The polypeptide neurotoxins and receptors: Yesterday and Today

Pharmacologist Dr. Doping tells about the importance of nicotinic receptors, the kinds of neurotoxins and proteomic studies. What are nicotine receptors? What are the physiological functions of acetylcholine binding protein? Is it possible to combine basic science and business?

Nicotinic receptors are involved in pain signal transmission. They play an important role as a neuroprotective. Regulation of the immune response, the control of cell growth, including the effects on the malignant growth - it is largely fulfill certain subtypes of nicotinic receptors are found on cells of the immune system.

If nicotinic receptors that something is wrong, it is expressed in a variety of diseases. Myasthenia gravis - one of the reasons for the formation of autoantibodies against muscle receptors. Some types of epilepsy - mutations in neuronal alpha-4 receptor. Some types of schizophrenia - the lack of expression of the alpha-7 receptors.

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Parkinson's disease and Alzheimer's disease. Of course, there nicotinic receptors are not the most important players. However, these diseases are always disturbed cognitive function. Always one of the first to suffer the cholinergic system, ie nicotinic receptors then partners. With nicotine dependence is clear: nicotinic receptors main culprits here.

Antioxidants and Cardiovascular Disease

Pharmacologist Dr. Doping tells about the components of the antioxidant system, and new forms of coenzyme properties of hydrogen.

Antioxidants and oxidative stress - a very important area of medicine, a field of study in medicine, and it is related to the possible harmful effects of reactive oxygen species that are produced in our body. They can be formed in various pathological conditions. But basically what it is? There is an active oxygen atom which is able to oxidize many parts of our cells - DNA, proteins, enzymes, membranes, etc. - and thus their damaging. There are several different types, and one of the most aggressive - a hydroxyl radical, or a radical OH - one of the active oxygen species. And in the modern view of the overproduction of reactive oxygen species, or oxidative stress is involved in the development of diseases such as myocardial infarction, heart failure, in neurology, in the development of Parkinson's disease there is overproduction of reactive oxygen species. And here the main role played by mitochondria, because there is synthesized ATP - is a very powerful energy band to create energy. But at the slightest irregularities, especially when defects in the transfer of electrons of the respiratory chain, such as mitochondria produce large amounts of reactive oxygen species.

In terms of medical theory it is very useful to use drugs that would have caught these reactive oxygen species and eliminated the negative impact on the basic components of the cell. I must say that the problem was not as easy as we would like, and the way of implementation and, most importantly, obtaining high efficiency of these drugs there are quite a few problems. We are engaged in the study of antioxidants in the University of Moscow in our department, and one of the problems is that the emergence of reactive oxygen species - is not only a negative effect, but also struggle with alien cells and so on, macrophages kill foreign cells just using reactive oxygen species. Therefore, we can not completely suppress the formation of reactive oxygen species, and the need to find the golden mean, when we act only on the excess of reactive oxygen species, without affecting essential physiological processes, which use active forms of oxygen.

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And we have in the body exists antioxidant system - are proteins, enzymes, which are activated and, in addition, many vitamins, such as Vitamin E or coenzyme such as coenzyme Q, are the components of the antioxidant system. That is, there must be a balance in the body between the rate of formation of reactive oxygen species and systems of recycling and elimination of life. But when the system begins to run poorly, this including leads to diseases and premature aging. Therefore, we can see a variety of drugs, which is advertised, for example, coenzyme Q10 as one of the most active endogenous agents that trap these reactive oxygen species. But the reality is in medicine that, despite the large publicity that exists, quite hard to find examples of very successful use of antioxidants. And when we started to deal with this issue, it turned out that much depends on the fact that these compounds may just very poorly absorbed in the body, that is, we accept them, but a very small fraction of them reaches the cells and produces its effect. Therefore it is very important to have those forms which are easy to digest.

There are coenzyme form that is much easier to penetrate into the mitochondria, Coenzyme have a standard, there are preparations using reduced coenzyme, and so on. That is, all these tricks are intended to be more successful these antioxidants ingested. But, say, coenzyme Q10, with whom we work long enough, the problem is that only 1-2% is absorbed from almost any form, known in the market.

We show that it is necessary to develop a form for intravenous administration, because if we introduce intravenously, then 100% of the drug enters the bloodstream.

And now we obtained a positive decision on the development of this form, and I think that in the next few years, a form will appear for the first time in our country and it will be a very important decision, because then we will be able better to deal with diseases of the cardiovascular system, such as heart failure, and, most importantly, we can quickly increase the concentration of the substance and its use in the ambulance service, for example, myocardial infarction, and then it can be administered intravenously at the first sign of heart attack. It will save 20-30% of the myocardium, which is otherwise simply on died, will not be reduced and, as a result, drastically worsen the prognosis for patients with myocardial infarction.

These areas are now very widely studied, and it is associated with this interest in natural or natural products. We know that there is a perception that what is created chemically, can be potentially dangerous and what has been created by nature, less dangerous. Although in general difficult to agree with this, but yet most people have the idea, and natural antioxidants, those that are found in many fruits and vegetables, rich in vitamins and so on, are becoming more and more popular, so the organic food, or organic food, that is used directly by farmers, fresh food. In general, one goal is to increase our oxidant protection against these reactive oxygen species.

There is a new direction, I myself recently found out, it's mostly the work of Japanese researchers that molecular hydrogen can have such a property, as well as hydrogen is a very small molecule, it easily penetrates through the membrane, and so on, that is, methods of introduction of hydrogen in the breathing mix - we breathe, and then it gets. Or, furthermore, just potable water saturated with hydrogen, and if it drink, this hydrogen enters the body. And, in general, are now in the literature a lot of publications on this positive action of hydrogen.

