Definite Stage Research Articles

On the Nature of Human Rights with Regard to Types of Law Understanding

The article raises the problem of understanding human rights in their relationship with the type of law understanding. Legal positivism, sociological positivism, theory of natural law and philosophical understanding of law (libertarian theory of law) stand out as the main approaches of law. It is noted that the normative approach involves the direct dependence of human rights on the will of the state; it does not matter the content of the right, but its formal consolidation in the law. The sociological approach, also within the framework of the legalist direction of law understanding, in contrast to legal positivism, connects human rights not with the state, but with social life, as a product of the development of society, and considers their existence not in law, but in legal relations. The natural law approach to understanding law is considered primarily as a definite stage in the development of ideas about law. Human rights in this context are considered as an expression of human freedom of choice and action, having a natural nature. However, in the modern world, such rights should be formally enshrined, reflecting the value aspect of law. The libertarian theory of Professor V.S. Nersesyants also reflects the idea of the meaning of freedom for the existence of a right that is different from the law, but recognizes the existence of human rights both natural and dependent on the will of the state. The authors conclude that the essential characteristics of human rights derived from the content of these types of law understanding in modern constitutional law have formed a symbiotic approach, In other words, the modern conception of human rights is based on all these types of law understanding.

Mixed Methodology in the Research of the Concept “Patriotism” in Modern English

The article deals with the problem of integrating the results obtained through different methods. The mixed methodology is considered to be the most effective method for an in-depth and detailed description of the semantic structure of the word and the conceptual content of the concept. Mixed methodology revealed some hidden associative potential in the words and expressions relating to the concept “patriotism”. This potential was revealed through the experiment in which certain word-stimuli are actualized.By identifying, generalizing, summarizing, and extracting the connections between word-stimuli and reactions, the combination creating the associative dimension of the concept was formed. The study of the associative dimension of the concept is impossible without considering the correlation between common approaches and trends in linguistics and the humanities. Anthropocentrism, as an approach to the study of language, society, and the human, recognizes the relevance of the study of “living” knowledge. The recognition of the relevance of the study of the “living” knowledge implies the recognition of the necessity of the study of thepossibilities of the research of the essence of the “living” knowledge, as well as the recognition of the necessity of the study of the means of representation of the structures of knowledge and consciousness. The conceptual sphere of the nation is determined by the specifics of the cultural markers that are valid within the premises of the nation’s worldview at a definite stage. Since the dictionary meaning of the word neither reflects the “life” of the word marked by temporal and spatial shifts, determination of the real psychological meaning of the word should involve the analysis of its associative meaning. The necessity of the analysis of the associative meaning of the word determines the relevance of the research.

Impact of etiology on disease course in chronic pancreatitis

BackgroundComplications in chronic pancreatitis (CP) can be grouped in inflammatory (ICC) and fibrotic (FCC) clusters and pancreatic insufficiency cluster (PIC). However, the association between etiological risk factors and the development of complication clusters remains obscure. In this study, the impact of the etiology and disease duration on disease onset and development of complications was investigated. MethodsThis cross-sectional study recruited patients with CP from Mannheim/Germany (n = 870), Gieβen/Germany (n = 100) und Donetsk/Ukraine (n = 104). Etiological risk factors, disease stage, age at disease onset, complications, need for hospitalization and surgery were noted. ResultsIn 1074 patients diagnosed with CP, main risk factors were alcohol and nicotine abuse. An earlier onset of the disease was observed upon nicotine abuse (−4.0 years). Alcohol abuse was only associated with an earlier onset of the definite stage of CP.Alcohol abuse was the major risk factor for the development of ICC (p < 0.0001, multiple regression modeling). Abstinence of alcohol reduced ICC, whereas abstinence of nicotine showed no association. PIC correlated with efferent duct abnormalities and the disease duration. In contrast, FCC was mainly dependent on the disease duration (p < 0.0001; t-test). The presence of any complication cluster correlated with the need for surgery (p < 0.01; X2-test). However, only ICC correlated with a prolonged hospital stay (p < 0.05; t-test). ConclusionsICC is mainly dependent on alcohol abuse. In contrast, FCC and PIC are mainly dependent on the disease duration. The etiology and disease duration can be used as predictors of the course of disease to provide individual treatment and surveillance strategies.

