[Comparative analysis of antibiotic therapy and cytokine therapy (the drug Superlymph) for male infertility associated with male accessory gland infection].

AIM: To compare the effects of cytokine and antibacterial therapy on semen parameters and additional functional tests in patients with infertility due to male accessory gland infections (MAGI) who are preparing for assisted reproductive technologies (ART). MATERIALS AND METHODS: A randomized, prospective, controlled clinical trial without blinding was carried out. A total of 60 men from infertile couples with MAGI who were preparing to ART was included in the study. In the main group (n=30) patients received Superlymph, 1 suppository of 25 units, 2 times a day for 20 days. In the control group (n=30), the antibacterial drug Doxycycline 100 mg 2 times a day for 28 days was given. After the end of therapy on day 33+/-3, a repeated sperm analysis, MAR test, a test for reactive oxygen species in the ejaculate and sperm DNA fragmentation, and bacteriological examination of sperm was performed. In addition, a survey for adverse events was carried out. The significance of differences in initial and final parameters and differences between groups was assessed using the Students t-test, Wilcoxon test and Mann-Whitney U-test depending on the data distribution. The Shapiro-Wilk test was done to investigate the normality of data distribution. Fisher's exact test was used to compare categorical variables. RESULTS: The final analysis included data from 53 patients (n=28 in the main group and n=25 in the control group). In both groups, a significant decrease in the level of free oxygen radicals in the ejaculate was noted (p=0.031), which was more pronounced in the main group. There were no differences in other semen parameters. Eradication of the microorganism according to bacteriological examination occurred in 57.1% of patients in the main group and in 88% of those in the control group (p=0.016). In patients receiving monotherapy with Superlymph, there was a significant decrease in the sperm DNA fragmentation index and the concentration of leukocytes in the ejaculate. In patients receiving antibacterial therapy, there was a significant increase in ejaculate volume, a decrease in the proportion of IgG-associated sperm and leukocyte concentration. CONCLUSION: Many issues of diagnosis and treatment of MAGI have not been thoroughly studied and are poorly standardized. Considering the problems of increasing antibiotic resistance, alternative treatment options are needed. Cytokine therapy (the drug Superlymph) is an effective alternative method of monotherapy for male infertility due to MAGI and is optimal for quickly preparing a couple for ART protocol, given its positive effect on oxidative stress and the index of sperm DNA fragmentation. The prospect of combination therapy with antibiotics and Superlymph seems promising.

[Evaluation of long-term results of using the drug Fertiwell: impact on the likelihood of conception and pregnancy outcome].

INTRODUCTION: Current methods of treating male infertility have limited efficiency, since they are aimed to individual stages of the pathogenesis. Preparations based on testicular regulatory polypeptides are the most physiological and universal, owing to a complex effect on the self-regulation of testicular tissue. AIM: To study the delayed efficiency and safety of therapy with Fertiwell in patients with pathospermia and to assess the frequency of conception and pregnancy outcome in their partners based on the collection, analysis and interpretation of medical data. MATERIALS AND METHODS: A telephone survey of patients participating in the phase III clinical trial was carried out. The fact of conception in a couple was assessed over a period of 1 to 9 months after completion of therapy, as well as time from completion of the course to conception, pregnancy outcomes, newborn health outcomes. RESULTS: In the period from 1 to 9 months after completion of therapy, pregnancy occurred in 17 out of 34 couples (50%) in the Fertiwell group and in 13 out of 42 couples (30.95%) in the placebo group. This difference was statistically and clinically significant (p<0.05). All pregnancies resulted in a live birth. The median time from completion of the course to conception was 4 months in Fertiwell group and 6 months in the placebo group. There were no significant differences in anthropometric parameters of newborns between the two groups (p>0.05). CONCLUSION: When using the drug Fertiwell, pregnancy and live birth rate was significantly higher (2.23 times) compared to the control group. There was a trend toward earlier pregnancies in partners of men receiving Fertiwell. Thus, this drug can be recommended for the treatment of men with idiopathic infertility as monotherapy, as well as in combination with assisted reproductive technologies.

[Prognostic ability of seminal plasma lipidomic analysis in predicting the success of microTESE in men with azoospermia].

