Research and Practical Medicine Journal
ISSN / EISSN : 2409-2231 / 2410-1893
Published by: QUASAR, LLC (10.17709)
Total articles ≅ 409
Latest articles in this journal
Research and Practical Medicine Journal, Volume 8, pp 62-74; doi:10.17709/2410-1893-2021-8-2-6
Purpose of the study. To determine the association of individual biomolecular markers of oncogenesis MMP‑2, MMP‑9 and the inhibitor of metalloproteinases TIMP‑1 with the risk of tumor invasion and metastasis in the early and late postoperative period in various types of surgical treatment of RCC. Materials and methods. The study prospectively included medical data of 60 patients with kidney cancer with T1-3N0 M0 who received surgical treatment at the Urology Clinic of the S.R.Mirotvortsev Design Bureau of the SSMU from 2016 to 2019. The patients were divided into 3 groups: 1st group included 20 patients who underwent kidney resection for elective indications, with tumors of the renal parenchyma; 2nd group – 20 patients who underwent radical nephrectomy by laparoscopic approach; Group 3-20 patients who underwent radical nephrectomy with lumbotomy access. All patients being in the early (7-10th day) and long-term postoperative period (after 1 and 2 years) by solid-phase ELISA, on a StatFax 4200 analyzer using eBiosence and Cloud-Clone Corp reagent kits, a study was made on the basis of the concentration in the blood serum of markers of oncogenesis MMP‑2, MMP‑9 and TIMP‑1 metalloproteinase inhibitor. Results. In all groups of patients with RCC, an initial increase in the concentration of MMP‑9 was revealed compared to the control (p≤0.05). According to the results of the ROC analysis, this indicator has a high specificity and sensitivity in terms of predicting RCC at the preoperative stage. The highest sensitivity and specificity for detecting tumor progression was demonstrated by matrix metalloproteinases: MMP‑2 – sensitivity 96 %, specificity 67 % (cut-off point 357.5 pg/ml) and MMP‑9 – sensitivity 87.5 % and specificity 62 % (cut-off point 958 ng/ml). At the same time, TIMP‑1 showed less significant indicators – sensitivity and specificity (74 % and 60 %, respectively) with a cut-off point of 0.49 ng/ml. Conclusion. Serum MMP‑2 and MMP‑9 are a marker of a poor prognosis for the progression of RCC. Elevated levels of MMP‑9 in the blood serum of RCC patients before and after various types of surgical treatment reflect the individual characteristics of the patient’s body and the tumor process. Dynamic monitoring of the level of markers of oncogenesis in patients with RCC allows a personalized approach to the choice of the scope and method of surgical treatment of RCC.
Research and Practical Medicine Journal, Volume 8, pp 34-42; doi:10.17709/2410-1893-2021-8-2-3
Purpose of the study. There is the generalized analysis of administration of vinflunine in real clinical practice in St.Petersburg Clinical Scientific and Practical Center of Specialized medical Care (oncological). Materials and methods. This analysis gathered 27 patients with urothelial carcinoma treated using this medicine in St.Petersburg Clinical Scientific and Practical Center of Specialized medical Care (oncological). We assessed efficacy, safety profile of vinflunine in this subset of patients. Results. Clinical efficacy of vinflunine (complete response + partial response + stable disease) was 51,86 %, one patient demonstrated complete response. Median of response duration accounts for 3,4 months. Adverse events were observed in 28,4 %, most of them were 1-2 grades. 2 patients stopped therapy due to adverse events. Conclusion. In our analysis vinflunine was more effective than in randomized clinical trial and other studies from real practice in Europe. Thus, confirm expediency to administer of vinflunine for metastatic urothelial carcinoma.
