Purpose of the study. Evaluation of the expression of E- and N-cadherins in tumor tissues in postmenopausal patients with primary operable luminal breast cancer (BC) without Her2/neu overexpression for inclusion in the panel of a comprehensive assessment of tumor biological parameters for the disease prognosis.

Patients and methods. The study included 120 patients divided into two groups: patients with luminal A and luminal B subtypes. To evaluate the prognostic significance of E- and N- cadherins in both groups of patients, we analyzed expression levels and correlation using the Mann- Whitney U-test and Spearman correlation criterion; overall survival, progression-free and tumor- specific one, at various values of the studied biomarkers — by the Kaplan- Meier method.

Results. The differences in the mean expression levels were not statistically significant (p>0,05). E-cadherin was twice higher in luminal A BC (55.4±5.2) compared to luminal B BC (28.1±4.9), N-cadherin in luminal A BC (12.8±5.3) was 1.3 times lower than in luminal B BC (17.06±5.4). Patients with luminal B BC demonstrated a tendency to the loss of E-cadherin and increased expression of N-cadherin, which is often associated with poor prognosis. However, the correlation between these markers was not statistically significant (p>0,05).

Conclusions. Thus, despite the differences in levels of E- and N-cadherin expression, these markers did not show their prognostic significance, and therefore, they were not included in the panel for a comprehensive assessment of tumor biological parameters when determining the prognosis of luminal breast cancer without Her2/neu overexpression in postmenopausal women.

Purpose of the study. To study the results of prepectoral reconstruction of the mammary gland after subcutaneous mastectomy for cancer with additional covering of the implant with a polypropylene mesh implant. (IPPBR)

Materials and methods. Case-series of 6 patients with luminal breast cancer T1–2N0M0 aged from 34 to 47 years. IPPBR was performed after subcutaneous mastectomy (nipple sparing in 2 cases). The anterior surface of implants (Polytech, Germany) was covered with Ethicon/Johnson& Johnson (USA) simple polypropylene mesh. The mesh was fixed with interrupted absorbable sutures to the big pectoral muscle.

Results. There was one successfully treated minor complication: limited skin incision necrosis. No other complications or tumor recurrences were registrated during observation period. The aesthetic results (mainly shape and volume breasts symmetry, nipples symmetry after nipple- sparing operation) were estimated as good both by surgeon and all patients. Periprosthetic connective tissue growth was minimal (grade I due to Baker’s scale) in all cases.

Conclusion. The first results of the use of a simple mesh polypropylene implant in cases of breast cancer after subcutaneous mastectomy for cancer for the prevention of implant migration are encouraging. The degree of development of periprosthetic scar contracture is minimal.

Purpose of the study. Analyzing the dynamics of VEGF-А, TGF-β and their receptors in the lung tissues in rats with antitumor effect of 1,3-diethylbenzimidazolium triiodide (Stellanin).

Material and methods. The study included white outbred rats weighing 180–220 g. The main group included males (n=27) and females (n=27) with sarcoma 45 (s45) inoculated into the subclavian vein but not developed in the lungs (2×106 cells in 0.5 ml of saline) due to the subsequent intragastric administration of Stellanin (0.4 mg/kg once a day) according to an intermittent scheme: administration for 5 days and a break for 2 days. The control group included males (n=14) and females (n=14) without treatment with growing s45 in the lungs. Intact groups included 5 males and 5 females. After 4, 5 and 8 weeks of the experiment animals were decapitated, and levels of VEGF-A, sVEGF-R1, sVEGF-R2, TGF-β and sTGFβR2 were measured in 10% lung homogenates by ELISA (CUSABIO BIOTECH Co., Ltd., China).

Results. Lung tissues of intact females showed 1.4 times (p<0.05) lower VEGF-А and 3.3 times higher sVEGF-R1, compared to males. The development of tumors in all control rats was accompanied by the VEGF-А increase (by 1.6–3.0 times) and the TGF-β reduction (by 3 times). The dynamics of both VEGF receptors differed in males and females. The levels of sVEGF-R1 in males increased by 1.5 times (p<0.05), while in females it decreased by 1.8 times (p<0.05), and as a result, the levels became similar in all animals. The levels of sVEGF-R2 in males decreased by 2 times, and in females it increased by 1.4 times (p<0.05), so the sVEGF-R2 content in females became 2.4 times higher than in males. In two-thirds of rats, Stellanin prevented s45 development in the lungs due to inhibition of VEGF-A growth by more than 2.0 times and an increase in concentrations of sVEGF-R1 by 10.0 times and TGF-β by 6.0 times, together with normalization of sVEGF-R2 and sTGFβR2.

