Human resources in a healthcare institution as the management efficacy improvement factor

The article analyzes the current HR of the local healthcare organization. There was carried a SWOT-analysis of personnel management has been out, disclosed the main problems of the management system of a medical institution. Development strategies and an algorithm for improving personnel policy are formulated in order to increase the efficiency of management and the quality of medical care to the population.Purpose of the study. Is to analyze the current personnel policy, SWOT-analysis of personnel management, develop a strategies and set of practical recommendations for improving the management system of a public health institution while ensuring high quality medical services to the population.Materials and methods. An analysis of the personnel policy in a phthisiatric institution (Makeevka Municipal TB Dispensary, Donetsk region) was carried out, the heads of the main structural divisions were questioned. The analysis results are structured using the SWOT scale.Results. Based on the results of the sociological survey, the main advantages and disadvantages of personnel policy were identified, a SWOT analysis matrix was drawn up, and strategies for the development of a budgetary healthcare institution were developed. The breakthrough strategy is based on improving the material and technical base, attracting funding and investment, increasing the speed and quality of TB care at the regional level using information technology, while the survival strategy is based on increasing the income of health workers, social protection, improving working conditions and developing personnel motivation systems. The main recommendations include increasing the number of employees, creating a strategy for the formation of qualified personnel, improving the quality of the working environment, creating a favorable psycho-emotional climate, and developing an effective system of incentive payments.Conclusion. The medical industry is in dire need of modernization in order to improve personnel processes, financial, economic and regulatory support. The conducted research and developed recommendations will have a beneficial effect on the achievement of the main strategic goal - improving the health and quality of life of the population of the state.

Serum HIF-1α and TGFβ1 levels depending on the clinical and morphological characteristics of breast cancer and sensitivity of tumor to neoadjuvant chemotherapy

Purpose of the study. To assess the serum levels of HIF-1 α and TGF-β1 in patients with invasive breast cancer (BC) depending on the clinical and morphological characteristics, molecular biological subtypes and the degree of pathological response (PR) of the tumor and metastases in the regional lymph nodes.Materials and methods. 65 patients with newly diagnosed invasive BC, of whom 32 received from 6 to 8 courses of neoadjuvant chemotherapy (neo-A-CT) were included in this pilot study. The levels of TGF-β1 and HIF-1α were determined by enzyme-linked immunosorbent assay. Statistical analysis was performed using the Statistica 12.0 software.Results. It was found that a high level of TGF-[31 was significantly more often observed in HER2-positive and I-IIa stages of luminal A and triple-negative BC (p = 0.01). HIF-1a levels were significantly higher in the presence of distant metastases (p = 0.04) and slightly higher in the presence of microcalcifications on mammograms (p = 0.07).The analysis showed that patients with grade III-IV of PR in tumor were significantly younger (p = 0.047). Grade III-IV of PR in tumor was significantly more often observed in G3 (p = 0.05), in Her2-positive and triple negative BC (p = 0.01), in the absence of perineural (p = 0.002) and lymphovascular invasion (LVI) (p = 0.045), in the presence of lymphoid infiltration (p = 0.011) and microcalcifications in the tumor (p = 0.043), and slightly higher in ductal BC (p = 0.08). No significant correlations were found between the levels of TGF-p1 and HIF-1a and tumor PR (p = 0.6 and p = 0.9, respectively). However, in patients with grade III-IV of PR in regional metastases, the level of TGFb1 was significantly lower than in patients with grade I-II (p = 0.03).Conclusions. Thus, these data indicate the presence of correlations between the levels of HIF-1 α and TGF-β1 in the blood serum and a number of clinical characteristics of BC. The highest levels of HIF-1α are observed in the presence of distant metastases, and the highest levels of TGF-β1 are noted in HER2-positive and I-IIa stages of luminal A and triple-negative breast cancer. Given the presence of significant correlations between the level of TGF-β1 and the degree of PR in regional lymph nodes, its determination may be useful for assessing the sensitivity of metastases to regional lymph nodes to the neo-A-CT.

