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The features of the pathogenesis and course of type 2 diabetes mellitus and diseases of the cardiovascular system comorbid with it are considered in patients of elderly and old age – coronary artery disease, arterial hypertension, chronic heart failure. The leading role of insulin resistance, hyperglycemia and dyslipidemia in the development of metabolic, homeostatic disorders, the formation of oxidative stress and endothelial dysfunction, which, together with age-related changes in the body, contribute to the progression of type 2 diabetes mellitus and microvascular complications, primarily diabetic cardiomyopathy. Particular attention is paid to the relationship between cognitive impairment, type 2 diabetes mellitus and chronic heart failure. The main factors that worsen the course and prognosis of type 2 diabetes mellitus in elderly patients, in particular, hypertension, atrial fibrillation, diabetic polyneuropathy, nephropathy, and other concomitant diseases, have been identified. Lack of compensation for type 2 diabetes due to metabolic disorders leads to the development of diabetic cardiovascular autonomic neuropathy, diabetic cardiomyopathy along with the progression of atherosclerotic lesions of different localization. The course of type 2 diabetes in these patients is often complicated by geriatric syndrome, which contains a set of cognitive impairment, senile weakness, depression, functional disorders, polymorbidity. Cognitive disorders negatively affect the course of type 2 diabetes and its complications, significantly disrupting the process of teaching patients the methods of self-control, following the advice of a doctor. It is noted that the management of this category of patients should be individual and include adequate correction of hyperglycemia to prevent microvascular complications and hypoglycemic conditions, as well as reduce cardiovascular mortality and maintain quality of life. Rational selection of drugs, taking into account the factors that determine their impact on the body of elderly patients with type 2 diabetes mellitus and possible adverse drug reactions, will increase the effectiveness and safety of drug therapy in such patients. Optimizing therapeutic approaches for elderly patients with type 2 diabetes requires effective changes in the health care system to provide them with comprehensive medical and social care according to their special needs

According to the literature review, the use of modern endoscopes with high resolution and a narrow-band imagine function with optical magnification, as well as autofluorescence, chromoscopy, endosonography, makes it possible to establish a diagnosis of early colorectal cancer with a high degree of accuracy. Nowadays, endoscopic submucosal dissection and endoscopic mucosal resection are the methods of choice in the treatment of early (Tis, T1sm1N0M0) colon cancer.

The use of high-adsorption membrane hemofiltration in COVID-19 positive patients to reduce the severity of a cytokine storm is clearly beneficial but at the same time, there are no certain procedures for its practical use.The objective:to study the change in the levels of IL-6 and IL-18 in response to prolonged (24-72 hours) high-adsorption membrane hemofiltration.Subjects and methods. We retrospectively analyzed the data on IL-6 and IL-18 levels and their changes in 69 patients who were COVID-19 positive and had different degrees of lung damage, they had received high-adsorption membrane hemofiltration during their stay at the intensive care unit. The extent of lung lesions was the following: 4 people had CT-2, 44 people had CT-3, and 21 patients had CT-4. 18 patients had an unfavorable outcome of the disease. High-adsorption membrane hemofiltration (Prismaflex) was used in the group of patients who had clinical signs of the rapid progression of the disease and also such laboratory findings as elevated values of C-reactive protein (above 100 mg/L), ferritin (more than 600 μg/L), and progression of lymphopenia. This intervention lasted for 24 hours at CT-2/3, and 48 hours at CT-4. The effluent dose was 30.0 ± 6.4 ml/kg/h. The levels of IL-6, IL-18, and procalcitonin were tested before and after the completion of the intervention, and the difference between their concentration before and after high-adsorption membrane hemofiltration was calculated. The potential association between received data (IL-6, IL-18, delta of IL-6, delta of IL-18) and degree of lung damage and outcomes was analyzed.Results.It was detected that the more the lungs were affected, the lower levels of IL-6 and IL-18 were and vice versa and this correlation was not associated with the use of tocilizumab (used in 44 people). The maximum decrease in the level of cytokines was observed in the group of patients with CT-2. There was a significant association between the delta of IL-6 (F = 6.69; p ≤ 0.05) and the outcome which was especially pronounced in people with a favorable outcome.Conclusion.As the inflammation progresses in the lungs, the levels of IL-6 and IL-18 decrease which may be a manifestation of the depletion of the cytokine storm. The use of prolonged high-adsorption membrane hemofiltration (24-48 h) allows reducing the level of cytokines. The delta value reflects a decrease in IL-6 concentration, it significantly correlates with the outcome which indicates the importance of using this method in a continuous mode.

Summary. The purpose of the study: to analyze the causes of development, terms of hospitalization, the frequency of severe type, complications and overall mortality in acute pancreatitis according to the clinic data. Materials and methods: the results of treatment of 622 patients with acute pancreatitis were analyzed. Among them there were 336 women (54.1 %) and 286 men (45.9 %). The mean age of patients was (48.2 ± 2.2) years. The diagnosis of acute pancreatitis was made according to the recommendations (Atlanta, 2012). All patients with acute pancreatitis underwent ultrasound examination of the abdominal cavity and computed tomography, enhanced by intravenous contrast. Results and discussion: Etiological factors of acute pancreatitis were: biliary factor in 270 (43.4 %) patients, alcohol — in 155 (24.9 %), acute pancreatitis on the background of triglyceridemia — in 135 patients (21.7 %), 21 (3.4 %) patients had postoperative pancreatitis, medication — in 8 (1.3 %) patients and without a clear etiology — in 33 (5.3 %) patients. The terms of hospitalization of patients are as follows: after 24–48 hours from the onset of the disease — 215 (34.6 %) cases, after 6–24 hours after the onset of the disease — 204 (32.8 %) cases, after 48 hours and later from the time of the disease — 129 (20.7 %) cases and 74 (11.9 %) cases of hospitalization up to 6 hours from the onset of the disease. Severe acute pancreatitis developed in 147 (23.6 %) patients and was accompanied by the development of organ failure lasting > 48 hours. 594 (95.4 %) patients with acute pancreatitis received only conservative infusion therapy. 28 (4.5 %) patients required surgical treatment. The overall mortality in patients with acute pancreatitis was 9 (1.4 %) cases. Conclusions: Hyperdiagnosis of acute pancreatitis is a common problem in modern surgery. Formulation of the diagnosis according to the unified diagnostic criteria considerably facilitated diagnosis. The dominant factors of acute pancreatitis are biliary (43.4 %) and alcoholic factors (24.9 %). Most often (34.6 %) patients were admitted to the department on the second day after the onset of the disease. Remains high level of severe acute pancreatitis, which amounted to 23.6 % of cases. 594 (95.4 %) patients with acute pancreatitis received infusion therapy. 28 (4.5 %) patients underwent surgical treatment. The total mortality in acute pancreatitis according to our clinic was 9 (1.4 %) cases, the majority of them (7 patients) died in the early period of acute pancreatitis.

