—A mathematical model is proposed to describe and solve problems of medical diagnostics and forecasting based on a risk criterion. Within the framework of the model, problems with ranked diagnoses ...are considered, whose solution benefits from taking medical preferences into account. A diagnostic algorithm, which is the implementation of this model, is used to solve the problem of predicting the clinical status of prostate cancer. A comparative analysis of the quality of the prediction for four model options was carried out, informative prognostic indicators were revealed, and the results were interpreted. Taking medical preferences into account increases the accuracy of prediction for patients with more frequent and aggressive tumor process due to loss of accuracy for patients with less frequent and aggressive tumor process.
Aim.
The clinical guidelines are intended to supplement specialty decision-making for improved aid quality in patients with gastritis and duodenitis though acknowledging the latest clinical evidence ...and principles of evidencebased medicine.
Key points.
Gastritis is an inflammatory disease of stomach mucosa, with a separate definition of acute and chronic gastritis. Chronic gastritis is a cohort of chronic diseases uniting a typical morphology of persistent inflammatory infiltration, impaired cellular renewal with emergent intestinal metaplasia, atrophy and epithelial dysplasia of gastric mucosa. Oesophagogastroduodenoscopy (OGDS) or high-resolution OGDS with magnified or non-magnified virtual chromoendoscopy, including targeted biopsy for atrophy and intestinal metaplasia grading and neoplasia detection, are recommended to verify gastritis and duodenitis, precancer states and/or gastric mucosal changes. All chronic gastritis patients positive for H. рylori should undergo eradication therapy as aetiological and subsidiary for gastric cancer prevention. Chronic gastritis patients with symptoms of dyspepsia (epigastric pain, burning and congestion, early satiety), also combined with functional dyspepsia, are recommended proton pump inhibitors, prokinetics, rebamipide and bismuth tripotassium dicitrate in symptomatic treatment. With focal restricted intestinal metaplasia, follow-up is not required in most cases, mainly when advanced atrophic gastritis is ruled out in high-quality endoscopy with biopsy. However, a familial history of gastric cancer, incomplete intestinal metaplasia and persistent H. pylori infection render endoscopy monitoring with chromoendoscopy and targeted biopsy desirable once in three years. Patients with advanced atrophic gastritis should have high-quality endoscopy every 3 years, and once in 1–2 years if complicated with a familial history of gastric cancer.
Conclusion.
The recommendations condense current knowledge on the aetiology and pathogenesis of gastritis and duodenitis, as well as laboratory and instrumental diagnostic techniques, main approaches to aetiological H. pylori eradication and treatment of dyspeptic states.
The paper provides substantiation of the necessity to determine the natural oscillations frequencies of manometric tubular springs. A mathematical model of manometric tubular springs is overviewed. ...Based on the given model a computer program was developed that was incorporated into a software suit for manometric tubular spring calculations. The results of numerical experiments in the software suit allowed us to identify the impact of geometric parameters on the natural oscillation frequency.
Aim. Current recommendations of the Russian Gastroenterological Association are developed to acquaint medical practitioners with modern diagnostics, treatment and trends in rational drug therapy for ...gastroesophageal reflux disease (GERD).General provisions. Incidence rate of GERD in the Russian Federation varies from 11.3 to 23.6%. GERD is diagnosed with medical history and laboratory examination evidence. Esophagogastroduodenoscopy (EGDS) allows detection of reflux esophagitis of various severity and cylindrical epithelial metaplasia of esophagus. The refractory form of disease (lack of conclusive clinical and endoscopic remission during 4-8 weeks of standard-dose PPI therapy), presence of strictures and Barrett's esophagus require EGDS with esophageal biopsy and bioptic histological examination. Patients should be conclusively performed esophageal 24-hour pH-metry or pH-impedance monitoring, high-resolution manometry to thoroughly examine functionality of esophagus, esophagogastric junction and assess disease prognosis and therapy outcomes.Treatment of GERD should be personalised accounting for clinical manifestations and severity, as well as aimed at symptom improvement, lesion healing in erosive esophagitis, averting complications, Barrett's esophagus progression, dysplasia and esophageal adenocarcinoma.Proton pump inhibitors (PPIs) are most effective agents in primary (4-8 weeks) and maintenance anti-GERD therapy. Antacids are recommended in monotherapy for occasional nonerosive heartburn and complex anti-GERD settings for fast symptom improvement. Prokinetics can be used in combination with PPIs for their properties to recover normal functionality of esophagus through affecting pathogenetic mechanisms of GERD.Complicated patients (repeated bleedings, peptic esophageal strictures) are recommended anti-reflux surgery with prior examination of esophageal functionality using pH-impedance and high-resolution manometry.Conclusion. Current recommendations provide an up-to-date evidential medicial review of GERD and guidelines to advance special medical care and timely preventive measures.
The Moscow Grand Seminar on Statistical Physics is one of the first seminars in the world devoted to rigorous methods in statistical physics. The achievements of the seminar can be appreciated in ...full measure from publications by the leaders of the seminar (R.L. Dobrushin, V.A. Malyshev, R.A. Minlos, Ya.G. Sinai). This paper presents a review (far from complete) of the proceedings of the seminar. The emphasis is made on the fundamental definitions and most important results.
Aim. These clinical recommendations present up-to-date methods for the diagnosis and treatment of peptic ulcer. The recommendations are intended for gastroenterologists and general ...practitioners.General provisions. Peptic ulcer (PU) represents a chronic relapsing disease occurring with alternating periods of exacerbation and remission. The main manifestation of the disease is the formation of a defect (ulcer) in the wall of the stomach and duodenum. Most cases of peptic ulcer are pathogenetically associated with the infection of H. pylori. PU can be an independent disease or represent symptomatic ulcers of the stomach and duodenum (medicinal, as a result of stress or endocrine pathologies, associated with chronic diseases of internal organs). In the absence of contraindications, esophagogastroduodenoscopy is recommended for all patients with suspected ulcer with the purpose of confirming the diagnosis. In order to determine indications for eradication therapy, all ulcer patients should be tested for the presence of H. pylori using a 13C-breath test or a stool antigen test. In the case of simultaneous endoscopy, rapid urease test can be used. For the prevention of subsequent relapses of ulcer, all PU patients with confirmed H. pylori should undergo eradication therapy. In addition, in order to achieve ulcer healing, 4–6 week antisecretory therapy with proton pump inhibitors is recommended. Clinical recommendations contain criteria for assessing the quality of medical care, an algorithm of the doctor’s actions, as well as information for patients.Conclusions. These clinical recommendations present modern ideas about the etiology and pathogenesis of peptic ulcer disease, its clinical manifestations, methods of laboratory and instrumental diagnostics and basic approaches to conservative and surgical treatment.
The problem concerning the prediction of the aggressive status of prostate cancer (PCa) is examined on the basis of preoperative data. This problem is solved using data on 360 patients with the ...established (aggressive or indolent) postoperative status of the disease. The collection of factors containing five informative indicators of prediction (from primarily accessible sixteen) is revealed and employed to create the diagnostic index used to predict the aggressive PCa status. In compliance with cross-validation data, the prognostic algorithm enables us to find the group involving 55% of patients with an aggressive status in the absence of patients with an indolent PCa status. The three-class prediction algorithm making it possible to ascertain whether any patient belongs to the group with the low, high, or uncertain risk of the aggressive disease stage is proposed.
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