Risk of Developing Severe Alimentary-Constitutional Obesity and Metabolic Disorders: Interventional Comparative Study

Background. The relevance of alimentary-constitutional obesity, especially its severe forms, is associated with a number of metabolic disorders, subsequently leading to serious chronic noncommunicable diseases.Objective. To identify factors that increase the risk of severe alimentary-constitutional obesity and metabolic disorders.Methods. A follow-up group of 426 patients aged 18 to 65 years was formed among those seeking help from an endocrinologist for overweight or obesity. The diagnosis of alimentary-constitutional obesity was confirmed at the initial examination in the outpatient clinic setting. Depending on the severity of obesity and the type of fat deposition according to anthropometric data (body mass index, waist circumference), the study participants were ratified into two study groups. The research was conducted between 2010 and 2017 in outpatient settings and was based on a cross-sectional comparative study. In order to assess the risk of severe obesity and factors associated with it, the authors studied medical history data, results of physical examination, including blood pressure level, laboratory examination with analysis of carbohydrate, fat metabolism and liver function, assessed eating behaviour, and performed diagnosis of anxiety-depressive disorder. Statistical analysis of the results was carried out using Statistica 10 (StatSoft, USA).Results. Women are more likely to see an endocrinologist with less severe obesity than men. Severe obesity risk is higher in middle-aged and elderly people, as well as in hereditary tainted patients and those having a history of obesity for more than 10 years. Severe obesity itself is a significant risk for metabolic events, with a 4-fold higher risk of hyperglycaemia and hypercholesterolaemia (due to very low density lipoproteins) and a 5-fold higher risk of hyperinsulinaemia and insulin resistance.Conclusion. Analysis of severe obesity risks has shown that earlier personal commitment to a healthy lifestyle is essential for weight loss and subsequent improvement of metabolic parameters, particularly in men and those aged 45 years or older

Risks for development of metabolic disorders in alimentary constitutional obesity

BACKGROUND: alimentary-constitutional obesity due to it’s high prevalence, is the key problem of modern healthcare system. However, obesity is not always accompanied with metabolic disorders, leading to early invalidization and mortality. That’s why it is important to study risks of metabolical nonhealth in obesity.AIM: to detect factors, increasing risks of development of metabolic disbalance in alimentary-constitutional obesity.MATERIALS AND METHODS: In patients with alimentary-constitutional obesity there was performed an examination including anthropometry (body mass index, Waist Circumference, Hip Circumference,waist to hip ratio), blood pressure measurement, laboratory tests – metabolic indexes: glucose, insulin, insulin resistance indexes, leptin, cholesterol, cholesterol of lipoproteins, triglycerides, aspartate aminotransferase, alanine aminotransferase, gamma-glutamiltransferase), body composition measurement by bioelectrical impedance analysis; patients were also interviewed on their behavior (food habits) and physical activity.RESULTS: There were formed two groups depending on metabolic health indexes: main group – metabolically non-healthy obesity (MNHO) - 241 persons (aged 41±12,09, duration of obesity 12,5±9,51 years) with alimentary-constitutional obesity and two or more signs of MS, a comparison group – of metabolically healthy obesity (MHO) – 120 persons (aged 35,5±10,03; p<0,05, duration of obesity 8,0±7,39 years; p<0,05) with alimentary-constitutional obesity and one sign of MS or without it. Data analysis of studied risk factors for development of metabolically non-healthy alimentary-constitutional obesity confirmed that most relevant factor in development of MNHO is abdominal fat mass distribution (increasing of Waist Circumference over 88 sm in females and over 102 sm in mails). At the same time MNHO had correlation not only with classical signs of MS, but also with blood insulin level, insulin resistance indexes, fat metabolism disbalance and liver disfunction. More severed risk for appearance of metabolic disorders have patients over 45 years old with decreased active cell mass (less than 45%), duration of obesity above 10 years and obesity-burdened heredity. In food habits risk of development of metabolically non-healthy obesity was increased in taking of fat milk food, and, on the contrary, - frequent snacks, alcohol free sweet drinks didn’t affect it.CONCLUSION: Development of MNHO is associated not only with the age of patient, duration of obesity, carbohydrate and fat metabolism indexes, but also with decreased percentage of metabolically active tissues and some food habits

