The hereditary aspect of obesity is a major focus of modern medical genetics. The genetic background is known to determine a higher-than-average prevalence of obesity in certain regions, like Oceania. There is evidence that dysfunction of brown adipose tissue (BAT) may be a risk factor for obesity and type 2 diabetes (T2D). A significant number of studies in the field focus on the UCP family. The Ucp genes code for electron transport carriers. UCP1 (thermogenin) is the most abundant protein of the UCP superfamily and is expressed in BAT, contributing to its capability of generating heat. Single nucleotide polymorphisms (SNPs) of Ucp1–Ucp3 were recently associated with risk of cardiometabolic diseases. This review covers the main Ucp SNPs A–3826G, A–1766G, A–112C, Met229Leu, Ala64Thr (Ucp1), Ala55Val, G–866A (Ucp2), and C–55 T (Ucp3), which may be associated with the development of obesity, disturbance in lipid metabolism, T2D, and cardiovascular diseases.

In this review, we have considered and discussed the existing data to achieve a deeper understanding of the role of intestinal microbiota in the development and progression of chronic heart failure (CHF). The key moments of the CHF pathogenesis (an imbalance of neurohumoral systems, inflammatory theory and metabolic disorders) and the respective changes of the intestinal microflora composition were compared. Here, we also present the latest results of the positive influence of the microflora modulations on the course and prognosis of CHF with the prescribing antibiotics, probiotics and prebiotics.

Objective: to study myocardial contractile function in patients with liver cirrhosis and ascites in the presence of bacterial overgrowth syndrome (BOS) and pathological bacterial translocation. Materials and methods. We included in this study 59 patients with Child-Pugh class B and C liver cirrhosis (LC) of various etiology and ascites. Control group comprised 12 patients with ischemic heart disease complicated by chronic heart failure (CHF). Examination included history taking and laboratory and instrumental investigation. LC was diagnosed basing on clinical symptoms and instrumental studies. Child-Pugh and MELD scores were used for assessment of LC severity and prognosis. International ascites club grading system was used for evaluation of severity of ascites. Hydrogen breath test was applied for diagnosing BOS. Syndrome of pathological bacterial translocation was established based on blood levels of lipopolysaccharide-binding protein and detection of bacterial DNA in ascitic fluid. Structural-functional parameters of the myocardium and hemodynamics were assessed by echocardiography. Brain natriuretic peptide (BNP) concentration was measured in blood serum and ascitic fluid. Results. In 13 of 59 patients with LC the hydrogen breath test was negative, in 33 positive and in 13 patients the positive hydrogen test was combined with the presence of BOS and pathological bacterial translocation. Blood serum and ascitic fluid BNP concentrations in LC patients were low and within normal limits (62.5±4.1 and 53.3±4.9 rg / ml, respectively), what contrasted with high BNP concentrations in patients with CHF (1820±95.5 and 497.1±39.6 rg / ml, respectively). Total protein level in ascitic fluid also was significantly lower in patients with LC than in patients with CHF (1.77±0.1 and 4.43±0.35 mg / dL, respectively). The serum-ascitic albumin gradient (SAAG) in both groups of patients exceeded 1.1 (1.58±0.13 in patients with CHF and 1.88±0.19 in patients with LC). Conclusions. In patients with liver cirrhosis the presence of BOS and bacterial translocation did not produce a distinct negative impact on contractile function.

