#106
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"Нейроэндокринная система ЖКТ" оказалась весьма перспективной в поисках новых методов обмануть ненасытные мозги...
Что же касается физической активности - эти препараты будут крайне ценны для тех, кто физически не мобилен и крайне ограничен даже в ходьбе (остеоартриты, тяжелое поражение ног при сахарном диабете).
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Чтобы поставить диагноз неправильно, надо иметь особый талант и премного постараться: сделать МРТ и КТ всех любопытных мест больного, рентгеновские снимки от головы до пят, анализы всех биожидкостей, пригласить пяток-другой консультантов… Сам черт потом во всем этом не разберется! П. Рудич |
#107
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A three-pronged acne treatment known as IDP-26 demonstrated greater efficacy than single and double treatments recently in matching randomized phase 3 trials.
IDP-126 gel is a fixed-dose therapy consisting of topical clindamycin phosphate 1.2%, adapalene 0.15%, and benzoyl peroxide 3.1%. The report was published in JAAD. The 12-week studies randomized participants ages 9 or older with moderate or severe acne (n=183 and n=180, respectively) to receive either daily IDP-126 or a control treatment.
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Г.А. Мельниченко |
#108
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Хотелось бы знать мнение коллег о таком докладе
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#109
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Рады увидеть Сергея Александровича практически вживую, он активен на форуме.
Что именно мы должны подчеркнуть из ролика?
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Г.А. Мельниченко |
#110
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Мы привыкли работать по правилам - УЗИ, ТАБ - стандартизированные параметры. Насколько можно использовать предложенный им метод , является ли он основным или дополнительным? Насколько доказателен? Спрашиваю именно об этом.
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#111
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Мне, честно, не хватает времени дослушать. В чем предложение? Кто проверял?
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Г.А. Мельниченко |
#112
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Сцинтиграфия с Тс - миби как альтернатива ТАБ с 17,5 минуты
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#113
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Полноте, как сие доказано? Дизайн исследования ? Количество наблюдений? Публикации?
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Г.А. Мельниченко |
#114
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не самое последнее в публикациях, но в полном тексте:
МИБИ как и ПЭТ дорого стоят, нужны специалисты в интерпретации и соотв. оборудование плюс не самая высокая точность: The average cost of FDG-PET/CT is 1,132 USD/test [92] and it is similar to that for MIBI-Scan (1,648 USD/test) [48]. Both these procedures can only be performed in a highly specialized radiology and nuclear medicine Units, and they expose patients to radiations, that can be reduced if only the thyroid bed is scanned. However, for these reasons they are not recommended as routine screening methods. FDG-PET/CT and MIBI-Scan showed a combination of intermediate values of both accuracy (65% and 79% respectively) and cost (both tests 1,000 - 2,000 USD). поэтому авторами предлагается Galectin-3-ICC (GAL-3-ICC) ...GAL-3-ICC performed well as rule-out (sensitivity = 83%) and rule-in test (specificity = 85%), with good accuracy (84%)... The clinically validated test-method with one of the lowest cost is, indeed, the GAL-3-ICC. The cost of this test-method (113 USD/test) is very competitive, compared with those estimated for FDG-PET/CT and is remarkably low compared to that reported for the molecular genetic test-methods (up to 20 times cheaper). For this reason it has been previously suggested that GAL-3-ICC could have a potential screening role, particularly in low-income Countries [31]. The present comparative analysis shows that GAL-3-ICC performs well both as an efficient rule-out and rule-in test-method, with rather good likelihood ratios and diagnostic accuracy. Visualization of sensitivity, specificity, likelihood ratios, accuracy and, more importantly, cost, in both two- and three-dimensional scatterplot diagrams, clearly indicates that GAL-3-ICC represents, at the present time, the candidate test-method to be chosen on large-scale basis. Moreover, GAL-3-ICC uses conventional FNA cytological substrates, is very easy to be performed in different clinical settings and does not require to be centralized in high specialized laboratories. Recently, we demonstrated that the sensitivity of GAL-3-ICC can be further improved by combination with clinical and ultrasound follow-up of negative nodules [93]. For all these reasons GAL-3-ICC can be proposed as a screening test-method for the preoperative characterization of indeterminate thyroid nodules in different clinical settings. GAL-3-ICC was recently included in a new algorithm for the management of patients with indeterminate FNA that was based on four different markers... Comparative analysis of diagnostic performance, feasibility and cost of different test-methods for thyroid nodules with indeterminate cytology [Ссылки доступны только зарегистрированным пользователям ]
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Искренне, Вадим Валерьевич. |
#115
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У нас была горячая дискуссия с Сергеем Александровичем конкретно по этому вопросу два года назад. Основное, что я пытался донести – это, то, что пунктировать нужно только избранные узлы, в зависимости от категории TIRADS, и то, что вероятность точного ответа ТАБ зависит от категории bethesda. А когда он говорит про огромную ошибку ТАБ, он опирался на данные где пунктировалось все подряд и не было гистологической стратификации риска вообще. Причем, когда я приводил аргументы, что ни в одном современном гайде нет вообще речи о сцинтиграфии, как о методе диагностики рака это вообще игнорировалось.
