[Clinical guidelines for male infertility: controversial issues and the need to reach interdisciplinary consensus].

A review of controversial issues about the terminology on male infertility and reproductive function, which is currently used, as well as proposals for updating clinical guidelines for the diagnosis and treatment of male infertility and men in infertile couples are presented in the article. An algorithm is described, the elements of which ensure referral of patients based on the possibility and timing of restoration of reproductive function, taking into account the reproductive health of a woman, as well as increasing the likelihood of successful treatment aimed at the birth of a healthy child.

[The daily dose of testosterone-replacement therapy dependence from the body mass index in FtM transgender PATIENTS].

BACKGROUND: The basis for the management of transgender patients is the use of various hormonal correction schemes necessary for changing the hormonal sex and, possibly, further preparation for surgical correction. Currently, the choice of the starting dose and the scheme is carried out empirically, which lengthens the period of selection of therapy and increases the risk of its complications. Taking into account the individual characteristics of the patient can help in optimizing therapy. AIM: Investigate Factors Affecting the Daily Demand for Testosterone Ester Blends in Transgender MenMATERIALS AND METHODS: This study is a case-control observational study. Patients included prior to initiation of testosterone replacement therapy. The analysis of factors interrelated with the daily requirement of testosterone preparations was carried out. Among the factors of interest, the body mass index (BMI), the results of blood tests for total testosterone and the functional state of the liver and kidneys are considered. Testosterone replacement therapy (TRT) regimens were evaluated in transgender men. For the calculation, we used the formulas for BMI and the average daily dose of testosterone. Based on the data obtained, conclusions were drawn that allow determining the necessary TRT scheme in different trans-gender men at an early stage of hormonal correction. RESULTS: Our study included 58 transgender FtM patients who were prescribed testosterone preparations with an identical composition. We found a positive correlation between BMI and testosterone dose in patients of group II (p = 0.04). CONCLUSION: In the conclusion, the obtained schemes of hormonal sex reassignment with a minimum risk of possible complications are presented. Our results demonstrated a relationship between BMI in overweight and obese patients and the need for TRT. For patients with a BMI of 25 to 29 kg / m2, the interval between injections of a mixture of testosterone esters does not differ significantly from that in the group with a BMI below 25 kg / m2 and averages once every 18 days, and in the group with a BMI ≥ 30 kg / m2 tested testosterone ester preparations should be prescribed once every 2 weeks (14 days).

Type 2 Diabetes Mellitus and Chronic Heart Failure with Midrange and Preserved Ejection Fraction: A Focus on Serum Biomarkers of Fibrosis.

As myocardial fibrosis might be an important contributor to the association of diabetes mellitus with left ventricular (LV) dysfunction and chronic heart failure (HF), we investigated the profile of some proinflammatory, profibrotic biomarkers in patients with type 2 diabetes mellitus (T2DM) at various stages of the cardiovascular disease continuum from absence of clinic since and symptoms to HF with preserved (HFpEF) and midrange ejection fraction (HFmrEF). Material and Methods. Sixty-two patients with T2DM (age 60 [55; 61]), 20 patients without clinical manifestations of HF and 2 groups with clinical manifestations of stable HF, 29 patients with HFpEF, and 13 patients with HFmrEF, were included in the study. The control group consisted of 13 healthy subjects and normal BMI. All patients underwent transthoracic echocardiography, laboratory assessment of N-terminal fragment of the brain natriuretic peptide (Nt-proBNP), highly sensitive C-reactive protein (hsCRP), soluble suppression of tumorigenesis-2 (sST2), galectin-3, C-terminal propeptide of procollagen type I (PICP), N-terminal propeptide of procollagen type III (PIIINP), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of matrix proteinase-1 (TIMP-1). Results. Patients with HFmrEF had higher values of LV volumetric parameters, indexed parameters of LV myocardial mass (LVMM), and higher concentrations of Nt-proBNP (all p < 0.05). The concentrations of galectin-3 were greater in patients with HFpEF and HFmrEF compared to patients without HF (p = 0.01 and p = 0.03, respectively). PICP and PICP/PIIINP ratio were greater in patients with HFmrEF compared to patients with HFpEF (p = 0.043 and p = 0.033, respectively). In patients with T2DM and HF, a relationship was found between galectin-3 and LVMM/body surface area (r = -0.58, p = 0.001), PIIINP, TIMP-1, and LV end-diastolic volume (r = -0.68 and p = 0.042 and r = 0.38 and p = 0.02, respectively). Conclusion. The dynamics at various stages of the cardiovascular disease continuum in the serum fibrosis markers may reflect an increase in fibrotic and decrease in antifibrotic processes already at the preclinical stage of HF. At the same time, the changes found in the circulating procollagen levels may indicate a shift in balance towards type I collagen synthesis in HFmrEF compared with HFpEF.

