[The evaluation of efficiency of the program "The automated working place of the senior medical nurse"].

The qualitative functioning of any medical institution depends on both professional competence of its staff and document management. The contemporary society is moving towards e-document management. The topicality of investigation stems from necessity to give scientific rationale and put into practice modern information systems and electronic technologies in the activities of head nurses. The article considers realization issues of the Decree of the President of the Russian Federation of May 7, 2018 No. 204 "On national goals and strategic objectives of the development of the Russian Federation for the period until 2024". Among other "national development goals of the Russian Federation for the period until 2024, the Decree sets the goal to ensure the accelerated digital enabling in the economy and social sphere". Therefore, it is no coincidence that the Federal project "Creating a single digital circuit in health care based on unified state health information system" takes central position in the National Health Care Project. The study used content analysis, expert judgment, sociological and statistical methods. The introduction of the AWP SMS program into professional activities of senior medical nurses allows optimizing documents processing. Its effectiveness was evaluated using mathematical modeling methodology.

[The anemic syndrome in patients with prevalent stages of Hodgkin's lymphoma under application of intensive chemotherapy according the scheme EACOPP-14.]

The sampling of 61 patients with prevalent stages of Hodgkin's lymphoma at various stages of chemotherapy became subject of clinical blood analysis and evaluation of anemic syndrome. The anemia of I-IV degrees was diagnosed in all patients with Hodgkin's lymphoma. Among them patients with anemia of chronic disease prevailed. The single cases of iron-deficient and auto-immune hemolytic anemia were marked. In 24 patients with Hodgkin's lymphoma (39.3%) the deficiency of endogenous erythropoietin which was marked in both patients with anemia of chronic disease and patients with iron-deficient anemia. The lower level of endogenous erythropoietin was fixed in patients with leukopenia and very low erythropoietic activity of marrow. In 8 patients (13.1%) functional deficiency of iron against the background of anemia of chronic disease was established. Therefore, anemic syndrome in patients with prevalent stages of Hodgkin's lymphoma both inactive phase of disease and during application of chemotherapy represents complicated complex of symptoms. It requires accurate laboratory analysis and individual approach in treatment that in turn will favor optimal efficiency of therapy.

[The characteristics of anemic syndrome in patients with prevalent phases of Hodgkin lymphoma before treatment].

The study was carried out to analyze peripheral blood covering 23 patients with prevalent phases of Hodgkin lymphoma received no treatment previously. The clinical analysis of blood was implemented using hematologic analyzer Sysmex XE-2100. The content of ferritin, soluble receptors of transferrin and erythropoietin was estimated using enzyme-linked immunosorbent assay. The free hemoglobin was estimated using hemoglobin cyanide method. The direct Coombs test, counting of leukogram and analysis of morphology of erythrocytes were applied to all patients. The anemia is diagnosed in 19 patients (83%). In 18 out of them the anemic syndrome corresponded to anemia of chronic disease and in one patient asiderotic anemia was established. The rest of patients had no anemia. The anemia of chronic diseases characterized by microcytosis and hypochromia of erythrocytes, inadequate degree of anemia by production of erythropoietin and functional deficiency of iron in most of the patients. It should be emphasized that anemia of chronic diseases commonly is normocyte normochrome anemia whereas in patients with prevalent phases of Hodgkin Iymphoma the microcyte hypochrome anemia was detected before the treatment and it was followed by functional deficiency of iron. In patients without anemic syndrome microcytosis and hypochromia of erythrocytes were marked too. The techniques of laboratory diagnostic objectively reflecting iron metabolism (evaluation of level of soluble receptors of transferrin andferritin) and appropriate hormonal response to degree of anemia (production of erythropoietin) are to be included into algorithm of treatment of patients. The purpose is to timely detect type of anemia with the purpose of its appropriate correction prior to treatment onset.

[Effect of synthetic cyclopentane beta,beta'-triketones on amino acid metabolism in roots of buckwheat (Fagopyrum esculentum Moench.) seedlings].

