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PREVENTIVE MEDICINE

Methodical approaches to calculating the probability of negative responses for personal human health risk assessment

N.V. Zaitseva ^{1, 2}, P.Z. Shur ^{1, 2,} D.A. Kiryanov ^{1, 2}, V.M. Chigvintsev ¹, O.V. Dolgich ^{1, 2,} K.P. Luzhetsky ¹

¹ Federal Budget Scientific Institution «Federal Scientific Center for Medical and Preventive Health Risk Management Technologies», Perm, Russian Federation

² Fedral State Budget Educational Institution of Higher Professional Education «Perm State National Research University», Perm, Russian Federation

Abstract

The aim of this study is to improve the methodical approaches to estimation of the probability of negative responses in order to assess the individual risks to human health.

Methodological approaches. These approaches included the consistent modeling of the probability of developing of the single nosological forms of respiratory system’s diseases in groups of people with different variations of genes that determine sensitivity to the studied risk factors. Their approbation on example of the individual characteristics of sensitivity to environmental exposure to vanadium by the humans with the variations of the candidate genes has been carried out using the results of cross-epidemiological studies. To define a human’s genotype, the method of allelic discrimination was used. The content of vanadium in urine (a marker of exposure) was determined by mass spectrometry with inductively coupled plasma. Simulation of the factor’s influence on the probability of response both for whole subpopulation and for the most sensitive subgroups was performed by constructing the logistic regression models for the exposure levels that exceeded the benchmark.

Results. During approbation of the approaches it was found out that people with the CT gene variation FAS, and TLR4 gene variation AG are a contingent with high sensitivity to the effects of vanadium on the respiratory system. For these individuals the individual risk of respiratory diseases (hypertrophy of the adenoids) is registered and it is higher than that of the total population exposed to vanadium. The level of this risk (up to 2.62·10-4) id characterized as inadmissible.

Conclusion. The proposed methodological approaches to the calculation of the probability of negative responses to the impact of habitat factors on the results of special epidemiological studies allow to take into account the individual characteristics of the human genotype, modifying the development of such responses on the influence of habitat factors.

Keywords: individual risk, genetic status, dependences modeling.

Hygienic validation of assessment of drinking water quality in terms of epidemiological safety using methodology of public health risk assessment

A.V. Mel’tser, A.V. Kiselev, N.V. Erastova

North-West State Medical University named after I. I. Mechnikov, Saint-Petersburg, Russia

Abstract

Introduction. Drinking water can become a factor of various infectious diseases transmission etiologically connected with water factor. Existing national methods for assessing the safety of drinking water are based primarily on a score assessment approach with a certain degree of conditionality which is not focused on a real threat to health. It is appropriate to add a method based on a score assessment system including overall positions for calculation of probable risks.

Purpose. Hygienic validation of method of probabilistic assessment of drinking water quality in terms of epidemiological safety to improve management of drinking water quality.

Materials and methods. Materials of the study are based on the existing approaches, methodological and guidance documents aimed at assessing the quality of drinking water on indicators of epidemiological safety, scientific publications. Methodology and methods: methodology analysis of health risk assessment, methodical recommendations Mr 2.1.10.0031-11 “a Comprehensive assessment of the risk of bacterial intestinal infections transmitted by water”, a comparative analysis, generalization, modeling.

Results. For purposes of this study the methodological approaches described in the methodological recommendations 2.1.10.0031-11 “a Comprehensive assessment of the risk of bacterial intestinal infections transmitted by water” are adapted in terms of methodology principles of public health risk assessment. The algorithm of probabilistic assessment of epidemiological safety of drinking water is discovered. The value of acceptable epidemiological health risk, the levels of its upper and lower confidence limits are proposed and approved.

Conclusions. The proposed method provides the ability to perform epidemiological risk assessment to human health associated with the consumption of drinking water, based on the calculated boundary values of acceptable/unacceptable risk. Using this method combined with method of integrated assessment of drinking water in terms of chemical harmlessness it allows us to develop and implement the models of integrated risk assessment related to the combined effect of chemical substances and microbiological agents contained in drinking water.