And as reactive oxygen species has formed during irradiation, and now space institutions and researchers are beginning to pay attention to it, in order to protect astronauts because at the height of radiation protection harder, and in order to preserve the health of the astronauts, the new developed how active antioxidants and may be molecular hydrogen will take its place in these effects, or as protection against oxidative stress.

So this is the direction, in spite of all the difficulties, continues to evolve, and the example of hydrogen reveals that there are more and more new players in the background. Although still ongoing work to improve the properties of known antioxidants that are better absorbed, so they acted quickly in the body and thus protects the body from the harmful effects of oxidative stress. Then it will help to reduce early aging, and very fond of Estheticians these drugs, because it is proven that reduces the formation of wrinkles and so on. This is a very nicely done with the help of the research profile of the skin by laser irradiation, then quantitatively evaluated all the lines, and it can be shown that this effect does exist, and is not just a placebo effect, when a person simply convinced that this is how it should be said, it acts in fact physically no effect occurred.

So here is an area for antioxidants, and there are many chemical compounds that are antioxidants, but the process of their creation - it is quite difficult, as with any drug, and in the case of antioxidants is difficult to prove their effectiveness.

Vasoneurosis (Cardiovascular Dystonia)

Neurologist Dr. Doping tells about the autonomic nervous system, psycho-vegetative syndrome and diagnostic difficulties.

Vegetative dystonia, or vegetative dystonia syndrome, and neurological perspective on this issue. The autonomic system and, accordingly, its violation lurking in this term, has a number of structural elements of the organization: the central link, the so-called segmental, segmental and peripheral units. Accordingly, vegetative dystonia is divided into the following components of the syndrome - it psycho-vegetative syndrome, autonomic failure syndrome, angio-trophy-pathic syndrome. What is it?

Angio-trophy-pathic syndrome - is, in fact, the peripheral autonomic nervous system lesions that appear in the background of some other co-morbidities. This diabetes, infectious diseases, neurological disorders accompanied by pain syndromes such as complex regional pain syndrome, is a systemic disease in which necessarily visible, noticeable and is subject to the treatment of the underlying disease.

Autonomic failure - it is also largely a condition manifested more important systemic disorders. That is a decrease in cardiac rhythm when changing body position, it is possible decrease in blood pressure when sudden change in body position, such as standing up, without the pain of heart attacks until, unfortunately, the sudden nocturnal death syndrome. It develops mostly in elderly patients on the background of some neurodegenerative diseases or is a consequence of the current status or the current condition in which the subject underlying disease treatment.

Now psycho-vegetative syndrome. Sam syndrome vegetative dystonia was formulated in the 70s, maybe even a little earlier as a syndrome, not as some sort of condition. And his study was completed by the fact that the autonomic system - a stand-alone system, to do what is beyond our will. Regardless of my will is the respiration rate, heart rate, vascular tone, and many of the processes aimed at maintaining homeostasis, to increase so-called catabolic or anabolic processes, which are aimed at maintaining the body's homeostasis and survival. It is part of the autonomic nervous system.

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Great interest in this has been a long time, and in the second half of the last century has been active use and study of autonomic reflexes, depending on a given situation. Then there was a whole laboratory based on the first honey in the department of nervous diseases, which was engaged in the autonomic nervous system, under the control of Alexander M. Wayne. Then there was formulated a theory that autonomic failure, and autonomic dystonia syndrome - it is only a syndrome, that is a secondary condition. Such changes, or similar disorders now engaged neurologists, faced with this general practitioners, cardiologists, internists and psychiatrists.

What is, strictly speaking, substrates? Why autonomic failure, a so-called segmental, or loss of peripheral units - a purely neurological work, but psycho-vegetative syndrome, segmental or defeat - it's a big mystery?

Unfortunately, in real life, often in the scientific life there is the term "vegetative dystonia", with which we began. What does this mean? Autonomic reactions, vegetative response to some external stimulation. This stimulation can be anything, ranging from stress factors, ending the weather conditions change in some internal state of homeostasis, exercise and so on.

What is the reason? Supra-segmental system, which deals with autonomic management, autonomic system, autonomic innervation, - a system which has very strong ties and contacts with the systems responsible for motivation, emotion and all the emotional substratum of all our reactions. It is the relative area of the brain is responsible for our emotions, fears, desires, motivation and so on. If their violation is required to run some vegetative symptoms.

The downside syndrome vegetative dystonia, which is studied by neurologists, and, unfortunately, is now often treated by neurologists - is the lack of proper diagnosis.

Because when first taken out syndrome, in contrast to the failure of autonomic disorders and Angio-trophy-pathic where secondary autonomic disorders in the apparent disease, vegetative dystonia syndrome is often the leading diagnosis, there is searched for a reason for this.

From a report on the psychiatric health of the Commission, 26% of the population in prosperous Europe has a mental illness and requires monitoring. Prevail in the structure of diseases anxiety disorder and depressive disorder. General statistics on Russia or Moscow, I have not met, but for a variety of publications by 25% of patients have a similar condition. I must say that often these patients just complaints related vegetative disturbances, that is manifested various palpitations, pains of various localization, nonlocalizability sensations, general asthenic complaints: complaints of weakness, the overall malaise, a feeling of dissatisfaction with sleep, feeling of lack of rest during the time available to rest, inability to sleep, - complained of the presence of some overvalued ideas, the presence of migratory uncomfortable sensations in the end, the presence of physical symptoms that have no physical evidence - are examples of fairly complex patients who are often on the receiving GP did not receive proper diagnosis by the fact that hide behind a diagnosis of vegetative dystonia.

