[The clinical practice guidelines for primary hyperparathyroidism, short version].

Primary hyperparathyroidism (PHPT) is an endocrine disorder of parathyroid glands characterized by excessive secretion of parathyroid hormone (PTH) with an upper normal or elevated blood calcium level. Classical PHPT refers to a symptomatic, multi-system disorder, wich can lead to a significant decrease in the quality of life, disability of patients, and even an increased risk of premature death. Hypercalcemia and the catabolic effect of PTH on various cells are considered as the main pathogenetic mechanisms of the PHPT associated complications. In the last two decades, there has been an increase in the incidence of PHPT, mainly due to the mild forms of the disease, primarily due to the routine calcium screening in North America, Western Europe and, Asia. High prevalence of the disease, as well as the variety of clinical manifestations, cause the attention of different specialists - physicians, rheumatologists, urologists, nephrologists, cardiologists and other doctors. This review cover the main issues of Russian guidelines for the management of PHPT, approved in 2020, including laboratory and instrumental methods, differential diagnosis, surgical and conservative approach, short-term and long-term follow-up. This guidelines also include the recommendations for special groups of patients with hereditary forms of PHPT, parathyroid carcinoma, PHPT during pregnancy.

[Primary hyperparathyroidism in Russia according to the registry].

BACKGROUND: There are no large-scale epidemiological studies on primary hyperparathyroidism (PHPT) in Russia. The high prevalence of the disease, the high risk of disability and death in this cohort of patients requires the study of the epidemiological and clinical structure of PHPT to determine the extent of medical care. AIM: Evaluate the frequency of PHPT detection and characterize its clinical forms in Russia using an online registry. METHODS: The object of the study is the database of the State Register of Patients with PHPT 1914 patients from 71 regions of the Russian Federation. New cases of the disease, as well as dynamic indicators are recorded when patients visit outpatient clinics or medical institutions. The analysis of data made at the end of December 2017 was carried out. The following parameters were evaluated: demographic and clinical indicators; indicators of phosphorus-calcium metabolism, the main forms of PHPT and its course, the primary characteristic of PHPT in hereditary syndromes and parathyroid carcinoma. Results are presented as mean and standard deviations, or medians and quartiles; descriptive statistics of qualitative attributes absolute and relative frequencies. RESULTS: the total number of patients with PHPT in the registry on 31 of December 2017 was 1914 cases (0.001% of the population of the Russian Federation). Identification of PHPT was 1.3 cases per 100 thousand of the population in Russia, 7.6 cases in Moscow, 6.1 cases per 100 thousand in the Moscow region. The average age of patients at the time of diagnosis was 55.6 10 years. The active phase of the disease was registered in 84.6% of patients (1620/1914), most of whom had a symptomatic PHPT 67.1% (1087/1620), and 32.9% a asymptomatic disease (533/1620). Symptomatic disease with visceral complications was detected in 15.8% cases (172/1087), with bone complications in 48.4% (526/1087). The mixed form of the disease was detected in 35.8% of patients with manifest form (389/1087). Normocalcemic variant PHPT (nPHPT) was registered in 14.5% cases (234/1620). Sporadic PHPT occurs in 83% of cases (1592/1914). 326 patients (17%) had a suspicion for hereditary form of the disease: average age was 31.2 12.3 years. A genetic analysis was conducted in 61 patients (3.2%): showed the mutation in the MEN1 gene in 2.9% of cases (55/1914) and the mutation in the CDC73 gene in 0.3% of cases (6/1914) (HPT-JT syndrome). Parathyroid carcinoma was confirmed in 1.8% of all patients (35/1914). Surgical treatment was performed in 64.5% of patients (1234/1914). Remission was achieved in 94% of cases (1160/1234), in 6% of cases relapse after surgical treatment or persistence of PHPT was recorded. CONCLUSION: detection of PHPT in the Russian Federation raised in comparison to 2016, which is associated with an active start of registration of patients in the regions. At this stage, it is necessary to modify the principles of registration and control, to make a platform for gathering information and calculating the necessary volumes of medical care for PHPT patients.

[Study of Chloroplast DNA Polymorphism in the Sunflower (Helianthus L.)].

The polymorphism of microsatellite loci of chloroplast genome in six Helianthus species and 46 lines of cultivated sunflower H. annuus (17 CMS lines and 29 Rf-lines) were studied. The differences between species are confined to four SSR loci. Within cultivated forms of the sunflower H. annuus, the polymorphism is absent. A comparative analysis was performed on sequences of the cpDNA inbred line 3629, line 398941 of the wild sunflower, and the American line HA383 H. annuus. As a result, 52 polymorphic loci represented by 27 SSR and 25 SNP were found; they can be used for genotyping of H. annuus samples, including cultural varieties: twelve polymorphic positions, of which eight are SSR and four are SNP.

