Diagnostics and correction of metabolic disorders in patients with recurrent urolithiasis after endoscopic removal of stones

The article is devoted to the problem of kidney stones. The authors provide the results of a study of 107 men aged 48 to 76 years, were divided into three groups – primary and two control groups. The main and the first control group consisted of 40 patients with recurrent urolithiasis without urinary tract obstruction after endoscopic stone removal and partial androgen deficiency. The second control group consisted of 27 healthy men aged 48 to 70 years. Patients for one year he was promoted endoscopic removal of urinary stones: transurethral nephrolithotripsy – 55 patients, and percutaneous nephrolithotripsy – 25. After discharge from hospital all patients had a diagnosis and correction of metabolic disorders using physical-chemical and biochemical indicators of urine and blood. To study the mineral composition and structural-textural features of urinary stones and their fragments after surgical interventions were performed: x-ray diffraction, infrared spectroscopy, polarization and electron microscopy. Was carried out following the relapse of urolithiasis: patients of the main group received pathogenetic androgen therapy as monotherapy, and patients in the control group conventional treatment (antibiotics, spasmolytic, herbal remedies). The results of therapy and follow-up care for 6 years showed a low recurrence of stone formation in patients of the main group and highest in the control. Age-related decline in androgen levels in men may be an additional factor in stone formation. Pathogenic androgen replacement therapy leads to normalization of the content of lithogenic substances in the blood and urine, as well as physico-chemical properties of urine, thereby reducing the process of stone formation

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ДАННЫХ ДВУХЭНЕРГЕТИЧЕСКОГО КОМПЬЮТЕРНОГО ТОМОГРАФА И РЕЗУЛЬТАТОВ МИНЕРАЛОГИЧЕСКОГО ИССЛЕДОВАНИЯ МОЧЕВЫХ КАМНЕЙ ПРИ УРОЛИТИАЗЕ

Introduction. The idea of using dual-energy computed tomography (DECT) originated in the early development of computed tomography (CT). However, only recently, advances in radiation diagnosis have made it possible to use dual-energy CT for routine clinical use. We describes the characteristic features of dual-energy CT scanners, as well as the results of a study of 245 patients with urolithiasis, the identification of urinary stones in vivo and the subsequent comparative characteristics with mineralogical studies of uroliths. Purpose. Evaluate the possibility of using DECT in the diagnosis of urolithiasis with the determination of the chemical composition of urinary stones in vivo. Materials and methods. A group of patients (n=245) aged 18 to 84 years was examined. All patients with the established diagnosis-urolithiasis-were treated with DECT (Somatom Definition, Siemens, Forchheim, Germany) with data processing, then in-vitro infrared spectrometry (IR-Alpha-P spectrometer) to determine the true composition of the calcu lus. Results. After conducting the DECT and then ROC analysis and comparing the results with the IR-spectrometry data, it was established that stones with an average density of less than 500 HU according to DECT can be attributed to urate, with a uric acid content of more than 50% with a sensitivity of 91,1% (34 stones of 35) and specificity of 100% — the content of uric acid is also determined in polymineral calculi with a content of less than 50%. The knowledge gained on the composition and structure of the stone in vivo can subsequently be used in pathogenetic treatment and prevention of complications in patients with urolithiasis, and influence the choice of the tactics of removing the uroliths. Conclusions. The obtained results give the right to apply DECT in the diagnosis of urolithiasis, and with high sensitivity to identify urate stones in vivo, thereby influencing the choice of the tactics of removal of uroliths and pathogenetic treatment, as well as the prevention of complications in patients with urolithiasis.Идея применения двухэнергетической компьютерной томографии (ДЭКТ) возникла в раннем развитии компьютерной томографии (КТ). Однако только в последнее время достижения в лучевой диагностике сделали возможным использование ДЭКТ для повседневного клинического применения. В статье описываются характерные особенности двухэнергетических КТ-сканеров, а также результаты обследования 245 пациентов с мочекаменной болезнью, идентификация мочевых камней in vivo и последующая сравнительная характеристика с минералогическим исследованием уролитов. Цель работы: оценить возможность применения ДЭКТ в диагностике мочекаменной болезни с  определением химического состава мочевых камней in vivo. Обследована группа пациентов (n=245) в  возрасте от  18 до  84 лет. Всем пациентам с  установленным диагнозом мочекаменной болезни выполнялась ДЭКТ (Somatom Definition, Siemens, Forchheim, Germany) с обработкой данных, затем производилась in vitro ИК-спектрометрия (спектрометр ИК-Фурье Alpha-P) для установления истинного состава конкремента. После проведения ДЭКТ, а затем ROC-анализа и сопоставлении результатов с данными ИК-спектрометрии установлено, что конкременты средней плотностью менее 500 HU по данным ДЭКТ могут быть отнесены к уратам, при содержании мочевой кислоты более 50% с чувствительностью 91,1% (34 конкремента из 35) и специфичностью 100% — содержание мочевой кислоты определено также и в полиминеральных конкрементах при содержании ее менее 50%. Полученные знания о составе и структуре камня in vivo в последующем могут быть использованы в  патогенетическом лечении и  профилактики осложнений у  пациентов с МКБ, а также влиять на выбор тактики удаления уролитов. Полученные результаты дают право применять ДЭКТ в диагностике мочекаменной болезни, а также с высокой чувствительностью идентифицировать уратные камни in vivo, тем самым влиять на выбор тактики удаления уролитов и патогенетического лечения, а также профилактики осложнений у больных уролитиазом

