Hypogonadism and visceral obesity in men are full–fledged components of the metabolic syndrome

Hypogonadism in men can cause the development of obesity, primarily abdominal, associated with high cardio-metabolic risks. Chronic obesity, in turn, almost inevitably leads to the manifestation of hypogonadism, which requires treatment and aggravates cardiovascular risks. Testosterone therapy, prescribed according to indications, has a significant positive effect not only on a man’s sexual function, but also on body weight, carbohydrate and lipid metabolism, bone metabolism and the emotional component of men’s health. The improvement of many metabolic parameters in men with verified hypogonadism occurs against the background of fairly long-term testosterone therapy. Hypogonadism and visceral obesity are now considered as components of the metabolic syndrome, mutually burden each other and require a comprehensive therapeutic approach

Specific features of entrepreneurial departments management in Russian companies

The topic is considered to be relevant due to the fact that entrepreneurship is necessary for the businesses survival and development worldwide, including Russia, and today some Russian companies are adapting their economies to the more developed economic standards. The entrepreneurial format adoption is an important stage of development for possible changes and growth in the future. The aim of this research work is to analyze some approaches to the phenomenon of entrepreneurship, to determine some specific features of entrepreneurial departments, including in the context of the Russian business space, and to study specific characteristics of these departments management in Russian companies. The main methods used in the study are the theoretical materials analysis, as well as the analysis of statistical data in the study area, the method of expert judgments, the survey method. The research work included the study of Russian entrepreneurship experience, specific features of entrepreneurial departments. The specific features of the Russian entrepreneurship were identified during the own diagnostic research, as well as some entrepreneurial difficulties caused by the entrepreneurship. Identified due to this research peculiarities of Russian entrepreneurship and difficulties of this phenomenon development in the Russian business space will allow to develop the Russian entrepreneurial business model based on its specific characteristics. On the basis of the obtained data a special mechanism can be created for the support and development of intra-entrepreneurship departments within the overall entrepreneurship management mechanism in Russian companies, where the full range of necessary organizational and economic conditions, as well as the possibilities for entrepreneurial results assessment will be presented, combined with a complete list of tools to facilitate the emergence and development of intrarepreneurship in companies. © 2016 Troshina et al

High protein diet: benefits and risks

The nature of human nutrition has become increasingly important as an effective element in the prevention and treatment of many pathologies, especially obesity, type 2 diabetes and cardiovascular diseases. High protein diets are some of the most popular eating patterns and the Dukan diet has taken the lead in popularity among the diets of this type. An increase of protein in the diet is effective in reducing body weight, primarily due to the loss of adipose tissue, without a significant effect on muscle mass. Another advantage of a high-protein diet is earlier and longer satiety compared to other diets, which makes it comfortable for use. Besides obesity, high protein diets are presumably effective for treating such diseases as nonalcoholic fatty liver disease, diabetes mellitus and cardiovascular diseases However, despite the important advantages, this nutritional model is not universal and is contraindicated in patients with diseases of liver, kidneys and osteoporosis. Besides, the prolonged use of a high protein diet may increase the risks of urolithiasis and reduced mineral bone density even for healthy individuals. Thus, the increase in the proportion of protein in the diet should take place exclusively under the supervision of a physician

The first experience of using beta-hydroxybutyrate analysis of capillary blood in the diagnosis of non-diabetic hypoglycemia in adults

Background: The diagnostic threshold of β-hydroxybutyrate (BHB) at the moment of hypoglycemia in insulinoma was developed for venous blood many years ago, when there were no alternative ways to measure ketones. Number of works, mainly on patients with diabetes mellitus, found differences in the measurement of this indicator in venous and capillary blood, but the results were contradictory. Moreover, this study was not previously used in the diagnosis of non-diabetic hypoglycemia (NDH) in adults on the territory of the Russian Federation.Aim: To estimate the effectiveness of the method for determining BHB in capillary blood and its place in the diagnosis of NDH.Materials and methods: We conducted an experimental, cross-sectional, comparative study and included patients with suspected NDH who underwent a standard fast test. The BHB level in capillary blood was determined every 6 hours during the fast test and at its completion.Results: Based on the results of the fast test, the participants (n=154) were divided into groups: with hyperinsulinemic variant of NDH and IFRoma (n=98; group 1), with hypoinsulinemic variant of NDH /absence of NDH (n=56; group 2). When comparing the level of BHB at the moment of fasting completion, significant differences were obtained between groups 1 and 2 (p<0.001). According to the ROC analysis, the determination of BHB for differentiation the hyper- and hypoinsulinemic variants of hypoglycemia is characterized by excellent quality of model (AUC=99,1% [98,0%; 100,0%]). The BHB determination in capillary blood has the maximum diagnostic accuracy at a cut-off point of ≤ 1.4 mmol/L (Se 98.0%, Sp 96.4%, PPV 98.0%, NPV 96.4%, Ac 97.4%). Exceeding the diagnostic threshold of BHB was first recorded after 24h of fasting; at the same point, a significant difference was determined when comparing BHB indicators between two consecutive measurements (between 18h and 24h).Conclusion: The BHB determination in capillary blood is a highly sensitive and highly specific additional method for the differential diagnosis of NDH variants. The diagnostic threshold for BHB of capillary blood, which allows differentiating hyper- and hypoketonemic variants of NDH, is ≤1.4 mmol / L. It is advisable to initiate control of BHB in the blood no earlier than 18 hours after the start of the fast test

