Pub Date : 2024-05-09DOI: 10.33667/2078-5631-2024-7-13-17
D. Enaldieva, P. Krivorotko, E. Imyanitov, R. Donskih, A. Sokolenko, V. O. Azaova, N. N. Amirov, Yana Bondarchuk, V. E. Levcheko, D. G. Ulrikh, V. Semiglazov
Rationale. BRCA1 associated triple-negative breast cancer (TNBC) is one of the most aggressive subtypes of breast cancer. At the same time, carcinomas that develop in carriers of BRCA1 mutations are characterized by extremely high sensitivity to DNA-damaging chemotherapy. Mitomycin C alone or in combination with platinum agents has already demonstrated promising results in the treatment of BRCA-associated ovarian cancer (OC) and metastatic breast cancer. In this article, we present the results of a retrospective study aimed at comparing standard neoadjuvant chemotherapy regimens (NACT) with mitomycin-based regimens for primary locally advanced BRCA1-associated TNBC.The aim of the study is to determine the effectiveness of the combination of mitomycin and platinum compounds during neoadjuvant therapy in patients with primary locally advanced BRCA1 – associated TNBC.Materials and methods. The study included 89 patients diagnosed with primary locally advanced BRCA1-associated TNBC. Patients were divided into three groups depending on the therapy: 1) 4 cycles of anthracycline and cyclophosphamide followed by 12 weekly injections of paclitaxel (n = 48) (AC + T), 2) 4 cycles of anthracycline and cyclophosphamide followed by 12 weekly injections of paclitaxel and carboplatin (n = 27) (AC + TCbP), 3) mitomycin C plus platinum followed by 12 weekly injections of paclitaxel (n = 14) (MR + T). Pathological complete response (pCR) rates were compared.Results. The pCR rate in the MP+T group was 10/14 (71%). In patients with BRCA1-associated breast cancer who received AC + T and AC + TCbP regimens as NACT, the pCR rate was 17/48 (35%) and 19/27 (70%), respectively. The difference in pCR rate between mitomycin-containing therapy and the standard AC + T regimen was statistically significant (p = 0.03); the frequency of regressions was comparable to the frequency in the AC + TCbP group. During the 20-month follow-up period, no relapses were observed in the MR + T group. Relapses were more frequent in the AC + T group compared with the AC + TCbP group (16/48 (33%) vs 1/27 (4%), p = 0.003, Fisher’s exact test). The toxicity profile of the mitomycin-containing regimen included hematologic adverse events, the most common of which were anemia and leukopenia. Compared to standard regimens, nausea was significantly less pronounced. No patients reported alopecia with this regimen.Conclusions. The addition of mitomycin C to neoadjuvant therapy for BRCA1-associated TNBC may be a promising treatment option for this category of patients and merits further study.
理由与 BRCA1 相关的三阴性乳腺癌（TNBC）是乳腺癌中最具侵袭性的亚型之一。同时，BRCA1 基因突变携带者所患癌症的特点是对破坏 DNA 的化疗极度敏感。在治疗与 BRCA 相关的卵巢癌（OC）和转移性乳腺癌方面，单独使用或与铂类药物联合使用丝裂霉素 C 已经取得了良好的效果。在本文中，我们介绍了一项回顾性研究的结果，该研究旨在比较标准新辅助化疗方案（NACT）与丝裂霉素方案治疗原发性局部晚期BRCA1相关TNBC的效果。研究包括89名确诊为原发性局部晚期BRCA1相关TNBC患者。根据治疗方法将患者分为三组：1）4 个周期的蒽环类和环磷酰胺治疗，然后每周注射 12 次紫杉醇（48 人）（AC + T）；2）4 个周期的蒽环类和环磷酰胺治疗，然后每周注射 12 次紫杉醇和卡铂（27 人）（AC + TCbP）；3）丝裂霉素 C 加铂治疗，然后每周注射 12 次紫杉醇（14 人）（MR + T）。对病理完全应答率（pCR）进行了比较。MP+T组的pCR率为10/14（71%）。在接受 AC + T 和 AC + TCbP 方案作为 NACT 的 BRCA1 相关性乳腺癌患者中，pCR 率分别为 17/48 (35%) 和 19/27 (70%)。含丝裂霉素疗法与标准 AC + T 方案的 pCR 率差异有统计学意义（p = 0.03）；退变频率与 AC + TCbP 组相当。在 20 个月的随访期间，MR + T 组未发现复发。与 AC + TCbP 组相比，AC + T 组的复发率更高（16/48（33%） vs 1/27 (4%)，P = 0.003，费雪精确检验）。含丝裂霉素方案的毒性包括血液学不良反应，其中最常见的是贫血和白细胞减少。与标准疗法相比，恶心症状明显减轻。没有患者报告使用该方案后出现脱发。在BRCA1相关TNBC的新辅助治疗中加入丝裂霉素C可能是这类患者的一种有前途的治疗选择，值得进一步研究。
{"title":"Mitomycin C in the treatment of early triple-negative locally advanced BRCA-associated breast cancer","authors":"D. Enaldieva, P. Krivorotko, E. Imyanitov, R. Donskih, A. Sokolenko, V. O. Azaova, N. N. Amirov, Yana Bondarchuk, V. E. Levcheko, D. G. Ulrikh, V. Semiglazov","doi":"10.33667/2078-5631-2024-7-13-17","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-7-13-17","url":null,"abstract":"Rationale. BRCA1 associated triple-negative breast cancer (TNBC) is one of the most aggressive subtypes of breast cancer. At the same time, carcinomas that develop in carriers of BRCA1 mutations are characterized by extremely high sensitivity to DNA-damaging chemotherapy. Mitomycin C alone or in combination with platinum agents has already demonstrated promising results in the treatment of BRCA-associated ovarian cancer (OC) and metastatic breast cancer. In this article, we present the results