Key words: water supply, drinking water quality, safety of drinking water, integrated assessment of drinking water, risk assessment for health.

Modernization of radiation safety supervision SYSTEM in MEDICAL PREVENTIVE INSTITUTIONS

E.E. Andreeva, E.N. Ignatova, P.A. Istratov, SA Ryzhov

Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow Department, Moscow, Russia

Abstract

The purpose of research is to analyse and assess the operation and prospects of development and modernization of radiation safety supervision system in medical preventive institutions in order to improve its efficiency and reduce excessive administrative barriers to business.

Materials and methods of research: This paper describes the medical preventive institutions of Moscow in terms of the radiation hazard, briefly justifying the need for modernization of the state sanitary and epidemiological supervision of radiation safety. The purpose and objectives of the study determined the methods used in the article: statistical and analytical methods, modelling, expert assessment, system analysis, process analysis, process approach, clinical and economic analysis. A comparative analysis of sufficiency of ionizing radiation sources in the city of Moscow and the Russian Federation has been conducted, as well as the assessment of major trends in diagnosis and radiation therapy.

Results: The analysis shows that the existing system of state sanitary and epidemiological supervision of sources of ionizing radiation does not fully meet the challenges of today: the regulatory framework used is outdated and requires updating. Approaches used in supervisory practices do not always ensure compliance with the requirements of radiation safety in the course of radiation diagnosis and therapy.

Conclusions: The results of the research lead to the following conclusions: 1. The state regulation of the use of ionizing radiation for medical purposes is a worldwide practice and is necessary in the Russian Federation. 2. The current system of supervision of radiation safety needs to be upgraded. 3. Several possible ways of modernizing supervision of radiation safety in medical preventive institutions are proposed.

Key words: sources of ionizing radiation; radiation safety; radiation monitoring; radiology; ray diagnosis and therapy; state sanitary and epidemiological supervision; radiation accident.

Defects of medical documentation as a result of inadequate medical supervision for a modification of risk factors of the most important non-communicable diseases

A.V. Zelionko, V.S. Luchkevich, I.A. Mishkich, M.V. Avdeeva

North-Western State Medical University named after I.I. Mechnikov, St.-Petersburg, Russia

Abstract

Introduction. Under conditions of high morbidity and mortality from diseases of the cardiovascular system, respiratory system, diabetes and tumors timely identification of risk factors for the above diseases with close medical supervision over the process of their personal modification is extremely important.

Methods: According to the 310 accounts forms “№025/y” it is evaluated the wealth of information of the patient cards for the presence/absence of medical records of the most important risk factors of the most important non-communicable diseases.

Results. Most often fixed as medical records are risk factors for blood pressure (BP) (76.9%), glucose (52.3%) and total cholesterol (49.2%). Blood pressure is determined and documented in the medical record at 80.4% of patients with hypertension and 88.2% of patients with coronary heart disease. However, during the calendar year, the level of glucose is controlled in only 25.0%, the mass index – at 7.3%, and total cholesterol – in 22.1% of patients with hypertension. Body mass index is calculated and monitored in only 8.0% of patients with coronary heart disease.

Conclusion. Revealed the typical defects of patient management and registration of primary medical records, reducing the wealth of onformation of the patient cards for the expert evaluation of the effectiveness of medical and preventive interventions implemented at the level of primary health care. The findings suggest the need to tighten control over modification of medical risk factors of the leading non-communicable diseases on the basis of systematic monitoring of clinical indicators of risk to the health and lifestyle of urban residents.

Key words: primary health care, quality of medical care, disease risk factors, prevention of non-communicable diseases

DYNAMICS OF ANDROLOGICAL DISEASES IN STUDENTS OF THE FRUNZE DISTRICT OF ST. PETERSBURG

V.E. Mirskij, S.V. Rishchuk, T.A. Dushenkova, T.A. Dudnichenko

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Abstract

The purpose of the study was to analyse the prevalence and patterns of andrological diseases among schoolchildren of the Frunze district of St. Petersburg gained from the screening examinations.

