Diabetic retinopathy: history, modern approaches to management, prospective views of prevention and treatment

Diabetic retinopathy (DR) is a serious complication of diabetes mellitus (DM). As DR progresses, it could be complicated with a significant decrease or complete loss of vision. It is the leading cause of blindness in the working-age population and, according to global estimates, occurs in one in every three patients with diabetes. DR has been studied for more than 160 years, and the implementation of retinal laser coagulation into clinical practice in the 20th century, and then vascular endothelial growth factor (VEGF) inhibitors in the 21th century, allowed us to influence vascular proliferation in DR and reduce the risk of vision loss from diabetic macular oedema (DME). However, these tools can only stop the progression of DR at the stages with risk of complications with vision loss, and prevention – screenings and the impact on risk factors (hyperglycaemia, arterial hypertension, and dyslipidemia) – remains as the main method of management of DR. Possible new risk factors (hypodynamy, obesity, body weight deficiency, and obstructive sleep apnoea syndrome) attract a lot of attention, and there is ongoing research for early markers of DR in the fundus, which could allow more active influence on the pathological process in its early stages. This review focuses on epidemiology, history of research, proven and possible risk factors, and current and promising approaches to the prevention and treatment of DR, including accurate, less traumatic laser techniques (PASCAL, NAVILAS, and D-MPL), and intravitreal antiangiogenic drugs in studies

Non-alcoholic fatty liver disease and type 2 diabetes mellitus: the problem of conjunction and phasing

The widespread prevalence of non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM), as well as their combination, determines the need for a targeted analysis of this pathology in order to optimize approaches to the diagnosis and treatment of patients with NAFLD and T2DM. As components of the metabolic syndrome, these two diseases have largely similar mechanisms of development and progression, simultaneously increasing the risk of adverse outcomes in comorbid patients. Despite the common pathophysiological mechanisms, the question of the development of NAFLD and T2DM remains significant.Upon conducting literature analysis, two main theories have been identified: alimentary and metabolic. According to the alimentary theory, the primary link in the pathogenesis is obesity and the associated excessive accumulation of free fatty acids and triglycerides in the liver, which subsequently leads to insulin resistance and the development of T2DM. In contrast, the metabolic theory considers diabetes-related insulin resistance as the first hit, which, regardless of obesity, creates preconditions for liver damage. In addition, the review focuses on the consideration of the new concept of Metabolic associated fatty liver disease (MAFLD) as a hepatic manifestation of the metabolic syndrome and considers the clinical phenotypes identified within this pathology. In conclusion, pathogenically based treatment goals in patients with NAFLD and T2DM are overcoming insulin resistance, correcting atherogenic dyslipidemia, and restoring the structures and functions of liver cells

Special aspects of concentrated insulins: basic characteristics and research findings

The appearance of concentrated insulins in clinical practice determines the need to analyze product priorities in appropriate groups of patients with diabetes. The aim of this article is to summarize the literature on concentrated insulins (i.e. insulin lispro 200 units/mL, insulin degludec 200 units/mL, insulin glargine 300 units/mL) from randomized controlled trials, derive guidance on appropriate and safe use of these agents and demonstrate experience in real clinical practice. Severe hypoglycemia in all studies was generally low (though higher with prandial plus concentrated basal analogue therapy), and statistical improvements in other hypoglycemia categories were observed for concentrated basal insulins versus insulin glargine 100 units/mL. In all analyzed data hypoglycemic effect of insulin glargine 300 units/mL was equitable to insulin glargine 100 units/mL. Other important findings demonstrate more constant and prolonged insulin action with low within-subject/ between-day variability for insulin glargine 300 units/mL versus insulin glargine 100 units/mL, therefore, more physiological treatment might prevent from diabetic microvascular complications. The results of randomized trials are comparable with our clinical practice experience and indicate efficacious and safe glucose-lowering properties without risk of severe hypoglycemia

Prediabetes. A new paradigm for early prevention of cardiovascular disease

This literature review focuses on the association of prediabetes with cardiovascular disease (CVD). Recently, much attention has been paid to the study of prediabetes due to its extremely high prevalence and strong association with a high risk of developing serious complications that worsen the quality of kife of patients. Prediabetes is not only a metabolic condition with a high risk of developing type 2 diabetes mellitus (T2DM), but also CVD and death from all causes. This association is true for both patients who do not yet have CVD and those with a history of CVD. Also during the COVID-19 pandemic, attention is drawn to the fact that people with prediabetes have a higher risk of a severe course of infection, complications and a worse prognosis of the disease. This is associated with hyperglycemia, the  presence of  chronic systemic inflammation of  a  low degree of  activity, impaired immune response mechanisms and a procoagulant state in patients with prediabetes, although these disorders are less developed than in patients with T2DM. Therefore, early screening of early disorders of normal metabolism. Since active early intervention at the stage of prediabetes helps to prevent the development of type 2 diabetes and CVD

