Treatment overview of axial spondyloarthritis in 2023.

The treatment of patients with axial spondyloarthritis (axSpA) is characterized by non-pharmacological and pharmacological treatment options. It may depend on the type and extent of musculoskeletal and extramusculoskeletal manifestations. Recent data on non-pharmacological treatment options, such as physical activity, physiotherapy, and modification of lifestyle factors, are summarized in this review. Moreover, we have provided an overview on non-steroidal anti-inflammatory drugs and the ever-expanding number of biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs, respectively). In addition to data on efficacy and safety, the review also encompasses data on switching/cycling, tapering, and treatment selection for specific patient subgroups to optimize treatment outcomes.

The role of interleukin-6 and hepcidin 25 in the pathogenesis of anemic syndrome associated with malignant neoplasms with breast cancer patients before neoadjuvant chemotherapy.

A study of interleukin-6 (IL-6), hepcidin-25 (GP-25) was conducted in 22 patients with breast cancer before neoadjuvant chemotherapy and in 27 healthy women in the control group. Significant expression of the GP-25 protein was revealed in breast cancer patients, compared to control. The rates were high both in patients with anemic sindrome (AS) and without it (p <0.01). Latent iron deficiency, AS, IDA and functional iron deficiency (FJ) were more often detected in patients with stage III disease. A significant difference in the parameters of GP-25 and IL-6 was noted, the indicators were higher in patients with stage III (p <0.01). No close correlation was found between IL-6, GP-25 and other acute-phase proteins (FR, CRP) at the initial stages of AS formation. On the contrary, a positive correlation was observed in patients with IDA and FJ between IL-6 and all acute-phase proteins (GP-25, FR, CRP). However, a small number of observations do not allow an unambiguous conclusion about the role of IL-6 and GP-25 expression in the development of AS in cancer patients with breast cancer and requires further study.

[Development of strategic approaches to modern diagnosis of anemic syndrome in patients with breast cancer.]

A study of the clinical analysis of blood and major metabolites of ferrokinetics in 107 breast cancer patients before treatment was conducted. In 31 (28.9%) patients revealed anemic syndrome (AS). A feature of the AS is pronounced microcytosis, erythrocyte hypochromia and low hemoglobin content in reticulocytes. Most often (n = 22; 71%) there was iron deficiency (IDA), which was characterized by a low concentration of iron (F), ferritin (FR), hepcidin 25 (GP25), interleukin-6 (IL-6) and high - soluble transferrin receptors (rTFR), transferrin (TRF). In 9 (29%) patients with AS, on the basis of a high concentration of FR, GP25, IL-6, the anemia of chronic disease (AHZ) with functional iron deficiency (FDI) was established. In 23 (74.2%) patients with AS, the was a deficiency of erythropoietin (EPO), the lowest rates were found in the group of patients with a common tumor process and FDI, with less in patients with IDA.

[Diabetes mellitus and chronic liver diseases. Literature review (part 2): treatment features].

Diabetes mellitus (DM) and chronic liver disease (CLD) are pathological conditions associated with each other and reaching epidemic proportions. There is a strong pathogenetic relationship of carbohydrate metabolism disorders and a number of CLD. Common mechanisms that provoke metabolic and autoimmune disorders in the development of various CLD, leading to steatosis, insulin resistance (IR), impaired glucose tolerance and the development of DM are described. Effective glycemic control can have a beneficial effect on the treatment of these patients, and, conversely, there is evidence of a positive effect of CLD therapy on carbohydrate metabolism. This review discusses the correction of carbohydrate metabolism in patients with CLD, the main groups of modern hypoglycemic drugs, mechanisms of their action, the impact on the physiology of the liver, the possibility of using each of these pharmacological groups in patients with impaired liver function. The modern approaches and possibilities of drug effects on the process of fibrogenesis in CLD, the effect of these drugs on carbohydrate metabolism are listed.

[Diabetes mellitus and chronic liver diseases. Part 1: general mechanisms of etiology and pathogenesis].

