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New approaches to pathogenetic anti-inflammatory therapy of cardiovascular diseases 心血管疾病病原性抗炎治疗新途径
Pub Date : 2023-07-28 DOI: 10.17816/mechnikov296331
E. Kolesova, A. Maslyanskiy, O. Rotar, A. Konradi, V. Mazurov
In recent years, new data have been obtained confirming the role of inflammation as the leading pathogenetic mechanism for the development of atherosclerosis and its complications. In addition, atherosclerosis is considered in the spectrum of atypical autoinflammatory diseases. The aim of the paper is to highlight the role of inflammation in the development and progression of atherosclerosis and other cardiovascular diseases as well as to identify new therapeutic targets for the treatment of cardiovascular disease. The search has been performed in the PubMed, e-library, Embase, ClinicalTrials.gov databases, using the keywords: inflammation, NLRP3 inflammasome, TNF-, IL-1 blocker, atherosclerosis, cardiovascular disease. As a result, 210 references have obtained; the results of 15 clinical studies have been selected for the final analysis as well as 15 papers containing the results of original studies with access to the full text articles in Russian or English. The analysis of literature sources revealed that inflammation plays a crucial role in the development of cardiovascular diseases, and modern anti-inflammatory therapy is a promising, pathogenetically justified strategy for the prevention and treatment of cardiovascular diseases.
近年来,有新的数据证实炎症是动脉粥样硬化及其并发症发生的主要发病机制。此外,动脉粥样硬化被认为是非典型自身炎症疾病的一种。本文的目的是强调炎症在动脉粥样硬化和其他心血管疾病的发生和进展中的作用,并为心血管疾病的治疗寻找新的治疗靶点。检索已在PubMed、e-library、Embase、ClinicalTrials.gov数据库中进行,检索关键词为:炎症、NLRP3炎性体、TNF-、IL-1阻滞剂、动脉粥样硬化、心血管疾病。结果,获得了210份参考资料;最终分析选择了15项临床研究的结果以及15篇包含原始研究结果的论文,这些论文可以获得俄文或英文全文。对文献资料的分析表明,炎症在心血管疾病的发展中起着至关重要的作用,现代抗炎治疗是预防和治疗心血管疾病的一种有前途的、病理合理的策略。
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引用次数: 0
Effect of thrombocytosis on cardiovascular risk in rheumatoid arthritis 类风湿关节炎患者血小板增多对心血管风险的影响
Pub Date : 2023-07-28 DOI: 10.17816/mechnikov116907
V. Mazurov, E. Melnikov, Kira P. Morozova
BACKGROUND: Patients with rheumatoid arthritis have a high level of comorbidity, and their most common and socially significant conditions are cardiovascular diseases, which represent a major cause of mortality. Currently, there are no data on the differences in cardiovascular risk scales in patients with rheumatoid arthritis depending on the presence or absence of thrombocytosis. AIM: To assess and compare cardiovascular risk according to conventional scales in patients with thrombocytosis and normal thrombocytes. MATERIALS AND METHODS: The study involved 85 patients diagnosed with rheumatoid arthritis: 40 with thrombocytosis [including 25 (62,5%) women] and 45 with normal thrombocytes [including 29 (64,4%) women]. The following scales were used to assess risk of cardiovascular complications: Systematic COronary Risk Evaluation with adjustment factor 1.5 (mSCORE), Reynolds Risk Score (RRS), QRESEARCH Cardiovascular Risk Algorithm (QRISK3), Assessing Cardiovascular Risk to Scottish Intercollegiate Guidelines Network / SIGN to Assign Preventative Treatment (ASSIGN). RESULTS: The obtained findings have demontrated that according to the mSCORE and RRS scales the patients of both groups had almost identical parameters; however, according to the ASSIGN and QRISK3 high risk of cardiovascular complications has been detected nearly twice as frequently in the patients with rheumatoid arthritis and thrombocytosis in comparison with those with normal level of thrombocytes. It is also worth noting that more frequent determination of high risk of cardiovascular complications by the QRISK3 was statistically significant. CONCLUSIONS: The QRISK3 calculation has shown significantly higher prevalence of high-risk cardiovascular complications among the patients with platelet counts 450 ∙ 109/l compared with those with platelet levels within the reference values. Thus, the QRISK3 scale can be considered as more informative for estimating risk of cardiovascular complications in rheumatoid arthritis.
