Репозиторий Университета

© Copyright © 2019 Poddubskaya, Bondarenko, Boroda, Zotova, Glusker, Sletina, Makovskaia, Kopylov, Sekacheva, Moisseev and Baranova. Non-small cell lung carcinoma (NSCLC) is the major cause of cancer-associated mortality. Identification of rearrangements in anaplastic lymphoma kinase (ALK) gene is an effective instrument for more effective targeted therapy of NSCLC using ALK inhibitors dramatically raising progression-free survival in the ALK-mutated group of patients. However, the tumors frequently develop resistance to ALK inhibitors. We describe here a case of 48 y.o. male patient with ALK-positive NSCLC who was clinically managed for 6.5 years from the diagnosis. The tumor was surgically resected, but 8 months later multiple brain metastases were discovered. The patient started receiving platinum-based chemotherapy and then was enrolled in a clinical trial of second-generation ALK inhibitor ceritinib, which resulted in a 21 months stabilization. Following disease relapse, the patient was successfully managed for 33 months with different lines of chemo- and local ablative therapies. Chemotherapy regimens, including off-label combination of crizotinib + bevacizumab + docetaxel, were selected using the cancer transcriptome data-guided bioinformatical decision support system Oncobox. These therapies led to additional stabilization for 22 months. Survival of our patient after developing resistance to ALK inhibitor was longer for 16 months than previously reported average survival for such cases. This case shows that transcriptomic-guided sequential personalized prescription of targeted therapies can be effective in terms of survival and quality of life in ALK-mutated NSCLC.

© Copyright © 2019 Goryaynov, Okhlopkov, Golbin, Chernyshov, Svistov, Martynov, Kim, Byvaltsev, Pavlova, Batalov, Konovalov, Zelenkov, Loschenov and Potapov. Objective: This study is to analyze fluorescence sensitivity in the diagnosis of brain and spinal cord tumors. Material and methods: The authors conducted a multicenter retrospective analysis of data on 653 cases in 641 patients: 553 of them had brain tumors and 88 spinal cord tumors. Brain tumor resection was performed in 523 patients, of whom 484 were adults and 39 children. The analyzed series was presented by 320 gliomas, 101 meningiomas, and 72 metastases. A stereotactic biopsy was performed in 20 patients and endoscopic surgery in 10 patients. In all cases, 20 mg/kg of 5–Aminolaevulinic acid was administered orally 2-h before surgery. All surgical interventions were performed with a microscope BLUE 400 to visualize fluorescence, while endoscopic surgery—with an endoscope equipped with a fluorescent module. Fluorescence spectroscopy was conducted in 20 cases of stereotactic biopsies and in 88 cases of spinal cord tumors. Results: Among adult brain tumors operated by microsurgical techniques, meningiomas showed the highest 5-ALA fluorescence sensitivity 94% (n = 95/101), brain metastases 84.7% (n = 61/72), low-grade gliomas 46.4% (n = 26/56), and high-grade gliomas 90.2% (n = 238/264). In children the highest 5-ALA visible fluorescence was observed in anaplastic astrocytomas 100% (n = 4/4) and in anaplastic ependymomas 100% (n = 4/4); in low-grade gliomas it made up 31.8% (n = 7/22). As for the spinal cord tumors in adults, the highest sensitivity was demonstrated by glioblastomas 100% (n = 4/4) and by meningiomas 100% (n = 4/4); Fluorescence was not found in gemangioblastomas (n = 0/6) and neurinomas (n = 0/4). Fluorescence intensity reached 60% (n = 6/10) in endoscopic surgery and 90% (n = 18/20) in stereotactic biopsy. Conclusion: 5-ALA fluorescence diagnosis proved to be most sensitive in surgery of HGG and meningioma (90.2 and 94.1%, respectively). Sensitivity in surgery of intracranial metastases and spinal cord tumors was slightly lower (84.7 and 63.6%, correspondingly). The lowest fluorescence sensitivity was marked in pediatric tumors and LGG (50 and 46.4%, correspondingly). Fluorescence diagnosis can also be used in transnasal endoscopic surgery of skull base tumors and in stereotactic biopsy.

