Subgroup 1B Research Articles

HISTORICAL AND PSYCHOTHERAPEUTIC ASPECTS OF PENILE IMPLANTATION

Introduction. To date, despite significant progress in the field of erectile dysfunction (ED) pharmacotherapy, for a certain group of patients, the implantation of a penile prosthesis is the only possible way to return them to an active sexual life. To increase the satisfaction with the sexual life of men and their partners, the improvement of models of penile prostheses, which has its own history, is being carried out. In addition, in andrology, methods of psychotherapeutic correction of ED are introduced for both men and their partners.
 The aim. To determine the influence of the type of penile implant and psychotherapeutic correction on the frequency of satisfaction of sexual partners.
 Materials and methods. Out of 354 patients operated on by us, 80 men with severe organic ED and their sexual partners consented to participate in the study. Men underwent penile implantation. Participants were divided into two groups:
 1st group – 40 couples in which men had a plastic implant installed;
 The 2nd group – 40 couples in which men had a hydraulic implant installed.
 Each group was divided into two subgroups. In subgroups 1a (20 couples) and 2a (20 couples), psychological counseling was given to both partners before and after the operation, in subgroups 1b and 2b no psychological counseling was given.
 Results: Between subgroups 1b and 2b, patients whose psychological counseling was not performed, differences in the general satisfaction with sexual life in women were not observed, and it was observed in both subgroups in 65% of the patients' partners. Men of these subgroups were satisfied with their sex life after implantation in 80% and 85%, respectively.
 In 95% of women after psychotherapeutic support (subgroups 1a and 2a), satisfaction with sexual life was noted, which was statistically significantly higher (Fisher's exact test, p < 0.05) than in women of subgroups 1b and 2b.
 In men of subgroups 1a and 2a, this indicator corresponded to 90% and 95%, respectively. Dissatisfaction among partners in subgroups 1b, 2b, respectively, was 35%, among women after psychotherapeutic correction (subgroups 1a, 2a), 10% and 5%, respectively.
 Conclusions. The obtained data show that satisfaction with sexual life in men does not depend on the implant model and psychological counseling. Unlike men, the frequency of satisfaction with sexual life in female partners after psychotherapeutic correction reaches 95%, which is statistically significant more than without it (р˂0.05).

Thrombodynamics and Quantitative phase imaging of platelets in the assessment of hemostasis in pregnant women with protein C / protein S deficiency

Relevance. A hypercoagulable state caused by hereditary or acquired deficiency of antithrombotic factors can contribute to disruption of the uteroplacental circulation with the development of serious pregnancy complications, which requires effective monitoring of hemostasis during the use of pathogenetic anticoagulant therapy.The purpose of the study is to improve methods for diagnosing and monitoring hemostatic disorders in pregnant women with thrombophilia (protein C/protein S deficiency) and complicated pregnancy based on the use of an integral thrombodynamic test and quantitative phase imaging of platelets.Material and methods. 45 pregnant women were examined in the first and second trimester: 20 women with normal pregnancy (comparison group) and 25 (main group) with thrombophilia (protein S/protein C deficiency). 16 pregnant women (subgroup 1A) received a full course of preconception preparation with the prescription of LMWH, 9 pregnant women (subgroup 1B) did not complete the course in full for various reasons. To study hemostasis, along with routine methods (determination of APTT, TT, PT, Fibrinogen, INR and D-dimer), an integral assessment of coagulation using the Thrombodynamics method and quantitative phase imaging (QPI) of platelets in real time were performed.Results. It was found that routine methods are not sufficiently informative; statistically significant changes against the background of thrombophilia and during treatment with LMWH were noted only based on the results of assessing the level of fibrinogen and D-dimer. In the complex of thrombodynamics indicators, the most sensitive parameters were the steady-state clot growth rate (Vst), clot size at 30 minutes of the study (CS) and clot density (D). The QPI method revealed features of the morphological structure of platelets with a predominance in pregnant women with protein S/protein C deficiency of the activated cell population with an increase in the median values of diameter and perimeter by 14 and 20 %, respectively (p < 0.05). The effectiveness of LMWH therapy was assessed by normalization of the analyzed parameters.Conclusion. Timely and adequate correction of hemostasis disorders, carried out while monitoring coagulation and platelet parameters, taking into account all clinical data, can significantly reduce the risk of complications for the mother and fetus.

RISK FACTORS FOR THE DEVELOPMENT OF VENOUS THROMBOEMBOLISM IN PATIENTS WITH UNCOMPLICATED ACUTE CALCULOUS CHOLECYSTITIS

The aim is to identify and analyze risk factors for venous thromboembolism in patients diagnosed with uncomplicated acute calculous cholecystitis.
 Materials and Methods. A prospective analysis of clinical data of 71 patients diagnosed with uncomplicated acute calculous cholecystitis was conducted. Two clinical groups were formed: subgroup 1A (n=6) included patients diagnosed with venous thromboembolism, and subgroup 1B (n=65) included patients without venous thromboembolism.
 Results and Discussion. During the study, the coagulation potential of the patients was studied. The prothrombin index on the third day of the postoperative period and at the time of discharge was significantly higher in subgroup 1A patients (109.1% and 123.0%) compared to subgroup 1B patients (98.0% and 96.4%). The situation with total fibrinogen is similar: the mean level of this indicator during the entire observation period was significantly higher in patients of subgroup 1A (p<0.05). The mean D-dimer level at the time of hospital discharge in subgroup 1A was 3.6 mg/ml higher compared to the level of this indicator on the first day after surgery, and in subgroup 1B it was only 0.5 mg/ml higher. The risk of venous thromboembolism according to the Caprini score in subgroup 1A was 7.5 [5.5; 9.0] points, compared to 6.0 [4.0; 8.0] points in subgroup 1B. Assessment of the risk of venous thromboembolism according to the Rogers scale showed similar results: 8.0 [6.3; 9.8] points for patients of subgroup 1A and 7.0 [6.0; 8.0] points for subgroup 1B. When assessing the interleukin 1 beta (IL1b) level, its increased value was detected in subgroup 1A - 14.0 [7.0; 33.7] pg/ml, as opposed to subgroup 1B, where it was 9.0 [3.5; 26.2] pg/ml. Similar results were found in the assessment of tumor necrosis factor TNF: the mean values of this cytokine level were also higher in subgroup 1A (13.9 [7.9; 15.8] pg/ml) than in subgroup 1B (8.8 [6.0; 13.1] pg/ml).
 Conclusions. According to the results of the study, the following factors for the development of venous thromboembolism in patients with uncomplicated acute calculous cholecystitis were determined: elevated levels of indicators of total fibrinogen, D-dimer, interleukin 1 beta (IL1b) and tumor necrosis factor (TNF) at the time of admission. The mean values of the total risk assessment points according to the Caprini score and Rogers scale were significantly higher (p<0.05) in the subgroup of patients with uncomplicated acute calculous cholecystitis who later developed venous thromboembolism.

