[Influence of standard treatment on changes in the structural and functional properties of circulation red blood cells in obstructive and non-obstructive acute pyelonephritis].

AIM: To determine the effect of standard treatment on changes in the structural and functional properties of erythrocytes in obstructive and non-obstructive acute pyelonephritis. MATERIALS AND METHODS: The structural and functional properties of erythrocytes and their intracellular metabolism in 78 patients with a diagnosis of primary non-obstructive and secondary obstructive acute pyelonephritis, randomized by age, gender, and the minimum number of concomitant diseases were investigated. RESULTS AND DISCUSSION: In acute non-obstructive pyelonephritis, changes of the content of proteins in circulating erythrocytes responsible for the structure formation and stabilization of the plasma membrane (-spectrin, anion transport protein, pallidin, protein 4.1), intracellular metabolism (anion transport protein, glutathione-S-transferase), membrane flexibility and shape (actin, tropomyosin) are insignificant, alike from acute obstructive pyelonephritis. In addition, processes of lipid peroxidation inside red blood cells are intensified, and oxidative stress develops with a decrease in the sorption capacity of erythrocytes, as well as the content and ratio of lipid fractions in the plasma membrane, which form the basis of the lipid components and play the main role in the sequencing of protein macromolecules and the normal metabolism of red blood cells. CONCLUSION: In acute obstructive pyelonephritis, changes in the content and ratio of proteins and lipids in the erythrocyte membrane lead to functional rearrangements that are not corrected by standard treatment.

[Study of allelic variants of the CYP2D6 and CYP3A genes on the effectiveness and safety of tamsulosin therapy in patients with BPH: results of a pilot study].

INTRODUCTION: Tamsulosin is a member of the group of selective 1-adrenoblockers. Tamsulosin monotherapy is the most common first-line option in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and can be used regardless on severity of LUTS. The CYP2D6, CYP3A4, and CYP3A5 enzymes are involved in the metabolism of tamsulosin. Carriage of different allelic variants of CYP2D6, CYP3A4 and CYP3A5, involved in its metabolism, may potentially affect the variability of efficacy and safety of the drug. AIM: To evaluate the effect of carriage of allelic variants of cytochrome P450 superfamily enzyme genes (CYP2D6*3, CYP2D6*4, CYP2D6*9, CYP2D6*10, CYP2D6*41, CYP3A4*3, CYP3A4*22 and CYP3A5*3) on the efficiency and safety of tamsulosin in patients with LUTS associated with BPH. MATERIALS AND METHODS: All phases of the study were completed by 106 patients with LUTS/BPH (N40 according to ICD 10). All patients received monotherapy with tamsulosin 0.4 mg/day for a minimum of 8 weeks. Based on the severity of symptoms, they were divided into two groups using the International Prostate Symptom Score (IPSS). In Group 1, there were patients with moderate symptoms (IPSS score of 8-19) (n=57), while Group 2 consisted of those with severe symptoms (IPSS score >20) (n=49). Treatment outcomes were assessed using the IPSS score with determination of quality of life (QoL), transrectal ultrasound with evaluation of prostate volume and residual urine, and uroflowmetry. Follow-up visits were at 2, 4, and 8 weeks after the start of therapy. Genotyping of all patients was performed using polymerase chain reaction to determine the CYP2D6 (*3, *4, *9, *10, and *41), CYP3A4 (*3, *22), and CYP3A5*3 markers. RESULTS: In the group of patients with moderate symptoms, carriers of the CYP2D6*10 and CYP2D6*41 polymorphisms showed a significantly greater reduction in symptoms according to the overall IPSS score at 8 weeks (p=0.046) and in the micturition symptom subscale starting from 4 weeks of treatment (p<0.05). Carriers of the CYP2D6*10 polymorphism in both groups were associated with a decrease in residual urine volume at 8 weeks (p<0.05). The presence of the CYP3A5*3 variant in those with severe symptoms significantly improved quality of life during therapy. Allelic variants of the CYP2D6 and CYP3A genes did not affect the frequency of adverse events. CONCLUSION: The results obtained by calculating the prognostic significance of individual polymorphic markers pointed to the contribution of CYP2D6*10 and CYP2D6*41. Tamsulosin therapy is more effective in patients with LUTS who are carriers of these allele variants. The safety parameters of tamsulosin were not influenced by the studied polymorphic variants. It was found that CYP3A5*3 was associated with an increase in the subjective assessment of the patient's quality of life, but it is too early to draw final conclusions. The issue of the contribution of genetic factors to the efficiency and safety of treatment of LUTS in BPH requires further study with a larger sample size and analyzed parameters.

