Right-sided Localization Research Articles

Математичне моделювання частоти патології вагінального відростка очеревини в дитячій популяції залежно від віку та статі

The pathology of the processus vaginalis of the peritoneum (inguinal hernia, hydrocele testis) is quite widespread among the pediatric population, both in our country and throughout the whole world. More than 99% of inguinal hernias in children are oblique, right-sided localization is more than 3 times more common than left-sided. High interest of scientists in the study of the pathology of the processus vaginalis of the peritoneum is caused by data on the appearance of infertility as a complication of inguinal hernias and dropsy of the testicles. In the structure of the causes of this situation, 30% belongs to the male factor, and this percentage has a constant tendency to increase. This became the reason for an additional study of the mathematical component of the prevalence of the pathology of the processus vaginalis of the peritoneum among the children’s population. Purpose - to create a mathematical model of the prevalence of pathology of the processus vaginalis of the peritoneum depending on age and gender among the children’s population. Materials and methods. 205 patients under the age of 18 who underwent surgical correction of the pathology of non-obliterated processus vaginalis of the peritoneum (inguinal hernia, hydrocele testis) took part in the conducted scientific study. For mathematical modeling, software built into Microsoft Excel was used (Trend line, polynomial regression equation of the 4th degree). Results. In the course of mathematical modeling, characteristic features were identified: they occur both in the female part of the pediatric population and in the male, similar fluctuations are noted in the general pediatric population, namely periods of increase in the frequency of pathology of the vaginal peritoneum, which alternate with periods of its decline. a rapid increase in the frequency of pathology of the vaginal peritoneum, and, accordingly, their surgical correction, in children under 3-4 years of age, followed by a decrease in frequency by the age of 11-13 years. The following slight increase in the frequency of diagnosis of pathology of the vaginal peritoneum and its surgical treatment was detected by the age of 15-16 years, followed by a gradual decrease in the frequency by the age of 18 years Conclusions. Therefore, there are two mathematically confirmed peaks of growth in the frequency of detection of the pathology of the processus vaginalis of the peritoneum, which fall on the age of verticalization of the child and the age of “specialized” loads. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

ДИАГНОСТИЧЕСКИЕ И ТАКТИЧЕСКИЕ ОШИБКИ ПРИ ВЕДЕНИИ БОЛЬНЫХ С ФЕОХРОМОЦИТОМОЙ

Objective: To analyze the causes of diagnostic and tactical errors in the management of patients with pheochromocytoma (PCC) and to develop a respective treatment and diagnostic algorithm. Methods: The mistakes made during clinical and instrumental diagnostics, preoperative preparation, and treatment of 55 patients with PCC were analyzed. Among the patients, there were 38 women (69.1%), and 17 men (30.9%). The mean age of the patients was 35.9±6.2 years. In 23 (41.8%) patients, right-sided localization of the tumor was noted, in 29 (52.7%) – left-sided one, while bilateral adrenal lesion occurred in 3 (5.5%) patients. The duration of arterial hypertension (AH) ranged from 6 months to 10 years (mean 4.56±1.7 years). Results: In 52.7% of cases, patients visited a doctor after more than three years from the onset of the first symptoms of the disease. The reasons for late treatment were: an insufficient examination of patients for the symptomatic genesis of hypertension due to low awareness of primary care physicians, self-administration of antihypertensive drugs, and treatment of patients by traditional healers. Errors in the interpretation of the results of ultrasound examination and computed tomography (CT) were noted in 7.3% of cases. During preoperative preparation, tactical errors were made in 7 patients, when instead of α-blockers, antihypertensive drugs of another class were prescribed, as a result of which two of the patients developed the syndrome of "uncontrolled hemodynamics" and died. In 5.5% of cases with large size of the tumor, iatrogenic injury to the inferior vena cava (IVC) and vessels of the right kidney occurred during the operation. In a histological examination of removed pheochromocytomas, the misinterpretation rate was 3.6%, and the diagnosis was reconsidered during repeated assessment. Conclusion: In more than half of the cases, during the primary diagnosis and treatment of PCC, various errors were made due to non-targeted examination of patients, incorrect interpretation of the results of radiological methods of examination, inadequate preoperative preparation of patients, as well as the iatrogenic injuries. In order to timely identify the discussed pathology in patients with AH, it is necessary to examine them in a targeted way for PCC. The basic medications for preoperative preparation of patients should be selective α-adrenoblockers. In order to prevent iatrogenic injuries of large vessels and organs of the retroperitoneal space, a thorough preoperative study of their relations with the tumor is necessary, as well as an improvement of the practical skills of the operating doctors. Keywords: Pheochromocytoma, diagnosis, errors, adrenalectomy, iatrogeny.