INCREASING THE VALUE AND THE STABILITY OF POLYLACTIDE ELECTRET CHARACTERISTICS THROUGH INTRODUCTION OF MAGNESIUM OXIDE

Electret properties of the polylactic acid and its compositions with magnesium oxidewere studied. Samples were manufactured using different methods and with various components ratio. Mixing magnesium oxide with polylactic acid in viscous-flow state increased values and time stability of the electret state in the polymer by a factor of 1.5 – 3.5. The most efficient increase of the electret properties was observed for composition of polylactic acid and 8 % magnesium oxide

Protocol for the SEED-trial: Supported Employment and preventing Early Disability

Background: Early withdrawal or exclusion from the labor market leads to significant personal and societal costs. In Norway, the increasing numbers of young adults receiving disability pension is a growing problem. While a large body of research demonstrates positive effects of Supported Employment (SE) in patients with severe mental illness, no studies have yet investigated the effectiveness of SE in young adults with a range of social and health conditions who are receiving benefits. Methods/design: The SEED-trial is a randomized controlled trial (RCT) comparing traditional vocational rehabilitation (TVR) to SE in 124 unemployed individuals between the ages of 18-29 who are receiving benefits due to various social- or health-related problems. The primary outcome is labor market participation during the first year after enrollment. Secondary outcomes include physical and mental health, health behaviors, and well-being, collected at baseline, 6, and 12 months. A cost-benefit analysis will also be conducted. Discussion: The SEED-trial is the first RCT to compare SE to TVR in this important and vulnerable group, at risk of being excluded from working life at an early age

Consensus guidelines for the use and interpretation of angiogenesis assays

The formation of new blood vessels, or angiogenesis, is a complex process that plays important roles in growth and development, tissue and organ regeneration, as well as numerous pathological conditions. Angiogenesis undergoes multiple discrete steps that can be individually evaluated and quantified by a large number of bioassays. These independent assessments hold advantages but also have limitations. This article describes in vivo, ex vivo, and in vitro bioassays that are available for the evaluation of angiogenesis and highlights critical aspects that are relevant for their execution and proper interpretation. As such, this collaborative work is the first edition of consensus guidelines on angiogenesis bioassays to serve for current and future reference

SUBSTITUTION ANDROGEN THERAPY AFTER RADICAL TREATMENT OF PROSTATE CANCER

Introduction. The question of safety and efficacy of hormonal therapy with androgen deficiency after successful treatment of the prostate cancer (PC) remains debatable, despite the availability of data of the lack of correlation between the level of endogenous testosterone and the risk of developing PC or even reducing the risk of testosterone replacement therapy (TRT).Objective: a preliminary assessment of the possibility of using the TRT in men with androgen deficiency syndrome after radical treatment of PC – brachytherapy and radical prostatectomy (RP).Materials and methods. At the bases of North-Western State Medical University n. a. I.I. Mechnikov examined 12 men aged 50 to 65 years with history localized PC (T1-2N0M0) and symptoms of androgenic deficiency: 5 patients after brachytherapy (all with Т1сN0M0G ) and 7 after RP (1 with Т2aN0M0G , 6 with Т1сN0M0G ). All patients were prescribed TRT in transdermal form (1 % gel) for 15 months.Before and after TRT determined the total level testosterone in blood, prostate-specific antigen; was performed the evaluation of erectile dysfunction according to the IIEF (International Index оf Erectile Function) and of androgen deficiency according to the AMS (Aging Males’ Symptoms Scale), transrectal ultrasound, multislice computed tomography or magnetic resonance imaging and osteoscintigraphy. Clinical data were not processed by statistical methods due to insufficient number of observations. The actual average value of indicators is given. Further accumulation of sufficient number of cases for the statistical analysis and check of efficiency and safety of the investigated therapy is planned.Results. After TRT the average level of total testosterone increased compared to baseline in patients undergoing brachytherapy, from 3.4 to 18.4 nmol/l, in patients undergoing RP, from 2.7 to 15.3 nmol/l; the level of the prostate-specific antigen decreases from 2.1 to 1.7 ng/ml and from 1.9 to 1.3 ng/ml. Evaluation according to the AMS after TRT decreased in comparison with the initial in patients who underwent brachytherapy from 43 to 20 points, in patients who underwent RP – from 47 to 23 points, which indicated a change in the degree of androgen deficiency from severe to mild; evaluation of IIEF increased from 10 to 19 points, accordingly, and from 8 to 17 points, which reflected a change in the degree of erectile dysfunction from severe to mild. According to control transrectal ultrasound, multislice computed tomography, magnetic resonance imaging, and osteoscintigraphy, there has been detected no progress and recurrence of the tumor process.Conclusion. In patients with androgen deficiency syndrome after radical PC treatment, TRT is possible, since it is associated with improvement of erectile function and reduction of androgen deficiency and does not lead to relapse of the tumor

