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Efficacy of the adapted protocol of complex immunosuppressive therapy regimen "fludarabine-cyclophosphamide-dexamethasone- rituximab" in CLIPPERS syndromee (clinical case) “氟达拉滨-环磷酰胺-地塞米松-利妥昔单抗”复合免疫抑制治疗方案对CLIPPERS综合征的疗效观察(附临床病例)
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-10-580-588
A. Polushin, Yury R. Zalyalov, A. Tsynchenko, E. Lopatina, D.Yu. Zamorina, Y. Skiba, D. Skulyabin, O. V. Sergienya
CLIPPERS (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) syndrome is a chronic lymphocytic inflammation of the pons with perivascular accumulation of contrast agent responding to glucocorticosteroid therapy (GCS). This immune- mediated brainstem lesion syndrome requires extensive differential diagnosis. The literature provides descriptions of CLIPPERS with delayed response to GCS or refractory to GCS. Such cases require a customized treatment tactics. In the clinical case of CLIPPERS presented by the authors, it was possible to achieve disease remission using an adapted chemotherapeutic protocol regimen "fludarabine-cyclophosphamide- dexamethasone-rituximab". During the follow-up, the patient did not have any disease relapses. Persistent immunosuppressive effect a year after therapy according to flow cytometry indicated effective inhibition of proinflammatory phenotypes of cellular components. The stabilization of the condition with the improvement of parameters according to the rating scales was noted. The study of cerebrospinal fluid 12 months after nonselective immune depletion indicated a decrease in the myelin basic protein content, normalization of lambda free light chains, the blood-brain barrier permeability and a change in the synthesis type from oligoclonal to polyclonal. The authors conclude that using this method, a long-term clinical, radiological and immunological remission of potentially any autoimmune process can be achieved. KEYWORDS: CLIPPERS, immunosuppressive therapy, fludarabine, rituximab, cyclophosphamide, immunosuppression, autoimmune disease. FOR CITATION: Polushin A.Yu., Zalyalov Yu.R., Tsynchenko A.A. et al. Efficacy of the adapted protocol of complex immunosuppressive therapy regimen "fludarabine-cyclophosphamide-dexamethasone-rituximab" in CLIPPERS syndrome (clinical case). Russian Medical Inquiry. 2022;6(10):580–588 (in Russ.). DOI: 10.32364/2587-6821-2022-6-10-580-588.
CLIPPERS(慢性淋巴细胞炎症伴桥桥血管周围增强对类固醇反应)综合征是桥桥慢性淋巴细胞炎症伴血管周围造影剂积聚对糖皮质激素治疗(GCS)反应。这种免疫介导的脑干病变综合征需要广泛的鉴别诊断。文献提供了对GCS延迟反应或对GCS难治的CLIPPERS的描述。这种情况需要定制治疗策略。在作者提出的CLIPPERS临床病例中,使用“氟达拉滨-环磷酰胺-地塞米松-利妥昔单抗”的化疗方案有可能实现疾病缓解。随访期间,患者无任何疾病复发。根据流式细胞术,治疗后一年持续的免疫抑制作用表明有效抑制细胞成分的促炎表型。注意到根据评定量表,随着参数的提高,情况趋于稳定。非选择性免疫耗损后12个月的脑脊液研究表明,髓鞘碱性蛋白含量降低,lambda自由轻链正常化,血脑屏障通透性,合成类型从寡克隆变为多克隆。作者得出结论,使用这种方法,任何潜在的自身免疫过程的长期临床、放射学和免疫学缓解都可以实现。关键词:CLIPPERS,免疫抑制治疗,氟达拉滨,利妥昔单抗,环磷酰胺,免疫抑制,自身免疫性疾病。引文:Polushin A.Yu。Zalyalov Yu.R。, Tsynchenko A.A.等。“氟达拉滨-环磷酰胺-地塞米松-利妥昔单抗”复合免疫抑制治疗方案对CLIPPERS综合征的疗效观察(附临床病例)俄罗斯医学调查。2022;6(10):580-588(俄文)。DOI: 10.32364 / 2587-6821-2022-6-10-580-588。
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引用次数: 0
Optimal medical therapy for heart failure: eplerenon in a hospital setting (case report) 心力衰竭的最佳药物治疗:住院治疗(病例报告)
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-1-45-51
D. Sedykh, V. Kashtalap, O. Barbarash
Heart failure (HF) is a major issue in the modern society. A growing number of users, re-hospitalizations due to decompensation and disability cause significant economic costs and a high workload for both in-patient and out-patient practitioners. This article highlights the practical importance of timely prescription of mineralocorticoid receptor antagonists (specifically, eplerenone, a selective drug) in inpatient and outpatient settings. The efficacy and tolerability of this drug are established through the results of large studies. Eplerenone is included in the clinical guidelines of the Ministry of Health of Russian Federation, national guidelines on acute heart failure of the Russian Cardiological Society and Russian Therapeutic Society guidelines on HF diagnosis and treatment. It is recommended for all patients with moderate and severe HF, irrespective of the origin and LV ejection fraction. The established safety of eplerenon allows for its use in multimorbid patients. This case report demonstrates the effects of bioequivalent eplerenone (Espiro) for stabilizing the condition after HF decompensation with a transient decrease in LV ejection fraction. KEYWORDS: heart failure, decompensation, mineralocorticoid receptor antagonists, eplerenon. FOR CITATION: Sedykh D.Yu., Kashtalap V.V., Barbarash O.L. Optimal medical therapy for heart failure: eplerenon in a hospital setting (case report). Russian Medical Inquiry. 2022;6(1):45–51 (in Russ.). DOI: 10.32364/2587-6821-2022-6-1-45-51.