Studies of photon-stimulated transport through a quantum point contact based on a high-mobility two-dimensional electron gas in a GaAs quantum well are reviewed. This review includes a brief historical introduction, experimental results on giant terahertz and microwave photoconductance of the quantum point contact in the tunneling regime, and the analysis of its behavior within a developed theoretical model of photon-stimulated tunneling. Prospects of further studies and production of a new class of terahertz and microwave detectors are discussed in closing.

Aim of the study To investigate the feasibility of enhanced recovery after surgery (ERAS) protocol for patients with primary peritoneal carcinomatosis (PC) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (HIPEC) based on the length of hospital stay (LOS), return of bowel function, the incidence of postoperative complications, and quality of life (QLQ) analysis. Material and methods The study included a total of 37 patients with primary PC of different origin, who underwent cytoreductive surgery plus HIPEC. Patients were divided into 2 groups: Group I (nonERAS) – 20 patients and Group II (ERAS) – 17 patients. Results The median LOS in Group I (nonERAS) (12.35 ± 3.9) was longer than in Group II (ERAS) (6.8 ± 1.9) (p < 0.01). The use of the ERAS protocol significantly contributed to the faster return of bowel function (peristalsis and stool) in the postoperative period (p < 0.01). There was no statistically significant difference in the incidence of postoperative complications between the ERAS and nonERAS groups, which supports its clinical safety. Improved QLQ according to the obtained data has also been achieved due to the introduction of the principles of the ERAS protocol. Conclusions The obtained results prove the expediency and feasibility of the implementation of the ERAS protocol among patients undergoing cytoreductive surgery in combination with HIPEC.

THE AIM . Comparison of indirect immunofluorescence (IIFT) and enzyme-linked immunosorbent assay (ELISA) methods for the determination of circulating antibodies to the podocytic transmembrane receptor of M-type secreted phospholipase A 2 (PLA 2 R-AB) in patients with primary membranous nephropathy (PMN). PATIENTS AND METHODS . The study included 54 patients with PMN (M: F [33:21]) aged 55 (40-63) years and 10 apparently healthy individuals of the corresponding gender and age. Proteinuria and glomerular filtration rate (eGFR) was determined in all patients. The anti-PLA 2 R-AB levels were measured by indirect immunofluorescence (IIFT) and enzyme-linked immunosorbent assay (ELISA) using EURUIMMUN AG test systems (Lubeck, Germany). RESULTS . The levels of anti-PLA 2 R-АB determined by the two investigated methods were changed in the same direction (r = 0.82, p < 0.005). The ELISA method made it possible to detect a larger number of anti-PLA 2 R-positive cases, both in the group of patients before treatment (ELISA – up to 80 %, IIFT – up to 67 %) and among patients receiving immunosuppressive therapy (ELISA – up to 63 %, IIFT – up to 50 %). The concentration of autoantibodies determined by ELISA (both quantitative and semi- quantitative) correlated with proteinuria (r = 0.69, p = 0.001) and eGFR (r = -0.38, p = 0.035). The response to therapy was more clearly traced when the study was performed by quantitative ELISA. CONCLUSION . The ELISA method is more effective in identifying PLA 2 R-positive patients with PMN, allows obtaining quantitative results and assessing the dynamics of the concentration of autoantibodies, which contributes to the early correction of the therapy and decisionmaking on immunosuppressive treatment.

Objective: to study clinical and laboratory features in patients with anticentromere antibody (ACA)-positive SjЪgren's disease (SD), as well as the sensitivity of different methods for determination of ACA, and to elaborate an algorithm for differential diagnosis in ACA-positive patients.Patients and methods. The V.A. Nasonova Research Institute of Rheumatology followed up 136 patients who were highly positive for ACA. The investigators used the 2001 Russian criteria for the diagnosis for SD; the 2013 ACR/European League Against Rheumatism (EULAR) criteria for that of scleroderma systematica (SDS); the guidelines of the American Association for the Study of Liver Diseases, the Russian Gastroenterological Association, and the Russian Society for the Study of the Liver for that of primary biliary cholangitis (PBC)/biliary duct epitheliitis in the presence of SD. Lymphomas were diagnosed by biopsies of affected organs according to the WHO classification. SD was diagnosed in 119 patients; SDS in 49 cases (37 with SDS concurrent with SD and 12 with isolated SDS), PBC/biliary duct epitheliitis in 23 (all cases with PBC/biliary duct epitheliitis concurrent with SD and/or SDS); 5 patients were excluded from the investigation. Further analysis included 131 ACA-positive patients. The patients were divided into three groups: SD (n=82 or 62.6%); SD+SDS (n=37 or 28.24%); SDS (n=12 or 9.16%).Results and discussion. Autoantibodies to centromere peptide (CENP) A and CENP-B in the same titers were detected in all ACA-positive patients, regardless of diagnosis. Comparative analysis of three patient groups revealed no statistically significant differences in the frequency of laboratory deviations. The signs characteristic of classical SD (rheumatoid factor (RF)), anti-Ro and anti-La antibodies, leukopenia, higher ESR values, hypergammaglobulinemia, and elevated IgG/IgA levels) were found in a small proportion of patients. The frequency and severity of glandular manifestations did not differ in SD and SD + SDS. PBC/biliary duct epitheliitis was present in 17.5% of ACA-positive patients (in most antimitochondrial antibody-positive cases); no statistically significant differences in its frequency were found between the groups. Other extraglandular manifestations in SD and SD + SDS were identified in a smaller number of patients. All sclerodermic spectrum manifestations were more common in SD and SD + SDS than in BS. Pulmonary arterial hypertension was not diagnosed in any patient from the SD group. MALT lymphomas were detected in 19 ACA-positive patients. Those were present only in BS patients and absent in the SDS group. MALT lymphomas developed in the first 10 years after the onset of SD. The transformation of MALT lymphoma into diffuse large B-cell lymphoma was observed in 2 patients. The main signs of lymphomas in SD patients were persistent parotid salivary gland enlargement, decreased levels of complement C4 and peripheral blood CD19+ cells, as well as cryoglobulinemic vasculitis, serum monoclonal secretion, lymphoid infiltration in the minor salivary glands (a focus score of >4), and severe damage to the salivary and lacrimal glands.Conclusion. ACA-associated SD is an independent disease subtype characterized by an increased risk for SDS, PBC, and MALT lymphomas and by a low frequency of the systemic manifestations and laboratory signs characteristic of classical SD. Regardless of the detected type of antibodies and the presence or absence of extraglandular manifestations, damage to the salivary and lacrimal glands progresses in SD, which often leads to lymphomas; therefore, the therapy that may prevent this complication should be initiated as soon as possible after SD diagnosis. The lymphoproliferation signs identified in this investigation should be taken into account in all ACA-positive patients with SD for the early diagnosis of lymphoid tumors before therapy is prescribed. An algorithm for differential diagnosis in seropositivity for ACA is presented. Determination of autoantibodies to CENP-A and CENP-B does not allow the differential diagnosis in ACA-positive patients.

