Management of patients with operated refractory neovascular glaucoma (clinical observation)

Introduction. Thrombosis (occlusion) of the central retinal vein (RCVO) and its branches is one of the main causes of loss or significant decrease in vision, including in people of working age, while RCVO is the second most common retinal vascular disease after diabetic retinopathy. The incidence rates steadily increase with age, amounting to 0.7% in the 49–60 age group and reaching 4.6% in people over 80 years old. Acute violation of retinal venous blood flow often leads to retinal ischemia, triggering the mechanism of activation of endothelial vascular growth factor (VEGF). In a quarter of patients, occlusions of the retinal veins and its branches initially proceed according to the ischemic type, which is characterized by the formation of extensive non-perfused retinal zones occupying an area of 10 or more areas of the optic nerve head (optic nerve disc) according to fluorescent angiography (FAG). In 34% of such patients, the non-ischemic type of venous occlusion becomes ischemic within 3 years.Aim. To develop an optimal algorithm for  the  management of  patients with operated neovascular uncompensated glaucoma against the background of occlusion of the central retinal vein.Materials and methods. Two patients with operated secondary neovascular glaucoma of stage III-c. In the combined sequential therapy, the anti-VEGF medication Aflibercept (0.5 mg) was used, laser coagulation of residual newly formed vessels, laser reconstruction in the surgical area, contact transcleral cyclolazercoagulation, and laser coagulation of the peripheral parts of the retina were performed.Results. The combined sequential treatment, combined with the appointment of antihypertensive drugs in drops, allowed to stabilize the level of IOP. IOP indicators remained at the level of normal values during 1 year of follow-up.Conclusion. The use of combined laser technologies and anti-VEGF therapy allows potentiating and prolonging the hypotensive effect in the treatment of patients with operated secondary refractory neovascular glaucoma against the background of occlusion of the central retinal vein

Difficulties in differential diagnosis between obstructive and non-obstructive azoospermia

Introduction. The difference between obstructive and non-obstructive azoospermia (OA and NOA) is important for the choice of treatment tactics and adequate counseling of a married couple.Objective. To describe, analyze, and classify possible challenges in differentiating between two types of azoospermiaMaterials and methods. The retrospective review of database on surgical sperm retrieval attempts performed our hospital (n = 754). A subpopulation of 216 patients who were preliminary diagnosed with OA, was selected for further analysis. All patients had testicular pathology data following sperm retrieval attempt. Rate of reclassification was assessed as a primary outcome. Reclassified cases were further analyzed to find a possible reason for incorrect differential diagnosis.Results. Among 216 patients with initially suspected OA, 131 (60.6%) had evidence of spermatogenic dysfunction on pathological examination of seminiferous tubules. Multivariate regression analysis showed that only regular exposure to high temperatures was an independent predictor of NOA detection in patients with normal endocrine and clinical parameters (OR = 1.989; 95% CI = 1.101 – 3.595). Analysis of the decision tree showed that patients with inhibin B levels below 93 pg/ml had the highest risk of an incorrect initial diagnosis (82.6%).Conclusions. Differential diagnosis of OA and NOA is not such a simple task. Any case of azoospermia against the background of normal semen volume by default should be considered as a case of NOA if there is no anamnestic or clinical data clearly indicating obstruction. Regular exposure to high temperature is likely to cause azoospermia in men with initially severe disorders of spermatogenesis. Finally, the reference values of inhibin B offered by most laboratories are not intended to assess reproductive function

Experience in the use of docosahexaenoic acid (BrudiPlus) in patients with increased sperm DNA fragmentation index in Acad. V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology

Male factor is the reason of infertility in almost half of marriages. Infertile men have the percentage of sperm with violations of DNA integrity of over 30 %; with that, healthy fertile men have that indicator of less than 15 %. Understanding of importance of damages of sperm DNA is growing with distribution ofauxiliary reproductive technologies. As of today, these consequences have not been studies yet, and the therapeutic effect of intake of antioxidants has not direct correlation with the sperm DNA fragmentation level. Docosahexaenoic acid is one of the most valuable omega-3 polyunsaturated fatty acids for human health. Docosahexaenoic acid is the main component of the brain gray matter, retina, testes, and sperm cell membranes. In connection with that, a study was held the purpose of which was to assess the effect of the nutraceutical enzymatic docosahexaenoic acid triglyceride (BrudiPlus) in high concentrations on damaged sperm DNA of patients with idiopathic pathozoospermia. 40 patients with idiopathic pathozoospermia and the level of DNA fragmentation over the statutory value took part in this study. The following positive results were received: intake of BrudiPlus allowed decreasing sperm DNA damages and improving of antioxidant system of sperm

Lipidomic profile of seminal plasma in non-obstructive azoospermia with sperm maturation arrest

Introduction. The difference between obstructive and non-obstructive azoospermia with sperm maturation arrest is important for the choice of treatment tactics and adequate counseling of a married couple.Purpose of the study. The study aimed to assess the semen lipid profile in patients with sperm maturation arrest. Materials and methods. Samples of seminal plasma for lipid composition of 24 men with normozoospermia and 64 men with azoospermia were studied. Patients with azoospermia underwent microdissection testicular biopsy followed by the detection of testicular tissue pathology. Lipid extracts were analyzed by liquid chromatography with mass spectrometry. Lipid data were compared with the results of pathomorphological studies.Results. Comparison of two groups revealed a statistically significant concentration differences for 22 lipids detected in positive-ion mode and 11 lipids detected in negative-ion mode. Those lipids mainly belong to the classes hexosylceramides, sphingomyelins and phosphatidylcholines — simple ethers and oxidized lipids. In multivariate analysis, the following lipids were found to be statistically significant predictors of sperm maturation arrest: PC 16: 0_22: 6 lipid (β-coefficient: -0.73; 95% confidence interval (95% CI): -1.42 to -0.27; odds ratio (OR): 0.48; OR CI: 0.24 to 0.76; Wald's test: -2.58; p = 0.01), SM d20: 1/22:2 lipid (β-coefficient 4.96; 95% CI 2.29 to 9.13; OR: 142.31; OR CI: 9.90 to 9.22^103; Wald's test: 2.93; p = 0.003); PG 20:3_22: 6 lipid (β-coefficient 2.52; 95% CI 1.13 to 4.49; OR: 12.37; OR CI: 3.10 to 89.27; Wald's test: 3.02; p = 0.002); PC O- 16: 1/16:0 lipid (β-coefficient 1.96; 95% CI -4.12 to 0.27; OR: 0.14; OR CI: 0.02 to 0.76; Wald's test: -2.05; p = 0.04). The prediction model characteristics of sperm maturation arrest, obtained during cross-validation in the positiveion mode composed: sensitivity 91%, specificity 85%; in negative-ion mode: sensitivity 75%; specificity 81%.Conclusions. Even though early stages of spermatogenesis are equally preserved in both fertile men and men with homogeneous sperm maturation arrest, the semen in the studied group of patients differed in its lipid profile. Patients with non-obstructive azoospermia, associated with meiosis arrest, may have unique lipidomic characteristics of seminal plasma, which in the future will make it possible to differentiate various variants of severe male infertility using non-invasive methods

Результаты деятельности отделения сосудистой хирургии в условиях пандемии COVID-19

