Using FLIM and multiphoton fluorescence microscopy we investigated the metabolic status in mesenchymal stem cells during adipogenic, osteogenic and chondrogenic differentiation, the metabolic activity and intracellular pH in iPSC differentiating in dermal, epidermal, neuronal directions, in 3D neurospheres from iPSCs, in neural spheroids with Down syndrome, metabolic changes in living islets of Langerhans, and during liver regeneration.

The Russian consensus on the treatment of intrahepatic cholangiocarcinoma was prepared by the group of experts consisting of surgeons, interventional radiologists, radiation therapists and oncologists. The purposes of this consensus are clarification and consolidation of opinions of multidisciplinary team on the following issues of management of patients with intrahepatic cholangiocarcinoma: indications for surgical treatment, features of therapeutic tactics for mechanical jaundice, technical aspects of liver resection, prevention of post-resection liver failure, indications for liver resection using transplantation technologies, laparoscopic and robot-assisted liver resection, perioperative systemic chemotherapy, local non-resection/non-radiotherapy methods of treatment, radiotherapy, follow-up and choice of treatment for recurrence.

The aim of the study was to evaluate efficacy of combined treatment for well-differentiated pancreatic neuroendocrine tumors according to the data provided by a specialized center. Materials and Methods. Treatment of 40 patients with pancreatic neuroendocrine tumors was assessed. All of the patients underwent surgical removal of the primary tumor. Liver metastases (stage IV) were diagnosed in 14 patients, postoperative courses of hepatic artery chemoembolization were performed in 12 patients, and 10 of them had well-differentiated cancer. Results. Good survival rates in patients with stage IV disease (n=12) are comparable with those in the group of patients with stage III (n=6) provided tumors are well-differentiated and courses of intra-arterial hepatic chemoembolization are given. In patients with poorly differentiated neuroendocrine tumors (n=7), there was progression within a short time, but survival was less than 1-year after surgery despite active management. Conclusion. To manage well-differentiated pancreatic neuroendocrine tumors, aggressive surgical approach should be used, despite the presence of metastatic lesions. In management of poorly differentiated neuroendocrine cancer, surgical approach proves to have unsatisfactory long-term results.

It is presented a review of current and the most relevant materials including evidence-based researches, guidelines, devoted to anesthesia during extended liver resections. Present algorithms of anesthesia were analyzed based on these data. It was noted significant differences in anesthetic approaches which are mainly explained by the problem of massive intraoperative blood loss. Expanding practice of liver transplantation is making significant adjustments to the carrying out of anesthesia during surgical intervention. Optimal algorithm of anestesia is determined based on the experience of extended liver resections and transplantations.

The aim of the study is to assess the possibility of using an original UHF (ultra-high frequency) coagulator with an operating frequency of 2.45 GHz to achieve hemostasis on the surfaces of parenchymatous organs. Materials and Methods. The coagulator represents a coaxial line loaded on the antenna in the form of a monofilar Archimedean spiral. A maximal input power was 300 W. Coagulator parameters were determined by the results of numerical simulation and laboratory tests at various loads. Coagulator work was studied on ovalbumin and liver parenchyma at various exposures. Biological tissue samples from the coagulation foci were histologically investigated. Results. A coagulation focus with the diameter equal to the applicator diameter (20 mm) is formed during 10 s exposure at the maximum input power level. Tissue coagulation sufficiently uniform in depth is observed in the focus area. Conclusion. The character of UHF field impact on the tissue does not depend on the degree of surface humidity. The impact area matches the diameter of the device working part allowing surgeons to plan the area of the appropriate exposure. The created complex is expected to find its application for hemostasis in parenchymatous hemorrhage.