[The demand for medical technologies during provision of stomatological care to adult population in polyclinic].

The high prevalence of dental diseases, increase of population exactingness to availability and quality of dental medical care predetermine the development of relevant management decisions. The purpose of study was to define the priorities of demand of medical technologies in dental polyclinic. The evaluation of importance of the technologies implemented in case of particular dental diseases was given based on analysis of 37.3 thousand visits of adult population to dental polyclinic and implementation of more than 200 thousand dental manipulations. The 13 groups of technologies applied were established. The calculation of the coefficient of relative importance and its integrated evaluation was carried out. It is established that most of implemented technologies in dental polyclinic were targeted to treatment of caries of teeth and other defects of tissues of tooth that made 37.4% of all dental medical care provided and also pulpitis (20.9%), periodontitis and periapiсal pathology (25.1%). The most demanded technologies are treatment of caries, restoration of crown of tooth, all-diagnostic procedures, anesthesia, survey and consultation. The preventive manipulations consisted 69.2% of all important for patient technologies. The established quantitative importance of dental technologies defines perspective of their demand and main positions of dental polyclinic in development of corresponding strategy.

New Oligaphorura species (Collembola: Onychiuridae) from the forests of East Asia.

Three new species of the genus Oligaphorura are described from southwestern China (O. wanglangensis sp. nov.) and Russian Far East (O. ussurica sp. nov. and O. kedroviensis sp. nov.). The first species is most similar to O. inya (Weiner Kaprus', 2014) known from the Altai Mountains, and can be distinguished from the latter by larger body size and the number of ventral psx (00/000/121101m in O. wanglangensis sp. nov. vs 1/000/212101m in O. inya). The other two species, together with O. montana Weiner, 1994, O. pseudomontana Sun Wu, 2012 and O. chankaensis Sun Wu, 2012, form a distinct species-group characterized by the presence of 4+4 pso on antennal base and full-sized anal spines. Both these new species differ from the known congeners of this group by having only 2+2 posterior pso on the head. O. ussurica sp. nov. and O. kedroviensis sp. nov. can be separated due to different number of abdominal pso, i.e. 5(6)5554 in the former vs 44454 in the latter species.

Effects of Bariatric Surgeries on the Size of Myocardial Infarction and Ghrelin Level in Rats with Experimental Decompensated Type 2 Diabetes Mellitus.

The effects of bariatric surgeries (sleeve gastrectomy and ileal transposition) on the dynamics of changes in ghrelin level were studied in rats with severe decompensated type 2 diabetes mellitus under conditions of glucose challenge as well as on the size of myocardial infarction in these animals. Diabetes was modelled by high fat diet and a single administration of streptozotocin (25 mg/kg, intraperitoneally). Both bariatric surgeries significantly decreased glucose-induced ghrelin level in the blood of rats with type 2 diabetes mellitus, which attested to an increase in the tissue sensitivity to ghrelin. Sleeve gastrectomy resulted in a decrease in the size of myocardial infarction in diabetic rats, which was calculated as the ratio of the necrosis zone to the zone of the risk of myocardial infarction. Ileal transposition had no effect on this parameter. Our data can be used as the basis for optimization of treatment approaches when using bariatric surgery in the treatment of patients with severe forms of type 2 diabetes mellitus with a high risk of cardiovascular diseases.

