[Comprehensive analysis of the efficacy of personalized rehabilitation programs in patients with breast cancer]. / Kompleksnyi analiz effektivnosti personalizirovannykh programm reabilitatsii bol'nykh rakom molochnoi zhelezy.

The concept of the personalized rehabilitation is based on the principle of applying physical and rehabilitative medicine techniques depending on the factors that mostly influence on rehabilitation efficacy in a particular patient - determinant of effectiveness. Current achievements in the diagnosis and treatment of breast cancer (BC) significantly increased overall patients' life expectancy, updating rehabilitative treatment stage, which is often unmet. OBJECTIVE: To perform the comprehensive analysis of the efficacy of personalized rehabilitation programs in patients with BC. MATERIAL AND METHODS: The combined comparative multi-centre randomised trial of rehabilitation program efficacy in patients with breast cancer was done. The study included 219 patients aged from 30 to 45 years (median 39.4 year), who were divided into 2 groups. The rehabilitation by programs, that included current personalized rehabilitative techniques (RT) with proved efficiency, based on scientometrical analysis of evidential research was performed in the first group patients. In the second group aftercare was done according to the standard programs. The comprehensive evaluation of treatment efficacy was conducted in several stages: 1) performance analysis of rehabilitative programs; 2) verification of the effectiveness' determinant of rehabilitation; 3) factor analysis to assess the mechanisms of therapeutic effects in experimental groups; 4) comparative analysis of alternative strategies for selecting rehabilitation programs. RESULTS: The use of rehabilitative programs, based on recommended RT, changes the rehabilitation structure, significantly increasing its efficacy by 17%. Furthermore, the percentage of high-efficiency usage of this type programs increases by 17% compared with standard programs. The main determinants, affecting the efficacy of rehabilitation programs, based on selected RT, are anamnestic data, parameters of exercise tolerance and physical activity and ultrasound parameters of upper limb blood flow. The therapeutic effects of personalized rehabilitation programs are realized by correction of clinical rates, increasing exercise tolerance and physical activity, as well as psychophysiological parameters. CONCLUSION: The use of the evaluation system of anamnestic, clinical, functional and psychophysiological features of patient (the effectiveness' determinant) in realization of personalized rehabilitation programs for women with BC, allows to predict and manage the efficacy of RT applying.

[Opportunities of intraoperative hyperthermic perfusion application in treatment of peritoneal carcinomatosis].

Normothermic intraperitoneal perfusion (IPEP) and hyperthermic intraperitoneal perfusion (HIPEP) were performed in 44 Wistar female rats with transplanted ascites tumor of the ovary. Opportunities of intraoperative hyperthermic perfusion application in treatment of peritoneal carcinomatosis. Antineoplastic affects were evaluated according to increase of animals' survival. IPEP and HIPEP increase median survival time by 78% (p=0.307) and 150% (p=0.005) respectively in comparison with conventional intraperitoneal introduction of physiological solution. Thus HIPEP has statistically more significant antineoplastic affect in vase of peritoneal carcinomatosis.

[Hyperthermic intraperitoneal chemotherapy in the treatment for recurrent ovarian cancer].

There are presented data of literature and own observations of the treatment for recurrent ovarian cancer using hyperthermic intraperitoneal chemoperfusion. The possible complications during hyperthermic chemoperfusion are discussed and the effectiveness of the method is analyzed. Further studies are needed to obtain more certain criteria for abdominal chemotherapy in these patients.

[Antitumor effect of dioxadet in intraperitoneal chemoperfusion treatment for advanced ovarian cancer in experimental setting].

The study of antitumor efficacy of dioxadet in chemoperfusion treatment of ascitic ovarian cancer was carried out in 125 Wistar female rats. Ovarian cancer was inoculated intraperitoneally at a number 1x10(7) tumor cells per rat. Intraperitoneal administration of dioxadet as well as chemoperfusion was performed once in 48 hours after the ovarian cancer inoculation. Dioxadet was used at maximal tolerated doses which were 1.5 mg/kg for intraperitoneal administration, 30 mg/kg for normothermic intraperitoneal chemoperfusion (IPEC), and 15 mg/kg for hyperthermic intraperitoneal chemoperfusion (HIPEC). Antitumor effects of dioxadet were estimated in increase of median survival. In the control group, where animals didn't receive any treatment, the median survival was 9 days. Increase of the median survival after intraperitoneal administration of dioxadet, IPEC and HIPEC with dioxadet was 211% (p=0,001), 244% (p=0,001) and 444% (p=0,001), respectively, compared to the control group. Hence, intraperitoneal chemoperfusion with dioxadet (normo- or hyperthermic) is more effective compared to standard intraperitoneal administration of the drug. At HIPEC with dioxadet potentiating antitumor action of hyperthermia and dioxadet on the ovarian cancer growth was achieved.