Research and Practical Medicine Journal, Volume 8, pp 51-61; doi:10.17709/2410-1893-2021-8-2-5
Purpose of the study. To conduct a clinical trial of the local treatment efficacy of skin and soft tissue inflammatory processes combination with sodium carboxymethylcellulose, immobilized miramistin and metronidazole. Patients and methods. The study involved patients with purulent-inflammatory skin processes, divided into two groups – control and experimental – 30 in each. The most common nosological form were abscesses of various localization. In the control group, local treatment was carried out with dioxomethyltetrahydropyrimidine ointment with chloramphenicol, and in the experimental group – with a combination of sodium carboxymethylcellulose with miramistin and metronidazole. We studied the local temperature, wound pH, wound planimetry, the appearance of wounds, the species composition of infectious agents in the discharge from the wound, a general blood test (with the determination of leukocyte indices), blood biochemical parameters, and the number of bed-days in the hospital. The data obtained were processed statistically. Results. The percentage of reduction in the area and volume of wounds in the experimental group was significantly higher than in the control. The maximum rate of wound healing in the experimental group was noted on days 1-3 and amounted to 9.7 (6.3; 15.5) % / day, and in the control group – 5.6 (2.9; 7.7). Starting from the 5th day of treatment, the local temperature indices in the experimental group were significantly lower than in the control group, and the pH values of the wounds in the experimental group tended to neutral values from the 5th day of treatment, and in the control group there was an increase in pH. Most often, S. epidermidis and S. aureus were inoculated from the wound discharge (in total, more than 50 % of observations); in the control group, pathogenic microorganisms were inoculated 1.6 times more often than in the experimental group. Conclusion. Patients in the experimental group were hospitalized for 2.5 days less than patients in the control group. It is possible to recommend further study and application of the combination of miramistin and metronidazole immobilized on the sodium salt of carboxymethylcellulose in the treatment of wounds.
Research and Practical Medicine Journal, Volume 8, pp 124-132; doi:10.17709/2410-1893-2021-8-2-11
This article presents a systematic literature review to assess the survival outcomes of patients with bilateral renal cell carcinoma who underwent nephro-preserving surgery. Patients with bilateral renal neoplastic lesions represent a rare subpopulation, numbering, according to different authors, from 2 to 6 % of the total RCC group. Despite the increase in the number of cases of bilateral RCC, the number of works devoted to the study of the features of surgical intervention, prognosis factors, treatment outcomes and survival of this cohort of patients is limited, and a number of important questions regarding this problem remain unresolved. Currently, the only effective method of treating bilateral renal cancer is nephro-preserving surgery in the volume of bilateral renal resection / nephrectomy with resection of the contralateral kidney in case of synchronous lesion or resection of a single kidney in case of metachronous lesion. This strategy avoids or reduces the risk of developing renal failure and its consequences after surgery. Conclusion. Nephro-preserving surgery for bilateral renal cell carcinoma is the only effective method to achieve satisfactory oncological results with a low incidence of complications.
Research and Practical Medicine Journal, Volume 8, pp 109-123; doi:10.17709/2409-2231-2021-8-2-10
Currently, lung cancer is a global problem and public health issue in the world. Chemoradiotherapy remains the optimal method in the treatment of patients with unresectable non-small cell lung cancer (NSCLC). Nowadays, immune response checkpoint inhibitors (monoclonal antibodies) are actively introduced into clinical practice which demonstrated significant improvements in the overall survival for patients with unresectable NSCLC. These drugs block programmed cell death protein (PD‑1) and programmed cell death ligand 1 (PD-L1) that increases regulation on the surface of T-cells and improves the patient's immune system respond to tumor cells. In 2019, durvalumab was introduced into clinical practice for the treatment of patients with unresectable NSCLC (stage III) after chemoradiotherapy. In our study, we’ve summarizes studies investigated the feasibility and safety of radiotherapy with immunotherapy for locally advanced lung cancer.
