Development of professional tolerance in medical students through professionally-oriented foreign language training

Global sociocultural transformations in the modern world are associated with expansive digitalisation and its impact on human life. Given the advantages of digital technology development, a number of significant problems arise, in particular, social differentiation, commercialisation of socionomic professions, information consumerism, emotional estrangement due to the virtualisation of communication, a shift in value orientations, replacement of traditional moral norms with their destructive simulacra. There is a clear need for intensification of educational activities in higher education focused on the humanisation of public consciousness, the promotion of social cohesion and the development of the moral backbone of an individual. Hence, it is necessary to refer to the theoretical and methodological foundations of tolerance development in students. The aim of this article is to clarify the concept of professional tolerance of a doctor and describe the strategy of its development in students in the process of foreign language training. Considering the issue of professional education of future doctors, the authors note that the vector of students’ spiritual and moral development is determined by the values, attitudes, and norms of medical ethics and deontology. Herewith, the principle of tolerance is of the basic ones since professional medical practice is based on regular interpersonal interaction. The authors define the concept of a doctor’s professional tolerance as the willingness to provide patients with high-quality medical care regardless of the heterogeneity of socio-cultural factors and subjective personal aspects. This concept assumes the doctor’s tact, empathy, psychological flexibility and poise. The proposed strategy for the development of professional medical tolerance in students via professionally-oriented foreign language training involves the holistic formation of its cognitive, affective and conative components through the educational content and the parity in subject-subject interaction. In the development of the cognitive component, considerable importance is ascribed to supplementing the basic educational materials by authentic content of social and professional orientation. The connecting link of the development of cognitive and affective components is the identification and levelling of stereotypes and prejudices regarding socially significant diseases. The basis for the development of the affective component is pedagogical tolerance, a favourable educational environment, interactive activities at classes, and the facilitation of students’ reflection. The development of the conative component of tolerance is directly tied to the development of professional communicative competence of future doctors: the study and development of various speech clichés in the format of interaction with patients; revision of politeness formulas; practicing non-verbal communication means in playing out quasi-professional situations; mastering the speech norms “plain language” and “people-first language”

Фармакоэкономическое исследование применения препарата энзалутамид у больных неметастатическим кастрационно-резистентным раком предстательной железы

