The correlations of glycated hemoglobin and carbohydrate metabolism parameters with heart rate variability in apparently healthy sedentary young male subjects

Introduction Sedentary lifestyle is a major risk factor for diabetes, cardiovascular and many other age-related diseases. Heart rate variability (HRV) reflects the function of regulatory systems of internal organs and may sensitively indicate early metabolic disturbances. We hypothesize that quantitative and qualitative changes of HRV in young subjects may reflect early metabolic derangements responsible for further development of clinically significant disease. Aim The aim of our study was to determine whether the parameters of carbohydrate metabolism (fasting blood glucose, HBA1c and surrogate insulin sensitivity/resistance indices) correlate with anthropometric data and HRV. Methods The study group consisted of 30 healthy sedentary male subjects aged 20–40, nonsmokers, mainly office and research employees, medical staff and students. Athletes, actively training more than one hour per week, severely obese and men of physical work were excluded from the study. HRV parameters were derived from short term ECG records (five minutes intervals) in supine position and during orthostatic test. Anthropometric data included height, weight, body mass index (BMI), age and body composition (estimation by bioelectric impedance method). The fasting blood glucose, insulin and C-peptide, homeostatic model assessment (HOMA-IR) index and glycated hemoglobin (HbA1c) were evaluated. Linear correlation coefficient (r) was calculated using Statistica 10.0 software. Results and discussion HOMA-IR index correlated positively with body weight, visceral fat and BMI (p=0.047, 0.027 and 0.017 respectively). In supine position pNN50 positively correlated with glucose/insulin ratio (p=0.011) and heart rate with HOMA-IR (p=0.006). In orthostatic test negative correlations of HBA1c with standard deviation, total and low frequency power were determined (p=0.034, 0.400 and 0.403 respectively), which indicates a gradual worsening of functional capacity of cardiovascular system with low-grade increase (under the conventional threshold) of HBA1c. Conclusions In apparently healthy sedentary subjects HRV reduction correlates with the age advancement, subclinical deteriorations of carbohydrate metabolism and excessive fat accumulation

Content of Some Pro- and Anti-inflammatory Factors, Insulin Resistance Parameters in Patients with Type 2 Diabetes Mellitus and Cardiovascular Autonomic Neuropathy, Influence of Omega-3 Polyunsaturated Fatty Acids on These Parameters

