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Simultaneous pancreas and kidney transplantation the best way to restore normoglycemia and renal function in patients with type 1 diabetes mellitus and terminal chronic kidney disease. Pregnant patients after simultaneous pancreas and kidney transplantation are a high-risk group for adverse events/loss of both fetal and grafts. These risks are significantly reduced with pregnancy planning, regular monitoring of the woman and fetus with timely correction of immunosuppressive therapy, maintenance of target blood pressure and glycemia, selection of optimal timing and method of delivery. The presented clinical case demonstrates the need for an comprehensive multidisciplinary approach to the management of pregnancy and delivery with minimization of potential risks for mother and child.

The purpose of this article is to consider the specific features of the artistic embodiment of the components of the author’s childhood world model in the story From the Little House by the writer of the first wave of the Russian émigré, M. A. Osorgin. The author-narrator appears as the central world-modeling category of the work. He remembers, reflects, describes himself as a child. The theme of memory stated in the story is the leading one for the autobiographical prose of the Russian émigré writers. Everything in the work is controlled by the author’s creative power, his inner experiences and sensations. Alongside with that, by describing himself in his childhood, the author gives an infant, a child an opportunity to become the subject of world modeling and at the same time a participant of the depicted events. As a result, the reader sees the child’s world as he himself created and modeled it. The “voice” of the adult narrator is nevertheless significant in the story. The artistic model of the world, recreated in the work, is based on a number of images-memories, saturated with philosophical, historical, and ethical issues. The story presents a picture of the world that has special world-modeling universals, expressed by means of oppositions, the antithesis of the eternal and the mundane, models of world duality, the opposition of Space and Chaos, the image of changing space, recurrent themes, motifs and images that undergo a symbolic generalization. The earthly world correlates with the idea of the fragility of human existence. The image of home is interpreted as a space of protection, peace, desired solitude, and unaffectedness. Infancy is associated with the category of eternity. The world-modeling category of time in Osorgin’s story acquires the characteristics of fleetingness, cosmic f l ow, return from the present to the past, duration, and expansion. The theme of music plays a big role. Childhood is interpreted as a time of ultimate harmonious existence. Scenes of nature are closely related to the themes of origins, beauty and spiritual purity. The story combines real and fantastic plans. The author’s reflections are addressed to the fate of Russia and issues of spiritual national existence.

AIM: To evaluate the impact a fixed-ratio combination of insulin glargine(100U/ml) and lixisenatide(iGlarLixi) on the glycemic control in Russian study T2D population uncontrolled on OAD ± insulin therapy in real-world settings.MATERIALS AND METHODS: The Russian subanalysis of international, multicentre, prospective, observational SUCCESS study included 160 T2DM patients who had initiated iGlarLixi within 1 month prior to study inclusion from 11 regions of the Russian Federation. The primary endpoint — HbA1c change from baseline to month 6. Secondary endpoints: HbA1c change after 12 months, achievement of target HbA1c levels after 6 and 12 months; change in FPG and PPG, change in body weight after 6 and 12 months, iGlarLixi dose dynamics. Safety endpoints: adverse events, serious adverse events, adverse events of special interest, frequency of hypoglycemia during the study period.RESULTS: The average age of patients in the Russian population was 60.8±9.4 years; average duration of T2DM was 11.4 years, mean HbA1c — 9.3±1.5%; mean BMI 33.3 kg/m2. Prior to the study, most patients were on 2 (36.3%) and 3 OADs (27.5%), 32.5% — on insulin therapy. The mean change of HbA1c at month 6 was -1.81%, and -2.03% at month 12. 51.3% patients achieved individual HbA1c targets at month 12, 46.7% of patients achieved the HbA1c target without hypoglycemia and weight gain. The decrease of body weight in 12 months was -3.3±4.4 kg. During the study period, 17 cases of hypoglycemia were recorded (0.11 events per patient-year); 1 severe hypoglycemia (0.01 events per patient-year). The total number of adverse events (AEs) was 43(26.9%), serious AEs - 10 (6.3%).CONCLUSION: According to the results of this prospective real world sub-group analysis, initiation of iGlarLixi in Russian adults with T2DM uncontrolled on OADs ± insulin significantly improves glycemic control with low risk of hypoglycemia and no body weight increase.

