Breast cancer is one of the most significant problems in oncology. This pathology is characterized by increased risk of fractures associated with postmenopausal decrease in bone mineral density, use of hormone therapy, and presence of osteolytic metastases in the spine. All these factors can cause non-traumatic spine fractures decreasing patient mobility and leading to permanent pain syndrome and neurologic deficit. The article presents the modern view on the osteoporosis problem and risk of non-traumatic spine fractures in patients with breast cancer and spine metastases. Literature data on predictors of pathological bone fractures, as well as time and risk of spine metastases in these patients are analyzed. Data of modern studies on the effectiveness of various methods of breast cancer treatment and their combinations, as well as possibilities of minimally invasive surgical interventions, antiresorptive and radiological therapy are considered.

Relevance. In accordance with Federal Law No. 323-FZ [17], emergency medical assistance, including emergency specialized medical care, is provided in emergency form outside a medical organization, as well as on outpatient and inpatient basis. An ambulance is an emergency medical service that travels to those whose lives and health are in danger. Emergency medical assistance, including emergency specialized medical care, is provided in case of diseases, accidents, injuries, poisonings and other conditions requiring urgent medical intervention. The reasons for calling an ambulance in an emergency form are sudden acute diseases (conditions) and (or) sudden exacerbations of chronic diseases without obvious signs of a threat to life, requiring urgent medical intervention. In the training of doctors, including in postgraduate education, these factors are taken into account. Aim of the study. Improvement of the quality of theoretical and practical training of emergency medical specialists, as well as clinical residents and practical doctors of various specialties, taking into account issues of emergency and military medicine. Material and methods. A review of official documents of the Ministry of Healthcare of the Russian Federation and the literature on postgraduate education of doctors with subsequent primary specialized accreditation for 2018-2022 was carried out. The literature on modern approaches to the provision of emergency medical care to victims was studied, taking into account the specifics of military (tactical) medicine for 2020–2022. Conclusion. The training of emergency medical professionals, taking into account the realities of the present, should include issues of tactical medicine and be practice-oriented using simulation equipment. It is necessary to know and be able to work with modern means of protection and medical care available in the troops; be prepared to work in medical institutions of various levels with the mass flow of injured and wounded.

Baseline anti-SEA/E-120 and plasma concentration of Nap Day 1 at 1h in different territories.

Introduction . In the structure of fractures of long tubular bones, pathological fractures account for about 1 %, and 2/3 of all cases are pathological fractures associated with bone metastases. Primary bone tumors are complicated by the development of a pathological fracture in 1– 10 % of cases, bone metastases in 8–30 % of cases. With a pathological fracture, as the primary manifestation of the tumor process, as a rule, patients come to the attention of orthopedic traumatologists providing emergency care. In the practice of oncologists, there are often patients with bone tumors who have performed deliberately non-radical surgical interventions associated with insufficient oncological alertness of traumatologists. Aim . To study and present the results of combined treatment of patients with bone tumors complicated by a pathological fracture. Materials and methods . The results of treatment and observation of 159 patients with tumors of long tubular bones complicated by a pathological fracture or the threat of its development, who received combined or surgical treatment and were observed in the polyclinic of the Republican Oncological Dispensary from 2008 to 2020, were analyzed. Results . A pathological fracture that has taken place, in the absence of somatic contraindications, is not a contraindication to neoadjuvant treatment, which allows performing organ-preserving surgical treatment with optimal local and systemic control. However, with verified bone metastases, when segmental bone resections are not shown, and the diagnosis of myeloma (solitary plasmocytoma) is established, it is permissible to perform surgery in a trauma hospital, after consulting an oncologist. Conclusion . The combined approach in the treatment of malignant bone tumors complicated by a pathological fracture makes it possible to perform a functional-saving, organ-preserving surgical intervention, significantly reducing the risk of tumor recurrence and systemic progression.

Cox regression analysis with interaction between baseline covariates and treatment.

