Manifestations of cardiotoxicity in patients after radiation therapy

Cardiotoxic effects of antitumor treatment are diverse and develop both after chemotherapeutic treatment and after the application of radiation therapy. In recent decades, the problem of heart lesions due to the use of radiotherapy has acquired new significance, primarily due to a significant increase in the number of patients exposed to radiation in the modern world. The frequency of radiation damage to the cardiovascular system is quite high and, according to various data, can reach 54%. The structure of radiation-induced disease describes the development of pericarditis, cardiomyopathy, coronary and valvular pathology, rhythm and conduction disorders, post-radiation heart disease is one of the most difficult in treatment and early diagnosis is the most important task of the modern trend - cardiooncology. The need for long-term follow-up of patients after antitumor treatment with radiation therapy is one of the topical issues of practical public health.Кардиотоксические эффекты противоопухолевого лечения разнообразны и развиваются как после химиотерапевтического лечения, так и после применения лучевой терапии. В последние десятилетия проблема поражений сердца вследствие применения лучевой терапии приобрела новое значение, прежде всего в связи с существенным увеличением в современном мире числа пациентов, подвергшихся лучевому воздействию. Частота развития лучевых повреждений сердечно-сосудистой системы достаточно высока и, по различным данным, может достигать 54%. В структуре радиационно-индуцированной болезни описаны развитие перикардитов, кардиомиопатии, коронарная и клапанная патологии, нарушения ритма и проводимости, постлучевое поражение сердца является одним из самых трудных в вопросах лечения и ранняя диагностика является важнейшей задачей современного направления - кардиоонкологии. Необходимость длительного наблюдения пациентов после противоопухолевого лечения с использованием лучевой терапии является одним из актуальных вопросов практического здравоохранения

Cardiovascular complications of immune checkpoint inhibitors

Cardiovascular toxicity of cancer therapies remains an urgent problem today. The creation of highly effect antitumor drugs also means the appearance of new adverse effects. Immune checkpoint inhibitors (ICI) is a new class of antitumor drugs that is different from traditional chemotherapeutic and targeted drugs. Immunotherapy with ICI (monoclonal antibodies targeting the cytotoxic T-lymphocyte associated antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1) or its ligand (PD-L1)) significantly improved the results of treatment of cancer therapy. These drugs regulate antitumor immunity and promote cancer regression and improve survival, but can also cause a wide range of immunity-related adverse events (AEs). Although cardiotoxicity associated with ICI is rare, it is important because of its high mortality rates. In recent years, cases of myocarditis and fatal heart failure have been recorded more often in patients receiving ICI. This review focuses on the mechanisms of cardiotoxicity, methods for the prevention and treatment of these adverse events. Severe cardiovascular consequences associated with the use of ICI are important issues for oncologists, cardiologists and immunologists

The composite first person narrative: Texture, structure, and meaning in writing phenomenological descriptions

This paper illustrates the use of composite first person narrative interpretive methods, as described by Todres, across a range of phenomena. This methodology introduces texture into the presently understood structures of phenomena and thereby creates new understandings of the phenomenon, bringing about a form of understanding that is relationally alive that contributes to improved caring practices. The method is influenced by the work of Gendlin, Heidegger, van Manen, Gadamer, and Merleau-Ponty. The method's applicability to different research topics is demonstrated through the composite narratives of nursing students learning nursing practice in an accelerated and condensed program, obese female adolescents attempting weight control, chronically ill male parolees, and midlife women experiencing distress during menopause. Within current research, these four phenomena have been predominantly described and understood through quantified articulations that give the reader a structural understanding of the phenomena, but the more embodied or “contextual” human qualities of the phenomena are often not visible. The “what is it like” or the “unsaid” aspects of such human phenomena are not clear to the reader when proxies are used to “account for” a variety of situated conditions. This novel method is employed to re-present narrative data and findings from research through first person accounts that blend the voices of the participants with those of the researcher, emphasizing the connectedness, the “we” among all participants, researchers, and listeners. These re-presentations allow readers to develop more embodied understandings of both the texture and structure of each of the phenomena and illustrate the use of the composite account as a way for researchers to better understand and convey the wholeness of the experience of any phenomenon under inquiry

Prevention of stroke in atrial fibrillation: desired and real

The analysis of the data ot the register of patients with atrial fibrillation (retrospective part -1860 patients, prospective observation - 498 patients), which were observed in the period 2009-2017 in outpatient facilities and hospitals in Moscow, is presented. The dynamics of the appointment of antithrombotic drugs of various groups in routine clinical practice and in conditions of observation in an anticoagulant room on the basis of a day hospital were studied. The results are compared with data from other domestic observational studies of patients with atrial fibrillation. Other ways to improve the quality of antithrombotic prophylaxis are discussed.Представлен анализ данных регистра пациентов с фибрилляцией предсердий (ретроспективная часть -1860 пациентов, проспективное наблюдение - 498 пациентов), наблюдавшихся в период 2009-2017годы в амбулаторных учреждениях и стационарах г. Москвы. Исследована динамика назначения антитромботических препаратов различных групп в рутинной клинической практике и в условиях наблюдения в антикоагулянтном кабинете на базе дневного стационара. Результаты сопоставлены с данными других отечественных наблюдательных исследований пациентов с фибрилляцией предсердий. Обсуждаются другие способы повышения качества антитромботической профилактики

Resoundings of the flesh: Caring for others by way of “second person” perspectivity

