Fatty Hepatosis Research Articles

The prevalence of ultrasound signs of fatty hepatosis and comorbidities in hospital patients in Kyrgyzstan

The prevalence of ultrasound signs of fatty hepatosis and comorbidities in hospital patients in Kyrgyzstan

Cholesterosis: is it related to pancreatology?

Gallbladder (GB) cholesterosis is a disease characterized by impaired cholesterol metabolism with its predominant deposition in the GB wall. GB cholesterosis is considered as a component of lipid distress syndrome, i. e. a combination of a range of pathological conditions caused by lipid metabolism disorders (atherosclerosis, lipogenic pancreatitis, GB cholesterosis, fatty hepatosis). Indeed, GB cholesterosis is often detected in patients with coronary atherosclerosis, hypertension, obesity, and non-alcoholic steatohepatitis. This allows us to consider the GB as a target organ in atherogenic dyslipidemia and point out that its lesion is not as an independent disease, but a systemic manifestation of impaired cholesterol metabolism in the liver.
 Considering the general pathogenetic factors of the development of gallstone disease and GB cholesterosis, as well as its frequent combination with cholecystolithiasis, some authors consider GB cholesterosis a specific option of gallstone disease or the pre-stage of cholecystolithiasis, justifying this by the decrease in nucleation time of GB bile upon the absence of stones in patients with GB cholesterosis, as well as with gallstone disease.
 Clinical manifestations of GB cholesterosis have not been sufficiently studied. They are nonspecific and do not allow differentiating it from other chronic GB diseases. The relevant symptoms in GB cholesterosis are due to the addition of cholecystitis, cholecystolithiasis or dysfunction of the biliary tract.
 Sonography is considered the most informative technique for diagnosing GB cholesterosis. This study is especially informative in case of polypous form of GB cholesterosis. According to the results of sonography, reticular, polypous (pseudopolypous), calculous and mixed forms of GB cholesterosis are distinguished.
 The use of ursodeoxycholic acid preparations in GB cholesterosis is pathogenetically substantiated. Ursonost (Organosyn LTD) is one of the best drugs.

Protein-synthesizing, bile-forming, urea-forming and carbohydrate functions in cows with fatty degeneration of the liver

In dairy farms of Ukraine, where highly productive dairy cows are kept, liver lesions are often diagnosed in the postpartum period. Postmortem studies of the liver of cows that were forcibly slaughtered showed that in mostly animals were diagnosed with fatty degeneration of the liver. The main causes of fatty hepatosis were violations of the structure of rations, imbalance of feeding on essential nutrients and biologically active substances, low content of easily digestible carbohydrates and high protein content. The study was performed on cows aged 4–5 years with productivity for the previous lactation of 5.600–7.500 L of milk, in a winter-stall period of keeping, 2–3 weeks after calving. According to clinical and biochemical blood tests, two groups of cows were formed – 50 clinically healthy and 50 cows with fatty liver disease. In cows diagnosed with fatty liver degeneration, the disease was manifested by decreased productivity and fatness, loss of appetite, oppression, hypotony of the rumen, reticulum and omasum. In some cows, there was pain at the liver area, increasing boundaries of hepatic dullness, jaundice of the visible mucous membranes and sclera. The blood serum of all cows with fatty liver disease established a decrease in albumin content, indicating impaired protein synthesis function of the liver. In some cows, the content of total protein in the serum increased due to globulin fractions, mainly gamma globulins. The ratio between the content of albumins and globulins decreased, which indicates the development in the blood of sick animals dysproteinemia. The development of fatty infiltration of the liver caused an increase in the concentration of bile acids in the serum of all sick cows. This is due to reduced conjugation and excretion of cholates by affected hepatocytes from the bile capillaries. The formation, absorption, conjugation, and excretion of bilirubin in the bile is disturbed, which causes the accumulation of total and conjugated bilirubin in the serum of sick animals. The cholesterol content in the blood of cows decreased, caused a violation of the esterification of its esters by hepatocytes. The established changes in the content of bile acids, total and conjugated bilirubin, and cholesterol in the blood of sick cows indicate a violation of bile secretion, bile production, and cholestasis development. In some cows with fatty liver degeneration, urea formation function and carbohydrate function are impaired, leading to a decrease in blood urea content and glucose.