of a retrospective study aimed at comparing standard neoadjuvant chemotherapy regimens (NACT) with mitomycin-based regimens for primary locally advanced BRCA1-associated TNBC.The aim of the study is to determine the effectiveness of the combination of mitomycin and platinum compounds during neoadjuvant therapy in patients with primary locally advanced BRCA1 – associated TNBC.Materials and methods. The study included 89 patients diagnosed with primary locally advanced BRCA1-associated TNBC. Patients were divided into three groups depending on the therapy: 1) 4 cycles of anthracycline and cyclophosphamide followed by 12 weekly injections of paclitaxel (n = 48) (AC + T), 2) 4 cycles of anthracycline and cyclophosphamide followed by 12 weekly injections of paclitaxel and carboplatin (n = 27) (AC + TCbP), 3) mitomycin C plus platinum followed by 12 weekly injections of paclitaxel (n = 14) (MR + T). Pathological complete response (pCR) rates were compared.Results. The pCR rate in the MP+T group was 10/14 (71%). In patients with BRCA1-associated breast cancer who received AC + T and AC + TCbP regimens as NACT, the pCR rate was 17/48 (35%) and 19/27 (70%), respectively. The difference in pCR rate between mitomycin-containing therapy and the standard AC + T regimen was statistically significant (p = 0.03); the frequency of regressions was comparable to the frequency in the AC + TCbP group. During the 20-month follow-up period, no relapses were observed in the MR + T group. Relapses were more frequent in the AC + T group compared with the AC + TCbP group (16/48 (33%) vs 1/27 (4%), p = 0.003, Fisher’s exact test). The toxicity profile of the mitomycin-containing regimen included hematologic adverse events, the most common of which were anemia and leukopenia. Compared to standard regimens, nausea was significantly less pronounced. No patients reported alopecia with this regimen.Conclusions. The addition of mitomycin C to neoadjuvant therapy for BRCA1-associated TNBC may be a promising treatment option for this category of patients and merits further study.","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140997444","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 : 2024-05-09DOI: 10.33667/2078-5631-2024-6-51-57
A. V. Borsukov, D. Shestakova, A. I. Skutar'
Objective. Study and comparison of the diagnostic performance of various ultrasound elastometry methods in detecting liver fibrosis in patients with heart failure.Materials and methods. The study was conducted from June 2022 to January 2024. 57 patients with heart failure and metabolic syndrome were examined, divided into three groups depending on the stage of the disease: stage I (n = 21), stage II (n = 24), stage III (n = 11), each of which was divided into subgroups depending on the severity of liver fibrosis (F0–F4). Standard parameters of sensitivity, specificity, and accuracy were used to compare the performance of transient elastometry, vibration-controlled transient elastometry, point elastometry, and two-dimensional shear wave elastometry. A complex of multislice computed tomography with color assessment of the liver structure, a biochemical blood test with the de Ritis coefficient and the FIB‑4 scale were used as a reference method.Results. In stage I heart failure, all four methods showed similar sensitivity, specificity and accuracy. At stage II, using transient elastometry, sensitivity was 59.4%, specificity — 68.2%, accuracy — 62.4%; visual transient elastometry — 72.8%, 87.2%, 79.4%, respectively; point elastometry — 68.6%, 83.7%, 77.4%, respectively; two-dimensional shear wave elastometry — 89.6%, 94.3%, 91.6%. At stage III, transient elastometry turned out to be uninformative; visual transient elastometry showed a sensitivity of 61.2%, specificity of 70.4%, accuracy of 64.6%; point elastometry — 48.6%, 60.1%, 52.3%, respectively; while two-dimensional shear wave elastometry showed a sensitivity of 85.6%, specificity of 92.5%, accuracy of 88.8%.Conclusions. For patients with stage I heart failure, the choice of a specific elastometry method is not of fundamental importance, since the indicators do not differ. However, in stages II and III, shear wave elastometry is the preferred method, especially in stage III, where it demonstrates higher diagnostic performance compared to point elastometry. Visual transient elastometry can be used additionally with the method of two-dimensional shear wave elastometry or in the case where two-dimensional shear wave elastometry is not possible.
