Introduction. Radical cystectomy with urine diversion is recognized as the standard for the treatment of muscle-invasive bladder cancer. One of the dangerous complications in the postoperative period is the stricture of uretero-ileal anastomosis leading to hydroureteronephrosis, renal failure, and urosepsis. One of the factors in the development of the anastomotic stricture is ischemia. In order to reduce possible ischemic injury, the following manipulations are performed: careful treatment of tissues in the area of future anastomosis, preservation of periureteral adventitia, minimal mobilization of ureters before implantation into conduit. Intraoperative assessment of ureteral and intestinal tissue perfusion using ICG-fluorescence is a promising area.

   Materials and methods. The study enrolled 56 patients who underwent a robotic-assisted radical cystectomy with intracorporeal urine diversion from January 2021 to March 2022 at the Bashkir State Medical University Clinic. Patients were divided into two groups: group 1 (22 patients) underwent intraoperative ICG-imaging, and group 2 (34 patients) — imaging without fluorescence. The median follow-up period was 14 months for group 1 and 12 months for group 2. The comparison criteria between the groups were demographic indicators, perioperative outcomes (including 30- and 90-day complications), and the incidence of strictures of uretero-ileal anastomoses. The groups were compared using a test for equality of means and a test for sampling distributions.

   Results and discussion. No statistically significant differences between patients were reported during the time of surgery, estimated blood loss, and duration of hospital stay. No significant differences were also detected in the incidence of 30- and 90-day complications and the number of readmissions among patients in group 1 and group 2 (p = 0.477 and p = 0.089, respectively). The incidence of strictures of uretero-ileal anastomosis in group 1 demonstrated a statistically significant decrease, as compared with group 2 (0/34 [0 %] and 7/68 [10.3 %], p = 0.020).

   Conclusion. The ICG-fluorescence imaging to assess vascularization of the distal ureter during robotic-assisted radical cystectomy with intracorporeal urine diversion may reduce the risk of postoperative uretero-ileal anastomotic ischemic strictures.

   Introduction. Aortic valve replacement with pulmonary autograft (Ross procedure) demonstrated excellent immediate and long-term results. Dilation of the pulmonary autograft in the long-term period is the main reason for repeated surgery. Aim: to study the prevalence of pulmonary autograft dilatation and its risk factors.

   Materials and methods. From April 2009 to December 2022, 158 patients underwent classical Ross surgery. Inclusion criteria: patients aged 18 and older, patients who underwent classical surgery. Exclusion criteria: patients under 18, modifi ed methods of Ross procedure. Follow-up period: 104 (49–124) months.

   Results and discussion. The median age of patients was 33 (25–43) years. Hospital mortality accounted for 0.6 %. Perioperative myocardial injury was 3.8 %, conduction disorder requiring permanent pacemaker implantation accounted for 1.9 %, the incidence of strokes and acute kidney injury requiring hemodialysis was 0.6 %. Ten-year freedom from autograft reoperation was 88.4. Ten-year freedom from reoperation for aortic aneurysm accounted for 92 %. Predictors of autograft dilatation in the long-term period were: age (OR: 0.942; 95% CI: 0.901–0.984, p = 0.008) and the initial size of sinuses of Valsalva (OR: 1.18; 95% CI: 1.027–1.215, p = 0.01).

   Conclusion. Ten-year freedom from autograft reoperation due to aortic dilatation and freedom from aortic dilatation ≥ 45 mm was 92 % and 37.2 %, respectively. The main predictors of autograft dilatation in the postoperative period are the age and the initial diameter of the sinuses of Valsalva.

   Introduction. At present, medical practice lacks a unifi ed approach to the choice of therapeutic tactics for acute catarrhal appendicitis and therefore lacks understanding of negative appendectomy.

   Aim. To study the incidence of negative appendectomy in acute appendicitis. Materials and methods. The methodology involved a retrospective analysis of the results of 1590 appendectomies performed from 2003 to 2005 and a prospective non-randomized study of 1112 patients
for the period from 2018 to 2019. During the first observation period, the examination included physical and laboratory examinations, and in the second period, Alvaro scoring, ultrasound scan, and videolaparoscopy.

