Клинические аспекты применения искусственного интеллекта для интерпретации рентгенограмм органов грудной клетки

The review considers the possible use of artificial intelligence for the interpretation of chest X-rays by analyzing 45 publications. Experimental and commercial diagnostic systems for pulmonary tuberculosis, pneumonia, neoplasms and other diseases have been analyzed.В обзоре рассмотрены возможности применения искусственного интеллекта для интерпретации рентгенограмм органов грудной клетки путем анализа 45 литературных источников. Проанализированы экспериментальные и коммерческие системы диагностики туберкулеза легких, пневмоний, новообразований и других заболеваний

Перспективы применения пробиотических препаратов при острых инфекциях респираторного тракта

Аcute respiratory infection (ARI) is one of the most prevalent diseases worldwide. The disease occurs in any age, so its course could be associated with complications  and poor outcome.  Prevention  and treatment of ARI and complications  are important  problems in clinical practice.  Recent researches of human microbiome  composition  and functions have aroused a great interest to this field in order to prevent ARIs.In this review, the authors discuss non-specific  mechanisms  of human  innate antiviral defense and available data about a role of symbiontic intestinal microf lora for ARI prevention. Typically, main biological properties of probiotic bacteria are considered in the context of modulating effects on the inf lammatory immune response. Published data demonstrated reduction in the risk, severity and duration of ARI under the treatment with probiotic agents both in the children and in adults. The strain-specific effect and potential molecular antiviral mechanisms of probiotics enhancing the antiviral response of symbiontic bacteria are also discussed in the review.Острые  вирусные  инфекции верхних  дыхательных  путей  (ВДП)  являются  одним  из самых  распространенных заболеваний в мире. Заболевание возникает  у лиц всех возрастных  групп и в некоторых случаях может иметь неблагоприятные осложнения и исходы. Одна из приоритетных задач практического здравоохранения состоит в возможности профилактики и лечения  острой респираторной вирусной инфекции и ее осложнений. В представленном обзоре рассмотрены собственные механизмы  неспецифической защиты человеческого организма  от вирусной инфекции. Обобщены  результаты исследований по изучению роли симбионтной кишечной микрофлоры в профилактике острой инфекции ВДП. На основании имеющихся литературных  данных представлены  основные  аспекты биологических свойств пробиотических бактерий,  которые,  как правило,  рассматриваются в контексте  их модулирующего  влияния на воспалительную иммунную реакцию.  Проведен  анализ имеющихся данных о снижении риска возникновения, продолжительности и выраженности симптомов  респираторной инфекции при приеме пробиотических препаратов  (ПБП) как в детском возрасте,  так и во взрослой популяции. Обсуждается  вопрос  штаммоспецифического эффекта  ПБП.  В статье рассмотрены основные  возможные  молекулярные противовирусные механизмы  ПБП, за счет которых симбионтные бактерии усиливают противовирусный ответ

Recovery of the Intestinal Microbiota Metabolic Activity in Patients with Bronchial Asthma

Aim. To investigate the feasibility of correcting the content and profile of short-chain fatty acids (SCFA) in feces of patients suffering from allergic bronchial asthma.Materials and methods. The study included 30 patients with allergic bronchial asthma (BA). All patients underwent a generally accepted range of clinical laboratory tests, functional respiratory tests and a hydrogen breath test with lactulose to detect SIBO. The SCFA spectrum was determined by gas-liquid chromatographic analysis. All patients with BA underwent standard basic therapy with combined preparations containing long-acting beta-2-adre nergic agonists and inhaled glucocorticoids. For the treatment of SIBO, 10 patients were prescribed rifaximin-α at a dose of 200 mg × 3 times a day for 7 days, 10 patients were prescribed rifaximin-α at the same dose, followed by the administration of the Lactobalans drug containing at least 3.0×109 CFU/caps. probiotic microorganisms (Lactobacillus gassery KS-13, Lactobacillus gasser LAC-343, Lactobacillus ramnosus LCS-742, Bifi dobacterium bifi dum G9-1, Bifi dobacterium longum MM-2, Bifi dobacterium longum BB536 Strain M, Bifi dobacterium biumidum BB536 Strain M. Bifi dobacterium biumidum biumidum BB536 Strain M. lactis B1-04) in 1 capsule once a day for 1 month. A probiotic course of 1 month was assigned to 10 patients without SIBO as part of the complex treatment of BA. The study of SCFA was carried out in all groups immediately after the end of probiotic therapy (after 1 month).Results. All patients demonstrated normalisation of the SCFA spectrum and anaerobic index. In patients without SIBO, during a probiotic therapy, an increase in the total content of SCFA (p <0.001), acetic and butyric acid (p <0.001) was revealed. The administration of a probiotic after a course of rifaximin-α led to a decrease in the relative amount of isoacids and the isoacids/acids ratio in comparison with patients who received rifaximin-α only for treatment of SIBO (p <0.05).Conclusion. The obtained results demonstrate the potential of drugs in affecting the composition and number of active bacterial metabolites of the intestinal biotope, which indicates the restoration of intestinal microbiocenosis

Intestinal Short-Chain Fatty Acids in Patients with Bronchial Asthma

Aim. Tostudy the content and profile of short-chain fatty acids (SCFAs) in faeces of patients with bronchial asthma and healthy individuals, as well as to evaluate possible correlations between the SCFA spectrum and clinical phenotype of patients with bronchial asthma. Materials and methods. 44 patients with asthma and 17 healthy volunteers participated in the study. All participants underwent a generally accepted range of clinical and laboratory studies, as well as functional respiratory tests. The SCFA spectrum was determined using gas-liquid chromatographic analysis. The results of patients with asthma showed a significant decrease in the total fatty acid content in faeces (p <0.001); changes in the absolute concentrations of individual acids, such as acetate (p <0.001), propionate (p <0.001) and butyrate (p <0.001); as well as a change in the total isoacid content (p <0.001). In 83% of the cases, the anaerobic type of the SCFA spectrum was detected. The aerobic type of the SCFA metabolic profile was detected in 17% of the cases. The change in the metabolic profile did not depend on the phenotype of the disease.Conclusion. Changes in SCFAs indicate pronounced disorders in the microbiocenosis of the intestinal biotope. The values of the anaerobic index in the context of various changes in the acid metabolic profile indicate the disturbance of the microorganism’s habitat, contributing to the growth of anaerobic or aerobic microflora populations

Liver cirrhosis in the Moscow Region: figures and facts

The majority of deaths related to complications of liver cirrhosis would have been preventable with timely diagnosis and proper treatment. However, absence of the population-based screening programs for hepatitis, an asymptomatic course of the majority of liver disorders, failures in the registration of etiologically confirmed cases of liver cirrhosis, low population awareness of its risks and of current diagnostic and management opportunities do impede the collection of reliable epidemiological data on the incidence and prevalence of liver disorders including their end-stages, and on the related mortality of the population; as a consequence, all these factors hinder a comprehensive assessment of the medical and social burden of hepatic disorders. Medical registries are the single system for their registration and follow-up. Analysis of data from the Moscow Regional Registry of patients with liver disease has shown that the leading cause of liver cirrhosis is HCV infection (66%), with alcoholic liver cirrhosis ranking second (16.1%). There is a trend towards higher proportions of liver cirrhosis as an outcome of HCV hepatitis among newly referred patients (7.2% in 2012 and 10.6% in 2016). HCV genotype characteristics determine the rates of the disease progression: in those with genotype 3, liver cirrhosis would occur at an earlier age (51.8% of patients aged from 26 to 45) than with genotype 1 (58.7% of patients aged from 46 to 65). In older patients, various comorbidities can contribute to the development of liver cirrhosis. Among patients with HBV infection, 4.9% have liver cirrhosis, and most of patients receive antiviral treatment with nucleoside/nucleotide analogues. The highest percentage of liver cirrhosis has been found in the patients with chronic D hepatitis (46/116, 39.7%). In 10.3% of the patients with chronic D hepatitis, the aggressive course of the disease leads to primary liver cancer. Thus, the necessity of the development of prevention measures and early detection of liver disorders, as well as modernization of the public healthcare system at all stages of medical care should be recognized as the short-term goals, in addition to the search for highly effective etiologic treatment and making it available within the state-financed programs

Small Bowel Bacterial Overgrowth Syndrome in Patients with Bronchial Asthma

Aim.  This work is aimed at studying the role of the small bowel bacterial overgrowth syndrome (SBBOS) in the pathogenesis of bronchial asthma (BA).Materials and methods.  The study included 80 BA patients (45 and 35 patients allergic and non-allergic BA forms, respectively). Conventional laboratory and instrumental studies were conducted. SBBOS was confirmed by a hydrogen breath test with lactulose. Patients received conventional basal therapy with combined drugs (long-acting β2-adrenomimetics, and inhaled glucocorticoids). For SBBOS treatment, rifaximin (23 patients) or rifaximin followed by probiotic (B. bifidum, B. longum, B. infantis, L. rhamnosus) for 1 month (22 patients) was administered. Control studies were conducted on the 14th day and following 1 month of treatment.Results. A frequent combination of the small bowel bacterial overgrowth syndrome and bronchial asthma was revealed. 67 % and 43 % of the patients with the allergic form and non-allergic asthma form, respectively, are shown to suffer from SBBOS, p = 0.028. High levels of IgE (p < 0.01) and eosinophils in sputum (p < 0.001), combined with severe impairment of the function of external respiration (p < 0.01) in the case of SBBOS with allergic asthma reflect a more pronounced degree of sensitization of these patients. The correction of composition disorders of the intestinal microflora is accompanied by a statistically significant decrease in the immune response (p < 0.01) and improvement in the function of external respiration (p < 0.001).Conclusion.  SBBOS is a significant factor, aggravating the course of bronchial asthma and playing an important role in the development and maintenance of sensitization of patients

Clinical Traits of SARS-CoV-2 Infection

Aim. Analysis of clinical manifestations, laboratory and instrumental examination data in SARS-CoV-2 patients with taking into account the disease severity and outcome.Materials and methods. The study included 92 patients with confirmed coronavirus infection, including 15 lethal cases, hospitalised at the Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology of the Sechenov University in April 2020. The analysis included demographic data, the presence of concomitant diseases, chest computed tomography (CT) results, laboratory tests (including SARS-CoV-2-diagnostic PCR, general and metabolic blood panels, coagulogram) and the duration of disease.Results. Patients infected with SARS-CoV-2 usually exhibit lymphopenia (p ≤ 0.001), leucocytosis, the elevated neutrophils (p ≤ 0.05), neutrophil-lymphocyte ratio (p ≤0,05), C-reactive protein (p ≤ 0.05), ferritin (p ≤ 0.05), D-dimer (p ≤ 0.05) and fibrinogen (p ≤ 0.05), altered prothrombin time (p ≤ 0.05) and INR (p ≤ 0.05). In a critical coronavirus infection, the pulmonary lesion exceeds 50% (corresponds to CT3 — CT4). The risk of critical SARS-CoV-2 infection increases with elder age (p ≤ 0.001), associates with the male gender and presence of concomitant diseases, such as obesity (p < 0.01), diabetes mellitus (p < 0.001), hypertension (p ≤ 0.001), CHD (p ≤ 0.001) and atrial fibrillation (p <0.05).Conclusion. The risk of severe and adverse coronavirus infection is significantly higher in elder comorbid patients

Small Bowel Bacterial Overgrowth Syndrome in Patients with Bronchial Asthma

Aim.  This work is aimed at studying the role of the small bowel bacterial overgrowth syndrome (SBBOS) in the pathogenesis of bronchial asthma (BA).Materials and methods.  The study included 80 BA patients (45 and 35 patients allergic and non-allergic BA forms, respectively). Conventional laboratory and instrumental studies were conducted. SBBOS was confirmed by a hydrogen breath test with lactulose. Patients received conventional basal therapy with combined drugs (long-acting β2-adrenomimetics, and inhaled glucocorticoids). For SBBOS treatment, rifaximin (23 patients) or rifaximin followed by probiotic (B. bifidum, B. longum, B. infantis, L. rhamnosus) for 1 month (22 patients) was administered. Control studies were conducted on the 14th day and following 1 month of treatment.Results. A frequent combination of the small bowel bacterial overgrowth syndrome and bronchial asthma was revealed. 67 % and 43 % of the patients with the allergic form and non-allergic asthma form, respectively, are shown to suffer from SBBOS, p = 0.028. High levels of IgE (p < 0.01) and eosinophils in sputum (p < 0.001), combined with severe impairment of the function of external respiration (p < 0.01) in the case of SBBOS with allergic asthma reflect a more pronounced degree of sensitization of these patients. The correction of composition disorders of the intestinal microflora is accompanied by a statistically significant decrease in the immune response (p < 0.01) and improvement in the function of external respiration (p < 0.001).Conclusion.  SBBOS is a significant factor, aggravating the course of bronchial asthma and playing an important role in the development and maintenance of sensitization of patients

Epidemiology of hepatitis C in the Moscow Region: data from the Moscow Regional Registry and screening for HCV antibodies

