Comparative effectiveness of statin therapy in patients with hypertension of high and very high cardiovascular risk in actual clinical practice in Irkutsk

Aim. To study lipid-lowering therapy in patients with high and very high risk of cardiovascular events (CVEs) at the outpatient and inpatient care stages in Irkutsk.

Material and methods. We analyzed 260 discharge summaries of patients with hypertension of high and very high risk of CVEs for the second half of 2019: 145  — from a hospital; 115  — from outpatient records. Patient adherence to statin therapy, achievement of target lowdensity lipoprotein cholesterol (LDL-C) levels in each patient subgroup was assessed.

Results. The proportion of patients who reached the recommended LDL-C levels in accordance with the 2017 guidelines tends to increase in comparison with prior data. High adherence to lipid-lowering therapy was accompanied by an increase in the proportion of patients reaching the recommended LDL-C levels. In most cases, regardless of cardiovascular risk, low-dose statin therapy were used. A detailed analysis of adherence to statin therapy using questionnaires revealed that more than half of patients in high-risk categories (64%) did not comply with lipid-lowering therapy.

Conclusion. Favorable trends were revealed in relation to an increase in the proportion of high-risk patients reaching target LDL-C levels. Adherence to statin therapy remains low. Previously established problems in managing such patients remains: stereotyped lipid-lowering therapy prescriptions without taking into account cardiovascular risk, the use of low-dose therapy, and the frequent prescription of statins with a lower lipid-lowering effect. Inpatients use higher statin doses than outpatients.

[Leiomyosarcoma of the splenic vein]

Vascular leiomyosarcoma (LMS) is an extremely rare disease. Venous lesion is approximately 5 times more common than arterial. LMS is usually found in retroperitoneal veins and in inferior vena cava. Lesion of the splenic vein is extremely rare. A 52-year-old woman with recurrent abdominal pain is reported in the article. Abdominal contrast-enhanced CT revealed a 6 cm tumor of the pancreatic tail. The patient underwent laparoscopic distal pancreatectomy with splenectomy en bloc. Histological and immunohistochemical studies revealed LMS originating from the smooth muscles of the splenic vein. Surgery was followed by adjuvant chemotherapy. There was no local recurrence in 1 year after surgery. In this article, we analyze the available information on leiomyosarcoma of the splenic vein.

Abstract P3-01-18: Determining the need for axillar lymph node dissection based on pre-neoadjuvant chemotherapy sentinel lymph node biopsy results

An open-label single institution study of sentinel lymph node biopsy prior to neoadjuvant chemotherapy is conducted in the N.N. Petrov research institute of oncology. So far 30 patients with locally advanced breast carcinoma (T2-4N0) were included. Mammography, breast US and SPECT are performed prior to hospitalization so as core biopsy with subsequent IHC staining to determine the levels of ER, PR, KI67 and HER2. Sentinel lymph node biopsy with the use of radiocompound is performed prior to the first cycle of neoadjuvant chemotherapy. Patients receive 4 to 6 cycles with response evaluation after cycles 2, 4 and 6 (same evaluations as at the baseline). Axillary lymph node dissection is later performed along with the definitive surgery of the primary.

Interim analysis showed: 3 of 30 patients with cN0 were node positive after sentinel lymph node biopsy, 27 were node-negative (sn)pN0. All patients with (sn)pN0 completed neoadjuvant chemotherapy with clinical response. No cases of upfront progression were detected. All patients (sn)pN0 underwent axillary dissection upon completion of the neoadjuvant therapy. No cases of nodal involvement were detected (ypN0). All of the patients considered node-positive after sentinel biopsy also underwent lymph node dissection after completion of the neoadjuvant therapy. 2 of them were pN1 and one was pN2.

Conclusion: sentinel lymph node biopsy in cN0 patients prior to neoadjuvant chemotherapy allows to determine a category of patients ((sn)pN0) in whom axillary dissection can be avoided, provided they remain clinically node-negative at the time of definitive surgery.

