Cost-effectiveness analysis of surgical treatment of patients with early-stage breast cancer luminal subtype A in order to optimize the treatment of organic-savings

Evaluate the cost effectiveness of different options of surgical treatment in patients with early breast cancer luminal subtype A. An analysis of 200 patients with T1N0M0 stage breast cancer with luminal subtype A. The patients were divided into 4 groups: 1 gr. - mastectomy- 50,2 gr. - resection of breast cancer - 50,3 gr. - sectoral resection with lymphadenectomy stadiruyuschey - 50,4 gr. - sectoral resection with sentinel lymph node biopsy. Follow-up was 5 years. As a result, it was found that survival and distant metastasis in patients with breast cancer groups stage T1N0M0 after mastectomy and sparing surgery is no different.Цель работы -оценить экономическую эффективность различных вариантов хирургического лечения у больных с ранним РМЖ люминальным подтипом А. Проведен анализ 200 пациенток с T1N0M0 стадией РМЖ с люминальным типом А. Пациентки разделены на 4 группы: 1 гр. - мастэктомия - 50; 2 гр. - радикальная резекция молочной железы - 50,3 гр. - секторальная резекция со стадирующей лимфодиссекцией - 50,4 гр. - секторальная резекция с биопсией сторожевого лимфоузла. Сроки наблюдения составили 5 лет. В результате нами установлено, что выполнение секторальной резекции с биопсией сигнального лимфоузла у пациенток с раком молочной железы T1N0M0 стадией (люминальный подтипом А) позволяет сократить длительность стационарного лечения и соответственно уменьшить стоимость стационарного лечения, при сопоставимой общей и безрецидивной выживаемости

Whole exome sequencing links dental tumor to an autosomal-dominant mutation in ANO5 gene associated with gnathodiaphyseal dysplasia and muscle dystrophies

Tumors of the jaws may represent different human disorders and frequently associate with pathologic bone fractures. In this report, we analyzed two affected siblings from a family of Russian origin, with a history of dental tumors of the jaws, in correspondence to original clinical diagnosis of cementoma consistent with gigantiform cementoma (GC, OMIM: 137575). Whole exome sequencing revealed the heterozygous missense mutation c.1067G \u3e A (p.Cys356Tyr) in ANO5 gene in these patients. To date, autosomal-dominant mutations have been described in the ANO5 gene for gnathodiaphyseal dysplasia (GDD, OMIM: 166260), and multiple recessive mutations have been described in the gene for muscle dystrophies (OMIM: 613319, 611307); the same amino acid (Cys) at the position 356 is mutated in GDD. These genetic data and similar clinical phenotypes demonstrate that the GC and GDD likely represent the same type of bone pathology. Our data illustrate the significance of mutations in single amino-acid position for particular bone tissue pathology. Modifying role of genetic variations in another gene on the severity of the monogenic trait pathology is also suggested. Finally, we propose the model explaining the tissue-specific manifestation of clinically distant bone and muscle diseases linked to mutations in one gene

Cost-effectiveness of lymphadenectomy in patients with early breast cancer luminal type A

Everyone knows that the surgical treatment of breast cancer is a major step in the combined treatment of breast cancer. One of the problems faced by cancer clinics are large economic costs in the treatment of patients with breast cancer. Thereby significantly affect the budget oncology clinics. In turn, the operations for performing advanced breast cancer significantly increases the time of hospital stay and also increases the cost of treating the patient. The objective of our study is to evaluate the cost-effectiveness of different options for surgical treatment in patients with early breast cancer luminal type A. We analyzed 200 patients with stage T1N0M0 breast cancer with luminal type A follow-up was 5 years. Patients were divided into four groups. The first group included 50 patients who underwent mastectomy with preservation of both pectoral muscles. The second group included 50 patients who had undergone radical resection of the breast. The third group included 50 patients who underwent resection of sectoral with stadiuma lymph node dissection. The fourth group included 50 patients who underwent resection with wide sectoral lymph node biopsy signal. As a result, we found that the implementation of sectoral resection with lymph node biopsy signaling in patients with breast cancer T1N0M0 stage (luminal type A) allows to reduce the duration of inpatient treatment and thus reduce the cost of inpatient care at a comparable overall and disease-free survival

COMPARATIVE ANALYSIS OF HOSPITAL PHARMACOTHERAPY OF CHRONIC HEART FAILURE WITH REDUCED LEFT VENTRICULAR EJECTION FRACTIONS IN 2009-2010 AND 2014-2015

Aim. To compare features of pharmacotherapy of patients with chronic heart failure (CHF) with a reduced ejection fraction of the left ventricle (LV EF) who were admitted in a specialized department of the multidisciplinary hospital in Saratov before and after the publication of the Russian National Recommendations (4 revision) on the diagnosis and treatment of CHF (2012). Material and methods. A pharmacoepidemiological retrospective study was conducted. The object of the study was the medical records of inpatients (form 003/y) with the diagnosis "Heart failure" (ICD-I50), that consecutively admitted to the cardiology department of the multidisciplinary hospital in Saratov from April 28, 2009 to January 19, 2010 (n=52) and from February 19, 2014 to May 20, 2015 (n=95). Patients over 18 years of age with diagnosis of CHF (NYHA II-IV) and LV EF <45% were enrolled into the analysis. For each patient, an individual registration card was filled in which the patient's clinical and demographic characteristics, prescribed medications, their daily dose, the frequency of administration, the route of administration were indicated. Pharmacoepidemiological analysis was carried out for the drugs prescribed at the 1st day of hospitalization, at the 3rd-6th day (the time of stabilization of the patient's condition, which was evaluated by the reduction in dyspnea and increase in the tolerance to physical loads). The recommendations given by the physicians at discharge of the patients from the hospital were also considered. Results. In 2014-2015 years, compared to 2009-2010 years, the number of identified arrhythmias and severe forms of arterial hypertension significantly (82.1 vs 77%; р<0.05) increased. In 2014-2015 the frequency of the prescriptions of ACE inhibitors decreased (77.8 vs 86.5%; p<0.05). The frequency of the prescriptions of angiotensin II receptor blockers, antagonists of mineralocorticoid receptors (AMCR), diuretics, oral anticoagulants, clopidogrel increased (p<0.05). In the structure of combination therapy in 2014-2015, the frequency of the prescription of the ACE inhibitor+beta-blocker and ACE inhibitor+beta-adrenoblocker+AMCR combinations decreased significantly (18.9 vs 26.9%, p<0.05 and 22.1 vs 42.3%, p<0.05, respectively). At the same time prescription frequency of the ACE inhibitor+beta-blocker+AMCR+diuretic combination increased (25.2 vs 11.5%, p<0.05). Conclusion. Pharmacotherapy of CHF in hospital in 2014-2015 is consistent with the Russian National Recommendations (4 revision) and is significantly different from the CHF therapy in 2009-2010. Keywords: pharmacoepidemiology, chronic heart failure, treatment