Purpose. Pharmacoeconomic rationale for the use of sorafenib in malignant tumors in comparison with drugs that are included in the list of pharmaceuticals to provide to certain categories of citizens.

Method of the study. Pharmacoeconomic rationale for the use of sorafenib in this study is made by analyzing the impact on the budget. The calculated costs of treatment with sorafenib at a hypothetical group of 100 patients with metastatic renal cell carcinoma (MRCC), hepatocellular carcinoma (HCC) and differentiated thyroid cancer resistant to radioactive iodine (DCT). These costs were compared with costs of treatment of a similar group of 100 patients, with treatment of MRCC applied bevacizumab (original or generic) in combination with interferon α, and patients with HCC and DCT were excluded from receiving drugs from a program of providing with necessary medicines (PNM). As a result the potential economic effect of the inclusion of sorafenib in the list of PNM was calculated.

Results. Treatment of MRCC is cheaper with the use of sorafenib compared to bevacizumab in combination with interferon α: savings is 592 878 rubles in the original use of bevacizumab and 274 976 rubles in the use of generic bevacizumab for one patient-year. If we use sorafenib in a group of 100 people with MRCC, HCC and DCT suitable for treatment with sorafenib, the overall expenses are more than 175 million rubles, while using the original combination of bevacizumab with interferon α – more than 204 million rubles, and in the application of the generic combination of bevacizumab with interferon α – more than 176 million rubles, while in the two last cases the treatment of patients with HCC and DCT is not carried out. The total amount of annual budget savings in the treatment of 100 patients is more than 28.5 million rubles at the account of original of bevacizumab or more than 1 million rubles in accounting of generic bevacizumab.

Conclusion. The inclusion of the targeted drug sorafenib in the list of pharmaceuticals to provide certain categories of citizens is economically justified. The use of sorafenib, instead of the combination of bevacizumab + interferon-α in patients with MRCC gives us the opportunity to release the funds and provide a systemic treatment of patients with other malignancies (HCC, DCT) while reducing the burden on the budget.

Literature review over the last 10 years suggests that the brain is a rare target of metastasis of neoplasms of female reproductive system. However, over the past 20 years, incidence of secondary brain damage increased 6.5 times. Genital tumor metastasis in the brain is around 5%. The optimal treatment strategy of intracerebral metastases in this case is still an unsolved problem: the presence of foci of more than 3 cm surgery and then chemotherapy and radiation therapy is recommended; with smaller foci method of choice is a stereotactic brain radiosurgery followed by chemotherapy.

Purpose. The Union of our own experience of treatment of patients with ovarian cancer (OC), cervical cancer (СС) and endometrial cancer (EC) with brain metastases and data from literature to develop the tactics of conducting patients with these diseases.

Patients and methods. The neurosurgical department of P. Hertsen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center, Ministry of Health of Russia from 2007 to 2016 we treated 9 patients with metastatic OC in the brain, 6 patients with metastatic ER, 4 patients with metastatic cervical cancer.

Resuts. Patients received microsurgical removal of metastatic tumors of the brain, followed by complex treatment, so they achieved a high median overall survival: patients with metastatic ovarian cancer - 14.0 months with diseasefree survival of 9.4 months. The survival median of patients with metastatic ER and cervical cancer was significantly lower, amounting to only 5.4 months.

Conclusion. The article presents modern views on the problem of treating patients with intracranial metastases of malignant tumors of the female reproductive system. Our experience demonstrates that a comprehensive treatment, including neurosurgery, leads to increased survival of patients, providing a satisfac tory quality of life.

Malnutrition in the early stages of life cause hypomotilinemia and shape the epigenome, and does not change the genetic code. Increasing the frequency of non-communicable chronic diseases (NCDS) in the world associated with influence of external factors, including poor diet and obesity .

Purpose. A comparative study of dietary patterns in countries with similar social conditions but with different frequency of breast cancer.

Materials and methods. Data on incidence of breast cancer in 160 countries is selected from the database GLOBOCAN 2008. Levels of consumption of food and nutrients (53 species) for each country selected from the FAO database for 1990–2005 and 2003–2005 years. The power structure of countries were represented in the form of a total daily level of consumption (DLC) (g/person/day), and also in the form of blocks of products with common source of origin (g/person/day): animal products, grains, vegetables”, “fruit drinks”, “alcoholic beverages”; “nutrients of animal products” (%): energy, protein, fat; “full of nutrients” (%): carbohydrates, proteins, fats; energy (kcal/person/day), proteins and fats (g/person/day). Determined the percent contribution of each block in the structure of food in the total daily consumption of food and nutrients (DLC). In the comparative analysis used as a predictor of the metabolic syndrome: body mass index (BMI ≥ 25 kg/m2) and blood cholesterol (NF ≥ 50 mmol/l).

