ИЗУЧЕНИЕ ДИНАМИКИ ОПУХОЛЕВОГО КРОВОТОКА ДЛЯ ОЦЕНКИ РАННЕГО ОТВЕТА РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ НА НЕОАДЪЮВАНТНУЮ ХИМИОТЕРАПИЮ

Background. Over the past 20 years, there has been a change in approaches to the treatment of breast cancer, in particular, a significant increase in the role of drug therapy. Breast cancer response to neoadjuvant chemotherapy is currently considered as a surrogate biomarker, which allows evaluation of the clinical course and prognosis of the disease. To solve this problem, it is necessary to assess the functional and metabolic changes in tumor tissue during treatment. Doppler ultrasound is a non-invasive, affordable, and low-cost imaging technique that can be safely used for repeated measurements.The purpose of the study was to study vascular changes in the tumor by power Doppler ultrasound for the evaluation of the early breast cancer response to neoadjuvant chemotherapy.Material and Methods. From May 2017 to August 2019, 63 patients with breast cancer received neoadjuvant chemotherapy. Changes in the tumor blood flow were assessed before starting the treatment and prior to the second course of neoadjuvant chemotherapy using Doppler scanning. Changes in tumor blood floor after chemotherapy were compared with the pathological tumor response after surgical treatment.Results. In the vast majority of cases (78 %), there was a decrease in the number of tumor vessels after the first cycle of neoadjuvant chemotherapy independent of the grade of pathological response. In 8 cases with increased vascularization after the first cycle of neoadjuvant chemotherapy, histological examination of the removed tumor showed no response / weak response to treatment in the absence of peritumoral inflammation. In 5 cases, a sharp increase in the number of vessels around large areas of intranodular necrosis and peritumoral inflammation was observed. In general, a comparison of changes in tumor vascularization and pathological response revealed a weak, although statistically significant, negative correlation between changes in the tumor blood flow after neoadjuvant chemotherapy and pathological response.Conclusion. It was not possible to establish an unambiguous relationship between the reaction of the vascular bed and the tumor response to the cytostatic effect. An increase in the number of tumor vessels in the absence of peritumoral inflammation was the only situation when changes in tumor blood flow during chemotherapy can be unambiguously interpreted as a predictive criterion for the absence / weak response of the tumor to treatment.Введение. В течение последних 20 лет произошло изменение подходов к лечению рака молочной железы, в частности существенное повышение роли лекарственной терапии. Ответ на неоадъювантную химиотерапию рассматривается в настоящее время как суррогатный биомаркер, который позволяет оценить течение и прогноз заболевания. Для решения данной задачи необходимо проводить оценку функциональных и метаболических изменений опухолевой ткани в процессе лечения. Ультразвуковая допплерография – это неинвазивный, доступный и недорогой метод визуализации, который можно безопасно использовать для повторных измерений. Цель исследования – изучение динамики васкуляризации опухоли ультразвуковым  методом в режиме энергетического допплера для оценки раннего ответа рака молочной железы на неоадъювантную химиотерапию. Материал и методы. Исследование проводилось на базе ФБУЗ ПОМЦ ФМБА России с мая 2017 по август 2019 г. В исследование были включены 63 больных раком молочной железы, которым проводилась неоадъювантная химиотерапия. Оценка кровотока опухоли с использованием допплеровского сканирования проводилась до начала и перед вторым курсом неоадъювантной химиотерапии. Изменения кровоснабжения опухоли на фоне химиотерапии сопоставлялись с патоморфологическим ответом опухоли после оперативного лечения.Результаты. В подавляющем большинстве случаев (78 %) наблюдалось не зависящее от степени лечебного патоморфоза уменьшение количества опухолевых сосудов после первого курса химиотерапии. В 8 случаях повышения васкуляризации после первого  курса неоадъювантной химиотерапии при гистологическом исследовании удаленной опухоли наблюдалось отсутствие ответа/слабый ответ на лечение при отсутствии перитуморального воспаления, в 5 случаях – резкое увеличение количества сосудов вокруг обширных зон интранодулярного некроза и обусловленного им перитуморального воспаления. В целом сопоставление динамики васкуляризации опухоли и  патоморфологического ответа выявило слабую, хотя и статистически значимую отрицательную корреляцию между изменениями кровоснабжения опухоли на фоне химиотерапии и степенью лечебного патоморфоза. Выводы. Не удалось установить однозначной зависимости между реакцией сосудистого русла и ответом опухоли на цитостатическое воздействие. Повышение количества  опухолевых сосудов при отсутствии перитуморального воспаления оказалось  единственной ситуацией, когда изменения опухолевого кровотока на фоне проведения химиотерапии могут быть однозначно интерпретированы как предиктивный критерий отсутствия/слабого ответа опухоли на лечение

