Оценка факторов риска передачи гемоконтактных инфекций (гепатит в, с и вич) при выполнении манипуляций с венозным катетером

Cancer increases the risk of venous thromboembolism (VTE) in adults and children. The aim of our study was to evaluate the incidence of VTE in children and adolescents with lymphomas. The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. A retrospective analysis based on medical data of 262 children and adolescents (0–18 years) with primary lymphomas (n = 262) who were treated in Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology since 01.01.2013 to 31.12.2019 had been performed. Such parameters as age and sex distribution of patients, the frequency, as well as the cumulative incidence of detection (CI) and differences in localization, the median time of detection of symptomatic (sVTE) and asymptomatic episodes of VT (aVTE), their relationship with central venous catheters (CVC) were analyzed. Statistical processing of the obtained data was carried out using the XLSTAT 2020 program (Addinsoft, France). The median age was 11,1 years (interquartile range (IQR) 6.5–15 years), the ratio of males to females was 2.2:1. There were 71 episodes of VTE in 65 patients (24.8%, 95% confidence interval (CI): 19.6–30). Among all episodes of VTE 31% were defined as sVTE at 400 day CI for sVTE was found to be 8.1% (95% CI: 5.4–12.2) and CI for aVTE – 18.7% (95% CI: 14.4–24.2). The median time to VTE episode was 38 days (IQR 16.5–91.5 days). There was a trend towards an earlier diagnosis of sVTE (median 23.5 days, IQR – 17–42 days) than aVTE (median 62 days, IQR 14–80 days), p = 0.075. VTE was CVC-related in 67.7 of all VTE cases. In one case, asymptomatic thrombosis of right atrium led to pulmonary embolism (PE). VTE is a frequent complication in children and adolescents with lymphomas. Most episodes of VTE were asymptomatic, one of which was the most likely cause of PE in the child. Further research is needed to find risk factors for VTE.

Telemedicine technologies are an indispensable tool in pediatric oncology, hematology and immunology. They improve the availability, quality and effectiveness of medical care, enhance the quality of life of patients and their families, and optimize the use of healthcare resources. Further development and implementation of telemedicine technologies in these areas of medicine is a priority task aimed at improving treatment outcomes and increasing the survival rate of children with these complex diseases. Purpose of the study was to evaluate the effectiveness of the use of telemedicine technologies by the Dmitry Rogachev National Medical Research Center for Pediatric Hematology and Immunology of the Ministry of Health of the Russian Federation within the framework of the Federal Project «Development of the NMRC Network» (2019–2024) to improve the provision of medical care to children with oncological, hematological and immunological diseases in the constituent entities of the Russian Federation. Materials and methods. The data of more than 72 thousand telemedicine consultations conducted by the telemedicine center of the Dmitry Rogachev National Medical Research Center for Pediatric Hematology and Immunology were analyzed. Dmitry Rogachev National Medical Research Center for Pediatric Hematology and Oncology of the Ministry of Health of the Russian Federation with third-level medical organizations in the constituent entities of the Russian Federation in the period from 2019 to 2024. The distribution of consultation profiles and diagnoses by region, as well as the frequency of hospitalizations and the need for reference studies were assessed. Results. Telemedicine consultations have proven highly effective in treating children with oncological, hematological and immunological diseases. Remote consultations made it possible to overcome geographical limitations, a shortage of qualified specialists and reduce the time before treatment, which is critically important for this category of patients. Conclusions. The use of telemedicine technologies by the Dmitry Rogachev National Medical Research Center for Pediatric Hematology and Oncology of the Ministry of Health of the Russian Federation within the framework of the Federal Project «Development of the NMRC Network» helps to increase the availability and quality of medical care for children with oncological, hematological and immunological diseases in the constituent entities of the Russian Federation, optimizes the clinical decision-making process and reduces the time before treatment.