Loss of SATB2 expression correlates with cytokeratin 7 and PD-L1 tumor cell positivity and aggressiveness in colorectal cancer

Colorectal carcinoma (CRC) is a disease that causes significant morbidity and mortality worldwide. To improve treatment, new biomarkers are needed to allow better patient risk stratification in terms of prognosis. This study aimed to clarify the prognostic significance of colonic-specific transcription factor special AT-rich sequence-binding protein 2 (SATB2), cytoskeletal protein cytokeratin 7 (CK7), and immune checkpoint molecule programmed death-ligand 1 (PD-L1). We analyzed a cohort of 285 patients with surgically treated CRC for quantitative associations among the three markers and five traditional prognostic indicators (i.e., tumor stage, histological grade, variant morphology, laterality, and mismatch-repair/MMR status). The results showed that loss of SATB2 expression had significant negative prognostic implications relative to overall survival (OS) and cancer-specific survival (CSS), significantly shortened 5 years OS and CSS and 10 years CSS in patients with CRC expressing CK7, and borderline insignificantly shortened OS in patients with PD-L1 + CRC. PD-L1 showed a significant negative impact in cases with strong expression (membranous staining in 50–100% of tumor cells). Loss of SATB2 was associated with CK7 expression, advanced tumor stage, mucinous or signet ring cell morphology, high grade, right-sided localization but was borderline insignificant relative to PD-L1 expression. CK7 expression was associated with high grade and SATB2 loss. Additionally, a separate analysis of 248 neoadjuvant therapy-naïve cases was performed with mostly similar results. The loss of SATB2 and CK7 expression were significant negative predictors in the multivariate analysis adjusted for associated parameters and patient age. In summary, loss of SATB2 expression and gain of CK7 and strong PD-L1 expression characterize an aggressive phenotype of CRC.

D2, D3 LYMPH NODE DISSECTION IMPORTANCE IN COLON CANCER SURGERY

Colorectal cancer (CRC) is a relevant issue of modern oncology and ranks the third place among most common malignancies. Every year, more than 1 million new cases of CRC are diagnosed worldwide, with approximately the same frequency of prevalence among the male and female population. Colon cancer (CC) amounts for more than half of all cases of CRC, and it’s incidence and mortality remain rather high. Surgery remains the main method of CRC treatment, and determining the extent of surgery and lymph node dissection remains an urgent problem. For the first time in Japan, a classification of groups of lymph nodes (l.n.) was proposed depending on the level of lymph outflow and location in relation to the main vessels. According to the numbering of l.n. groups by the Japanese Society for Cancer of the Colon and Rectum (JSCCR), all lymph nodes are numbered with three digits. As a rule, lymphogenic metastasis occurs in one direction, bilateral spread is possible if the tumor is located at the same distance from two feeding vessels. With tumors of the right-sided localization, all groups of l.n. located along the branches of the superior mesenteric artery are removed, and with tumors of the left half of the colon, all l.n. located along the trunk of the inferior mesenteric artery are removed. The presence of affected l.n. is important for assessing the prognosis and further determining the need for adjuvant therapy. Some literature data demonstrate good results of surgical interventions performed in accordance with the concept of embryonic planes and complete mesocolonic excision. D3 lymph node dissection is not performed in daily practice in some European countries and North America, unlike a number of Eastern countries. However, the level of vessel ligation remains the subject of scientific discussion. The purpose of this review was to analyze the available literature on the problem of choosing the level of lymph node dissection in CC surgery.

Хірургічне лікування секвестрації легень у дітей

Pulmonary sequestration is a complex malformation of the lungs, which is based on a violation of the development of their bronchopulmonary and vascular components. The multifactorial nature of morphological and functional disorders is clinically manifested by respiratory distress syndrome and heart failure with a threat of a critical outcome for a newborn child, despite the sufficient development of the respiratory system as a whole. Purpose - optimization of diagnosis and treatment of lung sequestration in children based on the study of clinical and diagnostic data, as well as the results of surgical treatment. Materials and methods. The study included 18 patients aged from 8 days to 18 years, including newborns - 6, children from 1 to 12 months - 5, from 1 to 3 years - 3, from 7 to 9 years - 2 and from 15 to 18 years - 2. Median age was 4.5 months. Research methods included evaluation of clinical symptoms, chest X-ray, contrast-enhanced CT, and angiography. Prenatal diagnosis was carried out using ultrasonography and fetal MRI. In all cases, open surgical treatment was used. Results. Intrapulmonary sequestration was diagnosed in 13 (72.2%) patients, extrapulmonary - in 5 (27.8%), p=0.082. Left-sided localization in 11 (61.1%) patients, right-sided localization in 7 (38.9%) patients, р=0.3. Associated malformations had 9 (50%) patients: polycystic (n=4) or hypoplasia (n=2) of the lung, diaphragmatic hernia (n=3), pericardial defect (n=1), thoracic dystopia of the kidney (n=2), Waardenburg syndrome (n=1), ventricular septal defect (n=1), innominate artery tracheal compression (n=1). Symptomatic course was noted in 15 (83.3%) patients, asymptomatic - in 3 (16.7%) cases (p=0.021). Main symptoms were as follows: pulmonary bleeding, hemophthisis, respiratory and hemodynamic disorders, signs of inflammation. Lobectomy (n=8), atypical segmental lung resection (n=4) and transection of aberrant vessels (n=1) were performed for intrapulmonary sequestration, and sequestrectomy (n=4) for extrapulmonary sequestration. In cases of associated diaphragmatic hernia (n=3), simultaneous diaphragmatic plasty was performed, including using a non-free pericardial flap (n=1) or a PTFE patch (n=1), and in case of innominate artery compression of the trachea, aortopexy (n=1). In 17 (94.4%) cases, a positive result of surgical treatment was noted. Postoperative complications (intrathoracic bleeding) and lethality were observed in 1 (5.6%) case. Patients were examined in the long-term period from 2 months to 30 years after surgery. Conclusions. Surgical correction of pulmonary sequestration is appropriate as the diagnosis is made, mainly in the neonatal period. Given the complexity of the pathology, especially in the presence of associated malformations, and the expediency of early correction in the neonatal period, thoracotomy access should be preferred as safer for sequential division of arterial and then venous vessels, and for atypical segmental lung resection or lobectomy, depending on peculiarities of sequester. The presence of associated defects requires simultaneous correction. In the case of associated diaphragmatic hernia, autopericardial defect plastics or a synthetic patch are appropriate as an alternative to simple suturing. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: congenital malformations of the lungs, lung sequestration, surgical treatment, children.