BACKGROUND. Skeletal muscles play a key role in the organism’s carbohydrate metabolism. Dysregulation of insulin-dependent glucose uptake in skeletal muscle disrupts carbohydrate metabolism in the organism and can lead to the development of obesity and type 2 diabetes.AIM. To identify expression markers (genes) of human skeletal muscle associated with disorders of glucose metabolism in the basal state and after a mixed meal normalized for body mass.MATERIALS AND METHODS. The study involved three groups of 8 people: healthy volunteers, obese patients without and with type 2 diabetes. Venous blood samples were taken in the morning (09:00) after an overnight fast and 30 min, 60 min, 90 min, 120 min, and 180 min after ingestion of a mixed meal normalized by body mass (6 kcal/kg). Biopsy samples from m. vastus lateralis was taken before and 1 h after a meal to assess gene expression (RNA sequencing) and search for genes correlating with markers of impaired glucose metabolism in the basal and postprandial state.RESULTS. Strong correlations (|ρ|>0.7 and p1.5-fold) in expression between healthy people and patients, or differences in expression changes in response to a meal. We can note genes whose role in impaired glucose metabolism has already been shown earlier (FSTL1, SMOC1, GPCPD1), as well as a number of other genes that are promising for further study of the mechanisms of insulin resistance in skeletal muscle.CONCLUSION. Skeletal muscle expression markers were identified as promising candidates for future targeted studies aimed at studying the mechanisms of insulin resistance and searching for potential therapeutic targets.

Boreal fire regimes are intensifying because of climate change, and the northern parts of boreal forests are underlain by permafrost. Boreal fires combust vegetation and organic soils, which insulate permafrost, and as such deepen the seasonally thawed active layer and can lead to further carbon emissions to the atmosphere. Current understanding of the environmental drivers of post-fire thaw depth is limited but of critical importance. In addition, mapping thaw depth over fire scars may enable a better understanding of the spatial variability in post-fire responses of permafrost soils. We assessed the environmental drivers of post-fire thaw depth using field data from a fire scar in a larch-dominated forest in the continuous permafrost zone in eastern Siberia. Particularly, summer thaw depth was deeper in burned (mean=127.3 cm, standard deviation (SD) = 27.7 cm) than in unburned (98.1 cm, SD=26.9 cm) landscapes 1 year after the fire, yet the effect of fire was modulated by landscape and vegetation characteristics. We found deeper thaw in well-drained upland, in open and mature larch forest often intermixed with Scots pine, and in high-severity burns. The environmental drivers basal area, vegetation density, and burn depth explained 73.3 % of the measured thaw depth variability at the study sites. In addition, we evaluated the relationships between field-measured thaw depth and several remote sensing proxies. Albedo, the differenced normalized burn ratio (dNBR), and the pre-fire normalized difference vegetation index (NDVI) derived from Landsat 8 imagery together explained 66.3 % of the variability in field-measured thaw depth. Moreover, land surface temperature (LST) displayed particularly strong correlations with post-fire thaw depth (r=0.65, p). Based on these remote sensing proxies and multiple linear regression analysis, we estimated thaw depth over the entire fire scar. Our study reveals some of the governing processes of post-fire thaw depth development and shows the capability of Landsat imagery to estimate post-fire thaw depth at a landscape scale.

The extracellular matrix is an organized three-dimensional network of protein-based molecules and other macromolecules that provide structural and biochemical support to tissues. Depending on its biochemical and structural properties, the extracellular matrix influences cell adhesion and signal transduction and, in general, can influence cell differentiation and proliferation through specific mechanisms of chemical and mechanical sensing. The development of body tissues during ontogenesis is accompanied by changes not only in cells but also in the composition and properties of the extracellular matrix. Similarly, tumor development in carcinogenesis is accompanied by a continuous change in the properties of the extracellular matrix of tumor cells, called ‘oncomatrix’, as the tumor matures, from the development of the primary focus to the stage of metastasis. In this paper, the characteristics of the composition and properties of the extracellular matrix of tumor tissues are considered, as well as changes to the composition and properties of the matrix during the evolution of the tumor and metastasis. The extracellular matrix patterns of tumor tissues can be used as biomarkers of oncological diseases as well as potential targets for promising anti-tumor therapies.