Treatment of patients with high-risk neuroblastoma (NB) is a complex challenge, and it is based on response to certain elements of therapy. The development and introduction of new treatment approaches, such as GD2-targeted immunotherapy (IT), leads to improved survival in this cohort of patients. The aim of the study was to retrospectively assess the effectiveness of therapy in patients with high-risk NB before the introduction of IT into clinical practice. We retrospectively analyzed the data of 151 NB patients stratified into a high-risk group who had received treatment in accordance with the modified NB2004 protocol of the German Society for Pediatric Oncology and Hematology (GPOH) at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology from 01.2012 to 12.2017. This study was approved by the Independent Ethics Committee and the Academic Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. All the study subjects (or their legal representatives) signed a voluntary informed consent form indicating their agreement to treatment and use of their data for research purposes. Overall survival (OS), event-free survival (EFS), and risk factors were analyzed in the patients with high-risk NB including those who had completed multimodal therapy with autologous hematopoietic stem cell transplantation and post-consolidation therapy with isotretinoin and had achieved a satisfactory response to induction therapy (complete response (CR), very good partial response (VGPR), partial response (PR)) (population of special interest). The main unfavorable prognostic clinical and molecular genetic factors affecting survival in the high-risk NB patients were older age, MYCN gene amplification, and stage 4 of the disease. The use of the modified GPOH NB2004 protocol resulted in a satisfactory response (CR/VGPR/PR) to the induction therapy in most patients: 124/151 (82.1 %). Surgery (other than primary tumor biopsy) led to improved survival, with no statistical difference between macroscopic radical surgery and macroscopic residual tumor. At the same time, radiation therapy (RT), as the second element of local control, had a significant impact on EFS in the group of the patients with stage 4 disease: the 3-year EFS was 39.4 % (95 % confidence interval (CI) 23.1–55.4) in the patients with RT versus 25.7 % (95 % CI 17.5–34.7) in the patients without RT (p = 0.0295). The introduction of a new high-dose TreoMel chemotherapy regimen did not result in worse survival rates but led to a decrease in transplant-related toxicity. The 5-year OS and 5-year EFS were 49.4 % (95 % CI 40.9–57.3 %) and 33.3 % (95 % CI 25.9–40.9) respectively for all the study subjects, and 81.6 % (95 % CI 70.3–88.9) and 55.1 % (95 % CI 43.1–65.5) respectively for the patients from the population of special interest. The analysis of the results of therapy in the high-risk NB patients who had received treatment at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, yielded results comparable to those of the original GPOH NB2004 protocol. The patients with CR/VGPR/PR to the induction therapy who had completed the protocol treatment with autologous hematopoietic stem cell transplantation and isotretinoin post-consolidation therapy demonstrated higher 5-year EFS rates. However, there remains a need to develop more effective treatment regimens for high-risk NB.