Hypereutectic al-ca-mn-(Ni) alloys as natural eutectic composites

Data Availability Statement: Data are available from the corresponding author on reasonable request.In the present paper, Natural Metal-Matrix Composites (NMMC) based on multicomponent hypereutectic Al-Ca-(Mn)-(Ni) alloys were studied in as-cast, annealed and rolled conditions. Thermo-Calc software and microstructural observations were utilised for analysing the equilibrium and actual phase composition of the alloys including correction of the Al-Ca-Mn system liquidus projection and the solid phase distribution in the Al-Ca-Mn-Ni system. A previously unknown Al10CaMn2 was discovered by both electron microprobe analysis and X-ray studies. The Al-6Ca-3Mn, Al-8Ca-2Mn, Al-8Ca-2Mn-1Ni alloys with representative NMMC structure included ultrafine Ca-rich eutectic and various small-sized primary crystals were found to have excellent feasibility of rolling as compared to its hypereutectic Al-Si counterpart. What is more, Al-Ca alloys showed comparable Coefficient of Thermal Expansion values due to enormous volume fraction of Al-based eutectic and primary intermetallics. Analysis of tensile samples’ fracture surfaces revealed that primary intermetallics may act either as stress raisers or malleable particles depending on their stiffness under deformation. It is shown that a compact morphology can be achieved by conventional casting without using any refining agents. Novel hypereutectic Al-Ca NMMC materials solidifying with the formation of Al10Mn2Ca primary compound have the best ductility and strength. We reasonably propose these materials for high-load pistons.Russian Science Foundation (project no. 20–19–00746)

Management of heart failure patients in Russia: perspectives and realities of the second decade of the XXI century

The article highlights the central components of Russian heart failure (HF) management programs in actual clinical practice. The experience of the Competence Center of Almazov National Medical Research Center, as well as opportunities and prospects for improving the monitoring of decompensated HF

Type 2 Diabetes Mellitus and Chronic Heart Failure with Midrange and Preserved Ejection Fraction: A Focus on Serum Biomarkers of Fibrosis

As myocardial fibrosis might be an important contributor to the association of diabetes mellitus with left ventricular (LV) dysfunction and chronic heart failure (HF), we investigated the profile of some proinflammatory, profibrotic biomarkers in patients with type 2 diabetes mellitus (T2DM) at various stages of the cardiovascular disease continuum from absence of clinic since and symptoms to HF with preserved (HFpEF) and midrange ejection fraction (HFmrEF). Material and Methods. Sixty-two patients with T2DM (age 60 [55; 61]), 20 patients without clinical manifestations of HF and 2 groups with clinical manifestations of stable HF, 29 patients with HFpEF, and 13 patients with HFmrEF, were included in the study. The control group consisted of 13 healthy subjects and normal BMI. All patients underwent transthoracic echocardiography, laboratory assessment of N-terminal fragment of the brain natriuretic peptide (Nt-proBNP), highly sensitive C-reactive protein (hsCRP), soluble suppression of tumorigenesis-2 (sST2), galectin-3, C-terminal propeptide of procollagen type I (PICP), N-terminal propeptide of procollagen type III (PIIINP), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of matrix proteinase-1 (TIMP-1). Results. Patients with HFmrEF had higher values of LV volumetric parameters, indexed parameters of LV myocardial mass (LVMM), and higher concentrations of Nt-proBNP (all p<0.05). The concentrations of galectin-3 were greater in patients with HFpEF and HFmrEF compared to patients without HF (p=0.01 and p=0.03, respectively). PICP and PICP/PIIINP ratio were greater in patients with HFmrEF compared to patients with HFpEF (p=0.043 and p=0.033, respectively). In patients with T2DM and HF, a relationship was found between galectin-3 and LVMM/body surface area (r=−0.58, p=0.001), PIIINP, TIMP-1, and LV end-diastolic volume (r=−0.68 and p=0.042 and r=0.38 and p=0.02, respectively). Conclusion. The dynamics at various stages of the cardiovascular disease continuum in the serum fibrosis markers may reflect an increase in fibrotic and decrease in antifibrotic processes already at the preclinical stage of HF. At the same time, the changes found in the circulating procollagen levels may indicate a shift in balance towards type I collagen synthesis in HFmrEF compared with HFpEF

Molecular biomarker profile of heart failure with mid-range and preserved ejection fraction in patients with type 2 diabetes

