Background. Breast cancer (BC) is distinguished with its biological tumour subtypes as luminal A, B, HER2-positive and triple-negative. The current clinical guidelines of the Russian Ministry of Health prescribe neoadjuvant targeted chemotherapy as combined treatment in the HER2-positive cancer subtype. An adequate model for treatment efficacy prediction in such patients had been missing to date.
Aim. Development of a mathematical model and its computer realisation for complete morphological regression estimation in patients with primary operable HER2-positive breast cancer.
Materials and methods. Statistically significant predictors were estimated with the treatment outcome data on 103 HER2- positive breast cancer cases with neoadjuvant targeted chemotherapy. A binary logistic regression model was developed to account for a dichotomous variable dependency on certain predictors.
Results and discussion. Multivariate analysis laid out a mathematical model and software “Complete morphological regression estimation in primary operable EGFR-expressing breast cancer under neoadjuvant chemotherapy”. Our results attest that the program correctly automates a systematic estimation of complete morphological regression achieved prior to neoadjuvant targeted chemotherapy and is clinically justified for optimising treatment regimens in primary operable HER2-positive BC.
Conclusion. The mathematical model and computer program developed estimate the rate of complete morphological regression achieved prior to neoadjuvant targeted chemotherapy with a high 92 % sensitivity, 97.33 % specificity and 93.21% accuracy.

Background. Postoperative failure is a major cause of adverse outcomes in extensive liver resection. Post-resection liver failure requires intensive, including extracorporeal, care. Issues in correcting liver failure warrant novel approaches to prevent severe cases.

Materials and methods. A retrospective analysis of 228 various-extent liver resections included minor (55.7 %), major (26.8 %) and extended (17.5 %) operations for malignant, benign and parasitic liver lesions. The post-resection liver failure rate has ben graded according to ISGLS.

Results and discussion. Postoperative hepatic failure developed in 58 (25.4 %) cases, including 5 of 127 minor (3.9 %) resections, 18 major (29.5 %) and 35 of 40 extended resections (87.5 %). Mild class A liver failures were reported in 12.3 %, and severe classes B and C — in 9.2 % and 3.9 % cases, respectively.

CT volumetry in place of the number of resected segments is suggested as a criterion to grade the expected post-resection residual liver, with >70 % defining a minor, 36–70 % — major and 25–35 % — extended expected residual liver.

A two-staged extended hepatic resection approach is proposed to reduce postoperative liver failure, with vascular radiology-guided right portal vein embolisation (RPVE) or associating liver partition and portal vein ligation (ALPPS) at stage 1.

A comparison of extended hepatic resection outcomes (n = 40) showed a significantly higher rate and severity of liver failure in single- vs. two-staged operations (p < 0.05).

Conclusion. Liver failure is a leading cause of death in major and extended hepatic resection. Preoperative CT volumetry allows a more accurate volumetric control of expected post-resection residual liver. Two-staged extended hepatic resection can reliably reduce the rate and severity of postoperative liver failure.

Background. Two-stage colostomy is a common choice in treatment for obstruction-complicated colorectal cancer.

Aim. Research into paracolostomy complications in obese and non-obese patients.

Materials and methods. Material on obstruction-complicated colorectal cancer was collected from 50 patients divided into two cohorts by the body mass index (BMI). Cohort 1 contained 25 patients with BMI <24, and cohort 2 — patients with BMI >30.

Results. Compared to cohort 1 with BMI <24, obese cohort 2 revealed more paracolostomy complications, the increase in parastomal skin lesions by 32% (p < 0.05), pyoinflammatory complications by 36% (p < 0.05) and abscesses by 24% (p < 0.05).

Discussion. Paracolostomy complications in patients with BMI >30 are due to obesity, a poorly fitting colostomy bag, faecal leakage, skin irritation, infection and crude coagulation in haemostasis. Stoma gradually becomes difficult to visualise, faecal leakage continues and the paracolostomy space is poorly drained in obese patients, contributing to pyoinflammatory parastomal complications.

Conclusion. The main causes of pyoinflammatory parastomal complications in obese patients are a low stoma positioning and poor paracolostomy drainage. The circumstances described warrant improvement of colostomy techniques in obese patients.