Introduction.Neuroblastoma (NB) is the most common extracranial solid tumor in children. As a rule, NB is localized in the adrenal gland, retroperitoneal space and posterior mediastinum. The head and neck area belongs to the rare localization of NB, which accounts for 2.6 % of cases, and is most common in children aged 0–3 years. Localization of NB in the neck in most cases has a favorable prognosis.Materials and methods.For the period from September 2013 to September 2017 (48 months) in the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology received treatment for 8 patients with NB in the neck. Examination, assessment of the prevalence of the process and stratification into risk groups in all patients were carried out according to the recommendations of the protocol of the German group for the treatment of NB NB-2004. For the purpose of histological verification of the diagnosis and detection of unfavorable molecular genetic markers, patients underwent surgical intervention, performed risk-adapted therapy according to the NB-2004 protocol.Results.The median age of diagnosis was 8.7 (1.2–34.1) months. In our cohort of patients in 87.5 % of cases, the diagnosis was made in the first year of life. In most cases, there was not only the identification of tumor masses, but also other symptoms of the disease. In 3 (37.5 %) patients the 2nd stage was established, in 1 (12.5 %) patient – the 3rd stage, in 3 (37.5 %) patients – the 4th stage and in 1 (12.5 %) patient – 4S stage of the disease. When stratifying patients into risk groups, in the observation group and the high-risk group was stratified by 3 (37.5 %) children and 2 (25 %) patients were classified as high-risk group. 3 (37.5 %) patients showed unfavorable cytogenetic abnormalities. When evaluating the response to therapy in most patients, a complete and very good partial response was stated. Overall (OS) and event-free (EFS) survival rates were 75 ± 15 % and 50 ± 17 %, respectively. The median of observation is 43 (26–61) months.Discussion.NB with the localization of the primary tumor in the head and neck area is a favorable form in terms of the stage of the disease and the risk group, however, it should be noted that in our patient cohort half of the subjects showed the development of certain adverse events, which was also reflected in the OS and EFS. Moreover, this localization dictates its risks from the point of view of the surgical stage of treatment. The main danger is complications after surgical treatment associated with the anatomical proximity of the central arteriovenous trunks, cranial nerves, and their involvement in the tumor process. In the case of the development of life threatening conditions (LTC), it is possible to use low-intensity chemotherapy courses.Conclusion.Experience Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology shows the need for timely diagnosis and the start of treatment of NB with localization in the neck. The choice of management tactics in favor of carrying out only surgical treatment is possible in patients of the observation group without the development of LTC. Not always the localization of NB in the neck region correlates with a favorable prognosis.Conflict of interest. The authors declare no conflict of interest.Funding. The study was performed without external funding.

High-risk neuroblastoma (NB) is characterized by unsatisfactory treatment results and low probability of long-term survival despite the multimodal therapeutic approach (chemotherapy, surgical treatment, radiation therapy, autologous hematopoietic stem cell transplantation, etc.). One of the prognostic factors in this cohort of patients is the response to induction therapy. The article presents the experience of the intensification of induction therapy in 12 patients with high-risk NB with a poor response (mixed response, stable disease) to standard induction therapy who received treatment at Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, assessing its impact on the prognosis of the disease. The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. Patients received an additional two courses of chemotherapy with the inclusion of a type I topoisomerase inhibitor topotecan (TCE – topotecan, cyclophosphamide, etoposide). This regimen of intensification of therapy has demonstrated its feasibility. The main grade 3–4 toxicity was hematologic. An improvement in response was achieved in 5/12 (41.6%) patients. However, long-term results of therapy remained unsatisfactory. The 3-year EFS was 16.7% (95% CI 0.0–37.8), the 3-year OS was 50.0% (95% CI 21.7–78.3). Thus, the intensification of therapy in patients with high-risk NB with a poor response to standard induction therapy did not improve treatment outcomes.