Germination of buckwheat seeds in solutions of synthetic mono- and tricyclic cyclopentane-containing beta,beta'-triketones of various concentrations was accompanied by inhibition of seedling root growth and changes in the contents of glutamate, gamma-aminobutyric acid, proline, glutamine, and alanine. The monocyclic triketone also affected the amount of isoleucine. It is likely that the increase in proline content is a nonspecific response significant for enhancing stress tolerance in seedlings.

[Influence of cyclopentane beta,beta'-triketones on the ultrastructure of root cap meristematic cells of Cucumis sativus L. seedlings].

The influence of cyclopentane beta,beta'-triketones on the ultrastructure of root cap meristematic cells of Cucumis sativus L. under inhibition of root growth by these compounds was studied. It was shown that treatment of the seedlings by these substances at the concentration of 100 microg/ml caused, on the one hand, stimulation of protein-synthesizing apparatus (increase in the nucleolus size and in the number of mitochondria and rough endoplasmic reticulum membranes) and, on the other hand, stimulation of lytic processes. The fact that the used compounds, causing inhibition of the seedling growth, do not suppress but stimulate protein-synthesizing activity of the cells, according to existing concept, testifies to the compound-mediated induction of the cell resistance to unfavourable factors. Consequently, these compounds, in contrast with growth inhibitors suppressing cell metabolism completely, possess properties peculiar to retardants, growth inhibitors valuable for crop production.

[Velcade in multiple myeloma].

AIM: To study efficacy of velcade therapy in patients with progressive or refractory multiple myeloma (MM). MATERIAL AND METHODS: From April 2005 to November 2006 velcade was used in therapy of 18 patients (11 females and 7 males) with progressive or refractory to prior standard therapy MM course. The patients' age median was 55 years (36 to 76 years). Velcade was injected intravenously on the course days 1, 4, 8 and 11 with interval 10 days between the courses. A total of 77 courses were made (median 4.5). RESULTS: Overall efficacy was assessed according to EBMT criteria in 16 (68%) patients. Partial remission (PR) was achieved in 9 patients, complete remission (CR)--in 1, minimal response (MR)--in 1 patient. Five patients failed the treatment. In 5 of 11 patients with confirmed efficacy of velcade the drug was used in induction of remission before high-dose chemotherapy (HDC) and autotransplantation of hemopoietic stem cells (HSC), in 3--as monotherapy, in 1--in combination with high-dose dexamethasone, in--with high dose dexamethasone and doxorubicin. Four patients achieved PR, one--MR. HSC were obtained before velcade therapy in one patient, in 4--after its conduction. After HDC there were one CR and 4 PR. Recovery of hemopoiesis after HDC took the same time as after standard induction therapy. In 6 of 11 patients HDC was not performed. Velcade therapy is continued in 2 patients, in 1 case with CR the treatment was stopped. In 3 cases PR for 2 to 6 months was followed by the disease progression. CONCLUSION: Velcade as a new effective antitumor drug can be used for treatment of progressive and refractory forms of MM.

[Infectious complications in patients with Hodgkin's lymphoma of unfavourable prognosis].

Analysis of the infectious complications in 48 primary patients with Hodgkin's lymphoma of infavourable prognosis recorded within 1998-2006 is presented. Respiratory tract infections, mucositis and Herpes infection were stated in 43, 24 and 22% of the patients respectively. Bacterial infections predominated (61% of the patients), then followed viral and fungal infections (26 and 43% of the patients respectively). Associations of bacterial and fungal infections were most frequent (50% of the patients). Associations of bacterial and viral infections were less frequent (30%) and fungal and viral infection associations were revealed in 20% of the patients. The structure of the bacterial, viral and fungal infections and the dynamics of the pathogen spectra are presented. The results of the analysis showed that the infections were frequent complications in such patients and could be due not only to obligate but also to opportunistic pathogens, that requires design of the diagnostic algorithm for prediction of the complication process and outcome, thus improving the remote results of the treatment.

[Cytogenetic and carcinogenic effects in liquidators of Chernobyl accident]. / Tsitogeneticheskie i kantserogennye éffekty u likvidatorov posledstvii Chernobyl'skoi avarii.

A tendency of the increasing frequency of malignant neoplasms in liquidators at low radiation doses was found. The dose-effect dependence of the frequency of radiation markers (dicentric chromosomes) in lymphocytes of peripheral blood was revealed only in a group of liquidators of the ChNPP accident with malignant neoplasms in remote terms.

