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

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

[Comparative evaluation of the results of one- and two-piece mushroom keratoplasty]. / Sravnitel'naya otsenka rezul'tatov mono- i dvukhkomponentnoi modifikatsii gribovidnoi keratoplastiki.

PURPOSE: To compare and evaluate the outcomes of one- and two-piece mushroom keratoplasty configurations for various corneal pathologies. MATERIAL AND METHODS: A total of 32 patients (32 eyes) with corneal perforations, descemetocele and deep corneal opacities underwent surgery. Depending on the surgery technique, the patients were divided into 2 groups: group I (17 eyes) underwent manual one-piece mushroom keratoplasty according to our own technique; group II (15 eyes) underwent modified two-piece microkeratome-assisted mushroom keratoplasty according to the technique by M. Busin. All patients underwent clinical and functional studies before surgery and in the course of a 1-year follow-up. RESULTS: Transparent engraftment of the cornea was achieved in 82 and 80% of cases; best corrected visual acuity (BCVA) averaged 0.57±0.19 and 0.53±0.17; spherical component of refraction varied from 1.25 to +5.5 and from 1.25 to 6.0 diopters; mean corneal astigmatism was 3.15±1.73 and 3.21±1.89 diopters in groups I and II, respectively. At 6 months after surgery, the mean endothelial cell density (ECD) was 2336±198 and 2291±175 cells/mm2, at 1 year - 2041±189 and 1955±161 cells/mm2 in groups I and II, respectively. CONCLUSION: One- and two-piece mushroom keratoplasty is effective in surgical treatment of various corneal pathologies ensuring a high rate of transparent corneal engraftment. The revealed risk of false chambers formation between separate parts of the graft after the two-piece method could in most cases be eliminated by re-injecting air into the anterior eye chamber.

[Protective properties of urothelium and possibilities of targeted pathogenetic therapy of chronic pelvic pain: sodium pentosan polysulfate].

The review article is devoted to the possibilities of using targeted therapy for urothelial diseases, namely painful bladder syndrome (BPS). The protective structural components of the bladder mucosa, as well as their chemical features, are described in detail. Pentosanpolysulfate (PPS), being an oral heparinoid, can be used as part of pathogenetic therapy to restore the mucous membrane of the bladder. The efficacy and safety of this drug has been proven by us in a multicenter, randomized, double-blind, placebo-controlled trial. An additional assessment of the effectiveness and safety of the use of PPS in BPS was confirmed as part of our systematic review and meta-analysis. Thus, PPS is a pathogenetically sound tool in the treatment of patients with painful bladder syndrome.

[Fosfomycin: potential and perspectives for use in urological practice].

The increase in infections caused by multidrug-resistant microorganisms is currently one of the most serious medical issues. In fact, antimicrobial resistance is viewed by the World Health Organization as one of the most serious threats to health worldwide. The problem is exacerbated by the lack of new antibiotics with respective benefits for the treatment of multidrug-resistant bacteria. While new compounds are being developed a number of "old" antibiotics used in clinical practice for several decades may acquire new indications for use.

[Lower urinary tract symptoms and COVID-19].

The data presented in the review showed that the coronavirus affects not only the lungs, but also the organs of the urinary system. The new virus causes a mosaic, multi-organ disease with severe consequences after the egg and has a wide organotropism. The role of SARS-CoV-2 in the development of lower urinary tract symptoms (LUTs), which are manifested by frequent, imperative urges, dysuria, nocturia, is not entirely clear. It is assumed that biologically active substances, the activation of which is caused by a virus, play a certain role in the development of SNMP, namely the expression of angiotensin converting enzyme 2 (ACE2), cytokines, activation of toll-like receptor 4 (TLR4), etc. An increase in cytokines that are released into the urine and / or expressed in the bladder and the presence of SNMP in patients with coronavirus infection have been called de novo urinary symptoms or COVID-19 associated cystitis (CAC) in the literature. Urinary symptoms de novo or associated cystitis COVID-19 (CAC) develops against the background of a complete lack of data for the presence of a bacterial pathogen in the urine. Despite the unusual manifestation of coronavirus infection, similar mechanisms of damage to urothelial cells in viral and bacterial infections give us the right to think about the use of pathogenetically justified prevention of the development of an inflammatory reaction in the urinary tract, as well as short-and long-term consequences of this disease. For this purpose, it is necessary to recommend drugs that have a multifactorial effect: diuretic, anti-adhesive, anti-inflammatory and regulate the local immunity of the bladder mucosa. We assume that against this background, we can expect a decrease in the number of complications from the organs of the urinary system, and more successful rehabilitation of patients with coronavirus infection and in the post-ovarian period. Final conclusions and recommendations will be available after well-planned clinical trials have been conducted.

