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Introduction. Studying the influence of music on the human brain is one of the key topics in neuroscience as it allows extending our understanding of brain neuroplasticity. This study aimed to investigate structural brain organization in professional musicians. Materials and methods. We investigated 27 brains (i.e. 54 hemispheres) of male musicians, female musicians, male non-musicians, and female non-musicians by magnetic resonance imaging. All study participants were aged 20 to 30 years and did not have any mental or neurological disorders. Gray matter volume and cortex thickness in different cortical structures of the right and left hemispheres were measured. Results. We found major changes in the brain structure in professional musicians (both male and female) vs. non-musicians. We found differences in the macroscopic structure of the triangular region in the Broca’s motor speech area in musicians’ brain. Increases in gray matter volume in the brain of musicians and its individual cortical structures were shown in the superior temporal region, Broca’s motor speech area, hippocampus, superior parietal lobule, and other structures. We found increased thickness of cortical structures in musicians vs. non-musicians. Conclusions. Practicing music regularly was shown to change structural brain organization; we found significant increases in gray matter volume and cortex thickness in various cortical structures in the right and left brain hemispheres of musicians vs. non-musicians.

Introduction. Premature ejaculation (PE) is the second most common male sexual dysfunction with a significant negative impact on quality of life. A significant number of conservative and surgical methods for the treatment of PE are proposed, but their effectiveness and, in some cases, safety, remain the subject of discussion.Objective. To study the effectiveness of pulsed radiofrequency impulse neuromodulation (RPN) with different modes on the penile dorsal nerve in treatment of patients with premature ejaculation.Materials & methods. Two groups of PE-patients participated in a prospective multicenter study: Group 1 — 11 patients aged 22 – 34 years; Group 2 — 12 patients aged 23 – 34 years. Group 1 received pulsed RPN at a temperature of 42°C, a stimulation frequency of 2 Hz, 45 V, and a duration of 180 seconds; in Group 2 — pulsed RPN at a temperature of 50 °C and the same frequency and duration of stimulation as Group 1. All patients before and after treatment measured intravaginal ejaculation latency time (IELT) and completed a premature ejaculation profile (PEP). The results were evaluated after 30 days.Results. In both groups, there was a statistically significant increase in IEDT and PEP. Thus, in Group 1, IELT increased from 58 to 101.9 seconds, PEP from 3.8 to 12.6 points. In Group 2, IELT increased from 66.5 to 210.9 seconds, PEP from 3.2 to 12.6 points. At the same time, in Group 2, IELT increased by 107% more than in Group 1. No significant side effects were observed in both groups.Conclusion. RPN appears to be a very promising treatment for premature ejaculation, as it is a minimally invasive, safe, and reversible procedure. The technique of influencing the penile dorsal nerve at an electrode temperature of 50 °C compared to 42 °C seems to be more effective, however, additional studies are needed.

An illustrated description of a new species Atractides turkestanicus sp. nov. from the Turkestan Region of Kazakhstan is given. Diagnostic features of the new species include the following characters: integument smooth; genital plate with 23–24 fine setae on each side, anterior margin straight; excretory pore smooth; P-2 with moderately large ventrodistal protrusion; P-3 longer than P-2, with four thick dorsal setae; P-4 sword seta between ventral setae; I-Leg-5 S-1- S-2 separation 12 μm.

The analysis of domestic and foreign literature on the epidemiology, etiology, and possible sexual transmission of urinary tract infections (UTI) was carried out. It has been established that more than 30 pathogens are currently classified as sexually transmitted infections (STI). The molecular genetic method has shown the identity of uropathogenic Escherichia coli in familial cases of UTI, which confirms the sexual route of infection transmission, which was not previously classified as a classic STI. Several works are cited that undoubtedly testify to the possible sexual transmission of Mycobacterium tuberculosis. Up to date, few reports of sexual transmission of UTI have been published, although tuberculosis is one of the most common infectious diseases worldwide. Perhaps because the partner of a patient with genital tuberculosis or other UTI is not actively evaluated. Thus, the possibility of sexual transmission may be underestimated. Sexual transmission of M. tuberculosis as well as uropathogenic E. coli is unlikely, but possible.

New records of one of the rarest longicorn beetle species of the Russian fauna, Pseudogaurotina magnifica (Plavilstshikov, 1958), in Primorskiy and Khabarovsk regions are presented. It was previously known only from three females, including two type specimens. A description of the male of this species that strongly differs from the female by the colouration of the legs and venter is given for the first time. The distribution area of P. magnifica covers at least more than half of the territory of Sikhote-Alin Mountain Range in the meridional direction, from the vicinity of Dalnegorsk in the south to the vicinity of Tumnin village in the north. The locality of the paratype of this species is established (Primorskiy Region, Sikhote-Alin Reserve, Serebryanka River basin, Serebryanyy Stream), while the locality of specimen in question, given by M.L. Danilevsky (Primorskiy Region, Serebryanyy Stream, about 60 km north of Nakhodka), is recognized as fictitious. The type locality of Gaurotina sichotensis Danilevsky, 1988 is designated (Primorskiy Region, eastern macroslope of the Sikhote-Alin, Kema River floodplain between the Gorelaya Polyana and the Yasnaya Polyana natural boundaries), whereas the type locality of this species indicated by M.L. Danilevsky (Primorskiy Region, western slope of the Sikhote-Alin) turned out to be fictitious as well. One of the two collected males of Pseudogaurotina magnifica in the Sikhote-Alin Reserve was found when shaking off a honeysuckle bush (Lonicera sp.). Based on this finding and some other data, it is assumed that this species is ecologically related to honeysuckle like the Carpathian endemic P. excellens (Brancsik, 1874). A strong morphological similarity between males of P. magnifica and males of Gaurotina sichotensis, a species that also inhabits the Sikhote-Alin Mountains, is noted. This fact seems to the authors very curious, although it is not excluded that G. sichotensis may be a synonym of P. magnifica.

Data on the frst records of males of Otiorhynchus pseudomias Hochhuth, 1947 and O. victori Davidian et Savitsky, 2006 are presented. Otiorhynchus pseudomias is a widespread in the Caucasus parthenogenetic species, occurring also in Crimea and in northeastern Turkey. One male of this species is recorded for the frst time in Abkhazia between Gumista and Kelasuri rivers. Otiorhynchus victori is a eyeless species, which was described based on a single female. One male of this species was collected for the frst time in Andreevskaya cave (Abkhazia), which is located near 7 km west of the type locality.

The present study explores the impact of gender on the use of apology strategies by Algerian speakers. Specifically, the research aims to identify the apology strategies utilized by male and female Algerian participants and to examine the potential influence of gender on such usage. The study employed a discourse completion task (DCT) as its methodological tool for data collection. The DCT included nine scenarios in which participants were required to provide an apology. Sixty participants, consisting of 30 males and 30 females, were recruited for the study. Both qualitative and quantitative analyses were employed to examine the data collected. To facilitate the analysis, a modified version of Blum-Kulka and Olshtain’s (1984) framework was applied, given its widespread usage and convenience in similar studies. The findings of the study indicate that male and female Algerian participants employed seven primary apology strategies, and gender influenced the frequency of their usage. These findings provide new insights into the role of gender in the choice of apology strategies in Algerian Arabic.

Based on folk tales of Northern European nations, Arnold’s poems ‘The Forsaken Merman’ (1849) and ‘The Neckan’ (1853), both tell a story of human women who marry sea creatures, mermen, and replace their home on the land with the mermen’s underwater world. By crossing the boundaries between their worlds, they cause numerous problems, most significantly the tension resulting from their different religious beliefs. In ‘The Forsaken Merman’, Margaret, the merman’s wife, fearing that her soul will be damned because of her marriage to a pagan, decides to rejoin the human world on the most important Christian holiday, Easter. In ‘The Neckan’, in order to comfort his wife, the Neckan goes to the human world to find a priest who would be willing to baptise him, but he is rejected because he is a ‘monster’ who cannot be saved. The paper will examine the way in which Arnold’s poems reflect the fears of the Victorian era as well as his own anxieties. This will be accomplished by comparing the two opposite worlds of the poems – the human world of everyday activities, rules, laws, and expectations; and the mermen’s home, the mysterious, colourful, and peaceful world of sea-beasts. In addition, the paper will analyse the reversal of traditional gender roles and re-examine literary, cultural, and social stereotypes. The paper will also attempt to find a connection between the main topics of these poems and Arnold’s life and career of a poet and literary critic.