Results. Under similar social and geographical conditions in countries with a high incidence of breast cancer part of the power Structure were represented: 36% of “animal products”, 37% “of grain and vegetables,” 14% “fruits and beverages”, 13% “alcoholic beverages”. In the Mediterranean countries with a low incidence of breast cancer: 28% of “animal products”, 55% “grain & vegetables 11% fruits & drink”, 5% “alcoholic beverages”. In countries with a high incidence of breast cancer Nutrients “animal products” in 1,5 times more than in the Mediterranean countries with a low incidence of breast cancer.

Conclusions. The food pattern has modifying effects on the risk of breast cancer.

Modern authors believe that male infertility accounts for 40–50%. The most severe form of male infertility is azoospermia, which is observed in 10–15% of cases. The only method of diagnosis of azoospermia is testicular biopsy, which allows not only to differentiate the secretory and excretory forms of infertility, but also to determine the degree of impairment of spermatogenesis.

Purpose. To improve the diagnosis of male infertility.

Materials and methods. We have examined 26 men with non-obstructive azoospermia (according to semen). The comparison group included healthy men – 22 people. Patients underwent biopsy of the testicle, followed by morphological analysis of biopsies. Sections of testicular tissue was stained with hematoxylin and eosin, indirect immunohistochemical studies – definition of Inhibin B, a protein prolife ration and apoptosis (ki-67)

Results. According to clinical and instrumental examination (ultrasound) we found no abnormalities. Patients set idiopathic form of infertility. When painting testice slices with hematoxylin and eosin, we recorded significant changes in the convoluted seminiferous tubules in patients with azoospermia: the diameter is reduced to 1.5–2 times (hypoplasia), the basement membrane with a strong fiber component (fibrosis) (p < 0,05). Expressed Inhibin tissue expression observed in Sertoli cells (“+++”) and to a lesser extent in spermatogonia ( «±»), located closer to the basal membrane convoluted seminiferous tubule. The expression level of Inhibin in germ cells - up to 5%. ki-67 protein expression was observed in the nuclei (S-phase of mitosis) spermatogonia (“++”) at stages II and III and spermatogenesis in some primary nuclei (“+”) and secondary (“+”) spermatocytes. Expression of ki-67 level in the germ cells – up to 25%.

Conclusion. Determination of tissue levels of Inhibin-B can be used as a p rognostic test backup testicular function.

Inflammatory cystic lesion of the descending part of the duodenum, mainly in the field of small duodenal papilla in chronic pancreatitis (CP) is described as “duodenal dystrophy” (DD). The pathogenesis of this condition has not been studied and treatment strategy is not defined.

Purpose. Investigation of cystic inflammatory transformation of duodenal wall pathogenesis in patients with CP, described as a DD, and evaluate the clinical ef ficiency of surgical treatment.

Material and methods. Eighty two patients with DD were retrospectively included over 12 years. The diagnosis of DD was established by transabdominal ultrasound, CT, MRI and endosonography. Initially, all patients were treated conservatively. 74 patients required surgical treatment subsequently after conservative treatment with a median duration of 2 years. 34 patients underwent pancreaticoduodenectomy (PD), 21 patients underwent duodenum resection, 15 – duodenum preserving pancreatic head resection of (DPPHR). 4 patients underwent palliative operations. Diagnosis of CP and DD was verified by histological study of surgical specimens. Not operated patients (8) are under observation. Long-term results of surgical treatment were evaluated in 47 patients with a median follow-up was 49.9 months.

Results. Histological examination resulted that in 69.9% of DD was related with groove pancreatitis, with ectopic pancreatic tissue – in 30.1%. DD was associated with CP in 92.6% of cases. Clinical presentation of DD was not related with etiology and showed typical symptoms of CP: abdominal pain occurred in 98.8% of patients, body weight loss – 61.7%, duodenal obstruction – 35.8%, biliary hypertension – 34.1%. The overall morbidity was 35.1%. Overall postoperative mortality was 1.37% (1 patient). 66% of patients had no clinical symptoms postoperatively, a significant
improvement – 32%, no effect – 2%.

Conclusion. The most cases of DD is related with groove pancreatitis, less – with ectopic pancreatic tissue in the duodenal wall. Typically DD occurs in patients with CP. Treatment of patients with CP and DD should be started with conservative therapy. Surgery is indicated for persistent abdominal pain and presence of CP complications. Procedures of choice are PD and DPPHR.

