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E. A. Kruglov, Yu. A. Pobedinseva, E. V. Filimonov, А. А. Ильин, Yu. A. Kolotilov, I. N. Yablokov, I. V. Chervonogorodskij, V. M. Unguryan
Research and Practical Medicine Journal, Volume 7, pp 155-163; doi:10.17709/2409-2231-2020-7-4-12

Abstract:
The occurrence of tracheal fistulas of ischemic genesis combined with the failure of esophagogastroanastomosis and the communication between them is a rare and formidable complication after esophagectomy with mediastinal lymphadenectomy due to its anatomical position and extensiveness. However, it is insufficiently documented in the literature, both in terms of treatment and in terms of its causes. This observation aims to demonstrate the rare cause of this complication and the atypical successful treatment. In this case, a patient with squamous cell carcinoma G2 of the middle third of the esophagus and TNM stage cT3NxM0. On the McKeown thoracoscopic-laparotomy esophagectomy intraoperatively a short arterial vessel with a diameter of about 3 mm, which passed through the paracancerous infiltration and supplied blood to the esophagus and trachea revealed. The vessel was not isolated from the infiltrate, but was clipped and crossed between the aorta and infiltrate to maintain surgery ablastic. On the 7th day after the operation the insolvency of esophagogastroanastomosis, the fistula of the trachea with mediastinum and the communication between the leak of esophagogastroanastomosis and the fistula of the trachea were diagnosed. We consider this combination as a special case of esophagogastroanastomosis fistula, complicated by the communication between the right pleural cavity and pneumothorax. According to our experience, partial leak of esophagogastroanastomosis successfully heals by secondary tension within 10–15 days against the background of cervicotomic wound drainage and feeding through a nasointestinal tube. In this case there was a leak of saliva in the mediastinum and its penetration into the lumen of the trachea and the right pleural cavity. Surgical diversion of the fistula and stenting of the trachea were considered, but not applied, as the fistula in our opinion was controlled, but the aggressive content of the gastric conduit prevented healing. The patient was on assisted lung ventilation with minimal pressure support and inflow increased oxygen fractio. For this reason, we considered the best stenting of the esophagogastroanastomosis leak area to be covered with a stent in order to stop the aggressive content of the gastric stem from entering the fistula, which led to the successful treatment of the developed severe complication. It should be noted that this method of treatment may be ineffective in patients who need pressure support during ventilation.
E. M. Frantsiyants, I. V. Kaplieva, L. K. Trepitaki
Research and Practical Medicine Journal, Volume 7, pp 27-35; doi:10.17709/2409-2231-2020-7-4-3

Abstract:
Purpose of the study. Analyzing the dynamics of VEGF-А, TGF-β and their receptors in the lung tissues in rats with antitumor effect of 1,3-diethylbenzimidazolium triiodide (Stellanin).Material and methods. The study included white outbred rats weighing 180–220 g. The main group included males (n=27) and females (n=27) with sarcoma 45 (s45) inoculated into the subclavian vein but not developed in the lungs (2×106 cells in 0.5 ml of saline) due to the subsequent intragastric administration of Stellanin (0.4 mg/kg once a day) according to an intermittent scheme: administration for 5 days and a break for 2 days. The control group included males (n=14) and females (n=14) without treatment with growing s45 in the lungs. Intact groups included 5 males and 5 females. After 4, 5 and 8 weeks of the experiment animals were decapitated, and levels of VEGF-A, sVEGF-R1, sVEGF-R2, TGF-β and sTGFβR2 were measured in 10% lung homogenates by ELISA (CUSABIO BIOTECH Co., Ltd., China).Results. Lung tissues of intact females showed 1.4 times (pConclusions. Stellanin prevents the development of malignant process in the lungs by inhibiting neoangiogenesis (deficiency of VEGF-A and excess of sVEGF-R1) and suppressing the proliferation of malignant cells (TGF-β growth).
D. N. Rovenskikh, S. A. Usov, S. V. Petrosyants
Research and Practical Medicine Journal, Volume 7, pp 19-26; doi:10.17709/2409-2231-2020-7-4-2

Abstract:
Цель исследования. Изучить результаты одномоментной препекторальной реконструкции молочной железы (ОППРМЖ) после подкожной мастэктомии по поводу рака с дополнительным укрытием эндопротеза полипропеленовым сетчатым имплантатом.Пациенты и методы. Серия последовательных наблюдений из 6 больных раком молочной железы T1–2N0M0 в возрасте от 34 до 47 лет. Всем выполнена операция подкожной мастэктомии, 2 — с сохранением сосковоареолярного комлекса («nipple- sparing») с ОППРМЖ силиконовым имплантом с покрытием из вспененного полиуретана (Polytech, Германия). Для профилактики миграции импланта его переднюю поверхность укрывали полипропиленовой сеткой (Ethicon/Johnson& Johnson, США) с фиксацией последней к большой грудной мышце.Результаты. В одном наблюдении имел место успешно излеченный незначительный некроз кожи в области края разреза. Других осложнений операций и рецидивов опухоли за весь истекший период наблюдения не было. Эстетический результат (симметрия субмаммарных складок, сосково- ареолярного комплекса (после nipple- sparing мастэктомии), формы и объема протезированной и контрлатеральной молочной железы) объективно и субъективно расценен как хороший, во всех наблюдениях. У всех больных развитие перипротезной соединительной ткани было минимальным (Бэйкер- I).Заключение. Первые результаты применения простого сетчатого полипропиленового имплантата при ОППРМЖ после подкожной мастэктомии по поводу рака для профилактики миграции импланта являются обнадеживающими. Степень развития перипротезной рубцовой контрактуры минимальная.
V. B. Filimonov , P. V. Vasin, V. N. Panchenko
Research and Practical Medicine Journal, Volume 7, pp 94-104; doi:10.17709/2409-2231-2020-7-4-8

Abstract:
Purpose of the study. To improve the results of treatment of benign prostatic hyperplasia with symptoms of the lower urinary tract in the presence of concomitant metabolic syndrome.Materials and methods. The investigation included 103 patients aged 42 to 75 years with a reliable diagnosis of BPH and signs of MS, according to the criteria of GFCF (2009). Patients were randomized into two comparable groups: Group 1 included 52 men who were prescribed tamsulosin in combination with targeted correction of metabolic disorders; Group 2 consisted of 51 men who were prescribed tamsulosin monotherapy. After 6 and 12 months of the study, the dynamics of metabolic parameters, prostate volume, residual urine volume, maximum urine flow rate, and total IPSS and QoL score were evaluated in each group of patients.Results. A direct correlation was established between the severity of metabolic disorders and the progression of BPH /LUTS in the main assessed indicators. The use of combination therapy with metformin, ACE inhibitors / ARA and statins in combination with tamsulosin showed efficacy after 6 and 12 months of the study compared with tamsulosin monotherapy. The treatment is based on the rinciple of T2T ("Treat to Target"): maintaining target levels of blood pressure, glucose, blood lipid parameters, and body weight correction.Conclusion. Overweight, arterial hypertension, the atherogenic profile of dyslipidemia and hyperglycemia are risk factors for more pronounced progression of BPH / LUTS and a deterioration in the quality of life of patients. The investigation IMSYPA showed the effectiveness of pathogenetically based complex therapy aimed at eliminating metabolic imbalance.
A. B. Novikov, V. P. Sergeev, D. V. Ergakov, E. A. Galliamov, A.G. Martov Martov
Research and Practical Medicine Journal, Volume 7, pp 105-117; doi:10.17709/2409-2231-2020-7-4-9

Abstract:
Internal stenting of the upper urinary tract is a widespread urological surgery. Its frequency in modern practice is high and continues to grow due to the widespread use of endourological, percutaneous, and laparoscopic interventions. The presence of a stent in the patient's body often leads to a decrease in the quality of life due to the occurrence of stent-dependent symptoms, which often requires urgent hospitalization. According to various data, they are registered in at least 80% of patients. The most common stent-dependent symptoms are frequent and / or painful urination, urge to mix (up to imperative), nocturia, pain in the lumbar region, macrohematuria. According to existing data, a fair share of responsibility for the development of these symptoms lies with the distal (vesicular) curl of the internal stent, especially if the technology of its installation is not followed or the length of the drainage is incorrectly selected. The review describes methods for correct installation of internal ureteral stents by transurethral retrograde, antegrade, and laparoscopic approaches, as well as a method for installing and removing mono-pigtail drains. The internal drainage procedure is standard, so the focus is on the nuances and details of this widespread manipulation. The given cohort of patients and the range of surgical interventions indicate a significant experience of the authors in this issue. All illustrations are author's own and taken from the daily workflow. It should be noted that the modern understanding of the process and technological equipment ensure correct stenting when performing any interventions with any access. An adequate choice of installation method and correct positioning of the stent, knowledge of simple details and "secrets" allow not only to restore urodynamics, but also to effectively prevent the development of stent-dependent symptoms, thereby preserving patients quality of life.
Yu. A. Belikova, Yu. V. Samsonov , E. V. Abakushina
Research and Practical Medicine Journal, Volume 7, pp 135-154; doi:10.17709/2409-2231-2020-7-4-11