背景:类风湿关节炎患者具有高水平的合并症,其最常见和社会意义重大的疾病是心血管疾病,这是导致死亡的主要原因。目前,尚无关于类风湿关节炎患者心血管风险量表差异的数据,这取决于是否存在血小板增多。目的:根据常规量表评估和比较血小板增多患者和正常血小板患者的心血管风险。材料和方法:该研究纳入85例诊断为类风湿性关节炎的患者:40例有血小板增多症[包括25例(62.5%)女性],45例有正常血小板[包括29例(61.4%)女性]。使用以下量表评估心血管并发症的风险:系统冠状动脉风险评估调整因子1.5 (mSCORE)、雷诺兹风险评分(RRS)、QRESEARCH心血管风险算法(QRISK3)、评估苏格兰校际指南网络/ SIGN分配预防治疗(Assign)的心血管风险。结果:得到的结果表明,根据mSCORE和RRS量表,两组患者的参数几乎相同;然而,根据ASSIGN和QRISK3,与血小板水平正常的患者相比,类风湿关节炎和血小板增多患者的心血管并发症高风险被检测出的频率几乎是其两倍。同样值得注意的是,通过QRISK3更频繁地确定心血管并发症的高风险具有统计学意义。结论:QRISK3计算结果显示,血小板计数450∙109/l的患者高危心血管并发症发生率明显高于血小板水平在参考值范围内的患者。因此,QRISK3量表可以被认为是评估类风湿关节炎心血管并发症风险的更有用的量表。
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引用次数: 0
Persistent postural-perceptual dizziness as a regulatory dysfunction of the balance system 作为平衡系统调节功能障碍的持续性体位知觉头晕
Pub Date : 2023-07-28 DOI: 10.17816/mechnikov115269
L. Mirzaeva, Victor A. Voronov, D. Demidenko, Anna K. Savinova, Arina I. Griva
The problem of chronic functional dizziness is highly relevant nowadays. In case of a great number of patients suffering from persistent postural-perceptual dizziness, lack of a unified understanding of the pathogenesis, diagnostic mistakes, and, as a result, improper treatment lead to a deterioration in the quality of life and disability. The purpose of the review is to analyse and highlight the persistent postural-perceptual dizziness problem, to explore the currently existing pathogenetic concepts, methods of diagnosis and treatment of this group of patients. Domestic and foreign scientific papers have been analysed using the largest world citation databases according to the following keywords: psychogenic dizziness, chronic subjective dizziness, vestibular rehabilitation, stabilometry, persistent postural-perceptual dizziness, postural phobic instability, selective serotonin reuptake inhibitors, cognitive behavioral therapy. The data of 78 scientific works of the research subject are the basis of the review. The article presents a brief historical background, contemporary conceptions of pathogenesis, symptoms and clinical manifestations of persistent postural-perceptual dizziness. The particular attention is given to the diagnostic methods and treatment principles. Relevant questionnaires and diagnostic scales as well as the Barany Society criteria are also considered. A multidisciplinary approach to treatment which allows to achieve a lasting positive effect is described. Segregation of persistent postural-perceptual dizziness into a separate nosological item, understanding of its pathogenesis, an integrated approach to diagnosis with assessment of structural, functional and mental disturbances, just like complex therapeutic strategies make а fully recovery possible.
