Pub Date : 2023-01-01DOI: 10.31550/1727-2378-2023-22-4-70-76
M. Dudina, S. Dogadin, A. Savchenko, V. D. Belenyuk, V.А. Mankovsky, A. Borisov
Aim: To study the levels of regulatory T lymphocytes (Treg) and B-cells in peripheral blood in patients with Graves' disease in dynamics after thyroidectomy. Design: Single center, observational, prospective, cohort, open, controlled study. Materials and methods. The study included 96 patients with Graves' disease, mean age 42.86 ± 10.81 years. Clinical, hormonal and immunological examinations were performed against the background of persistent drug-induced euthyroidism, before surgery, and also 1, 3, and 6 months after thyroidectomy. The levels of Treg and B-cells in the blood was examined by flow cytometry using direct immunofluorescence and monoclonal antibodies. The level of antibodies to thyroid-stimulating hormone receptors (rTSH) was assessed by enzyme immunoassay. The control group consisted of 85 healthy women of the same age. Results. In patients with Graves' disease in the dynamics of the postoperative period, there was a consistent statistically significant decrease in the titer of antibodies to rTSH: from 14.69 (8.67–19.81) to 0.81 (0.59–0.93) IU/l. The absolute amount of Treg in their blood was reduced relative to the control values already in the preoperative period and decreased even more at 6 months after thyroidectomy. The proportion of CD19+CD5+- and CD19+CD5–-cells in the examined patients before surgery was significantly higher than in the control group. The content of CD19+CD5+ cells decreased as early as 1 month after thyroidectomy and remained at the level of control values. The сontent of CD19+CD27–-cells in patients with Graves' disease in the preoperative period was higher than in the control group, decreased to the control values 1 month after thyroidectomy and remained in this range until the end of the follow-up. The content of CD19+CD27+ cells in patients before thyroidectomy was lower compare to control, in the period of 1–3 months it corresponded to the control values, but decreased again on the 6th month after surgery. Conclusion. The reduction of Treg and B-memory cells in the peripheral blood in patients with Graves' disease six months after thyroidectomy remains of immunosuppressive regulatory mechanisms with an increase in the migration activity of immune cells for a long time. Keywords: Graves' disease, thyroidectomy, regulatory T lymphocytes, memory B cells, target therapy.
{"title":"The Levels of Regulatory T Lymphocytes and B Cells in Patients with Graves' Disease after Thyroidectomy","authors":"M. Dudina, S. Dogadin, A. Savchenko, V. D. Belenyuk, V.А. Mankovsky, A. Borisov","doi":"10.31550/1727-2378-2023-22-4-70-76","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-4-70-76","url":null,"abstract":"Aim: To study the levels of regulatory T lymphocytes (Treg) and B-cells in peripheral blood in patients with Graves' disease in dynamics after thyroidectomy. Design: Single center, observational, prospective, cohort, open, controlled study. Materials and methods. The study included 96 patients with Graves' disease, mean age 42.86 ± 10.81 years. Clinical, hormonal and immunological examinations were performed against the background of persistent drug-induced euthyroidism, before surgery, and also 1, 3, and 6 months after thyroidectomy. The levels of Treg and B-cells in the blood was examined by flow cytometry using direct immunofluorescence and monoclonal antibodies. The level of antibodies to thyroid-stimulating hormone receptors (rTSH) was assessed by enzyme immunoassay. The control group consisted of 85 healthy women of the same age. Results. In patients with Graves' disease in the dynamics of the postoperative period, there was a consistent statistically significant decrease in the titer of antibodies to rTSH: from 14.69 (8.67–19.81) to 0.81 (0.59–0.93) IU/l. The absolute amount of Treg in their blood was reduced relative to the control values already in the preoperative period and decreased even more at 6 months after thyroidectomy. The proportion of CD19+CD5+- and CD19+CD5–-cells in the examined patients before surgery was significantly higher than in the control group. The content of CD19+CD5+ cells decreased as early as 1 month after thyroidectomy and remained at the level of control values. The сontent of CD19+CD27–-cells in patients with Graves' disease in the preoperative period was higher than in the control group, decreased to the control values 1 month after thyroidectomy and remained in this range until the end of the follow-up. The content of CD19+CD27+ cells in patients before thyroidectomy was lower compare to control, in the period of 1–3 months it corresponded to the control values, but decreased again on the 6th month after surgery. Conclusion. The reduction of Treg and B-memory cells in the peripheral blood in patients with Graves' disease six months after thyroidectomy remains of immunosuppressive regulatory mechanisms with an increase in the migration activity of immune cells for a long time. Keywords: Graves' disease, thyroidectomy, regulatory T lymphocytes, memory B cells, target therapy.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85711533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.31550/1727-2378-2023-22-1-28-32