Conclusions. Stellanin prevents the development of malignant process in the lungs by inhibiting neoangiogenesis (deficiency of VEGF-A and excess of sVEGF-R1) and suppressing the proliferation of malignant cells (TGF-β growth).

Purpose of the study. To give a qualitative and quantitative assessment of different types of tumor microvessels depending on the histological type of cervical cancer (CC).

Material and methods. The tumor samples from 76 patients with CC stage I–IIA who received the surgical treatment on the first phase were the object of study. The immunohistochemical study was performed using antibodies to CD34 and podoplanin. Statistical analysis of the data was performed using the Statistica 6.0 software.

Results. In CC, the following types of tumor microvessels have been identified: normal microvessels, dilated capillaries (DCs) with a normal endothelial lining, DCs with a weak expression of CD34, DCs of contact type, capillaries in the solid component of tumor, the atypical dilated capillaries (ADCs), the structures with partial endothelial lining and the lymphatic capillaries in lymphoid and polymorphic cell infiltrates. It was found that DCs with a mild expression of CD34 (p=0.0005), DCs of contact type (p=0.000005), and capillaries in the solid component of tumor (p=0.006) were correlated with the prognosis in early CC. The detection frequency of this tumor microvessels was lower in more prognostically favorable squamous non-keratinizing CC, while in the prognostically unfavorable squamous cell keratinizing CC and adenocarcinoma of the cervix uteri, the higher DCs values with a mild expression of CD34 (р=0,004 and р=0.005, respectively) and DC of contact type (p=0.02 and p=0.14, respectively) were typical.

Conclusion. We consider it is expedient to further study the relationship of different types of tumor microvessels with clinical and morphological characteristics and prognosis of cervical cancer.

Purpose of the study. To study the diagnostic informativeness of magnetic resonance imaging (MRI) with the assessment of diffusion- weighted images and the measured diffusion coefficient in the diagnosis of endometrial tumor lesions in polyineoplasias.

Materials and methods. The article presents the results of a study of patients with synchronous and metachronous polyneoplasias who were in the AU "Republican clinical oncological dispensary" of the Ministry of health of the Chuvash Republic from 2014 to 2018. All were performed magnetic resonance imaging on Excelart Vantage Atlas (Toshiba, Japan, 1.5 T), ultrasound (Aplio, Xario and Nemio, Toshiba, Japan; Sono Scape, China), x-ray computed tomography on Light Speed VEX Plus and Light Speed RT 16 (GE, USA). All MRI results were compared with morphological data obtained after
histomorphological examination of the postoperative material. The differences were considered significant at values p≤0.05.

Results. 80 cases of endometrial tumor lesions in polyineoplasias (N1a) were detected, which was 44.7% of all cases of the main group (N1; n=179), of which metachronous polyineoplasias were found in 56 (70.0%), synchronous — in 11 (13.7%), combined — in 13 (16.3%) patients. The informative value of MRI in the diagnosis of malignant neoplasms with lesions of the endometrium when multiple neoplasias were: sensitivity of 91.3%, specificity — 82,4%, accuracy was 89.7% (p<0.001).

Conclusions. Magnetic resonance imaging using the diffusion- weighted image Protocol with an assessment of the measured diffusion coefficient has shown high information both in the diagnosis of primary endometrial tumor lesions in primary multiple malignancies, and in establishing the stage of the tumor process and in the diagnosis of subsequent malignancies.

Purpose of the study. Was to compare the early and long-term results of different variants of the classical KEAE.

Materials and methods. In a retrospective study, we collected data on 1.242 patients who trans- ferred KEA from January 2011 to December 2019, using a patch was performed in 239 cases in 1003 — primary suture closure. We used 3 methods of arteriotomy closure with the use of a patch. There were 848 men and 394 women, the average age was 63.16 years, all of them were sympto- matic. Most patients had a transient disorder (49.2%) or ischemic stroke (50.8%). All patients had significant (moderate to severe) carotid stenosis. After the operation 5 (0.4%) patients had ischemic stroke, 1 (0.08%) had n. hypo-glossus damage, 3 (0.24%) had postoperative hematoma. The usual endarterectomy was performed without a shunt in all cases. All arteriotomies were mostly open. Early and late results of this procedure with a period of observation of at least 36 months were ana-lyzed: technical aspects of arteriotomy, features of restoration of the integrity of the vessel, changes in the "geometry" of the vessel, the use of zaplat. We studied the state of hemodynamics and complications in the early (30 days) and late postoperative period, the development of restenosis was compared between groups during the 36 months of observation. 