[Prognostic criteria in the course of duodenal ulcer]. / Prognosticheskie kriterii techeniia iazvennoi bolezni dvenadtsatiperstnoi kishki.

Examination and long-term follow-up covered 95 patients with duodenal ulcer (DU). Mean age of the patients was 32 +/- 1.67 years. The patients were divided into two groups: with rare DU recurrences (n = 36) and with frequent recurrences (n = 59). Diagnostic criteria for development of rarely recurrent DU were the following: blood group A(II), exacerbations in winter, weak symptoms at DU onset, weak abdominal pains, solitary surface ulcers. For development of frequently recurrent DU, diagnostic criteria include O(I) blood group, spring exacerbations, marked symptoms of the exacerbation, severe abdominal pains, multiple deep ulcers.

[Dose curves for radiation-induced cytogenetic damage in human lymphocytes]. / O forme dozovykh krivykh radiatsionno indutsirovannykh tsitogeneticheskikh povrezhdenii limfotsitov cheloveka.

Insufficient fitness of experimental data with convenient linear and linear-quadratic models of "dose-effect" dependence for the number of chromosome aberrations of different types were revealed. Proposed method of approximation of the experimental "dose-effect" dependence with piece-linear splines allows to obtain more accurate results in the most cases and therefore is more preferable than the linear and linear-quadratic models.

[The cytogenetic assessment of the degree of severity of acute radiation sickness in those who cleaned up the Chernobyl catastrophe]. / Tsitogeneticheskaia otsenka stepeni tiazhesti ostroi luchevoi bolezni u likvidatorov Chernobyl'skoi katastrofy.

The study is of a retrospective character and is based on the author's own cytogenetic findings secured in May-June 1986 in the examination of patients diagnosed as having had a first to third-degree acute radiation sickness while receiving massive detoxicating therapy. We consider it expedient to employ the model of multiple linear regression relying on a complex of most informative cytogenetic indicators rather than on only one such indicator alongside the traditional dose reaction identifiable by the level of dicentric chromosomes in blood lymphocytes. This will allow the degree of severity of the radiation injury to be determined with greater precision and permits assessing the therapeutic efficiency of the measures implemented.

[Treatment of local Hodgkin's disease with massive mediastinal involvement]. / Lechenie bol'nykh limfogranulematozom I-II (lokal'nykh) stadii s massivnym porazheniem sredosteniia.

AIM: To define the scope of combined therapy in patients having local Hodgkin's disease (LHD) with massive mediastinal lesion. MATERIAL AND METHODS: From 1980 to 1997 the treatment was given to 75 LHD patients with massive lesion of the mediastinum (mediastinal-thoracic index, MTI, > or = 0.33). The patients have received combined chemoradiotherapy according to 3 cycle CVPP (cyclophosphamide 600 mg/m2, vinblastine 6 mg/m2, prokarbasin 100 mg/m2, prednisolone 40 mg/m2) with a 2-week interval + radiation to all the lymphatic collectors above the diaphragm with a single focal dose 2 Gy to total focal dose 36-38 Gy + 3 cycle CVPP. According to the size of the mediastinum the patients were divided into 3 groups: group 1--MTI = 0.33, 27 patients; group 2--MTI = 0.33 > 0.45, 32 patients; group 3--MTI > or = 0.45, 16 patients. The response was estimated according to the latest EORTC recommendations. Survival curves were plotted according to the E.L. Kaplan and P. Meier procedure. RESULTS: Complete remission was achieved in 93, 94 and 56% of group 1, 2 and 3 patients, respectively. 6-year recurrence-free survival reached 84, 71 and 32%, while survival free of treatment failure 80, 66 and 27%, respectively. 6-year overall survival and uneventful survival made up 94, 97 and 70%; 72, 66 and 27%, respectively. CONCLUSION: Treatment of LHD patients of group 1 is performed according to the standard scheme (6 cycles of first-line polychemotherapy plus radiotherapy). Patients of group 2 can be treated more intensively, while for patients of group 3 more intensive treatment is a treatment of choice.

