Репозиторий Университета

© 2020, LLC Science and Innovations. Pancreatic cancer (PC) is one of the most fatal types of oncological disease in the world and is an extremely aggressive cancer with a poor prognosis. The objective of this review was to analyze the domestic data of the incidence of PC in the Russian Federation and to analyze the protocols that are used for the management of this group of patients in Russian clinical centers. For the analysis of the literature sources, the data in the elibrary.ru database published in the period from 2015 to 2019 were used. The methodology that was used in each study was examined in order to ensure its reliability, and these data were selected as potential sources of evidence for the preparation of national recommendations. The study results influence the level of evidence assigned to the publication. Updates to the national recommendations are conducted at least once every three years, and these updates depend on new information about the diagnosis and management of patients with PC.

© 2020, LLC Science and Innovations. Pancreatic cancer (PC) is one of the most fatal types of oncological disease in the world and is an extremely aggressive cancer with a poor prognosis. The objective of this review was to analyze the domestic data of the incidence of PC in the Russian Federation and to analyze the protocols that are used for the management of this group of patients in Russian clinical centers. For the analysis of the literature sources, the data in the elibrary.ru database published in the period from 2015 to 2019 were used. The methodology that was used in each study was examined in order to ensure its reliability, and these data were selected as potential sources of evidence for the preparation of national recommendations. The study results influence the level of evidence assigned to the publication. Updates to the national recommendations are conducted at least once every three years, and these updates depend on new information about the diagnosis and management of patients with PC.

© 2019 Wiley Periodicals, Inc. Background: Despite advances in treatment, the recurrence rates for laryngeal cancer range from 16% to 40%. Methods: Patients with recurrent laryngeal cancer treated at Memorial Sloan Kettering (MSK) from 1999 to 2016 were reviewed. Survival outcomes were analyzed. Results: Of 241 patients, 88% were male; the median age was 67 years; 71% had primary glottic tumors. At initial treatment, 72% of patients were seen with early stage disease; primary treatment was radiation (68%), chemoradiation (29%), and surgery (3%). The most common salvage surgery was total laryngectomy (74%). Forty-seven percentage were upstaged at salvage surgery. The 2- and 5-year disease-specific survival (DSS) was 74% and 57%, respectively. Patients with cT4 disease treated with nonsurgical primary management had a 0% 5-year DSS. Independent predictors of DSS were tumor location, perineural invasion, margin, and stage. Conclusions: Salvage surgery results in acceptable oncologic outcomes. Stage, disease site, perineural invasion, and margins are associated with inferior DSS.

© 2019 Context: This overview presents the updated European Association of Urology (EAU) guidelines for non–muscle-invasive bladder cancer (NMIBC), TaT1, and carcinoma in situ (CIS). Objective: To provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation and recommendations. Evidence acquisition: A broad and comprehensive scoping exercise covering all areas of the NMIBC guidelines has been performed annually since the last published version in 2017. Databases covered by the search included Medline, EMBASE, and the Cochrane Libraries. Previous guidelines were updated, and the level of evidence and grade of recommendation were assigned. Evidence synthesis: Tumours staged as Ta, T1, and/or CIS are grouped under the heading of NMIBC. Diagnosis depends on cystoscopy and histological evaluation of the tissue obtained by transurethral resection (TURB) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TURB is essential for the patient's prognosis and correct diagnosis. Where the initial resection is incomplete, where there is no muscle in the specimen, or where a T1 tumour is detected, a second TURB should be performed within 2–6 wk. The risks of both recurrence and progression may be estimated for individual patients using the European Organisation for Research and Treatment of Cancer (EORTC) scoring system. Stratification of patients into low-, intermediate-, and high-risk groups is pivotal to the recommendation of adjuvant treatment. In patients with tumours presumed to be at a low risk and in those presumed to be at an intermediate risk with a low previous recurrence rate and an expected EORTC recurrence score of <5, one immediate chemotherapy instillation is recommended. Patients with intermediate-risk tumours should receive 1 yr of full-dose bacillus Calmette-Guérin (BCG) intravesical immunotherapy or instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1–3 yr is indicated. In patients at the highest risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is recommended in BCG-unresponsive tumours. The extended version of the guidelines is available at the EAU website: https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/. Conclusions: These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice. Patient summary: The European Association of Urology Non–muscle-invasive Bladder Cancer (NMIBC) Panel has released an updated version of their guidelines, which contains information on classification, risk factors, diagnosis, prognostic factors, and treatment of NMIBC. The recommendations are based on the current literature (until the end of 2018), with emphasis on high-level data from randomised clinical trials and meta-analyses. Stratification of patients into low-, intermediate-, and high-risk groups is essential for deciding appropriate use of adjuvant intravesical chemotherapy or bacillus Calmette-Guérin (BCG) instillations. Surgical removal of the bladder should be considered in case of BCG-unresponsive tumours or in NMIBCs with the highest risk of progression.

