Pub Date : 2018-11-21DOI: 10.21303/2585-663.2018.00764
O. Glavatskyi, O. Zemskova
Glioblastoma multiforme (GBM) is the most common primary malignant tumor of the central nervous system in adults. Dismal survival rates and poor prognosis for recurrent GBM patients still remains a challenging problem. Despite aggressive initial treatment, above 100 % GBM patients have development of recurrent diseases. Management of GBM recurrence is still debatable. The multimodality approaches using combination of stereotactic radiosurgery (SRS), cytostatic agents (Тemozolomide (TMZ)) and antiangiogenic therapy (bevacizumab (BEV)) are often beneficial for such patients and may achieve survival improving. Aim of research: to assess the efficacy and toxicity of combination therapy approach using stereotactic radiosurgery (SRS) and systemic treatment (chemotherapy and antiangiogenic therapy) in glioblastoma multiforme recurrence treatment. Materials and methods: at the State Institution “Institute of Neurosurgery named after acad. A.P. Romodanov of NAMS of Ukraine” (Kyiv, Ukraine) 21 patients (pts) with GBM recurrence were treated (8 females and 11 men; median age at time of diagnosis 52.4 (29.7–69.3) from January 2014 till December 2017. The initial surgical treatment as gross total tumor resection was performed in 12 pts (57.1 %), subtotal resection – 5 pts (23.9 %), biopsy – 4 pts (19 %). 12 pts (57.1 %) were MGMT methylated and 9 pts (42.9 %) were MGMT unmethylated. In all cases adjuvant radiation therapy (60 Gy in 30 fractions) were used, 12 pts of them (57.1 %) – in combination with TMZ followed by 6-12 courses of chemotherapy (TMZ) according Stupp protocol. Recurrent disease was treated by SRS followed by TMZ + BEV. SRS was performed by means of “Trilogy” LINAC (“Varian”, USA) with a median dose and fractions of 19.2 Gy (range, 12.0–36.0) in 1 to 5 fractions. Results: median survival after initial diagnosis was 18.3 months, and 1- and 2-year survival rates of 85.7 % (18 from 21 pts) and 38.1 % (8 from 21 pts) respectively. The median survival from the time of recurrence treatment was 8.3 months. The 6‐ and 12‐months overall survival from SRS were 95.2 % (20 from 21 pts) and 23.8 % (5 from 21 pts), respectively. Adverse radiation effects were noted in 6 (28.6 %) pts and were controlled with corticosteroids. Adverse events grade 1-2 related to the systemic therapy included hematological complications, fatigue, hypertension and proteinuria were observed in 23.8 % (5 from 21 pts) without the occurrence of grade 3 events. Conclusion: recurrent GBM management using combination of SRS, chemotherapy and antiangiogenic therapy is a promising multimodal treatment approach providing survival improving whereas appropriate toxicity ratio. Further studies of combined treatment of GBM relapse are needed.
