Cancer patients are at risk of developing arterial and venous thrombosis during chemotherapy (CT) and after its cessation. A prothrombotic risk may arise via pathogenetic pathways such as activation of external and internal coagulation pathways, decreased anticoagulant levels, platelet activation, fibrinolysis blockade, etc. Chemotherapeutic agents exert direct cytotoxicity, as well as indirectly suppress cellular processes necessary for tumor cell proliferation. CT-related cytotoxicity act on both tumor and healthy body cells. Available targeted drugs with improved selectivity for tumor cells are also associated with thrombosis risk. Low molecular weight heparins, which effectively reduce the risk of venous thromboembolism, have not yet been officially recommended for routine use during CT. Here, we discuss the prothrombotic effects of various antitumor agents aimed at gaining deeper understanding of the underlying mechanisms that may allow to develop new strategies for prevention and treatment of such formidable complications.

One of the most common gynecologic diseases is polycystic ovary syndrome (PCOS). The pathologic conditions caused by this syndrome require careful attention from not only gynecologists, but also therapists, endocrinologists, oncologists, cardiologists, and psychologists. The reproductive function of women with PCOS and associated infertility needs further careful study. At the same time, it is necessary to develop measures for the correction and prevention of all disorders associated with this pathology. The article describes the importance of multidisciplinary, comprehensive approach to PCOS patients, the need to study and implement rehabilitation means aimed at restoring all aspects of women's health, including after surgical treatment.

This article presents a clinical case of chemotherapy-induced thrombotic microangiopathy (TMA) in a patient with ovarian cancer, which manifested as kidney failure. Laboratory and biochemical findings were analyzed, which were initially misinterpreted, and only kidney biopsy allowed to make the correct diagnosis and initiate pathogenetic therapy. Cancer patients are at higher risk of secondary TMA, which requires closer attention to symptoms that are not characteristic of the underlying disease. Key words: cancer, thrombotic microangiopathy, secondary TMA, chemotherapy-associated TMA, antiphospholipid syndrome, ADAMTS13, mitomycin C, gemcitabine

Aim: to study the features of thrombotic complications in cancer patients during COVID-19 infection, and identify the most significant diagnostic and prognostic criteria. Materials and Methods. Within the framework of cohort non-randomized study, there were analyzed the course of coronavirus infection in 72 hospitalized patients with uterine cancer (n = 22), cervical cancer (n = 19), ovarian cancer (n = 24) as well as vaginal and vulvar cancer (n = 7). All patients hospitalized for COVID-19 were examined and treated in accordance with the Interim guidelines “Prevention, diagnosis and treatment of novel coronavirus infection (COVID-19)” effective at the time of therapy. Additionally, on days 3–7 after hospitalization, a blood test was performed once to determine the level of metalloproteinase ADAMTS-13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13), ADAMTS-13 activity, ADAMTS-13 inhibitor and von Willebrand factor (vWF) level. Results. It was shown that the average age of the patients was 56.96 ± 7.55 years, the length of hospitalization ranged from 7 to 19 (13.0 ± 3.79) days. The disease severity was assessed by the degree of lung tissue damage based on computed tomography (CT), respiratory failure and development of systemic inflammatory response syndrome (SIRS). During hospitalization, CT-2 was detected in 46 (63.9 %) patients, CT-3 – in 26 (36.1 %) patients; 37 (51.4 %) patients were transferred to the intensive care unit (ICU). Clinically significant deep vein thrombosis (DVT) was diagnosed in 9 (12.5 %) patients, and pulmonary embolism (PE) – in 4 (5.6 %) patients. Of these, 6 cases of DVT and 3 cases of PE were fatal. A total of 14 (19.44 %) patients deceased due to developing acute cardiopulmonary failure. A vWF/ADAMTS-13 ratio greater than 2.1 was found in all ICU patients. Despite anticoagulant therapy, patients with DVT and PE had this ratio higher than 3.3 (4.00 ± 0.48), whereas in all 14 deceased patients it exceeded 2.98. Conclusion. Venous thromboembolism, including PE and DVT, has been identified as а serious complication of COVID-19. An opportunity to predict them early is of special importance because they may lead to serious complications such as disseminated intravascular coagulation, SIRS, cardiopulmonary failure, and death. In patients suffering from cancer infected with COVID-19, not only a decline in ADAMTS-13 activity and level was detected, but also a parallel increase in vWF level. A vWF/ADAMTS-13 ratio may be an early indicator of COVID-19 severity in such patients: a vWF/ADAMTS-13 ratio exceeding 2.1 was common for all ICU patients. Hence, it evidences about a potential for using this parameter to early identify such risk patients who may require more intensive care and medical intervention.