APPLICATION FEATURES OF FUZZY CONTROLLERS ON EXAMPLE OF DC MOTOR SPEED CONTROL

A prerequisite for the use of intelligent control methods, including algorithms of fuzzy logic, is increasing complexity in all industries, especially when parameters of technical systems while in operation vary in wide range. The paper provides comparative analysis of the basic types of common fuzzy direct action controllers on the example of speed control system in the DC motor drive. Design features of these types of fuzzy controllers are shown. Their comparison with traditional PI controller is carried out through the use of simulation, including the conditions of uncertainty expressed in changing of equivalent moment of inertia of the motor shaft. As a result, the conclusion about the feasibility of fuzzy PID-type controller application is made. The features of fuzzy controllers outlined in the paper can be summarized to more complex motor drive systems and to other non-linear systems that require the maintenance of any parameter within a given range

Gut microbiota is an endocrine organ

The gut microbiota affects the processes of food digestion, intestinal peristalsis, controls the work of the intestinal epithelium, has protective properties against pathogenic microorganisms, activating local immunity and stimulating the secretion of mucus by intestinal cells. Besides the gut microbiota participates in the metabolism of proteins, fats and carbohydrates, mediates the processes of gluconeogenesis, glycogenolysis, lipogenesis and lipolysis, and affects on feelings of hunger and satiety. All these processes occur because the gut microbiota produces active metabolites throughout their life activity. Gut microbiota and active metabolites of the gut microbiota activate the synthesis of hormones. The gut microbiota affects the synthesis of hormones such as glucagon-like peptide-1, glucagon-like peptide-2, YY-peptide, glucose-dependent insu-linotropic peptide, ghrelin, leptin, cholecystokinin, serotonin, and insulin. Disturbance of the secretion of these hormones is one of the links in the pathogenesis of endocrine diseases such as diabetes and obesity. Thus, the gut microbiota is an endocrine organ. Changes in the composition and functions of the gut microbiota lead to metabolic disorders.This article describes the effect of gut germs and active metabolites of the gut microbiota on the synthesis hormones by means of receptor mechanisms, genes, and enzymes

Геном ділової досконалості і ділова культура виробничої організації-основа культури виробничих відносин суспільства

The genome of business excellence and business culture of the production organization – the basis of the culture of production relations of societyОцінка ефективності функціонування будь-якої системи управління та її відповідність сучасним вимогам повинна мати узагальнений критерій, необхідну кількість ефективних інструментів вимірювання та регулювання процесів. Такий критерій необхідний для аналізу оптимальності цієї системи та прогнозування напрямку її модифікації. Найбільш доцільним або оптимальним способом управління буде такий, при якому критерій якості управління досягає заданого значення. Управління виробничою будівельною організацією - це система людина-машина, в якій остаточні рішення приймаються керівниками на відповідному рівні. Тому міру "ентропії" такої системи неможливо розрахувати математично абсолютно точно, але її потрібно передбачити та спланувати. Сьогодні термін "ентропія" може бути використаний як теоретичний захід для аналізу та проектування систем людина-машина. Закон Больцмана діє не тільки в мікро світі, молекулярній фізиці, але і в інформатиці та соціальних системах. Відсутність можливості точної формалізації загального критерію функціонування системи свідчить про те, що будь-яка суворо формалізована модель має меншу різноманітність, ніж сама система. Як результат, система управління організацією, побудована за вищевказаною моделлю, не буде виконувати своїх функцій, якщо в неї не вбудована людина, як стохастичний, але свідомий, мислячий, керуючий елемент методології формалізованих планових розрахунків. Таким чином, для успішного функціонування будь-якої сучасної системи управління виробництвом повинна включатись людина як ланка, що забезпечує життєздатність усієї системи та реалізацію функції самоорганізації. Важко точно виміряти параметри та взаємний вплив факторів та елементів системи всередині організації, особливо визначити величину зовнішніх сил. Щоб створити геном досконалості або стійку досконалу модель діяльності, необхідно на науковій основі відібрати людей, що мають потрібні здібності та характери, і сформувати ефективні організації. Досвід впровадження систем управління якістю та моделей досконалості організацій показує, що зрештою персонал вирішує все, формує і зберігає ділову культуру-геном організації і впливає на характер і якість виробничих відносин, які встановлюються законами економічних формацій і державними нормами