[Changes in the structural and functional properties of erythrocytes in serous and purulent acute pyelonephritis].

to establish violations of the structural and functional properties of peripheral blood erythrocytes in serous and purulent acute pyelonephritis before and after conventional therapy. MATERIALS AND METHODS: The structural and functional properties of erythrocytes of 62 patients with various forms of acute pyelonephritis, randomized by age, sex, and the minimum number of concomitant diseases in remission, were examined. Results and its discussion. In serous, to a greater extent, in the purulent form of acute pyelonephritis, violations of the usual ratio of erythrocyte membrane proteins responsible for the flexibility and shaping of the membrane, intracellular metabolism, stabilization and structure formation of the plasma membrane skeleton were established. Disturbances in the lipid content of erythrocyte membranes, which form the basis of the lipid framework of the plasma membrane and play a major role in the ordering of protein macromolecules and normal erythrocyte metabolism, were revealed. CONCLUSION: In the serous and purulent phases of inflammation, disturbances in the qualitative and quantitative variant of the protein and lipid fractions of the membranes cause functional changes in blood erythrocytes that are not normalized by standard treatment in the purulent form of the disease, which requires the development of correction methods.4 CONCLUSIONS: In patients with NDE before treatment, an increase in the level of only one representative of the investigated proteins of the circulating erythrocyte membrane out of 12, namely tropomyosin, was revealed, which can be used in the differential diagnosis of pyelonephritis forms. In patients with a purulent form of pyelonephritis, a more significant increase in lipid peroxidation processes, a weakening of the bodys antioxidant system, and a decrease in the adsorption characteristics of erythrocytes were revealed. Given the lack of effectiveness of basic treatment in relation to most indicators of the structural and functional properties of erythrocytes, it is necessary to include immunomodulatory and antioxidant drugs in the complex treatment for serous and purulent forms of acute pyelonephritis, which will help reduce complications and enhance regenerative processes. RECOMMENDATIONS: to recommend to medical specialists to use indicators of structural and functional properties of erythrocytes in difficult cases of differential diagnosis of forms of acute pyelonephritis.

[The main aspects of the impact of the new coronavirus infection SARS-CoV-2 on the development of infertility in men].

Since the end of 2019, the world has been overwhelmed by a pandemic of a new coronavirus infection (COVID-19), a disease that damages various organs and systems. Because of the extensive coverage of the population by the infection, the long-term effects of the disease are not well understood, which is of considerable scientific and practical interest. We performed an in-depth analysis and systematization of data from foreign and domestic publications in the Scopus, Web of Science, eLIBRARY, PubMed, Wiley Online Library, and Google Scholar databases were performed. Information searches included original articles, reviews, guidelines, manual comments, and editorials related to the effects of SARS-CoV-2 virus on the male reproductive system. Accumulated clinical evidence suggests that the SARS-CoV-2 virus and the COVID-19 disease it causes have a negative impact on male reproductive health.. Drugs with a negative effect on spermatogenesis are used in the therapy of patients with COVID-19. These include lopinavir, chloroquine and its derivatives, and widely used glucocorticosteroids. Lopinavir and chloroquine have subsequently been excluded from potential COVID-19 therapy. Although available data on the fertility of men with COVID-19 are scarce and the results of published studies are from a limited sample, it is clear that maintaining male reproductive health during the COVID-19 pandemic is a pressing issue in modern medicine and requires further in-depth study. Preconceptional screening should be recommended for men who have undergone COVID-19.

[Application of laser technologies in the treatment of non-muscle-invasive bladder cancer].

This review includes the facts of bladder treatment by means of laser technologies application in historical perspective. Advantages and disadvantages of different laser technologies were considered in comparison with the traditional TUR of the bladder wall.

[Molecular genetic predictors of the efficacy and safety of tamsulosin therapy].

Individual differences in efficacy and safety of drugs between patients are a significant problem in modern pharmacotherapy. The bodys pharmacological response to the administration of a particular drug is determined by multiple factors, where up to 50% of the variability of the pharmacological response may be determined by the genetic variability of the body. The article presents an up-to-date review of the data on genetic polymorphisms influencing the efficacy and safety of tamsulosin therapy in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia.

[Laparoscopic management of the prostatic utricle cyst in a 4-year-old child].

