[Resolution based on the results of the interdisciplinary expert council "Cognitive health of a comorbid patient"].

On September 29, 2023, a meeting of the interdisciplinary expert council "Cognitive health of a comorbid patient" was held in Vladikavkaz. To reduce the social and economic burden of cognitive impairment, which is increasingly being detected in comorbid patients in the Russian Federation, it is necessary to introduce socially significant initiatives for the timely diagnosis and prevention of these diseases, as well as update modern approaches to treatment, taking into account their multifactorial pathogenesis and the risk of complications. Based on the results of scientific reports and discussions held during the expert council, experts made decisions on a further plan within the framework of socially significant initiatives for the prevention of obesity.

[Clinical significance of uremic toxin indoxyl sulfate and inflammation in the development of vascular calcification and cardiovascular complications in stage C3-C5D chronic kidney disease].

AIM: To clarify the role of the uremic toxin indoxyl sulfate (IS) and inflammation in the development of vascular calcification and cardiovascular complications in chronic kidney disease (CKD). MATERIALS AND METHODS: One hundred fifteen patients aged 25 to 68 years with CKD stage C3-C5D were examined. Serum concentrations of IS, interleukin 6 (IL-6), tumor necrosis factor (TNF-α), troponin I, parathyroid hormone were determined by enzyme immunoassay using kits from BluGene biotech (Shanghai, China), Cloud-Clone Corp. (USA), ELISA Kit (Biomedica, Austria). RESULTS: An increase in the serum concentration of IS, IL-6, TNF-α was revealed, which was significantly associated with a deterioration in renal function and changes in the morphological and functional parameters of the heart and aorta. CONCLUSION: High concentrations of IS, IL-6, TNF-α, which are closely associated with an increase in renal failure and cardiovascular complications, indicate their significant role in vascular calcification, which underlies the damage to the cardiovascular system in CKD.

[Small bowel volvulus due to a giant mesenteric lipoma]. / Zavorot tonkoi kishki, obuslovlennyi gigantskoi lipomoi bryzheiki.

Mesenteric lipomas are very rare. They are asymptomatic in most cases, but some patients can develop certain complications such as small bowel volvulus and acute small bowel obstruction. We report a 78-year-old patient with giant mesenteric lipoma complicated by jejunum volvulus and acute small bowel obstruction. The patient underwent laparotomy, en-bloc resection of small bowel, mesentery and lipoma followed by side-to-side anastomosis.

[The ecological determinancy of development of bronchial asthma in adult population (as exemplified by the Republic of the North Ossetia-Alania].

The intensive impact of anthropogenic factors on health causes more than 40% of all human diseases. First of all, it has to do with respiratory organs and comes out as the main determinant of development of chronic respiratory pathology. The article presents an assessment of negative impact of environmental factors on dynamics of increasing of incidence of bronchial asthma morbidity in the Republic of North Ossetia-Alania. The indicators of the general morbidity that increased up to 75.6% and for the first time detected up to 97.5% over six-year period. The results of present study correspond with the results of similar studies implemented in various territories of Russia indicating at mediation of increasing of bronchial asthma morbidity by negative impact of environment risk factors. In the Republic, over a period of many decades, contribution of the metallurgical plant producing zinc, cadmium, sulfuric acid and zinc-aluminum alloys, to atmospheric air pollution made up not less than 40%. Only two out of eight rural municipal districts are relatively environmentally problem-free today. In rural areas, more than 50% of atmospheric air pollutants is related to carbon oxide. Nowadays, along with industrial emissions into atmospheric air and their accumulation, increases importance of motor transport in environmental pollution. The cars account for 50-70% of all harmful emissions. The presence of harmful substances contained in exhaust gases exceeds permissible standards by 2-3 times. According to the data of systematic analysis of urban air quality, most of the year citizens breathe atmospheric air not meeting normative requirements. The actual situation favors development of bronchial asthma. In the Republic, its morbidity has not decreased for many decades. To improve indicators of bronchial asthma morbidity can be achieved by leveling harmful effects of environment through identification of main sources of environmental troubles. The priority is both to decrease industrial emissions that pollute atmosphere and to transit to more ecologically safe modern power supplies of motor transport facilities.

[Clinical significance of serum levels of osteoproteherin and sclerostin in assessment of vascular calcification in chronic kidney disease stage 3-5].

