INFLUENCE OF TRANSURETRAL PROSTATE RESECTION ON THE REFLECTOR MECHANISM OF PELVIC FLOOR MUSCLE REGULATION

A group of 9 patients, average age 62, with symptoms of urination disorders, who underwent surgical intervention for infravesical obstruction (IVO), were under observation. Patients underwent urodynamic examination in the volume of liquid static profilometry using a specialized standard 10F catheter before and after surgery. The urodynamic system of domestic production LEVELEST SURD-02 was used. Based on the data obtained, the reflex mechanism of pelvic floor tone was analyzed in patients with prostate adenoma operated by transurethral enucleation.

Diagnostic capabilities of breast scintigraphy and molecular imaging of the mammary glands in the detection of various biological subtypes of breast cancer

Background. The accurate and early diagnosis of breast cancer can improve efficacy of the treatment. The standard diagnostic methods such as mammography, ultrasound, and magnetic resonance tomography have a pivotal role in the detection of breast tumors, however, in some cases, they have low diagnostic accuracy. Mammoscintigraphy (MSG) / molecular breast imaging (MBI) with tumor-specific radiopharmacy 99mTc-Technetril in patients with breast cancer can considerably increase the accuracy of diagnosis. However, the diagnostic performance of MSG / MBI in the detection of different biological subtypes of breast cancer is still under investigation.

Aim. To evaluate the accuracy of MSG / MBI with 99mTc-Technetril in diagnosis of different biological subtypes of breast cancer.

Materials and methods. The analysis included the results of MSG / MBI of 1080 patients (2154 mammary glands), who were examined for suspected breast cancer. MSG / MBI were performed 5–15 min after intravenous injection into the vein of one of the feet of 370–740 MBq of tumor-specific radiopharmacy 99mTc-Technetril. Examinations performed from 2007–2020 was carried out on the emission computed tomography Forte (Philips); since 2020 the molecular visualization has been providing on the special gamma-camera Discovery NM750b (General Electric). The obtained data were evaluated by 2 experienced radiologists. Verification of changes in breasts was provided by morphological examination (1060 cases) or dynamic observation.

Results. The sensitivity, specificity and overall accuracy of MSG / MBI were 90 %, 98 %, 95 % correspondingly. When diagnosing tumors with a diameter of up to 10 mm, the sensitivity of MSG / MBI was decreased to 83 %. In patients with various biological subtypes, the sensitivity of MSG / MBI was as follows: luminal A – 88 %; luminal B– – 91 %; luminal B+ – 92 %; triple negative – 93 %; HER2-positive – 96 %. The intensity of tumor uptake depended on the biological subtype of breast cancer. The average values of the 99mTc-Technetril uptake coefficient were as follows: luminal A – 1.59; luminal B– – 1.71; luminal B+ – 1.95; triple negative – 1.93; HER2-positive – 2.22.

Conclusion. Retrospective analysis indicate high diagnostic performance of MSG / MBI: sensitivity – 90 %, specificity – 98 %, accuracy – 95 %. There are significant differences in the intensity of 99mTc-Technetril accumulation in tumors in patients with different biological subtypes of breast cancer (p = 0.01–0.004). MSG / MBI characterized by significant differences in the sensitivity in the diagnosis of luminal A and HER2+ breast cancer subtypes: 88 % and 96 %, respectively (p = 0.02).

THE MECHANISM OF URINARY CONTROL AND OPERATIONS OF SYNTHETIC SLING

Background: Over the past two decades, synthetic loop surgeries have gained widespread popularity due to their ease of implementation, relatively high efficiency and low cost in the treatment of women with stress urinary incontinence (SUI). To date, several dozen variants of minimally invasive surgical procedures are known, but none of the known methods provides a 100% reliable result. At the same time, the effectiveness of the performed operation to eliminate involuntary loss of urine is inexorably reduced in the follow-up.

Aims of the study. On the basis of a neuroregulatory theory published in 2019 and according to a neurophysiological model, provide an explanation for both the mechanism of urinary retention and the role of the tape implanted under the urethra in its recovery.

Material and methods. Analysis of a large number of foreign and domestic literary sources, the results of clinical observations of surgery using the original author's version of the trocar synthetic sling (TSS) for 19 years, the data of the original method of uroflowmetric monitoring.

Results. Taking into account the created and published theoretical basis, an explanation is presented for the effect of increasing the tone of the pelvic floor muscles in women with urinary incontinence after surgical correction using modern synthetic materials.

