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Introduction. The gold standard of treatment for intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) is transurethral resection of the bladder (TURB) in combination with intravesical therapy. However, this procedure may cause serious complications. At the same time, studies of various lasers for the treatment of NMIBC have demonstrated their safety and efficacy. Despite this, the topic has not yet been fully explored and is not widely practiced in clinical oncology, making further research necessary.Objective. To compare thulium and holmium lasers with conventional TURB for management of non-muscle-invasive bladder cancer (NMIBC).Materials & methods. In our study, depending on the treatment approach, 84 NMIBC-patients were divided into three groups. Group 1 included 27 patients (34.14%), who underwent laser thulium bladder resection; group 2 included 25 patients (29.76%), who underwent laser holmium bladder resection, and group 3 included 32 patients (38.1%), who underwent standard TURB. Prior to surgery, all patients received a standard set of preoperative general clinical and instrumental examinations for bladder cancer, and the choice of surgical approach was based on informed patient consent, taking into account the benefits and risks of the three treatment options. All surgeries were performed in accordance with established protocols.Results. In the TURB group, the surgery time was the longest and totalled in 20.5 ± 7.4 min. Laser technologies reduce the surgery time to 16.3 ± 5.3 min for a holmium laser and to 14.7 ± 5.2 min for a thulium laser. Also, in groups 1 and 2, a shorter duration of postoperative bladder irrigation was noted (4.4 ± 1.8 and 4.7 ± 1.6 hours) and shorter periods of postoperative bladder catheterisation (1.5 ± 0.08 and 1.6 ± 0.08 days) compared to group 3, where these indicators were 16.4 ± 2.5 hours and 2.5 ± 0.13 days, respectively. Among patients undergoing either holmium or thulium surgery, a higher rate of disease-free survival has been noted. Independent prognostic factors that influence the prognosis of NMIBC in all groups include the type of surgery, history of bladder tumors, and pathological stage.Conclusion. The use of laser technology, such as thulium and holmium laser, in bladder wall resection for NMIBC shows promising results and provides a good clinical outcome that is comparable to (and in some cases, superior to) standard TURB.

Pelvic organ prolapse is a problem with no ideal solution. Unfortunately, there is still no unified opinion about etiopathogenesis of genital prolapses in general and cystocele in particular. The aim of the study is to increase the effectiveness of surgical treatment in patients with symptomatic cystocele, by double plication of the pubocervical fascia. Materials and methods. The study included 112 patients with symptomatic cystocele of grade II–IV according to POP-Q system, who underwent different variants of surgical treatment method: I – comparison group (n=60) – traditional anterior colporrhaphy; II – the main group (n=52) by the method of double plication of pubocervical fascia. The average age of the patients of the studied cohort was 53.2±9.6 years. The duration of follow-up after surgical treatment was 12 months. The frequency of intra- and postoperative complications, as well as anatomical (recurrence rate) and functional (levelling of cystocele symptoms) treatment results were evaluated. Study. Patients in the study cohort did not differ in age, anthropometric data, social status and clinical characteristics of the underlying disease (p≥0.05). Analysis of early postoperative complications, as well as anatomical and functional results of treatment demonstrated statistically significant advantages of surgical correction of cystocele by double plication of the pubocervical fascia, compared to traditional anterior colporrhaphy (p

Objective. Evaluate efficacy and safety of cavutilide (Refralon) for pharmacological cardioversion in patients with recurrent atrial fibrillation and flutter (AF/AFL), in 90days blanking period of catheter ablation.Materials and methods. included 56 patients: 46 patients with recurrent paroxysmal AF/AFL and 10 patients with recurrent persistent AF/AFL. In 45 patients (80.3%), sinus rhythm (SR) restoration was performed within 7 days from the moment of catheter ablation. Intraoperative confirmation of pulmonary vein (PV) isolation was noted in 85.7% cases (n=48). After excluding contraindications, cavutilide was administrated in the intensive care unit according to a 4-stage protocol (5 µg/kg – 5 µg/kg-10 µg/ kg – 10 µg/kg). Effectiveness of pharmacological cardioversion was assessed as the fact of restoring SR and the fact of preservation of SR 24 hours after cavutilide administration. Safety points – QT prolongation, ventricular arrhythmogenic effects, pauses and bradyarrhythmias.Results. The overall effectiveness of cavutilide among all included patients reached 98.2% (n=55), and preservation of SR 24 hours after cavutilide administration was observed in 94.5% (n=53) patients. All the patients with recurrent persistent AF/AFL successfully restored and maintained SR 24 hours after cavutilide administration 100% (n=10). In patients with recurrent paroxysmal AF/AFL restoration of SR observed in 97.8% (n=45) and preservation of SR after 24 hours – in 93.4% (n=43), respectively. The effectiveness of cavutilide did not depend on the results of the catheter ablation. Recurrences of AF/AFL after SR restoration were more common in patients without successful PV isolation. QT prolongation >500ms observed in 8.9% (n=5) of cases, including 1 case of self-terminating torsade de pointes, managed by MgSO4 infusion. Bradyarrhythmias that did not require urgent therapy were noted in 10.7% (n=6) of cases.Conclusion. Pharmacological cardioversion with Cavutilide (Refralon) is highly effective and safe method of SR restoration in patients with recurrent AF/AFL in 90days blanking period after catheter ablation.

Introduction. Despite modern advances in technologies for the treatment and prevention of varicose veins, there is currently no radical treatment for varicose veins. The probability of recurrence of dilated veins, according to various authors, ranges from 5 to 70%. Along with the well-established concept of recurrence of varicose veins, the term progression of varicose veins is increasingly common in everyday life.Aim. To study the current understanding of the term relapse and the practical attitude of specialists involved in the treatment of varicose veins to it.Material and methods. In 2023, a survey of 117 specialists on the recurrence/progression of varicose veins was conducted. The respondents were doctors involved in the treatment of varicose veins: vascular surgeons 22.4%, phlebologists 50%, general surgeons 19.8%, specialists in ultrasound/functional diagnostics 7.8%, X-ray endovascular surgeon 0.85%. The questionnaire included 18 questions regarding the frequency of visits of patients with relapse/progression of varicose veins; views on tactics, as well as the attitude of specialists to the issue of progression and recurrence of varicose veins in patients after its surgical treatment.Results and discussion. The concept of recurrence and progression of varicose veins among specialists dealing with this pathology is not always comparable. There are differences in views both on the predisposing factors for the recurrence of dilated veins, and, accordingly, on the tactics of treatment and preventive measures. In some cases, according to statistics, they are due to specialization.Conclusions. The incidence of relapse and progression at the reception of the respondents has a slight difference. Despite the fact that there are opinions that do not correspond to generally accepted and abhorrent collegiality, mostly specialists try to separate these concepts, see differences in provoking factors and, accordingly, in recommendations.

The issues of recurrencies in chronic rhinosinusitis with nasal polyps (CRSwNP) still remain unresolved. Therefore, detection patients with uncontrolled clinical course of CRSwNP is required.The aim of the present study was to assess cytokine profile in nasal polyps as well as clinical characteristics of patients with CRSwNP at varying levels of therapeutic control.The study included 99 patients with chronic rhinosinusitis. The contents of interferon IFNγ, interleukin IL- 1β, IL-4, IL-5, IL-13, tumor necrosis factor TNFα, transforming growth factors TGF-β1, TGF-β2, TGF-β3 were measured in polyp tissue samples by means of multiplex analysis. The patients were treated according to a stepwise СRSwNP therapeutic algorithm [9]. Following observation for 5 years, all patients were divided into groups, as based on medical control degree. Group 1 included patients with mild CRSwNP, who mainly received stage I and II treatment for the entire observation period. Group 2 was presented by moderate- severity CRSwNP, with stage II or III therapy according to the referred algorithm. Group 3 included the patients with severe CRSwNP who received one or more stage IV courses. The patients underwent repeated SNOT-22 questionnaire, endoscopic examination, clinical assessment. In case of bronchial asthma (BA), ACQ-7 was repeated. Initial cytokine profile of nasal polyps was analyzed by the mentioned clinical groups.Results:After 5 years of observations in group 1 (mild CRSwNP), we found a minimal decrease in quality of life (SNOT-22), severity of nasal congestion, or smell impairment. Bronchial asthma duration in these patients was significantly lower compared to group 3, the patients had better asthma control level. Cytokine profile of nasal polyps was characterized by the highest IL-4 concentration, average values IL-1β, TNFα, IFNγ and minimal TGF-β1 values.In group 2 (moderate CRSwNP), we noted more pronouced impairment of smell, nasal congestion and quality of life. Bronchial asthma was less controlled than in group 1. The maximal concentrations of IFNγ, IL-1β, TNFα, IL-5, TGF-β1, TGF-β2 were registered.In group 3 with poor CRSwNP control, the highest SNOT-22 scores, severity of difficulty in nasal breathing, impaired sense of smell were revealed. Duration of bronchial asthma was longer, with lowest levels of medical control. In nasal polyps, minimal levels of IFNγ, IL-1β, TNFα, IL-4, IL-5, TGF-β2, TGF-β3 were noted.Treatment of patients depending on the clinical phenotypes of CRSwNP in the presence/absence of allergic rhinitis or bronchial asthma may improve control and reduce incidence of relapses in CRSwNP.

