MIL OSI Translation. Region: Russian Federation –
The capital’s doctors – about how modern methods reduce mortality from cancer, and new technologies help fight depression.
This year, six teams of medical organizations of the Moscow Department of Health became the laureates of the Moscow Medical Award in the field of medicine. Doctors receive payments in the amount of one million rubles for the best scientific and practical development and innovative projects. How they contribute to the development of medicine, prolong and save the lives of patients – in the material mos.ru.
For the early detection of cancer
Employees Scientific and practical clinical center for diagnostics and telemedicine technologies received an award for the development and implementation of screening methods for lung cancer using low-dose computed tomography. The method allows the doctor to find tumor foci of a size of six millimeters and thereby diagnose the disease in its early stages.
Experts have proved the possibility of using artificial intelligence to control the quality of screening research. The program analyzes the research texts and finds possible errors in the description of the results. In addition, the resulting images are used to train the algorithms of artificial intelligence. At the same time tomographs are connected to Unified Radiological Information System (ERIS), which allows experts to see the examination process and helps doctors in clinics to avoid mistakes.
Sergey Morozov: Lung cancer in the early stages began to be detected 40 percent more often
Director of the Scientific Clinical Center for Diagnostic and Telemedicine Technologies
– Until recently, it was almost impossible to detect lung cancer at an early stage. The disease is usually diagnosed in the third or fourth stage, when the tumor is practically inoperable. With the advent of computed tomography, it became possible to conduct screening studies in people without symptoms. This allows you to detect cancer at the initial stage, when the tumor can be cured with minimally invasive surgery and radiotherapy. The method saves both the patient’s life and its quality.
The results of recent studies say: if massively screening patients at risk (these are people over 55 years old and with smoking experience of more than 30 years), then lung cancer mortality can be reduced. This is a great achievement.
This screening method was developed by our team. For this we needed not only the equipment on which to conduct the study, but also specialists able to interpret the results, and the information system (ERIS), to which all tomographs are connected in polyclinics. Thanks to her, we see all the results of research, we can evaluate their quality, double-check the conclusions of doctors in clinics. And description templates help automate the process.
We showed that lung cancer in the early stages — first and second — was detected 40 percent more often. These are numbers that could not be achieved in any region of Russia. In the two years of the project, the mortality from lung cancer among those patients who have been screened has decreased by 70 percent. This is impressive: a new mechanism for the early diagnosis of cancer has appeared. The earlier a tumor is detected, the easier and cheaper to treat it. The patient’s quality of life is also maintained. Thanks to the methods of treatment that are now in Moscow, a person undergoing chemotherapy and radiotherapy can live for many years at different stages of lung cancer and continue to do what he likes, sports. It depends on the will power of the patient and his attitude to the success of the treatment.
We are not satisfied with what has already been achieved and are now planning to integrate speech recognition technology into ERIS and EMIAS, to create standardized data sets for training and testing artificial intelligence algorithms.
We also plan to expand the screening program. Muscovites who have reached the age of 55 will receive a warning that it is time to undergo screening for lung cancer, breast cancer or for coronary calcium. They will be invited to the survey via SMS, instant messengers, emails. So we will define those for whom screening is really necessary. This is personalized medicine.
Lung cancer screening with low-dose computed tomography is performed at 10 clinics. In the future, it is planned to scale the method to all Moscow medical institutions. There is a demand for screening programs in many regions of Russia: we are approached by key oncologists and radiologists, representatives of regional ministries with a request to help calculate economic performance indicators and determine the necessary resources for the launch. The professional community understands that the introduction of screening programs has a real result in reducing cancer mortality.
When every minute counts: operative care for patients with ischemic stroke
For the organization of the system of endovascular care for patients with ischemic stroke, the prize was awarded to a research group of employees of the IV Klimenko City Clinical Hospital. Davydovsky, Clinical Medical Center, Moscow State Medical and Dental University (MSMSU) named after A.I. Evdokimov and the Federal Center for Cerebrovascular Pathology and Stroke. Stroke centers have been opened in the capital, where specialists assist patients around the clock.
