Опыт применения сальтоса в лечении хронического обструктивного бронхита

Saltos, a pioneer Russian-manufactured β2 agonist of prolonged effect, was used on 45 COB patients, with broncholithic activity and effects on the vegetative nervous system under study. The experiment demonstrated the highest activity for mild forms of the disease and smaller for more pronounced forms. The broncholithic effect was negligible with extreme forms. Saltos improved the state of the vegetative nervous system by leveling sympathetic prevalence characteristic of COB.В настоящей статье приводятся сведения об использовании нового отечественного пролонгированного β2-агониста сальтоса в лечении больных хроническим обструктивным бронхитом. У 45 больных изучена его бронхолитическая активность и влияние на вегетативную нервную систему. Доказано, что применение сальтоса наиболее эффективно у больных с умеренной и в меньшей степени — со значительно выраженной бронхиальной обструкцией. При резко выраженной бронхиальной обструкции бронхолитический эффект практически отсутствует. Показано, что прием сальтоса улучшает состояние вегетативной нервной системы, нивелируя преобладание симпатического отдела, которое характерно для больных хроническим обструктивным бронхитом

ПЛАНИРУЕМОЕ МНОГОЦЕНТРОВОЕ РАНДОМИЗИРОВАННОЕ КЛИНИЧЕСКОЕ ИССЛЕДОВАНИЕ II ФАЗЫ: НЕОАДЪЮВАНТНАЯ ХИМИОЛУЧЕВАЯ ТЕРАПИЯ С ПОСЛЕДУЮЩЕЙ ГАСТРЭКТОМИЕЙ D2 И АДЪЮВАНТНОЙ ХИМИОТЕРАПИЕЙ У БОЛЬНЫХ МЕСТНОРАСПРОСТРАНЕННЫМ РАКОМ ЖЕЛУДКА