Background: Epidemiological characteristics of chronic hepatitis C virus (HCV) infection presented in the literature are not representative for the real situation with its incidence and prevalence in the Russian Federation. In the Moscow Region, which is the second largest population in the Russian Federation (7.2 million people), the Moscow Regional Registry of patients with hepatic disorders has been continuously maintained since 2010, as well as screening programs for anti-HCV positive individuals. Analysis of this data allows for generalization of the results obtain to the general population and for description of the prevalence of the infection among adult population of the Russian Federation. Aim: To analyze the epidemiological situation with chronic hepatitis C in the Moscow Region. Materials and methods: We analyzed data from the Moscow Regional Registry of patients with hepatic disorders as per April 2016, as well as the results of large scale screening of the population of the Moscow Region with oral express test for anti-HCV antibodies (OraQuick HСV Rapid Antibody Test). Based on the registry, we assessed the following parameters of the patient cohort with chronic HCV infection (n = 17 182): age, gender, HCV genotype, grade of liver fibrosis, allele variants of interleukin 28В. Within the large scale screening program among the population of the Moscow Region, 1447 individuals from 6 districts of the region were screened for anti-HCV antibodies. Results: As per April 2016, the proportion of patients with chronic viral hepatitis in the Registry was 75.3% (n = 12 938 of 17 182). The vast majority of them (80.3%, or n = 10 393) had chronic hepatitis C, with 84% (n = 8726) of referrals were patients of productive age (from 20 to 50 years). 8.4% (n = 873) of all HCV infected patients had liver cirrhosis. Although the proportion of patients with cirrhosis was negligibly low (< 1.5%) in patients below 30 years of age, it was progressively increasing with age, with a maximum of 23.8% in those above their 50-es. As far as the HCV genotype distribution is concerned, it was as follows: genotype 1, 54.1% (n = 5622) of patients, genotype 2, 7.2% (n = 747), genotype 3, 38.4% (n = 3990). According to the results of assessment of IL28B genetic polymorphisms (n = 3212), СС rs12979860, which is associated with the most favorable sensitivity to interferon α, was found in 27.5% (n = 883), СТ allele, in 58.4% (n = 1876), and ТТ in 14,1% (n = 453). Prevalence of HCV infection in the Moscow Region, assessed by the screening program, is 1.38% of adults, or 77 200 anti-HCV positive persons, whereas estimated number of patients with chronic hepatitis C may amount to 54 000 to 61 700. Conclusion: HCV infection is the most prevalent among other viral hepatites in the Moscow Region (80.3%), and the largest numbers of infected individuals are of productive age. Almost three quarters of these patients are referred for medical care at the stage of minimal liver injury, and antiviral therapy can be used on an elective basis. Knowing the proportion of patients with liver cirrhosis (8.4%) allows for planning of the need in emergency treatments. The true prevalence of HCV infection estimated from the results of the screening program is at least 5-fold higher than that in the Registry. This indicates the necessity to upgrade the system of primary assessments. In particular, it seems reasonable to include detection of anti-HCV antibodies into the list of obligatory screening laboratory tests

Efficacy and safety of 3D-therapy at HCV-related subcompensated liver cirrhosis (genotype 1b)

Aim of the study. To estimate efficacy and safety of 3D mode of interferon­free therapy in patients with subcompensated liver cirrhosis (LC) of HCV etiology (genotype 1b). Material and methods. Original study included the data of 66 patients (26 men and 40 women) with subcompensated LC of HCV etiology (genotype 1b) who underwent interferon­free therapy by ombitasvir/paritaprevir/ritonavir, dasabuvir and ribavirin for 12 weeks (the latter was cancelled at receiving the new data on treatment efficacy after 4 weeks of therapy) in September, 2015, before the drug instruction was updated. Mean age of patients was 56.4±10.0 years. At onset of etiological therapy 21 patients (31.8%) had Child­Pugh score of 9, eleven patients (16.7%) had Child­Pugh 8, 34 patients (51.5%) had Child­Pugh 7. The causes of inefficacy of previous modes of combined antiviral therapy (CAT) included absence of virologic response in 43.9% of the cases, recurrence of HCV replication - in 30.3%, virological breakthrough - in 16.7%, development of serious adverse effects - in 9.1%. Taking into account the change of the group quantity during the course of therapy because of treatment cancellation for safety reasons and the subsequent assessment of its efficacy in patients with early treatment cancellation, the modified «intent­to­treat» (ITT) analysis was the basic method of results evaluation. Along with that «per protocol» (PP) analysis was carried out as well. Results. During the treatment course aviremia in 14 days was achieved in 53.8% of patients (in 35 patients of 65), prompt virologic response - at 79.7% (in 51 of 64 patients). All patients underwent complete 12 week course of CAT (n=60) and those for whom treatment was canceled for safety reasons (n=3) - in terms from 14 to 30 days - sustained virologic response (SVR) in 12 weeks and SVR in 24 weeks was registered. The assessment of liver function compensation degree in 6 months after CAT termination demonstrated 3 to 4 points reduction of the Child-Pugh Score in 21 patients (33.9 %), 1 to 2 points in 35 patients (56.5 %). According to the MELD score the clinical improvement was achieved in 66.1% of patients. The early treatment termination was caused by progression of hepatic encephalopathy symptoms and/or jaundice development (4 cases). Most cases of the progression­related treatment termination due to liver failure were reversible after CAT interruption. Three lethal outcomes after the early treatment termination and 1 patients death in follow­up period were registered. Conclusion. Antiviral therapy in 3D mode for subcompensated LC is highly effective not only in those patients who received complete treatment course, but also in those with early treatment secession. Profiling of 3D therapy safety demonstrated that development of serious adverse effects during the treatment is comparable to outcomes at natural course of subcompensated LC in the absence of etiological therapy