Somatic state assessment of the health of patients with retinoblastoma in a long-term follow-up

AIM: To comprehensively assess the incidence and nature of the chronic diseases in patients with retinoblastoma in the long-term follow-up
 MATERIAL AND METHODS: The study analyzed the long-term treatment results of 176 patients with retinoblastoma. Group 1 included 46 patients aged 18 years and Group 2 included 88 patients aged 18 and 35 years. A gynecologist and a urologist were consulted, a medical history was taken, and a physical examination with emphasis on the presence of secondary sexual characteristics and laboratory tests were performed to assess the endocrine function in surviving patients aged 18 years. Anamnestic data were used in patients aged 18 years.
 RESULTS: The somatic status data analysis of 46 surviving adolescents revealed that 29 (63%) have abnormalities. Chronic gastritis and gastroduodenitis, biliary dyskinesia, fatty hepatosis, and lactase deficiency predominate in gastrointestinal structure diseases. Respiratory diseases are represented by chronic nasopharyngeal diseases in 13.0% of children. Secondary immunodeficiency condition was diagnosed in 3 (6.5%) patients. Musculoskeletal system and connective tissue pathologies in deforming dorsopathies were identified in 10.9% of cases and bone and joint pain were identified in 8.7%. Chronic conditions were found in 42 (47.7%) of 88 patients in Group 2. Somatic disorders were found in 95.2%, hormonal disorders in 11.9%, psycho-emotional disorders in 9.5%, and combined pathology in 9.5% of cases. Endocrine pathology was detected in 14 patients (30.4%) aged 18 years.
 CONCLUSION: Retinoblastoma survivors have a high risk of somatic and endocrine disorders. The main risk factors are distance radiation therapy and alkylating agents. Regular lifelong follow-up of these patients is necessary to establish a medical rehabilitation system for children with retinoblastoma.

Influence of Ketogenic Diet and Nutraceutical Correction in the Complex Treatment of Lower Limbs Lipedema

Currently, the ketogenic diet (KD) is used to treat obesity. A prospective study on the use of KD and nutraceutical correction of the nutritional status of patients with lipedema was carried out. Aim. To study the effect of the ketogenic diet, accompanied by correction of changes in the intestinal microbiome and hepatoprotection,on the reduction of fatty deposits in lipedema and the dynamics of changes in lipid and carbohydrate metabolism hormones. Material and methods. 60 patients with lower limb lipedema of stages I-III were randomized into 2 groups: Group 1 received a lowcalorie diet (LCD), physical exercises in the gym (PE), and physical activity (FA) in the form of daily walking up to 3-5 km/ day. Group 2 received a modified version of the Atkins ketogenic diet, physical exercises in the gym and FA, as well as nutraceutical correction of increased appetite, probiotic intestinal composition, hepatoprotection. The duration of the treatment course was 4 weeks. Anthropometric methods and bioimpedansometry were used to control limb circumferences, waist and thigh. Results and discussion. After treatment, patients in 1st group showed a decrease in body weight, lean and active cell mass, a decrease in musculoskeletal mass, and a decrease in total water due to extracellular water. A decrease in total cholesterol and high density lipoproteins (HDL) fraction, an increase in blood triglyceride fraction was noted. Leptin decreased by 12.73%. Patients of the 2nd group showed a decrease in body weight, fat mass, lean mass, total water and extracellular water. There was a decrease in total cholesterol, triglycerides, transaminases. Leptin decreased by 32.02%, insulin decreased by 9.87%. To prevent the development of fatty hepatosis against the background of the use of KD, patients of the 2nd group received nutraceutical correction: hepatoprotector Gepamin, metaprebiotic Stimbifid-plus, modulating the formation of resident intestinal microbiota. To reduce appetite, the patients of the 2nd group were also prescribed anorexic - an algal product Nativ containing the polysaccharide fucoidan, having a prebiotic effect. Improvement of reparative processes in the liver, suppression of oxidative processes also contributed to the restoration of the sensitivity of insulin receptors, which was confirmed by the normalization of the lipid-carbohydrate spectrum of blood in patients of the 2nd group after the course of the treatment. The insulin decrease in patients of Group 2 indicated not only insulin resistance decrease , but also the lipogenesis decrease and stimulation of lipolysis. Adipose tissue reduction due to lipolysis stimulation was also indicated by a decrease in leptin expression. Conclusion. Thus, a ketogenic diet, accompanied by nutraceutical correction of the intestinal microbiome and hepatoprotection can be effectively used in combination with physical activity in order to reduce body weight, fat mass and edema, as evidenced by a decrease in the expression level of leptin and insulin, correlating with the levels of fat loss and free water.