   Results and discussion. In the first period, catarrhal forms of appendicitis were reported in 7.82 % of cases, while in the second period — in 3.04 %. The diagnoses were confi rmed pathohistologically in all cases.

   Conclusion. No cases of performing negative appendectomy were reported, based on the results of clinical, endoscopic and pathomorphological examinations. However, the ambiguous interpretation of acute catarrhal appendicitis in the national clinical practice guidelines for acute appendicitis does not allow for unambiguous conclusions from the study.

   Introduction. The present paper considers the issue of emotional burnout among doctors of oncology departments. The profession of a doctor refers to so-called socionomic professions, which are associated with higher socio-psychological requirements as well as mental and psycho-emotional stress.

   The relevance of the study stems from the persistent psycho-emotional problems that arise in the process of professional activity of oncologists.

   Aim. To study theoretical aspects of professional burnout, to carry out experimental evaluation of professional burnout among oncologists and to develop the preventive measures contributing to reduction in symptoms of emotional burnout in oncologists.

   Materials and methods. The author conducted an experimental study of the emotional burnout among oncologists and explored the diagnostics aspects of emotional burnout. The experiment was carried out by means of the questionnaire “Diagnostics of the level of emotional burnout” (V. V. Boyko). The study sample consisted of 50 oncologists.

   Results and discussion. The author revealed that the symptom “experiencing psychotraumatic circumstances” is highly expressed at the stress stage in the group of oncologists with developed emotional burnout (24, 58). The symptom shows preventive reaction to the influencing aspects for emotional burnout: “emotional response” (24, 6), “reduced job performance” (31, 66), characterizing the methods of mental support; the “emotional defi cit” (25, 33), “emotional detachment” (28,12), reflecting the state of parasympathetic nervous system, are considered as the main symptom at the overstrain stage. It was found that the work with critically ill patients demands high level of professional competence, considering the increased responsibility and constant emotional stress.

   Conclusion. The results of the study confi rm the presence of leading symptoms in developing emotional burnout. In order to prevent the development of emotional burnout syndrome, the author proposes to introduce psychological training programs on various topics in medical institutions to minimize professional burnout and to develop soft skills, including self-regulation in communication.

   Aim: to improve the outcomes of surgical treatment of benign prostatic hyperplasia by bipolar transurethral prostatic resection based on the personalized approach.

   Materials and methods. Surgical treatment of prostatic hyperplasia by bipolar transurethral resection of the prostate was carried out in 50 patients: the personalized approach, that is extensive preoperative preparation, was adopted in 25 cases, and the standard procedure was implemented in the rest 25 cases. Functional outcomes were assessed in 1, 3 and 6 months aft er surgery, taking into account intra- and postoperative complications.

   Results and discussion. The use of the personalized approach resulted in the reduction in the duration of surgery (p = 0.019), amount of blood loss (p = 0.027), incidence of hyperthermia in the early postoperative period (p = 0.021), duration of bladder catheterization (p = 0.030) and the duration of hospital stay (p = 0.031). The personalized approach was proved to have a positive eff ect on the functional outcome of bipolar transurethral resection of the prostate: Qmax value in 1, 3 and 6 months (p = 0.037, p = 0.030, p = 0.036), IPSS score in 6 months (p = 0.037), QOL score in 1 and 3 months (p = 0.041, p = 0.030) and residual urine volume in 3 and 6 months (p = 0.035, p = 0.040).

   Conclusions. Th e personalized approach contributes to improving the functional outcomes of bipolar transurethral resection of the prostate, namely, improving the Qmax value in 1, 3 and 6 months, reducing the IPSS score in 6 months and the QOL score in 1 and 3 months, and decreasing the residual urine volume in 3 and 6 months.

   Randomized clinical trials and actual clinical practice differsignificantly. Evidence-based medicine develops new agents referring to, primarily, pharmaceutical findings, preclinical studies and, most importantly, randomized clinical trials. Hepatocellular carcinoma is the most common primary malignancy of the liver, and one of the main causes of fatal outcomes among cancer patients worldwide, including in the Asia-Pacific region, with an estimated 800,000 deaths annually. For more than 10 years, sorafenib, a tyrosine kinase inhibitor, was the only authorized treatment for advanced hepatocellular carcinoma. The next stage in the development of drug therapy for hepatocellular carcinoma involved immune checkpoint inhibitors. The combination of atezolizumab with bevacizumab in the phase III trial (IMbrave150) improved outcomes of advanced hepatocellular carcinoma, such as overall survival and progression-free survival (6.8 versus 4.3). The paper presents the trials of atezolizumab and bevacizumab combination, demonstrates comparable data on the treatment of patients with HCC in real clinical practice and data on the phase III IMbrave150. To further analyze the efficacy of the combination of atezolizumab and bevacizumab, prospective clinical trials should include heterogeneous patient groups.

