[Clinical and instrumental characteristics of psoriatic arthritis in men and women. Data from a cohort observational study].

AIM: To study and compare the clinical and imaging characteristics of psoriatic arthritis (PsA) in men and women. MATERIALS AND METHODS: The study included 956 PsA patients observed in the Russian register, 411 (43%) men and 545 (57%) women. The average age of men/women was 46.0±16.50/50.7±17.20 years (p<0.001), the duration of PsA was 9.9±6.4/10.3±7.6 years (p>0.05), the age at the time of PsA establishment was 37.1±12.30/41.8±13.5 years (p<0.001). Rheumatological examination, X-ray of the pelvis, hands, feet were performed, the LEI, plantar fascia tenderness, body surface area (BSA), body mass index (BMI), CRP, HLA-B27 were determined. Patients filled out assessment scales of pain (Pain), disease activity (patient global assessment of disease activity - PGA), questionnaires HAQ-DI. The indices of Disease Activity in PSoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), criteria of minimal disease activity (MDA) were evaluated. RESULTS: The following differences in the course of PsA in men/women were revealed: X-ray sacroiliitis was detected in 175 (42.6%)/153 (28.1%); p<0.001; the presence of erosions of the joints of the hands and feet - 138 (33.6%)/170 (31.2%); p=0.435; LEI≥3 - 34 (11.4%)/78 (20.9%); p=0.001; Pain - at 48.5±22.60/51.5±22.80 mm VAS; p=0.043; PGA - 50.2±23.07/54.0±21.91 mm VAS; p=0.010; moderate and severe functional disorders (HAQ-DI) were more often observed in women (p=0.002 and p<0.001, respectively); the average value of DAPSA is 26.4±16.8/31.9±22.58; p<0.001; average BASDAI value: 2.7±2.83/1.8±2.78; p<0.001; MDA was achieved in 13 (3.2%)/22 (4.1%); p=0.486; BSA>10% - 54 (13.1%)/102 (18.7%); p=0.021; comorbid diseases - 154 (37%)/277 (51%); p<0.001. At the time of inclusion in the register, the proportion of patients receiving biologic disease-modifying anti-rheumatic drugs was higher in the group of men. CONCLUSION: Our data, based on a large cohort study, demonstrate that PsA debuts in women at a later age than in men, the course of the disease is characterized by higher activity of peripheral arthritis, more pronounced functional disorders and a high prevalence of comorbid diseases. This creates a heavier burden of PsA in women and indicates that gender is an important characteristic of the patient that should be used to predict the course, therapeutic response and progression of the disease.

[Characteristics of PIK3CA gene mutations in Her2-low breast cancer]. / Kharakteristika mutatsii gena PIK3CA pri rake molochnoi zhelezy s nizkim urovnem ekspressii belka Her2/neu.

BACKGROUND: Mutations in the PIK3CA gene, encoding the catalytic subunit of the PI3K class IA p110α, is a common mechanism of activating of PI3K/AKT/mTOR pathway in breast cancer (BC). The detection of these mutations in patients with hormone-positive Her2-negative BC is of important clinical value, since they are the predictor of the sensitivity of the tumor to the PI3K inhibitor - alpelisib. According to the status of the Her2/neu expression, all patients with hormone-positive Her2-negative BC can be divided into two groups - with low expression of Her2/neu (IHC 1+; 2+, ISH-) and with a complete lack of expression of this protein (IHC 0). OBJECTIVE: Establish whether there are differences of the PIK3CA gene mutations charasteristics in BC with luminal immunophenotype and low expression of Her2/neu in comparison with tumors in which Her2/neu expression is absent. MATERIAL AND METHODS: The presence of PIK3CA mutations was determined using real-time PCR on 96 patient tissues of hormone-positive Her2-negative BC. Commercially available cobas PIK3CA Mutation Kit (Roche) and cobas z480 analyzer were used. RESULTS: PIK3CA gene mutations were detected in 40 of 96 cases studied (41.6%). Most of them were localized in the exons 9 and 20, encoding helicase (p.E542K, p.E545X) or kinase (p.H1047X) domains of PI3K, respectively. The frequency of mutations in the exon 9 (p.E542K+p.E545X) was 2.6 times higher in Her2-low BC compared to tumors in which the Her2/neu expression was absent (p<0.05). There were no statistically significant differences in mutation frequency in the exon 20. CONCLUSION: Statistically significant increase in the frequency of exon 9 mutations of the PIK3CA gene is specific for the group of patients with Her2-low BC. Our results supported the concept of Her2-low BCs as the unique entity and pointed out the need of their further study.

