[The possibilities and advantages of conducting multicenter clinical trials on the basis of outpatient clinics in Moscow].

The article presents the special role of the outpatient unit (urban polyclinics) in the system of urban medical organizations, which has significant development potential in the field of clinical research. This activity became possible due to the systematic work on equipping outpatient clinics with the most modern diagnostic equipment, the availability of specialists trained in the organization and conduct of clinical trials according to the international rules of good clinical practice. A special value lies in the fact that the polyclinic network has an extensive database that includes millions of patients and provides the opportunity to perform the highest level of medical expertise and research.

[Factors influencing recovery in patients with hemoblastoses and candidemia].

UNLABELLED: aim: To study the factors influencing the results of treatment for candidemia (CE) in patients with blood system tumors. SUBJECTS AND METHODS: The investigation enrolled patients with hemoblastoses and CE. 30-day all-cause mortality was analyzed. RESULTS: In an 8-year period (2006-2013), CE was diagnosed in 55 patients (median age, 50 years); there was a preponderance of patients with lymphomas (47%) and acute leukemias (27%). The causative agents of CE were C. albicans (38%), C. parapsilosis (17%), C. krusei (11%), C. guilliermondii (11%), C. lusitaniae (6%), C. tropicalis (6%), C. glabrata (3%), C. famata (3%), C. pelliculosa (3%), and C. kefyr (2%). 30-day all-cause mortality was 43.6%. Recovery was statistically significantly more frequently seen following removal of a central venous catheter (67% versus 13%; p=0.004; odds ratio (OR), 14); after use of an antifungal drug on day 1 of isolation of Candida spp. from blood cultures (62% versus 13%; p=0.01; OR, 12); and that of echocandin as a first-line agent (86% versus 42%; p=0.005; OR, 8.4). The poor predictors were septic shock (5% recovery rate versus 86% in the patients without this factor; p<0.0001; OR, 0.01), granulocytopenia (42% versus 88%; p=0.001; OR, 0.1); use of amphotericin B as a first-line drug (26% versus 71%; p=0.002; OR, 0.15); hemoblastosis recurrence or resistance (39% versus 73%; p=0.01; OR, 0.24). Multivariate analysis showed the positive impact of antifungal administration on day 1 of isolation of Candida spp. from blood cultures on treatment results (p=0.03; OR, 27). CONCLUSION: High mortality rates were noted in the patients with hemoblastoses and CE. The recovery rates were statistically significantly higher after use of echinocandin as a first-line agent, after that of an antifungal agent on day 1 of positive blood cultures, after removal of a central venous catheter, and hemoblastosis remission.

[Results of treatment for candidemia in patients with blood system tumors].

AIM: To study the etiology, clinical manifestations, risk factors, and results of treatment for candidemia (CE) in patients with blood system tumors. SUBJECTS AND METHODS: The investigation included the patients with CE and hemoblastoses treated at the Hematology Research Center, Ministry of Health of the Russian Federation, in 2006 to 2012. The diagnosis of CE was established according to the single isolation of Candida spp. from blood cultures and the presence of infection symptoms. RESULTS: Over 7 years, CE was diagnosed in 57 patients aged 17 to 77 years (median age 48 years). Among the patients with CE, there was a preponderance of those with lymphomas (54%) and acute leukemias (30%). The pathogens of CE were C. albicans (33%), C. guilliermondii (26%), C. parapsilosis (12%), C. krusei (8%), C. lusitaniae (5%), C. famata (4%), C. tropicalis (4%), C. glabrata (4%), and C. pelliculosa (4%). The major risk factors were polychemotherapy (85%), granulocytopenia (63%), mucosal Candida spp. colonization (82%), the presence of central venous catheter (CVC) (97%), antibiotics (100%), and glucocorticosteroids (70%). The infection occurred with the intake of an antifungal agent in 33% of the patients; 60% had concomitant infections of other etiology. Antifungal agents were given to 52 (91%) patients. Within 30 days after CE diagnosis, 20 (35%) patients died; of them 12 (60%) patients showed tumor progression concurrent with the infection. The cure rate for CE was significantly higher in the use of echinocandin as a first-line drug (92%), in complete or partial remission in hemoblastosis (90%), CVC removal (76%) and in the administration of an antifungal drug on day 1 of detection of positive blood cultures (75%). The cure rate was significantly lower when septic shock developed and a patient was transferred to an intensive care unit (15%), when amphotericin B was used as a first-line drug (45%), when granulocytopenia occurred (53%), or glucocorticoids were given (55%). CONCLUSION: Candida non-albicans constitute a high proportion among the pathogens of CE. A number of risk factors influencing survival rates in CE have been identified. It is crucial to use echinocandin as a first-line agent as soon as possible after isolation of Candida spp. from blood cultures.

[A cytofluorescence study of the peripheral blood in radiation exposure]. / Tsitofliuorestsentnoe issledovanie perifericheskoi krovi pri radiatstionnom vozdeistvii.

The cytofluorescent probing method has shown that the radiation action under sharp irradiation regime in experimental animals and chronic regime in people influences the level of synthetic processes in lymphocytes and granulocytes of peripheral blood, characterized by alpha-index (RNA/DNA). The correlation has been found between alpha-index, survivability, doses. alpha-Index can be used to estimate the radiation biological effects and radiosensitivity testing.