The «bronchiolitis» unites a heterogeneous group of diseases of inflammatory nature, the anatomical substrate of which are Airways without cartilage wall-bronchioles. Despite the etiological diversity of bronchiolitis, pathomorphological they manifest a certain set of changes in the lung tissue. This determines the similarity of visualization of different types of bronchiolitis during computed tomography of the chest. The key to successful diagnosis of bronchiolitis is a clear understanding of the definition of this pathology and a comprehensive analysis by a Clinician of anamnestic, clinical, laboratory and radiological data. In this article, we will consider three types of cellular bronchiolitis, which are combined by imaging on computed tomography of the chest pattern «tree in the kidneys»: infectious, aspiration bronchiolitis and diffuse panbronchiolitis.

The lectures present the current understanding of the renal continuum, reflecting the relationship between acute kidney injury (AKI), acute kidney disease (AKD) and chronic kidney disease (CKD). The issue of early diagnosis of AKI remains unresolved, despite numerous studies on biomarkers of acute kidney injury. The epidemiology, clinical and prognostic significance of AKD have not been sufficiently studied. Awareness of both doctors and patients about the «renal continuum» and the possibilities of timely diagnosis and prevention of renal complications is required.

The search for reliable algorithms for diagnosing heart failure with preserved left ventricular ejection fraction (LVEF) in elderly patients is an urgent problem due to the low specificity of clinical manifestations and the peculiarities of involutive processes occurring in the human body. As an alternative diagnostic approach, it is possible to determine in the blood laboratory biochemical markers — a promising method of diagnosis, prognosis and control of the effectiveness of treatment. The article examines the significance of myocardial stress markers (brain natriuretic peptide, N-terminal brain natriuretic peptide, median fragment of atrial natriuretic peptide); «mechanical» myocardial stress (soluble stimulating growth factor expressed by gene 2 — sST2), copeptin, galectin-3 in patients with heart failure and preserved LVEF, including older persons, as well as the possibility of their use in outpatient practice to predict the course of heart failure. The contribution of the multimarker model for a comprehensive assessment of prognosis is discussed, taking into account both the «hemodynamic» side of myocardial stress (pressure or volume overload, markers — natriuretic peptides), and «mechanical» (fibrosis / hypertrophy / heart remodeling, marker — sST2) myocardial changes.

The European society of cardiology guideline for the diagnosis and treatment of acute and chronic heart failure (CHF) in 2016 identified a new group of patients with mid-range left ventricular ejection fraction (LVEF) with reference interval in the range of 40-49 %. This review highlights the issues of epidemiology and etiology of CHF, outlines the echocardiographic portrait, biomarker profile and patients` dynamic phenotypes, considers the guidelines of their managements and the prognosis of the disease determiner’s factors. Special attention is paid to the peculiarities of the formation of this heterogeneous cohort of patients and the feasibility of expanding the existing CHF classification by introducing two transitional phenotypes.

Relevance. The presence of oncological diseases, high polymorbidity in elderly and senile patients can lead to a complicated course of acute coronary syndrome, including the development of acute kidney injury and/or chronic kidney disease, which contributes to a deterioration of the immediate and long-term prognosis and an increase in mortality.

The research purposes. To study the course of acute coronary syndrome depending on the presence or absence of oncological diseases in elderly and senile people and to identify clinical and laboratory-instrumental features.

Materials and methods. The study included 200 patients (men — n=122 (61 %), women — n=78 (39 %), Me age — 69 (65;77) years). The patients were divided into two groups: 1) the main group — acute coronary syndrome in combination with oncological diseases (n=100) (men — n=61 (61 %), women — n=39 (39 %), Me age — 69 (65;77) years); 2) the comparison group — acute coronary syndrome without oncological diseases (n=100). The groups were formed by the copy-pair method in a ratio of 1:1 by gender and age. All patients were evaluated for anamnesis parameters, the total number of diseases, the Charlson comorbidity index, the main clinical and laboratory-instrumental parameters and the development of complications. We collected an average portion of morning urine on the first day of hospitalization to determine the content of KIM-1 (pg/ml) in 40 patients of the main group and 47 from the comparison group. We collected daily urine on the 2nd day of hospital treatment to determine the level of K+, Na+, Cl-, uric acid and albumin.

The results. Patients of the main group, according to the anamnesis, were more often diagnosed with stable angina (p = 0.042), diabetic kidney disease (p = 0.017), chronic kidney disease (p = 0.013) and anemia (p = 0.008). In addition, these patients had a higher Charleson comorbidity index [8 (6; 9) and 5 (4; 6) points; p <0.001] and a total number of diseases [6 (5; 7) and 4 (3; 5); p <0.001]. Patients with oncological diseases with the development of acute coronary syndrome more often complained of shortness of breath (p=0.008) and heart rhythm disturbance (p=0.004). In patients of the main group a lower left ventricular ejection fraction was diagnosed [51.0 (44; 55) and 54 (48; 57), p=0.013]. Acute kidney injury was more frequently diagnosed in the study group than in the comparison group (p <0.001), including acute kidney injury by “basal” creatinine (p=0.005), acute kidney injury by creatinine dynamics (p=0.047), and acute kidney injury by chronic kidney disease (p=0.003). The KIM-1 leel in patients of the main group was higher [921.0 (425.1; 1314.8) and 658.0 (345.6; 921.4) pg/ml; p=0.011]. In patients with acute kidney injury, in contrast to patients without acute kidney injury, a higher level of KIM-1 was detected [999.2 (480.8;1314.1) and 663.1 (360.5;905.2) pg/ml; p=0.008]. Patients with acute coronary syndrome and oncological diseases in the hospital were more likely to develop urgent complications (p=0.005), including death (p=0.024) and acute heart failure (p <0.001). They also had a higher incidence of early post-infarction angina (p=0.018) and anemia (p=0.005).

