Заболеваемость сахарным диабетом 2-го типа и традиционные факторы риска нарушений углеводного обмена у больных ревматоидным артритом

Objective: to clarify the primary incidence of type 2 diabetes mellitus (DM) in patients with rheumatoid arthritis (RA) and to compare the prevalence of traditional risk factors (RFs) in groups of patients with and without carbohydrate metabolic disorders.Patients and methods. A retrospective analysis was carried out in 158 patients with RA (diagnosed at the age of 45 years and older; the disease duration was more than 12 months). The exclusion criteria were concomitant type 1 DM and type 2 DM that was diagnosed before or at the onset of RA. The patients' median age was 62 [57; 68] years. Most RA patients had moderate (41.8%) and high (39.9%) DAS28. New cases of type 2 DM and the presence of hyperglycemia were recorded at the time of the examination. The traditional RFs of type 2 DM were assessed using the Finnish Diabetes Risk Score (FINDRISC).Results and discussion. The incidence rates of type 2 DM was 9.3 per 1000 patient-years. The patients with developed type 2 DM versus those without DM had a larger number of RFs according to the the FINDRISC questionnaire (6 [5; 7] and 5 [4; 5]; p<0.01), had more frequently experienced myocardial infarction and undergone surgery for myocardial revascularization (27.3 and 2.7%; p<0.01), taken beta-adrenoblockers (72.7 and 33.3%; p<0.05) and calcium channel blockers (36.4 and 12.2%; p<0.05). Fasting hyperglycemia was detected in 10.1% of RA patients. The patients with hyperglycemia versus those with normal venous blood glucose levels more often had obesity (50.0 and 29.8%) and a history of hyperglycemic episodes (43.8 and 19.1%) and less frequently used glucocorticoids (18.8 and 47.3%; p<0.05 for all cases). Conclusion. The high incidence of type 2 DM in RA was associated with the presence of a set of traditional RFs and previous cardiovascular disease, while fasting hyperglycemia was with individual RFs for carbohydrate metabolic disorders. Цель исследования – уточнить первичную заболеваемость сахарным диабетом (СД) 2-го типа у больных ревматоидным артритом (РА) и сравнить распространенность традиционных факторов риска (ФР) в группах пациентов с нарушениями углеводного обмена и без них.Пациенты и методы. Проведен ретроспективный анализ 158 пациентов с РА (диагноз установлен в возрасте 45 лет и старше, длительность болезни более 12 мес). Критериями исключения были сопутствующий СД 1-го типа и диагноз СД 2-го типа, установленный до дебюта РА или одновременно с ним. Медиана возраста пациентов – 62 [57; 68] года. Большинство больных имели умеренную (41,8%) и высокую (39,9%) активность РА по индексу DAS28. Регистрировали новые случаи СД 2-го типа и наличие гипергликемии на момент обследования. Традиционные ФР развития СД 2-го типа оценивали по опроснику Finnish Type 2 Diabetes Risk Assessment Form (FINDRISK).Результаты и обсуждение. Заболеваемость СД 2-го типа составила 9,3 случая на 1000 пациенто-лет. Пациенты с развившимся СД 2-го типа по сравнению с больными без СД имели большее число ФР по опроснику FINDRISK  (6 [5; 7] и 5 [4; 5]; p<0,01), чаще переносили инфаркт миокарда и операции по его реваскуляризации (27,3 и 2,7%; р<0,01), принимали бета-адреноблокаторы (72,7 и 33,3%; р<0,05) и блокаторы кальциевых каналов (36,4 и 12,2%; р<0,05). У 10,1% больных РА выявлена гипергликемия натощак. Пациенты с гипергликемией чаще, чем больные с нормальным уровнем глюкозы в венозной крови, имели ожирение (50,0 и 29,8%) и эпизоды гипергликемии в анамнезе (43,8 и 19,1%) и реже принимали ГК (18,8 и 47,3%; р<0,05 для всех случаев).Выводы. Высокая заболеваемость СД 2-го типа при РА ассоциировалась с наличием комплекса традиционных ФР и предшествующей сердечно-сосудистой патологией, в то время как гипергликемия натощак – с отдельными ФР нарушений углеводного обмена

PRIMARY HYPERPARATHYROIDISM AT THE BACKGROUND OF PARATHYROID GLAND HYPERPLASIA. PECULIARITIES AND DIFFICULTIES OF DIAGNOSTICS

The article uses a clinical case of primary hyperparathyroidism in young patient with hyperplastic parathyroid gland localization in tissues of thyroid gland as an example to study the matters of cytological, histological, clinical and laboratory diagnostics of such pathology. It provides a literature reference on the difficulties of establishing a cytological and histological diagnoses, sets out the peculiarities of morphological pattern, discusses the tactical matters of primary hyperparathyroidism management, indications for surgical treatment and case follow-up of patients

