Aim. To investigate prevalence and types of azoospermia factor (AZF) microdeletions in infertile men.Materials and Methods. We performed the genotyping of AZF locus within Y chromosome in 76 male inhabitants of Kemerovo Region (23-38 years of age, mean with standard error 34.2 ± 2.35) with primary infertility. DNA was extracted from the peripheral blood utilizing thermocoagulation method with the following amplication of sequence tagged sites (STS) specic for AZFa, AZFb, and AZFc subregions. We calculated the prevalence of AZF microdeletions and proportions of their different types.Results. The prevalence of AZF microdeletions among infertile men in Kemerovo Region was 7.8%, comparable to other populations. Microdeletions in AZFс subregion, frequently correctable by assisted reproductive technology, were the predominant type. Conclusions. We recommend genotyping of the AZF locus to all male patients with primary infertility to exclude other causes of this disorder. This approach may also define whether assisted reproductive technology should be applied for infertility treatment in these patients, as in the case with microdeletions in AZFc subregion.

Aim. Bioprosthetic mitral valves frequently undergo severe calcification causing bioprosthetic valve failure, an urgent problem in cardiovascular surgery. However, no research have been performed on genetic susceptibility to severe bioprosthetic mitral valve calcification. Here we assessed whether inherited variation in genes of calcium metabolism is associated with severe bioprosthetic mitral valve calcification. Materials and Methods. We recruited 124 consecutive patients who underwent mitral valve replacement surgery. We assessed eight polymorphisms within the five genes: rs13290979 (NOTCH1 gene), rs731236 and rs2228570 (VDR gene), rs1042636 (CASR gene), rs3134069, rs2073618, rs3102735 (OPG gene) and rs1801197 (CALCR gene). Genotyping was carried out in 96-well format using the TaqMan SNP genotyping assay. Statistical analysis was performed utilizing the SNPStats software, with the calculation of the odds ratio according to codominant, dominant, recessive, overdominant, and log-additive models of inheritance. Adjustment for multiple comparisons was conducted using false discovery rate.Results. G/G genotype of the rs13290979 polymorphism within the NOTCH1 gene was associated with 2.75-fold increased risk of severe bioprosthetic mitral valve calcification compared to the A/A and A/G genotypes. Other genotypes did not show a significant association with this condition.Conclusions. Polymorphisms within the calcium metabolism genes (e.g., NOTCH1 gene) may be associated with severe bioprosthetic mitral valve calcification.

Aim. To evaluate early and long-term results of renal denervation in patients with resistant arterial hypertension and different anatomy of renal arter-ies as compared to those who underwent a conser-vative treatment.Materials and Methods. We recruited 53 con-secutive patients with resistant hypertension (25 males and 28 females, median age 54 (interquartile range 43-66) years). Depending on the anatomy of renal arteries defined by non-invasive visualization, patients who underwent renal denervation were as-signed into the subgroups with typical anatomy (A1 and A2) and with multiple arteries (B1 and B2). Pa-tients with complex renal anatomy unacceptable for the surgery or those who refused to undergo renal denervation received conservative therapy. Evalua-tion of blood pressure (BP) was performed at the baseline and upon 12 months of follow-up.Results. Patients with typical anatomy of renal arteries were characterized by significant decrease in mean BP as well as its variability (from 20 to 11 mmHg and from 17 to 10 mmHg for systolic and diastolic BP, respectively). Index of BP time de-creased from 100 to 25% for systolic BP and from 90 to 45% for diastolic BP (р < 0.05). Similar dy-namics were revealed in the B1 subgroup (all arter-ies available for ablation) of patients with multiple arteries. In the B2 subgroup (≥ 1 artery unavail-able for ablation) office and 24-hour BP decreased significantly from 165/95 to 155/90 mmHg (р ≤ 0.05), and mean systolic BP also decreased from 165 to 150 mmHg (p = 0.04). Patients with com-plete renal denervation (A1 + B1) were character-ized by a significant reduction of mean systolic BP (25 mmHg) as compared to those with incomplete renal denervation (10 mmHg) or conservative therapy (1 mmHg).Conclusions. The long-term efficacy of renal denervation was superior to conservative therapy in BP reduction, its variability and time index re-gardless of the anatomy of renal arteries. However, BP reduction in patients with incomplete denervation was less pronounced.

