Molecular genetic features of the diabetes mellitus development and the possibility of precision therapy

The purpose of this review is to analyze existing data on the molecular genetic features of the development of type 1 and type 2 diabetes mellitus, gestational diabetes and specific types of diabetes (maturity onset of diabetes of the young, neоnatal diabetes) and to assess the possibility of precision therapy.The etiology of diabetes is heterogeneous, and a genetic predisposition plays a significant role in its development. Genetic studies, conducted in the past few decades, allow us to identify a number of genes that directly affect the development of diabetes. The genetic prerequisites indicate high levels of predictability for the occurrence of type 1 diabetes. The only personalized treatment that is known to date for such patients is insulin therapy. For monogenic specific types of diabetes, genetic testing is a diagnostic factor which allows to prescribe adequate therapy. The molecular genetic characteristics of the development of type 2 diabetes and gestational diabetes are very complex and ambiguous, however, the existing rich data will become the basis for future recommendations for the prevention, diagnosis and personalized treatment

Prognostic criteria of paracentetic - drainage method effectiveness for treatment of extra-organ infected fluid collection in abdominal cavity

Introduction: One of the most important current surgical tasks is the treatment of the intraabdominal abscess patients, because there is neither positive tendency to reduce the amount of acute inflammatory diseases of abdominal cavity organs nor the tendency to reduce the postoperative suppurative complications. There is no doubt today about efficiency of transcutaneous abscess drainage under ultrasound guidance, but there are some contradictory opinions about efficiency of paracentetic treatment as compared to conventional surgical procedure. Research goal is to study the effectiveness criteria of paracentetic-drainage method in extra-organ infected fluid intraabdominal collections treatment and their dependence on collection echostructure and etiology. Material and methods: The retrospective analysis was carried out on 53 medical case-histories of extraorgan intra-abdominal abscess patients treated in surgical department of Regional clinical hospital No 1 in Kemerovo. The ultrasonic data, such as size, wall structure and characteristics of content were analyzed. The patients were divided into two groups: the 1st group (37 patients, n=37) consisted of patients who underwent only abscess paracentesis or drainage under ultrasound guidance; the 2nd group consisted of patients (n=16) who underwent open abscess drainage after inefficient paracentetic-drainage. Results: the etiology analyses of intraabdominal collections showed the paracentetic-drainage approach to be more often efficient for surgery on hepatobiliary system of patients with fluid collections in subhepatic area (42%). The most frequent cause for fluid formations in the 2nd group patients was acute pancreatitis, pancreatonecrosis - 45.3%. The volume of fluid collection in the 1st group patients was significantly less (74.4±0.3 ml) than in the 2nd patients group (117.8±2.3 ml). The formation echostructure analyze of both groups showed the 1st group to have formations with well-defined shapes (x2 = 2.55; p=0.01) and smaller size (x2 = 5.71; p=0.017). Heterogeneous echostructure and infiltrated fluid collections around were characteristically to the 2nd group patients. The analysis also showed that infected fluid collections containing pus in the 1st patients group were smaller in volume than in the 2nd group (73.84±0.3 ml to 111.75±0.5 ml respectively). According to the leukocyte index of intoxication (LII) analysis there is no reliable difference between LII in the 1st and the 2nd groups (p-29). But it is certain that LII reduces on the 3rd day after the drainage (the 1st group patients from 1.9 to 1.3; the 2nd group patients from 4.6 to 1.45). Conclusion: The efficiency of transcutaneous paracentesis under ultrasound guidance depends on etiology and echostructure of intraabdominal abscess. In case of pancreatic necrosis the minimal invasive method has an insignificant effect as the final treatment stage because of sequesters

CLINICAL AND HISTOLOGIC FEATURES OF UTERINE MYOMA IN REPRODUCTIVE-AGE WOMEN UNDER THE TREATMENT BY SELECTIVE PROGESTERONE RECEPTOR MODULATORS

Aim of the study was to investigate the clinical features of reproductive age women with uterine body myoma and the production of vascular endothelial growth factor (VEGF) in the dominant myoma node and perifocal myometrium under the preoperative use of ulipristal acetate (UA). Material and methods. 140 samples of 35 women surgical material were studied, VEGF content in the incubation medium of samples of myoma and myometrium was measured using enzymelinked  immunosorbent assay.Results and discussion. The treatment by UA before myoma surgery according to the standard regimen per 5 mg daily for 13 weeks deals with significantly reduced production of VEGF in the dominant myoma node compared to perifocal myometrium (p < 0.001), which is similar to patients of the control group. However, when comparing tumor nodes, a significantly lower content of VEGF was revealed in the UA-group (p = 0.026); unlike the perifocal myometrium samples. Conclusion. The use of a selective modulator of progesterone receptors downregulates the production of VEGF by the cells of the myoma nodes and doesn’t impact on the perifocal myometrium