Potential Significance of Serum Autoantibodies to Endometrial Antigens, α-Enolase and Hormones in Non-Invasive Diagnosis and Pathogenesis of Endometriosis.

The objective of the study was to evaluate the profile of serum autoantibodies and their diagnostic and pathogenetic significance in ovarian endometrioma (OEM) and deep infiltrative endometriosis (DIE). The study enrolled 74 patients with endometriosis (Group 1), including 53 patients with OEM (Subgroup 1a); 21 patients with DIE without ovarian lesions (Subgroup 1b); and 27 patients without endometriosis (Group 2). The diagnosis was confirmed by laparoscopic surgery and histologic examination of resected tissues. Antibodies (M, G) to tropomyosin 3 (TPM), tropomodulin 3 (TMOD), α-enolase (ENO), estradiol (E2), progesterone (PG), and human chorionic gonadotropin (hCG) were identified in blood serum using modified ELISA. In endometriosis, antibodies to endometrial antigens, hormones, and ENO were detected more often than antiphospholipid and antinuclear antibodies. Higher levels of IgM to TPM, hCG, E2, and PG and IgG to TMOD, ENO, E2, and hCG were found in Subgroup 1a compared to Group 2. IgM to TPM, hCG, E2, PG, and IgG to E2 and ENO had a high diagnostic value for OEM (AUC > 0.7), with antibodies to TPM having the highest sensitivity and specificity (73.6% and 81.5%). In Subgroup 1b, only the levels of IgM to TPM and hCG were higher than in Group 2. These antibodies had a high diagnostic value for DIE. Thus, endometriosis is associated with autoantibodies to endometrial antigens, α-enolase, steroid, and gonadotropic hormones. A wider spectrum of antibodies is detected in OEM than in DIE. These antibodies have a high diagnostic value for OEM and DIE and potential pathogenetic significance for endometriosis and associated infertility.

The potential role of radiochemical analysis of CT images of epicardial adipose tissue in the prognosis of acute myocardial infarction

Introduction. Multispiral computed tomography (MSCT) coronary angiography (CAG) is a highly informative method of visualizing atherosclerotic plaques in the coronary arteries and assessing their structure. At the same time, this method has a few significant drawbacks associated with the intravenous administration of iodine-containing radiopaque agents as well as high radiation exposure. The radiomic analysis of contrast-free MSCT images allows calculating many additional quantitative parameters, which can potentially be associated with atherosclerotic plaque instability and the degree of coronary artery stenosis. At the same time, the prognostic and diagnostic value of radiomic characteristics has not been investigated.Aim: To assess whether there is an association between radiomic indexes of EAT on non-contrast MSCT cardiac images with the degree of atherosclerotic coronary artery stenosis in patients with stable CAD, as well as the incidence of acute coronary syndrome (ACS) within 5 years in this category of patients.Material and Methods. We retrospectively reviewed 100 MSCT-CAG studies performed to diagnose coronary heart disease in patients. 39 patients with signs of coronary stenosis up to 50% and registered in Tomsk medical information systems (MIS) for at least 5 years were selected, as well as 15 people without signs of coronary arteries (CA) atherosclerosis as a control group. Epicardial adipose tissue (EAT) volume was assessed and 837 radiomic characteristics were calculated on non-contrasted MSCT cardiac images of all patients (54 people). The presence or absence of ACS within 5 years after MSCT-CAG in each patient was monitored according to Tomsk MIS data. Statistical analysis and comparison of indices were performed in control group (group 2) and study group (group 1), as well as in subgroups of patients who had suffered AMI (group 1a) and those who had not (group 1b).Results. When comparing group 1 with the control group, significant differences (p < 0.05) were found for all radiomic parameters, density, and volume of EAT. Correlation analysis did not reveal any relationship between the radiomic characteristics of EAT and the degree of coronary artery stenosis, as well as the calcium index. According to the results of the MIS of Tomsk analysis, group 1 was divided into 2 subgroups: without ACS (group 1a; n = 27 (50%)) and with ACS (group 1b; n = 12 (22%)). When comparing subgroups 1a and 1b, there were no significant differences in the volume and density of EAT (p > 0.05), however, 8 out of 837 radiomic parameters differed significantly. Multiple regression analysis has shown that the Size Zone Nonuniformity gray level zone matrix (SZN-GLSZM) and Gray Level Variance (GLCM) gray co-occurrence matrix are independent predictors of the development of ACS within 5 years. According to the results of the ROC analysis, the logistic model with the inclusion of radiomic data showed high sensitivity and specificity in predicting the development of ACS (cut-off point <8025.7; specificity 96%, sensitivity 75%, AUC = 0.806, p < 0.001 for SZN; cut-off point <4.08; specificity 93%, sensitivity 83%, AUC = 0.861 for GLV; p < 0.001).Conclusion. SZN GLSZM and GLV GLCM radiomic features on non-contrast MSCT images of EAT are associated with the incidence of ASC in patients with coronary artery atherosclerosis. Radiomic analysis of EAT could potentially be used for personalized assessment of the ACS risk.