T. P. Shevlyukova, L.A. Bahova, M. Shvedsky, O. V. Nekrasova, V.V. Shkuratova, O.A. Fedchuk
Aim: to assess the severity of the pathomorphological response according to the classification of Residual Cancer Burden (RCB) in patients with breast malignancies depending on the surrogate molecular biological subtype after neoadjuvant drug therapy (chemotherapy ± anti- HER2 therapy). Design: Retrospective comparative study. Materials and methods. The retrospective study included 90 patients with breast cancer (T0-3, N0-1, M0) with luminal In HER2-negative, luminal In HER2-positive, HER2-positive non-luminal, thrice negative subtypes who were on complex treatment. The age of women ranged from 26 to 39 years (median age — 36 years). A retrospective analysis of the evaluation of residual tumor load in 85 patients according to the RGB system after neoadjuvant drug therapy and subsequent surgical treatment was performed. Results. In patients with luminal B HER2-negative breast cancer, a complete pathomorphological response was noted in 20% of cases, in 16% — RCB-I, in 36% — RCB-II, in 28% — RCB-III. Among women with luminal B HER2-positive breast cancer, a complete response was achieved in 26.67%, RCB-I was noted in 33.33%, RCB-II — in 13.33%, and RCB-III — in 26.67%. Among the patients with HER2-positive breast cancer, 46.16% had RCB-0, 23,08% had RCB-I, 15.38% each had RCB-II and RCB-III. In participants with thrice negative breast cancer, a complete response was achieved in 41.94% of cases, RCB-I was noted in 22.58%, RCB-II — in 19.35% and RCB-III — in 16.13%. The frequency of complete pathomorphological response (RCB-0) after neoadjuvant chemotherapy significantly differed among the more aggressive subtypes of breast cancer (thrice negative and HER2-positive), compared with HER2-negative (p < 0.0001). Conclusion. The unified assessment of the residual tumor after neoadjuvant therapy makes it possible to clearly identify prognostic groups of patients with different treatment responses and plan additional drug therapy for them. Keywords: neoadjuvant chemotherapy, targeted therapy, breast cancer, HER2.
目的:评价乳腺癌患者在新辅助药物治疗(化疗±抗HER2治疗)后，根据替代分子生物学亚型对残余癌负担(Residual Cancer Burden, RCB)进行分类的病理形态学反应的严重程度。设计:回顾性比较研究。材料和方法。回顾性研究纳入90例接受综合治疗的腔内In her2阴性、腔内In her2阳性、非腔内her2阳性、三阴性亚型乳腺癌患者(T0-3、N0-1、M0)。妇女的年龄从26岁到39岁不等(中位年龄- 36岁)。回顾性分析85例患者在新辅助药物治疗及后续手术治疗后，根据RGB系统评估残余肿瘤负荷。结果。在管腔B her2阴性乳腺癌患者中，20%的病例有完全的病理形态学反应，16%的病例有RCB-I反应，36%的病例有RCB-II反应，28%的病例有RCB-III反应。在luminal B her2阳性乳腺癌患者中，完全缓解率为26.67%，RCB-I为33.33%，RCB-II -为13.33%，RCB-III -为26.67%。在her2阳性乳腺癌患者中，RCB-0占46.16%，RCB-I占23.08%，RCB-II和RCB-III各占15.38%。在三阴性乳腺癌患者中，完全缓解率为41.94%，RCB-I为22.58%，RCB-II为19.35%，RCB-III为16.13%。与her2阴性相比，侵袭性更强的乳腺癌亚型(三阴性和her2阳性)在新辅助化疗后完全病理形态学反应(RCB-0)的频率有显著差异(p < 0.0001)。结论。新辅助治疗后残留肿瘤的统一评估，可以清晰地识别不同治疗反应患者的预后组，并为其规划额外的药物治疗。关键词:新辅助化疗，靶向治疗，乳腺癌，HER2。
{"title":"The Effectiveness of Neoadjuvant Therapy in the Treatment of Patients with Locally Advanced Breast Cancer","authors":"T. P. Shevlyukova, L.A. Bahova, M. Shvedsky, O. V. Nekrasova, V.V. Shkuratova, O.A. Fedchuk","doi":"10.31550/1727-2378-2023-22-1-28-32","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-1-28-32","url":null,"abstract":"Aim: to assess the severity of the pathomorphological response according to the classification of Residual Cancer Burden (RCB) in patients with breast malignancies depending on the surrogate molecular biological subtype after neoadjuvant drug therapy (chemotherapy ± anti- HER2 therapy). Design: Retrospective comparative study. Materials and methods. The retrospective study included 90 patients with breast cancer (T0-3, N0-1, M0) with luminal In HER2-negative, luminal In HER2-positive, HER2-positive non-luminal, thrice negative subtypes who were on complex treatment. The age of women ranged from 26 to 39 years (median age — 36 years). A retrospective analysis of the evaluation of residual tumor load in 85 patients according to the RGB system after neoadjuvant drug therapy and subsequent surgical treatment was performed. Results. In patients with luminal B HER2-negative breast cancer, a complete pathomorphological response was noted in 20% of cases, in 16% — RCB-I, in 36% — RCB-II, in 28% — RCB-III. Among women with luminal B HER2-positive breast cancer, a complete response was achieved in 26.67%, RCB-I was noted in 33.33%, RCB-II — in 13.33%, and RCB-III — in 26.67%. Among the patients with HER2-positive breast cancer, 46.16% had RCB-0, 23,08% had RCB-I, 15.38% each had RCB-II and RCB-III. In participants with thrice negative breast cancer, a complete response was achieved in 41.94% of cases, RCB-I was noted in 22.58%, RCB-II — in 19.35% and RCB-III — in 16.13%. The frequency of complete pathomorphological response (RCB-0) after neoadjuvant chemotherapy significantly differed among the more aggressive subtypes of breast cancer (thrice negative and HER2-positive), compared with HER2-negative (p < 0.0001). Conclusion. The unified assessment of the residual tumor after neoadjuvant therapy makes it possible to clearly identify prognostic groups of patients with different treatment responses and plan additional drug therapy for them. Keywords: neoadjuvant chemotherapy, targeted therapy, breast cancer, HER2.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76384101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.31550/1727-2378-2023-22-4-40-46