目的研究和比较各种超声弹性测量方法在检测心力衰竭患者肝纤维化方面的诊断性能。研究于 2022 年 6 月至 2024 年 1 月进行。57名心力衰竭合并代谢综合征患者接受了检查，根据疾病的分期分为三组：I期（21人）、II期（24人）、III期（11人），每组又根据肝纤维化的严重程度分为若干亚组（F0-F4）。采用敏感性、特异性和准确性等标准参数来比较瞬态弹性测量法、振动控制瞬态弹性测量法、点弹性测量法和二维剪切波弹性测量法的性能。多层计算机断层扫描与肝脏结构彩色评估、生化血液检测与德里蒂斯系数和 FIB-4 量表的复合方法被用作参考方法。在心力衰竭 I 期，这四种方法的灵敏度、特异性和准确性相似。在 II 期，使用瞬时弹性测量法，敏感性为 59.4%，特异性为 68.2%，准确性为 62.4%；视觉瞬时弹性测量法分别为 72.8%、87.2% 和 79.4%；点弹性测量法分别为 68.6%、83.7% 和 77.4%；二维剪切波弹性测量法分别为 89.6%、94.3% 和 91.6%。在Ⅲ期，瞬时弹性测量的信息量不大；视觉瞬时弹性测量的敏感性为61.2%，特异性为70.4%，准确性为64.6%；点弹性测量的敏感性为48.6%，特异性为60.1%，准确性为52.3%；而二维剪切波弹性测量的敏感性为85.6%，特异性为92.5%，准确性为88.8%。对于 I 期心衰患者，选择特定的弹性测量方法并不重要，因为各项指标并无差异。然而，在第二和第三阶段，剪切波弹性测量法是首选方法，尤其是在第三阶段，与点式弹性测量法相比，剪切波弹性测量法具有更高的诊断性能。视觉瞬态弹性测量法可与二维剪切波弹性测量法结合使用，或在无法使用二维剪切波弹性测量法的情况下使用。
{"title":"The range of diagnostic possibilities of ultrasound liver elastometry in patients with chronic heart failure and diffuse changes in the live","authors":"A. V. Borsukov, D. Shestakova, A. I. Skutar'","doi":"10.33667/2078-5631-2024-6-51-57","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-6-51-57","url":null,"abstract":"Objective. Study and comparison of the diagnostic performance of various ultrasound elastometry methods in detecting liver fibrosis in patients with heart failure.Materials and methods. The study was conducted from June 2022 to January 2024. 57 patients with heart failure and metabolic syndrome were examined, divided into three groups depending on the stage of the disease: stage I (n = 21), stage II (n = 24), stage III (n = 11), each of which was divided into subgroups depending on the severity of liver fibrosis (F0–F4). Standard parameters of sensitivity, specificity, and accuracy were used to compare the performance of transient elastometry, vibration-controlled transient elastometry, point elastometry, and two-dimensional shear wave elastometry. A complex of multislice computed tomography with color assessment of the liver structure, a biochemical blood test with the de Ritis coefficient and the FIB‑4 scale were used as a reference method.Results. In stage I heart failure, all four methods showed similar sensitivity, specificity and accuracy. At stage II, using transient elastometry, sensitivity was 59.4%, specificity — 68.2%, accuracy — 62.4%; visual transient elastometry — 72.8%, 87.2%, 79.4%, respectively; point elastometry — 68.6%, 83.7%, 77.4%, respectively; two-dimensional shear wave elastometry — 89.6%, 94.3%, 91.6%. At stage III, transient elastometry turned out to be uninformative; visual transient elastometry showed a sensitivity of 61.2%, specificity of 70.4%, accuracy of 64.6%; point elastometry — 48.6%, 60.1%, 52.3%, respectively; while two-dimensional shear wave elastometry showed a sensitivity of 85.6%, specificity of 92.5%, accuracy of 88.8%.Conclusions. For patients with stage I heart failure, the choice of a specific elastometry method is not of fundamental importance, since the indicators do not differ. However, in stages II and III, shear wave elastometry is the preferred method, especially in stage III, where it demonstrates higher diagnostic performance compared to point elastometry. Visual transient elastometry can be used additionally with the method of two-dimensional shear wave elastometry or in the case where two-dimensional shear wave elastometry is not possible. ","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140996996","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 : 2024-05-08DOI: 10.33667/2078-5631-2024-6-16-20
Y. Fedulaev, I. V. Makarova, T. V. Pinchuk, G. A. Khairetdinova
Electrocardiography (ECG) is considered as an essential step in acute coronary syndrome (ACS) diagnostic algorithm. Сurrent classification is based on the ECG changes of ST-segment and includes ACS with persistent ST elevation and without persistent ST elevation. ACS with persistent ST elevation is characterized by prolonged (more than 20 min) ST-segment elevation exceeding 0.1 mV in two or more contiguous ECG leads (except V2–3 as well as aVR). When the symptoms of acute myocardial ischemia are present, ECG should be recorded within 10 minutes from the first contact with a medical professional. Some changes on the initial ECG of a patient with ACS may be nonspecific or absent, so the key role in diagnosis is given to the clinical presentation and the ECG in dynamics.