Complicated intestinal anastomoses: the risk factors, preventive measures

SummaryIntroduction. Disorders in the psycho-emotional sphere in people with gunshotwounds can have a significant impact on the post-traumatic course and results oftreatment, which necessitates their detection and appropriate correction. Screening foranxiety and depression in patients with gunshot wounds of the extremities in the earlypost-traumatic period is relevant.Objective. Study of anxiety and depression indicators in patients with gunshotwounds of the extremities to optimize diagnostic and therapeutic approaches.Material and methods. The study of anxiety and depression is a fragment of acomprehensive examination of patients with gunshot wounds of the extremities who weretreated at the National Military Medical Clinical Center «Main Military ClinicalHospital» of the Ministry of Defense of Ukraine. A comparative analysis of the results ofpsychometric testing of anxiety and depression using the Beck Alarm Scale, HospitalAnxiety and Depression Scale as well as Hamilton Scale was performed in 54 people(33 patients with gunshot wounds of the extremities and 21 – in the control group).Statistical data processing was performed.Results and discussion. According to the comparative analysis, the level of anxietyand depression among the examined patients with gunshot wounds of the extremitieswas significantly higher (p

The paper presents the world’s first clinical case of two full-term successive pregnancies in a patient following simultaneous liver-kidney transplantation with reno-portal transposition. Both pregnancies ended with the birth of healthy children and favorable course of postpartum and long-term periods. The features of management and childbirth are highlighted. Literature review on this problem is presented.

In this work we aimed to test the atherosclerotic changes in the aortic wall and pro-coagulant response of the blood coagulation system of spontaneously hypertensive rats (SHR) fed cholesterol-rich diet (CRD) and to study the effect of the anti-inflammatory agent N-stearoylethanolamine (NSE) on the development of atherosclerosis in this model. Female rats (n = 30) with genetically determined hypertension proven by direct measurement of blood pressure were fed CRD (5% cholesterol) for 2 months. Control group of SHR (n = 10) received standard pellet diet, 10 were fed CRD and 10 received CRD with daily per os application of NSE at a dose of 50 mg/kg of body weight. Histological analysis detected swelling and detachment of endothelial cells, huge edema of the subendothelial layer and a disruption of the middle shell integrity. CRD rats had higher fibrinogen concentration, increased rate of platelet aggregation and decreased level of anticoagulant PC. Platelet aggregation speed increased in CRD-fed rats (52.5±4.1%/min) was slightly normalized under the action of NSE (40±8.3 vs 35±9%/min in controls). Fibrinogen concentration was slightly increased in CRD-fed rats (2.75±0.7 vs 1.9±0.5 mg/ml in controls). However, the level of anticoagulant PC that was decreased in CRD-fed rats (65±16 vs 100±11% in controls) was normalized under the action of NSE (92±17%). NSE also influenced the aorta architecture, however normalizing the thickness of the aorticwall did not change the cholesterol-induced inclusions within aorta media. NSE anti-inflammatory action changes the atherogenic processes in CRD-fed rats mainly protecting PC from consumption during the inflammatory process and reducing edema of the aorta. However hematological parameters (including clotting time in the APTT test and fibrinogen concentration) changed independently on NSE application. Anti-aggregatory action of NSE on platelets can be a result of direct action on platelets or the consequence of its anti-inflammatory action. During atherogenesis induced by CRD in the model, NSE demonstrated valuable anti-inflammatory action protecting the organism during atherogenesis, however it cannot be assumed as an antithrombotic or antiatherogenic agent because it is unable to influence hemostasis directly.

The epidemiology of chronic heart failure in patients with diabetes mellitus type 2, their general pathophysiological mechanisms, the influence of diabetes mellitus type 2 on the course and prognosis of chronic heart failure are considered. The high prevalence of chronic heart failure of all phenotypes among patients with diabetes mellitus type 2 and the increased risk of developing diabetes mellitus type 2 in patients with chronic heart failure confirm the close relationship and the high degree of comorbidity between these pathological conditions. It is shown that the development and progression of chronic heart failure in patients with diabetes mellitus type 2 is the formation of diabetic cardiomyopathy, which is characterized by disorders of energy metabolism of cardiomyocytes, mitochondrial dysfunction with subsequent apoptosis and myocardial fibrosis. Important links in the pathogenesis of chronic heart failure in diabetes mellitus type 2 are also the accession of diabetic cardiovascular autonomic neuropathy, activation of the renin-angiotensin-aldosterone system, endothelial dysfunction, exposure to atherogenic factors, arterial hypertension, obesity. The features of treatment of chronic heart failure in patients with diabetes mellitus type 2, the results of randomized clinical studies, the choice of target glycemic levels, the effectiveness of different groups of antihyperglycemic agents, drugs for the treatment of chronic heart failure, as well as their impact on the course and prognosis of chronic heart failure. Keywords: chronic heart failure, diabetes mellitus type 2, course, prognosis, treatment.

Antiphospholipid antibodies (aPLs) are a heterogenous group of auto‑ antibodies that interact with phospholipids (PL), phospholipid‑protein complexes and phospholipid‑binding proteins. aPLs are pathogenic and associated with the development of thrombosis and pregnancy pathology. The detection of aPLs as a diagnostic indicator is included in the criteria for antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) SLISS 2012. Also, aPLs is found in patients with other autoimmune, infectious diseases and cancer, in 10–12 % of elderly and 1–5 % healthy young people, but do not lead to the development of thrombosis and/or miscarriage. Simultaneous detection of aPLs with different tests indicate bad prognosis and a higher risk of clinical manifestation of APS. Triple positivity for classical markers of disease is found in patients with oncoming thrombosis. Another concept is the Global APS Score (GAPSS) that also takes into account the aPL profile as well as conventional cardiovascular risk factor and also some autoantibodies found in systemic disease. Currently, enzyme‑linked immunosorbent analysis (ELISA) are most widely used test for detection of aPLs. The advantage of new methods for detecting aPLs is to improve the parameters of sorption of antigens, automation, multiplex approach. Thus, new techniques can serve as a tool for the detection of aPLs and contribute to improving the quality of diagnosis of autoimmune diseases.

