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SOME ASPECTS OF EPIDEMIOLOGY, PATHOGENESIS, DIAGNOSIS AND TREATMENT OF MULTIPLE MYELOMA 多发性骨髓瘤的流行病学、发病机制、诊断和治疗
Pub Date : 2021-01-01 DOI: 10.25005/2074-0581-2021-23-3-395-409
S. Abdullaeva
A literature review article provides a comprehensive overview of literature related to epidemiology, pathogenesis, diagnosis and treatment of multiple myeloma (MM). Literature data show that MM has unclear patterns of the disease distribution, and there are trends in rising incidence. Although the aetiology of MM is not fully understood, according to most researchers, risk factors (RFs) leading to a progressively high incidence of MM include advanced age, male gender, exposure to harmful environmental factors (ionising radiation, chemical agents), family predisposition, an increased prevalence of autoimmune diseases and obesity. MM is characterised by the absence of specific clinical manifestations and similarity with other conditions, which is one of the factors associated with delay in diagnosis of MM. Damage to internal organs, particularly the heart and kidneys, a frequent complication of MM, leads to mutual burdening and is also one of the factors of adverse outcomes early during the disease. The International Myeloma Working Group (IMWG) diagnostic criteria and additional investigation techniques allow high accuracy to diagnose MM and its complications. Despite the development and introduction of new drugs and treatments, the long-term survival rates in MM patient remains low. Therefore there is a need for further research in this direction. Keywords: Multiple myeloma, cardiorenal complications, diagnostics, free light chains of immunoglobulins, treatment.
本文对多发性骨髓瘤(MM)的流行病学、发病机制、诊断和治疗进行综述。文献资料显示MM疾病分布规律不明确,发病率有上升趋势。尽管MM的病因尚不完全清楚,但大多数研究人员认为,导致MM发病率逐渐升高的危险因素(rf)包括高龄、男性、暴露于有害环境因素(电离辐射、化学制剂)、家庭易感性、自身免疫性疾病患病率增加和肥胖。MM的特点是没有特定的临床表现,与其他疾病相似,这是MM诊断延迟的因素之一。MM的常见并发症是内脏器官,特别是心脏和肾脏的损害,导致相互负担,也是疾病早期不良结局的因素之一。国际骨髓瘤工作组(IMWG)的诊断标准和附加的调查技术使得诊断骨髓瘤及其并发症的准确性很高。尽管开发和引进了新的药物和治疗方法,MM患者的长期生存率仍然很低。因此,有必要在这个方向上进行进一步的研究。关键词:多发性骨髓瘤,心肾并发症,诊断,免疫球蛋白游离轻链,治疗
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引用次数: 0
THE OUTCOMES OF THE FOREARM FLAP APPLICATIONS IN THE UPPER LIMB SEVERE INJURIES RECONSTRUCTION 前臂皮瓣在上肢严重损伤重建中的应用效果
Pub Date : 2021-01-01 DOI: 10.25005/2074-0581-2021-23-3-450-461
G. D. Karim-zade, M. Malikov, B. Odinaev, M. A. Khasanov, N. Mirzoev, N. A. Makhmadkulova
Objective: Improving the outcomes of surgical treatment of upper limb (UL) injuries by using regional soft tissue flaps. Methods: The analysis of surgical interventions outcomes of integumentary tissue defects and forearm and hand structures of traumatic genesis was conducted in 37 patients. Traumatic injuries to the forearm and hand structures with soft tissue defects occurred in 11 patients, and 26 trauma patients were hospitalized. The patients had superficial soft tissue defects (STDs) involving various areas, accompanied by damage to the underlying neurovascular bundles (NVBs), tendons and bones. Results: Depending on the nature of trauma and the injured tissues’ state, the reconstruction sequence’s principle was followed. In 32 (86.5%) cases, the restoration of functional skin integument and reconstruction of injured anatomical structures of the limb were performed in a single stage. Twostage reconstruction was carried out in 5 (13.5%) patients, with initial STDs repair followed by reconstruction of the NVBs and tendons. Selection criteria for a sequence of surgical repair included the nature of the injury and the severity of the patient’s condition in emergencies. The following grafts were used: RFFF: radial forearm free flap (n=3); RRF: the reverse radial forearm flap (n=25); the ulnar reverse forearm flap (n=6), PIA: posterior interosseous artery flap (n=3). In the immediate postoperative period, compromised blood circulation in the transplanted flaps were observed in 2 (5.4%) cases. Timely diagnosis and treatment resulted in a positive outcome. Long-term functional and aesthetic outcomes of the reconstruction were considered acceptable in all patients. Conclusion: A proper surgical procedure selection for UL structures injuries and their consequences influences long term postoperative aesthetic and functional outcomes. Choice of single or multiple stages of reconstruction largely depends on the location of the defect, the state of the tissues in the recipient area and the nature of the injury to the underlying anatomical structures of the limb. Keywords: Upper limb, injuries and their consequences, soft-tissue defect, flaps.
