bluuebunny/crossref_metadata_2025 huggingface dataset:
Transmedial Storytelling and Transfictionality
Authors: Ryan Marie-Laure
Published: November 2013

This article investigates the relations between the narratological concept of transfictionality and the trendy phenomenon of transmedial storytelling. Made popular as a concept by Henry Jenkins (2006), transmedial storytelling is the creation of a storyworld through multiple documents belonging to various media. The three fundamental operations of transfictionality—expansion, modification, and transposition—are investigated in terms of their potential for transmedial storytelling. After an analysis of the variety of documents that make up the storyworld of Alpha 0.7 (Südwestrundfunk 2010), a German transmedial story system that comprises a TV miniseries, radio plays, fictional web pages, and links to nonfictional texts created independently of the project, the article asks under which conditions an alternate reality game (ARG) could be added to the system without spoiling the experience of those people who limit their exploration of the storyworld to watching the TV show. In turn, the last section asks what kind of stories lend themselves to transmedial projects and why such projects are currently popular.
Pulmonary embolism presented by syncope in a low-risk patient: a case report
Authors: Othman Amr A A , Tohamy Aly M , Hassan Ayman K M
Published: November 2013

Introduction: Pulmonary embolism, an emergency that can have fatal consequences, can be presented with a common symptom that can be missed, such as syncope.

Case presentation: We present a case of a young, low-risk male who presented with attacks of syncope and dyspnea followed by massive pulmonary embolism. We also review the pathophysiology of syncope in pulmonary embolism cases and strategy of how to work up with similar cases.

Conclusion: Pulmonary embolism should be considered and excluded in every case of recurrent attacks of syncope.
Proactive ecology for the Anthropocene
Authors: Chapin F. Stuart , Fernandez Erica
Published: November 2013

The rapid, directional global changes that characterize the Anthropocene provide unprecedented opportunities for ecologists and other scientists to discover new paradigms that shape our understanding of the ways that the world is changing. These paradigms will likely focus more strongly on interactions, feedbacks, thresholds, and model uncertainty than on steady-state dynamics and statistical uncertainty. We advocate a shift in ecology and other disciplines to a more proactive leadership role in defining problems and possibilities in a rapidly changing world rather than being relegated to a reactive role of trying to fix the problems after the horse has left the barn. This requires not only renewed commitment by ecologists (and other citizens) to a more proactive ethic of environmental citizenship but also institutional changes in education, the scientific review and funding processes, and promotion and tenure processes to encourage and celebrate those who seek to shape trajectories toward greater ecosystem and social resilience and well-being.
Factors Influencing Utilization of Woody Biomass from Wood Processing Facilities in Mississippi
Authors: Joshi Omkar , Grebner Donald L , Munn Ian A , Grado Stephen C , Grala Robert K , Hussain Anwar
Published: November 2013

Mill residues obtained from wood processing industries are potentially important feedstocks for the wood-based bioenergy industry. Although many mills recognize the value of their residue as an integral fuel for energy production, some recent studies suggest that ample mill residues are available to expand wood-based bioenergy in United States. This study analyzed factors that influence the availability of residues from mills in Mississippi. Information pertaining to available residues from forest products industries in Mississippi was obtained by a mail survey instrument. Generalized least square and Tobit models were used to analyze the data. Results indicated that availability of residues was higher in primary wood processing manufacturers than secondary manufacturers and that feedstocks availability would be higher if wood-based bioenergy firms were located near larger, year-round, forest products industry operations. Residue availability may be constrained by lack of awareness regarding market opportunities for bioenergy products. The study results are useful for entrepreneurs interested in creating sustainable bioenergy production in Mississippi.
Personalisation, ambiguity and conflict: Matland’s model of policy implementation and the ‘transformation’ of adult social care in England
Authors: Ellis Kathryn
Published: November 2013

The article draws on Matland’s (1995) modelling of policy implementation to investigate the personalisation of adult social care in England. The shift from policy formation to enactment by local authorities is linked to a move from ‘symbolic’ to ‘political’ implementation. Successive studies, however, highlight certain enduring features of local authorities as sites of contradiction and dissent in adult social care, particularly on the frontline. Taking these into account arguably permits a closer analysis of the dynamics of power at work in the implementation of the personalisation agenda as well as enriching our understanding of the nature of political implementation.
Does volunteering improve employability? Insights from the British Household Panel Survey and beyond
Authors: Paine Angela Ellis , McKay Stephen , Moro Domenico
Published: November 2013

Policy interest in the role of volunteering as a route to employment is enduring, with an assumption that links between volunteering, employability and employment are positive and straightforward. This has largely been supported by existing evidence, although there have been few longitudinal studies testing the theory. Analysing data from the British Household Panel Survey, we used multivariate techniques to explore the effects of volunteering on moves from being out of work into work; and on retention and wage progression for people in employment. We suggest that the relationship is complex: volunteering may have a positive effect on the labour market position of some individuals in some circumstances; for others it may have a negative, or no, effect. We offer some suggestions for the variations we found: the limitations of the dataset and our analysis; a limited concept of employability; and too narrow a view of volunteering and its impact.
Foundations: accountability and legitimacy
Authors: Tomei Anthony
Published: November 2013

Many charitable foundations seek to influence social change. As independent endowed bodies with their own funds, foundations are, on the face of it, not accountable so there are questions about the legitimacy of their actions. This article draws on contemporary examples and practitioner experience to discuss accountability and legitimacy in the context of foundations that want to influence social change need to work with others. For such foundations legitimacy and accountability are operational necessities.
Great expectations. Dual-earner policies and the management of work–family conflict: the examples of Sweden and Slovenia
Authors: Grönlund Anne , Javornik Jana
Published: November 2013