Treatment intensification in patients with intermediateand high-risk neuroblastoma (NB) has led to improved survival rates. However, NB survivors face a high risk of long-term side effects associated with intensified therapy, with second malignant neoplasms (SMN) being the most serious and occurring in 1.2% of cases. Our study included 176 cancer survivors who had been treated for intermediateand high-risk NB at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Healthcare of the Russian Federation. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Healthcare of the Russian Federation. Specific treatment was carried out according to the modified GPOH NB-2004 protocol from January 2012 to December 2019. High-dose preparative chemotherapy regimens included carboplatin/etoposide/melphalan (CEM) (until June 2013) and treosulfan/melphalan (TreoMel) (from July 2013). Starting from July 2014, high-risk NB patients with metabolically active residual tumors received 131I-metaiodobenzylguanidine (131I-MIBG) therapy after induction chemotherapy. Thirty-six (20%) patients enrolled in our study developed disease relapse. Treatment for relapsed NB depended on the initial risk group, the extent of previous therapy and the type of relapse. The median follow-up time from the date of diagnosis of NB to the date of last follow-up for the patients included in the study was 76 months (range 37–152 months). The final analysis was performed on 31 December 2023. All the patients diagnosed with a second malignancy underwent molecular genetic testing for germline and somatic gene variants at the Laboratory of Molecular Biology and the Laboratory of Molecular Oncology of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Healthcare of the Russian Federation. High-throughput sequencing of DNA isolated from tumor tissues was used for the detection of somatic variants (Genetic Characteristics of Pediatric Solid Tumors panel (Pediatric Oncopanel v.4.2)) and whole-genome sequencing of DNA isolated from the patients’ peripheral blood was utilized for the detection of germline mutations in genes associated with tumor predisposition syndromes. Three (1.7%) out of 176 patients developed SMNs: papillary thyroid carcinoma (n = 2) and secondary acute myeloid leukemia (n = 1). At the diagnosis of NB, they had been aged 39, 52, and 55 months. Two of them had been initially stratified to the high-risk group, and one case had been allocated to the intermediate-risk group (and subsequently developed a combined relapse). The two patients from the high-risk group received high-dose chemotherapy as a part of frontline treatment, while the patient with intermediate-risk NB was given high-dose chemotherapy at the time of relapse. 131I-MIBG-therapy as a component of frontline therapy and cranial radiotherapy at relapse were performed in one case. The time from the date of NB diagnosis to the development of second malignancy was 66.5, 76.5, and 56.6 months. The cumulative incidence of SMN in the patients diagnosed with intermediateand high-risk NB after 5, 6, and 7 years was 0.73% (95% confidence interval (CI) 0.01–5.07), 1.64% (95% CI 0.41–6.44), and 2.75% (95% CI 0.88–8.42), respectively. Our molecular genetic analysis revealed the presence of somatic genetic variants in the tumor tissue samples, however, no germline mutations were found in the regions of interest. Second malignancies are rare but serious complications of NB treatment. It is important to closely follow-up surviving patients after treatment for NB, and a follow-up care program should be based on the extent of the prior treatment.

We conducted a prospective observational registry study at the Dmitry Rogachev National Medical Research Center aiming to evaluate acute myeloid leukemia (AML) treatment and its outcomes in children in regional oncology/hematology centers of Russia as well as to report the results. The study was approved by the Independent Ethics Committee and the Scientific Council of the The Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. We enrolled a total of 380 patients (205 boys and 175 girls) with newly diagnosed AML with the median age of 6.6 years (52 days to 18 years) and the median white blood cell count at disease onset equaling 17.7 (0–540) × 109/L. Fifty-two patients (13.6%) had WBC count greater than 100 × 109/L (hyperleukocytosis), 55 patients (14%) presented with neuroleukemia, and 60 (16%) had extramedullary lesions. The enrolled patients were stratified into a standard risk (92 patients), intermediate risk (99) or high risk (189) group. The first clinical and hematological remission (CR1) was achieved in 324 patients (85%), with early mortality rate reaching 8.4%. The median follow-up of the survivors was 8.3 years (1.5 months to 11.5 years). The 5-year overall survival (OS) in the entire cohort was 0.60 ± 0.025, the 5-year event-free survival (EFS) – 0.42 ± 0.025, and the cumulative incidence of relapse (CIR) – 0.37 ± 0.027. Initial extramedullary lesions (OS 0.47 ± 0.06 and EFS 0,37 ± 0.06) and hyperleukocytosis (OS 0.47 ± 0.07 and EFS 0.25 ± 0.06) led to a poorer prognosis in the AML patients, but CIR was not affected by these factors. The lowest OS rate was observed in the patients with monosomy 7 and with t(10;11)(p11-15;q21)/PICALM::MLLT10, totaling 0.2 ± 0.2 and 0.14 ± 0.1, respectively. Hematologic stem cell transplantation (HSCT) performed in CR1 significantly improved OS (0.84 ± 0.05), EFS (0.77 ± 0.06) and CIR (0.18 ± 0.05) in the high-risk patients. The majority of allogeneic HSCTs were performed using cells from haploidentical (51%), unrelated (25%) and genoidentical donors (18%). In the 50 patients treated with HSCT while in active disease, the OS was 50%. Out of 189 high-risk patients, only 67 (35%) underwent HSCT in CR1. The OS and EFS of the patients from regions were 0.51 ± 0.033 and 0.38 ± 0.032, respectively. The CIR was 0.36 ± 0,04. Relapses were reported in 37% of the patients who had achieved СR1. A total of 157 (41%) patients died during the study, out of which 112 patients had been treated at regional hospitals. The OS in the AML pediatric patients in Russia was 60%. The main treatment failures were toxic deaths (16%) and relapses (37%). In 2018, healthcare professionals of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology developed the AMLMRD-2018 protocol that could also be implemented in regional clinics, aiming to reduce toxic (infectious) death rates and thus increase the OS by at least 10% as well as to ensure HSCT accessibility for all high-risk patients.