This work is devoted to the development of software that would allow the recognition of sound signals of non-speech origin. The article reviews the current sound recognition systems, identifies their advantages and disadvantages. The list of the most widespread algorithms which can be used for process of training of model and classification of sounds is resulted. The Gaussian mixed distribution model, which is used to describe the program's sound models, is considered in more detail. An overview of the process of recognition of sound signals and their further classification is given. This program can be used for audio detection of signals that are available in the database. The product can be used on its own or included in other more advanced recognition systems. Using the tools of the C ++ programming language allowed to make it efficient and maintain speed. Statistics of recognition results are also given and a conclusion on the efficiency of the system is made.

Purpose of the study. Was to investigate life quality in patients with comorbidly pathology of chronic obstructive pulmonary disease in combination with arterial hypertension. Materials and methods. 77 subjects with a diagnosis of chronic obstructive pulmonary disease stage I–III (according to the GOLD criteria) in combination with arterial hypertension I–III stage. The comparison groups included 30 patients with essential hypertension and 45 patients with chronic obstructive pulmonary disease. All groups were completely comparable by the length and disease severity. All patients underwent general clinical examination, blood pressure measurement, spirometry, electrocardiography, and echocardiography. Study of the life quality in patients was carried out by means of self-questioning using General official Russian-language analogue of the MOS SF-36 questionnaire. Results. It was determined, that life quality parameters of physical status and psychosocial status were reduced in all patients, but to a greater extent in patients with comorbidity than in patients of the comparison group. Disease duration influenced on life quality. In patients with newly diagnosed chronic obstructive pulmonary disease with a history of marked increase in blood pressure, changes in life quality were more expressed in comparison with the comparison group; at the same time there was tendency of it’s increasing over time. When assessing the relationship between quality of life and parameters of pulmonary ventilation, it was found that depending on the severity of respiratory function disturbances it is directly proportional to decreased quality of life, both physical and psychosocial status. Life quality of in patients with chronic obstructive pulmonary disease worsens due to addition and progression of essential hypertension. Conclusions. Сomorbidly pathology has a negative impact on physical and psychosocial status of patients, which is significantly reduces life quality and depends on the severity of pulmonary ventilation disturbances, «length of the disease» and hypertension degree.

Pseudomonas infection is one of the most problematic pathogens of pneumonia, because it has natural resistance to many antibiotics, is able to quickly form acquired resistance, often causes severe pneumonia with a poor prognosis. Analysis of the literature data showed that today P. Aeruginosa demonstrates resistance to all anti-pest control antibiotics, with the exception of polymyxin. The levels of resistance of P. Aeruginosa are very considerably depending on the region of the survey and the profile of the hospital, which requires monitoring the sensitivity of microorganisms in each department of the hospital. The data on the degree of resistance to P. Aeruginosa antibiotics in Ukraine are limited, but available local studies on this issue also show a high level of resistance of this microorganism to the main anti-pest antibiotics. In patients with pneumonia and risk factors for the involvement of Pseudomonas infection, most authors recommend combination antibiotic therapy, which has a synergistic effect on P. Aeruginosa, which allows, in most cases, to overcome the resistance of this microorganism. According to the literature, such synergism has been proven for the combination: beta-lactams (ceftazidime, cefepime, antipseudomonas carbapenems) + aminoglycosides (amikacin) or fluoroquinolones (ciprofloxacin or levofloxacin). The use of these drugs in the maximum allowable dose allows a higher degree of probability to achieve the eradication of P. Aeruginosa in patients with pneumonia and to improve the prognosis for this disease.

The theory of coherent photon-assisted electron transmission through a one-dimensional smooth barrier is successfully used to model the results of measuring the terahertz photoconductivity of a tunneling point contact in a two-dimensional electron gas. For this barrier in a deeper tunneling mode, photon steps in the curve of the transmission coefficient versus initial electron energy were found. Their position is determined by the terahertz photon energy.

The functioning algorithm of the automated system optimization of the pulverized fuel consumption (PFC) for blast furnace has been developed. It is assumed that the system consists of subsystems: control of information reliability, stabilization of the slag basicity and the theoretical burning temperatures; heat losses compensation and the oxidation process fluctuations of cast iron on the tuyeres; thermal state stabilization of the melting process; PF consumption optimization and blasting. The algorithm includes a set of algorithms for the functioning of these subsystems.According to the information about the technological parameters, the composition of the flue gas is calculated and compared with gas analyzers reading. If the differences between them exceed the given values, we conclude that metrological characteristics of the measuring and computing channels are unsatisfactory and begin checking these channels.The value of the theoretical combustion temperature, which is compared with the given limits has been calculated. The recommendations for changing technological oxygen consumption and blast humidity are determined by the difference between them. For every 10 min, the temperature of tuyere fire flow, theoretical burning temperature and the difference between them is determined, which defines the change in the iron oxidation and adjust the prediction of cast iron quality.The combined principle of controlling the thermal state of blast-furnace smelting is provided. The change in the incoming heat into the zone of indirect restoration, which calculates the recommendations for changing the mass of coke in the feed is determined. The qua-lity of pig iron is determined according to the incoming heat in the lower part of the furnace and recommendations for its stabilization are predicted. Taking into account fluctuations in heat losses with blast furnace gas and cooling water, the complex parameters of the thermal state and the quality prediction of pig iron are adjusted.The coke coefficient of substitution, the amount of coke replaced, the amount of sa-vings is calculated. The optimum amount of PFC is determined by the extreme value of the savings., Разработан алгоритм функционирования автоматизированной системы оптимизации расхода пылеугольного топлива (ПУТ) на доменную плавку. Предусматривается, что система состоит из подсистем: контроля достоверности информации, стабилизации основности шлака и теоретической температуры горения; компенсации потерь тепла и колебания процесса окисления чугуна на фурмах; стабилизации теплового состояния процесса плавки; оптимизации расхода ПУТ и дутья. Алгоритм состоит из комплекса алгоритмов функционирования этих подсистем.По информации о технологических параметрах рассчитывают состав колошникового газа и сравнивают его с показаниями газоанализаторов. Если разница между ними превышает заданные величины, то делают вывод о том, что неудовлетворительны метрологические характеристики измерительных и вычислительных каналов и начинают проверку этих каналов.Рассчитывают значения теоретической температуры горения, которое сравнивают из заданными границами. По разнице между ними дают рекомендации по смене расхода технологического кислорода и влажности дутья. За каждые 10 мин. определяют температуру фурменных очагов, теоретическую температуру горения и разницу между ними, по которой определяют смену окисления железа и корректируют прогнозирование качества чугуна.Обеспечивается комбинированный принцип управления тепловым состоянием доменной плавки. Определяют смену прихода тепла в зону непрямого восстановления, по которой дают рекомендации на смену массы кокса в подаче. По показателям прихода тепла в нижнюю часть печи прогнозируют качество чугуна и дают рекомендации его стабилизации. С учетом колебаний потерь тепла с колошниковым газом и охлаждающей водой корректируют комплексные показатели теплового состояния и прогнозирования качества чугуна.Рассчитывают коэффициент замены кокса, количество замененного кокса, сумму сэкономленных средств. Оптимальное количество пылеугольного топлива определяют по экстремальным значениям сэкономленных средств., Розроблено алгоритм функціонування автоматизованої системи оптимізації витрати пиловугільного палива (ПВП) на доменну плавку. Передбачається, що система складається із підсистем: контролю достовірності інформації, стабілізації основності шлаку і теоретичної температури горіння; компенсації втрат тепла і коливання процесу окиснення чавуну на фурмах; стабілізації теплового стану процесу плавки; оптимізації витрати ПВП і дутт. Алгоритм включає комплекс алгоритмів функціонування цих підсистем.За інформацією про технологічні параметри розраховують склад колошникового газу і порівнюють його з показами газоаналізаторів. Якщо різниці між ними перевищують задані величини, то роблять висновок про те, що незадовільні метрологічні характеристики вимірювальних та обчислювальних каналів і починають перевірку цих каналів.Розраховують значення теоретичної температури горіння, яке порівнюють із заданими границями. За різницею між ними визначають рекомендації на зміну витрати технологічного кисню і вологості дуття. За кожні 10 хв. визначають температуру фурмених вогнищ, теоретичну температуру горіння та різницю між ними, за якою визначають зміну окиснення заліза та корегують прогнозування якості чавуну.Забезпечується комбінований принцип керування тепловим станом доменної плавки. Визначають зміну приходу тепла у зону непрямого відновлення, за якою вираховують рекомендації на зміну маси коксу у подачі. За показниками приходу тепла в нижню частину печі прогнозують якість чавуну і визначають рекомендації на її стабілізацію. З урахуванням коливання втрат тепла з колошниковим газом та охолоджуючою водою корегують комплексні показники теплового стану і прогнозування якості чавуну.Розраховують коефіцієнт заміни коксу, кількість заміненого коксу, суму заощаджених коштів. Оптимальну кількість пиловугільного палива визначають за екстремальним значенням заощаджених коштів.