State of the blue crab stock and production is considered for the Russian sector of the Bering Sea on the data of bottom trawl and trap surveys conducted by TINRO in 2005–2017 and fishery statistics. The commercial stock was assessed for 2018 by cohort analysis. The absolute majority of commercial males within the West Bering Sea fishing zone concentrated in two areas located at Koryak coast and at Cape Navarin, whereas the commercial aggregations were absent in the Olyutorsky Bay and Karaginsky Bay. The stock distribution between these two areas was unstable; recently the aggregation at Koryak coast increased to 72 % of the total number of commercial males in 2017. This dynamics is conditioned by both changes in reproduction and intensity of fishery. The total commercial stock of blue crab had increased since 2014 and reached the maximum of 18.133 × 106 ind. (males) in 2017 that exceeded significantly the level of 2005–2013. The blue crab fishery extends in the Bering Sea, since 2010 the portion of used TAC increased from approximately 93 % in 2011–2015 to 98 % in 2016–2017 and 99 % in 2018. State of the population is evaluated as satisfactory and stable.

An illustrated description of a new species Arrenurus pogorelkaensis sp. nov. from Yaroslavsky Region of Russia is given. Color red, cauda well developed, petiole very small without ligulate process, pentagonal, not extending beyond idiosoma posterior margin, hyaline membrane absent.

Introduction. For revascularization in the absence of autovenous material, epoxy-treated bioprostheses from the bovine internal mammary artery are widely used in the Russian Federation, which are subjected to certain structural deformations.Purpose and objectives. To compare the structural changes of the biological prosthesis and autovenes in the long-term period after surgery and to determine the influence of some clinical and laboratory parameters on this process.Materials and methods. The study included 45 patients with isolated occlusion of the superficial femoral artery (PBA), who underwent blood flow restoration using various types of prostheses. The patients were divided into 2 groups: group 1 (main) – 25 patients who underwent femoral-popliteal proximal bypass surgery with epoxy-treated bioprostheses from the bovine internal mammary artery; group 2 (control) – 20 patients who underwent femoral-popliteal proximal bypass surgery with a reversed autovena.Results and discussion. During the follow – up period from 1 year to 8 years, 28% of bioprostheses underwent expansion, and 20.0% of patients with autovena showed narrowing of the shunt. In the main group, males had better biological graft patency (RR = 0.76 CI (0.3 2; 1.77)), but in the control group, the male sex increased the risk of occlusion (RR = 1.25 CI (0.18; 8.77)). When followed up for 5 years, the relative risk of prosthetic expansion decreased. At the same time, in patients of the control group, which is not characterized by ectasia, we revealed a decrease in the relative risk of stenosis. The clinical factor affecting the expansion of the biological prosthesis was type 2 diabetes mellitus.Conclusions. The characteristic structural changes in the separated period (more than a year) for an autovenous conduit are narrowing, and for a biological prosthesis – expansion with the formation of aneurysms.

Pituitary carcinoma (metastatic neuroendocrine tumor of the pituitary gland) is the pituitary tumor with confirmed craniospinal and/or systemic metastases. These tumors are extremely rare accounting for only 0.1% to 0.5% of all pituitary tumours and are characterized by high mortality. In the presented case, pituitary carcinoma with intracranial metastasis was diagnosed in a young patient 25 years after manifestation of an aggressive recurrent prolactin-secreting pituitary tumor. Standard therapy (removal of metastasis, radiation therapy, cabergoline therapy) resulted in a long-term remission of the disease.

Laboratory diagnostic methods are the main tools in the practice of a doctor of any specialty, including an endocrinologist. Factors were identified that could change the concentration of the biologically active fraction of the test substance, subsequently complicating the interpretation of laboratory results and making the right clinical decision. The literature describes a variety of circulating autoantibodies involved in binding to pituitary hormones (prolactin (PRL), thyroid-stimulating hormone (TSH), growth hormone, luteinizing, follicle-stimulating, and adrenocorticotropic hormones), hypothalamus (vasopressin and oxytocin), pancreas (insulin and glucagon) , parathyroid glands (parathyroid hormone), as well as with thyroid hormones. As a rule, the resulting macromolecules lead to an increase in laboratory parameters, in which the prevailing fraction of the hormone does not have biological activity, which determines the main problem of this phenomenon. The most common variants include immune complexes with PRL and TSH, causing the phenomena of macroprolactinemia and macrothyrotropinemia (macro-TSH-emia/macro-TSH), respectively. Most laboratory test systems used in clinical practice are capable of determining only the total amount of PRL and TSH. The presented clinical observation describes a combination of the phenomena of macro-TSH and macroprolactinemia in a patient with autoimmune thyroiditis (AIT) and vitiligo.

Metastatic lesion of pituitary is a rare condition and is diagnosed in 1.8-4% of cases. Monitoring and treatment of such patients is a complex task and requires increased attention from a multidisciplinary team of specialists. The authors represent three patients with metastatic pituitary lesion who underwent neurosurgical treatment at the National Research Center of the National Research Institute of Endocrinology with subsequent pathomorphological confirmation of the diagnosis. The primary tumors were breast cancer, lung carcinoid, and clear cell kidney cancer. Two patients had distant metastases other than the pituitary gland. The clinical manifestation consisted in the appearance of symptoms of panhypopituitarism, chiasmal syndrome and mass effect in all cases. The follow-up period after surgical treatment was 0.25-2.5 years. Progression of the underlying disease was noted in two patients. One of them carried out stereotactic radiosurgical treatment and stereotactic oriented irradiation. One patient has a stable condition.

Background: Modern studies suggest that lifestyle changes of the indigenous Arctic residents lead to the loss of the "adaptive polar type of metabolism", which is characterized by the intensification of protein metabolism, optimization of lipid metabolism, and minimization of carbohydrate metabolism at low insulin concentrations. How to survive the era of change?, Aim: To assess insulinemia, glycemia, β-cell secretory activity, and insulin sensitivity in Arctic indigenous people in relation to their lifestyle., Materials and Methods: A cross-sectional study of a population of indigenous Arctic residents (Nenets, Komi) aged from 22 to 60 years was conducted. Insulin levels were studied in blood serum using ELISA, and glucose levels using the spectrophotometric method. Insulin resistance (HOMA-IR) and β-cell function (HOMA1-%β) indices were calculated., Results: 397 people were examined; 89 (22%) of them were nomadic people (NP) and 44 (49%) were male. Another 308 (78%) were sedentary people (SP), and 69 (22%) were male. The insulin level was significantly lower in NP (6.0 [3.5-11.8] µU/ml) compared to SP (8.3 [4.6-13.1] µU/ml), p=0.006. There was no difference in glycemia (4.6 [4.2-5.0] in NP and 4.6 [4.1-5.2] in SP) between lifestyles.The HOMA-IR was significantly lower in NP (1.3 [0.7-2.4]) than in SP (1.8 [0.95-2.8]), p=0.013. IR-HOMA >2 units was 1.8 times more frequent in the SP than in NP, with adjusted for sex, age, and BMI OR=0.56; 95% CI: 0.33-0.96, p=0.034. The median HOMA1-%β was 128 [67-241] % in NP and 144 [93-236]% in SP with no significant differences between groups. The proportion of individuals with HOMA1-%β <48.9 was 17% in NP versus 5% in SP, p<0.001. The adjusted odds of having HOMA1-%β <48.9 in NP are 3.5 times higher than in SP; 95% CI: 1.56-7.92, p=0.002. Fifty-six cases of glycemia ≥5.6 mmol/l were identified: 13.5% in NP and 14.3% in SP. The ratio IR-HOMA >2/ HOMA1-%β <48.9/BMI was 1.8 units/45%/25.2 kg/m2 in NP and 3.0 units/88%/29.6 kg/m2 in SP., Conclusion: Maintaining a nomadic lifestyle helps keep lower insulin concentrations; at the same time, glycemic levels in the groups were similar. In the NP group, there was a high proportion of individuals with low β-cell secretory activity, predominantly men; in the SP group, more individuals were insulin-resistant. Analysis of cases of glycemia ≥5.6 mmol/l confirmed, that hyperglycemia in a nomadic lifestyle was associated with β-cell hypofunction and the absence of obesity; on the contrary, in a sedentary lifestyle, it was associated with increased insulin resistance and obesity.

