The 2019 coronavirus infection (COVID-19) is a dangerous infectious disease proceeding as an acute respiratory viral infection with specific complications, which may include pneumonia leading to acute respiratory distress syndrome or respiratory failure with a high risk of death. The etiological agent of COVID-19 is a new coronavirus, referred to as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This new viral form is most likely to have appeared from zoonotic coronaviruses, such as SARS-CoV emerged in 2002. This article sets out to present a strategy for manag‑ ing neurosurgical patients, which was developed taking into account the experience of the Neurosurgery Department of the First Affiliated Hospital of Harbin Medical University in the prevention and control of pneumonia outbreaks caused by the new coronavirus. This strategy can be helpful for neurosurgeons in providing emergency care in the context of the COVID-19 pandemic in the Russian Federation.

Introduction. Hepatocellular carcinoma (HCC) is the most common primary malignant neoplasm of the liver. During the early stages, HCC is asymptomatic, which makes X-ray examination a particularly important diagnostic tool. According to WHO data, the mortality rate from HCC was 782,000 in 2018. HCC is associated with a number of risk factors: a high viral load, liver cirrhosis, detected HBeAg and elevated serum HBsAg levels. Inhibitors of tyrosine kinase receptors increase the overall survival and progression-free survival rates in patients with metastatic HCC. In this article, we conduct an analysis of results of the REFLECT study obtained for Russian patients by the Republican Clinical Oncological Dispensary, Ufa.

Materials and methods. The experimental group included 9 patients (52.9%) receiving Lenvatinib. The control group included 8 patients (47.1%)) underwent therapy with Sorafenib at a dose of 800 mg per day 7 (41.17%) patients had a history of chronic hepatitis, of which hepatitis B and chronic hepatitis C was confirmed in 6 and 1 cases, respectively.

Results and discussion. Over the period from 2017 up to the present, progression-free survival was observed in three patients (17.6%), of which 2 and 1 received Lenvatinib and Sorafenib, respectively. Overall survival was 10.5 months. The median overall survival rate in the experimental and control groups was 9.8 and 11.2 months, respectively. These parameters are considered comparable, provided that the sample was small.

Conclusions. The use of Lenvatinib demonstrated the efficacy comparable to that of Sorafenib in terms of the overall survival rate in patients with inoperable HCC. Lenvatinib allowed statistically and clinically significant improvement in the progression-free survival and time to progression to be achieved. 

The aim of the study was to compare functional results prior to and following neoadjuvant chemoradiation therapy.

Materials and methods. An analysis of the functional results of a prospective clinical study was carried out. The study included 90 patients who underwent low anterior rectal resection for cancer of the lower or middle ampullar rectum with T1-4aN0-2M0 using various reconstruction methods.

Results and discussion. Group A included 22 patients with J-shaped reservoirs; group B — 30 patients with side-to-end anastomoses; group C — 38 patients with end-to-end anastomoses. Out of the total study group (n = 90), 43 patients underwent neoadjuvant chemoradiotherapy vs. 47 patients without any preoperative treatment. No statistically significant difference was observed in the frequency of applied reconstructive techniques (р = 0.725) and the incidence of postoperative complications (p = 0.103) in the groups with and without neoadjuvant chemoradiotherapy. The baseline scores of the Wexner scale and the results of anorectal manometry in the comparison groups were comparable (p > 0.05). However, upon completion of neoadjuvant chemoradiotherapy and during the period from the moment of surgery up to 12 months after the closure of preventive intestinal stomas, the functional results were less satisfactory in the group of patients having received neoadjuvant chemoradiotherapy (n = 43) with regard to the comparison group (n =  47). Nevertheless, a statistically significant difference in the results was observed from the end of neoadjuvant chemoradiotherapy up to 3 months after closure of the stoma (p <0.05).

Conclusions. Neoadjuvant chemoradiation therapy has a negative effect on the function of the anal sphincter, thus requiring concomitant therapy and physiotherapy both at the stages of neoadjuvant chemoradiotherapy and at long intervals after the main surgical stage. 

Introduction.In recent years, computer technologies are more and more widely used in medicine. Thus, medical neuro‑ informatics solves diagnostic and forecasting tasks using neural networks.

