[Surgical treatment of recurrent herniated discs of the lumbar spine depending on risk factors]. / Vybor taktiki khirurgicheskogo lecheniya retsidivov gryzh diskov poyasnichnogo otdela pozvonochnika na osnovanii analiza faktorov riska ikh razvitiya.

According to the literature, recurrent disc herniation of the lumbar spine occurs in 5-10% of cases. Objective. To develop an algorithm for surgical treatment of recurrent lumbar spine disc herniation based on analysis of risk factors of relapse and assessment of intra- and postoperative period. MATERIAL AND METHODS: The study included 61 patients with recurrent intervertebral disc herniation. Thirty patients underwent repeated microdiscectomy without transpedicular fixation, 31 patients - resection of recurrent disc herniation with transpedicular fixation (PLIF technique). The control group included 63 patients without recurrent disc herniation. Mean follow-up period was 3.5 years. RESULTS: Discectomy with transpedicular fixation is characterized by larger extent, prolonged surgery time and rehabilitation period. However, there is lower risk of recurrent disc herniation and CSF leakage. Repeated microdisectomy without transpedicular fixation is characterized by smaller extent and shorter surgery time, as well as faster recovery period. Nevertheless, we have higher risk of recurrent disc herniation and CSF leakage. We developed a method for assessing the probability of recurrent intervertebral disc herniation. This algorithm allows us to predict the probability of recurrent disc herniation in a particular patient with 86.7% accuracy. CONCLUSION: We proposed an algorithm for choosing surgical treatment of recurrent disc herniation. Microdiscectomy without fixation is advisable for the risk of recurrent disc herniation <30%, discectomy with transpedicular fixation - for risk of disc herniation >30%.

[Genetic factors in degenerative disc disease]. / Rol' geneticheskikh faktorov v razvitii degenerativno-distroficheskogo porazheniya mezhpozvonkovykh diskov.

OBJECTIVE: To analyze available literature data on the role of genetic factors in degenerative disc disease. METHODOLOGY: We reviewed the PubMed, MEDLINE, Cohrane Library, e-Library databases using the following keywords: degenerative spine lesions, intervertebral disc herniation, pathogenesis, genetic regulation. RESULTS: Searching depth was 2002-2022. We reviewed 84 references. Exclusion criteria: duplicate publications, reviews without detailed description of results, opinions. Finally, we included 43 the most significant studies. CONCLUSION: There are literature data on proinflammatory cytokines, growth factors and osteodestructive processes in pathogenesis of degenerative disc disease. However, there is only fragmentary information about the role of genetic regulation of these processes. Some factors, such as microRNA, TGF-b, VEGF, MMP are still poorly understood.

Educational video for training specialists in clinical laboratory diagnostics.

The adaptation of educational programs under restrictions during the SARS-CoV-2 coronavirus pandemic and after it is based not only on the widespread use of video lectures, but also on the introduction of a number of new educational technologies. Hybrid learning will become the cornerstone of future educational technologies in clinical laboratory diagnostics and will contribute to the creation of virtual practical classes with examples of analysis of laboratory testing results based on case histories (Case Technologies). The key aspect in the implementation of video cases into the educational process is the development of video materials. The use of educational video cases developed by Vector-Best in the process of training specialists in clinical laboratory diagnostics during the cycles «Retraining¼ and «General Improvement¼ at the Department of Clinical Laboratory Diagnostics of the Saratov State Medical University named after V. I. Razumovsky of the Ministry of Health of Russia was a convenient format and received positive assessment of cadets. Currently, the «IVD gallery¼ section has appeared on the FLM website and the placement of an additional educational resource - a library of educational video cases.

Potential targets for preclinical diagnostics of acute kidney injury in covid-19 patients (review of literature).