Introduction. The tumor microenvironment (TME) consisting of non-tumor cells and other components plays a crucial role in cancer development by promoting uncontrolled tumor growth.Aim: to detail all the components in TME and their contribution to carcinogenesis by analyzing available publications.Results. Currently, TME study is of great interest in the medical field. Its crucial role in the tumor initiation, progression, and spreading is emphasized. Several constituents have been identified in TME including cancer-associated fibroblasts, neutrophils, adipocytes, tumor vasculature, lymphocytes, extracellular matrix, dendritic cells, neutrophil extracellular traps, etc. Thromboinflammatory reactions are also considered an important TME element.Conclusion. TME constituents can serve as new targets for both diagnostics and antitumor therapy.

Objective: to evaluate the effectiveness and safety of rehabilitation programmes in patients with vulvovaginal atrophy (VVA). Material and methods. The study involved 350 patients with VVA in surgical (n=140) and natural (n=140) menopause, the control group included 70 women without VVA. Patients with VVA were distributed into groups receiving complex “active” rehabilitation (surgical menopause: group 1A, natural menopause: group 2A) and “passive” rehabilitation (surgical menopause: group 1B, natural menopause: group 2B). Body mass index (BMI), vaginal pH, carbohydrate profile with calculation of insulin resistance index (HOMA-IR), inflammatory markers leptin, interleukin-6, tumour necrosis factor alpha, serum magnesium, and safety profile with evaluation of adverse events related to rehabilitation measures were assessed over 24 months. Results. BMI decreased significantly in groups 1A and 2A. Vaginal pH at 1-year follow-up decreased in groups 1A and 2A, but increased in groups 2A and 2B. BMI was higher than normal in all patients with VVA, as well as in the control group, demonstrating preobesity (groups 1A, 2A, control group) or first-degree obesity (initially in group 1B and throughout follow-up in group 2B). HOMA-IR initially reflected postoperative insulin resistance in groups 1A and 2A, but in those receiving complex “active” rehabilitation the dynamics of its reduction was the most pronounced. The concentration of inflammatory markers was initially increased compared to the control group and decreased over time in groups 1A and 1B, but only leptin levels reached the control group values by the end of the study. Serum concentration of magnesium levels was 0.71±0.12 mmol/l in group 1A, 0.71±0.10 mmol/l in group 2A, 0.76±0.08 mmol/l in group 1B, 0.72±0.17 mmol/l in group 2B (magnesium deficiency). When organic magnesium salts in combination with pyridoxine were supplemented in groups 1A and 1B, serum magnesium levels were restored to normal from the 3 rd month of follow-up. No adverse events were registered. Conclusion. The personalised programme of complex “active” rehabilitation in patients with VVA is more effective than “passive” rehabilitation with comparable safety profile. Its implementation into routine practice will contribute to the improvement of the quality of health care for such patients.

This article presents a clinical case of a 46-year-old patient with aggravated obstetric and gynecological history, personal and family thrombotic history, who underwent surgery for endometrial adenocarcinoma complicated by the development of pulmonary embolism. The examination revealed hereditary and acquired forms of thrombophilia (PAI-1 4G/5G polymorphism, heterozygous mutation in factor V Leiden 1691 G>A, heterozygous mutations in folate pathway gene polymorphisms (MTHFR 677 C>T, MTRR 66 A>G, MTR 2756 A>G), hyperhomocysteinemia (a homocysteine concentration of 24 μmol/L), circulation of antibodies to β2GP, and the activation of immunothrombosis with a significant increase in the concentrations of NETosis specific markers (CitH3 and MPO). Key words: thrombophilia, NETosis, endometrial adenocarcinoma, PAI-1, hyperhomocysteinemia