Abstract:
Вакцины представляют собой успешный пример в современной медицине и отвечают за значительное снижение заболеваемости и смертности во всем мире. Очевидно, что необходимы исследования, позволяющие разработать эффективные вакцины против некоторых сложных патогенов, включая вирус иммунодефицита человека и гепатита C. В обзорной статье рассматриваются современные возможности создания вакцин как нового поколения, так и разработанных с помощью более ранних технологий, проверенных временем: живые аттенуированныйе вакцины, инактивированные, рекомбинантные, синтетические пептидные и субъединичные вакцины на основе вирусоподобных частиц, ДНК- и мРНК-вакцины. Однако многие инфекции все еще не поддаются профилактике с помощью имеющихся в настоящее время вакцин. Они являются основной причиной смертности во всем мире — например, вирус атипичной пневмонии, ближне-восточного респираторного синдрома и коронавирус 2 — SARS-CoV-2, вызывающий тяжелый острый респираторный синдром и коронавирусную болезнь 2019 года — COVID-19. Поскольку сегодня не существует эффективного лечения от COVID-19, актуальным является разработка вакцин для предотвращения инфекции. Целью большинства вакцин- кандидатов является индукция выработки нейтрализующих антител против SARS-CoV-2. В настоящее время разрабатывается несколько платформ, а некоторые потенциальные вакцины- кандидаты прошли клинические испытания I и II фазы. В России клинические испытания проходит вакцина на основе вектора ДНК аденовируса, в которую встроен ген вируса SARS-CoV-2.
V. V. Akhmetov, V. I. Dunaeva, F. A. Vryganov, S. V. Ordynets, И. П. Дуданов
Research and Practical Medicine Journal, Volume 7, pp 62-78; doi:10.17709/2409-2231-2020-7-4-6

Abstract:
Purpose of the study. Was to compare the early and long-term results of different variants of the classical KEAE.Materials and methods. In a retrospective study, we collected data on 1.242 patients who trans- ferred KEA from January 2011 to December 2019, using a patch was performed in 239 cases in 1003 — primary suture closure. We used 3 methods of arteriotomy closure with the use of a patch. There were 848 men and 394 women, the average age was 63.16 years, all of them were sympto- matic. Most patients had a transient disorder (49.2%) or ischemic stroke (50.8%). All patients had significant (moderate to severe) carotid stenosis. After the operation 5 (0.4%) patients had ischemic stroke, 1 (0.08%) had n. hypo-glossus damage, 3 (0.24%) had postoperative hematoma. The usual endarterectomy was performed without a shunt in all cases. All arteriotomies were mostly open. Early and late results of this procedure with a period of observation of at least 36 months were ana-lyzed: technical aspects of arteriotomy, features of restoration of the integrity of the vessel, changes in the "geometry" of the vessel, the use of zaplat. We studied the state of hemodynamics and complications in the early (30 days) and late postoperative period, the development of restenosis was compared between groups during the 36 months of observation. Results. When assessing the geometrical changes in the group with the patching, it was noted that the worst results were obtained using the technique with a U-shaped fixation suture on the distal part of the patch and the use of a wide patch. When using a narrow patch geometric changes in the width of the patch are the smallest. The main reason of the frequent geometrical changes in the dis-tal part of the patch was the patch wrapping inside the artery with the formation of a duplicate. The application of the modified technique of patch closure allowed to reduce the number of distortions in the operation area, to avoid the formation of artery stenoses in the place of patch imposition, to prevent changes in the bifurcation geometry of the internal carotid artery. The best results in the application of the primary edge suture were obtained by the method of closing the arteriotomy with the counter edge suture with the precision control of the application. The application of the U-shaped suture along the edges of the arteriotomy allowed avoiding deformations in this place. Con-trol of needle injection by means of straightening and lifting of the wall edge ensured absence of deformations in the suture.Conclusions. The post-CEAE closure technique affects the hemodynamic profile. Sewing patch-ing does not seem to create favorable flow dynamics. Consideration should be given to the elective use of the patch to improve disturbed flows. However, the linear precision suture remains the method of choice for suturing the arteriotomy.
L. I. Moskvicheva, L. V. Bolotina
Research and Practical Medicine Journal, Volume 7, pp 118-134; doi:10.17709/2409-2231-2020-7-4-10

Abstract:
Currently, pancreatic cancer remains one of the most unfavorable tumor pathologies, characterized by pronounced difficulties in diagnostics and treatment, a significant impact on the ability to work and quality of life of patients, and low indicators of patient life expectancy. Features of the development of malignant neoplasms of this localization contribute to limiting the possibility of performing radical surgery, and therefore a special role in the treatment of patients with pancreatic cancer is assigned to chemotherapy. Specific systemic drug therapy for this pathology is the most important and, in the majority of cases, mandatory element of treatment. It can be carried out in a neoadjuvant, adjuvant and independent mode, include mono- or multi- component schemes, and be combined with other types of systemic or local antitumor effects. The choice of chemotherapy regimen depends primarily on the General somatic status of the patient and is determined by the potential toxicity of a particular combination of cytostatics. This review of the literature demonstrates the effectiveness of various chemotherapy regimens in patients with stage III–IV pancreatic cancer in the first and second lines, describes the frequency of adverse reactions to treatment and their nature, and mentions ways to reduce the toxicity of multicomponent drug therapy regimens. This review is based on the analysis of scientific sources of the Internet resource "National Center for Biotechnological Information".
P. G. Berezin, V. V. Milovanov, A. A. Ivannikov, N. A. Ognerubov
Research and Practical Medicine Journal, Volume 7, pp 79-93; doi:10.17709/2409-2231-2020-7-4-7

Abstract:
Purpose of the study. To determine the effectiveness of antiandrogenic therapy — 10-year General and tumor-specific survival (OV, OSV) depending on the type of hormone therapy, the stage of the disease, and the risk of progression.Patients and methods. The study was based on a retrospective analysis of 100 patients with localized, locally advanced, and metastatic prostate cancer over the period 2008–2018. The assessment was conducted in 2019. All patients received antiandrogenic treatment in the form of castration therapy (n=59) and combined (complex) treatment (n=41) in various variants and modes for more than 5 years. Patients had a 100% 5-year survival rate. The control point of the study was General and tumor- specific survival, as well as prognostic factors that determine this survival. Results. By the end of the study, 53 (53%) patients were alive, 8 (8%) died, and 39 (39%) patients were censored. The highest percentage of 10-year overall survival was achieved in localized stages of the disease and was 52% (31 patients) — stage 1, 38% (22 patients) — stage 2. Tumor specific survival rate (1–2 stages) — 62% (33 patients). At stage 3–30% (14 patients) and 51% (21 patients) and at stage 4–18% (1 patient) and 32% (2 patients), respectively. Depending on the risk of progression (Gleason index), high rates of both General and tumor- specific survival were achieved with low Gleason (2–5), and moderate risk of Gleason progression (6–7), and were 85% and 62%, respectively. The most effective method of treatment that determines the 10-year overall survival was combined (hormone radiation) therapy, which allowed to achieve results in 75% of patients. The tumor — specific survival rate was more than 80%.Conclusion. In real clinical practice, the use of antideprivation therapy in various variants and modes allows to obtain a 10-year General and tumor- specific survival rate in 75% and more than 80% of patients. Stratification of patients by risk groups forms a personalized approach to the treatment of each patient. Use of research treatment regimens in the work STAMPEDE, CHAARTED allows to increase the overall survival of patients with metastatic stage of the disease.
K. N. Movchan, K. E. Chernov , B. S. Artyushin , A. V. Zharkov, A. Yu. Chernova
Research and Practical Medicine Journal, Volume 7, pp 164-174; doi:10.17709/2409-2231-2020-7-4-13

