Tactics Of Patients Research Articles

Biomechanics cerebral and carotid arteries: aneurysm development and atherosclerotic plaque detachment in the presence of combined pathologies

Today, the main cause of mortality in the world remains cardiovascular diseases. In this case, the combined pathology of the neck and head arteries, in which atherosclerosis affects the carotid arteries and there is a change in blood flow in the vertebral arteries or in the circle of Willis due to aplasia of the communicating artery, significantly increases the risk of aneurysms formation and their subsequent rupture. Assessing the risk of complications in this type of pathological condition may allow the physician to initiate timely preventive measures in specific clinical cases. The paper presents the results of modelling various variants of combined pathologies in the arteries of the neck and head. The segment under consideration includes sections of the common carotid, external and internal carotid arteries, as well as vessels of the circle of Willis and the basilar artery. The main idea of the study was to create a prognostic model to assess the risks of aneurysm formation in the circle of Willis and atherosclerotic plaque rupture in the carotid arteries. Such a system may be useful for physicians in routine practice when planning treatment tactics in patients with combined pathologies of the arterial channel. Based on the literature analysis, a number of pathologies of the cerebral and carotid arteries, most frequently occurring in various combinations, were identified: stenoses of the ICA (30 % and 70 %) and aplasia (absence) of one of the connecting arteries were considered from the point of view of geometrical features. In addition, the character of blood flow in the basilar artery, which can change its direction in steal-syndrome, was taken into account. Based on the analysis of blood flow and wall shear stress, two degrees of risk of aneurysm formation were distinguished. High risk corresponds to cases for which both of these values were statistically significantly different from the norm. Medium risk corresponds to cases for which only one of the values was statistically significantly different from the norm. For models containing atherosclerotic plaques, data on shear and normal stresses on the surfaces of atherosclerotic plaques were tabulated. The risk of plaque rupture on each side was determined for each case by analysing the result sets 11 combinations of pathological conditions with increased risk were indicated.

НЕКРОТИЗИРУЮЩАЯ ИНФЕКЦИЯ МЯГКИХ ТКАНЕЙ. ОБЗОР ЛИТЕРАТУРЫ

Necrotizing soft tissue infection is a potentially dangerous infection often resulting in disability and mortality. Polymorphism of clinical symptoms often makes it difficult to diagnose necrotizing soft tissue infection in the early stages of the disease. The treatment tactics in patients with necrotizing soft tissue infection shall be active and include early surgical intervention and antibiotic therapy. Multidisciplinary approach is a key to successful treatment of the patients with this pathology.

Asymptomatic Cholecystitis Presents a New Challenge for Correcting Treatment Tactics in Patients with Gallstone Disease Rather Than Being an Unsolvable Problem of Biliary Surgery

Gallbladder stones, or cholelithiasis, represent a significant public health concern, particularly in Russia, with an incidence of 5-6 per 1,000 people annually. Western countries report a prevalence of 10%-20%, which has nearly tripled in the last three decades due to advancements in diagnostic techniques. Notably, the condition disproportionately affects women and the elderly, with a marked increase in prevalence after the age of 70. Approximately 80% of cases are asymptomatic, and the clinical manifestations develop in only 1-4% of patients annually. Despite the rising identification of asymptomatic cases through enhanced imaging, management strategies remain unclear, leading to hesitancy among surgeons regarding surgical intervention. Current guidelines from various national and international bodies, including NICE and ESGE, advocate for a watch-and-wait approach for asymptomatic patients, citing spontaneous stone clearance. However, the treatment of asymptomatic choledocholithiasis remains contentious, with some guidelines supporting intervention. This ambiguity is compounded by the recognition that complications can arise from unnecessary cholecystectomy, with 10-40% of patients experiencing ongoing symptoms post-surgery. The article emphasizes the need for a comprehensive understanding of asymptomatic cholecystitis, advocating for a meticulous diagnostic approach that considers the potential underlying causes of gallstone formation. The lack of consensus in current literature regarding management strategies highlights the necessity for further research into the natural history of asymptomatic gallstones and the implications of various treatment options. By addressing these complexities, clinicians can enhance patient outcomes and reduce the incidence of post-cholecystectomy syndrome, ultimately leading to more individualized and effective management strategies for patients with asymptomatic cholecystitis.

