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BACKGROUND: Diabetic neuroosteoarthropathy is a severe and insufficiently studied complication of diabetes mellitus, which is characterized by progressive destruction of bones and joints against the background of neuropathy and leads to the formation of foot deformities of varying severity. The search for predictors of this pathology is extremely relevant, because will optimize therapy and reduce the risk of limb amputation.AIM: To compare the levels of advanced glycation end products and their receptors in the blood and bone tissue in patients with type 2 diabetes mellitus and diabetic neuroosteoarthropathy and in individuals without this complication in order to determine the possibility of using these parameters as early predictors of severe foot deformities in this category of patients.MATERIALS AND METHODS: During hospitalization for planned surgical treatment, venous blood and bone tissue samples were taken from patients with chronic (inactive) stage of DNOAP and patients with neuropathic foot ulcers.RESULTS: The study included 88 patients with type 2 diabetes mellitus and neuropathic form of diabetic foot syndrome, who were divided into 2 groups. Group 1 consisted of patients with chronic diabetic neuroosteoarthropathy, group 2 — patients with severe diabetic neuropathy without osteoarticular disorders. The study did not show statistically significant differences in the level of AGE in the blood serum of patients with DNOAP and without this complication, however, a significant increase in AGE receptors (RAGE) in bone tissue was recorded in the group of patients with DNOAP compared with the control. Patients with increased RAGE expression in bone had higher blood levels of AGE compared to the group without this complication, but this difference was not significant.CONCLUSION: For the first time, a study of AGEs and receptors for them in the blood serum and bone tissue in individuals with DNOAP and without this complication was carried out. The obtained results suggest that the determining factor in the rate of formation and the likelihood of recurrence of DNOAP in type 2 diabetes mellitus is not the content of AGEs in the blood, but the expression of their receptors in bone tissue.

Aim: to present a clinical and morphological observation of an extremely rare combination of medullary carcinoma of the jejunum and intestinal lymphangiectasia in a 33-year-old patient with clinical features of malabsorption syndrome over the 10 years.Key points. An autopsy revealed a tumor formation spreading from the wall of the jejunum to the mesentery, with metastases to the mesenteric lymph nodes. The medullary carcinoma with positive expression of СD117, DOG1, EMA, PanCK, PDL-1, vimentin, mosaic non-intense expression of CA19-9, calretinin, CD10, CDX2, CEA, MUC-5AC, SATB2, and negative reaction to ALK, CD3, CD8, CD20, CD30, CD31, CD34, CD45, CD56, chromogranin, CK7, CK20, desmin. The proliferative index was high: Ki-67 > 80 %. Moreover, during the histological examination of the intestinal wall, intestinal lymphangiectasia complicated by the malabsorption syndrome was revealed.Conclusion. The uniqueness of this clinical and morphological case is in the combination of medullary carcinoma of the jejunum metastasized to the mesenteric lymph nodes with the underlying intestinal lymphangiectasia accompanied by the development of malabsorption syndrome.

BACKGROUND. Growth factors play a leading role in wound healing. Their deficiency in diabetic foot syndrome has been demonstrated in experimental studies, most of them performed on acute wounds. At the same time, currently the effectiveness of local therapy with growth factors of this category of patients, as well as indications and contraindications to it are contradictory and are a subject for discussion. There is no data on the content of growth factors in diabetic foot ulcers of various durations. Meanwhile, the results obtained will help to expand the understanding of the pathogenetic mechanisms of the course and outcomes of diabetic foot ulcers at different stages of healing.AIM: To evaluate the level of growth factors and their receptors in non-healing neuropathic diabetic foot ulcers of different duration.MATERIALS AND METHODS. 89 samples of neuropathic diabetic foot ulcers were examined. Immunohistochemical analysis of biopsies was performed using antibodies to the following growth factors and their receptors: vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), epidermal growth factor (EGF). Depending on the duration of the wound, the biopsies were divided into 3 groups: group 1 — ≤ 90 days, group 2 — 91-365 days, group 3 — > 365 days.RESULTS. In the samples of wounds, the duration of which did not exceed 90 days, the expression of growth factors and receptors to them was significantly higher than in wounds of longer duration (p=0.0001). There was no significant difference in quantitative indicators of the expression of growth factors and their receptors between wounds lasting from 91 to 365 days and more than 365 days. According to the data of correlation analysis, the expression of VEGF, IGF, EGF and their receptors has a significant negative dependence on the duration of the wound (p= 0.0001).CONCLUSION. In diabetic foot ulcers lasting less than 90 days, the expression of growth factors such as VEGF, IGF, EGF and their receptors is significantly higher than in wounds of longer duration. The dependence of the expression of growth factors on the duration of the ulcer was revealed. The data obtained may explain the differences in the outcomes of chronic wounds and the absence in some cases of the effect of local therapy with growth factors.

