Nonspecific aortoarteritis as a Cause of Aortic Dissection in a Middle Aged Man

Nonspecific aortoarteritis (Takayasu's disease) is a systemic inflammatory disease characterized by granulomatous lesions of the aorta and its large branches. The article describes the clinical manifestations, methods of diagnosis and treatment of this pathology. It also describes a clinical observation that illustrates the delayed diagnosis of the disease in a 47-year-old man, where Takayasu arteritis with lesions of the root, ascending aorta, both common carotid arteries, thoracic and abdominal aorta (type V according to the angiographic classification proposed by Moriwaki R.) manifested a syncopal state, just a few days before the development of a life – threatening complication-aortic dissection of type I according to the DeBakey classification. From a clinical point of view, it is important that Takayasu's disease does not always develop in young people, women, and Asian origin, and, unfortunately, it is often very late to diagnose, although the effectiveness of therapy, including surgical correction of this disease, is entirely determined by the timeliness of its diagnosis

Explainable AI for higher cognitive functions: How to provide explanations in the face of increasing complexity

Since the introduction of the term explainable artificial intelligence (XAI), many contrasting definitions and methods have been proposed. This lack of a common framework impedes not only further progress in the field but also the realization of existing regulations, such as the EU’s general data protection regulation on the ‘right to an explanation’ (Goodman & Flaxman, 2017). While some researchers use interpretation algorithms as post-hoc explanations (Samek et al., 2021; Ribeiro, 2016), others argue that we should use models which are interpretable in the first place (Rudin, 2019). Although the latter is important, developers are not always willing to sacrifice accuracy by choosing a less complex interpretable model. Here, we propose a working definition of what explaining an AI model means, focusing on robustness, representativeness, and comprehensibility as central properties, and on the importance of causal links (Miller, 2019). In addition, we suggest starting with simple models and gradually scaling up the level of complexity if necessary, whilst setting a case-specific threshold for its trade-off with accuracy and ensuring that we obtain explanations that meet the requirements of our working definition

Statin-induced rhabdomyolysis in a 60-year-old woman with decompensated type 2 diabetes: a case report

Rhabdomyolysis is a very rare and most severe form of statin-induced muscle adverse event characterized by muscle pain, muscle necrosis with myoglobinemia and/or myoglobinuria with a very high risk of acute kidney injury and death. The article presents a case report of developing rhabdomyolysis in a middleaged female patient with hypertension, decompensated type 2 diabetes and albuminuria. A 60-year-old woman was admitted to the hospital for emergency indications with complaints of severe muscle weakness that began in the neck, which spread over several days to the upper and lower extremities, with a symptoms progression up to paresis. According to the appointment of a primary care physician, three months before hospitalization, the patient was switched from therapy with European generic brand-name rosuvastatin 20 mg to the Russian generic unbranded atorvastatin in the same dose (20 mg), which is not comparable in lipid-lowering effect. In a laboratory study, an increase in creatine phosphokinase level by 348 times (50462 U/L) of upper normal limit in combination with severe hypokalemia 1б7 mmol/L in the absence of renal dysfunction was recorded. Cancellation of statin, metformin and empagliflozin, intensive infusion therapy and treating electrolyte imbalance made it possible to prevent the development of acute renal damage, life-threatening arrhythmias and completely stop muscle complaints within a few days. The patient was discharged from the hospital on the 23rd day with reference clinical and laboratory values, including creatine phosphokinase.This case emphasizes the importance of maintaining clinical suspicion regarding rhabdomyolysis in patients receiving statin therapy in the presence of risk factors (in this case, female sex, hyperglycemia, chronic kidney disease, concomitant therapy), as well as the relevance of timely diagnosis and treatment of this condition

Ablation Strategies for Different Types of Atrial Fibrillation in Europe: Results of the ESC-EORP EHRA Atrial Fibrillation Ablation Long-Term Registry