心力衰竭(HF)是现代社会的一个重大问题。越来越多的使用者、因失偿和残疾而再次住院给住院和门诊医生带来了巨大的经济成本和高工作量。这篇文章强调了矿皮质激素受体拮抗剂(特别是依普利酮,一种选择性药物)在住院和门诊及时处方的实际重要性。这种药物的疗效和耐受性是通过大量研究的结果确定的。埃普利酮被列入俄罗斯联邦卫生部临床指南、俄罗斯心脏病学会关于急性心力衰竭的国家指南和俄罗斯治疗学会关于心衰诊断和治疗的指南。推荐用于所有中度和重度心衰患者,无论病因和左室射血分数如何。eperenon已确定的安全性允许其用于多种疾病的患者。本病例报告证明了生物等效eplerenone (Espiro)对稳定HF失代偿后左室射血分数短暂下降的情况的作用。关键词:心力衰竭,代偿失代偿,矿皮质激素受体拮抗剂,epleenon引文:Sedykh D.Yu。心脏衰竭的最佳药物治疗:在医院环境中发作(病例报告)。俄罗斯医学调查。2022;6(1):45-51(俄文)。DOI: 10.32364 / 2587-6821-2022-6-1-45-51。
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引用次数: 0
Pulmonary surfactant in the complex treatment of severe pneumonia associated with COVID-19. Efficacy markers 肺表面活性物质在新冠肺炎合并重症肺炎综合治疗中的作用疗效指标
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-7-352-359
E. Volchkova, Y. Alexandrovich, O. Titova, N. Kuzubova, V. Volchkov, D. Piskunov, M. N. Bakholdina, F. Bitakova
Aim: to evaluate the effect of pulmonary surfactant therapy in the complex treatment of severe community-acquired pneumonia caused by the SARS-CoV-2 on the disease course and outcome and to determine the possibility of using the level of surfactant protein D (surfactant protein D, SP-D) in blood serum as a criterion for the treatment efficacy. Patients and Methods: a prospective randomized study included 60 patients. Inclusion criteria confirmed SARS-CoV-2; bilateral pneumonia with at least grade 3 of lesion according to CT; SpO2 less than 92%. Patients were divided into two groups: group 1 (n=30) received surfactant therapy in addition to standard therapy, group 2 (n=30) received only standard therapy. Surfactant was administered by inhalation at a dose of 150–300 mg/day. The duration of surfactant therapy was 10 days. Arterial blood gas values, clinical parameters and SP-D levels were analyzed before and after treatment. Results: 48 hours after the therapy start, a statistically significant increase in SpO2 was registered in patients from group 1 versus an increase in patients from group 2 (p=0.048). On the 10th day of treatment, group 1 versus group 2 showed a statistically significant increase in the oxygenation index (PaO2/FiO2) (266.82±10.5 mmHg vs. 199.67±11.7 mmHg, respectively, p=0.001), a decrease in the frequency of artificial lung ventilation (ALV) (27% vs. 67%, respectively, p=0.002), length of hospital stay (21.0 (15;25) days vs. 27.0 (15;35) days, respectively, p=0.05). The fatal outcome was registered in 8 (27%) patients from group 1 and 18 (60%) patients from group 2 (p=0.001). Among patients from group 1 who had a favorable disease outcome, in 84% of cases surfactant therapy was prescribed in a shorter period from the disease onset versus patients whose treatment was ineffective (3±1.5 days vs. 7±2.0 days). A stable, reliable correlation was established between SP-D and PaO2 (r= 420, p=0.001), between SP-D and PaO2/FiO2 (r=460, p=0.001). Conclusion: the major effects of surfactant therapy are a faster recovery of the arterial blood gas, a decrease in the frequency of ALV, the length of hospital stay, and mortality. The success of surfactant therapy is associated with its early prescription. Surfactant therapy can be considered as an additional pathogenetically justified component in the complex treatment of severe pneumonia caused by the SARS-CoV-2. Significantly higher levels of SP-D were observed in patients with severe pneumonia associated with COVID-19, with the disease progression and adverse outcome. KEYWORDS: SARS-CoV-2, COVID-19, pneumonia, surfactant, artificial lung ventilation, respiratory failure, surfactant protein D, SP-D. FOR CITATION: Volchkova E.V., Alexandrovich Yu.S., Titova O.N. et al. Pulmonary surfactant in the complex treatment of severe pneumonia associated with COVID-19. Efficacy markers. Russian Medical Inquiry. 2022;6(7):352–359 (in Russ.). DOI: 10.32364/2587-6821-2022-6-7-352-359.