[Prevalence of anabolic androgenic steroid use, its effect on the male pituitary-gonadal axis, and the possibility of reproductive rehabilitation].

The purpose of this review is to assess the prevalence of AA steroid use, to identify the steroids that are used, and to present the negative effects of AA steroids on the human body while describing the mechanisms of their actions on the male reproductive system. The review highlights the diagnostic features of steroid-induced hypogonadism, and assesses the effectiveness of various drugs in the reproductive rehabilitation of patients who cease taking AA steroids. Emphasis is placed on the feasibility and effectiveness of various drug treatments in the context of post cycle therapy (PCT), which seeks to stabilize and restore normal hormonal function. All this data is necessary for the development of modern treatment algorithms for steroid-induced hypogonadism in men.

Multimodal Optical Diagnostics of Glycated Biological Tissues.

Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia accompanied by the disruption of carbohydrate, lipid, and proteins metabolism and development of long-term microvascular, macrovascular, and neuropathic changes. This review presents the results of spectroscopic studies on the glycation of tissues and cell proteins in organisms with naturally developing and model diabetes and in vitro glycated samples in a wide range of electromagnetic waves, from visible light to terahertz radiation. Experiments on the refractometric measurements of glycated and oxygenated hemoglobin in broad wavelength and temperature ranges using digital holographic microscopy and diffraction tomography are discussed, as well as possible application of these methods in the diabetes diagnostics. It is shown that the development and implementation of multimodal approaches based on a combination of phase diagnostics with other methods is another promising direction in the diabetes diagnostics. The possibilities of using optical clearing agents for monitoring the diffusion of substances in the glycated tissues and blood flow dynamics in the pancreas of animals with induced diabetes have also been analyzed.

[The medical aspect of using anabolic androgenic steroids in males attending gyms of Saint-Petersburg].

BACKGROUND: Anabolic androgenic steroids (AASs) are often used by individuals engaged in physical recreational activity. AASs inhibit the hypothalamus-pituitary-gonad axis and can cause erectile dysfunction and reduced fertility. There is no data on the use of AASs in this category of people in the Russian Federation; therefore, a study exploring the rate and patterns of using steroids for non-medical purposes is topical. Aim - of this study was to investigate the rate and patterns of using AASs in males attending gyms in Saint Petersburg. MATERIAL AND METHODS: We used individual anonymous postal survey of males attending gyms. We analyzed demographic and anthropometric data, information on the use of AASs, awareness of their side effects, used agents, patterns and duration of their use, and rehabilitation therapy. RESULTS: Out of 1,815 sent questionnaires, we received back 762 ones. The criteria were met by 550 questionnaires. The mean age was 29.3±7.4 years. The use of AASs was reported by 30.4% of respondents. The main AAS (74.3%) consumers were males aged 22 to 35 years. The most popular drug was Testosterone Propionate (51.5%); the drug was often combined with Oxandrolone (19.7%). In 70.6% of cases, drugs were administered by injection or injection combined with tablet intake. The injectable testosterone dose ranged from 500 to 2,000 mg/week and above. The most common dose was 1,000 mg/week (23.9%). AAS administration for more than 1 year was reported in 16.1% of males. Anastrozole (55%), hCG (51.3%), Clomiphene (41.3%), and Tamoxifen (30.5%) were used during the recovery period. The main source of information on AASs, doses, and dosage patterns was the Internet (48.7%). A negative attitude towards AASs was found in 17.3% of respondents. The desire to receive qualified information about AASs and their impact on health was reported by 54.8% of the surveyed respondents. CONCLUSION: Almost every fourth gym visitor has experience in using AASs. These are males of an optimal reproductive age. The common pattern of using AASs is an aggressive steroid course followed by a recovery period. The list of used drugs and their doses indicate a significant pharmacological intervention and a high risk to health.

