Financial support for the development of the northern territories of the country

This article studies the issues related to the economic development of the Lower Angara region located in Krasnoyarsk Territory, analyzes the state programs for the development of the Soviet and post-Soviet era territory, and makes an attempt to determine the reasons for the unsuccessful implementation of it. Based on the conclusions made, a new approach to the socio-economic development of the area has been proposed. It consists in the application of a number of specialized industrial clusters on the territory. It is proposed to use bond financing for the financial basis of its formation. To substantiate it, the analysis of the current state of the national bond market in terms of volumes of issuance, maturity has been made and segments of the corporate bond market in the country have been considered. It is suggested that the use of an appropriate financial infrastructure would make the bond financing mechanism operation more effective

Несостоятельность колоректального анастомоза после передней резекции прямой кишки: частота, факторы риска

Purpose of the study. To study the frequency and risk factors for the development of colorectal anastomosis leakage after anterior rectal resection for cancer.Materials and Methods. In a retrospective cohort study between April 2011 and February 2018. The data of the case histories of patients who underwent combined treatment for rectal cancer were analyzed. The study included patients who underwent neoadjuvant chemoradiotherapy followed by surgery. The influence of risk factors on the incidence of AN was assessed based on multivariate analysis using the logistic regression method.Results. The study was conducted in 474 patients who underwent anterior resection for rectal cancer. Depending on the outcome of the operation, the patients were divided into two groups: with the formation of a preventive intestinal stoma (main group, n = 344) and without formation (control group, n = 140) The overall incidence of postoperative complications was 20.6 % in patients with preventive stoma (PS) and 26.1 % without PS (p = 0.198). Colorectal anastomosis (RCA) leaks were detected in 40 (11.6 %) patients in the PS group and in 9 (6.9 %) patients in the non-PS group (р = 0,134). This complication was detected on the 7th day (2–12 days) after the operation in 5 (9.8 %) patients, while in patients with PS on the 10th day (11.6 %) and without PS on 3 (6.9 %) %), (p = 0.134). According to the classification of NCA severity, grade A was detected in 12 patients, B – at 24, C – in 11 patients. The frequency of reoperations in patients with PS was 10.8 %, while in patients with PS it was 15 % (p <0.001). The most common reason for reoperations in patients with LCA in the group without PS was the development of peritonitis (5.4 %, p <0.001). In a statistical multivariate analysis, the most significant risk factors for the development of NCA were: the presence of preoperative chemoradiotherapy (p = 0.001), diabetes mellitus (p = 0.031) and stage III–IV of the disease (p = 0.051).Conclusions. The formation of a preventive intestinal stoma after anterior resections does not reduce the incidence of colorectal anastomosis leaks (p = 0.134), however, it reduces the degree of manifestation of AN in the severity of the course of the postoperative postoperative period (p = 0.029). The frequency of reoperations in patients without a PS is significantly higher than in patients with a stoma (p <0.0001). Diabetes mellitus, chemoradiotherapy, and stage III–IV of the disease are factors influencing the development of leakage.Цель исследования – изучить частоту и факторы риска развития несостоятельности колоректального анастомоза (НКА) после передней резекции прямой кишки по поводу рака.Материалы и методы. В ретроспективном когортном исследовании за период с апреля 2011 по февраль 2018 г. проанализированы данные историй болезни пациентов, которым проведено комбинированное лечение по поводу рака прямой кишки. В исследование были включены пациенты, которым проведена неоадъювантная химиолучевая терапия с последующим хирургическим вмешательством. Оценивали влияние факторов риска на частоту развития несостоятельности анастомоза на основании многофакторного анализа методом логистической регрессии.Результаты. Исследование было проведено у 474 пациентов, перенесших переднюю резекцию по поводу рака прямой кишки. В зависимости от исхода операции больные были разделены на 2 группы: с формированием кишечной превентивной стомы (ПС) (основная группа, n = 344) и без формирования ПС (контрольная группа, n = 140). Общая частота послеоперационных осложнения составила 20,6 % у больных с ПС и 26,1 % – без ПС (р = 0,198). НКА была выявлена у 40 (11,6 %) пациентов в группе с ПС и у 9 (6,9 %) – в группе без ПС (р = 0,134). Данное осложнение выявлялось на 7-е (медиана) сутки (2–12 сут) после операции у 5 (9,8 %) больных, при этом у больных с ПС (11,6 %) – на 10-е сутки и без ПС (6,9 %) на 3-и, (р = 0,134). По классификации тяжести НКА степень A выявлена у 12 больных, B – у 24, C – у 11 пациентов. Частота повторных операций у больных с ПС составила 10,8 %, в то время как у больных без ПС – 15 % (р <0,001). Наиболее частой причиной повторных операций у больных с НКА в группе без ПС являлось развитие перитонита (5,4 %, р <0,001). При многофакторном анализе наиболее значимыми факторами риска развития НКА являлись наличие предоперационной химиолучевой терапии (р = 0,001), сахарный диабет (р = 0,031), а также III–IV стадия заболевания (р = 0,051).Выводы. Формирование превентивной кишечной стомы после передних резекций не снижает частоту НКА (р = 0,134), однако снижает степень проявления НКА в послеоперационном периоде. Частота повторных операций у больных без ПС достоверно выше, чем у больных с наличием ПС. Сахарный диабет, проведенная химиолучевая терапия, а также III–IV стадия заболевания являются факторами, влияющими на развитие НКА

