bluuebunny/crossref_metadata_2025 huggingface dataset:
Percutaneous tibial nerve stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review
Authors: Gaziev Gabriele , Topazio Luca , Iacovelli Valerio , Asimakopoulos Anastasios , Di Santo Angelo , De Nunzio Cosimo , Finazzi-Agrò Enrico
Published: November 2013

Background

Percutaneous Tibial Nerve Stimulation (PTNS) has been proposed for the treatment of overactive bladder syndrome (OAB), non-obstructive urinary retention (NOUR), neurogenic bladder, paediatric voiding dysfunction and chronic pelvic pain/painful bladder syndrome (CPP/PBS). Despite a number of publications produced in the last ten years, the role of PTNS in urinary tract dysfunctions remains unclear. A systematic review of the papers on PTNS has been performed with the aim to better clarify potentialities and limits of this technique in the treatment of OAB syndrome and in other above mentioned urological conditions.

Methods

A literature search using MEDLINE and ISI web was performed. Search terms used were “tibial nerve” and each of the already mentioned conditions, with no time limits. An evaluation of level of evidence for each paper was performed.

Results

PTNS was found to be effective in 37-100% of patients with OAB, in 41-100% of patients with NOUR and in up to 100% of patients with CPP/PBS, children with OAB/dysfunctional voiding and patients with neurogenic pathologies. No major complications have been reported.

Randomized controlled trials are available only for OAB (4 studies) and CPP/PBS (2 studies). Level 1 evidence of PTNS efficacy for OAB is available. Promising results, to be confirmed by randomized controlled studies, have been obtained in the remaining indications considered.

Conclusions

PTNS is an effective and safe option to treat OAB patients. Further studies are needed to assess the role of PTNS in the remaining indications and to evaluate the long term durability of the treatment. Further research is needed to address several unanswered questions about PTNS.
In vitro anti-mycobacterial activity of nine medicinal plants used by ethnic groups in Sonora, Mexico
Authors: Robles-Zepeda Ramón Enrique , Coronado-Aceves Enrique Wenceslao , Velázquez-Contreras Carlos Arturo , Ruiz-Bustos Eduardo , Navarro-Navarro Moisés , Garibay-Escobar Adriana
Published: November 2013

Background

Sonoran ethnic groups (Yaquis, Mayos, Seris, Guarijíos, Pimas, Kikapúes and Pápagos) use mainly herbal based preparations as their first line of medicinal treatment. Among the plants used are those with anti-tuberculosis properties; however, no formal research is available.

Methods

Organic extracts were obtained from nine medicinal plants traditionally used by Sonoran ethnic groups to treat different kinds of diseases; three of them are mainly used to treat tuberculosis. All of the extracts were tested against Mycobacterium tuberculosis H37Rv using the Alamar Blue redox bioassay.

Results

Methanolic extracts from Ambrosia confertiflora, Ambrosia ambrosioides and Guaiacum coulteri showed minimal inhibitory concentration (MIC) values of 200, 790 and 1000 μg/mL, respectively, whereas no effect was observed with the rest of the methanolic extracts at the concentrations tested. Chloroform, dichloromethane, and ethyl acetate extracts from Ambrosia confertiflora showed a MIC of 90, 120 and 160 μg/mL, respectively.

Conclusions

A. confertiflora and A. ambrosioides showed the best anti-mycobacterial activity in vitro. The activity of Guaiacum coulteri is consistent with the traditional use by Sonoran ethnic groups as anti-tuberculosis agent.

For these reasons, it is important to investigate a broader spectrum of medicinal plants in order to find compounds active against Mycobacterium tuberculosis.
Economic benefits of safety-engineered sharp devices in Belgium - a budget impact model
Authors: Hanmore Emma , Maclaine Grant , Garin Fiona , Alonso Alexander , Leroy Nicolas , Ruff Lewis
Published: November 2013

Background

Measures to protect healthcare workers where there is risk of injury or infection from medical sharps became mandatory in the European Union (EU) from May 2013. Our research objective was to estimate the net budget impact of introducing safety-engineered devices (SEDs) for prevention of needlestick injuries (NSIs) in a Belgian hospital.

Methods

A 5-year incidence-based budget impact model was developed from the hospital inpatient perspective, comparing costs and outcomes with SEDs and prior-used conventional (non-safety) devices. The model accounts for device acquisition costs and costs of NSI management in 4 areas of application where SEDs are currently used: blood collection, infusion, injection and diabetes insulin administration. Model input data were sourced from the Institut National d’Assurance Maladie-Invalidité, published studies, clinical guidelines and market research. Costs are discounted at 3%.

Results

For a 420-bed hospital, 100% substitution of conventional devices by SEDs is estimated to decrease the cumulative 5-year incidence of NSIs from 310 to 75, and those associated with exposure to blood-borne viral diseases from 60 to 15. Cost savings from managing fewer NSIs more than offset increased device acquisition costs, yielding estimated 5-year overall savings of €51,710. The direction of these results is robust to a range of sensitivity and model scenario analyses. The model was most sensitive to variation in the acquisition costs of SEDs, rates of NSI associated with conventional devices, and the acquisition costs of conventional devices.

