The First Pavlov State Medical University of St. Petersburg (Russian: Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова, ПСПбГМУ им. акад. И. П. Павлова) is a higher education institution, medical university in St. Petersburg.[citation needed]PSPbGMU is called the First Medical Institute in St. Petersburg because of its renaming in 1936, relative to Saint Petersburg State Medical Academy named after I.I. Mechnikov, which is called the Second Medical Institute.
Background/Objective(s) In a phase III clinical trial (MIRANTIBUS), divozilimab (DIV) has demonstrated efficacy in significantly reducing annualized relapse rate (ARR) and MRI activity compared with teriflunomide along with favorable safety profile for up to 2 years in patients with relapsing multiple sclerosis (RMS). BCD-132 EXT was aimed to assess long-term efficacy and safety of divozilimab in patients with RMS. Material(s) and Method(s) BCD-132-EXT (NCT06987851) enrolled patients with RMS who had been previously treated with divozilimab at a dose of 500 mg Q6M in phase II BCD-132-2 (NCT04056897) and phase IIIBCD-132-4/MIRANTIBUS (NCT05385744) trials. Total treatment duration was 4 years. The efficacy assessment included ARR, MRI endpoints (T1 Gd+ lesions per scan, combined unique active lesions (CUA) per scan), and 6-month confirmed disability progression (CDP). Safety monitoring included evaluation of standard laboratory parameters and reporting of adverse events. Result(s) 44 patients were enrolled in BCD-132-EXT, 93.2% (41/44) completed 4 years of follow-up. In patients continuously treated with divozilimab ARR remained constantly low, with the overall ARR over 4 years of therapy being 0.052 (95% CI: 0.028; 0.097). Adjusted numbers of T1Gd+ lesions and CUA per scan during the treatment period were 0.011 (95% CI 0.004; 0.035) and 0.018 (0.006; 0.052), respectively. Cumulative probability of 6-month CDP rate was 4.5%. Adverse reactions were reported in 59.1% (26/44) of patients, most of which were mild to moderate. The most frequent adverse reactions were leukopenia, lymphopenia, neutropenia and infusion reactions. No serious adverse events were registered in study population. No new safety signals were identified. Conclusion(s) A favorable divozilimab long-term efficacy/safety profile for patients with relapsing MS was demonstrated in BCD-132-EXT.
Introduction. Chronic placental insufficiency (CPI) is one of the leading causes of fetal growth restriction (FGR), perinatal loss, and complicated pregnancy. Currently, no validated methods for predicting CPI during pregnancy planning are available, which complicates high-risk patient stratification early and enabling timely prevention. Aim: to develop a mathematical model for predicting CPI risk in women with a complicated obstetric history at the pre-pregnancy preparation stage. Materials and Methods . A retrospective clinical study assessing 462 patients with a complicated obstetric history was conducted. The outcomes of previous pregnancies, concomitant extragenital diseases, circulation of criterial (anti-β2glycoprotein and anti-cardiolipin antibodies, lupus anticoagulant) and non-criterial (anti-annexin 5, anti-phosphatidylserine, anti-phosphatidylinositol, anti-prothrombin, anti-human chorionic gonadotropin) antiphospholipid antibodies (APA), indicators of lymphocyte subpopulation composition, coagulation profile, and genetic thrombophilia were evaluated. Enzyme-linked immunosorbent assay, flow cytometry, ultrasound, and histological diagnostics were used. Binary logistic regression was applied to construct a prognostic model, and the diagnostic significance of the indicators was assessed using ROC curves. Results. Detected APA high titers and/or lupus anticoagulant were associated with significantly elevated CPI incidence (63.1% vs. 4.6%; p < 0.001) and FGR (43.4% vs. 4.6%; p < 0.001). Immunological imbalance (increased percentage of B-lymphocytes and NK cells) increased CPI risk by 1.3–5.5 times. The constructed prediction model, which included indicators of immunological activity and comorbidity, demonstrated high accuracy: AUC = 0.89, sensitivity 85.7%, specificity 85.7%. Conclusion. The developed mathematical model allows for highly accurate prediction of CPI risk developing in women with a complicated obstetric history even before pregnancy, which opens up avenues for personalized selection of preventive measures, including immunomodulatory therapy and dynamic monitoring, and contributes to lowering frequency of perinatal complications.
