45 research outputs found
Comparison of the yeast Saccharomyces cerevisiae var. boulardii and top-fermenting brewing yeast strains during the fermentation of model nutrient media and beer wort
Received: June 27th, 2022 ; Accepted: September 18th, 2022 ; Published: October 17th, 2022 ; Correspondence: [email protected], the yeast Saccharomyces cerevisiae var. boulardii have attracted the
attention of Food Science researchers due to their unique properties, the main among which are
probiotics. Thus, research is conducted on the use of this yeast as a starter culture in the
technology of yogurt, fermented vegetables, fruit, vegetable juices, as well as beer. This paper is
aimed at studying Saccharomyces cerevisiae var. boulardii 's fermentation performance
compared to top-fermenting brewing yeast strains during fermentation of model nutrient media
and beer wort. Fermentation activity of the studied strains was assessed based on the character of
fermentation curves, as well as the values of the maximum substrate assimilation rate and
apparent degree of fermentation. Moreover, during the study, beer was produced using the yeast
Saccharomyces cerevisiae var. boulardii as a starter culture. According to the obtained results, it
can be concluded that Saccharomyces cerevisiae var. boulardii have less fermentation activity
compared to brewing strains. In turn, beer produced with Saccharomyces cerevisiae var.
boulardiisignificantly differed in physicochemical, microbiological, and organoleptic parameters
from the control sample obtained using the 047A brewing strain. Thus, it contained less ethanol
and secondary metabolites; however, the concentration of living cells was significantly higher,
which indicates a relatively high viability of the yeast Saccharomyces cerevisiae var. boulardii.
From an organoleptic point of view, final beer has a positive sensory profile. The aroma of the
product had a complex character: it included caramel, spicy, fruity and phenolic notes, as well as
smoked and wine elements; while honey was the dominant note of the taste
Application of the cost-effectiveness method in improving the pharmacotherapy of multiple myeloma
Multiple myeloma (MM) accounts for 1 % of all cancers and about 10 % of all hemoblastoses. The use of innovative technologies with the inclusion of targeted drugs leads to a significant improvement in the quality of pharmacotherapy and the achievement of overall survival (OS).The aim of the work is to conduct a pharmacoeconomic analysis of the most used MM therapy regimens with the use of targeted drugs and to determine the dominant treatment regimens using a costeffectiveness analysis.Materials and methods. To determine the cost of a course of treatment, we summed up the costs of drugs included in the pharmacotherapy regimen, taking into account taxes, marginal trade markup and duration of the course. Dosing of the targeted drug included in the regimen was determined according to the official instructions for the drug. Progression-free survival (PFS) was adopted as the main criterion for the effectiveness of treatment. Information on PFS of targeted drugs was obtained from data from international phase III RCTs — ASPIRE, TOURMALINEMM1, POLLUX and ELOQUENT2.Results. Based on the results of the pharmacoeconomic analysis, the dominant treatment regimen for MM was determined — daratumumab / lenalidomide / dexamethasone, which has the best cost-effectiveness ratio. The combination of elotuzumab / lenalidomide / dexamethasone was recognized as the least effective technology
Efficacy and safety of weekly carfilzomib (70 mg/m2), dexamethasone, and daratumumab (KdD70) is comparable to twice-weekly KdD56 while being a more convenient dosing option : a cross-study comparison of the CANDOR and EQUULEUS studies
The regimen of carfilzomib, daratumumab, and dexamethasone (KdD) shows activity in patients with relapsed/refractory multiple myeloma. KdD at the twice-weekly 56 mg/m carfilzomib dose (KdD56) was used in the randomized phase 3 CANDOR study (NCT03158688), whereas KdD at the once-weekly 70 mg/m carfilzomib dose (KdD70) was used in the phase 1 b EQUULEUS study (NCT01998971). We analyzed efficacy data from comparable CANDOR and EQUULEUS patients using inverse probability of treatment weighting (IPTW)-adjusted models. These weights were calculated from propensity scores derived to balance prespecified baseline covariates. The side-by-side and adjusted comparisons showed similar efficacy for overall response rates and progression-free survival in the two groups, with a series of sensitivity analyses showing consistent findings. Safety data were generally consistent with the known safety profiles of each individual drug. Once-weekly KdD70 is comparable to twice-weekly KdD56 in terms of efficacy and safety while being a more convenient dosing option