INTRODUCTION: The aim of this work is to assess the possibility of metabolomic (specifically lipidomic) analysis of seminal plasma to identify patients with preserved focal spermatogenesis in the testes who may have a reasonable chance of sperm retrieval during the microTESE procedure. MATERIALS AND METHODS: lipid composition of semen plasma samples from 64 men with azoospermia and 24 fertile control men was analyzed. Lipids were isolated from semen by a modified Folch extraction method. Lipid extracts were analyzed by reverse phase liquid chromatography coupled to mass spectrometry. Lipidomic data were compared with the results of the microTESE procedure. RESULTS: Comparison of two groups revealed a statistically significant difference in concentration for 23 lipids detected in positive ion mode and 37 lipids detected in negative ion mode. Those lipids mainly belong to hexosylceramides, sphingomyelins and phosphatidylcholines, phosphatidylethanolamines and their ethers. In multivariate analysis content of SM d16: 1/18:0 lipid (beta coefficient: -7.23; 95% confidence interval [95% CI]: -11.93 to - 2.53; odds ratio: 7.23e-04; CI for odds ratio: 6.59e-06 to 7.93e-02; Walds test: -3.02; p=0.003), content of TG 14: 1_16 : 0_18: 3 lipid (beta 2.95; 95% CI 0.98 to 4.93; odds ratio: 1.92e + 01; CI for odds ratio: 2.66e + 00 to 1.39e + 02 ; Walds test: 2.93; p=0.003) and testicular volume (beta: 0.14; 95% CI: 0.04 to 2.45; odds ratio: 1.15e + 00; CI odds ratio: from 1.04e + 00 to 1.27e + 00; Walds test: 2.65; p=0.008) were significantly associated with positive MicroTESE outcome. The sensitivity of this regression model was 61%, the specificity was 83%, and the AUC was 0.75. CONCLUSIONS: seminal plasma serves as a rich source of biological markers for identifying patients with preserved focal spermatogenesis in the testes. Seminal plasma lipidomic profile of the of patients in the control group with normal spermatogenesis clearly differs from the profile of patients with azoospermia, also there was a significant difference in content of a difference in lipids between patients with positive and negative microTESE outcomes. These are preliminary results and further research is needed to confirm the validity of the resulting lipid panel.

[The use of a complex of natural antimicrobial peptides and cytokines for treatment of male infertility and chronic prostatitis].

INTRODUCTION: Chronic prostatitis (CP) has long been considered one of the common causes of male infertility. The influence of therapy for CP on spermatogenesis is well studied. However, recently, especially in the era of the new coronavirus infection (COVID-19), much attention has been paid to the effects of cytokines on the pathogenesis of the inflammatory process, and their impact on male fertility. AIM: To study the effect of a complex of natural antimicrobial peptides and cytokines (Superlymph) on ejaculate, MAR test, oxidative stress (OS), and sperm DNA fragmentation (SDF) in men with infertility and a history of CP. In some patients, the level of cytokines before and after treatment was determined. MATERIALS AND METHODS: A total of 583 infertile men with a history of CP, aged 18-75 years, were screened according to the inclusion/ exclusion criteria. In group I, patients received antioxidant stimulation of spermatogenesis (triovit, trental, mexidol) in combination with a complex of natural antimicrobial peptides and cytokines (Superlymph) one suppository 25 IU at night for 20 days for 1-3 weeks and for 6-8 weeks for 2 months. In group II, antioxidant stimulation of spermatogenesis was prescribed along with suppositories for the prevention of CP for 2 months. The evaluated criteria included sperm analysis, MAR test, oxidative stress in spermatozoa (reactive oxygen species (ROS)) and SDF. The levels of seminal plasma cytokines were also measured before and after treatment in 32 patients using the Bio-Plex Pro panel for the simultaneous determination of 17 human cytokines, the Human Cytokine 17-plex Assay. Statistica-10 software was used for statistical analysis (p<0.05). RESULTS: Of 135 eligible patients, results were collected from 125 men (mean age 31.7 +/- 13.4 years). In group I, there was a more pronounced increase in motility by 42.3%, a decrease in the MAR-test level by 64.7%, oxidative stress in spermatozoa by 56.1%, and SDF by 25.6%, compared to group II (30.4 %, 10.5%, 45.7%, 21.9%), respectively. All these changes were significant with the exception of a decrease in the level of SDF. In group I, there was a predominant increase in the activity of anti-inflammatory cytokines (IL-4, 10, 13), a decrease in the level of pro-inflammatory cytokines ((IL-2, 12). In group II, there was a significant decrease in both pro-inflammatory (IL-2, 6, 8), and anti-inflammatory cytokines (IL-4). The remaining changes were insignificant. Among mild side effects, there were a change in the color of the sclera in 4 (3.2%), anal pain in 3 (2.4%), a decrease in libido in 2 (1.6%) patients. No differences between groups in the frequency of side effects were recorded (p>0.05). CONCLUSION: Antioxidant stimulation of spermatogenesis in infertile men and CP is an effective and safe. The addition of a complex of natural antimicrobial peptides and cytokines (Superlymph) leads to a more profound increase in sperm motility, a decrease in the MAR-test, oxidative stress in sperm cells, which potentiates the effects of therapy. The use of Superlymph is accompanied by a more pronounced positive effect on pathospermia, an increase in anti-inflammatory and a decrease in pro-inflammatory cytokines. In the contrary, in control group, where patients received antioxidant stimulation of spermatogenesis, only a decrease in the level of main cytokines was observed. The effect of a complex of natural antimicrobial peptides and cytokines (Superlymph) on the level of SDF, as well as the relationship with fertility and childbirth rates, requires further study.

