The prevalence of risk factors for HCC in the Russian population is reflected in a significant potential growth in morbidity. In the absence of active screening programs in the Russian Federation, mortality from liver cancer in risk groups and late diagnosis groups significantly exceeds the growing morbidity. Cancer care for HCC patients in the Russian Federation is at an early stage of development and is represented by several clinical centers in Moscow, St. Petersburg, and several regions. In the absence of approved standards for diagnosis and treatment of HCC, surgical treatment of early stage diseases is primarily carried out; some clinics have experience of interventional radiology procedures for the locally advanced process and pharmaceutical therapy. Fast and significant reduction in mortality is possible with an overall introduction of a multidisciplinary approach in the diagnosis and treatment of HCC, based on extensive intra- and inter-hospital cooperation between different specialists – surgeons, transplantologists, interventional radiologists, chemotherapeutists, hepatologists, diagnosticians at all stages of the development of cancer.

The article tells about the current problems in the treatment of castrate-resistant prostate cancer. An extensive search for more effective treatments resulted in the development of a number of novel drugs which affect the quality of life of patients as well as increase the overall survival rate and time to PSA progression. The article studied the clinical efficacy of first-line cytotoxic chemotherapy with docetaxel. Satisfactory tolerance of docetaxel monotherapy was demonstrated. PSA levels declined > 50% in 43.7% of patients with overall survival up to 16 months.

The review deals with research of new multikinase inhibitor regorafenib used for treatment of chemorefractory metastatic colorectal cancer. Regorafenib inhibits various protein kinases implicated in oncogenesis, angiogenesis, and the tumour microenvironment. In two placebo- controlled, randomized, phase III trials (CORRECT and CONCUR) treatment with regorafenib has demonstrated statistically significant improvements in terms of overall survival, progression-free urvival and disease control rates when compared with placebo in pretreated patients. Correlative analyses suggest a clinical benefit favouring regorafenib across various patient subgroups including subgroups defined by KRAS mutational status and other biomarkers. The most common grade ≥3 adverse events were hand-foot syndrome, fatigue, diarrhea, hypertension and rash/desquamation. The benefit provided by regorafenib was observed in two open-label, single-arm studies (REBECCA and CONSIGN) performed in the real-world setting.

Prostate cancer (PCa) is a hormonsensitive tumor. Due to the discovery of the androgen receptor (AR) it became possible to implement the antiandrogens as drugs blocking testosterone Binding to the AR into routine clinical practice. There have been discovered several generations of the antiandrogens over the years and the possibility of using these drugs in clinical practice has significantly changed. First generations of the antiandrogens (cyproterone, flutamid, bicalutamid) are used mainly for the treatment of advanced hormonsensitive PCa in combination with castration therapy. However these drugs do not increase survival in patients with PCa and are not indicated in terms of castration resistant PCa. Discovery of the enzalutamide (antiandrogen of 2’d generation), acting on the nuclear level of the tumor cell, allowed to increase significantly survival in patients with metastatic castration-resistant prostate cancer (mCRPC) and improve treatment results in patients with mCRPC. At the moment enzalutamide is being studied in combination with castration therapy in patients with hormonsensitive PCa.

The article covers the results of clinical application of a domestic drug based on recombinant tumor necrosis factor-alphathymosin-alpha1 (TNF-T) combined with chemotherapy FAC and РА during neoadjuvant treatment of patients with breast cancer IIB-IIIB stage. In contrast to the standard subcutaneous application method, the authors proposed peritumoral administration of TNF-T to maximize the drug’s action directly on the tumor, peritumoral tissue. TNF-T 200000 IU peritumorally on days 1–5 of each treatment course during chemotherapy showed significant increase in objective effect rate, including increase in frequency of complete regressions, and decrease in frequency and intensity of chemotherapy complications. Morphological examination revealed an increase rate of medical pathomorphosis grade III-IV, decreased number of microvessels in tumor in comparison with primary tumors. Study of immune status of patients in dynamics shows that the proposed method of peritumoral application of recombinant hybrid protein of tumor necrosis factor-alpha- thymosin-alpha1 has an immunocorrective effect because of its effect on T- and B-cell component of the immune system.