Bilateral adrenal pheochromocytoma (PCС) is extremely rare in children, with major predisposing factors being multiple endocrine neoplasia type 2 and von Hippel–Lindau syndrome. In case of bilateral PCC with underlying von Hippel–Lindau syndrome, organ-preserving surgery is preferred in view of the low malignant potential of such neoplasms. We aimed to study clinical and molecular genetic features of patients with bilateral adrenal PCCs treated at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Healthcare of the Russian Federation. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Healthcare of the Russian Federation. The study included 20 patients with paraganglioma (PGL)/PCC (PPGL) who had received treatment (n = 17) or outpatient care (n = 3) at the Center over the period from 2012 to 2023. Bilateral adrenal PCC was diagnosed in 4 (20%) patients. In all these cases, the diagnosis was confirmed by histology. Molecular genetic testing was carried out at the Laboratory of Molecular Biology at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Healthcare of the Russian Federation in order to search for germline pathogenic variants in PCC/PGL susceptibility genes. The median age of the four patients with bilateral adrenal PCC was 9.5 years (range 4.5–14.6 years). All the patients were male. In one patient, synchronous bilateral PCC/PGL was observed. In 100% of the cases, arterial hypertension was diagnosed at the onset of the primary disease and was treated with alpha-blockers as part of preparation for surgery. According to the results of a 24-hour urine biochemistry test, all the patients had at least a 4-fold increase above the upper limit of normal for normetanephrine levels. Molecular genetic testing using the multiplex ligation-dependent probe amplification method revealed a pathogenic germline variant in exon 3 of the VHL gene in all the children (4/4). Hereditary PPGL was proven in 2/4 (50%) patients. In all the cases, R0/R1 resection was achieved. Organ-sparing surgery on one/two adrenal glands was performed in 3/4 cases. One out of four (25%) patients developed a local relapse 18.4 months after diagnosis. The overall survival rate in this group was 100%, with a median follow-up time of 8.1 months (range 0.8–50.2 months). Bilateral adrenal PCC is a very rare childhood tumor. A medical genetic consultation is necessary to identify tumor predisposition syndromes. A multidisciplinary team discussion of a surgical strategy is recommended, with organ-sparing surgery on one or two adrenal glands being the treatment of choice that should be carried out at centers specializing in pediatric surgical oncology. Here, we report a rare clinical case of bilateral retroperitoneal PCC/PGL in a patient with von Hippel-Lindau syndrome. The patient's parents gave consent to the use of their child's data, including photographs, for research purposes and in publications.

