Adrenal incidentaloma: management of patients with functionally autonomous cortisol synthesis

Over recent decades due to improved visualization (ultrasound, computer tomography and magnetic resonance imaging) prevalence of adrenal incidentaloma has increased. The term «adrenal incidentaloma» is generic and includes a group of tumors of various morphology and over 1 cm in diameter accidentally discovered during radiologic investigation. The found tumor can be hormonally inactive or actively releasing different hormones, malignant or benign, and originating from different adrenal zones or having non-specific organ origin. Based on the frequency of revealing and clinical significance the most noteworthy is functionally autonomous cortisol synthesis. It means changes of hypothalamic pituitary adrenal axis without classic clinically prominent signs of cortisol excess such as proximal myopathy, stretch marks, body fat redistribution and other metabolic changes related to cortisol. Currently a large number of recommendations on the management and tactics of treatment of adrenal incidentaloma can be found in the literature. Based on the analysis of these guidelines the conclusions were made about the diagnostic errors and incorrect approaches to the choice of treatment of such patients. Recently a lot of studies have been directed to the early detection of carbohydrate and lipid metabolism disorders, relation with obesity and type 2 diabetes mellitus, arterial hypertension and osteoporosis for preserved quality of life of such patients. Influence of hypercorticism is considered to worsen the course of these conditions but at the moment no effect of adrenalectomy on mortality and life duration was confirmed

Theory of differential inclusions and its application in mechanics

The following chapter deals with systems of differential equations with discontinuous right-hand sides. The key question is how to define the solutions of such systems. The most adequate approach is to treat discontinuous systems as systems with multivalued right-hand sides (differential inclusions). In this work three well-known definitions of solution of discontinuous system are considered. We will demonstrate the difference between these definitions and their application to different mechanical problems. Mathematical models of drilling systems with discontinuous friction torque characteristics are considered. Here, opposite to classical Coulomb symmetric friction law, the friction torque characteristic is asymmetrical. Problem of sudden load change is studied. Analytical methods of investigation of systems with such asymmetrical friction based on the use of Lyapunov functions are demonstrated. The Watt governor and Chua system are considered to show different aspects of computer modeling of discontinuous systems

Clinical manifestations of functionally autonomous cortisol secretion in patients with adrenal masse

The aim of the study was to determine the most significant clinical manifestations of FASC in unoperated AM patients.Цель исследования – определить наиболее значимые клинические проявления ФАСК у неоперированных пациентов с ОН

Evolution in Binary and Triple Stars, with an application to SS Lac

We present equations governing the way in which both the orbit and the intrinsic spins of stars in a close binary should evolve subject to a number of perturbing forces, including the effect of a third body in a possibly inclined wider orbit. We illustrate the solutions in some binary-star and triple-star situations: tidal friction in a wide but eccentric orbit of a radio pulsar about a B star, the Darwin and eccentricity instabilities in a more massive but shorter-period massive X-ray binary, and the interaction of tidal friction with Kozai cycles in a triple such as Algol (beta-Per), at an early stage in that star's life when all 3 components were ZAMS stars. We also attempt to model in some detail the interesting triple system SS Lac, which stopped eclipsing in about 1950. We find that our model of SS Lac is quite constrained by the relatively good observational data of this system, and leads to a specific inclination (29 deg) of the outer orbit relative to the inner orbit at epoch zero (1912). Although the intrinsic spins of the stars have little effect on the orbit, the converse is not true: the spin axes can vary their orientation relative to the close binary by up to 120 deg on a timescale of about a century.Comment: 30 pages, 6 figure

Specific nature of the integrative (complex) effect of environmental factors on hazelnut cultivars in the Russian humid subtropics

Corylus pontica K. Koch is a valuable nut crop. The expediency of the crop’s large-scale cultivation calls for measuring the parameters of agroclimatic indicators, ranging in variability, intensity, and duration of their impact. Environmental factors were assessed using phenological techniques based on recording the flowering and fruiting dates, recognized as the function demonstrating the complex effect of these factors on the hazelnut yield throughout the crop’s perennial cycle. Climate change urges the selection of adaptable cultivars for such areas where limiting factors are turning into stressors. Dependence of hazel cultivars on climate indicators (air temperature and humidity, and total precipitation) was observed in the phases of harvest formation. The crop’s genotypic diversity contributed to the specific nature of the complex effect produced by environmental factors. Peculiar responses of hazel plants to weather conditions in both flowering and fruiting phases were instigated by the biology of their development. Flowering started in January and depended on air temperature and humidity. Fruiting was affected by air temperatures and precipitation amounts (in July/August). Dependencies between yield and weather were well expressed, with module values of 0.86–1.0 (p < 0.05). The effect size of limiting factors is better measured with the coefficient of determination (%), a direct indicator of the correlations between harvest and weather factors. Flowering (I–III) under unpredictable conditions is regarded as a “critical” stage in the ontogenesis of hazel trees. No less critical is the fruiting phase, occurring simultaneously with the setting and differentiation of generative organs for the next year’s yield. Registration of limiting factors and their variations over the perennial plant cycle made it possible to recommend cvs. ‘Cherkesskiy-2’, ‘Anastasiya’, ‘Kristina’ and ‘Viktoriya’ as adaptable to the subtropics of Krasnodar Territory

