Conservative Therapy In Patients Research Articles

Modern approaches to the management of blunt liver trauma

Relevance. Liver trauma is one of the most common abdominal injuries. The purpose is to review the evidence and present the current level of diagnosis, tactics and treatment of blunt liver trauma.Materials and methods. The results of clinical studies in liver trauma have been analyzed. Literature was searched in PubMed electronic search engines (https://pubmed.ncbi.nlm.nih.gov), eLibrary (https://elibrary.ru) by keywords: "liver trauma", "management liver trauma", "diagnosis liver trauma". 134 publications were selected for analysis.Results. Historically, most patients with liver trauma were cured promptly using techniques such as liver suturing, liver resection, ligation of the hepatic artery, atrioval shunts. Conservative management was practically not used. Consequently, mortality was high and reached almost 90% in patients with severe trauma, including damage to the main hepatic vessels. The introduction of such techniques as perigepathic packaging and direct suturing of damaged vessels significantly improved the prognosis of patients. The widespread use of conservative therapy in patients with stable hemodynamics, the management of which is based on instrumental assessment, carefully selected diagnostic imaging of the nature of liver injury, instrumental dynamic observation using operative X-ray angiology and endoscopy, in a hybrid operating room, contributed to the improvement of treatment results.Conclusion. In recent decades, conservative therapy has been performed in 80–86% of cases in patients with stable hemodynamics. The use of minimally invasive interventions such as angiography and embolization, a combination of percutaneous drainage and endoscopic methods for injury to vascular and biliary structures can be considered as the main method of treating post-traumatic complications.

Intentional coronary revascularization versus conservative therapy in patients after peripheral artery revascularization due to critical limb ischemia: the INCORPORATE trial.

INCORPORATE trial was designed to evaluate whether default coronary-angiography (CA) and ischemia-targeted revascularization is superior compared to a conservative approach for patients with treated critical limb ischemia (CLI). Registered at clinicaltrials.gov (NCT03712644) on October 19, 2018. Severe peripheral artery disease is associated with increased cardiovascular risk and poor outcomes. INCORPORATE was an open-label, prospective 1:1 randomized multicentric trial that recruited patients who had undergone successful CLI treatment. Patients were randomized to either a conservative or invasive approach regarding potential coronary artery disease (CAD). The conservative group received optimal medical therapy alone, while the invasive group had routine CA and fractional flow reserve-guided revascularization. The primary endpoint was myocardial infarction (MI) and 12-month mortality. Due to COVID-19 pandemic burdens, recruitment was halted prematurely. One hundred eighty-five patients were enrolled. Baseline cardiac symptoms were scarce with 92% being asymptomatic. Eighty-nine patients were randomized to the invasive approach of whom 73 underwent CA. Thirty-four percent had functional single-vessel disease, 26% had functional multi-vessel disease, and 90% achieved complete revascularization. Conservative and invasive groups had similar incidences of death and MI at 1year (11% vs 10%; hazard ratio 1.21 [0.49-2.98]). Major adverse cardiac and cerebrovascular events (MACCE) trended for hazard in the Conservative group (20 vs 10%; hazard ratio 1.94 [0.90-4.19]). In the per-protocol analysis, the primary endpoint remained insignificantly different (11% vs 7%; hazard ratio 2.01 [0.72-5.57]), but the conservative approach had a higher MACCE risk (20% vs 7%; hazard ratio 2.88 [1.24-6.68]). This trial found no significant difference in the primary endpoint but observed a trend of higher MACCE in the conservative arm.

Comparative effects of different treatments based on the levonorgestrel intrauterine system in endometrial carcinoma and endometrial hyperplasia patients: a network meta-analysis.

