Carotid endarterectomy in Russia. What if current guidelines do not answer difficult questions?

This literature review covers the publications of Russian vascular surgeons in recent years and deals with debatable issues of carotid surgery, including: 1. What is the best technique for carotid endarterectomy (CEA)? 2. Why does restenosis of the internal carotid artery (ICA) develop and how to eliminate it? 3. How to operate on bilateral ICA stenosis? 4. Should carotid glomus be preserved? 5. Is CEA safe in the acute phase of cerebrovascular accident (CVA)? 6. Is CEA safe in elderly patients? 7. How to operate on patients with combined internal carotid and coronary artery involvement? The evidence presented in this publication makes it possible to draw the following conclusions: 1. When choosing a CEA technique, the classical technique with patch angioplasty should be avoided due to the high risk of ICA restenosis. 2. To eliminate ICA restenosis, carotid angioplasty with stenting (CAS) should be used. When performing primary CEA with ICA transposition over the hypoglossal nerve, reCEA can be used 3. In the absence of contraindications, bilateral ICA stenosis can be operated at the same time using CEA. 4. CEA with carotid glomus preservation is the operation of choice in the treatment of patients with hemodynamically significant ICA stenosis due to the elimination of the risks of postoperative hypertension and the formation of hemorrhagic transformation. 5. If there are indications for cerebral revascularization in the most acute period of stroke, CEA should be abandoned in favor of CAS. 6. In old age, CAS is the safest treatment strategy. 7. In the presence of a combined ICA and coronary involvement, the choice of treatment tactics should be carried out only by a multidisciplinary commission, taking into account the risk stratification of adverse cardiovascular events

Canagliflozin: from glycemic control to improvement of cardiovascular and renal prognosis in patients with type 2 diabetes mellitus. Resolution of Advisory Board

Inhibitors of the sodium-glucose cotransporter type 2 (SGLT2i) are a modern class of antihyperglycemic drugs with an insulin-independent mechanism of action. Due to its ability to effectively lower blood glucose levels, improve a number of other cardiometabolic parameters (body weight, blood pressure, uric acid), as well as reduce cardiovascular and renal risks, SGLT2i have become drugs of choice for many of patients with type 2 diabetes mellitus (T2DM). Meanwhile, along with the generally recognized classes-effects of this group of drugs, there are intragroup features, including those associated with their different selectivity in sodium-glucose cotransporters of types 1 and 2 (SGLT1 and SGLT 2). For example, one of the most studied SGLT2i, canagliflozin, in addition to its inhibitory activity against SGLT2, can also moderately block SGLT1 in the intestine and kidneys that could give a maximum efficiency in the control glycemia and others cardiometabolic parameters. In addition, canagliflozin improves not only cardiovascular, but also renal prognosis in patients with T2DM, which is reflected in the corresponding indications in the summary of product characteristics of the drug. This document summarize the established and new data regarding the efficacy and safety of canagliflozin, as well as its place in the treatment of T2DM

EFFECTS OF PROLINE-RICH PEPTIDES OF THE INNATE IMMUNE SYSTEM ON DRUG-RESISTANT BACTERIAL STRAINS

Resistance of pathogenic microorganisms to conventional antibiotics is growing rapidly in recent years, accompanying with an increase of mortality caused by hospital-acquired infections. Therefore, a search for novel drugs to combat antibiotic resistant bacteria is one of the priorities in biomedicine. Natural compounds which are contained in host defense effector cells of humans and animals, may serve as prototypes for developing principally new antibiotics. Such compounds include antimicrobial peptides of innate immunity, in particular, a group of proline-rich peptides. The aim of this work was to evaluate antimicrobial activity of proline-rich peptides, belonging to bactenecins family, against several clinical isolates of drug-resistant Gram-negative bacteria. The bactenecins under examination (ChBac3.4, ChBac5, mini-ChBac7.5Nα, miniChBac7.5Nβ) have been previously found in leukocytes of a domestic goat Capra hircus. We have shown that chemically synthesized analogs of these peptides exhibited a pronounced in vitro antimicrobial activity against Escherichia coli and Acinetobacter baumannii (minimum inhibitory concentrations (MIC) as estimated by a broth microdilution assay varied between 1 to 4 µM) and, to a lesser degree, against Pseudomonas aeruginosa and Klebsiella pneumoniae (MIC 2-16 µM). It was revealed that antibacterial activity of these peptides may be increased if applied in combination with some conventional, antibiotics. E.g., synergistic antimicrobial effects against E. coli have been shown for mini-ChBac7.5Nα bactenecin combined with amikacin (minimal fractional inhibitory concentration index (FICI), 0.375), A. baumannii (FICI, 0.5), and K. pneumoniae (FICI, 0.325), and, using ofloxacin, towards K. pneumoniae (FICI 0.5). Lack of hemolytic activity towards human red blood cells is an important benefit of the studied peptides when used at concentrations several times higher than those showing antimicrobial effects. The data obtained presume certain prospects for further investigations of proline-rich peptides, as well as their structural modifications, for the development of new combined drugs based on these compounds, in order to combat antibiotic-resistant microorganisms, e.g., medications for local applications, various components of medical devices, in particular, venous catheters, stents and wound dressings