A rare case of solitary fibrous tumor of the liver and highly differentiated rectal adenocarcinoma

Solitary fibrous tumors (SFT) are rare spindle cell mesenchymal neoplasms of presumably fibroblastic origin with undefined malignancy potential and rare metastasis. Their most frequent localization is in the pleura, where they have been first described. The incidence of solitary fibrous tumors localized in liver is extremely low. The clinical picture of SFT is nonspecific and is not due to the anatomical location of the tumor and it's size.In the majority of cases these tumors are benign. However, a number of them still may have signs of malignancy: an aggressive course with possible local recurrence and distant metastasis. The main method of treatment of hepatic solitary fibrous tumor (as well as SFT of other localization) with it's resectability is surgery. Radical removal of the tumor in the majority of cases leads to recovery. Subsequently, the operated patients should be subjected to strict dynamic observation with regularity as in malignant neoplasms (MN).The importance for chemotherapy and radiation therapy in the treatment of hepatic solitary fibrous tumor has not been determined in clinical guidelines to date.There are isolated reports of the use of chemotherapy or radiation therapy for the treatment of cases when tumor resection is not radical or there are signs of malignant neoplasm.In literature, there are numerous reports of a combination of a solitary fibrous tumor of any localization with malignant neoplasms of other organs in the same patients.In this report, we represent a clinical case of a 64-year-old woman, who had a solitary fibrous tumor of the liver and highly differentiated rectal adenocarcinoma. The patient underwent resection of the first segment of the left lobe of the liver. After a month and a half, transanal excision of the villous tumor of the rectum. The pathologic and immunohistochemical examination of the liver tumor revealed a malignant solitary fibrous tumor. After researching villous tumor of the rectum - a highly differentiated adenocarcinoma with a depth of invasion of the submucous layer of the intestinal wall up to 1/3 (T1sm1 according to Kikuchi). During dynamic observation for twenty-five months after the operation, the patient has no signs of tumor recurrence and metastasis.

Current biomarkers of prostate cancer

Prostate cancer is one of the most common malignancies in men. Early detection of prostate cancer is largely determined by the widely used prostate specific antigen (PSA) blood test. However, as a diagnostic and prognostic test of prostate cancer, PSA has limited specificity, sensitivity and leads to hyper or underdiagnosis, which, in turn, can lead to excessive treatment. There fore, it is very important to develop diagnostic markers that can be used to determine prostate cancer at an early stage of development, assess the possible progression of the disease and prescribe optimal therapy. Significant progress has been made in the discovery of biomarkers for prostate cancer. For example, biomarkers such as %-free PSA, Prostate Health Index (PHI) or 4K score can be used to increase specificity and reduce the number of unnecessary biopsies, while the PCA3 test can be used to reduce the number of repeated biopsies in men with previously negative biopsy. To determine aggressiveness and predict the outcome of the disease, tissue multigenic tests can be used, such as: T2-ERG, ExoDx, SelectMDx and ConfirmMDx, Prolaris, Oncoytype DX, Decipher. The development of such diagnostic tests opens up new opportunities for improving the diagnosis of prostate cancer, prognosis and decision-making on the appointment of therapy. And with the increase in their availability, finally, the possibility of an individual approach to the appointment of treatment for men with prostate cancer appears on the horizon. This review paper presents the data on the most advanced diagnostic biomarkers of prostate cancer.

Isolated chemohyperthermal perfusion of the liver with melphalan in the treatment of unresectable liver metastases with uveal melanoma

Uveal melanoma belongs to rare malignant neoplasms, and the biological peculiarity of this tumor determines the high rate of distant metastasis, which reaches 60 %. Most frequently, uveal melanoma metastases are localized in the liver and have an isolated character. At the same time, despite the achievements of modern drug therapy, the treatment results of this category of patients remain unsatisfactory. Among the regional methods of treatment of metastatic uveal melanoma, surgical treatment is considered to be the most effective. Median survival rate in the group of radically operated patients (R0) is 27 months. At present, in the vast majority of cases, surgical treatment is impossible because of multiple bilobar metastasis and advanced cancer process. Median life expectancy of patients with liver metastases is only 9 months. A promising method of regional treatment of inoperable metastatic uveal melanoma is isolated liver chemoperfusion. Multidisciplinary team of Radiology Scientific Research Center and Kostroma Oncologic Dispensary for the first time in Russia presents a clinical case of a patient with isolated inoperable uveal melanoma liver metastases using an innovative method - isolated high-dose chemo hyperthermic liver perfusion with melphalan. The article describes in detail the method of the procedure, estimates immediate (partial response in 1 month after the procedure) and long-term results of the method (stabilization of the condition against the background of immunotherapy in 9 months after surgery). Based on the presented clinical observation, isolated liver chemoperfusion with melphalan for this category of patients is reasonable. However, despite the encouraging immediate results, clinical experience needs to be accumulated in order to be further evaluated in clinical trials.

