[Hemobilia as a sign of arterio-biliary fistula]. / Gemobiliya kak proyavlenie arteriobiliarnoi fistuly.

Hepatic artery aneurysms (HAA) are rare (20% of all visceral arteries). Most often, HAAs are asymptomatic and detected at autopsy. However, their ruptures and/or bleeding following pressure ulcers in visceral gastrointestinal organs are a significant clinical and diagnostic problem. We present 2 patients with obstructive jaundice and hemobilia. Diagnostics revealed aneurysm of the right hepatic artery with arterio-biliary fistula. Life-threatening hemobilia is a consequence of HAA rupture into biliary system. Endovascular approach is preferable for HAA without clinical manifestations. Awareness of this disease is important for early detection and active surgical intervention before possible complications.

Phase transformation in the "Brodie graphite oxide-acetonitrile" system - influence of the oxidizing level of the material.

Reversible phase transformation in the Brodie graphite oxide-acetonitrile system, which is intercalation or release of part of the sorbed liquid from the interplanar space accompanied by an increase or a decrease in interplanar distances, is commonly observed in twice-oxidized materials. We observed this phenomenon for once-, twice- and thrice-oxidized materials using the EPR spin probe technique, DSC, and temperature programmed XRD. It was shown that all materials under study formed similar low temperature (LT) and high temperature (HT) swollen structures with acetonitrile. The phase transformation of these structures is observed for materials with different oxidation levels in the same temperature range (∼20 K). The twice- and thrice-oxidized Brodie graphite oxides form swollen structures with the same parameters, while the once-oxidized material sorbs less acetonitrile at lower temperatures, but shows the same interplanar distances as those in twice- and thrice-oxidized materials. The spin probe technique has proven its sensitivity to the appearance of small amounts of the new forming swollen structures, which makes this method useful in studies of phase transformations.

Creating superconductivity in WB2 through pressure-induced metastable planar defects.

High-pressure electrical resistivity measurements reveal that the mechanical deformation of ultra-hard WB2 during compression induces superconductivity above 50 GPa with a maximum superconducting critical temperature, Tcof 17 K at 91 GPa. Upon further compression up to 187 GPa, the Tcgradually decreases. Theoretical calculations show that electron-phonon mediated superconductivity originates from the formation of metastable stacking faults and twin boundaries that exhibit a local structure resembling MgB2 (hP3, space group 191, prototype AlB2). Synchrotron x-ray diffraction measurements up to 145 GPa show that the ambient pressure hP12 structure (space group 194, prototype WB2) continues to persist to this pressure, consistent with the formation of the planar defects above 50 GPa. The abrupt appearance of superconductivity under pressure does not coincide with a structural transition but instead with the formation and percolation of mechanically-induced stacking faults and twin boundaries. The results identify an alternate route for designing superconducting materials.

[Nonimmunogenic staphylokinase in the treatment of acute ischemic stroke (FRIDA trial results)]. / Neimmunogennaya stafilokinaza ­ novyi tromboliticheskii preparat v lechenii ishemicheskogo insul'ta (rezul'taty issledovaniya FRIDA).

AIM OF THE STUDY: To investigate the efficacy and safety of non-immunogenic staphylokinase (NS) compared with alteplase (A) in patients with acute ischemic stroke (AIS) within 4.5 h after symptom onset. MATERIAL AND METHODS: 336 patients with IS within 4.5 h after symptom onset were included in a randomized, open-label, multicenter, parallel-group, non-inferiority comparative trial of NS vs A (168 patients in each group). NS was administered as an intravenous bolus in a dose of 10 mg, regardless of body weight, over 10 s, A was administered as a bolus infusion in a dose of 0.9 mg/kg, maximum 90 mg over 1 hour. The primary efficacy endpoint was a favorable outcome, defined as a modified Rankin scale (mRS) score of 0-1 on day 90. Safety endpoints included all-cause mortality on day 90, symptomatic intracranial haemorrhage, and other serious adverse events (SAEs). RESULTS: At day 90, 84 (50%) patients reached the primary endpoint (mRS 0-1) in the NS group, 68 (41%) patients - in the A group (p=0.10, OR=1.47, 95% CI=0.93-2.32). The difference between groups NS and A was 9.5% (95% CI= -1.7-20.7) and the lower limit of the 95% CI did not cross the margin of non-inferiority (pnon-inferiority<0.0001). There were no significant differences in the frequency of deaths between the groups: on day 90, 17 (10%) patients in the NS group and 24 (14%) in the A group had died (p=0.32). There was a trend towards significant differences in the frequency of symptomatic intracranial haemorrhage: NS group - 5 (3%) patients, A group - 13 (8%) patients (p=0.087, OR=0.37, 95% CI=0.1-1.13). There were significant differences in the number of patients with SAEs: in the NS group - 22 (13%) patients, in the A group - 37 (22%) patients (p=0.044, OR=0.53, 95% CI=0.28-0.98). CONCLUSION: The presented results of the FRIDA trial are the first in the world to use a drug based on NS in patients with IS. It has been shown that a single bolus (within 10 s) administration of NS at a standard dose of 10 mg, regardless of body weight, allows to conduct fast, effective and safe thrombolytic therapy in patients with IS within 4.5 h after symptom onset. In further clinical tials of NS, it is planned to expand the therapeutic window beyond 4.5 h after symptom onset in patients with IS.

