[Experience with the use of bacteriophages in patients with neurogenic lower urinary tract dysfunction, complicated by recurrent lower urinary tract infection].

Clinical cases of three patients with neurogenic lower urinary tract dysfunction, complicated by chronic urinary tract infection are presented in the article. All patients underwent clean intermittent catheterization and, in order to prevent symptomatic lower urinary tract infections, received bacteriophage therapy with a clinically proven positive effect. During 3 months follow-up, there were no episodes of urinary tract infection. A change in the concentration of uropathogens and restoration of sensitivity to a number of antimicrobial drugs were observed. Although phage therapy in urology requires further clinical research, it provides an additional strategy to treat urinary tract infections considering an increase in antibiotic resistance.

[The role of optimal nutrition in the prevention of cardiovascular diseases].

A balanced diet has always been part of a set of preventive measures with cardiovascular diseases (CVD). The aim of the research is to present relevant international data on the role of nutrients in reducing the risk of CVD. Results. This article discusses current data on the effect of consumption of saturated and unsaturated fatty acids, trans fats, cholesterol, dietary fiber, protein, edible salt potassium, magnesium and vitamins on the state of the cardiovascular system and the prevention of CVD. Recommendations on optimal nutrition are given to reduce cardiovascular risks, including those according to the new 3rd edition of the Guide to Cardiovascular Medicine (The ESC Textbook of Cardiovascular Medicine, 3 edn). Conclusion. When managing patients with cardiovascular diseases, it is necessary not only to take into account international nutritional recommendations, but also to focus the patient's attention on how to comply with them.

[Deliberate medication poisoning in adolescence as a medical and socially significant problem].

One of the urgent medical and social problems of modern society is the steady growth of auto-aggressive behavior and deliberate medication poisoning among adolescents and young adults. This investigation was held to optimize the provision of specialized medical care for acute deliberate self-poisoning in teenagers. We examined 498 patients admitted to the Toxicology Department of N. F. Filatov Children City Clinical Hospital No. 13 with a diagnosis of acute deliberate medication poisoning. The diagnosis was confirmed by chemical and toxicological urine test using thin-layer chromatography. From 2016 to 2018 the number of patients with deliberate medication poisoning increased by more than 2.5 times and amounted to 236 cases. Female patients were prevalent and accounted for up to 85% of cases. The leading position among medication self-poisoning is held by psychopharmacological drugs at 56%, in second place are non-steroidal anti-inflammatory drugs at 18.5%. The main causes of self-poisoning were social or family conflicts (47%), problems at school (35%), and Internet-related complaints (18%). The clinical manifestations of the disease in the acute period of chemical poisoning depended on the toxic agent and the dose taken. Psychological testing revealed a high level of neuroticism in 71% of adolescents, severe anxiety was observed in 57% of patients, and depression was diagnosed in 28% of cases. All patients were provided specialized medical care, including resuscitation, detoxification, and psychiatrist examination. Based on the accumulated clinical experience, an algorithm for managing adolescents with deliberate medication poisoning has been developed, which has reduced the number of repeated suicides by 1.8 times.

[Experimental verification of thulium lithotripsy].

AIM: Experimental evaluation of the efficacy and safety of lithotripsy using a new pulsed thulium fiber laser operating at a wavelength of 1.94 microns, peak power of 500 watts (maximum average power of 50 watts) by comparing it with a holmium laser operating at a wavelength of 2.1 microns (average maximum power 100 W and 120 W). RELEVANCE: The proportion of minimally invasive surgery in the management of urolithiasis, including retrograde intrarenal surgery, is steadily growing. The most appropriate tool for stone destruction is a laser. To date, the gold standard of minimally invasive surgical treatment of nephrolithiasis is holmium laser lithotripsy, which uses a laser on yttrium-aluminum-garnet activated by holmium ions (Ho: YAG) operating at a wavelength of 2.1 m. However, in recent years, lasers on a Tm-activated fiber with a wavelength of 1.94 m have become increasingly popular since the water absorption coefficient for the Tm radiation of a fiber laser is 5.5 times higher than for a Ho: YAG laser and in 2.2 times higher than for the Tm: YAG laser. This difference may translate into greater effectiveness and speed of stone crushing, which in turn leads to shorter operating time. MATERIALS AND METHODS: This article describes physical foundations of holmium and thulium laser radiation, the mechanisms of stone fragmentation, data from a series of experiments comparing the efficiency and safety of ex-vivo lithotripsy using a holmium solid-state laser with a wavelength of 2.1 m and a thulium fiber laser with a wavelength of 1.94 m. RESULTS: The study findings suggest that the STA IRE-Polyus thulium fiber laser operating at a wavelength of 1.94 microns and a maximum power of 500 watts has several advantages over the holmium laser in the stone fragmentation in urological practice. CONCLUSION: The results of the experimental work allow us to conclude that the use of a thulium fiber laser operating at a wavelength of 1.94 m and a maximum peak power of 500 W enables highly effective and safe lithotripsy.