Aim. To study molecular biomarkers in patients with type 2 diabetes (T2D) in combination with heart failure with preserved (HFpEF) and mid-range ejection fraction (HFmrEF) and compare the data obtained with clinical characteristics of myocardial remodeling.Material and methods. The study included 42 patients with T2D (men — 53%, mean age — 60 years) with clinical manifestations of class II HF: 29 patients with HFpEF (group 1) and 13 patients with HFmrEF (group 2). The control group consisted of 13 healthy people, which were comparable in sex and age and had a normal body mass index (BMI). Patients received stable glucose-lowering and optimal drug therapy for HF for 3 months prior to enrollment in the study. Patients with HFpEF and HFmrEF were comparable in clinical and demographic parameters, had glycated hemoglobin (HbA ) of 8,5% and 8,8%, respectively (p&gt;0,05), increased BMI or grade I-II obesity.We studied following biomarkers: NT-proBNP, highly sensitive C-reactive protein (hsCRP), sST2, galectin-3, procollagen type I C-terminal propeptide (PICP), matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1).Results. Volumetric parameters of the left ventricle (LV),LV mass indexed to growth and NT-proBNP were higher in the group of HFpEF patients (p&lt;0,05 for all). The concentrations of galectin-3, PICP were higher, and the MMP-9/TIMP-1 ratio decreased in patients with T2D compared with the control group (p&lt;0,05 for all). PICP values were higher in patients with HFmrEF compared with patients with HFpEF (106,4 (85,4; 140,4) ng/ml vs 46,8 (12,6; 98,6 ng/ml), respectively, p=0,043). In patients with T2D and HF, a relationship was found between TIMP-1 andLV end-diastolic volume (r=-0,68; p=0,042).Conclusion. Patients with HFmrEF and T2D have higherLV volume and mass, higher concentrations of NT-proBNP and PICP in comparison with patients with HFpEF. The direction of MMP-9/TIMP-1 changes may reflect a decrease in antifibrotic processes. Further prospective studies on large samples using a multiple biomarker model are required in T2D and various HF phenotypes

FUNCTIONAL STATE DYNAMICS OF BLOOD CELLS AND ENDOTHELIUM IN PATIENTS WITH ESSENTIAL HYPERTENSION WITH ENALAPRIL TREATMENT

The influence of ACE inhibitor enalapril therapy on functional activity of blood cells and vasomotor function of endothelium in patients with essential hypertension (EH) was studied. 21 patients with EH II stage and 17 almost healthy persons (all males) were included. Ultrasound of heart, radial and carotid arteries, spontaneous platelet and erythrocyte aggregation, erythrocyte deformity and leukocyte activity were assessed. The second examination of patients with EH was carried out in 12 weeks following enalapril treatment with 10-40 mg a day. Baseline increase of spontaneous platelet and erythrocyte aggregation, erythrocyte hardness and leukocyte activity were revealed in patients with EH. Antihypertensive effect of enalapril was in 15 patients (71 %). Hemoreology improvement and decrease of leukocyte activity were accompanied by increase of volume flow velocity in radial artery while endothelium-dependent vasodilation was unchanged. Long-term enalapril therapy was accompanied by improvement of hemoreology, decrease of leukocyte activity and increase volume flow velocity in radial artery. Positive dynamics of functional states of blood cells did not depend on severity of antihypertensive effect of enalapril

<i>RBM20</i> gene variants associated with left atrial dilatation in patients with old myocardial infarction and heart failure with reduced ejection fraction

Aim. To study the prevalence of RBM20 gene polymorphisms and their relationship with the structural and functional left atrial (LA) characteristics in patients with coronary artery disease and heart failure with reduced ejection fraction (HFrEF).Material and methods. The study included 138 men aged 55,8±6,6 years with prior myocardial infarction ³12 months ago and HFrEF (class II-IV heart failure, left ventricular ejection fraction (Simpson’s methods), 25,1±7,2%). The control group consisted of 384 healthy donors. Genotyping of two RBM20 polymorphic variants (rs942077 and rs35141404) was performed by real-time polymerase chain reaction.Results. The prevalence of RBM20 polymorphisms did not differ in the HFrEF cohort and the control group. The GA rs35141404 genotype was more common among patients with a less pronounced increase in LA volume index (LAVI) (p=0,034). The minor A allele rs35141404 was associated with a protective effect on severe LA remodeling. However, this association did not reach the level of significance.Conclusion. For the rs942077 and rs35141404 polymorphic variants of the RBM20 gene, no significant associations were found with the LA size and atrial fibrillation presence in patients with HFrEF and old myocardial infarction. There was a tendency towards the association of the A allele and the GA rs35141404 genotype with a protective effect on LA remodeling. The data obtained confirm the need for further search for genotype-phenotype relationships of a wider population of patients with heart failure and coronary artery disease

Significant improvement of clinical course and reverse myocardial remodeling in young patients with chronic heart failure using cardiac contractility modulation

Three clinical cases of 2-year follow-up of young patients with chronic heart failure with a low left ventricular ejection fraction of non-coronarogenic genesis after implantation of the cardiac contractility modulation system are presented. Significant positive dynamics of clinical course and reverse myocardial remodeling according to two-dimensional echocardiography and 2D speckle tracking echocardiography (STE) is shown. The 2D STE technique allowed us to demonstrate the improvement in local contractility of the interventricular septum in the area of implanted electrodes and the remote effect of global contractility improving during 1 year of observation with cardiac contractility modulation