Background. Prostate cancer is one of the most common malignant diseases among men. Until recently, the most common treatment of nonmetastatic castration-resistant prostate cancer (nmCRPC) in Russia was to continue previously started hormonal therapy. Enzalutamide is a second-generation anti-androgen indicated for treatment of CRPC, regardless of a patient’s metastatic status, which significantly increases metastasis-free survival in nmCRPC compared with androgen deprivation therapy (ADT).Objective: to evaluate the incremental cost-effectiveness ratio (ICER) of enzalutamide use in patients with nmCRPC and the ICER of abiraterone as the first-line therapy for mCRPC from the Russian healthcare system perspective.Materials and methods. Standard ADT regimens for nmCRPC were used as a comparator as it was the only approved treatment for nmCRPC in Russia. We proposed a Markov model of CRPC progression on enzalutamide plus ADT (hereinafter enzalutamide) or ADT based on PROSPER trial data. Model was used to calculate progression-free life years and costs of nmCRPC and post-progression CRPC treatment. Simulation period was 5 years with one cycle of 1 month. In the “cost–effectiveness” analysis, we calculated enzalutamide ICER compared to ADT. In addition, we calculated ICER for abiraterone plus ADT and prednisolone (hereinafter abiraterone) vs ADT + prednisolone in the first-line therapy of metastatic CRPC (mCRPC) as a benchmark. In both cases, time to disease progression over a 5-year period was used as an efficacy criteria.Results. According to the Markov model, progression-free life-years gained for enzalutamide were 3.12 years compared to 1.79 for ADT within a 5-year period. The average enzalutamide therapy costs were 7,989,475.8 rubles/1 patient for 5 years, which were 5,716,983.5 rubles higher than when using ADT (2,272,492.3 rubles). ICER for enzalutamide (vs ADT) was 4,307,136.3 rubles per one progression-free life-year gained. ICER for abiraterone in the first line of mCRPC treatment (vs ADT + prednisolone) was 6,191,617.4 rubles per one progression-free life-year gained.Conclusion. In the Russian healthcare system, ICER for enzalutamide in nmCRPC was 4,307,136.3 rubles and the ICER for abiraterone in mCRPC was 6,191,617.4 rubles. Введение. Рак предстательной железы относится к числу наиболее распространенных злокачественных заболеваний у мужчин. До недавнего времени основным методом лечения неметастатического кастрационно-резистентного рака предстательной железы (нмКРРПЖ) являлось продолжение начатой ранее гормональной терапии. Энзалутамид – антиандроген 2-го поколения, показанный для лечения кастрационно-резистентного рака предстательной железы (КРРПЖ) независимо от наличия метастазов, который позволяет существенно увеличить выживаемость без метастазов у пациентов с нмКРРПЖ по сравнению с андроген-депривационной терапией (АДТ).Цель исследования – оценить инкрементальное соотношение «затраты–эффективность» (ICER) для энзалутамида у пациентов с нмКРРПЖ и ICER для абиратерона в 1-й линии терапии пациентов с метастатическим КРРПЖ (мКРРПЖ) как препаратов, включенных в перечни и применяющихся при заболеваниях из одного и того класса МКБ-10 с позиции российской системы здравоохранения.Материалы и методы. В качестве варианта сравнения для энзалутамида были выбраны стандартные режимы АДТ для лечения нмКРРПЖ, так как это был единственный одобренный вариант лечения данного заболевания в России. Предложена марковская модель прогрессирования КРРПЖ при применении энзалутамида + АДТ (далее энзалутамид) или АДТ на основании данных исследования PROSPER. Модель была использована для расчета числа прожитых лет без прогрессирования и затрат на лечение нмКРРПЖ и КРРПЖ после прогрессирования. Период моделирования составил 5 лет с длительностью одного цикла моделирования 1 мес. В ходе анализа «затраты–эффективность» мы оценили инкрементальное соотношение «затраты/эффективность» для энзалутамида по сравнению с АДТ. В дополнение мы оценили ICER для абиратерона + АДТ и преднизолон (далее абиратерон) по сравнению с АДТ + преднизолон в 1-й линии терапии мКРРПЖ в качестве ориентира. При этом в обоих случаях в качестве критерия эффективности использовали время жизни до прогрессирования заболевания за период 5 лет.Результаты. Согласно результатам марковского моделирования среднее время предстоящей жизни без метастатического прогрессирования за период 5 лет при использовании энзалутамида составило 3,12 года по сравнению с 1,79 года при применении АДТ. При терапии энзалутамидом средние расходы составляют 7989475,8 руб. на 1 пациента за 5 лет, что на 5716983,5 руб. выше, чем при использовании АДТ (2272492,3 руб.). Стоимость дополнительного года жизни без прогрессирования при применении энзалутамида для лечения нмКРРПЖ по сравнению с АДТ составляет 4307136,3 руб. Стоимость дополнительного года жизни без прогрессирования при применении абиратерона для лечения мКРРПЖ по сравнению с преднизолоном составляет 6 191 617,4 руб.Заключение. В условиях российской системы здравоохранения ICER для энзалутамида для лечения нмКРРПЖ составило 4 307 136,3 руб., для абиратерона для лечения мКРРПЖ – 6 191 617,4 руб.

A Study of Embryotoxic, Foetotoxic, and Teratogenic Effects of the Original Antituberculosis Agent Thiozonide in Pregnant Rabbits