[Initial experience in clinical application of thulium laser contact lithotripsy for transurethral treatment of urolithiasis].

INTRODUCTION: The choice of an effective and safe method of disintegration of stones in upper and lower urinary tract is very important in the context of continuous scientific and technological progress. In current clinical urological practice, various lithotriptors with rigid and flexible probes are used for contact disintegration of stones, having both advantages and disadvantages. This study aimed to analyze the first results of the clinical application of the native Tm: fiber Urolaz laser (STA IRE-Polyus, Russia) for contact transurethral lithotripsy. MATERIALS AND METHODS: The study comprised 56 patients who underwent transurethral contact thulium laser lithotripsy for 68 stones of the upper and lower urinary tracts between April and September 2017. Forty-four patients had kidney and ureteral stones, and twelve patients had urinary bladder stones. Twenty-four kidney stones were removed by retrograde intrarenal surgery using ureteral casing, flexible ureteropyeloscope and thulium laser, 32 stones in various ureteral segments - by rigid contact thulium laser ureterolithotripsy and 12 bladder stones - by thulium laser cystolithotripsy. The size of the upper urinary tract stones varied from 0.6 to 1.8 cm, bladder stones measured from 1.1 to 3.5 cm. Also, experimental studies were carried out to investigate the effects of the fiber thulium and holmium laser on the stone displacement and temperature environment during lithotripsy. RESULTS: Full stone fragmentation was achieved in 100% of patients. 47.7% of patients required additional lithoextraction of fragments; there was no retrograde migration of large stones. The mean duration of stone disintegration was 19 minutes. Postoperatively, 15.9% of patients had an exacerbation of pyelonephritis, which was successfully managed by conservative measures. The mean postoperative hospital stay was 2.4+/-1.1 days. At follow-up examination 4-6 weeks after surgery, one patient was found to have a residual symptomatic ureteral stone, which required extracorporeal short-wave lithotripsy. The experimental study showed that fiber thulium laser lithotripsy produced much less propulsion of artificial stone than Holmium laser lithotripsy. With the use of therapeutic power, neither of the lasers resulted in "dangerous" rises of the washing fluid temperature during stone disintegration. CONCLUSION: Using the universal thulium laser system "Urolaz" provides a significant improvement in the effectiveness of endourologic upper urinary tract interventions and significantly reduces the likelihood of intraoperative trauma and postoperative complications, which contributes to improving the quality of specialized urological care.

[The possibilities for the restoration of the laryngeal function: the current state-of-the-art]. / Vozmozhnosti vosstanovleniia funktsii gortani: sovremennyi podkhod.

The restoration of the functional competence of the larynx following bilateral laryngeal nerve damage and vocal fold paralysis is a serious challenge for the surgeon that has thus far no satisfactory solution. Physiological re-innervation that occurs naturally with time is non-selective and, in the majority of the cases, leads to synkinesis. Laryngeal pacing achieved with the application of the implantable microchips appears to be a promising approach. The animal experiments have demonstrated the possibility of successful restoration of all the functions of the larynx by means of laryngeal pacing but simultaneously revealed a number of technical issues that have to be addressed if the further progress in this field is to be achieved including the choice of the proper materials for implantation, solution of problems pertaining to the neuromuscular mapping during pacer implantation, etc.). The results of the first prospective clinical trial involving the human patients gave evidence suggesting that the laryngeal electrostimulation technology is both safe and efficient. Nevertheless, further investigations and modification of the method are needed before it can be recommended for the wider application in the routine clinical practice.

Status Epilepticus Impairs Synaptic Plasticity in Rat Hippocampus and Is Followed by Changes in Expression of NMDA Receptors.

Cognitive deficits and memory loss are frequent in patients with temporal lobe epilepsy. Persistent changes in synaptic efficacy are considered as a cellular substrate underlying memory processes. Electrophysiological studies have shown that the properties of short-term and long-term synaptic plasticity in the cortex and hippocampus may undergo substantial changes after seizures. However, the neural mechanisms responsible for these changes are not clear. In this study, we investigated the properties of short-term and long-term synaptic plasticity in rat hippocampal slices 24 h after pentylenetetrazole (PTZ)-induced status epilepticus. We found that the induction of long-term potentiation (LTP) in CA1 pyramidal cells is reduced compared to the control, while short-term facilitation is increased. The experimental results do not support the hypothesis that status epilepticus leads to background potentiation of hippocampal synapses and further LTP induction becomes weaker due to occlusion, as the dependence of synaptic responses on the strength of input stimulation was not different in the control and experimental animals. The decrease in LTP can be caused by impairment of molecular mechanisms of neuronal plasticity, including those associated with NMDA receptors and/or changes in their subunit composition. Real-time PCR demonstrated significant increases in the expression of GluN1 and GluN2A subunits 3 h after PTZ-induced status epilepticus. The overexpression of obligate GluN1 subunit suggests an increase in the total number of NMDA receptors in the hippocampus. A 3-fold increase in the expression of the GluN2B subunit observed 24 h after PTZ-induced status epilepticus might be indicative of an increase in the proportion of GluN2B-containing NMDA receptors. Increased expression of the GluN2B subunit may be a cause for reducing the magnitude of LTP at hippocampal synapses after status epilepticus.

