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Introduction. An increasing number of patients of reproductive age get cancer and are highly interested in preserving fertility. Survival rates for cancer patients are improving. Methods of reproductive technologies are being improved to preserve the ability to bear children. Rehabilitation aimed to ensure a satisfactory quality of life takes on a new meaning, and with the development of new technologies, the level of possible assistance also changes. Today, rehabilitation measures for cancer patients of reproductive age should undoubtedly include all possible ways to preserve and restore fertility. Aim: preservation of fertility in patients with ovarian tumors. Material and Methods. After ovariectomy, the ovaries were transported to the embryology laboratory, where oocyte-cumulus complexes were extracted and subsequently matured using the OTO-IVM (ovarian tissue oocyte in vitro maturation) method. The resulting mature oocytes (Metaphase II) were cryopreserved by vitrification or, if a partner was available, fertilized by ICSI (intracytoplasmic sperm injection), the embryos were cultured to the blastocyst stage and also cryopreserved by vitrification. Cryopreserved oocytes and embryos can be used by patients after cancer treatment in assisted reproductive technology programs. Results. A total of 218 OCCs were recovered, 29.8 % were degraded oocytes (n=65). The proportion of OCC suitable for ripening was 153 (70.2 %). After 36 or 48 hours, 65 oocytes matured in 13 patients, which amounted to 42.5 % of oocytes without signs of degradation. In 11 patients the OCC was removed from the tumor-affected ovary. 149 oocytes were obtained, of which 50 (33.6 %) were oocytes with signs of degradation. The remaining 99 (66.4 %) of OCCs had satisfactory quality; after maturation, the Metaphase II stage reached in 49 (49.5 %) of oocytes. As a result, biological material was cryopreserved in 13 of 15 patients: 5 embryos and 60 oocytes.

Aim of study To evaluate the safety and efficacy of percutaneous transhepatic cholangiostomy (PTC) as a first-line intervention in the treatment of patients with acute cholangitis (AC) Grade II–III (TG 13/18).Material and methods The results of treatment of 42 patients with AC Grade II–III, who underwent PTC, were analyzed. The criteria for non-inclusion were the presence in patients of destructive cholecystitis and (or) acute pancreatitis, AC due to proximal block of the bile ducts, regardless of etiology, as well as the presence of cholangiogenic liver abscesses. Literature data were used as reference results of the use of endoscopic techniques. AC was diagnosed and its severity was determined in accordance with the diagnostic criteria TG 13/18. The control points of the study were the frequency of post-manipulation complications associated with PTC, as well as the immediate efficacy of cholangiostomy, assessed by the dynamics of Grade-status within 24 and 48 hours.Results In all 42 patients, PTC was technically successful. Major complications that might require a change in treatment tactics (significant hemobilia, bile peritonitis, bleeding into the abdominal cavity) were not observed. Two complications occurred: subcapsular hematoma (2.4%) and right-sided pleurisy (2.4%). When assessing the dynamics of Grade status, its significant decrease was found in the group of patients with initial Grade III after 24 hours (from 16 to 9 hours) and 48 hours (from 9 to 4 hours). In patients with initial Grade II status, in three cases it worsened to Grade III, which still persisted in one patient even in 48 hours. There was no in-hospital mortality in the examined patients.Conclusion Antegrade endobiliary intervention for acute cholangitis involves performing real-time monitored biliary decompression. Experience with the use of percutaneous interventions does not confirm the high risk and frequency of post-manipulation complications in comparison with endoscopic retrogradeprocedures. It seems obvious that there is a need for and the possibility of choosing both retrograde and antegrade methods of emergency biliary decompression in the arsenal of treatment for patients with acute cholangitis.