Conclusions

NSIs are a significant potential risk with the use of sharp devices. The incidence of NSIs and the costs associated with their management can be reduced through the adoption of safer work practices, including investment in SEDs. For a Belgian hospital, the budget impact model reports that the incremental acquisition costs of SEDs are offset by the savings from fewer NSIs. The availability of more robust data for NSI reduction rates, and broadening the scope of the model to include ancillary measures for hospital conversion to SED usage, outpatient and paramedic device use, and transmission of other blood-borne diseases, would strengthen the model.
Fixed points of multivalued mappings in partial metric spaces
Authors: Ahmad Jamshaid , Azam Akbar , Arshad Muhammad
Published: November 2013

We use the notion of Hausdorff metric on the family of closed bounded subsets of a partial metric space and establish a common fixed point theorem of a pair of multivalued mappings satisfying Mizoguchi and Takahashi’s contractive condition. Our result extends some well-known recent results in the literature.

MSC:46S40, 47H10, 54H25.
New insights of aquaporin 5 in the pathogenesis of high altitude pulmonary edema
Authors: She Jun , Bi Jing , Tong Lin , Song Yuanlin , Bai Chunxue
Published: November 2013

Background

High altitude pulmonary edema (HAPE) affects individuals and is characterized by alveolar flooding with protein-rich edema as a consequence of blood-gas barrier disruption. In this study, we hypothesized that aquaporin 5 (AQP5) which is one kind of water channels may play a role in preservation of alveolar epithelial barrier integrity in high altitude pulmonary edema (HAPE).

Methods

Therefore, we established a model in Wildtype mice and AQP5 −/− mice were assingned to normoxic rest (NR), hypoxic rest (HR) and hypoxic exercise (HE) group. Mice were produced by training to walk at treadmill for exercising and chamber pressure was reduced to simulate climbing an altitude of 5000 m for 48 hours. Studies using BAL in HAPE mice to demonstrated that edema is caused leakage of albumin proteins and red cells across the alveolarcapillary barrier in the absence of any evidence of inflammation.

Results

In this study, the Lung wet/dry weight ratio and broncholalveolar lavage protein concentrations were slightly increased in HE AQP5 −/− mice compared to wildtype mice. And histologic evidence of hemorrhagic pulmonary edema was distinctly shown in HE group. The lung Evan’s blue permeability of HE group was showed slightly increased compare to the wildtype groups, and HR group was showed a medium situation from normal to HAPE development compared with NR and HE group.

Conclusions

Deletion of AQP5 slightly increased lung edema and lung injury compared to wildtype mice during HAPE development, which suggested that the AQP5 plays an important role in HAPE formation induced by high altitude simulation.
Immune response profiling in early rheumatoid arthritis: discovery of a novel interaction of treatment response with viral immunity
Authors: Davis John M , Knutson Keith L , Strausbauch Michael A , Green Abigail B , Crowson Cynthia S , Therneau Terry M , Matteson Eric L , Gabriel Sherine E
Published: November 2013

Introduction

It remains challenging to predict the outcomes of therapy in patients with rheumatoid arthritis (RA). The objective of this study was to identify immune response signatures that correlate with clinical treatment outcomes in patients with RA.

Methods

A cohort of 71 consecutive patients with early RA starting treatment with disease-modifying antirheumatic drugs (DMARDs) was recruited. Disease activity at baseline and after 21 to 24 weeks of follow-up was measured using the Disease Activity Score in 28 joints (DAS28). Immune response profiling was performed by analyzing multi-cytokine production from peripheral blood cells following incubation with a panel of stimuli, including a mixture of human cytomegalovirus (CMV) and Epstein-Barr virus (EBV) lysates. Profiles identified via principal components analysis (PCA) for each stimulus were then correlated with the ΔDAS28 from baseline to follow-up. A clinically meaningful improvement in the DAS28 was defined as a decrease of ≥1.2.

Results

A profile of T-cell cytokines (IL-13, IL-4, IL-5, IL-2, IL-12, and IFN-γ) produced in response to CMV/EBV was found to correlate with the ΔDAS28 from baseline to follow-up. At baseline, a higher magnitude of the CMV/EBV immune response profile predicted inadequate DAS28 improvement (mean PCA-1 scores: 65.6 versus 50.2; P = 0.029). The baseline CMV/EBV response was particularly driven by IFN-γ (P = 0.039) and IL-4 (P = 0.027). Among patients who attained clinically meaningful DAS28 improvement, the CMV/EBV PCA-1 score increased from baseline to follow-up (mean +11.6, SD 25.5), whereas among patients who responded inadequately to DMARD therapy, the CMV/EBV PCA-1 score decreased (mean -12.8, SD 25.4; P = 0.002). Irrespective of the ΔDAS28, methotrexate use was associated with up-regulation of the CMV/EBV response. The CMV/EBV profile was associated with positive CMV IgG (P <0.001), but not EBV IgG (P = 0.32), suggesting this response was related to CMV exposure.

Conclusions

A profile of T-cell immunity associated with CMV exposure influences the clinical response to DMARD therapy in patients with early RA. Because CMV latency is associated with greater joint destruction, our findings suggest that changes in T-cell immunity mediated by viral persistence may affect treatment response and possibly long-term outcomes of RA.
Eco-physiological adaptation of dominant tree species at two contrasting karst habitats in southwestern China
Authors: Zhang Shouren , Fan Dayong , Wu Qian , Yan Hui , Xu Xinwu
Published: November 2013