Research and Practical Medicine Journal, Volume 8, pp 12-22; doi:10.17709/2410-1893-2021-8-2-1
Purpose of the study. Was to assess diagnostic informative value of liquid-based cytology optimized with genetic methods for the differential diagnosis of precancerous and malignant diseases of the cervix. Materials and methods. The study included 381 patients. Cervical pathologies were diagnosed with liquid-based cytology only and liquid-based cytology optimized with genetic methods of assessing the expression of miRNA‑20a, miRNA‑375, miRNA‑21 and –23b. Results of liquid-based cytology and genetic methods were verified by histological examination of the material. Statistical analysis was performed using descriptive statistics methods with the calculation of the mean and standard error of the mean. The mean values were compared with the help of the Mann-Whitney test. Results. Diagnostic results of liquid-based cytology were consistent with histological results in 107 (73.8 %) of 145 cervical cancer (CC) patients, in 52 (57.1 %) of 91 patients with high-grade squamous intraepithelial lesions (HSIL), and in 30 (65.2 %) of 46 patients with low-grade squamous intraepithelial lesions (LSIL). Optimization of liquid-based cytology by assessing the expression of miRNA‑21 and miRNA‑23b in the cervical epithelium improved the diagnostic sensitivity of the method from 73.8 % to 80 %, and its specificity from 94.1 % to 97.9 %. The diagnostic sensitivity and specificity of liquid-based cytology for differential diagnosis of CC and HSIL was 87 % and 78.8 %, respectively. Optimization of liquidbased cytology by assessing the expression of miRNA‑20a and miRNA‑375 in the cervical epithelium for the differential diagnosis of CC and HSIL improved the diagnostic sensitivity of the method from 87 % to 95.1 %, and its specificity from 78.8 % to 93.9 %. Conclusions. We revealed the most informative pairs of miRNAs in the cervical epithelium, as an analysis of their expression expanded the possibilities of liquid-based cytology both as a method for diagnosing CC and as a method for the differential diagnosis between CC and HSIL.
Research and Practical Medicine Journal, Volume 8, pp 90-108; doi:10.17709/2410-1893-2021-8-2-9
In this article we performed publication analysis devoted to pain medicine in oncology during anticancer therapy and in palliative setting. Until recently, the main WHO guidelines for pain management in oncology were the recommendations of 1996, which included only pain relievers, as well as adjuvant and symptomatic drugs, which were applied according to the WHO analgesic ladder. These recommendations were based on the collective expert opinion of leading clinicians and scientists. The new WHO clinical guidelines were published in 2019. They are based on the principles of evidence-based medicine, including modern concepts of the etiology and pathogenesis of tumor pain syndrome. This recommendations contain sections on the analgesic efficacy of radiation therapy and antitumor drug therapy. The new WHO recommendations have not yet been published in Russian and are not sufficiently available for a wide range of oncologists and palliative specialists in our country. The purpose of this publication is to present within one volume a concise but complete and comprehensible discussion of the latest trends in pain therapy in oncology, published by WHO experts.
Research and Practical Medicine Journal, Volume 8, pp 23-33; doi:10.17709/2410-1893-2021-8-2-2
Purpose of the study. Evaluation of expression of the epithelial-mesenchymal transition markers E-cadherin and ZEB1 in patients with stage II-IV colorectal cancer (CRC). Materials and methods. The study included operational material obtained from 299 patients aged 42–86 years (mean age 64.2±1.7 years) with stage II-IV CRC treated at National Medical Research Centre for Oncology in 2013-2017. Stage II CRC (T3-4 N0 M0 ) was diagnosed in 110 patients, stage III (T1-4 N1-2 M0 ) – in 88 patients, stage IV (T1-4 N0-2 M1 ) – in 101 patients. Polyclonal rabbit antibodies to ZEB1 (Biorbyt Ltd., UK) and mouse monoclonal antibodies to E-cadherin (Diagnostic BioSystems, USA) were used for an IHC analysis. The intensity and degree of tumor cell staining, percentage of stained tumor cells in the sample and the number of patients with positive and negative marker expression were determined. Groups were compared using the Mann–Whitney U test and the Pearson's chi-square test. Results. Positive expression of E-cadherin was found in 64.5 % (193 of 299 patients), ZEB1 – in 80.6 % (241 of 299 patients). The number of patients with E-cadherin-positive tumors statistically significantly decreased (χ2 =15.888 at p<0.05). No significant differences were found in the mean values of ZEB1 and E-cadherin expression in stages III and IV, II and III respectively. Conclusions. The study demonstrated statistically significant relationship between tumor stages and expression of E-cadherin and ZEB1 in the epithelial-mesenchymal transition. The loss of the E-cadherin expression in tumor cells of patients from stage II to stage IV and increased expression of ZEB1 in the studied groups were statistically significant (p<0.05).
