Aim. To study the technical possibility of em-ploying the original technique of long-term osmium tetroxide postfixation and uranyl acetate/lead citrate counterstaining with the following embedding into epoxy resin for the investigation of histological and histopathological features of the blood vessels. Materials and Methods. The study was carried out on rat abdominal aorta, carotid atherosclerot-ic plaque excised during endarterectomy, and stent excised during total surgical correction of Fallot’s tetralogy. After the 24-hour fixation in 10% neutral phosphate buffered formalin, samples were stained with 2% osmium tetroxide for 60 hours, dehydrated in ascending ethanol series (50, 60, 70, 80, and 95% ethanol, 99,7% isopropanol, acetone), impregnated into acetone : epoxy resin (Epon-Araldite, 1:1), and embedded into fresh epoxy res-in with the following grinding and polishing of polymerised epoxy resin blocks. Counterstain-ing with 2% uranyl acetate was performed during the incubation in 95% ethanol while counterstain-ing with Reynolds’ lead citrate was conducted af-ter the grinding. Samples were then sputter coated with carbon and were finally visualised by back-scattered scanning electron microscopy.Results. Our technique retained integrity of the blood vessels, preserving all vascular layers (intima, media, adventitia, and perivascular adipose tissue) and allowed visualisation of all vessel structures (endothelial cells, elastic fibers, smooth muscle cell layers, fibroblasts, perivascular adipose tissue cells, vasa vasorum, and lymphoid follicles) at x5000 magnification. In addition, it was possible to differentiate even small caliber vasa vasorum from lymphoid follicles. The developed technique considerably ex-pands quality of visualization as compared to the conventional approach (paraffin embedding, routine histological staining, and light microscopy) with a limited magnification not permit-ting quantitative analysis of vasa vasorum and lymphoid follicles. Further, it makes possible to analyse tissues containing metal implants or large amounts of calcified tissue without their disintegration.Conclusions. Out technique may be suggested for the evaluation of physiological and pathological neovascularisation and assessment of adventitial and perivascular inflammation.

Aim. To study amino acid composition, quantify the amino acids, and investigate neurotropic effects of bifidobacterial exometabolites isolated from HIV-infected children.Materials and Methods. Amino acid composition and quantities in bifidobacterial exometabolites and hydrolysates were measured using reversed-phase high-performance liquid chromatography. An antidepressant activity of exometabolites was evaluated in Balb/c mice by behavioural despair test. Results. The total content of amino acids as well as levels of threonine and serine were 3, 7, and 14-fold higher, respectively, in exometabolites of bifidobacteria isolated from HIV-infected children as compared to those from HIV-negative children. Glycine and histidine were found only in bifidobacterial hydrolysates. Bifidobacteria from HIV-infected children were characterized by high levels of tryptophan and reduced ability to accumulate kynurenine in cells. Exometabolites of bifidobacteria had antidepressant, sedative and stimulating effects on laboratory animals.Conclusions. Bifidobacteria in HIV-infected children are characterized by an increased synthesis of serine, threonine, tryptophan as well as low levels of histidine and glycine production. The ability of bifidobacteria to accumulate the products of the kynurenine pathway of tryptophan oxidation is significantly reduced. The neurotropic effects of bifidobacterial exometabolites are strain-specific.

Aim. To compare the efficiency of one-stage and two-stage vaginoplasty and suburethral sling placement in patients with pelvic organ prolapse combined with stress urinary incontinence. Materials and Methods. We recruited 242 women with second-degree pelvic organ prolapse requiring surgical treatment. Of these, 63 patients having stress urinary incontinence according to the cough test were randomized to undergo either one-stage (n = 31) or two-stage (n = 32) vaginoplasty and suburethral sling placement (3 months after the vaginoplasty). The primary outcome was the frequency of complaints on stress urinary incontinence after 4 months of follow-up. Secondary outcomes included prevalence of postoperative complications, cough test results, score of Incontinence Impact Questionnaire, Short Form (IIQ-7), and degree of prolapse (Pelvic Organ Prolapse Quantifications System). Results. Both surgical approaches did not differ in prevalence of early postoperative complications and long-term treatment outcomes. Conclusions. One-stage and two-stage vaginoplasty and suburethral sling placement have equal efficiency in treating the patients with pelvic organ prolapse combined with stress urinary incontinence.

