The article is devoted to the most relevant topic at present — the possibilities of providing full medical care to cancer patients in the context of the spread of the COVID‑19 coronavirus pandemic. Cancer patients are the most vulnerable group, because they are at high risk from the position of immunosuppression, which is often combined with other risk factors for infection: old age, diabetes and cardiovascular diseases. Procrastination and delaying the start of antitumor therapy is unacceptable, since it inevitably leads to a deterioration of treatment results, an increase in one-year mortality and worsens the overall survival rate for malignant neoplasms. Thus, it is necessary to develop a set of measures that will allow all types of anti-cancer treatment to be carried out in parallel with anti-epidemic measures without losing the quality of treatment and preserving the safety of patients and medical personnel.

Purpose of the study. To assess the chances of development of squamous intraepithelial cervical lesions of high degree (H‑SIL) in patients infected with human papillomavirus (HPV).

Patients and methods. 75 HPV positive patients. The main group — with a histological diagnosis of H‑SIL (n=50), the control group — with a histological diagnosis without H‑SIL (n=25). Liquid-based cytology, colposcopy, cervical excision; HPV test, diagnosis of sexually transmitted infections — PCR in real time; a comprehensive bacteriological study. Assessment tool interconnections — odds ratio, categorical data analysis — statistical packages STATISTICA 6.0 and SPSS 22 "Statistical Package for the Social Sciences".

Results. In the age group up to 30 years, the chances of H‑SIL development are 26 times higher, 30–40 years — 38 times higher compared to patients over 50 years (p<0.05). With a menstrual cycle of more than 35 days, the chances of H‑SIL development are 71 times greater than in patients with a normal menstrual cycle (p<0.05).Comparison of the chances of the presence of abnormal colposcopic patterns — the presence of significant lesions related to the II degree of colposcopic changes increases the chances of H‑SIL 8.4 times compared to the normal colposcopic pattern. The chances of development of H‑SIL in patients with colposcopy results of minor lesions (I degree), do not differ from those who have a normal colposcopic picture (p>0.05). The presence of chronic inflammatory diseases of the pelvic organs. Earlier treatment of cervical diseases by destruction reduces the risk of H‑SIL 0.08 times. The presence of chronic diseases of the pelvic organs increases the risk of H‑SIL 24 times (p<0.05).

Conclusion. The group at greatest risk of having H‑SIL -women 30–40 years, whose menstrual cycle is more than 35 days, with significant lesions according to the results of colposcopic examination, chronic diseases of the pelvic organs, which had not previously been carried out destruction of the cervix.

Purpose of the study. A comparative analysis of the intensity of lipid peroxidation and the functioning of various units of the antioxidant system in the blood of patients with malignant pancreatic lesions and with chronic pancreatitis.

Patients and Methods. The content of malondialdehyde (MDA) and diene conjugates, the activity and content of antioxidant enzymes (superoxide dismutase, catalase, glutathione reductase, glutathione peroxidase), the content of reduced glutathione and blood thiol status, as well as the content of vitamins E and A (as indicators of the non-enzymatic link of the antioxidant system), were studied in the blood of 51 patients before treatment and 22 donors. Based on a histological study of tumors, patients were divided into groups: neuroendocrine pancreatic cancer, pancreatic adenocarcinoma, pancreatic adenocarcinoma with a neuroendocrine component; a group of patients with chronic pancreatitis was also identified.

Results. According to most of the studied parameters, neuroendocrine cancer differs from pancreatic adenocarcinoma in a more pronounced imbalance in the functioning of all units of the antioxidant system, which contributes to a greater intensification of free radical processes. Chronic pancreatitis was characterized by a lower content of all the studied antioxidant enzymes, as well as a decrease in the thiol status of the blood as compared with a malignant pancreatic lesion, which was possibly associated with the highest MDA level in the plasma of patients with chronic pancreatitis. At the same time, the content of vitamin E in chronic pancreatitis was significantly higher than for adenocarcinoma and adenocarcinoma with a neuroendocrine component.

Conclusions. The most pronounced violation of oxidative status is one of the metabolic features of neuroendocrine cancer. Differences revealed in patients with neuroendocrine cancer, adenocarcinoma and pancreatitis can be useful both in the diagnosis of different types of pancreatic lesions and for assessing the state of patients during treatment.

Purpose of the study. To evaluate the potentialities of ultrasound method in diagnosing cervical lymph node metastasis in patients with first diagnosed papillary thyroid cancer (group 1) and in patients previously treated surgically at different clinics of the Russian Federation and subsequently admitted to the A.F.Tsyb Medical Radiological Research Center — Branch of the National Medical Research Radiological Center to receive radioactive iodine therapy (group 2).