   Cancer is one of the most common diseases in the world. Th e transcription factor NF-κB plays a key role in various physiological processes including immune response, cell proliferation, cell apoptosis and inflammation. Due to participation of NF-kappa B signaling pathways in carcinogenesis, angiogenesis, and tumor resistance to chemo- and radiotherapy, the factor is considered to be the ideal target for pharmacological treatment of cancer. Th e paper presents a literature review of the RSCI, PubMed, Scopus, Web of Science, Chemical Abstracts NCCN databases and other open access data. The carcinogenesis inhibitors were selected from all NF-κB inhibitors found. Inhibitors with antitumor activity of analytical interest include Bruton tyrosine kinase (BTK) inhibitors, cellular inhibitors of apoptosis proteins (c-IAP), proteasome inhibitors, and one inhibitor of NF-κB translocation to the nucleus. Th e authors analyzed products of diff erent development stages with recorded antitumor activity to varying degrees. NF-κB inhibitors are promising drug candidates, but since NF-κB is involved in most biological processes and the broad spectrum of action can cause side eff ects, the selective action of these compounds is to be explored.

   The off-label use of anticancer drugs is widespread in modern oncology. The potential advantages of such prescriptions are associated with exceeding the expected clinical benefi ts over the risks of complications. The off-label use of anticancer drugs demonstrates the inconsistent efficacy of this approach depending on the type of malignancy, the reasons for prescribing these agents and their belonging to a particular pharmacological group. In a number of situations, the clinical benefits of off-label drugs are more convincing than in case of authorized indications. Currently, prescribing the “old” registered anticancer drugs, used in everyday clinical practice, is seen routine. However, labeling does not reflect the full range of indications with strong evidence of safety and efficacy. The paradigm shift toward molecularly targeted therapy and immunotherapy in various malignancies may increase the off-label use of the specified agents. Lack of treatment options for rare forms of malignancies and exhaustion of the possibilities for registered therapy are the major reasons for off-label prescribing targeted drugs based on the identifi ed molecular genetic disorders. In such cases, the concept of precision therapy is oft en implemented by using agents, the clinical efficacy of which is confi rmed by data with a low level of evidence or with no evidence. Studying the eff ectiveness of the off-label use of anticancer agents is necessary to systematize information and develop algorithms for making decisions about the prescription of these drugs in routine clinical practice.

   Today, the incidence of iatrogenic bile duct injury in laparoscopic cholecystectomy averages 0.4 % worldwide. In Russia, it accounted for 0.6 % in 2020. Side-to-side hepaticojejunostomy is the operation of choice with complete injury of the common bile duct. It is considered the safest operation, which preserves blood supply, provides wider anastomosis, ensures complete rehabilitation in 75–98 % of cases. Even in the centers of hepatobiliary surgery, the development of strictures after hepaticojejunostomy with traditional access after iatrogenic injury to the bile ducts occurs in 10–20 % of cases. Bile leakage develops in 3.0–3.3 % of cases. The success of reconstructive surgery largely depends on the precision technique of performing anastomosis, which can be ensured mainly by the quality of imaging. The possibility of laparoscopic hepaticojejunostomy after a common bile duct injury is currently a subject of debate, and only few publications report on its successful performance. Most surgeons prefer open anastomosis due to insufficient space for laparoscopic instruments. Although the advantages of laparoscopic surgery over traditional interventions are essential for this category of patients no less than for the others. Robotic laparoscopic surgery with its additional space for instruments in the complete absence of tremor, a twenty-fold increase in three-dimensional image, which increases the accuracy of tissue dissection and the precision of anastomotic sutures, can be an excellent option for working on thin tubular structures in the porta hepatis.