Изменения сосудов головного мозга у пациентов с неалкогольной жировой болезнью печени и нарушением углеводного обмена

Актуальность. Исследование сосудов головного мозга у пациентов с неалкогольной жировой болезнью печени (НАЖБП) может раскрыть новые аспекты раннего выявления нарушений церебральной гемодинамики, а также обнаружить группу больных высокого риска. Цель исследования: изучить особенности изменений в сосудах головного мозга у пациентов с НАЖБП в сочетании с инсулинорезистентностью (ИР) или сахарным диабетом (СД) 2 типа. Материалы и методы. Обследовано 74 пациента с НАЖБП (34 больных с неалкогольным жировым гепатозом (НАЖГ) и 40 больных с неалкогольным стеатогепатитом (НАСГ)). Группа сравнения включала 38 пациентов (16 больных с ИP и 22 пациента с СД 2 типа). Состояние кровотока в cосудах головного мозга изучали с помощью ультразвукового дуплексного сканирования экстракраниального отдела общей сонной артерии (ОСА), наружной сонной артерии (НСА), экстракраниального отдела внутренней сонной артерии, средней мозговой артерии, вертебральной артерии (ВА), глазной артерии. Определяли пиковую систолическую скорость (ПСС) и среднюю по времени максимальную скорость кровотока (ТАМХ) в исследуемых сосудах. Результаты. Обращает на себя внимание асимметричное поражение сосудов головного мозга с более выраженным дефицитом кровотока слева при НАЖБП, что более выражено у больных со стадией НАСГ, особенно в сочетании с ИP. Гемодинамически наиболее значимые изменения установлены в ОСА, а именно выявлено снижение ПСС до (38,1 ± 2,3) см/с справа и до (36,6 ± 3,4) см/с слева, снижение ТАМХ — до (20,4 ± 2,1) см/с справа и до (16,7 ± 1,8) см/с слева. Выводы. У пациентов с НАЖБП, ИP и СД 2 типа выявлено снижение скоростных показателей кровотока по экстракраниальным сосудам головного мозга, преимущественно по ОСА, НСА и ВА (сегмент 3). Наиболее выраженный дефицит кровотока установлен у больных НАСГ в сочетании с ИP, преимущественно слева, особенно по ОСА.

Нейровегетативные и когнитивные нарушения у пациентов с неалкогольной жировой болезнью печени и сахарным диабетом 2 типа

Актуальность. Проводятся разнонаправленные исследования для лучшего понимания влияния когнитивных нарушений на лечение, мобильность, смертность пациентов, особенно лиц с полиморбидной патологией. Цель: изучить особенности когнитивных и нейровегетативных нарушений у пациентов с различными формами неалкогольной жировой болезни печени (НАЖБП) (неалкогольный жировой гепатоз (НАЖГ) и неалкогольный стеатогепатит (НАСГ)) и сахарным диабетом (СД) 2 типа. Материалы и методы. Обследовано 50 пациентов с НАЖБП (24 — с НАЖГ и 26 — с НАСГ). Группа сравнения включала 22 человека с СД 2 типа. Нарушения функций центральной и вегетативной нервной системы определяли с помощью нейропсихометрических тестов. Результаты. У обследованных пациентов по результатам анкетирования установлена вегетативная дисфункция. Когнитивные нарушения (преимущественно легкие и умеренные) выявлены в обеих группах больных. Максимально выраженные нарушения определялись в сфере внимания и концентрации, памяти, менее выраженные — в зрительно-конструктивной сфере, особенно у больных с НАСГ в сочетании с СД 2 типа. Стрессовые ситуации негативно влияют на жизнь этих пациентов, при этом они недостаточно критически реагируют на обнаруженные проблемы. У больных НАСГ в сочетании с СД 2 типа установлен наименьший уровень сопротивляемости стрессу — (56,7 ± 3,1) балла; p < 0,01. У них определяется легкая уязвимость даже при незначительном негативном влиянии. Выводы. У пациентов с НАЖБП и СД 2 типа выявлены когнитивные нарушения и вегетативная дисфункция по результатам нейропсихометрического тестирования. Наиболее выраженными когнитивные нарушения были у больных НАСГ в сочетании с СД 2 типа и ожирением I степени по результатам Монреальской шкалы оценки когнитивных функций (r = 0,90; р < 0,01), Бостонского теста (r = 0,94; р < 0,01) и Висконсинского теста сортировки карточек (r = 0,92, р < 0,01).

