Cytokines, insulin resistance and arterial wall stiffness in assessing the course of non-alcoholic fatty liver disease

The progression of non-alcoholic fatty liver disease is associated with an increased prevalence of cardiovascular disease. Aim: to assess the level of cytokines, insulin resistance, arterial wall stiffness during the progression of hepatic steatosis in patients with non-alcoholic fatty liver disease. Material and methods. 87 patients with non-alcoholic fatty liver disease were examined. Group I consisted of 14 patients without steatosis, group II – 32 patients with steatosis grade 1; III – 30 patients with steatosis grade 2, IV group – 11 patients with steatosis grade 3. The control group consisted of 30 apparently healthy individuals. Steatometry with a quantitative assessment of the grade of hepatic steatosis was performed using a Soneus P7 ultrasound machine. The content of cytokines (interleukin-6, interleukin-10, TNF-α) was determined using an enzyme-linked immunosorbent assay using a Stat Fax 303 Plus analyzer. The level of insulin resistance was determined using the HOMA-IR index. Results. The content of interleukin-6 in the blood serum of patients of group IV was significantly increased relative to the level in the control group (by 1.8 times, P < 0.05), patients of group I (by 3.2 times, P < 0.05), II group (by 3.0 times, P < 0.05) and group III (2.3 times, P < 0.05). The level of TNF-α increased with the progression of structural changes in the liver and at grade 4 of steatosis its content was increased by 6.4 times (P < 0.05) relative to the level in the control group, by 8.0 times (P < 0.05) relative to group I patients, by 3.4 times (P < 0.05) – group II patients and by 1.8 times (P < 0.05) – group III patients. An increase in the HOMA-IR index by 3.2 times (P < 0.05) was found in patients with moderate steatosis and 3.9 times (P < 0.05) in patients with severe steatosis compared to controls. A correlation was established between the intima-media thickness of the left common carotid artery and the level of TNF-α (r = 0.438; P = 0.006) and the HOMA-IR index (r = 0.557; P = 0.0008). Conclusions. In patients with non-alcoholic fatty liver disease with progression of the grade of hepatic steatosis, a significant increase in proinflammatory cytokines, insulin resistance and intima-media thickness of the left common carotid artery was found.

Specificities of lipotoxicity of free fatty acids and cytokine profile in patients with chronic diffuse liver diseases

Non-alcoholic fatty liver disease is an important cause of global liver disease characterized by diffuse hepatocytes with hepatocellular ballooning, intrahepatic inflammation and progressive fibrosis. A relevant task is the study of the relationship between content of free fatty acids and serum cytokine profile in patients with chronic diffuse liver diseases. A total of 74 people with chronic diffuse liver diseases were examined, including 32 patients with non-alcoholic fatty liver disease, 22 patients with alcoholic liver disease, 20 patients with toxic hepatitis. Chromatographic examination of free fatty acids (FFA) in blood serum was carried out using a Chromatek-Crystal 5000 gas chromatography system. Patients with chronic diffuse liver diseases had a significant increase in the level of unsaturated free fatty acids (USFA) in cases of toxic hepatitis (by 2.92 times, P > 0.05) and a decrease in the level of saturated free fatty acids (SFA) in cases of non-alcoholic fatty liver disease (by 1.52 times, P > 0.05) compared with the control group; the balance between omega-6 and omega-3 PUFA significantly changed due to increase in linoleic acid in patients with alcoholic liver disease and toxic hepatitis (by 1.91 and 2.11 times, respectively) and arachidonic acid in patients with toxic hepatitis (by 1.78 times). The level of interleukin (IL)-6, IL-10, tumor necrosis factor alpha (TNF-α) were determined. In patients suffering chronic diffuse liver diseases there were multidirectional changes in the composition of free fatty acids of blood serum: a significant increase in the level of USFA, levels ІL-6 in toxic hepatitis; a decrease in the level of SFA, levels ІL-6 and TNF-α during non-alcoholic fatty liver disease; increased TNF-α production, ІL-6 during alcoholic liver disease compared with the control group. Significant change occurred in the balance between omega-6 and omega-3 PUFA due to increase in linoleic acid in cases of alcoholic liver disease and toxic hepatitis and arachidonic acid in cases of toxic hepatitis. The revealed correlations support the hypothesis that inflammation and lipotoxicity of FFA of blood serum contribute to the development and progression of structural changes in the liver. However, the pathomechanism of lipid metabolism and cytokine regulation with different etiological factors have their own characteristics, which should be taken into account when treating patients of these groups. Prospects for further research: these parameters may be used for serologic biomarkers of liver disease and development and implementation of the ratio between FFA and cytokines for the differential diagnosis of chronic diffuse liver disease in medical practice.

