Influence of temperature on the strength of alumina-containing raw materials

The work is devoted to the study of the effect of temperatures on the physical and mechanical properties of an alumina-containing product in order to select crushing and grinding equipment for subsequent enrichment operations. In the course of the study, three series of experiments were carried out: at room temperature 23 °C, with heating the material in a drying chamber to 200 °C, and also under cryogenic exposure – 195,75 °C using liquid nitrogen. As a result, the substantiation of the change in the physical and mechanical properties of raw materials when changing is presented. Recommendations for the selection of crushing equipment have been developed

Influence of temperature on the strength of alumina-containing raw materials

The work is devoted to the study of the effect of temperatures on the physical and mechanical properties of an alumina-containing product in order to select crushing and grinding equipment for subsequent enrichment operations. In the course of the study, three series of experiments were carried out: at room temperature 23 °C, with heating the material in a drying chamber to 200 °C, and also under cryogenic exposure – 195,75 °C using liquid nitrogen. As a result, the substantiation of the change in the physical and mechanical properties of raw materials when changing is presented. Recommendations for the selection of crushing equipment have been developed

TREATMENT OF TRIPLE-NEGATIVE BREAST CANCER

The rate of triple-negative breast cancer is 10–24  %, and in recent years it’s one of the most studied subtypes of breast cancer due to its clinical aggressiveness and a small number of molecular targets.The study objective is to evaluate effectiveness of different NAPCT regimens including their dependence on the presence of mutations in the ВRСА 1, 2, СHEK2 genes.Materials and methods. The study included 40 female patients with triple-negative breast cancer. The patients were monitored from 2012 to 2016; surgical treatment was performed at the P.A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center, Ministry of Health of Russia. Median patient age was 45.9 (31–69)  years. All patients received neoadjuvant polychemotherapy (NAPCT) per different regimens. Then the patients underwent surgery of different volume (from radical mastectomies to resections), and in 25 % of cases reconstructive breast surgery was performed. In 5 patients with BRCA1, – 2 mutations, prophylactic subcutaneous mastectomy with immediate reconstruction with an implant was performed; 2 patients refused prophylactic mastectomy; in 1 patient with СНЕК2 mutation, metachronous multiple primary breast cancer was diagnosed, previously she didn»t undergo prophylactic mastectomy, and 6 years later cancer in the second breast was diagnosed.Results. The study included 11 patients under 40 (27.5 %), 4 (50 %) of them in the group with mutations in ВRCA1, -2, CHEK2.The study demonstrated high effectiveness of NAPCT regimens per the АС + Т scheme and weekly injections of doxorubicin 25 mg/m2, cisplatin 30 mg/m2, and paclitaxel 100 mg/m2. Grade IV treatment pathomorphosis for NAPCT per АС + Т scheme was achieved in 50.0 ± 7.9 % cases, for intensified regimen – in 62.5 ± 12.5 % cases.Median follow-up duration for this patient group was 22.1 months, and during this time disease progression was observed in 3 patients: in the 1st patient continued growth on the thoracic wall and brain metastases were diagnosed, in the 2nd patient – lung and supraclavicular lymph nodes metastases, in the 3rd patient – metastases in the cerebellum. In all of these patients, grade IV treatment pathomorphosis wasn»t achieved. Conclusions. The study demonstrated high effectiveness of NAPCT in patients with triple-negative breast cancer of different stages: objective response rate was 90.0 ± 4.7 %, grade IV treatment pathomorphosis was 50.0 ± 7.9 %.Grade IV treatment pathomorphosis for NAPCT per АС + Т scheme was achieved in 50.0 ± 7.9 % cases, for intensified regimen – in 62.5 ± 12.5 % cases. Rate of grade IV treatment pathomorphosis was higher in patients with hereditary form of the disease (62.5 ± 18.3 %) compared to the group with sporadic breast cancer (46.9 ± 8.8 %), р >0.05. In all patients, 2-year disease-free survival was 92.5 %, 2-year overall survival was 95 %