{"title":"RECURRENT GLIOBLASTOMA MANAGEMENT USING STEREOTACTIC RADIOSURGERY AND SYSTEMIC TREATMENT","authors":"O. Glavatskyi, O. Zemskova","doi":"10.21303/2585-663.2018.00764","DOIUrl":"https://doi.org/10.21303/2585-663.2018.00764","url":null,"abstract":"Glioblastoma multiforme (GBM) is the most common primary malignant tumor of the central nervous system in adults. Dismal survival rates and poor prognosis for recurrent GBM patients still remains a challenging problem. Despite aggressive initial treatment, above 100 % GBM patients have development of recurrent diseases. Management of GBM recurrence is still debatable. The multimodality approaches using combination of stereotactic radiosurgery (SRS), cytostatic agents (Тemozolomide (TMZ)) and antiangiogenic therapy (bevacizumab (BEV)) are often beneficial for such patients and may achieve survival improving. Aim of research: to assess the efficacy and toxicity of combination therapy approach using stereotactic radiosurgery (SRS) and systemic treatment (chemotherapy and antiangiogenic therapy) in glioblastoma multiforme recurrence treatment. Materials and methods: at the State Institution “Institute of Neurosurgery named after acad. A.P. Romodanov of NAMS of Ukraine” (Kyiv, Ukraine) 21 patients (pts) with GBM recurrence were treated (8 females and 11 men; median age at time of diagnosis 52.4 (29.7–69.3) from January 2014 till December 2017. The initial surgical treatment as gross total tumor resection was performed in 12 pts (57.1 %), subtotal resection – 5 pts (23.9 %), biopsy – 4 pts (19 %). 12 pts (57.1 %) were MGMT methylated and 9 pts (42.9 %) were MGMT unmethylated. In all cases adjuvant radiation therapy (60 Gy in 30 fractions) were used, 12 pts of them (57.1 %) – in combination with TMZ followed by 6-12 courses of chemotherapy (TMZ) according Stupp protocol. Recurrent disease was treated by SRS followed by TMZ + BEV. SRS was performed by means of “Trilogy” LINAC (“Varian”, USA) with a median dose and fractions of 19.2 Gy (range, 12.0–36.0) in 1 to 5 fractions. Results: median survival after initial diagnosis was 18.3 months, and 1- and 2-year survival rates of 85.7 % (18 from 21 pts) and 38.1 % (8 from 21 pts) respectively. The median survival from the time of recurrence treatment was 8.3 months. The 6‐ and 12‐months overall survival from SRS were 95.2 % (20 from 21 pts) and 23.8 % (5 from 21 pts), respectively. Adverse radiation effects were noted in 6 (28.6 %) pts and were controlled with corticosteroids. Adverse events grade 1-2 related to the systemic therapy included hematological complications, fatigue, hypertension and proteinuria were observed in 23.8 % (5 from 21 pts) without the occurrence of grade 3 events. Conclusion: recurrent GBM management using combination of SRS, chemotherapy and antiangiogenic therapy is a promising multimodal treatment approach providing survival improving whereas appropriate toxicity ratio. Further studies of combined treatment of GBM relapse are needed.","PeriodicalId":33846,"journal":{"name":"Technology Transfer Innovative Solutions in Medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86108395","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 : 2018-11-21DOI: 10.21303/2585-663.2018.00774
O. Buznytska
Non-alcoholic fatty liver disease occurs in most obese people, the main pathway of which is the process of fibrogenesis. This disorder is currently classified into two types: hepatic steatosis and nonalcoholic steatohepatitis. Hepatic steatosis is a reversible condition in which large vacuoles of triglyceride fat accumulate in the liver cells, causing nonspecific inflammation. Most people with this condition experience few, if any, symptoms, and it does not usually lead to scarring or serious liver damage. The majority of patients with nonalcoholic fatty liver disease have this type. Nonalcoholic steatohepatitis is the more severe, progressive form that involves not only fat accumulation (steatosis) in the liver but also inflammation. Steatohepatitis can lead to fibrosis and eventually to cirrhosis, which is severe scarring that can lead to liver failure. The real frequency of the prevalence of the disease is difficult to establish, due to the insufficient use of non-invasive screening diagnostic methods, through which it is possible to detect the initial forms of the disease. The aim: to study the diagnostic significance of the serum biomarkers of liver fibrogenesis in adolescents with obesity. Methods. On the base of the Department of Endocrinology, SI “Institute of children and adolescence health care of NAMS” (Kharkov) 226 patients with obesity aged 8–18 years were examined. Investigation of liver fibrosis consisted of measurement in blood the levels of fibronectin, collagen type IV, N-terminal propeptides and C-terminal telopeptides of type I collagen by IFA method. Results. The study of liver fibrogenesis revealed a significant increase in levels of type IV collagen and fibronectin in children with obesity (p<0.05). As diagnostic criteria for two physiologically diverse processes – fibrogenesis and fibrolysis, the levels of N-terminal propeptides and C-terminal telopeptides of type I collagen, respectively, were determined. The serum level of N-terminal propeptides of type I collagen significantly exceeds the normal values in all children with obesity, in contrast to the children of the control group (p<0.05). Conclusion. It has been established that a biochemical method for determining the level of type IV collagen, fibronectin, N-terminal propeptides and C-terminal telopeptides of type I collagen has a high sensitivity for the diagnosis of liver fibrogenesis.
