The growth of obesity and type 2 diabetes incidence has made bariatric surgery a widespread method of treatment. The effectiveness of bariatric
operations in the treatment of obesity and related metabolic diseases is thoroughly highlighted in medical literature. However, the results
of surgery do not always correlate with type of operation. As before, the mechanisms have not been fully studied of how the bariatric surgery
influence on insulinresistance, entero-insulin axes, adipokines. Understanding such mechanisms will allow us to determine more precisely the
indications relating to surgical treatment, and enhance the effectiveness of surgery in specific patient. The review is focusing on the influence of
various types of bariatric surgery on the level of adipokines and incretines that participate in regulation of appetite and of fat and carbohydrate
metabolism. The article elaborates modern concepts related to the impact of bariatric operations on metabolic disorders in obesity.

The paper presents data from competent drug controlling agencies form Russia, United States, Europe and other regions, comments on the main serious misconceptions of sibutramine-containing medicines, discusses the prerequisites for the analysis of the situation with sibutramine that initiated a SCOUT study, analyzes the history of sibutramine-containing drug Meridia. The results of observational research programs carried out in Russia (completed – "VESNA" and continued – "Primavera") are discussed in relation to the efficacy and safety of sibutramine-containing drug Reduxine for the target audience patients.

Guidelines for enhanced recovery after surgery (ERAS) are widely used and their efficiency was clearly demonstrated by numerous studies. Number of publications on this topic in bariatric surgery is significantly lower compared with other fields of surgery. However, the data accumulated allow to compose recommendations based on studies with high level of evidence. Authors review existing methods of enhanced recovery in their implementation into bariatric surgery. Enhanced recovery methods can be used to optimize all stages of perioperative care and include data on preoperative preparation, maintenance of electrolyte balance, prevention of postoperative nausea and vomiting, sufficient analgesia and safe discharge form hospital. Suggested guidelines for bariatric surgery are implied to be used by a multidisciplinary team.

This review presents data on the efficacy and safety of alogliptin, a new representative of the DPP-4 inhibitors, in adult patients with type
2 diabetes mellitus (DM type 2) as monotherapy or in combination with metformin, pioglitazone, glibenclamide and insulin.

Diabetes insipidus represents a serious disease that dramatically interferes with the everyday life of patients due to the need to constantly replenish of fluid lost in the urine, which comes amid shortage of synthesis, secretion or action of pituitary hormone vasopressin. The main difficulty is the differential diagnosis of types of diabetes insipidus in patients with the syndrome of polydipsia-polyuria as the correct differential diagnosis of these forms predetermine the safety and efficacy of further treatment. This lecture presents the current concepts of etiology, diagnosis and treatment of central diabetes insipidus (CDI). We give the comparative characteristics of various preparations of desmopressin for the treatment of the central form of the disease. We also consider the features of the management of selected patient populations with CDI: during pregnancy and lactation, pathology of the thirst sensation, after traumatic brain injury and neurosurgery.

Cushing's disease (CD) is a progressive neuroendocrine disease caused by a pituitary tumor producing excessive amounts of ACTH. In most cases (80-85%) the cause of the disease is a pituitary corticotroph microadenomas (located within the sella, measuring 3–10 mm, rarely multiple microadenomas) and only 15% of cases are presented as corticotroph hyperplasia or pituitary macroadenoma extending beyond the sella. The macroadenomas in CD usually extend suprasellar (10%), infrasellar tumor growth is relatively rare (5%). If the clinical picture is subtle, the symptoms are caused by the development "mass effect" of the tumor as it propagates to the surrounding pituitary structures. Suprasellar growth leads to compression of the optic chiasm with narrowing of visual fields, infrasellar growth destructs the bottom of the sella turcica and may cause nasal cerebrospinal fluid leak, which is dangerous due depressurization of the cranial cavity and its communication with environmental pathogens, development of life-threatening conditions such as meningitis, meningoencephalitis, ventriculitis. Leading life-threatening complications of the CD are infectious and cardiovascular. But in the case of nasal liquorrhea with expansion of the tumor in sphenoid sinus with destruction of the bottom of the sella, there is an immediate threat to the life of the patient. This article presents an example of a patient with morbid obesity and lack of specific clinical manifestations of CD, in whom the diagnosis of disease CD was made on the results of laboratory and instrumental examination, which experienced a spontaneous nasal cerebrospinal fluid leak.

