[Optical coherence tomography angiography in the diagnosis of multiple sclerosis]. / Opticheskaya kogerentnaya tomografiya-angiografiya v diagnostike rasseyannogo skleroza.

PURPOSE: This study analyzes the main changes in retinal microcirculation in patients with multiple sclerosis (MS) and their relationship with the type of disease course. MATERIAL AND METHODS: 159 patients (318 eyes) were examined. The groups were formed according to the type of course and duration of MS: group 1 - 37 patients (74 eyes; 23.27%) with relapsing-remitting MS (RRMS) less than 1 year; group 2 - 47 patients (94 eyes; 29.56%) with RRMS from 1 year to 10 years; group 3 - 44 patients (86 eyes; 27.05%) with RRMS >10 years; group 4 - 32 patients (64 eyes; 20.12%) with secondary progressive MS (SPMS). Subgroups A and B were allocated within each group depending on the absence or presence of optic neuritis (ON). Patients underwent standard ophthalmological examination, including optical coherence tomography angiography (OCTA). RESULTS: A decrease in the vessel density (wiVD) and perfusion density (wiPD) in the macular and peripapillary regions was revealed, progressing with the duration of the disease and with its transition to the progressive type. The minimum values were observed in patients with SPMS (group 4), with the most pronounced in the subgroup with ON (wiVD = 16.06±3.65 mm/mm2, wiPD = 39.38±9.46%, ppwiPD = 44.06±3.09%, ppwiF = 0.41±0.05). CONCLUSION: OCTA provides the ability to detect subclinical vascular changes and can be considered a comprehensive, reliable method for early diagnosis and monitoring of MS progression.

[Three-year follow-up study of clinical effectiveness of antiangiogenic therapy for neovascular age-related macular degeneration]. / Klinicheskaya effektivnost' antiangiogennoi terapii neovaskulyarnoi vozrastnoi makulyarnoi degeneratsii po rezul'tatam trekhletnego nablyudeniya.

PURPOSE: The study analyzes long-term (three years) clinical effectiveness of anti-VEGF treatment of neovascular age-related macular degeneration (nAMD) and attempts to identify the most clinically significant associations between the functional and structural parameters. MATERIAL AND METHODS: The study included 122 patients (122 eyes) diagnosed with nAMD, mean age -73.4±6.6 years old. Prospective follow-up lasted 144 weeks. All patients were treated with angiogenesis inhibitor (aflibercept 2 mg), and most of them (72.9%) - according to the Treat-and-Extend protocol. RESULTS: The average number of injections was 7.39±1.28, 4.63±0.97 and 4.06±0.81 during the first, second and third years of the follow-up, respectively. The mean baseline best-corrected visual acuity (BCVA) was 0.24±0.21. After three loading doses, BCVA increased to 0.33±0.26 (+0.09; 37.5%), by the end of follow-up BCVA was 0.35±0.27 (+0.11; 45.8%). Central retinal thickness (CRT) decreased from 314.89±88.07 µm to 234.4±42.8 µm (a 25.5% decrease) by the end of the follow-up. After three loading injections baseline functional and anatomical parameters had the most significant correlations (r≥0.7, p<0.05) with intraretinal fluid, ellipsoid zone integrity and the area of macular atrophy. CONCLUSIONS: Analysis of the morphological and functional outcomes by the end of the first year demonstrates the feasibility of preserving the results while reducing the number of visits and injections according to the Treat-and-Extend protocol. Achieving maximum improvement of functional parameters most significantly correlated with changes in such biomarkers as central retinal thickness, area of macular atrophy and integrity of the ellipsoid zone.

[Diagnosis and clinical features of non-exudative macular neovascularization]. / Diagnostika i klinicheskie osobennosti neekssudativnoi makulyarnoi neovaskulyarizatsii.