Choice of treatment tactics in patients with acute bacterial intestinal infections who have a high risk of developing irritable bowel syndrome

Choice of treatment tactics in patients with acute bacterial intestinal infections who have a high risk of developing irritable bowel syndrome

Ultrasound Features of the Peroneal Nerve in Type 2 Diabetes Mellitus

The aim of the work is to study the ultrasound features of the peroneal nerves in people with type 2 diabetes mellitus and compare them with the symptoms of diabetic peripheral neuropathy and the characteristics of diabetes. The study included 67 patients (average age 59,4 ± 9.7 years) with type 2 diabetes mellitus duration least 7 years. All patients underwent standard general clinical and biochemical examinations, insulin and proinflammatory biomarkers blood levels were assessed. Diabetic peripheral neuropathy was diagnosed by assessing pain, tactile and vibration sensitivity. The presence and severity of neuropathic pain were determined on the basis of a DN4 questionnaire and a visual analog scale. All patients underwent ultrasound examination of the peroneal nerves: the cross-sectional area of the nerve, its echogenicity and structure were studied. The results of the study allow us to state in the overwhelming majority of people with a long course of type 2 diabetes mellitus and unsatisfactory glycemic control the presence of significant changes in peripheral nerves according to ultrasound examination (92,5 % of cases), including in the absence of clinical manifestations of diabetic peripheral neuropathy. Among patients with clinical manifestations of diabetic peripheral neuropathy (49,3 %), significant ultrasound changes in the peroneal nerves were more common than in those with no symptoms of this complication and correlated with the prescription of diabetes mellitus, glycated hemoglobin levels, age, manifestations of metabolic syndrome and the presence of other micro- and macrovascular complications. The study results suggest the possibility of wider use of peroneal nerves ultrasound examination for early diagnosis of diabetic peripheral neuropathy, its course prediction and, probably, can be used to improve the principles of choosing therapeutic tactics in patients with type 2 diabetes mellitus.

Diagnostic Efficacy of Trephine Biopsy and Core Biopsy of Bone and Soft Tissue Tumors

Verification of pathomorphological diagnosis is a key stage in selection of treatment tactics in patients with neoplasms. Understanding of the nature of pathological process is especially important in context of primary tumors of the bones, soft tissues and metastases as despite active development of diagnostic techniques, they do not allow to obtain full information on histological nature of the tissues, differentiation grade, as well as molecular and genetic characteristics of the tumor. These data are associated with selection of optimal treatment tactics at every stage and disease prognosis. The optimal approach to obtaining histological materials in tumor of the bones and soft tissues are radiologically guided (X-ray, computed tomography and magnetic resonance imaging) trephine biopsy or ultra-sound-guided core biopsy.Aim. To determine information value of trephine and core biopsies of neoplasms of the bones and soft tissues of various locations, identify mistakes during manipulation affecting results of morphological diagnosis.Materials and methods. Between 2015 and 2023 at the Russian Scientific Center of Roentgenoradiology, 788 patients aged 18–85 years (380 men, 408 women) underwent 602 trephine biopsies and 248 core biopsies (n = 850) of neo-plasms of the soft tissues and bones of various locations. Absence of informational value of morphological study required repeat trephine biopsies in 19 patients, core biopsies in 2 patients, open biopsies in 13 patients.Results. Informational value of trephine biopsy of the bones was 90.5 % (long bones – 96.8 %, flat bones – 91.6 %, spine bones – 82.1 %), core biopsy of the soft tissues 98.8 %. Sufficient amount of material for immunohistochemical testing was obtained in 89 % biopsies. Interventions in cases of bone neoplasms were performed using CT (computed tomography) navigation; for core biopsies of the soft tissues, ultrasound was used. Absence of informational value in trephine bio psies was caused by insufficient amount of material (48 (7.97 %) cases), retrieval of trephine biopsy from the area of tumor necrosis (4 (0.67 %) cases), incorrect selection of access (4 (0.67 %) cases) and needle type (1 (0.17 %) case).Conclusion. Results of analysis of trephine and core biopsy data of bone and soft tissue neoplasms showed high information value, which is supported by literature data. This allows to consider these methods of histological material retrieval the “golden standard” of bone and soft tissue tumor diagnosis.

Specific Features of Diagnostic and Treatment Tactics in Patients with Crushed Abdominal Hernias Without Resection of a Hollow Organ.

