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

Effect of weight loss on the course of non-alcoholic fatty liver disease: results of 6-month follow-up

Aim of investigation. To study the effect of nonpharmaceutical correction of body weight on the level ofhigh cardio-vascular risk markers at non-alcoholic fatty liver disease (NAFLD).Material and methods. Overall 117 patients with NAFLD at steatosis stage combined to obesity or metabolic syndrome (MS) — 59 and 58 patents respectively, mean age 43 years (38 to 46 years) and 45 years (39- 49) were investigated. Levels of lipid and carbohydrate metabolism markers, TNF-α, leptin, adiponectin and nitric oxide (NO) metabolites were evaluated.Results. Weight loss for at least 5% was gained in 44,1% of patients with NAFLD in association to obesityand in 56,6% of those with NAFLD in combination to MS, that was accompanied by significant reduction of lipid atherogenic fraction levels (cholesterol, low density lipoproteins), decrease of insulin resistance index, CRP and TNF-α inflammation markers, and decrease of leptin concentration in MS group. Comparative analysis of adiponectin and NO metabolites concentration has shown demonstrated, that in patients with NAFLD both in combination to obesity, and in combination to MS the target level of weight loss is accompanied by elevation of adiponectin level (р<0,05) and NO stable metabolites (р<0,05), whereas concentration of nitrites is increased significantly (р<0,05) only in obese patients.Conclusions. Weight loss for 5% and over at steatosis stage of NAFLD is characterized by decrease ofbiochemical cardio-vascular risk markers, in addition the group with 40 min/day physical exercises inefficacy had lower level of insulin resistance index and TNF-α along with higher levels of NO metabolites

КОНТРОЛЬ РЕЛЬСОВОЙ ЛИНИИ ПО НАПРЯЖЕНИЮ ПИТАЮЩЕГО КОНЦА

The article is devoted to a new method of the control of interaction of rail circuits. The threshold value simultaneously with increased frequency is detected when the train occupies the rail circuit. When the current voltage exceeds the threshold value the train releases the line. The proposed pattern raises shunt sensitivity and extends the length of the rail circuit.Статья посвящена новому методу контроля взаимовлияния рельсовых цепей. В момент занятия поездом рельсовой линии фиксируется пороговое напряжение с участием повышенной частоты, а освобождение ее происходит при превышении текущим напряжением его порогового значения. Используемая схема повышает шунтовую чувствительность и увеличивает длину рельсовой цепи

Liver fibrosis and markers of endothelial function at metabolic syndrome and early disorders of carbohydrate metabolism

Aim of investigation. Complex estimation of endothelial function at non-alcoholic fatty liver disease (NAFLD) in association with early disorders of carbohydrate metabolism, in relation to liver fibrosis severity.Material and methods. Overall 67 patients with metabolic syndrome (MS) in combination to early carbohydrate metabolism disorders (71,6% women), mean age was 47,5 (42–49 years), body mass index — 34,6 kg/m2 (32,4–38,4 kg/m2) were investigated. In 72% of patients presence of NAFLD at steatosis stage and in 18% —at non-alcoholic steatohepatitis stage was found.Results. In patients with MS in association to early disorders of carbohydrate metabolism liver fibrosis at F1 METAVIR stage was revealed in 25%, at F2 — in 16%, at F3 — in 13% and at F4 — in 1,5% of all cases. Along with increase of fibrosis stage progressive elevation of TNF-α (p=0,0265), IL-6 (p=0,0012) and endothelin-1 (p=0,0137) contents on background of decrease of adiponectin concentration (p=0,0026) and gain of humeral artery diameter after compression (p=0,005) was marked.Conclusions. Presence and severity of liver fibrosis at MS in combination to early disorders of carbohydrate metabolism are related to increase of proinflammatory cytokines, endothelin-1 concentration on a background of reduction of adiponectin contents and decrease of endothelium vasodilation capacity

Autoantibody levels in blood of <i>H. pylori</i>-infected patients with chronic gastritis

