The time of blood sampling has an important role in the interpretation of TSH levels. Moreover, the high TSH circadian variability should be considered in discussions about the narrowing of its reference range.

<b><i>Introduction:</i></b> A number of classification systems (TIRADS) have been developed to estimate the likelihood of malignancy in thyroid nodules, but their reproducibility is yet to be assessed. We evaluated the interobserver variability and diagnostic performance of the TIRADS in Kwak’s modification (Kw-TIRADS) and European TIRADS (EU-TIRADS). <b><i>Methods:</i></b> Two independent specialists, blinded concerning the morphology of the nodules, evaluated ultrasound images of 153 thyroid nodules identified in 149 patients at multiple time points. <b><i>Results:</i></b> The interobserver agreement (Cohen’s κ) was 0.52 and 0.67 for Kw-TIRADS and EU-TIRADS, respectively, and rated as substantial. There were strong correlations between Kw-TIRADS and EU-TIRADS for the two observers with Spearman’s coefficients of 0.731 (<i>p</i> = 0.00025) and 0.661 (<i>p</i> = 0.0012), respectively. Sensitivity of Kw-TIRADS for the diagnosis of thyroid cancer was 95–92.31% and that of EU-TIRADS was 92.31–89.74%, with specificity of about 60% for both TIRADS. <b><i>Conclusion:</i></b> Despite the wide variability in the description of single ultrasonographic features, both Kw-TIRADS and EU-TIRADS may be a useful diagnostic tool in clinical practice.

Recent studies have shown that immune system cells take an active part in the regulation of metabolic homeostasis. Disruption of the interaction between the immune system and metabolic processes makes a major contribution to the current epidemic of a number of non-communicable metabolic diseases. Due to central and peripheral insulin resistance, obesity is closely associated with type 2 diabetes mellitus. Many mechanisms are involved in the genesis of insulin resistance including chronic inflammation in metabolically active tissues (adipose tissue, intestines, muscles, pancreas, liver), as well as in the central nervous system. Potential triggers of obesity-induced metainflammation are cellular hypoxia, mechanical stress of the fat cells, excess of free fatty acids and lypopolysaccharides. Weight loss is a key factor to eliminating inflammation and improving tissue insulin sensitivity. This review presents literature data on the mechanisms of metainflammation in obesity. Taking into account the contribution of metainflammation to the pathogenesis of the disease, the possibilities and prospects of obesity therapy are discussed.

The article describes a method for assessing the malignancy potential of thyroid nodules and their stratification according to the European Thyroid Imaging And Reporting Data System (Eu-TIRADS) scale based on ultrasound diagnostic images using an artificial intelligence system. The method is based on the use of transfer learning technology for multi-parameter models of convolutional neural networks and their subsequent fine tuning. It was shown that even on a small dataset consisting of 1129 thyroid ultrasound images classified by 5 Eu-TIRADS categories, the application of the method provides high training accuracy (Accuracy: 0.8, AUC: 0.92). This makes it possible to introduce and use this technology in clinical practice as an additional tool (‘second opinion’) for an objective assessment of the risk of malignancy in thyroid nodules for the purpose of their further selection for fine needle biopsy.

An active discussion of TI-RADS modifications (Thyroid Imaging Reporting And Diagnostic System) classification continues in the world professional medical community. This system of thyroid nodules stratification on the malignancy signs is intended primarily to select thyroid nodules for a fine needle aspiration biopsy. The classification should be uniform for all medical institutions of our country, easy to use and understandable by various medical specialists. This article presents a modification of TI-RADS prepared for discussion in the professional communities of Russia. Some “major” ultrasound features of malignancy (with specificity >95%) and additional or “minor” features (with specificity >90%) of thyroid nodules are pointed out to emphasise the need of fine needle biopsy. After comparison of diagnostic parameters of proposed TI-RADS and European TIRADS (EU-TIRADS), both systems showed comparable specificity of 93%, while sensitivity of proposed TI-RADS was slightly higher than for EU-TIRADS, with 94.2% and 91.0%, respectively. This discrepancy may be related to “minor” features of malignancy which were taken into consideration.

Subclinical hypothyroidism (SG) is a syndrome caused by a persistent borderline decrease in the level of thyroid hormones in the body, in which a normal level of T4 is determined in combination with a moderately elevated level of TSH. SG is the most common thyroid dysfunction.

The leading cause of systemic vascular complications in diabetes mellitus (DM) is partial damage to the vascular wall and hemorheological changes in the lumen of blood vessels against the background of chronic hyperglycemia. Vasoconstriction, edema, ischemia and tissue hypoxia develop as a result of these processes, which, in addition to increasing the risk of cardiovascular diseases, lead to impaired endoneural circulation. The use of a drug with an antihypoxant effect as a pathogenetic therapy in patients with type 2 diabetes mellitus (T2DM) and a subclinical stage of diabetic peripheral neuropathy (DPN1) makes it possible to slow down the progression of micro- and macrovascular complications, along with achieving sustainable compensation for diabetes.Aim. To assess the effect of a drug with antihypoxic effects (Actovegin®) on the parameters of macro- and microcirculation of the capillary bed, arterial stiffness and endothelial function in patients with T2DM and DPN1.Material and methods. A comparative study of macro- and microcirculation parameters, arterial stiffness and endothelial function in patients with T2DM and DPN1 before and after treatment with Actovegin® (group “A”, n = 20), and a group of patients with T2DM and DPN1 without Actovegin® treatment (group “B”, n = 20).Results. An improvement in the parameters of microcirculation was revealed: expansion of the arterial section of the capillaries during treatment with Actovegin®. In patients with reduced endothelial function during treatment with Actovegin®, there is a significant increase in its function, as well as a decrease in perivascular edema. Treatment with Actovegin® does not affect the indicators of central hemodynamics and indicators of arterial stiffness in patients with T2DM and DPN1.Conclusion. The results of the study clearly demonstrated that the use of a drug with an antihypoxic effect (Actovegin®) in patients with T2DM and DPN1 significantly improves the parameters of microcirculation, and, therefore, can be recommended as pathogenetic therapy at the earliest stages of diabetes development. Integral assessment of microcirculation parameters, as well as a new technology for determining the pulse wave velocity and endothelial function allows to identify patients in need of more intensive monitoring. Conducting this examination before the start of drug therapy can serve as a guideline in assessing the effectiveness of the treatment.

Bariatric surgery is among successful methods of obesity treatment, with effects going beyond weight reduction alone, but rather involving improved glucose tolerance, along with control or remission of the type 2 diabetes mellitus. The precise mechanisms causing metabolic effects of bariatric surgery are not fully elucidated, even though substantial evidence suggest that they include changes in the gut microbiota, bile acid homeostasis, and the close interactions of these factors. Intestinal microflora is directly involved in the energy metabolism of a host human. Obesity and type 2 diabetes mellitus are associated with certain changes in the species composition and diversity of intestinal microflora, which are considered important factors in the development and progression of these ailments. Bariatric surgery leads to significant and persistent changes in the composition of the intestinal microbiota, often bringing it closer to the characteristics of the microbiota of an average person with a normal weight. An important role in implementing the metabolic effects of bariatric surgery, primarily in the improvement of glucose metabolism, belongs to postoperative changes in homeostasis of bile acids. These changes imply close metabolism. Moreover, changes in the bile acid metabolism after bariatric surgery affect the microbiota of the host. Further study of these relationships would clarify the mechanisms underlying metabolic surgery, make it more predictable, targeted and controlled, as well as open new therapeutic targets in the treatment of obesity and associated conditions.