© The Author(s) 2018. Purpose: To review our experience with peripherally inserted central catheters in pediatric cancer patients. Methods: The analysis included 353 patients (3 months up to 17 years, mean age 11.2 years) with a variety of cancers diseases, which in 2011–2016, 354 peripherally inserted central catheters were placed. All settings are carried out using ultrasound guidance. In 138 (39%) patients, external anatomical landmarks were used and in 216 (61%) intraoperative fluoroscopy. Results: Maximal duration of the line was 1.3 years, the lowest 1.5 months, and average 6.3 months. Among the technical difficulties during placement, most frequently have been the migration of the distal end of the catheter into the internal jugular vein against blood flow—32 (9%) patients. In one (0.3%) case, we were unable to catheterize the patient’s vein. Among the most common complications of operation were marked peripherally inserted central catheter clot occlusion of the lumen—26 (7.3%) cases. Symptomatic catheter-related thrombosis was observed in 16 (4.5%) cases. Catheter-related blood stream infections were not reported. Removal of peripherally inserted central catheters related to the complications was performed in 30 (8.5%) patients who were later implanted venous ports. Conclusion: Peripherally inserted central catheters are recommend to use in the treatment of children with cancer. There should be trained nursing staff to minimize the risk of complications.

© Nikolay N. Krylov, Aftandil V. Alekberzade, Elena A. Piatenko. The eponym is a part of the nomenclature of medicine. In 1848, R. Virchow described the enlarged left supraclavicular lymph node (Virchow's node), which he uncovered by physical examination. He believed that such lymphadenopathy occurs in cases of stomach cancer (less often – with lung cancer), when the metastatic process spreads up the thoracic duct to the left supraclavicular fossa. He described the pathogenesis of this trait and proved its malignant nature. Russian authors, apparently, borrowed this eponym from German textbooks on medicine. In 1886, Troisier added to Virchow’s insights and presented a detailed substantiation for the increase in the size of the left supraclavicular lymph node. Troisier described its typical location above the middle third of the clavicle behind the clavicular portion of the sternocleidomastoid muscle. He considered this enlargement as a direct sign of the existence of a neoplasm in the abdominal cavity or in the pelvic cavity, breast cancer, tuberculosis, and syphilis. In his opinion, identifying a diseased lymph node by physical examination does not indicate the exact location of the primary focus of the tumor, but will direct the diagnostic search in the right direction. Palpable lymph nodes in the supraclavicular fossa (Troisier-Virchow), as a rule, indicate a malignant nature. If the lymph node enlargement is due to tumor emboli in cases of stomach cancer, it should be referred to as Virchow’s metastasis. Troisier’s symptom can be detected due to the metastasizing of cancer of other abdominal organs and the small pelvis, lung, breast, esophagus and tuberculosis lesions.

© 2018 National Academy of Pediatric Science and Innovation. All rights reserved. Relevance. Statistical indicators are the basis for planning of the organization of medical care for children with cancer, as well as analysis of the effectiveness of medical care. Materials and methods. The authors have analyzed operational reports for 2017 of the executive authorities in the field of health care of 18 objects of the Russian Federation being part of the Central Federal District. Results. There 9 pediatric oncology departments, there are 464 children’s oncological beds, the bed occupancy per year is 319.3. There are 91 doctors providing medical care to children with cancer, 64 (70.3%) of the doctors have a certificate of pediatric oncologist. In 11 subjects there are no Departments for Pediatric Oncology. There are 821 primary patients with malignant neoplasms. There are 156 deceased patients, 66 of them were diagnosed in 2017. 52 (6.3%) patients are revealed actively. There were 12 (per 100 thousand for the age group of 0–17 years) cases of incidence of malignant neoplasms, mortality is 2.3 (per 100 thousand for the age group of 0–17 years), one-year mortality is 8%. The average time taken to diagnose and to verify the diagnosis before the beginning of treatment remains unknown. Conclusion. Operational reports contain non-matching indicators, thus, the information is not completely reliable. Incidence rates are significantly lower than those in countries with high reliability of statistical data. The percentage of patients identified actively remains extremely low. In order to eliminate the noted defects, it is necessary to introduce a single database of children with cancer in the Russian Federation.