Materials and methods: examined 19597 students of the Frunze district of St. Petersburg at the age from 7 to 17 years. The work was carried out by specialists of the Northwest andrology Institute in the period from 1998 to 2014 on the basis of school and health facilities of the district. In 1998-99 14189 people were examined, in 2008-2009 – 1660, in 2010-2011 – 2684, in 2013-2014 –1064. Identification of andrological pathology was carried out by conventional clinical diagnostic approaches. Statistical analysis was performed using nonparametric methods (CHI-square, the coefficient of the Spearman rank correlation) and parametric (calculation of average value, variance and error, and t-student test) statistics. The calculation of these parameters was conducted using the computer software statistical processing SPSS 13, 0 [Zaitsev V. M. et al., 2006]. 39 Профилактическая медицина № 3 (56) ¦ 2015

Results and discussion: the analysis of levels and patterns of andrological pathology of students gained from the screening examinations in the Frunze district for 15 years showed that andrological pathology has increased in 2 times, and in the last 2 years more than in 3 times. The inspection identified following andrological pathology: varicocele, testicular hypotrophy (usually the left), phimosis, rigid foreskin, hypospadias, cryptorchidism, posthitides various etiologies, adhesions, gynecomastia, delayed sexual development, cysts of various localization, short frenulum, inguinal-scrotal hernia, mobile testicle, hydrocele, spermatocele, metally stenosis, micropenis. Analysis of the spread dynamics of individual nosological forms showed that some of them were detected frequently enough and varied in different years in a wide range. Of particular interest are data on detection of andrological pathology depending on age. It seemed that the greatest spread of this pathology was observed in the age of 7-9 years (313, 9‰) in 2013-2014 as we approach reproductive age (14-16 years of age and older) level of pathology is reduced (74, 2‰ with 35.8‰). In the structure of andrological pathology in 2013-2014 among adolescents of 14-16 years and older the leading value had varicocele, phimosis, posthitides, rigid foreskin, adhesions and a short frenulum. Conclusion: 1. Andrological pathology among adolescent boys in recent years tends to increase. 2. Age group 14-16 year olds and older, as the closest ones to reproductive age, in 2013-2014 was characterized by the presence of several leading andrological diseases: varicocele, phimosis, posthitides, rigid foreskin, synechiae, and short frenum. 3. During clinical examination of adolescents of 7 and 14 years for better detection of andrological pathologies simultaneously it requires the participation of urologists and andrologists, pediatricians and endocrinologists.

Key words: sexual development, andrological pathology, reproductive disorders, infertility.

Medico-social features of risk groups formation and the quality of life of urban residents with respiratory diseases

T.V. Samsonova ^1, E.A. Abumuslimova ¹, A.A. Gorshkov ²

¹ North-Western State Medical University named after ^{I. I.} Mechnikov, Saint-Petersburg, Russia

² Interdistrict Tikhvin hospital named after A. F. Kalmykov, Tikhvin, Russia

Abstract

Purpose: to study medical and social characteristics and risk factors of the major life functioning that can effect on Health- Related Quality of Life (HRQoL) of urban residents and can lead to the formation of chronic pulmonary disease among Saint-Petersburg residences.

Materials and methods. medico-sociological study was organized with 3032 St. Petersburg residents which were selected by stratified cluster randomization. Presence of respiratory symptoms and lung diseases were identified by WHO specialized questionnaire “Burden of major Respiratory Diseases Who Survey”. Socio-statistical study of quality and efficiency of medical aid was conducted among 369 patients hospitalized at a specialized pulmonological department of the St. Petersburg multi-profile hospital. Program for clinical-organizational and treatment efficiency with estimation of dynamics of HRQoL indicators for chronic respiratory diseases was used. Statistical data processing was performed with calculation of reliability and correlation coefficients of the revealed patterns.