Research and Practical Medicine Journal, Volume 8, pp 133-140; doi:10.17709/2410-1893-2021-8-2-12
In 2020, the activities of the oncological service of the Russian Federation were complicated by the development of the SARS-CoV‑2 respiratory syndrome, which had a pronounced effect on the health of patients with malignant neoplasms (MN) and contributed to the reorientation of employees of oncological services to ensure a special regime. The vertical line of continuity in the diagnosis and treatment of patients with malignant neoplasms was violated, the timing of treatment was violated. Aspects of the organization of the oncological service of the Magadan region (MagO) in the context of the SARS-CoV‑2 pandemic have been studied. Purpose of the study. To assess the features cancer detection among the citizens of the Magistral District in 2019-2020. Materials and methods. The available sources of information (documents of the Ministry of Health of the MagO), databases of the oncological dispensary (IODE), based on information from the state reporting forms – ff. 7 and 30, as well as from Internet resources. Results. MagO region, leading in the rate of morbidity and mortality from malignant neoplasms in the Far Eastern Federal District: incidence of malignant neoplasms for 2009-2019 increased by 23 %. In 2020, the indicator of malignant neoplasm (from 35 % to 25.4 %) decreased in the MAO, and the proportion of patients with malignant neoplasms in localized (III) stages was 50 %. In August 2020, the CAPC began to work, for 5 months. Cancer was detected in 35 people (7.6 %), including in the early (I-II) stages in 18 people, which did not significantly affect the rate of early detection of cancer. Physical examinations revealed 107 cases of malignant neoplasm (a decrease of 27.4 % compared to 2019). In 2019-2020 In the MAO, cancer screening was carried out for a number of nosoologies: as a result, the proportion of patients with lung cancer (MagO – 36 %, RF – 29.4 %) and cervix (MagO – 82 %, RF – 66 %) exceeded the national average. Conclusion. To increase the detection of malignant neoplasms, it’s necessary to provide examination rooms in the districts of the MagO; drawing up a "map of contamination of the territory"; assessment of the conditions of human production activity and population density; introduction of the standard of examination of patients with cancer; increasing the alertness and qualifications of primary outpatient medical personnel.
Research and Practical Medicine Journal, Volume 8, pp 83-89; doi:10.17709/2410-1893-2021-8-2-8
Preconception care is an essential component of promoting maternal and child health at the national and international levels. The term “preconception care” is found both in various recommendations of the World Health Organization and in practical recommendations for the protection of maternal and child health. Although programs and guidelines may differ depending on local needs (endemic diseases, financial security, educational level of the population, etc.), the general concept of preconception care is present in developing and developed countries within different health systems and does not depend on political, cultural or religious beliefs. In addition, the history of incorporating various preconception strategies and ideologies into international maternal and child health programs and policies spans nearly 30 years, demonstrating the long-term recognition of the relative importance of this approach as a means of optimizing pregnancy outcomes. However, at present there is a large proportion of women who do not know about the importance of preparing for pregnancy. The purpose of this review was to study international experience in the implementation of preconception care in the practice of practical health care professionals. The main tools were highlighted – motivated counseling and reflective practice. Since the United States of America is the world health leader in improving pregnancy outcomes, the information sources were selected from PubMed and the Centers for Disease Control. This review provides evidence of the importance of motivated counseling, identifies the main stages of establishing a trusting relationship between a doctor and a woman or a married couple. Conclusions. Correct pregravid behavior will improve the demographic indicators of the country, however, systematic work is needed with regard to the social responsibility of married couples and the interest of medical personnel in high-quality motivated counseling.