Background: Type 1 diabetes mellitus (T1DM) is the most common form of diabetes mellitus in childhood, where, unlike in adults, it accounts for more than 90% of all cases of diabetes. The constant change in the epidemiology of T1DM with significant differences in populations and regions requires systematic data collection and analysis for timely monitoring of T1DM trends., Aim: Analysis of the main epidemiological indicators of T1DM in children in the Russian Federation over the past 10 years - from 2014 to 2023., Materials and Methods: The object of the study was the data obtained from the federal statistical observation form No. 12 «Information on the number of diseases registered in patients living in the service area of a medical organization» for the period from 2014 to 2023. The prevalence (total number of registered cases) and incidence (cases with a diagnosis established for the first time) of T1DM (ICD-10 code: E10) were analyzed in children in three age groups: from 0 to 14 years, from 15 to 17 years, and combined from 0 to 17 years (inclusive)., Results: Over the analyzed period, the prevalence of T1DM increased steadily from 238.6 in 2014 to 374.2 cases per 100,000 children in 2023. The prevalence of T1DM in adolescents from 15 to 17 years was higher than in children and amounted to 120.3-203.2 cases per 100,000 adolescents, while in children under 14 years of age, the prevalence was 100.1-172.2 cases per 100,000 children. The annual increase in the prevalence of T1DM averaged 6.3% (95% CI 4.9-7.8). The incidence of T1DM during the analyzed period was 19.1-27.2 cases per 100,000 children and also had a general tendency toward an annual increase in new cases. At the same time, over the past three years, there has been a relative stabilization of incidence rates at 26.5-27.2 per 100,000 children. The annual increase in incidence averaged 4.9% (95% CI 0.9-8.9). The greatest increase in the incidence of T1DM was observed in regions with low incidence., Conclusion: The epidemiology of T1DM in the Russian Federation is characterized by significant regional and dynamic changes. Over the period 2014-2023, the incidence of type 1 diabetes in children has increased significantly, increasing annually by an average of 5%, while there has been a relative stabilization of incidence rates over the past three years.

The development of devices for continuous subcutaneous insulin infusion (CSII or insulin pumps) dramatically improved medical care for patients with diabetes mellitus. Insulin pump production widens annually resulting in number of new models entering the market, that differs in price but are similar in technical features. The entering of such new models to the Russian market can cause practical issues both in patient and in health care provider, so their estimation is of great importance. Insulin pump TruCare III (Apex Medical Co., Ltd, China) was registered in Russian Federation in September 15, 2023. The clinical experience of the TruCare III use in patients with type 1 diabetes mellitus is presented with the focus on glycemic parameters and custom features.

Cowden disease (Cowden syndrome) refers to PTEN-associated hamartoma tumor syndromes. It arises due to a mutation in the phosphatase and tensin homolog gene, one of the main functions of which is cell cycle regulation. The presence of a mutation in the gene leads to uncontrolled cell growth, and patients have a lifelong increased risk of neoplasms of various degrees of malignancy. This article presents a clinical case of Cowden syndrome with an early debut at the age of 7 years. The combination of macrocephaly (SDS of head circumference >2) with various skin manifestations (facial trichilemmomas, acral keratosis, papillomatous papules) and the presence of benign and/or malignant neoplasms are pathognomonic for Cowden syndrome. Of the malignancies, breast and thyroid cancer, colorectal cancer, renal cell carcinoma, and endometrial cancer are the most common. Thyroid carcinoma has been shown to have an earlier age of manifestation and often occurs already in childhood. This determines the need to screen patients with a proven mutation in the PTEN gene for nodal neoplasms from an early age. If surgical treatment is necessary, thyroidectomy remains preferable due to the frequent recurrence of nodules, as well as the uncertain potential for malignancy due to the low study of thyroid nodules in patients with mutations in the PTEN gene.

The purpose of our work was to assess the possibility of predicting the risks of postoperative complications in patients with urolithiasis in a urological hospital., Materials and Methods: We performed a retrospective comparative study. We analyzed the medical records of patients in the department of urology of hospital clinics of Siberian State Medical University from November 2022 to May 2023. A total of 48 records of patients who had a verified diagnosis of urolithiasis were selected. Inclusion criteria were the presence of stones in the kidney or ureter and surgical intervention during the current hospitalization. Exclusion criteria included bladder stones. All patients underwent surgery for urolithiasis. The laboratory range of studies included a general urine test before surgery, bacteriological examination of urine for microflora and sensitivity to antibacterial drugs before surgery, as well as bacteriological examination of stone obtained intraoperatively. Risk factors for antibiotic resistance were also assessed., Results: Of the 48 patients included in the study, urine and stone cultures did not reveal microflora growth in 26 (54.2%) patients. In the remaining 22 patients, we received different results: 1. only positive urine culture in 9 (18.8%) patients 2. only positive stone culture in 5 (10.4%) people 3. combination of positive bacteriological examination of urine and stone in 8 (16.7%) patients. Looking separately at 22 patients who had a positive urine or stone culture, or a combination of both, we noted that the combination of a positive urine culture with a positive stone culture and the combination of a positive urine culture with a negative stone culture were not significantly different and occurred in 36.4% and 40 .9% of cases, respectively, i.e. with a positive urine culture, there is an equal probability of about 40% of both an infected stone and a sterile one, while with a negative urine culture, an infected stone can occur in 22.7% of cases. In the early postoperative period, infectious complications were recorded in 3 (6.25%) patients. Complications were observed in 2 patients on the 4th day after surgery, and in one patient on the 2nd day. All three cases were postoperative pyelonephritis., Conclusions: Our small study demonstrated the importance of culture in planning surgical treatment for urolithiasis. And further study of bacteriological studies of urine before surgery, urine obtained from the renal pelvis intraoperatively, and stones represents new directions for creating algorithms for monitoring patients with urolithiasis, predicting complications in the postoperative period, as well as local protocols for perioperative antibiotic prophylaxis and antibacterial therapy for patients with urolithiasis.

Introduction: Prostatic hyperplasia (BPH) is one of the most common diseases of elderly and senile men. Its natural "evolution" leads to an increase in deformity disorders, gradual decompensation of the bladder and the progression of CKD. If the morphogenesis of BPH, as well as the patterns of adaptive and pathological restructuring of the lower urinary tract are described in the literature, then there is practically no evidence of adaptive processes in the prostate itself against the background of the growth of hyperplasia nodes. The purpose of the work: to study the features of morphological restructuring of prostate tissue and its vascular system in persons suffering from benign prostatic hyperplasia, with different levels of compensation for bladder function., Material and Methods: Autopsy material of 82 men aged 60-80 years was studied, divided into 4 groups: 25 men without GPH who died from causes unrelated to urological pathology; 25 men with GPH without clinical and morphological signs of bladder decompensation; 22 men with decompensated BPH, which is the main disease, where the immediate cause of death was chronic urinary retention, bilateral ureterohydronephrosis, CKD, uremia; 10 people who died from various causes, however, having a pathological diagnosis of BPH complicated by acute urinary retention. Fragments of the prostate gland were subjected to morphological examination. Histological sections were stained with hematoxylin-eosin, according to Mason and Hart, and also performed: overview microscopy, vascular morphometry and stereometry of the structural components of the prostate. In addition, an immunohistochemical study (IHC) was performed using mouse monoclonal antibodies to SMA. The results of the study. The formation and progressive growth of prostate nodes in elderly and senile men leads to a compensatory restructuring of the tissue of this organ. Its manifestation is hypertrophy of the smooth muscles of the prostate and the restructuring of the arterial bed, which provides trophism to the overly developed smooth muscles of the stroma. Over time, sclerotic processes progress in the prostate tissue, which, on the one hand, have an inflammatory genesis, and, on the other, have a senile dyscirculatory character due to atherosclerosis of the extraorgan arteries and restructuring of the intraorgan arteries in connection with long-term arterial hypertension. As a result, the prostate gland becomes not only enlarged in volume due to hyperplasia nodes, but also rigid due to fibrosis, which, along with hypertrophy of the smooth muscle component of the stroma, contributes to a further increase in resistance to urine outflow. An increase in the size of nodes, inflammatory edema of the organ, its sclerosis and petrification, as well as progressive reduction of the arterial bed, lead to the development of venous hyperemia and lymph circulation disorders, being a morphological prerequisite for acute urinary retention., Conclusion: In GPH, compensatory and adaptive processes occur not only in the detrusor, but also in the prostate gland, as well as its vascular bed. At the same time, aimed at ensuring the normal functioning of the organ in conditions of formation of hyperplastic nodes, they eventually lead to its pathological restructuring, themselves becoming the cause of impaired urine outflow, predetermining the dynamics of the disease and the occurrence of its complications.