慢性功能性头晕问题是当今高度相关的问题。大量患者出现持续性体位知觉性头晕,发病机制缺乏统一认识,诊断错误,治疗不当,导致生活质量下降和致残。本文综述的目的是分析和突出持续性体位感眩晕问题,探讨目前该类患者存在的发病观念、诊断和治疗方法。使用世界最大的引文数据库对国内外科学论文进行分析,关键词:心因性头晕,慢性主观性头晕,前庭康复,稳定性测量,持续性体位-知觉头晕,体位性恐惧不稳定,选择性血清素再摄取抑制剂,认知行为治疗。该研究课题的78篇科学著作的数据是本综述的基础。本文简要介绍了持续性体位感眩晕的历史背景、发病机制、症状和临床表现。特别注意的是诊断方法和治疗原则。相关的调查问卷和诊断量表以及Barany学会的标准也被考虑在内。多学科的治疗方法,允许实现持久的积极效果描述。将持续性体位知觉性头晕分离为一个单独的分科项目,了解其发病机制,结合结构、功能和精神障碍的综合诊断方法,就像复杂的治疗策略一样,使完全康复成为可能。
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引用次数: 0
Differential diagnosis of thrombocytosis: a case study 血小板增多症的鉴别诊断:一个案例研究
Pub Date : 2023-07-28 DOI: 10.17816/mechnikov326388
Aleg P. Budai, Sergei Yu. Ermolov, Valerii P. Dobritca, I. G. Ilyashevich, A. G. Apresyan
The article presents a clinical case of an unclassifiable myeloproliferative neoplasm in a 65-year old patient. Platelet count is not a criteria for differential diagnosis of reactive and tumor processes. A typical course of the disease is associated with the persistence of symptoms of microcirculation disorder against the background of previous asymptomic thrombocytosis for several years. The diagnosis of an unclassifiable myeloproliferative neoplasm is established by a combination of clinical, laboratory, instrumental, molecular genetic and morphological methods of research.
本文报告一位65岁患者的骨髓增生性肿瘤无法分类的临床病例。血小板计数不是鉴别诊断反应性和肿瘤过程的标准。该疾病的典型病程与微循环障碍症状的持续存在有关,而先前的无症状血小板增多已持续数年。不可分类的骨髓增生性肿瘤的诊断是通过临床、实验室、仪器、分子遗传学和形态学研究方法的结合来建立的。
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引用次数: 0
Evaluation of the quality of life dynamics in comorbid patients with hip and knee joint arthroplasty 髋关节和膝关节置换术合并症患者的生活质量动态评价
Pub Date : 2023-05-05 DOI: 10.17816/mechnikov112015
B.G. Aliev, Aleksandr A. Spichko, Sergey A. Saiganov, V. Mazurov, Aleksey A. Korneenkov, D. Mansurov, Valerii M. Khaydarov, I. Urazovskaya, A. N. Tkachenko
BACKGROUND: In recent years, in traumatology and orthopedics, statistical methods of survival analysis have been used to assess long-term treatment results, which make it possible to take into account censored clinical observations. This method of statistical analysis allows to take into account both cases of attrition from care and cases of incomplete follow-ups. There is no concurrent point of view on the dependence of the long-term results of hip and knee arthroplasty on the comorbidity of a patient. This circumstance fosters a special study using survival analysis. AIM: To study the long-term results of total hip and knee arthroplasty in the patients with osteoarthritis. To determine the patients quality of life depending on the presence of pronounced concomitant pathology. MATERIALS AND METHODS: The groups of patients with comorbidity and without significant concomitant pathology have been compared. The first group included 806 patients aged 19 to 88 years who underwent primary total hip replacement in the Clinic of Traumatology and Orthopedics of the North-Western State Medical University named after I.I. Mechnikov from 2014 to 2018 in connection with osteoarthritis. The second group consisted of 376 patients aged 43 to 85 years who underwent primary total KR due to osteoarthritis in the V.A. Baranov Republican Hospital (Petrozavodsk) in 20162019. Statistical data processing and graph design have been carried out with R programming language with open access via https://cran.r-project.org. The probability of maintaining a satisfactory assessment of the quality of life by a certain observation point t (year of observation) has been assessed using the KaplanMayer method. The logrank test has been used in order to compare the probability of maintaining a satisfactory assessment of quality of life during the entire follow-up period in the groups of patients with and without polymorbidity. RESULTS: At the end of the 5th year of follow-up, the probability of maintaining excellent and good quality of life after hip replacement with a 95% confidence interval was 0.88 (0.81; 0.94) in the patients without comorbidity, 0.84 (0.79; 0.88) in the