TAVISCORE: a computer program for risk stratification of complications after aortic valve interventions in patients with reduced ejection fraction

Aim. To demonstrate the TAVISCORE program designed to stratify the risk of complications after aortic valve (AV) interventions in patients with reduced ejection fraction.Material and methods. For the period from 2015-2022 at the Almazov Federal North-West Medical Research Center, 128 interventions on AV were performed for aortic stenosis in patients with reduced ejection fraction as follows: 61 — surgical AV replacement (SAVR), 67 — transcatheter aortic valve implantation (TAVI). To create an interactive calculator TAVISCORE (link for free download: https://drive.google.com/file/d/1a3s2MK6Tpk0cIQ_aMB7xe63upEwJsJOh/view?usp=sharing) all patients were combined into one group. For each factor present in the patient, the prognostic coefficient, its contribution to the likelihood of an event in the long-term follow-up period (death, myocardial infarction, stroke), was calculated. The next step, based on the calculations obtained and using the Python 3.10.6 language, was the creation of the TAVISCORE program.Results. The TAVISCORE was created for the personalized choice of tactics for the treatment of patients with aortic stenosis. It contains 54 risk factors and makes it possible to determine probability of cardiac or non-cardiac events in the long-term follow-up period after SAVR and TAVI. Thus, a tactic with lower probability of a complication can be chosen as optimal in this particular case. Retrospective use of the TAVISCORE after surgery can identify patients at high risk of complications, which will allow them to be selected for more thorough management and more frequent screening.Conclusion. The TAVISCORE can be used by a multidisciplinary consensus to select the treatment tactics and stratify the risk of complications after different AV replacement variants in patients with a reduced ejection fraction. Further prospective testing of this program is required

Место фиксированной комбинации будесонид / формотерол в лечении хронической обструктивной болезни легких стабильного течения. Заключение совета экспертов Приволжского федерального округа Российской Федерации

Late diagnosis of chronic obstructive pulmonary disease (COPD) at advanced stage, high risk of exacerbations, low compliance of patients, and adverse effects of treatment have been still unresolved problems in the treatment of COPD despite the development of new drugs. The personalized medicine rneeds distinct indications and predictors of efficacy and safety of treatment. Budesonide/formoterol fixed combination is recommended for patients with asthma – COPD overlap syndrome and bronchitis phenotype, blood eosinophilia > 300 cells/mm3, if other causes were excluded, post-bronchodilator forced expiratory volume in 1 second (FEV1) < 50% pred.; and ≥ 2 exacerbations or ≥ 1 hospitalization related to exacerbation during the previous year. Budesonide/formoterol fixed combination is not recommended for regular use in patients with emphysema phenotype of COPD and rare exacerbations (< 2 exacerbations and without hospitalizations in the previous year).Несмотря на появление новых препаратов для лечения пациентов с хронической обструктивной болезнью легких (ХОБЛ), в настоящее время нерешенными проблемами в терапии этого заболевания остаются поздняя диагностика и выявление ХОБЛ уже на стадии тяжело протекающего заболевания, высокий риск обострений, низкая комплаентность пациентов, побочное действие лекарственных средств. Персонализированная медицина требует четких показаний, предикторов эффективности и безопасности лечения. Терапия фиксированной комбинацией будесонид / формотерол рекомендована пациентам с сочетанием бронхиальной астмы (БА) и ХОБЛ; высоким уровнем эозинофилов в периферической крови (> 300 клеток в 1 мкл крови) при исключении других причин (гельминты, лямблии и т. п.) и с постбронходилатационным объемом форсированного выдоха за 1-ю секунду (ОФВ1) < 50 %долж.; бронхитическим фенотипом; ≥ 2 обострениями в предшествующий год; ≥ 1 госпитализацией по поводу обострения в течение 1 года при наличии постбронходилатационного ОФВ1 < 50 %долж. Фиксированная комбинация будесонид / формотерол не рекомендуется к регулярному назначению при эмфизематозном фенотипе ХОБЛ у больных с редкими обострениями (< 2 / без госпитализаций за предшествующий год)

A remarkable synergistic effect at the transcriptomic level in peach fruits doubly infected by Prunus necrotic ringspot virus and Peach latent mosaic viroid

