Tumor thrombosis in extremity soft tissue sarcomas Katelnitskaya, Oksana V.; Nepomnyashchaya, Evgeniya M.; Ausheva, Tatiana V. ...
Journal of clinical oncology,
06/2022, Letnik:
40, Številka:
16_suppl
Journal Article
Recenzirano
e23551
Background: Malignant tumors of bones and soft tissues often reach large sizes, compress and invade the major vessels, leading to the development of venous thrombosis. Venous thrombosis is ...difficult to distinguish from tumor thrombosis in the preoperative period. However, the management differs. Both conditions require anticoagulant therapy, but tumor thrombosis requires expanding intervention with the thrombus removal and major venous resection. The major vessel involvement complicates surgery. It is much more difficult to achieve negative resection margins. The risk of damage to the main vessels during tumor mobilization increases and, as a result, the risk of hemorrhagic complications increases as well. An interdisciplinary approach reduces the risk of surgical complications and helps achieve radical tumor resection. Our purpose was to analyze the rates of tumor thrombosis in malignant tumors of bones and soft tissues and evaluate the results of surgical treatment. Methods: 115 patients (mean age 46 years) with malignant tumors of bones and soft tissues received surgical treatment in 2020-2021. The most common histological subtypes were synovial sarcoma (25.3%), pleomorphic sarcoma (18.2%), and liposarcoma (15.6%). Venous thrombosis of the lower extremity veins was diagnosed at the stage of preoperative preparation in 17 patients (14.8%), the femoral segment was more often affected (70.6%). All patients received anticoagulant therapy. The tumor genesis of a thrombus was confirmed intraoperatively in 7 patients. Thus, the incidence of tumor thrombosis in malignant tumors of bones and soft tissues was 6%. All patients underwent tumor removal, thrombectomy, and the femoral or iliac venous segment resection. Results: The following complications were observed in the postoperative period: seroma - 5 cases (29.4%), lymphorrhea - 12 (70.5%), swelling of the lower limb - 12 cases (70.5%). Conclusions: Tumor thrombosis in malignant tumors of bones and soft tissues of the lower extremities is not a rare complication, it requires timely diagnosis and an expanded intervention to achieve negative resection margins and reduce the risk of embolism.
e21587
Background: The purpose of this study was to assess the effect of a strain 100 of a new group of rotavirus of Reoviridae family on the growth of transplantable B16/F10 melanoma in mice and the ...survival of the animals. Methods: We studied the strain 100 of a new group of rotavirus of Reoviridae family (RVK) ( http://jbks.ru/archive/issue-10/article-6 ). RVK 100 is a live attenuated non-pathogenic virus growing on pig embryo kidney cell culture with concentration 5·10
9
per 1 ml. The dynamics of melanoma growth and the survival of tumor-bearing animals receiving RVK were studied in 25 male mice divided into 5 equal groups, each n = 5. RVK was administered intramuscularly and orally once a week 0.3 mL and 25 µL, respectively: to groups 1-2 21 days prior to the tumor inoculation, a total of 4 injections (“vaccination” regimen); to groups 3-4 – 7 days after tumor inoculation with the onset of tumor nodes, a total of 3 injections (“treatment” regimen); group 5 included controls receiving 0.85% NaCl solution. Groups 1 and 3 received live RVK, groups 2 and 4 - RVK inactivated by UV radiation. Results: Survival of mice in groups 1-2 receiving both live and inactivated RVK in the “vaccination” regimen was increased statistically significantly: in group 1, Me = 25 days after melanoma transplantation (LQ 24; UQ 30), in group 2 Me = 26 days (LQ 25; UQ 30), in controls Me = 14 days (LQ 10; UQ 22); p = 0.032 and p = 0.0079, respectively. RVK administration in the “treatment” regimen did not cause such changes. While mice of group 3 receiving the live strain 100 showed a tendency to higher survival, compared to controls (Me = 23 days, LQ 22; UQ 24, p = 0.056), the administration of inactivated RVK (group 4) did not significantly improve the survival of animals, compared to controls (Me = 22 days (LQ 21; UQ 33, p = 0.151). Conclusions: Improved survival of animals with B16/F10 melanoma after the RVK administration indicates the virus ability to slow down tumor growth and confirms our previously published data on the RVK strain 228, although, in contrast to it, the strain 100 is able to increase the survival rate of tumor-bearing mice only when used in the “vaccination” regimen, which refers mainly to the inactivated virus. Since the inactivation of the RVK strain 100 eliminates its effect when used in the “treatment”, but not “vaccination” regimen, it seems to be associated with an immunostimulatory effect but not with an oncolytic one.
