[Long-term efficacy and safety of divozilimab during 2-year treatment of multiple sclerosis patients in randomized double-blind placebo-controlled clinical trial BCD-132-4/MIRANTIBUS]. / Effektivnost' i bezopasnost' dvukhletnei terapii divozilimabom u patsientov s rasseyannym sklerozom v ramkakh randomizirovannogo dvoinogo slepogo platsebo-kontroliruemogo klinicheskogo issledovaniya BCD-132-4/MIRANTIBUS.

OBJECTIVE: To evaluate the efficacy and safety of the anti-CD20 monoclonal antibody divozilimab (DIV) used as an intravenous infusion at a dose of 500 mg every 24 weeks during 100 weeks for the treatment of patients with multiple sclerosis (MS), including relapsing-remitting multiple sclerosis (RRMS) and secondary progressive MS (SPMS) with relapses. MATERIAL AND METHODS: The multicenter, randomized, double-blind and double-masked phase III clinical trial (CT) BCD-132-4/MIRANTIBUS (NCT05385744) included 338 adult patients with MS distributed in a 1:1 ratio into two groups: DIV 500 mg and teriflunomide (TRF) 14 mg. After screening, subjects were included in the main CT period, which consisted of two cycles of therapy over 48 weeks, then entered an additional period from weeks 49 to 100, which included three cycles of therapy. The efficacy was assessed based on the results of brain MRI and registration of data on relapses. RESULTS: 308 subjects completed 5 therapy cycles according to the study protocol. An analysis of the effectiveness of DIV therapy over 2 years showed a persistent suppression of MRI and clinical activity of the disease in comparison with TRF, which was confirmed by all the studied MRI indicators (including CUA; total number of gadolinium-enhancing (GdE) lesions on T1-weighted scans ; number of new or enlarged lesions on T2-weighted scans; lesions volume change on T2-weighted scans; change in the volume of hypointense lesions on T1-weighted scans). The use of DIV was associated with a statistically significant decrease in ARR compared to TRF (p=0.0001). The ARR in the DIV group was 0.057, in the TRF group - 0.164 with 95% confidential interval for the frequency ratio [0.202; 0.593]. The incidence of GdE lesions on T1-weighted scans in the DIV group was significantly lower than in the TRF group. The average number of such lesions was 0.0±0.08 and 1.0±4.46 in the DIV and TRF groups, respectively (p<0.0001). Progression of EDSS was detected in 18 (10.7%) and 36 (21.3%) patients in the DIV and TRF groups, respectively (p=0.0075). The proportion of patients with relapses was 11.2% (n=19) in the DIV group and 23.1% (n=39) in the TRF group (p=0.0039). In the subpopulation of patients with SPMS, no cases of increase in EDSS were detected, and not a single case of exacerbation was recorded over 2 years of using DIV. Also, DIV has shown a favorable safety profile. Among the adverse reactions (AR), infusion reactions and laboratory abnormalities, such as a decrease in the number of leukocytes, neutrophils, and lymphocytes, were most often recorded. Identified AR were expected, had mild to moderate severity, and resolved without any negative consequences. CONCLUSION: The results of the BCD-132-4/MIRANTIBUS CT indicate a high sustained efficacy and safety of long-term use of DIV in comparison with TRF during 2 years of therapy.

[Diseases of the nervous system as the underlying cause of death]. / Bolezni nervnoi sistemy kak pervonachal'naya prichina smerti.

OBJECTIVE: To identify the leading causes of death in the adult population from the class of diseases of the nervous system (DNS, class G) according to medical death certificates (MDC) and to discuss the problems of their assessment. MATERIAL AND METHODS: The source of information was the electronic database of the Main Department of the Civil Registry Office of the Moscow Region. All cases of class G deaths were selected (total 10.739), an analysis was carried out according to underlying cause of death (UCD) codes and the immediate cause of death. RESULTS: In 2022, mortality from diseases included in the DNS amounted to 130.7 per 100 000 of the population over 18 years old (100.3 among men, 191.0 among women). The average age of men is 74.3±14.1, women - 83.5±9.9 years (p<0.0001) due to the younger age of death of men from «G31.2 Degeneration of the nervous system caused by alcohol¼ and a higher contribution of this cause to male mortality; 82.5% of deaths were for codes G90-G99 («Other disorders of the nervous system¼); 15.5% were neurodegenerative diseases (G10-G32). Sixty-six percent of all UCD in both women and men accounted for «unspecified encephalopathy¼ (G93.4), in 2nd place (10.5%) was «cerebral cyst¼ (G93.0). In 45 cases, code G93.6 (cerebral edema) was mistakenly used as UCD. Differences in the structure of causes of death at home, in hospital and elsewhere are statistically significant (p<0.00001). In 58.3%, cerebral edema and herniation were indicated as the immediate cause of death (G93.6 and G93.5). CONCLUSIONS: Nosologically unfounded, insufficiently well-defined UCD were established in most cases of death from DNS, In 0.5% of the total number of deaths from DNS, an erroneous presentation as UCD of transient disorders of cerebral circulation or cerebral edema was noted. The results indicate the need for an analysis of the causes of death based on a comparison of medical records and MDC.

[Obstructive uropathia in pregnant women: results of treatment depending on the etiopatogenetic factor of development].

Actuality. The development of renal colic in pregnant women is one of the most common reasons for visiting a hospital that is not associated with obstetric pathology. Given the pharmacological and diagnostic limitations during gestation, the problem of expanding the renal cavitary system in pregnant women, as well as the choice of treatment tactics, remains a difficult clinical task. MATERIALS AND METHODS: The study group included 537 patients with obstructive uropathy with a gestation period of 5 to 36 weeks, who were hospitalized from January 2018 to January 2022 at the GBUZ GKB named after. S.S. Yudina DZM. Depending on the etiopathogenetic obstructive uropathy, the patients were divided into 3 groups: group I - 201 (37.4%) patients with gestational pyelonephritis (the presence of a systemic inflammatory response syndrome) and expansion of the renal cavitary system without confirming the diagnosis of urolithiasis; group II - 216 (40.2%) patients with renal colic (presence of pain without signs of a systemic inflammatory reaction) and enlargement of the renal cavitary system not associated with urolithiasis; group III - 120 (22.4%) pregnant women with an expansion of the cavitary system of the kidney caused by urolithiasis, both with and without signs of a systemic inflammatory reaction. Age, body mass index and previous number of pregnancies in all groups did not differ. The mean age of the patients in the three groups was 26.1 years, with a mean gestational age of 20.8 weeks. In 433 (80.6%) patients, pain was observed in the lumbar region on the right, in 83 (15.5%) - on the left, the bilateral nature of the process - in 21 (3.9%) patients. RESULTS: In group I, despite ongoing conservative therapy, 129 (64.2%) pregnant women received an internal ureteral stent. After 2-4 weeks of follow-up, the ureteral stent was removed in all patients. As a result, a short-term drainage method (up to 4 weeks) was effective in 90.1% of pregnant women, and in 13 (9.9%) patients, it was necessary to re-insert the stent, followed by a routine replacement of the drain every month. Considering the pain syndrome among patients of group II, drainage was performed in 80 (37%) pregnant women. Routine stent replacement was required in 2 (2.3%) patients. In group III, the location of the calculus in the pyelocaliceal system was in 28 (23.3%) patients, in the ureter - in 92 (76.7%) patients. Independent passage of the calculus was noted in 8 (6.7%) pregnant women, ureteroscopy without prior stenting was performed in 31 (25.8%) pregnant women with ureteral calculus. The remaining 81 (67.5%) pregnant women underwent stent placement at the first stage. When the stone was localized in the ureter, 32 (22.7%) patients underwent contact laser ureterolithotripsy and 21 (17.5%) patients underwent ureterolithoextraction. When a stone was located in the kidney, 28 (23.3%) pregnant women underwent pyelocalicolithotripsy. Achievement of the stone-free status was observed in 92.8%. CONCLUSION: Obstructive uropathy in pregnant women requires identification of the cause and a multidisciplinary approach. Long-term drainage of the urinary tract should be avoided and short-term drainage should be preferred. Surgical treatment of urolithiasis, regardless of gestational age, is an effective and safe method.

[Development of purulent-destructive forms of acute pyelonephritis in patients with a history of new coronavirus infection Covid-19].

INTRODUCTION: Since 2019, more than 600 million cases of the new coronavirus infection Covid-19 have been reported worldwide. According to various studies, the development of a systemic inflammatory response and "cytokine storm" play an important role in the pathogenesis of kidney damage, which leads to impaired microcirculation, increased thrombus formation and the development of ischemic areas in the parenchyma. AIM: To study the frequency and possible causes of purulent forms of pyelonephritis in patients who have had a new coronavirus infection Covid-19. MATERIALS AND METHODS: The prospective and retrospective study included the results of 403 patients with acute non-obstructive pyelonephritis in the pre-Covid period and those with a history of a new coronavirus infection. RESULTS: In patients with acute non-obstructive pyelonephritis without past urological history who had a new coronavirus infection, an increase in purulent-destructive forms from 5.0 to 17.0% was noted. One of the reasons is increased antibiotic resistance and the emergence of pan-resistant uropathogens due to irrational use of antibacterial drugs. CONCLUSION: The use of reserve antibacterial drugs in patients with acute pyelonephritis as empirical therapy and anticoagulants in order to improve microcirculation and prevent thrombosis is pathogenetically justified.

[Long-term results of ureteral replacement using small bowel in patients with long strictures: 9-years single-center experience].