Macular neovascularization (MNV) is the process of new abnormal blood vessels formation in the choroid and/or retina. The widespread adoption of optical coherence tomography angiography (OCTA) has significantly expanded the possibilities of not only detecting pathological blood flow before the development of exudation and deterioration of visual acuity, but also determining its characteristics. The purpose of this review is to substantiate the criteria for choosing terminology and diagnostic markers of MNV. The term "non-exudative MNV" refers to type 1 neovascularization without intraretinal or subretinal exudation detected on repeated OCT scans in the course of at least 6 months. This type of MNV may include previously untreated, non-exudative membranes with a low tendency to exudate, as well as previously treated membranes that have become inactive or dormant and no longer require anti-angiogenic therapy. The criterion for dividing the non-exudative form of MNV into inactive (with a low growth rate and vascular density (VD) at baseline) and subclinical (with a high growth rate and VD) is the time of its activation, generally recognized as 6 months. The diagnostic criteria is the visualized "double layer" sign on OCT scans (retinal pigment epithelium and Bruch's membrane), as well as patterns of neovascular membranes of varying sizes, morphology and localization on OCTA scans. The cumulative risk of conversion from subclinical to exudative at two years of follow-up is 13.6 times higher than in eyes without detectable neovascularization, which highlights the importance of frequent monitoring in this healthy eye population for early detection of MNV signs.

[Prognosis criteria of optical coherence tomography angiography for the long-term efficacy of anti-VEGF therapy of neovascular age-related macular degeneration]. / Prognosticheskie kriterii opticheskoi kogerentnoi tomografii-angiografii v otsenke dolgosrochnoi effektivnosti anti-VEGF-terapii neovaskulyarnoi vozrastnoi makulyarnoi degeneratsii setchatki.

PURPOSE: The study aimed to determine the most significant optical coherence tomography angiography (OCTA) parameters in terms of predicting anti-VEGF therapy effectiveness during long-term (3-year) follow-up of patients with neovascular age-related macular degeneration (nAMD). MATERIAL AND METHODS: The study included 122 patients (122 eyes) with mean age of 73.4±6.6 years who were diagnosed with nAMD. Subgroup analysis included 50 patients (50 eyes) with detailed OCT angiography examination of macular neovascularization (MNV) characteristics and their changes in the course of the follow-up, which lasted 144 weeks. All patients were treated by angiogenesis inhibitor (aflibercept 2 mg), most of them - according to Treat-and-Extend protocol. RESULTS: Treatment response (either 'good' or 'partial') was achieved in all patients, and the proportion of the response types was similar in both types 1 and 2 MNV. Key OCTA parameters associated with the number of injections, as well as morphological and functional response (best-corrected visual acuity, retinal neuroepithelium and pigment epithelium detachment), were vascular network area and MNV area assessed at baseline and three months after treatment initiation. Both of these parameters were closely related in both MNV types during the follow-up. Key parameter with maximum number of clinically significant correlations ('very high' strength, p<0.05) in eyes with 'good' response was MNV area, in eyes with 'partial' response - vascular density and greatest vascular caliber. CONCLUSIONS: Vascular network area and MNV area assessed at baseline and after three loading doses were determined as the most significant OCTA characteristics for predicting the number of injections and treatment response based on functional and morphological parameters. MNV area was found to be the most clinically significant marker in 'good' response, vascular density and greatest vascular caliber - in 'partial' response.

[Choroidal microvascular dropout as a biomarker of glaucoma progression in patients with diabetes mellitus]. / Mikrososudistye narusheniya khorioidei kak biomarker progressirovaniya glaukomy pri sakharnom diabete.

PURPOSE: To study the occurrence, features of the development of choroidal microvascular dropout (CMvD) as a possible marker of the severity of the glaucoma process and to assess the impact of diabetes mellitus (DM) on the progression of these changes. MATERIAL AND METHODS: The study included 258 eyes (258 patients), which were divided into groups: 1st - 58 patients (58 eyes) with stage I POAG and DM; 2nd - 50 patients (50 eyes) with stage I POAG; 3rd - 50 patients (50 eyes) with stage III POAG and DM; 4th - 50 patients (50 eyes) with stage III POAG; 5th - 50 patients (50 eyes) with DM. The observation period lasted 24 months. The occurrence and dynamics of the development of CMvD, their relationship with structural and functional indicators of the optic disc in the course of observation were evaluated in patients with POAG and DM. RESULTS: CMvD was detected in stage I POAG in 17 eyes (34%), in patients with DM - in 27 eyes (54%), in the combined course of stage I POAG and DM - in 46 eyes (79.31%), in patients with stage III glaucoma - in 100% of cases. In patients with stage III glaucoma, the CMvD area indicators exceeded the values in other groups and practically did not differ regardless the presence of DM (0.59±0.13 mm2, p=0.005) and its absence (0.57±0.14 mm2, p=0.005). In the first year of follow-up, the increase in the area size of microvascular disorders in patients with POAG I was 5.88%, in comorbid patients - 3.84%, but by the end of the follow-up it increased by 19.23%, and in the group of patients with a high rate of progression - by 31.25%. Strong reliable correlations of CMvD with mean deviation (r=0.89) were revealed, as well as moderate correlations - with structural indicators of the optic disc (r=0.59) and with hemodynamic indicators (r=0.54 and r=0.52). CONCLUSION: Development of CMvD is both a result of glaucomatous damage to the optic nerve and a consequence of a disruption of its hemodynamics at the level of the deep capillary plexus. The results of the study demonstrate the adverse effect of DM on the course of glaucoma, which determines the initiation of microvascular disorders that aggravate the severity of the glaucoma process and the rate of its progression.