AIM OF THE STUDY To compare the dynamics of thrombolytic therapy effectiveness in patients with stroke after the reorganization of medical care using JCI standards. MATERIAL AND METHODS In 2022, a new system for routing patients with stroke at the level of the emergency department was introduced in the Emergency Care Hospital; and 976 patients with the diagnosis of brain infarction were treated. The analysis of the results was carried out by comparing the mortality rates from ischemic stroke, the number of thrombolytic therapies and procedures of mechanical methods of revascularization, as well as the indicators “Door-CT”, “DoorNeedle”, “Door-Opening” for 2021 and 10 months of 2022. RESULTS After the introduction of the new routing system for patients with stroke at the emergency department level, there appeared the first positive results. Thus, the mortality rate from brain infarction in 10 months of 2022 decreased by 5.6% compared to 2021. The number of thrombolytic therapies performed increased by 5.2%, and mechanical revascularization procedures by 1.62% over the same period, while the “Door-CT” indicator decreased by 27 minutes, “DoorNeedle” by 22 minutes, “Door-Opening” by 31.6 minutes. CONCLUSIONS The immediate results of the introduction of the new patient routing system at the level of the emergency department have proved successful, primarily due to the significant reduction in the mortality rate of patients with cerebral infarction by 5.6%. However, the process requires further investigation and has application points for further improvement.

Cox regression analyses with three way interaction stratified by either MSKCC or HENG risk.

Overlapping anti-SEA/E-120 windows in Moving median and adapted Subpopulation Treatment Effect Pattern Plot (STEPP) analysis. Anti-SEA/E-120 by blocks where min, median and max values are depicted

The article is devoted to the main directions of oncology development in the Republic of Tatarstan. The results of comprehensive scientific research of the Kazan Scientific Oncology School are presented, the main scientific directions of the development of oncology in the Republic of Tatarstan are highlighted. Currently, the Oncological Service of the Republic of Tatarstan unites the Oncological Dispensary with branches, the Departments of Oncology, Radiology and Palliative Medicine, Obstetrics and Gynecology, Urology, Radiation Diagnostics of KSMA, the Department of Oncology, Radiation Diagnostics and Radiation Therapy of KSMU and other departments. Several important stages of the formation of the Kazan Scientific Oncological School are noted. The history of development is inextricably linked with the formation of the Department of Oncology at Kazan State Medical Academy. The main measures to reduce mortality from cancer are presented. The main tasks of the oncological service of the Republic of Tatarstan are described. Scientifically based complexes of measures for the rehabilitation of cancer patients have been implemented. Scientific knowledge has been translated into healthcare. Approaches to the organization of oncological services based on modern scientific achievements, developed methods of rehabilitation and palliative care, the implementation of these approaches into clinical practice contribute to improving the effectiveness of providing medical care to cancer patients, achieving the set targets.

The basic laws of malignant tumor formations in rural and industrial regions in Tatarstan Republic comparing with the world standards are analyzed. The increase of the malignant tumor incidence especially among women more often than among men is noted. The growth of the malignant tumor incidence in rural regions is significantly higher than in industrial regions. The predominance of the malignant tumors of lung, stomach and mammory gland is noted.

Introduction. Giant cell tumor refers to tumors with an uncertain malignancy potential, has a locally aggressive course. Intra-focal resections performed for a giant cell tumor of long tubular bones are accompanied by the development of relapse in 30–46 % of cases. The combination of pathogenetic therapy with surgical intervention makes it possible to reduce the frequency of relapses in operable tumors after marginal and intra-focal resections, and in inoperable tumors to provide local control and relieve pain. Objective – to analyze the results of combined treatment of patients with giant cell bone tumor. Materials and methods. In the conditions of Republican Clinical Oncological Dispensary of the Ministry of Health of the Republic of Tatarstan, 13 patients aged 20 to 63 years are in the process of combined treatment of a giant cell tumor. As of November 2021, 7 patients have completed treatment.Results. Among the 7 patients who completed treatment, 6 people were operated on (1 patient refused surgery). In 5 patients, intra-focal resection of the tumor with osteoinductive material “BoneMedic-S” was performed, in 1 patient with a giant cell tumor of the sciatic bone, resection of the sciatic bone was performed without reconstruction. 1 patient with a widespread tumor (sacral lesion) receives supportive treatment. Conclusion. The combined approach in the treatment of giant-cell bone tumor allows performing a functional-saving, organpreserving surgical intervention, significantly reducing the risk of tumor recurrence and its malignant transformation.

