Combined Treatment Of Patients Research Articles

Combined treatment of rectal cancer with moderate risk of tumor progression

To increase the effectiveness of combined treatment in patients with rectal cancer and moderate risk of progression based on the concept of polyradiomodification (PRM). The study included 337 patients with rectal cancer and moderate risk of tumor progression. A short course of radiotherapy (cRT) (5x5 Gy) combined with several radiomodifiers (cRT+PRM) was performed in 147 (43.6%) patients. Other 190 (56.4%) patients underwent cRT. The following radio modifiers were used: three-time application of local microwave hyperthermia (Yacht-3 or Yacht-4 devices), two-time intrarectal delivery of a biopolymer composition with Metronidazole before the 3rd and 5th irradiation sessions and two-week oral administration of Capecitabine (Xeloda) at a daily dose of 2.0 g/m2. Surgery was performed in 4-6 weeks after radiotherapy. CRT+PRM program increased 5-year relapse-free survival up to 81.3% compared to 60.3% after cRT alone (p=0.0003) due to significant reduction of the incidence of cancer recurrence from 8.4% to 0.7% (p=0.0013). More effective local growth control expanded the indications for sphincter-sparing surgery. These procedures were performed in 89.1% and 70.5% of patients, respectively (p=0.00001). In the cRT+PRM group, sphincter-sparing surgery reduced incidence of cancer recurrence from 13.7% to 0.8% (p=0.0110), distant metastases - from 23.9% to 13.7% (p=0.00349). Radiomodification in neoadjuvant radiotherapy is justified in patients with moderate risk of tumor progression, improves long-term results and increases the incidence of sphincter-sparing surgery.

Low-intensity laser efficacy in Combined Treatment of Patients with Alveolar Osteitis

Objective: To study the effectiveness of combined treatment in patients with alveolar osteitis after tooth extraction. Materials and methods: The 87 patients with alveolar osteitis were selected for the study (from 2017 to 2020). Clinical and radiological methods were used to evaluation socket. To conduct a comparative analysis of the treatments results, two groups were formed: Group I is represented by 44 patients with alveolar osteitis received complex treatment with the inclusion of hyaluronic acid (HA) and magnetic-laser therapy. The II group is represented by 43 patients, with alveolar osteitis received treatment without the inclusion of hyaluronic acid (HA) and magnetic-laser therapy. To assess the pain syndrome in dynamics, we used visual analogue scale. Patients noted pain intensity in the first visit, as well as in dynamics on the 3rd, 5th, 7th day, respectively. Results:Group 1 patients, the VAS score indicator shows that by the 5th procedure in 93% of cases the pain is completely absent, and only 1 patient has mild pain. Patients of the 2 group, we observed a similar picture only on the 7-8th day of treatment.When comparing 2 group the best pain relief was patients first group. Hyperemia of the mucous membrane of the socket of the extracted tooth on the 5th day of treatment is completely absent in the 2nd group only in 32% of patients of the 1st group, this indicator reaches 98%. Conclusion: The results of the treatment showed that, сomplex treatment using Hyaluronic acid (HA) and magnetic-laser therapy reduced the time pain, recovery time, increase the effectiveness of treatment. Thus, on the basis of clinical data, it can be concluded that the anti-inflammatory effect of hyaluronic acid (HA) and magneto-laser therapy is more pronounced than standard treatment methods.

The use of probiotics in the combination treatment of patients with moderate acne

The use of probiotics in the combination treatment of patients with moderate acne

Efficacy, safety and outcome of fixed dose Sofosbuvir and Velpatasvir combination treatment in patients with HCV and ESRD on maintainance haemodialysis

Background and Aim: The treatment of HCV patients with end stage renal disease (ESRD) who are on maintenance haemodialysis (MHD) pose a great challenge to hepatologist. There are scarce data on safety and efficacy of directly acting antivirals (DAA) on patients with CKD from India. We conducted this study to assess the safety and efficacy of Sofosbuvir plus Velpatasvir fixed-dose combination in CHC patients with ESRD on MHD.

Add-On Effect of Simultaneous Intravitreal Dexamethasone to Intravitreal Bevacizumab in Patients with Macular Edema Secondary to Branch Retinal Vein Occlusion.