Association of sagittal alignment of tibial and femoral components with clinical outcome in total knee arthroplasty: A prospective cohort study

BackgroundIn total knee replacement component alignment is a very crucial parameter to achieve better clinical outcomes. Only a few studies exist in the literature on the association between sagittal alignment of components and clinical outcomes. The study aimed to measure the functional outcome and association between the sagittal alignment of total knee replacement components and their clinical outcome. Material & methodsProspectively we collected data of 81 knees (cases) following total knee replacement. The sagittal femoral angle, anterior and posterior tibial slopes were assessed on 2nd postoperative week using a lateral radiograph. Based on these measures 2 groups were made. Group A comprises of the femoral component which was further divided into A1 (41 cases) and A2 (40 cases) based on the component's sagittal femoral angle in flexion or extension.Group B comprises of Tibial component subgrouped based on the degree of Tibal angle as the posterior tibial slope or anterior tibial slopes. The B1 subgroup has posterior tibial slope of more than 5° (23 cases), B2 posterior tibial slope within 5° (53 cases), and B3 anterior tibial slope (5 cases). Preoperative and follow-ups at one month, 6 months, and 3 year; the functional assessment was performed using the American Knee Society score and Oxford knee scores. The duration to raise the leg straight (in days) was also measured. Results52 patients (81 total knee replacement cases) with a mean age of 62.88 ± 8.21 were enrolled. Results showed significant improvement in mean American Knee Society score (preoperative 32.91 ± 2.61 to 86.68 ± 2.52 postoperatively at 3 years; P < 0.001) and mean Oxford knee score (preoperative 34.69 ± 1.06 to 19.20 ± 1.91 postoperatively at 3-years; P < 0.001). The correlation of American Knee Society score between the femoral component angle and tibial component angle suggested that the maximum correlation was between Group A2 (Femoral angle = 91 to 95) and Group B2 (Tibal angle = 86 to 90), with p-value <0.0001. ConclusionsThere is a positive association between the proper sagittal alignment of femoral component and tibial component in total knee replacement with clinical outcome. The functional outcome (in terms of mean American Knee Society score) is better when the femoral component is positioned in extension and the posterior tibial slope of less than 5° is achieved.

Survival Outcomes of Patients with Esophageal Cancer Who Did Not Proceed to Surgery after Neoadjuvant Treatment.

This retrospective study examined outcomes in esophageal squamous cell carcinoma (ESCC) patients who did not undergo surgical resection after neoadjuvant chemoradiotherapy (nCRT). Patients receiving nCRT between 2012 and 2020 were divided into two groups: group 1 (scheduled surgery) and group 2 (no surgery). Group 2 was further categorized into subgroups based on reasons for not proceeding to surgery: group 2a (disease progression), group 2b (poor general conditions), and group 2c (patient refusal). Overall survival (OS) was the primary outcome. Group 1 comprised 145 patients, while subgroups 2a, 2b, and 2c comprised 24, 16, and 31 patients, respectively. The 3-year OS rate was significantly lower in group 2 compared with group 1 (34% versus 56%, p < 0.001). A subgroup analysis showed varying 3-year OS rates: 13% for group 2a, 25% for group 2b, and 58% for group 2c (p < 0.001). Propensity score matching for group 2c and group 1 revealed no significant difference in 3-year OS rates (p = 0.91). One-third of ESCC patients receiving nCRT did not undergo surgical resection. Overall survival in this group was generally poorer, except for those who refused surgery (group 2c).

The effectiveness of preventive use of partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFibre®) in patients with benign prostatic hyperplasia and chronic functional constipation

Anatomical proximity of the prostate gland and colon, common innervation, blood and lymph circulation create prerequisites for the involvement of the intestine in the pathological process in prostate diseases.&#x0D; Aim To evaluate the effectiveness of preventive treatment of chronic constipation (CC) with the use of partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFiber®) in patients with benign prostatic hyperplasia (BPH) who are shown to have a prostate tour and its effect on the course of the postoperative period.&#x0D; Materials and methods. We examined 60 patients with BPH who were referred for surgical treatment (transurethral resection of the prostate), who had chronic functional constipation. By random sampling, the patients were divided into two groups of 30 people. In group 1, standard preparation for surgical treatment was carried out for 1 month. In group 2, patients, in combination with standard preparation for surgical treatment, took partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFiber®) with food for the first 3 days – 1 sachet (5 g) per day, from the 4th to the 6th day – 2 sachets per day. From day 7, patients in group 2 were divided into two subgroups. In subgroup 2a, patients whose bowel function returned to normal continued taking the drug at a dose of 2 sachets per day. Those patients in whom the effect of restoring the regularity of bowel function was not satisfactory, took 3 sachets a day from the 7th day and were assigned to subgroup 2b. In the preoperative period, patients were examined on the 1st day (visit 1), 15th day (visit 2) and 30th day (visit 3) of observation. The average number of acts of defecation during the previous week, the severity and dynamics of clinical manifestations of constipation were evaluated on the basis of the Patient Assessment of Constipation Symptoms (PAC-SYM questionnaire), according to the totality of symptoms in points, as well as for each criterion separately. Evaluation of the effectiveness of treatment in the postoperative period was carried out on the basis of dynamic observation for 5–7 days.&#x0D; Results. Initially, all patients in the two groups had signs characteristic of BPH and chronic functional constipation, the groups were homogeneous. According to the results obtained in group 1 for 30 days of follow-up before surgery, none of the studied parameters significantly changed (p0.05). In group 2, after 15 days of follow-up, a significant (p0.05) positive dynamics was revealed for all the studied indicators, both in comparison with group 1 and in comparison with the results obtained at visit 1. By visit 3, despite the absence of statistically significant dynamics in the indicators of both group 1 and group 2, in comparison with visit 2, significant (p0.05) differences remained between the groups. During the study, subgroup 2a included 19 patients who took 2 sachets of OptiFiber® per day, and subgroup 2b included 11 men who took 3 sachets per day from the 7th day of observation. Restoration of intestinal motility in patients taking dietary fiber occurred at an earlier time, while the differences were also statistically significant (p0.05). In group 1, 14 cases of early postoperative complications were registered, and in group 2–9 cases, which is 35.7% less. The number of cases of antibiotic-associated diarrhea in group 1 was 3, while in group 2 there was 1 such case, which is 66.7% less. When analyzing the results obtained, there were no significant differences in the studied parameters in the postoperative period between subgroups 2a and 2b. All 30 (100%) patients of group 2 gave a positive review of partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFiber®), and plan to continue taking them after completing participation in the study.&#x0D; Conclusion. Thus, according to the results of the study, we consider it appropriate to use partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFiber®) in the treatment of CC in patients with BPH who are shown to have a prostate tour as a means to effectively eliminate the manifestations of CC, improve the results of surgical treatment and improve the quality of life of this category of patients.