Results. When assessing the geometrical changes in the group with the patching, it was noted that the worst results were obtained using the technique with a U-shaped fixation suture on the distal part of the patch and the use of a wide patch. When using a narrow patch geometric changes in the width of the patch are the smallest. The main reason of the frequent geometrical changes in the dis-tal part of the patch was the patch wrapping inside the artery with the formation of a duplicate. The application of the modified technique of patch closure allowed to reduce the number of distortions in the operation area, to avoid the formation of artery stenoses in the place of patch imposition, to prevent changes in the bifurcation geometry of the internal carotid artery. The best results in the application of the primary edge suture were obtained by the method of closing the arteriotomy with the counter edge suture with the precision control of the application. The application of the U-shaped suture along the edges of the arteriotomy allowed avoiding deformations in this place. Con-trol of needle injection by means of straightening and lifting of the wall edge ensured absence of deformations in the suture.

Conclusions. The post-CEAE closure technique affects the hemodynamic profile. Sewing patch-ing does not seem to create favorable flow dynamics. Consideration should be given to the elective use of the patch to improve disturbed flows. However, the linear precision suture remains the method of choice for suturing the arteriotomy.

Purpose of the study. To determine the effectiveness of antiandrogenic therapy — 10-year General and tumor-specific survival (OV, OSV) depending on the type of hormone therapy, the stage of the disease, and the risk of progression.

Patients and methods. The study was based on a retrospective analysis of 100 patients with localized, locally advanced, and metastatic prostate cancer over the period 2008–2018. The assessment was conducted in 2019. All patients received antiandrogenic treatment in the form of castration therapy (n=59) and combined (complex) treatment (n=41) in various variants and modes for more than 5 years. Patients had a 100% 5-year survival rate. The control point of the study was General and tumor- specific survival, as well as prognostic factors that determine this survival. 

Results. By the end of the study, 53 (53%) patients were alive, 8 (8%) died, and 39 (39%) patients were censored. The highest percentage of 10-year overall survival was achieved in localized stages of the disease and was 52% (31 patients) — stage 1, 38% (22 patients) — stage 2. Tumor specific survival rate (1–2 stages) — 62% (33 patients). At stage 3–30% (14 patients) and 51% (21 patients) and at stage 4–18% (1 patient) and 32% (2 patients), respectively. Depending on the risk of progression (Gleason index), high rates of both General and tumor- specific survival were achieved with low Gleason (2–5), and moderate risk of Gleason progression (6–7), and were 85% and 62%, respectively. The most effective method of treatment that determines the 10-year overall survival was combined (hormone radiation) therapy, which allowed to achieve results in 75% of patients. The tumor — specific survival rate was more than 80%.

Conclusion. In real clinical practice, the use of antideprivation therapy in various variants and modes allows to obtain a 10-year General and tumor- specific survival rate in 75% and more than 80% of patients. Stratification of patients by risk groups forms a personalized approach to the treatment of each patient. Use of research treatment regimens in the work STAMPEDE, CHAARTED allows to increase the overall survival of patients with metastatic stage of the disease.

Purpose of the study. To improve the results of treatment of benign prostatic hyperplasia with symptoms of the lower urinary tract in the presence of concomitant metabolic syndrome.

Materials and methods. The investigation included 103 patients aged 42 to 75 years with a reliable diagnosis of BPH and signs of MS, according to the criteria of GFCF (2009). Patients were randomized into two comparable groups: Group 1 included 52 men who were prescribed tamsulosin in combination with targeted correction of metabolic disorders; Group 2 consisted of 51 men who were prescribed tamsulosin monotherapy. After 6 and 12 months of the study, the dynamics of metabolic parameters, prostate volume, residual urine volume, maximum urine flow rate, and total IPSS and QoL score were evaluated in each group of patients.

Results. A direct correlation was established between the severity of metabolic disorders and the progression of BPH /LUTS in the main assessed indicators. The use of combination therapy with metformin, ACE inhibitors / ARA and statins in combination with tamsulosin showed efficacy after 6 and 12 months of the study compared with tamsulosin monotherapy. The treatment is based on the rinciple of T2T ("Treat to Target"): maintaining target levels of blood pressure, glucose, blood lipid parameters, and body weight correction.

Conclusion. Overweight, arterial hypertension, the atherogenic profile of dyslipidemia and hyperglycemia are risk factors for more pronounced progression of BPH / LUTS and a deterioration in the quality of life of patients. The investigation IMSYPA showed the effectiveness of pathogenetically based complex therapy aimed at eliminating metabolic imbalance.