High-dose methotrexate (MTX) is one of the key components of multimodal therapy for children and adolescents with osteosarcoma (OS). This study aimed to evaluate the prognostic significance of peak plasma concentrations of MTX (12 g/m²) at the end of the 4-hour infusion in newly diagnosed OS patients under 18 years of age who received comprehensive treatment at Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. We analyzed a total of 1,195 MTX concentration measurements in 136 patients with localized and metastatic OS. The mean peak plasma concentration was 1249 ± 337 μmol/L. Significantly higher mean peak MTX concentrations were observed in the patients demonstrating a good histological response to neoadjuvant chemotherapy (1274 μmol/L vs. 1154 μmol/L; p = 0.0056), as well as in those with localized disease compared to the patients with metastatic OS (1280 μmol/L vs. 1180 μmol/L; p = 0.0131). Survival analysis revealed higher 5-year event-free survival rates among the patients with mean peak MTX concentrations ≥1500 μmol/L (79.4% vs. 53.8%; p = 0.044). No statistically significant difference in overall survival was observed depending on peak MTX concentrations. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation.

Angiosarcoma is a rare and highly malignant endothelial tumor, which occurs mainly in adults and is extremely rare in children and adolescents. The German guidelines for the treatment of soft tissue sarcomas provided by the Cooperative Weichteilsarkom Studiengruppe in 2012 included a separate therapeutic regimen for pediatric angiosarcoma consisting of a combination of vincristine/doxorubicin/cyclophosphamide (VDC) and paclitaxel. The aim of this article was to describe the epidemiological, clinical, and morphological characteristics of angiosarcoma, to review treatment approaches, and to present the experience of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation in the treatment of children with angiosarcoma. Our study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. The study included 5 patients diagnosed with angiosarcoma who had received treatment between 2012 and 2022. The patients’ parents gave consent to the use of their child's data, including photographs, for research purposes and in publications. Data on the patients’ age, gender, tumor location and extension, performed treatment and outcomes of the disease were analyzed. The male:female ratio was 0.66:1 and the median age was 5.2 years. Tumors were located in the soft tissues (n = 3) and in the bones (n = 2). In all the cases, invasion of the surrounding tissues was observed. There were no distant metastases at the time of diagnosis. Two (40%) patients underwent primary resection (R1) and 3 (60%) patients had tumor biopsy. Four patients received therapy according to the German guidelines for the treatment of angiosarcoma (VDC/paclitaxel courses), and 1 patient received treatment according to the guidelines for the management of non-rhabdomyosarcoma soft-tissue sarcomas (courses with vincristine, ifosfamide, doxorubicin/ vincristine, ifosfamide, actinomycin D). Objective response to treatment was achieved in 3 (60%) cases. Local control treatment of these 3 patients consisted of radiation therapy with a total dose of 50.4 Gy after R1 resection in 2 cases and biopsy in 1 case. After a median follow-up of 32 months, 2 patients who had received VDC/paclitaxel were alive without events (with complete and partial response), 3 patients died of progressive disease. Our data confirm the aggressive behavior of angiosarcoma in children. Protocol therapy that includes multiagent chemotherapy based on paclitaxel and doxorubicin along with local control treatment makes it possible to achieve a long-term control of the disease in some patients. However, further research on molecular and genetic characteristics of angiosarcoma is required to find potential novel targets for molecular targeted therapy. Further studies investigating the effectiveness of checkpoint inhibitors in angiosarcoma are also needed.

In this study, we explored the development and durability of humoral and T cell immune responses among the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology staff members after vaccination with Sputnik V vaccine during the rapid spread of the novel coronavirus disease (COVID-19). The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. Three weeks after the first dose of Sputnik V vaccine, anti-spike antibodies were detected in 78.0% of the study subjects. Three weeks after the second dose, anti-spike antibodies were found in 98.4% of the subjects. Three months later, the percentage of the study subjects with anti-spike antibodies fell to 82.7 %. At first, the median antibody level increased from 198.0 BAU/mL (prior to the second vaccination) to 1050.0 BAU/mL (3 weeks after the second dose of the vaccine) but then decreased to 710.7 BAU/mL by 3 months after the full vaccination. Six months after the full vaccination, spike-specific antibodies were detectable in 82.5 % of the studied samples; the median antibody level dropped significantly (to 253.0 BAU/mL). The majority of the study subjects had SARS-CoV-2-specific T cells. They were detected in 71.9 %, 73.9 % and 67.4 % of the subjects at 3 weeks, 3 months and 6 months after the completion of the vaccination course, respectively. The level of S-specific T cells reached a peak at 3 weeks after the vaccination and was found to decline at later time points. Thus, 6 months after the vaccination with Sputnik V, we observed a reduction in both humoral and T cell-mediated immune responses, and this should be taken into consideration when implementing COVID-19 infection prevention and control measures among the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology staff members.