   Introduction. Malignant tumors dominate in the picture of disability and mortality worldwide. One of the most frequent and dangerous comorbid conditions is kidney injury. At the same time, the most unfavorable incidence of acute kidney injury is recorded in multiple myeloma, leukemia, lymphoma and kidney and/or liver cancer and malignant ovarian neoplasms. In this regard, of vital importance is the choice of tactics in the prevention of thrombosis and thromboembolic complications, as well as the individual approach to of the anticoagulant therapy regimen during renal replacement therapy sessions, depending on the underlying disease and the state of the hemostatic system.

   Aim. To evaluate the effect of calcium citrate veno-venous hemodiafi ltration sessions on the hemostatic system of a patient with progressive organ dysfunctions associated with malignant ovarian neoplasm.

   Materials and methods. The methodology involved literature review and a case study to assess the effect of veno-venous hemodiafi ltration on hemostasis.

   Results and discussion. The clinical case was assessed in terms of P-selectin (CD62), which characterizes platelet activation processes. It should be noted that in this patient, the expression of P-selectin increased with each session of renal replacement therapy, while the platelet aggregation values remained at the level of the lower thresholds, which indicates a low probability of coagulation initiation. However, due to aggressive regulation of ovarian cancer by the hemostatic system in the form of production of inflammatory mediators, microvesicles, tissue factor expression and endothelial activation, attention should be paid to the molecular aspects of platelet activation in renal replacement therapy with regional citrate coagulation.

   Conclusion. The widespread use of extracorporeal detoxification methods is an independent risk factor not only for bleeding events, but may potentially contribute to thrombosis and thromboembolic complications, which requires a further detailed study of molecular mechanisms of hemostasis regulation by tumor and clinical evaluation of various anticoagulation methods.

   Introduction. Traumatic liver injury is associated with the danger of developing various insidious complications, with some of them appearing immediately and others — eventually against a background of apparent clinical recovery. Modern sophisticated methods enable the character and localization of liver complications to be accurately revealed and those complications to be stopped by means of minimally invasive techniques.

   Materials and methods. A clinical case of the traumatic hepatic rupture caused by a fall from height and the subsequent development of successive complications, which, except for the primary surgery — suturing of the liver rupture through laparotomy — were stopped by minimally invasive techniques.

   Results and discussion. All complications that occurred and were subsequently treated have been divided into seven stages. Stage 1: rapid transfer of the patient to a multidisciplinary hospital. Stage 2: diagnostic laparoscopy followed by laparotomy and suturing of the liver rupture. Stage 3: puncture of the infected biloma. Stage 4: minilaparotomy cholecystectomy. Stage 5: antegrade percutaneous transhepatic drainage of the bile ducts. Stage 6: angiography of the hepatic artery and its branches. Stage 7: endovascular embolization of the pseudoaneurysm cavity.

   Conclusion. The authors presented the clinical case in order to demonstrate the feasibility and proper application of minimally invasive techniques to manage various complications of liver injury, avoid resection, save life, and preserve quality of life.

   Introduction. A solid pseudopapillary pancreatic tumor accounts for less than 3 % of all pancreatic tumors. It is more common in young women aged 20 to 30. The prognosis for this pathology is favorable. Complete removal of the tumor leads to full recovery in more than 85 % of patients.

   Materials and methods. The paper presents a clinical case which demonstrates the surgical outcome of a patient with a malignant pancreatic tumor. Patient M., female, born in 1998, underwent inpatient treatment at the I.K. Akhunbaev Clinic of National Hospital, Kyrgyzstan, from January 12, 2015 to January 26, 2015 with a clinical diagnosis — pancreatic head mass, which was found intraoperatively. Due to this, the decision was made to expand the scope of the surgery. Histopathological examination revealed a solid pseudopapillary tumor.

   Results and discussion. This tumor is extremely rare and is usually detected accidentally during preventive examinations, or when the tumor becomes large. Against the background of treatment, the dynamics of observation for 7 years revealed no signs of progression and relapse of this pathology.

   Conclusion. Solid pseudopapillary tumor is a rare, highly differentiated malignancy, which develops most oft en in young women. It is characterized by a relatively favorable clinical course, which is demonstrated by this case report.