Abstract:
Cystectomy, as a type of surgical treatment, is performed for various diseases of the bladder. Most often — with malignant tumors, as well as with benign pathological conditions. Complications in the postoperative period in patients undergoing cystectomy are mainly caused by the need to ensure adequate urine derivation. One of the options for solving this problem is the implementation of ileocystoplasty, which, in turn, is associated with the performance of technically difficult and large-scale manipulations during the operation. Successful prevention of severe complications of cystectomy (or their elimination) is probably possible only in those multidisciplinary medical organizations in which the provision of medical care to patients with urological oncology is a daily programmed activity. Outpatient health care specialists play a special role in routing patients with bladder diseases, and not only their formal referral and delivery to multidisciplinary medical and prophylactic institutions in an emergency mode with “on-duty” syndromic diagnoses such as “renal colic or hematuria”. At present, in St. Petersburg, all conditions have been created for the concentration of patients with severe diseases of the bladder in a number of specialized medical organizations, in which a large number of cystectomies with intestinal plastic are routinely performed annually, which makes it possible with a high probability to guarantee a favorable clinical outcome without discrediting method of the rarity of its implementation.
V. V. Tokmakov, E. P. Ulianova, Yu. S. Shatova, A. B. Sagakyants, N. M. Mashchenko, I. A. Novikova, E. M. Nepomnyashchaya, O. G. Shulgina
Research and Practical Medicine Journal, Volume 7, pp 10-18; doi:10.17709/2409-2231-2020-7-4-1

Abstract:
Цель исследования. Оценить прогностическую роль уровня экспрессии E- и N-кадгерина в опухолевой ткани у пациенток с первично- операбельным люминальным раком молочной железы без гиперэкспрессии Her2/neu в постменопаузе для включения в панель комплексной оценки биологических показателей в опухоли при определении прогноза данного заболевания.Пациенты и методы. Материалом послужила выборка из 120 пациенток, которые были поделены на две группы: с Люминальным А и Люминальным В подтипами. Для оценки прогностического значения E- и N- кадгерина у пациенток обеих групп были проанализированы уровень экспрессии и корреляционная связь с помощью U-критерия Манна- Уитни и критерия корреляции Спирмена; общая выживаемость до прогрессирования и опухоль- специфическая при различных значениях изучаемых биомаркеров — методом Каплана- Мейера.Результаты. Различия в среднем уровне экспрессии в ходе исследования оказались статистически не значимы (p>0,05). При определении E-кадгерина разница наблюдалась в 2 раза выше в Люминальном А — 55,4±5,2 — по сравнению с Люминальным В — 28,1±4,9), N- кадгерина — в 1,3 раза ниже в Люминальном А — 12,8±5,3 — по сравнению с Люминальным В — 17,06±5,4. В группе с Люминальным В прослеживалась тенденция к потере E-кадгерина и усилению экспрессии N-кадгерина, которая часто связана с плохим прогнозом. Однако, корреляционная связь между данными маркерами также была статистически не значима (p>0,05).Заключение. Таким образом, несмотря на различия в уровне экспрессии Е- и N-кадгеринов в исследуемых группах, данные маркеры не показали своей прогностической значимости и поэтому не были включены в панель для комплексной оценки биологических показателей в опухоли при определении прогноза заболевания люминального В РМЖ без гиперэкспрессии Her2/neu в постменопаузе.
V. N. Diomidova, M. A. Safonova, O. V. Zakharova, A. N. Dmitrieva, O. A. Efimova
Research and Practical Medicine Journal, Volume 7, pp 51-61; doi:10.17709/2409-2231-2020-7-4-5

Abstract:
Purpose of the study. To study the diagnostic informativeness of magnetic resonance imaging (MRI) with the assessment of diffusion- weighted images and the measured diffusion coefficient in the diagnosis of endometrial tumor lesions in polyineoplasias.Materials and methods. The article presents the results of a study of patients with synchronous and metachronous polyneoplasias who were in the AU "Republican clinical oncological dispensary" of the Ministry of health of the Chuvash Republic from 2014 to 2018. All were performed magnetic resonance imaging on Excelart Vantage Atlas (Toshiba, Japan, 1.5 T), ultrasound (Aplio, Xario and Nemio, Toshiba, Japan; Sono Scape, China), x-ray computed tomography on Light Speed VEX Plus and Light Speed RT 16 (GE, USA). All MRI results were compared with morphological data obtained afterhistomorphological examination of the postoperative material. The differences were considered significant at values p≤0.05.Results. 80 cases of endometrial tumor lesions in polyineoplasias (N1a) were detected, which was 44.7% of all cases of the main group (N1; n=179), of which metachronous polyineoplasias were found in 56 (70.0%), synchronous — in 11 (13.7%), combined — in 13 (16.3%) patients. The informative value of MRI in the diagnosis of malignant neoplasms with lesions of the endometrium when multiple neoplasias were: sensitivity of 91.3%, specificity — 82,4%, accuracy was 89.7% (pConclusions. Magnetic resonance imaging using the diffusion- weighted image Protocol with an assessment of the measured diffusion coefficient has shown high information both in the diagnosis of primary endometrial tumor lesions in primary multiple malignancies, and in establishing the stage of the tumor process and in the diagnosis of subsequent malignancies.
M. A. Senchukova , E. V. Makarova, E. I. Shurygina , N. N. Volchenko
Research and Practical Medicine Journal, Volume 7, pp 36-50; doi:10.17709/2409-2231-2020-7-4-4

Abstract:
Purpose of the study. To give a qualitative and quantitative assessment of different types of tumor microvessels depending on the histological type of cervical cancer (CC).Material and methods. The tumor samples from 76 patients with CC stage I–IIA who received the surgical treatment on the first phase were the object of study. The immunohistochemical study was performed using antibodies to CD34 and podoplanin. Statistical analysis of the data was performed using the Statistica 6.0 software.Results. In CC, the following types of tumor microvessels have been identified: normal microvessels, dilated capillaries (DCs) with a normal endothelial lining, DCs with a weak expression of CD34, DCs of contact type, capillaries in the solid component of tumor, the atypical dilated capillaries (ADCs), the structures with partial endothelial lining and the lymphatic capillaries in lymphoid and polymorphic cell infiltrates. It was found that DCs with a mild expression of CD34 (p=0.0005), DCs of contact type (p=0.000005), and capillaries in the solid component of tumor (p=0.006) were correlated with the prognosis in early CC. The detection frequency of this tumor microvessels was lower in more prognostically favorable squamous non-keratinizing CC, while in the prognostically unfavorable squamous cell keratinizing CC and adenocarcinoma of the cervix uteri, the higher DCs values with a mild expression of CD34 (р=0,004 and р=0.005, respectively) and DC of contact type (p=0.02 and p=0.14, respectively) were typical.Conclusion. We consider it is expedient to further study the relationship of different types of tumor microvessels with clinical and morphological characteristics and prognosis of cervical cancer.
Л. Е. Валькова, M. L. Levit, V. M. Merabishvili, A. Yu. Pankrateva, M. V. Krupina, D. M. Dubovichenko , A. V. Agaeva, A. Yu. Ryzhov, E. F. Potekhina, M. Yu. Valkov
Research and Practical Medicine Journal, Volume 7, pp 175-182; doi:10.17709/2409-2231-2020-7-4-14

Abstract:
Цель исследования. Провести анализ динамики смертности населения от злокачественных новообразований (ЗНО), выявляемых при реализации онкологического компонента диспансеризации отдельных групп взрослого населения (ДОГВН) по данным Архангельского областного канцер-регистра (АОКР) за период с 2006 по 2019 гг.Материалы и методы. Из базы данных АОКР были извлечены анонимизированные данные больных ЗНО ободочной, прямой кишки, легкого, молочной железы, шейки, тела матки, яичников, предстательной железы, почки, подлежащими обследованию (скринингу) на первом этапе ДОГВН — индексные ЗНО (иЗНО). Сравнивали усредненные грубые и стандартизованные по возрасту (мировой стандарт ВОЗ 2001 г.) показатели смертности в периоды до (2006–2012 гг.) и после введения ДОГВН (2013–2019 гг.) во всей популяции, а также у мужчин и женщин и в возрастных группах 15–59 лет для мужского и 15–55 лет для женского населения («смертность в трудоспособном возрасте») и 30–69 лет («преждевременная смертность»). Проводили сегментированный анализ динамики показателей смертности. Интервенционное значение ДОГВН считали положительным в случае снижения линейного тренда смертности в период между 2013 и 2017 гг.Результаты. Всего в анализ включено 33824 случая смерти. От иЗНО погибли 25106 (74,2%) больных, доля смертей от других причин варьировала от 14% при раке легкого до 83% при раке шейки матки и предстательной железы. Грубый показатель смертности после введения ДОГВН возрастал при всех иЗНО, за исключением рака шейки матки, стандартизованный по возрасту — при раке тела матки и простаты. При раке легкого зарегистрировано снижение стандартизованных по возрасту уровней смертности у мужчин с 64,7 до 60,3 на 100 000 населения и повышение 5,1 до 6,5 на 100 000 населения у женщин. Показатели «смертности в трудоспособном возрасте» были низкими при всех иЗНО, за исключением рака шейки матки и молочной железы и не различались между периодами; «преждевременная смертность» снизилась только при раке легкого у мужчин с 40,1 до 36,2 на 100 000 населения, при других иЗНО различий между периодами не выявлено. При сегментированном анализе значимых изменений трендов смертности не обнаружено.Заключение. Снижения смертности при всех девяти иЗНО в период после введения ДОГВН не выявлено, что, вероятно, связано с ростом онкологической заболеваемости в этот период и недостаточностью времени последующего наблюдения. Положительные сдвиги после введения ДОГВН могут быть обнаружены при сравнительном анализе выживаемости, не подверженной влиянию вариаций заболеваемости.
L. N. Izurov, J. A. Zuenkova
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 99-107; doi:10.17709/2409-2231-2020-7-3-10