Aim. To conduct comparative analysis of the activities of the department of vascular surgery before and during the spread of new coronavirus infection COVID-19 (SARS-CoV-2).Methods. The analysis was performed on the number of outpatient visits of vascular surgeon for types of diagnosis, number and type of surgeries performed at the inpatient facilities of the LLC “Grand Medica” over 2019 (whole year) and 2020 (quarterly).Results. Significant decrease was noted in the number of visits of patients with cardiovascular diseases to vascular surgeon in the outpatient facility. The number of surgeries on limb arteries in patients among Kuzbass residents decreased by 26.4 %, among residents of other regions – by 59.5 %; in brachiocephalic arteries – by 12.5 % and 54.5 %, respectively. The number of percutaneous transluminal coronary angioplasty (PTCA) in patients among Kuzbass residents increased by 25.3 %, among residents of other regions remained unchanged.Conclusion. Decrease in the volume of provision of care for patients with cardiovascular diseases over 2–4 quarters of 2020 is caused by two groups of factors. The first one is associated directly to the epidemiological situation and countermeasures against the spread of SARS-CoV-2 while the second one is associated indirectly.Цель. Сравнительный анализ результатов деятельности отделения сосудистой хирургии до и в период распространения новой коронавирусной инфекции (COVID-19), вызванной вирусом SARS-CoV-2.Материалы и методы. Проведен анализ числа посещений сосудистого хирурга, ведущего амбулаторный прием, по видам диагнозов, числа и видов операций, выполненных в стационаре ООО «Гранд Медика» за 2019 (весь год) и 2020 (поквартально) гг.Результаты. Отмечено существенное снижение числа посещений сосудистого хирурга в поликлинике больными с артериальной патологией. Количество операций на артериях конечностей у жителей Кузбасса уменьшилось на 26,4%, жителей других регионов – на 59,5%; на брахиоцефальных артериях – на 12,5 и 54,5% соответственно. Число чрескожных транслюминальных коронарных ангиопластик среди жителей Кузбасса возросло на 25,3%, среди жителей других регионов осталось на прежнем уровне.Заключение. Снижение объемов оказания помощи больным сердечно-сосудистого профиля во втором – четвертом кварталах 2020 г. обусловлено двумя группами факторов. Первая из них непосредственно, вторая косвенно связаны с эпидемиологической обстановкой и мерами по противодействию распространению COVID-19

Method of the Cyclotorsion Error Compensation for Myopic Astigmatism during SMILE Surgery

Purpose: to develop an effective and safe method of cyclotorsion compensation, to improve the clinical and functional results of the of myopic astigmatism correction with SMILE surgery.Patients and methods: Two equivalent groups of 30 people (30 eyes) were formed with cyclotorsion from ±5 degrees («Standard» and «Verion»). The correction for cyclotorsion was carried out only in the «Verion» group. Before the laser-refraction surgery, all eyes were examined using «Verion» image guided system (Alcon, USA) to determine cyclotorsion. In the «Verion» group, the obtained cyclotorsion data was used to aligement the astigmatism axis by Introducing into the «Visumax» femtolaser system. Further, the operation was carried out according to the standard protocol. At 3 months after SMILE surgery, all patients were examined by a UDVA, CDVA, objective refraction. Furthermore, efficiency and safety, as well as vector analysis of corneal astigmatism according to Alpins were calculated indices at 3 months after surgery.Results: The mean and standard deviation of cyclotorsion of the «Standard» and «Verion» groups was 6.16 ± 1.31 D and 6.30 ± 1.36 degrees, respectively (p > 0.05). The increasement of 1 or more UDVA lines was noted at 20 % and 7 %, respectively after 3 months in the «Standard» and «Verion» groups. The safety index (postoperative UDVA / preoperative UDVA) in both groups was not statistically significantly different (p > 0.05). The predictability of the spherical equivalent within ±0.5 D relative to the target refraction (emmetropia) in the «Standard» and «Verion» groups was 70 % and 100 %, respectively. The predictability of the cylindrical component of refraction within ±0.5 D relative to the target refraction (emmetropia) was 40 % and 90 % for the «Standard» and «Verion» groups, respectively (p < 0.05). Difference vector was 1.01 ± 0.59 D in the group «Standard» and 0.64 ± 0.33 D in the «Verion» group (p < 0.05). Correction index was 0.80 ± 0.43 in the «Standard» group and 0.99 ± 0.04 in the «Verion» group (p < 0.05).Conclusions: Сyclotorsion compensation using the «Verion» image guided system is a safe method. It improves the efficiency and predictability of correction myopic astigmatism in patient undergoing to SMILE surgery. This method recommended for patients with cyclotorsion from ±5 degrees and myopic astigmatism from –0.75 D

