[Combined treatment of rectal cancer with moderate risk of tumor progression]. / Rezul'taty primeneniya kombinirovannogo metoda lecheniya bol'nykh rakom pryamoi kishki so srednim riskom progressirovaniya opukholevogo protsessa.

OBJECTIVE: To increase the effectiveness of combined treatment in patients with rectal cancer and moderate risk of progression based on the concept of polyradiomodification (PRM). MATERIAL AND METHODS: The study included 337 patients with rectal cancer and moderate risk of tumor progression. A short course of radiotherapy (cRT) (5x5 Gy) combined with several radiomodifiers (cRT+PRM) was performed in 147 (43.6%) patients. Other 190 (56.4%) patients underwent cRT. The following radio modifiers were used: three-time application of local microwave hyperthermia (Yacht-3 or Yacht-4 devices), two-time intrarectal delivery of a biopolymer composition with Metronidazole before the 3rd and 5th irradiation sessions and two-week oral administration of Capecitabine (Xeloda) at a daily dose of 2.0 g/m2. Surgery was performed in 4-6 weeks after radiotherapy. RESULTS: CRT+PRM program increased 5-year relapse-free survival up to 81.3% compared to 60.3% after cRT alone (p=0.0003) due to significant reduction of the incidence of cancer recurrence from 8.4% to 0.7% (p=0.0013). More effective local growth control expanded the indications for sphincter-sparing surgery. These procedures were performed in 89.1% and 70.5% of patients, respectively (p=0.00001). In the cRT+PRM group, sphincter-sparing surgery reduced incidence of cancer recurrence from 13.7% to 0.8% (p=0.0110), distant metastases - from 23.9% to 13.7% (p=0.00349). CONCLUSION: Radiomodification in neoadjuvant radiotherapy is justified in patients with moderate risk of tumor progression, improves long-term results and increases the incidence of sphincter-sparing surgery.

Grain size dependent high-pressure elastic properties of ultrafine micro/nanocrystalline grossular.

We have performed sound velocity and unit cell volume measurements of three synthetic, ultrafine micro/nanocrystalline grossular samples up to 50 GPa using Brillouin spectroscopy and synchrotron X-ray diffraction. The samples are characterized by average grain sizes of 90 nm, 93 nm and 179 nm (hereinafter referred to as samples Gr90, Gr93, and Gr179, respectively). The experimentally determined sound velocities and elastic properties of Gr179 sample are comparable with previous measurements, but slightly higher than those of Gr90 and Gr93 under ambient conditions. However, the differences diminish with increasing pressure, and the velocity crossover eventually takes place at approximately 20-30 GPa. The X-ray diffraction peaks of the ultrafine micro/nanocrystalline grossular samples significantly broaden between 15-40 GPa, especially for Gr179. The velocity or elasticity crossover observed at pressures over 30 GPa might be explained by different grain size reduction and/or inhomogeneous strain within the individual grains for the three grossular samples, which is supported by both the pressure-induced peak broadening observed in the X-ray diffraction experiments and transmission electron microscopy observations. The elastic behavior of ultrafine micro/nanocrystalline silicates, in this case, grossular, is both grain size and pressure dependent.

Cases of Q fever detected in residents of the novosibirsk region hospitalized with suspection of infections transmitted by ticks.

Coxiella burnetii is the causative agent of Q fever (coxiellosis), which, in addition to acute manifestations, often occurs in a latent form, is prone to chronic course and, in the absence of antibiotic therapy, has a high risk of disability or death. As a result of the presence of a wide range of clinical manifestations specific to other infectious diseases, the use of laboratory test methods (LTM) is required to make a diagnosis. The presence of Q fever anthropurgic foci in the Novosibirsk region was described in the 90s of the last century, but due attention to its laboratory diagnostics is not paid in this region. The aim of the study was to identify genetic and serological markers of the causative agent, C. burnetii, in patients of the Novosibirsk region who were admitted for treatment with fever with suspected tick-borne infections (TBIs). DNA marker of the causative agent of Q fever was detected in blood samples by real time PCR in 9 out of 325 patients. In three patients, the presence of C. burnetii DNA was confirmed by sequencing of the IS1111 and htpB gene fragments. In ELISA tests, antibodies against the causative agent of coxiellosis were detected in the blood sera of 4 patients with positive results of PCR analysis. Contact with tick was registered in 7 out of 9 patients who had C. burnetii DNA and lacked markers of other TBIs. Six people were infected in the Novosibirsk region, two suffered from tick's bite in Altai, and one case was from the Republic of Kyrgyzstan. Thus, a complex approach using both PCR analysis and ELISA provided the identification of markers of the Q fever causative agent in patients admitted with suspected TBIs, thereby differentiating it from other infections. Contact with ticks in most cases suggests that infection with C. burnetii had a transmissible pathway.