Problems of formation of the toxic hepatopathy forming in the conditions of chronic fluoride intoxication of the body

Introduction. Aluminium production is characterized by the accumulation of impurities of various toxic and chemical compositions in the air of working areas, the predominant among which are fluoride compounds. The accumulation of fluorides in the body causes the development of osteoarticular and associated systemic pathology. The aim of the study was to evaluate the hygienic and medico-biological features of toxic liver damage in the conditions of chronic fluoride intoxication of the body. Material and methods. The hygienic working conditions of the workers of the primary professions in aluminium production were evaluated. The analysis of hepatobiliary dysfunction based on clinical and instrumental methods was carried out in 263 subjects with fluoride intoxication and a comparison group of 116 persons. Experimental studies of the morpho-functional liver state in modelling chronic fluoride intoxication were carried out based on toxicological, biochemical, pathomorphological methods with histological analysis of tissues. The toxic properties of sodium fluoride were studied in 117 white laboratory male rats with its peroral route intake into the body. Results. The qualitative composition of the air in the working areas in the electrolysis building was analyzed. The prevalence of pathological disorders of the biliary tract in metallurgists engaged in aluminium production was assessed. Clinical studies revealed a significant prevalence of toxic fluoride hepatopathy, fatty hepatosis, cholecystitis and other disorders in the group of patients with chronic fluoride intoxication. The harmful effect of sodium fluoride on hepatocytes, vessels of the portal tract was shown in an experiment. Hyperfunction of the reticuloendothelial system, Kupffer cell proliferation, irreversible destruction of hepatocytes, necrosis against the background of severe dystrophy, and decreased synthetic activity of the liver were determined. Conclusion. The structure of occupational diseases in the workers engaged in the aluminium production is dominated by hepatobiliary pathology caused by toxic liver damage with fluoride confirmed by experimental data on destructive violations of its morphostructure.

Non-alcoholic fatty liver disease: time for changes

The review contains updated information on the epidemiology, etiology, pathogenesis, diagnosis, treatment and prevention of non-alcoholic fatty liver disease (NAFLD). We searched for terms including NAFLD, non-alcoholic steatohepatitis (NASH), metabolic syndrome and type 2 diabetes mellitus in literature published over the past 5 years using the Scopus, Web of Science, CyberLeninka, PubMed databases. The concept of NAFLD includes two morphological forms of the disease with different prognosis: non-alcoholic fatty hepatosis and NASH. The severity of NASH is quite variable, including fibrosis, cirrhosis and hepatocellular carcinoma. NAFLD, a spectrum of fatty liver disorders of viral, autoimmune, drug-induced, and genetic origin, which are not caused by alcohol abuse, has recently been renamed as metabolic (dysfunction) associated fatty liver disease (MAFLD). The average prevalence of NAFLD is approximately 25% among the adult population worldwide, and in some regions exceeds 30%. An increase in the prevalence of this pathology is in parallel with the global epidemic of obesity and type 2 diabetes mellitus in the world. It is time to reach a general consensus in the scientific community on changing the nomenclature and moving from a negative to a positive definition of NAFLD/NASH. The new nomenclature points to the “positive” determinants of the disease, namely the close relationship with metabolic disorders, instead of defining it as what it is not (ie. non-alcoholic). The MAFLD abbreviation more accurately discloses existing knowledge about fatty liver diseases associated with metabolic dysfunction and should replace NAFLD/NASH, as this will stimulate the research community’s efforts to update the disease nomenclature and subphenotype and accelerate the transition to new treatments. It is important that primary care physicians, endocrinologists, and other specialists are aware of the extent and long-term consequences of NAFLD. Early identification of patients with NASH can help improve treatment outcomes, avoid liver transplantation in patients with decompensated cirrhosis. There are currently no effective treatments for NAFLD, so it is important to follow a multidisciplinary approach, which means using measures to improve prognosis, reduce the risk of death associated with NAFLD, the development of cirrhosis or hepatocellular carcinoma. Epidemiological data suggest a close relationship between unhealthy lifestyles and NAFLD, so lifestyle adjustments are needed to all patients. Insulin sensitizers, statins, ezetimibe, a cholesterol absorption inhibitor, hepatoprotectors, antioxidants, incretin analogues, dipeptidyl peptidase 4 inhibitors, pentoxifylline, probiotics, angiotensin-converting enzyme inhibitors, and endocannabinoid antagonists are used in the treatment of NAFLD.

Hepatic fibrosis as an additional risk factor for the development of cardiovascular disorders in patients with type 2 diabetes mellitus with non-alcoholic fatty liver disease