Several treatment regimens with antituberculosis medicinal products are available for tuberculosis. Thiozonide is a newly developed original antimicrobial agent that exhibits bacteriostatic activity against Mycobacterium tuberculosis strains H37Rv, CN-37, CN-40, and MS-115.The aim of the study was to investigate the embryotoxic, foetotoxic, and teratogenic effects of thiozonide in pregnant rabbits.Materials and methods. The study involved 66 pregnant rabbits (4 groups of 16–17 animals each). The rabbits received oral thiozonide from day 6 to day 19 of gestation at doses of 20.6 mg/kg (1 TD (therapeutic dose)), 103 mg/kg (5 TDs), and 206 mg/kg (10 TDs). The control group received a 1% starch solution. The authors conducted a macroscopic examination of the reproductive organs and a histological evaluation of the placenta in eutha nised pregnant rabbits. Live foetuses underwent a check for developmental abnormalities, a skeletal development evaluation with a modified Dawson’s method, and a histologic examination of the internal organs.Results. The study showed no clinical signs of toxicity and no mortality associated with thiozonide in pregnant rabbits across all dose groups. Macroscopic and histological examinations revealed no pathological changes in the reproductive organs of pregnant rabbits. The evaluation of embryotoxic and foetotoxic effects did not identify any differences between the foetuses of the animals assigned to different doses of thiozonide and the control group. The authors found no developmental abnormalities in the foetuses. Examinations of foetal skeleton development and internal organ condition identified no differences between the groups and no abnormalities. The authors registered the death of all foetuses (late resorption) in one rabbit from the 206 mg/kg group. Therefore, the 103 mg/kg dose (5 TDs) was selected as a reasonable No Observed Adverse Effect Level (NOAEL).Conclusions. Thiozonide has no embryotoxic, foetotoxic, or teratogenic effects

Sex differences of subpopulation composition of lymphocytes in the peripheral blood in experimental acute and chronic ulcerative colitis

We studied sex differences lymphocytes subpopulations of peripheral blood in adult C57Bl/6 mice during acute and chronic colitis, induced with 1% DSS. We measured subpopulations of lymphocytes with flow cytometry. We showed that in the control group the female mice had statistically significantly higher values of the relative number of regulatory and cytotoxic T lymphocytes comparing to the males. During acute colitis the females showed an increase in the relative number of Thelpers and a decrease of cytotoxic Tlymphocytes, which reflects the activation of immune response. The males had a decrease in the absolute number of leukocytes, lymphocytes and cytotoxic and regulatory T lymphocytes, probably because of an increase in migration of these cells to the inflammation locus and local lymph nodes. In chronic colitis the females had a decrease in the absolute number of leukocytes, lymphocytes, T helpers, cytotoxic T lymphocytes and B lymphocytes when comparing with acute colitis. During chronic colitis the males had a decrease in the absolute number of T helpers and B lymphocytes but an increase of regulatory T cells in comparison with the control group; in comparison with acute colitis the males with chronic colitis had higher relative and absolute number of regulatory T cells. The increase of T regulatory lymphocytes is due to an increase in their proliferation rate in the thymus and increase of their migration to the inflammatory locus – the colon. Future clinical studies may be based on these results, which show that the treatment of colitis, especially with immunotropic agents, must take sex differences into account

Клинико-экономическое исследование применения комбинации энкорафениба и биниметиниба в первой линии терапии метастатической или неоперабельной меланомы кожи с мутацией V600 в гене BRAF в Российской Федерации