[Experimental technology of chemoperfusion treatment for abdominal carcinomatosis in ovarian cancer].

An experimental technology of normothermic intraperitoneal chemoperfusion and hyperthermic intraperitoneal chemoperfusion with cisplatin and dioxadet has been elaborated to treat abdominal carcinomatosis in ovarian cancer. Antitumor effects of the treatment were evaluated for the duration of animal life. Normothermic intraperitoneal chemoperfusion and hyperthermic intraperitoneal chemoperfusion with cisplatin and dioxadet in comparison with the standard intraperitoneal administration significantly increased the median life expectancy by 75-92%. Hyperthermic intraperitoneal chemoperfusion with dioxadet demonstrated potentiation of antitumor effect of hyperthermia and dioxadet. Experimental technology is recommended for testing new drugs and methods of chemoperfusion for malignant tumors affecting the peritoneum.

[Exosomal intercellular communication system and its role in the process of metastatic dissemination].

Metabolism and information between cells is the basis of the existence of any multicellular organism. Malfunction of the intercellular communication play an important and sometimes decisive role in the pathogenesis of the most diseases, including cancer. According to traditional views, functional integration of individual cells in tissues, organs and organ systems is mediated by the efficient work of regulatory systems: nervous, immune, endocrine. Over the past few years the attention of scientists is attracted the ability of cells to "communicate" with the help of nanoscale vesicular formations, or so-called exosomes. There are accumulated data that the cells of the most tissues secrete exosomes into the intercellular environment, after which, by means of stream of blood or lymph, exosomes transferred to anatomically distant sites where they are accepted by the other cells. It is showed that the content of exosomes are not random and that vesicular transport may be targeted and to play a significant physiological and even "pathophysiological" role. The aim of this review is the analysis and integration of modern scientific data on the role of exosomes in the process of tumor progression and presentation of possible ways and methods of using these data in the practice of oncology.

[Options for pelvic floor reconstruction after extralevatory abdomino-perineal resection of the rectum].

Extralevatory surgery requires a use of additional techniques for closure of extensive defects of the pelvic floor. This study analyzed the results of 55 extralevatory abdomino-perineal extirpations of the rectum using a variety of methods of plastic of defects of the pelvic floor. There were performed 20 simple plastics, 13 alloplastics and 22 myoplastics. Complications in the perineal wound were observed in 10 (50%) cases after a simple plastic, 4 (32%) after plastic using mesh endoprosthesis and 5 (23%) after myoplastic. It is showed that the highest rate of postoperative complications in the perineal wound (up to 50%) occurs in a case of "simple" plastic. Complication rate reduces to 23-32% when alloplastic and myoplastic are used. It is concluded that alloplastic and myoplastic have significant advantages over the simple plastic.

Hybrid in situ replacement for Samson group V Staphylococcus aureus aortic graft infection.

Aortic prosthesis replacements including extra-anatomical bypass procedures, in situ revascularisations with the neoaortoiliac system, antibiotic bounded prostheses or allogeneic grafts have high graft reinfection rates. We described a case of a 68-year-old man with Samson group V Staphylococcus aureus infection of his aortobifemoral graft. He underwent an explantation of the infected graft, wound debridement and a hybrid in situ allogeneic aortoiliofemoral replacement. During surgery one of the limbs of the cryopreserved human aortic allogeneic graft was anastomosed with the endarterectomised left common iliac artery, which later was angioplastied and stented. The closed system Jackson-Pratt drains were used to prevent perigraft fluid collection. The groin wound was treated with the vacuum-assisted closure dressing. On review in 6 months he remained symptom free. We conclude that a hybrid management of infected aortic prosthesis may reduce graft reinfection.