[Features of structural and microvascular changes of the choroid in angioretinopathy of various etiologies]. / Osobennosti strukturnykh i mikrovaskulyarnykh izmenenii khorioidei pri angioretinopatii razlichnoi etiologii.

PURPOSE: To study structural and microvascular changes in the choroid in patients with chronic kidney disease (CKD), diabetic retinopathy (DR) and arterial hypertension (AH), and their relationship with the level of renal function, carbohydrate metabolism and blood pressure. MATERIAL AND METHODS: The study involved 172 patients (325 eyes): 56 patients with CKD (109 eyes); 66 patients with DR (121 eyes); 50 patients with AH (95 eyes). All patients underwent comprehensive ophthalmological examination including visometry, biomicroscopy, ophthalmoscopy, optical coherence tomography (OCT) and OCT angiography. RESULTS: In patients with DR and CKD, a decrease in the thickness of the ganglion cell complex and the inner plexiform layer (GCL+IPL) was noted: in proliferative DR (PDR) - 62.45±4.25 µm, in stage 4-5 CKD - 75.23±6.43 µm; a decrease in choroidal thickness (CT) of minimal values in stage 4-5 CKD (179.9±37.72 µm) and PDR (211.0±40.7 µm). The decrease in choroidal vascularity index (CVI) depended on the stage of CKD and PDR (in PDR - 63.47±1.37, in stage 4-5 CKD - 65.93±2.01). Maximum decrease in perfusion density and vascular density was found in patients with DR (37.22±9.00% and 15.11±3.39 mm, respectively). An increase in the area, perimeter of the foveolar avascular zone (FAZ), and a decrease in the circularity index were noted in all groups, with most pronounced changes in PDR and stage 4-5 CKD. Patients with CKD were found to have strong correlations of CT and CVI with creatinine, urea, proteinuria and glomerular filtration rate (GFR). Patients with diabetes mellitus and PDR were revealed to have strong relations of CT, CVI, GCL+IPL, the area and perimeter of FAZ with creatinine levels and the duration of diabetes mellitus. CONCLUSION: Choroidal thickness and choroidal vascularity index are important diagnostic markers of disorders of chorioretinal microcirculation that allow stratifying individual assessment of risk factors for progression of both chronic kidney disease and diabetic retinopathy.

[New findings on pathogenetic mechanisms in the development of age-related macular degeneration]. / Novye dannye o patogeneticheskikh mekhanizmakh razvitiya vozrastnoi makulyarnoi degeneratsii.

Age-related macular degeneration (AMD) is a complex multifactorial disease that occurs due to disfunction and degeneration of retinal pigment epithelium (RPE) and choriocapillaris, as well as death of photoreceptors. The exact pathogenetic mechanism remains uncertain. The aging process is the main and the clearest risk factor of AMD. In the development of this condition, a special role belongs to the secretory phenotype of aging spreading from one cell to another and mediated by the secretion and release of growth factors, cytokines, chemokines, proteases, and other molecules. Another major contributor is oxidative stress caused by violations in the recirculation of vitamin A in the vision cycle and accompanied by accumulation of lipofuscin, which mediates the formation of iron-based oxidants that are toxic for mitochondria. Furthermore, prolonged oxidative stress and constant light exposure induce the development of inflammation in the retina. Accumulation of metabolic products and cellular defects with age can induce an inflammatory reaction that amplifies the damage. The inflammatory processes including innate immune response, activation of microglia and parainflammation that occur locally in the vascular membrane, pigment epithelium and neuroretina are very significant contributors to the age-related changes, their progression, and the development of advanced stages of AMD. Various growth factors play a special role in the development of choroidal neovascularization (CNV). Vascular endothelial growth factor A (VEGF-A) has traditionally been considered the main factor of neoangiogenesis and, consequently, the main therapeutic target, but in recent years various studies have determined the role of other factors - VEGF-B, C, D, PGF, Gal-1, angiopoietins. This article describes the main underlying mechanisms in the development of choroidal neovascularization including retinal aging, impaired metabolic activity, mitochondrial dysfunction, inflammatory reactions and genetic variations, as well as the role of various growth factors.