S. Gogoleva, A. Ametov, A. Shabalina
Aim: To determine the effects of dapagliflozin in impaired carbohydrate and fat metabolism in type 2 diabetes mellitus (T2DM). Design: An open cohort controlled prospective study. Materials and methods. In this study 60 patients with T2DM and obesity were examined. Dapagliflozin 10 mg was added to metformin monotherapy. Carbohydrate metabolism and fat metabolism markers were evaluated for 6 months: anthropometry, body composition analysis, assessment of adipokines (adiponectin, leptin, irisin, interleukin (IL) 6) and lipid panel. Results. Dapagliflozin addition resulted in glycated hemoglobin level decrease by an average of 0.6% (p = 0.093) along with significant positive effects on fat metabolism markers. The mean body mass decrease was 3.3 kg (p < 0.05). There was also a significant decrease in fat mass of 3 kg (p = 0.001) and a muscle mass extension, according to a body composition analysis report, which correlated with leptin levels decrease (p = 0.073) and adiponectin and irisin levels increase (p < 0.05). A significant decrease in total cholesterol, triglycerides and low-density lipoproteins levels also occurred (p = 0.001). Conclusion. Leptin and IL-6 levels decrease and irisin and adiponectin levels increase correlating with a fat mass reduction and muscle mass expansion occurred with dapagliflozin added to the therapy. These findings suggest the possibility of metabolically unhealthy obesity transitioning to metabolically healthy obesity. Adipose tissue dysfunction treatment as a focus of therapy may provide not only a better control of T2DM, but also cardiometabolic risks reduction. Keywords: type 2 diabetes mellitus, dapagliflozin, adiponectin, leptin, irisin, interleukin 6, lipid panel, fat metabolism.
{"title":"Effect of Dapagliflozin on Fat and Carbohydrate Metabolism in Patients with Type 2 Diabetes Mellitus","authors":"S. Gogoleva, A. Ametov, A. Shabalina","doi":"10.31550/1727-2378-2023-22-4-40-46","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-4-40-46","url":null,"abstract":"Aim: To determine the effects of dapagliflozin in impaired carbohydrate and fat metabolism in type 2 diabetes mellitus (T2DM). Design: An open cohort controlled prospective study. Materials and methods. In this study 60 patients with T2DM and obesity were examined. Dapagliflozin 10 mg was added to metformin monotherapy. Carbohydrate metabolism and fat metabolism markers were evaluated for 6 months: anthropometry, body composition analysis, assessment of adipokines (adiponectin, leptin, irisin, interleukin (IL) 6) and lipid panel. Results. Dapagliflozin addition resulted in glycated hemoglobin level decrease by an average of 0.6% (p = 0.093) along with significant positive effects on fat metabolism markers. The mean body mass decrease was 3.3 kg (p < 0.05). There was also a significant decrease in fat mass of 3 kg (p = 0.001) and a muscle mass extension, according to a body composition analysis report, which correlated with leptin levels decrease (p = 0.073) and adiponectin and irisin levels increase (p < 0.05). A significant decrease in total cholesterol, triglycerides and low-density lipoproteins levels also occurred (p = 0.001). Conclusion. Leptin and IL-6 levels decrease and irisin and adiponectin levels increase correlating with a fat mass reduction and muscle mass expansion occurred with dapagliflozin added to the therapy. These findings suggest the possibility of metabolically unhealthy obesity transitioning to metabolically healthy obesity. Adipose tissue dysfunction treatment as a focus of therapy may provide not only a better control of T2DM, but also cardiometabolic risks reduction. Keywords: type 2 diabetes mellitus, dapagliflozin, adiponectin, leptin, irisin, interleukin 6, lipid panel, fat metabolism.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90063110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.31550/1727-2378-2023-22-3-45-50
E.V. Aseeva, N. Geppe, V. S. Malyshev, D. G. Bukharov, L. S. Starostina, S. Shatalina
Aim: To evaluate the reference/normal breathing parameters in healthy children aged 6 to 18 years using a respiratory sound recorder. Design: Prospective, open-label, non-randomized clinical trial. Materials and methods. The function of external respiration was assessed in practically healthy children without respiratory pathology using a respiratory sound recorder. 165 practically healthy children from 6 to 18 years old were examined. Mean age — 11.4 ± 1.9 years, of which 86 (52%) boys and 79 (48%) girls. The indicators of the acoustic component of the work of breathing in the low-frequency P1 (200–1200 Hz), mid-frequency P2 (> 1200–5000 Hz) and high-frequency P3 (> 5000 Hz) ranges and the total acoustic work of breathing (P total on inhalation and exhalation) were determined. Results. When examining children, data were obtained for the acoustic component of the work of breathing on inspiration for the low-frequency range — 16.1 (9.8; 20.4) milliPascal (mPa), the mid-frequency range — 5.84 (4.1; 9.4) mPa and the high-frequency range — 2.26 (1.3; 2.5) mPa, on exhalation — 23.9 (16.2; 30.1), 8.35 (5.6; 12.2) and 2.57 (2.0; 3.3) mPa, respectively. In the study of the general acoustic component of the work of breathing, the following values were obtained: on inhalation P total — 23.8 (16.5; 32.8) mPa, on exhalation — 35.6 (24.5; 47.6) mPa. There were no statistically significant gender differences and differences between children of different ages (p > 0.05). Conclusion. The respiratory sound recorder — is a promising device that can be used to diagnose various respiratory pathologies in children of all age groups. Keywords: respiratory sound recorder, computer bronchophonography, respiratory sounds, children.
