Degree Of Metabolic Disorders Research Articles

Obesity in the 21st Century. Prevalence, Phenotypes, Course Variants and Consequences

The review article examines the issues of obesity regarding its prevalence, phenotypes, course and consequences. The anatomical, physiological and functional features of adipose tissue are discussed. The “Discussion” section presents the authors’ own clinical observations on therapeutic and surgical issues in the treatment of obesity. Currently, adipose tissue is divided into white, brown and beige. White and brown adipose tissue can turn into each other through the beige adipose tissue stage. The volume and activity of brown adipose tissue require greater expenditure in the metabolism of oxygen molecules and are more pronounced in women. The components of the extracellular matrix of adipose tissue are collagen types I, III, V, VI. The collagen structure of adipose tissue varies depending on the location, volume and size of fat, age, gender, functional state of the kidneys, thyroid gland, nature of food, energy expenditure and sleep patterns. With intense work and cold exposure, the hormone irisin is formed in skeletal muscles, which promotes the transformation of white adipose tissue into brown or beige, helps reduce body weight in obesity, and has a beneficial effect on the course of type 2 diabetes mellitus and associated diseases. Traditionally, obese individuals are divided into metabolically healthy obesity and metabolically unhealthy obesity based on the degree of metabolic disorders. In visceral fat, lipolysis occurs with high intensity, which supports the development of inflammation. In obesity, decreased expression of adiponectin accelerates the development of atherosclerotic cardiovascular diseases. As body weight increases, visceral adipose tissue acquires an inflammatory phenotype, manifested by increased expression of cytokines (interleukin-6, interleukin-1, interleukin-17, tumor necrosis factor-alpha), hyperactivation of the tissue renin-angiotensin-aldosterone system, as well as excessive cell infiltration immune system (leukocytes, neutrophils, T-lymphocytes, monocytes, macrophages). During inflammation in adipose tissue, inflammatory (M1) and atherogenic (M4) phenotypes of macrophages dominate. In morbid obesity, the number of macrophages in adipose tissue can reach up to 50% of all cells.

Diseases of the Biliary System in Children with Type 1 Diabetes Mellitus

The course of type 1 diabetes in childhood and its prognosis generally depends on the degree of development of metabolic disorders and the functional state of internal organs, in particular the state of the biliary system. The study was conducted at the National Center for Maternal and Child Health. 69 children aged 5 to 17 years with type 1 diabetes mellitus and damage to the biliary system in the form of biliary dyskinesia and hepatic steatosis were examined. As a result of the study, it was revealed that the development and progression of diseases of the biliary system in children with type 1 diabetes mellitus have a direct relationship with the degree of metabolic disorders, in particular with disorders of carbohydrate metabolism.

Features of the metabolic activity of the intestinal microbiota in children with obesity

Purpose: to evaluate the quantitative and qualitative features of the metabolic activity of the intestinal microbiota in patients with obesity. Materials and methods: a comprehensive clinical, laboratory and instrumental examination of 60 children aged 12-16 years was carried out. The main group (n=30) - patients with exogenous constitutional obesity, the comparison group (n=30) - adolescents with normal body weight. The metabolic activity of the intestinal microbiota was assessed by gas-liquid chromatography of a fecal sample with the determination of the relative and absolute values of short-chain fatty acids (SCFAs). Results: All patients with obesity showed a decrease in the concentration of SCFA compared with the comparison group, which indicated a decrease in the metabolic activity of the obligate lactic acid flora and the predominance of the fraction of non-proteolytic anaerobic microorganisms. When assessing the relationship between the lipid spectrum and individual SCFAs and their indices, numerous positive relationships of moderate strength were obtained, which indirectly may indicate the progression of the imbalance of aerobes and anaerobes of the intestinal microbiome with an increase in the degree of metabolic disorders in obese patients. Conclusion: The identified qualitative and quantitative disorders of the intestinal microbiota in obese children are associated with the development of insulin resistance and are a reflection of metabolic endotoxinemia associated with the maintenance of chronic sluggish inflammation in overweight children.