Helicobacter pylori (H. pylori) increases the risk of diseases associated with mucous membrane inflammation of gastrointestinal tract, in particular, gastritis, stomach ulcers, and duodenal ulcers. It may also induce a chronic immune response, causing damage to the mucous membrane and development of these diseases. In addition, the role of H. pylori in the initiation of a wide range of autoimmune diseases is discussed. The aim of this study was to assess the level of autoantibodies – markers of various autoimmune diseases in the blood of H. pylori-infected patients with chronic gastritis. We used samples of whole peripheral blood from 267 primary patients with chronic gastritis in the acute stage. The presence of H. pylori in gastric juice from patients was determined using real-time PCR. The level of autoantibodies to double-stranded and single-stranded DNA, autoantibodies to thyroglobulin, thyroid peroxidase, concentration of rheumatoid factor, IgG autoantibodies to the cyclic citrullinated peptide, IgM and IgG autoantibodies to beta(2)-glycoprotein were determined by the enzyme immunoassay. The average level of rheumatoid factor in blood serum was similar for H. pylori-infected and non-infected patients, and did not exceed the normal values. The level of antibodies to cyclic citrullinated peptide, one of the sensitive markers of rheumatoid arthritis, was increased in all patients, being, however, significantly lower in H. pylori-infected patients compared with non-infected persons. Autoantibodies to thyroglobulin, thyroid peroxidase are considered classic markers of autoimmune diseases of the thyroid gland. In blood of H. pylori-infected patients we have found an increased concentration of autoantibodies to thyroglobulin and thyroid peroxidase in comparison with non-infected ones, but the average level of these antibodies did not exceed the normal range. Any differences in the levels of systemic lupus erythematosus serological markers, i.e., autoantibodies to double-stranded and single-stranded DNA, were found between H. pylori-infected and non-infected patients. The levels of thrombosis risk marker in patients with systemic lupus erythematosus (IgG and IgM autoantibodies to beta(2)-glycoprotein) were also within the normal ranges. However, in H. pylori-infected patients, it even turned out to be statistically significantly lower than in non-infected ones. Thus, no data have been obtained on increased levels of the tested markers of autoimmune pathology in blood of H. pylori-infected patients with chronic gastritis at the acute stage. However, this does not allow us to make an unambiguous conclusion that the influence of H. pylori does not affect the development of immunological changes associated with autoimmune diseases

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 &lt;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

Изменения сетей покоя фМРТ у пациентов с тяжелой черепно-мозговой травмой при терапевтической ритмической транскраниальной магнитной стимуляции (клиническое наблюдение)

   Severe traumatic brain injury (TBI) accompanied by impaired consciousness manifesting as prolonged postcoma unawareness (PCU) is one of the current medical and social problems causing high morbidity and mortality worldwide. Difficult recovery of such patients necessitates the development of additional neurorehabilitation approaches, including neuromodulation methods, as well as the search for objective markers of treatment efficacy.   Aim of the study: to evaluate the effect of therapeutic rhythmic transcranial magnetic stimulation (rTMS) on fMRI resting state networks (RSN) in PCU after severe TBI.   Materials and Methods. We analyzed individual fMRI RSN in three patients with PCU before and after a course of rTMS performed at different timepoints after severe TBI and with different efficacy of treatment. We assessed the topography and quantitative characteristics of the networks (DMN, sensorimotor, control functions, left and right fronto-parietal, auditory, and speech) known to be most significant for recovery of consciousness.   Results. We found a trend toward normalization of RSN topography as well as an increase in the integral index of network intensity in two of three patients with a distinct increase in consciousness after a course of rTMS.   Conclusion. Using case observations, we have demonstrated the therapeutic efficacy of rTMS and feasibility of using fMRI RSN as a reliable diagnostic approach in PCU following severe TBI.   Тяжелая черепно-мозговая травма (ТЧМТ), сопровождающаяся нарушением сознания в форме затяжных посткоматозных бессознательных состояний (ПКБС), относится к числу актуальных медико-социальных проблем, обусловливающих высокую инвалидизацию или летальность пациентов во всем мире. Трудности восстановления пациентов обосновывают необходимость разработки дополнительных нейрореабилитационных подходов, включая методы нейромодуляции, а также поиск объективных маркеров эффективности лечения.   Цель исследования. Оценить влияние терапевтической ритмической транскраниальной стимуляции (рТМС) на сети покоя фМРТ (resing state networks — RSN) при ПКБС после ТЧМТ.   Материалы и методы. Проанализировали индивидуальные RSN фМРТ у трех пациентов с ПКБС до и после курсовой рТМС, выполненной в разные сроки после ТЧМТ и с разной эффективностью лечения. Оценивали топографию и количественные характеристики сетей (сеть DMN, сенсомоторная, управляющих функций, лобно-теменные (левая и правая), аудиторная, речевая), наиболее значимых для восстановления сознания по данным литературы.   Результаты. Выявили тенденцию к нормализации топографии RSN, а также увеличение интегрального показателя сетевой интенсивности у двух из трех пациентов с выраженным повышением уровня сознания после курсовой рТМС.   Заключение. На примере индивидуальных наблюдений показали перспективность рТМС в качестве лечебного воздействия, а также оценки RSN фМРТ — как объективного диагностического подхода при ПКБС вследствие ТЧМТ