Conclusions. The restoration of the mechanism of urinary retention in women after the operation of a synthetic sling occurs under the condition of activation of the 4th mictional reflex. In the event of a violation of the components of this reflex, the effectiveness of the sling procedure decreases and a recurrent form of the disease occurs, regardless of the type and volume of the operation used. The presence of a theoretical basis that explains both the mechanism of urinary retention itself and the pathogenesis of the development of the disease allows us to offer options for conservative therapy to prepare for the sling procedure and thereby increase the follow-up efficiency of any loop surgery.

REASONS FOR FAILURES OF SURGICAL TREATMENT OF WOMEN WITH URINARY INCONTINENCE

Аnalysis of literature sources devoted to synthetic sling operations shows that it is not possible to achieve 100% of the result. In addition, the catamnestic effectiveness of surgical correction has been steadily decreasing over the years and after a few years is estimated at about 70%, regardless of the type of intervention, the method of implantation and the properties of the synthetic material used for loop plastic surgery. At the same time, there are a number of works whose results contradict the generally accepted mechanistic point of view about the effects resulting from the implantation of the tape. At the same time, consideration of the problem from the standpoint of the neurophysiological model of the neuroregulatory theory eliminates contradictions and makes it possible to explain the restoration of urine retention after surgery due to the activation of the urethro-sphincter protective reflex. The same approach provides a logical explanation for failures when performing a synthetic sling operation.

ASSESSMENT OF EFFICIENCY OF COMBINED PHARMACOTHERAPY FOR IMPERATIVE AND MIXED URINARY DISORDERS IN WOMEN WITH THE INTERVAL SCALE

Introduction. The search for effective drug combinations for treating continental disorders in women is still relevant. The interval scale for assessing lower urinary tract symptoms in women is a simple and convenient tool for monitoring pharmacotherapy. Objective: to evaluate the effectiveness of treatment of imperative and mixed urination disorders in women with alpha1-blockers in combination with nootropic drugs using an interval symptom rating scale.Materials and methods. Under observation there were 31 patients aged 40 to 73 years who applied to the Center “Urination Pathology” with mixed and imperative disorders of the continent and urinary incontinence. Conservative therapy was carried out with the appointment of alpha1-adrenoblockers, nootropic and metabolic drugs for an average of 5.8 months. The therapeutic effect is recorded using the interval symptom score scale.Results. After discontinuation of drugs, the overall score on the symptom rating scale decreased by 40.2%, imperative symptoms – by 29.5-50%, and quality of life increased by 19%. In the group of women aged 40-49, with comparable dynamics of symptoms with patients older than 50 years, therapy lasted less. The difference averaged 4.1 months and was associated with a higher frequency in the older age group of vascular, metabolic and neurological disorders that slow down the regulatory processes of urination recovery.Conclusion. Alpha1-blockers and nootropics are pathogenetically substantiated for the treatment of imperative disorders of urination and urinary incontinence. Evaluation using the interval scale reliably demonstrates their high clinical effectiveness, persistence of the therapeutic effect and the feasibility of application at the stage of selection for surgical treatment.

Two-color interferometer for study of dense low-ionized plasma on the target in high-power pulse linear accelerator

A two-color infrared interferometer has been developed for the investigation of high-density weakly ionized tantalum plasma in x-ray complexes based on linear induction accelerators (1.6 kA electron beam current, 4.6 MeV energy, and 100 ns pulse duration). Simultaneous probing at two different wavelengths makes it possible to independently measure the density of neutral and electron components. The interferometer uses wavelength values of 1.064 µm (Nd:YAG laser) and 10.6 µm (CO₂ laser). To attenuate the effect of sample beam refraction in inhomogeneous plasma, the interferometer used a refraction suppression scheme composed of spherical mirrors focusing the object beam into the region occupied by the plasma. In addition, the power of the sample beam transmitted through the plasma was controlled in order to analyze whether there was a distortion of the interference pattern because of strong sample beam refraction and absorption in the plasma cloud. To calibrate the initial phase shift of the probe radiation, a movable mirror mounted on a piezoelectric element and oscillating according to a harmonic law with amplitude greater than the laser wavelengths was used. In initial experiments, the parameters of target plasma registered by this interferometer are as follows: the linear density of neutrals reached 1.5 · 10¹⁷ cm^-2, and the degree of ionization was of the order of 10^-2. The target plasma expansion velocity is determined as ∼6 km/s.

[Minimally invasive thoracoscopic and robot-assisted lobectomy]

OBJECTIVE

To compare the early outcomes of video-assisted and robot-assisted lobectomy.