{"title":"Respiratory Sound Recorder for Computer Analysis of Breathing Patterns in Children","authors":"E.V. Aseeva, N. Geppe, V. S. Malyshev, D. G. Bukharov, L. S. Starostina, S. Shatalina","doi":"10.31550/1727-2378-2023-22-3-45-50","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-3-45-50","url":null,"abstract":"Aim: To evaluate the reference/normal breathing parameters in healthy children aged 6 to 18 years using a respiratory sound recorder. Design: Prospective, open-label, non-randomized clinical trial. Materials and methods. The function of external respiration was assessed in practically healthy children without respiratory pathology using a respiratory sound recorder. 165 practically healthy children from 6 to 18 years old were examined. Mean age — 11.4 ± 1.9 years, of which 86 (52%) boys and 79 (48%) girls. The indicators of the acoustic component of the work of breathing in the low-frequency P1 (200–1200 Hz), mid-frequency P2 (> 1200–5000 Hz) and high-frequency P3 (> 5000 Hz) ranges and the total acoustic work of breathing (P total on inhalation and exhalation) were determined. Results. When examining children, data were obtained for the acoustic component of the work of breathing on inspiration for the low-frequency range — 16.1 (9.8; 20.4) milliPascal (mPa), the mid-frequency range — 5.84 (4.1; 9.4) mPa and the high-frequency range — 2.26 (1.3; 2.5) mPa, on exhalation — 23.9 (16.2; 30.1), 8.35 (5.6; 12.2) and 2.57 (2.0; 3.3) mPa, respectively. In the study of the general acoustic component of the work of breathing, the following values were obtained: on inhalation P total — 23.8 (16.5; 32.8) mPa, on exhalation — 35.6 (24.5; 47.6) mPa. There were no statistically significant gender differences and differences between children of different ages (p > 0.05). Conclusion. The respiratory sound recorder — is a promising device that can be used to diagnose various respiratory pathologies in children of all age groups. Keywords: respiratory sound recorder, computer bronchophonography, respiratory sounds, children.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76820863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.31550/1727-2378-2023-22-2-7-14
E. Shmidt, S. Berns, I. Zhidkova, O. A. Nagirnyak, A. G. Neeshpapa, O. Barbarash, D. Duplyakov, A. D. Erlikh
Aim: To study approaches to the management of patients with pulmonary embolism at the hospital stage with varying degrees of risk of death in the clinical practice of Russian hospitals. Design: Registry, multicentre, prospective observational study. Materials and methods. The study included 571 patients (SIRENA registry database), in all patients the risk of death was calculated according to the Pulmonary Embolism Severity Index (PESI). A comparative analysis was carried out in three groups of patients: with low (PESI I + II class), intermediate (PESI III class) and high risk (PESI IV + V class). Results. Among patients with low and high risk for PESI who received thrombolytic therapy (TLT), fewer people died than among those who did not: 2 vs. 5.9%, respectively, and 13 vs. 30% (p = 0.01), respectively. In the group of intermediate-risk patients with TLT, all remained alive, and among patients without TLT, 25.8% died (p = 0.033). In patients at low risk for PESI, the most common cause of thrombolysis was massive thrombosis of the main branches and trunk of the pulmonary artery (PA) (3.9%), the first diagnosis of acute coronary syndrome with ST elevation (0.8%), and persistent signs of respiratory failure against the background of anticoagulant therapy (5.5%). At intermediate risk according to PESI, the most common reasons for thrombolysis were the presence of respiratory failure with low blood pressure (6.2%) and massive thrombosis of the pulmonary arteries (2.7%). Conclusion. In patients with intermediate and high risk according to the PESI index, a significant efficacy of systemic TLT in reducing the risk of in-hospital mortality has been proven. Patients with low and intermediate risk according to PESI need to conduct a more thorough analysis of the presence of comorbidities and risk factors, additional instrumental and laboratory parameters, aggravating factors (central massive pulmonary thrombosis in combination with a respiratory failure clinic), followed by consideration of the possibility and feasibility of TLT. Keywords: Pulmonary Embolism Severity Index, pulmonary embolism, SIRENA registry, thrombolysis.