[Structural and microvascular changes in the retina and choroid in patients with chronic kidney disease]. / Osobennosti strukturnykh i mikrovaskulyarnykh izmenenii setchatki i khorioidei pri khronicheskoi bolezni pochek.

PURPOSE: To study the main structural and microvascular changes in the retina and choroid in patients with diabetic retinopathy (DR) and chronic kidney disease (CKD), and their relationship with impaired renal function. MATERIAL AND METHODS: The study included 158 patients (304 eyes). The 1st group consisted of 50 patients with CKD (97 eyes); group 2 - 65 patients with DR (119 eyes), group 3 - 43 patients with CKD and DR (86 eyes). All study patients underwent complete ophthalmological examination, including optical coherence tomography (OCT) and OCT angiography (OCTA) of the macular region. RESULTS: The analysis of structural parameters in groups of patients showed a decrease in the thickness of the ganglion cell layer and the inner plexiform layer of the retina in patients with DR (70.85±14.49 µm), with the lowest value in the CKD+DR group (65.84±15.34 µm) in comparison with the CKD group (75.64±10.32 µm). In the groups of patients with CKD, the thickness of the choroid (207.3±40.36 µm) was significantly reduced in comparison with the group of patients with DR (258.8±26.63 µm) and correlated with the stage of the disease. Patients in the CKD+DR group had the lowest perfusion and vascular density in the macular region (31.23±10.91% and 13.15±2.73 mm), an increase in the area and perimeter of the foveal avascular zone (0.55±0.26 mm2, 3.30±0.84 mm). Pronounced correlations of decrease in choroidal thickness, vascular density, and perfusion volume with low glomerular filtration rate and CKD stage, as well as urea and creatinine levels were determined. An increase in the area of the foveal avascular zone correlated with lower retinal capillary density, decreased perfusion volume, and the stage of both DR and CKD. CONCLUSION: Structural and hemodynamic disorders of the retina and choroid can be recognized as significant biomarkers for non-invasive diagnosis of microvascular complications of diabetes mellitus and impaired renal function.

Boron and Gadolinium Loaded Fe3O4 Nanocarriers for Potential Application in Neutron Capture Therapy.

In this article, a novel method of simultaneous carborane- and gadolinium-containing compounds as efficient agents for neutron capture therapy (NCT) delivery via magnetic nanocarriers is presented. The presence of both Gd and B increases the efficiency of NCT and using nanocarriers enhances selectivity. These factors make NCT not only efficient, but also safe. Superparamagnetic Fe3O4 nanoparticles were treated with silane and then the polyelectrolytic layer was formed for further immobilization of NCT agents. Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), energy dispersive X-ray (EDX), ultraviolet-visible (UV-Vis) and Mössbauer spectroscopies, dynamic light scattering (DLS), scanning electron microscopy (SEM), vibrating-sample magnetometry (VSM) were applied for the characterization of the chemical and element composition, structure, morphology and magnetic properties of nanocarriers. The cytotoxicity effect was evaluated on different cell lines: BxPC-3, PC-3 MCF-7, HepG2 and L929, human skin fibroblasts as normal cells. average size of nanoparticles is 110 nm; magnetization at 1T and coercivity is 43.1 emu/g and 8.1, respectively; the amount of B is 0.077 mg/g and the amount of Gd is 0.632 mg/g. Successful immobilization of NCT agents, their low cytotoxicity against normal cells and selective cytotoxicity against cancer cells as well as the superparamagnetic properties of nanocarriers were confirmed by analyses above.

[Ophthalmic safety profile of antiangiogenic therapy]. / Profil' oftal'mologicheskoi bezopasnosti antiangiogennoi terapii.