Introduction. Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus (DM), that is strongly associated with increased risk of cardiovascular mortality. CAN among type 2 DM (T2DM) patients, is characterized by lesion of nerve fibers in the sympathetic and parasympathetic divisions of the autonomic nervous system, is diagnosed unsatisfactorily and may be accompanied by severe postural hypotension, decreased tolerance to the physical loadings, and cause the cardiac arrhythmias, ischemia of coronary vessels, ″silent″ myocardial infarction (MI), sudden death syndrome. CAN manifests in a spectrum of things, ranging from resting tachycardia and fixed heard rate to development of ″silent″ MI. Although it is a common complication, the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today. The pathogenetic treatment of CAN include lifestyle modification, intensive glycemic control, treatment of dyslipoproteinemia (DLP), correction of metabolic abnormalities in the myocardium, thrombosis prevention, prescription of α-lipoic acid, aldose reductase inhibitors; γ-linoleic acid, acetyl-L-carnitine, antioxidants, long-chain ω-3 polyunsaturated fatty acids (ω-3 PUFAs), vasodilators, vitamin B1 and some other substances. American Diabetes Association (2016) recommend the prescription of ω-3 PUFAs in algorithms of DLP treatment among patients with T2DM and cardiovascular diseases. However, the data about the ω-3 PUFAs effectiveness are incomplete, the future investigation are needed. The aim of the study was to investigate the content of some pro- and anti-inflammatory factors, insulin resistance parameters in patients with T2DM and CAN, influence of ω-3 PUFAs on these parameters. Materials and methods. The study involved 48 patients with T2DM (16 women, 32 men, patients were aged between 50-59 years), among them: 1) 12 patients with T2DM without CAN; 2) 36 (aged 50-59 years, disease duration 1-6 years, glycated haemoglobin (HbA1c) level (7,1 ± 0,6) %) – with functional CAN stage. Control group – 15 healthy people of median age (51,9 ± 3,2) years. The concentration of glucose, immunoreactive insulin (IRI), high sensitivity C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-8 and IL-10 in the blood were determinate; insulin resistance index (HOMA-IR) and TNF-α/IL-10 ratio were calculated. Patients with T2DM and functional stage of CAN were divided into 2 groups: patients of 1nd group (n = 21) received one capsule/day of the ω-3 PUFAs in addition to standard treatment, each one gram capsule of the ω-3 PUFA contains approximately 465 mg of eicosapentaenoic and 375 mg of docosahexaenoic acid and 4,0 g of tocopferol acetate; patients of 2nd group (n = 15) received standard glucose lowering therapy (control group). The duration of the study was 3 months. Results. According to the results of our study there can be seen the increase of IRI, HOMA-IR levels are accom- panied with increase of hsCRP, TNF-α, IL-6, IL-8 and IL-10 (compared to the control). The development of func- tional stage of CAN was accompanied with statistically significant increase of IRI, hsCRP, TNF-α, IL-6, IL-8, IL-10 and TNF-α/IL-10 levels (compared to patients with T2DM without CAN). Obtained results could witness about the violation of cytokines dysbalance, development of compensative type of cytokine dysbalance. The administration of ω-3 PUFAs to patients with T2DM and CAN promoted to the statistically significant decrease in hsCRP, TNF-α, IL-6 and IL-8 levels and TNF-α/IL-10 ratio; but no statistically significant changes of IL-10, HbA1c, IRI and HOMA-IR was found. Conclusions. Obtained results could witness, that prescription of ω-3 polyunsaturated fatty acids leads to decrease of the proinflammatory immune response activity and allows to consider ω-3 polyunsaturated fatty acids as a promising medicine in the treatment of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus

Benfotiamine and Long-Chain Omega-3 and Omega-6 Polyunsaturated Fatty Acids in Treatment of Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus

Introduction. The cardiovascular form of diabetic autonomic neuropathy (DANP) in patients with type 2 diabetes mellitus (DM), is characterized by the damage of the nerve fibers of the parasympathetic and sympathetic parts of the autonomic nervous system, and is considered to be one of the main causes of cardiac arrhythmias, an independent risk factor of cardiovascular mortality. Therefore, the problem of prevention and treatment of DANP is especially relevant. The pathogenetic treatment of DANP includes rational nutrition and physical activity, optimization of glycemic control, treatment of dyslipoproteinemia (DLP), correction of metabolic disorders of the myocardium, prevention and treatment of thrombosis, use of aldose reductase inhibitors, γ-linolenic acid, acetyl-L-carnitine, antioxidants, in particular α-lipoic acid (α-LA), long-chain ω-3 and ω-6 polyunsaturated higher fatty acids, vasodilators, fat-soluble vitamin B1, aminoguanidine, substitution treatment with myoinozitol, growth factors, etc. Aim. To evaluate the efficacy of treatment with benfotiamine, long-chain ω-3 and ω-6 polyunsaturated higher fatty acids of the cardiovascular form of diabetic autonomic neuropathy in patients with type II DM. Materials and methods. Тhe study involved 59 patients with type 2 diabetes mellitus (DM) and cardiovascular autonomic neuropathy (CAN), aged 50–59 years, with a disease duration of 1–6 years and HbA1c index (7.1 ± 0.6 %). Patients with type 2 DM and CAN were allocated to four treatment groups: patients of the 1st group received traditional hypoglycemic therapy (n=15); to patients from the 2nd group (n = 21), in addition to the standard treatment, was prescribed 1 capsule of “Omacor®” daily; to the 3rd group of patients (n = 12) – benfotiamine 300.0 mg per day; to the 4th group (n = 11) – “Omacor®” (1 capsule/day) in combination with benfotiamine 300.0 mg per day. Results. It has been established, that combined prescription of “Omacor ®” and benfotiamine is accompanied by more significant positive changes in HDL, triglycerides and leptin levels comparing to control group and group treated with benfotiamine, but no statistically significant changes compared to the therapy with “Omacor®” have been obtained. Application of this combination was accompanied by more significant positive changes in IRI, hsCRP and TNF-α levels compared to other groups. Conclusions. The efficacy of combined therapy with “Omacor®” and benfotiamine is not determined by the improved compensation of type 2 DM, but is the result of direct effect of pharmacological agents on the investigated metabolic parameters

