yes, dna breakdown, breakdown at the level, it can be a very large breakdown, yes, a chromosome break, an exchange of large pieces of chromosomes with each other, or it can be a very small breakdown, like the replacement of one letter among the billions that actually make up the cell's genome, yes, from this point of view, any oncological disease is genetic in nature of the breakdown, and i... i still remember, sometimes there are some, well , phrases that, you don't need to read a whole book, sometimes it's enough to read the title there, here i still have in my head a phrase from a book that you should be more familiar with there was such a book - alberts, molecular biology of the cell, it is such a university bible for us molecular biologists yes, and there was at the very end there was a subchapter dedicated to cancer oncological

diseases, there was the title of this chapter was the following: cancer dash genetic disease of somatic cells, in some sense it is, that is, the cells of our body, yes the cells of our body, somatic cells - this means those cells that will not pass on their genetic information to the offspring, there are germinal cells, cells that are either gomets, yes cells that can become a new organism, yes an egg cell, a sperm cell. they are formed in the body, if there is a mutation in these cells, it has a chance to continue in the offspring, but there are somatic cells, they are the majority, there are trillions of them in the body, here is a genetic breakdown in such a cell, it can cause a disease, but it is not inherited, here this line between genetics and somatic and inherited genetics must be clearly imagined, that is cancer is always genetics, but not necessarily inherited genetics. well, and non-inherited,

that is why the disease can manifest itself at 4 years and at 7 years, because it is a random process, it is a random process, but it is not accidental that, for example, the peak incidence of acute lycosis in children occurs at 4 years, the fact is, the fact is that our immune system, the first years of a person's life are a period of such formation of the immune system, yes, when the body's immune system encounters all ... the diversity of the surrounding world from the point of view of microbes, bacteria, viruses, fungal infections, from the point of view of food, from the point of view of just any such chemical molecular environment, and the immune system during this period develops very rapidly, in the development of the immune system there is such a very important stage when the genes encoding antibodies, they are rebuilt very intensively, that is, literally at the dna level, cuts occur and ...

these small breaks in the dna cross-linking disappear, sometimes, apparently, very rarely, in fact, an error occurs there, if as a result of such a break the gene controlling cell division, or affecting the death of the cell, then there will be trouble, yes, then such a cell can turn into a tumor, well, in a practical sense, given that this is well , obviously, that this is a tragedy for the family, that is, that is, are there any measures that can be taken at... a

certain age of the child to reduce the likelihood of this, or is it just a roulette , no, in my opinion, it is largely a roulette, yes, it is largely a random event, although there have been attempts for many years to find a connection between with some types of diet or with some types of lifestyle, if you like, yes, they found something or that's all, nothing that can be actively influenced, they didn't find anything, yes, that is , that is, we can only hope for the best or for... the accuracy of this process of producing antibodies and so that well i think, unfortunately, this is the kind of chance that we have to somehow learn to coexist with, and here, unfortunately, with the exception of those families where the hereditary predisposition is known, yes, why else is it important to find this hereditary predisposition, if this is known about the family, then for such a child or adult it is possible to form a monitoring program, yes, that is, some program that will allow... to find this tumor at

an earlier stage and try to treat it with a simpler or more gentle method, only for such patients, perhaps, you said that there are 10% of them, for this one. nisterov himself does not understand what he was getting himself into, he brought together a siberian bandit and a french swindler and thinks that he has achieved great success, not only that they agreed on your back, they don't care yet that you 'll find out about it, if you get away with it, i'm afraid they'll stop respecting you, trade, tomorrow after

the program time, sit down please, listen to me, i'll think of everything, everything.

