Clinical Treatment Course Research Articles

A novel therapeutic strategy of personalized medicine based on anti-epidermal growth factor receptor monoclonal antibodies in patients with metastatic colorectal cancer.

Achieving tumor shrinkage may be a clinically relevant improvement in the treatment of metastatic colorectal cancer (mCRC). The present study attempted to evaluate early tumor shrinkage (ETS) and deepness of response over 6–8 courses of therapy, which were assessed previously in first-line trials of anti-epidermal growth factor receptor (EGFR) monoclonal antibodies. A total of 37 patients with mCRC that was considered unresectable or borderline resectable were enrolled in the study. Patients exhibited the wild-type RAS gene, and anti-EGFR monoclonal antibodies were used as the first-line treatment in the Department of Surgical Oncology at Gifu University School of Medicine (Gifu, Japan) between January 2010 and March 2017. Tumor shrinkage and other characteristics were evaluated according to the Response Evaluation Criteria In Solid Tumors (RECIST) classifications (version 1.1). The 3-year overall survival (OS) rate was >60.0% for all cases (n=37). The mean tumor shrinkage rate in the right side of the colon according to the RECIST classifications was −11.1%, whereas that for CRC on the left side showed a statistically significant difference at −54.0% (P=0.042). In addition, the rates of OS for stable disease + progressive disease compared with partial response + complete response, and those of OS for conversion therapy compared with non-conversion therapy were significantly different (both P<0.001). Carcinoembryonic antigen (CEA) was suggested to be a possible predictive factor for convalescence due to the 50% drop in its value after the 6–8 courses of therapy. Overall, the predictive performance of ETS with respect to PFS and OS is at least as good as the standard RECIST response, with the advantage of an earlier assessment, and this may improve convalescence, with CEA as a marker in support of ETS over a clinical treatment course. In RAS wild-type patients, it is important to evaluate the rate of tumor shrinkage from the beginning of the first-line treatment until 6–8 courses of anti-EGFR monoclonal antibodies have been administered.

Diagnosis and treatment of paradoxical vocal fold motion in infants

ImportanceParadoxical vocal fold motion (PVFM) is a disorder often misdiagnosed in children presenting with shortness of breath and stridor. In infants, little is known about the clinical course and best approach for treatment of PVFM. This retrospective study assesses the approach to treatment and outcomes for infants with PVFM. ObjectiveTo investigate the clinical course of paradoxical vocal fold motion (PVFM) in infants. DesignRetrospective review. SettingTertiary academic medical center. ParticipantsPatients less than 2 years of age diagnosed with PVFM were identified and included in the study. Main outcomes and measuresHistory, physical exam findings, and clinical course of treatment for patients less than 2 years old with PVFM were reviewed. Findings including those on flexible fiberoptic laryngoscopy (FFL) and subjective assessment by parents and clinicians were compiled for review. ResultsSeven infants were diagnosed with PVFM. All patients were full term at birth, and average age at diagnosis was 7 months. All patients initially presented with inspiratory stridor, and two patients had stertor. Two of seven patients also had a history of reactive airway disease and one with laryngomalacia. Five had a history of reflux. Two of seven patients had weight percentiles at diagnosis lower than the 25th percentile, while the remainder were between 37th and 75th percentiles. Initial voice evaluation revealed stridor in all patients, as well as finding of PVFM on FFL. All patients were started on anti-reflux medication. Average time to resolution of PVFM was 5.9 months after treatment. ConclusionsPVFM can be challenging to diagnose in the infant population. PVFM resolves uneventfully with reflux treatment, however, it is unknown whether reflux treatment is essential or if PVFM would spontaneously resolve. The rarity of infantile PVFM mandates formal evaluation and monitoring by a pediatric otolaryngologist.