The Effect of Original Russian Neurotropic Drugs on Organic Anion Transporting Polypeptides OATP1B1 and OATP1B3.

In experiments on HepG2 cells, we studied the effect of the original domestic neurotropic drugs omberacetam, fabomotizole, and ethylmethylhydroxypyridine succinate (EMHPS) (1-500 µM) on the activity and content of organic anion transporting polypeptides OATP1B1 and OATP1B3. It was shown that omberacetam (500 µM) increased the content of OATP1B1 and OATP1B3, fabomotizole did not affect the level of both transporters, and EMHPS (500 µM) increased the content of OATP1B1 compared to the control and did not affect the level of OATP1B3. The tested substances also reduced the OATP1B1/OATP1B3 ratio, as evidenced by a decrease in the penetration of atorvastatin, a substrate of the transporters, into HepG2 cells in the presence of omberacetam (100-500 µM), fabomotizole (500 µM), and EMHPS (10-500 µM). Evaluation of clinical significance of the obtained results, according to the FDA approach based on the calculation of the Cmax/IC50 ratio, showed that the effect of the tested substances on OATP1B1/OATP1B3 is clinically insignificant.

[The role of health resort factors in preconception preparation of patients with reproductive disorders]. / Rol' sanatorno-kurortnykh faktorov v pregravidarnoi podgotovke patsientok s narusheniyami reproduktivnoi funktsii.

Reproductive dysfunction is a multifactorial problem, for the correction of which the most difficult are cases of pathology comorbidity. Individual preconception preparation, taking into account risk factors, is recognized as an effective measure to increase the chances of conception and prevent reproductive losses. OBJECTIVE: Optimization of treatment and rehabilitation measures at the preconception stage in patients with reproductive disorders. MATERIAL AND METHODS: The effectiveness of the use of natural and preformed physical factors in the preconception preparation of 180 women who underwent medical and rehabilitation measures in the health resort of the Altai Territory - the resort town of Belokurikha (Group 1, 79 patients) and outpatient conditions in the city of Barnaul (Group 2, 101 patients). Comprehensive spa treatment included climatotherapy, a combination of various methods: balneotherapy, peloidtherapy, physiotherapy and a prolonged course of herbal medicine. RESULTS: In patients of the 1st group, who underwent a course of rehabilitation treatment in a sanatorium-resort environment, compared with patients of the 2nd group, early reproductive losses were less common during pregnancy (7.1% and 20.7%, respectively; p=0.04) and more frequent term deliveries occurred (92.8% and 77.2%, respectively; p=0.02). The most significant predictors of the ineffectiveness of preconception preparation were the presence in patients of: chronic cystitis and autoimmune thyroiditis with hypothyroidism; oligomenorrhea at the time of pregnancy planning; aggravated by early reproductive losses and long-term wearing of intrauterine contraception history; burdened heredity for violation of carbohydrate metabolism. CONCLUSION: Comprehensive preconception preparation in the sanatorium-resort conditions of Belokurikha helps to increase the fertility of patients with reproductive disorders, the trophostimulating effect in the genital organs and the restoration of endometrial reception, which makes it possible to recommend this method for use in clinical practice.

[Creation of a model of HER2/neu-positive transplantable tumor on the immunocompetent mice].