Urolithiasis complicated by chronic obstructive pyelonephritis in patients with concomitant diseases of the cardiovascular system

Purpose of the study. To study the features of chronic obstructive pyelonephritis in patients with recurrent nephrolithiasis and concomitant diseases of the cardiovascular system.Materials and methods. The study included a total of 618 patients suffering from recurrent nephrolithiasis complicated by ChOP. The 3 groups were formed: the first (I) of them included 42 patients with ChOP and uncomplicated coronary heart disease (CHD); the second (II)- 38 patients with CHD complicated by chronic heart failure (CHF); III (control) group consisted of 24 respondents with recurrent urolithiasis.Results. The sample was dominated by men (78 %). In total, there were 474 (76.7 %) patients with intact cardiovascular system. Cardiovascular disease (CVD) suffered from 144 (23.3 %) patients, 38 (26.4 %) of whom had CHF of varying severity. Exacerbations of ChOP in patients of group I developed 1.5 times more often (once in 2.8-3 years) than in patients from the control group (on average after 18 months versus 28), and in group II almost annually (1 time in 13 months). In the entire cohort (n = 618), pyelonephritis was transformed into purulent-destructive in 19 (3.1 %) cases; with concomitant CVD, this complication developed in 7 (4.9 % of 144) cases, the remaining 12 (2.5 % of 474) respondents did not suffer from CVD. In group II, the purulent-destructive form occurred in 4 (10.5 %) patients; their share in the general group of patients with CVD was 2.8 % (the differences were significant - p < 0.05). Of the 19 patients with purulent-destructive pyelonephritis on the background of nephrolithiasis, more than a third (7 people - 36.8 %) had concomitant CHD, and of the 7 patients with this terrible complication that developed on the background of concomitant CHD, more than half (4 people - 57.1 %) had CHF of varying severity. The chemical composition of the urine samples was determined using a NICOLET iS10 spectral analyzer (Thermo scientific, USA). The stages of CHF were determined in accordance with the Strazhesco-Vasilenko classification [N. D. Strazhesco, V. H. Vasilenko, 1935]. Statistical data processing was carried out using the SPSS program 19. Absolute and relative indicators were calculated, as well as the exact Fisher criterion, taking into account the Bonferroni correction; the differences were considered reliable at p < 0.05.Conclusion. in patients with recurrent nephrolithiasis and concomitant CVD (especially with complicated CHF), exacerbations of obstructive pyelonephritis develop more often, the inflammatory process often turns into a purulent-destructive form.

Analysis of relapse-free and overall survival in oncoplastic and organ-preserving surgeries in patients with breast cancer

Purpose of the study. To study the results of relapse-free and overall survival during organ- preserving and oncoplastic surgeries in patients with breast cancer.Materials and methods. A prospective clinical study of 84 patients was carried out in the mammology department on the basis of GBUZ NSO "GKB № 1". The first group of patients (40 patients) underwent OPR with ALAE - oncoplastic resection of the mammary gland with axillary lymphadenectomy. The second group (44 patients) WSR with ALAE - wide sector resection of the mammary gland with axillary lymphadenectomy.During the study, the patients were comparable in age, stage (TNM), histological type, and morphogenetic data. The survival rate was studied by the number of local relapses and distant metastases, using laboratory and instrumental studies. The quality of life was assessed on the basis of anamnestic data (Karnofsky index, ECOG scale).Results. In the first group of patients, disease-free and overall survival rate was 97.5 %. At the same time, a local recurrence was found in a patient with a triple negative tumor type, distant metastases to the lungs in a patient with a HER2/neu-positive type. In the second group, relapse-free survival was 95.4 %, overall - 97.7 %. Relapses in two patients with HER2/neu-positive type, metastases to the lungs in a patient with triple negative type.Conclusion. Relapse-free survival rates are 2.1 % higher in group I patients who underwent oncoplastic resection with axillary lymphadenectomy. And the indicators of overall survival in patients of both groups do not differ relatively.

Effect of diabetes mellitus on levels of insulin-like growth factors and their carrier proteins in Guerin’s carcinoma and it’s perifocal tissue in rats