© 2018 Paediatrician Publishers, LLC. All Rights Reserved. Background. Improving the quality of medical care is based on a coordinated policy at the federal, regional and municipal levels in the field of health. The implementation of this goal is based on a regular assessment of the current state of the healthcare system in the Russian Federation. Objective. Our aim was to analyse of the main indicators characterizing medical care for children with cancer in the South Federal District. Methods. The operative reports for 2017 of the executive authorities in the sphere of health protection of 8 subjects of the Russian Federation that are part of the South Federal District of the Russian Federation have been analyzed. Results. The number of children were 3 216 797 people (aged 0-17 years), the number of children's oncological beds is 272 (0.8 per 10 thousand children aged 0-17 years), the average number of days of berth employment in the year is 289.9 bed days. In 4 (50%) subjects of the department of pediatric oncology are absent, in 1 (12.5%) - there are no children's oncological beds. The number of doctors providing medical care to children with cancer is 50, of them 42 (84%, 0.1 per 10 thousand children aged 0-17 years) have a certificate of a pediatric oncologist. In 2 (25%) subjects, there are no pediatric oncologists. Incidence of malignant tumors was 13.9 (per 100,000 children aged 0-17 years), prevalence was 86.5 (per 100,000 children aged 0-17 years), mortality was 2.5 (per 100,000 children aged 0-17 years), a one-year mortality rate of 4.7%. 8% of patients were actively detected. 104 (23.2%) of primary patients were sent to medical organizations of federal subordination, 4 (0.9%) of primary patients left the territory of the Russian Federation. Conclusion. The analysis revealed a number of defects: incorrect information contained in the reports, low incidence (detectability) of patients, including during planned preventive examinations, staff shortages and non-rational use of bed facilities.

© 2018 University of Rijeka, Faculty of Medicine. All Rights Reserved. Background. The analysis of the quality of medical care for children with cancer is based on statistical data. Evaluation of the results is also the basis of the strategy for the development of medical care for this category of patients. Objective. Our aim was to analysie the main indicators characterizing medical care for children with cancer in the North-Caucasian, Volga, Urals, Siberian and Far Eastern Federal Districts. Methods. In ecological study the operative reports for 2017 of the executive authorities in the sphere of health protection of 44/48 (91.6%) subjects of the Russian Federation that are part of the listed above federal districts have been analyzed (Chuvash Republic, Irkutsk Region, Republic of Sakha (Yakutia) and Khabarovsk Territory did not provide data). Results. The number of children's population was 15 555 306 people (0-17 years), the number of children's oncological beds - 1166 (0.7 per 10 thousand 0-17 years), the average number of days of berth employment in the year - 324.6 bed days. In 13 (29.5%) subjects of the department of pediatric oncology are absent, in 6 (13.6%) - there are no children's oncological beds. The number of doctors providing medical care to children with cancer is 213, of which 132 (62%; 0.08 for 10 thousand 0-17 years) have a certificate of a pediatric oncologist. In 6 (13.6%) subjects there are no doctors-children oncologists (6 more (13.6%) subjects did not provide data). The incidence of malignant neoplasms was 13.1 (per 100.000 0-17 years), the prevalence of 93.1 (per 100.000 0-17 years), mortality rate 2.5 (per 100.000 0-17 years), one-year lethality - 6.8%. 10.1% of patients were actively detected. 781 (38.3%) of primary patients were sent to medical organizations for federal subordination, 39 (1.9%) of primary patients left the territory of the Russian Federation. Conclusion. Obvious accounting defects (low incidence rate) and lack of reliable follow-up data (estimation of mortality levels is difficult) are eliminated by introducing electronic accounting systems. For reliable estimation of the level of provision of the population with children's cancer beds and the percentage of patients sent for treatment in medical organizations of federal subordination, audit of patients' illnesses is necessary. The traditional problems - the deficiency of doctors and children's oncologists and a low percentage of patients identified actively - must be addressed through the reform of the training program for medical personnel.

