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Rationale: Cystic dilatation of the bulbourethral gland duct (Cowper's syringocele, CS) is a rare urethral pathology. No more than 150 cases of CS have been reported in the literature, of which the vast majority are children with a unilateral location. Bilateral CS has been reported in eight cases; however, detailed anatomy and clinical manifestations have not been reported. In this study, we report a case of bilateral CS with cavity junctions through the medial septum and its successful minimally invasive treatment in an adolescent., Case Presentation: A 16-year-old adolescent patient complained of painful urination and post-micturition urinary dribbling. Magnetic resonance imaging (MRI), urethrography, and ureteroscopy data enabled the establishment of the diagnosis and determination of the type of CS. The surgical treatment that was performed was endoscopic marsupialization of both CS chambers. At follow-up examination after 7 months, the complaints had ceased, and there was complete normalization of urination. The maximum flow rate during uroflowmetry was 35 ml per second, on voiding cystourethrography, the residual cavities were not contrasted, and there was no residual urine or bacteriuria., Conclusion: MRI and retrograde urethrography made it possible to visualize changes in the bulbous part of the urethra, and ureteroscopy was the leading imaging modality. These studies was applied precisely because of the suspicion of the presence of a cavity communicating with the urethra. Minimally invasive surgical treatment for double-chamber CS was successful with no resulting complications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Osipov, Lebedev, Uzintseva and Sidorova.)

Purpose: Investigation of the results of ureteral stricture single balloon dilation in children with primary obstructive megaureter., Materials and Methods: Since 2012 to 2020 79 children (65 boys and 15 girls) with primary obstructive megaureter of II and III grades who had 92 affected ureters were operated on by method of ureteral stricture balloon dilation. Duration of postoperative stenting period was Me=68 [48; 91] days, bladder catheterization period - Me=15 [5; 61] days. Follow-up was from 1 to 10 years., Results: There were no intraoperative complications in the group of investigation. Pyelonephritis exacerbation in the early postoperative period occurred in 15 cases (18,98%). Control comprehensive examination revealed that urodynamics of 63 children (79,74%) tended to normalization what persisted in the future. There was no positive dynamics in 16 cases (20,25%). Vesico-ureteral reflux was revealed in 4 cases., Discussion: Assessment of impact of various predictors (passport, urodynamic, infectious, anatomic, operation and postoperative period characteristics) on the treatment results proved that the effectiveness of the procedure depends on the following factors: ureteral stricture length (M-U Test U=202,5 p=0,0002) and features of the stricture rapture during ballooning (Fisher exact p=0,0006). There was significant difference in results in the group of up to 10 mm inclusive stricture length and the longer stricture group (Fisher exact p=0,00001). High activity of pyelonephritis in postoperative period was the predictor of adverse outcome (Fisher exact p=0,00001)., Conclusion: Practically 80% of children with primary obstructive megaureter may be reliably cured by the method of ureteral stricture balloon dilation. The risk of intervention failure is greatly increased in case of the stricture length is more than 10 mm and technical difficulties of ballooning indicating a high resistance of the narrowed portion of the ureter to dilation.

A low 25-hydroxyvitamin D (25(OH)D) level is considered as an independent risk factor for COVID-19 severity. However, the association between vitamin D status and outcomes in COVID-19 is controversial. In the present study we investigate the association between the serum 25(OH)D level, immune response, and clinical disease course in patients with COVID-19. A total of 311 patients hospitalized with COVID-19 were enrolled. For patients with a vitamin D deficiency/insufficiency, the prevalence of severe COVID-19 was higher than in those with a normal 25(OH)D level (p < 0.001). The threshold of 25(OH)D level associated with mortality was 11.4 ng/mL (p = 0.003, ROC analysis). The frequency of CD3+CD4+ T helper (Th) cells was decreased in patients with 25(OH)D level ≤ 11.4 ng/mL, compared to healthy controls (HCs). There were no differences in the frequency of naive, central memory (CM), effector memory (EM), and terminally differentiated effector memory Th cells in patients with COVID-19 compared to HCs. The frequency of T-follicular helpers was decreased both in patients with 25(OH)D level > 11.4 ng/mL (p < 0.001) and 25(OH)D level ≤ 11.4 ng/mL (p = 0.003) compared to HCs. Patients with 25(OH)D level > 11.4 ng/mL had an increased frequency of Th2 CM (p = 0.010) and decreased Th17 CM (p < 0.001). While the frequency of Th2 EM was significantly increased, the frequency of Th17 EM was significantly decreased in both groups compared to HCs. Thus, 25(OH)D level is an independent risk factor for the disease severity and mortality in patients with COVID-19. We demonstrate that the serum 25(OH)D level ≤ 11.4 ng/mL is associated with the stimulation of Th2 and the downregulation of Th17 cell polarization of the adaptive immunity in patients with COVID-19.