[Evaluation of the efficacy of dapoxetine in primary and secondary forms of premature ejaculation].

OBJECTIVE: to compare the efficacy of dapoxetine in treatment of primary and secondary premature ejaculation. MATERIALS AND METHODS: The study included 60 patients with premature ejaculation (PE). Depending on the form of premature ejaculation they were divided into two groups: 27 patients with primary PE (group 1) and 33 patients with secondary PE (group 2). Patients were recommended to take dapoxetine 30 mg 1 hour before intercourse. A follow-up visit was scheduled on day 30 after receiving the drug. The intravaginal ejaculation latency time (IELT) and the Premature ejaculation diagnostic tool (PEDT) score were evaluated before dapoxetine was given and after 30 days from the start of the study. The significance of differences between baseline and follow-up values were compared using Wilcoxons test. In both groups, the proportion of patients with an incomplete response (IELT less than 2 minutes, PEDT more than 10) to symptomatic therapy with dapoxetine was evaluated. The proportion of patients with incomplete response to therapy was compared using the chi-square test. RESULTS: The median IELT among all patients before starting therapy was 63 seconds (interquartile interval [IQR]: 28.75-94). After one month of therapy median IELT increased to 119 seconds (IQR: 58.75-321.75). Median PEDT score was 16 (IQR: 13-19) at baseline and 7 (IQR: 4-12) at follow-up. In group 1, the median IELT increased from 57 to 83 seconds (p = 0.02088), and in group 2, the median IELT increased from 70 to 173 seconds (p<0.00001). The mean PEDT score decreased to 7 in both groups (p<0.00001). Incomplete response to therapy was observed in 66.7% of patients in group 1 and in 39.4% of patients in group 2. The difference between two groups was statistically significant (p=0.035456). CONCLUSION: Symptomatic therapy with dapoxetine has a positive effect on the intravaginal ejaculation latency time and patient satisfaction in both primary and secondary premature ejaculation. However, the incidence of incomplete response to therapy is higher in patients with primary premature ejaculation, which may be due to characteristic differences in the pathogenesis of primary and secondary premature ejaculation.

[On the new (2021) Norms of physiological requirements in energy and nutrients of various groups of the population of the Russian Federation].