This article explores mechanisms linking family policy to work–family conflict, work demands and gender. The conflict construct has dominated survey-based work–family research; however, both the individual actor and the societal context have been conspicuously absent. In qualitative interviews, including established instruments of work–family conflict, we studied how perceptions of work–family conflict were linked to strategies and use of policy entitlements among working parents in Sweden and Slovenia, two countries with policies promoting the dual-earner family. Our findings imply that such policies contribute to ‘have-it-all’ aspirations, but collide with practical realities, including norms related to work, parenthood and gender. In Sweden, policy tools and work demands appeared more decisive, especially for women’s conflict, whereas in Slovenia, informal care by extended family was important. Based on the analysis, we propose a typology of strategies and perceived conflict that can help develop research on work–family conflict, especially from a comparative perspective.
Deciding on leave: how US women in dual-earner couples decide on maternity leave length
Authors: Barnes Medora W.
Published: November 2013

This research contributes to the dialogue on maternity leave policy in the United States through analysing how pregnant school teachers with access to extended maternity leave decide how long a leave to take. The lived experiences of new mothers are examined through a series of longitudinal interviews with 16 public school teachers conducted at three points over the course of the transition to parenthood (pregnancy through first year). Findings indicate that although financial reasons played a large role in women deciding to return to work more quickly, issues of professional identity and personal happiness were also meaningful. Additionally, holding gendered parenting ideologies and being uncomfortable with available childcare options were important in the decision to take an extended leave.
Interviews with divorced women from the United Arab Emirates: a rare glimpse into lived experiences
Authors: Bromfield Nicole
Published: November 2013

The United Arab Emirates, an oil-wealthy Gulf nation, has undergone significant social changes since the discovery of oil. Although many changes have been positive, there has also been an increase in social problems, including divorce. The rising divorce rate is alarming, considering that divorce is detrimental to Emirati families, where commitment to Islam, strong family ties and a sense of tradition are highly valued. This article presents findings from a qualitative study in which I interviewed 10 divorced Emirati women, using phenomenology as my methodological framework. Data were collected through one-to-one in-depth interviews. Several issues being common to the respondents emerged, including family interference, early marriage, the desire to know more about the partner before marriage, domestic violence, controlling spouses and the social stigma of divorce. Social exchange theory of divorce is presented in an effort to analyse why divorce is an option for some of today’s Emirati women.
The timing of parental divorce and filial obligations to care for ageing parents
Authors: Sage Joanna , Evandrou Maria , Jane Falkingham
Published: November 2013

This article explores how the timing of parental divorce within a child’s lifecourse can influence the obligations they feel to care for their parents later in life. The majority of studies have suggested that parental divorce that occurs earlier in a child’s life will have the most detrimental effect on their filial obligations. Drawing on life-history interviews with 23 midlife participants in Southampton (UK) we challenge this contention by demonstrating how midlife experiences of parental divorce have weakened adult children’s relationships with their parents, and we explore how this may impact on their future willingness to provide care. We also demonstrate how deteriorating marital relations have resulted in some older parents ‘living together apart’ and becoming socially withdrawn, which has weakened relationships with their midlife adult children who, as a result, expect to feel less willing to care for their parents in the future. These findings are presented within the context of rising divorce rates in older age groups and an informal care gap in the UK.
Association of type 1 diabetes mellitus (DM1) with polymorphous alleles of HLA-DR and DQ genes in two Russian populations of Moscow and Vologda regions
Authors: Kuraeva Tamara Leonidovna , Kashenin M N , Boldyreva, M N , Tsitlidze N M , Nikitin A N , Prokofiev Sergey Alexandrovich , Zilberman Lyubov' Iosifovna , Peterkova Valentina Alexandrovna , Nosikov Valery Vyacheslavovich , Dedov Ivan Ivanovich
Published: November 2013

Aim. To consider association of type 1 diabetes mellitus (DM1) with polymorphous alleles of HLA-DRB1 HLA-DQB1, and DQA1 genes in two Russian populations of Moscow (MP) and Vologda (VP) regions. Materials and methods. Identification of alleles of HLA-DRB1 HLA-DQB1, and DQA1 genes in 138 patients with type 1 diabetes and a random sample of 242 subjects from the local population (residents in at least three successive generations) of the Vologda region, 204 patients and a random sample of 300 subjects from the city of Moscow and Moscow region. Results. MP and VP exhibited identical predisposing alleles. The occurrence of DRB1*4 (RR=5.96 and 3.93 in MP and VP respectively), DRB1*17 (RR=4.33 and 4.23), DQA1*0301 (RR=5.70 and 3.66), DQB1*0201, (RR=2.06 and 1.77), DQB1* 0302 (RR=7.10 and 3.95), DQB1* 0304 (RR=8.94 and 19.98) alleles was significantly higher in DM1 patients. The following protective alleles were identified in MP and VP respectively: DRB1*7 (RR=0.37 and 0.18), DRB1*11 (RR=0.12 and 0.21), DRB1*13 (RR=0.09 and 0.26), DRB1*15 (RR=0.23 and 0.04), DQA1*0102 (RR=0.29 and 0.23), DQA1*0103 (RR=0.13 and 0.23), DQA1*0201 (RR=0.37 and 0.17), DQb1*0301 (RR=0.16 and 0.24), and DQB1*0602/8 (RR=0.10 and 0.13). Conclusion. ?New? associations unknown in other populations (e.g. DQB1*0304) were revealed, besides the majority of classical predisposing and protective alleles characteristic of European populations. DQB1*0304 proved the strongest predisposing allele in MP and especially in VP. These data suggest different contribution of predisposing alleles to the development of DM1 in individual populations.
Endothelial dysfunction in children and adolescents with type 1 diabetes mellitus and its role in the development of diabetic peripheral polyneuropathy
Authors: Afonin A A , Komkova M V , Galkina G A , Morozova N V
Published: November 2013

