Moscow State Medical University Research Articles

Choice of surgical approach to insulin-producing pancreatic tumors

To determine the optimal surgical approach to insulin-producing pancreatic tumors via an analysis of early postoperative results. There were 134 patients with insulin-producing pancreatic tumors followed by organic hyperinsulinism who have undergone surgery in the faculty-based surgical clinic of the Sechenov First Moscow State Medical University for the period 1990-2017. Patients were divided into three groups depending on type of surgical intervention. Surgical procedure was determined after comprehensive preoperative and intraoperative examination including intraoperative ultrasound. Incidence of postoperative complications was 32.8%. Ten (7.5%) patients required redo surgical interventions. Overall postoperative mortality was 4.5%. The best immediate results were observed in patients undergoing distal pancreatectomy. There was a correlation between incidence of early postoperative complications and tumor location depth in the enucleation group. Enucleation is advisable for insulinoma of pancreatic head or uncinated process, as well as superficial tumors of the left half of the pancreas. Distal pancreatectomy is indicated for deep tumors of the left half of the pancreas. Indications for pancreatoduodenectomy are individual.

Депрессия при болезни Паркинсона: аспекты психопатологической структуры и нозологической квалификации

Background: depression along with cognitive impairment is one of the most common non-motor psychopathological symptom of Parkinson's disease (PD), however, the problem of nosological differentiation and typology of affective disorders in PD is still unresolved. The goal: of this study is the investigation of psychopathological and nosological differentiation of depression in PD with the determination of the mode of association between affective and neurological disorders. Patients and methods : the research was conducted at the Clinic of Nervous Diseases named after A.Ya. Kozhevnikov of the I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). 28 patients (22 women, 6 men; mean age 64.4±9.4 years) with verified diagnoses of depression and PD were enrolled in the study. For assessment of depression we used Hamilton Depression Scale (HADS-21), for assessment of cognitive functions were used a brief neuropsychological examination of the cognitive sphere (KNOKS) and a brief mental status assessment scale (MMSE). Neurological examination was provided with unified Parkinson's disease rating scale (UPDRS). Results: a clinical typology of depression in PD, considering the patterns of formation and the association between affective and neurological disorders, has been proposed. Two types of depressive disorders were identified, each of which included two clinical subtypes: (I) depression directly associated with the onset of PD, including (1) nosogenic and (2) organic subtypes; and (II) depressions manifesting independently of PD, including (3) reactive and (4) endogenous subtypes. In addition, a special group of endoform depressive states have been identified. Conclusion: as the result of this study, the clinical and nosological heterogeneity of depression in PD was established, psychopathological structure of depressive episodes and the pattern of interaction between affective disorder and PD were determined. These findings expand the possibility of differential diagnosis, the determination of an individual prognosis and selection of personalized therapy.

Noninvasive Assessment of Fractional Flow Reserve Using Mathematical Modeling of Coronary Flow

Nowadays an invasive evaluation of fractional flow reserve (FFR) is one of the main methods used for detecting lesions that cause ischemia. Invasively obtained FFR <0.75 has the specificity of 100 %, and FFR >0.80 has the sensitivity >90 %. Recent achievements in computational fluid dynamics and computer simulations allow noninvasive assessment of FFR using data obtained by CT angiography performed according to standard protocol at rest without additional radiation, modification of image acquisition protocols, or added medications for vasodilatation. The present review covers the results of the DISCOVER, the NXT, the DEFACTO and the PLATFORM randomized multicenter studies as well as the prospects of using a noninvasive method for measuring FFR developed by specialists of the Institute of Numerical Mathematics in collaboration with specialists of the I. M. Sechenov First Moscow State Medical University.