Levonorgestrel intrauterine system (LNG-IUS) has been widely used in patients with endometrial carcinoma (EC), endometrial hyperplasia without atypical (EH), and atypical endometrial hyperplasia (AEH). The purpose of our Network meta-analysis (NMA) is to evaluate the efficacy of the treatments based on the LNG-IUS in patients with EC and EH with or without atypical. We examined PubMed, EMBASE, Web of Science and the Cochrane Library up to 22 April 2024 to determine studies reporting treatment outcomes in EC and EH patients receiving LNG-IUS therapy, LNG-IUS + metformin (MET), oral progestins (OP), etc. We used EndNote 9 to select studies, Jadad scale and NOS scale to assess quality, stata(16.0) and R (4.3.1) to analysis the data. Overall, 28 studies involving 3752 patients were included in our NMA. As for EH patients, LNG-IUS (RR 1.21; 95% CrI [1.11, 1.34]) and LNG-IUS + MET (RR 323.57; 95% CrI [1.61, 214,223,188.1])] significantly increased CR rate in comparison with OP. Based on SUCRA, LNG-IUS + OP was the best treatment to improve CR(SUCRA = 67.2%) in patients with EC, whereas LNG-IUS + MET was superior in increasing CR (SUCRA = 99.8%) than any other treatments for EH patients. Besides, the ranking based on SUCRA illustrated that LNG-IUS alone was the best choice to raise CR rates (SUCRA = 76.7%) for AEH patients. In head-to-head meta-analysis, OP has a higher progression rate (RR 4, 95% CI 1.89-8.46, p = 0.062; I2 = 71.3%), a higher nausea rate (RR 1.93, 95% CI 1.24-3.01, p = 0.187; I2 = 40.4%) than LNG-IUS in patients with EH. In contrast, LNG-IUS had a irregular vaginal bleeding rates (RR 0.76, 95% CI 0.64-0.90, p = 0.034; I2 = 77.7%) than OP in EH patients. In addition, as for AEH patients, OP has a higher persistence rate (RR 4.31, 95% CI 1.43-13.00, p = 0.93; I2 = 0.0%) than LNG-IUS. According to the NMA, LNG-IUS related studies are feasible for conservative therapy in patients with EC and EH with or without atypical. Therefore, concerning the curative effect, we recommend LNG-IUS-based treatments as the best conservative therapy for EC and EH patients. However, future studies require large sample sizes and more outcomes to further evaluate the differences of treatment selections based on LNG-IUS.

Влияние консервативной терапии на зрительные функции и гемодинамику глаз при первичной открытоугольной глаукоме

Aim. To evaluate the effect of combined conservative therapy on the condition of visual functions and ocular hemodynamics in primary open-angle glaucoma. Methods. The study included 14 patients (22 eyes) aged from 59 to 83 years. All the patients underwent visometry, static Humphrey perimetry, tonometry, biomicroscopy, gonioscopy, ophthalmoscopy and optical coherence tomography (including the Angio-disk protocol) using Optovue RTVue-100 device. All the studies were performed before and after a course of conservative treatment. Patients received a course of conservative treatment for 10 days including Emoxipine 10 mg/ml – 0.5 s/с № 5, Mildronate 100 mg/ml – 0.5 s/с № 5, Piracetam 200 mg/ml – 2.0 i/m № 10, Nicotinic acid 10 mg/ml – 2.0 i/m № 10. Electrical stimulation of the optic nerve № 10, low-frequency magnetic therapy № 10, laser stimulation of the retina № 10 were also performed. Results The course of conservative therapy led to an increase in visual acuity, average light sensitivity of the retina, a decrease in the level of intraocular pressure, an increase in the thickness of the choroid, and an increase in the density of capillaries of the optic nerve head. Conclusions. Regular courses of conservative therapy in patients with primary openangle glaucoma may preserve visual functions. Key words: conservative therapy; primary open-angle glaucoma; visual functions; ocular hemodynamics.

Odontoid Fracture with Accompanying Severe Atlantoaxial Instability in Elderly Patients-Analysis of Treatment, Adverse Events, and Outcome.

(1) Background: In elderly patients with type II odontoid fractures, accompanying severe atlantoaxial instability (AAI) is discussed as a marker possibly warranting more aggressive surgical therapy. This study aimed to characterize adverse events as well as the radiological and functional outcomes of surgical vs. conservative therapy in patients with odontoid fracture and AAI. (2) Methods: Patients aged 65 years and older with type II odontoid fracture and AAI treated were included. AAI was assumed if the mean subluxation across both atlantoaxial facet joints in the sagittal plane was greater than 50%. Data on demographics, comorbidities, treatment, adverse events, radiological, and functional outcomes were analyzed. (3) Results: Thirty-nine patients were included. Hospitalization time was significantly shorter in conservatively treated patients compared to patients with ventral or dorsal surgery. Adverse events occurred in 11 patients (28.2%), affecting 10 surgically treated patients (35.7%), and 1 conservatively treated patient (9.1%). Moreover, 25 patients were followed-up (64.1%). One secondary dislocation occurred in the conservative group (11.1%) and three in the surgical group (18.8%). (4) Conclusions: Despite the potential for instability in this injury, conservative treatment does not seem to lead to unfavorable short-term results, less adverse events, and a shorter hospital stay and should thus be considered and discussed with patients as a treatment option, even in the presence of severe AAI.