Diabetic cardiac autonomic neuropathy: Omega-3 polyunsaturated fatty acids and heart rate variability

The aim of the study was to analyze the effect of ω-3 polyunsaturated fatty acids (ω-3 PUFAs) on the heart rate variability (HRV) parameters in patients with type 2 diabetes mellitus (T2DM) and advanced stage of cardiovascular autonomic neuropathy (CAN). We have examined 36 patients with T2DM and definite stage of CAN, aged between 50-59 years with disease duration 1-6 years and median glycated hemoglobin A1c 7.1%±0.12%. Patients were divided into 2 groups. The first group received traditional antihyperglycemic therapy (n=15, control) for three months; patients in group 2 (n=21) received in addition 1 g/day of the ω-3 PUFAs for three months. Results. Prescription of the ω-3 PUFAs to the patients with T2DM and definite stage of СAN was accompanied by a statistically significant increase of the time-domain HRV parameters; the spectral HRV parameters during the active and passive periods compared to the control group. Conclusion. Obtained results suggest that the efficacy of ω-3 PUFAs is the result of a direct effect of the ω-3 PUFAs on the investigated indexes.

The value of 68 Ga-PSMA-11 PET/CT in patients with prostate cancer and inconclusive standard imaging at primary staging.

The current standard imaging recommended for primary staging of intermediate- and high-risk prostate cancer (PCa) consists of bone scintigraphy (BS) and computed tomography (CT). Some patients will have equivocal lesions or divergent findings on BS and CT, leading to inconclusive disease staging. Our aim was to investigate the value of 68 Ga-PSMA-11 PET/CT in PCa with inconclusive disease stage based on standard imaging. We made a single-center study of patients with newly diagnosed PCa who underwent a 68 Ga-PSMA-11 PET/CT due to equivocal findings or discrepancies between BS and CT from 1 January 2017 to 31 December 2020. The value of 68 Ga-PSMA-11 PET/CT was evaluated for each location of equivocal findings (regional lymphnode, nonregional lymphnodes, bones and other metastases) and on a patient level. Seventy-six patients were included in the study (62 patients with 72 equivocal lesions, 14 with discrepancy between BS and CT). Equivocal lesions were predominately in the bones (61%, 44/72), or in the regional lymph nodes (17%, 12/72). 68 Ga-PSMA-11 PET/CT provided a conclusive diagnosis in 90% (65/72) of the equivocal lesions. All patients with discrepancies between BS and CT had definite answers after 68 Ga-PSMA-11 PET/CT. 68 Ga-PSMA-11 PET/CT also uncovered 32 additional sites of metastasis in 25 patients not visible by standard imaging. 68 Ga-PSMA-11 PET/CT provides a definite disease stage in more than 90% of newly diagnosed patients with inconclusive standard imaging. Furthermore, it revealed additional sites of metastasis in 25 patients not detected by standard imaging.

DIABETIC CARDIAC AUTONOMIC NEUROPATHY: EFFECT OF BENFOTIAMINE ON THE CORRECTED QT INTERVAL, QT DISPERSION AND SPATIAL QRS-T ANGLE

The significance of cardiac autonomic neuropathy (CAN) has not been fully appreciated and there is no unified treatment algorithm. Aim: To investigate the effects of benfotiamine (BFT) on the corrected QT interval (QTc), QT dispersion (QTd) and spatial QRS-T angle in patients with type 2 diabetes mellitus (T2DM) and CAN. 32 patients with T2DM and definite stage of CAN were allocated to two treatment groups: control (n = 15) received standard antihyperglycemic therapy; group 2 (n = 17) - in addition BFT 300 mg/d for three months. The QTc interval, QTd and spatial QRS-T angle parameters were analyzed. It was found out that BFT contributed to decrease of the QTc, QTd and QRS-T angle. The positive influences of BFT suggests the feasibility of its administration to patients with T2DM and definite stage of CAN. Obtained results suggest that the efficacy of BFT is the result of a direct effect of the BFT on the investigated indexes.