{"title":"ADVANTAGES OF BIOCHEMICAL METHODS OF DIAGNOSING FIBROSIS IN NON-ALCOHOLIC FATTY LIVER DISEASE IN ADOLESCENTS WITH OBESITY","authors":"O. Buznytska","doi":"10.21303/2585-663.2018.00774","DOIUrl":"https://doi.org/10.21303/2585-663.2018.00774","url":null,"abstract":"Non-alcoholic fatty liver disease occurs in most obese people, the main pathway of which is the process of fibrogenesis. This disorder is currently classified into two types: hepatic steatosis and nonalcoholic steatohepatitis. Hepatic steatosis is a reversible condition in which large vacuoles of triglyceride fat accumulate in the liver cells, causing nonspecific inflammation. Most people with this condition experience few, if any, symptoms, and it does not usually lead to scarring or serious liver damage. The majority of patients with nonalcoholic fatty liver disease have this type. Nonalcoholic steatohepatitis is the more severe, progressive form that involves not only fat accumulation (steatosis) in the liver but also inflammation. Steatohepatitis can lead to fibrosis and eventually to cirrhosis, which is severe scarring that can lead to liver failure. The real frequency of the prevalence of the disease is difficult to establish, due to the insufficient use of non-invasive screening diagnostic methods, through which it is possible to detect the initial forms of the disease. The aim: to study the diagnostic significance of the serum biomarkers of liver fibrogenesis in adolescents with obesity. Methods. On the base of the Department of Endocrinology, SI “Institute of children and adolescence health care of NAMS” (Kharkov) 226 patients with obesity aged 8–18 years were examined. Investigation of liver fibrosis consisted of measurement in blood the levels of fibronectin, collagen type IV, N-terminal propeptides and C-terminal telopeptides of type I collagen by IFA method. Results. The study of liver fibrogenesis revealed a significant increase in levels of type IV collagen and fibronectin in children with obesity (p<0.05). As diagnostic criteria for two physiologically diverse processes – fibrogenesis and fibrolysis, the levels of N-terminal propeptides and C-terminal telopeptides of type I collagen, respectively, were determined. The serum level of N-terminal propeptides of type I collagen significantly exceeds the normal values in all children with obesity, in contrast to the children of the control group (p<0.05). Conclusion. It has been established that a biochemical method for determining the level of type IV collagen, fibronectin, N-terminal propeptides and C-terminal telopeptides of type I collagen has a high sensitivity for the diagnosis of liver fibrogenesis.","PeriodicalId":33846,"journal":{"name":"Technology Transfer Innovative Solutions in Medicine","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83508664","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 : 2018-11-21DOI: 10.21303/2585-663.2018.00779
I. Zhabchenko, S. Tertychnaya-Telyuk
Aim of the research is to study identification of peculiar issues associated with psycho-emotional state and the related stress-associated hormones and micronutrients in pregnant-displace individuals for further improvement of programmes for antenatal research. Materials and methods. In order to reach the research objective, a dynamic prospective clinical-paraclinical examination of 96 pregnant women (experimental group) – temporary displaced individuals with gestation period of more than 22 weeks who have been treated and gave birth to their children in the Central Municipal Hospital in Rubizhne and Perinatal Centre in Severodonetsk, Lugansk region. The control group consists of 39 randomly selected pregnant women for the purposes of prospective research that are living in the areas under the control of Ukraine government. All pregnant women were examined (clinical-laboratory and special midwifery examinations), the evaluation of psycho-emotional state of examined pregnant women was conducted with the help of screening by performing clinical interviews together with routine questioning. The questionnaires that contained the questions of Spielberg’s tests in the modification of Khanin were composed in advance. Concentration of stress-associated hormones in the blood serum, Ca and Mg was identified using the method of solid-phase immuno-ferment analysis. Results. According to the Spielberg’s test, the average score of reactive anxiety in the experimental group exceeded the analogous indicator in the control group by 1.6 times. The indicators of personal anxiety exceeded the normal indicator in the