目的:提高局部软组织皮瓣治疗上肢损伤的手术效果。方法:对37例外伤性外伤性前臂及手部组织缺损的手术治疗结果进行分析。外伤性前臂及手部结构损伤伴软组织缺损11例,住院26例。患者有浅表软组织缺损(STDs),涉及多个区域,并伴有潜在神经血管束(NVBs)、肌腱和骨骼的损伤。结果:根据创伤的性质和损伤组织的状态,遵循重建顺序的原则。32例(86.5%)患者一次性完成功能性皮肤修复和肢体解剖结构重建。5例(13.5%)患者进行了两阶段重建,首先进行性病修复,然后重建NVBs和肌腱。手术修复顺序的选择标准包括损伤的性质和紧急情况下患者病情的严重程度。采用的移植物有:RFFF:前臂桡骨游离皮瓣(n=3);RRF:前臂桡侧逆行皮瓣(n=25);尺侧前臂逆行皮瓣(n=6), PIA:骨间后动脉皮瓣(n=3)。术后立即出现2例(5.4%)移植皮瓣血液循环受损。及时的诊断和治疗取得了积极的结果。所有患者重建的远期功能和美观结果均可接受。结论:选择合适的手术方式治疗UL结构损伤及其后果影响术后长期的美观和功能预后。选择单阶段或多阶段的重建在很大程度上取决于缺损的位置、受区组织的状态和肢体底层解剖结构损伤的性质。关键词:上肢,损伤及其后果,软组织缺损,皮瓣。
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引用次数: 0
BONE MINERAL DENSITY IN POSTMENOPAUSAL WOMEN WITH TYPE 2 diabetes mellitus in THE HIGH FERTILITY REGION 高生育地区绝经后2型糖尿病妇女的骨密度
Pub Date : 2021-01-01 DOI: 10.25005/2074-0581-2021-23-1-67-72
S. Anvarova, M. E. Muzafarova
To study the state of the sceletal system in type 2 diabetes mellitus (T2DM) in postmenopausal women, taking into account parity.