Genetic diversity and geographical distribution of the Siberian subtype of the tick-borne encephalitis virus.

The tick-borne encephalitis virus (TBEV), a member of the Flaviviridae family, is currently subdivided into three main subtypes-the European (TBEV-Eu), the Far-Eastern (TBEV-FE), and the Siberian (TBEV-Sib). The TBEV-Sib is the most common subtype and found in all regions where TBEV was detected, except for Central and Western Europe. Currently, four genetic lineages have been described within TBEV-Sib. In this study, detailed analysis of TBEV-Sib genetic diversity, geographic distribution, phylogeography and divergence time of different TBEV-Sib genetic lineages based on E gene fragments, complete genome sequences, and all currently available data in the GenBank database was performed. As a result, a novel Bosnia lineage within the TBEV-Sib was identified. It was demonstrated that the Zausaev lineage is the most widely distributed among the TBEV-Sib lineages, and was detected in all studied regions except the Far East. The Vasilchenko lineage was found from Western Siberia to the Far East. The Baltic lineage is presented from Europe to Western Siberia. The Obskaya lineage was found only in Western Siberia. TBEV strains from a newly described Bosnia lineage were detected in Bosnia, the Crimean peninsula, Kyrgyzstan and Kazakhstan. The greatest divergence of the TBEV-Sib genetic variants was observed in Western Siberia. Within the TBEV-Sib, the Obskaya lineage diverged from the common ancestor the earliest, after that the Bosnia lineage was separated, then the Baltic lineage, and the Zausaev and Vasilchenko lineages diverged most recently.

High resolution hard X-ray 3D mapping of a Macaca fascicularis eye: A feasibility study without contrast agents.

Several complementary methods able to visualize the internal structures of eyes are used in the clinical practice in the diagnosis of pathologies affecting a specific zone of the eye. Despite the significant technological progress, the visualization of the entire eyeball at micrometric resolution is yet an unsolved task both in clinical diagnostics and in laboratory research. With this respect, high resolution 3D images of the eyeball would be extremely useful, in the study of various pathologies of the retina, the lens, and of the optic nerve. In this work we combined the state-of-the-art of micro computed tomography technology with phase-contrast imaging, a recent highly sensitive technique well adapted to investigate soft tissues without the use of contrast agents; we applied the technique in the post-mortem analysis of monkey eyes, which share several similitudes with the human organ. We reported here vascular, nervous and anatomical details of monkey eyes imaged with a 3.1 × 3.1 × 3.1 µm3 voxel size as well as the first 3D visualisation of the entire globe of Macaca's fascicularis eye. Results have also been compared with, and validated by, histological analysis.

Case Report: Education and training of RTTs for radiation oncology departments in Russia.

Modern radiotherapy is performed with sophisticated equipment that requires highly qualified professionals. In the Russian Federation the responsibilities of Radiation Therapy Technologists (RTTs) are carried out by medical nurses who receive on-the-job training. The article discusses the problems of RTT education and training, describes our own teaching experience and suggests further development for the national RTT education system in Russia.

DEFINITION AND COMPARATIVE ANALYSIS OF THE GENOMIC STRUCTURE OF SIBERIAN STRAINS OF TICK-BORNE ENCEPHALITIS VIRUS OF THE EUROPEAN SUBTYPE.