Aim. To measure endothelial factors (nitric oxide (NOx) metabolites, endothelin-1 (ET-1), and basic fibroblast growth factor (bFGF)) in children and adolescentswith diabetes mellitus (DM) during development of diabetic peripheral polyneuropathy (DPNP). Materials and methods. A total of 130 children and adolescents with diabetes mellitus were examined. Duration of DM varied from 3 months to 14 years. Thecontrol group comprised 20 children and adolescents without DM or neurologic pathology. Subjective manifestations of DPNP were assessed based on thedata of a standardized Neuropathy Symptom Score (NSS) questionnaire. Neuropathy Disability Score (NDS) questionnaire was used to monitor objectivechanges of DPNP. NOx metabolites were detected with Griess reagent (Aldrich Chemical Co, USA). Serum ET-1 and bFGF were measured using solid-phaseimmunoenzyme assay (DRG, USA) and CYTIMMINE (USA) kits respectively. Results. All children and adolescents with DM1 had lower NOx and bFGF levels than controls. ET-1 level in DM patients was 3.5 times that in controls. DMpatients with DPNP had more pronounced endothelial dysfunction than DM patients without DPNP and control subjects. Patients with hyperproduction ofNOx had DM for more than 10 years and their total NDS score was significantly higher than in two other groups. Conclusion. Endothelial dysfunction in children and adolescents with type 1 diabetes mellitus progresses with the development of DPNP. Depletion of endothelialfunctional reserve is responsible for the unfavourable course of DPNP.
Association of type 1 diabetes mellitus (DM1) with polymorphous alleles of class II HLA genes in Yakutian and Russian populations
Authors: Titovich Elena Vital'evna , Kuraeva Tamara Leonidovna , Danilova G I , Alekseev L P , Boldyreva M N , Nikitin A N , Ivanova O N , Prokofiev Sergey Alexandrovich , Zilberman Lyubov' Iosifovna , Tsitlidze N M , Nosikov Valery Vyacheslavovich , Dedov Ivan Ivanovich
Published: November 2013

Materials and methods. HLA genotyping was accomplished in 51 DM1 patients and 51 volunteers randomly selected from the indigenous populationof Yakutia (Yakuts in three successive generations). Another 205 DM1 patients and 300 healthy subjects comprised random samples of patients andcontrols respectively from residents of Moscow and Moscow region. Results. HLA DRB1*17(03) allele proved to be the strongest one predisposing to DM1 in the Yakutian population (relative risk, RR=8,47) andDQB1*0304 in the Moscow population (RR=8,94). The presence of DRB1*04, DRB1*17(03), DQA1*0301, DQB1*0201, and DQB1*0302 accountedfor RR >2 in both populations. Only two alleles, DRB1*04 and DRB17(03), in the Yakutian population and five of the six (DRB1*04,DRB1*17(03), DQA1*(0301), DQB1*0302, and DQB1*0304) in the Moscow one were closely associated with DM1 (RR >4). DRB1*09, DRB1*11,DQB1*13, DQB1*0602/8 in Yakutian and DRB1*11, DRB1*13, DQA1*0103, DQB1*0301, DQB1*0602/8 in Moscow populations had the highestprotective potential (RR
Class II HLA diabetogenic markers in an Udmurtian population: genotype dependence, the role of DQ trans-heterodimers
Authors: Ivanova Olga Nikolavna , Prokof'ev Sergey Alexandrovich , Zvereva Yana Stanislavovna , Kovalenko Tatiana Viktorovna , Blinov Andrey Vladimirovich , Peterkova Valentina Alexandrovna
Published: November 2013

Aim. To analyse association of class II HLA genotype (DRB1, DQA1, DQB1) with type 1 diabetes mellitus (DM1) in an Udmurtian population. Materials and methods. The case-control method was applied in the study involving 29 children with DM1 and 97 age-matched healthy subjects. HLAalleles were identified by multiprimer allele-specific PCR. Association with DM1 was evaluated from the OR-odds ratio. Calculations were made usingStatSoft and STATISTICA 6 programs. Results. The occurrence of ?classical? highly predisposing haplotypes in the studied Udmurtian population proved significantly lower than in otherCaucasoid populations (DRB1*04-DQA1*0301-DQB1*0302 - 2,6 vs 8-16% and DRB1*17(03)-DQA*0501-DQB1*0201 - 3,6 vs 6-12,9%)trans-Encoded DQ heterodimers (DQA1*0301-DQB1*0201 and DQA1*0301-DQB1*0302) were shown to play the key role in determining the riskof DM1. They were found in 62,1% of the patients compared with 10,3% of control subjects (OR=14,2; pc=6Ч10-5). Conclusion. Positive DQA1*0301-DQB1*0302 or/and *0201 genotype is the most sensitive predictor of DM1 in the studied Udmurtian population.
Can simple intensification of therapy with modern two-phase insulin help in type 2 diabetes when target glycemia failed to be achieved withbasal insulin? Results of subanalysis in the PRESENT study
Authors: Yang Ch S , Guler S , Shestakova Marina Vladimirovna
Published: November 2013

