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Atezolizumab and Bevacizumab in Therapy for Patients with Hepatocellular Carcinoma in Real Clinical Practice 阿特唑单抗和贝伐单抗在实际临床中治疗肝细胞癌患者
Pub Date : 2023-06-30 DOI: 10.24060/2076-3093-2023-13-2-131-142
G. A. Serebrennikov, К. V. Menshikov, A. V. Sultanbaev, S. Musin, I. Menshikova, N. Sultanbaeva, D. Lipatov, A. S. Rezyapova
   Randomized clinical trials and actual clinical practice differsignificantly. Evidence-based medicine develops new agents referring to, primarily, pharmaceutical findings, preclinical studies and, most importantly, randomized clinical trials. Hepatocellular carcinoma is the most common primary malignancy of the liver, and one of the main causes of fatal outcomes among cancer patients worldwide, including in the Asia-Pacific region, with an estimated 800,000 deaths annually. For more than 10 years, sorafenib, a tyrosine kinase inhibitor, was the only authorized treatment for advanced hepatocellular carcinoma. The next stage in the development of drug therapy for hepatocellular carcinoma involved immune checkpoint inhibitors. The combination of atezolizumab with bevacizumab in the phase III trial (IMbrave150) improved outcomes of advanced hepatocellular carcinoma, such as overall survival and progression-free survival (6.8 versus 4.3). The paper presents the trials of atezolizumab and bevacizumab combination, demonstrates comparable data on the treatment of patients with HCC in real clinical practice and data on the phase III IMbrave150. To further analyze the efficacy of the combination of atezolizumab and bevacizumab, prospective clinical trials should include heterogeneous patient groups.
随机临床试验与实际临床实践差异显著。循证医学主要参考药物发现、临床前研究和最重要的随机临床试验开发新药。肝细胞癌是最常见的原发性肝脏恶性肿瘤,也是全世界(包括亚太地区)癌症患者死亡的主要原因之一,估计每年有80万人死亡。10多年来,索拉非尼(sorafenib)是一种酪氨酸激酶抑制剂,是唯一被批准治疗晚期肝细胞癌的药物。肝细胞癌药物治疗发展的下一阶段涉及免疫检查点抑制剂。在III期试验(IMbrave150)中,atezolizumab联合贝伐单抗改善了晚期肝细胞癌的预后,如总生存期和无进展生存期(6.8 vs 4.3)。本文介绍了atezolizumab和bevacizumab联合治疗HCC患者的试验,展示了实际临床实践中治疗HCC患者的可比数据和III期IMbrave150的数据。为了进一步分析阿特唑单抗与贝伐单抗联合使用的疗效,前瞻性临床试验应纳入异质性患者组。
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引用次数: 0
Acute Appendicitis: How Often is Appendectomy Negative? 急性阑尾炎:阑尾切除术阴性的频率是多少?
Pub Date : 2023-06-30 DOI: 10.24060/2076-3093-2023-13-2-112-118
S. Timerbulatov, M. V. Timerbulatov, S. V. Fedorov, A. R. Gafarova, V. M. Timerbulatov, V. M. Sibaev
   Introduction. At present, medical practice lacks a unifi ed approach to the choice of therapeutic tactics for acute catarrhal appendicitis and therefore lacks understanding of negative appendectomy.   Aim. To study the incidence of negative appendectomy in acute appendicitis. Materials and methods. The methodology involved a retrospective analysis of the results of 1590 appendectomies performed from 2003 to 2005 and a prospective non-randomized study of 1112 patientsfor the period from 2018 to 2019. During the first observation period, the examination included physical and laboratory examinations, and in the second period, Alvaro scoring, ultrasound scan, and videolaparoscopy.   Results and discussion. In the first period, catarrhal forms of appendicitis were reported in 7.82 % of cases, while in the second period — in 3.04 %. The diagnoses were confi rmed pathohistologically in all cases.   Conclusion. No cases of performing negative appendectomy were reported, based on the results of clinical, endoscopic and pathomorphological examinations. However, the ambiguous interpretation of acute catarrhal appendicitis in the national clinical practice guidelines for acute appendicitis does not allow for unambiguous conclusions from the study.