PERIOPERATIVE METABOLISM IN PATIENTS WITH ACUTE CALCULUS CHOLECYSTITIS AND METHODS OF ITS CORRECTION

It is important to study changes in metabolism in patients with acute calculus cholecystitis (ACC) during laparoscopic cholecystectomy and to find ways to correct them.
 The aim of the study. To study the perioperative metabolism in ACC patients and evaluate the possibilities of its correction.
 Materials and methods. The study was prospective, not randomized. 129 patients with ACC, aged 36-84 years (54 men, 75 women), who underwent laparoscopic cholecystectomy, were studied. Preoperative risk ASA II-IV. General anesthesia with the use of the inhaled anesthetic sevoflurane and the narcotic analgesic fentanyl in low-flow mechanical ventilation. Perioperative intensive care was conducted in accordance with the International Standards for the Safe Anesthesiology Practice WFSA (World Federation of Societies of Anesthesiologists, 2010). In group I (n = 61) a retrospective energy audit was performed according to the protocols of anesthesia of medical histories and calculations of indirect calorimetry with the determination of current the Metabolic Rate (MR) and Basal Metabolic Rate (BMR). In group II (n = 68), operational monitoring was supplemented by the use of indirect calorimetry to determine MR, BMR, Target Metabolic Rate (TMR) and the degree of Metabolic Disorders (MD) (MD = 100 × (TMR-MR)/TMR %), and intensive care is supplemented by additional infusion therapy and glucocorticoids, taking into account the dynamics of metabolic changes.
 Results. The initial parameters of metabolism, in both groups, were without disturbance, and MR significantly exceeded BMR (in group I - by 30,5%, in group II - by 28,8%) and had the following values: in group I - 749±12 cal×min-1×m-2, in group II - 756±13 cal×min-1×m-2.
 In both groups, at the stage of the reverse position of Trendelenburg, the imposition of pneumoperitoneum and the beginning of the operation, significant metabolic disorders were observed with MR reduction to the basal level. Slow recovery of MR was observed in patients of group I, the value of which at the time of awakening remained 7,6% below baseline (p <0,05). In patients of group II, on the background of enhanced infusion therapy and glucocorticoids, the recovery of MR was more intense and, by the time of awakening, its value exceeded the corresponding value of group I by 10,4% (p <0,05). At the same time, the MD and TMR were low and did not differ from the initial values. Patients in group II, compared with group I, woke up faster and were transferred to the ward, and nausea and vomiting were 2,7 times less common: 7,35% in group II and 19,7% in group I (p <0,05). At 6 and 12 hours after awakening, the sensation of pain on the VAS scale in group II was lower than in group I, respectively, by 24,3% and 34,4% (p <0,05).
 Conclusions. Perioperative energy monitoring makes it safer to perform laparoscopic cholecystectomy in patients with ACC. Additional determination of the target metabolism and the degree of metabolic disorders allows you to more effectively build perioperative intensive care.