DIABETIC CARDIAC AUTONOMIC NEUROPATHY: SIMVASTATIN, INSULIN RESISTANCE AND LIPIDS

Treatment of diabetic cardiac autonomic neuropathy (CAN) is a complex process, that includes: lifestyle modification; reducing of insulin resistance (IR); optimal glycemic control; management of diabetic dyslipidemia; antioxidants; vitamins; treatment of myocardial metabolic abnormalities; thrombosis and others. The aim of study was to investigate the effects of simvastatin on insulin resistance and blood lipid profile parameters in patients with type 2 diabetes mellitus (T2DM) and the definite stage of cardiac autonomic neuropathy. The study involved 107 patients with T2DM among them 16 patients without CAN, 19 with subclinical stage of CAN and 72 with definite CAN. Median age of patients was 53.6 ± 0.41 yrs, disease duration - 4.12 ± 0.24 yrs and median glycated hemoglobin (HbA1c) - 7.01% ± 0.09%. The control group included 14 almost healthy people without DM. Patients with definite CAN were allocated into two treatment groups: 1st group - 22 patients received standard hypoglycemic therapy and simvastatin 20 mg/day; 2nd group - control (n = 15). The duration of the study was 3 mos. The concentrations of glucose, HbA1c, immunoreactive insulin (IRI) in the blood were determined. Lipid metabolism was assessed by the concentration of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) measurements. The IR index (HOMA-IR), atherogenic coefficient (AC), TG/HDL-C parameters, and TG-glucose (TyG) index were calculated. It was established that in patients with T2DM with subclinical stage of CAN there was statistically significant increase in the parameters of HbA1c, IRI, TC, TG and HOMA-IR, AC, TyG indices and decrease of TG/HDL-C and HDL-C compared to control; increase of IRI, TG, TG/HDL-C and TyG indices compared to patients with T2DM without CAN. The definite stage of CAN is characterized by an increase of HbA1c, IRI, TC, LDL-C levels and HOMA-IR, AC indices and a significant decrease in the concentration of HDL-C (compared to patients with subclinical CAN). As a result of our study, we found out that prescription of simvastatin to patients with definite stage of CAN was accompanied by a statistically significant decrease in the concentration of TC, LDL-C, TG and an increase in the content of HDL-C (compared to 2nd, control group). Obtained results justify the appropriateness of statins prescription to patients with T2DM and the definite stage of CAN.

The value of contrast-enhanced ultrasound and magnetic resonance imaging in the diagnosis of bladder cancer.

Imaging examination, tumor marker detection, bladder biopsy, and other methods are the common methods for the diagnosis of bladder cancer (BC). This study was aimed to assess the value of contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) in the diagnosis of BC. Fifty-nine patients with BC were recruited in our hospital from September 2012 to December 2015, who had CEUS and magnetic resonance diffusion-weighted imaging (MRI + DWI). All patients underwent surgical treatment and definite pathological stage. The series and parallel combined diagnosis methods were applied to calculate the diagnostic sensitivity, specificity, and accuracy through using quantitative apparent diffusion coefficient (ADC) and receiver operating characteristic curve. The accuracies of CEUS and MRI + DWI examination for T staging of BC were 74.6% and 76.3%, respectively. Compared with the single diagnostic methods, the two combined diagnosis accuracy was 91.5%, which was significantly improved in diagnosis accuracy (P < 0.05). The diagnostic accuracies of CEUS, MRI + DWI, and ADC for muscle invasion of BC were 81.4%, 83.1%, and 84.7%, respectively. The diagnostic accuracy of CEUS parallel combined with MRI + DWI (91.5%) was obviously enhanced, compared with that with the single diagnostic method. The accuracy of CEUS and MRI + DWI combined diagnosis was higher than that with the single diagnostic method. CEUS and MRI + DWI combined diagnosis was a feasible and effective method for the clinical diagnosis of BC.

Effect of alpha-lipoic acid on arterial stiffness parameters in type 2 diabetes mellitus patients with cardiac autonomic neuropathy.