THE AIM OF THE RESEARCH: is to present the features of the technique and results of intestinal reconstruction surgery of ureters., Materials and Methods: From 2001 to 2024 ileoureteroplasty was performed in 217 patients. The average age was 51+/-3.2 years. The ileum was used in 213 (98.2%) and the colon in 4 (1.8%) patients. The panel consisted of 85 men (39.2%), 132 women (60.8%). Unilateral ileoureteroplasty was performed 174 (80.2%), bilateral - 43 (19.8%). 41,8% of the operations were performed laparoscopically. The total number of operated ureters was 262, taking into account the doubled ones., Results: The early complications occurred in 18 (8.4%) patients. There were no fatal outcomes. Late complications were observed in 165 people between 3 and 254 months (average 66 +/- 2 months) after surgery. They developed in 16 (9.7%). The functional state of the upper urinary tract improved in 143 (86.7%), remained at the same level in 18 (10.9%) and worsened in 4 (2.4%) patients. On average, positive results of operations were obtained in 97.6% of cases., Discussion: The ureteral reconstraction surgery with its indicated in cases of extended constrictions and obliterations, when impossible to restore urine passage, remains one challenge of reconstructive urology today. The isolated segment of the ileum is the best and universal substitution plastic material for the replacement of ureteral defects of any localization and extent, including including bilateral cases. The isolated segment of the ileum was applied in 98.2% of patients. Most of these operations can be performed in laparoscopic manner., Conclusion: Reconstruction of the ureters by intestinal sites is an effective method of treating their extended constrictions. We have obtained good long-term results, a minimal number of postoperative complications and no fatal outcomes, which allows us to recommend the use of this operation in clinical practice.

Background: Throughout the course of transplantation oxidative stress is a major mediator of adverse outcome. The major objective of this investigation is to measure the total antioxidant capacity (T-AOC) and its correlation with immunosuppressive drug levels after kidney transplantation., Method: s: Thirty-five kidney transplanted recipients and thirty-five healthy subjects that matched for age were entered in this study. The obtained data were analyzed using the Statistical Package (SPSS Inc, Chicago, IL, USA). The significance level was set at P<0.05., Results: In healthy controls, the mean+/-SD for T-AOC was 91.9+/-16.6 (U/ml), that was significantly higher when compared to mean value of 27.3+/-24.1 (U/ml), kidney transplanted recipients (P less or equal 0.01). The mean value of tacrolimus levels was 13.7+/-5.3 (ng/ml). Correlation between tacrolimus trough levels and TAOC was 0.19 (P less or equal 0.14). There were not any significant differences regarding age in cases and controls (P less or equal 42)., Conclusion: The outcomes of this study suggested that within the limited sample size TAOC in kidney transplanted recipient was lower than controls. Further studies associated with TAOC and clinical outcome after kidney transplantation recommended.

Introduction: An inguinal hernia is frequently identified in men with prostate cancer, which is likely due to similar risk factors, including age, gender and smoking., Aim: To assess the safety and feasibility of performing concomitant robotic-assisted radical prostatectomy (RARP) and robotic-assisted transabdominal preperitoneal (TAPP) inguinal hernia repair., Materials and Methods: We retrospectively analyzed the treatment outcomes of 23 patients who underwent RARP between January 2022 and June 2023. All patients underwent RARP and robotic-assisted TAAP inguinal hernia repair using a polypropylene mesh implant., Results: The mean age was 70 years. Median prostate volume and preoperative prostate-specific antigen (PSA) were 52 ml and 8.0 ng/ml, respectively. In all cases the procedure was successful. The mean total duration of RARP and inguinal hernia repair was 147.17 and 26.01 minutes, respectively. The mean estimated blood loss and length of hospital stay was 171.96 mL and 7 days, respectively. In nine cases there was Clavien-Dindo grade 1 complications in the postoperative period; all complications were resolved conservatively. At a median follow-up of 12 months, there were no cases of mesh infection, seroma formation, or inguinal pain., Conclusions: Our results confirm the safety and feasibility of simultaneous RARP and robot-assisted TAPP inguinal hernia repair.

In half of the cases, a decrease in the quantity and/or quality of spermatozoa is the cause of infertility. The pathogenesis of such disorders is multifactorial, often unknown, and data on the treatment efficiency are still contradictory. Based on the recent high-level evidences (randomized studies and meta-analyses), the real clinical efficiency of various surgical and conservative treatment methods for the main clinical forms of male reproductive dysfunction, including hypo- and hypergonadotropic hypogonadism, secretory and obstructive azoospermia, retrograde ejaculation and anejaculation, pathospermia associated with varicocele, and idiopathic forms, is analyzed. An algorithm for managing patients with these disorders is proposed, which can be convenient in the routine practice of a urologists regardless of the level of equipment of a healthcare facility.

Introduction: The problem of male infertility is multifactorial. However, in recent years, the involvement of viruses, in particular human papillomaviruses (HPV), in the development of this condition has been actively discussed., Purpose of the Study: to study the effect of HPV in mono and mixed versions on ejaculate parameters., Materials and Methods: We analyzed the results of a survey of 105 patients aged from 22 to 40 years (average age - 32.3+/-6.4) with a diagnosis of infertility and pathospermia combined with PVI, with the absence of other risk factors., Results: The presence of several viruses in the ejaculate increased the degree of biochemical and cytopathomorphological disorders of sperm recorded in patients with HPV-associated infertility., Conclusions: a combination of several types of virus leads to a deterioration in the functional activity of Leydig and Sertoli cells of the testicles, characterized by a decrease in the synthesis of total testosterone levels and the development of qualitative and quantitative disorders of the ejaculate. This circumstance is due to the fact that with the association of several microorganisms, there is most likely an increase in the pathogenic potential of HPV.

Introduction: The most reliable method for bladder catheterization when necessary is to put a urethral catheter under visual control. However, this requires endoscopic equipment and transportation of patient to a cystoscopy unit or operating room, which is not always possible. To solve these problems, we have developed the optical urethral catheter Visus MG., Aim: To evaluate the safety and efficacy of a new optical urethral catheter with a portable endoscopic complex., Materials and Methods: The prospective single-center clinical study included men, in whom the first bladder catheterization with a soft urethral catheter was impossible. They underwent insertion of the optical urethral Visus MG catheter under visual control., Results: A total of 60 men were included in the study. The median age was 70 years, the average prostate volume was 40 cc. Successful repeated catheterization was performed in 57/60 (95%) patients. In 5% cases (n=3), bladder catheterization was unsuccessful due to urethral obliteration. In 53 (88.3%) men, various surgical methods or manipulations were previously performed, including temporary bladder catheterization in most cases (n=16; 30.7%). The cause of failure of primary catheterization were urethral strictures in 19 (31.7%), benign prostatic hyperplasia in 9 (15%), false passage in 10 (16.7%), bladder neck sclerosis in 10 (16.7%), urethal obliteration in 3 (5%), and the foreign body in the urethra in 1 case (1.7%). In 6 (10%) men, there were signs of iatrogenic urethral trauma with urethrorrhagia due to previous attempts of catheterization, which, however, did not prevent a placement of the urethral catheter under vision control in safe manner., Conclusion: Bladder catheterization with an optical urethral catheter Visus MG with a portable endoscopic complex was successful in 57/60 (95%) patients after failed primary catheterization, which indicates the high efficiency of the method. The advantages of the technology are its portability, mobility and direct visualization of the urethra.

This article presents our experience of performing a new laparoscopic method of radical orchiectomy. At the JSC "European Medical Center" in the period from 2022 to 2024 we performed laparoscopic radical orchiectomies in three patients with testicular cancer. All patients were examined on an outpatient basis, ultrasound and MRI of the scrotum, PET-CT scan were performed, and laboratory tests were carried out. Malignant testicular lesion was confirmed in all patients. All operations were performed in full volume, without complications during the operation and in the postoperative period. The duration of the laparoscopic surgery was comparable to the standard open technique. In the postoperative period the pain intensity in the area of surgery, the recovery period and the presence of complications were evaluated. CONCLUSION: Radical orchiectomy with laparoscopic assistance is a minimally invasive method of surgical treatment of testicular tumors, which allows to perform the removal of the testis and elements of the spermatic cord as radically and safely as possible, and also has pronounced advantages in the form of reduction of postoperative pain syndrome in the area of surgery (no more than 2 points on VAS), reduction of the recovery period and the risk of possible postoperative complications.

Introduction: Despite all the achievements of modern medicine, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remains a difficult disorder to treat. Patients are often dissatisfied with the treatment outcomes, since the main symptoms, namely pain and urination disorders, usually decrease, but do not completely resolve., Aim: To study the efficiency of the combined drug Prostatex Plus in the treatment of patients with CPPS (IIIb)., Material and Methods: A total of 60 patients with chronic abacterial prostatitis of category IIIb with a severe pain were included in the study. The main group included 37 patients, who received one suppository Prostatex Plus per rectum at night for 20 days. In the control group (n=23), patients received non-steroidal anti-inflammatory drugs and vitamins. The examination was performed at baseline, on the 20th day (upon completion of the Prostatex Plus therapy) to assess the immediate effect and 30 days after completion of cytokine therapy to assess the long-term results., Results: The average age of patients was 48.3+/-3.7 years. The duration of the disease ranged from 2 to 16 years, averaging 9.7+/-3.2 years. The leading symptom was pain in 100% of patients, the pain intensity was higher than 8 points. For all the assessed parameters, more significant positive results were obtained in the Prostatex Plus group, the effect of the treatment lasted for a month., Conclusion: The combined use of tamsulosin and organ-specific regulatory in patients with CP/CPPS with severe pain syndrome led to a stable effect. A significant decrease in pain intensity and the total score on the CP symptom scale was seen, as well as an improvement in local microcirculation, sexual function, an increase in the maximum and average urine flow rate compared to the control group. Satisfactory treatment outcomes led to an improvement in the quality of life.