研究绝经后2型糖尿病(T2DM)妇女的大脑系统状态,考虑胎次。
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引用次数: 0
CLINICAL AND MORPHOLOGICAL EVIDENCE OF THE EFFECTIVENESS OF HYDROGEN PEROXIDE (PERHYDROL) APPLICATION FOR THE RECURRENCE PREVENTION AFTER HYDATID CYSTECTOMY FOR HEPATIC ECHINOCOCCOSIS 过氧化氢(过氢)应用于预防肝包虫病包虫病切除后复发的临床和形态学证据
Pub Date : 2021-01-01 DOI: 10.25005/2074-0581-2021-23-4-542-552
M. Gulov, A. Dzhaborov, S. M. Abdulloev, A. S. Ashurov, S. Ali-Zade
Objective: Experimental and histological justification of the use of perhydrol to treat the residual cavity (RC) and recurrence prevention after hydatid cystectomy for hepatic echinococcosis (HE) Methods: The results of surgical treatment of 85 patients with HE were evaluated between 2010 and 2019. In all patients after hydatid cystectomy, RCs were treated with 33% perhydrol. The scolicidal activity of 33% perhydrol was tested in vitro when the latter acted on protoscoleces obtained during the operation. In addition, a histological examination of the fibrous capsule (FC) was performed before and after RC treatment with a perhydrol solution. Results: Following exposure to perhydrol, the protoscolices lost their characteristic round or oval shape with the translucence of the parenchymatous tissue and the disappearance of the calcareous corpuscles. Following 1-minute exposure to a perhydrol solution, scolex swelling was observed, followed by a decrease in size due to the "boiling" of the released gas bubbles, as a result of perhydrol decomposition to oxygen and water with release of heat. Following 1.5-minutes of exposure to perhydrol solution, significant destructive changes were observed: delamination and tegument integrity loss, free hooklets, protoscolices dissolution, which indicated the parasite's death. On RC histological tissue preparations, stratification and destruction of FC were noted. In the long-term follow-up period for operated patients, there were no cases of HE recurrence. Conclusion: In vitro studies have shown that the treatment of protoscoleces with perhydrol solution leads to destruction followed by dissolution of the germinal layer. The perhydrol penetration into the FC walls resulting in its stratification and destruction contributes to the disease recurrence prevention. Keywords: Hepatic echinococcosis, hydatid cyst disease (HCD), fibrous capsule, residual cavity, recurrence, scolex, morphological study.residual cavity, recurrence, scolex, morphological study.
目的:对肝包虫病(HE)包虫膀胱切除术后使用过氢醇治疗残留腔(RC)及预防复发的实验和组织学依据。方法:对2010 - 2019年85例肝包虫病(HE)患者的手术治疗结果进行评价。在所有包囊切除术后的患者中,RCs用33%的过水治疗。33%过水对手术中获得的原头节起作用,体外测定了其杀脊柱活性。此外,纤维囊(FC)的组织学检查是在用过氢溶液进行RC治疗前后进行的。结果:经过水处理后,原脊柱失去了原来的圆形或椭圆形,实质组织呈半透明状,钙质小体消失。在过氢溶液中暴露1分钟后,观察到头节肿胀,随后由于释放的气泡“沸腾”,由于过氢分解为氧气和水并释放热量,导致尺寸减小。暴露于过氢溶液1.5分钟后,观察到明显的破坏性变化:分层和被皮完整性丧失,游离钩,原脊柱溶解,这表明寄生虫死亡。在RC组织学组织制备中,注意到FC的分层和破坏。术后患者长期随访,无HE复发病例。结论:体外研究表明,用过水溶液处理原头节会导致生发层的破坏和溶解。过氧化氢渗透到FC壁,导致其分层和破坏,有助于预防疾病复发。关键词:肝包虫病,包虫病(HCD),纤维囊,残留腔,复发,头节,形态学研究残腔,复发,头节,形态学研究。
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引用次数: 0
PERSONALISED MEDICINE IN BRONCHIAL ASTHMA: CURRENT CONCEPTS AND PROSPECTS 支气管哮喘个体化治疗:目前的概念和前景
Pub Date : 2021-01-01 DOI: 10.25005/2074-0581-2021-23-3-418-431
R. Fayzullina, V. V. Viktorov, R. R. Gafurova
Bronchial asthma (BA) is today a global medical and socio-economic issue in the health care system. Manifesting in childhood, the disease persists throughout the patient’s life, characterised by a variable clinical course. The periods of remission are combined with the periods of exacerbation and a wide range of symptoms ranging from mild symptoms to severe illness. Following the data of epidemiological studies, BA occupies a leading place among the chronic disorders of the lungs of non-infectious aetiology with increasing the annual prevalence trend. The article presents a literature review on the prospects for a personalised medicine (PM) approach for the group of socially significant, multifactorial diseases, including BA. Implementing PM for asthma patients makes it possible to diagnose and predict the disease even at the preclinical stage. This will reduce mortality, morbidity and disability rates, cut the costs of treatment and rehabilitation of symptomatic patients, and increase the patient’s adaptive capabilities, coping with outdoor environmental and local factors. Keywords: Bronchial asthma, personalised medicine, HealthNet program, P4 medicine concept.