The article present the clinical observation of 4 year old boy with scrotal hypospadias. Previous surgery management had unsatisfactory results due to complications of the cyst of the prostatic utricle. Laparoscopic removal of the cyst of the prostatic utricle was performed. The next step was urethral plastic. The results of the operation were satisfactory. A brief review of the literature is provided.

[Immune system disorders in acute pyelonephritis. II art].

New information about typical changes in the immune status at both local and systemic level in various forms of acute pyelonephritis is provided in the second part of the review. The literature review and analysis of current national and foreign literature dedicated to immune disorders in various forms of acute pyelonephritis has been performed. The degree and nature of changes in systemic and local immunological parameters in nonobstructive and obstructive, serous and purulent forms are highlighted in details. In particular, it has been established that in patients with obstructive and purulent pyelonephritis, there are more pronounced changes in the serum and urine level of cytokines and complement factors in comparison with serous and non-obstructive pyelonephritis. Recommendations are given on monitoring of the immunological status in patients with various forms of acute pyelonephritis in order to optimize treatment approaches. In addition, the rationales for effective pathogenetic, including specific, immunotherapy drugs for various forms of pyelonephritis are presented.

[Immune disturbances in acute pyelonephritis. Part I].

In the part I of a literature review of modern national and foreign publications dedicated to the problem of immune disorders in acute pyelonephritis, information on the role of innate and adaptive immunity in the pathogenesis of acute pyelonephritis is summarized and systematized. The relationship between the pathogens and immune system, in particular the ability of pathogens to overcome the protective immune mechanisms are discussed. The role of neutrophilic granulocytes as well as cellular immunity in the pathogenesis of acute pyelonephritis is shown. The changes in level of pro- and anti-inflammatory cytokines are separately highlighted. In conclusion, perspective directions for the studies in the area of immune disorders in acute pyelonephritis are proposed.

[Focal laser coagulation in the treatment of a patient with kidney cancer and prostate cancer].

The article describes the clinical observation of the patient 84 years old with prostate cancer T2bNxM0, left kidney cancer T1N0M0 and severe comorbidity. Stepwise interstitial laser coagulation was performed using the Russian microsecond Nd: YAG laser surgical complex.

[Interstitial laser coagulation in the management of urothelial papillary carcinoma of the renal pelvis].

This article presents a case of a 59-year-old patient with a primary tumor of the right kidney with bladder and liver metastases. The patient was treated in three-stages. In the first stage, he underwent ureteral stone extraction, laser resection of the tumor with subsequent vaporization. In the second stage, a repeat laser resection and vaporization of the tumor was performed. During the third stage, the patient underwent TUR of the bladder wall with the tumor, followed by laser vaporization of the tumor bed. During a 9-year follow-up, no signs of tumor growth or metastasis were observed.

[Age-related androgen deficiency. The current state of the problem].

This paper reviews the modern concept of age-related androgen deficiency. The authors discuss the prevalence of androgen deficiency and its relationship with age, concomitant diseases, pharmacotherapy and other factors.

[Condition of the immune status at patients with the serous and purulent pyelonephritis according].

AIM: Studying of a condition of the immune status on for standard treatment at an acute serous and purulent pyelonephritis. MATERIALS AND METHODS: The immune status of 62 patients with various forms of an acute pyelonephritis, randomized on age, sex, the minimum quantity of associated diseases in a remission stage is surveyed. RESULTS: and their discussion. Purulent form of acute pyelonephritis was accompanied by higher levels of pro-inflammatory cytokines with decreased levels of anti-inflammatory cytokines. In serous form, imbalance in the cytokine system was found. Both serous and purulent forms of pyelonephritis were characterized by the imbalance in the complement system, increased production of immunoglobulins with simultaneous reduction of circulating immune complexes, decreased activity and the intensity of phagocytosis with increased metabolic activity of neutrophils. CONCLUSION: At serous and purulent forms of a pyelonephritis there are differences in an orientation and expression of changes of the immune indicators demanding development of methods of the differentiated immunorehabilitation.

[Large urethral stones: a case report].

The article describes a clinical observation of a 68 y/o patient with large stones of the urethra, reaching 5 cm in length and located in the penile urethra. The patient underwent a three-stage treatment: the first stage consisted of drainage of the urinary bladder, the second stage of the urethrolithotomy and a double-barreled fistula, the third was an anastomotic urethroplasty. After removing the cystostomic drainage tube, normal urination was restored.

[Features of endoscopic surgical treatment of urolithiasis in overweight patients].

