Место роботической хирургии в лечении рака ротоглотки. Клиническое наблюдение

Background. The incidence of HpV-associated oropharyngeal squamous cell carcinoma (oscc) is steadily increasing. given the better prognosis in patients with HpV-positive cancer compared to HpV-negative cancer, attempts were made to reduce the therapeutic effect in patients with early-stage oscc to improve the quality of life of these patients. early-stage oscc can currently been treated with radiation therapy or surgery used alone or in combination. Currently, the concept of transoral surgery includes both transoral laser microsurgery and robot-assisted surgeries (da Vinci, medrobotics Flex system). Case description. We report a case of using the da Vinci robot-assisted system in the combined modality treatment of oropharyngeal cancer. The patient underwent surgery followed by chemoradiotherapy. At a follow-up of 10 months, no evidence of disease progression was found. The patient experienced no any pain on swallowing.Conclusion. The use of the da Vinci robot-assisted surgical system in the combined modality treatment of oropharyngeal cancer, especially in such a hard-to-reach area as the root of the tongue, makes it possible to better visualize and determine the boundaries of the lesion, followed by en block resection, as well as to improve functional and aesthetic results. However, careful selection of patients for this type of treatment is necessary.Актуальность. Заболеваемость плоскоклеточным раком ротоглотки растет, и связано это с увеличением частоты инфицирования вирусом папилломы человека (ВПЧ). Учитывая лучший прогноз у пациентов с ВПЧ-позитивным раком по сравнению с ВПЧ-негативным, предприняты попытки уменьшить терапевтическое воздействие с целью улучшения качества жизни у пациентов с ранними стадиями. При ранних стадиях рака ротоглотки возможно применение как лучевого, так и хирургического методов лечения в самостоятельном варианте или в комбинации. На современном этапе понятие «трансоральная хирургия» включает в себя как трансоральную лазерную микрохирургию, так и робот-ассистированные операции (da Vinci, medrobotic Flex system). Описание клинического случая. В статье представлен один из клинических случаев использования робот-ассистированной системы da Vinci в комбинированном лечении рака ротоглотки. После операции пациент получил адъювантное химиолучевое лечение. Срок наблюдения за пациентом составил 10 мес. При контрольном обследовании – без признаков рецидива заболевания. Жалоб со стороны органов полости рта, ротоглотки не предъявляет, глотание любой пищи безболезненное.Заключение. Использование робот-ассистированной системы da Vinci в комбинированном лечении рака ротоглотки, особенно в такой труднодоступной зоне, как корень языка, позволяет лучше визуализировать и определить границы поражения с последующим удалением в едином блоке в пределах здоровых тканей в ограниченном пространстве, а также улучшить функциональные и эстетические результаты. Однако необходим тщательный отбор пациентов для данного вида лечения

Approaches to the therapy of heart failure with reduced ejection fraction. Resolution of an online meeting of the Volga Federal District experts

At an online meeting of experts held on May 14, 2021 additional research results on a sodium-glucose co-transporter-2 (SGLT2) inhibitor empagliflozin in patients with heart failure with reduced ejection fraction were considered. According to the data from the EMPEROR-Reduced international study, cardiovascular and renal effects of empagliflozin therapy in patients with and without type 2 diabetes (T2D) were analyzed. A number of proposals and recommendations was accepted regarding the further study of cardiovascular and renal effects of empagliflozin and its use in clinical practice in patients with heart failure, regardless of the T2D presence

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Opyt distantsionnogo prepodavaniya endokrinologii s ispol'zovaniem telemeditsinskikh tekhnologiy

Вопросы поддержания и повышения квалификации медицинских кадров, оказывающих первичную медицинскую помощь населению отдаленных районов, относятся к наиболее актуальным проблемам современного здравоохранения. Особое значение они приобретают в условиях реализации приоритетного национального проекта в области здравоохранения

Glucose-lowering medication selection in patients with diabetes and acute cerebrovascular accident

The review presents the analysis of current approaches to the management of diabetic patients with acute cerebrovascular accident. Based on the results of meta-analyzes, glycemic targets on the first day after acute cerebrovascular accident were determined and management strategy regarding the insulin therapy issue was discussed. The pros and cons of various ways injecting insulin and the prospects for further management of patients with the use of glucose-lowering medications in patients with type 2 diabetes were considered

Combination versus monotherapy with statins in patients with type 2 diabetes mellitus of high and very high cardiovascular risk

Aim. Comparison of the influence of mono- and combined lipid-lowering therapy on lipid profile and glycemia in patients with T2DM.Methods. A comparative assessment of lipid profile dynamics in patients with type 2 diabetes from the group of high and very high risk of cardiovascular diseases depending on lipid-lowering therapy - atorvastatin in increasing doses (group 1), or by a combination of low doses of rosuvastatin and ezetimibe (group 2) was carried out.Results. It was found that at baseline comparable lipid metabolism in the study groups, after completion of therapy in both groups there was a significant decrease in total cholesterol, low-density lipoprotein cholesterol, and triglycerides. In group 2 after completion of treatment triglyceride levels were significantly lower than in group 1. At the same time, after completion of hypolipidemic therapy course with atorvastatin, there was a significant increase in the level of both basal and postprandial glycemia, as well as glycated hemoglobin. In the group of combined therapy the level of postprandial glycemia and glycated hemoglobin after completion of the course of treatment was significantly lower than the baseline. As a result, by the end of 6 months of treatment in group 2 was significantly lower level of basal glycemia and glycated hemoglobin compared to group 1.Conclusion. Combined lipid-lowering therapy with rosuvastatin and ezetimibe is significantly more effective than monotherapy with atorvastatin. This is expressed in a more pronounced lipid-lowering effect of this combination on the background of almost neutral effect on carbohydrate metabolism. At the same time, there was a negative effect of atorvastatin therapy on carbohydrate metabolism. The results require further research to clarify the mechanisms of this effect

