National Medical Research Center Research Articles

Installation of percutaneous endoscopic gastrostomy for children. The tactics of a nurse

The article is based on the data and experience of the Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation, obtained during endoscopic practice. Currently, the number of pediatric patients requiring installation of a percutaneous endoscopic gastrostomy is significantly increasing, due to the increase in treatment regimens and the expansion of the range of indications for its installation. PEG combines endoscopic and surgical stages. The nurse must know the difference and differences of each stage, as well as have all the basic and advanced knowledge about all indications, contraindications and any complications during and after surgery. Compliance by the nurse with all the rules of asepsis and antisepsis, knowledge of SANPIN, is the foundation of her professionalism. Interest in the process will undoubtedly influence the quality of medical care provided. The nurse must study and know all the instruments, consumables and additional materials for performing endoscopic surgery. Her clear actions and orientation in what is happening guarantees the speed and success of the manipulation. The purpose of this work will be to emphasize the importance of professional development for nurses. To achieve the goal, we use all facets of a nurse’s work: knowledge of the concept of «sterility», orientation in all stages of manipulation from preparing the room to its complete routine cleaning after the intervention, all theoretical knowledge about the reasons for installing a gastrostomy tube and free orientation in any types of complications, etc. All of the above guarantees that the operating room endoscopic nurse is interested in the process, which will undoubtedly affect the quality and convenience of the doctor’s work, and subsequently the patient’s quality of life. The main goal of the entire operating team is to improve the patient’s quality of life. Understanding the meaning of all surgical endoscopic interventions obliges the nurse to constantly improve their skills and engage in self-education.

Diagnostic aspects of pediatric embryonal tumors of the central nervous system: what should know pediatrician

Background. Early identification of pediatric central nervous system (CNS) tumors is important in relation to disease prognosis, as well as long-term treatment outcomes, which determine subsequent quality of life. The predominance of embryonal tumors (ETs) in early childhood actualizes the problem of timely verification of the diagnosis. Factors contributing to the extension of diagnostic time in the presented patient’s cohort include the inability to adequately verbalize complaints in young children, a wide range of clinical presentations, including nonspecific ones, the relatively low incidence of ET in the population and the low level of oncological alertness among specialists. This determines the need for a more careful assessment of the clinical manifestations and disease-associated symptoms by doctors of all specialties and, especially, primary care specialists. Aim. Analysis of clinical symptoms at the disease’s onset in pediatric CNS ET in order to determine their associations with the tumor’s characteristics (site, hystologic type) and the patient’s features. Materials and methods. A retrospective analysis of data from 124 pediatric patients with CNS ET who received treatment from 2010 to 2023 in the departments of pediatric oncology of the Almazov National Medical Research Center and the St. Petersburg Scientific Research Center for Medical Sciences (o) named after. N. P. Napalkov. The analyzed parameters were the age of manifestation, initial symptoms, duration of the anamnesis and the period before verification of the diagnosis, localization and histological type of tumors. For statistical analysis, Fisher’s exact test, modified Pearson test, Kruskal-Wallis and Mann-Whitney tests, as well as (to assess the duration of anamnesis) the Cox model were used. Results. The most common type of CNS ET in the study group was medulloblastoma (MB; 66.1%). The average age of patients, in general, was 61 months, boys predominated (58%). The median age varied depending on the histological tumor type: the maximum was 72 months in patients with medulloblastoma and the minimum was 9 months in children with atypical teratoid rhabdoid tumor (ATRT). Both medians are significantly different from the total median (29 months) of all other tumors (p = 6.53 ∙ 10-4 and p = 0.029, respectively). The most frequent symptoms in patients with ET were nausea and vomiting (68%), headache (50%), and gait disturbances (25.6%). Increased head circumference/bulging fontanel (p = 0.0016) and torticollis (p = 0.0057) were the most common symptoms associated with younger age. Headache (p = 1.30 ∙ 10-9), nausea and vomiting (p = 0.019), diplopia (p = 0.0057), weight loss (p = 0.017) and dizziness (p = 0.013) were associated with older age. Headache was predominated symptom in medulloblastoma (p = 2.60 ∙ 10-4) compared to other ETs, and less common in ATRT (p = 1.51 ∙ 10-4), which may be due to the patient’s age. Fontanel bulging in medulloblastoma, unlike other ET, was not observed, which is also associated with age. Seizures were observed in all cases of CNS neuroblastoma - significantly more often (p = 0.034) than in other ETs. The most common tumor location was the posterior cranial fossa (PCF) (83.6%). PCF localization was associated with headache (p = 0.05, borderline significance) and nausea/vomiting (p = 0.040). Parietal localization was associated with seizures (p = 0.041). Four patients in the cohort had asymptomatic disease’s manifestations. The diagnosis was established by a routine screening examination. The absence of symptoms was associated with location outside the PCF (p = 0.011) and with younger age (p = 0.053, borderline significance). The diagnosis was established in a significantly shorter time if children had symptoms such as nausea and vomiting (p=0.0017), paresis and paralysis (p=0.0059). Conclusion. In patients with CNS ETs, statistically significant relationships are revealed between age, histological type, tumor site and certain symptoms. Nevertheless, the absence of strictly specific clinical manifestation determines the indications for a careful assessment of the pediatric somatic and neurological status and timely neuroimaging in children when even potential symptoms typical for CNS tumors are identified.