INTRODUCTION: When reconstructing long ureteral strictures, the optimal substitution material is reconfigured pelvis or bladder flaps. However, it is not always possible to use them due to involvement in the pathological process or insufficient length to replace the defect. In such cases, substitution of the ureter by ileal segment is successfully used. MATERIALS AND METHODS: A total of 25 patients, 10 men (40%) and 15 women (60%), who undergone to reconstructive procedure during the period from 2012 to 2021 with a follow-up period of at least 6 months (mean 51.26 months) were included in the retrospective analysis. Additionally, a comparative analysis was carried out between the laparoscopic and open access according to a set of criteria. The endpoints in the study were the functional state of the kidneys, repeated procedures and development of metabolic disorders. RESULTS: The average length of the stricture was 10.7 cm (5-20 cm). Eleven patients underwent open approach (44%), while in 14 cases laparoscopic approach was used (56%). Primary procedure was performed in 16 (64%) patients, repeated intervention due to stricture recurrence was performed in 7 (28%) cases, and two patients (8%) underwent bowel substitution of the ureter, implanted into the ileal conduit after radical cystectomy. The average duration of the procedure was 240 min (Q1-186 min, Q3-307 min). For laparoscopic access it was 230 min (Q1-186 min, Q3-292 min) compared to 240 min (Q1-202 min, Q3- 312 min) for open access. Complications of the Clavien I grade developed in 5 cases (20%). With a minimally invasive approach, the length of stay in hospital was 6 days (5-6), including 0.7 days (0-1) in the intensive care unit. The average number of drains after laparoscopic procedure was 1.3 (0-2), and the drains were removed in average after 4.4 days (3-5). With open access, the median length of stay was 8 (5-11), including 2 days (1-5) in the intensive care unit. The number of drains was 1.6 (1-2), and the drains were removed in average after 4 days (3-5). Thirteen patients were undergone to follow-up examination until discharge. Regression of dilatation of the pelvicaliceal system was noted in 12 patients (92.3%). Among them, renal function stabilized in 8 (61.5%), improved in 4 (30.8%) and deteriorated in 1 case (7.7%). Clinically significant metabolic acidosis was detected in 1 patient (7.7%). CONCLUSION: Substitution of the ureter by ileal segment showed satisfactory results in long-term follow-up.

[The effect of the start date of cognitive rehabilitation after ischemic stroke on the level of recovery]. / Vliyanie sroka nachala kognitivnoi reabilitatsii posle perenesennogo ishemicheskogo insul'ta na uroven' vosstanovleniya.

OBJECTIVE: The dependence of result of cognitive training in patients who have suffered an ischemic stroke (IS) on the timing of their onset continues to be discussed. The aim was to study the results of cognitive rehabilitation of patients after IS during various periods after it. MATERIAL AND METHODS: 140 patients were examined during complex rehabilitation in terms up to 1, 2-3, 4-6 and 7-12 months after IS, 78 of them received drug support (DS) of rehabilitation with intravenous injections of ampasse. The Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS) were used to monitor the effectiveness of rehabilitation. RESULTS: In all subgroups, there was a statistically significant increase in the MoCA score after the course, but number of people with an increase in the score by 1 or more points was highest among those who started the course 3 or more months after the development of IS (p=0.015). Among those who received DS, an increase in the MoCA was noted in 87.2%, in those who did not receive it - 38.7% (p<0.001). There was no statistically significant increase in the severity of anxiety and depression after the course of treatment in any of the subgroups. CONCLUSION: The used approach of a combination of cognitive, physical rehabilitation and DS proved to be justified for achieving results during a two-week course of inpatient rehabilitation of patients both in the early and late recovery period after IS.

[Efficacy and safety of antiCD20 monoclonal antibody divozilimab during 48-week treatment of multiple sclerosis patients in randomized double-blind placebo-controlled clinical trial BCD-132-4/MIRANTIBUS]. / Effektivnost' i bezopasnost' 48 nedel'nogo primeneniya monoklonal'nogo antitela protiv CD20 divozilimaba u patsientov s rasseyannym sklerozom: rezul'taty randomizirovannogo dvoinogo slepogo platsebo-kontroliruemogo klinicheskogo issledovaniya BCD-132-4/MIRANTIBUS.