Conclusions. Our study found that patients in the main group had a higher Charlson comorbidity index, a greater number of diseases, including stable angina, diabetic kidney disease, chronic kidney disease, and anemia. These patients with the development of acute coronary syndrome more often complained of shortness of breath and heart rhythm disturbance. Patients with oncological diseases were more often diagnosed with acute kidney damage, including “basal” creatinine, creatinine dynamics, and chronic kidney disease. The level of KIM-1 in the urine was higher in this group of patients. Patients of the main group in the hospital were more likely to develop urgent complications, including acute heart failure and death. There was also a high incidence of early post-infarction angina and anemia.

Introduction. Liver cirrhosis (LC) is the final stage in the progression of chronic diffuse diseases. As common, late stages of LC do not respond to conservative treatment methods, so liver transplantation is the most effective method at this stage. Widespread use of transplantation in clinical practice is due to serious obstacles: a shortage of donor organs, transplant rejection, complications during the operation and the postoperative period, as well as the high cost of such an intervention. We consider bone marrow stem cell transplantation as a potential treatment for liver cirrhosis and additional clinical trials for efficacy and safety.

The aim of the study was to assess the efficacy and safety of intraparenchymal transplantation of autologous MSCs from the bone marrow for the treatment of patients with cirrhosis of the liver caused by the hepatitis C virus (HCV-LC).

Materials and methods. A pilot open-label non-randomized prospective study with the inclusion of 6 patients with HCV-LP. Autologous MSCs were transplanted intraparenchymally into the liver tissue at the rate of 1x106/kg body weight — 1 ml at 5 points.

Results. By 6 months after transplantation, there has been a decrease in the level of bilirubin (from 36,4 μmol/L to 27 μmol/L, p=0.03), MELD scores (from 11,5 to 8, p=0.035), and an increase in platelet levels by 3 months (from 83x109 / l to 124,6x109/l, p=0,031) and 6 months (up to 119,5x109/l, p=0,031). By 6 months after transplantation, there has been no statistically significant result in changing on points on the Child-Pugh scale (p=0,181), cytolysis indicators (maintaining elevated levels of ALT (p=0,062) and AST (p=0,844)), replicative activity of the virus (рreservation of HCV RNA in the blood) (p=0,219 ). Moreover, introduction of MSCs by 6 months after transplantation did not lead to resolution of liver cirrhosis and inflammatory infiltration according to light microscopy data, as well as to resolution of sinusoidal capillarization (p=0,586) and PCI transdifferentiation into myofibroblasts (p>0,99) according to immunohistochemical studies. None of the procedures after the transplantation had an increase in body temperature, an increase in laboratory parameters, or changes in vital functions. One patient was admitted to hospital after 6 months. after MSC transplantation, deep vein thrombosis of the right leg was diagnosed.

Conclusion. The positive effect of MSCs on the improvement of liver function was noted. There was no effect on the replicative activity of the virus. The continuing activity of the inflammatory process was observed. The used MSC transplantation technique is a safe procedure for patients with HCV-LC severity classes A and B and can be applied in clinical practice.

Статья посвящена поражению мышечной системы при новой коронавирусной инфекции (COVID-19). Проведен анализ литературы российских и иностранных исследователей по внелегочным проявлениям COVID-19. Главной мишенью COVID-19 (Corona Virus Disease 2019) является эндотелий сосудов. Для проникновения в клетки вирус использует рецептор — ангиотензинпревращающий фермент 2 (АПФ2). Показано, что к одной мишени могут присоединиться до трех вирусов. В скелетной мускулатуре также имеется АПФ2. При COVID-19 вовлечение в патологический процесс мышечной системы является предиктором неблагоприятного прогноза. В 20 % случаев среди госпитализированных пациентов COVID-19 выявляются лабораторные признаки повреждения сердечной мышцы. К основным механизмам повреждения мышечной системы при COVID-19 относятся АПФ2-зависимый механизм, степень вирусной нагрузки, цитокиновый шторм, острая гипоксемия и лекарственная токсичность. Поражение мышечной системы при COVID-19 служит дополнительным фактором риска смерти. В представленной работе приводятся сведения о возможных патогенетических механизмах развития миопатии, а также мышечной слабости при COVID-19, протекающие с повышением содержания креатинкиназы крови.

Carpal tunnel syndrome is the most common peripheral compression neuropathy and can be caused by many diseases and conditions, including the formation of gouty tophi in various structures of the tunnel. This publication provides a review of literature and a case report on Carpal tunnel syndrome in a 58-year-old male patient with tophaceous gout. The case is characterized by the extremely rare combination of median nerve compression and tendons dysfunction due to the tophi deposits in the flexor tendons of the hand.