Aim. To study the ovarian reserve in women of reproductive age with polycystic ovary syndrome (PCOS). Materials and Methods. We recruited 200 women of reproductive age with and without PCOS (n = 100 per group) and performed a comprehensive clinical, gynecological, laboratory, and ultrasound examination. Results. We found that 53% women had a major (A) polycystic ovary syndrome phenotype. Anti-Mullerian hormone (AMH) index was high in women with main (A) and non-androgenic (D) PCOS phenotypes but within the reference values in those with anovulatory (B) and ovulatory (C) phenotypes and healthy women. Ultrasound parameters of the ovaries in women with main (A), ovulatory (C) and non-androgenic (D) PCOS phenotypes were significantly higher compared to those with anovulatory (B) phenotype and healthy women. Conclusions. Ovarian reserve in women of reproductive age with PCOS significantly differs between its phenotypes and as compared to healthy women.

Aim. To study quality of life, anxiety, awareness and treatment compliance in patients with myocardial infarction before and after the educational program on secondary prevention.Materials and Methods. The prospective study included 132 patients (mean age 60.6 ± 1.8 years) who were on outpatient follow-up after myocardial infarction. Using an original questionnaire, we interviewed all patients about their anxiety, quality of life, and compliance before and after the educational program on secondary prevention. Results. Initially, the patients with myocardial infarction had a high level of anxiety, low mental and physical quality of life, and an insufficient level of compliance and awareness of secondary prevention issues. One-month educational program significantly improved all these indicators.Conclusions. The educational program on secondary prevention after myocardial infarction is justified.

Aim. To assess the effect of pre-hospital administration of statins on the levels of inflammatory markers and matrix metalloproteinases in the se-rum of patients with acute ST-segment elevation myocardial infarction (STEMI).Materials and Methods. We consecutively recruited 175 patients with STEMI (116 (66.3%) men and 59 (33.7%) women, average age 61.3 ± 8.4 years). Serum concentrations of interleukins (IL-6, IL-10, IL-12), C-reactive protein (CRP), tu-mor necrosis factor-α (TNF-α), and matrix metal-loproteinases (MMP-1, -3, -9) as well as blood lipid parameters were evaluated in all patients at the admission and on 12th day after STEMI onset. All the patients were divided into 2 groups depending on pre-hospital use of statins: 136 (77.71%) patients without and 39 (22.29%) patients with statin administration.Results. As compared to the patients without prior statin treatment, those who used statins ≥ 7 days prior to the development of STEMI had significantly lower values of serum low-density lipoproteins [2.91 (1.31; 5.13) vs 1.34 (0.76; 9.77), respectively], IL-6, CRP, TNF-α, and MMP-9 at both time points. In keeping with these ndings, serum level of anti-inflammatory marker IL-10 was two-fold higher in patients taking statins at the pre-hos-pital stage in comparison with those without statin administration. Conclusions. The lack of pre-hospital statin administration in patients with STEMI is associated with the higher values of pro-inflammatory markers (IL-6, CRP, TNF-α), and MMP-9 during in-hospital period.

Currently, rheumatologists consider osteoporosis as a complication of ankylosing spondylitis, however, in recent years, it is discussed as a comorbidity but not a complication. Disturbances in bone tissue metabolism provoked by ankylosing spondylitis-related inflammation increase the risk of osteoporosis and suggest osteoporosis as a manifestation of ankylosing spondylitis. Further, patients with ankylosing spondylitis are frequently diagnosed with a reduction of bone mineral density, the extent of which is determined by gender, age, type and duration of ankylosing spondylitis, severity of the inflammation, vitamin D deficiency, and extraskeletal calcification. Inflammation defined by excessive levels of pro-inflammatory cytokines plays a leading role in the development of osteoporosis. Another reason of bone loss in patients with ankylosing spondylitis is dysregulated balance in RANK/RANKL/OPG pathway. A combination of sarcopenia and osteopenia/osteoporosis (sarco-osteopenia/sarco-osteoporosis) results in a significant increase in the risk of low-energy fractures affecting quality of life, morbidity, and mortality in this patient category. Therefore, an active screening for osteoporosis/sarco-osteopenia/sarco-osteoporosis followed by the respective secondary prevention and treatment is of particular importance

The genus Acinetobacter is a major cause of severe healthcare-associated infections. Acinetobacter baumannii is one of the six most hazardous multidrug-resistant bacteria in the hospitals world-wide. This review is focused on the epidemiology, microbiological features, ecology, infection control precautions, and preventive measures.