The purpose of this study was to investigate the eco-physiological adaptation of indigenous woody species to their habitats in karst areas of southwestern China. Two contrasting forest habitats were studied: a degraded habitat in Daxiagu and a well-developed habitat in Tianlongshan, and the eco-physiological characteristics of the trees were measured for three growth seasons. Photosynthetic rate (Pn), stomatal conductance (gs), and transpiration rate (Tr) of the tree species in Daxiagu were 2-3 times higher than those in Tianlongshan under ambient conditions. However, this habitat effect was not significant when measurements were taken under controlled conditions. Under controlled conditions, Pn, gs, and Tr of the deciduous species were markedly higher than those for the evergreen species. Habitat had no significant effect on water use efficiency (WUE) or photochemical characteristics of PSII. The stomatal sensitivity of woody species in the degraded habitat was much higher than that in the well-developed habitat. Similarly, the leaf total nitrogen (N) and phosphorus (P) contents expressed on the basis of either dry mass or leaf area were also much higher in Daxiagu than they were in Tianlongshan. The mass-based leaf total N content of deciduous species was much higher than that of evergreen species, while leaf area-based total N and P contents of evergreens were significantly higher than those of deciduous species. The photosynthetic nitrogen- and phosphorus-use efficiencies (PNUE and PPUE) of deciduous species were much higher than those of evergreens. Further, the PPUE of the woody species in Tianlongshan was much higher than that  of the woody species in Daxiagu.

The results from three growth seasons imply that the tree species were able to adapt well to their growth habitats. Furthermore, it seems that so-called “temporary drought stress” may not occur, or may not be severe for most woody plants in karst areas of southwestern China.
Rethinking depoliticisation: beyond the governmental
Authors: Wood Matt , Flinders Matthew
Published: November 2013

Stagnating political participation, the growth of delegated agencies and the prevalence of rationalistic-technocratic discourse all represent interlinking aspects of what can been termed ‘the depoliticised polity’. Existing research has overwhelmingly focused on institutional or governmental depoliticisation strategies and fails to acknowledge repoliticisation as a critical counter-trend. This article argues that these weaknesses can be addressed through ‘a three faces’ approach that embraces societal and discursive depoliticisation strategies as complementary statecraft dynamics that often underpin more tangible governmental strategies. By revealing the existence of multiple forms of depoliticisation this approach also offers new insights in terms of politicisation and sociopolitical change.
Why do people live apart together?
Authors: Duncan Simon , Carter Julia , Phillips Miranda , Roseneil Sasha , Stoilova Mariya
Published: November 2013

Interpretations of living apart together (LAT) have typically counter-posed ‘new family form’ versus ‘continuist’ perspectives. Recent surveys, however, construct LAT as a heterogeneous category that supports a ‘qualified continuist’ position – most people live apart as a response to practical circumstances or as a modern version of ‘boy/girlfriend’, although a minority represents something new in preferring to live apart more permanently. This article interrogates this conclusion by examining in depth why people live apart together, using a nationally representative survey from Britain and interview accounts from 2011. Our analysis shows that LAT as a category contains different sorts of relationship, with different needs and desires. While overall coupledom remains pivotal and cohabitation remains the goal for most, LAT allows people flexibility and room to manoeuvre in adapting couple intimacy to the demands of contemporary life. Hence, we suggest, LAT is both ‘new’ and a ‘continuation’.
Therapeutic efficiency of trimetazide MR in patients with type 2 diabetes mellitus after myocardial infarction
Authors: Novitskaya E E , Baryshnikova G A
Published: November 2013

Aim. To evaluate efficiency of trimetazide MR combined with basic therapy of type 2 diabetes mellitus (DM2) in patients with myocardial infarction (MI). Materials and methods. The study included 106 patients with DM2 who underwent MI. Polycomponent basic therapy supplemented by trimetazideMR at a daily dose of 70 mg was given to 51 patients. The patients condition 6 and 12 months after treatment was evaluated from the results of echo-CG, 24 hr ECG monitoring, and 6 min walking test. Quality of life was estimated using modified Minnesota questionnaire scores. Results. Trimetazide MR combined with polycomponent basic therapy reduced consumption of nitroglycerine by DM2 patients after myocardial infarction,frequency of ventricular and supraventricular extrasystole in 25.3 and 25.3% of the cases respectively. Episodes of painless myocardial ischemiaoccurred only in 35.6% of the patients. Long-term treatment with trimetazide MR as a component of combined therapy increased injectionfraction in patients with abnormal myocardial contractility (p
Clinical features and differential diagnosis of type 2 diabetes mellitus in children
Authors: Kuraeva Tamara Leonidovna , Dubinina I A
Published: November 2013

This review was designed to evaluate prevalence, specific clinical features, and differential diagnosis of type 2 diabetes mellitus (DM2) in childrenand adolescents. Special emphasis is laid on the importance of immunological and molecular-genetic studies for the verification of diagnosis and activecase detection in h groups.
Evaluation of the degree of metabolic compensation and prevalence of diabetic complications in a Russian population of childrenand adolescents (results of the ?Screening for diabetic complications and assessment of medical aid to diabetic patients? Project)
Authors: Andrianova Ekaterina Andreevna , Aleksandrova Irina Ivanovna , Shiryaeva Tatiana Yur'evna , Suntsov Yury Ivanovich
Published: November 2013

Aim. To analyse the degree of compensation of disturbed carbohydrate metabolism and to evaluate its effect on the prevalence of diabetic complicationsin children and adolescents from 20 regions of RF. Materials and methods. A total of 2984 patients with DM1 were examined in 2002-2005 including 1532 children below 14 yr and 1452 adolescentsof 15-17 yr. The patients were selected from regional DM registries by the random number method. Results. Mean HbA1с was 9,77?2,30%. The number of children with compensated carbohydrate metabolism at the time of screening was significantlyhigher than that of adolescents (21,1 and 15,1% respectively, p
Insulin pump therapy of type 1 diabetes mellitus in children and adolescents in the Moscow region
Authors: Petryaykina Elena Efimovna , Dukhareva Olga Viktorovna , Rybkina Irina Georgievna , Pronina Ekaterina Alexandrovna , Mikhaylova Tatiana Dmitrievna , Garyaeva Irina Viktorovna , Mandzhieva Eleonora Tavanovna , Volkov Igor Eduardovich , Grenkova Natalya Mikhailovna
Published: November 2013