Background. In the 21st century, there is a clear trend towards an increase in the proportion of women with climacteric syndrome (CS) and surgical menopause. Medical care for such patients usually includes menopausal hormone therapy (MHT), which often causes changes in magnesium and pyridoxine metabolism and their deficiency, leading to the development of adverse reactions. Therefore, it is necessary to improve rehabilitation programs designed to increаse the quality of life (QoL) for this category of gynecological patients. Objective : to assess the profile of women with CS and surgical menopause receiving and not receiving MHT and to identify the significance of magnesium deficiency (MD) effect on the recovery process. Material and methods . The observational non-interventional study included a total of 9168 women, of which 1528 patiеnts with CS and surgical menopause were taking MHT (Group 1), and 1528 patients with CS and surgical menopause were not taking MHT (Group 2). The Magnesium Deficiency Questionnaire (MDQ) was used to determine the number of participants with MD. A biochemical blood test was also performed, including determination of plasma magnesium concentration. The patients’ profile was analyzed for general somatic pathologies, obstetric and gynecological history, complaints, and MD symptoms using visual analogue scale. To assess QoL before the start of 4-week MD replenishing course and at the end of therapy, the World Health Organization Quality of Life Questionnaire (WHOQL-26) was applied. Results. The MDQ data showed that the prevalence of DM in Group 1 was higher compared to Group 2. In both groups, women with hypomagnesemia had a higher incidence of viral infections, vegetative-vascular dystonia, osteochondrosis and arterial hypertension, more pronounced sleep disorders, irritability, back pain, rapid fatigue, and higher MDQ scores. After completion of the course of therapy with magnesium citrate and pyridoxine combination, the MDQ scores in patients with DM decreased along with an increase in plasma magnesium concentration. Besides, women's satisfaction with their physical, psychological, social wellbeing and microsocial support increased, and self-perception improved. A decrease in the severity of DM and a significant improvement in QoL according to WHOQOL-26 were demonstrated in patients with CS and surgical menopause after therapy. Conclusion. The profile of patients with CS and surgical menopause, regardless of MHT, is often characterized by DM and decreased QoL. It seems reasonable to include blood magnesium level monitoring and DM correction in the comprehensive rehabilitation program for such patients.

Introduction. Endometriosis is one of the common diseases with poorly elucidated underlying nature and pathogenetic mechanisms. Clinical trials suggest that women suffering from it have hemostasis disorders. However, the severity of relevant changes and their origin remain debated.Aim: to study the dynamics of hemostasis system parameters in patients underwent surgical treatment of external genital endometriosis (EGE).Materials and Methods. A total of 120 women were enrolled into the prospective interventional comparative controlled study: 40 patients with EGE scheduled for surgical treatment (main group), 40 patients with other benign gynecological diseases requiring surgical intervention (comparison group), and 40 apparently healthy women (control group). Нemostasis system status was assessed based on the results of 3 visits during 3 month-follow-up by assessing the following biomarkers: metalloproteinase ADAMTS-13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13), von Willebrand factor (vWF), D-dimer, protein C, antithrombin III (AT-III), activated partial thromboplastin time (APTT) and Рarus-test values.Results. Prior to surgery, among EGE women a subclinical but significant increase in procoagulant biomarkers was observed compared to other groups: vWF – 1.24 [1.17–1.35] U/ml, D-dimer – 173.5 [73.5–221.23] ng/ml. Evaluation of the remaining parameters showed no clinical significance of the observed changes. The endometriosis-related surgical intervention was accompanied by increase in specific procoagulant factors a week post-treatment apparently associated with surgical manipulations. However, 3 months later, hemostasis system status partially normalized as revealed by lower biomarkers examined, which in some cases were significantly decreased compared to those observed before surgery. At the same time, differences between the study groups remained statistically significant.Conclusion. Patients with EGE were noted to have a subclinical risk of thrombogenesis. Upon this, surgical treatment and rehabilitation during recovery period allowed to improve overall state of the hemostasis system, thereby reducing a thrombogenesis risk.