The huge global burden of oncological diseases is growing and measures to counter this complex challenge are high on national health agendas. The Russian National Long-Term Oncology Strategy 2030 defines priorities, goals and directions in the fight against cancer. Italso contains action plans for more effective prevention, earlier and more specific diagnosis and more effective treatment options. Against this backdrop, experts now suggest to complement standard oncology treatment strategies by adding Patient Blood Management (PBM). For many clinical disciplines where a low blood count and considerable blood loss are commonly encountered, this bundle of care is the new standard. Based on clinical and scientific evidence, it aims to optimise medical and surgical patient outcomes by clinically managing and preserving a patients blood. The principles of this comprehensive concept can and must be transferred to oncology, thus offering value in improving cancer care and the efficacy of medical institutions. Accumulating evidence demonstrates that anaemia and iron deficiency, but also thrombocytopenia, blood loss and coagulopathy are independent risk factors for adverse patient outcomes including morbidity, mortality, reduced quality of life and prolonged average length of hospital stay in both surgical and medical patients. For the timely and effective detection and correction of these risk factors, an international network of multi-disciplinary clinicians and researchers has developed PBM. The rapidly growing body of evidence for PBM not only shows improved patient outcomes, but also reduced resource utilisation including the use of allogeneic blood components. The reduction of allogeneic blood transfusion further improves patient safety and outcomes, since transfusion is another independent risk factor for adverse outcomes. Supported by WHO endorsements and following the recommendations of an increasing number of state or national health authorities, PBM is about to become a new standard of care. However, even though the aforementioned risk factors are highly prevalent in oncology settings due to chemo-/radiotherapy and the pathology of the disease, the integration of PBM in standard oncology treatment pathways is lagging behind. Thus, and in support of the Russian National Long-Term Oncology Strategy 2030 to improve quality of oncological care, with the support of the National Association of Specialists in PBM (NASPBM), the PBM Oncology Working Group of the Russian Federation was created, consisting of national and international experts in oncology and PBM. On July 9, 2020, the Working Group met to discuss the rationale for PBM in oncology and to assess the need to implement PBM in Russian oncology care. As a result, the Group recommended to include PBM as an integral part of standard oncology treatment pathways, delineated the action required from facilitating stakeholders in the Russian Federation, determined a roadmap for implementation and developed a national resolution as a call to action on the matter. Presented herein, this resolution acknowledges the global and local impetus to reduce cancer mortality, and the rationale for PBM interventions to improve patient outcomes and alleviate the social and economic burden of cancer on the healthcare system.

Background. Recent studies have shown that a combination of surgery with chemotherapy and radiotherapy can signifcantly improve survival in patients with primary and metastatic bone tumors. Reconstruction of bone defects after resection of long bones is critical for successful functional limb salvage. The choice of the reconstruction technique depends on the tumor location, tumor extension, presence of pathological fracture, and somatic status of the patient. Reconstruction of bone defects in cases with diaphyseal tumor location can pose a surgical challenge. For the reconstruction of diaphyseal bone defects, endoprostheses, alloimplants, and autologous bone grafts are used. To achieve stability of the affected segment of the limb, various options for osteosynthesis are used. Modern technological achievements provide the emergence of materials with characteristics close to those of human bone tissue, however, without the disadvantages inherent in allo- and autologous implants. The purpose of the study was to improve surgical treatment outcomes in patients with long tubular bone tumors. Material and Methods. For the reconstruction of postoperative long bone defects, we used carbon nanostructured implants (СNI) in combination with intramedullary osteosynthesis with a blocked pin. A total of 25 patients underwent surgery (including 9 patients with a pathological fracture), 24 of them had metastases. Results. There were no intraoperative and postoperative complications. All patients had a signifcant decrease in pain 1 month after surgery. At 3 months after surgery, functional outcomes were satisfactory. None of the patients had a local recurrence, instability of the operated limb segment, or a reaction of rejection of a carbon nanostructured implant. Conclusion. Reconstruction of postoperative defects with carbon nanostructured implants after resection of long tubular bones for metastatic cancer provides good functional results and satisfactory local control.