PERIOPERATIVE METABOLISM IN PATIENTS WITH THYROTOXICOSIS, POSSIBILITIES OF ITS CORRECTION

In the past, thyroid surgery has been the most common cause of thyroid storm, but recently, preoperative drugs that create a euthyroid state before surgery have somewhat improved treatment outcomes. Therefore, the anesthesia of such operations is very important.
 The aim of this work: to evaluate the possibility of using dexmedetomidine for perioperative correction of metabolism in thyroidectomy under general anesthesia in patients with thyrotoxicosis.
 Materials and methods. The study was prospective, not randomized. The study involved 137 patients (53 men, 84 women, aged 21 to 76 years) with thyrotoxicosis, who underwent planned thyroidectomy under general anesthesia, using the inhalation anesthetic sevoflurane and the narcotic analgesic fentanyl, in low-flow artificial lung ventilation. Perioperative monitoring was complemented by the use of indirect calorimetry. The degree of preoperative risk of patients is ASA III-IV. In group I (n=71), situationally, during the operation, with a heart rate of > 90 beats/min, a selective β-blocker esmolol hydrochloride was administered intravenously (25-50 μg×kg-1×min-1) under the control of ECG and hemodynamic parameters until the heart rate normalizes. In group II (n=66) - dexmedetomidine – 0,1 μg×kg-1×h-1.
 Results and discussions. The initial metabolic parameters in both groups were high and amounted, respectively, 830±15 cal×min-1×m-2 in group I and 832 ± 13 cal×min-1× m-2 in group II, which exceeded their basal metabolic rate: in group I - by 54,9% and in group II - by 58,5% (p <0.01). At the stage of induction of anesthesia in group I, a depression of the hemodynamic profile was revealed, probably associated with the effect of the introduction of esmolol hydrochloride, which led to a decrease in oxygen transport without metabolic disturbances. At the stages of mobilization and removal of the thyroid gland, manifestations of hyperdynamia and hypermetabolism were observed in both groups. Metabolism at these stages, in group II, respectively, was lower, by 9,3% and 10,1%, than in group I. The degree of metabolic disorder, in group I, was 42,8% ± 2,3 % and 32,6 ± 1,8%, in group II – 31,2 ± 1,6% and 22,3 ± 1,2% (p <0.05). The blood cortisol level in group I was higher than in group II (p <0.05).
 Conclusions. Perioperative energy monitoring using indirect calorimetry allows timely detection of metabolic disorders and appropriate pathogenetic correction. The use of dexmedetomidine at a dose of 0.1 μg × kg-1 × h-1 is quite effective as an intravenous adjuvant for general anesthesia during thyroidectomy in patients with thyrotoxicosis.

Atypical progeroid syndrome (p.E262K LMNA mutation): a rare cause of short stature and osteoporosis.

SummaryLamin A/C (LMNA) gene mutations cause a heterogeneous group of progeroid disorders, including Hutchinson–Gilford progeria syndrome, mandibuloacral dysplasia, atypical progeroid syndrome (APS) and generalized lipodystrophy-associated progeroid syndrome (GLPS). All of those syndromes are associated with some progeroid features, lipodystrophy and metabolic complications but vary differently depending on a particular mutation and even patients carrying the same gene variant are known to have clinical heterogeneity. We report a new 30-year-old female patient from Russia with an APS and generalized lipodystrophy (GL) due to the heterozygous de novo LMNA p.E262K mutation and compare her clinical and metabolic features to those of other described patients with APS. Despite many health issues, short stature, skeletal problems, GL and late diagnosis of APS, our patient seems to be relatively metabolically healthy for her age when compared to previously described patients with APS.Learning pointsAtypical progeroid syndromes (APS) are rare and heterogenic with different age of onset and degree of metabolic disorders, which makes this diagnosis very challenging for clinicians and may be missed until the adulthood.The clinical picture of the APS depends on a particular mutation in the LMNA gene, but may vary even between the patients with the same mutation.The APS due to a heterozygous LMNA p.E262K mutation, which we report in this patient, seems to have association with the generalized lipodystrophy, short stature and osteoporosis, but otherwise, it seems to cause relatively mild metabolic complications by the age of 30.The patients with APS and lipodystrophy syndromes require a personalized and multidisciplinary approach, and so they should be referred to highly specialized reference-centres for diagnostics and treatment as early as possible.Because of the high heterogeneity of such a rare disease as APS, every patient’s description is noteworthy for a better understanding of this challenging syndrome, including the analysis of genotype-phenotype correlations.

Changes of biochemical indicators of blood serum and the skeletal muscle homogenate of the hind limbs of the rats in acute ischemia-reperfusion and in the condition of using of the carbacetam