Introduction. Current generally accepted clinical and laboratory criteria for antiphospholipid syndrome (APS) have been clearly determined, which include vascular thrombosis and pregnancy complications in patients with circulating antiphospholipid antibodies (aPLs). However, in the last several years, aPLs have become a common finding in patients with malignancies. Accumulating data provide strong evidence for such association and suggests that thrombosis in cancer patients may be related to aPLs activity. According to global publications, aPLs circulation in cancer patients varies from 15 to 74 %, which may be due to differences in clinical characteristics of cancer patients examined as well as distinct interpretations on aPLs diagnostic tests.Aim: to determine aPLs profile in patients with malignant neoplasms of the female reproductive system, identify an association between aPLs and thrombosis as well as degree of disease progression and outcome.Materials and Methods. A single-center observational study was conducted with 130 women, among which 70 subjects had adenocarcinoma of the uterine body, cervix and ovaries. 60 age-matched apparently healthy women lacking thrombotic complications were included into control group. All study participants were examined for circulating lupus anticoagulantas well as anti-cardiolipin antibodies (aCLs), anti-β2-glycoprotein 1 antibodies (anti-β2-GР1), annexin V antibodies, and anti-phosphatidylserine-prothrombin complex antibodies (anti-PS-PT) IgG and IgM by using enzyme-linked immunosorbent assay.Results. Moderate or low aPLs titers were found in 34.2 % of patients with uterine, cervical and ovarian cancer. Ten (14.2 %) of 70 women in main study group had thrombosis so that aPLs were detected only in 5 of 10 women with thrombosis. No significant differences between patients with thrombosis and without thrombotic complications in gynecological cancer were observed. In addition, assessed parameters had no impact on relapse-free survival in cancer patients. However, a significant relation was found between circulating aCLs (IgG, IgM) and anti-PS-PT (IgG, IgM) as well as degree of oncological process. In addition, a significant association was found between aCLs isotype IgG (p = 0.017) and disease relapse.Conclusion. Although thrombosis along with acute thrombosis is a hallmark of APS patients, they demonstrate other non-thrombotic manifestations, one of which is the impact on tumor growth invasion and progression.

Cervical cancer (CC) has been increasing in prevalence, imposing a high economic burden, that is a serious problem for health care system, despite the success of HPV vaccination and the use of screening programs. Additionally, studies on rehabilitation programs impact on anxiety and depression in patients after CC surgery remain limited. OBJECTIVE:To evaluate the level of anxiety and depression in females undergoing various rehabilitation programs in the recovery period after surgery of early-stage CC. MATERIAL AND METHODS:The study included 103 female patients with CC divided into 2 groups: 1) undergoing multicomponent rehabilitation (CC-1, 51 patients) and 2) undergoing rehabilitation according to the principles of approved guidelines (CC-2, 52 patients). The level of anxiety and depression was evaluated before surgery and during 36 months after surgery according to the Hospital Anxiety and Depression Scale. RESULTS:The anxiety level before surgery was in average 10.7±3.0 scores on the HADS in the CC-1 group and 10.9±2.0 scores in the CC-2 group. It decreased up to 7.1±3.3 scores at the 3rd month and remained within 5.6±3.4-5.4±3.5 scores in the CC-1 group, while in CC-2 group it varied between 8.0±2.1-9.6±2.3 scores throughout the study period. The depression level before surgery was 9.7±2.3 scores on the HADS in the CC-1 group and 9.9±2.8 scores in the CC-2 group. It reached 5.2±2.4 scores at the 3rd month in the CC-1 group remaining further within the range of 5.3±2.5-5.7±2.7 scores until the 36th month. The depression level remained in the range of 7.8±3.1-10.2±3.0 scores throughout the study period in the CC-2 group. CONCLUSION:Multicomponent rehabilitation led to a faster and more pronounced reduction of anxiety and depression. This confirms the necessity of such programs application in the clinical practice in recovery period after surgery of early-stage CC.