Evaluation of the index of resistance and excretion of uromodulin in patients with predialysis chronic kidney disease, taking into account the index of comorbidity

Background. The purpose of this study was to investigate urinary uromodulin (uUmod) excretion, reactivity of the autonomic nervous system and impaired renal blood circulation in patients with predialysis chronic kidney disease (CKD), and the effect of antioxidant therapy on these parameters. Materials and methods. Ninety-one patients with CKD stage 1–5 took part in the ROLUNT (UROmoduLin UbiquinoNe GlutaThione) study, their average age was 47.00 ± 12.12 years. Thirty (32.97 %) men and 61 (67.03 %) women were divided into two groups, which were representative in terms of age and gender composition: the first one (n = 46) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≤ 2, the second one (n = 45) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≥ 3. The first and second groups were divided into subgroups A and B. Subgroup A included patients with impaired vegetative status, subgroup B — without impaired vegetative status. Subgroups 1A and 2B took glutathione 100 mg twice a day with food for 3 months; subgroups 1B and 2A received ubiquinone 100 mg once a day with food for 3 months. In patients with CKD stage1–5, uUmod, albumin to creatinine ratio (ACR), glomerular filtration rate (GFR) were evaluated. Ninety-one ultrasound duplex color scans of the kidneys were performed and the index of resistance (IR) was determined in patients with CKD stage1–5. Results. The results of the paired t-test showed that there is a significant difference between the indicators at the beginning and at the end of the study, with the exception of the following: in subgroup 1A: hemoglobin (Hb) (T = –1.5863 [–2.0739, 2.0739] 95% confidence interval (CI) [–2.4077, 0.3207], p = 0.127); in subgroup 1B: Hb (T = –0.382 [–2.0739, 2.0739], 95% CI [–1.3977, 0.963], p = 0.706); ACR (T = –1.5899 [–2.0739, 2.0739], 95% CI [–16.7323, 2.2105], p = 0.126); systolic blood pressure (SBP) (T = –0.5625 [–2.0739, 2.0739], 95% CI [–2.2414, 1.2849], p = 0.579); diastolic blood pressure (DBP) (T = –1.7936 [–2.0739, 2.0739], 95% CI [–2.3437, 0.1698], p = 0.087); Chernov questionnaire (T = 1.5071 [–2.0739, 2.0739], 95% CI [–0.6083, 3.8431], p = 0.146); Kérdö index (T = 0.9392 [–2.0739, 2.0739], 95% CI [–1.1083, 2.9431], p = 0.358); in subgroup 2A: ACR (T = –2.0147 [–2.0796, 2.0796], 95% CI [–39.1946, 0.6219], p = 0.057); in subgroup 2B: ACR (T = –1.3328 [–2.0739, 2.0739], 95% CI [–17.4695, 3.7999], p = 0.196). The Pearson correlation results showed that in subgroup 1A, there is a significant average positive relationship between uUmod and eGFR (r(21) = 0.418, p = 0.047); a significant very small negative relationship between uUmod indicators and age (r(21) = 0.438, p = 0.037); in subgroup 1B, there is a significant large positive relationship between uUmod and Hb indicators (r(21) = 0.513, p = 0.012); a significant positive relationship between uUmod and Morisky Medication Adherence Scale-8 (MMAS-8) indicators (r(21) = 0.515, p = 0.012); a significant very small negative relationship between uUmod and ACR indicators (r(21) = 0.441, p = 0.035); in subgroup 2A, there is a significant very small negative relationship between uUmod indicators and Kérdö index (r(20) = 0.427, p = 0.048); in subgroup 2B, there is a significant very small negative relationship between the uUmod indicators and Chernov questionnaire score (r(21) = 0.421, p = 0.045); a significant very small negative relationship between uUmod indicators and Charlson Comorbidity Index (r(21) = 0.481, p = 0.020); a significant very small negative relationship between uUmod and age (r(21) = 0.471, p = 0.023). In subgroup 1A at the end of the study, the following independent variables are not significant as predictors for uUmod: IRd, IRs, SBP, DBP, Hb, ACR, age, Vein and Chernov questionnaires score, MMAS-8, Charlson Comorbidity Index and Kérdö index. In subgroup 1B at the end of the study, the following independent variables are not significant as predictors for uUmod: eGFR, IRs, SBP, DBP, Hb, Vein and Chernov questionnaires score, MMAS-8, Charlson Comorbidity Index and Kérdö index. In subgroup 2A at the end of the study, the following independent variables are not significant as predictors for uUmod: eGFR, IRd, IRs, SBP, DBP, Hb, ACR, age, Vein questionnaire score, MMAS-8, Charlson Comorbidity Index. In subgroup 2B at the end of the study, the following independent variables are not significant as predictors for uUmod: eGFR, IRd, IRs, SBP, DBP, Hb, ACR, age, Vein questionnaire score, ­MMAS-8, Kérdö index. Conclusions. Antioxidant therapy with glutathione and ubiquinone significantly affects the examination parameters of patients with CKD. Considering the safety and effectiveness of antioxidant therapy, we suggest including antioxidant therapy into the treatment protocols for patients with CKD. Further research is recommended to establish a standard protocol.

