Intense competition and innovative activity characterize the modern business industry. In order to achieve high efficiency of business processes, remain competitive and earn profit, provide customers with quality products within the shortest time possible, the company needs to optimize production, timely eliminate losses and efforts that do not bring results. The relevance of the research topic is beyond doubt, since the improvement of the enterprise's activities at all its stages is facilitated by introducing methods and tools of lean manufacturing, which are currently widely used. Based on studying the practical experience of using lean tools by Russian and foreign organizations in various sectors of the economy, this study presents the features and benefits of the concept of lean manufacturing, as well as the problems associated with its use. The article presents the results of a pilot project on introducing lean technologies at a meat-processing enterprise in order to optimize the work of a canning shop. The project focuses on applying basic lean methods and tools: a system for organizing a safe and efficient workplace (5S), value stream mapping, work standardization, quick readjustment (SMED) and a system for collecting proposals for improvements (Kaizen). The current state of the pilot stream has been assessed in the work in order to identify existing losses and problems; the main directions for optimizing the value stream, eliminating identified problems and minimizing losses have been developed; the results of implementing measures to introduce lean technologies in the canning shop have been evaluated. The dynamics of the enterprise performance key indicators confirms the effectiveness of the lean production system and the need to replicate positive experience to other flows and processes operating at the enterprise.
e15500 Background: The immune response plays a key role in the oncogenesis of colorectal cancer. The heterogeneity of the tumor environment determines the need for immunogenetic profiling to identify associations with the implementation of tumor-specific immune responses in colorectal cancer. The purpose of our study was to describe the expression profiles of miRNAs and genes involved in the regulation of the immune response in colorectal cancer. Methods: The study included 18 patients (median age 66 years) diagnosed with colorectal cancer who were treated at the National Medical Research Centre for Oncology in 2018-2019. Total RNA was isolated using TRIzol (Thermo Fisher, USA) followed by treatment with DNase 1 (ThermoFisher, USA). Sequencing of RNA samples was performed using two approaches: AmpliSeq for Illumina Immune Response Panel (Illumina, USA) and TruSeq Small RNA Library Prep Kit -Set A (Illumina, USA) according to the manufacturer's instructions on a NextSeq 550 device (llumina, USA). Results: The study revealed 168 differentially expressed genes and 46 differentially expressed miRNAs (p < 0.05). 29 miRNA-mRNA pairs were identified. It has been established that the key signaling mechanism involved in the regulation of the tumor-specific immune response is chemokine signaling pathway (hsa04062). Expression of the CXCL1 and CXCL10 genes encoding the chemokines of the same name is increased in tumor cells (logFC = 1.51, p = 0.006 and logFC = 2.67, p < 0.001, respectively). At the same time, the level of hsa-miR-30a-5p and hsa-miR-99b-5p, which negatively regulate the expression of CXCL1 and CXCL10, is decreased (logFC = -2.26, p < 0.001 and logFC = -1.57, p < 0.001). Conclusions: Activation of expression CXCL1 and CXCL10 with simultaneous loss of negative regulators hsa-miR-30a-5p and hsa-miR-99b-5p was determined in colorectal tumors by NGS-sequencing, which seems promising for the development of personalized therapy, based on the immunogenetic features of colon tumors.
e15503 Background: The purpose of this study was to analyze the effect of the CD44+ and CD133+ co-expression in cancer stem cells (CSCs) on lymphocytic microenvironment of colon cancer (CC). Methods: 200 CC patients received surgery as the first stage of treatment. The percentage of CSCs with the expression of CD44+ and/or CD133+ markers was studied in the tumor homogenates by flow cytometry, as well as some indicators of local immunity (CD3+, CD4+, CD8+, T regs (CD4+CD25+CD127dim), CD19+, PD-1, PD-L1, Th0, Tm, CD16/56+ and immunophenotypic characteristics of tumor cells (PD-L1, MHC-ABC). Results: Gradation depending on the absence or presence of co-expression of CSC markers on tumor cells allowed identification of 11 statistically significant differences out of 17 studied parameters of tumor cells and their lymphocytic microenvironment. Co-expression of CSC markers was accompanied by higher percentage of T regs (7.3±0.4 versus 5.3±0.5%), together with lower levels of CD4+ cells. At the same time, a higher content of the total number of T-lymphocytes was noted due to CD8+ with an increase in the percentage of memory T cells and a decline in naive T lymphocytes within this subpopulation. In addition, the co-expression of CSC markers was accompanied by a lower content of PD-L1 (34.3±3.0 vs. 42.9±2.5%) on lymphocytes and its higher content on tumor cells (10.6±1.5 vs. 4.1±0.8%), while the PD-1 expression on lymphocytes was higher (38.4±3.7 versus 22.3±2.9%). The presence of CD44+CD133+ CSCs was also accompanied by lower percentage of tumor cells expressing MHC class I (60.4±4.9 vs. 79.3±7.6%), which characterized the inhibition of recognition processes, and increased levels of CD8+, perhaps, should be considered as compensatory. Conclusions: The lymphocytic microenvironment of CC in the presence of CSCs with the CD44+CD133+ immunophenotype seems to be more immunosuppressive, according to the increase in the local content of T regs and the decrease in MHC-ABC expression. Higher expression of PD-L1 on tumor cells and PD-1 on lymphocytes allows activation of the PD-1/PD-L1 interaction, which enhances the immunosuppressive and growth-stimulating properties of the tumor microenvironment, but at the same time, makes tumor cells adequate targets for immunotherapy with immune checkpoint inhibitors.