Currently, there is an increase in the number of patients with nodular formations of the thyroid gland (TG), which requires preoperative diagnostics, which allows to detect in a timely manner follicular neoplasia and highly differentiated forms of cancer, colloid goiter with compression of the neck organs, nodular and diffuse toxic goiter (DUS) [5]. Most often, the nodes are located in the thyroid gland, but there are cases with atypical localization. Ectopia of the thyroid gland, or thyroid ectopia (from the Greek “ektopos”, i.e. “displaced”) is the presence of its atypical tissue in a place that is not characteristic of normal localization. This pathology develops due to a violation of the migration of progenitor cells of the thyroid gland during its embryonic development. The prevalence of thyroid ectopia is 1 per 100,000–300,000 people, 1 case per 4–8 thousand patients with thyroid pathology. Among the sick in 65–80 % of cases are women. According to the studied literature, thyroid ectopia can become a source of malignancy, so timely diagnosis and surgical treatment is necessary to prevent the development of life-threatening conditions. An analysis of a clinical case of atypical location of a thyroid nodule with a suspected oncological neoplasm in case of recurrence after hemithyroidectomy was carried out.

Literature review reflects the current status and development status of intraoperative photodynamic therapy in neurooncology and discusses the results of the most important studies on photodynamic therapy (PDT). We searched the Pubmed, EMBASE, Cochrane Library and eLibrary data-bases for publications published between January 2000 and December 2022. Found 204 publications in foreign sources and 59 publications in domestic editions, dealing with the issues of photodynamic therapy in neurooncology. An analysis of the literature has shown that intraoperative PDT in neurooncology is an important tool that contributes to increasing the radicality of the operation and local control. The basic rationale for the effectiveness of PDT lies in the study of the pathways leading to the complete devitalization of a malignant tumor, the study of the mechanisms of the local and systemic immune response. In addition, subcellular targets in PDT are determined by the properties of photosensitizers (PS). Second generation PSs have already been introduced into clinical practice. The effectiveness of PDT using photoditazine, 5-aminolevulinic acid has been demonstrated. The mechanisms of action and targets of these PS have been established. In Russia, a number of studies have repeatedly shown and proved the clinical effectiveness of PDT in groups of neurooncological patients with glial tumors and secondary metastatic tumors, but so far, the method has not been included in the clinical guidelines for the provision of high-tech neurosurgical care. There is certainly a need for further development of PTD techniques in neurooncology, especially in patients at high risk of recurrence and aggressive CNS tumors.

Annually increasing quantity of liver transplants and the growing population of long-survived recipients determine the relevance of late allograft dysfunction study. Variety of morphological and functional disorders of the transplanted liver complicates their timely diagnostics. Moreover, in some patients, serious graft damage may proceed for a long time without clinical manifestations and laboratory abnormalities.The review summarizes the structure, prevalence, risk factors and prognostic value of different liver allograft pathology determined by histological examination in the long term after transplantation.

Introduction. Intervertebral disc herniations are a common condition that is often associated with painful sensations and restricted spinal mobility. Since this condition can significantly deteriorate a patient's quality of life, it is essential to seek effective and safe methods for its treatment. Therefore, evaluating the effectiveness and safety of treating patients with pain caused by intervertebral disc herniation, which includes performing surgical interventions for hernia removal using endoscopic and minimally invasive techniques, is a relevant task today. In this context, comparing endoscopic and minimally invasive surgical interventions becomes a pertinent topic for research, as it can help determine the optimal treatment method for each patient. The aim of the study is to compare endoscopic and minimally invasive surgical procedures for intervertebral disc herniations in the lumbar spine. Materials and Methods. The study involved 100 patients diagnosed with lumbar intervertebral disc herniation. Of these, 50 patients underwent endoscopic surgery, while the remaining 50 underwent minimally invasive surgery. The effectiveness and safety of both methods were compared using several criteria, including the duration of surgery, blood loss, length of hospital stay, pain level, overall health status, the incidence of complications, and patient satisfaction with the procedure. Results. Compared to minimally invasive surgery, endoscopic surgery resulted in lower blood loss, shorter treatment duration, reduced pain levels, and fewer complications. All patients in both groups returned to normal activity according to their health status. Conclusions. Endoscopic surgery is more effective and safer compared to minimally invasive surgery in the treatment of herniated intervertebral discs in the lumbar spine. The endoscopic technique allows for better visualization and more precise manipulation in hernia removal, which positively affects treatment outcomes, reduces the risk of complications, shortens hospitalization, and leads to faster patient recovery. The results of this study can be valuable for physicians and patients when choosing the method of treatment for herniated intervertebral discs in the lumbar spine.

Recurrent aphthous stomatitis (RAS) is an inflammatory disease of the oral mucosa, which has a chronic course with periods of remission and exacerbations. RAS requires adequate diagnosis for the purposes of properly treating. The study on RAS remains relevant over many years and continues to be a priority in modern dentistry. The aim of the work is to analyze the information in the professional literature on pathogenetic variants of RAS and approaches to its treatment and prevention. Despite the variety of studies, the etiology and pathogenesis of the disease remain the subject of numerous discussions. This article provides a review of current research on the main etiopathogenetic mechanisms of the disease development and progression, specifies current recommendations for therapeutic approaches to treatment and prevention. Conclusions. To date, there is no definitive therapeutic tactic for recurrent aphthous stomatitis, so it is advisable to systematize and study methods for the prevention and treatment of this pathology, including pain relief, acceleration of ulcer healing and reduction of its episode frequency and severity. Considering the etiopathogenetic variant of the disease development (metabolic disorders, stress, allergies, etc.), preventive measures should be comprehensive and include oral hygiene, a sparing diet, multivitamin and micro-, macroelement complexes, etc.

Background. Reliable data on the efficacy and safety of fistulectomy with primary sphincter repair for the treatment of high transsphincteric anal fistulas are deficient.The aim. To compare the efficacy and safety of fistulectomy with advancement muco-muscular flap (F) and fistulectomy with primary sphincter reconstruction (SR) for the treatment of high anorectal fistulas.Methods. A cohort of 92 consecutive patients with transsphincteric anal fistula involving 1/3 to 2/3 of the sphincteric complex were included in prospective randomized study. The primary endpoint was the recurrence rate. The duration of surgery, blood loss, pain intensity, postoperative complications, the duration of wound healing, incontinence, quality of life were registered.Results. Forty-six patients were randomized in each group. A statistically significant difference was obtained for operative time (Group “F” – 45 (20–160) min, Group “SR” – 33 (10–55) min). The blood loss was 3 (1–20) and 2 (1–10) ml in Groups “F” and “SR”, respectively (p = 0.482). The return to work in Groups “SR” and “F” occurred after 7 (2–14) and 8 (4–20) days, respectively (p = 0.005). The pain syndrome was significantly greater in Group “F” (p < 0.05) on days 1 and 7. Recurrence rate was in 23.9 % (11 cases) in Group “F” and in 6.5 % (3 cases) in Group “SR” (p = 0.042). Incontinence was in 7 (15.2 %) people in Group “F”, in 10 patients (21.7 %) – in Group “SR” (p = 0.591). There was no statistically significant difference in postoperative complications.Conclusion. Findings can expand the indications for the treatment of high transsphincteric anorectal fistulas involving from 1/3 to 2/3 of the sphincter complex without statistically significant risk for functional results.

The aim of this study is to evaluate the efficacy of microsurgical clipping of anterior communicating artery (AComA) aneurysms as a method of prevention of repeated aneurysm rupture. Materials and methods. A total of 98 patients were included in the study, with a mean age of 47.8 ± 11.0 years. The female-to-male ratio was 1.04 : 1.00. Aneurysms were verified using computer tomography of the head and neck vessels, selective cerebral angiography, and MRI angiography of cerebral vessels. Results. Pterional access was used for surgical intervention in all patients. In the first three days after the aneurysm rupture, microsurgical treatment was performed on 18 of the most severe patients. After three days and later, surgical intervention was performed in patients with compensated and sub-compensated conditions. Patients were further examined; microsurgical tactics were carefully planned. Brain compression, pronounced dislocation, and occlusive hydrocephalus were indications for emergency surgery. Angiospasm was detected in 45 patients (45.9 %), among them pronounced angiospasm was detected in 36 %, widespread – in 20 %, intracerebral hematomas – in 30 (30.6 %), intraventricular hemorrhages – in 28 (28.6 %). In five cases, intracerebral hematomas led to pronounced compression of the brain and dislocation of the middle structures. These patients underwent hematoma removal and aneurysm clipping. Half of the patients had simultaneous intraventricular hemorrhages and intracerebral hematomas of the frontal lobes and the blood was most often localized in several ventricles. Four patients with decompensated hydrocephalus underwent ventricular drainage and CSF bypass operations before aneurysm clipping. Postoperative mortality in this group of patients was 11 %, and severe neurological deficits were 22 %. It was established that repeated ruptures of AComA aneurysms occurred in 15 % of treated patients after admission to the hospital. Conclusions. Microsurgical treatment provides a minimally invasive approach that minimizes damage to the surrounding brain tissue and helps preserve brain function and minimizes the risk of postoperative neurological complications.