Systematic review and meta-analysis of early aortic valve replacement versus conservative therapy in patients with asymptomatic aortic valve stenosis with preserved left ventricle systolic function

BackgroundA quarter of patients with severe aortic stenosis (AS) were asymptomatic, and only a third of them survived at the end of 4 years. Only a select subset of these...

Efficacy of conservative therapy in patients with neurologically intact thoracolumbar burst fractures

Efficacy of conservative therapy in patients with neurologically intact thoracolumbar burst fractures

Adult Moyamoya Disease and Moyamoya Syndrome: What Is New?

Recent advances are in the genetics, diagnosis, pathophysiology, and management of moyamoya disease (MMD), and moyamoya syndrome (MMS), a term used to describe moyamoya-like vasculopathy associated with various systemic diseases or conditions. Ring finger protein (RNF213) has been reported to be a susceptibility gene not only for MMD but also for atherosclerotic intracranial arterial stenosis and ischemic stroke attributable to large artery atherosclerosis. The latest guidelines by the Research Committee on MMD of the Japanese Ministry of Health, Labor, and Welfare, removed limitations of the previous definition that required bilateral involvement of the intracranial carotid artery to make the diagnosis, given the increasing evidence of progression to bilateral involvement in unilateral MMD. 3-dimensional constructive interference in steady-state MRI is useful for the differential diagnosis of MMD from atherosclerosis. Recent advances in the pathophysiology of MMD suggest that genetic and environmental factors play important roles in vascular angiogenesis and remodeling via complex mechanisms. The latest Japanese Guidelines and American Scientific Statement described that antiplatelet therapy can be considered reasonable. Endovascular interventional stent placement fails to prevent ischemic events and does not halt MMD progression. In the Japan Adult Moyamoya trial, a randomized controlled trial for bilateral extracranial-intracranial direct bypass versus conservative therapy in patients with MMD, who had intracranial hemorrhage, recurrent bleeding, completed stroke, or crescendo transient ischemic attack was significantly fewer with direct bypass than with conservative care. This review presents updated information on genetics, diagnosis, pathophysiology, and treatment of adult MMD and MMS. Despite recent advances, many mysteries still exist in the etiologies of moyamoya vasculopathy. The diagnostic criteria and treatment guidelines have been updated but not yet been globally established. Ongoing and future studies investigating underlying pathophysiological mechanisms of MMD and MMS may clarify potentially effective medical, surgical, or endovascular treatments.

Possibilities of combination treatment of urinary incontinence in women of different age groups

The effectiveness of conservative therapy in patients with urinary incontinence depends on a variety of factors. There are no clinical guidelines for the use of pharmacological and non-pharmacological treatment concepts for women of reproductive and menopausal age. The aim of the study was evaluating the efficacy of various combinations of treatment for patients with urinary incontinence, based on electrical stimulation of the pelvic floor muscles with biofeedback, fractional photothermolysis with a CO2‑laser, and medications (antimuscarinics, selective β3‑agonist). The prospective randomized study included 105 patients, of whom 20 were of reproductive age and 85 were of menopausal age. The patients were divided into three groups: group 1 included the patients who underwent a course of electrical stimulation of the pelvic floor muscles and photothermolysis (with fractional CO2‑laser); in group 2, the patients received a combination of non-drug treatment and medications; in group 3, the patients receivedonly pharmacological treatment. In group 1, there were 7 patients of reproductive age and 28 menopausal patients, in group 2–5 and 30, and in group 3–8 and 27 patients, respectively. Results. The bladder diary scores improved significantly. Increasing the urinary flow rate was more effective with non-pharmacological treatment in young patients, and reducing the frequency of urination was more efficient with drug therapy in menopausal patients. The probability of achieving a urinary frequency of less than 8 times per day in the combination treatment group was 80 % higher than that in the non-drug treatment group and 62 % higher than that in the drug treatment group. The effectiveness of non-pharmacological therapy in increasing urinary flow rate is higher in patients of reproductive age. Pharmacological treatment is more effective for three months in menopausal women. The combination treatment is equally effective in patients aged 35 to 65 years and is superior in total effect to drug and non-drug treatment, with the effect maintaining for up to 6 months in menopausal patients.

