[Thoracoscopy in combined treatment of thymoma (in Russian only)]. / Videotorakoskopiia v kombinirovannom lechenii timom.

The experience of video-assisted thoracoscopic interventions for thymus tumors in the Research Institute of Oncology of Tomsk National Research Medical Center is presented. We also evaluate the features of postoperative management of these patients.

Genomic variation among populations of threatened coral: Acropora cervicornis.

BACKGROUND: Acropora cervicornis, a threatened, keystone reef-building coral has undergone severe declines (>90 %) throughout the Caribbean. These declines could reduce genetic variation and thus hamper the species' ability to adapt. Active restoration strategies are a common conservation approach to mitigate species' declines and require genetic data on surviving populations to efficiently respond to declines while maintaining the genetic diversity needed to adapt to changing conditions. To evaluate active restoration strategies for the staghorn coral, the genetic diversity of A. cervicornis within and among populations was assessed in 77 individuals collected from 68 locations along the Florida Reef Tract (FRT) and in the Dominican Republic. RESULTS: Genotyping by Sequencing (GBS) identified 4,764 single nucleotide polymorphisms (SNPs). Pairwise nucleotide differences (π) within a population are large (~37 %) and similar to π across all individuals. This high level of genetic diversity along the FRT is similar to the diversity within a small, isolated reef. Much of the genetic diversity (>90 %) exists within a population, yet GBS analysis shows significant variation along the FRT, including 300 SNPs with significant FST values and significant divergence relative to distance. There are also significant differences in SNP allele frequencies over small spatial scales, exemplified by the large FST values among corals collected within Miami-Dade county. CONCLUSIONS: Large standing diversity was found within each population even after recent declines in abundance, including significant, potentially adaptive divergence over short distances. The data here inform conservation and management actions by uncovering population structure and high levels of diversity maintained within coral collections among sites previously shown to have little genetic divergence. More broadly, this approach demonstrates the power of GBS to resolve differences among individuals and identify subtle genetic structure, informing conservation goals with evolutionary implications.

[Substantiation of Expressive Markers Use to Personalize Lung Cancer Chemotherapy].

Surgery results of II-III stage lung cancer remain unsatisfactory and the chemotherapy does not improve the survival. The main obstacle is the use of the standard clinical parameters for the treatment strategy and not sufficiently effective selection of regimens for the chemotherapy. Monoresistance genes defining the tumor cells sensitivity to the chemotherapeutic drugs play a significant role in development of the lung tumor resistance. The review examines the mechanisms of transport, activation and targets of the chemotherapeutic drugs, identifies the key markers for predicting their effectiveness and possible use in the clinical practice. Monoresistance genes, such as ABCC5, RRM1, ERCC1, TOP1, TOP2a, TUBB3 and TYMS are characteristic of lung cancer. Clinical trials demonstrating the efficiency of their use as predictive markers for the lung cancer chemotherapy are described. A prospective study with a personalized adjuvant chemotherapy for lung cancer patients will be performed.

[The results of the practical use of the destructive peritonitis' standartized treatment].

The results of inspection and treatment 117 patients with an acute destructive pancreatitis from 1998 to 2010 are presented. Distinguishing features of management approach of the patients, which was hospitalized in clinic from 2005 to 2010, were high frequency of octreotide use, de-escalated orientation of antibacterial therapy, without early laparotomy interventions and expansion of indications to program sanitation by development of widespread forms of infected pancreatic necrosis. Achievements of intensive therapy of last years and change of surgical tactics have allowed to reduce postoperative mortality by sterile necrosis from 21.1 to 11.8%, to reduce frequency of infected pancreatic necrosis from 68.3 to 40.4%. Development of the infected pancreatic necrosis accompanied by statistically significant growth of frequency of local purulent complications and the tendency to increase--extended.

[Lung cancer: 25-year experience with surgical and combined treatment].

Data on surgical and combined treatment of 950 patients with non-small lung cancer are evaluated. After combined treatment of lung cancer stage III using intraoperative radiotherapy and adjuvant chemotherapy or radiosensitization, recurrence-free survival rose to 13.3 +/- 2.3 and 23.0 +/- 1.1 months, respectively; 5-year overall survival--32.8 +/- 3.2% and 40.3 +/- 4.2% respectively. Compare with 10.4 +/- 1.3 months and 20.8 +/- 8.5%, respectively, for surgery alone. Despite the prejudice against preoperative radiotherapy, postoperative one administered in TTD of 40-60 Gy (median 55 Gy) may be recommended for treatment of lung cancer spreading to mediastinal lymph nodes.

[Improvement of differential diagnostics and prognostication of the course of destructive forms of acute pancreatitis].