Clinical stigmas of irritable bowel syndrome associated with obesity and overweight

Objective. To identify clinical stigmas and eating habits of patients with irritable bowel syndrome (IBS) against the background of overweight and obesity in order to improve the effectiveness of management of this cohort of patients.Material and methods. Open cross-sectional cohort study with 175 participants aged 18 to 44 years (mean age 30,06 ± 6,15 years) was carried out. Group 1 included 100 obese or overweight IBS patients aged 18 to 44 years (mean age 30.63 ± 6.37 years, BMI 25.88 ± 6.28 kg/m2). In group 1, subgroup 1A included 50 people with IBS associated with overweight or obesity. Subgroup 1B included 50 IBS patients with normal weight. Group 2 included 75 people without IBS, aged 19 to 43 years (mean age 29.31 ± 5.81 years, BMI 27.80 ± 6.20 kg/m2). Subgroup 2A included 50 participants without IBS who were overweight or obese. Subgroup 2B included 25 conditionally healthy participants. IBS symptoms were assessed using a 10-point scale. The severity of gastrointestinal symptoms, the presence of anxiety and depression, the level of specific anxiety, quality of life, and eating habits were assessed using verified questionnaires.Results. Patients suffering from IBS associated with obesity and overweight have characteristic clinical stigmas, namely: IBS with predominant constipation, severe course of IBS, depressive and anxiety disorders, eating habits characterized by predominance of floury, sweet, fatty and salty foods in the diet, and low intake of fruits and vegetables containing dietary fiber.Conclusions. The identified clinical stigmas suggest the presence of a portrait of an IBS patient with excessive body weight or obesity, which creates the need to elucidate the mechanisms of IBS formation and progression in overweight and obese individuals.

Ассоциации лептина и адипонектина у больных синдромом раздраженного кишечника с избыточной массой тела и ожирением

Irritable bowel syndrome (IBS) in overweight and obese individuals is characterized by a more severe course than in patients with normal weight. The purpose. To assess the level of adipokines (leptin and adiponectin) in blood serum, the correlation of these laboratory markers with the clinical manifestations of IBS, quality of life, eating habits, and signs of anxiety and depression based on the results of using a special questionnaire in patients with IBS. Material and methods. An open cohort cross-sectional study was conducted with the inclusion of 175 participants aged 18 to 44 years (mean age 30.06 ± 6.15 years). Group 1 included 100 obese or overweight IBS patients aged 18 to 44 years (mean age 30.63 ± 6.37 years, BMI 25.88 ± 6.28 kg/m2). In group 1, subgroup 1A included 50 people with IBS associated with overweight or obesity. In subgroup 1B – 50 people suffering from IBS, with normal weight. Group 2 included 75 people without IBS, aged 19 to 43 years (mean age 29.31 ± 5.81 years, BMI 27.80 ± 6.20 kg/m2). Subgroup 2A included 50 non-IBS participants who were overweight or obese. Subgroup 2B included 25 apparently healthy participants. IBS symptoms were assessed using a 10-point scale. Using verified questionnaires, the severity of gastrointestinal symptoms, the presence of anxiety and depression, the level of specific anxiety, quality of life and eating habits were assessed. Results. IBS patients with overweight and obesity are characterized by higher levels of leptin and low levels of adiponectin than patients with normal weight (Mann – Whitney test, p &lt; 0.05). Adipokine levels correlate with high cravings for sweet, fatty, starchy, and salty foods. A higher concentration of leptin is characteristic of patients suffering from IBS with a predominance of constipation (Mann – Whitney test, p &lt; 0.05). High levels of leptin and low levels of adiponectin in overweight and obese IBS patients correlate with more severe symptoms of abdominal pain, flatulence, poor quality of life, and more frequent signs of anxiety and depression (Spirmen test p &lt; 0.05, Mann – Whitney test, p &lt; 0.05). Conclusion. The results obtained suggest a significant role of adipokines in the formation of more severe symptoms in IBS patients with overweight and obesity compared to patients with normal weight

Inhibitors for metallo-β-lactamases from the B1 and B3 subgroups provide an avenue to combat a major mechanism of antibiotic resistance

Metallo-β-lactamases (MBLs) are a group of Zn(II)-dependent enzymes that pose a major threat to global health. They are linked to an increasing number of multi-drug resistant bacterial pathogens, but no clinically useful inhibitor is yet available. Since β-lactam antibiotics, which are inactivated by MBLs, constitute ∼65% of all antibiotics used to treat infections, the search for clinically relevant MBL inhibitors is urgent. Here, derivatives of a 2-amino-1-benzyl-4,5-diphenyl-1H-pyrrole-3-carbonitrile (1a) were synthesised and their inhibitory effects assessed against prominent representatives of the MBL family. Several compounds are potent inhibitors of each MBL tested, making them promising candidates for the development of broad-spectrum drug leads. In particular, compound 5f is highly potent across the MBL family, with Ki values in the low µM range. Furthermore, this compound also appears to display synergy in combination with antibiotics such as penicillin G, cefuroxime or meropenem. This molecule thus represents a promising starting point to develop new drugs to inhibit a major mechanism of antibiotic resistance.