there are breakdowns in which the sensitivity is super high, such patients have a 98% chance of fully recovering and returning to normal life, yes, that is, and how do you know, how do you determine where it occurred mandatory mandatory analysis at the start is a genetic examination and tumor cells in this case and it consists of several methods, yes there are simple methods, we are now going a little roundabout, this is chromosome staining, what is called: standard cytogenetics, yes, when the cells are fixed, the chromosomes are stained with a special dye, the doctor looks at them under a microscope and says that, for example, chromosome number 12 exchanged a piece with chromosome 21 and there was formed

such a chimeric gene that controls cell division, here are lycosis with rearrangement 12-21, they are supersensitive. to - chemotherapy, they are very easy, this is a good option, yes, and if, for example, uh, in the genome tumor cell, again at the level of chromosome analysis yet, we have not yet reached the reading of letters, but at the chromosome level we see that there are not 46 chromosomes in the cell, but 39, well, this is specifically in cancer cells, yes, because in all other cells of the child's body everything is like in people, yes, in a cancer cell, for example, not 46, but 39, there is a loss of chromosomes. this is called hypoploidy, yes, that is, there are fewer chromosomes than there should be, such leukemias are incredibly difficult to cure with conventional chemotherapy, almost all such patients need to do bone marrow transplant, but we live in the era of so-called targeted therapy, when not immediately for all variants, but

gradually drugs appear that act on a specific protein formed as a result of such a chromosomal rearrangement, and in order to give such a drug we must... know exactly whether the patient has this breakdown or not. there are famous examples, the so-called philadelphia chromosome, a rearrangement at the chromosome level is called 9.22, the ninth and twenty-second chromosomes exchange pieces, a chimeric gene, the so-called bcrable, that is , a gene that connects two normal proteins in a pathological way, they begin to give the cell a signal so that it divides well, and dies.

just, well, in a sense, just look, this does not exhaust all the diversity, hematological diseases of children there are a lot of so-called single-nucleotide polymorphisms, yes or, well , if you want, point mutations, where one letter or several letters are replaced, this is what yes, several nucleotides, that is, letters in this genetic code, and such a replacement can be no less effective for...

and scientists together identify the causes of diseases, then, probably, articles are published and you can read it, and after reading this article, you simply take it on faith or begin to introduce a new analysis, and, relatively speaking, a child who came to you, you must analyze him, if the nature of the disease is unknown, it must be established in order to prescribe the correct treatment, you simply must look at all possible candidates for points in dna and say that here it is all good or or or not. and there is, but the task is divided into still searching in known places, it is relatively simple,

technically, it is a rather complicated procedure, but when you know where to look and what you are looking for, it is a relatively clear task, and a much more complicated story with the search for something new, yes, something that has not yet been described in the literature, has not been proven, because when we can certainly find some kind of a bug that looks like a typo in the genetic code, but ... it is necessary to prove that this typo really affects behavior cells, this is much more difficult to do, and this needs to be done quickly, this is a disease that is developing rapidly, it needs to be caught right now, an urgent decision needs to be made based on gene analysis, you know, i would say the sooner the better, but the starting days, when the patient is just starting treatment, they basically follow a fairly standard scheme, where this molecular information is not used... but there are at least a few diseases where it is critically important, but there is one form

leukemia, which is called acute promelacic leukemia, it has a feature, at the very beginning of the disease, tumor cells secrete substances that unbalance the blood clotting system, and such patients during the first days from the onset of the disease from diagnosis, have a huge risk of dying from bleeding or from thrombosis. at one time, somewhere in the mid -eighties in china, it was discovered that a very simple substance, an analogue of vitamin a, oltransretinoic acid, these cells actually, well, block this the peculiarity makes them turn into normal cells, but in order to prescribe this analogue of the vitamin, which exists in the form of tablets, you need to know for sure that this is the same promelacitis lycosis, yes, that is , there is a situation and i think there will be more such situations. over time, there will be more when there is a drug that should be prescribed only to a patient with a specific molecular breakdown, then

the patient's life generally depends on how quickly you find this breakdown, but for most patients this is not the case yet, for most patients this information is needed somewhere in 2-3 weeks from the start of treatment, because it greatly influences the choice of the second stage and in general further genetic tests allow you to find the desired answer in 2-3 weeks. as a rule , a whole set of different tests is needed, there is no single test yet that would answer all the questions, there is such a concept as validation, but it is very boring, when you do not just have to show that there is a test that finds some kind of breakdown, you also have to prove that this finding will affect your chance of curing the patient there, and it takes years, and for some very rare disorders, we have one of the big problems that is just now uh... beginning to be realized, is that the whole system of drug development there, the whole

system of funding, it comes from this basic hypothesis that patients with one disease name, for example, with acute leukemia, they are more or less the same, then you can establish on a large mass of patients whether a certain treatment works or does not work, and now imagine that you are not a thousand patients with one disease, but a thousand patients, each of whom in some sense has his own disease, that his own genetic change, then in general it is completely incomprehensible, and how to prove the effectiveness of some medicine, if you cannot even collect.