The purpose of the work is to analyze the results of the use of optimized diagnostic and therapeutic tactics in patients with strangulated abdominal hernias without resection of the hollow organ. Materials and methods: The work is based on the analysis of the results of surgical treatment of 665 patients with strangulated abdominal hernias without resection of the hollow organ, who were divided into 2 groups depending on the features of the diagnostic and treatment tactics. Unlike the patients of group 1, the following diagnostic tactics were used in group 2: substantiated laparoscopic diagnosis of abdominal organs; mandatory biochemical assessment of hernia water; mandatory intraoperative instrumental assessment of the state of the strangulated organ; expansion of indications for the use of laparoscopic interventions and components of the comprehensive Fast track program; substantiated complex prevention of malignancy. The clinical diagnostic algorithm included laboratory, instrumental and biochemical research methods. Results: The use of priority diagnostic and therapeutic tactics in the patients of group 2 allowed to increase the number of laparoscopic hernioplasty by 49.34%, the number of allohernioplasty by 18.62%, among which the "Sublay" technique was preferred for strangulated ventral hernias. This was accompanied by a decrease in the pain syndrome on the VAS scale during the four days of observation, both during coughing and at rest, and amounted to only 2.21 ± 0.29 points on the fourth day when at rest. In addition, and after 12 months, the patients of group 2 observed a better recovery according to the SF-36 questionnaire, which amounted to 76.77±6.63 points for the assessment of the general state of health, 70.81±5.86 points for the assessment of physical functioning, 68.88±5.37 points for the assessment of role functioning due to physical condition, 68.03±5.92 points for the assessment of role functioning due to emotional state, and social activity was characterized by 72.82±5.52 points. Conclusions: 1. The proposed diagnostic and treatment tactics in the patients of group 2 with strangulated abdominal hernias without resection of a hollow organ, in contrast to patients in group 1, made it possible to increase the number of laparoscopic operations to 227 (66.37%) in contrast to 55 (17.03%) in the first group, which was accompanied by a decrease in pain syndrome on the VAS scale on the fourth day when coughing from 4.35 ± 0.38 points to 2.97 ± 0.43 points. 2. The expansion of indications for the use of laparoscopic operations in patients of group 2, in contrast to patients of group 1, led to a decrease in the postoperative complications by 10.48% and the postoperative mortality by 2.29% and was characterized by better postoperative rehabilitation according to the assessment of the patients' condition after 12 months according to the SF-36 questionnaire..

Selection of optimal revascularization tactics in patients with polyvascular disease: a literature review

Patients with polyvascular disease (PVD), involving two or more vascular beds, are a difficult group for cardiologists, cardiovascular surgeons and endovascular surgeons. The relevance of the problem is due to its widespread prevalence, rapid progression, and comorbidity, which worsens the prognosis in this cohort of patients. The problem of selecting the optimal revascularization tactics remains unresolved. The results of original research on this problem are analyzed. The need for an individual multidisciplinary approach to determine the best revascularization strategy is demonstrated. The use of various methods of optimal therapy, open and endovascular surgery in each specific case is the most acceptable tactic.

Long-term results of transferring the patient from therapy with glucagon-like peptide-1 receptor agonists in combination with metformin to a dipeptidyl peptidase-4 inhibitor in combination with pioglitazone and inhibitor of type 2 sodium-glucose cotransporter in type 2 diabetes

The pioglitazone belongs to the class of antidiabetic medications and has various pleiotropic effects. The evidence base for this medication, based on the results of randomized clinical trials, demonstrates convincing cardio- and cerebroprotective efficacy of pioglitazone, comparable to innovative glucose-lowering drugs from the classes of GLP-1 agonists and SGLT-2 inhibitors. Currently, in Russia, a fixed combination of pioglitazone and alogliptin is available. However, it should be noted that there has been a recent lack of GLP-1 agonists on the domestic pharmaceutical market, which raises questions about the choice of further tactics for patients who have been taking them until recently.This clinical case presents an example of the transformation of glucose-lowering therapy from a combined treatment regimen with semaglutide and metformin to the combined use of a fixed combination of alogliptin and pioglitazone with empagliflozin. Against the background of therapy change, a stable and pronounced glucose-lowering effect was obtained and confirmed after six months, comparable to GLP-1 receptor agonists without the effect of escape and hypoglycemia. No edema or weight gain was observed, and no other adverse events were detected, which allowed continuing the chosen glucose-lowering therapy. Strategic perspectives of the prescribed therapy were determined — reducing cardio- and cerebrovascular risk and improving the patient’s prognosis.

