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.
Пациенты с билатеральным опухолевым поражением почек представляют собой редкую субпопуляцию, насчитывающую, по данным разных авторов, от 2 до 6 % из общей группы ПКР. Несмотря на рост числа случаев билатерального ПКР, количество работ, посвященных изучению особенностей хирургического вмешательства, факторов прогноза, результатов лечения и выживаемости данного контингента пациентов, ограничено, и ряд важных вопросов, касающихся этой проблемы, остается нерешенным. В настоящее время единственным эффективным методом лечения билатерального рака почек является нефронсохраняющая операция в объеме двусторонней резекции почек / нефрэктомии с резекцией контралатеральной почки при синхронном поражении или резекции единственной почки при метахронном поражении, которая позволяет избежать или снизить риск почечной недостаточности и ее последствий после операции.
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.
В 2020 г. деятельность онкослужбы РФ осложнилась развитием респираторного синдрома SARS-CoV-2, что оказало выраженное воздействие на здоровье пациентов со злокачественными новообразованиями (ЗНО) и способствовало переориентированию сотрудников для обеспечения особого противоэпидемического режима. Изучены аспекты организации онкологической службы Магаданской области (МагО) в условиях пандемии 2020 г.
Purpose of the study . To assess the chances of development of squamous intraepithelial cervical lesions of high degree (H‑SIL) in patients infected with human papillomavirus (HPV). Patients and methods . 75 HPV positive patients. The main group — with a histological diagnosis of H‑SIL (n=50), the control group — with a histological diagnosis without H‑SIL (n=25). Liquid-based cytology, colposcopy, cervical excision; HPV test, diagnosis of sexually transmitted infections — PCR in real time; a comprehensive bacteriological study. Assessment tool interconnections — odds ratio, categorical data analysis — statistical packages STATISTICA 6.0 and SPSS 22 Statistical Package for the Social Sciences. Results . In the age group up to 30 years, the chances of H‑SIL development are 26 times higher, 30–40 years — 38 times higher compared to patients over 50 years (p 0.05). The presence of chronic inflammatory diseases of the pelvic organs. Earlier treatment of cervical diseases by destruction reduces the risk of H‑SIL 0.08 times. The presence of chronic diseases of the pelvic organs increases the risk of H‑SIL 24 times (p<0.05). Conclusion . The group at greatest risk of having H‑SIL -women 30–40 years, whose menstrual cycle is more than 35 days, with significant lesions according to the results of colposcopic examination, chronic diseases of the pelvic organs, which had not previously been carried out destruction of the cervix.
Purpose. Comparative analysis of the diagnostic value of traditional cytology (TC) and liquid cytology (LC) in the identification of cervical intraepithelial neoplasia (CIN) and cervical cancer (CC).Patients and methots. The study included 87 women aged 18 to 80 years. All women were referred with suspicion of CIN, or underwent a control cytological examination after treatment for CIN and cervical cancer. Smears were taken separately from ecto-, endocervix and mixed. Various tools were used (trowel, brushes type D, F and Cervex-Brush Combi). Each patient was sampled at the same time by different types of instruments. All surveyed women were performed at the same time traditional and fluid cytology. Liquid preparations were prepared using SurePath™ technology (BD and Company, Netherlands, USA) and E‑Prep (Biodyne, South Korea). Traditional cytological preparations were stained according to the Pappenheim method, liquid preparations — by Papanicolaou. A comparative analysis of cytological and histological findings was carried out.Results. According to our data, the number of non-informative material practically coincides in the shopping center and in the LC, from the instruments used the best results were obtained when using a cytobrush of type D and a wooden spatula. The frequency of detection of CIN squamous epithelium in the LC is somewhat less than in the shopping center (60% vs. 62%). This is due to the lack of experience in evaluating the life cycle drugs. Despite the fact that the overall frequency of CIN detection is somewhat lower in the LC than in the TC, the frequency of detection of high grade squamous intraepithelial lesion (HSIL) is higher in the LC (51% versus 46%). This is due to the fact that cellular elements are concentrated in a limited area and single small HSIL complexes that are missed in the shopping center are better detected in the LC. The sensitivity of the TC smear from the cervix was 96.2%, life cycle — 92.4%. The accuracy of the shopping center is 92%, the life cycle is 89.6%.Conclusion. LC is an alternative to traditional cytological examination in order to detect pretumor diseases and cervical cancer. For an objective assessment of liquid preparations, additional training of cytologists is necessary.
Purpose. Population assessment of the quality and effectiveness of medical services, as well as the activities of medical organizations working with the child population in comparison with 2016–2017.Materials and methods. Sociological research in polyclinics of four large health care institutions of Yakutsk of the compared groups is carried out: Polyclinic No. 1–100 respondents, City hospital No. 2–60 respondents, City hospital No. 3–80 respondents, medical center of Yakutsk — 100 respondents. The study was conducted in 2016–2017. during the study, 340 respondents were interviewed, including 87% of women and 13% of men (the survey was conducted among parents and other legal representatives of minor patients).Results. The article deals with the issues related to the implementation in the activities of public health institutions of the Republic of Sakha (Yakutia) quality standards and evaluation of the results of their implementation in terms of patient awareness of the service (availability, openness of information), comfort conditions of service, waiting time for the service, the attitude of staff to patients (courtesy, goodwill), competence of staff and the overall level of satisfaction with the service provided. Despite the fact that more than 60% of respondents are aware of the functioning of the official websites of medical institutions, only 15.8% of respondents used information about the services and how to get them posted on them. At the same time, three-quarters of respondents are aware of the possibility of remote appointment by phone or Internet. However, only 18.6% of them took advantage of these opportunities, and 56% did not resort to them. The greatest criticism is caused by the lack of medical report on the patients’ state of health –60.8% of dissatisfied surveyed parents chose this criterion. More than 40% of complaints are due to the fact that pediatricians have not given recommendations for diagnosis and treatment. More than half of the survived participants (54.5%) at the recent visit to a medical institution, received a medical service on the day of making an appointment. The average waiting time to visit a paediatrician is 76 minutes. Two-thirds of respondents complain about the lack of available sitting chairs. Almost half of the respondents indicate the lack of drinking water in medical institutions, Almost 80% of respondents are generally satisfied with the medical services received in the clinics of Yakutsk. More than 70% of respondents are ready to recommend their clinic to friends, acquaintances and colleagues.Conclusion. According to the results of the study, it was concluded that the organizers of health care need to readjust appropriately some management procedures of the organizations, in particular: patients’ attendance by specialists, public relations, personnel management, facilities and resources, in connection with the visitor’s basic rebukes.