P-104 Impact of Semen Microbiota on the Embryo Quality

Abstract Study question Is there a relationship between the microbiota composition of semen samples used for assisted reproductive technologies (ART) and quality of embryos? Summary answer The obligate anaerobes prevalence in semen microbiota was associated with reduced embryo quality in patients with astenozoospermia, but no difference was found for normozoospermic samples. What is known already The success of the ART depends on a number of factors, including embryo quality. The viability of IVF embryo could be affected by various environmental factors, including contamination with semen microbiota. Semen is not sterile, and even processed it may contain some bacteria, which may colonize culture dishes with oocytes and embryos. It was shown that the presence of bacteria might alter the sperm quality and the contamination of embryo culture dishes with bacteria was associated with poor quality of the developing embryos. Study design, size, duration 126 infertile couples attending the “Garmonia” Medical Center (Yekaterinburg, Russia) for IVF in 2020-2021, were included in the study. Depending on the spermiogram results, they were divided into two groups Group 1 (n = 51) — asthenozoospermia, Group 2 (n = 75) — normospermia. Participants/materials, setting, methods Semen microbiota was analyzed using RT-PCR kit Androflor (DNA-Technology, Russia). Cluster analysis was performed for 78 samples with the total bacterial load (TBL) of at least 103 GE/ml (asthenozoospermia = 31, normozoospermia = 47). Cluster analysis was conducted using the k-means ++ algorithm, scikit-learn. The blastocyst development rate (BDR), as the proportion of 2PN zygotes, was determined on day 5 after injection. BDR ≥ 40% was considered satisfactory, BDR &amp;lt; 40% - unsatisfactory. Main results and the role of chance When analyzing semen microbiota, 8 stable clusters were distinguished. Cluster 1 was lactobacilli-dominated, Cluster 2 and 3 - Gram-positive facultative anaerobes dominated with prevalence of Corynebacterium spp. and Streptococcus spp. respectively; Cluster 4 –Enterobacteriaceae/Enterococcus spp-dominated,; Cluster 5, 6 - obligate anaerobes dominated with prevalence of Bacteroides spp./Porphyromonas spp./Prevotella spp. or Peptostreptococcus spp./Parvimonas spp., respectively. Cluster 7 was formed by mixed obligate anaerobes (MOA); Cluster 8 - by Mycoplasmae. There was no difference in detection rate of individual clusters in samples with normospermia and asthenozoospermia. Depending on their BDR each group were divided into subgroups: Subgroup 1A (n = 25) with BDR ≥ 40%, Subgroup 1B (n = 26) with BDR &amp;lt; 40%; Subgroup 2A (n = 38) with BDR ≥ 40%, Subgroup 2B (n = 37) with BDR &amp;lt; 40%. The detection rate of different microbiota clusters in Subgroups 2A and 2B (normospermia samples) was almost similar. In asthenozoospermia samples the lower embryo quality (Subgroup 1B) was associated with higher prevalence of Cluster 7 (53.8%) comparing to those of Subgroup 1A (16.0%), p &amp;lt; 0.001. Cluster 1 was detected more often in Subgroup 1A (20.0%) than in Subgroup 1B (7.8%), but p &amp;gt; 0.05. TBL &amp;gt; 103 GE/ml was present in 52% of Subgroup 1A samples and in 69.2% of Subgroup 1B samples. Limitations, reasons for caution Cluster analysis was not conducted for the samples with TBL lower than 103 GE/ml, since their results were incompatible with the data received for the negative control samples. Wider implications of the findings Further research could determine the significance of the described bacterial clusters in semen with other pathologies. Establishing the relationship between the characteristics of semen microbiota and poor embryo quality might allow the development of new algorithms for treating patients with reproductive disorders, depending on the composition of semen microbiota. Trial registration number not applicable

Structure, function, and evolution of metallo-β-lactamases from the B3 subgroup-emerging targets to combat antibiotic resistance.

β-Lactams are the most widely employed antibiotics in clinical settings due to their broad efficacy and low toxicity. However, since their first use in the 1940s, resistance to β-lactams has proliferated to the point where multi-drug resistant organisms are now one of the greatest threats to global human health. Many bacteria use β-lactamases to inactivate this class of antibiotics via hydrolysis. Although nucleophilic serine-β-lactamases have long been clinically important, most broad-spectrum β-lactamases employ one or two metal ions (likely Zn2+) in catalysis. To date, potent and clinically useful inhibitors of these metallo-β-lactamases (MBLs) have not been available, exacerbating their negative impact on healthcare. MBLs are categorised into three subgroups: B1, B2, and B3 MBLs, depending on their sequence similarities, active site structures, interactions with metal ions, and substrate preferences. The majority of MBLs associated with the spread of antibiotic resistance belong to the B1 subgroup. Most characterized B3 MBLs have been discovered in environmental bacteria, but they are increasingly identified in clinical samples. B3-type MBLs display greater diversity in their active sites than other MBLs. Furthermore, at least one of the known B3-type MBLs is inhibited by the serine-β-lactamase inhibitor clavulanic acid, an observation that may promote the design of derivatives active against a broader range of MBLs. In this Mini Review, recent advances in structure-function relationships of B3-type MBLs will be discussed, with a view to inspiring inhibitor development to combat the growing spread of β-lactam resistance.

Incremental value of myocardial work analysis for detection of coronary artery disease during dipyridamole stress echocardiography

Abstract Funding Acknowledgements Type of funding sources: None. Background Dipyridamole stress-echocardiography (DipSE) relies on operator’s expertise and might have suboptimal diagnostic accuracy in identifying patients (pts) with single-vessel coronary artery disease (CAD). 2D strain, and, recently, myocardial work (MW) analysis, provide a more accurate evaluation of myocardial function, being able to detect subtle regional abnormalities. Purpose Aim of our study was to investigate whether MW analysis could have an additive role, when implemented to DipSE, in CAD detection. Methods We retrospectively enrolled 50 pts (20 M) who underwent DipSE followed, within one month, by coronary CT (CCT), in the absence of stress-induced WM abnormalities, or by invasive coronary angiography (ICA), when new WM abnormalities occurred. According to the presence of obstructive CAD (confirmed by ICA in any case), the population was subdivided into 2 groups: group 1 (with obstructive CAD: 34 pts) and group 2 (without obstructive CAD: 16 pts). After matching DipSE and CCT/ICA results, we further subdivided the population into three subgroups: 1 (true positives: 34 pts), 2A (false positives: 9 pts) and 2B (true negatives: 7 pts); no patients had a false negative DipSE result. Global longitudinal strain (GLS), work index (GWI), constructive work (GCW), waste work (GWW) and work efficiency (GWE) were calculated, at baseline, low and peak dose. Results In group 1, GLS increased at low and decreased at peak dose (p 0.015), while, in group 2, increased, mostly from low to peak dose (p&amp;lt; 0.001), Fig. 1. GWI and GCW, at low dose, decreased in group 1 (p 0.035 and p 0.009) whereas increased in group 2 (p 0.042 and p ns). GWW increased, at peak dose, in group 1 (p 0.003), whereas decreased in group 2 (p 0.047). GWE decreased, at peak dose, in group 1 (p 0.025), whereas increased in group 2 (p 0.001). When evaluating the subgroups (Fig. 1, right panels), we found that, in subgroup 2A, GLS increased at low and decreased at peak dose (p 0.015), similarly to subgroup 1 (at low dose p 0.011) and differently from subgroup 2B (from baseline to peak dose p 0.003). GWE, in subgroup 2A, increased at peak dose (p 0.023), differently from subgroup 1 (p 0.001) and similarly to subgroup 2B (at low dose: p 0.026; at peak dose: p 0.029). ROC analysis, for obstructive CAD, showed that GLS had a lower AUC (0.653) than GWW (0.735) and GWE (0.845), whereas GWI and GCW had, an AUC of 0.606 and 0.591, respectively (Fig. 2). A ≥ 0.5% GLS change (from low to peak dose) gained a sensitivity of 58%, a specificity of 67%, a positive predictive value (PPV) of 66% and a negative predictive value (NPV) of 64%. Conversely, a ≥ −1.5% GWE change (from low to peak dose) provided a sensitivity of 73%, a specificity of 84%, a PPV of 86% and NPV of 79%. Net reclassification improvement (NRI) for GWE was 0.049 (p 0.005). Conclusion MW analysis beyond GLS shows an additive role in the detection of CAD, thus improving diagnostic performance of DipSE.

