[The feasibility of specialized products for nutrition of sportsmen in the preparatory period of the sports cycle].

The nutrition factor is one of the most important in the achievement of high sport results and in maintaining of athlete health along with the methodological and psychological aspects of training. Improving the methods of training in different sports leads to a significant increase in the level of energy expenditure. In order to provide athletes with a large amount of energy, it is advisable to use specialized products with increased nutritive and biological value. Specialists should pay special attention to the scientific justification of composition of special food products (SPP) with consideration of age and gender of athlete, type of sport, the stages of sports activities, training regimes, the qualifications of the athlete and individual level of metabolism. An analytical review of literature on the appropriateness of the application of SPP for athlete nutrition in the preparatory period was conducted to justify the need for further research in this field.

[Use of SPECT-CT for visualization of sentinel lymph nodes in breast cancer patients].

This study was performed in order to determine individual variability of axillary sentinel lymph nodes (SLN) localization in patient with breast cancer (BC). Individual topography of axillary SLN was determined in 182 patients with early BC. All women were candidates for conservative surgical treatment with postoperative radiotherapy. SPECT-CT visualization of SLN started 120-240 min after intratumoral injection of 74-150MBq of 99mTc-radiocolloids. Distribution of axillary SLN was allocated to following subregions: central (C), pectoral (P), apical (AP), lateral (L), subscapular (SSc). SLN visualization by SPECT-CT was successful in 153 cases (84%). AP nodes were detected in 7 patients (5%). SLN were localized on thoracic wall in 34 cases (22%), in the intrapectoral region--in 3 (2%) women. According to axillary levels they were detected on level I--in 149 (97%), level II--15 (10%), level III-- (7.5%) cases.

[Human dirofilariasis: clinical and diagnostic signs and diagnostic methods].

The clinical and diagnostic signs caused by the tissue location and migration of adult Dirofilaria in the human body determine the use of different methods for the diagnosis of dirofilariasis. During their investigations, the authors modified polymerase chain reaction (PCR): they chose and synthesized primers and selected amplification regimens for them and obtained agarose gel bands that corresponded to PCR fragment length nucleotide sequences that were equal to 245 bp for D. (N.) repens and 656 bp for D. immitis. There was 100% agreement in the results of PCR and microscopic examination of sera from 32 dogs and 1 female patient with low parasitemia and in the blood nucleotide sequence characteristic of D. repens.

[Results of studies of human dirofilariasis in Russia].

Human dirofilariasis is a pressing health problem in Russia. By 2014, there have been as many as 850 Dirofilaria repens-infested people living in 42 subjects of the Russian Federation. One of the favorable factors for circulation and spread of invasion is a temperature of above +20-24 degrees C; when the latter is maintained during at least 20 days there may be 1.-1.5 circulations of invasion in the carrier and a 2.8-fold increase in transmission intensity. The border ofa dirofilariasis area with a temperate climate is southward to 58 degrees N in European Russia and West Siberia and southward to 50 degrees N in the Far East. The conditions in the human body have been found to be more favorable for the development of Dirofilaria than considered before and allow the helminth to achieve sexual maturity and to propagate. If man has microfilaremia, he may be a source of invasion. It is necessary to examine venous blood by the enrichment method and, if possible, polymerase chain reaction and enzyme immunoassay, which make it possible to establish a diagnosis in occult invasion and to identify a pathogen species.

[SPECT-CT in the diagnosis of metastatic skeletal lesion].