[The frequency of formation of a motivated refusal to take androgenic anabolic steroids by men with recreational activity].

BACKGROUND: The widespread use of AAS for non-medical purposes is more than often becoming the cause of secondary hypogonadism. The study of the formation of the negative attitude towards the use of AAS among the gym visitors is quite relevant. AIMS: To identify the frequency of the formation of a motivated refusal to continue taking androgenic anabolic steroids among men who voluntarily declared their use. MATERIALS AND METHODS: The study included 44 men, all users of AAS. There has been estimated the effectiveness of the clinical examination: how ready they were to disclose information about the use of AAS (drugs, doses, regimens, duration) or how much they were aware of the mechanisms of action of AAS and their effects on the body. The participants were also asked to evaluate their psychological and emotional state (on the scale Index of life satisfaction, Hamiltons depression, aggressiveness). The experience of our informational lectures on the topic Risks of using AAS prior to the selection of volunteers for research, anonymous surveys and interviews with potential participants in the clinical trial, the clinical work itself with the selected volunteers, the characteristic features of a medical history and tests that we identified were compared with clinical recommendations for hypogonadism diagnostic (domestic and foreign). RESULTS: More than 105 gym visitors responded positively to a motivated offer (free medical consultation and laboratory tests) to participate in a clinical study. Based on the results of the individual interview, 54 men (51.4%) who indicated the use of AAS signed an informed consent. 44 volunteers (41.9%) completed all stages of the study. Among them, 32 participants (72.7%) were aware of the mechanisms of action and side effects of AAS. 21 volunteers (47.7%) filled in the scales. The index of life satisfaction was determined as high, equal to 34 [29; 38] points; the index of aggressiveness was higher than the generally accepted standard and composed 27 [25; 29] points, the level of depression corresponded to a mild depressive disorder, equal to 9 [3; 12] points. Over the use of AAS 22.7% (n = 10) of the examined noted an increase in aggressiveness, which they themselves associated with the use of steroids. The clinical symptoms of hypogonadism (decreased libido, erectile dysfunction) after the cancellation of AAS were indicated by 25% (n = 11) of the volunteers and that was one of the reasons they continued to use anabolics. 31.8% (n = 14) of the participants were ready to completely stop using the steroids. CONCLUSIONS: Individual informational interviews aimed at providing knowledge about the negative effects of steroids on the body motivated the desire to stop using them amongst 31.8% of AAS users. The obtained data points out to a developed AAS addiction which requires the involvement of psychiatrists to get rid of it.

[The actual state of problem of traumatism].

The traumatism remains of major medical social problems not only in the Russian Federation but in the most of the countries. In 2001-2012 dynamics of indices of traumatism was characterized by increasing of level of traumatism from 87 to 93 cases per 1000 of population. In 2012 and later tendency to decreasing of indices of traumatism is observed but there is no enough data to testify single-valued turning point. Despite progress in treatment of the injured, decreasing of lethality and development of rehabilitation programs considerable prevalence of traumatism in the Russian Federation is related to inadequate efficiency ofpreventable efforts ofsociety and health care system concerning issues of decreasing risks for population of getting traumatized. The absence of systemic approach, underestimation of social economic, geographic, climatic factors, demographic characteristics of territory drastically decreases efficiency of implemented preventive activities.

[The general methodological approaches identifying strategic positions in developing healthy lifestyle of population].

