101 research outputs found

    Legal regulation of rational energy production and consumption in Russia and other states

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    The authors of the artlcle analyze the problems of legal regulatlon of ratlonal subsoll use and energy consumptlon ln Russla, Germany, USA, Japan and other countrles. It also compares the energy leglslatlon of dlfferent countrles. Based on the results, lt was concluded that the development of the leglslatlon of these countrles ls ln general compllance wlth the strateglc goals ln the fleld of energy productlon and consumptlo

    ИТТЕРБИЕВЫЕ КОМПЛЕКСЫ ПОРФИРИНОВ И ИХ ПРИМЕНЕНИЕ В МЕДИЦИНЕ

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    Malignant tumors are the second most frequent cause of death after cardiovascular diseases. The photodynamic therapy based on the interaction of laser light with different photosensitizers was discovered in the 20th century as one of treatment methods. When using photosensitizers, the process of singlet oxygen and other active forms generation is observed in both malignant and healthy body tissues, which leads to a number of adverse reactions. More promising diagnostic compounds that do not have these disadvantages are ytterbium porphyrin complexes. These compounds slightly generate singlet oxygen under light irradiation, while maintaining a high level of tumorotropic agents as for therapeutic photosensitizers. This work continues a series of studies devoted to the analysis of physicochemical properties of Yb-complex 2,4-dimetoxyhematoporphyrin IX as a promising marker for fluorescent diagnostics of various tumors. Pharmaceutical compositions based on Yb3+-dimetoxyhematoporphyrin IX dipotassium salt were created. These compositions are capable of accumulating in the sites of inflammation and proliferation in diseases of mucosal membranes and cancer lesions. Toxicological and pharmacokinetic studies were carried out with the use of laboratory animals and volunteers. The analysis results showed that the pharmaceutical compositions are perspective for use in clinical practice.Рассмотрены области применения солей иттербия и иттербиевых комплексов с порфиринами в качестве лечебных и диагностических средств. Приведен синтез 2,4-диметоксигематопорфирина IX, исходя из гемина крови. Получена дикалиевая соль Yb-комплекса этого порфирина, исследованная в качестве перспективного нефототоксичного маркера для люминесцентной диагностики новообразований. Изучены основные фотофизические характеристики данного Yb-комплекса (электронные спектры поглощения, время жизни и интенсивность люминесценции, относительный квантовый выход 4f-люминесценции). Показано влияние колебаний OH-осцилляторов на тушение люминесценции иона Yb3+ в его комплексах с порфиринами, при этом максимальная интенсивность люминесценции наблюдается в растворе 100%-го ДМСО. С целью применения Yb-комплексов для дифференциальной диагностики патологических изменений кожи и слизистых оболочек создана фармацевтическая композиция на основе различных гелей. На основании этого впоследствии выявлено, что при люминесценции в ближнем ИК-диапазоне (900-1100 нм) достигаются высокие значения диагностического контрастного индекса измененная/здоровая ткань (3÷15). Время накопления фармацевтических композиций в различных новообразованиях составляет менее 1 часа. Предложенные фармацевтические композиции позволяют обнаруживать поврежденные участки тканей, не выявляемые визуально, и проводить контроль за лечением воспалительных заболеваний кожи и слизистых оболочек

    Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

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    Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

    Use of anticoagulants and antiplatelet agents in stable outpatients with coronary artery disease and atrial fibrillation. International CLARIFY registry

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    Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

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    OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

    Прогнозирование продолжительности сроков заболевания и возраста пациентов с разными стадиями первичной открытоугольной глаукомы

