Search

The incidence of extended ureteral strictures has been on the rise in the past decade. This increase is attributed to the growing number of endoscopic surgeries, expanded criteria for surgical treatment of cancer patients, and complications from radiation therapy. When correcting an extended ureteral stricture, if there is a lack of urinary system tissues to replace the defect or if they are involved in the pathological process, replacement reconstruction using a segment of small or large intestine becomes necessary. Options for ureteral reconstructions using ileum and colon sections were discussed, as well as the use of the appendix as a graft. Data on the effectiveness and frequency of postoperative complications were analysed, and the pros and cons of different surgical techniques for ureteroplasty were evaluated. It is necessary to conduct further scientific and practical research and evaluation of long-term results to solve the remaining unclear problems and to inform the doctors of our country about the existence of this pathology.

Introduction. Renal colic during pregnancy is a common cause of pain in the lower back. Currently, with a diagnosed kidney or ureter stone, the standard treatment is serial drainage of the urine tract using an internal ureter stent, with replacement of the drainage before delivery, followed by surgery to remove the stone after delivery.Objective. To study the effectiveness and safety of ureteroscopic interventions in the treatment of urolithiasis in pregnant women in comparison with the method of serial drainage of the upper urinary tract during gestation followed by surgical treatment of urolithiasis 4 weeks after delivery.Materials & methods. The study group consisted of 119 patients with a confirmed diagnosis of urolothiasis using instrumental diagnostic methods and a gestational age up to and including the 27th week. Two groups were formed based on treatment approaches for urolithiasis: group 1 included 59 patients (49.6%) who underwent surgical removal of the stone; group 2 included 60 patients (50.4%) who underwent internal ureteral stent replacement every 4 – 6 weeks prior to delivery and subsequent ureteroscopy There were no significant differences in age, body mass index, or number of pregnancies between the two groups.Results. The frequency of complete stone removal in groups 1 and 2 was 96.6 and 96.7%, respectively. The median amount of time spent on urolithiasis treatment in groups 1 and 2 was 60 [45; 72] and 97 [54; 105] minutes, respectively (p = 0.002). Migration of the ureteral stent in group 2 was observed in 13.3% of cases (p = 0.05). Among group 1 patients who underwent ureteroscopic intervention aimed at stone removal, the incidence of internal drainage dislocation was 3.4%. Encrustation of the ureteral stent in groups 1 and 2 was observed among 2 (3.4%) and 17 (28.3%) patients, respectively (p < 0.001). The bed-day (median time in days spent in hospital for drainage replacement and time of surgical treatment of urolithiasis) in groups 1 and 2 was four and eight days, respectively (p < 0.05). The frequency of natural childbirth in groups 1 and 2 was 81.35% and 55.0%, respectively (p = 0.002).Conclusion. Urolithiasis among pregnant women is a complex multifactorial disease that affects not only the health of the mother, but also the condition of the developing foetus. It is possible to perform surgical treatment with high efficiency and low complication rate, which improves the quality of life.

Introduction. Circumcision is one of the most common surgical procedures for men. WHO programs aimed at reducing HIV transmission have led to the development of various circumcision devices designed to standardize surgical techniques, reduce operating time and the number of complications.Objective. To examine available data on the efficacy and safety of different methods of device-based circumcision.Materials & methods. The results of a search in scientific databases such as eLibrary and PubMed were analyzed using the keywords: "circumcision", "circumcision device", and "phimosis". The search was conducted without regard to date or language of publication. After reviewing the literature, 25 articles were selected that best reflect the topic of device-assisted circumcision for further analysis.Results. Device-based circumcision can significantly reduce surgical time, regardless of the type of device used. Device-based circumcision is the safe treatment method; however, it may have a higher incidence of adverse events compared to the standard circumcision technique. The use of self-suturing devices is preferred over ring devices due to fewer complications, better cosmetic results, and greater patient satisfaction. The article is supplemented with a description of the surgical technique of various options for device-based circumcision.Conclusion. Device-based circumcision is effective and safe treatment method on an outpatient basis, which successfully competes with conventional circumcision of the foreskin.

Introduction. The use of oral mucosa in augmentation and replacement urethroplasty is the gold standard for several reasons. Most commonly, the mucous membrane of the cheek, the underside of the tongue or lip is employed. Assessing postoperative complications in the donor area is crucial as it impacts patients' quality of life.Objective. To evaluate early and late postoperative changes in the donor area after oral graft extraction for urethroplastyMaterials & methods. A retrospective analysis of the results of surgical treatment using oral mucosa from 2017 to 2022 was carried out. The study included 65 patients. The intensity of pain syndrome in the graft sampling area was assessed by patients on a visual analog scale (VAS). The donor area was sutured only in the case of tongue and lip mucosa sampling.Results. The mucous membrane of the oral cavity was harvested from different sites in 65 patients. Specifically, it was taken from the inside of the cheek in 49 patients (75.38%), from both inner sides of the cheeks in 13 (20.0%), the lower lip in two (3.07%) and the lower surface of the tongue in one (1.54%) patient, respectively. On the first day after surgery, the median pain level according to VAS was 4 points (range: 2 – 7), at the time of discharge — 3 points (1 – 6). After 120 days, a follow-up examination showed a regression of pain symptoms: the median was 0 points (0–1). In the late postoperative period, incomplete opening of the mouth was recorded in two patients (3.07%), cosmetic defect in the donor area in two (3.07%), discomfort during meals in six (9.23%), impaired sensitivity in the donor area in two (3.07%), exacerbation of chronic stomatitis and hypersalivation in two (3.07%) patients, respectively.Conclusion. The incidence of complications in the donor area is low, but for some patients this can result in a reduced quality of life. Using proper technique when extracting oral mucosa grafts reduces pain and the likelihood of early- and late-stage postoperative complications in this area.

Neuromyelitis optica spectrum disorders (NMOSD) are a group of chronic autoimmune diseases of the central nervous system with a relapsing course. Unfortunately, the symptoms of exacerbation cannot always be completely stopped, and in addition to motor disorders, chronic pain and depression can worsen the patient's condition. Currently, one of the factors that significantly affects the quality of life of patients in this group is chronic, debilitating pain.Objective: to determine the prevalence of the pain syndrome in the population of NMOSD patients in Moscow region, to investigate its clinical characteristics and its impact on quality of life.Material and methods. The study included 33 patients with NMOSD (6 men and 27 women) aged 22 to 64 years. The following criteria were used to assess the neurological condition, presence and severity of the pain syndrome: Expanded Disability Status Scale (EDSS), Diagnostic Neuropathic Pain Questionnaire (DN4), Pain Detect Questionnaire (PDQ), McGill Pain Questionnaire (MPQ), SF-36 Quality of Life Questionnaire, Beck Depression Inventory and MRI data.Results. Among the patients analysed, the pain syndrome occurred in 19 patients (57.6%): 4 patients with NMOSD without antibodies against aquaporin-4 (AQP4-) and 15 with antibodies against AQP4 (AQP4+). In this group, neuropathic pain was observed in 14 patients (11 – AQP4+ and three – AQP4-), pain due to spasticity in 6 patients (5 – AQP4+ and 1 – AQP4-), painful tonic spasms in 2 patients with AQP4+ and neuropathic itching – in 1 patient with AQP4-. According to the questionnaires of the seropositive patients, the median DN4 was 3 [2; 3] (here and below the data are given in Me format [25th; 75th percentile]), PDQ – 6 [5; 12], on the MPQ scale: pain rank index – 11 [9; 15], index of the number of selected symptoms – 3 [3; 4], pain intensity – 2 [1; 3]. The results for the physical and psychological health domains of the SF36 questionnaire were 35.9 [6.5; 36] and 50.5 [5; 51.5] respectively. Among AQP4+ patients, 7 out of 15 patients were diagnosed with depression; in the AQPpatients, only one man was diagnosed with depression. There was a statistically significant correlation between the age of the patients and pain level: neuropathic pain according to DN4 was more pronounced in younger patients (p=0.009), and neuropathic pain was significantly more severe in patients with an early onset of the disease (p=0.04).Conclusion. There is currently no clear approach for the treatment of pain in NMOSD. In the present small study, different causes of pain were identified, depending on the location and severity of the lesion, the age of the patient and the duration of the disease. The most important factor in the prevention and treatment of pain syndrome in NMOSD is probably adequate immunotherapy of the disease.