[Surgical management of infectious keratitis]. / Khirurgicheskie metody lecheniya infektsionnykh keratitov.

Infectious keratitis is one of the most common causes of blindness worldwide. Despite the existence of a wide arsenal of quite effective antimicrobial drugs, some forms of bacterial and viral keratitis are resistant. Advanced acanthamoeba and mycotic lesions of the cornea, as well as mixed forms of infection usually do not respond well to conservative treatment. In the absence of positive dynamics from the applied etiotropic therapy with observed further progression of the microbial process, there is a risk of corneal perforation and spread of infection to the sclera or deep ocular structures with a high probability of irreversible functional disorders or anatomical death of the eye. In such cases, a timely transition to surgical treatment is necessary in order to maintain structural integrity of the eyeball. For this purpose, corneal crosslinking, microdiathermocoagulation, tissue adhesive, autoconjunctival plasty, amniotic membrane, corneoscleral flap coating, various combinations of these methods, as well as therapeutic keratoplasty are used most often in clinical practice. The choice depends on the etiology, size and depth of the lesion, its localization, prognosis of visual outcomes, somatic status of the patient. Therapeutic keratoplasty is the most radical and effective method of surgical intervention that allows eradication of the infectious focus and best possible restoration of the structural integrity of the eyeball. However, in some cases due to inaccessibility of donor material or high risks of the surgery and non-transparent graft engraftment, it is advised to use alternative surgical approaches, and keratoplasty, if necessary, should be carried out for optical purposes at a further, "quiet" period.

[Chronic pelvic pain syndrome in women: diagnostic and therapeutic aspects].

Chronic pelvic pain syndrome (PPS) refers to pain of three to six months duration (or longer) that occurs below the umbilicus. PPS is considered a form of chronic regional pain syndrome or functional somatic pain syndrome. Multimodal ollaborative and patient-centered approach is critical component of treatment for women with CPPS. The current review encompasses the linical manifestations and therapeutic interventions for CPPS - a yet to be defined problem.

[ORGANIZATION OF MEDICAL CARE FOR ELDERLY PATIENTS UNDER THE CONDITIONS OF THE COVID-19 PANDEMIC].

The first report of the new coronavirus infection (COVID-19) appeared at the end of December 2019 and in March,2020 the World Health Organization announced COVID-19 a pandemic. The steady number of newly detected cases increase predetermined the modernization of the global healthcare system, shifting the paradigm of fighting with the COVID-19 pandemic towards maximum resource conservation. The change in the medical care provision for infectious patient's approach led first to a gradual decrease, and then to a complete cessation of planned surgical treatment, outpatient examinations, as well as observation of high-risk patients, which primarily include elderly patients. As a result of this, the key objective of this systematic review was to analyze sources of existing practice of providing urological care to patients of the older age group in the context of the COVID-19 pandemic. In accordance with the search for the keywords, the study reflects world and its own experience of MSMSU Urology Department in the treatment of age-related patients in the current epidemiological situation. The analysis showed that infectious complications from the urinary system take a leading position among the common complications inherent in elderly patients with COVID-19. The development of catheter-associated infection, the occurrence of antibiotic-resistant forms of bacteria, asymptomatic bacteriuria are only a small part of the problems clinicians have to face in newly profiled departments.

[Ipsilateral automated anterior lamellar rotational autokeratoplasty in the treatment of superficial central stromal opacity]. / Ipsilateral'naia avtomatizirovannaia peredniaia posloinaia rotatsionnaia autokeratoplastika v lechenii poverkhnostnogo stromal'nogo tsentral'nogo pomutneniia.

Corneal opacity is one of the main causes of monocular blindness in the world. Various modifications of keratoplasty are considered radical, effective - and in some cases the only - way of visual rehabilitation of this category of patients. The article describes a case of using the original surgical method of ipsilateral automated anterior lamellar rotational autokeratoplasty. Application of the described surgical technique made it possible to preserve the advantages of the known methods of ipsilateral rotational penetrating autokeratoplasty (IRA) and to level out their main disadvantages. In addition, the use of anterior lamellar rotational autokeratoplasty allowed the endothelial layer of the cornea to remain intact; its decompensation is one of the main reasons for unsatisfactory outcomes of penetrating keratoplasty. The use of a microkeratome device and the formation of an interface between the layers of its own tissues made it possible to achieve clinically insignificant violation of light scattering in this zone. With the right choice of a patient with shallow local central corneal opacity and careful planning of the original method, ipsilateral lamellar rotational automated autokeratoplasty can be an alternative to both standard penetrating and lamellar allokeratoplasty.

[Mushroom keratoplasty in rosacea keratitis complicated by corneal perforation (a clinical case)]. / Gribovidnaia keratoplastika pri rozatsea-keratite, oslozhnennom perforatsiei rogovitsy (klinicheskii sluchai).