© The authors team, 2018.All Rights Reserved. Due to its cardinal differences from the adult oncology the children's oncology takes a special place in the national cancer control program. The article analyzes up-to-date problems and suggests their solutions. It contains statistical indicators and a three-level model of medical care for children with cancer. The tasks of the national program stated in the article reflect the author's point of view and are to be further discussed.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: In recent years, whole-body MRI have been increasingly used in the field of oncological radiology owing to its advantages such as: yield of high-quality diagnostic information in relatively short scan time, lack of radioisotope or intravenous contrast use, and comparingly low examination cost in contrast to traditional nuclear medicine techniques. Aim of this article is to bring the overview of whole-body MRI as a technique and current applications of its use in oncological radiology.

© 2018 Paediatrician Publishers, LLC. All rights reserved. Background. Planning the management for medical care delivery for children with cancer, as well as analysis of the effectiveness of medical care delivery is based on the statistical indicators analysis. Objective. Our aim was to analyze the main indicators characterizing medical care delivery for children with cancer in the Central Federal District. Methods. The operative reports for 2017 provided by the executive health protection authorities of 18 subjects of the Russian Federation that are part of the Central Federal District have been analyzed. Results. The study enrolled the following data: number of children was 6 824 049 (0–17 years), pediatric oncological departments — 9, pediatric oncological beds — 464, days of berth employment per year — 319.3. The number of practitioners providing medical care to children with cancer was 91, 64 (70.3%) of them had a certificate of training as a pediatric oncologist. In 11 subjects, the department of pediatric oncology was not available; one of the districts did not provide any pediatric oncological beds. The number of primary patients with malignant neoplasms was 821. The number of deceased patients was 156 including 66 identified in 2017. The incidence of malignant tumors was 12 (per 100 000 for the 0–17 age group), the mortality rate was 2.3 (per 100 thousand for the age group 0–17 years), one-year mortality rate — 8%. We failed to reveal the average time from diagnosis establishing till its validation before the treatment onset since the reports did not provide precise information on the point. 12 (1.5%) primary patients left for treatment abroad. Conclusion. Most reports included indicators which lack congruity with one another. The incidence rates were significantly lower than those in countries with high statistical reliability. The percentage of patients identified actively remained extremely low. To improve the revealed defects a single database of children with oncological diseases should be implemented in the Russian Federation.

© 2018 Onkopediatria. All rights reserved. Background. Analysis of statistical data in the federal districts of the Russian Federation provides opportunities to assess the quality of medical care delivery in children with cancer and plan further development with consideration for the point elimination of existing defects. Objective. Our aim was to analyze the main indicators characterizing medical care for children with cancer in the North-West Federal District. Methods. The study analyzed operative reports for 2017 provided by the executive public health authorities of 11 subjects of the Russian Federation affiliated to the North-West Federal District. Results. The pediatric population was 2 537 133 children (0-17 years), the pediatric oncological bed capacity - 174 (0.7 per 10 000 aged 0-17 years), the annual berth average occupancy - 290.7 days. 6 (54.5%) subjects did not provide pediatric population with departments of pediatric oncology, 4 (36.4%) subjects did not have bed capacity. The number of practitioners providing medical care to children with cancer was 38, 27 among them (71%; 0.1 per 10 thousand 0-17 years) had a certificate of pediatric oncologist. 2 (18.2%) subjects did not have pediatric oncologists in the medical stuff. The incidence of malignant tumors in children aged 0-17 was 15.6 (per 100,000), the prevalence was 92.6 (per 100,000), the mortality rate was 2.6 (per 100,000), one-year mortality rate - 4.5% (18/397). The number of patients identified actively was 11 (2.8%). 160 (40.3%) primary patients were sent to Federal medical facilities, 6 (1.5%) - left the territory of the Russian Federation for the further treatment. Conclusion. The incidence and mortality rates are rather low which indicates the defects in patient detection and lack of reliable follow-up data. The percentage of patients referred for treatment to Federal medical facilities is not very high; however, to interpret this indicator according to patient routing, we have to analyze the medical history of all the patients. We can assert that health care delivery service for children with oncological diseases is at an acceptable standard level but needs to be improved.

