[Application of alpha-fetoprotein and osteopontin combination for early diagnosis of hepatocellular carcinoma associated with hepatitis C.]

Liver cirrhosis in the outcome of hepatitis C is the leading cause of hepatocellular carcinoma (HCC) in the world. Early diagnosis and timely treatment of HCC are important for reducing mortality and increasing life expectancy of patients with hepatocellular carcinoma. To assess the risk of HCC, the definition of alpha-fetoprotein (AFP) in the blood is most widely used, but low sensitivity limits its diagnostic value. In 2012, a new HCC biomarker - osteopontin (OPN), which is a secreted phosphoprotein that has a high affinity for integrins was proposed. The level of acute renal failure begins to rise in the early stages of malignancy, before the period of HCC detection by imaging methods, and has significantly better sensitivity than AFP. The purpose of this study is to evaluate the diagnostic efficacy of the combined determination of alpha-fetoprotein and osteopontin in prospective monitoring of patients with chronic hepatitis C in the advanced phase of liver fibrosis. Monitoring of 588 patients with hepatitis C was carried out from February 2013 to February 2019. HCC was detected in 55 of them (2.6% per year). The combination of 2 biomarkers showed better diagnostic efficacy than alpha-fetoprotein and osteopontin separately: AUC 0.85 (95% CI 0.80-0.90) versus AUC 0.63 (95% CI 0.57-0, 70) and AUC 0.82 (95% CI 0.77-0.88), respectively. This combination showed a sensitivity of 85.5% and made it possible to diagnose HCC with a prognostic level of a positive result of 72.3% at 19,4±0,8 weeks before the diagnosis was confirmed by instrumental imaging methods (ultrasound, MRI, CT). In the combined variant, ARF made the greatest contribution to the increase in diagnostic efficacy (AUC). At an early and very early stage of HCC development, isolated HCC elevations were found in only 5.4% of patients. Conclusion: the combined use of alphafetoprotein and osteopontin as a diagnostic panel can be recommended for monitoring patients with liver cirrhosis in the outcome of hepatitis C and predicting HCC at an early stage of development.

[Pharmacoeconomic Analysis of the Use of Hepatoprotectors in Management of Drug-Associated Liver Injury Due to Hodgkin's Lymphoma Chemotherapy].

The data on the pharmacoeconomic research of the use of Remaxol in treatment of drug-associated liver injury due to the chemotherapy in cancer patients are presented. The costs-efficiency method was applied to two groups of the patients with drug-associated liver injury treated according to different schemes. The research showed economical benefits of the Remaxol use.

[Ethnic aspects of hereditary breast cancer in the region of Siberia].

BACKGROUND: Ethnic diversity of the population in the region of Siberia suggests the existence of different germline mutations in the BRCA1/2 genes associated with breast and ovarian cancer in different ethnic populations, but spectrum of these mutations has not been studied. OBJECTIVE: Our aim was to evaluate the frequency of the most common mutations BRCA1/2 (BRCA1 5382insC, BRCA1 185delAG, BRCA1 4153delAG, BRCAI T300G, BRCA2 6174delT) in women diagnosed with breast cancer among indigenous people and newcomers living in Siberia. METHODS: We tested 1281 genomic DNA samples for the presence of BRCA1 5382insC mutation in patients diagnosed with breast cancer considering no family history. 72 patients having hereditary cancer signs were tested for the mutations BRCA1 185delAG, BRCA1 4153delAG, BRCA1 T300G, BRCA2 6174delT. RESULTS: Out of 765 patients of Slavic ethnic group, 27 women (3.5%) were carriers of allele BRCA1 5382insC. The frequencies of mutations in patients with signs of hereditary cancer were: 8.3% in group of young patients (under 40 years), 20.0% in patients with bilateral cancer and 5.7% in patients with family history of breast or ovarian cancers. We tested 516 BC patients residing on the territory of the Buryat-Aginsky district, Republics of Tyva and Altai. Out of them, there were 197 patients among the indigenous population (buryats, tuvinians, altaians), and 319 patients among newcomers (Slavic ethnics). Mutations BRCA1 5382insC were detected only in women from Slavic ethnic groups. The frequency of BRCA1 5382insC mutation was 6% in the group where family history was excluded and 14% in the group of patients with characteristics of family cancer. Allele BRCA1 5382insC was not found in indigenous breast cancer patients, although 59 patients had signs of hereditary cancer. In women from Slavic ethnic group, the BRCA1 185delAG, BRCA1 4153delAG and BRCA1 T300G mutations were detected in 9.1% of cases and were not found in patients among the indigenous population. CONCLUSION: studies of mutations in the BRCA1 gene in breast cancer patients from Siberia confirmed data on the high frequency of "founder mutation" BRCA1 5382insC in Slavic population and indicate the advisability of further studies to identify the genes responsible for the occurrence of hereditary breast cancer in the indigenous population.

