bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathophysiological mechanisms, clinical manifestations, and methods of therapy of hypothalamic obesity
Authors: Il'ina E Iu , Strebkova N A
Published: March 2014

The authors present the current literature data concerning pathogenesis and clinical manifestations of hypothalamic obesity along with methods of its treatment. Lesions in the hypothalamus associated with infiltrative processes, neoplastic growth, and consequences of medical interventions not infrequently lead to the development of obesity characterized by the rapid gain of body weight. The major factor contributing to this increase is the compromised function of the regulatory hypothalamic centres controlling the sense of hunger and satiation and the energy balance. This dysregulation is responsible for hyperphagia, vegetative disorders, reduced energy expenditure, and hyperinsulinemia. It is extremely difficult to control the body weight only by adhering to diet guidelines and altering the lifestyle. The weight-losing efficacy of the present-day pharmacotherapy targeted for modulation of insulin secretion and activation of sympathetic nervous system is rather low and does not ensure the desired prevention of the weight gain. More detailed information about the risk factors and pathogenetic mechanisms of hypothalamic obesity is needed to develop efficacious therapeutic strategies for the treatment of this condition.
Using of strontium ranelate in the treatment of postmenopausal osteoporosis
Authors: Zazerskaia I E , Kuznetsova L V
Published: March 2014

The current trends in the diagnostics and treatment of postmenopausal osteoporosis are considered. A review of the results of clinical studies of strontium ranelate in patients with this condition is presented. It is concluded that this agent may be an efficacious tool for the treatment of postmenopausal osteoporosis.
Clinical, hormonal, and molecular-genetic characteristics of two cases of abnormal sex formation (ASF) in 46XY subjects caused by type 3 17-beta hydroxysteroid dehydrogenase deficiency
Authors: Kolodkina A A , Kalinchenko N Iu , Nizhnik A N , Nokel' M A , Tiul'pakov A N
Published: March 2014

Type 3 17-beta hydroxysteroid dehydrogenase (17HSD3) deficiency is a rare form of abnormal sex formation (ASF) in 46XY subjects in which the conversion of androstendione to testosterone is blocked; this defect results in compromised masculinization of the external genitalia during the intrauterine development. A distinctive feature of this form of sex development is masculinization at puberty due to the extragonadal conversion of androstendione to testosterone. Two clinical cases are reported: both girls were born with the female-type of external genitalia and 46XY karyotype, but progressive virilization in the pubertal period gave reason to suspect diagnosis of 17HSD3 deficiency. In both cases, this diagnosis was confirmed in molecular genetic studies (the following mutations were identified in the HSD17B3 gene: c.728-734delGATAACCp.1244fsX254/c.277+4A>T and c.277+4A>T). These two cases are the first reports of 17HSD3 deficiency in the Russian literature.
Victosa: the experience with clinical application in patients with type 2 diabetes mellitus
Authors: Voĭchik É A
Published: March 2014

Type 2 diabetes mellitus that comes from insulin resistance and deficit of insulin secretion has recently been described as associated with reduced incretin effect. The efficiency of traditional hypoglycemic therapy (metformin, secretagogues, glitazones, insulin) gradually decreases due to progressive loss of functioning beta-cell mass. The achievement of target blood glucose levels for the prevention of complications and cardiovascular pathology as a rule leads to such adverse events as increased body weight and hypoglycemia. The search for an «ideal» drug included the study and the use of incretin effect in DM2 patients. Liralglutide, the first analog of human glucagon-like peptide (GPP-1), is an innovative preparation with the desired properties the action of which is not confined to traditional hypoglycemic effects and improvement of glycemic control (as many as 65% of the patients have the targeted HbA1c level <7% at a minimal risk of hypoglycemia). It also prevents a rise in body weight, decreases arterial pressure and trigyceride levels, improves beta-cell function. This paper reports the first experience with clinical application of liraglutide (marketed in this country under commercial name Victosa since November 2010) for the treatment of patients with type 2 diabetes mellitus. Our data confirm results of the randomized placebo-controlled clinical study LEAD 1-6.
The role of YY3-36 peptide in the regulation of body weight in patients presenting with the exogenous constitutional form of obesity
Authors: Vlasova Iu Iu , Ametov A S
Published: March 2014

The objective of the present study was to measure the total YY3-36 peptide levels in blood sera obtained from the patients presenting with the exogenous constitutional form of obesity and excessive body weight. The secondary objective was to elucidate the influence of YY3-36 peptide on the process of body weight elevation. A significant rise in the serum YY3-36 peptide level was documented in those of the 327 patients included in the study who suffered grade I and II obesity (p<0,05). It was especially high in the patients with grade II obesity (p<0,05). It is concluded that the exogenous constitutional form of obesity is associated with a statistically significant elevation of blood YY3-36 peptide level in patients presenting with grade I and II obesity.
Clinical and metabolic aspects of the influence of type 2 diabetes mellitus on the manifestation of articular syndrome in patients with gonarthrosis
Authors: Strongin L G , Klimova K D , Grunina E A , Korneva K G , Trifonova E S
Published: March 2014