Purpose of the study. Diabetes mellitus (DM) is considered an independent risk factor for higher cancer incidence and death rates. The system of insulin-like growth factors and their carrier proteins (IGF and IGFBP) and hyperglycemia create favorable conditions for the proliferation and metastasis of cancer cells.Materials and methods. Outbred male and female rats were divided into groups (n = 8 each): controls - with Guerin's carcinoma; main group - Guerin's carcinoma growing in presence of DM. Experimental DM was reproduces in animals by the single intraperitoneal alloxan injection (150 mg/kg body weight). After 10 days of the carcinoma growth, levels of IGF and IGFBP in the tumor and in it's perifocal area were measured using ELISA.Results. DM in females upregulated levels of glucose both in the tumor and in perifocal tissues by 1.8 (p < 0.05) and 8.1 times, respectively, but caused opposite changes in IGF-I - it's increase by 6.3 times in the tumor and decrease by 3.2 times in the perifocal area; as a result, such tumors with small primary nodes were more "aggressive" and actively metastasized. In males, induced DM downregulated levels of glucose, IGF-II and IGFBP2 in the carcinoma by 8.4, 3.1 and 1.7 (p < 0.05) times, respectively, and increased levels of IGF-I and IGFBP2 by 1.4 and 1.3 times (p < 0.05) in the perifocal area without changing glucose levels; as a result, tumor volumes exceeded the values in the standard growth, without metastasizing into visceral organs.Conclusion. We revealed gender differences in changing levels of glucose and IGF both in the tumor and in it's perifocal tissue in rats with Guerin's carcinoma growing in presence of DM; these differences could determine different tumor growth dynamics in male and female rats.

Glutathione-dependent system in the blood of gastric cancer patients with various tumor histotypes and prevalence of the disease

Purpose of the study. Exploring the erythrocyte glutathione system functioning in patients with gastric cancer in a comparative aspect, depending on tumor histotype and disease prevalence.Patients and methods. The study included 89 patients with gastric cancer, divided into 6 groups depending on the histotype of the tumor. Separately, the results of the study were analyzed in patients with T4 status according to TNM and in patients at stage 4. The content of reduced glutathione and the activity of glutathione-dependent enzymes in the erythrocytes of the patients' blood were studied by conventional spectrophotometric methods. Statistical processing of the results was carried out using the Statistika 6.0 software package according to the Student's t-test and the nonparametric Wilcoxon-Mann-Whitney test for two independent samples.Results. An increase in the content of glutathione was revealed in patients with gastric cancer compared with the group without oncopathology. The maximum increase was observed in patients with low-grade adenocarcinoma - by 42.5 %, while in signet ring cell carcinoma (SRCC) there was only a tendency to increase by 17.8 %. Glutathione reductase activity was decreased in adenocarcinoma by 23.4-26.2 % and did not change in SRCC. The activity of the antioxidant enzymes glutathione peroxidase and glutathione transferase was increased in all groups, and especially in SRCC - by 76 % and 23-29 %, respectively. In patients with the T4 status and at stage IV of the process, a lower activity of the studied glutathione-dependent enzymes was revealed in comparison with all other groups of patients.Conclusions. The data obtained indicate a greater functional potential of the glutathione system in SRCC. A significant increase in glutathione transferase activity at a sufficiently high level of reduced glutathione can contribute to the development of treatment resistance in SRCC patients.

Chlorin E6-photodynamic therapy basal cell carcinoma

Purpose of the study. Evaluation of the therapeutic efficacy of chlorin E6-photodynamic therapy (PDT) with photosensitizers (PS) photoditazine, photolone and photoran in patients suffering basal cell skin carcinoma.Materials and methods. The efficacy of chlorin E6-PDT was studied in 532 patients with basal cell skin cancer (BCC) aged 28 to 93 years. PhS Photoditazine was used in 72 (13,5 %) patients at a dose of 0.5-1.0 mg/kg, PhS Photolon - in 281 (52,8 %) patients at a dose of 1.1-1.6 mg/kg and PhS Photoran - in 179 (33,6 %) people at a dose of 1.1-1.6 mg/kg.Sessions of local irradiation of tumor foci were performed on a laser device "Latus-2" (662 nm) with a power density of 200-500 mW/cm2, light energy was applied to the tumors at a dose of 100-300-600 J/cm2.Results. During the follow-up period from 6 months to 5 years, 16.2 % of cases of relapse were diagnosed in the study group. When analyzing the results, it was found that the percentage of relapses was minimal when using all PhS in patients who underwent PDT for the first time established BCC of the initial stages (neoplasms up to 2.0 cm) and amounted to 2.2 % (4 patients out of 183), and with a prevalence of the process of more than 2.0 cm and up to 4.0 cm, 9.5 % (10 patients out of 105) of relapses were found. In the results of treatment of recurrent skin malignancies with PDT using derivatives of chloride E6, depending on the prevalence of the process, a similar trend was observed: with the size of tumor foci up to 2.0 cm, the percentage of repeated relapses was less and amounted to 17.1 % (18 patients out of 105) than in the treatment of neoplasms more than 2.0 cm and up to 4.0 cm (28.8 % of relapses - 21 patients out of 73).Conclusions. Chlorin E6-PDT makes it possible to effectively treat primary and recurrent BCC in an independent variant, and the results of treatment depend on a number of factors, including the prevalence of the disease and the presence or absence of previous treatment.