OBJECTIVE: To evaluate the efficacy and safety of the anti-CD20 monoclonal antibody divozilimab (DIV) used as an intravenous infusion at a dose of 500 mg for the treatment of patients with relapsing-remitting multiple sclerosis (RRMS) in comparison with the teriflunomide (TRF). The study of the efficacy and safety of the use of the drug DIV was carried out for 48 weeks of therapy. MATERIAL AND METHODS: The multicenter, randomized, double-blind and double-masked phase III clinical trial (CT) BCD-132-4/MIRANTIBUS included 338 adult patients with RRMS distributed in a 1:1 ratio into two groups: DIV 500 mg and TRF 14 mg. After screening, subjects were included in the main CT period, which consisted of two cycles of therapy over 48 weeks. The primary end point was «Mean annualized relapse rate 48 weeks after the last patient is randomized in the study¼. RESULTS: 321 subjects completed 48 weeks of therapy according to the study protocol. The analysis of the of efficacy data for the primary endpoint successively proved the hypothesis of superiority of the test drug DIV at a dose of 500 mg over the reference drug TRF. A rapid suppression of acute disease activity according to the brain MRI and clinical manifestations of the disease was shown after the first infusion of DIV in patients with RRMS. Thus, after 48 weeks of therapy in patients treated with DIV, there were no T1 gadolinium-enhancing lesions, while in the TRF group such lesions were observed in 20.7% (35/169) of subjects. Evaluation of the CUA per scan showed that the mean values for the estimated period were statistically significantly lower in the DIV drug group compared to the TRF group: the ratio of the adjusted per scan rates (DIV/TRF) was 0.125 [95% CI: 0.089; 0.177]. Over the 48 weeks of therapy, the proportion of subjects with relapses was 9.5% (n=16/169) in the DIV group and 19.5% (33/169) in the TRF group (p=0.0086). DIV has shown a favorable safety profile. Among the adverse reactions (AR), infusion reactions and deviations of laboratory data, such as a decrease in the number of leukocytes, neutrophils, and lymphocytes, were most often recorded. Identified AR were expected, had mild to moderate severity, and resolved without any negative consequences. CONCLUSION: The results of the clinical study indicate the high efficacy and safety of DIV in comparison with TRF.

[The use of monoclonal antibodies in the treatment of patients with high-active multiple sclerosis in real clinical practice]. / Primenenie monoklonal'nykh antitel v lechenii bol'nykh vysokoaktivnym rasseyannym sklerozom v real'noi klinicheskoi praktike.

OBJECTIVE: To study the efficacy of ocrelizumab (OCR) and natalizumab (NAT) using indicators of activity and progression in patients with highly active multiple sclerosis (HAMS) during the first year of therapy in real clinical practice. MATERIAL AND METHODS: The study included 110 patients with HAMS and 13 patients with rapidly progressive MS (RPMS), aged 19 to 60 years, who received monoclonal antibody (MAT) therapy for 12 months. Group 1 consisted of 77 patients receiving NAT therapy, group 2 of 46 patients receiving OCR therapy. To assess the efficacy of therapy, we used indicators of the average frequency of exacerbations per year, EDSS estimates, and MRI data. RESULTS: EDSS score at the time of initiation of MAT therapy was 2.4±1.0 in group 1 and 2.8±1.2 in group 2 (p=0.047); 12 months after the start of MAT therapy, EDSS score in group 1 decreased slightly (p=0.001), in group 2 it has not changed. The frequency of exacerbations per year after the start of MAT therapy was 0.04±0.2 in group 1 and 0.07±0.2 in group 2 (p<0.0001 in both groups). The number of foci accumulating gadolinium detected during the year was 3 in group 1, one in group 2 (p=0.629 between groups). Subgroups of patients who received line 1 DMT (n=22) or NAT (n=21) before the start of OCR therapy were considered separately. In both subgroups, a stable assessment of EDSS was noted, the average annual number of exacerbations did not differ (p=0.117). In patients with RPMS after a year of MAT therapy, EDSS scores were stable, the average annual frequency of exacerbations was 0.08±0.3 per year. CONCLUSION: The administration of MAT therapy led to a statistically significant decrease in the number of exacerbations and stabilization of neurological deficits during the first year of follow-up. After 12 months of therapy, both groups experienced a dramatic decrease in the average annual number of exacerbations, no increase in disability, and positive dynamics according to MRI results. A similar level of OCR efficacy was found in patients who switched from DMT 1 line therapy and NAT.

[Modern methods for determining the positive surgical margin during radical prostatectomy].

Determining and evaluation of predictors of biochemical recurrence (BCR) is one of the essential aim, which may help to achieve the most effective treatment of prostate cancer. Obviously, positive surgical margins represent an independent risk factor for BR following radical prostatectomy. The development of methods determining the status of the surgical margin during surgery is an important direction which can upgrade the effectiveness of prostate cancer treatment.Moreoverit is relevant to review modern methods for diagnosing the status of the surgical margin during radical prosta-tectomy. This article presents a systematic review carried out at the Department of Urology and Andrology of Pirogov Russian National Research Medical University. In September 2021, we performed a PubMed/ Web of Science search to include articles published in 1995-2020 evaluating the key words "prostate cancer", "surgical margin", "radical prostatectomy", "biochemical recurrence", "methods for determining the surgical margin". Nowadays the following technologies have been developed and being actively studied: the usage of aminolevulinic acid, optical coherence tomography, optical spectroscopy, confocal laser microscopy, 3D augmented reality, 3D modeling, the study of frozen samples.

