[The burden of COVID-19 in a heterogeneous population of immunocompromised patients - realities of the postpandemic].

On July 3, 2023, an interdisciplinary Council of Experts "The burden of COVID-19 in a heterogeneous population of immunocompromised patients - post-pandemic realities" was held in Moscow with leading experts in pulmonology, rheumatology, hematology, oncology, nephrology, allergology-immunology, transplantation, and infectious diseases. The aim of the meeting was to discuss the current clinical and epidemiologic situation related to COVID-19, the relevance of disease prevention strategies for high-risk patients. The experts addressed the following issues: 1) the disease burden of COVID-19 in 2023 for patients with immunodeficiency in different therapeutic areas; 2) the place of passive immunization with monoclonal antibodies as a method of COVID-19 prophylaxis among immunocompromised patients; 3) prerequisites for the inclusion of passive immunization of immunocompromised patients into routine clinical practice.

[Anemia and quality of life of chronic kidney disease patients on renal replacement therapy by programmed hemodialysis].

AIM: To study relationship between anemia and health-related quality of life (HRQOL) of chronic kidney disease stage 5 patients (CKD) undergoing renal replacement therapy by programmed hemodialysis. MATERIALS AND METHODS: The study was conducted on the basis of dialysis centers/departments in Moscow. The Russian-language version of the KDQOL-SFTM questionnaire, validated in Russia, was used to assess the HRQOL of patients on hemodialysis. A total of 723 patients were interviewed. Hemoglobin (Hb) levels were assessed in 442 patients based on outpatient records. To identify the relationship between Hb level and HRQOL scales, a correlation analysis was performed, as well as a HRQOL analysis in the three groups differing in hemoglobin levels (<100; 100-120 and >120 g/l). Statistical data processing was carried by SPSS.22 and using parametric and nonparametric statistical methods. RESULTS: Correlation relationship was revealed between Hb and HRQOL of patients on hemodialysis on the scales "symptoms/problems", "pain", "vital activity, energy" and "total physical component of health". According to the scales "symptoms/problems" and "vital activity, energy", higher rates were noted among patients with Hb higher than the target level, which confirms the recommendations concerning the possibility of achieving higher Hb among individual patients who have not serious concomitant diseases and cardiovascular complications in order to improve their quality of life. CONCLUSION: HRQOL assessment is important tool for planning and evaluating the effectiveness of anemia drug therapy among patients with CKD on hemodialysis.

Seasonal dynamics of a complex cheilostome bryozoan symbiosis: vertical transfer challenged.

Symbiotic associations are dynamic systems influenced by both intrinsic and extrinsic factors. Here we describe for the first time the developmental and seasonal changes of the funicular bodies in the bryozoan Dendrobeania fruticosa, which are unique temporary organs of cheilostome bryozoans containing prokaryotic symbionts. Histological and ultrastructural studies showed that these organs undergo strong seasonal modification in the White Sea during the ice-free period. Initially (in June) they play a trophic function and support the development of a large population of bacteria. From June to September, both funicular bodies and bacteria show signs of degradation accompanied by development of presumed virus-like particles (VLPs); these self-organize to hollow spheres inside bacteria and are also detected outside of them. Although the destruction of bacteria coincides with the development of VLPs and spheres, the general picture differs considerably from the known instances of bacteriophagy in bryozoans. We broadly discuss potential routes of bacterial infection in Bryozoa and question the hypothesis of vertical transfer, which, although widely accepted in the literature, is contradicted by molecular, morphological and ecological evidence.

[Diagnosis of infected kidney cysts in patients with autosomal dominant polycystic kidney disease and end-stage renal disease].