A modern approach to surgical tactics in patients with residual post-tuberculosis changes of lungs

In patients with residual changes after the treatment of destructive forms of tuberculosis (TB), the risk of recurrence of the disease increases significantly. The study of the surgical material of patients with pulmonary TB as a result of the progression of residual post-tuberculosis changes a year or more after the completion of anti-tuberculosis therapy makes it possible to justify the need for surgery in this category of patients. Objective. To substantiate surgical tactics in patients with residual post-tuberculosis lung changes. Materials and methods. The analysis of 1121 adult patients who underwent surgery from 2015 to 2021 for etiologically verified pulmonary TB and completed anti-tuberculosis therapy more than a year before the operation. Of these, 176 patients were divided into two comparable groups: the main group included 37 patients in whom non-tuberculosis mycobacteria (NTMB) DNA was found in the surgical material, the comparison group included 139 patients in whom NTMB was not found in the surgical material. All patients underwent a comprehensive microbiological and morphological examination of the surgical material. Results. In the comparison group, in the majority of operated patients with microbiological screening of surgical material, the etiological diagnosis was positive: the most informative method for both destructive forms of pulmonary TB and forms without destruction was the real-time PCR method: in 82.0% and 87.2% of positive results, respectively, and luminescent microscopy, which allowed to identify acid-resistant Mycobacteria in 67.2% of cases with destructive forms of TB and in 73.1% – without lung destruction In the comparison group, in 19 (13.2%) patients, no evidence of TB was obtained by any screening method, but morphologic examination of surgical material showed the presence of TB inflammation with high activity in 11 (58.0%) and moderate activity in 8 (42.0%) patients. In the main group species identification of NTMB in the surgical material was obtained in the majority of cases, both in forms without destruction of lung tissue and in destructive forms – in 72.2 and 63.3% of patients, respectively, slow-growing NTMB prevailing. Fast-growing NTMB were detected in isolated cases. Morphological examination of the surgical material in a group of patients with NTMB revealed structural changes in the lungs that affected the air parenchyma and/or small airways in areas of the lungs free from TB foci, which should be taken into account when planning surgical intervention. Conclusion. Surgical treatment immediately after completion of the course of anti-tuberculosis therapy in case of formation of residual post-tuberculosis changes is the method of choice in the complex treatment of this category of patients.

Successful treatment of relapses of primary mediastinal large B-cell lymphoma with central nervous system involvement

Introduction. Relapses of primary mediastinal large B-cell lymphoma (PMBСL) with involvement of the central nervous system (CNS) are usually incurable. Therapy tactics in patients with PMBCL with relapse in the CNS have not been defined. Aim: to present clinical observations of the treatment of relapses of PMBCL with CNS involvement using the “R-PML-CNS-2022” protocol. Main findings. Two clinical observations of patients with relapses of PMBCL with involvement of the CNS are presented. In both cases, the “R-PML—CNS-2022” protocol was used as a second-line treatment, and a complete remission of the disease was achieved. In the first case, within 6 months after auto-HCT, maintenance therapy with pembrolizumab was performed. Complete remission of the disease continues for 15 months. In the second observation, maintenance therapy with pembrolizumab was also started, however, due to the development of autoimmune complications after 2 cycles, treatment was discontinued. Complete remission of the disease continues for 13 months. Conclusion. The development of a new strategy for the treatment of relapses of PMLCL with CNS lesion according to the “R-PML—CNS-2022” protocol is a potentially curative approach in this group of patients.

MODERN METHODS OF DIAGNOSIS AND TREATMENT OF ACUTE PANCREATITIS

We used modern diagnostic methods of instrumental investigations. All patients in this work was divided to groups depended on estimating patient statement with APACHE II and RANSON scale. Instead at this, we estimated multislice computed tomography sings depended on Balthazar scale. This scale helped us to purpose existing and spreading of the lesion in pancreas, prognoses course of the disease after diagnosing disease. We entered new diagnostic and treatment algorithms, which helps to chose right surgical methods of treatment of acute pancreatitis in different stages of disease. After using this tactics in patients with difficult forms of acute pancreatitis (total ball 3-9 on integral scale RANSON and 9-20 on APACHE II scale) results was: mortality 25.9%, which conforms to low limit prognosing mor-tality in this group.