© 2019 European Association of Urology In this review, we investigated the treatment options for primary urethral cancer. While organ-confined disease can be managed with local resection, growth beyond the organ calls for a combination of different treatment modalities, such as surgery, chemotherapy, and radiotherapy, to improve the survival of patients.

© 2019 Elsevier Ltd Objective: Polymorphous adenocarcinoma of salivary gland (PAC) is rare. Despite being described as a low risk histology, some patients develop regional and distant metastasis. More aggressive behavior has been attributed to a PAC subcategory called cribriform adenocarcinoma of minor salivary glands (CAMSG). We examined oncological outcomes of PAC. Patients and methods: Fifty-seven patients with PAC were identified from an institutional database of 884 patients surgically treated for salivary gland malignancies from 1985 to 2015. Detailed histopathological analysis was performed. Survival outcomes were calculated using the Kaplan-Meier method. Factors predictive of recurrence were identified using the Cox proportional hazard method. Results: Fifty-four (95%) had tumors of minor salivary gland origin; the most frequent location was the oral cavity in 41 (76%), specifically the hard palate in 32 (55%). Forty-six patients (81%) were clinical T1-T2; 3 (5%) had a clinically positive neck. Thirty-two patients (56%) were classified as PAC and 14 (25%) as CAMSG. Forty-four patients (77%) had surgery alone; 13 (23%) had surgery and postoperative radiotherapy. The 5- and 10-year overall survival and disease-specific survival were 88% and 79% and 98% and 94%, respectively (median follow up 84 [1–159] months); 5- and 10-year recurrence-free survival were 93% and 88%, respectively. Univariate analysis showed male sex, III/IV stage, and CASMG variant had increased incidence of recurrence but were not statistically significant. Conclusion: PAC of the salivary glands is an indolent disease with good survival outcomes. Recurrence is uncommon and tends to occur late. Long-term follow-up is indicated in patients with this disease.

© NA Kuznetsov. This article reviews the main approaches to the interpretation of the term “risk”, which has acquired the status of a general scientific and widely interpreted concept. The unresolved issues of surgical risk terminology make it extremely difficult to solve the problem of perioperative prognosis at the narrow professional (medical) level. The author considers the problem of objec-tifying operational risk at an interdisciplinary level. In his opinion, understanding risk as a specific form of the subject’s active relation to the surrounding reality is the most justified at the present time. The essential particular features of such activities are the lack of confidence and the subject’s uncertainty in achieving the stated goal since a doctor’s professional activity takes place under conditions of risk, uncertainty and in contradictory situations. The author of the article suggests using the definition of “risk” proposed by A.P. Algin, according to which risk should be understood “as an activity connected with overcoming uncertainty and the situation of inevitable choice, in the process of which it is possible to quantitatively and qualitatively assess the probability of achieving the expected result, failure and deviation from the goal.” This definition prevents the use of antiscientific and scholastic views of this phenomenon. With reference to medical science (in particular, to surgery), this approach to risk allowed the author to formulate an individual quantitative prognosis and to distinguish five types of perioperative prognosis.

© 2018 Media Sphera Publishing Group.All right reserved. Aim. To estimate association between disorders of salt-water homeostasis on admision and the remote one-year prognosis for patients hospitalized with decompensated CHF NYHA FC III-IV. Materials and methods. This prospective study was based on clinical amnestic data and results of one-year follow-up of 111 consecutive patients admitted for decompensation of CHF to the State Clinical Hospital No. 24 in January 2015-February 2016. Results. The relative risk of death within one year for patients hospitalized for decompensated CHF with disorders of water and salt homeostasis increased 1.43 times by the end of one-year follow-up compared to patients with normal blood levels of sodium and potassium on admission (RR=1.43; 95 % CI: 1.10-1.87; p<0.01). Furthermore, the relative risk of death within one year was significantly increased 1.4 times in the subgroup of patients with hypernatremia (RR=1.41; 95 % CI: 0.99-2.01; p<0.05, respectively) and 1.4 and 2.3 times in subgroups with hypo-/hyperkalemia respectively (RR=1.39; 95 % CI: 0.93-2.07; p<0.05 and RR=2.23; 95 % CI: 1.04-4.78; p<0.01) compared to patients with normal blood levels of sodium and potassium on admission. Conclusion. Disturbed water and salt homeostasis on admission of patients hospitalized for decompensated NYHA FC III-IV CHF is a predictor for an unfavorable remote prognosis.