AIM: to improve the differential diagnosis of infected cysts in patients with ADPKD and to reduce false-positive rate of MR-urography. MATERIALS AND METHODS: a total of 33 patients with ADPKD who underwent bilateral nephrectomy from 2015 to 2020 were included in the retrospective single-center study. In the group 1 (n=17) patients with histologically confirmed infected cyst (s) were included, while in the group 2 (n=16) there were patients without infected cysts. The frequency of symptoms (pain in the loin area, fever), the level of leukocytes in blood and urine, C-reactive protein (CRP) and the results of kidney MRI were compared. RESULTS: Pain, fever, leukocytosis, leukocyturia, and increased CRP levels were significantly associated with infected cysts. The sensitivity and specificity of MRI was 88.2% and 43.8%, respectively. The infected cysts were characterized by a significantly (p=0.004) lower value of the apparent diffusion coefficient (ADC): 0.67+/-0.2110-3 mm2/s (95% confidence interval (CI) 0.56-0.79), versus 1.2+/-0.5910-3 mm2/s (95% CI 0.89-1.5) in group 2. According to ROC analysis, the ADC value at the cut-off point was 0.8310-3 mm2/s. The frequency of infected cysts during histological examination increased when the volume of the cyst was more than 13 ml. In multivariate analysis, only the CRP level was a reliable predictor of the presence of infected cysts. ROC analysis showed that the CRP level at the cut-off point was 83 mg/L (sensitivity 70.6%, specificity 75%). CONCLUSION: In case of fever, pain in the loin area and high CRP level in patients with ADPKD, it is necessary to exclude infected cysts. MRI of the kidneys with the determination of the ADC level in cysts with limited diffusion on diffusion-weighted images is a highly informative method that allows to clarify the content of cysts.

Three in one: evolution of viviparity, coenocytic placenta and polyembryony in cyclostome bryozoans.

BACKGROUND: Placentation has evolved multiple times among both chordates and invertebrates. Although they are structurally less complex, invertebrate placentae are much more diverse in their origin, development and position. Aquatic colonial suspension-feeders from the phylum Bryozoa acquired placental analogues multiple times, representing an outstanding example of their structural diversity and evolution. Among them, the clade Cyclostomata is the only one in which placentation is associated with viviparity and polyembryony-a unique combination not present in any other invertebrate group. RESULTS: The histological and ultrastructural study of the sexual polymorphic zooids (gonozooids) in two cyclostome species, Crisia eburnea and Crisiella producta, revealed embryos embedded in a placental analogue (nutritive tissue) with a unique structure-comprising coenocytes and solitary cells-previously unknown in animals. Coenocytes originate via nuclear multiplication and cytoplasmic growth among the cells surrounding the early embryo. This process also affects cells of the membranous sac, which initially serves as a hydrostatic system but later becomes main part of the placenta. The nutritive tissue is both highly dynamic, permanently rearranging its structure, and highly integrated with its coenocytic 'elements' being interconnected via cytoplasmic bridges and various cell contacts. This tissue shows evidence of both nutrient synthesis and transport (bidirectional transcytosis), supporting the enclosed multiple progeny. Growing primary embryo produces secondary embryos (via fission) that develop into larvae; both the secondary embyos and larvae show signs of endocytosis. Interzooidal communication pores are occupied by 1‒2 specialized pore-cells probably involved in the transport of nutrients between zooids. CONCLUSIONS: Cyclostome nutritive tissue is currently the only known example of a coenocytic placental analogue, although syncytial 'elements' could potentially be formed in them too. Structurally and functionally (but not developmentally) the nutritive tissue can be compared with the syncytial placental analogues of certain invertebrates and chordates. Evolution of the cyclostome placenta, involving transformation of the hydrostatic apparatus (membranous sac) and change of its function to embryonic nourishment, is an example of exaptation that is rather widespread among matrotrophic bryozoans. We speculate that the acquisition of a highly advanced placenta providing massive nourishment might support the evolution of polyembryony in cyclostomes. In turn, massive and continuous embryonic production led to the evolution of enlarged incubating polymorphic gonozooids hosting multiple progeny.

[The technology of enhancement of detection of chronic renal diseases].