Структура 90-дневных осложнений после резекции единственной почки при опухолях ее паренхимы

Objective. Study of 90 day complications after solitary kidney resection and determination of their dependence on resection complexity level in accordance with the RENAL nephrometry scoring system.Materials and methods. Seventy (70) resections due to solitary kidney tumors were performed in 65 patients (34 males and 31 females). Mean age was 59.1 years (40–75 years). Fifty-five (55) patients had renal cell carcinoma, 10 patients had benign tumors. According to the RENAL scoring system, in 17 (24 %) cases resection complexity was 4–6 points, in 21 (30 %) cases it was 7–9 points, in 32 (45 %) cases it was 10–12 points. Mean tumor diameter was 4.4 (1.5–10.0) cm. Kidney resection without ischemia was performed in 3 patients, with segmental ischemia – in 39 cases. In 28 (40 %) cases general ischemia was used, its mean duration was 18 (6–48) minutes. Local hypothermia was used in 5 patients. Statistical analysis was performed using SPSS Statistics 16.Results. Analysis of 90 day complications revealed no complications in 41 (58.6 %) cases, severity grade I complications were observed in 2 (2.9 %) cases, grade II – in 20 (28.6 %), grade III – in 6 (8.6 %); there were no grade IV and V complications. Hemodialysis wasn’t performed. Complications were significantly more frequent when total RENAL points were higher (Mann–Whitney U-test, р = 0.001); a positive correlation between RENAL score and presence of complications was observed (Spearman’s rho 0.411; p <0.001). A dependence between complications severity and RENAL score (Mann–Whitney U-test, р = 0.004) and a positive correlation between complications severity and RENAL score (Spearman’s rho 0.432; p <0,001) were revealed.Conclusion. Forty-five percent (45 %) of kidney resections were of maximum complexity according to the RENAL scoring system. In 60 % of cases resection was performed without general ischemia. Analysis of the results of solitary kidney resection demonstrated high efficacy and safety of the procedure and dependence of the frequency and severity of complications on complexity level per the RENAL scoring system.Цель исследования: изучить структуру 90-дневных осложнений после резекции единственной почки и определить зависимость их возникновения от степени сложности резекции по нефрометрической системе R.E.N.A.L.Материал и методика. 65 пациентам с опухолями единственной почки произведено 70 резекций  почки. Мужчин было 34, женщин – 31 в возрасте 59,1 (40 – 75) лет. У 55 больных был ПКР, у 10 – доброкачественные опухоли. Степень сложности резекции почки по системе R.E.N.A.L. определена: 4-6 баллов - в 17 (24%) случаях, 7–9 – в 21 (30%), 10–12 - в  32 (45%). Средний диаметр опухолей составил 4,4 см (1,5–10 см).  Резекция почки без ишемии осуществлена у 3 больных, в 39 случаях - с сегментарной ишемией. В 28 случаях (40%) применяли общую ишемию, среднее время ишемии составило 18,0 мин (6–48 мин). У 5 больных применяли местную гипотермию. Статистический анализ проведен с использованием SPSS statistics 16.Результаты. При анализе 90-дневных осложнений установлено: не было осложнений – 41 (58,6%) случаев; I степени –2 (2,9%); II –20 (28,6%); III – 6 (8,6%); IV – 0; V степени – 0. Гемодиализа не было. Осложнения статистически значимо чаще встречались при увеличении балла RENAL (U-test р=0,001), выявлена положительная корреляция между величиной балла RENAL и наличием осложнений (R=0,411, p<0,001). Выявлена зависимость тяжести осложнений от величины RENAL (U-test р=0,004) и положительная корреляция между тяжестью осложнений и баллом RENAL (R=0,432, p<0,001).Заключение. 45% случаев резекции почки относилось к максимальной степени сложности по системе R.E.N.A.L. В 60% случаев резекцию почки выполняли без общей ишемии. Анализ результатов резекции единственной почки показал их высокую эффективность и безопасность и зависимость частоты и тяжести осложнений от степени сложности резекции по системе RENAL