Results. the results of the screening survey identified a high proportion of St. Petersburg residents with prenosological conditions and presence of respiratory symptoms (34,1%). Adverse environmental risk factors, occupational hazards, living accommodations, family lifestyle, insufficient level of medical awareness, low level of medico-social and preventive activity of urban residents, their late appealability for medical aid, presence of concomitant diseases have a significant impact for the formation of chronic respiratory diseases and the effectiveness of treatment. It was determined risks groups of urban residents that need different types and amount of clinical diagnostic examinations and specialized treatment. The analysis of dynamics of HRQoL showed that the presence of respiratory diseases in a significant proportion of urban residents (23,1 %) contributes to the exacerbation of physical functioning, social adaptation and self-service ability, emotional wellbeing, diseases symptoms manifestations and unhealthy status. It’s proved high efficiency of treatment with a significant improvement in the dynamic of clinical-functional condition and parameters of HRQoL.

Conclusion. there is defined a high prevalence of chronic respiratory disease in St.-Petersburg region what is significantly higher than the official statistical data. There is hypodiagnostic of chronic respiratory diseases that increases possibility for forming of chronic kind of illnesses, can aggravate personal physical condition and diseases symptoms. There is correlation between the features of formation of chronic respiratory diseases, risk factors and quality of life of urban residents. Pulmonary diseases development lead to significantly declining quality of life, satisfaction level of accessibility and quality of medical care among patients and increasing a share of people with emotional discomfort. Treatment in a specialized hospital showed a positive trend of these indicators.

Key words: chronic respiratory diseases, chronic obstructive pulmonary disease, risk factors, quality of life, effectiveness of inpatient treatment.

Using of life quality indicators as a criterion of the treatment effectiveness of patients in the intensive care and resuscitation department of general hospitals

D.S. Tiagunov, V.S. Luchkevich, M.V. Avdeeva, N.T. Gonchar

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Abstract

Introduction. The structure of the patients, the severity of their condition and specifics of treatment largely influence the duration and effectiveness of treatment in the intensive care and resuscitation department. Therefore, at the stages of the treatment process is necessary to substantiate the organizational measures to ensure continuity in the conduct of clinicaldiagnostic and therapeutic and resuscitation measures, with psychological correction and improving quality of life.

Methods: according to the primary form «003/y» clinical condition and indicators of quality of life of 200 patients in the intensive care and resuscitation department of general hospital were studied. With the help of a specially designed program studied the main types of functioning in the structure of the quality of life of 150 patients.

Results: Persons under 60 years of age urgently delivered in hospital more often than people older than 60 years (p<0,05). The average duration of stay of patients in the intensive care and resuscitation department is 2,89±0,12 days. 1 patient has an average of 13,85±0,68 examination. After the complex of intensive treatment and resuscitation measures quality of life for most patients improved (p<0,01), especially indicators of psycho-emotional state, severity and intensity of pain, the ability of selfservice and others. But some patients still need further psychological correction from the medical staff and support from family members. For patients of the intensive care and resuscitation department the main part of indicators of quality of life is in relation to the availability of medical care (r = 0,8; p<0,05), attitude of medical staff (r = 0,54; p<0,05), level of psychological support (r = 0,46; p<0,05), the severity of the psycho-emotional experiences, anxiety and depression (r = 0,42; p<0,05), satisfaction with the timeliness and quality of medical aid (r = 0,38; p<0,05), availability of medications (r = 0,36; p<0,05).

Conclusion. Quality of life and satisfaction with treatment results depend on the efficiency and quality of medical care, attitude of medical staff to their professional duties, completeness of use of existing in department diagnostic capabilities, degree of psycho-emotional correction from medical professionals and support from family members.

Key words: quality of life, intensive care and resuscitation department, medico-social characteristics, efficiency and quality of medical care.

HEALTCARE PLANNING FOR THE POPULATION RESIDING THE ARCTIC REGION OF THE RUSSIAN FEDERATION

V. P. Chashchin, I. E. Plakhin

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Abstract

Many factors influence on health of population living in Russian Federation Arctic Zone. Factors are include anthropogenic environment pollution, severe natural-climatic conditions and unfavorable social and economic situation. Geographical and political isolation of Arctic Zone regions have an impact on availability and quality of medical aid.

Objectives. This study identifies priorities in strategic planning of public health program in Russian Federation Arctic Zone.

Methods. Years of potential life lost (YPLL) and disability-adjusted life years (DALY) were calculated for indigenous Arctic population.