Background. More than 80 % of cases ovarian cancer are detected at stage III–IV. One of the most important predictive factors is the cytoreductive surgery without residual tumor. Aim. To determine the selection criteria for cytoreductive surgery in the advanced ovarian cancer patients. Materials and methods. The study included 190 primary IIB–IV stage ovarian cancer patients who underwent surgical treatment in the oncogynecological department of the N. N. Petrov NMRC on Oncology in the period from August 2017 to August 2020. All patients underwent pelvic magnetic resonance imaging, chest and abdominal computed tomography, and diagnostic laparoscopy. Assessment of the peritoneal carcinomatosis index (PCI) was performed according to P. Sugarbaker. The outcome of cytoreductive surgery was determined by the size of the residual tumor: complete – without a macroscopically detectable tumor, optimal – residual tumor ≤1 cm, suboptimal – residual tumor ≥1 cm. Results. The complete or optimal cytoreduction achieved in 72.6 % of cases (48.9 % (93 / 190) and 23.7 % (45 / 190), respectively), suboptimal in 22 % (42 / 190) of cases, 5 % (10 / 190) only a diagnostic laparoscopy due to the initial underestimation of the tumor dissemination. In the entire sample PCI value ranged from 0 to 35 points, the median was 4 points (2; 11). In the group of optimal cytoreductions PCI ranged from 0 to 19 points, median – 3 points (2; 6), in the group of suboptimal from 5 to 35 points, median – 19.5 points (15; 23) (p < 0.0001, Mann–Whitney test). No optimal cytoreduction was performed in PCI >20 points. The optimal cut-off PCI point was 9.5 points (sensitivity 92.1 %, specificity 86.2 %, overall accuracy 87.4 %), if PCI ≤ 9 points – the operation will be hypothetically optimal, if PCI ≥ 10 then hypothetically suboptimal. The main cause of non-optimal interventions (n = 52) were: diffuse carcinomatosis of the small bowel and its mesentery – 73 % (38 / 52), carcinomatosis of the hepatoduodenal zone – 9 % (5 / 52) and a total of 16 % (9 / 52) were other non-resectable tumors (paraaortal, intrathoracic lymph nodes, invasion of the pancreas or pleura, lung metastases). Radiation diagnostic and intraoperative revision were comparable in 60.5 % (115 / 190) of cases. The sensitivity of radiological diagnostic methods in detecting of the small intestine lesions was 23.7 %, the specificity was 90 %, while for laparoscopic diagnostics, the sensitivity in detecting of the small intestine lesions was 93.3 %, and the specificity was 100 %. In assessing of carcinomatosis of the hepatoduodenal zone, the advantage belongs to radiation diagnostic methods: the sensitivity of computed tomography was 66.7 %, the specificity was 97 %, while the sensitivity of diagnostic laparoscopy was 0 %. Conclusions. Determination of a high score in assessing the index of peritoneal carcinomatosis, detection of damage to the hepatoduodenal zone, diagnosed mainly by radiation imaging methods, detection of diffuse lesions of the small intestine, determined mainly by laparoscopic diagnosis reduces the frequency of suboptimal cytoreductive operations from 67 % to 13 %.

Human mesenchimal stem cells (MSC) growth dynamics, immunophenotype change, genetic stability on early (3—4) and late (10—12) passages at in vitro culturing was studied. Results of bone marrow stromal fibroblasts culturing (n=25) from allogeneic transplant recipients with hematological disorders are presented. It has been shown, that in MSC population cultivated in vitro linear homogeneity of cells is observed on 3—4 passage, and remains on 10—12 passage. Clonal heterogeneities of MSC population and selective advantage of certain clones during culturing was revealed as aneuploidy analysis results of cultivated cells. The MSC culturing protocol used in our work allows receiving well characterized MSC number sufficient for clinical application as early as 3—4 passage. While using in the therapeutic purposes MSC later terms of expansion it is necessary to have close control of cells immunophenotype and genetic stability, which will allow avoiding in the future the undesirable long-term consequences of MSC cultures clinical use. The obtained data are discussed and compared with literature data.

Mesenchymal stem cells (MSC) have been widely used in different areas of medicine because of their immunosupressive properties and influence on regeneration of the damaged tissues. The improvement of MSC expansion standard protocols allowing receiving necessary MSC amount with the ability of self-renewal and multilineage differentiation potential for clinical application is required. The present article summarizes the current experience concerning uses of various culture mediums and supplements for the ex vivo MSC expansion. The author's experience of ex vivo MSC expansion using both standard medium DMEM with the supplementation of fetal bovine serum (FBS) and serum-free medium MesenCult MSC Basal Medium (Human) (StemCell technologies Inc.) with addition Mesenchymal Stem Cell Stimulatory Supplements (Human) is presented. The influence of medium type on MSC growth and immunophenotype is analyzed.

Cord blood cell composition is a short-lasting delivery stress consequence and is similar on adult G-CSF-mobilized peripheral blood.G-CSF realizes biological effect by number of secondary messengers, many of which are also natural effectors of stress. In this research comparative characteristics of cell composition, including lymphocytes subpopulations, CD34+ and CD133+ cells, hematopoietic progenitor cells colony-forming activity and mobilizing cytokines concentration (IL-8, MMP-2, MMP-9), between term newborns cord blood and G-CSF-mobilized peripheral blood is shown.Mobilized cytokines concentration ratio in combination with CD34+ cells count in cord blood and mobilized peripheral blood suggests that delivery stress possibly is not single cause of cord blood features.