Purpose: To report the effect of simultaneous dexamethasone and bevacizumab combination treatment in patients with macular edema secondary to branch retinal vein occlusion (BRVO). Methods: Treatment-naive patients who had a macular edema secondary to BRVO with a duration of less than 1 month were treated either with intravitreal bevacizumab (Group-1) or intravitreal bevacizumab simultaneously combined with dexamethasone intravitreal implant (Group-2). In both groups, patients received monthly bevacizumab injection during the first 3 months. Between months 3 and 12, all patients were allowed to receive pro-re-nata bevacizumab. In Group-2, the first dexamethasone implant injection was simultaneously received with first bevacizumab injections. The patients were evaluated for re-treatment after 6 months and 11 months for second and third dexamethasone simultaneously with intravitreal bevacizumab. Results: In Group-1, 35 eyes of 35 patients and in Group-2, 32 eyes of 32 patients were treated. The mean gains in BCVA were +10.7 letters in the Group-1 and +21.3 letters in the Group-2 (P = 0.021) at month 12. The mean reduction in Central Macular Thickness (CMT) from the baseline were -173.74 μm in the Group-1 and -257.97 μm in the Group-2 (P = 0.0018). In Group-1, the mean intravitreal bevacizumab injection number was 7.18 ± 1.05. In Group-2, the mean intravitreal bevacizumab and dexamethasone injection number was 5.15 ± 1.24. There was a significant difference in mean injection numbers between 2 groups (P = 0.044). Conclusion: In the early period of macular edema adding dexamethasone to bevacizumab therapy does improve visual acuity and CMT, and reduce the injection frequency more than bevacizumab alone.

Efficacy evaluation of entomological drug Adenoprosin® usage in combined treatment of patients with lower urinary tract symptoms due to benign prostate enlargement

BACKGROUND: Increasing the effectiveness of treatment of patients with symptoms of the lower urinary tract is one of the main problems of modern urology, which is associated both with their high prevalence and with a significant deterioration in the quality of life of patients.
 AIM: The article presents the results of the usage of the entomological drug Adenoprosin in the combined treatment of patients with lower urinary tract symptoms due to benign prostatic enlargement.
 MATERIALS AND METHODS: 80 patients were treated (mean age 63.6 6.4 years). At the initial phase of the study, all patients received Tamsulosin 0.4 mg once a day for 4 weeks. At the second phase, the patients were divided into two groups. Group 1 patients were prescribed a combination therapy with Adenoprosin (1 rectal suppository (150 mg) at night, for a course of 30 suppositories) and Tamsulosin (0.4 mg per day). Patients of the 2nd group continued monotherapy with Tamsulosin (0.4 mg per day). The duration of the second phase of treatment was 4 weeks.
 RESULTS: The results of the study showed a more pronounced positive dynamics of clinical indicators in patients of the 1st group, who received combination therapy with Adenoprosin and Tamsulosin, compared to patients of the 2nd group. There was a more pronounced decrease in the IPSS score, an improvement in the quality of life, an increase in the urine flow rate and a decrease in the volume of residual urine. The volume of the prostate gland did not change significantly. When examined 2 weeks after the end of treatment, the positive dynamics of clinical indicators in patients of the 1st group persisted. The tolerability of the treatment was satisfactory in patients of both groups.
 CONCLUSIONS: The results of the study indicate the advisability of including Adenoprosin in the combination therapy of patients with lower urinary tract symptoms due to benign enlargement of the prostate gland.

The study of the efficiency of micropulse transscleral cyclophotocoagulation in the combined treatment of patients with secondary neovascular glaucoma