目的:探讨俄罗斯医院临床实践中不同死亡风险的住院期肺栓塞患者的处理方法。设计:注册、多中心、前瞻性观察研究。材料和方法。该研究纳入571例患者(SIRENA注册数据库)，根据肺栓塞严重程度指数(PESI)计算所有患者的死亡风险。对低危(PESI I + II级)、中危(PESI III级)和高危(PESI IV + V级)三组患者进行比较分析。结果。在接受溶栓治疗(TLT)的PESI低风险和高风险患者中，死亡率低于未接受溶栓治疗的患者:分别为2 vs 5.9%， 13 vs 30% (p = 0.01)。在接受TLT的中危患者组中，所有患者存活，未接受TLT的患者中，25.8%的患者死亡(p = 0.033)。在低风险的PESI患者中，最常见的溶栓原因是肺动脉主干大量血栓形成(3.9%)，首次诊断为急性冠状动脉综合征伴ST段抬高(0.8%)，抗凝治疗背景下持续出现呼吸衰竭迹象(5.5%)。根据PESI，在中等风险中，最常见的溶栓原因是存在呼吸衰竭伴低血压(6.2%)和肺动脉大量血栓形成(2.7%)。结论。在PESI指数为中高危的患者中，已证实全身TLT在降低院内死亡风险方面有显著疗效。PESI为中低危的患者需要对是否存在合并症和危险因素、其他仪器和实验室参数、加重因素(中枢性大面积肺血栓合并呼吸衰竭)进行更深入的分析，然后考虑TLT的可能性和可行性。关键词:肺栓塞严重程度指数，肺栓塞，SIRENA登记，溶栓。
{"title":"Limitations of the PESI Index in Determining the Optimal Treatment Tactics for Pulmonary Embolism: Data from the Russian SIRENA Registry","authors":"E. Shmidt, S. Berns, I. Zhidkova, O. A. Nagirnyak, A. G. Neeshpapa, O. Barbarash, D. Duplyakov, A. D. Erlikh","doi":"10.31550/1727-2378-2023-22-2-7-14","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-2-7-14","url":null,"abstract":"Aim: To study approaches to the management of patients with pulmonary embolism at the hospital stage with varying degrees of risk of death in the clinical practice of Russian hospitals. Design: Registry, multicentre, prospective observational study. Materials and methods. The study included 571 patients (SIRENA registry database), in all patients the risk of death was calculated according to the Pulmonary Embolism Severity Index (PESI). A comparative analysis was carried out in three groups of patients: with low (PESI I + II class), intermediate (PESI III class) and high risk (PESI IV + V class). Results. Among patients with low and high risk for PESI who received thrombolytic therapy (TLT), fewer people died than among those who did not: 2 vs. 5.9%, respectively, and 13 vs. 30% (p = 0.01), respectively. In the group of intermediate-risk patients with TLT, all remained alive, and among patients without TLT, 25.8% died (p = 0.033). In patients at low risk for PESI, the most common cause of thrombolysis was massive thrombosis of the main branches and trunk of the pulmonary artery (PA) (3.9%), the first diagnosis of acute coronary syndrome with ST elevation (0.8%), and persistent signs of respiratory failure against the background of anticoagulant therapy (5.5%). At intermediate risk according to PESI, the most common reasons for thrombolysis were the presence of respiratory failure with low blood pressure (6.2%) and massive thrombosis of the pulmonary arteries (2.7%). Conclusion. In patients with intermediate and high risk according to the PESI index, a significant efficacy of systemic TLT in reducing the risk of in-hospital mortality has been proven. Patients with low and intermediate risk according to PESI need to conduct a more thorough analysis of the presence of comorbidities and risk factors, additional instrumental and laboratory parameters, aggravating factors (central massive pulmonary thrombosis in combination with a respiratory failure clinic), followed by consideration of the possibility and feasibility of TLT. Keywords: Pulmonary Embolism Severity Index, pulmonary embolism, SIRENA registry, thrombolysis.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78334550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.31550/1727-2378-2023-22-3-51-55
P. A. Romanov, P. L. Sokolov, A. G. Prityko, N. V. Chebanenko
Aim: Based on the study of a large amount of available information, to create an idea of the use of magnetic resonance imaging (MRI) in hypoxic-ischemic brain lesions in newborns, to present the available research algorithms, classifications, the scope of the technique and its information content in the named pathology. Key points. MRI has long been a common practice in a neuropediatric hospital. To date, examination by this method has absolute significance in the diagnosis of perinatal hypoxic-ischemic brain lesions. In addition, MRI data help to objectify the effectiveness of therapeutic interventions and predict the further development of a child with perinatal brain damage. There are several classifications of MRI changes in hypoxic-ischemic brain lesions in newborns. These classifications have varying degrees of sensitivity to the initial hypoxic-ischemic changes in the child's brain, however, allow us to roughly represent the process of their formation in dynamics in the morphological aspect according to the scheme “periventricular white matter — subcortical ganglia and thalamus — subcortical structures of the hemispheres and cerebral cortex”. Thus, the target structures of hypoxic ischemic lesions allow us to identify its main patterns: lesions of neuronal structures, leukopathy, and their combination. Conclusion. Studies of MRI phenomena as predictors of developmental pathology show that an increase in detail increases the accuracy of the prognosis. However, the available data do not currently allow us to form a spatial model for the development of hypoxic-ischemic changes in the brain of a newborn. It seems necessary to create such a model depending on the time and intensity of the impact of the ischemic process. This will allow developing a morphological and pathophysiological classification of perinatal encephalopathies. Keywords: magnetic resonance imaging, hypoxia-ischemia, hypoxic-ischemic brain damage, newborns, cerebral palsy.