ОБОСНОВАНИЕ ВЫБОРА ПЛОМБИРОВОЧНОГО МАТЕРИАЛА ДЛЯ ЛЕЧЕНИЯ ПРИШЕЕЧНОГО КАРИЕСА ПАЦИЕНТАМ С ВОСПАЛИТЕЛЬНЫМИ ЗАБОЛЕВАНИЯМИ ПАРОДОНТА ПРИ ПРОВЕДЕНИИ КЮРЕТАЖА ДЕСНЫ НА ПРИМЕРЕ ЭКСПЕРИМЕНТАЛЬНОЙ МОДЕЛИ

Background. The problem of choice of filling material in cervical caries treatment of patients with inflammatory periodontal diseases is considered in the article. It was evaluated the adaptation of filling materials to tooth tissues, as a result of mechanical some aggressive methods applied for treatment of periodontal tissues with curettes using ultrasonic apparatus. The following filling materials were suggested: composite light-curing filling material, hybrid composite light-cured material, and hybrid glass ionomer material with triple curing.
 Objectives. The aim of the work is to give arguments for the choice of filling material for cervical caries treatment of patients with inflammatory diseases of the periodontium during the treatment with the use of gingival curettage.
 Materials and methods. Carious cavities were artificially prepared on the teeth removed for surgical indications in the cervical areas and, according to the manufacturer's instructions, filled with: light-curing composite filling material, hybrid light-curing composite, hybrid glass-ionomer triple-curing cement and immersed for maturation at 37 °C into isotonic solution for 5 days. After that, there was removal of dental deposits and gum curettage carried out according to the Protocol developed by Moscow state medical and dental University under the name of A. I. Evdokimov, the Ministry of Healthcare, Russian Federation. The fillings were isolated with1 mm indentation from the edge of the insulating coating. All available cavities and apical holes of the roots are filled with wax. Then the teeth were placed in the eosin-B solution for 2 hours at a temperature of 37 °C. On the longitudinal saws in the center of the filling, a visual assessment of the edge permeability of the filling material was carried out using a Khera S .C., Chan K.C. five-point system.
 Results. The best results were obtained by light-curing composite filling material. So, it did not reveal the edge permeability of the filling material in 26 % of case and did not reveal any case of staining in the bottom of cavity. Also, in the composite of light curing, no staining of the bottom of artificial cavity was revealed. However, only 9 % of the samples had no permeability. In hybrid glass ionomer triple-cured cement, the greatest penetration of colorant beyond the edges of the artificial cavity was observed and amounted to 87 % of cases. Staining at the bottom of the artificial cavity was revealed in 13 % of cases. 
 Summary. The carried out studies on experimental models have shown that after the gingival curettage the lowest indices of edge permeability and better adaptive properties has composedly light-curing material. It proved the best resistance to traumatic and aggressive factors. It is optimal to use a light-cured composite filling material to cure patients with inflammatory periodontal diseases in the cervical areas, with mandatory compliance in the stages of preparation, filling and polishing.

Studying the Effect of New Didactic Tool on the Effectiveness of Educational Activity

This article presents the results of studies devoted to assessing the survival of students' knowledge, regardless of their basic training. The study was conducted based on two groups of specialists, recertified under the program "Pharmacy management and economics" at the Pharmacy Department of Sechenov First Moscow State Medical University. Some of the specialists of the experimental groups had been previously trained at the Pharmacy Department of Sechenov First Moscow State Medical University in 2012-2013 using a new developed didactic tool named "Activity Book". According to the results obtained, the skills acquired by the specialists trained using on "Activity Book" in 2012-2013, were characterized by higher "survivability".

The relationship between the parameters of microcirculation and the lung function in bronchial asthma in children