Aim. To assess dynamics of glycated hemoglobin levels and insulin doses per kg bw in children and adolescents with poorly controlled type 1 diabetes mellitus using insulin pumps. Materials and methods. Retrospective analysis of HbA1c levels and insulin doses per kg bw in children aged 2-17 years with DM1 (mean duration 5.3?3.1) before and 18 months after onset of insulin pump therapy (Medtronic Minimed 712 and 722) with a short-acting insulin analog Novopramid (Novo Nordisk) or Humalog (Ely Lilly) given to 55 (52,4%) and 50 (47,6%) of the patients respectively. НbА1с level and mean daily insulin dose per kg bw were determined when a patient visited the doctors office every 3 months. Results. Insulin pump therapy in patients with initially poorly controlled DM1 resulted in a decrease of HbA1c from 9.8?0.8 to 7,8?0,5% within 18 months after its beginning (p
Ketosis-prone type 2 diabetes mellitus (review of the literature)
Authors: Molitvoslovova, Natalya Alexandrovna , Nikonova Tatiana Vasil'evna
Published: November 2013

Idiopathic ketosis-prone type 2 diabetes is intermediate between two major forms of diabetes mellitus. The aim of this review is to analyse factors contributingto its development and occurrence and to discuss approaches to differential diagnosis of this pathology.
Vascular endothelial growth factor in the fluid of the anterior chamber of the eye in patients with diabetic retinopathy, cataract andneovascular glaucoma
Authors: Kuz'min Anatoliy Gennad'evich , Lipatov Dmitriy Valentinovich , Chistyakov Timofey Alexandrovich , Smirnova Olga Mikhailovna , Arbuzova Margarita Ivanovna , Il'in Alexander Viktorovich , Shestakova Marina Vladimirovna
Published: November 2013

Aim. To study the role of vascular endothelial growth factor (VEGF-A) in the fluid of the anterior chamber of the eye (ACE) in the evolvement ofdiabetic retinopathy (DR) and the outcome of cataract surgery. Materials and methods. The study included 120 patients with diabetes mellitus (DM) operated for the removal of cataract. 16 patients received treatmentfor DR-related neovascular glaucoma (NG). The control group comprised 22 subjects without DM. VEGF-A and glucose levels were measuredin the ACE fluid prior to surgery. Results. Patients with DM were not significantly different in terms of VEGF-A, fasting glucose, and HbA1c levels on the day of surgery excepting DMpatients without DR. VEGF-A and glucose levels in AEG increased in proportion to DR severity. VEGF-A concentration was minimal in the absenceof DR (22.75 pg/ml [10.78; 63.36]) and amounted to 336.6 pg/ml [232.3; 410.74] in patients with DM and DR (P
Metformin and cancer mortality
Authors: Bershteyn Lev Mikhaylovich
Published: November 2013

The author analyses recent publications supporting the ability of metformin to decrease the risk of cancer morbidity and mortality in patients with type 2diabetes mellitus. Pre-history of the problem (including the use of biguanides for metabolic rehabilitation of oncological patients), the role of DM as a riskfactor of cancer morbidity and mortality, mechanisms and targets of metformin anticancer effects, and potential use of this agent in non-diabetic patientsare discussed. The need for the search of the markers of sensitivity and resistance to metformin to be used in oncological practice is emphasized.
Statin use and risk of diabetes mellitus
Authors: Drapkina Oksana Mikhailovna , Kostyukevich Marina Viktorovna
Published: November 2013

At present time four groups of medications are used to correct dyslipidemia: bile acid sequestrants, niacin, fibric acid derivatives andstatins. During last years statins' potential to increase risk of type 2 diabetes mellitus (T2DM) is actively discussed, though no commonopinion about the possible mechanism of such effect has evolved as yet. Insulin desensitizing effect as a class feature of statins remainsa disputable question.Position of statins as a first-line therapy for severe hyperlipidemia seems undoubted; however they do not improve insulin sensitivity.Moreover, several studies reported increased risk of T2DM. It is feasible to consider combined treatment (including metformin) inpatients from risk groups for development of T2DM, receiving statins
Diabetes mellitus and other pathology in patients with INS and INSR mutations
Authors: Pankov Yury Alexandrovich
Published: November 2013

Over 20 missense mutations and Y108X nonsense mutation in INS are dominant and induce synthesis of chimeric proteins that may interfere with folding and processing of all insulin molecules. In heterozygous state they cause insulin deficiency and PND. Over 10 recessive mutations and the p.Q62X nonsense mutation of INS do not induce synthesis of anomalous protein, being associated with PND only in homozygous state. Most of significant mutations that induce insulin resistance, lipodystrophy, and other pathology were found in INSR gene. Lipodistrophy suggests an important role of insulin in stimulating fat accumulation and controlling lipid consumption in energy metabolosm.
Prospects of antigen-specific therapy in type 1 diabetes mellitus
Authors: Nikonova Tatiana Vasil'evna , Alekseeva Yulia Viktorovna
Published: November 2013