Metabolic determinants of NAFLD in adults with type 1 diabetes.

AIM: To assess the main metabolic determinants of non-alcoholic fatty liver disease (NAFLD) in adult patients with type 1 diabetes (T1D). METHODS: 115 patients with T1D were divided into 4 groups according to NAFLD grade. NAFLD was diagnosed via transient elastography when CAP > 233 dB/m. Body composition was evaluated by Inbody720, Biospace. Serum lipids, liver enzymes, uric acid, creatinine, hsCRP and HbA1c were evaluated at fasting. RESULTS: The overall prevalence of NAFLD was 47% (n = 54). In the subgroup with BMI > 25 kg/m2 NAFLD prevalence was 66%; and positive family history of type 2 diabetes brought the risk up to 76%. 37% of the lean individuals also had NAFLD. HbA1c > 7% doubled the risk of NAFLD. Waist circumference > 82.5 cm was independently related to NAFLD, accounting for 24% of its variation in females. Accumulation of two and three metabolic syndrome (MetS) components, besides hyperglycemia, increased the risk of NAFLD by 14% (p < 0.0001) and 6% (p = 0.024), respectively. Lean NAFLD correlated with total insulin dose; NAFLD in overweight T1D patients correlated with triglycerides. CONCLUSIONS: NAFLD is highly prevalent in adults with T1D and obesity or other metabolic derangements and might be independently related to poor long-term glycemic control and waist circumference in females.

The state of cognitive function in patients with stable coronary artery disease after coronary artery bypass grafting.

Aim      To study the cognitive function (CF) state in patients with chronic ischemic heart disease (IHD) depending on the method of coronary bypass (CB), with extracorporeal circulation (EC) or on beating heart.Material and methods  Postoperative cognitive dysfunction (POCD) is a frequent complication of CB, and its development may depend on the method of surgery, with EC or on beating heart. This single-center, prospective, nonrandomized study included 196 patients with chronic IHD aged 61.0±5.1 years. Patients were divided into two groups based on the CB method: an EC group (n=11) and a beating heart surgery group (n=85). Mean follow-up period was 26±2.1 mos. The state of CF was evaluated before and after CB (at the hospital stage, at 3, 6, 12, and 24 mos.).Results The mean duration of CF recovery was 3 mos. only in the group of CB without EC (p<0.05), whereas after CB with EC, CF parameters were similar to those during the hospital stage with somewhat reduced values. In 6 mos. after CB, CF normalized to baseline values in both groups (with and without EC). A possible CF decline in patients with chronic IHD after CB depended on the following factors: age older than 60 years (p<0.05), diabetes mellitus with glycated hemoglobin >7.5 % (p=0.001) and 6.5-7.5 % (p=0.03), smoking (p=0.04), atherosclerotic damage of the internal carotid artery (p<0.05), and a Charlson comorbidity index >5 (p=0.03). The CB surgery either with EC (p=0.04) or on beating heart (p=0.04) was associated with the development of CD.Conclusion      The results of the study allow identifying patients with chronic IHD and POCD-predisposing factors to recommend them beathing heart CB surgery.

[CLINICAL AND IMMUNOLOGICAL FEATURES OF HERPESVIRUS DISEASES ON THE BACKGROUND OF HIV].