Adrenocortical cancer: late diagnosis of the disease on the example of a clinical case. Case report

Adrenocortical carcinoma (ACC) is a rare malignant tumor originating in the adrenal cortex and characterized by poor 5-year survival. It occurs with a frequency of 2–4 cases per 2 million in the population. Women are more frequently affected than men and it is mostly detected in the fourth and fifth decades. In the most of cases, the cancerogenesis occurs sporadically because of gene driver mutations in somatic adrenocortical cells, in other cases it can be found as part of a genetically determined syndrome such as Li–Fraumeni syndrome or Wermer's syndrome (multiple endocrine adenomatosis type I). ACC most frequently happens occurs without symptoms in the initial stages leading to poor diagnoses. Because of this lack of early detection, the tumor is not considered malignant reducing the benefits of further treatment. Sometimes the fact that the resected tumor is indeed adrenocortical carcinoma becomes clear only after recurrence, or after the appearance of metastases. We present a case of adrenocortical carcinoma in a 46-year-old woman who went to the doctor in 1.5 year after symptoms were manfested. This clinical case illustrates the consequences of late diagnosis of a malignant tumor. We would like to emphasize the importance of timely detection of a neoplasm, using all of the potential of laboratory-instrumental and genomic analysis. Due to low oncological awareness, our patient was slow to seek medical help, which in turn led not only to metastases, but also to complications in the cardiovascular system

Гормонально-иммунологический статус и особенности питания у лиц с ожирением

Nourishment peculiarities of 120 patients aged from 41 years having excess body mass and obesity were investigated. Interre-lations with changed hormonal-immune status were assessed. Method of food taking rate developed in the Institute of Nourishment, RAMS, taking into account nourishing peculiarities of Russian population was used. Study results revealed, that patients had imbal-ance concerning main macro- and micronutrients: nourishment regimen was disturbed in 90% of cases, taking main part of energy value was shifted to the second half of a day, increased calorie content of nourishment, excess of monosaccharides in the setting of decreased physical activity were seen which plays the main role in the development and advancing obesity, increased level of leuco-cytes, of TNF-α, IFN-γ, humoral immunity link imbalance, increased serum concentration of leptin and insulin which is closely cor-relates with excess body mass and nourishment peculiarities.Исследованы особенности питания 120 пациентов в возрасте от 18 до 41 года с избытком массы тела и ожирением. Оценены взаимосвязи с изменениями гормонально-иммунологического статуса. Применялся метод анализа частоты потребления пищи, разработанный в Институте питания РАМН с учетом особенностей питания населения России. По результатам исследования установлено, что у пациентов наблюдался дисбаланс по основным макро- и микронутриентам, примерно в 90% случаев нарушен режим питания, прием основной части энергетической ценности рациона смещен на вторую половину дня, отмечены рост общей калорийности питания, избыток моносахаридов, жиров на фоне прогрессирующего снижения физической активности, а значит и энергозатрат, что играет основную роль в развитии и прогрессировании ожирения, отмечается повышение уровня лейкоцитов, TNF-α, IFN-γ, дисбаланс гуморального звена иммунитета, повышение сывороточной концентрации лептина и инсулина, тесно коррелированное с ИМТ и особенностями питания