The state of the heart after a coronavirus disease 2019 (COVID-19, coronavirus disease 2019) is very diverse and in some cases requires a complex differential diagnosis. We described a 35-year-old smoking male patient who, by the end of the first month after COVID-19, developed left ventricular dysfunction with decrease in ejection fraction to 25-30% and persistent left bundle branch block (LBBB). Echocardiography also detected local contractility disorders. A significant increase in blood anticardiac antibody titers was noted. Myocardial biopsy revealed active lymphocytic myocarditis, coronavirus ribonucleic acid, while coronary angiography revealed extensive stenosis of the anterior interventricular artery. On the first day after balloon angioplasty and stenting, the disappearance of LBBB block was noted with the appearance of deep negative T waves in the precordial leads, which did not allow ruling out a previous myocardial infarction. As a result of treatment of heart failure and steroid therapy, the structural and functional cardiac parameters and the electrocardiography were completely normalized by the end of the second year of treatment. Only a transient LBBB remained at high loads. Cardiac computed tomography after 2 years showed no delayed contrast agent accumulation in the myocardium, and coronary stenosis up to 30%.The mechanisms of complex myocardial and coronary damage (including the role of coronaritis in the atherosclerosis progression) after COVID-19 are discussed.

Aim. To assess the incidence of myocarditis in patients with primary myocardial hypertrophy and to study its contribution to the disease course.Material and methods. The study included 100 patients with primary left ventricular myocardial hypertrophy, 52 men and 48 women (mean age, 51,5±15,7 years; followup period 10,4 [2,1; 36,1] months). All patients underwent electrocardiography, 24-hour electrocardiographic monitoring, echocardiography, as well as DNA analysis (n=96), myocardium pathological study (n=29), cardiac magnetic resonance imaging (n=31), cardiac multislice computed tomography (n=26), assessment of anti-cardiac antibodies (n=43), free light chain level in serum and urine by immunofixation method (n=10); 99mTc-pyrophosphate myocardial scintigraphy (n=5); biopsy of the rectal mucosa and/or subcutaneous fat for amyloid (n=9).Results. In 68%, true (sarcomeric) hypertrophic cardiomyopathy (HCM) was diagnosed, in 16% — amyloidosis with cardiac involvement, in 10% — storage diseases, in 3% — neuromuscular diseases, in 2% — myocardial hypertrophy was combined with severe restriction (mixed phenotype), and in 1% — LEOPARD syndrome. Concomitant myocarditis was diagnosed in 30% of patients. In HCM, myocarditis was detected in 31% of cases. These patients had a significantly higher heart failure class (heart failure class 3 [2; 3] vs 2 [1; 3], p=0,026) and mortality (33,3% vs 6,4%, p=0,01). In amyloidosis, the incidence of myocarditis was 31,3%. In these patients, ventricular tachycardia was observed significantly more often: 80,0% vs 18,2% (p=0,036). The prevalence of concomitant myocarditis in the subgroup of storage diseases was 30%: 2 patients with Fabry disease and 1 patient with Danon disease. Of the three patients with neuromuscular diseases, myocarditis was diagnosed in 1. In the subgroups with the restrictive phenotype and LEOPARD syndrome, no cases of myocarditis were recorded. Treatment of myocarditis made it possible to stabilize the patients' condition.Conclusion. Concomitant myocarditis led to heart failure progression, worsening ventricular arrhythmias and, as a consequence, an increased risk of sudden cardiac death. It is necessary to actively diagnose and treat myocarditis in patients with primary myocardial hypertrophy.

Introduction. Today, due to the insufficient diagnostic accuracy of existing tools for determining clinically significant forms of prostate cancer, the search for new indicators that predict the course of the disease and the effectiveness of radical treatment is relevant. Various malignant tumors could increase glucose consumption and grow under hypoxic conditions. It seems promising to assess the expression level of glucose transporter type 1 (GLUT1) and carbonic anhydrase IX (CAIX) in prostate adenocarcinoma cells of different malignancy score.Objective. To determine CAIX and GLUT1 expression in ISUP grades 1-5 prostate adenocarcinoma cells for evaluation of the disease prognosis and radical prostatectomy effectiveness.Materials and methods. Immunohistochemical study of postoperative material after radical prostatectomy with determination of GLUT1 and CAIX expression by tumor cells was carried out. The presence or absence of biochemical recurrence within one year after surgery was determined. The correlation between the level of expression, the presence of biochemical relapse and a few other clinical parameters was determined.Results. GLUT1 expression level statistically significant correlated with ISUP 4 and 5 (r = 0.457, p < 0.0001), prostate-specific antigen (PSA) level (r = 0.378, p < 0.0001), pT3b disease stage (r = 0.380, p < 0.0001), extracapsular extension (r = 0.355, p = 0.001), and inversely correlated with ISUP 1 (r = -0.274, p = 0.009). CAIX immunoexpression was observed in 10.0% of samples and the intensity was low (< 20% of cells).Conclusion. Elevated expression of glucose transporter type 1 (GLUT1) by prostate adenocarcinoma cells among patients after radical prostatectomy is associated with high grade of malignancy (ISUP 4 and 5), pT3b disease stage, extracapsular extension of the tumor, as well as high PSA, which allows using it for the prognosis evaluation.