Introduction. The prognosis for surgical treatment of locally advanced gastric cancer remains disappointing. Neoadjuvant chemo-radiation therapy is relatively new and the least researched method of treatment, it is attracting more and more attention, mainly abroad in recent years. The aims of neoadjuvant therapy is the earliest start of systemic therapy, damage of the primary tumor and regional metastases, an increase in the percentage of radical operations, improving treatment outcome. Material and methods. The planning study is a multicenter, randomized clinical phase II trial. Patients of the first (experimental) group will be treated as the followes: neoadjuvant chemo-radiotherapy (total tumor dose of 46 Gy in 23 fractions with the concurrent modified CapOX scheme) followed by D2 gastrectomy and adjuvant chemotherapy. Patients of the second (control) group will be treated with D2 gastrectomy and adjuvant chemotherapy. Adjuvant chemotherapy will be carried out under the following schemes (optional for the researchers): CapOX or FOLFOX. Toxicity evaluation of neoadjuvant chemo-radiotherapy and adjuvant chemotherapy will be conducted with NCI CTC Toxicity Scale Version 3.0. The main objectives of the trial are to assess the safety and immediate effectiveness of neoadjuvant chemo-radiotherapy according to the criteria of the frequency and severity of postoperative complications and mortality, and tumor response. We are planning to include 80 patients with morphologically confirmed gastric cancer сT2–4N1–3, сT3–4N0–3; М0. The proposed trial will be carried out in accordance with the principles of the Helsinki Declaration, it has been approved by local ethic committees of the participated institutions. Results. As a result of this multicenter randomized trial it is planned to show the reproducibility of obtained in MRRC and a number of foreign centers results – that is, the safety and high immediate effectiveness of neoadjuvant chemo-radiotherapy in patients with locally advanced gastric cancer. Conclusion. If we reach the goals of the planning trial, the results would allow to reasonably recommend the start of large international phase III trials for the final evaluation of the proposed neoadjuvant treatment as a standard one in patients with locally advanced gastric cancer.Введение. Прогноз при хирургическом лечении местнораспространенного рака желудка остается неутешительным. Неоадъювантная химиолучевая терапия является относительно новым и наименее исследованным методом лечения, привлекающим к себе в последние годы все большее внимание, преимущественно за рубежом. Цели неоадъювантной терапии состоят в максимально раннем начале системной терапии, повреждении первичной опухоли и регионарных метастазов, увеличении процента выполнения радикальных операций, улучшении результатов лечения. Материал и методы. Исследование является многоцентровым рандомизированным клиническим исследованием II фазы. Больным первой (исследуемой) группы будет проведено лечение в составе: неоадъювантная химиолучевая терапия (СОД 46 Гр за 23 фракции на фоне модифицированного режима CapOX) с последующей гастрэктомией D2 и адъювантной химиотерапией. Больным второй (контрольной) группы будет выполнена гастрэктомия D2 и адъювантная химиотерапия. Адъювантная химиотерапия будет проводиться по следующим схемам (на выбор исследователя): САРОX или FOLFOX. Оценка токсичности неоадъювантной химиолучевой терапии и адъювантной химиотерапии будет проводиться с помощью шкалы токсичности NCI CTC, версия 3.0. Основные цели состоят в оценке безопасности и непосредственной эффективности неоадъювантной химиолучевой терапии по критерию частоты и степени выраженности послеоперационных осложнений и летальности, и терапевтического патоморфоза. Планируется включение 80 больных морфологически верифицированным раком желудка сT2–4N1–3, сT3–4N0–3; М0. Исследование выполняется в соответствии с принципами Хельсинкской декларации, оно одобрено локальными этическими комитетами учреждений-соисполнителей. Результаты. В результате проведения данного многоцентрового рандомизированного исследования планируется показать воспроизводимость полученных в МРНЦ и ряде зарубежных Центров результатов – то есть безопасность и высокую непосредственную эффективность неоадъювантной химиолучевой терапии у больных местнораспространенным раком желудка. Заключение. В случае достижения поставленных целей полученные результаты позволят обоснованно рекомендовать проведение крупных международных исследований III фазы для окончательного изучения предложенного метода в качестве стандартного у больных местнораспространенным раком желудка

ANALYSIS OF THE COURSE OF PREGNANCY, DELIVERY AND POSTPARTUM PERIOD IN WOMEN WITH MULTIPLE SCLEROSIS

Background: Due to high prevalence of multiple sclerosis among women of childbearing age, special attention is paid to the problems of pregnancy management in such patients.Aim: To study clinical particulars of the course of pregnancy, delivery and postpartum period in patients with multiple sclerosis.Materials and methods: Eighty seven pregnant women with multiple sclerosis were followed up. Forty eight patients were taking disease modifying therapies (DMT), among them, 27 patients were taking glatiramer acetate, 17, interferon beta, 2, cladribine and 2, mitoxantrone. Thirty nine patients received no DMT. We evaluated the number and time to exacerbations; clinical particulars of the course of pregnancies and deliveries were studied depending on previous treatment with immune modulators.Results: The rate of exacerbations during pregnancy decreased by 47.7% and increased by 12.4% in the postpartum period, compared to this parameter in the year before pregnancy. Most often, the attacks occurred in the first trimester (54.5%, р < 0.05) and in the first 6 months after delivery (40.1%, p < 0.05). A long remission before the pregnancy (2 years and more, р < 0.01), the use of the 1st line DMT just before conception (p < 0.01) and multiple pregnancies (р < 0.001) were all predictors of the reduced number of postpartum exacerbations of the disease. Pregnancy and delivery did not significantly affect the degree of neurological deficiency (mean EDSS at the postpartum period increased by 0.05 ± 0.01).Conclusion: Multiple sclerosis and the use of DMT are not contraindications to pregnancy and delivery. Management of pregnancies and deliveries in multiple sclerosis patients does not differ from that in the general population. Previous use of DMT decreased the number of exacerbations during pregnancy and postpartum. Health status of the newborns, the numbers of complications during pregnancy and delivery, as well as changes in EDSS in the patients did not depend on previous DMT and on the time of its cessation