Healthcare facilities have always played an important role in transmission of bloodborne infections. Procedures involving blood and blood fluids pose a risk of transmitting hepatitis B, hepatitis C and HIV not only to healthcare workers, but also to patients. To assess the role of healthcare facilities in transmission of bloodborne infections and to identify risk groups among patients as well as transmission factors, a total of 75 outbreaks of hepatitis B, hepatitis C and HIV have been analyzed with reference to the data published in different countries in 2008–2020. The comparative analysis was conducted for the outbreaks in the United States during 1992–2008 and 2008–2019. Most of the outbreaks of bloodborne infections at healthcare facilities were caused by non-adherence to standard precautions among healthcare workers: Reusing disposable items; improper handwashing; reusing gloves; non-disinfecting surfaces, reusable equipment and devices; non-sterilizing reusable instruments. In terms of bloodborne infections, high-risk facilities include hemodialysis centers, oncohematology clinics, outpatient clinics, nursing homes, residential care facilities, and diabetes treatment centers. High-risk groups include patients undergoing hemodialysis, oncohematological patients, and patients with diabetes. Diagnosis of bloodborne infections on a regular basis, hepatitis B vaccination among high-risk patients, investigation of outbreaks, adoption of rules and procedures combined with training and compliance control of healthcare workers contribute to solution of the problem associated with nosocomial transmission of bloodborne infections.

The vast majority of ICU patients require some form of venous access. There are no evidenced-based guidelines concerning the use of either central or peripheral venous catheters, despite very different complications. It remains unknown which to insert in ICU patients. We investigated the rate of catheter-related insertion or maintenance complications in two strategies: one favoring the central venous catheters and the other peripheral venous catheters. Multicenter, controlled, parallel-group, open-label randomized trial. Three French ICUs. Adult ICU patients with equal central or peripheral venous access requirement. Patients were randomized to receive central venous catheters or peripheral venous catheters as initial venous access. The primary endpoint was the rate of major catheter-related complications within 28 days. Secondary endpoints were the rate of minor catheter-related complications and a composite score-assessing staff utilization and time spent to manage catheter insertions. Analysis was intention to treat. We randomly assigned 135 patients to receive a central venous catheter and 128 patients to receive a peripheral venous catheter. Major catheter-related complications were greater in the peripheral venous catheter than in the central venous catheter group (133 vs 87, respectively, p=0.02) although none of those was life threatening. Minor catheter-related complications were 201 with central venous catheters and 248 with peripheral venous catheters (p=0.06). 46% (60/128) patients were managed throughout their ICU stay with peripheral venous catheters only. There were significantly more peripheral venous catheter-related complications per patient in patients managed solely with peripheral venous catheter than in patients that received peripheral venous catheter and at least one central venous catheter: 1.92 (121/63) versus 1.13 (226/200), p<0.005. There was no difference in central venous catheter-related complications per patient between patients initially randomized to peripheral venous catheters but subsequently crossed-over to central venous catheter and patients randomized to the central venous catheter group. Kaplan-Meier estimates of survival probability did not differ between the two groups. In ICU patients with equal central or peripheral venous access requirement, central venous catheters should preferably be inserted: a strategy associated with less major complications.