© 2018 National Research University Higher School of Economics. All rights reserved. Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is defined as an acute clinically significant respiratory deterioration characterized by evidence of new, widespread alveolar abnormalities, such as diffuse bilateral ground-glass opacification and/or consolidation, and the absence of other obvious clinical causes like fluid overload, left heart failure, or pulmonary embolism, etc. AE-IPF is subcategorized as “triggered” (where specific causes are identified, for example, infections, surgery procedures, drug toxicity, etc.) or “idiopathic” (where no specific causes are identified). In randomized trials, the annual incidence of AE-IPF is about 8%, in retrospective studies it reaches 19%. Severe forms of IPF are an important risk factor for the development of AE-IPF. In-hospital mortality from AE-IPF is more than 50%, and the average survival of patients with AE-IPF is 1-4 months. Currently, there remain no proven, effective therapies for AE-IPF. In real clinical practice patients with AE-IPF still receive high doses of systemic corticosteroids and antibiotics. Antifibrotic therapy can reduce the risk of exacerbations; it has been shown that therapy with nintedanib leads to a reduction in the number of confirmed/suspected AE-IPF by 68%. It is necessary to further study the potential methods of prevention and therapy of AE-IPF in future clinical trials.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. In this article we have described clinical pharmacology and data of clinical studies of an innovational drug valsartan + sacubitril in patients with chronic heart failure (CHF). The use of supramolecular complex valsartan + sacubitril allows to elevate quality of life and improve prognosis of patients with CHF. High efficacy of valsartan+sacubitril relative to impact on composite primary end-point (cardiovascular death + hospitalization due to CHF) was demonstrated in the clinical trial PARADIGM-HF in which it was compared with angiotensin converting enzyme inhibitor enalapril. Advantages of the use of valsartan + sacubitril for the budget were demonstrated in pharmacoeconomic studies. These advantages are maximally realized at long-term administration. Cost-efficacy of the use of valsartan+sacubitril in pharmacotherapy of CHF is comparable with that of statins in the treatment of ischemic heart disease or implantation of a cardioverter-defibrillator in prevention of sudden cardiac death. Thus, introduction of the drug into practice can be expected to reduce budget expenditures.

© 2018 Stolichnaya Izdatelskaya Kompaniya. Синдром такоцубо - это остро развивающаяся и, как правило, обратимая дисфункция миокарда левого желудочка. Наиболее часто синдром такоцубо проявляется локальной гипокинезией апикальных сегментов миокарда левого желудочка в ответ на эмоциональные или физические триггеры. Синдром такоцубо составляет около 2% от всех госпитализаций с подозрением на острый коронарный синдром. Диагностика синдрома такоцубо остается затруднительной. Клиническая картина острой фазы синдрома такоцубо зачастую не отличима от симптомов острого коронарного синдрома с подъемом или без подъема сегмента ST. Заболевание также сопровождается повышением маркеров по- вреждения миокарда, которое, однако, отличается от такового у пациентов с инфарктом миокарда с подъемом сегмента ST. Наиболее рас- пространенными для постановки диагноза являются модифицированные критерии клиники Mayo. Патогенез заболевания также мало изучен и представлен различными теориями, в которых главную роль играют катехоламины и их воздействие на миокард. На основании описанных семейных случаев синдрома такоцубо нельзя исключить генетическую предрасположенность к развитию заболевания. Несмотря на обратимую дисфункцию миокарда, почти в половине случаев синдром такоцубо осложняется развитием острой сердечной недостаточности, а госпитальная летальность сопоставима с таковой при инфаркте миокарда с подъемом сегмента ST. Вопрос о лечении синдрома такоцубо на сегодняшний день малоизучен. Проспективных клинических исследований каких-либо препаратов не проводилось. Считается, что тактика ведения пациентов с синдромом такоцубо, госпитализированных с подозрением на острый коронарный синдром, должна соответ- ствовать протоколу ведения больных с инфарктом миокарда, пока острая коронарная патология не исключена. На сегодняшний день забо- левание требует дальнейшего изучения.