Objective. Significantly underdiagnosed, diabetes-associated cardiac autonomic neuropathy (CAN) causes a wide range of cardiac disorders that may cause life-threatening outcomes. This study investigated the effects of alpha-lipoic acid (ALA) on arterial stiffness and insulin resistance (IR) parameters in type 2 diabetes mellitus (T2D) patients and definite CAN. Methods. A total of 36 patients with T2D and a definite stage of CAN were recruited. This investigation was carried out on two separate arms: traditional hypoglycemic therapy (n=18, control) and ALA (n=18) 600 mg in film-coated tablets/q.d. in addition to traditional hypoglycemic therapy. The duration of the study was three months. Results. In subjects with T2D and definite stage of СAN, treatment with ALA resulted in a significant decrease of glucose, immunoreactive insulin concentration, and Homeostasis Model Assessment (HOMA)-IR (HOMA-IR) parameters; pulse wave velocity (PWV), aorta augmentation index (AIxao) during the active period of the day and decrease of PWV, AIxao, and brachial augmentation index during the passive period of the day compared with the results, obtained in the control group. Therefore, the administration of ALA to patients with T2D for three months promotes the improvement of glucose metabolism and arterial stiffness parameters. Conclusions. In patients with T2D and definite stage of СAN treatment with ALA improved HOMA-IR and arterial stiffness parameters. These findings can be of clinical significance for the complex treatment of diabetes-associated CAN.

Predictors of Infarction in Tuberculous Meningitis in Indian Patients

BackgroundStroke is a devastating complication of tuberculous meningitis (TBM) and is an important determinant of its outcome. We propose a model which would help to predict development of infarction or cerebrovascular events in patients of TBM. MethodsA prospective study with n=129 patients of TBM were evaluated for predictors and outcomes of stroke. A diagnostic grid was formulated with clinical, laboratory and radiology as parameters to predict the vascular outcomes. All patients were followed up for mortality and disability on the basis of modified rankin score (mRS). MRI & CSF cytokines TNF–alpha, IFN- gamma & IL-6,8, 10 were measured at baseline and 3 months. The diagnosis of TBM included definite, probable & possible types and stage I & II with early and late onset of symptoms respectively. ResultsThe mortality was 16.2% and 19.4% of all patients developed stroke. The mean GCS, barthel index and mRS at admission was 57.03± 9.5,10.2±2.3 & 3.3±0.03 respectively mild to moderate infection and functional limitation. Barthel index (BI) happened to be a strong predictor [F=32.6, p=0.001, t=15.5, βeta coefficient =0.002] followed by biomarker TNF-α [F=18.9, p=0.02, t= -2.07, βeta coefficient=-0.04]. N=25 patients developed stroke with TNF-α, IL-6, IFN -γ showing statistically significant increase in all the stroke affected TBM (95% CI; 4.5 to 1.2; p=0.003). At 3 months, it was observed that mRS was statistically significant between stage I & II (95% CI; 5.4 to 2.1; p=0.04). ConclusionsOur data revealed that 19.4% patients developed vascular events during the hospital stay or follow up. We recruited late onset TBM as compared to early onset. BI, TNF-α, IL6 are most potent predictors of stroke post TBM.

Потенциальная роль бенфотиамина в лечении диабетической автономной нейропатии сердца

Актуальность. Диабетическая нейропатия сердца — серьезное осложнение сахарного диабета, связанное с примерно пятикратным повышением риска сердечно-сосудистой смертности. Автономная нейропатия сердца проявляется широким спектром, начиная от тахикардии покоя и фиксированного сердцебиения до развития бессимптомного инфаркта миокарда. Значение диабетической автономной нейропатии сердца до конца не выяснено, также не существует единого алгоритма лечения. Цель: исследовать влияние бенфотиамина на состояние вариабельности ритма сердца, корригированный интервал QT, дисперсию QT и пространственный угол QRS-T у больных сахарным диабетом 2-го типа и автономной нейропатией. Материалы и методы. Тридцать два пациента с сахарным диабетом 2-го типа и функциональной стадией автономной нейропатии сердца были распределены в две группы лечения: контрольную (n = 15), получавшую стандартную сахароснижающую терапию, и группу 2 (n = 17) — бенфотиамин 300 мг/сут в дополнение к традиционной терапии в течение трех месяцев. Результаты. Установлено, что назначение бенфотиамина вызывало увеличение процента последовательных интервалов NN, разница между которыми превышает 50 мс, — pNN50 (Δ% = + 45,90 ± 7,91 %, р &lt; 0,05), высокочастотной компоненты вариабельности ритма сердца во время активного (Δ % = + 25,80 ± 5,58 %, p &lt; 0,05) и пассивного периодов суток (Δ% = +21,10 ± 4,17 %, р &lt; 0,05), способствовало уменьшению корригированного интервала QT (Δ% = –7,30 ± 1,36 %, p &lt; 0,01), дисперсии QT (Δ% = –27,7 ± 9,0 %, p &lt; 0,01) и пространственного угла QRS-T (Δ% = –24,4 ± 10,2 %, p &lt; 0,01). Выводы. Положительное влияние бенфотиамина свидетельствует о целесообразности его назначения пациентам с сахарным диабетом 2-го типа и функциональной стадией автономной нейропатии сердца.