DIABETES MELLITUS 2ND TYPE WITH CARDIOVASCULAR AUTONOMIC NEUROPATHY

Aim. To perform the analysis of some parameters of insulin resistance, concentration of N-terminal natriuretic pro-brain peptide (NT-prоBNP), hi-sensitive С-reactive proteine (hsCRP) and some proand anti-inflammatory cytokines in diabetes mellitus patients with diabetes mellitus 2nd type (DM2) with cardiovascular autonomic neuropathy (CAN).Material and methods.   Totally 48 patients studied with DM2, of those 12 without verified cardiovascular diseases (CVD), 36 patients with functional stage of CAN, age 50-59 y., DM2 1-6 y. duration, HbA1c 7,1±0,6%. Controls: 15 same age almost healthy persons (р>0,05). The screening for CAN was performed that included 5 cardiovascular tests, the data from ambulatory blood pressure monitor was analyzed, ECG; and echocardiography, HbA1c, insulin (IRI), NT-proBNP, hsСRP, tumor necrosis factor-a (TNF-a), interleukin (IL)-6, IL-8 и IL-10. The Index of insulin resistance was calculated (НОМА-IR), coefficient TNF-a/IL-10.Results.   In DM2 patients with CAN there was an increase of insulin resistance values, e. g. IRI concentration (26,6±1,73 mcIU/ml, р<0,001 — comparing to controls; р1 <0,001 — patients with DM2 not CVD), НОМА-IR (8,56±0,72, р<0,001, р1 <0,01); levels of proinflammatory cytokines TNF-a (5,75±0,24 pg/ml, р<0,001, р1 <0,001), IL-6 (5,88±0,38 pg/ml, р<0,001, р1 <0,001), IL-8 (6,65±0,3 pg/ml, р<0,001, р1 >0,05); and hsCRP (2,77±0,24 pg/L, р<0,001, р1 <0,001) and coefficient TNF-a/IL-10 (44,2±3,57%, р<0,01, р1 <0,05). Addition of CAN is associated with the increase of NTproBNP (407,0±23,0 fmol/ml, р<0,001, р1 <0,001), that correlates with the growth of the left ventricle myocardial mass (LVMM) (r=0,52, p<0,05).Conclusion. In DM2 patients with the functional stage of CAN there is an increase of IRI, НОМА-IR; concentrations of NT-prоBNP, hsСRP, TNF-a, IL-6, IL-8 и IL-10. there is also an increase of TNF-a/IL-10, that witnesses for the compensatory type of cytokine balance. The level of NT-prоBNP in DM2 patients correlates with LVMM that is associated with CAN development

EFFECTS OF OMEGA-3 POLYUNSATURATED FATTY ACIDS ON THE CIRCADIAN RHYTHM OF HEART RATE VARIABILITY PARAMETERS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND CARDIOVASCULAR AUTONOMIC NEUROPATHY