支气管哮喘(BA)是当今卫生保健系统中的一个全球性医学和社会经济问题。这种疾病在儿童时期表现出来,在患者的一生中持续存在,其特点是临床病程多变。缓解期与加重期相结合,症状范围广泛,从轻微症状到严重疾病。根据流行病学研究数据,BA在非感染性肺部慢性疾病中占主导地位,且每年患病率呈上升趋势。本文介绍了一篇文献综述的前景,个体化医疗(PM)的方法组的社会意义,多因素疾病,包括BA。对哮喘患者实施PM可以在临床前阶段就诊断和预测疾病。这将降低死亡率、发病率和残疾率,降低有症状患者的治疗和康复费用,并提高患者的适应能力,应对室外环境和当地因素。关键词:支气管哮喘,个体化治疗,健康网计划,P4医学理念
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引用次数: 0
EVALUATION OF VENTILATION-PERFUSION RATIO IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE 慢性阻塞性肺疾病患者通气灌注比的评价
Pub Date : 2021-01-01 DOI: 10.25005/2074-0581-2021-23-1-25-31
T. A. Miroshkina, S. Shustova, I. Ponomaryova
To study ventilation-perfusion ratio (VPR) in patients with chronic obstructive pulmonary disease (COPD) using method of volumetric capnography.
目的:应用容积造影方法研究慢性阻塞性肺疾病(COPD)患者的通气灌注比(VPR)。
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引用次数: 1
9 CASES OF AMYAND’S HERNIA IN CHILDREN 小儿阿米巴氏疝9例分析
Pub Date : 2021-01-01 DOI: 10.25005/2074-0581-2021-23-1-118-123
M. Malikov, F. Rashidov, F. B. Bokiev, F. Khamidov
9 children aged 4 to 14 years underwent a right-sided inguinal hernia repair, at the same time, a vermiform appendix was found in the hernial sac. All patients were hospitalized with a diagnosis of «Congenital right-sided inguinoscrotal hernia», bilateral hernias were not observed. Objectively, there were all signs of the disease, all hernias were reducible. The presence of the appendix in the hernial sac before the operation was not diagnosed either clinically or by ultrasound. The contents of the hernial sac had a thickened and long vermiform appendix, a greater omentum, and in two cases – a cecum of the type of sliding hernia. The children were operated on under general anesthesia: appendectomy and plastic surgery of posterior wall of inguinal canal were performed. No complications were observed in the postoperative period.
9例4 ~ 14岁儿童行右侧腹股沟疝修补术,同时在疝囊内发现蚓状阑尾。所有患者均因诊断为“先天性右侧腹股沟阴囊疝”而住院,未观察到双侧疝。客观地说,所有的症状都有,所有的疝气都是可以减轻的。术前阑尾在疝囊内的存在未被临床或超声诊断。疝囊的内容物有一个增厚的长蚓状阑尾,一个更大的网膜,在两个病例中-一个盲肠类型的滑动疝。患儿在全麻下行阑尾切除术和腹股沟管后壁整形手术。术后无并发症发生。
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引用次数: 1
ALL THE NEW IS THE WELL FORGOTTEN OLD: AUTOPERICARDIAL MITRAL ANNULOPLASTY FOR DEGENERATIVE DEFECTS 所有新的都是被遗忘的旧的:自体心包二尖瓣成形术治疗退行性缺陷
Pub Date : 2021-01-01 DOI: 10.25005/2074-0581-2021-23-3-366-378
S. A. Zhurko, A. Gamzaev, K. M. Aminov, P. V. Pimenova
Objective: To present the first-hand results of a modified mitral annuloplasty (MA) with an autopericardial strip (APS) in degenerative mitral valve disease (DMVD). Methods: Fifty-three patients with DMVD (mean age, 54.9±9.5 years (36-78 years); n=32 men (60.4%) and n=21women (39.6%)) undergoing MA with an APS, between January 2017 and January 2020 were retrospectively studied. In the overwhelming majority of cases, triangular and quadrangular resections of the P2 segment were performed. In addition, in some cases, neochords were implanted to the A2 segment. Intraoperatively, the result of MA was considered satisfactory if, according to transoesophageal echocardiography, the degree of mitral regurgitation (MR) did not exceed grade 1. Results: No in-hospital mortality was observed. One female patient had an early relapse caused by the rupture of one of the neochords at the A2 segment. However, the MR did not exceed grade 2, and the patient was actively followed up. Conclusion: Individual APS length selection avoids overcorrecting and achieves adequate systolic and diastolic mitral valve performance. Keywords: Annuloplasty, mitral regurgitation, autopericardium, mitral regurgitation.