Aim To study factors that influence the consistency of real prescriptions with applicable national guidelines for outpatient physicians in the management of patients with common cardiovascular ...diseases (CVDs).Material and methods This was a cross-sectional study based on 16 randomly selected municipal polyclinics, where internists filled in validated questionnaires, including the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), Hospital Anxiety and Depression Scale (HADS), Visual Analogue Scale (VAS), WHO Quality of Life - BREF (WHOQOL-BREF), and the Personal Decision-Making Factors (PDF-25). Participating physicians provided outpatient case reports of sequentially arriving patients with a high risk of CVD or confirmed CVDs during 2-3 working days, corresponding to the questionnaire period of ±1 week. The consistency of the prescriptions recorded in these case reports with the Russian Society of Cardiology (RSC) Guidelines was assessed.Results This study included 108 physicians (mean age, 44.0±13.1 years, 87.0 % women) who provided case reports of 341 patients (mean age, 64.4±13.2 years, 59.5 % women) with most common diagnoses of arterial hypertension (92.1 %), ischemic heart disease (60.7 %), and chronic heart failure (32.8 %). According to results of multivariate regression analysis, the following factors increased the likelihood of the prescription inconsistency with the guidelines: the fact that the physician had the highest attestation category (OR 2.56; 95% CI 1.39-4.7; p<0.002), attended professional events less than 2 times in 5 years (OR 2.23; 95% CI 1.18-4.22; p=0.013), had an additional, part-time job (OR 15.58; 95% CI 1.51-160.5; p=0.021), was prone to prescribe familiar trade names (OR 2.04, 95% CI 1.08-3.85; p = 0.028), perceived drug supply problems as an important factor influencing the decision making (OR 5.13, 95% CI 2.69-9.75; p<0.001), and a total score on the emotional exhaustion scale (OR 1.03, 95 % CI 1.01-1.06; р=0.031). Also, this likelihood was increased by older age of the patient (OR 3.29; 95 % CI 1.65-6.55; р<0.001) and excessive alcohol consumption by the patient (OR 1.79, 95 % CI 1.31-2.43; р<0.001). The likelihood of non-compliance with the guidelines was reduced by a high assessment of own health status according to the WHOQOL-BREF questionnaire (OR 0.19; 95% CI 0.05-0.72; p = 0.014), a high assessment of own working conditions (OR 0.76; 95% CI 0.64-0.9; p=0.002), and postgraduate education within the last 5 years (OR 0.14; 95% CI 0.06-0.36; p<0.001).Conclusion The study identified the factors that influence the likelihood of the consistency of prescriptions made by outpatient physicians for patients with CVD with applicable national clinical guidelines. Among these factors, the most important ones were access to educational events, additional, external part-time job, indicators of inertia of previous practice, problems with drug provision, satisfaction with own health status and working conditions, and emotional exhaustion (a component of professional burnout), older age of patients and their excessive alcohol consumption.
Abstract
Background
Several drug classes have shown their ability to improve risk factors control and prognosis in coronary heart disease (CHD). Therefore, it is important to monitor the prescription ...patterns on a regular basis to ensure that all the eligible patients receive the potentially lifesaving medications.
Purpose
To describe prescription and uptake of main guideline-recommended drug classes in men and women with history of acute coronary syndromes (ACS) or cardiac revascularization enrolled into the hospital care arm of EUROASPIRE V (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) study in Russian centers vs the whole study population.
Methods
The hospital arm of EUROASPIRE V was a cross sectional survey covering multiple European countries including Russia. Within each country one or more hospitals were selected where consecutive pts (both genders, ≥18 and <80 years of age) hospitalized for myocardial revascularization procedures or for ACS were retrospectively identified. Identified patients were invited for interview, which had to take place ≥6 months and <2 years after the index hospitalization. Pharmacological treatment was assessed based on the prescriptions in the discharge letters and during the interview.
Results
A total of 399 pts (women, 27.1%) have been interviewed in Russia vs 8261 pts (women, 25.8%) in the whole survey. The mean age of the Russian cohort at interview was 62.8±8.7 years in Russia vs 63.6±9.6 years in all EUROASPIRE V pts. The table below represents the proportion of pts prescribed and actually receiving main drug classes. Both in the Russian cohort and in the whole study population the proportion of patients receiving essential drug classes didn't differ much by gender. In Russian centers, 95.9% of men and 91.7% of women received antiplatelets (vs 92.8% and 91.8%, respectively, in the whole study population). For statins the corresponding numbers were 86.9% for men and 91.7% for women in Russia (vs 82.2% and 76.8%), for beta-blockers – 82.5 in both genders (vs 80.8% and 81.8%), for ACE inhibitors and/or ARBs 78.0% in men and 80.6% in women (vs 75,3% and 75.0%).