The article presents the main provisions of the new "Norms of physiological requirements in energy and nutrients for various groups of the population of the Russian Federation" developed and approved in accordance with the established procedure, accumulating the latest fundamental knowledge and world and domestic experience, that determine the values of physiological requirements in nutrients and energy sources, adequate levels of consumption of micronutrients and biologically active substances with an established physiological effect. In the Norms the conceptual apparatus has been expanded and updated, several terms and definitions to them (nutriome, intestinal microbiome, trans-isomers of fatty acids, critical nutrients, edible salt, glycemic index of food products, etc.) have been introduced. Changes have been made to the age periodization of the child and adult population of the Russian Federation, as well as adjustments in the differentiation of the population by the level of physical activity (4 groups for men and women). Taking into account these data, the recommendations on the proportion of macronutrients in the calorie content of the daily diet have been adjusted. The levels of physiological requirements in energy and nutrients have been clarified, depending on the physical activity of the population, including vitamins and mineral substances for both men and women, including period of pregnancy and lactation, as well as for children of different ages. For the first time, recommendations are included to reduce the intake of critical nutrients for health (dietary salt, added sugars, trans-isomeric fatty acids), based on data from modern meta-analyzes on the negative health effects of their excessive intake. Recommendations on the consumption of ω-3 and ω-6 polyunsaturated fatty acids by children and adults, including pregnant and lactating women, have been significantly expanded; adequate dietary intake of plant sterols have been introduced for the first time; while adequate dietary intake of certain phenolic compounds (phenolic acids, flavonoids, polymeric phenolic compounds and stilbenes) were specified. For the first time, the Norms include recommended levels of water (drinks) consumption to maintain the body's water balance under optimal environmental conditions for adult men and women at different levels of physical activity, for children, as well as pregnant and lactating women. For the first time in world practice, a complex of qualitative and quantitative indicators of the reference intestinal microbiome is presented, including modern taxonomic and functional characteristics that give an conception of microbiota phenotype in adults with a normal body mass index.

[Herd immunity to SARS-CoV-2 in the Novosibirsk Region population amid the COVID-19 pandemic].

AIM: To determine the level of SARS-CoV-2 seroprevalence among the Novosibirsk Region population against the background of the COVID-19 pandemic. MATERIAL AND METHODS: The work was carried out in 2 phases: 1) a cross-sectional cohort study performed 28.06- 15.07.2020; 2) longitudinal cohort 3-stage seromonitoring: 1st stage 28.06-15.07.2020; 2nd 14.09-04.10.2020; 3rd 10-30.12.2020 The work was carried out according to a unified methodology developed by Rospotrebnadzor with the participation of St-Petersburg Pasteur Institute, taking into account the recommendations of the WHO. IgG antibodies to the SARS-CoV-2 nucleocapsid protein were detected by ELISA using a kit of reagents produced by the SRCMSB (Obolensk) according to the manufacturer's instructions. Statistical analysis was performed using Microsoft Excel 2010 and other programs. RESULTS: The seroprevalence in the region's population was 9.1% (95% CI 8.0-10.2): maximum in children 14-17 years old (17.6%, 95% CI 12.3-23.9) and persons over 75 years (14.8%, 95% CI 11.4-18.8), minimum among persons 30-39 years old (4.9%, 95% CI 3.0-8.0). Increased rate was noted among the unemployed (15.4%, 95% CI 9.9-17.1) and other individuals (13.0%, 95% CI 8.6-18.5). Seroprevalence was 33.3% (95% CI 16.3-59.0) in COVID-19 convalescents and 19.0% (95% CI 13.9-25.0) in contact persons. More than 94.7% (95% CI 91.2-97.2) of seropositive individuals were asymptomatic. During the serological monitoring, seroprevalence increased from 7.4% (95% CI 6.2-8.9) at 1st stage 1 to 12.4% (95% CI 10.6-14.3) at 2nd , and 31% (95% CI 28.8-33.3) at 3rd stage. CONCLUSION: SARS-CoV-2 herd immunity has not reached the threshold level, this does not exclude exacerbation of the epidemic process.

[Double-blind, randomized placebo-controlled study of efficiency and safety of complex acetyl-L-carnitine, L-carnitine fumarate and alpha-lipoic acid (Spermactin Forte) for treatment of male infertility].