An relevance of the topic was defined by the high occurrence, unfavorable prognosis, lack of diagnostic techniques for early stages of acute kidney injury (AKI) disclosed in patients with COVID-19 (Coronavirus Disease 2019). Screening of medical literature for selection of AKI preclinical biomarkers was considered as main aim of this review. More than 200 publications from Russian Science Citation Index (RSCI), Scopus, The Cochrane Library, and MEDLINE were reviewed. Such risk factors as hypoxemia, increased intrathoracic pressure associated with Acute Respiratory Distress Syndrome (ARDS), hypertension (HT) involving endothelial dysfunction, and Diabetes mellitus were considered to be associated with AKI. There were explicated cytopathic and immune-mediated (cytokine-induced) mechanisms of COVID-19 associated AKI pathogenesis. Multiple methodological approaches were defined for detection and identification of the biomarkers based on urine proteome and metabolome screening. Perspective ways in the preclinical diagnostics of AKI such as detection of the markers of injury of the hypoxia-sensitive proximal canaliculi and the ATP metabolites that reflect first stages of the energy metabolism disorder in the epithelium lining canaliculi were identified in this study. The instantaneous and non-invasive investigation of different markers was regarded as possible method of the prognostication. The accuracy of the diagnosis on the initial stages of AKI, substantiate for preventive start of therapy, and make projections on the disease`s outcome will be improved due to the identification of high-sensitive specific biomarkers.

[Reflux nephropathy in children: pathogenesis and prognosis. Part 2].

The second part of this review is devoted to the issues of modern and promising diagnosis of RN in children. The advantages and limits of the available methods for recording the structural and functional state of the kidneys in childhood are considered. Particular attention is paid to possibilities non-invasive methods for diagnosis and prediction of the disease course. Data on promising biomarkers of the early stages of RN formation and progression are presented. For the purpose of a comprehensive and adequate assessment of morphological changes in the kidneys, the necessity of studying various combinations of cytokines in biological media with the subsequent determination of the optimal spectrum is shown. The sensitivity and specificity of molecular indicators of renal damage reviewed as potential targets for renoprotective therapy in the nearest future.

[Reflux nephropathy in children: pathogenesis and prognosis. Part 1].

The purpose of this review is to analyze the modern literature about renal damage caused by vesicoureteral reflux (VUR). VUR is the most common urodynamic pathology in children and reflux nephropathy (RN), as its main complication, ranks first among the causes of chronic kidney disease (CKD). The risk factors for the appearance and progression of RN are presented in the first part of the review. In the framework of this issue, the main methods of treatment of VUR and associated urinary tract infection are described. The possibilities of conservative and surgical methods for the elimination of reflux for prevention of RN and prognosis of its course are considered. The main morphological aspects of RN formation are described.

[Characteristics of age-dependent changes in the urine´s proteom composition of the of the healthy persons (experimental and theoretical study).]

For the first time proteins are described, reliably increasing and decreasing in urine with age in the range of 20 to 60 years. The combinations of proteins associated with changes in immune processes, violation of blood reology, including the risk of coagulopathy, anticancer defense mechanisms, insulin signaling pathway, changes in cell characteristics are characterized division and quality of the newly formed fabric. Thus, the age dynamics of the main processes triggers a cascade of reactions manifested in the closure of «pathological biochemical circles¼ that form the prerequisites for the development of diseases and, over time, clinical manifestations.

[Chromato-mass spectrometric analysis of urine proteins associated with the functions of Toll-receptors in a healthy person under conditions of 17-day isolation.] / Хромато-масс-спектрометрический анализ белков мочи, ÑÐ¾Ð¿Ñ€ÑÐ¶ÐµÐ½Ð½Ñ‹Ñ Ñ функциями Toll-рецепторов у здорового человека в ÑƒÑÐ»Ð¾Ð²Ð¸ÑÑ 17-суточной изоляции.