The presence of foreign bodies in the lower urinary tract has always been an interesting topic. From time to time, every urologist encounters such patients in their practice. A large number of such observations are described in the literature. A clinical case of foreign bodies in the lower urinary tract in 9 children admitted from January 2020 to December 2023 to the Department of pediatric urology of the Chelyabinsk Regional Children's Clinical Hospital are presented in the article. The patients charts were analyzed retrospectively. The methods of introducing foreign bodies into the lower urinary tract, diagnostic pathway, as well as the treatment tactics were studied.

Aim: To evaluate the effect of microsurgical subinguinal varicocelectomy on sperm DNA fragmentation (SDF) in patients with elevated SDF levels (more than 15%) and clinical varicocele., Materials and Methods: A single-center, retrospective, observational, uncontrolled study was carried out. The results of a survey of 33 patients with clinical varicocele, infertility or recurrent miscarriage and sperm DNA fragmentation of more than 15% were analyzed. All patients in 2021-2022 underwent microsurgical subinguinal varicocelectomy at the clinic "Mother and Child Yaroslavl". The level of sperm DNA fragmentation was assessed before and 3 months after varicocelectomy using TUNEL assay based on flow cytometry., Results: The level of SDF before surgery ranged from 17 to 73% (Me [Q1-Q3]: 32% [21-42]). After 3 months, it ranged from 1 to 27% (14,4% [7,5-17,4]). The differences between the groups were significant (p <0.001). In all patients, SDF levels after varicocelectomy were lower compared to baseline. The differences ranged from 4 to 55% (19,1% [9,5-25,7]). In 21 patients (63.6%) SDF level after treatment did not exceed the upper limit of the reference interval (15%), and in 11 (35.4%) patients the postoperative values were higher than 15%. A significant (p<0.001) positive correlation (r=0.626) was revealed between the preoperative SDF level and the degree of reduction in sperm DNA fragmentation. However, no correlation was found with other preoperative indicators (varicocele degree, patient age, body mass index, side of varicocele)., Conclusion: Performing microsurgical subinguinal varicocelectomy in patients with an increased SDF level (more than 15%) allows reducing SDF within 3 months by an average of 19.1% and achieving normative values in 63.6% of men. The degree of reduction in SDF after varicocelectomy positively correlates with preoperative values.

The smoking negatively affects main sperm parameters and male fertility. Men of reproductive age (20-39 years old) make up less than half of male smokers. The decision to stop smoking is a rational element of lifestyle modification for a man planning fatherhood or man who are experiencing infertility. The use of electronic cigarettes (vaping) is often recommended as an alternative and an aid in the conventional cigarette smoking cessation process. In older men, the use of electronic cigarettes promoted as an aid for conventional cigarette smoking cessation, 40% of young vapers had never smoked before. Scientific data on the effect of electronic cigarette aerosol on the male reproductive system and spermatogenesis are currently limited. The analysis of the composition of liquids for electronic cigarettes and the resulting aerosols revealed more than 80 different compounds. This review presents new scientific data on the effect of the main components of electronic cigarette liquid on the male reproductive system and spermatogenesis. The paper presents the results of experimental studies proving the negative effect of electronic cigarette aerosol on the cellular organization of the seminal tubules and the system of hormonal regulation of spermatogenesis. Clinical studies have been analyzed. The results obtained do not allow us to assert that vaping is a safe alternative to traditional smoking in the case of a man planning fatherhood and preparing to conceive a child. The results do not allow us to consider vaping to be perceived as a safe alternative to traditional smoking in the case of a men planning fatherhood and men who are experiencing infertility.

Purpose: In this study, we compared the effects of a single patient dialysis fluid delivery system (SPDDS) against a continuous dialysis fluid delivery system (CDDS) on inflammatory markers and endotoxemia in a population of patients receiving routine hemodialysis (HD) at Ain Shams University., Materials and Methods: Eighty prevalent HD patients, ages 18 to 60, who were clinically stable and receiving thrice weekly dialysis treatments via an arteriovenous fistula were the subjects of a cross-sectional research. The study excluded patients with double lumen venous catheters used for hemodialysis, acute infections, cancer, and chronic liver disease. Two groups of patients were created by random selection: group I underwent HD using a CDDS water purification system that was implemented at El Demerdash Hospital two years prior, and group II underwent HD using an SPDDS water purification system at Ain Shams University Specialised Hospital., Results: In both groups, laboratory, inflammatory marker, and demographic data were gathered. Serum samples were taken before and after dialysis to assess the endotoxin levels in each group. Pre-dialysis endotoxin levels were significantly lower in the CDDS group (0.07+/-0.05) compared to the SPDDS group (0.20+/-0.07) with a P value <0.001, and post-dialysis serum endotoxin levels were significantly lower in the CDDS group (0.04+/-0.02) compared to the SDDPS (0.15+/-0.03) with a P value <0.001., Conclusion: According to our research, the CDDS groups circulating endotoxins had significantly decreased.

Reactive oxygen species are secondary messengers in multiple intracellular and tissue reactions, modulate the activity of mitogenic signaling pathways, and are formed predominantly in the course of metabolic activity. Both direct and indirect data on male reproductive dysfunction associated with SARSCoV-2 are described, as well as its possible pathophysiological and immunological explanations., Purpose: of the work: to evaluate the dynamics of lipid peroxidation and antioxidant protection in men after SARS-CoV-2 infection while taking an antioxidant complex., Results: In the observed patients, the components characterizing significant damage to metabolic homeostasis were analyzed in the blood plasma: the state of lipid peroxidation was judged by the level of compounds with double bonds, ketodienes and conjugated trienes, diene conjugates, and TBA-active products in the blood. The intensity of antioxidant defense processes was assessed by the concentrations of -tocopherol and retinol, as well as by the activity of superoxide dismutase. In the prooxidant-antioxidant system, the balance was restored towards antioxidant components in the group of patients after taking the antioxidant complex., Conclusions: the effectiveness of antioxidant correction largely depends on the degree of protection of the structure and function of cell membranes, as a result, the use of this drug is advisable, since it reduces the level of lipid peroxidation and enhances the antioxidant defense of the body.

Aim: To evaluate the automated medical decision support system "Sechenov.AI&#95;nephro" in the treatment of patients with renal parenchymal tumors., Materials and Methods: The beta version of the web-platform "Sechenov.AI&#95;nephro" consists of a neural network based on MONAI (Medical open network for AI) and a web interface, with algorithms classified based on segmentation data in manual mode using the 3D modeling program "Amira". A total of 441 patients with renal parenchymal tumors were included in the multicenter prospective study. Testing was carried out over 12 months in 3 urological centers: 358 (81.2%) patients from I.M. Sechenov First Moscow State Medical University, Moscow; 73 (16.6%) patients from Bashkir State Medical University; and 10 (2.3%) patients from Saratov State Medical University named after V.I. Razumovsky. In all cases, contrast-enhanced computed tomography (CT) was performed preoperatively. DICOM (Digital Imaging and Communications in Medicine) data of each patient's CT was uploaded to the web-platform "Sechenov.AI&#95;nephro" for automatic construction of a 3D model of the tumor. The work of the web-platform "Sechenov.AI&#95;nephro" was evaluated based on a questionnaire completed by surgeons who performed the surgical intervention. The questionnaire consisted of 14 questions, with a scoring system from 1 to 10 points. It was divided into 3 main sections, including first for assessment of the quality of work of the web-platform "Sechenov.AI&#95;nephro"; second for evaluation of the use of the 3D model in communication with the patient, for surgical planning and intraoperative navigation; and third for analysis of the choice of useful data display mode, errors in constructing the 3D model., Results: The questionnaire was completed in 253 (57.37% of 441) cases. The quality of 3D models was rated 7.8-9.4 points, and the use of the 3D model in communication with the patient, for surgical planning and intraoperative navigation was rated 7.8-9.4 points. The 3D models were constructed correctly in 70% of cases. The area of interest was the useful mode of 3D models display in surgical planning. Incorrectly constructed anatomical elements were veins in 25.5% and the tumor in 26.4% of cases, respectively., Conclusion: The automated medical decision support system in the treatment of patients with renal parenchymal tumors "Sechenov.AI&#95;nephro" demonstrated satisfactory quality of 3D reconstruction of pathological process. 3D models allow for personalized determination of the surgical tactic for treating patients with renal tumors.