Aims: The ESC EORP EHRA Atrial Fibrillation (AF) Ablation Long-Term registry was designed to assess management and outcomes of AF catheter ablation procedures in Europe. To investigate the current ablation approaches and their outcomes for patients with paroxymal AF (PAF) and non-PAF in Europe. Methods and results: Data from index ablations were collected in 27 European countries at 104 centres in a prospective fashion. Pre-procedural, procedural, and 1-year follow-up data were captured on a web-based electronic case record form. Data on the ablation procedure were available for 3446 patients. Of these, 2513 patients and 933 patients underwent pulmonary vein isolation (PVI) or PVI plus (PVIplus) additional ablation, respectively. The ablation strategy was limited to PVI in 81% and 56% of patients in the PAF and non-PAF group, respectively (P < 0.001). In the non-PAF group, left atrial linear ablation and ablation of complex fragmented atrial electrograms were more commonly performed. Arrhythmias recurrence after PVI was 29% and 39% in the PAF and non-PAF group, respectively (P < 0.001) and 42% after PVIplus in both groups. Atrial fibrillation related hospital admissions were more common in the PVIplus group (20% vs. 14%). A very low procedural complication rate was observed. No relevant differences were observed with regard to repeat ablation (PVI 9% and PVIplus 11%). Conclusion: In patients with PAF and non-PAF, the ablation strategies of PVI and PVIplus led to similar arrhythmia-free survival rates after 1 year. A considerable hospital readmission rate was noted.info:eu-repo/semantics/publishedVersio

Reproducibility of cytological diagnoses in evaluating liquid cervical smears and immunocytochemical co-expression of p16/Ki-67 using manual and automatic methods

Aim. To assess the reproducibility of cytological diagnoses in evaluating liquid cervical smears and immunocytochemical co-expression of p16/Ki-67 using manual and automatic methods. Materials and methods. Cytological smears prepared using the liquid cytology method on the Becton Dickinson device (SurePath technology) were studied. An immunocytochemical study was carried out using a Ventana BenchMark Ultra automatic immunostainer with a commercial CINtec kit (determination of p16/Ki-67 co-expression). In total, 100 cytological slides (50 pairs of Pap-smears and immunocytochemical slides) were studied. The diagnostic kit was reviewed by five cytologists independently, and the cytologic slides were evaluated using four categories according to the Bethesda system (2014) and according to the categories of normal/abnormal. The co-expression of p16/Ki-67 was assessed per the manufacturer's recommendations (Roche) using the manual method (light microscope) and the automatic Vision Cyto Pap ICC system. Statistical processing of the results was performed using the SPSS software package version 26.0.0.0 with the calculation of the reproducibility indices of Cohen's kappa and Fleiss' kappa. Results. When assessing the reproducibility of four categories of cytological diagnoses according to the Bethesda system (2014), Cohen's kappa was 0.0480.265. The overall Fleiss' kappa between all cytologists was 0.103. When only two categories (normal/abnormal) were used, the reproducibility ranged from 0.058 to 0.377. When assessing the co-expression of p16 and Ki-67, Cohen's kappa reproducibility was from 0.196 to 0.574, while the overall Fleiss' kappa was 0.407. When comparing the evaluation results of each of the cytologists with the neural network, Cohen's kappa reproducibility ranged from 0.103 to 0.436. Conclusion. The reproducibility of cytological diagnoses according to the Bethesda system (2014) and two categories (normal/abnormal) based on the Pap smear study was low. Such results are primarily due to a large number of abnormal smears in the study. The immunocytochemical method has diagnosis reproducibility three times higher, indicating the need to measure the co-expression of p16 and Ki-67 to increase the sensitivity and specificity of the cytological method. Similar reproducibility when comparing the manual and automatic evaluation of the "double label" suggests that the neural network algorithm can currently help in decision support rather than replace the cytologist at the diagnostic stage