Aim. To evaluate efficiency and safety of intensification of therapy by substituting two-phase insulin aspart 30 (DiAsp 30) for basal insulin in patients with type2 diabetes mellitus after a failure to achieve target glycemia. Materials and methods. Analysis of the data obtained in a group of patients involved in the PRESENT study (Physicians Routine Evaluation of Safety andEfficacy of NovoMix 30 Therapy), a 6 month-long observational study conducted in 15 countries. The subanalysis included patients previously treated with along-acting insulin analog (AB, n=34) or intermediate and long-acting human basal insulin (HB, n=3414) and transferred thereafter to DiAsp 30 therapy.End-points of efficiency were the difference between blood HbА1c and glucose (fasting and postprandial) levels measured at the onset of the study and upon itscompletion, the number of hypoglycemic episodes and adverse events, physician and patients content with the results of the treatment. End-points were consideredseparately with reference to preceding basal therapy (AB or HB). Results. Treatment with DiAsp 30 for 6 months resulted in a fall of HbА1c levels compared with initial values (-1,60 and -142% in AB and HB patients respectively,p
Results of assessment of the efficacy of therapeutic and diagnostic aid to diabetic patients based on prospective studies
Authors: Suntsov Yury Ivanovich , Maslova Oksana Vladimirovna , Kazakov Igor Vladislavovich
Published: November 2013

Aim. Comparative assessment of the prevalence of diabetic complications (DC) and the main metabolic indices in adult patients with DM1 and DM2 in the periodfrom 2003 to 2009. Materials and methods. The study based on the Diabet Tsentr mobile module was designed to perform screening (2003) and rescreening (2009) for DC in severalregions of the Russian Federation. Laboratory analyses included measurement of blood HbA1c, creatinine, urea, total cholesterol levels, and albumin in singlevoidurine samples. The patients underwent fundoscopy, evaluation of all forms of sensory responsiveness, measurement of arterial pressure, and ECG. The resultswere treated with the use of Statistica 6 software. They are presented as median, 25th and 75th percentiles (Me[25%;75%]). The difference between the groups wasregarded as statistically significant at p
Experience with sitagliptin (the first DPP-4 inhibitor) application to the treatment of type 2 diabetes mellitus in the Russian Federation:Results of the DIA-DA observation program
Authors: Shestakova Marina Vladimirovna
Published: November 2013

This paper reports results of the DIA-DA observation program designed to study the efficacy and safety of the DPP-4 inhibitor sitagliptin added tometformin therapy in different regions of the Russian Federation. The study included 923 patients with DM2 (mean duration 4.5 years) uncontrolledby diet and metformin monotherapy. They were transferred to the combined treatment with sitagliptin and metformin during 6 months. The mainend-points assessed in the study were hypoglycemic efficiency, frequency of side-effects, and satisfaction of patients and physicians with the treatment.The target HbA1c level
Efficacy and safety of metformin-sitagliptin combination for the treatment of patients with diabetes mellitus and obesity
Authors: Ametov Alexander Sergeevich , Pakus Elena Nikolaevna
Published: November 2013

Aim. To elucidate therapeutic effect of metformin-sitaglitin combination on the dynamics of indices of insulin resistance and functional activity of pancreaticbeta-cells, lipid metabolism and body weight in patients with type 2 diabetes mellitus (DM2) and obesity. Materials and methods. The study included 32 patients treated by a combination of metformin (500-2550 mg/day) and sitagliptin (100 mg) for18 weeks. Standard parameters of carbohydrate and lipid metabolism, body mass index (BMI), blood adiponectin and leptin levels were measured, indices of insulin resistance and functional activity of pancreatic beta-cells were calculated. Results. Therapy with metformin-sitagliptin combination ensured compensation of fasting and postprandial hyperglycemia, reduced HbA1c level, increasedfunctional activity of beta-cells, decreased peripheral insulin resistance and BMI, had beneficial effect on lipid metabolism and hormonalactivity of adipose tissue. Conclusion. Metformin-sitagliptin combination can be recommended as a clinically efficacious modality for the treatment of patients with diabetesmellitus and obesity.
The level of glycemia as a risk factor of cardiovascular diseases
Authors: Mkrtumyan Ashot Musaelovich
Published: November 2013

The paper deals with the main aspects of pathogenesis of cardiovascular diseases in patients with disturbed carbohydrate metabolism. Results of theADVANCE study are presented that confirm the importance of intensive control of glycemia for the reduction of the overall risk of diabetic complicationsand death from cardiovascular pathology.
Vildagliptin and its role in the treatment of diabetes mellitus
Authors: Khalimov Yury Shavkatovich
Published: November 2013