The subject of the article is the theoretical development of the probabilistic model for a Poisson-type tsunami sequence that is consistent with data on the manifestations of historical events, in order to obtain estimates of the accuracy of the tsunami activity parameters. An example of a tsunami recurrence function, which is the most important quantitative characteristic of tsunami activity for the Port of Malokurilskoye, one of the places in the South Kuril Islands region with the most reliable tsunami height dataset, was created on the basis of a theoretical essay. An explanation for the weak statistical stability of all large values of the tsunami heights, especially for the largest one in the series of observations, was given based on the probability density functions of the ranked tsunami heights. In particular, it means, for example, that the maximum tsunami height recorded at a certain location during a 30-year observation period should be correlated with a wide range of possible recurrence periods of about 10 to 100 years. Synthetic catalogs of the tsunami heights, built for the Port of Malokurilskoye, showed that the tsunami height datasets with a duration of at least 250 or 500 years without gaps are needed to obtain the tsunami activity parameters with an acceptable accuracy of 10 or 5 %. The most important results are the analytical equations for the variances of estimates of the tsunami activity parameters, which characterize the accuracy of these estimates, depending on a priori unknown values of the tsunami activity parameters and the amount of data used.

Introduction. Recurrence of head and neck tumors occurs in 50 % of cases and usually has locoregional character. Due to the characteristics of dose distribution, proton beam therapy is a promising treatment option for patients with recurrences of tumors in this location who previously underwent radiation therapy.Aim. To evaluate the effectiveness and tolerability of repeat irradiation using active scanning proton beam therapy in patients with recurrent head and neck tumors who previously underwent radiation therapy.Materials and methods. Between November of 2015 and December of 2020, 40 patients with locoregional recurrence of head and neck tumors underwent treatment using active scanning proton beam therapy at the A. F . Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center. Median cumulative dose of primary irradiation was 64.5 Gy. Median time between primary and repeat irradiation was 35.7 months, mean irradiated volume of the repeat course was 94.5 cm3. Proton beam therapy was performed using standard mode (2 isoGy) and accelerated hypofractionation (2.4 isoGy / 3 isoGy) with mean equivalent cumulative dose of 56.4 Gy (α / β = 10). Radiation toxicity was evaluated using the Radiation Therapy Oncology Group European (RTOG) / Organization for Research and Treatment of Cancer (EORTC) scale.Results. Treatment response was achieved in 34 (85 %) patients: in 17 (42.5 %) patients, stable disease was observed; in 10 (25 %) patients, partial response was observed; and in 7 (17.5 %) patients, complete response was observed. In 6 (15 %) cases, disease progression was diagnosed at first follow-up examination. One- and two-year locoregional control, progression-free survival and overall survival were 58.4 / 19.8; 44.5 / 19.8 and 82.3 / 38.8 % respectively with median follow-up duration of 14.2 months. Median survival was 19.5 months. Grade III and above early radiation toxicity was observed in 3 (7.5 %) patients. In total, 6 (15 %) cases of grade III complications and 2 (5 %) episodes of carotid artery rupture leading to death were observed. Overall frequency of complications of grade III and higher was 20 %.Conclusion. Repeat irradiation using proton beam therapy can be considered an effective and safe treatment method for patients with recurrent head and neck tumors. Dosimetric and radiobiological benefits of proton beams allow to achieve balance between high doses and radiation exposure in previously irradiated tissues.

Objective of the study: To review worldwide literature data on the efficacy of combined modality treatment including intraoperative radiation therapy (IORT) in patients with operable breast cancer (BC). Material and Мethods. Of 110 publications (2000–2021) available from Scopus, Pubmed, Elibrary and other databases, using the key “breast cancer”, “local recurrence”, “intraoperative radiotherapy” and “radiation technique”, 45 were included in the literature review. Results. Radiotherapy is of paramount importance in the organpreserving treatment of breast cancer, as numerous randomised studies have shown that the use of postoperative radiotherapy dramatically reduces the number of locoregional recurrences. The use of IORT as an effective method of relapse prevention compared to standard postoperative adjuvant radiotherapy is an important trend in radiation oncology.Conclusion. The use of IORT in combination treatment modality for operable breast cancer should be differentiated and based on clinical and morphological prognostic factors. Different molecular subtypes of breast cancer are characterized by significant differences in pathogenesis and response to therapy. Further studies on the effectiveness of IORT are required to identify a group of patients with absolute indications for the use of IORT.

Basal cell carcinoma is the most common malignant neoplasm, andits incidence has been rapidly increasing worldwide. This malignancy is a serious public health problem that can lead to disability and severe aesthetic damage. The results of the analysis of gene expression and proteomic profiling of tumor cells and the tumor microenvironment indicate that certain molecules involved in the pathogenetic pathways of basal cell skin cancer may represent new prognostic biomarkers or serve as the basis for their development. The purpose of this review is to summarize information on known genes, proteins, and enzymes that can be used to diagnose, monitor therapy, and predict the course of basal cell skin cancer. The PubMed, MedLine, Web of Science and RSCI databases were used to search for the necessary literature.

Objective.Studying of morphological characteristics of venous angiodysplasia of the face and scalp. Materials and methods. The operation material (soft tissues of the face and scalp) was investigated in 20 patients for studying of morphological characteristics of venous dysplasia. In the histological investigation frame the material was fixed and processed in accordance to conventional method, the tissue slices were colored with hematoxilin and eosin. In 7 observations immuno–histochemical investigation with CD34 antibodies (clone QBEND10) and S100 (polyclonal) was applied. Results. Basing on patho–histological investigations of the operation material in 8 patients, morphological features, characteristic for arterio–venous angiodysplasia, were revealed, what may constitute the recurrence cause in postoperative period. Conclusion.The recurrence prognosis and further surveillance of patients with venous angiodysplasia demands decision of the question concerning the presence of arterio–venous component in clinically and instrumentally confirmed simple venous angiodysplasia, concerning every patient.

The use of all-trans retinoic acid (ATRA) drastically improved the results of therapy for acute promyelocytic leukeimia (APL). The high efficiency of the Russian protocol APL-93—98 applied to 62 children and adolescents with APL (event-free and overall survival (EFS and OS) were 84±5% respectively with a relapse rate of 7%) was achieved, by administering the high cumulative dose of daunoruicin (495 mg/m2) and single doses of АТRА (45 mg/m2). In this connection, the APL-2003 protocol attempted to reduce both acute and chronic toxicity of the therapy, by decreasing the cumulative dose of daunorubicin to 405 mg/m2 and the single dose of АТRА to 25 mg/m2 under regular control of minimal residual disease via molecular monitoring of the specific transcript PML/RARα. Analysis of the results of treatment in 61 patients aged 1.3 to 17 years (median 11.3) showed that despite of the reduced protocol intensity, the efficiency of therapy did not generally reduce — EFS and OS were 79±6 and 93±3%, respectively. The likelihood of the development of a relapse was significantly affected by molecular resistance, i.e. the retention of the transcript PML/RARα before a phase of maintenance therapy: the recurrence risk in this group was 57% whereas there were no differences in all cure rates between the patients depending on baseline leukocytosis. All 6 patients with relapses were treated with arsenic trioxide, resulting in not only clinical and hematological, but also molecular remissions; thereafter the patients received myeloablative therapy and autologous hemopoietic stem cell transplantation. The second remission lasted 3 to 24 months. Thus, reducing the cumulative dose of anthracyclines and the dose of АТRА did not make the results of the therapy for APL worse. The monitoring of minimal residual disease before and during maintenance therapy is a mandatory component of successful treatment in APL patients. Arsenic trioxide is an effective agent for the treatment of APL relapses.

Treatment of poorly-pigmented tumors of small sizes can be carried out using photodynamic therapy (PDT). The material for the analysis was data on 112 patients. We used data from the Belarusian Cancer Registry, medical records of patients with clinically diagnosed choroid melanoma (C69.3 according to ICD-10) for the period 2013–2021. The size and level of blood flow in the tumors were assessed using an ultrasound machine with a doppler attachment. PDT was carried out using a «UPL PDT» semiconductor laser (Lemt, Republic of Belarus, λ=661 nm) with a light spot diameter of 1 to 3 mm for 60 s per field with a light dose of 50 J/cm2. The entire surface of the tumor was exposed to the action, with the fields “tiled”, from the periphery to the top of the tumor, with overlapping fields. Tumor pigmentation was assessed visually. To evaluate the treatment outcome, the general group of patients was divided into three subgroups according to thickness and basal diameter. Group I – 40 (35.7%) patients, with an average tumor thickness of 1.4±0.2 mm, basal diameter – 5.8±1.5 mm. II – 51 (45.5%) patients, with an average tumor thickness of 2.3 ± 0.3 mm, basal diameter – 7.9 ± 1.5 mm. III – 21 (18.8%) patients. The mean value of the tumor thickness was 3.8±0.4 mm, the basal diameter was 9.8±1.4 mm. After PDT in the general group (n=112), 29 (25.9%) patients had complete tumor resorption, and 83 (74.1%) patients had stabilization. The eyeball was saved in 107 (95.5%) patients. Continued growth and relapse were recorded in 34 patients: 25 (22.3%) and 9 (8.0%), respectively. In 29 (85.3%) patients, the eyeball was preserved after treatment of relapse and continued growth. 5 (4.5%) enucleations were performed. Adjusted one-year cumulative survival was 100%, 3-year and 5-year 95.8±2.4%, 93.7±3.1%, respectively