Antiangiogenic therapy with inhibitors of vascular endothelial growth factor (anti-VEGF) has not only fundamentally changed the treatment outcomes of vasoproliferative eye diseases, but also became the most common ophthalmic surgical manipulation. At the same time, in 36-48% of bilateral lesions there is a need to perform injections in both eyes, making relevant the issues of safety and prevention of severe complications that threaten irreversible loss of visual function. The article reviews the results of randomized clinical trials and real clinical practice, analyzes the incidence and causes of its most dangerous complication - endophthalmitis, characterizes the clinical course depending on the type of drug used, and considers the possibility of reducing the risk of this complication occurring. Special attention is paid to the safety profile of a new VEGF inhibitor - brolucizumab - which has received registration for the treatment of neovascular age-related macular degeneration (nAMD). Specialists dealing with retinal pathologies acknowledge the need to monitor the state of the anterior and posterior parts of the eye in order to detect the signs of intraocular inflammation as quickly and early as possible. Drug efficacy, treatment regimen, duration of action and safety are the main characteristics that should determine the personalized approach in each clinical case.

[Development, clinical manifestations and diagnosis of retinal changes in chronic kidney disease]. / Osobennosti razvitiya, klinicheskie proyavleniya i diagnostika izmenenii setchatki pri khronicheskoi bolezni pochek.

Chronic kidney disease (CKD) is a significant public health problem with a high risk of developing age-dependent eye diseases. Renal glomeruli and the choroid have similar structures and vascular networks; the internal hematoretinal barrier and the glomerular filtration barrier have similar developmental path; the renin-angiotensin-aldosterone hormonal system is found in both the eye and the kidneys. All this determines the similarity of physiological and pathogenetic features of the development of diseases associated with these organs. The article discusses general risk factors and pathophysiological mechanisms of development of retinal and renal lesions in CKD, the influence of various factors of pathogenesis on their development and progression. The anatomical similarity of vascularization, accompanied by microvascular changes in the retina and kidneys, leads to similar complications in both organs. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A) are accurate, well reproducible and non-invasive methods for diagnosing and assessing changes in the retinal microvascular bed, which make it possible to assess microvasculature changes in the kidneys. In CKD, the retina shows signs of impaired capillary perfusion, a decrease in their density, expansion of intercapillary spaces, a rarefaction of the density of the parafoveolar capillary network, which may indicate a decrease in peritubular capillary blood flow, blood circulation of the kidneys in general and their ischemia. Significant thinning of the retina and choroid, along with a decrease in macular volume, even in the initial stages of CKD, is accompanied by impaired renal function (changes in the estimated glomerular filtration rate and urinary albumin excretion), which is a sign of systemic microvascular lesion and pathological process in the kidneys. Therefore, monitoring of retinal vessels using OCT and OCT-A can become a reliable indicator of the progression of renal microvascular changes at any stage of the disease.

[Anti-angiogenesis therapy of diabetic macular edema in patients with primary open-angle glaucoma]. / Antiangiogennaya terapiya diabeticheskogo makulyarnogo oteka u patsientov s pervichnoi otkrytougol'noi glaukomoi.

Despite the high clinical effectiveness and widespread introduction of anti-angiogenesis (anti-VEGF) therapy into practice, its long-term effect on the development of structural changes in the treatment of primary open-angle glaucoma (POAG) patients with diabetic macular edema (DME) hasn't been studied sufficiently and so presents certain interest. PURPOSE: To study the effect of anti-VEGF therapy on the structural and functional state of the retina and optic nerve in patients with DME and POAG. MATERIAL AND METHODS: The study included 72 patients (132 eyes): the 1st group - 22 patients (40 eyes) with stage I POAG and DME, the 2nd group - 25 patients (46 eyes) with DME receiving anti-VEGF therapy. The 3rd group (control) consisted of 25 patients (46 eyes) with stage I POAG. The observation period lasted 24 months. The average number of injections was 8.48±3.65. The indicators for evaluation were: visual acuity, tonometry, perimetry, optical coherence tomography (OCT) of the optic nerve and macular region. RESULTS: By the end of the observation period, the increase in IOP in the groups was +0.82 (4.4%), 0.41 (2.4%), 0.65 (3.6%) mm Hg. In the group of comorbid patients, a small-scale increase trend of BCVA was noted: +0.05 (6.6%), a decrease in MD by -2.48 Db (92.1%), an increase in excavation volume by 0.16 (43.2%) mm3, decrease in the area of RA by 0.3 mm2 (12.7%). A decrease in retinal nerve fibers layer (RNFL) thickness of 6.55 µm (7.8%), mainly the superior (9.2%), inferior (7.3%) and nasal sectors (7.9%). Loss of GCL+IPL 8.68 µm (12.7%) in the superior (19%), superonasal (20.2%) and inferonasal (20.7%) sectors. CONCLUSION: The combined course of POAG and DME is accompanied by a decrease in the functional and structural parameters of the retina and optic nerve, and a higher rate of progression of glaucomatous optic neuropathy. Long-term results did not reveal a significant deterioration in the structural parameters of the optic disc and retina against the background of anti-VEGF therapy when comparing the study groups.