Anemia is one of the most frequent complications arising in patients with malignant growths, it is characterized by reduction of hemoglobin level and disturbance of a number of physiological and metabolic processes in the organism, impairing the course of the disease and patients’ life quality. The major reasons of the hemoglobin concentration reduction include: anemia induction by the tumour, chemotherapy and chronic inflammation anemia. The most frequent methods of therapy are: red blood cell transfusion, prescription of erythropoiesis-stimulating drugs (ESA) and iron supplements. Erythropoietins indication is the most preferential method taking into account complications related to red blood cell transfusions. Erythropoetins alpha and beta are the most well-known and well-studied among the first generation ESAs. The erythropoietin theta is not a biological analogue. It is represented as a separate product. It demonstrated non-inferiority of anemia treatment in cancer patients as compared to the erythropoietin beta in studies. Dosage of 20 000 IU of erythropoietin theta was sufficient for the full hemoglobin response in more than a half of patients.

Information about retraction of an article

Analysis conducted by the members of the editorial board has revealed the direct borrowing without reference to the specific source of citations in the following articles:

The article by Alekseev B.Ya., Nyushko K.M., Kalpinskiy A.S. Targeted therapy in patients with metastatic kidney cancer in real clinical practice and the article by Alekseev B.Ya., Nyushko K.M., Kalpinskiy A.S. The use of sunitinib in real clinical practice in patients with metastatic kidney cancer // Onkourologiya = Oncourology  – 2016 – V. 12 - No. 1 – p. 14-20.

Based on the decision of the Editorial Board of the journal Medical Council dated January 17, 2020, the following article has been retracted:

Alekseev B.Ya., Nyushko K.M., Kalpinskiy A.S. Targeted therapy in patients with metastatic kidney cancer in real clinical practice // Meditsinskiy sovet - Medical Council – 2016 – 10 – p. 48-55.

The article presents the findings of clinical studies with use of sunitinib with advanced inclusion criteria and of non-randomized studies in which sunitinib clinical effectiveness is proved in patients with unfavorable forecast of the therapy course, non clearcell variants of mRCC, metastases in the brain, in elderly patients and in patients at the terminal stage of the renal insufficiency requiring hemodialysis. Despite lower values of objective response frequency, the survival rate without progressing in this category of patients as compared to patients with small-cell mRCC was comparable and the total survival rate was a little lower than in the registration randomized clinical study.

Conversion of the incurable disease in the chronic form and improvement of the life quality parameters on the background of appearance of new drugs is of specific importance for patients with NSCLC with activating mutations. “ESMO thinks that treatment of patients with wide-spread and incurable cancer forms a greater share of the oncologists work… and for these patients the quality of life is of chief importance irrespective of its duration. Use of high-precision targeted anti- EGFR therapy allows considerably improving the quality of life of oncologic patients with non-small pulmonary carcinoma with activating mutations.

Randomized clinical trials results have shown the advantage of non-selective EGFR tyrosine kinase inhibitor 2nd generation – afatinib compared with platinum-based chemotherapy in adenocarcinoma EGFR-positive patients in both the first and second-line of treatment. Shown significant improvement in PFS compared with standard platinum contain regimen and gefitinib in the first line of treatment. Also afatinib demonstrated the efficacy in the second line of treatment of squamous cell carcinoma of lung. The advantage of OS demonstrated in the subgroup of patients with Del19 in the global randomized clinical trials. According to the local experience FSBSI «Russian Cancer Research Center n.a. N.N.Blokhin» ORR afatinib therapy was 62.7% in the tumor growth control 94.1%. Median PFS – 18.0 months. The most common adverse events observed a rash, paronychia, and diarrhea requiring dose reduction of up to 30 and 20 mg / day, 34.5% and 16.4% of patients, espectively. On the whole, marked by a favorable toxicity profile and improve the quality of patients life.