patients with severe concomitant pathology. Test statistics (Z = 0.93) and p = 0.31 indicate statistically insignificant differences in survival curves between the groups of patients with varying degrees of comorbidity. When analyzing the five-year results of the knee replacement, the quality of life among patients with high and low comorbidity did not differ significantly. The probability of excellent and good quality of life at the 5th year of follow-up in practically healthy patients and in cases of mild therapeutic disease was 0.78 (0.67; 0.88); with a high degree of comorbidity 0.74 (0.65; 0.81). CONCLUSIONS: By the end of the 5th year of follow-up of the patients who have undergone hip or knee replacement due to osteoarthritis, an excellent and good quality of life can be expected on average in 80% of
背景:近年来,在创伤学和骨科中,生存分析的统计方法已被用于评估长期治疗结果,这使得考虑审查的临床观察成为可能。这种统计分析方法可以考虑到护理人员流失和随访不完全的情况。髋关节和膝关节置换术的长期结果是否依赖于患者的合并症,目前尚无一致的观点。这种情况催生了一种使用生存分析的特殊研究。目的:探讨骨关节炎患者行全髋关节置换术的远期疗效。确定患者的生活质量取决于是否存在明显的伴随病理。材料和方法:对有合并症和无显著伴发病理的两组患者进行比较。第一组包括806名年龄在19至88岁之间的患者,他们于2014年至2018年在以I.I. Mechnikov命名的西北州立医科大学创伤和骨科诊所接受了原发性全髋关节置换术,与骨关节炎有关。第二组包括376名年龄在43至85岁之间的患者,他们于2016年至2019年在va巴拉诺夫共和国医院(彼得罗扎沃茨克)因骨关节炎接受了原发性全KR。统计数据处理和图形设计使用R编程语言进行,并通过https://cran.r-project.org开放访问。通过某一观察点t(观察年)维持满意的生活质量评估的概率已使用KaplanMayer方法进行了评估。logrank检验用于比较在整个随访期间,有和没有多发性疾病的患者组维持令人满意的生活质量评估的可能性。结果:随访第5年结束时,髋关节置换术后维持优秀和良好生活质量的概率为0.88(95%置信区间为0.81;无合并症患者为0.94),无合并症患者为0.84 (0.79;0.88),伴有严重病理的患者。检验统计(Z = 0.93)和p = 0.31表明不同程度合并症患者组间生存曲线差异无统计学意义。在分析膝关节置换术的5年结果时,高合并症和低合并症患者的生活质量没有显著差异。在实际健康患者和轻度治疗性疾病病例中,第5年随访时生活质量优良和良好的概率为0.78 (0.67;0.88);高共病程度0.74 (0.65;0.81)。结论:对因骨关节炎而行髋关节或膝关节置换术的患者进行第5年随访时,平均80%的患者可获得良好的生活质量。20%的患者满意和不满意。有严重合并症的患者在髋关节或膝关节置换术后5年的生活质量与无合并症的实际健康患者无显著差异(p < 0.05)。
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引用次数: 1
Evaluation of the nephroprotective strategy effectiveness in the late stages of chronic kidney disease 慢性肾病晚期肾保护策略的有效性评价
Pub Date : 2023-05-05 DOI: 10.17816/mechnikov119586
D. Sadovskaya, K. A. Vishnevsky, I. N. Konakova, Olga R. Golubeva, N. V. Bakulina
Background. Classical nephroprotection reduces its effectiveness at the late CKD stages; the search for effective algorithms is hampered by accelerating decline in GFR, therefore there are no generally accepted ways to evaluate the effectiveness. Aim: to build a model for predicting the GFR decline rate in order to assess the effectiveness of the intensive follow-up. Methods. A representative group of regular follow-up (N=540) was allocated from the city database (N=7696) to built-up the polynomial model that predicts GFR annual decline. We used the model to evaluate the intensive monitoring effectiveness (N=100) by the difference between predicted and actual rates of GFR decline. We also selected well matched subgroup of 200 patients for direct comparison of hard and surrogate outcomes. Results. During last year before need in dialysis, the rate of GFR decline in intensive group was 5.981.69 vs. the predicted 9.060.59ml/min/1.73 m/year. We used that assessment of the intervention effectiveness as dependent variable in regression and categorical analysis. The significant components of the nephroprotection: phosphatemia decrease (0.25 mmol/l), hemoglobin increase (1 g/dl), effective administration of RAAS blockers (to reduce proteinuria by 0.1 g/l), systolic blood pressure decrease (5 mmHg), calcemia deviations decrease from the target (0.1 mmol/l), acidosis correction (2 mmol/l), inflammation reduction and albumin increase (1.5 g/l) -were associated with the smaller GFR decrease rate by 15%. In intensive group, the dialysis risk was 2.2 times lower, the death risk was 4 times. The only planned dialysis start was ensured in intensive group, 67% chose peritoneal dialysis. Conclusions. The prediction of GFR decline rate calculated by nonlinear model in comparison with the actual one can evaluate the nephroprotection effectiveness; it differs significantly from the classical ones at the CKD late stages.
