[Prognosis of ureteral dilatation during procedures using a ureteral access sheath in patients with urolithiasis].

AIM: To improve the results of treatment of patients with urolithiasis who underwent endoscopic interventions using a ureteral access sheath (UAS) by developing a predictive model of ureteral dilatation without pre-stenting. MATERIALS AND METHODS: A total of 180 patients with kidney stones up to 20 mm were included in the study. They were divided into two groups: in the group 1 (n=79) UAS of 12/14 Ch was used, while in group II (n=101) UAS of 10/12 Ch was inserted. In group I, 48 (60.8%) patients underwent micropercutaneous nephrolithotomy and in 31 (39.2%) retrograde intrarenal surgery was done, compared to 42 (41.6%) and 59 (58, 4%) of patients in group 2. A non-inclusion criterion was a history of ureteral stenting. At the stage of preoperative diagnosis, 60 minutes before the X-ray examination, the patient took a single dose of 80 mg of furosemide per os to improve visualization of the upper urinary tract. After digital processing of computed tomography data and 3D-reconstruction of the upper urinary tract using the DICOM image processing program "RadiAnt DICOM Viewer," a visual assessment of the ureter was carried out to exclude significant deviations and strictures. The ureteral width was measured at three points: pyeloureteral segment, the level of the iliac bifurcation and intramural part. The number of cases of successful insertion of UAS and the rate of damage to the ureteral wall according to the classification proposed by O. Traxer and A. Thomas (2012) were analyzed. The prediction of successful insertion of a UAS was carried out using ROC analysis. RESULTS: In group 1, successful insertion of UAS was observed in 37 (46.8%) patients compared to 84 (83.2%) patients in group 2. In the remaining 42 (53.2%) and 17 (16.8%) cases, respectively, placement of UAS was not possible due to significant tissue resistance and high risk of traumatic injury. The average ureteral diameter at the points of physiological narrowing in patients with successful insertion of 12/14 Ch UAS were 2.0+/-0.1 mm, compared to 1.2+/-0.4 mm in those with failed insertion (p<0.05). In the group 2, similar indicators were 1.6+/-0.1 mm and 1.2+/-0.5 mm, respectively (p<0.05). According to ROC analysis, the diagnostic efficiency of the predictive model when using 12/14 Ch and 10/12 Ch UAS was confirmed by high AUC values (0.925 [95% CI 0.871-0.98] and 0.944 [95% CI 0.89=0.97], respectively). The total number of patients with ureteral injuries was 35 (44.3%) and 40 (39.6%) in groups with 12/14 Ch and 10/12 Ch UAS, respectively. At the same time, complications of the I degree were observed in 24 (30.4%) patients of the group 1 and in 31 (30.7%) patients of the group 2, while injuries of II degree were detected in 10 (12.7%) and 9 (8.9%) cases, respectively (p>0.05). Only in 1 (1.3%) patient, when 12/14 Ch UAS was inserted, grade III damage to the ureteral wall was determined. CONCLUSION: The proposed technique for measuring the cross-section of the ureter allows to predict the successful insertion of UAS at the preoperative stage. The probability of successful passage of UAS of 10/12 and 12/14 Ch in patients with ureteral diameter in physiological narrowings of more than 1.6 mm and 2 mm, respectively, is 95%. An insertion of UAS is a safe procedure, and most complications are classified as grades I or II.

Experimental Validation of a Kinetic Ballooning Mode in High-Performance High-Bootstrap Current Fraction Fusion Plasmas.

We report the observation of a set of coherent high frequency electromagnetic fluctuations that leads to a turbulence induced self-regulating phenomenon in the DIII-D high bootstrap current fraction plasma. The fluctuations have frequency of 130-220 kHz, the poloidal wavelength and phase velocity are 16-30 m^{-1} and ∼30 km/s, respectively, in the outboard midplane with the estimated toroidal mode number n∼5-9. The fluctuations are located in the internal transport barrier (ITB) region at large radius and are experimentally validated to be kinetic ballooning modes (KBM). Quasilinear estimation predicts the KBM to be able to drive experimental particle flux and non-negligible thermal flux, suggesting its significant role in regulating the ITB saturation.