it kills diseased cells, but we need such medicines that will not damage normal problems of chemotherapy, well, here are your children, i was there, many children without hair, well, that is, this is all so serious, current chemotherapy, well, loss hair is psychologically important, but of course it is not the worst thing that can happen to a person, i can, i can testify, of course, about this, but the problem is that the chemotherapy that is used today, it is not very selective, it damages tumor cells more, but it affects ...

well, just a kilogram of makeup on the face - this is not about our women. montevide, rent for local residents is quite expensive, but there is an option when you can live even for free. if we see that a person is normal, neat, tidy, just he is having financial problems now, we accept him and settle him in one of the rooms.

the favorite dish of the ruguayans is meat-siege. usually we eat this dish with bread, vegetables, sauce paint. this will be described by the term second tumor, a break in dna, like a new such transforming event, rather in medicine in exceptional cases what you just described the situation when it happened again

happens, this is the same, if if the tumor itself is a rare event, probably like a shell falling on one thief. this is very rare event, and it is precisely in people who develop a second tumor, in them we find with a high probability the so -called predisposition syndrome, yes, that is, they have some basic defect, which, well, if you like, affects the stability of dna, a basic genetic defect, yes, a basic genetic defect, hereditary, which affects the stability of dna, then they can have this second event, that is, a second tumor can develop a second time, it’s just that people who develop tumors more often in general, yes, absolutely right, but in... patients, a relapse is not a repeated transformation, not a repeated formation of a tumor, it is rather like several cells from the original tumor survived the treatment, hid, were in a dormant state, sometimes for many years, then woke up and again about the tumor, but in your case, in the case of hematology, we are not talking about some piece, they can,

they can form a tumor in the classical sense, yes, that is, they can. it can be everywhere, but it can be in one place, it could be a tumor of some lymph node, but most often with tumors of the hematopoietic system, yes, it is common in the blood, in the bone marrow, in the lymph nodes, and how to find out about the predisposition, then i understand that this is a smaller part of all tumors, this is to find out about the predisposition, well, there are two, if you like , ways, the first is precedent, yes, that is , if there are... tumors in the family, which in general tumors, this is not such a rare thing, yes, it seems to us that cancer is something, well, this is not very common, in fact, what is called risk, yes, that is. the risk of getting a tumor during a person's lifetime is about 25%, yes, that is, after all, for babies, for children, well, i mean the total risk of a tumor, the peak for a tumor in adults is

somewhere around 65 years old, 65-70, if a doctor meets with a patient who developed a tumor at an early age, for example, a tumor before 40 years old is rare, or if a doctor meets with a family. during a medical examination, yes, that is, in fact, that is, you give your sample, you give a blood sample, a study of the type is performed

whole genome sequencing or whole exome sequencing, some genetic variants are found that affect medical risks, including oncology, what to do then, if the risk, if someone finds out that he has an increased risk, this does not mean that he has a tumor , but that's it. in general , your attending knows the situation in life, but you don't know, this is possible, yes, this is possible, but if the patient finds out about it, this is certainly, well, how would it be