介绍目前,医学实践对急性卡他性阑尾炎的治疗策略选择缺乏统一的方法,因此对阴性阑尾切除术缺乏了解。目标。研究急性阑尾炎阑尾切除术阴性的发生率。材料和方法。该方法包括对2003年至2005年进行的1590例阑尾切除术的结果进行回顾性分析,以及对2018年至2019年期间1112名患者进行的前瞻性非随机研究。在第一个观察期内,检查包括身体和实验室检查,在第二个观察期,检查包括Alvaro评分、超声扫描和视频腹腔镜检查。结果和讨论。在第一阶段,7.82%的病例报告了卡他性阑尾炎,而在第二阶段,报告了3.04%。所有病例的诊断均经病理组织学证实。结论。根据临床、内镜和病理形态学检查的结果,没有进行阴性阑尾切除术的病例报告。然而,国家急性阑尾炎临床实践指南中对急性卡他性阑尾炎的模糊解释不允许该研究得出明确的结论。
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引用次数: 0
Intraoperative ICG-Fluorescence as a Method to Prevent Postoperative Strictures of Uretero-Ileal Anastomoses in Robot-Assisted Radical Cystectomy 术中icg -荧光预防机器人辅助根治性膀胱切除术后输尿管-回肠吻合口狭窄的方法
Pub Date : 2023-06-29 DOI: 10.24060/2076-3093-2023-13-2-97-104
V. Pavlov, M. Urmantsev, M. R. Bakeev, A. S. Deneyko
   Introduction. Radical cystectomy with urine diversion is recognized as the standard for the treatment of muscle-invasive bladder cancer. One of the dangerous complications in the postoperative period is the stricture of uretero-ileal anastomosis leading to hydroureteronephrosis, renal failure, and urosepsis. One of the factors in the development of the anastomotic stricture is ischemia. In order to reduce possible ischemic injury, the following manipulations are performed: careful treatment of tissues in the area of future anastomosis, preservation of periureteral adventitia, minimal mobilization of ureters before implantation into conduit. Intraoperative assessment of ureteral and intestinal tissue perfusion using ICG-fluorescence is a promising area.   Materials and methods. The study enrolled 56 patients who underwent a robotic-assisted radical cystectomy with intracorporeal urine diversion from January 2021 to March 2022 at the Bashkir State Medical University Clinic. Patients were divided into two groups: group 1 (22 patients) underwent intraoperative ICG-imaging, and group 2 (34 patients) — imaging without fluorescence. The median follow-up period was 14 months for group 1 and 12 months for group 2. The comparison criteria between the groups were demographic indicators, perioperative outcomes (including 30- and 90-day complications), and the incidence of strictures of uretero-ileal anastomoses. The groups were compared using a test for equality of means and a test for sampling distributions.   Results and discussion. No statistically significant differences between patients were reported during the time of surgery, estimated blood loss, and duration of hospital stay. No significant differences were also detected in the incidence of 30- and 90-day complications and the number of readmissions among patients in group 1 and group 2 (p = 0.477 and p = 0.089, respectively). The incidence of strictures of uretero-ileal anastomosis in group 1 demonstrated a statistically significant decrease, as compared with group 2 (0/34 [0 %] and 7/68 [10.3 %], p = 0.020).   Conclusion. The ICG-fluorescence imaging to assess vascularization of the distal ureter during robotic-assisted radical cystectomy with intracorporeal urine diversion may reduce the risk of postoperative uretero-ileal anastomotic ischemic strictures.
介绍。根治性膀胱切除术加导尿术是公认的治疗肌肉浸润性膀胱癌的标准方法。输尿管回肠吻合口狭窄是术后最危险的并发症之一,可导致输尿管积水、肾功能衰竭和尿脓毒症。缺血是引起吻合口狭窄的因素之一。为减少可能出现的缺血性损伤,应谨慎处理未来吻合区组织,保留输尿管外膜,在输尿管植入前尽量减少输尿管的活动。术中应用icg荧光评价输尿管和肠组织灌注是一个很有前途的领域。材料和方法。该研究招募了56名患者,他们于2021年1月至2022年3月在巴什基尔国立医科大学诊所接受了机器人辅助的根治性膀胱切除术和体内尿转移。患者分为两组:1组(22例)行术中造影,2组(34例)行无荧光造影。组1中位随访时间为14个月,组2中位随访时间为12个月。两组比较标准为人口统计学指标、围手术期结局(包括30天和90天并发症)、输尿管回肠吻合口狭窄发生率。使用均数相等检验和抽样分布检验对各组进行比较。结果和讨论。在手术时间、估计失血量和住院时间方面,患者之间没有统计学上的显著差异。1组与2组患者30天、90天并发症发生率及再入院次数差异无统计学意义(p = 0.477、p = 0.089)。1组输尿管回肠吻合口狭窄发生率较2组有统计学意义(0/34[0%]和7/68 [10.3%],p = 0.020)。结论。在机器人辅助根治性膀胱切除术合并膀胱内尿分流术中,采用icg荧光成像评估输尿管远端血管化可能降低术后输尿管-回肠吻合口缺血性狭窄的风险。
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引用次数: 0
Pulmonary Autograft Dilatation and its Risk Factors After Classical Ross Procedure: a Retrospective Single Center Study 经典Ross术后自体肺扩张及其危险因素的回顾性单中心研究
Pub Date : 2023-06-29 DOI: 10.24060/2076-3093-2023-13-2-105-111
I. Chernov, S. Enginoev, S. Ekimov, T. K. Rashidova, U. K. Abdulmedzhidova, M. A. Guliyev, A. Ziankou, A. Gamzaev