Elena Vasilyeva: The number of rescued patients is measured in hundreds
Chief Cardiologist, Chief Doctor of the I.V. Davydovskogo
– In 2015, international studies appeared for the first time, which showed that endovascular care is the most effective way to treat patients with ischemic stroke. The methods of treatment rather quickly entered class I of the European recommendations for the treatment of stroke, which is rare. And at the same time we joined the whole world in organizing the system of such assistance. To implement this program, the Moscow Department of Health created a working group led by Professor Alexander Shpektor, where, together with Moscow’s chief neurologist Nikolai Shamalov, chief freelance specialist in emergency medical care Nikolai Plavunov, chief freelance radiotherapy specialist Dmitry Skrypnik, and I developed system of care for patients with ischemic strokes.
Ischemic stroke occurs when one of the large arteries supplying the brain closes with a blood clot. The blood flow is broken, the death of those parts of the brain that must be supplied with this artery begins. This can lead to paralysis and speech disorders, and in the worst case scenario – to the death of a person.
A blood clot that closes a large artery needs to be removed as quickly as possible – then there is a chance that necrosis will not occur or be minimal. During endovascular treatment, special instruments are carried out to the brain vessels, with the help of which a blood clot is removed.
It is important that the treatment gives a quick result. Often, in the event of a successful operation, speech and movement can recover within a few hours. The number of rescued patients is already in the hundreds. Without this method, the most severe patients either died or became disabled for life.
Now in Moscow created a unique system of care for patients. This was made possible thanks to the active participation in the work of ambulance specialists (under the direction of Nikolay Plavunov) and the fact that there already existed an endovascular system for treating patients with heart attack. Among the available infarct vascular centers, we chose those where there were at least two angiographs, and also trained people – endovascular specialists who had extensive experience in the treatment of heart attacks. Thanks to this, nine stroke centers are now operating, where round-the-clock assistance is organized. They conduct well-coordinated work of neurologists, cardiologists, and specialists in imaging (CT, MRI diagnostics) and endovascular treatment.
In the future, the system should be expanded. I think that in the near future the number of operated patients should increase no less than five times.
Overtake the diver and get out of depression: new techniques in the treatment of mental illness
The prize for the introduction of new technologies in the diagnosis and treatment of brain diseases was received by the team of the Scientific and Practical Psycho-Neurological Center named after Z.P. Soloviev, City Clinical Hospital named after VM. Buyanov, Clinical Medical Center Moscow State Medical University named after AI. Evdokimova and the Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences (RAS). Specialists conducted a set of studies of borderline mental disorders and epilepsy and developed algorithms for treating patients. The practice includes modern techniques – biofeedback, transcranial stimulation and micropolarization, as well as methods of gravitational medicine.
Renat Akzhigitov: Having completed the course of our treatment, almost 90 percent of patients return to work
Deputy Director for Medical Services of the Z.P. Scientific and Practical Psychoneurological Center named after Z.P. Solovyov
– Our main profile is borderline mental disorders: depression, panic attacks, insomnia, and other disorders that many people have. If they are treated in time and properly, patients recover, the person returns to a full life. Our contribution to this work was appreciated by such a high award. We have developed a multidirectional complex of therapeutic measures, which affects not only the psyche, but also the entire body. If the patient has any concomitant somatic diseases, then we also deal with them.
We treat mental disorders not only with drugs and psychotherapy, although, of course, one cannot do without it. We use a fairly wide range of non-medicinal methods and technologies: biofeedback, transcranial micro-polarization and magnetic brain stimulation, neuro fitness, aqua aerobics and much more. In a fairly short time we manage to achieve very good results.
Biofeedback (BFB) is a special computer program that records the physiological parameters of the human body: pulse, heart rate, blood pressure, galvanic skin response. These parameters reflect the state of the human autonomic nervous system, which regulates in the body what one does not realize (for example, pressure increase, sweating). Sometimes we say: “it throws cold sweat or trembling”, “the heart is pounding”, “the blood rushes to your face” – these are manifestations that cannot be somehow slowed down by the mind or, on the contrary, activated.
The method of biofeedback is based on a computer program that registers indicators and, depending on them, displays a kind of image. It may be just a view of nature or the like of a computer game. For example, the diver, which is controlled by the patient, swims at a certain speed. The more a person is tense, the speed is less. In this case, the diver, which is controlled by the system, swims at an average speed. If a person is worried, then he lags behind a computer diver, if he relaxes, he overtakes. Still, for example, a picture of nature: when a person is tense, he sees a dull, unclear image. The more he relaxes, the sharper, clearer and more beautiful this picture becomes.