Levels of isoforms of fibronectin and α5/CD49e integrin on lymphocytes and in blood plasma in the conditions of chronic diffuse liver diseases

Chronic diffuse liver diseases are characterized by accumulation of complex inflammatory infiltrate in the liver tissues, blood, and lympha, and activation of the immune system. Leukocytes become involved in the area of inflammation after the activation of receptors of blood adhesia, particularly integrins and their ligands. Plasma lymphocytes quickly activate the function of integrins by changing their conformation, leading to high affinity and underlying the formation of strong stable connection between the components of extracellular matrix. A vitally important role in the process of liver fibrogenesis is performed by a pro-fibrogenicic protein fibronectin which induces the expresson of collagen genes and precedes the deposition of other components of matrix. The studies were conducted in the group of patients suffering from chronic diffuse liver diseases of non-viral etiology aged 28–60 years, n = 36 and in the group of 15 practically healthy volunteer donors aged 25 to 52 years without a history of liver diseases using the methods of flow cytofluorometry, immunoenzymatic analysis, and quantitative real-time polymerase chain reaction. The patients of the group with chronic diffuse liver diseases were observed to have statistically significant decrease in the concentration of plasmatic form of fibronectin measuring 27.6% compared with the control group. We determined increase in the concentration of cellular fibronectin in blood plasma of patients with the diseases on average accounting for 63.8% compared with the norm, and the highest increase in this parameter equaling 77.2% was seen in patients suffering from drug-induced hepatitis. Significant increase in the level of exposure of cellular FN on blood lymphocytes was determined in patients with chronic diffuse liver diseases, measuring 231.8%, whereas the level of plasmatic form of fibronectin in these cells was decreased (statistically unreliable). For α5-integrin subunit, we determined a 390.8% increase in the level of its exposure in blood lymphocytes in the surveyed groups compared with the control. Level of blood lymphocytes that express the cellular fibronectin significantly decreased by 140.1%. Statistical characteristics of diagnostic possibility of the parameters of the level of plasmatic and cellular fibronectin in blood, determined over the analysis of ROC-curves, demonstrated excellent informativeness of these tests. Analysis of the possibility of predicting the presence of pathology using the model of logistic regression revealed zero error of prediction and maximum efficiency of the tests: intensity of exposure of α5-integrin receptor on the surface of lymphocytes, intensity of exposure of plasmatic fibronectin on the surface of lymphocytes, intensity of exposure of cellular fibronectin on the surface of lymphocytes, concentration of plasmatic fibronectin in blood, concentration of cellular fibronectin in blood plasma. These parameters may be proposed for further surveys for developing serologic biomarkers based on the parameters for diagnostics of chronic diffuse liver diseases.

[Ontogenetic characteristics of patients with erectile dysfunction with different types of aging.]

Age-related erectile dysfunction (ED) can be formed during ontogenesis in accordance with various mechanisms of the pathogenesis of aging in conjunction with a particular cluster of diseases. The aim of the work is to study ontogenetic features of ED patients in late ontogeny of various types of aging. 65 men over 45 with an explicit form of ED were examined. The first group consisted of patients with general-somatic diseases (GSD) arising mainly from the accumulation model of aging, and the second group included patients with age-associated diseases (AAD), arising primarily from the ontogenetic model of aging. Both variants of age-related ED are closely related to ontogenetic events, especially with the debut of obesity and the loss of morning erections, preceding the ED debut, on average over a decade of life. ED, combined with AAD, is most clinically and pathogenetically compromised. Thus, it is characterized by: earlier age of debut ED, dismetabolic pattern, low geroprotective pattern, poor quality of primary health, pronounced instability of gonadostat, weak sexual constitution, decreased sensitivity of hypothalamic-pituitary complex to feedback signals, the large proliferative pattern. ED associated with GSD had a later age of debut ED, developed much later from the debut of obesity, had a lower level of testicular volume with a more conserved incretory function, but a higher index of IPSS. Thus, the separation of two ED variants associated with different types of aging in conjunction with the use of ontogenetic analysis, allowed to identify significant differences in such clinical and pathogenetic forms, which is important for the development of ideas about the diagnosis and treatment of age-related ED.

[Prognosis of the hemorrhage recurrence in the patients suffering from acute gastroduodenal ulcer bleeding]

The prognostication method for the hemorrhage recurrence, permitting to estimate the risk of its occurrence and to prescribe an adequate antirecurrence treatment, was proposed. Among numerous predictors of recurrence the most significant clinical, endoscopic and laboratory factors were selected to raise the prognostication precision. Depending on therisk degree of a recurrent hemorrhage, different methods of treatment were prescribed to the patients. The proposed method was applied in 112 patients, suffering ulcer gastroduodenal hemorrhage. The hemorrhage recurrence have had occurred in 45 (43.3%) of them, in 5 (4.46%)--operative intervention was conducted, using organpreserving methods. General lethality have had constituted 0.89%, postoperative one in a control group--7.14%, and in the main all the patients were alive. The method proposed permits with a high precision to prognosticate and to determine effective tactics of treatment. Taking into account the additional factors of risk raises the prognosis precision and permits to prescribe antihelicobacter therapy and the proton pump inhibirors in a rational dosage soundly.

[Treatment strategy for ulcerative gastrointestinal bleeding from the upper gastrointestinal tract]

The deep statistical analysis of patients treatment with the ulcerous gastroduodenal bleeding set 2 years works of Center of the gastroduodenal bleeding of Dnepropetrovsk is conducted. It is exposed, that wide application of methods of endoscopic haemostasis and endoscopic monitoring allowed substantially to reduce the amount of operations at this category of patients and improve the results.

[Rational antibacterial therapy of acute surgical diseases of abdominal organs]

Comparative analysis of medical documents, concerning 1055 patients, aged 18-92 yrs old, operated for an acute surgical diseases of abdominal organs in 2007-2009 yrs, was performed. Preoperative antibioticotherapy was performed in all the patients, in 877 of them ceftazidim (ceftadim) was administered as the main antibacterial preparation and in 178--other antibacterial preparations. Application of ceftadim, as a basic preparation in antibioticotherapy, had permitted to lower the purulent-septic complications rate by 61% and to reduce the stationary treatment duration of the patients.

[An experimental validation of the use of various types of allografts for the replacement of mandibular defects]

The intensity of restructuring of various types of bone transplants and reaction of the adjacent tissues of the femoral distal epiphysis to these transplants was studied in rat experiments. The most manifest bone-inducing properties were detected in demineralized allobone, the least so in formalin-treated one; lyophilized and frozen transplants occupy an intermediate position between these two. These data are recommended to be borne in mind when replacing mandibular defects.

[Changes in the mouth mucosa during local UHF-hyperthermia and radiotherapy of malignant tumors of the maxillofacial region]

Morphological investigations under experimental conditions have demonstrated that local UHF-hyperthermia at 42-43 degrees C for 30 min does not cause alterative changes of the oral mucosa in animals. The revealed signs of activization of metabolic processes can probably increase radiosensitivity of tumors and their reparation. A favorable course of radiation mucositis was noted after experimental local hyperthermia and irradiation. Morphological changes of the oral mucosa, determined mainly by exposure to radiation, are characterized in the early period by alternative and dystrophic changes, and later on (in 3 mos.) by atrophy and sclerosis. In patients local UHF-hyperthermia had a radiosensitizing effect on the oral mucosa at 40-41,5 degrees C for 30 and 60 min. However it did not prevent the completion of a radical split course in the regimen of dynamic dose fractionation nor did it increase the number of postradiation complications. Under this temperature-time regimen the time of development and a degree of expression of radiation reactions did not depend on the succession of hyperthermia and irradiation, and the time of heating.

[Therapeutic effect of a saline solution with sodium lactate (lactasol) in traumatic shock]

Acute experiments on 67 adult dogs have demonstrated that infusions of lactasol in a dose of 25 ml/kg in the early period and in a dose of 50 ml/kg in the late period of shock are not efficacious enough. Injection of the increased amount of the saline in the early and late period of shock (up to 50 and up to 100 ml/kg, respectively) makes it possible to save from death almost all the animals. A conclusion is made that the therapeutic effect of lactasol depends on the amount of the saline injected and on the period of shock during which the saline is injected, as well as on the specific action of sodium lactate.

[Experimental study of the influence of reovirus infection on the course and outcome of pregnancy]

The possibility of intrauterine infection of fetuses of random-bred white mice with reovirus type 3 at various periods of pregnancy has been demonstrated. The unfavourable effect of reovirus infection on the course and outcome of pregnancy in some cases was manifested by impairment of embryogenesis, stillbirths and subsequent death of defective offsprings. Morphological examinations revealed marked pathological alterations in the lungs, brain, liver, and kidneys of suckling mice infected in utero.