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trolled) was similar and did not reach statistically significant differences versus control group (P> 0.05).
Thus, we can conclude that the homozygous genotype T/T of rs1045642 polymorphism -MDR1 gene is an important determinant of increased risk for MPD development in Uzbekistan (P <0.05). These data further reinforce the position of rs1045642 polymorphism of -MDR1 gene as a marker, causing disorder of the regulatory function of P-glycoprotein and processes of biotransformation of xenobiotics, and perhaps associated with the formation of cancer processes.
Conclusion:
1. rs1045642 polymorphism ofMDR1 gene is associated with a risk ofMPD developing. Functionally unfavorable genotype T/T is a predisposing marker to damage the expression level of P-glycoprotein and elimination ofvarious toxins and carcinogens from the body. On the contrary, the carriage of wild genotype C/C was significantly associated with a protective effect against MPD development (P <0.05).
2. The prognostic value of genotyping of rs1045642 polymorphism of -MDR1 gene demonstrates a high level of efficiency by classifier as an independent gene-determinant in developing MPD, at significantly higher values (P <0.05).
References:
1. Sychev D. A., Ramenskaya G. V., Ignatiev I. V., Kukes V. G., Clinical pharmacogenetics: Teaching medium/under Ed. of V. G Kukes, N.P Bochkova. - M.: GEOTAR Media, 2007. - P. 9.
2. Deininger M. W., Goldman J. M., Melo J. V. The molecular biology of chronic myeloid leukemia. Blood.2000; 96: P 3343-3356.
3. Rumjanek V.M, Vidal R.S, Maia R. C. Multidrug resistance in chronic myeloid leukaemia Biosci Rep.2013;33 P.
4. Mabel Lardo, Marcelo Castro, Beatriz Moiraghi, Francisca Rojas. MDR1/ABCB1 gene polymorphisms in patients with chronic myeloid leukemia 2015 sep; 50 (3): P. 154-159.
5. Callen D. F., Baker E., Simmers R. N., Seshadri R., Roninson I. B. 1987. Localization of the human multiple drug resistance gene, MDR1, to 7 q 21.1. Hum. Genet. 77, 142-144 p.
6. Chin J. E., Soffir R., Noonan K. E., Kyunghee C., Roninson I. B. Structure and expression of the human MDR (P-glycoprotein) gene family.//Molecular and Cellular Biology. 1989. 9, P. 3808-3820.
7. Chen C., Clark D., Ueda K., Pastan I., Gottesman M. M., Roninson I. B. 1990. Genomic organization of the human multidrug resistance (MDRl) gene and origin of P-glycoproteins. J. Biol. Chem. 265, P. 506-514.
8. Rao D. N., Anuradha C., Vishnupriya S., Sailaja K., Surekha D., Raghunadharao D., Rajappa S. Association of an MDR1 gene (C3435T) polymorphism with acute leukemia in India. Asian Pac J Cancer Prev. 2010; 11 (4): P. 1063-1066.
9. Qian X., Cao S., Yang G., Dong J., Jin G., Shen Y., Hu Z. Variant genotypes of MDR1 C3435T increase the risk of leukemia: evidence from 10 case-control studies. Leuk Lymphoma. 2012 Jun; 53 (6): P. 1183-7.
10. Andersen V., Ostergaard M., Christensen J., Overvad K., Tjonneland A., Vogel U. Polymorphisms in the xenobiotic transporter Multidrug Resistance MDR1) and interaction with meat intake in relation to risk of colorectal cancer a Danish prospective case-cohort study. BMC Cancer. 2009 Nov 21;9: P. 407.
11. Mrozikiewicz P. M., Seremak-Mrozikiewicz A., Semczuk A., Landt O., Breborowicz G. H., Drews K. The significance of C3435T point mutation of the MDR1 gene in endometrial cancer. Int J Gynecol Cancer. 2007 May-Jun;.17. (3):.P 728-31.
12. Nizar M., Mhaidat, Osama Y Alshogran, Omar F Khabour, Karem H Alzoubi, Ismail I Matalka, William J Haddadin, Ibraheem O Ma-hasneh, and Ahmad N Aldaher. Multi-drug resistance 1 genetic polymorphism and prediction of chemotherapy response in Hodgkin's Lymphoma. J Exp Clin Cancer Res. 2011; 30 (1): P. 68.