Patients and methods. Patients with PTC were divided into two groups. Group 1 included 649 patients with first diagnosed PTC. All the patients underwent thyroidectomy and level VI lymph node neck dissection at the clinic of the A.F.Tsyb Medical Radiological Research Center — Branch of the National Medical Research Radiological Center. Of these patients, 92 patients underwent cervical lymph node dissection including levelsII–III–IV and 9 patients underwent cervical lymph node dissection including level VB. Group 2 consisted of 2875 patients who had previously received surgery at different clinics of the Russian Federation. Subsequently, they were admitted to our institution to receive radioactive iodine therapy. In 291 of these patients, cervical lymph node metastases were found and reoperations were performed: in 89 cases at level VI, in 170 cases at levels II–III–IV and in 32 cases at level VB. The detected metastases were verified histologically.

Results. Histology confirmed the presence of nodal metastasis in 57.6% of 649 patients in group 1, and in 10.1% of 241 patients in group 2. In group 1, the incidence of metastatic disease in level VI nodes was 73% and in group 2, it was 30.6%. Metastases in levels II–III–IV were noted in 24.6% of patients in group 1, and in 58.4% of patients in group 2. Level VB metastasis was found in 2.4% of patients in group 1, and in 11% of patients in group 2. Multiple metastases were detected in 75.4% of patients in group 1, and in 20.3% of patients in group 2.

Conclusion. Central lymph node metastasis was observed in 73% of patients who were first diagnosed with PTC and treated with thyroidectomy and prophylactic level VI cervical lymph node dissection. In group 2, solitary metastases to lateral lymph nodes occurred more frequently after surgical treatment for PTC, which suggested that the primary treatment was insufficiently radical.

Purpose of the study. To study experimental model of purulent wounds efficiency of the combined effects of benzalkonium chloride and metronidazole immobilized on various bases.

Materials and methods. The material was in vitro studies and experimental animals (Wistar rats), which was modeled a purulent wound and then divided into 3 groups according to the treatment method with the three studied combinations, each of which contained benzalkonium chloride and metronidazole, the combinations differed in bases, which were polyethylene oxide or sodium salt of carboxymethylcellulose, or polymethylsiloxane polyhydrate. Research methods: in an in vitro experiment, growth retardation zones were determined for the most common pathogens of wound infection using the standard disc method. In an in vivo experiment the healing process was evaluated by Popov's planimetric method, the contamination of the wounds was studied by sowing the biopsy of wounds on nutrient media with subsequent counting of the grown up colonies. The data were processed statistically, the reliability of the differences was assessed by the Kruskal-Wallis test.

Results. All test combinations showed high growth retardation areas for all test strains of microorganisms. Objectively, the highest results were observed with a combination of polyethylene oxide (Staphylococcus aureus 30 (29; 30), Bacillus cereus 27 (27; 28), Escherichia coli 20.5 (20; 21), Proteus vulgaris 21.5 (20; 22), Pseudomonas aeruginosa 17 (16; 17), Candida albicans 25.5 (25; 26)). In determining the healing rate, it was noted that the maximum values in the groups when using combinations based on the sodium salt of carboxymethylcellulose and polymethylsiloxane polyhydrate occurred on day 1–3 (29.6 (27.6; 31) and 20.2 (18.8; 24.2) mm²/day, respectively), and in the group using a combination on polyethylene oxide — for 3–5 days (20.6 (17.3; 22.8) mm²/day).

Conclusion. Our studies have shown the high antimicrobial activity of all the developed combinations for all the strains of microorganisms studied. It is also possible to recommend combinations on polyethylene oxide and sodium salt of carboxymethylcellulose for further preclinical studies at all times of treatment, and a combination based on polymethylsiloxane polyhydrate only in the first phase of the wound process.

Purpose of the study. To demonstrate the difficulties of objective interpretation of providing medical care to patients with critical limb ischemia.

Materials and methods. The results of treatment of more than 29 thousand patients of one of the highly specialized medical organizations of St. Petersburg were studied, in which the main activity of the staff is the examination of patients with surgical infection of soft tissues (particularly, the critical limb ischemia).

