КЛИНИЧЕСКИЙ СЛУЧАЙ ЛИЗИСА ТРОМБА УШКА ЛЕВОГО ПРЕДСЕРДИЯ НА ФОНЕ ТЕРАПИИ ДАБИГАТРАНОМ У ПАЦИЕНТА С ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ, РАНЕЕ ПОЛУЧАВШЕГО ВАРФАРИН

The article describes the clinical observation of LAA thrombosis in a 46-year-old patient with atrial fibrillation that first occurred during taking warfarin; discusses further management of the patient. Due to inefficacy of medical cardioversion (CV) and the need to restore sinus rhythm, electric CV was planned. Before the planned restoration of the rhythm, transesophageal echocardiography was performed and a thrombus in the LAA was detected. Given that the patient had been on adequate warfarin therapy for a long time, it was decided to prescribe a drug from the direct oral anticoagulants group dabigatran etexilate at a dose of 150 mg BID for 8 weeks. The control transesophageal echocardiographic examination showed evidence of complete lysis of thrombus.Описывается клиническое наблюдение тромбоза ушка левого предсердия у пациента 46 лет с впервые возникшей фибрилляцией предсердий на фоне приема варфарина; обсуждается дальнейшая тактика ведения больного. Вследствие неэффективности медикаментозной кардиоверсии (КВ) и необходимости восстановления синусового ритма планировалась электрическая КВ. Перед плановым восстановлением ритма была выполнена чреспищеводная эхокардиография и выявлен тромб в ушке левого предсердия. Учитывая, что пациент длительно находился на адекватной терапии варфарином, было принято решение назначить препарат из группы прямых пероральных антикоагулянтов дабигатрана этексилат в дозе 150 мг 2 р/сут сроком на 8 недель. Контрольное чреспищеводное эхокардиографическое исследование констатировало растворение тромба

An invasive adenocarcinoma of the accessory parotid gland: a rare example developing from a low-grade cribriform cystadenocarcinoma?

Low-grade cribriform cystadenocarcinoma (LGCCA) is a rare tumor of the salivary gland that exhibits clinically indolent behavior. In this paper, we present a case of invasive adenocarcinoma of the accessory parotid gland in a young male that exhibited histology suggestive of an association of LGCCA. A 27-year-old man presented with a subcutaneous tumor in his left cheek. The tumor was separated from the parotid gland and located on the masseter muscle. The tumor was resected, and the postoperative histological diagnosis was adenocarcinoma, not otherwise specified (ANOS). The tumor exhibited papillary-cystic and cribriform proliferation of the duct epithelium and obvious stromal infiltration. Some tumor nests were rimmed by myoepithelium positive for smooth muscle actin, p63, and cytokeratin 14, indicating the presence of intraductal components of the tumor. Tumor cells exhibited mild nuclear atypia, and some of them presented an apocrine-like appearance and had cytoplasmic PAS-positive/diastase-resistant granules and hemosiderin. Other cells had foamy cytoplasm with microvacuoles. Immunohistochemistry revealed that the almost all of the tumor cells were strongly positive for S-100. These histological findings suggest the possibility that ANOS might arise secondarily from LGCCA. This is an interesting case regarding the association between ANOS and LGCCA in oncogenesis

ОЦЕНКА ЭФФЕКТИВНОСТИ И БЕЗОПАСНОСТИ ПЕРОРАЛЬНЫХ АНТИКОАГУЛЯНТОВ У ПАЦИЕНТОВ С ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ В ПРОСПЕКТИВНОМ НАБЛЮДЕНИИ

PURPOSE. To evaluate the effectiveness and safety of warfarin therapy using a clinical laboratory model of centralized monitoring of international normalized relationships, and direct oral anticoagulants in patients with atrial fibrillation in real clinical practice.MATERIAL AND METHODS. In a non-interactive prospective study, 661 atrial fibrillation patients were prescribed oral anticoagulants to prevent cardioembolic complications. The study included patients older than 18 years of age, with creatinine clearance at least 50 ml/min. Рatients were divided into 4 groups: 1 group of 120 people who took warfarin was observed in the conditions of centralized monitoring the international normalized ratio (INR), group 2 – 112 people– was taking Rivaroxaban, group 3 – 106 people– was taking Dabigatran, group 4 – 98 people took Apixaban. Formed 4 groups of patients were comparable in age, concomitant diseases, risks of thromboembolic and hemorrhagic complications.The follow-up period was 2 years from the date of prescribing.RESULTS. In patients who were observed in the clinical laboratory model of centralized monitoring of INR, the TTR was 69.4%. The groups did not differ in the number of thromboembolic complications (p>0.05). Warfarin had an advantage in the amount of large bleeding - 0.9% versus 3.6% taking rivaroxaban and 3.8% taking dabigatran (p = 0.044 and p = 0.035, respectively) without statistical significance for apixaban.CONCLUSION. The ratio of efficacy and safety of warfarin therapy can be successfully maintained at a satisfactory level using a centralized monitoring system of international normalized relationships. It allows you to get comparable treatment results with warfarin and direct inhibitors of blood coagulation factors in real clinical practice.ЦЕЛЬ. Оценить эффективность и безопасность терапии варфарином при использовании клинико-лабораторной модели централизованного мониторинга международного нормализованного отношения и прямыми оральными антикоагулянтами у пациентов с фибрилляцией предсердий в условиях реальной клинической практики.МАТЕРИАЛ И МЕТОДЫ. В ходе неинтервенционного проспективного исследования наблюдались 661 пациент с фибрилляцией предсердий старше 18 лет и с клиренсом креатинина не менее 50 мл/мин, получавшие варфарин (n = 120), ривароксабан (n = 112), дабигатран (n = 106) и апиксабан (n = 98). Пациенты, принимавшие варфарин, наблюдались в условиях централизованного мониторинга международного нормализованного отношения (МНО). Сформированные четыре группы пациентов были сопоставимы по возрасту, сопутствующим заболеваниям, рискам тромбоэмболических и геморрагических осложнений. Срок наблюдения составил 2 года от момента назначения препарата. В качестве конечных точек наблюдения рассматривали тромбоэмболические осложнения (ТЭО), большие кровотечения и смерть по любой причине.РЕЗУЛЬТАТЫ. В ходе наблюдения и использования клинико-лабораторной модели централизованного мониторинга МНО для варфарина достигнуто среднее время нахождения пациентов в терапевтическом целевом интервале 69,4%. Сравнение клинических результатов не показало статистически значимых отличий в исследованных группах по частоте ТЭО и некоторое преимущество в группе принимающих варфарин по количеству больших кровотечений – 0,9% против 3,6% принимающих ривароксабан и 3,8% принимающих дабигатран (р = 0,044 и р = 0,035 соответственно) без статистической значимости для апиксабана.ВЫВОД. Соотношение эффективности и безопасности терапии варфарином может с успехом поддерживаться на удовлетворительном уровне с помощью системы централизованного мониторинга международного нормализованного отношения, которая позволяет получать сопоставимые результаты лечения варфарином и прямыми ингибиторами факторов свертывания крови в реальной клинической практике