Under controlled conditions of 17-day isolation (Sirius-17 experiment), the protein composition of urine was studied in 6 healthy test volunteers-3 women and 3 men. Collection of samples in the form of a second freely separated morning urine fraction was carried out in the background (seven days before the experiment), as well as 1 day after the end of exposure. Chromatographic-mass-spectrometric semi-quantitative analysis of the protein composition of samples was performed on a system consisting of an Agilent 1100 chromatograph and an LTQ-FT Ultra hybrid mass spectrometer using bioinformatics resources UniProtKB, GeneOntology. An asymptomatic change in the immune defense system of kidney tissue after isolation in a closed hermetic object is associated with a change in the content of 7 proteins that provide functional activity of the TLR tubules of the kidneys - FcRIII, MUC1, Galectin-3, Ficolin-2, APOA1, FLNA, FCGR3A and Clusterin. These proteins are found to be useful biomarkers in the study of physiology and kidney diseases. They can be attributed to candidates for protein markers of the initial stages of impaired recognition by the epithelium of renal tubules of bacteria with known pathogenic potential.

[Nephroprotective effect of calcium channel blocker lercanidipine in treatment of patients with urolithiasis and urinary tract obstruction and monitoring of the serum cytokine profile].

OBJECTIVE: to evaluate the nephroprotective effect of lercanidipine, its effect on the dynamics of creatinine clearance and blood cytokine levels in patients with nephrolithiasis with obstructive uropathy during renal drainage. MATERIAL AND METHODS: 66 patients were included in the study with concretions of the pelvic segment and the presence of obstruction according to instrumental methods of examination. In order to prevent the occurrence of infectious complications before lithotripsy patients the first stage was performed installation of nephrostomic drainage, followed by antibacterial, anti-inflammatory therapy. Patients were divided into 2 groups: the first (33 patients) received standard therapy, the second (33 people) additionally received lercanidipine at a dose of 10 mg per day for 1 month. Determined the concentration of IL-8, VEGF, MCP-1, G-CSF and GM-CSF in the blood serum by the method of solid-phase ELISA. The glomerular filtration rate was calculated using the CKD-EPI formula. All studies were performed at the preoperative stage, on 7, 14, 21 and 28 days after renal drainage. RESULTS: In the appointment of lercanidipine, there was a more rapid decrease in levels of IL-8, VEGF, MS-1, GM-CSF in serum (21 days), and an improvement in renal function, compared with the group that did not receive nephroprotective therapy. CONCLUSION: The administration of lercanidipine may contribute to a more rapid recovery of renal function and normalization of blood cytokine levels. This drug can be used in the complex treatment of patients with nephrolithiasis with obstructive uropathy.

[Use of local baroimpulse therapy in the treatment of patients with chronic abacterial prostatitis / chronic pelvic pain syndrome and erectile dysfunction].

AIM: To study the efficiency of local baroimpulse therapy (BIT) in the complex treatment of patients with chronic abacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS) and erectile dysfunction (ED). MATERIALS AND METHODS: A total of 112 men with confirmed diagnosis of CP/CPPS and ED, who received drug therapy according to the standards and guidelines were included in the study. In the main group (n=68) all patients additionally received local BIT in the form of rectal pneumovibromassage (PVM) of the prostate (totally, 10 procedures). In the control group (n=44) only standard treatment was provided. The efficiency of therapy was assessed based on the complex clinical examination, laboratory tests and imaging methods. RESULTS: At the visit 2 (1 month after the start of therapy) there were significant differences in clinical (resolution of symptoms of CP/CPPS and improvement of erectile function), laboratory and imaging criteria between 2 groups. The rectal PVM using apparatus MKV-01 "Inavita" resulted in decrease the activity of inflammation process and levels of pro-inflammatory cytokines, increase of flow rate and intraprostatic blood flow. According to the analysis of long-term results, after 6 months of therapy the remission was seen in the most of patients in the main group (79.4%), which was 40.8% higher than in the control group. CONCLUSION: The use of local BIT by mean of rectal PVM allows to increase efficiency of complex treatment of patients with CP/CPPS and ED.

[Features of the proteome of the urine in chronic pyelonephritis.]