control group by 2.2 times. Of the pregnant women in the experimental group had the concentration of cortisol in the blood serum exceeded the upper physiological standard by 5.5 % and exceeded the analogous indicator in the control group by 43.4 %. The increase concentration of prolactin was yet observed in the II trimester of pregnancy if compared to the upper level of physiological standard by 13.3 %; if compared to the average indicator of this hormone in the control group - by 20.3 %. In the III trimester - concentration in both groups was within normal ranges, but in the experimental group this indicator was higher by 10.5 %. In the experimental group of pregnant women the concentration of Ca in the blood serum in comparison to the physiological standard was higher by 19.2 % and by 9.6 % higher if compared to the analogous indicator in the control group of pregnant women. At the same time, the pregnant women in the experimental group have low concentration of Mg. Conclusions. Taking into account the identified patterns, it is useful to categorise the pregnant women from among the internally displaced individuals as the group of high risk with respect to the development of obstetric and perinatal complications.
{"title":"POSTTRAUMATIC SYNDROME DURING PREGNANCY: EXPECTATIONS AND REALITY","authors":"I. Zhabchenko, S. Tertychnaya-Telyuk","doi":"10.21303/2585-663.2018.00779","DOIUrl":"https://doi.org/10.21303/2585-663.2018.00779","url":null,"abstract":"Aim of the research is to study identification of peculiar issues associated with psycho-emotional state and the related stress-associated hormones and micronutrients in pregnant-displace individuals for further improvement of programmes for antenatal research. Materials and methods. In order to reach the research objective, a dynamic prospective clinical-paraclinical examination of 96 pregnant women (experimental group) – temporary displaced individuals with gestation period of more than 22 weeks who have been treated and gave birth to their children in the Central Municipal Hospital in Rubizhne and Perinatal Centre in Severodonetsk, Lugansk region. The control group consists of 39 randomly selected pregnant women for the purposes of prospective research that are living in the areas under the control of Ukraine government. All pregnant women were examined (clinical-laboratory and special midwifery examinations), the evaluation of psycho-emotional state of examined pregnant women was conducted with the help of screening by performing clinical interviews together with routine questioning. The questionnaires that contained the questions of Spielberg’s tests in the modification of Khanin were composed in advance. Concentration of stress-associated hormones in the blood serum, Ca and Mg was identified using the method of solid-phase immuno-ferment analysis. Results. According to the Spielberg’s test, the average score of reactive anxiety in the experimental group exceeded the analogous indicator in the control group by 1.6 times. The indicators of personal anxiety exceeded the normal indicator in the control group by 2.2 times. Of the pregnant women in the experimental group had the concentration of cortisol in the blood serum exceeded the upper physiological standard by 5.5 % and exceeded the analogous indicator in the control group by 43.4 %. The increase concentration of prolactin was yet observed in the II trimester of pregnancy if compared to the upper level of physiological standard by 13.3 %; if compared to the average indicator of this hormone in the control group - by 20.3 %. In the III trimester - concentration in both groups was within normal ranges, but in the experimental group this indicator was higher by 10.5 %. In the experimental group of pregnant women the concentration of Ca in the blood serum in comparison to the physiological standard was higher by 19.2 % and by 9.6 % higher if compared to the analogous indicator in the control group of pregnant women. At the same time, the pregnant women in the experimental group have low concentration of Mg. Conclusions. Taking into account the identified patterns, it is useful to categorise the pregnant women from among the internally displaced individuals as the group of high risk with respect to the development of obstetric and perinatal complications.","PeriodicalId":33846,"journal":{"name":"Technology Transfer Innovative Solutions in Medicine","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89360380","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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