心电图（ECG）被认为是急性冠状动脉综合征（ACS）诊断算法的重要步骤。目前的分类基于心电图的 ST 段变化，包括有持续 ST 段抬高和无持续 ST 段抬高的 ACS。有持续 ST 段抬高的 ACS 的特征是两个或两个以上连续心电图导联（V2-3 以及 aVR 除外）的 ST 段抬高超过 0.1 mV，且持续时间较长（超过 20 分钟）。当出现急性心肌缺血症状时，应在首次接触医务人员后 10 分钟内记录心电图。急性心肌梗死患者初期心电图上的某些变化可能是非特异性的或不存在，因此诊断的关键在于临床表现和动态心电图。
{"title":"Electrocardiography in myocardial infarction diagnosis: a view through the prism of guidelines (Lecture)","authors":"Y. Fedulaev, I. V. Makarova, T. V. Pinchuk, G. A. Khairetdinova","doi":"10.33667/2078-5631-2024-6-16-20","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-6-16-20","url":null,"abstract":"Electrocardiography (ECG) is considered as an essential step in acute coronary syndrome (ACS) diagnostic algorithm. Сurrent classification is based on the ECG changes of ST-segment and includes ACS with persistent ST elevation and without persistent ST elevation. ACS with persistent ST elevation is characterized by prolonged (more than 20 min) ST-segment elevation exceeding 0.1 mV in two or more contiguous ECG leads (except V2–3 as well as aVR). When the symptoms of acute myocardial ischemia are present, ECG should be recorded within 10 minutes from the first contact with a medical professional. Some changes on the initial ECG of a patient with ACS may be nonspecific or absent, so the key role in diagnosis is given to the clinical presentation and the ECG in dynamics. ","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":" 32","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141001202","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 : 2024-05-08DOI: 10.33667/2078-5631-2024-6-28-38
V. F. Romanovsky, A. N. Rogoza, A. M. Romanovskaya, R. V. Kuzmenkov
Systolic and diastolic BP values are determined guided by measurement signals (Korotkoff tones, oscillations). The source of these signals are hydrodynamic processes occurring in the artery under the influence of cuff pressure on the upper arm. The article is devoted to the study of these processes. The value of body tissues pressure on the artery walls is equal to the value of air pressure in the cuff only at the middle of the cuff and smoothly decreases to zero to its edges. Such non-uniformity of distribution of body tissues pressure on the artery walls is caused by the physical property of elasticity of their shape, which was not taken into account earlier. Therefore, the equality of the value of blood pressure on the artery walls from its inner side and the value of body tissues pressure on the artery walls from its outer side is possible only at one point. At this point, the open part of the artery passes into its constricted part, and the point itself is called the boundary of arterial constriction. The pulsations of blood pressure in the artery caused by the heart cause rhythmic movements of this boundary along the artery. Therefore, the arterial walls open up when the constriction boundary is moved in the distal direction. When the convergence boundary is moved in the proximal direction, the walls of the artery connect. During systole, when the blood pressure exceeds the air pressure in the cuff, the boundary of compression moves distally across the middle of the cuff. At the same time, a blood flow front is formed beyond the middle of the cuff, moving towards the distal edge of the cuff. When this edge is reached, the artery opens across the entire width of the cuff. In the diastole periods following systole, the blood pressure decreases. As a result, the blood pressure drops below the air pressure in the cuff, and the arterial wall at the midpoint of the cuff interconnect again. In this case, there is a re-boundary of constriction moving in the proximal direction. Thus, the hydrodynamics of blood in the artery is completely determined by the movements of the boundary of its compression. This hydrodynamics is substantiated theoretically and confirmed experimentally. It is shown that oscillations of air pressure in the cuff, Korotkoff tones and surface pulse waves are different consequences of a single biomechanical process, which allows us to consider in detail the formation of oscillations, surface pulse waves, as well as to put forward a physically justified version of the Korotkoff tones.
{"title":"Possibilities to increase reliability and accuracy of blood pressure measurement taking into account blood hydrodynamics and biomechanics of processes during compression of shoulder tissues with a pneumatic cuff","authors":"V. F. Romanovsky, A. N. Rogoza, A. M. Romanovskaya, R. V. Kuzmenkov","doi":"10.33667/2078-5631-2024-6-28-38","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-6-28-38","url":null,"abstract":"Systolic and diastolic BP values are determined guided by measurement signals (Korotkoff tones, oscillations). The source of these signals are hydrodynamic processes occurring in the artery under the influence of cuff pressure on the upper arm. The article is devoted to the study of these processes. The value of body tissues pressure on the artery walls is equal to the value of air pressure in the cuff only at the middle of the cuff and smoothly decreases to zero to its edges. Such non-uniformity of distribution of body tissues pressure on the artery walls is caused by the physical property of elasticity of their shape, which was not taken into account earlier. Therefore, the equality of the value of blood pressure on the artery walls from its inner side and the value of body tissues pressure on the artery walls from its outer side is possible only at one point. At this point, the open part of the artery passes into its constricted part, and the point itself is called the boundary of arterial constriction. The pulsations of blood pressure in the artery caused by the heart cause rhythmic movements of this boundary along the artery. Therefore, the arterial walls open up when the constriction boundary is moved in the distal direction. When the convergence boundary is moved in the proximal direction, the walls of the artery connect. During systole, when the blood pressure exceeds the air pressure in the cuff, the boundary of compression moves distally across the middle of the cuff. At the same time, a blood flow front is formed beyond the middle of the cuff, moving towards the distal edge of the cuff. When this edge is reached, the artery opens across the entire width of the cuff. In the diastole periods following systole, the blood pressure decreases. As a result, the blood pressure drops below the air pressure in the cuff, and the arterial wall at the midpoint of the cuff interconnect again. In this case, there is a re-boundary of constriction moving in the proximal direction. Thus, the hydrodynamics of blood in the artery is completely determined by the movements of the boundary of its compression. This hydrodynamics is substantiated theoretically and confirmed experimentally. It is shown that oscillations of air pressure in the cuff, Korotkoff tones and surface pulse waves are different consequences of a single biomechanical process, which allows us to consider in detail the formation of oscillations, surface pulse waves, as well as to put forward a physically justified version of the Korotkoff tones. ","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140998748","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 : 2024-05-08DOI: 10.33667/2078-5631-2024-6-7-15
M. Kameneva, L. D. Kiryukhina, P. V. Struchkov
The second part of the article discusses the spirometry interpretation using the latest international and national recommendations. Different systems of predicted values were considered, attention was paid to the GLI‑2012 reference equations advantages and the z-score assessment. The severity classification, obstructive disorders, extrathoracic and intrathoracic airway obstruction and possible spirometry indications of restrictive and mixed ventilation disorders were considered. The algorithm for spirometry evaluation was also presented, and the most common errors in the spirometry interpretation were discussed.