The same psycho-vegetative syndrome is mostly just a consequence of some emotional disturbance, as I said, most alarming, or depressive disorders range. Personality characteristics of these patients - a change in the threshold of sensations, that is, and as a result the patient complained of a much more significant than they are for each of any normal person. Do you have a numb arm or my hand? Yes, numb, but I'll say it quietly, because I know that it happens, I know that it goes through. A man with a depressive or anxiety disorder is much more important to take this complaint, it will be one of the major sensations, it will not leave him, accordingly, it is with this complaint will not leave the doctor. And if with it numb hand will not leave a neurologist, which, in principle, to the psychiatrist it is sometimes a little bit to go, just to the neighboring office, then, if we are talking about cardiology, gastroenterology and doctors somatic specialties, this is a very extensive expensive test, long search drugs, and, according to statistics, which often issue of psychiatric experts, 80-90% of patients with anxiety or depressive disorders, with the dominant somatic disorders receive their diagnosis within 8-12 years after the onset of the complaints are not received, of course, at the same time proper treatment, did not give a proper survey and give the development of distrust of physicians and health care in general.

What all of this are the substrate - only whether psychiatric or some morphological too? Surprisingly, but the further we move on to the study of anatomical and biochemical substrates, the more we begin to lose. In fact, about a hundred years ago, such a condition, such as epilepsy, treated with psychiatrists, it was considered a mental illness. Currently, those involved neurologists. Dementia, or dementia, too, at one time been treated by psychiatrists, it is now engaged to a lesser extent, psychiatrists, neurologists are more specialized centers. Another thing is that the diagnosis of the organizational moments - it's still a mental inheritance, as it is a question of capacity and incapacity of the person. So, many of somatoform or some mental reactions must now be examined and treated by psychiatrists.

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It proves a definite genetic link, predisposing certain level of response to external stimuli.

This reaction to external stimuli can be transmitted as a suspected genetic or by environmental mechanisms. If we are in a single environment perceive this or that tradition to respond to any external factors, then, of course, the man raised in a particular environment, will inherit this tradition and will continue to spread.

Currently relevant is a slight change in the organization of assistance to these patients, the diagnosis is considered to be unlawful as a vascular encephalopathy syndrome and unlawful arrest of diagnostic search in the formulation of this syndrome. And the future, perhaps, is the development of a neurochemical direction in finding a substrate that can be removed, and the adequate development of certain schools of psychotherapy, which will change the perception, if not, what to do with this perception.

Why grow hair and nails after death?

Pathologist tells about inertial processes in the human body and organ transplantation.

The growth of hair and nails continues after death, in the first place, because those conventionally called skin appendages do not have such a high degree of organization, which is inherent in other organs. And after biological death, they continue to operate in standalone mode. We can say that the metabolism continues to operate by inertia. These processes are going on and they do not affect vital organs, because in the first die brain and the heart, the kidneys are disabled, the liver, but these fabrics and easy arranged bodies continue to function.

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The duration of these processes depends on storage conditions of the body. If the body is in cool conditions, it can last a day or two. And if the body is kept in warm conditions, then pretty quickly begin the processes of decay, and after a few hours of the growth of these tissues is stopped. Generally, the hair can grow for a long time, even a few days after the death, but then the process is still slow-fades. In the animal organism similar changes occur after death, so they too can find the elongation of wool or claws, although some of the processes they are generally faster than a human.

Notice is started when, for example, after the death of a man found him unshaven, appeared suddenly bristles regrown nails - this could be addressed. This could throw in the eye when did the exhumation of the corpse. But these situations are rare, as the decaying process of growth is still going on for long. Then they stopped due to the fact that there is no blood flow, no oxygen supply. But first die vital organs and the tissues while still continue to function.

These processes in antiquity must have been some kind of mystical explanations related to the cult things, but of course, when science began to explain the processes of growth of hair and nails after death, all sorts of mystical and paranormal explanations stepped aside. There really is not anything mystical: the cells remain alive, although the body is dead, but they still continue to exist independently. Different parts of the body die in different ways: the brain, for example, ten minutes is sufficient without oxygen, and the cells begin to die. Other tissues, such as the heart, there may be almost no oxygen hour, and during this time can be taken for heart transplantation. A hair and nails arranged so primitive that can exist independently much longer time, but then it stops.

It is necessary to emphasize another important and interesting point. If all the bodies died out at the same time, if some organs or tissues has not continued to function for some time after death, it would have been impossible organ transplantation. In fact, after the death can take to transplant a liver, a kidney, is now learned how to transplant and lungs, and the heart - all thanks to the fact that the process of the withering away of tissue stretched in time. First, consciousness is turned off, then the vital organs, but they still retain their viability, so they can be transplanted. Otherwise, no transplantation as a field of medicine would not exist, and transplant organs would have been impossible.

Vascular dementia

Neurologist Dr. Doping about the Mini-Mental State Examination, cerebral ischemia, and cognitive changes.

The "vascular dementia" Russian clinical life, there are many concepts of international definitions. The terms "encephalopathy", "chronic brain ischemia" made in Russia or "chronic insufficiency of cerebral blood supply." These terms are not entirely reflect the true clinical or physiological essence of this concept, however, applicable to current clinical life.

In fact, according to the pathophysiology of such symptoms is one of the sections of the so-called block cardio-neurology and somatic-neurology. When we see the complications of systemic diseases or medical conditions, certain risk factors developing in the neurological field of activity.
What is the general history of the emergence and development of the term? The Russian neurological school there is a very powerful organization, namely the Institute of Neurology, who at one time (a little bit of this before - the chair of nervous diseases' first honey ") developed these areas, because they were seen certain focal changes in patients with risk factors for patients and attempted to assess the cardiovascular risk factors and their relationship with focal symptoms and prognosis. Currently, several approaches have changed, depending on the development of scientific thought and, unfortunately, from certain economic realities.