Кристаллообразующая активность мочи и методы ее измерения.

ntroduction. Diagnosis and determination of treatment tactics in patients with urolithiasis are based on determining the causes of lithogenesis. At the moment, the standard of examination in patients at high risk of recurrence of urolithiasis is the detection of metabolic disorders based on the results of a biochemical analysis of blood and daily urine, as well as an assessment of the chemical composition of the urinary stone. The violations determined using this approach are a manifestation of the physico-chemical processes of stone formation, the assessment of which is currently practically not performed by urologists, due to the lack of simple diagnostic methods and tools. Materials and methods. The review was conducted on the basis of data published in PubMed databases (https://www.ncbi.nlm.nih.gov/pubmed) and Scientific Electronic Library еLibrary.ru (https://elibrary.ru/), and was limited only to articles in scientific peer-reviewed journals. The search was devoted to the study of the crystal-forming activity of urine, factors affecting the lithogenic properties of urine, as well as methods for assessing the risk of stone formation in the most common metabolic types of urolithiasis. We found 189 sources no older than 10 years (published after 2012) that were relevant to the topic of the review. Conference abstracts, short messages, duplicate publications wereexcluded from them. After that, based on the relevance of the data, reliability of sources, impact factors of journals and the sequence of presentation of the material in the manuscript, 41 articles were selected directly for citation in the review. Also, when writing the review, original articles published before 2012 were used. Results. The analyzed literature sources demonstrated a large number of methods for determining the crystallization properties of urine. However, none of them, in view of the complexity, as well as the ambiguity of the results obtained, have not been widely introduced into clinical practice. In view of this, it is required to develop a simple and informative method for diagnosing the crystal-forming properties of urine, which will increase the percentage of non-reactive urolithiasis. Conclusions. The methods available to doctors for determining the crystal-forming properties of urine are extremely laborious. The development of an easy-to-use and sufficiently accurate real-time determination of the crystallization and anti-crystallization properties of urine, will significantly improve the diagnosis, treatment and metaphylaxis of urolithiasis.

Studying of Thyroid Dysfunction on Patients with Metabolic Syndrome

A retrospective study was conducted several studies aimed at knowing the relationship between the level of thyroid hormone and the metabolic syndrome and according to the results of the study, it is recommended to determine the level of tsh hormone in the pituitary gland in all patients as well as in all patients with risks of developing cardiovascular diseases: in patients who they suffer from obesity, dyslipidemia, arterial hypertension, hyperhomocysteinemia, and tobacco smoking., hereditary factor, diabetes mellitus type 2. No less important is the issue of treatment tactics in patients and in accordance with current recommendations, the appointment of thyroid hormone preparations is indicated for patients with an increase in the level of tsh more than 10 μm / l. The assignment of thyroxine to the boundary level of tsh is still a matter of debate. Most authors consider surgical myocardial revascularization, continuous statin therapy, and correction of subclinical hypothyroidism with small doses of thyroxine to normal tsh values as ideal. The most appropriate is the early detection of subclinical hypothyroidism in patients and correction of disorders identified with thyroid hormone preparations. The study showed that subclinical hypothyroidism is an additional independent risk factor.

Principles of diagnosis and choice of treatment tactics for patients with pancreatic-pleural fistulas

Introduction. Pancreatic-pleural fistula is a rare complication of pancreatitis that has no pathognomonic symptoms and unified approaches to the choice of treatment tactics.The aim of the study was to formulate the principles of diagnosis and choice of treatment tactics in patients with pancreatic-pleural fistulas.Materials and methods. Five patients with pancreatic-pleural fistulas were treated from 2012 to 2022. All patients underwent standard clinical-laboratory and instrumental methods of investigation.Results. The diagnosis of pancreatic-pleural fistula was made at 18−65th day from the disease on the basic of amylase activity in the pleural effusion from 29462 to 51328 U/L. Surgical treatment consisted of pleural cavity and pancreatic pseudocyst drainage in two patients, in one patient we performed pleural cavity drainage and Virsung’s duct stenting, one patient underwent pancreatic duct stenting and repeated pleural punctures, one patient had papillosphincterotomy, video-thoracoscopy and pleural cavity drainage. Discussion Diagnosis of pancreatic-pleural fistulas is based on a set of criteria: history of acute attacks or exacerbation of chronic pancreatitis, presence of pancreatic pseudocyst, recurrent hydrothorax, brown pleural effusion, and high amylase activity in it. Surgical treatment tactics can be staged and characterized by the principle “from simple to complex”.Conclusion. The diagnostic algorithm of pancreatic-pleural fistulas is based on the data on acute pancreatitis, recurrent hydrothorax, hemorrhagic nature of the effusion and high level of amylase in it. The choice of surgical treatment tactics implies combination of pleural cavity drainage with Virsung’s duct stenting, as well as external drainage of pancreatic pseudocyst (if any).