Background: Neovascular glaucoma (NVG) is a highly refractory form, it is characterized by fast development and a high level of the intraocular pressure (IOP).
 Aims: To evaluate the effectiveness of micropulse transscleral cyclophotocoagulation (mCPC) in the combined treatment of patients with secondary neovascular glaucoma.
 Methods: The study included 32 patients (32 eyes) with secondary NVG as an outcome of diabetes mellitus and (or) thrombosis of the central retinal vein or its branches. The preoperative IOP averaged 38.88.8 mm Hg with the most intense hypotensive therapy. All the patients underwent mCPC. In the postoperative period, the patients were examined on the first day after the operation, then in 1 week, 1, 3, 6 months, 1 year after the operation.
 Results: All the operations were performed without complications. Pain syndrome in all cases was stopped on the first day after surgery. Six patients had reactive hypertension on the first day, therefore, the hypotensive therapy was intensified. The IOP 1 week after mCPC was 20.97.9 mm Hg, after 1 month of observation 23.76.0 mm Hg with the hypotensive therapy. 34 weeks post-surgery, six patients with the preserved visual function experienced a repeated IOP increase, and the Ahmed valve was implanted. 6 months after mCPC, the IOP level averaged 22.87.7 mm Hg with the hypotensive therapy. Against the background of the IOP compensation, anti-VEGF drugs were injected in 4 cases, followed by laser coagulation of the retina.
 Conclusion: Application of mCPC in NVG glaucoma patients showed only a small number of postoperative complications. This method of laser treatment can be used in combination with panretinal laser coagulation before or after the surgery, including administration of anti-VEGF drugs before or after the surgery. In case of the IOP increase, mCPC may be repeated.

Abstract P208: Synergistic antitumor activity of lisaftoclax (APG-2575) and alrizomadlin (APG-115) through dual targeting of BCL-2/MDM2-P53 apoptotic pathways in preclinical models of acute myeloid leukemia

Abstract Background: In many hematologic malignancies, BCL-2 is overexpressed and is a viable therapeutic target. In relapsed or refractory acute myeloid leukemia (R/R AML), BCL-2 inhibitor venetoclax as a single agent has limited activity, thereby necessitating combination treatments, some of which are actively under clinical development. In addition, the mutation rate of TP53 is rare in AML, and the frequency of MDM2 overexpression is high, representing an opportunity for pharmacologic intervention of the MDM2-P53 apoptosis pathway. Synergistic effects of MDM2 inhibitor idasanutlin and venetoclax have been reported in preclinical models of TP53 wild-type AML (Pan et al, Cancer Cell 2017). Lisaftoclax (APG-2575) and alrizomadlin (APG-115) are novel BCL-2 and MDM2 inhibitors, respectively. They show unique pharmacological properties as well as clinical activity and tolerable safety profiles in patients with hematologic or solid malignancies (Tolcher et al, J Clin Oncol 2021:2506; Ailawadhi et al, J Clin Oncol 2021:7502). Here, we examined the effects of combined lisaftoclax and alrizomadlin in preclinical models of AML. Materials and Methods: AML cell lines and mouse xenograft models were employed. Antiproliferative activity was measured by CellTiter-Glo luminescent cell viability assay. Apoptosis was evaluated by annexin V/propidium iodide staining and flow cytometry. Meso-Scale Discovery ELISA assay and western blot analyses were used to characterize the mechanisms of the synergistic effects of this combination. In animal studies, clinically relevant doses of lisaftoclax were employed. A pulsed high-dose regimen of alrizomadlin was used to achieve best efficacy and manage on-target toxicity. Results: In TP53 wild-type AML cell lines MOLM-13, MV-4-11, and OCI-AML-3, both single-agent lisaftoclax and alrizomadlin exerted apoptogenic activity. The combination had synergistic apoptogenic and antiproliferative activity. In subcutaneous xenograft models derived from MV-4-11 and OCI-AML-3 cells, the combination substantially inhibited tumor growth relative to the impact observed with either single agent. In a systemic xenograft model derived from MOLM-13 cells, the combination significantly (P < .05) extended the life span of tumor-bearing mice by 135% to 237% compared to that of tumor-bearing mice treated with lisaftoclax or alrizomadlin alone, which resulted in extensions of 4% to 26% and 41% to 95%, respectively. Synergistic anti-leukemic activity was confirmed in a patient-derived systemic AML model. Mechanistically, the combination synergistically downregulated anti-apoptotic proteins MCL-1 and BCL-xL and primed AML cells to apoptosis induced by lisaftoclax. Conclusions: We show a significant synergy of lisaftoclax and alrizomadlin and novel mechanisms associated with the combination of these agents in preclinical models of TP53 wild-type AML. These data support investigation into the clinical outcomes of the combination treatment in patients with TP53 wild-type AML. Citation Format: Douglas D. Fang, Qiuqiong Tang, Qixin Wang, Na Li, Feng Zhou, Guoqin Zhai, Yan Yin, Dajun Yang, Yifan Zhai. Synergistic antitumor activity of lisaftoclax (APG-2575) and alrizomadlin (APG-115) through dual targeting of BCL-2/MDM2-P53 apoptotic pathways in preclinical models of acute myeloid leukemia [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P208.

