The article presents the current state and problems of clinical diagnostics of undifferentiated connective tissue dysplasia based on the determination of external phenotypic features, while postulating the primacy of clinical diagnostics of this condition. The terms applied to this problem are considered — phenotypic feature, stigma, minor developmental anomaly, congenital malformation. An original concept of the dysplastic process is introduced to describe the global in the population and private for a specific patient dynamic of the course of the state of altered metabolism of connective tissue, which is determined by the interaction of hereditary and behavioral factors, environmental conditions and the natural process of growth and aging of the organism. An original classification of external phenotypic features by categories of belonging to the organ system, determination method, influence on the clinical picture, potential dynamics of the feature, frequency of occurrence, relation to ontogenesis, dysplastic process and the affected element of connective tissue is given as the basis for pathogenetic analysis of their diagnostic significance. As an example of the application of this approach, minor developmental anomalies are analyzed, anamnestic (impaired hemostasis, traumatic episodes), subjective (variants of pain syndrome), bone (dolichostenomelia, osteochondral dysplasia, limitation of elbow joint extension) and skin external phenotypic signs, for each of which the methods of determination are specified and possible limitations in real clinical practice are indicated. For skin signs, a grouping is carried out in relation to the main properties of the skin determined by a specific structural element of connective tissue. For the sign of increased extensibility, an alternative method of determination by a stretching maneuver on a plane between two standard strokes is proposed.

A review of modern Russian and foreign literature on the problem of impaired coronary blood flow reserve as a manifestation of microvascular dysfunction has been conducted. When searching for information on this issue, materials from the following databases were used: RSCI, Best Evidence, Scopus, Elsevier, PubMed, Clinical Evidence, Cochrane Library. Violation of the coronary blood flow reserve is an important manifestation of microvascular dysfunction and a key diagnostic criterion for microvascular angina. The evaluation of this indicator has high prognostic and therapeutic significance. Given the heterogeneity of pathogenesis, further research is needed for a personalized approach to the treatment of patients with microvascular angina.

Hyperuricemia is a significant and independent risk factor for cardiovascular diseases. In recent years, scientists have been paying attention to the gut microbiota and its impact on various processes in the human body. Currently, there is evidence of the important role of the microbiota in the pathogenesis of hyperuricemia. An increase in the number of pathogenic microflora contributes to chronic inflammation and an increase in uric acid levels through the mechanisms of purine metabolism. The purpose of this review is to analyze and systematize current data on the impact of the intestinal microbiota on the pathogenesis of hyperuricemia and cardiovascular risk. The article discusses promising methods for correcting hyperuricemia, such as lifestyle modification, fecal microbiota transplantation, probiotics, and postbiotics. The review highlights the need for further research on the microbiota as a key factor in the pathogenesis of hyperuricemia and the development of new and innovative therapeutic strategies.

The article is devoted to the analysis of the therapeutic potential of mesenchymal stem cells obtained from adipose tissue in the treatment of diabetes mellitus types 1 and 2 and their complications. Brief information on the prevalence of the disease is provided, the main existing approaches to the treatment of diabetes mellitus aimed at maintaining normal glucose and glycated hemoglobin levels are considered, the use of mesenchymal stem cells obtained from adipose tissue is based. The main disadvantage of insulin therapy is the impossibility of imitation the physiological regulation of the glycemic profile and completely eliminating vascular complications in patients. This fact became the reason for searching for more advanced techniques using the regenerative potential of mesenchymal stem cells obtained from adipose tissue. The morphological and immunohistochemical features of these cells are described; a wide range of growth factors and signaling molecules determining their immunomodulatory, antioxidant and antiapoptotic properties is characterized. The paracrine effect of mesenchymal stem cells obtained from adipose tissue can be used in transplantation of pancreatic islets to increase their survival. The ability to preserve the residual mass of the patient’s β-cells, as well as to supply their number by differentiating into insulin-producing cells determines the use of these cells in the treatment of type 1 diabetes mellitus. At the same time, a positive effect on the mechanisms of insulin resistance, stimulation of glycogenesis and regulation of the glycemic profile characterizes the demand for them in the treatment of type 2 diabetes mellitus. Pluripotency and plasticity of mesenchymal stem cells obtained from adipose tissue allow their use in the treatment of diabetic complications: trophic ulcers, diabetic retinopathy and nephropathy. The state of clinical trials aimed at obtaining evidence-based data on the efficacy and safety of mesenchymal stem cells obtained from adipose tissue in the treatment of types 1 and 2 diabetes mellitus is discussed.