With this technique, a person begins to understand how to achieve a state of relaxation, how to regulate these seemingly unregulated functions of the body. As a result, the patient copes better with life situations, with depressions, worries, emotions.
Transcranial micropolarization and magnetic stimulation are two, on the one hand, different methods, and on the other, very similar. This effect is either a magnetic field or a current of certain frequencies on the points in the brain that are responsible for the emotional state, for the ability for attention, for coordination, for the speed of reaction, and so on. This effect is healing, regulating and normalizing the work of the brain. Thanks to these techniques, less drugs are needed and a positive effect is achieved in a shorter period.
We actively interact with the Institute of Higher Nervous Activity and Neurophysiology RAS. Now a lot of research is being done in the direction of searching for neurochemical or neurophysiological causes of development, for example, depression or other disorders. Translational studies on stress reactivity, depression, are also carried out on laboratory mice. Scientists determine the changes at the biochemical level in the body that are responsible for the development of stress, for the development of the reaction – how much it is pronounced, bright and how it becomes painful.
The results of treatment of borderline mental disorders are difficult to quantify. There are still no such biological markers that, like a blood test, would demonstrate, say, a decrease in the level of some parameter from 100 units to 50. A lot is estimated by the doctor and the patient himself at the level of sensations. That is how a person feels, how he perceives, how he copes with what is happening in his life.
If people of working age without disabilities come to us, then, having undergone the course of our treatment, almost 90 percent of patients return to work. The rest do not usually return because of some related, somatic diseases.
The population is now on average getting older, people are starting to live longer. At the same time, the older a person is, the more he has various chronic diseases. On their background, people often have depression, anxiety, insomnia. Older people make up the majority of our patients.
Thanks to the modernization carried out by the Moscow Department of Health, our center is very well equipped – we have the opportunity to treat not only the mental component, but also the somatic one.
An important direction of our work is epileptology. This is also the frontier field of medicine, at different times both psychiatrists and neurologists have been involved in it. Now medicine has reached quite high heights in the treatment of epilepsy, modern drugs allow good control of attacks, to achieve partial or almost complete remission. However, in some cases, even despite adequate treatment, the so-called therapeutic resistance persists — when a person continues to experience epileptic seizures. When all conservative treatments have been tried, neurosurgical intervention is necessary. This is a brain surgery when an epileptic focus is removed or certain paths responsible for seizure activity intersect.
After neurosurgical operations are very good results, they are widely used throughout the world. In Moscow, a program of neurosurgical treatment of epilepsy started several years ago. Our director, Professor Alla Hecht, together with the head of the Moscow Clinical Center of the Yevdokimov Moscow State Medical University, academician Vladimir Krylov, organized an association of medical organizations with clear routing. The patient who came to the local neurologist is referred to a regional epileptologist, who is doing everything to improve in a conservative way. If the doctor sees that it is ineffective, then he refers the patient to a neurosurgeon.
The program is becoming more common, the school “Epi Kuskovo” is organized, where neurologists, epileptologists and neurosurgeons come from all regions of Russia. This experience will be spread throughout the country. The results of this practice are very good. In general, about 80–90 percent of operated patients stop epileptic seizures, and they return, as far as possible, to a full life.
Another very big and difficult problem is strokes, there are a lot of them, they are increasingly affecting people at an earlier age. Our center accepts patients with good rehabilitation potential for treatment. To restore lost or reduced functions, we use axial loading suits. This technology came from space medicine – when astronauts return to the earth and get used to gravity again, they are dressed in something like that. This is a suit with a special spring system that affects all muscle groups of a person.
Of course, we are not satisfied with what has already been achieved and continue our research. Every year we hold scientific and practical conferences, we invite scientists, including from abroad. Our employees themselves go to various conferences, including international ones. We really hope that we will be able to develop, to varying degrees, machine learning technologies and the search for biological markers that will allow us to diagnose mental disorders as early as possible. Then it will be possible to prevent the development of severe conditions. The sooner it turns out to detect the disease and start treatment, the better the results.
EDITOR’S NOTE: This article is a translation. Apologies should not be perfect.