Background. Diagnosis of thyroid and mammary gland neoplasms is a persisting challenge. The common punch biopsy techniques exhibit significant drawbacks responsible for biasing the gland tumour inspection. The authors propose technical and methodological novelties in punch biopsy for improving the sensitivity and accuracy of neoplasm differential diagnosis in surgery.

Materials and methods. A control cohort of 1406 patients had a conventional punch biopsy without ultrasonic guidance, whereas the study cohort of 1870 patients had puncturing with a novel device suitable for voluminous thyroid and mammary gland neoplasm biopsy.

Results. A novel punch biopsy method is developed basing on the oscillation amplitude and tissue optical density determination. The novel puncture appliance and technique allowed an accuracy improvement of voluminous thyroid and mammary gland neoplasm puncture up to 90 %. No complications of thyroid neoplasm punch biopsy were observed in the study cohort. The control group exhibited the complications of impaired swallowing, local inflammation and haematomas at the puncture site.

Discussion. The punch biopsy technique based on the pulse oscillation amplitude and optical tissue density measurement was proved to allow an earlier detection of voluminous neoplasms compared to visual inspection, while an additional canal allows concurrent biopsy of the lesion-adjacent tissue and the assessment of therapeutic efficacy and disease progression.

Conclusion. Creative surgical approaches to punch biopsy based on emitter and optic sensor-geared pulse optometry and their implementing tool have been developed. The method improves the efficiency and accuracy of voluminous neoplasm differential diagnosis, provides control of treatment efficacy and prevents false positive and false negative detections.

Background. Aortic valve stenosis is common with prevalence of about 0.5 %, peaking in people aged over 70 years mostly due to age-related valve calcification. The year 2002 was marked by the invention and use of the endovascular aortic replacement valve by an A. Cribier’s group of French surgeons. Russian endovascular surgery introduced transcatheter aortic valve replacement in 2009, having since built an extensive experience in this practice. Perioperative mortality in patients under 70 years with no serious comorbidity ranges from 1 to 3 %, however, reaching two-fold 4–8 % in elderly patients. The emergence of minimally invasive technologies offered cure to critical patients, who would merely not get over an open surgery.

Materials and methods. This case study provides video recordings of transcatheter aortic valve replacement (Accurate Neo) in transfemoral approach performed for the first time in the Republic of Bashkortostan. Patient K., 70 yo, diagnosis: Atherosclerosis. Aortic valve stenosis. FC III. Complications: aortic valve calcification st. III, CHF II A, FC III, persistent atrial fibrillation, tachysystole. Comorbid: CHD. Exertional angina. FC III. CHF II A, FC III.

Results and discussion. Improving the transcatheter valve type facilitates an optimal individual aortic valve selection. Pre-replacement valvuloplasty was performed in all patients. The valve replacement is followed by transoesophageal echocardiography to justify possible aortic valve post-dilatation upon marked paravalvular regurgitation. The implant positioning relative to the aortic valve fibrous crown and mitral valve flaps is precisely controlled with ultrasound.

Conclusion. Interventional radiology currently provides high-quality, effective, minimally invasive medical aid even in aortic stenosis patients with multiple comorbidity. In the patient’s denial of open surgery, transcatheter aortic valve replacement represents a sole alternative treatment, also increasing the life expectancy and quality. A wider diversity of available transcatheter devices enables a better personalisation of the biological valve replacement procedure.

Background. Carotid artery restenosis is a rare complication of carotid stenting. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) reveals an in-stent restenosis rate of 0–6 %, a fairly low value given an extensive study sampling of patients. Restenosis still lacks an adequate explanation in endovascular carotid surgery. Intravascular ultrasound visualisation, drug-coated balloons, stent reimplantation or reconstructive surgery have actively been used since relatively recently to tackle restenosis. Drug-coated balloons may fail in certain cases due to hampered restenosis angioplasty in a markedly rigid neointimal hyperplasia. Surgical reconstruction also possessed drawbacks, mostly due to obstacles in the stent removal and the procedure infeasibility in high-risk surgical patients.

Materials and methods. The article describes a clinical case of stent-in-stent restenosis correction with drug-coated balloon-expandable re-stenting of right internal carotid artery and a long-term prognosis estimation with optical coherence tomography.