Aim. The aim of the study was to analyze the effect of a-3 polyunsaturated fatty acids (a-3 PUFAs) on the heart rate variability (HRV) parameters in patients with type 2 diabetes mellitus (T2DM) and advanced stage of cardiovascular autonomic neuropathy (CAN).Material and methods. We have examined 36 patients with T2DM and advanced stage of CAN, aged between 50-59 years with disease duration 1-6 years and median glycated hemoglobin A1c 71%±0,12%. Patients with T2DM and advanced stage of CAN were divided into 2 groups. The first group received traditional antihyperglycemic therapy (n=15, control) for three mo; patients in group 2 (n=21) received in addition 1 g/day of the a-3 PUFAs for three months.Results. Prescription of the a-3 PUFAs to the patients with T2DM and advanced stage of CAN was accompanied by a statistically significant increase of the timedomain HRV parameters; the spectral HRV parameters during the active and passive periods compared to the control group.Conclusion. Obtained results suggest that the efficacy of a-3 PUFAs is the result of a direct effect of the a-3 PUFAs on the investigated indexes

Effects of benfotiamine on the insulin resistance state, some pro- and anti-inflammatory factors content in patients with type 2 diabetes mellitus and cardiac autonomic neuropathy

Aim. The aim of the study was to analyze the effect of benfotiamine (BFT) on the insulin resistance state, the content of some pro- and anti-inflammatory factors in patients with type 2 diabetes mellitus (T2DM) and advanced stage of cardiac autonomic neuropathy (CAN).Material and methods. 40 patients with T2DM and advanced stage of CAN, aged between 50-59 yrs with disease term 1-6 yrs and average glycated hemoglobin A1c (HbA1c) 7,16%±0,19% were examined. Patients were divided into 2 groups. The patients from first group received standard hypoglycemic treatment (n=19, control) for three mo. To patients from the second (n=21, treatment group) was prescribed 300 mg/q.d. of the BFT in addition for three mo. The levels of blood glucose, HbA1c, immunoreactive insulin (IRI), high sensitivity C-reactive protein (hs-CRP), leptin, tumor necrosis factor-alpha (TNF-alpha), interleukins (IL)-6, IL-8 and IL-10 were determined. The Homeostasis Model Assessment (HOMA) insulin resistance (IR) index (HOMA-IR) parameters, TNF-alpha/IL-10 ratio were calculated.Results. Treatment with BFT led to significant decrease in the concentration of IRI [Δ=-12,74%±1,42% (p<0,05)]; hs-CRP [Δ=-13,62%±1,96% (p<0,05)], TNF-alpha [Δ=-10,24%±1,54% (p<0,05)] and IL-6 [Δ=-15,41%±2,03% (p<0,05)] compared to the control group. At the same time, prescription of BFT does not affect the concentration of glucose, leptin, IL-8, IL-10; HOMA-IR and TNF-alpha/IL-10 ratio parameters (p>0,05).Conclusion. Obtained data may indicate a decrease in the activity of the proinflammatory link of the immune response and allow us to consider BFT as a promising pharmacological agent in the complex treatment of the advanced stage of CAN

Features of Lipid Spectrum and Insulin Resistance Parameters in Patients with Type 2 Diabetes Mellitus and Cardiac Autonomic Neuropathy and Appropriateness of Simvastatin and Omega-3 Polyunsaturated Fatty Acids Combined Prescription

