Remission Stage Research Articles

Changes in retinal circulation and choroidal thickness in patients with acute myeloid leukemia detected by optical coherence tomography angiography.

To investigate changes in retinal circulation and the choroid in patients with acute myeloid leukemia (AML) in the acute and remission stages, to analyze the correlation between retinal circulation and laboratory parameters, and to assess risk factors associated with leukemic retinopathy. Forty-eight patients (93 eyes) with AML were enrolled and divided into two groups according to fundus examination findings: the retinopathy and no retinopathy groups. Patients underwent eye measurements before treatment and after remission. Macular vessel density (VD), perfusion density (PD), foveal avascular zone (FAZ), and choroidal thickness (ChT) were measured using optical coherence tomography angiography. Patients with healthy eyes were recruited as control participants. Patients with leukemic retinopathy had higher measurements of white blood cells (WBCs), circulating blasts, fibrin degradation products, and cross-linked fibrin degradation products (D-dimer) and a lower hemoglobin (HB) count (p < 0.05). In the acute phase of the disease, the VD and PD were lower and the ChT was thicker in patients with AML than in controls (p < 0.05), irrespective of the presence of leukemic retinopathy; however, the patients were partially recovered in the remission stage. The VD was lower in patients with higher WBC (r = -0.217, p = 0.036), D-dimer (r = -0.279, p = 0.001), fasting blood glucose (FBG) (r = -0.298, p = 0.004) and triglyceride (r = -0.336, p = 0.001) levels. The FAZ area was negatively correlated with HB (r = -0.258, p = 0.012). Patients with AML appear to have subclinical retinal perfusion loss and choroidal thickening in the acute phase of the disease, but this is reversible. Injury to bone marrow function may cause a decrease in retinal perfusion. Leukemic retinopathy is associated with abnormal hematologic parameters and coagulopathy.

Complex applying physical therapy and preformed physical factors in pregnant women with chronic pyelonephritis

The aim of the work is to evaluate the impact of physical therapy and preformed physical factors in pregnant women with chronic pyelonephritis on central hemodynamic indicators. Materials and methods. The dynamics of 134 pregnant women with chronic pyelonephritis (CP) in the remission stage, who underwent a complex sanatorium rehabilitation program, were examined. The main study group consisted of 79 pregnant women with chronic pyelonephritis. In this contingent of women, the sanatorium rehabilitation complex additionally included a course of intermittent normobaric hypoxytherapy (INH). The comparison group consisted of 55 pregnant women with CP, for whom the sanatorium rehabilitation complex did not include an INH course. The control group is represented by 37 somatically healthy women with a physiological course of pregnancy. All pregnant women were examined for central hemodynamic (CH) indicators using the computer diagnostic complex REOKOM (Kharkiv). Results. Pregnancy periods of 20–30 and 31–30 weeks in women with CP are characterized by a pathological load on central hemodynamics. At the same time, the application for the INH course in the sanatorium rehabilitation complex (the main group) allows for an increase in the compensatory capabilities of the pregnant woman with CH. Thus, in the period of pregnancy of 22–30 weeks in the main group, indicators of diastolic blood pressure and heart rate were probably lower than the control values (P &lt; 0.001), which in this group is determined by values of peripheral resistance of blood vessels close to those of the control group (P &gt; 0.05), regardless of the timing of the study. The study of CH and the comparison of different periods of gestation and between research groups indicate an inverse relationship between indicators that reflect the intensity of cardiohemodynamics and indicators of vascular resistance, as one of the final mechanisms of maintaining blood pressure at a physiological level, or its pathological increase in chronic pyelonephritis and preeclampsia Taking into account that the ratio of cardiac index indicators and total peripheral vascular resistance in all study groups was stable and directly dependent on the level of blood pressure, it is advisable to recommend for practical application in order to assess the state of CH of pregnant women with CP indicators of stroke or cardiac indices, which characterize the intensity cardiohemodynamics and do not depend on the anthropometric data of the pregnant woman. Conclusions. The application of physical therapy and preformed physical factors, namely, intermittent normobaric hypoxytherapy in pregnant women with chronic pyelonephritis in a complex program of sanatorium rehabilitation increases the compensatory capabilities of the cardiovascular system, which is confirmed by a significant decrease in the values of the total peripheral resistance against the background of an increase in the cardiac index.

Differential Brain Structural and Functional Patterns in Crohn's Disease Patients are Associated with Different Disease Stages.