Background. In conditions of a large information flow and accessibility of information, problems often arise related to the ability to process it, analyze it, and optimally memorize it. One of these tools is mind maps, which in this study were considered as didactic means of structuring, ordering, visualization, systematization, and establishing relationships. Purpose: to identify the conditions for developing students’ ability to use mind maps in teaching activities. Materials and methods. The study is of a theoretical and empirical nature. The identified conditions were introduced into the student learning process during experimental work. As part of the ability to use mind maps in teaching activities: knowledge of theoretical material on mind maps, requirements for them, capabilities and limitations; the ability to draw up mind maps, including using digital resources; include mind maps in work with schoolchildren. The study used a complex of theoretical and empirical methods. To check the reliability of the results obtained, the Wilcoxon T-test was used. Results. The conditions for developing students' ability to use mind maps in teaching activities are identified: embedding mind maps as a meaningful line into disciplines and practices; inclusion in the educational process of working with ready-made maps, checking their correctness, addition and/or adjustment, development, use of maps in the design and research work of the teacher and student; inclusion of tasks for working with mind maps in the program of teaching practice, with their subsequent defense. With the help of experimental work, the effectiveness of the identified conditions for developing students’ ability to use mind maps in teaching activities has been proven.

Abstract Aims/Introduction We analyzed patient‐reported outcomes of people with type 2 diabetes to better understand perceptions and experiences contributing to treatment adherence. Materials and Methods In the ongoing International Diabetes Management Practices Study, we collected patient‐reported outcomes data from structured questionnaires (chronic treatment acceptance questionnaire and Diabetes Self‐Management Questionnaire) and free‐text answers to open‐ended questions to assess perceptions of treatment value and side‐effects, as well as barriers to, and enablers for, adherence and self‐management. Free‐text answers were analyzed by natural language processing. Results In 2018–2020, we recruited 2,475 patients with type 2 diabetes (43.3% insulin‐treated, glycated hemoglobin (HbA1c) 8.0 ± 1.8%; 30.9% with HbA1c

BACKGROUND: Molecular genetic testing (MGT) is increasingly accessible, improving diagnosis of monogenic diabetes (DM), particularly maturity-onset diabetes of the young (MODY). While most MODY research focuses on pediatric populations, diagnosis is possible after age 18. The Federal Diabetes Registry (FDR) offers unique insights into real-world management of MODY patients.AIM: To analyze the clinical features of DM onset, carbohydrate metabolism, complications, and hypoglycemic therapy (HT) in patients with the main types of MODY based on the FDR data.MATERIALS AND METHODS: A cross-sectional analysis of the FDR was conducted. All patients with registered MODY diagnoses (MODY-1, MODY-2, MODY-3, or other) as of June 1, 2023, were included. The specified MODY type was considered indicative of prior MGT. Direct MGT results are not recorded in the FDR.RESULTS: The study included 640 patients. MODY2 was the most prevalent type (69.4%), followed by MODY1 (18.2%) and MODY3 (12.4%). The median age of DM diagnosis was 19 years for MODY1, 10 years for MODY2, and 14 years for MODY3. The majority of patients (71.4%) were diagnosed with MODY before the age of 18 years.While 61% of MODY2 patients received monotherapy with diet, others received various ADT. Sulfonylureas were commonly prescribed for MODY3 patients (45.8%), and for a smaller portion of MODY1 patients (14.1%). Insulin therapy was more frequent in MODY1 and 3 (35.9% and 31.2%, respectively). The target glycated hemoglobin level was achieved in 82% of MODY2 patients and in 50.7% and 52.9% of MODY1 and 3 patients, respectively.Diabetic complications were observed in 6.04% of MODY2 patients, 23.0% of MODY1 patients, and 22.0% of MODY3 patients. Specific complications included diabetic retinopathy (5.75%, 1.21%, and 3.39% in MODY1, MODY2, and MODY3, respectively), diabetic nephropathy (10.3%, 2.11%, and 11.9%), and diabetic polyneuropathy (14.9%, 4.53%, and 15.3%).CONCLUSION: The FDR analysis revealed real-world practice patterns in MODY management, highlighting a lack of standardized treatment approaches and potentially unnecessary insulin use. These findings, coupled with an expected rise in MODY diagnoses, underscore the need for clinical guidelines for this population.