ВОЗМОЖНОСТИ ОПТИЧЕСКОЙ ДИФФУЗИОННОЙ СПЕКТРОСКОПИИ В ДИАГНОСТИКЕ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Breast cancer (BC) is one of the most common malignancies and the leading cause of cancer-related death in women worldwide. Currently, mammography and ultrasound are the methods most commonly used for the detection of BC, but these methods have significant limitations in the absence of “classic” visual symptoms of cancer in the breast tissue. In the complicated clinical situations, such methods as magnetic resonance imaging and positron emission tomography are used for the differential diagnosis of breast cancer. Over the past 20 years, the BC imaging capabilities have expanded due to the introduction of optical methods into clinical practice. These methods are based on differences in the optical properties between normal and pathological breast tissues. Optical imaging provides the ability to obtain indirect information about oxygenation, blood supply, delivery and consumption of oxygen in the breast tissue, as well as changes in its scattering properties. We present a clinical case of a woman with enlarged axillary lymph nodes. After the core biopsy of the lymph node, histological examination reveled breast cancer metastasis. The standard imaging modalities, such as digital mammography and ultrasound, did not show the evidence of breast cancer. However, the use of diffuse optical spectroscopy (DOS) allowed the detection of changes in the absorption and scattering coefficients in a small part of the breast tissue characteristic of a malignant tumor. Ultrasound and mammography images of this site of the breast demonstrated the features of benign lesion. After ultrasound-guided biopsy, cytological examination revealed cancer cells. Thus, the method of DOS allowed identification of changes characteristic to malignant tumor that was not detected by routine imaging modalities.Рак молочной железы (РМЖ) является одной из ведущих проблем клинической онкологии. Общепринятыми методами диагностики РМЖ являются рентгеновская маммография и ультразвуковое исследование, которые имеют существенные ограничения при отсутствии «классических» визуальных симптомов рака в ткани молочной железы. В сложных клинических ситуациях для дифференциальной диагностики РМЖ применяются такие методы, как МРТ и ПЭТ. В течение последних 20 лет возможности уточняющей диагностики РМЖ расширились благодаря внедрению в клиническую практику оптических методов, основанных на различиях оптических свойств нормальных и патологических тканей. Использование различных длин волн зондирующего излучения позволяет детектировать различные тканевые составляющие в зависимости от их спектра поглощения. Использование оптических методов позволяет получить косвенную информацию об оксигенации, кровенаполнении, доставке и потреблении кислорода в ткани молочной железы, а также об изменении ее рассеивающих свойств. В представленном клиническом случае метод оптической диффузионной спектроскопии (ОДС) позволил выявить существенные изменения оптических свойств образования молочной железы, не имеющего никаких «классических» визуальных симптомов рака. У пациентки заболевание проявилось увеличением аксиллярных лимфоузлов. После выполнения core-биопсии лимфатического узла при гистологическом исследовании был выявлен метастаз рака молочной железы. При этом в молочных железах по стандартным методам исследования (цифровая рентгеновская маммография, УЗИ) данных за наличие злокачественной опухоли не было. Однако методом ОДС в небольшом участке ткани молочной железы слева были выявлены изменения коэффициентов поглощения и рассеяния, характерные для злокачественной опухоли. По данным УЗИ и рентгеновской маммографии этот участок соответствовал доброкачественным изменениям. После пункции образования под ультразвуковым контролем цитологически были обнаружены раковые клетки. Таким образом, метод ОДС позволил выявить изменения, присущие злокачественной опухоли, в случае образования, не имеющего признаков малигнизации при использовании рутинных методов диагностики

POLICY OF MULTICULTURALISM AND REGULATION OF INTENSIFYING MIGRATION FLOWS: FOREIGN EXPERIENCE

The article is devoted to the review of different opinions on immigration policies carried out by European countries, which can be useful for the creation of new approaches to managing migration processes in the Russian Federation. The rising number and activity of Muslim population requires new strategies and approaches. Recognizing the unsuccessful results of different models of immigrants’ integration (including multiculturalism) contemporary Europe has to deal with new challenges and threats caused by intensive migration processes from Muslim countries.DOI: http://dx.doi.org/10.12731/2227-930X-2012-1-