Crohn's disease (CD) is an inflammatory, chronic disorder that alternates between a quiescent phase and inflammatory flare-ups. Research has begun to elucidate the impact of CD in modulating brain structure and function. The previous neuroimaging studies mainly involved CD patients in remission (CD-R); therefore, little is known about how inflammation influences brain-related features in different stages of the disease. We carried out a magnetic resonance imaging (MRI) study to explore whether the different levels of disease activity may differentially affect brain structure and function. Fourteen CD-R patients, 19 patients with mild to moderate inflammatory activity (CD-A), and 18 healthy controls (HCs) underwent an MRI scan including structural and functional sequences. Between-group comparisons showed morphological and functional brain differences distinctively associated with the stage of disease activity. The CD-A patients had reduced gray matter within the posterior cingulate cortex (PCC) relative to CD-R patients. Analysis on resting fMRI data showed the following patterns: (1) increased connectivity within the left fronto-parietal network (in the superior parietal lobe) in CD-R patients relative to CD-A patients; (2) decreased connectivity in the motor network (in parietal and motor areas) in the CD-A group relative to the HC group; (3) reduced connectivity in the motor network and (4) in the language network (in parietal areas and in the PCC) in CD-R patients relative to HC. The present findings represent a further step towards understanding brain morphological and functional changes in the active vs remission stages of CD patients.

Biomedical statistics study on the correlation between peripheral blood follicular helper T cell subsets and primary Sjogren's syndrome.

To study the expressions of follicular helper T cell (Tfh) subsets--Tfh1, Tfh2, and Tfh17, in peripheral blood (PB) of primary Sjogren's syndrome (PSS) patients in the active phase and remission period after treatment, and to analyze the pathogenic effects of Tfh subsets in PSS patients. The proportions of Tfh1, Tfh2, and Tfh17 were measured by flow cytometry in the healthy group, PSS patients group, active phase group, and remission phase group. Enzyme-linked immunosorbent assay was used to detect IL-21 expression in SS patients in active and remission stages. Biomedical statistics was used to analyze the correlation between Tfh subsets and SS disease activity index; and analyze the correlation between the proportions of Tfh subsets in the healthy group, primary group, active stage, and remission stage In contrast with the healthy group, the levels of Tfh1, Tfh2, and Tfh17 in CD4+ T cells of PSS patients were prominently reduced. PSS patients in the active phase had significantly lower Tfh1, Tfh2, and Tfh17 levels but remarkably higher IL-21 levels than in the remission phase. The contents of Tfh1, Tfh2, and Tfh17 are negatively correlated with the severity of PSS.

Changes of serum uric acid level during acute gout flare and related factors.

By studying the changes of serum uric acid (SUA) in acute stage and remission stage of gouty arthritis, we aimed to explore the relationship between the changes of SUA level and free glucocorticoids and inflammatory factors. A prospective, longitudinal study was conducted on 50 acute gout patients in the dedicated gout clinic of the Affiliated Hospital of Qingdao University. Blood and 24-hour urine samples were collected during the acute phase and two weeks after the initial visit. Patients with acute gouty arthritis were treated primarily with colchicine and nonsteroidal anti-inflammatory drugs. A total of 32 patients completed the two-week follow-up trial. SUA levels were significantly downregulated during the acute flare than after the flare (464.14 ± 90.97 vs. 527.36 ± 86.90 μmol/L, p < 0.001). The 24-hour fractional excretion of uric acid (24 h FEur) (5.54 ± 2.82% vs. 4.68 ± 2.83%, p < 0.001) and 24-hour urinary uric acid excretion (24 h Uur) (663.08 ± 249.48 μmol/L vs. 540.87 ± 263.18 μmol/L, p = 0.001) increased significantly in patients during the acute phase. The percent change in SUA was associated with those in 24 h FEur and C-reactive protein. Meanwhile, the percent change in 24 h Uur was associated with those in 24-hour urinary free cortisol, percent change in interleukin 1β and interleukin 6. Decreased SUA level during the acute gout flare was associated with increased excretion of urinary uric acid. Inflammatory factors and bioactive free glucocorticoids may play significant roles in this process.