Type 2 diabetes mellitus (T2DM) and chronic heart failure (HF) have close association, and several biomarkers have been studied to better understand this association and improve prediction of HF in T2DM. Furthermore, in recent clinical trials, sodium glucose cotransporter 2 inhibitors (SGLT2i), glucose-lowering drugs, improved HF outcomes. The objective of the present study was to evaluate association between circulating biomarkers of fibrosis and incidence of HF with preserved ejection fraction (HFpEF) in patients with T2DM receiving sodium glucose cotransporter 2 inhibitors (SGLT2i). Materials and Methods . At baseline, transthoracic echocardiography and laboratory assessment of N-terminal fragment of the brain natriuretic peptide (Nt-proBNP), soluble suppression of tumorigenesis-2 (sST2), galectin-3 (Gal-3), C-terminal propeptide of procollagen type I (PICP), N-terminal propeptide of procollagen type III (PIIINP), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of matrix proteinase-1 (TIMP-1) were done. After 3 years of follow-up, information about HF events (hospitalization for HF, established HF in outpatient department by a cardiologist) was obtained. Results . Seventy-two patients were included in the study. The mean age was 57 (49.7; 63.2) years; 44% were female. Most patients had T2DM for more than 4 years. All patients were overweight or had obesity, and 93% patients had arterial hypertension (AH). After 3 years of follow-up, HFpEF was established in 21% patients. Patients were divided into two groups according to the presence of HFpEF, and baseline characteristics were compared. Patients with HF were older and had longer diabetes and AH duration and higher Nt-proBNP, Gal-3, PIIINP, and PICP levels at baseline than patients without HF (all p < 0.05). Gal - 3 > 10 ng/ml (OR = 2.25; 95% CI, 1.88-5.66; p = 0.01) and NT - pro - BNP > 80 pg/ml (OR = 2.64; 95% CI, 1.56-4.44; p = 0.001) were associated with increased risk of HF incidence. Age > 60 years, diabetes duration > 10 years, and presence of abdominal obesity were independent predictors of HFpEF as well. Conclusions . T2DM patients treated with SLGT2i, who developed HFpEF after 3 years of follow-up, had higher PICP, PIIINP, Gal-3, and NT-proBNP serum concentrations at baseline, and Gal-3 level was an independent predictor of HFpEF., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Denis A. Lebedev et al.)

Objective: The aim of our study was to investigate the distribution of the PHPT clinical manifestations and biochemical features in patients who underwent parathyroidectomy., Materials and Methods: Medical records of 449 patients from three Medical Centers (Saint-Petersburg, Russia), hospitalized during a period from 2011 to 2018, were reviewed. History and anthropometric data, laboratory results (iPTH, total and iCa, phosphorus, ALP, 24-h urinary calcium, 25(OH)D) and imaging data (ultrasonography, scintigraphy, CT/MRI scan, DXA) were analyzed., Results: Three hundred ninety-four patients were included in the final analysis. Median age was 60 years with 94.2% being women. Symptomatic disease was evident in 222 (56.4%) patients, asymptomatic in 172 (43.6%). Skeletal involvement was more common for women, while frequency of other manifestations did not differ in both genders. There was no difference between symptomatic and asymptomatic patients in age. Serum iPTH level was higher in symptomatic patients (202.9 and 181.0 pg/mL, P = 0.022). Serum 25(OH)D level was estimated in few patients and negatively correlated with PTH (r = ¯0.294, P = 0.005), iCa (r = ¯0.268, P = 0.010) and total Ca (r = ¯0.284, P = 0.014) levels. Manifestations of CVD were observed in 67.7% of cases and affected equally both symptomatic and asymptomatic patients (70.7 and 63.4%, P = 0.076). Both age and BMI were higher in patients with CVD, whether or not they were symptomatic (62 and 53 years, P < 0.0001; 30.4 vs 26.0 kg/m2, P < 0.0001, respectively)., Conclusions: This experience illustrates that symptomatic phenotype is still the most common form of PHPT.