背景。经典的肾保护在CKD晚期降低了其有效性;寻找有效的算法受到GFR加速下降的阻碍,因此没有普遍接受的方法来评估有效性。目的:建立GFR下降率预测模型,以评价强化随访的有效性。方法。从城市数据库(N=7696)中抽取有代表性的定期随访组(N=540),建立预测GFR年下降的多项式模型。我们使用该模型通过预测和实际GFR下降率之间的差异来评估强化监测的有效性(N=100)。我们还选择了200例匹配良好的亚组患者,直接比较硬结局和替代结局。结果。在需要透析前的最后一年,强化组GFR下降率为5.981.69,而预测为9.060.59ml/min/1.73 m/年。我们在回归和分类分析中使用干预有效性评估作为因变量。肾保护的重要组成部分:磷血症降低(0.25 mmol/l),血红蛋白增加(1 g/dl), RAAS阻滞剂的有效使用(减少蛋白尿0.1 g/l),收缩压降低(5 mmHg),钙偏离目标(0.1 mmol/l),酸中毒纠正(2 mmol/l),炎症减少和白蛋白增加(1.5 g/l) -与GFR降低率降低15%相关。强化组透析风险降低2.2倍,死亡风险降低4倍。强化组只有计划透析开始,67%的患者选择腹膜透析。结论。将非线性模型计算的GFR下降率与实际预测结果进行比较,可以评价肾保护的效果;它与CKD晚期的经典方法有很大不同。
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引用次数: 0
Evolution of precancerous changes in the gastric mucosa. A case report 胃粘膜癌前病变的演变。病例报告
Pub Date : 2023-05-05 DOI: 10.17816/mechnikov115057
Alexander V. Tryapitsin, V. Malkov, Emil M. Gasanov, I. A. Belyakov
To present the experience of long-term observation of a patient with atrophic and dysplastic measurements of the gastric mucosa, to try to analyze the correctness of treatment, dynamic observation. The analysis included the period from 2008 to 2022. 19 esophagogastroduodenoscopies were performed. A histological study was conducted according to the Operative Link for Gastritis Assessment. Neoplastic changes were evaluated according to the World Health Organization classification of gastrointestinal tumors of 2019. The evolution of changes was observed under conditions of limited possibility of eradication of Helicobacter pylori due to intolerance to antibacterial drugs. During 14 years of follow-up, the endoscopic picture did not demonstrate significant changes. In each study, atrophy of the gastric mucosa was noted; in most cases no intestinal metaplasia and hyperplasia, erosion, ulcers, and neoplasms of the examined segments were detected. According to the histology, atrophy, intestinal metaplasia and hyperplastic changes in the gastric mucosa, Helicobacter pylori were constantly present from 2008 to 2013. Unsuccessful attempts of eradication were made. In 2013 low-grade intraepithelial neoplasia was detected, and in 2014 local high-grade intraepithelial neoplasia. Due to the small-scale nature of the changes, the observation tactics were continued. In 2015, against the background of persistent intraepithelial neoplasia of an indeterminate nature, an attempt was made to eradicate Helicobacter pylori. In 2016, a regression of neoplastic changes to low-grade intraepithelial neoplasia was recorded. From 2016 to 2022, there was a stabilization of inflammatory and atrophic changes. Intraepiteal neoplasia of the gastric mucosa and Helicobacter pylori did not recur. The observation is notable for the fact that for 7 years it was impossible to carry out Helicobacter pylori eradication therapy. There was no negative dynamics for 5 years. In the period from 2013 to 2015, high-grade intraepithelial neoplasia of gastric mucosa was formed. The situation changed with the introduction of antibacterial therapy, after which neoplastic changes regressed and a stable picture was observed over the next 6 years. Despite the observations of various specialists, the availability of objective and reliable information, and the decisions made on its basis allowed to prevent the development of stomach cancer.
