (DM) of varying gravity according to which all the patients were distributed into 3 groups of DM. Work fitness was discovered to be lowered, correlating with the disease gravity. Overweight was noted to influence its lowering. During rehabilitation treatment including dietetic management, the treatment with sugar-reducing drugs, physical rehabilitation, work therapy and physiotherapy, work fitness and hemodynamics improved. The rise of work fitness due to rehabilitation treatment was associated with its more effective maintenance. Compensation of DM is a necessary prerequisite for work fitness increase.

[Thyrotoxicosis and thyroid cancer]. / O tireotoksikoze i rake shchitovidnoi zhelezy.

The paper is concerned with the results of examination of 41 of 407 thyroid cancer patients in whom cancer was combined with thyrotoxicosis. The succession of occurrence and possible ways of the development of this combination were considered. A study was made of the nature of endocrine changes in patients with thyroid cancer combined with thyrotoxicosis using clinical and laboratory methods. It was shown that the frequency of the combination of thyroid cancer with thyrotoxicosis made 10.1%; it was most common in women (92.68%).

[Characteristics of immune system in patients with metabolic syndrome]. / Osobennosti sostoianiia immunnoi sistemy u bol'nykh s metabolicheskim sindromom.

AIM: To characterize features of immune status in patients with metabolic syndrome (MS). MATERIAL AND METHODS: 41 MS patients entered the study (mean age 55.9 +/- 9.7 years). Blood free triiodthyronine (T3f), thyroxine (T4f), TTH, antibodies to thyroglobulin (abTG), thyroid peroxidase (AbTP) were studied with enzyme immunoassay; levels of CD3+, CD4+, CD8+, CD16+, CD72+ were studied with monoclonal antibodies; IgG, IgA, IgM were measured by radial immunodiffusion in gel by Manchini. The size and the structure of the thyroid were investigated with ultrasound. RESULTS: Thyroid pathology was in 48.8% patients with MS, chronic infectious diseases (CID)--in 51.2%. MS patients free of thyroid pathology and CID had elevated blood levels of IgG, IgA, dysimmunoglobulinemia and low relative number of CD3+ lymphocytes, close correlations of T3free with the levels of CD3+, CD4+, CD8+, T4free with CD72+ (r = -0.97 to +0.92), T4free with IgA, IgG (r = -0.96, r = -0.90), TTH and IgA (r = -0.89), weak negative correlations of uric acid with the levels of CD3+, CD4+, CD72+ and positive with CD8+, CD16+, immunoglobulins. Combination of MS with thyroid pathology and/or CID was characterized with aggravated defects in T- and B-cell immunity, fall in IgG, IgA and changed direction of correlations of thyroid and immune statuses. CONCLUSION: Immune status in MS patients was characterized by stimulation of humoral immunity, dysimmunoglobulinemia, T-cell immunity deficiency. This may be related to chronic hyperinsulinemia, dyslipidemia, antigenic stimulation with modified lipoproteins. Thyroid hormones levels positively correlate with concentrations of immunocytes and negatively--with immunoglobulins.

[Lipid peroxidation and the antioxidant protection of the erythrocytes in diabetes mellitus patients]. / Perekisnoe okislenie lipidov i antioksidantnaia zashchita éritrotsitov u bol'nykh sakharnym diabetom.

The study included 16 patients with diabetes mellitus (DM) type 1 and 15 healthy controls. By the moment of examination the patients had achieved subcompensation. 10 patients developed diabetic vascular complications. The patients received biosynthetic insulins Humulin S, Humulin I, Humulin M3. Pretreatment glycemia in the patients surpassed that in the controls, MDA red cell levels per ml of hemolysate were higher by 121% and 130% per protein 1 mg. MDA measured equal both in angiopathy patients and those without it. The activity of the antioxidant enzymes in DM patients was similar to control indices. Human insulin administration reduced red cell MDA levels both in angiopathy and free of it patients, though in the former MDA remained higher than normal, while in the latter normal levels are obtained. The parameters of the antioxidant defense enzymes changed on the treatment week 12: catalase activity rose by 41%, that of superoxide dismutase and glutathione peroxidase lowered by 35 and 65%, respectively. Variations in these enzymes activity showed no dependence on vascular complications.