The aim of the study was to determine the relationship between the degree of progression of liver fibrosis and the risk of cardiovascular complications in patients with Type 2 diabetes mellitus (DM) with non-alcoholic fatty liver disease (NAFLD). The study included 110 patients with Type 2 diabetes (62 men and 48 women), the average age of the subjects was 52.07±1.11 years. All patients were divided into 2 groups: the main group included 72 patients with Type 2 diabetes with concomitant NAFLD (38 men and 34 women); the control group included 38 patients with Type 2 diabetes without clinical manifestations of NAFLD (24 men and 14 women). Patients of the main group were divided into 3 subgroups, taking into account the predominant pathological processes in the clinical picture. The division into subgroups was carried out in 2 stages: at the first stage, those with predominant manifestations of liver fibrosis (F2 or more) were selected from the general population of patients with Type 2 diabetes with NAFLD according to the results of liver elastography and the use of Bonacini and Metavir scales. The number of such patients was 29, which accounted for 40.3% of the total number of patients in the main group. The remaining patients were divided into 2 subgroups: 11 patients (15.3%) had non-alcoholic liver steatosis, and 32 patients (44.4%) had signs of non-alcoholic steatohepatitis (NASH). As a result of the study, it was found that the presence of liver fibrosis in patients with Type 2 diabetes with NAFLD is significantly more often associated with cardiovascular complications, such as arterial hypertension, coronary heart disease, myocardial infarction, stroke, diabetic retinopathy and nephropathy. A significant decrease in the ejection fraction (EF) was found in patients with Type 2 diabetes with concomitant NAFLD. At the same time, the number of patients with EF disorders of varying degrees in the main group significantly exceeded that in the comparison group (33.3% and 6.7%, respectively, p<0.001). The average values of left ventricular myocardial mass are significantly lower in patients with NASH and fibrosis formation compared to patients with NAFLD at the stage of fatty hepatosis. There was also a significant decrease in the size of the left and right atria in patients with NASH compared to both patients with steatosis and patients with fibrotic liver changes. Patients with predominant fibrotic changes in the liver are characterized by a relative decrease in myocardial mass, a decrease in final diastolic and systolic volumes and EF, which may indicate the development of diastolic dysfunction in them. It is shown that it is necessary to take into account in clinical practice not only the generally accepted stages of NAFLD, but also the predominant pathological process in the liver in patients with Type 2 diabetes, namely steatosis, manifestations of inflammation and fibrotic disorders. It is proved that fibrotic changes in the liver can develop at all stages of liver tissue damage.

The efficiency of the correction of metabolism and normalization of reproductive function of cows with the use of modified iodinol

The article presents theoretical substantiation for injecting a iodometabolic composition based on the well-known veterinary preparation iodinol in combination with succinic acid to correct pathobiochemical precesses of highly productive cows. Until recently injection method of the preparation administration in clinical veterinary medicine has not been considered and is not practiced/ The main deterrent was the old regulations that only regulated the external ana oral use of the preparation. More recently the possibility of injecting iodinol to accelerate the recovery of reproductive function in cows was successfully implemented in the dissertation study of Vitol V.A. (2010). The modification of iodinol with the inclusion of the hepatoprotector succunic acid as a strong metabolic is even more promising for its use in infectious and non-infectious pathology. In our research the injectable method of using iodinol in a complex with succinic acid was tested on highly productive cows during intensive endogenous lipolysis with well- expressed symptoms of metabolic acidosis, ketoacidosis, a high risk of developing fatty hepatosis and an unfavorable prognosis of practical use, According to the results of clinical studies it was found out that the cows of the first experimental group in which iodinol was tested in combination with succinic acid, protein content, total lipids, cholesterol, and glucose were already within the average physiological values on the 15th day. This indicated that energy processes of fat oxidation in the liver began to proceed without any deviations. Actually this is evidenced by the low levels of ketone bodies. On the contrary, the use of pharmacopeic iodinol in the second group did not have such a pronounced metabolic effect. In the animals of this group all biochemical parameters were either lower (glucose) or higher (total lipids, total bilirubin, cholesterol, ketone bodies, ASAT and ALAT transamination enzymes) than physiological values. This had a positive impact on the health of cows and the restoration of their reproductive ability. Within 60 days of lactation period the indicators of the cows disposal were as follows: 3 (3.5 %) in the first group of 83 cows, 9 (10.7 %) in the second group of 84, and 25 (25.5 %) in the third (control) group of 98 animals. Thus, a technologically simple approach to correcting metabolism with the availability and environmental safety of the components can reduce the severity of the problem of ensuring the health of high-yielding cows.

Liver steatosis in brain death donors

Aim. To study the frequency of fatty hepatosis in liver biopsies of consecutive brain death donors before cold preservation. Materials and methods. Liver biopsies (before cold preservation) of 300 consecutive donors with brain death were studied. Histological preparations were stained with hematoxylin and eosin, and tricolor Masson staining was performed. Results. The frequency of different degrees of fat hepatosis in men and women did not differ significantly (>0.05). Fat dystrophy of hepatocytes was absent in more than half of the cases (n = 182; 60.7%). A slight degree of fatty degeneration was diagnosed in 57 (19,0%) donors. In total, 239 (79.7%) donor livers were absolutely suitable for transplantation. Moderate degree of steatosis, which is associated with early biliary complications, was detected in 18 (6.0%) cases, and severe degree, which is a contraindication to the use of the organ for transplantation, was detected in 43 (14.3%) cases. Conclusion. Before cold preservation, liver from brain death donors is relatively rarely unsuitable for transplantation.