Introduction. In patients with suprapubic tube (SPT) surgical restoration of voiding is not 100% successful. Sometimes urination is inadequate or not recovered at all.Objective. To determine factors influencing the outcomes of benign prostatic hyperplasia / benign prostate obstruction (BPH/BPO) surgery in patients with cystostomy drainage.Materials & methods. The study included 52 men with suprapubic tube initially placed for urinary retention caused by prostate hyperplasia. Afterwards, all patients underwent transurethral resection of the prostate. The age of the patients ranged from 48 to 85 years old. Clinical and urodynamic data of the patients were analysed, restoration of adequate urination after surgery was evaluated as well. We took into account patients age, IPSS scores, bacterial growth in the urine culture test, number of episodes of urinary retention, volume of urinary retention prior to cystostomy, prostate volume, intravesical prostate growth, detrusor overactivity and ability to void in the presence of SPT.Results. We were unable to achieve adequate bladder emptying after transurethral resection of the prostate in 4 (7.6%) patients. These patients required continued bladder drainage after surgery. In 48 (92.4%), adequate urination was restored after surgery and cystostomy drains were removed. Patients with one or more of the following characteristics were more likely to experience a failure of surgical treatment: age over 80, residual urine volume over 1500 mL, and absence of overactive bladder.Conclusion. The study indicates that use of cystometry prior to BPH/BPO surgery is reasonable in such patients. Feasibility of BPH/BPO surgery for this group of patients should be considered individually.

Objective: to study the pyramidal tract in patients with highly active multiple sclerosis (HAMS) during treatment switching from first-line MS therapy to second-line therapy due to suboptimal response.Material and methods. 24 patients with HAMS were analyzed. Depending on the severity of pyramidal functional system (PFS) impairment according to EDSS, patients were divided into 2 groups; group 1 — 17 patients with an EDSS score of 0—2.5 points, group 2 — 7 patients with an EDSS score of ≥3 points. All patients underwent MRI of the brain according to the standard protocol. The diffusion tensor images (DTI) were processed using the DTI FiberTrak software.Results. The volume of the pyramidal tract was decreased in patients in group 2 (p

An analytical method is presented for force analysis of plain lever mechanisms with one degree of freedom, based on the vector method. Using the example of a two-drive structural group, a method is outlined for finding reaction vectors in all its kinematic pairs, while maintaining the clarity and consistency of the solution inherent in the graphic-analytical method of diagrams of component forces. An original analytical description is given for finding the vectors of tangential and normal components of reactions in kinematic pairs. Application of the proposed method of force analysis makes it possisble to find reaction vectors in kinematic pairs without compiling and solving complex systems of equilibrium equations or graphical construction. Adaptation of the proposed force analysis in modern mathematical packages allows for the study of plain lever mechanisms with one degree of freedom in a short time and with high accuracy.

Abstract The participation of women in space programs of increasing flight duration requires research of their reproductive system from the perspective of subsequent childbearing and healthy aging. For the first time, we present hormonal and structural data on the dynamics of recovery after a 157-day space flight in a woman of reproductive age. There were no clinically significant changes in the reproductive system, but detailed analysis shows that weightlessness leads to an increase in the proportion of early antral follicles and granulosa cells in large antral follicles. Returning to Earth’s gravity reduces the number and diameter of early antral follicles.

Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection with severe brain damage caused by the JC-virus, against the background of immunosuppressive conditions. The diagnosis of PML is complex and includes: the clinical picture, neuroimaging data, the presence of JC-virus DNA in samples of cerebrospinal fluid or brain tissue. HIV-associated PML is difficult to diagnose. In patients with multiple sclerosis, an increase in the incidence of PML is associated with the use of natalizumab. Increasing alertness towards the development and detection of PML makes it possible to achieve a favorable outcome.

The effectiveness of staged reperfusion therapy in real clinical practice requires clarification. Objective: to evaluate the efficacy and safety of mechanical thromboextraction and staged reperfusion therapy with alteplase in real clinical practice. Material and methods. The study included 106 patients who were retrospectively divided into two groups: Group I underwent staged reperfusion therapy (intravenous thrombolysis with alteplase followed by aspiration thromboextraction), Group II underwent thromboaspiration only. The clinical and functional results, incidence of hemorrhagic transformation and mortality rate were compared. Results. The groups did not differ in terms of demographic data, cardiovascular risk factors or stroke severity. Group II patients were characterized by a longer delay in reperfusion therapy (225 minutes versus 180 minutes) and a lower score on the Alberta Stroke Programme Early CT score (ASPECTS; 8.8 points versus 9.3 points). There were no differences in National Institutes of Health Stroke Scale (NIHSS) scores at day 28, dynamics of NIHSS scores, Rankin scores at day 28, rates of hemorrhagic transformation or mortality. In both groups, the deceased patients were older; in Group I they suffered more frequently from atrial fibrillation, in Group II – from diabetes mellitus type 2. In addition, mortality in Group II was associated with a higher severity of early signs of cerebral infarction.Conclusion. The results of the analysis of real-life clinical practice show the comparability of the efficacy and safety of staged reperfusion therapy and isolated thromboaspiration in a “natural” selection of patients.

Introduction. Natalizumab (NTZ) is a humanized monoclonal antibody (mAb) that selectively inhibits α4-integrin adhesion molecule located on the surface of lymphocytes and prevents their trafficking into the central nervous system (CNS). The aim of this study was to identify characteristics of lymphocyte population and subpopulation pattern in the peripheral blood (PB) of multiple sclerosis (MS) patients who discontinued NTZ due to an increased risk of developing developing progressive multifocal leukoencephalopathy. Materials and methods. We conducted an open-label prospective observational study in 26 MS patients. Of those, 6 patients had rapidly progressive MS, 10 patients discontinued NTZ and had confirmed relapses afterwards, and 10 patients received NTZ and had no relapses during the washout period. Ten apparently healthy individuals were used as controls. Cell-mediated immunity parameters were evaluated by flow cytometry using a panel of mAbs to differentiation antigens of PB lymphocytes. Results. Patients who discontinued NTZ had significantly decreased absolute lymphocyte counts in PB, decreased T-cytotoxic, NKT and B1 lymphocyte subpopulation levels, and decreased activated T-cell (CD3+HLA–DR+) levels, which may be related to their redistribution, passing through the blood-brain barrier, and trafficking into the central nervous system. CD20+ В-cell levels did not differ from normal. Additional immune predictors of MS relapses after NTZ discontinuation can include decreased absolute count of PB lymphocytes and decreased percentage of CD3+CD8+ T-cell, NKT-cell, and B1-cell (CD19+CD5+) subpopulations. Significantly increased levels of CD25+- and CD38+-activated B-cells compared with the normal levels in naïve patients and subjects without relapses after NTZ discontinuation may suggest a high activation potential of the circulating B-cell pool and, therefore, a high risk of MS relapses. Conclusions. The changes in the lymphocyte subpopulation pattern in the PB of MS patients after NTZ discontinuation may have a prognostic value for assessing the risk of relapses; they justified switching patients to anti-B-cell therapy.

Introduction. To date, there has been insufficient research into the prostate volume as a factor that may influence the effectiveness and safety of surgical treatments. With the advent of relatively new laser techniques, it is important to take a closer look at this parameter, especially considering the success of these techniques in the treatment of benign prostatic hyperplasia (BPH) of various volumes.Objective. To assess the functional outcomes and postoperative complications of holmium laser enucleation of the prostate (HoLEP) depending on its volume.Materials & Methods. We performed a prospective study of HoLEP on 252 patients. Patients were divided into two groups according to their prostate volume: Group I included 206 patients (81%) with a prostate volume of < 100 mL, and Group II included 46 patients (19%) with a prostate volume ≥ 100 mL.Results. The prostate volume was the most significant prognostic factor regarding duration of surgery. This indicator significantly differed between the two groups. Group I had an average surgery time of 67.1 ± 26.7 minutes, while Group II had a time of 98.1 ± 24.2 minutes (p < 0.05). There were no significant differences in the number of complications between the groups — 36 cases (17.5%) in Group I and 12 cases (26%) in Group II, as well as functional results of urination between the groups. In the early postoperative period, the Q max in Group I was 17.4 ± 9.1 ml/s, in Group II — 18.2 ± 10.9 ml/s (p > 0.05), PVR — 52 ± 39.4 and 56 ± 31.8 ml (p > 0.05), respectively. After 3 months of observation, there were also no differences in the studied parameters: IPSS — 5.7 ± 4.1 vs 6.2 ± 4.9 points; QoL — 1.0 ± 0.9 vs 1.1 ± 0.9 points; Q max — 18.9 ± 6.7 vs 20.3 ± 11.5 ml/s; PVR — 53.5 ± 33.1 vs 54.9 ± 30.6 ml (p > 0.05).Conclusion. HoLEP is an effective and safe method of treating patients with different volumes of BPH. However, the duration of the procedure is an important factor that influences the surgery outcome, as it correlates with the prostate volume.

