The Clinician最新文献

{"title":"ИНФАРКТ МИОКАРДА 4-ГО ТИПА: ОСОБЕННОСТИ ТЕЧЕНИЯ, ПРОФИЛАКТИКА И ВЕДЕНИЕ БОЛЬНЫХ ПОСЛЕ ЧРЕСКОЖНЫХ КОРОНАРНЫХ ВМЕШАТЕЛЬСТВ","authors":"Наталья Григорьевна Правдюк, Анна Владимировна Новикова, Елена Анатольевна Королева","doi":"10.17650/1818-8338-2016-10-2-43-49","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-2-43-49","url":null,"abstract":"To date, cardiovascular diseases occupy the first place in the structure of total morbidity and mortality in many countries. In 2013 in the Russian Federation from cardiovascular disease died 1 million 799 thousand people, from the bottom 529.8 thousand from coronary heart disease, the primary role belongs to myocardial infarction and its complications. Currently, the \"gold standard\" for the diagnosis of coronary heart disease, including myocardial infarction, remains coronary angiography; the main objectives of coronary angiography are to assess the features of the coronary anatomy, determination of the possibility of endovascular treatment of myocardial infarction and revascularization by stent implantation. Despite the constant improvement of technology and the progress made in relation to pharmacological support, percutaneous coronary intervention (PCI) is an invasive manipulation, which is associated with a certain risk. Diagnostic criteria for myocardial infarction 4a type include increasing the level of troponin above 5 rules of 99th the upper threshold reference values within 48 hours after the PCI procedure, in patients with normal troponin increased (≤ 99th the upper threshold reference values), or a level of troponin 20 % or more in patients with initial high level troponin combined with evidence of prolonged myocardial ischemia. Stent when performing percutaneous coronary interventions, accompanied by the activation of thrombogenic reactions, can lead to thrombosis and development 4b type. To the diagnostic signs of the myocardial infarction 4b type are the stent thrombosis, angiographic proven and/or at autopsy, in combination with increased troponin level at least one greater than the 99th the upper threshold reference values. Stent when performing PCI, accompanied by the activation of thrombogenic reactions, can lead to thrombosis and development myocardial infarction 4b type. The diagnostic signs myocardial infarction 4b type are the stent thrombosis, angiographic proven and/or at autopsy, in combination with increased troponin level at least one greater than the 99th the upper threshold reference values. You should consider the fact that the setting of drug-eluting stents increases the period of their endothelization after implantation, which in turn increases the likelihood of late thrombosis and is an indication for long-term dual antiplatelet therapy. The article describes the varieties of myocardial infarction associated with PCI, an algorithm for the diagnosis and management of patients in accordance with current clinical recommendations.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"10 1","pages":"43-49"},"PeriodicalIF":0.0,"publicationDate":"2016-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770274","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":"ТРОМБОЗ ГЛУБОКИХ ВЕН У ПАЦИЕНТКИ С БОЛЕЗНЬЮ ВИЛЛЕБРАНДА","authors":"В. А. Елыкомов, А. Н. Копылов","doi":"10.17650/1818-8338-2016-10-2-50-54","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-2-50-54","url":null,"abstract":"Objective: to identify the possible factors of thrombogenic risk and ways of its prevention in patients with von Willebrand disease. Case description. Patient X., 42 years old, who suffers from von Willebrand disease type 3 with 5-years of age. Asked on reception to the traumatologist in the polyclinic of the Regional Hospital with pain in the left hip joint. Recommended planned operative treatment in the Altai Regional Clinical Hospital. Preoperative preparation included the infusion of concentrate of von Willebrand factor and coagulation factor VIII. Operation – cement total arthroplasty of the left hip joint. In the postoperative period analgesic treatment, elastic compression of the lower extremities, iron supplements, also conducted infusion of concentrate of von Willebrand factor and coagulation factor VIII for 20 days and thromboprophylactic with dabigatran. On the 3rd day after the operation the patient revealed deep vein thrombosis of the femoral segment (floating clot). Results. The patient was operated for emergency indications in the Department of endovascular surgery – installation of venous cava filter “Volan”. Dabigatran is cancelled, appointed clexane for 3 months. In our clinical example the patient lacked risk factors of