Современное состояние проблемы системной красной волчанки в Казахстане

Objective: to analyze the provision of medical, including rheumatology, care in Kazakhstan, to study the incidence of systemic lupus erythematosus (SLE), and to develop a registry of patients with this condition.Material and methods. The investigators analyzed the guidelines for the organization of medical, including rheumatology, care in the republic and the official statistical materials of the Ministry of Health of the Republic of Kazakhstan in the period 2012 to 2017. Articles were searched to select activity indices, organ damages and to assess the quality of life and treatment programs in order to create a registry of patients with SLE.Results and discussion. The paper presents the basic principles of providing medical, including rheumatology, care in the republic. It gives data on the issues of providing SLE patients with medicines in outpatient and inpatient settings. It also analyzes trends in the incidence of SLE in the population of Kazakhstan in 2012 to 2017. There were 4,448 SLE patients, including 3,986 women; a comparative analysis of indicators demonstrated a 62.8% increase in the incidence of SLE from 2012 to 2017. The purpose and objectives of the registry of patients with SLE were substantiated.Conclusion. An analysis of morbidity rates suggests that SLE remains to be significant in the republic. The incidence of SLE has been noted to increase in the period from 2012 to 2017; there is a female preponderance (89.6%). The application of the SLE registry in clinical practice will be able to improve the diagnosis of the disease in the early stage and to prevent possible complications. Цель исследования – анализ оказания медицинской, в том числе ревматологической, помощи в Казахстане, изучение показателей заболеваемости и разработка регистра пациентов с системной красной волчанкой (СКВ).Материал и методы. Проводился анализ руководящих документов по организации медицинской, в том числе ревматологической, помощи в республике и официальных статистических материалов Министерства здравоохранения Республики Казахстан (МЗ РК) за период с 2012 по 2017 г. Выполнен поиск статей для отбора индексов активности, повреждения органов, оценки качества жизни и программы терапии с целью создания регистра пациентов с СКВ.Результаты и обсуждение. Представлены основные принципы оказания медицинской, в том числе ревматологической, помощи в республике. Приведены данные по вопросам обеспечения пациентов с СКВ лекарственными средствами на амбулаторном и стационарном этапе. Проведен анализ динамики заболеваемости СКВ населения Казахстана за период с 2012 по 2017 г. Число пациентов с СКВ составило 4448 человек (из них женщин – 3986), сравнительный анализ показателей за период с 2012 по 2017 г. продемонстрировал увеличение заболеваемости на 62,8%. Обосновываются цель и задачи регистра пациентов с СКВ.Заключение. Анализ показателей заболеваемости свидетельствуют о сохранении значимости СКВ в республике. Отмечены прирост заболеваемости СКВ в период с 2012 по 2017 г., преобладание лиц женского пола (89,6%). Использование регистра пациентов с СКВ в клинической практике позволит улучшить диагностику заболевания на раннем этапе и предотвратить возможные осложнения.

Thermally Responsive Amphiphilic Conetworks and Gels Based on Poly(N‑isopropylacrylamide) and Polyisobutylene

Novel amphiphilic conetworks (APCN) consisting of thermoresponsive poly(N-isoproplyacrylamide) (PNiPAAm) cross-linked by hydrophobic methacrylate-telechelic polyisobutylene (MA-PIB-MA) were successfully synthesized in a broad composition range. The resulting PNiPAAm-l-PIB conetworks (“l” stands for “linked by”) were obtained by radical copolymerization of NiPAAm with MA-PIB-MA in tetrahydrofuran, a cosolvent for all the components. Low amounts of extractables substantiated efficient network formation. The composition dependent two glass transition temperatures (Tg) by DSC analysis indicate microphase separation of the cross-linked components without mixed phases. It was found that the PNiPAAm-l-PIB conetworks are uniformly swellable in both water and n-hexane; i.e., these new materials behave either as hydrogels or as hydrophobic gels in aqueous or nonpolar media, respectively. The uniform swelling in both polar and nonpolar solutes indicates cocontinuous (bicontinuous) phase morphology. The equilibrium swelling degrees (R) depend on composition, that is, the higher the PIB content, the lower the R in water and the higher in n-hexane. The PNiPAAm phase keeps its thermoresponsive behavior in the conetworks as shown by significant decrease of the swelling degree in water between 20 and 35 °C. The lower critical solubility temperature (LCST) values determined by DSC are found to decrease from 34.1 °C (for the pure PNiPAAm homopolymer) to the range of 25–28 °C in the conetworks, and the extent of the LCST decrease is proportional with the PIB content. Deswelling-swelling, i.e., heating–cooling, cycle indicates insignificant hysteresis in these new thermoresponsive materials. This indicates that PNiPAAm-l-PIB conetworks with predetermined and thermoresponsive swelling behavior can be designed and utilized in several advanced applications on the basis of results obtained in the course of this study

Angiogenesis inhibitors in the treatment of prostate cancer

Prostate cancer remains a significant public health problem, with limited therapeutic options in the setting of castrate-resistant metastatic disease. Angiogenesis inhibition is a relatively novel antineoplastic approach, which targets the reliance of tumor growth on the formation of new blood vessels. This strategy has been used successfully in other solid tumor types, with the FDA approval of anti-angiogenic agents in breast, lung, colon, brain, and kidney cancer. The application of anti-angiogenic therapy to prostate cancer is reviewed in this article, with attention to efficacy and toxicity results from several classes of anti-angiogenic agents. Ultimately, the fate of anti-angiogenic agents in prostate cancer rests on the eagerly anticipated results of several key phase III studies

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

The current status of the problem with systemic lupus erythematosus in Kazakhstan

Objective: to analyze the provision of medical, including rheumatology, care in Kazakhstan, to study the incidence of systemic lupus erythematosus (SLE), and to develop a registry of patients with this condition.Material and methods. The investigators analyzed the guidelines for the organization of medical, including rheumatology, care in the republic and the official statistical materials of the Ministry of Health of the Republic of Kazakhstan in the period 2012 to 2017. Articles were searched to select activity indices, organ damages and to assess the quality of life and treatment programs in order to create a registry of patients with SLE.Results and discussion. The paper presents the basic principles of providing medical, including rheumatology, care in the republic. It gives data on the issues of providing SLE patients with medicines in outpatient and inpatient settings. It also analyzes trends in the incidence of SLE in the population of Kazakhstan in 2012 to 2017. There were 4,448 SLE patients, including 3,986 women; a comparative analysis of indicators demonstrated a 62.8% increase in the incidence of SLE from 2012 to 2017. The purpose and objectives of the registry of patients with SLE were substantiated.Conclusion. An analysis of morbidity rates suggests that SLE remains to be significant in the republic. The incidence of SLE has been noted to increase in the period from 2012 to 2017; there is a female preponderance (89.6%). The application of the SLE registry in clinical practice will be able to improve the diagnosis of the disease in the early stage and to prevent possible complications