Влияние регулятора энергетического обмена на клиническое течение и биомаркеры воспаления при лечении обострений тяжелой хронической обструктивной болезни легких

We assessed in a prospective, randomised, placebo-controlled trial the effects of «yantar-antitox» in patients with exacerbations of COPD requiring hospital admission. We recruited patients with exacerbations of severe COPD who were randomly assigned oral «Yantar-antitox» (n=33) or identical placebo (n=45) for 14 days, in addition to standard treatment with nebulised bronchodilators, antibiotics, and oxygen. We did spirometry and recorded symptom scores in inpatients. The 6-min walking distance (6MWD) was also determined. Inflammatory markers were measured in induced sputum and serum. Significant increase in the percentage predicted lung vital capacity, maximal expiratory flow volume, 6MWD were found between the patient in the «Yantar-antitox» — treated group.В проспективном рандомизированном плацебоконтролируемом исследовании изучались эффекты препарата «Янтарь-антитокс» у пациентов с обострением хронической обструктивной болезни легких (ХОБЛ), потребовавшим госпитализации. Пациенты с обострением тяжелой ХОБЛ были разделены на две группы: принимавшие «Янтарь-антитокс» (33 человека) и принимавшие плацебо (45 человек) в течение 14 дней в дополнение к стандартным мероприятиям: небулайзерная терапия бронходилататорами, антибактериальная, оксигенотерапия. Регистрировали показатели спирометрии и выраженность симптомов в баллах, проводили тест с 6-минутной ходьбой. Маркеры воспаления измеряли в индуцированной мокроте и в крови. Значимое увеличение показателей жизненной емкости легких, форсированной жизненной емкости легких, дистанции, пройденной за 6 мин было обнаружено только у пациентов основной группы

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Acute and chronic rhinosinusitis: principles of therapy

Rhinosinusitis (RS) is inflammation of the nasal mucosa and paranasal sinuses (PNS) which manifests itself in two or more symptoms: nasal congestion or discharge, sometimes also headache and partial loss of smell

Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

Background: Patent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurrent stroke compared with antiplatelet therapy. We hypothesised that anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, would reduce the risk of recurrent ischaemic stroke compared with aspirin among patients with PFO enrolled in the NAVIGATE ESUS trial. Methods: NAVIGATE ESUS was a double-blinded, randomised, phase 3 trial done at 459 centres in 31 countries that assessed the efficacy and safety of rivaroxaban versus aspirin for secondary stroke prevention in patients with ESUS. For this prespecified subgroup analysis, cohorts with and without PFO were defined on the basis of transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE). The primary efficacy outcome was time to recurrent ischaemic stroke between treatment groups. The primary safety outcome was major bleeding, according to the criteria of the International Society of Thrombosis and Haemostasis. The primary analyses were based on the intention-to-treat population. Additionally, we did a systematic review and random-effects meta-analysis of studies in which patients with cryptogenic stroke and PFO were randomly assigned to receive anticoagulant or antiplatelet therapy. Findings: Between Dec 23, 2014, and Sept 20, 2017, 7213 participants were enrolled and assigned to receive rivaroxaban (n=3609) or aspirin (n=3604). Patients were followed up for a mean of 11 months because of early trial termination. PFO was reported as present in 534 (7·4%) patients on the basis of either TTE or TOE. Patients with PFO assigned to receive aspirin had a recurrent ischaemic stroke rate of 4·8 events per 100 person-years compared with 2·6 events per 100 person-years in those treated with rivaroxaban. Among patients with known PFO, there was insufficient evidence to support a difference in risk of recurrent ischaemic stroke between rivaroxaban and aspirin (hazard ratio [HR] 0·54; 95% CI 0·22–1·36), and the risk was similar for those without known PFO (1·06; 0·84–1·33; pinteraction=0·18). The risks of major bleeding with rivaroxaban versus aspirin were similar in patients with PFO detected (HR 2·05; 95% CI 0·51–8·18) and in those without PFO detected (HR 2·82; 95% CI 1·69–4·70; pinteraction=0·68). The random-effects meta-analysis combined data from NAVIGATE ESUS with data from two previous trials (PICSS and CLOSE) and yielded a summary odds ratio of 0·48 (95% CI 0·24–0·96; p=0·04) for ischaemic stroke in favour of anticoagulation, without evidence of heterogeneity. Interpretation: Among patients with ESUS who have PFO, anticoagulation might reduce the risk of recurrent stroke by about half, although substantial imprecision remains. Dedicated trials of anticoagulation versus antiplatelet therapy or PFO closure, or both, are warranted. Funding: Bayer and Janssen