[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.

[Treatment of infertility in men with pathospermia associated with oxidative stress].

INTRODUCTION: Oxidative stress considered to be the main cause of male infertility. Surgical treatment of varicocele and elimination of the inflammatory process in the male accessory glands can help reduce the level of oxidative stress, however, in most cases, antioxidant therapy is additionally prescribed. Currently, much attention is paid to regulatory peptides as a component of antioxidant therapy due to their antioxidant, anti-inflammatory and immunomodulatory properties. AIM: To evaluate the efficiency of a complex of antimicrobial peptides and cytokines Superlymph for the treatment of male infertility associated with oxidative stress. MATERIALS AND METHODS: A total of 30 patients with elevated levels of reactive oxygen species were recruited in the open, prospective, multicenter study. Ejaculate analysis (WHO-2010), MAR-test, sperm DNA damage testing and reactive oxygen species measurement were performed. All patients received Superlymph 25 IU/day for 60 days. Antibiotics and vitamin D were also prescribed if indicated. In addition, 12 patients took dietary supplements with antioxidant action. Laboratory tests were repeated after the completion of treatment. RESULTS: Superlymph therapy led to an improvement in standard semen parameters as well as decrease in sperm DNA fragmentation and oxidative stress. At the end of treatment, a significant increase in the sperm concentration was observed (46.8 [30; 87] vs. 62 [43-89], p=0.002). After treatment, there was also an increase in the median of sperm cells with normal morphology (3 [1; 7] vs. 4.5 [2; 9], p=0.002). The median sperm DNA fragmentation was lower compared to baseline, but this difference did not reach significant level (19 [14; 26] vs. 15 [10.5; 19.5], p=0.06). A significant decrease in the level of oxidative stress both in patients who took Superlymph as monotherapy (43 [27; 51] vs. 33 [22; 44], p=0.005), and as part of combination therapy with other antioxidants (31 [22; 54] vs. 21 [12; 36], p=0.009) was also observed. CONCLUSION: Superlymph contributes to the improvement of standard ejaculate parameters as well as decrease in the level of sperm DNA fragmentation and oxidative stress.

[The role of doppler ultrasound in the scrotal and penile trauma].

INTRODUCTION: The injuries of the external genital organs in men accounts for 30-50% of the total number of injuries of genitourinary system. In half of the cases, there is a trauma of the penis. In 80% of cases, trauma of the penile or scrotal area occurs. AIM: To study the role of Doppler ultrasound in diagnosing injuries of the scrotum and penis. MATERIALS AND METHODS: The analysis of Doppler ultrasound study of the scrotum and penis in 32 patients with injuries of the external genital organs was carried out. RESULTS: The analysis revealed various ultrasonographic variants of damage to the penis and scrotum. In the vast majority of cases, scrotal trauma without testicular rupture (n=15; 46%) and with testicular rupture (n=11; 33%) was seen. Penile injury was diagnosed in 6 (19%) patients. CONCLUSION: Doppler ultrasound is a gold standard for diagnosing injuries of the scrotum and penis. The mandatory ultrasound study allows to determine the indications and type of salvage surgical procedure.

[Association of tension-free inguinal hernia repair and pathospermia in fertile men]. / Assotsiatsiya nenatyazhnoi pakhovoi gernioplastiki i patospermii u muzhchin reproduktivnogo vozrasta.

OBJECTIVE: To reveal the association of tension-free inguinal hernia repair and pathospermia in fertile men. MATERIAL AND METHODS: We have retrospectively analyzed medical records of 512 men who appealed to andrologist with complaints of the absence of pregnancy in wife in 2018. We evaluated duration and features of infertility, presence/absence of previous inguinal hernia repair, spermogram data (according to WHO criteria, 2010) in all patients. RESULTS: Duration of infertility in men after inguinal hernia repair persists for 4.2±2.1 years. Right-sided hernia repair was performed in 36 (48.6%) patients, left-side - 23 (31%), bilateral repair - 15 (20.2%) patients. Men with impaired sperm motility prevailed among patients after right-sided inguinal hernia repair (17 (47.2%) people). Left-sided hernia repair was followed by asthenozoospermia in 8 (34.7%) cases, bilateral hernia repair - in 3 (20%) cases. The most severe abnormalities in semen analysis (azoospemia) develop after bilateral hernia repair. CONCLUSION: Inguinal tension-free hernia repair is a risk factor for male infertility in 14.4% of cases. It is very important to examine a man in case of infertile marriage. Previous surgical interventions including inguinal hernia repair should be considered.