Клиническое значение лептина при системной красной волчанке

Objective: to study the frequency of hyperleptinemia in patients with systemic lupus erythematosus (SLE), its relationship with clinical and laboratory manifestations of the disease, drug therapy, and other metabolic disorders.Patients and methods. The cross-sectional study included 46 women with a definite diagnosis of SLE (median age 40 [31; 48] years) and disease duration 3.0 [0.9; 9.0] years. Glucocorticoids (GC) were received by 38 (83%) patients, hydroxychloroquine – by 35 (76%), immunosuppressants – by 10 (22%), biologic disease-modifying antirheumatic drugs – by 5 (11%). In all patients, fasting levels of glucose, leptin, apoliproprotein B (ApoB) and immunoreactive insulin were determined, and homeostatic model assessment for insulin resistance (HOMA-IR) was calculated. Concentration of leptin ≥11.1 ng/ml, ApoB – >1.6 mg/ml were considered an elevated level. HOMA-IR index ≥2.77 corresponded to the presence of insulin resistance (IR).Results and discussion. Hyperleptinemia was found in 34 (74%) patients with SLE, an increased level of ApoB – in 19 (41%), IR – in 10 (22%). In patients with hyperleptinemia, serositis, positivity for anti-double-stranded DNA (aDNA) and hypocomplementemia were less common, overweight and obesity were more frequent, the SLEDAI-2K index was lower, the aDNA level was lower, and the concentration of the C3 component of complement, insulin, HOMA-IR index, body mass index (BMI) and disease duration were higher (p<0.05 for all cases). BMI <25 kg / m2 had 26 (57%) women, 14 (54%) of whom had hyperleptinemia. In patients with BMI <25 kg / m2, we found a relationship between leptin concentration and disease duration (r=0.4, p=0.04), SLE activity according to SLEDAI-2K (r=-0.6, p=0.003), levels of aDNA (r=-0.6, p<0.001), C3 component of complement (r=0.5, p=0.01), maximum (r=0.7, p<0.001) and supporting (r=0,5, p=0.023) GC doses.In patients with BMI ≥25 kg/m2 (n=20), no such relationship was observed.Conclusion. Hyperleptinemia was found in the majority of women with SLE; elevated levels of ApoB and IR were much less common. Patients with hyperleptinemia are characterized by a longer duration and less activity of the disease, as well as the presence of overweight and obesity and an increase in the HOMA-IR index. In SLE patients with normal body weight, the concentration of leptin increased along with GC dose elevation.Цель исследования – изучение частоты гиперлептинемии у пациентов с системной красной волчанкой (СКВ), ее взаимосвязи с клинико-лабораторными проявлениями заболевания, лекарственной терапией, а также другими метаболическими нарушениями.Пациенты и методы. В поперечное исследование включено 46 женщин с достоверным диагнозом СКВ (медиана возраста 40 [31; 48] лет) и длительностью заболевания 3,0 [0,9; 9,0] года. Глюкокортикоиды (ГК) получали 38 (83%) больных, гидроксихлорохин – 35 (76%), иммуносупрессанты – 10 (22%), генно-инженерные биологические препараты – 5 (11%). У всех больных определены натощак уровни глюкозы, лептина, аполипропротеина В (АпоВ) и иммунореактивного инсулина, рассчитан индекс оценки гомеостатической модели резистентности к инсулину (HOMA-IR). Повышенной считали концентрацию лептина ≥11,1 нг/мл, АпоВ – >1,6 мг/мл.Индекс HOMA-IR ≥2,77 соответствовал наличию инсулинорезистентности (ИР).Результаты и обсуждение. Гиперлептинемия обнаружена у 34 (74%) больных СКВ, повышенный уровень АпоВ – у 19 (41%), ИР – у 10 (22%). При гиперлептинемии реже встречались серозит, позитивность по антителам к двуспиральной ДНК (аДНК) и гипокомплементемия, чаще – избыточная масса тела и ожирение, были ниже индекс SLEDAI-2K, уровень аДНК, выше – концентрация С3-компонента комплемента, инсулина, индекс HOMA-IR, индекс массы тела (ИМТ) и длительность заболевания (р<0,05 для всех случаев). ИМТ<25 кг/м2 имели 26 (57%) женщин, у 14 (54%) из которых обнаружена гиперлептинемия. У пациенток с ИМТ <25 кг/м2 выявлена взаимосвязь концентрации лептина с длительностью заболевания (r=0,4, p=0,04), активностью СКВ по SLEDAI-2K (r=-0,6, p=0,003), уровнем аДНК (r=-0,6, p<0,001), С3-компонента комплемента (r=0,5, p=0,01), максимальной (r=0,7, p<0,001) и поддерживающей (r=0,5, p=0,023) дозами ГК. У больных с ИМТ ≥25 кг/м2 (n=20) подобной взаимосвязи не отмечено.Заключение. Гиперлептинемия выявлена у большинства женщин с СКВ, повышенный уровень АпоВ и ИР встречались гораздо реже.Для пациенток с гиперлептинемией характерны большая длительность и меньшая активность заболевания, а также наличие избыточной массы тела и ожирения, увеличение индекса HOMA-IR. У больных СКВ с нормальной массой тела концентрация лептина нарастала по мере увеличения дозы ГК