Secondary hyperparathyroidism based on the materials of the appeal to the surgeon, endocrinologist

The aim of the study - to describe the tendency of secondary hyperparathyroidism in a patient with stage 5 CKD with the determination of the most effective treatment methodЦель исследования – описать тенденцию возникновения вторичного гиперпаратиреоза у пациента с ХБП 5 стадии с определением наиболее эффективного метода лечени

The Multiple Origin of Blue Straggler Stars: Theory vs. Observations

In this chapter we review the various suggested channels for the formation and evolution of blue straggler stars (BSSs) in different environments and their observational predictions. These include mass transfer during binary stellar evolution - case A/B/C and D (wind Roche-lobe overflow) mass transfer, stellar collisions during single and binary encounters in dense stellar cluster, and coupled dynamical and stellar evolution of triple systems. We also explore the importance of the BSS and binary dynamics in stellar clusters. We review the various observed properties of BSSs in different environments (halo and bulge BSSs, BSSs in globular clusters and BSSs in old open clusters), and compare the current observations with the theoretical predictions for BSS formation. We try to constrain the likely progenitors and processes that play a role in the formation of BSSs and their evolution. We find that multiple channels of BSS formation are likely to take part in producing the observed BSSs, and we point out the strengths and weaknesses of each the formation channel in respect to the observational constraints. Finally we point out directions to further explore the origin of BSS, and highlight eclipsing binary BSSs as important observational tool.Comment: Chapter 11, in Ecology of Blue Straggler Stars, H.M.J. Boffin, G. Carraro & G. Beccari (Eds), Astrophysics and Space Science Library, Springe

Some aspects of the distribution of Fusarium on cereals of Russia

Since 1995 the pathogens of genus Fusarium causing Root Rot, Snow Mold, Fusarium Head Blight of grain crops have been monitored in the Volga-Vyatka, Central, Central Chernozem and North Caucasian regions of the Russian Federation and in there were identified 15 Fusarium spp.: F. culmorum, F. heterosporum, F. sporotrichioides, F. oxysporum, F. nivale, F. graminearum, F. avenacеum, F. gibbosum, F. sambucinum, F. moniliforme, F. semitectum, F. poae, F. lateritium, F. solani, F. redolens. The high uniformity of Fusarium spp. has been revealed for the regions due to the susceptibility of crops to the soil-inhabiting micromycetes. Consistent long-term monitoring of the dynamics and frequency of occurrence of Fusarium spp. in a wide range of climatic areas has made it possible to characterize the state of the species of fungi in the regions and also to study their intraspecific and interspecific variability in toxicity and pathogenicity depended on biotic and abiotic factors. The prevalence of Fusarium spp. in the mycobiota has been determined by their plasticity and viability in the soil, on the weed roots and in the stubble of many crops and high competitive ability expressed pathogenicity and toxicity