, this is, if you like, a completely new humanity, yes, when he is healthy at that the moment he found out, he absolutely put a tick: i don’t want, that is, the doctor is healthy, maybe, yes, but when such a curtain of the future opens a little in front of a person, and in some sense he gets the opportunity to find out something. and maybe influence something, here’s the bad news, unfortunately, he doesn’t find out anything pleasant, he doesn’t know anything pleasant, but firstly, there are attempts to create such surveillance programs, yes, when for many tumors it makes sense to diagnose them as early as possible and catch some tumors at the stage when they can be simply surgically removed, but there is a classic situation that is widely known, for example, intestinal polyposis, yes, now it concerns not children, but adults, and if such microtumors are removed at the polyp stage, then the tumor does not form, but if you let it

develop calmly for a couple of decades, then the tumor is already at the carcinoma stage, invasive cancer is much more difficult to treat and the predisposition to this kind of tumor can be determined simply genetically, genetically, and a program can be drawn up observations in such a way that, well, to prevent the development of a tumor is a separate topic, and people are trying to develop regimens for such preventive therapy with the help of drugs that affect the mechanisms, yes, of the development of these tumors, but most often today, of course, we are talking about some kind of examination program, for example, to do a comanoscopy not once in a lifetime at 50 years old, but every 2 years, for example, in our country we have this, you are talking about this now as something in principle or this. approaches are certainly being formed, i am not ready to say how universally accessible they are, well, so far such a large-scale

genetic examination of citizens does not take place, so probably here because in general probably in the district clinic, well, doctors do not know, probably and should not know much about genetics, well, i would like them to know more, at least i would like these methods to be as much as possible... in the nineteenth year, until the thirtieth year , a program for the development of genetic technologies is in effect, i understand that the medical part is quite significant, and this is good news, and tell me, please, what percentage... of

the children who come to you with these genetic defects, how many of them then go on to a normal and full life, let's put it this way, in general it is considered that the probability of a cure, yes, that is , a return to normal life without subsequent relapse in pediatric oncology is approximately 75-80%, is this a lot or a little, well, if you look at it historically, it is a lot, because... 50 years ago it was zero, that is , there is some progress here, there is certainly progress, it is happening and i think that over these 20 years we have added about 10-15% to this general probability of development, in particular , genetic diagnostic technologies, due to a deeper understanding of the biology of these tumors, including due to genetic diagnostics, and of course due to the improvement of treatment, it is developing very strongly due to the availability

of this treatment, but here, you know, this figure, unfortunately, is deceitful, because, as i already said, these are many different diseases, these 70% or 80% of cure are made up of patients who have a 99% probability will be cured, unfortunately, there are a number of tumors or variants, for example, lycosis, where the probability is still less than 20%, or some gleoglossoma, where it is rather 0%, yes. that is, unfortunately, when we boast about successes like that, we must understand that well, this is a population observation, yes, it may not mean anything for a specific person, but in general, if, nevertheless, if the percentage of cure increases, as you said, in a circle over the years, here due to the interaction of doctors, of course, apparently the families of patients, philanthropists and scientists, then it is still, that is, it seems that there is some light at the end of the tunnel, but at least a small, well, frankly speaking, in... in

our profession, without seeing this light, it would be, it seems to me, very difficult to live and work, because the number of failures that a doctor in this area is forced to face during his professional life, it greatly exceeds the capabilities of a normal psyche, it seems to me, on such a coexistence with failures, but only some vision of this light at the end of the tunnel the feeling that you are moving in in the right direction, it allows you not to give up all this. thank you, mikhail, good luck to you and, of course, to your patients. thank you, konstantin. hello, dear viewers, you

are watching the podcast lab. triggers on the first channel with you its host tatyana krasnovskaya psychologist psychotherapist sergey nasebyan, our guest today is alexandra, hello, hello, alexandra, tell me what 's wrong with you, i buy everything, a good start, so, i buy everything, everything that is possible, everything that is not possible, in any situation, bad, i go for new underwear, ok i go for a new bracelet, boringly i open some marketplace, that soon all the things will simply evict me from the house, that is, they need a separate house for us to exist together, does this bother you or does it already bother your loved ones, is that where the problem begins? this has always bothered my loved ones, i have always been like this, that is , if my mother and i buy, for example, in childhood one down jacket, or someone buys one