Metabolic syndrome in rheumatoid arthritis: role of adiponectin (preliminary results)

The clinical value of the disorders and diseases integrated within the metabolic syndrome (MS) is in the combination of traditional risk factors for cardiovascular diseases (CVD), which significantly accelerates the development of cardiovascular events (CVEs). The detection rate for MS in patients with rheumatoid arthritis (RA) is shown to be higher than in the controls regardless of the diagnostic criteria for MS. At present, there are confusing data on the role of adipokins in RA. Objective: to determine the rate of MS and its components in RA patients and the association of the level of adipokin (adiponectin) with the components of MS in relation to the duration of RA. Subjects and methods: The investigation enrolled 69 RA patients divided into two groups: 1) 34 patients with early-stage (<2-year) RA and 2) 35 patients with end-stage (>2-year) RA. Results. MS occurred in 12 (17.4%) of the 69 patients with RA. There was central (abdominal) obesity in 37 (53.6%) patients with RA, hypertension in 29 (42%), low high-density cholesterol levels in 20 (29%), hyperglycemia in 11 (15.9%), and hypertriglyceridemia in 10 (14.5%). According to the presence or absence of MS, the patients were divided into 2 groups: 1) 12 patients with MS; 2) 57 without MS. In the patients with RA and MS, the duration of the disease was shorter; DAS28 and CDAI were higher than in those without MS: 15.4 [7; 24] months versus 51.8 [6; 72] months; DAS28 was 5.8 [4.9; 6.7] scores versus 5.1 [4.5; 5.8] scores; CDAI: 34.8 [21.8; 41.4] scores versus 24.2 [18; 31] scores, respectively (p < 0.05 in all cases). The serum level of adiponectin was lower: 13.1 [5.7; 10.7] ng/ml versus 20.6 [6.9; 30.9] ng/ml in the patients with RA and MS as compared to those without MS; but there were no significant differences. In the patients with early-end RA, the rate of MS was twice higher than that in those with end-stage RA; however, the differences were statistically insignificant (p = 0.1). The components of MS were encountered with the same frequency in early- and end-stage RA. The early RA group showed a correlation between SDAI (r = -0.34), body mass index (r = -0.41), high-density lipoprotein cholesterol (r = 0.33), erythrocyte sedimentation rate (r =-0.35), and adiponectin. The >2-year RA group displayed no relationship between adipokins, activity markers, and metabolic disturbances. Conclusion. The preliminary results suggest the high rate of MS in patients with a high level of early RA disease activity untreated with disease-modifying antirheumatic drugs, thus determining the high risk of CVEs just at disease onset. The role of adiponectin in the development of MS, CVEs in rheumatic diseases remains to be solved, which is the subject of further investigations. It is possible that normalization of adiponectin concentrations may promote reductions in the incidence of CVD, mortality rates due to atherosclerosis-induced CVEs, and the prevalence of MS and insulin resistance

Microwave-Assisted Hydrothermal Synthesis and Annealing of DyF 3

The series of DyF3 nanosized samples was synthesized by the colloidal chemistry method. The microwave-assisted hydrothermal treatment was used for the first time for the modification of DyF3 nanoparticles. Transmission electron microscopy images show that the DyF3 nanoparticles have average particle size of about 16–18 nm and the size distribution becomes narrower during the microwave irradiation. The X-ray diffraction analysis shows the narrowing of the diffraction peaks versus microwave treatment time. The experimental data demonstrates restructuring of the nanoparticles and their crystal structure becomes closer to the ideal DyF3 regular structure during the microwave irradiation of colloidal solution. The defect-annealing model of the microwave-assisted hydrothermal modification process is suggested