[Long-term results of the first treatment of men with May-Thurner syndrome and varicose veins of pelvic organs].

Recurrent and bilateral varicocele represent two least studied aspects of the disease. There is no recommendation in current urological and andrological guidelines in various countries on the diagnosis and treatment of such patients. The first experience of successful surgical treatment of a patient with recurrent varicocele due to May-Thurner syndrome is presented in this paper. The patient had a severe form of the disease and admitted with the varicocele recurrence after 5 previous intervention with chronic pelvic pain syndrome, erectile dysfunction, chronic calculous prostatitis and varicose veins of the pelvic organs. The patient underwent balloon angioplasty and stenting of the left iliac vein on 28th March, 2017 in the City hospital named after E.O. Mukhin. There was almost complete resolution of pelvic pain in the immediate postoperative period (within 1 hour). One week after surgery the patient noted a recovery of erection without any therapy. Three months later, a 45% reduction in the maximum diameter of the prostatic veins was noted according to transrectal ultrasound (TRUS) as well as a lack of antegrade blood flow according to the color Doppler TRUS at rest and during Valsalva's test. There was no deterioration of symptoms during follow-up. Overall, the venous blood flow in prostate was decreased which accompanied by the reducing in pain syndrome and restoration of sexual function without medical therapy. The reduction of diameter of testicular and epididymal varicose veins was seen 6 months after surgery. The diameter of veins of pampiniform plexus in supine position at rest was less than 2 mm. There was no retrograde flow neither in supine, nor in stand position during Valsalva maneuver. Thus, X-ray endovascular angioplasty and stenting of the iliac veins in case of arterio-venous crossing at the lower level is a pathogenetically justified and highly effective treatment of varicocele and varicose veins of the pelvic organs in men.

[Docosahexaenoic acid in the treatment of idiopathic male infertility].

AIM: docosahexaenoic acid is one of the most common fatty acids in the cell membranes of sperm. This substance is a structural component of cell membranes, and is responsible for such properties as plasticity and fluidity which are necessary for the implementation of the process of capacitation and acrosome reaction. In addition, docosahexaenoic acid has antioxidant properties. Aim of our study was to assess the effect of dietary supplement docosahexaenoic acid (Brudi PLUS) on such markers of male fertility as the sperm DNA integrity, standard indicators of semen analysis and cryotolerance in infertile men. MATERIALS AND METHODS: a randomized, multicenter, double-blind, placebo-controlled study was conducted. A total of 109 infertile men were recruited to participate in the study. All patients underwent different analyzes, including semen analysis, sperm DNA fragmentation, MAR-test, test of cryotolerance and electron microscopy analysis of spermatozoa. In active treatment group patients were prescribed to drug containing 350 mg of docosahexaenoic acid 3 times a day for 90 days. In the control group, patients were administered to a placebo with a similar scheme. All analyzes were repeatedly performed after 3-months of therapy. RESULTS: An increase in the progressive mobility and sperm viability was determined after the test of cryotolerance in the active treatment group. According to electron microscopy analysis of spermatozoa, positive changes were observed in the number of heads of the normal form with the normal structure of chromatin and acrosome, as well as a decrease in the number of spermatozoa with insufficiently condensed chromatin. CONCLUSIONS: the therapy with drug Brudi PLUS in patients with male infertility allows to increase in cryotolerance of sperms as well as decrease in number of sperm ultrastructure defects.

[TREATMENT OF AGE-RELATED ANDROGEN DEFICIENCY IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA].

This paper reports the results of a comparative study evaluating the safety and efficacy of testosterone therapy in 44 patients with BPH and age-related androgen deficiency. All patients received α-blockers. The findings of the study showed a substantial improvement in the quality of life of patients in the study group that received testosterone therapy, compared with the control group treated with only α-blockers.

Comparative study of pathological changes in the mouse viscera in infection caused by two orthopoxviruses.

The mechanisms of infection development in intraperitoneal inoculation of mice by ectromelia virus strain K-1 and cowpox strain EP-2 were studied. Ultrastructural parameters of virus assembly and maturation are described. Differences in the types of cells replicating the viruses and in the type of visceral injuries were detected. The studies showed a local type of strain EP-2 cowpox infection and dissemination of ectromelia strain K-1.

[Reproduction of cowpox virus strain EP-2 isolated from an elephant in primary fibroblast cultures and chorion-allantoic chick embryos].