down jacket. then i need three, i need them to be like mine, like masha's, like katya's, like sisters and also like olga dmitrievna has some conditional, i need everything, the problem is that i need everything, well , it's great that your parents had such an opportunity, and what's wrong, well, great, but probably, instead of the fifteenth cream, i would like to buy at least a second apartment, that is , to feel that this is unreasonable, i understand that this is unreasonable, and i feel like an absolute fool when i start to bathe the same, identical things in a circle, that is, 15 gray jeans, conditionally, there are three identical skirts, the point is not that i simply don't have these things, i have a basic wardrobe as such, it's collected, i start taking - philip kirkorov's concert clothes, which i will never wear, they will forever hang there with

a label, well, maybe... then it doesn't bring any pleasure, than just a new thing appears, which i do you do? i'm doing smm now, before that i was married, i didn't work in my education, i'm a lawyer, when we were married, we also bought everything, yes, at what age did it start, you say from childhood, i it was always like that, yes, well, that is, it was during the period of toys and... the period there , when i lived with my parents, when i lived alone, when i then lived there with my husband, it was always like that and my husband once told me, how much can you do, was there ever such

a short period, maybe when you didn’t buy, no, never at all, not even once a day like that, okay, you go somewhere on vacation, there is such a trip, less often now, but there was, let’s say, you went somewhere on vacation. yes, do you buy there too? yes, i buy a suitcase to bring what me, what do you buy there? well, let's say, i used to bring from abroad, some cheeses, wine, olives, even food, and cosmetics, i really love different cosmetics, things, clothes, shoes, in principle, well , it's not that important to me, but have you ever been to any countries or places where everything that is sold there, you definitely wo n't need, well, for example, in cairo, no, i haven't been, i haven't been. yeah, yeah, well, i'm just wondering what you brought from cairo, and what do you feel in general when that thing, which you so desperately wanted, becomes yours, seven-minute joy,

that's why i possess it, look, you possess it after that, but there is no joy from possession, so having received it, you get some joy, yeah, yeah, let's see, what was the last thing you bought, today, yesterday, a bag, yesterday everything. yesterday, yesterday, yeah, we were sitting at home, bought a bag or went to the store, bought a bag, and i saw it, where on the internet, yeah, yeah, i saw it, i realized that i needed one, i waited for it for 2 weeks, that is, it's not just like that, i went and bought it, it wasn't available, i was waiting for it, i went and bought it, yesterday you went and bought it, today i'm with it, today you came with it, okay, but tell me, at that

moment how... tell me, you, this, this is rationalization, what emotion arose when you saw it? well, i liked it, it was beautiful, it seemed to me that it was comfortable, i understand that you liked it, i like you too, but that doesn't mean that we 'll go from here to my home, no, you understand, and i like you, but somehow i'll survive this, but you might not, well, i 'm not sold yet, but let's see, you liked the bag, but besides the fact that you liked it, there's some other emotion there, which, you know, it looks like maybe some kind of hole that needs to be closed, this bag will definitely close that hole, it seems as if, i actually thought that it was because, well , like, i have a desire, it's

wrong to say, like everyone else, to be better than everyone else, probably, when i, well, that is , buy everything, everything i can, i feel as if i were better than i actually am, yeah. maybe that's possible, well that is, it turns out that without this bag i'm somehow different, not better than everyone else, well like everyone has one and i need one too, well wait, clearly not everyone has a bag, not everyone, it's either with some friend you saw it with, i don't know, with some actress you saw it with, or in an advertisement with some girl you saw it with, well yeah, but the lack of this bag makes you what, yeah. i don't know, makes me without a bag, you without bags, what kind, sasha, not fashionable, probably not stylish, that is, it seems like you are lagging behind, yeah, yeah, probably good, in this lagging behind, what kind of feeling, what kind of emotions,

sadness, unhappiness is possible, that is , it seems to me that if i buy something, maybe it will make me happy, of course, but now i am more interested in this feeling, parents, i am an only child, that is, they loved me very much, they waited for me, i am always there, even if we look at my childhood photos, we have, i can show you after the program, there we are, we are sitting in the kindergarten, all children are like children, i have socks with frills, that means glasses on a chain, grandma attached a bow, then grandma sewed some kind of sweater with flowers, and i was always such a favorite , i aroused admiration in everyone, so it seems to me that this is possible for me. created in