MATERIAL AND METHODS

There were 74 robot-assisted lung resections for the period 2017-2018. Sixty-six patients underwent lobectomy and 8 - segmentectomy. Patients were divided into 2 groups to compare thoracoscopic procedures. The main group consisted of 66 patients after robot-assisted lobectomy. The control group included 247 patients after video-assisted lobectomy. Mean age of patients was 60.5 years (range 35-70). There 72% men and 28% women.

CONCLUSION

Both thoracoscopic procedures are characterized by high efficiency and safety. However, certain disadvantages are peculiar to both methods.

[Video-assisted thoracoscopic thymectomy in myasthenia gravis. New approach]

AIM

To present possibility and technical aspects of anesthetic management during video-assisted thoracoscopic thymectomy in patients with myasthenia gravis.

MATERIAL AND METHODS

The article describes the proposed modified anesthetic method that is suitable for video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. Nine patients with myasthenia underwent VATS-thymectomy. Anesthesia was performed with artificial airway and auxiliary ventilation without muscle relaxants administration.

[Anesthesia during video-assisted thoracoscopic lobectomy using laryngeal ductwork and auxiliary mechanical ventilation]

The article presents the experience of video-assisted thoracoscopic lobectomies in patients without endotracheal intubation and sparing of spontaneous breathing. The results of intraoperative monitoring and laboratory data of all perioperative period are described. In view of these data it was concluded that such approach can decline the severity of stress-response against surgical aggression in this group of patients.

[Anesthetic management of reconstructive surgery on the respiratory tract]

In the article provides an analysis of own of clinical experience peculiarities of carrying out of anesthesia, when performing 466 various tracheo-bronhoplastiс of operations for the period from 1979 to 2014 the year a one team of surgeons. Preoperative preparation, anesthesia and postoperative management of patients are key to improving treatment outcomes. Full arsenal of modern methods of ventilation lets you choose for each stage of surgery is most convenient for the surgeon and patient-safe way to maintain gas exchange. Presented in this paper our anestiology experience allows you to discuss and elect the proposed management of patients through the selection and optimization of the method that best meets modern requirements.

[Fluorescense enhancing of 5, 10, 15, 20-tetraphenylporphyrin in complex with human serum albumin and gold nanorods]

Using absorption and fluorescence spectroscopy methods we obtained the results demonstrating alterations in spectral characteristics in supramolecular system composed of gold nanorods (AuNR) (10 x 38 nm) and complexes of human serum albumin (HSA) and 5, 10, 15, 20-tetraphenylporphyrin (TPP). TPP fluorescence (max = 636 and 658 nm) was found to enhance. The dependence of fluorescence enhancing in time was of nonlinear nature. Maximum TPP fluorescence enhancing value was as high as 16% and it was achieved in 7 min after mixing the components. Simultaneously with TPP fluorescence enhancing we observed a decrease in HAS own fluorescence (max = 340 nm) and optical density reduction in maximum of longitudinal localized plasmon band of AuNR (max = 752 nm).

[Clinical and urodynamic evaluation of efficacy of conservative treatment of urination disorders in patients with benign prostate hyperplasia]

17 patients (mean age, 61 +/- 1.7 years) with an benign prostate hyperplasia (BPH) and urination disorders were under observation. After examination by ultrasound, urodynamic and laboratory studies, patients received conservative combined therapy, including alpha1-adrenoblocker silodosin, L-carnitine, B vitamins and picamilon. As a result of the 4,5-month treatment, most of the symptoms were eliminated as evidenced by the decrease in IPSS score from 17 to 3; urodynamic parameters have improved that was recorded by the home uroflowmetry. It was concluded that the use of proposed combined therapy in patients with BPH as the first stage of treatment, followed by the administration of 5alpha-reductase inhibitors or performing surgical correction in case of formation of bladder outlet obstruction is justified.

Electrically controlled polarized photoluminescence of CdSe/ZnS nanorods embedded in a liquid crystal template

A novel homogeneous composite material, consisting of luminescent CdSe/ZnS quantum nanorods, embedded in the nematic liquid crystal 5CB, has been prepared. Liquid crystal cells and free-standing stretched polymer films incorporating this composite material were characterized using polarized micro-photoluminescence and electro-optical measurements under an applied electric field. A liquid crystal induced, macroscopic orientation of the nanorods in a thin layer of the material has been demonstrated. A conventional liquid crystal cell, filled with this composite, exhibits 40% modulation of the nanorod's photoluminescence intensity when subjected to an external electric field. These results indicate that quantum nanorods may have practical applications in photonic devices.