Conclusion
Current prescription of guideline-recommended drug classes in the Russian cohort of EUROASPIRE V survey is close to the average European levels and doesn't demonstrate any obvious gender gaps. However, there is still room for improvement. In particular, this applies to the maintenance of prescriptions made at discharge, especially of statins, in the long term.
Funding Acknowledgement
Type of funding sources: None. Table 1
Abstract
Background
Regular monitoring of risk factors control in patients (pts) with atherosclerotic cardiovascular diseases is of paramount importance for interventions and policies targeting ...secondary prevention settings.
Purpose
To describe traditional risk factors control in men and women with history of acute coronary syndromes (ACS) or cardiac revascularization enrolled into the hospital care arm of EUROASPIRE V (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) study in Russian centers vs the whole study population.
Methods
The hospital arm of EUROASPIRE V was a cross sectional survey covering multiple European countries including Russia. Within each country one or more hospitals were selected where consecutive pts (both genders, ≥18 and <80 years of age) hospitalized for myocardial revascularization procedures or for ACS were retrospectively identified. Identified patients were invited for interview, which had to take place ≥6 months and <2 years after the index hospitalization. The risk factors control was assessed during the interview.
Results
A total of 399 pts (women, 27.1%) have been interviewed in Russia vs 8261 pts (women, 25.8%) in the whole survey. The mean age of the Russian cohort at interview was 62.8±8.7 years in Russia vs 63.6±9.6 years in all EUROASPIRE V pts. The proportion of pts with uncontrolled risk factors in Russia vs the whole survey population was as follows: current smokers 19.0% vs 18.7%, obesity 47.0% vs 37.7%, abdominal obesity 60.4% vs 58.5%, uncontrolled diabetes 52.9% vs 45.6%, blood pressure (BP) not at goal 36.0% vs 46.3% and uncontrolled LDL cholesterol in 72.4% vs 71.0%, respectively. The table below represents uncontrolled risk factors by gender in Russian pts and in the whole study population.
Conclusion
Both in Russian centers and in the whole survey participants there was a considerable room for improvement o risk factors control. Smoking seemed to be a more common issue in men whereas obesity, uncontrolled diabetes and low physical activity were more prevalent in women.
Funding Acknowledgement
Type of funding sources: None. Table 1
Aim
To study features of the psychological status, job burnout syndrome (JBS)m and quality of life (QoL) in outpatient physicians.
Material and methods
This cross-sectional study was performed ...at 16 randomly selected municipal outpatient hospitals of Moscow and included physicians (district physicians, primary care physicians, and cardiologists). The participants signed an informed consent form and then filled out a registration card that included major social and demographic (sex, age, education, position) and professional characteristics (specialization, work experience, qualification category), and questionnaires. The degree of job burnout was evaluated with the Maslach Burnout Inventory (MBI-HSS), and the presence of anxio-depressive symptoms was evaluated with the Hospital Anxiety and Depression Scale (HADS). The level of stress was assessed with a visual analogue scale (VAS) in a score range from 0 to 10. The QoL of physicians was assessed with the short version of the World Health Organization Quality of Life (HOQOL-BREF) questionnaire.
Results
This study included 108 physicians from 16 municipal outpatient clinics aged 24 to 70 years (mean age, 44.0±13.1 years), mostly women (87.0 %). Among JBS components, a high level of emotional exhaustion was observed in 50.0 % of physicians, a high level of depersonalization in 34.1 %, and a severe reduction of personal accomplishment in 37.5 %. A high level of stress (VAS score ≥7) was observed in 66.3 % of physicians; symptoms of anxiety and depression of any degree (HADS-A and HADS-D subscale score ≥ 8) were found in 23.8 and 22.7 % of participants, respectively. 42.0% of physicians evaluated their QoL lower than “good” and 41.6% of physicians evaluated their health condition lower than “good”. Most of the studied factors did not significantly depend on the gender and the duration of work, except for emotional exhaustion (55.3 % of women and 16.7 % of men; p=0.0086) and a high level of stress (72.2 % of women and 28.6 % of men; р=0.002).