Universal values in contemporary foreign policy: Russian perspectives

© Serials Publications. This paper is devoted to one of the topical issues of the current Russian political science in the light of ongoing global changes taking place in Russia as well as in the whole world. The authors of the study make an attempt to examine Russia's changing foreign policy outlook by analyzing the values and their role in understanding contemporary Russian foreign policy. There are still open debates that Russia has a lot of problems building a strategic partnership and alliances with both the CIS countries and other foreign states and International Institutions. The emphasis of the study is particularly made on Russia's view on the role of values in foreign policy. In the course of the study the authors conclude that the lack of strong links between universal values and foreign policy is the reason for inconsistency of Russian foreign policy and problems existing between Moscow and its partners. If a state seeks to gain power and influence in the world arena, it should have such a model of development that will draw other countries to build any kind cooperation with it

Universal values in contemporary foreign policy: Russian perspectives

© Serials Publications. This paper is devoted to one of the topical issues of the current Russian political science in the light of ongoing global changes taking place in Russia as well as in the whole world. The authors of the study make an attempt to examine Russia's changing foreign policy outlook by analyzing the values and their role in understanding contemporary Russian foreign policy. There are still open debates that Russia has a lot of problems building a strategic partnership and alliances with both the CIS countries and other foreign states and International Institutions. The emphasis of the study is particularly made on Russia's view on the role of values in foreign policy. In the course of the study the authors conclude that the lack of strong links between universal values and foreign policy is the reason for inconsistency of Russian foreign policy and problems existing between Moscow and its partners. If a state seeks to gain power and influence in the world arena, it should have such a model of development that will draw other countries to build any kind cooperation with it

Universal values in contemporary foreign policy: Russian perspectives

© Serials Publications. This paper is devoted to one of the topical issues of the current Russian political science in the light of ongoing global changes taking place in Russia as well as in the whole world. The authors of the study make an attempt to examine Russia's changing foreign policy outlook by analyzing the values and their role in understanding contemporary Russian foreign policy. There are still open debates that Russia has a lot of problems building a strategic partnership and alliances with both the CIS countries and other foreign states and International Institutions. The emphasis of the study is particularly made on Russia's view on the role of values in foreign policy. In the course of the study the authors conclude that the lack of strong links between universal values and foreign policy is the reason for inconsistency of Russian foreign policy and problems existing between Moscow and its partners. If a state seeks to gain power and influence in the world arena, it should have such a model of development that will draw other countries to build any kind cooperation with it

STUDY OF CHANGES IN TUMOR BLOOD FLOW FOR THE ASSESSMENT OF EARLY RESPONSE TO NEOADJUVANT CHEMOTHERAPY IN BREAST CANCER PATIENTS

Background. Over the past 20 years, there has been a change in approaches to the treatment of breast cancer, in particular, a significant increase in the role of drug therapy. Breast cancer response to neoadjuvant chemotherapy is currently considered as a surrogate biomarker, which allows evaluation of the clinical course and prognosis of the disease. To solve this problem, it is necessary to assess the functional and metabolic changes in tumor tissue during treatment. Doppler ultrasound is a non-invasive, affordable, and low-cost imaging technique that can be safely used for repeated measurements.The purpose of the study was to study vascular changes in the tumor by power Doppler ultrasound for the evaluation of the early breast cancer response to neoadjuvant chemotherapy.Material and Methods. From May 2017 to August 2019, 63 patients with breast cancer received neoadjuvant chemotherapy. Changes in the tumor blood flow were assessed before starting the treatment and prior to the second course of neoadjuvant chemotherapy using Doppler scanning. Changes in tumor blood floor after chemotherapy were compared with the pathological tumor response after surgical treatment.Results. In the vast majority of cases (78 %), there was a decrease in the number of tumor vessels after the first cycle of neoadjuvant chemotherapy independent of the grade of pathological response. In 8 cases with increased vascularization after the first cycle of neoadjuvant chemotherapy, histological examination of the removed tumor showed no response / weak response to treatment in the absence of peritumoral inflammation. In 5 cases, a sharp increase in the number of vessels around large areas of intranodular necrosis and peritumoral inflammation was observed. In general, a comparison of changes in tumor vascularization and pathological response revealed a weak, although statistically significant, negative correlation between changes in the tumor blood flow after neoadjuvant chemotherapy and pathological response.Conclusion. It was not possible to establish an unambiguous relationship between the reaction of the vascular bed and the tumor response to the cytostatic effect. An increase in the number of tumor vessels in the absence of peritumoral inflammation was the only situation when changes in tumor blood flow during chemotherapy can be unambiguously interpreted as a predictive criterion for the absence / weak response of the tumor to treatment