BACKGROUND: To date, the results of Metformin, Gosogliptin and combination thereof have not been studied on a large patient population with type 2 diabetes mellitus (DM2), including comorbid patients, in real clinical settings in the Russian Federation.AIM: The aim is to evaluate the efficacy, safety, treatment adherence and satisfaction of patients with DM2 with the use of Metformin and Gosogliptin sugar-lowering drugs and combination thereof in routine clinical practice.MATERIALS AND METHODS: The nationwide PALITRA multicenter observational study was conducted among patients with DM2 who were prescribed therapy with Metformin or Gosogliptin or combination thereof in everyday clinical practice. Groups were formed according to the sugar-lowering drug administered; a total of 5741 patients aged 18 to 65 years with DM2 and a wide comorbidity profile participated. The observation period was 6 months. Body weight, body mass index (BMI), blood pressure (BP), glycated hemoglobin (HbA1c) level, glycemic parameters, and biochemical parameters (ALT, AST and plasma creatinine) were recorded initially and 3 and 6 months after the initiation of therapy with the study drugs. Adherence to therapy and patient and physician satisfaction with the treatment were assessed using Likert scale.RESULTS: HbA1c level decreased by 1.03% in the Metformin monotherapy group and by 0.95% in the Gosogliptin monotherapy and Metformin and Gosogliptin combination therapy groups by Week 24. By the end of the study, 49.6% of patients with DM2 reached the target HbA1c level (

Interdisciplinary studies often refer to such general categories as world model. This article is an analytical review of the artistic world model as a problematic issue of modern literary criticism. The author studied the essential content of the term model in different areas of scientific knowledge, as well as the relationship between the concepts of worldview and world model, artistic worldview and scientific worldview, etc., as well as the role of the author’s personality in their artistic world model and principles of world modeling, the latter being a popular scientific subject. The article is an attempt to systematize the latest publications on these issues. The methodology included structural-descriptive and descriptive-functional approaches. The analysis shows that the concept of world model is a process of reproducing external reality by a subject who builds its model in line with their own value systems, cultural background, and historical environment. An artistic worldview (model) focuses on all things figurative and emotional while scientific worldview is accurate, verified, and factual. The artistic world model broadcasts the author’s view. It has a special chronotope and a deep emotional impact on its reader. The uniqueness of the artistic world model largely depends on the genre. The principles of world modeling rely on metaphor and associations.

Cynics as the poetics and worldview of imagism suggests, gives the impression of a kind of novel-rebellion against Russian literary culture that has developed since the era of Pushkin. This is despite the fact that Mariengof at the end of the 1920s, when predictably dominated by social-political issues, creates a novel about a love story, seemingly quite traditional for Russian literature. This novel is not only about a love story, however, but also about adultery, proposed almost as a norm in married life. This violates and partly as it were destroys the traditions developed by the Russian literary process in the sphere of motives. Love stories and adulteries are inscribed in the motif, gradually gaining strength, of marital unfaithfulness which increases the independent poetics in Russian literature. According to literary scholars, adultery has its origins in the prose of Pushkin, and Lermontov, and it is further developed by Leo Tolstoy. However, researchers have not paid enough attention to the genres of the romantic, secular novella of the 1820s–1840s, with Turgenev’s works as another line of adultery, largely autonomous, experiencing the natural influence of the European medieval tradition. From this angle, the motif of adultery in Cynics has an “external” dimension, correlating with historical time, a catastrophic social-political situation, and internal literary history, as Veselovsky designated it. This naturally and inextricably connects the novel with the thickness of national and Western European literary meanings, images, types of heroes, and conflicts.