Scientific contribution to this. If the maximum capacity of the faceless and the term "encephalopathy" is applicable to a large number of patients, but recently the science is still trying to flesh out the pathology, on which the doctor says, and therefore certain syndromes must be attributed to the damaged location. The modern school is often in articles found mention in the framework of vascular encephalopathy some headaches or vestibular disorders, emotional disorders, that is actually quite non-specific things that can be attributed to a large number of manifestations of the area of pain phenomena from the field of vestibular disorders of field of toxic effects, or, again, from the field of activity of the psychiatrist.

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At the same time there is the concept of cognitive changes, pre-dementia and dementia changes. This change in cognitive function of the surrounding world, cognitive changes. According to the latest classification, they are divided into mild, moderate, and finally, the extreme severity - dementia. In fact, the English-language term "vascular dementia" - this is an extreme degree of vascular disorders caused by development of focal changes or effects of stroke. The term "encephalopathy" was removed from the International Classification of the tenth revision of the disease due to the fact that he was diagnosed too often and all too often exposed, because on the one hand, a convenient mask, and on the other - vascular diagnoses are very well paid, and paid better than many others.

What is hidden under the diagnosis of which we are now speaking, that is a circulatory encephalopathy? Often it is a whole bunch of conditions, the effects of which are manifested in neurology. This hypertension, uncorrectable diabetes with high blood glucose numbers at which neuro –metabolic processes do not occur as they should proceed normally. Why is wrong in this case, the setting of a masking the diagnosis? Again, because there is treatment of a non-existent state or secondary status. The primary condition - idiopathic disease or endocrine disorders - at the same time takes a back seat. And doctors and patients are focusing on treatment, relatively speaking, vessels, while forgetting about the correction of sugars, forgetting about the pressure correction, or save money, in fact, on the most important treatment.

The very same stage directly reduce cognitive function due to vascular process is subject to a very precise diagnosis. The process of reducing the severity of memory or cognitive function - this process, unfortunately, the current over time. There are certain pathological proteins that are deposited more in the course of life, their number, their localization deposits correlated with the development of cognitive impairment. Vascular cognitive impairment to be much worse treatment than primary neurodegenerative diseases such as Alzheimer's disease and block all such neurodegenerative diseases.

If we talk about vascular dementia as a manifestation of neurodegenerative diseases and complaints, are stacked in the diagnosis of "encephalopathy", which is actually the first symptoms of a neurodegenerative disease, there is a varying degree of confidence we can say that these symptoms can be corrected . It may be gait disturbance, it may be impaired memory, it may be some behavioral reactions, which require specific tests, a specific survey, and most importantly, training. GP - the same cardiologist, general neurologist - unfortunately, this can not cope. There need a specialist dealing with cognitive impairment: a neuroscientist, past a certain specialization or psychiatrist.

The first step in diagnosing disorders that fit in the diagnosis of "encephalopathy," or more correctly "vascular dementia", is an interview with the patient. In the interview taped adequate perception of the world, time and space, self, and those skills that we all have, that is the correct perception of speech, the right execution of simple commands, repetition rather complex sentences, graphical perception repeat pattern, and also account. Often, patients, producing the impression of a completely adequate people, this team can not cope: properly perform something incorrectly redraw the picture, wrong count and so on. This so-called Mini-Mental State Examination allows certain people to take points. It is not working people - for example, they may not know the day of the week: while slightly shifted. Yes, in fact, perfectly healthy people during the holidays do not always remember what day of the week, because all too well.

At the same time, the short range allows us to understand whether there is any more resistant disorders or not. When we were at a rate of 30 points indicates the presence of the patient reduce the functions of up to 25 or 22 points, it is obvious violations. Conducting research on the patient's mental status brief scale takes a few minutes and, in principle, available at any doctor's office. Two minutes, perhaps we could understand how the patient is guided in these matters. In fact, the latest trends is the maximum screening attempt to conduct such research and the introduction of such tests, in fact, just to the work of practicing physicians, practicing neurologists, and perhaps in the future, and general practitioners to understand the extent of the process of neglect.

There are more specific tests and scales. It takes much more time, and as they are filled and their interpretation. There already have to work really specialists memory laboratories - one of these labs have in the department of nervous diseases - and in the future to determine the etiology of this. Itself as such diagnostic tool, in this case it is somewhat difficult. Any magnetic resonance imaging, which allows to see a general substrate specific processes atrophic changes in the brain, but they are not always correlated with changes in the memory. There is one area - this is the atrophy of the hippocampus, which is 100 percent correlated, but this does not mean that patients with intact hippocampus can not determine complaints of memory loss or patients with a wasting or atrophy of the hippocampus may not have memory. Most often they do not already have.

The next step is to determine the development of specific proteins in the cerebrospinal fluid, and possibly carrying out functional MRI. However, in the clinic due to the cost of these studies is used rather seldom.

Turning to the issues of treatment and diagnosis. Often, patients and doctors of different specialties are very pessimistic about the questions of treatment, the question does not even treat, and cure. But here arises another question: what can we recover? Can we recover from the effects of fractures, which were children, from colds? Cure is possible, but it does not mean that does not get sick again. Same thing here. Here, the main task is to try to stabilize the process, which requires specific preparations, very unfortunately, costly, however, have proven effective in clinical studies by the method of evidence-based medicine and rehabilitation need to influence. Here the impact of rehabilitation and skills - this is what lies on the shoulders of already watching doctors and patients, as the social rehabilitation of the relatives - that is what will extend the years of life of the patient, as well as enhance the quality of life for him and his own relatives.