文章的第二部分讨论了使用最新的国际和国内建议对肺活量测定的解释。文章考虑了不同的预测值系统，关注了 GLI-2012 参考方程的优势和 z 值评估。文章还考虑了严重程度分类、阻塞性疾病、胸腔外和胸腔内气道阻塞以及限制性和混合性通气障碍的可能肺活量指标。此外，还介绍了肺活量评估的算法，并讨论了肺活量解释中最常见的错误。
{"title":"Updated national guidelines for spirometry. Part 2. An Approach to Interpreting Spirometry","authors":"M. Kameneva, L. D. Kiryukhina, P. V. Struchkov","doi":"10.33667/2078-5631-2024-6-7-15","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-6-7-15","url":null,"abstract":"The second part of the article discusses the spirometry interpretation using the latest international and national recommendations. Different systems of predicted values were considered, attention was paid to the GLI‑2012 reference equations advantages and the z-score assessment. The severity classification, obstructive disorders, extrathoracic and intrathoracic airway obstruction and possible spirometry indications of restrictive and mixed ventilation disorders were considered. The algorithm for spirometry evaluation was also presented, and the most common errors in the spirometry interpretation were discussed. ","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":" 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140998280","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 : 2024-05-08DOI: 10.33667/2078-5631-2024-6-21-26
V. A. Amanatova, T. Uskach, A. K. Vashtanian, D. V. Drozdov
Cardiac contractility modulation (CCM) is a method of non-drug treatment of chronic heart failure (CHF) in patients with no indications for resynchronization therapy. Now, a detailed study of this method and its capabilities is ongoing, and the indications for its use are expanding. As with any other implantable device, it is important to be able to monitor the operation of the CCM, identify its dysfunction and promptly refer patients to specialized institutions. Assessment of the function of CCM- therapy can be carrying out by recording a standard 12‑channel electrocardiogram (ECG), as well as 24‑hour Holter ECG monitoring (HM-ECG). The mechanism of action of CCM-therapy is fundamentally different from that of other implantable devices. Knowledge of the features of the manifestation of CCM-therapy during instrumental studies is necessary for their correct interpretation.
{"title":"Interpretation of electrocardiograms and results of daily ECG Holter monitoring in patients with an implanted cardiac contractility modulator","authors":"V. A. Amanatova, T. Uskach, A. K. Vashtanian, D. V. Drozdov","doi":"10.33667/2078-5631-2024-6-21-26","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-6-21-26","url":null,"abstract":"Cardiac contractility modulation (CCM) is a method of non-drug treatment of chronic heart failure (CHF) in patients with no indications for resynchronization therapy. Now, a detailed study of this method and its capabilities is ongoing, and the indications for its use are expanding. As with any other implantable device, it is important to be able to monitor the operation of the CCM, identify its dysfunction and promptly refer patients to specialized institutions. Assessment of the function of CCM- therapy can be carrying out by recording a standard 12‑channel electrocardiogram (ECG), as well as 24‑hour Holter ECG monitoring (HM-ECG). The mechanism of action of CCM-therapy is fundamentally different from that of other implantable devices. Knowledge of the features of the manifestation of CCM-therapy during instrumental studies is necessary for their correct interpretation. ","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":" 40","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140999201","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 : 2024-05-07DOI: 10.33667/2078-5631-2024-5-32-35
N. Geyvandova, G. K. Bolbat, A. Yagoda
Background. Alcoholic liver disease (ALD) – is a disease that leads to the development of liver cirrhosis (LC) with a high mortality rate. N-terminal type lll procollagen peptide (PIIINP) is one of the optimal biomarkers for assessing fibrogenesis.Objective: to determine the clinical significance of PIIINP blood level in patients with ALD.Materials and methods. 97 patients with ALD were examined. The age of the patients was 48,5±9,9 years, there were 30 women, 67 men. Steatosis was diagnosed in 12 patients, 11 – alcoholic hepatitis (AH), 74 – LC. In group with LC, 16 patients was diagnosed AH against confirmed cirrhosis. PIIINP blood level determined by ELISA. Control group consisted of 22 healthy volunteers who have not consumed alcohol in hepatotoxic doses.Results. In all patients, PIIINP blood level was increased. In steatosis PIIINP slightly increased the norm, indicating the beginning of fibrogenesis. In LC, PIIINP blood level was higher than in patients with steatosis, which reflected increasing of fibrosis and progression of the disease. The highest levels of PIIINP were observed in cases with AH. Levels PIIINP in patients with AH but without LC and in patients with AH against the background of the formed LC did not differ. In Maddray index of more than 32 (9 patients), the PIIINP level was higher than in 18 patients with index values <32, which confirmed the role of AH in development of fibrosis and decompensation of liver function.Conclusion. Determination of PIIINP blood level in patients with ALD will allow predict the activity of fibrogenesis and the severity of subsequent changes in liver tissue. In cases of severe AH, PIIINP may be an additional criterion determining the severity and prognosis of hepatitis outcomes.