Annotation. Simulation of ischemia-reperfusion causes the biochemical disorders and changes in the prooxidant-antioxidant system, both in the serum and skeletal muscles of the affected limb. The severity of local and systemic postischemic imbalance decreases in with correction with medicine from the group of nootropics – carabacetam. The aim of the study was determining the degree of metabolic disorders based on the analysis of changes in serum biochemical parameters and muscle homogenate in ischemic-reperfusion disorders caused by the imposition of an arterial tourniquet and under conditions of correction with carbacetam. Materials and methods. A biochemical study of blood serum and muscle homogenate of 60 rats was performed. Ischemia was simulated by applying SWAT rubber tourniquets on the hind limbs of the rats, on the inguinal fold, for 2 hours, and reperfusion was modeled by removing the tourniquet and restoring of blood circulation through 2 hours after its application. Observations of the animals were carried out during for 14 days. 30 rats in the reperfusion period were intraperitoneally administered the carbacetam at a dose of 5 mg per kilogram of body weight 1 time a day for 14 days of the reperfusion period. The Blood serum was separated and the soft tissue samples were taken below the turniquet site for the biochemical studies. Statistical processing of the material was performed using the package of programs “Microsoft Excel”. The largest deviations in serum were observed after 1 day of the reperfusion: an increase in creatinine by 28.16 % (p<0.005), total bilirubin by 20.75 % (p<0,005), ALT by 96.14 % (p<0,005), AST by 147.27 % (p<0.005) and alkaline phosphatase by 70.84 % (p<0.005), as well as an increase in prooxidant activity of CD by 77.27 % (p<0.005), CT 147.47 % (p<0,005) and TBC-AL by 82.52 % (p<0,005) against the background of a decrease in SOD activity by 9.77 % (p<0.005) and an increase in catalase levels by 15.37 % (p<0.005) relative to the value of the control group. The development of ischemia and reperfusion was accompanied by the largest increase in the level of prooxidants (CD – by 27.55 % (p<0.005), CT – by 47.34 % (p<0.05), TBC-AL – by 62.09 %) (p<0.005)) in the homogenate of the skeletal muscles after 2 hours after restoration of the blood supply. Antioxidant activity, on the other hand, decreased by 15.06 % (p<0.005) SOD and by 8.96 % (p<0.005) catalase after 1 day. After 14 days, a gradual increase and return of most of the studied values to the level of the control group. Under the influence of the carbacetam, the biochemical parameters of blood serum most significantly decreased in relative to the value of the groups without correction after 7 days of the experiment. The level of total bilirubin was lower by 29.65 % (p˂0.05), ALT by 14.95 % (p˂0.05), AST by 19.84 % (p˂0.05), alkaline phosphatase by 25.53 % (p˂0.05), and the difference in the content of diene, triene conjugates and TBC-LP was the largest after 1 day – by 17.09 % (p<0.005), 20,41 % (p<0.05) and 11.24 % (p<0.05), respectively. Under the conditions of correction, the indicators of SOD and catalase activity increased, being significantly higher than in the groups of the animals without correction, especially after 7 days of reperfusion – by 29.41 % (p<0.005) and by 15.71 % (p<0.05) in accordance. The content of the diene, triene conjugates and TBC-LP muscle homogenate was statistically significantly lower in the groups with the introduction of the carbacetam than in the groups of the animals without correction. The largest difference between the groups was found after 1 day with a difference of 9.16 % (p<0.05), 7.35 % (p<0.005) and 16.05 % (p<0.05), respectively. Antioxidant activity of SOD and catalase after 1 day was higher by 27.41 % (p<0.005) and by 25.13 % (p<0.005), compared with the group of the animals without introduction of the carbacetam. Thus, simulated ischemia-reperfusion is accompanied by the greatest biochemical disorders in the serum – after 1 day, and in the muscle homogenate – after 2 hours of the reperfusion. After 14 days of the experiment, most indicators still do not return to the level of the control group. The application of the correction helps to reduce the severity of biochemical disorders at the systemic and local levels, especially during periods of their greatest deviations.