Implementation of a Multidisciplinary Preoperative Protocol for Geriatric Hip Fractures Improves Time to Surgery at a Level III Trauma Center.

Hip fractures are common among the elderly, and delays in time to surgery (TTS) and length of stay (LOS) are known to increase mortality risk in these patients. Preoperative multidisciplinary protocols for hip fracture management are effective at larger trauma hospitals. The purpose of this study is to evaluate the effect of a similar multidisciplinary preoperative protocol for geriatric hip fracture patients at our Level III trauma center. In this single-center retrospective study, patients aged 65 and older who were admitted from March 2016 to December 2018 (pre-protocol group, Cohort #1, n = 247) and from August 2021 to September 2022 (post-protocol group, Cohort #2, n = 169) were included. Demographic information, TTS, and LOS were obtained and compared using Student's t-test and Chi-square testing. There was a significant decrease in TTS in Cohort #2 compared to Cohort #1 (P < .001). There was a significant increase in LOS in Cohort #2 compared to Cohort #1 (P < .05), but when comparing a subset of Cohort #2 (Subgroup 2B, patients admitted from May to September 2022 when the effects of COVID-19 were likely dissipated) to Cohort #1, there was no significant difference in LOS (P = .13). For patients admitted to skilled nursing facilities (SNF), LOS in Cohort #2 was significantly longer than in Cohort #1 (P = .001). In general, Level III hospitals have fewer perioperative resources compared to larger Level I hospitals. Despite this fact, this multidisciplinary preoperative protocol effectively reduced TTS which improves mortality risk in elderly patients. LOS is a multifactorial variable, and we believe the COVID-19 pandemic was a significant confounder that reduced available SNF beds in our area which prolonged the average LOS in Cohort #2. A multidisciplinary preoperative protocol for geriatric hip fracture management can improve efficiency of getting patients to surgery at Level III trauma centers.

MODERN METHODS OF TREATING PATIENTS WITH DISEASES OF THE BILIARY TRACT COMPLICATED BY MECHANICAL JAUNDICE

Summary. Introduction. Treatment of patients with diseases of the biliary tract complicated by jaundice remains an urgent problem in abdominal surgery. The development of mechanical jaundice (MJ) is observed in 15–40 % of patients with gallstone disease complicated by choledocholithiasis. MJ of malignant etiology occurs in 40–67 % of patients.&#x0D; Aim. To study the results of the use of minimally invasive surgical interventions in patients with diseases of the biliary tract complicated by mechanical jaundice.&#x0D; Materials and methods. The object of the study were 56 patients with biliary tract complicated by MJ who were being treated in the State Institution “Zaycev V.T. Institute of general and emergency surgery of the National academy of medical sciences of Ukraine”. The first group included 34 patients with non-neoplastic diseases of the biliary tract, complicated by MJ, the second group included 22 patients with cholangiocarcinoma.&#x0D; Results. In subgroup 1A, 15 (41.1 %) patients underwent antegrade endobiliary interventions for the purpose of biliary decompression, in subgroup 1B 19 (55.9 %) patients had unsuccessful attempts at retrograde biliary decompression. The second stage of surgical treatment consisted of reconstructive and restorative operations or combined interventions from antegrade and retrograde approaches. Using antegrade endobiliary interventions, we managed to reduce the development of complications of biliary decompression, compared to patients who had an unsuccessful attempt at endoscopic treatment from 15 (78.9 %) to 1 (6.67 %), as well as reduce the number of complications after reconstructive and restorative operations from 10 (52.6 %) to 1 (6.67 %) and the fatality rate from 2 (10.5 %) to 1 (6.67 %).&#x0D; After successfully performed biliary decompression, 11 (50 %) patients underwent reconstructive and restorative surgical interventions, which were included in the 2A subgroup. The remaining 11 (50 %) patients, who made up the 2B subgroup, underwent similar surgical interventions without prior biliary decompression. In patients of the 2A subgroup, the performance of antegrade endobiliary intervention allowed to reduce the number of postoperative complications by 9.1 % and mortality by 9.1 % in comparison with the patients of the 2B subgroup.&#x0D; Conclusions. Thus, antegrade endobiliary interventions are an alternative method of treatment of diseases of the biliary tract complicated by MJ. Antegrade endobiliary interventions reduced the number of complications after reconstructive operations from 27.3 % to 18.2 %, the mortality rate from 18.2 % to 9.1 %. Antegrade endobiliary interventions for benign diseases of the biliary tract and improved minimally invasive methods of treatment of “endoscopic difficult” forms of choledocholithiasis reduced the number of complications of biliary decompression compared to patients in whom endoscopic decompression was ineffective from 78.9 % to 6.67 %, as well as reduced the level of postoperative complications after reconstructive treatment from 52.6 % to 6.67 % and mortality from 10.5 % to 6.67 %.