As myocardial fibrosis might be an important contributor to the association of diabetes mellitus with left ventricular (LV) dysfunction and chronic heart failure (HF), we investigated the profile of some proinflammatory, profibrotic biomarkers in patients with type 2 diabetes mellitus (T2DM) at various stages of the cardiovascular disease continuum from absence of clinic since and symptoms to HF with preserved (HFpEF) and midrange ejection fraction (HFmrEF). Material and Methods . Sixty-two patients with T2DM (age 60 [55; 61]), 20 patients without clinical manifestations of HF and 2 groups with clinical manifestations of stable HF, 29 patients with HFpEF, and 13 patients with HFmrEF, were included in the study. The control group consisted of 13 healthy subjects and normal BMI. All patients underwent transthoracic echocardiography, laboratory assessment of N-terminal fragment of the brain natriuretic peptide (Nt-proBNP), highly sensitive C-reactive protein (hsCRP), soluble suppression of tumorigenesis-2 (sST2), galectin-3, C-terminal propeptide of procollagen type I (PICP), N-terminal propeptide of procollagen type III (PIIINP), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of matrix proteinase-1 (TIMP-1). Results . Patients with HFmrEF had higher values of LV volumetric parameters, indexed parameters of LV myocardial mass (LVMM), and higher concentrations of Nt-proBNP (all p < 0.05). The concentrations of galectin-3 were greater in patients with HFpEF and HFmrEF compared to patients without HF ( p = 0.01 and p = 0.03, respectively). PICP and PICP/PIIINP ratio were greater in patients with HFmrEF compared to patients with HFpEF ( p = 0.043 and p = 0.033, respectively). In patients with T2DM and HF, a relationship was found between galectin-3 and LVMM/body surface area ( r = -0.58, p = 0.001), PIIINP, TIMP-1, and LV end-diastolic volume ( r = -0.68 and p = 0.042 and r = 0.38 and p = 0.02, respectively). Conclusion . The dynamics at various stages of the cardiovascular disease continuum in the serum fibrosis markers may reflect an increase in fibrotic and decrease in antifibrotic processes already at the preclinical stage of HF. At the same time, the changes found in the circulating procollagen levels may indicate a shift in balance towards type I collagen synthesis in HFmrEF compared with HFpEF., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 D. A. Lebedev et al.)

Aim: To evaluate the effects of glucagon-like peptide-1 analogs (GLP-1a) combined with insulin on myocardial ischemia-reperfusion injury in diabetic rats., Methods: Type 2 diabetes mellitus (T2DM) was induced in male Wistar rats with streptozotocin (65 mg/kg) and verified using an oral glucose tolerance test. After anesthesia, the left coronary artery was occluded for 40 min followed by 80 min reperfusion. Blood glucose level was measured during surgery. Rats were randomized into six groups as follows: (1) control rats; (2) insulin (0.1 U/kg) treated rats prior to ischemia; (3) insulin (0.1 U/kg) treated rats at reperfusion; (4) GLP-1a (140 mg/kg) treated rats prior to ischemia; (5) GLP-1a (140 mg/kg) treated rats at reperfusion; and (6) rats treated with GLP-1a (140 mg/kg) prior to ischemia plus insulin (0.1 U/kg) at reperfusion. Myocardial area at risk and infarct size was measured planimetrically using Evans blue and triphenyltetrazolium chloride staining, respectively., Results: There was no significant difference in the myocardial area at risk among groups. Insulin treatment before ischemia resulted in a significant increase in infarct size (34.7% ± 3.4% vs 18.6% ± 3.1% in the control rats, P < 0.05). Post-ischemic administration of insulin or GLP-1a had no effect on infarct size. However, pre-ischemic administration of GLP-1a reduced infarct size to 12% ± 2.2% ( P < 0.05). The maximal infarct size reduction was observed in the group treated with GLP-1a prior to ischemia and insulin at reperfusion (8% ± 1.6%, P < 0.05 vs the control and GLP-1a alone treated groups)., Conclusion: GLP-1a pre-administration results in myocardial infarct size reduction in rats with T2DM. These effects are maximal in rats treated with GLP-1a pre-ischemia plus insulin at reperfusion., Competing Interests: Institutional animal care and use committee statement: All animal experiments were performed according to the Guide for the Care and Use of Laboratory Animals in Almazov National Medical Research Centre, which strictly conforms to the Guide for the Care and Use of Laboratory Animals, published by the US National Institutes of Health (NIH, Bethesda, MD). The protocol was approved by the Institutional Animal Care and Use Committee of Almazov National Medical Research Centre (protocol #2016-3).

A comparative analysis of efficacy of two methods was the purpose of the research. Politano-Leadbetter technique was applied in 41 cases and nipple way was used in 13 cases. The investigation included 45 patients aged from 2 months till 17 years with congenital obstructive ureterohydronephrosis of terminal stage (the pathology was diagnosed from both sides in 15 children). A follow-up period was from 1 till 6 years. Recurrent intervention was required in 31 cases. An analysis of overall results allowed determining the outcome as positive in 26 cases after Politano-Leadbetter operation. There were a vesicoureteral reflux in 6 cases and signs of obstruction appeared in 9 cases. The application of nipple operation had positive results in 9 cases, at the same time, the complication such as vesicoureteral reflux was noted in 2 cases, the signs of obstruction were in 2 cases. The authors prefer using the nipple method of reimplantation in spite of identical results of two different methods.