HIGHER EDUCATION IN THE SYSTEM OF POLITICAL SOCIALIZATION

The article deals with the problem of political socialization of young people in the system of higher education. College students - this generation, which in a few years will determine the character of our country, to generate political, economic and cultural elite. Political socialization of youth is the key to further effective development of our country, and to achieve these goals it is necessary to ensure asystem of political education and training. The article analyzes the nature and underlying factors hindering political socialization of students

Morphologic Versions of Postoperative Opacities of the Lens Capsule in Contemporary Cataract Surgery (Working Classification)

Purpose: creation of working classification of morphologic variations of postoperative lens capsule opacity after Micro-Invasive cataract surgery. Material and methods. Morphologic study of the lens capsule (LC) has been conducted on 4 artiphakic cadaveric eyes. A specimen of an isolated anterior lens capsule, obtained during the repeated operation with changes characteristic for anterior capsular contraction syndrome has been studied too. The obtained specimens have been researched with the method of semithin sections. Results. The analysis of the morphologic cadaveric LC specimens revealed the polymorphism of secondary cataract (SC). Besides well known “classic” SC forms, which were caused by fibroplasias processes or pseudo-regeneration a new type of postoperative LC opacity not represented in the available literature before has been revealed. The given variant of opacities was called “pseudo-hyaloid” form and characterized by the absence of clear LC borders, changes of its normal structure, the appearance of loose fibrillar structure with microslit spaces and exfoliations, that possibly was the consequence of acustic cavitation, arising in the result of ultrasonic effect. As a result the LC lost characteristic for it the role of the dense bed and made impossible adhesion and migration on its changed surface the proliferative fibrocellular elements characteristic for “classic” SC forms. The microscopy results of the isolated anterior LC specimen in the area of capsulotomic aperture showed the presence of altered abundant loose fibrillar tissue with microporous structure and expressed forming of folds. Making layers of fibrous tissue exceeded the thickness of the normal anterior LC in 10 and more times and considerably reduced the diameter of capsulotomic aperture. Conclusion. The variety of postoperative LC opacities confirmed by the results of morphologic studies afforded to suggest a new working classification in which all possible morphologic variants and the stages of the secondary pathologic changes forming of anterior LC. The suggested classification is convenient for the understanding and must promote to make a right algorithm in the choice of optimal and safe technology of laser reconstructive interventions

Sperm oxidative stress: clinical significance and management

Oxidative stress is one of the leading causes of sperm dysfunction. Excessive amounts of reactive oxygen species can damage sperm membranes and disrupt their DNA integrity, which affects not only the likelihood of getting pregnant naturally, but also the clinical outcomes of assisted reproductive technologies and the risk of miscarriage. Sperm cells are extremely vulnerable to oxidative stress, given the limited functional reserve of their antioxidant systems and the DNA repair apparatus. Lifestyle factors, most of which are modifiable, often trigger generation of reactive oxygen species.  Both the lifestyle modification and use of antioxidant dietary supplements are adequate and compatible ways to combat male oxidative stress-associated infertility. The search for other internal and external sources of reactive oxygen species, the identification of the etiology of oxidative stress and treatment of respective diseases are necessary for the successful regulation of redox processes in the male reproductive system in clinical practice, which is required not only to overcome infertility, but also to prevent induced epigenetic disorders in subsequent generations. The article presents the analysis of the molecular mechanisms of male idiopathic infertility. The authors provide an overview of how to prevent oxidative stress as one of the causes of subfebrile fever. The article provides an overview of modern therapeutics, as well as the options for eliminating the consequences of the effect of reactive oxygen species on spermatogenesis and male reproductive system in general