Electron microscopy was used to study the reproduction of cowpox virus strain EP-2 in the cells of a primary fibroblast cultures (PFC) and chorion-allantoic membrane (CAM) of chick embryos (CE). The sequential stages of viral morphogenesis and the structure of A-type inclusions were described. The parameters of viral reproduction in PFC and CE CAM were compared. The formation of crystalloid tubular structures in PFC, unusual electron dense inclusions in the cells of CE CAN, and different variants of A-type inclusions in the cells of a pock was found. The histological and ultrastructural characteristics of pocks in CE CAM are described.

[Intranasal infection in mice inoculated with cowpox virus strain EP-2 isolated from the elephant].

The specific features of reproduction of EP-2 strain of cowpox virus (CPV) were studied in intranasally infected BALC/C mice by light and electron microscopy. Virus replication was found in the ciliated, intercalary, basal, and goblet cells (the nasal respiratory area), basal and supporting cells (the nasal olfactory area), ciliated, intercalary, goblet cells (the tracheal and bronchial epithelium), and collagen-producing, Schwann's, endothelial, smooth muscle, and adventitial cells. It has been shown that the CPV strain EP-2 locally replicates in the nasal cavity, trachea, and large bronchi and that there is no generalized infection.

[An experimental infection caused by the EP-2 strain of cowpox virus in mice of different ages]. / Eksperimental'naia infektsiia, vyzyvaemaia shtammom EP-2 virusa ospy korov, u myshei raznogo vozrasta.

The specificity of lethal infection was studied in noninbred white mice (age--15 to 20 and 25 to 30 days) infected intraperitoneally with the EP-2 strain of cowpox virus (CPV) in doses 10(5), 10(6) and 10(7) PFU. The virus caused the lethal infection in the 15-20-day mice; while the 25-30-day mice remained healthy and survived. Virologic, immunologic-and-histochemical and electron-microscopy examinations of the 15-20-day mice revealed a replication of the EP-2 strain in tissues bordering on the virus introduction area; there was no generalization of infection. The virus replicated first in the mesothelium cells, and after that, in fibroblasts as well as in the endothelial, fatty, adventicial, cross-striated and muscle cells and in myosatellites.

[Effects of low-intensity laser irradiation on the functional activity of leukocytes and blood antioxidant system in acute myocardial infarction]. / Vliianie nizkointensivnogo lazernogo izlucheniia na funktsional'nuiu aktivnost' leikotsitov i antioksidantnuiu sistemu plazmy krovi pri ostrom infarkte miokarda.

Activation of lipid peroxidation and inadequate antioxidant activity essentially contribute to the pathogenesis of acute myocardial infarction, this fact dictating the necessity of correcting these processes. High efficacy of of He-Ne laser therapy was demonstrated in the treatment of 92 patients with myocardial infarction in the acute and subacute periods. This treatment modality corrected lipid peroxidation parameters, which fact manifested by reduction of leukocytic functional activity and elevation of blood plasma antioxidant characteristics.

[Mechanism of the nonspecific protective action of Shigella antigens]. / O mekhanizme nespetsificheskogo protektivnogo deistviia antigenov shigell.

The mechanism promoting the nonspecific action of antigens obtained from S. flexneri and S. sonnei by a sparing method has been studied. These antigens stimulate the T- and B- systems of immunity, that is followed by activation of myelopoiesis and the humoral protective factors of the body, which seems to underlie the formation of resistance to infection caused by nonspecific microorganisms.

[Shigella antigens in early pathogenetic therapy of experimental acute radiation sickness]. / Antigeny shigell kak sredstvo rannei patogeneticheskoi terapii éksperimental'noi ostroi luchevoi bolezni.

In experiments on gamma-irradiated hamsters it is shown that antigens, obtained from Sh. flexneri and sonnei by the sparing method, have a radioprotective therapeutic action. The antigens exhibit the immunostimulating activity which is perhaps one of the aspects of the mechanism involved in the formation of resistance to infectious complications in irradiated animals and of the favourable radioprotective effect.

[Immunogenicity of a conjugate of bovine serum albumin with polyacrylic acid]. / Immunogennost' kon"iugata bych'ego syvorotochnogo al'bumina s poliakrilovoi kislotoi.

The conjugate of bovine serum albumin (BSA) with polyacrylic acid, in contrast to pure BSA and the mixture of BSA with polymer, induces a pronounced primary humoral response. The injection of the conjugate in Freund's complete adjuvant leads to considerable immune response to BSA, 30-40 and 100-130 times more intensive than that produced, respectively, by the injection of the conjugate alone or BSA in the adjuvant.