目的:评价复合治疗SARS-CoV-2所致重症社区获得性肺炎中肺表面活性物质治疗对病程和转转率的影响,探讨以血清表面活性物质蛋白D (SP-D)水平作为治疗疗效指标的可能性。患者和方法:一项前瞻性随机研究包括60例患者。纳入标准确诊为SARS-CoV-2;双侧肺炎,CT显示病变3级以上;SpO2小于92%。将患者分为两组:组1 (n=30)在标准治疗的基础上给予表面活性剂治疗,组2 (n=30)只给予标准治疗。表面活性剂吸入给药,剂量为150-300 mg/天。表面活性剂治疗10 d。分析治疗前后动脉血气值、临床参数及SP-D水平。结果:治疗开始48小时后,1组患者SpO2升高,与2组患者相比有统计学意义(p=0.048)。治疗第10天,1组与2组相比,氧合指数(PaO2/FiO2)升高(分别为266.82±10.5 mmHg和199.67±11.7 mmHg, p=0.001),人工肺通气(ALV)频率降低(分别为27%和67%,p=0.002),住院时间分别为21.0(15;25)天和27.0(15;35)天,p=0.05)。1组有8例(27%)患者死亡,2组有18例(60%)患者死亡(p=0.001)。在疾病预后良好的第1组患者中,与治疗无效的患者相比,84%的病例在发病后较短的时间内给予表面活性剂治疗(3±1.5天对7±2.0天)。SP-D与PaO2 (r= 420, p=0.001)、SP-D与PaO2/FiO2 (r=460, p=0.001)存在稳定、可靠的相关性。结论:表面活性剂治疗的主要作用是动脉血气恢复较快,ALV发作次数减少,住院时间延长,死亡率降低。表面活性剂治疗的成功与其早期处方有关。表面活性剂治疗可以被认为是SARS-CoV-2引起的严重肺炎复杂治疗中一个额外的病理合理的组成部分。在与COVID-19相关的严重肺炎患者中,随着疾病进展和不良结局的发生,SP-D水平显著升高。关键词:SARS-CoV-2、COVID-19、肺炎、表面活性剂、人工肺通气、呼吸衰竭、表面活性剂蛋白D、SP-D引文:Volchkova e.v., Alexandrovich yus。, Titova O.N.等。肺表面活性物质在新冠肺炎合并重症肺炎综合治疗中的作用功效标记。俄罗斯医学调查。2022;6(7):352-359(俄文)。DOI: 10.32364 / 2587-6821-2022-6-7-352-359。
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引用次数: 2
Concurrent surgeries in patients with varicose vein disease and ventral hernias 静脉曲张合并腹疝的并发手术治疗
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-4-164-170
A. Chernookov, M. R. Kuznetsov, S. Kandyba, A. Atayan, Yu. N. Lebedeva, A. A. Ramazanov
Aim: to substantiate the feasibility of concurrent surgeries in patients with varicose vein disease and anterior abdominal wall hernias (ventral hernias). Patients and Methods: the paper presents the treatment results of 82 patients with ventrial hernias and lower limb varicose vein disease. The method choice and the scope of surgical intervention were determined on the basis of clinical and instrumental examination data. Commonly, Lichtenstein tension-free hernia repair in combination with crossectomy, endovasal laser coagulation (EVLC), varicose veins radiofrequency ablation (VVRFA) were performed. The long-term results were analyzed 1–2 years after the use of concurrent surgeries. The life quality before surgery and a year after was determined by the SF-36 questionnaire. Results: the patients consisted of 45 (54.9%) men and 37 (45.1%) women aged 19 to 69 years. In 20 (24.4%) of the admitted patients, work was associated with physical activity, and 56 (68.3%) patients were at the most capable age: 19 to 50 years. Upon admission to the clinic, 78 patients had complaints. Commonly, they had a combination of varicose vein disease with inguinal or umbilical hernias. After the use of concurrent surgeries, no specific complications were observed in this patient cohort, as well as complications associated with both diseases concomitantly. In the long-term period, patients noted an improvement in their general health by 23.2%. In the preoperative period, the indicator of physical functioning was 41.27 points; after the operation, there was an increase in this indicator according to patients’ estimates by 1.6 times — to 67.32 points. After surgery, the greatest positive trend of vital activity (42.8%) and role limitations due to emotional state (57.3%) were observed. There was an increase in all indicators of life quality by 18.2–53.9% in patients who underwent concurrent surgeries. Conclusion: the obtained results demonstrated the safety and high efficacy of concurrent surgeries in patients with varicose vein disease and ventral hernias. Thus, the use of concurrent surgeries is considered to be an alternative to the staged treatment of patients with varicose vein disease and ventral hernias KEYWORDS: concurrent surgeries, varicose vein disease, ventral hernias, life quality, postoperative complications. FOR CITATION: Chernookov A.I., Kuznetsov M.R., Kandyba S.I. et al. Concurrent surgeries in patients with varicose vein disease and ventral hernias. Russian Medical Inquiry. 2022;6(4):164–170 (in Russ.). DOI: 10.32364/2587-6821-2022-6-4-164-1.
目的:探讨静脉曲张合并前腹壁疝(腹疝)并发手术的可行性。患者与方法:报告82例腹疝合并下肢静脉曲张病患者的治疗结果。根据临床和器械检查资料确定手术方法选择和手术干预范围。通常,利希滕斯坦无张力疝修补联合横切面切除术、血管内激光凝固(EVLC)、静脉曲张射频消融(VVRFA)。在采用并行手术后1-2年分析远期结果。术前及术后1年的生活质量采用SF-36量表进行评定。结果:男性45例(54.9%),女性37例(45.1%),年龄19 ~ 69岁。在20例(24.4%)住院患者中,工作与身体活动有关,56例(68.3%)患者处于最能运动的年龄:19至50岁。入院时,78名患者有抱怨。通常,他们有合并静脉曲张疾病与腹股沟或脐疝。在采用并行手术后,在该患者队列中未观察到特异性并发症,以及两种疾病合并的并发症。长期来看,患者的总体健康状况改善了23.2%。术前身体功能指标41.27分;手术后,该指标根据患者的估计增加了1.6倍,达到67.32分。术后生命活动的积极趋势最大(42.8%),情绪状态导致的角色限制最大(57.3%)。同时进行手术的患者生活质量各项指标均提高18.2-53.9%。结论:所获得的结果证明了并发手术治疗静脉曲张病变合并腹疝的安全性和有效性。关键词:并发手术,静脉曲张病变,腹侧疝,生活质量,术后并发症。引用本文:Chernookov a.i., Kuznetsov m.r., Kandyba S.I.等。静脉曲张合并腹疝的并发手术治疗。俄罗斯医学调查。2022;6(4):164-170(俄文)。DOI: 10.32364 / 2587-6821-2022-6-4-164-1。
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引用次数: 0
Endocrine adverse events in patients with malignant neoplasms receiving treatment with immune checkpoint inhibitors 恶性肿瘤患者接受免疫检查点抑制剂治疗的内分泌不良事件
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-9-528-533
K. Zherebchikova, Y. Sych, M. V. Amosova, M. Sekacheva, V. Fadeev, A.A. Vilensky
Immune checkpoint inhibitors are monoclonal antibodies directed against the molecules blocking immune response, such as cytotoxic T-lymphocyte- associated protein 4 (CTLA-4), programmed cell death protein-1 (PD1) and its ligand, which enhance anti-tumor immunity. Immune checkpoint inhibitors have demonstrated high efficacy in cancer treatment, including the most common types of cancer and helped to increase recurrence- free and overall survival of cancer patients. At the same time, the use of checkpoint inhibitors is associated with a high risk of immune-related adverse events (irAEs) — autoimmune conditions that occur in multiple organs and tissues, including endocrinopathies. Endocrine irAEs can affect the thyroid, pituitary gland, adrenal glands, and pancreas. These events are unique when compared with other irAEs because the manifestations are often irreversible. The awareness of clinicians of potential irAEs, including endocrinopathies caused by agents from the group of immune checkpoint inhibitors will improve their timely identification and treatment. Thus, it will promote the safe use of highly effective anti-tumor therapy. KEYWORDS: checkpoint inhibitors, CTLA-4, PD1, PDL1, immune-related adverse events, hypothyroidism, thyrotoxicosis, thyroiditis, hypophysitis, adrenal insufficiency. FOR CITATION: Zherebchikova K.Yu., Sych Yu.P., Amosova M.V. et al. Endocrine adverse events in patients with malignant neoplasms receiving treatment with immune checkpoint inhibitors. Russian Medical Inquiry. 2022;6(9):528–533 (in Russ.). DOI: 10.32364/2587-6821- 2022-6-9-528-533.