TCT-211 Intentional Coronary Revascularization Versus Conservative Therapy in Patients, Who Underwent Successful Peripheral Artery Revascularization due to Critical Limb Ischemia: The INCORPORATE Randomized Clinical Trial

TCT-211 Intentional Coronary Revascularization Versus Conservative Therapy in Patients, Who Underwent Successful Peripheral Artery Revascularization due to Critical Limb Ischemia: The INCORPORATE Randomized Clinical Trial

Acute thrombosis of the lower limb arteries on the background of the XBB.1.5 ("Kraken") subvariant of omicron SARS-COV-2 - medical or surgical treatment?

Comparative analysis of the results of open thrombectomy and conservative therapy in patients with acute thrombosis of the lower limb arteries against the background of the XBB.1.5 ("Kraken") subvariant of Omicron Severe acute respiratory syndrome-related coronavirus-2 (Sars-cov-2). The present prospective, open, multicenter comparative study for the period 04/01/2022 to 12/01/2023 included 167 patients with acute thrombosis of the lower limb arteries against the background of the XBB.1.5 ("Kraken") subvariant of the XBB.1.5 ("Kraken") subvariant of Omicron Sars-cov-2.Depending on the treatment strategy, two groups were formed: group 1 - open thrombectomy (n = 136) and drug treatment with an anticoagulant (unfractionated heparin in a therapeutic dosage) and an antiplatelet (acetylsalicylic acid 125mg once a day); group 2 - only drug therapy (n = 31). This group consisted of patients who refused surgical revascularization and were on a prophylactic dose of unfractionated heparin (5000 U 3 times a day subcutaneously). On the development of acute arterial thrombosis, 80 U/kg (maximum 5000 U) of unfractionated heparin was injected intravenously in a bolus, followed by transfer to intravenous infusion using an infusion pump with an initial rate of 18 U/kg per hour under control of activated partial thromboplastin time. Analgesic and antiplatelet therapy was also prescribed (acetylsalicylic acid 125mg once a day). No significant intergroup differences either in mortality rates (group 1: n = 58, 38.2%; group 2: n = 7, 22.6%; p = 0.09) or limb amputation (group 1: n = 63, 46.3%; group 2: n = 9, 29.0%; p = 0.07) were found. However, there was a trend towards a decrease in the incidence of these events in the drug treatment group. After open thrombectomy, rethrombosis developed in 50.7% (n = 69) cases; and thrombosis after rethrombectomy followed by amputation in 46.3% (n = 63). There were no hemorrhagic complications in both groups. Myocardial infarction and ischemic strokes were not recorded. Anticoagulant therapy demonstrates several advantages over aggressive surgical management. However, probably due to the small size of the studied sample, significant differences were not obtained. Further study of this issue is required with the identification of the optimal reperfusion method in this complex cohort of patients.

Conservative treatment strategies for endometrioid ovarian cysts: A review

Endometriosis remains one of the most topical diseases in current gynecology and is a multifactorial condition with an overgrowth of tissue morphologically and functionally similar to the endometrium outside the uterine cavity. One of the most frequently diagnosed forms of endometriosis is endometrioid ovarian cysts. An important feature of the clinical course of ovarian endometriosis is its negative impact on reproductive function and the recurrent nature of the disease, which may require repeated surgeries with even greater damage to the ovarian tissue. Therefore, the development of a long-term drug treatment strategy for patients with a history of endometrioid cysts aimed at preventing recurrences is urgently needed. According to domestic and foreign clinical guidelines, progestagen hormone therapy is recommended as first-line therapy for such patients. One of the most clinically studied drugs with a favorable efficacy and safety profile proven in numerous studies is dienogest. The paper presents the experience of foreign and domestic authors in conservative therapy in patients with a history of endometrioid cysts using dienogest in terms of recurrence prophylaxis.