© 2018, Stolichnaya Izdatelskaya Kompaniya. The aim of the review is presenting the possibilities and perspectives of the third generation of thienopyridine P2Y12 receptor inhibitor prasugrel in the treatment of patients with acute coronary syndrome (ACS). The main pathogenetic stage of ACS is intracoronary thrombosis, which develops on the surface of a damaged atherosclerotic plaque. The use of acetylsalicylic acid with addition of the second antiplatelet agent, so-called dual antiplatelet therapy, is a standard component in the treatment of any type of ACS, regardless of reperfusion and the selected treatment strategy. Due to some limitations in the use of clopidogrel as the second component of dual antiplatelet therapy, the possibility of prasugrel or ticagrelor usage should be considered in patients with ACS with percutaneous coronary intervention (PCI). Prasugrel therapy is associated with better clinical outcomes as compared with clopidogrel therapy in moderate or high-risk patients who undergo PCI. Because of higher bleeding risk and the lack of clinical benefits in special subgroups of patients, prasugrel must not be used in patients with a stroke or transient ischemic attack in the past. If, after a thorough individual benefit-risk assessment a decision is in favor of prescribing prasugrel to the patient older than 75 years or with a small body weight the maintenance dose of prasugrel is to be reduced by half. Real clinical practice data has shown that with following these recommendations prasugrel demonstrates optimal efficacy, safety, and even more significant impact on the prognosis than this in clinical trials. Prasugrel is able to reduce significantly the incidence of cardiovascular events such as cardiovascular death, myocardial infarction and stroke in patients with ACS who undergo PCI.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Aim: to assess the prevalence of bendopnea and association of this symptom with clinical, laboratory and echocardiographic features, clinical outcomes during 2 years of followup in ambulatory elderly patients with chronic heart failure (CHF). Materials and methods. We conducted an open, prospective, nonrandomized study of 80 ambulatory patients aged ≥60 years admitted with heart failure II-IV NYHA class CHF. Baseline survey included physical examination, estimation of Charlson comorbidity index, echocardiography and laboratory tests. Bendopnea was considered when shortness of breath occurred within 30 sec of sitting on a chair and bending forward. Mean followup was 26.6±11.0 months. Results. Bendopnea was present in 38.8% patients. All these patients complained of shortness of breath during physical exertion and 45.2% of them had orthopnea. Bendopnea was associated with the male gender (odds ratio [OR] 11.8, 95% confidence interval [CI] 4.04-34.8, p<0.001), severity of the clinical status (ШОКС [shocks] scale score) (OR 1.78, 95% CI 1.29-2.38, p<0.001), Charlson comorbidity index (OR 1.29, 95% CI 1.07-1.52, p=0.007), coronary heart disease (OR 26.6, 95% CI 3.34-21.3, p=0.002), history of myocardial infarction (OR 13.9, 95% CI 4.2-46.6, p<0.001), left ventricular (LV) aneurysm (OR 13.3, 95% CI 2.69-65.9, p=0.002), increased indexed LV endsystolic diameter (OR 8.2, 95% CI 1.9-34.1, p=0.004), left atrial size (OR 4.3, 95% CI 1,4-12.5, p=0.008), indexed LV endsystolic volume (OR 1.32, 95% CI 1.07-1.64, p=0.010), pulmonary artery systolic pressure (OR 1.26, 95% 1.03-1.45, p=0.002), high levels of NTproBNP (OR 1.0, 95% CI 1.0-1.002, p=0.055), creatinine (OR 1.04, 95% CI 1.02-1.07, p=0.001), uric acid (OR 1.006, 95% CI 1.002-1.011, p=0.004); hospitalizations (OR 7.61, 95% 2.04-28.4, p=0.003), and patient's mortality (OR 5.63, 95% CI 1.94-16.4, p=0.001). Multifactorial analysis confirmed association of bendopnea with severity of clinical status (OR 1.70, 95% CI 1.04-2.8, p=0.033), increased left atrial size (OR 5.67, 95% CI 2.75-21.32, p=0.029) and Charlson comorbidity index (OR 1.17, 95% CI 1.04-2.80, p=0.050). During followup 51.6 and 12.2% of patients died among those with and without bendopnea, respectively (OR 4.22, 95% CI 1.85-9.9, p<0.001). Conclusion. Bendopnea is associated with an adverse hemodynamic profile and prognosis, what allows to consider this symptom as a reliable marker of CHF severity.