Type 2 diabetes mellitus is a most serious medical problem throughout the world. Traditional hypoglycemic agents do not ensure long-term control ofglycemia and fail to affect the natural course of DM. An ideal hypoglycemic medicine must be efficacious, safe, and convenient to use for the preventionof progressive deterioration of beta-cell function during prolonged therapy; also, it should have positive effect on the outcome of DM. The use of incretinsin the recent decade is a new promising approach to the management of DM2. The group of incretins includes gastrointestinal hormones released inresponse to food intake to stimulate insulin secretion. Dipeptidyl peptidase-4 (DPP-4) inhibitors, a new class of hypoglycemic agents, have been inuse in this country for over 3 years. Vildaglyptin (Galvus) is a representative of DPP-4 inhibitors and GalvusMet is the sole combination of DPP-4inhibitor with metformin registered in Russia. The advent of incretin mimetics necessiatate revision of national and international guidelines for DM2therapy. Results of international clinical studies show that Galvus and GalvusMet are efficacious and safe, they ensure adequate control of glycemiafree from complications and side effects. An important advantage of these preparations is the possibility of their use by elderly patients with arterialhypertension and moderate renal dysfunction and by those at risk of cardiovascular disorders. The evidence-based Galvus information is highly convincing.The advantages of Galvus over traditional agents give reason to recommend it as a medicine of choice for the initiation of DM2 therapy. Approvedcombinations of Galvus with other hypoglycemic agents may be used at all stages of intensive therapy of DM2.
Vildagliptin: the first innovative DDP-4 inhibitor
Authors: Villkhauer Edvin
Published: November 2013

A review of the main stages of investigation undertaken by Novartis Pharmaceuticals in search of a new molecule for the treatment of type 2 diabetesmellitus, dipeptidyl peptidase-4 (DPP-4) inhibitor (Vildaglyptin). The data on specificity and selectivity of the action of this molecule are presentedalong with the results of its comparison with another agent of this group (sitagliptin).
Acute coronary syndrome in patients with type 2 diabetes mellitus: analysis of Russian hospital care
Authors: Erlikh Aleksey Dmitrievich , Gratsianskiy Nikolay Andreevich
Published: November 2013

Aims. To analyze basic clinical characteristics, inhospital therapeutic approaches and outcomes in patients with acute coronary syndrome(ACS) and diabetes mellitus (DM). Materials and methods. Patients were included in this study according to the protocol, established for Russian ACS Registry (RECORD),based on data from 18 hospitals operating in 13 Russian cities. Results. 796 patients took part in the current study. 15.6% reported diagnosis of DM at admission. We observed positive correlationbetween initial glycemic levels and presence of DM (r=0.43; р
Role of distal diabetic polyneuropathy in the development of media calcification in patients with diabetesmellitus
Authors: Molitvoslovova Natalya Alexandrovna , Galstyan Gagik Radikovich
Published: November 2013

Arterial media calcification is a common finding in diabetes mellitus (DM) and is associated with distal symmetric neuropathy. Arterialcalcification also emerges as a complication of chronic kidney disease and is considered to be a risk factor for cardiovascular andgeneral morbidity. "Calcification" is actually not an accurate term, because morphologic alterations also include bone tissue formationor "ossification". Both processes are complex and exist in tight connection with bone homeostasis. Connection between distal symmetricneuropathy and arterial calcification suggests that neuropathy may be an independent risk factor for cardiovascular morbidity.
Statins and diabetes mellitus: price of collaboration
Authors: Aleksandrov Andrey Alexeevich , Yadrikhinskaya Maria Nikolaevna , Kukharenko Svetlana Semenovna , Shatskaya Olga Alexandrovna
Published: November 2013

It is now well established that clinical use of statins for primary and secondary prevention of cardiovascular complications in patientswith diabetes mellitus (DM) increases life expectancy. At the same time, meta-analysis of major randomized trials shows statins to increaseglycemic levels and incidence of diabetic symptoms, especially in patients at risk for developing glycemic disorders. However,comparison of positive and negative effects of statins suggests prevalence of clinically beneficial factors.
Insulin pump therapy in children with diabetes mellitus: practice of Krasnoyarsk Krai
Authors: Taranushenko Tatiana Evgen'evna , Panfilova Viktoriya Nikolaevna , Terent'eva Oksana Alekseevna , Koreshkova Nadezhda Dmitrievna , Petrova Maria Nikolaevna
Published: November 2013

Aim. To summarize practical experience of insulin pump therapy (IPT) in child population of Krasnoyarsk and to assess its efficacy for treatment of type 1 diabetes mellitus (T1DM) in paediatrics. Materials and Methods. We performed a comparative analysis of clinical and laboratory data from 48 children with T1DM prior to and after 6-12 months of IPT. Results. IPT yielded fourfold decrease in complaints of hyperglycemia and labile glycemia without concurrent increase in reports of severe hypoglycemia.  We observed a trend for lowering of mean HbA1c levels, where 65% of patients showed positive dynamics in comparison with the period of multiple daily injection regimen. Interestingly, after 6-12 months of IPT, insulin requirement dropped in most patients. Conclusion. Our data support clinical efficiency and safety of IPT, as well as superiority of this treatment over multiple daily injection regimen. We conclude that IPT is a treatment of choice for children with T1DM.
Compromised calcium and phosphorus metabolism in patients with diabetes mellitus and chronic kidney disease
Authors: Biragova Margarita Stanislavovna , Gracheva Svetlana Alexandrovna , Martynov Sergey Andreevich
Published: November 2013

Disturbance of bone and mineral metabolism (BMM) is one of manifestations of chronic kidney disease (CKD), but its significance goes beyond bone disorders per se. Current discourse is as broad as to include vascular calcification, anemia and arterial hypertension, - conditions increasing mortality in patients with CKD. In this regard the active search for and development of novel approach to correction of BMM is under way. Apart from capacity to normalize calcium and phosphorus metabolism, parathyroid hormone secretion and to reduce morphologic alterations of bone tissue, modern therapeutic agents feature cardio- and renoprotective capabilities, which make them a treatment of choice for compromised BMM in CKD.
Individual stepwise intensification of insulin analogue therapy in type 2 diabetes mellitus
Authors: Ametov Alexander Sergeevich , Chernikova Natalya Al'bertovna
Published: November 2013

