The use of {99m}Tc-Al[2]O[3] for detection of sentinel lymph nodes in cervical cancer patients

The purpose of the study was to evaluate the feasibility of using {99m}Tc-Al[2]O[3]- based radiopharmaceutical, a novel molecular imaging agent for sentinel lymph node detection in patients with invasive cervical cancer. The study included 23 cervical cancer patients (TlaNxMx- T[2]bNxMx) treated at the Tomsk Cancer Research Institute. At 18 hours before surgery, 80 MBq of the {99m}Tc-Al[2]O[3] were injected peritumorally, followed by single-photon emission computed tomography (SPECT) of the pelvis and intraoperative SLN identification. Twenty-seven SLNs were detected by SPECT, and 34 SLNs were identified by intraoperative gamma probe. The total number of identified SLNs per patient ranged from 1 to 3(the mean number of SLNs was 1.4 per patient). The most common site for SLN detection was the external iliac region (57.2%), followed by the internal iliac, obturator, presacral and retrosacral regions (they amounted to 14%, respectively),and the parametrial region (1%). Sensitivity in detecting SLNs was 100% for intraoperative SLN identification and 79% for SPECT image

Дифференциальная диагностика плазматических дискразий в ревматологической практике

Plasma cell dyscrasias (PCD) present certain difficulties in differentially diagnosing with autoimmune rheumatic diseases (RD) as they have some clinical and laboratory manifestations that are characteristic of the latter. Objective: to generalize the experience in diagnosing PCD at the Research Institute of Rheumatology (RIR), Russian Academy of Medical Sciences (RAMS). Subjects and methods. Nineteen patients admitted to the RIR, RAMS, for rheumatological referral diagnoses were diagnosed as having different types of PCD, both PCD in the presence of RD (n = 10) and primary PCD without RD (n = 9). Immunochemical studies of serum and urinary proteins and bone marrow trepanobiopsy were performed in all the patients. Histological studies were made of the minor salivary glands (n = 12), lymph nodes (n = 3), parotid salivary glands - PSG (n = 5), spleen (n = 1), cranial bones (n = 2) and humerus (n = 1). The immunophenotype of tumor lymphocytes in the biopsy and trepanobiopsy specimens were determined by an immunoflurenscence method with standard monoclonal antibody panels and the paraffin sections of biopsy specimens were examined by an immunoperoxidase technique. Biopsy and trepanobiopsy speciments and myelograms were assessed by the researchers of the N.N. Blokhin Russian Cancer Research Center, RAMS. Results. Over 10 years of follow-up, 19 patients (13 females and 6 males) were diagnosed as having different types of PCD: multiple myeloma (MM) (n = 9), extramedullary plasmacytoma of lymph nodes (n = 2), solitary plasmacytoma (SP) of bone (n = 2), Bence-Jones myeloma (BJM) (n = 2), primary amyloidosis (PA) (n = '), lymphoplasmacytic lymphoma (n = '), Waldenström's macroglobulinemia (WM) (n = 2). In the presence of RA, '0 patients with PCD developed Sjogren's disease (SD) (n = 7), rheumatoid arthritis (RA) + SD (n = 2), RA (n = '); and 9 patients had primary PCD (MM (n = 5), BJM (n = '), WM (n = '), SP (n = '), and PA (n = ')). These 9 patients with different rheumatological diagnoses were long followed up and referred to the RIR, RAMS, to specify these. One third of the patients had recurrent conjunctivitis, enlarged PSG and xerostomia (55%). Arthralgias, arthritis of minor and large joints, flexion contractures