Among the chronic nonspecific lung diseases, bronchial asthma (BA) takes the leading place. BA in children is primarily diagnosed on the basis of clinical manifestations, methods of functional diagnosis, which allows you to verify the disease and assess the severity of the flow. An important role in the pathogenesis of asthma is played by the microcirculation system, affecting the course and progression of the disease. Dysfunction of microcirculation system supports chronic inflammatory process, affecting the level of perfusion, metabolism and gas exchange. The study was carried out on the basis of the University Children's Clinical Hospital (pulmonology department) of the First Moscow State Medical University named after I.M. Sechenov Ministry of Health of Russia (Sechenovsky University). 100 children aged 6-17 years with asthma were examined. Based on the study of the nature of microcirculatory disorders by the LDF method in bronchial asthma in children with different severity of the disease, correlation links between microcirculation indices, clinical manifestations and external respiration function (spirometry and computer bronchophonography) in children have been revealed. The observed decrease in microcirculation during the exacerbation of asthma is short-term and insignificant in mild severity and is longer and more significant with moderate BA, which supports a chronic inflammatory process in the bronchi. Correction of disorders of microcirculation is an important link in the therapeutic approach.

The history of the museum of human anatomy department of the I.M. Sechenov first moscow state medical university.

The history of the museum of human anatomy department of the I.M. Sechenov first moscow state medical university.

Ossified pseudomeningocele after the removal of an intradural neurinoma in the lumbar spine. A case report and literature review

The study objective is to describe a case of ossified pseudomeningocele after spinal surgery and to develop an optimal treatment strategy for this disorder.Materials and methods. We report a case of ossified pseudomeningocele developed after the removal of an intradural neurinoma in the lumbar spine in a female patient treated in the Clinic for Nervous Diseases, University Clinical Hospital No. 3 of the I.M. Sechenov First Moscow State Medical University in 2017. We also reviewed research literature describing this pathological condition.Results. Upon admission, the patient was diagnosed with paresis of the left foot occurring in ankle joint dorsiflexion (score 4), absence of the Achilles reflex on the left side, and hypoesthesia of two first toes of the left foot. Magnetic resonance imaging revealed a postoperative cyst of irregular shape located in soft tissues at the level of L vertebral body and compressing the dural sac. The patients underwent surgery that included separation of the pseudomeningocele cavity from the dural sac and placement of an external lumbar drainage. In the postoperative period, we observed a complete regression of neurological symptoms.Conclusion. Since ossified pseudomeningocele in the lumbar spine is extremely rare, an optimal treatment strategy has not been developed so far. We believe that maximum possible excision of the cyst wall and anastomotic sealing with a muscular or fat flap with biological glue followed by flap fixation from the extradural space is a simple and robust method of decompression and separation of the anastomosis. To eliminate the cavity in soft tissue of the paravertebral space, we recommend reconstruction of epidural fat with additional sealing using biological glue. To prevent anastomosis recurrence, we recommend placing an external lumbar drainage.

Ganglion cyst of Guyon’s canal as a rare cause of compression neuropathy of the ulnar nerve (literature review and case report)

The study objectiveis to analyze the existing research literature devoted to this problem and to assess clinical characteristics and specific features of the diagnosis and rational neurosurgical treatment for ganglion cyst of Guyon’s canal (GCGC) that caused compression neuropathy of the ulnar nerve.Materials and methods.Since 1955, researchers reported only 19 cases of ganglion cysts located in the wrist area and associated with tunnel neuropathy of the ulnar nerve. Since this condition is extremely rare, we present our own clinical observations.Results.Using the literature data, we described various types of ulnar nerve compression according to individual nerve characteristics determining clinical manifestations of GCGC. We analyzed the prevalence of GCGC among patients of various age and gender, disease pathogenesis, and main diagnostic methods. A patient with GCGC-associated compression ischemic neuropathy of the ulnar nerve was treated in the neurological clinic of the I. M. Sechenov First Moscow State Medical University in 2016. Using visualization tools, we found a ganglion cyst located on the palmar surface at the level of the hook-shaped bone. The cyst caused medial displacement of the ulnar nerve and ulnar artery. We performed microsurgical decompression of the right ulnar nerve at the level of Guyon’s canal and removed the articular ganglion cyst using a standard procedure. In the postoperative period, we observed partial regression of neurological disorders.Conclusion.To identify the cause of ulnar nerve neuropathy in Guyon’s canal, a physician should consider both clinical and electrophysiological data and the results of ultrasound examination and/or magnetic resonance imaging. A detailed examination of these patients allows clarifying morphological characteristics of the lesion and identifying such a rare lesion as ganglion cyst.

