Treatment Scheme Research Articles

Chinese expert consensus on the clinical management of liver disease-associated thrombocytopenia syndrome

Liver disease-associated thrombocytopenia syndrome refers to thrombocytopenia caused by liver disease or the treatment of liver disease, and its incidence rate is related to the duration and severity of liver disease. The direct effect of thrombocytopenia on clinical outcomes is an increased risk of bleeding in patients with liver disease, whereas the indirect effect involves delay or termination of treatment due to the potential risk of bleeding. Liver disease-associated thrombocytopenia pathophysiological mechanisms involve decreased platelet production, abnormal distribution, destruction, or increased consumption. Presently, treatment strategies targeting different mechanisms include platelet-stimulating drugs, surgery, immunosuppressive drugs, and platelet transfusion, but the clinical application needs to be standardized further. The National Clinical Research Center for Infectious Diseases organized experts to discuss and formulate consensus with reference to the latest evidence-based medical evidence in the field so as to improve the clinical management level of liver disease-associated thrombocytopenia syndrome in China in terms of diagnosis, typing, and reasonable selection of treatment schemes.

Polymer-Based Self-Assembled Drug Delivery Systems for Glaucoma Treatment: Design Strategies and Recent Advances.

Glaucoma has become the world's leading cause of irreversible blindness, and one of its main characteristics is high intraocular pressure. Currently, the non-surgical drug treatment scheme to reduce intraocular pressure is a priority method for glaucoma treatment. However, the complex and special structure of the eye poses significant challenges to the treatment effect and safety adherence of this drug treatment approach. To address these challenges, the application of polymer-based self-assembled drug delivery systems in glaucoma treatment has emerged. This review focuses on the utilization of polymer-based self-assembled structures or materials as important functional and intelligent carriers for drug delivery in glaucoma treatment. Various drug delivery systems, such as eye drops, hydrogels, and contact lenses, are discussed. Additionally, the review primarily summarizes the design strategies and methods used to enhance the treatment effect and safety compliance of these polymer-based drug delivery systems. Finally, the discussion delves into the new challenges and prospects of employing polymer-based self-assembled drug delivery systems for the treatment of glaucoma.

Feasibility study of faecal sludge treatment by Geotube and jute tube-based technologies.

The decentralized standalone treatment of faecal sludge is a generally cumbersome, energy-intensive, and expensive process. Particle size enlargement, dewatering, and disinfection are the crucial unit operations that contribute to the major portion of the operational expenditure. Therefore, the present study took up the task to investigate and yield a natural alternative to each of the above-delineated unit operations. Crushed seed powders of Moringa, Guilandina bonduc, Nirmali, tamarind, soap nut, nutmeg, jackfruit, and custard apple were experimented as natural coagulants, while a double-stitched cow dung-lined jute tube was utilized as the media for solid-liquid separation. Finally, the powder of Neem and custard apple seed and leaf were considered herbal disinfectants for the separated liquid and solid fractions, respectively. The findings of the physicochemical and biological analyses of the above unit operations were compared with a conventional polymer-based Geotube-driven treatment scheme. The natural alternatives registered some promising outcomes. However, the combined treatment efficiency of 79.32% (mean value of TS, TSS, TDS, COD, and BOD percentage removal) for pollutant removal and disinfection could not exceed the value of 97.98% offered by the conventional method. Further, the financial comparison for processing a 10 KL batch of FS indicates that the conventional scheme is considerably cheaper (USD 7.95) than the herbal alternate (USD 22.1). Therefore, though the present findings depict promising alternatives for sustainable and eco-friendly faecal sludge treatment, the authors advocate conducting further research to address the existing challenges to facilitate their seamless implementation on a field-scale level.