Here I attempted to analyze and summarize current data on etiology of duodenal ulcer, with the fo-cus on diagnostics and treatment of its perforation. Duodenal ulcer is diagnosed in ≈ 3% of the adult population worldwide, and 5-14% of the patients suffer from perforated ulcer. Duodenal ulcers are caused by a dysregulated balance between aggressive and protective factors of the intestinal mucosa. In up to 80% of the patients, it is caused by Helicobacter pylori infection; less commonly, it is associated with a long-term use of nonsteroidal anti-inflammatory drugs, excessive smoking, alcohol abuse, gastrinoma, starvation, emotional overload, and genetic disorders. Main clinical manifestations of perforated duodenal ulcer are sudden abdominal pain, symptoms of peritonitis, and tachycardia. In around 66% of patients, perforation symptoms are the first manifestations; in 60-91% of patients, pneumoperitoneum is diagnosed. Current diagnostic methods include ultrasound examination, computed tomography scan, duodenoscopy, laparoscopy and even laparocentesis. Treatment is based on laparotomic or laparoscopic suturing of the perforation. Vagotomy is considered a worthwhile addition, as it may prevent repeated ulceration. When perforated duodenal ulcers are combined with stenosis or bleeding, Judd pyloroplasty (diamond-shaped transverse excision) or Heineke-Mikulicz pyloroplasty (transversely closed longitudinal incision across the pylorus) is recommended. Sealing pads and endoscopic duodenal stenting may be considered as appropriate options in elderly patients with multiple comorbidities. Eradication therapy should be prescribed in patients with Helicobacter pylori infection. Late diagnosis, old age, severe or multiple comorbidities, and hypoalbuminemia are the risk factors of an adverse outcome; case fatality rate ranges from 0.3 to 30%. Overall, the number of perforated duodenal ulcers remains high.

Menopausal and postmenopausal disorders represent a signiашcant problem in women of working age and considerably reduce the quality of life. Current treatment of these diseases includes the use of hormonal drugs, vitamins, minerals, drugs improving cerebral circulation, homeopathic remedies, hypotensive agents, tranquilizers, antidepressants, and sleeping pills, most of which have a number of major side effects. Clinical studies demonstrated insufficient safety of a long-term hormone replacement therapy; hence, the screening of alternative treatment methods is rapidly ongoing. Medicinal plants are a rich source of bioactive substances, and herbal medicine (phytotherapy) was proposed as a promising approach to treat menopausal and postmenopausal disorders. Of note, molecular weight and structure of phytoestrogens are similar to those of endogenous estrogens, enabling the former to bind to human estrogen receptors and activate respective signaling pathways.

Here we present a clinical case of atypical hemolytic uremic syndrome (aHUS) associated with delivery. Even in timely diagnosed patients with aHUS, case fatality rate reaches 29%. Currently, aHUS is considered as a thrombotic microangiopathy, along with typical hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, severe preeclampsia, and HELLP syndrome. There is a considerable genetic predisposition to all abovementioned types of thrombotic microangiopathy; however, additional significant stimulation of the complement system is mandatory for aHUS to occur. In children, it can be triggered by respiratory or gastrointestinal infections, while in women it is typically provoked by pregnancy. High mortality of aHUS is due to its rarity and consequent low awareness, non-specific symptoms at its initiation, and rapid development of multiple organ failure including acute kidney injury due to generalized thrombosis in the microvasculature. Successful treatment of aHUS largely depends on the timeliness of diagnosis, specific therapy with eculizumab in combination with a renal replacement therapy, and rapid delivery according to the protocol on severe pre-eclampsia.

Here we present current data on the mechanisms of development, clinical symptoms, diagnosis and treatment of intestinal ischemia on a clinical case of erosive ulcerative ischemic colitis in a 67-year-old male patient. The need for awareness on chronic mesenterial ischemia in risk groups is underlined. A particular attention is paid to the non-specificity of clinical manifestations in comorbid patients. In elderly and senile patients, any change in abdominal symptoms is a subject for intestinal ischemia screening.