НА АМБУЛАТОРНОМ ПРИЕМЕ ПАЦИЕНТ С ИЗБЫТОЧНОЙ МАССОЙ ТЕЛА, СЧИТАЮЩИЙ СЕБЯ ЗДОРОВЫМ

According to WHO forecasts, 60% of the worlds population (3.3 billion people) may be overweight (2.2 billion people) and obese (1.1 billion people) by 2030. Increased body weight and atherogenic dyslipidemia are independent risk factors for chronic non-infectious diseases, which, in turn, lead to premature mortality of the working population. Management of patients with increased body weight requires a complex change in their lifestyle and their consistent and sustained efforts. Taking into account the latest data on the contribution of abdominal obesity, dyslipidemia, fatty hepatosis to the risks for development of cardiovascular diseases, these patients are indicated the earliest therapeutic and preventive outpatient intervention. The success of treatment depends on the degree of motivation, the level of compliance of the patient and regular control throughout life. However, when a patient considers himself healthy, he hopes to solve the arising problems quickly and easily, which is often impossible for objective reasons. In this case, the fundamental attitude of the patient may be crucial in the success of treatment. In the article, a typical clinical case of overweight and of other risk factors for chronic non-infectious diseases at the stage of early clinical manifestations associated with increased risks of multiple comorbidities, is described. But the patient, considering himself quite healthy and the first clinical manifestations insignificant, faced with the necessity of regular medical monitoring and complex life-long intervention, partially follows doctors recommendations and eventually is shying away from solving problems. By focusing on a paternalistic or engineering model of relationships with the doctor, the patient significantly reduces the effectiveness of the earliest control of risk factors for chronic non-infectious diseases. Analyzing the presented clinical case, it is possible to draw attention of specialists to the necessity of rationalization of diagnostic and treatment programs in real outpatient practice.

Study Of The Market Of Drugs Used In Hepatosis

This article reveals the need for study of the market of drugs used in hepatosis, it is rather difficult to substantiate and systematize the treatment of fatty hepatosis with such a variety of causes that cause it. therapy should be aimed at eliminating the causes, at stopping the syndromes of impaired digestion and absorption, at restoring the function of the liver and biliary system. this excludes the intake of certain drugs and alcohol abuse.

One-hour postload plasma glucose levels as a new criterion for assessing insulin secretion in obese children

BACKGROUND: Incidence of Type 2 Diabetes Mellitus (T2DM) and associated dysglycemic conditions, increasing the risk of diabetes development, continues to rise worldwide, most notably due to ever-growing obesity rate. Early identification of the persons who are exposed to the risk of T2DM development holds much significance for prevention of both this disease and associated cardiometabolic complications.AIM: To study characteristics of insulin secretion and insulin sensitivity among obese children and adolescents versus the glycemic level 60 minutes (GL60) after the standard oral glucose tolerance test (OGTT).METHODS: This open-label comparative cross-sectional study involved 613 children in the age between 6 and 17.9 years old with constitutive-exogenous obesity, divided into 2 groups: 173 patients with GL60 level ≥ 8.6 mmol/L and 440 children with GL60 level < 8.6 mmol/L. They underwent a screening for dyslipidemia, non-alcoholic fatty liver disease, arterial hypertension and impaired glucose tolerance (IGT). Insulin secretion was evaluated on the basis of maximal (IRI max), average level (IRI avg) of insulin in the course of OGTT and insulinogenic index (IGI), insulin resistance (IG) — by Matsuda index.RESULTS: The groups were comparable in the terms of age, sex, sexual maturation stage and obesity level. Children with GL60 level ≥ 8.6 mmol/L were characterized by higher IR (Matsuda 2.8 ± 2.3 vs 3.5 ± 2.2, р < 0.01), hyperinsulinemia (IRI max 190.0 ± 59.5 vs 157.1 ± 63.4 μU/ml, р < 0.001, IRI avg 115.3 ± 59.7 vs 90.2 ± 54.1 μU/ml, p < 0.001) along with low IGI value (1.84 ± 1.62 vs 2.61 ± 1.3, р < 0.01), which is indicative of the first phase insulin secretion impairment. The lowest IGI values were found among the "GL60 level ≥ 8.6 mmol/L" group patients with IGT (1.4 ± 0.9). Besides, the patients with GL60 level ≥ 8.6 mmol/L are characterized by the higher rate of metabolic complications in the form of impaired glucose tolerance, arterial hypertension, fatty hepatosis and steatohepatitis.CONCLUSIONS: GL60 level ≥ 8.6 mmol/L can be used as an additional marker for metabolically complicated obesity among children and adolescents with a high risk of the carbohydrate metabolism disorder development.