Internal stenting of the upper urinary tract is a widespread urological surgery. Its frequency in modern practice is high and continues to grow due to the widespread use of endourological, percutaneous, and laparoscopic interventions. The presence of a stent in the patient's body often leads to a decrease in the quality of life due to the occurrence of stent-dependent symptoms, which often requires urgent hospitalization. According to various data, they are registered in at least 80% of patients. The most common stent-dependent symptoms are frequent and / or painful urination, urge to mix (up to imperative), nocturia, pain in the lumbar region, macrohematuria. According to existing data, a fair share of responsibility for the development of these symptoms lies with the distal (vesicular) curl of the internal stent, especially if the technology of its installation is not followed or the length of the drainage is incorrectly selected. The review describes methods for correct installation of internal ureteral stents by transurethral retrograde, antegrade, and laparoscopic approaches, as well as a method for installing and removing mono-pigtail drains. The internal drainage procedure is standard, so the focus is on the nuances and details of this widespread manipulation. The given cohort of patients and the range of surgical interventions indicate a significant experience of the authors in this issue. All illustrations are author's own and taken from the daily workflow. It should be noted that the modern understanding of the process and technological equipment ensure correct stenting when performing any interventions with any access. An adequate choice of installation method and correct positioning of the stent, knowledge of simple details and "secrets" allow not only to restore urodynamics, but also to effectively prevent the development of stent-dependent symptoms, thereby preserving patients quality of life.

Currently, pancreatic cancer remains one of the most unfavorable tumor pathologies, characterized by pronounced difficulties in diagnostics and treatment, a significant impact on the ability to work and quality of life of patients, and low indicators of patient life expectancy. Features of the development of malignant neoplasms of this localization contribute to limiting the possibility of performing radical surgery, and therefore a special role in the treatment of patients with pancreatic cancer is assigned to chemotherapy. Specific systemic drug therapy for this pathology is the most important and, in the majority of cases, mandatory element of treatment. It can be carried out in a neoadjuvant, adjuvant and independent mode, include mono- or multi- component schemes, and be combined with other types of systemic or local antitumor effects. The choice of chemotherapy regimen depends primarily on the General somatic status of the patient and is determined by the potential toxicity of a particular combination of cytostatics. This review of the literature demonstrates the effectiveness of various chemotherapy regimens in patients with stage III–IV pancreatic cancer in the first and second lines, describes the frequency of adverse reactions to treatment and their nature, and mentions ways to reduce the toxicity of multicomponent drug therapy regimens. This review is based on the analysis of scientific sources of the Internet resource "National Center for Biotechnological Information".

Vaccines represent an outstanding success story in modern medicine and are responsible for a huge reduction in morbidity and mortality worldwide. It is clear that improvements are necessary to enable the development of successful vaccines against some difficult pathogens, including human immunodeficiency virus and hepatitis C virus. This review is on recent advances in the development of new generation vaccines, as well as those developed using earlier time-tested technologies: live attenuated vaccines, inactivated vaccines, recombinant vaccines, subunit vaccines, virus-like particle-based vaccines, synthetic peptide vaccines, DNA vaccines and mRNA vaccines. However, many infections are still not preventable with the currently available vaccines and they represent a major cause of mortality worldwide — for example, severe acute respiratory syndrome coronavirus, middle east respiratory syndrome coronavirus and severe acute respiratory syndrome coronavirus 2 that causes coronavirus disease 2019 — COVID-19. As no effective treatment against COVID-19 is currently available, the best action is to develop vaccines to prevent the infection. The majority of candidate vaccines aim to induce neutralizing antibodies against the SARS-CoV-2. Multiple platforms areunder development. Some potential vaccine candidates have progressed to phase I and II clinical trials. In Russia, a vector vaccine based on adenovirus DNA, which has the SARS-CoV-2 virus gene embedded in it, is undergoing clinical trials.