Background and Objectives: Dyslipidemia is prevalent among patients with chronic kidney disease on maintenance hemodialysis. A high LDL is a known indicator of major adverse cardiovascular outcomes, but levels may be affected by malnutrition. A high TG/HDL ratio is another indicator of hard cardiovascular outcomes that should be sought carefully., Patients and Methods: This was a cross-sectional study conducted on 111 patients on maintenance hemodialysis attending the hemodialysis unit at Basrah Nephrology and Transplantation Center at Al-Sader Teaching Hospital from September 1, 2022, to March 1, 2023. A high LDL is defined as > 60 mg/dl, and a high TG/HDL ratio is defined as >2., Results: Among 111 patients with CKD on maintenance hemodialysis, high LDL was prevalent in 59.1%, and high TG/HDL ratio in 64.5%. Their mean ages were 52.6+/-15.7 years, 51.4% were males, and their BMIs were 25.2+/-5.6. Thirty-nine patients (35.1%) were on Aspirin (ASA), 49 patients (44.1%) were on Statins, eight patients (7.2%) were on Fibrate, and 11 patients (9.9%) were on Omega-3 fatty acids. No correlations were found between serum LDL and serum TG/HDL ratio with clinical and laboratory characteristics. A non-linear correlation between serum LDL and TG/HDL ratio was reported., Conclusions: A high TG/HDL ratio should be sought and addressed carefully among patients with CKD on maintenance hemodialysis, as low LDL may be misleading in those populations.

Introduction: An evaluation and prognosis of complications of different treatment options in patients with staghorn stones are necessary to choose optimal surgical strategy and perioperative prophylaxis on individualized basis. Intra- and postoperative thrombotic and hemorrhagic complications are not still well-studied in modern operative urology., Aim: To explore the influence of morpho-densitometry changes of blood platelets on perioperative thrombotic and hemorrhagic complications in patients with staghorn nephrolithiasis after percutaneous nephrolithotomy (PCNL)., Materials and Methods: Data of 292 patients aged from 20 77 (mean 53,4+/-12,3) yrs after PCNL with staghorn stones were included in the retrospective study. We used a method of quantitative phase imaging of peripheral blood platelets on the domestic microscopic phase interference device MIM-320 ("Amphora", Moscow, Russia). Particular functional activity of 4 morphologic types of living cells based on a degree of activity was evaluated., Results and Discussion: In patients with staghorn stones, significant morpho-functional changes in the platelets were observed: the average cell diameter exceeded the control values by 1.2 times, the perimeter by 1.4 times, the area by almost 2 times, and the volume by 1.3 times. The state of platelet hemostasis in patients with staghorn stones can be assessed as a state of "stress with elements of decompensation". Intraoperative examination of platelets showed a decrease in cell size (diameter, perimeter, area, and volume) with a slight increase in their phase height, possibly due to cell spherization as a stage of preparation for their activation. These changes persisted on the 3rd and 5th days after surgery. A positive correlation was found between the size of the stone and platelets type 3 intraoperatively (r=0.590, p<0.05). The duration of the surgery positively correlated with platelets type 4 on the 5th day after surgery (r=0.646, p<0.05), a negative correlation was found with the height (r= -0.767, p<0.05) and platelets type 2 (r= -0.747, p<0.05) on the 5th day. The time of ultrasonic stone fragmentation positively correlated with platelet type 4 intraoperatively (r=0.740, p<0.05), mean diameter (r=0.610, p<0.05), perimeter (r=0.628, p<0.05) and area (r=0.710, p<0.05) of platelets on the 5th day. Intraoperative bleeding positively correlated with platelet type 2 in patients preoperatively (r=0.7312, p<0.05). A history of type 2 diabetes mellitus (T2DM) positively correlated with the area of platelets intraoperatively (r=0.615, p<0.05), as well as the perimeter (r=0.592, p<0.05), 2nd (r=0.635, p<0.05) and platelet type 3 (r=0.592, p<0.05) on the 3rd day, the area (r=0.615, p<0.05) and volume (r=0.717, p<0.05) of platelets on the 5th day, and the platelets type 2 (r=0.590, p<0.05) on the 5th day. A negative correlation was observed between T2DM and platelet type 1 (r= -0.720, p<0.05) on the 3rd day. Preoperative thrombin time negatively correlated with platelet type 3 before surgery (r= -0.712, p<0.05). Preoperative platelet counts negatively correlated with platelet area on day 5 after procedure and the presence of T2DM., Conclusion: Morpho-densitometric parameters of peripheral blood platelets objectively reflect the functional adequacy of this component of hemostasis. Platelet anergy, i.e. the absence of platelet response to external intervention (surgery), is evidence of a decompensated state of the platelet component and can serve as a prognostic risk factor for the development of intra- or postoperative bleeding.

Aim: To present the four-year experience and the accomplishments of the Scientific and Practical Cardio-Oncology Center of the Sechenov University., Material and Methods: The records of patients referred for cardio-oncology consultation from January 2020 through March 2024 were retrospectively analyzed. The patients' cardiovascular (CV) status was assessed at baseline and after optimizing the cardiac therapy during the antitumor treatment. The endpoints were the completion of all antitumor therapy courses and the level of overall and CV mortality., Results: Among 233 enrolled patients (66% women), a considerable part belonged to the group of high/very high cardio-oncological risk (n=134, 57%). Various cardiovascular toxicities were observed in 22% of patients. At baseline, these patients significantly more frequently had heart failure and ischemic heart disease as well as previous radiation and chemotherapy. After the optimization of cardiac therapy, 88% of patients successfully completed all scheduled treatments. The overall mortality, including the CV mortality, was 14% (n=7)., Conclusion: Creation of cardio-oncological services allows considerably reducing the probability of adverse CV events during the antitumor therapy and successfully completing all scheduled treatments in most patients..

Aim: To analyze the relationship between the occurrence of atrial fibrillation (AF) and thyroid dysfunction caused by low concentrations of free triiodothyronine (FT3), free triiodothyronine and free thyroxine (FT3 and FT4), and high concentrations of free thyroxine (FT4) with normal values of thyroid-stimulating hormone (TSH) in experiments on outbred rats., Material and Methods: The pathogenesis of AF with low concentrations of FT3, FT3 and FT4, and a high concentration of FT4 was studied in an experiment on 146 outbred rats. In the experiment, hypothyroidism, euthyroidism, and thyrotoxicosis were modeled by changing the concentrations of thyroid hormones, and the effect of these conditions on ECG and the incidence of AF was evaluated., Results: The types of the hypothalamic-pituitary-thyroid system response to the L-thyroxine administration in experimental hypothyroidism were identified. A relationship was determined between AF paroxysms and threshold values of thyroid hormones at low concentrations of FT3, FT3 and FT4, and a high concentration of FT4 with normal TSH values. It was shown that achieving the euthyroid status did not reduce the incidence of AF paroxysms by more than 70.0%., Conclusion: In AF with low FT3, low FT3 and FT4, and high FT4, the dose of L-thyroxine must be adjusted.

Aim: To study the factors that influence the occurrence of postoperative atrial fibrillation (POAF) in patients with chronic ischemic heart disease (IHD) after coronary artery bypass grafting (CABG)., Material and Methods: This single-center prospective observational non-randomized study included 152 patients with chronic IHD. Mean age of patients was 64.4±5.9 years. All patients after CABG were divided into two groups based on the occurrence of atrial fibrillation (AF) in the early postoperative period: group 1, with POAF (n=43; 28.3%) and group 2, without POAF (n=109; 71.7%). The primary study endpoint was new-onset POAF in the early postoperative (hospital) period after CABG. The secondary study endpoint was in-hospital postoperative complications (non-fatal/fatal acute coronary syndrome (ACS), non-fatal/fatal stroke, major bleeding, death)., Results: Patients with POAF had significantly more pronounced structural and functional changes in the heart than patients with preserved sinus rhythm after CABG: larger left ventricular (LV) volume, greater LV myocardial mass, lower LV systolic function parameters and impaired diastolic function, and an enlarged left atrial (LA) cavity. Analysis of in-hospital complications did not show any differences between the groups associated with the development of POAF. The following risk factors for POAF were identified: age older than 65 years (p=0.022), body mass index ≥30.5 kg/m2 (p=0.020), epicardial adipose tissue thickness &gt;10.5 mm (p=0.015), indexed LA volume &gt;33 ml/m2 (p&lt;0.001), LV myocardial mass index &gt;115 g/m2 (p=0.042), left main coronary artery disease &gt;50% (p=0.043), duration of cardiopulmonary bypass during CABG &gt;60 min (p=0.019), blood potassium concentration in the early postoperative period after CABG (on the first day) &lt;3.6 mmol/l (p&lt;0.001), and pericardial effusion volume in the early postoperative period &gt;88 ml (p&lt;0.001)., Conclusion: Determining the risk of developing POAF is important and necessary for the closest monitoring of a patient with chronic IHD in the postoperative period.