Introduction. Meningiomas are the second most common central nervous system (CNS) tumors in adults. most meningiomas are benign tumors. Anaplastic and atypical meningiomas account for 25% and have a high recurrence rate even after radical tumor resection and radiotherapy. The prognosis of patients with anaplastic meningiomas remains disappointing; most of them die within the first 2 to 5 years after surgery. Purpose: to discuss the challenges in diagnosis and treatment of recurrent meningiomas, to identify the causes of tumor progression, and to assess the clinical features and radiographic findings as well as specific pathomorphological and molecular genetic characteristics. material and methods. We searched for publications in the Pubmed, EMBASE, Cohrane Library and eLibrary databases published between January 2000 and January 2019 on the issue of recurrent intracranial meningiomas, in particular atypical and anaplastic meningiomas. Results. The review systematizes data on the prognostic factors for survival, relapse-free period, and disease progression. particular attention was paid to the radical resection of the tumor and the assessment of the grade of anaplasia. The current data on radiotherapy and drug therapy were presented. the controversial issues of approaches to the assessment of morphological prognostic criteria were discussed. The current knowledge on the most common genetic mutations in meningiomas, the prospects for their study and use for targeted therapy were presented. Conclusion. The management of meningioma still presents some unresolved issues. There are no optimal standards for diagnosis and treatment of patients with meningiomas that would take into account biological characteristics, including growth characteristics and molecular genetic profile. There are no clear prognostic criteria for recurrence and continuity in further management after surgical treatment, which affects the mortality rate and quality of life in this category of patients. New fundamental data that will determine a different strategy in the treatment of intracranial meningiomas are needed.

Cavernous hemangioma of the orbit (CHO) is a vascular space-occupying lesion that develops as a result of an abnormal anlage of the vascular system and occurs in 70% of patients with vascular neoplasms of the orbit. CHO is more often considered as a venous malformation with slow blood flow, rather than a benign tumor. Very rarely CHO spreads into the cranial cavity, usually through the upper orbital fissure and the optic canal. The recurrence of CHO after its complete removal is low, however no reliable data are available. It is supposed that CHO relapse can occur in three cases: the continued growth of an incompletely removed tumor, growth of an undiagnosed space-occupying formation, and the emergence of a new tumor. The purpose of the study is to present a clinical case of a multiple recurrence of orbitocranial cavernous hemangioma. The clinical case demonstrates such a recurrence after an incomplete CHO removal, which was manifested by exophthalmos and moderate oculomotor disorders. Special features of the clinical case also include CHO spread into the cranial cavity accompanied by a cavernous hemangioma of the brain structure.

Endometrial polyp (EP) is a frequent incidental finding during hysteroscopy in asymptomatic patients. To date, the pathogenesis of EPs has not been fully disclosed, which challenges the primary and secondary prevention of EPs and their targeted therapy. It determined the focus of our work. We searched for scientific publications in Cochrane Library, ScienceDirect, PubMed (MEDLINE), eLIBRARY using the keywords "polyps", "endometrial polyps", "pathogenesis", "reproductive age", "recidive" for 20122022. Analysis of the literature data allowed us to conclude that ES pathogenesis most likely involves several mechanisms, both estrogen-mediated (hyperestrogenism, including related to impaired progesterone reception and deficiency) and non-hormonal (inflammatory, immune, genetic factors, neoangiogenesis). Hormonal and non-hormonal factors disturb normal cyclic changes of the endometrium during the menstrual cycle, alter the balance and dynamics of proliferation and apoptosis, and initiate neoangiogenesis that serves as a resolving mechanism of polyposis formation, persistence of ES, and their recurrence after surgical removal. The objective of our study was to analyze and summarize the scientific data available on the mechanisms of ES pathogenesis in women of reproductive age.

Introduction Congenital clubfoot is the most common congenital malformation of the foot in children. Despite the relatively low birth rate clubfoot shows no tendency to decrease in the population. On the contrary, there is an increased number of foot pathologies associated with central nervous system anomalies and other pathological syndromes. Atypical clubfoot according to Ponseti's classification requires early recognition and continues to challenge the skills of the pediatric orthopedic surgeon. The objective was to draw the attention of pediatric orthopedists on the problem of atypical clubfoot. The goals were to discuss common errors in the treatment of atypical clubfoot and assess a recurrence rate that would require a re-operation. Material and methods A total of 135 children (184 feet) with atypical clubfoot which amounted to 12.1 % of the total clubfoot cases were treated in hospitals of the city of Yaroslavl between May 2006 and December 2019. The review included 106 children (147 feet) with atypical clubfoot who could benefit from Ponseti treatment. The mean long-term followup period was 7.2 years. Results Relapses requiring re-operation occurred in 51 children (83 feet) that amounted to 48.1 % of the total atypical clubfoot cases treated in Yaroslavl. Discussion Appropriate bracing is an important component of the Ponseti technique of atypical clubfoot correction in everyday practice of the pediatric orthopedist. Untimely detection of atypical clubfoot and non-compliance with bracing protocol in typical clubfoot can result in an iatrogenic atypical clubfoot with likelihood of major reconstructions and poor prognosis. Conclusion The Ponseti method in Russia is the "gold standard" for the treatment of clubfoot.

Background. The main method of surgical treatment of toe walking is Achilles tendon extension, which is associated with the risk of excessive correction, tendon rupture, its poor blood supply, plantar flexion deformity. Another alternative is minimally invasive technique, myofasciotomy.Objective. The aim of the study is to study the results of percutaneous myofasciotomy in patients with idiopathic toe walking with severe foot deformity and with no effect of conservative therapy.Methods. The study included data (medical records) from patients with idiopathic toe walking who underwent Ulzibat percutaneous myofasciotomy. We have evaluated the frequency of persistence (recurrence) of toe walking on the next day and 12 months after surgery among all the treatment outcomes. Additionally, the range of motions in ankle joint, the presence of foot deformities, parental satisfaction with surgery results, as well as the number of postoperative complications were analyzed.Results. Percutaneous myofasciotomy was performed in 50 children (11 females) with median age of 13 (10; 16) years during the study period. There were no cases of toe walking on the next day after surgery. Recurrence of toe walking was revealed in 3 (6%) patients within 12 months after surgery. Dorsiflexion rates reached ≥ 10 degrees in all patients at evaluating foot mobility on the next day after surgery and 12 months later. The only revealed surgical treatment complication was postoperative hematoma in 10 (20%) patients. Parents of 3 (6%) children (all with recurrent toe walking) were dissatisfied with surgery results.Conclusion. Ulzibat percutaneous myofasciotomy has shown high efficacy and relative safety in the treatment of patients with idiopathic toe walking.

Rationale: During neoplastic transformation, epithelial cells become mobile, which is one of the main mechanisms of metastatic disease and recurrence. Cell motility is regulated by actin-binding proteins, which ensure the association/dissociation of actin filaments and their interaction with the cell membrane. Previously, we have shown the presence of actin-binding proteins in the serum from patients with squamous cell carcinoma of the head and neck (HNSCC); however, their association with the development of metastases and relapses in cancer patients has not been sufficiently studied. Aim: To evaluate the serum levels of actin-binding proteins fascin-1 and ezrin in patients with HNSCC depending on the disease recurrence and lymphatic metastasis. Materials and methods: Serum fascin-1 and ezrin levels before combination therapy were measured with ELISA assay in 30 HNSCC (T1-4N0-2M0) patients (mean age 56 7 years). Results: The median fascin-1 level was significantly higher in the patients with lymphatic metastases, compared to those without metastases: 0.64 (0.40; 5.89) vs 6.35 (1.72; 8.35) ng/mL, respectively (p 0.001). At 12 to 36 months after combination therapy, the disease relapsed in 12 (40%) patients. Ezrin levels were significantly higher in the relapsed patients, compared to those without a relapse within 3 years after combination therapy: 2.55 (2.35; 2.75) vs 1.93 (1.87; 2.5) ng/mL (p = 0.02). The ROC analysis showed an association between fascin-1 serum levels with metastatic disease (AUC = 0.71, 95% confidence interval 0.570.85) and an association between ezrin levels and the disease relapse (AUC = 0.76, 95% confidence interval 0.570.94). Conclusion: These indicators can be used for the development of minimally invasive early detection of metastases in lymphatic nodes and for the prognosis of HNSCC recurrence.