Objective. To evaluate the effectiveness of the detection of malignant neoplasms (MNPs) when implementing secondary preventive measures against cancer in municipal healthcare facilities during the COVID-19 pandemic. Material and methods. The model of the Volga Federal District (VFD) of Russia was used to conduct analytical and statistical studies of the rates of active detection of MNPs in the municipal healthcare facilities in 2019-2020. The demographic indicators and state statistics data, which were publicly available on the Internet, on the official websites of the territorial health authorities, oncology dispensaries of the VFD subjects, were comparatively analyzed. A database (State Registration Certificate of the Russian Federation under No. 2021621834/01.09.21) was used to evaluate the effectiveness of secondary preventive measures against cancer during the COVID-19 pandemic in 2020. Results. Compared to 2019, the COVID-19 pandemic caused a 2.1% expansion in the network of patients’ examination rooms mainly due to an increase in the number of male rooms by 5.6% and mixed-type rooms by 6.3%. The number of mid-level healthcare workers that provided the functioning of patients’ examination rooms rose by 5.2%;the proportion of specialists trained in the area of oncology decreased by 20% (85% in 2019 and 68.1% in 2020). The introduction of restrictive measures determined a statistically significant (p<0.05) decline in the proportion of people who had undergone a primary medical examination in the male (32.9%), female (35.6%), and general (34.7%) populations. The mean frequency of detected MNPs in 2019 and 2020 was 0.91‰ and 0.76‰, respectively (a 16.5% decrease). There was an increase in the incidence of lung cancer (LC) (a 4.2% increase) and a reduction in that of breast cancer (BC) (a 56.6% decrease). A comparative assessment of changes in the rate of active detection of MNPs in healthcare facilities at all health levels revealed a negative increase in its mean value in 2020 versus 2019 for colorectal cancer (CRC) (–25.6%), LC (–25.0% ), BC (–11.6%), cervical cancer (CC) (–12.4%), and prostate cancer (PC) (–2.1%). The prognosis of the number of actively detected MNP cases during the pandemic shows that, provided that the effectiveness of MNP detection rates remains the same as in 2019;there were no CRC (n = about 1100 cases), LC (n=1050), BC (n=1470), CC (n=300), and PC (n=300) cases in the VFD in 2020. An analysis of the effectiveness of secondary preventive measures against LC and BC in the VFD showed that among the number of newly diagnosed cases of a disease in 2019, there were LC (92.3%) and BC (75.1%) cases in the municipal healthcare facilities;there were LC (100%) and BC (60.9%) cases during the COVID-19 pandemic. Conclusion. The COVID-19 pandemic led to a decline in the number of participants in preventive activities. Considering the uneven territorial spread of COVID-19, the development of a methodology for the preventive measures adapted to a pandemic, mainly in the municipal healthcare facilities, is an extremely important area of preventive healthcare activities. © 2022, Media Sphera Publishing Group. All rights reserved.