INTRODUCTION: Oxidative stress of sperm is a common pathologic condition, which can be detected in 30-80% infertile men. It is established that dietary consumption of antioxidants and microelements contributes to an increase of conception probability in subfertile couples, and also reduces the risk of reproductive losses. Drug complexes influencing various factors of spermatogenesis disturbance (oligo-, astheno-, teratozoospermia), oxidative stress and the level of sperm DNA fragmentation are of greatest and reasonable interest. AIM: To study the effects of complex acetyl-l-carnitine, l-carnitine fumarate and alpha-lipoic acid (SpermActin Forte) on oxidative stress, ejaculate quality and sperm DNA fragmentation in men with infertility. MATERIALS AND METHODS: A total of 80 infertile men aged 25-40 years with increased level of sperm DNA fragmentation and oxidative stress were included in open-label, prospective, randomized study. In Group A (n=20) patients received a placebo for 180 days, and in Group B patients were prescribed to SpermActin Forte, 1 sachet of 10 g once a day. The criteria for the efficiency of therapy included sperm analysis, the level of sperm DNA fragmentation, the level of sperm oxidative stress, as well as information about achievement of pregnancy, obtained by interviewing all participants. RESULTS: In patients taking antioxidant complex SpermActin Forte there were significant positive changes in the main parameters of sperm analysis, including sperm mobility and morphology starting from the third month of therapy. The level of free oxygen radicals (as indicator of oxidative stress) in Group B also significantly decreased (by 86%). A more profound decrease in DNA fragmentation was seen in Group B compared to Group A (21.5% vs. 3.6%). Pregnancy was achieved in 1 and 13 cases in Group A and B, respectively. CONCLUSION: The use of the SpermActin Forte antioxidant complex allowed to improve sperm analysis in most patients, and these changes were significant starting from the third month of therapy. Stimulation of spermatogenesis using the antioxidant complex SpermActin Forte is an effective and safe method of treating male infertility.

[Erectile function after corporoplasty in patients with peyronies disease].

PURPOSE: To evaluate erectile function in patients with Peyronies disease (PD) who underwent corporoplasty. MATERIALS AND METHODS: A total of 374 patients who underwent corporoplasty by a single surgeon during 1996-2016 were analyzed. In all cases IIEF questionnaire was evaluated pre- and postoperatively. Intracavernous injection test and penile doppler ultrasonography were performed if required. Median follow-up was 9.5 years. Analysis of risk factors for erectile dysfunction (ED) before and after corporoplasty was performed. RESULTS: Prevalence of risk factors for ED in our sample has greatly increased during follow-up. At the last follow-up visit 285 patients were sexually active. Evaluation of patient satisfaction with the quality of erections has shown that 139 patients were fully satisfied (48.8%), 84 patients were somewhat satisfied (29.5%) and 62 patients were not satisfied with their erectile function (21.7%). According to IIEF questionnaire, 105 patients (36.8%) had no ED (> 26 points); 74 patients (26%) had mild ED; 67 patients (23.5%) had mild-to-moderate ED; 21 patients (7.4%) had moderate ED; and 18 patients (6.3%) had severe ED. However, a causal relationship between ED and treatment of Peyronie's disease was found not in all cases. Seven patients had infrequent sexual intercourse (1-2 per month) and 50 patients had no sexual activity. DISCUSSION: At long term after corporoplasty some patients experience ED, though causality between ED and PD treatment couldnt be confirmed in all such cases. It should be noted that we have found an increase in prevalence of independent risk factors for ED during follow-up period. These patients could possibly benefit in terms of quality of life if they underwent penile prosthesis placement during primary surgical treatment for PD. However, some patients had no sexual activity due to causes unrelated to ED. CONCLUSION: Not all patients with PD are satisfied with their sexual functioning after corporoplasty. However, ED after surgical management of PD is not always a consequence of surgery itself.

[Docosahexaenoic acid in the treatment of idiopathic male infertility].