Tuning Pt characteristics on Pt/C catalyst for aqueous-phase reforming of biomass-derived oxygenates to bio-H-2

Pt/C catalysts with varied Pt sizes and distributions were investigated for aqueous-phase reforming (APR) of ethylene glycol (EG) to H2. APR experiments were performed on a continuous-flow fixed bed reactor with a catalyst loading of 1 g and EG feeding of 120 mL h−1 at 225 °C and 35 bar for 7 h. The fresh and used Pt/C catalysts were characterized by XRF, BET, CO chemisorption, TEM, XTEM, and XPS. Catalyst preparation protocols changed Pt characteristics on Pt/C catalysts, leading to a distinguishable H2 production. The rates for EG conversion and H2 production increased linearly with mean Pt size (3–11 nm), while having a volcano relationship with the mean size of agglomerated Pt particles (17–30 nm). Pt with concentrated Pt particles on surface of Pt/C catalysts was more preferable for APR of EG than the homogeneously distributed in catalysts. Optimal performance was obtained over a Pt/C-PR catalyst, which was prepared by precipitation method, showing a superb turnover frequency of 248 molH2 molPt−1 min−1 for H2 production from EG in APR. Besides, Pt/C catalysts also showed excellent stability. These results have shown the promise of Pt/C catalyst for APR of EG, which can be extended for bio-H2 production via APR of biomass-derived oxygenates in waste streams

Clinical characteristics of patients with COVID-19 depending on the treatment received and the presence of type 2 diabetes mellitus

BACKGROUND. Type 2 diabetes mellitus (T2DM) is an independent risk factor for adverse clinical outcomes in patients with Covid-19. There is currently insufficient data evaluating the efficacy and safety of drugs for the treatment of COVID-19, especially in patients with T2DM.AIM. The aim of study was to identify an associative relationship between the drugs used and the clinical outcomes of patients with Covid-19 and T2DM.MATERIALS AND METHODS. A retrospective analysis of the clinical outcomes of 1753 patients with COVID-19 who were hospitalized to the redesignated departments of multidisciplinary city clinical hospital in the period from 23.03.2020 to 01.06.2020.RESULTS. The total number of patients is 1,753, of which 311 (17.7%) are patients with DM2. 92.6% of patients received treatment for COVID-19. At the same time, 91.4% of patients received antibiotics (a/b), 61.5% — bronchodilators, 56.6% — injectable anticoagulants (a/c), 45.2% — hydroxychloroquine, 6.3% — antiviral drugs, 5.4% — oral a/c, 4.6% — glucocorticosteroids (GCS), 1.9% — Tocilizumab.Decrease of risk of death among patients with COVID-19 was as the therapy of a/b (OR 0.07, 95% CI 0.05–0.11, p<0.05), bronchodilators (OR 0.12, 95% CI 0.08–0.18, p<0.05) and injection a/c (OR 0.47, 95% CI 0.34–0.67, p<0.05). At the same time, among patients with DM2, compared with patients without DM2, there was a more pronounced reduction in the risk of death during injectable a/c therapy: among patients with DM2, the risk of death decreased by 2.6 times (OR 0.39, 95% CI 0.21–0.73, p<0.05), among patients without DM2 — by 2.1 times (OR 0.47, 95% CI 0.31–0.71, p<0.05). Antiviral drugs was associated with an increased chance of death among patients without DM2 (OR 2.64, 95% CI 1.44–4.86, p<0.05) and among patients with DM2 (OR 4.98, 95% CI 2.11–11.75, p<0.05).CONCLUSION. A significant decrease of the risk of death among patients with COVID-19 was as the therapy of a/b, bronchodilators, and injectable a/c. An increase of the risk of death was observed during therapy with antiviral drugs

Klinefelter syndrome mosaicism in boys with neurodevelopmental disorders: a cohort study and an extension of the hypothesis

Our study provides data on the occurrence of KSM in neurodevelopmental disorders among males. Accordingly, it is proposed that KSM may be a possible element of pathogenic cascades in psychiatric and neurodegenerative diseases. These observations allowed us to extend the hypothesis proposed in our previous report on the contribution of somatic gonosomal mosaicism (Turner’s syndrome mosaicism) to the etiology of neurodevelopmental disorder