Type 1 diabetes mellitus is commonly recognized as an autoimmune disease characterized by progressive destruction of pancreatic ?-beta-cells. Progress in diagnostics at preclinical stage is accompanied with active development of preventive measures. So far, there are no specific therapeutic agents approved for clinical practice. However, ongoing large-scale studies have outlined some promising solutions, antigen-specific immunotherapy being one of them.
Prognostic significance of proinflammatory factors in patients with progressive angina pectoris and type 2 diabetes mellitus
Authors: Barbarash Olga Leonidovna , Sumin Aleksey Nikolaevich , Avramenko Olesya Evgen'evna , Osokina Anastasia Vyacheslavovna , Veremeev Aleksey Vladimirovich
Published: November 2013

Aims. Our study was aimed to assess the influence of non-specific inflammation and endothelial dysfunction on developmentof cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and progressive angina pectoris. Materials and methods. 140 patients (63 of them were also diabetic) received follow-up for cardiovascular events during12 months after an episode of unstable angina pectoris. Upon hospitalization for acute coronary syndrome analyses wereperformed to assess the degree of systemic inflammation evaluating plasma concentration of pro- and anti-inflammatorymarkers (CRP, fibrinogen, IL-6, -8, -10, TNF-?), as well as blood glucose and glycated haemoglobin HbA1c. Results. TNF-? and IL-6 levels were significantly higher in patients with unfavorable prognosis (p
Diabetes mellitus type 2: a new indication for hypercortisolism screening?
Authors: Volkova Natalya Ivanovna , Antonenko Maria Igorevna , Ganenko Liliya Alexandrovna
Published: November 2013

Current review discusses novel data concerning prevalence of Cushing syndrome without characteristic clinical signs among patients with type 2 diabetes mellitus. We also provide detailed analysis of difficulties in diagnostics and management of this condition
The early use of insulin in type 2 diabetes
Authors: LEVY PHILIP
Published: November 2013

60?70% of all patients with Type 2 Diabetes Mellitus will ultimately require insulin therapy for the management of their diabetes. Irisulin may be used alone, or in combination with oral agents. The early use of insulin can be very important in decreasing the incidence of micro-vascular complications and in helping to delay the onset of macro-vascular complications. The United Kingdom Prospective Diabetes Study and the Kumamoto Study have shown the beneficial effects of good glucose control in type 2 diabetes mellitus. The DECODE study has related overall mortality to the level of glucose control and specifically to the postprandial glucose. The American Association of Clinical Endocrinologists has established a goal of 6.5% or less for HgbAlc. The appropriate use of insulin will allow us to achieve this goal without causing the patient any undue harm. There are many barriers to insulin therapy including psychological barriers of both the patient and the doctor, and unrealistic fears of both insulin therapy and therapy with self-administered injections. These barriers will be discussed as well as methods to overcome them. Insulin therapy is beneficial and has no long term adverse effects. The incidence of severe hypoglycemia is extremely low in type 2 diabetes. Weight gain is minimal. Insulin therapy by reducing glucose toxicity may also increase the effectiveness of oral anti-hyperglycemic agents. The physician taking care of patients with diabetes should be aggressive and should have no fears of initiating insulin therapy. Insulin dosage is flexible and good control is possible in most patients. The most common use of insulin in type 2 diabetes is as an add-on to oral agents if control with oral agents alone is unsatisfactory. Frequently this involves the use of a single dose of intermediate or long acting insulin or an insulin mixture in the evening. If control is not attained with a single dose, then the patient can be placed on an insulin mixture 2 or 3 times a day. An alternative would be a short acting insulin analogue prior to each meal with a longer acting insulin given 1 or 2 times a day. Titration schedules for insulin dosing will be presented. Insulin available in Russia will be listed along with some guidelines on using these insulins. Increasing the use of insulin and starting insulin earlier in type 2 diabetes will lead to better control of diabetes, increased patient compliance, and decreased long-term complications of diabetes mellitus.
Preclinical diagnosis of diabetic nephropathy in children and adolescents with type 1 diabetes
Authors: Anikeeva Tatiana Petrovna , Volchanskiy Evgeny Ignat'evich
Published: November 2013

Aim. To evaluate the diagnostic and prognostic value of hemodynamic characteristics and endothelial function (EF), viz. endothelium-dependent vasodilation (EDVD) and vasoconstriction (EDVC), during development of diabetic nephropathy (DN). Materials and methods. A total of 155 children and adolescents aged 9-17 years (residents of Volgograd) with type 1 diabetes mellitus (DM1) from 1 to 14 years in duration were examined at the Endocrinological Department of the Regional Childrens Clinical Hospital. The patients were divided into 3 groups depending on DM1 duration. EF and arteriolar tone (AT) were determined by the rheovasographic method. AT was calculated from vascular distension by a pulse wave based on tetrapolar rheovasography of the shoulder and its first derivative. Rheograms were registered using the Valenta software-hardware system. EF was evaluated in a reactive (working) hyperemia test with occlusion of blood vessels in the arm for 4 min followed by decompression; these procedures resulted in an abrupt acceleration of blood flow and endothelium response to shear stress by EDVD. EDVC was determined by occlusion of blood flow in the wrist area that caused its steady decline in the brachial artery and a decrease of its diameter suggesting enhanced vascular tone. Rheovasography was performed during occlusion. Results. Children with DM1 showed enhanced EDVC and impaired EDVD diagnosed before manifestation of microalbuminurea (MAU) characteristic of early DM1. Conclusion. Changes of EF determined from AT, EDVD and EDVC in children with DM1 before manifestation of microalbuminurea make it possible to identify patients at risk of vascular complications.
Lypohypertrophy in patients receiving insulin therapy: state of the art
Authors: Volkova Natalya Ivanovna , Davidenko Il'ya Yur'evich
Published: November 2013