IM OF STUDY To show the possibilities of antegrade X-ray surgical techniques in the treatment of iatrogenic bile duct injuries after videolaparoscopic cholecystectomy.MATERIAL AND METHODS The study included 24 patients with “minor” and 20 patients with “major” (according to Strasberg) iatrogenic injuries of the extrahepatic biliary tract. Antegrade endobiliary intervention was performed in 26 patients, including the “bridge-procedure” variant preceding the reconstructive surgery. Endobiliary drains were maintained during the reconstructive surgery and in the early postoperative period to control the viability of the anastomosis.When a stricture of the biliodigestive anastomosis (BDA) was detected, balloon dilatation of the anastomotic area was performed. In the subgroup of “minor” injuries, external drainage of the subhepatic biloma in 18 people were supplemented with endoscopic papillotomy in 12 cases.RESULTS In all patients with “minor” injuries of the biliary tree, X-ray surgical techniques were effective. In 11 patients with “major” bile duct injuries, cholangiostomy drainage was gradually transformed into external-internal drainage. In 2 trauma cases of classes D and E temporary antegrade stenting of the duct injury area with a coated self-expanding endobiliary stent was performed. The follow-up period after removal of the antegrade frame drainage ranged from 8 months to 14 years. There were no stricture or failure of BDA.CONCLUSION Short-term external biliary drainage, including the use of rendezvous techniques, may be suffi cient to eliminate the failure of the cystic duct stump. Cholangiostomy drainage, temporary endobiliary stent allow preparing the patient for reconstructive intervention. Drainage marking of the damaged area facilitates the verifi cation of tubular structures in the reconstruction area. Preservation of drainage after reconstructive intervention is the prevention of failure of the biliodigestive anastomosis in the early postoperative period, the development of its stricture in the long term.

The aim of this study is to develop the technology of dry extracts from the roots of Morinda citrifolia as a prospective phyto-active pharmaceutical ingredient (API) for obtaining medicinal products. Factors influencing the extraction process of active ingredients from the roots of Morinda citrifolia were investigated. The modes of extraction were formulated: extraction time of 60 minutes, the hydro-module was established to be 1:30, the extractant - 70% ethyl alcohol. The study developed a technological process of obtaining dry extracts.The technological scheme of production of dry extracts was proffered. The parameters of standardization of the dry extract of Morinda citrifolia roots were established.

Introduction. A number of paraproteinemic polyneuropathy is directly linked to the monoclonal gammapathy of undetermined significance (MGUS). One of the first manifestations of MGUS in addition to the secretion of monoclonal immunoglobulin, and long before the manifestation of malignancy is polyneuropathy.Materials and Methods. Were examined in 16 patients with polyneuropathy associated with MGUS in age from 53 to 78 years. Patients underwent a course of infusion therapy with human immunoglobulin in the dose of 0.4 g/kg for 5 days.Results. After treatment revealed a reduction of the manifestations of the sensory component of the neuropathy, neuropathic pain and sensitive ataxia that was confirmed by electromyographic data of stabilography, and a rating on a scale Lovett, the scale of neuropathy disability score, the questionnaire «Pain detect». The motor component of polyneuropathy had more persistent symptoms.Conclusion. Treatment with human immunoglobulin is effective in reduction of neuropathic pain and sensory ataxia and in increase of superficial and deep sensation, while the motor component of polyneuropathy had more persistent symptoms.

The article considers the type of a hero from the heroic legends of the Evenk But clan. The heroic legend of the But clan is an archaic epos, the epos of the tribal community which is shown in plots and images of the epic narrators. The legends of the Evenk clan But have high-quality records and are voluminous in content. During the study, the author reveals the features reflecting the material and spiritual culture of the Evenks, which manifest themselves in military-hunting equipment, housing, and heroes’ clothing. By analyzing images of heroes of the But clan, the author highlights the features that reflect the Evenk ethnic culture. The author describes hero’s dwelling, typical to the ancient population of Siberia, describes his clothing (dressed appropriately for the conditions of the nomadic lifestyle of the Evenks; military and hunting gear) and his methods of hunting. The author concludes that the legens of the Evenk clan But describe a typical type of an Evenk epic hero, i.e., “evenki-beye”, “uryangkay-Evenks”. The type of a hero from the heroic legends of the But clan reflects the material and spiritual culture of the Evenks, which manifest themselves in military-hunting equipment, housing, and heroes’ clothing and deeds. For example, the clothing of the hero - mukuke is determined by the conditions of the nomadic way of life of the Evenks (the type of hunting on foot); the hero hunts using the most ancient Evenk way of hunting - by the way of rut, etc. The aim of this work is in the description, identifying the type of the Evenk warrior in the heroic legends of the But clan.