The mathematical models of optimality criteria of blast, fuel additives and steam consumption for blasting moisture have been developed. The criterion for optimal blast consumption is the furnace performance, which should be maintained at the highest possible level. The maximum possible level of performance varies over time, even at a constant value of blasting. Therefore, optimal amount of blasting search is carried out continuously every 5 to 10 minutes. The mathematical model of furnace efficiency has been developed. It is determined by information on the amount of combined blast and its content of reducing gas, the oxidation of the charge, the amount of gasified oxygen of the charge from one filing, the amount of cast iron, which is smelted from the charge of one feed, the output of the dry blast furnace gas. The mathematical model of the optimization criterion of fuel additives consumption includes mathematical models: the coke coefficient of substitution by a fuel additive; the amount of coke replaced by a fuel additive; the amount of profit from the additive use. The coefficient of coke substitution is defined as the ratio of the heating power in the blast furnace to of coke combustion heat, based on information on the composition of the blast furnace gas, the composition of the fuel additive and coke. The amount of coke substituted by a fuel additive is determined by the value of the substitution coefficient and the fuel additive consumption. The amount of profit from the additive use is determined by the information on the consumption of fuel additive and oxygen, fuel additive price, oxygen and coke, the furnace efficiency. The mathematical model of the optimization criterion of steam consumption for blas-ting moisture includes models; the amount of heat consumed for steam decomposition; the heat input at the expense of improving the degree of hydrogen and carbon monoxide use; the intensity change of carbon combustion in the tuyeres; required mass of coke for heat compensation expended on the decomposition of the blow moisture in the furnace; total savings or over-consumption of coke mass when humidity changes; increase in the furnace's efficiency due to changes in the moisture content of the blast; money saving from steam using for moistening.

Сучасні тенденції в лікуванні раку шлунка, ускладненого канцероматозом очеревини

Мета роботи — порівняти результати застосування ендовенозної лазерної коагуляції (ЕВЛК) торцевим світловодом ізольовано чи в комбінації з ехосклерооблітерацією стовбура великої підшкірної вени (ВПВ) у пацієнтів різних вікових категорій з хронічною венозною недостатністю, спричиненою варикозною хворобою нижніх кінцівок класу С2—С5 EpAsPr. Матеріали і методи. Проведено ретроспективний аналіз комбінованого хірургічного лікування 152 пацієнтів з вертикальним рефлюксом по ВПВ із сафено­феморального співустя в Університетській клініці Одеського національного медичного університету в 2015 — 2017 рр. Групи сформовано ретроспективно: перша група — 44 пацієнти (32 жінки, 12 чоловіків), яким проведено ЕВЛК неспроможного сегмента ВПВ у 2015 р., друга група — 108 пацієнтів (92 жінки, 16 чоловіків), яким виконано ЕВЛК у комбінації з ехосклерооблітерацією неспроможного сегмента ВПВ у 2016 — 2017 рр. Віковий діапазон хворих — від 25 до 65 років. Середній вік пацієнтів 1­ї групи — (38,2 ± 13,6) року, 2­ї групи — (45,1 ± 13,3) року. Довжина неспроможного сегмента ВПВ становила в середньому (277 ± 18) мм. Для оцінки ефективності методик використовували ультразвуковий контроль апаратом Toshiba Nemio XG SSA 580A інтраопераційно, через 7 днів, 1, 2 та 6 міс після операції, а також опитування. Як критерій було обрано повноту облітерації неспроможного сегмента ВПВ. Результати та обговорення. За повнотою облітерації стовбура ВПВ виявлено статистично значущі відмінності між групами. За додатковими критеріями (біль, інфільтрація, пігментація, флебіти) статистично значущих відмінностей між групами не встановлено. Висновки. Застосування комбінації методів фізичного і хімічного впливу на внутрішній шар венозної стінки дає змогу використовувати більш низькоенергетичні режими ЕВЛК та менші концентрації склерозанта для досягнення ефективної веноблітерації, порівнянної з такою при застосуванні високоенергетичних параметрів, ніж при використанні методів лікування поодинці. Застосування комбінації ЕВЛК та ехосклерооблітерації дає змогу досягти ефективнішої облітерації просвіту підшкірних вен більшого діаметра порівняно з використанням лише ЕВЛК.