(Re)-constructing patients’ post-treatment identities through a gender lens: a case among psychiatric patients in Malaysia

Purpose Psychiatric patients’ post-treatment identities are one of the potent indicators reflecting the efficacy of the medical intervention. This study aims to explore how psychiatric patients construct their post-treatment social identities through a gender lens. Design/methodology/approach This study used a descriptive phenomenological approach, and in-depth interviews were undertaken on 29 informants with experience of psychiatric treatment for at least one year and who are in the remission stage. The lived experience of each informant was scrutinised, which covered how psychiatric post-treatment affects and alters their personal life, work and social relationships. Data collected were then analysed using thematic analysis. Findings The result found two mutually reinforced identities, namely, self-empowerment and resilience emerged from their experience with psychiatric post-treatment. Firstly, self-empowerment themes include acceptance of the disorders, meaningful choices, assertiveness and helping others. Such self-empowerment attributes enabled them to negotiate with the doctors during the treatment and also with their family members and partners. Secondly, psychiatric post-treatment allows them to be resilient; their good feeling of being liberated from the symptoms while allowing them to partake in a normal lifestyle. Meanwhile, gender differences were found to have diverse meaning-making that positively impacted their lives, particularly among female informants. Research limitations/implications Firstly, the data collection was only made in two states in North Peninsular Malaysia; hence, it would be biased in this sense to generalize to a larger population. At the same time, a prevalent study could be undertaken to view the pervasiveness of mental illness among Malaysians. Secondly, the study did not investigate the social institutions that are linked to the relief of psychiatric patients in the country. Thus, there is a grey area on how at the systemic level aid is given to the patients and the impact of such action. Practical implications A rigour campaign on promoting mental health should be undertaken to create an inclusive environment for the patients. This is consistent with the aspiration of deinstitutionalization and the Shared Prosperity Vision 2030 agenda by the Malaysian government. This is a call for an allotment in special education, training, and funding, employment, housing and other aspects that are significant for their livelihood. Social implications The findings discovered that their social environment primarily caused the depression suffered by the patients. The remark is particularly true for female informants who had very little control over their lives and bodies. Hence, health professionals should consider practicing cultural and gender-sensitive treatment for these patients. Such treatments are to avoid re-discriminating, or re-victimisation feelings to occur during the treatment. Originality/value Patients’ post-treatment social identity construction is seldom reported systematically through a gender lens. This study is one of the early efforts on gender lens that allow one to understand how it influences social structures and institutions, especially in the Malaysian realm.

Cognitive Impairment Mechanism in Patients with Bipolar Disorder.

Bipolar disorder (BD) is a common chronic mental disorder usually characterized by manic, hypomanic and depressive episodes. Patients diagnosed with BD have cognitive impairments in both the mood attack and remission stages, that is impairment of attention, memory and executive function. Up till the present moment, the causative mechanisms of cognitive impairment in BD patients remain poorly understood. Several studies have demonstrated that cognitive impairment in patients with bipolar disorder is not associated with a single factor, but with gene polymorphism, brain structural and functional variables, inflammatory and metabolic factors. Herein, we reviewed and summarized the recent reports on cognitive impairment mechanisms in patients with BD. To prevent or alleviate cognitive damage at an early stage, we propose that future research should focus on investigating the pathological mechanism of specific cognitive dimension damage as well as the pathological mechanism network between the damage of each dimension. It is crucial to recognize mechanisms of cognitive impairment for improving the symptoms and prognosis of BD patients, restoring their social function and integration.

Expression Profile and Clinical Significance of Cytokines and Chemokines in Patients with Epstein-Barr Virus-Associated Hemophagocytic Lymphohistiocytosis

To investigate the cytokine/chemokine profile in patients with Epstein-Barr virus (EBV)-related hemophagocytic lymphohistiocytosis (HLH), and assess the prognostic value of survival. Serum levels of thirty-eight cytokines/chemokines were measured by multiple cytokine assay kit in EBV-related HLH patients, EBV-infected patients, and controls. The expression profile of cytokines/chemokines was compared among groups. The changes of cytokine/chemokine expression in active and remission stage of EBV-related HLH patients were also compared, and the prognostic values for survival were evaluated. Serum levels of interferon-α2 (IFN-α2), interleukin (IL)-6, and IL-7 in EBV-related HLH patients were 33.67(23.23-68.78) pg/ml, (74.95±25.53) pg/ml, and 35.35(19.50-63.55) pg/ml, respectively, which were significantly higher than those in EBV-infected patients［IFN-α2: 16.07(9.87-29.63); IL-6: 55.91±20.29; IL-7: 20.40(13.35-31.40)］ and controls ［IFN-α2: 11.02(4.67-21.25); IL-6:42.64±13.41; IL-7: 16.95(14.95-33.78)］(all P<0.05). Serum levels of IL-8, IL-9, and marcophage-derived chemokine (MDC) in EBV-related HLH patients were 11.00(7.50-15.27) pg/ml, 81.30(40.79-111.0) pg/ml, and (512.6±128.7) pg/ml, respectively, which were significantly higher than those in controls ［IL-8: 6.80(5.56-8.38); IL-9: 41.30(29.82-67.91); MDC: 384.1±156.6］(all P<0.05), but there was no remarkable differences compared with EBV-infected patients (P>0.05). Serum IFN-α2, IL-6, IL-7, IL-8, IL-9, and MDC in survival and death groups of EBV-related HLH patients were analyzed by receiver operating characteristic curve with area under curve of 0.781, 0.778, 0.633, 0.805, 0.562, and 0.657, respectively (P=0.019, 0.021, 0.269, 0.015, 0.607, and 0.190). IFN-α2, IL-6, and IL-8 had good predictive effect on survival. Serum level of IFN-α2, IL-6, and MDC of EBV-related HLH patients in remission stage were significantly lower than those in active stage (P<0.05), while IL-7, IL-8, and IL-9 were not different (P>0.05). IFN-α2, IL-6, IL-7, IL-8, IL-9, and MDC may take part in the pathogenesis of EBV-related HLH.

