Боль – основной компонент качества жизни больных анкилозирующим спондилитом и возможности ее купирования

The paper gives the results of an investigation of quality of life (QL) in patients with ankylosing spondylitis. It shows the implication of chronic pain syndrome in lowering QL and considers the issues of combination therapy with nimesulide (nise) and tizanidine (sirdalud) for pain syndrome.Представлены результаты исследования качества жизни (КЖ) у больных анкилозирующим спондилитом. Показано значение хронического болевого синдрома в снижении КЖ. Рассмотрены вопросы комплексной терапии болевого синдрома с использованием нимесулида (найз) и тизанидина (сирдалуд)

Predictive Genomic Biomarkers of Hormonal Therapy Versus Chemotherapy Benefit in Metastatic Castration-resistant Prostate Cancer

Drug development; Predictive biomarkers; Prostate cancerDesarrollo de fármacos; Biomarcadores predictivos; Cáncer de próstataDesenvolupament de fàrmacs; Biomarcadors predictius; Càncer de pròstataBackground Biomarkers predicting second-generation novel hormonal therapy (NHT) benefit relative to taxanes are critical for optimized treatment decisions for metastatic castration-resistant prostate cancer (mCRPC) patients. These associations have not been reported simultaneously for common mCRPC genomic biomarkers. Objective To evaluate predictive associations of common genomic aberrations in mCRPC using an established comprehensive genomic profiling (CGP) system. Design, setting, and participants A retrospective cohort study used data from a deidentified US-based clinicogenomic database comprising patients treated in routine clinical practice between 2011 and 2020, evaluated with Foundation Medicine CGP in tissue biopsies obtained around the time of treatment decision. The main cohort included 180 NHT and 179 taxane lines of therapy (LOTs) from 308 unique patients. The sequential cohort comprised a subset of the main cohort NHT LOTs immediately followed by taxane from 55 unique patients. Outcome measurements and statistical analysis Prostate-specific antigen (PSA) response, time to next treatment (TTNT), and overall survival (OS) were assessed. Main cohort analyses were adjusted for known treatment assignment biases via inverse probability of treatment weighting (IPTW) in treatment interaction models. Results and limitations In the main cohort, patients with AR amplification (ARamp) or PTEN aberrations (PTENalt) had worse relative PSA response on NHT versus taxanes compared with patients without. Patients with ARamp, PTENalt, or RB1 aberrations (RB1alt) also had worse relative TTNT and OS on NHT but not on taxanes. In multivariable models for TTNT and OS adjusted via IPTW, ARamp, PTENalt, and RB1alt were shown as poor prognostic factors overall and demonstrated significant treatment interactions, indicating reduced hazards of therapy switch and death on taxanes versus NHT. Consistent associations favoring increased benefit from subsequent taxane despite prior NHT treatment line were observed only for ARamp in the sequential cohort, in which very few patients had RB1alt for assessment. Conclusions ARamp status is a candidate biomarker to predict poor effectiveness of NHT relative to taxanes in mCRPC in scenarios where both options are considered

Pain is a major component of quality of life in patients with ankylosing spondylitis and the possibilities of its relief

The paper gives the results of an investigation of quality of life (QL) in patients with ankylosing spondylitis. It shows the implication of chronic pain syndrome in lowering QL and considers the issues of combination therapy with nimesulide (nise) and tizanidine (sirdalud) for pain syndrome