The article presents a clinical case of perioperative non-ST-segment elevation myocardial infarction in a patient with primary metasynchronous cancer of the rectum, stomach and bladder, which developed during simultaneous surgical intervention in the volume of proximal gastrectomy and abdominoperineal extirpation of the rectum. Fluctuations in blood pressure and imbalance in the hemostasis system at the stages of anesthesia and surgery in a patient with severe systemic atherosclerosis caused the development of myocardial ischemia in the area of significant coronary stenosis. Emergency coronary angiography detected subtotal stenosis of the anterior descending artery; stenting of the affected area of the coronary artery was performed. Monitoring of hemodynamic parameters and changes in the hemostasis system during the optimal antianginal therapy allowed to bring the patient out of critical condition and discharge him from the hospital on the 18th day.

Aim: To study the concentration of immunoglobulin free light chains (FLCs) in patients with myocarditis in comparison with non-inflammatory heart diseases, their relationship with inflammatory markers and the severity of chronic heart failure (CHF)., Material and Methods: This study included 77 patients (31 women, mean age 54.1±13.3 years): 41 patients with myocarditis verified by myocardial biopsy (n=18) or using a noninvasive diagnostic algorithm, 31 patients with noninflammatory CHF (comparison group), and 5 patients with monoclonal gammopathy identified during the study (4 of them were diagnosed with AL amyloidosis with heart damage). In the myocarditis group, CHF was diagnosed in 29 patients, mean stage IIA, functional class (FC) 2-3, with a mean left ventricular ejection fraction 43%. In the comparison group, patients had predominantly IIA stage, FC 2-3 CHF without systolic dysfunction. The blood concentration of kappa and lambda FLC types was measured with Cloneus S-FLC-K TIA Kit and Cloneus S-FLC-L TIA Kit. Concentrations were considered normal at FLC-kappa 4.84-14.20 mg/l, FLC-lambda 7.03-22.50 mg/l, and the FLC-kappa/lambda ratio 0.426-1.050., Results: Increased FLC concentrations were found in 58% of patients with myocarditis and in 77% of patients in the comparison group. The FLC-lambda concentration was significantly higher in the comparison group; there were no significant differences between the groups in FLC-kappa and their ratio. The closest significant correlations in both groups and the entire cohort were noted between FLCs of either type and CHF, as well as the requirement for loop diuretics (correlation coefficients, 0.60-0.90), independent on the severity of systolic dysfunction. Myocarditis patients also showed correlations of FLCs with the titer of antibodies to cardiomyocyte nuclear antigens, levels of C-reactive protein, leukocytes, neutrophils, erythrocyte sedimentation rate, and the concentration of N-terminal fragment of brain natriuretic peptide. In a subgroup of 10 myocarditis patients who were treated with immunosuppressants, FLCs of both types were significantly lower than in the comparison group; only with the persistence of severe CHF was an increase in FLCs noted., Conclusion: An increased FLC concentration can be considered as an important pathogenesis component that reflects both the specific mechanisms of myocarditis and the severity of CHF. In the absence of a statistically significant increase in general inflammatory markers in the blood of myocarditis patients, the measurement of FLCs can be used as an additional diagnostic marker and predictor of the decompensated variant of the course of myocarditis. However, the diagnostic and prognostic significance of FLC concentration in patients without CHF requires a further study.

Dilated cardiomyopathy (DCM) is a leading cause of heart failure, sudden cardiac death, and heart transplantation in young patients. The causes of DCM are varied and include genetic factors and metabolic, infectious, toxic and others factors. Today it is known that germline mutations in more than 98 genes can be associated with the occurrence of DCM. However, the penetrance of these genes often depends on a combination of factors, including modifiable ones, i.e. those that change under the influence of the environment. About 20-25% of genetically determined forms of DCM are due to mutations in the titin gene ( TTN ). Titin is the largest protein in the body, which is an important component of the sarcomer. Although titin is the largest protein in the human body, its role in the physiology of heart and disease is not yet fully understood. However, a mutation in the TTN gene may later represent a potential therapeutic target for genetic and acquired cardiomyopathy. Thus, the analysis of clinical cases of cardiomyopathy in patients with identified mutations in the TTN gene is of great scientific interest. The article presents a clinical case of manifestation of DCM in patient with a revealed pathogenic variant of mutation in the gene TTN and reverse left ventricular remodeling of the against the background of optimal therapy of heart failure in a subsequent outpatient observation.

Background: Arterial hypertension (AH) remains the leading risk factor associated with cardiovascular diseases (CVDs), cerebrovascular disease and chronic kidney disease. About 70% of patients with AH who are on monotherapy cannot achieve blood pressure (BP) targets, and therefore all quidelines for the management of AH have recently recommended prescribing combination therapy (PCT). In real clinical practice (RCP), there remains significant uncertainty in the effectiveness and rationality of therapy, despite the wide availability of antihypertensive drugs (AHD) and the presence of recommendations for a stepwise approach to prescribing combinations of specific groups of AHD in different clinical situations., Aim: Analyze the real ongoing antihypertensive therapy, including the PCT; international nonproprietary names of drugs and their dosages in RCP; compliance of therapy with clinical recommendations; changing trends in the PCT., Materials and Methods: An analysis was carried out of the data from the register of AH, the compliance of treatment in different clinical groups of patients and the achievement of BP and low-density lipoprotein cholesterol targets in the sample of 2019-2022 ( n =5012). The prescription of AHD and achievement of targets values were assessed in accordance with current clinical guidelines for the management of AH and hypercholesterolemia. Data from 2010 ( n =7782) and 2020 ( n =3061) were analyzed to assess the dynamics of prescription of monotherapy and PCT., Results: The greatest increase in the number of AHD was observed in patients with hypertension in combination with coronary heart disease, heart failure, and atrial fibrillation. In a small group of patients with hypertension without other CVDs, the recommended combinations of AHD were not prescribed; preference was given to angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and β-adrenoblocker (β-AB). PCT mainly differed from the recommended combinations by the wider use of drugs from the β-AB group. The PCT of recommended drugs was highest in patients with hypertension and coronary artery disease - more than 90%, hypertension and heart failure in 56.2%, hypertension and atrial fibrillation - 33.3%, hypertension and chronic kidney desease - 19.6%. Achievement of BP and low-density lipoprotein cholesterol targets was insufficient in all analyzed groups. Among the international nonproprietary names of drugs, the most frequently prescribed are the following: bisoprolol, metoprolol, lisinopril, perindopril, losartan, spironolactone, amlodipine, torasemide, indapamide, hypochlorothiazide, moxonidine. The prescribed daily dosages were closer to the initial recommended ones. By 2020, the prescription of PCT with β-AB and a more uniform prescription of various combinations will come to the fore, while PCT in 2010 is characterized by the presence of one or two leaders combinations., Conclusion: The described features of prescribing AHD partially reproduce clinical recommendations for the management of AH. Differences in therapy provided in RCP may be associated with an attempt to intensify the treatment of hypertension in patients with other concomitant CVDs. At the same time, analysis of combinations and dosages of prescribed drugs suggests the presence of wide opportunities for further escalation of therapy. The presented data can provide insight into current patterns of antihypertensive therapy prescription in patients in RCP and lay the foundation for optimizing therapy in different categories hypertensive patients.

Aim: To analyze the experience of Chazov National Medical Research Center of Cardiology in patient selection for left ventricular assist device (LVAD) implantation., Materials and Methods: 901 patients, whose documents were sent to Chazov National Medical Research Center of Cardiology from regional medical and prophylactic institutions, were screened as selection for LVAD implantation. Firstly, all patients underwent transthoracic echocardiography performed according to the extended protocol with a comprehensive assessment of the left and right ventricle size and function. Patients who underwent the screening procedure underwent further examination including both laboratory and instrumental diagnostic methods. In addition, the polyclinic database of patients diagnosed with chronic heart failure (CHF) and dilated cardiomyopathy was also analyzed., Results: Among 901 screened patients 7.9% were suitable candidates for LVAD implantation and only 23 (2.6%) patients underwent surgery. Among those not eligible for surgery: 208 (29%) patients were not on optimal medical therapy, 15% of patients had indications for other surgical treatment of CHF, 12% of patients had severe right ventricular failure, 9.8% had severe comorbidities, 6.8% of patients refused surgery., Conclusions: The main problems of selection for LVAD implantation were: low awareness of doctors about the introduction of new treatment methods, poor quality of transthoracic echocardiography, a large percentage of patients not receiving basic therapy for CHF, untimely referral of patients for other types of surgical treatment.