Background: Aggressive course of liver alveococcosis makes it possible to designate it as a “parasitic liver cancer”. The main treatment method for the disease is surgery. The parasitic mass is resected according to R0 principles, with concomitant plastic surgery of the major vessels and bile ducts to increase resectability.Aim: To assess the potential of surgical treatment in patients with advanced liver alveococcosis using transplantation techniques.Materials and methods: We retrospectively analyzed in- and outpatient medical files of 62 subjects with confirmed liver alveococcosis, who had been treated in the Volga District Medical Centre (Nizhny Novgorod, Russia) from 2008 to 2018. Thirty two (32) patients had advanced liver alveococcosis with involvement of afferent and efferent vasculature and biliary tract. Surgical procedures were used in 50/62 patients (or 4.2% of the total number of liver resections performed during this time interval, n = 1197). Complications occurred in 46% (23 / 50) of the cases. Twenty nine (29, or 58%) patients had been operated before (mostly cytoreductive resections and/or explorative laparotomies). Distant lung metastases were found in 2 (4%) patients.Results: Fifty (50) patients had curative surgical procedures: liver resections in 45, deceased donor orthotopic liver transplantations in 5. Most common were extensive liver resections (more than 4 segments). Resection and reconstruction of the main vessels were necessary in 50% (25 cases) of the patients, including v. cava inferior in 25 cases and the portal vein in 24 cases. In 31 patients, resection and reconstruction of extra-hepatic bile ducts was performed, and in 17 (33%) patients resections of the neighboring organs, such as diaphragm, lung, right adrenal, duodenum, stomach, and colon. In 4 cases, resections were performed ex situ ex vivo, followed by auto-transplantation, including 2 cases with reverse auto-transplantation of the left lateral sector to the right. The incidence of liver failure events grade A and B (by International Study Group of Liver Surgery, ISGLS) did not exceed 10% (4 patients). Complications were seen in 25 cases, including Clavien – Dindo Grade II in 5, Grade IIIb in 13, Grade IVb in 2, and Grade V in 5. The number of bile leakage events (ISGLS) class B was 6 and class C 10. All patients underwent obligatory adjuvant anti-parasitic therapy.Conclusion: At present, surgical treatment of liver alveococcosis remains a method of choice, that requires that the hepato-pancreato-biliary center would have in place a well-developed transplantation program, adequate equipment and well-trained surgical and anesthetic teams.

Аннотация Российский консенсус по диагностике и лечению хронического панкреатита подготовлен по инициативе Российского «Панкреатологического клуба» с целью выяснения и консолидации мнений отечественных специалистов (гастроэнтерологов, хирургов и педиатров) по наиболее важным проблемам диагностики и лечения хронического панкреатита. Настоящая статья продолжает серию публикаций, разъясняющих наиболее важные положения междисциплинарного консенсуса и посвящена вопросам заместительной ферментной терапии.

Aim. To assess an efficiency of modern methods of vicarious hypertrophy stimulation of the remnant liver after advanced resection and to reduce the risk of postoperative liver failure. Material and Methods. Programmed stimulation of liver vicarious hypertrophy was applied in 119 patients including ligation and transection of portal vein branches in 76 patients (64.8%), endovascular embolization of portal vein branches in 21 patients (17.6%), endovascular embolization of the portal vein combined with chemoembolization of the hepatic artery in 15 patients (12.7%), and split in situ liver resection in 7 patients (5.9%). Volume of remnant liver was measured using computerized tomography, magnetic resonance imaging and/or ultrasound prior to and in 2–4 weeks after occlusion of portal vein branches. Results. According to CT/MRI data remnant liver volume increased from 28.4% to 48.7% (by 38.9 ± 5.5% on the average). 72 patients (60.5%) were operated: right-sided or extended right-sided hemihepatectomies were performed in 49 cases (68%), atypical liver resection – in 21 cases (29.2%). Postoperative complications were registered in 16 cases (22%). Mortality due to post-resection hepatic failure was 2.8%. Liver resection was not performed in 47 cases (39.5%) due to insufficient increase of liver fragment, newly diagnosed intrahepatic metastases or local recurrence of colorectal cancer. Conclusion. Preoperative programmed stimulation of liver fragment is a perspective method that increases percent of operable patients with liver tumors and reduces the risk of hepatic failure after extensive liver resection. Surgical and endovascular methods of preoperative programmed stimulation of liver vicarious hypertrophy are technically feasible and safe.