The aim of this study was to compare the diagnostic capabilities of SPECT-CT and planar osteoscintigraphy with 99m-Tc-labeled phosphates in cancer patients. There were examined 227 patients with various primary malignancies (mean age 57 years). Depending on the identified changes in the planar study patients were divided into four groups: I--no abnormalities (n = 62), II--benign changes (n = 67), III--suspected metastatic lesion (n = 41), IV--metastatic lesion (n = 57). The use of SPECT-CT in group I revealed metastatic lesion in 7 (11%) patients, in 15 (24%) patients there were additionally found benign focal changes in the skeleton. In group II metastases were found in 4 (6%) patients; it was not possible to exclude secondary lesion in 3 (4%) patients. In group III suspected metastatic lesion was excluded in 29 (71%) and confirmed in 7 (17%) patients. In group IV in 14 (25%) patients there were found non-tumor changes, the nature of the changes has not been found in 2 (4%) patients. As a result, SPECT-CT with 99m-Tc-labeled phosphates is more informative method of diagnosis of metastatic skeletal lesion than planar osteoscintigraphy. SPECT-CT application resulted in changes of conclusions of the planar scintigraphy about the nature of bone pathology in 67 (30%) cancer patients. However, in 4% the recognition of the nature of changes in the skeleton has failed.

[Role of single-photon emission-computed tomography and x-ray computed tomography in diagnosing lymphatic metastases in patients with non-small cell lung cancer].

Single photon emission tomography (SPECT) with 99mTc-MIBI was performed after conventional staging in 83 operated non-small cell lung cancer (NSCLC) patients. Diagnostic results of SPECT and conventional computerized tomography (CT) staging were validated by histological examinations of operation material. According to histological verification 35 of 83 evaluated patients had lymph node (LN) invasion by NSCLC. SPECT detected LN involvement in 28 of these 35 patients and was false positive in additional 16 patients. Pneumonia or atelectasis were detected in 12 of 16 patients with false positive SPECT results. Sensitivity (Sen), specificity (Sp), accuracy (Ac), positive (PPV) and negative (NPV) predictive values of SPECT in diagnosis of LN invasion by NSCLC was as follows: 80%, 66%, 72%, 65%, 82%. Diagnostic accuracy of CT for detection of LN involvement was inferior to SPECT: Sen--71%, Sp--62%, Ac--66%, PPV--58%, NPV--75%. Combination of SPECT and CT data offer promising solutions with Sen reached 94% or high Sp which in patients without atelectasis or pneumonia can reach 96%.

[The use of SPECT-CT with 99mTc-labeled phosphates in patients with suspected skeletal metastases in planar bone scintigraphy].

We assessed the diagnostic capabilities of SPECT-CT in patients with unclear and suspicious on the secondary lesion with bone scintigraphy background in planar mode (227 patients (mean age - 57 years) with various primary malignancies). All patients underwent planar scintigraphy with 99mTc-labeled phosphates in the "whole body" mode and then - bizonal single-photon-emission computed tomography combined with X-ray computed tomography (SPECT-CT). In patients with the presence of lesions in the skeleton, suspicious on metastases, there was conducted comparison with the data of SPECT-CT. During planar investigation the suspicion on metastases was detected in 41 patients (18%). The use of SPECT-CT allowed excluding metastases in 29 (71%) and confirmed in 7 (17%) of them. In 5 (12%) cases the nature of the changes remained unclear. Thus, in cancer patients with revealed by planar bone scintigraphy unclear or suspicious for metastatic foci in the skeleton, the use of SPECT-CT allowed in most cases (88%) to clarify the nature of these changes.

[Effectiveness of mammary scintigraphy for determining the results of neoadjuvant polychemotherapy in breast cancer].

Analysis of mammoscintigraphy is presented to assess the effectiveness of neoadjuvant polychemotherapy for locally advanced breast cancer. In 90% of patients there is defined conformity of scintigraphy data on the effectiveness of performed polychemotherapy to the results of histologic examination of the postoperative material. The sensitivity of scintigraphy in assessing the effectiveness of neoadjuvant polychemoterapy was 83.3%, specificity--87.9%, accuracy--86.3%, predictive value of positive and negative results-78.9% and 90.1%, respectively. Mammoscintigraphy is an effective method to control the response of locally advanced breast cancer to neoadjuvant polychemotherapy.

[Methodological issues of sentinel lymph nodes biopsy in patients with breast cancer].