The present work was designed to study the influence of type 2 diabetes mellitus on the clinical course of articular syndrome in patients with combined pathology. A total of 45 patients with diabetes mellitus and gonarthrosis were examined and 45 ones with gonarthrosis without concomitant type 2 diabetes. The patients of both groups were matched for age, sex, duration and stage of gonarthrosis, and body mass index. It was shown that concomitant diabetes mellitus promotes progression of articular syndrome. Decompensation of diabetic state leads to exacerbation of pain syndrome, marked functional changes and increased severity of the inflammatory processes in the joints.
The antioxidative activity of oral hypoglycemic agents
Authors: Spasov A A , Kosolapov V A , Chepliaeva N I
Published: March 2014

Oral hypoglycemic agents, such as glibenclamide, gliclazide, metformin, rosiglitazone maleate, and diabenol, are known to exert in vitro a mild direct antioxidatove action. Rosiglitazone maleate showed moderate activity only on the hemiluminescence model with generation of active oxygen species while diabenol behaves as a scavenger of superoxide anion and hydroxyl radical in model hemiluminescence systems. Gliclazide exhibited dose-dependent activity only with respect to stable diphenyl-1-picrylhydrazyl (DPPG) radicals. Metformin and glibenclamide were inactive under in vitro conditions. It is hypothesized that the antioxidative action of hypoglycemic agents used for long-term pharmacotherapy should be attributed to their direct effect on the activity of enzymes of the antioxdative system.
NPH insulin. Effective mixing - effective dose regimen
Authors: Nikonova T V
Published: March 2014

Insulin therapy, a corner stone of the treatment of diabetes mellitus, both type 1 and type 2, has undergone substantial modification since the manufacture of the first insulin preparations 90 years ago up to the present time. Human insulins, such as neutral protamin Hagedorn (NPH) insulins, remain a major instrument of therapy of diabetes mellitus despite rapid developments in this field of knowledge and the wide availability of insulin analogs. When prescribing these preparations, the attending physician should be absolutely confident that the patient has a minimum background of knowledge and skills indispensable for efficacious and safe treatment. Such skills include the habit of mixing NPH insulin suspensions by 20-fold turning the vial or the cartridge upside-down or rolling them between the palms in order to ensure the uniform distribution of insulin in the suspension and its accurate dosing. The manufactures place from one to three glass or metal bullets inside the vials and cartridges for more homogeneous mixing of their contents. P. Kaiser et al. undertook the study of several pharmaceutical forms of NPH insulin manufactured by different companies to estimate the accuracy of dosing (variability of the insulin dose depending on the number of turns of the cartridge for homogeneous mixing). The insulin concentration in a single dose was measured by high-performance liquid chromatography. Marked variability of the insulin dose after less than ten (three or six) turns was documented for all cartridges with the exception of Insuman Basal insulin cartridges ("Sanofi"). It may be expected that the accuracy of dosing will not deteriorate using these cartridges owing to the presence in them of three heavy metal bullets even if the patient does not perform the necessary mixing procedure for one or another reason.
The incidence of abdominal obesity and the associated metabolic disturbances in the children aged 7-13 years
Authors: Vaĭnilovich E G , Lushchik M L , Sretenskaia Zh L , Zapol'skiĭ S A , Danilova L I
Published: March 2014

Stage 1 of the present study was designed to estimate the incidence of abdominal obesity among 878 schoolchildren aged between 7 and 13 years using the percentile tables for the waist circumference (WC) in the children's population of the United Kingdom and from the WC/height ratio that makes it possible to identify children at the highest risk of metabolic disturbances. The incidence of abdominal obesity based on the criterion of WC≤90th percentile (PC) for the age and the sex was estimated to be 33.1% for the entire group in the absence of significant difference between boys and girls (30.7% vs 35,5%). The incidence of abdominal obesity based on the criterion of WC/height ratio with a threshold value of ≤0.5 was 9.9% for both sexes in the entire group; it was significantly higher in the boys than in the girls (13.1% vs 6.9%). At the second stage of the study, the group of the children having WC≤90th percentile (n=51) showed significantly higher systolic and diastolic arterial pressure, blood triglyceride and insulin levels and HOMAIR index but lower HDL levels than control patients with WC < 90th percentile (n=28). The results of the study suggest the high incidence of abdominal obesity among young schoolchildren residing in large cities. Moreover, such children tend to develop metabolic disturbances and are at risk of cardiovascular diseases.
Defects of AR and SRD5A2 genes in the patients presenting with the abnormal peripheral action of androgens
Authors: Kolodkina A A , Kalinchenko N Iu , Nizhnik A N , Faĭzulin A K , Karmanov M E , Tiul'pakov A N
Published: March 2014

The objective of the present study was to estimate the frequency of defects of AR and SRD5A2 genes in the 46XY patients of the Russian population with abnormal sex formation and disturbed peripheral action of androgens. Moreover, we assessed the diagnostic value of hormonal characteristics for the differentiation between the above patients and those having 46XY and normal testosterone secretion.
Dynamics of glycemia following subcutaneous administration of Rinsulins NPH and P in comparison with insulins Protaphane and Actrapid at the onset of insulinotherapy in the patients with type 2 diabetes mellitus
Authors: Kalinnikova A A , Strongin L G , Petrov A V , Neliubina T A
Published: March 2014