Molecular genetic characteristics of colorectal cancer depending on the status of microsatellite instability

Introduction. The emergence of new markers that determine the choice of therapy for metastatic colorectal cancer (CRC) has led to an increase in overall survival. The optimal treatment tactics now take into account both clinical and molecular-genetic characteristics of the tumor.Aim. Investigation of the features of the KRAS, NRAS and BRAF mutations and amplification of the HER2 gene depending on microsatellite instability (MSI) in CRC.Materials and methods. The study included 400 patients with CRC. MSI, BRAF V600E mutation, mutations in the KRAS and NRAS genes was identified to them. MSI was determined by fragment analysis, and mutations in the KRAS, NRAS, BRAF genes by realtime PCR. HER2 amplification was determined in 100 patients with a negative RAS/BRAF. NTRK translocations were determined in all patients with MSI. Data on preoperative levels of CEA and CA19-9 were obtained from 185 patients.Results and discussion. The prevalence of MSI was 6.8%. The prevalence of KRAS, NRAS, BRAF mutations in CRC with MSI was 66.7%, and in CRC with MSS - 52.3%. In patients with MSI, the level of CEA was lower than in MSS (p = 0.0061). The overall prevalence of KRAS and NRAS mutations was 45% and 2.5%. The overall prevalence of the BRAF V600E mutation was 5.8% and was more common in MSI-positive tumors (p < 0.0001). Regardless of MSI, BRAF-positive tumors were characterized by right-sided localization (p < 0.0001), category T3-4 (p = 0.013), lymph node involvement (p = 0.004), carcinomatosis (p = 0.046), high levels of CA19-9 (p = 0.014). HER2 amplification was found in 7% of wild-type RAS/BRAF cases and was associated with rectal cancer (p = 0.044), category T3-4 (p = 0.041), and distant metastases (p = 0.038). HER2 amplifications and NTRK translocations were not detected in cases with MSI.Conclusion. MSI-positive CRC had a higher prevalence of mutations in major genes. CRC with the BRAF V600E mutation and HER2 amplification had aggressive clinical and morphological parameters.

Multivariate Risk Analysis of RAS, BRAF and EGFR Mutations Allelic Frequency and Coexistence as Colorectal Cancer Predictive Biomarkers.

Simple SummaryThe colorectal cancer (CRC) stage and evolution should be described by biomarker profiles. In 60 CRC cases, KRAS, NRAS, BRAF, and EGFR mutations were analyzed by droplet digital PCR (ddPCR). KRAS G12/G13 mutation was present in all patients with variable allelic frequencies. KRAS Q61 mutation was correlated with tumor invasion beyond the subserosa and poor differentiation, both associated with worst prognosis. Tumors with NRAS and BRAF mutations were prevalently localized on the right segment colon. The discovery of the KRAS Q61 role in tumor phenotypes provides the foundation for new therapeutic strategies and perspectives on molecular subtypes classification of CRC.Background: Biomarker profiles should represent a coherent description of the colorectal cancer (CRC) stage and its predicted evolution. Methods: Using droplet digital PCR, we detected the allelic frequencies (AF) of KRAS, NRAS, BRAF, and EGFR mutations from 60 tumors. We employed a pair-wise association approach to estimate the risk involving AF mutations as outcome variables for clinical data and as predicting variables for tumor-staging. We evaluated correlations between mutations of AFs and also between the mutations and histopathology features (tumor staging, inflammation, differentiation, and invasiveness). Results: KRAS G12/G13 mutations were present in all patients. KRAS Q61 was significantly associated with poor differentiation, high desmoplastic reaction, invasiveness (ypT4), and metastasis (ypM1). NRAS and BRAF were associated with the right-side localization of tumors. Diabetic patients had a higher risk to exhibit NRAS G12/G13 mutations. BRAF and NRAS G12/G13 mutations co-existed in tumors with invasiveness limited to the submucosa. Conclusions: The associations we found and the mutational AF we reported may help to understand disease processes and may be considered as potential CCR biomarker candidates. In addition, we propose representative mutation panels associated with specific clinical and histopathological features of CRC, as a unique opportunity to refine the degree of personalization of CRC treatment.