of hands, ossalgias, and pains in the lumbar spine and ribs were present in '0-45% of the patients. Vascular lesions, such as Reynaud's phenomenon, recurrent purpuras, lower extremity ulcerative lesions, and toe gangrenes, were observed in '0-35% of the patients with PCD. Lesions in the reticuloendothelial system, such as lymphadenopathy, splenomegaly ('5%), hepatomegaly (45%), and fever (25%), were also detected. Conclusion. Many clinical and laboratory manifestations of primary PCD and RD are similar and only the absence of classical laboratory markers of autoimmune disease, as well as the presence of serum monoclonal immunoglobulins and urinary Bence Jones protein suggest the presence of PCD, both primary PCDs and those with RD.Плазматические дискразии (ПД) представляют определенные трудности для дифференциальной диагностики с аутоиммунными ревматическими заболеваниями (РЗ), так как имеют некоторые клинические и лабораторные проявления, присущие последним. Цель исследования - обобщить опыт диагностики ПД в НИИ ревматологии РАМН. Материал и методы. У 19 пациентов, поступивших в НИИ ревматологии РАМН с направительными диагнозами РЗ, диагностированы различные варианты ПД, как на фоне имеющегося РЗ (у 10), так и первичные ПД без признаков РЗ (у 9). Всем больным проводили иммунохимическое исследование белков сыворотки крови и мочи, трепанобиопсию костного мозга. Выполняли гистологическое исследование малых слюнных желез (у 12), лимфатических узлов (у 3), околоушных слюнных желез - ОСЖ (у 5), селезенки (у 1), костей черепа (у 2) и плечевой кости (у 1). Иммунофенотип опухолевых лимфоцитов в биоптатах и трепанобиоптатах определяли им-мунофлюоресцентным методом со стандартными панелями моноклональных антител, а парафиновые срезы биоптатов изучали им-мунопероксидазным методом. Биоптаты, трепанобиоптаты и миелограммы оценивали сотрудники РОНЦ им. Н.Н. Блохина РАМН. Результаты исследования. За '0лет наблюдения у 19 больных (13 женщин и 6 мужчин) диагностированы различные варианты ПД: множественная миелома (ММ) - у 9, внекостная плазмоцитома лимфатических узлов (ВП) - у 2, солитарная плазмоцитома костей (СП) - у 2, миелома Бенс-Джонса (МЫ) - у 2, первичный амилоидоз (ПА) - у 1, лимфоплазмоцитарная лимфома (ЛПЛ) - у 1, макроглобулинемия Вальденстрема (МВ) - у 2. У 10 больных ПД развились на фоне РЗ: болезни Шёгрена - у 7, ревматоидного артрита (РА) + синдрома Шёгрена - у 2, РА у - 1, и у 9 больных ПД были первичными (ММ - у 5, МЫ - у 1, МВ - у 1, СП - у ', ПА - у '). Эти 9 больных длительно наблюдались с различными ревматологическими диагнозами и были направлены в НИИ ревматологии РАМН для уточнения таковых. У трети больных присутствовали рецидивирующие конъюнктивиты, увеличение ОСЖ и ксеростомия (у 55%). Артралгии, артрит мелких и крупных суставов, сгибательные контрактуры кистей, оссалгии, боли в поясничном отделе позвоночника и в ребрах имелись у '0-45% больных. Сосудистые поражения: феномен Рейно, рецидивирующие пурпуры, язвенные поражения нижних конечностей и гангрена пальцев стоп наблюдались у '0-35% больных ПД. Выявлены также поражение ретикулоэндотелиальной системы: лимфаденопатия, спленомегалия ('5%), гепатомегалия (45%) и лихорадка (25%). Заключение. Многие клинико-лабораторные проявления первичных ПД и РЗ являются сходными и только отсутствие классических лабораторных маркеров аутоиммунного заболевания, а также наличие моноклональных Ig в сыворотке крови и белка BJ в моче позволяет предположить наличие ПД, как первичных, так и на фоне РЗ