Results and discussions. This tactic was adopted due to haemodynamically and clinically significant internal carotid artery restenosis, the patient’s denial of carotid endarterectomy and insufficiently effective balloon angioplasty. The choice of the correction technique was conclusive basing on a negative stent deformation testing that showed the lack of deforming stress factors at internal carotid artery restenosis. Intravascular imaging greatly enhances our ability to understand and assess endovascular processes.

Conclusion. We consider clinically significant restenoses in previously stented carotid arteries as requiring further research effort, with the clinical case presented describing an individual solution.

Background. Ovarian cancer in pregnancy is quite rare having a top 5th incidence among other pregnancy-associated tumours [1]. Due to a low population rate in pregnant women, the lack of standardised management of such patients and the paucity of relevant randomised and cohort studies, analyses of individual clinical cases acquire particular importance.

Materials and methods. This article presents a clinical case of de novo diagnosed ovarian cancer in pregnancy tackled with a modified Porro’s operation of peritonectomy, para-aortic and parametric lymphadenectomy and greater omentum resection at a gynaecology unit of the Kuvatov Republican Clinical Hospital of Ufa.

Results and discussion. This clinical case is special in terms of a rare occurrence of ovarian cancer in pregnancy. The choice of this radical surgical technique is considered optimal for inspecting most plausible metastatic foci and ensuring a life-preserving prognosis.

Conclusion. In the absence of standardised management protocols in pregnancy-associated ovarian cancer, further analyses and discussions of routine clinical case evidence are imperative.

Background. Combined thyroid cancer is extremely rare. There is no unified approach currently to the choice of treatment and extent of surgery in combined cancer.

Aim. A clinical case description of left hemithyroidectomy for follicular papillary cancer in a patient previously operated for follicular right lobe cancer with right recurrent laryngeal nerve injury.

Materials and methods. Patient N., 48 yo, had a routine surgical admission in December 2019 with nodular goiter in left thyroid lobe. Suspicio c-r of left thyroid lobe. Condition after right hemithyroidectomy in 2002, postoperative paresis of right recurrent laryngeal nerve.

Results. The patient had a routine surgery upon further examination. Morbid histology corresponded to follicular papillary cancer of left thyroid lobe.

Discussion. Combined thyroid cancers are relatively poorly documented, stimulating further case studies. The chosen extent of surgery and iatrogenic injury of right recurrent laryngeal nerve in history are also distinctive of this clinical case.

Conclusion. A non-standard extent of surgery is described in a clinical case of combined thyroid cancer complicated by postoperative paresis of right recurrent laryngeal nerve in history.

Background. Gallstone ileus is a rare complication of cholelithiasis accounting for 0.3–2.1% total acute intestinal obstructions. The recent years are witnessing a sharply elevated incidence of cholelithiasis and its entailed complications. The major diagnostic biases are the atypical clinical presentation, instrumental and laboratory evidence, and a relative paucity of surgical cases.

Aim. Highlighting to surgeons the feasibility of this rare reluctantly diagnosed form of acute small bowel obstruction.

Materials and methods. The article presents the clinical observations of gallstone-induced small intestinal obstruction collected at a surgery unit of the Bashkir State Medical University Clinic. Patients had surgeries for cholecystoduodenal fistula embolisation, gastro/enterotomy and lithoextraction followed by gastro/enterotomy wound suturing.

Results and discussion. Patients had a benign postoperative period are were discharged in a satisfactory condition on day 7–10 after surgery for outpatient surveillance.

Conclusion. Surgeons need to contemplate this pathology to ensure timely diagnosis and treatment, as well as avoid possible complications. Mostly important still is a timely gallbladder resection upon diagnosing cholelithiasis via laparoscopic cholecystectomy as a “gold standard” in treatment for this disease.

Cervical cancer is a socially significant illness often impacting women of reproductive and working age. The patients’ young age and social activity warrant the development of effective and safe therapies.

The past decades have witnessed the novel radiation techniques to contain cervical cancer: 3DCRT-3D, IMRT, and VMAT, adaptive radiotherapy, CT/MRI-guided intracavitary radiation, combined interstitial and intracavitary radiation, abandoning intracavitary intervention for external beam delivery with sequential or concurrent cervical dose escalation, under brachytherapy unfeasible.

Modern equipment and treatment planning systems allow a high dose delivery to the tumour and intracavitary treatment with visual control of the target and organs at risk. Combining of intracavitary and interstitial radiotherapy enables a better dose coverage of the target at a minimal radiation impact on organs at risk.