Forests around the world are under immense pressure from human land use and climate change. Old-growth and primary forests have been degraded in recent decades, yet are generally more resilient and resistant to climate change effects compared to human-modified forests. Nowhere is this more evident than in Russian Siberia, which contains almost one-fifth of the world’s forest area and has been subjected to a variety of land uses and disturbances since the mid-20th century. Although a number of related geospatial products exist, there are no large-scale maps of old-growth and primary forests across Siberia. However, remotely sensed metrics of forest stability have been shown to relate to old-growth and primary forests in tropical and boreal environments. Here we apply stability indices from the Moderate Resolution Imaging Spectroradiometer (MODIS) sensors across boreal Siberia from 2003 to 2020. Our results indicate that forests in the central and southern taiga contain most areas of high stability, but also distinct zones of disturbance and low stability. We identified three regions with particularly low forest stability: (i) the Zabaikal region in southern Siberia, (ii) a portion of the central taiga spanning the Republic of Sakha (Yakutia), and (iii) the West Siberian lowlands. This approach can be used to monitor Siberian boreal forest condition, and could be applied to other boreal forested regions.

Adapting a crop to a cultivation environment is one of its most essential properties, characterizing its suitability to the climatic zone and its ability to respond to new elements of agrotechnology. Two field experiments were carried out in 2021 and 2022 in two different climatic zones (dry steppe and steppe) of Kazakhstan to study the adaptive traits of the spring wheat variety ‘Shortandinskaya 2012’ based on the different management practices. Each experiment included 18 treatments (three sowing dates, three seeding rates, and two fertilizer application levels). In the dry steppe zone, the variety showed adaptive properties by increasing yields up to 332–397 kg/ha or 17–21% compared to the average of 1913 kg/ha in the fertilized treatments with sowing on May 15 and May 20 dates. The seeding rate effect was insignificant. The leading components in yield formation were productive tillering, thousand kernel weight, and grain weight. A very high correlation existed between yield and grain weight per ear (r = 0.86–0.93). In the steppe zone, yield improvements of up to 539–716 kg/ha or 16–21% compared to an average for all treatments of 3391 kg/ha were observed for the fertilized treatments with sowing on May 20 and May 25 dates, and with higher seeding rates at 350 or 400 seeds/m2. With the predominance of the development of the thousand kernel weight, its correlation with yield was between 0.91 and 0.99. The yield was also highly correlated with grain weight per ear (r = 0.83–0.94) and productive tillering per plant (r = 0.86–0.97). The results indicate that implementing the adaptation methods, such as adjusting the sowing date, seeding rate, and fertilization, significantly enhanced the expression of the genetic potential in the soft wheat variety ‘Shortandinskaya 2012’ across two distinct agroclimatic zones.

An erratum on « Insufficiency/deficiency of vitamin B12 in patients in the endocrinological practice» by Natalya G. Mokrysheva, Marina V. Shestakova, Alexander S. Ametov, Mikhail B. Antsiferov, Igor G. Bakulin, Tatiana V. Vavilova, Gagik R. Galstyan, Tatiana Y. Demidova, Fatima K. Dzgoeva, Tatiana L. Karonova, Elena A. Lukina, Ashot M. Mkrtumyan, Rodion V. Ponomaryov, Natalia A. Suponeva, Olga Y. Sukhareva, Minara S. Shamkhalova (2024). Diabetes mellitus. 27(3). doi: 10.14341/DM13181An error was made in the list of authors: Nina A. Petunina was not indicated as author of this article. The correct list of authors: Natalya G. Mokrysheva, Marina V. Shestakova, Alexander S. Ametov, Mikhail B. Antsiferov, Igor G. Bakulin, Tatiana V. Vavilova, Gagik R. Galstyan, Tatiana Y. Demidova, Fatima K. Dzgoeva, Tatiana L. Karonova, Elena A. Lukina, Ashot M. Mkrtumyan, Nina A. Petunina, Rodion V. Ponomaryov, Natalia A. Suponeva, Olga Y. Sukhareva, Minara S. Shamkhalova.The identifier in the ORCID system for F.K. Dzgoeva was also indicated incorrectly. The correct link is: https://orcid.org/0000-0002-0533-7652.The editorial board apologize for this error and state that this does not change the scientific conclusions of the article in any way.The original article has been updated.

