Klinicist最新文献

{"title":"ФАКТОРЫ РИСКА И ОСОБЕННОСТИ ОСТЕОПЕНИЧЕСКОГО СИНДРОМА У БОЛЬНЫХ ХРОНИЧЕСКИМИ НЕИНФЕКЦИОННЫМИ ЗАБОЛЕВАНИЯМИ","authors":"Н. Г. Платицына, Татьяна Викторовна Болотнова","doi":"10.17650/1818-8338-2016-10-1-36-42","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-1-36-42","url":null,"abstract":"Objective: to analyze the risk factors (RFs) of osteoporosis (OP), the risk of OP-related fractures, the specific features of osteopenic syndrome in patients with chronic non-infectious diseases (CNID) (coronary heart disease (CHD), hypertension, chronic obstructive pulmonary disease (COPD), and asthma). Materials and methods. The investigation enrolled 377 patients (mean age 55.3 ± 1.6 years) with CNID and 221 persons (mean age, 53.2 ± 1.3 years) who formed a control group. According to the nosological entity, the patients were divided as follows: Group 1 included 84 patients with CHD and hypertension; Group 2 comprised 99 hypertensive patients; Group 3 consisted of 70 patients with COPD; and Group 4 included 124 asthmatic patients. The examinees of all the groups were matched for age, gender, and body mass index. The investigation excluded patients with functional class IV chronic heart failure, continuous atrial fibrillation, heart valve disease, or myocardial noncoronarogenic diseases and those with other diseases and conditions that could have an independent impact on bone metabolism. Prior to the examination, the patients had received no specific therapy for the prevention and treatment of OP. RFs for OP were assessed using the one-minute test recommended by the International OP Foundation (2008); 10-year risk for OP-related fractures were calculated applying the FRAX computer program in accordance with the guidelines of the International OP Association and the World Health Organization (WHO, 2008). To investigate bone mineral density (BMD), bioenergy X-ray densitometry of the lumbar spine and proximal femur was carried out by means of a Lunar DPX apparatus (USA). The results were assessed using the t-test in standard deviations (SD) from the peak bone mass according to the WHO guidelines. Results. The RFs of OP were more frequently recorded in the patients with CNID than in the healthy individuals. RFs, such as smoking, low physical activity, and low-energy fractures, were most common in the patients with cardiovascular disease or COPD. The frequent use of glucocorticoid therapy was also an important RF in the patients with COPD. CHID considerably increased the risk of fractures in the succeeding 10 years after disease onset. The high risk of fractures, those of the proximal femur in particular, provides a rationale for the need for timely antiosteoporotic therapy in the majority of patients with CNID. The performed investigation demonstrated that the BMD values in the patients with CNID corresponded, on the average, to the osteopenia criteria; the lowest BMD values were recorded in the patients with COPD and associated cardiovascular disease. The severe course of osteopenic syndrome (a BMD decrease that was diagnostically significant for OP concurrent with fractures was observed in one-third of patients with CNID. The patients with cardiovascular disease or COPD showed a high incidence and degree of OP, which allows these diseases to be c","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"10 1","pages":"36-42"},"PeriodicalIF":0.0,"publicationDate":"2016-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67769446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ЛИПОДЕРМАТОСКЛЕРОЗ КАК РАЗНОВИДНОСТЬ ЛОБУЛЯРНОГО ПАННИКУЛИТА: КЛИНИЧЕСКИЕ ОСОБЕННОСТИ","authors":"О. Н. Егорова, Борис Сергеевич Белов, С. И. Глухова, С. Г. Раденска-лоповок","doi":"10.17650/1818-8338-2015-9-4-28-34","DOIUrl":"https://doi.org/10.17650/1818-8338-2015-9-4-28-34","url":null,"abstract":"Objective: to to study and reveal the diagnostic signs of lipodermatosclerosis (LDS) as one of the types of panniculitis (PN). Materials and methods. A total of 550 patients were examined; LDS with its duration of 18.97 ± 7.4 months was verified in 53 (9.6 %) patients (3 men and 50 women; whose age was 18–80 years), including 32 overweight ones. All the patients underwent comprehensive clinical examination and laboratory and instrumental studies involving biochemical and immunological parameters, as well as chest computed tomography and Doppler ultrasound (DUS) of the lower limb vascular bed. While