SIGNIFICANCE OF DEFINING BRAF-MUTATIONS IN PATIENTS WITH INOPERABLE AND METASTATIC SKIN MELANOMA

Меланома – опасное злокачественное заболевание, характеризующееся высоким потенциалом метастазирования и неблагоприятным прогнозом. Своевременная диагностика на ранних стадиях заболевания и удаление очага в полном объеме – определяющие факторы, которые делают лечение меланомы кожи максимально успешным. Хирургическое лечение до настоящего времени остается основным радикальным методом лечения ранних стадий болезни. Для поздних, неоперабельных стадий заболевания и метастатической меланомы кожи продолжаются поиски эффективной комбинации лекарственных препаратов. Сигнальный каскад RAS/RAF/MEK/ERK играет существенную роль в прогрессировании меланомы. Активация этого пути происходит, в том числе, вследствие мутации в генах семейства RAS, RAF, регулирующих продукцию сигнальных молекул этого пути. Предварительные результаты нашего исследования показывают, что частота встречаемости мутации V600 в гене BRAF у больных меланомой кожи, включенных в наше исследование, составляет 81%. Максимальное число больных с мутациями в нашем исследовании приходится на молодой и средний возраст (94% и 81%), а доля выявляемых мутаций в группах пожилого и старческого возраста ниже (67% и 71%). В случае неизъязвленной меланомы мутации встречаются в 87,5% случаях (т.е. чаще), чем в случае изъязвления, где мутации встречаются в 79% случаев. Оценка мутационного статуса гена BRAF, несомненно, важна для определения группы прогноза и индивидуализации терапии, в том числе таргетной, больных диссеминированной меланомой кожи и должна стать стандартной диагностической процедурой.Melanoma is a dangerous malignancy with high metastatic potential and unfavorable prognosis. The timely diagnostics at early stages and full removal of the focus of disease are the decisive factors making skin melanoma treatment maximally successful. Surgical treatment has been the main definitive treatment method for early stages of the disease. For late inoperable stages of the disease and metastatic skin melanoma, an efficient combination of medications is being sought for. Signaling cascade RAS/RAF/MEK/ERK is playing an important part in melanoma advance. It is activated, among others, due to mutation in genes of RAS, RAF family, regulating signaling molecules products of this way. The preliminary results of our research show that the frequency of V600 mutation in BRAF gene in skin melanoma patients included in our research is 81%. The maximal number of patients with mutations in our research is accounted for young and average age (94% and 81%), while the portion of mutations found in senior and old age patient groups is lower (67% and 71%). In the event of a non-ulcerated melanoma, mutations occur in 87.5% cases (i.e., more often), than in the event of a chromoma when mutations occur in 79% cases. The study of mutation status of BRAF gene is undoubtedly important for the determination of prognosis group and individualization of therapy included targeted therapy, for patients suffering disseminated skin melanoma and should become a standard diagnostic procedure

Abstracts of the First Eurasian Conference; The Coronavirus Pandemic and Critical ICT Infrastructure

While the world is struggling with COVID-19, the ICT industry seeks to play a constructive role in combating the spread of the virus. This book contains the abstracts of the papers presented at The First Eurasian Conference; The Coronavirus Pandemic and Critical ICT Infrastructure (PANDEMIC-ICT-2020) organized by AMIR Technical Services LLC, Tbilisi, Georgia held on November 28-30, 2020. Conference Title: The Coronavirus Pandemic and Critical ICT InfrastructureConference Acronym: PANDEMIC-ICT-2020Conference Date: 28-30 November 2020Conference Location: Online (Virtual Mode)Conference Organizer: AMIR Technical Services LLC, Tbilisi, Georgi

Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles = 35-62) vs 56 (40-69) years, p < 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p < 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p < 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p < 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR = 1.612, 95% Confidence Interval, CI = 1.243-2.091, p < 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR = 1.017, 95% CI = 0.823-1.257, p = 0.873). No significant association between the use of TIL and neurological outcome was observed. Conclusions: During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome