The extracellular matrix is an organized three-dimensional network of protein-based molecules and other macromolecules that provide structural and biochemical support to tissues. Depending on its biochemical and structural properties, the extracellular matrix influences cell adhesion and signal transduction and, in general, can influence cell differentiation and proliferation through specific mechanisms of chemical and mechanical sensing. The development of body tissues during ontogenesis is accompanied by changes not only in cells but also in the composition and properties of the extracellular matrix. Similarly, tumor development in carcinogenesis is accompanied by a continuous change in the properties of the extracellular matrix of tumor cells, called ‘oncomatrix’, as the tumor matures, from the development of the primary focus to the stage of metastasis. In this paper, the characteristics of the composition and properties of the extracellular matrix of tumor tissues are considered, as well as changes to the composition and properties of the matrix during the evolution of the tumor and metastasis. The extracellular matrix patterns of tumor tissues can be used as biomarkers of oncological diseases as well as potential targets for promising anti-tumor therapies.

The most common primary malignant brain tumors in adults are gliomas. Glioblastoma is the most prevalent and aggressive tumor subtype of glioma. Current standards for the treatment of glioblastoma include a combination of surgical, radiation, and drug therapy methods. The drug therapy currently includes temozolomide (TMZ), an alkylating agent, and bevacizumab, a recombinant monoclonal IgG1 antibody that selectively binds to and inhibits the biological activity of vascular endothelial growth factor. Supplementation of glioblastoma radiation therapy with TMZ increased patient survival from 12.1 to 14.6 months. The specificity of TMZ effect on brain tumors is largely determined by special aspects of its pharmacokinetics. TMZ is an orally bioavailable prodrug, which is well absorbed from the gastrointestinal tract and is converted to its active alkylating metabolite 5-(3-methyl triazen-1-yl)imidazole-4-carbozamide (MTIC) spontaneously in physiological condition that does not require hepatic involvement. MTIC produced in the plasma is not able to cross the BBB and is formed locally in the brain. A promising way to increase the effectiveness of TMZ chemotherapy for glioblastoma is to prevent its hydrolysis in peripheral tissues and thereby increase the drug concentration in the brain that nanoscale delivery systems can provide. The review discusses possible ways to increase the efficacy of TMZ using nanocarriers.

Surgical and natural menopause is often associated with depression symptoms. Along with the postpartum period, perimenopause is a “window of vulnerability” for depression development, because decline in estrogen level accounts for extinction of reproductive function, emotional disorders, genitourinary menopausal syndrome, which are combined with non-endocrine risk factors, such as decreasing income levels, low social support, and stress. Although a direct relationship between blood estrogens level and depression has not been demonstrated, the relation between menopause symptoms and depression has been proven, i.e., the symptoms of menopause can be considered as risk factors. Here, we summarizes the current view on the correct counseling and routing of menopausal women with depression symptoms in primary health care facilities, the principles of managing patients with risk factors, including genitourinary menopausal syndrome, as well as methods of rehabilitation and informational support. This will aid to improve the quality of medical care for such patients.