Objective: to perform a cost-effectiveness analysis of using encorafenib and binimetinib combination in the first-line therapy for metastatic or unresectable BRAF V600-mutated melanoma in the Russian Federation. Material and methods. The comparators included “dabrafenib + trametinib” combination and vemurafenib monotherapy, which are listed in the Russian clinical guidelines and the Vital and Essential Drugs List. Since “encorafenib and binimetinib” combination demonstrated superior overall response rate compared to “dabrafenib + trametinib” and vemurafenib monotherapy, the method of cost-effectiveness analysis was used. We developed a disease progression model based on data from the COLUMBUS randomized control trial and published network meta-analysis. The model was used to calculate the direct medical costs associated with the considered alternatives over a 3-year modeling horizon. We compared the incremental cost-effectiveness ratio for “encorafenib + binimetinib” vs. “dabrafenib + trametinib” to the same ratio calculated for “dabrafenib + trametinib” vs. vemurafenib monotherapy.Results. Mean costs of using “encorafenib + binimetinib” combination over a 3-year period, considering the discontinuation of treatment as the disease progresses, was 6,547,693.07 rubles. Meanwhile, it was 5,962,742.52 rubles for “dabrafenib + trametinib” and 2,581,781.45 rubles for vemurafenib monotherapy. The incremental cost-effectiveness ratio of “encorafenib + binimetinib” vs. “dabrafenib + trametinib” was 3,846,818.71 rubles per 1 patient with a response to therapy. This was 85.14% lower than the same ratio estimated for “dabrafenib + trametinib” vs. vemurafenib monotherapy (25,890,022.64 rubles per 1 patient with a response to therapy).Conclusion. The “encorafenib + binimetinib” combination is a cost-effective treatment method for patients with unresectable or metastatic BRAF V600-mutated melanoma in the Russian Federation.Цель: провести клинико-экономическую оценку применения комбинации «энкорафениб + биниметиниб» в первой линии терапии метастатической или неоперабельной меланомы кожи с мутацией V600 в гене BRAF в условиях системы здравоохранения Российской Федерации.Материал и методы. В качестве вариантов сравнения выбраны комбинация «дабрафениб + траметиниб» и вемурафениб – терапевтические опции, применяемые в одной и той же клинической ситуации согласно клиническим рекомендациям и включенные в перечень жизненно необходимых и важнейших лекарственных препаратов. Поскольку комбинация «энкорафениб + биниметиниб» статистически значимо эффективнее комбинации «дабрафениб + траметиниб» и монотерапии вемурафенибом по критерию общей частоты ответа, для фармакоэкономического анализа использован метод «затраты–эффективность». На основании данных рандомизированного контролируемого испытания COLUMBUS, а также опубликованного сетевого метаанализа, в котором проводилось непрямое сравнение рассматриваемых альтернатив, разработана математическая модель прогрессирования заболевания. Модель применяли для расчета прямых медицинских затрат при использовании рассматриваемых альтернатив на горизонте моделирования 3 года. Полученное на ее основе соотношение затрат и эффективности для комбинации «энкорафениб + биниметиниб» по сравнению с комбинацией «дабрафениб + траметиниб» сравнивали с аналогичным соотношением, рассчитанным на тот же клинический эффект, для комбинации «дабрафениб + траметиниб» по сравнению с вемурафенибом.Результаты. С учетом постепенной отмены терапии по мере прогрессирования заболевания средние расходы за 3 года при использовании комбинации «энкорафениб + биниметиниб» составляют 6 547 693,07 руб., комбинации «дабрафениб + траметиниб» – 5 962 742,52 руб., вемурафениба – 2 581 781,45 руб. Инкрементальное соотношение затрат и эффективности для комбинации «энкорафениб + биниметиниб» по сравнению с комбинацией «дабрафениб + траметиниб» составляет 3 846 818,71 руб. на 1 пациента с ответом на терапию, что на 85,14% ниже аналогичного соотношения, рассчитанного на тот же клинический эффект, в случае применения комбинации «дабрафениб + траметиниб» по сравнению с вемурафенибом (25 890 022,64 руб. на 1 пациента с ответом на терапию).Заключение. Комбинация «энкорафениб + биниметиниб» представляет собой затратно-эффективный метод первой линии терапии у пациентов с неоперабельной или метастатической меланомой кожи с мутацией V600 в гене BRAF в условиях системы здравоохранения Российской Федерации

Sex differences of molecular mechanisms of insulin sensitivity in young and adult C57BL/6J mice

