ВВЕДЕНИЕ: инциденталома гипофиза (ИГ) – объемное образование, случайно выявленное при прове- дении магнитно-резонансной (МРТ) или компьютерной томографии (КТ) головного мозга, не сопровожда- ющееся явными клиническими симптомами и нарушениями гормональной секреции. Стратегии лечения ИГ адаптированы к конкретному подтипу образования и могут включать хирургическую резекцию, меди- каментозную и/или лучевую терапию. Однозначно проблема лечения ИГ в рутинной практике не решена, выбор метода лечения возможен только на экспертном уровне. В связи с этим актуальной задачей является создание системы поддержки принятия клинических решений (СППКР) дифференциальной диагностики ИГ (пролактином, кортикотропином, соматотропином, гонадотропином, тиреотропином). ЦЕЛЬ: разработка СППКР дифференциальной диагностики ИГ для помощи специалистам в условиях реальной клинической практики. МАТЕРИАЛЫ И МЕТОДЫ: разработанная СППКР дифференциальной диагностики ИГ относится к клас- су интеллектуальных СППКР (иСППКР). Данная иСППКР основана на позициях федеральных клинических рекомендаций, для моделирования клинической логики рассуждения врача привлекались ведущие экс- перты ГНЦ РФ ФГБУ «НМИЦ эндокринологии» Минздрава России. При разработке алгоритма иСППКР анализировались: пол, возраст пациента, анамнез (наличие сахарного диабета, менопаузы и нарушений менструального цикла) и результаты гормонального исследования. Разработка алгоритма работы иСППКР осуществлялась с использованием бесплатного онлайн-редактора диаграмм DrakonHub (DRAKON Labs, Норвегия), а разработка самой автоматизированной системы осуществлена на языке программирования C# с помощью среды разработки Visual Studio.NET 2019 (Microsoft, США). РЕЗУЛЬТАТЫ: разработанная автоматизированная экспертная система на первом этапе анализирует наличие отклонений гормональных показателей путем сравнения их с референсными преднастроенными границами диапазонов. Проанализировав результаты первичного гормонального исследования, иСППКР может запросить дополнительные данные, которые необходимы для постановки решения. Например, при выявлении отклонения от нормы свободного кортизола суточной мочи, будет предложено внести данные о результатах малой дексаметазоновой пробы или кортизола в вечерней слюне. Система позволяет не толь- ко определить наличие гормональной активности ИГ и оценить таким образом тип опухоли (пролактино- ма, кортикотропинома, соматотропинома, гонадотропинома, тиреотропинома), но и дать рекомендации по дальнейшей тактике ведения пациента (наблюдение, лечение, дополнительные обследования). ВЫВОДЫ: дифференциальная диагностика ИГ является сложным процессом, что приводит к суще- ственной задержке в постановке правильного диагноза и, следовательно, к ухудшению исходов пациентов. Своевременная постановка диагноза важна для успешного лечения пациента и улучшения его прогноза. Разработанная автоматизированная экспертная система может помочь врачам-эндокринологам в рутин- ной клинической практике.

Objective: To evaluate the effectiveness and conduct a comparative analysis of consumer qualities of desmopressin intranasal drops 0.01% 5ml ("Biopharm", Georgia) in patients with central diabetes insipidus (CDI). Materials and Methods: The study included 9 patients (3 men and 6 women, mean age 44 ± 12 years) diagnosed with CDI. Patients for 7 days were switched to desmopressin intranasal drops 0.01% (JSC "Biopharm" Georgia) from there basal desmopressin preparations by means of recalculating daily dose by proposed formular: 10 mg (2 drops) of desmopressin intranasal drops = 0.2 mg of desmopressin tableted = 10 micrograms (one dose) of intranasal spray metered desmopressin = 120 mcg sublingual tablets of desmopressin. Safety biochemical parameters, efficiency to control of the main manifestations of CDI, increase in urine specific gravity, quality of life, basic consumer properties of different desmopressin preparation were evaluates at baseline and after treatment period. Results: Desmopressin nasal drops 0.01% showed to be an effective drug for the treatment of patients with CDI. Dose calculation algorithm daily was adequate in most patients. Hyponatremia was detected in 2 out of 9 patients during the study period but has been related to study drug alone in one case. The investigational drug was marked convenient to use by less than 25% of patients which may be associated with the pharmacological form of the drug as intranasal drops with special storage conditions (refrigerator). Conclusions: The drug desmopressin intranasal drops can be recommended as a second line (reserve) therapy in the treatment of patients CDI. Sodium levels should be checked during initiation of therapy.

The National Medical Research Center for Endocrinology (NMRCE) received the right to implement the development program of the World-class Research Centre “The National Center for personalized medicine of endocrine diseases” (NMCPMED). The objective of the NMCPMED will be not only the creation of a system of personalized treatment, but also the training of new specialists for medicine. Fundamental researches, carried out on the basis of the already existing institutes and laboratories of the NMRCE will be expanded by creating new laboratories of the NCPMED created de novo in accordance with the approved project. This article introduces the reader to the most important laboratories that would be created in NCPMED. These are laboratories of general, molecular and population genetics, bioinformatics, pharmacogenomics, microbiota, genome editing, mathematical and digital technologies, non-invasive technologies for the diagnosis of endocrinopathies, cellular technologies, artificial intelligence and a fundamentally new laboratory of metabolic visualization and radioteranostics. The authors hope that readers of one of the main journals for endocrinologists in our country will actively participate in the implementation of NMRCE, as both young and experienced talented researchers will have a chance to be a part of the Centre. To realize the ambitious implementation plans for the achievements of the Centre, it is necessary to radically change the worldview of the doctors in our country, to train them in a new way, and to expand the structure of the Center’s team by increasing the number of specialists in medical genetics, transcriptomics, biostatistics and bioinformatics, working at the intersection of experimental and clinical endocrinology, and ensuring the transit of innovative technologies into clinical practice. New laboratories of the World-Class Research Center, will become the place of routine work of a new generation of doctors, who possess not only the basics of clinical work, but also the skills of fundamental researches that will allow them to significantly improve the methods of diagnosis and treatment.