Biomedical future: Genes and Stem Cells

The biologist Dr. Doping speaks about genome editing technology, clinical trials of modern medicine and the prospects of cloning.

Man is composed of individual cells. All organisms in the world consist of a cell - either of one or of several. Inside each cell has a nucleus. The nucleus contains these "worms" that are called chromosomes. Chromosome - a complex consisting of deoxyribonucleic acid, DNA, and various proteins. A DNA, in turn, is very long (in a human cell is its half meter) chemical molecule consisting of individual bases. And the order of these reasons, in fact, is the genetic code.

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Today we are able to take and cut the genetic text as it is convenient with the help of genetically engineered scissors. If we cut a normal piece of text, you can then move it to another molecule, where this genetic text was incorrect. Thereafter, a corrected DNA molecule, we can introduce a vector such as a virus. Everything that we built in it, drag it into the cells, respectively, it will go into the cage, then go down to the core, take the genetic information, this new genetic information is somehow mixed with previous genetic information. If she was wrong, she will fix it, and the cell will use the new gene. The viruses may be delivered to the person as an injection or as you contract adenovirus, aerosol, through the nose. A is another kind of gene therapy, where we can take cells from the body, in any way to manipulate them, and then deliver the gene into a culture of these cells and then transplanted back into the body. In addition, there are other viruses, non-viral delivery form. But in any case it is not necessary to be afraid of viruses. Today viruses as vectors for gene therapy are widely used throughout the world.

The market potential of reprogramming technology in 2013 was estimated around $ 200 million if the entire market - 600 million and is expected to experts in the implementation and development of reprogramming technologies, in 2015-2016 it will amount to one third of the total market use of cellular technologies in practice.. The Gurdian this year called the next revolution in human biology, and it has already begun, organelles. It's fantastic because you can take from each ear lobe fibroblasts, skin cells, grow them, and then reprogram differentiated neurospheres. But scientists from Austria went further: they began to cultivate them in a bioreactor, and it turned out that after a while there is an analogue of the human brain.

Sweeteners lead to obesity by acting on the intestinal microflora

About the principles of action of sugar substitutes, experiments with laboratory mice and human microbiota.

In the journal Nature they published the results of a study demonstrating that the use of sweeteners in food leads to physiological changes typical of obesity status, and are responsible for these changes in our living microorganisms.

Obesity is considered to be a universal negative consequence of modern way of life and is associated with a number of serious diseases, such as diabetes, one of the precursors of which is high blood sugar. Limiting the amount of sugar in the diet is a common way to lose weight, and it is imperative for diabetics. At the same time to preserve the taste of food commonly used low calorie sweeteners - saccharin or aspartame. These substances are considered to be harmless, and are the most common nutritional supplements in the world (think, for example, Diet Coke). Unlike sugar sweeteners are not a source of energy, and thus their use should not lead to accumulation of excess weight. In addition, it is believed that they do not contribute to the level of blood sugar, which is usually observed after meals and is unacceptable for diabetics. Nevertheless, the use of sugar substitutes do not often results in weight loss, which usually is the primary cause for their use.

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In the issue of Nature published a great article of Israeli authors, which shows that eating foods containing sugar substitutes, leads to physiological changes that are typical of the obesity condition, ie an effect opposite of what is sought consumers of sugar substitutes. In addition, the authors show in direct experiments, that microbes inhabiting us are responsible for this unexpected (and unwanted) effect.

The work investigated the mice in their drinking water which is added one of three common sweeteners at concentrations typical of commercial products containing these substances. Control groups of animals received water without additives or water with glucose or sucrose (ie ordinary table sugar). After 11 weeks, all mice treated with sweeteners, developed glucose intolerance - a pre-diabetic condition, which is characterized by high blood sugar. Studies carried out on various strains of mice with different diets and regimes, led to the conclusion that the occurrence of hyperglycaemia resulting from the use of sugar substitutes is a common property and is observed in animals with increased weight and in normal animals.

So how do sweeteners are not digested by the body, it has been suggested that they affect the intestinal microbiota - varied and very numerous microbes that inhabit the intestine of mammals. Indeed, it appeared that the spectrum of microbes in the animals who received sweeteners, reliably and significantly different from the control. Moreover, it was found that the addition of a sweetener to the intestinal microbial community growing in petri dishes on laboratory, ie the mouse is also led to similar changes.

But by themselves, these observations do not establish the link between hyperglycemia and caused by changes in the microbiota. Two experiments were done to establish such a connection. First, the hyperglycemic mice treated sweeteners, were treated with broad-spectrum antibiotics (with their water continued to add sweetener). After a course of antibiotic treatment of hyperglycemia disappeared, indicating that this state really has something to do with the microbiota. In another experiment, fecal transplants were performed from hyperglycemic mice treated with sweetener, to sterile mice that did not have its own microbiota. It was found that stool from transfer hyperglycemic but not on control animals led to the rapid development of hyperglycemia in recipient mice. Thus, it is proven that hyperglycemia "intertwined" with intestinal microbes contained in feces, and consequently, these microbes, the composition of which changes in the use of sugar substitutes, and are responsible for Pre-Diabetes.

These observations are not limited to mice: tests on volunteers showed that the use of sugar substitutes leads to symptoms glucose intolerance and changes in microbiota in humans, and fecal transplant from these people to sterile mice are guaranteed to give rise to their hyperglycemia.