As known insulin therapy is associated with induration of subcutaneous fat at injections sites called lypohypertrophy. It develops at any age and at anysite regardless of duration of the treatment. The size of lypohypertrophy varies in a wide range. Numerous studies have been conducted to elucidatemechanisms of lypohypertrophy (LH) and its risk factors including young age, low or high body mass index, frequency of the change of needles andinjection sites, female gender, and type 1 diabetes mellitus. It was shown that insulin crystals induce a local immune reaction and thereby interfere withadipocyte differentiation. At the same time, patients with LH have elevated titters of anti-insulin antibodies. The problem with LH is uncontrollableabsorption of insulin from injection sites. We noticed that patients with a target glucose level due to insulin therapy undergo its apparently causelessperiodic rises. Comparative ultrasonic examination of subcutaneous fat at different injection sites and control body areas revealed specific pathologicalchanges in adipose issue. This finding provided a basis for the hypothesis that LH can be detected by ultrasonography of subcutaneous fat. It wasconfirmed by the results of examination of 50 patients with DM1 treated with insulin of whom 41 were found to have pathological changes at injectionsites.
Experience of the use of liraglutide (Victoza) in women with type 2 diabetes mellitus and obesity
Authors: Kudinov Vladimir Ivanovich , Zolotareva Natalya Vladimirovna , Nichitenko Maria Sergeeva
Published: November 2013

Aim. To study efficacy of treatment with liraglutide in women with type 2 diabetes (T2D) and obesity. Materials and methods. A group of 12 women aged 52-58 yr with T2D duration of 3-5 years, BMI 32-35 kg/m2, abnormally high C-peptide level,and НbА1с 7.5-8.5% were treated with 1500-2000 mg metformin/day and sulfonylureas at 50% of the maximum dose. Liraglutide was given insteadof sulfonylureas by a standard method (0.6 U/day for 1 week subcutaneously and 1.2 U/day thereafter). The total duration of therapy was 3 months.We analysed blood glucose level before and 2 hr after meals, НbА1с, lipidogram, C-peptide, HOMA index, BMI, waist circumference, percent of totalfat in the body, frequency of hypoglycemia, and side effects (nausea). Results. All patients achieved target values of НbА1с and a significant decrease in blood glucose before and after meals, body weight, total fat content,BMI, HOMA, systolic blood pressure; HDL cholesterol increased while LDL decreased. No case of hypoglycemia was documented. All the patientshad mild nausea of short duration (2-3 days). Conclusion. The use of liraglutide (Victoza) in women with T2D and obesity improve carbohydrate metabolism and insulin resistance without seriousside effects.
Clinico-expert diagnostics of gastrointestinal form of diabetic neuropathy
Authors: Kurnikova Irina Alekseevna , Chernyshova Tatiana Evgen'evna , Gur'eva Irina Vladimirovna , Kliment'eva Guzyal' Ilgisovna
Published: November 2013

Aim. To estimate dynamics of secretory and motor-evacuational functions of the stomach in patients with type 1 diabetes mellitus and gastrointestinalform of diabetic neuropathy. Materials and methods. 32 patients with DM1 without gastrointestinal pathology allocated to different groups depending on DM duration (gr. 1 lessthan 10 yr, gr. 2 over 10 yr). Vegetative equilibrium was estimated from the Kerdo index, rehabilitative potential from its basic constituent (morphophysiologicalindex). The motor-evacuational function of the stomach was studied with the use of a scintillation gamma-chamber, the gastric secretoryfunction by pH measurements. Results. Half of the patients in gr 2 presented with hypersympathicotony. The frequency of hypertonic form of gastric tone increased with durationof DM while the acid-producing and evacuational functions of the stomach decreased (as estimated by pH-measurement and gastroscintiographyrespectively). The propulsive function most significantly decreased in the pyloric part. The efficacy of rehabilitation of diabetic patients with gastrointestinalform of diabetic neuropathy was much lower than in those with preserved vegetative function of the stomach. Conclusion. Impairment of evacuational function of the stomach and duodenum with DM1 duration may be a cause of unstable blood glucose level.Hypomotor dyskinesia of the upper gastrointestinal tract due to DM1 and deficit of parasympathetic innervation occurs more frequently in patientswith low rehabilitative potential. Functional changes in the gastrointestinal tract of DM1 patients do not depend on the quality of compensation ofmetabolic disorders but correlate (r=-0.39) with DM duration. It is concluded that the gastrointestinal form of diabetic neuropathy impairs rehabilitativepotential of fhe patients.
Diabetes mellitus due to biliary recurrent pancreatitis. Case report
Authors: Kharlashina Elena Alexandrovna , Kononenko Irina Vladimirovna , Smirnova Olga Mikhailovna , Mayorov Alexander Yur'evich
Published: November 2013

The majority of diabetes cases are referred to two pathogenetic forms, DM1 and DM2. Other variants are much rarer. One of them is DM resultingfrom disturbances in the pancreatic exocrine apparatus, e.g. pancreatitis, underlain by a different pathogenetic mechanism. A case of diabetes mellitusassociated with biliary recurrent pancreatitis is described. The importance of comprehensive examination of such patients and their specific treatmentis emphasized
Mechanisms of adaptive immunity (exemplified by type 1 diabetes mellitus)
Authors: Repina Ekaterina Alexandrovna
Published: November 2013