Состояние минеральной плотности кости у пожилых пациентов с остеоартрозом

Objective: to study bone mineral density (BMD) in elderly patients with different clinical forms of osteoarthrosis (OA). Patients and methods. A hundred and fifty-five patients above 65 years of age, diagnosed as having OA according to the criteria developed by R. Altman were examined. In all the patients, anthropometric indices, duration of the disease, and degree of functional impairment were assessed and joint X-ray study and densitometry were made. According to the clinical form of the disease, the patients were divided into 3 groups (with signs of gonarthrosis, oligoarthrosis of the knee and hip joints, and polyosteoarthrosis). Results. Both the clinical and anthropometric characteristics of patients facilitated the development of osteopenia. Involvement of a larger number of joints into a pathological process was followed by a significant BMD reduction in the predominant number of patients with OA. With the more progressive X-ray stage of the disease, a significantly higher BMD was observed in the distal forearm of patients from all groups. The patients aged 75 years or older who had gonarthrosis and polyosteoarthrosis showed a significant reduction in BMD as compared with those of less than 75 years of age. A greater reduction in the T test was shown to correspond to less body weight. The examinees' inactivity correlated with decreased BMD. In patients with polyosteoarthritis, early onset and longer menopause negatively affected BMD in the distal forearm. Conclusion. Reduced distal forearm BMD in elderly patients with OA is associated with patients' older age and a longer menopause, less body weight, early menopause, and no regular exercises. Progression of the X-ray stage of OA correlates with increased bone density.Цель исследования - изучение состояния минеральной плотности кости (МПК) у пожилых больных с различными клиническими формами остеоартроза (ОА). Материал и методы. Обследованы 155 больных старше 65 лет с диагнозом ОА, соответствующим критериям R. Altman. У всех больных оценивали антропометрические показатели, длительность заболевания, степень функциональной недостаточности, проводили рентгенологическое исследование суставов, денситометрию. В зависимости от клинической формы заболевания пациенты были разделены на три группы (с признаками гонартроза, олигоартроза коленных и тазобедренных суставов, полиостеоартроза). Результаты исследования. Развитию остеопении способствовали как клинические, так и антропометрические характеристики пациентов. Вовлечение в патологический процесс большего числа суставов сопровождалось достоверным снижением МПК у преобладающего числа больных ОА. При увеличении рентгенологической стадии заболевания отмечена достоверно более высокая МПК дистального отдела предплечья у больных всех групп. У больных с гонартрозом и полиостеоартрозом в возрасте 75 лет и старше наблюдалось достоверное снижение МПК по сравнению с данными пациентов моложе 75 лет. Показано, что меньшей массе тела соответствовало большее снижение Т-критерия во всех группах. Отсутствие физических нагрузок у обследованных коррелировало со снижением МПК. У пациенток с полиостеоартрозом раннее начало и увеличение продолжительности менопаузы отрицательно влияли на МПК дистального отдела предплечья. Заключение. Снижение МПК дистального отдела предплечья у пожилых пациентов с ОА ассоциируется с увеличением возраста больных и длительностью менопаузы, уменьшением массы тела, наличием ранней менопаузы и отсутствием регулярных физических нагрузок. Прогрессирование рентгенологической стадии ОА коррелирует с увеличением показателей костной плотности

Indicators of the osteoclastogenesis system in men with different clinical types of ankylosing spondylitis

Objective: to evaluate the osteoclastogenesis regulatory system – osteoprotegerin/receptor activator of nuclear factor-κβ ligand (OPG/RANKL) system – in men with different clinical types of ankylosing spondylitis (AS).Subjects and methods. The osteoclastogenesis regulatory system was studied in 60 men, including 40 patients diagnosed with AS complying with the 1984 New York criteria and 20 men without AS. RANKL, a major stimulant of osteoclastogenesis, and OPG, a decoy receptor that binds RANKL and, accordingly, blocks osteoclastogenesis, were investigated.Results. It was shown that in the patients with AS, RANKL concentrations were normal and the content of OPG and OPG/RANKL ratio proved to be significantly higher than those in the men without AS. The highest OPG concentrations were recorded in patients with the axial form of this disease, its moderate activity and early X-ray stage. No relationship was found between the level of RANKL and the clinical characteristics of AS; however, there was a tendency to a slight increase in its concentration in patients with extraskeletal manifestations of AS, its high activity, high functional class, and late X-ray stage.Conclusion. The considerable increase in OPG levels and OPG/RANKL ratio was ascertained to be associated to the fact that 94% of the patients with late-stage AS characterized by the presence of numerous syndesmophytes. These changes must be compensatory in response to modestly increased RANKL level and enhanced bone resorption