characterizing the skin lesion, the extent, skin color, number and intensity of pain were assessed using the visual analogue scale (VAS) in the affected areas. Chronic venous insufficiency (CVI) was evaluated in accordance with the international classification and the classification developed by V.S. Savel’ev et al. The skin and hypodermic tissue were biopsied from an area of the highest lesion and further pathomorphologically examined. Results. Thirty-seven (70 %) of the 53 patients with LDS were noted to have predominantly inflammation of the subcutaneous adipose layer of the leg (88.6 %) on its medial surface (54.7 %) with the development of the glass symptom (79.2 %) (p = 0.005). Main types of the disease course (acute, subacute, and chronic) were identified, which differed in clinical symptoms. ROC analysis indicated that the VAS sensitivity (86 %) and specificity (58 %) in the patients with LDS corresponded to a separation point of 40 mm. In 46 % of the cases, skin lesion was associated with polyarthralgias (n = 15) or myalgias (n = 12) in the presence of insignificant inflammatory activity. Twenty-eight patients (including 19 with chronic LDS) had CVI with a duration of 10.2 ± 1.3 years, which was verified by DUS of the lower limb vessels (p < 0.05). All the patients took venous tonics, nonsteroidal anti-inflammatory drugs, aminocholines, and antioxidants for 3 months. A therapeutic effect was observed in 68 % of the cases. A therapeutic effect was absent in 23 % of the patients and worse health was seen in 9 %, which needed glucocorticoid therapy to be added. Conclusion. LDS is a clinical type of lobular PN, which requires an extensive diagnostic search. The factors contributing to the development of LDS are female sex, middle age, overweight, anamnestic predisposition, and CVI of the lower extremities. Asymmetric indurations with their characteristic color on the medial surface of the leg with the development of subcutaneous adipose layer dystrophy (the glass symptom) are a diagnostic sign of LDS.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"9 1","pages":"28-34"},"PeriodicalIF":0.0,"publicationDate":"2016-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67769013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Саркопения и перекрестные синдромы – значение в клинической практике","authors":"Надежда Александровна Шостак, А. А. Мурадянц, А. А. Кондрашов","doi":"10.17650/1818-8338-2016-10-3-10-14","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-3-10-14","url":null,"abstract":"Sarcopenia and overlapping syndromes, such as decrepitude and cachexia, are important medical and social problems due to their high prevalence and association with unfavorable outcomes. The article describes some issues of terminology, classification and differentiation of sarcopenia, decrepitude and cachexia, main diagnostic principles as well as different sarcopenia phenotypes (like sarco-osteoporosis sarcopenic and osteosarcopenic obesity). Identification of sarcopenia secondary forms associated with low physical activity, eating disorders or chronic illnesses (including inflammatory ones) was an important achievement for better understanding of the disease. Studying of sarcopenia in people with rheumatoid arthritis is a matter of particular interest.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"10 1","pages":"10-14"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ДИСЛИПИДЕМИИ И ИХ АССОЦИАЦИИ С ХРОНИЧЕСКИМИ НЕИНФЕКЦИОННЫМИ ЗАБОЛЕВАНИЯМИ (ИССЛЕДОВАНИЕ МЕРИДИАН-РО)","authors":"Евгений Владимирович Филиппов, С. С. Якушин, В. С. Петров","doi":"10.17650/1818-8338-2016-10-3-32-40","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-3-32-40","url":null,"abstract":"Objective: to study the frequency of lipid disorders and their association with chronic non-communicable diseases (NCD) in the unorganized population of Ryazan’ region 25–64 yo. Materials and methods. The study was conducted as a prospective cohort with a cross-sectional retrospective and included the study of biochemical samples, an electrocardiogram and a survey using a standardized questionnaire. In a study in 1622 people were included in 2011 (1220 – city, 402 – rural) in the 25–64 years of age (mean age – 43.4 ± 11.4 years), of which, 42.6 % were male, 53.8 % – female. The cohort was observed 36 months, annually evaluated endpoints. Dyslipidemia was considered as total cholesterol greater than 5 mmol/L