Reduced insulin sensitivity plays an important role in the pathogenesis of type II diabetes. There are sex differences in the development of metabolic disorders. The aim of this work was to investigate the insulin signal transduction gene expression in mice of different sex and age. Male and female C57BL/6J mice were used in our studies. Gene expression was assayed by RT-PCR. It was shown that insulin sensitivity in females was higher than in males regardless of age because the level of glucose in blood plasma of females does not differ from that in males, whereas female insulin levels were lower than male insulin levels. Female glucose tolerance increased with age, and glucose tolerance was higher in females than in males at the age of 30 weeks. It was shown that sex and age affect the expressions of insulin signal transduction genes. It was shown that there are sex differences in the levels of mRNA Pik3cd in the liver, in the levels of mRNA Irs1 in the muscle, in the levels of mRNA Irs1 and Slc2a4 in adipose tissue at the age of 10 weeks, and there are sex differences in the levels of mRNA Irs2 and Pik3cd in the liver, in the levels mRNA Pik3cd and Slc2a4 in the muscle, in the levels mRNA Insr and Pik3cd in adipose tissue at the age of 30 weeks. In young animals, the expression of the genes was higher in females than in males in all tissues. In adult animals, the expression of the genes in the liver was higher in females than in males, the expression of the genes in muscle and adipose tissues were lower in females than in males. In males, the levels of mRNA Insr in the liver and muscles and mRNA Pik3cd in adipose tissue decreased with age, and the level of mRNA Pik3cd in muscles  increased with age. In females, the levels of mRNA Irs1 in muscle and mRNA Pik3cd and Slc2a4 in adipose tissue decreased with age. Thus the molecular basis of sex differences and age-related changes in insulin sensitivity may be a change in expressions of insulin signal transduction genes in the target tissues

Фармакоэкономический анализ применения лекарственного средства Бретарис Дженуэйр в лечении хронической обструктивной болезни легких

The aim of this study was to determine the optimal therapy of chronic obstructive pulmonary disease (COPD) according to costeffectiveness of Bretaris Genuair, Spiriva Respimat, Spiriva Handihaler or Seebri Breezhaler.Methods. Pharmacoeconomic evaluation was performed using cost effectiveness analysis, economic impact analysis, and cost analysis. Initially, search of pharmacoeconomic data for treatment with Bretaris Genuair, Spiriva Respimat, Spiriva Handihaler or Seebri Breezhaler was performed using specialized databases Pubmed and Medlink. Then, two clinical situations were modelled. The first situation included a direct comparison between Bretaris Genuair and Spiriva Handihaler. The second situation included comparison between all the studied drugs.Results. The first clinical situation presumed that all patients treated with Spiriva Handihaler were switched to Bretaris Genuair. This allows saving 695,785 RUB per 100 patients. Therapy with Bretaris Genuair was characterized by the min imal cost per a clinical effectiveness unit, which was lung function improvement, in comparison with Spiriva Respimat, Spiriva Handihaler and Seebri Breezhaler. The second situation presumed that proportion of patients treated with Spiriva Respimat, Spiriva Handihaler and Seebri Breezhaler was equally about 33%. In this situation, switching at least of 10% of patients from each drug to treatment with Bretaris Genuair could save 50,000 to 68,000 RUB.Conclusion. Therapy of COPD using Bretaris Genuair is superior over the treatment with Spiriva Handihaler, Spiriva Respimat and Seebri Breezhaler in terms of pharmacoeconomic evaluation.В России среди болезней органов дыхания 1е место по распространенности занимает хроническая обструктивная болезнь легких (ХОБЛ), опережая при этом бронхиальную астму и пневмонию и нанося существенный экономический и социальный ущерб пациентуи обществу в целом.Цель. Целью проведенного исследования было определение с позиций фармакоэкономического анализа наиболее оптимальной терапии ХОБЛ на основании сравнения зарегистрированных лекарственных средств (ЛС) Бретарис Дженуэйр, Спирива Респимат, Спирива ХандиХалер и Сибри Бризхалер.Материалы и методы. Фармакоэкономическая оценка была проведена с использованием методов анализа «затраты – эффективность» и «влияния на бюджет», а также анализа затрат.Результаты. По результатам анализа «влияния на бюджет» выявлено, что экономия бюджетных средств системы здравоохранения в случае применения ЛС Бретарис Дженуэйр при переводе 100 пациентов с терапии альтернативными ЛС составляет до 695 тыс. руб. В ходе анализа «затраты – эффективность» установлено, что терапия ЛС Бретарис Дженуэйр характеризуется наименьшими затратами за единицу эффективности – улучшение функции легких по сравнению с ЛС Спирива ХандиХалер, Спирива Респимат и Сибри Бризхалер.Заключение. При фармакоэкономической оценке установлено, что терапия ЛС Бретарис Дженуэйр является доминантной по сравнению с ЛС Спирива Ханди Халер, Спирива Респимат и Сибри Бризхалер