The article deals with analysis of national and international publications concerning methodological aspects of elaborating systematic approach to healthy life-style of population. This scope of inquiry plays a key role in development of human capital. The costs related to healthy life-style are to be considered as personal investment into future income due to physical incrementation of human capital. The definitions of healthy life-style, its categories and supportive factors are to be considered in the process of development of strategies and programs of healthy lifestyle. The implementation of particular strategies entails application of comprehensive information and educational programs meant for various categories of population. Therefore, different motivation techniques are to be considered for children, adolescents, able-bodied population, the elderly. This approach is to be resulted in establishing particular responsibility for national government, territorial administrations, health care administrations, employers and population itself. The necessity of complex legislative measures is emphasized. The recent social hygienic studies were focused mostly on particular aspects of development of healthy life-style of population. Hence, the demand for long term exploration of development of organizational and functional models implementing medical preventive measures on the basis of comprehensive information analysis using statistical, sociological and professional expertise.

[Smart eye data : Development of a foundation for medical research using Smart Data applications]. / "Smart eye data" : Entwicklung eines Fundaments für medizinische Forschung mittels Smart-Data-Applikationen.

BACKGROUND: Smart Data means intelligent data accumulation and the evaluation of large data sets. This is particularly important in ophthalmology as more and more data are being created. Increasing knowledge and personalized therapies are expected by combining clinical data from electronic health records (EHR) with measurement data. OBJECTIVE: In this study we investigated the possibilities to consolidate data from measurement devices and clinical data in a data warehouse (DW). MATERIAL AND METHODS: An EHR was adjusted to the needs of ophthalmology and the contents of referral letters were extracted. The data were imported into a DW overnight. Measuring devices were connected to the EHR by an HL7 standard interface and the use of a picture archiving and communications system (PACS). Data were exported from the review software using a self-developed software. For data analysis the software was modified to the specific requirements of ophthalmology. RESULTS: In the EHR 12 graphical user interfaces were created and the data from 32,234 referral letters were extracted. A total of 23 diagnostic devices could be linked to the PACS and 85,114 optical coherence tomography (OCT) scans, 19,098 measurements from IOLMaster as well as 5,425 pentacam examinations were imported into the DW including over 300,000 patients. Data discovery software was modified providing filtering methods. CONCLUSION: By building a DW a foundation for clinical and epidemiological studies could be implemented. In the future, decision support systems and strategies for personalized therapies can be based on such a database.

[The development of family health through implementation of its functions].

The article presents analysis of qualitative characteristics of information sources concerning formation of family health through implementation of its priority functions as an element of health and quality of life of population based on review of1224 Russian and foreign publications in medical (78 sites), sociological (12 sites) and economic (3 sites) Web-resources. It is established that 92.7-100% of scientific publications mark inconsistence of prevention direction related to formation of family health on all levels of ambulatory polyclinic stage. The necessity of enhancement of this direction is also emphasized. The evaluation of health of individuals and population is implemented on the basis of different indices but without accounting health conditions of family members through priority of its functions at the stages of development and conditions of their implementation for health and quality of life of population.

[The prevalence of diseases among persons drafted to military service].

The article considers dynamics of indices of suitability to military service of individuals drafted to military service in the Novosibirskaia oblast in 1997-2014. The level of suitability without limitations because of health conditions made up to in 37.7% in average. and with fluctuations according years - 31.6-43.6%. The negligible limitations of suitability included 23.4% of examined, restrictedly suitable - 33.9% and provisionally non-suitable - 1.6% of conscripts. The main classes and nosologic groups of diseases limiting suitability were determined. It is established that 86.3% of limitation of suitability resulted from morbidity of conscripts with diseases of musculoskeletal system and connective tissue, endocrine system, disorders of nutrition and metabolism, aftermaths of trauma of head and spinal cord with disorders of central nervous system, flat-footedness and foot deformation, disorders of refraction and accommodation of eyes, mental deficiency, ulcer diseases, diseases of skin, organic psychic disorders, asthma, pathology of liver and pancreas, hypertension disease, diseases of oral cavity and throat rheumatoid affections of heart. This situation predetermines implementation of corresponding curative health promoting measures with purpose of avoiding loss of servicemen during time military service and returning of this contingent because of diseases inconsistent with implementation of military duty.