Citation Format: Semiglazov VF, Krivorotko PV, Zhiltsova EK, Dashayan GA, Zernov KU, Bessonov AA, Trufanova ES, Tabagua TT, Ivanova OA, Kanaev SV, Novikov SN, Krzivickiyi PI, Brayanceva ZV, Komayachov AV, Nikolaev KS, Gigolaeva LP. Determining the need for axillar lymph node dissection based on pre-neoadjuvant chemotherapy sentinel lymph node biopsy results [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-18.

Overview of the Liulin type instruments for space radiation measurement and their scientific results

Ionizing radiation is recognized to be one of the main health concerns for humans in the space radiation environment. Estimation of space radiation effects on health requires the accurate knowledge of the accumulated absorbed dose, which depends on the global space radiation distribution, solar cycle and local shielding generated by the 3D mass distribution of the space vehicle. This paper presents an overview of the spectrometer-dosimeters of the Liulin type, which were developed in the late 1980s and have been in use since then. Two major measurement systems have been developed by our team. The first one is based on one silicon detector and is known as a Liulin-type deposited energy spectrometer (DES) (Dachev et al., 2002, 2003), while the second one is a dosimetric telescope (DT) with two or three silicon detectors. The Liulin-type instruments were calibrated using a number of radioactive sources and particle accelerators. The main results of the calibrations are presented in the paper. In the last section of the paper some of the most significant scientific results obtained in space and on aircraft, balloon and rocket flights since 1989 are presented.

[PHOTODYNAMIC THERAPY FOR INTRADERMAL METASTASES OF BREAST CANCER USING THE MATRIX LIGHT-EMITTING DIODES APPARATUS LATUS]

There are presented results of photodynamic therapy (PDT) for patients with chemo- and radioresistant intradermal metastases of breast cancer using the matrix light-emitting diodes apparatus. To all patients prior to irradiation there was performed fluorescence diagnostics to assess the accumulation of the photosensitizer of chlorine series and photobleaching during PDT. The size of the irradiation area was 400 sm, the total dose of irradiation was 250J/cm2. PDT was accompanied by mild pain, which was stopped by administration of non-narcotic analgesics. Complete regression of intradermal lesions was registered in 2 of 4 cases, partial response was observed in 1 patient and the progression of the process in 1 case.

[AUTOLOGOUS TRANSPLANTATION OF ADIPOSE TISSUE IN RECONSTRUCTIVE AND PLASTIC SURGERY. NEW POSSIBILITIES OF "OLD" MATERIAL]

The work is devoted to the methods of application of own adipose tissue as a plastic material and presents the summary of the currently known data on the use of transplantation of adipose tissue in order to correct various defects of the body in plastic and reconstructive surgery. There are analyzed theoretical basis for the use of adipose tissue, provided the methods of administration depending on the area of the use, the severity of the defect and its localization. Data on new methods of the use of adipose tissue and own observations are presented. As an example of the effective use there is provided a detailed analysis of the use of adipose tissue transplantation in breast cancer patients who have different area defects after reconstructive surgery.

[The use of factor analysis in determining the dietary patterns in the population]

The possibilities of using one of the methods of multivariate statistics, factor analysis, in the study of the frequency of consumption of food categories for the population are considered. Comparison of the results with the results of other statistical methods (cluster and variance analysis) showed the adequacy of factor analysis in the study purposes.

[Whether to apply the standard treatment for breast cancer in older patients: arguments for and against]

Data results of treatment of elderly breast cancer patients in different medical centers are provided, cohort up to 1922 patients. Better survival indicators are recorded within this category when using standard treatment plans (the same as for main category of patients). However it has been noticed that in most cases the patients' age (70-80 years) was considered a barrier to prescription the adequate treatment; 54-98% of patients do not receive standard treatment.

