Azamat Kh. Kade

This review discusses the role of capsule endoscopy in diagnosing suspected small bowel bleeding and compares guidelines of the European Society of Gastrointestinal Endoscopy (ESGE), the American College of Gastroenterology (ACG), the American Society for Gastrointestinal Endoscopy (ASGE), the Canadian Association of Gastroenterology (CAG), and the consensus document of 4 Japanese medical societies. European and North American experts recommend capsule endoscopy as a first-line diagnostic modality for suspected small bowel bleeding without life-threatening signs in adult patients when ileocolonoscopy and esophagogastroduodenoscopy failed to be informative. Japanese experts, on the contrary, prefer cross-sectional imaging “from the chest to the pelvis” and consider capsule endoscopy as an alternative.

Background. Transcranial electrical stimulation is a promising method for correction of malnutrition-induced hyperlipidemia, in the absence of indications for drug hypolipidemic therapy in young and middle-aged patients with low and moderate cardiovascular risk. Objectives — to study the effect of transcranial electrical stimulation on lipid metabolism in a high-fructose/high-fat (HFHF) diet in rats.Methods. An experimental randomized trial was performed to study the effect of transcranial electrical stimulation on lipid metabolism in a high-calorie diet enriched with fructose and saturated animal fat in rats. The experiments involved 180 outbred male rats and were carried out on the basis of the vivarium of Kuban State Medical University. The animals were divided into three groups: group 1 (control group, n = 60) — followed a standard diet; group 2 (comparison group, n = 60) — followed a HFHF diet; group 3 (experimental group, n = 60) — underwent transcranial electrical stimulation against the background of a HFHF diet. According to the target reference point of the study, the groups were divided into three equal subgroups of 20 rats each: subgroup A — day 30, subgroup B — day 60, and subgroup C — day 90 (biomaterial sampling and euthanasia were carried out on those days). In the obtained blood samples, the following lipid metabolism parameters were evaluated: total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and atherogenic index. Statistical analysis was performed using Microsoft Office Excel 2021 (Microsoft, USA), GraphPadPrism 9 (GraphPad Software, USA) and Statistica 13.3 (StatSoft, USA).Results. On the 30th day of the study, it was noted that in group 3, the concentration of low-density lipoprotein cholesterol was 14.9% lower and the atherogenic index was 30.8% lower (p < 0.05) than in group 2, while total cholesterol concentration, triglycerides, and high-density lipoprotein cholesterol had no statistically significant differences (p > 0.05). On the 60th day of the study, in group 3, when compared to group 2, the concentration of total cholesterol was 18.7% lower, low-density lipoprotein cholesterol was 42.9% lower, high-density lipoprotein cholesterol was 16.7% higher, and the atherogenic index was 56.3% lower (p < 0.05), while triglycerides had no statistically significant differences (p > 0.05). On the 90th day of the study, in group 3, when compared to group 2, the concentration of total cholesterol was 29.2% lower, the concentration of triglycerides was 36.0% lower, low-density lipoprotein cholesterol was 42.8% lower, and the atherogenic index was 57.0% lower (p < 0.05), while the concentration of high-density lipoprotein cholesterol had no statistically significant differences (p > 0.05).Conclusion. High-fructose/high-fat diet leads to a progressive increase in the serum concentration of low-density lipoprotein cholesterol, total cholesterol, triglycerides, as well as to a moderate decrease in high-density lipoprotein cholesterol and a growth in the atherogenic index. Transcranial electrical stimulation has a moderate lipid-lowering effect, manifested in the form of a decrease in the serum concentration of low-density lipoprotein cholesterol, total cholesterol and atherogenic index, while the effect on the concentration of triglycerides and high-density lipoprotein cholesterol is insignificant.