Extracranial arteriovenous malformations in children: features of clinical course, diagnosis and treatment

Background. Extracranial arteriovenous malformations are uncommon in children, but it remains challenging to accurately diagnose and treat them due to a high risk of recurrence. The purpose of the study is to analyze the clinical course and results of combined treatment of arteriovenous malformations in children. Materials and methods. Extracranial arteriovenous malformations are diagnosed in 9 children among 238 patients with vascular anomalies. Diagnosis and outcomes were based on clinical data, ultrasonography, computed tomography angiography. Arteriovenous malformations were localized in the head and neck region (n = 6), limbs (n = 3), and also there were multiple lesions (n = 2). The follow-up period was from 6 to 80 month. Results. The first clinical symptoms of arteriovenous malformations appeared in patients at the age from 0 to 9 years, the age of diagnosis ranged from 2 to 12 years, on average 7.67 ± 3.64 years. Previous treatment interventions were performed in 4 children, in particular, surgical removal (n = 3), ligation and cryodestruction of the nidus (n = 1), propranolol therapy (n = 2). The combined treatment of arteriovenous malformations was performed in all children in our investigation, in particular, embolization with one-stage sclerotherapy of the nidus — in 6, embolization and conservative treatment — in 1, embolization with subsequent sclerotherapy and surgical resection — in 2 patients. Treatment was started at the age from 1 to 14 years, on average 8.11 ± 3.85 years. Clinical result was achieved in 8 (88.89 %) patients with extracranial arteriovenous malformations, in one case (11.11 %), no treatment result was obtained. The best outcome has been achieved in patients treated by embolization with subsequent sclerotherapy. Conclusions. Combined treatment of arteriovenous malformations in children allowed achieving long-term remission.

Clinical characteristics and treatment courses for cytomegalovirus-associated thrombocytopenia in immunocompetent children after neonatal period.

BackgroundCytomegalovirus (CMV) causes severe diseases in premature infants and immunocompromised hosts, and antiviral therapy is often required for disease control. However, the clinical manifestations and treatment courses for CMV-associated thrombocytopenia in immunocompetent children are unclear.MethodsMedical records of the children who suffered from thrombocytopenia, and showed positive CMV polymerase chain reaction and CMV-like symptoms were retrospectively analyzed at three university hospitals in Daegu from January 2000 to March 2017. Patients suffering from leukemia, immunodeficiency, and other infections were excluded.ResultsAmong 1,065 children with thrombocytopenia, 29 (2.7%) displayed CMV-associated thrombocytopenia. The median age at diagnosis was 15 months and the median platelet count was 26,000/µL. They were classified into the CMV-induced thrombocytopenia (23/29) and CMV-related secondary immune thrombocytopenia (ITP, 6/29) groups. Fourteen subjects had hepatic dysfunction, four had Evans syndrome, two had pneumonitis, and one had gastritis. IVIG was used for 21 patients, and six patients among them showed recurrence, for whom IVIG or antiviral therapy was used. All, except one, recurrent or chronic cases belonged to the CMV-induced thrombocytopenia group. Antiviral therapy was used more frequently for the CMV-induced thrombocytopenia group (8/23, 34.8%) than for the CMV-related secondary ITP group (0/6); however, the results were not statistically significant (P=0.148).ConclusionCMV is a rare but unique etiology of thrombocytopenia, and observed even in healthy children after the neonatal period. About one-third patients need antiviral therapy for disease control. Further, CMV-induced thrombocytopenia is more complex than CMV-related secondary ITP.

Splenic Abscess: An Uncommon Entity with Potentially Life-Threatening Evolution.

Background/Purpose Splenic abscess is rare with potentially life-threatening evolution. The aim of this study is to review the clinical features, microbiological etiologies, treatment, and outcomes of patients with splenic abscess. Methods We reviewed the admitted patients with suspected splenic abscess and made the diagnosis of splenic abscess. The clinical characteristics, underlying diseases, treatment course, organism spectra, abscess number and size, therapeutic methods, and clinical outcome at a tertiary medical center in Taiwan over a period of 5 years were analyzed. Results Of 16 patients with splenic abscess, the male to female ratio was 1 : 1. Common presentations were fever (11 patients, 68.7%), diffuse abdominal pain (6 patients, 37.5%), left upper quadrant pain or tenderness (6 patients, 37.5%), and left-sided pleural effusions (8 patients, 50%). Antimicrobial therapy was administered in all patients. Fourteen (87.5%) patients recovered under medical treatment. One (6.2%) patient underwent splenectomy, four (25%) patients performed percutaneous drainage of their splenic abscess, and 11 (68.7%) patients received antimicrobial therapy alone. Conclusion We noted that mortality may be more related to patients with underlying immunodeficiency. Patients with splenic abscesses receiving antimicrobial therapy alone were in a relatively high proportion and got a good prognosis especially in patients with small and multiple abscesses.