A complex dynamic investigation of the state of oxidative homeostasis in patients with different forms of acute pancreatitis has shown that a reliable reduction of the indices of maximal intensity of chemiluminescence and the coefficient of blood serum antioxidative activity can be considered as an additional criterion for early diagnosis of infected pancreatonecrosis. The absence of a tendency to increased peroxide erythrocyte resistance in the postoperative period in pancreatonecrosis patients speaks of unfavorable prognosis of the disease. Improvement of differential diagnostics allows optimization of the surgical strategy and minimization of the number of early traumatizing surgical interventions.

[Postoperative features in lung cancer patients receiving intraoperative radiotherapy and radiosensitization].

Research Institute of Oncology, Research Center, Russian Academy of Medical Sciences, Siberian Branch, Tomsk. Postoperative course was studied of stage III non-small cell lung cancer (35) treated radically using intraoperative radiotherapy (15Gy) and cisplatin radiosensitization. Postoperative complications were reported in 11.4 +/- 5.4%. Reduction in complication rates was due to the use of a combined treatment complex. There were no postoperative lethalities.

[Morphofunctional changes in the bronchial epithelium in combined therapy for lung cancer].

Morphofunctional changes in the bronchial mucosa were studied in 33 patients with stage 3 lung cancer. The patients underwent intraoperative radiation therapy (IORT) in a dose of 15 Gy, using cisplatine as a radiosensitizer. No degenerative changes in the bronchial epithelium were found 2 weeks after IORT. Basal cell proliferation was observed, goblet cells were reduced in size and the basement membrane was thickened and twisted. Epithelial reparation due to pronounced local basal cell proliferation was observed 3 months later. A year later, the mucosa was covered with the multinuclear cylindrical epithelium and the cover of ciliated cells was preserved. The functional activity of goblet cells was in the normal range and scanty lymphoplasmocytic infiltration was found in the stroma. With IORT without radiosensitization, the damaged epithelium was regenerated due to the reserved cells coming from the damaged margins with the formation of an epidermoid regenerative layer and subsequent cell differentiation. Moderate sclerosis occurred in the stroma. A year later the bronchial epithelium was characterized by moderate goblet cell hyperplasia with preserved functional activity. Thus, IORT caused mucosal damage as alteration, dystrophy, and desquamation of the epithelium. Subsequently, the bronchial epithelium recovered through reparative regeneration.

[Complications of intraoperative radiotherapy and adjuvant chemotherapy in patients with lung cancer]. / Oslozhneniia pri sochetanii intraoperatsionnogo oblucheniia i ad''iuvantnoi khimioluchevoi terpii u bol'nykh rakom lëgkogo.

A high single dose of radiation can be delivered precisely to tumor or regional metastasis area by means of intraoperative radiation therapy (IORT). A program of combined treatment including radical IORT, postoperative distant gamma-therapy and adjuvant polychemotherapy with cisplatin and etoposide has been developed at the Center. Treatment was given to 43 patients with stage III lung cancer. Complications were reported in 23.3 +/- 6.0%. Prophylactic methods have been worked out to minimize IORT--related postoperative complications. The postoperative lethality rate was 2.3 +/- 1.4%. No program-related hazards have been observed. Complications from adjuvant polychemotherapy were moderate.

[Morphologic changes of bronchial epithelium after intraoperative radiotherapy of lung cancer]. / Morfologicheskie izmeneniia bronkhial'nogo épiteliia posle provedeniia intraoperatsionnoi luchevoi terapii.

Integration of intraoperative radiotherapy (IORT) with combined treatment of non-small cell carcinoma of the lung seems to be promising. Of particular interest are studies of morphological changes in the bronchial epithelium under the influence of large single dose of radiation (15 Gy). Our clinical investigation included patients with non-small cell carcinoma stage III who had received different schedules of treatment at the Center's clinics. Examination was carried out of biopsy material sampled from the bronchus stump as well as from the contralateral segment of the bronchial tree following combined therapy. Exacerbation of the chronic process in the bronchus stump after IORT was reported. One month after bronchial resection, 80% of patients suffered from catarrhal sclerosing bronchitis. Its progression triggered on bronchial sclerosis in 20%. Catarrhal sclerosing bronchitis in the contralateral segment of the bronchial tree occurred in 60%; there was no significant correlation between catarrhal sclerosis, on the one hand, and the initial condition of the bronchus, on the other. In the control group, there were also signs of chronic bronchitis exacerbation on the site of operation. On the whole, the distribution of patients by bronchitis patterns remained unchanged.

[Intraoperative radiotherapy during plastic surgery for lung cancer]. / Intraoperatsionnaia luchevaia terapiia pri rekonstruktivnykh operatsiiakh po povodu raka lëgkogo.

The results of 28 bronchoplastic operations for non-small cell lung cancer and 3-8 year follow-up have been evaluated. Intraoperative radiotherapy (IORT) (10 Gy) was conducted in 6 patients. IORT was used as a component of combined treatment with good results and without postoperative complications.