Introduction. The most advanced and effective method of surgical treatment for benign prostatic hyperplasia (BPH) is transurethral laser enucleation of the prostate (tLEP). Recently, there has been a growing interest in exploring new approaches to reduce the risk of complications following tLEP.Objective. To evaluate the efficacy of using Phlogenzym® as part of a comprehensive treatment plan for patients following tLEP to reduce dysuria (urinary discomfort), leukocyturia (white blood cells in urine), and prevent infectious and fibrosis-related complications.Materials & methods. An open-label, randomized trial enrolled 105 patients undergoing tLEP. The patients were randomly assigned to two groups: the study group (n=50) received standard postoperative care in combination with Phlogenzym® for 30 days, while the control group (n=55) received standard care (α1-adrenergic blocker for 28 days) only. uring the follow-up period, which lasted for 1, 3, and 6 months postoperatively, complaints were evaluated using the IPSS-QoL, and IIEF-5 questionnaires, as well as indicators of urinalysis and urine culture, prostate volume measurements, residual urine volume, and uroflowmetry data.Results. Among all patients, the median preoperative values for prostate volume, IPSS, QoL score, and median peak urine flow rate were 90 cc, 18 points, 5 points, and 7.9 mL/s, respectively, with no significant differences between the groups. One month after surgery, in the study group, there was a more significant decrease in prostate volume (57% vs. 41%), although this difference was not statistically significant (p > 0.05). At the 6-month follow-up, bacteriuria was less common in the study group (42% vs. 67%), and there was a consistent trend toward a reduction in the incidence of fibrous complications, although these differences were not statistically significant either (p > 0.05). No adverse events occurred during the follow-up period.Conclusion. Our experience suggests that the use of Phlogenzym® is safe during the postoperative period following tLEP surgery. The use of this drug leads to a reduction in prostate volume postoperatively and significantly reduces the bacteriuria by the six-month follow-up. Additionally, there is a persistent positive trend towards reducing the overall incidence of fibrotic complications in the surgical site. The results achieved and the absence of significant side effects characterize Phlogenzym® as having a favorable clinical profile.

Introduction. In most cases, double-J stent placement is the initial method of drainage in patients with urolithiasis. Until ureteroscopic intervention, most patients report «stent-related symptoms» that reduce the quality of life.Objective. To improve the results of treatment in female patients with urinary stone disease (USD) and preoperative drainage of the upper urinary tract using double-J stent by assessing the effect of the NefroBest® and UroBest® complexes on the prevention of the development of «stent-related symptoms» and inflammatory processes.Materials & methods. The study group included 90 female patients with USD, who were performed ureteroscopic interventions with preoperative stent placement from March to September 2023 in the Yudin City Clinical Hospital. Patients were divided into two groups: the main group 1 (n = 30) — patients who received phytotherapy with NefroBest® (30 days) and UroBest® (7 days) complexes after placement of an internal ureteral stent; the control group 2 (n = 60) — patients who did not receive specific therapy postoperatively.Results. According to the USSQ, in group 1 the median score due to urinary symptoms was 22 points, and in group 2 — 28 points (p = 0.001), when assessing symptoms associated with pain — 12 and 18 points (p < 0.001), general health — 17 points both and work performance — 9 and 11 points, respectively. Among patients in group 1, stonefree rate was observed in 90.0%, and among patients in group 2 — in 93.3%. In group 1, antibacterial therapy in the postoperative period was in 37.0% of patients, and in group 2 – among 53.0%.Conclusion. The co-use of the NefroBest® and UroBest® complexes in female patients with USD and preoperative drainage of the upper urinary tract using double-J stent can reduce the severity of symptoms associated with urination and pain, and postoperatively resulted in a lower incidence of infectious-inflammatory complications.

Introduction. The prevalence of patients with extended ureteral strictures has been steadily increasing over the past decades. When it is not possible to perform reconstruction with the tissues of the urinary system, the best solution is intestinal replacement plasty. However, despite the great world experience, the search for the optimal method of intestinal reconstruction does not stop, which determines the relevance of conducting an experimental prospective study.Objective. To evaluate morphological changes in renal parenchyma after ureteral replacement reconstruction by segments of small and large intestine.Materials & methods. Fifteen white giant rabbits (6-months-old, weighing 5 kg) were divided into three groups. Group A (n = 5) underwent small intestine [ilealplasty] replacement plasty. Group B (n = 5) double-flap ileoplasty using the Yang-Monti technique. Group C (n = 5) – large intestine [coloplasy] ureteral reconstruction. Before the operation and before withdrawal from the experiment, the level of creatinine and electrolytes was assessed, kidney ultrasound was performed on days 2, 5, 10. Excretory urography was performed to assess the patency of the anastomoses. Animals were withdrawn from the experiment from day 10 to 30. The material used for morphological study included kidneys from the operated and intact sides, proximal and distal anastomoses.Results. No increase in creatinine level, metabolic disorders were detected in animals. According to ultrasound data, hydronephrosis developed in all animals on day 2 and remained unchanged during the entire follow-up. Group A: no complications were detected. Histologically, the renal parenchyma showed moderate signs of chronic inflammation, single foci of lymphoid infiltration, but there were no irreversible processes in the form of necrosis and sclerosis. Group B: complications — stricture in the anastomosis area of the detubularised fragments and necrosis of the small intestine due to compression of the mesentery by the graft vascular stem. Histologically there were marked dilatation of the tubules at all levels, enlargement of the Bowman-Shumlansky capsule, as well as signs of moderate inflammatory process, there were hydropic and hyaline-droplet dystrophy, tubular necrosis foci. Group C: complications — accumulation of a significant amount of grit, mucus, and fibrin in the colocystoanastomosis area. Histologically, the renal parenchyma showed a marked inflammatory process, in particular, purulent inflammation with demarcation zones, infiltration with polymorphonuclear leukocytes and bacterial cells, foci of necrosis and sclerosis of both stroma and tubules, dilatation of tubules and Bowman-Schumlansky capsules.Conclusion. The use of an unchanged ileal-graft reconstruction of an extended ureteral defect showed acceptable histological results in an animal model, which confirms the feasibility of its use in clinical practice. The absence of foci of necrosis and fibrosis in the renal parenchyma indicates the preserved functional potential, which suggests the stabilization of renal function in the long term.

Objective: vascular complications (VCs) following liver transplantation (LT) can pose a significant threat to the recipient’s life – as the risk of graft loss increases significantly when blood flow in the graft is impaired. Diagnosis and early treatment of VCs seems to be a pressing issue in transplantology. The aim of this study is to evaluate the incidence, treatment and outcome of VCs in patients after orthotopic LT at the Center for Surgery and Donor Coordination, Rostov Regional Clinical Hospital.Materials and methods. Between July 2015 and April 2023, 100 orthotopic LTs were performed. VCs were retrospectively identified and analyzed.Results. The overall incidence of VCs was 24% (n = 24): hepatic artery stenosis, 5% (n = 5); intra-abdominal bleeding, 6% (n = 6); hepatic artery dissection, 2% (n = 2); intrahepatic venous thrombosis Budd–Chiari syndrome), 2% (n = 2); portal vein thrombosis, 1% (n = 1); inferior vena cava thrombosis/iliofemoral deep vein thrombosis, 2% (n = 2); inferior vena cava stenosis, 1% (n = 1); hepatic vein stenosis, 1% (n = 1); recurrent hepatic artery stenosis/thrombosis, 2% (n = 2); mesenteric vein thrombosis, 2% (n = 2).Conclusion. Most VCs following orthotopic LT occur in the early postoperative period and can lead to a high risk of graft dysfunction and patient death. Early recognition, diagnosis, and treatment of post-LT complications are critical to successful short- and long-term graft function and patient survival, even in patients with asymptomatic complications. Treatment options typically include surgical revascularization, percutaneous thrombolysis, percutaneous angioplasty, retransplantation, or, less commonly, a conservative approach.