Ademetionine treatment cost analysis of patients with intrahepatic cholestasis and non-alcoholic fatty disease
Relevance. Ademetionine is a hepatoprotective drug, is included in the draft Russian clinical guidelines for the diagnosis and treatment of non-alcoholic fatty liver disease (NAFLD) and in the clinical guidelines for treating intrahepatic cholestasis (ITH), the cost analysis of treating patients with ITH and NAFLD is topical. Aim. The cost analysis of treatment with ademetionine for ITH and NAFLD in the Russian Federation. Methods. This clinical and economic analysis was conducted in accordance with the requirements of GOST R 57525–2017 and the methodological recommendations of the Center for Expertise and Quality Control of Medical Care. At the first stage, to determine the structure and number of costs, a review of legal acts and publications on the pharmacoeconomic analysis of clinical situations and drugs of interest in the e-Library and ConsultantPlus databases was carried out. The source of prices for medical services was the tariffs of the compulsory medical insurance system and data from the tariff agreement in Moscow within the framework of the compulsory medical insurance system, and in the absence of tariffs, the prices for paid medical services. Prices for drugs were obtained from an open source — the Russian Pharmaceutical Portal (Pharmindex.rf). In the absence of data on the cost structure, a survey of physicians conducted through a questionnaire. Results. Because of the literature review, 34 publications were found in the e-Library database on the use of ademetionine in NAFLD and ITH. Additionally, outside the scope of the literature review, a study was found in 2011, which provides a comparative clinical and economic analysis of the use of ademetionine (Heptral®) and essential phospholipids (Essentiale) in alcoholic liver damage and in infectious hepatitis. A review of legal acts in the ConsultantPlus database initially identified 93 documents, of which 25 turned out to be irrelevant to the current purpose of the study, that is, they didn’t allow analyzing the costs of ademetionine therapy. Of the 20 identified standards of medical care, only 2 are devoted to diseases of the liver and biliary tract. Because of the analysis, it was revealed that the cost per case of NAFLD treatment in a round-the-clock hospital amounted to 24.6 thousand rubles; in a day hospital, the cost per case of both NAFLD and ITH in adults amounted to 19.8 thousand rubles each. The average total cost of treating one patient during the year on an outpatient basis for NAFLD amounted to 65.3 thousand rubles, of which only 14.3 thousand rubles. covered by the compulsory medical insurance system, 16.9 thousand rubles outside the compulsory medical insurance system and 34.1 thousand rubles — drug costs. The average total costs for treating one patient during the year on an outpatient basis from ITH amounted to 65.4 thousand rubles, of which 23.9 thousand rubles. covered by the compulsory medical insurance system, 17.6 thousand rubles outside the compulsory medical insurance system and 23.9 thousand rubles — drug costs. Conclusion. Because of the study, the average costs for treating patients with NAFLD and ITH were calculated, which can later be used to conduct other types of pharmacoeconomic analysis
Оценка качества жизни реципиентов органов по итогам проведения Первых Российских трансплантационных игр
Objective: to evaluate the role of physical activity (at sports games) in improving the quality of life of organ recipients.Materials and methods. We examined 42 adult lung, heart, kidney and liver recipients, and patients undergoing renal replacement therapy (mean age 42.6 ± 12.09 years) - participants of the First Russian Transplant Games. The results were analyzed. Quality of life of the recipients was assessed using the nonspecific SF-36 questionnaire.Results. After solid organ transplantation, the interviewed recipients answered that they try to lead an active lifestyle, to engage in accessible physical activities, and to participate in sports events intended for organ recipients. Assessment of the quality of life according to the SF-36 questionnaire showed that all the participants had high scores in terms of the physical and psychological component, which is associated with regular physical training and sports. Conclusion. Physical exercise and active participation in sports activities are an important component in the socialization and rehabilitation of organ recipients. These two factors also improve the psychological and physical components of the quality of life of the recipients.