Pulmonary vein isolation is a standard for catheter treatment of atrial fibrillation (AF). As for the need for additional impact on the arrhythmogenic substrate in the atria, there is no consensus or unified technique. The aim. To study the efficiency of AF induction by frequent atrial pacing as a prognostic criterium for arrhythmia recurrence in the long term after catheter treatment. Materials and methods. We analyzed 55 catheter procedures of AF ablation in 55 patients (27 women, mean age 52 ± 6.8 years) without structural heart disease. There were 28 patients and 27 patients with paroxysmal and persistent arrhythmia, respectively. Concomitant diseases (coronary heart disease, hypertension, diabetes) were reported in 30 (54.5%) cases. The technique of the procedure was as follows. At first, the pulmonary veins were isolated. After that frequent stimulation was carried out from two sites with a cycle of 300 ms for 10 seconds, with a phased shortening by 20 ms, until atrial refractoriness was achieved. Arrhythmia was considered induced if its episode lasted more than 30 seconds. In case of induction of AF and absence of its spontaneous termination within the pre-specified time, the search and ablation of the areas with fragmented activity were performed. There were no additional effects on the substrate in the atria. Recurrence of AF was defined as the occurrence of AF within 3 months after ablation. Results. Atrial fibrillation was induced in 9 (16.4%) of 55 patients. During the follow-up period lasting 12 to 26 months, recurrent arrhythmia occurred in 11 (20%) of 55 patients, including 3 (33.3%) of 9 with induced AF, and 8 (17.4 %) of 46 in whom it was not induced (relative risk 1.9; odds ratio 2.4; 95% confidence interval 16.5-23.5). Comparison of the recurrence rate depending on the form of arrhythmia did not reveal significant differences: the relative risk was 2.2 for persistent form and 1.5 for paroxysmal form (P > 0.05). Conclusions. Our results indicate that in cases where AF was induced after pulmonary vein isolation, the likelihood of its subsequent recurrence was twice as high as in cases when it was not induced. This trend was observed both in paroxysmal and persistent forms of arrhythmia.

Background. Patient-related risk factors for periprosthetic joint infection (PJI) are currently investigated in detail. However, the influence of those factors on PJI recurrence and their confounding effect was not investigated. Identifying factors that influence PJI recurrence and establishing the role of each risk factor are important. The study aimed to analyze the comorbidity structure in patients with knee PJI and create, based on obtained data, a rating scale that allows predicting the probability of PJI recurrence after spacer implantation. Methods. A single-center study was conducted based on retrospective data of 161 patients with PJI after primary total knee arthroplasty treated with staged reimplantation from January 2007 to January 2017. To clarify comorbidity structure and the most important risk factors, all patients were divided into two groups: patients with PJI recurrence after spacer implantation (group 1, n = 48) and patients who successfully passed spacer implantation (n = 113, group 2). Based on the obtained data, the frequency of comorbidities was analyzed. The list included 17 points that characterized the presence and severity of different comorbidities. Then, we conducted a logistic regression analysis to identify the significance of each factor and thresholds for the comorbidity index (CI) for the interpretation of the final score. With the presented scale, spacer implantation in the compared groups was analyzed. Results. The most significant comorbidities were anemia, chronic kidney disease, obesity, and cardiovascular pathology. The CI thresholds were calculated, which allowed interpretation of the obtained score. The distribution of patients by risk categories within each group was also analyzed, and differences between groups were determined. The CI value corresponding to the minimal risk of PJI recurrence was more common (p0.0001) in group 1. Moreover, more than half of the patients with failed spacer implantation had a high risk of PJI recurrence according the CI value, and only 6.2% of patients who had successful treatment had CI high value (p0.0001). Conclusions. The multivariate analysis of the presence and severity of concomitant pathologies enabled the development of a comorbidity scale with the calculation of an integral indicator (comorbidity index) and establishment of its threshold values. The proposed CI could be the basis for a combined relapse risk calculator and an algorithm for choosing the surgical treatment strategy in patients with knee PJI, which requires further investigation.

Objective: Experimental and histological justification of the use of perhydrol to treat the residual cavity (RC) and recurrence prevention after hydatid cystectomy for hepatic echinococcosis (HE) Methods: The results of surgical treatment of 85 patients with HE were evaluated between 2010 and 2019. In all patients after hydatid cystectomy, RCs were treated with 33% perhydrol. The scolicidal activity of 33% perhydrol was tested in vitro when the latter acted on protoscoleces obtained during the operation. In addition, a histological examination of the fibrous capsule (FC) was performed before and after RC treatment with a perhydrol solution. Results: Following exposure to perhydrol, the protoscolices lost their characteristic round or oval shape with the translucence of the parenchymatous tissue and the disappearance of the calcareous corpuscles. Following 1-minute exposure to a perhydrol solution, scolex swelling was observed, followed by a decrease in size due to the "boiling" of the released gas bubbles, as a result of perhydrol decomposition to oxygen and water with release of heat. Following 1.5-minutes of exposure to perhydrol solution, significant destructive changes were observed: delamination and tegument integrity loss, free hooklets, protoscolices dissolution, which indicated the parasite's death. On RC histological tissue preparations, stratification and destruction of FC were noted. In the long-term follow-up period for operated patients, there were no cases of HE recurrence. Conclusion: In vitro studies have shown that the treatment of protoscoleces with perhydrol solution leads to destruction followed by dissolution of the germinal layer. The perhydrol penetration into the FC walls resulting in its stratification and destruction contributes to the disease recurrence prevention.

Colorectal cancer (CRC) is the second leading cause of mortality among cancers after malignant tumors of respiratory system. One of the most significant prognostic features of CRC is tumor budding (TB), which isn’t widely implemented in clinical practice. The aim of this research: to find the prognostic criteria of recurrence and lethal outcome of CRR IIA and IIIB stages (рТ3N0-2M0), the ratio of tumors with certain differentiation in groups of research was taken equal. Material and methods. The group I was formed from primary CRC without recurrences. The main relapse-free survival time was 5 years (62.5 ± 16.5 months). The ІІ group – primary CRC with recurrences; ІІА – with recurrences during 5 years from the moment when the tumor was removed, without fatal outcome; ІІВ – with recurrences and lethal outcome from genera­lization of tumor process during 5 years from the moment when the tumor was removed. The microslides of CRC were made by using the standard methods. Results. TB was identified in 46.66 % (28/60) of CRC рТ3N0-2M0. The direct relationship between tumor grade and presence of TB was found (Р < 0.05), but TB didn’t define differentiation of the CRC. There was a statistically significant relationship between TB and metastatic spreading of CRC to regional lymph nodes (Р < 0.001). Metastasis was associated with 3 stage of TB, absence of metastasis was typical for CRC without TB. The tendency was found in a larger number of cases of the CRC with TB 3 stage among recurring CRC compared with CRC without recurrence, mainly due to the ІІВ group of the research. Inverse correlation between TB stage and time of recurrence appearance was found (Р < 0.05). TB in central tumor sites was followed by presence and higher stage of TB in peripheral tumor sites (Р < 0.05), that can be taken into account during biopsies of CRC. Conclusions. TB is a prognostic criterion of metastasis and time of recurrence appearance for CRC рТ3N0-2M0, which is mostly typical for tumors in patients with recurrences and lethal outcome at the taken equal ratio of tumors by differen­tiation.

Study design Retrospective analysis of a single-center cohort of patients with pyogenic vertebral osteomyelitis. The purpose of the study was to review risk factors for perioperative complications and recurrences in patients diagnosed with hematogenous pyogenic vertebral osteomyelitis. Material and methods 141 inpatient records of hematogenous pyogenic vertebral osteomyelitis were reviewed at the Regional Clinical Hospital No. 2, Tyumen. Patients who developed complications, neurological deficits and recurrences were assigned to A group (n = 66), and those who did not included in B group (n = 75). Results Perioperative complications, recurrences, risk factors and neurological disorders that could develop with different treatment methods were explored. There was a greater risk of recurrences and a lower rate of neurological complications seen in chronic cases and drug addicts. There was a lower risk of intra- and postoperative complications seen in thoracic spine involvement, a greater risk of neurological deficit with involved cervical spine and a lower risk in the lumbar spine involvement. There was a lower risk of neurological disorders in type A and type B disorders, and a greater risk in type C disorders as categorized by E. Pola. There were no differences in recurrence rates among different types of involvement. HIV did not increase the risk of complications and relapses. Surgical site infection developed in 8.1 % cases of transpedicular fixation and in 6.9 % following ventral interventions. No correlation was observed between the recurrence and complication rate and the surgical methods used. Overall, recovery or stable remission was achieved in 88.6 % of cases after treatment of relapses. Conclusion Recurrences and complications were primarily caused by delayed diagnosis, co-morbidities and neurological deficits. No correlation was observed between the recurrence and complication rate and the surgical methods used. There was a greater risk of recurrences and a lower rate of neurological complications seen in chronic cases and drug addicts. Neurological disorders are common for cervical spine disorders. The risk of complications was dependent on the type of involvement as categorized by E. Pola. There was a lower risk of neurological disorders in type A and B disorders and a statistically greater risk in type C disorders.