Carcinoembryonic antigen BEFORE AND AFTER neoadjuvant chemoradiotherapy IN PREDICTION OF pathological complete response in patients with locally advanced rectal cancer

Carcinoembryonic antigen (CEA) is widely used to evaluate the effectiveness of treatment in patients with rectal cancer.The aim of the study was to investigate whether the CEA levels measured before and after neoadjuvant chemoradiotherapy (nCRT) can be used to predict pathological complete response (pCR) in patients with locally advanced rectal cancer.Material and methods. 179 patients with locally advanced rectal cancer were treated with nCRT followed by surgical treatment. The serum CEA level was measured before and 610 weeks after the completion of nCRT. Preand post nCRT CEA levels were compared with pCR. The factors associated with pCR were studied.Results. pCR after nCRT was achieved in 12 % (22/179) patients. The incidence of pCR was higher in patients with normal (<5 ng/mL) pre-treatment CEA level (20 % vs 8 %, p=0.019). In patients with the elevated pre-treatment CEA level (> 5 ng/mL), there were no significant differences in the incidence of pCR between cases with normalization and without normalization of CEA level after treatment (p=0.08). The maximum likelihood of pCR determined by the ROC curve was <2.8 ng/mL with pre-treatment CEA (31 %) and <1.8 ng/mL with post-treatment CEA (23 %). Well differentiated tumors (G1) had higher likelihood of pCR (46%) in patients with low pre-treatment CEA (<2.8 ng/mL).Conclusion. Low CEA before and after nCRT is a predictor of pCR. Well differentiated tumors increase the probability of pCR after nCRT

CANCER-EMBRYONIC ANTIGEN IN PREDICTING THERAPEUTIC TUMOR PATHOMORPHISM AFTER NEOADJUVANT CHEMORADIOTHERAPY IN PATIENTS WITH RECTAL CANCER

The purpose of the study was to evaluate the prognostic significance of carcinoerembryonic antigen in patients with rectal cancer and correlate its baseline with the degree of therapeutic pathomorphosis after neoadjuvant chemoradiotherapy.Materials and methods. An estimate of the informative value of carcinoerembryonic antigen (CEA) indices in 179 patients with colorectal cancer determined before and after preoperative chemoradiotherapy (CRT) in SOD 50 Gy.Results. Analysis of the results presented in the study showed that in all patients, CRT caused a significant decrease in the level of CEA (–71%) 10 weeks after its end (p < 0.001). In the course of the pathomorphological study, after the neoadjuvant treatment, the first degree of tumor pathomorphism was recorded in 4.5% of patients, II – 38.5%, III – 45%, IV – 12% (the degree of pathomorphosis is not related to the clinical stage and the degree of differentiation of colorectal cancer). It was revealed that patients with III and IV degrees of therapeutic pathomorphosis initially had a CEA level lower, in comparison with patients with grade I-II. Clinical progression of the disease is diagnosed in 24% of cases (43/179). It was noted that in patients with the IV degree of therapeutic pathomorphism of the tumor, no recurrence of the rectal cancer was detected in either case.Conclusion. The results of the study showed that the problem of individual prediction of the effectiveness of combined treatment of the rectal cancer remains very relevant, rather complicated and yet not completely solved. However, it can be assumed that the use of such an indicator as CEA in monitoring patients after the treatment, can serve as a criterion for the sensitivity of colorectal cancer to CRT. Initially low antigen level can be considered as a positive factor of tumor response to ongoing treatment and disease-free survival of patients with locally advanced rectal cancer