ДВУХЭТАПНАЯ ОТСРОЧЕННАЯ РЕКОНСТРУКЦИЯ У ПАЦИЕНТОК РАКОМ МОЛОЧНОЙ ЖЕЛЕЗЫ ПОСЛЕ МАСТЭКТОМИИ

Delayed breast reconstruction after performing radical mastectomy for cancer is a surgical method of rehabilitation of patients. Breast reconstruction is performed to improve the quality of life of patients with breast cancer. Breast restoration using expander is used in women with a small breast size, as well as in patients who refuse to use patchwork techniques of breast restoration. In P. A. Herzen MORI 27 patients with a diagnosis of breast cancer was performed in delayed breast reconstruction after radical mastectomy.To achieve symmetry in 51,9 % of cases the operations were also performed on the healthy breast. During the observation period up to 4 years, no signs of progression of the underlying disease were found in this group.Отсроченная реконструкция молочной железы после выполнения радикальных мастэктомий по поводу рака является хирургическим методом реабилитации пациенток. Реконструкцию молочной железы выполняют для улучшения качества жизни больных раком молочной железы.Восстановление молочной железы с использованием экспандера применяют у женщин с небольшим размером молочной железы, а также у пациенток, которые отказываются от применения лоскутных методик. В МНИОИ им. П. А. Герцена 27 пациенткам с диагнозом «рак молочной железы» выполнили отсроченную реконструкцию молочной железы после радикальной мастэктомии.Для достижения симметрии в 51,9 % выполнены операции на здоровой молочной железе. За период наблюдения до четырех лет в данной группе не выявлено признаков прогрессирования основного заболевания.Цель работы – улучшение качества жизни больных раком молочной железы с помощью отсроченной реконструкции молочной железы

Тактика лечения рака молочной железы у пациентки с почечным трансплантатом

Objective – the choice of tactics for the treatment of breast cancer in a kidney transplant recipient. The article presents a clinical case of a 51-year-old patient with a clinical diagnosis: left breast cancer IIA stage рТ2N0М0G3; triple-negative type. About chronic renal failure 10 years ago the patient was kidney transplantation was performed. The development of transplantation has expanded the use of immunosuppressive therapy in clinical practice. As a result, the risk the development of secondary tumors, including breast cancer, increases.Цель исследования – выбор тактики лечения рака молочной железы у реципиента почечного трансплантата. В статье представлено клиническое наблюдение пациентки 51 года с клиническим диагнозом: рак левой молочной железы IIA стадии рТ2N0М0G3; тройной негативный тип. По поводу хронической почечной недостаточности 10 лет назад пациентке была выполнена трансплантация почки. Развитие трансплантологии расширило применение в клинической практике иммуносупрессивной терапии. В результате риск развития вторичных опухолей, в том числе рака молочной железы, возрастает

ИНТРАОПЕРАЦИОННАЯ ФОТОДИНАМИЧЕСКАЯ ТЕРАПИЯ БОЛЬНОЙ РАКОМ МОЛОЧНОЙ ЖЕЛЕЗЫ IIIC СТАДИИ (8-ЛЕТНИЙ ПЕРИОД БЕЗРЕЦИДИВНОГО НАБЛЮДЕНИЯ)

The article presents  a clinical observation  of the patient  of 38 y.o. with cancer of the left breast stage IIIC урТ4bN3М0L1V1. On the 1st  step of the treatment the patient  had 2 courses of CAF neoadjuvant chemotherapy, on the 2nd  step – extended radical mastectomy on the left with intraoperative photodynamic therapy and closure of the defect with ТRАМ-flap, on the 3rd step – continuation of the chemotherapy (8 courses), on the 4th  step  – radiation  therapy  to the chest wall on the left and zones of regional lymph drainage, targeted therapy  with herceptin  a (1 year). Four years later a silicone implant was inserted  into the left breast. Corrective surgery (reduction  mammoplasty on the right side) was performed in april, 2017. Currently, the patient has remission of the disease of the left breast, the period of remission accounts for 8 years. В статье представлено  клиническое наблюдение пациентки 38 лет с диагнозом рак левой молочной железы IIIС стадии урТ4бN3М0L1V1.На первом  этапе лечения  пациентке выполнено  2 курса неодъювантной  химиотерапии  по схеме САF, на втором  этапе – радикальная расширенная  мастэктомия слева с интраоперационной фотодинамической  терапией  и закрытием дефекта ТRАМ-лоскутом, на третьем этапе – продолжение полихимиотерапии (8 курсов), на четвертом этапе – лучевая терапия на грудную стенку слева и зоны регионарного лимфооттока, таргетная терапия герцептином (1 год). Через 4 года выполнена установка силиконового  эндопротеза в левую молочную железу. Корригирующая операция  (редукционная  маммопластика справа) проведена в апреле  2017 г. В настоящее  время  у пациентки ремиссия заболевания левой молочной железы – период ремиссии 8 лет