EFFECTIVE ANESTHESIA FOR ONCOGYNECOLOGICAL SURGERIES IN FEMALE PATIENTS WITH CONCURRENT OBESITY

The basic pathophysiologic characteristics, technical difficulties and handling methods thereof, including among others the difficult respiratory passages, the characteristics of ventilation and oxygenation, circulatory dynamics, dependence on the patient’s position on the operation table are described by the example of 60 gynecological cancer patients with concurrent obesity. It is shown that as of today the multimodal combined anesthesia based on the tricomponent epidural analgesia in combination with sevoflurane and apparently desflurane appears to be the best choice of anesthetic protection during traumatizing surgical treatment for the cancer patients with the associated obesity. The focus is made on advisability of hemodynamic monitoring of these patients

COGNITIVE IMPAIRMENT IN MULTIPLE SCLEROSIS: ASSOCIATION WITH THE ACTIVITY OF INFLAMMATORY PROCESS AND SEVERITY OF DISABILITY

Background: Multiple sclerosis is the most common neurological disease leading to disability in young and productive patients. One of available methods of control over the course of the disease and detection of its progression is neuropsychological testing. However, selection of the most informative tests, as well as the search for interpretation of their results is still ongoing.Aim: To study cognitive functions in multiple sclerosis patients depending on the disease activity and degree of disability.Materials and methods: Fifty patients with multiple sclerosis were evaluated during their remissions and 15 of them were additionally assessed during an exacerbation. During neuropsychological testing a computer test “Selection of figures” was used for assessment of attention, productivity, frontal functions and visual neglect. We studied potential dependency of the parameters obtained from degree of disability and disease stage (exacerbation or remission). The control group comprised 12 healthy subjects.Results: Compared to healthy subjects, the multiple sclerosis patients had a prolonged time of test performance, decreased learning, and statistically significant decrease of the working efficacy (p < 0.05). During an attack, there was a decreased conceptualization (48 answers compared to 51.5 at remission stage); more than 3-fold (from 1,3 to 4,4) increase in the number of figures missed in one visual field, that could indirectly indicate visual neglect. Also, changes in frontal functions were noted as a tendency to almost 2-fold higher numbers of perseverative answers, more frequent categorical escape and learning abnormality. There was a positive correlation between expanded disability scale score (EDSS) and working efficacy (r = 0.453, p = 0.001), and a negative correlation between EDSS and mental stability (r = 0.4055, p = 0.0035).Conclusion: Patients with multiple sclerosis had abnormal rate and accuracy of test performance, compared to those in healthy subjects. During an exacerbation of the disease, there was a deterioration of the parameters compared to those registered in the remission. Also, a negative association with disease severity assessed by EDSS, was found. The data obtained documents feasibility of the computer test “Selection of figures” for dynamic control in multiple sclerosis patients

Changes in prescribing antithrombotic therapy in patients with atrial fibrillation and myocardial infarction in 2016-2019

