TREATMENT OPTION TO THE FERTILITY-SPARING RADICAL TRACHELECTOMY AFTER NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH CERVICAL CANCER WITH TUMOR SIZE >2CM.

Radical trachelectomy combined with pelvic lymphadenectomy (PLND) has been used to treat early stage cervical cancer patients who wish to preserve their fertility. But vaginal, abdominal, laparoscopic, and robotic approaches used for radical trachelectomy with pelvic PLND cause peritoneal damage, which could result in periadnexal adhesion. Here, we propose the neoadjuvant platinum based chemotherapy (NACT) with the vaginal radical trachelectomy with retroperitoneal PLND as a fertility-preserving option for early stage cervical cancer patients. VRT with retroperitoneal PLND was performed in three women with FIGO 2018 stage IB2 and IIA1 cervical cancers. In all three patients, complete response was achieved without causing any intraoperative and severe postoperative complications. NACT for fertility sparing treatment is an innovative approach, which is potentially quite interesting for many young women affected by cervical cancer with the tumor size >2 cm. Vaginal radical trachelectomy with retroperitoneal PLND can be safely performed and peritoneal damage, which can cause periadnexal adhesion, could be avoided. We consider that this surgical approach and NACT may be a good treatment option for women with cervical cancer who wish to preserve their fertility.

ANTI HOMOTOXIC DRUGS USING IN DENTAL PRACTICE.

In modern conditions, against the background of increasing numbers of complications when using potent chemicals, it became necessary to looking for alternative medicines, such as homeopathic medicines. The aim of this review article is to prove the importance of further research of the antihomotoxic drugs (AHTD) using, which are an integral part of homeopathic therapy, for the complex treatment of diseases of the maxillofacial region of various genesis, taking into account the mechanism of action of this group of homeopathic medicines. More than 30 scientific sources of the antihomotoxic drug "TRAUMEEL®S" using in treatment of inflammatory diseases of the maxillofacial region, as well as the use of homeopathic medicines to prevent the development of necrotic phenomena in the pulp of tooth have been processed. The importance of further studies on the use of antihomotoxic drugs, which are an integral part of homeopathic therapy, for the complex treatment of diseases of the maxillofacial region of various origin, taking into account the mechanism of action of this group of homeopathic drugs have been substantiated. The therapy with antihomotoxic drugs, namely, "TRAUMEEL®S", produces positive results in treatment of various inflammatory processes of the maxillofacial area in various dental diseases.

BACTERIAL CONTAMINATION AND METHODS OF DECONTAMINATION OF BASES COMPLETE REMOVABLE PROSTHESES DURING THE APPLICATION OF ADHESIVE MATERIALS.

It turned out that the permanent microbiota of surfaces of acrylic bases of complete removable plastic dentures (CRPD) characterized by several features: the presence of aerobic (7) and anaerobic (10) species. Qualitative and quantitative compositions of microbiocenosis in orthopedic treatment stages have been changed. The revealed patterns require further study in the context of the improvement of decolonization of acrylic bases in the stages of orthopedic treatment by CRPD. Deactivation of acrylic bases of CRPD significantly affects the species composition of microbiota, reduces the quantitative parameters of bacterial contamination. The purpose of our work was determination of bacterial contamination of acrylic bases of CRPD in stages of their clinical exploitation and study of changes in the quantitative composition of the acrylic bases microbiota of CRPD under different decontamination modes. Smears from the inner surface of the acrylic base were stained with Gram and microscopic and seeded on blood agar, Endo agar, Chistovich, Saburo. Species belonging to the micro-organisms were identified by the LAHEMA test system and were determined in colonies forming units (CFUs). These data indicate accumulation under the acrylic base in the course of clinical operation of certain types of microbiota, which requires improvement of the methods of their decontamination. We studied the change in the quantitative and specific composition of the microbiota (bacterial contamination) of acrylic bases CRPD under different modes ("A", "B"). Patients in group "A" used the Sideex solution - a two-component system consisting of a liquid component (glutaraldehyde solution) and a powdery activator, mixed before use to obtain a working activated solution. The liquid component is a clear, colorless solution with a specific odor, which is a 2.2-2.7% aqueous solution of glutaraldehyde, which is an active ingredient, pH=3.0 - 4.5. Powdery activator is a pale-yellow powder containing alkaline components, a corrosion inhibitor, and a dye. The activated working solution is a fluorescent green solution with a specific odor and containing 2.2-2.7% glutaraldehyde; pH=8.2-9.2. (Great Britain). Preparation of the activated solution: a powder-activator is added to the container containing the liquid component (avoiding losses). Cleaning is carried out by the method of full immersion of the prosthesis in solution, with a thickness of the drug over it not less than 1 cm. The dentures are soused in solution for 15 minutes, then thorough washing in the same solution for 1-3 minutes. Sideex activated solution is used for sterilization and disinfection of metal, glass, polymeric (plastic, rubber, etc.) medical products. The dentures of patients from group "B" are decontaminated with 0.2% solution of chlorhexidine bigluconate. The dentures were placed in the solution overnight for 14 days, changing the solution every two days. The decontamination of acrylic bases of CRPD should be considered mode "B" as more effective because of the significant decrease in the species composition of the microbiota (the qualitative indicator of reduction of microbial contamination was 72.0%). It is substantiated that decontamination of acrylic bases of CRPD with mode "A" has a small effect on the species composition of the microbiota, although it significantly (p<0.05) reduces quantitative indicators of microbial contamination. Regarding "B" mode, the species composition of aerobes from 31 lgCFU/ml to 8.7 lgCFU/ml and anaerobes from 42.7 lgCFU/ml to 14.6 lgCFU/ml was considered more effective.