Случай из практики: капсуло‑ассоциированный плоскоклеточный рак молочнойжелезы

Breast augmentation with the use of silicone breast implants is a routine practice for breast surgeons. Breast implant capsule‑associated squamous cell carcinoma is a rare and aggressive malignant tumor accounting for less than 0,1 % of invasive breast cancer. Currently there is no single concept of a complex therapy for such tumors due to the low incidence rate. The article describes a case of a 49‑year‑old female patient after surgical treatment of left‑sided breast implant capsule‑associated squamous cell carcinoma diagnosed in 2019. After the disease progression the patient underwent removal of the chest wall tumor with resection of ribs 3–5, allo‑and autoplasty, and left axillary lymph node dissection (ALND). In most cases, breast implant capsule‑associated squamous cell carcinoma is treated surgically but the role of adjuvant chemotherapy, radiation therapy, and endocrine therapy is still ambiguous.Выполнение аугментационной маммопластики молочных желез с использованием силиконовых эндопротезов является рутинной практикой онкомаммологов. Капсуло-ассоциированный плоскоклеточный рак молочной железы является редким и агрессивным злокачественным новообразованием, составляющим менее 0,1 % от инвазивного рака молочного железы.До настоящего времени в связи с низкой заболеваемостью подобными опухолями не существует единой концепции в комплексном лечении данной патологии. В статье описывается случай лечения пациентки 49 лет после хирургического удаления капсуло-ассоциированного плоскоклеточного рака левой молочной железы в 2019 году. После прогрессирования заболевания спустя год пациентке выполнено удаление опухоли грудной стенки с резекцией 3–5 ребер, алло-и аутопластикой, подмышечной лимфаденэктомией (ЛАЭ) слева. В большинстве случаев, основным лечением капсуло-ассоциированного плоскоклеточного рака молочной железы является хирургическое вмешательство, однако роль адъювантной химиотерапии, лучевой терапии и эндокринотерапии все еще не однозначна