The introduction of novel insulin analogs into medical practice requires clinical data confirming their comparability with the currently used preparations. The objective of present work was to compare the hypoglycemic action of a single injection of Rinsulins NPH and P (Natsional'nye tekhnologii, Russia) on the one hand and insulins Protaphane and Actrapid (Novo Nordisk, Denmark) on the other hand in 18 insulin-naïve patients with type 2 diabetes mellitus treated in the hospital environment. The tested analogs were randomly administered to the patients within 4 days after hospitalization. Blood glucose levels were measured ten times each day. No significant difference in the dynamics of glycemia between the patients treated with either group of preparations was documented.
Causes of primary refractoriness to the treatment of erectile dysfunction with phosphodiesterase type 5 inhibitors and means to overcome it
Authors: Rozhivanov R V , Kurbatov D G
Published: March 2014

Aim: to elucidate causes of primary refractoriness to phosphodiesterase type 5 inhibitors. Materials and methods: 28 men aged from 38 to 59 (mean 46) years suffering from erectile dysfunction and primary refractoriness to the treatment with phosphodiesterase type 5 inhibitors were interviewed using the International Index of Erectile Function (IIEF-5) questionnaire. In addition, they were examined by ultrasound dopplerography of penile vessels, subjected to neurologic testing and measurement of blood testosterone, TSH, prolactin, and glucose levels. Results and discussion: The primary refractoriness to the treatment with phosphodiesterase type 5 inhibitors was attributable to hypothyroidism in 3.5% of the cases, to diabetic neuropathy in 3.5%, to complications of radical prostatectomy in 3.5%, to hyperprolactinemia in 7%, to atherosclerosis of cavernous arteries in 7%, to venogenic erectile dysfunction in 7%, to hypogonadism in 11%, to combination of hypogonadism, diabetic neuropathy and angiopathy in 57%. Hypothyroidism, hyperprolactinemia, hypogonadism, and type 2 diabetes mellitus (12.5% of the cases) were detected for the first time in the examined patients. Pathogenetic therapy resulted in the elimination of erectile dysfunction in the patients presenting with hypothyroidism, hyperprolactinemia, and isolated hypogonadism. Combined treatment of erectile dysfunction with Nebido and Levitra proved efficacious in 14 of the 16 patients with combined hypogonadism, diabetic neuropathy, and angiopathy. Conclusion: The main causes of primary refractoriness to phosphodiesterase type 5 inhibitors appear to be endocrinopathies and diabetic neuro/angiopathy. Combined examination of the patients in these conditions makes it possible to reveal dangerous disorders. Self-treatment with phosphodiesterase type 5 inhibitors is undesirable. Medicamental therapy (including combined application of testosterone preparations and phosphodiesterase type 5 inhibitors) permits to cope with erectile dysfunction in 75% of the patients.
Diagnostics of Cushing's disease in the children (a literature review)
Authors: Udalova N V
Published: March 2014

The present review concerns diagnostics of Cushing's disease in the children with special reference to its different stages, relevant pharmacological tests and instrumental methods used for the purpose. The clinical course of the disease is described.
Inflammation of the adipose tissue (Part 4). Obesity: a new infectious disease? (a literature review)
Authors: Shvarts V Ia
Published: March 2014

This review considers the role of adenovirus 36, Chlamydia pneumoniae, Helicobacter pylori, and Trypanosoma cruzi in pathogenesis of obesity. Infection with either of the three microorganisms leads to the development of obesity in animals. The infected people usually have antibodies to these bacteria. One of the causes of obesity is believed to be activation of the receptors of the innate immune system (TLR2 and TLR4) by certain factors of the microorganisms; these receptors are known to localize in the adipose tissue. Saturated fatty acids as well as lipoploysaccharides (components of the microbial cells) are the ligands of TLR2 and TLR4. Activation of TLR2 and TLR4 promotes the development of both inflammation in the adipose tissue and insulin resistance and thereby leads to obesity. The mechanism of action of activated TLR2 and TLR4 during microbial infection consists of the suppression of sensitivity of adipose, hepatic, and muscular cells to insulin in conjunction with the enhancement of the blood glucose and fatty acid levels to produce the energy-rich substrates necessary to maintain the immune processes. The fact that saturated fatty acids and components of microbial cells can function as ligands for the receptors of the innate immune system and induce identical reactions gives evidence of the possible cumulative action of both excessively consumed dietary items and certain species of microorganisms.
Serological markers of coeliac disease in the children and adolescents with type 1 diabetes mellitus
Authors: Khennessi E O , Zvereva Ia S , Stepanova S M , Il'in A V , Kuraeva T L , Peterkova V A
Published: March 2014

We have studied the frequency of antibodies, markers of coeliac disease, in the children presenting with type 1 diabetes mellitus and obtained clinical and metabolic characteristics of seropositive and seronegative groups. The study included 499 diabetic children and adolescents admitted to the Pediatric Department of the Endocinological Research Centre. They were examined for the presence of anti-gliadin antibodies (anti-GL) and antibodies against tissue transglutaminase (anti-TG). These serological markers of coeliac disease were detected in 7.4% of the patients. More specific anti-TG occurred in 3.2% of the cases. As many as 29.7% of the seropositive patients with DM1 had gastrointestinal symptoms, such as stool disturbances, abdominal distension and pain, vomiting, and reduced appetite. Similar symptoms were documented in 11.7% of the seronegative children. Iron deficiency anemia was diagnosed in 24.3 and 8.6% of the seropositive and seronegative patients respectively (p<0.05). There was no significant difference between the children with type 1 diabetes mellitus having serological markers of coeliac disease and the seronegative patients in terms of anthropometric characteristics, plasma levels of glycated hemoglobin and vitamin D. It is concluded that the presence of serological markers of coeliac disease is association with a number of clinical manifestations confirms the necessity of immunological screening for coeliac disease among patients with DM1.
The efficacy of insulin glargine under real clinical practice conditions: results of the LAURUS-2 observational program
Authors: Skudaev S A , Verbovaia N I
Published: March 2014