Monoclonal gammopathy of undetermined significance represents a number of conditions, the development of which is based on functional impairment of B-lymphocytes, which results in permanent pathological secretion of a single clone of immunoglobulins or their constituent chains. One of the leading and often the only clinical manifestation of monoclonal gammopathy is peripheral neuropathy associated with paraproteinemia. The article presents a clinical case of severe peripheral neuropathy associated with monoclonal gammopathy of undetermined significance. The diagnosis was confirmed on the basis of a comprehensive diagnosis, including screening paraproteinemic proteins in serum and a single urine sample is a method of immunofixation. Polyneuropathy was treated by using intravenous human immunoglobulin, as well as non-drug methods of rehabilitation (local cryotherapy, physical therapy and stabilometry). The therapy made a positive effect in reducing the symptoms, primarily the sensory and neuropathic components and polyneuropathy.

OBJECIVE. The authors would like to design an original device for aerosol laparoscopic chemotherapy and propose the most effective and safe mode. MATERIALS AND METHODS. The experimental and clinical studies were carried out and included 6 series. Male rabbits (n=71) were used for experimental part and the method was applied on 4 patients in clinical part. RESULTS. The original device and the effective mode of its application were developed for aerosol laparoscopic chemotherapy. The supposed method of chemotherapy appeared to be more effective than the standard method. There weren’t noted any complications or side effects. The method proved its safety. CONCLUSIONS. The aerosol laparoscopic intraperitoneal chemotherapy using the proposed regime is the effective and safe method of peritoneal carcinomatosis treatment.

Nowadays, treatment of paraproteinemic polyneuropathy is a fairly complex interdisciplinary process. The main method of therapy is still the use of chemotherapeutic drugs as means of pathogenetic treatment of the underlying disease. However, the use of chemotherapy with neurotoxicity can cause development of toxic polyneuropathy which increases neurological deficit. Any comprehensive neurorehabilitation program for patients with these forms of polyneuropathies have not been developed to date. The article presents data of clinical observations of 26 patients with paraproteinemic polyneuropathy which had undergone a course of neurorehabilitation treatment, both medical and nondrug technologies, including the methods of kinesiotherapy and physiotherapy.

Objective: to improve the results of preoperative diagnosis of Mirizzi syndrome.Material and methods. Under our supervision for 2006–2015 we had 23 patients with the Mirizzi syndrome. Verification of cholecystolithiasis, condition of gallbladder’s wall and biliary tract dilatation degree was evaluated sonographically. Biliary decompression was realised by percutaneous transhepatic cholangiostomy that was implemented under the combined ultrasonic and X-ray control by the Seldinger technique for self-locking pigtail drainages 8 F. As a method for direct visualization of the bile ducts was used antegrade cholangiography. Results. Preoperative diagnosis was verified in 18 (78.3%) patients, based on the results of ultrasound and data of antegrade cholangiography. In I type of Mirizzi syndrome (prefistule form) was revealed a combination of non-standard ultrasonic symptoms: if there were signs of "high" extrahepatic block of bile ducts (area of liver gate and confluence of hepatic ducts) there was recorded actual intravesical bile hypertension. Lack of lymphadenopathy near the choledoch and focal lesions of liver parenchyma in the goal area confirmed the benign character of the "high" bile ducts block. II type of Mirizzi syndrome (fistula form) was characterized by the presence of megacholelitiasis combined with a lack of intravesical bile hypertension. Antegrade cholangiography in combination with intra-ductal diagnostic catheters and manipulation wires and in some cases with cholecystography allowed to differentiate types of Mirizzi syndrome. In 5 cases Mirizzi syndrome was an intraoperative finding. Antegrade minimal-invasive access to the biliary tree was used in patients with high risk of surgery for subsequent X-ray interventions (lithotripsy, balloon dilatation of major duodenal papilla, dislocation of stones to the duodenum).Conclusions. Effective preoperative diagnosis of Mirizzi syndrome can be successful more than in half cases of the combined use of ultrasonography of the biliary tract and the results of antegrade dynamic cholangiography. That was carried out through percutaneous transhepatic cholangiostomy in conjunction with additional diagnostic intraluminal manipulations (wires and catheter inspection and palpation).