Clinical observation and examination of 12 patients with chronic pyelonephritis (CPN) were performed. The first group (GI) included patients with exacerbation of the disease. In the comparison group (GII)- the same patients after 1.5-3 months after completion of treatment, without clinical manifestations of exacerbation of CPN. Laboratory signs of acute renal damage were not revealed in all examined patients. Additionally, urine was collected in the afternoon after Breakfast, in the form of a freely separated 2nd fraction and its sample preparation, consisting of the stages: recovery, alkylation, protein deposition and proteolysis using trypsin. The resulting polypeptide mixture was separated by liquid chromatography in three repetitions and analyzed on a system consisting of Agilent 1100 chromatograph and ltq-FT ultra hybrid mass spectrometer. A list of proteins was obtained, indicating the number of peptides by which they were identified, and the parameters of its reliability. Most of the information about the obtained proteins was obtained from UniProt databases. Identified and analyzed 10 proteins that differ significantly in occurrence in the clinical group of patients in the period of exacerbation of PN. The appearance of these proteins in urine in 1patients with exacerbation of chronic PH allows us to consider them as potential biomarkers directly associated with inflammation and damage to the epithelial lining of the renal tubules.

[Mechanisms of development of chronic cerebral ischemia in arterial hypertension]. / Mekhanizmy formirovaniya khronicheskoi ishemii golovnogo mozga pri arterial'noi gipertenzii.

AIM: To study a relationship of arterial hypertension (AH) severity with the cerebral blood flow and structural changes in the brain matter, processes of lipid peroxidation and antioxidant defense, parameters of homeostasis, indicators of endothelial dysfunction and apoptosis. MATERIAL AND METHODS: A complex study of 84 patients with AH, aged from 43 to 64 years, was carried out. RESULTS AND CONCLUSION: The severity of atherosclerotic damage increased with the increasing of the AH degree. There were the sings of cerebral atrophy, changes in the white matter of brain hemispheres accompanied by the increase of oxidative stress and insufficient antioxidant activity, appearance of procoagulation shifts in the homeostasis system, along with the moderate activity of fibrinolysis, increase in the level of proinflammatory cytokines and markers of apoptosis, endothelin-1, decrease in nitrogen oxide concentration.

[The impact of concentrations of nitric oxide and activity of oxistat on development of inflammatory alterations in vascular wall].

The analysis was applied to results of study of impact of concentrations of nitric oxide and activity of oxistat on development of alterations in vascular wall in patients with different stages of atherosclerosis of vessels. The priority indicators according established marker are revealed.

[Diagnostic value of the determination of angiogenic factors and cytokine composition parameters in the serum and urine of patients with scleroderma systematica].

AIM: To study the associations of the concentration of interleukins (IL) 1beta, 6, 8, 10, monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-alpha, vascular endothelial growth factor (VEGF) in the serum and urine with the clinical features of scleroderma systematica (SDS). SUBJECTS AND METHODS: The investigation enrolled 51 patients with a valid SDS diagnosis. The serum and urinary concentrations of interleukins, TNF-alpha, MCP-1, and VEGF were measured by solid-phase enzyme immunoassay. RESULTS: The patients with SDS were found to have higher serum and urine concentrations of proinflammatory cytokines and VEGF than in the comparison group. There were relationships between the levels of VEGF and proinflammatory cytokines and the disease duration, clinical forms, and clinical manifestation of SDS. CONCLUSION: Higher serum VEGF levels in patients with SDS may be used to estimate the magnitude of endothelial dysfunction. Estimation of serum IL-6 concentrations may be employed to determine the degree of sclerosis progression; that of MCP1 for the activity of fibrosing alveolitis. Quantitative analysis of urinary IL-6, IL-8, and VEGF levels in patients with SDS may be used to evaluate tubulointerstitial inflammation and to predict the development of interstitial fibrosis.

[Angiogenesis and vascular endothelial growth factor, role in the pathology of the gastrointestinal tract].