Closed-Eye Visualizations in the Setting of Hyponatremia

Purpose To report a case of closed-eye visualizations and to clarify the different types of hallucinations and their etiologies. Methods Retrospective case report of a patient with closed-eye visualizations secondary to hyponatremia. Clinical findings, physical exam, laboratory assessment, treatment, and disease course from the patient's hospitalization were used in creating this report. Follow-up data after discharge were also obtained. Results Closed-eye visualizations were diagnosed as secondary to hyponatremia, as they did not occur with the eyes open, and potential alternate causes were excluded. Serum sodium nadir was 119 mEq/L. Symptoms resolved with correction of hyponatremia via fluid resuscitation and electrolyte replenishment. There has been no recurrence of the symptoms. Conclusion This patient had hallucinations exclusively with the eyes closed, which must be differentiated from the release hallucinations seen with the eyes open in Charles Bonnet syndrome. This patient had no visual loss or retinal disease, which should be suspected in open eye hallucinations.

Novel device-based acne treatments: comparison of a 1450-nm diode laser and microneedling radiofrequency on mild-to-moderate acne vulgaris and seborrhoea in Korean patients through a 20-week prospective, randomized, split-face study.

While device-based acne treatments are widely applied for patients not tolerating conventional medications, related controlled studies have been still limited. Recently, non-ablative 1450-nm diode laser (DL) and fractional microneedling radiofrequency (FMR) have been effectively used for acne, in addition to well-recognized dermal remodelling effects. To compare the clinical course of acne treatment between DL and FMR. Twenty-five Korean patients with mild-to-moderate facial acne completed treatments with DL and FMR through a 20-week, randomized split-face study. One randomly assigned half side of each patient's face received DL and the other side by FMR. Treatments were scheduled to receive three consecutive sessions at 4-week intervals. Objective assessments including revised Leeds grades, lesion counts, sebum output measurements, and patients' subjective satisfaction were investigated. Both DL and FMR demonstrated steady improvement of acne and seborrhoea during treatment sessions. While results between two devices were similar during treatment sessions, FMR was superior to DL in the 12-week follow-up. Patients' subjective assessments for seborrhoea improvement were similar between two devices, while those for acne, skin texture, and acne scars were more satisfactory for FMR. For safety profile, no significant difference was observed between two regimens, while mild postinflammatory hyperpigmentation was observed only in DL side. Both DL and FMR demonstrated efficacies for acne and seborrhoea, with reasonable safety profile. FMR was more effective than DL for the long-term maintenance, and subjective assessments for texture and scar improvements. Therefore, a few sessions of these devices would be a viable option for acne treatments.

ОСОБЛИВОСТІ ХІРУРГІЧНОГО ТА КОМБІНОВАНОГО ЛІКУВАННЯ МЕДУЛОБЛАСТОМ МОЗОЧКА У ДІТЕЙ МОЛОДШОГО ВІКУ

Медулобластоми мозочка (ММ) є високозлоякісними ембріональними пухлинами головного мозку, що діагностують переважно у дітей, характеризуються раннім метастазуванням. Дані літератури свідчать про особливості перебігу та результатів лікування ММ у дітей різного віку.&#x0D; Матеріали і методи. Проаналізовані результати лікування 297 дітей різного віку з приводу ММ. В усіх дітей видаляли пухлину та проводили ад’ювантну терапію у різному обсязі.&#x0D; Результати. Тотальне видалення пухлини здійснене у 40,6% хворих, субтотальне – у 53,6%, часткове чи біопсія – у 5,8%. У 71 (25,5%) хворих видалення пухлини доповнене лікворошунтувальними операціями. У строки до 30 днів після видалення пухлини помер 31 (10,8%) хворий. Медіана виживання дітей віком до 3 років становила 12 – 18 міс залежно від обсягу лікування, дітей старшого віку – 24 – 36 міс.&#x0D; Висновки. Тотальне видалення пухлин виявилося можливим у 40,3% дітей молодшого віку, субтотальне – у 42%. У дітей віком до 3 років гірший прогноз виживання.