Objective: to evaluate the outcomes of heart transplants performed at Rostov Regional Clinical Hospital within five years.Materials and methods. Between 2017 and 2022, 29 orthotopic heart transplants (HT) were performed in our clinic. Heart failure was caused by postinfarction cardiosclerosis (21 cases, 72.4%) and dilated cardiomyopathy (8 cases, 27.6%). Among the recipients, 27 (93.1%) were men and 2 (6.9%) were women. Mean age was 53.14 ± 8.7 years (34 to 67 years). All patients received quadruple-drug immunosuppressive therapy, including induction with monoclonal antibodies; calcineurin inhibitor, mycophenolic acid, and corticosteroid were used after HT.Results. In-hospital mortality was 10.34% (n = 3). The causes of death were multiple organ failure and infectious and septic complications. After discharge, 4 (13.8%) recipients died over 5 years. Rejection reaction with the development of graft dysfunction (3 recipients, 75%), infectious and septic complications (1 recipient, 25%) were the causes of death in the long-term period. The survival rate was analyzed according to the Kaplan–Meier estimate. One-year survival was 80.9%. Three-year survival rate corresponded to the 5-year survival rate – 70.56%. Five-year survival of patients surviving the first year after HT was 86.1%. Maximum follow-up period was 64 months.Conclusion. HT continues to be the gold standard for patients with end-stage heart failure. Five-year HT experience in our center has shown a survival rate that is comparable to that of the International Society for Heart and Lung Transplantation (ISHLT).

MERRF syndrome (myoclonic epilepsy ragged red fibres) belongs to the group of primary mitochondrial diseases and is characterized by a combination of myoclonic epilepsy and the phenomenon of ragged red fibres on muscle biopsy. The aim of this work is to study mitochondrial disorders in patients from a family with MERRF syndrome by determining the cytochemical activity of mitochondrial enzymes in peripheral blood lymphocytes and the level of lactate in the blood. Clinical cases of a 25-year-old sister and a 19-year-old brother with MERRF syndrome with the m.8344A>G variant in MT-TK (tRNA (Lys)) with a blood heteroplasmy level of 50 % in the sister and homoplasmy in the brother are presented. Mitochondrial disorders were assessed by blood lactate levels and cytochemical studies of mitochondrial enzyme activity in peripheral blood lymphocytes. Pre-prandial blood lactate levels were elevated in both patients. After a carbohydrate load, it increased in the sister, and decreased in the brother. The sister had decreased activity of peripheral blood lymphocyte enzymes while taking levetiracetam, 100 mg of coenzyme Q10 and 100 mg of L-carnitine. The dose of energotropic drugs was increased, which led to an increase in the activity of mitochondrial enzymes. The brother had a compensatory increase in the level of succinate dehydrogenase and a decrease in the activity of other enzymes. The methods we used can be used in clinical practice to diagnose mitochondrial disorders and to adjust the dosage of energotropic drugs, which remain relevant due to the lack of effective gene therapy.

This is a comprehensive overview on our research work to link interdisciplinary modeling and simulation techniques to improve the predictability and reliability simulations (PARs) of compressible turbulence with shock waves for general audiences who are not familiar with our nonlinear approach. This focused nonlinear approach is to integrate our “nonlinear dynamical approach” with our “newly developed high order entropy-conserving, momentum-conserving and kinetic energy-preserving methods” in the quantification of numerical uncertainty in highly nonlinear flow simulations. The central issue is that the solution space of discrete genuinely nonlinear systems is much larger than that of the corresponding genuinely nonlinear continuous systems, thus obtaining numerical solutions that might not be solutions of the continuous systems. Traditional uncertainty quantification (UQ) approaches in numerical simulations commonly employ linearized analysis that might not provide the true behavior of genuinely nonlinear physical fluid flows. Due to the rapid development of high-performance computing, the last two decades have been an era when computation is ahead of analysis and when very large-scale practical computations are increasingly used in poorly understood multiscale data-limited complex nonlinear physical problems and non-traditional fields. This is compounded by the fact that the numerical schemes used in production computational fluid dynamics (CFD) computer codes often do not take into consideration the genuinely nonlinear behavior of numerical methods for more realistic modeling and simulations. Often, the numerical methods used might have been developed for weakly nonlinear flow or different flow types other than the flow being investigated. In addition, some of these methods are not discretely physics-preserving (structure-preserving); this includes but is not limited to entropy-conserving, momentum-conserving and kinetic energy-preserving methods. Employing theories of nonlinear dynamics to guide the construction of more appropriate, stable and accurate numerical methods could help, e.g., (a) delineate solutions of the discretized counterparts but not solutions of the governing equations; (b) prevent numerical chaos or numerical “turbulence” leading to FALSE predication of transition to turbulence; (c) provide more reliable numerical simulations of nonlinear fluid dynamical systems, especially by direct numerical simulations (DNS), large eddy simulations (LES) and implicit large eddy simulations (ILES) simulations; and (d) prevent incorrect computed shock speeds for problems containing stiff nonlinear source terms, if present. For computation intensive turbulent flows, the desirable methods should also be efficient and exhibit scalable parallelism for current high-performance computing. Selected numerical examples to illustrate the genuinely nonlinear behavior of numerical methods and our integrated approach to improve PARs are included.

The article considers the features of strategic planning in knowledge-intensive subsidiaries of vertically integrated oil and gas companies. Based on the analysis, it has been proposed to improve the approach to strategic planning by incorporating principles and mechanisms of participatory planning. In modern conditions, strategic development of vertically integrated oil and gas companies is closely connected with obtaining high-quality R&D work results that meet the challenges that stand in the way of successful development of the oil and gas complex. Obtaining such results is possible with competent strategic planning of science-intensive subsidiaries activities that produce main scientific results for vertically integrated oil and gas companies. The use of principles of participatory approach to industrial enterprise management at the stages of strategic planning can become one of the options for improving strategic planning quality. The existing approach to strategic planning in science-intensive subsidiaries of vertically integrated oil and gas companies has been considered, its advantages and disadvantages analyzed. It has been recommended to eliminate the identified shortcomings and thus improve the existing approach by adapting interactive strategic planning to peculiarities of vertically integrated oil companies and supplementing it with participatory mechanisms. New principles have been proposed and directions for strategic planning tools development in knowledge-intensive subsidiaries of vertically integrated oil and gas companies defined.

Benign prostatic hyperplasia (BPH) is a highly prevalent condition in older men, often associated with both lower urinary tract symptoms (LUTS) and reduced quality of sexual life. During the past three decades, researchers have focused on improving new operative techniques to reduce complications of traditional surgery for BPH, such as urethral stricture, stress urinary incontinence. Surgeons have increased interest in investigating the relationship between surgical treatment and postoperative sexual dysfunction such as erectile and ejaculatory dysfunction, as the demand to minimise adverse events has become a concern for more patients. In view of the above, this paper aims to systematise information on the quality of sexual life of patients after surgical treatment of BPH. This work has shown that this problem remains topical to nowadays. It is noteworthy that only a limited number of well-designed, randomised studies exist on this issue. This is mainly due to the unavailability of a uniform methodology for assessing sexual function in surgically treated BPH-patients.