Radionuclide imaging of sentinel lymph nodes (SLN) was performed in 122 breast cancer patients, which before the biopsy of lymph nodes it was performed intratumoral injection of colloidal radiopharmaceuticals (RFP): in 89 patients--nanocolloidal (NC) and in 33--colloidal with particle size from 200 to 1000 nm. After the introduction of NC the SLN image was obtained in 83 of 89 women. (93.3%). After the introduction of large colloids (200-1000 nm or more) SLN visualization in this group was achieved in 27 of 33 patients, i.e., in 81.8% of cases (p < 0.05). Along with the axillary SLN, in 55.8% of cases SLN image was obtained in parasternal area and/or lymph nodes of the second and higher orders in axillary as well as under-and supraclavicular regions. On the contrary while using larger colloids, RFP accumulated only in SLN of axillary region in 85.1%. These differences in the topography of the absorption of various diameters radiocolloids were reliable (p = 0.01). Using the NC RFN compared with colloidal RFP of larger diameter can reliably improve SLN visualization till 98.9% however leads to a concomitant accumulation of RFP in lymph nodes of the second order in 55.8% of patients.

[Combined use of 99mTc-MIBI scintigraphy and ultrasonography (US) in the diagnosis of axillary lymphatic metastasis in patients with breast cancer].

We aimed to evaluate different imaging strategies for diagnosis of axillary LNMs in patients with primary breast cancer (BC). 168 consecutive patients with primary BC were included in the study. Functional imaging by scintigraphy (AxSc) with 99mTc-MIBI was performed in static and tomography modes 15 min after i/v injection. Focal areas of tracer accumulation in axial region were considered as sings of LNMs. Ultrasound (US) examination of axillary region was performed on 7.5 kH scanner. Nodes with diameter more than 1 cm were considered abnormal. All patients were operated with axial LN dissection and subsequent histological evaluation. Scintigraphic signs of LNMs revealed in 65 patients: 48--true positive, 17--false positive. Among 103 women with normal AxSc results 27 had LNMs and 76--uninvolved nodes. Sensitivity (Sen), Specificity (Sp) and Accuracy (Ac) of AxSc were as follows: 64%, 82% and 74%. Sonography diagnosed LNMs in 74 women: 56 were metastatic on histology while other 18--uninvolved. On the contrary, 19 of 94 US normal sized nodes were metastatic on histology. US had following values when used for diagnosis of axillary LNMs: Sen--75%, Sp--81%, Ac--78%. When LNMs were diagnosed as the combination of concordantly abnormal US and AxSc examinations Sp reached 95%, Sen dropped down to 56% and Ac--to 77%. Another model was based on the assumption that LNMs must be diagnosed in all patients with abnormal US or AxSc examinations. According to this strategy Sen reached 83%, Sp--68% and Ac--74%. Thus, we found comparative accuracy of US and AxSc in diagnosis of axillary LNMs in patients with primary BC. Combination of both modalities can significantly improve sensitivity (83%) or specificity (95%) of final conclusion which is determined by established diagnostic strategy and criteria's that are used for BC diagnosis.

[Use of simultaneous double-tracer SPECT with 99m-Tc-technetril and 67-Ga-citrate for follow-up of patients with non-small cell lung cancer].