目的:介绍改良二尖瓣环成形术(MA)与自心包带(APS)治疗退行性二尖瓣疾病(DMVD)的第一手结果。方法:53例DMVD患者(平均年龄54.9±9.5岁,36-78岁);回顾性研究了2017年1月至2020年1月期间接受MA合并APS的男性32名(60.4%)和女性21名(39.6%)。在绝大多数情况下,对P2节段进行三角形和四边形切除。此外,在一些病例中,新声带被植入到A2段。术中,如果经食管超声心动图显示二尖瓣反流(MR)不超过1级,则认为MA的结果令人满意。结果:无院内死亡。1例女性患者因A2段新声带破裂而早期复发。然而,MR未超过2级,并积极随访患者。结论:个体化的APS长度选择避免了矫治过度,达到了适当的收缩和舒张二尖瓣性能。关键词:环成形术,二尖瓣反流,心包自闭,二尖瓣反流。
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引用次数: 0
ABDOMINOPLASTY IN A WOMAN AFTER A SIGNIFICANT WEIGHT LOSS 体重显著减轻后的女性腹部成形术
Pub Date : 2021-01-01 DOI: 10.25005/2074-0581-2021-23-4-633-637
A. Davlatov, H. Dodariyon, G. AL OMER
In this paper, we wish to present a case report of a 38-year-old woman who underwent abdominoplasty (AP). Patient history obtained during the preoperative phase of care included sleeve gastroplasty, after which she noted a significant weight loss (about 35 kg). As a result, a saggy skin-fat flap of the abdomen in the form of an apron was formed. In addition, she was worried about the pronounced drooping and sagging breasts. Therefore, the patient was offered AP through combined vertical and horizontal incisions. However, due to the patient's refusal of the combined incisions, AP with a transverse incision and vertical mammoplasty were performed. A year later, dissatisfied with the cosmetic result, the patient insisted on AP through a combined incision, which was performed. At this time, the patient indicated her satisfaction with the aesthetic outcomes. Keywords: Saggy abdomen, abdominal dermatochalasis, bariatric surgery, abdominoplasty, mammoplasty.
在本文中,我们希望提出一个病例报告的38岁的妇女谁接受腹部成形术(AP)。术前护理阶段获得的患者病史包括胃套筒成形术,术后患者体重明显减轻(约35公斤)。结果,腹部形成了围裙形状的松弛的皮肤脂肪瓣。此外,她还担心乳房明显下垂和下垂。因此,通过垂直和水平联合切口为患者提供AP。然而,由于患者拒绝联合切口,我们进行了横向切口AP和垂直乳房成形术。一年后,患者对美容效果不满意,坚持行联合切口AP手术。此时,患者表示对美学结果满意。关键词:腹部下垂,腹部皮松弛,减肥手术,腹部成形术,乳房成形术。
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引用次数: 0
INFLUENCE OF PLASTIC AND RECONSTRUCTIVE SURGERY ON THE QUALITY OF LIFE OF PATIENTS WITH LOCALLY ADVANCED HEAD AND NECK CANCER 整形重建手术对局部晚期头颈癌患者生活质量的影响
Pub Date : 2021-01-01 DOI: 10.25005/2074-0581-2021-23-1-46-52
I. K. Niyazov, D. R. Sanginov, Z.KH. Khuseynzoda, N. Bazarov
A comparative assessment of the quality of life (QOL) parameters in patients with head and neck cancer (HNC) depending on the methods of reconstruction.
头颈癌(HNC)患者不同重建方法的生活质量(QOL)参数比较评估。
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引用次数: 1
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