The objective of the Program is to estimate the efficacy and safety of insulin glargine (Lantus) used in routine clinical practice for the treatment of patients presenting with type 2 diabetes mellitus who failed to reach adequate compensation of the disease by therapy with two hyperglycemic agents in combination with NPH insulin and have a glycated hemoglobin level in excess of 7.0%. The data obtained by examining 2395 patients (755 men and 1640 women) were available for analysis. 2157 patients (685 men and 1472 women) were transferred to insulin glargine therapy whereas the remaining 238 ones (70 men and 168 women) continued to use NPH insulin. The patients of the former group were offered two algorithms for dose titration of glargine (Lantus). Significant improvement of the parameters of carbohydrate metabolism was achieved within 12 weeks after the onset of therapy without the risk of hypoglycemia. It is concluded that the results of the Program demonstrate a higher efficacy and safety of insulin glargine compared with NPH insulin for the treatment of the patients with type 2 diabetes mellitus. The use of a simple dose titration algorithm and glycemic self-control makes it possible to quickly, safely, and efficiently achieve optimal parameters of carbohydrate metabolism in the majority of the patients treated with insulin glargine at a low incidence of episodes of all types of hypoglycemia.
Multiple type 2 endocrine neoplasia (case report)
Authors: Iukina M Iu , Goncharov N P , Bel'tsevich D G , Troshina E A
Published: March 2014

The congenital form of pheochromocytoma is known to be fraught with high risk of post-treatment relapse, bilateral, multicentric or primarily multiple lesions. The patients presenting with the syndrome of multiple type 2 endocrine neoplasia usually have no extra-adrenal pheochromocytomas or metastases. Both examination and treatment of these patients should be performed taking these peculiarities into consideration. We describe a family with multiple type 2 endocrine neoplasia and highlight selected aspects of the management of the patients presenting with genetically determined pheochromocytoma.
A case of diffuse toxic goiter and concomitant Buschke's scleroderma
Authors: Shuvaeva F K , Vorozhtsova E I , Verbovoĭ A F
Published: March 2014

A patient presenting with diffuse toxic goiter and concomitant Buschke's scleroderma is described.
Differential diagnostics of adrenal incidentalomas
Authors: Bel'tsevich D G , Soldatova T V , Kuznetsov N S , Remizov O V , Vorontsov A V , Rogal' E Iu , Vanushko V É , Kulezneva Iu V , Kats L E , Lysenko M A , Mel'nichenko G A
Published: March 2014

We have analysed the results of radiological investigations (USI, CT, and MRT) involving 177 patients given surgical treatment at the Endocrinological Research Centre during 2006-2010. In addition, the study included measurement of cortisol levels in the dexamethasone suppression test, fractionated metanephrins, and the relationship between aldosterone levels and plasma rennin activity (in the patients presenting with arterial hypertension). Twenty two patients underwent tumour puncture. Seventy six (55.9%) of the 136 patients having incidentalomas were found to have no indications for the surgical intervention (because of the absence of hormonal activity and low malignancy potential of the neoplasm). The follow-up period averaged 24.9±19 months. The choice of indications for the surgical treatment should be based on the results of standardized hormonal studies and the determination of malignancy potential using the native CT density above 20 UH as the principal criterion. Differential diagnostics by USI, MRT, and descriptive CT is believed to be inadequate. USI may be applied as a highly specific method for the detection of cysts and myelolopomas. Native CT density should be taken into consideration for the interpretation of the results of fractionated metanephrin measurements. Diagnosis of pheochromocytoma is very unlikely in the patients presenting with low CT density. Puncture biopsy is indicated only when the presence of metastases in the adrenal glands is suspected.
Serum adiponectin in obese children and adolescents
Authors: Peterkova V A , Kosygina A V , Vasiukova O V
Published: March 2014

The objective of this work was to study the relationship between the serum adiponectin level on the one hand, and the age, stage of sexual development and main anthropometric characteristics of children and adolescents depending on the degree of obesity, the presence or absence of metabolic disorders on the other hand. A total of 111 children and adolescents at the age from 2.5 to 17.9 years were available for the examination including 56 presenting with "simple" constitutional exogenous obesity, 12 overweight patients, and 43 with normal body weight. The concentration of adiponectin in the serum of obese children and adolescents was lower than in those with normal body weight (p=0.009). The highest adiponectin level was documented in prepubertal children; it decreased progressively in the course of sexual development and negatively correlated with BMI, waist circumference---???---(WC), and BMI SDS. The children presenting with obesity complicated by insulin resistance, the serum adiponectin level was lower than in those having normal and stimulated immunoreactive insulin concentrations, HOMA-IR and Matsuda's ISI indices. The study revealed the relationship between serum adiponectin levels, concentrations of high density lipoprotein cholesterol and triglycerides. The data obtained give reason to conjecture that the reduction of serum adiponectin level may be a link connecting obesity, insulin resistance, and atherogenic changed in the serum developing as early as the childhood that can be used as an additional biomarker for the identification of a group of children and adolescents at high risk of complications associated with obesity.
The role of matrix metalloproteinases and their inhibitors in the development of renal fibrosis in the patients with diabetes mellitus
Authors: Bondar' I A , Klimontov V V
Published: March 2014