Introduction. In patients with thermal injury, changes in microcirculation and liver dysfunction lead to impaired detoxification of ammonia, resulting in its accumulation in the body. This develops hyperammonemia, which exacerbates the phenomena of encephalopathy. To date, questions remain regarding the application of hypoammonemic therapy in burn patients and its impact on disease outcomes.

Aim: To assess the severity of hepatic encephalopathy, the level of ammonia in capillary blood, and its reduction against the backdrop of therapy in patients with thermal injury.

Materials and methods. The study selectively included a group of 29 patients with severe burn injury (IF more than 145 units) who were treated in the intensive care unit, and a group with mild burn injury (IF no more than 90 units) of 15 patients who were in the hospital ward. The severity of hepatic encephalopathy was determined using the West Haven scale. The level of ammonia in the serum was investigated by microdiffusion method using the portable express analyzer PocketChemTM BA PA-4140. For the correction of hyperammonemia, ornithine was intravenously administered via an infusion pump at a dose of 80 g/day for 10 days. All statistical calculations were performed using the software SPSS v27 (Statistical Package for the Social Sciences).

Results. According to the Frank index, patients with burn injury were divided into 3 subgroups (1-3), the lesion depth ranged from 31 units to 91 units or more. High levels of ammonia in the blood were recorded in all three subgroups, and with a Franck index of 91 units. and higher than 285 mmol/l in more than half of the patients. There was a direct relationship between the Franck index and the level of ammonia in patients with burn injury (p=0.01). The higher the Franc Index, the higher the level of ammonia in the blood plasma. This trend can be traced both before the start of treatment (rs1=0.971, rs2=0.996) and after the start of treatment (rs1=0.898, rs2=0.948) in both groups of patients. On the 2-3 day of combined treatment with the inclusion of ornithine, a decrease in ammonia in the blood by 20-30 % of the baseline level was noted in all study groups (p <0.001). The level of ammonia after treatment decreased significantly in all 44 patients (p <0.001).

Conclusions. Hepatic dysfunction is one of the manifestations of the systemic response to thermal injury. Therefore, disruption of ammonia utilization processes can have an adverse effect on the overall clinical picture. The presence of liver dysfunction, high levels of ammonia and, as a result, the development of hepatic encephalopathy aggravate the course of burn disease, which significantly complicates the provision of care to this category of patients.

Background: To identify independent clinical and laboratory predictors of 28-day mortality in patients with liver cirrhosis.

Materials and Methods: A prospective cohort study included 137 patients with liver cirrhosis (decompensated cirrhosis without ACLF, n=72; with ACLF, n=65). Univariate and multivariate Cox regression analysis was used to identify independent predictors of 28-day mortality. Three models were built and compared: a comprehensive model (all significant variables), a basic clinical model (CLIF-C OFs, SpO₂/FiO₂, pneumonia, ACLF stages), and an extended laboratory model (basic model + lactate, ammonia, C-reactive protein).

Results: In the univariate analysis, significant predictors of mortality were the severity according to the CLIF-C OFs score, ACLF grades 2 and 3, the presence of pneumonia and urinary tract infection (UTI), elevated levels of lactate, ammonia, C-reactive protein (CRP) and transaminases, as well as decreased SpO₂/FiO₂. In all multivariate models, the following remained independent predictors of an unfavorable outcome: CLIF-C OFs score, ACLF grades 2 and 3, presence of pneumonia, UTI, elevated levels of lactate, ammonia, CRP, and decreased SpO₂/FiO₂.