Mortality risk stratification in severely anaemic Jehovah's Witness patients.

The aim of this retrospective cohort study was to identify early risk factors of mortality and develop a mortality risk stratification instrument for severely anaemic Jehovah's Witness patients. It has been shown that Jehovah's Witness patients with the Auckland Anaemia Mortality Risk Score (Auckland AMRS) of 0 to 3 had 4% mortality, Auckland AMRS 4 to 5 32%, Auckland AMRS 6 to 7 50% and Auckland AMRS 8 and above 83%. It is concluded that the Auckland AMRS predicts mortality of severely anaemic Jehovah's Witness patients.

Clinical benefits and cost-effectiveness of allogeneic red-blood-cell transfusion in severe symptomatic anaemia.

BACKGROUND: It is well known that blood transfusion is life-saving, but also that it carries a serious risk of transmitting viral infections. Introduction of new methods of testing for transmissible diseases, blood banking and dispatch regulations has considerably increased the cost of blood products. However, the clinical benefits and cost-effectiveness of allogeneic red-blood-cell (ARBC) transfusion remain assumed yet undetermined. We assessed the clinical benefits and cost-effectiveness of ARBC transfusion in severe anaemia. METHODS: This was a multicenter observational study comparing Jehovah's Witness (JW) patients with matched ARBC-transfused patients. Inclusion criteria were age ≥15 years and severe anaemia (haemoglobin ≤ 80 g/l). Two JW patients with palliative care cancer and five JW patients with haemoglobin (Hb) concentration between 70·1 and 80 g/l, mild symptoms of anaemia and Auckland Anaemia Mortality Risk Score of 0-3 were excluded. RESULTS: The entry criteria were met by 103 JW patients and the same number of patients treated with ARBC transfusion. ARBC transfusion reduced mortality by 94%, shock by 88%, gastrointestinal bleeding by 81%, infective complications by 81%, cardiac arrhythmia by 96%, angina by 86%, ischaemic myocardial injury by 81%, acute/acute on chronic renal failure by 66%, neurologic complications by 92%, delirium by 76%, depression by 91% and syncopal episodes by 95%. The incremental cost-effectiveness ratio of ARBC transfusion was 2011 US$22 515 for death prevented. CONCLUSION: ARBC transfusion in anaemic patients is clinically beneficial and cost-effective.

[Ways to improve efficacy of emergency operative interventions in patients with cancer of the left flank of the colon complicated by obstruction].

In order to improve radicalism of emergency surgical interventions an appropriate method of total mesocolonectomy and D3-lymph node dissection in the medial-lateral direction and the principle of "no-touch technique" were used in 14 patients. This technique is safe, effective, does not prolong the duration of operation and postoperative period, is not followed by increased number of complications and lethality.

[One-stage operations for left side colon obstruction].

A method of intraoperative lavage of the colon was used for the improvement of results of treatment of patients with cancer of the left colon. The method allowed performing one-stage operations and forming primary anastomosis. Incompetence of the anastomosis was noted in one case, no reoperation was needed. Postyopetrative lethality was 3.4%.

[Spread of new pandemic influenza A(H1N1)v virus in Russia].

The paper presents the results of the investigations of the development of a influenza A(H1N1)v pandemic, conducted by the D. I. Ivanovsky Research Institute of Virology, Russian Academy of Medical Sciences, and collaborating laboratories in the European part of Russia, in the Urals, Siberia, and in the Far East. In the prepandemic period (April 27 - June 11, 2009) its first diagnosis was established on May 21, 2009; the first strain was isolated on May 24, 2009; the data on complete genome sequencing were sent to the GenBank; the sensitivity of the strain to commercial antiviral commercial agents was studied. In the early pandemic period (June 11 - August 15), 73 patients who had come from 14 countries of Europe, America, and Asia were identified; 19 virus strains (partially or completely sequenced) were isolated. The pandemic period (August 15 - December 1) was marked by absolute dominance of pandemic influenza virus virtually in the absence of seasonal influenza; the first death caused by pandemic influenza was detected in late August; 3053 subjects were infected with the pandemic strain, as shown by polymerase chain reaction diagnosis; 202 strains were identified.