Vol 23, No 1 (2018)

Malignant pleural mesothelioma is associated with poor prognosis and resistance to chemotherapy. This gives reason to search for as well new effective methods of treatment as predictive factors. Programmed cell death receptor PD-1 and its ligands PD-L1 and PD-L2 are the representatives of the system of the «immunologic checkpoint» whose main function is the regulation and modulation of immune response, the decrease of the immune cell damage in organs and tissues and also prevention running of an autoimmune process. Tumor cells are able to use a PD-1/PD-L1-signaling pathway to evade the immune system. The assessment of the level of expression of PD-L1 is regarded as a prognostic marker of the life expectancy, but also as a predictor of response to anti-PD-1/PD-L1 immunotherapy.

Purpose. To determine the indications for the supra - and transpapillary externally-internal drainaging of the biliary tree in case of jaundice syndrome. Material and methods. The results of minimally invasive treatment of 246 patients with external-internal drainage of the biliary tree were analyzed. Among patients with proximal tumor block the external-internal drainage is made in 92 cases, in 42 (45,7%) out of them in suprapapillary embodiment and in 50 (54,3%) - via transpapillary approach. In 154 cases with distal tumor (obstruction peripapillary cancer) transpapillary drainage was performed. Results. The technical success of the external-internal drainaging was achieved in 242 patients (98,4%). It was failed to pass the duodenum in 4 patients with the cancer of common bile duct (3) and cancer of papilla of Vater (1). There was no complications related to the technique of external-internal drainage. In 18 patients (8,8%) out of 204 with transpapillary location of the drainage, we were forced to temporarily return to full outer bile outflow because of acute cholangitis. The syndrome of an acute blockade of the papilla of Vater arising after transpapillary external-internal drainaging required endoscopic papillosphincterotomy in 42 (84%) out of 50 patients with proximal tumor block bile outflow and in 7 (4.5%) out of 154 patients with peripapillary cancer. Conclusion. Suprapapillary and transpapillary embodiment of the drainage are equivalent in terms of the efficacy of cholestasis elimination. Syndrome of an acute blockade of papilla of Vater is the most often complication of the transpapillary external-internal drainage requiring the carrying out of endoscopic papillotomy «on drainage». This syndrome arises very frequently in a case of transpapillary external-internal drainage due to the proximal tumor obstruction of the biliary tree. The risk of acute cholangitis due to regurgitation after manipulation is absent in the suprapapillary location of the external-internal drainage, and with its transpapillary position is realized only with a concomitant violation of the outflow of bile.

This paper describes the work experience gained at the Federal State Budget Institution «National Medical Research Center of Radiology» (FSBI «NMRC of Radiology») of the RF Health Ministry in 2015-2016. Information about 94 grants received by researchers by means of the use of domestic and international information resources stored on electronic and print media is presented. The results of processing and analysis of databases enabled to characterize the personnel activity in branches to receive financial support for research in the areas of medical radiology, radiobiology, radiation epidemiology and oncology as well as to make a decision and highlight problems in funding of projects.

The authors analyzed the incidence rate of malignant neoplasms in the population of the Republic of Buryatia without division into separate locations by regions over a long period, beginning from 1995 to 2015 in comparison with that in the Russian Federation, using a comparative-geographical method. According to statistical data, the growth of general oncopathology has been revealed every year, in connection with which the aim of the work was to search for its causes in the analysis of environmental factors in the region. There was established a high morbidity rate in the population during analyzed four periods: over 1995-2000; 2001-2005; 2006-2010; 2011-2015 in the same regions of the republic, as Bountov, Tarbagataysky, Kabansky, Pribaikalsky, Zaigraevsky, North Baikal, Barguzin and Ulan-Ude. The authors explain this pattern by the abnormal natural conditions of the region, the development of the mining industry, in particular the development of powerful reserves of uranium and polymetallic ores. And the city of Ulan-Ude, where the entire industrial hub and fuel and energy complex is concentrated, is one of the ten most polluted cities in Russia due to the location in a closed basin of a mountainous country. In the first three analysis periods until 2011 there was a low incidence in the high-altitude region of Okinsk, and in Tunkinsky until 2006, in Muisky until 2001, however, in their territories in the last five years, sharp gain was seen respectively from 147%, 205% in relation to 231% initial period. This is probably due to the fact that the development of natural raw materials, begun in the 1960s by the Soviet authorities, is still a handicraft way, leaving a pathological “trace” on the health of the population, manifested in tens of years. The gradual gain of oncopathology is observed in Dzhidinsk, Kizhinginsky, Mukhorshibirsky, Selenginsky, Khorin, Kyakhta districts. However, there are territories of the regions of the republic, like Eravnensky and Ivolginsky, where the incidence is insignificant.

Considering the findings regarding the excellent frequency response (approximately 70%), survival without disease progression (median approximately of 9 months), better safety profile and the superior quality of life for patients compared with standard chemotherapy, EGFR TKIs in EGFR mutation positive non-small cell lung cancer patients can be now considered as first-line treatment in these patients. Evaluation of epidermal growth factor receptor mutations is necessary for all non-small cell lung cancer patients as the effective prognostic marker of the response to tyrosine kinase inhibitors of EGFR.