Introduction/Background Recently, ESGO/ISUOG/IOTA/ESGE Consensus Statement on pre-operative diagnosis of ovarian tumors implied that neither Human epididymis protein 4 (HE4) nor Risk of Ovarian Malignancy Algorithm (ROMA) improve the discrimination between benign and malignant masses compared with CA 125 alone. This statement may be reassessed if a novel algorithm, more powerful than ROMA, will be developed. Thereby the aim of this study was to elaborate a new predictive algorithm, based on serum CA125&HE4, which performs better than ROMA Methodology A novel algorithm, based on serum HE4, CA125 and patient's age as variables, has been developed using a training dataset. This algorithm was named Risk of Ovarian Cancer Kazan Index (ROCK-I). The validating group consisted of 227 consecutively operated premenopausal patients with pelvic mass out of which there were 193 cases of benign diseases, 27 cancers and 7 borderline ovarian tumors (BOT). Results ROCK-I demonstrated two fold less false positive results than ROMA. Thus, in the validating dataset, there was a statistically significant superiority of ROCK-I over ROMA in the specificity (92.2% and 84.5% respectively, p=0.017). Meanwhile, the sensitivity of ROCK-I was also numerically higher in all the scenarios of discrimination (table 1). When the scenario of discrimination 'benign disease vs the joint group of EOC (all stages) together with BOT stage Ic2-III' was used, ROC-AUC of ROCK-I, ROMA and CA 125 were 0.988, 0.946 and 0.937 respectively (figure 1). The difference in ROC-AUC between ROCK-I and CA125 was statistically significant (p=0.01) while the difference between ROMA and CA125 was not (p=0.79). Conclusion ROMA provides a suboptimal prediction, at least, in premenopausal patients. If a large independent validation shows similar or even slightly lower superiority of the novel ROCK-I over ROMA, it may provide a new basis of routine-use of HE4 in the preoperative assessment of premenopausal patients with pelvic mass.

The purpose of the study: to develop an expert system based on the construction of a «decision tree» for predicting the 5-year survival rate of patients with colorectal cancer.Material and Methods. T he study included 654 patients with colorectal cancer (CRC) who were treated from 2013 to 2015, including 434 men and 220 women. The average age of patients was 64,1 ± 10,2 years. All patients underwent genetic analysis for the presence of a mutation in the K-ras gene from the primary tumor.Results. For the Republic of Tatarstan, there are regional features of mutation of the K-ras gene: the frequency of mutations in tumors in men was less frequent (20.3 %) than in women (37.7 %), in patients of Slavic nationality, mutations were slightly more frequent – 39 % than in Tatars – 21 %. The gender approach to assessing long-term treatment results showed that in men with colorectal cancer, the most favorable treatment results were observed in patients with tumors in stage T1–2N0M0, regardless of the differentiation of the tumor and its mutational status. Low-grade tumors with any T should be considered prognostically unfavorable in men, with the presence of regional metastases and mutation of the K-ras gene, even in the absence of distant metastases: no patient lived 5 years. Based on the construction of a «decision tree», the most favorable treatment results were observed in female patients with tumors in stage T1–2–3N0M0 at the age of 70 years (5-year survival rate of 90 %), with tumors T1–2N0M0 at the age of 70 years (5-year survival rate of 81.8 %), regardless of the tumor differentiation and its mutational status. Tumors of any differentiation are prognostically unfavorable for women of the T3–4N0 stage with the presence of distant metastases (6 % of patients lived 5 years) and lowdifferentiated stage T4N0M0 tumors (5-year survival rate of 8 %).Conclusion. G ender- and age-associated features of the development and course of CRC are relevant for oncologists to choose effective diagnostic and therapeutic measures.

Aim. To conduct a clinical and economic analysis of the effectiveness of the program fissure sealing of first permanent molars with fluorine-containing sealants among schoolchildren of 78 years old in six cities of the Republic of Tatarstan. Methods. Between 2007 and 2011, dentists of six cities of the Republic of Tatarstan performed fissure sealing of permanent first molars using a fluorine-containing sealant in 24,394 schoolchildren aged 78 years according to the manufacturer's instruction. A clinical assessment of fluorine-containing sealant retention during tooth eruption was carried out annually, the results were submitted to the organizational and methodological office of the Republican Dental Clinic. The analysis of the complex of signs that have a normal distribution and characterize four degrees of sealant retention on the occlusal surfaces of teeth in children from several cities was carried out by using one-way ANOVA (analysis of variance) with the calculation of a p-value and F-test (according to Ronald Fischer). Statistical data processing was performed using the Microsoft Office Excel 2017 software. The economic analysis was performed by using mathematical modelling. Results. The use of sealants at the age of 78 years ensured the complete safety of the sealant in 80% of children; the development of dental caries in 1.7%; complete and partial loss 14.3%; disturbance of fit without the development of caries in 4.1% of cases [р=0.0095 (0.01); f-test 3.09839]. Clinical and economic analysis using a mathematical hypothesis in sealing with a fluorine-containing composite sealant determined the preservation of the conditionally spent funds for the treatment of 80% of healthy teeth for 4 years of the project in the amount of 6,001,177 rubles. Notional saved costs for the treatment of one tooth with a sealant amounted to 23.7 rubles. Conclusion. Implementation of the program fissure sealing of first permanent molars with fluorine-containing sealants among schoolchildren of 78 years old allows a total of 98.3% of healthy teeth to be preserved and notionally saved costs of sealing fissures to be reduced.