The accumulation of components of extracellular matrix in the glomerular and interstitial compartments of the kidneys is a characteristic feature of diabetic nephropathy. The leading role in the extracellular matrix catabolism is played by matrix metalloproteinases (MMP). The activity of these enzymes is regulated by a group of inhibitors including tissue metalloproteinase inhibitors, plasminogen activator inhibitor-1, etc. Both in vivo and in vitro studies have demonstrated that a reduction of MMP activities and/or an increase of expression of MMP tissue inhibitors in the glomerular and tubular cells result in the suppression of catabolism of the components of extracellular matrix under the hyperglycemic conditions. Both circulating and urinary MMP as well as their inhibitors are considered to be new potential markers of renal fibrosis associated with diabetes mellitus. It is concluded that the directed activation of MMP and neutralization of their inhibitors provide a promising tool for the treatment of diabetic nephropathy.
Modern biochemical methods for the diagnostics of pheochromocytoma
Authors: Goncharov N P , Katsiia G V , Malysheva N M
Published: March 2014

The objective of the present work was to estimate the possibility of using the ELISA technique for the quantitative analysis of the metanephrine and normetanephrine levels in urine and to determine the cross-off points for the discrimination between their normal and pathological values for the purpose of diagnostics of pheochromocytoma. Methylated derivatives of adrenaline and noradrenaline were measured in 3,234 urine sample obtained from the patients presenting with elevated arterial pressure, resistance to therapy, and adrenal mass lesions who had visited the inpatient and outpatient departments of the Endocrinological Research Centre during the past 4 years. The measurement of total metanephrine and normetanephrine (free plus deconjugated fractions) was performed using commercial ELISA kits (IBL, Hambutg, Germany). The content of normetanephrine over 612 mcg in daily urine samples was shown to be the borderline between the normal values and those suggesting diagnosis of pheochromocytoma. The sensitivity of this assay was 97,5% (95% CI 91,1-99,6%), specificity 100% (95% CI 93,8-100%). For metanephrine, the level of more than 550 mcg/24 hours was the borderline between the normal values and those suggesting diagnosis of pheochromocytoma. The sensitivity of the method was 100% (95% CI 88-100%), specificity - 96% (95% CI 86-99,4%). The biochemical diagnosis of pheochromocytoma was confirmed by the reference pathomorphological method in 99% of the cases. The incidence of pheochromocytoma predicted by the biochemical analysis of the urine samples delivered to the laboratory during 4 years from the patients with the tentative diagnosis of this pathology (based on the elevated arterial pressure and the presence of adrenal mass lesions) was 4% on the average. It is concluded that the application of ELISA in a "manual" mode provides high sensitivity and specificity of quantitative determination of metanephrines in daily urine comparable to those achieved with the widely used but more expensive high performance liquid chromatography.
Mammographic breast density in postmenopausal women presenting with the disturbances of carbohydrate metabolism and metabolic syndrome
Authors: Bershteĭn L M , Vasil'ev D A , Poroshina T E , Kovalenko I G
Published: March 2014

Mammographic breast density (MBD) was determined visually in 51 postmenopausal women examined in the fasting state and after oral glucose level for obtaining their anthropometric and laboratory characteristics. The women presenting with impaired glucose tolerance/newly diagnosed diabetes mellitus (n=16) had the same MBD values as those having no such disorders (n=35). In the presence of the symptoms of metabolic syndrome, mammographic breast density tended to decrease to 16.5±4.3% in 17 women compared with 24.4±3.1% in 34 women without such symptoms. The diabetes risk score, unlike the blood glucose and reactive insulin levels, showed negative correlation with the MBD values. Such inverse relationship was especially pronounced in the women with the disturbances of carbohydrate metabolism and symptoms of metabolic syndrome. The inverse correlation between these characteristics and MBD values showed the strong dependence on the body mass index. It is concluded that parameters associated with impaired glucose tolerance and metabolic syndrome considered to be risk factors of the development of breast cancer are unrelated to increased mammographic breast density which suggests the difference in the mechanisms responsible for hormonal and metabolic predisposition to these pathologies.
The advantages of the treatment of the patients with type 2 diabetes mellitus with gliclazide MR
Authors: Pekareva E V
Published: March 2014

Type 2 diabetes mellitus (DM2) is a chronic condition characterized by progressive hyperglycemia resulting from beta-cell dysfunction and impaired insulin secretion. The maintenance of the target blood glucose level not only promotes preservation of the beta-cell pool but also reduces the risk of the development and progression of vascular complications of diabetes. This paper is designed to report the results of comparative investigations of the application of sulphonylurea derivatives for the treatment of the patients with type 2 diabetes mellitus.
Intestinal microbiocenosis in the obese patients with osteoarthritis
Authors: Gul'neva M Iu , Noskov S M , Malafeeva É V
Published: March 2014