Introduction. Prostate cancer (PCa) is one of the most common malignant diseases. The prostate biopsy is the verification standard of PCa. The multifocal biopsy under ultrasound (US) guidance shows high rate of false negative results. As a result, the new diagnostic methods have been discovered. HistoscanningTM is the new method of visualization. HistoscanningTM is a new prostate tissue differentiation technology based on US backscatter analysis. The software analyses tissue density builds a 3D model of the prostate and indicates the localisation of PCa-suspect foci that are targeted for biopsy.Objective. To rate the diagnostic accuracy of HistoscanningTM and identify the benefits of targeted prostate biopsy compared to the multifocal biopsy.Matherials & methods. A prospective study conducted between Jan 2017 and May 2021 is presented. Ninety-hundred nine patients who underwent transrectal prostate biopsy in Pirogov City Clinical Hospital No. 1 were included. Control group A — 443 men after standard multifocal biopsy, comparison group B — 506 men after combined standard multifocal biopsy together with targeted biopsy using HistoscanningTM.Results. In the control group, prostate cancer was detected in 33.4% of patients, while in the group using the HistoscanningTM device it was found in 39.7%. ISUP 1 high-grade PCa were more frequent in group В — 71.1%, in group А— 52.7%. Isolated lesion of targeted biopsy specimens was found only in 9 patients (4.5%) of the group В. Combined lesion of standard and targeted biopsy specimens was more frequent and was detected in 121 patients. However, in 72 patients no atypical cells were detected in targeted biopsy specimens when prostate cancer was verified in standard biopsy specimens. The efficacy of HistoscanningTM was comparable to standard biopsy for prostate volumes > 60 cс.Conclusion. The use of HistoscanningTM improves the diagnosis of PCa, mainly due to the ISUP 1. Performing only targeted cores is impractical due to the high percentage of false negative results. Combined prostate biopsy with mandatory sampling of targeted biopsy cores along with standard biopsy specimens is indicated. The diagnostic accuracy of HistoscanningTM showed the best results with a prostate volume

The article presents a review of the literature and a description of a clinical case of osmotic demyelination syndrome manifested by pontine and extrapontine myelinolysis in a 36-year-old woman after her third surgical preterm delivery. The reasons for the development of a demyelinating lesion of the central nervous system are discussed, and clinical cases described in world literature sources are presented. An analysis of the pathogenesis of the development of this disease in women during pregnancy, childbirth, and lactation is provided. The importance of this period in a woman's life as an independent significant risk factor for the development of osmotic demyelination syndrome is discussed.

Introduction. Today absorbable suture material as well as plastic nonabsorbable clips are widely used for surgical haemostasis and stabilisation of sutures during minimally invasive operations, however, they are capable of potential and spontaneous migration into the lower and upper urinary tract.Objective. In this paper, we present clinical cases of clip migration after radical prostatectomy and renal resection.Clinical cases. Clinical cases of spontaneous clip migration after the two most common minimally invasive interventions: kidney resection with subsequent removal of a foreign body after the use of lithokinetic therapy and a case of hemostatic material migration after robot-assisted radical prostatectomy. The literature review is also available.Conclusion. Excessive use of non-absorbable plastic clips around their close contact with the kidney cavity or the bladder wall should be avoided to achieve adequate hemostasis during minimally invasive methods of treating patients.

Introduction. The prevalence of urinary stone disease (USD) historically considered a predominantly male disease. It has been rising over the last several decades with the rate of increase being higher among females. However, factors such as stone localisation, size, and density are usually analysed in postureteroscopic complications, and reports on gender-specific differences in the treatment of USD are scarce.Objective. To investigate the impact of gender differences on treatment success, intraoperative and postoperative complications in patients undergoing ureteroscopy.Materials & methods. A total of 300 patients with USD, who were performed ureteroscopic interventions in the period from September 2021 to November 2022 in Yudin City Clinical Hospital. Depending on gender, patients were divided into two groups — 194 (64.7%) men and 106 (35.3%) women. Recurrent USD was observed in 71 (36.6%) cases in Group I and in 45 (42.5%) cases in Group II, with an average recurrence time of 4.3 and 6.3 years, respectively. Male and female patients have had stone location in the upper third in 14.4% and 18.9% of cases, in the middle third in 18% and 6.6% (p = 0.005), in the lower third in 36 .1% and 49.1% (p = 0.04), in the intramural ureter in 28.9% and 21.7%, and in several localisations in 2.6% and 3.8% of cases, respectively.Results. The duration of surgery did not differ in both groups and composed 41.6 minutes. Internal ureteral stent placement was in 37 (19.1%) male patients and in 14 (13.2%) female patients. Based on specialised postureteroscopic lesion scales such as PULS and Satava, the percentage of complications in Groups I and II was 2.1 and 2.8 and 4.1 and 9.4 (p = 0.03) respectively.Conclusion. The development of acute renal colic in women with patients less intensity than in the male group leads to hospitalisation in the delayed period. In female patients, the number of postureteroscopic complications has higher rates due to the size and density of the stone and its location.

Introduction. Bladder cancer (BCa) is one of the most common oncological diseases with many relapses and progressions, which requires more and more new ways to solve this problem.Objective. To analyse of existing data on the molecular and genetic features of BCa classification based on them, assessment of the possibility of its introduction into clinical practice as a criterion for recurrence and progression.Materials & methods. We analysed the data of studies on molecular subtypes of BCa published in PubMed, Scientific Electronic Library of Russia (eLibrary), Scopus, Medline, EMBASE, websites of professional associations. We searched the following keywords: "molecular subtypes of bladder cancer", "non-muscle invasive bladder cancer", "molecular subtypes of bladder cancer" "non-muscle invasive bladder cancer". The paper focuses on the current classifications and the April 2020 consensus, which can be universal and applied in everyday practice.Results. During the analysis of the obtained data, it was revealed that the molecular and genetic heterogeneity of BCa is reflected not only in the proteins expressed on tumor cells, but also in the response to treatment and prognosis of the disease.Conclusion. Molecular and genetic markers seem promising for introduction into wide clinical practice to adjust treatment and assess the risks of recurrence and progression.

Introduction. Radical prostatectomy (RP) is the "gold standard" treatment for patients with prostate cancer (PCa). Obviously, one of the predictors actively studied of biochemical recurrence is the presence of a positive surgical margin.Objective. To develop and initially evaluate the techniques of targeted urgent intraoperative histological study of fresh frozen sections during radical prostatectomy.Materials & methods. This study was carried out within the framework of the academic research at the University Clinic of Urology, Pirogov Medical University. We conducted a prospective clinical study of fresh frozen tissue samples during laparoscopic RP (LPR). The subject of the investigation are 112 patients with PCa underwent LRP (extra- and transperitoneal approaches) by one surgeon in 2021 – 2022. Group A involves 62 patients underwent intraoperative examination of fresh frozen sections based on preoperative data (MRI, FUSION biopsy). Group B (control retrospective group) consists of 50 patients with standard surgery without fresh frozen sections.Results. The accumulation of new data allows us to say that the presence of an oncological process was found in the gross specimen obtained by performing cito histology in 42 (67.7%) patients. A primary positive margin was found in 12 (19.4%). Compared to group B, a positive surgical margin was found in 7 (14%). Migration of surgical margin status from initially negative to finally positive margin found in 2 (3.3%). Migration of status from primary positive to negative surgical margin was found in 2 (3.3%). The specificity of the method (true negative margin) was determined in 48 of 50 patients (96.1%), and the sensitivity (true positive margin) was determined in 10 of 12 patients (83.3%). The average time to complete the technique of rapid histological study was 27 minutes.Conclusion. Since the work carried out, we have come to the following conclusion that the obtained results indicate the effectiveness and expediency of using targeted urgent histological study during RP.

Introduction. Various speech disorders that lead to impaired communication occur in 3050% of ischemic stroke (IS) survivors. Although most attention is traditionally paid to aphasia, speech disorders also include the following: dysarthria, dysphonia (isolated or in combination with dysarthria and/or dysphagia), fluency disorders, and non-specific speech disorders associated with the severity of condition and a cognitive disorder. Objective: to study the variety of speech disorders and their features in patients with acute IS. Materials and methods. We examined 69 right-handed patients with mild-to-moderate acute IS and NIHSS score of 412. The patients were enrolled in the study on days 17 of the IS. Results. We found aphasia in 27/69 patients (39.1%), dysarthria in 21/69 patients (30.4%), dysphonia (isolated or in combination with dysarthria) in 17/69 patients (24.6%), fluency disorders in 19/69 patients (27.5%; 2 patients with tachylalia and 17 patients with bradylalia). In addition, 30 patients (43.5%) had dysphagia (isolated or in combination with dysarthria). At the initial examination, patients admitted within the 17 days of the acute IS onset presented with global or severe sensory and motor aphasia. At the same time, we discovered a pronounced positive dynamics in speech recovery thanks to speech therapy sessions. A significant remission in a speech disorder component led to the development of cortical aphasia affecting either anterior or posterior language areas at the end of the most acute IS period, while aphasia severity reduced to mild or moderate. Conclusions. A fast reduction in aphasic disorders due to the speech therapy sessions suggests that the focal and connectional diaschisis are the basis for the severe speech disorders.