The purpose of the review: to summarize the main data of the literature and our own accumulated practical experience of everyday diagnosis of inflammatory bowel diseases (IBD) to better represent the morphological features and histological conclusions.Key points. The microscopic picture of IBD is often represented by a combination of basic histological characteristics that can be detected in other diseases and only in rare cases can be considered pathognomonic. No single histological feature can be used in isolation to diagnose ulcerative colitis or Crohn’s disease. Diagnostic accuracy is improved if several signs are taken into account at once, if changes within one or more parts of the intestine are analyzed, it is necessary to compare the identified changes with the clinical picture of the disease.Conclusion. The presented stages of the morphological study of biopsy specimens in patients with IBD and the exact characteristics of the detected changes will help to increase the diagnostic value of the study of ileo- and colonobiopsies, as well as improve mutual understanding between gastroenterologists and pathologists and, as a result of interaction between specialists, will increase the accuracy of the diagnosis.

School and university, as two stages of continuous education, have a significant impact on forming a young person’s personality. When studying at school, young people cannot always appreciate the usefulness of their knowledge, skills, qualities, and applicability in further studies and life. The article presents the results of the sociological survey on the influence of school and higher education institutions on the development of students’ personal qualities and skills.The empirical base was the results of a study conducted among 1–3-year students of four Moscow universities: Moscow Aviation Institute (NRU), Moscow State Pedagogical University, Moscow Automobile and Road Construction Institute, and the State Academic University for the Humanities. Questionnaires and mini-interviews were used as research methods. The purpose of the study was to identify the specifics of the influence of school and university on the formation of students’ personal qualities and skills in the Moscow region.The survey showed that school had the most significant influence on forming the ability to communicate, perform routine work, and subject to the rules, and such qualities as discipline, stress resistance, adaptability, tolerance. While at university, students learn to take the initiative, set goals and realize them, defend their opinion and solve non-standard tasks, be independent and flexible.The survey participants would like the school to be more focused on developing students’ creative abilities and their own opinions; they lack practice and interaction in the classroom and an individual approach. Nevertheless, many qualities and skills developed at school helped them study at university.

Background: Diabetic neuroosteoarthropathy is a serious disabling complication of diabetes mellitus, which, in the absence of timely correct treatment, can lead to high amputations of the affected limb. At present, the reasons and mechanism of the development of Charcot’s foot are not completely clear. It is extremely important to determine the pathophysiological mechanisms of DNOAP formation and to search for reliable markers-predictors of this pathology.Aim: To study the immunohistochemical characteristics of the bone tissue of the lower extremities in patients with diabetic neuroosteoarthropathy in comparison with patients with diabetes mellitus without this pathology.Materials and methods: During the foot surgery, a bone fragment of the foot was harvested for immunohistochemical study of receptor markers for PINP, PIIINP, and RAGE in the group of patients with DNOAP compared with the control group.Results: The study included 20 patients with type 2 diabetes mellitus and were divided into 2 groups: 10 patients with DNOAP made up group 1, 10 patients without DNOAP — group 2.Patients in both groups were comparable in AGE, experience with type 2 diabetes, and glycemic control.During the immunohistochemical study, a significant increase in the staining intensity of receptor markers for PINP, PIIINP, and AGE was recorded in the group of patients with DNOAP compared with the control group (p