{"title":"Magnetic Resonance Imaging in Hypoxic-Ischemic Brain Lesions in Newborns: Evolution of Views and Development Prospects","authors":"P. A. Romanov, P. L. Sokolov, A. G. Prityko, N. V. Chebanenko","doi":"10.31550/1727-2378-2023-22-3-51-55","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-3-51-55","url":null,"abstract":"Aim: Based on the study of a large amount of available information, to create an idea of the use of magnetic resonance imaging (MRI) in hypoxic-ischemic brain lesions in newborns, to present the available research algorithms, classifications, the scope of the technique and its information content in the named pathology. Key points. MRI has long been a common practice in a neuropediatric hospital. To date, examination by this method has absolute significance in the diagnosis of perinatal hypoxic-ischemic brain lesions. In addition, MRI data help to objectify the effectiveness of therapeutic interventions and predict the further development of a child with perinatal brain damage. There are several classifications of MRI changes in hypoxic-ischemic brain lesions in newborns. These classifications have varying degrees of sensitivity to the initial hypoxic-ischemic changes in the child's brain, however, allow us to roughly represent the process of their formation in dynamics in the morphological aspect according to the scheme “periventricular white matter — subcortical ganglia and thalamus — subcortical structures of the hemispheres and cerebral cortex”. Thus, the target structures of hypoxic ischemic lesions allow us to identify its main patterns: lesions of neuronal structures, leukopathy, and their combination. Conclusion. Studies of MRI phenomena as predictors of developmental pathology show that an increase in detail increases the accuracy of the prognosis. However, the available data do not currently allow us to form a spatial model for the development of hypoxic-ischemic changes in the brain of a newborn. It seems necessary to create such a model depending on the time and intensity of the impact of the ischemic process. This will allow developing a morphological and pathophysiological classification of perinatal encephalopathies. Keywords: magnetic resonance imaging, hypoxia-ischemia, hypoxic-ischemic brain damage, newborns, cerebral palsy.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74510821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.31550/1727-2378-2023-22-2-70-75
K. V. Petrov, E. Mozheyko, A. Petrov, I. Demko
Objective of the Review: To summarise the data from literature sources on respiratory rehabilitation of patients with the novel coronavirus infection; to assess the current state and perspectives. Key Points. The novel coronavirus infection (COVID-19) is a highly contagious acute respiratory disease with primary involvement of upper and lower respiratory tract, organs and systems of the body. The symptoms of the disease vary from asymptomatic carrier to clinically severe viral pneumonia that requires oxygen therapy and respiratory support. Respiratory rehabilitation is vital for patient recovery. Globally, there is more and more professional information and databases on respiratory rehabilitation of COVID-19 patients, since the common methods of rehabilitation after a respiratory disease can be ineffective or unsafe. Conclusion. Respiratory rehabilitation should be an integral part of COVID-19 therapy, starting from ICU once the patient’s condition has stabilised. Rehabilitation should be personalised. Future studies will help in understanding the development path of pulmonary rehabilitation in order to improve the quality of patients’ life and to facilitate faster activity restoration. Keywords: rehabilitation, respiratory rehabilitation, coronavirus infection, COVID-19, breathing exercises.