通过对1例胃黏膜萎缩和发育不良患者的长期观察,分析治疗的正确性,动态观察。该分析涵盖了2008年至2022年这段时间。19例行食管胃十二指肠镜检查。根据胃炎评估的手术环节进行组织学研究。肿瘤变化根据世界卫生组织2019年胃肠道肿瘤分类进行评估。由于对抗菌药物不耐受,在根除幽门螺杆菌的可能性有限的情况下观察到变化的演变。在14年的随访中,内窥镜图像没有显示出明显的变化。在每项研究中,胃粘膜都出现萎缩;大多数病例未见肠上皮化生、肠内增生、糜烂、溃疡和肿瘤。从组织学上看,胃粘膜萎缩、肠化生和增生性改变,2008 - 2013年幽门螺杆菌持续存在。曾有过不成功的根除尝试。2013年检出低级别上皮内瘤变,2014年检出局部高级别上皮内瘤变。由于这些变化的规模较小,因此继续采用观察战术。2015年,在性质不确定的持续性上皮内瘤变的背景下,尝试根除幽门螺杆菌。2016年,记录了肿瘤变化向低级别上皮内瘤变的消退。从2016年到2022年,炎症和萎缩变化趋于稳定。胃粘膜上皮内瘤变及幽门螺杆菌未复发。值得注意的是,在7年的时间里,无法进行幽门螺杆菌根除治疗。在5年的时间里没有负面的动态变化。2013 - 2015年期间胃粘膜上皮内高级别瘤变形成。这种情况随着抗菌治疗的引入而改变,此后肿瘤变化消退,并在接下来的6年里观察到稳定的情况。尽管有各种专家的观察,但客观可靠的信息的可用性,以及在此基础上做出的决定,使预防胃癌的发展成为可能。
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引用次数: 0
Optimization of treatment of patients of older age groups with osteoporosis and fractures of the proximal femur 老年人群骨质疏松及股骨近端骨折的优化治疗
Pub Date : 2023-05-05 DOI: 10.17816/mechnikov209839
I. Kucheev, M. Kabanov, S. Linnik, K. Sementsov, Yurii B. Kashanskii, Anatolii V. Polikarpov, P. P. Romashov, I. P. Kondratev, Y. Tsololo, V. G. Radysh
BACKGROUND: Osteoporosis is mainly found in elderly people, often leading to fractures of the proximal part of the femur, and can worsen the patients quality of life. The article describes approaches to the choice of tactics and techniques of medical assistance to patients of older age groups (elderly, senile age, and centenarians according to World Health Organization criteria) with fractures of the proximal femur (S72.0, S72.1, S72.2. according to International Classification of Diseases 10th Revision) and with concomitant osteoporosis. AIM: To improve the treatment results of patients of older age groups with fractures of the proximal femur by modernizing and developing new methods for implant fixation. MATERIALS AND METHODS: 322 patients with fractures of the proximal femur with the presence of II and III degree of osteoporosis, who were treated at the Hospital for War Veterans in Saint Petersburg from 2017 to 2020 were included for the analysis. All the patients were divided into two groups depending on the methods of the treatment used. The first group consisted of 145 patients treated with the proposed method. The patients of the 2nd group (177 people) were treated using the traditional method. To assess the immediate results, the anatomical and functional result and possible complications (false joint, delayed consolidation of fragments, shortening of the damaged lower limb, dislocation of the endoprosthesis, migration of metal structures, osteomyelitis) were studied. The results were evaluated according to Lekens functional index, and the quality of life was assessed according to the World Health Organization scale. RESULTS: In 52.5% of the paients from the first group, good outcomes were obtained after 6 months according to the Lekens scale, while in group 2 such results were demonstrated only in 21.6% of the patients, and a year later, in 53.7% and 19.1%, respectively. In the first group, 13 patients (12.0%) had unsatisfactory outcomes after a year, 12 (13.5%) after 3 years, while in the second group 36 patients (31.3%) had unsatisfactory outcomes after a year, and 38 (35.8%) after 3 years. CONCLUSIONS: As a result, the use of the proposed method for providing care to patients with fractures of the proximal femur ensures significant improve (p 0.01) of the treatment outcomes for this category of patients.