Functional brain MRI in the setting of drug correction of obesity

AIMS. Study of the dynamics of brain activity using functional MRI (fMRI) in obese patients treated with sibutramine (Reduxine®).MATERIALS AND METHODS. The study enrolled patients with a body mass index (BMI) ≥30 kg/m2 . All participants underwent initial brain fMRI mapping. The obesity cohort was treated with sibutramine at a dose of 10 or 15 mg per day for 3 months. After treatment patients with obesity underwent a second fMRI mapping to assess changes against the initial mapping.RESULTS. The study included: 30 patients (86,7% women) with mean age of 31 [27.25; 36] years, mean body weight (BW)  - 106 [95.75; 121.75] kg, mean BMI 37.4 [33.55; 41.9] kg/m2 , mean waist circumference (WC) - 109 [100; 114.75] cm. The most marked activation volume (via fMRI) was observed in patients with obesity (before treatment) in the visual cortex (occipital lobes). After 3 months of treatment with sibutramine, 80% of patients lose ≥5% of BW. Mean BW decrease was -7.2 [-13.46; -5.37] kg, BMI decrease — -7.2 [-13.49; -5.34] кг/м2 , WC decrease — -6.9 [-11.88; -4.03] см, p <0,05. According to fMRI data, a  decrease in brain activation in the projection of the occipital lobes (35%), left insula (44%), and increase inactivation by 70% in the area of the left DMPF.CONCLUSION. A dynamic study of brain activity using fMRI in obese patients showed that during treatment with sibutramine, a decrease in body weight is accompanied by a decrease in activation in the projection of the occipital lobes and the left insular lobe of the brain, and an increase in activation in the area of the left DMPFC. These data may indicate a decrease in the emotional perception of high-calorie food, a decrease in motivation to eat it, and an increase in cognitive control. In general, the noted dynamics of the functional activity of the brain in obese patients against the background of obesity therapy can be regarded as a change in previously formed patterns of eating behavior

Agreement of body adiposity index (BAI), bioimpedance analysis and ultrasound scanning in determining body fat

BACKGROUND: The steadily increasing number of people with obesity requires the development of simple and accurate methodological approaches to assess the absolute and relative amount of body fat mass. The body adiposity index (BAI) is one of the indices proposed to assess the body fat percentage. However, the comparison analysis of common methods, i.e., of bio-electrical impedance analysis and ultrasound scanning, and BAI was not performed for the Russian population.AIM: Comparison analysis of the body fat percentage estimates by bio-electrical impedance analysis, ultrasound scanning, and body adiposity index in the group of adult male and females.MATERIALS AND METHODS: An examination of healthy males and females from Moscow was conducted. Height, weight, waist and hip circumferences were measured. The body fat percentage was obtained by bio-electrical impedance analysis — BIA (ABC-02 Medas), ultrasound scanning — US (BodyMetrixTM, IntelaMetrix), and body adiposity index.RESULTS: 263 females and 134 males aged 18 to 73 years participated in the study. Correlation coefficients between BAI values and the body fat percentage obtained by BIA and US were 0.749 and 0.763 (p<0.000), respectively. Comparison of body fat percentage measurements obtained by BAI, BIA and US showed the low agreement (ССС<0.90) between BAI and other methods in pooled sample as well as in the female and male groups. Comparison of the US and BAI methods revealed higher level of agreement (ССС=0.84 [0.80–0.86]) and no systematic bias. Lower level of agreement was obtained in the group of males.CONCLUSION: Conducted study allows to conclude that, at the individual level, BAI is not an appropriate method for estimating the body fat percentage relatively to other indirect methods. However, all three methods can be used in the group of pooled males and females when testing at the population level

Effect of glucocorticoids on bone metabolism in replacement therapy of adrenal insufficiency. Literature review

Adrenal insufficiency (AI) is a syndrome caused by disturbance in the synthesis and secretion of hormones of the adrenal cortex, which ensure the vital activity, energy and water-salt homeostasis. The widest hormonal deficiency is observed in primary hypocorticism, when the synthesis of not only glucocorticoids (GC) and adrenal androgens, but also mineralocorticoids is disrupted. Lifelong replacement therapy with GCs for this pathology may be associated with a risk of bone loss and osteoporosis. However, at present, there are no clear guidelines for diagnosis of bone condition, including and bone mineral density (BMD) monitoring during treatment with GCs in patients with AI. This review summarizes collected data on the key pathogenetic links of glucocorticoid-induced osteoporosis, incidence of decreased BMD and fractures in patients with AI. In this review factors that influence bone metabolism in this cohort of patients are considered: the type and the dose of prescribed GCs, the type (primary, secondary, HH in congenital adrenal cortex dysfunction) and the duration of AI, age, gender, and the presence of concomitant endocrine disorders (hypogonadism, growth hormone (GH) deficiency). In addition, the review presents data on the effect of adrenal androgen replacement therapy and recombinant GH therapy on bone metabolism in secondary AI