Systematic Review of the Clinical Efficacy of Various Terms of Non-Surgical Treatment in Patients With Acute Adhesive Intestinal Obstruction

BACKGROUND The question of the duration and volume of conservative measures in patients with acute adhesive intestinal obstruction (AAIO) remains the subject of numerous discussions. Aim of study To evaluate the efficacy and safety of various periods of conservative therapy in patients with AAIO using a systematic review. MATERIAL AND METHODS Criteria for inclusion in the systematic review were cohort studies investigating various regimens and duration of conservative therapy in adult patients with AAIO. The search for primary sources was carried out in the CENTRAL, PubMed and eLibrary databases. The assessment of the safety of various terms of AAIO was carried out by comparing the immediate results of treatment. RESULTS The review included 19 papers with a total of 2,570 observations. At the first stage, the effectiveness of various conservative therapy regimens was evaluated by calculating the risk ratio for the success of non-surgical treatment. Taking into account the significant statistical heterogeneity of the participants, the calculation of the final risk ratio was carried out using a random effects model. The hazard ratio for nonoperative success was 1.91 (95% CI 1.2–3.1) in favor of gastrografin and 3.71 (95% CI 1.3–10.6) in favor of preoperative intestinal intubation. Taking into account the multidirectional pathogenetic action of the studied methods of conservative therapy, the obtained results suggested that the probability of success of non-surgical treatment correlates to a greater extent with the total duration of the AAIO episode than with the duration of conservative therapy, which was indirectly confirmed by constructing scattering graphs with approximation lines and calculating the coefficients determination, which amounted to 0.69 and 0.77 for the subgroups of standard therapy and undiluted gastrografin, respectively. Subsequently, the impact of different duration of an episode of AAIO on the immediate outcomes was assessed: mortality, frequency of resection interventions, complications, and total bed-day. There were no statistically significant differences in favor of early interventions (up to 48 hours) for all compared parameters; an increase in the total duration of AAIO up to 89 hours was not associated with worse results. CONCLUSION The total duration of the episode of acute adhesive intestinal obstruction, including both the pre-hospital duration and the duration of non-surgical treatment is prognostically significant. In other words, when calculating the allowable duration of conservative measures, one should proceed from the total duration of intestinal passage disturbance, which should not exceed 89 hours.

Antibiotics vs observational therapy in acute uncomplicated diverticulitis, a systemic review and meta-analysis.

Antibiotics have long been recommended as a form of conservative therapy in patients with acute uncomplicated diverticulitis despite no supporting evidence. This meta-analysis aims to assess the difference in outcomes between observational therapy and antibiotics regime in patients with acute uncomplicated diverticulitis. Medline and Embase electronic databases were reviewed. A comparative meta-analysis in odds ratios (ORs) or mean difference (MD) was conducted using a random effects model for dichotomous and continuous outcomes, respectively. Randomized controlled trials comparing outcomes in patients with acute uncomplicated diverticulitis on observational therapy compared to antibiotics regime were selected. Outcomes of interest included all-cause mortality, complications, emergency surgery rates, length of stay, and recurrence. A total of 7 articles looking at 5 different randomized controlled trials were included. A total of 2959 patients with acute uncomplicated diverticulitis comprising of 1485 patients on antibiotics therapy and 1474 patients on observational therapy were included in the comparison. We found that there was no statistically significant difference in all-cause mortality (OR = 0.98; 95% CI 0.53;1.81; p = 0.68), complications (OR = 1.04; 95% CI 0.36;3.02; p = 0.51), emergency surgery (OR = 1.24; 95% CI 0.70;2.19, p = 0.92), length of stay (M.D: -0.14, 95% CI -0.50;0.23, p < 0.001), and recurrent diverticulitis (OR 1.01; 95% CI 0.83;1.22, p < 0.91) between the two arms. This systemic review and meta-analysis found that there is no statistically significant difference in outcomes between patients with acute uncomplicated diverticulitis who were put on observational therapy compared to the antibiotics regime. This suggests that observational therapy is an equally safe and effective therapy as compared to antibiotics therapy.

Лечение пациентов с хроническим калькулезным пиелонефритом.