免疫检查点抑制剂是针对阻断免疫反应分子的单克隆抗体,如细胞毒性t淋巴细胞相关蛋白4 (CTLA-4)、程序性细胞死亡蛋白1 (PD1)及其配体,可增强抗肿瘤免疫。免疫检查点抑制剂在癌症治疗中已经证明了很高的疗效,包括最常见的癌症类型,并有助于增加癌症患者的无复发和总生存率。同时,检查点抑制剂的使用与免疫相关不良事件(irAEs)的高风险相关——包括内分泌疾病在内的多器官和组织中发生的自身免疫性疾病。内分泌干扰素可影响甲状腺、脑垂体、肾上腺和胰腺。与其他irae相比,这些事件是独特的,因为其表现往往是不可逆的。临床医生对潜在的irae,包括免疫检查点抑制剂组药物引起的内分泌病变的认识将提高其及时识别和治疗。从而促进高效抗肿瘤治疗的安全使用。关键词:检查点抑制剂、CTLA-4、PD1、PDL1、免疫相关不良事件、甲状腺功能减退、甲状腺毒症、甲状腺炎、垂体炎、肾上腺功能不全。引文:Zherebchikova K.Yu。, Sych。, Amosova M.V.等。恶性肿瘤患者接受免疫检查点抑制剂治疗的内分泌不良事件。俄罗斯医学调查。2022;6(9):528-533(俄文)。Doi: 10.32364/2587-6821- 2022-6-9-528-533。
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引用次数: 0
Alopecia areata in atopic dermatitis: coincidence or regularity? 特应性皮炎斑秃:偶然性还是规律性?
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-2-85-91
S. Petrova, V. Albanova
Extensive trials have identified a close relationship between atopic dermatitis (AD) and alopecia areata (AA). This review paper summarizes and analyzes available data on the immunological pattern of AD-associated AA. The analysis of scientific findings suggests that epidermal barrier dysfunction in AD promotes AA in the presence of target genes contributing to its development. Both pathological entities negatively affect each other. The results are the reduction in regulatory T cell (Treg) suppression activity and an increase in inflammatory and autoimmune activity of Th-17 cells. Hyperergic Th2 response affects AD-associated AA clinical presentations. The regression of bald patches after IL-4, IL-13, and histamine receptors blockage further establishes the association between AA and AD. The possibility of atopic alopecia requires both skin and hair care products in AD. Dry peeling skin vulnerable to infections should be treated to reduce the risk of autoimmunity in AA. The presence of two family lines of genetic predisposition (atopy and AA) results in severe combined manifestations of these disorders in progeny. Therefore, attention should be paid to early AD signs in children in these families to commence treatment timely. KEYWORDS: atopic dermatitis, аlopecia areata, genetics, autoimmunity, epidermal barrier, regulatory T cells, immune privilege, hair follicle, T helper 17 cells, mast cells. FOR CITATION: Petrova S.Yu., Albanova V.I. Alopecia areata in atopic dermatitis: coincidence or regularity? Russian Medical Inquiry. 2022;6(2):85–91 (in Russ.). DOI: 10.32364/2587-6821-2022-6-2-85-91.