Peyronie's disease (PD) is an acquired disease, which is based on a violation of the wound healing process, which results in the formation of fibrous plaques in the tunica albuginea of the cavernous bodies. The prevalence of erectile dysfunction (ED) among patients with PD ranges from 22% to 54%, according to various studies. Surgical treatment remains the "gold standard" for correcting penile curvature in PD. It is important to note that the existing methods of PD surgery (techniques with shortening or lengthening of the tunica albuginea) carry the risks of developing ED or aggravating its severity. At the same time, the absence of adequate sexual rehabilitation following PD surgery is associated with a significant deterioration in functional outcomes. In view of the above, the article is aimed to systematise information on penile rehabilitation methods in patients following PD surgery, which showed that the problem remains relevant to the present day. Most existing penile rehabilitation methods are currently not sufficiently investigated, and it is therefore impossible to give clear recommendations on the use of any method. The small number of well-designed and randomised studies on this problem is noteworthy, most likely due to the relative rarity of the disease.

Introduction. Nephrometric scales have been developed to determine the appropriate surgical tactics and to predict intraoperative values more accurately, considering the characteristics of the renal tumour. However, there is a need to assess the perinephric fat. The Mayo Adhesive Probability (MAP) scale aims to identify adherent perinephric fat (APF) or 'complex' paranephric fat preoperatively.Objective. To evaluate the effect of APF on intraoperative and functional outcomes of patients with renal cell cancer (RCC) who underwent laparoscopic partial nephrectomy.Materials & methods. We analysed 118 patients with localised RCC who underwent laparoscopic partial nephrectomy. At the preoperative stage, according to the results of contract-enhanced msCT, the presence of APF was assessed using the MAP scale. At the same time, the thickness of the posterior perinephric fat was measured and the grade of its twisting was assessed. As a result, the patients were divided into two groups: group 1 MAP 0 – 2 pts (no APF) 34 patients and group 2 MAP 3 – 5 pts (presence of APF) 84 patients. In each group, the following indicators were assessed: stage according to the TNM classification, mean age and BMI, average nephrometry score according to the R.E.N.A.L. system, glomerular filtration rate (GFR).Results. The median surgery time for group 1 patients was 115.0 [92.5; 142.5] min, for group 2 — 130.0 [101.3; 180.0] min. The median warm ischemia time in patients in group 1 was 15 [0; 20] min, in group 2 — 12 [0; 18] min. The median blood loss in the groups 1 and 2 was 50 [15; 100] and 50 [0; 100] ml, respectively. The mean GFR on the first day after surgery was 63.34 ± 18.40 ml/min/1.73 m2 in group 1 and 55.09 ± 16.01 ml/min/1.73 m2 in group 2. Openings of the pyelocalyceal system were observed in 8 (23.53%) and 23 (27.38%) patients in groups 1 and 2, respectively. A positive surgical margin was detected one patient in group 1 and two in group 2. Early postoperative complications in group 1 were four patients and group 2 — 15 patients.Conclusion. The presence of APF and its severity can be effectively assessed using the MAP score, which is promising, but is limited only to the prognostic of APF without correlation with nephrometric scales that assess tumour anatomy parameters. However, the issue of developing a unified assessment system that includes APF and kidney morphometry is currently open, and the definition of APF is still subjective and requires an objective analysis to obtain more accurate outcomes.

The paper describes actual problem of socio-economic inequality between the East and West of Germany. We examine the analysis of sociological differences between parts of the country in terms of the results of German unity policies, the introduction of coronavirus restrictions, technological equipment and economic potential. All those issues are considered with key works of German literature of recent years on understanding the contradiction «East-West». It is determined that the ongoing intellectual attempts have not overcome the split in the country. Additionally, we examine the federal government’s concept of a «new look to the East» was explored. The results show that as an independent region, for which the western part of the country does not serve as an indisputable reference point. Most likely, in fact, this approach has shifted the focus from the traditionally important internal chronic shortages of new lands in economic power, labor, infrastructure and technology. This problem is particularly relevant in connection with the lack of representation of people from East Germany in key positions in many areas of society and politics. This explains why its that these issues will be considered in a special concept of the federal government, adopted at the beginning of 2023. The second part of the state's efforts is related to changes in approaches to the implementation of regional policy in the country and financing of measures to improve the economic structures of the regions. The author concludes that they are synchronized with the tasks of ensuring energy security and accelerating the transformation at oil refineries and ports in eastern Germany after the cessation of oil and gas supplies from Russia. In this regard, we consider that the continuation of the polycrisis in the country makes a decisive contribution to the growing disillusionment of East Germans in politics. On the example of this analyses, we obtained that they do not reject democracy as such, but are much more critical of political actions than the population of the western part of Germany.

Improvement of therapy of patients with ischemic stroke (IS) remains a relevant problem, despite the widespread use of drug and mechanical revascularization methods during recent years. One of the pathogenetic mechanisms of IS is oxidative stress as one of the components of brain tissue damage in the acute period and a factor that prevents the processes of repair and neuroplasticity in the recovery period. This is the rationale for the use of antioxidant drugs in the acute and recovery periods of stroke. Data from clinical studies on the use of antioxidants in the treatment of patients with IS are presented. We describe the use of the domestic drug dimephosphone (dimethyloxobutylphosphonyl dimethylate), a synthetic non-anticholinesterase organophosphorus compound, which has a wide range of effects: antioxidant, antacidotic, vasodilating, membrane stabilizing, anti-inflammatory, etc. Data are given on the use of dimephosphone in the acute period of IS in patients with no indications for thrombolytic therapy, there was a decrease in neurological deficit and a decrease in disability. The positive results of the use of dimephosphone in the recovery period of IS and in chronic cerebrovascular insufficiency are described. The data of our own study on the use of dimephosphone in the complex therapy of cognitive rehabilitation of patients in the recovery period of IS are presented. A statistically significant recovery of cognitive functions was registered according to the Montreal Cognitive Scale (MoCA), and an increase in the MoCA score by 2 points or more in 59.6% of patients. An improvement in executive functions, an increase in the flexibility of cognitive control of cognitive processes, and the predominance of verbal thinking over sensory-perceptual were noted.

Background: Systemic thrombolytic therapy (STLT) with alteplase is the method of choice in all patients with acute ischemic stroke (IS) within the first 4.5 hours after the symptom onset. There is a noticeable difference between men and women in the clinical characteristics and results of stroke treatment; however, results of studies have been contradictory. Aim: To evaluate the efficacy of STLT with alteplase in women compared to men, depending on the presence of some risk factors for stroke. Materials and methods: This open-label prospective observational non-interventional cohort study of STLT in IS included 209 patients (102 women, the main group, and 107 men, or the comparison group) aged 32 to 86 years. All patients received STLT with alteplase within 4.5 hours from the onset of IS symptoms. The primary endpoint of the study was 28-day survival, and the secondary endpoint was the achievement of mobility independence (0 to 2 points by the modified Rankin Scale (mRS)). Results: The demographic and clinical patient characteristics of both groups were comparable, but women were on average 5 years older than men (p = 0.003). The index IS was not the first one in 31.4% of women and 23.4% of men (p 0.05). There were no significant differences in the severity of stroke and the timing of STLT. Men had a high mortality rate in the acute period of IS, but the difference was non-significant. PST-STLT hemorrhagic transformation was more common in men, with the difference being non-significant (2 0.743, p = 0.389). Women were more likely to have type 2 diabetes mellitus (DM2) (37.3% and 20.6%, respectively, 2 7.111, p = 0.008). In women, there was a trend towards better symptom regression by about 1 point (p = 0.129). The women with DM2 had a 13% higher survival than men (p = 0.038). The numbers of patients achieving independence (02 points on the mRS scale) by Day 28 was not different (56 women and 52 men). No between-groups differences were found in the numbers of patients with arterial hypertension and atrial fibrillation. Only 13 women (12.75%) and 21 men (20%) had a normal body mass index, while 56.3% of women and 46.7% of men had obesity 2 or 3 grades, with the gender differences being non-significant. Conclusion: In women, who have received STLT in the acute period of IS, the death rates and the functional outcomes were non-inferior to those in men, despite their older age, hyperglycemia in the acute period and past history of DM2. The risk factors for stroke in women, compared to men, could be the potential cause of more frequent IS recurrence (every third case in women and every fourth in men was recurrent). Despite a number of negative factors (age, obesity, metabolic syndrome, hyperglycemia, DM2, atrial fibrillation), there was a trend towards better outcomes of STLT in women.