Aim. To evaluate the efficacy of vaginal training device in treatment of pelvic organ prolapse in elderly women.Materials and Methods. We consecutively recruited 49 elderly women with grade 1 pelvic prolapse and overt or occult urinary inconti-nence having strict contraindications for surgical treatment. Half of the patients (n = 24) were pre-scribed to the use of vaginal training device Yolana Phase 1 while another half (n = 25) utilized Kegel exercises for the training of pelvic floor muscles. Outcomes were studied 6 months after the start of treatment. The primary treatment outcome was the prevalence of overt or occult urinary incontinence diagnosed by cough test and Valsalva maneuver. Secondary treatment outcomes included pelvic pain, dyspareunia, degree of pelvic organ prolapse (Baden-Walker classification), and strength of the pelvic floor muscles defined by a cone test. Results. Patients who employed vaginal training device had a lower prevalence of urinary in-continence, pelvic pain, and dyspareunia and were generally characterized by a higher strength of the pelvic floor muscles, as compared to those who used Kegel exercises. Conclusions. Vaginal training devices are use-ful to increase strength of pelvic floor muscles in patients with grade 1 pelvic organ prolapse, decreasing both overt and occult urinary incontinence and improving other symptoms related to the quality of life.

Aim. To determine the hospitalization patterns in patients with upper gastrointestinal bleeding in Kemerovo.Materials and Methods. We analyzed the amount and structure of hospitalizations due to peptic ulcer disease, Mallory-Weiss syndrome, erosive gastritis, and liver cirrhosis in Kemerovo between 1997 and 2017. We compared two seven-year periods (2000-2006 and 2011-2017) or two decades (1997-2006 and 2007-2016). Results. Gastric/duodenal ulcers, Mallory-Weiss syndrome, erosive gastritis, and esophageal bleeding accounted for 64.5%, 18.9%, 9.7%, and 6.9% of hospitalizations, respectively. Time periods did not differ significantly in both number and prevalence of hospitalizations due to any of abovementioned disorders. However, the number of hospitalizations related to bleeding esoph-ageal/gastric varices and portal hypertension in-creased significantly (almost 2-fold for portal hypertension). Conclusions. Over the past 20 years, there has been no change in the average annual number of patients with bleeding gastroduodenal ulcers, Mallory-Weiss syndrome, and erosive gastritis. However, the number of hospitalizations due to a portal hypertension demonstrated an unacceptably high increase.

Aim. To investigate the influence of ethylmethylhydroxypyridine succinate and lysozyme on in vitro biological properties of bifidoflora isolated from HIV-positive patients. Materials and Methods. We investigated hydrophobicity, autoaggregation, and specific adhesion of 15 bifidobacteria strains from HIV-infected children after exposure to ethylmethylhydroxypyr-idine succinate, lysozyme, or both combined. Hydrophobicity was studied according to the Rosen-berg method (1980) modified by Wang (2010); autoaggregation was documented as by Del Re (2000); specific adhesion was measured in accordance with Brilis (1986). The content of fatty acids in cell walls was determined using gas chromatog-raphy-mass spectrometry. Results. Addition of ethylmethylhydroxypyridine succinate to the cultures with low antioxidant activ-ity led to the 10-fold increase in the number of Bi-dobacteria, 4-fold increase in autoaggregation, and 2-fold increase in hydrophobicity by stimulating the synthesis of unsaturated fatty acids, as compared to the control culture. Combination of ethylmethylhy-droxypyridine succinate with lysozyme elevated specific adhesion of Bifidobacteria up to 9.1%.Conclusions. The use of ethylmethylhydroxy-pyridine succinate allows to control surface properties of Bifidobacteria affecting their growth and non-specific adhesion. This may indicate usefulness of ethylmethylhydroxypyridine succinate and lysozyme for the correction of gut microbiota in HIV-infected patients.

Аim. Extracorporeal circulation, temporary aortic cross-clamping, cardioplegic arrest, perioperative heart failure, and comorbidities all are among the leading risk factors of a systemic inflammatory response syndrome (SIRS), which in some cases progresses to multiple organ failure (MOF). It has been recently suggested that sorption of inflammatory mediators using selective cytokine sorbents can prevent the development of MOF. We tested the efficacy of interleukin-6 (IL-6) sorption in pa-tients who underwent coronary artery bypass graft surgery requiring extracorporeal circulation with the subsequent development of sepsis (n = 9) and patients who was subjected to preventive adsorption during perfusion (n = 3). Materials and Methods. In addition to stan-dard clinical and biochemical parameters, we measured levels of serum IL-6 prior to the procedure, after the procedure and 24 hours after the sorption.Results. We noted a decrease in norepinephrine support and serum IL-6 as well as regression of MOF severity, particularly in patients with a preventive adsorption during the perfusion.Conclusions. IL-6 sorption is a promising method for correcting SIRS and MOF in patients who underwent coronary artery bypass graft sur-gery, particularly if applied in a preventive manner during the perfusion.