广泛的试验已经确定了特应性皮炎(AD)和斑秃(AA)之间的密切关系。本文对ad相关AA的免疫学模式进行综述和分析。对科学发现的分析表明,AD的表皮屏障功能障碍在参与其发展的靶基因存在的情况下促进了AA的发生。两种病理实体相互负向影响。结果是调节性T细胞(Treg)抑制活性降低,Th-17细胞的炎症和自身免疫活性增加。超能Th2反应影响ad相关AA的临床表现。IL-4、IL-13和组胺受体阻断后秃斑的消退进一步证实了AA和AD之间的关联。特应性脱发的可能性需要皮肤和头发护理产品在AD。应治疗易受感染的干燥脱皮,以降低AA患者自身免疫的风险。遗传易感性的两个家族系(特应性和AA)的存在导致这些疾病在后代中严重的联合表现。因此,应重视这些家庭儿童的早期AD症状,及时开始治疗。关键词:特应性皮炎,斑秃,遗传学,自身免疫,表皮屏障,调节性T细胞,免疫特权,毛囊,辅助性T 17细胞,肥大细胞。引文:Petrova S.Yu。特应性皮炎的斑秃:偶然性还是规律性?俄罗斯医学调查。2022;6(2):85-91(俄文)。DOI: 10.32364 / 2587-6821-2022-6-2-85-91。
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引用次数: 0
Postcovid syndrome: risk factors, pathogenesis, diagnosis and treatment of patients with respiratory damage after COVID-19 (overview) COVID-19后综合征:COVID-19后呼吸损伤患者的危险因素、发病机制、诊断和治疗(综述)
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-7-367-375
T. Bilichenko
In COVID-19 of moderate to severe degree, there are significant inflammatory changes in the lungs and other organs involved in the pathological process with corresponding symptoms and functional disorders lasting longer than 12 weeks. They are designated as postcovid syndrome (PCS) and require further treatment. The article presents the pathogenetic mechanism of PCS, in which organ damage has the systemic nature. Special attention is paid to the changes in the organs of the respiratory system (atelectasis in the alveoli within the lungs, remodeling of the bronchial epithelium, hyaluronan deposition in the lumen of alveoli, bronchi and perialveolar interstitial with the formation of connective tissue), which in the long term lead to fibrous changes, especially in patients with severe COVID-19 and concomitant respiratory diseases. This, in turn, makes oxygen and carbon dioxide to pass through the alveoli wall with difficulties, decreases exercise tolerance and life quality, and increases mortality in elderly patients. The article also outlines the main directions of pathogenetically conditioned therapy of patients with respiratory disorder in the outpatient settings, providing a decrease in rehabilitation period and improving the patients condition. KEYWORDS: postcovid syndrome, alveolar epithelium, atelectasis, comorbidity, rehabilitation. FOR CITATION: Bilichenko T.N. Postcovid syndrome: risk factors, pathogenesis, diagnosis and treatment of patients with respiratory damage after COVID-19 (overview). Russian Medical Inquiry. 2022;6(7):367–375 (in Russ.). DOI: 10.32364/2587-6821-2022-6-7-367-375.
中重度COVID-19患者,肺部及其他参与病理过程的器官出现明显的炎症改变,相应的症状和功能障碍持续时间超过12周。他们被指定为covid后综合征(PCS),需要进一步治疗。本文介绍了PCS的发病机制,其中器官损害具有全身性。特别关注呼吸系统器官的变化(肺内肺泡不张、支气管上皮重塑、肺泡腔、支气管和肺泡周围间质中透明质酸沉积以及结缔组织的形成),这些变化长期导致纤维改变,特别是在严重的COVID-19和伴随呼吸道疾病的患者中。这反过来又使氧气和二氧化碳难以通过肺泡壁,降低运动耐量和生活质量,并增加老年患者的死亡率。本文还概述了呼吸系统疾病患者病理条件治疗在门诊的主要方向,缩短康复时间,改善患者病情。关键词:covid后综合征,肺泡上皮,肺不张,合并症,康复。引用本文:Bilichenko T.N. COVID-19后综合征:COVID-19后呼吸损伤患者的危险因素、发病机制、诊断和治疗(概述)。俄罗斯医学调查。2022;6(7):367-375(俄文)。DOI: 10.32364 / 2587-6821-2022-6-7-367-375。
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引用次数: 2
POEMS-syndrome with the disease onset in the form of сhronic dysimmune neuropathy 以慢性免疫功能障碍神经病为发病形式的poems综合征
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-10-589-595
V. Korotaeva, Y. Kushnir, O. Kudyasheva, A. Polushin, V. Krasnov
POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, Skin changes) is a rare paraneoplastic disease associated with plasma cell dyscrasias, the pathogenesis of which is currently not fully understood. The diagnosis of POEMS syndrome is commonly confirmed after an extended period of time from the disease onset, since the syndrome is rare and can be mistaken for other neurological diseases, for instance, chronic inflammatory demyelinating polyneuropathy (CIDP). The article describes a clinical case of the disease in a young male patient with the onset of neurological disorders in the form of the CIDP clinical phenotype, refractory to first-line therapy, and further systemic clinical and laboratory comorbidities of POEMS syndrome. The necessary laboratory and radiological studies were performed to confirm the diagnosis. The diagnosis was established based on the presence of 2 major, 1 additional major and 4 minor criteria of POEMS syndrome in the patient. Then the patient was discharged for further observation of hematologists to initiate basic therapy of POEMS syndrome. Early detection of the POEMS syndrome "red flags" in patients with the CIDP allows for timely treatment initiation, prevention of further disease progression and the development of persistent disabling disorders. KEYWORDS: POEMS-syndrome, chronic inflammatory demyelinating polyneuropathy, paraprotein, monoclonal gammopathy of undetermined significance. FOR CITATION: Korotaeva V.V., Kushnir Ya.B., Kudyasheva O.V. et al. POEMS-syndrome with the disease onset in the form of сhronic dysimmune neuropathy. Russian Medical Inquiry. 2022;6(10):589–595 (in Russ.). DOI: 10.32364/2587-6821-2022-6-10-589-595.
POEMS综合征(多神经病变、器官肿大、内分泌病变、m蛋白、皮肤改变)是一种罕见的与浆细胞异常相关的副肿瘤疾病,其发病机制目前尚不完全清楚。POEMS综合征的诊断通常在发病后较长一段时间后才得到证实,因为该综合征罕见,可被误认为是其他神经系统疾病,例如慢性炎症性脱髓鞘性多神经病变(CIDP)。本文描述了一名年轻男性患者的临床病例,该患者以CIDP临床表型的形式出现神经系统疾病,对一线治疗难治,并进一步出现POEMS综合征的系统性临床和实验室合并症。进行了必要的实验室和放射学检查以确认诊断。根据患者POEMS综合征的2项主要标准、1项附加主要标准和4项次要标准进行诊断。出院后接受血液科医生进一步观察,开始POEMS综合征的基础治疗。在CIDP患者中早期发现POEMS综合征的“危险信号”,可以及时开始治疗,预防进一步的疾病进展和持续致残障碍的发展。关键词:poems综合征,慢性炎症性脱髓鞘性多神经病变,副蛋白,意义不明的单克隆γ病。引文:Korotaeva v.v., Kushnir Ya.B。Kudyasheva O.V.等。以慢性免疫功能障碍神经病为发病形式的poems综合征。俄罗斯医学调查。2022;6(10):589-595(俄文)。DOI: 10.32364 / 2587-6821-2022-6-10-589-595。
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引用次数: 1
Biliary gastritis: modern methods of diagnosis and therapy 胆道性胃炎:现代诊断与治疗方法
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-5-244-251
M. Livzan, O. Gaus, S. Mozgovoi
According to the prevalence, chronic biliary gastritis is among the most common etiological variants of chronic gastritis along with Helicobacter pylori associated gastritis and NSAID gastropathy. This review has been prepared to systematize data on the causes, pathogenetic mechanisms and methods of the diagnosis and therapy of chronic biliary gastritis. The widespread prevalance of biliary gastritis in clinical practice with insufficient understanding of the pathogenesis, the lack of diagnostic standards and unified treatment methods make the coverage of this problem very relevant. The review also systematizes known information about risk factors and pathogenetic mechanisms of biliary gastritis, discusses methods of the diagnosis and treatment of this disease, in particular, the use of ursodeoxycholic acid and cytoprotectors as pathogenetic therapy. The authors note that the treatment of biliary gastritis should be comprehensive and aimed not only at relieving dyspeptic symptoms and improving the life quality of patients, but also at preventing and inhibiting atrophic changes in the gastric mucosa. KEYWORDS: biliary gastritis, duodenogastric reflux, reactive gastritis, bile reflux gastropathy, reactive gastropathy, ursodeoxycholic acid, cytoprotectors. FOR CITATION: Livzan M.A., Gaus O.V., Mozgovoi S.I., Telyatnikova L.I. Biliary gastritis: modern methods of diagnosis and therapy. Russian Medical Inquiry. 2022;6(5):244–251 (in Russ.). DOI: 10.32364/2587-6821-2022-6-5-244-251.