Published results show conclusively that the sweeteners should be used with caution, and once again demonstrate the role of microbiota in health and disease development. As for the mechanism by which the intestinal microbial community change increases the amount of sugar in the blood, then on this fundamental question is not answered. As a hypothesis can be seen increase in the proportion of bacteria able more actively extract nutrients from the low-calorie foods. On the other hand, it is possible that the use of sugar substitutes called dysbiosis leads - directly or indirectly - to suppress certain, as yet unknown to science intestinal microbes that secrete special substances that limit the accumulation of sugar in the blood. The choice between these two possibilities will ultimately determine the strategy for the control of undesirable effects of the use of sugar substitutes.

Obesity as a problem of modern medicine

Surgeon Dr. Doping tells about diet, sleep apnea syndrome, causes and methods of treating obesity. What is the history of the study of obesity as a disease? What factors lead to obesity? What are the possible consequences of being overweight?

Obesity is defined as a chronic relapsing life multifactorial disease characterized by excessive accumulation of fat in the body, which leads to serious social and health consequences. About obesity spoke after the Second World War, and in countries that have traditionally been industrialized, particularly in the United States. At this point, the problem is sharply marked themselves with medical products. Since that time, medical researchers tried to find approaches to the treatment of this disease, although historically obesity has long been known. For a long time this issue has not received much attention, but today, in a civilized time, when many people have virtually unlimited access to food, obesity problem is marked not only in industrialized countries, but the observed "triumphant march" around the world of the disease . Who is obese and in third world countries, and where most had to deal with hunger, rather than with excessive power.

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Referring to the medical aspects of obesity, I want to remind you that it is not in itself defines overweight medical problems, and secondary diseases, which are laminated on it. First of all we must highlight hypertension, respiratory failure, which manifests syndrome sleep apnea. In severe forms of obesity in patients have excessive daytime sleepiness, because such patients, especially men, do not fill up at night: they arise bouts of apnea during sleep and choking, which is fraught with already a sudden and fatal respiratory failure. Sleep apnea syndrome is a deadly disease.

Treatment of obesity can not be reduced to courses dietetics. Patients who want to lose weight, all the time talking about coursework assignments diets. It can not be in principle. Treatment of obesity - it is always a radical change of lifestyle that often develops over decades. And this is not so simple. Treatment of obesity can not be reduced to a reduction in caloric intake, although it is correct. The man who aims to significantly reduce body weight should not just temporarily go on a diet, it should limit itself systematically for the rest of life, normalize your diet so that it attended and breakfast, and dinner, and - lesser extent - dinner. Next, you must determine the level of caloric intake that is required in this case, that is, go to the obviously more low-calorie food: eliminate carbohydrates, both simple and complex, to eliminate fats, salt, excessive fluid intake, especially in severe forms of obesity.

Cryosurgery

Surgeon Dr. Doping tells about surgical methods of treatment using frozen, open cryosurgery and "CyberKnife" system. When I first began to use cold during surgery? What methods are used for removing frozen tumors? How can I combine cryotherapy with increasing temperature?

Cryosurgery - this word is made up of two Greek words "cryo" - "freeze", "surgery" - all clear, but if translated literally, it is "crafts", that is "handmade". Accordingly, cryosurgery is a surgical treatment using frozen.

The story is very interesting, because since the time of Hippocrates, the ancient doctors, healers and even just ordinary people have noticed that if you cool some part of the body that hurts, the pain gradually reduced. Using cold long been known in medicine. If you again look at history, we see that in 1812 the famous surgeon Larrey, which is very respected by Napoleon Bonaparte, to perform operations on the battlefield, using cold. He noted that the French soldiers who were injured in the winter, much easier transferred amputation, almost did not feel the pain when the affected limb has been supercooled. It was like the beginning of what we have now.

If we look at the XIX century to the mid-XIX century, in 1851 year, Arnaud in England has used a mixture of ice and salt to lower the temperature of the ice in the treatment of cancer, such as breast cancer, skin cancer. And this method has been widely popular in Europe because it does reduce inflammation, swelling, pain, tumor growth is also decreased. In addition, further special devices have been invented in order to obtain stable ice lumps low temperature to -24 degrees, and it is used to treat various skin diseases. To treat skin disease – use Peptide complex for effective skin rejuvenation of the face and the entire body, Peptides Ovagen, Peptides Svetinorm.

In the last century, this method left in the official practice, because at mid-century devices have been invented which allow liquefied gas to low temperatures, in particular nitrogen to freeze -195 degrees. There was a special equipment, and it has been used in clinical practice. In particular, Cooper, neurosurgeon tried to freeze the brain tumor. It is in 1961, imagine. And then, this method has become quite popular.

However, for unknown reasons, the United States began to forget about this method of treatment. However, in Russia in the same period, in the 60's, our surgeons and scientists also drew attention to the healing quality of deep-frozen using liquid nitrogen, and the doctor Kandel used liquid nitrogen to freeze the brain tumors. If we compare priorities, who started first clinical use extremely low temperatures - Russia, then the Soviet Union, too, is in the cage.

In 70-ies formed cryosurgical Association in the United States, Europe and Japan. In 2013 it formed a cryosurgical Association in Russia. This shows the urgency of the problem. It brings together doctors of various specialties, which use extremely low temperatures in their practice.

In most cases, liquid nitrogen. Treatment with liquid nitrogen doctors of many specialties are now used: dermatologists, urologists, surgeons, operating in the abdominal cavity, oncology, traumatology, ENT doctors, gynecologists - you can access this list to continue, because thanks to cryosurgical associations all over the world that communicate with each other , various techniques are gradually finding its place in the treatment of many serious diseases. This also applies to malignant diseases, malignant tumors of the liver and pancreas. (Riboxin, Meldonium)

In Russia at the present time it is a priority of public cryosurgical operations on the liver, pancreas.