Долгосрочный анализ влияния на бюджет применения препарата канаглифлозин для лечения сахарного диабета 2-го типа у взрослых пациентов с наличием диабетической нефропатии в условиях Российской Федерации

Background. Diabetic nephropathy (DN) is a specific kidney lesion in patients with diabetes mellitus, which leads to the development of endstage kidney disease and requires substitutive renal therapy (dialysis or transplantation). Canagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor, which exerts a renoprotective effect. According to the published data, the application of canagliflozin in patients with type 2 diabetes mellitus (DM2) and DN could postpone dialysis therapy for almost 13 years.Objective: to perform a long-term analysis of canagliflozin budget impact in adult patients with DM2 and DN from the point of view of the constituent entities of the Russian Federation.Material and methods. A group of comparison for canagliflozin was placebo (no renoprotective pharmacotherapy). The authors proposed a mathematical model for DN progression in groups of patients who received canagliflozin (100 mg orally, daily, long-term) or placebo. The model was based on the extrapolation of the CREDENCE study data. The model was used for the analysis of the direct costs on the lifetime pharmacotherapy and dialysis per one patient. Epidemiologic data from the federal register on the number of adult patients with DM and DN prevalence among these patients were used to evaluate the size of the target population. Based on the clinical recommendations and the medical care standards for patients with DM and the data on the actual state procurement of SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists in 2021, we evaluated the share of patients with DM2+DN who currently do not receive renoprotective therapy but who must be supplied with canagliflozin according to the standards. Among this population, we determined the patients with the glomerular filtration rate within 30–90 ml/min/1.73 m2, which provides the comparability of the target population with patients included in CREDENCE clinical study.Results. Direct medical costs per one patient receiving canagliflozin therapy were 678 108 rubles, which was 52.8% (759,239 rubles) lower than without renoprotective pharmacotherapy (1,437,347 rubles). As a result, considering the modeling period and current practice, the budget costs for pharmacotherapy of patients with DM2+DN were 99.82 billion rubles, in comparison with the proposed practice, which was 47.09 billion rubles (difference in budget costs is 52.73 billion rubles, or 52.8%). The accumulated costs of the regional health care system were lower in patients receiving canagliflozin in comparison with patients without renoprotective pharmacotherapy 11 years after the beginning of treatment.Conclusion. The expansion of canagliflozin application in the therapy for patients with DM2+DN leads to the budget cost cuts in the long run due to the extension of the dialysis-free period.Актуальность. Диабетическая нефропатия (ДН) – специфическое поражение почек при сахарном диабете, которое приводит к развитию терминальной почечной недостаточности, требующей проведения заместительной почечной терапии: диализа или трансплантации. Канаглифлозин – препарат класса ингибиторов натрий-глюкозного котранспортера 2-го типа (иНГЛТ-2), обладающий нефропротективным эффектом. Согласно литературным данным применение канаглифлозина у взрослых пациентов с сахарным диабетом 2-го типа (СД2) и ДН позволяло почти на 13 лет отсрочить возникновение потребности в диализе.Цель: проведение долгосрочной оценки влияния на бюджет применения препарата канаглифлозин для лечения СД2 у взрослых пациентов с наличием ДН с позиции систем здравоохранения субъектов Российской Федерации.Материал и методы. В качестве варианта сравнения для канаглифлозина выбрано отсутствие нефропротективной лекарственной терапии (плацебо). Предложена математическая модель прогрессирования ДН при применении канаглифлозина (в режиме дозирования 100 мг перорально ежедневно длительно) или плацебо на основании экстраполяции данных исследования CREDENCE. С помощью модели выполнен анализ прямых медицинских затрат на лекарственную терапию и проведение диализа в расчете на одного пациента до конца его жизни. Для оценки численности целевой популяции использованы эпидемиологические данные федерального регистра о числе состоящих на учете взрослых больных СД2 и распространенности ДН среди таких пациентов. На основании клинических рекомендаций и стандарта оказания медицинской помощи взрослым больным СД2, а также данных о фактических государственных закупках препаратов классов иНГЛТ-2 и агонистов рецептора глюкагоноподобного пептида-1 в 2021 г. была оценена доля пациентов с СД2+ДН, которые сегодня не получают нефропротективную терапию, но в соответствии со стандартом должны обеспечиваться канаглифлозином. Среди них были выделены больные с уровнем скорости клубочковой фильтрации в пределах 30–90 мл/мин/1,73 м2, что обеспечивает сопоставимость характеристик целевой популяции пациентов с лицами, включенными в клиническое исследование CREDENCE.Результаты. Прямые медицинские затраты в расчете на одного пациента в случае терапии канаглифлозином составляют 678 108 руб., что на 52,8% (759 239 руб.) ниже, чем при отсутствии нефропротективной лекарственной терапии (1 437 347 руб.). В результате за период моделирования расходы в рамках текущей практики терапии пациентов с СД2+ДН составляют 99,82 млрд руб., в рамках предлагаемой практики – 47,09 млрд руб. (разница в расходах бюджета – 52,73 млрд руб., или 52,8%). Накопленные расходы региональной системы здравоохранения при применении канаглифлозина оказываются меньше, чем при отсутствии нефропротективной лекарственной терапии через 11 лет после начала лечения.Заключение. Расширение использования канаглифлозина для лечения пациентов с СД2+ДН позволяет в долгосрочной перспективе сокращать расходы бюджета за счет более позднего возникновения потребности в диализе