© 2018 Onkopediatria. All rights reserved. Background. Analysis of medical care delivery for children with cancer in armed conflict is highly important because the high-tech treatment in this context is extraordinary difficult and challenging task. Objective. Our aim was to analyze the morbidity and mortality rates in children with malignant tumors, to assess the pediatric patient capacity and medical service density in the Donetsk People's Republic. Methods. The ecological study was conducted where the units of analysis were represented by the aggregated data of the Republican Cancer Registry on the number of primary and secondary patients with malignant and benign tumors, the deceased patients in the DNR in 2014-2017, pediatric patient capacity, and medical service density. Results. The number of pediatric patient capacity for children with cancer was 10 (0.27 per 10,000 children aged 0-17), pediatric patient capacity for children with hematological disorders - 40 (1.37 per 10,000 children aged 0-17). The treatment of children with cancer was performed by 5 healthcare providers: 1 pediatric oncologist (0.02 per 10,000 children aged 0-17), 3 hematologists (0.08 per 10,000 pediatric population aged 0-17), and 1 practitioner who did not have a specialist certificate in oncology. Morbidity rate for malignant neoplasms from 2014 to 2017 decreased by 25% (in 2014 - 9.6 per 10,000 children aged 0-17; in 2017 - 7.2). In the morbidity structure, the incidence proportion of hemoblastoses was 68.4%, brain tumors - 2.6%, other solid tumors - 29%. The death rate due to malignant neoplasms decreased by 37% (in 2014 - 2.7; in 2017 - 1.7). Conclusion. Low levels of the incidence rate and pattern of morbidity indicate defects in the identification and recording of patients. This explains the performance of the bed: low average bed occupancy per year and low turnover. For a reliable analysis of mortality statistical data is not available: in 2014-2015 only the number of in-hospital deceased patients is presented. Limited data is due to the lack of reliable patient catamnesis which is explained by the high rate of population migration.

© 2018 Paediatrician Publishers, LLC. All rights reserved. At present, there is no reliable statistical data (morbidity, mortality, one-year mortality, etc.) that characterize the state of medical care for children with cancers in the Russian Federation seen in due to the lack of an universal electronic database of patients. Objective. Improve the reliability of statistical data. Methods. In the clinical practice of two pilot medical facilities, an electronic database of pediatric cancer patients was introduced which allows: keep patient records with a diagnosis, key dates, follow-up data; analyze the treatment received earlier and assess its quality; make a treatment plan; obtain information on the availability of beds and the number of patients in various medical facilities; perform medical consultations involving the of specialists of the third level medical institutions. Patient (or legal representatives of the patient), has access to the «private cabinet » which provides information on the treatment plan including a schedule for taking medicines, as well as routing possibilities. Results. In the period of 6 months (09.17-02.18), information on 75 patients who received treatment from 2017 to the present was put into the electronic database. Conclusion. The electronic database provides reliable statistical data, helps monitoring the quality of medical care and routing patients. This results in reducing the budget costs and improving the survival of patients.