THE ROLE OF DIFFUSE OPTICAL SPECTROSCOPY IN THE DIAGNOSIS OF BREAST CANCER (CASE REPORT)

Breast cancer (BC) is one of the most common malignancies and the leading cause of cancer-related death in women worldwide. Currently, mammography and ultrasound are the methods most commonly used for the detection of BC, but these methods have significant limitations in the absence of “classic” visual symptoms of cancer in the breast tissue. In the complicated clinical situations, such methods as magnetic resonance imaging and positron emission tomography are used for the differential diagnosis of breast cancer. Over the past 20 years, the BC imaging capabilities have expanded due to the introduction of optical methods into clinical practice. These methods are based on differences in the optical properties between normal and pathological breast tissues. Optical imaging provides the ability to obtain indirect information about oxygenation, blood supply, delivery and consumption of oxygen in the breast tissue, as well as changes in its scattering properties. We present a clinical case of a woman with enlarged axillary lymph nodes. After the core biopsy of the lymph node, histological examination reveled breast cancer metastasis. The standard imaging modalities, such as digital mammography and ultrasound, did not show the evidence of breast cancer. However, the use of diffuse optical spectroscopy (DOS) allowed the detection of changes in the absorption and scattering coefficients in a small part of the breast tissue characteristic of a malignant tumor. Ultrasound and mammography images of this site of the breast demonstrated the features of benign lesion. After ultrasound-guided biopsy, cytological examination revealed cancer cells. Thus, the method of DOS allowed identification of changes characteristic to malignant tumor that was not detected by routine imaging modalities

Structure of 90 day complications after solitary kidney resection due to parenchyma tumors

Objective. Study of 90 day complications after solitary kidney resection and determination of their dependence on resection complexity level in accordance with the RENAL nephrometry scoring system.Materials and methods. Seventy (70) resections due to solitary kidney tumors were performed in 65 patients (34 males and 31 females). Mean age was 59.1 years (40–75 years). Fifty-five (55) patients had renal cell carcinoma, 10 patients had benign tumors. According to the RENAL scoring system, in 17 (24 %) cases resection complexity was 4–6 points, in 21 (30 %) cases it was 7–9 points, in 32 (45 %) cases it was 10–12 points. Mean tumor diameter was 4.4 (1.5–10.0) cm. Kidney resection without ischemia was performed in 3 patients, with segmental ischemia – in 39 cases. In 28 (40 %) cases general ischemia was used, its mean duration was 18 (6–48) minutes. Local hypothermia was used in 5 patients. Statistical analysis was performed using SPSS Statistics 16.Results. Analysis of 90 day complications revealed no complications in 41 (58.6 %) cases, severity grade I complications were observed in 2 (2.9 %) cases, grade II – in 20 (28.6 %), grade III – in 6 (8.6 %); there were no grade IV and V complications. Hemodialysis wasn’t performed. Complications were significantly more frequent when total RENAL points were higher (Mann–Whitney U-test, р = 0.001); a positive correlation between RENAL score and presence of complications was observed (Spearman’s rho 0.411; p <0.001). A dependence between complications severity and RENAL score (Mann–Whitney U-test, р = 0.004) and a positive correlation between complications severity and RENAL score (Spearman’s rho 0.432; p <0,001) were revealed.Conclusion. Forty-five percent (45 %) of kidney resections were of maximum complexity according to the RENAL scoring system. In 60 % of cases resection was performed without general ischemia. Analysis of the results of solitary kidney resection demonstrated high efficacy and safety of the procedure and dependence of the frequency and severity of complications on complexity level per the RENAL scoring system