Neuroblastoma is one of the most common malignant tumor in infants and the most common extracranial solid tumor of childhood. Despite the advances in diagnostics, the median age at diagnosis is 14 months and 50–60 % of patients will have metastatic disease when diagnosed. The clinical course of neuroblastoma and the prognosis are extremely heterogeneous and are determined primarily by the molecular genetic features of the tumor, its localization, and the presence of metastatic lesions. Precise stratification on risk groups is a key aspect for treatment choice and the possibility to avoid the toxicity of anticancer treatment in groups with favorable prognosis and to use the most intensive multimodal treatment in high and ultra-high-risk groups. We present clinical cases of neuroblastoma in pediatric patients with demonstration of anamnesis features, diagnostic algorithms and appropriate standard of care.

Relevance. Stereotactic biopsy (STB) is one of the main methods for diagnosing deep brain lesions. STB has several advantages over conventional intraoperative biopsy, as it is less traumatic and safer, especially for patients in critical condition. However, the most common complications of STB are hemorrhages, with a risk ranging from 0.9 % to 59.8 % depending on various studies. Intracranial hemorrhages are serious complications of surgical treatment of brain tumors, especially during biopsy using stereotactic techniques.

Objective. To assess the risk of intracranial hemorrhages during STB of brain tumors and investigate possible factors influencing this risk, such as involvement of different brain regions in the neoplastic process, patient’s gender and age, degree of malignancy of the tumor, and use of different stereotactic devices.

Materials and Methods. A retrospective study of data from 20 patients who underwent STB of brain tumors was conducted. Clinical data, examination results including coagulogram and aggregatogram, as well as data on involvement of different anatomical brain regions in the neoplastic process, degree of malignancy of the tumor, and use of a specific stereotactic device were analyzed.

Results. Analysis of the frequency and structure of hemorrhagic complications of STB was performed, prognostic factors for high risk were identified, and preventive measures were proposed to reduce the number of hemorrhages.

Conclusions. The introduction of the modern CRW Radionics stereotactic device into practice has reduced the frequency and severity of hemorrhagic complications after STB by two times. Lymphoproliferative processes and glioblastomas have a higher frequency of hemorrhages, but in most cases, they are clinically insignificant. There is a correlation between the degree of anaplasia of astrocytic tumors and the severity of hemorrhages. Ways to reduce the risks of intracranial hemorrhages during STB of brain tumors may include: careful preoperative planning of the biopsy trajectory; use of informative neurovisualization methods in planning the needle insertion trajectory; use of modern stereotactic systems by neurosurgeons who have undergone additional specialization and training on the specific device; use of modern biopsy needles. In addition, it is advisable to consider preoperative preventive hemostatic therapy in patients suspected of having a high degree of tumor anaplasia.

Seizures are a well-recognized symptom of primary brain tumors, and anticonvulsant use is common. This paper provides an overview of epilepsy and the use of anticonvulsants in glioma patients. Overall incidence and mechanisms of epileptogenesis are reviewed. Factors to consider with the use of antiepileptic drugs (AEDs) including incidence during the disease trajectory and prophylaxis along with considerations in the selection of anticonvulsant use (ie, potential side effects, drug interactions, adverse effects, and impact on survival) are also reviewed. Finally, areas for future research and exploring the pathophysiology and use of AEDs in this population are also discussed.

Purpose. According to the literature, to assess the state of the problem of diagnosis and treatment of meningiomas with recurrent course, to identify the causes of tumor progression, features of the clinical picture, radiology diagnostics, the specificity of pathomorphological and molecular genetic characteristics.

Materials and methods. We searched for publications in the Pubmed, EMBASE, Cohrane Library and eLibrary databases published between January 2000 and January 2019 on the issue of recurrent intracranial meningiomas, in particular atypical and anaplastic.