Proposals for medical guidelines creation at the time of digital transformation of healthcare in Russian Federation

The article presents the experience of the «National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov» in creation of medical guidelines based on the patient’s route business process for vertically integrated medical information system for “Obstetrics and gynecology” and “Neonatology” (VIMIS “AKiNEO”), with simultaneous digitization of the document, describes the advantages of this an approach before the classical form of writing document.Aim. To conduct a comparative analysis of approaches to writing a medical guideline based on a digitized medical guideline and patient’s route business process for VIMIS “AKiNEO” and in the classical way.Materials and methods. The content of digitized medical guidelines and procedures for the provision of medical care, formed by experts on the basis of the “National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov” with the methodological support of the Center for Healthcare Quality Assessment and Control were used. The assessment of the methodological advantages of writing medical guidelines based on patient routes business processes in comparison with writing in the classical way was carried out using methods of analysis and synthesis.Results. Experts have created 17 patient routes using the content of digitized medical guidelines for immersion in the VIMIS “AKiNEO”. These routes fully reflect the amount and timing of medical interventions necessary to ensure the quality of medical care. Methodological approaches for writing medical guidelines based patient routes business processes have been developed. It has been demonstrated that digitizing the content of medical guidelines and medical care procedures, describing medical guidelines in the form of a business process diagram, identify “zones of uncertainty” that ar e not visible in the text document, and can significantly affec t the quality of medical care to the patient.Conclusion. The creation of regulatory legal acts on the organization and provision of medical care and medical guidelines in modern conditions of healthcare digital transformation should take place after digitizing the text of the document and creating a business process for the patient’s route, which will improve the quality of these documents.

Social Frustration Level Questionnaire: Substantiation, Design, and Probation

The current preventive trends in clinical examination draw attention to the role of the external factors and stressful circumstances in psychodiagnostic research. Social frustration is an incapacity to fulfill relevant social needs because of a current situation. This term makes it possible to qualify criteria for the potential stress related to social functioning among family members, colleagues, and peers. The authors rationalized and tested a formalized questionnaire of Social Frustration Level developed at Bekhterev National Medical Research Centre for Psychiatry and Neurology in 2004 for patients with social adjustment disorders. The experiment justified the criterion validity of the Social Frustration Level Questionnaire. The article describes the structure of social frustration regarding the key spheres of activity attributed to internal and external frustration. The pilot study involved 45 patients with adjustment disorders, who showed significant frustration related to health problems and socio-economic status accompanied with relative satisfaction with interpersonal relations, i.e., family, friends, colleagues, and strangers. The research relied on the method of clinical psychological interview, as well as the Questionnaire of Social Frustration Level and the Integrative Anxiety Test. Personal anxiety and actual anxiety experiences proved to correlate with social frustration. The internal social frustration prevailed over the external one. The Questionnaire of Social Frustration Level proved to be an efficient practical tool to be used in systematic medical psychodiagnostics research, programs of disorder prevention, and psychotherapy.