[Pharmacourodynamic non-invasive studies in patients with prostatic adenoma]

After examination 47 patients with prostatic adenoma (mean age 63 years) received a course of alpha1-adenoblocker (omsulosin in a dose 0.4 mg/day). A three-day uroflowmetric monitoring was made at home before and after treatment. The findings were assessed with Liverpool nomo-gram by maximal flow. Omsulosin treatment was found to change voiding structure, to identify the obstructive component due to displacement of the flow characteristics to the low centiles of the nomogram. Thus, long-term treatment with alpha1-adrenoblockers can be used as a pharmacourodynamic test to detect infravesical obstruction in patients with prostatic adenoma.

[Sexual dysfunction in women with overactive bladder and their correction with m-cholinolytic spasmex]

A 4-month course of spasmex (15 mg three times a day) was conducted in 57 females (age 18-69 years, mean age 48 years) suffering from imperative urination manifesting as pollakiuria, imperative urges and urgent urinary incontinence in combination with sexual disorders. After the treatment the score of urination disorders went down from 21.4 to 12.7. Quality of life score decreased from 4.3 to 1.7. Sexual dysfunction diminished from 3.6 to 0.8 points. Clinical data showed that spasmex has a marked effect on m-cholinoreceptors, is well tolerated, has a moderate spasmolytic effect on the smooth muscles of the lower urinary tract. Moreover, spasmex can be used for correction of female sexual dysfunction caused by overactive bladder.

[Clinical and urodynamic rationale of the overactive bladder neurophysiological model]

The analysis of 58 cases of overactive bladder has shown that detrusor activity is not linked with clinical symptoms but is caused by supra segmentary lesion of the nervous system. The clinical picture of overactive bladder fits the proposed neurophysiological model where ischemic damage of the association neuron located in the lumbar spinal marrow triggers miction disorders leading to preganglionary detrusor denervation. Combined therapy with alpha1-adrenoblocker and M-cholinolytic is pathogenetically sound. Trospium chloride (spasmex) was used for long-term treatment of the patients as it produces minimal number of side effects and enables dose and schedule variation.

[Tadenan treatment of prostatic adenoma]

Tadenan, a drug of plant origin, was given to 27 patients with documented prostatic adenoma for 3-12 months. Home uroflowmonitoring for 1, 3, 6 and 12 months registered positive changes in urinary flow rate and urination volume. Side effects were absent. IPSS and QoL parameters were also assessed.

[24-h dynamics of urination in patients with overactive urinary bladder]

Home 3-day uroflowmetry was made in 41 female patients (mean age 46 years) before and after therapy for overactive bladder (OB). The course of therapy lasting from 6 weeks to 3 months included M-cholinolytics and vascular medication. Estimation of the bladder capacity in different time of 24-h period revealed circadian deviations of urinary flow and volumes. Administration of short-term M-cholinolytics enables chronotherapy providing maximal effects within 4-6 hours, possibility to vary doses. In view of this, optimal cholinergic therapy of OB is trospium chloride which has necessary properties, high safety and wide dose range.

[Changes in lower urinary tract function in children with hyperactive urinary bladder treated with combined therapy]

Low clinical efficacy of M-cholinolytics remains a serious problem in conservative therapy of hyperactive bladder (HB). To improve treatment outcomes, combined therapy (pikamilon plus driptan) was tried in 22 boys and 25 girls aged 7 to 14 years. The children were examined with uroflowmetry, cystometry. The response to the treatment was found to depend on mean effective capacity of the urinary bladder. Duration ofurodynamic correction has a negative colleration with this capacity. Urodynamic investigations performed in different periods of therapy show that improvement of lower urinary tract function is pathogenetically important for treatment of children with urologic pathology running in the presence of hyperactive urinary bladder.

[M-cholinolytic spasmex and its role in preoperative preparation of patients with urine incontinence]

Non-invasive uroflowmetric monitoring in females with combined incontinence has demonstrated that hyperactive urinary bladder and stress urine incontinence in females are similar in relation to functional disorders of the low urinary tract both in complete and partial syndrome of imperative urination. In the latter case, when imperative urine incontinence is absent, voiding structure is changed in the same manner, and the patients' preparation for surgical intervention demands long-term treatment with M-cholinolytics. We propose to use spasmex (trospium chloride) which has minimal side effects in long-term therapy. Conservative therapy of such patients with spasmex radically changes background for planning surgical intervention.