13. Hoffmeyer S., Burk O., von Richter O., Arnold H. P., Brockmoller J., Johne A., Cascorbi I., GerloffT., Roots I., Eichelbaum M., Brinkmann U. 2000. Functional polymorphisms of the human multidrug-resistance gene: Multiple sequence variations and correlation of one allele with P-glycoprotein expression and activity in vivo. Proc. Natl. Acad. Sci. USA. 97, P. 3473-3478.
Kahhorov, Jamoliddin Professor, MD. PhD., Atakhanova Nigora, Professor, MD. PhD., Shayusupov Nariman, Professor, MD. PhD., Kakhkharov Alisher Dr., Tashkent Medical Academy, Oncology and radiology department Tashkent City Oncology Center, Breast cancer unit E-mail: alisher1510@mail.ru
Tumor-to-breast ratio in forecast of breast cancer
Abstract: The role of tumor-to-breast ratio is determined in breast cancer forecast. Case histories of 49 patients with breast cancer were analyzed. The undergone analysis showed that tumor-to-breast ratio has a statistically significant impact on the outcome of the treatment of breast cancer.
Keywords: forecast, tumor-to-breast ratio, breast MRI, TNM system.
Tumor-to-breast ratio in forecast of breast cancer
In recent years, despite the increase in the incidence of breast cancer in Uzbekistan noted the same trend as in the developed countries: a reduction in mortality from tumors of this localization, which is explained on the one hand — the identification of a growing number of patients in the early stages of tumors, and on the other — the use of modern methods of treatment.
As we know, the course and outcome of tumor diseases affect a complex of factors, depending on the biological characteristics of the tumor itself, the body, as well as on the adequacy of the diagnosis, treatment, management of patients.
In recent years, impressive results of treatment of patients with cancer, including breast cancer are achieved. In clinical practice, the choice oftreatment strategy comes from the prognostic features of the disease, which is the main indicator ofthe clinical classification and staging process. In a narrow sense, the forecast called the scientific prediction of future properties ofan object or situation, based on its current and past symptoms. In summary, in order to predict in medicine, particularly in oncology, it is to anticipate the nature of the pathological process both stages of treatment, and subsequently — during its progression.
Individual plan of treatment of cancer patients are still made on the basis of personal experience and intuition clinicians take into account a number of factors that characterize the tumor and tumor-bearing characteristics of the organism. However, only the individual prognosis may suggest in each case the most rational plan of remedial measures.
The problem of the individual prognosis of cancer is a relatively new trend in the domestic oncology. The study of the individual problems of forecasting dedicated work of many domestic and foreign researchers [1; 2; 3].
However, it proposed, in most cases difficult, mathematical methods of group and individual prediction is not widely available in the clinic due to the complexity of the methods and difficulties of multivariate analysis.
The diagnosis is the main prognostic factor as to the prognostic factors are fundamental signs that determine the course and outcome of the disease. Factors predictive of response to treatment (predictive factors), are those that help to detect subgroup ofpatients with more or less significant response to this treatment. The final results of the flow nature of the forecast, outcomes and complications of any of the examined clinical entities directly dependent on the choice of a competent reliable diagnostic indicators that best reflect the clinical, functional, morphological, social and many other features of the disease process.
Of interest is the fact that the conduct of the treatment with the same histological types and stages of breast cancer process often gives different results. None of the locations has such a number of treatment options, like breast cancer, for example, Letyagin V. P. (2000) pointed out that for the treatment of breast cancer the same stage, there are about 60 thousand nuances in the approaches to the treatment of breast cancer.
In everyday practice, the question arises whether the same cancer patient's prognosis breast with the same size of the primary tumor and the different size of the affected organ. For example, a tumor measuring 5 cm in a small breast strikes it almost totally, and a similar tumor in the large breast takes only a part of it. However, according to the TNM system, in both cases the same diagnosis of T2 will be installed.
In connection with which the question of the advisability of taking into account the ratio of the tumor volume in breast volume.
Materials and methods
To study the effect tumor-to-breast ratio on the forecast we had studied the history of the disease, case histories of 49 patients
with breast cancer T2N0-1M0 treated in Tashkent City Oncology Center. All the patients, depending on the stage, clinical and pathological features of the tumor, received comprehensive treatment in accordance with international recommendations. We studied the correlation of tumor volume in breast volume and their effect on the overall and disease-free survival.