{"title":"Clinical significance of procollagen type III N-terminal peptide in patients with alcoholic liver disease","authors":"N. Geyvandova, G. K. Bolbat, A. Yagoda","doi":"10.33667/2078-5631-2024-5-32-35","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-5-32-35","url":null,"abstract":"Background. Alcoholic liver disease (ALD) – is a disease that leads to the development of liver cirrhosis (LC) with a high mortality rate. N-terminal type lll procollagen peptide (PIIINP) is one of the optimal biomarkers for assessing fibrogenesis.Objective: to determine the clinical significance of PIIINP blood level in patients with ALD.Materials and methods. 97 patients with ALD were examined. The age of the patients was 48,5±9,9 years, there were 30 women, 67 men. Steatosis was diagnosed in 12 patients, 11 – alcoholic hepatitis (AH), 74 – LC. In group with LC, 16 patients was diagnosed AH against confirmed cirrhosis. PIIINP blood level determined by ELISA. Control group consisted of 22 healthy volunteers who have not consumed alcohol in hepatotoxic doses.Results. In all patients, PIIINP blood level was increased. In steatosis PIIINP slightly increased the norm, indicating the beginning of fibrogenesis. In LC, PIIINP blood level was higher than in patients with steatosis, which reflected increasing of fibrosis and progression of the disease. The highest levels of PIIINP were observed in cases with AH. Levels PIIINP in patients with AH but without LC and in patients with AH against the background of the formed LC did not differ. In Maddray index of more than 32 (9 patients), the PIIINP level was higher than in 18 patients with index values <32, which confirmed the role of AH in development of fibrosis and decompensation of liver function.Conclusion. Determination of PIIINP blood level in patients with ALD will allow predict the activity of fibrogenesis and the severity of subsequent changes in liver tissue. In cases of severe AH, PIIINP may be an additional criterion determining the severity and prognosis of hepatitis outcomes.","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"6 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005270","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 : 2024-05-07DOI: 10.33667/2078-5631-2024-5-48-51
Yu. Yu. Shkuratova, T. G. Morozova
Acute kidney failure is a polyetiological disease that is often occurs in patients, which requires a rapid therapeutic response to avoid progression of the condition. Magnetic resonance imaging of the kidneys (MRI) improves the understanding and assessment of pathological processes, supplementing the mandatory diagnostic minimum information in the study of kidney pathology.Objective. To evaluate the clinical diagnostic capabilities of kidney imaging biomarkers using diffusion-weighted imaging (DWI) and ASL-perfusion data for intensive care unit patients.Materials and methods. At the first Clinical Hospital in Smolensk 54 patients were examined who were inpatient treatment and in the intensive care unit. All patients underwent ultrasound examination of the kidneys with assessment of blood flow in the main kidney vessels, MRI of the kidneys, with DWI of the kidney parenchyma and ASL-perfusion included in the study protocol. MRI was carried with assessed b-factor 800 and was drawn apparent diffusion coefficient (ADC) maps. When carried ASL perfusion, the field of view covered the area of the parenchyma of both kidneys. The reference method was glomerular filtration rate for all of the patients. The control group was represented by healthy people (n=59). Consent to participate in the study was obtained from patients or their legal representatives. All stages of the study comply with the normative and regulatory documentation of Ministry of Health ща the Russian Federation.Results. It was concluded that there is a significant difference in ADC for prerenal causes and in ASL for renal causes. In 9 (16.7 %) patients, kidney ADC was 1.5±0.3 mm2/sec, ASL – perfusion – ≤ 250 ml/100g/min, compared with the control group. In this group, negative dynamics were observed within a week, тnegative laboratory dynamics correlates with radiation-based kidney biomarkers (r=0,965).Conclusion. The criteria of DWI and ASL-perfusion allow us to suspect or confirm the cause of acute kidney failure. A high correlation has been established between radiation biomarkers and laboratory criteria of functional damages (r=0.998), direct correlation between imaging biomarkers and organic kidney disease (r=0,901). These biomarkers make it possible to predict the first stage of acute kidney failure (AUROC 0,995, DI 0,867–0,999).