Specific features of colonic microbiocenosis were investigated in 64 patients presenting with osteoarthritis. They were divided into 4 groups including patients with the normal body weights and those with grade I, II, and III obesity respectively. The qualitative and quantitative analysis of intestinal microflora was performed by the bacteriological method. It was shown that obesity was associated with an increased frequency of isolation of enterococci despite their decreased content. Simultaneously, variations in the diversity of opportunistic microorganisms were documented. Alterations in the qualitative and quantitative composition of intestinal microbiocenosis in the patients with osteoarthrosis depended on the degree of obesity. Grade III obesity was associated with the most pronounced decrease in the occurrence of bacteroids, entercococci, and lactose-positive coliform bacteria. It is concluded that the development of dysbiosis in the large intestine should be taken into consideration in the choice of combined therapeutic strategy for the treatment of the patients with osteoarthritis and concomitant obesity of different severity.
Comparative characteristic of different methods for topical diagnostics of primary hyperparathyroidism
Authors: Kuznetsov N S , Kim I V , Kuznetsov S N , Artemova A M , Mokrysheva N G
Published: March 2014

Topical diagnostics of pathology of parathyroid glands (PTG) is an important stage of preoperative examination of the patients presenting with primary hyperparathyroidism (PHPT). Individual patients do not necessarily need the entire scope of the currently available diagnostic techniques to be applied for the elucidation of their clinical conditions. The objective of the present study was to estimate the diagnostic value of each concrete method and its combination with other tools. The data obtained point out to the high efficacy and specificity of each method of preoperative topical diagnostics of PTG pathology in the patients with PHPT. The sensitivity of ultrasound studies, scntiography, their combination, and multispiral computed tomography (MSCT) was estimated at 96.8%, 91.8%, 99.2%, and 95.2% respectively. Their specificity was 91.9%, 84.2%, 94.1%, and 94.1%. The study did not reveal a significant difference between sensitivity and specificity of ultrasound studies and the "golden standard" of diagnostics of PTG pathology. This finding allows the ultrasound studies to be recommended as the sole method for primary topical diagnostics of PTG pathology in the patients presenting with PHPT. At the same time, any doubt as regards the results of an ultrasound study requires that a more comprehensive examination of the patients be performed with use of the entire scope of the scintigraphic techniques including single-photon emission computed tomography (SPECT) and MSCT especially in the cases of atypical localization of parathyroid glands. The results of the study provided a basis for the development of the optimal algorithm for diagnostics of PHPT.
The efficacy of application of vildagliptin in the patints presenting with co-morbid pathology
Authors: Vertkin A L , Magomedova A Iu , Mychka V B , Prokhorova Iu V , Nosova A V
Published: March 2014

The patients presenting with type 2 diabetes mellitus (DM2) not infrequently have concomitant diseases of the cardiovascular, respiratory, digestive, and urogenital systems which hampers the choice of optimal hypoglycemic therapy. The prescription of insulin injections appears to be the most natural and efficacious modality of such therapy. However, excessive doses of insulin are known to cause hypoglycemia and body weight increment. Hypoglycemia interferes with the optimal control of the diabetic patients' conditions especially in those of advanced age who may poorly respond to the treatment. In the present study, the intake of vildagliptin in combination with insulin administration resulted in the significant improvement of the characteristics of carbohydrate and lipid metabolism in the absence of overweight, with the minimal risk of hypoglycemia and cardiovascular diseases (complications).
The experience with the clinical application of liralgutide (victosa), the first analog of human glucagon-like peptide-1 in the patients with type 2 diabetes mellitus - expanding the range of possibilities
Authors: Ostroukhova E N , Khmel'nitskiĭ O K , Krasil'nikova E I , Davidenko K S
Published: March 2014

This paper reports the results of the treatment of 71 patients presenting with type 2 diabetes mellitus using liraglutide, a long-acting analog of glucagon-like peptide-1 (GLP-1) marketed under the brand name Victoza. Practically all the patients experienced either improvement or normalization of the parameters of carbohydrate metabolism in conjunction with a reduction of their body weight and arterial pressure. There were no severe hypoglycemic episodes and other adverse reactions to the therapy. It is recommended that Victoza should be more widely used for the treatment of the patients with type 2 diabetes mellitus.
Modern approaches to the treatment of type 2 diabetes mellitus and its complications
Authors: Ametov A S , Doskina E V
Published: March 2014

According to the International Diabetes Federation, there are over 366 mln subjects suffering diabetes mellitus (DM) in the world. This figure is expected to reach 552 mln by 2030. The patients are treated with preparations acting on different components of DM pathogenesis on the one hand and with medicines facilitating prophylaxis of the disease on the other hand. Diabeton MB decreases the mean HbA1c level of 7-8% by 0.9%. Also, it causes reduction of the initial HbA1c levels of 8-9% and 10% by 1.7% (2.6---??) and 4.2% respectively. Diabeton MB produces a number of other effects besides the hypoglycemic activity; specifically, it reduces the intensity of LDLP oxydation, platelet adhesion and aggregation, adhesion of monocytes, etc.
The treatment of acromegaly with long-acting octreotide: the effective control of disease activity and decrease of the tumour volume
Authors: Dogadin S A , Dudina M A , Lobyntseva L A
Published: March 2014