[EN] Background: Microarray profiling is a powerful technique to investigate expression changes of large amounts of genes in response to specific environmental conditions. The majority of the studies investigating gene expression changes in virus-infected plants are limited to interactions between a virus and a model host plant, which usually is Arabidopsis thaliana or Nicotiana benthamiana. In the present work, we performed microarray profiling to explore changes in the expression profile of field-grown Prunus persica (peach) originating from Chile upon single and double infection with Prunus necrotic ringspot virus (PNRSV) and Peach latent mosaic viroid (PLMVd), worldwide natural pathogens of peach trees. Results: Upon single PLMVd or PNRSV infection, the number of statistically significant gene expression changes was relatively low. By contrast, doubly-infected fruits presented a high number of differentially regulated genes. Among these, down-regulated genes were prevalent. Functional categorization of the gene expression changes upon double PLMVd and PNRSV infection revealed protein modification and degradation as the functional category with the highest percentage of repressed genes whereas induced genes encoded mainly proteins related to phosphate, C-compound and carbohydrate metabolism and also protein modification. Overrepresentation analysis upon double infection with PLMVd and PNRSV revealed specific functional categories over- and underrepresented among the repressed genes indicating active counter-defense mechanisms of the pathogens during infection. Conclusions: Our results identify a novel synergistic effect of PLMVd and PNRSV on the transcriptome of peach fruits. We demonstrate that mixed infections, which occur frequently in field conditions, result in a more complex transcriptional response than that observed in single infections. Thus, our data demonstrate for the first time that the simultaneous infection of a viroid and a plant virus synergistically affect the host transcriptome in infected peach fruits. These field studies can help to fully understand plant-pathogen interactions and to develop appropriate crop protection strategies.We thank Drs M.A. Perez-Amador y J. Gadea for helping in the result analysis. This work was supported by grant BIO2011-25018 from the Spanish granting agency Direccion General de Investigacion Cientifica for the transcriptomic analyses and from the grant 2009CL0020 from the bilateral project INIA-Chile/CSIC-Spain for the phytosanitary evaluation. MC Herranz was the recipient of a contract from the Juan de la Cierva program of the Ministerio de Educacion y Ciencia of Spain.Herranz Gordo, MDC.; Niehl, A.; Rosales, M.; Fiore, N.; Zamorano, A.; Granell Richart, A.; Pallás Benet, V. (2013). 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Adaptive mechanisms of plants against salt stress and salt shock

Salinization process occurs when soil is contaminated with salt, which consequently influences plant growth and development leading to reduction in yield of many food crops. Responding to a higher salt concentration than the normal range can result in plant developing complex physiological traits and activation of stress-related genes and metabolic pathways. Many studies have been carried out by different research groups to understand adaptive mechanism in many plant species towards salinity stress. However, different methods of sodium chloride (NaCl) applications definitely give different responses and adaptive mechanisms towards the increase in salinity. Gradual increase in NaCl application causes the plant to have salt stress or osmotic stress, while single step and high concentration of NaCl may result in salt shock or osmotic shock. Osmotic shock can cause cell plasmolysis and leakage of osmolytes in plant. Also, the gene expression pattern is influenced by the type of methods used in increasing the salinity. Therefore, this chapter discusses the adaptive mechanism in plant responding to both types of salinity increment, which include the morphological changes of plant roots and aerial parts, involvement of signalling molecules in stress perception and regulatory networks and production of osmolyte and osmoprotective proteins

Ограничения инспираторного потока у пациентов с хронической обструктивной болезнью легких: важность оценки в клинической практике. Заключение Совета экспертов

Pharmacotherapy for patients with chronic obstructive pulmonary disease is administered through various inhalation devices. The inhalers have different designs, principles of operation and activation methods, the number of steps necessary to prepare the device for use, the resistance that the patient has to overcome with inhalation, and many other characteristics. The suboptimal choice of an inhalation device may affect the clinical outcomes of the disease. Therefore, the guidelines consider replacement of the inhaler to be an alternative to escalation of therapy with treatment failure. When choosing an inhalation device, a number of the patient’s clinical features should be considered, including the patient's ability to induce an inspiration effort. Since devices that estimate the force of inspiratory effort at different resistances are not available in Russian Federation for routine clinical practice, the expert group described some clinical features that may be observed in patients with suboptimal inspiratory flow based on the existing data. Their final choice was made by voting according to the Delphi panel method that accounts for the opinion of each expert.Фармакотерапия больных хронической обструктивной болезнью легких (ХОБЛ) проводится с использованием ингаляционных устройств, различающихся между собой конструкцией, принципами работы и способами активации, количеством шагов, необходимых для подготовки устройства к использованию, сопротивлением, которое пациент должен преодолеть при ингаляции, и другими характеристиками. Неоптимальный выбор ингаляционного устройства может оказать влияние на клинический исход заболевания, поэтому в руководствах замена ингалятора рассматривается как альтернатива эскалации терапии при неэффективности лечения. При выборе ингаляционного устройства необходимо учитывать ряд клинических особенностей пациента, в т. ч. его способность вызывать усилие вдоха. Поскольку устройства, способные оценивать силу вдоха при различном сопротивлении, в рутинной клинической практике в Российской Федерации отсутствуют, на основании имеющихся данных членами экспертной группы описаны некоторые клинические особенности, которые могут наблюдаться у лиц с субоптимальным потоком вдоха. Окончательный выбор обеспечивался голосованием по методике панели Delphi с учетом мнения каждого эксперта