Results. It has been ascertained that, despite the unconditional success of providing medical care to patients with critical limb ischemia, a high frequency of unsatisfactory treatment results for this category of patients remains (in 2017, among 685 patients of the specialized department of the highly specialized medical organization, the proportion of cases of performing high amputations of limbs and mortality, respectively, was 11,7% (80) and 2,6% (18)). It has been demonstrated on clinical examples that the pronounced comorbidity of critical limb ischemia patients and the severity of their general condition (combined with organizational difficulties in providing them with providing medical care in conditions of highly specialized medical organization) contribute to the formation of complications (up to lethal outcomes) of not only the underlying, but also concomitant diseases. Difficulties in providing medical care of adequate quality in life-threatening conditions for patients of highly specialized medical organization in cases of critical limb ischemia necessitate a wider interaction between specialists in narrow and multidisciplinary hospitals as part of the emergency surgery service.

Conclusion. When creating specialized medical centers outside of multidisciplinary medical institutions, the possibilities should be provided for the regulated involvement of highly professional consultants with a reasonable algorithm for routing patients in cases of the need for their emergency re-hospitalization to other medical institutions.

Purpose of the study. To assess the degree of influence of ischemic disorders in the prostate on the level of androgens.

Materials and methods. This was an experimental study that included 20 white non-linear sexually Mature rats. All animals were divided into 2 equal groups: main and control (intact). In the main group of animals (n=10), we created a model of chronic ischemic disorders in the prostate by partial ligation of the inferior Vena cava. After 1.5 months, we conducted a hormonal study in all rats (n=20) — determining the concentration of androgens (testosterone, dihydrotestosterone) and estrogens (estradiol) in the blood of animals and prostate tissue.

Results. In the blood of animals of both groups, the level of total testosterone and estradiol did not significantly differ (p>0.05). The level of dihydrotestosterone in the blood serum of rats of the main group on the background of ischemia was reduced by 18.1%, compared to the intact group (p>0.05). However, we detected elevated levels of testosterone (p<0.05) and dihydrotestosterone (p>0.05) in prostate tissue against the background of chronic ischemia.

Conclusions. Chronic ischemic disorders in the prostate can be an independent pathogenetic factor in the development of BPH. Vascular damage leads to impaired blood flow and hypoxia, with increased tissue concentration of testosterone, which potentiates the development of BPH.

The review is devoted to the analysis of the problem of synergistic ideas application in oncology after simultaneous combined application of agents. An example of the determination and quantification of the synergistic enhancement ratio is presented. It is emphasized that independent addition is determined by product of probabilities of the effects induced by each agent applied separately. Elevated temperatures synergistically enhance the lethal effect of ionizing radiation and chemical compounds used in the treatment of cancer. Analyzing the dependence of the synergistic effect on the acting temperature after its simultaneous application with ionizing radiation or cisplatin, the existence of an optimal temperature ensuring the greatest synergistic interaction was shown for cultured mammalian and yeast cells. The universal regularities of the manifestation of synergism, independent on the agents, biological objects and tests used, are noted. The greatest synergy is observed with the simultaneous application of agents. The synergism recorded as a result of the combined effects of two factors is observed only with a certain ratio of the effects induced by each agent. Synergism depends on the intensity of the factors used — the current temperature, the dose rate of ionizing radiation or the concentration of chemical agents. These universal patterns have been demonstrated for proand eukaryotic cells, including oncological origin. The existence of universal patterns of synergism indicates the need to develop a new paradigm and theoretical model of synergism, which should take into account the identified patterns. An original biophysical concept of synergistic interaction is proposed. Concrete results are presented that demonstrate the possible ways of using the ideas of synergism in oncology by achieving the greatest synergistic enhancement ratio for the combined effects of various physical and chemical agents. It is concluded that the knowledge and the application of the ideas and general patterns of synergy described in this paper can be useful for specialists using the simultaneous action of various agents to optimize combined treatment methods in modern oncology.

Mitochondria are intracellular organelles in eukaryotic cells that participate in bioenergy metabolism and cell homeostasis, including ATP generation through electron transport and oxidative phosphorylation in combination with oxidation of metabolites by the tricarboxylic acid cycle and fatty acid catabolism via β-oxidation. the production of reactive oxygen species, as well as the initiation and implementation of apoptosis. Mitochondria play a crucial role in cellular energy metabolism and the regulation of programmed cell death. mitochondria activate numerous signaling pathways associated with cell death. Mitochondria have the ability to control the activation of programmed cell death by regulating the translocation of proapoptotic proteins from the intermediate space of mitochondria to the cytosol. This is the reason for the emergence of a new discipline — mitochondrial medicine. The review examined and analyzed scientific publications on the role of mitochondria in the life support of transformed cells, the study of their functioning and structurally functional dysfunctions, as part of mitochondrial medicine. Mitochondrial medicine is a developing discipline whose significance stems from the central function of mitochondria in the production of adenosine triphosphate, the generation of reactive oxygen species, and cell death due to necrosis or apoptosis. Consequently, mitochondrial dysfunction plays an important role in the pathophysiology of cancer, many other common diseases and side effects of drugs. Perhaps the combined use of modulators of mitochondrial metabolism and antitumor therapy will contribute to the emergence of a new direction in antitumor treatment, which will significantly increase the effectiveness of cancer treatment.