Modern therapeutic approaches allow achieving stable therapeutic effect, extension and maximum long-term preservation of the quality of life of metastatic mammary gland cancer patients. Currently there is no optimal consequence of cytostatic agents use. The advantage of using cytostatic peroral forms is related to easiness of their use in clinical practice, no necessity in venopuncture and reduction of need in hospitalization, as well as with the possibility of a more convenient therapy domiciliary. Due to active use of peroral forms of vinorelbine, fluoropyrimidines, methotrexate, cyclophosphamide, ethopozide, patients received a possibility to choose: to remain in the inpatient hospital or to undergo outpatient therapy domiciliary with minimum changes of the style of life.

Metastatic melanoma remains a refractory disease. Great progress in therapy of metastatic melanoma patients has been made in the recent five years. Targeted immunotherapy – a selective effect on lymphocytes signal molecules - became a principally new trend in the drug therapy of tumors. Ipilimumab is the first drug of this class that demonstrated clinical effectiveness in metastatic melanoma patients. This article deals with a review of the latest data of internal studies and own clinical experience of ipilimumab application in metastatic melanoma patients.

Heart failure and atrial fibrillation are the most common cardiovascular conditions in clinical practice and frequently coexist. The number of patients with heart failure and atrial fibrillation is increasing every year. Nowadays the question of anticoagulant therapy for this category of patients is being discussed. In our review we summarized data on the guideline adherence and prevalence of long-term anticoagulant therapy in patients with atrial fibrillation and heart failure.

Double anti-platelet therapy (DAPT) comprising a combination of acetylsalicylic acid and one of the thrombocyte P2Y12-receptor blockers is considered an obligatory element of the acute coronary syndrome (ACS) therapy [1–5]. Enlargement of the antiplatelet drugs range with active implementation of ticagrelor and prasugrel led to questions in cardiologists who render medical aid to acute coronary syndrome patients. Despite the priority use of these drugs declared in recommendations instead of clopidrogel doctors practically daily face a necessity to choose the optimal P2Y12 blocking agent assessing the expected individual effectiveness, hemorrhagic safety and cost of the rather long-acting therapy. For doctors practicing in the territory of the RF as opposed to doctors in other countries the problem of the P2Y12 blocking agent is less large-scale as they have to choose only between ticagrelor and clopidrogel (prasugrel is not applied in the RF).

L-carnitine (LC) and its esters do not only participate in the metabolic exchange of the cardiac myocytes (they are responsible for transfer of long-chain fatty acids from the cytoplasm in mytochondria) but have other vital types of activity. They have antioxidant and anti- nflammatory effect at various levels. LC is proved to be a direct antioxidant and to remove already formed oxygen radicals as well as to suppress generation of oxygen radicals by cytoplasmic and membrane-connected ferments as a result of formation of complexes with iron and copper ions in their active centers. The leading reason of LC protective effects is change of activity of redox-sensitive signal paths targeted at nuclear receptors (they are factors of NF-kB; PPARs; Nrf2, AP1 etc. gene transcription). These factors control activity of a group of genes responsible for survival and stability of the cardiovascular system to various types of stress, including oxidative stress, and prevent loss of cardiac myocytes and endothelial cells at ischemia/reperfusion and other hypoxia-conditioned pathologic states. The review considers a number of mechanisms participating in protective effects of LC and its derivatives in the heart and other oxygen-dependent organs and tissues. 