Conclusion
The study showed a high prevalence of personal factors that potentially adversely affect the work of outpatient physicians. These factors included high degrees of stress, anxio-depressive symptoms, job burnout, unsatisfactory QoL, and low satisfaction with own health. Management decisions and actions are required to create the optimum psychological climate at the workplace of physicians, to develop new strategies for prophylaxis and correction of their psychological condition, and to implement comprehensive programs for improving the professional environment to maintain and enhance the mental health and to increase the professional prestige of the medical speciality.
Aim.
To evaluate the relationship between the in-hospital mortality of patients with COVID-19 and the history of cardiovascular disease (CVD) using data from the Russian registry of patients with ...COVID-19.
Material and methods.
This study included 758 patients with COVID-19 (403 men, 355 women) aged from 18 to 95 years (median, 61 years), successively hospitalized in the COVID hospital of the Chazov National Medical Research Center of Cardiology from April through June 2020. Death predictors were studied using single- and multivariate regression analyses with the SPSS Statistics, Version 23.0 software.
Results.
During the stay in the hospital, 59 (7.8 %) patients with COVID-19 died, 677 (89.3 %) were discharged, and 22 (2.9 %) were transferred to other hospitals. The univariate regression analysis showed that the increase in age per decade was associated with a 92% increase in the risk of death relative risk (RR), 1.92; 95% confidence interval (CI), 1.58-2.34; p <0.001, and an increase in the number of CVDs increases the risk of death by 71% (RR 1.71; 95% CI 1.42–2.07; p<0.001). The presence of one or more CVDs or specific diseases atrial fibrillation, chronic heart failure (CHF), ischemic heart disease, myocardial infarction, history of cerebrovascular accidents, as well as diabetes mellitus were associated with a higher risk of fatal outcome during the hospitalization for COVID-19. The presence of any CVD increased the risk of in-hospital death by 3.2 times. However, when the model was adjusted for age and sex, this association lost its strength, and only the presence of CHF was associated with a 3-fold increase in the risk of death (RR, 3.16; 95 % CI, 1.64-6.09; p=0.001). Age was another independent predictor of death (RR, 1.05; 95 % CI, 1.03-1.08; p < 0.001).
Conclusion.
A history of CVD and the CVD number and severity are associated with a higher risk of death during the hospitalization for COVID-19; the independent predictors of in-hospital death are an age of 80 years and older and CHF.
Abstract only
e23522
Background: The disruptions in redox homeostasis in the nonmalignant tissues surrounding neoplasm can promote the tumor progression. The aim of this work was to assess the ...changes of the redox-regulatory system in the tumor and tumor-surrounding tissues in STS patients (pts) under the influence of a mofified metod of NC. Methods: The activity of glutathione S-transferase (GST), glutathione peroxidase (GPx), glutathione reductase (GR), content of reduced glutathione (GSH) and malondialdehyde (MDA) were determined by spectrophotometric methods. All markers were measured in the samples of tumor, peritumoral area and healthy tissues (taken along the line of resection) obtained during the surgery from 42 STS pts (T2a-bN0M0). The control group consisted of 21 primary pts who underwent resection only. Patients of the experimental group (21) received NC comprising systemic and local administration of antitumor drugs. Doxorubicin (40 mg/m
2
) was injected intravenously on the 1st and 7th days with autologous red blood cells as drug carriers; at the same time, cyclophosphamide (600 mg/m
2
) and methotrexate (40 mg/m
2
) were injected along the tumor periphery, on autologous plasma as a carrier. After 14 days, tumor removal surgery performed. All STS pts received standard postoperative chemoradiotherapy. Results: The level of GSH in tumor without NC treatment was higher than in the healthy and peritumoral tissue (by 2.3-2.5 times), and the activity of all glutathione-dependent enzymes was higher by 53.0-147.0 % (p = 0.0413-0.00124). The content of MDA in tumor was lower than in other tissues by 30.0-46.0 % (p = 0.00061). We did not find any differences between the healthy and peritumoral areas. In tumor samples of the experimental group, we also observed statistically significant increase in the level of GSH (by 2.8–3.0 times) and activation of GPO (by 37.3-95.8 %) and GR (by 2.0-3.2 times) vs. other tissues. However, after NC, the studied samples showed an increase in GSH by 3.1–3.8 times (p = 0.0143–0.00112), compared with the corresponding control samples. Also, the activity of GPO (by 54.5 %) and GsT (by 38.9 %) was significantly increased in peritumoral tissue vs similar area in the control group. After NC, the content of MDA was reduced in the healthy and tumor tissues vs control by 52.0 % (p = 0.0074) and 30.6 % (p = 0.04815), respectively. Clinical efficacy of NC was confirmed by reduced tumor volume in most patients by 30-40 %; the 5-year monitoring of STS pts showed that local recurrence and metastasis occurred in 14 of 21 pts in the control group, and in 6 of 21 in the main group (p = 0.0294). Conclusions: The NC treatment modifies the redox balance in the tumor-surrounding tissues and, as a result, decreases the oxidation damages in the healthy tissues. This effect, apparently, is an additional factor that improves the effectiveness of the proposed NC method.