Article reviews basic steps and regimens of insulin analogue therapy intensification in patients with type 2 diabetes mellitus (T2DM). Intensification of insulin therapy is commonly implemented by supplementation of basal insulin with prandial before breakfast, lunch and dinner. Updated EASD/ADA guidelines (August 2012) recommend individual stepwise intensification of T2DM insulin therapy. Application of insulin analogues simplifies diabetes training and patient self-monitoring.
Islet cell transplantation
Authors: RICORDI CAMILLO
Published: November 2013

The discovery of insulin changed the course of history in the treatment of diabetes. However, despite tremendous progress in insulin formulations and treatment strategies, insulin treatment still cannot fully prevent chronic complications and intensive insulin treatment to improve metabolic control, has often paralleled an increased risk of severe hypoglycemia. A cure for Type 1 diabetes should include: ? Restoration of self tolerance, to prevent recurrence of autoimmunity ? Restoration of physiologic metabolism by replacement of the biologic function (insulin producing cells) that was partially of completely impaired as a result of the disease process. ? Prevention of destruction of the new insulin producing cells by the recipient immune system in the absence of any treatment that could introduce an additional risk to the patient, which could be comparable to, or higher than the risk imposed by disease progression under exogenous insulin treatment. Pancreatic islets could be considered an ideal and more physiologic alternative to insulin, as they can restore metabolic control after transplantation, preventing the development of chronic complications. In fact, islets are capable of perfectly timed insulin release and can keep glucose levels in the normal range, functioning for an entire lifetime, if they are not destroyed by the recipient's immune system. Significant progress has been recently reported in the translational research approach towards the development of a cure for Type 1 diabetes. There is now strong evidence for the technical feasibility of human islet isolation and purification procedures. Proof of function of isolated human islets has been clearly established both in animal models and in pilot clinical trials of human islet allotransplantation in patients with surgical and Type 1 diabetes. Additional research in now needed to improve the current clinical results in terms of long term prevention of rejection and recurrence of autoimmunity, the development of safe, non diabetogenic immunomodulation strategies and ultimately the achievement of donor specific immune tolerance. If success will be achieved in these areas, then we will face the critical challenge of identifying sufficient and suitable sources of insulin producing tissue to treat the increasing number of patients who could benefit from this form of therapy and which would not be limited to Type 1 diabetes. That is why the work on xenogeneic islets, embryonic and adult stem cells, islet regeneration and proliferation, as well as engineering of insulin producing cells must be continued, to identify the most ideal source of insulin producing tissue that could be utilized on a large scale once the impediments and limitations of immunosuppression will be resolved.
Imunnological status in patients whis type 2 diabetes mellitus
Authors: Belyakova Natalya Alexandrovna , Rudenko Evgenia Vladimirovna , Mikhaylova Daria Gennad'evna , Egorova Elena Nikolaevna , Nekrasova Elizaveta Georgievna , Gogina Elena Dmitrievna
Published: November 2013

Aim. To elucidate peculiarities of autorosette formation (ARF), immunological status and associated factors in patients with type 2 diabetes mellitus. Materials and methods. The study included 148 patients with DM2 and 63 practically healthy subjects. The following parameters were measured:the number of autorosettes in peripheral blood, C-reactive protein level, and humoral immunity (from blood immunoglobulin levels); spontaneousand induced TNB tests were performed. Results. Patients with DM2 suffered disturbances of carbohydrate metabolism and had an elevated number of autorosettes in peripheral blood, dysimmunoglobulinemia,increased level of acute phase protein, impaired functional activity of neutrophils. Conclusion. Intensity of ARF increases with duration of DM2 and a rise in AP. Patients with long-standing severe DM2, AH, micro- and macroalbuminurea,hyperglycemia, and triglyceridemia experience deterioration of immunological status.
The influence of high glucose concentration on the ability of mesenchymal stromal cells to stimulate blood vessel growth
Authors: Akopyan Zhanna Alekseevna , Sharonov Georgy Vladimirovich , Kochegura Tatiana Nikolaevna , Il'yashenko Natalya Fedorovna , Belyanko Igor Eduardovich , Dimitrova Valentina Ivanovna , Zotikov Andrey Evgen'evich , Kalinina Natalya Igorevna , Parfenova Elena Viktorovna
Published: November 2013

Adipose issue is a source of mesenchymal stem cells (MSC) that can be used to stimulate blood vessel growth in ischemic tissues. Various metabolicdisorders including hypeglycemia may have negative effect on therapeutic properties of these cells. Aim. To study the influence of high glucose concentration on functional activity in human adipose tissue. Materials and methods. Flow cytometry and real time PCR were used to study functional activity of cultured MSC from human adipose issue at highglucose concentration. Results. Prolonged (10-12 days) incubation at a high glucose concentration (25 mM) suppressed the ability of MSC to stimulate angiogenesis. Also,glucose modified expression of genes activating and inhibiting angiogenesis but had no effect on MSC proliferation and apoptosis. Conclusion. High glucose concentration suppresses angiogenic activity of MSC in adipose tissue; it may account for incomplete restoration of bloodflow in diabetic patients.
Thymus in children with type 1 diabetes mellitus
Authors: Sirotina Olga Borisovna
Published: November 2013