Ator A Zan Adua (Christian Traditional Rulers) and Tiv Culture in the 21st Century

The chieftaincy and traditional rulership institution is dynamic and one of the most enduring legacies from traditional African societies. Until the coming of the colonialists, the traditional institution led by chiefs, emirs, obas, Ezes, etc performed legislative and judicial functions as well as political, religious, social and economic roles etc. The chieftaincy and traditional rulership institution among the Tiv was not organised in a systematic manner until the creation of the Tor Tiv stool in 1946. With several reformations, the chieftaincy institution has taken a definite stage in Tiv society. However, the problem of the study has to do with the fact that there has arisen in the Tiv chieftaincy scene; the ator a zan adua (Christian traditional rulers) who rather than protect and preserve Tiv cultural heritage are in the vanguard of the corrosion of a culture they had taken an oath to protect and preserve. If prompt action is not taken by the Tiv, their culture would soon disappear as these ator a zan adua have “churchmentised” and Christianised Tiv culture. As scholars of Tiv History, Religion and Culture, the researchers are alarmed at this cultural imperialism being perpetrated by Tiv traditional rulers. The study adopts the historical, descriptive and evaluative methods. In data collection, the primary and secondary methods have been adopted. In the primary source, oral interviews and the observation methods have been used; whereas in the secondary sources of data collection, documented sources from books, journal articles, newspapers and e-sources have been employed. The study established that by the orientation of ator a zan a dua as Christians, they are on the verge of completely supplanting Tiv culture with a foreign one. The study noted that culture gives an identity to a group of people and without it, they cannot be defined. In view of this challenge, the study made various suggestions as means of preserving and sustaining Tiv cultural heritage for generations yet unborn. One of these suggestions is that traditional rulers in Tiv be made to take their oath of office by Swem (the Tiv symbol of justice) so that when they renege on their oath, they would immediately bear the consequences (death by swollen stomach, limbs and severe headache). The study concluded that Tiv culture must not be sacrificed on the altar of Christianity by anybody not even the ator (traditional rulers).

Alpha-lipoic Acid: Effects on the Beat-to-Beat Vectorcardiographic Parameters in Type 2 Diabetes Mellitus Patients with Cardiac Autonomic Neuropathy

Objective: Relevance of cardiac autonomic neuropathy has not been fully recognized and there is no standardized treatment protocol.Aim: To evaluate the effects of alpha-lipoic acid on the beat-to-beat vectorcardiographic parameters, namely spatial QRS-T angle, QT dispersion (QTd) and corrected QT interval (QTc) in type 2 diabetes mellitus persons with cardiac autonomic neuropathy. Research designs and methods: Our study involved 33 persons with definite stage of cardiac autonomic neuropathy and diabetes mellitus type 2, which were assigned to each of two groups: one took standard antihyperglycaemic treatmen (n=15, control group) and the other (n=18) in addition to standard therapy - 600 mg of alpha-lipoic acid daily for three months. The analysis of vectorcardiographic parameters was performed. Results: It was found out that alpha-lipoic acid contributed to decrease of the vectorcardiographic parameters, namely QRS-T angle, QTd and QTc. Conclusions: The positive influences of alpha-lipoic acid suggest the usefulness of its prescription to type 2 diabetes mellitus persons with definite stage of cardiac autonomic neuropathy. The efficacy of alpha-lipoic acid is the result of its direct effect on the parameters of vectorcardiography.