In 20 primary patients with focal abnormalities on conventional CT we evaluated diagnostic properties of simultaneous double-tracer SPECT. Scintigraphy was performed as a single examination with simultaneous registration of 67Ga and 99mTc-MIBI. Image acquisition was started 48-74 hours after IV injection of 130-175 MBq 67Ga-citrate and immediately after IV injection of 500-740 MBq of 99mTc-MIBI. All images for each agent were classified as positive and negative for primary tumor, N1 and N2 lymph-nodes (LN). According to histology 18 of 20 evaluated patients had non-small cell lung cancer (NSCLC), the other two patients had tuberculosis and nonspecific inflammation. SPECT with 99mTc-MIBI correctly visualized tumor in 18, 67Ga allowed correct visualization in 16 cases. Both tracers were truly negative in a patient with tuberculosis and false positive in a patient with nonspecific inflammation. Double-tracer SPECT was slightly more specific than CT in primary lesions. In 18 patients histological verification of LN status was obtained: NO was revealed in 9 cases, N1 in 4 and N2 in 5 cases. Both tracers correctly discriminated LN-positive and LN-negative cases with 94% specificity. On the contrary, CT was false-positive in 3 and false-negative in another 5 patients. Differentiation between N1 and N2 LN involvement is crucial for therapy planning. 99mTc MIBI and 67Ga revealed N1 in 2 cases and N2 in 4 cases, the diagnosis was later verified by postoperative morphology. In 2 patients SPECT overestimated extent of LN involvement and LN status was changed after surgery from N2 to N1. In 18 patients results of 99mTc-MIBI and 67Ga augmented each other. Accuracy of LN staging by SPECT with 99mTc-MIBI and 67Ga was 83%. CT accurately determined LN stage only in 7 patients, it was overestimated in 7 and underestimated in 4 cases. SPECT with 99mTc-MIBI and 67Ga demonstrated high overall accuracy in diagnostics of regional LN invasion for patients with NSCLC. Diagnostic value of conventional CT was significantly lower. Correct level of LN involvement was determined by SPECT in 83% of cases.

[Methodologic aspects of radionuclide diagnosis of breast cancer with 99mTc-MIBI].

The aim was to study the diagnostic possibilities of breast scintigraphy with help of domestic RFP tehnetril labeled 99mTc. Breast scintigraphy was performed in 132 women at age between 32 and 68 years. Visualization of both breasts in planned mode was performed in the lateral and anterior projections in 10-15 minutes after intravenous injection of 740-860 MBq of 99mTc-tehnetril. After this, a study was conducted in the mode emission computed tomography. Morphological verification of changes in the breast was performed in all cases. Sensitivity, specificity and overall accuracy of planar breast scintigraphy was 96% (105/112), 94% (245/252) and 95% respectively. Upon planar study of 132 breasts suspicious on cancer presence breast scintigraphy showed not high specificity 68% (7/21), sensitivity reached 94% (105/112), overall accuracy--90%. SPECT did not show visible benefits: sensitivity-92% (100/112), specificity--75% (5/21), and overall accuracy--89%. Usage of a semi-quantitative accrual rate of RFP in tumor allowed distinguishing four groups of patients with different, to breast scintigraphy data, likelihood of breast cancer (from 2-10% to 96%). As a result current methods of breast scintigraphy provide high sensitivity (88-96%) and accuracy in breast cancer detecting of any size as far as the use of additional diagnostic criteria, semi-quantitative ratio RFP accumulation in tumor in particular, can significantly increase (up 94%), specificity of diagnostic conclusions.

[Dirofilariasis in the Moscow Region, a low disease transmission risk area].

The spread of canine and human dirofilariasis was first studied in the Moscow Region, a low disease transmission risk area. D.repens infestation was found to have a tendency to increase in Moscow residents with the imported cases being predominant. In 33 (84.6%) districts of the Moscow Region, dogs were registered to have D. immitis and D. repens infestation, with the former being preponderant in 31 districts. An original map of dirofilariasis distribution was compiled with the areas being singled out at a distance of Moscow: 15-20 km (6 districts) (the first ring); as long as 70 km (11 districts) (the second ring), and over 70 km (16 districts) where infestation rates greatly varied in both the number of infected animals and human beings and the species of causative agents.

[Lymphoscintigraphy of separate lymph nodes for radiotherapy planning in breast cancer].

Determination of lymph flow from breast cancer can be used as effective tool for individualization of radiation portals for regional radiotherapy. We evaluated this technique in 86 patients with lymph nodes (LN) scintigraphy which was performed 20-240 min after intratumoural injection of 50-100 MBq of 99mTc-nanocolloids. After visualisation of lymph flow patterns standard radiation portals were modified in 75% of patients with external and 85%--with internal localisation of primary tumours, In addition we recognised that extent and wideness of radiation portals for internal mammary lymph LN must be arranged in accordance with individual lymph flow pattern. In particularly irradiation of LN on both sides of the sternum was performed only in 3 of 27 (11%) evaluated cases.