Relapses of congenital mesoblastic nephroma: description of three clinical cases and literature review

Congenital mesoblastic nephroma (CMN) is a rare renal tumor of young children with intermediate biological behavior, accounting for 3.5-4% of all renal tumors in children. СMN is characterized by a favorable prognosis in case of radical surgical treatment. Relapses of CMN are considered to be quite a rare occurrence (4% of all cases), however, both local and metastatic relapses are possible. There are no fully standardized treatment approaches for patients with relapsed CMN. In our study, we performed a retrospective analysis of patients (n = 3) with a verified relapse of CMN who had received treatment at the D. Rogachev NMRCPHOI between 2012 to 2022 (132 months). At relapse, all the patients underwent at least one part of treatment at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. The diagnosis of CMN was established at the Pathology Department of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation, based on a histological examination. The patients with the cellular histological subtype of CMN underwent fluorescent in situ hybridization testing for ETV6 gene rearrangements. The demographic characteristics, clinical data, the extent of initial treatment and relapse therapy were assessed. Here, we describe three clinical cases of relapse in patients with CMN. The median age at initial diagnosis was 0.8 months (range 0.7–1.4). Our analysis of the extent of primary surgical treatment, including nephrectomy, in all cases revealed the following factors associated with a higher risk of relapse: preoperative tumor rupture – 1, intraoperative tumor rupture – 1, inability to confirm tumor-free margins – 1. The distribution of histological subtypes was as following: classical CMN (n = 1), cellular CMN (n = 1), and mixed CMN (n = 1). One patient had local stage II and 2 patients had local stage III. The median time from diagnosis to disease relapse was 0.8 months (range 2.3–4.3). One patient with mixed CMN died 10.6 months after diagnosis from complications of intensive therapy carried out for extremely aggressive relapse. Two patients are alive after repeated surgical treatment (R1 resection) and adjuvant therapy with actinomycin D and vincristine (AV regimen) for 27 weeks in one case, and neoadjuvant therapy (AV regimen for 4 weeks), delayed surgery (R0 resection), and adjuvant therapy (AV regimen for 4 weeks) in the other case. These patients were followed up for 92.2 and 21.3 months, respectively. By acknowledging the possibility of recurrent CMN, it seems important to provide multidisciplinary clinical care to young children with renal tumors involving a detailed planning of surgical procedures, radical surgeries in accordance with practice guidelines and standards in surgical oncology, and careful follow-up, especially during the first year after surgery. The patients' parents gave consent to the use of their children's data, including photographs, for research purposes and in publications.

Creation and Preclinical Testing of a Spirometer with Extended Functionality

RELEVANCE. We present the results of preclinical testing of an upgraded portable AR­1 gas flow analyzer produced by JSC Krasnogvardeets (Saint Petersburg) in order to create import-substituting technologies and develop practical and scientific spheres of healthcare.THE AIM OF THE STUDY. was to substantiate the possibility of clinical use of the upgraded device, originally intended for testing ventilators and inhalation anesthesia devices, as a monitor of the external respiration apparatus function.MATERIAL AND METHODS. The preclinical study of the upgraded gas flow analyzer was conducted at the V.A. Almazov National Medical Research Center in comparison with devices for conventional (Bellavista 950, Berner Ross Medical, Russia) and high-frequency (IPV-2C, Intrapulmonary Percussive Ventilation, Percussionaire Corporation, USA) mechanical ventilation in volume- and pressure-controlled modes using an artificial lung. The following reflected spirometry parameters were compared: tidal and minute volume under inhalation and exhalation, respiratory rate, maximum and minimum flows, peak and positive end expiratory pressure, fraction of inspired oxygen.RESULTS. A high accuracy of parameter matching shown by the gas flow analyzer and ventilators was demonstrated.CONCLUSION. The upgraded model of the gas flow analyzer can be used clinically as a portable spirometer at the prehospital and hospital stages.

Modified infra-promontorium trans-channel approach to the petrous apex. Case report

This article describes the approach to the petrous pyramid developed at National Medical Research Center of Otorhinolaryngology, namely an endoscopy – microscopy-guided modified trans-channel infra-promontorium approach with internal carotid artery retraction maneuver in patients with lesions of the petrous pyramid but with preserved hearing. A clinical report describing the apical cholesteatoma of the petrous pyramid and the use of this approach are presented. Anatomical and functional features after the surgery are also described. The purpose of this paper is advancing of the surgical approach to the petrous pyramid with the possibility of hearing preservation. The results of surgical treatment in lesions of the petrous pyramid were evaluated in the immediate and distant periods. The functions of facial mimic muscles were evaluated immediately after the surgery, in 6 months, and in one year. The functions of facial mimic muscles remained at the baseline level during the whole follow-up period. The pure tone audiogram demonstrated the preserved hearing function in the postoperative period. Complete elimination of the pathological process was achieved in all cases (n=15); according to the MRI of the temporal bones, no relapses occurred in a year. The surgical approach proposed for patients with the lesions of the petrous pyramid enables complete removal of the pathological process from the petrous pyramid with the preservation of hearing and facial functions, based on the subjective examinations (audiometry, facial function diagnosis) and radiology (CT and MRI of temporal bones) at the preoperative stage.