根据患病率,慢性胆道性胃炎与幽门螺杆菌相关的胃炎和非甾体抗炎药胃病是慢性胃炎最常见的病因变体之一。本文对慢性胆道性胃炎的病因、发病机制、诊断和治疗方法进行了系统的综述。胆道性胃炎在临床上普遍存在,对其发病机制认识不足,缺乏诊断标准和统一的治疗方法,使得对这一问题的报道非常有意义。本文还对胆道性胃炎的危险因素和发病机制进行了系统整理,讨论了该病的诊断和治疗方法,特别是熊去氧胆酸和细胞保护剂作为发病治疗的应用。胆道性胃炎的治疗应全面,不仅要缓解消化不良症状,提高患者的生活质量,而且要预防和抑制胃粘膜的萎缩变化。关键词:胆道性胃炎,十二指肠胃反流,反应性胃炎,胆汁反流性胃病,反应性胃病,熊去氧胆酸,细胞保护剂。引用本文:Livzan m.a., Gaus o.v., Mozgovoi s.i., Telyatnikova L.I.胆道性胃炎:现代诊断和治疗方法。俄罗斯医学调查。2022;6(5):244-251(俄文)。DOI: 10.32364 / 2587-6821-2022-6-5-244-251。
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引用次数: 0
Neuroimaging in pediatric patients with new-onset status epilepticus 小儿新发癫痫持续状态的神经影像学研究
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-10-596-599
É. A. Kulish, V. M. Frolova
Status epilepticus (SE) is one of the most common urgent neurological conditions in children. SE occurs as a result of the failure of the mechanisms responsible for stopping seizures, or of those that cause abnormally long seizures. The International League against Epilepsy recommends examining patients with epilepsy (including those with new-onset SE) using neuroimaging methods. In order to assess the informative value of neuroimaging methods in determining the causes of SE, we conducted a retrospective analysis of 44 medical records of pediatric patients with new-onset SE who were admitted in critical condition to the children’s intensive care unit for the period from 2000 to 2019. In the studied sample, only 32 patients were examined using neuroimaging methods (MRI, CT, EEG, video EEG monitoring). In 25% of cases, no changes were detected. The rest revealed epileptogenic (15.3%), conditionally epileptogenic (65.5%) and non-epileptogenic (19.2%) changes. To clarify the etiology of epilepsy in the latter case, it is recommended to conduct additional examination using other diagnostic methods. Thus, the use of neuroimaging methods is an important link in the patient management with new-onset SE. KEYWORDS: epilepsy, status epilepticus, children, brain, neuroimaging, magnetic resonance imaging, computed tomography. FOR CITATION: Kulish E.A., Frolova V.M. Neuroimaging in pediatric patients with new-onset status epilepticus. Russian Medical Inquiry. 2022;6(10):596–599 (in Russ.). DOI: 10.32364/2587-6821-2022-6-10-596-599.
癫痫持续状态是儿童最常见的紧急神经系统疾病之一。SE的发生是由于负责停止癫痫发作的机制失败,或那些导致异常长时间癫痫发作的机制失败。国际抗癫痫联盟建议使用神经成像方法检查癫痫患者(包括新发SE患者)。为了评估神经影像学方法在确定SE病因方面的信息价值,我们回顾性分析了2000年至2019年儿童重症监护室收治的44例新发SE患儿危重病历。在研究样本中,仅32例患者采用神经影像学方法(MRI、CT、EEG、视频EEG监测)进行了检查。在25%的病例中,没有检测到任何变化。其余为癫痫性(15.3%)、条件性癫痫性(65.5%)和非癫痫性变化(19.2%)。为了明确后一种情况下癫痫的病因,建议使用其他诊断方法进行额外的检查。因此,神经影像学方法的使用是新发SE患者管理的重要环节。关键词:癫痫,癫痫持续状态,儿童,脑,神经成像,磁共振成像,计算机断层扫描。引用本文:Kulish e.a., Frolova V.M.新发癫痫持续状态患儿的神经影像学研究。俄罗斯医学调查。2022;6(10):596-599(俄文)。DOI: 10.32364 / 2587-6821-2022-6-10-596-599。
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引用次数: 0
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Russian Medical Inquiry
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