Background. Radical treatment of malignant neoplasms (MNs) of female reproductive system often has serious consequences. Chronic pain syndrome, distress, anxiety and depression, decreased self-esteem, sexual dysfunction and social maladjustment reduce quality of life (QoL) and require psychotherapeutic support.Objective: to create an algorithm for the provision of comprehensive psychotherapeutic support during rehabilitation following the treatment of reproductive system MNs and to evaluate its effect on QoL indicators in women with neuropsychiatric disorders.Material and methods. The algorithm for the provision of comprehensive psychotherapeutic support included clinical interview, cognitive behavioral therapy, visualization, audio therapy, art therapy, group and individual psychotherapy, family psychotherapy, image therapy. The QoL indicators were determined by questionnaires using the Functional Assessment of Cancer Therapy – General (FACT-G) with nosology-specific extensions (subscales of physical well-being, social/family well-being, emotional wellbeing and functional well-being), Hospital Anxiety and Depression Scale (HADS), Kupperman–Uvarova Modified Menopausal Index (MMI). The follow-up period was 1 year after radical surgical treatment of reproductive system MNs in different localizations. The main group received the algorithm for the provision of comprehensive psychotherapeutic support as part of active medical rehabilitation, the comparison group received basic rehabilitation.Results. The study included 47 women with vulvar cancer (VC): active rehabilitation group (VC-1) – 24 patients and basic rehabilitation group (VC-2) – 23 patients; 61 women with endometrial cancer (EC): active rehabilitation group (EC-1) – 29 patients and basic rehabilitation group (EC-2) – 32 patients; 103 women with cervical cancer (CC): active rehabilitation group (CC-1) – 51 patients and basic rehabilitation group (CC-2) – 52 patients; 62 women with stages I–II ovarian cancer (OC) and low malignant potential tumor (LMPT): active rehabilitation group (LMPT-1) – 29 patients and basic rehabilitation group (LMPT-2) – 33 patients. Differences in physical, social/family and functional well-being (FACT-G) were significant from the 6th month and in emotional well-being – by the end of follow-up. Neurovegetative and psycho-emotional disorders, as assessed by Kupperman–Uvarova MMI, showed significant positive dynamics in women who received the algorithm for the provision of comprehensive psychotherapeutic support, in contrast to the comparison group, where these indicators remained without significant dynamics or worsened by the end of the follow-up period. The HADS scores during psychotherapeutic support decreased to normal values at the 6–12th months of follow-up, while those who received the basic rehabilitation continued to have subclinical anxiety and depression.Conclusion. The developed algorithm for psychotherapeutic support as part of active medical rehabilitation of women who underwent radical treatment for reproductive system MNs (VC, EC, CC, OC, and LMPT) has demonstrated its effectiveness, justifuing its implementation in clinical practice.

Strengthening rehabilitation for patients with ovarian tumors: current approaches and future directions

Introduction. It is believed to be relevant to assess a profile in patients not using menopausal hormone therapy (non-MHT) with climacteric syndrome (CS) and surgical menopause, because this cohort includes patients with malignant neoplasms of the reproductive system at the stage of rehabilitation after radical surgery, for whom few study data in real-world data are available.Aim: to describe a profile of non-MHT women with CS and surgical menopause included in the MAGYN study.Materials and Methods. A non-interventional epidemiological study screened for magnesium deficiency in 1528 non-MHT women with CS and surgical menopause; 29 patients were at recovery period after radical surgical treatment of reproductive system cancer (vulvar, cervical, endometrial, ovarian, and breast cancer). The number and proportion of women with magnesium deficiency was assessed using the Magnesium Deficiency Questionnaire (MDQ), and a biochemical blood test was performed to measure serum magnesium concentration. Quality of life (QoL) was assessed using the World Health Organization Quality of Life Brief Version (WHOQOL-BREF). There were analyzed general somatic pathology, complaints, symptoms of magnesium deficiency by using visual analog scale, as well as the data of drug therapy, including a combination of magnesium citrate + vitamin B6 (pyridoxine) applied for 4 weeks.Results. According to the MDQ, the prevalence of magnesium deficiency was 72.3 % (55.1 % with moderate and 15.2 % with severe deficiency). Of 469 women, serum magnesium concentration ≤ 0.80 mmol/L was found in 377 (80.38 %), ≤ 0.70 mmol/L – in 278 (59.28 %). Surgical menopause was significantly more common in patients with magnesium deficiency (13.0 %). Among the symptoms of CS in patients with magnesium deficiency, neuropsychiatric symptoms were significantly more common: 47.3 % vs. 43.2 % (p = 0.035). After 4 weeks of therapy, the MDQ score decreased from 46.0 ± 12.7 to 29.2 ± 15.1 points (p < 0.001), serum magnesium level increased to 0.79 ± 0.23 mmol/L. The WHOQOL-BREF demonstrated a significantly improved QoL compared to pre-therapy, including physical and psychological well-being (21.1 ± 4.5 vs. 26.2 ± 3.5 score; p < 0.001), selfperception (18,2 ± 3.7 vs. 22.2 ± 3.6 score; p < 0.001), social well-being (24.8 ± 4.9 vs. 28.1 ± 4.4 score; p < 0.001) and satisfaction with microsocial support (9.3 ± 2.7 vs. 11.0 ± 2.8 score; p < 0.001).Conclusion. The high prevalence of magnesium deficiency and its close relationship with symptoms decreasing QoL (neuropsychic symptoms, hot flashes, irritability, sleep disturbances, fatigue, chronic stress, frequent headaches, etc.) have been confirmed. Further research is needed to assess an effect of magnesium deficiency correction as part of complex medical rehabilitation on the QoL of women with malignant neoplasms of the reproductive system after radical surgery.