The internal system for quality assessment of education results at a medical university

Objective:The problem of devising an education quality assessment system at a medical higher educational institution has been analyzed in the article. The authors compare the views on the interpretation of the concept of “quality of education”, as well as examine the principles and criteria for the quality of education. A new approach to the internal system for assessing the quality of education at a medical higher education is offered in the article on the basis of the integration of all the components of the pedagogical system. The following components of the internal system of education quality assessment are considered: the conceptual component (forecasting, planning the strategic areas of the educational process development to achieve the quality of education, the mission and objectives), the procedural content component (monitoring at the initial and final stages of the education quality assessment), the self-analysis component (the analysis of students, teachers, department chairs’ activity); the analytical component (visualization of information obtained on the basis of transparency, informational openness of learning and upbringing results, the analysis and elimination of identified shortcomings, the introduction of advanced pedagogical experience into the educational process).Method:The study was conducted at the FSAEI HE I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenov University) in the period from February 2011 to March 2017. The sample group size was determined with the use of a special formula. Based on the sample size, 450 respondents were included in the study, and the number of people who would drop out was determined in the sample (n = 429), so the sample was representative in terms of quality and quantity. The students from 1 to 6 years were involved in the study in five training programs of the university who were randomly selected. An original questionnaire was devised. The questionnaire contained some standard questions and special questions on the research topic.Results:The main contingent of students is satisfied with the quality of education at Sechenov University and the level assessment of the quality of education is higher in comparison to other universities, but among the final-year students the assessment of the quality of education compared with other universities does not differ significantly. To attract applicants to FSAEI HE I.M. Sechenov First Moscow State Medical University the significant factors were: preserving a good reputation of the university (64.7%), prestige (53%) and the quality of education (50.7%). The most popular competencies among students of all the faculties and courses were the following: willingness to work with modern medical equipment (45% ± 2,3%), knowledge of innovative medical technologies (31,9% ± 2,2%). Almost every second student (55% ± 2.3%) believes that the quality of education at Sechenov University corresponds to the requirements of the current labor market.Conclusion:The conclusion has been drawn on the basis of the conducted research, that the internal system of assessing the quality of education is directed to increasing prestige of Russian higher medical education, its integration into the international educational space.

Local anesthesia for ultrasound-guided percutaneous cryoablation of renal cell carcinoma

Background. There is a category of patients with renal masses, due to severe concomitant diseases, can not perform the operation or may be associated with a threat to life. In addition, many patients with small tumor sites are extremely concerned about their disease and are negative about the tactics of active observation and insist on treatment. These patients can be offered alternative methods of treatment of renal cell carcinoma (RCC), the leading of which is cryoablation.Objective: to evaluate the effectiveness and safety of percutaneous cryoablation of the kidney tumor under ultrasound control.Materials and methods. In the Urology Clinic of the I.M. Sechenov First Moscow State Medical University during the period from 2015 to 2017 performed 23 percutaneous cryoablation of RCC, 7 (men – 4, women – 3) of which were performed under local anesthesia. In 4 patients due to severe concomitant diseases, general anesthesia was associated with an extremely high risk. Three patients refused from dynamic observation and from traditional surgical treatment; preferred an alternative treatment in the form of a percutaneous cryoablation under local anesthesia. In 4 cases, the formations were located in the lower segment along the posterior surface of the kidney, in 3 – along the lateral surface in the middle segment. The size of the formations was not used 4 cm (T1a). The age of the patients was 62.3 years (51 to 83 years). Right-sided localization of the tumor was noted in 3 patients, left-sided – in 4. One patient had a single kidney.At the preoperative stage and 6 months after the operation, all patients underwent ultrasound with dopplerography, multislice computerized tomography with contrast, and computer 3D modeling, which helped to clearly assess the size of the tumor, clarify the prevalence of the tumor process and the spatial ratio of the internal surface of the tumor node to the elements of the bowl-and-pelvis system. In all the observations, the formations were located along the posterior or lateral surface of the kidney; in the lower or middle segment; without invasion of the sine. We used a 3rd generation cryomash machine SeedNet gold (Galil Medical), cryoprobes IceSeed and IceRod. Intraoperative, immediately before cryoablation, a tumor biopsy was performed, the presence of RCC in all patients was confirmed morphologically.Results. According to the ultrasound examination with echodopplerography at 6 months after the operation, the size of the tumor node’s formations decreased on average by 6–8 mm, while there was no blood flow in them. When multislice computerized tomography with 3D modeling was performed, the formation was reduced and the accumulation of the contrast preparation was completely absent or their accumulation gradient did not exceed 10 HU (initially it was about 200 HU). There were no intraoperative complications. In 1 observation, a postoperative hematoma measuring 7 × 3 cm was resolved conservatively and did not require surgical treatment.Conclusions. Percutaneous cryodestruction under local anesthesia using ultrasound guidance seems to be an effective and safe technique for treating patients with stage T1a RCC with localization in the posterior or lateral surface in the lower or middle segments without invasion of the renal sinus and surrounding tissues. It is planned to continue monitoring patients to assess the long-term effectiveness of cryoablation.