Features of ovarian steroidogenesis and endometrial hypertrophy during adjuvant therapy with tamoxifen in premenopausal patients with hormone-dependent breast cancer

Background. Difficulties in the prevention and treatment of endometrial pathology in hormone-positive breast cancer are associated with the lack of an unambiguous understanding of the mechanisms of the effect of tamoxifen on target tissues and the development of possible hyperestrogenism.Aim. To study the effect of ovarian steroidogenesis on the endometrium during adjuvant therapy with tamoxifen in pre-menopausal patients with hormone-dependent breast cancer.Materials and methods. All patients at inclusion in the study had intact menstrual function and received adjuvant therapy with tamoxifen. Group 1 included 42 patients without chemotherapy, group 2 included 41 patients with chemotherapy. Depending on the safety of the menstrual function, each group was divided into 2 subgroups. At the control points (3, 6 and 9 months from the start of tamoxifen therapy) patients underwent transvaginal ultrasound with measurement of endometrial thickness, and also determined the content of follicle-stimulating hormone and estradiol in peripheral blood. When menstruation persisted, blood sampling and measurement of endometrial thickness were performed on days 5-8 of the menstrual cycle.Results. In subgroups 1A and 2C, patients with preserved menstrual function showed a trend towards higher values of estradiol levels and endometrial thickness, compared with subgroups 1B and 2D of patients with amenorrhea. Against this background, the absence of statistically significant intergroup differences in the content of follicle-stimulating hormone in patients receiving tamoxifen with a preserved menstrual cycle (1A and 2C) and amenorrhea (1B and 2D) attracts attention. An intragroup analysis of follicle-stimulating hormone dynamics in patients with amenorrhea without chemotherapy in subgroup 1C shows an increase in its content by 162 %, without statistically significant changes in endometrial thickness and estradiol concentration. The statistically significant increase in endometrial thickness by 25 % and the proportion of patients with increasing endometrial wall thickness in 63.3 % in the 2D subgroup in patients receiving tamoxifen, with amenorrhea and previous chemotherapy treatment are cause for concern.Conclusion. The results of the study indicate a possible additive effect of such factors as intact menstrual function before the start of treatment for hormone-positive breast cancer, chemotherapy, and the development of amenorrhea on the progressive increase in endometrial thickness when using tamoxifen in premenopausal patients.

Characteristics of changes in the coronary arteries in patients with acute coronary syndrome on the background of chronic obstructive pulmonary disease

Aim. Study of the nature and characteristics of changes in the coronary bed in patients with acute coronary syndrome (ACS) and chronic obstructive pulmonary disease (COPD).Materials and methods. The study included 85 patients with ACS: group 1 included 47 patients with ACS and COPD, group 2 included 38 patients with ACS. All patients underwent a comprehensive clinical, instrumental and laboratory examination.Results. In the majority of patients of group 1 (76.6%), two- and three-vessel lesions of the coronary bed were revealed, and arterial stenoses were multiple, located mainly in the middle and distal parts of the arteries. In (76.3%) patients of the 2nd group, one- and two-vessel lesions of the coronary bed with localization of stenoses mainly in the proximal and middle segment of the coronary arteries (CA) were revealed. The total number of stenosis and hemodynamically significant stenosis was higher in group 1 compared to group 2 (p=0.01). Extended stenoses were more common in group 1 patients (p=0.04). Damage to the CA of the 2nd order was also higher in the 1st group of patients (p=0.01). The 1st group was divided into two subgroups: 1A (26 people) − patients with COPD of moderate severity and 1B (21 people) − patients with severe COPD. In patients of subgroup 1B, a more significant lesion of the coronary bed was noted due to an increase in the total number of stenoses (p=0.02), hemodynamically significant stenoses (p=0.01), localized in the proximal (p=0.04) and distal (p=0.02) segments of the coronary artery, in the branches of the 2nd order (p=0.02), as well as occlusions and critical stenoses of the coronary artery (p=0.02).Conclusion. The severity of COPD in patients with ACS significantly affects the number of hemodynamically significant proximal and distal stenoses, as well as branches of the second order coronary arteries, which reduces the effectiveness of surgical treatment and worsens the prognosis of patients with comorbidities.

The Results of Using the Method of Bipolar High-frequency Electric Welding to Close Defects of the Dura Mater in Frontal Sinus Tumors with Intracranial Spread, and its Comparison with the Standard Method

The frequency of cerebrospinal fluid leak (CSFL) in the postoperative period after surgical interventions on the structures of the skull base reaches 6.2%, and after interventions on the structures of the anterior cranial fossa - 5.9%, middle cranial fossa - 6.4% and - 5.8% in all subtentorial interventions (Jamshidi, 2022; Rajendran, 2020). The aim of the study is to increase the effectiveness of surgical treatment of patients with tumors of the frontal sinuses with intracranial spread by using the method of high-frequency bipolar electric welding. Depending on the method of dura mater defect repair, patients were divided into 2 groups. The 1st group (control) included patients whose dura mater defect was connected according to the conventional method (suturing with polypropylene threads). In the 2nd group – the dura mater defect was connected by high-frequency bipolar electric welding. Patients of the 1st and 2nd groups were divided into 2 subgroups. Subgroups 1A and 2A included patients in whom the DM defect was up to 3 cm in diameter and linear; if necessary, a pericranium was used to close the DM defect. Subgroups 1B and 2B included patients in whom the connection of the defect was performed with the help of a fascia lata. As a result of the study, the authors proposed an effective method of connecting the dura mater defects after the removal of frontal sinus tumors spreading intracranially. Such methods include a high-frequency bipolar electric welding method, the use of which contributed to a minimal destructive effect on adjacent tissues but at the same time hermetically connected the dura mater. Presented data indicate that the use of high-frequency bipolar electric welding allowed to reduce the frequency of external CSFL by 2.2 times, compared to the use of suture material, and to reduce of hidden CSFL by 4.6 times, which indicates a statistically significant advantage of using high-frequency bipolar electric welding to close DM defects and prevent the occurrence of external and hidden CSFL in the postoperative period. In the presence of a DM defect of more than 3 cm and when it is closed with the fascia lata, it is possible to reduce the occurrence of external CSFL by 2.0 times compared to the control group. The use of high-frequency bipolar electric welding almost completely reduces the possibility of the formation of a meningeal scar in the postoperative period, which significantly accelerates the recovery of CSFL circulation and the recovery of brain tissue (due to the absence of factors that would irritate it), as a result of which the patient's rehabilitation and recovery are faster, compared to standard methods of connecting DM. The use of high-frequency bipolar electric welding was manifested by a faster recovery of normal intracranial pressure indicators - a faster recovery of fluid dynamics, a faster regression of inflammatory changes in the brain tissue and, as a result, a faster recovery of its functions, which indicates a higher quality of life of postoperative patients in the main group, compared to the control group.