Invasive fungal disease due to Candida spp. – Invasive candidiasis/candidaemia, is a life-threatening complication in immunosuppressed patients. The publications on epidemiology of invasive candidiasis (IC) in children after hematopoietic stem cell transplantation (HSCT) is limited. The purpose of the study was to study the epidemiology of IC in children after HSCT for the 7 years in Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation. In 2009–2016 yy have been performed 754 HSCT in children: 494 allogeneic and 260 autologous. The study was approved by the Independent Ethics Committee of the Raisa Gorbacheva Memorial Research Institute of Children's Oncology, Hematology and Transplantation. A retrospective study included 22 cases of invasive candidiasis in after HSCT. EORTC/MSG 2008 criteria were used for the diagnosis of proven invasive candidiasis as well as to evaluate response to therapy. Incidence of IC was 2.9%: allo-HSCT – 3% (n = 15), auto-HSCT – 2,7% (n = 7). The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology. The etiology: Candida parapsilosis – 50%, Candida albicans – 27%, Candida krusei – 14%, Candida tropicalis – 5%, Candida dubliniensis – 4%. The most frequent underlying diseases was acute leukemia – 45% (n = 10). The median age was 8 y.o. (3 month–18 years). The median day of onset of IC after allo-HSCT was 63 days (4–243), auto-HSCT – 12 days (3–20). Febrile fever was the main clinical symptom; septic syndrome develops in 32% cases. Antifungal therapy was with echinocandins – 23%, lipid ampho B – 27%, triazole (fluconazole, voriconazole) – 32%, without therapy (due to early mortality) – 18%. Overall survival (OS) at 30 days from diagnosis invasive candidiasis was 50%. The central venous catheter (CVC) removal was the only factor significantly improved OS (70% vs 33%, p = 0,035). Incidence of Invasive candidiasis in children after hematopoietic stem cell transplantation was 2.9%. The main etiology agent was Candida parapsilosis. Invasive candidiasis infections most often affect leukemia patients, after allo-HSCT developed later than auto-HSCT. Overall survival at 30 days from the diagnosis was 50%. Removing of CVC improved overall survival in children with invasive candida infections after HSCT

Purpose: This study was conducted to evaluate the knowledge level of high school students regarding risk factors for transmission of blood borne infection. Factors of interest in this study included vaccines, sharing of personal care items, methods used to eliminate pathogens, and Universal Health Precautions (UHP). UHP are recommended to prevent infection transmission between patients and health care workers. Even though the precautions were designed for hospitals, they should be used universally by people who do not wish to contract blood borne diseases. Health education is not a required part of high school education across the nation. This may be a particular problem for high school students who will be living outside their usual home environment in the near future. The aims were to evaluate the knowledge level of high school students regarding risk factors for transmission of blood borne infections. Methods: The method used was the creation and distribution of a brief 13 question survey. The survey was sent to a private school in Arlington, Texas and dispersed among the freshmen, sophomores, and juniors. The target population consisted of 248 students with 184 (74%) completing the survey. Results: The majority of students that completed the survey were Caucasians (63%). According to the survey, 82% of students had never heard of UHP with only 11% realizing that UHP applied to all people regardless of disease status. On protective vaccine availability, 70% knew of the HBV vaccine; however, 46% and 30% thought there were vaccines for HCV and HIV, respectively. Sixty percent lacked knowledge that use of bleach was the best method to clean up a blood spill. Fifty-four percent of students were unaware that using an infected persons toothbrush or razor blade could transmit blood borne infections. The majority were aware of sexual transmission of HIV (89%) and that HIV cannot be transmitted with an ink pen or hairbrush (85%). Conclusion: We concluded that high school students lacked some basic knowledge of risk factors related to blood borne infection transmission. The majority of students were unaware of the importance of not sharing personal care items that are potentially contaminated with blood, how to clean up a blood spill, or handle an active bleeding episode where gloves may not be available. The high school students' awareness and knowledge of HIV transmission was higher than that for HCV. As most respondents thought there were vaccines for HIV and HCV, they may not utilize UHP when needed. UHP need to be a routine part of health education for teenagers. Programs to address issues related to transmission of blood borne infections and possible applications in teenagers' daily lives need to be developed.