L5–S1 Spondylolisthesis: What Has Changed in 20 Years? A Review of Key Issues in Comparison with Personal Experience

The very first issue of the Russian Journal of Spine Surgery (2004;(1):39–46) published an article entitled “Surgical Treatment for L5 Spondylolisthesis with Transpedicular Fixators”. Twenty years later, the authors analyzed changes in approaches to surgical treatment of spondylolisthesis, taking into account the experience in surgical treatment of this pathology gained at the N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics. The issues of classification, fixation methods, reduction, changes in sagittal balance, the possibility of using additive technologies and possible complications of surgical treatment are considered.In conclusion, it is noted that the development of surgical treatment methods, the study of biomechanical features, the introduction of additive technologies and much more enable improving the outcomes of spondylolisthesis treatment.

Patient selection for left ventricular assist device implantation. The main problems

To analyze the experience of Chazov National Medical Research Center of Cardiology in patient selection for left ventricular assist device (LVAD) implantation. 901 patients, whose documents were sent to Chazov National Medical Research Center of Cardiology from regional medical and prophylactic institutions, were screened as selection for LVAD implantation. Firstly, all patients underwent transthoracic echocardiography performed according to the extended protocol with a comprehensive assessment of the left and right ventricle size and function. Patients who underwent the screening procedure underwent further examination including both laboratory and instrumental diagnostic methods. In addition, the polyclinic database of patients diagnosed with chronic heart failure (CHF) and dilated cardiomyopathy was also analyzed. Among 901 screened patients 7.9% were suitable candidates for LVAD implantation and only 23 (2.6%) patients underwent surgery. Among those not eligible for surgery: 208 (29%) patients were not on optimal medical therapy, 15% of patients had indications for other surgical treatment of CHF, 12% of patients had severe right ventricular failure, 9.8% had severe comorbidities, 6.8% of patients refused surgery. The main problems of selection for LVAD implantation were: low awareness of doctors about the introduction of new treatment methods, poor quality of transthoracic echocardiography, a large percentage of patients not receiving basic therapy for CHF, untimely referral of patients for other types of surgical treatment.

Germline Variants Of The MMR/EPCAM Genes In Russian Patients With Lynch Syndrome

Objective — Lynch syndrome is the most common hereditary cancer syndrome caused by pathogenic variants in the MMR/EPCAM genes. Our goal was to study the germline variants of these genes in the largest sample of patients with Lynch syndrome in Russia. Methods — The study included data on pathogenic and likely pathogenic variants in the MMR/EPCAM genes collected from the local Registry of Hereditary Colorectal Cancer of Ryzhikh National Medical Research Centre for Coloproctology (RNMRCC). We analyzed all available data on 141 probands with Lynch syndrome: 78 men and 63 women aged 21 to 80 years treated at RNMRCC from 2012 through 2023. Results — The numbers of pathogenic and likely pathogenic variants detected in the key genes were as follows MLH1 (69 probands), MSH2 (57), MSH6 (10), EPCAM (3), PMS2 (1), and PMS1 (1). Of the 141 germline variants, 17 (12.1%) were detected for the first time: MLH1 (8 probands) MSH2 (8), and MSH6 (1). Thirteen (9.2%) of the detected variants were associated with large deletions/duplications. The most frequent pathogenic variants in the MLH1 gene were c.1852_1854del (9 probands), c.350C>T (4), and c.1459C>T (3). The most frequent pathogenic variants in the MSH2 gene were c.942+3A>T (9 probands) and c.1288A>T (3). Conclusion — Our results allowed establishing the frequency and spectrum of different types of germline variants in the MMR/EPCAM genes, which helped optimize the algorithm for selecting and diagnosing Russian patients with Lynch syndrome.