The modern cardiology has a wide range of medications which affect various pathogenetic links of atherosclerosis, but even the best of them still obtain disadvantages causing intolerance and medicine discontinuation. The development of new hypolipidemic medications will allow not only to introduce alternative therapies into the cardiology practice, but also to completely execute the strategy of residual risk reduction by utilizing rational combinations of medications. One of such alternatives could be bempedoic acid, which can have a positive effect on a number of endpoints as the results of third phase trials have shown. These effects are also confirmed in Mendelian randomization studies. The mechanism of action of bempedoic acid is presumably associated with inhibition of the activity of ATP citrate lyase – the enzyme responsible for the breakdown of citrate into acetyl-CoA and oxaloacetate. Acetyl-CoA, in turn, is used by the cell to synthesize cholesterol and fatty acids. Thus, bempedoic acid affects in the same metabolic pathway as statins, but at an earlier stage. According to this, it is possible that medications of these classes will have similar side effects and pleiotropic effects associated with modulation of the mevalonic pathway, such as prenylation regulatory proteins (small GTPases) or reduction of coenzyme Q synthesis. However, there are also some specific features of the pharmacodynamics and pharmacokinetics of bempedoic acid to be considered. In particular, once entered the body, it must be activated via esterification by very long-chain acyl-CoA synthetase-1. The enzyme isoform required for this process is expressed in a tissue-specific manner and, for example, is absent in skeletal myocytes. In addition, citrate, oxaloacetate, and acetyl-CoA are important regulators of many intracellular processes: metabolism, growth and proliferation, mechanotransduction, posttranslational modifications of histones and other proteins. The levels of all three substances are altered by bempedoic acid, although no firm conclusions about the effects of these changes can be drawn at this time. The mentioned features probably have a significant impact on the clinical profile of bempedoic acid and underlie the differences from statins already observed in third phase trials, including, for example, a reduced risk of the onset or worsening of diabetes mellitus while taking bempedoic acid.

The study aims to conduct a transcranial electrical stimulation therapy trial in rats influencing the indicators of systemic inflammation dynamics and the percentage content of visceral adipose tissue in a highfat fructose diet. The study included 180 male outbred rats, which were randomly distributed into three groups: the first group had a standard diet; the second group received the high-fat fructose diet; and the third group received both transcranial electrical stimulation therapy and the high-fat fructose diet. Tumor necrosis factor-α, interleukin-15, and interleukin-19 concentrations were measured in blood serum. The percentage of visceral adipose tissue in relation to body weight was calculated. The percentage content of visceral adipose tissue and serum concentration of tumor necrosis factor-α were lower, and interleukin-19 was higher in rats that received transcranial electrical stimulation with a high-fat fructose diet in comparison to the second group, which did not undergo the stimulation. Interleukin-19 level in the blood serum of rats in the second group grew as the trial progressed, whereas the opposite occurred in the third group. There was an inverse relation between the predictive variables of transcranial electrical stimulation, interleukin-19, and the variable of tumor necrosis factor-α. The data obtained in the experiment may also indicate that interleukin-15 cannot be unequivocally considered as a key factor associated with a decrease in visceral adipose tissue content when introducing a high fructose and animal-based saturated fat diet to rats.

Objective: To study the effect of transcranial pulsed current stimulation (tPCS) therapy on cardiac arrhythmias developed after percutaneous transluminal coronary angioplasty (PTCA) with stenting in patients with myocardial infarction (MI).Material and methods: Characteristics of patient groups: the comparison group (n = 17) – with myocardial infarction, after PTCA with stenting, standard treatment; the main group (n = 21) – the same and tPCS therapy. Control points of the study: 1st day – Electrocardiography (ECG), Echocardiography (ECHO), Creatine phosphokinase (CPK), Creatine phosphokinase-MB (CPK-MB), Troponin-I, potassium, β-endorphin; 5th day – the same without ECHO; 10th day – the same and ECG with the determination of harmony and quantum of the electromagnetic flux of the cardiac cycle. PTCA was performed using drug-eluting stents. tPCS therapy was performed in pulsed bipolar mode, current strength 2 mA, current frequency 77.5 Hz, session duration 45 min.Results: In patients of the main group (against the background of tPCS therapy), the studied parameters of the cardiac cycle approached the optimal values. It was shown that intergroup differences in harmony (p = 0.002) and the size of the electromagnetic flux quantum of the cardiac cycle (p = 0.001) are statistically significant. Also, against the background of the tPCS therapy, the concentration of highly sensitive troponin-I is statistically significantly (p = 0.0042) lower by 109%. On the 5th and 10th days of the study, the serum concentration of β-endorphin in the main group was higher by 38.3 and 35.0% than in the comparison group (p < 0.05).Conclusion: The results of the study clearly demonstrate the cardioprotective and antiarrhythmic potential of tPCS therapy in patients with myocardial infarction and cardiac arrhythmias after PTCA with stenting.