Dupilumab in complex therapy for chronic rhinosinusitis with nasal polyps and asthma

Chronic Rhinosinusitis with Nasal Polyps (CRwNP) caused by T2 inflammation has a complex pathogenesis, for which treatment options include medical therapy (topical and systemic glucocorticosteroids, leuktriene inhibitors, etc.) and surgical therapy, often recurs and significantly reduces the quality of life for patients. Chronic rhinosinusitis with nasal polyps is common in patients with asthma and, particularly, severe asthma and an allergic reaction to nonsteroidal anti-inflammatory drugs. These conditions are in most cases associated with a common pathogenesis, including a type II immune response, hyperproduction of interleukins (IL) 4, 5 and 13, activation of eosinophils and tissue remodeling. Biological therapy which block the effect of IL-4, 5, 13 can significantly improve the condition of such patients. Dupilumab is a humanized IgG4 monoclonal antibody that targets the IL-4 receptor alpha chain (IL-4Rα), thereby blocking the action of IL-4 and IL-13. Currently, dupilumab is approved for asthma, CRwNP and atopic dermatitis. Dupilumab can reduce the number of exacerbations, treatment with systemic corticosteroids, improve the condition of the upper and lower respiratory tract and achieve an increase in FEV1 by 0.2–0.3 L, which leads to a significant control of these diseases. One of the topical issues is the choice of tactics choice of treatment tactics in patients with CRwNP, asthma and nasal septum deviation. This article presents a clinical case of a patient with severe asthma, CRwNP and deviated nasal septum receiving dupilumab for 4 months.

Efficacy of treatment with glucagon-like peptide receptor agonists-1 in Asian patients with type 2 diabetes mellitus

The projected 68% increase in patients with type 2 diabetes mellitus (T2D) in the upcoming decades and the specific pathophysiological course of the disease are critical factors for the development of optimal disease management tactics in the Asian population. It is now known that β-cell dysfunction is dominant in the pathogenesis of T2D in Asians. In a number of Asian countries, incretin therapy is the leading therapy. To review literature on glucagon-like peptide-1 (GLP-1) secretion and clinical trial results of GLP-1 receptor agonist class (GLP-1RA) drugs as well as to evaluate their effectiveness in Asian population with T2D. A review of studies on pathophysiological aspects of GLP-1 secretion and evaluation of the efficacy of therapy with GLP-1RA preparations registered and used in clinical practice in Asian regions. Several studies in Asian countries have shown that intact GLP-1 levels were significantly lower in both T2D patients and healthy Japanese volunteers; as well as in patients with impaired glucose tolerance. It is suggested that either impaired secretion of GLP-1 in the gut, accelerated processing by dipeptidyl peptidase-4, or a combination of both are responsible for the decrease in GLP-1. The greater efficacy of GLP-1RA treatment in achieving glycemic control in Asian T2D patients was presented by Kim Y.G. et al. in a meta-analysis of 15 randomised controlled trials, the reduction in HbA1c on GLP-1RA treatment averaged -1.16% in Asian-dominated studies and -0.83% in non-Asian-dominated studies. In the PIONEER 9 clinical programme, similar results were obtained, with oral semaglutide having a more pronounced effect on glycaemic control in Japanese patients. Thus, the mean change in HbA 1c was -1.1%, 7 mg -1.5%, and 14 mg -1.7% at the 3 mg dose; whereas in the PIONEER 1 study in the global population, the mean change in HbA1c was -0.6%, -0.9% and -1.1% for 3, 7, 14 mg semaglutide, respectively. The PIONEER 10 study concluded that oral semaglutide was well tolerated by Japanese patients with T2D. Oral semaglutide reduced HbA1c (14 mg dose) and body weight (7 and 14 mg doses) more significantly compared to dulaglutide at 0.75 mg dose. Results of a pooled analysis of long-acting GLP-1RA showed a more significant reduction in cardiovascular event risk in the Asian subpopulation. The presented review describes benefits in glycemic control as well as in the reduction of relative cardiovascular event risks with GLP-1RA treatment in the Asian population, which requires further in-depth research and implies optimal management tactics in patients with T2DM.