Results. The review systematizes data on the prognostic criteria for diagnosing meningiomas that affect survival, relapse-free period, and the progression of the neoplastic process. Particular attention is paid to the radicality of the operation and the assessment of the degree of anaplasia. The present day information on radiation therapy and drug treatment is presented, the results of studies on their effectiveness are discussed. The controversial issues of approaches to the assessment of morphological prognostic criteria are touched upon. The latest information on the most common genetic mutations in meningiomas, the prospects for their study and use for targeted therapy are presented. The authors come to the conclusion that the problem of managing patients with meningiomas is still far from its final solution; there are no optimal standards for the diagnosis and treatment of patients with meningiomas, taking into account biological characteristics, including growth characteristics, molecular genetic profile. There are no clear prognostic criteria for recurrence and continuity in further supervision after surgical treatment, which cannot but affect the mortality rate and quality of life of this category of patients.

We retrospectively analyzed the effectiveness of ruxolitinib in patients with myelofibrosis (MF) in real clinical practice in Russia. The study included 42 patients with MF with an average age of 56 years from 10 inpatient and outpatient clinics. The majority of patients (55 %) belonged to the intermediate risk group 1 on the DIPSS scale, 86 % had massive splenomegaly and 88 % had constitutional symptoms. The average initial dose of ruxolitinib was 15 mg twice a day. At the time of analysis, 74 % of patients continued taking ruxolitinib with an average duration of therapy of 20 months. A decrease in the palpable size of the spleen by at least 50 % was recorded in 36 % and 46 % of patients assessed after 3 and 6 months of treatment, respectively. A correlation was found between OV, initial splenomegaly and splenic response after 3 months of therapy. It should be noted that no deaths were recorded in patients with a decrease in the size of the spleen by ≥ 50 %. There were no cases of discontinuation of treatment due to side effects. In general, in our retrospective study, ruxolitinib effectively controlled constitutional symptoms and reduced the size of the spleen in patients with MF. An early splenic response after 3 months of therapy is apparently a prognostic factor for OS, and a decrease in the size of the spleen by less than 25 % should be considered as treatment ineffectiveness in patients with MF taking ruxolitinib.

Vaccine therapy as a method of immunotherapy is a promising direction in neurooncology, the ultimate goal of which is to increase the effectiveness of the treatment of patients with malignant glial tumors of the brain. In this article, based on the analysis of domestic and foreign literature sources devoted to the creation and application of vaccine therapy in neurooncology, the main principles of vaccine therapy used in the treatment of glioblastomas are considered, and the results of the most significant clinical studies in this area are presented. The article discusses the prospects for the use of vaccine therapy as an additional treatment for glioblastoma and possible obstacles to its widespread use.

Pancreatic cancer is a highly aggressive disease with a high mortality rate in need of innovative diagnostic and therapeutic approaches. In recent years, due to the development of molecular genetic methods a large amount of data has appeared on the genetic and epigenetic alterations that occur in pancreatic cancer, and the genetic landscape of this disease has been determined. Additionally, the genetic factors underlying the multistep carcinogenesis in precursor lesions of the pancreas have been clarified. This review highlights the pathways of carcinogenesis in the pancreas, as well as the molecular genetic processes underlying it.

Modern genome technologies and a widespread use of omics data have revolutionized healthcare and brought unprecedented opportunities to apply genetics to medicine to maximize patient benefit. Genomic medicine provides innovative approaches to rapid and reliable early disease diagnostics, patients stratification to assess and monitor the effectiveness of therapy and, finally, population-scale screening for predisposition to certain diseases. In view of this, many countries took steps to adopt of genomics in clinical practice, thus transforming national healthcare systems. Here we discuss main applications of genomic data in clinical practice, its contribution to personalised medicine and associated emerging challenges, as well as key considerations for the successful integration of genomic technologies into healthcare systems. Besides that, we showcase several national genomic medicine programmes, particularly the UK one, providing a detailed review of approaches to transformation of the national healthcare system as implemented by Genomics England initiative. Finally, we discuss possible avenues for the development of genomic medicine system in Russia.