Aim. To study the changes in prescribing antithrombotic therapy (ATT) among patients with myocardial infarction (MI) and atrial fibrillation (AF), hospitalized in a cardiology hospital in 2016-2017 and 2018-2019.Material and methods. The study included 362 patients with MI and AF in 20162017 — 106 patients, of which 104 were included in the analysis, in 2018-2019 — 256 patients. The median age of patients hospitalized in 2016-2017 was 70,0 (61,0; 78,0) years, in 2018-2019 — 71 (65,0; 79,3) years (p=0,09). There were 60 men (55,6%) in 2016-2017 and 143 (55,8%) in 2018-2019 (p=0,90).Results. In 2016-2017, 80 (76,9%) patients were prescribed dual antiplatelet therapy (DAPT), 17 (16,3%) — therapy with oral anticoagulants (OAC), while 7 (6,7%) of them were as part of triple ATT, 9 (8,7%) — as part of dual ATT (OAC+antiplatelet agent), and 1 (1,0%) — as monotherapy.In 2018-2019, 97 (37, 9%) patients were prescribed DAPT, 140 (54,7%) — OAC therapy, while 115 (44,9%) of them were as part of triple ATT 25 (9,8%) — as a part of dual ATT (OAC+antiplatelet agent). Among all cases of OAC prescription in 2016-2017 and 2018-2019, warfarin was prescribed in 11 (64,7%) and 51 (36,4%) patients,respectively (p=0,02), while rivaroxaban — in 6 (35,3%) and 88 (62,9%) patients, respectively (p=0,03). In 2018-2019, one patient was prescribed dabigatran etexilate.Conclusion. The study revealed that the prescription rate of triple ATT at discharge in 2018-2019 increased 6,7 times compared to 2016-2017 and amounted to 44,9% (n=115) (p<0,001). The prescription rate of OAC in 2018-2019 also increased 3,4 times compared to 2016-2017 and amounted to 54,7% (n=140) (p<0,001)

Surface Studies of Coarse-Grained and Nanostructured Titanium Implants

The results of XPS measurements of nanostructured Ti (ns-Ti) prepared with a help of severe plastic deformation (SPD) have been presented. We have measured XPS spectra of core levels (Ti 2p, O 1s, C 1s, F 1s and valence bands before and after treatment of ns-Ti-implants in HF. The obtained data have been compared with XPS measurements of untreated and acid treated coarsegrained Ti (cg-Ti). According to these measurements the surface composition has not practically been changed by reduction of grains size of Ti-implants. It has been found that the surface of both types of implants is covered with thick TiO 2 layer. The acid treatment reduces the surface contamination of ns-Ti and cg-Ti by hydrocarbons and induces better passivation and formation of more thick TiO2 layer. It has been shown that severe plastic deformation not only improves mechanical properties but also preserves corrosion stability of Ti-implants. Copyright © 2012 American Scientific Publishers

MONITORING OF OPHTHALMOLOGICAL INDICATORS IN PATIENTS WITH MULTIPLE SCLEROSIS

Background: According to the literature data, more than 70% of patients diagnosed with multiple sclerosis with disease duration > 5 years and absence of retrobulbar neuritis, have visual analyzer involvement manifested by decreased thickness of peripapillary nervous fibers. Aim: To assess interrelations between retinal/optic nerve changes and clinical signs of multiple sclerosis; to estimate prognostic value of optic coherence tomography in the monitoring of patients with multiple sclerosis. Materials and methods: We studied 132 eyes of 66 patients (41 women, 62.12%, and 25 men, 37.8%, age 20–57 years old) with verified diagnosis of relapsing-remitting multiple sclerosis. All patients underwent routine ophthalmological examination and optical coherence tomography every 3 months during 2 years. Results: Significant correlations were demonstrated between disability severity (Expanded Disability Status Scale, EDSS) and changes of total thickness of peripapillary nervous fibers (r = -0.362, p = 0.042), mean thickness of superior temporal peripapillary nerve fibers (r = -0.373, p = 0.046), mean thickness of inferotemporal peripapillary nerve fibers (r = -0.504, p = 0.005), optic disc volume (r = -0.645, p = 0.001), total retinal thickness at the posterior pole of the eyeball (r = -0.470, p = 0.010), and total retinal volume (r = -0.453, p = 0.012). Demonstrated relations were independent of the history of retrobulbar neuritis. Conclusion: Changes of visual analyzer demonstrated in optical coherence tomography reflect the severity of diffuse neurodegenerative process in the brain and correlate well with disability and disease progression

A COMPARATIVE ANALYSIS OF EFFICACY OF INTERFERON BETA 1-B AND NATALIZUMAB TREATMENT IN PATIENTS WITH RELAPSING-REMITTING MULTIPLE SCLEROSIS

