Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

MODERN REHABILITATION TENDENCIES IN PSYCHIATRY (LITERATURE REVIEW)

В статье рассмотрены основные направления в реабилитации в психиатрии. Процесс реабилитации освящен в контексте метода профилактики инвалидизации психически больных. Подчеркнуто значение психообразовательных программ как современного направления реабилитационных мероприятий в психиатрии. Затронуты вопросы психосоциальной реабилитации как одного из важнейших направлений улучшения социального функционирования психически больных. Освещены процессы психосоциальной терапии и психосоциальной реабилитации в контексте оккупациональной терапии как необходимые и взаимодополняющие терапевтические стратегии в современной психиатрической службе в России.In article the main directions of rehabilitation in psychiatry are considered. The process of rehabilitation is consecrated in the context of prophylaxis of psychic patients’ disability as the main method. The value of psychoeducation programs as modern direction of rehabilitation actions in psychiatry is emphasized. The questions of psychosocial rehabilitation as one of the most important direction of psychic patients’ social functioning improvement are raised. The processes of psychosocial therapy and psychosocial rehabilitation in the context of occupational therapy as necessary and complementary therapeutic strategy are covered in modern psychiatric service in Russia

Obesity and cognitive dysfunction

Obesity takes epidemic proportions, encompassing different groups of society. In turn, cerebrovascular pathology holds a leading position in the spectrum of neurological disorders. Researchers indicate a role of obesity in the development of cognitive impairment. However, the cellular and biochemical mechanisms underlying that connection are still poorly understood. In addition, despite the obvious association of obesity with the deterioration of mental activity demonstrated in clinical trials for a long time it was unclear whether these disorders are caused by obesity per se or related conditions, such as metabolic syndrome, diabetes or cardiovascular disease. Currently there is scarse systematic data on a cause-effect relationships of these two pathologies

Perspectives for cognitive rehabilitation of patients with diabetes mellitus

Currently, the problem of cognitive dysfunction is becoming increasingly important due to the raising demand for effective intellectual activity in modern society. One of the most significant causes of cognitive dysfunction is dismetabolic nature of the disorder, such as diabetes mellitus, which has recently been gaining prevalence. Much of the resistance of clinical symptoms of diabetic encephalopathy to conventional therapy requires a search for new approaches for solving this problem. Cognitive rehabilitation as a correctional technique has proved a positive effect in terms of the treatment of neurodegenerative diseases of different nature.This review present the ways for correction of cognitive impairment using the method of cognitive rehabilitation in patients with diabetes, its methodology, mechanisms of action and perspectives