EPCO-20. DYNAMICS OF TUMOR GENOME SHAPING AND CLINICAL RESPONSE IN GLIOBLASTOMAS UNDER IMMUNE CHECKPOINT INHIBITORS

Abstract Immune checkpoint inhibitors (ICI) have shown remarkable success in several tumor types; however, this success has not been common in glioblastomas (GBMs). Given the immune-suppressive tumor microenvironment, the timing when to apply ICI may be a determining factor for clinical success. With this hypothesis, we compiled a longitudinal cohort of GBMs treated with different ICI schemes and a control cohort (upfront ICI (n=16), recurrent ICI (n=23), and control cohort by standard of care (n=33)). We investigated the genomic correlates to clinical response. Neither ICI itself nor different timing strategies failed to show a survival benefit for GBMs. However, the upfront-ICI cohort had more long-term survivors (overall survival >= 36 months) than the recurrent-ICI cohort (37.5% (n=6/16) vs. 26.1% (n=6/23)). Genomic analysis revealed that alterations in the PI3K-pathway or TP53 were associated with a poor response to ICI, while BRAF mutation was related to a favorable response. Interestingly, only TP53 alteration was associated with a worse prognosis in GBMs treated with upfront ICI. Tumor mutational burden (TMB) or the amount of neo-antigens failed to show any correlation with the response to ICI. However, ICI-treated GBMs experienced divergent evolution regarding the TMB, while GBMs treated by standard of care only exhibited unidirectional change. We also explored the immunogenomic shifts following different treatment modalities. ICI-treated GBMs showed more variable changes in both HLA alleles and neo-antigen burden (p-value=0.41 & 0.008, respectively). Among the upfront-ICI cohort, GBMs with a better response showed an increased neo-antigen burden upon recurrence (p-value=0.03), suggesting the selection of fitting clones during therapy. Collectively, we observed that that GBMs experienced distinct evolutions under different treatment schemes. The vulnerability of GBMs to ICI should be considered in the context of tumors’ capability to dynamically shape the tumor genome to fit into therapeutic pressure.

CTNI-06. RHENIUM (RE-186) OBISBEMEDA{RE-186-NANOLIPOSOME (186RNL)} IN LEPTOMENINGEAL METASTASES [LM] PHASE 1/2A DOSE ESCALATION TRIAL: INITIAL SAFETY AND FEASIBILITY

Abstract CONCLUSIONS: Adjuvant MHT may induce tumor radio-sensitization, immune cell recruitment, and survival benefit when combined with CRT. Optimization of the combination therapy treatment scheme is required.

Outcomes following hypofractionated radiation therapy alone for surgically unfit early esophageal squamous cell carcinoma patients; a retrospective single center analysis

Background and purposeTo report the feasibility of hypofractionated radiation therapy (RT) alone for early stage esophageal squamous cell carcinoma (ESCC) patients. Materials and methodsThe oncologic outcomes of 60 cT1-2 N0 ESCC patients who received hypofractionated RT (54 ∼ 60 Gy by 3.0 Gy per fraction) from 2004 to 2018 were retrospectively evaluated. ResultsThe 5-year rates of local control (LC), progression-free survival, cancer-specific survival, and overall survival were 81.1 %, 44.2 %, 73.7 %, and 54.5 %, respectively. In Cox regression analysis, tumor length < 3 cm was correlated with favorable LC (HR 0.167, p = 0.090), and the 5-year LC rates were 95.7 % and 72.0 % in < 3 cm and ≥ 3 cm subgroups, respectively (p = 0.053). Grade ≥ 2 esophagitis was observed in 44 patients (73.3 %) and grade ≥ 2 esophageal strictures developed in five (8.3 %), respectively. The patients with ≥ 3 cm tumor more frequently suffered from grade ≥ 2 esophagitis (13/24 vs. 31/36, p = 0.006) and grade ≥ 2 esophageal stricture (0/24 vs. 5/36, p = 0.056), respectively. The patients with cT2 tumor suffered from grade ≥ 2 esophagitis more frequently than those with T1 tumor (29/44 vs. 15/16, p = 0.03). ConclusionsHypofractionated RT alone, with the merit of short treatment course, could be used as feasible option in treating the early stage ESCC patients who are unfit for surgical resection or chemoradiation. Especially, tumor length < 3 cm seems a good indication of this treatment scheme based on favorable LC rate with low incidence of esophageal toxicities.

Partial versus radical nephrectomy for T1b renal cell carcinoma: A comparison of efficacy and prognostic factors based on the Surveillance, Epidemiology, and End Results database