you this feeling that if you are the most beautifully dressed, dressed up, there, dressed up, i don’t know and so on, yes, then at that moment you are in the center of this attention, and moreover, look how well you describe the photograph, all children are like children, and i am there in little buns and bows, yeah. parental family i grew up, i don’t remember my dad well, because my dad didn’t become, i was in the fifth grade, at that time my parents were already divorced, well , that is, we communicated, my mother, and such a very calm person, she never instilled in me there, well, i just, among other things, i encountered different situations in life, i see how my friends behave in relation to their ex-husbands, and communication with children, i didn’t have that.

with my mother, how did this happen? well, i spent less time with my dad, of course, most

often on weekends, because i had my school life is busy, that is , even, probably, my mother tried to implement some things that she probably did not have, because in my childhood i was never refused anything, when i asked, that is, at my school i studied from eight there , say, until 3-4, or at five, we had a lesson format and then. there was an after-school program, after which i attended a music school, dance, gymnastics, i don’t remember half of where i went, i just came and said, mommy, i want, my mother said to me, please, there to daddy, i came and said, daddy, i want, he says, go, and dad, when they divorced, did he start his own family, no, he didn’t, that is, you remained the only child for dad, yes, yes, but at the same time, when you...

spending time together, i don’t remember, can i ask why they divorced? yes, you can, it was, it was the nineties, such a rather difficult time, my dad worked in a hospital, he worked in gynecology, in dentistry, then there were questions, well, how did everyone relax in the nineties, god willing, well, or not so much, mom was not happy with such a life, and mom wanted safety. mostly for me and for herself, well considering i'm from

a gangster city, yeah, from vladivostok, it's so specific, mom wanted a quiet life, you were close to death, yes, several times, i lived in a cruel, difficult and wonderful time, and despite everything, the best moments of my life are connected with work in intelligence, we burn everything behind us, you and i will cope, because i worked for the good of the motherland, fulfilling my duty, the duty of a patriot of russia. dmitry bystroletov, an outstanding illegal intelligence officer, an unrivaled master of recruitment, a courageous man who did not break under the blows of fate. in the camps, i quickly stopped identifying my executioners with my homeland. there were periods in russian history when the only place for a decent russian was in prison, so even in the camps i was in my place. sometimes your strength is exhausted, the meaning of what is happening becomes completely illusory. what becomes your support? love? we are

together again. i believe that i have lived a good life and am ready to live it in exactly the same way again time. intelligence, genius of transformation, recruiter on saturday on the first. volleyball, as you have not seen it yet? the channel one cup, live broadcasts from

august 17 and 18 on the first. you are watching the podcast triggers with you. and its host tatyana krasnovskaya and sergey, we are talking with sasha, who is our guest today, and we are discussing the problems of chapagalism. where is mom now, in vladivostok? yeah, how is your relationship with your mom? excellent, wonderful, well, how is it, after all, there is a 5-hour time difference there, we communicate with mom through instant messengers, i communicate with my mother via video calls, by phone, we text each other, and did you have a close relationship with your mother? in what sense were you close? such a warm relationship, where you are with each other, where you trust each other, not really a teenager now, yes, in childhood? in childhood, i don’t really remember my mother either, actually, because my mother worked a lot, i remember how my mother took me to school and how my mother picked me up from school, well, that is, as such

, we didn’t spend time together, we began to spend this time, probably, i was already in class in sixth, seventh, eighth when... that is, although everyone always teased me that i was a favorite child, very much loved, my grandmother, grandfather looked after me, i have a wonderful family, i have cousins ​​there , we all had a great, great time, but i also, i don’t remember my dad well, and i don’t remember my mother well, that’s the thing, that you

talk about your life in such a way that in essence you tell, you talk about how all these negative things were leveled out. your story, then mom and dad got divorced, like yes, they could communicate normally, and your mother never set you against your father, but that doesn’t mean at all that you didn’t suffer from the fact that they don’t live together, of course, but at the same time, as if everything.