In recent years there has been an active discussion about the relationship between diabetes mellitus (DM) and chronic liver diseases (CLD). On the one hand, patients with diabetes have an increased risk of developing CLD. On the other hand, patients with CLD very often identify abnormal glucose metabolism which ultimately leads to impaired glucose tolerance and the development of diabetes. This review outlines potential causal relationships between some CLD and DM. Common mechanisms that provoke metabolic and autoimmune disorders in the development of various nosologies of the CKD group, leading to steatosis, insulin resistance, impaired glucose tolerance and the development of diabetes are described. Certain features of the assessment of carbohydrate metabolism compensation in patients with hepatic dysfunction, anemia and protein metabolism disorders are described.

Qualitative and quantitative studies of chemical composition of sandarac resin by GC-MS.

The chemical composition of sandarac resin was investigated qualitatively and quantitatively by gas chromatography-mass spectrometry (GC-MS). Six compounds with labdane and pimarane skeletons were identified in the resin. The obtained mass spectra were interpreted and the mass spectrometric behaviour of these diterpenoids under EI conditions was described. Quantitative analysis by the method of internal standard revealed that identified diterpenoids represent only 10-30% of the analysed sample. The sandarac resin from different suppliers was analysed (from Kremer, Okhra, Color Rare, La Marchande de Couleurs, L'Atelier Montessori, Hevea). The analysis of different lumps of resins showed that the chemical composition differs from one lump to another, varying mainly in the relative distributions of the components.

[Features of consumption of vitamins and foods enriched with biologically active substances by Petersburgers].

Purpose. To study and evaluate the use of vitamins and products enriched with biologically active substances by the residents of St. Petersburg. The study was conducted with the use of the questionnaire survey method of 1200 Petersburgers. Results. A third of residents (35.5 per cent) never used enriched food products in nutrition. The majority of St. Petersburgers (59.3%) when cooking do not use iodized salt or do it rarely. While the use of salt increases with the age. Inclusion of vitamins in the diet fails to be widely distributed among the citizens: monthly they are used by only 20.3% of citizen, 2 times a year - 28.2% and only during illness - 17.7%. One third of the population (33.8 percent) never takes vitamins in the form of tablets, syrups, solutions, etc. Conclusion. The analysis indicates the need to improve the nutrition of Petersburgers to reduce risk factors for diseases by improving health literacy in organized units for healthy nutrition on the base of Health Centers or clinics in St. Petersburg.

[Risk factors and glycation end products in patients with different forms of coronary heart disease and type 2 diabetes mellitus]. / Faktory rosta i konechnye produkty glikirovaniya u bol'nykh s razlichnymi formami ishemicheskoi bolezni serdtsa i sakharnym diabetom 2-go tipa.

AIM: To determine the levels of growth factors and glycation end products in patients with different forms of coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM). MATERIAL AND METHODS: A total of 134 patients with CHD and T2DM, including 38 patients with non-ST-elevation acute coronary syndrome (ACS), were examined. The arterial and venous serum levels of basic fibroblast growth factor-ß (FGF-ß), transforming growth factor-ß (TGF-ß), placental growth factor (PlGF), advanced glycation end products (AGEs) and their receptors (RAGE) were estimated in all the patients. RESULTS: A direct correlation was found between the degree of arterial stenosis and the level of growth factors and AGEs in the patients with T2DM; there was also a direct correlation of the examined factors with lipid metabolic parameters. There was a significant two-fold increase in FGF-ß, PlGF, and RAGE levels in the patients with ACS. CONCLUSION: Hyperglycemia was found to negatively affect the progression of atherosclerotic changes in the vessel wall and on that of fibrotic processes.

[Monitoring the nutritional status of the residents of St. Petersburg].