Aim. To identify the relationship between rhythm disturbances, including ventricular tachycardia (VT), and the small intestinal bowel bacterial overgrowth syndrome in chronic heart failure (CHF) with left ventricular systolic dysfunction. Materials and methods. The study included 60 patients with CHF with systolic dysfunction of the left ventricle (left ventricular ejection fraction less than 50 %). Conventional biochemical and hematological tests , ECG and echocardiography were performed. The level of the N-terminal fragment of the brain natriuretic peptide (NT-proBNP) and nonspecific inflammatory markers (C-reactive protein (CRP), fibrinogen, leukocytes, lymphocytes, neutrophil to lymphocyte ratio) were studied. Lactulose hydrogen breath test was fulfiled to detect the small intestinal bowel bacterial overgrowth syndrome (SIBOS). In the presence of complaints of palpitation and interruptions in the heart work or other indications, Holter ECG monitoring was performed. The control group consisted of 20 patients comparable to the main group by sex, age and major diseases in the absence of CHF and SIBOS.Results. The prevalence of SIBOS among patients with CHF significantly exceeded its prevalence in the group of patients without CHF (SIBOS was detected in 25 of 60 patients with CHF (42 %) and in 2 of 22 patients without CHF (9 %); p = 0.0034). The small bowel bacterial overgrowth syndrome with CHF did not have a significant impact on the functional class and the indicators of clinical and biochemical analysis of blood as well as on echocardiographic data and the number of supraventricular and ventricular extrasystoles. However, in patients with SIBOS, higher CRP values were observed (median and interquartile range: 3.6 (2.5; 4.1) vs 2.15 (0.4; 5.1); p = 0.041). In addition, among patients with CHF and a positive SIBOS test, ventricular tachycardia was significantly more common (in 45 % of patients with SIBOS and in 10.71 % of patients without SIBOS; p = 0.01555). The presence of SIBOS increased the risk of VT in patients with CHF (OR = 6.818, 95 % CI: 1.542 - 30.153; P = 0.011)). The development of VT in patients with SIBOS was associated rather with systemic inflammation than with the severity of CHF characterized by high NTproBNP numbers, while in the absence of SIBOS the opposite trend was noted.Conclusion. The development of VT in patients with SIBOS is associated rather with systemic inflammation rather than with the severity of CHF. SIBOS can be considered as an additional risk factor in the development of systemic inflammation and ventricular tachycardia in patients with CHF.

Aim.  This paper is aimed at presenting the materials of clinical observations associated with diagnosing rare-occurring ruptures of the right dome of the diaphragm that have been overlooked for a long period.Results.  A 61-year-old man was admitted to hospital with a diagnosis of chronic heart failure. Chest radiograph revealed a high position of the right dome of the diaphragm. Computed tomography revealed a defect in the central parts of the diaphragm on the right, the liver was rotated outward with its visceral surface deployed anteriorly and upward. In the right thoracic cavity, anterior to the liver, were the loops of the intestine and the outlet of the stomach.More than 30 years before, the patient had experienced an explosive trauma, which might have caused a rupture in the right dome of the diaphragm. A 70-year-old man, a smoker with a ten-year history of hypertension, was hospitalized with an increase in dyspnea, a cough with the discharge of purulent sputum, the feeling of heaviness behind the sternum. Chest radiograph revealed a high standing of the right dome of the diaphragm at the level of 3rd rib with a decrease in the volume of the right lung, and an increase in cardiac silhouette (cardiothoracic index 0.64). Computed tomography revealed a high standing of the right dome of the diaphragm as well as the compression of the middle and lower lobe of the right lung with the presence of compression atelectasis. The liver was rotated, displaced into the right thoracic cavity, the deformation of the inferior vena cava to the right was visualized due to the displacement and rotation of the liver. The consolidated fractures of 10th–12th ribs on the right were visualized. The patient had had a chest injury resulting from a traffic accident about 15 years before, with no X-ray examination having been conducted at that time.Conclusion.  In the case of left-sided diaphragm ruptures, which are much more frequent than the right-sided ones, the stomach, large and small intestines as well as spleen are displaced into the thoracic cavity. In the case of rightsided diaphragm ruptures, the liver and gallbladder are displaced into the thoracic cavity. Right-sided posttraumatic diaphragmatic hernias that are not diagnosed at the time of injury or trauma and continue to be asymptomatic for a number of years are very rare. The sensitivity and specificity of computed tomography for the diagnosis of diaphragm ruptures is 61–87 % and 72–100 %, respectively. In an acute period, the treatment of diaphragm ruptures is surgical. However, in long-term asymptomatic ruptures, expectant management is possible, particularly if the risk of surgical treatment is high.