Objective: to evaluate the efficacy of hypothermic machine perfusion (HMP) of a donor kidney obtained from a non-heartbeating (NHB) donor, using an experimental dextran-40-based preservation solution, in subsequent orthotopic transplantation in a rabbit model.Materials and methods. Twenty grey giant rabbits weighing 2,500–3,100 g, divided into donors (n = 10) and recipients (n = 10), were used in the study. After obtaining kidney from an NHB donor, ex vivo HMP of the left donor kidney using a dextran-40-based preservation solution was performed and peripheral vascular resistance (PVR) parameters were measured. This was followed by bilateral nephrectomy and orthotopic transplantation. The follow-up period was 12 days. Creatinine levels, urea levels, and glomerular filtration rate (GFR) were measured during follow-up.Results. During ex vivo HMP of donor kidneys from NHBs, PVR dropped progressively from 1.90 ± 0.27 mmHg/mL/min to 0.72 ± 0.09 mmHg/mL/min at p < 0.001. In the early post-transplant period (during the first 2 days after implantation), creatinine and urea levels were moderately elevated compared to normal. Creatinine and urea levels were 91.07 ± 11.49 μmol/L at p < 0.011 and 9.09 ± 1.06 mmol/L at p < 0.009 on day 2, respectively, but by day 12, they reverted to physiologic values, which were 77.17 ± 10.19 μmol/L at p < 0.019 and 4.88 ± 0.54 mmol/L at p < 0.022, respectively. These findings were correlated with GFR values, which ranged from 26.29 to 26.74 mL/min/1.72 m2 in mean values over the course of a 12-day follow-up period.Conclusion. Ex vivo HMP using dextran-40-based preservation solution has a positive effect on the kidney at 30 minutes of warm ischemia following asystole and achieves satisfactory graft function over 12 days of follow-up.

Due to its effect on insulin resistance, ease of administration and favorable safety profile, metformin has been included in the recommendations of foreign medical communities for the management of pregnant women with hyperglycemia since 2008. However, in Russia, the use of any oral hypoglycemic agents during pregnancy is still contraindicated. However, recent studies demonstrate the safety and positive effects of metformin on pregnancy in patients with pregestational diabetes mellitus, polycystic ovary syndrome and gestational diabetes mellitus. In 2023, the Federal Service for Surveillance in Healthcare of the Ministry of Health of Russia updated the instructions for the medical use of Glucophage® and Glucophage®Long: pregnancy was excluded from the “Contraindications” section and moved to the “With caution” section. This resolution is intended to evaluate studies of the effectiveness and safety of metformin, as well as to study the experience of foreign colleagues and Russian legal aspects of prescribing metformin in the stages of preparation for pregnancy, during it and in the post-gravid period.

On March 20, 2024, an interdisciplinary meeting of the Expert Council on the current problem of B12 insufficiency/deficiency and the prevalence of this condition among endocrine patients was held at the Endocrinology Research Centre (Moscow). The purpose of the meeting was to assess the role of B12 deficiency in reducing the quality of life of patients of different groups and to outline a strategy for the management of patients with vitamin B12 insufficiency/deficiency by endocrinologists.The resolution of the expert council was developed by leading specialists in various specialties.

Lipodystrophy syndromes are a heterogeneous group of extremely rare, inherited or acquired disorders that are characterized by total or partial fat loss or its improper redistribution. The prevalence of lipodystrophies is estimated to be 1:1,000,000 in the population, with approximately 1,000 cases currently described in the literature.Sarcoidosis is a multisystem disease of unknown etiology that is characterized by the formation of non-caseating epithelioid granulomas in the affected tissues. Despite the large number of studies, the etiology and pathogenesis of sarcoidosis still remain unknown. Most researchers allude to the possible autoimmune or immune-mediated genesis of the disease.This article presents a series of unique clinical cases of a combination of two rare diseases in one patient: sarcoidosis and familial partial lipodystrophy.