Observation of the clinical effect of ERCP biliary metal stent implantation and PTCD in the treatment of malignant obstructive jaundice

Objective To observe the clinical effect of endoscopic retrograde cholangiopancreatography (ERCP) biliary stent implantation and percutaneous transhepatic cholangiography (PTCD) in the treatment of malignant obstructive jaundice (MOJ). Methods Eighty-eight patients with MOJ treated in the Second Affiliated Hospital of Hainan Medical University from January 2013 to March 2016 were selected and then randomly divided into ERCP group and PTCD group, 44 cases in each group.ERCP group received biliary tract stent implantation via ERCP pathway, and PTCD group underwent percutaneous transhepatic biliary puncture.The success rate, clinical efficacy, liver function and complication rate of the two groups were compared. Results The success rate of ERCP group was 93.18% (41/44), and the success rate of PTCD group was 90.91% (40/44). There was no significant difference between the two groups (P>0.05). In terms of the clinical curative effect, the total effective rate of ERCP group was 92.68% (38/41), the total effective rate of PTCD group was 90.00% (36/40), there was no significant difference between the two groups (P>0.05); the low obstruction efficiency in ERCP group was significantly higher than that of PTCD group (100.00% vs.75%), the high obstruction efficiency in ERCP group was significantly higher than that of PTCD group (96.43% vs.83.33%), the differences between the groups were statistically significant (χ2=3.503, 2.771, P 0.05). Conclusion The ERCP pathway and PTCD pathway implantation of biliary metal stent have great clinical efficacy, while in comparison, ERCP pathway performs better in low obstruction and PTCD pathway was more suitable in high obstruction.In the course of clinical treatment, the selection of surgical approach should be based on the different obstruction sites of the patients, so as to obtain the best therapeutic effect. Key words: ERCP; PTCD; Malignant Obstructive Jaundice; Stent Implantation; Effect comparison

P3.16-041 Pleural Photodynamic Therapy and Surgery for Pleural Metastasis by Non-small Cell Lung Cancer

Photodynamic therapy (PDT) is one of the established treatment modality for non-small cell lung cancer (NSCLC). Early-stage lung cancer and superficial endobronchial lesions less than 1 cm in thickness can be e ectively treated with external light sources. Thicker lesions and peripheral lesions may be amenable to interstitial PDT, where the light is delivered intra-tumorally. The primary adverse event, phototoxicity, is expected to be minimized with the introduction of new photosensitizers that have shown promising results in phase I and II clinical studies. Moreover, the addition of PDT to standard-of-care surgery and chemotherapy (or target therapy) can improve survival and outcomes in patients with pleural dissemination. Therefore, pleural PDT with surgery has shown promise in the treatment of non-small cell lung cancer with pleural spread. Between January 2007 and January 2017, we retrospectively reviewed the clinical characteristics, treatment course and outcome of 39 patients with pleural seeding by non-small cell lung cancer. The eligibility criteria are as follows: pathologic diagnosis of lung cancer or thymoma with pleural spread, medical feasibility for PDT and surgery. The exclusion criteria are as follows: younger than 18 years old, leukopenia, or thrombocytopenia; chronic renal insufficiency with serum creatinine >2.5 mg/dL; significantly impaired liver function; pregnancy or lactation. Patients underwent anatomic resections in whom it was possible to remove all gross tumor. After finishing the procedure, the parietal pleura were stripped from the bony hemithorax as radical parietal pleurectomy. Debulking of all gross tumor was performed in the mediastinum, too. For thymoma patients, the radical thymothy- mectomy was performed concurrent with radical pleural pleurectomy. The goal was to remove all detectable tumor in the operation field before proceeding to the photodynamic therapy. Thirty-nine patients enrolled in this study. There are 18 men and 21 women included in this study. The mean patient age was 52.6 ± 11.9 years. Using Kaplan-Meier survival analysis, the 3-year survival rate and the 5-year survival rate were 69.4% and 59.5%, respectively. There is one ARDS occurred immediately after the procedure. After medical treatment, the condition gradually improved. Other minor complications included prolonged air-leakage (five patients) and skin redness (six patients). The complications were successfully treated using medication. There was no procedure-related mortality. Photodynamic therapy and surgery for pleural dissemination in patients with non-small cell lung cancer is feasible and associated with a good soutcome.

A Review on Medical Image Registration as an Optimization Problem.

Objective: In the course of clinical treatment, several medical media are required by a phy-sician in order to provide accurate and complete information about a patient. Medical image registra-tion techniques can provide a richer diagnosis and treatment information to doctors and to provide a comprehensive reference source for the researchers involved in image registration as an optimization problem.Methods: The essence of image registration is associating two or more different images spatial asso-ciation, and getting the translation of their spatial relationship. For medical image registration, its pro-cess is not absolute. Its core purpose is finding the conversion relationship between different images.Result: The major step of image registration includes the change of geometrical dimensions, and change of the image of the combination, image similarity measure, iterative optimization and interpo-lation process.Conclusion: The contribution of this review is sort of related image registration research methods, can provide a brief reference for researchers about image registration.