Background. Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by autonomous production of parathyroid hormone (PTH). Currently, parathyroidectomy (PTX) is considered the main method of PHPT treatment. Its outcome is largely depended on precise preoperative localization of the parathyroid adenoma. Traditional visualization techniques include ultrasound (US), scintigraphy and computed tomography (CT), each of which has its own limitations. In order to improve visualization results positron emission tomography/ computed tomography (PET/CT) with 11C-methionine is used. Objective. To compare the sensitivity and specificity of 11 C-methionine PET/CT with those of conventional imaging techniques for parathyroid adenomas localization.

Design and methods. The data of 91 patients diagnosed with PHPT was analyzed. Ultrasound, scintigraphy with 99mTc-sestamib i/99mTc-pertechnetate and CT were performed in 91, 56, and 86 patients, respectively. Since 2020, 11C-methionine PET/CT has been used as the final diagnostic method in 45 patients. Histologу results were used as the benchmark in order to evaluate the diagnostic accuracy of the studied methods.

Results. Histological examination confirmed parathyroid adenoma/ hyperplasia in all patients. Multiple adenomas/hyperplasia were found in 5 cases. Ectopic adenomas were detected in 19 patients. The sensitivity of PET/CT with 11C-methionine was 98 %, CT, scintigraphy and ultrasound — 75 %, 79 %, 67 %, respectively. Specificity — 93 %, 73 %, 75 %, 70 %, respectively.

Conclusion. 11C-methionine PET/CT showed higher sensitivity and specificity than traditional methods.

Despite their relatively low prevalence compared to cardiac valve lesions and coronary heart disease, thoracic aortic aneurysm and dissection are potentially fatal and represent serious public health problems. The indications for surgical treatment in most thoracic aortic diseases are predominantly based on the maximum aortic diameter in a particular area. Congenital connective tissue disorder, thoracic aortic anomalies (e.g., coarctation), family history of aneurysms, aortic dissections, and sudden deaths are considered as additional risk factors of aortic-related complications influencing the “stricter” indications and lowering the “threshold” aortic diameter. At the same time, a certain proportion of patients with aortic diseases develop aortic dissection and rupture in normal or near-normal thoracic aortic diameter in certain section. Many factors influence the development of aortic diseases and complications, and assessing the contribution to the aetiology and pathogenesis of each factor is difficult. Machine learning and mathematical modeling using artificial intelligence is an actively developing area of computer science, which also finds application in medicine, in particular in the study, diagnosis, and treatment of thoracic aortic aneurysms and dissections. This article discusses modern methods of data analysis, prediction of thoracic aortic aneurysms and dissections, treatment planning in thoracic aortic diseases, and prediction of complications using machine learning and artificial intelligence.

Despite their relatively low prevalence compared to cardiac valve lesions and coronary heart disease, thoracic aortic aneurysm and dissection are potentially fatal and represent serious public health problems. The indications for surgical treatment in most thoracic aortic diseases are predominantly based on the maximum aortic diameter in a particular area. Congenital connective tissue disorder, thoracic aortic anomalies (e.g., coarctation), family history of aneurysms, aortic dissections, and sudden deaths are considered as additional risk factors of aortic-related complications influencing the “stricter” indications and lowering the “threshold” aortic diameter. At the same time, a certain proportion of patients with aortic diseases develop aortic dissection and rupture in normal or near-normal thoracic aortic diameter in certain section. Many factors influence the development of aortic diseases and complications, and assessing the contribution to the aetiology and pathogenesis of each factor is difficult. Machine learning and mathematical modeling using artificial intelligence is an actively developing area of computer science, which also finds application in medicine, in particular in the study, diagnosis, and treatment of thoracic aortic aneurysms and dissections. This article discusses modern methods of data analysis, prediction of thoracic aortic aneurysms and dissections, treatment planning in thoracic aortic diseases, and prediction of complications using machine learning and artificial intelligence.