P538 Suboptimal disease control is common in patients with Crohn’s perianal fistulas with capacity to optimise medical and surgical treatment in real-world experience: A cross-sectional analysis of baseline disease characteristics in the FINESS study

Abstract Background Crohn’s perianal fistula treatment is often challenging, requiring combined medical and surgical treatment with heterogeneity in real-world practice. We herein evaluate disease activity and management history of patients with Crohn’s perianal fistulas, identifying those with active disease amenable for treatment optimisation. Methods We present the results of a cross-sectional study of disease characteristics among patients with Crohn’s perianal fistulas at a single specialist Inflammatory Bowel Disease service. Patients with Crohn’s perianal fistulas seen in clinic from February 2021 to June 2022 (new and review appointments) were sequentially enrolled. Patients were excluded based on rectovaginal or rectovesical fistulas, proctectomy, pregnancy or breastfeeding. Baseline disease activity was defined as active (stage A/B: sepsis, actively draining), optimised with a chronic seton in situ (stage C), or remission (stage D: no discharge from fistula tract external opening). Radiologic disease activity was assessed with magnetic resonance imaging using the Van Assche Index (VAI), VAI-inflammatory sub-score (VAIinfl; derived from T2-hyperintesnity, collections &amp;gt;3mm diameter, and rectal wall involvement), and Magnetic Resonance Novel Index for Fistula Imaging in Crohn’s Disease (MAGNIFI-CD) score. Results Sixty patients were included with a median age of 39 years (IQR 17.7), 52% male, median clinic attendance of 6 years (IQR 7.9), median Crohn’s and perianal disease duration of 13 (IQR 16.8) and 8 (IQR 13.5) years, respectively. Majority were on anti-tumour necrosis factor-α therapy (28% infliximab, 40% adalimumab) and an immunomodulator (55% thiopurine, 5% methotrexate). Forty-two percent had undergone perianal surgical intervention within the preceding 12 months, see Table 1. Forty-eight percent (n=29), 7% (n=4), and 45% (n=27) had stage A/B, C, and D disease activity, respectively. Radiologic disease activity scoring indices were lower between stage D and A/B (VAI 4 vs 12; VAIinfl 0 vs 8; MAGNIFI-CD 2 vs 6, respectively), see Table 2. Of those with stage A/B disease activity, 31% were not on a biologic (63% new diagnosis, 25% prior remission, 13% comorbidities precluding), 52% were infliximab naïve (71% new diagnosis, 14% prior remission, 14% contraindications), 85% who were on a biologic had potential for initial or further dose escalation, and 31% did not undergo perianal surgical intervention in the preceding 12 months. Conclusion In a single specialist centre, almost half the patients with Crohn’s perianal fistulas have clinically active disease, with capacity to optimise medical and/or surgical treatment in the majority. Prospective assessment of a model of care directed towards optimising treatment in these patients is needed.

