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Miravitlles M.,CIBER ISCIII | Miravitlles M.,Hospital Universitari Vall dHebron | Vogelmeier C.,University of Marburg | Roche N.,University of Paris Descartes | And 9 more authors.
European Respiratory Journal

The quality of care can be improved by the development and implementation of evidencebased treatment guidelines. Different national guidelines for chronic obstructive pulmonary disease (COPD) exist in Europe and relevant differences may exist among them. This was an evaluation of COPD treatment guidelines published in Europe and Russia in the past 7 years. Each guideline was reviewed in detail and information about the most important aspects of patient diagnosis, risk stratification and pharmacotherapy was extracted following a standardised process. Guidelines were available from the Czech Republic, England and Wales, Finland, France, Germany, Italy, Poland, Portugal, Russia, Spain and Sweden. The treatment goals, criteria for COPD diagnosis, consideration of comorbidities in treatment selection and support for use of long-acting bronchodilators, were similar across treatment guidelines. There were differences in measures used for stratification of disease severity, consideration of patient phenotypes, criteria for the use of inhaled corticosteroids and recommendations for other medications (e.g. theophylline and mucolytics) in addition to bronchodilators. There is generally good agreement on treatment goals, criteria for diagnosis of COPD and use of longacting bronchodilators as the cornerstone of treatment among guidelines for COPD management in Europe and Russia. However, there are differences in the definitions of patient subgroups and other recommended treatments. Copyright © 2016 by the European Respiratory Society. Source

Bratus A.S.,Moscow State University | Kovalenko S.Yu.,Federal Medical and Biological Agency | Fimmel E.,Mannheim University of Applied Sciences
Mathematical Biosciences and Engineering

A mathematical spatial cancer model of the interaction between a drug and both malignant and healthy cells is considered. It is assumed that the drug influences negative malignant cells as well as healthy ones. The mathematical model considered consists of three nonlinear parabolic partial differential equations which describe spatial dynamics of malignant cells as well as healthy ones, and of the concentration of the drug. Additionally, we assume some phase constraints for the number of the malignant and the healthy cells and for the total dose of the drug during the whole treatment process. We search through all the courses of treatment switching between an application of the drug with the maximum intensity (intensive therapy phase) and discontinuing administering of the drug (relaxation phase) with the objective of achieving the maximum possible therapy (survival) time. We will call the therapy a viable treatment strategy. Source

Cazzola M.,University of Rome Tor Vergata | Calzetta L.,University of Rome Tor Vergata | Page C.,Sackler Institute of Pulmonary Pharmacology | Jardim J.,Federal University of Sao Paulo | And 3 more authors.
European Respiratory Review

In order to clarify the possible role of N-acetylcysteine (NAC) in the treatment of patients with chronic bronchitis and chronic obstructive pulmonary disease (COPD), we have carried out a metaanalysis testing the available evidence that NAC treatment may be effective in preventing exacerbations of chronic bronchitis or COPD and evaluating whether there is a substantial difference between the responses induced by low (≤ 600 mg per day) and high (>600 mg per day) doses of NAC. The results of the present meta-analysis (13 studies, 4155 COPD patients, NAC n=1933; placebo or controls n=2222) showed that patients treated with NAC had significantly and consistently fewer exacerbations of chronic bronchitis or COPD (relative risk 0.75, 95% CI 0.66-0.84; p<0.01), although this protective effect was more apparent in patients without evidence of airway obstruction. However, high doses of NAC were also effective in patients suffering from COPD diagnosed using spirometric criteria (relative risk 0.75, 95% CI 0.68-0.82; p=0.04). NAC was well tolerated and the risk of adverse reactions was not dose-dependent (low doses relative risk 0.93, 95% CI 0.89-0.97; p=0.40; high doses relative risk 1.11, 95% CI 0.89-1.39; p=0.58). The strong signal that comes from this meta-analysis leads us to state that if a patient suffering from chronic bronchitis presents a documented airway obstruction, NAC should be administered at a dose of ≥1200 mg per day to prevent exacerbations, while if a patient suffers from chronic bronchitis, but is without airway obstruction, a regular treatment of 600 mg per day seems to be sufficient. © ERS 2015. Source

Vlasyuk V.V.,Federal Medical and Biological Agency
Bulletin of Experimental Biology and Medicine

We studied the spinal cords of 14 dead premature newborn with intraventricular hemorrhages. In all cases, grade III intraventricular hemorrhage was followed by the translocation of blood into the subarachnoid space of the cervical, dorsal, and lumbar parts of the spinal cord. Ischemic changes were found in neurons of the cervical intumescence and other parts of the spinal cord. These changes are important during thanatogenesis. Three stages in the development of intraventricular hemorrhage were distinguished. Imperfections of clinical classification of this pathology were demonstrated. © 2014, Springer Science+Business Media New York. Source

Remizova M.I.,Federal Medical and Biological Agency | Gerbut K.A.,Federal Medical and Biological Agency
Bulletin of Experimental Biology and Medicine

Effects of a NO donor L-arginine and a non-selective NO-synthase inhibitor NG-nitro-L-arginine methyl ester on BP, microcirculation, acid-base balance, and gas content of blood were examined on rat model of hemorrhagic shock; the substances were administered without infusion media before blood loss. Bloodletting was stopped after manifestation of marked microcirculation disorders. Inhibition of NO synthesis in response to blood loss resulted in pronounced centralization of blood circulation with microcirculation disturbances, which was accompanied by metabolic changes aggravating hemorrhagic shock. Administration of NO donor reduced the degree of circulation centralization, maintained vasodilatatory vascular tone and perfusion of vital organs, improved animal resistance to blood loss, and prolonged their lifespan. Enhanced NO generation after administration of NO donor promoted longer microcirculation maintenance, which suggests that the so-called basal level of NO is essential at early stages of hemorrhagic shock. © 2014 Springer Science+Business Media. Source

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