[Development of an ophthalmological clinical information system for inpatient eye clinics]. / Entwicklung eines augenärztlichen klinischen Informationssystems für bettenführende Augenkliniken.

BACKGROUND: In times of increased digitalization in healthcare, departments of ophthalmology are faced with the challenge of introducing electronic clinical health records (EHR); however, specialized software for ophthalmology is not available with most major EHR sytems. The aim of this project was to create specific ophthalmological user interfaces for large inpatient eye care providers within a hospitalwide EHR. Additionally the integration of ophthalmic imaging systems, scheduling and surgical documentation should be achieved. MATERIAL AND METHODS: The existing EHR i.s.h.med (Siemens, Germany) was modified using advanced business application programming (ABAP) language to create specific ophthalmological user interfaces for reproduction and moreover optimization of the clinical workflow. RESULTS: A user interface for documentation of ambulatory patients with eight tabs was designed. From June 2013 to October 2014 a total of 61,551 patient contact details were documented. For surgical documentation a separate user interface was set up. Digital clinical orders for documentation of registration and scheduling of operations user interfaces were also set up. A direct integration of ophthalmic imaging modalities could be established. CONCLUSION: An ophthalmologist-orientated EHR for outpatient and surgical documentation for inpatient clinics was created and successfully implemented. By incorporation of imaging procedures the foundation of future smart/big data analyses was created.

Polymorphisms of ß 1-adrenoreceptor gene and cardiovascular complications in patients with thyrotoxicosis.

Human cardiac ß 1-AR perform a crucial role in mediating the cardiostimulating effects of norepinephrine. Gly389Arg and Ser49Gly polymorphisms of ß 1-adrenoreceptors ( ß 1-AR) can influence the cardiovascular prognosis. However, the possible effect of Gly389Arg and Ser49Gly polymorphisms on heart function in thyrotoxicosis has not been studied. We investigated the possible link between Gly389Arg and Ser49Gly polymorphisms and echocardiography parameters in 165 normotensive patients with a thyrotoxicosis without any cardiovascular disorders. Echo-CG was performed according to standard protocol before and during the thyreostatic treatment. Our data demonstrate that both Gly389Arg and Ser49Gly polymorphisms have very moderate influence on the risk of left ventricular hypertrophy and atrial fibrillation with no statistically significant effects on cardiac function and the development of cardiovascular complications.

[The model and stages of social hygienic evaluation of prevalence of pathology in population].

The article presents the model of social hygienic evaluation of prevalence of pathology in population. The main information flows such as population morbidity according medical aid appealability, the results of patient examination in regional diagnostic center and self-assessment of patients of presence of disorders of organs and systems are considered. The stages of analysis of data information to be applied to evaluate prevalence of pathology, social hygienic value of diagnostic techniques and estimation of potential relevance of medical technologies are discussed.

[The characteristics of medical technologies in emergency medical care hospital].

The article analyzes the implementation of major 12 diagnostic and 17 treatment technologies applied during medical care of patients with 12 key nosology forms of diseases in departments of the emergency medical care hospital No 2 of Omsk. It is established that key groups of technologies in the implementation of diagnostic process are the laboratory clinical diagnostic analyses and common diagnostic activities at reception into hospital and corresponding departments. The percentage of this kind of activities is about 78.3% of all diagnostic technologies. During the realization of treatment process the priority technologies are common curative and rehabilitation activities, intensive therapy activities and clinical diagnostic monitoring activities. All of them consist 80.1% of all curative technologies.

[The social hygienic assessment of significance of diseases under organization of ambulatory polyclinic care].

The article presents the results of analysis of appealability of adult population of Omsk to municipal polyclinic on the subject of diseases. The coefficients of relative importance of different classes of diseases to determine the groups af their significance were calculated on the basis of integrated evaluation of common and primary morbidity and diseases of patients under dispensarization monitoring. The established character of formation of flows of appealabiliy of population on the subject of diseases is a basic one to determine demand in medical technologies and planning of activities of ambulatory polyclinic section of health care.