Photogallery of diseases of the oral mucosa. Part I

Nowadays, more than 300 diseases of the oral mucosa have been established in the scientific literature. Since pemphigus vulgaris and lichen planus can mimic many other skin conditions it could be difficult to make the diagnosis according only to clinical features. Moreover, pemphigus vulgaris is known to be an autoimmune life-threatening disorder which necessarily need to be treated with high doses of systemic glucocorticoids, whereas lichen planus in some cases can be transformed into squamous cell carcinoma.&#x0D; The drug associated erythema and the herpes associated erythema multiforme both affect not only the oral mucosa but also the skin, which makes differential diagnosis easier. Nevertheless, in our practice we can encounter only the oral cavity involvement. Previously, StevensJohnson syndrome was considered as severe form of erythema multiforme affecting both the skin and the oral mucosa.&#x0D; Additionally, cheilitis can be observed in patients with atopic dermatitis even in the remission stage.&#x0D; Furthermore, MelkerssonRosenthal syndrome is a rare neurological disorder characterized by recurring facial paralysis, swelling of the face and lips, and the development of folds and furrows in the tongue.

Impulsivity and aggression in patients at risk for schizophrenia at the stage of remission after the first depressive episode

To study the phenomenon of impulsivity, its components and aggression in patients at risk for schizophrenia at the stage of remission after the first depressive episode. Forty-eight male patients (mean age 19.4±2.9 years) with the first depressive episode (ICD-10 F32.1, F32.2) with attenuated positive, negative and/or disorganized symptoms were examined. According to the severity of impulsivity, the patients were divided into the clinical group (n=26) with pathological impulsivity and the comparison group (n=27) without it. The control group consisted of 41 mentally healthy young men, students of higher education of 1-3 courses, (mean age 19.7±1.6 years). HDRS, SOPS, SANS, Barratt Impulsiveness Scale (BIS-11) and Buss Perry Aggression Questionnaire (BPAQ) were used. Statistical analysis was carried out using the Statistica 12 software. The differences between the clinical group and the comparison group were determined by the total score of the subscale of general symptoms of SOPS at admission (53 [41.75; 56] and 45.5 [41.75; 51.25], respectively) (U=187.5; p=0.037) and at discharge (28 [19; 37] and 25 [17.75; 29.25] points respectively) (U=166.5; p=0.012), according to the total HDRS score at admission (35 [31; 38] and 29 [26; 34.25]) (U=191.0; p=0.046). In the clinical group, the motor component of impulsivity and the factor of general impulsivity on the BIS-11 correlated with the severity of aggression on the BPAQ (r=0.395, p<0.05 and r=0.635, p<0.05, respectively). Significant differences were revealed in the clinical group depending on the presence of negative symptoms on the corresponding SOPS subscale according to the total BPAQ score (p=0.01). Correlation analysis showed numerous connections: positive between the total aggressiveness score and the duration of depression (p<0.05), negative between the factors of self-control, consistency, attention, and total scores on the SANS and SOPS (p<0.05). We identify the differences in the structure of impulsivity in patients at risk of developing schizophrenia at the stage of remission after the first depressive state, the comparison group and the control group, as well as the relationship of impulsivity factors with individual clusters of psychopathological disorders.

Психологические особенности женщин, больных раком молочной железы на стадии ремиссии и четвертой стадии

Breast cancer is one of the most common types of cancer worldwide. The specific situation of the disease at certain stages, for example, at the stage of remission and the fourth stage, may contribute to the manifestation of certain psychological characteristics in cancer patients, which can be considered as personal resources for the adaptation of women with breast cancer to the disease situation. It is assumed that the complex of psychological characteristics studied in the study makes it possible to fully reflect the adaptive potential of a person in overcoming a difficult life situation, including one associated with a life-threatening disease. Objective. To study the psychological characteristics of women diagnosed with breast cancer at the stage of remission and the fourth stage. Materials and methods. The study involved 140 women aged 26 to 80 years. The study included patients with stage 4 (N=42) and women with remission from 6 months (N=98). Survey methods were used as research methods: the scale of basic beliefs (adaptation by M. A. Padun, A.V. Kotelnikova); the test of life orientations (adaptation by D.A. Tsiring, K.Yu. Evnina); the test of resilience (adaptation by D. Leontiev); questionnaire of subjective control (adaptation by E.F. Bazhin, S.A. Golynkin, A.M. Etkind); questionnaire of personal helplessness (D.A. Tsiring, A.V. Stepanenko); questionnaire "Subjective age of a person" (adaptation by E.A. Sergienko); subjective assessment of quality of life (questionnaire SF-36). Methods of mathematical processing: primary descriptive statistics, comparative analysis (U-Mann-Whitney criterion). Results. Psychological features of women with breast cancer at stage 4 were found, distinguishing them from women with breast cancer at the stage of remission in terms of the picture of the world, indicators of quality of life, personal helplessness-independence, subjective control, resilience. Conclusion. The data obtained indicate the presence of a special complex of psychological characteristics that occurs at a certain stage of the disease, and reflects the adaptive potential of women with breast cancer in overcoming a difficult life situation associated with a lifethreatening disease.