Biallelic Loss of 7q34 (TRB) and 9p21.3 (CDKN2A/2B) in Adult Ph-Negative Acute T-Lymphoblastic Leukemia

Tumor cells of acute lymphoblastic leukemia (ALL) may have various genetic abnormalities. Some of them lead to a complete loss of certain genes. Our aim was to reveal biallelic deletions of genes in Ph–negative T-ALL. Chromosomal microarray analysis (CMA) was performed for 47 patients with de novo Ph–negative T-ALL, who received treatment according to RALL-2016m clinical protocol at the National Medical Research Center for Hematology (Moscow, Russia) from 2017 to 2023. Out of forty-seven patients, only three had normal molecular karyotype. The other 44 patients had multiple gains, losses, and copy neutral losses of heterozygosity. Biallelic losses were found in 14 patients (30%). In ten patients (21%), a biallelic deletion of 9p21.3 involved a different number of genes, however CDKN2A gene loss was noted in all ten cases. For seven patients (15%), a biallelic deletion of 7q34 was found, including two genes—PRSS1, PRSS2 located within the T-cell receptor beta (TRB) locus. A clonal rearrangement of the TRB gene was revealed in 6 out of 7 cases with 7q34 biallelic loss. Both biallelic deletions can be considered favorable prognostic factors, with an association with 9p21 being statistically significant (p = 0.01) and a trend for 7q34 (p = 0.12) being observed.

Assessment of the economic benefit of smoking cessation in cancer patients

Introduction. In 2021, the results of the first large-scale prospective cohort study were published showing the negative impact of post-diagnosis smoking on the prognosis of non-small cell lung cancer (I-IIIа). The purpose of the study is to assess the possible benefits of postdiagnosis smoking cessation of patients with non-small cell lung cancer (NSLC) stage I–IIIa to both the health care system society as a whole. Materials and methods. A mathematical model (calculator) has been developed to calculate the economic benefits of smoking cessation among patients with a confirmed diagnosis of NSCLC (I–IIIa). The calculator uses indicators characterizing the postdiagnosis smoking status of patients with stage I–IIIa NSCLC, the probability of disease progression and survival in the groups of those who continue to smoke and those who quit smoking. These data were obtained from the prospective epidemiologic study performed in the department of clinical epidemiology, N. N. Blokhin NMRC of oncology in cooperation with the IARC. The calculator takes into account the average cost of treating patients with late-stage NSCLC (IIIb-IV stage) in 2020–2022, which is calculated based on an analysis of the medical records of patients who were treated in the Department of Medical Cancer Therapy No. 3 of the of the Federal State Budgetary Institution «N. N. Blokhin National Medical Research Center of Oncology» (Head K. K. Laktionov), statistical data on incidence and mortality from NSCLC in Russia, the Gross Domestic Product (GDP) per capita indicator, and the MINEC Forecast of socio-economic development of the Russian Federation for 2023, 2024 and 2025. Results. Stopping smoking after diagnosis of NSCLC stage I–IIIa results in cost savings due to a reduced likelihood of relapses and an increased number of patients who avoid relapses when quitting smoking. Taking into account the fact that the average cost of treatment for patients with stage IIIb–IV NSCLC is 4,000,000 rubles, savings on treatment due to a decrease in the likelihood of relapses and as a result of an increase in the number of relapse-free patients who quit smoking amounted to 3,321 million rubles. and 9,251 million rubles, respectively, per year. Thus, the total cost savings on treatment will amount to 12,588 million rubles or slightly more than 2.3 million rubles per patient who quit smoking. The second source of saving is maintaining the economically active potential of some patients diagnosed with stage I–IIIa NSCLC, due to increased progression free survival as a result of smoking cessation аmounts to 3 304 million rubles per year in terms of per capita GDP. If 100 % of patients with stage I–IIIa NLCLC hypothetically quit smoking, the potential budget savings could reach a significantly greater value of 29,480 million rubles per year. The economic benefit to society in the total metric of per capita GDP, obtained as a result of increased survival and possible preservation of labor activity, could exceed 14 billion rubles over a 5-year period. Conclusion. Smoking cessation in cancer patients is accompanied not only by clinical benefits, i. e. it reduces mortality and improves survival rates, but also by economic benefits for the healthcare system and the country as a whole.