Nowadays, the palm of superiority in elective surgery belongs to the problem of hernias. According to the literature worldwide, more than 20 million patients undergo surgical treatment for hernia of the anterior abdominal wall every year, most of whom undergo alloplasty using various kinds of nets. The study of the influence of methods for fixing implants and the emerging local inflammatory response of tissues on the frequency of relapses after allognioplasty is devoted to isolated works. Aim of the study was to investigate in an experiment the characteristics of the reaction of local tissues when implanting a rigid monofilament mesh polypropylene implant with a shape memory effect, and a classic mesh endoprosthesis made of monofilament polypropylene (PP) with various methods of fixing implants. Material and methods. An experimental study on 60 white male Wistar rats was performed to identify tissue reaction features around the PP mesh. Group 1 animals (n = 30) were implanted with a rigid mesh monofilament PP implant (Herniamesh, Italy) with shape memory effect, group 2 animals (n = 30) – with a classic mesh endoprosthesis made of monofilament PP for soft tissue repair ESFIL® standard (Lintex, Russia). Biopsies were examined at 1, 2, 3 months after implantation of the PP mesh. Results. A morphological study showed that 1 month after the implantation of a rigid mesh monofilament PP implant, the inflammatory reaction is less obvious than when implanting a classical PP endoprosthesis. This reaction contributed to the earlier germination of collagen fibers around the rigid implant monofilaments. At 2 and 3 months after the implantation of PP nets in both groups of animals, there were no advantages as the regenerate formed. Conclusions. When introducing PP mesh with suture fixation and rigid monofilament PP mesh without fixation, there is a natural response to the integration of the endoprosthesis, which is characterized by aseptic inflammation followed by pronounced fibrosis around the implant. Such processes, occurring in response to the implantation of synthetic polypropylene nets, increase local mechanical tissue resistance, and can create additional strength against recurrence of inguinal hernias.

Systemic chemotherapy is the main treatment option for patients with advanced intrahepatic cholangiocarcinoma (iCCA), however, its efficacy is limited. Herein, we report a young patient with NRAS-mutated chemoresistant metastatic iCCA, who received second-line therapy with a combination of trametinib (MEK1/2 inhibitor), hydroxychloroquine (autophagy inhibitor), and bevacizumab (angiogenesis inhibitor). A significant response was achieved during therapy, resulting in a 25% decrease in the size of tumor lesions after 2 months of treatment and an improvement in the patient’s condition. The duration of this response was 4 months, but the patient died 10 months after the initiation of this triple therapy. This case report and the analysis of other available studies warrant further investigations on combined MEK and autophagy inhibition in RAS-mutated tumors.

The features of the artistic embodiment of the image of childhood in the genre of “Yuletide story” by the Russian writer of the late 19th - early 20th centuries Fyodor Sologub are revealed. The material for the research was the story “The Christmas Boy.” The purpose of the study is to identify the originality of the author’s world modeling in the genre of “Yuletide story” by Fyodor Sologub in comparison with the works of this genre in the works of F.M. Dostoevsky, M.E. Saltykov-Shchedrin and N.G. Garin-Mikhailovsky. The unique, original perception and interpretation of the theme of childhood by a symbolist writer is a current trend in modern literary criticism. The novelty of the work lies in the consideration of Sologubov’s story through the prism of world modeling. The results obtained during the study showed that the theme of purity, sinlessness of the child hero, his suffering and death due to fundamental incompatibility with the norms of earthly life bring F. Sologub’s story closer to the works of his literary predecessors. The general space-time universals, the theme of Christmas as the leading world-modeling category, and the theme of child death are preserved. F. Sologub concentrates the text space around the mystical and philosophical ideas of the turn of the 19th-20th centuries, introducing into it the aesthetic principles of symbolism.

ABSTRACT. The article presents a modern view of the diagnosis and treatment of pulmonary echinococcosis. The etiology, pathogenesis, clinical picture, ways of diagnosis and available methods of treatment of this pathology are highlighted. The purpose of the work was to acquaint doctors of various specialties with clinical cases of pulmonary echinococcosis. Two clinical cases of pulmonary echinococcosis became the object of the work. The first clinical example concerned a 17-year-old boy who had a typical course of echinococcosis and who underwent left lower lobectomy. The second clinical example concerned a young woman in whom pulmonary echinococcosis had an atypical course and was diagnosed only intraoperatively. It was concluded that the most effective method of treatment of echinococcal lung cysts is surgical operation. The volume of surgical intervention depends on many factors and is decided individually in each specific case. In the postoperative period, preventive anthelmintic therapy is mandatory.