[Work intensity and arterial hypertension]

The authors presented dependence of arterial hypertension on work intensity, exemplified by two occupational groups--teachers and electricians, and demonstrated modifying influence of occupation on prevalence of traditional cardiovascular risk factors.

[Working adaptation in brain workers: sociohygienic aspects]

The parameters of subjective well-being in teachers and their significance in a possible reduction in work capacity and precocious retirement were studied. The teachers with low need satisfaction levels were found to have increased subjective stress or fatigability on doing their work and decreased rest recovery of work capacity. Lower need satisfaction levels with negative reasons for refusal to continue work activities appear to be one of the factors of professional aging and its related reduction in their active work period.

[Fatiguability and performance of comprehensive school teachers in accordance with length of service]

Polling covered 184 comprehensive school teachers and touched occupationally mediated fatiguability and performance recovery facilities. In connection to teachers' length of service, the parameters studied appeared to differ--that is caused by natural age-related differences and occupational self-selection process.

[The Hirsch index is a new criterion for evaluation of scientific activity]

A new criterion for evaluation of scientific activity by J. Hirsch has been considered.

[Inflammatory breast carcinoma and prognosticators of efficacy of primary chemotherapy]

The efficacy of primary chemotherapy for inflammatory breast carcinoma (IBC) was studied vis-a-vis certain symptoms characterizing patient's status and biological features of tumor. It was shown that such factors as estrogen (ER) and progesterone (PR) receptor status and malignancy grade of tumor can be used to predict the efficacy. Negative ER/PR status plus high malignancy grade involved higher frequency of complete pathomorphological responses. Worst prognosis was in patients under 35 years of age, with ductal BC and negative ER/PR status of tumor.

Polyclonal Antibodies against a Structure Mimicking the Covalent Linkage Unit between Picornavirus RNA and VPg: An Immunochemical Study

We propose that therapy of patients with anticancer drugs that poison DNA topoisomerases induces formation of covalent complexes of cellular RNAs and DNA topoisomerases. The appearance of these complexes can be detected with antibodies against a synthetic hapten mimicking the covalent linkage unit Tyr-pU(p) of picornavirus RNA and VPg. We synthesized hapten [N(Ac),CO(NH2)]Tyr-(5 P --> O)Up-O-(CH2)6NH2, conjugated it with BSA, and immunized rabbits with the antigen obtained. The raised polyclonal antibodies were purified by successive affinity chromatography on BSA-Sepharose and hapten-Sepharose columns. Target antibodies recognized hapten and encephalomyocarditis virus RNA-VPg complex specifically as found using the dot-immunogold method. We believe that these antibodies might be useful to study mechanism of picorna and similar virus RNA synthesis. The discovery and qualitative determination of the cellular RNA-DNA topoisomerases covalent complexes with these antibodies might be useful to monitor therapy efficacy by drugs "freezing" dead-end complexes of DNA topoisomerases and nucleic acids and to understand the mechanism of DNA topoisomerase poisoning in situ.

Desialylation Decreases the Resistance of Apo B-Containing Lipoproteins to Aggregation and Increases Their Atherogenic Potential

Subfractions of apo B-containing lipoproteins (VLDL and intermediate-density lipoproteins) with reduced content of sialic acid were found in human blood. These lipoproteins are characterized by high capacity to spontaneous association (aggregation) and stimulated accumulation of cholesterol in smooth muscle cells of human aortic intima. In vitro treatment of apo B-containing lipoproteins with alpha-2,6-sialidase and alpha-2,3-sialidase stimulated aggregation and increased the ability of these particles to potentiate cholesterol accumulation in smooth muscle cells of the intact human aortic intima. Probably, desialylation of various apo B-containing lipoproteins can occur in the blood; this process decreases their resistance to aggregation, and increases the ability of these particles to stimulate accumulation of cholesterol in human aortic intima cells, i.e. increases their atherogenic potential.