Bullous Impetigo Case Series: An Updated Review

Impetigo also known as pyoderma is a common paediatric skin infection presenting to clinics and hospitals in summer season. The illness is acquired from close skin contact with the victim and is highly contagious. The lesions are fluid filled vesicles that leave crust after rupture and usually heal without treatment. The infection is classified as bullous and non-bullous impetigo, the latter one having the least occurrence and is most commonly associated with complications, therefore prompt treatment is necessary.&#x0D; The case series holds a brief literature review of bullous impetigo, its clinical course, treatment op- tions and complications. The author reports two cases presenting with bullous impetigo in the month of June. A five-year old boy and fifteen months old girl; both presenting with similar rashes involving limbs, trunk and neck with slight differences in the clinical symptoms. Both were treated with fluids, oral and topical antibiotics. The climatic conditions of Karachi favours the incidence of impetigo. Also, poor sanitation and overcrowded areas have further more increased the incidence of the disease. Families are unaware of these types of skin infections and hence do not isolate the victim which, in case of highly contagious illnesses like impetigo, is of great importance. Furthermore, not getting prompt treatment is another factor that cannot be ignored and results in complications in case of bullous impetigo. The most important conclusions which can be drawn from our case series are the lack of paediatric centres that treat dermatological conditions promptly and effectively. Lack of proper guidance convinces families to switch to self-medication and sometimes neglect. The role of a paediatrician is vital when creating understanding with the patient's attendant by explaining them the clinical features and course of treatment of bullous impetigo to avoid self-medication while dealing with skin diseases in children.

The impact of expert- and peer feedback on communication skills of undergraduate dental students – a single-blinded, randomized, controlled clinical trial

ObjectiveTo evaluate the effect of peer- and expert feedback on communication skills of undergraduate dental students. MethodsAll students of the first clinical treatment course (n=46) were randomly assigned into two groups. For three times a medical-dental interview/consultation of each student with a real patient was videotaped. After every consultation the videos were assessed either by a person experienced in communication (expert group) or by a fellow student (peer group), giving the students feedback regarding their chairside performed communication skills. Before and after the feedback-interventions all students conducted an interview with simulated patients, which was rated using a validated global rating and analyzed statistically. ResultsGlobal ratings mean scores after feedback-intervention were significantly improved (p<0.05). Thereby, no significant differences in the overall assessment could be observed between expert and peer feedback (p>0.05). ConclusionDuring this study students improved their communication skills in dentist-patient interactions. The communication experience of the feedback provider seems not to have any impact on the communication skills in undergraduate dental students. Practice implicationsThe clinical courses in dentistry offer the opportunity to implement peer-feedback interventions in real treatment situation as part of communication training to longitudinally improve communication skills.

Long-Term Follow-Up of Resistance-Associated Substitutions in Hepatitis C Virus in Patients in Which Direct Acting Antiviral-Based Therapy Failed.

We evaluated the transition of dominant resistance-associated substitutions (RASs) in hepatitis C virus during long-term follow-up after the failure of DAAs (direct acting antivirals)-based therapy. RASs in non-structure (NS)3/4A, NS5A, NS5B, and deletions in NS5A from 20 patients who failed simeprevir/pegylated-interferon/ribavirin (SMV/PEG-IFN/RBV) and 25 patients who failed daclatasvir/asunaprevir (DCV/ASV) treatment were examined by direct sequencing. With respect to SMV/PEG-IFN/RBV treatment, RAS was detected at D168 in NS3/4A but not detected in NS5A and NS5B at treatment failure in 16 of 20 patients. During the median follow-up period of 64 weeks, the RAS at D168 became less dominant in 9 of 16 patients. Among 25 DCV/ASV failures, RASs at D168, L31, and Y93 were found in 57.1%, 72.2%, and 76.9%, respectively. NS5A deletions were detected in 3 of 10 patients treated previously with SMV/PEG-IFN/RBV. The number of RASs in the breakthrough patients exceeded that in relapsers (mean 3.9 vs. 2.7, p < 0.05). RAS at D168 in NS3/4A became less dominant in 6 of 15 patients within 80 weeks. Y93H emerged at the time of relapse, then decreased gradually by 99% at 130 weeks post-treatment. Emerged RASs were associated with the clinical course of treatment and could not be detected during longer follow-up.