pulmonary embolism as obesity, age, smoking, prolonged immobilization, estrogen therapy. Overdose of factor VIII were not observed – the level of factor did not exceed 135 % on transfusions. At the same time, the patient was found polymorphisms in the genes ITGA2, FGB, MTHFR, MTR – heterozygote, MTRR – mutant homozygote, which may indicate the genetic factors of thrombogenic risk. Also a significant risk factor was massive surgical intervention (total hip replacement). Despite preventive measures (elastic compression, thromboprophylactic dabigatran, early activation) we cannot to avoid thrombotic complications. Conclusion. This article presents a case demonstrating a thrombotic complication in patients with von Willebrand disease type 3 in the postoperative period of total hip arthroplasty. It is shown that despite preventive measures, she developed a very rare von Willebrand disease the phenomenon of deep vein thrombosis, bleeding was not observed. Pulmonary embolism was avoided by the installation of cava filter.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"10 1","pages":"50-54"},"PeriodicalIF":0.0,"publicationDate":"2016-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770339","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":"МУЛЬТИДИСЦИПЛИНАРНЫЙ ПОДХОД В ТЕРАПИИ ПЕРЕЛОМОВ ПРОКСИМАЛЬНОГО ОТДЕЛА БЕДРЕННОЙ КОСТИ НА ФОНЕ СЕНИЛЬНОГО ОСТЕОПОРОЗА","authors":"Н. В. Загородний, А. А. Волна, И.И. Панфилов","doi":"10.17650/1818-8338-2016-10-2-18-24","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-2-18-24","url":null,"abstract":"The article presents a review of published data on the problem of osteoporosis in patients older than 75 years who have had fractures of the proximal femur. We used descriptive and analytical methods. Search publications have done in accessible to free search databases. Based on our analysis, it was found: the majority of researchers in Russia and abroad are united in the opinion that this issue requires a multidisciplinary approach; surgical treatment should be initiated as early as possible after the onset of fracture, before the complications from side of the internal organs; patients with fractures on the background of senile osteoporosis should receive drugs that affect to the quantitative and qualitative components of bone.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"10 1","pages":"18-24"},"PeriodicalIF":0.0,"publicationDate":"2016-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67769496","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":"РАЗВИТИЕ АЛОПЕЦИИ НА ФОНЕ ЛЕЧЕНИЯ ИНГИБИТОРОМ ФАКТОРА НЕКРОЗА ОПУХОЛИ АЛЬФА У БОЛЬНОЙ ПСОРИАТИЧЕСКИМ АРТРИТОМ: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ","authors":"Р. Г. Мухина, Л. И. Мясоутова, А. Г. Васильев, Р. О. Демидов, Г. А. Семенова","doi":"10.17650/1818-8338-2016-10-1-43-47","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-1-43-47","url":null,"abstract":"Objective: to describe a case of the total development of alopecia in a female patient with psoriatic arthritis during treatment with a tumor necrosis factor-αlpha (TNF-α) inhibitor. Materials and methods. Patient I., aged 36 years has been followed up at the Kazan’ Center of Rheumatic Diseases and Osteoporosis since 1998. At approximately the same time, the patient noted the appearance of skin eruptions behind the ears, on the skin of the scalp. She was examined by a dermatologist who diagnosed psoriasis. In 2005, she was admitted to Kazan’ Rheumatology Center, City Clinical Hospital Seven, for the development of obvious synovitis of the knee joint and for the inefficiency of therapy with nonsteroidal anti-inflammatory drugs and diagnosed with psoriatic arthritis. During the prescribed therapy with methotrexate 10 mg/week, evident menstrual irregularities were observed in the patient who stopped using the drug herself. The second pregnancy occurred in 2008. Articular syndrome progression and eruptive psoriasis were recorded in the lactation period. After lactation cessation in 2009, she was hospitalized again. Her examination revealed high laboratory activity (erythrocyte sedimentation rate, as high as 40 mm/hr); magnetic resonance imaging of the knee joints showed the signs of bilateral synovitis; lumbar spine radiography exhibited grade II sacroiliitis. Leflunomide 20 mg/day was recommended as a basic drug. In 2012, the patient used leflunomide, her condition worsened; joint pain progressed; new joints were involved into the process, and cutaneous manifestations were aggravated. To verify a diagnosis and to choose therapy, the patient was referred to a consultation at the Moscow Research Institute of Rheumatology. Results. In connection with the high