Introduction. Frequent complications of kidney stone disease (KSD) are infectious and inflammatory processes in the organs of the genitourinary system, the most important of which is pyelonephritis. Adhering to a restrained tactic with small caliceal calculi, we observe a significant number of patients with chronic calculous non-obstructive pyelonephritis. Conservative treatment of these patients presents great practical difficulties, as it involves the mandatory parallel treatment of two diseases – pyelonephritis and KSD. The aim of this prospective study was to investigate the effectiveness of conservative therapy in patients with chronic calculous pyelonephritis. Materials and methods. The study included 100 patients with a verified diagnosis of chronic calculous pyelonephritis against the background of existing small caliceal calculi (up to 10 mm). Patients were divided into 2 groups, comparable in terms of the main evaluated criteria. Patients of the first (control) group (40 people) received etiotropic antibiotic course therapy in combination with antispasmodics and immunomodulators. Patients of the second (main) group (60 people) additionally for 3 months took the phytocomplex Onpelvicit 1 capsule 3 times a day under the control of urine pH. Results. At the control examination after 3 months in the group of patients treated with Onpelvicit the frequency of exacerbations of chronic pyelonephritis was significantly lower than in the control group of patients. In the main group, 50% of patients showed a decrease in the size of the calculus, in 15% of cases – complete litholysis. The noted positive effect in relation to chronic pyelonephritis is obviously associated with the phytocomponents of the drug. The effect on the size of the stones is largely due to the presence of sodium and potassium citrates in the complex. Citrate is one of the main inhibitors of crystallization. This effect is realized in both calcium oxalate and urate nephrolithiasis, although the mechanisms differ. Stabilization of the colloidal state of urine, normalization of the acidity index prevents the crystallization of salts and the growth of calculi. Conclusion. Chronic calculous pyelonephritis, which occurs against the background of small calyx calculi of the kidney, is a variant of a combined pathology that is widely encountered in urological practice. The dominant concept of management of this group of patients is to conduct conservative treatment. A pronounced acid reaction of urine in combination with crystalluria of one kind or another is a significant factor in the progression or recurrence of stone formation and the severe course of the inflammatory process. The present study shows that the correction of these disorders has a positive effect on the course of both diseases.

Thyroid Hormone Receptor β Knockdown Reduces Suppression of Progestins by Activating the mTOR Pathway in Endometrial Cancer Cells.

Progestin resistance is a major obstacle to conservative therapy in patients with endometrial cancer (EC) and endometrial atypical hyperplasia (EAH). However, the related inducing factor is yet unclear. In this study, thyroid hormone and its receptor α (TRα) and β (TRβ) of patients were assayed. THRB-silenced RL95-2 and KLE EC cells were cultured to investigate the response of progestins. Transcriptomics and Western blotting were performed to investigate the changes in signaling pathways. We found that THRB, rather than THRA, knockdown promoted the viability and motilities of RL95-2 cells but not KLE cells. The suppressive effect of progestins on cell growth and motility significantly decreased in THRB-silenced RL95-2 cells. Multiple proliferation-related signaling pathways were enriched, and the activities of mammalian targets of rapamycin (mTOR)/4e-binding protein 1 (4EBP1)/eukaryotic translation initiation factor 4G (eIF4G) rather than phosphorylated protein kinase B (Akt) were remarkably boosted. Progestin treatment enhanced the effects, and the augmentation was partially abated on supplementation with T3. In THRB-knockdown KLE cells, the progestins-activated partial signaling pathway expression (either mTOR or eIF4G), and supplementation with T3 did not induce noticeable alterations. The serum levels of triiodothyronine (T3) were significantly lower in patients with EC compared with healthy women. A strong expression of TRβ was observed in most patients with EC and EAH sensitive to progestin treatment. In contrast, TRα positive expression was detected in less than half of the patients sensitive to progestin therapy. In conclusion, THRB knockdown enhanced the viability and motility of type I EC cells and attenuated the suppressive effects of progestins by activating the mTOR-4EBP1/eIF4G pathway. Lower expression of THRB is likely correlated with progesterone resistance.