A review of the literature, the authors present information about angiogenesis, as the process of formation of new blood vessels in the organ or tissue from pre-existing vasculature by migration and proliferation of endothelial cells, as well as on the processes of regulation. Presents key regulatory system angiogenesis. The main attention is paid Vascular endothelial growth factor (VEGF). Specially structured data on the role of Vascular endothelial growth factor in human pathology, including diseases of gastrointestinal tract, inflammatory and neoplastic nature.

[Modern principles of diagnosis and prediction of course of chronic obstructive pyelonephritis in children].

An assessment of changes in the levels of cytokines, cell adhesion molecules, acute phase proteins in serum, urine and biopsy using ELISA was performed. The evaluation was performed in 167 patients with various congenital urinary tract obstructions in the perioperative period. It is shown that serum C-reactive protein and IL-6, IL-8 urine levels have high diagnostic significance for determining the severity of inflammation in the urinary tract in the development of chronic obstructive pyelonephritis at different levels of obstruction. The calculation of the proposed index of inflammation activity based on IL-8 and IL-10 urine levels in children in the dynamics allows to estimate the phase of inflammation and efficacy of the treatment.

[Sexual development of boys with hypospadias].

The article presents the results of a clinical evaluation of 39 boys with hypospadias aged 10-15 years. The examination included clinical assessment of pubertal development, and Doppler ultrasound scan of the gonads, transrectal ultrasound of the prostate in adolescents over 14 years, the definition of serum levels of gonadotropins, sex steroids and inhibin B. Puberty in boys with hypospadias is characterized by later appearance of pubarhe, microphallus, lack of testicular blood flow, and hypotrophy of the prostate. Statistically significant difference in sexual development of boys with penile and scrotal hypospadias was detected. On the basis of the hormonal examination, a violation of function of Sertoli cells in 43% of boys with the penile hypospadias and in 68% with scrotal hypospadias was identified. Leydig cell dysfunction was not found.

[Molecular markers of endothelial damage in patients with Parkinson's disease].

A comparative analysis of clinical, instrumental and laboratory data in groups of patients with Parkinson's disease and chronic brain ischemia (stages I-II) was carried out. The information obtained in the groups showed significant differences in clinical and instrumental data that indicated the presence of chronic brain ischemia. A significant increase in molecular markers of endothelial damage comparable with the group of chronic cerebral ischemia was identified in patients with Parkinson's disease. The increase in indicators including monocyte chemoattractant protein-1, vascular endothelial growth factor and endothelin-1 is important for the verification of the disease before the appearance of symptoms of chronic cerebral ischemia in the examined groups of patients.

[Tumor markers p53, sFAS, FASL, CEA and CA 19-9 in evaluating the effectiveness of surgical and pharmaco nutritional treatment of patients with gastric cancer].

UNLABELLED: The objective of this study is to develop a marker panel of abnormalities of immune regulatory systems and cell genome in patients with gastric cancer for assessment of efficacy of surgical treatment in combination with pharmaco-nutritional therapy in early postoperative period. MATERIALS AND METHODS: Expression of p53, sFAS, FASL, CEA, and CA 19-9, nutritial status, as well as incidence of purulent-septic complications in early postoperative period were determined in 40 patients with gastric cancer (21 patients--the test group and 19 patients--the comparative group) prior to a curative surgical intervention, postoperative days 1 and 7, while the pharmaco-nutritional therapy (the test group) or partial parenteral nutrition (the comparative group) has been performed. RESULTS: The pharmaco-nutritional therapy significantly decreases in activity of tumor suppressing genome, lymphocyte apoptosis, expression of oncology-associated markers, incidence of purulent-septic complications, as well as exacerbation risk for hypotrophy in patients with gastric cancer in early postoperative period. CONCLUSION: To assess the efficacy of the surgical intervention performed in patients with gastric cancer, an expression of mutant p53 and markers of lymphocyte apoptosis (sFAS/FASL) is reasonable to be evaluated together with determination of oncomarkers (CEA and CA 19-9).