Причем я даже был согласен подружить ТАБ с сцинтиргафию с МИБИ и предложил вот такой алгоритм: 1) УЗИ назначается при низком ТТГ или при наличии пальпируемого образования 2) ТАБ назначается всегда при ответе УЗИ TIRADS 4-5, или TIRADS 3 более 2 см, или при быстром росте узла при любом TIRADS 3) При ответе ТАБ Bethesda 2 – наблюдать, при Bethesda 3 переделать ТАБ, при Bethesda 4-5 выполнить сцинтиграфию с МИБИ 4) После МИБИ: при наличии горячего узла на первой фазе – наблюдать узел по УЗИ (можно даже не вводить МИБИ), при отсутствии накопления МИБИ на второй фазе – наблюдать узел по УЗИ, при наличии накопления МИБИ на второй фазе – оперировать 5) При низком ТТГ, после УЗИ сразу сделать сцинтиграмму с пертехнетатом, и если горячий узел ТАБ не затевать вообще. Но он же настаивал на полной замене ТАБ сцинтирграфией с МИБИ, что мне показалось совершенно не реальным и дискуссия зашла в тупик.
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С уважением, Андрей Владимирович Поляков врач-УЗД |
#116
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Но он продолжает искать новые аудитории, теперь он Лайн . Нашел группу эндокринологов Новосибирска , там я и нашла сей ролик . Сложно понять, чем это обусловлено .
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#117
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Ну и что?
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Г.А. Мельниченко |
#118
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Палопегтерипаратид ( TransConПТГ) - пролонгированный ПТГ1-34.Ascendis Pharma
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Г.А. Мельниченко |
#119
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n December, the U.S. Food and Drug Administration (FDA) approved crinecerfont capsules and oral solution adjunctive treatment to glucocorticoid replacement to control androgens in adult and pediatric patients four years of age and older with classic congenital adrenal hyperplasia (CAH).
Crinecerfont is a selective oral corticotropin-releasing factor type 1 receptor (CRF1) antagonist that directly reduces excess adrenocorticotropic hormone (ACTH) and downstream adrenal androgen production, allowing for glucocorticoid dose reduction. Neurocrine Biosciences is marketing the drug as CRENESSITY. The FDA approval is supported by the largest-ever clinical trial program of classic CAH, the CAHtalyst Pediatric and Adult Phase 3 global registrational studies. CAHtalyst Phase 3 data results in pediatric and adult patients with classic CAH were published in The New England Journal of Medicine. In both CAHtalyst studies, CRENESSITY enabled lower steroid doses and decreased androgen levels. Phase 3 CAHtalyst Pediatric Study: The CAHtalyst Pediatric study met its primary endpoint, with CRENESSITY significantly decreasing androstenedione levels from baseline to Week 4 versus patients taking placebo who experienced a substantial increase in androstenedione levels. Children taking CRENESSITY were also able to significantly reduce their GC doses at Week 28 while maintaining or improving androgen levels, a key secondary endpoint. Children taking CRENESSITY saw approximately four times greater reduction in androstenedione compared with those taking placebo. Approximately four times greater steroid dose reduction in children taking CRENESSITY was seen compared with those taking placebo. Children taking CRENESSITY saw approximately 12 times greater reduction in 17-hydroxyprogesterone (17-OHP) compared with those taking placebo. Headache, abdominal pain, fatigue, nasal congestion and nosebleed were the most common adverse drug reactions (ADRs) among the pediatric population treated with CRENESSITY. Most side effects were temporary and mild to moderate in severity. “In this phase 3 trial,” the authors write in their conclusion, “crinecerfont was superior to placebo in reducing elevated androstenedione levels in pediatric participants with CAH and was also associated with a decrease in the glucocorticoid dose from supraphysiologic to physiologic levels while androstenedione control was maintained. “Chronic treatment with supraphysiologic glucocorticoids can cause a number of short- and long-term health consequences, such as obesity, hypertension, and osteoporosis, so the ability for patients with CAH to lower their glucocorticoid dose to a more physiologic level can have profound benefits.” – Richard Auchus, MD, PhD, professor, University of Michigan Health Phase 3 CAHtalyst Adult Study: The CAHtalyst Adult study met its primary endpoint with CRENESSITY enabling significant GC dose reductions at Week 24 (while maintaining or improving baseline androstenedione levels) and key secondary endpoint of decreasing androstenedione levels at Week 4. A significantly higher number of patients taking CRENESSITY (63%) achieved a GC dose in the physiologic range while androstenedione was maintained or improved compared with patients taking placebo (18%). Approximately two times greater steroid dose reduction was seen in people taking CRENESSITY compared with those taking placebo. People taking CRENESSITY saw an eight times greater reduction in androstenedione compared with those taking placebo. People taking CRENESSITY saw a 37 times greater reduction in 17-OHP compared with those taking placebo. Fatigue, headache, dizziness, joint pain, back pain, decreased appetite and muscle pain were the most common ADRs in the CRENESSITY treatment group. Most side effects were temporary and mild to moderate in severity. The authors conclude: “Among patients with CAH, the use of crinecerfont resulted in a greater decrease from baseline in the mean daily glucocorticoid dose, including a reduction to the physiologic range, than placebo following evaluation of adrenal androgen levels.” “The clinical results across both CAHtalyst studies support the efficacy and safety profile of CRENESSITY and its ability to reduce the overproduction of adrenal androgens, allowing for a meaningful reduction in glucocorticoid dosage, while maintaining or enhancing control of these androgens,” says Richard Auchus, MD, PhD, a professor at the University of Michigan Health, and principal investigator. “Chronic treatment with supraphysiologic glucocorticoids can cause a number of short- and long-term health consequences, such as obesity, hypertension, and osteoporosis, so the ability for patients with CAH to lower their glucocorticoid dose to a more physiologic level can have profound benefits.”
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Г.А. Мельниченко |
#120
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Давно не было никаких особых новостей- эта долгожданная
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Г.А. Мельниченко |