Evaluation of bovhyaluronidase azoxymer efficacy in combined treatment of patients with endometriosis based on the results of multicenter prospective non-interventional study (ISLAND)

Background. Endometriosis is a chronic progressive recurrent disease associated with pelvis pain, menses disorders and infertility. The prevalence of endometriosis (EGE) tends to increase steadily and reaches 15% among women of reproductive age. Endometriosis-associated pain can persist despite surgical and drug treatment of this disease, resulting in a significant decrease in the quality of life of patients. The main causes of EGE-associated pain are local inflammatory, adhesive, neuro- and angiogenic processes. Currently, the search for alternative methods of pathogenesis-based therapy of the disease is one of the priority tasks. Given its anti-inflammatory, enzymatic, antioxidant effects and anti-adhesion mechanism of action, bovhyaluronidase azoximer, an enzyme agent with hyaluronidase activity, is a promising drug in the complex therapy of EGE.
 Aim. To compare bovhyaluronidase azoxymer efficacy in complex therapy of patients with EGE using dienogest (2 mg) versus monotherapy with this progestogen in real clinical practice.
 Materials and methods. 149 female patients of reproductive age were enrolled in the study after surgical treatment for EGE. The patients were divided into two groups: the first group (n=94) was treated with complex therapy by dienogest (2 mg) daily within 6 months in combination with suppositories containing bovhyaluronidase azoxymer (3000 IU): 1 suppositorium once within 3 days,10 administrations; and then 1 suppositorium once in 7 days, 17 administrations, within 120 days; the second group (n=55) received monotherapy with dienogest (2 mg) daily up to 6 months. EGE-associated pelvic pain intensity, uterine bleeding severity and life quality were assessed during the study, after 30, 90, 150 and 180 days with regard to the basic values.
 Results. There was a statistically significant reduction of pain intensity observed in both groups compared to the basic level, using visual analogue scale of pain (VAS), the Biberoglu and Berman scale, but there was a distinct trend towards a more significant decrease in pelvic pain score basing on VAS in patients received complex therapy versus monotherapy with dienogest 2 mg after 30 days of treatment (p=0.051). Life quality assessment of patients in both groups revealed statistically significant increase in scores for all values of the SF-36 life quality scale just after the second follow-up visit. More significant life quality improvement in patients was observed with complex therapy with regard to such descriptors of the SF-36 Questionnaire as Physical functioning, Role-physical functioning, Pain intensity (p0.05).
 Conclusion. Bovhyaluronidase azoxymer in combination with dienogest (2 mg) improves the overall therapy effectiveness for EGE and is associated with more significant reduction in pelvic pain intensity, inflammatory and adhesive processes in the pelvis, and significant life quality improvement compared to monotherapy with 2 mg dienogest.

Вибір оптимальної нейропротективної інфузійної терапії при ішемії/ реперфузії в комплексному лікуванні пацієнтів з ішемічним інсультом в гострому періоді