RADIATION AND CHEMORADIATION THERAPY FOR I STAGE INTERMEDIATE AND HIGH/INTERMEDIATE ENDOMETRIAL CANCER - DESCRIPTIVE ANALYSIS. / PROMENEVA TA KhIMIOPROMENEVA TERAPIIa U LIKUVANNI RAKU ENDOMETRIIa I STADIÏ PROMIZhNOÏ TA VYSOKOÏ GRUP RYZYKU -DESKRYPTYVNYI ANALIZ.

INTRODUCTION: Endometrial cancer ranks the third place in prevalence among all cancers in Ukraine. The surgicaltreatment and subsequent adjuvant treatment is planned according to the patient's risk group. The choice of radi-ation therapy and the need to add chemotherapy determines the level of recurrence-free survival. OBJECTIVE: The aim of the study was to analyze the database of treated patients in National Cancer Institute, with Istage endometrial cancer intermediate and high-intermediate group; determination of the most frequent choice ofradiation treatment in accordance with the risk group of patients with a hysterectomy with salpingo-oophorectomyfor further observation and evaluation of diseasefree survival. MATERIALS AND METHODS: Retrospective was analysed 245 patients with high and intermediate risk groups with stageI endometrial cancer. The exclusion criteria were: low-risk patients, stages II-IV and non-endometrioid histologi-cal variant. RESULTS: According to the analysis, there were 122/245 (49.8 %) patients of high risk group, 123/245 (50.2 %) ofintermediate risk group. High-risk patients underwent external beam therapy and brychytherapy, supplemented bychemotherapy in 5.8 % of cases (7 patients), brachytherapy with external beam therapy was performed in 58.2 % ofcases (71 patients), brachytherapy - in 8.1 % of cases (10 patients), external beam therapy was performed in 27.9 %cases. Intermediate and high-intermediate risk patients were distributed as follows: brachytherapy was performedin 41.5 % of cases (51 patients), brachytherapy with external beam therapy - 54.5 % (67 patients), external beamtherapy was performed in 5 patients. CONCLUSION: Brachytherapy is available for patients with intermediate risk endometrial cancer and external beamtherapy with possible addition of brachytherapy is recommended for high-intermediate and high-risk groups, espe-cially in patients with lymphatic vascular involvement. All patients are monitored for further assessment of recur-rence-free survival.

Features of recurrence of endometrioid type endometrial cancer of I stage.