In this study we established a HER2/neu expressing mouse tumor model using hepatoma MH-22a cell line tumorigenic in DBA mice. G10 clone with high level of HER2/neu expression was obtained by stable transfection and cloning. Solid tumors induced by subcutaneous injection of G10 cells into immunocompetent mice retain the expression of human receptor for at least three weeks. Treatment with trastuzumab results in statistically significant inhibition of tumor growth. This model can be used to evaluate in vivo efficiency of novel anti-HER2/neu antibodies and to test antibody-based conjugates for diagnostics.

[Numerical impairments in genes in breast cancer: a multiplex ligation-dependent probe amplification study].

OBJECTIVE: To analyze breast cancer samples using the new technique multiplex ligation-dependent probe amplification (MLPA) assay. MATERIAL AND METHODS; Formalin-fixed paraffin-embedded breast carcinoma samples from 65 patients were examined. After manual microdissection, DNA was isolated using a commercial kit ("QIAGEN") and analyzed with SALSA MLPA KIT P078-B1 Breast Tumour ("MRC-Holland"). Capillary electrophoresis provided results. RESULTS: MLPA assay was successful in all examined samples. The amplification and deletion frequencies of the analyzed genes were in line with the literature data. The technique requires conventional work-related skills in a molecular genetic laboratory and, as a whole, presents no problems with its usage. The interpretation of results is devoid of subjective meaning due to exclusively their mathematical analysis. MLPA assay provides an insight into numerical impairments in the following genes: ERBB2, MYC, TRAF4, C11orf30 (EMSY), ADAM9, IKBKB, CCNE1, TOP2A, CDH1, CDC6, ESR1, CPD, EGFR, MTDH, CCND1, BIRC5, MED1, FGFR1, MAPT, PRDM14, and AURKA. CONCLUSION: MLPA is an easy-to-use and promising method for multiplex genetic analysis of tumor cells in breast cancer.

Treatment with afobazole at delayed time points following ischemic stroke improves long-term functional and histological outcomes.

There is currently a significant lack of therapeutic options for acute ischemic stroke, and no drug has been approved for treating patients at delayed time points (≥6h post-stroke). Afobazole, an anxiolytic currently used clinically in Russia, has been shown to reduce neuronal and glial cell injury in vitro following ischemia. Experiments using the permanent middle cerebral artery occlusion (MCAO) rat model were carried out to determine if afobazole can reduce ischemic stroke damage in vivo and expand the therapeutic window for stroke treatment. Post-stroke (24h) application of afobazole (0.3-3mg/kg) significantly decreased infarct volume at 96h post-surgery, as determined by Fluoro-Jade and NeuN staining of brain sections. Moreover, afobazole helped preserve both the levels and normal histological distribution of myelin basic protein, indicating a reduction in white matter injury. A time-dependence study showed that either pre-treatment or treatment started 6 to 48h post-stroke with the drug yields improved outcomes at 96h. The decrease in infarct volume produced by afobazole was blocked by the application of either a σ-1 (BD 1063, 30mg/kg) or a σ-2 (SM-21, 1mg/kg) antagonist, indicating that both receptor subtypes are involved in the effects of afobazole. Treatment with afobazole starting at 24h post-stroke resulted in enhanced survival one month following surgery. Behavioral testing of animals 28-32days post-surgery using the elevated body swing and forelimb grip-strength tests revealed that treatment with afobazole starting 24h post-stroke significantly reduces behavioral deficits caused by ischemic stroke. The increase in survival and improved functional outcomes are accompanied by a reduction in infarct volume, as determined by thionin staining of brain sections. Taken together, our data support the use of afobazole as a post-stroke pharmacological agent to expand the current therapeutic window.

[A FISH analysis in one day. Experience in evaluating HER2 gene status by means of a new HER2 IQFISH pharmdx kit].

Determination of the HER2 status of tumor cells in stomach and breast cancer is a routine diagnostic method. Immunohistochemical study is sufficient for its evaluation in most cases. However, a specifying molecular genetic study using the FISH technique is performed when borderline results are obtained. The paper describes the new procedure IQFISH that allows the results to be obtained in one working day.