Hand hygiene is an essential element to reduce the transmission of nosocomial pathogens in healthcare facilities. The WHO has launched a global campaign on hand hygiene with the aim to reduce healthcare-associated infections. Hand disinfection using alcohol-based hand rubs is the treatment of choice for clean hands according to the five indications for hand hygiene. The dermal tolerance is usually good when emollients are part of the formulation. Hand washing should be an exception, e.g. when hands are visibly soiled or contaminated with bacterial spores such as C. difficile. Use of plain liquid soap is usually sufficient, antimicrobial soaps do not provide a relevant advantage over plain soaps. Preoperative treatment of hands is ideally done with alcohol-based hand rubs. Additional biocidal agents with a persistent antimicrobial activity are not necessary and may cause skin irritation, allergic reactions or biocidal tolerance. Surgical scrubbing with an-timicrobial soaps is more and more replaced by surgical hand rubbing which is faster (often 1.5 min application time) and more gentle to the skin. Following the WHO recommendations will help to prevent health-care-associated infections and to reduce the occupa-tional stress to the skin of healthcare workers.

Here we review the current concept on the definition of myocardial infarction (MI) and its diagnosis. We briefly highlight features of all international documents on the universal definition of MI and specify type 2 MI as a particularly difficult form. We then consider clinical difficulties in providing medical care to these patients and underline the crucial importance of myocardial necrosis biomarkers (high-sensitivity troponins) in MI diagnosis. Finally, we talk about the principles of distinguishing MI from myocardial injury.

The human body is currently considered as a meta-organism, evolutionarily inhabited by numerous microbes which populations evolve and adapt according to the changing conditions. The advent of high-throughput genomic and metabolomic approaches uncovered the complexity of interactions between the host and its microbiota, primarily mediated by synthesis of microbial bioactive compounds including mutagens. Alter-ations in microenvironment may disturb homeostasis of microbiota leading to the increased production of hazardous metabolites that, in turn, may initiate or promote disease development. Here we evaluate existing data on the role of human microbiota in physiological and pathological processes, with a particular focus on metabolomics.

Here I critically review conventional concepts in the national theory of epidemiology to denote promising routes in its development for improving terminology, systematics, and teaching of this discipline in medical universities. I propose that the progress in epidemiological theory should be based on Belyakov model of epidemic process in anthroponoses and must be accompanied by current data from the modern fields of biomedicine. The united ecological approach to form laws of disease spreading may eventually lead to the integration of biomedical disciplines.

Amniotic fluid embolism (EAF) is a critical condition in pregnant women, parturients and puerperas, provoked by the release of amniotic fluid into the maternal bloodstream and resulting in acute hypotension, respiratory failure or sudden cardiac arrest all accompanied by a coagulopathy. The frequency of EAF considerably varies across different countries, occurring on average in 1 per 20,000 deliveries. Risk factors include maternal age > 35 years, polyhydramnios, intense labor, abdominal trauma, cesarean section, labor induction, abnormal uterine activity, placenta previa, eclampsia, multiple pregnancy, uterine rupture, placental abruption, diabetes mellitus, fetal macrosomia, acute fetal distress, antenatal or intrapartum death, and male fetus. EAF is characterized by acute hypotension (systolic blood pressure < 90 mmHg), maternal hypoxia (shortness of breath, cyanosis, or peripheral oxygen saturation < 90%), fetal hypoxia, coagulopathy, disseminated intravascular coagulation, shock, and cardiac arrest. Early onset of appropriate treatment is a key factor determining the favorable outcome.

Cardiovascular diseases caused by atherosclerosis and its complications represent the leading cause of death in developed countries. The main risk factor of atherosclerosis development is dyslipidemia, in particular familial hypercholesterolemia (FH) characterized by inherited dysregulation of lipid metabolism. Standard medications to control dyslipidemia did not exhibit notable efficacy in patients with FH; instead novel cholesterol-lowering medications (e.g. PCSK9 inhibitors) or extracorporeal treatment such as LDL-apheresis should be applied. Here we present a clinical case of employing HELP-apheresis to treat a female patient with FH. Initially, combined therapy by maximum tolerated dose of statins and ezetimibe demonstrated little if any efficacy. Two sessions of HELP-apheresis showed high efficacy and safety rates. In addition to the main hypolipidemic effect, this method improves blood rheological properties, potentiating anti-atherogenic effects and favoring the prognosis in patients with severe lipid metabolism disorders.