Complex therapy of acute bacterial rinosinusis

Federal State Funded Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University under the Ministry of Health of the Russian Federation (I.M. Sechenov First MSMU) Acute rhinosinusitis is a common disease with worldwide prevalence. It is a disease that leads to the temporary disability and associates with decrease of quality of life. Patients with acute rhinosinusitis seek a medical care not only at otorhinolaryngologist but also to general practitioner, physician and pediatrician of the outpatient departments. Acute bacterial rhinosinusitis (ABRS) usually comes from acute viral upper respiratory infections or acute viral rhinosinusitis. Distinguishing acute viral rhinosinusitis and acute bacterial rhinosinusitis is a frequent challenge to the primary care clinician because of the lack of reliable criteria. So, the diagnosis of acute bacterial rhinosinusitis is most appropriately made on the basis of the medical history, length of the disease and clinical features. The treatment of ABRS should be complex, because despite the infectious etiology of the disease the necessity of antibiotics is still the point at issue. The main required effects of treatment of the acute bacterial rhinosinusitis are anti-inflammatory, mucolytic and anciliary. Phytotherapy is recommended for ABRS treatment by European, American and Russian guidelines.

High energy techniques in surgical treatment of reinke’s edema (data analyses and our experience)

Reinke’s edema is a form of chronic hypertrophic laryngitis. Conservative treatment includes IPP in case of concomitant refux esophagitis, phonopedic and anti-inflammatory local treatment. It’s strongly recommended to give up smoking to all patients. Unseccessful conservative therapy, laryngeal stenosis and severe hoarseness are indications for surgical treatment. In ENT Department of IM Sechenov First Moscow State Medical University 10 adult patients (female) with Reike’s edema were treated. In 7 patients surgery performed by K.Storz «cold-steel» instruments, in other 3 cases semiconductor laser was used. Results assessed by laryngostroboscopy and acoustic voice analyses data. Patients were observed upon 1 month after surgery. In «laser» group of patients shorter rehabilitation time has been noticed.