Poikilocytosis under dogs’ spontaneous babesiosis

The article presents the results of studies of changes in the shape of red blood cells during spontaneous babesiosis in dogs. It was found that in 2019, seasonal outbreaks are caused and characterized by the presence of two waves – spring-summer with a peak in June and autumn with a peak in October. The intensity of parasitemia increases synchronously with the extensity of infestation in the first half of the year(a narrow direct correlation), in the future it falls and does not correlate with outbreaks of animal disease. Clinically, the spring-summer wave of the disease is characterized by an acute-subacute typical course with pronounced classic clinical signs. The autumn wave had a predominantly subacute-atypical course, with the development of severe complications with signs of hepatopathy and acute renal insufficiency, cardiomyopathy and myocarditis, lesions of the nervous system, the development of shock with a significant tendency to decompensation. Changes in the shape of red blood cells are bright and indicative markers of the state of animals on babesiosis. Poikilocytosis was detected in 92.3 % of sick dogs. The most common changes are acanthocytosis and vacuolization of erythrocytes (irreversible forms), which qualitatively assess the degree of damage to vital organs. Echinocytes are reversible forms that appear in the early stages and determine the development of renal and hepatic pathologies. Stomatocytes accompany the development of inflammatory and dystrophic pathologies, qualitatively characterize the degree of hemolytic anemia. Their intensity is synchronous with the extent of the invasion. The appearance of schizocytes is a formidable symptom that is pathognomonic for disseminated intravascular coagulation syndrome. This marker requires immediate use of intensive care. The assessment of qualitative changes in the form of red blood cells, the calculation of the intensity of erythrocyte lesions allows you to determine the severity of the condition of the body of sick dogs, the degree of metabolic disorders, hemolytic anemia, hepatopathy, the severity of intoxication, uremic syndrome, spleen hyperplasia, as well as identify the development of DIC syndrome, kidney failure and “shock kidney”. Such an assessment is necessary for making timely and adequate decisions regarding therapeutic measures for spontaneous babesiosis of dogs.

Correlation analysis of metabolic syndrome and its components with thyroid nodules.

ObjectiveThis study aimed to analyze the relationship between the metabolic syndrome (MetS) and its components with the occurrence of thyroid nodules.MethodsA total of 2719 volunteers from some areas of Gansu Province, China, who participated in the national survey of thyroid diseases and iodine nutrition status (Tide) and diabetes prevalence, were selected. Their height, weight, waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure were recorded. The fasting plasma glucose (FPG), 2-h plasma postprandial glucose (2hPG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and glycosylated hemoglobin (HbA1C) levels were measured. The prevalence of MetS and thyroid nodules was evaluated, and the correlation between each component of MetS and thyroid nodules was studied.ResultsThe prevalence of MetS and thyroid nodules was 15.4% and 17.2%, respectively. WC, SBP, body mass index, FPG, 2hPG, TG, TC, and thyroid-stimulating hormone levels were significantly higher in the thyroid nodule group. The prevalence of thyroid nodules was significantly higher in the MetS group. A positive correlation was found between the degree of metabolic disorder and the occurrence of thyroid nodules. WC was found to be a risk factor for the occurrence of thyroid nodules. For WC≥90 cm, an increase in the independent variables led to a significant rise in the incidence of thyroid nodules.ConclusionThe prevalence of thyroid nodules was higher in the MetS group. The WC of the MetS components might be an independent risk factor for the occurrence of thyroid nodules.

Circulating ANGPTL8 Is Associated with the Presence of Metabolic Syndrome and Insulin Resistance in Polycystic Ovary Syndrome Young Women.

Background ANGPTL8 has been reported to be a regulator of lipid metabolism, and it is associated with insulin resistance (IR) and metabolic syndrome (MetS). We investigated whether ANGPTL8 plays a role in MetS. Methods ANGPTL8 and adiponectin concentrations were measured in PCOS patients with or without MetS and in their corresponding healthy controls. The association of circulating ANGPTL8 with adiponectin and other parameters was also examined. Results Circulating ANGPTL8 concentrations were higher in PCOS women with MetS than in those without MetS and in the controls (P < 0.01). ANGPTL8 was positively correlated with age, BMI, FAT%, WHR, SBP, TG, FBG, HbA1c, Fins, and HOMA-IR (all P < 0.01) in the study populations and negatively associated with adiponectin and M-values (P < 0.001). In addition, ANGPTL8 was positively correlated with PRL, LH, TEST, and FAI and negatively correlated with SHBG (all P < 0.01). ROC curve analyses showed that the AUCMetS was 0.87 (P < 0.001), with a sensitivity of 92.4% and specificity of 75.4%, and the AUCIR was 0.82 (P < 0.01), with a sensitivity of 76.4% and specificity of 75.6%. Conclusion ANGPTL8 levels progressively decrease from PCOS patients with MetS to those without MetS and may be a serum marker associated with the degree of metabolic disorders.