Abstract Objectives This study compared the long-term efficacy and prognostic factors of partial nephrectomy (PN) and radical nephrectomy (RN) for T1bN0M0 renal cell carcinoma (RCC) using data from the Surveillance, Epidemiology, and End Results database. Materials and methods We retrospectively analyzed the clinical data of 12,471 patients diagnosed with T1bN0M0 RCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2019. Patients were divided into the PN and RN groups, and propensity score matching was conducted to balance the differences between the groups. We compared overall survival (OS), RCC cancer–specific mortality (CSM), and noncancer-specific mortality (NCSM) between the 2 groups. The risk factors for all-cause and RCC-related mortality were analyzed. Results After propensity score matching, there were 3817 patients in each group. After matching, OS and NCSM were significantly longer in the PN group (p &lt; 0.001); however, there was no significant between-group difference in the RCC-CSM. The hazard ratio (HR) for all-cause mortality was significantly lower in the PN group (HR, 0.671; 95% confidence interval [CI], 0.579–0.778, p &lt; 0.001), but PN was not associated with lower RCC-related mortality. Subgroup analysis showed that PN reduced the HR of all-cause mortality by 35% (HR, 0.647; 95% CI, 0.536–0.781; p &lt; 0.001) in patients with 4.0- to 5.5-cm tumors compared with RN and by 29% (HR, 0.709; 95% CI, 0.559–0.899; p = 0.004) in those with larger tumors (5.6–7.0 cm). Multifactorial analysis showed that PN was an independent predictor of OS (HR, 0.671; 95% CI, 0.579–0.778; p &lt; 0.001). In addition, multivariate analysis validated that age at diagnosis, sex, pathological grade, and tumor size were associated with outcomes. Conclusions In patients with T1b RCC, PN resulted in better OS and NCSM outcomes than RN. The benefit of PN in all-cause mortality was pronounced in patients with 4.0–5.5 cm tumor loads. Therefore, individualized treatment schemes should prioritize PN, when technically feasible.

Should the Carbon Footprint of Care be Taken into Account When Choosing a Treatment for Lymphoma? a Case Application on Mantle Cell Lymphoma

OBJECTIVE While climate change represents the greatest threat of the current century on human health, the carbon footprint of the healthcare sector represents 7-10% of occidental countries green house gas (GHG) emissions. Purchases, mostly of drugs and medical devices, represent about 50% of emissions. Oncology and hematology are suspected to be particularly carbon intensive, as they require long term and frequent consumption of healthcare resources. Here, we estimate the carbon footprint associated with different therapeutic strategies (including chemo-free or high dose chemotherapy) in patients with Mantle Cell Lymphoma (MCL) and discuss their future health impacts. METHODS Standard immunochemotherapy based versus chemo-free strategies were compared both in 1) the ≤65 years old/fit and 2) in the &amp;gt;65 years old/unfit populations. Namely, we compared 1) immunochemotherapy induction (rituximab, dexamethasone, cytarabine, and a platinum derivative) followed by autologous stem-cell transplantation and 3-year rituximab maintenance (LyMa) to obinituzumab, ibrutinib, venetoclax combination (OIV), and 2) rituximab, bendamustine combination (RB) to rituximab, ibrutinib combination (RI). These treatment schemes were considered to have similar clinical efficacy in each sub-group of patients. Carbon footprints were estimated by considering drugs, medical devices, hospital stays, car journeys, medical biology and imaging consumption in the French context. Drug specific method (including production, packaging and transport with or without R&amp;D, sales, general and administrative costs), and non-drug specific methods using mean emission factors based on their costs (kgCO2eq/€ from the French Environment Agency (ADEME) and the US Environmentally-Extended Input-Output (USEEIO) models) were applied to estimate drug carbon footprints and were compared in a sensitivity analysis. Carbon footprints were translated into future disability adjusted life years (DALY, a metric similar to quality adjusted life years QALY) expected to be lost in the future using the ReCiPe 2016 model. RESULTS The carbon footprint of each therapeutic strategy varied from 6.6 to 69.1 tCO2eq. In each, &amp;gt;70% of the total carbon footprint was related to drug purchase. A larger fraction (10-70%) of the carbon footprint of biotherapies (rituximab, obinituzumab) and low-cost small molecules (cotrimoxazole, valaciclovir) is related to their production while it is smaller (&amp;lt;10%) for high-cost small molecules (ibrutinib, venetoclax) that require higher R&amp;D, sales, general and administrative costs. In the ≤65 years old/fit population, treating a patient with LyMa leads to the emission of 16.8 tCO2eq corresponding to an estimated 0.21 [95%CI 0.08-0.51] induced DALY. Treating a patient with OIV for 5 years leads to the emission of 69.1 t CO2eq (0.86 [0.35-2.09] DALY) whereas stopping the treatment at 2 years leads to the emission of 36.6 tCO2eq (0.46 [0.19-1.11] DALY). In the &amp;gt;65 years old/unfit population, treating a patient with RB leads to the emission of 6.6 tCO2eq (0.08 [0.03-0.2] DALY) while treating a patient with RI for 5 years leads to the emission of 41.1 tCO2eq (0.51 [0.21-1.25] DALY) whereas stopping the treatment at 2 years leads to the emission of 22.7 tCO2eq (0.28 [0.12-0.69] DALY). These estimates have to be taken with caution, as they are highly dependent on the method chosen. Using non-drug specific ADEME or USEEIO mean emission factors increase the carbon footprint of 2 year OIV from 36.6 tCO2eq to 164 tCO2eq and 313 tCO2eq, respectively. On the contrary, only accounting for drug production, packaging and transport diminishes its carbon footprint to 10.8 tCO2eq. Detailed discussion on the models, on the impact of R&amp;D and on the use of generic/biosimilar drugs will be provided at the congress. CONCLUSIONS Treatment of patients with MCL is associated with a significant carbon footprint. Integrating their carbon footprint in the therapeutic decisions (such as length of treatment) could lead to significant decreases in carbon emissions that could translate into less health damages to future generations. Drug specific carbon accounting methods seem more adapted than nonspecific ones to estimate the carbon footprint of high cost drugs . Future research is required to determine more precisely the carbon footprint of drugs and therapeutic strategies in patients with hematological malignancies.

Uncovering key molecular mechanisms in the early and late-stage of papillary thyroid carcinoma using association rule mining algorithm.

Thyroid Cancer (TC) is the most frequent endocrine malignancy neoplasm. It is the sixth cause of cancer in women worldwide. The treatment process could be expedited by identifying the controlling molecular mechanisms at the early and late stages, which can contribute to the acceleration of treatment schemes and the improvement of patient survival outcomes. In this work, we study the significant mRNAs through Machine Learning Algorithms in both the early and late stages of Papillary Thyroid Cancer (PTC). During the course of our study, we investigated various methods and techniques to obtain suitable results. The sequence of procedures we followed included organizing data, using nested cross-validation, data cleaning, and normalization at the initial stage. Next, to apply feature selection, a t-test and binary Non-Dominated Sorting Genetic Algorithm II (NSGAII) were chosen to be employed. Later on, during the analysis stage, the discriminative power of the selected features was evaluated using machine learning and deep learning algorithms. Finally, we considered the selected features and utilized Association Rule Mining algorithm to identify the most important ones for improving the decoding of dominant molecular mechanisms in PTC through its early and late stages. The SVM classifier was able to distinguish between early and late-stage categories with an accuracy of 83.5% and an AUC of 0.78 based on the identified mRNAs. The most significant genes associated with the early and late stages of PTC were identified as (e.g., ZNF518B, DTD2, CCAR1) and (e.g., lnc-DNAJB6-7:7, RP11-484D2.3, MSL3P1), respectively. Current study reveals a clear picture of the potential candidate genes that could play a major role not only in the early stage, but also throughout the late one. Hence, the findings could be of help to identify therapeutic targets for more effective PTC drug developments.

Effect of Co content on microstructure and mechanical properties of maraging steel

Effect of Co element on the microstructure and mechanical properties of maraging steel is studied and summarized. The microstructure and mechanical properties of five different compositions of maraging steels were characterized and tested in three heat treatment states, with the heat treatment schemes of homogenization treatment at 1300 °C × 10h, solution treatment at 800 °C × 2h, and aging treatment at 480 °C × 5h. The research has discovered that increasing the Co content in three different heat treatment states can lead to a reduction in the size of the original austenite grains and the width of martensite laths. In the aged state, higher Co content causes the precipitation phase to transform from an ellipsoidal Mo-rich phase to a needle-like Ni3(Mo, Ti) phase. These changes in the size, shape, and density of the precipitated phases result in a more pronounced effect of precipitation strengthening, leading to a significant increase in the material's strength.