Мета — оцінити динаміку тяжкості стану та вираженості неврологічного дефіциту, стан реології крові у пацієнтів з ішемічним інсультом на фоні стандартної базисної терапії з додатковим застосуванням нейропротективної інфузійної терапії та корекції гематоелектролітних змін і порівняти її з перебігом захворювання у пацієнтів, які отримують тільки стандартну базисну терапію. Матеріали та методи. У дослідження були включені 80 пацієнтів Одеської обласної клінічної лікарні в гострому періоді ішемічного інсульту. Пацієнти контрольної групи отримували базисну терапію відповідно до клінічного протоколу (наказ МОЗ України № 602 від 03.08.2012 р.), в тому числі розчин магнезії сульфату. Пацієнти основної групи були розподілені на три підгрупи. Вони отримували базисну і комбіновану нейропротективну терапію: Цитокон (цитиколін натрію), розчин Рінгера лактатний, Нейроцитин (цитиколін натрію + Рінгера лактатний). Результати. Результати нашого дослідження показали позитивну динаміку регресу неврологічного дефіциту за шкалами NIHSS, індексом Бартел, збільшення частки пацієнтів у свідомості або з легким ступенем його порушення за шкалою Глазго у пацієнтів основної групи, які отримували додаткове лікування Цитоконом (починаючи з 5-го дня) і Нейроцитином (починаючи з 3-го дня), порівняно з конт­рольною групою пацієнтів, які отримували магнезії сульфат, і з групою розчину Рінгера лактатного. Висновки. Комплексний збалансований ізотонічний інфузійний розчин з цитиколіном натрію (Ней-роцитин) дозволяє викликати більш раннє «пробудження» в гострому періоді ішемічного інсульту порівняно з розчином Рінгера лактатним або цитиколіном натрію в 200 мл 0,9% розчину NaCl. Нейроцитин дещо більш позитивно впливає на регрес неврологічного дефіциту за шкалою NIHSS і індексом Бартел порівняно з розчином Рінгера лактатним або цитиколіном натрію в 200 мл 0,9% розчину NaCl. Комбіноване застосування Нейроцитину з базисною терапією в гострому періоді ішемічного інсульту має переваги перед стандартним лікуванням.

The role of neurophysiological assessments during the combined treatment of patients with malignant brain tumors

Introduction. Dynamic monitoring and evaluation of the results of therapy of patients with malignant brain diseases is a complex and urgent problem in modern medicine. The aim of the study was to assess the reliability of the transcranial magnetic stimulation technique as a tool for neurophysiological monitoring in patients with malignant brain tumors. Material and methods. Two groups of patients were formed: adults with large focal solitary lesions of the central nervous system (glioma) (n=20), who underwent radiotherapy, and a control comparison group (n=16). All patients underwent diagnostic transcranial magnetic stimulation before and after treatment. Results. In the main group the application of transcranial magnetic stimulation in dynamics allowed to reveal reliable improvement of conduction along the central motor pathways (increase in amplitude of the evoked motor response). The obtained data of neurophysiological examination correlated with clinical improvement in the patient group. Discussion. Some parameters of the motor evoked response (MEP) changed reliably, as after the radiation treatment performed. Obtained changes (amplitude of MEP and, especially, its threshold) to the greatest extent reflect functional state of cortical motoneurons, as well as their anatomical preservation in case of organic changes. Before therapy in all cases there was a reliable tendency to a smaller amplitude and a higher threshold of cortical MEPs, which reflects a decrease in the functional activity of motor cortex neurons; a slower central motor conduction time also draws attention. These changes had a universal character and were registered in all patients. Conclusion. Diagnostic transcranial magnetic stimulation, taking into account age limitations inherent to it as a technique, is a valuable additional neurophysiological technique. It is safe, inexpensive and does not require expensive consumables, and is applicable to a wide range of diseases.

The optimal timing of radiotherapy in the combination treatment of limited-stage extranodal natural killer/T-cell lymphoma, nasal type: an updated meta-analysis.

This study was designed to explore the relative efficacy and toxicity of upfront radiotherapy (RT) and late RT in combination treatments for patients with limited-stage extranodal natural killer/T-cell lymphoma nasal type (LS-ENKTL). We searched for clinical trials in the PubMed database that compared upfront RT with late RT in the combined treatment of patients with LS-ENKTL. We systematically evaluated the differences in survival, treatment response, and treatment-related adverse events (AEs) between these two groups. Ten retrospective studies with a total of 1752 patients were included. Upfront RT significantly prolonged the overall survival (OS) and progression-free survival (PFS) of patients compared to late RT in combination with chemotherapy (CT) (HR = 0.72, 95% CI 0.59-0.88, P = 0.001 for OS; HR = 0.57, 95% CI 0.41-0.79, P = 0.0007 for PFS). The complete remission (CR) rate in the upfront RT group was superior to that in the late RT group (HR = 1.61, 95% CI 1.09-2.37, P = 0.02). Patients experienced similar local recurrence-free survival (LRFS), objective response rates (ORR), and toxicity between these two arms (P > 0.05 for all) in the analysis of each subgroup. The survival benefit of upfront RT was not correlated with the RT dose, concurrent chemoradiotherapy (CCRT) (or not), or the CT regimen (P > 0.05 for all). Without compromises in terms of toxicity, RT dose, and treatment modality, upfront RT can significantly benefit OS, PFS, and CR compared to late RT in combination treatment. These findings verified that the upfront RT regimen is more suitable for patients with LS-ENKTL.