This review was designed to evaluate mechanisms of adaptive immunity in DM1. Special attention is devoted to such immunological concepts as antigen,long-term immunological memory, central and peripheral tolerance. Current views of the role of interleukins in DM1 are discussed.
Evaluation of effectiveness of different modes of per os therapy of painful diabetic peripheral polyneuropathy with alpha-lipoic acid
Authors: Khramilin Vladimir Nikolaevich , Demidova Irina Yur'evna , Ignatova Olga Yur'evna
Published: November 2013

Aim. To evaluate effectiveness of different modes of per os therapy of painful diabetic peripheral polyneuropathy with alpha-lipoic acid. Materials and methods. This work is a prospective open randomized comparative clinical study including 4 parallel groups of patients. Group 1(n=31) comprised patients given 600 mg ALA daily (two 300 mg tablets at a time), group 2 (n=28) 600 mg ALA daily (two 300 mg tablets in succession),group 3 (n=35) 900 mg ALA daily (three 300 mg tablets at a time in the morning), group 4 (n=27) 900 mg ALA daily (three 300 mg tablets in succession30-40 min before meals). Active treatment lasted 3 months. Results. Beneficial effect of 3 ALA tablets on neurologic symptoms estimated by NTSS-6 and 9 scales was significantly more pronounced than that oftwo 300 mg tablets taken either once or twice a day. The groups were analysed in terms of the number of patients who achieved or failed to achievethe end point of therapy (responders, n=86 and non-responders, n=29). The HbA1c level and the degree of sensory deficit were shown to begood predictors of therapeutic efficiency. There was moderate correlation between HbA1c level (>8%), NIS LL and NIS LL-sensory function points,and frequency of response to ALA therapy (r=0.251; p=0.007 // r=0.32; p=0.00077 // r=0.32; p=0.0015 respectively). Patients having HbA1c8.0%) and severedisturbances of sensory function (e.g. monofilament resistance) may be used as predictors of therapeutic efficiency.
Efficacious and safe management of type 2 diabetes mellitus using DPP-4 inhibitors
Authors: Ametov Alexander Sergeevich , Karpova Ekaterina Vladimirovna
Published: November 2013

Diabetes mellitus (DM) is believed to be the third most frequent direct cause of death after cardiovascular and oncological diseases. Therefore, solutionof DM-related problems is a major challenge facing health authorities in many countries. No doubt, strict control of glycemia is an indispensablecondition for the reduction of the frequency of diabetic complications. Indeed, many strategies developed in the recent years allowed metabolic controlin DM patients to be significantly improved. Basic and clinical research of the last decade provided a basis for the development of highly promisingtrends in the treatment of CD2, such as the use of incretins. Inhibitors of dipeptylpeptidase-4 (DPP-4) including Galvus (vildagliptin) and GalvusMet (vildagliptin + metformin) have been available in this country for the last 2 years. International studies showed high efficiency and safety of bothagents. They help to achieve adequate glycemic control in the absence of side effects and complications. Galvus significantly reduces daily variabilityof glycemia that is known to be a risk factor of severe vascular complications of DM. Another advantage of these drugs is they can be used by agedpatients at risk of cardiovascular disorders suffering hypertension. An example of combined therapy using Galvus Met in a DM2 patient is presenteddemonstrating markedly improved glycemic control, blood glucose dynamics, and quality of life. Galvus and Galvus Met can be prescribed as aninitial treatment in combination with all traditional oral hypoglycemic agents and insulin.
Immunity status of patients with type 1 and 2 diabetes mellitus and pyelonephritis
Authors: Chakryan Sergey Arutyunovich , Timerbulatov Vil' Mamilovich , Morugova Tatiana Vyacheslavovna , Alibaeva Gul'nara Fatikhovna
Published: November 2013

Aim. To elucidate changes in the immunity status of patients with type 1 and 2 diabetes mellitus (DM) and pyelonephritis (PN). Materials and methods. The study included 48 patients with type 1 and 2 diabetes mellitus and acute pyelonephritis and 15 ones with pyelonephritiswithout DM. Bacteriological study of urine in the acute phase of the disease was supplemented by evaluation of phagocytic activity, NBT test, measurementof circulating immune complexes, T and B-lymphocyte populations and subpopulations (CD3, CD4, CD8, CD16, CD19, CD95), HLA-DR,determination of lymphocyte immunoregulatory index and serum IgA, G, M, E levels. All patients were given identical antibacterial, anti-inflammatory,and detoxication treatment. Results. Patients with DM and PN suffered more pronounced disturbances of phagocytosis, humoral and cellular immunity than those with PN withoutDM. Immunity changes in DM1 and DM2 patients were similar, but the former had smaller phagocytic reserve and lower CD8, CD19, IgM, and IgElevels than the latter. Immunity status in DM1 and DM2 patients with PN was related to the duration of diabetes. Conclusion. Greater changes in the immune system of DM (especially DM1) patients with PN account for the enhanced frequency of upper urinarytract diseases.
The role of phenofibrate in the treatment of microvascular complications of type 2 diabetes mellitus
Authors: Koshel' Larisa Viktorovna , Romantsova Tatiana Ivanovna
Published: November 2013

Results of numerous studies give definitive evidence that phenofibrate affects activity of PPAR-a receptors in liver and thereby decreases the level oflipids responsible for the development of atherosclerosis (VLDL, small dense LDL); simultaneously, it increases the level of anti-atherogenic HDL.Activation of PPAR-a receptors in vascular cells decreases activity of inflammation markers, such as C-reactive protein, TNF-a, IL-6, fibrinogen,etc. These effects of phenofibrate eventually lead to reduced risk of macro- and microvascular diabetic complications.
Treatment of DM2 to-day. Should we change priorities? Conclusions based on recent clinical studies
Authors: Zilov Aleksey Vadimovich
Published: November 2013

