EPIDEMIOLOGICAL FEATURES OF MELANOMA SKIN CANCER AND SURVIVAL OF ONCOLOGY PATIENTS IN KRASNODAR REGION

Aim. To assess the effectiveness of preventive, diagnostic and therapeutic work of the oncological service of Krasnodar Region, analyze the epidemiological features of morbidity, mortality, indicators reflecting the diagnosis (the proportion of early detection, neglect) in patients with melanoma skin cancer for the period 2007–2017, and the survival of cancer patients in Krasnodar Region for the period 2007–2016.Materials and methods. Subjects of the study were patients with newly diagnosed melanoma skin cancer in Krasnodar Region for the period 2007–2017. Using an automated information and analytical system the Population Cancer Registry, survival of 3 961 patients with melanoma skin cancer for the period 2007–2016 was analyzed. Standardized rates of morbidity and mortality were calculated according to the accepted world standard with the same age groupings. Statistical processing of data according to the studied indicators was carried out using statistical software packages Statistica. The reliability of the difference in the relative indicators was determined by the t test of the Student, the significance level was adopted as p <0.05.Results. For the period from 2007 to 2017, there has been a significant trend towards an increase in the incidence of melanoma skin cancer of the population of Krasnodar Region. The incidence of melanoma skin cancer in Krasnodar Region is higher than the average for the Russian Federation, which may be due to the presence of an increased level of insolation. During the analyzed period there has been a decrease in the indicator of neglect. With the increase in the stage of melanoma skin cancer, the survival rates both in general among all the diseased and among patients of working age are decreasing. The highest rates of observed and adjusted survival in patients with melanoma skin cancer reduce in the first three years from the date of diagnosis. The indicators of the observed and corrected survival of men of working age with melanoma skin cancer are lower than in women of working age. The indicators of the observed and corrected survival of women of working age with melanoma skin cancer are higher than among the population of all age groups.Сonclusion. The study showed a high level of early diagnosis and quality of treatment for patients with melanoma skin cancer in the Krasnodar Region, as positive trends in the rates of observed and adjusted survival of patients were noted

Patient routing and process approach implementation for regional oncology service

Background. Cancer care involves a multidisciplinary approach to diagnosis and treatment of patients. A complex interaction of actors in the deployment of oncology services dictates usage of modern management technologies for improving the quality and efficiency of patient care through processes optimisation.Objectives. Provision of recommendations for patient routing based on research into the oncology service inter-level information exchange, integration of the process approach and electronic services. The lack of a unified information space with a regional oncology service has been explained. Measures are proposed for the patient routing optimisation as part of establishing a unified digital oncology service circuit.Methods. The oncology service was effectively remodelled through functional and information engineering of electronic services and the process management integration to establish a horizontal decision flow between facilities and employees on a process level bypassing the supervisor coordination. Statistical approaches were used to analyse the oncological patient population.Results. The following electronic services have been implemented: specialised patient referral routing, telemedicine and teleradiology. A comprehensive information framework has been created comprising medical, laboratory and radiological information subsystems integrated through regional electronic services of the unified state healthcare information platform. The goals, objectives, general principles, architecture and expected social economic impact on healthcare of Krasnodar Krai have been defined.Conclusion. Use of electronic services ensures an improved quality of specialised care and effective routing of patients. We perceive prospects of the integrated information platform in the extension and improvement of its subsystems’ functionality and content, sourcing more data providers and the circuit expansion to the federal and regional levels

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

СOMPARATIVE ANALYSIS OF 10-YEAR RESULTS OF TREATMENT EFFICACY IN PATIENTS WITH COLORECTAL CARCINOMA

Aim. To study the dynamics of survival of patients with colorectal cancer in the Krasnodar region for the period of 2006-2015Materials and methods. Patients are divided into groups: registered in 2006, 2009, 2012, 2015. According to the Regional Population Cancer Registry, a comparative analysis of the long-term outcome of treatment of 9,741 patients was conducted by groups.Results. In patients with newly diagnosed colorectal cancer for the past 10 years, a significant increase in the three-year observed, as well as a three-year and five-year adjusted survival rate over the entire follow-up period, was obtained. For all stages of the disease and overall, the observed and adjusted survival rates declined for the first four years after the diagnosis was established, this result was most significant in patients with stage III and IV cancer. An unfavorable prognosis of survival was obtained in patients with stage IV: one-third survive less than a third of patients, the five-year life expectancy in this group was 9.8%.Conclusion. Improving the survival rates of patients with colorectal carcinoma indicates an increase in the effectiveness of providing specialized care for patients with colorectal cancer in the regio