and/or low density lipoprotein more than 2.5 mmol/L. Results. The prevalence of dyslipidemia in the population of the Ryazan region was 84.1 % (81.4 % – the city, 89.3 % – the village, p = 0.0001). It was found that an increase in apolipoprotein B, more than 180 mg/dL was associated with an increased risk of more than 5 % on the SCORE (OR 1.81, 95 % CI 1.61–2.03), diabetes (OR 1.87, 95 % CI 1,38–2,54), hypertension (OR 1.44, 95 % CI 1.29–1.60), CKD (OR 1.83, 95 % CI 1.28–2.62), gastrointestinal diseases (OR 1.12, 95 % CI 1.02–1.24), and ischemic heart disease/stroke/myocardial infarction combined point (ОR 1.61, 95 % CI 1.05–2.46). Increased total cholesterol greater than 5 mmol/L or low-density lipoprotein cholesterol greater than 2.5 mmol/L was also associated with hypertension (OR 1.28, 95 % CI 1.08–1.51), CKD (OR 1.97, 95 % CI 1.04–3.71) and dorsopathy. Links with ischemic heart disease/stroke/myocardial infarction has been received (ОR 0.89, 95 % CI 0.51– 1.56). Ups increased the risk of death from all causes (RR 3.98, 95 % CI 1.48–10.70, p = 0.006) and the combined endpoint (RR 7.12, 95 % CI 3.26–15.57, p = 0.0001). Conclusion. The frequency of dyslipidemia in the Ryazan’ region was high and amounted to 84.1 %. Adverse outcomes of NCD associated with elevated levels of apoB in the MERIDIAN-RO study, which should be considered when assessing the atherogenic dyslipidemia.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"10 1","pages":"32-40"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DISSECTING AORTIC ANEURYSM IN REAL–LIFE CLINICAL PRACTICE: DIAGNOSTICS, TREATMENT AND PROGNOSIS","authors":"S. Seleznev, I. Baranova, E. P. Krivonosova, N. V. Kuvychlina, K. Pereverzeva, L. Kalinina","doi":"10.17650/1818-8338-2016-10-3-46-50","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-3-46-50","url":null,"abstract":"Objective: analysis of clinical features of the dissecting aortic aneurysm (DAA) and factors affecting prognosis in a group of 40 patients, hospitalized in Ryazan Regional Cardiology Dispensary during 2008–2012. Material and methods. We have analyzed clinical data of 40 patients with DAA, assessed their survival and identified factors affecting prognosis. Results. The mean age of the patients was 61.1 ± 15.6 years; 82 % of them were males. 80 % of the patients were hospitalized in the acute period of the disease, 60 % – during the first 24 hours. 4 2 % of the patients had DAA as a referral diagnosis. The main clinical manifestations of DAA included: chest pain and abdominal pain (92 %), weakness (51 %), shortness of breath (28 %), heart disruptions (8 %), dizziness (5 %), and cough (3 %). Pain syndrome was absent in 8 % of the DAA patients. At physical examination 49 % of the patients demonstrated pale skin, 1 patient (3 %) had cyanotic skin. Low blood pressure was observed in 33 % of the cases, tachycardia – in 31 %, and tachypnea – in 13 % of the cases. 26 % of the patients were found to have murmur over the aorta, 10 % – abnormal heart rhythm. 44 % showed tenderness on palpation of the abdomen. Electrocardiography was carried out for 97 % of the study population, chest X-ray for 33 %, transthoracic echocardiography for 4 4 %, and computed tomography (CT) for 42 %, including contrast-enhanced computed tomography scanning for 38 %. 31 % of the patients received antiplatelet agents and anticoagulants. 24 % of the patients underwent surgical treatment in Ryazan» Regional Cardiology Dispensary, 36 % were referred to Federal centers of cardiovascular surgery. In-hospital mortality rate was 52 %, 24-hour mortality rate was 30 %. The following factors were found to be statistically significant in terms of the disease prognosis: systolic and diastolic blood pressure, left ventricular ejection fraction, levels of hemoglobin, blood urea and creatinine. Conclusion. In 8 % of the patients with DAA pain syndrome was not observed. Visualizing examinations (echocardiography, CT), aiding in DAA-diagnosis verification, were performed in less than 50 % of the cases. In-hospital mortality rate among DAA-patients was 52 %, 24-hour mortality rate was 30 %. Lower values of systolic and diastolic blood pressure, left ventricular ejection fraction, lower hemoglobin level together with increased levels of blood urea and creatinine were significantly associated with death.