   Introduction. Aortic valve replacement with pulmonary autograft (Ross procedure) demonstrated excellent immediate and long-term results. Dilation of the pulmonary autograft in the long-term period is the main reason for repeated surgery. Aim: to study the prevalence of pulmonary autograft dilatation and its risk factors.   Materials and methods. From April 2009 to December 2022, 158 patients underwent classical Ross surgery. Inclusion criteria: patients aged 18 and older, patients who underwent classical surgery. Exclusion criteria: patients under 18, modifi ed methods of Ross procedure. Follow-up period: 104 (49–124) months.   Results and discussion. The median age of patients was 33 (25–43) years. Hospital mortality accounted for 0.6 %. Perioperative myocardial injury was 3.8 %, conduction disorder requiring permanent pacemaker implantation accounted for 1.9 %, the incidence of strokes and acute kidney injury requiring hemodialysis was 0.6 %. Ten-year freedom from autograft reoperation was 88.4. Ten-year freedom from reoperation for aortic aneurysm accounted for 92 %. Predictors of autograft dilatation in the long-term period were: age (OR: 0.942; 95% CI: 0.901–0.984, p = 0.008) and the initial size of sinuses of Valsalva (OR: 1.18; 95% CI: 1.027–1.215, p = 0.01).   Conclusion. Ten-year freedom from autograft reoperation due to aortic dilatation and freedom from aortic dilatation ≥ 45 mm was 92 % and 37.2 %, respectively. The main predictors of autograft dilatation in the postoperative period are the age and the initial diameter of the sinuses of Valsalva.
介绍自体肺移植主动脉瓣置换术(Ross手术)显示出良好的近期和长期效果。自体肺移植物的长期扩张是重复手术的主要原因。目的:探讨自体肺移植扩张的发生率及其危险因素。材料和方法。从2009年4月到2022年12月,158名患者接受了经典的罗斯手术。纳入标准:年龄在18岁及以上的患者,接受经典手术的患者。排除标准:18岁以下患者,改良罗斯手术方法。随访时间:104(49-124)个月。结果和讨论。患者的中位年龄为33(25-43)岁。住院死亡率占0.6%。围手术期心肌损伤占3.8%,需要植入永久性起搏器的传导障碍占1.9%,需要血液透析的中风和急性肾损伤的发生率为0.6%。10年无自体移植物再次手术88.4例。主动脉瘤10年无再手术发生率为92%。长期预测自体移植物扩张的因素是:年龄(OR:0.942;95%CI:0.901-0.984,p=0.008)和瓦尔萨尔瓦窦的初始大小(OR:1.18;95%CI:1.027-1.215,p=0.001)。结论。10年内因主动脉扩张而再次进行自体移植物移植的自由度和主动脉扩张≥45mm的自由度分别为92%和37.2%。术后自体移植物扩张的主要预测因素是瓦尔萨尔瓦窦的年龄和初始直径。
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引用次数: 0
Aortic Valve Reinterventions after Ozaki: Clinical Case Series from Four Centers Ozaki术后主动脉瓣再狭窄:来自四个中心的临床病例系列
Pub Date : 2023-04-06 DOI: 10.24060/2076-3093-2023-13-1-87-92
Introduction. One of surgical methods for treatment of aortic valve (AV) pathology is Aortic Valve Neocuspidalization Ozaki procedure (AVNeo). Thus, according to the latest systematic review, freedom from reoperation within one, three, five years after AVNeo was 98%, 97% and 96%. Available references provide few descriptions of reoperations after AVNeo. Aim. To analyze the immediate results of AV reinterventions after AVNeo. Materials and methods. In the medium term, reinterventions after AVNeo were necessary for 11 patients (4.3%). The age of patients ranged from 26 to 69 years. 11 patients who underwent surgery included 6 males and 5 females. Four patients had class III-IV CHF, according to NYHA classification. Three patients had previously been operated on for infective endocarditis (IE), and five patients had bicuspid aortic valve. The duration of follow-up, from AVNeo surgery to reinterventions, ranged from 3 to 43 months. Results and discussion. All patients underwent an isolated AV intervention. The main causes of dysfunction were IE (six patients) and leaflet rupture in the commissural area (five patients). Seven patients underwent aortic valve replacement with mechanical valves, one patient — with aortic homograft valve, one patient — with tissue valve and two patients underwent valve repair. In the early postoperative period, one patient had bleeding with the development of cardiac tamponade and one patient had a haemorrhagic stroke. No patients had ARF, perioperative myocardial damage, sternal infection or permanent pacemaker implantation. Two patients died during the hospital period. Conclusions. AV reinterventions are associated with a high incidence of complications and deaths. Therefore, prevention of IE and commissure enhancement should reduce the frequency of repeated interventions, which is to be confirmed by prospective studies in large cohorts of patients.