Aim. To determine size structure and blood circulation of thymus in children with type 1 diabetes mellitus (DM1) by ultrasound.We have undertaken an ultrasonic study of thymus in 62 children aged 4-17 years with DM1 to determine its size, structure and bloodcirculation. Results.It was shown for the first time that the thymus of DM1 children is enlarged and fairly well visualized unlike that in agematchedhealthy patients in whom it is much smaller due to age-related involution and substitution of the thymic tissue by adipose one. Colorand energetic Doppler mapping showed perfect vascularization of the thymus in DM1 children compared with healthy patients in whom thismethod failed to map blood flow due to the substitution of the original thymic tissue by parenchymal and adipose tissues and dropout of bloodvessels. Conclusion the study for the first time gave evidence that thymus, the main immunogenic organ (conductor of the immune system),undergoes age-specific changes of size and structure whereas DM1 of autoimmune etiology precludes its involution.
Renal functional reserve and tubular function in patents with type 2 diabetes mellitus
Authors: Khakimova Dilyara Makhmutrievna , Maksudova Adelya Nailevna , Salikhov Il'dar Gazimdzhanovich
Published: November 2013

Aim. To study renal functional reserve and partial functions in patents with type 2 diabetes mellitus in the absence of renal lesionsMaterials and methods. We examined 42 patients (17 men and 24 women) aged 38-69 (mean 49.8?8.3) years with DM2 4.6?2.6 yr in duration.Control group comprised 32 practically healthy subjects. Intrarenal hemodynamics was estimated from RFR values. Ethanolamine, uric acid, Ca,and P levels were measured in sera and 24-hr urine; daily excretion of ammonia and aminonitrogen in the urine was determined. Results. The patients were divided into 2 groups based on the results of RFR measurement. FRF remained unaltered in 21 patients (mean 60.7?27.6%)and decreased in the absence of filtration reserve in 20 (-25.8?23.4%). Correlation analysis revealed the relationship of lipid metabolism and abdominalobesity with the renal tubular function and intraglomerular hemodynamics. Conclusion. Examination of DM2 patients without clinical and laboratory signs of renal lesions revealed compromised function of all nephron compartments,viz. intraglomerular hypertension, impaired stability of renal cell membranes, and tubular dysfunction. The latter is related to hemodynamic disturbances.
Is it possible to achieve a safe glycated hemoglobin level during intensive hypoglycemic therapy? (results of ADVANCE study)
Authors: Shestakova Marina Vladimirovna , Shamkhalova Minara Shamkhalovna
Published: November 2013

Aim. To study efficacy of glycemic control in terms of reduced HbA1c level using glyclazide modified release (MR) in patients with DM2 and differentclinical characteristics at the initial stage of therapy in the framework of ADVANCE study (Action in Diabetes and Vascular Disease: Preterax andDiamicron Modified Release (MR) Controlled Evaluation). Materials and methods. A total of 11140 patients aged 55 years or older with DM2 and one or several cardiovascular risk factors were randomized forthe study. They were randomly distributed between 2 groups, one to receive intensive hypoglycemic therapy with glyclazide MR the other to be treatedin a standard mode as recommended by local, regional or national guidelines after a 6 week introductory phase. The efficacy of therapy was assessedbased on the following criteria: absolute change in HbA1c level (difference between the last and the first values obtained during the randomizationperiod), real HbA1c level achieved, percent of patients with target HbA1c level (
Organoprotecive effects of angiotensin II receptor blockers in patients with type 2 diabetes mellitus
Authors: Yarek-Martynova Ivona Yanovna , Shamkhalova Minara Shamkhalovna
Published: November 2013

High prevalence of arterial hypertension and related cardiovascular complications dictates the necessity of preparations possessed of markedorganoprotective activity and good tolerability. The currently available data suggest advantages of iACE and ARB as preparations for the treatmentof cardiovascular diseases such as ability of iACE to improve clinical picture and outcome of therapy of cardiac insufficiency, left ventricle dysfunction,and myocardial infarction. Large-scale prospective studies demonstrated effectiveness of these agents in the treatment of CHD, stroke, diabetes, renalpathology and revealed their additional advantages attributable to inhibition of angiotensin II secretion other than those related to reduction of AP.These studies gave evidence of a more pronounced decrease in the frequency of cardiovascular events under effect of ARB in high-risk patients. However,protective action of ARB on the cardiovascular system compared with that of iACE and combination of ARB+iACE awaits an in-depth study.
Metformin effects to carbohydrate and lipids metabolism in impaired glucose tolerance patients.
Authors: Dreval' Alexander Vasil'evich , Misnikova Inna Vladimirovna , Trigolosova Irina Vladimirovna , Tishenina Raisa Stepanovna
Published: November 2013

Aim of this study was to investigate the effect metformin to carbohydrate, lipids metabolism and leptin level in impaired glucose tolerance (IGT)patients.Methods. 16 patients with IGT were studied. Age of participant was 55.1?8.2 yrs. All patients was divide into two groups: treatment group (bagomet1700 a day and diet) and control group (only diet). Effect of therapy was access in HbA1c, fasting glucose (FG), HOMA, lipids, liver glucose production(LGP) and leptin, which investigate in intravenous glucose tolerance test (IVGTT). Results. Normalization of carbohydrate metabolism was discover in 37.5% in treatment group and in 12.5% in control group. HbA1c was decreasefrom 6.4 to 5.9 % (р
Clinical efficacy of oxidative stress correction by actovegin in diabetic polyneuropathy at type 2 diabetic patients with arterial hypertension
Authors: Gorshkov Ivan Petrovich , Zoloedov Vladimir Ivanovich , Volynkina Anna Petrovna
Published: November 2013