activity of the disease and with no response to the performed therapy, it was recommended to initiate therapy with biologics, such as infliximab, the drug of choice. Seven infliximab injections were well tolerated: the patient reported lower intensity of joint pains and regression of the skin manifestations of psoriasis. In 2013, after the eighth infliximab injection the patient sought medical advice because of complaints about an obvious exacerbation of psoriasis affecting the trunk, upper and lower extremities, and the development of total alopecia within a week. Discontinuation of cytostatics and biologics was recommended; whether ustekinumab therapy should be used was considered. Conclusion. Practical interest in this clinical case is due to the development of a rare (3.3 %) adverse event in the patient with psoriatic arthritis – hair loss (total development of alopecia) during treatment with a TNF-α inhibitor.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"10 1","pages":"43-47"},"PeriodicalIF":0.0,"publicationDate":"2016-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67769655","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":"BODY COMPOSITION AND BONE MINERAL DENSITY IN WOMEN WITH RHEUMATOID ARTHRITIS","authors":"S. Myasoedova, O. Rubtsova, E. Myasoedova","doi":"10.17650/1818-8338-2016-10-3-41-45","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-3-41-45","url":null,"abstract":"","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"10 1","pages":"41-45"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770182","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":"ПРЕДИКТОРЫ РАЗВИТИЯ ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕК У БОЛЬНЫХ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ","authors":"Array А. Долгополова","doi":"10.17650/1818-8338-2016-10-3-51-57","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-3-51-57","url":null,"abstract":"Оbjective: to identify predictors of reduction of glomerular filtration in patients with chronic obstructive pulmonary disease (COPD). Materials and methods. Maps analyzed 145 patients with a diagnosis of COPD. The majority (84.1 %, n = 122) were male (the average age of men 60.7 ± 0.9 years, average age of women 62.0 ± 2.7 years). A comparative analysis of the prevalence of risk factors for chronic kidney diseace (CKD) in patients with COPD by age, sex, smoking, hypertension, overweight and others. Calculated glomerular filtration rate (GFR) by using the equation Chronic Kidney Disease Epidemiology Collaboration (CKD–EPI), according to which the patients were divided into 6 groups: group 1 – hyperfiltration, group 2 – GFRCKD–EPI ≥ 90 ml/min/1.73 m2 , group 3 – GFRCKD–EPI 60–89 ml/min/1.73 m2 , group 4 – GFRCKD–EPI 45–59 ml/min/1,73 m2 , group 5 – GFRCKD–EPI 30–44 ml/min/1,73 m2 and group 6 – GFRCKD–EPI < 30 ml/min/1.73 m2 . Results. In COPD patients there is a high frequency of risk factors for CKD. The correlation between the prevalence of risk factors for CKD and the severity of COPD. The main predictors of CKD in patients with COPD: COPD experience more than 9.0 years, body mass index more than 26.5 kg/m2 , smoker index more of 51.3, albumin 44.0 g/l, total protein of more than 70.0 g/l, forced expiratory volume in the first second of less than 1.6 l, right atrium more than 35.5 mm, systolic pulmonary artery pressure more than 36.6 mm Hg, the thickness of the posterior wall of the left ventricle more than 10.5 mm, the Tiffeneau index less than 62.0 %. Conclusion. It is established that in COPD patients there is a high frequency of both traditional and additional risk factors for reduced GFR.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"10 1","pages":"51-57"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770200","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":"ГЕНДЕРНЫЕ ОСОБЕННОСТИ ТЕЧЕНИЯ ОСТРОГО ИНФАРКТА МИОКАРДА","authors":"Т. М. Мураталиев, В. К. Звенцова, Ю. Н. Неклюдова, З. Т. Раджапова, С. Ю. Мухтаренко","doi":"10.17650/1818-8338-2016-10-3-58-63","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-3-58-63","url":null,"abstract":"Objective: investigation of gender features and their role in progression and treatment of acute myocardial infarction (MI). Materials and methods. 