A new coalition government in Germany came into power at the end of 2021. The paper describes Germany’s 2022 G7 Presidency as a first major foreign policy priority and test. The article considers that this period gave the German government the opportunity to test diverse political initiatives. These include proposals in the economic and climate sphere, in the regulation of the labor market, the prospects for the global agro-industrial complex, and overcoming the consequences of the pandemic. The creation of the Climate Club has become the most ambitious project. In this regard the G7 will unify their environmental standards within the club. It will stimulate the entry into the club of countries that are also taking action to combat climate change. Additionally, we examine the of sectoral communiqués. Analysis showed that Olaf Scholz’s government did not propose any truly breakthrough initiatives. Many key ideas were duplicated from the Elmau summit in 2015. In each sectoral area, financial and military support for the Ukrainian regime was noted in the documents. In the author’s opinion, the strategic move of the German Presidency was to invite the leaders of India and South Africa to a key meeting, as well as to coordinate with the Indonesian G20 Presidency. The author comes to the conclusion that the results of the German presidency are twofold. On the one hand, despite the Ukrainian conflict, attempts have been made to develop the climate agenda. It is emphasized that main issue was the modernization of the WTO. Was put on the other hand, these topics constantly disappeared due to the topics of support for Ukraine. Most likely, the G7 once again demonstrated the soft nature of the organizational structure. The author concludes that main decisions to put pressure on Russia remained in the shadow of the sanctions packages of the European Union.

Introduction. Reinfection after drainage of obstructive pyelonephritis exacerbates the postoperative course of the disease and delays the possible surgical intervention aimed at eliminating the cause of obstruction.Objectives. To determine the percentage of re-infection in patients drained with double-J stent or nephrostomy catheter for obstructive pyelonephritis. To assess the relationship between the timing of drainage removal and development of re-infection. To establish risk factors for the development of re-infection.Materials and methods. Medical records from 1022 patients who were treated from January 2019 to December 2021 and underwent drainage for obstructive pyelonephritis. The data in patients after nephrostomy and stenting were evaluated separately. A retrospective analysis of the time and frequency of the development of re-infection, as well as the effect of diabetes mellitus on pyelonephritis relapse, was carried out.Results. Re-infection during drainage developed in 16 (4.8%) patients with a nephrostomy and 45 (6.5%) patients with a stent. Among those who had re-infection in the nephrostomy-group, 4 (25.0%) patients noted it within two weeks from the moment of drainage, and 11 (69.0%) at three-four weeks. In the stent-group, the number of patients who had a complication during the first two weeks was 15 (33.0%), and it was 22 (49.0%) during the next two weeks, The proportion of patients with diabetes mellitus was higher among those who developed pyelonephritis again.Conclusion. The percentage of patients hospitalized with clinical re-infection after drainage of the upper urinary tract was 6.0%. There was an increase in the number of hospitalizations with recurrent pyelonephritis in cases where the drainage period lasted more than two weeks (p < 0.05).

A 58-year-old patient with type 30 dystonia (OMIM619291) detected by genome-wide sequencing was described. A variant of rs778751388, not previously described in the literature, has been identified in the heterozygous state in exon 2 of 24 of the VPS16 gene, leading to the amino acid substitution of P.Cys36A4rg. DNA change (HG38)(protein change) 20:g.2859771TC ENST00000380445.8:c.106TC ENSP00000369810.3:p.Cys36Arg. The patient's disease began quite late, in the 4th decade of life, with spastic torticollis. Subsequently, the spread of the pathological process involving the muscles of the neck, the right upper limb, then the right lower limb, myoclonia of the right hand and tremor of the right lower limb was noted. Secondary mitochondrial disorders were revealed in the form of an increase in the level of lactate in the blood before and after loading with carbohydrates. A decrease in the activity of mitochondrial enzymes in peripheral blood lymphocytes was also revealed: succinate dehydrogenase, an enzyme of the mitochondrial respiratory chain complex II; -glycerophosphate dehydrogenase involved in mitochondrial fat metabolism; glutamate dehydrogenase (amino acid metabolism in mitochondria). The level of lactate dehydrogenase in peripheral blood lymphocytes in the patient was elevated. The identified secondary mitochondrial disorders may be an indication for the appointment of energotropic medicines along with levodopa drugs and dopaminergic receptor agonists. In the presented observation, it can be argued about autosomal dominant inheritance, since the patient has a characteristic clinical picture of the disease and a mutation in the heterozygous state in the VPS16 gene was detected.

The authors propose a methodological approach to quantitative assessing the level of organizational culture of a university of a humanitarian profile. This assessment methodology was tested on scientific and pedagogical workers who took part in an expert survey. The results of an expert interview are given in the article. Not only employees of humanitarian universities, but also employees of universities of a natural and technical profile, having education in the field of social (humanitarian) sciences acted as experts. The purpose of the study was to identify the features and patterns in the formation and implementation of the organizational culture of the university of humanitarian profile. The authors propose an original methodology, which allows assessing the level of organizational culture simultaneously from three positions – past, present and future (desired) state. The level of organizational culture is determined on the basis of an integral (generalizing) indicator, which, unlike analogues developed by other researchers, is calculated as the geometric mean of the integral indexes of groups of indicators, which makes it possible to determine the median value, which is the closest to the average value.

The collapse of the USSR led not only to the formation of 15 independent states in the place of the former Soviet republics, but also to the strengthening of secessionism and the emergence of de facto states in the post-Soviet. The emergence, formation and transit of states of this type have many, both common and specific features associated with the peculiarities of their birth.Aim. A comparative analysis of the formation and transit of the Pridnestrovian Moldavian Republic (PMR) and the Donetsk People’s Republic (DPR) as de facto states of the Russian world and a comparative analysis of the formation of industrial models of the economy of the unrecognized states and their management systems.Tasks. Development of models of management systems for the development of the economy of the self-proclaimed republics. Drawing up and substantiation of medium-term forecasts for the development of the PMR and the DPR: 1) integration into a new union state; 2) return to their “mother states” (Moldova and Ukraine); 3) joining Russia, 4) partial international recognition; 5) continuation of existence in the form of a “gray zone” of the economy and politics. Other options are possible, the most tragic of which is the end of support from Russia, which means the end of the existence of these de facto states.Methods. Methods of system analysis, short- and medium-term forecasting, comparative analysis were used.Conclusions. At the heart of any political system is the economy. It is the quality of the constructed economic model that determines the level and duration of the political independence of the state. This connection is especially evident in the construction of the statehood of territorial neoplasms, in which the creation of an economic system is built according to the patterns and principles of the economic system of the patron stateareas”, the shortcomings of the patron state system of the same name, from which the economic model and management mechanisms were “written off”, a comprehensive consideration of the features of secessionism in the specific historical conditions of the emergence of unrecogni zed states is necessary.