Tick-borne encephalitis virus (TBEV) is classified into three subtypes: Far Eastern (TBEV-FE), European (TBEV-EU) and Siberian (TBEV-SIB). In Russia, these are also called genotypes 1, 2 and 3, respectively. Geographically, TBEV-EU dominates in Central and Northern Europe, but its representatives are also found to the east - along the southern part of the forest zone of extratropical Eurasia - up to Eastern Siberia and South Korea. However, the strains isolated outside Europe remain poorly investigated. In the proposed study, eight full genomes of the Siberian isolates of TBEV-EU were determined and 13 complete genomes were compared. The analysis of 152 full-genome TBEV sequences showed that the TBEV-EU has a higher degree of stability of the genome-coding region in the entire Eurasian area (3.1% of differences) compared to TBEV-FE (6.6%) and TBEV-SIB (7.8%). At the same time, the maximum differences are observed not between European and Siberian strains, as one could expect, but between the representatives from Europe - TBEV strains Mandl-2009 from Norway and Hypr from the Czech Republic. The studied strains from Siberia form the compact genetic cluster of 42 TBEV-EU strains and are divided into two subclusters - West Siberian and East Siberian variants. These variants differ in the combinations of amino acid substitutions in all proteins except NS2B. The West Siberian variant mostly circulates in the territory of Altai, and the closest relative of its representatives is Absettarov strain from the European part of Russia. The strains similar to the East Siberian variant of the European subtype were recorded in the Altai (strain 84.2, 2007) and in Belarus (N256, about 1940).

A comparative analysis on the physicochemical properties of tick-borne encephalitis virus envelope protein residues that affect its antigenic properties.

This work is dedicated to the study of the variability of the main antigenic envelope protein E among different strains of tick-borne encephalitis virus at the level of physical and chemical properties of the amino acid residues. E protein variants were extracted from then NCBI database. Four amino acid residues properties in the polypeptide sequences were investigated: the average volume of the amino acid residue in the protein tertiary structure, the number of amino acid residue hydrogen bond donors, the charge of amino acid residue lateral radical and the dipole moment of the amino acid residue. These physico-chemical properties are involved in antigen-antibody interactions. As a result, 103 different variants of the antigenic determinants of the tick-borne encephalitis virus E protein were found, significantly different by physical and chemical properties of the amino acid residues in their structure. This means that some strains among the natural variants of tick-borne encephalitis virus can potentially escape the immune response induced by the standard vaccine.

Comparative analysis of complete genome sequences of European subtype tick-borne encephalitis virus strains isolated from Ixodes persulcatus ticks, long-tailed ground squirrel (Spermophilus undulatus), and human blood in the Asian part of Russia.

Tick-borne encephalitis virus (TBEV) is divided into three subtypes: European (TBEV-Eu), Siberian (TBEV-Sib), and Far Eastern (TBEV-FE) subtypes. The geographical range of TBEV-Eu dominates in Europe, but this subtype is present focally across the whole non-tropical forested Eurasian belt, through Russia to South Korea. However, the TBEV-Eu strains isolated outside Europe remain poorly characterized. In this study, full-genome sequences of eight TBEV-Eu isolates were determined. These strains were isolated from Ixodes persulcatus ticks, long-tailed ground squirrel (Spermophilus undulatus), and human blood in the natural foci of Western and Eastern Siberia, Russia. A phylogenetic analysis of all available TBEV-Eu genomic sequences revealed that strains from Siberia were closely related to other strains from Europe and South Korea. The closest relation was identified between the Siberian strains and strains from Zmeinogorsk (Western Siberia, Russia) and strain Absettarov (Karelia, Russia), and were most divergent from strains from the Czech Republic and Norway. TBEV-Eu strains isolated in Eastern Siberia were more closely related phylogenetically to strains from South Korea, but strains from Western Siberia grouped together with the strains from Europe, suggesting two genetic TBEV-Eu lineages present in Siberia.

Short-course preoperative radiotherapy combined with chemotherapy, delayed surgery and local hyperthermia for rectal cancer: a phase II study.

PURPOSE: The aim of this study was to investigate the feasibility of short-course radiotherapy with oral capecitabine, hyperthermia and delayed surgery for neoadjuvant treatment of rectal cancer. METHODS: Patients with clinically staged T2-3N0-2M0 primary rectal cancer were included. All patients received short-course 25 Gy in 5 Gy fractions radiotherapy with capecitabine, local hyperthermia and metronidazole. Capecitabine 1000 mg/m2 twice a day was given on days 1-14. Local hyperthermia, 41-45 °C for 60 min, was performed on days 3-5. Metronidazole 10 g/m2 was administered per rectum on days 3 and 5. The time interval to surgery was not less than four weeks after neoadjuvant treatment. The primary end-point was pathological complete response (pCR). Secondary end-points included neoadjuvant treatment toxicity, tumour regression, surgical and oncological outcomes. RESULTS: A total of 81 patients were included in the analysis. Ten (12.3%) patients had grade 3 toxicity and one (1.2%) patient had grade 4 toxicity. Sphincter-sparing surgery was performed for 78 (96.3%) patients. There was no postoperative mortality. Postoperative complications occurred in 11 (13.8%) patients. Sixteen (20%) patients had a pCR. The median follow-up was 40.9 months. There were no local recurrences. Nine (11.1%) patients developed distant metastases. Three-year overall survival was 97% and the three-year disease-free survival was 85%. CONCLUSIONS: Short-course radiotherapy with chemotherapy, radiosensitizers and delayed surgery is a feasible treatment for rectal cancer and may lead to tumour regression rate comparable with long-course chemoradiation.