Comparison of inhospital outcomes after open thrombectomy versus conservative therapy in patients with acute lower limb artery thrombosis and COVID-19

Aim. Comparative analysis of inhospital outcomes after open thrombectomy versus conservative in patients with acute lower limb artery thrombosis and coronavirus disease 2019 (COVID-19).Material and methods. In this retrospective, comparative study for the period from April 1, 2020 to December 1, 2021, 167 patients with acute lower limb artery thrombosis and COVID-19 were included. Depending on the treatment strategy, two following groups were formed: group 1 — open thrombectomy (n=136) + drug treatment (anticoagulant (unfractionated heparin) and antiplatelet (acetylsalicylic acid 125 mg 1 time per day) therapy; group 2 — only drug therapy (n=31). This group consisted of patients who refused surgical revascularization. In all cases, a psychiatrist examined for personality disorders that did not allow a critical assessment of their condition and the consequences of refusing surgical treatment. At admission to the hospital, all patients received prophylactic-dose unfractionated heparin (5000 IU 3 times/day). In the development of acute arterial thrombosis, 80 IU/kg (maximum 5000 IU) of unfractionated heparin was administered intravenously, followed by transfer to intravenous infusion at an initial rate of 18 IU/kg per hour with the partial thromboplastin time monitoring. Analgesic and antiplatelet therapy (acetylsalicylic acid 125 mg 1 time/day) was also prescribed.Results. Myocardial infarctions, ischemic strokes were not recorded. There were no significant intergroup differences in mortality rates (group 1: n=52, 38,2%; group 2: n=7, 22,6%; p=0,09; odds ratio (OR)=2,12; 95% confidence interval (CI): 0,85-5,27), limb amputation (group 1: n=63, 46,3%; group 2: n=9, 29,0%; p=0,07; OR=2,11; 95% CI: 0,9-4,91). However, there was a trend towards a decrease in the frequency of these events in the conservative therapy group. After open thrombectomy, retrombosis developed in 50,7% (n=69) of cases, whilethrombosis after retrombectomy followed by amputation — in 46,3% (n=63). There were no hemorrhagic complications in both groups.Conclusion. Open thrombectomy with concomitant medical therapy and single conservative therapy without surgical revascularization in the present study showed comparable rates of death and lower limb amputations in patients with COVID-19.

Efficacy and Safety of Add-on Mirogabalin to NSAIDs in Lumbar Spinal Stenosis with Peripheral Neuropathic Pain: A Randomized, Open-Label Study.

IntroductionIn Japan, conservative therapy for patients with lumbar spinal stenosis (LSS) includes non-steroidal anti-inflammatory drugs (NSAIDs), prostaglandin E1, tramadol, physical/exercise therapy, and nerve blocks. Mirogabalin, a selective oral α2δ ligand, is approved for treating peripheral neuropathic pain, though data regarding visual analog scores (VAS) for pain in patients with LSS are limited. We investigated the efficacy and safety of mirogabalin as an add-on treatment in patients with LSS taking NSAIDs compared with patients taking NSAIDs only.MethodsThis multicenter, randomized, open-label study (MiroTAS) was conducted at 32 centers in Japan between June 2020 and October 2021. Patients were randomly assigned to mirogabalin and NSAIDs or NSAIDs alone in a 1:1 ratio. NSAIDs were administered according to their Japanese package inserts; mirogabalin was administered based on renal function [creatinine clearance (CrCL) ≥ 60 mL/min, 5 mg twice daily (BID) in Weeks 1–2, 10 mg BID in Weeks 3–4, and 15 or 10 mg BID after Week 5; CrCL 30 to < 60 mL/min, 2.5 mg BID Weeks 1–2, 5 mg BID Weeks 3–4, and 7.5 or 5 mg BID after Week 5]. The primary endpoint was the change in VAS score for leg pain from baseline to Week 12. Secondary endpoints were quality of life, evaluated using the EuroQol five-dimensional descriptive system (EQ-5D-5L) (at baseline and Week 12) and Patient Global Impression of Change (PGIC) (at Week 12), and safety. Change in VAS score at Week 12 was calculated using a linear mixed model for repeated measures. The safety endpoints were treatment-emergent adverse events (TEAEs) and adverse drug reactions.ResultsIn total, 220 patients who met the eligibility criteria were enrolled. In the mirogabalin and NSAIDs and NSAIDs groups, mean ages (67.8 vs. 70.9 years), proportions of female patients (54.5% vs. 49.0%), mean body weights (63.9 vs. 62.0 kg), mean CrCL values (81.5 vs. 70.7 mL/min), proportions of patients with CrCL 30 to < 60 mL/min (27.3% vs. 33.7%), mean VAS scores (63.8 vs. 62.8 mm), and proportions of patients with VAS score ≥ 60 (53.6% vs. 52.9%) at enrollment were similar. The median durations of LSS were 9.0 and 11.0 months and the spine pain DETECT questionnaire (SPDQ) scores were 6.8 and 7.8, respectively. The least square (LS) mean change in VAS score from baseline to Week 12 was − 24.1 mm in the mirogabalin and NSAIDs group and − 14.2 mm in the NSAIDs group (both P < 0.0001 vs. baseline). The difference in LS mean was − 9.9 [95% confidence interval (CI), − 18.0, − 1.8] (P = 0.0174). The improvement in EQ-5D-5L score at Week 12 was significantly greater in the mirogabalin and NSAIDs group versus the NSAIDs group [mean difference, 0.0529 (95% CI, 0.0036, 0.1022), P = 0.0357]. At Week 12, the proportions of patients with PGIC scores ≤ 3 and ≤ 2 were higher in the mirogabalin and NSAIDs group vs. the NSAIDs group (76.2% vs. 50.0%, P = 0.0006, and 47.6% vs. 32.4%, P = 0.0523). In the mirogabalin and NSAIDs group, the incidences of TEAEs and adverse drug reactions were 60.9% and 57.3%, respectively, and the most common TEAEs were somnolence (30.0%) and dizziness (25.5%).ConclusionsThe addition of mirogabalin to NSAIDs improved VAS, EQ-5D-5L, and PGIC. The main TEAEs were somnolence and dizziness. The addition of mirogabalin to NSAIDs improved peripheral neuropathic pain associated with LSS and raised no new safety concerns.Trial RegistrationJapan Registry of Clinical Trials (jRCTs021200007).Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-022-00410-z.