OVEREXPRESSION OF STAT4 - A POSSIBLE DIAGNOSTIC MARKER OF EARLY STAGES OF MYCOSIS FUNGOIDES

Background. Mycosis fungoides (MF) is the most common disease among the cutaneous T-cell lymphomas (85-90%). The accuracy of the diagnosis of MF, which is confirmed only by clinical, histological and immunohistochemical signs, is 50-75%. The aim of the study was to investigate genetic markers (FOXP3, STAT4, IL-12B) for early diagnosis of mycosis fungoides. Material and methods. A study involving 42 patients with MF and plaque parapsoriasis (PP) treated at the Dermatology Department of I.M. Sechenov First Moscow State Medical University and National Medical Hematology Research Сenter, was performed. The analysis of gene expression FOXP3, STAT4, IL-12B was carried out by TaqMan Real time-PCR. The objects of the study were lesional skin samples of patients. A group with MF consisted of 29 patients, a group with PP consisted of 13 patients, a control group included 10 healthy volunteers. Results. The study revealed that the level of STAT4 gene expression showed a significant (9 times) increase in the mRNA expression of STAT4 transcripts in patients with MF (166) compared with patients with PP (17.9; p < 0.05) and 553 times - with healthy volunteers (0.3; p < 0.05). There was also a statistically significant predominance of the level of mRNA expression of STAT4 transcripts in patients with spotted and plaque stages of MF (180; 318) compared with patients with PP (17.9; p < 0.05) and healthy volunteers (0.3; p < 0.05), as well as a sharp decrease in patients with erythrodermic form of MF (7.19). For early diagnosis of MF the level of expression of mRNA transcripts STAT4 is of great importance. Inclusion of STAT4 in the list of diagnostic features increases the accuracy of differential diagnosis of MF and PP from 59.1 to 81.8%.

CLINICAL ASPECTS AND ALGORITHMS DIAGNOSTICS OF DIFFERENT TYPES OF ERYTHRODERMA

Erythroderma - the term used for the description intensive and usually widespread reddening of the skin which has arisen owing to activation of the previous inflammatory dermatosis. The aim is to study and compare clinical manifestations of various forms of an erythroderma and also to develop an algorithm of their diagnostics and therapy. We observed 133 patients with an erythroderma undergoing investigation and treatment on bases of dermatologic depatments: V.A. Rakhmanov Clinic of skin and veneral diseases I.M. Sechenov First Moscow State Medical University, Leningrad Regional centre of specialized types of a medical care, Skin-Venerologic Clinic of St. Petersburg and university clinic Bonn the period from 2001 to 2018. A prospective study was conducted at 51 patients, is retrospective - at 82 patients. From them were men - 83 persons and women - 50 people, whose average age was 49 years (in the range 26-85 years). The collecting of the anamnesis is carried out; clinical data are studied and for verification of the diagnosis are compared with results of a histological research. Clinical manifestations of all surveyed groups were similar. The most frequent symptoms were generalized reddening and a peeling of the skin, an itch of skin, different degree of expressiveness and a form of changes of nail plates, changes of palms and soles. Diagnosis on the basis of only clinical examination gave the chance to make the correct diagnosis in 77(58%), in comparison with the final diagnosis 112(84,1%) from 133 made on the basis of set of clinical, histological data and reaction to therapy. In particular, the diagnosis of a psoriatic erythroderma was made in 26(34,58%) from 133, an atopic eythroderma - 20(26,6%), the eythroderma caused by reception of drugs - 24(31,92%), an erythrodermic form of mycosis fungoides/Cezary syndrome - 7(9,31%) from 133 patients. The clinical diagnosis didn’t correspond to the final diagnosis in other 56(42%) from 133 patients. Thus, at diagnosis and definition of forms of an erythroderma important aspect is clinical examination and clinicopathologic correlation.

Safety and efficacy of thulium transurethral en block resection with fiber laser “Urоlaz” for treatment of non-muscle-invasive bladder cancer

Background. The high recurrence rate after conventional transurethral resection (cTUR) for bladder cancer (BC) requires search for more effective methods of surgical treatment. Objective: to evaluate the feasibility, safety, and efficacy of cTUR versus thulium laser en bloc resection of bladder tumors using new fiber laser “Urolaz”. Materials and methods. 129 patients, who underwent surgical treatment for BC between 2015–2017 in urological department of I.M. Sechenov First Moscow State Medical University were included in the study. The cTUR were performed for 58 patients, 71 patients underwent thulium laser en bloc resection of bladder tumors. Results. The presence of detrusor muscle in specimen was 58.62 % in cTUR group and 91.55 % in thulium laser en bloc resection group respectively. Obturator nerve reflex, bladder perforation, and bleeding in thulium laser en bloc resection group were absent, therefore immediate instillation of chemotherapy was made in all these cases. Recurrence rate after 12 and 18 months after surgery in the group of en bloc resection was statistically lower compared to the cTUR group. Conclusion. The results, obtained in our study shows that thulium en bloc resection using thulium fiber laser “Urolaz” is feasible, effective and safe procedure for patients with BC. Thulium en bloc resection has a number of advantages over the cTUR: absence of obturator nerve reflex, high quality of specimen for pathological examination (presence of detrusor muscle in specimen was 91.55 %) and low recurrence rate.