Aim. To study the medical and economic efficiency of the program for the prevention of dental caries using UltraSeal XT among schoolchildren of Kazan. Methods. In 2013, 200 schoolchildren from Kazan seen in the Republican Dental Clinic of the Ministry of Health of the Republic of Tatarstan (100 boys and girls aged 78) were selected. All patients were divided into two groups with similar distributions of sex and age: the test (main) group and control group. In the test group Sealants, the fissures of the first permanent molars were sealed with a composite fluorine-containing sealant according to the manufacturer's instructions. The control group was formed from children without dental sealants. The oral health assessment of children is reflected in the Examination Cards. Average indices of the severity of dental caries were determined (the number of decayed, filled and missing primary/permanent teeth dmft/DMFT). Re-examination of children was carried out in 2016 with the determination of the same indicators. The economic analysis was carried out using the method of mathematical modeling. Statistical processing was performed in Microsoft Office Excel 2017. Results. The use of sealants at the age of 78 years provided a lower level of caries severity in deciduous teeth (4.093.0; p 0.01). There was no statistically significant difference between the DMFT score of permanent teeth in children aged 78 years in the test group and the dmft score of deciduous teeth of children in the control group (p 0.05). The DMFT score in the permanent teeth of children in the test group of this age cohort (78 years old) was 0.660.95. The mean severity of dental caries DMFT index of 12-year-olds children with permanent dentition in the test group was 0.771.07, which is 1.52 more healthy teeth than in the control group DMFT score 2.291.59 (t=4.01; p 0.01). The medical and economic efficiency of the fluoride prevention of dental caries in 12-year-olds schoolchildren through the use of a composite fluorine-containing sealant is expressed in the eradication of caries (less than 1 affected tooth according to the World Health Organization classification) and amounts to 437.38 rubles of notional saved costs per child for sealing versus dental treatment. Conclusion. The use of a fluoride composite material reduces the severity of dental caries in children and the notional saved costs for sealing teeth.

Aim. To assess the reasonability to use CAD added to mammography with subsequent targeted ultrasound (US) of CAD markings in patients with low-density (ACR A-В) breasts.Materials and methods. In the prospective study we included 2326 women with low breast density. They were randomized for CAD (MammCheck II of our own design) checking with subsequent targeted US (MMG + CAD group) or without CAD (MMG only group). After the initial screening we performed the 3-year follow-up phase.Results. Totally, during the primary screening in the MMG only group we found 77 breast cancers (BCs) (28,57% of them sized less than 1 cm), in the MMG + CAD group – 69 BCs (36,23% of them sized less than 1 cm), р > 0.05. The suspicious lesion was identified only during the targeted US of the CAD marking in 4 of 25 women in the MMG + CAD group, and all these BCs were below 1 cm in size. During the subsequent follow-up in the MMG only group we found 5 additional BCs, with no such cases in the MMG + CAD group (p < 0.05). Three of these five BCs were retrospectively marked by CAD. The only visible BC that was not marked by CAD was 3 mm in size.Discussion. The overall false positive marking rate was 0.31 и 0.28 per film-screen and digital image, respectively (р > 0.05).Conclusion. The CAD usage added to mammography with subsequent targeted US of markings in patients with low-density (ACR A-В) breast is reasonable due to the significant decrease of the BC rate diagnosed during the 3-year follow-up. This combination detected 77 of the 77 (100.00%) BCs compared to 69 of 74 (93.24%) BCs when only mammography used.