The article presents the results of endoscopic and nephrolithotripsy and ureterolithotripsy in 73 overweight patients (body mass index of over 30 kg/m2) with kidney stones and urinary tract infections of different locations compared with 30 patients without obesity. The features of choice of tactics of surgical treatment and access, possible complications and their prevention are described.

[Modern tactics of management of patients with bilateral staghorn nephrolithiasis].

A comparative analysis of the effectiveness of open and percutaneous operations in the treatment of bilateral staghorn nephrolithiasis (SN) was performed. Of the 38 patients with bilateral SN, stage operation (without discharge) was performed in 26 (68.5%) patients, and single-step operation--in 12 (31.5%) patients. For the 47 patients with bilateral SN, who underwent open surgery, the interventions were following: pelviolithotomy (64 operations), nephrolithotomy (21 operations), nephrectomy (9 operations). Surgery was performed in stages on each side, but unlike percutaneous operations, with discharge from the hospital. When using open surgery, only in 27 of the 47 patients complete discharge of kidney stones was achieved. A comparative analysis of single-step and stage surgery for bilateral SN revealed no significant difference in the duration of surgery and intraoperative blood loss (p > 0.1); endoscopic surgery compared with open surgery is characterized by significantly lower intraoperative blood loss and postoperative in-hospital stay (p < 0.001).

[Experimental validation of the use of ND:YAG-interstitial laser coagulation of the kidney].

Interstitial laser coagulation (ILC) is one of the effective methods of minimally invasive destruction of small renal tumors. For the safe use of ILC in clinical practice, it is necessary to select the optimal mode of action of laser radiation on the tissue of target organ and techniques for the procedure. The effects of ILC on kidney tissue in 6 rabbits weighing less than 3 kg and 5 mongrel dogs weighing up to 20 kg were investigated in vivo. The impact of ILC was made intraoperatively. Organ retrieval in experimental animals for the macro- and microscopic examination was performed immediately after the impact of ILC and at various times thereafter during the month in rabbits and 35 days in dogs. Morphological study in different periods after exposure allowed to establish phasing and volumes of changes in the tissues of the kidney, confirming the safety and efficacy of ND:YAG laser irradiation on kidney tissues. The results indicate the possibility of effective application of ILC of kidney tissues for destruction of small size tumors, without impairment of functions of the organ.

[Relations between red cell structure, function and immune homeostasis in prostatic diseases].

Patients with chronic prostatitis alone and in combination with prostatic adenoma have changes in the activity of the complement system, neutrophil function and content of pro- and anti-inflammatory cytokines. Abnormal representation of the proteins of the red cell membrane in patients with prostatic diseases affects structural and functional activity of erythrocytes in these patients. Dynamic changes in immune status of patients with chronic prostatitis and prostatic adenoma correlate with changes in functional red cell activity. This fact helps better understanding of pathogenesis of chronic prostatitis and prostatic adenoma.

[Correction of complement system failure in patients with chronic prostatitis].

The aim of the study was detection of local and systemic changes in the complement system in patients with chronic abacterial prostatitis (CAP) and chronic bacterial prostatitis (CBP) and to assess a relevant corrective efficacy of the hardware and software complex Andro-Gin (KAP-ELM-01 Andro-Gin). Before treatment, blood plasma of CAP patients contained elevated concentrations of all studied components of the compliment system and factor H but subnormal concentration of C1-inhibitor. Locally, all the compliment indices were high including C1-inhibitor and factor H except component C5. Initial blood plasma compliment fractions in CBP patients were elevated but regulatory proteins concentrations were low. Local compliment components C3, C4, C5 and C5a and factor H were significantly higher. Standard treatment of CAP partially corrected the level of C3, C3a, C4 components, locally normalized concentration of C3 component and corrected C4 component, while in CBP standard treatment normalized concentration of C3 component and reduced C3a, C4, C5 and C5a components, locally normalized the levels of C3, C4 components, corrected concentration of C3a, C5, C5a components, raised regulatory factors. Combination of the standard treatment with Andro-Gin unit compared to standard treatment alone, in CAP corrected plasma concentrations of C3, C3a, C4 compliment components and significantly raised levels of regulatory factors, locally--partially normalized the level of factor H. In CBP additional use of Andro-Gin more significantly improved concentrations of C3a and C5a components , locally--C5a component, raised significantly concentration of regulatory factors C1-inhibitor and factor H. Thus, KAP-ELM-01 Andro-Gin administration in CAP and CBP patients promotes more effective correction of systemic and local disorders in the compliment system, the improvement being more pronounced in CBP.