Гипертриглицеридемия - мультидисциплинарная проблема современной медицины

Acute pancreatitis is one of the most common gastrointestinal causes for hospitalization after acute appendicitis. Despite recent advances in the treatment methods, mortality from acute pancreatitis and its complications remains high. Hypertriglyceridemia is an underestimated cause of acute pancreatitis, accounting for 10% among other etiological factors. Timely diagnosis of hypertriglyceridemia, a personalized approach, and the selection of adequate lipid-lowering therapy allow reducing the risk of developing and/or preventing recurrent acute pancreatitis. The article presents the clinical case of a patient with recurrent pancreatitis and hypertriglyceridemia. Despite high levels of triglycerides and annual hospitalizations for recurrent pancreatitis, the patient has not received optimal treatment for a long time. Therefore, lipid-modifying therapy has not been prescribed and none dietary recommendations have been suggested, including the exclusion of alcoholic beverages. Structural changes in the pancreas (the formation of pseudocysts) and the progression of pancreatogenic diabetes have developed.Острый панкреатит (ОП) - одна из основных причин госпитализаций по поводу заболеваний желудочно-кишечного тракта, уступающая лишь острому аппендициту. Несмотря на совершенствование методов лечения, летальность от ОП и связанных с ним осложнений до сих пор остается на высоком уровне. Гипертриглицеридемия (гиперТГ) является недооцененной причиной ОП и составляет около 10% среди других этиологических факторов. Своевременная диагностика гиперТГ, индивидуальный подход и подбор адекватной липидс-нижающей терапии позволяют снизить риски развития ОП и/или предотвратить рецидивы. В статье приводится клиническое наблюдение за пациентом с рецидивирующим течением панкреатита на фоне гиперТГ. Несмотря на высокие уровни триглицеридов и ежегодные госпитализации по поводу повторных эпизодов панкреатита, длительное время должного внимания основному этиологическому фактору не уделялось. Следовательно, не назначалась липидмо-дифицирующая терапия и не соблюдались диетические рекомендации, в том числе исключение употребления алкогольных напитков, что привело к структурным изменениям в поджелудочной железе (псевдокисте) и прогрессированию сахарного диабета за счет панкреатогенного компонента

Cytokine mRNA profiles of immunocompetent vaginal cells of women with chronic recurrent vulvovaginal candidiasis

The main idea of this study was to describe cytokine profiles of immunological vaginal cells of women with chronic recurrent vulvovaginal candidiasis (CWC). There were 76 women recruited into the study. Out of them CW C was verified among 34 women. A control group included 23 relatively healthy women without inflammatory diseases of reproductive system and 19 patients with “classical" bacterial vaginosis (BV). Biocoenosis data and cytokines expressions profile were evaluated in vaginal swabs of women with CWC, BV and healthy women. It was demonstrated that CW C was associated with an elevation of cytokine levels (TNF-α, IL-β, IL-6, IL-8, IFN-γ, IL-10) and the decrease of IL-12α/p35 and IL-18.Данная статья посвящена особенностям иммунного ответа при хроническом рецидивирующем вульвовагинальном кандидозе (ХРВК). Из 76 обследованных женщин репродуктивного возраста, ХРВК выявлен у 34 пациенток. Группу сравнения составили 23 условно-здоровые женщины и 19 пациенток с бактериальным вагинозом (БВ). Описано состояние микрофлоры и проведен анализ профиля экспрессии мРНК генов цитокинов при ХРВК, в норме и при БВ. Показано, что ХРВК сопровождается повышением уровня экспрессии мРНК провоспалительных цитокинов (TNF-α, IL-1β, IL-6, IL-8, IFN-Υ), а также IL-10 и снижением уровня экспрессии мРНК генов IL-18 и IL-12α/p35

Эндометриоз-ассоциированные опухоли яичника: морфологические и иммуногистохимические особенности