Materials and methods. Using the example of erysipelas, the possibility of forecasting the course and outcome of the dis‑ ease is demonstrated. A retrospective study of the medical histories of patients treated for erysipelas at the Ufa Clinical Hospital No.8 during 2006–2015 was carried out. Modern statistical packages and the MATLAB environment were used.

Results and discussion.The conducted comparative analysis showed a 3-layer recurring network of direct distribution to be the most suitable neural network architecture. The optimal structure of the neural network was found to be: 27–6–1 (i.e. 27 neurons are used at the entrance; 6 — in a hidden layer; 1 — in the output layer). The best convergence of the network learning process is provided by the quasi-Newton and conjugated gradient algorithms. In order to assess the effectiveness of the proposed neural network in predicting the dynamics of inflammation, a comparative analysis was carried out using a number of conventional methods, such as exponential smoothing, moving average, least squares and group data handling.

Conclusion.The proposed neural network based on approximation and extrapolation of variations in the patient’s medi‑ cal history over fixed time window segments (within the ‘sliding time window’) can be successfully used for forecasting the development and outcome of erysipelas. 

Introduction. Kidney cancer remains an urgent problem in modern oncology. More than 200 thousand new cases of kidney cancer are diagnosed globally every year, with about 100 thousand patients dying. 15–17% of patients are diagnosed with stage IV kidney cancer. Arterial tumour embolization and nephrectomy are used as a palliative treatment.

Aim. To evaluate the results of renal artery embolization in combined treatment of stage IV kidney cancer.

Material and methods. The treatment results of 22 patients with stage IV kidney cancer are presented: 6 patients had metastases in the skeletal bones; 15 — metastases in the lungs; 1 — bilateral kidney damage. At the first stage, all patients underwent renal artery embolization. Subsequently, 6 patients received bisphosphonates and radiation therapy for metastases in the skeletal bones, 15 patients underwent operation followed by a targeted therapy with Sunitinib and Sorafenib), 1 patient with bilateral kidney damage underwent operation followed by a 2-year targeted therapy with Sorafenib.

Results and discussion. Renal artery embolization was performed successfully without technical difficulties in all the patients. After embolization, hemostasis was achieved in all patients with hematuria (n = 14). Postembolization syndrome was noted in 13 patients with total renal artery embolization. 6 patients with metastases in the skeletal bones lived for 16.4 ± 2.1 months, the survival time of 15 patients who received renal artery embolization, nephrectomy and targeted therapy was 41.7 ± 15.3 months. Only one patient (bilateral kidney damage) has been under dynamic observation for the period of 10 years.

Conclusion. Renal artery embolization is an effective and minimally invasive technical procedure that should be used in the combined treatment of patients with kidney cancer. The combined use of renal artery embolization and subsequent targeted therapy for kidney cancer provide new opportunities for stage IV combined treatment. 

Introduction. To maximize the effectiveness of hemostatic technologies, it is necessary to optimize local hemostasis through hybrid and controlled approaches, as well as to improve the conditions for tissue surgical dissection preventing perforation of hollow organs. This study is aimed at assessing the efficacy of stopping bleeding and the safety of resection of digestive hollow organs in experimental models of trauma to abdominal organs in laboratory animals.

Materials and methods. Experiments were carried out in vivo on 20 rabbits. All animals were divided into 4 experimental groups (5 animals each): I — the control group, in which no methods for stopping bleeding were used; II — the group, in which infiltration of the wall of a hollow organ with saline solution was used; III — the group, in which physical hemostasis was applied using an electrosurgical unit and an argon plasma coagulation apparatus; IV — the group, animals in which underwent controlled local biological hemostasis using autoplasma. Prior to laparotomy, 2–3 ml of whole blood was taken from the rabbit’s ear for preliminary preparation of autoplasma. The prepared autoplasma was introduced into the area of resection or other operation of the mucous membrane of the rabbit’s digestive tract.