Herpesvirus infections (HI) are the most common HIV-associated diseases. Due to the development of the HIV pandemic, the incidence of HI against the background of HIV infection is steadily increasing, and the implantation of HAART makes certain changes in the course of diseases of this category. The aim of the study was to compare clinical and immunological data in different forms of HI in HIV-positive patients and in patients with normal immune status. From March, 2019 to April 2021, 59 HIV-positive and 60 HIV-negative patients were included in the study. The study used clinical and laboratory methods: ELISA, PCR (HIV RNA, HSV-1, HSV-2, VZV, EBV, CMV, HHV-8), immunological studies (CD3 +, CD4 +, CD8 +, CD4 +/CD8 +, CD20 +). The data were statistically processed using the IBM SPSS Statistics statistical package. The clinical features of herpesvirus skin diseases associated with HIV is closely related to the immune status. The spectrum of clinical manifestations and the incidence of skin and mucous membrane diseases in HIV-infected people are influenced by the severity of immunodeficiency and the systemic use of antiretroviral drugs. The severity of manifestations correlates with the level of CD4 + cells: with a value below 349 cells/µl, an atypical course was observed, and with a value of less than 200 cells/µl, a generalized infectious process.

[18F-fluorodeoxyglucose PET/CT in the diagnosis of vascular graft infection]. / Vozmozhnosti PET/KT S 18F-ftordezoksiglyukozoi v diagnostike infektsii sosudistykh protezov.

OBJECTIVE: To investigate diagnostic role of 18F-fluorodeoxyglucose PET/CT in patients with suspected vascular graft (VG) infection. MATERIAL AND METHODS: A prospective analysis included data of 30 PET/CT examinations for suspected infection of aortic VG (n=27) and bypass grafts (n=3) after surgical treatment (median 48 months). In 77% (23/30) of cases, the diagnosis was initially «possible¼ (n=11) or «rejected¼ (n=12) in accordance with common diagnostic criteria. All PET/CT results were verified by clinical, laboratory and intraoperative («=20) data. VG infection was confirmed in 18 patients and ruled out in 12 cases. RESULTS: PET/CT confirmed VG infection in 94% (17/18) and excluded in 50% (6/12) of cases. False PET/CT results were obtained in 23% (7/30) cases: false positive in 6 cases and false negative in 1 case. Thus, sensitivity, specificity and diagnostic accuracy of PET/CT were 94%, 50% and 77%, respectively; positive and negative predictive value - 74% and 86%. PET/CT results allowed correct reclassifying 33% (10/30) of cases. VG infection was confirmed in 73% (8/11) of patients with initially «possible¼ diagnosis and excluded in 17% (2/12) of patients with initially «rejected¼ infection. Moreover, whole body PET/CT revealed unknown inflammation foci outside VG in 73% (22/30) of cases. These data were applied to correct treatment approach in 80% (24/30) of cases. CONCLUSION: Our results showed high efficacy of 18F-fluorodeoxyglucose PET/CT in the diagnosis of VG infection. Despite low specificity, this technique has high sensitivity and accuracy that allowed reclassifying 33% of cases.

DNA methylation across the genome in aged human skeletal muscle tissue and muscle-derived cells: the role of HOX genes and physical activity.

Skeletal muscle tissue demonstrates global hypermethylation with age. However, methylome changes across the time-course of differentiation in aged human muscle derived cells, and larger coverage arrays in aged muscle tissue have not been undertaken. Using 850K DNA methylation arrays we compared the methylomes of young (27 ± 4.4 years) and aged (83 ± 4 years) human skeletal muscle and that of young/aged heterogenous muscle-derived human primary cells (HDMCs) over several time points of differentiation (0, 72 h, 7, 10 days). Aged muscle tissue was hypermethylated compared with young tissue, enriched for; pathways-in-cancer (including; focal adhesion, MAPK signaling, PI3K-Akt-mTOR signaling, p53 signaling, Jak-STAT signaling, TGF-beta and notch signaling), rap1-signaling, axon-guidance and hippo-signalling. Aged cells also demonstrated a hypermethylated profile in pathways; axon-guidance, adherens-junction and calcium-signaling, particularly at later timepoints of myotube formation, corresponding with reduced morphological differentiation and reductions in MyoD/Myogenin gene expression compared with young cells. While young cells showed little alterations in DNA methylation during differentiation, aged cells demonstrated extensive and significantly altered DNA methylation, particularly at 7 days of differentiation and most notably in focal adhesion and PI3K-AKT signalling pathways. While the methylomes were vastly different between muscle tissue and HDMCs, we identified a small number of CpG sites showing a hypermethylated state with age, in both muscle tissue and cells on genes KIF15, DYRK2, FHL2, MRPS33, ABCA17P. Most notably, differential methylation analysis of chromosomal regions identified three locations containing enrichment of 6-8 CpGs in the HOX family of genes altered with age. With HOXD10, HOXD9, HOXD8, HOXA3, HOXC9, HOXB1, HOXB3, HOXC-AS2 and HOXC10 all hypermethylated in aged tissue. In aged cells the same HOX genes (and additionally HOXC-AS3) displayed the most variable methylation at 7 days of differentiation versus young cells, with HOXD8, HOXC9, HOXB1 and HOXC-AS3 hypermethylated and HOXC10 and HOXC-AS2 hypomethylated. We also determined that there was an inverse relationship between DNA methylation and gene expression for HOXB1, HOXA3 and HOXC-AS3. Finally, increased physical activity in young adults was associated with oppositely regulating HOXB1 and HOXA3 methylation compared with age. Overall, we demonstrate that a considerable number of HOX genes are differentially epigenetically regulated in aged human skeletal muscle and HDMCs and increased physical activity may help prevent age-related epigenetic changes in these HOX genes.