Pre-diagnostic faecal calprotectin levels in patients with colorectal cancer: a retrospective study

BackgroundFaecal calprotectin (FC) is a potential biomarker for colorectal cancer (CRC) screening. There is uncertainty if tumor characteristics are associated with FC levels. We investigated how tumor stage and tumor localization influence the extent of FC levels in patients with CRC in clinical practice.MethodsIn two cohorts of patients with CRC, we retrospectively analyzed FC tests (CALPRO®) performed within three months prior to diagnosis. One hundred twenty-four patients with CRC were included (mean age 68 years, 44% women).ResultsNinety-eight patients with CRC (79%) had a FC ≥ 50 µg/g. FC correlated positively with tumor stage (UICC based on WHO TNM classification) (rs 0.24; p = 0.007) and with CRP levels (rs 0.31, p = 001), and a negatively with B-haemoglobin (rs -0.21; p = 0.019). The patients with right-sided CRC had significantly more often a FC ≥ 50 µg/g than patients with left-sided CRC (92% vs 74% p = 0.027). In a binary logistic regression analysis, tumor stage III/IV (adjusted OR 3.47; CI 1.27–9.42) and right-sided tumor localization (adjusted OR 3.80; CI 1.01–14.3) were associated with FC ≥ 50 µg/g. Tumor stage III/IV (adjusted OR 2.30; CI 1.04–5.10) and acetylsalicylic use (adjusted OR 3.54; CI 1.03–12.2) were associated with FC ≥ 100 µg/g. In a cox regression analysis, a FC ≥ 100 µg/g was not associated with survival (Hazard OR 0.61; CI 0.24–1.52).ConclusionsElevated pre-diagnostic FC levels were common in patients with CRC in close proximity to diagnosis. Right-sided localization and tumor stage were significantly associated with a rise in FC levels.

Clinical and morphological portrait of tumors with microsatellite instability

Background. Microsatellites are short tandem nucleotide repeats, the change in length of which plays a key roles in the pathogenesis of various malignant neoplasms. This change is called microsatellite instability. It is caused by aberrations in the genes of DNA mismatch repair system. Tumors with microsatellite instability are a special subtype regardless of location and are characterized by high sensitivity to immune checkpoint inhibitors.Objective – determination of characteristic clinical and morphological patterns of tumors of various localizations with microsatellite instability.Materials and methods. The study included 512 patients with malignant tumors of different localizations. Of these, 359 patients were diagnosed with colorectal cancer, 57 with uterine body cancer, and 57 with stomach cancer. Determination of the status of microsatellite instability was performed by a PCR-based method using 5 mononucleotide markers: BAT-25, BAT-26, NR-21, NR-24, NR-27.Results. The prevalence of microsatellite instability in colorectal cancer, uterine neoplasm and gastric cancer was 6.4; 22.8 and 1.75 %, respectively. Patients with MSI-positive colorectal cancer are characterized by yonger age (p = 0.023), right-sided localization of the tumor (p <0.0001), presence of multiple primary tumors (p = 0.0299), poorly differentiation (p = 0.0025), mucinous component (p <0.0001), tumor-infiltrating lymphocytes (p <0.0001) and Crohn-like reaction (p = 0.0006). Patients with uterine neoplasms with microsatellite instability are characterized by the presence of endometrial adenocarcinoma (p = 0.047), as well as the presence of tumor-infiltrating lymphocytes (p = 0.0022) and cribriform growth (p = 0.0011).Conclusion. A common pattern for colorectal cancer and uterine neoplasms is the presence of tumor-infiltrating lymphocytes. Certain clinical and morphological features of tumors of these localizations will more accurately identify candidates for microsatellite instability status determination for further immunotherapy.

Prognostic role and biologic features of Musashi-2 expression in colon polyps and during colorectal cancer progression.

The RNA-binding protein Musashi-2 (MSI2) controls the translation of proteins that support stem cell identity and lineage determination and is associated with progression in some cancers. We assessed MSI2 as potential clinical biomarker in colorectal cancer (CRC) and tubulovillous adenoma (TA) of colon mucosa. We assessed 125 patients, of whom 20 had polyps of the colon (TAs), and 105 had CRC. Among 105 patients with CRC, 45 had stages I-III; among metastatic CRC (mCRC) patients, 31 had synchronous and 29 metachronous liver metastases. We used immunohistochemistry to measure MSI2 expression in matching specimens of normal tissue versus TAs, primary CRC tumors, and metastases, correlating expression to clinical outcomes. We analyzed the biological effects of depleting MSI2 expression in human CRC cells. MSI2 expression was significantly elevated in polyps versus primary tissue, and further significantly elevated in primary tumors and metastases. MSI2 expression correlated with decreased progression free survival (PFS) and overall survival (OS), higher tumor grade, and right-side localization (p = 0.004) of tumors. In metastases, high MSI2 expression correlated with E-cadherin expression. Knockdown of MSI2 in CRC cells suppressed proliferation, survival and clonogenic capacity, and decreased expression of TGFβ1, E-cadherin, and ZO1. Elevated expression of MSI2 is associated with pre-cancerous TAs in the colonic mucosa, suggesting it is an early event in transformation. MSI2 expression is further elevated during CRC progression, and associated with poor prognosis. Depletion of MSI2 reduces CRC cell growth. These data imply a causative role of MSI2 overexpression at multiple stages of CRC formation and progression.