ACTIVITY OF PHOSPHATASES IN THE ORAL LIQUID OF PATIENTS FROM POLLUTED AREAS WHO ARE DIAGNOSED WITH GENERALIZED PERIODONTITIS AND RHEUMATOID ARTHRITIS.

The aim: To study the activity of acid and alkaline phosphatases as markers of bone metabolism in patients from bad environmental areas who are diagnosed with rheumatoid arthritis and are affected by generalized periodontitis. Materials and methods: A total of 137 residents from Kalush district of the Ivano-Frankivsk region, Ukraine were enrolled in this investigation. There were 105 patients aged between 18 and 60 years with generalized periodontitis of the I-II degree severity selected for further research. Among them were 70 patients diagnosed with rheumatoid arthritis at the stage of remission. The research comprised the study of oral fluid of the examined individuals in order to assess the bone metabolism based on activity of the acid and alkaline phosphatases. Results: The results of the conducted studies testify an increase of acid phosphatase in subgroups of patients diagnosed with rheumatoid arthritis and affected by generalized chronic periodontitis. On the other hand, the obtained results of alkaline phosphatase activity demonstrated a decrease of this indicator in all subgroups. Conclusions: The results of biochemical studies suggest that there is a significant violation of bone tissue metabolism observed in patients from environmentally unfavorable areas affected by generalized periodontitis and diagnosed with rheumatoid arthritis.

ОБОСНОВАНИЕ АНТИБАКТЕРИАЛЬНОЙ ХИМИОТЕРАПИИ В ПАРОДОНТОЛОГИИ НА ОСНОВАНИИ ОЦЕНКИ АНТИБИОТИКОРЕЗИСТЕНТНОСТИ ПО ДАННЫМ РАЗНЫХ МЕТОДОВ ИССЛЕДОВАНИЯ

The aim of the study was to establish the prevalence of strains of microorganisms resistant to antibacterial drugs isolated from subgingival dental plaques of periodontitis patients in the acute and remission stages. Materials and methods of research։ For the study, were recruited 90 patients who were diagnosed with chronic periodontitis (K05.3) because of clinical examination and subsequent treatment. The research methods included culture (disco-diffusion method) and molecular biological technologies (PCR), which allows identifying resistant strains of bacteria isolated from subgingival biofilm. Results։ Our results confirm that periodontopathogenic anaerobic bacteria, in contrast to sanitary-significant microbes of the ESCAPE pathogen group, were not found to be resistant to doxycycline and ciprofloxacin in the phenotypic test (disk method). The data obtained regarding the detection of genetic markers of resistance to betalactam antibiotics are generally consistent with the results of studies obtained in Western Europe (Spain, Italy, Greece). At the same time, in relation to genetic markers of resistance to tetracyclines and fluoroquinolones, significantly lower levels of detection of resistant strains were established than in studies by foreign authors. Perhaps this is due to the widespread use of these drugs in these years. On the other hand, closer results for tetracycline and fluoroquinolone resistance markers are from researchers in the People's Republic of China. Conclusion։ The results obtained allow us to justify the return to treatment regimens using doxycycline, as one of the most adequate domestic tetracycline drugs.

Эффективность и безопасность различных режимов отмены ингибиторов фактора некроза опухоли альфа при длительной ремиссии ювенильного идиопатического артрита без системных проявлений: результаты проспективного простого рандомизированного исследования