Nonfunctional adrenal masses in practice of the endocrinologist

To study the clinical picture in patients with non-functional adrenal adenoma (NFAI), «malignant» potential by computed tomography (CT), morphological structure to identify more significant clinical and diagnostic signs. An analysis of case histories of 110 patients with NFAI operated on for adrenal gland lesions over 10 years from 01.01.2009 to 10.10.2018 on the basis of City Hospital № 40 in Yekaterinburg. The average age of the patients with NFAI were 47,0 ± 12,7 years. There were 86 women (78,2%), 24 men (21,8%). According to the results of histology, 42 (38,2%) people had clear cell adenoma, a mixed structure adenoma - 17 (15,5%), pheochromocytoma / ganglioneurinoma - 3 (2,7%). NFAI equally often affected both the right 53 (48,2%) and left 48 (43,6%) adrenal glands, the NFAI of both adrenal glands - 9 (8,2%). The size of the NFAI 6±2,9 cm in diameter, observation period before surgery 2,12±3,3 years. 73 CT: 38 with CT of < 10 HU (19 accumulated contrast), 9 – heterogeneous (6 accumulated contrast), 26 ≥ 10 HU (13 accumulated contrast). Arterial hypertension – 59 (53.6%) patients, impaired glucose metabolism – 26 (23,6%), obesity – 37 (33,6%). Histology: 42 (38.2%) people had clear cell adenoma, pheochromocytoma – 3 (2.7%). Conclusion: the high tumor density on CT scan picture ≥ 10 HU, heterogeneous and / or accumulated contrast had a histological various structures and shorter follow-up period before surgeryЦель исследования — изучить клиническую картину у больных с гормонально-неактивными образованиями надпочечников (ГНОН), «злокачественный» потенциал образований по компьютерной томографии (КТ), морфологическую структуру удаленных образований для выявления наиболее значимых клинико-диагностических признаков ГНОН. Ретроспективно изучены истории болезней 110 прооперированных пациентов с ГНОН за период с 01.01.2009 по 01.10.2019 гг. в муниципальном автономном учреждении городской клинической больнице № 40 (МАУ «ГКБ №40») г. Екатеринбурга Свердловской области. Средний возраст оперированных пациентов с ГНОН составил 47,0±12,7 года, женщин — 86 (78,2%), мужчин — 24 (21,8%). Локализация ГНОН в правом надпочечнике — 53 (48,2%), в левом — 48 (43,6%), в обоих надпочечниках — 9 (8,2%). Утренний кортизол составил 381,64 ± 173,2 нмоль/л, метанефрины (МН) общие в суточной моче — 106,78±85,75 мкг/сут., ДГЭА-с — 3,63±1,96 мкмоль/л. Средний размер ГНОН — 6±2,9 см, период наблюдения до операции — 2,12±3,3 года. Отобрано 73 КТ: у 38 пациентов плотность образований в НФ < 10 HU (19 накапливали КВ); у 9 — неоднородной структуры (6 накапливали КВ); у 26 плотность опухоли в НФ ≥ 10 HU (13 накапливали КВ). Артериальная гипертензия (АГ) — 59 (53.6%) больных, нарушение углеводного обмена — 26 (23,6%), ожирение — 37 (33,6%). Гистологическая структура: 42 (38,2%) светлоклеточная аденома, 3 (2.7%) — феохромоцитома. Заключение. Опухоли по КТ в НФ ≥ 10 HU, образования неоднородной структуры и / или накоплением КВ имели разнообразный по структуре гистологический вариант и меньший период наблюдения до операции

Bilateral adrenalectomy in the 21st century, its role in hypercorticolism? (Review of literature)

Relevance. In recent years, the number of operations performed on the adrenal glands has increased significantly. This is also related to the improvement of diagnostic methods for various pathologies of adrenal diseases in the general population. objective: 1) the identification of potential indications for bilateral adrenalectomy (BA) in the conditions of the updated therapeutic algorithms of CS; 2) to compare the efficacy and side effects of various therapeutic options for treating hypercorticism with the results of a BA to better determine the indications for it in the 21st century. Materials and methods. Literature search with the search term: "Bilateral adrenalectomy". Source: PubMed, Medline. Results. Review of 174 viewed publications, signs of hypercorticolism (hypertension, obesity and depression) improved in most patients after BA (7 studies, 195 patients). Approximately 46% of patients died in the first year after surgery. Conclusions. to study the effect of BA, its timeliness in the treatment of patients.Актуальность. В последние годы значительно увеличилось число операций, проводимых на надпочечниках. Это связано также с улучшением методов диагностики различного рода патологий этих желез и увеличило цифры распространенности заболеваний надпочечников в общей популяции. Цель обзора: 1) выявление потенциальных показаний к двусторонней адреналэктомии (ДА) в условиях обновленных терапевтических алгоритмах СК; 2) сравнить эффективность и побочные эффекты различных терапевтических вариантов лечения гиперкортицизма с результатами двусторонней ДА, чтобы лучше определить показания к ней в 21 веке. Материалы и методы. Поиск литературы с поисковым термином: «двусторонняя адреналэктомия». Источник: PubMed, Medline. результаты. обзор 174 просмотренных публикаций, cимптомы гиперкортицизма (гипертония, ожирение и депрессия) улучшились у большинства пациентов после ДА (7 исследований, 195 пациентов). Примерно 46% пациентов умерли в первый год после операции. Вывод. Изучить влияние ДА, ее своевременность в лечении пациентов