The article considers the current problem to build terminals for the import of liquefied natural gas (LNG). The paper demonstrates that projects considered in recent years have been hampered due to lack of investment and lack of demand. Due to the aggravation of the conflict in Ukraine and the desire to reduce energy dependence on natural gas supplies from Russia, these projects is necessary for Germany’s economy. We examine the criticism of the projects by environmental public organizations. The article analyzes the unprecedented speed of investment decisions in the energy infrastructure, the newly created framework conditions by the Law on accelerating the construction of LNG terminals. The article discusses that the German federal government assigns them a key role in ensuring the security of gas supplies. On the example of key locations: Brunsbüttel, Wilhelmshaven and Stade, we examine various options potential investors. We hypothesise that in the future, these projects open up Germany the possibility of global natural gas supplies without the use of pipelines and, thus, interaction with new market players. Simultaneously, although LNG volumes from terminals in neighboring European countries are also available to the German natural gas market. This paper proved that in detail the importance for ensuring the reliability of gas supply of planned domestic investments that do not depend solely on commercial benefits. Significant positive impact of gas infrastructure is only found in the context of hydrogen energy in the country.

Introduction. The majority of patients who undergo radical prostatectomy, apart from loss of sexual function, note a decrease in penis size which negatively affects their self-esteem. Penile rehabilitation is a set of measures aimed at recovery of sexual function to improve the quality of life.Objective. To analyze various options for penile rehabilitation in order to choose a method for preventing penis size reduction in patients undergoing nerve-sparing radical prostatectomy.Materials and methods. Patients who undergo radical prostatectomy (n = 83) at status flaccid and status erect were measured: length, circumference of the base, body and glans penis (mm) at different periods of penile rehabilitation. As a control, the tumescence coefficient was determined using pharmacodopplerography. All results were evaluated before, at the 6th and 12th months after radical prostatectomy.Results. Depending on the type of restoration of erectile function, the patients were divided into several groups: group 1 – men without penile rehabilitation; group 2 – patients treated with phosphodiesterase inhibitors of type 5; group 3 – using vacuum erection device (VED) and group 4 – taking combined penile rehabilitation. Medians of tumescence coefficient in group 1 on the 6th and 12th months was 2.7 (2.4; 3.1) and 2.6 (1.9; 2.9), in group 2 – 2.8 (2.2; 3.5) and 2.9 (2.2; 3.5), in group 3 – 2.7 (2.3; 3.3) and 2.8 (2.3; 3.3), in group 4 – 3.0 (2.2; 3.2) and 3.1 (2.1; 3.2), respectively (p

Introduction. The learning curve (LC) of radical prostatectomy (RP) is an actual problem in contemporary urology.Objective. To assess the LC of retropubic (rpRP), perineal (plRP), laparoscopic (LRP), and robot-assisted radical prostatectomy (RARP).Materials and methods. The study included 400 patients with localized or locally advanced prostate cancer (T1cT3bN0M0) who underwent rpRP, plRP, LRP or RARP performed by a single surgeon. Exclusion criteria: refusal of surgical treatment, metastatic prostate cancer, primary multiple cancer, neoadjuvant hormonal, radiation or chemotherapy.Results. Progressive improvement of metric indicators was noted in all groups as the surgical technique was mastered. Maximum rates of reaching the plateau of satisfactory functional and early oncological results were demonstrated in the RARP group after 25 – 50 procedures. In terms of the duration of the surgery, the LRP group showed the longest mastering period of 75 – 100 cases. Regression of blood loss volume requires 50 – 75 procedures in the rpRP and LRP groups, and 25 – 50 approaches in the rpRP and RARP groups. RARP demonstrates advantages in the context of minimization of catheterization time and inpatient period (25 – 50 cases). rpRP is not only associated with a maximum amount (n = 30) and frequency (21,0%) of complications, but also with a relatively long period of reaching a plateau of 50 – 75 cases. The stabilization of functional results is proceeding at the maximum pace in the RARP group at 25 – 50 procedures, in the other groups at 50 – 75 cases. Oncological safety (positive surgical margin) in the LRP, rpRP and RARP groups is achievable after 25 – 50 cases, in the rpRP group at 50 – 75 cases.Conclusion. The period of RP mastering depends on surgical approaches. RARP demonstrates the shortest LC duration.

Introduction. The purpose of the article is to consider the effect of damping in the shock absorber on smooth running, continuous rolling of the wheel and energy loss in the suspension of the car.Materials and methods. The review is based on the analysis of the amplitude-frequency characteristics of a two-mass car model and the dependence of the shock absorber operation during the oscillation cycle on the frequency of kinematic action.Results. The article presents a calculation scheme and equations of dynamics of a two-mass oscillatory system equivalent to an automobile suspension. The frequencies at which the amplitude-frequency characteristics intersect for different levels of damping (invariant points) in a two-mass oscillatory system are calculated. The relative operation of the shock absorber for the oscillation cycle concept is proposed and a formula for calculating the relative operation of the shock absorber in a two-mass oscillatory system is given. A comparative analysis of graphs characterizing smooth running, continuous rolling of the wheel and energy losses in the suspension is carried out.Discussion and conclusions. It is revealed that significant contradictions between these requirements arise only near the second resonance of the sprung mass, with an increase in the frequency of vibrations in the resonant zone, these contradictions are decrease.

April 16, 2022 marks the 100th anniversary of the Treaty of Rapallo, concluded between Russia and Germany during the Genoa Conference. His fate and role is still controversial. Particular attention is paid to the «spirit of Rapallo» – a realistic and pragmatic idea of peaceful development in the context of today’s increased politicization and curtailment of Russian-German economic relations. We consider that following a direct decrease in mutual trade the very significance of Russian-German economic cooperation is further underestimated emotionally and subjectively. Based on a cross-country cross-sectoral analysis, the paper analyzes the interdependence of the key economies of Russia and Germany are presented. We identified the key import positions of both countries. It is emphasized that a purely quantitative calculation of the reduction of ties may be insufficient, since it does not take into account the cascading economic effects generated from supply chains. Using results of surveys of the German business community, we assessed the strength of the sanctions measures introduced with the active support of Germany against Russia regarding the disconnection from the SWIFT system, the freezing of financial accounts, the measures introduced against the Central Bank of Russia – up to the freezing in principle of economic relations between countries are presented. The author concludes that the anniversary of the Rapallo Treaty, for objective reasons of the military-political situation, remained in the shadows and cannot again put forward considerations for constructive cooperation. Most likely, in the expert community, a reference to it may have an impact on western companies in order to prevent a complete break in business relations with Russian companies.

Three case studies of adults with Leber hereditary optic neuropathy with and without neurological symptoms are presented. An elevated blood lactate level and changes in the activity of the mitochondrial enzymes in peripheral blood lymphocytes were noted. Mutations in the mitochondrial DNA (G3460A in one patient and G11778A in two patients) were found. The patient with a G3460A mutation, in addition to reduced visual acuity, was diagnosed with a cerebellar disorder due to cerebellar vermis hypoplasia. These changes are indications for prescribing energotropic drugs (idebenone, carnitine); carnosine can also be prescribed. These case studies show that patients with optic nerve atrophy should be assessed for Leber hereditary optic neuropathy. Differential diagnosis with multiple sclerosis should be performed, since this condition often presents as optic neuropathy.

The paper describes the experience of treatment during the preparation of stone objects from the collection of Bolgar State Historical and Architectural Museum-Reserve, which consist of 200 storage units, for museum display. The collection includes gravestones of the 13th-14th centuries decorated with ornamental carvings, inscriptions, monochrome painting, and fragments of architectural decor made of limestone, tuff and plaster. The objects date back to the period of the Bolgar ulus being part of the Golden Horde. Most of them are in poor condition and require restoration and conservation. Besides, the museum cannot provide a complete display of the collection in the existing exposition conditions. In order to provide the conditions for collection display, a lapidarium is being constructed in the territory of the Bolgar Museum-Reserve. Preservation of cultural heri­tage sites requires joint efforts by various specialists - conservators, curators, and archaeologists. Along with the development of an exposition concept and its spatial and architectural solutions, a cycle of conservation treatment of the objects is performed, which is described in this paper.

Ischemic stroke (IS) is the leading cause of neurological inpatient care, readmission, and long-term disability. Until now, there is no single point of view on when the second stage of medical rehabilitation after an IS should be started and the amount of the rehabilitation activities.Objective: to compare the effectiveness of the course of motor rehabilitation during the first 30–90 days and 91–180 days after IS.Patients and methods. The patients were divided into two groups: group 1 included 44 patients in whom ≤3 months passed from IS onset, and group 2–39 patients in whom >3 but