Including the tumor necrosis factor TNF inhibitors (TNFi) in the management guidelines for children with juvenile non-systemic juvenile idiopathic arthritis (JIA) has significantly increased the effectiveness of antirheumatic treatment. However, the guidelines of TNFa withdrawal when disease remission is achieved remains unclear. Objective. To study the efficacy and safety of different TNFi withdrawal regimens in patients with juvenile idiopathic arthritis without systemic manifestations due to the achievement of long-term disease remission. Patients and methods: The prospective simple randomized trial included 76 patients with JIA without non-systemic juvenile idiopathic arthritis, with a disease remission duration of ≥24 months, developed under the conditions of treatment with TNFi. Of these, 38.2% are male, the average age is 11.6 years; 67 (88.2%) patients received etanercept (0.8 mg / kg / week. subcutaneously 1 time per week), the rest – adalimumab (24 mg/m2 subcutaneously 1 time in 2 weeks). Depending on the withdrawal regimen, patients were divided into three groups: in the I group, one-time withdrawa was presented, in the II group, the interval between administrations was of two times and the III group was reduced by a dose of two times. The main indicator of the study: preservation of the stage of inactive disease / remission (according to the criteria for remission of C. Wallace) for 6, 12 and 18 months after the withdrawal of TNFi. Results. At the time of withdrawal of TNFi, the average duration of the disease was 7.3 years, the duration of therapy with TNFa was 5 years, remission – was 4.4 years. For 6, 12 and 18 months after the withdrawal of TNFi, the stage of remission persisted in 44 (57.9%), 21 (27.6%) and 18 (23.7%) patients. Exacerbation of disease was registered in 58/76 (76%) patients. Biologic therapy was resumed in 56/58 children, in all cases the stage of inactive disease was reached. Among patients with exacerbation of JIA, 23/56 (41%) continued to receive disease-modifying antirheumatic drugs. Predictors of successful withdrawal of TNFa in patients with non-systemic JIA 6 and 12 months after discontinuation of the biological therapy were the female sex, the absence of HLA B27, antinuclear factor and long-term methotrexate therapy; predictors of exacerbation - increasing in the serum concentration of calprotectin (S-100 protein), the presence of subclinical synovitis according to ultrasound and MRI of the joints and uveitis. Conclusion. After the withdrawal of TNFi, the remission stage for 6 and 12 months persisted more than in half and one third of patients. The withdrawal regimens did not affect the duration of the remission of disease. The resumption of biological therapy in the exacerbation stage of JIA made it possible to reach the remission stage in most patients. Predictors of successful withdrawal of TNFi in patients with non-systemic JIA 6 and 12 months after discontinuation of the biological therapy were the female sex, the absence of HLA B27, antinuclear factor and long-term methotrexate therapy; predictors of exacerbation – increasing in the serum concentration of calprotectin (S-100 protein), the presence of subclinical synovitis according to ultrasound and MRI of the joints and uveitis. The presence of exacerbation predictors makes it impractical the withdrawal of biological therapy due to the high risk of developing an exacerbation of disease. Key words: (TNF)-alpha inhibitors, juvenile idiopathic arthritis, long-term remission, withdrawal predictors, high-sensitivity C-reactive protein (hsCRP), serum calprotectin (S-100 protein)

A comparison of DNA methylation profiles of blood mononuclear cells in patients with multiple sclerosis in remission and relapse

To study the whole-genome DNA methylation profiles of peripheral blood mononuclear blood cells (PBMCs) of patients with relapsing-remitting multiple sclerosis (RRMS) in remission and relapse in order to assess the contribution of this epigenetic mechanism of gene expression regulation to the activity of the pathological process. Eight patients with RRMS in remission and 6 patients in relapse were included in the study. Methylation levels of DNA CpG sites in PBMCs were analyzed using Infinium HumanMethylation450 BeadChip DNA microarrays. Seven differentially methylated positions (DMPs) were identified, of which 3 were hypermethylated (cg02981003, cg18486102, cg19533582) and 4 were hypomethylated (cg16814680, cg1964802, cg18584440, cg08291996) during RRMS relapse. Five DMPs are located in protein-coding genes (GPR123, FAIM2, BTNL2, ZNF8, ASAP2), one in microRNA gene (MIR548N), and one in an intergenic region. For all identified DMPs, we observed a change in DNA methylation levels of more than 20% (range 20.2-57.5%). Hierarchical clustering of DNA samples on the heatmap shows their clear aggregation into separate clusters corresponding to RRMS patients in the stages of relapse and remission. For the first time it was shown that during relapse and remission of RRMS there are differences in the DNA methylation profile that allow discrimination between these clinical stages. These data indicate the involvement of the epigenetic mechanism of DNA methylation in the activation of the pathological process in RRMS.