The chronic kidney disease takes a special place among chronic non-communicable diseases because it is characterized by wide prevalence worldwide. However, its detection rate among Moscow adult population is 1%, though in the European countries this indicator is significantly higher and is made up on average to 6%. At the terminal stage of chronic kidney disease, quality of life of such patients decreases dramatically, that result in working capacity loss and disability. These patients often require expensive methods of programmed hemo- and peritoneal dialysis. The corresponding mortality is much higher as compared with total mortality. Among the frequent causes of hospitalization and mortality of such patients, complications of blood circulation system diseases are registered. The existing problem of low detection of kidney pathology in the population is the main cause of untimely treatment start. The rapid disease progression results in higher indices of premature mortality and increased costs of treatment of patients with this pathology. The timely diagnosis of disorders of carbohydrate and lipid metabolism permits to identify chronic kidney disease at an early stage and to start to carry out adequate treatment and prevention measures. The purpose of the study is to implement the technology of improving efficiency of detection of chronic kidney disease. Methods. The organizational experiment, analytical, mathematical and statistical research methods. Results of the study. The detection rate of chronic kidney disease amounted to 8%. Among the respondents with chronic kidney disease diagnosed, more than 80% had initial stages of disease (I-III). In this case, appropriate therapy and prevention can prolong kidney functioning and reduce velocity of disease progression. At the same time, 16.3% of patients at the late stage of diseases progression (stages IV-V) were identified.The detection rate for all stages of chronic kidney disease increases with age Conclusions. The level of detection of chronic kidney disease in the base territory is comparable with the indices established in the European countries. The need to improve quality of diagnostic and prevention of chronic kidney disease was proven. To improve overall prognosis and prevention of development of terminal renal failure is possible only in case of brigade approach to treatment including active interaction of cardiologist and nephrologist, endocrinologist and nephrologist or of all these three specialists. Scope of the results. The established higher detection rate of chronic kidney disease (8%), as compared to actual one (1%), permits to claim that with systematic improvement of diagnosis, the detection of chronic kidney disease will increase iteratively and population need for nephrologic medical care will significantly increase that will require increasing in resource support and revising of planned and normative indices for this type of medical care.

[Immunosuppressive therapy as a risk factor for new-onset diabetes after transplantation].

AIM: To analyze the modes of immunosuppressive therapy as a risk factor for new-onset diabetes after transplantation (NODAT) in kidney recipients. MATERIALS AND METHODS: The retrospective analysis included data from 1367 recipients (755 men and 612 women) who lived more than one year after NODAT and were observed at the Moscow City Nephrology Center from January 1989 to December 2018. NODAT was established for 178 (13%) patients based on criteria from the World Health Organization and the American Diabetes Association. The modes of immunosuppressive therapy using cyclosporin A (CSA), tacrolimus (Tac), mTOR inhibitors, glucocorticoids in patients with NODAT and without NODAT were evaluated. To assess the impact of risk factors, descriptive statistics methods were used, the odds ratio (OR) and the 95% confidence interval (CI) were calculated. RESULTS: NODAT was diagnosed in 105 men and 73 women. The OR for men was 1.19 (95% CI 0.871.64), the OR for women was 0.84 (95% CI 0.611.15). At the time of transplantation, the average age of the kidney recipients in the NODAT group was higher than in the group without NODAT: 51 [43; 57] and 43 [32; 52] years, respectively (p=0.0001). Most patients with NODAT (82%) were older than 50 years, while in the group without NODAT, the proportion of patients of the same age was 48.5% (p=0.0001). Among patients without NODAT, transplantation of a kidney from a living donor was significantly more often compared with the group with NODAT+ (7.1% vs 1.1%;p=0.001). Among the recipients who received the regimen with CSA, diabetes developed in 75 (42.1%), those who received Tac in 102 (57.3%;p0.05). The chance (risk of development) of NODAT in patients receiving i-mTOR + Tac was 3.2 (95% CI 1.476.78;p=0.032), and for patients receiving i-mTOR + cyclosporin A, the chance of development NODAT was 1.95 (95% CI 0.884.35;p=0.044). CONCLUSION: 13% of recipients developed de novo kidney diabetes after allograft. Age at the time of allotransplantation, gender, as well as the use of tacrolimus in combination with i-mTOR are the most significant risk factors for the development of NODAT.

N-Terminal Fragment of Brain-Type Natriuretic Peptide (NT-proBNP) as a Prognostic Marker in Patients with Newly Diagnosed Multiple Myeloma Complicated by Dialysis-Dependent Renal Failure.

Prognostic value of N-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) was analyzed in patients with multiple myeloma complicated by dialysisdependent renal failure. The prospective study included 20 patients with newly diagnosed multiple myeloma. The concentrations of NT-proBNP were measured before antimyeloma chemotherapy. The median age of the patients was 67 (63-76) years. The median glomerular filtration rate was 4 (4, 5) ml/min/1.73 m2. For overall survival, the area under ROC curve was 0.75 and the cut-off point was 7000 pg/ml. At median follow-up of 17.3 months, the overall survival was 76.6±14.8 and 27.3±13.4% (p=0.02) for cases with NT-proBNP levels below and above the cut-off point, respectively. There were no cases of death due to cardiovascular causes. We concluded that the increase in serum concentration of NT-proBNP>7400 pg/ml is associated with the severity of kidney damage and the risk of non-cardiac mortality.

