Breast cancer is the most common cancer in women and the most common cause of death in working-age women. According to the results of immunohistochemical studies, 10�20% of cases revealed a triple-negative type of breast cancer. This subtype is characterized by significant proliferative activity and growth rate, aggressive clinical course, and early metastasis. This leads to a suspicious prognosis and, accordingly, encourages an increase of surgical treatment radicalism and aggressive systemic treatment. This review briefly analyzes existing treatment strategies for triple-negative breast cancer with a focus on surgical treatment. Surgical treatment is an integral part of complex therapy. Currently, the attention of researchers is focused not only on the radicalism of the operation, ensuring long-term survival, but also on achieving a good cosmetic result that determines the quality of life of patients. In this aspect, organ-preserving and prosthetic methods of operations are promising, the feasibility and effectiveness of which are being discussed. The relevance of choosing the optimal method of operation is evidenced by the lack of generally accepted approaches based on informative markers for the prognosis of the course of the disease. Therefore, the choice of the optimal method of surgical treatment taking into account the individual characteristics of the patient and the tumor, indications for chemotherapy, and radiation therapy remains an unresolved issue and requires further research.
Surveys of small mammals (insectivorous and rodents) and their ectoparasites were carried out in the Subpolar Urals (eastern macro-slope) near Mount Neroyka (Berezovsky district, Khanty-Mansi Autonomous Okrug Ugra) in different altitude zones (from 407 to 1018 m above sea level) in 2020 and 2021. A total of 15 species of parasitic gamasid mites, 1 species of ixodid ticks, 11 species of fleas and 1 species of lice were identified. Two counting methods, ditch with pitfalls and trap-lines, were used to better reveal the composition of small mammals (feeders of ectoparasites). Specific parasites of Eurasian water voles, Laelaps muris and Hyperlaelaps amphibius, dominated among gamasid mites regardless of the method of trapping insectivores and rodents. At the same time, the proportion of the Eurasian water vole in the small mammal community of the Subpolar Urals (eastern macro-slope) did not exceed 7%. The group of dominant species also included Laelaps algericus, which was recorded in only three species (of 16 small mammal species recorded in the Subpolar Urals): the Eurasian water vole, the field vole and the Middendorff's vole. Among rare species of gamasid mites, Haemogamasus dauricus is of particular interest, a species not previously recorded in the Urals and Western Siberia. Ixodes persulcatus is a single occurrence in the area. The find of this tick is one of the most northerly in the Asian part of the Russian Federation. Among representatives of flea and lice groups the share of specific species (shrews and red-backed voles) is high. This is probably due to the high mobility of shrews, their close contact with rodents, and the specificity of animal counting methods.
Introduction. Survival of patients with advanced-stage cancers remains poor despite significant successes in targeted and chemotherapy. Immunotherapy is a systemic method of treatment that has expanded the possibilities of drug therapy for malignant tumors. Immunotherapy's side effect significantly differs from chemotherapeutic drugs and targeted therapy. Research rationale. One of the most common side effects is a toxic effect on the endocrine system, particularly the thyroid gland. Aim of the research. Conduct a systematic analysis of scientific literature on the side effects of immune checkpoint inhibitors on the thyroid gland. Materials and methods. A scientific search was conducted in Pubmed, Scopus, and Web of Science databases. The following search terms were used: "immune checkpoint inhibitors," "immunotherapy," "thyroid gland," and "side effects." Research results and discussion. Both PD-1/PD-L1 inhibitors and CTLA-4 inhibitors can cause thyroid dysfunction (hyperthyroidism or hypothyroidism). One of the meta-analyses reported no difference in the incidence of thyrotoxicity between the two drug groups. However, other meta-analyses have shown that this phenomenon is more common in patients treated with PD-1/PD-L1 inhibitors than with CTLA-4 inhibitors. In addition, scientists proved that hypothyroidism occurred statistically more often (3.8% of patients) than hyperthyroidism (1.7%). Hypothyroidism was more common in PD-1 inhibitor users than hyperthyroidism (7.0% vs. 3.2%, respectively). Patients with a history of autoimmune thyroid disease have a high risk of disease exacerbation after initiating immune checkpoint inhibitor therapy. The side effect of immune checkpoint inhibitors is developed mainly in women. The first laboratory signs of hypothyroidism are observed after 2-4 courses of immunotherapy. In most cases, the disease is asymptomatic, but in rare cases, it turns into permanent hypothyroidism and even thyroid crisis. The leading causes of destruction of the thyroid gland due to immune checkpoint inhibitors are damaged by autoantibodies or the production of thyroid-stimulating antibodies. Levothyroxine is prescribed at 0.8–1.6 μg/kg/day for treating hypothyroidism with clinical symptoms. For elderly patients and patients with cardiac pathology, the initial dose of the drug should be no more than 25-50 μg. Treatment with immune checkpoint inhibitors is usually continued. Treatment of thyrotoxicosis depends on the pathological mechanism that caused it. Most often, beta-blockers (atenolol and propranolol) are used to eliminate the symptoms of thyrotoxicosis. A feature of thyroiditis is its ability to transition into hypothyroidism, which can become permanent. Conclusions. The development of thyroid dysfunction is the most common consequence of autoimmune damage. PD-1 inhibitors are the most common cause of this condition. Usually, the disorders are asymptomatic and have the first degree of severity. Timely appointment for hormone replacement therapy allows the effective continuation of immunotherapy. However, some conditions may be refractory to such treatment, requiring steroid therapy and discontinuation of immunotherapy.