{"title":"Respiratory Rehabilitation of COVID-19 Patients: Current State of the Problem","authors":"K. V. Petrov, E. Mozheyko, A. Petrov, I. Demko","doi":"10.31550/1727-2378-2023-22-2-70-75","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-2-70-75","url":null,"abstract":"Objective of the Review: To summarise the data from literature sources on respiratory rehabilitation of patients with the novel coronavirus infection; to assess the current state and perspectives. Key Points. The novel coronavirus infection (COVID-19) is a highly contagious acute respiratory disease with primary involvement of upper and lower respiratory tract, organs and systems of the body. The symptoms of the disease vary from asymptomatic carrier to clinically severe viral pneumonia that requires oxygen therapy and respiratory support. Respiratory rehabilitation is vital for patient recovery. Globally, there is more and more professional information and databases on respiratory rehabilitation of COVID-19 patients, since the common methods of rehabilitation after a respiratory disease can be ineffective or unsafe. Conclusion. Respiratory rehabilitation should be an integral part of COVID-19 therapy, starting from ICU once the patient’s condition has stabilised. Rehabilitation should be personalised. Future studies will help in understanding the development path of pulmonary rehabilitation in order to improve the quality of patients’ life and to facilitate faster activity restoration. Keywords: rehabilitation, respiratory rehabilitation, coronavirus infection, COVID-19, breathing exercises.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74032040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.31550/1727-2378-2023-22-3-65-69
A. M. Levchin, I. B. Ershova, A. G. Rogovtsova
Aim: To study the specific functional condition of the cardiovascular system in primary school-aged children who experienced stress from military actions. Design: Prospective cohort non-randomised study. Materials and methods. There were 730 children under observation: 239 children of the main group lived in the territories where active hostilities took place; the younger schoolchildren of the control group (491 children) lived in territories where military operations were not carried out. The functional state of the cardiovascular system was studied by calculating and determining the parameters of the Martinet–Kushelevsky sample. Results. The study showed that the recovery of heart rate after the Martinet–Kushelevsky test in younger schoolchildren who were in peaceful living conditions occurred faster than in children who experienced the stress of military operations (p < 0.05). The initial study of children who experienced the stress of military operations allowed us to establish not only a longer recovery time of blood pressure (p < 0.001), but also gender differences. The study conducted repeatedly, against the background of the integrated integration program, revealed a significant (p < 0.05) decrease in pulse blood pressure values in all subgroups. Conclusion. In younger schoolchildren who have experienced the effects of active hostilities, the ability of the cardiovascular system to recover after dosed physical activity is sharply reduced; the identified features of the functioning of the CCC in children must be taken into account during physical education lessons at school. Keywords: children, primary school age, cardiovascular system, Martinet–Kushelevsky test.
{"title":"Optimization of the Functional State of the Cardiovascular System of Children Who Have Experienced the Stress of Military Operations","authors":"A. M. Levchin, I. B. Ershova, A. G. Rogovtsova","doi":"10.31550/1727-2378-2023-22-3-65-69","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-3-65-69","url":null,"abstract":"Aim: To study the specific functional condition of the cardiovascular system in primary school-aged children who experienced stress from military actions. Design: Prospective cohort non-randomised study. Materials and methods. There were 730 children under observation: 239 children of the main group lived in the territories where active hostilities took place; the younger schoolchildren of the control group (491 children) lived in territories where military operations were not carried out. The functional state of the cardiovascular system was studied by calculating and determining the parameters of the Martinet–Kushelevsky sample. Results. The study showed that the recovery of heart rate after the Martinet–Kushelevsky test in younger schoolchildren who were in peaceful living conditions occurred faster than in children who experienced the stress of military operations (p < 0.05). The initial study of children who experienced the stress of military operations allowed us to establish not only a longer recovery time of blood pressure (p < 0.001), but also gender differences. The study conducted repeatedly, against the background of the integrated integration program, revealed a significant (p < 0.05) decrease in pulse blood pressure values in all subgroups. Conclusion. In younger schoolchildren who have experienced the effects of active hostilities, the ability of the cardiovascular system to recover after dosed physical activity is sharply reduced; the identified features of the functioning of the CCC in children must be taken into account during physical education lessons at school. Keywords: children, primary school age, cardiovascular system, Martinet–Kushelevsky test.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74137002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.31550/1727-2378-2023-22-2-21-25
E. Kasparov, S. V. Klemenkov, S. S. Gorbunova
Aim: to study the effect of a two-week course of sanatorium treatment using both iodine-bromine baths (IBB) and physical training (PT) on physical performance of coronary heart disease (CHD) patients with stable angina when using their different combinations. Design: the randomized, controlled, prospective study. Materials and methods. The study included 126 CHD patients, divided into 3 groups. 42 patients (Group 1) were prescribed IBB and PT on a bicycle ergometer; with PT performed 1,5–2 hours before taking IBB (Complex No. 1). 43 individuals (Group 2) were prescribed IBB and PT, with the latter performed 1,5–2 hours after taking IBB (Complex No. 2). 41 patients (Group 3, control) received IBB and therapeutic exercises (TE) Complex No. 3). Physical factors in the groups of CHD patients were prescribed every other day, with the treatment duration being 2 weeks (14 days). The evaluation of the results in CHD patients was carried out using 24-hour Holter ECG monitoring, spiro- and bicycle ergometry. Results. A spiro- and bicycle ergometry showed that the rehabilitation courses for CHD patients with the Complex No. 1 gives a more pronounced training effect and an increase in coronary reserve than the Complex No. 2 or when prescribing IBB and TE. The decrease in myocardial ischemia while 24-hour Holter ECG monitoring in CHD patients was also the largest after the Complex No. 1 rehabilitation. The training effect of the Complex, i.e. when PT was prescribed before taking IBB, led to both a greater increase in the coronary reserve and a decrease in myocardial ischemia in CHD patients, compared with either prescribing PT after taking IBB or when using IBB and TE. Conclusion. Thus, the rehabilitation effectiveness for CHD patients with a shortened time of using iodine-bromine baths and physical training up to fourteen days depends on their combinations. The best result was obtained when prescribing PT before taking IBB. Keywords: coronary heart disease, balneotherapy, physical training, physical performance cardiac arrhythmia, myocardial ischemia.
