Early diagnostics of insulin resistance (IR) is one of the methods of primary prevention of cardio-vascular diseases and type 2 diabetes mellitus. The HOMA-IR index and ratio of plasma triglyceride to high-density lipoprotein cholesterol concentration are the most frequently used indices in clinical and epidemiological scientific research. Prognostic value and efficacy of these tests as a screening method are not high. What method of IR detection should be used in clinical practice and how to interpret received values of the indices is still a matter of dispute. Aim. To evaluate informative value, sensitivity and specificity of a new metabolic index (MI) for IR estimation in comparison with the calculated HOMA-IR index. Material and methods. A total of 845 patients (298 men, 547 women) were enrolled into the further study after an outpatient regular medical check-up of 2,615 persons. Mean age of the patients was 45.77±12.18 years, body mass index -28.95±1.44 kg/m 2 . To evaluate lipid and carbohydrate metabolism blood chemistry parameters were assessed. IR was determined by the Homeostasis Model Assessment (HOMA-IR) and an oblique calculated index based on lipid metabolism parameters. In accordance with the developed screening method of IR detection (invention patent № 2493566) MI considering carbohydrate and lipid changes was proposed. Results. Calculation of MI and its threshold level was performed by analysis of a characteristic curve. Graphical dependence between sensitivity and specificity of the proposed index was demonstrated: sensitivity of the test was 75.7%, specificity -89.1%. Probability of IR at MI value >7.0 was 63.5% (positive predictive value), probability of IR absence at the index value ≤7.0 was 93.6% (negative predictive value). The general accuracy of the test, which is characterized by the area under the characteristic curve, was 0.881 with 95%-confidence interval within 0.854-0.905. Conclusion. The importance of negative result -absence of IR at normal values of MI and use of routine blood chemistry parameters for its calculation allows to recommend MI for IR screening in clinical practice. Distinction of the proposed method of IR diagnostics from the other known oblique laboratory methods is in easy calculation based on the routine biochemistry parameters detected in venous blood on one occasion. Use of the proposed MI allows to economically and efficiently estimate indirectly sensitivity to insulin without additional assessment of laboratory indices.

Эксперты международных организаций расценивают метаболический синдром (МС) как «пандемию XXI века» [1]. По данным различных авторов встречаемость дан-ного состояния у лиц в старшей возрастной категории составляет от 20 до 30% [2]. Существует точка зрения, что формирование МС генетически детерминировано. Наряду с этим доказано влияние факторов внешней сре-ды, из которых наиболее значимыми являются избы-точное питание, гиподинамия, артериальная гипер-тензия, стресс и гормональный дисбаланс [2][3][4].К настоящему времени накоплен значимый клини-ческий материал и научно-экспериментальные данные, указывающие на первичное изменение углеводного об-мена, проявляющееся инсулинорезистентностью (ИР), при формировании МС [2,[5][6][7].Снижение чувствительности тканей к инсулину -ге-терогенное состояние. Физиологические причины раз-вития ИР продолжают исследоваться. Предполагается, что существует нарушение передачи сигнала от ре-цептора инсулина к его мишеням. В процессе форми-рования и прогрессирования МС состояние ИР может возникать одномоментно в основных органах-мише-нях (мышечная, жировая ткани, печень), либо неза-висимо в каждом из них, но затем приобретает си-стемный характер с поражением всех заинтересован-ных тканей и систем, что и определяет разнообразие кли-нических проявлений [8][9][10].Основными компонентами МС [11] являются аб-доминальное ожирение (АО), нарушения углеводно-го обмена (НУО), артериальная гипертензия (АГ), ате-рогенная дислипидемия (ДЛ). Прогрессирование этих состояний приводит к развитию заболеваний сердеч-но-сосудистой системы и сахарного диабета (СД) 2 типа, являющихся лидерами в структуре смертности среди на- ВЛИЯНИЕ ИНСУЛИНОРЕЗИСТЕНТНОСТИ НА ФОРМИРОВАНИЕ И ПРОГРЕССИРОВАНИЕ КОМПОНЕНТОВ МЕТАБОЛИЧЕСКОГО СИНДРОМА (ИТОГИ ПЯТИЛЕТНЕГО ИССЛЕДОВАНИЯ)Г. Е. Ройтберг, Ж. В. Дорош*, О. О. Шархун Российский национальный исследовательский медицинский университет им. Н.И. Пирогова 117997, Москва, ул. Островитянова, 1Сочетание факторов риска, объединенных понятием метаболический синдром (МС), увеличивает вероятность развития сердечно-сосудистых заболеваний и сахар-ного диабета 2 типа. При наличии инсулинорезистентности (ИР) происходит сложение эффектов каждого из факторов риска, что увеличивает вероятность развития кардио-васкулярной патологии и ее осложнений. Цель. По итогам 5-летнего наблюдения определить влияние инсулинорезистентности на формирование и прогрессирование компонентов МС. Материал и методы. Проведено амбулаторное обследование 711 клинически здоровых пациентов в возрасте 20-65 лет (327 мужчин и 384 женщины). Средний ИМТ не превышал 34,5 кг/м 2 . Для оценки состояния липидного и углеводного обмена определяли показатели биохимического анализа крови. ИР диагностировали по индексу HOMA-IR, превышающему 2,6 балла. Результаты. Установлено, что у пациентов с ИР достоверно чаще встречается сочетание трех и более составляющих МС (p<0,01). Среди обследованных пациентов с нарушенной чувствительностью к инсулину количество многокомпонентного синдрома наблюдается в 69,7% случаев, что в 1,8 раза чаще, чем в г...

