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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.