Results. Cardiovascular diseases, diseases of respiratory system, gastrointestinal system, musculoskeletal system, mental disorders, neoplasm and injures are make the largest contribution in DALY. Changes in Arctic climate may possibly cause the increase of DALY.

Conclusions. Health care planning should be focused on foreground diseases, which make the largest contribution in DALY. A higher attention should be given on preventive measures.

Key words: Arctic, public health, burden of disease, DALY.

THE EVALUATION OF THE MEDICAL AND SOCIAL REHABILITATION EFFECTIVENESS OF THE PERSONS WITH DISABILITIES IN SIBERIAN AND VOLGA FEDERAL DISTRICTS OF THE RUSSIAN FEDERATION

G. I. Chernova ¹, А.А. Svintsov ^{1, 2,} T.S. Chernyakina ^{1, 2,} V.I. Raduto

¹ Saint-Petersburg Scientific and Practical Center of Medical and Social Expertise, Prosthetics and Rehabilitation of the Disabled Persons named after G.A. Albrecht, the Ministry of Labour and Social Protection of the Russian Federation, Saint-Petersburg, Russia

² North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Abstract

Рurpose: the analysis and the evaluation of the individual rehabilitation programs effectiveness designed by the institutions

of medical and social expertise in the Buryat Republic and the Republic of Tatarstan.

Materials and methods: To evaluate the effectiveness of the rehabilitation programs implementation there was carried out a comparative analysis of materials of federal statistical observation form №7-social security “Information on medical and social examination of persons aged 18 years and older” and form number 7 D (social services office) “Information about the medical and social examination of persons under the age of 18 years “. We used the methodology of scientific-theoretical analysis of the organizational principles of the disabled rehabilitation, systematic and comprehensive analysis of statistical indicators, mathematical and statistical methods for calculating the prevalence (level) and distribution (structures), methods of observation and comparison. In 2010, the data on the rehabilitation services delivery was analyzed as well as a comparative analysis on the indicators of the disabled rehabilitation effectiveness in the federal districts of the Russian Federation was carried out. The indicators were calculated for the the Russian Federation in general and for two subjects of the Siberian and Volga Federal Districts (Buryatia Republic and the Republic of Tatarstan).

Results: The calculated rates of primary and re-disability adults and children according to the analysis of materials of federal statistical observation in the Buryat Republic and the Republic of Tatarstan in comparison with the Federal District and the Russian Federation in general. The evaluation of the effectiveness of the individual rehabilitation programs implementation in the regions of Siberia and the Volga Federal District was given. These regions demonstrate a steady trend of the growing number of people with disabilities. The selected regions of the Russian Federation allowed to substantiate the regularities of the individual rehabilitation programs effectiveness in the typical territorial – administrative entities of Russia.

Conclusion: The materials of the federal statistical observation suggests that in the Buryat Republic and the Republic of Tatarstan there is insufficient use of mechanisms of comprehensive rehabilitation. In order to improve the system of measures for the rehabilitation of the disabled the further development and formation of the rehabilitation facilities network availability should be implemented as well as the evaluation of the effectiveness of the quality work of the rehabilitation performers and the interdepartmental cooperation of medical and social expertise institutions and organizations engaged in the rehabilitation of people with disabilities.

Key words: people with disabilities, primary disability, re-disability rehabilitation efficiency.

Factor analysis in the study of medico-social aspects of acute alcohol poisoning among the population of Omsk

A. V. Sabaev ¹, P. O. Goleva ²

¹ City clinical emergency hospital No. 1. Omsk, Russia

² Omsk state medical University, Omsk, Russia

Abstract

The purpose of the study. To study medico-social aspects of acute alcohol poisoning among the population of Omsk.

Materials and methods. Conducted complex medical-social study of the problem of acute alcohol poisoning by means of the technique of factor analysis.

Results. Factor analysis allowed us to determine the leading causes and risk factors of acute alcohol poisoning in the population of Omsk, which is necessary for optimization of organizational and managerial decisions in the light of prevention of this pathology.