[Primary multiple malignant lung tumors. References and a clinical observation].

The problem of primary multiple tumors is relevant to current clinical oncology because of increasing of number of patients with multiple malignant tumors and unsolved issues of treatment. Primary multiple malignant lung tumors is a common oncological situation requires an individualized, differentiated approach to treatment. The results of treatment are associated with the prevalence of the process, stages of tumor development, spare capacity of patients. There is presented clinical example of a patient with metachronous primary multiple malignant tumors of one lung.

Prophylaxis and treatment of radiation oral cavity mucositis by hydrogel preparations in patients with oropharyngeal cancer.

Development of radiation mucositis in patients with oropharingeal cancer who are treated by radiation therapy leads to constrains breaks, decreases of the quality of life and makes the radiation dose in target insufficient. All above mentioned increases recurrence risk. Since 2010 there was developed and introduced the method of prophylaxis and treatment of radiation injuries of oral cavity in patients with oropharingeal cancer which gives an ability to improve radiation treatment outcomes and the quality of life of patients.

[Conformal radiotherapy in nasopharyngeal cancer patients].

The paper is aimed at the determination of the efficiency of various technologies of conformal radiotherapy for patients with nasopharyngeal carcinoma. The study included 56 patients with squamous cell carcinoma of the nasopharynx treated with conformal radiotherapy. 3D-CRT was performed for 28 patients, IMRT--22 patients, RapidArc--6 patients. Dosimetric parameters were determined for planned volumes and organs at risk. TD on high-risk areas was 70Gy, intermediate-risk zones 60-66Gy and low-risk areas 50-56 Gy. There were determined session duration of exposure and the number of monitor units to evaluate the efficiency of treatment. Average (Dmean), maximum (Dmax) and the minimum (Dmin) dose for RapidArc, IMRT and 3D-CRT on PTV amounted to 70.2 Gy, 69.1 Gy and 70.7 Gy; 76.2 Gy, 76.1 Gy and 77Gr; 48.8, 54.4 and 46,6Gr respectively. Compared with IMRT and 3R-CRT RapidArc reduce Dmean in the brainstem and optic nerves by 14.1% and 23%; 12.2% and 25% respectively. The average number of MU (monitor unit) with RapidArc, IMRT and 3D-CRT was 357, 1386 and 870. The average session time of irradiation was: with RapidArc, IMRT and 3D-CRT--300, 900 and 480 seconds. Compared with IMRT and 3D-CRT average treatment time and the number of monitor units in RapidArc were reduced by 74%, 42% and 67%, 47%. Thus RapidArc and IMRT technologies allow getting a better dose distribution in the irradiated volume, compared with 3 D-CRT on homogeneity and conformity. RapidArc technique reduces the pressure on the critical organs, diminishes exposure to the session and a number of MU.

[Results of complex treatment of patients with squamous cell carcinoma of the anal canal using advanced radiotherapy technologies].

During recent decades radiotherapy is the basis, on which it is built a medical complex that is the first-line treatment of patients with squamous cell carcinoma of the anal canal. An increase of overall and disease-free survival and quality of life of patients with squamous cell carcinoma of the anal canal at the present stage of development of a comprehensive medical treatment is largely due to the improvement of technical equipment of radiotherapy departments of oncology clinics. The use of modem linear electron accelerators and systems of computer dosimetric planning to create a 3D program of isodose distribution, diagnostic devices (computed tomography and magnetic resonance imaging) as well as a number of other conditions permit accurate summarizing of proposed dose, reducing of absorbed dose to critical structures, diminishing unplanned interruptions in chemoradiotherapy course by means of modern technologies of conformal radiotherapy (3D CRT, IMRT, VMAT). The paper presents the preliminary results of a comprehensive medical treatment of 14 patients with squamous cell carcinoma of the anal canal.

[Detection of potential sites of recombination in the Tick-borne encephalitis virus by the methods of comparative genomics].