This literature review describes various surgical techniques that reduce the urinary incontinence chance after orthotopic plastic surgery of the bladder by Studer. Satisfactory retention of urine is possible in case of maintaining the maximum length of the urethra, consistency of vesico-urethral anastomosis, sufficient volume of neocystis with low pressure, as well as functional and morphological adaptation of the intestinal wall. The techniques that help to reduce tension in the region of the vesico-urethral anastomosis and pressure in a short mesentery, preservation of functional urethral length by "secondary sphincter" using, attention is paid to some exposure characteristics of the ileum segment of sufficient length for the formation of neocities a satisfactory amount of, performing neotestamentaria during robot-assisted of cystoplasty, comparing the surgical techniques, as well as possible the feasibility of using suture V‑loc. A modified method for forming a robot-assisted anastomosis for laparoscopic operations is described. The results of clinical studies are presented, in one of which the results of modification of the "non-hole" technique are considered, and in the other — the method of temporary tension of the anastomosis zone. The article describes the experience of forming a vesico-urethral anastomosis using a CAPIO cross-linking device, as well as the experience of reconstructing The denonvillier fascia intraoperatively. An artificial device to achieve urinary retention: the artificial urinary sphincter (AUS).

Purpose of the review. Analysis of the objective methods to evaluate the need for prognostic scalesin the intensive care unit for predicting the risk of complications and mortality of cancer patients after elective surgery. The review considers methods for an objective assessment of the severity of the condition of patients in the intensive care unit of the oncological surgical profile: prognostic scales and expert evaluations. We have analyzed studies of foreign and Russian experts about comparing the best of the different prognostic scales in clinical practice for post-elective surgical cancer patients.

Conclusion. Our review considers the need for an objective value of the severity of patients on admission to the intensive care unit for elective oncological surgeries by using prognostic scales. Further researchand selection of the most effective prognostic score complying with the principles of evidence-based medicine for this group of patients have a goodprospect.

Abstract In recent years, there has been a steady increase in the incidence of bladder cancer (RMP) in our country. So, over the past ten years there has been an increase in the number of cases of primary diagnosis of RMP by more than 1.5 times, which corresponds to 77.1 cases per 100,000 population. At the same time, mortality in the first year for the same time period decreased from 22.4% in 2008 to 14.4% in 2019. In 75% of patients, this disease is diagnosed at an early stage (the tumor spreads to the muscle layer — non-muscle-invasive forms of RMP), which allows organ-preserving treatment. One of the factors influencing these indicators is the introduction of new diagnostic search methods into the routine of doctors. Such methods include: photodynamic and narrow-spectrum diagnostics when performing cystoscopy, as well as other methods of increasing the visualization of hidden tumors.

Purpose of the study. The study of the current problems for acute external hemorrhoids (AEH) diagnosis and treatment from the point of view of a practicing ambulatory coloproctologist in the Tver region (based on an analysis of the clinical features of the disease, its course and the applied tactics of the coloproctologist) was made.

Patients and methods. A retrospective study with continuous series of 124 patients (2016–2017), using clinical and statistical research methods.

Results. Acute external hemorrhoids (AEH) is a painful formation that suddenly arises due to acute thrombosis of the external hemorrhoid plexus, located near the anus, mainly at 3, 5, 7 hours on the proctological dial, with a free space between the hemorrhoid and the mucous membrane of the anal canal. Patients with AEH turned to the ambulatory coloproctologist at a later date (on average 11.7 days after the onset of the disease), most often without pain or with slight pain in the anus, with mild and moderate severity of the disease. The main complications of AEH were necrosis and hemorrhoidal wall rupture with bleeding from it. Conservative treatment of patients with AEH was due to clinical guidelines of the Russian Coloproctologists Association (RCA); it was ineffective in 11.3% of patients, who underwent outpatient surgery. All patients with severe pain, high grades of AEH, were offered for hospitalization to the surgical department (including coloproctologcal), but they refused. Low operative activity and late surgery in patients with AEH, who applied to the polyclinic, were due to the fact that only 12 (9.7%) patients sought help within the first 72 hours of the onset of the disease, low severity of pain, as well as the patients refused the proposed operations.