[Efficacy and safety of divozilimab during 24-week treatment of multiple sclerosis patients in randomized double-blind placebo-controlled clinical trial BCD-132-2]. / Effektivnost' i bezopasnost' 24 nedel' primeneniya divozilimaba sredi patsientov s rasseyannym sklerozom v ramkakh randomizirovannogo dvoinogo slepogo platsebo-kontroliruemogo klinicheskogo issledovaniya BCD-132-2.

OBJECTIVE: To find the optimal therapeutic dose of the anti-B cell mAb divozilimab (DIV) based on the efficacy and safety data of intravenous administration at a dose of 125 mg or 500 mg in patients with relapsing remitting multiple sclerosis (RRMS) compared to placebo (PBO) and teriflunomide (TRF). To study the efficacy and safety of DIV within 24 weeks of treatment. MATERIAL AND METHODS: A multicenter, randomized, double-blind and double-masked, placebo-controlled phase 2 clinical trial (CT) BCD-132-2 involved 271 adult patients with RRMS from 25 centres In Russia. Patients were randomly assigned (2:2:2:1) into 4 groups: TRF, DIV 125 mg, DIV 500 mg and PBO. After screening patients entered to the main period, which consisted of one cycle of therapy for 24 weeks. The primary endpoint was the total number of gadolinium-enhancing T1 lesions (Gd+) observed on brain MRI scans after 24 weeks (per scan - involves estimating the mean value of the score from all the MRI assessments performed for each participant in the study). RESULTS: 263 patients completed 24 weeks of treatment. Most of the patients in the DIV groups had no lesions on T1-weighted MRI after 24 weeks of treatment (94.44% on 125 mg and 93.06% on 500 mg). In the TRF and PBO groups the values were significantly lower: 68.06% and 56.36% respectively (both p<0.05). The proportions of relapse-free patients in the DIV groups were 93.06% and 97.22% (125 mg and 500 mg, respectively). As expected, DIV reduced the CD19+ B-cells. However, the repopulation rate of CD19+ B-cells in the 125 mg group was more pronounced (mainly due to the recovering pool of CD27-naive B-cells) compared to the 500 mg group. DIV showed a favorable safety profile at both doses. CONCLUSION: Thus, the assessment of 24 weeks treatment demonstrated that DIV is a highly effective, safe and convenient option for the treatment of RRMS patients, both naive and previously treated with disease modifying therapy. A dose of 500 mg is recommended for further efficacy and safety evaluation during phase 3 CT.

[Assessment of disorders of neurodynamic processes in patients with acute ischemic stroke]. / Otsenka narushenii neirodinamicheskikh protsessov u bol'nykh v ostrom periode ishemicheskogo insul'ta.

OBJECTIVE: To develop a method for assessing neurodynamic disorders in the acute period of stroke. MATERIAL AND METHODS: Sixty-three right-handed patients in the acute period of ischemic stroke (IS) were examined, including 28 patients with IS in the basin of the left middle cerebral artery (LMCA) (group 1), 19 patients with IS in the basin of the right middle cerebral artery (group 2) and 16 patients with IS in the vertebrobasilar system (group 3). The control group consisted of 37 healthy individuals. The «Tapping Test¼ technique developed by E.P. Ilyin was used to assess the strength of nervous processes. The mobility of nervous processes was determined by a complex sensorimotor reaction of discrimination. To assess the balance of the processes of excitation and inhibition, a complex sensorimotor reaction to a moving object was used. RESULTS: There was a significant decrease in the strength of nervous processes in the patients compared to the control group (p<0.0001), more pronounced in IS in LMCA. When checking the mobility of nervous processes in patients of groups 1 and 2, the number of errors was statistically significantly higher than in the control group (inertness of nervous processes). These indicators were the highest in patients with IS in LMCA while in patients of group 3 the lowest values, approaching the data of healthy individuals, were noted. When checking the balance of nervous processes, torpidity of reactions was noted in patients of group 1, torpidity when performing the test with a paretic hand was noted in group 2. In group 3 these indicators approach the data of healthy individuals, which reflected the approximate balance of the processes of excitation and inhibition. CONCLUSION: In the study of neurodynamic processes in patients in the acute period of IS, there was a decrease in strength, inertness, and torpidity of the mobility of nervous processes, more pronounced in the damage of the dominant hemisphere. It can be assumed that in the origin of these shifts in patients in the acute period of IS, a diaschisis plays an important role, and with left-sided localization of IS, not only the focal, but also its connective, transcallosal form.

[Possibilities of the brain-computer interface in the correction of post-stroke cognitive impairments]. / Vozmozhnosti interfeisa «mozg­komp'yuter¼ v korrektsii postinsul'tnykh kognitivnykh narushenii.