Background. Magnesium is one of the main macronutrients involved in maintaining human health. Magnesium deficiency (DM) is a common problem in patients after radical cancer therapy, including women with malignant neoplasms of reproductive system. To date, no large-scale studies have been conducted on the prevalence of DM in the convalescence period after oncogynecological treatment. Objective : clinical assessment of DM in patients during rehabilitation period after treatment for reproductive system cancer. Material and methods . The study consisted of two stages. At the first stage (cross-sectional study), 9,168 women with hormonedependent conditions (endometriosis and hyperplastic endometrial processes, uterine fibroids, polycystic ovary syndrome) aged 18–60 years were selected. The second stage (longitudinal study) included 2,101 women with confirmed DM who took a combination of magnesium citrate and pyridoxine. The dynamics of changes were assessed after 1 month using Magnesium Deficiency Questionnaire (MDQ) and World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire. Results . We analyzed information on 70 (0.76%) patients who were in the recovery period after treatment for malignant neoplasms of female reproductive system. According to MDQ data, 57.1% of women had a high risk of MD, 37.1% had an average risk, and 5.7% had no MD. According to biochemical blood test, MD was found in 76.9% of patients. One month after the appointment of magnesium preparations, high probability of DM according to MDQ decreased to 16.7%, and the average risk was 66.7%. The absence of MD was determined in 16.7% of women. MD was found in blood plasma in 33.3% of cases. In the study group, a decrease in the prevalence of seizures, nervousness, muscle weakness was determined. Analyzis of results by WHOQOL-BREF confirmed an improvement in the quality of life of patients (physical and psychological condition and environment). Conclusion. The results substantiate the importance of DM early detection and correction in women who are in the rehabilitation period after treatment of reproductive organs. Increasing the alertness of doctors, conducting dynamic monitoring of magnesium content will accelerate the diagnosis, which is necessary to prevent the development of DM-related complications and increase the patients’ quality of life.

The results of recent studies show that tumor biology, coagulation activation, and inflammatory reactions profoundly contribute to the thrombosis pathogenesis in cancer as well as tumor progression, metastasis, and developing chemoresistance. Cancer is an independent predictor of thrombosis. During carcinogenesis, tumor cells express proinflammatory cytokines, proangiogenic and procoagulant factors, and also stimulate other cells to express various components promoting emerging thromboinflammation. The discovery of neutrophil extracellular traps (NETs) provides an opportunity to take a new look at biology and a role neutrophils may play in thromboinflammation and tumorigenesis. The close interplay between tumor cells, tumor-associated neutrophils and NETs as well as other players in the tumor microenvironment underlies activation of thromboinflammation in cancer patients not only resulting in thrombus formation, but also promoting tumor growth and dissemination.

Magnesium is an important cofactor for metabolic reactions involving more than 300 enzymes, regulating a series of fundamental processes, such as myocardial contraction and blood pressure control, glucose regulation, participation in neuromuscular transmission. The prevalence of magnesium deficiency in various cohorts of fertile age women comprises up to 73.8 %. In clinical studies it was demonstrated that magnesium deficiency is associated with diseases and states such as dysmenorrhea, premenstrual syndrome (PMS), polycystic ovary syndrome (POS), climacteric syndrome, osteoporosis, use of combined oral contraceptives (COCs) and menopausal hormone therapy (MHT). Magnesium supplementation in combination with basic therapy can positively affect course and outcome of such pathologies. Magnesium organic salts could be used for countering magnesium deficiency. Among such agents, magnesium citrate has some advantage used in combination with pyridoxine (vitamin B6) providing additional effects. Health care professionals should be guided by the criteria for Mg-containing preparation selection, defined by the Russian Society of Obstetricians and Gynecologists (RSOG).

The article describes a clinical case of ectopic pregnancy with localization in the liver. The patient Sh. was admitted to the gynecological department with pain in the lower abdomen and epigastrium. Clinical, laboratory and instrumental examinations were conducted in accordance with clinical recommendations. The examinations showed that human chorionic gonadotropin level was 17,440.85 mIU/ml. Pelvic ultrasound did not determine the fetal egg in the uterine cavity. However, free fluid in the pelvis (about 50 ml) was found. Repeated pelvic ultrasound revealed a paraovarial formation on the right, and free fluid in the pelvis. Laparoscopic surgery was performed, during which a fetal egg was found in the V segment of the liver. Liver resection and cholecystectomy were performed on an emergency basis. This case describes the importance of timely and correct diagnostics and determination of patient management tactics to prevent the development of life-threatening complications.