The results of the bioinformatic search for the potential sites of the recombination in the genome-wide structures of the tick-borne encephalitis virus (TBEV) through a series of software techniques were presented in this work. The genomes of the 55 TBEV strains were assayed, 21 of them showed the presence of the recombination sites. Recombinant strains belonged to the Far Eastern (19 strains) and European (2 strains) genotypes. 22 sites of the recombination attributed were identified to five types based on position, strain, and regional characteristics. The parental strains were identified based on the genotypic and geographical parameters, which do not contradict the possibility of the formation of the recombinants. Nearly two-thirds of the sites are located in the regions of NS4a and NS4b genes, which are the "hot spots" of the recombination, most of them being concentrated in the gene NS4. It was shown that the recombination processes did not occur at the level of the genotypes (European genotype) or certain groups within the genotype (Far East) and were typical of the peripheral populations.

[The role of stereotactic radiotherapy in the treatment of patients with liver metastases].

Application of modern linear electron accelerators, equipped with precise navigation systems, maximum conformal dose delivery as well as imaging of irradiated focus significantly increased possibilities of escalating of doses of ionizing radiation in a selected volume with the necessary protection of the surrounding critical structures. These technological solutions and modern ideas about possibilities of remote beam radiation therapy resulted in a significant increase of the role of radiation therapy and, in particular, stereotactic radiotherapy in the treatment of patients with liver metastases. This technique allows creating locally in metastatic tumor site a high dose of ionizing radiation causing by that the destruction of the tumor. This promising direction in treatment of liver metastases significantly expanded possibilities of complex treatment and enabled us to provide specific assistance to those patients who have been rejected from other methods of treatment.

[Radiation pneumonitis in the treatment of early-stage breast cancer].

Despite of improvement of radiotherapy techniques and increasing usage of conformal radiation therapy which provides decrease of dose for normal tissues and organs, cases of radiation-induced injuries are still registrated. The aim of this study is to determine frequency and severity of lung toxicity in 513 breast cancer patients with Tis-2N0-2M0 disease after breast conserving surgery and chemotherapy depending from radiation therapy technique and irradiation volume. It is quite clear that in breast cancer patients frequency of lung toxicity after breast conserving surgery and RT increases from 20-24% when irradiating only breast to 37-41% when irradiating breast and regional lymph nodes. In our analysis the frequency of lung toxicity was quite similar for 2D conventional therapy (27,4%) and for 3D conformal therapy (28,7%). The risk of developing radiation pneumonitis increases dramatically with extension of V20 for ipsilateral lung more than 30%, mean lung dose more than 18 Gy, in patients with initial small volume of the lung (less than 110 cm3).

[Possibilities of stereotactic radiotherapy in the palliative treatment of patients with pancreatic cancer].

Morbidity and mortality from pancreatic cancer is steadily increasing. Resectable cases are not more than 20%. Conventional schemes of chemoradiation and radiation therapy are durable over the time, have toxicity and low treatment outcomes. Many foreign authors consider as promising the technique of stereotactic radiotherapy, which is often used in pancreatic cancer and permit achieving high local control. At our institution there has been developed and introduced into clinical practice a method of stereotactic radiotherapy for the palliative treatment of patients with pancreatic cancer, which improved not only the duration but also the quality of life of patients.

[The role of stereotactic radiotherapy in treatment of patients with metastatic lesion of lungs].

Since February 2012, in order to increase the effectiveness of treatment and quality of life of patients with disseminated disease, there was developed and implemented a method of stereotactic radiotherapy for metastatic lesion of lungs by tumors of different histological types. 20 patients were treated by stereotactic radiotherapy ROD 7 Gy in five sessions during 5 days. There were evaluated results of treatment and prospects of this method.

[Complex treatment of breast cancer patients with brain metastases].

Brain metastases in breast cancer develop for 24-32 months after the detection of the primary tumor. The study included patients with brain metastases who were divided into three groups: the first group--with early chemoradiotherapy (CRT) without induction chemotherapy (IC) by capecitabine; the second group--with delayed CRT with 4 or 8 courses of IC by capecitabine; the third group (a historical control) who received only whole brain radiation therapy. The median time to progression of intracranial metastases was 15.3, 12 and 5 months, respectively. The median time to the intracranial progression significantly less in the third group (5 months) compared with the first (15.3 months) (p = 0.0007) and the second (12 months) (p = 0.027) groups. The overall survival rate was 22.1, 15.1 and 6.8 months in three groups, respectively.