Results and discussion. Although no statistical difference in the time of stopping bleeding was observed between the control (I) and saline (II) groups, one more episode of bleeding was noted in group II. Preventive local administration of autoplasma (group IV) was established to have a high hemostatic potential. As expected, electrocoagulation was more effective than saline; however, hemostasis achieved by means of argon plasma coagulation is characterized by rapid formation of a necrotic zone, which may lead to undesirable consequences in the long-term period.

Conclusion. Preventive local administration of autoplasma and recombinant human protein has a high hemostatic potential in animals. In comparison, electrocoagulation is less effective due to the rapid filling of the pathological focus with blood. 

Introduction. Chemotherapy in the form of endovascular infusion or its combination with radiotherapy is a method for treating non-small cell lung cancer (NSCLC), which raises heated discussions among specialists. This study is aimed at assessing the early results of combined treatment of NSCLC patients with selective chemotherapy infusion via the bronchial artery.

Materials and methods. A retrospective analysis of treatment results for 24 patients with central pulmonary cancer hospitalized in the Shymkent Oncological Centre (Kazakhstan) during 2016–2019 was carried out. The average age of the patients was 46.4 ± 11.3 years. According to the histological study, 19 and 5 patients were diagnosed with squamous cell lung cancer and undifferentiated carcinoma, respectively. The patients were recognized as surgically incurable; three courses of neoadjuvant polychemotherapy via selective catheterization of the bronchial artery and regional intra-arterial administration of drugs were prescribed according to the DR scheme: Docetaxel 75 mg/m2 , Cisplatin 75 mg/m2 .

Results and discussion. Upon completion of three courses of selective chemotherapy, 20 (83.3%) patients showed the possibility of surgical treatment: 15 patients underwent extended pulmonectomy, 5 patients underwent extendedcombined pulmonectomy with pericardial resection with intrapericardial, separate processing of the vessels of the lung root. After the surgical stage, all patients received radiation therapy to the mediastinal area at a single tumour dose of 2 Gy and a total radiation dose of 45–50 Gy. According to an analysis of the mortality and survival rates, 28-day mortality comprised 5% (1 patient, whose death occurred as a result of acute cardiovascular failure); one-year survival rate was 91.6%.

Conclusions. Preliminary results of our study show that selective chemotherapy via the bronchial artery increases the frequency of surgical interventions and the overall survival of patients with inoperable pulmonary cancer. 

Introduction. Recent years have witnessed an increased incidence of multiple neoplasms. In multiple combined cancer, the choice of treatment strategy remains challenging, as two or more tumours require treatment in the shortest perspective. However, an intense treatment may induce many and severe complications with co-located organs and systems. No universal protocol or treatment standard for managing multiple primary cancers is accepted in Russia or worldwide.

Materials and methods. The clinical case describes radiation treatment of a female patient with synchronous gynaecologic cancer of vagina and endometrium at the “TOOD” medical facility’s radiotherapy unit. Our treatment was designed to maximise the dosage targeting at a minimal off-coverage of healthy tissues. The treatment was conducted in two steps on an Elekta Synergy Platform S instrument, with the total duration of 62 days.

Results and discussion. After radiotherapy, the patient had an oncologic and gynaecologic observation for one year. A complete tumour regression in two localities was confirmed visually, cytologically and instrumentally.

Conclusion. A treatment strategy in multiple primary cancers should be personalised. With unfeasible “standard therapy”, alternative approaches for the patient’s treatment are to be explored. We report a successful therapy in a woman with synchronous gynaecologic cancer by applying remote conformal radiation in regional uterine cancers with simultaneous integrated boost to the vaginal tumour during the first radiation step. Brachytherapy at the second step was replaced with stereotactic radiation due to vaginal constriction, pain syndrome and unfeasible applicator installation. 

Introduction. Stomach perforations caused by ingested foreign bodies are extremely rare injuries in adults, accounting for less than 1% of all gastrointestinal perforations. The clinical picture is diverse and often presents a diagnostic problem. There are few publications reporting such cases in literature.

Materials and methods. Using the example of a clinical case, this paper describes the clinical picture, diagnostic role of X-ray instruments and surgical tactics of diagnosing and treating a stomach perforation concealed by a foreign object, which occurred one week prior to admission. The patient V., 52 yo, was admitted to hospital on an emergency basis in the condition of moderate severity, complaining of abdominal pain for two days. The onset of the disease had no apparent reason. Similar pains had bothered the patient a week earlier the incident but were relieved without treatment.