Determination of the Anatomical Features of the Temporal Bones at the Stage of Planning Extraoral Implantation in Ectoprosthetics of the Auricle

At the present stage of the development of maxillofacial surgery, the treatment of patients with defects in the auricles is one of the most difficult. Defects of the auricles, characterized by its absence, are divided according to the etiological factor into two main groups: congenital (microtia) and acquired (as a result of injuries of various origins). Microtia (including anotia the complete absence of the auricle) is a malformation of the auricle and the external auditory canal caused by anomalies of the first and second zygomatic arch and the first sulcus.Congenital malformations of the auricle occur in 1 out of 700–15 000 newborns and more often have a right-sided localization. In 15 % of cases, they are hereditary, and in 85 % they are sporadic, in boys they are detected on average 2–2,5 times more often than in girls.Currently, much attention is paid to the prosthetic reconstruction of the auricle with fixation by means of cranial intraosseous implants. At the same time precise diagnostics of the state of the temporal bones in the area of the proposed implantation and the correct positioning of the intraosseous supports are the basis of an effective fixation system. Among the methods of radiological diagnostics used for planning ectoprosthetics of the auricles, radiography has long been preferred. However, the introduction of computed tomography into clinical practice has provided a high-quality assessment of the temporal bones state, which has increased the efficiency of surgical intervention planning and treatment.

CLINICAL AND STATISTICAL CHARACTERISTICS OF PATIENTS WITH CEREBRAL STROKE

A retrospective analysis of 1354 case histories of patients admitted to the multidisciplinary medical center of Bukhara with a diagnosis of "Acute cerebrovascular accident" for 2009-2019 was carried out. The study revealed that in the structure of hospitalizations, the largest number of patients with cerebral stroke (MI) lived in rural areas, and among them, females predominated. The ratio of ischemic and hemorrhagic strokes in Bukhara city and the Bukhara region was 4.9: 1. Among the patients with both IS and HI, females predominated. The totality of therevealed indicators, depending on the hemispheric lateralization of the focus, showed that the overall severity of the neurological and functional defect according to the NIHSS, Gusev-Skvortsova, and Bartel scales significantly predominates with the right-sided localization of the focus. Moreover, it was shown that in females with all IS forms, the indicators, according to the stated scales, are worse than inmales

Red Blood Cell Distribution Width (RDW) Correlates to the Anatomical Location of Colorectal Cancer. Implications for Clinical Use.

The pathological, clinical, and therapeutic features of colorectal cancer (CRC) depend on its anatomical localization. We investigated possible associations between the red blood cell distribution width (RDW) and CRC localization. Two-hundred eighty-eight consecutive patients with CRC were retrospectively studied. Demographic, clinical, pathological and laboratory data were retrieved from clinical records and reports. Median RDW values were significantly higher in patients with right-sided CRC when compared to those with CRC in other localizations (16.2, IQR: 14.5-20.0 vs 13.8, IQR: 13.0-16.1, p < 0.0001). Anisocytosis was statistically associated to haemoglobin (Hb), mean haemoglobin concentration (MHC), and mean corpuscular volume (MCV) values in all the patient groups examined. A cut-off value of 14.3% was associated with right-sided localization with sensitivity and specificity of 76.3% and 64.2%, respectively (AUC 0.71). Median RDW values were significantly higher in right-sided CRC when compared to other tumour locations, and may represent an additional marker for differential diagnosis.

Assessment of hemodynamics in the vertebral arteries with instability of the cervical vertebrae and uncovertebral arthrosis with functional tests

Instability of the cervical vertebrae and uncovertebral arthrosis are often the cause of hemodynamic disorders in the vertebral arteries. The aim of the investigation was to perform Doppler analysis of the parameters of blood flow in the vertebral arteries in patients with instability of the cervical spine (CS) and uncovertebral arthrosis with functional tests. Materials and methods. We examined 43 patients aged 18 to 44 years with CS instability, in 34 cases in combination with uncovertebral arthrosis (UVA). Determined Vs, Vd, RI, PI, MFV at the level in the second segment of the VA in the neutral position of the head and functional tests. Instability and uncovertebral arthrosis were diagnosed by radiography of the neck in frontal and lateral projections. Doppler sonography was performed on a Philips HD 11XE device using linear and microconvection sensors in the frequency range of 5-10 MHz Results. In patients with antilisthesis, the Vs value in the extension position was 32.1 ± 3.4 cm / s, RI - 0.71 ± 0.03, CCV - 84 ± 7 ml / min, significantly (P &lt;0.05) lower than in the case of retrolisthesis and in comparison group (CG). With head flexion, the lowest Vs value was found in the group with retrolisthesis and was 31.5 ± 3.1 cm / s, RI – 0.72 ± 0.03, CCV – 87 ± 8 ml / min, significantly (P&lt;0.05) lower than with antelisthesis and in CG. In the case of left localization of UVA, the lowest Vs value was recorded in the left VA during ipsilateral head rotation and amounted to 31.2 ± 2.9 cm / s, RI index - 0.72 ± 0.03, PI - 1.03 ± 0.06, and MFV - 85 ± 9 ml / min, reliably (P&lt;0,05) are lower than the indices of the right VA with right-sided localization of UVA. In right-sided uncovertebral arthrosis, Vs in the right VA had the smallest value and amounted to 30.4 ± 3.2 cm / s, RI index - 0.73 ± 0.03, PI - 1.04 ± 0.06, MFV - 81 ± 8 ml / min, respectively. These indices significantly (P &lt;0.05) differed from the indices of the left VA in the case of left-sided localization of UVA. Conclusions. With antelisthesis, the deterioration of blood flow parameters in the form of a decrease in systolic peak velocity and minute blood volume, as well as an increase in resistance and pulsation indices, occurs during extension, and in retrolisthesis, on the contrary, with bending of the head. With uncovertebral arthrosis, the deterioration of hemodynamic parameters is better manifested with rotational head movements. A decrease in the systolic velocity and minute volume of blood flow, an increase in the indices of resistance and pulsation occur during impsilateral rotation of the head on the side of arthrosis. Key words: instability of the cervical vertebrae, uncovertebral arthrosis, duplex scanning, vertebral arteries, functional tests.