The JAK2 V617F somatic mutation is one of the most frequent markers of CHIP (clonal hematopoiesis of indeterminate potential). CHIP is characterized by the presence of a myeloid cells clone in peripheral blood in the absence of the sufficient reasons to diagnose the hematologic disease. The CHIP is proposed as a potential independent risk factor for vascular pathology. The aim of this study is to identify carriers of JAK2 V617F mutation among patients admitted for planned hospitalization at the Federal Center of Cardiovascular Surgery of Krasnoyarsk.The study included 930 venous blood samples. JAK2 V617F mutation was detected by using the allele - specific real time polymerase chain reaction.JAK2 V617F mutation was detected in 15 (1.6%) patients, but only two of them had blood cell count that could cause a hematological disease to be suspected.The inclusion of the JAK2 V617F mutation detection in the complex of laboratory tests of the cardiovascular patients can facilitate the timely identification of patients with increased thrombotic risk, as well as the timely diagnosis of myeloproliferative diseases.Соматическая мутация V617F в гене JAK2 является одним из наиболее частых маркеров клонального гемопоэза «неопределенного потенциала», так называемого синдрома CHIP (clonal hematopoiesis of indeterminate potential). Синдром CHIP характеризуется наличием в периферической крови клона миелоидных клеток при отсутствии достаточных оснований для диагноза онкогематологического заболевания. Наличие CHIP предложено рассматривать как потенциальный независимый фактор риска сосудистой патологии. Цель работы - выявление мутации V617F в гене JAK2 у пациентов, поступивших на плановую госпитализацию в ФГБУ «Федеральный центр сердечно - сосудистой хирургии» Красноярска. Материалы и методы. В исследование включено 930 образцов венозной крови пациентов. Выявление мутации V617F в гене JAK2 выполняли методом аллель - специфической полимеразной цепной реакции в режиме реального времени. Результаты. Среди обследованного контингента выявлены 15 (1,6%) пациентов с мутацией V617F в гене JAK2, при этом только у двух из них показатели гемограммы могли указать на возможность гематологического заболевания. Заключение. Включение теста выявления мутации V617F гена JAK2 в меню лабораторных исследований пациентов кардиологического профиля может способствовать своевременному выявлению больных с повышенным тромбогенным риском, а также своевременной диагностике миелопролиферативных заболеваний.

Objective. To compare the immediate and late results of treatment in patients, suffering locally-spread mammary gland cancer (LSMGC), using various methods of administration of preparations for polychemotherapy (PCHTH). Materials and methods. The investigation was conducted, basing on selective analysis of medical cards of 112 stationary patients, suffering LSMGC Stage T4A-DN0-3M0, who obtained complex antitumoral treatment on the base of the Donetsk Regional Antitumoral Centre and the University Clinic of the Odessa National medical University in 2000 - 2017 yrs. Into the comparison group 65 (58%) women-patients were included, suffering inoperable forms of a LSMGC, to whom a systemic polychemotherapy (SPCHTH) was conducted in a neoadjuvant regime. Into the investigation group 47 (42%) women-patients were included with inoperable forms of a LCMGC, to whom, as a neoadjuvant course, endolymphatic PCHTH (EPCHTH), was conducted. Result. In the aspect of indices of a three- and a five-year survival a statistically significant difference between the groups investigated was absent. Immediate results of the women-patients, to whom a neoadjuvant ELPCHTH was conducted, have shown no statistically significant difference with those, treated, using SPCHTH. Conclusion. Immediate and late results of complex therapy for a LSMGC in unfavorable prognosis of tumoral growth with conduction of ELPCHTH in a neoadjuvant regime and performance of radical operative intervention are better, comparing with the treatment result in accordance to similar scheme, but with conduction of SPCHTH on a preoperative stage, without statistical significance.

Objective. To compare the indices for complex estimation of the women-patients’ quality of life (QL), who suffer unfavorable locally-spread forms of a mammary gland cancer (MGC) before and after conduction of intravenous systemic polychemotherapy (SPCHTH) and selective endolymphatic polychemotherapy (ELPCHTH) in a neoadjuvant regime. Маterials and methods. The investigation was conducted, basing on selective analysis of cards of 112 women-patients, suffering locally-spread (LS) MGC of a T4A-DN0-3M0 Stage, who received complex antitumoral therapy on the base of Donetskyi Regional Antitumoral Centre and in the University Clinic of the Odessa National Medical University in 2000 - 2017 yrs. and to whom there was proposed to take part in answering to questionnaires on various stages of preoperative treatment. There were compared the QL indices in two groups of patients: in a control group were included 65 (58%) patients, to whom SPCHTH was conducted in a neoadjuvant regime; and in a control group - 47 (42%) women-patients, to whom ЕLPCHTH was conducted in a neoadjuvant setting. Results. In accordance to data on integrative indices of QL and quality of health (QH) the statistically trustworthy differences between women-patients of a control and investigation groups were absent. A detailed analysis of indices of symptomatic scales have revealed the intergroup difference, which did not exceeded a critical one. As a result, the investigation was conducted in the women-patients, who obtained ЕLPCHTH in the neoadjuvant regime. Subjective estimation in absolute numerals of the treatment conducted have had the best referent values without statistical advantages. Conclusion. Investigation of integrative index of QL and its discrete elements constitutes an ergonomic and economic method of heuristic estimation procedure of the health state in patients, suffering a LS MGC. It is mandatory to elaborate a more rational and convenient methods of the actual issues of modern oncology solving, using compliance and search to achieve a compromise between physician and patient.

The aim of the research – to study the structural-functional state of artery walls in patients with rheumatoid arthritis depending of disease duration, seropositivity for rheumatoid factor/ cyclic citrullinated peptide antibodies, disease activity. Materials and methods. 82 patients with rheumatoid arthritis were investigated: 19 men (23.1 %) and 63 women (76.9 %), the average age of whom was (37.6 ± 5.1) years old. The control group consisted of 30 apparently healthy persons. In all the patients measurements of diameter and thickness of intima-media complex of common carotid arteries were carried out, the stiffness index was calculated. Results. 47.5 % (n = 39) of patients had rheumatoid arthritis with the present illness duration less than 3 years, in 47.5 % of patients (n = 39) the duration of rheumatoid arthritis was more than 3 years. In 48 (58.5 %) of patients rheumatoid factor/cyclic citrullinated peptide antibodies were present – seropositive variant of rheumatoid arthritis, in 34 (41.5 %) patients – rheumatoid factor/cyclic citrullinated peptide antibodies seronegative variant of the disease. Within all investigated patients with rheumatoid arthritis the highest rates of intima-media thickness complex of common carotid arteries were detected in patients with longer-term (more than 3 years) present illness rheumatoid factor/cyclic citrullinated peptide antibodies of seropositive rheumatoid arthritis; in patients of this group higher stiffness index of common carotid arteries was also detected that characterizes the local (carotid) rigidity of artery wall. Correlation analysis showed the existence of direct relationship between DAS28 and intima-media complex of common carotid arteries, the duration of rheumatoid arthritis and stiffness index of intima-media complex of common carotid arteries, and also between their size and the level of rheumatoid factor, cyclic citrullinated peptide antibodies, which shows the substantial contribution of activity and duration of autoimmune inflammation course in rheumatoid arthritis to changes of common carotid arteries architectonics. Conclusions. The data obtained demonstrate the existence of subclinical lesion of common carotid arteries in patients with rheumatoid arthritis and absence of cardiovascular diseases, more significant in long-term course (more than 3 years) of seropositive for rheumatoid factor/ cyclic citrullinated peptide antibodies disease variant.

In recent years, breast cancer (BC) is the most common cancer pathology and the most common cause of disability among women in developed countries. Finding the most effective ways of interaction between the patient and the doctor creates the preconditions for the necessary analysis of the treatment process from an objective and subjective point of view. Therefore, an important indicator to be taken into account is the quality of life of a patient. To compare the indicators of a comprehensive assessment of the quality of life of patients to the adverse locally advanced forms (LA) of breast cancer before and after systemic intravenous polychemotherapy (SPCTx) and selective endolymphatic polychemotherapy (ELPCTx) in neoadjuvant mode. The study was conducted on the basis of a random analysis of outpatient cards from 112 patients with LA BC T4A-DN0-3M0 who received a comprehensive antitumor treatment on the basis of the Donetsk regional antitumor center and the University Clinic of the Odessa National Medical University from 2000 to 2017, which was proposed a questionnaire at various stages of preoperative treatment. The first (control) group consisted of 65 patients (58 %) with inoperable forms of LA BC, which was performed in neoadjuvant mode by SPCTx. The second (study group) included 47 patients (42 %) with inoperable forms of LA BC, which was performed as a neoadjuvant course ELPCTx. According to the integral indicators of quality of life and quality of health between patients in the control and study groups, there was no statistically significant difference. In a detailed analysis of the indicators of symptomatic scales, the difference between the groups did not exceed the critical. Based on the results of a study conducted among patients receiving endolymphatic chemotherapy in a neoadjuvant mode, the subjective evaluations of treatment in absolute numbers have better reference values without statistical superiority. The study of the integrative indicator of quality of life and its discrete elements is an ergonomic and economical means of heuristic assessment of the health of patients in order to further develop more rational and convenient ways of solving urgent issues of modern oncology by increasing compliance and finding a compromise between the physician and the patient.

Objective. Investigation of quality of life (QL) in patients, suffering inoperable forms (locally-spread) of mammary gland cancer (MGC), before and after conduction of neoadjuvant courses of systemic polychemotherapy (SPCHTH) and selective intraarterial polychemotherapy (SIAPCHTH) in combination with SPCHTH. Маterials and methods. Complex treatment was conducted in 154 patients, suffering locally-spread MGC T4A-DN0-3M0 in a period 2000 -2017 yrs, on base of Donetsk Regional Antitumoral Centre and The University Clinic of Odessa National Medical University. All the patients were divided into two groups. Tо Group I (control) were included 65 patients, suffering inoperable forms of a locally-spread MGC, to whom as a neoadjuvant course a SPCHTH was conducted; and to the Group II (investigating) - 89 patients, suffering inoperable forms of locally-spread MGC, to whom a SIAPCHTH was conducted as a neoadjuvant course. Results. Through the period of treatment a wave-like dynamics of the quality of life index was observed, which indicated a definite advantage of SIAPCHTH over SPCHTH. A limited statistically trustworthy difference in favor of regional polychemotherapy was formed between the Groups of patients in accordance to the quality of life index. Conclusion. Investigation of quality of life constitutes a secure, informative and economic method of estimation of a patient state of health on the groupings and the individuals levels. In oncological investigations the QL assessment constitutes an important criterion of the treatment efficacy estimation and has a prognostic significance. Estimation of quality of life in clinical investigations improves the investigation quality itself.

For several decades, breast cancer (BC) undoubtedly ranks first in the structure of oncopathology and is the most common cause of the loss of working capacity of the female population in most countries. Considering the increasing quality of care for patients with breast cancer, there is the need for standardization and implementation of methods to assess not only quantitative but also qualitative component of a comprehensive opinion on the results of therapy. Therefore, an important indicator to be taken into account is the quality of life (QL) of a patient. Definition of QL of patients with inoperable forms of locally advanced breast cancer before and after neoadjuvant courses of systemic polychemotherapy (SPCT) and selective intra-arterial polychemotherapy in combination with systemic (SIAPCT). 154 patients with LA BC T4A-DN0-3M0, who received comprehensive treatment on the basis of the Donetsk regional antitumor center and the University clinic of the Odessa National Medical University during the period from 2000 to 2017, who received SPCT or SIAPCT as a neoadjuvant course, were included in the study. According to the quality of life during the treatment period, wavelike dynamics with a clear advantage of selective intra-arterial polychemotherapy over the system was observed. According to the quality of health between groups, the marginal statistically significant difference in favour of regional PCTs was formed. In a detailed study of each of the options found stable symptomatic scale dependent components of the integral index of quality of life on the severity and duration of intoxication syndrome. On the basis of the results obtained, the statistical advantage of the RMRM remains with the regional PCT. The QL study is a reliable, informative and economical method for assessing the health status of the patient, both at the group and at the individual level. In cancer studies, the evaluation of QL is an important criterion for assessing the effectiveness of treatment and has a prognostic value.

OBJECTIVE. The study aimed to raise an efficacy of motor functions after stenting of precerebral arteries in acute period of ischemic stroke in patients of elderly and senile age. MATERIAL AND METHODS. Treatment efficacy was assessed according to dynamics of neurological status, data of duplex scanning of brachiocephalic vessels, index of mobility «Rivermed», scale «Bartel» in 30 patients. RESULTS. Stenting of precerebral arteries in acute period of ischemic stroke facilitated to regress of motor disorders and normalized cerebral hemodynamics. CONCLUSIONS. Stenting is an alternative method to carotid endarterectomy. This approach should be applied in patients with expressed carotid stenosis in combination with accompanied diseases and high surgical risk.

The article is dedicated to the problem of pregnancy management and delivery after simultaneous liver-kidney transplantation (SLKT). The article contains general historic and statistic information, and presents the first real world clinical case of favorable pregnancy outcome in patient after simultaneous liver-kidney transplantation with reno-portal transposition.