Development of cultural linguistic module in open education courses

The article deals with the analysis of data and the development of the educational program "In Search of the National Russian Code: Educational Paths". The program is compiled according to the relevant trends in the field of proliferation and strengthening the position of the Russian language and education in Russian in the Commonwealth of Independent States and foreign countries. The authors justify the cultural-linguistic content of the program by the compliance with the modern scientific and methodological trends in studying and teaching Russian as a foreign language: forming the linguistic, communicative and cultural-linguistic competence through addressing such notions and national cultural code, national mentality, cross-cultural dialogue, etc. The materials of the study include the results of the questionnaire taken by the potential students in the open education course within the program "In Search of the National Russian Code: Educational Paths". The article features the analysis of 165 questionnaires by respondents from different student groups: post-graduate students, university and college teachers and schoolteachers in the Republic of Kazakhstan. The authors analyze the answers in three content blocks: motivation for education; the most relevant questions that should be included in the courses; the most efficient ways of presenting material, that is, educational technologies, forms and techniques based on which the interaction between the subjects of open courses should be built. The results of the study allow authors to make conclusions about the potential students' preferences and interests and round up the most relevant issues and popular educational technologies. Based on the study, the authors have designed the content and methodological solutions of the educational module "Man and the world in the mirror of the Russian word" within the curriculum of open education courses.O artigo trata da análise de dados e do desenvolvimento do programa educacional "Em Busca do Código Nacional Russo: Percursos Educacionais". O programa é compilado de acordo com as tendências relevantes no campo da proliferação e fortalecimento da posição da língua russa e da educação em russo na Comunidade de Estados Independentes e países estrangeiros. Os autores justificam o conteúdo lingüístico-cultural do programa pela conformidade com as tendências científicas e metodológicas modernas no estudo e ensino do russo como língua estrangeira: formando a competência lingüística, comunicativa e cultural-lingüística por meio da abordagem de tais noções e do código cultural nacional, mentalidade nacional, diálogo intercultural etc. Os materiais do estudo incluem os resultados do questionário respondido pelos alunos potenciais no curso de educação aberta dentro do programa "Em Busca do Código Russo Nacional: Caminhos Educacionais". O artigo apresenta a análise de 165 questionários por respondentes de diferentes grupos de estudantes: estudantes de pós-graduação, professores universitários e professores da República do Cazaquistão. Os autores analisam as respostas em três blocos de conteúdo: motivação para a educação; as questões mais relevantes que devem ser incluídas nos cursos; as formas mais eficientes de apresentar o material, ou seja, as tecnologias, formas e técnicas educacionais a partir das quais deve ser construída a interação entre as disciplinas dos cursos livres. Os resultados do estudo permitem aos autores tirar conclusões sobre as preferências e interesses dos alunos em potencial e reunir as questões mais relevantes e tecnologias educacionais populares. Com base no estudo, os autores desenharam o conteúdo e as soluções metodológicas do módulo educacional "O homem e o mundo no espelho da palavra russa" dentro do currículo dos cursos de educação aberta.El artículo trata sobre el análisis de datos y el desarrollo del programa educativo "En busca del Código Nacional Ruso: Itinerarios educativos". El programa se compila de acuerdo con las tendencias relevantes en el campo de la proliferación y el fortalecimiento de la posición del idioma ruso y la educación en ruso en la Comunidad de Estados Independientes y países extranjeros. Los autores justifican el contenido cultural-lingüístico del programa por el cumplimiento de las tendencias científicas y metodológicas modernas en el estudio y la enseñanza del ruso como lengua extranjera: formando la competencia lingüística, comunicativa y cultural-lingüística abordando tales nociones y el código cultural nacional, mentalidad nacional, diálogo intercultural, etc. Los materiales del estudio incluyen los resultados del cuestionario realizado por los estudiantes potenciales en el curso de educación abierta dentro del programa "En busca del Código Nacional Ruso: Itinerarios educativos". El artículo presenta el análisis de 165 cuestionarios por encuestados de diferentes grupos de estudiantes: estudiantes de posgrado, profesores universitarios y universitarios y profesores de escuela en la República de Kazajstán. Los autores analizan las respuestas en tres bloques de contenido: motivación por la educación; las preguntas más relevantes que deben incluirse en los cursos; las formas más eficientes de presentar material, es decir, tecnologías, formas y técnicas educativas a partir de las cuales se debe construir la interacción entre las asignaturas de los cursos abiertos. Los resultados del estudio permiten a los autores sacar conclusiones sobre las preferencias e intereses de los potenciales estudiantes y resumir los temas más relevantes y las tecnologías educativas populares. A partir del estudio, los autores han diseñado el contenido y las soluciones metodológicas del módulo educativo "El hombre y el mundo en el espejo de la palabra rusa" dentro del plan de estudios de los cursos de educación abierta

The Signaling Mechanism of Remote Postconditioning of the Heart: Prospects of the Use of Remote Postconditioning for the Treatment of Acute Myocardial Infarction

Acute myocardial infarction (AMI) remains the leading cause of mortality in the world, highlighting an urgent need for the development of novel, more effective approaches for the treatment of AMI. Remote postconditioning (RPost) of the heart could be a useful approach. It was demonstrated that RPost triggers infarct size reduction, improves contractile function of the heart in reperfusion, mitigates apoptosis, and stimulates autophagy in animals with coronary artery occlusion and reperfusion. Endogenous opioid peptides and adenosine could be involved in RPost. It was found that kinases and NO-synthase participate in RPost. KATP channels, MPT pore, and STAT3 could be hypothetical end-effectors of RPost. Metabolic syndrome and old age abolish the cardioprotective effect of RPost in rats. The data on the efficacy of RPost in clinical practice are inconsistent. These data are discussed in the review