Phasing-out of intracavitary for external radiotherapy may enable a cancericide dose delivery to the tumour under intractable intracavitary treatment.

The major goal of technic novelties is the establishment of personalised radiotherapy for improving treatment outcomes and reducing the incidence and/or severity of radiation side effects. The article overviews the radiotherapy techniques for cervical cancer treatment and routes of their development.

Carcinogenesis research uncovers new pathogenesis links as vulnerable targets of effective antitumour therapies. Among the key mediators of immune response, cell proliferation, cell apoptosis and inflammation is transcription factor NF-κB. Misregulation of an NF-κB-dependent pathway is found in solid and haematopoietic tumour cells. One of the best known NF-κB functions is expression regulation of genes involved in the apoptosis inhibition or activation and survival in both intact and malignant cells. The NF-κB-mediated pathways’ involvement in carcinogenesis, angiogenesis and tumour resistance to chemo- and radiotherapies makes this factor a promising target for drug anti-cancer interventions. This review summarises evidence on the antitumour and anti-inflammatory activity of a high-potent and specific low molecular-weight NF-κB inhibitor, dehydroxymethylhepoxyquinomycin (DHMEQ), as a candidate therapeutic agent in treatment for variant malignancies.

The review highlights the power and prospects of confocal laser scanning microscopy in cutaneous cancer diagnosis. This non-invasive technology allows optical skin sectioning at a varying depth with no special tissue treatment or staining. This diagnostic method is currently considered the most promising in imaging and assessment of superficial skin neoplasms. It enables a deeper investigation of skin structures at higher beam powers, which, however, implies possible skin damage. Recent technological advances in the field facilitated the development of new, portable, more practical personal confocal laser scanning microscopy devices providing for an efficient and deeper imaging of skin lesions less accessible otherwise. The technology enables a multiple repeated visualisation of the same skin spot at different time intervals for monitoring the neoplasm progression, therapy impact and cancer dynamics in skin. Numerous studies have determined the basic confocal properties of various tumoural lesions and showed a good correlation with dermatoscopy and histology data. This diagnostic technique allows a multiple non-damaging examination of same skin area, as well as the monitoring of tumourigenesis, clinical dynamics and treatment outcome.

Peritoneal carcinomatosis (PC) is a global challenge of modern oncology representing the most unfavourable scenario in diverse-locality tumourisation. Despite certain attention by the oncological community, the management of PC patients is currently palliative, which weakly promotes research into the basic principles of this morbidity. This literature review attempts to comprehensively cover the PC problematic from a global perspective and presents a key evidence on the world schools of thought in this area. Briefly taking, peritoneal carcinomatosis is viewed today as a local process in the conventional implantation theory, which imposes a locoregional character on all current or emerging therapies, such as cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Their inadequate efficacy is largely due to pronounced gaps in our understanding of PC logistics and signalling. PSOGI is a key organisation for centralising the specialty effort in peritoneal carcinomatosis. Despite its global geography and approach to PC discussion, a multitude of scientific questions remain unanswered impeding the establishment of novel effective therapies. The seven countries that nurtured distinguished schools of thought in PC studies are the USA, UK, Japan, China, Italy, France and Germany. Taking peritoneal carcinomatosis in a global perspective, an insufficient attention to its problematic in Russia should be addressed. The founding and fostering of national PC institutions will benefit cancer patients and progress in oncological science.

Stromal vascular fraction (SVF) is a heterogeneous cell extract obtained with enzymatic dissociation of adipose tissue followed by centrifugation. This population includes many different cell types, i.a. adipose tissue stem cells (ATSCs), vascular endothelial and smooth muscle cells and their precursors, pericytes, fibroblasts, macrophages, T-lymphocytes, etc., excluding mature adipocytes. The main SVF component is ATSCs capable of self-renewal and multipotent differentiation. Since early research on SVF, an extensive effort has been aimed at understanding its clinical applications promoting a significant progress in the SVF use for treatment of various diseases and injuries. The past decade has witnessed an upward publication trend in basic and clinical research into the SVF therapeutic value. Manifold methods and devices for the SVF isolation from human liposuction lipoaspirate have been developed, continuously contributing to preclinical and clinical trials of its safety and efficacy. This review discusses the main properties and functions of the SVF cell population, its efficacy and safety for human therapy.