© 2018 ABC-press Publishing House. All rights reserved. The review is devoted to loop-mediated isothermal amplification (LAMP) - a novel molecular diagnostic method that has recently become increasingly popular. Unlike polymerase chain reaction, LAMP does not require thermal cycling; DNA or RNA amplification occurs at a constant temperature (about 65 °C) with 4 or 6 primers. This is a fast, highly-sensitive, and highly specific method, which does not require expensive equipment, where visual detection of the reaction products is performed by the unaided eye. LAMP is successfully used for the diagnosis of multiple viruses, bacteria, and other pathogens (including those in food). Moreover, it can be applied for the detection of single-nucleotide polymorphisms. Recently, a modified LAMP assay - one-step nucleic acid amplification (OSNA) - was validated for metastasis detection. OSNA was demonstrated to have almost the same sensitivity and specificity as standard diagnostic methods (sometimes even higher). Particular attention is paid to the mechanism of LAMP, primer design, and diagnostics of cancer using OSNA.

© 2018 Paediatrician Publishers, LLC. All rights reserved. Background: Moscow and St. Petersburg are cities of federal significance with the largest number of children and consequently a large number of primary patients identified annually. Objective: Our aim was to analyze the main indicators characterizing the delivery of medical care for children with cancer in cities of federal significance. Methods: The operative reports for 2013–2017 of the Department of Health of Moscow, the Ministry of Health of the Moscow Region, the Health Committee of the Government of St. Petersburg, and the Health Committee of the Leningrad Region were analyzed. Results. In 2013–2017 in the Russian Federation, 18 090 primary patients were identified, 2734 (15.1%) of them in the analyzed subjects: in Moscow — 1315 (7.3%), in the Moscow Region — 492 (2.7%), in St. Petersburg — 697 (3.9%), in the Leningrad Region — 230 (1.3%). For 5 years, the number of primary patients increased in Moscow by 18.1%, in St. Petersburg — by 36%, in the Leningrad Region — by 2.5%. In the Moscow Region, the number of primary patients decreased by 2.3%. The incidence in Moscow increased by 5.3% (from 11.3 per 100 000 of children aged 0–17 in 2013 to 11.9 in 2017), in St. Petersburg — by 18.1% (from 14.9 in 2013 to 17.6 in 2017). The incidence in the Moscow Region fell by 20% (from 11.8 in 2013 to 9.4 in 2017), in the Leningrad Region by 4.9% (from 14.4 in 2013 to 13.7 in 2017). Mortality in 2016–2017 in Moscow decreased by 37.5% (from 6.4 per 100 thousand children’s population 0–17 years to 4), in the Moscow Region — by 50% (from 2 to 1), in St. Petersburg increased by 50% (from 2 to 3), in the Leningrad Region — by 12.5% (from 2.4 to 2.7). The one-year mortality rate in Moscow increased by 3.7% (from 8.3% in 2016 to 12% in 2017), in the Moscow Region — by 3.5% (from 5.4 to 8.9% %), in St. Petersburg — by 3.9% (from 2.5 to 6.4%). In the Leningrad Region, the one-year mortality rate decreased from 6.5% in 2016 to 0 in 2017. The number of pediatric oncological beds did not change in the Moscow Region (0.4 per 10,000 children aged 0–17 years), St. Petersburg (0.9), and the Leningrad Region (0). In Moscow and St. Petersburg patients were not identified actively in 2016–2017; in the Moscow Region, their percentage decreased from 34.2 to 7.3, in the Leningrad Region — from 8.7 to 0. In Moscow, the number of pediatric oncological beds increased by 50% (from 0.6 to 0.9). The number of oncologists increased in the Moscow Region from 0.009 per 10 000 children aged 0–17 years to 0.06 (66.7%), in St. Petersburg from 0.09 to 0.12 (+33.3%), in the Leningrad Region — from 0 to 0.03. In Moscow, the number of pediatric oncologists decreased from 0.13 to 0.11 (-15.3%). Conclusion: Defects of statistical data were revealed. Patients were not identified during routine preventive examinations which indicate a low oncologic alertness of district pediatric physicians. Delivery of medical care for children with cancer and the statistical data accumulation procedures should be improved.