[Different types localisation of retinal fluid as prognostic biomarkers in the choice of anti-VEGF therapy for age-related macular degeneration]. / Rol' razlichnykh tipov lokalizatsii retinal'noi «zhidkosti¼ kak prognosticheskikh biomarkerov v vybore rezhima antiangiogennoi terapii pri vozrastnoi makulyarnoi degeneratsii.

Age-related macular degeneration is an advanced chronic disease and the main cause of vision loss in geriatric patients. Optical coherence tomography (OCT) is a modern method of retinal imaging allowing to detect different types of fluid: intraretinal fluid (IRF), subretinal fluid (SRF) and fluid under pigment epithelial detachment (PED). Finding relevant imaging biomarkers is necessary for identification of basic activity criteria of the disease, choosing treatment algorithms, determining treatment duration and termination criteria, and predicting the outcomes. Presence of IRF is associated with poor functional outcomes. Its presence is an indication for early beginning of treatment aimed at full resorption of the fluid with further possible careful extension of anti-VEGF therapy intervals with a regular follow-up. Degenerative intraretinal cysts developing in the background of subretinal fibrosis in absence of choroidal neovascularization (CNV) should be a sign for discontinuation of anti-VEGF therapy due to the lack of targets. Presence of SRF is associated with favorable outcomes and good treatment prognosis and is not a barrier to the extension of treatment intervals even up to the maximum of 16 weeks as described in existing randomized controlled trials, on the condition of no other CNV activity. PED with active CNV is one of the biomarkers that reveal the need for long-term aggressive therapy. In case of its size gain, it is necessary to restart the anti-VEGF treatment to prevent visual loss in the long-term. Combination of different fluid types is a sign of lasting disease history with a poor outcome prognosis. In this case, anti-VEGF treatment should be started as soon as possible with long-term fixed regimen or Treat-and-extend (T&E) with minimal suitable interval for the patient and precise monitoring of the condition of retina until complete suppression of activity. Developing a personalized approach in each case plays an important role in preserving visual functions.

[Tropical malaria with a fatal outcome]. / Tropicheskaya malyariya s letal'nym iskhodom.

Tropical malaria is an acute infectious disease from a group of parasitic diseases transmitted by the vector-borne route. Russia registers deaths due to imported malaria. The paper gives brief information on the epidemiology, etiology, and clinical manifestations of the disease and describes the fatal outcome of cerebral tropical malaria, as well as morphological changes in organs and tissues. The K76T mutation associated with drug resistance in parasites was identified in the structure of the plasmodium gene.

Oxidative destruction of phenol on Fe/SiO2 catalysts.

In the present study, the sol-gel technique helped to obtain Fe-containing samples with a base of amorphous silicon dioxide from rice husks RH-Fe and RH-Fe-300. These materials are characterized by IR spectroscopy, X-ray phase and X-ray spectral analysis. It was shown that the samples contain silicate structures Si-O-Si(Fe) and are in an amorphous state. Structure of the surface layers of RH-Fe-300 catalyst particles was established for the first time using X-ray photoelectron spectroscopy (XPS) and energy-dispersive spectra (EDX) methods. It was shown that the surface layers of the synthesized particles are oxygen depleted due to oxygen vacancies and silanol groups, therefore defects can form in its structure. Photocatalytic activity of the samples in the phenol oxidation reaction under ultraviolet and solar irradiation in the presence of hydrogen peroxide was studied. It was shown that the degree of phenol decomposition in the presence of RH-Fe for 24 hours under solar irradiation was 92%, in the presence of RH-Fe - 17%. Under two-stage irradiation (ultraviolet and solar), the percentage of phenol decomposition using both catalysts after a day amounted to more than 80%. It was established that RH-Fe-300 catalyst increases oxidation of phenolic compounds in alkaline rice husk hydrolysates under solar irradiation in the presence of hydrogen peroxide.

[Urethral diverticulum in female].