Aim. To study Actovegin efficacy in oxidative stress (OS) correction at diabetic polyneuropathy (DPN) in patients with diabetes mellitus type 2 (DM2)and arterial hypertension (AH).Materials and Methods. 51 patients (24 women and 27 men) aged 53.4?0.7 with the average duration of DM2 5.6?0.2 years, DPN - 4.9?0.2years and AH - 6.0?0.2 years were examined. Daily albuminuria, glomerular filtration rate (GRF) were evaluated, standard methods for diagnosisof DPN were used. 26 patients took Actovegin therapy during 6-8 weeks, the rest 25 patients were in the control group. Parameters of the OS werestudied. Results. The increase of total oxidative capacity, the decrease of total antioxidant capacity and the rise of levels of antibodies to oxidated LDL wererevealed in patients with DM2, DPN and AH. Antioxidant and anti-hypoxic effects of 400 mg/day of Actovegin were established in this group of patients.Conclusions. Actovegin impacts oxidative stress parameters and improves the clinical manifestation of diabetic polyneuropathy.
The frequency of hypoglycemia and cardiovascular disorders during therapy with sulfonylureas compared with other secretagogues: a systematic review
Authors: Zilov Aleksey Vadimovich , Morgunova Tatiana Borisovna , Terekhova Anna Leont'evna
Published: November 2013

In this systematic review the analysis of hypoglycemia and cardio-vascular events was analyzed due to therapy by SU and other secretagenes. Accordingto more then 1400 publications from 1984 to 2009 there is no clear data of increasing hypoglycemia and cardio-vascular events by using micronisedglibenklamide (glyiburide) in comparison to other medications.
Male reproductive function in diabetes mellitus
Authors: Rozhivanov Roman Viktorovich , Parfenova Natalya Sergeevna , Kurbatov Dmitriy Gennad'evich
Published: November 2013

This article is designed to discuss data on diabetic complications negatively affecting male fertility, such as retrograde ejaculation and secondary hypogonadismthat frequently occur in patients with diabetes mellitus. It has been shown that 5 - 10% of the DM1 patients present with retrogradeejaculation associated with long-term decompensation of carbohydrate metabolism. Over 40% of the patients with DM2 have decreased total andfree testosterone levels regardless of compensation of carbohydrate metabolism. These complications are managed using neurotropic therapy (retrogradeejaculation) and stimulatory hormonal therapy (secondary hypogonadism).
Topical problems of diabetes treatment during pregnancy
Authors: Demidova Irina Yur'evna , Arbatskaya Natalya Yur'evna , Mel'nikova Elena Petrovna
Published: November 2013

The main causes behind decompensation of diabetes mellitus (DM) in pregnant women are consid-ered, such as metabolic and hormonal disturbancesinfluencing insulin requirement in different periods of pregnancy and variability of glycemia related to pharmacokinetic and pharmacodynamicproperties of insu-lin preparations. Recommended target levels of glycemia in pregnant women with DM are cited. The fre-quencyof self-monitoring blood glucose and principles of intensive insulin therapy are discussed. Advan-tages of continuous subcutaneous insulin infusionand its role in the maintenance of stable control of car-bohydrate metabolism during pregnancy are discussed.
Genetic markers of insulin resistance in gestational diabetes
Authors: Sebko Tatiana Vasil'evna , Dobrokhotova Yulia Eduardovna , Ivanova Tatiana Alekseevna , Nosikov Valery Vyacheslavovich , Osipova Tatiana Alekseevna , Potapov Victor Andreevich
Published: November 2013

Aim. To search for genetic markers of insulin resistance and impaired insulin secretion in pregnant women with gestational diabetes mellitus (GDM). Materials and methods. A total of 100 healthy pregnant women and 185 patients with GDM were available for examination. 80 patients developedGDM during current pregnancy, in 105 it was diagnosed 4-19 years ago. 25 of the 105 GDM patients had a history of type 2 DM. The following parameterswere measured: beta-cell secretory activity (proinsulin, ITI, C-peptide), total cholesterol (CH), HDL and LDL CH, triglycerides, HbA1c,fasting glycemia. Molecular-genetic DNA testing using PCR included studies of KCNJ 11, TCF7L2, PPARG2, ADIPOQ, ADIPOR1, ADIPOR2gene polymorphism. These genes were chosen based on the published data associating them with disturbed insulin secretion and sensitivity in DM2patient. Results. Pregnant women with GDM and obesity showed elevated IRI and leptin levels compared with controls. This rise was accompanied bymarked insulin resistance in 75% of these patients. In 50% of the healthy women proinsulin and insulin secretion decreased. Obesity in pregnantpatients was associated with significant elevation of proinsulin, IRI, and C-peptyide levels and GDM with Lys/Lys genotype of polymorphous markerGlu23k of KCNJ11 gene, pro and ala allele of polymorphous marker A219T of ADIPOR2 gene. These associations suggest specific genetic featuresof GDM related to impaired insulin secretion and sensitivity. Conclusion. Studies of common genetic nature of GDM and DM2 permit to identify risk groups at the preclinical stage, plan prevention and treatmentof these disorders.