[Gene amplification and coamplification in breast cancer: frequency and prognosis value].

Numerical impairments in genes or some genome sites - gene amplifications or deletions - are one of the most frequent genetic mutations occurring in breast cancer. Gene amplifications in breast cancer, their frequency, prognostic value, and the possible role of these disorders in the identification of the subtypes of this heterogeneous disease are considered.

[Molecular genetic study of B- and T-lymphocyte clonality in the diagnosis of non-Hodgkin's lymphomas].

The value of molecular genetic methods in the current diagnosis of lymphoproliferative diseases is estimated. A standardized BIOMED2 protocol for these studies is described. The merits and demerits of this method are considered.

[Different Her-2 status in infiltrative and intraductal components of the breast cancer].

In the article a breast cancer case with different Her2 status in invasive and non-invasive components is described. We emphasize on the importance of knowledge about tumor histology for correct interpretation of FISH Her2-test results.

[HER-2/neu-testing in breast cancer: is the immunocytochemistry competent?].

According to ASCO/CAP guidelines, there are two recommended methods for Her2/neu-testing in breast cancer patients such as immunohistochemistry and fluorescence in situ hybridization. This paper analyses results of alternative immunocytochemical method for Her2/neu detection and its diagnostic pitfalls.

[Bcl-2 as a prognostic factor in different molecular genetic subtypes of breast cancer].

It is well known that breast cancers (BC) are divided into 4 molecular genetic subgroups (luminal A, luminal B, HER2/neu-positive, and triple-negative (TNBC). The purpose of the investigation was to comparatively estimate the pattern of expression of Bcl-2, known as a good prognostic marker of BC, in different molecular genetic subgroups and to study the correlation of this protein with proliferative activity index and genetic aberrations on chromosome 17. The investigation covered 290 samples of invasive ductal BC. Bcl-2 expression was identified in 14% of HER2/neu-positive and TNBC cases while 77% of luminal B tumors and 100% of luminal A ones expressed Bcl-2. Loss of Bcl-2 expression correlated with clinically more aggressive BCs having a high proliferative activity and amplification of HER2/neu and chromosome 17 centromere. This may suggest the poor prognosis of luminal B, HER2/neu-positive and TNBC with no Bcl-2 expression and calls for further investigations on larger samples.

[Multifactorial analysis of the results of integrated radiation study in breast cancer].

Breast cancer can be successfully diagnosed at its early stage on the basis on the detailed analysis of its clinical and radiation signs, by keeping in mind the significance of multiple factors that influence the development of the tumor. Among these factors, the endogenous causes associated with female menstrual status in particular, and the states caused by the cytohistological features of the occurred cancer are of particular importance. To assess the significance of these factors, the authors examined a set of clinical, mammographic, and ultrasound data from 120 women of different ages with the breast cancer established and verified by cytohistological examination. The findings were compared in relation to the menstrual status (pre- and postmenopausal age) at the first stage and to the sizes of a cancer nodule detected by mammography at the second stage. A number of clinical and X-ray signs of cancer were noted to be associated with premenopausal age (the uneven pattern of a skin-matted nodule, enlarged lymph nodes, limited skin thickening, oval mottled tumor shadow with prominences and frequent calcifications) and others are substantially more frequently seen in menopause (the outlines of a tumor nodule with prominences, as well as altered adjacent tissues as prominences and strands). Assessing the pattern of changes in relation to the sizes of a tumor revealed ascertained that the development of the signs of invasive tumor growth was associated with the altered low-grade cancer/ moderate-grade tumor extent ratio.

[Cancer morbidity and mortality among the liquidators of the Chernobyl accident: estimation of radiation risks].

