Treatment for Paget’s disease: surgical approaches

Breast cancer (BC) ranks first in the pattern of female malignancies (20.7 %) and remains the top cancer among women. Paget’s disease (PD) is a rare BC form that occurs in the orifice of the lactiferous tubes and that is characterized by involvement of the nipple, large ducts, often to form a lump in the breast; this rare abnormality is encountered in 0.5–5 % of all BC cases. PD has a number of peculiarities. According to different authors, PD is attended with invasive or noninvasive BC in most cases (90–98 %). The involvement is commonly multifocal. PD has a very high risk for a lump (100 and 96 % for palpable and nonpalpable breast tumors, respectively). Almost 50 % of these patients have palpable breast lumps. Despite the fact that the course of PD has its peculiarities because of the rarity of this abnormality, the approaches to its treatment are not different from those in other histopathological types of BC. As for the surgical treatment of PD, until the present time there have been many unsolved problems that remain a matter of debate. The surgical treatment of PD does not differ from the treatment of BC and is primarily determined by disease stage and tumor subtype. The volume of operations for PD varies: from Madden’s radical mastectomy to lumpectomy and sentinel lymph node biopsy. It should be kept in mind that besides nipple-areole complex involvement, invasive or noninvasive BC is often detected in PD. Organ-sparing surgery for PD is mainly a method of rehabilitation for patients. Whether organsparing surgery can be performed is also determined by breast size. Oncoplaplastic resections may be carried out for PD. If the patient wishes to preserve her breast, the range of both single-stage and delayed reconstructive operations is wide. The assessment of the biological features of a tumor and the more differentiated approach to therapy in this cohort of patents might improve considerable survival rates; the determination of indications for organ-sparing treatment is to improve quality of life in patients and their rehabilitation

Formação de competência social do futuro especialista

Modern society is in dire need of socially competent professionals who can quickly adapt to the changing life situations, are ready to solve new problems, interested in improving the efficiency of professional activities, planning the future and ready to take responsibility for the decisions. The problem of development of social competency of the individual is interdisciplinary and in contrast to the problem of development of competency in general and professional competency in particular. In the scientific literature the approaches by which it is possible to give the essential characteristic of this phenomenon and to construct a model are designated: a) set of social knowledge, abilities, awareness of the person of social processes; b) social interaction, the ability and willingness of a person to it, the ability to build their relationships with other people and social organizations in real life; c) the integral quality of the individual, formed in the process of training and education; d) the purpose and result of the implementation of special development and educational programs of educational organizations. Comparative analysis allowed us to determine the components of social competency: personal component, social component, cognitive component, value-semantic component. In the social competency formation of students active teaching methods are the most popular. We consider the method of training “Educational firm” approved in the process of research at different educational levels as a systematized set of simulation methods. Effective socialization of a person should be considered in the context of competence-based approach, including the essential characteristics of competency, professionalism, qualification, personality.La sociedad moderna está en extrema necesidad de profesionales socialmente competentes que puedan adaptarse rápidamente a las situaciones cambiantes de la vida, estén listos para resolver nuevos problemas, interesados en mejorar la eficiencia de las actividades profesionales, planificar el futuro y listos para asumir la responsabilidad de las decisiones. El problema del desarrollo de la competencia social del individuo es interdisciplinario y en contraste con el problema del desarrollo de la competencia en general y la competencia profesional en particular. En la literatura científica se designan los enfoques mediante los cuales es posible dar la característica esencial de este fenómeno y construir un modelo: a) conjunto de conocimientos sociales, habilidades, conciencia de la persona de los procesos sociales; b) la interacción social, la capacidad y la disposición de una persona para ello, la capacidad de construir sus relaciones con otras personas y organizaciones sociales en la vida real; c) la calidad integral del individuo, formada en el proceso de formación y educación; d) El propósito y el resultado de la implementación de programas especiales de desarrollo y educación de organizaciones educativas. El análisis comparativo nos permitió determinar los componentes de la competencia social: componente personal, componente social, componente cognitivo, componente semántico de valor. En la formación de competencias sociales de los estudiantes, los métodos de enseñanza activos son los más populares. Consideramos el método de capacitación “firma educativa” aprobado en el proceso de investigación en diferentes niveles educativos como un conjunto sistematizado de métodos de simulación. La socialización efectiva de una persona debe considerarse en el contexto del enfoque basado en la competencia, incluidas las características esenciales de la competencia, el profesionalismo, la calificación, la personalidad.A sociedade moderna está em extrema necessidade de profissionais socialmente competentes que possam se adaptar rapidamente às situações de mudança da vida, prontos para resolver novos problemas, interessados em melhorar a eficiência das atividades profissionais, planejando o futuro e prontos para assumir a responsabilidade pelas decisões. O problema do desenvolvimento da competência social do indivíduo é interdisciplinar e em contraste com o problema do desenvolvimento da competência em geral e da competência profissional em particular. Na literatura científica as abordagens pelas quais é possível dar a característica essencial deste fenômeno e construir um modelo são designadas: a) conjunto de conhecimentos sociais, habilidades, consciência da pessoa de processos sociais; b) interação social, a capacidade e a disposição de uma pessoa para com ela, a capacidade de construir relacionamentos com outras pessoas e organizações sociais na vida real; c) a qualidade integral do indivíduo, formada no processo de formação e educação; d) o propósito e resultado da implementação de programas especiais de desenvolvimento e educação de organizações educacionais. A análise comparativa permitiu determinar os componentes da competência social: componente pessoal, componente social, componente cognitivo, componente valor-semântico. Na formação de competências sociais dos alunos, os métodos de ensino ativos são os mais populares. Consideramos o método de treinamento “Empresa Educacional” aprovado no processo de pesquisa em diferentes níveis educacionais como um conjunto sistematizado de métodos de simulação. A socialização efetiva de uma pessoa deve ser considerada no contexto da abordagem baseada em competência, incluindo as características essenciais de competência, profissionalismo, qualificação, personalidade

