Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

Kinetics of the formation of precipitates and the physicochemical properties of technetium-99 and rhenium sulfides according to small-angle X-ray scattering and ultramicrocentrifugation data

International audienceThe interaction of technetium and rhenium with sulfides in aqueous solutions was studied by small-angle X-ray scattering and ultramicrocentrifugation. It was shown that, although the stoichiometry of technetium sulfide corresponds to the formula Tc2S7–x , the oxidation state of technetium in it is +4 and the excess sulfur is bound into a disulfide group so that its formula can correctly be written as [Tc3(µ3-S)(µ2-S2)3(S2)(3n–n)/n)] n . The determination of the solubility of technetium sulfide is complicated by its tendency to form colloids, which was the reason why the above methods were chosen to find features of its formation and describe its solubility in solutions

New procedures for determining resection margins during organ-sparing surgery in patients with breast cancer

Breast cancer (BC) occupies a leading place in the structure of cancers among the female population worldwide. The number of breast cancer patients currently tends to increase in the 30–45-year-old group. Organ-sparing treatment (OST) is recommended to improve quality of life in the patients. The operation involves the excision of a segment with a breast lump, but achievement of negative resection margins is mandatory. The latest data show that to achieve the purity of resection margins, indents of up to 2 mm and 1 mm are currently recommended for ductal carcinoma in situ and an invasive form, respectively. Despite the existing data on the safety and benefits of OST, 20 to 30% of patients with invasive or non-invasive BC usually undergo a reoperation. The increased number of repeated resections, and especially mastectomies, leads to severe psychological and physical traumas in women, substantially worsening the quality of life. It is important to correctly mark resection margins during surgery. The paper presents up-to-date methods to examine resection margins intraoperatively. It includes techniques, such as micro-CT, Cherenkov luminescence imaging, radiofrequency spectroscopy-based “Margin Probe”, and fluorescence imaging. The use of the most promising techniques and their long-term results are described. © A group of authors, 2020

Treatment options of breast cancer patients after breast-conserving surgery with positive margins R1

Introduction: in organ-preserving operations for breast cancer, the risk of recurrence is associated with many factors, including positive resection margins. The article presents data from the literature, which considers the risk of relapse depending on the positive, close and negative edges of resection. The purpose of this study was to increase the effectiveness of treatment of breast cancer patients after organ-preserving operations with positive resection edges. Materials and methods: the study included 1219 patients with breast cancer who underwent organ-preserving and oncoplastic resections of the breast. Urgent cytological and histological intraoperative examination of the resection edges is analyzed in detail, and the marking of the resection edges is presented. The clinical and morphological characteristics of patients with breast cancer at R0 and Rl are presented. Results: positive edge of Rl resection was diagnosed in 53 cases, which was 4,3±2,8%, in oncoplastic resections in 4,1±1,1%, in classical breast resections in 4,6±0,7% (p>0,05). In the group of patients with Rl, multicentricity of the tumor was diagnosed in 11,1±5,3%, and monocentric tumor was detected in 4,1 ±0,5%. Further tactics in the case of Rl detection were as follows: in 21 cases, radiation therapy was performed on the breast, in 32 cases, re - operation: resection of the edges - in 14 patients, radical mastectomy - in 9 patients, subcutaneous mastectomy with simultaneous reconstruction with autologous flaps or endoprostheses - in 9 patients. In the group of patients with re-operation, 43,7% of the planned study showed no signs of malignancy, 56,3% showed a residual tumor, while 31.3% were diagnosed with cancer in situ. So in the case of resection of the edges in 5 cases, a residual tumor was diagnosed in the resected edges, which was 35,7%, and in the case of mastectomy, a residual tumor was detected in 68,4%. Re-operation in R1 after oncoplastic resections was performed in 71,4%, and in classical resections in 56,4%, which correlates with the literature data. Conclusion: in two groups of patients after organ-preserving operations with positive resection margins, no local recurrence was detected during the follow-up period from 1 to 60 months, and distant metastases, namely, lesions of the bones of the skeleton, were diagnosed in 2 patients. Thus, with a positive edge of resection after organ-preserving surgery, both surgical treatment and radiation therapy can be performed. Although the presence of a tumor in the colored edges of resection is clearly associated with a high frequency of local relapses, but the relapse is also influenced by the biological characteristics of the tumor and the body. Individual characteristics are the basis of tumor biology, and the extent of their influence on long-term results is not reduced due to the wide surgical margins of resection. © 2020 Izdatel'stvo Meditsina. All rights reserved

Complications after simultaneous prepectoral breast reconstruction using polyurethane-coated implants in patients with breast cancer

Background. The development and improvement of reconstructive breast surgery provides medical, psychological and social rehabilitation of cancer patients, allowing them to achieve the best cosmetic and functional results. The trend towards the return of prepectoral reconstruction is associated not only with the improvement of mastectomy techniques, but also with implant coating and the emergence of highly cohesive silicone gel filling of implants. The use of polyurethane-coated endoprostheses in prepectoral reconstruction provides more reliable fixation to the surrounding tissues and allows reconstruction of the mammary glands without additional covering of the endoprosthesis. Objective: To improve the results of surgical treatment when performing a one-stage reconstruction by pre-rectal placement of polyurethane-coated implants in breast cancer. Materials and methods. In the period from April 2017 to September 2020 at the Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin of P.A. Herzen Moscow Oncology Research Institute performed 340 prepectoral breast reconstructions (direct-to-implant) using polyurethane-coated implants in breast cancer patients. A group of patients was analyzed (n = 208). Results. We noted the following complications: Prolonged seroma (more than 30 days) in 39 (18.6 %) patients, red breast syndrome in 31 (14.8 %) patients, capsular contracture III-IV degree by J.L. Baker in 43 (20.57 %) patients, protrusion/extrusion of the endoprosthesis in 23 (11 %) patients, suture divergence in 8 (3.8 %) patients, necrosis in 8 (3.8 %) patients, infectious complications in 14 (6.7 %) patients, ripping in 10 (4.8 %) patients. Also, 2 (0.95 %) patients had a violation of the integrity of the endoprosthesis, and 2 (0.95 %) patients had rotation of the endoprosthesis. Conclusions. Prepectoral breast reconstruction can be used as an alternative to subpectoral reconstruction in primary operable forms of breast cancer with sufficient thickness of integumentary tissues. © 2020 ABC-press Publishing House. All right reserved