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period

THE ROLE OF AN AUXILIARY PHONETIC COURSE IN TEACHING RUSSIAN FOR PROFESSIONAL PURPOSES TO INTERMEDIATE LEVEL STUDENTS

The article substantiates and justifies the need to include an auxiliary phonetic course in teaching Russian for professional purposes to intermediate-level students. The purpose is to give methodological clues to teaching Russian pronunciation to intermediate-level learners speaking different native languages. Pronunciation is an essential part of acquiring a second language, but little time or not at all is spent on teaching it beyond the bounds of elementary level. It seems as if it is generally thought that pronunciation is something that will be maintained and developed on its own. However, it's useless to say that the development of communicative competence in any type of language activity reading, listening, speaking and even writing is impossible without established listening comprehension and pronunciation skills, which ensure adequate perception of other people's speech and the natural sound of the produced utterance. Usually, these skills are underdeveloped in many intermediate-level students. In this article we propose a concept of an auxiliary corrective phonetic course aiming at pronunciation skill automatization and accent neutralization (the accent is viewed as an interference of the native language). The concept stems from our research on the development of articulatory and prosodic skills in Russian learners with different native languages. In this study, audio recordings (3.5 hours in total) of first and second-year students' answers at an oral examination in Russian language were analyzed using the following methods: auditory analysis of the students' speech (listening and transcribing); definition of the acoustic-articulatory characteristics of vowels and consonants in different positions in the sounding speech and their comparison with the corresponding sounds in the students' native languages; analysis and classification of phonetic and prosodic errors typical for a particular group of students. The article lays out the main linguistic and methodological principles of the course and gives guidelines for selecting and sequencing vocabulary, grammar and phonetics material, based upon methods of teaching Russian as a foreign language in mind with a student's native-language specific characters. Consistent work with the course materials contributes to establishing native-like pronunciation and prosodic skills, which are an essential prerequisite to the natural and adequate professional and business communication in Russian

Creutzfeldt–Jakob disease in the Republic of Sakha (Yakutia)

Creutzfeldt–Jakob disease (CJD) is a rare neurodegenerative disease caused by the accumulation of the pathological isoform of prion protein. The classic clinical presentation of CJD is characterized by rapidly progressive dementia, ataxia, myoclonus, and akinetic mutism at the terminal stage of the disease. Of the instrumental techniques, brain magnetic resonance imaging plays a leading role in clinical practice. The authors followed up 4 patients with probable CJD in the Republic of Sakha (Yakutia) in 2014 to 2019. All the patients had approximately the same age (50–60 years) at disease onset and onset with non-specific cerebral symptoms. However, the subsequent development of rapidly progressive dementia and other characteristic features might suggest CJD. The patients were found to have characteristic neuroimaging signs as hyperintensity of the caudate nuclei and pulvinars in the fluid-attenuated inversion recovery (FLAIR) and diffusion weighted imaging (DWI) modes to form the typical signal of hockey sticks, as well as hyperintensity of the gray matter in the DWI mode (the symptom of the «Venus necklace»). In 3 patients, the disease ended fatally within a year of its onset. The fourth patient with a disease duration of 6 months is being supervised at home. The authors reason that the diagnosis of CJD is now insufficient due to the similarity of its clinical symptoms at the onset with other disorders, including cerebrovascular and neurodegenerative diseases

CLINICAL MANIFESTATIONS OF VASCULITIS AT THE ONSET OF MULTIPLE MYELOMA

The paper describes two patients (a 50-year woman and a 72-year man) in whom the clinical manifestations of ulceronecrotic vasculitis had long preceded before the diagnosis of multiple myeloma was made. In the former, monoclonal cryoglobulinemia type I induced ulcerative lesions with the development of dry toe gangrene and paraproteinemic renal lesion. In the latter, ulceronecrotic vasculitis with the development of dry toe gangrene was a manifestation of monoclonal paraproteinemia without signs of cryoglobulinemia. Both patients were found to have monoclonal blood secretion (РIgGλ и РIgGκ) and urine Bence Jones protein (BJλ+BJκ, BJκ) in the absence of immunological markers of vasculitis developing in patients with rheumatic diseases. Immunochemical study of serum/urine and, when monoclonal secretion of PIg+BJ is detected, further examination for plasma cell dyscrasia should be performed in all cases of vascular disorders (cold allergy, Raynaud's syndrome, purpura, ulcers of cruses, and gangrene of distal phalanxes of the hands/feet) in patients with atypical vasculitis. The timely immunochemical study of blood and urine will make it possible to diagnose plasma cell dyscrasia (different types of myelomic disease, Waldenstrцm macroglobulinemia, primary amyloidosis) at the early stage of the disease and to rule out unjustifiably diagnosed vasculitis in patients with atypical vascular lesions