Multiple Intravitreal Ranibizumab Injections for Persistant Choroidal Neovascularization Associated with Presumed Ocular Histoplasmosis Syndrome.

Presumed ocular histoplasmosis syndrome (POHS) is a clinical entity that is characterized by small, round, discrete, macular or mid peripheral atrophic (punched out) chorioretinal lesions (histo spots), peripapillary scarring, choroidal neovascularization (CNV), and the absence of anterior uveitis and vitritis. Diagnosis of this disorder is based upon characteristic clinical findings and a positive histoplasmin skin test or residence in an endemic region for Histoplasma capsulatum. There is no active systemic disease during diagnosis of POHS. Disciform scarring and macular CNV secondary to POHS is a well-known complication which leads to loss of visual acuity or visual disturbance. Without therapy, the visual prognosis in these patients is unfavorable. Submacular surgery, radiation, steroids, photodynamic therapy, and most recently anti-vascular endothelial growth factor therapy are current therapeutic options for this condition. We report a case with persistent CNV secondary to POHS in a middle-aged woman with moderate myopia and the clinical course of treatment with multiple intravitreal ranibizumab (Lucentis®, Novartis) injections.

SU114. Switching to Clozapine Treatment in Patients With Schizophrenia: The Clinical Course, Remission, and Augmentation of Treatment After the Switch

Background: This study aims to compare clinical features of schizophrenia patients before and after clozapine initiation and to investigate the clinical course of illness, clinical features, remission state, and augmentation methods under clozapine treatment. Methods: A total of 122 consecutive outpatients diagnosed with DSM-IV criteria for schizophrenia and receiving clozapine treatment were included. Patients were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders, Positive and Negative Syndrome Scale, Clinical Global Impression Scale, Global Assessment of Functioning, Calgary Depression Scale for Schizophrenia, Panic Agoraphobia Scale, Yale-Brown Obsessive Compulsive Scale, and the World Health Organization Disability Assessment Schedule-2.0 to determine the severity of psychopathology and comorbid symptoms, as well as the level of functioning and disability. The remission state of the patients was assessed utilizing the Schizophrenia Working Group’s remission criteria for schizophrenia. Results: The number of psychotic relapses, hospitalizations, and suicide attempts along with alcohol-drug misuse rates declined after the initiation of clozapine. The study group consisted of schizophrenia patients using clozapine for a mean period of 9 years, and 44.5% of these patients were found to be in a symptomatic remission state. No relationship was shown between remission state and clozapine dose/plasma levels. Education level was found to be higher, work status better, and comorbid symptom severity lower in remitted patients. There was no difference between remitted and not remitted patients in terms of the duration of clozapine use and age at disease onset. Education level, positive and negative symptom severity predicted achievement of remission on clozapine. The augmentation strategies were examined in patients showing partial response to clozapine, and combined antipsychotic drug use was found to be the most prevalent method utilized. Patients on augmentation treatment were on higher daily clozapine doses and their remission rates were lower. In addition, the severity of psychopathology related with schizophrenia and comorbid symptoms, the level of functioning and disability were worse in this particular patient group. History of antipsychotic combination use prior to clozapine was found to predict the future use of clozapine augmentation. Conclusion: Shortening the duration of switch to clozapine and avoiding antipsychotic combinations prior to clozapine use should both be considered as important goals in the management of treatment resistant schizophrenia.

The α4β1 Homing Pathway Is Essential for Ileal Homing of Crohn's Disease Effector T Cells In Vivo.

The precise mechanisms controlling homing of T effector (Teff) cells to the inflamed gut in Crohn's disease (CD) are still unclear, and clinical outcome data from patients with inflammatory bowel disease treated with the anti-α4β7 integrin antibody vedolizumab suggest differences between ulcerative colitis and CD. Expression of homing molecules was studied with flow cytometry and immunohistochemistry. Their functional role was investigated in in vitro adhesion assays and in a humanized mouse model of T cell homing to the inflamed gut in vivo. Despite in vitro blockade of CD Teff adhesion to mucosal vascular addressin cell adhesion molecule-1 (MadCAM-1) and in contrast to previous observations in ulcerative colitis, anti-α4β7 treatment did not result in reduced Teff cell homing to the colon in vivo. However, the integrin α4β1 was expressed in higher levels on Teffs from patients with CD compared with controls, while its expression in the peripheral blood declined, and its expression in the intestine increased during the course of clinical vedolizumab treatment. Consistently, adhesion of CD Teffs to vascular cell adhesion molecule-1 (VCAM-1) was blocked by inhibition of α4 and α4β1 in vitro. Moreover, in vivo homing of CD Teffs to the ileum was reduced by inhibition of α4 and α4β1 integrins, but not α4β7 integrins. Our findings suggest that Teff cell homing to the ileum through the axis α4β1-VCAM-1 is an essential and nonredundant pathway in CD in vivo, possibly affecting efficacy of clinical treatment with antiadhesion compounds.