A case of successful treatment of arterial and biliary complications in a patient after liver transplantation

In April, 2018, a 57-year old patient with cirrhosis of the liver (Child-Turcotte-Pugh B class) during the outcome of viral hepatitis B and C was performed Transjugular Intrahepatic Portosystemic Shunt (TIPS); and in June, 2018 – liver transplantation (LТ) from a deceased donor by Piggyback technique. In the postoperative period, abscesses in the left and right lobes of the liver and thrombosis of the hepatic artery thrombosis (HAT) were noticed. Balloon dilatations of biliary stricture with changes of biliary drainage were made during the period of 2 years. In May, 2022, according to the results of angiography, hepatic artery and its branches were seen up to segmental level that meant natural revascularization. Considering the low efficiency of the balloon plastic procedures carried out, there was formed trihepaticojejunostomy on the loop of the small intestine disconnected according to Roux-en-Y. The follow-up period is one and a half years; there are no signs of cholangitis and biliary hypertension.There is no unified scheme of treatment for vascular and biliary complications in the clinics engaged in LТ, because every technique has both advantages and disadvantages. The idea of choice between intervention revascularization, transplantation and surgical reconstruction in the treatment of arterial thrombosis still remains incompletely understood.

Magnitude and Impacts of Adverse Events of Injectable Containing Shorter Regimen in Programmatic Management of Multi-Drug Resistant Tuberculosis in Ethiopia: A Retrospective Cohort Study.

Since its launch as a standardized treatment for multidrug-resistant tuberculosis (MDR-TB) in Ethiopia in April 2018, the safety profile of the shorter injectable regimen under a programmatic setting has not been well studied. Thus, this study aimed to assess the status of adverse events in patients treated with a shorter injectable regimen in Ethiopia. This is a retrospective cohort study. Data were collected using a structured data abstraction form and analyzed using SPSS, version 25, both descriptively and analytically. Logistic regression was conducted to assess predictors, and Kaplan-Meier analysis was used to examine the time to AEs and survival experiences. Of 256 patients, 245 (95.7%) were eligible for the study. Of 245, 107 (43.7%) patients experienced at least one AE. In total, 276 AE cases were observed out of which the most common were nausea/vomiting (20.3%), dyspepsia (18.1%), and ototoxicity (11.6%). Of 276 AEs, approximately 49 (17.8%) were serious. AEs led to drug discontinuation, dose modification, and regimen change in 29 (27%), 15 (14%) and 10 (9.3%) patients, respectively. Only 19.2% of 276 the overall AEs and 22.6% of 62 AE of special interest (AESI) were reported to the National Pharmacovigilance Center. Although the observed extent of AEs associated with the shorter regimen (SR) seemed to be moderate, it significantly influenced the treatment schemes and patient conditions. Reporting of AEs was low, irrespective of their severity and AESI. Therefore, strengthening the implementation of active drug safety monitoring and management is required.

The Inhibitory Activity of Lactobacillus plantarum Supernatant against Enterobacteria, Campylobacter, and Tumor Cells.

Cell-free supernatant of Lactobacillus plantarum exhibit a strong antimicrobial effect against a number of pathogenic enterobacteria (E. coli, Shigella flexneri, Salmonella typhimurium, Proteus mirabilis, and Campylobacter jejuni). The degree of growth inhibition in broth culture reached a high level for all tested bacteria. The highest rates were noted for P. mirabilis (by 13 times) and the lowest for S. flexneri (by 5 times) and C. jejuni (by 4.5 times). Significant antiproliferative effect of the supernatant on cells of tumor-derived epithelial cell lines was shown. The highest degree of inhibition (by 22 times) was observed for HT-29 cells (colon carcinoma). Thus, inclusion of probiotics in traditional treatment schemes can increase the effectiveness of antibacterial and antitumor drug therapy.