[Investigation of the drug "Mamoclam" for the treatment of patients with fibroadenomatosis of the breast]

The clinical trial of a new drug "mamoclam" was carried out in patients with benign breast disease. The drug contains omega-3 polyunsaturated fatty acids, iodine and chlorophyll derivatives and is produced from the brown sea alga laminaria. The study involved 33 patients (mean age 42.5 +/- 1.1 yrs). Two tablets were administered thrice a day for three months. Examination included clinical evaluation of symptoms of mastopathy and dysalgomenorrhea, breast sonography and mammography. Therapeutic response presented as reduced mastalgia, premenopausal syndrome, dysmenorrhea and algomenorrhea, breast cyst regression as well as attenuated pain associated with benign breast disease and palpation. Positive response was reported in 94%. The drug should be recommended for benign breast disease treatment.

[Study of an antioxidant dietary supplement "Karinat" in patients with benign breast disease]

A randomized double blind placebo-controlled trial of efficiency of a dietary supplement "Karinat" in patients with benign breast disease was carried out. Karinat contains beta-carotene 2.5 mg, alpha-tocopherol 5 mg, ascorbic acid 30 mg and garlic powder 150 mg per one tablet. Out of 66 patients, 33 patients were given karinat, 33 were given placebo. The patients reccived a tablet of karinal or placebo twice a day during 6 months. Examinations of the patients included clinical estimation of symptoms of mastopathy and dysalgomenorrhea, breast sonography and mammography. It was found that karinat reduced the severity of mastalgia, premenstrual syndrome, dysmenorrhea and algomenorrhea and caused regression of palpable symptoms of the breast fibromatosis. On the whole karinat had positive action in 75.8% that was significantly greater by 45.5% as compared with placebo. Karinat may be useful for the treatment of patients with benign breast disease.

[Results of a prospective randomized investigation [Russia (St.Petersburg)/WHO] to evaluate the significance of self-examination for the early detection of breast cancer]

Indications for puncture or excision biopsy were significantly higher in the study group (7.5%) as compared with control (3.5%) (p < 0.01) in a randomized prospective controlled trial of a comprehensive breast cancer screening (123,748) carried out in the framework of a self-examination education program. In the self-examination group, detection rates were higher both for benign (1.1%) and malignant (0.85%) tumors than in control (0.5% and 0.69%, respectively) (p < 0.05). Early stage (T1NOMO, Tis) distribution difference in the study group and controls was insignificant--23 and 17.6%, respectively. Compliance with the program requirements including monthly or bimonthly self-examination was followed by higher 15-year survival rates (53.2%) in 70-75% as compared with controls(45.8%) (p = 0.05105): yet it did not affect mortality.

[Comparative characteristics of hormonal status in patients with receptor-negative cancers of the breast and of the endometrium]

2,429 breast cancer patients and 478 patients with endometrial carcinoma were examined. It was suggested that the absence of estrogen receptors (ER) and/or progesterone receptors (PR) should be accounted for by peculiar endocrine features (including those of reproductive function) of the patients' medical history and/or hormonal metabolic status (body weight, estrogenemia, insulinemia, etc.) at clinical detection of tumor. The differences between breast and endometrial cancer in receptor-negative (R-) incidence were related to age (decade of lifespan) and menstrual cycle. Indices describing hormone-metabolic status were used for identification of receptor-negative or receptor-positive status of tumor (reliability of 65-70% for breast cancer and 75-80%--endometrial carcinoma) when it was not feasible under laboratory conditions.