[Neonatal injections of pharmacological agents and their remote genotype-dependent effects in mice and rats].

Experimental data were reviewed which demonstrated that the neonatal injection effects of certain biologically active drugs (ACTH(4-10) fragment and its analogue Semax, piracetam, caffeine, levetiracetam, busperone, etc.) could be detected in adult animals as changes in physiological and behavioral reactions and in several morphological traits as well. Audiogenic seizures proneness, anxiety-fear and exploration behavior as well as pain sensitivity were analyzed. The remote effects discovered were either similar in direction to those applied to an adult organism, or opposite to it. Pharmacological treatments of such type presumably interfere the CNS development during early postnatal ontogeny and change the normal pattern ofbrain development. These modulatory influences could be due to changes in neurotransmitter system development and are presumably capable to induce CNS morphological deviations (numbers of neurons, adult neurogenesis).

[Selection of mice for high level of extrapolation capacity with cobcommitant low anxiety level].

The behavior scores were assessed in mice selected simultaneously for high percentage of correct extrapolation task solutions and for low anxiety during test performance. Extrapolation test requires that the hungry animal searches for the food bait which disappeared from the view moving in the direction of food bait movement. In the 4th selection generation no significant changes occurred in the percentage of correct task solutions neither in comparison to control unselected population, nor against 50% chance level. Although the proportion of mice in selected strain which performed with 80-100% of correct solutions increased and in F4 was higher in comparison to controls (approaching significance). The proportion of "0" solution (when mouse made no choice) and of "refusals" of performance (anxiety indices in this test) were lower in selected line and the proportion of refusals in F4 was significantly lower than in controls. Elevated plus maze, closed plus maze and inescapable slippery funnel tests demonstrated significantly lower anxiety in mice of selected strain. These data demonstrate much more complex genetic basis for the capacity for extrapolation (lack of response to selection) in comparison with that of anxiety traits in mice (changes in the response to selection).

Audiogenic epilepsy in mice with different genotypes after neonatal treatments enhancing neurogenesis in dentate gyrus.

Pups of Wistar and KM rats (with predisposition to audiogenic epilepsy) were daily injected with neuropeptide semax (50 mg/kg) or NO-synthase inhibitor L-NAME (50 mg/kg) on days 7-11 of life. Alterations of audiogenic seizures pattern were revealed in rats of both strains at the age of 1 month, while changes in seizure severity were genotype-dependent. Both agents enhance neurogenesis in the dentate gyrus of the hippocampus and the delayed effect in the form of altered seizure pattern seems to be determined by this factor. Genotype-dependent alterations of seizure severity after administration of semax and L-NAME were differently directed. These effects are suggested to be underlined by physiological and biochemical mechanisms not related to the intensity of postnatal neurogenesis.

[The remote effects of neonatal injections of caffeine and piracetam on audiogenic seizure susceptibility in mice of three genotypes].

Neonatal DBA/2J, 101/HY and CBA/Lac/Sto mice (2-7-day-old) were subcutaneously injected with caffeine (200 mg/kg), piracetam (50 mg/kg) or distilled water. At the age of 1 month, they were tested for audiogenic seizure susceptibility (SS). The neonatal injections changed SS in 1-month-old mice in a genotype-dependent manner. Distilled water (control of neonatal pain stimulation) slightly reduced the audiogenic fit severity (arbitrary scores) the effect being most distinct in DBA/2J, less strong in 101/HY strain and absent in CBA. Caffeine neonatal injections induced slight changes in DBA/2J, no changes in CBA and increased SS in 101/HY mice. Piracetam reduced fit intensity in DBA/2J mice but increased it in CBA and, especially, in 101/HY strain. Genotype-dependent differences in physiological mechanisms of audiogenic seizures may be responsible for different remote effects of early treatment.

Audiogenic epilepsy in young mice of different strains after neonatal semax treatment.

Neonatal (from day 2 to day 7 of life) injection of neuropeptide semax to mice of 5 inbred strains significantly reduced predisposition to audiogenic epilepsy in only one-month-old DBA/2J mice, which manifested in changes in the mean audiogenic sensitivity score and percentage of animals dead as a result of acoustic stimulation.

[Neonatal buspirone modulates the intermale aggression in adult mice].

Mice of two strains with different levels of male aggression (RSB and RLB) were subjected to daily injections of 5-HT1A receptor agonist buspirone (25 microg) on the 2nd - 6th postnatal days. This neonatal treatment augmented the aggressive behavior (tested in the dyadic contests with non-aggressive A/Sn males) in aggressive RSB mice and reduced aggression in less aggressive RLB. Correlations with different signs were found between the 5-HT and 5-HIAA levels in the neocortex, hippocampus, and hypothalamus and behavioral indices of aggression in RSB and RLB males. The remote effects of neonatal buspirone in these two mice strains presumably depend on genotype-related features of ontogeny of the 5-HT system.