In most countries, particularly in Europe, the United States, China, Japan, using thin KHOLODOVA needle sensors or probes, that is, using a puncture, in order to convey cold to a particular affected organ, in particular, in prostate cancer . In our country, a popular method of open cryosurgery, where the diseased organ is exposed and made it an open freezing. This method manages to freeze large amounts of tumor. This requires special cryosurgical equipment, equipment that we have, and the quality is not worse, sometimes even ahead of their foreign counterparts.

Thus, cryosurgery is now occupied a strong position it in the treatment of a number of benign diseases that do not require the use of a scalpel and with the help of freezing you can remove some cosmetic blemishes on the skin. If we talk about cancers, then cryosurgery allows to achieve tumor regression, tumor growth inhibition in situations where surgically impossible to remove the tumor because of the prevalence of the process, ie the so-called locally advanced tumors, for example, pancreas, liver metastases, which we do not can remove, is now successfully treated with cryosurgical method.

Speaking about the prospects of cryosurgery, continuing the development of new equipment, in order to get the most efficient, fastest cooling method, achieve flexibility cryoprobe to achieve complex anatomical areas with open surgery, as well as the completion of puncture cryoprobe for the possibility of forming a puncture through the skin under ultrasound guidance or computed tomography, or magnetic resonance imaging, and the achievement of cryosurgical effect without open surgery. In our country, the development of this equipment is engaged in several industries, while new models are under development. I hope that in the coming years, they will appear on the market, and the doctors involved in this, will be able to use the new equipment, which will obviously be different for the better in terms of convenience.

Cryosurgery prospects now, from my point of view, interest in the field of neurosurgery. We have excellent scientists, neurosurgeons headed by Academician Krylov, his students work in RNCH, and perhaps we are the leaders in this field, namely in cryosurgery brain tumors - small, located deep in the central parts of the brain when perform operations very risky, but with the help 3mm cryoprobe is possible under ultrasound control after the craniotomy enter the cryoprobe in brain tumor and freeze under the control of the ultrasound tumor.

These results were presented at a conference in Japan. We went to Tokyo and caused great interest despite the fact that there cryosurgical Association arose much earlier than in Russia. Of great interest is probably due to the fact that, unfortunately, after Cooper in Europe and in the East, few people tried to brain cryosurgery. Now addicted operations "CyberKnife» (CyberKnife) - is also a method of treatment, the use of radiation exposure on the small structures in the brain. But this does not preclude the use of other methods that have just a local effect. And, as shown by the first results are very encouraging: the fast rehabilitation of patients, rapid functional recovery, early discharge of patients.

If we talk about the tumors at other sites, it is very interesting to use cryosurgery for tumors of the maxillofacial region, language, when it is necessary to perform, if possible, rather complex operation with Gone with the large number of tissues, then plastic surgery, there are cosmetic defects, disfiguring his face. Use in situations where it may be an alternative, the suppression of tumor growth by a low temperature is very promising. Furthermore, soft tissue and bone tumors, tumors of the liver and pancreas.

Perhaps a combination of cryotherapy with increasing temperature. That is, first frost, after the introduction of thugs RF probes and heating the tumor. It becomes much more accessible to the impact of heat already.

For tumors to rapidly dividing cells dangerous as cold and high temperatures.

It is shown that if the achieved temperature -70-50 degrees in the tumor long enough and keep for 5-10 minutes, then thawed again, slowly cooled, it is possible to completely destroy the tumor cells.

High temperatures, when the temperature is 100 degrees, causing boiling in the tissues, and now has equipment that allows you to control the temperature of the probe and to ensure that was just boiling temperature, not the temperature, when the tissues become non-conducting to electricity, because they simply lose water. And the combination of different methods of physical restraint in the future will allow us in those situations when a scalpel can not remove the tumor, with locally advanced tumors, to achieve good results in combination, undoubtedly with chemotherapy and radiotherapy.

Cryosurgery prospects are now in the sphere of interaction with other related areas not only cryo, but also the heating, ie it radiofrequency surgery; not only the local effects of cold and heat, but also systemic effects with chemotherapy; not only the use of chemotherapy and radiation exposure with radiation therapy. Thus, our knowledge about the possibilities of treatment of tumors expand and cryosurgical method is one such method that allows with minimal cost to achieve great effects in the future.

Surgical treatment of type II diabetes

Surgeon Dr. Doping tells about the relationship between diabetes and obesity, the effectiveness of bariatric surgery and the risk of food stereotypes.

Diabetes mellitus is one of the most common and life-threatening diseases in the modern era. Moreover, in the structure of the sugar diabetes Type II diabetes is currently takes about 90%. And about the same proportion of diabetes of the second type - a disease of obese people, that is combined with obesity. In general, the disease is well-known, fairly widespread and has long been a subject of scientific research and therapeutic effects by endocrinologists. They invented a number of medications: insulin, a group of drugs that are designed to reduce excess body weight and blood glucose. But here's the paradox: if we say that the diabetes of the second type - this is usually the lot of obese patients, is a prerequisite for the treatment of diabetes is weight loss. That is, obesity and diabetes of the second type - this is the disease, the development of which takes place in parallel.