The aim of the work was to determine the species diversity of the causative agents of Ixodidae tick-borne borrelioses in Ixodes persulcatus ticks in the Khabarovsk Territory. Materials and methods . ...During the epidemic season (April–October) 2017–2023, 4751 specimens of I. persulcatus Schulze, 1930, removed after attachment to humans and 418 ones collected from vegetation in the Khabarovsk Region, were studied. Ixodidae ticks were collected in the green areas of Khabarovsk city during the snowless season of 2021–2023, as well as in the territory of the Khabarovsk Region on the flag. DNA of the borrelia complex Borrelia burgdorferi sensu lato (s.l.) and B. miyamotoi was detected in ticks using real-time polymerase chain reaction (PCR). Differentiation of borrelia species in samples containing genetic material of B. burgdorferi s.l. was carried out in two stages. At the first stage, the presence of DNA from borrelia of the B. garinii s.l. group ( B. garinii + B. bavariensis ) and B. afzelii DNA was determined in the sample. At the second stage, positive samples of B. garinii s.l. were differentiated into B. garinii sensu stricto (s.s.) and B. bavariensis. Results and discussion . In engorged ticks, genetic material of B. burgdorferi s.l. was detected in 45.7 % of the cases, DNA of B. miyamotoi was identified in 7.2 % of samples. In ticks collected from vegetation, the DNA of B. burgdorferi s.l. was detected in 38.0 % of cases. Upon further study, the genetic material of B. afzelii and borrelia of the B. garinii s.l. group was identified in 47.2 % of cases for both pathogens. Within the group B. garinii s.l., DNA of B. bavariensis was detected in 18.6 %, B. garinii s.s. – in 8 % of samples, at the same time, mixed infection was noted in 53.3 % of cases. The infection rate with B. afzelii in I. persulcatus ticks turned out to be statistically significantly higher than that for B. garinii s.s. and B. bavariensis , thereat statistically significant differences in tick infection rates with B. garinii s.s. and B. bavariensis was not detected.
Abstract
Background
Salt restriction is essential for a healthy diet, especially for patients (pts) with cardiovascular diseases. Pts education has a potential to promote healthier dietary patterns.
...Purpose
To assess the impact of 2 preventive counselling programs with subsequent remote support resulted after hospitalization on salt intake in pts with coronary artery disease (CHD).
Methods
A prospective randomized parallel-group study in hospitalized nonsurgical pts with confirmed stable CHD and concomitant abdominal obesity. Most hospitalizations were due to elective percutaneous coronary intervention. Pts were randomized (1:1:1) into 3 groups. Before discharge, Groups 1 and 2 received comprehensive counselling with focus on diet followed by remote counselling by phone (Group 1) or via text messages (Group 2). Remote counselling was delivered weekly (Months 1–3) and then monthly (Months 4–6). Group 3 received standard advice only. Self-reported salt intake was assessed by consumption of sodium-reach foods such as sausages, pickles and by adding salt to cooked foods.
Results
A total of 120 pts (mean age±SD, 57,75±6,25 years, men, 83.4%) were enrolled. The Table presents self-reported dietary habits at baseline and at 12 months. At 1 year, significant improvements of relevant dietary habits vs control were seen in both intervention groups.
Group 1
Group 2
Group 3 (Control)
Group 1 vs 3,
Group 2 vs 3,
(n=40)
(n=40)
(n=40)
P for change from baseline
P for change from baseline
Pts adding salt to cooked foods at least sometimes
Baseline
87.5%
90.0%
85.0%
At 12 months
25.0%**
10.0%**
89.5%
<0.01
<0.01
Pts avoiding pickled vegetables
Baseline
17.5%
20.0%
15.4%
At 12 months
62.5%*
77.5%**
7.9%
<0.05
<0.01
Pts avoiding wurst, sausages, smoked meats
Baseline
0.0%
10.0%
7.5%
At 12 months
77.5%**
87.5%**
2.6%
<0.01
<0.01
*p<0.05, **p<0.01 vs baseline within group.
Conclusion
Pre-discharge preventive counselling with subsequent remote support in coronary patients with abdominal obesity resulted in significant improvement of dietary habits in terms of salt and high-sodium foods intake.