Risk factors for urethral stricture and/or bladder neck contracture after monopolar transurethral resection of the prostate for benign prostatic hyperplasia

To identify risk factors for urethral stricture and/or bladder neck contracture after transurethral resection of benign prostatic hyperplasia. We performed a retrospective analysis of 402 patients, which underwent a monopolar transurethral resection of the prostate in the urology clinic of Sechenov First Moscow State Medical University for prostatic hyperplasia during the period 2011-2014. Urethral stricture and (or) bladder neck contracture in the postoperative period were diagnosed in 61 (15.27%) patients; 34 patients (8.6%) had urethral stricture, 20 (4.97%) bladder neck contracture, and 7 (1.7%) had a combination of urethral stricture and bladder neck contracture. In 341 of cases (84.73%), no late postoperative complications were observed. A total of 106 of the 341 patients met the inclusion criteria, hence, containing all the information necessary for analysis such as the volume of the prostate, the duration of the surgery, the size of the endoscope, data on concomitant diseases, analysis prostatic secretion, and so on. Thus, two groups were formed. Group 1 (106 patients) is the control group in which urethral strictures and/or bladder neck contractures did not occur in the long-term postoperative period and group 2 (61 patients), in which was observed the formation of these complications. To calculate the statistical significance of the differences for categorical data, Fisher criterion was used. For quantitative variables, in the case of normal data distribution, an unpaired t-test or one-way analysis of variance was used; for data having a distribution different from normal, a Mann-Whitney rank test was used. Regression analysis established the significance of the influence of four factors on the development of scar-sclerotic changes of urethra and bladder neck: the tool diameter 27 Fr ( p < 0.0001), presence of prostatitis in past medical history ( p < 0.0001), prostate volume ( p = 0.003), and redraining of the bladder ( p = 0.0162). The relationship between the diameter of the instrument, presence of chronic prostatitis in anamnesis, increased volume of the prostate, and repeated drainage of the bladder using the urethral catheter with the risk of developing scar-sclerotic changes in the urethra and/or bladder neck are statistically reliable and confirmed as a result of regression analysis.

Multiple application of three-dimensional soft kidney models with localized kidney cancer: A pilot study.

To evaluate the effectiveness of three-dimensional printing application in urology for localized renal cancer treatment using three-dimensional printed soft models. The study included five patients with kidney tumors. The patients were treated in the Urology Clinic of I.M. Sechenov First Moscow State Medical University from February 2016 to June 2017. Personalized three-dimensional printed models based on computed tomographic images were created. Five surgeons took part in a survey in which the utility of computed tomographic images versus three-dimensional printed models for presurgical planning was compared. A laparoscopic partial nephrectomy training using the developed three-dimensional printed models was performed by the same surgeons in a surgical training box. The patients underwent endoscopic surgery using laparoscopic access. The average time of surgery was 187 min. All the operations were performed with complete renal artery clamping. The average warm ischemia time was 19.5 min and the average blood loss was 170 mL. No conversions to open surgery or radical nephrectomy, and no postoperative complications and deaths were observed. All the surgical margins were negative. The tumors were morphologically identified as renal cell carcinoma in four cases and as oncocytoma in one case. The developed three-dimensional printed models allow one to evaluate the pathological anatomy of tumors more effectively. High similarity between three-dimensional models and native kidneys contribute to improvement of surgical skills necessary for partial nephrectomy. Training on the three-dimensional models also allows surgeons to facilitate selection of an optimal surgical tactics for each patient.