This work is devoted to the analysis of results of recent clinical studies. It is argued that the absence of close association between normalized glycemiaand reduced incidence of cardiovascular disorders may be due to both relatively short duration of observations and possible effect of co-factors (e.g. hypoglycemia/drug interaction, etc.). Some results suggest the necessity of multifactor approach to the treatment of DM2 especially for the reductionof cardiovascular mortality or prevention of vascular catastrophes. Sulphonylurea derivatives are regarded as putative risk factors of hypoglycemiaor vascular disorders. A number of publications are reviewed in which glibenclamide was shown to be safe in terms of risk of myocardial infarction.
Actual ambulatory care in patients with type 2 diabetes mellitus in Russian Federation according to open label prospectiveobservational study DIA-CONTROL
Authors: Shestakova Marina Vladimirovna
Published: November 2013

This review presents a comprehensive analysis of actual ambulatory care in patients with type 2 diabetes mellitus provided in 10 federal subjects withinthe period of 1 year. The analysis is based on results from non-interventional open label prospective observational study DIA-CONTROL, whichincluded 9844 patients with DM type 2. The study was aimed to assess the initial level of glycated hemoglobin and its further dynamics according tomeasurements repeated every 3 months. Composition and efficiency of hypoglycemic therapy were also estimated in these patients.Inclusion visit showed 38.5% of patients to have adequate HbA1c levels (8%, which is quite disturbing and suggests a more careful approach to instruction of healthcarespecialists.
Alpha-lipoic acid in non-proliferative diabetic retinopathy treatment
Authors: Demidova Tatiana Yul'evna , Trakhtenberg Yulia Alexandrovna
Published: November 2013

Aim. The aim of this study is to assess the therapeutic efficacy of alpha-lipoic acid in patients with type 2 diabetes mellitus (DM) and non-proliferativediabetic retinopathy. Materials and methods. 47 patients with mild to moderate non-proliferative diabetic retinopathy were included in this trial. Dynamics of ophthalmologicparameters were assessed by means of stereoscopic photography of ocular fundus. Patients were examined every 6 months in order to registernew cases of clinically significant macular oedema. Results. During 24 months follow-up period, patients treated with 600 mg of alpha-lipoic acid showed stabilization in development of diabetic retinopathy.New cases of macular oedema, as well as transition into a more severe stage of retonopathy were less common in those patients. Vision andcontrast sensation also remained stable in the majority of participants from experimental group.Conclusions. 600 mg of alpha-lipoic acid may be recommended for patients with type 2 DM as part of complex therapy
ACE inhibitors as a risk factor for hypoglycemia
Authors: Aleksandrov Andrey Alexeevich , Kukharenko Svetlana Semenovna , Kulieva Maria Nikolaevna , Shatskaya Olesya Mikhailovna , Shatskaya Olga Alexandrovna , Mart'yanova Irina Ivanovna , Drozdova Elena Nikolaevna , Kudryashova Alexandra Leonidovna
Published: November 2013

It is known that hypoglycemia is associated with an increased risk of cardiovascular adverse events including death. ACE-inhibitors, when taken withantidiabetic drugs, can cause hypoglycemic episodes by improving insulin sensitivity. This clinical case illustrates the necessity to monitor plasmaglucose in the early phase of the treatment by the ACE-inhibitors in diabetic patients.
Modern antihyperglycemic agents prescribed in Russia for type 2 diabetes mellitus
Authors: Suntsov Yury Ivanovich
Published: November 2013

Aims. To conduct an analysis of modern antihyperglycemic prescription patterns in type 2 diabetes mellitus (T2DM). Materials and methods. Russian DM State registry was studied. Results. We obtained absolute and comparative data on use of insulin analogues, dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 agonists in treatment of T2DM. Conclusion. Percentage of DPP-4 inhibitors and GLP-1 analogues in T2DM treatment patterns remains nominal and does not exceed0.2%, which is significantly lower than in the majority of other countries. Insulin analogues are prescribed considerably more frequentlyand currently appear to be the most promising agents for treatment of T2DM.
Polymorphic gene markers ILRA and IL2: population distinctions in association with diabetes mellitus
Authors: Kopylova Olga Igorevna , Kuraeva Tamara Leonidovna , Lavrikova Elena Yur'evna , Titovich Elena Vital'evna , Nikitin Aleksey Georgievich , Peterkova Valentina Alexandrovna , Nosikov Valery Vyacheslavovich , Dedov Ivan Ivanovich
Published: November 2013

AIMS: In order to study type 1 diabetes mellitus associations, we conducted a comparative analysis of allele and genotype frequencydistribution of polymorphic markers rs41295061 and rs11594656 of IL2RA gene, which encodes -chain of interleukin-2 receptor, - and rs2069762, a marker of IL2, gene, encoding interleukin-2.

MATERIALS AND METHODS: Experimental group included 451 patients with type 1 diabetes mellitus (DM); control group consistedof 306 healthy subjects (both groups were represented by ethnic Russians). Alleles and polymorphic markers were identified byreal-time amplification method.

RESULTS: A comparative analysis of patients with type 1 DM and healthy control group did not show statistically significant differencesfrom the viewpoint of allele and genotype frequency distribution of polymorphic markers rs41295061, rs11594656 and rs2069762. This makes Russian patients considerably different from European ones where markers in question show substantialassociation with type 1 DM.

CONCLUSIONS: A comparative analysis of allele and genotype frequency distribution of IL2-RA and IL2 genes polymorphic markersshowed population differences in association of these markers in Russian and European patients.