ДИАГНОСТИЧЕСКАЯ ЦЕННОСТЬ ОНКОМАРКЕРОВ TRF1 И MMP-7 В ОТНОШЕНИИ РАЗЛИЧНЫХ НОВООБРАЗОВАНИЙ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ

 The authors analyzed the relative levels of telomeric repeat-binding protein factor 1 (TRF1) and matrix metalloproteinase-7 (MMR-7) mRNA expression by the cells obtained from prostate biopsy specimens of patients with benign prostate hyperplasia and cancer (PC) and healthy men without visible prostate diseases and calculated a TRF1/MMR-7 expression ratio for the above conditions. There was a statistically significant difference in the levels of TRF1 and MMP-7 expression and TRF1/MMP-7 ratio in the study groups, which may be suggestive of the high diagnostic value of these markers in determining the early-stage of PC and which enables clinicians to make a more accurate diagnosis in patients with various urologic diseases.Проанализированы относительные уровни экспрессии мРНК теломерсвязывающего белкового фактора (TRF1) и матриксеталлопротеиназы-7 (MMP-7) клетками, полученными из биоптатов предстательной железы пациентов с доброкачественной гиперплазией и раком предстательной железы (РПЖ) и здоровых мужчин, не имевших видимых заболеваний предстательной железы, и рассчитан индекс отношения уровней экспрессии TRF1/MMP-7 для указанных выше патологий. Установлено статистически достоверное различие уровней экспрессии TRF1, MMP-7 и индекса TRF1/MMP-7 в исследуемых группах, что может свидетельствовать о высокой диагностической значимости данных маркеров в отношении определения ранних стадий РПЖ и позволит клиницистам проводить более точную диагностику пациентов с различными урологическими заболеваниями

ЭКСПРЕССИЯ МАТРИКСНОЙ МЕТАЛЛОПРОТЕИНАЗЫ-9 В АДЕНОКАРЦИНОМЕ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ

Iimmunohistochemical study of cells proliferative activity by Ki-67 protein and localization of matrix metalloproteinase-9 (MMP-9) has been carried out at benign prostatic hyperplasia and adenocarcinoma of different gradations by the Gleason score. A significant decrease of the MMP-9 levels in the adenocarcinoma of different gradations have been found. A moderate positive correlation between the Gleason score and cell proliferation Ki-67 index (rs = 0.674) and a moderate negative correlation with the level of such score and expression of MMP-9 (rs = –0.660) were detectedВ статье представлены результаты сравнительного иммуногистохимического исследования пролиферативной активности кле-ток, оцениваемой по экспрессии белка Ki-67, и локализации белка матриксной металлопротеиназы-9 (MMP-9) при доброкаче-ственной гиперплазии предстательной железы и аденокарциноме различной градации по шкале Глисона. Выявлено достоверное снижение уровня MMP-9 в аденокарциноме различной градации. Установлена умеренная положительная корреляция между гра-дацией по шкале Глисона и индексом пролиферации клеток по показателю Ki-67 (rs = 0,674) и умеренная отрицательная корре-ляция градации по шкале Глисона с уровнем экспрессии MMP-9 (rs = –0,660)

Сравнение периоперационных и ранних функциональных результатов лапароскопической резекции почки с опухолью при стадии cT1aN0M0 и cT1b-T2aN0M0