ФАКТОРЫ, ВЛИЯЮЩИЕ НА ПРОЦЕССЫ СУЛЬФАТРЕДУКЦИИ И МЕТИЛИРОВАНИЯ РТУТИ ВО ЛЬДАХ РЕКИ АМУР

Results of the layer-by-layer studies of distribution of organic matter (OM) and mercury in ice cores sampled from the Amur River near the Khabarovsk city: its mainstream and the Pemzenskaya and Amurskaya branches, are presented. Comprehensive investigation of ice performed at the end of the freeze-up period allows making a retrospective analysis of the river ecosystem pollution during winter. Analysis of the total content of dissolved organic substances and aromatic compounds, determining a level of humification of the aquatic environment, was carried out with a spectrophotometer Shimadzu UV-3600 at 254 and 275 nm. The mercury content was determined by inductively coupled plasmamass spectrometry (ICP-MS). The number of cultured heterotrophic bacteria, sulfate-reducing bacteria (SRB) and their resistance to mercury (0.0005 and 0.001 mg/L) were used as indicators of biogeochemical processes going on in vitro. The maximum resistance to mercury at concentration of 0.001 mg/l was revealed from the sulfate-reducing bacteria in cores taken from the upper ice layer (0-10 cm) near the right bank of the Amurskaya branch. Periodical high mercury contamination of ice (up to 0.71 mkg/L) is estimated as a risk factor. In Pemzenskoy branch, the main factors for the mercury methylation in the ice were fine detritus, coming at the reservoir discharges, and the SRB resistant to mercury. These microorganisms were found in upper layers of the ice (10-35 cm) near the left bank and in the middle of the water stream (60–80 cm). A layer of ice (70–117 cm) with conditions also favourable for the sulfate reduction and the mercury methylation had been revealed in the mainstream of the Amur River near its right bank that is the cross-boundary area in the zone of influence of the Songhua river runoff. Among these conditions are high levels of OM, the presence of heterotrophic bacteria, which are destructors of high-molecular compounds, the potential producers of metabolites with methyl radicals, and the activity of the SRB resistant to mercury.Представлены результаты послойного исследования кернов речного льда с использованием спектральных и микробиологических методов. Активность биогеохимических процессов во льдах определяется высокими концентрациями органических веществ (растворённых и в виде детрита), загрязнением водной среды ртутью при формировании ледяного покрова, численностью культивируемых гетеротрофных бактерий и сульфатредуцирующих бактерий. К основным предпосылкам метилирования ртути во льдах р. Амур относятся: поступление из водохранилищ гумифированных вод и детрита; трансграничное загрязнение летучими ароматическими соединениями; образование бактериальных метаболитов с метильными радикалами; устойчивость сульфатредуцирующих бактерий к ртути

ЦУКАТЫ ИЗ АРБУЗОВ. ПРОМЫШЛЕННОЕ СЫРЬЕ (ТЕХНИЧЕСКИЕ УСЛОВИЯ)

The purpose of the standard is the valuation of the indicators of quality of candied fruit watermelon, cooked in sugar syrup, dried and coated in granulated sugar intended for industrial processing and nutrition. This standard is developed for the first time in the Russian Federation.Целью стандарта является нормирование показателей качества цукатов из плодов арбуза, сваренных в сахарном сиропе, высушенных и обваленных в сахарном песке, предназначенных для промышленной переработки и для питания населения. Разработан стандарт впервые для РФ

Vitamin D Status Among Children With Juvenile Idiopathic Arthritis: A Multicenter Prospective, Non-randomized, Comparative Study

BackgroundJuvenile idiopathic arthritis (JIA) is a chronic autoimmune disease characterized by destructive and inflammatory damage to the joints. The aim in this study was to compare vitamin D levels between children and adolescents, 1–18 years of age, with juvenile idiopathic arthritis (JIA) and a health control group of peers. We considered effects of endogenous, exogenous, and genetic factors on measured differences in vitamin D levels among children with JIA.MethodsOur findings are based on a study sample of 150 patients with various variants of JIA and 277 healthy children. The blood level of vitamin D was assessed by calcidiol level. The following factors were included in our analysis: age and sex; level of insolation in three regions of country (center, south, north); assessment of dietary intake of vitamin D; effect of prophylactic doses of cholecalciferol; a relationship between the TaqI, FokI, and BsmI polymorphisms of the VDR gene and serum 25(OH)D concentration.ResultsWe identified a high frequency of low vitamin D among children with JIA, prevalence of 66%, with the medial level of vitamin D being within the range of “insufficient” vitamin D. We also show that the dietary intake of vitamin D by children with JIA is well below expected norms, and that prophylactic doses of vitamin D supplementation (cholecalciferol) at a dose of 500–1,000 IU/day and 1,500–2,000 IU/day do not meet the vitamin D needs of children with JIA. Of importance, we show that vitamin D levels among children with JIA are not affected by clinical therapies to manage the disease nor by the present of VDR genetic variants.ConclusionProphylactic administration of cholecalciferol and season of year play a determining role in the development of vitamin D deficiency and insufficiency