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"37 1","pages":"46-50"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"РИСК ПОЯВЛЕНИЯ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА У БОЛЬНЫХ АНКИЛОЗИРУЮЩИМ СПОНДИЛИТОМ (БОЛЕЗНЬЮ БЕХТЕРЕВА) И ПСОРИАТИЧЕСКИМ АРТРИТОМ ПО РЕЗУЛЬТАТАМ ДЕСЯТИЛЕТНЕГО ПРОСПЕКТИВНОГО НАБЛЮДЕНИЯ (ИССЛЕДОВАНИЕ ПРОГРЕСС)","authors":"И. З. Гайдукова, Андрей Петрович Ребров","doi":"10.17650/1818-8338-2016-10-3-26-31","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-3-26-31","url":null,"abstract":"Objective: assessment of coronary artery disease (CAD) incidence among patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) without manifestation of cardiovascular diseases. Materials and methods. We analyzed the data of 10-year prospective follow-up of the patient with AS (n = 278), psoriatic arthritis (n = 85) and healthy controls (n = 150) without any cardiovascular diseases. All groups were comparable in regard to cardiovascular risk factors. During these 10 years all new cases of CAD (verified by cardiologist) in the study population were tracked. Results. New cases of CAD were fixed in 64 out of 278 patietns with AS and in 16 out of 150 controls (p = 0.0017). Using log-rank MantelCox test and logrank test for trend we demonstrated statistically significant differences in CAD incidence between patients without spondyloarthritis (SpA) and patients with AS and PsA (p 0.05). Conclusion. The risk of exertional stenocardia in patients with AS was not higher than that in individuals without SpA. However, patients with AS have higher risk of myocardial infarction than those without SpA. PsA patients have increased risk of CAD development comparing to healthy controls and individuals with AS.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"89 1 1","pages":"26-31"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ ДИАГНОСТИКИ И ЛЕЧЕНИЯ ДЕФИЦИТА ВИТАМИНА В12","authors":"Александр Леонидович Красновский, С. П. Григорьев, Р. М. Алёхина, И. С. Ежова, И. В. Золкина, Е. О. Лошкарева","doi":"10.17650/1818-8338-2016-10-3-15-25","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-3-15-25","url":null,"abstract":"An article reflects modern concepts of the etiology of vitamin B12 deficiency including medication-induced conditions. Particular attention is paid to diagnostic algorithm in case of overt and latent forms of deficit. As the method of choice for the diagnosis of vitamin B12 deficiency it is recommended to determine the level of holotranscobalamin and use additional methods for detecting metabolic deficiency of vitamin B12 – to study the levels of homocysteine and methylmalonic acid. Diagnostic algorithms for patients with clinical suspicion of vitamin B12 deficiency and the presence of subclinical deficiency. We reviewed the possibility of vitamin B12 oral preparations to correct low levels of cobalamin in asymptomatic patients, as well as maintenance therapy in patients with clinical signs of vitamin B12 deficiency.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"10 1","pages":"15-25"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Post-Thromboembolic Pulmonary Hypertension Development in a Patient With Hereditary Thrombophilia: A Case Report","authors":"A. Klimenko, V. Shemenkova, D. P. Kotova, N. Demidova, D. A. Anichkov","doi":"10.17650/1818-8338-2016-10-3-64-68","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-3-64-68","url":null,"abstract":"Objective: to describe a clinical case of chronic post-thromboembolic pulmonary hypertension (CTEPH) development and progression in a patient with recurrent pulmonary thromboembolism (PTE) and hereditary thrombophilia. Materials and methods. Patient K., female, 50 years old, was hospitalized in the 1st therapeutic department of N.I. Pirogov First City Clinical Hospital with complaints of shortness of breath, occurring at rest and exacerbating after minimal physical activity, dry cough, chest heaviness, swelling of the lower extremities (mainly right one). The patient had a history of deep venous thrombosis (DVT) of the lower extremities, PTE, splenectomy, and long glucocorticosteroid drugs intake for thrombocytopenic purpura. The patient underwent different examinations in the hospital, including evaluation of laboratory tests in dynamics, echocardiography, contrast-enhanced multislice computed tomography of the pulmonary artery and its branches, perfusion lung scintigraphy, right heart catheterization. Results. After examination the patient was diagnosed with multiple segmental and subsegmental perfusion defects of both lungs; we also observed signs of pulmonary hypertension (PH) at echocardiography, proved by right heart catheterization. Also the patient was diagnosed with inherited thrombophilia. The patient was included in the register of PH-patients, thromboendarterectomy together with administration of special medications, approved for use in patients with pulmonary arterial hypertension (PAH-specific therapy) were recommended. Conclusion. This article describes the main features of CTEPH, its diagnostics and treatment in patients with CTEPH after PTE.