Abstract:
One of the elements of the quality of medical care is its accessibility, which depends on the material and technical base of the institution, as well as on the availability of stuff and work management. Implementation of the new clinical guidelines of the Association of Oncologists of Russia (AOR) for the treatment of non-melanoma skin cancer (NRC), revealed the problem of increasing the load on stuff and equipment. Purpose of the study. To investigate and forecast the load of the kilovoltage X-ray therapy unit taking into account the updated clinical guidelines for the treatment of patients with non-melanoma skin cancer using radiotherapy. Determine the clinical and organizational changes in the technology of x-ray therapy for non-melanoma skin cancer within the day-hospital department for the skin cancer size more than 2 cm after implementation of new clinical guidelines and fraction regimes in compare with previously used schemes; derive a mathematical model of the work of the kilovoltage x-ray therapy room. Materials and methods. Data from the kilovoltage X-ray therapy office of radiotherapy unit No. 2 of the Sverdlovsk Regional Oncology Dispensary (SROD) were used. The average duration of radiotherapy sessions per patient was estimated and calculated using timekeeping. The results were evaluated using correlation analysis. In order to forecast the use of material and human resources, an economic method of mathematical modeling was used. Results. The analysis of the kilovoltage X-ray therapy unit of radiotherapy department No. 2 of the SROD for 3 years showed an increase from 10.4 to 17.3 in the average number of therapeutic fractions per patient after the implementation of the updated clinical guidelines. An increase in the average number of radiotherapy sessions leads to a doubling of the average bed-day of the patient's stay in the day-hospital. The formula was proposed for predicting the work of the unit. There is a clear correlation between the duration of treatment, the dynamics of hospitalization and the number of treated patients. The calculated results obtained using a mathematical model fully correspond to the actual performance of the radiotherapy room. Conclusion. To ensure optimal availability of medical care, it is necessary to match treatment technologies with available resources of the organization. The introduction of new treatment programs may require both the expansion of staff (medical, nursing), and an increase in the number of units of medical equipment. The obtained mathematical model of the kilovoltage X-ray therapy room allows to predict the optimal mode of work of employees while maintaining the quality and accessability of medical care.
Nina Kulchenko
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 74-82; doi:10.17709/2409-2231-2020-7-3-7

Abstract:
At the turn of 2019–2020, humanity was struck by a new viral infection SARS-CoV-2 (COVID-19), which quickly spread in many countries and reached the scale of a pandemic. A feature of the SARS-CoV-2 virus (COVID-19) is it’s high contagiousness, virulence and tropism to many cells of human organs. Human infection primarily occurs through the respiratory tract. Then, getting into the respiratory divisions, SARS-CoV-2 (COVID-19) can enter the blood and interact with cells of other organs. It is already known that COVID-19 uses the angiotensin converting enzyme type 2 (ACE2) receptor to enter the cell, and ACE2 is highly expressed in the kidneys. Therefore, kidney disease is a risk factor for COVID-19 infection, exacerbating the clinical course of the disease. This article discusses the main aspects of the etiology and pathogenesis of kidney diseases in the context of the COVID-19 pandemic. Since there is currently no specific vaccine against the SARS-CoV-2 virus, and there is no effective drug for the treatment of COVID-19, the identification of risk factors and early medical correction of kidney diseases can help reduce the overall incidence and mortality. Conclusion. Early detection and correction of violations of filtration and excretory function of the kidneys, including adequate hemodynamic support and restriction of nephrotoxic drugs, can improve the prognosis of recovery of a patient with COVID-19.
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 136-145; doi:10.17709/2409-2231-2020-7-3-14

Abstract:
Most of cancer patients are faced with various nutritional disorders at the process of anticancer treatment. Cancer-induced metabolic abnormalities are impeded muscle recovery even with normal nutritional support. As a result, malnutrition can develop into the cancer anorexia-cachexia syndrome, aggravate the disease and adversely affect the outcome of treatment. Purpose of the study. Evaluate the effectiveness of oral nutritional support in cancer patients at different stages of antitumor treatment. Materials and methods. The literature research was conducted with keywords «quality of life», «nutritional support», «oral nutrition», «cancer» in such databases as eLIBRARY and MEDLINE in Russian and English. There was performed an analytical review of various methods of quality of life assessing, methods for assessing nutritional status and measures of choice for the necessary nutritional therapy in cancer patients. Results. Nutritional support at all stages of treatment for cancer patients may have an impact on treatment outcomes and the incidence of complications. In case of palliative care, nutritional support can be aimed at improving patient's quality of life and reducing the severity of a number of clinical symptoms, in particular, such as nausea and vomiting. Conclusion. It has been shown, that individual and intensive elimination of nutritional defects improves the quality of life of patients, especially if this occurs at an early stage of the disease. Further study of the effect from nutrition-oriented interventions in cancer patients undergoing treatment, is needed.
A. N. Kazantsev , K. P. Chernykh, Nona E. Zarkua , R. Y. Lider, Kubach G. Kubachev, G. S. Bagdavadze, E. Y. Kalinin, Tatyana E. Zaitseva, A. E. Chikin, Yu. P. Linets
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 33-42; doi:10.17709/2409-2231-2020-7-3-3

Abstract:
Purpose of the study. Comparison of hospital and long-term results of autoarterial reconstruction of carotid artery bifurcation and the formation of a new bifurcation with an extended atherosclerotic lesion of the internal carotid artery (ICA). Materials and methods. In the period from January 2018 to May 2020, this cohort, comparative, prospective, open-label study included 279 patients with an extended atherosclerotic lesion of the ICA operated on in the Alexandr Hospital. Depending on the implemented strategy of surgical correction, all patients were divided into two groups: group 1 (n=132) — autoarterial reconstruction of bifurcation of the carotid arteries; Group 2 (n=147) — the formation of a new bifurcation. Complications were recorded in the hospital and long-term postoperative periods. The total follow-up period was 16.4±9.3 months. The endpoints of the study were such adverse cardiovascular events as death, myocardial infarction (MI), stroke, thrombosis / restenosis of the anastomosis zone, combined endpoint (death from stroke / IM + IM + stroke). Results. The ICA clamping time in group 1 was 32.6±3.3 minutes, in group 2 – 31.7±3.5 minutes, which did not receive statistically significant differences (р=0.81). In the hospital postoperative period, adverse cardiovascular events were not recorded. In the long-term follow-up, the groups were comparable in the frequency of all complications. Identified lethal outcomes developed as a result of the formation of MI in patients with multiple lesions of the coronary arteries and a history of myocardial revascularization. The likely cause was shunt / stent thrombosis with subsequent coronary insufficiency and an increase in ischemic heart damage. The causes of stroke, recorded in each group in isolated cases, were the presence of atrial fibrillation. Patients did not comply with the recommended regimen of anticoagulant therapy, which provoked the development of cerebral catastrophe. In turn, the identified restenoses of the reconstruction zone were asymptomatic and were also observed in isolated cases in each group in the period 12 months after CEE. Conclusion. Autoarterial reconstruction of carotid bifurcation and the formation of a new bifurcation are comparable in safety and effectiveness methods of surgical treatment of an extended atherosclerotic lesion of the ICA. Operation techniques differ in the choice of an artery that is cut off from bifurcation — the external carotid artery or ICA. Further, the reconstruction progress is absolutely identical. Hospital and long-term follow-up results showed minimal indicators of the development of cardiovascular and hemodynamic changes due to the type of operation. Thus, both reconstruction techniques can be the operation of choice for an extended ICA lesion.
S. A. Ivanov, L. O. Petrov, D. V. Erygin, I. A. Gulidov, A. A. Karpov
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 10-20; doi:10.17709/2409-2231-2020-7-3-1