Комбинированное эндоскопическое лечение больного неоперабельным раком средней трети пищевода (4-летнее клиническое наблюдение)

The results of 4-year clinical follow-up in the patient with obstructive inoperable retropericardial esophageal cancer are represented. According to cardiac co-morbidity (myocardial infarction, postinfarction cardiosclerosis) the palliative care for patient was managed. To preserve patency of esophagus multiple courses of endoscopic photodynamic therapy by means of the approach developed in P.A. Herzen MCRI were performed. From 2011 to 2014 thirteen courses of photodynamic therapy with photosens were conducted. The patient was under follow-up for 4 years and 3 months to his death in 2015. For follow-up period the patient had oral feeding with no signs of dysphagia, not significant weight loss and with good quality of life. Приведены результаты 4-летнего клинического наблюдения за пациентом со стенозирующим неоперабельным раком пищевода в ретроперикардиальном сегменте. С учетом сопутствующей кардиальной патологии (инфаркт миокарда, постинфарктный кардиосклероз) был разработан план паллиативного лечения пациента. С целью сохранения проходимости пищевода была выполнена многокурсовая эндоскопическая фотодинамическая терапия по разработанной в МНИОИ им. П.А. Герцена методике. С 2011 по 2014 гг. проведено 13 курсов фотодинамической терапии с препаратом фотосенс. Пациент находился под динамическим наблюдением 4 года 3 мес до смерти в 2015 г. Весь срок наблюдения пациент питался через рот, без признаков дисфагии, без выраженной потери веса, с хорошим качеством жизни.

Motor activity of paramecium | Dvigatel'naia aktivnost' parametsii.

A systemic study of the mechanisms of motor activity of paramecium was carried out. The movements of paramecium responding to various influences were photographed. The analysis of the data revealed the time dependences of the rate of movement, rate of rotation, and the radius and the pitch of the helix trajectory. Mathematical models of the membrane and a unit that transforms the calcium signal to programs of regulating the effectors were constructed. A system of equations for constructing the trajectory of movement was proposed. It is concluded that the biomolecular system that involves calmodulin, calmodulin-dependent ionic channels, adenylate cyclase, guanylate cyclase, phosphodiesterases, Ca(2+)-calmodulin, cAMP, cGMP-dependent protein kinases, and phosphoprotein phosphatases is capable of regulating motor reactions necessary for complex maneuvering of paramecium under various conditions