Rosacea is a polyethiologic chronic inflammatory disease with varying clinical manifestations. It is primarily a dermatologic disease, which often manifests in the eyes affecting eyelids, cornea and conjunctiva. The leading role in the pathological process belongs to disruption of regulatory mechanisms in the vascular, immune and nervous systems. It is accompanied by increased levels of metalloproteinases and vascular endothelial growth factor (VEGF). Treatment depends on the severity of the disease and may vary from hygiene of the eyelid margins and use of artificial tears for dry eye disease management, to antibiotics and anti-inflammatory agents in moderate cases, and surgical treatment in severe or neglected state. A clinical case of severe rosacea shows that keratoplasty with mushroom-shaped profile of the surgical incision helps achieve good functional results and reduce the post-operative rehabilitation time, while significantly reducing the risk of postsurgical complications. Anti-VEGF therapy significantly reduces the risk of histoincompatibility reaction typical for rosacea keratitis.

Serotonin Modulates Differently the Functional Properties of Damaged and Intact Motoneurons in the Frog Spinal Cord.

When studying a preparation of the isolated spinal cord segment of an adult frog, damaged and intact lumbar motoneurons were found to differ significantly in the membrane potential, input resistance and the action potential properties (amplitude, duration, fast and medium phases of the afterhyperpolarization, and the frequency of spikes). Serotonin (5-HT) reduced the amplitude of afterpolarization and increased the frequency of the spikes of the intact neurons, while in the damaged motoneurons, 5-HT increased the amplitude of afterpolarization and had no effect on the frequency of discharges.

[Prospects of using bacteriophages in urological practice].

In modern clinical practice, antimicrobial resistance creates a significant problem for the effective metaphylaxis of various infectious and inflammatory diseases of the urinary system. Annually, researchers note an increasing number of mutations in the genomes of bacteria that cause infectious diseases, which leads to the appearance of more aggressive strains. The inefficiency of antibiotic therapy requires to a search for alternative methods for treatment and prevention of infectious diseases. use of viruses that infect bacteria (bacteriophages) represent one of such methods. A literature review of recent publications indicates that phage therapy has been gained significant increase. The general aspects of phage therapy, mechanism of action, as well as the existing possibilities and limitations of phage therapy in treatment and prevention of infectious diseases of the urinary system are highlighted in this article.

[The role of fosfomycin in the management of urinary tract infections].

The article analyses major guidelines on the management of uncomplicated cystitis. The authors outline and substantiate the role of fosfomycin in the management of urinary tract infections. They provide current evidence on the resistance of uropathogens, including those producing extended-spectrum -lactamase. Combination therapy (fosfomycin + -lactams or aminoglycosides) is often used to treat infections caused by multiresistant microorganisms. The possibility of using fosfomycin for perioperative prophylaxis of UTI during endourologic operations and transrectal prostate biopsy is shown.

Early morphological and functional changes in the GABAergic system of hippocampus in the rat lithium-pilocarpine model of epilepsy.

We studied early alterations in the GABAergic system of the rat hippocampus in the lithium-pilocarpine model of epilepsy. Twenty-four hours after the pilocarpine treatment, a decrease in the number of calretinin-positive interneurons was observed in the CA1 field of the hippocampus, whereas the number of parvalbumin-positive interneurons remained unchanged. The decreased levels of the GABA-synthesizing enzyme glutamic acid decarboxylase (GAD67) and the membrane GABA transporter GAT1 were revealed using Western blot analysis. These data indicate an altered excitation/inhibition balance in the hippocampus with excitation dominance.

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

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

Status epilepticus induced by pentylenetetrazole increases short-term synaptic facilitation in the hippocampus of juvenile rats.

We studied the effect of status epilepticus (SE) on short-term synaptic plasticity. The amplitudes of field potentials in response to extracellular stimulation of the Schaffer collaterals were recorded in hippocampal slices. Subtle modifications were revealed on day 1 after SE, whereas on days 3 and 7 we did not find any differences from the control. These data show that, one day after SE, the probability of a transmitter release in hippocampal synapses decreases that serves as a compensatory mechanism, which prevents seizure activity.

Memantine attenuates cognitive impairments after status epilepticus induced in a lithium-pilocarpine model.

The capability of memantine, a noncompetitive antagonist of the NMDA receptors, to prevent impairments of cognitive functions in rats was investigated in the lithium-pilocarpine model of epilepsy. After status epilepticus, rats exhibited impaired exploratory behavior and spatial memory, and a decline of extinction of orienting behavior. Memantine administration prevented these disturbances. Thus, the blockade of the NMDA receptors immediately after status epilepticus allowed prevention of the development of the possible cognitive impairments.