AIM: docosahexaenoic acid is one of the most common fatty acids in the cell membranes of sperm. This substance is a structural component of cell membranes, and is responsible for such properties as plasticity and fluidity which are necessary for the implementation of the process of capacitation and acrosome reaction. In addition, docosahexaenoic acid has antioxidant properties. Aim of our study was to assess the effect of dietary supplement docosahexaenoic acid (Brudi PLUS) on such markers of male fertility as the sperm DNA integrity, standard indicators of semen analysis and cryotolerance in infertile men. MATERIALS AND METHODS: a randomized, multicenter, double-blind, placebo-controlled study was conducted. A total of 109 infertile men were recruited to participate in the study. All patients underwent different analyzes, including semen analysis, sperm DNA fragmentation, MAR-test, test of cryotolerance and electron microscopy analysis of spermatozoa. In active treatment group patients were prescribed to drug containing 350 mg of docosahexaenoic acid 3 times a day for 90 days. In the control group, patients were administered to a placebo with a similar scheme. All analyzes were repeatedly performed after 3-months of therapy. RESULTS: An increase in the progressive mobility and sperm viability was determined after the test of cryotolerance in the active treatment group. According to electron microscopy analysis of spermatozoa, positive changes were observed in the number of heads of the normal form with the normal structure of chromatin and acrosome, as well as a decrease in the number of spermatozoa with insufficiently condensed chromatin. CONCLUSIONS: the therapy with drug Brudi PLUS in patients with male infertility allows to increase in cryotolerance of sperms as well as decrease in number of sperm ultrastructure defects.

[Antioxidant therapy improves the results of -test in infertile men during a preparation for assisted reproductive technology (IVF/ICSI)].

INTRODUCTION: Male infertility accounts for 45-50% of all barren marriages, and in up to 40% of cases an idiopathic male infertility is diagnosed. The introduction of ART programs into clinical practice allowed to restore the childbearing function in various diseases, both in women and men, which were previously considered absolutely unpromising for treatment. AIM: to study an influence of the antioxidant complex (Androdoz) on the results of HBA-test in infertile men during a preparation for assisted reproductive technology (IVF/ICSI). MATERIALS AND METHODS: A total of 80 men aged from 25 to 45 years planning an ART program were included in a comparative, randomized, prospective, controlled study. Sixty men in a main group received an antioxidant complex (Androdoz) for 3 months, while 20 men were allocated to control group. The criterion of efficiency of the treatment was an improvement of HBA-test as well as pregnancy rate in the couples determined by interviewing patients participating in the study. RESULTS: After 3 months of therapy an increase in the number of morphologically normal spermatozoa in the ejaculate was shown in the main group, while in the control group negative changes were noted. There was a decrease in the proportion of spermatozoa with a progressive movement (+) in comparison with the control group. A positive influence of antioxidant complex (Androdoz) on the functional properties of sperm was proven by the increase in HBA-test by 13.8%, whereas there were no positive changes in the control group. A pregnancy rate after the first cycle of ART in the main group was 45% compared to 25% in the control group. CONCLUSION: The use of the antioxidant complex (Androdoz) for the treatment of male infertility in those patients who considers ART program is perspective method which allows to improve the main criteria of sperm analysis and functional tests (HBA-test), and also contributes to an increase in positive outcomes of ART program.

[The role of drug therapy in the management of varicocele].

Varicocele-related infertility is traditionally considered an indication for surgery. At the same time in some specific clinical settings, especially with subclinical varicocele, conservative therapy using hormonal or antioxidant drugs is also possible. The potential role of drug therapy in this patient category remains controversial. The article discusses the options and treatment regimens for men with varicocele-related infertility. Given the difficulties in interpreting the results of studies and the heterogeneity of the data, it is not yet possible to recommend abandoning varicocelectomy in favor of drug therapy. The most promising option for drug therapy is adjuvant antioxidants after surgical treatment of varicocele.

[Adjuvant antioxidant therapy in varicocele infertility].