Background: Disease modifying drugs for multiple sclerosis have similar indications for use and at the same time, their specifics of the effect on the pathophysiological process. This complicates the choice of an optimal therapy for a  given patient. Aim: To assess efficacy of treatment for multiple sclerosis with interferon beta-1b (IFN-β-1b) and natalizumab. Materials and methods: We performed an open label prospective study in 110  patients with multiple sclerosis who were followed up in the Moscow Regional Center of multiple sclerosis from 2012 to 2015. From those, 99  patients with relapsing-remitting multiple sclerosis (disease modifying drugs naïve) were treated with IFN-β-1b, 11 were non-responders to interferon (1 and more attacks for the previous year of therapy with IFN-β-1b) or had progressive course of multiple sclerosis (more than 2  attacks and an increase in the Expanded Disability Status Scale (EDSS) score by 1 and more within 1 year) and were treated with natalizumab. Analysis of treatment efficacy was performed with consideration of their past history, results of a  3-year neuromonitoring with Kurtzke EDSS and Functional System Scale, neuroophthalmologic testing with Farnsworth dichotomous test, and changes in optical coherent tomography parameters. Results: During 3  years of treatment with IFN-β-1b, the mean number of attacks decreased by over 70% (from 1.28±0.7 in the year before treatment to 0.35±0.09 in the 3rd year of treatment; p<0.05), whereas the degree of disability assessed by EDSS increased nonsignificantly by 0.44 (p>0.05). During the follow-up in the natalizumab group, the number of attacks decreased from 2.3±0.04 to 0.13±0.01 (p<0.05), and the degree of disability by EDSS decreased by 0.8 (p>0.05). There was a significant difference between changes in the thickness of peripapillar nervous fibers during 2  years of the follow up, this parameter decreasing by 2.5 mcm in patients treated with IFN-β-1b and by 0.1  mcm in those treated with natalizumab (p<0.01). Conclusion: Although the patients from natalizumab group had initial more severe course of multiple sclerosis, both agents were highly effective, with the most prominent clinical effect observed for natalizumab. The results obtained may serve as a  basis for recommendation of the 2nd line disease modifying drugs for patients with aggressive course of the multiple sclerosis and failure of the 1st line disease modifying drugs. Also, we were able to demonstrate the efficacy of neuroophthalmological monitoring in the assessment of disease modifying drugs efficacy. The strict safety policy is essential while using natalizumab

ASSESSMENT OF COLOR VISION FOR DIAGNOSIS AND DYNAMIC MONITORING OF MULTIPLE SCLEROSIS

Background: Multiple sclerosis is regarded as the most frequent cause of neurological disability. Visual disturbances are common and may be due to pathology of retina, optic nerve and cerebral conduction tracts (optic tract). Routine methods of assessment of visual function are insufficient in diagnosing some visual problems including color vision disturbances. Aim: To assess color vision in patients with multiple sclerosis. Materials and methods: We examined 110 patients (age > 18 years old) with previously diagnosed multiple sclerosis. Neurological status was assessed using functional scales; results of neuroimaging, medical records and history were taken into account. Color vision was examined using Farnsworth dichotomous test. Control group included 20 healthy volunteers (8 men, 12 women, mean age 29.1 ± 1.4 years old). Results: In patients with multiple sclerosis, color vision defects were significantly more prevalent compared to the control group (89.1% vs. 65%, p < 0.05). Deuteranopia was found in 18.6% of patients with multiple sclerosis, protanopia in 17.3%, tritanopia in 7.3% of patients. Significant color vision defects positively correlated with disability level of the Expanded Disability Status Scale (EDSS) and were independent of disease duration and history of retrobulbar neuritis. Conclusion: In patients with multiple sclerosis, color vision defects were associated with the activity of pathological process. Severity of neurological disability level estimated by EDSS positively correlated with visual disturbances. Thus, Farnsworth dichotomous test may be recommended for dynamic monitoring of multiple sclerosis