急性肾衰竭是一种多病因疾病，经常发生在患者身上，需要迅速采取治疗措施以避免病情恶化。肾脏磁共振成像（MRI）可提高对病理过程的理解和评估，补充肾脏病理学研究中必须的最低诊断信息。利用重症监护室患者的弥散加权成像（DWI）和ASL-灌注数据评估肾脏成像生物标志物的临床诊断能力。斯摩棱斯克第一临床医院对 54 名住院治疗和重症监护室患者进行了检查。所有患者都接受了肾脏超声波检查，并评估了肾脏主要血管的血流量；肾脏核磁共振成像，包括肾脏实质的 DWI 和 ASL 灌注。核磁共振成像的b因子为800，并绘制了表观弥散系数（ADC）图。进行ASL灌注时，视野覆盖双肾实质区域。所有患者的参考方法均为肾小球滤过率。对照组为健康人（59 人）。研究征得了患者或其法定代理人的同意。研究的所有阶段均符合俄罗斯联邦卫生部的规范和监管文件。研究结果表明，肾前性心脏病患者的 ADC 和肾性心脏病患者的 ASL 存在显著差异。与对照组相比，9 名（16.7%）患者的肾脏 ADC 为 1.5±0.3 mm2/sec，ASL-灌注-≤ 250 ml/100g/min。在该组中，一周内观察到阴性动态，实验室阴性动态与基于辐射的肾脏生物标志物相关（r=0,965）。通过 DWI 和 ASL 灌注标准，我们可以怀疑或确认急性肾衰竭的原因。辐射生物标志物与实验室功能损伤标准（r=0.998）、成像生物标志物与器质性肾病（r=0.901）之间建立了高度相关性。这些生物标志物可以预测急性肾衰竭的第一阶段（AUROC 0,995，DI 0,867-0,999）。
{"title":"Analysis of the clinical diagnostic capabilities of kidney imaging biomarkers based on diffusion-weighted imaging and ASL-perfusion data","authors":"Yu. Yu. Shkuratova, T. G. Morozova","doi":"10.33667/2078-5631-2024-5-48-51","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-5-48-51","url":null,"abstract":"Acute kidney failure is a polyetiological disease that is often occurs in patients, which requires a rapid therapeutic response to avoid progression of the condition. Magnetic resonance imaging of the kidneys (MRI) improves the understanding and assessment of pathological processes, supplementing the mandatory diagnostic minimum information in the study of kidney pathology.Objective. To evaluate the clinical diagnostic capabilities of kidney imaging biomarkers using diffusion-weighted imaging (DWI) and ASL-perfusion data for intensive care unit patients.Materials and methods. At the first Clinical Hospital in Smolensk 54 patients were examined who were inpatient treatment and in the intensive care unit. All patients underwent ultrasound examination of the kidneys with assessment of blood flow in the main kidney vessels, MRI of the kidneys, with DWI of the kidney parenchyma and ASL-perfusion included in the study protocol. MRI was carried with assessed b-factor 800 and was drawn apparent diffusion coefficient (ADC) maps. When carried ASL perfusion, the field of view covered the area of the parenchyma of both kidneys. The reference method was glomerular filtration rate for all of the patients. The control group was represented by healthy people (n=59). Consent to participate in the study was obtained from patients or their legal representatives. All stages of the study comply with the normative and regulatory documentation of Ministry of Health ща the Russian Federation.Results. It was concluded that there is a significant difference in ADC for prerenal causes and in ASL for renal causes. In 9 (16.7 %) patients, kidney ADC was 1.5±0.3 mm2/sec, ASL – perfusion – ≤ 250 ml/100g/min, compared with the control group. In this group, negative dynamics were observed within a week, тnegative laboratory dynamics correlates with radiation-based kidney biomarkers (r=0,965).Conclusion. The criteria of DWI and ASL-perfusion allow us to suspect or confirm the cause of acute kidney failure. A high correlation has been established between radiation biomarkers and laboratory criteria of functional damages (r=0.998), direct correlation between imaging biomarkers and organic kidney disease (r=0,901). These biomarkers make it possible to predict the first stage of acute kidney failure (AUROC 0,995, DI 0,867–0,999).","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"25 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005499","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 : 2024-05-07DOI: 10.33667/2078-5631-2024-5-43-47
R. S. Frantsev, T. Derevyanko, I. V. Pavlenko, O. G. Hadzhiev, A. V. Osipov, N. V. Karaseva, O. O. Krupina, D. M. Tkachenko
Renal colic is a condition caused by the passage of a concretion from the kidney through the ureter into the bladder, which is accompanied by a pronounced pain syndrome. Patients with renal colic often seek emergency help with complaints of severe pain, nausea, dysuria. However, there is a category of people who, for various reasons, cannot verbally express their feelings. Such patients are called nonverbal. Nonverbal patients are people with severe cognitive impairments or those who are temporarily unable to speak due to surgery or illness, but they can still demonstrate pain using nonverbal signals.In this article, we present an observation of an atypical clinical picture of renal colic in a nonverbal elderly patient. In the observed woman, an acute attack of renal colic lasted 5 days and passed first under the «mask» of acute pancreatitis. Without receiving pathogenetic therapy, the patient developed acute obstructive pyelonephritis, septic shock, which was initially mistaken for an acute violation of cerebral circulation. The performed computed tomography (CT) helped to identify a concretion in the upper third of the ureter on the left, a violation of the outflow of urine from the left kidney. The patient urgently had a stent installed in the pelvis of the left kidney, urine outflow was restored, anti-inflammatory, detoxification, litolytic therapy was prescribed. After that, the patient's condition improved significantly, and after 3 months, a decrease in the size and fragmentation of the concretion was observed during the control CT scan.Conclusion. Nonverbal patients are a special group of patients whose clinical picture may be blurred or atypical. Assessment of pain symptoms in nonverbal patients is difficult, which can lead to an incorrect diagnosis and lengthen the period of diagnosis of the disease. The timely diagnosis of renal colic in nonverbal patients is also affected by the localization of pain, since its irradiating nature can direct the diagnostic search «on the wrong track».