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    PURPOSE: To find out the expected duration of the disease and age of patients with different primary open-angle glaucoma changes. METHODS: The study protocol included data from 120 patients (50 males (41.7%), 70 females (58.3%)); 189 eyes; 102 right eyes; 87 left eyes). The first study group (28 patients, 44 eyes) comprised patients with suspected glaucoma. The second group (53 patients, 84 eyes) consisted of patients with early glaucoma changes. The third group (21 patients, 33 eyes) included patients with advanced glaucoma changes. The forth group (18 patients, 28 eyes) comprised patients with terminal glaucoma. The mean age of the patients was 61.6 (58.4; 66.9) years at the time of diagnosis and 66.9 (63.4; 72.8) years at the endpoint visit in 2013. In all cases the diagnosis was made according to the differential diagnosis system and was proved by special diagnostic techniques. The database included data from 3 qualified examinations as well as tonometry and static automatic perimetry results. RESULTS: The expected mean age of the patients at the moment of total vision loss was 75.1 years. The period, during which patients developed blindness, was limited to 6.1 years. Mean age of the patients at the time of possible glaucoma development was 59.58 (56.14; 64.36) years. The disease itself could have developed within -3.24 (-5.38; -1.2) years prior to the diagnosis. CONCLUSION: Glaucoma diagnostic research should be focused on the age group of 55-60 years. The degree of IOP-lowering in patients with advanced glaucoma changes does not correspond with the Russian glaucoma society recommendations, which determines further progression of the disease.ЦЕЛЬ. Определить предполагаемую продолжительность сроков течения заболевания и возраст пациентов с разными стадиями первичной открытоугольной глаукомы. методы. в протокол исследования были включены данные 120 человек (50 (41,7%) мужчин, 70 (58,3%) женщин; всего 189 глаз, из них 102 правых и 87 левых). В 1-ю группу (28 человек, 44 глаза) вошли пациенты с диагнозом подозрение на глаукому. Пациенты с начальной стадией глаукомы составили 2-ю группу (53 человека, 84 глаза), с развитой стадией заболевания - 3-ю (21 пациент, 33 глаза), с далекозашедшей стадией болезни - 4-ю группу (18 пациентов, 28 глаз). Средний возраст всех пациентов на момент проведения первичной диагностики составил 61,6 (58,4; 66,9) года и 66,9 (63,4; 72,8) года на момент проведения финального исследования в 2013 г. Во всех случаях диагноз был установлен в соответствии с системой дифференциальной диагностики заболеваний и подтвержден специальными методами исследования. В базу данных были включены результаты трех квалифицированных заключений, с результатами тонометрии и статической периметрии. РЕЗУЛЬТАТЫ. Средний предполагаемый возраст пациентов на момент наступления слепоты составил 75,1 года, а период, когда такие изменения наступят, был ограничен сроком в 6,1 года. Возраст пациента при вероятном возникновении глаукомы составил 59,58 (56,14; 64,36) года, а само заболевание могло начаться за 3,24 (-5,38; -1,2) года до момента постановки диагноза на практике. ЗАКЛЮЧЕНИЕ. Профилактические осмотры населения с целью выявления глаукомы должны быть в первую очередь ориентированы на возрастную группу от 55 до 60 лет. Степень понижения уровня внутриглазного давления у пациентов с продвинутыми стадиями заболевания не соответствует рекомендациям Российского глаукомного общества для этих категорий пациентов, что определяет дальнейшее прогрессирование заболевания

    Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

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    AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

    Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

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    BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

    Оптимизация лечебно-диагностического процесса у пациентов с первичной открытоугольной глаукомой