Methods of surgical treatment of the patients, operated on the reason of chronic pancreatitis, complicated by the obstructive jaundice, were comparatively analyzed. 25 patients received pancreatoduodenal resection, 19 patients had the Bern variant of Beger operation. The quality of life was assessed with the use of MOS-SF-36. The duodenum preserving resection of the head of the pancreas showed better long-term results then pancreatoduodenal resection. Those patients, who received biliodigestive anastomosis as the basic operation, showed no good results at all.

There have been analyzed the results of surgical treatment of 128 patients with metastases of colorectal cancer in the liver operated in the Privolzhsky district medical center of Federal Medico-Biologic agency of Russia (Nizhny Novgorod). There has been carried out the comparative assessment of the results processed by means of international register LiverMetSurvey (www.livermetsurvey.org) with collective data of the project published. All main aspects were compared. Age, primary tumour localization, the number, size and localization of hepatic metastases, the presence of associated pathologies, as well as the volume of surgeries performed in the compared groups had differences representing the work of Regional Hepatology Centre. The main difference was in postoperative survival of such patients: according to International register, two-year survival amounts to 76%, and in our centre - 57%. The obtained results of the analysis show the approaches to the treatment of this difficult group of patients in the Privolzhsky district medical center correspond to the international protocol.

The ultrasound pattern of hepatic and renal changes after different types of resection is depicted. Ultrasound studies were performed in 335 patients operated on for focal hepatic masses and in 72 patients operated on for focal renal masses. The authors identified 3 patient groups after hepatic resection (segment-oriented liver resection (99 patients), portal hemihepatectomy (n=163), and extended hemihepatectomy (n=73)) and 3 patient groups after renal resection (planar (n = 83), wedge (n = 104), and frontal (n = 66)). It has been established that the number and location of hepatic veins in the liver stump, which the authors have designated as a hepatic vein rule, are of basic value in defining the type of hepatic resection. To determine the type of renal resection, it is essential to assess the shape of the organ and the area of its resection. The found echosemiotic patterns allow the type of performed resection of parenchymatous organs to be correctly determined in the majority of cases.

The aim of the investigation is to estimate shortand long-term results of the treatment of ductal adenocarcinoma of the head of pancreas after conventional and extensive pancreatoduodenal resection. Materials and methods. There were performed total 27 conventional and 27 extensive interventions. The groups under study were comparable by sex, age, and the degree of tumour differentiation. Mean time of surgery, the volume of blood loss and hemotransfusion, the frequency of postoperative complications, and mortality did not differ significantly. Results. After extensive pancreatoduodenal resection, local recurrence occurred significantly more rarely (7.4 versus 33.3% after conventional surgery). Broadened lymphadenectomy in ductal adenocarcinoma of the head of pancreas did not lead to the increase of postoperative complications, mortality and overall survival. In the meantime, extensive gastropancreatoduodenoal resection enables to decrease significantly recurrence rate.

The aim of the investigation is to estimate short-and long-term results of the treatment of ductal adenocarcinoma of the head of pancreas after conventional and extensive pancreatoduodenal resection.Materials and methods. There were performed total 27 conventional and 27 extensive interventions. The groups under study were comparable by sex, age, and the degree of tumour differentiation. Mean time of surgery, the volume of blood loss and hemotransfusion, the frequency of postoperative complications, and mortality did not differ significantly.Results. After extensive pancreatoduodenal resection, local recurrence occurred significantly more rarely (7.4 versus 33.3% after conventional surgery). Broadened lymphadenectomy in ductal adenocarcinoma of the head of pancreas did not lead to the increase of postoperative complications, mortality and overall survival. In the meantime, extensive gastropancreatoduodenoal resection enables to decrease significantly recurrence rate.