[The ability to extrapolate the direction of movement in mice selected for large and small brain weight: the influence of environmental enrichment].

Female mice from the strains selected for large and small brain weight (LB, SB) were kept either in "enriched" or in standard laboratory environment for 3 months. At the end of this period they were tested in the open field and for the ability to extrapolate the direction of the food stimulus movement. Scores of the LB mice kept in the "enriched" environment were significantly higher in the extrapolation test as compared to the LB mice kept in the standard environment as well as to the SB mice of both groups.

Genotype-dependent changes in pain thresholds in adult mice after neonatal treatment.

We studied the effect of neonatal treatment with pharmacological preparations (Semax and buspiron) and solvents (distilled water and physiological saline) on the pain threshold in 3-4-month-old mice of 6 genotypes. Neonatal administration of the solvent (nociceptive stimulation) decreased pain thresholds in DBA/2, 101/HY, and RSB males, but not in female mice and animals of other strains. Neonatal administration of Semax significantly increased pain thresholds in adult DBA/2 and 101/HY males compared to those in animals neonatally treated with the solvent. Injection of buspiron in the neonatal period decreased pain thresholds in RLB males.

[The influence of neonatal ketamine injection on pain sensitivity and audiogenic seizures in adult rats]. / Vliianie neonatal'nogo vvedeniia ketamina na bolevuiu chuvstvitel'nost' i audiogennye sudorozhnye pripadki vzroskykh krys.

The remote effects of neonatal (on the 3d-to-9th postnatal days) ketamine injections (10 and 50 mg/kg in 20 microliters of distilled water, s.c.) were analyzed in adult Wistar, WAG/Rij, and KM (a strain with high audiogenic sensitivity) rats. Both ketamine and water injections increased pain sensitivity in adult rats. Neonatally injected water increased the mean score of seizures in Wistar and WAG/Rij, whereas ketamine water solution injected in the dose of 50 mg/kg did not change the seizure intensity (as compared to the intact control). Consequently, ketamine significantly reduced the mean score of the audiogenic seizure fit without change in its latency. In highly sensitive KM rats the neonatally injected ketamine (50 mg/kg) significantly shortened the mean latency of the fit onset, and fit stages developed faster. Thus, the neonatal ketamine injection increased the audiogenic seizure susceptibility of brain structures in KM rats.

[Neonatal Semax and saline injections induce open-field behavior changes in mice of different genotypes]. / Neonatal'nye in''ektsii preparata Semaks i fiziologicheskogo rastvora vyzyvaiut izmeneniia povedeniia vzroslykh myshei raznykh genotipov v teste "otkrytoe pole".

DBA/2, CBA mice, and their F1 hybrids (first series) and 101/HY and C3H mice (second series) were injected as neonates (2-7 days of life) with Semax (sc., 7 microg per animal). Semax is a peptide analogue of ACHT4-10 fragment which is resistant to degradation. The common feature of remote effects of both Semax and saline injections was the set of changes in the open-field behavior in adult (2.5- to 3-month-old) animals as compared to intact mice. Unexpectedly, the neonatal saline injections induced many changes in adult behavior, part of these effects being genotype-dependent. The most conspicuous shifts (genotype-dependent increase or decline) in freezing, grooming and rearing scores were displayed by DBA/2 and C3H mice, whereas the hole-poke frequencies were significantly changed in CBA and C3H mice. Squares crossed in the center of arena and rearing number were significantly increased in saline group of DBA/2 mice, whereas in Semax-injected DBA/2 group they were approximately equal to the level of intact mice. This means that the remote effects of noxious stimulation (injections of saline) were in some ways "compensated" as the result of concomitant peptide effect. At the same time, the numbers of freezing and grooming episodes were also increased in these groups. Because exploratory behavior and manifestations of anxiety increased or decreased simultaneously, it proves to be difficult to ascribe these changes to behavioral modulation along the "novelty seeking--anxiety" axis. In mice of other genotypes, changes in the same indices of the open-field behavior were revealed, but these changes were different in their direction. It was suggested that the complex patterns of postnatal behavior was the result of neonatal injections modulating subsequent brain development.

[The correlation between brain weight and behavior changes in response to ethanol administration in laboratory mice]. / Korreliatsiia vesa mozga i izmenenii povedeniia v otvet na vvedenie étanola u laboratornoi myshi.