Varicose vein clinical course and effectiveness of treatment in patients with arteriosclerosis of lower limbs

The purpose and objectives of this work was to study the character and severity of varicose veins of the legs on the background of arteriosclerosis and evaluation of medical measures in these patients. The study included 302 patients (227 men and 75 women aged 29-72 years), 16 % of which had previous phlebothrombosis and the frequency of II, III, IV, V and VI venous insufficiency class was 10 %, 14 %, 37 % 16 % and 23 %. 263 patients underwent endovenous laser coagulation, and 39 – the traditional phlebectomy and ligation of perforating vein. Arteriosclerosis of femur, tibia, iliac and popliteal arteries is observed in 23 % of patients with varicose veins of legs, more common in men and people who have had phlebotrombosis, which was accompanied by higher blood pressure and venous insufficiency parameters, more frequent involvement of the great saphenous vein in the process, larger diameter and its preestuarine extension, with that the results of endovascular ablation after two, four and twenty-four weeks were worse, in spite of the prevalence of using rivaroxaban and heparins in this group, and the frequency of complications of medical measures were 2,7 times higher, while complete occlusion of the vessel a month after the operation – in 3,2 times less, that was determined by the levels of thromboxane-A2, surface viscosity, elasticity and tension of venous blood serum, the last indicator had predictive value in the presence of arteriosclerosis, a surfactant index – in case of its absence.

Spinal epidural abscesses as a complication of spondylodiscitis: a retrospective single-center study

Objective. To present the clinical course and outcomes of surgical treatment in patients with spinal epidural abscesses. Material and Methods . Sixteen patients (7 males and 9 females) with clinical, neuroimaging and/or histological evidence of spinal epidural abscess were treated in 2015 and 2016 at our institution. Results . The mean age of patients was 60.200 ± 10.387 years. The period from disease onset to hospital admission ranged from 15 to 120 days. Upon hospitalization, only 3 patients (18.75 %) were neurologically intact. Seven patients (3.75 %) underwent interlaminotomy at one or more levels or hemilaminectomy. The remaining 9 patients (56.25 %) were treated with laminectomy, and 5 of them with additional posterior pedicle screw fixation. Disability decreased after surgery in 7 patients (43.75 %), and remained unchanged until hospital discharge in 7. Two patients (12.5 %) died. Conclusion . Urgent surgery is the method of choice for patients with spinal epidural abscess. It allows decompression of neural structures, correction of spinal deformity by means of stabilization that aims at rapid mobilization of patients.

AN EXPERIENCE OF TREATMENT OF PNEUMONIA IN BASHKORTOSTAN DURING THE GREAT PATRIOTIC WAR, 1941 – 1945

The aim of this review was to analyze an experience of treatment of pneumonia in hospitals of Bashkortostan during the Great Patriotic War, 1941 – 1945. Methods. Archive materials of the Bashkir State Medical University and Ufa hospitals, attestors' recollections, original scientific papers and articles published in Soviet academic medical journals of the time and later historical issues about the medicine of Bashkortostan at the wartime have been used in this review. Results. Clinical course and pathogenesis of pneumonia, treatment and rehabilitation of wounded militaries with pneumonia have been described including specific features of pneumonia during the 1943 – 1944 influenza pandemics. Typically, diagnosis of pneumonia was based on clinical signs, chest X-ray, and sputum microscopic examination. A common treatment included intravenous antibiotic therapy with Sulfidine, physiotherapy, physical and psychological rehabilitation, and nutritional support. These medical interventions could reduce mortality from pneumonia from 30% to 4%. Conclusion. Basic principles of diagnosis and treatment of pneumonia developed by Soviet clinicians during the Great Patriotic War have being currently used both in the national Russian medicine and worldwide.