The objective of the present retrospective study was to evaluate the results of the long-term treatment of the patients suffering from active acromegaly with octreotide. It included a total of 48 patients at the age from 30 to 77 years (15 men and 33 women) of whom 18.7% and 81.2% presented with pituitary microadenoma and macroadenoma respectively. All the patients were given long-acting octreotide either as primary or as adjuvant therapy at a dose of 20-40 mg once every 28 days for 3 years. The treatment resulted in the remission in 9 (100%) patients having pituitary microadenoma and 9 (23%) ones with macroadenoma. By the end of the 3-year treatment period the clinically significant decease of the tumour volume was documented in 9 (100%) and 32 (82%) patients presenting with microadenoma and macroadenoma, respectively.
Secondary testicular structures in the patients presenting with congenital adrenal cortical dysfunction
Authors: Kuznetsova E S , Kalinchenko N Iu
Published: March 2014

According to publications in the foreign literature, the incidence of secondary testicular structures in the patients with congenital adrenal cortical dysfunction (CACD) amounts to 90%. In this country, the scheduled screening for TART tumours in the male patients presenting with CACD is not carried out. At the same time, the late consequences of this pathology (infertility, obstructive testicular diseases) require increasingly more attention starting from the early childhood.
A new principle of the treatment of type 2 diabetes mellitus by stimulation of glucosuria
Authors: Shvarts V Ia
Published: March 2014

The results of clinical and experimental studies of a new group of medications are presented, with special emphasis laid on the inhibitors of sodium-glucose co-transporter SGLT2 employed for the treatment of type 2 diabetes mellitus. The mechanism of action of these inhibitors consists of the stimulation of glucosuria and the subsequent decrease of hyperglycemia. The new group of pharmaceutical products being considered is characterized by high therapeutic efficacy, safety, and the narrow spectrum of side effects. The most important adverse reactions are infectious lesions in the urinary tract and genital organs.
Biphasic insulin analog NovoMix 30 is a possible solution to overcome key problems of biphasic human insulin therapy for DM type 2 patients
Authors: Surkova E V
Published: March 2014

This review discusses publications on the usage of biphasic analogue insulin aspart 30/70 (NovoMix 30) in the treatment of patients with type 2 diabetes mellitus. Data on the clinical and pharmaco-economic advantages of NovoMix 30 versus biphasic human insulin was analyzed. The problems of doctor's clinical inertia and patient's psychological insulin resistance, as well as possible solutions to key problems of insulin therapy with help of biphasic insulin aspart 30/70 were discussed.
Peculiarities of the blood oxygen and antioxidant status in the children presenting with somatotrophic insufficiency and managed by the substitution treatment with growth hormone
Authors: Pankratova M S , Iusipovich A I , Vorontsova M V , Kovalenko S S , Baĭzhumanov A A , Parshina E Iu , Shiriaeva T Iu , Maksimov G V , Peterkova V A , Dedov I I
Published: March 2014

The present work was designed to study the influence of therapy with recombinant growth hormone on the oxygen and antioxidant blood status in the children presenting with somatotrophic insufficiency. A total of 11 children (2 girls and 9 boys) at the age from 3 to 9 years with confirmed somatotrophic insufficiency were available for the observation. They had never before been treated with growth hormone preparations. The blood oxyhemoglobin level and superoxide dismutase (SOD) activity increased within 3 months after the onset of therapy. There is direct correlation between oxyhemoglobin levels and SDS for the growth rate (r= 0.64; p<0.05) and negative correlation between mean hemoglobin content in erythrocytes (MHCE) and SDS for the growth rate (r=-0.69), p<0.05). The results of the study suggest the close relationship between the system of growth hormone/growth factors and the morphofunctional state of erythrocytes. It is concluded that the short-term treatment of the children suffering somatotrophic insufficiency with recombinant growth hormone appears to promote the development of adaptive mechanisms.
Estimation of the efficacy of the measurement of plasma renin activity and direct renin in diagnostics of primary aldosteronism
Authors: Goncharov N P , Kolesnikova G S , Katsiia G V , Rogal' E Iu
Published: March 2014

The objective of the present study was to estimate the informative value of the measurements of aldosterone level, direct renin, and plasma renin activity as well as the relationships between these characteristics for differential diagnostics of various forms of hypertension and, first and foremost, of primary aldosteronism. We have examined a total of 162 patients. The results of differential tests were used to allocate them to a few groups including 41 patients presenting with primary aldosteronism, 52 ones with incidentalomas, 26 with essential hypertension, and 43 with various endocrine diseases and normal arterial pressure (control groups). The aldosterone levels, direct renin, and plasma renin activity were measured in blood samples taken in morning hours from the patients in the supine position. The aldosterone to plasma renin activity (A/PRA) and aldosterone to direct renin (A/DR) ratios were calculated. The elevated blood aldosterone level is currently believed to be the principal criterion for primary aldosteronism in the patients suffering arterial hypertension. The RIA technology is the method of choice for the measurement of aldosterone levels. The determination of the A/PR ratio significantly improves the detectability of the disease. The use of direct renin level instead of kinetic renin ensures the high efficacy of screening for primary aldosteronism and its early diagnostics. The cut-off point for the calculation of the A/PRA ratio to differentiate between primary aldosteronism and incidentalomas is 2160 pmol/mcg/hr (sensitivity 100%, specificity 97.8%) in comparison with the analogous cut-off point for the discrimination between primary aldosteronism and endocrine pathology without hypertension is 49 pmol/mU (sensitivity 100%, specificity 95%). The cut-off point for the calculation of the A/PR ratio to differentiate between primary aldosteronism and incidentalomas is 2160 pmol/mcg/hr (sensitivity 89.5%, specificity 99%) in comparison with the analogous cut-off point for the discrimination between primary aldosteronism and endocrine pathology without hypertension is 1432 pmol/mcg/hr (sensitivity 89.5%, specificity 100%). It is concluded that the results of determination of direct renin level in the blood plasma are independent of the endogenous angiotensinogen level, less variable and more reproducible than than the results of the measurement of plasma renin activity. The aldosterone to direct renin ratio may be used for the screening of primary aldosteronism.
The pathogenetic substantiation of the use of angiotensin-converting enzyme for the treatment of diabetic retinopathy
Authors: Riabina M V , Chesnokova N B , Okhotsimskaia T D , Kuznetsova T P
Published: March 2014