[Substantiation of the duration of m-cholinolytics administration in conservative treatment of hyperactive urinary bladder]

The analysis of treatment outcomes in 74 patients with hyperactive urinary bladder (HUB) has shown that duration of the treatment depends on the initial function of the lower urinary tracts. There was a correlation between mean effective therapy and treatment duration. Estimation of this correlation allows prognosis of treatment efficacy and selection of optimal anticholinergic drug for correction of miction disorders. Spasmex proved to be the most adequate drug for long-term treatment due to minimal number of side effects and feasibility to vary dose and regimen of intake.

[The role of alpha1-adrenoblocker alfuzosine in diagnostic-therapeutic algorithm of hyperactive urinary bladder management in women and selection of patients for treatment with M-cholinergic antagonists]

In management of patients with hyperactive urinary bladder (HAUB) it is necessary to take into consideration the fact that long-term intake of M-cholinergic antagonists may result in obstructive miction because of low contractile activity of the urinary bladder. Use of M-cholinergic antagonists also problematic in detruzor dysfunction leading to slowing down of the urinary flow. In view of these possible complications, an algorithm of urodynamic diagnosis is proposed based on non-invasive registration of miction disorders using home uroflowmetry. Correction of detruzor contractility with dalfas combines well with cholinoblockers. In some cases administration of nontitrated alphablockers has no alternative especially in long-term treatment with mediators suppressing nonadapted detruzor contractions as it happens in HAUB. The above diagnosticotherapeutic algorithm of female miction disorders management which regards urine flow rates and comprises intake of alfusozine if necessary allows treatment of females with small urinary bladder when cholinergic antagonists are low-effective.

[Combined treatment of voiding disorders in women with m-cholinolytic and alpha 1-adrenoblocker]

The drug spasmex (trospium chloride) having an m-cholinolytic and myotropic spasmolytic action has been used for treatment of enuresis in women with imperative voiding syndrome. Spasmex was given in combination with alpha 1-adrenoblockers to 20 women. The clinical picture was assessed with the original table. Urodynamic alterations were registered by means of home uroflowmeter. Clinical parameters improved 2 times after 4 weeks of the treatment. Mean effective capacity of the urinary bladder increased by 25%. Spasmex in combination with terasozine was well tolerated and had no side effects.

[Role of urodynamics correction in combined therapy of children with urinary infection]

The authors propose differentiated complexes of therapy of children with urinary infection. These complexes include medicines (M-cholinolytics, antihypoxic drugs and drugs improving microcirculation) and low-invasive therapy. Clinical experience is reported for 4 boys and 40 girls with microbial-inflammatory urinary diseases. Standard urodynamic tests were made in all the patients before and after the course of therapy. Three variants of driptan effects on the urinary bladder were identified: M-cholinolytic, spasmolytic and mixed (larger volume and lower intravesical hypertension). Some of the patients experienced standard endoscopic reflux correction with the use of synthetic hydrophilic gel. Control urodynamic examinations 3 months after the treatment showed that functional disorders were reduced. Treatment efficacy was assessed with home flowmetry. Thus, combined therapy of microbial-inflammatory diseases with parallel correction of lower urinary tracts urodynamics by M-cholinolytics improves treatment results. Courses of antibacterial and uroceptic therapy should be followed by non-invasive monitoring to reveal urodynamic disorders, define dysfunction type and perform an additional treatment with mediators in combination with physiotherapeutic procedures.

[Prospects for differentiated conservative treatment of patients with benign prostatic hyperplasia]

The results of conservative therapy of 30 patients aged from 50 to 79 years with benign hyperplasia of prostate according to the IPSS scale from 7 to 30 points were analyzed. Under the influence of treatment in all the patients the clinical symptoms severity, according to the monitoring data using the IPSS tables, had reduced by 72% at average and quality of life improve no less than by 50%. Average efficacy of the volume and volumetric of urination had enhanced according to uroflowmetry data.

Effects of resonances on halo formation in high-intensity storage rings

Numerical calculations for the Spallation Neutron Source accumulator ring indicate that lattice resonances excited by the space-charge potential can increase a mismatch significantly by deforming the beam distribution in phase space. Hence increased mismatch leads to enhanced envelope oscillations that are driving the 2:1 parametric resonance leading to halo formation, even for initially matched beams. We have observed this behavior for the 2 nu(x) - 2 nu(y) = 0 resonance and for the 4 nu(y) = 23 resonance. This mechanism for halo formation peculiar to rings through resonance driven mismatch is very sensitive to the tunes, which emphasizes the importance of a careful choice of operating point in tune space.