Introduction. The ambulance intensive care medical staff are the first ones who take care of critically ill patients. The diagnosis is often not clear, so treatment may not be optimal, which will lead to a worsening of the patient›s condition. The prehospital diagnostic capabilities of are limited. There is a need for informative, safe, and fast methods of examining critically ill patients. Ultrasound diagnostics seems to be just such a convenient and effective method. The purpose of the work . To evaluate the effect of ultrasonography on the accuracy of diagnosis in patients with different types of shock, developed prehospitally, as well as on the hemodynamic state of patients at the time of their admission to the hospital. Materials and methods . A prospective cohort study was conducted: a comparison was performed between two groups of patients over the age of 18 who were diagnosed with traumatic, hypovolemic, or cardiogenic shock by ambulance intensive care teams. The first group (67 patients) underwent ultrasound with a portable ultrasound scanner using the eFast protocol, followed by measurement of the diameter of the IVC during inhalation and exhalation and calculation of the IVC collapsibility index. The second group (97 patients) was a control group, without performing ultrasound. The following parameters were analyzed for both groups: the dynamics of blood pressure, pulse, and the Algover index, the volume of infusion, the total time of prehospital (ambulance) care, and difference in the diagnoses of the ambulance and the hospital. Results and discussion. In patients with traumatic shock, the diagnosis was correctly established in 90% of cases, in the control group — i n 77% of cases. In patients with hypovolemic shock, the diagnosis was correctly established in 91%, in the control group — in 85%. There were no differences in diagnostic accuracy between the groups for cardiogenic shock. In patients of the first group with signs of traumatic and hypovolemic shocks, a statistically significant increase in systolic and mean blood pressure, a decrease in heart rate and the Algover index were detected after prehospital treatment. The volume of intravenous infusion in the first group was also significantly higher. The ultrasound did not affect the duration of prehospital medical care. Conclusion . Emergency ultrasound performed on ambulance for patients in a state of traumatic and hypovolemic shock is appeared to be an informative method that affects the therapeutic tactics of the ambulance intensive care teams. It is associated with higher hemodynamic parameters of patients admitting to the hospital after prehospital therapy. It leads to a statistically significant decrease in the differences in diagnoses of the ambulance and hospital.
Bladder cancer (BC), primarily urothelial carcinoma, remains one of the most common and lethal genitourinary malignancies worldwide, with limited long-term outcomes from standard treatments such as chemotherapy and radical cystectomy. These conventional modalities often fail to achieve durable responses and can severely affect patients’ quality of life, underscoring the need for more effective and targeted therapeutic strategies. Immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), and cytotoxic T-lymphocyte–associated protein 4 (CTsLA-4) have revolutionized BC therapy by restoring antitumor immune function. Nevertheless, treatment resistance, immune-related adverse events, and patient heterogeneity continue to limit their universal efficacy. This review provides an in-depth overview of ICI mechanisms and highlights evolving therapeutic approaches, including combination strategies with chemotherapy, radiotherapy, Bacillus Calmette–Guérin (BCG), and antibody–drug conjugates (ADCs). It also discusses emerging biomarkers such as PD-L1 expression, tumor mutational burden (TMB), and DNA damage repair (DDR) deficiency as predictive tools for treatment selection. Overall, this study underscores the pivotal role of immunotherapy in reshaping bladder cancer management and outlines future directions toward safe, personalized, and biomarker-driven therapeutic paradigms.
Purpose. To evaluate the effect of combined estrogen-progestin drugs (CEPD) in patients with meningioma of the brain on the frequency of continued growth in the postoperative period. Material and methods. A prospective study was conducted, including 55 patients with an intact uterus, who underwent neurosurgical treatment and received histological confirmation of the diagnosis of meningioma of the brain. The studied patients were divided into 2 groups: group I (control) had a history without taking CEPD (35/63.6%), group II (main) had a history of taking CEPD (20/36.4%). The age of the patients included in the study ranged from 35 to 53 years old. The effect of taking, duration of treatment and the relationship with recurrence were analyzed for 5 years after surgical treatment. Results. Continued growth was detected in 16.6% of patients in group I and 16% in group II) over the course of 5 years. Despite the absence of statistically significant differences between the two groups, a correlation was found between the duration of taking CEPD and continued growth in the postoperative period: the longer the patient took CEPD, the higher the probability of continued growth (r=0,595, p=0,009). Patients taking CEPD are characterized by a denser consistency and abundant vascularization of meningioma (p<0.05). Conclusion. The taking of CEPD is an undeniable factor affecting such morphological characteristics of the tumor as consistency and vascularization. Long-term administration of CEPD to patients is a risk factor for continued meningioma growth in the postoperative period. Цель исследования – оценить влияние комбинированных эстроген-прогестиновых препаратов (КЭПТ) у пациентов с менингиомой головного мозга на частоту продолженного роста в послеоперационном периоде. Материал и методы. Проведено проспективное исследование, включившее 55 пациенток с интактной маткой, которым выполнено нейрохирургическое оперативное лечение и получено гистологическое подтверждение диагноза менингиомы головного мозга. Исследуемые пациентки были разделены на 2 группы: I группа (контрольная) – в анамнезе без применения КЭПТ (35/63,6%), II группа (основная) – в анамнезе при- сутствовал прием КЭПТ (20/36,4%). Возраст пациенток, включенных в исследование, варьировался от 35 до 53 лет. Влияние приема, продолжительности КЭПТ и взаимосвязь с рецидивированием анализировали в течение 5 лет после оперативного лечения. Результаты. В течение 5 лет продолженный рост был выявлен у 16,6% больных I группы и у 16% – II группы). Несмотря на отсутствие статистически значимых различий между двумя группами, обнаружена корреляционная связь между продолжительностью приема КЭПТ и продолженным ростом в послеоперационном периоде: чем более длительным был у пациентки прием КЭПТ, тем выше была вероятность продолженного роста (r=0,595, p=0,009). Для пациенток, принимающих КЭПТ, были характерны более плотная консистенция и обильная васкуляризация менингиомы (p<0,05). Вывод. Прием КЭПТ является неоспоримым фактором, влияющим на такие морфологические характеристики опухоли, как консистенция и васкуляризация. Длительное применение пациентками КЭПТ является фактором риска продолженного роста менингиомы в послеоперационном периоде.