[Preparation of Human Skeletal Muscle Samples for Proteomic Analysis with Isobaric iTRAQ Labels].

In the past decade, mass spectrometry studies of skeletal muscles have become common. In this tissue, the abundance of several contractile proteins significantly limits the depth of the panoramic proteome analysis. The use of isobaric labels allows improving assessment of the changes in the protein content, while analyzing up to 10 samples in a single run. Here we present the results of a comparative study of various methods for the fractionation of skeletal muscle peptides labeled with an isobaric label iTRAQ. Samples from m. vastus lateralis of eight young males were collected with a needle biopsy. After digestion into peptides and labeling, the preparations were carried out according to three different protocols: (1) peptide purification, HPLC-MS/MS; (2) peptide purification, isoelectric focusing, HPLC-MS/MS; (3) high pH reverse-phase LC fractionation, HPLC-MS/MS. Fractionation of labeled peptides by high pH reverse-phase LC was the optimal strategy for increasing the depth of the proteome analysis. This approach, in addition to contractile and mitochondrial proteins, allowed us to detect a variety of regulatory molecules, including the nucleic acids binding the proteins, chaperones, receptors, and transcription factors.

Adaptation of Skeletal Muscles to Contractile Activity of Varying Duration and Intensity: The Role of PGC-1α.

A large body of experimental data have shown that aerobic exercise of different duration, intensity, and pattern affect molecular mechanisms regulating mitochondrial biogenesis in skeletal muscles. This review focuses on the effects of exercise duration and intensity on the molecular mechanisms of mitochondrial biogenesis regulation in skeletal muscles, namely PGC-1α-dependent signaling. Studies of the effects of acute exercise and exercise training showed that an increase in the duration of aerobic exercise from 30 to 90 min does not provide additional stimuli to activate signaling pathways regulating post-translational modification of peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α) and expression of the PGC-1α gene (PPARGC1A). Conversely, exercise intensity substantially affects mitochondrial biogenesis due to the increase in the recruitment of type II muscle fibers with accompanying pronounced metabolic shift leading to the activation of signaling cascades and expression of genes regulating mitochondrial biogenesis. Therefore, intermittent exercise, which recruits type II muscle fibers, is more efficient in the activation of mitochondrial biogenesis than work-matched continuous exercise. In skeletal muscle adapted to aerobic training, intensity-dependent activation of mitochondrial biogenesis after acute exercise is associated primarily with the AMP-activated protein kinase/PGC-1α pathway, expression of PGC-1α-regulated genes, and expression of PPARGC1A from the alternative (distal) inducible promoter regulated by the cAMP response element-binding protein 1-related transcription factors and their coactivators. Elucidation of the effects of duration and intensity of aerobic exercise on the PGC-1α-dependent and -independent mechanisms of mitochondrial biogenesis is important for treatment of patients with various metabolic disorders, as well as for optimization of training in athletes.

CYTOKINE PRODUCTION PECULIARITIES IN DIFFERENT FORMS OF EPSTEIN-BARR VIRUS INFECTION.