Conclusions. Revealed the primary role of domestic factors in the development of acute alcohol poisoning among the population. The second most important drug is the factor that determines the likelihood of alcohol poisoning, depending on the timeliness and quality of drug treatment. Equally affect the risk of alcohol poisoning such factors as the patient’s sex (a biological factor), financial factor, personal-psychological and psychopathological factor factor.

Keywords: аcute alcohol poisoning, factor analysis, health and social aspects.

The introduction of quality management in testing laboratories: Human Resources

^I.Sh. Yakubova, E.S. Tregubova

North-Western State Medical University named after ^I.I. Mechnikov, Saint-Petersburg, Russia

Abstract

This article analyses the most important factors and reasons that create difficulties to implementing quality management system in a laboratory and gives recommendations to overcoming such factors. Aim of the investigation- to develop methodical system of competence formation on quality management amongst test laboratory personnel for introduction, practical application and continuous improvement of systems of quality management in test laboratory

Materials and methods. The development of methodology for formation of managerial competence amongst test laboratories personnel required the following methods to be used – systemic, competence-based and functional approaches, additionally the following research tools were also used: theoretical analysis of legislative documents, normative, didactic literature concerning difficulties with quality management’s training methods; analysis of curricula; diagnostic tools (observation, conversation, interviewing, questioning, testing); modeling, statistical processing of results.

Results and discussion. The analysis of the most important factors that create difficulties when introducing quality management system in test laboratory revealed the main problems that interfere with formation and introduction of quality management system. In connection with complexity of the studied material on quality management system which is based on systemic approach, for planning of the educational purposes the systemic method, in particular the taxonomical scheme of B. Blum was used. As a result of research the concept “competence on quality management” for the personnel of test laboratories was formulated and the methodical system for corresponding competence formation amongst the test laboratories personnel is offered.

Conclusion. The methodical system of competence formation in quality management amongst test laboratories personnel, contains the following structural components: target, substantial, procedural, controlled and productive. Efficiency of information transfer from the teacher to listeners is provided as traditional form(lectures, seminars, independent work), and by active forms of education. Formation of competence on quality management amongst test laboratories personnel is provided by active forms of education, such as lecture with methodical maintenance and feedback and training consultation.

Key words: quality management, test laboratory, methodical system for quality management competence formation amongst the test laboratories personnel, the training of the personnel, active methods of training, lecture with methodical maintenance and feedback training consultation.

HEALTH AND HYGIENE EDUCATION OF THE POPULATION AT THE STAGES OF FORMATION AND DEVELOPMENT OF THE RUSSIAN STATE (Part 1)

S.M. Kuznetzov ¹, V.A. Majjdan ¹, A.A. Shishlin ¹, M.A. Bokarev ¹, A.V. Majjdan ²

¹ Military-medical academy named after S.M. Kirov, Saint-Petersburg, Russia

² Российский университет дружбы народов, Россия

Abstract

Purpose: analytical review of historical materials characterizing the development of health education in the XVI-XVIII centuries.

Materials and methods: more than 20 scientific publications of different periods studied by historical analysis. Results: It was found that the basic sanitary rules found in the Slavic chronicles of Kievan Rus’, Novgorod and the Principality of Moscow were aimed to improve the public health in Russia in the XVIII century and continued the same trend during the Patriotic War of 1812.

Conclusion: Health and hygiene education were characterized by specific to the particular era public, cultural and religious backgrounds:

– military health priority, due to the numerous wars;

– limited hygiene education due to the lack of medical science development;

– distribution of hygiene knowledge not in the form of individual prevention because of the low level of literacy of the population, but by strict regulation of certain provisions relating to the organization and infrastructure of prevention, in the form of relevant decrees, instructions, regulations, rules, which determine the priority of the collective and social prevention, as well as “fiscal” method of imparting the implanted sanitary culture commanders, chiefs, governors;

– the sole responsibility of the government and military officials (not doctors) for compliance with the legal framework and the organization of disease prevention, due to their high level of education and culture in contrast to the general public;

– doctors carrying the responsibility for providing medical education and knowledge in the form of recommendations,

requests, suggestions and appeals to the government and military officials;

– the independent role of the Church in the formation of certain aspects of the world view on hygiene, morality and social responsibility in individual and public health protection.