Production of {\pi}+ and K+ mesons in argon-nucleus interactions at 3.2 AGeV

First physics results of the BM@N experiment at the Nuclotron/NICA complex are presented on {\pi}+ and K+ meson production in interactions of an argon beam with fixed targets of C, Al, Cu, Sn and Pb at 3.2 AGeV. Transverse momentum distributions, rapidity spectra and multiplicities of {\pi}+ and K+ mesons are measured. The results are compared with predictions of theoretical models and with other measurements at lower energies.Comment: 29 pages, 20 figure

Update on the Combined Analysis of Muon Measurements from Nine Air Shower Experiments

Over the last two decades, various experiments have measured muon densities in extensive air showers over several orders of magnitude in primary energy. While some experiments observed differences in the muon densities between simulated and experimentally measured air showers, others reported no discrepancies. We will present an update of the meta-analysis of muon measurements from nine air shower experiments, covering shower energies between a few PeV and tens of EeV and muon threshold energies from a few 100 MeV to about 10GeV. In order to compare measurements from different experiments, their energy scale was cross-calibrated and the experimental data has been compared using a universal reference scale based on air shower simulations. Above 10 PeV, we find a muon excess with respect to simulations for all hadronic interaction models, which is increasing with shower energy. For EPOS-LHC and QGSJet-II.04 the significance of the slope of the increase is analyzed in detail under different assumptions of the individual experimental uncertainties

MODERN APPROACH TO ASSESS THE ASTHMA CONTROL AND TREATMENT EFFICASY IN DIFFERENT PHENOTYPES BY ENDOTHELIAN DISFUNCTION

The aim of this study is to measure the level of the endothelin-1 in blood samples and to assess vasoactive function of the endothelial in asthma patients with different phenotypes and to develop the methods of the objective assess of the ongoing treatment. Materials and methods. 119 asthma patients were separated into several phenotypes: patients with atopic asthma (60 pat); patients with ACOS (35 pat); asthma with obesity (24 pat). In all patients endothelium-dependent vasodilation and plasma level of endothelin-1 were assessed. Results. Endothelial dysfunction revealed in all asthma phenotypes. The highest level of the endothelin-1 shown in ACOS patients. In patients which achieved asthma control during three month of the anti-inflammatory therapy showed decreasing of the endothelin-1 level by 1,5 times in comparison with basic level (0,35 ± 0,06 fmol/ml and 0,64 ± 0,15 fmol/ml respectively, р < 0,01). But in patients with persistent symptoms and/or without lung function improvement the level of the endothelin-1 was not decreased significantly. Conclusions. Change of the functional conditions of the endothelial depend on the time and severity and phenotype of the asthma. The endothelin-1 level and the endothelium-dependent vasodilatation assess on the course of the treatment allow to reveal success of this anti- inflammatory therapy

Direct transcriptional consequences of somatic mutation in breast cancer.

The disordered transcriptomes of cancer encompass direct effects of somatic mutation on transcription; co-ordinated secondary alterations in transcriptional pathways; and increased transcriptional noise. To catalogue the rules governing how somatic mutation exerts direct transcriptional effects, we developed an exhaustive bioinformatics pipeline for analyzing RNA-sequencing data, which we integrated with whole genome sequencing from 23 breast cancers. Using X-inactivation analyses, we find cancer cells are more transcriptionally active than intermixed stromal cells. This is especially true in ER-negative tumours. Overall, 59% of 6980 exonic substitutions were expressed. Compared to other classes, nonsense mutations showed lower expression levels than expected with patterns characteristic of nonsense-mediated decay. 14% of 4234 genomic rearrangements caused transcriptional abnormalities, including exon skips, exon reusage, fusion transcripts and premature poly-adenylation. We found productive, stable transcription from sense-to-antisense gene fusions and gene-to-intergenic rearrangements, suggesting that these mutation classes may drive more transcriptional disruption than previously suspected. Systematic integration of transcriptome with genome data therefore reveals the rules by which transcriptional machinery interprets somatic mutation