In article presented results of the study of basic levels of regulatory cytokines in patients with various forms of Epstein-Barr virus (EBV) infection. Analysis of the dynamics of cytokine profile in patients with EBV infection revealed the opposite changes studied synthesis of proinflammatory and anti-inflammatory cytokines, which was the basis for the establishment of the four types of immune response. The findings confirm the existence of cytokine imbalance with EBV infection. The established types of immune responses indicate inadequate cell humoral reactivity in a long persistence of EBV, which manifests a tendency to suppression of cell-mediated and humoral immune response enhancement mechanisms and displayed in the clinical and biochemical manifestations of the disease, and also leads to prolonged undulating course.

Stability of the fluid interface in a Hele-Shaw cell subjected to horizontal vibrations.

The stability of the horizontal interface of two immiscible viscous fluids in a Hele-Shaw cell subject to gravity and horizontal vibrations is studied. The problem is reduced to the generalized Hill equation, which is solved analytically by the multiple scale method and numerically. The long-wave instability, the resonance (parametric resonance) excitation of waves at finite frequencies of vibrations (for the first three resonances), and the limit of high-frequency vibrations are studied analytically under the assumption of small amplitudes of vibrations and small viscosity. For finite amplitudes of vibrations, finite wave numbers, and finite viscosity, the study is performed numerically. The influence of the specific natural control parameters and physical parameters of the system on its instability threshold is discussed. The results provide extension to other results [J. Bouchgl, S. Aniss, and M. Souhar, Phys. Rev. E 88, 023027 (2013)10.1103/PhysRevE.88.023027], where the authors considered a similar problem but took into account viscosity in the basic state and did not consider it in the equations for perturbations.

[Effect of Combined Aerobic and Strength Exercise on Regulation of Mitochondrial Biogenesis, Protein Synthesis and Degradation in Human Skeletal Muscle.]

We tested the hypothesis that strength exercise after intermittent aerobice exercise might activate signalling pathways related to mitochondrial biogenesis (phosphorylation level of AMPK, p38; expression of PGC-1a, NT-PGC-la, TFAM, VEGFA), to protein synthesis (phosphorylation level of p70S6Kl(Thr389) eEF2(Thr56) expression of IGF-lEa, IGF-lEc (MGF), REDDl) and to proteolysis (phosphorylation level of FOXOl(Ser256) and expression of MURFl, MAFbx, Myostatin) in trained skeletal muscle. Nine amateur endurance-trained athletes performed 70-Min bicycle intermittent exercise with both legs (E), followed by one-leg strength exercise (ES: 4 bouts of knee extensions at 75% MVC till exhaustion). Gene expression and protein level were evaluated in samples from m. vastus lateralis before, 40 min, 5 and 22 h after the aerobic exercise. The phosphorylation level of the ACC(Ser79/222)(an endogenous marker of AMPK activity) and expression of PGC-la-related TFAM - marker of mitochondrial biogenesis were increased after E exercise and did not changed after ES. Expression of PGC-lα and truncated isoform NT- PGC-lα was increased in both legs as well. Insulin concentration in blood was dramatically, 7.5-fold diminished after intermittent aerobic exercise. Phosphorylation of FOXO(Ser256) - regulator of ubiquitin-related proteolysis - was decreased after both E and ES exercise, it means it was activated in both cases, while expression of E3-ubiquitin ligase MURFl was increased only after E exercise. Both aerobic and combined exercise did not affect regulation of protein synthesis: neither expression of IGF-lEa and IGF-Ec (MGF) mRNA isoforms nor phosphorylation levels of markers of protein synthesis p70S6Kl(Thr389) and eEF2(Thr56) were changed. Thus effects of aerobic exercise in trained muscles are noticeably suppressed by performing strength exercise immediately after endurance one. In particular, the activity of signalling cascades and expression of genes regulating mitochondrial biogenesis are lessened, but protein synthesis regulation is not affected. And at last strength exercise suppresses induced by aerobic exercise expression of MURF1 gene - marker of ubiquitin proteasome system. It means that strength exercise just after intermittent aerobic exercise might have a negative effect on aerobic performance if used chronically.

[Determination of Aerobic-anaerobic Transition in Working Muscle Using EMG and Near Infrared-Spectroscopy Data].

A method to evaluate aerobic-anaerobic transition (AAT) during exercise is suggested. The subjects performed two tests with incremental increase of load: bicycle exercise and one leg knee extensions. In both tests the relation of deoxygenated hemoglobin (HHb) to EMG-activity of m. vastus lateralis during test has characteristic peak corresponding to AAT. The statistically significant correlation (r = 0.78, p < 0.05) between the load corresponding to AAT and anaerobic threshold (blood [La] = 4 mmol) was found during bicycle test. The method is applicable to determination of AAT during exercise of small muscle group.