Background. The problems of diagnosis, treatment and rehabilitation of patients with endometrial cancer (EC) remain relevant for the entire medical community. Radical surgical intervention shows high efficiency among the existing methods of EC treatment. However, it causes many complications that require rehabilitation support for patients. The development of new instruments and protocols for rehabilitation of EC patients is necessary. Objective: to evaluate the effectiveness of comprehensive personalized rehabilitation program in patients after radical surgical EC treatment. Material and methods. A prospective randomized comparative study included 61 patients with histologically verified stage IA endometrioid adenocarcinoma of high or moderate differentiation degree. The patients were divided into two groups: the group of “active” rehabilitation (n=29), and the group of “passive” rehabilitation (n=32). During 1 year, their physical, mental health and social engagement were assessed using questionnaires. Results. The survey showed a low level of physical, functional, emotional and social well-being of EC patients at the first 3–7 days after surgery. After 12 months, a recovery in the quality of life of all participants was observed. However, patients undergoing “active” rehabilitation recovered significantly faster, and their quality of life was significantly higher compared to patients undergoing “passive” rehabilitation. Conclusion. The obtained results indicate the effectiveness of a personalized approach in rehabilitation of EC patients. It is expected that its implementation will considerably reduce the incidence of complications and the burden on the healthcare system.

Background . Gynecological cancers in women are a widespread type of oncology. Among them, endometrial cancer (EC) is often highlighted as one of the most common diseases in this group. The analysis of publications showed insufficient effectiveness of rehabilitation in patients with EC and recurrent atypical endometrial hyperplasia (rAEH). Objective: to compare the state of patients with rAEH or EC after hysterectomy with bilateral salpingo-oophorectomy, depending on the recovery tactics. Material and methods . The study included 119 patients diagnosed with rAEH (n=58) or stage IA EC (n=61) after hysterectomy with bilateral salpingo-oophorectomy. The group of women with rAEH was divided into two subgroups: 1A (“active” rehabilitation, n=27) and 1B (“passive” rehabilitation, n=31); two subgroups were also formed from the cohort of EC patients: 2A (“active” rehabilitation, n=29) and 2B (“passive” rehabilitation, n=32). “Active’ rehabilitation included a comprehensive, personalized program, “passive” one was based on standard rehabilitation protocols. Apart from standard clinical examination of patients, their quality of life (QoL), physical condition as well as the levels of cytokines and other biochemical blood parameters were assessed. Results. An analysis of the overall picture showed a high incidence of rAEH or EC in women aged 40–49 years. Comorbid pathologies, low QoL level and a number of significant changes in laboratory parameters were often observed. Regardless of the approach to rehabilitation, the patients' health improved over the course of 12 months. “Active” rehabilitation significantly improved psychological well-being, sexual function, overall QoL and a number of other objective health indicators of patients with rAEH or EC compared to standard rehabilitation course. Conclusion. The overall picture of rAEH or EC patients was presented, the main factors that reduce QoL in women with these diseases were identified. A system of integral QoL assessment in patients with rAEH or stage IA EC was developed including subjective and objective parameters obtained during general clinical examination, laboratory tests and analysis of questionnairing results, which should be used to adequately monitor the state of patients after surgery and the effectiveness of rehabilitation. The advantage of comprehensive rehabilitation over standard protocols in terms of efficiency and speed of recovery was shown.

Background . Latest advances in medicine make it possible to significantly prolong the lives of patients with oncological diseases, including endometrial cancer (EC). The next medical goal is to restore the previous quality of life (QoL) level in these patients. One of the main elements of QoL in EC women is the state of sexual health. Therefore, it is necessary to develop effective rehabilitation programs aimed at overcoming sexual dysfunction in EC patients. Objective: to evaluate the effectiveness of a personalized comprehensive rehabilitation program in terms of restoring sexual function in patients after surgical treatment for EC. Material and method . A prospective, randomized, comparative study was conducted involving 61 EC women. All patients underwent radical surgical intervention. After the procedure, clinical and instrumental examinations were performed in the first week. Patients were also surveyed using the Female Sexual Function Index (FSFI) questionnaire. The participants were then divided into two groups: undergoing “active” rehabilitation (n=29) and “passive” rehabilitation (n=32). Subsequent surveys were conducted 3, 6 and 12 months after surgery. At the 3rd month after treatment, a correction of the rehabilitation program was performed in women undergoing “active” rehabilitation. Results. The FSFI sexual function assessment allowed to identify sexual dysfunction in all patients within a week after radical surgical treatment for EC. Women in both groups showed an increase in FSFI values after 3 months. Starting from the 6th month, significant differences were noted in the rate of sexual function recovery in participants who received “active” rehabilitation compared to “passive” rehabilitation group. After a comprehensive personalized 12-month rehabilitation program, the sexual function of patients in the main group improved to 24.93±2.86 points, while in the comparison group, a weak tendency to restore sexual function to 13.39±2.55 points was observed. Conclusion . The study showed a significant change in sexual function of women suffering from EC. A comprehensive personalized rehabilitation program demonstrated its effectiveness in overcoming sexual dysfunction that arose in response to surgery. The obtained results will allow expanding the evidence base to integrate interdisciplinary comprehensive personalized rehabilitation programs into routine clinical protocols for improving QoL in women after EC treatment.