Xq12q13.2 duplication detected in a child in selective exome screening

Background. Within the framework of the regional pilot project on selective exome screening of newborn children, which is carried out on the basis of the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, we conducted molecular genetic testing of children who meet the criteria for inclusion in the increased group of hereditary diseases. We examine not only children with suspected genetic etiology of the condition, but also children with borderline clinical and laboratory manifestations and minor developmental anomalies.The aim of the study. To describe the clinical and phenotypic features of a patient with a previously undescribed Xq12q13.2 duplication detected in the neonatal period.Materials and methods. The child was examined within the framework of a regional pilot project on selective exome screening of newborn children. DNA was isolated from a biological sample of venous blood of the newborn, and whole exome sequencing and chromosomal microarray analysis were performed. Signed informed voluntary consent for the publication of the examination data and a photograph of the child were obtained from the legal representatives of the proband.Results. Data in favor of the presence of a previously undescribed Xq12q13.2 duplication, confirmed by the reference method were obtained in a patient included in the project in accordance with the clinical criteria for the formation of a risk group according to the data of the conducted whole exome sequencing. Discussion. Xq12q13.2 duplication was detected in the proband from the present clinical observation with non-specific clinical manifestations in the neonatal period. Similar duplications have been described in the literature in three patients with congenital malformations, epilepsy and psychomotor retardation. Early diagnosis of such a copy number variation disorder before the appearance of severe clinical signs of the disease will allow determining the prognosis and tactics of observation and treatment of the patient.Conclusion. The described case of Xq12q13.2 duplication in a patient demonstrates the importance of timely genetic analysis to optimize medical genetic counseling, reduce diagnostic search and improve prognosis for patients.

Association between sialic acid, sialidase activity and cholesterol of lipid-containing circulating immune complexes in the blood serum of patients with atherosclerosis

Atherosclerosis is the most common chronic non-infectious diseases, in the pathogenesis of which the accumulation of lipids in the subendothelial layer of the arteries and the local inflammatory reaction play a significant role. The source of lipid accumulation in the vascular wall is modified low-density lipoproteins. Desialylation is one of the known modifications that leads to the emergence of atherogenic properties in low-density lipoproteins. Enzymes that have sialidase activity circulate in human blood, i.e., the ability to cleave sialic acid from low-density lipoproteins. Desialylated low-density lipoproteins are autoantigens and induce the production of IgG autoantibodies, which form immune complexes with low-density lipoproteins, which aggravates the course of atherosclerosis. The purpose of the study was to establish associations between the levels of sialic acid in low-density lipoproteins, sialidase activity and the cholesterol content of lipid-containing circulating immune complexes in the blood serum of patients with atherosclerosis. Blood sera from patients with coronary heart disease were used as biological material to determine indicators of sialidase activity, cholesterol content of lipid-containing circulating immune complexes and sialic acid in low-density lipoproteins, which were isolated from blood serum. Serum samples were obtained from the laboratory of clinical biochemistry of the Institute of Clinical Cardiology, A.L. Myasnikov Federal State Budgetary Institution National Medical Research Center of Cardiology named after Academician E.I. Chazov as unutilized residues after performing routine biochemical tests. Fifty-one samples of blood serum and low-density lipoproteins isolated from it were analyzed. A significant positive relationship was revealed between the cholesterol content of circulating immune complexes and sialidase activity in the blood serum (r = 0.305 at p = 0.029). At the same time, no correlation was found between the content of sialic acid in low-density lipoproteins and sialidase activity in the blood serum, as well as between the cholesterol content of circulating immune complexes in the blood serum and sialic acid in low-density lipoproteins. It should be assumed that increased sialidase activity in the blood serum leads to the formation of desialylated immunogenic low-density lipoproteins with the subsequent appearance of autoantibodies and the formation of lipid-containing circulating immune complexes.