Daytime sleepiness, depression and obesity in patients with type 2 diabetes mellitus of different sexes as a drug target

Introduction. Patients with type 2 diabetes are more likely to have concomitant depression. In addition, there are some studies that have alluded to a direct relationship between overweight and diabetes and daytime drowsiness.The aim of this study was to study the relationship of metabolic disorders, anthropometric data with daytime sleepiness and depression in patients with type 2 diabetes.Material and methods. A general clinical study consisted in interviewing the patient (complaints, medical history), obtaining physical data (anthropometry) – height (cm), weight (kg), neck circumference (cm), waist circumference (cm), hip circumference (cm). The object of the study was the whole blood and blood plasma of patients in order to determine the level of fasting plasma glucose, glycosylated hemoglobin and other blood biochemical parameters. To verify violations in the emotional-volitional sphere, the Beck Depression Inventory and the Epworth Sleepiness Scale were used.Results. All patients had visceral obesity, the waist circumference is significantly higher than normal, both in men and women. In accordance with the Epworth drowsiness scale, on average, borderline insomnia was recorded in the examined patients with type 2 diabetes. Drowsiness rate correlated with waist circumference (r = 0,65) and hips (0,67), age (0.34) only in male patients. The level of depression correlated with age in female patients (r = 0.37, p &lt; 0,05) and male (r = 0,6, p &lt; 0,05) and did not correlate with drowsiness in both groups. The level of depression was 16, which corresponds to mild to moderate depression. However, the rate of depression is negligible, but higher among female patients (14.00 [6.00; 18.00] versus 19.00 [10.50; 20.00], p = 0,047).Conclusions. Increased daytime sleepiness and depression accompany patients with type 2 diabetes, regardless of gender. The dependence between the severity of decreased daily activity and increased anthropometric indicators and age can be seen in male patients, which may illustrative of increasing androgen deficiency in men and its contribution to the development of metabolic disorders, including obesity. Depressive states have deeper manifestations in female patients with type 2 diabetes compared to male patients, which may indicate both emotional instability of female patients and a more pronouncedeffect of the disease itself on the psychoemotional background in women

Rol' svobodnoradikal'no oposredovannogo okislitel'nogo stressa v razvitii diabeticheskoy polineyropatii

Цель. Изучение некоторых патогенетических механизмов диабетической полинейропатии, а именно взаимосвязи перекисного окисления липидов, активности ферментативной антиоксидантной защиты и гемореологических нарушений у больных сахарным диабетом (СД), имеющих дистальную диабетическую полинейропатию. Материалы и методы. Обследовано 212 больных СД 1 и 2 типа, осложненным дистальной диабетической полинейропатией (ДДПНП) 1 и 2 стадии. Проводилось исследование процессов перекисного окисления (ПОЛ). Определялись диеновые конъюгаты (ДК) и триеновые конъгаты (ТК). Определяли уровнь общих липидов. Для определения деформируемости эритроцитов (ДЭ) был использован метод ригидометрии. Результаты. У больных СД и ДДПНП даже при наличии субкомпенсации гликемии имеет место повышение активности свободнорадикально-опосредованного окислительного стресса, что выражается в накоплении первичных, промежуточных и конечного продукта ПОЛ ? оснований Шиффа. У больных СД даже при небольшой длительности заболевания имеет место нарушение деформируемости эритроцита (ДЭ), что способствует усилению эндоневральной гипоксии. подтверждено наличие отрицательной взаимосвязи между этими двумя характеристиками метаболических и сосудистых нарушений: уровнем холестерина и деформируемости. Выводы. Наши исследования подтверждают механизмы диабетической полинейропатии: усиление окислительного стресса с накоплением промежуточных и конечных продуктов пероксидации, снижение активности ферментативной антиоксидантной защиты. Препараты, ограничивающие активность свободнорадикально-опосредованного окислительного стресса и активизирующие антиоксидантную защиту, являются средствами патогенетической терапии осложнений сахарного диабета, в том числе и полинейропатии

Hypoglycemia and hyperglycemia: potential risks of polypragmasia in type 2 diabetes in hospital settings

Chronic hyperglycemia imposes damage on a number of cell types and is strongly correlated with the variety of related complications such as eyes, kidneys, cardiovascular system etc. This fact implies pharmacological treatment. Some are metabolic neutral, some are apt to provoke hypoglycemia and/or hyperglycemia, invert pharmacological response. To take into account a potential role of treatment on glucose level is crucial for pharmacotherapy in patient with T2DM. Besides, some drugs may distort the meaning of lab tests