The clinical role of X-ray computed tomography to predict the clinical efficiency of extracorporeal shock wave lithotripsy

To evaluate the clinical efficiency of computed tomography for diagnostics of patients with urolithiasis and the choice of treatment strategy. The study was carried out at the Urological Clinic of I.M. Sechenov First Moscow State Medical University and included 1044 patients with urinary stones. The ultimate goal of this study was to predict the clinical efficiency of extracorporeal shock wave lithotripsy using a combination of computed tomography and densitometry. Extracorporeal shock wave lithotripsy was performed on "Siemens Lithostar Plus," "Siemens Modularis Uro," and "Dornier Gemini" lithotripters. Statistical analysis of clinical data included evaluation of individual sampling groups and calculation of weighted arithmetic mean ( M). The efficiency of extracorporeal shock wave lithotripsy has been determined primarily using X-ray analysis of the concrement outlines and the structure (homogeneous or heterogeneous) of its central zone. However, in terms of efficiency and repetition rate (the number of fragmentation procedures required for complete clearance) of extracorporeal shock wave lithotripsy, the mean density of the concrement along the whole length of its three-dimensional structure (expressed in Hounsfield units) appeared to be the most reliable and informative predictive index in this study. The combination of computed tomography with densitometry in the treatment of patients with urolithiasis allows one (1) to determine the exact localization, size, X-ray structure, and structural density of urinary stones and (2) to predict, on the basis of densitometric data histograms, the clinical efficiency and repetition rate of extracorporeal shock wave lithotripsy with due regard to the X-ray structure of peripheral and central zones, and mean density (in Hounsfield units) of urinary concrements.

Influence of ABCB1 and CYP3A5 gene polymorphisms on pharmacokinetics of apixaban in patients with atrial fibrillation and acute stroke.

IntroductionDifficulties in non-vitamin K anticoagulant (NOAC) administration in acute stroke can be associated with changes in pharmacokinetic parameters of NOAC such as biotransformation, distribution, and excretion. Therefore, obtaining data on pharmacokinetics of NOAC and factors that affect it may help develop algorithms for personalized use of this drug class in patients with acute cardioembolic stroke.Patients and methodsPharmacokinetics of apixaban in patients with acute stroke was studied earlier by Kryukov et al. The present study enrolled 17 patients with cardioembolic stroke, who received 5 mg of apixaban. In order to evaluate the pharmacokinetic parameters of apixaban, venous blood samples were collected before taking 5 mg of apixaban (point 0) and 1, 2, 3, 4, 10, and 12 hours after drug intake. Blood samples were centrifuged at 3000 rpm for 15 minutes. Separate plasma was aliquoted in Eppendorf tubes and frozen at −70°C until analysis. High-performance liquid chromatography mass spectrometry analysis was used to determine apixaban plasma concentration. Genotyping was performed by real-time polymerase chain reaction. CYP3A isoenzyme group activity was evaluated by determining urinary concentration of endogenous substrate of the enzyme and its metabolite (6-β-hydroxycortisol to cortisol ratio). Statistical analysis was performed using SPSS Statistics version 20.0. The protocol of this study was reviewed and approved by the ethics committee; patients or their representatives signed an informed consent.ResultsABCB1 (rs1045642 and rs4148738) gene polymorphisms do not affect the pharmacokinetics of apixaban as well as CYP3A5 (rs776746) gene polymorphisms. Apixaban pharmacokinetics in groups with different genotypes did not differ statistically significantly. Correlation analysis showed no statistically significant relationship between pharmacokinetic parameters of apixaban and the metabolic activity of CYP3A.ConclusionQuestions such as depending on genotyping results for apixaban dosing and implementation of express genotyping in clinical practice remain open for NOACs. Large population studies are required to clarify the clinical significance of genotyping for this drug class.