ИЗМЕРЕНИЕ БЕДНОСТИ В РОССИИ: ВОЗМОЖНОСТИ И ОГРАНИЧЕНИЯ

The article analyses prospects for incorporating multidimensional poverty indicators into Russian statistical practice. The advantages and disadvantages of one-dimensional and multidimensional approaches to measuring poverty are discussed. The authors place emphasis on the combination of both monetary and non-monetary indicators of poverty using workings of the UN Statistical Commission and the World Bank. Among monetary indicators special attention is given to «consumer expenditures» aggregate.It is demonstrated that there is a discrepancy between estimates of well-being indicators sourced from household surveys and obtained when calculating the system of national accounts. The issue of selecting poverty and well-being projections to calculate multidimensional indices agreeing with modern Russian conditions is reviewed. The authors underline the special importance of health indicators with regard to poverty characteristics. They also discuss ways to aggregate information on the poor into the final poverty index.Attention is paid to the Rosstat’s surveys on income, expenditure and living conditions of the population as sources of information for constructing multidimensional poverty index, material deprivation and social exclusion. The conclusion is made that these surveys provide enough information to base on them the multidimensional poverty index that meets the requirements of international statistics, provided that there is completeness and regularity of data collection. The method for calculating MPI [Alkire-Foster (AF) method] is illustrated in the article on the data of the notional example.В статье анализируются перспективы включения в российскую статистическую практику системных расчетов многомерных показателей бедности. Обсуждаются преимущества и недостатки одномерных и многомерных подходов к измерению бедности. Делается акцент на сочетании монетарных и немонетарных индикаторов бедности с привлечением разработок Статистической комиссии ООН и Всемирного банка. Из числа монетарных показателей особое внимание уделяется агрегату «Потребительские расходы».Отмечается несовпадение оценок показателей благосостояния по данным обследования домашних хозяйств и полученным при построении системы национальных счетов. Рассматриваются вопросы выбора проекций бедности и благосостояния для построения многомерных показателей, адекватных условиям современной России. Подчеркивается особая значимость показателей здоровья в контексте характеристики бедности. Обсуждаются способы агрегации информации о бедных в итоговый индекс бедности.Уделено внимание программам обследований Росстата по вопросам доходов, расходов и условий жизни населения как источникам информации для построения многомерных индексов бедности, материальной депривации и социальной изоляции. Сделан вывод о достаточности информации, содержащейся в данных обследований Росстата, для построения на их основе многомерного индекса бедности (МИБ), отвечающего требованиям международной статистики при условии полноты и регулярности сбора данных. Методика расчета МИБ (метод Алкир-Фостера) проиллюстрирована в статье на данных условного примера

Гендерные особенности остеопенического синдрома в зависимости от активности ревматоидного воспаления

Objective. The gender differences estimation of mineral bone density (MBD) dependence on the rheumatoid inflammation activity degree. Subjects and methods. 132 patients with the significant RA diagnose are included into the research among them there are 80 males (the main group), 28 females with retained menstrual cycle, 24 females in post-menopause. The control group (for the main) is 84 males without RA compared by the age. MBD was measured by the method of double-energetic absorptiometry with the help stationary radiological double-energetic bone densitometer Exceell XR-46 (Norland, USA). Results. The patients with RA had the significant decreasing of T-criteria and MBD in comparison with indexes of the control group. The average meaning of densitometric indexes at the males with the 3rd activity degree were significantly lower than at the males with the 2nd activity degree. The most risk of osteoporosis (OP) development has been noted at the males and females in post-menopause at the 3rd activity degree. RA at the males is reasonable to consider as a prognostic marker of unfavorable influence on MBD and high activity as a risk factor of OP development associated with the disease itself.Цель исследования - оценка гендерных различий зависимости минеральной плотности кости (МПК) от степени активности ревматоидного воспаления. Материал и методы. В исследование включено 132 пациента с достоверным диагнозом ревматоидного артрита (РА): 80 мужчин (основная группа), 28 женщин с сохраненным менструальным циклом, 24 женщины в постменопаузе. Контрольная группа - 84 мужчины без РА, сопоставимых по возрасту. МПК определяли методом двухэнергетической абсорбциометрии с помощью стационарного рентгенологического двухэнергетического костного денситометра Exceell XR-46 (Norland, США). Результаты исследования. У мужчин с РА установлено достоверное снижение Т-критерия и МПК по сравнению с показателями контрольной группы. Средние значения денситометрических показателей у мужчин с 3-й степенью активности РА были достоверно ниже, чем у больных со 2-й степенью. Наименьшие значения денситометрических показателей отмечены у мужчин и у женщин в постменопаузе при 3-й степени активности РА. Наличие РА у мужчин целесообразно рассматривать как прогностический маркер неблагоприятного влияния на МПК, а высокую активность - как ассоциированный с самим заболеванием фактор риска развития остеопороза

Rheumatoid arthritis in elderly patients

Rheumatoid arthritis (RA), which affects about 1% of the adult population mostly in old age, has specific clinical features at the onset in elderly and senile people. The paper describes two clinical cases that are demonstrative as the rare variant of RA onset at old age (86 years). In one case, the female patient was observed to have an acute onset, polyarthritis with sharp pains, obvious exudative phenomena, with significant functional limitation, and a relatively rapid course of the pathological process with high immunological activity. The other patient showed, on the contrary, a gradual onset of the disease with the minimal clinical and immunological manifestations and a rapid progressive joint destruction. Both patients were found to have several concomitant diseases, which corresponds to the comorbidity data given by different authors in elderly patients, including those with RA. The specific feature of the described clinical cases is the disease onset at 86 years; therefore during hospitalization, there was a differential diagnosis of articular syndrome in the presence of this age-related cancer that was ruled out by examination