EFFEKTIVNOST' DINAMIChESKOY ELEKTRONEYROSTIMULYaTsII (DENS) V LEChENII OSTEOARTROZA KOLENNYKh SUSTAVOV (REZUL'TATY MNOGOTsENTROVOGO RANDOMIZIROVANNOGO ISSLEDOVANIYa)

Динамическая электронейростимуляция (ДЭНС) - вид ЧЭНС, основанный на применении слабых (200-400мкА), низкочастотных (10-200 Гц) импульсных токов, изменяющих форму в зависимости от электрического сопротивления (импенданса) в подэлектродном участке кожи, для воздействия на биологически активные зоны и точки. Цель исследования: изучить клиническую эффективность терапии аппаратом ДиаДЭНС-ПК в лечении остеоартроза коленных суставов (ОА КС). Материалы и методы. Проведено многоцентровое рандомизированное двойное слепое плацебо-контролируемое исследование. Включено 132 пациента с ОА КС с интенсивностью болевого синдрома более 40 мм по ВАШ, с индексом Лекена > 4 и < 12. Группа ДЭНС (66 чел.) получала лечение аппаратом ДиаДЭНС-ПК с помощью выносного электрода - аппликатора на область коленного сустава- мишени в режиме стимуляции - «Терапия», частотой 77 Гц, уровнем мощности - 15 единиц. Курс лечения - 10 процедур, по 30 минут. Группы были исходно сопоставимы по оцениваемым показателям кроме возраста: пациенты группы плацебо были старше группы ДЭНС в среднем на 3,2 года. Осмотр и опрос пациентов проводился до и после 1,3,6,10й процедур лечения, опрос на визитах наблюдения через 2 и 4 недели после окончания курса терапии. Первичная конечная точка исследования: интенсивность боли по ВАШ (мм), вторичные: тест «Встань и иди» (сек), альгофункциональный индекс Лекена, индекс WOMAC. Результаты. Статистически значимое различие в уменьшении боли по ВАШ в сравниваемых группах наблюдалось после первой процедуры лечения (р=0,014) и далее сохранялось по окончании 3й (р=0,018), и 6й процедур (р=0,047) и на визите наблюдения через 2 недели после окончания лечения (р=0,003). Индекс Лекена статистически значимо различался между группами на 10м последнем визите лечения (р=0,001) и через 4 недели на визите наблюдения (р=0,001). Статистически значимая разница между группами показателя теста «Встань и иди» наблюдалась после 6й процедуры лечения (р=0,041), перед 10-й процедурой (р=0,010), и на визитах наблюдения через 2 недели (р=0,018) и через 4 недели (р=0,025). Индекс WOMAC статистически достоверно не различался между группами. Суточная потребность пациентов в нестероидных противовоспалительных препаратах статистически значимо не различалась между группами. Врачи и пациенты достоверно положительно оценили эффективность лечения в конце курса терапии в ДЭНС группе: при оценке пациентами (р=0,004), при оценке врачами (р <0,0001). ДЭНС терапия хорошо переносилась пациентами, частота нежелательных явлений статистически достоверно не различалась между группами (р=0,999). Заключение: ДЭНС-терапия - эффективный способ лечения ОА КС, купирующий болевой синдром и улучшающий функцию суставов