This review is devoted to the cytoreductive treatment of malignant tumors of the abdominal organs. The actuality of the issue is determined both by increase of the incidence of abdominal cancer in Russia and in majority of developed countries and by high rate diagnosis on late stages of disease. The methods of treatment of peritoneal carcinomatosis, based on possible effects on the secondary peritoneal tumors after surgical cytoreduction to reduce the risk of local recurrence and disease progression are described. These methods of additional intraoperative specific antitumor action include intraoperative radiation therapy, hyperthermic intraperitoneal chemotherapy, intraoperative photodynamic therapy characterized by differences in difficulty of performance, mechanisms of effect on tumor and healthy tissues, efficiency. Benefits, opportunities and possibilities of application of intraoperative photodynamic therapy (IOPDT) for secondary peritoneal tumors are described in details, the results of a number of domestic and foreign clinical studies are shown, the successful application of intraoperative photodynamic therapy in clinical oncology, which allows reducing the risk of secondary tumor lesions of the peritoneum significantly, is demonstrated. Photodynamic therapy – a method with high efficiency and almost no side effects and complications, based on the ability of photosensitizer to accumulate selectively and retain in the high proliferative tissues. The advantages of this type of treatment of patients with peritoneal carcinomatosis are a selective effect on the peritoneal carcinomatosis and on visually detected tumor tissue, high efficiency in patients with malignant tumors of the abdominal cavity and pelvis combined with surgical cytoreduction, minimal effect on normal organs and tissues of the patient, well tolerated procedure.

Nowadays autotransplantation of adipose tissue is the most popular subject for research in the field of plastic surgery and regenerative medicine. Transplantation of adipose tissue is widely recognized as a common technique to increase the volume of soft tissues or for filling of soft tissue defects caused by trauma or the aging process. Injections of autologous fat are widely used in plastic surgery and regenerative medicine, as performed transplant sometimes gives unpredictable and too short due to partial necrosis or progressive resorption of fat (from 20 to 60% according to various authors). Many scientists who involved in plastic surgery around the world (USA, Europe, China, Japan) has revised its Outlook on the problem of transplantation of own fat tissue in connection with the advances in cellular technologies. Currently, the main object of study in this area are growth factors, which can affect the degree of engraftment of the adipose tissue and make it more predictable. This literature review describes the experimental studies focused on the study of the angiogenic properties of SCAT (stem cells of adipose tissue) and SVCF (stromal- vascular cell fraction) and their use for the stimulation of neovascularization and improving the survival of fat grafts in plastic surgery and regenerative medicine. The results of studies on the survival of fat autografts in animal and clinical studies with the combination of dif ferent methods that improve the vascularization of adipose tiss ue.

Writing this article is prompted by growing interest in the technology of high intensity focused ultrasound (high-intensity focused ultrasound, HIFU), which, in turn, is associated with a wide range of potential points of use, minimal invasiveness of this method, minimal impact on the patient’s body, characterized by a short period of rehabilitation. Also, this treatment method has a high reproducibility, which in turn contributes to the rapid spread of HIFU therapy in practice. The review is devoted to the history of development, study and application of the method of ultrasonic ablation, the modern view on how to conduct HIFU therapy, the currently available technical possibilities for non-invasive high-intensity focused ultrasound therapy as well as demonstrate the effectiveness of this treatment in patients with malignant and benign tumors of different localization, as in a standalone version or in combination with other treatment options (surgery, drug therapy, radiation therapy), an attempt to systematize the early and remote results of treatment. The article represents the data of world and national literature. One of the important directions of the study of the described technique is an expansion of possible application in various malignant pathologies, both local and generalized nature of the lesion. A separate item is the application of HIFU therapy in the treatment of chronic pain syndrome.

From the experience of clinical observations, we have shown a high therapeutic effectiveness of the medical laser KULON-MED in: cosmetics, non-cancer inflammatory diseases of the gastrointestinal tract and cancer (cancer of the stomach and colon) as at different wavelengths, and with different types of photosensitizers. In the area of anti-tumor photodynamic therapy (PDT), based on experimental studies, we have showed the high antitumor (sarcoma S‑37) effectiveness of the laser (with the inhibition of tumor growth of up to 100%) for repetitively pulsed irradiation mode, and for mode fractionation doses laser radiation. In addition, significant differences are shown in the effectiveness of anticancer PDT methods in the application of high-intensity lasers, continuous and pulsed caused fundamental properties of laser radiation characteristics – time structure of the radiation pulses. Thus, for the first time we have shown that the time of high-intensity laser pulses structure significantly affects therapeutic efficacy laser system, and hence on the mechanisms of interaction of laser radiation with biological tissue.

The role of medical professional societies as a social mechanism of realization of personnel policy in the Russian health care system is characterized. The social nature of this mechanism is analyzed on the levels of Russian society, social groups, health workers and at the level of individual physician and health worker. According to the data of sociological survey of participants of X (XXVI) Emergency Pirogov Congress of doctors (may 2016), 93% of the doctors evaluating the state of Russian health care, pointed to the inherent manifestation of the crisis. This suggests that the Russian government, declaring himself at the same time by the customer, performer and supervisor of medical programs that inefficiently responds to the queries of patients as the ultimate consumers and the medical community. Under the theme of this study at the Congress were the main objectives of the professional medical community: licensing and certification of professional activity of doctors of all specialties; organization of advanced training of doctors; the control of activities of doctors; the creation and support of information databases on doctors; direct participation in policy income for the medical staff; the involvement of health personnel in policy development processes and health management.