Results and discussion. On the basis of clinical and laboratory-instrumental data, acute pancreatitis was pre-diagnosed. Conservative drug therapy with positive dynamics was started. Two days later, computed tomography of the abdominal organs with intravenous bolus contrast was performed. According to the CT data, a foreign body in the abdominal cavity was identified, which rested on the liver at the level of the gallbladder, perforating the wall of the pyloric department of the stomach. Localized inflammatory effusion in the abdominal fat was observed. The patient was operated and discharged in satisfactory condition.

Conclusion. Stomach perforations caused by small-sized foreign bodies are characterized by non-specific clinical manifestations. The use of radiation diagnostic methods facilitates the timely diagnosis and therapy choice in patients with stomach perforations caused by small-sized foreign bodies. 

The aim of the study was to review the international experience in providing oncological care during the COVID-19 pandemic. A literature search was conducted across the Medline, Cochrane Library, Elibrary and PubMed databases to select publications dealing with various aspects reflecting the state and capacity of oncological care during the COVID-19 pandemic. The research sample included 44 articles meeting the selection criteria.

The new coronavirus, known as SARS-Cov-, has become a worldwide threat and a serious health problem in 2020. The pandemic of this infection has had an impact on the management of cancer patients. According to studies conducted in China and the United States, patients with malignancies are at higher risk of severe COVID-19. This has led many oncologists to change their daily cancer treatment practices. An individual approach should be taken when considering the potential risk and beneficial effects of anticancer therapy in the population of cancer patients. A decision to delay the onset of cancer therapy should be made on an individual basis. Strict adherence to sanitary and epidemiological rules, as well as minimization of outpatient visits, can reduce the number of the infected and prevent the spread of the disease among cancer patients. Telemedicine consultations, which allow infectious exposures to be reduced, can be an option of choice. 

Visual examination of skin neoplasms remains a completely subjective method of diagnosis and requires instrumental confirmation, which is particularly relevant with malignant neoplasms. The review describes the diagnostic capacities and perspectives of dermatoscopy in dermato-oncological practice as a diagnostic method with an increasingly common clinical application. Success of dermatoscopy is evident from the modern publication corpus, with its high content referring to dermatoscopy as the main examination method in skin tumours. This diagnostic method is presently considered among the major tools for surface skin neoplasm imaging. Dermatoscopy enables an innocuous repeated spot examination of skin to monitor the tumour progression, clinical dynamics and treatment outcome. Modern dermatoscopy has facilitated both the reduction in surgical rate (provided a timely malignancy diagnosis) and progress in non-invasive treatment, such as topical drugs and photodynamic therapy.

Gastrointetinal stromal tumours are the most common primary mesenchymal tumours of the gastrointestinal tract. According to statistical data, the annual incidence of this pathology in Russia comprises 13 patients per 1 million inhabitants, i.e. about 2,000 patients per year on average. In the United States, 3,000–4,000 cases are registered every year. This article discusses general and specific issues associated with morbidity and mortality from gastrointestinal stromal tumours, as well as reasons for the low efficacy of surgical and targeted therapies. Methods for combined treatment of patients with gastrointestinal stromal tumours are proposed. The treatment of such pathologies has evolved with the development of immunohystochemical analytical procedures and therapies against KIT/PDGFRA-specific protooncogenes, as well as the emergence of low-molecular kinase inhibitors. However, the probability of non-recurrence survival can only be increased by complete surgical removal of gastrointestinal stromal colon tumours. In the surgical treatment, three main approaches are defined: the initial stage of treatment, provided that the tumour is resectable and has a small size; surgical treatment after neoadjuvant therapy; symptomatic treatment, so-called ‘debulking surgery’. Adjuvant targeted therapy with Imatinib provides for a high objective response. The use of Imatinib chemotherapy determines the efficacy and radicality of surgical treatment in most cases. In general, the question of treating gastrointestinal stromal colon tumours is still relevant, requiring further research and objective evaluation of all technical and tactical approaches in the context of distant results.