[The late results of the combined therapy of patients in 2nd-stage lymphogranulomatosis]. / Otdalennye rezul'taty kombinirovannoi terapii bol'nykh limfogranulematozom II stadii.

AIM: To define the scope of combined therapy according to prognostic factors in patients with Hodgkin's disease state II. MATERIALS AND METHODS: 98 patients with favorable and unfavorable Hodgkin's disease (HD) prognosis according to EORTC criteria (41 and 57 of group 1 and 2, respectively) entered the study. Unfavorable factors were: mixed HD variant and lymphoid depletion, ESR above 50 mm/h in stage A and 30 mm/h in stage B, involvement of more than 3 groups of lymph nodes, age over 40. Patients of group 1 received CVPP program: 2 courses before and after radiation of the primary disease zones in the total dose 40 Gy. Therapy of group 2 patients consisted of 3 CVPP courses before and 3 courses after irradiation of all the lymphatic collectors above the diaphragm in the total dose 35 Gy or radiation according to the extended program. Efficacy of therapy was assessed by EORTC criteria. The survival curves were calculated by Caplan and Meyer methods. RESULTS: In groups 1 and 2 a complete a complete remission was achieved in 98 and 93%, 6-year survival was 100 and 91%, recurrence-free survival--94 and 87%, respectively. Survival free of the treatment failure reached in group 1--88%, in group 2--81%. CONCLUSION: Reduced treatment in HD stage II in favourable prognosis did not worsen the results of treatment.

[The clinico-hematological picture of acute radiation sickness in the initial period after the Chernobyl catastrophe]. / Kliniko-gematologicheskaia kartina ostroi luchevoi bolezni v nachal'nye sroki posle chernobyl'skoi katastrofy.

The time and degree pattern of the primary response manifestations did not in all instances correlate with subsequent severity of radiation pathologies, which fact may be explained by different levels of bodily exposure to alpha and beta-emitting radionuclides, products of combustion of different substances, psychological status of the people. There is a wave-like change in the parameters characterizing the cellular composition of blood.

[An analysis of morbidity in those who worked in the cleanup of the aftermath of the Chernobyl accident]. / Analiz zabolevaemosti u likvidatorov posledstvii Chernobyl'skoi avarii.

Some aspects were studied of pathologies in those liquidators who sought to find out connection between health disorders and restorative work at the Chernobyl Power Plant through the Kiev Regional Expert Medical Counsel in 1990-1996. Those disorders in whose pathogenesis the radiation factor acts together with factors of nonradiation nature, namely of the nervous, cardiovascular systems, and digestive organs, rank first in the structure of pathologies during the first ten years of the postradiation period. The incidence rate of malignancies among those liquidators who had applied to the Council is on the increase. In the structure of oncopathologies prevalence, the leading place is taken up by tumours of digestive organs, respiratory system, and urogenital organs.

[Superhigh-dosage chemotherapy with the transplantation of autologous hemopoietic precursor cells in patients with a prognostically unfavorable relapse and resistant course of lymphogranulomatosis]. / Sverkhvysokodoznaia khimioterapiia s transplantatsiei autologichnykh kletok predshestvennikov gemopoéza u bol'nykh s prognosticheski neblagopriiatnym retsidivom i rezistentnym techeniem limfogranulematoza.

Eighteen patients with relapsed or refractory Hodgkin's disease (HD) have been treated with high-dose chemotherapy (BEAM regimen) followed by autologous peripheral stem cells and/or bone marrow rescue. There were no treatment-related deaths. Overall response rate was 82%. With a median follow-up of 10 months (3-24 months) overall survival and freedom from progression were 100 and 94% (95% confidence interval 58-97%), respectively. The use of peripheral stem cells in addition to bone marrow resulted in a significant shortening of the time to engraftment (p < 0.01). The BEAM regimen is an effective conditioning schedule which is well tolerated.

[The distribution of chromosome aberrations in cells under the action of radiation of different qualities]. / Raspredelenie aberratsii khromosom po kletkam pri deistvii izluchenii razlichnogo kachestva.

The distribution of chromosome aberrations in the cultured human peripheral blood lymphocytes exposed to 6 MeV neutrons was compared with that of lymphocytes exposed to gamma-rays. The regularities of both distributions were similar.