Characteristics of lipid fractions of larvae of the black soldier fly Hermetia illucens.

The lipid fraction of larvae of the black soldier fly Hermetia illucens was shown to contain lauric acid (38.43 wt %) and its esters, azelaic and sebacic acids, and azelaic acid dibutyl ester. The dominant compound in the group of identified glycerides was lauric acid monoglyceride (0.70 wt %). Glycerides were also represented by triglycerides and diglycerides of lauric acid. Sterols were represented primarily by phytosterols (over 75%), the major of which was alpha-sitosterol (45%). The identified lipid complex composition is apparently determined by the biological characteristics of the fly Hermetia illucens and ensures antibacterial defence of larvae and stability of lipids at changing ambient temperature.

[Diagnosis and surgical treatment of adrenocortical cancer with invasion into great veins]. / Diagnostika i khirurgicheskoe lechenie adrenokortikal'nogo raka s invaziei v magistral'nye venoznye sosudy.

AIM: To estimate immediate and remote resaults of treatment of adrenocortical cancer with invasion into great veins. MATERIAL AND METHODS: It was analyzed survey and treatment results in 3 patients with adrenocortical cancer and invasion into renal veins and inferior vena cava. RESULTS: Radical surgery with tumoral thrombi removal from great vessels was performed in all cases. There were no complications and deaths in early postoperative period. Life expectancy after surgery was 6, 13 and over 58 months. CONCLUSION: At present time surgical intervention for adrenocortical cancer with invasion into great veins is single method to prolong patients' life.

[Laser lithotripsy].

The article describes the diverse methods of stone destruction in urolithiasis patients, including laser lithotripsy as the least traumatic and most efficient method of demolition of all types of urinary stones. Different types of lasers for intracorporeal lithotripsy have different mechanisms of stone fragmentation depending on the type of laser and its radiation parameters. The latest researches showed that new and promising laser modalities for lithotripsy are devices based on thulium (Tm) doped fiber laser, which can not only increase by several times the speed of the of stone fragmentation, but also minimizes the risks of surgical complications, due to the peculiarities of interaction between radiation and biological tissues.

[A method of pylorus-preserving resection of the stomach for duodenum ulcer disease].

A method of pylorus-preserving resection of the stomach including dissection of the ulcer and segmental resection of the duodenum followed by a pylorus-preserving resection of the stomach was developed and used in the clinic in 8 patients with ulcer disease of the duodenum. Positive effect manifested itself as preserved functional activity of the pylorus complex and duodenum. The method allows securing adequate pathogenetic effects, leveling the development of such complications as chronic impairment of duodenal patency, duodenal-gastric reflux, dumping syndrome.

[The immunogenicity and heterogeneity of Pseudomonas pseudomallei surface antigen 8]. / Immunogennost' i geterogennost' poverkhnostnogo antigena 8 Pseudomonas pseudomallei.

Surface antigen 8, one of pathogenicity factors of P.pseudomallei and having an antiphagocytic action, contains glycoprotein with a mol. wt. of 200 kD and proteins with mol wt. of 25, 30 and 34 kD. According to its chemical structure, the carbohydrate part of antigen 8 is the homogeneous polymer of 6-d-D-mannoheptose, and its protein component is a collection of monomer proteins with mol. wt. of 12-120 kD. The consecutive fractionation of antigen 8 by gel and ion exchange chromatography has made it possible to isolate its individual fragments, differing by the collection of antigenic components, as well as by their antiphagocytic and protective activity. Experiments have shown that glycoprotein with a mol. wt. of 200 kD is an active immunosuppressive agent, while protein with a mol. wt. of 34 kD produces a pronounced immunogenic effect.

[The early laboratory diagnosis of the pulmonary form of glanders and melioidosis by using rapid methods of immunochemical analysis]. / Ranniaia laboratornaia diagnostika legochnoi formy sapa i melioidoza s ispol'zovaniem ékspress-metodov immunokhimicheskogo analiza.

The problems of the sanitary guarding of frontiers comprise such aspects as the early recognition of infectious diseases, even those which are considered exotic in the Russian Federation. These diseases include glanders and melioidosis, infections which are endemic for some frontier regions. The study performed on experimental models of the pulmonary form of glanders and melioidosis with the acute course of the diseases demonstrates that the use of such laboratory diagnostic methods as immunosorbent variants of the enzyme-linked, chemiluminescent and immunofluorescent immunoassays permits making reliable diagnosis as early as 3-12 hours after aspiration infection.

[The correction of the fluorine load in caries]. / K voprosu korrektsii ftornagruzki pri kariese.

The authors discuss the problem of fluorine load correction in caries. They claim that fluorine load of the body as regards caries prevention should never surpass the safe levels of total daily fluorine consumption. In children aged over 4 the safe level of total daily fluorine consumption is 2.5 mg, in adults 4 mg.