The work focuses on the results of the analysis of the cancer incidence among the Chernobyl emergency workers residing in Russia during 1991-2001. The analysis is based on the data for the cohort of male emergency workers from 6 regions of Russia including 55718 persons with documented external radiation doses in the range of 0.001-0.3 Gy who worked within the 30-km zone in 1986-1987. The mean age at exposure for these persons was 34.8 years old and the mean external radiation dose 0.13 Gy. In this cohort 1370 cases of solid cancer were diagnosed. Three follow-up periods were considered: 1991-1995, 1996-2001 and 1991-2001. The second follow-up period was chosen to allow for a minimum latency period of 10 years. Risk assessments were performed for two control groups: the first control group ("external") represented incidence rates for corresponding ages in Russia in general and the second control group ("internal") consisted of emergency workers. The estimated standardized incidence ratio (SIR) is in good agreement with that of the control within 95% CI. The values of the excess relative risk per unit dose 1 Gy (ERR/Gy) for solid malignant neoplasms have been estimated to be 0.33 (95% CI: -0.39, 1.22) (internal control) for the follow-up period 1991-2001 and 0.19 (95% CI: -0.66, 1.27) for 1996-2001. The analysis of cancer morbidity was carried out for the cohort of 29003 emergency workers who took part in liquidation of the consequences of the Chernobyl accident from 26 April 1986 to 25 April 1987. It was shown that the excess relative risk of cancer deaths per unit dose 1 Sv (ERR/Sv) is equal to 1.52 (95% CI: 0.20, 2.85).

The risk of radiation-induced cerebrovascular disease in Chernobyl emergency workers.

The paper deals with estimating radiation risks of non-cancer diseases of the circulatory system among the Chernobyl emergency workers based on data from the Russian National Medical and Dosimetric Registry. The results for the cohort of 61,017 people observed between 1986 and 2000 are discussed. These are essentially updated results for the similar cohort that was studied by authors earlier in 1986-1996. Newly discovered is the statistically significant dose risk of ischemic heart disease [ERR Gy = 0.41, 95% CI = (0.05; 0.78)]. Confirmation is provided for the existence of significant dose risks for essential hypertension [ERR Gy = 0.36, 95% CI = (0.005; 0.71)] and cerebrovascular diseases [ERR Gy = 0.45, 95% CI = (0.11; 0.80)]. In 1996-2000, the assessed ERR Gy for cerebrovascular diseases was 0.22 with 95% CI = (-0.15; 0.58). Special consideration is given to cerebrovascular diseases in the cohort of 29,003 emergency workers who arrived in the Chernobyl zone during the first year after the accident. The statistically significant heterogeneity of the dose risk of cerebrovascular diseases is shown as a function of the duration of stay in the Chernobyl zone: ERR Gy = 0.89 for durations of less than 6 wk, and ERR Gy = 0.39 on average. The at-risk group with respect to cerebrovascular diseases are those who received external radiation doses greater than 150 mGy in less than 6 wk [RR = 1.18, 95% CI = (1.00; 1.40)]. For doses above 150 mGy, the statistically significant risk of cerebrovascular diseases as a function of averaged dose rate (mean daily dose) was observed: ERR per 100 mGy d = 2.17 with 95% CI = (0.64; 3.69). The duration of stay within the Chernobyl zone itself, regardless of the dose factor, had little influence on cerebrovascular disease morbidity: ERR wk = -0.002, with 95% CI = (-0.004; -0.001). The radiation risks in this large-scale cohort study were not adjusted for recognized risk factors such as excessive weight, hypercholesterolemia, smoking, alcohol consumption, and others.

[The radiation risks of cerebrovascular diseases among the liquidators].