Цель: оценить роль физической активности (на спортивных играх) в повышении качества жизни людей после трансплантации органов.Материалы и методы. Анализированы результаты обследования 42 совершеннолетних реципиентов легких, сердца, почки и печени, а также пациентов, находящихся на заместительной почечной терапии (средний возраст - 42,6 ± 12,09 года) - участников Первых Российских трансплантационных игр. С помощью неспецифического опросника SF-36 было оценено качество жизни реципиентов.Результаты. После трансплантации солидных органов опрашиваемые пациенты ответили, что стараются вести активный образ жизни, заниматься доступными видами физической культуры, участвовать в проводимых спортивных мероприятиях для реципиентов органов. Оценка качества жизни по шкалам опросника SF-36 показала, что у всех участников отмечаются высокие показатели в шкалах физического и психологического компонента, что связано с регулярными занятиями физической культурой и спортом.Заключение. Показано, что физические упражнения и активное участие в спортивных мероприятиях являются важной составляющей в социализации и реабилитации реципиентов органов, а также позволяют улучшить их психологический и физический компоненты качества жизни
НОВЫЕ ПОДХОДЫ К РАЗРАБОТКЕ АЛГОРИТМОВ ИСКУССТВЕННОГО ИНТЕЛЛЕКТА В ДИАГНОСТИКЕ РАКА ЛЕГКОГО
The relevance of developing an intelligent automated diagnostic system (IADS) for lung cancer (LC) detection stems from the social significance of this disease and its leading position among all cancer diseases. Theoretically, the use of IADS is possible at a stage of screening as well as at a stage of adjusted diagnosis of LC. The recent approaches to training the IADS do not take into account the clinical and radiological classification as well as peculiarities of the LC clinical forms, which are used by the medical community. This defines difficulties and obstacles of using the available IADS. The authors are of the opinion that the closeness of a developed IADS to the «doctor’s logic» contributes to a better reproducibility and interpretability of the IADS usage results. Most IADS described in the literature have been developed on the basis of neural networks, which have several disadvantages that affect reproducibility when using the system. This paper proposes a composite algorithm using machine learning methods such as Deep Forest and Siamese neural network, which can be regarded as a more efficient approach for dealing with a small amount of training data and optimal from the reproducibility point of view. The open datasets used for training IADS include annotated objects which in some cases are not confirmed morphologically. The paper provides a description of the LIRA dataset developed by using the diagnostic results of St. Petersburg Clinical Research Center of Specialized Types of Medical Care (Oncology), which includes only computed tomograms of patients with the verified diagnosis. The paper considers stages of the machine learning process on the basis of the shape features, of the internal structure features as well as a new developed system of differential diagnosis of LC based on the Siamese neural networks. A new approach to the feature dimension reduction is also presented in the paper, which aims more efficient and faster learning of the system.Актуальность разработки интеллектуальной автоматизированной системы диагностики (ИАСД) рака легкого (РЛ) связана с социальной значимостью этого заболевания и его лидирующей позицией в структуре онкологической заболеваемости. Теоретически применение ИАСД возможно как на этапе скрининга, так и в уточненной диагностике РЛ. Применяемые подходы к обучению ИАСД не учитывают клинико-рентгенологическую классификацию и особенности клинических форм РЛ, используемые медицинским сообществом. С этим связаны трудности применения разрабатываемых в настоящее время систем. Авторы придерживаются мнения, что приближенность разрабатываемой ИАСД к «логике врача» способствует лучшей воспроизводимости и интерпретируемости результатов при ее использовании. Большинство описанных в литературе ИАСД созданы на основе нейронных сетей, которые обладают рядом недостатков, влияющих на воспроизводимость при использовании системы. Данная работа отражает применение комбинированного алгоритма с использованием методов машинного обучения, таких как глубокий лес и сиамская нейронная сеть, что является более эффективным подходом при малой выборке обучающих