OSTEOPATHIC CORRECTION IN TREATING PATIENTS WITH TENSION HEADACHE SYMPTOM AGAINST TMJ DYSFUNCTION

Patients may have headache due to pathological issues occurring in the cervical spine and resulting in compression of the vertebral artery passing nearby. This comes along with disturbed blood supply to the brain. The aim of this study is to offer reliable grounds, and evaluate osteopathic correction when treating headache of tension (HAT) caused by a dysfunction of the temporomandibular joint (TMJ). A comprehensive examination involved 26 patients aged 18 to 65. The study outcomes allow recommending to include soft osteopathic techniques in the set of therapeutic measures. In order to make osteopathic treatment available for patients with HAT caused by the TMJ dysfunction, computed tomography (CT) of the TMJ and cranio-cervical junction is a typical choice. Given the high efficiency of the combined work of an osteopath joining effort with an orthopedic dentist and an orthodontist who has a good command of neuromuscular correction approaches, it appears a feasible option to use such combined treatment in patients with the TMJ dysfunction-caused HAT. To improve the quality of osteopathic correction and maintain the positive outcome we recommend using a supporting teeth protector — an elastopositioning corrector or TMJ trainer. This enables to decompress the TMJ.

Комплексна терапія пацієнтів після ендоскопічних хірургічних втручань у носовій порожнині

У роботі наведені результати дослідження клінічної ефективності застосування назального спрея СептаНазал у комплексній терапії пацієнтів після перенесених ендоскопічних оперативних втручань у носовій порожнині. Дослідження проводились на базі кафедри оториноларингології з офтальмологією Вищого державного навчального закладу України «Українська медична стоматологічна академія» та ЛОР-відділення Полтавської обласної клінічної лікарні. Встановлено значне регресування суб’єктивної симптоматики та об’єктивних показників одужання пацієнтів, які застосовували спрей СептаНазал. У даній групі спостерігалось більш швидке покращення стану щодо початкового на 1,5 бала порівняно з контрольною групою. Закладеність носа зменшилась на 50 % в обох групах, при цьому відновлення нюхової функції спостерігалось у 87 % пацієнтів основної групи та 50 % — контрольної. На 7-му добу жоден пацієнт основної групи не скаржився на біль.

Досвід застосування психокорегуючої терапії в комплексному лікуванні хворих на гастроезофагеальну рефлюксну хворобу, поєднану з дисфункцією жовчовивідної системи

У сучасну епоху внаслідок бурхливого зростання числа стресорних факторів особливо велике значення мають психотерапія та психофармакотерапія в комплексному лікуванні хворих із захворюваннями шлунково-кишкового тракту. Психогенні нашарування відіграють провідну роль у клінічній картині захворювання та визначають зниження працездатності пацієнтів. Мета. Оцінити ефективність лікування із застосуванням психокорегуючого засобу у хворих на гастроезофагеальну рефлюксну хворобу (ГЕРХ), поєднану з дисфункцією жовчовивідної системи, при наявності у них депресивних і тривожних проявів. Матеріали та методи. Всі хворі були розподілені на дві групи: І групу становили 27 хворих, які отримували тільки комплексне базове лікування, ІІ групу — 25 пацієнтів, яким додатково до базисного лікування призначався тіоридазин, що є піперидиновим похідним фенотіазину та належить до групи нейролептиків. Обидві групи були репрезентативні за віком, тривалістю та перебігом захворювань. У всіх пацієнтів за допомогою шкали HADS були виявлені тривожно-депресивні прояви. Для аналізу якості життя був використаний опитувальник SF‑36. Ефективність терапії оцінювали через 14 діб. Результати. У результаті лікування в обох групах спостерігали покращення загального самопочуття на фоні зменшення больового та диспептичного синдромів. При додаванні психокорегуючого засобу (тіоридазину) до базисної терапії відзначалися більш виражені позитивні зміни за інтенсивністю тривожно-депресивних проявів. Розподіл пацієнтів за рівнем тривоги та депресії після лікування виявив, що відсутність цих показників частіше відзначалась хворими ІІ групи (в 2,6 та 1,5 раза відповідно). Проте в 4,6 та 3,7 раза більше встановлено випадків клінічно вираженої тривоги і депресії в групі пацієнтів, які не отримували тіоридазин. Різниця у балах між рівнем тривоги і депресії до та після лікування була в 4 рази більшою у хворих, які додатково отримували психокорекцію. Також у ІІ групі спостерігалося більш значне покращення показника якості життя при порівнянні балів до та після лікування. Висновок. Включення до основної терапії тіоридазину за наявності депресивних і тривожних порушень у хворих на ГЕРХ, поєднану з дисфункцією жовчовивідної системи, підвищує клінічну ефективність фармакотерапії даної коморбідної патології.