The objective of the present work was to study visual functions, as well as changes in the systemic and local renin-angiotensin system before and after intake of the ACE inhibitor perindopril in 65 patients (130 eyes) presenting with diabetic retinopathy. The treatment caused the most pronounced changes in the patients with preproliferative diabetic retinopathy including the two-fold (p<0.05) decrease of ACE activity in the blood and its 7.5-fold (p<0.05) increase in the tears. These effects appear to be attributable to the action of perindopril on the levels of the proangiogenic factors known to be elevated in the patients with severe retinal ischemia. The treatment of patients with diabetic macular oedema with perindopril resulted in the decrease of the retinal thickness from 392.5±46.7 to 347.2±39.6 mcm in the absence of significant improvement in the acuteness of vision. All the patients experienced a significant reduction in the level of glycosylated hemoglobin.
Three cases of Carney complex in the children: clinical and molecular-genetic features of Carney complex in the children (the first description in Russia)
Authors: Orlova E M , Kareva M A , Zakharova E Iu , Poliakova G A , Poddubnyĭ I V , Tolstov K N , Shiriaeva L I , Melikian M A , Kalinchenko N Iu , Udalova N V , Peterkova V A
Published: March 2014

Carney complex is a rare autosomal dominant condition that manifests itself as a combination of lentiginosis, heart and skin myxomas, primary pigmented micronodular adrenocortical hyperplasia with ACTH-independent hypercorticism, calcifying Sertoli cell testicular tumours, schwannomas, thyroid and breast tumours, and other neoplasms. A total of 400 patients presenting with this pathology has thus far been described worldwide. 75% of the patients with Carney complex were found to have mutations in the gene encoding for the regulatory alpha-subunit of proteinkinase A (PRKARIA). The present paper presents three cases of Carney syndrome diagnosed in adolescents. Two new mutations in the PRKARIA gene were identified (c.1111_1112insC (pp.Q370fsX11) and c.1016T>A (p.339V>D)). One of the patients had adrenal adenoma. To the best of our knowledge, it is the first case of benign adrenal tumour greater than 2 cm in size in the patient with Carney complex.
The level of vitamin D and its relationship with the amount of fatty tissue and adipocytokine content in the women of reproductive age
Authors: Karonova T. L. , Grineva E. N. , Mikheeva E. P. , Belyaeva O. D. , Krasil’nikova E. I. , Nikitina I. L.
Published: March 2014

The patients with obesity are known to suffer 25-hydroxy vitamin D (25(OH)D) deficiency, but the relationship between these two conditions remains unclear. The blood 25(ON)D levels in practically healthy women were compared with the amount and distribution patterns of the fatty tissue and with the content of plasma adipocytokines. The absence or deficit of vitamin D was documented in 61.3% of the women included in the present study. They exhibited negative correlation between 25(ON) D levels and body weight. The patients with obesity were characterized by correlation between the 25(ON)D levels and waist circumference, body weight, BMI, and the amount of fatty tissue. The women of reproductive age with the reduced blood 25(ON)D level (OR 1.86 [0.88—3.95]; CI 95%) or 25(ON)D deficiency (OR 2.23 [1.03—4.80]; CI 95%) were at a higher risk of development of obesity compared with the women in whom the 25(ON)D levels were in excess of 75 nmol/l. The study confirmed correlations between adypocytokine levels and the amount of fatty tissue even though it failed to demonstrate a significant relationship between the levels of adipocytokines and vitamin D.
The Project of Russian Consensus "Gestational diabetes mellitus: diagnostics, treatment, postpartum follow-up"
Authors: Dedov I I , Krasnopol'skiĭ V I , Sukhikh G T
Published: March 2014

This document is the consensus of the experts of the Russian Association of Endocrinologists and those of the Russian Association of Obstetricians and Gynecologists on diagnostic criteria for gestational diabetes mellitus and other carbohydrate metabolic disturbances during pregnancy. The consensus is based on the analysis of the results of the largest multinational Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study of more than 23 thousand pregnant women. The draft was repeatedly considered at the meetings of the working group and presented as oral reports at the 6th All-Russian Congress of Endocrinologists with international participation on Current Technologies in Endocrinology and at the All-Russian Interdisciplinary Educational Congress on Complicated Pregnancy and Premature Birth: from the Summit of Science to Everyday Practice in May 2012.