Headache and epilepsy: prevalence and clinical variants

Headache, which is often present in patients with epilepsy, can occur outside of epileptic seizures as well as have a temporary connection with them – occur immediately before, during or after an attack. Clinical types of headache in epilepsy are considered in the International Classification of Headache, but not in the classification of epileptic seizures and types of epilepsy. Meanwhile, the presence of concomitant headache and its clinical phenotype should be taken into account when choosing treatment tactics in patients with epilepsy. The article presents data on the prevalence of different types of headache in patients with epilepsy and a modern classification of cephalalgia depending on the temporal relationship with an epileptic attack. Diagnostic criteria for four clinical variants of cephalgia are given: interictal, preictal, ictal and postictal. The comorbid relationship between epilepsy and migraine is considered in more detail, including the pathophysiological mechanisms underlying the combination of these paroxysmal conditions.

Prophylaxis of postoperative hypoparathyroidism in thyroid surgery.

There are a number of thyroid gland diseases that require surgical treatment. Therefore, it is important to improve the surgical approaches and treatment tactics in patients that need such surgery. To provide an algorithm to prevent parathyroid gland damage during surgery. This work was based on treatment results of 226 patients with different thyroid diseases. All patients received extrafascial surgical interventions using modern methodological approaches. For prevention of postoperative hypoparathyroidism, we used the "stress-test", 5-aminolevulenic acid, and a method of double visual-instrumental registration of photosensitizer-induced fluorescence of parathyroid glands. Transient hypoparathyroidism was registered in four (1.8%) cases after surgery. Permanent hypocalcemia in patients was not recorded. Autotransplantation of parathyroid gland was required only in one case (0.44%). A deficiency or low level of vitamin D was detected in 35% of the cases, and in the majority of those cases, it was due to secondary hyperparathyroidism. The deficiency was corrected with the administration of vitamin D in all cases. In 10.17% (23 patients) of cases, there was no proper visual glow effect after administration of 5-aminolevulinic acid (5-ALA), which required proceeding to the second part of the proposed method (a helium-neon laser and registration of fluorescence using a laser spectrum analyzer). The proposed methodological approach allows prevention of persistent hypoparathyroidism and reduces the frequency of transient hypoparathyroidism and other complications in surgical treatment of patients with various thyroid gland diseases.

Optimal Surgical Treatment Tactics in Patients with Synchronous Metastatic Colorectal Cancer

Aim: The aim of the study is to choose the optimal tactics of surgical treatment in patients with colorectal cancer (CRC) with synchronous intra-abdominal metastases. Materials and methods: The study included 74 patients with CRC with synchronous intra-abdominal metastases (peritoneal carcinomatosis and/or liver metastases), which were divided into 3 groups: I group (25 patients)-Intestinal stoma + neoadjuvant chemotherapy + Cytoreductive Surgery (CRS) + Adjuvant Chemotherapy (ACT); II group (18 patients)-Colon/rectal resection + ACT + CRS + ACT; III group (31 patients)-CRS + ACT. Results: The best oncological results were obtained in III group (median overall survival 46 months vs 27m. in I group and 31m. in II group). In contrast, a higher incidence of postoperative complications was observed also in this group (29%). There is no significant difference in overall survival (p>0.05 according to Log-Rank test) and the rate of postoperative complications between all groups of patients. The mean length of hospital stay was shorter in III group-9.8 days (p<0.01). Conclusions: All three options could be selected for the treatment of synchronous metastatic CRC. Therefore, the main goal remains the achievement of complete cytoreduction. So, it is necessary to focus on its possibility when choosing the sequence of stages of treatment in such patients. However, if it is possible to achieve complete cytoreduction and in the setting of the oncological center it is recommended cytoreductive surgery as the first step followed by adjuvant chemotherapy as the best treatment tactics for patients with synchronous metastatic CRC.