A 10-year experience with endoscopic treatment of vesicoureteral reflux (VUR) was analyzed in 712 patients. Short hospital stay, high percentage of positive results of the gel endoplasty of the ureterovesical segment, the practical absence of complications characterize endoscopic plastic operations as the first choice method for VUR in children. It allows refusal to use antibiotics for a long time and to perform open surgical interventions.

The analysis of long-term results of complex surgical correction of urinary bladder extrophy in 83 patients has shown that 21 (25.3%) patients had concrements in the urethra. Multiple bacteriological tests detected urease-producing flora which was managed with specific antibacterial therapy. Two patients were exposed to extracorporeal shock-wave lithotripsy. Low-invasive lithotripsy was low effective and all the patients were operated. Chemical structure of the removed concrements was determined with x-ray difractometry. Recurrent concrements were found in 7 (33.3%) of 21 patients who had not received specific antibacterial therapy. All the stones detected were struvite. Thus, struvite concrements' risk in patients after surgical correction of urinary bladder extrophy can be reduced under the following conditions: suppression of urease-producing flora activity, catheterization regime compliance, systemic sanation of the artificial urinary bladder.

The examination of 41 patients with a complete renal duplication and vesicoureteral reflux (VUR) into 57 ureters has shown a direct dependence of morphological immaturity of the parenchyma of the double kidney segment and functional insufficiency of the obturative apparatus of the ostium of the corresponding ureter on the degree of its dislocation corresponding to the normal localization on the inner surface of the urinary bladder. For patients with marked lateral position of the main ostium of the organ saving operations are senseless because of high degree of VUR and deep dysplasia of the renal tissue. In cases with moderate lateralization of the ureter ostium it is expedient to fulfil such antireflux interventions as Lich-Gregoir operations in a "single block" or the endoscopic correction of the ostium with a synthetic medical siloxan rubber or polyacrylamide gel "Interfall".

The authors summed up the 9 years-long experiences with treatment of 2588 children with vesicoureteral reflux. Conservative methods were successful in treatment of 74% of the patients. Of great importance were antibacterial therapy and treatment of the urinary bladder. Surgical interventions were fulfilled in 26% of the patients. Good effects were noted after Lich-Gregoir, Cowen operations, reimplantation of the ureter in 91.4%, 100% and 94.7% of the patients correspondingly.

The authors purified the alkaline ribonuclease obtained from the pancreas and the contents of the superior part of the dog's intestine. A comparative examination of physico-chemical properties and specificity of the separated enzymes was effected. The resulting data prove the pancreas to be the source of the alkaline ribonuclease contained in the superior portion of the intestine.

The data on structure, biosynthesis, post-synthetic modifications, extracellular development and degradation of collagen are briefly reviewed. Role of main enzymes, participating in collagen turnover, is discussed. Isoforms of the protein are considered in details. The importance of studies on collagen proteins is noted in connection with investigations on morphogenesis, cell differentiation, regeneration.

Rate of collagen biosynthesis was evaluated by monitoring total radioactivity of 14C-proline in soluble and unsoluble collagen. The rate of collagen maturation was estimated by following radioactivity of 14C-hydroxyproline in unsoluble fraction of collagen. Correlation between the concentration of collagen in skin and the rate of its biosynthesis enabled to determine the rate of collagen degradation. The modified method differed from the original one in the procedure for estimation of total and radioactive hydroxyproline, in technique for extraction of collagen fractions, soluble in 0.45 M NaCl, in composition of experimental samples. Some reagents were substituted for more easily available analogues. The modified method, as compared with original one, was more informative, simple and less expensive, but maintained the good reproducibility and sensitiivity of the original method.

Content of cytochromes P-450 was lower in liver tissue of NZB mice strain as compared with the NZW strain. Lipid peroxidation in microsomal fraction was higher in females as compared with males (P less than 0.05); it was also higher in females of the NZB mice strain than in the NZW strain (P less than 0.05).

Rates of biosynthesis, maturation and degradation of collagen were studied in skin of patients with systemic sclerodermia. The rate of collagen biosynthesis was increased about 3-fold in most patients and in several persons--increased 4--6 fold. Collagen maturation was approximately twice increased in systemic sclerodermia. Content of collagen was decreased in skin of the patients and the rate of collagen degradation exceeded distinctly that of controls. The rate of collagen biosynthesis did not depend on the type of skin impairment. With development of sclerodermic disease maturation of collagen was increased and the rate of its degradation was, by contrast, decreased. The rate of collagen biosynthesis was the highest in chronic and progressive forms of sclerodermia. In subacute sclerodermia the rate of collagen biosynthesis was decreased as compared with chronic and progressive forms of the disease but it was higher than in normal state. Processes of biosynthesis and maturation of collagen were coupled, related to each other in subacute sclerodermia and in indurative skin. These processes were uncoupled in visually unimpaired skin under progressive and chronic sclerodermia.