In bringing ourselves to the encounter with the experience of others, we bring our bodies with us—and, in doing so, we are able to resonate not only intellectually but also empathically with the other's experiences and expressions (which are given to us both verbally and nonverbally). In remaining faithful to our foundations in phenomenology (Husserl, Heidegger, Merleau-Ponty, and Levinas), we shall talk about taking notice of others from within the relational “exchange” and reflect upon what, precisely, are the experientially given “affairs” to which Husserl invited us to return. Our interest begins with the other's “first person” experience, but since we cannot access this directly, we must rely on the resonance we find within ourselves, within our own lived bodies, when we are addressed by the other, whether in word or in gesture. I am wondering what the other is experiencing and all my powers of perception are driven toward this other, whose first person experience remains just out of reach and accessible only insofar as I have this capacity for a deeper “bodily felt” awareness in which the other's experience takes possession of me. Merleau-Ponty's notion of bearing “witness” to behavior is useful in illuminating this “second person” perspective, which takes its point of departure from Husserl's (1910–1911) intersubjective reduction, by means of which we “participate in the other's positing” (1952/1989, emphasis added) and thereby grasp the meaning of the other's expression. Ultimately, the intuitive talent of the caring professional will be shown to reside in his or her being able to move beyond what the other is able to say to a more deeply felt attunement to what is being revealed to us in the other's presence. Applications to patient care are discussed

The functional condition of left atrium during the endovascular treatment of atrial fibrillation

The atrial fibrillation causes structural and functional changes of atriums. In this case, the remodeling of left atrium increases the risk of AF. One of the treatment strategy is catheter isolation of the pulmonary veins. However, the effectiveness of these operations does not exceed 70% in most of the cases that may be due to remodeling of left atrium. In this regard, the assessment of the condition of left atrium is actual for the optimization of treatment tactics and improvement of effectiveness rate.Фибрилляция предсердий вызывает структурные и функциональные изменения предсердий. При этом ремоделирование левого предсердия увеличивает риск возникновения ФП. Одна из стратегий лечения - катетерная изоляция легочных вен. Однако эффективность данных операций в большинстве случаев не превышает 70%, что может быть обусловлено, в том числе, ремоделированием левого предсердия. В связи с этим, актуальна оценка состояния левого предсердия для оптимизации тактики лечения и улучшения показателей эффективности

Predictors of acute cerebrovascular events in patients with essential hypertension and sinus rhythm of the heart

The predictive value of left ventricular myocardium diastolic dysfunction regarding under aspect of cerebral vascular events development and stability of this disorder was determined in examination of 71 patients with arterial hypertension and normal sinus heart rhythm, who were in acute period of ischemic stroke, and retrospective analysis of survival and arterial hypertension current in 91 patients, who were kept under observation for a long time period.При обследовании 71 пациента с гипертонической болезнью и синусовым ритмом сердца, находившихся в остром периоде ишемического инсульта, и ретроспективном изучении выживаемости и течения артериальной гипертензии у 91 пациента в течение длительного периода наблюдения, выявлена предсказательная ценность в отношении развития сосудистых мозговых осложнений нарушения диастолической функции миокарда левого желудочка и продемонстрирована стойкость указанных изменений

Homeopathy – what are the active ingredients? An exploratory study using the UK Medical Research Council's framework for the evaluation of complex interventions

BACKGROUND: Research in homeopathy has traditionally addressed itself to defining the effectiveness of homeopathic potencies in comparison to placebo medication. There is now increasing awareness that the homeopathic consultation is in itself a therapeutic intervention working independently or synergistically with the prescribed remedy. Our objective was to identify and evalute potential "active ingredients" of the homeopathic approach as a whole, in a prospective formal case series, which draws on actual consultation data, and is based on the MRC framework for the evaluation of complex interventions. METHODS: Following on from a theoretical review of how homeopathic care might mediate its effects, 18 patients were prospectively recruited to a case series based at Bristol Homeopathic Hospital. Patients, who lived with one of three index conditions, were interviewed before and after a five visit "package of care". All consultations were recorded and transcribed verbatim. Additional data, including generic and condition-specific questionnaires, artwork and "significant other" reports were collected. Textual data was subject to thematic analysis and triangulated with other sources. RESULTS: We judged that around one third of patients had experienced a major improvement in their health over the study period, a third had some improvement and a third had no improvement. Putative active ingredients included the patients' "openness to the mind-body connection", consultational empathy, in-depth enquiry into bodily complaints, disclosure, the remedy matching process and, potentially, the homeopathic remedies themselves. CONCLUSION: This study has has identified, using primary consultation and other data, a range of factors that might account for the effectiveness of homeopathic care. Some of these, such as empathy, are non-specific. Others, such as the remedy matching process, are specific to homeopathy. These findings counsel against the use of placebo-controlled RCT designs in which both arms would potentially be receiving specific active ingredients. Future research in homeopathy should focus on pragmatic trials and seek to confirm or refute the therapeutic role of constructs such as patient "openness", disclosure and homeopathicity

Experiencing mindfulness meditation—a client narrative perspective

The study was based on the non-participant involvement of the researcher in four six-to-eight weeks' mindfulness meditation training courses led by chartered psychologists. The participants suffered from stress/sleeplessness, depression or agoraphobia in the presented cases. They were selected on the basis of recommendations by the psychologist who was the course instructor, who described them as positive and suitable. The participants wrote diaries on a weekly basis, and they were interviewed at the beginning, middle and end of the course. An in-depth analysis of three individual cases will be presented in the form of narratives constructed from their own words. The narratives demonstrate the unique and embodied changes of the individual participant's experiences during the training course. The purpose was to illustrate richly what happens and how changes happen during these weeks of learning and practicing mindfulness meditation. It is not the intention to give evidence about the effectiveness of mindfulness meditation in general, but to present the whats and hows of cases where mindfulness meditation appears to improve quality of life, health and well-being