[Early diagnosis of breast cancer with scintimammography and ultrasound ].

The purpose of this study was to evaluate the role of scintimammography (SMG) and ultrasound (US) in early diagnosis of breast cancer. SMG was administered to 32 women with breast lesions of less than 1 cm in diameter. In addition, all patients underwent high frequency US imaging with digital wide field of view. The following US features were set as diagnostic: heterogeneous echo pattern, irregular morphology, hyperecho, poorly defined edges, posterior acoustic attenuation. SMG was performed in planar and tomography modes 15 min. after i/v injection of 740-860 MBq 99mTc-sestamibi. Images with focal and scattered patchy uptake were discarded. Data on all lesions were verified by biopsy and/or surgery. Thirty-six women revealed lesions of less than 1 cm: 12 out of 14 cases of breast cancer had them, while malignancy was not detected in 16 of 21 women with benign breast lesions. Sensitivity (Sen), Specificity (Sp) and Accuracy (Ac) of SMG in this group was as follows: 86%, 76% and 80%, respectively. US examinations in this group diagnosed benign lesions in 27 out of 35 women: 21--negative, 6--false negative. In the remaining 8 cases, US findings on breast cancer were positive: Sen was low (57%), Sp--high (100%) and Ac--moderate (82%). Taking into account that SMG represents functional status of breast lesions while US--anatomical one, we tested diagnostic value of their combination too (US+SMG). Cancer diagnosis was passed when either SMG or US revealed abnormalities. This diagnostic strategy featured outstanding Sen (100%), moderate Sp (76%) and Ac of 82%. It may be concluded that the combination procedure seems highly promising as far as early diagnosis of small (< 1 cm) breast cancers are concerned.

[Radionuclide visualization of lymphatic flow from primary breast cancer].

Our study was concerned with evaluation of patterns of lymph flow from primary breast cancer. Radionuclide scintigraphy (RS) of lymph nodes was performed in 92 patients. Scinitigraphic images were obtained 30-60 and 240-360 min after intratumoral injection of 75-150 MBq (0,5-1 vl) of 99mTc nanocolloids. The pool sites of the radiodrug collection were as follows: axillary (Ax), sub-supraclavicular (SSCL) and internal mammary (IM). Imaging proved effective in 86 cases. No drug transport was recorded in 5 cases; 4 of them revealed macroscopic metaststases to the lymph nodes. External involvement of the axillary lymph nodes was visualized in 51 patients out of 52 while in 26 it occurred on the axillary site only. In another 25 patients, images of lymph nodes were obtained on 2 or 3 sites: drainage Ax+SSCL (12;23.1%), Ax+IM (6;11.6%) and Ax+SSCL+IM (7;13.4%). In patients with tumors in internal quadrants (34), the lymph flow patterns were as follows: Ax (12;35.3%), IM (2;5.8%), Ax+SSCL (8;23.5%), Ax+IM+SSCL (5;14.7%). Hence, the efficacy of lymph node visualization after intratumoral injection of nanocolloids was 98%. Visualization on Ax sites was further confirmed by lymph flow to SSCL and IM (29.1%) and (35.9%), respectively. The likelihood of lymph flow to IM is significantly higher in patients with internal localization of breast cancer (37.1%) but it is not negligible (22.9%) in cases of external quadrants.

[Human dirofilariasis: diagnosis and the pattern of pathogen-host relations].