Neuroendocrine control of the sympathetic nervous system in obesity

Orlistat, which reduces fat absorption by inhibiting intestinal lipase is a registered drug for obesity pharmacotherapy. Meta-analyzes indicate various positive metabolic effects of orlistat, including improvements in glucose and lipid metabolism, lowering both systolic and diastolic blood pressure. It is assumed that orlistat can reduce postprandial satiety by inhibiting the release of intestinal hormones (incretins), especially glucagon-like peptide-1 (GLP-1). Impact analysis of the secretion of incretins, with prolonged use of orlistat was conducted. The aim of the study M.Olszanecka-Glinianowicz et al. was to evaluate the effect of 8 weeks of treatment with orlistat as part of a weight loss program for preprandialnye levels of peptide YY and GLP-1.

Osteoporotic fractures in obesity

Effect of metformin on skeletal muscle in cardiotoxin-induced degeneration.

CREB3L3 transcription factor controls energy homeostasis and improves Obesity and diabetes.

Introduction. In patients with obesity coronary atherosclerosis and chronic heart failure (CHF) progress rapidly and have a worse long-term prognosis than those with normal weight.

Objective: To investigate the prognostic significance of GH and IGF-1 in the evaluation of cardiovascular risk in patients with obesity.

Materials and Methods. The study included 75 men (mean age 55.31±6.32 years), which are overweight or have mild obesity (body mass index (BMI) 28.69±3.6 kg/m2). Group 1 included 45 patients (age 56.4±6.29 years, BMI 28.69±3.69 kg/m2, blood pressure 124±10.18/80±4.59 mm Hg) who underwent coronary angiography. Group 2 included 30 patients (mean age 53.6 ± 6.1 years, BMI 28.68±3.52 kg/m2, blood pressure 128±9/83±6.81 mm Hg), CAD who are excluded by treadmill test. The coronary artery calcium score was assessed in group 2. All participants were evaluated impaired glucose tolerance (IGT), triglycerides (TG), IGF-1 and GH, LPHD, LPLD, geometry of the heart chambers was assessed by echocardiography.

Results. Patients in both groups did not differ in age, BMI, blood pressure. IGF-1 levels were not significantly different among the study groups. High circulating IGF-1 levels were frequently observed in group 1 (р=0.018). A statistically significant association of high IGF-1 observed with obesity (p=0.033), smoking (p=0.049), hypertension (p=0.002), end-diastolic dimension (p=0.045). GH was lower in group 1 compared with group 2 (p=0.046). Serum levels of GH are positively associated with EF (p=0.023) and E/A (p=0.043) and negatively associated with left atrial wall thickness (p=0.025) and coronary artery calcium score (p=0.005).

Conclusion: 1. IGF-1 may be a useful indicator to assess the prognosis of CAD and CHF in patients with obesity. 2. Relative GH deficiency was more often associated with severe CAD in patients with obesity.

Obesity consistently associated with the development of a number of chronic diseases, leading to a decrease in quality of life, disability and death. The article examines the connection between obesity and disease of the musculoskeletal system, describes the mechanisms by means of which obesity leads to the development of osteoarthritis. It is evident that reduction of body mass can slow the progression of osteoporosis. The own experience of non-pharmacological and pharmacological treatment of obesity with the use of orlistat in 50 obese patients with osteoarthritis of the knee II–III stage is presented. Treatment has resulted in a decrease in body weight, waist circumference, accompanied by a decrease in symptoms osteoarthritis among all the patients. Our results showed that the addition of orlistat to standard osteoarthritis scheme leads to significant reduction in weight and reduction of clinical manifestations of osteoarthritis. According to the above, the drugs that have impact on weight loss, should be included in the treatment regimen of patients with osteoarthritis and obesity.