Estimating the Inertia Tensor Components of an Asymmetrical Spacecraft When Removing It from the Operational Orbit at the End of Its Active Life.

The paper presents a method for estimating the inertia tensor components of a spacecraft that has expired its active life using measurement data of the Earth's magnetic field induction vector components. The implementation of this estimation method is supposed to be carried out when cleaning up space debris in the form of a clapped-out spacecraft with the help of a space tug. It is assumed that a three-component magnetometer and a transmitting device are attached on space debris. The parameters for the rotational motion of space debris are estimated using this measuring system. Then, the known controlled action from the space tug is transferred to the space debris. Next, measurements for the rotational motion parameters are carried out once again. Based on the available measurement data and parameters of the controlled action, the space debris inertia tensor components are estimated. It is assumed that the measurements of the Earth's magnetic field induction vector components are made in a coordinate system whose axes are parallel to the corresponding axes of the main body axis system. Such an estimation makes it possible to effectively solve the problem of cleaning up space debris by calculating the costs of the space tug working body and the parameters of the space debris removal orbit. Examples of numerical simulation using the measurement data of the Earth's magnetic field induction vector components on the Aist-2D small spacecraft are given. Thus, the purpose of this work is to evaluate the components of the space debris inertia tensor through measurements of the Earth's magnetic field taken using magnetometer sensors. The results of the work can be used in the development and implementation of missions to clean up space debris in the form of clapped-out spacecraft.

[Current approaches to the treatment of patients with dyslipidemia in the real practice in the outpatient stage].

Aim    To evaluate the frequency and structure of lipid-lowering therapy and of achieving the goal of low-density lipoprotein cholesterol (LDL-C) in patients with very high cardiovascular risk (CVR) who were monitored at the outpatient stage. Material and methods    A retrospective snapshot analysis was performed by continuous sampling method for 136 medical records of outpatient patients (71 men, 65 women) aged 42 to 91 years [median, 68 years; 25th and 75th percentiles (59; 78)].Results    134 (98,53 %) patients took statins; 8 (5.88 %) patients took a combination of statin and ezetimibe; 2 (1.47 %) patients took proprotein convertase subtilisin/kexin type 9 enzyme inhibitors (PCSK9): 2 (1.47 %) patients took evolocumab and 1 (0.74%) of 2 PCSK9-treated patients took a combination of PCSK9 inhibitor and statin. Atorvastatin at a dose of 20 (20; 40) mg as recommended at the hospital was the most frequently prescribed statin. 5 (3.68%) patients achieved the goal LDL-C of ≤1.4 mmol/l.Conclusion    Statins prevail in the structure of lipid-lowering therapy in patients with very high CVR. The frequency of combination therapy (statin/ezetimibe, 5.88%; PCSK9 inhibitor/statin, 0.74%) and PCSK9 inhibitors was noted to be low. Only 3.68% of patients achieved the goal LDL-C during the lipid-lowering treatment.

[Determination of factors influencing the desire and possibilities of prevention of inactivity and other behavi-oral risk factors by primary care physicians (REFLECTION). The results of a one-time survey].