КВЧ-ТЕРАПИЯ И ГИРУДОТЕРАПИЯ В КОМПЛЕКСНОМ ЛЕЧЕНИИ ХРОНИЧЕСКИХ ВОСПАЛИТЕЛЬНЫХ ЗАБОЛЕВАНИЙ ОРГАНОВ МАЛОГО ТАЗА ЖЕНЩИН

The aim of the study was to evaluate the effectiveness of the combined use of EHF-puncture and hirudotherapy (HT) in chronic pelvic inflammatory diseases in women and to substantiate the expediency of including a combination of these non-drug therapeutic factors in the combination treatment of pelvic inflammatory diseases (PID). Under observation there were 128 women aged 20 to 45 years (31.8 ± 0.41 years) with chronic adnexitis, chronic endometritis and both diseases at the stage of complete and incomplete remission. In 70.3% of patients, concomitant hormone-dependent diseases were recorded: fibromyoma of the uterine body, endometriosis and their combination. All patients were randomized into 2 groups: the main group (74 subjects) and the comparison group (54 subjects). The multimodality treatment of patients of the main group included EHF-therapy through the action upon biologically active points (BAP) and HT. The effectiveness of the treatment was assessed by the results of the analysis of the visual analogue scale of pain, bimanual and ultrasound examination data in dynamics. The combined use of EHF-puncture and hirudotherapy ensured the achievement of an analgesic effect in 82.9% of cases, an anti-inflammatory effect in 51.8% of cases, a resolving effect in 93.7% of cases, and contributed to the normalization of hemodynamics of the pelvic organs in 68.8% of cases. Under the influence of EHF-puncture and HT, the manifestations of endometriosis and fibromyoma of the uterine body decreased. The results of the study prove the clinical effectiveness of the combined use of EHF-puncture and hirudotherapy in the treatment of PID in women, including those with concomitant hormone-dependent gynecological diseases.

Characteristics of stroke-like lesions on cerebral imaging.

<p><strong>Objective</strong> &ndash; Stroke-like lesions (SLLs) are pathognomonic for mitochondrial ence&shy;pha&shy;lopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome but occur in other mitochondrial and non-mitochondrial disorders as well. This mini-review aims at summarising and discussing recent findings to open up future perspectives how to manage this fleeting phenomenon.<br><strong>Results </strong>&ndash;<strong> </strong>Typically, SLLs are dynamic lesions, which increase in size and intensity to regress after a nadir. SLLs are incongruent with a vascular territory, originate frequently from the cortex to spread subcortically, can be monofocal or multifocal, run through an acute (attack) and chronic (remission) stage, and may either completely disappear or end up as laminar cortical necrosis, white matter lesion, subcortical atrophy, cyst, or the toenail sign. On cerebral CT, SLLs are hypodense. SLLs can be best visualized on multimodal MRI showing up as hyperintensity on T2, FLAIR, DWI, and PWI, and as hypointensity on OEF-MRI. On MR-spectroscopy, SLLs typically present with a decreased N-acetyl-aspartate peak and an increased lactate peak. DTI in acute SLLs reveals reduced connectivity, increased global efficiency, and reduced focal efficiency. Tc-HMPAO SPECT of SLLs indicates hyperperfusion and L-iomazenil SPECT reduced tracer uptake. FDG-PET typically shows hypometabolism within a SLL.<br><strong>Conclusion</strong> &ndash; SLLs present with typical findings on various imaging modalities but the combination of cerebral CT, multimodal MRI, MRS, and PET clearly delineate a SLL from other acute or chronic cerebral lesions.&nbsp;</p>.

Clinical characteristics of the state of the autonomic nervous system and their correlations with psychometric indicators in patients with duodenal ulcer in the stage of exacerbation and remission

Clinical characteristics of the state of the autonomic nervous system and their correlations with psychometric indicators in patients with duodenal ulcer in the stage of exacerbation and remission

Prevalence, risk factors and implication of venous thromboembolism in inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic inflammatory disease that affects the gastrointestinal system and includes Crohn's disease and ulcerative colitis. Globally IBD accounts for approximately 84.3 cases per 100,000 persons. A well-known extraintestinal manifestation of IBD that increases morbidity and mortality in IBD patients is venous thromboembolism additionally its association with IBD is growing in importance as a result of the global incidence and prevalence of IBD being on the rise. Patients with IBD have a higher risk of developing venous thromboembolism. Prothrombotic mechanisms that include triggering activation of coagulation, which is partially mediated by weakening of the intestinal barrier and released bacterial components, predispose people with IBD to arterial and venous thrombosis. Clinical characteristics of venous thromboembolism in IBD include an earlier onset, high rates during active and remission stages, greater recurrence rates, and a poor prognosis. Surgery, old age and the use of drugs like corticosteroids or tofacitinib may raise the risk of venous thromboembolism in IBD patients. Post-thrombotic syndrome and a high recurrence incidence following hospital discharge are two long-term effects of venous thromboembolism. IBD outpatients frequently develop venous thromboembolism, hence it is advised that high-risk patients have prophylactic treatment timely. It is essential to keep emphasising on preventing and treating venous thromboembolism in IBD patients appropriately for which further research can be beneficial. The purpose of this research is to review the available information about prevalence, risk factors and implication of venous thromboembolism in IBD.