Urethral diverticulum is one of the rarest female urological diseases, which is characterized by various manifestations, ranging from an asymptomatic to severe urinary disorders, pain and dyspareunia. The aim of this work is to present a clinical observation of female urethral diverticulum with a description and discussion of its etiology, diagnosis, and treatment. Clinical observation is dedicated to 40-year-old woman with complaints of pain in the urethral area. The patient underwent ureteral stenting followed by a diverticulectomy. Vaginal diverticulectomy is the gold standard for treatment. The specialist performing such interventions should be aware for possible intraoperative complications. It seems appropriate to perform the surgical treatment of female urethral diverticulum in specialized centers with an experience in female urethral reconstruction.

[Pathological anatomy of tuberculosis in the presence of human immunodeficiency virus infection]. / Patologicheskaia anatomiia tuberkuleza na fone infektsii, vyzvannoi virusom immunodefitsita cheloveka.

Tuberculosis occupies a leading position among secondary infections in the structure of mortality in HIV-positive patients. Moreover, the concurrence of these diseases frequently makes a morphological diagnosis most difficult due to the atypical course of tuberculosis (TB) in the presence of immunosuppression. AIM: to assess the clinical and morphological characteristics of concurrent TB/HIV infection. MATERIAL AND METHODS: An autopsy material obtained from the S.P. Botkin Clinical Infectious Diseases Hospital (CIDH) in 2018 was analyzed. Eight samples stained with hematoxylin and eosin, Ziehl-Neelsen carbol-fuchsin, auramine-rhodamine were thoroughly examined, followed by fluorescent microscopy; an immunohistochemical (IHC) study was performed. RESULTS AND DISCUSSION: 736 autopsies made at the S.P. Botkin CIDH in 2018 revealed 357 deaths from HIV infection; 86 (24%) cases of which were caused by concurrent HIV/TB infection. All the cases showed an extremely diverse and heterogeneous pattern that considerably differed from that of classical granulomatous inflammation in tuberculosis. Ziehl-Neelsen staining could demonstrate single clusters of acid-resistant bacteria with a total of not more than 1000 in the specimen of predominantly rod-shaped bacteria. Auramine-rhodamine staining revealed focal clusters of mycobacteria with a total of 1000 to 2000 in the specimen of predominantly rod-shaped and coccoid bacteria. An IHC study identified clusters of mycobacteria with a total of more than 2000 in the sample, which were characterized by a moderate variety of shapes: rods, cocci, granules, clavate, and branched ones. Mycobacteria were present extracellularly in all the studied cases. CONCLUSION: Tuberculosis holds the most important place in the pattern of causes of death in HIV infection, accounting for 24%. The lifetime diagnosis of tuberculosis remains not entirely satisfactory. The alterative component of inflammation more often predominates, although without completely losing the ability to form granulomas. The concurrence of different morphological forms of tuberculosis makes it highly desirable to clarify and/or supplement the existing classifications. None of the methods used to detect Mycobacterium tuberculosis in the tissues could reveal the intracellular localization of the pathogen. Most mycobacteria had a typical rod-shaped morphology.

[Anti-VEGF therapy for diabetic macular edema. From theory to clinical practice]. / Antiangiogennaia terapiia diabeticheskogo makuliarnogo oteka. Ot teorii k klinicheskoi praktike.

PURPOSE: To evaluate clinical effectiveness of aflibercept therapy for patients with diabetic macular edema (DME) - both naïve to the drug and unresponsive to previous anti-VEGF treatment. MATERIAL AND METHODS: The study included 127 patients (127 eyes) divided into two groups. The first group consisted of 100 primary DME patients (100 eyes) with mean age of 68.48±2.56 years and average disease duration of 12.50±7.85 years. The second group comprised 27 patients (27 eyes) with resistant macular edema who had received three or more 0.5 mg ranibizumab loading injections. Their average age was 66±4.12 and the mean number of previous anti-VEGF injections before changing therapy was 4.56±1.21. The evaluation parameters included Best Corrected Visual Acuity (BCVA) and Central Retinal Thickness (CRT) that were assessed initially and after each 2 mg aflibercept injection (at 1-month intervals during the 6 months of DME therapy). RESULTS: The average number of aflibercept injections in the first group was 4.34±1.22. BCVA improved in 100% of patients of that group after the 3rd injection with resulting mean value of 0.32±0.15. Maximum BCVA improvement was seen after the 6th injection amounting to 0.46±0.2. CRT decreased in 100% of patients of that group after the 1st injection. One month after the therapy start, CRT decreased in average by 17.96% - to 370.89±50.55 µm; at 3 months, CRT was 344.65±48.56 µm; after 6 month - 283.40±49.76 µm. All patients of the second group had retinal morphology restored, visual function improved in 55% of patients. Mean CRT decrease was 180±44 µm, BCVA improvement - 0.13±0.08, mean number of aflibercept injections - 4.86±0.9. CONCLUSION: Aflibercept can be used as first-choice drug for treatment of DME patients (both therapy-naïve and unresponsive to previous ranibizumab therapy) to improve anatomical parameters and visual function.