данных и оптимальным с точки зрения воспроизводимости. Открытые базы данных, применяемые при разработке ИАСД, включают размеченные, но в ряде случаев не подтвержденные морфологически находки. В статье приводится описание базы данных LIRA, созданной на материале Санкт-Петербургского клинического научно-практического центра специализированных видов медицинской помощи (онкологический), которая включает только компьютерные томограммы пациентов с верифицированным диагнозом. В статье описаны этапы машинного обучения по признакам формы, внутренней структуры, а также новая разработанная архитектура дифференциальной диагностики образований на основе сиамских нейронных сетей. Также отражен способ понижения размерности данных для более эффективного и быстрого обучения системы
Организационно-экономические аспекты применения триплетов в терапии рецидивирующей и рефрактерной множественной миеломы в условиях российского здравоохранения
Background. The introduction of innovative drugs has significantly increased the treatment effectiveness in patients with relapsed/refractory multiple myeloma (RRMM), but the question of whether these expensive options can be financially secured remains open.Objective: to assess the cost of triplets of targeted drugs ixazomib, carfilzomib, elotuzumab and daratumumab with lenalidomide and dexamethasone used in the treatment of RRMM, and to determine possible payment options for this therapy at the level of the Russian Federation subjects.Material and methods. The cost of an annual course of treatment with the studied regimens with centralized purchases and the cost of targeted drugs per hospitalization case were calculated based on the maximum registered prices, recommended doses and treatment regimens. The normative legal acts regulating the payment of drug therapy for multiple myeloma were analyzed and possible financing channels and their limitations were identified. Using the example of the Volgograd and Saratov Regions, tariffs under the compulsory medical insurance system were calculated and their sufficiency in covering the cost of targeted therapy was estimated.Results. The cost of an annual course of triplet therapy per patient in the case of centralized procurement of drugs ranged from 5.51 million rubles (regimen with ixazomib) up to 8.03 million rubles (regimen with carfilzomib). The cost per hospitalization, depending on the number of doses, ranged from 80,667–242,000 rubles (ixazomib, 1–3 doses) in the Saratov Region up to 239,618–958,472 rubles (daratumumab, 1–4 doses) in the Volgograd Region. Possible reimbursement channels are High-Cost Nosologies (HCN), Obligatory Medical Insurance (OMI) and Regional Drug Coverage (RDC) programs, nevertheless triplet therapy cannot be purchased via the single channel and the combination of them is required. It has been shown that, in most cases, the costs for a case of targeted drug treatment in studied regions are covered by the average tariff for the corresponding diagnosis-related group (DRG), except for cases with a maximum duration in a day hospital setting. An analysis of the RDC lists and the procurement of drugs in the studied regimens at the expense of regional budgets showed that lenalidomide, ixazomib, carfilzomib, elotuzumab and daratumumab are included in the restrictive list in regions 77, 74, 66, 63 and 47, but they are purchased only in regions 15, 24, 6, 4 and 6, respectively.Conclusion. The use of a triplet with ixazomib is characterized by the lowest costs, which indicates its greater economic attractiveness relative to carfilzomib, daratumumab and elotuzumab in the treatment of patients with RRMM. The tariffs established in the current DRG model retain the possibility of paying for treatment with the high-cost medicines at the expense of the OMI funds in combination with the HCN or RDC programs. There are reasons to believe that the expansion of the list of 14 HCN program will increase the provision of patients with highly effective therapy and also reduce the financial burden on the regions.Актуальность. Появление инновационных лекарственных препаратов позволило значительно повысить эффективность лечения пациентов с рецидивирующей и рефрактерной множественной миеломой (РРММ), однако остается открытым вопрос о возможности финансового обеспечения этих дорогостоящих опций.Цель: провести оценку стоимости триплетов таргетных препаратов иксазомиб, карфилзомиб, элотузумаб и даратумумаб с леналидомидом и дексаметазоном, используемых в терапии РРММ, и определить возможные варианты оплаты данной терапии на уровне субъекта Российской Федерации.