Objective. To assess the significance of clinical factors of extramedullary tumors and new methods of their resection as potential predictors of their recurrence and continued growth. Material and Methods. The long-term results of removal of primary extramedullary tumors in 412 patients operated on in 1998–2014 were analyzed comparing the use of standard methods of microsurgical technique for tumor removal (277 patients) and of those with additional use of neodymium laser radiation (135 patients). Results. The use of laser technologies for resection of extramedullary tumors can significantly reduce the number of their recurrences and continued growth, along with other clinical factors is a significant prognostic indicator in determining the nature of the disease course and can be a predictor of their occurrence. The most reliable clinical factors determining the prognosis of a decrease in the incidence of recurrences and continued growth when using laser techniques of surgical resection were repeated operations (p = 0.002), the presence of ependymomas of the cone and cauda equina (p = 0.017), operations for primary tumors in the thoracic spine (p = 0.039) and extramedullary tumors with Grade I anaplasia (p = 0.007). An increase in the number of these conditions was associated with operations on the cervical spine (p = 0.027), the presence of a tumor with Grade II anaplasia (p = 0.007), and a primary extramedullary tumor involving more than three vertebrae (p = 0.017). Conclusion. The use of the laser is indicated for reoperations when removing neoplasms, that have arisen as a result of recurrence or continued growth of extramedullary tumors of any level and length after removal of primary neoplasms with a Grade I malignancy confirmed by intraoperative cytological examination involving no more than three vertebrae in the thoracic, lumbar and sacral spine and during resection of ependymomas with extramedullary growth.

Abstract. There is a tendency to an increase in the frequency of hospitalization of children with mixed forms of IgA-vasculitis with pronounced abdominal syndrome and involvement in the pathological process of the kidneys, which is possibly associated with an increase in the level of comorbid pathology of the gastrointestinal tract, and with a premorbid state of the mucosa membranes of the digestive system. There is a need to study the course and evolution of IgA vasculitis in children with gastrointestinal manifestations in order to improve the diagnostic search, accurate prognosis and create a standardized treatment protocol for IgA vasculitis in children. Objective. To investigate the clinical and diagnostic manifestations and evolution of IgA vasculitis in children with lesions of the gastrointestinal tract. Materials and method. The surveys of patients and their parents and retrospective analysis of 58 maps of inpatients with IgA vasculitis and digestive lesions aged 0 to 18 years, who were hospitalized in the somatic departments of the National Children's Specialized Hospital " OKHMATDYT" Kyiv, Ukraine in the period from 2008 to 2018. Results. The mean age of children with IgA vasculitis was 8,03 years, and the ratio of boys to girls was 1,32: 1. Skin syndrome occurred in 58/58 patients (100%), and joint symptoms were observed in 34/58 (58,62%) patients. There were 29/58 patients (50,0%) with kidney disease. The incidence of renal pathology was higher in children with severe symptoms of the digestive system and in persons older than 7 years. 23/29 (79,31%) patients had manifestations of kidney damage in the first month after the onset of IgA vasculitis with gastrointestinal symptoms. Conclusions. In the study among hospitalized children, clinical and laboratory features and the evolution of IgA vasculitis in children with gastrointestinal lesions were similar to the literature. In 79,31% of patients, the onset of renal syndrome occurred in the first month after the onset of IgA vasculitis. In 20,69% of patients there was an evolution of kidney damage into chronic kidney disease. Therefore, careful monitoring of renal impairment should be performed to assess the progression of chronic kidney disease in patients who develop IgA vasculitis over 7 years of age and in those children who have severe symptoms of gastrointestinal damage.

Pericarditis as an inflammatory heart disease is rarely discussed in the cardiology community. The latest European guidelines on pericarditis were published in 2015, and Russian clinical guidelines are dated 2022. However, in recent years, a number of publications have appeared that have forced the scientific community to take a fresh look at this problem. This is mainly due to a change in the paradigm of the treatment of idiopathic recurrent pericarditis (IRP) registered in the Russian Federation as a rare (orphan) disease. According to most experts, IRP is an underestimated cardiac disease, which, due to the lack of specific symptoms and the physicians' alertness regarding the IRP diagnostics, is rarely the subject of scientific discussions. The issues of diagnosis and therapy of IRP in light of the latest reports became the matter under discussion for a group of leading Russian experts chaired by Corresponding Member of the Russian Academy of Sciences, Professor G.P. Arutyunov.

Aim: To evaluate the long-term safety and efficacy of goflkicept treatment in patients with idiopathic recurrent pericarditis (IRP)., Materials and Methods: This report presents the interim analysis of an ongoing open-label extension (OLE) clinical trial of goflkicept in patients with IRP (NCT05673902), as a continuation of the core study (NCT04692766). The study assessed the frequency of pericarditis recurrence, time to recurrence after 12 and 60 weeks of goflkicept therapy, changes in C-reactive protein level, chest pain intensity, pericardial effusion size, and adverse events (AEs)., Results: All patients remained in clinical-laboratory remission during the 60 weeks of goflkicept treatment. The recurrence frequency was 31.3% (5/16) after 60 weeks and 90% (9/10) after 12 weeks of goflkicept treatment (p<0.001). A total of 64 AEs were reported in 16 patients (94.1%), mostly of mild to moderate severity. The most common AEs were infections, occurring in 11 patients (64.7%). Nine serious adverse events were reported in 5 patients, none of which were considered drug-related. There were no deaths., Conclusion: Long-term goflkicept therapy resulted in a significant reduction in the risk of recurrence and prolonged remission without an increase in adverse events.

Objective. To assess the effect of neodymium laser radiation on the recurrence rate and continued growth of primary extramedullary tu- mors on the basis of clinical data obtained in the long-term follow-up period in operated patients with extramedullary tumors. Material and Methods. The long-term results of surgical treatment of two groups of patients (n = 412) with primary extramedullary tu- mors operated on from 1998 to 2014 were studied and systematized. Patients of comparison group (n = 277; 67.2 %) underwent removal of tumors using standard microsurgical techniques, and the neoplasms in patients of the study group (n = 135; 32.8 %) were removed with additionally used neodymium (Nd:YAG) laser. Results. The use of the developed laser technologies for the resection of extramedullary intracanal primary tumors made it possible to re- liably reduce the relative number of recurrence and continued growth from 11.1 % to 1.2% compared with patients treated with standard surgery methods. The proportion of recurrences was 3.5 %, all of them were detected only in the group with the classical technique of tu- mor resection (p

Objective: to compare the immediate and long-term outcomes of patients with early breast cancer treated with intraoperative radial therapy depending on the biological subtype of breast cancer.Materials and methods. We prospectively evaluated number of recurrences, cosmetic effect and early treatment results of 104 patients with early breast cancer aged 66.72 ± 0.68 years old. The mean follow-up period was 36 months. The mean dose on the surface of applicator was 17.8 Gy, on the depth 0.5 cm – 8.8 Gy, on the depth 1.0 cm – 5 Gy. The mean time of radiation was 22.15 min ± 28.09 sec.Results. The local recurrence was in 3 patients. The first patient had triple negative breast cancer subtype, the second patient had luminal B HER2+, and the third one had luminal B HER2– subtype. Relapses occurred in 7, 14 and 20 months after the end of treatment respectively. The recurrence rate in patients with luminal B biological subtype was 10.71 %; in patients with triple negative subtype was 20 %. All recurrences were found in the area of the postoperative scar.Conclusion. The obtained results question the rationale for the use of the demonstrated method in patients with luminal B and triple negative molecular subtypes of tumors.

Recurrent cervical cancer is a difficult challenge for gynecological oncologist. In this paper we review papers concerning incidence and surgical treatment of pelvic recurrences. A point of interest is studies evaluating completion surgery after radiotherapy/chemoradiotherapy. Surgery after definitive radiotherapy is associated with high morbidity and should be performed only in patients with residual tumor. Magnetic resonance imaging in special regimen can be useful in detecting residual disease.

This article explores specific representation of regret in The Tale of Khan Tokhtamysh’ Invasion of Moscow. While there are two existing versions of this text, a brief version (Simeonovskaya Chronicle, Rogozhskii Chronicler) and an extended version (Novgorodskaya Chronicle 4, Sofiiskaya and Novgorodskaya Karamzinskaya Chronicles), the article focuses on the hitherto understudied brief version. In Simeonovskaya version, different recurrent patterns that underline the main idea of the chronicle and define its pathos, compensate for the minimum of expressive tropes employed in the narrative of the 1382 invasion. The analysis reveals two major motifs — of plundering and burning — that support the author’s main thought: Tokhtamysh’s invasion was a plunder and a terrible destruction that caused massive damage to Moscow and the neighboring towns. Whereas the author of the extended version focuses more on the heroism of the city defenders and laments the cruel death of civil citizens and clergy, the author of the brief chronicle is more concerned with the description of the devastating event itself. The author of the brief version regrets the material damage caused by Tokhtamysh more than he would grieve for the victims. It is possible to explain this peculiarity by turning to earlier chronicles. By the time the brief chronicle of Tokhtamysh invasion was written, Simeonovskaya Chronicle had developed a structural and stylistic pattern describing invasions of the Horde that accentuated motifs of plundering and burning. The recurrence of similar events in a long time-period together with laconic style typical for chronicles resulted in the mentioned specificity: the brief version of the chronicle, following the pattern, puts to the fore regret about the material damage instead of mourning.

