Clinical case the management of a patient with endometriosis of the diaphragm

Extragenital endometriosis — a rare pathology in which tissue similar morphologically to the endometrium is located outside the reproductive system. One of the main problems in the diagnosis and treatment of EGE is the erased course of different forms, so doctors of different profiles have difficulties with making an accurate diagnosis. The clinical case described in this article is a rare manifestation of EGE. Errors in diagnosis, management tactics, as well as in the treatment of the underlying disease were the reason for the provision of inappropriate specialized medical care.Экстрагенитальный эндометриоз (ЭГЭ) — редкая патология, при которой ткань, сходная морфологически эндометрии, лоцируется за пределами репродуктивной системы. Одной из главных проблем в диагностике и лечении ЭГЭ является стертое течение разных форм, поэтому у врачей разных профилей возникают трудности с постановкой точного диагноза. Описанный клинический случай в данной статье является редким проявлением ЭГЭ. Ошибки в диагностике, тактике ведениях, а также в лечении основного заболевания являлись причиной оказания несоответствующей профильной медицинской помощи

Analysis of risk factors for the development of external genital endometriosis

A comparative assessment of two groups of patients - with initially detected external genital endometriosis (n = 20) and relapse (n = 20), undergoing treatment in the hospital of the Department of Emergency Gynecology of Clinical Hospital No. 40, allowed us to rank the significance of various risk factors for the development of relapse of the disease. Clinical characteristics were derived from their medical records. Patients were interviewed, complaints and anamnesis were collected, and WHOQOL-BREF quality of life questionnaire was completed. The analysis of the obtained data was performed using the statistical package SPSS 20.0. and Еxcel.Сравнительная оценка двух групп пациенток - с первично выявленным наружным генитальным эндометриозом (НГЭ) (n=20) и с рецидивом (n=20), проходящие лечение в стационаре отделения неотложной гинекологии ГКБ № 40, позволила ранжировать значимость различных факторов риска для развития рецидива заболевания. Клинические характеристики были получены из их историй болезни. Проведен опрос пациентов, сбор жалоб и анамнеза, заполнение опросника качества жизни WHOQOL-BREF. Анализ полученных данных проводили с помощью статистического пакета SPSS 20.0. и Excel

Formation of the competitive potential of the agricultural territories

The purpose of the study is to develop a mechanism for the formation of the competitive potential of the agricultural territories of Kazakhstan as the basis for ensuring the dynamic development of agricultural business in Kazakhstan. The research methodology is based on strategic alternative modeling for agricultural territories competitiveness management with the help of fuzzy cognitive logic. The study used a cognitive approach to decision making in the management of poorly structured systems proposed by V. Silov and actively developed in the works of modern scientists. Fifteen competent experts were invited to select the concepts and build a fuzzy cognitive map of the formation of the competitive potential of the agricultural territories of Kazakhstan. To carry out calculations and justify the content of the strategy, the authors used the software product “Intelligent generation of the best alternatives” (“IGLA”). The result of the study is the developed strategy for the management of agricultural territories competitiveness in Kazakhstan with a set of strategic goals and the best option for managerial impact, ensuring the formation of agricultural export potential of the region. The proposed version of the content of the strategy for managing the competitiveness of the agricultural territories of Kazakhstan can be used either as a system or as its separate elements in managing the development of agricultural business in the country and in developing strategic planning programs for the agro-industrial complex of the region. The novelty of the study in theoretical terms is justified by the approach to the formation of the country's agricultural export potential through ensuring the competitiveness of its agricultural territories. In methodological terms, the novelty of the study is expressed by the use of cognitive modeling technologies to develop a strategy for managing the competitiveness of Kazakhstan's agricultural territories, the implementation of which will allow achieving sustainable dynamics of agricultural production and increase the efficiency of the agricultural economy. © 2020 by author(s) and VsI Entrepreneurship and Sustainability Center

Analysis of risk factors for the development of external genital endometriosis

A comparative assessment of two groups of patients - with initially detected external genital endometriosis (n = 20) and relapse (n = 20), undergoing treatment in the hospital of the Department of Emergency Gynecology of Clinical Hospital No. 40, allowed us to rank the significance of various risk factors for the development of relapse of the disease. Clinical characteristics were derived from their medical records. Patients were interviewed, complaints and anamnesis were collected, and WHOQOL-BREF quality of life questionnaire was completed. The analysis of the obtained data was performed using the statistical package SPSS 20.0. and Еxcel.Сравнительная оценка двух групп пациенток - с первично выявленным наружным генитальным эндометриозом (НГЭ) (n=20) и с рецидивом (n=20), проходящие лечение в стационаре отделения неотложной гинекологии ГКБ № 40, позволила ранжировать значимость различных факторов риска для развития рецидива заболевания. Клинические характеристики были получены из их историй болезни. Проведен опрос пациентов, сбор жалоб и анамнеза, заполнение опросника качества жизни WHOQOL-BREF. Анализ полученных данных проводили с помощью статистического пакета SPSS 20.0. и Excel