Tumor volume was measured by ultrasonography and MRI studies, and the volume of breast with anatomical measurements, mammograms, according to the formula proposed Kalbhen C. L. et al. [4], MRI and post-mastectomy, postoperative material by weighing and dipping into the liquid. Tumor volume was calculated with special programs were compared with the manual method for measuring breast volume. In all cases, we obtain accurate figures for further processing of the material.
To determine the volume of the breast we divided the following forms of breast cancer: a conical, hemispherical, pear.
Usually special device the size of the breast base, subsequent breast base line was measured, crossed in the nipples were determined. Determined base radius and apply the formula for determining breast volume. Depending on the patient fatness made relevant amendments. Manual method for determining breast volume compared with the data of MRI yielded 2.4% error in the calculations.
To determine the volume using the following formula: For cone formula for determining the volume of a cone, ie, one third of the product of the square base and the height. For hemispherical breast volume formula for determining the volume of a sphere and divided it into two for pear-shaped used formula for determining the volume of a sphere. The volume of the breast to 200 cm3 (172 cm3 on average) was observed in 4 patients (8.2%), and 300 cm3 (232.7 cm3) 14 (28.6%) patients, and 400 cm3 (349, 6 cm3) in 5 patients (10.2%) and 500 cm3 (459.2 cm3) in 6 patients (12.2%) and 600 cm3 (569.3 cm3), y3 (6.1%), up to 1000 cm3 (856.9 cm3) and more detected in 17 (34.7%) patients. The average volume of breast MRI studies was 410.4 cm3, the manual method 420.4 cm3, with the method of immersion — 410.7 cm3. Tumor volume at T2 ranged from 32 cm3 to 125 cm3, the average volume of 85cm3. Tumor volume 50 cm3 was found in 10 patients and 100 cm3 was observed in 22 patients and more than 100 cm3 in 17 patients.
For convenience, on the basis of the above findings, we divided patients depending on tumor-to-breast ratio and divided into three groups and the data designated as an addition to T2. The first group (T2/1) included patients whose tumor volume ratio to the volume of breast was from 1/1 to 1/3, in the second group (T2/2) 1/3 and 1/4, in the third group (T2/3) bolee1/4.
Results:
Influence of tumor-to-breast ratio at time of recurrence (progression) process were as follows: the ratio 1/3-25 months, at a ratio of 1/4-31.5 months and at the ratio 1/a 4-55.3 months. Depending on the results of the data of the treatment were followed in all patients. In two cases due to moving patients, the connection was lost. In 13 patients with fixed time progression (recurrence, metastasis) and studied the nature of their development. Five-year disease-free survival in the observation group was 72.3%. In the group of patients with breast cancer of up to 200 cm3 survival rate was 33.3% (rough average), in the group to 300 cm3, 57.1% to 400% cm3,75 to 500 cm3-66.7% to 600 cm3 66 7%, and in patients where the breast volume was more 600 cm3-only 94.1%. We followed the outcome of the disease after completing the full course of treatment. 5-year disease-free survival rate was 72.3% (34 patients). The survival of patients in the first group was 33.3% in the second group 57.1%,
best results with the tumor-to-breast ratio more than 1/4-81,1% (p= = 0,249). (x2 = 2,53 the third degree of freedom p <0,05).
Thus, comparing the results of treatment of breast cancer based on the tumor size only, excluding the ratio of the tumor volume and the body is not completely correct. In this regard, the only rational approach to the forecasting of issues in any pathological conditions including breast cancer can be a comprehensive analysis of information about the patient, the disease pattern, using the available arsenal of reliable clinical features and diagnostic indicators.
Tumor-to-breast ratio has a statistically significant impact on the outcome of the treatment of breast cancer. It is necessary to conduct a more in-depth study to determine the criterion laws discovered by us, for a supplement to the classification of breast cancer.
The study shows the complexity of a clear and reliable prediction of disease outcome. We have tried to link the size of the tumor and breast volume on outcome. Many questions still await answers. In the future, they will no doubt be developed by us, further developed and refined. Finally, in one study it is impossible to specify all possible variants of the disease. But all these problems, obviously, can and should be the subject of separate research.