Опыт применения ритмической периферической магнитной стимуляции при пояснично-крестцовой радикулопатии

Introduction. Lumbosacral radiculopathy is а leading cause of long-term disability. Taking into a consideration the duration of treatment radiculopathy, the risk of developing adverse reactions when taking analgesics, non-steroidal anti-inflammatory drugs, the physiotherapeutic method — repetitive peripheral magnetic stimulation may become a promising method of therapy.Aim of the study. Assessment of the effectiveness of the complex treatment for patients with lumbosacral radiculopathy using the course of the repetitive peripheral magnetic stimulation.Materials and methods. Forty patients with lumbosacral radiculopathy were enrolled in the open non-randomized study, were divided into 2 parallel groups. The patients of the 1st group received a course of traditional treatment and a course of the repetitive peripheral magnetic stimulation. The patients of the 2nd group were treated with the traditional treatment without the course of the stimulation. A magnetic stimulator MagPro (Magventure, Denmark) was used for repetitive peripheral magnetic stimulation.Results. A significant difference (p &lt;0.001) was registered regarding the reduction of pain syndrome and the improvement of the functional status after treatment in both groups. 14 (70 %) patients of the first group achieved a pain visual analogue scale relief by 50 % after 10 repetitive peripheral magnetic stimulation sessions, while 6 (30 %) patients did this after 15 repetitive peripheral magnetic stimulation sessions. We did not observed a statistically significant differences (p &gt;0.05) in pain syndrome, functional status, anxiety level at the end of follow-up between the groups.Conclusion. We did not receive the benefits of the repetitive peripheral magnetic stimulation course in comparison with a traditional treatment of a lumbosacral radiculopathy. Further placebo-controlled studies to study the effect of repetitive peripheral magnetic stimulation on pain and anxiety in patients with back pain and radiculopathy are required.Введение. Пояснично-крестцовая радикулопатия является частой причиной стойкой и длительной утраты трудоспособности. Если принимать во внимание длительность лечения радикулопатии, риск развития нежелательных реакций при приеме анальгетиков и нестероидных противовоспалительных препаратов, перспективным направлением терапии становится применение физиотерапевтического метода — ритмической периферической магнитной стимуляции.Цель исследования – оценить эффективность комплексного лечения с применением курса ритмической периферической магнитной стимуляции у пациентов с пояснично-крестцовой радикулопатией.Материалы и методы. В открытом нерандомизированном исследовании приняли участие 40 пациентов с пояснично-крестцовой радикулопатией, которые были разделены на 2 группы. Пациенты 1-й группы получали курс традиционного лечения и курс ритмической периферической магнитной стимуляции. Больные 2-й группы — курс традиционного лечения без применения курса магнитной стимуляции. Для проведения стимуляции был использован магнитный стимулятор MagPro (Magventure, Дания).Результаты. Было показано достоверное различие (р &lt;0,001) в отношении уменьшения интенсивности болевого синдрома, улучшения функционального статуса по окончании курса терапии в обеих группах. У 14 (70 %) пациентов 1-й группы уровень болевого синдрома уменьшился по визуально-аналоговой шкале на 50 % после 10 сессий ритмической периферической магнитной стимуляции, у 6 (30 %) больных — после 15 сессий. При оценке болевого синдрома, функционального статуса, уровня тревожности не было зарегистрировано статистически значимого различия (р &gt;0,05) параметров между группами на момент завершения лечения.Заключение. Полученные результаты не показали преимущества курса ритмической периферической магнитной стимуляции у пациентов с пояснично-крестцовой радикулопатией в сравнении с курсом традиционной терапии. Требуются дальнейшие плацебо-контролируемые исследования для изучения влияния магнитной стимуляции на болевой синдром и уровень тревожности у пациентов с болью в спине и радикулопатией