Introduction. Cardiovascular autonomic neuropathy (CAN) is a serious and common complication of type 2 diabetes mellitus (T2DM). Despite its relationship to an increased risk of cardiovascular mortality and its association with multiple symptoms and impairments, the significance of CAN has not been fully appreciated. CAN among T2DM patients may be accompanied by severe postural hypotension, decreased tolerance to the physical loadings, and cause the cardiac arrhythmias, ischemia of coronary vessels, ″silent″ myocardial infarction, sudden death syndrome. Although it is a common complication, the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today. It is obvious that the foreground should be the therapy aimed at lifestyle modification, reducing insulin resistance (IR), correction of hyperglycemia, dyslipoproteinemia (DLP), symptomatic treatment of concomitant diseases and syndromes. For DLP pharmacotherapy using statins, fibrates, bile acid sequestrants, nicotinic acid and its derivatives, products of long-chain ω-3 polyunsaturated fatty acids (ω-3 PUFAs), or as an alternative-their combination with cholesterol absorption inhibitors. Statins are widely accepted as the first-line therapy of the atherogenic DLP, the effectiveness of its prescription was proved in several studies. However, the data about the ω-3 PUFAs effectiveness are incomplete, the future investigation are needed. The aim of this study was to investigate the blood lipid profile and IR parameters in patients with T2DM and CAN and the effects of simvastatin and ω-3 PUFAs prescription. Materials and methods. The study involved 219 patients with T2DM (101 women and 118 men, patients were aged between 50-59 years), among them: 1) 19 patients without CAN; 2) 44 – with subclinical CAN; 3) 156 (aged 50-59 years, disease duration 1-6 years, glycated haemoglobin A1c (HbA1c) level (7,1 ± 0,4) %) – with functional CAN. Control group – 15 healthy people of median age (51,9 ± 3,2) years. The concentration of glucose, HbA1c, immunoreactive insulin (IRI) in the blood were determinated, the insulin resistance index (HOMA-IR) was calculated. Lipid metabolism was assessed by the concentration of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides (TG) measurements and calculation of the atherogenic coefficient (AC). Among 156 patients with T2DM and functional CAN stage, 76 patients were allocated into four treatment groups: 1st group – 22 patients received standard hypoglycemic therapy and simvastatin 20 mg/day; 2nd group – 21 patients received standard hypoglycemic therapy and one capsule/day of the ω-3 PUFAs; 3rd group – 18 patients received standard hypoglycemic therapy, one capsule of the ω-3 PUFAs and simvastatin 10 mg/day; 4th group – control group received standard hypoglycemic therapy (n = 15). The duration of the study was 3 month. Results and discussion. Obtained results of our study could witness that the increase of IRI, HOMA-IR parameters in patients with T2DM and CAN was accompanied by growth of TC, TG, LDL-C, AC and decrease of HDL-C levels. The most pronounced changes were observed in patients with functional stage of CAN. The prescription of simvastatin was accompanied by a statistically significant decrease in TC, LDL-C, TG, IRI and increase in HDL-C levels (compared to control); statistically significant decrease in TC, LDL-C and IRI (compared to ω-3 PUFAs). ω-3 PUFAs are not contributing to changes in HbA1c, preprandial glucose, IRI and HOMA-IR; statistically significant reduced TG, AC and increased HDL-C levels. The combined prescription of simvastatin and ω-3 PUFAs contributed to the most positive, statistically significant changes in hyperinsulinemia/IR parameters and lipid metabolism, allowing to reduce the daily dose of simvastatin. Conclusions. Obtained results could witness that effects of combined simvastatin and omega-3 polyunsaturated fatty acids prescription are not connected with diabetes mellitus compensation state and are as a direct influence of this pharmacological agents on investigated parameters that justify the appropriateness of their prescription to patients with type 2 diabetes mellitus and functional stage of cardiovascular autonomic neuropathy

The Verbal Content of Concepts Pride and Nobility Represented in the Quantity of their Components (Based on English Fiction at the End of the XIX Cent.)

Статтю присвячено дослідженню номінативного поля лексико-семантичної структури концептів PRIDE і NOBILITY та кількісному підрахунку елементів, що вербалізують його сегменти. The article deals with the research of the nominative field of concepts PRIDE and NOBILITY and quantitative analysis of the verbal elements of its segments

Estimation of diagnostics of fibers failure in composite materials by the method of acoustic emission

The model of acoustic emission caused by formation of penny-shaped cracks in fiber composite materials taking into account stress relaxation in breaking fibers is proposed. It is found that the maximal values of components of displacement vector are directly proportional to the total area of defect, which is formed, and inverse proportional to the relaxation time

Calculation and optimization of waveguide geometry for acoustic emission signals

Optimization of geometrical sizes of the waveguide of elastic acoustic emission (AE) waves, which is used in the search of hydrogen induced cracking during thermal cycling of structure alloys in a gaseous hydrogen environment, is considered. A waveguide is considered as on acoustic system that has the discrete spectrum of eigenfrequencies. Distribution of temperature field along the waveguide is calculated, decay of elastic AE waves is estimated. Basing on the obtained results the design implementation of the waveguide is carried out