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года ПОИСК ПРЕДИКТОРОВ ЗЛОКАЧЕСТВЕННОСТИ ОПУХОЛЕЙ ОКОЛОЩИТОВИДНЫХ ЖЕЛЕЗ У ПАЦИЕНТОВ С ПЕРВИЧНЫМ ГИПЕРПАРАТИРЕОЗОМ Айнетдинова А .Р ., Крупинова Ю

Introduction. Respiratory syncytial virus (RSV) is one of the main causes of lower respiratory tract infections (LRTI) in infancy. In certain categories of children the risk of development of potentially lethal severe forms of the disease requiring hospitalization, treatment within resuscitation departments and use of artificial pulmonary ventilation is significantly higher than in any other category. Palivizumab is used to prevent RSV infection in such children; its high efficacy and tolerance were proved by numerous clinical trials. The aim of this study is to assess use of palivizumab for preventing the RSV-associated LRTI in children from the groups of high risk of severe course of this pathology from a clinical economic point of view in the course of a regular stage of RSV infection immune prevention program realized in Moscow in the season of 2012/2013. Materials and methods. The study involved detailed analysis of results of LRTI immune prevention with palivizumab in a sample of 189 case report forms containing information on the children who had received 3-5 injections of the drug. The estimated number of hospitalizations and deaths in this group of children in the absence of immune prevention was calculated in the model on the basis of results of the previously conducted studies of the RSV-associated LRTI course. The authors also calculated expenses on this group of children in the presence and absence of palivizumab immune prevention, expenses per 1 disability-adjusted life year and averted economic damage due to infantile mortality increase. Results. Use of palivizumab in the group under study has possibly prevented 39 hospitalizations, including 13 hospitalizations with medical care rendering at resuscitation and intensive care units, and 1 death. Immune prevention expenses in the group under study equaled to 33,518,514.60 rubles, whereas the estimated expenses in the absence of immune prevention equaled to 1,698,103.90 rubles. Cost effectiveness increment equaled to 461,165.37 rubles per 1 disability-adjusted life year, which is only slightly more than gross domestic product (GDP) per capita in the RF in 2012 (437,476.22 rubles) and significantly lower than the triple GDP per capita (1.3 mn rubles) – the cost-effectiveness threshold recommended by the World Health Organization for application of health preservation technologies. The averted economic damage per preserved life of 1 child equaled to 29,760,927.36 rubles. Conclusion. Use of palivizumab for preventing the RSV-associated LRTI ought to be considered clinically and economically sound.

The pathogenetic subtype of ischemic stroke (IS) in 204 cases of acute ischemic stroke was based on the results of clinical estimation, computer tomography, duplex scanning of brain vessels, electrocardiography, echocardiography and Holter monitoring. Initially, experts assigned a diagnosis of large-artery atherosclerosis to 59 (29%) patients, cardio embolic subtype to 51 (25%), small-vessel occlusion to 43 (21%), stroke of other etiology to 10 (5%), stroke of unclear etiology to 41 (20%). The TOAST computerized algorithm has been used for stroke subtypes diagnosis but it failed in 73% of the cases. Basing on artificial neural network, the authors developed the algorithm for determination of stroke subtypes by estimating probabilities for 3 IS subtypes: atherothrombotic, cardio embolic and lacunar. Its efficacy was proved by high diagnostic sensitivity of 97% (95% CI, 93% to 99%); positive predictive value--98% ((95% CI, 94% to 99%) and index of agreement with expert (K=0.955; 95% CI, 0.911 to 0.998).

The results of multicenter study of Rebif 22 micrograms in Russia have been reported. 167 multiple sclerosis patients have received Rebif 22 micrograms three times a week for 1 year. This study provides evidence for reduction of the relapse rate in patients with relapsing/remitting and secondary progressive multiple sclerosis. The tendency to the decrease of the severity of relapses, less need for steroid use and the decrease of EDSS score in patients with relapsing/remitting multiple sclerosis have been shown. In general Rebif 22 micrograms was tolerated well.

A relationship of the functional status of the viscera with the immune system was studied in 38 cardiac surgical patients with septic complications and multi-organ failure in the postoperative period. In deceased patients (n = 13), the total functional organ compensation index was lower whereas the total functional decompensation index was higher than those in survivors (n = 25). In the deceased patients, each vital organ was more commonly decompensated than that in the survivors, but a definite discrepancy was ascertained only in the immune system (92% versus 16%, p < 0.0001). The average number of decompensated organs was found to increase with the severity of immunological disorders. Therefore, there is a rather high correlation between the functional status of vital organs and the degree of immunological imbalance. The authors show it necessary to use immunity-corrective drugs (splenopid) to enhance the efficiency of treatment organ failure.