[Prognostic factors of antiangiogenic therapy response in neovascular macular degeneration]. / Prognosticheskie faktory éffektivnosti antiangiogennoi terapii pri neovaskuliarnoi vozrastnoi makuliarnoi degeneratsii.

The apparent success of antiangiogenic therapy in patients with neovascular age-related macular degeneration (nAMD) shows the significance of effect prognosis and continuous observation. PURPOSE: to study the influence of prognostic factors on the dynamics of functional and morphological response during anti-VEGF therapy in patients with nAMD. MATERIAL AND METHODS: Retrospective analysis of anti-angiogenic therapy results was performed on the data of 1020 patients with nAMD. Some patients were put into two subgroups: 100 patients with retinal pigment epithelium detachment (PED) and 100 patients without PED. Comparative analysis of functional and morphological parameters was performed in the subgroups. RESULTS: Baseline visual acuity (VA) in patients with PED (0.14±0.1) was significantly (р<0.05) lower than in patients without PED (0.32±0.21) and had negative correlation with PED presence (r=-0.61, р<0.05). By the end of the 12 months follow-up Best Corrected Visual Acuity (BCVA) was 0.52±0.28 and 0.62±0.28 (р>0.05) in patients with PED and without PED respectively. Mean number of injections in patients with PED was 5.7±2.5 compared to 3.5±1.2 in patients without PED (р<0.05). After 12 months VA in patients with PED was associated with baseline BCVA (r=0.59, р<0.05), VA after 4th injection (r=0.84, р<0.05) and baseline retinal thickness (r=0.60, р<0.05). CONCLUSION: PED in patients with nAMD was shown to be an unfavorable factor associated with significantly lower baseline BCVA that requires careful monitoring. At least three 'loading' injections are required to determine drug responsiveness and acquire functional and morphological response data. Correlation of BCVA values at different timepoints (baseline/after 3 'loading' doses/after 12 month) was found.

Risk factors for diastolic left ventricular myocardial dysfunction in patients with chronic kidney disease.

AIM: To examine the frequency and risk factors for the development of diastolic dysfunction (DD) of the left ventricle (LV) of the heart in patients with chronic kidney disease (CKD). MATERIALS AND METHODS: The study included 225 patients with stage I-CKD of non-diabetic etiology (median age 47.0 years, 50.2% of women). Depending on the degree of decrease in the glomerular filtration rate (GFR), all patients were divided into 3 groups. Group 1 (n=70) consisted of patients with GFR 89-45 ml / min / 1.73 m2, group 2 (n=120) - patients with GFR 44-15 ml / min / 1.73 m2, group 3 (n=35) - patients with GFR <15 mL / min / 1.73 m2. The control group includes persons without CKD. All patients underwent general clinical examination and transthoracic echocardiography; in 86 patients the level of cystatin C in the blood serum was determined. RESULTS: Hypertrophy of the left ventricle (LVH) of the heart was detected in 87 (38.7%) of 225 patients with CKD. Hypertrophic type (type I) of myocardial DD is diagnosed in 90 (41.4%) of 225 patients with CKD. The incidence of myocardial left ventricular dysfunction of the 1st type increased with a decrease in GFR, amounting to 30, 40 and 60% in groups 1, 2 and 3, respectively. The systolic function of the left ventricular myocardium was preserved. Patients with DD were older, they had a higher body mass index (BMI), a more pronounced decrease in GFR, a higher level of fibrinogen. They were more likely to have LVH. The level of cystatin C as the kidney function worsened, but when comparing the mean levels of cystatin C in patients with the presence / absence of DD in the groups isolated depending on the stage of CKD, no statistically significant differences were found. According to the multivariate analysis, the independent predictor of DD was the age (odds ratio 1.106, 95% confidence interval 1.051-1.157, p=0.00001). CONCLUSION: DD of the myocardium of the LV is detected on average in 40% of patients with CKD, the frequency of its development increases with the progression of renal dysfunction. The development of DD is influenced by traditional factors of cardiovascular risk (age, BMI), as well as the decline in GFR and closely related structural remodeling of LV myocardium.