Ultrastructural evidence for nutritional relationships between a marine colonial invertebrate (Bryozoa) and its bacterial symbionts.

Autozooids of the cheilostome bryozoan Aquiloniella scabra contain rod-like bacteria in the funicular bodies - the complex swellings of the funicular strands. Each funicular body contains symbionts in the central cavity surrounded by a large, synthetically active internal "sheath-cell" (bacteriocyte) and a group of the flat external cells. The tightly interdigitating lobes of these cells form a capsule well-isolated from the body cavity. Slit-like spaces between bacteria are filled with electron-dense matrix and cytoplasmic processes of various sizes and shapes (often branching) produced by the "sheath-cell". The cell ultrastructure and complex construction of the funicular bodies as well as multiplication of the bacteria in them suggest metabolic exchange between host and symbiont, involving the nourishment of bacteria. We suggest that the bacteria, in turn, influence the bryozoan mesothelial tissue to form the funicular bodies as capsules for bacterial incubation. We present ultrastructural data, discuss possible variants in the development of the funicular bodies in Bryozoa, and propose the possible role of bacteria in the life of their bryozoan host.

Comparative analysis of the nervous system structure of polymorphic zooids in marine bryozoans.

The nervous system structure was compared for the first time in avicularia and vibracula in seven species of the cheilostome bryozoans from six families by immunohistochemical methods and confocal scanning microscopy. Regardless of significant differences in heterozooid shape, size, and position in a colony, their muscular and nervous systems have a common structure, which suggests their parallel evolution.

[A rare concurrence of polymyalgia rheumatica and AA-amyloidosis]. / Redkoe sochetanie revmaticheskoi polimialgii s AA-amiloidozom.

Polymyalgia rheumatica (PMR) is a rare chronic inflammatory disease. It predominantly affects the elderly. The disease has a slow onset, pain and stiffness in the muscles of the shoulder and pelvic girdle, fever, weight loss, and a high acute-phase inflammatory response. The disease is concurrent with giant cell arteritis in a quarter of cases, which allows some authors to consider them as two different manifestations of the same pathological process. The kidneys are rarely involved. This disease is rarely complicated by AA amyloidosis. The authors describe a case of RPM in a patient who has developed secondary AA amyloidosis.

[Chronic HCV infection: An internist's opinion (Part 2)]. / Khronicheskaia HCV-infektsiia: vzgliad internista (II chast').

Hepatitis C virus (HCV) infection results in not only chronic hepatitis and subsequent complications as liver cirrhosis and hepatocellular carcinoma, but also in a significant number of other diseases, the so-called extrahepatic manifestations of chronic HCV infection. In addition to lymphoproliferative and autoimmune disorders discussed in Part 1 of this review, many other diseases turned to be associated with chronic HCV infection. Part 2 of this review is dedicated to the analysis of the relationship of chronic HCV-infection to the development of some endocrine diseases, such as thyroiditis and diabetes mellitus, and cardiovascular disorders. It also provides the characteristics of the currently available antiviral agents and considers whether they may be used in patents with extrahepatic manifestations of chronic HCV infection.

[Chronic hepatitis C virus infection: An internist's opinion (Part 1)]. / Khronicheskaia HCV-infektsiia: vzgliad internista (I chast').

Hepatitis C virus (HCV) infection results in not only chronic hepatitis and subsequent complications as liver cirrhosis and hepatocellular carcinoma, but also in a significant number of other diseases, the so-called extrahepatic manifestations of chronic HCV infection. This is because of viral hepatotropicity and lymphotropicity. The most striking example of the course of chronic HCV infection, in which the infectious and inflammatory processes are concurrent with autoimmune disorders and carcinogenesis, is mixed cryoglobulinemia and B-cell non-Hodgkin's lymphoma. The pathogenesis of these diseases is based on the clonal expansion of B cells, which occurs under their prolonged stimulation with the virus or viral proteins. Part 1 of this review is devoted to the analysis of a correlation of chronic HCV infection with lymphoproliferative and autoimmune disorders, as well as its association with kidney injury.