The work concerns the assessment of radiation risks for non-cancer diseases of circulatory system among the Chernobyl liquidators. The medical and dosimetric data from Russian National Medical and Dosimetric Registry were used. The cohort data from 1986 to 2000 years of 61017 liquidators are discussed. Radiation risks are established for the cerebrovascular diseases and for the essential hypertension the significant. ERR =0.45/Gy, with 95% CI = (0.11; 0.80) for the cerebrovascular diseases and ERR = 0.36/Gy, with 95% CI = (0.005; 0.71) for the essential hypertension. It approves the results which were established by authors for the similar cohort in 1986-1996. The cerebrovascular diseases (CVD) are considered in greater details. The significant heterogeneity of the radiation risks by working time in Chernobyl zone is shown for the first time. ERR = 0.89/Gy for the working time less then 6 weeks, and ERR = 0.39/Gy in average for all periods of working in the zone. Among the liquidators entered Chernobyl zone during the first year after the accident (29003 liquidators), the CVD's risk group consists of persons accumulated more then 150 mGy from external sources in less, then 6 weeks (RR = 1.18 with 95% CI = (1.00; 1.40)). The significant CVD's risk from averaged dose rate was defined for external doses greater then 150 mGy (ERR for 100 mGy/day = 2.17, with 95% CI = (0.64; 3.69)).

[Frequency of different infectious agents persistence in mononuclear leukocytes of blood and synovial fluid in patients with rheumatoid arthritis].

The study of persistence in mononuclear leukocytes (ML) of blood and synovial fluid of 218 patients with rheumatoid arthritis (RA) Cytornegalovirus (CMV), the 1-st and 2-nd types of Herpes virus simplex (VH), Epstain-Barr virus (VEB), Mycoplasma arthritidis (Ma), Mycoplasma fermentans (Mf), Ureaplasma urealiticum (U), Chlamidia trachomatis (Ct), viruses of Hepatitis B and C was carry out by direct and indirect immunofruorescence, immunoenzymatic analysis and polymerase chain reaction. An increased frequency of contamination of blood ML with infectious agents in patients with RA was established (57,4% compared with 16,7% in control group). The following infectious agents were revieled more frequently: in ML of blood and synovial fluid the Ma (relatively 20,5% and 15,9%), Mf (15,6% and 13,2%), Ct (18,4% and 13,2%), VH (27,1% and 10,5%), VEB (12,7% and 5,3%) and CMV (11,2% and 7,9%). Types of frequency dynamics of ML contamination with these infectious agents in different time phases of RA were determined.

[Effect of low intensity helium-neon laser and decimeter electromagnetic irradiation on functional indices of immune cells in patients with rheumatoid arthritis]. / Vliianie nizkoénergeticheskogo gelievogo-neonovogo lazernogo i detsimetrovogo élektromagnitnogo izluchenii na funktsional'nye pokazateli immunykh kletok u bol'nykh revmatoidnym artritom.

Clinical, laboratory, and immunoassay of 58 patients with rheumatoid arthritis, first and second degree of activity was carried out. Low-energy helium-neon laser exposure and decimeter electromagnetic radiation (DMEM) of peripheral blood was given along with the use of non-steroidal antiinflammatory drugs and methotrexate. Peculiarities of this magnetic-laser effect on proliferation response and apoptosis of mononuclear leucocytes in vitro and in vivo have been revealed. It was also established that the application of DMEM-therapy brought patients with RA in shorter period of time to clinical improvement evaluated by ACR criteria.

Thyroid cancer incidence among liquidators of the Chernobyl accident. Absence of dependence of radiation risks on external radiation dose.

The increase of thyroid cancer incidence rate among children living in the Chernobyl contaminated territories of Belarus, Russia and Ukraine has widely been accepted. Our current work deals with thyroid cancer incidence in the cohort of liquidators (99024 persons) living in 6 regions of Russia: North-West, Volgo-Vyatsky, Central-Chernozemny, Povolzhsky, North-Caucasus and Urals. In the period 1986-1998, a total of 58 thyroid cancer cases were detected in this cohort. We found a statistically significant increase of the thyroid cancer incidence rate in liquidators as compared to the baseline (male population of Russia) level (SIR=4.33, 95% CI: 3.29; 5.60). It was demonstrated that there is no dependence of incidence rates due to external radiation exposure (ERR/Gy=-2.23, 95% CI: -4.67; 0.22).