Aim. To analyze the recurrence of endometriosis after surgical treatment of patients with deep endometriosis. Materials and methods. The case histories of 90 patients aged 19 to 45 years were retrospectively analyzed. The study group consisted of 70 endometriosis patients: 20 with peritoneal endometriosis and 50 with deep infiltrative endometriosis (DIЕ). The comparison group included 20 women without endometriosis. There was an in-depth study of anamnestic data in the cohort of patients under study. The results of preoperative laboratory tests, including serum levels of the CA-125 and CA 19-9 oncomarkers, were processed. Results. Analysis of the obtained data showed that about half of the DIE patients (54%) in the main group had a history of surgical interventions for endometriosis. The number of operations was significantly higher in patients compared to the peritoneal endometriosis group (68% vs 20%, respectively; р=0.0012). Two subgroups were formed from the group of women with DIE: patients who had no history of previous surgical treatment for endometriosis and those hospitalized for repeated surgical treatment of endometriosis (patients with recurrent endometriosis). Patients with recurrent endometriosis had a significantly higher incidence of heavy menstruation, pregnancy terminations (abortions), and a high proportion of gastrointestinal diseases. Analysis of the hormonal therapy received in patients with DIE showed that every second patient with relapses (18/53%) after surgical treatment and every third patient without a prior history of surgery (5/31%) received hormonal therapy. Examination of the preoperative serum levels of CA-125 and CA 19-9 serum markers in patients with DIE showed an increase in their serum levels and a correlation with the frequency of endometriosis recurrence and the size of DIE foci. Conclusion. Despite the conservative and surgical treatment of DIE patients, the recurrence rate is still high. At present, there is no satisfactory therapy for all endometriosis patients. Therefore, the development of therapy for the conservative treatment of the disease remains an urgent task.

Background: Adequate diagnosis of recurrent atrial fibrillation after the surgical treatment in patients with paroxysmal forms of the disease appears to be a difficult task. Aims: The manuscript is devoted to a comparative analysis of the results of subjective and objective assessment of atrial fibrillation recurrence after cryoballoon ablation of the pulmonary veins. Material and methods: 301 patients were included in the study. All of them consequentially underwent cryoballoon ablation of the pulmonary veins in the period of October, 2016 November, 2019. The inclusion criteria were as follows: symptomatic atrial fibrillation; confirmation of atrial fibrillation by instrumental diagnostic methods. The exclusion criteria were the following: a combination of atrial fibrillation and atrial flutter at the time of surgery; history of open-heart procedures and catheter procedures to cease atrial fibrillation; the presence of concomitant cardiac and "arrhythmogenic" pathology. Results: In the period of May 01-30, 2020, 100% (n=301) of the patients included in the study were assessed by the method of targeted survey. The median duration of the postoperative period to the time of a patient's survey was 21 (3; 43) months. The interviews have shown that 136 (45%) patients noted a return of complaints associated with atrial fibrillation recurrence in the postoperative period. There was a clear tendency towards a decrease in the total number of patients with complaints of the clinical recurrence of the disease, depending on the time elapsed since the surgical procedure. The longer the period from the moment of surgery, the lower the number of patients with recurrence. Of 136 patients with recurrent complaints associated with atrial fibrillation, 97 (71%) were able to conduct the daily electrocardiogram monitoring. Of these, the instrumental recurrence of atrial fibrillation was confirmed in 59 patients, which amounted to 20% of all the patients included in the study (n=301). Conclusion: To establish the true number of atrial fibrillation recurrence after cryoballoon ablation of the pulmonary veins, a targeted survey of patients is desirable for up to 12 months after the surgery. The patients with complaints which suggest atrial fibrillation recurrence, even if these complaints do not correspond to the preoperative ones, should be invited for the instrumental diagnostics of arrhythmia.

Various studies demonstrate that recurrence of cardiac myxoma (CM) occurs in 2.1–5.3% of cases. In cases of treatment of familial myxoma, the need for reoperations can reach 20–25%. It should be taken into account that among all benign cardiac tumors, CM is detected in up to 80% of cases, and the need for its surgical removal is beyond doubt. The aim. To present a case that is of particular interest due to an unusual multiple myxomas lesion of the heart of multi-chamber localization. Material and methods. This article presents an unusual case of detecting multiple myxomas of multi-cameral heart lesions 6 years after removal of myxoma of the left atrium of typical localization. The distinguishing feature of the course of the disease lies in the fact that in this case, a careful study of the life history did not reveal the characteristic signs of familial myxomas and Carney complex which is most often characteristic of multi-chamber lesions of the heart by a tumor process. At the same time, during the surgical removal of the myxoma of the left ventricle, the myxomas of the left and right atrium were revealed, which began to grow. A technical feature of the removal of the left ventricular myxoma of the apical localization was the use of video cameras and instruments for thoracoscopic surgery, which greatly facilitated revi-sion and removal of the hard-to-reach neoplasm. Our experience in surgical treatment of CM equals to 868 operations. Wherein, repeated operations performed in 12 patients were due to recurrence or appearance of a tumor in place other than the primary localization. Conclusions. CM recurrence is one of infrequent complications in the postoperative period, which, however, requires some vigilance and annual Echo monitoring. In the vast majority of cases, CM was represented by the so-called sporadic myxomas, which are more often localized in the left atrium, and rarely recur. If CM is suspected, it is necessary to exclude the possibility of “myxoma syndrome”, which has the frequency of 0.8%, according to our data. The use of the instruments for thoracoscopic surgery can greatly facilitate the removal of hard-to-reach heart tumors localization.

One of the main causes of the development of debilitating pain syndrome after surgical treatment of a herniated disc is herniation recurrence. This pathology dictates the need to perform reoperation on an already operated segment of the spinal column, which complicates the technique of surgical intervention and negatively affects the relief of pain syndrome. In the presented review of scientific publications selected from the medical literature databases PubMed, E-library and Cochrane, the current problems of the pathogenesis of recurrent herniated discs in the lumbar spine are considered. The concept of risk factors for the development of recurrent disc herniation is highlighted, their characteristics are given, and the significance of each of them in the development of recurrent disc herniation is analyzed.

The article discusses etiological factors, pathogenesis, features of clinical manifestations, optimization of diagnosis, treatment and prevention of exudative erythema multiforme of the oral cavity. Currently, such pathological changes in the oral cavity are insufficiently studied and remain relevant in modern dentistry. Promising approaches to the successful treatment of this disease involve the implementation of additional examination and joint treatment with related specialists. Numerous studies of domestic and foreign authors demonstrate that special attention is paid to the prevention of re-morbidity of exudative erythema multiforme, aimed at preventing the occurrence of lesions of the oral mucosa.

The aim of the work – to analyze modern scientific and practical achievements in the effectiveness of implants in planned and emergency hernia surgery and to identify promising areas for further research. The literature review presents modern views on the assessment of biocompatibility, effectiveness and appropriateness of the use of implants in planned and urgent hernia surgery. The importance of determining the main factors of ventral hernia occurrence, assessing the prognostic components of the reparative process course in the field of hernioplasty and methods of correction has been substantiated. Physicochemical characteristics of implants, which both historically and on an up-to-date level are used according to planned or urgent conditions for performing surgical intervention in patients with ventral hernias, are given. The necessity of using an integrated approach to choosing a method for correction or reconstruction of the abdominal wall, taking into account the biological and dynamic conditions of its state, is shown. The need for a selective approach to the choice of therapeutic tactics in patients, especially if hernia repair is necessary in conditions of a clean-contaminated or infected surgical wound, is emphasized. Conclusions. In order to improve the consequences of hernioplasty, it is necessary to assess patient's reserves and risks more thoroughly and comprehensively, as well as to make absolute indications for the use of implants. An improvement in the results of urgent and planned repair of ventral hernias is to perform surgical interventions only in surgery departments constantly provided with modern world achievements.

The study objective is to assess functional and oncologic results of transhyoid approach used for surgical treatment of oropharyngeal carcinoma.Materials and methods. Operative records, hospital charts and data from out-patient department of 55 patients (T1 – 6, T2 – 16, T3 – 19, T4 – 14) with oropharyngeal carcinoma operated via a transhyoid approach were reviewed. Postoperative period was reviewed for complications. All oncologic adverse events were registered with special emphasis on the rate of local recurrence. A univariate analysis with chisquare and Fisher’s exact test was used to check the correlation between tumor factors and surgical variables (complications, mode of reconstruction). The influence of tumor- and treatment-related variables (T stage, differentiation, perineural invasion, p16 status, depth of invasion, extension to the oral cavity, adjuvant treatment) on the rate of local recurrence was studied in the same way. The log-rank test was used to assess differences in survival curves. The data was compared with other series of patients treated with the same technique.Results. Seventeen (30,9 %) patients developed 29 complications. There was 1 postoperative death. Five (9,1 %) patients required repeated operation. The mode of reconstruction (primary closure vs flaps) was a major factor influencing the rate of complications. Fifty (92,6 %) patients were able to resume oral diet with a duration of nasogastric tube feeding of 7–35 days. Three-year overall/disease-specific survival for the whole cohort were 47 and 51,1 %, for p16-positive (22 %) cohort – 65,6 and 87,5 %, for p16-negative (78 %) cohort – 40,6 and 46,8 %. Thirteen (24 %) patients developed a local recurrence. The rate of local recurrence was negatively affected by p16 negativity (p = 0,048), depth of invasion >10 mm (p = 0,044) and depth of invasion >15 mm (p = 0,003).Conclusion. Transhyoid approach may be considered as a surgical option for treatment of oropharyngeal carcinoma with acceptable rate of complications.