Tissue transglutaminase expression in breast carcinomas

Tissue transglutaminase (tTG) is known to participate in multiple cellular processes, including apoptosis, cellular adhesiveness etc. Alterations of tTG expression could contribute to the development of several categories of diseases, including AIDS, cancer etc. The aim of the study was to test the pattern and relevance of tTG expression in a subset of breast carcinomas. RT-PCR has detected tTG-specific RNA message in 11 out of 25 (44%) breast cancer samples. tTG message was detected in 6/8 (75%) breast carcinomas with high apoptotic index, but only in 5/17 (29%) with the low one (p = 0.03). Immunohistochemical analysis revealed that only 15% of breast carcinomas displayed tTG protein in tumor cells, while the staining of the stromal components occurred in approximately one-half of the tumours tested. Surprisingly, there was no significant association between tTG RNA expression and protein positivity. Moreover, there was no evident relationships between tTG immunostaining and apoptotic index or clinical parameters of breast neoplasms. There are at least 2 alternative explanations for the poor concordance between RNA and protein data. It is likely that the sensitivity of immunohistochemistry is not sufficient to detect functionally relevant tTG enzyme in all breast cancer sections. Otherwise, tTG RNA expression does not always lead to accumulation of its product in the tumor cells, but reflects the transcriptional activation of other pro-apoptotic genes due to common triggering mechanisms.

[Adjuvant chemotherapy with anthracyclines in comparison with the standard combination of CMF in breast cancer with high risk of relapse]

The effectiveness of adjuvant therapy with adriablastin and doxorubicin for breast cancer has been compared to that of standard CMF. During 1985-1990, the study included 349 patients with T1-2N2M0 and T3N0-2M0 tumors; mean age--46 yrs; mean follow-up--96.7 months. Overall survival rate in the doxorubicin group was 73%, CMF--62%; relapse-free survival--62.1 and 55%, respectively. The absolute difference in overall survival rates (11%) proved barely significant (p = 0.056). However, the difference in overall survival (p < 0.05) after anthracyclines and CMF in patients with tumors T1-2N2M0 and T3N1M0 was significant and in favor of the former. As far as frequency and degree of side-effects is concerned, their patterns were practically identical in both groups, except for the significantly higher frequency of cardiotoxity and complete alopecia in doxorubicin therapy. Cardiotoxic complication rate was significantly reduced from 13.8 to 3.9% by cardioxane treatment.

[Interim results of a prospective randomized study of self-examination for early detection of breast cancer (Russia/St.Petersburg/WHO)]

Training in breast self-examination (BSE) technique involved 57,712 women, aged 40-64, at 14 out of randomly selected out-patient hospitals in St. Petersburg (1985-1989). Another 64,759 women selected at another 14 out-patient hospitals were in control. All patients with detected tumor pathology of the breast were biopsied and treated at the Institute's Clinic. The study focused on breast cancer incidence, survival and mortality. More women in the BSE group sought medical advice for suspected pathology (4,300) than those in control (2,438; p < 0.05). There were 493 cases of breast cancer in the BSE group with 157 fatalities, 446 cases of breast cancer with 167 fatalities in the control group. There was no significant difference in tumor stage. Nine-year survival (after Kaplan-Meyer) from the time of tumor detection was 65% in the study group and 55% in control (log rank 0.774; p > 0.05). There has been no significant difference in death rates in both groups for the past ten years. The study is to continue until the year 2001.

[The effectiveness of adjuvant chemotherapy with anthracyclines (adriablastin, doxorubicin) for stage-IIb-IIIa breast cancer]

The effectiveness of adjuvant treatment with anthracyclins (adriablastin, doxorubicin) and standard CMF regimens for breast tumors has been compared. The study included 349 patients with stage IIB-IIIA tumors (T1-2N2M0, T3N0-2M0) (mean age-46 years) during 1985-1990 follow-up-60.38 months. In the doxorubicin group, overall 5-year survival was 73 +/- 8%, in the CMF group-62 +/- 8%. Recurrence-free 5-year survival was 62 +/- 8 and 55 +/- 8%, respectively. The differences are not significant. A stage-related analysis established a significant difference in overall survival in patients with T1-2N2M0 tumors (c-sqare 9.92, p < 0.01). However, due to a small number of cases, the phenomenon requires further study. Although adriablastin treatment involved a significantly higher frequency of carciotoxic symptoms, complete alopecia and dyspeptic complication, a systemic administration of cardioxan and effective antiemetic drugs was lacking.