AIM: To clarify the mechanisms of the effect of osteoprotegerin (OPG) and sclerostin on vascular calcification and the state of the cardiovascular system in chronic kidney disease (CKD). MATERIALS AND METHODS: A total of 110 patients aged 18 to 65 years with CKD stages 35D were examined. OPG, sclerostin, intact parathyroid hormone, and serum troponin I were determined using the commercial "Enzyme-linked Immunosorbent Assay Kit for Sclerostin" from Cloude-Clone Corp. (USA) by enzyme-linked immunosorbent assay. RESULTS: An increase in sclerostin and OPG levels was revealed, which significantly correlated with a decrease in glomerular filtration rate, as well as an increase in left ventricle myocardial mass index and peak systolic blood flow in the aortic arch. CONCLUSION: Changes in the regulation of bone-mineral metabolism, in which the proteins inhibitors of bone metabolism, OPG and sclerostin, as well as the interactive interaction between the vascular and skeletal systems, play a decisive role in the development of lesions of the cardiovascular system caused by vascular calcification in CKD.

The estimation of quality of life of children with diseases of musculoskeletal system.

The study of life quality was carried out covering 432 children aged 6-17 years with diseases of musculoskeletal system on the basis of the cardio-rheumatological department of the Republican Children Clinical Hospital and children polyclinics of the Republic of North Ossetia-Alania. The Russian version of the SF-36 questionnaire was applied which included 11 questions. The physical and emotional state was studied in 4 age groups: 6-8 years old (8.56%), 9-11 years old (20.14%), 12-14 years old (35.65%), 15-17 years old (35. 65%). The average age of children was 13.06±3.9 years. The significant influence of rheumatic diseases on parameters of life-quality of patients was established: physical and psychological state of children suffers, social adaptation is disturbed. According to the study results, the most problematic age group are children aged 15-17 years, who characterize their condition as mediocre (35.1%). Particular attention should be paid to the fact that there was no improvement in health state during a year among significant proportion of patients (65.3%). The obtained results testify limitation of physical state of health in 78.5% of cases, the most noticeable in age group of 15-17 years. The direct correlation between increase in pain syndrome and age of patient is established. In all age groups, there is decrease in emotional state, which increases with age. The indices of physical component of health in all age groups are significantly lower than the mental one. There are no significant gender differences in respondents assessment of life quality. The indices of life quality of children are generally characterized as low and do not reach 50 points on 100-point scale.The identified problematic age groups require increased attention from pediatric service of the Republic. The anxiety is caused by increase of negative symptoms in older age groups. The study results indicates both low efficiency of specialized rheumatological care of children and need for increased attention to dispensary work with this group of patients at early stages of disease.

[Isolated splenic metastasis from colorectal cancer]. / Izolirovannyi metastaz kolorektal'nogo raka v selezenku: klinicheskii sluchai.

Splenic metastases are a rare finding and usually associated with advanced cancer. At the same time, isolated splenic metastases are an exception. The authors report a 62-year-old woman with isolated splenic metastasis from colon carcinoma in 28 months after surgery. Splenectomy was successfully performed.

[Resolution on the results of the interdisciplinary expert council "Prevention and treatment of obesity. How to Achieve a Healthy Metabolic Balance].

On September 30, 2022, a meeting of the interdisciplinary expert council "Prevention and treatment of obesity. How to Achieve a Healthy Metabolic Balance. To reduce the social and economic burden of obesity and its consequences in the Russian Federation, it is necessary to introduce socially significant initiatives to prevent obesity and increase its detection rate, as well as to update modern approaches to the treatment of this chronic disease, taking into account its multifactorial pathogenesis, comorbidity, risk of complications and patient disability. Based on the results of the scientific reports and discussions held during the expert council, the experts made decisions on a further plan within the framework of socially significant initiatives for the prevention of obesity.

[Reality and prospects of sepsis epidemiology research]. / Real'nost' i perspektivy izucheniia épidemiologii sepsisa.

Current foreign and Russian literature for sepsis epidemiology is reviewed. There is advanced incidence of sepsis in developing countries among young people as a rule. Absent high-quality epidemiological studies lead to overdiagnosis of sepsis and increased morbidity. National and territorial screening and diagnostic programs for sepsis became possible with introduction of new recommendations 'Sepsis-3'. Thus, there is a possibility to systematize regular epidemiological studies devoted to sepsis.

[The definition of sepsis. 25-year experience of concept development]. / Chto takoe sepsis: 25-letnii opyt razvitiia kontseptsii.