In recent years, brain-computer interfaces have been widely used in neurorehabilitation, and an extensive database of results from clinical studies conducted around the world has been accumulated, demonstrating their effectiveness in restoring motor function after a stroke. Currently, their use in post-stroke cognitive impairment is expanding. This article discusses the potential and prospects for using brain-computer interfaces for the treatment of cognitive disorders, reviews the experience of using it, presents the results of clinical studies in stroke patients, evaluates the possibilities of using this technology, describes the prospects, new directions of work on studying its effects.

[Effectiveness of brain-computer interfaces and cognitive training using computer technologies in restoring cognitive functions in patients after stroke]. / Effektivnost' primeneniya interfeisov «mozg­komp'yuter¼ i kognitivnykh treningov s ispol'zovaniem komp'yuternykh tekhnologii v vosstanovlenii kognitivnykh funktsii u patsientov posle insul'ta.

OBJECTIVE: To study the effectiveness of brain-computer interfaces (BCI) and cognitive training using computer technologies in restoring cognitive functions in poststroke patients. MATERIAL AND METHODS: Thirty-four stroke patients (mean age 59.3±10.8 years) with stroke duration of 5.1±4.7 months, were included. To assess the effectiveness of treatment, patients before and after treatment were tested using memorization of words according to the method of Luria A.R. «10 words¼, the Montreal Cognitive Assessment Scale (MoCA), the Clock Drawing Test (CDT). All patients received standard rehabilitation therapy (exercise therapy, physiotherapy, sessions with a speech therapist-neuropsychologist). Patients of the first group additionally received training on the «Neurochat¼ complex, patients of the second group - on the «Exokist-2¼ complex, patients of the third group - cognitive training according to standard programs using computer technology and visual material. RESULTS: Patients of the three groups showed a significant improvement in the total MoCA score: in the 1st and 2nd groups - p<0.01, in the 3rd group - p<0.05. According to CDT, there was a significant change in the 2nd group (p=0.018). The Luria method «10 words¼ revealed an improvement in memory in all groups (p<0.01, p<0.05), being more pronounced in the 1st and 2nd groups. CONCLUSION: The effectiveness of BCI in restoring cognitive functions in patients after a stroke in comparison with cognitive training without BCI has been demonstrated. However, there are reasons to believe that various BCIs have a specific effect on cognitive functions and have their own target group.

[The influence of pyelovenous reflux on the development of acute pyelonephritis in an experimental model].

INTRODUCTION: currently, endoscopic methods are the main option for surgical treatment of patients with urolithiasis (ICD). The widespread use of these operations has led to the development of a number of specific complications associated with the technology of their implementation. One of the frequent complications is the development of postoperative acute pyelonephritis against the background of intraoperative pyelovenous reflux. THE PURPOSE OF THE STUDY: to study under experimental conditions the severity of pathomorphological changes in the ureter and kidney tissue against the background of pyelovenous reflux in the presence and absence of bacterial flora. MATERIALS AND METHODS: 32 mature female rabbits of the "White Giant" breed were selected as an experimental model. Experimental strain of the E. Coli microorganism 105 KOE/ml. Laboratory animals were divided into 4 groups, 1-3 experimental groups, 4 control group of observation without surgical intervention. In experimental groups, NaCl 0.9% 2.0 ml was injected into the ureteral lumen in group 1, E. Coli 1x105 CFU/ml 1.0 ml in group 2, NaCl 0.9% 1.0 ml + E. Coli 1x105 CFU/ml 1.0 ml in group 3. RESULTS: Results: according to the results of the study, the pathomorphological evaluation of kidney and ureter preparations revealed pronounced inflammatory changes in group 3. CONCLUSIONS: pyelovenous reflux does not independently lead to the development of acute pyelonephritis. The combination of reflux and microbial flora leads to inflammatory changes in the wall of the calyx-pelvic system with the development of acute pyelonephritis, which is confirmed by the results of pathomorphological examination of kidney and ureter tissue.

[Roadmap of ultrasound-guided percutaneous access to the renal collecting system].