[Electrocardiographic sign of secondary atrial tumor presentation].

Two cases of intravital diagnosis of left atrial tumor secondary to lung cancer and esophagus cancer are presented. The myocardial alteration was caused by direct invasion of primary tumor. In both cases the PQ (PR) segment depression was found on ECG, which could reflect neoplastic lesion of the atrium. We proposed to consider this phenomenon as ECG marker of secondary atrial malignancies.

[Results of karyometry of acinar adenocarcinoma of the prostate].

The paper presents the results of karyometry of acinar adenocarcinoma of the prostate in the biopsy specimens with total Gleason scores of 6, 7, and 8-10. There are statistically significant differences in the morphometric characteristics of tumor cell nuclei (the long and short diameters of nuclei and nucleoli, their area and perimeter) in the biopsy specimens as compared with those with total Gleason scores of 6 and 7, as well as in those of the nucleoli as compared to those with total Gleason scores of 6 and 7 and 7 and 8-10. The findings suggest that there are karyometric differences in the cells of prostatic acinar adenocarcinoma in the groups with total Gleason scores of 6, 7, and 8-10.

[Pharmacokinetics of essentiale N].

The optimum time of exposure of the Essentiale N hepatoprotector with an erythrocyte-leukocyte suspension has been determined in vitro using the blood of healthy donors. Variation of the drug distribution in the blood depending on the exposure time was studied by the method of UV absorption spectroscopy. It is established that the optimum exposure of Essentiale N with an erythrocyte-leukocyte suspension is about 10 min. This corresponds to a minimum concentration of Essentiale N in the supernatant phase, which is evidence for the maximum saturation of the cell composition by the preparation. At the same time, the degree of hemolysis does not exceed the normal physiological level.

[Possibilities of cytological diagnosis of central nervous system tumors].

The cytological and pathohistological pictures of 384 glial, meningeal, embryonic, neuronal, metastatic tumors and tumors growing into the cranial cavity and spinal canal (the impression smears of removed tumor fragments and the aspirates on fine needle puncture) were studied in parallel. The common supporting cellular and structural signs required for the diagnosis of the major groups of central nervous system (CNS) tumors, for the verification of some histological types of a neoplasm, and for the estimation of the stage of their malignancy were revealed. An algorithm of cytological diagnosis of some CNS tumors and an adapted working classification are proposed.

[A case of primary hyperparathyroidism in clinical practice].

The article presents a classic case of primary hyperparathyroidism with a variety of clinical "masks" and diagnoses.

[Clinical and acoustic characteristics of tracheoesophageal bypass with prosthesis]. / Klinicheskie i akusticheskie kharakteristiki trakheopishchevodnogo shuntirovaniia s protezirovaniem.

The authors analyse different aspects of tracheoesophageal bypass with prosthesis, how to prolong operation of voice prostheses. It is shown that replacement of the prostheses is frequently necessary not because of wear but rather due to fungal or microfloral affection. Radiotherapy had no adverse effects on prosthesis. Complications of tracheoesophageal bypass with prosthesis, acoustic characteristics of the repaired voice are described.

[Microflora of the voice prostheses]. / Mikroflora golosovykh protezov.

The study was made of the condition of voice prostheses Provox and Blom-Singer in 27 patients wearing them. The prostheses were to be replaced by new ones as they lost impermeability for water. The prostheses were used for 6 months to 2 years. At the prosthesis removal from the tracheoesophageal bypass it was found that the esophageal flange and protective valve were contaminated with fungi and pathogenic bacteria. The valve was deformed, had limited motility and did not close tightly the esophageal opening of the prosthesis as the result of which liquid leaked into the airways. Bacteriological examination identified C.albicans, C.krusei, C.glabralis in 11 patients. Nistatin, flucostat, fluconasol, amphotericin were used in antifungal therapy. Prophylactic use of these drugs against fungi prolonged use of the prostheses 2-fold.

[Rehabilitation of a voice function by means of prosthetic repair of voice after removal of the larynx for cancer]. / Reabilitatsiia golosovoi funktsii s pomoshch'iu golosovykh protezov posle udaleniia gortani po povodu raka.

The paper presents treatment results in 223 patients who have undergone tracheoesophageal anastomosis with prosthetic repair of voice (PRV) after laryngectomy for cancer. PRV was made both simultaneously with laryngectomy (n=126) and after it (n=97). The procedure, complications and their prevention are described. The authors support the idea of the "gold standard"--voice repair for each laryngectomized patient. Tracheoesophageal anastomosis opens great prospects: loud intelligible speech recovered in 91.9% patients.