This study examines the uniqueness of representing the image of Russia as an integral part of the artistic worldview in the autobiographical prose about childhood by first-wave Russian emigrant writers. The research is based on A.N. Tolstoy’s novella “Nikita’s Childhood” and I.S. Shmelev’s novel “The Lord’s Summer.” Comparative-historical, historical-literary methods, as well as the principle of comprehensive analysis of the ideological and artistic content of the texts, are employed. It is established that the image of Russia encompasses representations of the Russian people, nature, history, and generations. Time takes on mythological features, with historical and epic time shaping the narrative movement. The spatial dynamics are constructed as a contrast between city and village, where nature is animated and spiritualized. The concept of home emerges as a significant spatial parameter. In the novel “The Lord’s Summer,” it is intricately linked with the image of the church and sacralized. The central spiritual component of the world is embodied in the living image of Christ. The image of Russia is intertwined with themes of loss, with Moscow symbolized as the heart of the Motherland — Holy Rus’. Childhood and Russia are idealized, imbued with idyllic characteristics, while the image of a bygone era carries a nostalgic hue.

BACKGROUND: It is important to evaluate the effect of androgen replacement therapy on glycemic control.AIMS: Assessment of the effect of transdermal testosterone therapy on glycemic control in men with hypogonadism and T2DM.MATERIALS AND METHODS: The prospective, comparative study included 300 men aged 55[49;61] years: men receiving both glucose-lowering therapy (GLT) and transdermal testosterone; and patients receiving only GLT. Observation period 1 year. A medical history, a questionnaire for symptoms of androgen deficiency, and measurement of total testosterone and glycated hemoglobin were carried out. Groups were compared using nonparametric methods.RESULTS: Patients receiving androgen replacement therapy in combination with GLT at both 6 and 12 months from the moment of inclusion in the study, they had a statistically significantly higher level of total testosterone and less severity of symptoms of androgen deficiency. When assessing the magnitude of changes in the studied parameters, it was found that patients receiving testosterone replacement therapy (TRT) were characterized by a statistically significantly more pronounced decrease in the level of glycated hemoglobin (average difference 0,3%). In 29 (20,4% (95% ДИ 13,8–27,0)) men who received only GLT, hypogonadism was eliminated. In 3 patients from the TRT group, a pathological increase in the level of total blood PSA was observed, and therefore TRT was discontinued. An increase in hemoglobin above the reference value (>172 g/l) was detected in 8% and 1,3% of men on TRT and without correction of hypogonadism, respectively, p=0,011.CONCLUSIONS: The combination of transdermal TRT and GLT has a positive effect on glycemic control, which is manifested by a decrease in glycated hemoglobin to a greater extent than when using GLT alone. Normalization of testosterone levels leads to a decrease in the symptoms of androgen deficiency, which is accompanied by an improvement in quality of life. Elimination of hypogonadism only with GLT is possible in a small number of cases.

Background. Homologous recombination deficiency (HRD) is a valuable molecular marker for predicting response to platinum agents and poly(ADP-ribose)-polymerase (PARP) inhibitors. Germline and somatic alterations in the BRCA1 and BRCA2 genes are the major cause of HRD in ovarian cancer. However, in some cases, tumors arising in carriers of BRCA1 or BRCA2 pathogenic variants do not lose the normal copy of the corresponding gene and are not deficient for homologous recombination. Aim of the study was to present a case of high-grade ovarian carcinoma without HRD phenotype developed in a BRCA2 mutation carrier. Case report. A 48-year-old woman was diagnosed with multiple primaries: HER2-positive high-grade ovarian cancer and colorectal adenocarcinoma. analysis of the coding BRCA1/BRCA2 sequences revealed the germline BRCA2 c.658_659delgt [rs80359604] pathogenic variant. Given the unusual histological features, namely the absence of serous or endometrioid markers and high HER2 expression, we performed additional molecular analysis of the metastatic lesions in the lymph nodes. In all samples, the pattern of chromosomal instability did not match the HRD profile and there was loss of the mutant copy of the BRCA2 gene. Therefore, this tumor lacked the BRCAness phenotype. Conclusion. Tumors arising in HRR gene mutation carriers require additional molecular analysis for a comprehensive assessment of HRD.