Aim: To evaluate the long-term safety and efficacy of goflkicept treatment in patients with idiopathic recurrent pericarditis (IRP)., Materials and Methods: This report presents the interim analysis of an ongoing open-label extension (OLE) clinical trial of goflkicept in patients with IRP (NCT05673902), as a continuation of the core study (NCT04692766). The study assessed the frequency of pericarditis recurrence, time to recurrence after 12 and 60 weeks of goflkicept therapy, changes in C-reactive protein level, chest pain intensity, pericardial effusion size, and adverse events (AEs)., Results: All patients remained in clinical-laboratory remission during the 60 weeks of goflkicept treatment. The recurrence frequency was 31.3% (5/16) after 60 weeks and 90% (9/10) after 12 weeks of goflkicept treatment (p<0.001). A total of 64 AEs were reported in 16 patients (94.1%), mostly of mild to moderate severity. The most common AEs were infections, occurring in 11 patients (64.7%). Nine serious adverse events were reported in 5 patients, none of which were considered drug-related. There were no deaths., Conclusion: Long-term goflkicept therapy resulted in a significant reduction in the risk of recurrence and prolonged remission without an increase in adverse events.

Aim: Evaluation of genes polymorphisms frequencies of angiotensinogen (AGT), angiotensin converting enzyme type 1 (ACE1) and angiotensin II receptors type 1 (AGTR1) and type 2 (AGTR2) in patients admitted with coronavirus disease (COVID-19) and its association the severity of severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2)., Materials and Methods: The study included 100 patients admitted to the hospital with a laboratory-confirmed diagnosis of COVID-19. All patients were identified with alleles and genotypes of polymorphic markers rs4762 of the AGT gene, rs1799752 of the ACE1 gene, rs5186 of the AGTR1 gene and rs1403543 of the AGTR2 gene. The frequencies of each polymorphisms were compared with population. Statistical processing was performed using the Statistica 8.0 software package., Results: In evaluated cohort there was higher frequency of D-allele ACE1 rs1799752 compared to population. Depending on the availability of criteria for the severity of coronavirus infection, 44 (44%) patients were diagnosed with severe, 56 (56%) with moderate course. The groups did not significantly differ in age, gender, cardiovascular risk factors and comorbid pathology. In the groups with severe and moderate course, the same distribution of genotypes and alleles of AGT rs4762, AGTR2 rs1403543 and ACE1 rs1799752 was revealed. For the I/D alleles of the ACE1 rs1799752 gene, a significant deviation from the papulation was found in both the group of severe and moderate COVID-19. In the group with a severe course of the disease, a higher frequency of the mutant C-allele of the AGTR1 rs5186 gene was detected. In the same group, a deviation in the frequency ratio of A and C of the AGTR1 rs5186 alleles from Hardy-Weinberg Equilibrium was found. When calculating the risk of severe COVID-19 in the presence of the C-allele compared with the A-allele, an odds ratio 2.092 (95% confidence interval 1.066-4.108) was obtained., Conclusion: The data obtained suggest that the genes polymorphisms of the components of renin-angiotensin-aldosterone system, namely D-allele of ACE1 rs1799752 and C-allele of AGTR1 rs5186, may make it possible to identify groups of patients predisposed to the development of more severe COVID-19.

Aim: To analyze the relationship between metabolic disorders and obesity with hemodynamic parameters and the severity of the condition of patients with chronic thromboembolic pulmonary hypertension (CTEPH) based on the POLET register., Materials and Methods: The study included patients with CTEPH from the POLET register. Data from medical history, lipid profile, glycemia, uric acid level, weight, height, functional class (FC), distance in the 6-minute walk test (6MWT), echocardiography, and right heart catheterization were used for analysis., Results: The study included 84 patients 60±14 years old, including 45 men. The majority of patients had FC III - 51 (65%), which corresponded to 6MWT - 338±113 m. Nineteen (23%) people had experience in taking PAH specific therapy, 37 (46%) had cardiovascular comorbidity. In the general group, the body mass index (BMI) was 25.7±4.5 kg/m 2 , and normal glycemia, lipid profile, and uric acid levels were also determined. mPAP was 51±12 mmHg, RA area was 25.5 (20; 30) cm 2 . Correlations were identified between: RA area and the level of total cholesterol (r=0.60; p <0.01), triglycerides (r=-0.24; p <0.001), LDL cholesterol (r=0.75; p = 0.04), uric acid (r=0.75; p =0.03); total cholesterol and 6MWT (r=0.44; p =0.04). Analysis of metabolic disorders, FC and comorbidity revealed differences between FC III and IV groups in the level of HDL cholesterol ( p =0.02) and triglycerides ( p <0.01)., Conclusion: The POLET registry includes mainly older patients. Severe FC (87% - III and IV) may be a result of the older age and the presence of concomitant pathology in almost half of the patients. The discovered relationships between the area of RA and FC with lipid and purine metabolism were discovered for the first time, however, they correspond to the direction of the world scientific researches, are important due to the use of these indicators in the scale for calculating the risk of death in patients with PAH and require further development.

In the context of an aging population in megacities, it is important to maintain the health and activity of older people, improving their quality of life. To do this, it is necessary to study the factors affecting longevity, including individual health characteristics and perception of the health system (accessibility, responsiveness, effectiveness, ageism)., The Purpose of the Study: to identify an assessment of the quality of life of elderly Muscovites and the influence of factors related to health and the assessment of the health care system on it., Materials and Methods: a sociological survey, descriptive statistics, correlation analysis, and a z-test were used to compare the proportions of variables., Results: an assessment of the quality of life and its components based on questionnaires showed that health is a key factor for the elderly, although its assessment was low. 47% of the elderly are committed to healthy lifestyle, of which 40% regularly exercise. 25% have bad habits, 26% are disabled, which reduces the quality of life. 18% seek medical help on a monthly basis. Those who go to doctors less often rate the quality of life higher (p m 0.001). Satisfaction with the last medical visit is higher than with the healthcare system as a whole., Conclusion: the study revealed a link between healthy lifestyle and the quality of life of the elderly. Regular physical activity improves quality of life by reducing hypochondria and potentially offloading the healthcare system. Satisfaction with the health care system also affects the quality of life and requires an increase in the availability of medical care.

Knowledge of the epidemiology of Duchenne muscular dystrophy is advisable for planning measures to improve the diagnosis and treatment of this disease. Purpose: to study the epidemic situation of Duchenne muscular dystrophy, as well as the average age of its diagnosis in the Russian Federation. The problem of accuracy of statistical estimates is due to heterogeneous diagnostic criteria. The development of unified diagnostic criteria (male gender and mutation carrier) is required. It is advisable to consider the issue of screening the level of creatine phosphokinase in young children with subsequent targeted examination of children with high levels, including testing for carriage of the Duchenne muscular dystrophy mutation.

Purpose - to study Global Adult Tobacco Survey (GATS) indicators on tobacco consumption and the impact of the COVID-19 pandemic on them., Materials and Methods: In 2022, 2,453 residents were surveyed (men - 1137, women - 1316) aged from 15 to 86 years (average age - 43,0 ± 16,4 years). There were 58,9% city dwellers, 41,1% villagers. The GATS technique was used. The results of the 2022 survey were compared with 2019. Mathematical and statistical processing included descriptive statistics and calculation of the χ2 distribution., Results: Over the past three years, the share of smokers has not changed (19,0% in 2022 vs 19,9% in 2019). At the same time, there were significantly more women smoking (7,4% vs 5,4%), and fewer men smoking (32,4% vs 36,7%). The number of smokers has significantly increased in the age group 65+, among women, as well as among persons aged 45-64 years. In 2022, smokers made fewer attempts to quit smoking. The number of users of electronic nicotine delivery systems increased (7.1% vs 5.4%), especially among men (9.5% vs 6.0%); a noticeable increase was observed in the 45-64 age group (2.8% vs 0.9%)., Conclusion: During the COVID-19 pandemic, the proportion of smokers of both sexes in the older age group has increased significantly. The number of users of electronic nicotine delivery systems has increased. Many indicators of assistance to the population in quitting tobacco use and prevention of smoking among the adult population have worsened.