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Introduction. According to the guidelines, the stone maximum diameter is one of the main criteria for choosing the method of nephrolithotripsy. When planning an operation, the surgeon focuses not only on the diameter, but also on the renal pelvis anatomy, stone density and number of it, the presence of hydronephrosis, a history of surgery, etc. The maximum diameter is not an exhaustive characteristic that allows you to choose the optimal treatment.Objective. To evaluate the effect of stone volume (compared to its maximum diameter) on the duration of minimally invasive endoscopic nephrolithotripsy.Materials & methods. The study was retrospective. The study included 55 patients (22 women, 33 men), the average age was 47.0 ± 1.9 years. All patients underwent minimally invasive thulium fiber laser nephrolithotripsy for stones up to 20 mm (mean maximum diameter — 13.3 ± 0.6 mm, mean density — 1041.0 ± 48.0 HU). Minimally invasive endoscopic interventions such as retrograde intrarenal surgery (RIRS, n = 30), minipercutaneous and micropercutaneous nephrolithotripsy (miniPNL, n = 16 and microPNL, n = 9, respectively) were performed. Patients with urinary system abnormalities, acute urinary tract infections and patients without stone-free status were excluded from the study. In addition to evaluating standard indicators, the stone volume was calculated in all patients using the formula of a scalene ellipsoid (median volume — 287 [144; 538] mm3). Spearman's rank correlation coefficient (r) with an assessment of the significance level was calculated for the stone maximum diameter and volume for the total sample of patients and for each surgical intervention method separately.Results. The analysis of the total sample of patients reliably revealed a weak correlation (r = 0.39) between the stone maximum diameter and surgery time. And a moderate correlation was found between the stone volume and surgery time (r = 0.53). A similar relationship with the linear distribution was also observed in the analysis in all groups.Conclusion. When choosing minimally invasive laser nephrolithotripsy, it is advisable to focus not only on the stone maximum diameter, density, and localisation, but also on the stone volume, which has a great correlation with the surgery time.

Squamous cell carcinoma of the renal pelvis is a rare neoplasm. The incidence does not exceed 1% of all neoplasms of this localization. In the general population, up to 90% of all neoplasms of the renal pelvis are represented by urothelial carcinoma, while from 0.7% to 7.0% of cases are squamous cell carcinoma. Stones of the renal collecting system are found in 14 – 50% of patients with squamous cell carcinoma of the pelvis. As a possible etiopathogenetic mechanism, chronic inflammation on the background of a stone is considered, leading to squamous urothelial metaplasia with subsequent keratinization and malignization. Clinical manifestation of squamous cell carcinoma of the renal pelvis is nonspecific and is primarily associated with manifestations of urolithiasis. Squamous cell carcinoma of the renal pelvis is characterised by high aggressiveness, insensitivity to chemotherapy and radiation therapy, and consequently an unfavourable prognosis. The survival rate of most patients is less than one year from the diagnosis, while the 5-year survival rate does not exceed 10%. We present our own clinical case of a patient with a staghorn stone and squamous cell carcinoma of the renal pelvis.

Artificial Intelligence (AI) chatbots have emerged as powerful tools in modern academic endeavors, presenting both opportunities and challenges in the learning landscape. They can provide content information and analysis across most academic disciplines, but significant differences exist in terms of response accuracy for conclusions and explanations, as well as word counts. This study explores four distinct AI chatbots, GPT-3.5, GPT-4, Bard, and LLaMA 2, for accuracy of conclusions and quality of explanations in the context of university-level economics. Leveraging Bloom's taxonomy of cognitive learning complexity as a guiding framework, the study confronts the four AI chatbots with a standard test for university-level understanding of economics, as well as more advanced economics problems. The null hypothesis that all AI chatbots perform equally well on prompts that explore understanding of economics is rejected. The results are that significant differences are observed across the four AI chatbots, and these differences are exacerbated as the complexity of the economics-related prompts increased. These findings are relevant to both students and educators; students can choose the most appropriate chatbots to better understand economics concepts and thought processes, while educators can design their instruction and assessment while recognizing the support and resources students have access to through AI chatbot platforms.