The effects of ethanol injections on the F2 offspring of the cross between large-brain (LB) and small-brain (SB) mouse strains selected for high and low relative brain weights, respectively, have been studied. The parental strains have significantly differed in brain weight for many generations. The effects of ethanol (2.4 g/kg) have been compared in four subpopulations of mice that differ pairwise in brain weight. One pair of subpopulations has been isolated from the hybrid group and the other, from generation 22 of selection of the parental strains. The results of ANOVA have demonstrated that brain weight is related to the response to ethanol injections. The parameters of stereotyped behavior, which increased in after ethanol injections and reflected the decrease in exploratory activity) were different in mice with high and low relative brain weights. The pattern of behavioral changes after ethanol injections is the second (after increased learning ability) behavioral trait found to be correlated with brain weight.

[Behavioral and morphological asymmetry in brain weight selected mice]. / Asimmetriia povedeniia i morfologiia mozga u myshei, selektirovannykh po vesu mozga.

Mice selected for large and small brain weight preferred to move rightwards in two cognitive paradigms, food-motivated T-maze performance and extrapolation ability tests. The degree of asymmetry in choices of movement direction varied in selection generations and sometimes was accompanied by asymmetry in the weight of the left and right hippocampi and other forebrain structures and different numbers of right and left neocortical cells.

[Rapid tolerance to ethanol and high voluntary alcohol consumption in mice selected for brain weight]. / Bystraia tolerantnost' k étalonu i dobrovol'noe potreblenie bol'shikh doz alkogolia u myshei, selektirovannykh po vesu mozga.

Mice of two strains selected for small and large brain weight (SB and LB, respectively) had free access to 10% alcohol and water within three months. At the end of this period, they consumed alcohol in daily dose of 6.9 +/- 0.9 and 7.5 +/- 0.8 g/kg, respectively. After a period of imposed three-day abstinence, the alcohol consumption by the mice of these strains increased by 68.6 and 49.3%, respectively. Exploratory behavior of independent groups of mice from these strains was studied in the closed cross-maze. The animals were injected with ethanol (2.4 g/kg, i.p.) or vehicle twice with a weekly interval. In SB mice, the first ethanol administration increased the total time of maze exploration and the number of stereotyped visits. The second ethanol administration did not increase the time of exploration but increased the number of stereotyped visits even to the greater extent. The latter indicates the development of rapid tolerance and sensitization of these behaviors to the drug, respectively. The ethanol administration inhibited exploratory patrolling behavior and defecations. In LB mice, both the first and second ethanol administrations increased the number of stereotyped visits and decreased the exploration time and the number of defecations. The results do not support the psychomotor stimulant hypothesis of alcohol addiction. It is proposed that SB and LB mice may serve as models for Cloninger's types 1 and 2 alcoholics and may be useful for investigation of neuropharmacological mechanisms of stimulatory and inhibitory effects of ethanol.

[Effect of carbamazepine on the structure-function relations in the development of the epileptic structure]. / Vliianie karbamazepina na strukturno-funktsional'nye sviazi v razvitii épilepticheskoi sistemy.

The experiments on white outbred male rats with cobalt-induced epileptogenic focus in the left sensomotor cortical region showed that the anticonvulsant effect of carbamazepine (20 mg/kg) depends on the functional state of the epileptic system (ES). In various stages of the ES development, the drug effect is related to the influence upon the determinant focus generating the epileptic activity. In the initial stage, carbamazepine primarily affects epileptic activity of the cortical foci (ipsi- and contralateral hemisphere). In the second (generalization) stage, the drug decreases the epileptic activity in all structures, but to a greater extent, in the dorsal hippocampus and lateral hypothalamus.

Behavioral screening of two mouse lines selected for different brain weight.

1. Several behavioral tests were used to compare two lines of mice selected for large (LB) and small brain (SB) weight on the basis of brain/body weight ratio values. 2. An elevated pain sensitivity as well more intense startle response was shown in SB mice in comparison with LB mice. 3. In inescapable situations of slip funnel and tail suspension tests, analogues of the Porsolt swim test, higher immobility scores in SB mice suggest an increased level of fear and/or anxiety the stress situations. 4. The SB mice demonstrated higher levels of locomotion in open field and cross-maze tests. In the latter test, the SB mice also showed increased tendency for stereotyped alternation of two arms during maze exploration. 5. Acute administration of a moderate dose of ethanol (3 g/kg) had opposite effects on the total time of cross-maze exploration: this measure increased in the SB and decreased in the LB line. By contrast, the tendency for stereotypy was similarly increased and the efficacy of maze exploration decreased in both lines.

Sensitivity to hypobaric hypoxia in mice selected for high and low brain weights.

We studied the effect of hypobaric hypoxia on mice with various brain weights. Mice with low brain weight were more resistant to hypoxia than animals with high brain weight.