© 2018 Stavropol State Medical University. All Rights Reserved. The review presents the latest achievements in the field of complex adjuvant treatment of patients with portal cholangiocarcinoma. Modern data on the clinical efficacy and benefits of intraduct photodynamic therapy are presented.

© 2018, Silicea-Poligraf. All rights reserved. The review is focused on clinical significance of the left ventricle hypertrophy (LVH) — presentation of heart lesion as a target organ for systemic hypertension (SH). Various LVH development mechanisms are presented, and special attention is paid to sympathic nervous system and β-adrenoreceptors in pathogenesis. Fundamental methods of diagnostics are described for LVH, in comparison. The pathology is classified from the perspective of recent guidelines on echocardiographic diagnostics. Epidemiology provided. Taken current evidence, the prognostic role of LVH is described as a factor increasing the risk of fatal and non-fatal cardiovascular, cerebrovascular and renal complications in SH patients. Trials data presented that points on LVH regression with highly selective β1-blocker bisoprolol treatment. Pathophysiology of LVH regression is discussed for β1-blocker treatment.

© 2018, Silicea-Poligraf. All rights reserved. Aim. To evaluate the prevalence of myocarditis in adult patients with non-compaction myocardium (NCM) of the left ventricle (LV), and its influence on the disease course, results of treatment and outcomes. Material and methods. To the study, 103 adult patients included, with NCM, 61 males, mean age 45,6±14,9 y. o. (from 18 to 78). Mean end diastolic LV size was 6,0±0,8 сm, EF LV 38,8±14,5%. Diagnosis of NCM had been done by echocardiography, multispiral computed tomography (n=81) and magnetic resonance tomography (n=39). DNA-diagnostics was performed by NGS method with further Senger sequencing. Pathogenic mutations were found in 9% of patients in the genes MYH7, MyBPC3, LAMP2, DES, DSP, TTN. The investigation also included anticardiac antibodies, genome of cardiotropic viruses by PCR, coronary arteriography (n=26), scintigraphy (n=25). Morphological assessment of the myocardium was done in 19 patients (12 endomyocardial biopsies), 1 intraoperation biopsy, 3 explanted hearts, incl. 2 after biopsy, and 5 autopsies. Mean follow-up 12 [2; 32] months. Results. Myocarditis was found in 53,4%, incl. virus-positive in 32,7% of those, with morphology done for 19 patients (active myocarditis in 10, borderline in 6; with minimal signs of activeness in 3). Viral genome in myocardium found in 8 patients (42,1%). The prevalence of myocarditis 44,4% in an arrhythmic variant of NCM, 12,5% in chronic ischemic, 57,5% in dilation cardiomyopathy, 50,0% in NCM patients with other cardiomyopathies. Special cases were acute/subacute myocarditis in NCM (10,7% of all), acute necrosis (infarction) in 4,9%. Comorbidity with myocarditis in NCM led to significantly more severe LV dysfunction (CHF FC 2 [1; 3] v 1,75 [0; 2], p<0,01, EF 33,8±13,5 v 44,7±13,6%, p<0,001), more prevalent non-sustained ventricular tachycardia (67,3% v 29,3%, p<0,01), proper shocks (38,9% v 0, p<0,05), deaths (16,4 and 4,2%, OR 5,75, 95% CI 1,21-27,43, p<0,05) and transplantation (7,3% v 2,1%, p>0,05). Only in myocarditis patients, as a result of basis (antiviral, immune suppression) and cardiotropic therapy there was significant increase of EF (in acute myocarditis from 25,4±7,9 to 38,6±9,5%, p<0,01), decrease of LV size and pulmonary systolic pressure. Conclusion. Myocarditis is typical phenomenon developing in patients with the primary, i. e. genetically verified NCM. The nature of myocarditis in NCM varies (primary infectious-autoimmune, secondary as a response on genetic/ischemic damage of cardiomyocytes), however regardless of this, it leads to significant worsening of structural and functional parameters, increase of the life-threatening arrhythmias rate, and outcomes (death + transplantation, proper shocks), demanding for active basic therapy.