CHARACTERISTICS OF CLINICAL AND LABORATORY INDICATORS IN PATIENTS WITH DIABETES 2 TYPE DEPENDING ON THE DISEASE SEVERITY

Relevance. Clinical manifestations of complications associated with type 2 diabetes mellitus (T2DM) are associated with the development of micro- and macroangiopathies. Due to, as a rule, the lengthy experience of uncontrolled hyperglycemia, the complications of T2DM are characterized by a severe course, a high risk of disability and premature mortality, and require careful study of clinical and laboratory manifestations.&#x0D; Objective: to analyze the clinical and laboratory parameters in patients with T2DM, depending on the severity of the disease.&#x0D; Material and methods. The study involved data from 152 patients with T2DM. According to the results of clinical and laboratory studies, the presence of retinopathy, nephropathy was determined by the level of microalbuminuria and glomerular filtration rate, and sensory polyneuropathy, macroangiopathies of the lower extremities, and arterial hypertension. According to the severity of diabetes, the patients were divided into three groups. In the control group were drawn 95 healthy individuals. For mathematical processing of the data used, the program Statistica 10 (StatSoft, Inc., USA) was used.&#x0D; Results. All patients had hyperglycemia with an excess of glucose in the blood of 2,4-3,3 times (p&lt;0,001) compared with the control. The blood content of HbA1c also exceeded the control (1,5-2,0 times; p&lt;0,001). According to the carbohydrate metabolism in the 1st group, all patients were compensated, and in the 2nd and 3rd groups, they were decompensated. Patients of the 3rd group were on average 6 years older and longer (by 8,5 years) were ill (p&lt;0,001). In patients with the 1st and 2nd groups, hyperinsulinemia occurred, in patients of the 3rd group - hypoinsulinemia and a decrease in beta-cell function; insulin resistance was observed in patients of all groups. Patients of the 3rd group had excess weight or obesity (BMI from 28,4 kg/m2 to 35,0 kg/m2), which could be associated with hypertriglyceridemia; in patients with hyperleptinemia and leptin resistance. In groups, the frequency and degree of retinopathy (p=5,8e-04), nephropathy in albuminuria (p=0,032), macroangiopathy of tender extremities (p&lt;0,001), and hypertension (p=0,004) increased significantly.&#x0D; Conclusion: the obtained data allowed objectifying the patient's condition according to the degree of metabolic disorders, hormonal regulation and the presence of complications.

Report of the Committee on the classification and diagnostic criteria of diabetes mellitus

Diabetes mellitus is a group of diseases associated with various metabolic disorders, the main feature of which is chronic hyperglycemia due to insufficient insulin action. Its pathogenesis involves both genetic and environmental factors. The long-term persistence of metabolic disorders can cause susceptibility to specific complications and also foster arteriosclerosis. Diabetes mellitus is associated with a broad range of clinical presentations, from being asymptomatic to ketoacidosis or coma, depending on the degree of metabolic disorder.

Report of the committee on the classification and diagnostic criteria of diabetes mellitus.

Abstract Concept of Diabetes Mellitus: Diabetes mellitus is a group of diseases associated with various metabolic disorders, the main feature of which is chronic hyperglycemia due to insufficient insulin action. Its pathogenesis involves both genetic and environmental factors. The long‐term persistence of metabolic disorders can cause susceptibility to specific complications and also foster arteriosclerosis. Diabetes mellitus is associated with a broad range of clinical presentations, from being asymptomatic to ketoacidosis or coma, depending on the degree of metabolic disorder.

Significant correlations between severe fatty liver and risk factors for metabolic syndrome