Современный взгляд на вчерашнее лекарство (обзор литературы)

Phospholipids (PL) – lipids that are not involved in accumulation of fatty deposits play a significant role and serve various functions. Firstly, as a component of cell membranes of all cells in the organism. In clinical practice, for the past decades, phospholipids were primarily used as hepaprotective substances, going by the name of “essential phospholipids (EPL)”. Becoming a popular, demanded, well-promoted remedy for the treatment of liver diseases. However, despite the many years of approbation, the existing and sufficientclinicalexperience, discussions regarding their benefits, effectiveness, safety and reliability are still underway and have brought up diametrically opposed views. From complete rejection of EPL as medicinal means, to full recognition of the advertised properties of EPL drugs based on the given manufacturer’s descriptions. For this reason, to clarify the issuing situation, we have conducted a literature search on the object of investigation. Purpose of the study. Search and critical analysis of modern literature sources on the topic of work using the principles of evidence-based medicine. Material and Methods. A critical online review of the literature sources chosen for the research has been carried out in the Web of Science Thompson Reuters, Springer Link and Pubmed databases, as well as in research works and online articles 10 years deep. Inclusion criteria: research papers with a high index of evidence base. Exclusion criteria: literature sources with no evidence, low quality works. Results and Discussion. The articleoutlines the natural role of proteins, lipids and the function of the cytolemma of intracellularorganoids in the restoration of damaged membranes of hepatocytes - de novo. Substantiating the obvious uselessness of using essential phospholipids in the treatment of liver diseases in general, fatty hepatosis in particular. The inability of penetration into liver cells for phospholipids in their native form and their alignment in thehepacyte membrane is indicated, since they belong to different biological species and have a mutually closed genetic system. In the literature search undertaken by us on this issue, the analytical and critical review of scientific literature have also shown that when ingested, essential phospholipids have low bioavailability, as the phospholipids in the chylomicrons do not directly enter the liver, but first the lymphatic system through which they are transported to the adipose tissue of the organism, where they are accumulated and metabolized. With parenteral administration, EPL spreading through the bloodstream can accumulate in other organs, systems, without reaching the liver tissue. For example, the largest amounts of EPL are usually found in the cell membranes of the nervous tissue and the brain. Conclusion. Essential phospholipids in the form of soy lecithin products cannot replace the endogenous phospholipids of the human body - in principle. Keywords: essentialphospholipids, liver cell membranes, hepaprotectors.

Метаболические атерогенные нарушения у подростков с жировым гепатозом

To determine the features of disorders and the relationship of the blood lipid spectrum, indicators of peroxidation and insulin resistance in adolescents with fatty hepatosis, a single-stage study was conducted of a sample of 58 adolescents from Arkhangelsk aged 16–17 y. o. who have instrumental signs of fatty hepatosis according to ultrasound diagnostics. The comparison group consisted of 219 adolescents from Arkhangelsk who did not have acute and chronic diseases at the time of the examination. The results of the study showed higher average values of total lipid peroxidation, HOMA index, insulin, glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol and lower high-density lipoprotein cholesterol in the group of adolescents with fatty hepatosis than in the comparison group and the presence of a correlation of the HOMA index with the level of total lipid peroxidation, triglycerides and the presence of dyslipidemia (r = 0.53; 0.44; and 0.31; p < 0.05). Thus, when detecting fatty hepatosis in adolescents during diagnostic and corrective measures, it is necessary to take into account the possibility of formation and interrelation of the following pathogenetic factors of non-alcoholic fatty liver disease: insulin resistance, lipid peroxidation and dyslipidemia.

The relationship between snp-polymorphisms of the leptin gene and the development of fatty liver disease in dairy cows

This article shows the results of studies in the course of which in a comparative aspect the LEP polymorphism was studied in subpopulations of Holstein dairy cattle in cows with fatty hepatosis and in healthy animals. This is the first time such studies are being conducted. In this case, a hepothesis about the relationship of genetic markers, in particular the leptin gene, with the risk of developing and progression of fatty liver disease in a model of dairy cows when determining the frequency of occurrence of genotypes with LEP polymorphisms in groups of animals with hepatosis and healthy animals was studied. The aim of the research was to establish the possible influence of the genotype at the leptin locus (polymorphisms Y7F, A80V, R25C) on the frequency of occurrence of fatty hepatosis in dairy cows. In the course of studies on the A80V, R25C, Y7F loci of the leptin gene, 180 cows were genotyped, where 80 animals were diagnosed with fatty hepatosis and 100 animals were healthy. In the group of healthy Holstein cows, compared with the group of animals with pathology, the RC genotypes (R25C polymorphism) were significantly more frequent, the frequency of the CC genotype (R25C polymorphism), on the contrary, was much higher in the group of animals with fatty hepatosis. Similar trends were noted for another polymorphism (A80V).