Key words: health education, hygiene education, the history of Russia, military health care, disease prevention, sanitary culture.

CLINICAL MEDICINE

Morbidity, diagnosis, dynamics of the histological structure, the effectiveness of lung cancer treatment of patients in different age and gender groups at the present stage

V.М. Merabishvili ¹, А.S. Barchuk ¹, А.А. Barchuk ¹, А.V. Atroshchenko ³, А.М. Shcherbakov ¹, S.А. Tarkov ², А.I. Arseniev ², Е.V. Demin ¹, E.N. Merabishvili ⁴, V.G. Preis ², М.V. Xaritonov ³, О.F. Chepik ¹

¹ N.N.Petrov Research Institute of Oncology

² St. Petersburg Clinical Research Center of Specialized Types of Medical Care (Oncology)

³ Oncology Center of Moskovskiy district

⁴ I.I.Mechnikov North-West State Medical University St. Petersburg

Abstract

Introduction. According to the International Agency for Research on Cancer (IARC) forming its basis (Globocan-2012) [10] it contains information on new cases of malignant neoplasms of 28 major cancer sites in 184 countries around the world. The total number of new cases of cancer in 2012 increased to 14.1 million and the number of deaths increased to 8.2 million. According to the IARC, lung cancer ranks the first among all malignancies (13%), breast cancer – the second (11.9%), colorectal cancer – the third (9.75%). The greatest number of deaths accounts for lung cancer (1.6 million, 19.4% of total deaths). In a previous article [4], we presented the dynamics of cancer morbidity in Russia and St. Petersburg until 2003. This research provides a more detailed analysis, including the year 2012. In most of the countries lung cancer ranks the first in the structure of cancer incidence.

Purpose. the continuation of the study on the dynamics of lung cancer incidence by patients’ gender, age, the histological structure and the coverage of patients by specialized treatment on the basis of the first Russian population-based Cancer Registry of St. Petersburg working in accordance with international standards.

Materials and methods. The estimations of crude and standardized (world standard) and gender and age indicators, the index of accuracy, the use of geographic information systems in creating cartograms. The estimation of analytical indicators of the morphologically verified patients proportion, the distribution of patients by stages, the estimation of a 5-year observed patient survival taking into account the stage of the disease. The use of the international classifications ICD-10 and ICD-0 -2.

Results. There was a substantial reduction of the standardized lung cancer incidence for men in St. Petersburg from 1980 to 2012 by 46.2% as in women this rate increased by 2.6%. The mortality rate in the city because of lung cancer decreased by 45.3% in case of men and in case of women – by 26.7%. Significant defects in staging of primary cancer were revealed as well as the low level of specialized treatment. A low level of morphological verification of lung cancer was also detected.

Conclusion. Thus, this study allowed revealing the significant reduction of standardized incidence rate of lung cancer since 1980 by 46.2% in men and mortality rate – by 45.3%. In women, despite the increase of morbidity during this period by 2.6%, the mortality rate decreased by 26.7% [5]. There were found some substantial defects in staging of primary lung cancer cases, especially among the male population. The low proportion (32.3% and 29.3%) of specialized treatment was revealed. A detailed histological structure of tumor was not specified in 44.1% of patients but was presented in general terms, for example in case of squamous cell carcinoma – without additional features.

Key words: lung cancer, morbidity, diagnosis, histological structure, coverage of patients by specialized treatment by gender and age.

THE PERSPECTIVES OF ENZYMATIC TEST APPLICATION IN PATIENTS WITH GASTROINTESTINAL AND LUNG CANCERS

E.M. Bakurova, R.V. Buzina, I.V. Vasilenko, B.G. Borzenko

Donetsk National Medical University named after M. Gorky, Donetsk, Ukraine

Abstract

Purpose: to evaluate the diagnostic relevance of thymidine phosphorylase (TP) in case of gastrointestinal and lung cancers. Materials and methods: The comparative study of TP activity by means of spectrophotometric method in solid gastric and lung tumors, non-neoplastic tissues of resection margin and blood plasma of 88 patients.