INTRODUCTION: The key point of successful PCNL is getting access to the renal collecting system. Ureteral catheterization and injection of contrast material provide an important advantage of visualizing and dilating the collecting system. However, catheterization increases the operation time, exposure to anesthesia, and requires additional reusable and disposable medical supplies. The purpose of the study was to develop a surgical algorithm for accessing the renal collecting system for mini-PCNL without catheterization. MATERIALS AND METHODS: We analyzed the treatment results of 82 patients with a single kidney stone, who underwent mini-PCNL without prior catheterization of the ureter. The percutaneous access was obtained according to the roadmap we had developed. The puncture was performed under X-ray control and US guidance. For a calyx stone, the puncture was performed "to the stone". For a pelvis stone, the targeted calyx was accessed using the following algorithm where each next step was performed if the puncture had been impossible at the previous one: 1. 30 min before the operation: infusion load of normal saline, 1000 ml. 2. Intraoperatively: intravenous furosemide, 60 mg. 3. Puncture "to the pelvic stone", injecting contrast material into the collecting system and correcting the access puncture through the required calyx. RESULTS: In all 82 cases, puncture access was performed without ureteral catheterization. In 20 patients with calyceal stones, puncture onto a stone was successfully performed in 100% of the cases. Of 62 patients with pelvic stones, preliminary infusion was enough to allow a successful puncture in 49 (79%), access after intravenous administration of furosemide was obtained in 13 (21%), and a primary puncture onto a pelvic stone had to be done in 6 (10%) patients. CONCLUSIONS: Our proposed algorithm for accessing the PCS of the kidney was successfully used in 100% of the cases. It makes possible to avoid routine ureteral catheterization and thus reduce the overall operation time and the risk of complications, as well as save medical supplies. Clearly, such results require that the surgeon should have significant experience with puncture interventions under ultrasound control.

[The impact of a comprehensive support response biofeedback program on patient recovery and quality of life after stroke]. / Vliyanie kompleksnoi programmy na osnove biologicheskoi obratnoi svyazi po opornoi reaktsii na vosstanovlenie patsientov i kachestvo zhizni posle insul'ta.

OBJECTIVE: To assess the impact of a comprehensive support response biofeedback program on patient recovery and quality of life after a stroke during a six-month follow-up. MATERIAL AND METHODS: One hundred poststroke patients were followed-up during six months after a course of treatment using a comprehensive program based on biofeedback on the support reaction, including stabilometric training «standing on the platform¼; training using a power joystick for a hand on a static stabilometric platform; therapeutic gymnastic exercises for the upper shoulder girdle. RESULTS: Within six months after the course of treatment, there were no statistically significant changes in the motor function of the paretic hand according to the Fugle-Meyer and Ashworth scale. In neuropsychological testing after 3 months, the indicators on MoCA, Stroop, Symbols and Numbers, Schulte, Speech Fluency, and Kohs block design tests did not show negative dynamics. There was a decrease in indicators, which did not reach the values before treatment, after 3 months according to the Digit Span test, delayed recall according to the «memorizing 10 words¼ test by A.R. Luria After 6 month, there were no changes on MoCA, Symbols and Numbers, Schulte and Kohs block design tests. The decline after 6 months was observed on Speech Fluency, Stroop, Digit Span tests and Delayed Recall on the 10-Word Memory Test. At the same time, there was a positive dynamic of indicators of emotional status, activity of daily life and functional activity after 3 and 6 months of follow-up, the indicator of the quality of life of patients improved after 6 months. CONCLUSION: Persistent therapeutic effect of the complex program carried out for 6 months was noted in relation to motor disorders in the paretic hand. There is an improvement in the emotional state, functional status, quality of life. When assessing cognitive functions, the therapeutic effect is stable for 3 months according to most scales. At the same time, the decrease in cognitive testing indicators on individual scales, in our opinion, determines the feasibility of repeated courses of treatment in three to six months in order to prevent the progression of disorders.

[Transurethral resection and buccal mucosal graft for the treatment of refractory bladder neck contracture].

Bladder neck contracture after prostate surgery is a rare but feared complication. The treatment of choice is endoscopic incision or resection of fibrotic tissue. In case of ineffective transurethral correction, bladder neck reconstruction has to be done. In this report, we present a complicated case treated with combined transurethral and laparoscopic bladder neck reconstruction with buccal mucosal graft inlay. Using retrograde endoscopy fibrotic tissue in the bladder neck was resected to achieve a smooth and wide prostate cavity. After that the laparoscopy performed. The retropubic space is created and prostatic urethra opened via longitudinal prostatic-vesical incision. Buccal mucosal graft was fixed in place. Bladder and prostatic urethra were closed with resorbable suture. Two weeks after surgery the urethral catheter was removed and adequate voiding reestablished. After eleven months patient had no urination complaints and any sings of recurrence. Thus, the combined surgical approach for bladder neck reconstruction using buccal mucosa inlay may be a durable option for treatment of recalcitrant bladder neck contracture.

[Ampakines - a promising approach to neuroprotection]. / Ampakiny ­ novyi podkhod k neiroprotektsii.

Increased interest in glutamatergic neurotransmission emerged in the second half of the twentieth century. Later, the role of glutamate neurotransmission in learning and memory processes became clear. AMPA receptors (AMPR) and NMDA receptors (NMDAR) turned out to be important links in the mechanism of long-term potentiation (LTP) involved in memory processes, which was expressed in an increase in the excitatory postsynaptic potential in response to repeated stimuli. The data obtained in recent decades indicate that AMPR is the main regulators of synaptic plasticity, learning and memory. In clinical terms, the greatest interest is not the formation of memory traces in various parts of the brain, but its restoration in various pathological processes, including reactivation of connections between neurons activated by learning in various areas of the brain. AMPAR synaptic plasticity disorder has been detected in several neurodegenerative diseases accompanied by cognitive disorders. Ampakines, a heterogeneous class of numerous small molecules that bind to the allosteric site on the AMPAR receptor, which slows down the kinetics of AMPAR deactivation, enhances excitatory synaptic current and enhances LTP, have become increasingly attracting the attention of researchers.