Organ-preserving operation in case of massive testicular rupture

The objective is to present a clinical case of blunt trauma of the scrotum with a massive testicular crush. The presented nosology, methods of diagnosis and surgical treatment is highlighted.Clinical case. Patient, 18 years old, was admitted to the clinic with acute symptoms and complaints of pain and increased size of the right part of the scrotum. Questioning revealed that 48 hours prior the patient received a blunt injury of the scrotum. Ultrasound of the scrotal organs showed that in the right part of the scrotum testicle is not clearly differentiated, in the lower pole hypoechogenic signal is observed, no blood flow was evident using the color Doppler mode, but examination of the upper pole showed weak blood flow, the epididymis was partially differentiated. Hematocele was observed. The diagnosis of injury of the scrotal organs was confirmed, traumatic injury of the right testicle. Emergency surgery was performed: necrotized areas of the lower pole of the testicle were resected, plastic sealing of the upper pole of the right testicle to the epididymis was performed. Postoperative period was free of complications. The patient was discharged on day 6 after the surgery. Control ultrasound after 3 months showed that the right testicle was smaller, its echostructure was homogenous, blood flow in the testicular parenchyma was observed. Hormonal status, blood testosterone levels, ejaculate parameters were normal.Conclusion. The presented clinical observation confirms that organ-sparing interventions for massive crush injury of the testicle with minimal volume of viable tissue are possible but patient’s age and time after injury should be taken into account

Results of surgical treatment of urethral prolapse in women

The study objective is to analyze the results of surgical treatment of urethral prolapse in women and to determine the optimal surgical tactics.Materials and methods. The authors conducted a retrospective analysis of case histories of 17 patients aged from 52 to 78 years who were treatedfrom 2003 to 2018 at the clinical bases of the Department of Urology of the North-Western State Medical University n. a. I.I. Mechnikov.Results. The urethral prolapse of the segmentalform was detected without complication in 4 women, and paraurethral cysts and urethral polyps accompanied in 3patients. In 13 others, circular forms complicated by urethrorrhagia and necrosis were detected. It is established that conservative therapy is often ineffective, with a circularform of urethral prolapse. At the same time, surgical tactics consist in strengthening the urethra (urethropexy) using tension free vaginal tape and obturator, mucosal plication or resection of a section of tissue leaving the urethra gives a favorable prognosis, and timely surgery helps prevent prolapse complications such as urinary retention or anemia due to chronic bleeding.Conclusion. Timely surgical treatment allows to quickly eliminate prolapse, which is accompanied by a favorable prognosis. This condition rarely leads to serious and life-threatening complications. Conservative methods of treatment are ineffective, especially with circular prolapse of the urethra, but such therapy is possible with a segmentalform, and also as a preparatory stage for surgical intervention; prevention of urethral prolapse is effective in the timely treatment of urinary tract infections, diseases of the gastrointestinal tract, weight control, exclusion of excessive physical exertion, active lifestyle

Synthesis, crystal structure and Hirshfeld surface analysis of diaquabis(o-phenylenediamine-κ2N,N′)nickel(II) naphthalene-1,5-disulfonate

The reaction of o-phenylenediamine (OPD), sodium naphthalene1,5-disulfonate (Na2NDS) and nickel sulfate in an ethanol–water mixture yielded the title compound, [Ni(OPD)2(H2O)2]·NDS or [Ni(C6H8N2)2(H2O)2](C10H6O6S2). This salt consists of a complex [Ni(OPD)2(H2O)2]2+ cation with two bidentate OPD ligands and trans aqua ligands, and a non-coordinating NDS2– anion, which is the double-deprotonated form of H2NDS. The NiII atom is situated at a center of inversion and exhibits a slightly tetragonally distorted {O2N4} octahedral coordination environment, with four shorter equatorial Ni—N bonds [2.0775 (17) and 2.0924 (18) Å] and a longer axial Ni—O bond [2.1381 (17) Å]. The OPD ligand is located about an inversion center and is nearly coplanar with the NiN4 plane [dihedral angle 0.95 (9)°]. In the crystal, the cations and anions are connected by charge-assisted intermolecular N—H...O and O—H...O hydrogen-bonding interactions into the tri-periodic network structure. Hirshfeld surface analysis indicates that the most important contributions to the crystal packing are from H...H (44.1%), O...H/H...O (34.3%), C...H/H...C (14.8%) C...C (6.5%) (involving the cations) and O...H/H...O (50%), H...H (25%), C...H/H...C (15.3%), C...C (8.2%) (involving the anions) interactions

One-time use of a free perforated cutaneous autograft during the surgical treatment of the oleogranuloma of the penis (clinical case)

A clinical case of oleogranuloma of the penis is presented. The article outlines the relevance of this problem, which has increased in recent years due to the emergence of new cases. current and treatment of this problem. The authors describe the diagnosis of oleogranuloma of the penis and the stages of its removing with one-time use of free perforated cutaneous autograft. It was the optimal method of surgical treatment in this case