A monopodial rosette model of shoot formation as a program of secondary-aquatic grasses appearing

On the basis of comparative morphological analysis of the structure of life forms the concept “key biomorph” is offered; it is a mien of a plant which reflects adaptation to the conditions of a definite habitat (a static aspect, a model) and a definite stage in evolutional changes of biomorphs (a dynamical / evolutional aspect). The paper shows a comparative morphological range of key biomorphs in accordance with a monopodial rosette model of shoot formation per gradient of moisture increase in the direction: a floodplain meadow – shores, shore fronts – the water line – a water body. Polygonum bistorta is considered the original key biomorph, changes in it could occur in three lines: 1) Polygonum bistorta – Butomus umbellatus – Nuphar lutea; 2) Polygonum bistorta – Scirpus lacustris – Eleocharis palustris; 3) Polygonum bistorta – Limosella aquatica – Stratiotes aloides. It seems that appearing of secondary-aquatic grasses with a monopodial rosette model of shoot formation was provided by the following modes of morphological evolution: deviation on the shoot level; abbreviation of the bud stage in shoot formation, in forming a part of the shoot (inflorescence), in the anatomic structure of the shoot and the ontogenesis of the original plant; prolongation of the bud phase in shoot development and ontogenesis of the genet.

CNN algorithm for plant classification in deep learning

The prior methodology of characterizing the plants for dependent on surface based order and another strategy depends on KNN classifier. This paper presents qualities examination of plants utilizing picture preparing methods for robotized vision framework utilized at horticultural field. In farming examination, the programmed plant attributes recognition is fundamental one in observing huge field. The proposed dynamic framework uses picture content portrayal and regulated classifier sort of neural organization. This will naturally distinguish the plant species when we import its picture as info. Picture preparing strategies for this sort of choice investigation includes pre-processing and characterization stage. At Processing, an info picture will be resized and commotion expulsion procedure is applied. At definite stage the neural organization orders the pictures as farming plant, harmful plant and therapeutic plant separately. At that point it will show the attributes of each plant.

РЕПРЕЗЕНТАЦИИ ТЕЛА В ТРАДИЦИОННОЙ И СОВРЕМЕННОЙ КУЛЬТУРАХ: ПРОБЛЕМЫ ОСМЫСЛЕНИЯ

The article examines the main problems of the representation of the nude body as one of the significant components of traditional and modern culture. It was revealed that the functioning of ideas about the meaning of nudity in culture is associated with a number of binary oppositions. The first is the opposition between sexuality and asceticism. The second presupposes the opposition and unity of traditionalism and nihilism. The third is associated with humiliation or an increase in the importance of the individual. In each specific case of exposure, we are dealing with a kind of message due to the state of the culture of a particular society at a very definite stage of its development. Nudity is interpreted by the addressee based on his own ideas about acceptable behaviors.

ОТСТАВКА А. И. ГУЧКОВА В САТИРЕ И КАРИКАТУРАХ В МАЕ 1917 ГОДА

The article analyzes the cartoons and satirical works published in May 1917 that mentioned Alexander Guchkov and his resignation from the post of war minister. The scrutiny of materials from specialized satirical publications has enabled the author to conclude that the highly popular satire magazines Pugach, Novy Satirikon, Trepach, Baraban, and Strekoza refrained from mocking Guchkov, his resignation and his political position, although many newspapers – and particularly the pro-Socialist ones – passed highly acerbic comments on the former war minister. Even if they mentioned him, they viewed him a neutral emblem of the epoch, a definite stage of revolutionary development rather than an object of satirizing. Only the magazines Bich and Budilnik offered an excited reaction to the resignation of the Provisional Government’s first defense minister. Their authors compared Guchkov with Napoleon and with more notorious personalities associated then with ‘dark forces’ and the ‘old regime’. In May 1917, Guchkov was also mentioned in the satirical works published by the Bolshevist press where he was portrayed as a personage, cooperation with which would defame the Socialists, who were more moderate than the Bolsheviks and their allies. Thus, the leftist newspapers, opposing the coalition cabinet and the Socialists’ participation in the Provisional Government, drew a parallel between the actual political situation of May 1917 and the engagement of some Mensheviks in the activity of war industry committees. By that time, Guchkov, the leader of those committees, was viewed as a potential helmsman of a counterrevolutionary revolt of the bourgeoisie not only by the Bolsheviks, but also by many of their opponents among the Socialists.