Background. Since partial nephrectomy and radical nephrectomy demonstrate comparable oncological safety, nephronsparing surgery is the method of choice in patients with stage T1-T2aN0M0 renal cell carcinoma.Objective: to compare the main perioperative parameters and short-term functional outcomes of treatment for localized stage cT1aN0M0 and cT1b-T2aN0M0 renal cell carcinoma.Materials and methods. A total of 148 laparoscopic partial nephrectomies were performed at N.I. Pirogov City Clinical Hospital No. 1, N.I. Pirogov Russian National Research Medical University between 2016 and 2020. Study participants were divided into two groups. Group 1 included patients with stage cT1aN0M0 tumors (n = 89; 60.1 %), whereas group 2 comprised patients with stage T1b-T2aN0M0 tumors (n = 59; 39.9 %).Results. The duration of surgery was 120 min (range: 90-150 min) in group 1 and 145 min (range: 120-170 min) in group 2 (p = 0.001). The median time of warm ischemia was 13 min (range: 7-17) and 15 min (range: 12-19 min) in groups 1 and 2, respectively (p = 0.002). Seven individuals from group 1 (7.9 %) and 12 individuals from group 2 (22.3 %) had their pelvicalyceal system lanced. The median glomerular filtration rate calculated using the MDRD (Modification of Diet in Renal Disease) formula was 56.4 mL/min/1.73 m2 in group 1 and 54.3 mL/min/1.73 m2 in group 2 (p = 0.252). Three patients in group 1 (3.4 %) had positive resection margin. The median follow-up time was 21 months.Conclusion. Nephron-sparing surgeries are an acceptable option for patients with stage cT1b-T2aN0M0 tumors in terms of their oncological and functional safety. Tumors exceeding 4 cm were associated with an increased risk of disease progression.Введение. С учетом сопоставимой онкологической безопасности резекции почки и радикальной нефрэктомии органосохраняющее лечение является методом выбора у пациентов с почечно-клеточным раком стадии T1-T2aN0M0.Цель исследования - сравнение основных периоперационных показателей, а также ранних функциональных результатов лечения локализованного рака почки клинических стадий сТ1аN0M0 и сT1b-T2аN0M0.Материалы и методы. С 2016 г. по октябрь 2020 г. включительно в университетской клинике урологии РНИМУ им. Н.И. Пирогова на базе Городской клинической больницы № 1 им. Н.И. Пирогова было выполнено 148 лапароскопических резекций почки. Пациенты были разделены на 2 группы: 1-я - 89 (60,1 %) пациентов со стадией рака сТ1аN0M0; 2-я - 59 (39,9 %) пациентов со стадией сT1b-T2аN0M0.Результаты. Продолжительность операции у пациентов 1-й группы составила 120 (90-150) мин, у пациентов 2-й группы - 145 (120-170) мин (p = 0,001). Медиана времени тепловой ишемии в 1-й и 2-й группах составила 13 (7-17) и 15 (12-19) мин (p = 0,002), вскрытие чашечно-лоханочной системы наблюдалось в 8 (8,9 %) и 14 (23,7 %) случаях соответственно. Осложнения развились у 7 (7,9 %) пациентов 1-й группы и у 12 (22,3 %) пациентов 2-й группы. Медиана скорости клубочковой фильтрации, рассчитанная по формуле MDRD (Modification of Diet in Renal Disease), в 1-й группе составила 56,4 мл/мин/1,73 м2, во 2-й - 54,3 мл/мин/1,73 м2 (p = 0,252). Положительный хирургический край наблюдался в 3 (3,4 %) случаях в 1-й группе. Медиана времени наблюдения составила 21 мес.Заключение. Выполнение резекции почки у пациентов со стадией почечно-клеточного рака сT1b-T2аN0M0 является допустимым с точки зрения онкологической и функциональной безопасности. Размер опухоли, превышающий 4 см, сопряжен с риском прогрессирования заболевания

Оценка функциональных результатов и безопасности раннего удаления уретрального катетера после лапароскопической радикальной простатэктомии

Background. Currently, there is no single point of view on the timing of safe removal of the urethral catheter in patients who have undergone laparoscopic radical prostatectomy.Objective of the study: to evaluate the safety and functional results of early removal of the urethral catheter after laparoscopic radical prostatectomy.Materials and methods. In the period from January 2020 until April 2021, the study included 100 patients with a diagnosis of prostate cancer who underwent laparoscopic radical prostatectomy by one surgeon. Patients were divided into 2 groups. Group A (n = 50) included patients with the urethral catheter removed on the second day after surgery. Group B (n = 50) – the control group – included patients with standard catheter removal (14 days).Results. According to the results of cystography, in group A extravasation of a contrast agent from the zone of urethrovesical anastomosis was determined in 3 (6 %) cases. Seven (14 %) patients developed acute urinary retention after the removal of the urethral catheter. Among 2 patients acute urinary retention occurred immediately after catheter removal. In 5 cases acute urinary retention developed 2–7 days after catheter removal. These patients underwent repeated catheterization for a period of 2–3 days. In our study, removal of the urethral catheter on the second day increased the dynamic of restoring urinary continence in the postoperative period. The frequency of complete recovery of urinary continence (0–1 pad per day) in the groups A and B, respectively, was: after 1 month – 22 and 16 %, after 6 months – 64 and 54 %, after 12 months – 78 and 78 %. Urinary incontinence in the groups A and B was as follows: mild (2–3 pads per day): after 1 month – 40 and 34 %, after 6 months – 30 and 32 %, after 12 months – 20 and 18 %; moderate (4–5 pads per day): after 1 month – 20 and 26 %, after 6 months – 6 and 10 %, after 12 months – 2 and 2 %; severe (6 pads or more): after 1 month – 18 and 24 %, after 6 months – 0 and 4 %, after 12 months – 0 and 2 %.Conclusion. Early removal of the urethral catheter (2 days) in patients who underwent laparoscopic radical prostatectomy is a relatively safe method that improves the restoration of urinary continence. Введение. В настоящее время нет единого мнения о сроках безопасного удаления уретрального катетера у пациентов, перенесших радикальную простатэктомию.Цель исследования – оценить безопасность и функциональные результаты раннего удаления уретрального катетера после лапароскопической простатэктомии.Материалы и методы. В период с января 2020 г. по апрель 2021 г. в исследование были включены 100 пациентов с раком предстательной железы, которым одним хирургом выполнена лапароскопическая простатэктомия (экстраи трансперитонеальным доступами). В группу А (n = 50) вошли пациенты, которым уретральный катетер был удален на 2-е сутки после оперативного вмешательства; в группу В (контрольную) (n = 50) – пациенты со стандартным сроком удаления катетера (14-е сутки).Результаты. В группе А по результатам цистографии у 3 (6 %) пациентов определялась экстравазация контрастного препарата из зоны уретровезикального анастомоза, принято решение о продлении катетеризации сроком до 10–14 сут. У 7 (14 %) пациентов после удаления уретрального катетера возникла острая задержка мочеиспускания: у 2 – непосредственно после удаления катетера, у 5 – через 2–7 сут после удаления катетера. Данным пациентам выполнена повторная установка уретрального катетера сроком на 2–3 сут. У 1 (2 %) из этих пациентов после удаления катетера возникла повторная задержка мочи, которая была разрешена однократной катетеризацией мочевого пузыря. В группах А и В частота полного восстановления удержания мочи (0–1 прокладка в сутки) через 1 мес составила 22 и 16 %, через 6 мес – 64 и 54 %, через 12 мес – 78 и 78 % соответственно. Частота недержания мочи легкой степени (2–3 прокладки в сутки) через 1 мес – 40 и 34 %, через 6 мес – 30 и 32 %, через 12 мес – 20 и 18 %; средней степени (4–5 прокладок в сутки) через 1 мес – 20 и 26 %, через 6 мес – 6 и 10 %, через 12 мес – 2 и 2 %;тяжелой степени (6 прокладок или более в сутки) через 1 мес – 18 и 24 %, через 6 мес – 0 и 4 %, через 12 мес – 0 и 2 %.Заключение. Раннее удаление уретрального катетера (2-е сутки) у пациентов, перенесших лапароскопическуюпростатэктомию, – относительно безопасный метод, позволяющий ускорить динамику восстановления удержания мочи