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"22 1","pages":"64-68"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Приверженность лечению, предшествующему госпитализации, у пациентов с острым коронарным синдромом","authors":"Ю. В. Лукина, М. Л. Гинзбург, Виктор Петрович Смирнов, Н. П. Кутишенко, С. Ю. Марцевич","doi":"10.17650/1818-8338-2012-6-2-41-49","DOIUrl":"https://doi.org/10.17650/1818-8338-2012-6-2-41-49","url":null,"abstract":"Aim – to study adherence prior hospitalization, and the most important factors of adherence in hospitalized patients with a diagnosis of acute coronary syndrome (ACS). Materials and methods. This study included all patients admitted to the Cardiology Department of the Clinical Hospital № 2 Lyubertsy with a diagnosis of ACS. All the patients were asked to complete a questionnaire on assessing adherence during their stay in hospital. Results. Under obtain preliminary results (six months from the start of the study) the study included 130 patients with ACS: 79 men and 51 women. Half of the patients (n = 61) are constantly observed by a doctor, and the other half almost did not seek for medical help. According to the Moriscos–Green test 71 persons (54.6 %) were adherented to medical treatment, 55 patients were found to have low adherence to therapy. Only 42 patients, one-third of the survey participants took all drugs recommended by the doctor . Less than 9 % of patients hospitalized with diagnosis of ACS took statins, one third of patients were recommended to take aspirin. Primary cause of recommendations for medical therapy is forgetfulness (18.5 %), about 10 % of patients are afraid of the side effects of drugs. The main way to improve patient adherence to therapy was mentioned like information from the doctor about the possibility of improving the life and disease prognosis (62.3 %), quality of life, improving well-being(25.8 %), only 4 patients (3 %) were totally unwilling to comply with medical recommendations. Conclusion. Specially designed questionnaire gave possibility to assess a number of facts (very low prescription of some of the main groups of cardiac drugs, high mortality) identified in the study of the, and their possible causes. In addition to the personal factors of patients (forgetfulness), the main causes of poor adherence to treatment is the lack of awareness of patients about their illness, the possibilities of modern therapy, which has demonstrated the contribution of medical (teaching-information, which forms the motivation) factor in the problem of treatment compliance.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"6 1","pages":"41-49"},"PeriodicalIF":0.0,"publicationDate":"2015-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67766604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Роль цитокиновой системы rankl-rank-opg и катепсина к в патогенезе остеопороза: достижения и перспективы в лечении заболевания","authors":"С. Сагаловски, П. Кунце, М. Шенерт","doi":"10.17650/1818-8338-2012-6-2-9-16","DOIUrl":"https://doi.org/10.17650/1818-8338-2012-6-2-9-16","url":null,"abstract":"The article presents review of literature dedicated to the contemporary view on the cellular-molecular mechanisms of the bone remodeling and pathogenesis of the osteoporosis. The discovery of the cytokine RANKL-RANK-OPG system and significant role of the cathepsin K in process bone remodeling has made progress in understanding the mechanisms development disease and possible to development drugs of the new generation – denosumab, a fully human RANKL monoclonal antibody and inhibitor cathepsin K odanacatib that inhibits of the bone resorption.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"6 1","pages":"9-16"},"PeriodicalIF":0.0,"publicationDate":"2015-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67766715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}