244 patients aged 30–85 (mean age 61.2 ± 12.3) with MI were included in this study. They were divided into 2 groups depending on their gender: the 1st group was comprised of 80 (32.8 %) women, the 2nd group – of 164 (67.2 %) men. We evaluated patients’ demographic data, diagnosis and its complications, comorbidities, medical history and risk factors (RF) of coronary heart disease (CHD), in-patient therapeutic activities, in-hospital mortality rate, and 12-month mortality rate after MI. Results. In women MI was significantly more often associated with arterial hypertension (p 0,05), however severe (class III–IV) heart failure was more common in female population (31.2 % vs 23.7 %; RR 1.31; 95 % CI 0.85–2.01; p > 0.05).Mortality rate was higher in women than in men (27.5 % vs 15.2 %; RR 1.8; 95 % CI 1.08–2.99; р 0.05). During the first 6 months after MI we found a tendency of higher mortality rate in females than in males (6.2 % vs 1.8 %; RR 3.41; 95 % CI 0.83–13.9; p > 0.05), but after 6–12 months after discharge males tended to have higher mortality than females (4.3 % vs 2.5 %; RR 0.58; 95 % CI 0.12–2.75; p > 0.05). Conclusion. The most important risk factors for MI in females are diabetes mellitus, arterial hypertension and obesity. MI in women is associated with severe HF development; their immediate prognosis and disease outcome is usually less favorable, than in men.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"10 1","pages":"58-63"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770244","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":"Toward Large-Scale Shallow Semantics for Higher-Quality NLP","authors":"E. Hovy","doi":"10.1007/11762256_2","DOIUrl":"https://doi.org/10.1007/11762256_2","url":null,"abstract":"","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"6 1","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2006-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89982267","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":"Handling Disfluencies in Spontaneous Language Models","authors":"J. Duchateau, T. Laureys, Kris Demuynck, P. Wambacq","doi":"10.1163/9789004334441_005","DOIUrl":"https://doi.org/10.1163/9789004334441_005","url":null,"abstract":"In automatic speech recognition, a stochastic language model (LM) predicts the probability of the next word on the basis of previously recognized words. For the recognition of dictated speech this method works reasonably well since sentences are typically well-formed and reliable estimation of the probabilities is possible on the basis of large amounts of written text material. However, for spontaneous speech the situation is quite different: disfluencies distort the normal flow of sentences and written transcripts of spontaneous speech are too scarce to train good stochastic LMs. Both factors contribute to the poor performance of automatic speech recognizers on spontaneous input. In this paper we investigate how one specific approach to disfluencies in spontaneous language modeling influences recognition performance.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"1 1","pages":"39-50"},"PeriodicalIF":0.0,"publicationDate":"2002-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76622347","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":"Computational Linguistics in the Netherlands 2001, Selected Papers from the Twelfth CLIN Meeting, Twente, November 30, 2001","authors":"M. Theune, A. Nijholt, H. Hondorp","doi":"10.1163/9789004334038","DOIUrl":"https://doi.org/10.1163/9789004334038","url":null,"abstract":"David R. TRAUM: Ideas on Multi-layer Dialogue Management for Multi-party, Multi-conversation, Multi-modal Communication. Leonoor van der BEEK, Gosse BOUMA, Rob MALOUF, Gertjan van NOORD: The Alpino Dependency Treebank. Gosse BOUMA, Begona VILLADA: Corpus-based Acquisition of Collocational Prepositional Phrases. Christophe COSTA FLORENCIO: Conservative vs Set-driven Learning Functions for the Classes k-valued. Bart DECADT, Jacques DUCHATEAU, Walter DAELEMANS, Patrick WAMBACQ: Memory-Based Phoneme-to-Grapheme Conversion. Jesse de DOES, John van der VOORT van der KLEIJ: Tagging the Dutch PAROLE Corpus. Fien DE MEULDER, Walter DAELEMANS, Veronique HOSTE: A Named Entity Recognition System for Dutch. Jan van EIJCK: Reference Resolution in Context. Tanja GAUSTAD, Gosse BOUMA: Accurate Stemming of Dutch for Text Classification. Markus GUHE, Frank SCHILDER: Incremental Generation of Self-corrections Using Underspecification. Djoerd HIEMSTRA, David van LEEUWEN: Creating a Dutch Information Retrieval Test Corpus. Gerard KEMPEN, Karin HARBUSCH: Performance Grammar: a Declarative Definition. Piroska LENDVAI, Antal van den BOSCH, Emiel KRAHMER, Marc SWERTS: Multi-feature Error Detection in Spoken Dialogue Systems. Arjen POUTSMA: Applying Monte Carlo Techniques to Language Identification. Vincent VANDEGHINSTE: Automated Compounding as a Means for Maximizing Lexical Coverage. List of Contributors.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2002-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83401937","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}