背景:骨质疏松症主要发生于老年人,常导致股骨近端骨折,影响患者的生活质量。本文描述了老年群体(根据世界卫生组织的标准,老年人、老年和百岁老人)股骨近端骨折(S72.0、S72.1、S72.2)的医疗援助策略和技术选择的方法。(国际疾病分类第十版)并伴有骨质疏松症。目的:通过现代化和发展新的内固定方法,提高老年股骨近端骨折患者的治疗效果。材料与方法:纳入2017年至2020年在圣彼得堡战争退伍军人医院治疗的322例股骨近端骨折伴II和III级骨质疏松症患者进行分析。根据所采用的治疗方法,将所有患者分为两组。第一组由145名接受上述方法治疗的患者组成。第二组(177例)采用传统方法治疗。为了评估即刻效果,我们研究了解剖和功能结果以及可能的并发症(假关节、碎片延迟巩固、受损下肢缩短、假体脱位、金属结构移位、骨髓炎)。结果按Lekens功能指数进行评价,生活质量按世界卫生组织量表进行评价。结果:第一组52.5%的患者治疗6个月后Lekens评分良好,而第二组仅21.6%的患者治疗6个月后Lekens评分良好,一年后分别为53.7%和19.1%。第一组患者1年后疗效不满意13例(12.0%),3年后疗效不满意12例(13.5%),第二组患者1年后疗效不满意36例(31.3%),3年后疗效不满意38例(35.8%)。结论:因此,采用所提出的方法对股骨近端骨折患者进行护理,可显著改善该类患者的治疗效果(p < 0.01)。
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引用次数: 0
Treatment of patients with knee osteoarthritis with hyaluronate sodium (Revisk) in clinical practice 透明质酸钠治疗膝关节骨性关节炎的临床应用
Pub Date : 2023-05-05 DOI: 10.17816/mechnikov229980
Michail S. Shostak, I. Leineman, E. Trofimov, V. Mazurov
BACKGROUND: Osteoarthritis is a disease highly associated with a wide range of comorbidities, which leads to significant limitations of the therapeutic possibilities, in particular, the long-term use of non-steroidal anti-inflammatory drugs. Thus, develop algorithms for effective treatment of osteoarthritis aimed at reducing the need for anti-inflammatory therapy is of great importance. AIM: To evaluate the efficacy and safety of hyaluronic acid for the treatment of osteoarthritis in patients with comorbid pathology. MATERIALS AND METHODS: 30 patients aged 40 to 65 years with IIIII stages of knee osteoarthritis who received treatment with the hyaluronate sodium were examined according to the KellgrenLawrence scale. The course of treatment included standard intra-articular injections of Revisk (sterile sodium hyaluronate gel obtained by microbial fermentation) into the knee joints once a week, in a course of 3 injections. During the study non-steroidal anti-inflammatory drugs therapy was allowed at stable standard dosages. The effectiveness of treatment was assessed by changes in the WOMAC index, the Visual Analog scale pain scores for pain on movement, at rest, goniometry data, 30-meters walking test and stair climb test. RESULTS: A positive effect of treatment on all the parameters has been noted: significant improvement in clinical indicators of pain according to the visual analog scale, functional tests, and the WOMAC index scores. The positive dynamics of the estimated parameters during treatment started from the 7th day of therapy. CONCLUSIONS: The hyaluronate sodium (Revisk) can be used for treating patients with IIIII stages of knee osteoarthritis with moderate dysfunction of joints.