The purpose of the study was to analyze the diet of the population of St. Petersburg from different social and age groups and justify organizational-methodological ways to improve it. 1200 inhabitants 18 years old and over (674 women, 526 men) were interviewed using questionnaires. One-third of St. Petersburg population did not adhere to the recommended 3-4 meals per day, taking meal 2 times per day or less (21.7%) or 5 times per day or more (11.3%). The young (18-29 years old) and socially active residents 1.5-2fold more likely than pensioners (13.8%) fed 2 times per day. Women 2.2 fold more frequently than men fed 5 times per day. Young people (20%) and socially active persons (24.4%) prefer not to have breakfast or take it 2-3 times per week compared with 9.6% pensioners. Supper as the main mealtimes called 27.8% women, that is 1.4 fold more likely than men. Thus, a great part of the population in the young and socially active adulthood violates proper diet, and women more often as compared to men. This can lead to disruption of the metabolic processes, increasing the risk of nutrition-related diseases, a decrease of efficiency and reduced life expectancy. This raises the feasibility of establishing of healthy eating offices based on health centers or clinics in St. Petersburg.

[Analysis of the -238(G/A)TNF polymorphism in breast cancer patients].

TNF is an inflammatory cytokine that involved in pathogenesis of different malignancies. Promoter single nucleotide polymorphism -238(G/A)TNF (rs361525) is investigated for the detection of susceptibility to the infectious, autoimmune and oncological diseases. The goal of the study was to investigate the association of-238(G/A)TNF polymorphism (rs361525) with breast cancer (BC) prognosis. -238(G/A) TNF allelic variants were detected by PCR-RFLP. We failed to reveal the genotype distributions disparity among groups with different stages of the disease, ER, PR or Her2/neu positive versus negative status. The AG genotype frequency was about 10% and there were no BC patients with AA genotype in all separated groups. However the overall survival was significantly lower for AG then for GG carriers with II stage or ER-positive BC. Our data suggest that -238(G/A)TNF polymorphism perhaps is not involved in the initiation of malignancies but it is a substantial factor of BC prognosis.

[A new type of bread in the diet of healthy and sick person].

In the study the hygienic assessment of a new type of bread in terms of quality and safety was performed. The results of the study showed that a new type of corn bread has a high nutritive and biological value, it is safe for human health. The glycemic index of bread was determined by the method described by FAO, WHO in 1998, "Carbohydrates in Human Nutrition." A new type of bread has a low glycemic index. This makes it possible to use the bread in dietary nutrition for persons who are overweight, suffers from the cardiovascular disease and type 2 diabetes, as well as for preventive nutrition for healthy individuals with risk factors for these diseases.

[Dietary correction of nutrition status in patients with irritable bowel syndrome].

Hygienic and dietology estimation of cereal breakfast (oat muesli and crispbread) were carried out on 137 irritable colon syndrome (SRK) patients with functional chronic constipation. It is established that inclusion of cereal breakfast in a diet of such patients positively influences on motor-evacuation function of digestive tract and promotes improvement of indicators of carbohydrate and lipid metabolism. It is important for patients with overweight and type 2 diabetes. Positive improvements of research allow making a cereal breakfast use recommendations: muesli in number of 50 g/days (with milk or kefir), crispbread and crunchy snacks in number of 100 g/days in SRK patients with functional chronic constipation dietary nutrition.

Prognostic factors in the prediction of chronic wound healing by electrical stimulation.

The aim of the study is to determine the effects of wound, patient and treatment attributes on the wound healing rate and to propose a system for wound healing rate prediction. Predicting the wound healing rate from the initial wound, patient and treatment data collected in a database of 300 chronic wounds is not possible. After considering weekly follow-ups, it was determined that the best prognostic factors are weekly follow-ups of the wound healing process, which alone were found to predict accurately the wound healing rate after a minimum follow-up period of four weeks (at least five measurements of wound area). After combining the follow-ups with wound, patient and treatment attributes, the minimum follow-up period was reduced to two weeks (at least three measurements of wound area). After a follow-up period of two weeks, it was possible to predict the wound healing rate of an independent test set of chronic wounds with a relative squared error of 0.347, and after three weeks, with a relative squared error of 0.181 (using regression trees with linear equations in its leaves). Regression trees with a relative squared error close to 0 produce better prediction than with an error closer to 1. Results show that the type of treatment is just one of many prognostic factors. Arranged in order of decreasing prediction capability, prognostic factors are: wound size, patient's age, elapsed time from wound appearance to the beginning of the treatment, width-to-length ratio, location and type of treatment. The data collected support former findings that the biphasic- and direct-current stimulation contributes to faster healing of chronic wounds. The model of wound healing dynamics aids the prediction of chronic wound healing rate, and hence helps with the formulation of appropriate treatment decisions.