Abstract:
Purpose of the study. Direct evaluation of the antitumor effectiveness of neoadjuvant chemoradiotherapy for rectal cancer using local electromagnetic hyperthermia. Materials and methods. The analysis of the direct results of treatment of patients with locally advanced rectal cancer in the clinic of the MRRC them. A.F.Tsyba is a branch of the Federal State Budgetary Institution Scientific Research Center for Radiology of the Ministry of Health of Russia from 2015 to 2018. The study included 2 groups of patients: the study group of 54 patients and the control group of 56 people. All patients underwent a comprehensive examination with the aim of staging and morphological verification of the tumor. Patients of the study group in the neoadjuvant mode received conventional radiation therapy with classical dose fractionation in ROD 2 Gy, up to SOD 50 Gy, for 5 weeks with CAPOX chemotherapy, and local electromagnetic hyperthermia on the Yacht 4 unit, in the amount of 6 sessions. Patients in the control group received neoadjuvant treatment in an absolutely identical manner, with the exception of local hyperthermia. After the end of neoadjuvant therapy after 8–10 weeks, a comprehensive examination was again performed to assess the response of the tumor and a decision was made to conduct surgical treatment. During the follow-up examination, the following parameters were evaluated: tumor regression according to clinical and radiological examination. After surgical treatment, a comprehensive evaluation of the removed drug was carried out, including an assessment of the degree of therapeutic tumor pathomorphism according to Lavnikova G. P. Results. When conducting a comparative analysis of the frequency of complete clinical regressions of the tumor in the thermo-chemoradiotherapy group, we more often recorded the full clinical response, 12 patients (22%), compared with the chemoradiotherapy group, 8 patients (14%). In terms of partial response and stabilization in the chemoradiotherapy group, partial regression was observed in 75% of patients, while in the thermochemioradiation group only in 52% of cases. Stabilization in the study and control groups was 14% and 6%, respectively. All patients of the study and control groups with partial tumor regression and stabilization underwent surgical treatment. As a result, the frequency of surgical operations in the control group was slightly higher than 48 (85.7%) versus 42 (77.7%) from the main group (p>0.05). When analyzing the frequency of a complete pathomorphological response, we noted that in the thermochemo-radiation therapy group it was 34% versus 4% in the chemo-radiation therapy group. On the contrary, pathomorphism of the 1st degree was much more common in patients of the control group — 21% versus 2% in the study group. The differences in both cases are statistically highly significant (p2 15, χ27). Conclusion. The use of thermochemoradiotherapy with high statistical significance (p
M. Yu. Vlasova, A. D. Zikiryahodzhaev, I. V. Reshetov, A. S. Sukhotko, E. K. Saribekyan, F. N. Usov, I. M. Shirokikh, T. S. Berestok, A. V. Tregubova
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 63-73; doi:10.17709/2409-2231-2020-7-3-6

Abstract:
Breast cancer is one of the most frequently diagnosed malignancies in the Russian Federation (RF), accounting for 20.9% of the female population in Russia. The surgery remains the primary treatment for breast cancer. Development and improvement of various options for reconstructive plastic surgery provides medical, psychological and social rehabilitation in patients with breast cancer, allows to achieve the best aesthetic and functional results. The possibility of performing such operations contributes to improving the quality of life of patients. According to ASPS (American Society of Plastic Surgeons), 80% of breast cancer reconstructions in the world are performed using silicone implants. Currently, the return of prepectoral space for placement of endoprostheses during breast reconstruction is trending, which is associated not only with the improvement of mastectomy techniques, but also with the coating of implants and the appearance of silicone highly adhesive gel filling of implants. According to the world literature data, the use of polyurethane-coated endoprostheses for prepectoral/subcutaneous reconstruction reduces the risk of capsular contracture, provides a more reliable fixation to the surrounding tissues, and thus allows breast reconstruction without the need for additional cover of the endoprosthesis. The use of the prepectoral space is characterized by a simpler operation technique compared to the retromuscular placement of the implant, the absence of damage to the large pectoral muscle, minimization of pain, reduction of the bed-day in the hospital and a faster rehabilitation period. So, this type of breast reconstruction can be considered as an alternative to submuscular implant placement in primary operable forms of breast cancer with sufficient thickness of the integumentary tissues.
V. S. Usachev, E. I. Smolenov, Yu. A. Ragulin
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 51-62; doi:10.17709/2409-2231-2020-7-3-5

Abstract:
Lung cancer is one of the leading causes of death in the world. Despite improvements in diagnostic procedures, most cases of this disease are diagnosed at common and metastatic stages. In recent years, new approaches to systemic antitumor treatment have been registered, which are the main method of treatment in patients with stage IIIB-IV. The diagnosis and staging of patients with lung cancer in recent decades has increasingly relied on minimally invasive tissue sampling techniques, such as endobronchial ultrasound (EBUS) or endoscopic ultrasound (EUS) needle aspiration, transbronchial biopsy, and transthoracic image guided core needle biopsy. These modalities have been shown to have low complication rates, and provide adequate cellular material for pathologic diagnosis and necessary ancillary molecular testing. It is important to understand how a small amount of biopsy material obtained using minimally invasive techniques is processed and evaluated by pathologists. An important condition is obtaining a sufficient number of cell or tissue substrate, can reliably establish the malignant process, to determine the histologic tumor type (whether it’s adenocarcinoma or squamous cell carcinoma), carry out the immunohistochemical and molecular genetic study to determine indications for the purpose of targeted, immunotherapy and the selection of chemotherapy regimen. It is necessary to conduct a single procedure that is as gentle as possible and provides a sufficiently large amount of tissue. The method of obtaining the material should be selected individually depending on the location of the pathological formation, the patient's condition and the capabilities of the clinic.
Vladimir Kuznetsov, Kirill Kosilov
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 108-118; doi:10.17709/2409-2231-2020-7-3-11

Abstract:
Purpose of the study. The goal is to conduct a comparative analysis of the correlation of learning success with self-assessment of physical and mental status and objective health status, taking into account the influence of demographic and socio-economic variables in senior students of medical and humanitarian specialties Materials and methods. The study was conducted from 01.12. 2017 to 01.03.2019 at the Far Eastern Federal University and the Pacific State Medical University. The sample size was 410 students (207 (50.6%) female, 203 (49.4%) male, average age 21.5 (1.2) years), who at the time of the study were studying in 4–6 courses. Information on demographic parameters, social conditions of study, residence, subjective data on morbidity and appeal was collected using: a comprehensive questionnaire on student status of a university (Pozdeeva, 2008; with additions of authors). The objective state of health and the comorbidity index were investigated when studying the medical documentation of medical institutions attached: Form 025 / y; 001–1 / y; 062 / y. In the study of quality of life associated with health, we used the international questionnaire “A short form of self-assessment of quality of life related to health MOS SF-36”. Results. The total score of self-esteem of physical well-being among students of humanities was 66.1 points, among students of medical specialties 56.4 points. Academic performance was higher among students of both directions, marking their learning conditions as satisfactory and good (r = 0.034; r = 0.048 / r = 0.045; r = 0.065). Student performance was also higher for students in both areas, evaluating the quality of education as high (r = 0.032; r = 0.046 / r = 0.033; r = 0.043), but lower for students with a high comorbidity index (r = –0.038 / r = –0.036). We also found that an increase in the number of HRQoL points is accompanied by a significant increase in academic performance in students of both directions (r = 0.035; r = 0.045 / r = 0.033; r = 0.050). An analysis of the linear regression model describing the association of academic performance with variables in the pooled sample revealed that this indicator strongly correlates with the comorbidity index (r = 8.27), HRQoL (r = 7.28), quality of education, and family income (5.55 / 5.06). At the same time, academic performance had an unreliable relationship with age, individual income, and weakly correlated with the conditions of study and residence. Conclusion. Chronic morbidity among senior medical and humanitarian students is high (comorbidity index 1.5–1.7), but the total self-assessment of the quality of life associated with health is 59–62 points and falls within the normal range of values. Thus, despite the high level of chronic somatic pathology, students generally positively assess their physical and psychological status.
E. V. Gameeva , A. A. Kostin, G. S. Alekseeva , E. Yu. Ogneva, Polina G. Gabay , L. V. Pashigorova, E. V. Kalita
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 119-126; doi:10.17709/2409-2231-2020-7-3-12