Current approach to male infertility treatment: sperm selection procedure based on hyaluronic acid binding ability

Intracytoplasmic sperm injection into an oocyte is widely used throughout the world in assisted reproductive technologies programs in the presence of male infertility factor. However, this approach can allow selection of a single sperm, which is carrying different types of pathologies. Minimizing of any potential risks, entailing the occurrence of abnormalities in the embryos development (apoptosis, fragmentation of embryos, alterations in gene expression, aneuploidies) is a very important condition for reducing the potential negative consequences resulting the manipulation with gametes. Processes that could be influenced by the embryologist must be fulfilled in safe and physiological way as much as it is possible. Data of numerous publications reporting about the positive effects of using the technology of sperm selection by hyaluronic acid binding, let make a conclusion about the high prospects of this approach in the treatment of male infertility by methods of in vitro fertilization. The selection of sperm with improved characteristics, which determine the maturity and genetic integrity, provides an opportunity to improve the parameters of pre-implantation embryogenesis, having thus a positive effect on clinical outcomes of assisted reproductive technologies programs

What affects the neurovisualisational detection of ischemic stroke?

Introduction. The incidence of stroke is 2.5–3 cases per 1 000 population per year, mortality – 1 case per 1 000 population per year. According to various data, up to 20% of computed tomography (CT) scans performed on the first day do not reveal signs of  an ischemic focus.Aim of the study. To assess the detectability of acute ischemia foci using CT, depending on the location of the foci, the timing of  neuroimaging, the severity of stroke, and other indicators.Material and methods. We analyzed 100 cases of acute cerebrovascular accident (ACV) by ischemic type. The timing of the CT scan, glucose level, coagulogram parameters, NIHSS scores at admission, focus localization, the presence of atherosclerosis of the arteries of the head, and atrial fibrillation were taken into account. Patients were divided into two groups depending on the fact of detection of the focus during the primary tomographic examination. Repeated neuroimaging (magnetic resonance imaging) was performed in 54 patients.Results. In the “CT-negative” group, stem strokes predominated (p = 0.01), patients were younger (р = 0.038), and there were significantly more women than men (р = 0.00006). An increase in glucose over 8 mmol/l, on the contrary, was more often detected in the “CT-positive” group (14 cases in “CT-positive” against 5 cases in “CT-negative” group, p = 0.022). NIHSS scores ≥ 5 were found in 24 patients (47%) in the “CT-positive” group and in 13 patients (26.5%) in the “CT-negative” group (p = 0.034).Conclusions. Cases of stroke that are not detected on CT scan upon admission to the hospital are more common among women, with stem localization, are associated with low NIHSS scores. High glucose levels at admission is associated with the detection of ischemic foci during the initial CT examination