RECURRENCE OF BREAST CANCER AFTER SUBCUTANEOUS MASTECTOMY WITH SIMULTANEOUS RECONSTRUCTION

Objective. To analyze the recurrence after radical subcutaneous mastectomy or konohana of mastectomy.Materials and methods. In FMIC them.P. A. Herzen patients performed radical subcutaneous mastectomy (95,5%) or konohana radical mastectomy (4.5 per cent). When radical subcutaneous mastectomy keep the skin of the breast, the nipple-areola complex (NAC), submammary fold, remove the entire gland tissue together with the axillary, subclavian and subscapularis lymph nodes. Konohana mastectomy differs from subcutaneous mastectomy with removal of the nipple-areola complex. Distribution of patients according to tumor stage process as follows: 0 (ТisN0М0) - 33 (4,3%), I - 180 (23,2%), IIA - 283 (36,6%), IIB - 123 (15,9%), IIIA - 91 (11,7%), IIIБ - 1 (0,1%), IIIС - 41 (5,3 %) IY - 6 (0,8%), 16 (2,1%) patients the operation was performed after recurrence of breast cancer.Results. In our study the recurrence was diagnosed in 37 (4,8%) patients. A minimum of recurrences of 8 months, maximum 10 years. Repeated local recurrences after treatment was 2. Local recurrence was diagnosed in 35 (4,5%) patients. Regional recurrence was diagnosed in 3 (0,4%) of patients, in one case after local recurrence. Regional recurrences detected in 2 (0,3%) cases in the armpit and 1 (0,1%) case in the infraclavicular region. The likelihood of regional recurrence is often associated with errors in surgical technique the operation. During follow-up revealed 3 (0,4%) cases of cancer Paget’s disease in the area of the nipple-areola complex. All 3 (0,4%) of cases the treatment was surgical and meant excision of the nipple-areola complex. In 1 (0,1%) patients diagnosed with breast cancer in the second breast after 7 years.In the area of the nipple-areola complex in the Central quadrant of the recurrence was diagnosed in 6 of the 35 local recurrence, which amounted to 17,1%. Among patients with konohana radical mastectomy recurrence in the Central quadrant is not revealed. The distribution of recurrence depending on the stage of breast cancer: in stage I of 5,5%, IIA - 3,5%, IIB - 5,7%, IIIA – 4,4% in S of 7,3%. In 2 cases after the first relapse of 16 was diagnosed with a relapse, which was 12.5%. In stage I breast cancer  as diagnosed with a relapse of 5,5%, which is probably due to the absence of radiation therapy in the postoperative period, since the initial stage and the operation volume is sufficient, the number of relapse - 10 and in any case, radiation therapy was not carried out.Conclusion. Over the 5 years of observation for patients with breast cancer after radical subcutaneous mastectomy/ konohana radical mastectomy with simultaneous reconstruction, recurrence developed in 34 cases (4.4%) patients. The important fact is the detection of local recurrence after 10 years of follow-up (8,1%) after treatment, which confirms the need for dynamic monitoring of patients throughout life. The frequency of relapses affected by stage of breast cancer, young age of patients, the histogenesis and subtype of the tumor. When combined adverse prognostic factors should be used for reoperation on the breast. Radical subcutaneous mastectomy or konohana radical mastectomy with simultaneous reconstruction of an adequate volume of transactions in the cancer plan, and effective method of reabilitacii breast cancer patients. Relapse of breast cancer after these surgeries is not different from the risk of recurrence after radical mastectomy. Despite the presence of repeated operations, the preservation of the reconstructed breast cancer after recurrence of breast cancer was possible in 65, 7% of cases in our study

TRAM flap in reconstructive operations in patients with breast cancer

The treatment of breast cancer (BC) is a relevant problem. Surgery is a key treatment method for BC. The volume of its operations varies from radical mastectomies to lumpectomies and, in the areas of regional metastases, from three-level lymphadenectomy to sentinel lymph node biopsy. Objective: to assess whether a displaced TRAM flap may be used for reconstructive operations for BC. The paper presents some experience in treating 11 BC patients in whom a displaced TRAMP flap was employed for reconstruction. At this time, the displaced TRAM flap was applied for delayed reconstruction in 3 patients. The mean age of the patients was 45.5 ± 15.7 years. In 8 BC patients undergoing one-stage reconstruction with a displaced TRAM flap, the treatment schedule was as follows: surgical treatment in 1 patient, combined treatment in 2 patients, and multimodality treatment in 5. The patients received targeted therapy in 3 cases or hormone therapy in 6. A lower abdominal skin-and-fat flap on one vascular pedicle was used in all the 11 patients.Indications for using a displaced TRAM flap were determined; complications were analyzed. The percentage of complications due to the use of a displaced TRAM flap was 9.1 % in our study.To reduce the rate of complications after breast reconstruction with a displaced TRAM flap, we carefully selected patients for this choiceof a plastic component. The displaced TRAM flap is one of the variants for delayed breast reconstruction despite its duration and complexity. Corrective surgery is further used to achieve breast symmetry. Corrective operations, namely, breast liposuction and submammary fold formation, were performed in 2 patients. For full breast recovery, the nipple-areolar complex is to be formed following skin-sparing mastectomies and delayed breast reconstructions. The cosmetic effect was evaluated in 11 patients as excellent in 4 (36.4 %) cases, good in 7 (63.6 %). Neither local recurrences nor distant metastases were revealed in the 11 patients during one-year follow-up

Оrgan-preserving surgery for breast cancer

The paper describes the experience in treating 435 breast cancer patients undergoing organ-preserving operations with and without plastic repair. Both the patients’ tissues and thir combination with a silicone endoprosthesis were used for repair. The specific features of a recurrence were analyzed after organ-preserving surgery depending on the stage, treatment method (surgical or combination) and histogenesis of a tumor