Prognostic Value and Immunohistochemical Analysis of Mismatch Repair Deficiency in Patients with Stage II and III Colorectal Carcinoma-A Single-Center Study.

Background and objectives: Deficient mismatch repair (MMR) status is associated with good prognosis but poor therapeutic response to adjuvant chemotherapy in patients with colorectal cancer. However, there are some opposed arguments considering therapeutic outcomes in patients with evidenced MMR deficiency in colorectal cancer. The aim of the study was the investigation of prognostic value and immunohistochemical analysis of the MMR-deficiency tumors. Materials and Methods: The study enrolled 104 patients with resected stage II and III colorectal cancer samples from the period 2018–2019. Results: The tumors with deficient MMR status were significantly associated with age up to 50 years and right-sided localization (p < 0.001). During the follow-up period of 22.43 ± 6.66 months, 21 patients (20.2%) died, whereas 14 patients (13.5%) had relapses. The loss of mutL homologue 1/postmeiotic segregation increased 2 (MLH1/PMS2) expression, compared to proficient MMR tumors, was associated with shorter disease-free survival in patients with lymphovascular invasion (p < 0.05), perineural invasion (p < 0.01), stage III (p < 0.05) and high-grade tumor (p < 0.05). Conclusions: This retrospective pilot study of a single-center cohort of patients with stage II and III colorectal cancer highlights the clinical importance of using immunohistochemistry (IHC) analysis as a guide for diagnostic algorithm in a country with limited resources, but with a high prevalence of colorectal carcinoma in the young patients. MMR-deficiency tumors compared with proficient MMR colorectal cancer was not shown to be a significant predictor of disease-free and overall survival.

Prognostic significance of Musashi 2 (MSI2) RNA-binding protein expression in precancerous polyps and during colorectal cancer (CRC) progression.

e16009 Background: The RNA-binding protein Musashi-2 (MSI2) controls the translation of proteins that support stem cell identity and lineage determination. Elevated expression of MSI2 plays an important role during progression, dissemination, and drug resistance in numerous solid and hematological malignancies. This study assessed MSI2 as potential clinical biomarker in colorectal cancer (CRC) and pre-malignant disorders of colon mucosa. Methods: This study included 125 patients, of whom 20 had tubulovillous adenomas (TAs) of the colon, and 105 had verified colorectal cancer. Of the 105 patients with CRC, 45 had locoregional invasion (stages I-III). The remaining 60 patients had liver metastases (mCRC), with 31 patients diagnosed with synchronous and 29 with metachronous metastases. We used immunohistochemical (IHC) approach to measure MSI2 expression in matching specimens of normal versus TA tissues, normal versus primary CRC tumor, and normal versus metastatic CRC, followed by correlative analysis in relation to clinical outcomes. In parallel, the biological effects of overexpressing or depleting MSI2 expression in human CRC cells were analyzed in vitro using qRT-PCR, western blot, proliferation and clonogenic assays. Results: MSI2 expression in patient samples was significantly elevated in TAs versus primary tissue (p &lt; 0.002), and was further elevated in primary tumor, and in metastatic sites (p &lt; 0.0001 versus normal tissue, p &lt; 0.003 versus TAs). MSI2 expression positively correlated with decreased progression free survival (PFS) and overall survival (OS), lower tumor grade, and right-side localization (p = 0.004) of tumors. In vitro knockdown of MSI2 in CRC cells suppressed of proliferation, survival and clonogenic capacities of the cells. Conclusions: Elevated expression of MSI2 is associated with pre-cancerous polyps (TAs) in the colonic mucosa, indicating it is an early event in transformation. MSI2 is further elevated during, CRC progression, and associated with poor prognosis, and loss of MSI2 reduces multiple growth properties of CRC cell models. These data imply a causative role of MSI2 overexpression at multiple stages of CRC formation and progression.

Impact of pulmonary vein anatomy on cryoballoon isolation results

Aim. To estimate the efficacy of pulmonary veins (PV) cryoballoon isolation in its different anatomical variants.Methods. 230 patients 57 (53; 62) years of age were enrolled in the study in approximately equal proportion of males and females. Up to 1/3 of patients suffered from isolated AF, most of them belonged to the category of high risk of thromboembolic complications. To evaluate the PV anatomical variant, a modified classification of E. Marom et al was used. In groups of cryoballoon and radio-frequency isolation, subgroups of typical and variant anatomy were distinguished. Evaluation of the effectiveness of the intervention was based on the identification of any (symptomatic and asymptomatic) documented episodes of atrial arrhythmias lasting more than 30 seconds during the observation period of 12 months.Results. Comparison of efficacy in typical PV anatomy did not reveal significant differences between cryo and RFA groups, regardless of the type of device used. Subgroup I of generation of cryoballoons showed freedom from AF 83.2%, II generation – 87.5%, RFA group – 82.7% at p = 0.82. At the same time, with PV variant anatomy, the efficiency of cryo isolation with the use of II generation devices was 52.2 versus 85.7% in the RFA group (OR = 0.25; 95% CI 0.09–0.71; p = 0, 02). When analyzing long-term results in cryo and RFA groups depending on the anatomical variant, it was found that with RFA, the presence of a left PV common trunk (collector / vestibule), as well as the presence of additional veins, showed results comparable with the group of typical anatomy. At the same time, in the cryoablation group, the presence of a left common trunk was accompanied by a decrease in efficiency to 23.1 versus 84.9% for typical anatomy (OR = 0.14; 95% CI 0.03–0.6; p = 0.02) and 90% in the presence of additional veins (OR = 0.1; 95% CI 0.01–0.64; p = 0.02). In the presence of a left common trunk, the efficiency of cryoablation using second-generation cylinders was 23.1 versus 82.4% in the RFA group (OR = 0.16; 95% CI 0.05–0.5).Conclusion. The presence of a left PV common trunk leads to a decrease in the effectiveness of cryoablation in the long-term observation period relative to the group of typical anatomy to 23.1 versus 84.9% (OR = 0.14; 95% CI 0.03–0.6) and 82.4% for radiofrequency ablation (OR = 0.16; 95% CI 0.05–0.5). The presence of additional veins of right-sided localization does not affect the effectiveness of the intervention.

CT-PLANNING ACCESS FOR ADRENALECTOMY

Aim: to determine the possibilities of modern multislice computed tomography in the preoperative planning of a rational variant of surgical access to the adrenal gland with a tumor. Materials and methods: the results of the examination and treatment of 1196 patients with surgical diseases of the adrenal glands (AG) were studied. The virtual-figurative design of a rational variant of surgical access to AG with a tumor was carried out in 362 patients after evaluating the features of their topographic-anatomical location according to CT-scan. The criterion for the inclusion of patients in the study was the ability to perform after 2013 multislice computed tomography (MSCT) with intravenous contrast on the modern installation Aquillion 64 (Toshiba, Japan) and subsequent post-processing of images with the construction of multiplane and 3D reconstructions. Results: studying the features of the topographic-anatomical location of AGs with a tumor using MSCT allowed us to form a virtual-figurative perception of their syntopy in 362 patients and to design options for access to perform adrenalectomy (AE): retroperitoneoscopic (n = 303), laparoscopic (n = 25), thoracophrenotomy ( n = 30), thoracophrenolaparotomic (n = 5). 363 surgical interventions were performed for 362 patients. A single-sided retroperitoneoscopic AE for pheochromocytoma was performed in 1 patient. Reliable CT criteria were determined that affect the duration and safety of the above-mentioned accesses performed by AEs. It has been established that when designing access to the right AG, it is necessary to consider: the diameter of the neoplasm; the location of the AG with a tumor relative to the inferior vena cava and the lower right hepatic vein; contact with vessels in the gate of the kidney, as well as the presence of additional central veins AG. The determining factors in planning access to the left AG are: neoplasm diameter, contact with vessels in the gate of the kidney and splenic vessels, location in the aorto-renal vascular triangle. It was established that retroperitoneoscopic AE, performed in 83.7% of patients with AG tumors with a diameter of ≤ 8 cm, is an operation of choice. Laparoscopic access remains relevant only when the right-sided localization of an AG tumor with a diameter of up to 8 cm and planning simultaneous surgical interventions on the abdominal organs in individuals of a brachymorphic physique (8.3%). Open approaches are shown in benign lesions of the AG more than 8 cm in diameter, generalized forms of adrenocortical cancer (ACC) (T3-4N0-2M0-1), malignant paragangliomas with signs of invasion or distant metastasis (n = 9.7%). Conclusions: multispiral computed tomography allows, before the operation, to carry out adequate planning of the safest surgical access for adrenalectomy, avoiding the development of intra- and postoperative complications, minimizing operative trauma, shortening the operating time, and speeding up the medical and social rehabilitation of patients.

Ендоскопічна хірургія пухлин надниркових залоз при первинному гіперальдостеронізмі