Aim    To evaluate clinical practice of primary care physicians with respect of preventing behavioral risk factors in patients as well as objective and subjective factors that influence their motivation for taking preventive measures. Material and methods    This study was a cross-sectional survey. The questionnaire was anonymous and included closed questions and multiple-choice questions. Based on the obtained results, prevalence of modifiable risk factors for chronic noninfectious diseases (CNID) was comprehensively evaluated in the survey population. Also, a special quantitative variable was introduced, the Index of Behavioral Risk Factors. that reflected the burden of risk factors. This composite index included the degree of risk factor in a specific respondent, for example, obesity degree, number of cigarettes smoked per day, severity of hypodynamia. Physicians' knowledge and beliefs about the effect of physical activity (PA) on certain diseases were evaluated. Result    623 physicians (mean age 40 years (31-52), 85.5 % women) participated in the survey. The respondents included general practitioners (7.5%), cardiologists (2.9 %), preventive care physicians (4.8 %), internists (25.4 %), and other specialists (59.4 %). 70.8 % of respondents never smoked, 17.5 % were current smokers. 38.5% (240) of the surveyed had a normal body weight index (BWI); 41.7 % (260) were overweight; 11.6 % (72) had degree 1 obesity; 3.7 % (23) had degree 2 obesity; and 0.8 % had degree 3 obesity. A very low PA level was noticed; most of the surveyed exercised not more than once a week (median, 1 (0-3) time). More than 90 % had behavioral risk factors, low PA and excessive body weight. The physicians with a higher index of behavioral risk factors 50% less frequently checked the body weight of patients (odds ratio (OR), 0.541; 95 % confidence interval (CI): 0.388-0.753, p<0.05); 33% less frequently asked whether the patient smoked (OR, 0.675; 95 % CI: 0.465-0.978, p=0.037); 50% less frequently asked the patients about his/her level of PA (OR, 0.482; 95 % CI: 0.343-0.678, p<0.001); and 60% less frequently recommended increasing the PA (OR, 0.408; 95 % CI: 0.292-0.570, p<0.001).Conclusion    Most of the surveyed were aware of the benefits of PA for prevention and treatment of CNID, however, they related the mechanism of this effect only with weight loss. The most frequently mentioned barriers to behavioral risk counseling were uncertainty about whether such counseling was within the physician's professional competence, lack of time, lack of confidence in the provision of advice and the effectiveness of interventions, and lack of patients' compliance.

Comparision of fluorimetric and mass spectrometric methods for Fabry disease newborn screening.

Fabry disease is an X-linked hereditary lysosomal storage disorder caused by mutations in the GLA gene. Neonatal screening for Fabry disease in males is feasible by measurement of α-galactosidase A activity in DBS using either the mass spectrometric or fluorigenic substrate. The aim of the study: to assess the possibility of introducing the compared methods into the practice of neonatal screening. In the both assays performed a statistically significant difference of the enzyme activity between affected individuals and controls is reported. The slight modification of the fluorimetric method by centrifugation of a 96-well microplate before measurement could improve signal to noise ratio.

[ANALYSIS OF THE CAUSES OF SUDDEN DEATH AMONG EMPLOYEES OF JSC «RUSSIAN RAILWAYS¼].

Protecting the health of railway workers of various professional groups is an important and integral part of the work of primary health care. The incidence of circulatory diseases is a significant problem among some groups of railway workers, given the considerable number of occupational risk factors. Among the most unfavorable complications of cardiovascular disease may be sudden cardiac death.Purpose of the study - сonducting an analysis of typical risk factors for sudden death among the main occupational groups of railway workers in Russia. MATERIALS AND METHODS: A retrospective analysis was carried out of all cases of sudden death of employees of Russian Railways in the period from 2009 to 2021. All deceased workers were conditionally divided into 6 groups depending on the professions and positions of workers. RESULTS: All 411 deceased patients worked on 16 railways, subordinate to 15 medical directorates of Russian Railways. 84.7% of patients felt the first symptoms during working hours and only 15.3% during non-working hours. The prevalence of cases of sudden death during working hours was noted - 81%. Among the occupational groups under consideration, death at home or outside the home was more often observed in groups I and VI, and at the workplace, from groups II to V (p < 0.001). 6.8% of those who died had high levels of ethyl alcohol in their blood, and 3 out of 4 of them died at the workplace. Among the deceased, 70.3% of the patients were smokers. 68.1% were overweight or obese. The level of total cholesterol exceeded 5 mmol/l in 20.7% of cases, and the largest number of patients (65%) had a moderate risk according to the SCORE scale. CONCLUSION: The study sample showed that cardiovascular diseases are the main cause of sudden death. Among the risk factors in the study group, smoking and obesity prevailed.

Assessment of Awareness and Experience of Using off-label Drugs by Doctors of Clinical Specialties.