MATHEMATICAL ANALYSIS OF THE SORPTION PROCESS OF MINE WATER PURIFICATION

Contaminated mine water with a large amount of salts makes underground and surface water sources unsuitable for household and drinking needs. Already in 2016, there was a shortage of drinking water in the Rostov region. Water from surface sources does not meet the hygienic requirements for chemical parameters in 36.1% of the samples taken. Water from underground sources in terms of color, turbidity, total hardness, dry residue, content of iron ions, manganese, hydrogen sulfide, nitrates, ammonia, chlorides, sulfates, magnesium, sodium did not meet the required standards in 72.2% of cases. Due to the need for huge expenses for the purification of highly mineralized waters and the poor development of cheap technologies for the neutralization of large volumes, attempts to purify discharged or flowing mine waters to a safe level turn out to be practically fruitless. In this article, studies were carried out to reduce the concentration of dissolved ions of heavy metals (iron, manganese, copper and zinc) in mine wastewater by sorption in a static mode (charring) using rice husk biochar with electromagnetic treatment. The authors proposed a method for pre-treatment of the sorbent from rice husk biochar in an electromagnetic field at a process activation unit. The results of laboratory tests confirmed the high efficiency of the sorbent for the removal of heavy metal ions from mine waters. On the basis of the results obtained, optimization of the sorption purification of mine waters in the mode of carbonization was carried out using the method of mathematical planning of the experiment (full factorial experiment FFE 2k). The factors most influencing the efficiency of mine wastewater treatment from iron and zinc ions have been identified. With a probability of 0.95, the proposed models are adequate, and they can be used to describe the sorption process when using the studied sorbent to remove heavy metal ions (iron, zinc, etc.), while the optimal concentration of the sorbent from rice husks is within 0.5 mg/l. With an increase and decrease in the concentration of the sorbent above the optimal values, the efficiency of sorption decreases, and this affects the iron to a greater extent. In general, the obtained sorbent has a chemical composition similar to that of activated carbon (the most widely used sorbent for water purification), but at the same time it is a cheap production waste, which confirms its efficiency, both technological and economic, when used to purify natural and waste water. With the introduction of the proposed treatment scheme for mine water treatment facilities, it is expected that the concentrations of dissolved heavy metal ions, in particular, iron, zinc, manganese, will decrease to the concentration of the discharge into the reservoir.

Targeted Treatment of Schizophrenia Symptoms as They Manifest, or Continuous Treatment to Reduce the Risk of Psychosis Recurrence.

Current pharmacological treatment of schizophrenia employs drugs that interfere with dopamine neurotransmission, aiming to suppress acute exacerbation of psychosis and maintenance treatment to reduce the risk of psychosis recurrence. According to this treatment scheme, available psychotropic drugs intended to treat negative symptoms, cognitive impairment, or anxiety are administered as add-ons to treatment with antipsychotics. However, an alternative treatment scheme proposes a targeted or intermittent treatment approach, by which antipsychotic drugs are administered upon psychosis exacerbation and discontinued upon remission or stabilization, while negative symptoms, cognitive impairment, or anxiety are treated with specific psychotropics as monotherapy. Along these lines, antipsychotics are renewed only in the event of recurrence of psychotic symptoms. This 50-year-old debate between targeted and continuous treatment schemes arises from disagreements about interpreting scientific evidence and discordant views regarding benefit/risk assessment. Among the debate's questions are: (1) what is the percentage of individuals who can maintain stability without antipsychotic maintenance treatment, and what is the percentage of those who exacerbate despite antipsychotic treatment? (2) how to interpret results of placebo-controlled 9- to 18-month-long maintenance trials in a life-long chronic disorder, and how to interpret results of the targeted trials, some of which are open label or not randomized; (3) how to weigh the decreased risk for psychotic recurrence vs the almost certainty of adverse effects on patient's quality of life. Patients' profiles, preferences, and circumstances of the care provision should be considered as the targeted vs continuous treatment options are considered.

A clinical case of fatty liver disease. How the new nomenclature can be applied in practice

Metabolic dysfunction‑associated steatotic liver disease (MASLD) is an urgent problem, as this condition is diagnosed in about 35% of the world’s population. Manifestations of metabolic dysfunction in MASLD include excessive body weight (abdominal obesity is the most dangerous), manifestations of dyslipidemia, hepatomegaly, signs of diabetes, arterial hypertension, and moderate alcohol consumption (&gt; 20 g/30 g of alcohol per day in women and men, respectively). According to a new meta‑analysis, MASLD significantly increases the risk of cardiovascular, metabolic, oncological and reproductive consequences. This disorder was associated with a significantly increased risk of cardiovascular outcomes (hazard ratio [HR], 1.43), metabolic outcomes such as incident hypertension (HR, 1.75), prediabetes (HR, 1.69), diabetes (HR, 2.56) and metabolic syndrome (HR, 2.57), chronic kidney disease (HR, 1.38), and various liver‑related outcomes (HR, 3.92). MASLD is also associated with all types of cancer (HR, 1.54); the highest risk is observed for hepatocellular carcinoma (HR, 4.37). Currently, there are no FDA‑approved drugs for the treatment of MASLD, but there are some drugs to treat comorbidities with potential benefit in MASLD that may be considered in the appropriate clinical setting. It is important to understand that MASLD is a complex and multifaceted condition that requires a comprehensive approach to diagnostics and treatment, in addition to the approach of a gastroenterologist‑hepatologist alone. The increasing MASLD prevalence will remain a major global health threat that requires the implementation of effective mechanisms of the disease management.&#x0D; The authors present a clinical case of metabolic dysfunction‑associated steatohepatitis, associated with the I degree obesity. Liver dysfunction, metabolic and asthenovegetative disorders were revealed on the basis of complaints, anthropometric and anamnestic data, and the results of laboratory studies. Treatment with the use of S‑adenosylmethionine (Agepta, manufactured by Italy, developed by the company Omnifarma, Ukraine) was proposed, which contributed to the stabilization of indicators, according to the data of repeated clinical examinations. The lifestyle changes, physical activity, compliance to the treatment scheme and doctor’s recommendations enabled improving the patient’s state of health.&#x0D;