Transforming growth factor β1 (TGF-β1) in patients with endocrine ophthalmopathy and Graves’ disease: A predictor of treatment efficiency

Current therapeutic approaches to the treatment of endocrine ophthalmopathy (EOP) are based on nonspecific immunosuppression with glucocorticosteroids (GCs) and radiation therapy of the eye orbits. However, some patients exhibit resistance to the treatment. In a previous study, we have detected high levels of soluble cytokine receptors: sTNFα-R1, sTNFα-R2, sIL-2R, and the TGF-β1 cytokine in euthyroid patients with long-lasting non-treated EOP and Graves’ disease (GD). TGF-β1 level was significantly higher in the patients with EOP compared to healthy individuals, and increased with prolonged EOP duration, thus suggesting activation of the factors regulating immune system which promote suppression of the autoimmune process. The aim of this work was to study the dynamics of TGF-β1 and cytokine receptors: sTNFα-R1, sTNFα-R2, sIL-2R in the course of immunosuppressive therapy with high doses of GCs, as possible predictors of treatment efficacy. The study included 49 patients (98 eye orbits) with GD of euthyroid state and subclinical thyrotoxicosis, and the persons with EOP in active phase, who had not previously treatment for EOP. Concentrations of TGF-β1 cytokine, sTNFα-RI and sTNFα-R2, sIL-2R, antibodies to the thyroid-stimulating hormone receptor (rTSH), free fractions of thyroxine (fT4) and triiodothyronine (fT3), TSH in blood serum were determined in blood serum. Ultrasound examination of the thyroid gland (ultrasound of the thyroid gland), multi-layer computed tomography (MSCT)/magnetic resonance imaging (MRI) of the orbits were also performed. The patients were administered immunosuppressive therapy with high doses of HCs (methylprednisolone) in the course of pulse therapy, at a standard dosage of 4500-8000 mg, taking into account the severity and activity of the EOP clinical manifestations. The examination was carried out 3, 6, 12 months after starting the treatment. 3 and 6 months after the GC administration, more than 30% of patients remained resistant to treatment. The levels of TGF-β1 did not change significantly in the patients with positive EOP dynamics. In the patients resistant to GC treatment, the level of TGF-β1 was significantly decreased compared with patients who showed positive clinical dynamics. The level of sNFR1 and sNFaR2 did not change significantly. There were no significant differences in the levels of antibodies to rTSH, thyroid hormones in the patients resistant to GC treatment and with positive dynamics.Immunosuppressive therapy with high-dose of methylprednisolone in pulse therapy regimen showed high efficacy and good tolerability, while some patients remain resistant to treatment. Lower levels of TGF-β1 cytokine at initial time and during the treatment allow usage of TGF-β1 levels as a biomarker of the activity of the process, treatment efficiency, and prognosis of the disease. Activation of TGF-β1, a fibroblast growth factor, may contribute to the development of fibrosis, strabismus, and diplopia

Интраоперационная оценка восстановления проведения импульса по спинному мозгу у пациентов с шейной спондилогенной миелопатией

The previous studies have data concerning surgery and diagnostic methods of cervical spondylotic myelopathy (CSM). The aim of this case was to study the on‑line assessment of the functions of corticospinal and somatosensory pathways changed due to surgical decompression of cervical spinal cord. Our study included 11 patients (6 men and 5 women, mean age 59,3 ± 9,2 years old) with MRI‑confirmed cervical spine stenosis (CSS). All of them had intraoperative neurophysiological monitoring standing for transcranial electric stimulation (TES) and recording of the median nerve somatosensory evoked potentials (SEP). Investigations were performed before and 10–15 minutes after surgical spinal cord decompression. The obtained data provides additional information about the spinal cord pathways functional status and it is a reliable predictor of neurological outcome.В литературе крайне мало встречается информации относительно восстановления проведения импульса по спинному мозгу в афферентном и эфферентном направлениях в ответ на декомпрессию в режиме реального времени, что и послужило основанием для проведения данной работы. Интраоперационному нейрофизиологическому мониторингу подверглось 11 пациентов (6 мужчин и 5 женщин, средний возраст 59,3 ± 9,2 года) с подтвержденным стенозом позвоночного канала по данным магнитно-резонансной томографии. Степень восстановления проведения по кортикоспинальному тракту и проводникам соматической афферентации оценивали с помощью регистрации вызванных моторных ответов (ВМО) при транскраниальной электростимуляции и записи соматосенсорных вызванных потенциалов (ССВП) при билатеральной стимуляции срединного нерва. Регистрацию ВМО и ССВП проводили до декомпрессии и через 10−15 мин после нее. Полученные данные отражают незамедлительное изменение проведения импульса в афферентном и/или эфферентном направлениях и коррелируют с неврологическим статусом в послеоперационном периоде