Тransplantation of autologous stem cells, obtained from adipose tissue, in complex treatment of chronic ischemia of the lower extremities

Objective. To investigate the efficacy of application of autologous mesenchymal stem cells (AMSC) in treatment of patients, suffering critical ischemia of the lower extremities (CILE). Маterials and methods. In 2012 - 2015 yrs there was conducted the treatment of 41 patients, suffering CILE: 22 (53.7%) - men, and 19 (46.3%) - women. In the Group I (the main) 21 (51.2%) patients have had obtained a standard course of treatment, using AMSC. In the Group II (the control one) 20 (49.8%) patients have obtained a standard course of conservative treatment, using prostaglandins of group Е1 (PGЕ1). The results were investigated, measuring ankle-brachial pressure index, and the indices of a laser duplex flowmetry and a walking distance. Results. During a one-year follow-up a trustworthy enhancement of microcirculation index was registered in the patients, who were treated, using AMSC, comparing with the patients, who obtained a course of therapy of PGЕ1 (р=0.037). Positive dynamics of the microcirculation index while a PGЕ1application was observed during (1.8 ± 0.3) mo, аnd while application of AMSC the microcirculation index have been enhanced trustworthily in (2.7 ± 0.4) mo and persisted during one-year of follow-up. Conclusion. Development of therapeutic effect in groups of patients, who were treated with AMSC and PGЕ1, did not occur simultaneously, thus , a complex treatment with simultaneous application of both methods and conduction of a dosed physical training may be considered a rational option

Russian multicenter experience of using talazoparib in the treatment of patients with BRCA-associated metastatic breast cancer

Introduction. The presence of a germinal BRCA mutation occurs in 3–4% of all breast cancer (BC) patients with various biological subtypes, but significantly with a high frequency in patients with a triple negative biological subtype (in 10–20% of cases). For the treatment of patients with HER2-negative metastatic breast cancer associated with gBRCA mutation, the effectiveness of biologically targeted drugs from the group of PARP inhibitors (olaparib and talazoparib) has been proven.Purpose. Comparison of the results of our experience with the use of talazoparib in patients with HER2-gBRCA+ + mBC with the data of the EMBRACA registration study.Materials and methods. As part of the multicenter compassionate use program (CUP) with the support of Pfizer, 24 patients with HER2-negative metastatic gBRCA-associated mutation metastatic breast cancer (HER2-gBRCA+ breast cancer) received biologically targeted therapy with the PARP inhibitor talazoparib at a standard oral dose of 1 mg per day for vital indications . The average age of patients with HER2-gBRCAm+ breast cancer was 50 years (29–90 years).Results. Objective response (OR) was registered in 29% of cases, disease control (OR+stabilization) – in 71% of cases. The median progression-free survival (PFS) was 6.5 months (95% CI [3–10]). Objective response, disease control, and median PFS were evaluated depending on the biological subtype, the number of lines of previous therapy, and the presence of platinum-containing agents in the anamnesis.Objective response and disease control were evaluated depending on the biological subtype: in patients with ER+HER2-mBC versus patients with triple negative subtype, OR was 33% vs 22%, and disease control was 83% vs 61%, respectively. In the presence of < 3 vs ≥ 3 lines of therapy for metastatic disease in the anamnesis, OR was 31% vs 12.5%, disease control – 75% vs 50% of cases, respectively. In the presence or absence of platinum-containing agents in the anamnesis, OR was observed in 22% vs 33% of cases, and disease control – 67% vs 67%, respectively.In patients with the luminal subtype versus patients with the triple negative subtype, the PFS was 9 months vs 5 months, respectively (HR = 0.705; 95% CI [0.231–2.147]; p = 0.5208). Median PFS in the presence of <3 vs ≥3 lines of therapy for metastatic disease in the anamnesis was 9 months vs 4 months, respectively (HR = 4,216; 95% CI [1,334–13,327]; p = 0.0056). In the presence or absence of platinum-containing agents in previous lines of therapy 5 months vs 9.5 months, respectively (HR =1.484; 95% CI [0.48–4.582]; p = 0.4750).During the treatment with talazoparib adverse events of the 3rd-4th grades were observed in 5 patients (20,8%). These include moderate and severe anemia in 3 patients (12.5%), thrombocytopenia in 1 patient (4%), and neutropenia in 1 patient (4%). The majority of patients (79,5%), which received talazoparib, did not require dose adjustment. The need to reduce the dose to 0.75 mg was noted in 3 patients (12.5%), to 0.5 mg – in 2 patients (8%). Hemotransfusion was performed in 3 patients. For effective therapy safety management regular monitoring of blood parameters is necessary.Conclusion. Thus, targeted therapy with talazoparib is an effective treatment option for HER2-gBRCA+ mBC