{"title":"Optimization of Rehabilitation for Patients with Coronary Heart Disease in Shortened Sanatorium Treatment Time","authors":"E. Kasparov, S. V. Klemenkov, S. S. Gorbunova","doi":"10.31550/1727-2378-2023-22-2-21-25","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-2-21-25","url":null,"abstract":"Aim: to study the effect of a two-week course of sanatorium treatment using both iodine-bromine baths (IBB) and physical training (PT) on physical performance of coronary heart disease (CHD) patients with stable angina when using their different combinations. Design: the randomized, controlled, prospective study. Materials and methods. The study included 126 CHD patients, divided into 3 groups. 42 patients (Group 1) were prescribed IBB and PT on a bicycle ergometer; with PT performed 1,5–2 hours before taking IBB (Complex No. 1). 43 individuals (Group 2) were prescribed IBB and PT, with the latter performed 1,5–2 hours after taking IBB (Complex No. 2). 41 patients (Group 3, control) received IBB and therapeutic exercises (TE) Complex No. 3). Physical factors in the groups of CHD patients were prescribed every other day, with the treatment duration being 2 weeks (14 days). The evaluation of the results in CHD patients was carried out using 24-hour Holter ECG monitoring, spiro- and bicycle ergometry. Results. A spiro- and bicycle ergometry showed that the rehabilitation courses for CHD patients with the Complex No. 1 gives a more pronounced training effect and an increase in coronary reserve than the Complex No. 2 or when prescribing IBB and TE. The decrease in myocardial ischemia while 24-hour Holter ECG monitoring in CHD patients was also the largest after the Complex No. 1 rehabilitation. The training effect of the Complex, i.e. when PT was prescribed before taking IBB, led to both a greater increase in the coronary reserve and a decrease in myocardial ischemia in CHD patients, compared with either prescribing PT after taking IBB or when using IBB and TE. Conclusion. Thus, the rehabilitation effectiveness for CHD patients with a shortened time of using iodine-bromine baths and physical training up to fourteen days depends on their combinations. The best result was obtained when prescribing PT before taking IBB. Keywords: coronary heart disease, balneotherapy, physical training, physical performance cardiac arrhythmia, myocardial ischemia.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91089303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.31550/1727-2378-2023-22-4-77-83
D. Mikhalkova, A. Vitebskaya
Aim: To demonstrate clinical cases of hypothyroidism in adolescents manifested under the guises of rheumatic diseases. Key points. We presented the cases of hypothyroidism which required differential diagnostics with systemic lupus erythematosus (SLE) and juvenile idiopathic arthritis (JIA). Thyroid arthropathy course is demonstrated. Conclusion. Hypothyroidism is characterized by nonspecific symptoms (weakness, oedema) which are also typical for SLE and JIA; thyroid hormones measurement for diagnostics is necessary. If joint syndrome remains in spite of hypothyroidism compensation repeated differential diagnostics of thyroid arthropathy and JIA is required. Keywords: adolescents, hypothyroidism, juvenile arthritis, systemic lupus erythematosus, thyroid arthropathy.
{"title":"Rheumatological Masks of Hypothyroidism","authors":"D. Mikhalkova, A. Vitebskaya","doi":"10.31550/1727-2378-2023-22-4-77-83","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-4-77-83","url":null,"abstract":"Aim: To demonstrate clinical cases of hypothyroidism in adolescents manifested under the guises of rheumatic diseases. Key points. We presented the cases of hypothyroidism which required differential diagnostics with systemic lupus erythematosus (SLE) and juvenile idiopathic arthritis (JIA). Thyroid arthropathy course is demonstrated. Conclusion. Hypothyroidism is characterized by nonspecific symptoms (weakness, oedema) which are also typical for SLE and JIA; thyroid hormones measurement for diagnostics is necessary. If joint syndrome remains in spite of hypothyroidism compensation repeated differential diagnostics of thyroid arthropathy and JIA is required. Keywords: adolescents, hypothyroidism, juvenile arthritis, systemic lupus erythematosus, thyroid arthropathy.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77831744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：