Treatment of patients with iatrogenic injuries of the biliary tract is the most difficult and important section in hepatobiliary surgery. When analyzing the causes, it was found that in 70–94 % of cases this type of injury is observed during cholecystectomy. We present a rare clinical case of the development of secondary biliary cirrhosis due to iatrogenic trauma of the biliary tract. This injury caused long-term suffering for the patient due to the further development of complications of cirrhosis, specifically of portal hypertension. The latter caused repeated recurrent profuse bleeding from varicose veins of the esophagus. The use of a minimally invasive transjugular intrahepatic portosystemic shunt procedure for the first time in the Udmurt Republic was of particular relevance in solving this problem. This procedure has become a key one in solving the abovementioned problems and will become the preventive measure for the cirrhosis progression in the future. It is also important to focus on prophylactic measures aimed at preventing iatrogenic injuries of the biliary tract, as this problem can cause irreversible complications. Prevention should include adequate examination and visualization of the bile ducts and gallbladder before surgery, their careful mobilization, compliance with the rules of operation with electrosurgical instruments, as well as the use of additional minimally invasive techniques such as choledoscopy, cholangiography and intraoperative ultrasound. Besides that, all manipulations should be carried out under strict control and clear visualization of instruments and anatomical structures of organs. The article provides a detailed description of the technique of transjugular intrahepatic portosystemic shunt surgery, as well as presents X-ray images obtained during this operation.

Introduction. Early diagnosis of cancer is one of the most important international strategies. Malignant and healthy tissues differ in the interaction with electromagnetic waves. Pilot studies show a potential perspective for non-invasive analysis of electromagnetic anisotropy in biological tissues.Objective. To assess the diagnostic importance of the electromagnetic detection of prostate cancer (PCa) within the prospective study.Materials & methods. One hundred and twenty-four patients were included to undergo a prostate biopsy, transurethral prostate resection, or radical prostatectomy. The investigators did not have information on their clinical details. Research technique: the probe was applied to the perineal region, turning it in three planes. A reduction of the 465 MHz band below a threshold was fixed and was considered suspect for PCa. The results of electromagnetic evaluation were compared with the findings of a pathomorphological study after biopsy or surgery.Results. Fourty-seven true-positive and 21 true-negative results were detected, 20 false-negative and 46 false-positive (follow-up group as potentially true-positive group). The overall sensitivity was 82%, specificity – 31%. The positive and negative predictive values were 73% and 62%, respectively. The accuracy of the method was 54%.Conclusion. Early PCa stage could be a reason for many false-positive results and low specificity, as a result. PCa detection is significantly reduced with lesions less than 3 mm, therefore patients with false-positive results were placed in the follow-up group. Patients’ examination with the TRIMprob TM («Galileo Avionica» SpA, Torino, Italy) could increase the early PCa detection at the screening. The research is currently ongoing.

The aim of our study is analysis of the androgenic status including testosterone (T) and dihydrotestosterone (DHT) in men hospitalized with coronavirus disease 2019 (COVID-19) and them relationship with the course of the disease. This is a monocentric prospective study performed on 125 male patients hospitalized for COVID-19. We conducted hematological examination, blood biochemical profile, hemostasis analysis and hormonal examination (T and DHT levels) lung and chest computed tomography and also assessed outcomes of hospitalization. Low DHT serum level was found only in 18 patients (14.4%). Subjects with low DHT were significantly older compare to subjects with normal DHT. At the same time in patients with normal DHT white blood cells (WBC) count, neutrophils at admission were higher than in patients with low DHT. No correlation was observed between T and DHT serum blood levels. C-reactive protein (CRP) has a weak positive correlation of DHT serum blood concentration (r = 0.22; p = 0.016). The inverse pattern was obtained for T serum blood concentration (r = −0.285; p = 0.001). After divided all males according to T concentrations we conducted next correlation analysis for DHT and CRP in two different groups: with normal T levels and with low T levels. We found that in males with normal T DHT levels are not correlated with CRP (r = 0.095; p = 0.462). However, in males with low T DHT and CRP had weak positive correlation with r = 0.317 (p = 0.012). Higher DHT concentrations are associated with higher CRP levels, however correlation is weak and in patients with normal T is absent, that may indicate anti-inflammatory effect of T and possible proinflammatory effect of DHT.

Severe course of COVID-19 among men compared to the female led to a detailed study of the hormonal status of men with COVID-19. The earliest works about this focused on the incidence and severity of COVID-19 depending on the intake of androgen deprivation therapy. At the same time, different classes of androgen deprivation therapy have different effects on androgen concentration that was not always considered in the analysis. In this regard, we conducted a review of the available literature data with a targeted study of works that included androgen deprivation therapy with a unidirectional effect on the concentration of male sex hormones. In addition, we conducted a review of studies focused on the relationship between COVID-19 and androgens (testosterone and dihydrotestosterone).