Report on the first All-Russian Student Olympiad on Endoscopy

Purpose: To demonstrate the results of the first All-Russian Student Olympiad on Endoscopy. Materials and methods: The team of authors prepared and conducted the first All-Russian Student Olympiad on Endoscopy within the framework of the conference «Topical Issues of Endoscopy». The Olympiad was held in two stages, which allowed evaluating the theoretical knowledge and practical skills of the participants. The topic of the first All-Russian Student Olympiad was upper GI tract endoscopy. The first stage consisted of testing and a quiz. The test was devoted to general issues of endoscopy, and the quiz was devoted to bleeding from the upper GI tract and methods of endoscopic hemostasis. The second stage consisted of a practical part and answers to the judges’ questions. The practical part involved performance of video endoscopy on a biopreparation (porcine esophagus and stomach), identification of a conditional ulcer complicated by bleeding and performance of endoscopic hemostasis by clipping. When performing the task, the team spoke through all their actions. After the manipulation, each team answered 2 questions from the judges. Results: The results of the All-Russian Student Olympiad revealed three winners. 1st place: the team of the N. I. Pirogov Russian National Research Medical University (A. A. Klimenko, 3rd year student; K. A. Kuznetsova, 5th year student; A. I. Khizhnyak, 5th year student); 2nd place: the team of the St. Petersburg State Pediatric Medical University (D. K. Skalinsky, 3rd year student; A. D. Komarova, 3rd year student; I. A. Cherepakhina, 5th year student); 3rd place: the team of the V. A. Almazov National Medical Research Center FSBI of the Ministry of Health of Russia (A. D. Shelimanova, 4th year student; Yu. M. Bogdanov, 5th year student; M. V. Chukin, 4th year student). Conclusion: The event enabled the students to show curiosity, determine the attitude to the future profession, demonstrate their knowledge and manual skills in the field of endoscopy, as well as gain experience in teamwork. Evaluating the work of the novice endoscopists, the leading specialists in the field of surgery and endoscopy identify promising students, which has a positive impact on attracting young promising specialists to the profession.

Factors affecting the effectiveness of conservative treatment of locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses

Background. Currently, the main method of treatment of locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses is surgical treatment with subsequent radiation/chemoradiation therapy. However, the survival rate of patients has not changed significantly in the last 20 years. Head and neck squamous cell carcinoma is highly sensitive to chemotherapy and radiation which allows to perform treatment even in cases of locally advanced squamous cell carcinomas of the nasal cavity and paranasal sinuses. However, the question of prognostic factors of the effect of chemoradiation therapy remains open. Therefore, determination of these factors is an important problem. Aim. To evaluate the effectiveness of conservative treatment of locally advanced squamous cell carcinoma of the nasal cavity and paranasalsinuses. Materials and methods. The retrospective analysis included 55 patients with squamous cell carcinoma of the nasal cavity and paranasal sinuses (stages III–IVA) who were under observation and receiving treatment at the N.N. Blokhin National Medical Research Center of Oncology between 2000 and 2020. In 50 (90.9 %) patients, treatment began with induction chemotherapy with subsequent radiation therapy per the radical program. In this patient group, treatment effectiveness was evaluated per the RECIST 1.1 (Response Evaluation Criteria In Solid Tumors) criteria. Results. Five-year overall and progression free survival rates were 49.5 and 22.5 %, respectively. Objective response rate after treatment was achieved in 65.5 % of cases: complete response was observed in 38.2 % of cases (n = 21); partial response in 27.3 % (n = 15); stable disease in 18.2 % of cases (n = 10); disease progression in 16.4 % (n = 9). Conclusion. According to the results of the study, conservative treatment is a promising approach in locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses. Patients with complete response to treatment have the highest odds of cure and improved long-term outcomes.

Diagnostic errors in suspicion for lung tumor

Using clinical cases of patients observed at the Endoscopic Division of the N. N. Blokhin National Medical Research Center of Oncology, we want do demonstrate that while diagnostic radiology has achieved high quality, videoendoscopic examination remains the most objective and usually definitive method in evaluation of contentious situations of differential diagnosis even in cases of seemingly obvious clinical and radiological picture.

Methodological characteristics of the academic competition for general practitioners, family doctors and internists as a type of informal education

The article analyzes the results of the All-Russian competition for general practitioners, family doctors and internists held over five years by the National Medical Research Center for Therapy and Preventive Medicine with the support of the Russian Society for the Prevention of Non communicable Diseases.Aim. To determine the methodological characteristics of managing the academic competition as a type of informal education.Material and methods. To conduct the competition, practice-oriented tasks corresponding to professional tasks of a general practitioner were developed. In addition, we developed an original questionnaire to assess the impact of participation in the academic competition on the professional development. Family doctors and general practitioners with 1-10 years of experience, as well as internists, were included.Results. The methodological characteristics of the academic competition management as a type of informal education were determined: practice-oriented goals aimed at improving the knowledge, skills and abilities, competencies of the participants; the content of tasks based on the theory-practice relationship; compliance of tasks and real situations in the practice of a general practitioner; a systematic approach to competition management. Conclusion. The effectiveness of the academic competition as a type of informal education contributes to the professional development of participants, promotes the development of long-term attitudes towards improving professional knowledge, skills, abilities and competencies necessary for solving professional problems.

