Vol 22, No 4 (2018)

Urothelial cancer (UC) is one of the leading onco-urological diseases. The lack of clinical manifestations of the disease at earlier stages does not allow assigning an adequate therapy in good time. Currently they extensively use conventional methods of treatment, which are constantly improving. Nevertheless, such methods are not always sufficiently effective: they neither always avert recurring, nor ensure sufficient remission and longevity of a patient. Identification of new trends in the early diagnostics of not only cancers but also pre-cancers plays an important role in forming conceptually new approaches to medical treatments. Molecular genetic features of UC have shown a significant chromosomal mutational variability, the dependence of genetic variations on the tumor invasion level, as well as its high level of immunizing power. Successes achieved in understanding the processes taking place not only in the tumor microenvironment but also in tumors have enabled creating fundamentally new anticancer drugs and achieving a significant progress in treating UC. This article presents a new classification of UCs based on immune histochemical data and molecular genetic characteristics of tumors, presents a cluster analysis of various types of UCs, recites present-day data on the disease incidence, analyses up-to-date conventional and innovative methods of UC treatment including non-specific and specific immunotherapy, describes the underlying mechanisms preventing tumors to evade immune surveillance, shows the role of immune checkpoints and their inhibitors, target and cytokine therapies, tumor vaccines, cell-based therapies, combined and integral methods of noninvasive and metastatic UC, as well as describes the results of clinical trials when using various methods of tumor treatments.

The paper presents an analysis of research by a number of Russian and foreign authors devoted to the study of various occlusal splits, in particular, the mechanisms of their work, classification, their effectiveness in various forms of temporomandibular joint (TMJ) lesions, the advantages and disadvantages of individual splits and materials, used in their manufacture. It should be noted that the use of occlusal splits in the complex treatment of TMJ disorders allows to achieve the normalization of spatial relations of intra-articular structures and to eliminate the chronic mechanical trauma of TMJ tissues. The choice of the optimal treatment method of the TMJ internal disorders is made with account of the nature of mandibular movements, of the joint disc displacement, the pain syndrome, its possible causes, and the presence of local and general aggravating factors. The dissipating appliances allow the joint disc to be positioned physiologically correctly relative to the mandible head and therapy eliminate the prerequisites for the TMJ dysfunction development. According to both Russian and foreign researchers, the use of dissipating appliances contributes to an increase in the effectiveness o conservative treatment of the TMJ dysfunction, as well as to the prevention of complications such as secondary osteoarthritis and uncontrolled displacement of the joint disc.

According to the Ministry of Industry and Trade, the degree of dependence of the medical industry and practical medicine on imports is 81%. Critical dependence causes a shortage of inexpensive consumables, medicines and medical devices, and as a consequence of the increase in the cost of medical services, which is estimated as a threat to national security. In various regions of the Russian Federation in the general structure of dental care for patients in all age groups, dental arch defects range from 40 to 75%. Non-removable prosthetics for socially unprotected segments of the population are carried out mainly by bridges with lining the metal frame with hot-curing plastic, short-lived due to low strength characteristics, significant abrasion, and hygroscopicity. To a large extent, the service life of fixed prostheses is determined by the combination of the physicomechanical properties of the facing material, such as flexural strength, modulus of elasticity, and hardness. Flexural strength characterizes the ability of a material to resist unaxial occlusal loading, the modulus of elasticity determines the stiffness of a material and its ability to withstand applied loads without significant deformations, and the hardness characterizes the wear resistance of a material and its ability to withstand abrasion by antagonists. This paper presents the results of a study of the physicomechanical properties of facing composite materials: Ceramage (Shofu, Japan) and Ultra Glass (VladMiVa, Russia). The revealed differences in flexural strength, modulus of elasticity and Vickers microhardness of the material “UltraGlass” allow us to recommend it for widespread clinical use. Expanding the range of domestic materials for orthopedic dentistry by developing a coating composite material UltraGlass helps to improve the quality of dental care to the population with social benefits.

Surgical methods for the treatment of glaucoma are used when other treatments are not effective to maintain intraocular pressure under control. Regardless of the method of choice of surgical treatment of glaucoma, penetrating and non-penetrating surgical intervention violates the integrity of the eyeball and causes a variety of complications. Some of these complications can threaten the vision as a whole. To keep complications to a minimum, it is important to know how to prevent, recognize and treat. One of the main problems of glaucoma surgery is scarring of the previously established ways of outflow of the experiences of all the researchers, who today are in search of new methods of prevention, means and methods for modulation of the process of excessive fibrosis of granulation tissue in the area of operations. The purpose of this article is to give an idea of some of the complications, advantages and disadvantages of the main methods of penetrating and non-penetrating surgical treatment, the use of different types of drains and the creation of new ways of outflow of intraocular fluid, which will help doctors in the future to improve the chosen techniques in the treatment of glaucoma patients in their clinical practice and to develop new methods against early scarring created outflow pathways and the extension of the hypotensive effect after surgery glaucoma.

The activities of public patient organizations are multifaceted: providing legal support to patients in order to protect their legal rights; information and educational work, conducting “schools”, providing specific types of assistance that can provide those involved in the problem. Public patient organizations are the “voice” of all patients with orphan diseases in solving their problems at the level of the highest echelons of power. From 2016-2017 years in the Reference center of congenital hereditary diseases, genetic disorders, orphan and other rare diseases of GBUZ “Morozovskaya DGKB DZM” on a specially designed questionnaire conducted a sociological study on awareness of parents of children suffering ABOUT the public patient organizations. Public organizations provide information and legal support, contact with pharmaceutical companies, participate in solving the problems of patients at the state level. Taking into account the rights and opportunities of public associations, it is necessary for doctors to inform parents about the existence of charitable organizations and their involvement in public patient organizations, as well as to participate in the work of health schools for parents.

In the literature there is a gap of publications about patella fractures management which is due to the absence of serious attention to the injuries of this largest sesamoid bone. In addition, in the world literature there is a lack of monographs and toolkits for the treatment of patients with these injuries, furthermore, in textbooks and traumatology manuals there are only a few template recommendations to the tactics of treating patients with this trauma. Meanwhile, patella fractures represent approximately 0.5-1.5% of all fractures, delayed union, formation of a false joint, and the emergence of patellofemoral arthrosis after these fractures is not uncommon. In the scientific literature on traumatology there is no unified, all-recognized classification of these fractures, which hinders the development of a single algorithm for the treatment of patients with patellar fractures. There are no contradictory views to the treatment of patella fractures without displacement; however, in relation to the treatment of patients with complex patella fractures, there are divergent views between the fracture fragments preservation to partial or even total patellectomy. In connection with the foregoing, We considered the issue of treating patients with patella fractures topical. Based on a thorough analysis of treatment results of 113 patients we provided a working classification based on the number of patellar fracture fragments (two-fragmentary, three-fragmentary, four-fragmentary, multi-fragmentary, upper and lower pole fractures). Based on this classification, traditional, modified and new methods of treating patients with patellar fractures were used. This is described in more detail in the forthcoming article.