Aim: to evaluate the impact of rehabilitation on various components of quality of life (QoL) in patients with vulvovaginal atrophy (VVA). Materials and Methods. A prospective comparative controlled longitudinal study involved 350 patients with VVA, divided into groups based on the type of menopause: surgical (n = 140) and natural (n = 140), with a control group of 70 women without VVA. Patients were further subdivided into those receiving complex "active" (groups 1A, 2A) and "passive" (groups 1B, 2B) rehabilitation. The study included 6 visits over 24 months, assessing QoL using the Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HADS), Modified Menopausal Index (MMI), Well-being, Activity, Mood questionnaire (WAM), Magnesium Deficiency Questionnaire (MDQ), and the Assessment Test of Magnesium Deficiency (ATMD). Results. Women with surgical menopause had severe sexual dysfunction initially. Complex "active" rehabilitation significantly improved sexual function over time compared to "passive" rehabilitation. Surgical menopausal women had higher initial levels of anxiety and depression. "Active" rehabilitation significantly reduced these levels, reaching normal values within the first year. Patients with surgical menopause exhibited more severe menopausal symptoms. "Active" rehabilitation led to significant reductions in these symptoms, improved well-being, activity, and mood more significantly than "passive" rehabilitation, particularly in the first year. Complex "active" rehabilitation normalized magnesium deficiency indicators within three months, maintaining normal levels throughout the study. Conclusion. Comprehensive "active" rehabilitation significantly improves sexual function, reduces anxiety and depression, alleviates menopausal symptoms, and enhances overall well-being in women with VVA, especially those in surgical menopause. Personalized rehabilitation programs are crucial for enhancing QoL in these patients.

Introduction. Initially discovered as a mechanism to protect host neutrophils from pathogens and prevent spread of infection outside inflammatory site, neutrophil extracellular traps (NETs) have been implicated in progression of other diseases associated with sterile inflammation such as autoimmune diseases, diabetes, and cancer. NETs components (myeloperoxidase, citrullinated histones, cell-free DNA) exhibit manifold effects on tumor cells, thereby emphasizing a need to be aware of the features of biological functions related to their constituents and their place in carcinogenesis to identify major molecular targets for targeted therapy of gynecologic cancers in the future.Aim: to determine an impact of NETs on tumor progression/metastasis and thrombosis risk in gynecologic cancer.Materials and Methods. A single-center interventional study was conducted: 70 women with uterine, ovarian and cervical cancer were examined; 60 age-matched apparently healthy women without thrombotic complications were selected as controls. All study participants were examined for myeloperoxidase (MРO), citrullinated histone (сitH3), proinflammatory cytokine interleukin-1β (IL-1β), and neutrophil/lymphocyte ratio (NLR).Results. Laboratory biomarkers such as MPO (p < 0.001), IL-1β (p < 0.001) and NLR (p = 0.003) were significantly more often elevated in patients with oncological pathology compared to group of healthy women. 32 (45.7 %) of the 70 women with cancer of the reproductive system had metastases. Metastases-related analysis in patients showed significant differences in MPO level (p = 0.002), but not in level of citH3, IL-1β and NLR (p = 0.441, p = 0.159, and p = 0.739, respectively). Elevated citH3 vs. MPO, IL-1β and NLR level was significantly more often associated with developing thrombosis in study patients (p < 0.001).Conclusion. The results of our study demonstrate that inflammation and NETs components such as MPO and citH3 may be potentially implicated in many aspects of carcinogenesis including tumor metastasis and the risk of developing thrombosis in cancer patients.