Experience of use of intraoperative computed tomography and navigation systems in minimally invasive surgery for lumbosacral spondylolisthesis

This article discusses the minimally invasive surgical technique for lumbosacral spondylolisthesis. The use of intraoperative computed tomography (iCT) and a navigation system significantly enhances the accuracy of screw placement and reduces the extent of soft tissue damage. From March 2018 to February 2024, 246 patients with lumbosacral spondylolisthesis underwent minimally invasive surgery with the use of iCT and navigation systems at the N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation. Of the above-mentioned cases, spondylolisthesis was most commonly observed at the L4-L5 (126 cases) and L5-S1 (98 cases) levels. This article presents two clinical cases from this series demonstrating successful use of these technologies.

The content of soluble forms of galectins -1, -3, -4, -7, -9 in patients with renal cell cancer of various morphological types

Background: Galectins are a family of β-galactoside binding proteins that regulate the vast majority of cellular functions, including proliferation, migration, adhesion, and phagocytosis in both health and disease. More and more experimental and clinical evidence indicates that galectins are involved in many stages of carcinogenesis, including patients with renal cell carcinoma (RCC). Aim: To analyze the clinical significance of soluble forms of galectins -1, -3, -4, -7, -9 in patients with various histological RCC types. Materials and methods: We performed a retrospective analysis of the clinical significance of galectins -1, -3, -4, -7, -9 in the serum of 140 RCC patients (84 with clear cell RCC (ccRCC), 38 with papillary (papRCC), 18 with chromophobe (chrRCC)) and in 73 healthy donors (control group), who were examined and treated from 2019 to 2023 in the N. N. Blokhin National Medical Research Center of Oncology. Galectin levels were measured in serum (obtained according to standard methods before the initiation of specific treatment) with an enzyme-linked immunosorbent assay. Results: There was a significant increase in serum galectin -1, -3, -9 levels in the whole RCC patient group, compared to the healthy donor control group; no increase was found for galectins -4 and -7. Serum galectin-1 levels in the ccRCC and papRCC patients were significantly higher than those in the controls (p = 0.0003 and p = 0.0135, respectively). No association between the serum galectins -1 and -7 and the clinical and morphological characteristics of RCC was found; however, serum galectin-7 levels in the papRCC patients correlated with the grade of tumor differentiation (r = -0.592; p = 0.001). The area under the ROC curve (AUC) for galectin-1 in ccRCC was 0.721 (p 0.0001), in papRCC 0.673 (p = 0.0086), and in chrRCC 0.576 (p = 0.355). For galectin-7, the ROC AUC values were 0.527 (p = 0.634) in ccRCC, 0.513 (p = 0.845) in papRCC, and 0.566 (p = 0.425) in chrRCC. In all histological types of RCC, there was a significant increase in serum galectin-3 compared to the controls (ccRCC, p = 0.0208; papRCC, p = 0.0014; chrRCC, p = 0.0041). The ROC analysis for galectin-3 in patients with RCC of various histological types showed AUC = 0.721 (p 0.0001) for ccRCC, 0.673 (p = 0.0086) for papRCC, and 0.576 (p = 0.355) for chrRCC. Galectin-9 levels was directly and significantly associated with the tumor size, as well as with regional metastases (r = 0.251, p = 0.021; r = 0.239, p = 0.028, respectively). The AUC values for galectin-4 were 0.619 (p = 0.021) in ccRCC, 0.577 (p = 0.214) in papRCC, and 0.534 (p = 0.666) for chrRCC. For galectin-9, they were 0.649 (p = 0.0075), 0.613 (p = 0.087), and 0.539 (p = 0.637), respectively. Conclusion: The study has demonstrated a certain association between serum galectin -1, -3, -4, -7, and -9 in the patients with RCC of various histological types. Although the results of the ROC analysis indicated average quality of the model, which does not allow for the use of the obtained data for diagnostic purposes, it is necessary to continue the research for better understanding of the mechanisms of galectin functioning, before galectin-based therapeutic agents would be introduced into clinical practice for the treatment of RCC.