Background. Lung cancer occupies the leading place in the structure of cancer incidence and death rate. Treatment results are still not satisfactory. Five-year postsurgical survival rate is 24–30%. Patients die in different periods of time from local recurrences and distant metastases. To this day, there is no unambiguous attitude towards ipsilateral mediastinal lymph node dissection in surgical treatment of patients with lung cancer. Despite the oncologic relevance of the abovementioned lymph node dissection, there are still concerns on worsening of recovery conditions of bronchial stump, increase in the amount of lymphorrhea and additional injury rate of the surgery. There is also an opinion that the risk of development of postsurgical complications, and, as a result, the increase in lethality rate, outweigh the positive impact of ipsilateral mediastinal lymph node dissection on radicality and long-term treatment results. Purpose – to study the impact of ipsilateral mediastinal lymph node dissection on the course of postsurgical period in patients with lung cancer, clarifying diagnostics of spread of tumor process and survival rate of the patients. Materials and methods. Treatment results of 187 patients with non-small-cell lung cancer with different clinical stages from T1-3N0 M0 to T1-2N1 M0 were analyzed. The patients were divided into two groups: the first group (comparison group) consisted of 72 patients, who underwent radical operations with selective lymph node dissection. The patients of the second group, the study group (115 patients), obligatorily underwent ipsilateral mediastinal lymph node dissection. The number of removed lymph nodes in one patient ranged from 5 to 10 in the first group and from 18 to 25 in the second one. In the cases when no cancer cells were found in lymph nodes, they were managed with monoclonal antibodies to cytokeratins, expressed with cancer cells, with further microscopic evaluation. During the postsurgical period the following values were studied: duration of the surgery, the volume of intraoperative blood loss, the amount and duration of exudation, frequency and character of postsurgical complications. Comparison of survival rates of the patients was performed with the test of statistical significance of differences by χ2 criterion. Methods of non-parametric statistical estimate were used for statistical analysis of the results by the means of Statistica 6.0, SPSS 17.0 software. Results. Adding ipsilateral mediastinal lymph node dissection to surgical interference increased its duration by 30 minutes on average. An increase in the volume of exudate by 136,2 ± 18,4 ml was observed in early postsurgical period. Structure and frequency of postsurgical complications in both groups was similar. In most cases heart rhythm disorder, namely ciliary arrhythmia, was observed in the first days after the surgery. Postsurgical lethality rate in both groups was caused by various factors and equaled 1,4% in the first, and 0,8% in the second one. Additional usage of immunohistochemicalanalysis of lymph nodes with monoclonal antibodies to tumoral cytokeratins in patients after performing ipsilateral mediastinal lymph node dissection led to their lesion being found more frequently. Indeed, metastases were detected in 21% of 19 patients, in which N0 status was previously established in light microscopy. Also, a significant increase in three-year survival rate by 15,3% (p=0,042) was observed in patients with lung cancer, who underwent ipsilateral mediastinal lymph node dissection and had no signs of mediastinal lymph nodes lesion, and 23,2% (p=0,014) in patients with the signs of the lesion. Conclusions. Performing ipsilateral mediastinal lymph node dissection in patients with lung cancer during surgical interference does not have an impact on postsurgical lethality rate and frequency and structure of complications. During the study of lymph nodes, which, according to light microscopy, were considered unaffected by cancer, additional lymphogland metastases were found in 20,7% of the patients by the means of monoclonal antibodies to cytokeratins. It allows the stage of the disease to be more accurately determined and optimal type of adjuvant therapy to be chosen. Detection rate of metastases in regional lymph nodes significantly increases from 51,4% to 67,8% in patients with lung cancer after radical operations with additional ipsilateral mediastinal lymph node dissection. Obligatory ipsilateral mediastinal lymph node dissection in surgeries for lung cancer increases overall three-year survival rate, especially in patients with affected lymph nodes by 16,3%.
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