Choice of tactics of combined treatment of patients with malignant diseases of colon

The aim. To determine the definition of nutritional extinction and its characteristics in various phases of carcinogenesis, to show the role of nutritional counseling in the selection of personalized metabolic correction programs.Materials and methods. 107 patients with pancreatic head adenocarcinoma (T3 and T4). In addition to traditional methods, the nutritional status was assessed according to the parameters of the well-known personalized alimentary-volemic diagnosis and the main common metabolic syndromes (inflammatory, hypermetabolism-hypercatabolism, toxic-anemic, anorexia-cachexia).Results. The phases of nutritional extinction are identified, in accordance with which the original schemes of metabolic correction are developed. The effectiveness of the programs used, calculated according to the degree of well-being, was significantly higher in comparison with standard solutions. The feasibility of using this tactic was confirmed (in addition to traditional tests) by measuring the metabolism in lysosomes (according to the analysis of the level of cathepsin L using ELISA in the blood serum of the considered groups of patients).Conclusions. 1) When determining the tactics of nutritional treatment of cancer patients, it is advisable to distinguish the phases of nutritional extinction, on the basis of which to carry out a differentiated metabolic correction. 2) The role of nutritional counseling (along with consulting with a surgeon and an anesthesiologist) allows you to clarify the strategy of treatment of patients with oncological pathology, and in some cases, make adjustments to the choice of the nature of the surgical aid.

Combined treatment of patients with localized pancreatic cancer of elderly and senile age

Introduction. The gold standard for the treatment of patients with a localized form of pancreatic cancer is radical surgical intervention. It is characterized by a high frequency of postoperative complications and is not performed in patients with a weakened general functional status and the presence of multiple severe concomitant somatic pathology.Purpose. The aim of this study is a assessment of the safety and effectiveness of combined treatment with the inclusion of gemcitabine chemotherapy and HIFU therapy in somatically inoperable patients with localized pancreatic adenocarcinoma of the elderly and senile age.Materials and methods. This study involved 15 patients with stage II (T3N0-1M0) disease aged 60 years and older, with a performance status ECOG 2 and a high operational and anesthetic risk, who received palliative combined treatment on the basis of the P. Hertsen Moscow Oncology Research Institute in the period from 2017 to 2020. HIFU therapy was performed on the HIFU2001 (Shenzhen Huikang Medical Apparatus Co., Ltd.), local treatment sessions were carried out in the amount of 3–8 per course, conducted daily, in the intervals between days of intravenous administration of gemcitabine at a dosage of 1000 mg/m2 (1, 8, 15 days every 4 weeks).Results. Adverse events of systemic drug therapy were observed in 9 (60%) patients, local complications of HIFU therapy — in 6 (37.5%) patients. 6 months after the start of treatment, pain control was achieved in 87.5% of patients, local progression of the disease was detected in 2 (13.3%) cases, and a partial tumor response was determined in 2 patients and stable disease in 11 patients. The median overall survival was 19 months, and the median progression-free survival was 12 months. The overall 1-, 2-, and 3-year survival rate was 80%, 20%, and 13%, respectively, and the 1-year progression-free survival rate was 54%.Conclusions. The results of this study demonstrate the prospects of using a combination of HIFU therapy and gemcitabine monotherapy in somatically inoperable patients with localized pancreatic adenocarcinoma of the elderly and senile age.