Оптимальні способи корекції зміщень та консервативної терапії у хворих із переломами дистального метаепіфіза променевої кістки

В роботі автори проаналізували результати лікування 97 постраждалих з переломами дистального метаепіфіза променевої кістки (ДМЕПК). Запропоновані оптимальні способи корекцій наявних зміщень, широко використовувався метод апаратного зіставлення внутрішньосуглобових нестабільних переломів. Обсяг проведення заходів щодо профілактики нейродистрофічного синдрому здійснювався з урахуванням імовірності його розвитку. Виявлена висока ефективність лікування у хворих із переломами ДМЕПК на запропонованих засадах: співвідношення добрих результатів за рентгенологічними даними — 44,9 %, за шкалою DASH — 67,2 %.

Evaluation of the Effectiveness of Personalized Treatment of Trace Element and Vitamin Status in Men with Initial Stages of Androgenic Alopecia Treated with Conservative Therapy

Background. Androgenic alopecia (AGA) is the most common form of pathological hair loss with multiple micronutrient disorders involvedin its occurrence and development.&#x0D; Aimto evaluatethe effectiveness of personalized treatment of micronutrient deficiencies in patients with early stages of AGA and conservative therapy using a vasodilator drug minoxidil based on evidence-based medicine.&#x0D; Methods. A total 48 patients with stages IIV of AGA (according to the NorwoodHamilton scale) were recruited to experimental prospective clinical study evaluating the effectiveness of pharmaceutical forms of trace elements and vitamins. The primary diagnosis of micronutrient deficiency was carried out by comparing laboratory parameters of patients with AGA and 25 healthy volunteers. After that, conservative treatment with 5% topical minoxidilin AGA patients was enriched with 2-month personalized systemic supplementation of pharmaceutical forms of trace elements and vitamins. At the end of the study, the correspondence between changes in trace elements and vitamins content in the plasma and the trichogram parameters before and after conservative therapy was assessed.&#x0D; Results. The majority (96%) of the examined patients with AGA were characterized by mono- or polynutrient deficiencies. Personalized correction made it possible to restore the content of Se, Mg, Fe and vitamin E to the baseline levels and to achieve a significant increase in Zn, vitamin D and folic acid plasma content. The relationship between changes in the level of micronutrients and trichogram parameters was recorded only for Se (decrease in anagen hairs: r = 0.43; p = 0.037; decrease in hair density: r = 0.45; p = 0.028) and folic acid (an increase in anagen hairs: r = 0.41; p = 0.024); the positive effect of vitamin E on hair density was also detected.&#x0D; Conclusion. The results of the study allow to recommend a personalized treatment of folic acid and vitamin E deficiencies, with possible refusal to use the Se-containing drugs in conservative therapy of patients with the early stages of AGA.