It is known that ultrasonography (US) cannot differentiate between non-alcoholic fatty liver disease (NAFLD) and steatohepatitis. However, US can accurately estimate the severity of the steatosis. The clinical significance of severe hepatic fatty change by US has not been explored. The aim of this study was to investigate the relationship between the severity of the fatty liver, classified by US, and the degree of metabolic disorders with insulin resistance. In 16 486 Taiwanese patients, severity of fatty change on US was classified as follows: group A (n = 6950), absence of fatty change; group B (n = 8694), mild; and group C (n = 842), severe fatty liver change. Biometabolic parameters included body mass index (BMI), blood pressure (BP), fasting plasma glucose, triglycerides, cholesterol, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and serum creatinine. Nominal logistic regression analysis was used to estimate the odds ratio for different degrees of fatty liver. The frequencies of obesity, hypertension, glucose intolerance and hypertriglyceridemia were all significantly higher in group C than in group A or B (P < 0.0001), and the mean values of BMI, BP, fasting glucose, triglyceride and ALT were also higher in group C (P < 0.0001). High BMI (>or=30 kg/m(2)) appears to be the most important factor for progression from mild to severe fatty liver in both sexes. The presence of severe fatty liver by US correlated significantly with the prevalence and degree of hypertension, abnormal glucose and triglyceride metabolism. Patients with severe fatty liver could be at an increased risk of atherosclerotic cardiovascular disease and should be screened regularly for metabolic disorders. The physician may also evaluate ALT and hepatic fat content by US in patients with metabolic syndrome. Evaluating the severity of fatty liver by US may be useful because it correlates with the status of hyperinsulinemia, the risks of developing cardiovascular disease, and the threshold for oxidative stress.

Metabolic determinants of efficacy of infrared laser therapy in hypertensive patients with combined pathology

By a distinct pathogenetic direction of a therapeutic action of laser therapy (LT) on different regulators of blood pressure (BP) and metabolism, 109 patients with essential hypertension (EH) and atherosclerosis and/or diabetes mellitus were studied for LT efficacy depending on metabolis disorders. LT demonstrated metabolic neutrality and unefficacy in patients with multiple marked disorders of fat metabolism and hyperglycemia. Metabolic factors determining LT efficacy comprise hypercholesterinemia, hypertriglyceridemia and hyperglycemia. The factorial analysis points to essential factor restructuring in metabolic disorders. The obtained equation of multiple regression allows prognostication of the degree of a fall of mean BP in response to LT depending on the degree of metabolic disorders.

Distribution of the total quantity of fatty acid double bonds in lipid components of the blood in children with diabetes mellitus

Children suffering from insulin-dependent diabetes mellitus (IDDM) were examined for unsaturation, that is, total quantity of double bonds in individual fractions of blood serum lipids was assessed. Lipid fractions were isolated by thin-layer chromatography. Unsaturation was assessed by ozonation method. The research was aimed at elucidation of biochemical criteria of the degree of metabolic disorders in children with IDDM and at development of methods for quantitative assessment of such disorders. Thirty-two inpatients with IDDM aged 7 to 15 were examined over time. Control group included 10 healthy age-matched children. Twenty children were examined during compensation stage (group 1), twelve during decompensation with ketoacidosis (group 2). Total unsaturation parameters were found reliably decreased in children with IDDM both during compensation and decompensation stages vs. those in healthy controls. A relative decrease of unsaturated fatty acids in the fraction of unesterified fatty acids (p < 0.05) was characteristic of group 2, with the content of their fragments in triglyceride fraction being the maximal (p < 0.05). The pattern of total unsaturation distribution in serum lipid fractions may serve as an indicator for metabolic disorders and decompensation in IDDM.

Mathematical modelling of metabolic pathways affected by an enzyme deficiency. Energy and redox metabolism of glucose-6-phosphate-dehydrogenase-deficient erythrocytes.

The effects of various forms of glucose-6-phosphate dehydrogenase deficiency on erythrocyte metabolism have been studied on the basis of a complex mathematical model which comprises the main pathways of this cell: glycolysis, pentose pathway, reactions of the glutathione and adenine nucleotide metabolism. The calculated flux rates through the oxidative pentose pathway with and without methylene blue are in good accord with experimental results. The degree of deficiency as predicted by the model on the basis of calculated upper oxidative load boundaries, as well as of maximal methylene blue stimulation, correlates with the individual clinical manifestation of the metabolic disease. Therefore, the model allows one to judge the degree of metabolic disorder in the presence of glucose-6-phosphate dehydrogenase enzymopathies if the kinetic properties of the defect enzyme are known. Experimentally accessible parameters for an assessment of the oxidative load capacity of cells in vivo are proposed. It is pointed out that the threshold of tolerance as to energetic load is drastically reduced in the case of severe glucose-6-phosphate dehydrogenase deficiency.