Aim      To evaluate the frequency of off-label prescription of medicines in practice of clinical specialists and the awareness of respondents of the procedure of justified off-label prescription.Material and methods  The sample included 542 clinical specialists who worked in definite medical organizations in 26 entities of the Russian Federation. The respondents were proposed to fill in remotely an anonymous questionnaire to evaluate the experience of prescribing medicines off-label to adult patients.Results Prescribing medicines not in consistence with the officially approved instruction for medical use (off-label or "outside instruction") is a relevant issue of global medical care since convincing scientific evidence for safety of such use is scarce. Analysis of information about off-label prescription is one of current tasks of national medical research centers according to the Federal Project "Development of a network of national medical research centers and implementation of innovative medical technologies". According to the responses about the frequency of off-label prescriptions 67.5 % of respondents reported of no experience of off-label prescription, 27.7 % said "rarely" or "sometimes", and 4.8 % said "frequently" and "very frequently". Specialties of physicians who have more often used medicines off-label (50% and more) included obstetrics and gynecology, pediatrics, rheumatology, hematology, and pulmonology. Cardiologists, neurologists and clinical pharmacologists use medicines off-label relatively rarely (19.6%, 28.6 %, and 22.2 %, respectively). 40 % of medicines used off-label were those designed for the treatment of coronavirus infection SARS-CoV-2. The medicines most frequently used off-label included metformin, rituximab, and thioctic acid. 65 % of respondents assessed their knowledge of off-label prescription as insufficient. In addition, 75 % of respondents consider it useful to receive additional information about risks and benefits of off-label prescription in clinical practice.Conclusion      The survey revealed the need of physicians for information about risks of the off-label use of medicines in clinical practice.

Wide Operational Windows of Edge-Localized Mode Suppression by Resonant Magnetic Perturbations in the DIII-D Tokamak.

Edge-localized mode (ELM) suppression by resonant magnetic perturbations (RMPs) generally occurs over very narrow ranges of the plasma current (or magnetic safety factor q_{95}) in the DIII-D tokamak. However, wide q_{95} ranges of ELM suppression are needed for the safety and operational flexibility of ITER and future reactors. In DIII-D ITER similar shape plasmas with n=3 RMPs, the range of q_{95} for ELM suppression is found to increase with decreasing electron density. Nonlinear two-fluid MHD simulations reproduce the observed q_{95} windows of ELM suppression and the dependence on plasma density, based on the conditions for resonant field penetration at the top of the pedestal. When the RMP amplitude is close to the threshold for resonant field penetration, only narrow isolated magnetic islands form near the top of the pedestal, leading to narrow q_{95} windows of ELM suppression. However, as the threshold for field penetration decreases with decreasing density, resonant field penetration can take place over a wider range of q_{95}. For sufficiently low density (penetration threshold) multiple magnetic islands form near the top of the pedestal giving rise to continuous q_{95} windows of ELM suppression. The model predicts that wide q_{95} windows of ELM suppression can be achieved at substantially higher pedestal pressure in DIII-D by shifting to higher toroidal mode number (n=4) RMPs.

Effects of Anti-Orthostatic Hypokinesia on the Parameters of Vertical Posture: Orthostatic and Stabilometric Study.

The effects of anti-orthostatic hypokinesia on the parameters of vertical posture (orthostatic and postural stability) were studied. Anti-orthostatic hypokinesia was followed by orthostatic instability manifested in a decrease in the tolerance time in the orthostatic test, a significant increase in HR and systolic BP starting from the 11th minute of the test. Significant changes in the parameters reflecting postural stability were observed starting from minutes 10-11 of the stabilometric test. Anti-orthostatic hypokinesia was shown to affect all parameters of postural stability; symmetry in paired stabilometric tests was impairmed.

Antihypertensive therapy in male and female: are there sex differences in choice of drugs?

Tis review presents data on prevalence, control, and effectiveness of treatment of hypertension in male and female. Te features of protective action and manifestations of undesirable effects of antihypertensive therapy in male and female, as well as situations influencing the choice of a drug depending on sex are discussed.

[The Characteristics of Personnel Resources of Medical Care System of the Tver Region].

The article presents results of analysis of physicians' personnel of the Tver region according the data of official reports. In the Tver region, at January 1, 2015 there were 40 physicians per 10 000 of population. The staffing made up to 85% in average. The study established certain feminization of personnel and prevalence of individuals of pre-retirement and retirement age. The number of vacancies in state medical organizations of the Tver region made up to 540 physicians (11%). This data factually complies with results of calculation of need in medical personnel in the Tver oblast carried out according technology approved by Ministry of Health of Russia and according which deficiency of medical personnel comes to 557 physicians.