Abstract:
Purpose of the study. To analyze the legal issues, related to the definition of «medical rehabilitation» established in Russian legislation. Materials and methods. A comparative review of the definitions "medical rehabilitation" formulated by World Health Organization and the Russian legislator is made. The main problems of the legal definition of "medical rehabilitation" are studied, including: the problem of distinguishing between "medical rehabilitation" and "treatment". Results. The definition of the term "medical rehabilitation" and terminology used for medical rehabilitation are not consistent in Russian law (legislation still includes such archaic definitions as "rehabilitation treatment" and "rehabilitation medicine"). There is also no unified approach to the question of whether medical rehabilitation is a part of treatment or whether it is an independent stage of medical care. The boundaries between the concepts of "medical rehabilitation" and "treatment" are blurred. Conclusion. The absence of clear boundaries between the definitions of “medical rehabilitation” and “treatment” leads to the risk of violation of licensing requirements by medical organizations, because to determine the list of works (services) to be licensed, it is necessary to correctly determine the specifics of the services provided. The correct classification of a service as medical rehabilitation or medical treatment also effects on the specialization of the involved medical specialists, as well as on the allocated structural units of medical organization. The analysis shows that the main difference between treatment and rehabilitation is the approach. The approach to rehabilitation is broader, it’s primary goal is to return the patient to his previous social status, rather than clinical recovery. At the same time, the main difficulty in distinguishing the mentioned above definitions is related to the fact that the method underlying the medical service is actually licensed, but the same tools and methods can be used both in treatment and medical rehabilitation. Due to these ambiguities, it appears that the current legislation needs to be improved.
Sergei Y. Lomakov
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 127-135; doi:10.17709/2409-2231-2020-7-3-13

Abstract:
Purpose of the study. To form proposals for improving the organization of the radiology diagnostics service in Oncology. Materials and methods. In 2019, the opinion of radiation diagnostics doctors (n=230) on the availability and quality of radiation studies for cancer patients was studied. The obtained empirical data were statistically processed with the calculation of intensive and extensive indicators, average values (M±δ) with a risk of error of 0.05. The student's t-test was used to assess the statistical significance of differences. The original data had a normal distribution. Individual parameters of the research results were given a score. Results. Radiologists highly rated the quality of their primary specialization for working with cancer patients (4.6 ± 0.3 points) and further postgraduate education (4.2 ± 0.8 points), but 38.6% need to deepen this knowledge. The respondents indicated that patients are not sufficiently informed about radiation studies, including: about the methods (67.3%); about contraindications (34.3%); about the procedure for obtaining a conclusion (30.8%); about the established waiting times (21.7%); about the procedure for pre-registration (15.6%). 33.9% of doctors pointed to the unreasonableness of radiological examinations in certain cases in cancer patients. According to the respondents, it will improve the quality and availability of medical care for cancer patients: additional training of radiologists (70.0%) and clinicians (42.6%); equipping medical institutions (38.2%), a separate procedure for routing cancer patients to radiological research (44.7%); increasing the staff of radiologists (36.1%) and nurses (17.4%); using telemedicine technologies (31,7%); excluding cases of unjustified referral of patients to research (27.3%); uninterrupted operation of medical equipment (27.3%). Conclusion. The results of the study revealed systemic shortcomings in the organization of the radiation diagnostics service in providing medical care to patients with cancer, the elimination of which will improve the system of organizing medical care for them, improve its quality and accessibility.
V. A. Lipatov , D. A. Severinov , M.D. Z. Naimzda, E. L. Puchkova
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 21-32; doi:10.17709/2409-2231-2020-7-3-2

Abstract:
Purpose of the study. To evaluate the dynamics of deformation of spongy application hemostatic materials in an in vitro experiment. Materials and methods. As materials of the study the following samples of hemostatic materials were used: Tachocomb (No. 1), Gelita-Spon Standard (No. 2), Reggicel Fibrillar (No. 3), samples of hemostatic sponges developed jointly with Lintex (St.Petersburg, Russia) on the basis of sodium-Carboxymethyl Cellulose (No. 3): Samples were placed on a glass substrate which was mounted on the rising REM cross-arm 0.2–1 to estimate 50% compression residual strain. A glass substrate rigidly attached to the indenter was mounted so that its lower surface would touch the upper surface of the sample. The crossarm was then lifted at 30 mm/min, compressing the sample until the force reached 50 N, after which the sample was allowed to stand under pressure for 10 seconds. After the load was removed, the sample was removed from the substrate and the compression thickness measured (immediately after compression, after 5, 10 and 30 minutes). Results. The values of the compression residual deformation on the thickness 50% (immediately after the load removal) of the samples of group No. 1 differ statistically significantly from the values of groups No. 2 and No. 3 on 5.92 and 3.51, respectively. The difference between groups No. 1 and No. 4 is 5.61. The ODP values 50% 5 minutes after the load of Group No. 1 samples was removed differ from Groups No. 2 and No. 3 on 5.93 and 3.85, respectively. The difference between groups No. 1 and No. 4 is 6.57. After 30 minutes after compression, the values of the residual deformation of the samples of group No. 1 differ from those of groups No. 2 and No. 3 on 6.9 and 4.3. The difference between groups No. 1 and No. 4 is 6.9. Also, the values of the residual deformation of the samples of group No. 2 exceed the values of the samples of group No. 3 by 1.6 times, and in comparison with group No. 4 is less by 0.03. There are fewer statistical differences with other groups in pilot groups 5–7. Conclusion. The highest values of the indicator "residual deformation at compression by thickness 50%" are noted in group No. 7 (samples based on Na-CMC unpressurized) — 32.34, which causes high mechanical properties of jaws made from this material.
Н. В. Воробьев, F. S. Ashyrova, M. P. Golovashchenko, L. O. Petrov, A. D. Kaprin
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 91-98; doi:10.17709/2409-2231-2020-7-3-9

Abstract:
Among malignant neoplasms, kidney cancer occupies one of the first places in terms of the growth rate of incidence in Russia. Despite the possibilities of modern diagnostic research methods, the number of patients with common forms of the disease does not decrease. In 5–10% of cases, renal cell carcinoma is complicated by the formation of a tumor clot in the inferior Vena cava (VCI), which requires volume surgery — nephrectomy with thrombectomy, which is the only effective treatment option for this group of patients. Previously, the results of treatment of locally advanced kidney cancer were unsatisfactory due to the high incidence of complications and mortality after extended surgical interventions. However, improving the operation technique requires a re-evaluation of previous representations. Performing a nephrectomy with a VCI thrombectomy is not an easy task and is often associated not only with technical difficulties due to the need for mobilization, control and resection of the inferior Vena cava, but also with the risk of intra — and postoperative complications. The most difficult task is the choice of surgical tactics for descending non-tumor hemorrhagic thrombosis. As a result of long-term tumor obstruction, organized blood clots that are soldered to the intima of the vessel often spread to the common iliac veins and, as a rule, are technically impossible to remove. If the VCI is preserved, a residual hemorrhagic blood clot in the area of its confluence is a potential source of pulmonary embolism (PE), for the prevention of which mechanical plication is used. This maneuver does not lead to the development of clinically significant chronic venous insufficiency of the lower extremities (CVI NC), postoperative VCI or PE thrombosis. Despite the technical complexity of the operation and the difficult course of the postoperative period, surgical treatment of renal cell cancer complicated by tumor thrombosis is certainly justified. This article presents a clinical case of surgical treatment of a patient with renal cell cancer complicated by massive specific (tumor) and non-specific thrombosis in the presence of reduced parenchymalexcretory function of the contralateral kidney and severe cardiac pathology. Goal: to share experience and demonstrate the results of successful surgical treatment of renal cell carcinoma.
N.G. Gasanov, S. I. Gamidov , T.V. Shatylko , A.Yu. Popova, N.P. Makarova, I. V. Ushakova, O. B. Loran
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 43-50; doi:10.17709/2409-2231-2020-7-3-4

Abstract:
Purpose of the study. To determine the practical value of puncture methods for obtaining spermatozoa in azoospermia. Patients and methods. The results of 127 puncture biopsies of testis (TESA) and testicular appendage (PESA) in patients with azoospermia of presumably obstructive origin were analyzed. The sperm production frequency (SPF) was calculated, as well as the frequency of transition to an open testicular biopsy. Was built a logistic regression model to analyze factors influencing the result, TESA / PESA, which included as independent variables the following parameters: patient age, duration of involuntary infertility, the level of sex hormones (testosterone, estradiol, luteinizing hormone, follicle-stimulating hormone, prolactin, progesterone, inhibin B), the total volume of testes, presence of varicocele, the presence of chemotherapy or radiation therapy, a history of alcohol abuse, Smoking, regular violation of the thermal mode, surgery in the inguinal and scrotal region. Indicators of the probability ratio (PR) with a 95% confidence interval (95% CI) were obtained. Results. 92 biopsy attempts out of 127 were successful, and the NPV was 72.4%. Independent statistically significant predictors of PESA / TESA success were testicular volume (PR = 1.113; 95% CI = 1.026–1.207) and inhibin b level (PR = 1.026; 95% CI = 1.011–1.041). In 35 patients whose spermatozoa were not found during the puncture biopsy, conversion to open microsurgical biopsy was performed. Conclusion. PESA and TESA have only limited effectiveness in azoospermia. We believe that puncture biopsy of the testicles and epididymis is justified only in patients with normal testicular volume and high levels of inhibin B. PESA / TESA should be performed in conditions that allow immediate transition to an open biopsy in case of failure.
P. V. Nesterov, A. V. Ukharskiy, N. V. Kislov
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 146-159; doi:10.17709/2409-2231-2020-7-3-15