{"title":"A clinical case of an atypical clinical pattern of renal colic in a nonverbal patient","authors":"R. S. Frantsev, T. Derevyanko, I. V. Pavlenko, O. G. Hadzhiev, A. V. Osipov, N. V. Karaseva, O. O. Krupina, D. M. Tkachenko","doi":"10.33667/2078-5631-2024-5-43-47","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-5-43-47","url":null,"abstract":"Renal colic is a condition caused by the passage of a concretion from the kidney through the ureter into the bladder, which is accompanied by a pronounced pain syndrome. Patients with renal colic often seek emergency help with complaints of severe pain, nausea, dysuria. However, there is a category of people who, for various reasons, cannot verbally express their feelings. Such patients are called nonverbal. Nonverbal patients are people with severe cognitive impairments or those who are temporarily unable to speak due to surgery or illness, but they can still demonstrate pain using nonverbal signals.In this article, we present an observation of an atypical clinical picture of renal colic in a nonverbal elderly patient. In the observed woman, an acute attack of renal colic lasted 5 days and passed first under the «mask» of acute pancreatitis. Without receiving pathogenetic therapy, the patient developed acute obstructive pyelonephritis, septic shock, which was initially mistaken for an acute violation of cerebral circulation. The performed computed tomography (CT) helped to identify a concretion in the upper third of the ureter on the left, a violation of the outflow of urine from the left kidney. The patient urgently had a stent installed in the pelvis of the left kidney, urine outflow was restored, anti-inflammatory, detoxification, litolytic therapy was prescribed. After that, the patient's condition improved significantly, and after 3 months, a decrease in the size and fragmentation of the concretion was observed during the control CT scan.Conclusion. Nonverbal patients are a special group of patients whose clinical picture may be blurred or atypical. Assessment of pain symptoms in nonverbal patients is difficult, which can lead to an incorrect diagnosis and lengthen the period of diagnosis of the disease. The timely diagnosis of renal colic in nonverbal patients is also affected by the localization of pain, since its irradiating nature can direct the diagnostic search «on the wrong track».","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"21 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141004986","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 : 2024-05-07DOI: 10.33667/2078-5631-2024-5-18-22
S. Shelukhina, A. S. Vasilevskaya, E. V. Markova, M. A. Butov, O. Maslova, I. A. Zagravskaya
The aim. Assessment of clinical manifestations of biliary dysfunction, duodenal hypertension. The analysis of data on the effect of drugs of various pharmacological groups on the motor function of the gallbladder is carried out.Materials and methods. We were examined 60 patients (18–50 years old, mean age 41±4.6 years), mostly women (44). All patients underwent a general clinical examination, including blood and urine tests, biochemical blood parameters, ultrasound examination of the abdominal organs and monitoring of gallbladder contractility, esophagogastroduodenoscopy. The examined patients were divided into 2 groups of 30 patients.Results and conclusion. The use of choleretics for spasm of the sphincter of Oddi and symptoms of duodenal hypertension is not always justified. The leading link in the treatment of this type of biliary dysfunction are antispasmodics, which eliminate spasm of the sphincter zones, which restores the passage of bile through the biliary tract and reduces the phenomena of biliary insufficiency. Mebeverine hydrochloride also eliminates the phenomena of duodenal hypertension, which facilitates the removal of bile from the biliary tract. When choleretics are prescribed for the treatment of patients with biliary dysfunction with spasm of the sphincter of Oddi, it is quite possible that the course of this pathology will worsen.
{"title":"Features of the management of patients with biliary dysfunctions with spasm of the sphincter of Oddi","authors":"S. Shelukhina, A. S. Vasilevskaya, E. V. Markova, M. A. Butov, O. Maslova, I. A. Zagravskaya","doi":"10.33667/2078-5631-2024-5-18-22","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-5-18-22","url":null,"abstract":"The aim. Assessment of clinical manifestations of biliary dysfunction, duodenal hypertension. The analysis of data on the effect of drugs of various pharmacological groups on the motor function of the gallbladder is carried out.Materials and methods. We were examined 60 patients (18–50 years old, mean age 41±4.6 years), mostly women (44). All patients underwent a general clinical examination, including blood and urine tests, biochemical blood parameters, ultrasound examination of the abdominal organs and monitoring of gallbladder contractility, esophagogastroduodenoscopy. The examined patients were divided into 2 groups of 30 patients.Results and conclusion. The use of choleretics for spasm of the sphincter of Oddi and symptoms of duodenal hypertension is not always justified. The leading link in the treatment of this type of biliary dysfunction are antispasmodics, which eliminate spasm of the sphincter zones, which restores the passage of bile through the biliary tract and reduces the phenomena of biliary insufficiency. Mebeverine hydrochloride also eliminates the phenomena of duodenal hypertension, which facilitates the removal of bile from the biliary tract. When choleretics are prescribed for the treatment of patients with biliary dysfunction with spasm of the sphincter of Oddi, it is quite possible that the course of this pathology will worsen.","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"27 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005332","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}
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