The aim of this study was to determine the rates of recurrences of stage I endometrial cancer (EC) and features of their localization depending on the clinical and pathological characteristics of the tumor and methods of patients' treatment. PATIENTS AND METHODS: The study included 968 patients with stage I endometrioid EC, who underwent surgical treatment in the Department of Oncogynecology of the National Cancer Institute in 2015-2019. Surveillance of patients lasted from January 2015 to December 2020, with a minimum follow-up period of 1 year from the date of surgery. Adjuvant radiation or chemotherapy was performed depending on the clinical and pathological characteristics of the EC case. RESULTS: During the follow-up period, recurrences were observed in 7.0% of cases and were most often found in stage IC of low differentiation grade. It was found that during surgical treatment without adjuvant therapy relapses occurred in 12-36 months after the start of treatment, with adjuvant radiation therapy - in 6-18 months, and with adjuvant chemotherapy - in 32-60 months. Recurrences most often occurred in patients with EC who underwent surgical treatment in combination with chemotherapy (p < 0.05). The lowest number of recurrences was recorded among patients who underwent surgery as an only treatment. The best 5-year survival rate was observed in the group of patients with surgical treatment (93%), and the worst - in the patients treated with combination of surgery and chemotherapy (57%). In patients without recurrences, the survival rate after treatment was 97%, while in patients diagnosed with relapses, the survival rate was 65%. CONCLUSION: Despite the predominantly favorable course of EC stage I, some patients develop relapses. The rate and localization of recurrences depend on the histological structure of the tumor and treatment regimens of the EC patients.

Expression of chemokine receptor CXCR4 in tumor cells and content of CXCL12+-fibroblasts in endometrioid carcinoma of endometrium.

BACKGROUND: The expression of the CXCL12 chemokine and its receptor CXCR4 in the stromal component of the tumor plays an important role in tumor cell migration, proliferation, inhibition of apoptosis and determination of invasive and metastatic potential of malignant neoplasms of various genesis. The significance of CXCL12 and CXCR4 expression in endometrial tumor cells for cancer progression is not fully understood. AIM: To evaluate the content of CXCL12+-fibroblasts and expression of CXCL12 and CXCR4 in endometrial cancer cells, depending on the tumor stage. MATERIALS AND METHODS: Surgical material of 45 patients with endometrioid carcinoma of the endometrium (ECE) of the stages I-II and III was studied using morphological and immunohistochemical methods. RESULTS: In ECE of stage I-II CXCR4 expression was lower (43.3 ± 4.2%) while CXCL12 expression was higher (33.6 ± 2.4%) compared with the corresponding indices​​ in ECE of stage III (63.6 ± 3.5%, 24.5 ± 1.9%, respectively, p < 0.05). In ECE of stage III, high expression of CXCR4 (> Me) and low CXCL12 (< Me) was observed in 80% of samples; these tumors invaded more than 1/2 of the myometrium. There was a positive correlation between the depth of tumor invasion in the myometrium and the presence of metastases and CXCR4 expression in tumor cells (R = 0.5 and R = 0.4, respectively, p < 0.05) and the negative correlation with the expression of CXCL12 (R = -0.6 and R = -0.3, respectively, p < 0.05). In tumors that deeply invaded the myometrium, a high number of the CXCL12+-fibroblasts (> Me) (14.9 ± 1.3%) was detected. CONCLUSION: The obtained data reflect the communication of the immunosuppressive factor of the tumor microenvironment, i.e. CXCL12+-fibroblasts and CXCR4 expressing tumor cells. We suggest that the aggressiveness of ECE is determined by the combined effect of these two factors.

KNEE JOINT STRUCTURAL CHANGES IN OSTEOARTHRITIS AND INJECTIONS OF PLATELET RICH PLASMA AND BONE MARROW ASPIRATE CONCENTRATE.

The article presents the results of an experimental study on the knee joint structural changes and morphometric evaluation of articular cartilage with the injections of platelet rich plasma (PRP) and bone marrow aspirate concentrate (BMAC). Cartilage defect, anterior cruciate ligament intersection and medial meniscus resection were performed for the induction of osteoarthritis in rabbits. After 28 days, 0.9% NaCl, PRP or BMAC was administered intra-articularly; 0.9% NaCl or PRP was injected intra-articularly within 14 days. After 2 months, histological and morphometric examination of the epiphyseal surface of the femur and tibia was performed. Animal models showed identical diameter of epiphyseal cartilage defect, chondrocyte reduction (by 55.1%), reduction of perifocal articular surface thickness (by 53.2%) and relative bone density of epiphysis (by 44.3%). Modeling of the joint defect was not limited to the area of damage and caused degenerative changes of the articular cartilage of the tibia. Statistical analysis showed that the introduction of PRP had no preventive effect on the degenerative changes in the articular surface. In the BMAC group, the thickness of the hyaline cartilage of the tibia was found to be 23.1% (P<0.05) greater compared with the 0.9% NaCl group and the double PRP group. However, the relative density of subchondral bone tissue in the experimental groups with osteoarthritis had no differences.