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    PURPOSE: To create an optimal scientifically based system of management of diagnosis and treatment process (diagnosis, follow-up, rational medication treatment, surgical treatment) in patients with primary open-angle glaucoma. METHODS: The final protocol of combined analytical research and clinical multicenter study conducted from July to November 2015 included data from 591 patients (824 eyes). Age, disease duration, disease stage, IOP level and visual field parameters during treatment and treatment regimens were analyzed. Regimen included various combinations of medical, laser and surgical treatment used in the disease management. RESULTS: Average patients' age at the time of diagnosis establishment was 64.3 (57.5; 70.4). Mean disease duration was 4.1 years (2.0; 7.1). The administered regimen was considered to be effective when IOP level was below 20 mm Hg. The IOP level between 21 and 25 mm Hg was considered to be a sign of reduced treatment effectiveness and need for change of the regimen. 8 regimen changes were analyzed in total, though 90% of cases had 1-5 regimen changes. The first three regimens were used for 1.2 (0.4; 2.6), 1.3 (0.5; 2.5) and 1.1 years (0.5; 2.4) respectively. B-blockers and prostaglandin analogues monotherapy was used as a first-line therapy in 40.1% and 20.8% of cases respectively. Treatment was started with combination therapy in 27.82% of cases. Proportion of surgical treatment was 9.9% in regimen 2 and achieved 73% in regimen 5. Laser treatment was started from regimen 3 though the frequency of administration did not exceed 20%. Combination treatment using 3 and more components was found starting from regimen 5 (57.3%). CONCLUSION: First line therapy choice is still not rational in many cases. Laser and surgical treatment are used ineffectively after 3-4 years from the diagnosis.ЦЕЛЬ. Создать оптимальную научно обоснованную систему управления (диагностика, динамическое наблюдение, рациональная фармакотерапия, хирургическое лечение) лечебно-диагностическим процессом у пациентов с первичной открытоугольной глаукомой. МЕТОДЫ. В итоговый протокол комбинированного аналитического научно-клинического многоцентрового исследования, проведенного в июле-ноябре 2015 года, были включены данные 591 человека (женщин - 352 (59,6%), мужчин - 239 (40,4%); 824 глаза). Были проанализированы: возраст, анамнез, стадии заболевания, уровни офтальмотонуса и характеристики поля зрения на фоне лечения и лечебная тактика (режимы назначений от момента обнаружения заболевания). Под понятием «режим» понимались различные варианты медикаментозного, лазерного и хирургического лечения, использованные в тактике лечебно-диагностического процесса. РЕЗУЛЬТАТЫ. Средний возраст пациентов на момент диагностирования глаукомы (все стадии, без деления на гендерные группы) составил 64,30 (57,50; 70,40) года, а на момент включения в исследование - 68,80 (64,10; 75,60) года. Средний анамнез заболевания составил 4,10 (2,00; 7,10) года. Назначенный режим лечения оценивался исследователями как эффективный при показателях офтальмотонуса не выше 20 мм рт.ст., при этом за понижение эффективности лечения и необходимость перевода на другой режим принимались показатели ВГД в диапазоне от 21 до 25 мм рт.ст. Всего было проанализировано 8 смен схем режимов, при этом в режимах 1-5 были проанализированы более 90% всех назначений. Продолжительность использования первых последовательных трех режимов составила: первого - 1,20 (0,40; 2,60) года, второго - 1,30 (0,50; 2,50) года, третьего - 1,10 (0,50; 2,40) года. Доля бета-адреноблокаторов в монотерапии в первом режиме составила 40,1%, значительно снизившись ко второму - до 3,16%, и полностью отсутствовала в последующих назначениях. Доля аналогов простагландинов в монотерапии также уменьшается от режима к режиму: на старте их применяют в 20,8% случаев, а при режиме № 3 - в 6,7% (снижение в три раза). В лечебной тактике второго режима начинает использоваться хирургический компонент (9,9%). Наиболее наглядно выглядят компоненты, использованные в режиме № 5. Действительно, активное применение схем комбинированной терапии, включая применение трех и более компонентов, было установлено начиная с режима № 5 (57,3%). В это же время в 9,6% случаев становится актуальным повторное хирургическое лечение. ЗАКЛЮЧЕНИЕ. Учитывая, что продвинутые стадии заболевания превалируют при обнаружении глаукомы, следует обратить внимание на нерациональную тактику выбора терапии первой линии у таких лиц. Недостаточно эффективно применяется лазерное и хирургическое лечение, которое становится актуальным только в режимах №№ 3-4, т. е. после 3-4 лет от обнаружения болезни
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