[Evaluation of inflammatory and endothelial dysfunction's biomarkers in patients with hypertension at achieving the target blood pressure.]

The target organs damage in hypertension is mainly realized through an endothelial dysfunction. The present study investigated the inflammatory and endothelial dysfunction's biomarkers in patients with hypertension before and after the achieving the target level of blood pressure. We've performed clinical and laboratory study of 44 patients (17 men, 27 women, mean age 58.59 ± 10.57 years) with the hypertension stage II, degrees2-3, high and very high risk of cardiovascular complications, not reaching the target level of blood pressure at the previous therapy. All patients received standardized therapy with a fixed combination of amlodipine / indapamide / perindopril in an individually selected dosage. The duration of the follow-up was 6 months. The levels of pro-inflammatory interleukin-6 (IL-6), anti-inflammatory interleukin-10 (IL-10), vascular cell adhesion molecule-1 (sVCAM-1) and vasculoendothelial growth factor (VEGF) were measured. All patients achieved the target blood pressure level at the end of the study (systolic blood pressure was 125.1 ± 6.9 mm Hg, diastolic - 82.2 ± 5 mm Hg, p < 0.001). After 6 months, there was no significant dynamics of inflammatory biomarkers. The level of sVCAM-1, as an indicator of endothelial dysfunction, decreased (898.67 ± 433.5 ng / ml vs. 1063.5 ± 442.4 ng / ml at the start of treatment, p < 0.001). Thus, it is possible to use vascular cell adhesion molecule-1 as a biomarker of endothelial dysfunction in patients with hypertension. Adequate therapy of hypertension with achievement of target blood pressure levels improves vascular endothelial function, significantly reducing sVCAM-1 expression.

Pedestal bifurcation and resonant field penetration at the threshold of edge-localized mode suppression in the DIII-D Tokamak.

Rapid bifurcations in the plasma response to slowly varying n=2 magnetic fields are observed as the plasma transitions into and out of edge-localized mode (ELM) suppression. The rapid transition to ELM suppression is characterized by an increase in the toroidal rotation and a reduction in the electron pressure gradient at the top of the pedestal that reduces the perpendicular electron flow there to near zero. These events occur simultaneously with an increase in the inner-wall magnetic response. These observations are consistent with strong resonant field penetration of n=2 fields at the onset of ELM suppression, based on extended MHD simulations using measured plasma profiles. Spontaneous transitions into (and out of) ELM suppression with a static applied n=2 field indicate competing mechanisms of screening and penetration of resonant fields near threshold conditions. Magnetic measurements reveal evidence for the unlocking and rotation of tearinglike structures as the plasma transitions out of ELM suppression.

The pathophysiology and consequences of red blood cell storage.

Red cell transfusion therapy is a common treatment modality in contemporary medical practice. Although blood collection and administration is safer and more efficient than ever before, red cells undergo multiple metabolic and structural changes during storage that may compromise their functionality and viability following transfusion. The clinical relevance of these changes is a hotly debated topic that continues to be a matter of intense investigation. In the current review, we begin with an in-depth overview of the pathophysiological mechanisms underlying red cell storage, with a focus on altered metabolism, oxidative stress and red cell membrane damage. We proceed to review the current state of evidence on the clinical relevance and consequences of the red cell storage lesion, while discussing the strengths and limitations of clinical studies.

Role of heat shock protein 27 in regulation of glutathione system and apoptosis of Jurkat tumor cells and blood lymphocytes.

Reaction of the glutathione system of Jurkat tumor cells and blood lymphocytes was evaluated under conditions of culturing with 5-(5-ethyl-2-hydroxy-4-methoxyphenyl)-4-(4-methoxyphenyl) isoxazole (KRIBB3), a selective inhibitor of heat shock protein Hsp27. The results indicated the regulatory role of Hsp27 in the maintenance of the functional activities of glutathione reductase, glutathione peroxidase, and realization of apoptotic death of Jurkat cells and blood lymphocytes. Inhibition of Hsp27 in Jurkat tumor cells led to imbalance of the glutathione system and increase of the share of annexin-positive cells.

[Epizootic and epidemic manifestation of natural foci of tularemia in Moscow region (1965-2013)].