Study of the efficiency of electromembrane separation of technological solutions of treatment facilities of RKS-Tambov

Improving industrial waste treatment processes is associated with solving environmental problems that involve saving consumed environmental resources and reducing the volume of waste disposed of in it. Both are achieved through the introduction of low-waste technologies with the ability to extract valuable components and use purified water in the recycling cycle, among which electro-membrane technologies occupy a worthy place. The paper considers the possibility of using electromembrane separation in the treatment of technological solutions of treatment facilities of RKS-Tambov. In order to study the influence of the parameters of the separation process on the main kinetic characteristics, experimental studies of the specific productivity and retention coefficient of MGA-95 and OPMN-P membranes were carried out during the separation of technological solutions from PO43- phosphate ions. Criteria-based dependences for calculating the specific productivity and retention coefficient in the electromembrane separation of process solutions containing phosphate ions are proposed for use. The calculation of the economic efficiency of the technological scheme of wastewater treatment of RKS-Tambov using an electromembrane apparatus was carried out and its profitability was assessed. The profitability index will be 1.703, that is, more than 1, which is considered a profitable business. High rate and profitability of products. The payback period of the project is 2 years, which should be considered a good indicator, that is, after 2 years, the monetary resources invested in the project will return to economic circulation. The calculated payback period can presumably be reduced, since we have not indexed the price of the concentrate to inflation.

SARS-COV-2 AND HYPERCOAGULATION IN PREGNANT WOMEN

The global pandemic caused by the SARS-CoV-2 virus has created unprecedented medical and social problems. The virus has the ability to induce a prothrombotic state, which in certain cases has led to severe thrombotic complications. Scientists all over the world were faced with the task of studying in detail the coagulation capacity of blood plasma and the procoagulant role of platelets in the development of pathogenic mechanisms of endothelial damage, major vascular thrombosis and systemic microangiopathies. These studies will be useful for clinicians to improve pathogenetic- based treatment schemes for this disease and to prevent serious complications. The aim of the study was to determine the eff ect of the SARS-CoV-2 virus on some parameters of the blood coagulation system in pregnant women with post-covid syndrome.Method and materials. From November 2020 to January 2022, we conducted a prospective cohort study of 50 pregnant women (main group) with SARS-CoV-2 confi rmed by the polymerase chain reaction method. The control group consisted of 25 women with physiological pregnancy who were undergoing inpatient treatment at the communal non-profi t enterprise «Ternopil City Communal Hospital No. 2». The conduct of this study was approved by the Ethics Committee of Ternopil National Medical University named after I. Gorbachevsky – protocol No. 61 dated November 13, 2020. Pregnant women were examined between 30 and 34 weeks of gestation. In the selected blood samples, the number of platelets, coagulogram indicators: international normalized ratio, prothrombin and thrombin time, prothrombin index, activated partial thromboplastin time, fi brinogen and D-dimer levels were studied. The studies were performed on a Coag Chrom 3003 analyzer. Microsoft Excel and Statistica-10 software were used for statistical analysis. The study was conducted within the framework of the National Development Program «Improvement of diagnosis and treatment of pregnant women with a burdened somatic history» of the Department of Obstetrics and Gynecology, Faculty of Postgraduate Education, TernopilNational Medical University named after I. Ya. Gorbachevsky, state registration number N 0121U100153, performance period 2021-2023).Results. A signifi cant decrease in the absolute platelet count to less than 100,000/μL was observed in 5 % of the pregnant women in the main group, and in 70 % of the patients in this group, the platelet count was less than 150,000/μL, and only 25 % of the pregnant women in this group had platelet counts within the normal range. In the control group, only 16 % of the platelets were in the 150-180 range, and 84 % of the pregnant women in this group had platelet counts within the normal range. Prothrombin time indicators were slightly longer in patients with COVID-19 (15.6 s; 14.4-16.3) compared with the control group (13.6 s; 13.0-14.3), (Р&gt;0.05). In pregnant women with SARS-CoV-2, the concentration of fi brinogen was 1.63 times higher than in the control group (P&lt;0.05). The indicators of activated partial thromboplastin time and international normalized ratio were longer in the group of patients with COVID-19 compared with the control group, although the diff erence was not statistically signifi cant (P&gt;0.05). A signifi cant (P&lt;0.05) acceleration of the thrombin time was observed in 82 % of the pregnant women in the main group compared to the control group. An increase in D-dimer concentration was the most signifi cant abnormality. Thus, when evaluating the indicators of laboratory studies of the main parameters of hemostasis in 26 % of patients with COVID-19, D-dimer increased fi ve times, and in 20 % it was 8-10 times more than in healthy pregnant women. Thus, the SARS-CoV-2 virus has a negative eff ect on the main indicators of both theprocoagulant and anticoagulant systems of homeostasis. And these changes are particularly dangerous for pregnant women, because micro- and macrothrombosis of the placenta and umbilical cord lead to life-threatening conditions for the fetus. The SARS-CoV-2 virus leads to hypercoagulation in the homeostatic system of pregnant women compared to control women who were not infected with the coronavirus. Conclusion: Thus, the results of our research allow us to pathogenetically justify the need for long-term use of anticoagulant therapy in pregnant women with post- CoV syndrome.