The review, presented in chronological order the stages of formation of the modern definition of sepsis syndrome, since the recommendations of the conciliation conference ACCP/SCCM (1991), the experience of the practical use of which has been extensively critically assessed in future studies. As a result, it formed a strong opinion that the global challenge of early diagnosis of sepsis, under the previously proposed definitive categories have not been solved, moreover, in the scientific community formed a firm belief in the need to make fundamental changes in the definition of the term 'sepsis'. As a result, in 2016 the scientific community were presented the recommendations of the working group 'Sepsis-3', in which sepsis is defined as life-threatening organ dysfunction due to dysregulated response to infection, and fundamentally distinguish them from the former, is a laconic definitions and availability of diagnostic criteria. National expert community to analyze, discuss and define the field of clinical testing 'Sepsis-3' in the Russian Federation.

[Bronchopulmonary ACTH-producing tumors].

Neuroendocrine tumors have the ability to produce the hormones and vasoactive peptides. Excess of these hormones leads to different symptoms and syndromes because of organs' injuries. Detection of ACTH origin by using of modern diagnostic methods is not always possible. Lungs and bronchi are one of the most frequent localization of ACTH-producing tumors. It is considered that carcinoids with bronchopulmonary localization like a benign tumors in the clinical course. But at the same time carcinoid tends to metastasize, so timely diagnostics and treatment improve quality of life significant and increase the life expectancy of patients. The modern state of diagnostics and surgical treatment problem of ACTH-producing tumors with bronchopulmonary localization is presented in the article. It was described the brief historical background, clinical symptoms, instrumental and biochemical methods of diagnosis. The principles of surgical treatment are presented in the article.

[Renal artery stenosis in patients with type 2 diabetes mellitus: clinical signs, diagnosis, prognostic value].

AIM: To define the prevalence, clinical features, risk factors, and prognostic value of atherosclerotic renal artery stenosis (RAS) in patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: One hundred and fifty-seven T2DM patients (63 males and 94 females) aged over 50 years were examined. Screening for RAS was carried out by duplex ultrasound scanning (DUSS); the diagnosis was verified by multispiral computed tomography and magnetic resonance imaging. Moreover, the detection rate of RAS was analyzed from the selective angiographic readings of 30 patients with T2DM and 26 coronary angiography patients without DM who had undergone coronary angiography (CA). RESULTS: In the total group of T2DM patients, the RAS detection rate was 36.9%, as evidenced by DUSS and 43.3% by selective renal artery angiography in the patients who had undergone CA. The factors associated with the development of RAS were smoking (relative risk (RR) = 3.3; p < 0.001); atherosclerosis of coronary (RR = 4.28; p < 0.001) and peripheral (RR = 3.38; p < 0.02) arteries, isolated systolic hypertension (RR = 3.9; p < 0.01), and anemia (RR = 6.4; p < 0.001). In patients with T2DM, RAS was one of the important factors of progressive renal and cardiac diseases and increased mortality determined by the combined end point: death, emergency hospitalization for heart failure, myocardial infarction, double creatinine, and end-stage renal failure (RR = 6.28; p < 0.001). CONCLUSION: The optimization of prognosis in T2DM patients with RAS requires its timely clinical identification in combination with other types of renal lesion, aggressive correction of the mechanisms of the progressive process, and development of medical and endovascular therapies.

[The first experience with selective blood collection from the inferior petrosal sinuses in Russia (case reports)].

This paper reports two clinical cases of ACTH-dependent hypercorticism. Difficulties encountered in differential diagnosis of this condition were due to poor informative value of routine diagnostic methods. The use of selective blood collection from the inferior petrosal sinuses (for the first time in Russia) greatly facilitated the choice of the adequate treatment strategy. A detailed description of clinical features of ACTH-dependent hypercorticism in two young women is presented along with the results of laboratory and instrumental studies. Technical aspects of selective blood collection from the inferior petrosal sinuses in conjunction with the desmopressin stimulation protocol are considered. Indications for the use of this diagnostic method under real clinical conditions are proposed. Results of the study are discussed with reference to the treatment strategy chosen for the management of ACTH-dependent hypercorticism and the outcome of surgical intervention.

[Significance of the method of selective blood collection from the inferior petrosal sinuses for differential diagnosis of ACTH-dependent hypercorticism].

This review paper was designed to discuss the accumulated worldwide experience with selective collection of blood from the inferior petrose sinuses for the purpose of differential diagnostics of ACTH-dependent hypercorticism. The history of the development of the method is described, principal indications and contraindications to its clinical application are considered with reference to the informative value of this diagnostic tool. Possible causes of false positive and false negative results as well as complications ever reported as associated with the diagnostic procedure are discussed. Much attention is given to the comparative analysis of advantages and disadvantages of alternative techniques for blood collection and to the use of pharmaceutical agents that may increase efficiency of the method under consideration.