Machine learning for medical diagnosis: history, state of the art and perspective.

The paper provides an overview of the development of intelligent data analysis in medicine from a machine learning perspective: a historical view, a state-of-the-art view, and a view on some future trends in this subfield of applied artificial intelligence. The paper is not intended to provide a comprehensive overview but rather describes some subareas and directions which from my personal point of view seem to be important for applying machine learning in medical diagnosis. In the historical overview, I emphasize the naive Bayesian classifier, neural networks and decision trees. I present a comparison of some state-of-the-art systems, representatives from each branch of machine learning, when applied to several medical diagnostic tasks. The future trends are illustrated by two case studies. The first describes a recently developed method for dealing with reliability of decisions of classifiers, which seems to be promising for intelligent data analysis in medicine. The second describes an approach to using machine learning in order to verify some unexplained phenomena from complementary medicine, which is not (yet) approved by the orthodox medical community but could in the future play an important role in overall medical diagnosis and treatment.

Analysing and improving the diagnosis of ischaemic heart disease with machine learning.

Ischaemic heart disease is one of the world's most important causes of mortality, so improvements and rationalization of diagnostic procedures would be very useful. The four diagnostic levels consist of evaluation of signs and symptoms of the disease and ECG (electrocardiogram) at rest, sequential ECG testing during the controlled exercise, myocardial scintigraphy, and finally coronary angiography (which is considered to be the reference method). Machine learning methods may enable objective interpretation of all available results for the same patient and in this way may increase the diagnostic accuracy of each step. We conducted many experiments with various learning algorithms and achieved the performance level comparable to that of clinicians. We also extended the algorithms to deal with non-uniform misclassification costs in order to perform ROC analysis and control the trade-off between sensitivity and specificity. The ROC analysis shows significant improvements of sensitivity and specificity compared to the performance of the clinicians. We further compare the predictive power of standard tests with that of machine learning techniques and show that it can be significantly improved in this way.

Induction of decision trees and Bayesian classification applied to diagnosis of sport injuries.

Machine learning techniques can be used to extract knowledge from data stored in medical databases. In our application, various machine learning algorithms were used to extract diagnostic knowledge which may be used to support the diagnosis of sport injuries. The applied methods include variants of the Assistant algorithm for top-down induction of decision trees, and variants of the Bayesian classifier. The available dataset was insufficient for reliable diagnosis of all sport injuries considered by the system. Consequently, expert-defined diagnostic rules were added and used as pre-classifiers or as generators of additional training instances for diagnoses for which only few training examples were available. Experimental results show that the classification accuracy and the explanation capability of the naive Bayesian classifier with the fuzzy discretization of numerical attributes were superior to other methods and estimated as the most appropriate for practical use.

Machine learning in prognosis of the femoral neck fracture recovery.

We compare the performance of several machine learning algorithms in the problem of prognostics of the femoral neck fracture recovery: the K-nearest neighbours algorithm, the semi-naive Bayesian classifier, backpropagation with weight elimination learning of the multilayered neural networks, the LFC (lookahead feature construction) algorithm, and the Assistant-I and Assistant-R algorithms for top down induction of decision trees using information gain and RELIEFF as search heuristics, respectively. We compare the prognostic accuracy and the explanation ability of different classifiers. Among the different algorithms the semi-naive Bayesian classifier and Assistant-R seem to be the most appropriate. We analyze the combination of decisions of several classifiers for solving prediction problems and show that the combined classifier improves both performance and the explanation ability.

[Clinico-functional evaluation of chronic obstructive lung diseases in association with hypertension]. / Kliniko-funktsional'nye osobennosti khronicheskokh obstruktivnykh zabolevanii legkikh v sochetanii s gipertonicheskoi bolezn'iu.

A study of 108 patients with chronic obstructive lung diseases revealed in 36 of them concomitant hypertensive disease. This association is accompanied by a benign course of each of these diseases. A study of the central hemodynamics showed the presence of hemodynamic changes typical of hypertensive disease.