AIM: Detection of contemporary features of tularemia focimanifestations, determination of territories of high epidemic risk in various landscape zones and creation of a map of foci territories of Moscow Region for isolation of tularemia infectious agent cultures and registered human morbidity for justified planning of prophylaxis measures. MATERIALS AND METHODS: Report materials of epizootologic examinations of natural foci for 1965-2013, 156 maps of epidemiologic examination of cases of human infection with tularemia, results of studies of casting of predatory birds and dung of predatory mammals were used. Registered morbidity and isolation of tularemia infectious agent cultures from 1965 to date were applied to an electronic map of Moscow Region by sign method using modern. GIS-technologies (MapInfo 10.5 program). Electronic maps Ingit at 1:200,000 scale, as well as Google Earth program were used to search for base points. RESULTS: Analysis of morbidity has revealed structure change in human tularemia morbidity--an increase of the fraction of urban population and a decrease of the fraction of patients among rural inhabitants, unimmunized against this infection are mostly ill. The presence of DNA of tularemia causative agent in biological objects in the complex with serologic and bacteriological studies was shown to allow to detect flaccid epizootics even at low numbers of rodents. CONCLUSION: Cartographic reflection of registered morbidity and isolation of tularemia infectious agent cultures allowed to show territories with various degrees of epizootic activity and epidemic manifestation. Positive results of serologic and molecular-genetic studies of environmental objects gives evident on epizootic activity and constant risk of aggravation of epidemic situation for this infection.

[THE SELF-ASSESSMENT OF PHYSICIANS THEIR QUALIFICATION AND SOCIAL STATUS].

The 103 medical organizations of the Tverskaia oblast were involved as study base to carry out questionnaire survey of physicians of different specialties concerning issues of self-assessment of qualification and social status. The most of the respondents (66.8 ± 1.98%) assessed themselves as good specialists, 20.8 ± 1.71% as fair specialists and 11.9 ± 1.36%--as perfect specialists. The own social status respondents assessed in general as not too high. So, 53.1 ± 2.10% of physicians refer themselves to middle class of society and 30 ± 1.93%--to below middle class of society. Among respondents, 3 ± 0.71% referred themselves to high class of society and 3.2 ± 0.74%--to the lowest class of society. The low incomes and overwork were noted by respondents as main problems of their life. The study results testify the necessity of correction of programs of medical education at all levels, actuality of activities of increasing social status of physician and development of benevolent conditions of work and rest.

[The phosphorylation state of transducin beta-subunits].

The supposition that nucleoside diphosphate kinase is the enzyme that phosphorylates transducin beta-subunits on one of the histidine residues (His-266) has been analyzed. It stands the reason that 1) this enzyme is multifunctional and plays in particular the role of protein histidine kinase; and 2) the phosphorylated beta-subunit of transducin may activate transducin via the mechanism of transphosphorylation. Nevertheless, in our experiments, in which different forms of transducin preparations were incubated with α- and ß-isoforms of recombinant rat NDP kinase in the presence of [γ32P]ATP or [γ32P]GTP (specific activity of about 1 Ci/mmol) followed by separation of proteins by electrophoresis and-gel radio-autography, the phosphorylation of the transducin beta-subunit wasn't succeeded to be found. The negative result of our experiments most likely implies that the major part of transducin beta-subunits in the preparations has already been phosphorylated via a process that takes place in vivo.

[The "natural focal diseases" medical and geographical atlas of Russia as a tool to analyze their incidence in the population].

The Faculty of Geography, M.V. Lomonosov Moscow State University, is creating a "Natural Focal Diseases" medical and geographical atlas of Russia. The paper considers the possibilities of the atlas to monitor and assess the epidemiological situation of a number of diseases. The atlas allows one to define a spectrum of the most epidemically significant natural focal diseases in Russia, to quantitatively characterize their incidence in the population, and to visualize it in a series of maps, to make a medical geographical analysis of the prevalence of the nosological entities of natural focal diseases in both individual subjects of the Russian Federation and in Russia as a whole. By using tick-borne encephalitis as an example, the authors consider approaches to analyzing the incidence of natural focal infections, by using different types of the maps given in the atlas.