Diabetic Cardiovascular Autonomic Neuropathy: Insulin Resistance, Lipids and Simvastatin

Background: Treatment of diabetic cardiac autonomic neuropathy (CAN) is a complex process, that includes: lifestyle modification; reducing of insulin resistance (IR); optimal glycemic control; management of diabetic dyslipidemia; antioxidants; vitamins; treatment of myocardial metabolic abnormalities; thrombosis and others. The aim of study was to investigate the effects of simvastatin on insulin resistance and blood lipid profile parameters in patients with type 2 diabetes mellitus (DM) and the definite stage of cardiac autonomic neuropathy. Methods: The study involved 107 patients with type 2 DM among them 16 patients without CAN, 19 with subclinical stage of CAN and 72 with definite CAN. Median age of patients was 53.6±0.41 years, disease duration - 4.12±0.24 years and median glycated hemoglobin (HbA1c) - 7.01%±0.09%. The control group included 14 almost healthy people without DM. Patients with definite CAN were allocated into two treatment groups: 1st group - 22 patients received standard hypoglycemic therapy and simvastatin 20 mg/day; 2nd group - control (n = 15). The duration of the study was 3 mos. The concentrations of glucose, HbA1c, immunoreactive insulin (IRI) in the blood were determined. Lipid metabolism was assessed by the concentration of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) measurements. The IR index (HOMA-IR), atherogenic coefficient (AC), TG/HDL-C parameters, and TG-glucose (TyG) index were calculated. Result: It was established that in patients with type 2 DM with subclinical stage of CAN there was statistically significant increase in the parameters of HbA1c, IRI, TC, TG and HOMA-IR, AC, TyG indices and decrease of TG/HDL-C and HDL-C compared to control; increase of IRI, TG, TG/HDL-C and TyG indices compared to patients with type 2 DM without CAN. The definite stage of CAN is characterized by an increase of HbA1c, IRI, TC, LDL-C levels and HOMA-IR, AC indices and a significant decrease in the concentration of HDL-C (compared to patients with subclinical CAN). As a result of our study, we found out that prescription of simvastatin to patients with definite stage of CAN was accompanied by a statistically significant decrease in the concentration of TC, LDL-C, TG and an increase in the content of HDL-C (compared to 2nd, control group). Conclusion: Obtained results justify the appropriateness of statins prescription to patients with type 2 DM and the definite stage of CAN.

Molecular Diagnosis and Treatment of Multiple Endocrine Neoplasia Type 2B in Ethnic Han Chinese.

Multiple endocrine neoplasia type 2B (MEN 2B) is mainly caused by M918T RET germline mutation, and characterized by medullary thyroid carcinoma (MTC), pheochromocytoma (PHEO) and non-endocrine features. However, the diagnosis and treatment are usually delayed. This study reports 5 Chinese pedigrees with 5 individuals harboring germline RETM918T, and systematically reviewed previous Chinese literature reported. All 5 patients initially presented MTC, but none had biochemically cured postoperatively. 2 also presented bilateral PHEO after adrenal-sparing surgery, 1 needed steroid replacement. Further, a total of 32 MEN 2B patients from literature were clustered with 28 available for analysis. 26 (92.8%) were diagnosed by endocrine-related symptoms; the remaining 2 (7.2%) due to RET testing and oral symptoms, respectively. 25 patients underwent thyroidectomy with/without neck lymph node dissection at the mean age of (23.3 ± 10.4) years. Histopathological examination revealed MTC (100%). Of them, 17 had definite TNM stage, with 1 in stage III and others in IV. Other information of MEN 2B-related symptoms included penetrance of PHEO (60.7%), constipation (32.1%), Hirschsprung disease (25%), alacrima (17.8%), mucosal ganglioneuroma (96.4%) and marfanoid habitus (71.4%). 19 patients were verified harboring RET-M918T (c.2753T>C), of whom 15 (78.9%) were de novo mutation. The other 9 were clinically diagnosed as MEN 2B. The initial diagnosis of MEN 2B is relatively later, and diagnosed by non-endocrine components is extremely lower. Recognition of MEN 2B and its non-endocrine-related components is still the utmost requirement for a Chinese physician. Combined RET screening and serum calcitonin detection can facilitate early diagnosis.

A Freshening Breath of Insight

A Freshening Breath of Insight