e15501 Background: The purpose of this study was to demonstrate the importance of circulating tumor cells (CTCs) in the formation of immunosuppression in colon cancer. Methods: 200 patients with stage II-IV colon cancer underwent surgery as the first stage of treatment. Blood levels of CTCs were determined before surgery by flow cytometry using the CellSearch method (the sample was considered positive with CTCs > 3), as well as some indicators of innate immunity (NK cells, neutrophilic and monocytic phagocytosis). Results: Regardless of the stage, patients with CTCs had statistically significantly lower levels of NK lymphocytes (16.8±1.9 versus 22.3±1.8%, p≤0.05) compared with the absence of CTCs; on the contrary, levels of NKT cells in this group were higher than in the absence of CTCs (8.8±0.9 versus 5.0±1.0%, p≤0.05). The presence of CTCs was accompanied by higher levels of CD16dim56bright cells (13.1±3.2 versus 5.9±1.0% p≤0.05) with a lower content of CD16+56dim (82.5±3.6 versus 90.4±0.8%), and levels of perforin and granzyme were similar. The presence of CTCs was characterized by a higher percentage of phagocytic monocytes in the Phagotest test, as well as a higher percentage of monocytes and neutrophils capable of developing oxidative burst upon fMLF stimulation in the Phagoburst test (10.8±3.3 versus 3.2±1.5% and 5.1 ±0.8 vs. 2.0±1.1%, respectively; p≤0.05). A separate analysis of phagocytosis indicators by disease stages revealed that the presence of CTCs in patients was accompanied by stimulation of phagocytosis in local tumors and inhibition in advanced disease, however, in the latter case, the ability of granulocytes and monocytes to generate reactive oxygen species (ROS) was preserved and even increased. Conclusions: The presence of CTCs in patients with colon cancer is characterized by a redistribution of natural killer subpopulations with an increase in the blood levels of NKT cells, some of which have immunosuppressive activity, due to a decrease in NK cells, and an increase in CD16dim56bright and a decrease in CD16+56dim, apparently, indicates disturbance of their maturation. The established changes in the presence of CTCs indicate the inhibition of antitumor properties of the NK cell and phagocytic components of innate immunity in tumor cell circulation. The N-formylpeptide fMLF is known as a powerful neutrophil chemoattractant, stimulator of their migration and cytokine production, which plays a role in the development of inflammatory bowel diseases. The growth-promoting activity described for the similar antimicrobial protein LL-37 can be mediated through neutrophil migration and ROS production. Thus, the presence of CTCs has a negative impact on the parameters of NK cell and phagocytic components of innate cellular immunity in patients with colon cancer, which can serve as one of the strategies for survival and dissemination of the tumor.
e16243 Background: Surgical treatment is considered the main treatment for pancreatic cancer improving the patient survival. The most common obstacle to surgery with R0 resection is the involvement of the great vessels. Recently, venous resections have been increasingly performed for this type of tumors. Our purpose was to evaluate radicality of surgical treatment and postoperative morbidity in patients with locally advanced pancreatic cancer. Methods: The study included patients with locally advanced pancreatic cancer (T3 N0-1 M0) with damage to the venous segment (portal vein system) confirmed by CT angiography. Results: Over a 5-year period, 73 (18.9%) of 386 operated-on patients with pancreatic cancer underwent surgeries for pancreatic ductal adenocarcinoma with venous resection. The frequency of wedge venous resection was 24.7% (18), segmental resection with end-to-end anastomosis - 46.6% (34), prosthetics - 26% (19), prosthetics with replantation of the splenic vein - 2.7% (2). The postoperative morbidity rate was 30.1%. Within 30 days after surgery, the mortality rate reached 5.5% (4 patients). The main causes were bleeding and thrombosis of the reconstruction area. Only patients with venous segment replacement developed thrombotic complications. Microscopically complete resection was performed in 87.7% of cases (64 patients). During the follow-up period, the 1-year survival rate reached 90%, and the recurrence-free rate was 93%. Conclusions: Surgical treatment for locally advanced pancreatic tumors with damage to the portal vein system shows an acceptable rate of postoperative complications due to the vascular stage, and a high rate of reaching a negative resection margin. Initial assessment of the need for venous resection is required in patients with pancreatic tumors, as well as expanding the extent of surgical intervention due to venous resection to achieve R0 resections.
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