Conclusions. The studied features of the outpatient coloproctologic service in AEH reveal the inadequate availability of system resources for patients, inappropriate informing the population with «mass-media» technologies; it makes difficulties to implement the recommendations of the RCA.

Currently the main way of curable treatment of hepatocellular carcinomas (HCC)* is a liver resection. Candidates for surgery are patient with good score of liver function (Child-Pugh A group), without destruction of great vessels and distant metastases. Hemihepatectomy is associated with a high risk of postoperative liver failure (including portal hypertension, cirrhosis, portal vein thrombosis). This reason leads to premature failure of the operation. According to current clinical guidelines, system therapy is more suitable, despite of the lack of reliable data on its effectiveness in such clinical situations. The presented cases may support the selection of advanced hemihepatectomy as a treatment for hepatocellular cancer C stage BCLC classification.

The case report demonstrates the difficulties in the differential diagnosis between cases of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BI-ALCL) and rupture of the breast implant. Such patients examining algorithm should include breast ultrasound, magnetic resonance imaging, puncture of the breast under sonographic navigation, cytological examination of the obtained fluid. In cases of suspected BI-ALCL a total capsulectomy should be performed during surgery with subsequent histological, immunohistochemical examination of the removed tissue. The low incidence of BI-ALCL should not lead to a lack of caution regarding the verification of this neoplastic process by plastic surgeons and oncologists. If BI-ALCL is suspected, patients should be purposefully examined to confirm or exclude the diagnosis and surgeries are to be performed with the participation of an oncologist-mammologist.

At the present time primary-multiple malignancies are of interest in connection with the frequency of prevalence, which remains at the rather high level and continues to grow up, therefore increasing the relevance of this pathology in clinical oncology and everyday practice. With the exception of the treatment of primary multiple malignancies requiring a multimodal approach, as well as in the case of the use of complex treatment in conjunction with chemotherapists and radiotherapy specialists. In the past three decades, the development of screening tests that prevent and detect some cancers at an early, more treatable stage, and treatment advances have increased the 5‑year relative survival rate for all cancers to 66%. In addition to concerns about cancer recurrence, survivors also worry about their risk of developing a new cancer. Prostate cancer is a leader in terms of morbidity and mortality in the world, just as often are found in combination with other malignant tumors. However, given the high detectability of prostate cancer, primary patients are currently receiving radical treatment, and if metastatic prostate cancer is detected, they are receiving drug treatment, which improves the survival and quality of life of patients. Soft tissue sarcomas are rare malignant tumors that develop in the connective tissues and remain poorly understood due to the fact that they make up less than 1% of all malignant diseases. One of the main methods for treating soft tissue sarcomas is the surgical method. Soft tissue sarcomas are difficult to treat and therefore it is imperative that surgeons and other specialists have experience in treating this disease. Studies show that patients with this pathology show better results if they receive treatment in specialized cancer centers that have experience in treating soft tissue sarcoma. This article demonstrates the clinical case of surgical treatment of a patient with primary multiple retroperitoneal tumors and metastatic prostate cancer.

Purpose of the study. Improving the work of the admission department of a large multidisciplinary hospital with the help of new organizational technologies.

Materials and methods. The basis of the study is N.I. Pirogov Samara State Clinical Hospital No. 1. The paper used methods of organizational modeling and statistical analysis.

Results. Prior to the introduction of new organizational patient-oriented technologies, the following problems were identified in the hospital admission department: mixing flows of planned and emergency patients, patients with a neurological and cardiology profile, patients receiving paid services; the inability to provide resuscitation in the ward; ineffective routing and coordination of patients; the start time for medical care ranged from 30 minutes to 3 hours. After improving the organization of medical care in the admission department, the infrastructure, the order of the department, the staffing of the department and the logistics of patients changed. The flows of patients were divided, zones for emergency patients were allocated: the “red zone” is intended for patients in an extremely serious condition with impaired vital functions; The "yellow zone" is intended for patients who are in a serious condition or in a state of moderate severity, with impaired self-movement, the "green zone" is intended for patients whose health condition does not threaten life. As a result of the introduced changes, the time to begin providing medical care to patients in serious condition was reduced to 1–2 minutes, the time spent by patients in the admission department was reduced to an average of 40 minutes, the number of outpatients received over the past three years increased by 37.7% (from 15528 to 21387).

Conclusion. As a result of improving the work of the admission department, the time spent by patients in the admission department was reduced; increased throughput of the department; qualitative and quantitative indicators of work have changed.