Study objective: to evaluate safety of prolonged therapy of venous thrombosis by rivarixaban compared to the standard scheme of therapy by low-molecular heparins (LMH) with subsequent transfer to warfarin administration. Materials and methods. Prospective observation comparative study was conducted that included 243 patients with verified venous thrombosis. The control group included 96 patients to whom therapy by LMH/warfarin was prescribed. The major group included 147 patients to whom rivaroxaban was prescribed. Results. The frequency of major hemorrhages reached 0% in the major group versus 2% in the control group (р = 0.32). The total frequency of hemorrhagic complications development amounted to 10.2% in the major group and 12.5% in the control one (p = 0.73). 86.7% of patients of the major group and only 50% of the control group (р = 0.049) continued the anticoagulant therapy after development of hemorrhagic complications. Conclusions: the results obtained by us confirm higher safety of rovaroxaban use compared to warfarin within prolonged therapy of venous thrombosis. These data correspond to the results of the previously published studies EINSTEIN and XALIA.

Approaches traditionally used in phthisiological practice to determine tuberculosis can’t be used for population of HIV-infection patients due to peculiarities of the course and forms of tuberculosis developing in conditions of immunological suppression. We analyzed 1 057 cases of the first diagnosed tuberculosis in HIV-infection patients by the nature of the disease diagnostics, forms of the tuberculosis process depending on the initial level of the immune status. In the overwhelming majority of cases (81.7%) tuberculosis was diagnosed when the patient sought medical aid. It was established than 71.7% of patients underwent the chest X-ray in less than a year before tuberculosis diagnosis and a half of them – in less than 6 month, which allows speaking about the low informative value of the chest X-ray for HIV patients even with the interval two times per year. It was established that the most frequent form of early tuberculosis diagnostics is tuberculosis of intrathoracic lymphatic nodes that should be considered as a criteria of timeliness of tuberculosis identification in HIV persons.

Currently, one of the most common issues in medicine is antibiotics resistance. This relates to nosocomial and to communityacquired infections. This problem is common for economically developed countries of the whole world and in its significance must be placed side by side with issues of the threat to national security. In Russia annual mortality from nosocomial infection remains high and, unfortunately, this indicator doesn’t reduce from year to year [1].

The advent of botulinum toxin (BT) in healthcare has revolutionized the treatment of several diseases and the aesthetic medicine. Botulinum toxin is a powerful neurotoxin with a paralytic/muscle relaxant effect. The most potent substance has been successfully used for the treatment of pathological conditions that can not be effectively managed and provide a stable effect with other known methods. Many disorders of the lower urinary tract function are associated with muscle hypertonia or spasms and can be treated with accurate infiltration of BT in the concerned area. Treatment of idiopathic overactive bladder using BT is also effective and safe. Efficacy and safety of BT administration for neurogenic and idiopathic DO were investigated and confirmed in large multicenter trials.

Hyperactive urinary bladder (HUB) is one of the most frequent disturbances of the urination. Hyperactive urinary bladder (HUB) is a syndrome characterized by presence of imperative uriesthesia accompanied and not accompanied by urgent urinary incontinence usually in combination with frequent urination and nocturia with proved lack of infection and other evident pathologic changes. Pharmacotherapy is a priority method of HUB therapy. The major group of drugs is m-cholinblockers (tolterodine, oxybutinine, trospium chloride, solifenacin). Solifenacin is a modern and effective drug for therapy of HUB that has limitations on indications such as closed- ngle glaucoma, retention of urine, grave gastrointestinal diseases, myasthenia gravis. Mirabegron is the first β3-adrenoreceptor antagonist for therapy of HUB that proved its effectiveness in patients ho previously received therapy by m-cholinolytics. Mirabegron can be used at glaucoma and myasthenia, it doesn’t cause acute urine retention.

Therapy of patients with disturbances of the locomotor system requires use of drugs to prevent venous thromboembolic complications. In addition to non-drug measures low-molecular heparins are the drugs of choice among coagulants at conservative therapy of traumas and in the post- operative period. The second generation low-molecular heparin – bemirin sodium – demonstrates high effectiveness and safety and might be applied by patients with medium and high degree of development of venous thromboembolic complications (VTEC).