Abstract:
Purpose of the study. To evaluate the clinical and economic efficiency of colorectal cancer screening model in the Yaroslavl region. Materials and methods. To achieve this goal, we have given a clinical and economic assessment of the existing approach to the diagnosis and treatment of colon cancer. We have also developed a clinical and economic model of colorectal cancer screening strategy in the Yaroslavl region. After that, we made a comparative assessment between the strategies on such parameters as total costs, efficiency, and CER coefficient. Results. The strategy for the absence of colorectal cancer screening has a cost-effectiveness rate equal to 246 712 rubles (3820$)/LYG, with the value of added years of life in 2.9 years. According to our calculations, the implementation of the program of screening of CRC based on fecal occult blood immunochemical method, followed by the implementation of colonoscopy in the case of a positive result, will require an increase in funding for patients with colon cancer by 6.9% per year. At the same time, by changing the structure of morbidity and increasing the part of early forms in the implementation of the screening program, an increase in the estimated life expectancy of patients will be achieved, which is consistent with the long-term results of programs conducted in Europe and the United States. The CER for the screening strategy is 103.95 thousand rubles (2030$) / LYG. Long-term modeling shows that the introduction of screening program will reduce the incidence of CRC by 12% from the baseline by the 15th year of implementation and reduce the cost of diagnosis and treatment of colon cancer by 16.1% per year without taking into account inflation expectations. Conclusion. The introduction of a colorectal cancer-screening program at the regional level is clinically effective and cost-effective.
A. V. Balandina, Pm M Zelter , A.V. Kapishnikov, S. V. Kozlov, Alexander Kolsanov, S. S. Chaplygin
Published: 12 September 2020
Research and Practical Medicine Journal, Volume 7, pp 83-90; doi:10.17709/2409-2231-2020-7-3-8

Abstract:
Purpose of the study. To develop an information technology for calculating perfusion computed tomography parameters and to evaluate the effectiveness of using the proposed program in the differential diagnosis of continued glioblastoma growth and post-radiation necrosis. Materials and methods. We examined 53 patients who were treated at the Samara Clinical Oncological Dispensary. All patients underwent CT scan in perfusion mode. The results of using the program were compared with the data that were calculated on the workstation of the GE Discovery CT750 HD computed tomograph. Results. Significant differences were found in CBV and CBF perfusion indices in groups with continued growth and post-radiation necrosis, verified by biopsy. The parameters calculated using the developed program did not differ significantly from the results obtained on a standard workstation. Conclusion. The application of the developed computer program for the analysis of CT perfusion does not depend on the equipment manufacturer, works with standard DICOM data, which increases the availability of a valuable diagnostic method. The results obtained using the proposed information technology make it possible to differentiate the continued growth of glioblastoma from post-radiation necrosis.
F. A. Pchelintseva, Marina V. Petrova Marina V.Petrova, I. S. Shmyr, K. A. Mironov, E. V. Gameeva
Research and Practical Medicine Journal, Volume 7, pp 116-128; doi:10.17709/2409-2231-2020-7-2-11

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G. E. Roitberg, K. G. Mkrtchyan, Nina Kulchenko
Research and Practical Medicine Journal, Volume 7, pp 75-81; doi:10.17709/2409-2231-2020-7-2-7

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Arsen Yu Grigoryan, A. I. Bezhin , Tatyana А Pankrusheva , L. V. Zhilyaeva
Research and Practical Medicine Journal, Volume 7, pp 56-63; doi:10.17709/2409-2231-2020-7-2-5

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A. A. Nekrasov, N. P. Korableva, N. S. Romanenkov, A. G. Grigoryan, Ya. V. Cekhmistro
Research and Practical Medicine Journal, Volume 7, pp 164-170; doi:10.17709/2409-2231-2020-7-2-15

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I. N. Zaborskii, K. N. Safiullin, O. B. Karyakin , S. A. Ivanov , V. S. Chaikov, И. О. Дементьев, A. V. Sidorin, G. N. Grishin, A. N. Yurchenko
Research and Practical Medicine Journal, Volume 7, pp 129-143; doi:10.17709/2409-2231-2020-7-2-12

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Research and Practical Medicine Journal, Volume 7, pp 82-91; doi:10.17709/2409-2231-2020-7-2-8

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T. A. Dimitriadi , D. V. Burtsev, E. A. Dzhenkova
Research and Practical Medicine Journal, Volume 7, pp 22-29; doi:10.17709/2409-2231-2020-7-2-2

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D. V. Sidorov, M. V. Lozhkin, Leonid O. Petrov, A. G. Isaeva, M. S. Gusakova
Research and Practical Medicine Journal, Volume 7, pp 154-163; doi:10.17709/2409-2231-2020-7-2-14

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A. D. Kaprin , E. V. Gameeva , D. O. Roshchin, A. A. Kostin, G. S. Alekseeva , Viktoria E. Khoronenko , G. R. Abuzarova, A. A. Fedenko, L. V. Pashigorova, Yu. V. Samsonov
Research and Practical Medicine Journal, Volume 7, pp 10-21; doi:10.17709/2409-2231-2020-7-2-1

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P. S. Kozlova, K. M. Nushko, V. A. Gorbach, B. Ya. Alekseev
Research and Practical Medicine Journal, Volume 7, pp 109-115; doi:10.17709/2409-2231-2020-7-2-10

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I. M. Khokhlova, V. B. Kozhevnikov, K. N. Movchan, B. S. Artyushin , E. V. Bartashevich, A. V. Zharkov, E. V. Zheleznyi
Research and Practical Medicine Journal, Volume 7, pp 64-74; doi:10.17709/2409-2231-2020-7-2-6

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E. M. Frantsiyants, I. V. Neskubina, E. A. Sheiko
Research and Practical Medicine Journal, Volume 7, pp 92-108; doi:10.17709/2409-2231-2020-7-2-9

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S. A. Suslin , A. V. Vavilov, R. I. Ginnyatulina
Research and Practical Medicine Journal, Volume 7, pp 179-193; doi:10.17709/2409-2231-2020-7-2-17

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I. A. Goroshinskaya, E. M. Frantsiyants, V. I. Aleynov, L. A. Nemashkalova, N. D. Cheryarina, A. V. Shaposhnikov, E. A. Dzhenkova
Research and Practical Medicine Journal, Volume 7, pp 30-46; doi:10.17709/2409-2231-2020-7-2-3

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O. A. Mailyan, K. Yu. Kanukoev, P. G. Berezin, K. M. Nushko, V. A. Gorbach
Research and Practical Medicine Journal, Volume 7, pp 171-178; doi:10.17709/2409-2231-2020-7-2-16

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D. A. Lomonosov, A. L. Lomonosov, S. V. Volkov, A. A. Golubev
Research and Practical Medicine Journal, Volume 7, pp 144-153; doi:10.17709/2409-2231-2020-7-2-13

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V. S. Parshin, A. D. Kaprin , S. A. Ivanov , A. A. Veselova, P. I. Garbuzov, V. S. Medvedev
Research and Practical Medicine Journal, Volume 7, pp 47-55; doi:10.17709/2409-2231-2020-7-2-4

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R. V. Royuk, S. K. Yarovoy, N. A. Guseva, Sh. L. Voskanyan, V. V. Royuk, D. B. Rodin
Research and Practical Medicine Journal, Volume 7, pp 38-47; doi:10.17709/2409-2231-2020-7-1-4