Background. In 2016, the World Health Organization published an updated version of the Histological Classification for ovarian tumors presenting a new category of endometriosis-associated tumors. The predictors of malignant transformation of endometriosis have not been clearly defined so far.Purpose. The search for histological and immunohistochemical markers of endometriosis-associated malignancy.Materials and methods. 28 female patients with endometrioid ovarian cancer and 11 patients with clear cell ovarian carcinoma were enrolled. Histological and immunohistochemical studies were carried out using conventional techniques. Immunohistochemistry was applied to determine the hormone receptor status: expression of steroid hormone receptors, BAF250a (ARID1A), PTEN, P-catenin, MSH6, PMS2, р-53, WT-1, proliferative index (Ki-67). Microsatellite instability (MSI) testing was conducted according to the standard protocol.Results. In all cases of ovarian cancer, histological examination showed one of the endometriosis features. Atypical endometriosis was found in 39 % (11 / 28) of endometrioid tumors and in 9% (1/ 11) of clear cell carcinomas. Endometrioid ovarian cancer was found to be ER (74±7,8%) — and PR (67±5,4%) — positive; Ki-67 index was 68,2±3,7 %; loss of BAF250a (ARID1A) expression was observed in 14% (4/ 28), loss of PTEN expression in 29 % (8 / 28), nuclear expression of P-catenin in 32% (9/28) of cases. Loss of MMR expression was detected in 7% (2/28) of cases. MSI was found in one case only, which was also associated with loss of expression of BAF250a (ARID1A) and MSH6. Clear cell carcinoma of the ovary showed histological criteria for endometriosis; however, there were no changes immunohistochemical markers expression that were typical for endometriosis-associated malignancies. It could be due to a small number of patients in the group so further research is needed.Conclusion. Atypical endometriosis may be a morphological precursor of endometrioid and clear cell carcinoma of the ovary. Comprehensive assessment of a marker panel consisting of BAF250a (ARID1A), P-catenin, PTEN, p53, Ki-67 index, PMS2 and MSH6 will allow improving the diagnosis of atypical endometriosis and endometriosis-associated ovarian cancer.Актуальность. В 2016 Всемирная Организация Здравоохранения обновила классификацию опухолей яичника и представила новую группу эндометриоз-ассоциированных опухолей. Проблема поиска предикторов злокачественной трансформации эндометриоза до сих пор не решена.Цель исследования. Поиск гистологических и иммуногистохимических маркеров малигнизации эндометриоза.Материал и методы. В исследование были включены 28 женщин с диагнозом эндометриодный рак яичника и 11 больных светлоклеточным раком яичника. Гистологическое и иммуногистохимическое исследования проводились по стандартной методике. Иммуногистохимическим методом определялся рецепторный статус опухоли: экспрессия рецепторов стероидных гормонов, экспрессия BAF250a (ARID1A), PTEN, р-катенин, MSH6, PMS2, р-53, WT-1, индекс пролиферации (Ki-67). Молекулярно-генетический анализ MSI проводился по стандартному протоколу.Результаты. При морфологическом исследовании во всех случаях рака яичника присутствовал один из признаков эндометриоза. Атипический эндометриоз обнаружен в 39% (11/28) эндометриодных и в 9% (1/11) светлоклеточных опухолях. Эндометриодный рак яичника демонстрировал позитивную реакцию к рецепторам стероидных гормонов — ER (74±7,8%) и PR (67±5,4%), индекс Ki-67 составил 68,2±3,7%, потеря экспрессии BAF250а (ARID1A) выявлена в 14% (4/28), потеря PTEN 29% (8/28), ядерная экспрессия р-катенина в 32% (9/28) случаев. Потеря экспрессии белков MMR выявлена в 7% (2/28) случаев. MSI обнаружена только в 1 случае, в котором наблюдалась потеря экспрессии BAF250а (ARID1A) и MSH6. В светлоклеточном раке яичника определялись гистологические критерии эндометриоза, однако изменения экспрессии иммуногистохимических маркеров, характерные для эндометриоз-ассоциированных опухолей, не были обнаружены. Можно предположить, что это связано с малочисленностью группы, поэтому требуются дальнейшие исследования.Заключение. Атипический эндометриоз может являться морфологическим предшественником эндометриодного и светлоклеточного рака яичника. Комплексная оценка экспрессии панели маркеров BAF250a (ARID1A), р-катенина, PTEN, p53, индекса Ki-67, PMS2 и MSH6 позволит улучшить диагностический поиск атипического эндометриоза и эндометриоз-ассоциированных опухолей яичника

The paradigm of human capital in the context of digitalization across countries

The purpose of this article is to analyze the characteristics of the formation and development of human capital across countrie