Материал и методы. Рассчитаны стоимость годового курса терапии исследуемыми схемами при централизованных закупках и стоимость таргетных препаратов в расчете на 1 случай госпитализации на основании предельных зарегистрированных цен, рекомендуемых дозировок и схем назначения. Проанализированы нормативные правовые акты, регулирующие оплату лекарственной терапии при множественной миеломе, определены возможные каналы финансирования и их ограничения. На примере Волгоградской и Саратовской областей рассчитаны тарифы для оплаты в системе обязательного медицинского страхования (ОМС) и оценена их достаточность для покрытия стоимости таргетной терапии.Результаты. Стоимость годового курса терапии пациента триплетами в случае централизованных закупок препаратов колебалась от 5,51 млн руб. (схема с иксазомибом) до 8,03 млн руб. (схема с карфилзомибом). Стоимость в расчете на 1 госпитализацию в зависимости от числа введений составила от 80 667 – 242 000 руб. (иксазомиб, 1–3 введения) в Саратовской области до 239 618 – 958 472 руб. (даратумумаб, 1–4 введения) в Волгоградской области. Возможными источниками финансирования являются программы ОМС, высокозатратных нозологий (ВЗН) и регионального льготного обеспечения (РЛО), но при этом в настоящий момент терапия триплетами не может быть оплачена из одного источника, необходима их комбинация. Показано, что в большинстве ситуаций затраты на 1 случай лечения таргетными препаратами в выбранных субъектах покрываются средним тарифом на соответствующую клинико-статистическую группу (КСГ), за исключением случаев с максимальной длительностью в условиях дневного стационара. Анализ перечней РЛО и закупок препаратов исследуемых схем за счет средств региональных бюджетов показал, что леналидомид, иксазомиб, карфилзомиб, элотузумаб и даратумумаб включены в ограничительный перечень в 77, 74, 66, 63 и 47 регионах соответственно, однако закупаются только в 15, 24, 6, 4 и 6 регионах соответственно.Заключение. Применение триплета с иксазомибом характеризуется наименьшими затратами, что свидетельствует о его большей экономической привлекательности относительно карфилзомиба, даратумумаба и элотузумаба в терапии пациентов с РРММ. Установленные в действующей модели КСГ тарифы сохраняют возможности оплаты лечения с применением дорогостоящих препаратов за счет средств ОМС в комбинации с программами ВЗН или РЛО. Есть основания полагать, что расширение перечня программы 14 ВЗН позволит повысить обеспеченность пациентов высокоэффективной терапией, а также снизить финансовую нагрузку на регионы
Спорт для пациентов с трансплантированным и органами
The article offers analysis of the problem status as well as World and Russian experience of donor organ recipients participation in sports and physical training. The connection of physical activity with the quality of life of patients after transplantation is reflected. The problems associated with organ donation in Russia and other countries and the importance of sports activities in promoting this problem are described. The analysis of foreign experience in the organization of sports games for people with transplanted organs, which indicates: the importance of research methods in admission to physical education and sports among recipients, the need for dosing and selection of physical activity, the involvement of a transplant doctor for individualization of rehabilitation programs. The personal experience of foreign athletes with transplanted organs, including the experience of the Russian recipient’s participation in the 21st world games 2017 is presented. Experience of carrying out sports activities for people with transplanted organs in Russia is also given.Представлен анализ состояния проблемы, а также мирового и российского опыта участия реципиентов донорских органов в занятиях спортом и физической культурой. Отражена роль влияния физической активности на качество жизни пациентов после трансплантации. Отмечены трудности, связанные с органным донорством в России и за рубежом, и значимость спортивных мероприятий в содействии данной проблеме. Проанализирован зарубежный опыт по проведению спортивных игр для лиц с трансплантированными органами, который указывает на важность дополнительных методов исследования при допуске к занятиям физической культурой и спортом у реципиентов, необходимость дозирования при подборе режима физической нагрузки, привлечение врача-трансплантолога для индивидуализации программ реабилитации. Представлен личный опыт зарубежных спортсменов с трансплантированными органами, в том числе опыт участия российского реципиента в 21-х Всемирных играх 2017 года. Также приводится опыт проведения спортивных мероприятий для людей с трансплантированными органами в России