According to Russian statistics, breast cancer ranks fi rst among malignant neoplasms among women (20.9%). The largest proportion of breast cancer cases is detected in women aged 35 to 55 years. Therefore, an urgent issue is not only the provision of specialized medical care to patients, but also the prevention of the development of the disease. Almost 70% of malignant neoplasms, including breast cancer, are provoked by exogenous factors. This article provides an overview of the literature on primary breast cancer prevention. It is established that a woman's lifestyle, diet, physical activity, and bad habits can have a potentiating effect on the development of breast cancer. Conclusions. Currently, breast cancer prevention plays a key role in the fi ght against this disease. middle-aged women (who account for the main peak of morbidity) should understand that by changing behavior, it is possible to reduce the risk of developing breast cancer. In addition, increasing women's awareness of breast cancer and its prevention can help reduce the incidence and fi nancial costs of treatment.

Breast cancer (BC) remains one of the most common diseases of the female population. According to statistics, breast cancer is detected in every eighth woman. Approximately 20‑24% of breast cancer patients are diagnosed with triple negative breast cancer. Triple‑negative breast cancer is characterized by an aggressive clinical course, a higher relapse rate, and low overall survival. According to statistics, the median survival rate for women with metastatic triple‑negative breast cancer is less than one year. We demonstrate a successful case of treatment of a 60‑year‑old woman diagnosed with triple negative breast cancer on the right, edematous‑infiltrative form, St IIIC cT4bN3M0 on the background of metabolic syndrome. Antitumor treatment lasted 1 year and consisted of three stages: systemic chemotherapy, surgical treatment (radical mastectomy), and adjuvant radiation therapy. After the treatment, remission was achieved. The patient is alive and has a relapse‑free period of 3 years. Conclusion. Despite the severe concomitant pathology in the observed patient, we received a positive result of multi‑ stage therapy, where cytotoxic chemotherapy was the basic treatment for a woman with triple negative breast cancer.

Among the malignant neoplasms of the hepatobiliary zone, gallbladder cancer (GBC) is rare. The incidence of GBC is highest in patients over 65 years of age. In the early stages GBC rarely has clinical manifestations, and often occurs under the guise of other gastroenterological diseases, and is often an accidental finding. Since GBC tends to show high dissemination, at the time of diagnosis, almost every second patient has an advanced form of the disease that is not the subject to surgical treatment. Most authors tend to believe that the use of combined treatment of GBC (extended resection and adjuvant chemotherapy) significantly increases the survival rate of patients. Currently, about 1/3 of patients receive adjuvant chemotherapy in the treatment of GBC. This is due to a small number of prospective randomized trials. Today, most experts recognize that surgery is the only treatment that can be performed in patients with early stages of prostate cancer. At the same time, a reduction in the risk of complications and a large percentage of five- and ten-year survival are achieved. Traditional cholecystectomy can be used to treat stage 1a PCa, this is possible if PC is accidentally found during surgical treatment of GSD. Unfortunately, prostate cancer and bile ducts belongs to the group of malignant neoplasms, in which most patients are unable to perform radical surgical treatment due to for the rapid dissemination of the process. When determining the tactics of patient supervision, it is necessary to take into account the prognostic factors of overall survival in prostate cancer: the type of surgery, the patient's age and sex, the size of the tumor, the presence of metastases in the regional lymph nodes, the presence of adjuvant chemotherapy. There is still a dispute between specialists about the appointment of adjuvanted chemotherapy to patients after surgical treatment of prostate cancer. Many authors acknowledge that adjuvant chemotherapy plays a positive role in improving patient survival after surgery. RAD is recognized as a chemosensitive cancer. Several drugs are active in relation to RS, used for adjuvant chemotherapy: fluorouracil, gemcitabine, mitomycin, cisplatin, capecitabine, epirubicin, and oxaliplatin. This article provides an overview of current research that is aimed at studying the effectiveness of adjuvant chemotherapy in patients with verified GBC of various stages.