Мета. Оцінити ефективність хірургічного лікування пацієнтів з первинним гіперальдостеронізмом (ПГА).&#x0D; Матеріали і методи. За період з 2014 по лютий 2018 р. в клініці госпітальної хірургії Запорізького державного медичного університету у 46 пацієнтів діагностували ПГА, оперативне лікування проведено 23 пацієнтам, серед них 15 (65%) жінок і 8 (35%) чоловіків. Середній вік пацієнтів становив (52,3 ± 9,5) року. За даними комп’ютерної (КТ) та магнітно-резонансної ( МРТ) томографії правобічна локалізація аденом надниркових залоз встановлена у 10 (43,5%) пацієнтів, лівобічна - у 7 (30,4%), двобічна - у 6 (26,1%). Розмір об’ємних утворень надниркових залоз становив (18,3 ± 6,7) мм. Діагностику проводили згідно з Клінічними практичними рекомендаціями з діагностики та лікування первинного гіперальдостеронізму (Clinical Practical Guideline - The Management of Primary Aldosteronism; 2008, 2016). Оперативне лікування проводили з використанням ендоскопічних методів. Лапароскопічну адреналектомію виконали 19 (82,6%) пацієнтам, лапароскопічну резекцію надниркової залози - 4 (17,4%). Результати оперативного лікування оцінювали згідно зі стандартними та клініко-біохімічними критеріями PASO (Primary Aldosteronism Surgical Outcomes).&#x0D; Результати. Тривалість операцій становила в середньому 150 (120 - 200) хв, строки лікування пацієнтів у стаціонарі - (9 ± 2,1) доби. До конверсій не вдавалися, післяопераційних ускладнень не було. Ніхто з пацієнтів не помер. Порівняльний аналіз результатів оперативного лікування показав статистично достовірне зниження показників систолічного артеріального тиску (САТ), діастолічного артеріального тиску (ДАТ), концентрації альдостерону та підвищення рівня калію (p &lt; 0,05). Кореляційний аналіз не виявив статистично достовірного зв’язку між концентрацією альдостерону та масою міокарда лівого шлуночка (ММЛШ), товщиною міжшлуночкової перегородки (ТМШП), товщиною задньої стінки лівого шлуночка (ТЗСЛШ) у пацієнтів до та після оперативного лікування. Клінічні результати хірургічного лікування пацієнтів з ПГА, оцінені за критеріями PASO та стандартними критеріями, практично схожі: повне одужання констатовано у 39,2 та 43,5% пацієнтів, часткове - у 60,8 та 56,5% пацієнтів відповідно; біохімічні результати, оцінені аналогічно, суттєво різнилися: повне одужання - 91,3 та 43,5%, часткове - 8,7 та 56,5% відповідно.&#x0D; Висновки. В хірургічному лікуванні пацієнтів з аденомами надниркових залоз, що супроводжуються ПГА, слід надавати перевагу лапароскопічним методам (адреналектомія, резекція). Ефективність мініінвазивних методів хірургічного лікування ПГА статистично достовірна. Клініко-біохімічні критерії PASO в оцінці результатів хірургічного лікування пацієнтів з ПГА мають перевагу перед стандартними, оскільки є комплексними. Після хірургічного лікування пацієнтів з ПГА повне біохімічне одужання настає у 91,3% пацієнтів, повне клінічне - у 39,2%, часткове біохімічне - у 8,7%, часткове клінічне - у 60,8% пацієнтів.

Local anesthesia for ultrasound-guided percutaneous cryoablation of renal cell carcinoma

Background. There is a category of patients with renal masses, due to severe concomitant diseases, can not perform the operation or may be associated with a threat to life. In addition, many patients with small tumor sites are extremely concerned about their disease and are negative about the tactics of active observation and insist on treatment. These patients can be offered alternative methods of treatment of renal cell carcinoma (RCC), the leading of which is cryoablation.Objective: to evaluate the effectiveness and safety of percutaneous cryoablation of the kidney tumor under ultrasound control.Materials and methods. In the Urology Clinic of the I.M. Sechenov First Moscow State Medical University during the period from 2015 to 2017 performed 23 percutaneous cryoablation of RCC, 7 (men – 4, women – 3) of which were performed under local anesthesia. In 4 patients due to severe concomitant diseases, general anesthesia was associated with an extremely high risk. Three patients refused from dynamic observation and from traditional surgical treatment; preferred an alternative treatment in the form of a percutaneous cryoablation under local anesthesia. In 4 cases, the formations were located in the lower segment along the posterior surface of the kidney, in 3 – along the lateral surface in the middle segment. The size of the formations was not used 4 cm (T1a). The age of the patients was 62.3 years (51 to 83 years). Right-sided localization of the tumor was noted in 3 patients, left-sided – in 4. One patient had a single kidney.At the preoperative stage and 6 months after the operation, all patients underwent ultrasound with dopplerography, multislice computerized tomography with contrast, and computer 3D modeling, which helped to clearly assess the size of the tumor, clarify the prevalence of the tumor process and the spatial ratio of the internal surface of the tumor node to the elements of the bowl-and-pelvis system. In all the observations, the formations were located along the posterior or lateral surface of the kidney; in the lower or middle segment; without invasion of the sine. We used a 3rd generation cryomash machine SeedNet gold (Galil Medical), cryoprobes IceSeed and IceRod. Intraoperative, immediately before cryoablation, a tumor biopsy was performed, the presence of RCC in all patients was confirmed morphologically.Results. According to the ultrasound examination with echodopplerography at 6 months after the operation, the size of the tumor node’s formations decreased on average by 6–8 mm, while there was no blood flow in them. When multislice computerized tomography with 3D modeling was performed, the formation was reduced and the accumulation of the contrast preparation was completely absent or their accumulation gradient did not exceed 10 HU (initially it was about 200 HU). There were no intraoperative complications. In 1 observation, a postoperative hematoma measuring 7 × 3 cm was resolved conservatively and did not require surgical treatment.Conclusions. Percutaneous cryodestruction under local anesthesia using ultrasound guidance seems to be an effective and safe technique for treating patients with stage T1a RCC with localization in the posterior or lateral surface in the lower or middle segments without invasion of the renal sinus and surrounding tissues. It is planned to continue monitoring patients to assess the long-term effectiveness of cryoablation.