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Immunohistochemical expression of matrix metalloproteinase-9 and inhibitor of matrix metalloproteinase-1 in prostate adenocarcinoma

An immunohistochemical study on the cells proliferative activity by Ki-67 protein and localization of the matrix metalloproteinase-9 and the inhibitor of matrix metalloproteinase-1 was carried out at the benign prostatic hyperplasia (BPH) and the adenocarcinoma (AC) of different Gleason's grades. A significant decrease of the MMP-9 and TIMP-1 level in the AC of different gradations was observed. A moderate positive correlation between the Gleason score and cell proliferation Ki-67 index (rs = 0.674) and a moderate negative correlation with the level of such a score and expression of MMP-9 (rs = -0.660) was detected. A weak negative correlation exists also between the level of proliferative activity of secretory cells and the expression of MMP-9 by tumor cells (rs = -0.369). The invasive properties of AC cells that promote a degradation of the basal membrane and connective tissue in prostate may be explained by the imbalance between the MMP-9 and TIMP-1, which expression is significantly reduced in AC, in comparison with BPH

Immunohistochemical expression of matrix metalloproteinase-9 and inhibitor of matrix metalloproteinase-1 in prostate adenocarcinoma

An immunohistochemical study on the cells proliferative activity by Ki-67 protein and localization of the matrix metalloproteinase-9 and the inhibitor of matrix metalloproteinase-1 was carried out at the benign prostatic hyperplasia (BPH) and the adenocarcinoma (AC) of different Gleason's grades. A significant decrease of the MMP-9 and TIMP-1 level in the AC of different gradations was observed. A moderate positive correlation between the Gleason score and cell proliferation Ki-67 index (rs = 0.674) and a moderate negative correlation with the level of such a score and expression of MMP-9 (rs = -0.660) was detected. A weak negative correlation exists also between the level of proliferative activity of secretory cells and the expression of MMP-9 by tumor cells (rs = -0.369). The invasive properties of AC cells that promote a degradation of the basal membrane and connective tissue in prostate may be explained by the imbalance between the MMP-9 and TIMP-1, which expression is significantly reduced in AC, in comparison with BPH

DIAGNOSTIC VALUE OF TRF1 AND MMP-7 AGAINST VARIOUS PROSTATE NEOPLASMS

<p> The authors analyzed the relative levels of telomeric repeat-binding protein factor 1 (TRF1) and matrix metalloproteinase-7 (MMR-7) mRNA expression by the cells obtained from prostate biopsy specimens of patients with benign prostate hyperplasia and cancer (PC) and healthy men without visible prostate diseases and calculated a TRF1/MMR-7 expression ratio for the above conditions. There was a statistically significant difference in the levels of TRF1 and MMP-7 expression and TRF1/MMP-7 ratio in the study groups, which may be suggestive of the high diagnostic value of these markers in determining the early-stage of PC and which enables clinicians to make a more accurate diagnosis in patients with various urologic diseases.</p

The role of matrix metalloproteinases and vascular grouth facrors in differentional diagnostic of prostate’s diseases

The aim of this study was to determine of TRF1, MMP-7, FLT-1, KDR and VEGF mRNA expression levels obtained from prostate biopsies samples of patients with benign prostatic hyperplasia, prostate cancer and healthy men without prostate pathology. It was demonstrated that detection of TRF1, FLT-1, KDR and MMP-7 expression levels correlations and TRF1/MMP-7 index was criteria of different way for different prostate neoplasm diagnostics