Abstract:
Purpose of the study. To analyze prevalence and characteristics of the cardiovascular diseases (CVD) in patients with urolithiasis, revealed for the first timeMaterials and methods. In a period between 2009 and 2018, was made a retrospective analysis of medical histories of 2311 patients with urolithiasis, which were treated in in the urology departments of the branch No. 1 of the MCHG named after N.N. Burdenko (n=1487) and GBUZ MO Krasnogorsk City Hospital No. 1 (n=824). In 67,6% of the cases (1562 patients) the diagnosis of urolithiasis was diagnosed for the first time on admission. Isolated urolithiasis was recorded in 676 cases (43,3%), in other 154 cases (9,8%) nephrolithiasis was combined with different variants of cardiovascular diseases (CVD) and diabetes. From 732 respondents with urolithiasis and associated cardiovascular diseases (CVD), were formed 3 groups, in the first group (I) were included patients (n=363) with hypertension and arterial hypertension: the second group (II; n=79) was formed from patients with isolated coronary heart disease. In the third group (III) were included 290 patients which had urolithiasis combined with hypertension, arterial hypertension and coronary heart disease. The stages of hypertension and degree of expression of arterial hypertension were given according to the recommendations of Russian science society of cardiology (2004). Stages of congestive heart failure were defined according to c NYHA (New York Heart Association) classification. Functional class of stable angina was defined according to Canadian Cardiovascular Society classification (1970,1976). The obtained data was analyzed using descriptive statistics methods.Results. Average age of patients was 65,4 +– 3,27; 78% of the patients were men. On an emergency basis were hospitalized 30,9% from group I, 27,6% from group 2, and 31,3% from group III. In group I more often were recorded hypertension I + arterial hypertension I (32,5%) and hypertension II + arterial hypertension II (40,2%). In group II effort angina was recorded in 30 cases (38%). Congestive heart failure occurred among 153 patients (20,9%); most often it occurred among patients from III – in 102 cases (35,2%). In the whole sample, congestive heart failure of I and II degrees prevailed – in 88 (12%) and 57 (7,9%) patients. Kidney stones were found in 59,4% of patients, in the ureters – in 30,9% of patients, in kidneys and in the ureters – in 9,9% of patients. Share of the patients with kidney stones in the shape of corals is 3,4% of the whole sample. Average sizes of kidney stones of the patients with congestive heart failure are 9,2–11,8 mm which is different from the sizes in whole sample – 6,9–9,5 mm.Conclusion. During the observation period, share of the patients with first time revealed urolithiasis, complicated with the cardiovascular diseases (CVD) increased in 1,9 times (16,7 versus 31,7%). Congestive heart failure, which was registered in 20,9% of patients, was charged with I and II degrees. The presence chronic cardiovascular diseases (CVD), especially complicated by congestive heart failure in patients with first time revealed nephrolithiasis, implies changes in the algorithms of metaphylactic of nephrolithiasis (regime of water loads, selection of diuretics and anticoagulants).
T. A. Dimitriadi , D. V. Burtsev, E. A. Dzhenkova, T. N. Gudtskova, K. V. Dvadnenko
Research and Practical Medicine Journal, Volume 7, pp 8-15; doi:10.17709/2409-2231-2020-7-1-1

Abstract:
Purpose of the study. To determine the quantitative parameters of the molecular markers Ki‑67 and p16/INK4a at CIN 1–3 and to establish the possibility of using them to improve the quality of diagnosis by histological samples.Patients and methods. Biopsy material of the cervix was studied in 71 patients who were carriers of HPV infection. Immunohistochemical method (IHC) in biopsy specimens determined the expression of Ki‑67 and p16/INK4a markers.Results. According to the results of a standard histological examination, the distribution of patientsinto groups occurred as follows: CIN 1–18, in CIN 2–39, in CIN 3–14 patients. It was found that the expression of the studied markers is associated with the severity of dysplastic changes in the tissue of the cervix. By the studied marker, the most characteristic molecular profiles for the degrees of dysplasia were determined: CIN1 – Ki‑67–15–25%, p16/INK4a 10–15%; CIN2 – Ki‑67–70–80%, p16/INK4a – 65–70%; CIN3 – Ki‑67–85–90%, p16/INK4a – 90–95%. Heterogeneity was revealed in the expression of these markersin the CIN 2 group: in 7 cases (22,6%), the molecular profile corresponded to CIN 1, in 1 case (3,6%) to CIN 3. Clinical examples of using the IHC profile to clarify the degree of CIN are given.Conclusion. The use of an IHC study with Ki‑67 and p16/INK4a, in addition to the standard histological examination, makes it possible to objectify the initial diagnosis of the degree of CIN, as well as to identify patients with a high and low risk of developing severe injuries. This is especially true for the CIN2 group, the most problematic in terms of histological evaluation and tactics of clinical management of patients. The use of IHC in the initial diagnosis will contribute to: improving the information content of multiple aimed and loop excisional biopsies; reduction in relapse due to inadequate treatment; eliminating the unreasonable use of such a traumatic method as conization (especially in women of childbearing age).
E. M. Frantsiyants, I. V. Kaplieva, I. V. Neskubina, V. A. Bandovkina, L. K. Trepitaki, E. I. Surikova , N. D. Cheryarina, L. A. Nemashkalova, N. S. Lesovaya
Research and Practical Medicine Journal, Volume 7, pp 25-37; doi:10.17709/2409-2231-2020-7-1-3

Abstract:
Purpose of the study. Studying characteristics of the growth factor dynamics in the intact skin, tumors and perifocal tissues of melanoma in urokinase (uPA) gene-knockout mice.Materials and methods. The study included male and female С57 ВL/6 mice (n=47) and C57BL/6‑Plautm1.1BugThisPlauGFDhu/GFDhu mice with uPA gene-knockout (n=31). В16/F10 melanoma was transplanted subcutaneously at a dose of 0.5 mL (1:10 in normal saline). Intact mice of the same strain served as controls. Levels of VEGFA, VEGFC, sVEGFR1, sVEGFR3, IGF1, IGF2, TGFβ1 and FGF21 were determined by ELISA in the skin, tumor and perifocal tissues isolated on the 21st day of the tumor growth.Results. uPA gene-knockout inhibited the growth (mostly in females) and metastasis (predominantly in males) of melanoma in mice. Inhibition of the migration of malignant cells in males could be due to low levels of TGF-β1 compared to С57 ВL/6 mice: in the skin – by 5.0 times, in tumors – by 1.8 times and in perifocal tissues – by 6.1 times. In uPA gene-knockout females, lower levels of TGF-β1 were observed in tumors – by 1.4 times inhibited metastasis, but not completely, and solitary metastatic foci were registered in the lungs. Нigh levels of IGF1 in tissues of all uPA gene-knockout mice (males: in tumors by 1.4 times, in perifocal tissues by 2.6 times, in the skin by 3.6 times; females: in tumors by 2.6 times, in perifocal tissues by 25.0 times, in the skin by 13.9 times, compared to С57 ВL/6 mice) could maintain the metastatic phenotype of cancer cells (in females) or hiher proliferative activity of melanoma cells (in males). Lower levels of FGF‑21 in tumors (males – by 5.3 times, females – by 18.4 times), perifocal tissues (males – by 9.6 times, females – by 8,5 times) and skin (males – by 6.7 times, females – by 3.3 times) in uPA gene-knockout animals could be due to the IGF‑1 growth, as their reciprocal interaction is known. Interestingly, a significant, although lesser than in mice with a normal genotype, accumulation of VEGFA in melanoma tissues was observed: in males – in tumors by 44.9 times, in perifocal tissues by 6.8 times, in the skin by 2.4 times; in females – in tumors by 5.6 times, in perifocal tissues by 2.6 times, in the skin by 3.3 times, compared to the corresponding intact controls, due to the probable involvement of the uPA receptor (uPAR) in the implementation of VEGF-induced processes.Conclusion. Changing the activity of a system of some growth factors, uPA gene-knockout modifies melanoma metabolism by inhibiting its growth and eliminating or reducing its metastatic activity.
A. A. Kostin, L. V. Shaplygin, Nina Kulchenko, A. Mansur, I. S. Shulpina
Research and Practical Medicine Journal, Volume 7, pp 48-54; doi:10.17709/2409-2231-2019-7-1-5

Abstract:
In women aged from 20 up to 60 years paraurethral cysts occur in 1–6%. In most cases, the clinical course of paraurethral cysts is asymptomatic, so their diagnosis can cause difficulties. Women who have paraurethral cysts may complain of pain, dyspareunia, and urinary disorders. The size of a cyst more than 2 cm can affect the quality of patient’s life, and very often causes symptoms of the lower urinary tract, including obstructive ones. Paraurethral cysts need to be differentiated other perineal formations. This article presents a review of the literature on the etiology, clinical course and diagnosis of paraurethral cysts. The main points of differential diagnosis of paraurethral cyst with urethral diverticulum, adenocarcinoma are also consecrated. Taking into consideration the anatomical location and the specifics of the treatment of paraurethral cysts, this problem has an interdisciplinary nature and requires the attention of specialists such as: urologist, gynecologist, surgeon.
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