In this review are discussed experimental and clinical data about the role of gut microbiota and its changes associated with age and lifestyle. The large intestinal microbiota plays an important role in normal bowel function and the maintenance of host health through the formation of short chain fatty acids, modulation of immune system reactivity, and development of colonization resistance. The intestinal microflora is a peculiar indicator of the condition of a microorganism reacting to age, physiological, dietary, and geographical factors from change of qualitative and quantitative structure. Studies have demonstrated that obesity and metabolic syndrome may be associated with profound microbiotal changes. Changes
in gut microbiota control metabolic endotoxemia - induced chronic inflammation,
oxidative stress, and metabolic disorder which are connected with the increased
risk of development of cardiovascular diseases and pathology associated with
age, which leads to accelerated aging. It is obvious that maintenance of a homeostasis and a normal metabolism is impossible without restoration of a variety of normal associations of intestinal microorganisms.

The aim of this work was a review of literature data on the possible relationships between the levels of insulin, leptin, and adiponectin
and the formation of structural and functional changes in the myocardium in obesity, as well as their dynamics due to body weight reduction.
We analyzed the studies found by keywords «insulin, adiponectin, leptin, left ventricular hypertrophy» in international databases
Pubmed, Medline and Cochrane. Results of many studies suggest a positive association with hyperinsulinemia and hyperleptinemia mass
index and left ventricular mass. Insulin resistance can act as an independent predictor of subclinical diastolic dysfunction. Contribution
of adiponectin in the development of cardiovascular diseases has been investigated extensively: many authors have obtained results that
indicate its protective effect on the myocardium. Weight reduction is associated with decrease in levels of blood insulin and leptin, but
leptin reduction, according to some authors, there was only seen in a decrease in body weight by an amount exceeding 7% of the original.
The results of measuring the level of adiponectin in obese patients on the background of weight loss remains controversial: some authors
have obtained an increase in the concentration of this protein in the blood, while others pointed out the lack of any dynamics.

The obesity pandemia linked metabolic syndrome (MS) connected with it acquires not only medical, but also increasing social importance. This state has unfavorable action on human organism and is the serious diseases risk factor. Special importance MS available in the women of childbearing age. There are described some literature data about the special features of MS pathogenesis in women and the possibilities of its correction with sibutramine and by the combined medication Reduxin® (sibutramine + cellulose microcrystalline). Our own data of the experience of treatment by the Reduxin® 53 women in reproductive age with MS are cited, opsomenorrhea and with a formation of polycystic ovarian syndrome. Patients took the medication during 12 weeks. Mean body weight loss was 13% and 27 patients had weight loss more than 5% at the end the period of observation. Circle of waist was also the decreased on the average on 6±2 cm. 43 women had a normalization of rhythm, duration and intensity of menstrual hemorrhages. Remaining patients it was required the designation of gestagen in the cyclic regime. An improvement of the blood lipid profile was detect: the average value of atherogenic index triglycerides/ high density lipoproteins cholesterol was improved to 35,8%. The maximum decrease of the cardiovascular disease risk factors was marked in the patients, who had weight loss more than 10%.

Nonalcoholic fatty liver disease (NAFLD) – a common chronic disease of the liver, the main feature of which is the accumulation of fat in hepatocytes, is not related to alcohol abuse. NAFLD is associated with obesity, especially abdominal, metabolic syndrome and various metabolic markers of risk for cardiovascular disease and type 2 diabetes, which affects the incidence, prognosis and life expectancy of patients with obesity. This lecture describes the main causes of the disease, its pathogenesis, clinical presentation, diagnosis and treatment.

Silent, or clinically nonfunctioning adenomas are morphologically heterogeneous group, characterized by positive immunoreactivity for one or more hormones classically secreted by normal pituitary cells but without clinical expression. Although in some occasions enhanced or changed secretory activity can develop over time. According to immunoreactivity they are divided into "silent" gonado-, cortico-, somato -, mammo – and thyrotropinomas, oncocytomas, «zero-cell» tumors. All types of "silent" adenomas have different biological activity, secretory capacity and outcomes in the postoperative period. This series of clinical cases shows more «aggressiveness», a higher risk of relapse for "silent" cortico- and somatotropinomas. Immunohistochemical analysis of residual tissue can be used to identify patients with high risk of recurrence, to develop optimal treatment and follow-up.

Gene Expression Analysis of Murine Brown and Subcutaneous Adipose Tissue: Significance with Human

The main goal of any surgical intervention in morbid obesity is to improve the quality of life of patients which is considered directly related to the loss of excess body weight and a reduction in the incidence of related diseases. The aim of this study was to determine the interdependence of these indicators. In 2005-2013 we performed 457 operations of gastric banding (GB) and 198 - gastric bypass (GBP). After GB only body mass index (BMI) and quality of life index (QOL) had significant linear correlation, i.e., the higher the weight of the patient, the worse the quality of life. After GBP there was is a significant linear relationship only between the patient's body weight and dynamics of comorbidities, i.e. the higher the weight of the patient, the higher the level of comorbidity. The QOL of patients after GBP does not depend on the body weight or on the frequency of comorbidities.

The aim of research was to estimate the influence of hormone metabolism and sleep apnea on patients with obesity. 76 patients (37 males and 39 females) with obesity were included in this study. After night polysomnography all patients were divided in two groups comparable
by age, sex ratio and BMI. The first group consisted of 41 patients with obstructive sleep apnea syndrome (OSAS), the second (controls) – 35 patients without breath disorders during sleep. OSAS is accompanied by the increase in urinary cortisol during the night, high levels of
basal insulin, disturbances of hepatic production of IGF-1, dysfunction of the pituitary-gonadal axis. Our results show that sleep-related breathing disorders render markedly and negatively affect on hormonal parameters of patients with obesity. As a reliable difference of basal
secretion of orexin A in obese patients with and without OSAS was not revealed (42,0 [14; 99,5] vs. 18,0 [14,5; 124,5] pg/ml; р=0,9), we were not able to show the existence that the existence of OSAS is followed by any special changes of activity of the orexin system.

Since January 2005 till December 2013 655 patients with morbid obesity were operated on, 457 (69,7%) from which, had gastric banding with using different models of regulating bandages: AMI (AMI, Austria), SAGB (Ethicon, USA), Lap Band (ALLEGRAN, USA). Gastric bypass was made to 198 patients, that made 30,3%. The degree of lowering of overweight in general is more after gastric bypass, than after gastric banding. At the same time during the period of 1–1,5 year the degree of lowering of overweight with women is the same after both the operation. The degree of lowering of overweight with men after gastric bypass is a little higher. In the period of 2–4 years the degree of lowering of overweight both with men and women after gastric bypass is higher. In 5 years men after gastric bypass actually lose weight better than after gastric banding. The men older than 40 years having BMI more than 40 kg/m2 after gastric banding lose weight worst of all. In the period of more than 5 years the women in the age group of 30–39 years having BMI more than 40 kg/m2 had better results after gastric bypass. The women older than 50 years having BMI more than 40 kg/m2 after gastric banding had the worst results.