INTRODUCTION: Infertility affects an estimated 15% of couples globally. Male factor infertility accounts for about a half of infertility cases. About 40% of infertile men have varicocele. The aim of this study was to investigate the efficacy and safety of a complex of acetyl-L-carnitine, L-carnitine fumarate and alpha-lipoic acid (SpermActin-forte) (SA) for adjuvant antioxidant therapy after microsurgical varicocelectomy (MVE) in men with varicocele and assess its impact on the level of DNA fragmentation in sperm cells. MATERIALS AND METHODS: This is an open, prospective, randomized trial comprising 114 men aged 25-45 (mean 34.1+/-12.1) years who underwent MVE. The patients were allocated to receive either adjuvant SA (n=38), SA in combination with a vitamin complex (VC) (n=38) or no adjuvant therapy (n=38). The efficacy was assessed at 3 months by testing standard semen parameters and the level of sperm DNA fragmentation. RESULTS: MVE led to a 21.7% increase in the progressive sperm motility compared to the baseline level. In patients receiving SA, this was by 76.7% due to active sperm motility (category A) at 3 months. MVE with concurrent supplementation of SA resulted in a 22.3% decrease in the level of sperm DNA fragmentation at 3 months. When used in the postoperative period after MVE, SA and VC resulted in a 27% increase in the sperm concentration at 3 months. There were no side effects of pharmacotherapy. The statistical significance of the change in variables was calculated using the Wilcoxon test. Critical level =0.05 was established for all criteria. CONCLUSION: Using nutraceuticals (SA) after MVE is an effective and safe adjuvant antioxidant therapy of male infertility in patients with varicocele which leads to an improvement in the basic sperm parameters (sperm concentration and motility) and a decrease in the level of sperm DNA fragmentation in the short term. Adjuvant antioxidant therapy of varicocele infertility potentiates the effects of monotherapy (both medical and surgical), leads to an increase in its effectiveness and shortens the time to pregnancy. Further studies in this field are needed to assess long-term outcomes of the treatment.

[Results of urethral reconstruction in adults after multiple hypospadias repairs].

AIM: To improve treatment results in patients after multiple hypospadias repairs by optimizing the postoperative management. MATERIALS AND METHODS: Eighty-two patients (mean age 48.1+/-15.3 years) with urethral strictures secondary to failed hypospadias repairs underwent staged graft urethroplasty using oral mucosa (cheek, lip, tongue) as a grafting material. In 62 patients, at the end of surgery the bladder was drained with a standard Foley catheter. In twenty patients the bladder was drained with a modified silicone urethral catheter, which had an additional channel for delivering drugs and removing the urethral wound effluent, and a second additional channel for inflating a balloon fixed to the catheter tube at different parts of the catheter. RESULTS: The mean length of the stricture was 5.4+/-1.2 cm (from 1 to 16 cm). Twenty-eight patients had postoperative complications. Using the modified catheter resulted in statistically significantly (p<0.05) smaller percentage of complications (10% vs 41.9%) compared to standard Foley catheter. Urinalysis and sperm test on the follow up examination at 12 months showed that only 9 (10.9%) patients had signs of the inflammatory process. Seventy-five patients (91.5%) rated the appearance of the penis as "good"; only 5 (6.1%) and 2 (2.4%) patients considered the result as "satisfactory" and "unsatisfactory", respectively. Eighty patient (97.6%) regarded the treatment result as "good" for the quality of urination and only two (2.4%) considered it "satisfactory". When assessing the strength of urinary stream, 64 (78.1%), 13 (15.8%) and 5 (6.1%) patients rated it as "good", "satisfactory", and "unsatisfactory", respectively. CONCLUSION: The study findings shows that staged urethroplasty using the oral mucosa restores the urethral patency, reduces the severity of the inflammatory process, thus improving the quality of life of patients after failed hypospadias repair. The proposed modification of the catheter ensures the timely delivery of drugs to the surgical site, evacuation the wound effluent from the urethra and helps prevent strictures by periodically inflating the adjustable balloon-dilator.

[Phosphodiesterase type 5 inhibitors in the treatment of erectile dysfunction: past, present and future].

This review article describes the differences in efficacy and side effects between available phosphodiesterase type 5 (PDE-5) inhibitors used for treating erectile dysfunction. The most studied PDE-5 inhibitor is sildenafil.

[EPIDEMIOLOGIC SITUATION BY NATURAL-FOCI INFECTIONS IN THE CRIMEA FEDERAL DISTRICT IN 2014-2015].