Conclusion: The short-term prognosis in liver cirrhosis is determined by the severity of organ failure, infectious complications, and markers of metabolic stress and inflammation. A comprehensive approach using the CLIF-C OFs score and monitoring lactate, ammonia, and CRP is necessary for risk stratification, which will allow for optimized patient management.

Pure adenocarcinoma is a somatic-type malignancy that comes from a germ cell tumor and is extremely rare but has been reported. It is usually seen as sarcoma, and less often as carcinoma. This rare phenomenon is generally attributed to the development of a teratomatous component. In most cases, the diagnosis remains straightforward due to the mixing of different germ cell tumor parts and the existence of germ cell neoplasia in situ (GCNIS). But, there are some rare instances where metastatic carcinoma to the testis could be something more. This case presentation discusses a 35-year-old man who had a testicular tumor of adenocarcinoma with enteric features, which looked like metastatic colorectal carcinoma. GCNIS was found in the background testicular tissue, and fluorescence in situ hybridization for chromosome 12p abnormalities showed the presence of i(12p) in the testicular adenocarcinoma, which supports a shared germ cell origin. After the retroperitoneal lymph node dissection, it was found that there were metastatic deposits made up of mucinous adenocarcinoma. Extensive clinical workup helped exclude metastasis from another primary, particularly the GI tract. Our report indicates that adenocarcinoma of intestinal type in an orchiectomy specimen, although usually strongly suggestive of metastasis from a gastrointestinal tract primary, maybe a primary testicular neoplasm of germ cell tumor origin. The patient was treated with radial orchidectomy with retroperitoneal metastasectomy followed by somatic-type malignant histology-directed chemotherapy for colorectal adenocarcinoma. The patient remained in complete remission for a 3.5-years follow-up period.

We presented a clinical case of diagnosing eosinophilic esophagitis in a patient suffering from severe asthma for a long time and receiving therapy with genetically engineered biological drugs: Dupilumab. Difficulties in diagnosis are associated, on the one hand, with the need for histological verification of the diagnosis, and on the other hand, with the heterogeneity of the manifestations of the disease. The frequent coexistence of EoE and other allergic diseases emphasizes the unity of pathogenetic pathways united by mucosal immune reactions. Our clinical case demonstrates the possibility of diagnosing EoE in the absence of characteristic complaints and endoscopic picture in a patient with polyvalent allergies and a long history of severe asthma. Timely use of effective therapy helps prevent remodeling of the esophageal wall with the development of strictures, which can significantly worsen the patient’s quality of life.

Abramov-Fiedler myocarditis (idiopathic giant cell myocarditis) represents one of the most malignant forms of non-rheumatic inflammatory heart disease. It is typically diagnosed in young and middle-aged patients and is characterized by rapidly progressive heart failure, life-threatening arrhythmias, and thromboembolic complications. The present clinical observation is of particular interest due to the development of Abramov-Fiedler myocarditis in an elderly patient, which is uncommon for this condition. An 80-year-old male was admitted with a clinical picture of ST-segment elevation acute coronary syndrome. On admission, he presented with severe retrosternal chest pain, hypotension, dyspnea, and signs of acute left ventricular failure. Laboratory tests revealed markedly elevated troponin and cytolytic enzymes. Electrocardiography demonstrated ST-segment elevation in the inferolateral wall of the left ventricle, while coronary angiography showed only a 30 % stenosis of the right coronary artery with preserved coronary flow. Despite intensive therapy, the patient developed cardiogenic shock and died on the second day of illness. Post-mortem examination revealed extensive myocardial inflammatory lesions with dystrophic and necrotic changes of cardiomyocytes, massive mixed-cell infiltration, and the presence of multinucleated giant cells. Immunohistochemical staining using CD68 antibodies confirmed the macrophage origin of the infiltrating elements, consistent with the diagnosis of giant cell myocarditis. This clinical case highlights the diagnostic challenges of atypical Abramov–Fiedler myocarditis in elderly patients, where the presentation may closely mimic acute coronary syndrome. The findings emphasize the importance of maintaining clinical vigilance for inflammatory myocardial diseases in older individuals and underscore the decisive role of morphological and immunohistochemical confirmation in establishing the diagnosis.