介绍治疗主动脉瓣(AV)病理的手术方法之一是主动脉瓣新尖化Ozaki手术(AVNeo)。因此,根据最新的系统综述,AVNeo术后一年、三年、五年内免于再次手术的比例分别为98%、97%和96%。现有参考文献对AVNeo术后再次手术的描述很少。目标分析AVNeo后AV再干预的即时效果。材料和方法。从中期来看,11名患者(4.3%)需要在AVNeo后进行再干预。患者年龄从26岁到69岁不等。接受手术的11名患者包括6名男性和5名女性。根据NYHA分类,4名患者患有III-IV级CHF。三名患者之前曾因感染性心内膜炎(IE)接受过手术,五名患者患有二叶主动脉瓣。从AVNeo手术到再干预,随访时间为3至43个月。结果和讨论。所有患者均接受了单独的AV干预。功能障碍的主要原因是IE(6例患者)和连合区小叶破裂(5例患者)。7名患者接受了机械瓣膜主动脉瓣置换术,1名患者接受同种主动脉瓣移植术,1例患者接受组织瓣膜移植术,2名患者接受瓣膜修复术。在术后早期,一名患者因心脏填塞而出血,另一名患者发生出血性中风。没有患者出现ARF、围手术期心肌损伤、胸骨感染或永久性起搏器植入。两名患者在住院期间死亡。结论。AV再干预与并发症和死亡的高发生率相关。因此,预防IE和连合增强应减少重复干预的频率,这将通过对大量患者的前瞻性研究得到证实。
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引用次数: 0
Eribulin in Metastatic Breast Cancer: Actual Clinical Practice 艾瑞布林治疗转移性癌症的临床实践
Pub Date : 2023-04-05 DOI: 10.24060/2076-3093-2023-13-1-77-86
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引用次数: 0
Bowen's Disease: Literature Review 鲍恩病:文献综述
Pub Date : 2023-04-05 DOI: 10.24060/2076-3093-2023-13-1-68-76
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引用次数: 0
Urethral Stricture and Methods for its Correction 尿道狭窄及其矫正方法
Pub Date : 2023-04-05 DOI: 10.24060/2076-3093-2023-13-1-58-67
R. A. Kazikhinurov, B. I. Shamsov, A. A. Kazikhinurov, R. R. Kazikhinurov, A. Hasanov
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引用次数: 0
Laparoscopic Surgery for Acute Appendicitis Complicated by Peritonitis 急性阑尾炎并发腹膜炎的腹腔镜手术治疗
Pub Date : 2023-04-04 DOI: 10.24060/2076-3093-2023-13-1-33-38
O. Galimov, V. O. Khanov, D. Minigalin, D. Galimov, A. Safargalina, D. F. Galiullin
{"title":"Laparoscopic Surgery for Acute Appendicitis Complicated by Peritonitis","authors":"O. Galimov, V. O. Khanov, D. Minigalin, D. Galimov, A. Safargalina, D. F. Galiullin","doi":"10.24060/2076-3093-2023-13-1-33-38","DOIUrl":"https://doi.org/10.24060/2076-3093-2023-13-1-33-38","url":null,"abstract":"","PeriodicalId":52846,"journal":{"name":"Kreativnaia khirurgiia i onkologiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42566231","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}
引用次数: 0
Perioperative Patient Management in Mammary Coronary Bypass Surgery Using Da Vinci Surgical System 达芬奇手术系统在乳腺冠状动脉搭桥手术中的围手术期患者管理
Pub Date : 2023-04-04 DOI: 10.24060/2076-3093-2023-13-1-27-32
A. F. Nurimanshin, R. Bogdanov, A. A. Khusaenova
{"title":"Perioperative Patient Management in Mammary Coronary Bypass Surgery Using Da Vinci Surgical System","authors":"A. F. Nurimanshin, R. Bogdanov, A. A. Khusaenova","doi":"10.24060/2076-3093-2023-13-1-27-32","DOIUrl":"https://doi.org/10.24060/2076-3093-2023-13-1-27-32","url":null,"abstract":"","PeriodicalId":52846,"journal":{"name":"Kreativnaia khirurgiia i onkologiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42087054","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}
引用次数: 0
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