AIM: Analysis of epidemic manifestations of natural-foci infections (NFI), clarification of spectrum of their causative agents, determination of epizootic activity of natural foci in the Crimea Federal District (KFD). MATERIALS AND METHODS: Epizootologic examination of 10 administrative districts of KDF was carried out. 291 pools (2705 specimens) of ixodes ticks and 283 samples of organs of small mammals were studied by PCRmethod for the presence of DNA/RNA of causative agents of a number of NFI. RESULTS: Morbidity by NFI in KFD was registered by 6 nosologies: Lyme borreliosis, Marseilles fever, leptospirosis; tularemia, intestine yersiniosis and tick-borne viral encephalitis, wherein, transmissive infections made up 91.6%. Circulation of causative agents of Crimea hemorrhagic fever, Q fever, group of tick-borne spotted fever, Lyme borreliosis, human granulocytic anaplasmosis, human monocytic ehrlichiosis, hemorrhagic fever with renal syndrome, West Nile fever, tularemia and leptospirosis was established. CONCLUSION: Due to activity of natural foci of NFI further monitoring of epidemiologic and epizootologic manifestations of these infections in the Crimea, including using genetic methods of analysis, is necessary for ensuring sanitary-epidemiologic welfare of KFD population.

[Catering for client groups during the XXII Olympic winter games and XI Paralympic winter games of 2014 in Sochi].

The problems of catering control various client groups during the XXII Olympic Winter Games and XI Paralympic Winter Games of 2014 in Sochi is one of the priorities of the sanitary and epidemiological welfare of the population during mass events. The data on the order of nutrition of guests and participants of the games, control of food items, sanitary and microbiological monitoring of drinking water, food raw materials and products are presented. It is noted that the ongoing supervisory activities contributed to the sanitary and epidemiological well-being during the Games. The purpose of this study was to lighting modern achievements in the field of nutrition and food microbiology in the period of the Olympic Games and the determination of their value to the further improvement and use at when conducting mass gatherings.

[ACTUAL PROBLEMS OF EPIDEMIOLOGIC CONTROL, LABORATORY DIAGNOSTICS AND PROPHYLAXIS OF CHOLERA IN RUSSIAN FEDERATION].

Main problems of system of epidemiologic control for cholera active in Russian Federation, as well as laboratory diagnostics and vaccine prophylaxis of this especially dangerous infection, that had emerged in the contemporary period of the ongoing 7th pandemic of cholera, are discussed. Features of the genome of natural strains of Vibrio cholerae of El Tor biovar, that possess a poten- tial epidemic threat, as well as problems, that have emerged during isolation of these strains from samples of water of surface water bodies during their monitoring, are also examined. The main direction of enhancement of the system of epidemiologic control for cholera consist in develop- ment of a new algorithm of differentiation of administrative territories of Russian Federation by types of epidemic manifestations, as well as optimization of monitoring of environment objects. Integration of modern highly informative technologies into practice, as well as development of new generation diagnostic preparations based on DNA-chips and immunechips is necessary to increase effectiveness of the conducted operative and retrospective diagnostics in the contemporary period. Creation of national cholera vaccine, ensuring simultaneous protection from cholera causative agents of both O1 and O139 serogroups, is also required.

[A man's role in recurrent miscarriage in a spouse].

In a review article based on the published literature and their own research, the authors examine the role of a man in recurrent miscarriage and reproductive losses in a spouse. Detailed description is presented of the negative impact of elevated levels of sperm DNA fragmentation on the course of pregnancy, especially during the first trimester, on the occurrence of recurrent miscarriage or missed abortion, on the effectiveness of assisted reproductive technology (ART) programs. The etiology and pathogenesis of damage to sperm DNA are described. Outlined are positive effects of correcting adverse lifestyle factors, the role of varicocelectomy and antioxidant therapy, and advances in ART. The review specifies the role of different male karyotype abnormalities (translocations) in the pathogenesis of pregnancy loss. The implications of urologic surgery, preimplantation genetic diagnosis in solving this problem are discussed. New treatment strategies using correction of male disorders for couples with recurrent miscarriage are offered.

[Introduction of hazard analysis and critical control points (HACCP) principles at the flight catering food production plant].

In the article there is considered the quality control and safety system implemented in the one of the largest flight catering food production plant for airline passengers and flying squad. The system for the control was based on the Hazard Analysis And Critical Control Points (HACCP) principles and developed hygienic and antiepidemic measures. There is considered the identification of hazard factors at stages of the technical process. There are presented results of the analysis data of monitoring for 6 critical control points over the five-year period. The quality control and safety system permit to decline food contamination risk during acceptance, preparation and supplying of in-flight meal. There was proved the efficiency of the implemented system. There are determined further ways of harmonization and implementation for HACCP principles in the plant.