Results: TP activity in patient plasma in case of advanced cancer of various localization was determined to be 2,2–3,5 times lower (p<0,001). In most cases it is accompanied by the decrease of tumorous activity (by 1,9–2,7 times, p<0,01). The levels of CD 34 expression were determinated in 20 samples of tumors of lung cancer with increasing individual TP activity. The positive correlation between the intensity of the of CD 34 expression and TP activity was shown (the index of Spearman’s rank correlation, i.e. ρ = 0,67; p<0,05).

Conclusion: 1. Investigation of TP activity in blood plasma may be used as the individual prognostic test. 2. Tissue enzyme activity correlates with the intensity of angiogenesis.

Key words: thymidine phosphorylase, angiogenesis, gastrointestinal cancer, colon cancer, lung cancer.

Cavinton monotherapy of discirculatory encephalopathy in patients with arterial hypotension

V. V. Burdakov, Y. S. Sevastianova

Orenburg State Medical University, Orenburg, Russia

Abstract

The purpose of the study is a comparative analysis of the vasoactive drug Cavinton effect on the general and cerebral hemodynamics parameters in patients with dyscirculatory encephalopathy (DE) on the background of arterial hypotension and normothony.

Materials and methods. In the case of 56 patients with dyscirculatory encephalopathy stage I on the background of arterial hypotonia and normothony, there was studied the influence of the drug Cavinton on the indicators of General and cerebral hemodynamics, autonomic regulation, neuropsychological disorders with the definition of anxiety and emotional tension, electroencephalography, rheoencephalography and pulsometry. Digital material was processed by means of conventional methods of variation statistics.

The results of the study demonstrate a decrease in cerebral and cognitive symptoms, lowered blood pressure and the level of anxiety, increased heart rate, the improvement of rheoencephalography and electroencephalography parameters on the background of drug Cavinton application.

Conclusion: 1.Changes in General and cerebral hemodynamics parameters demonstrated the positive effects of drug Cavinton on the values of blood pressure, cardiac output, blood, pulse blood filling, venous outflow, elasticity and tonus of vessels in patients with dyscirculatory encephalopathy on the background of hypotension the normothony. 2. The method for determination the anxiety and emotional tension during treatment by means of Cavinton showed the decrease of high and medium levels of anxiety as well as the emotional tension to a lower value. 3. Variational pulsometry indicates chronotropic and vasodepressor effect of Cavinton to a greater extent in women with dyscirculatory encephalopathy on the background of arterial hypotension rather than in case of normothony.

Кey words: encephalopathy, cavinton, therapy, hypotension.

Antimetabolic therapy by metformin

O.P. Shatova, Eu.V. Butenko, Eu.V. Khomutov, D.S. Kaplun, I.Eu. Sedakov, I.I. Zinkovych

Donetsk National Medical University named after Maxim Gorky, Donetsk, Ukraine

Abstract

Introduction. Actual direction in therapy of cancer patients is considered to antimetabolite therapy, in particular the use of biguanide – metformin. However, there is still no clear understanding in the implementation of anti-tumor effect of metformin. We hypothesized that metformin affects the paradox Hellstrom, reducing adenosinergic immunosuppression in tumors. The product implements its action by increasing the activity of a key enzyme adenosine catabolism – adenosine deaminase.

The purpose of research – to study the effect of metformin on the activity of adenosine deaminase (ADA) in the tissues of breast adenocarcinoma.

Materials and Methods. Study of the activity of the enzyme and its substrate concentrations (adenosine) and products (inosine, hypoxanthine) was performed by reverse phase high performance liquid chromatography (HPLC) in 30 women aged 46-76 years with breast cancer the concentration of adenosine, inosine, hypoxanthine and activity of ADA.

Results. We have found that, given the long-term use of metformin activity of ADA’s adenocarcinoma tissue significantly increased.

Conclusions. The results suggest that long-term use of metformin significantly increases the activity of ADA in the tissues of breast adenocarcinoma.

Key words: metformin antimetabolite therapy, breast cancer, adenosine deaminase, adenosine, inosine, hypoxanthine.

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