Background: To predict the development and recurrence of cervical cancer (CC), we selected three oncoassociated miRNAs: miRNA-20a, -21, whose overexpression leads to the development of tumors, and -23b, which acts as an oncosuppressor. Aim: To evaluate the microRNA profile in the cervical epithelium for predicting CC recurrence in patients who underwent early treatment.Materials and methods: In the study of the informativeness of expression included 145 patients with T1a1-T2a1N0M0 CC who were followed up for 2 years after treatment. Expression of microR-NA-20a, -21 and -23b was analyzed in tumor tissue samples.Results: The risk of recurrence decreased from 1.0 to 0.92 after 1 year of the follow-up, and to 0.84 after 2 years. The initial expression of microRNA-20a and -21 in the cervical epithelium in patients with recurrent CC was 44% and 47% higher, respectively, than in patients without recurrence, while microRNA-23b expression was 46% lower. When initial levels of microRNA-20a and -21 expressions were 1.08 and 1.18, respectively, the risk of CC recurrence during the first two years after the surgery increased by 10.15 and 7.62 times, respectively. MicroRNA-20a expression in cervical epithelium equal to 1.08 was associated with 23% risk, and equal to 1.4 - with 79.7% risk. MicroRNA-21 expression equal to 1.18 was associated with 15% risk of CC recurrence; equal to 1.4 - with 55.5% risk; equal to 1.7 - 94.6%. Logistic regression showed that recurrence risks increased sharply when microRNA-23b expression declined.Conclusion: We registered higher levels of mi-croRNA-20a and -21 expressions and lower mi-croRNA-23b expression in patients with recurrent CC, compared to favorable course of the disease. An analysis of the expression profiles of micro-RNA-20a, -21 and -23b after CC diagnosis allow prognosis of recurrence risks within 2 years after the tumor removal surgery.

Helicobacter pylori infection is a common bacterial infection in humans and is associated with peptic ulcer disease and chronic gastritis. The presence of natural resistance to some antibiotics in bacteria, as well as the appearance of primary and secondary resistance to antibacterial agents, complicates treatment and determines the search for new methods of therapy. The aim of this study was to evaluate the efficacy and safety of 10-year complex treatment of patients with duodenal ulcer associated with H.pylori , 136 patients (96 men, 40 women; mean age 45.8 14.8 years; 18-65 years). H.pylori was determined morphologically and by rapid urease test one day before the start of therapy, after 1, 6, 12 months, 2 years, 5 and 10 years. Patients of the first group received basic therapy: omeprazole 0.02 g 2 times a day, clarithromycin 0.5 g 2 times a day, amoxicillin 1 g 2 times a day, for 10 days (OCA group 1; n = 98). Patients of the second group, in addition to the basic therapy, took 1 mg per day drug Liсopid (group 2 OСAL; n = 38). At the 1st stage of the clinical study, 130 patients completed eradication therapy. Tracking completeness was 96 %. The frequency of H.pylori eradication after per protocol treatment: OCA - 83 % (95 % CI: 75 %-91 %), OCAL - 97 % (95 % confidence interval (CI): 92 %-100 %). The incidence of adverse reactions after treatment (per protocol): OCA - 26 % (95 % CI: 17-35 %; nausea; n = 24), discontinued treatment - 5 % (95 % CI: 0.8 %-10 %; diarrhea; n = 5); OCAL - 3 % (95 % CI: 0.01 %-8 %; nausea; n = 1), all were treated. Taking the drug Liсopid 1 mg (glucosaminyl muramyl dipeptide, JSC Peptek, Russia) as part of complex therapy contributed to the elimination of H.pylori and the absence of relapses for 2 years. Observation of patients in the next 5 and 10 years also showed the advantage of including the immunomodulator in therapy: a significant 15 % decrease in H.pylori reinfection (P 0.05), a 23 % decrease in the frequency of gastrointestinal adverse reactions (P0.01), compared with a 10-day standard triple regimen without immunomodulatory therapy with glucosaminylmuramyl dipeptide. When using several antibiotics in H.pylori eradication therapy, not only pathogenic, but also commensal microorganisms are destroyed, the waste products of which are vital and maintain immune homeostasis, including through the NOD2 receptors of innate immunity. The effectiveness of the complex therapy of H.pylori infection can be explained by the fact that the drug Liсopid compensates for the signal for innate immunity receptors that is missing due to the absence of commensals, providing an adequate immune response and preventing chronicity and recurrence of infection.

Aim. To identify risk factors for recurrence of ovarian endometriomas after surgical treatment.Materials and methods. The retrospective cohort study included 82 patients operated on for the first time for ovarian endometriomas, the follow-up period was 30 months. The recurrence developed in 19 patients (group 1), in 63 the recurrence was not diagnosed (group 2). Data prior to surgery (clinical characteristics, level CA-125), during surgery (cytokine concentration in peritoneal fluid, immunohistochemical analysis in capsule of ovarian endometriomas), postoperative therapy were evaluated as risk factors for recurrence. The Mann-Whitney U-test, the Fisher exact test was used to compare the groups. Specificity, sensitivity, accuracy, AUC ROC and threshold values were calculated.Results. The recurrence rate of ovarian endometriomas was 23%. There were no differences between groups according to age, proportion of smokers, body mass index, gynecological anamnesis, obstetric status and postoperative hormone therapy. Preoperative concentrations of CA-125 in group 1 were higher than in group 2: 62.5 U/ml [40.7; 112.3] vs 40.3 U/ml [20.3; 68.8], р < 0.05. The concentration of IL-6, IL-8, TNFα, IL-1β, IL-17, VEGF, MCP 1 in peritoneal fluid taken during surgery was statistically significantly higher in group 1. The highest AUC ROC was received for VEGF 0.875 (0.778–0.973) and IL-8 0.953 (0.896–1.009). For VEGF the threshold value was 125.6 pg/ml, sensitivity 100%, specificity 71%, accuracy 79.8%. For IL-8 the threshold value was 128.78 pg/ml, sensitivity 93%, specificity 87.1%, accuracy 88.9%. In group 1, higher expression values of VEGF and CD34 angiogenesis markers in ovarian endometriomas were recorded. The highest AUC ROC was noted for CD34 — 0.844 (0.683–1.000), threshold value was 2.5%, sensitivity 90%, specificity 75%, accuracy 80.8%.Conclusion. Risk factors for recurrence of ovarian endometriomas after operative treatment include VEGF and IL-8 levels in peritoneal fluid and expression of CD34 in the capsule.

Objective: a retrospective analysis of association of the tumor stage of stromal cell ovarian tumors with the frequency of recurrence and development of metastases in lymph nodes.Materials and methods. 473 patients with stromal cell ovarian tumors with various histological types were examined, and long-term treatment results were evaluated.Results. The highest recurrence rate (more than 80 %) was observed in stages II, III and IV. The frequency of development of metastases in the lymph nodes was highest in patients with stromal cell ovarian tumors of III–IV stages (50 %); however, in more than 40 % of cases of metastases in the lymph nodes was developed in patients with stromal cell ovarian tumors of IА, IВ, IС stages. The remaining 10 % of cases were in patients with stromal cell ovarian tumors of II stage. In patients with I stage without lymphadenectomy, metastases in the lymph nodes was developed in 21 % cases.Conclusions. The high frequency of lymph node metastasis in patients with stromal cell ovarian tumors is a risk factor, which had to be evaluated to develop surgical treatment tactics.

Undifferentiated bladder cancer (G4 UBC) is aggressive disease with high potential for metastatis and local recurrence. All patients have muscle invasive disease at a presentation, which requires radical cystectomy (RCE). Purpose: to study current treatment modalities applied to G4 UBC patients, survival outcomes, the place of salvage cystectomy after organ-preserving treatment. Materials and methods. During 1998–2016, we treated 63 patients with G4 UBC, or 1.8 % of all UBC patients. We analyzed clinical data, treatment methods, and survival data. Kaplan-Meier method was used for comparative survival analysis between G4 UBC patients who developed recurrence after organ-preserving treatment and those who did not. Results. All patients had ≥рТ2 stage disease. Treatment with curative intent was delivered to 78 % patients – resection of the bladder (49 %), RCE (29%). Survival at 5 years was 11 %. Recurrence after resection was diagnosed in 35 % of patients. Salvage cystectomy was performed in 6 patients with median survival of 7 months vs. 47 months after RCE. Patients also demonstrated high median survival after combined treatment: after resection with adjuvant radiotherapy to the bladder (44 months), and RCE with adjuvant chemotherapy (12 years). Survival of patients with recurrence and further special treatment turned out to be better than in patients without recurrence (P = 0.005). Conclusions. Radical cystectomy demonstrates better survival results in managing G4 РСМ patients than salvage cystectomy. Organ-preserving treatment combined with radiotherapy demonstrates survival outcomes comparable to those after radical cystectomy.