[The study of the efficacy of Botulinum toxin type A in patients with poststroke upper-limb spasticity ULIS-II: an analysis of Russian patients].

AIM: To assess the efficacy of Botulinum toxin type A (BoNT-A) injections in routine practice. MATERIAL AND METHODS: An international, post-marketing, multi-center, observational, prospective, longitudinal study included patients ≥18 years with poststroke upper-limb spasticity in whom a decision to inject BoNT-A had already been made, and who had no previous treatment with BoNT-A or BoNT-B within the last 12 weeks. The responder rate was assessed by the patient-centered goal attainment scaling (GAS). RESULTS AND CONCLUSION: The study included 7 Russian research centers (41 patients). Sixteen patients (39%) received BoNT-A injections prior to entering the study. During the treatment, 29 patients (70.7%) received dysport injections; 2 (4.9%) botox injections, 8 (19.5%) xeomin injections and 2 (4.9%) other BoNT-A agents. The primary treatment goals were successfully attained in 87.8%, secondary treatment goals in 88.3%. An improvement in passive function as primary goal and as secondary goal were achieved in 100%, in the range of movement in 94.9%, pain reduction in 82.4%, improvement in active function of the upper limb in 76.5%, reduction in involuntary movements (associated reactions) in 83.3% of cases. Investigators' global assessment of benefits revealed that 97.6% of patients showed positive effects from BoNT-A injections. Pateitnts' assessment of global benefits was slightly lower - 90,2% of patients reported positive treatment effects When assessed by patients, the rate of global benefits was 90.2%. Botulinum-toxin therapy is an effective treatment option. In the vast majority of patients, it allows both for reduction in muscle tone and functional benefits that could improve quality of life of the patients.

[The Effect of Single Aerobic Training on the Regulation of Mitochondrial Biogenesis in Skeletal Muscles of Trained Men: a Time-Course Study].

Adaptation of skeletal muscles to physical training depends on intensity and duration of exercise sessions. The purpose of this study was to investigate the effect of the duration of moderately intensive single aerobic exercise session (60% V(O2max)) on the activation of signalling kinases which regulate PGC-1α gene expression and on the expression of regulatory genes of mitochondrial biogenesis and muscle catabolism. Nine athletes (V(O2max)) 59 mL/min/kg) performed 30-, 60-, and 90-min cycling sessions. An exercise-induced increase in PGC-1α gene expression was proved to occur without activation of AM PK, p38 MAPK and CAMKII. It was found that 60- and 90-min sessions result in comparable increases of PGC-lα gene expression, while VEGFA gene expression increased only after 90-min session. Even 90-min exercise did not induce the activation of FOXO1-E3 ubiquitin ligase pathway and did not result in an increase of expression of exercise-induced catabolic genes.

High pressure Laue diffraction and its application to study microstructural changes during the α → ß phase transition in Si.

An approach using polychromatic x-ray Laue diffraction is described for studying pressure induced microstructural changes of materials under pressure. The advantages of this approach with respect to application of monochromatic x-ray diffraction and other techniques are discussed. Experiments to demonstrate the applications of the method have been performed on the α → ß phase transition in Si at high pressures using a diamond anvil cell. We present the characterization of microstructures across the α-ß phase transition, such as morphology of both the parent and product phases, relative orientation of single-crystals, and deviatoric strains. Subtle inhomogeneous strain of the single-crystal sample caused by lattice rotations becomes detectable with the approach.

[PERCUTANEOUS CYSTOLITHOTRIPSY: THE FIRST CLINICAL EXPERIENCE].

This paper reviews results of examination and treatment for benign prostatic hyperplasia (BPH) and infravesical obstruction in 16 patients observed in Department of Urology of Zhukovsky CCH in 2013-2014. Most operated patients required particularly careful approach to the surgery planning due to advanced age and multiple comorbidities. Treatment of all patients was carried out in a single therapeutic session performed in two stages. Percutaneous cystolithotripsy was performed on the first stage and subsequently transurethral resection of the prostate (TURP) was carried out. It was found, that combination of minimally invasive percutaneous approach and TURP is the most sparing way to restore lower urinary tract urodynamics and eliminate bladder stones in all operated patients. With appropriate patient selection and a clear definition of indications, proposed treatment combination is a promising and effective strategy in management of patient with urolithiasis with infravesical obstruction and BPH.