References:
1. Christakis N.A. Death Foretold: Prophecy and Prognosis in Medical Care. Chicago: University of Chicago Press; 1999.
2. Fletcher S.W., Fletcher R.H., Greganti M.A. Clinical research trends in general medical journals, 1946-1976. In: Roberts EB, Levy RI, Finkelstein SN, Moskowitz J, Sondik EJ, eds. Biomedical Innovation. Cambridge, M.A.: MIT Press; 1981.
3. Mackillop WJ., Quirt C.F. Measuring the accuracy ofprognostic judgments in oncology. J Clin Epidemiol 1997; 50: 21-29.
4. Kalbhen C. L., McGill J. J., Fendley P. M., et al. Mammographic determination of breast volume: comparing different methods. Am J Roentgenol 1999; 173: 1643-9.
Kuldashev Kahramon Abduhalilovich, The chair Traumotology, orthopedics, neurosurgery and The department of military field surgery candidate of medical science E-mail: kuldashev-23@mail.ru
Surgical treatment of secondary brain injury combined with cranial trauma
Abstract: Rresearch based on analysis of 315 patients, between 2011 and 2016, passed a comprehensive examination and treatment in the Andijan branch of the Republican Scientific Center for Emergency Medical Aid. In the study groups at all 315 (100%) patients with traumatic brain injury, including the spine and spinal cord injuries occurred in 88 (27.9%), extremity injuries — 123 (39%) injuries of the pelvis — 37 (11.7%), chest trauma occurred in 67 (21.2%) cases. Keywords: concomitant traumatic brain injury, secondary damage, surgical aspects.
Introduction
Combined injury as the most serious form of damage is characterized by high and has no tendency to decrease mortality of between 23,5-85%, and long-term disability, and a high level of disability (from 25 to 80%), exceeding 10 times that of when isolated lesions [1; 2].
According to many authors, the poor results of treatment of patients related to the lack of a unified doctrine of surgical relief of severe combined trauma and the treatment of the majority of those affected by the general surgical hospitals and surgeons with insufficient representation about the features of surgical tactics in combined injuries [3; 4]. Combined traumatic brain injury (SCHMT) — a kind of type of injury, in which the pathological changes in the body create serious difficulties in the diagnosis and treatment especially in the acute period [5].
To date, the treatment of victims in the acute period of severe SCHMT remains complex and urgent problem (Reilli P., 1997, Konovalov AN, et al., 2001). It was found that the highest value for mortality and disability of victims, along with the primary are secondary brain injury factors (voiti SG, ea1991; Bullok K. ea.1995; Chegrut RM ea, 1993; Gaytur EI, 2000).These include extracranial factors such as hypoxia, arterial, hypo — and — hypertension, hyperthermia, violation of gas exchange and internal homeostasis, as well as intracranial factors (intracranial hypertension, disturbance of cerebral circulation and metabolism), accompanying the acute
phase of severe head injury, aggravating his clinical course and directly influencing the prognosis and outcome (Kohy Y., ea1984; Lam AM, ea 1991; Miller JD 1993; Nakamura Nea 1993).
Objective
To determine the indications for surgical and conservative treatment of the secondary damage of combined traumatic brain injuries
Materials and Methods: Our study is based on an analysis of 315 patients, between 2011 and 2016, passed a comprehensive examination and treatment in the Andijan branch RSCEMH (Andijan Regional Emergency Medical Hospital).
In the study groups at all 315 (100%) patients with traumatic brain injury, including the spine and spinal cord injuries occurred in 88 (27.9%), extremity injuries — 123 (39%) injuries of the pelvis — 37 (11.7%), chest trauma occurred in 67 (21.2%) cases. Of the 315 victims of brain squeezing intracranial hematomas were in 158 (46%). In this analysis included only 101 patients who underwent complete dynamic MDCT study, since the first days after the injury. Statistical analysis was conducted using the basic clinical and MSCT and MRI data (volume of intracranial hematoma, brain swelling severity, prevalence of cerebral edema, the degree of displacement of the transparent partition). Patients were divided into three groups depending on the cause compression of the brain: the first group — 46 affected by compression of the brain intracerebral hematomas; the second group — 34 affected by compression of the brain enveloped hematomas, which were accompanied by