Purpose. To study the presence of carotenoids in the tissues of prenatal human eye in the course of its development. Material and methods. The eyes were obtained from abortive human fetuses of 12-28 weeks of pregnancy. The fetuses were brought to the Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, the Russian Academy of Medical Sciences, from licensed institutions of the Ministry of Public Health, working under the Russian Federation legislation on citizen health protection, and in accordance with the approved list of medical indications. The ages of the fetuses were determined by an obstetrician. Totally, 49 samples of eye tissues from human fetuses at different pregnancy ages were used. The content of carotenoids and their oxidized forms was measured by high-performance liquid chromatography (HPLC) technique. Results. The presence of lutein and/or its oxidized forms was estimated by HPLC in the tissues of prenatal human eyes (cornea, sclera, optic nerve, retinal pigment epithelium with choroid, ciliary body with iris, vitreous body). Conclusion. The finding of lutein or oxidized forms of lutein in tissues of the human eye in the course of prenatal development is of essential interests for understanding physiology of the prenatal and postnatal eye.

Purpose. To compare the composition of retinoids of lipofuscin granules (LG) isolated from retinal pigment epithelium (RPE) of human cadaver eyes and Japanese quail. Material and methods. The Japanese quail’s retina and retinal pigment epithelium were chosen as a model of laboratory aging simulation. The evaluation of the amount of quail’s RPE retinoids was done by measuring of the fluorescence spectra and HPLC-analysis of the chloroform- methanol extraction from PRE. Results and conclusions. It has been shown that the spectral characteristics and the relative content of retinoids in lipofuscin granules (LG) isolated from retinal pigment epithelium (RPE) of human cadaver eyes and Japanese quail was very resemblance. These results allowed to consider Japanese quail (Coturnix japonica) as a suitable and enough adequate model of rapid human aging retinal processes.

The goal of the present study was the development of composition analysis method for vision pigments chromophore groups of different animals with the use of high performance liquid chromatography as well as the development of synthetic method for all-E-3,4-didehydroretinal – one of standard compounds. The all-E-3,4- didehydroretinal synthetic route developed earlier has been polished, and the product structure has been confirmed by physical-chemical analysis methods. The chromatographic separation process of Z-isomers of natural retinal and 3,4-didehydroretinal has been studied under isocratic flow conditions with the use of one and two sequentially connected normal phase columns. Optimal chromatographic conditions have been proposed for the separation and analysis of both retinoid model mixtures and animal eye extracts.

This study presents the genetic polymorphism of HLA-antigens in acquired aplastic anemia (AAA) in 147 children (85 boys и 62 girls) aged 1 to 18 with. The control group is consisted of 1700 umbilical cord blood samples of healthy newborns. The genetic polymorphism of HLA was studied in groups of children with AAA, divided by gender and age. Our results revealed distinction in HLA-markers of predisposition and sustainability to AAA. Possible differences in factors of immunogenetic predisposition suggest different mechanisms involved in the development of the disease in different groups of children and reconsider the existing model of the pathogenesis of AAA.

Cord blood cell composition is a short-lasting delivery stress consequence and is similar on adult G-CSF-mobilized peripheral blood. G-SCF realizes biological effect by number of secondary messengers, many of which are also natural effectors of stress. In this research comparative characteristics of cell composition, including lymphocytes subpopulations, CD34+ and CD133+ cells, hematopoietic progenitor cells colony-forming activity and mobilizing cytokines concentration (IL-8, MMP-2, MMP-9), between term newborns cord blood and G-SCF-mobilized peripheral blood is shown. Mobilized cytokines concentration ratio in combination with CD34+ cells count in cord blood and mobilized peripheral blood suggests that delivery stress possibly is not single cause of cord blood features.

The hypoxia is the powerful stressful factor, and, presumably, should result not only in rising of erythrocytes counts for the compensatory purpose, but also in rising of other blood cells number, as consequence of mobilization in the answer stress. In article the influence assessment of pregnancy and delivery features, acute and chronic fetal hypoxia on cord blood cell composition of the full-term newborns is shown. Increase of leucocytes count at elongation of the second period of delivery, presence of chronic prenatal hypoxia or acute hypoxia in delivery is revealed. Differences of cord blood cell composition depending on newborn gender and body weight which consist in higher leucocytes count (all subpopulations including hematopoietic stem cells) at boys and at higher body weight are shown. Differences according to gender and to body weight are independent from each other. It is shown, that boys worse adapt for delivery that is expressed in higher concentration of mobilization cytokines and higher leucocytes and hemopoietic progenitors count in cord blood. It is shown, that mobilization cytokine concentration (IL-8, G-CSF, MMP-9) in cord blood of full-term newborns statistically significantly above, than in peripheral blood of healthy donors. Thus IL-8, G-CSF, MMP-9 concentration higher at boys in comparison with girls; at normal delivery in comparison with delivery by planned cesarean sections and at acute fetal hypoxia.