A scoping review of the evidence for the impact of pharmacological and non-pharmacological interventions on shift work related sleep disturbance in an occupational setting

Background: Shift work is essential in society but can be detrimental to health and quality of life and is associated with decreased productivity and increased risk of accidents. Interventions to reduce these consequences are needed, but the extent and range of trial evidence for interventions for those most affected by their shift-work schedules is unclear. We therefore carried out a scoping review to assess the availability of evidence to inform the development and evaluation of future interventions. Methods: We aimed to identify clinical trials of any intervention for shift work-related sleep disturbance that included a comparator group, where the intervention was delivered in an occupational setting. We searched Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, EMBASE, Medline and Science Citation Index from inception to 30th March 2020 for relevant citations. Citations were screened by two independent reviewers, a third reviewer resolved disagreements. Data were extracted by two independent reviewers. Results: From 1250 unique citations, 14 studies met inclusion criteria for comparative trials of treatment in an occupational setting. There were five trials of hypnotics, five trials of stimulants, and four trials of non-pharmacological therapies (cognitive behavioural therapy, light therapy, aromatherapy and herbal medicine). Outcomes included sleep parameters, day-time sleepiness, and quality of life. There were no consistently reported outcomes across trials. Conclusions: Interventions fell into three distinct groups investigated in distinct time periods without progression from efficacy trials to wider-scale interventions. The lack of consistent patient-reported outcome measures limits synthesising findings. Some trials focussed on optimising sleep, others on reducing wake-time sleepiness. Adequately powered trials of existing interventions are needed, with the development and testing of novel combination treatments in patients with well-defined shift work sleep disorder. A core set of clinically relevant outcomes will develop and standardise the evidence-base for shift work sleep disorder.

Микроимпульсная хирургия глаукомы в комбинированном лечении неоваскулярной глаукомы

Purpose. To evaluate the effectiveness of micropulse laser glaucoma surgery in the combined treatment of patients with secondary neovascular glaucoma. Material and methods. The study included 24 patients (24 eyes) with secondary neovascular glaucoma. All patients underwent micropulse transcleral laser treatment. Results. A week after treatment, the IOP level was 23.1±10.2 mm Hg on the hypotensive drops. A decrease in IOP was achieved by an average of 34% from the preoperative one, and then a gradual decrease in the hypotensive effect was observed with a decrease in IOP by an average of 21-22% from the initial one 1 year after the operation. In 5 cases, in patients with terminal glaucoma, normalization of IOP was not achieved, but in all cases, relief of pain was noted. Conclusion. Micropulse laser glaucoma surgery can be used in the complex treatment of neovascular glaucoma in order to reduce IOP. Key words: secondary neovascular glaucoma, micropulse laser glaucoma surgery, proliferative diabetic retinopathy, CVS thrombosis, anti VEGF.

Efficacy of docetaxel plus ramucirumab as palliative second-line therapy following first-line chemotherapy plus immune-checkpoint-inhibitor combination treatment in patients with non-small cell lung cancer (NSCLC) UICC stage IV.

BackgroundChemotherapy plus immune-checkpoint inhibitor (CTx+ICI) therapy has become the preferred 1st line treatment in patients with metastatic NSCLC without oncogenic driven mutations. However, the optimal subsequent 2nd line treatment is not defined and several alternatives exist. The purpose of this analysis was to evaluate the efficacy of 2nd line docetaxel plus ramucirumab (D+R) initiated after failure of 1st line CTx+ICI.MethodsRetrospective data were collected during routine care from German thoracic oncology centers. Only patients who had received at least one course of 2nd line D+R were included. ORR, PFS, OS and numbers of courses of D+R were investigated with PFS after initiation of D+R being the primary endpoint.ResultsSeventy-seven patients met the inclusion criteria. 2nd line treatment with D+R achieved an ORR and DCR of 32.5% and 62.4%, respectively. Median PFS for 2nd line therapy was 3.9 months with a DOR of 6.4 months. Median OS of 15.5 and 7.5 months were observed from the start of 1st line therapy and 2nd line treatment, respectively. No unexpected toxicities occurred. Presence of KRAS mutations was associated with significantly worse median PFS to D+R (2.8 vs. 4.5 months in wild-type cases; P=0.021) and was an independent predictor of inferior PFS in multivariate analysis.ConclusionsD+R is an effective and safe 2nd line treatment after failure of 1st line CTx+ICI irrespective of NSCLC histology. However, patients with a KRAS mutation did not benefit from D+R in terms of PFS and will require further investigations.