The occurrence of tracheal fistulas of ischemic genesis combined with the failure of esophagogastroanastomosis and the communication between them is a rare and formidable complication after esophagectomy with mediastinal lymphadenectomy due to its anatomical position and extensiveness. However, it is insufficiently documented in the literature, both in terms of treatment and in terms of its causes. This observation aims to demonstrate the rare cause of this complication and the atypical successful treatment. In this case, a patient with squamous cell carcinoma G2 of the middle third of the esophagus and TNM stage cT3NxM0. On the McKeown thoracoscopic-laparotomy esophagectomy intraoperatively a short arterial vessel with a diameter of about 3 mm, which passed through the paracancerous infiltration and supplied blood to the esophagus and trachea revealed. The vessel was not isolated from the infiltrate, but was clipped and crossed between the aorta and infiltrate to maintain surgery ablastic. On the 7th day after the operation the insolvency of esophagogastroanastomosis, the fistula of the trachea with mediastinum and the communication between the leak of esophagogastroanastomosis and the fistula of the trachea were diagnosed. We consider this combination as a special case of esophagogastroanastomosis fistula, complicated by the communication between the right pleural cavity and pneumothorax. According to our experience, partial leak of esophagogastroanastomosis successfully heals by secondary tension within 10–15 days against the background of cervicotomic wound drainage and feeding through a nasointestinal tube. In this case there was a leak of saliva in the mediastinum and its penetration into the lumen of the trachea and the right pleural cavity. Surgical diversion of the fistula and stenting of the trachea were considered, but not applied, as the fistula in our opinion was controlled, but the aggressive content of the gastric conduit prevented healing. The patient was on assisted lung ventilation with minimal pressure support and inflow increased oxygen fractio. For this reason, we considered the best stenting of the esophagogastroanastomosis leak area to be covered with a stent in order to stop the aggressive content of the gastric stem from entering the fistula, which led to the successful treatment of the developed severe complication. It should be noted that this method of treatment may be ineffective in patients who need pressure support during ventilation.

Cystectomy, as a type of surgical treatment, is performed for various diseases of the bladder. Most often — with malignant tumors, as well as with benign pathological conditions. Complications in the postoperative period in patients undergoing cystectomy are mainly caused by the need to ensure adequate urine derivation. One of the options for solving this problem is the implementation of ileocystoplasty, which, in turn, is associated with the performance of technically difficult and large-scale manipulations during the operation. Successful prevention of severe complications of cystectomy (or their elimination) is probably possible only in those multidisciplinary medical organizations in which the provision of medical care to patients with urological oncology is a daily programmed activity. Outpatient health care specialists play a special role in routing patients with bladder diseases, and not only their formal referral and delivery to multidisciplinary medical and prophylactic institutions in an emergency mode with “on-duty” syndromic diagnoses such as “renal colic or hematuria”. At present, in St. Petersburg, all conditions have been created for the concentration of patients with severe diseases of the bladder in a number of specialized medical organizations, in which a large number of cystectomies with intestinal plastic are routinely performed annually, which makes it possible with a high probability to guarantee a favorable clinical outcome without discrediting method of the rarity of its implementation.

Purpose of the study.To conduct a comparative analysis of the mortality from malignant neoplasms (MNs) detected during the implementation of the oncological component of National Prevention Programme named Dispensarization of certain groups of the adult population (DCGAP) according to the data of the Arkhangelsk Regional Cancer Registry (ARCR) for the period from 2006 to 2019.

Materials and methods. Anonymous data about patients with malignant neoplasms of the colon, rectum, lung, breast, cervix, uterus, ovaries, prostate gland, kidney undergoing examination (screening) at the first stage of the DCGAP from 2006 to 2019 were extracted from the ARCR database. We compared the averaged crude and age-standardized (WHO world standard 2001) mortality rates in the periods before (2006–2012) and after the implementation of DCGAP (2013–2019) in the entire population, as well as in men and women and in age groups 15–59 years old for males and 15–55 years old for the female population ("mortality at working age") and 30–69 years old ("premature mortality"). A segmented analysis of the mortality rates was carried out. The interventional value of the DCGAP was positive in the case of a decrease in the linear trend in mortality between 2013 and 2017.

Results. A total of 33,824 deaths were included in the analysis. 25106 (74.2%) patients died from iMN, the proportion of deaths from other causes varied from 14% for lung cancer to 83% for cervical and prostate cancer. The crude mortality rate after the introduction of DCGAP increased for all iMNs, except for cervical cancer, while age standardized rate only for cancers of the uterus and prostate. In lung cancer, there was a decrease in age-standardized mortality rates for men from 64.7 to 60.3 per 100,000 population and an increase from 5.1 to 6.5 per 100,000 for women. Mortality rates “at working age” were low for all iMNs except for cervical and breast cancers and did not differ between periods; “premature mortality” decreased only in lung cancer in men from 40.1 to 36.2 per 100,000 population, with other iMNs differences between periods were not revealed. Segmented analysis revealed no significant changes in mortality trends.

Conclusion. There was no decrease in mortality among all nine iMNs in the period after the introduction of DCGAP, which is probably due to increased incidence and insufficient follow-up for later period. A comparative analysis of survival is required.