Introduction. Autonomic dysreflexia (AD) is a life-threatening dangerous condition in patients with spinal cord injury (SCI) above the T6 segment level. It is characterized by a sudden rise in systolic blood pressure more than 20 mmHg, and unpredictable reactions from the autonomic nervous system. An episode of autonomic dysreflexia can lead to several cardiovascular catastrophes – heart attack and/or acute cerebrovascular accident up to a lethal outcome. Currently, there is no diagnostic algorithm and no way to determine risk factors for the occurrence of autonomic dysreflexia.Objective. To search for the most informative diagnostic criteria for autonomic dysreflexia in patients with spinal cord injury.Materials and methods. The study included 40 patients with SCI above the T6 segment. Depending on the SCI degree, two groups were distinguished. Group 1 (n = 14) included patients with complete spinal cord injury, advising category A on the ASIA scale. Group 2 (n = 26) included patients with incomplete spinal cord injury, classified as ASIA-B, C, D. For a preliminary assessment of the risk factors for the development of AD, an ADFSCI questionnaire was used, then a urodynamic study was conducted with simultaneous registration of systolic / diastolic blood pressure (SBP / DBP), and heart rate, which confirmed or denied the presence of AD in patients.Results. According to the ADFSCI questionnaire, most patients showed a high degree of severity of autonomic disorders, suggesting the presence of AD. Subsequently, this assumption was confirmed by the results of a urodynamic testing with simultaneous monitoring of SBP / DBP and heart rate. When comparing the groups, statistically significant differences were found in the parameters of the ADFSCI questionnaire, as well as in the indicators of SBP / DBP (at the points of maximum detrusor pressure and when the cystometric capacity is reached).Conclusion. The obtained results allow us to draw conclusions about the high incidence of AD in patients with SCI above the T6 segment and the need for a preliminary assessment of the risks of developing this condition based on the ADFSCI questionnaire before conducting a urodynamic study. Considering the possible complications of AD, the urodynamic testing should be accompanied by continuous monitoring of the indicators of the cardiovascular system.

The purpose of the study. Mesenchymal tumors of the esophagus comprise 2 % of all esophageal tumors. Leiomyosarcoma is the most common mesenchymal tumor in the esophagus (up to 80 %). It is located in the lower third of the esophagus. The main treatment modality of leiomyosarcoma is surgery. Due to the low frequency of occurrence, there are no unified approaches to the choice of surgical volume and access. Minimally invasive techniques have advantages over open approaches. However, final treatment approach depends on many factors: localization and location of the tumor around the circumference of the esophagus, as well as size. Endoscopic resection is feasible for small tumors with an intramural growth. In case of large leiomyomas, Lewis operation should be performed. In all other cases, tumor enucleation is the gold standard of treatment. The issue of minimally invasive surgical access is relevant. Thoracoscopic access has limitations for tumors located in the lower thoracic esophagus closer to the esophageal-gastric junction. In this regard, a laparoscopic approach with the possibility of transhiatal mobilization of the esophagus provides an adequate opportunity for tumor enucleation.Clinical case description. We hereby report our case study in which we employ the use of laparoscopic transhiatal enucleation to remove leiomyoma of the lower thoracic part of the esophagus. A 47-year-old female presented to P.A. Herzen Moscow Oncology Research Institute with complaints of pain in the epigastrium, discomfort behind the sternum when taking solid food. R0 resection was performed. During the one year follow-up period no sign of disease recurrence was observed.Conclusion. This approach, in our opinion, is fully justified, with careful selection of patients and compliance with guidelines of cancer surgery. Laparoscopic approach with transhiatal mobilization of the esophagus provides a good opportunity to perform the enucleation of mesenchymal tumors localized in the lower third of the thoracic region, at the level of the supraphrenic and abdominal segments.

The study of the genital system' vessels in patients with erectile disfunction and chronic prostatitis was accomplished using ultrasound Dopplerography and pharmacological testing by phosphodiesterase inhibitors of 5th type (PDEI-5). The positive impact of PDEI-5 (such as Sildenafil, Vardenafil, Udenafil and Tadalafil) on organs' blood supply was revealed. The changes of USDG parameters were found comparable and, at the same time, individual. For patient-specific choosing the medicinal agent it is advisable to perform the pharmacological tests for each patient. The choice of the medicine for treating erectile disfunction and chronic prostatitis should be made on the basis of the results of ultrasound Dopplerography and pharmacological testing for each selected and tested medicine. For this purpose it is preferably to choose the medicine, which improves the blood flow in penis and, at the same time, in prostate gland and in testes.

This study explores the use of diffuse reflectance spectroscopy (DRS) and multiwavelength fluorescence spectroscopy for real-time kidney stone identification during laser lithotripsy. Traditional methods are not suitable for in situ analysis, so the research focuses on optical techniques that can be integrated with lithotripsy fibers. Experiments were conducted ex vivo, using DRS and multiwavelength fluorescence spectroscopy (emission–excitation matrix (EEM)) to distinguish between 48 urinary stones of three types: urate, oxalate and hydroxyapatite, with infrared spectroscopy as a reference. A classification model was developed based on EEM and DRS data. Initial classification relying solely on EEM data achieved an f1-score of 87%, which increased to 92% when DRS data were included. The findings suggest that optical spectroscopy can effectively determine stone composition during laser lithotripsy, potentially enhancing surgical outcomes via the real-time automatic optimization of laser radiation parameters.