[A pilot study of idebenone in the treatment of patients with hereditary myopathies]. / Pilotnoe issledovanie idebenona v lechenii bol'nykh s nasledstvennymi miopatiyami.

OBJECTIVE: To evaluate the efficacy of the energotropic drug idebenon in hereditary neuromuscular pathology. MATERIAL AND METHODS: A total of 9 patients with hereditary myopathies were examined during treatment with idebenone. Determination of muscle strength was carried out on the British medical research Council scale (0 points - no active movements, 5 points - no muscle weakness). The examination was performed before and 1 month after the start of treatment. Treatment regimen: idebenone was prescribed in a daily dose of 90 mg. RESULTS: In the general group of patients with hereditary ataxia, the median strength of the biceps muscle of the shoulder during treatment increased from 3.5 to 4.0 points (p>0.05). The median strength of the ilio-lumbar muscle increased from 3.0 to 4.0 points (p>0.05). Before treatment, the median number of sit-ups was 0, and after 1 month - 2 (p>0.05). CONCLUSION: We used the energotropic drug idebenon, a synthetic analog of the natural substance coenzyme Q10, which is involved in electron transfer in the mitochondrial respiratory chain complex III, for the treatment of patients with hereditary myopathies. In the general group of patients, there was an increase in muscle strength, although it did not reach statistical significance. Before the advent of energotropic drugs, the use of various methods of treating hereditary myopathies did not lead to an increase in muscle strength in patients. Therefore, the identified positive dynamics is of great importance in providing medical care to these patients and improving their quality of life.

[Results of using the BESTFertil preparation in patients after microsurgical sub-groin varicocelectomy (Marmaras operation)].

INTRODUCTION: Up to 15% of couples around the world face the problem of infertility, while male factor in infertile marriages occurs in up to 50% of cases. Varicocele occurs in 15% of the male population and in 35% of men with infertility. For now, the only effective method of treating varicocele is operative. After surgical treatment, there is an improvement in spermogram parameters, however, it is not always possible to achieve normal value of each parameter. PURPOSE OF THE STUDY: To assess the efficiency of BESTFertil in patients after varicocelectomy. MATERIALS AND METHODS: The single-center, prospective, randomized study at the University Clinic of Urology, Russian National Research Medical University named after N.I. Pirogov was conducted comparing the postoperative parameters of patients who underwent varicocelectomy, followed by the course of BESTFertil (main group) and without it (control group). A total of 63 patients were included in the study: the main group - 33 patients and the control group - 30 patients. The inclusion criteria for the study were: the presence of varicocele as the cause of pathospermia and / or the absence of pregnancy in marriage for 12 months or more of regular sexual activity without contraception, in the absence of other organic pathology as a possible cause of infertility, age from 18 to 45 years. Patients from both groups underwent surgical treatment of varicocele - microsurgical subinguinal varicocelectomy according to the standard Marmar technique using an operative microscope. Patients from the main group received BESTFertil for 3 months according to the recommended scheme. RESULTS: In the main group an average increase in the volume of ejaculate in 6 months was 0.48 ml (11.2% of the initial), the increase in concentration was 24.4 mln / ml (59.1%), the increase in motility was 25.2% (69.2%), morphologically normal forms - 3.4% (106.3%). A relapse of the disease was revealed in one patient, according to ultrasound and angiography, however, there was also a positive dynamic of spermogram parameters: an increase in ejaculate volume - 0.8 ml; increase in sperm concentration - 22 mln/ml; A + B motility-32%; morphologically normal forms - 1%. Four patients (16.7% of the total number of patients with infertile marriage in the main group) reported pregnancy. In the control group, an average increase in the volume of ejaculate in 6 months was 0.07 ml (1.7% of the initial), the increase in concentration was 11.7 mln / ml (27%), the increase in motility was 10.6% (32.7%), morphologically normal forms - 0.6% (9.8%). Two patients (9.1% of the total number of patients with infertile marriage in the control group) report pregnancy after treatment. One patient had a relapse of the disease, confirmed by angiography, despite his spermogram parameters correspond to normospermia. CONCLUSIONS: These results allow us to conclude that the course of BESTFertil in patients after treatment of varicocele allows to achieve a clinically and statistically significant increase in spermogram indicators such as ejaculate volume, its concentration, sperm motility and the number of morphologically normal forms, which can help patients achieve natural pregnancy or resort to assisted reproductive technologies.