Until recently, there has been no consensus of opinion as to that D.repens females can develop in the accidental host (man). The role of man is regarded as a biological dead end for Dirofilaria that are unable to develop the adult stage; human Dirofilaria migration is considered to be larval by the type of larva migrans. Studying these matters on a specific material of 140 cases of invasion by Dirofilaria that had been eliminated in patients in different seasons and the length of their bodies measured showed that the maximum number (51.4%) was mature females, 120 to 190 mm in size; 35.7 and 12.85% had a length of 70-115 and 40-65 mm, respectively, which corresponds to immature young and juvenile specimens. This suggests that Dirofilaria normally develop and achieve the adult stage in the accidental host. A correlation was found in the sizes of the body and the time of D. repens development. Thus, the human organism is not a biological dead end for Dirofllaria. The migration of adult Dirofilaria should be appraised as the imago-migrans phenomenon: As the particular diagnostic sign, it will aid a physician to establish a correct parasitiological diagnosis at the early stages of the disease. In recent years, there has been new evidence in the diagnosis of dirofilariasis that microfilaria have been detected in the skin tumor puncture specimen and blood of the patients. In this connection, it is conceivable that man may be an actual source of mosquito infection even in the presence and paucity of mature males and females.

[Prevalence of human dirofilariasis in Russia].

The nature of regional zoning of the prevalence of dirofilariasis in Russia was first established and a map reflecting the structure of an area with the identification of three zones (low, moderate, and stable transmission risks) was drawn up. In Russia, natural and climatic conditions are favorable for the development of transmitting mosquitoes and larvae of Dirofilaria to the invasion stage in the body of the transmitter to the south of the latitude of 58 degrees north in the European part and Western Siberia and to the south of the latitude of 50 degrees north in the Far East. The region of dirofilariasis covers 53 subjects of the Russian Federation, in 39 subjects (including 29 in the European part and 10 in the Asian part) of which 564 cases of dirofilariasis were notified in 1915-2008. 68.44% of dirofilariasis cases were registered in the endemic area in 11 subjects of the Russian Federation in the stable transmission risk zone while in the moderate and low transmission risk zones these amounted to 31.55% in 28 subjects. Information on the area of dirofilariasis is needed to estimate its incidence in man in different regions of Russia, which will assist in diagnosing this zoogenous transmissible helminthiasis.

[Analyzing the epidemic situation due to tuberculosis and ways of optimization of its control in the penitentiary facilities of the Ulyanovsk Region]. / Analiz épidemicheskoi situatsii po tuberkulezu i puti optimizatsii bor'by s nim v penitentsiarnykh uchrezhdeniiakh Ul'ianovskoi oblasti.

The dynamics of epidemic parameters and the specific features of development of tuberculosis were analyzed in prisoners in 1989-2001. It was ascertained that 98.7% of them were infected with tuberculosis and most of them belonged to a tuberculosis high-risk group. In 67.5% of those who had fallen ill, the process was detected within the first 3 years of their confinement. A scheme of interaction of main propulsive forces of an epidemic process in tuberculosis (exogenous and endogenous infections and risk factors) is presented. It has been found that surveys for tuberculosis are not a deterrent for a rise in the incidence rates due to endogenous infection. The use of factorial analysis and systems approach in the epidemiology of tuberculosis has explained some regularities in the development of an epidemic process, revealed reasons for the aggravated tuberculosis situation in penitentiary institutions, and considered prospects for its improvement.

[Human dirofilariasis in the Moscow region]. / Difiliarioz cheloveka v Moskovskom regione.

Dirofilaria repens Railliet et Henry, 1911 was for the first time studied in the Moscow Region where 11 patients (6 males and 5 females) aged 4-72 years were recorded in 2000-2002. The geographical distribution (the southern and south-eastern parts of the region) of local cases of dirofiliriasis, was observed. There was a relatively high rate of D. repens in the male genitalia of the infected patients as compared with that reported by other authors. In accordance with the current terminology, D. repens in the Moscow Region is proposed to be regarded as emerging infection. The authors show it necessary to obligatorily record all autochtonous cases of D. repens infection, to make epidemiological surveillance and analysis in order to early detect and prevent dirofilariasis-associated complications.