Successful education of modern students requires great immersion of teachers in a process that is constantly changing, acquiring new properties, and meeting new challenges. So, digital technologies, online learning are already a natural communication environment, and students are motivated for self-development and self-expression. The traditions of the Russian medical school, together with modern trends in the development of education, create the prerequisites for the application of the most successful forms of education that develop the thinking and skills necessary for professional activity.

In this article, the authors presented the experience of organizing training under the specialist’s program on the basis of the Department of Neurology and Psychiatry with the clinic of the Institute of Medical Education of the Federal State Budgetary Institution “Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation. Conclusions are formulated on the basis of the results of questioning teachers and students on the main characteristics of the educational process. The role of interactive and distance technologies is analyzed: online learning methods, video lectures, digital services, and other digital technologies. An analysis of the role of independent education, the most successful forms of knowledge testing, features of the development of communication skills, and the possibilities of mastering the competencies necessary for professional activity are presented. Separately, the interest of students in scientific work, the activity of participation in the student scientific club, the possibility of growth of interested students in professional and pedagogical aspects are analyzed. The presented data illustrated the success of the first experiment on the training of doctors on the basis of a scientific institution.

Aim. Integral rating system approbation of the Russian Federation regions using weight coefficients based on indicators characterizing the effectiveness of the organization of medical care in cardiovascular surgery.

Methods. The study included 6 indicators with the highest final rating and expert agreement coefficient (based on data from the previous study). The values of the indicators were calculated for 38 Russian Federation regions supervised by the national medical research centers in cardiovascular surgery based on the statistical data provided by the Russian Federation regions and compared with the data of federal statistical observation forms. Further, all indicators were transferred to a point scale to form a single integral rating. The value in points for each of the indicators was multiplied by the corresponding weight coefficient for each subject of the Russian Federation. At the end, we performed a comparative analysis of the two integral ratings and expert validation.

Results. It was found that the Moscow Region is in first place (880.00 points) based on the results of building an integral rating using weight coefficients. In second place instead of the Tambov region is the Republic of Bashkortostan (760.71 points). The third position of the Lipetsk region is occupied by the Samara region (750.89 points). The Smolensk region (259.28 points) occupies the 38th place in the integral rating with the use of weight coefficients, as well as in the ranking without the use of weight coefficients. The Republic of Ingushetiya (+18 seats) and the Republic of Dagestan (+17 seats) are characterized by the greatest positive change in the number of seats. The Kirov region (-16 places), the Penza region (-16 places), as well as the Tula region (-11 places) and the Vladimir region (-11 places) are characterized by the greatest change in the number of seats in the negative direction.

Conclusion. Presented system of integral rating of the Russian Federation regions with weight coefficients demonstrated the principal adequacy of all proposed approaches in relation to the real situation with the organization of medical care in the Russian Federation regions, and also made it possible, through the use of weight coefficients, to take into account the varying degree of contribution of the indicators used to the integral rating of the Russian Federation regions. In the same time the indicators should be choose very careful.

Currently, prostate cancer (PC) is one of the most common malignant neoplasms in men. More than 400,000 cases of prostate cancer are diagnosed annually in the world; in a number of countries, it occupies the second or third place in the structure of oncological diseases. A promising technology for the diagnosis and treatment of oncological diseases in nuclear medicine is radiotheranostics as an integrated approach that combines diagnostics and therapy using a single chemical molecule, but different ratioisotopes. For prostate cancer, the diagnostic radioisotope ⁶⁸Ga and the therapeutic isotopes — ¹⁷⁷Lu and ²²⁵Ac are used. The article discusses modern technologies for the production of radiopharmaceuticals for the diagnosis and radionuclide treatment of prostate cancer using theranostic pairs based on ⁶⁸Ga/¹⁷⁷Lu isotopes, as well as the prospects for the synthesis of new therapeutic radiopharmaceuticals labeled with the ¹⁷⁷Lu isotope.