The role of endogenous intoxication in pathogenetic mechanisms of heat stress in cattle

The article presents the results of studies to identify the role of endogenous intoxication in the pathogenetic mechanisms of heat stress in cows in a comparative aspect between healthy animals and animals with hepatopathology. The obtained data indicate that in summer period in a farm located on the flat territory of the Krasnodar region the cattle are influenced by the heat stress. The relationship between the state of moderate heat stress in dairy cattle and the dynamics of a number of indicators characterizing the syndrome of endogenous intoxication of their body was revealed. The increase in the concentration of medium mass molecules (MMM) in healthy livestock was almost two times lower than in animals with fatty hepatosis. The obtained results can serve as a rationale for the development of an effective strategy for pharmacological correction of heat stress in cattle.

Clinical efficacy of Heptrong in patients with non-alcoholic liver disease in real clinical practice (pilot study)

The purpose of the study: to assess clinical efficacy, dynamics of liver steatosis, effect on insulin resistance and hypolipidemic, ammonia level, systemic inflammation of the Heptrong in patients with non-alcoholic fatty liver disease (NAFLD) and dyslipidemia with obesity.Materials and methods. The study included 40 patients (23 men), age Me 48 (41–53) years, BMI Me 30.5 (28–34) kg / sqm. Inclusion criterion: presence of fatty hepatosis in ultrasound and the ALT level is more than 1.5 norms. Asthenia (AVS) was detected in 78% of patients, abdominal pain in 65% (hepatomegaly, chronic cholecystitis), flatulence in 26%, dyspepsia in 32%. In 36% of patients there was arterial hypertension, in 54% of cases — insulin resistance, in 72% of cases — dyslipidemia with hypertriglyceridemia. Before therapy, patients had an increase in the level of ALT up to 1.9 norms, AST up to 2.1 norms, GGTP up to 1.8 norms, total bilirubin — 1.4 norms, glycated hemoglobin — 1.2 norms, HOMA index up to 1,3 norms, total cholesterol up to 1.3 norms, triglycerides up to 1.4 norms, CRP up to 1.2 norms and ferritin up to 1.3 norms, combined with an increase in CRP and leukocytes up to 1.2 norms. According to the results of liver FIBROSCAN, hepatic steatosis was detected in all patients, Me CAP 295 (254–343), liver fibrosis was detected in 32% of cases (Me 6.4 (5.4–7.6) kPa). The level of ammonia in the peripheral blood on an empty stomach was Me 72 (42–91) mmol / l (with a norm of up to 54 mmol / l). Heptrong was prescribed in the form of 3 courses of 10 intramuscular injections according to the scheme 3.0 ml-3 ml-6.0 ml-6.0 ml-9.0 ml-9.0 ml-6.0 ml-6.0 ml-3.0 ml-3.0 ml for 3 months.Resaults. After 1 month of Heptrong therapy according to the scheme, there was a significant decrease (p≤0.05 according to the Wilcoxon criterion) in the frequency of AVS, pain and dyspeptic syndrome, the level of bilirubin, ALT, CRP, ferritin, ammonia, GGTP. After 3 courses of therapy, the examined patients showed further regression of clinical syndromes. During examination and communication, a positive trend was noted on the scales of quality of life and level of anxiety. Revealed a decrease in Me ALT by 31% (p <0.05); decrease in AST by 28% (p <0.05); GGTP — by 33% (p <0.05); glycated HB — by 15% (p <0.05); CRP — by 10% (p <0.03) ; ferritin — by 11% (p <0.05), ammonia — by24% (p <0.05); HOMA — index by 15% (p <0.04); total cholesterol — by 12% (p <0.05); triglycerides — by 20% (p <0.05); LDL — by 19% (p <0.05); HDL + 18% (p <0.05); Liver steatosis (dВ / m²) –26% (p <0.05); Liver fibrosis — reduction of 1 stage (Metavir) in 28% of patients. A positive response to therapy correlated (r> 0.3) with the patient’s age, male gender, BMI, Homa index, LDL, CRP, ammonia, ferritin.Conclusions. During the course of treatment with Heptrong, patients with NAFLD experience regression of clinical symptoms, stigma of systemic and local inflammation, correction of metabolic disorders, and improvement in the quality of life.