Application of omics in Sjögren's syndrome.

The pathogenesis, diagnosis, and treatment of Sjögren's syndrome (SS) face many challenges, and there is an urgent need to develop new technologies to improve our understanding of SS. By searching the literature published domestically and internationally in the past 20 years, this artical reviewed the research of various omics techniques in SS. Omics technology provided valuable insights into the pathogenesis, early diagnosis, condition and efficacy evaluation of SS. It is helpful to reveal the pathogenesis of the disease and explore new treatment schemes, which will open a new era for the study of SS. At present, omics research has made some gratifying achievements, but there are still many uncertainties. Therefore, in the future, we should improve research techniques, standardize the collection of samples, and adopt a combination of multi-omics techniques to jointly study the pathogenesis of SS and provide new schemes for its treatment.

ОЦЕНКА ВЛИЯНИЯ БИОПРЕПАРАТОВ НА ФОРМИРОВАНИЕ УРОЖАЯ ЯРОВОГО ЯЧМЕНЯ

The results of field researches on the experimental fields of the Agrobiotechnopark of KSAU conducted in 2020-2022 are given. The aim of the research was to evaluate the effect of double treatment during the growing season with various biological preparations on the formation of the crop and the quality of spring barley grain. The objectives of the research included studying the nature of changes in the biometric parameters of plants, leaf surface area, yield and protein content in grain when using a biofungicide and biofertilizer. The variety of spring two-row barley Kamashevsky was the object of research. Biopreparations were studied - biofungicide Orgamica S (biological agent - Bacillus amyloliquefaciens) and biofertilizer Organit P (biological agent - Bacillus megaterium). The treatment was carried out twice during the growing season - in the tillering phase and in the earing phase with a working fluid flow rate of 200 l/ha. The preparations were used separately and as part of a tank mixture. The studies were carried out on a gray forest highly cultivated soil. The agro-climatic conditions of vegetation during the years of the study varied significantly. In 2021, soil-air drought was noted, and in 2020, and especially in 2022, the moisture conditions were favorable for the growth and development of spring barley plants. It has been established that the treatment of spring barley crops with biological preparations contributes to an increase in the length of the ear, stems and roots. This effect was especially significant when using a biofertilizer in the tillering phase, and a biofungicide during the heading of barley. The use of all treatment schemes with biological preparations showed an increase in the area of spring barley leaves and, at the same time, the development of root rots of the crop decreased by an average of 50%. The greatest increase in yield (by 0.56 t/ha), the maximum protein content in the grain and the best profitability indicators were obtained using a treatment scheme in which Organit biofertilizer was used during the tillering period, and Orgamica S biofungicide during the heading period. Especially significant positive effect from treatment with biological preparations was in the conditions of a well-moistened 2022, but even in the conditions of a drought in 2021, treatment with biological preparations showed high efficiency.