The author gives a review of published data on the problem of terminology and classification of chronic wounds, as well as an overview of methods for the topical treatment of wounds with illustrations from his own clinical practice.

The urgency of the problem of diabetic distal polyneuropathy (DDPN) is preconditioned by its great prevalence, according to specialized studies data, late diagnostics and serious consequences. The importance of DDPN diagnostics at its early stage doesn’t generate doubts: just at this period disturbance of peripheral nerves is of reciprocal nature and the therapy is effective to the maximum degree. But the objectification of the DDPN diagnosis is difficult: the data of neurologic and electrophysiological tests often do not correspond to the clinical symptoms and signs as these methods evaluate lesions of large nervous fibers whereas in DDPN it’s small fibers that are damaged in the first place. Use of skin biopsy and confocal corneal microscopy for evaluation of small fibers is extremely restricted in a clinical practice. Possibilities of electroneuromyography (ENMG) are analyzed as an option: parameters with their subjective peculiarities, selection of nerves and their number for DDPN diagnostics as a context of topographic neurology and neurophysiology of distal fibers. 

Study objective. To evaluate effect of peroral administration of L-ornitin-L-aspartate (LOLA) on the frequency of road traffic accidents in persons with hepatic disease at the pre-cirrhotic stage. Material and methods. The study included 42 patients – men aged 25-45, drivers with the driving experience no less than 3 years acknowledged guilty of 3-4 road traffic accidents in the recent 3 years. All patients were diagnosed with chronic hepatitis C (genotype 1), with minimum or low activity of aminotransferase and the minimum hepatic fibrosis. Diseases that could affect performance of the road traffic accident as well as external factors (state of the car, road surfacing, weather conditions). LOLA therapy at a dosage 9 g per day was done by 2-month cycles with 2-month intervals, by the present moment the total duration reached 5 months. Each month biochemical blood analysis, blood ammonium ion concentration determination and psychometric tests were performed. Results. Ammonium ion concentration was reduced in a month after start of LOLA (from 145.4 μmol/l to 130.3 μmol/l, р = 0,016) maintaining stable tendency to reduction during the therapy until achievement of the medium level 90.4 μmol/l (р = 0.003) by the 6th month. Results of the flicker fusion frequency test significantly improved by the end of the first course LOLA (р = 0,003), remaining at the achieved level during the therapy. The results of the number connection test significantly improved by the end of the first month of therapy (р < 0.001), with maintenance of the trend on the background of the ubsequent courses. In the specified period of observation no road traffic accidents through the fault of persons included in the study, according to the data of the STSI. Conclusions. The intermitting LOLA therapy in patients with chronic hepatitis C and the minimum fibrosis reconditions quick reduction of the ammonium ion concentration in the blood and significant improvement of psychometric tests values.

Purpose of the study: to evaluate the lower respiratory tract microflora in patients with malignant lung tumors with chronic obstructive pulmonary disease (COPD). Material and methods: sputum of patients subdivided into three groups was evaluated: main group consisting of 52 patients with malignant lung tumors without COPD; group 2 – 23 patients with malignant lung tumors and COPD; Group 3 – 25 patients without lung cancer or COPD. Results: it was found that for patients with malignant lung tumors, none of the specific methods for the isolation of microorganisms from the respiratory tract was practically significant. The most reliable data on microbiota of the lower respiratory tract could be obtained only after a omprehensive study of throat swab, sputum, bronchial aspirate/lavage and protected brush biopsy. The approach allows for a science-based antimicrobial treatment of patients suffering from lung cancer. Results of the in-depth bacteriological study are especially relevant in the treatment of patients with lung tumors and COPD, for the most of whom adequate antimicrobial chemotherapy is vital.

Study of the immunological profile (cellular link, cytokine profile) in vibration disease opens up prospects for the rehabilitation and treatment of patients with this pathology and complements our knowledge of the pathogenesis of this disease.