The possibility of heart inflammation (both myocardial and endocardial) months after a coronavirus disease 2019 (COVID-19) has not been practically studied, especially since approaches to the treatment of myocarditis in combination with various endocarditis forms have not been developed.Aim. To study the prevalence and mechanisms of SARS-CoV-2-associated endocardial injury in patients with morphologically verified post-COVID-19 myocarditis, as well as to develop approaches to comprehensive therapy.Material and methods. The study included 18 patients with severe morphologically verified post-COVID-19 myocarditis (men, 9; 51,1±9,4 years; 35 to 66 years). Patients with prior verified myocarditis/myocardial infarction, rheumatic heart disease, and systemic immune diseases were excluded. The average time after COVID-19 was 6,5 [3.5; 10] months The diagnosis of myocarditis was confirmed by endomyocardial biopsy (including immunohistochemical examination with antibodies to CD3, CD20, CD45, CD68, and to SARS-CoV-2 antigens; polymerase chain reaction for SARS-CoV-2 RNA, DNA of cardiotropic viruses). The blood level of anticardiac antibodies was determined by indirect immunofluorescence. In addition, echocardiography, magnetic resonance imaging (n=8), cardiac multislice tomography (n=1), and coronary angiography (n=14) were performed.Results. Biopsy revealed active (n=12) and borderline (n=3) lymphocytic myocarditis, eosinophilic (n=2) and giant cell (n=1) myocarditis. In 4 patients, nonbacterial thrombotic endocarditis (NBTE) with parietal and intravascular thrombosis was diagnosed, and in one patient — infective endocarditis (IE) of the bicuspid aortic valve. Myocardial persistence of SARS-CoV-2 was detected in 72% of cases (in 3 patients — with NBTE; in 1 — with IE; in 9 — without endocarditis). Titers of anticardiac antibodies increased by 3-4 times in 94% of patients. Patients with endocarditis were characterized by larger heart chambers, lower ejection fraction (27,5±6,6 vs 36,0±13,4%), more severe pulmonary hypertension, and valvular regurgitation. Intraventricular thrombosis according to echocardiography/magnetic resonance imaging and cardiac embolism was not observed. Treatment in all patients included methylprednisolone at an average dose of 24 mg a day. In 10 patients, the result was monitored for at least 3 months as follows: the ejection fraction was 46,0±12,7% and 44,3±7,3% in patients with and without endocarditis, respectively.Conclusion. Endocarditis in patients with post-COVID-19 myocarditis was detected in 28% (1 patient — IE; 4 — NBTE). The key mechanisms of post-COVID-19 myocarditis and NBTE are long-term (up to 18 months) myocardial persistence of SARS-Cov-2 and the development of an autoimmune reaction. Endocarditis was diagnosed in more severe patients, including those with giant cell and eosinophilic myocarditis. The effectiveness of steroid therapy in combination with anticoagulants in patients with NBTE requires further study. In case of IE, steroids can also be used in the treatment of myocarditis (in combination with antibiotics and immunoglobulin).

Abstract Background Contraception knowledge and attitudes are largely formed from conversations within one’s social network. More recently, this network has expanded to include social media. As the fastest growing social media platform, we aimed to assess popular contraception videos on TikTok for content understandability, actionability and accuracy. Methods This is a secondary analysis of the most viewed, contraception-specific TikTok videos that were previously coded as containing educational messaging in a content-analysis study. We assessed videos for understandability (ability to explain a key message) and actionability (identify what they can do to act on that message) using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) instrument and for Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) using a modified instrument within the health information education literature. Results The 174 videos with educational content scored as understandable but not actionable in PEMAT-A/V assessment, with videos created by healthcare providers (HCPs) performing better than those by non-HCPs in six of eleven domains of understandability. Videos overall scored well in relevance and purpose within the CRAAP assessment. Videos created by HCP’s (n = 99) scored higher than those by non-HCPs (n = 75) in relevance (score = 3.9 versus 3.3), authority (score = 4.8 versus 1.7), accuracy (score = 6.0 versus 3.5), and purpose (score = 7.1 versus 5.7) [all p

Aim. To assess the compliance of the management of patients with heart failure (HF) with quality criteria (QC) for health care, including discharge instructions for patients.Material and methods. Hospitalizations of patients aged over 18 years with HF (ICD 10 code — I50.x) during the period from January 1, 2019 to October 1, 2020 were randomly selected from the "Chronic Heart Failure" registry of St. Petersburg. Discharge and post-mortem summaries were assessed for compliance with the quality criteria listed in the 2020 Russian Chronic Heart Failure guidelines.Results. The study included 553 patients (women, 71,1%, mean age, 82,0±9 years, comorbidities: hypertension — 99,1%, coronary artery disease — 97,6%, chronic kidney disease — 53,2%, diabetes — 32,6%). Electrocardiography (QC № 1) was performed in 94,2% of patients, chest radiography (QC № 2) 91,7%, echocardiography (QC № 3) — 81,0%, but the results were not always informative. The exact ejection fraction (EF) value was reported in 55,4% of patients. Laboratory examination corresponded to QC № 4-6 in 20,3% of cases and was performed in 53,3-94,9%. Natriuretic peptides (NPs) were not determined (QC № 7-0%).The completeness of intravenous therapy (QC № 8) was not assessed due to insufficient physical examination data.Oral therapy (QC № 9) was prescribed frequently as follows: renin-angiotensinaldosterone system inhibitors (RAASo) — 93,3%, beta blockers (BBs) — 85,4%, mineralocorticoid receptor antagonists (MRAs) — 78,7%. However, triple RAAS+BB+MRA therapy was carried out in 54,1% of HF cases with EF