背景:骨关节炎是一种与多种合并症高度相关的疾病,这导致了治疗可能性的显著限制,特别是长期使用非甾体类抗炎药。因此,开发有效治疗骨关节炎的算法,旨在减少对抗炎治疗的需求是非常重要的。目的:评价透明质酸治疗伴有合并症的骨关节炎的疗效和安全性。材料与方法:采用KellgrenLawrence评分法对30例年龄40 ~ 65岁的iii期膝关节骨关节炎患者进行透明质酸钠治疗。治疗过程包括标准关节内注射revk(微生物发酵获得的无菌透明质酸钠凝胶),每周一次,共注射3次。在研究期间,非甾体抗炎药治疗被允许在稳定的标准剂量。通过WOMAC指数的变化、运动疼痛的视觉模拟量表疼痛评分、休息时疼痛、角形测量数据、30米步行测试和爬楼梯测试来评估治疗的有效性。结果:治疗对所有参数均有积极影响:根据视觉模拟量表、功能测试和WOMAC指数评分,疼痛临床指标均有显着改善。治疗期间估计参数的正动态从治疗的第7天开始。结论:透明质酸钠(revk)可用于治疗iii - iii期膝关节骨性关节炎伴中度关节功能障碍患者。
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引用次数: 0
Complex treatment options of hip osteoarthritis 髋关节骨关节炎的复杂治疗方案
Pub Date : 2023-05-05 DOI: 10.17816/mechnikov108664
I. Urazovskaya, Sergey A. Saiganov, V. Mazurov, V.M. Khaidarov, D. Mansurov, A.G. Balgley, A. N. Tkachenko
Osteoarthritis has the highest prevalence among the musculoskeletal diseases in all economically developed countries. Despite the improvement of diagnostic and treatment methods, the number of patients with osteoarthritis is increasing. The number of cases of newly diagnosed osteoarthritis, cases of disease progression and subsequent disability are also growing. There are many guidelines for treatment of osteoarthritis, however, specialists have no consensus, especially regarding the amount and duration of conservative therapy. The aim of the study was to analyze publications providing complex treatment options of hip osteoarthritis. A systematic literature review has been conducted by means of the open acccess Pub-Med/MEDLINE database and eLibrary search for the period until January 2022. The search depth was 20 years and was performed by keywords and phrases: hip joint osteoarthritis, conservative treatment, minimally invasive surgery, total hip arthroplasty. Unfortunately, the screening criteria for patients with osteoarthritis for total hip arthroplasty are not developed. The review analyzes the options of conservative therapy and minimally invasive surgical treatment for patients with osteoarthritis as the opportunity to avoid or delay the total hip replacement. The hip arthroplasty is not considered the gold standard; joint decision on surgery based on a comprehensive approach is made only when all the possibilities of conservative therapy are exhausted. It is widely believed that complex treatment using modern conservative and organ-preserving methods is the most common strategy for managing osteoarthritis of the hip joint. This approach improves clinical and functional condition of patients and slows down the progression of the disease.
骨关节炎在所有经济发达国家的肌肉骨骼疾病中发病率最高。尽管诊断和治疗方法有所改进,但骨关节炎患者的数量仍在增加。新诊断的骨关节炎病例、疾病进展和随后的残疾病例的数量也在增加。骨关节炎的治疗有许多指导方针,但是,专家们没有达成共识,特别是关于保守治疗的量和持续时间。该研究的目的是分析提供髋关节骨关节炎复杂治疗方案的出版物。通过开放获取的Pub-Med/MEDLINE数据库和图书馆检索,对截止到2022年1月的文献进行了系统的综述。搜索深度为20年,搜索关键词和短语为:髋关节骨关节炎、保守治疗、微创手术、全髋关节置换术。不幸的是,骨关节炎患者进行全髋关节置换术的筛选标准尚未制定。本综述分析了骨关节炎患者选择保守治疗和微创手术治疗作为避免或延迟全髋关节置换术的机会。髋关节置换术不被认为是金标准;只有在用尽所有保守治疗的可能性后,才能联合决定是否采用综合方法进行手术。人们普遍认为,使用现代保守和器官保存方法的复杂治疗是治疗髋关节骨关节炎最常见的策略。这种方法改善了患者的临床和功能状况,减缓了疾病的进展。
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引用次数: 0
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