CHANGES IN VALUES OF MEAN AGE IN PATIENTS WITH PRIMARY DIAGNOSED MALIGNANCIES I N KRASNODAR REGION IN 2001-2015

Stages of Formation and functioning of population-based cancer registries (PBCR) in Krasnodar Region are presented now in this article. Introduction of this registries in Krasnodar Region had great impact on reliability of statistical information. We presented dynamic research results of mean age values in patients with malignancies in the region (according to PBCR). All indicators are considered regarding localization of malignant neoplasms, sex, rank places in dynamics for 15 years (2001-2015). We revealed authentic increase (p < 0,05) of average age in patients in general regarding all localizations (for 2,6 years). In female patients it has increased more (for 2,3 years) than in male patients (for 1,6 years). In the majority of localizations we observed authentic (p < 0,05) increase in middle age both in men (in 49% cases), and women (in 53,9%). Direct high correlation link of mean age and such indicators of health in the population as mean age and average life expectancy of the population in Krasnodar Region, with oncological incidence is noted

COMPARATIVE ASPECTS OF MANUFACTURING TECHNIQUES FOR THE FRAME OF AN ARCH PROSTHESIS

The technologies of manufacturing the arch of the arch prosthesis are constantly being refined and updated. The introduction of digital technologies, in particular CAD/CAM, into orthopedic dentistry has led to a qualitatively new level of precision in the planning, modeling and direct fabrication of the arch of the arc prosthesis. The purpose and tasks of this work was a comparative analysis of the laboratory stages of the production of the arc prosthetic framework on the classical and CAD/CAM technology. The object and methods of research. The object of the study was the technology of manufacturing arch arches prosthesis by the method of comparative analysis. To achieve the goal and to solve the tasks on the models of the same patient M., 42 years old, the laboratory stages of the manufacture of arch arches have been carried out: the first - on the classical technology, and the second - using CAD/CAM. Classical construction technology arch prosthesis well described in the literature and does not require detailed exposition. Making frame for CAD/CAM technology is as follows: 1) receiving an anatomical imprint and making a personal spoon; 2) obtaining a functional imprint using special matte imprint materials;3) scanning of a functional imprint after its spraying with a special light reflecting spray; 4) converting the received scanning results into digital format, obtaining a virtual model and installing it in a virtual articulator; 5) studying the computer model of the jaw in the visual parallelogram and determining the optimal way of applying the prosthesis. The program analyzes the inclination and location of the supporting teeth by the method of selection, while showing the size of the retention zone; 6) the next step is to prepare the model for duplication; 7) virtual duplication of the model; 8) simulation of the framework of the future bell-proof prosthesis on the virtual model. One of the peculiarities of this stage is the primary virtual arrangement of artificial teeth in a virtual articulator, and then the automatic modeling of the frame, taking into account the density of interdental contacts; 9) the simulated virtual skeleton is printed from ashless plastics on a 3D printer; 10) a frame made of ash-free plastic is packed in a cuvette and casting is carried out. Results of the research and their discussion. Planning and designing an arc prosthetic design with the help of specially designed computer programs avoids the subjective factor. The study of the model in a virtual parallelogram helps to choose the most optimal way of introducing an arc prosthesis, makes it possible to visually see the volume of the retention zone. If the crown of the reference tooth has an imperfect shape or an insufficiently expressed equator, the program itself will prompt in which direction it should be corrected by making a crochet, which is a significant advantage over classical technology. Proponents of common technology may be sceptical of the fact that the same manipulation can be performed without the use of digital technologies. But, this will be pretty rough and rough, without specifying the required amount of polishing the hard tooth tissues and visualizing the desired shape of the future crown design. In order to maximize the restoration of chewing efficacy and achieve a high aesthetic effect, an artificial teeth are first arranged in a virtual articulator, and then the automatic modeling of the frame. The patient has the opportunity to pre-see the appearance of the future prosthesis and to assess the aesthetic location of the fixation elements. Using for casting a printed on a 3D printer with a frame made of ashless plastic increases the accuracy of the boarding of the frame on the support teeth, which is better than casting on the ceramic model. Conclusions. By comparing the results of each stage of planning, designing and fabricating the arch of the arc prosthesis, it is safe to assert that the CAD / CAM technologies have a number of advantages and are promising for use in arc prosthetics

DISSEMINATED CUTANEOUS MELANOMA: URGENCY OF AN ISSUE, INCIDENCE, TREATMENT PERSPECTIVE (LITERATURE REVIEW)

We performed retrospective analysis for incidence and mortality rates in patients with skin melanoma in Krasnodar region for a 5-year period (2011–2015) and compared it to average Russian rates. All results of non-randomized and randomized series which demonstrated comparative effectiveness for various treatment agents were analyzed. We discussed significance of several agents indicated for patients in mono- and combined regimens