If we talk about the widespread increase in the incidence of obesity, the same time we are talking about an increase in the incidence of diabetes. Today, according to experts, where some 10 million people in Russia suffer from diabetes of type II. And less than half of the diagnosed diabetes. Many people who already have the disease, but the man did not yet know this latent form of the disease. First of all, dangerous complications of diabetes. Of course, this latent, hidden within - one of the dangers of diabetes; other hazards are its complications Uncorrected, uncompensated diabetes in the foreseeable future will lead to the development of cardiovascular disease (this disease vessels of the heart, blood vessels of the brain, extremities) to lead to the development of so-called diabetic nephropathy - kidney disease, complication by kidney, and further to renal failure, blindness. A high percentage of lower limb amputation in elderly patients is associated with diabetes mellitus.

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The most effective methods for the treatment of severe obesity are surgical. Obesity surgery has its origins in the 1950s, and as surgeons began to use these techniques to reduce body weight, pay attention to one detail: those patients who suffer from diabetes, sooner or later get rid of this disease. In the 1990s in the United States, a group of surgeons noticed that diabetes, for example, after surgery gastro-bypass offset by more than 80% of cases. And in this regard, he asked the question: could it be a diabetes of the second type of surgical disease if bariatric surgery has such a powerful, effective action? Since that time, our surgical techniques, and we, bariatric surgeons have turned to diabetes and began to expand the indications. If the patient is obese, even a moderate degree, but it has diabetes, we may apply the surgical effect is not only to reduce body weight but also for correction of diabetes.

And in some cases even to the 1960s in developing a new branch of obesity surgery, which gets the name "metabolic surgery". This is the surgical effects on healthy organs, the purpose of which is the impact on the course of diabetes of the second type.

If we consider the modern surgical techniques, then almost all of them one way or another contribute to the compensation of diabetes. But endocrinologists can say that any body weight reduction is good for patients suffering from Type II diabetes, but it's not just weight loss. Bariatric surgeons noticed that the compensation of diabetes after surgery comes from the first days, even before the patient reduces weight. It's not just weight reduction - there are a number of factors that are affected by the operation, the patient suffering from diabetes.

Now briefly about these factors. The first and, perhaps, the main thing in this series should be considered a forced transition to a low-calorie diet. If the patient with diabetes mellitus in a few days is on semi-starvation diet, then it usually has a normalized or substantially indicators of blood glucose decrease. And after our operations we often observed during the second week of the first absolute-normalization of blood glucose levels regardless of whether the patient is receiving hypoglycemic drugs, whether it was on insulin therapy and so on.

The next question is: what kind of operation to offer the patient if he has diabetes? The answer also becomes rather obvious, that is, more complex operations profound effect on diabetes. If, for example, gastric banding surgery - a fairly simple operation - leads to diabetes compensation less than a half percent of the cases, then, for example, such an operation as Biliopancreatic bypass surgery, according to our own data, helps to compensate for diabetes - think about this figure! - 98.6%. With a probability we can speak to the patient that he has for a large period of time (I can not say that the whole life) problems with decompensation of diabetes will not.

What's the advantage of surgical exposure? Firstly, if the patient had surgery Biliopancreatic bypass surgery, he actually does not have to comply with particularly any diets, that is with the free food, without any additional glucose-lowering therapy - just say, that the mineral support, vitamins are a must after this type of surgery. The patient need, of course, be observed, to implement the recommendations of doctors: fully fed, for example, protein food and comply with a number of recommendations that we always give, regular blood tests, that is, to control other parameters. Gastro-bypass facilitates compensation of diabetes in more than 80% of cases. Some patients even have a problem with hypoglycemic states: sugar not only normal, but even in some cases the percentage may be reduced below normal that sometimes, too, is undesirable. This specificity gastro-bypass operation. If we are talking about Biliopancreatic bypass, the hypoglycemic conditions, we almost do not see after this operation.

Not so long ago there was a decision of the International Federation of Surgery of Obesity and metabolic disorders, which is capable of performing surgery in patients with a body mass index above 30, ie it is not very stout contingent of people, if such patients have diabetes of the second type. Here there is a large scope for endocrinologists, scientists in the field of endocrinology: understand why the operation affect the course of diabetes. Several mechanisms have already been opened. The mechanism of the so-called incretin response when the intestine produces specific hormones that affect carbohydrate metabolism, and thus contributes to surgery, these hormones are normally worked out. Moreover, based on these intestinal peptide developed by a group of drugs that have proven effective in the treatment plan.

Here, of course, there are many outstanding issues that are the subject of interest for bariatric surgeons and working with us, endocrinology specialists. For example, how can we effectively help when complications of diabetes have already developed? The next question is how effectively we can help if, for example, the patient is not obese at all? And in these cases already have such jobs, there are observations, there is evidence that bariatric surgery in many cases, these patients could rectify the situation. It is important that diabetes has not reached the stage of the disease, when completely or almost completely killed beta-cells capable of producing insulin. If, for example, when pre-operative examination revealed, for example, a significant reduction of the secretory function of the pancreas, is close to zero, in which case, of course, wide effect of the operation, we can not guarantee. This whole series of questions that we need to work together.

But now it is clear that the surgical techniques that are traditionally used for the treatment of severe obesity, have proven effective in the treatment of diabetes of the second type. And it's probably important result of the work of my colleagues, bariatric surgeons. It would seem, to date, developed a large number of drugs that can lower blood glucose, insulin, including various modifications of insulin. And, apparently, across a variety of medicines spectrum is why until now we are faced with the complications of diabetes? The fact that, as in obesity, patients can not always effectively reverse their dietary patterns. It is not only medical treatment, but also in the fact that the patient should be at the same time to eat. Unfortunately, many patients with Type II diabetes, these stereotypes are simply impossible to reverse. Although there is a wide range of medicines to those patients who, in spite of the use of these drugs can not get results, we can recommend the use of surgical treatment of obesity.