This case report demonstrates a clinical treatment tactic of a 39 y.o. patient with acute necrotizing pancreatitis. The peculiarity of the disease course is its cause – hypertriglyceridemia associated with poorly managed type 2 diabetes. Within 5-year interval in 2007 and 2012 respectively, the patient suffered two attacks of severe necrotizing pancreatitis. In 2007 he had necrotizing noninfectious pancreatitis, and in 2012 – infectious necrotizing pancreatitis requiring open sequestrectomy. The patient underwent efferent therapy methods such as hemosorbtion and plasmapheresis in combination with standard treatment scheme. The post-operative period was marked by arrosive hemorrhage, subphrenic abscess, ligature fistulas and giant post-operative hernia. During all period of observation (2007 – 2017), the patient was suffering hypertriglyceridemia (blood test as of December 22, 2016 demonstrated high level of triglycerides – 21.92 mmol/L), which required the periodical plasmapheresis procedure. Despite two attacks of severe acute necrotizing pancreatitis, five years later the patient’s life quality according to SF-36 questionnaire is approaching normal.

Anti-heterogeneous nuclear ribonucleoprotein (RNP) autoantibodies (AAbs) are encountered in many autoimmune rheumatic diseases (ARDs). The potential diagnostic value of the RA33 AAb complex consisting of RNP A2 and alternative domains of the splicing proteins RNP B1 and RNP B2 is now of interest to rheumatologists. Subjects and methods. The authors studied the frequency of anti-RNP B1 AAbs in 300 patients with systemic ARDs, including those with rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and Sjo gren's syndrome (SS) and in 53 people without ARDs, who constituted a control group. Serum anti-RNP B1 AAbs were assessed by enzyme immunoassay. Results and discussion. The frequency of anti-RNP B1 AAbs in patients with ARDs was much higher than that in the control group: 170/300 (56.6%) and 8/53 (13%) patients, respectively. Anti-RNP B1 AAbs were detected in 78.5% (113/144) of the patients with RA; 40.3% (23/57) of those with AS, in 67.5% (27/40) of those with SSc, in 36.4% (16/44) of those with SLE, and in 13.3% (2/15) of those with SS. The diagnostic sensitivity of the marker for RA was 78.5%, its diagnostic specificity was 84.9%; the likelihood ratio of positive and negative results was 5.24 and 0.24, respectively. In the patients with RA, the level of anti-RNP B1 AAbs significantly correlated with that of C-reactive protein and erythrocyte sedimentation rate, while in those with SSc the detection of anti-RNP B1 AAbs was related to the rigidity of the vascular wall and the presence of hypertension. The frequency of anti-RNP B1 AAbs among the RA patients seronegative for rheumatoid factor and anti-cyclic citrullinated peptide antibodies was 15.4%. Conclusion. Anti-RNP B1 AAs are a useful laboratory marker (with the upper limit of the normal range being 3.3 U/ml), but are of limited value in the diagnosis of RA. Anti-RNP B1 AAbs may be regarded as an additional diagnostic marker for RA.

The authors evaluated the efficacy of endoscopic submucosal dissection in treatment of early gastric cancer. The study included 60 patients who underwent endoscopic submucosal dissection in cases of differentiated early gastric cancer. RESULTS. The radical surgeries were performed on 59 (98,3%). Complications were noted in 9 (14,9%) of cases and they were removed by endoscopic method. The early recovery period consisted of 24 hours. There weren’t observed any local recurrence or progression of the disease during 6-48 months of follow-up study. The method efficacy was 98,3%. The authors have taken into account the results of the study and a literature analysis. Endoscopic submucosal dissection is the choice of treatment strategy in case of early gastric cancer T1aN0M0 and T1bN0M0 in differentiated adenocarcinoma. The method is highly effective and relatively safe. This approach corresponds with oncological principles of radicalism, thus it reduces the rate of postoperative complications and the period of social rehabilitation of patients. The surgery maintains the high quality of life after treatment without decline of long term results.

The study was conducted to evaluate the activity parameters of local and systemic inflammation in women suffering from bronchial asthma (BA). 119 women with asthma were studied, and 48 with a regular menstrual cycle and 71 in menopause; 38,7% of BA was mild, 61,3% – moderate severity. All patients were examined in the remission phase of the disease. On the background of normal values of conventional indicators of inflammation it was showed a significant increase of IL 1 alpha and IL 8 more in the group of women with regular menstrual cycles and normal body weight, IL1 alpha amounted to 489±80 pg/ml and IL8 – 631±122 pg/ml (p

A method is presented to be used in a computational experiment aimed at studying the internal structure of nano- and mesoscopic objects, i.e., conducting subsystems and quantum phenomena in solid submicron objects, which demonstrate an individual behavior of low-temperature resistance.

The thematic justification of the study into the phenomenon of contemporary consumer behaviour models is the IT growth, peculiarities of the digital economy formation, the development of retail chains’ omnichannel strategies, and the emerging digital era. All these factors induce the development of a new perplexed market environment, which is distinctive due to its ambiguity and uncertainty among other things, which in its turn affects a prospect customer and makes for companies’ business modernization. The purpose of the research is to consider approaches to studying parameters, habits, pre-buying and post-buying behaviour, as well as preferences and expectations of the omnichannel consumer. The article considers the essence of concepts of “omnichannel consumer” and “consumer gates”, the latter being singled out by the authors as an actual field for companies’ marketing efforts improvement. The authors have considered the algorithm for a “buyer’s map” development with due regard to his or her actions during the online and offline shopping decision-making process. Secondary information analysis enabled the presentation of the key trends in changing consumer behaviour models. The research conducted in a form of an online poll has convincingly shown the importance of mobile communication channels, while the in-depth interview methods allowed spotting gates for product purchase with due regard to different consumer archetypes.

Plasty of the stenosed terminal sygmostoma, using the rotated flap

T ota l mesorectal excision is the “golden standard” of surgical treatment for rectal cancer. Development of endoscopic technologies allowed to implement the benefits of minimally invasive surgery in early rectal cancer treatment, decrease morbidity and mortality, improve functional outcome and quality of life. Oncological safety of this method is still a subject for discussion due to lack of lymph node harvest. Endoscopic operations for early rectal cancer are being actively implemented in daily practice, but lack of experience does not allow to include this method in national clinical prac-tice guidelines.

Aim – to determine the peculiarities of asthenic syndrome in patients with diabetes mellitus (DM) type 2 in the clinical and medico-psychological context. Materials and methods . 543 patients with DM type 2 were examined. The first clinical group (CG-1) consisted of 57 patients with DM type 2 of mild severity; the average age in the group was (51.80 ± 1.28) years. The second clinical group (CG-2) was made up of 312 patients with DM type 2, moderate severity; the average age in the group was (55.10 ± 1.12) years. The third clinical group (CG-3) included 174 patients with DM type 2, severe degree of severity; the average age in the group was (the 61.80 ± 0.85) years. Research methods: clinical-anamnestic, clinical-psychopathological, statistical. Results . Asthenic syndrome was detected in 52.30 % of patients with DM type 2 and by the frequency of prevalence it ranked third – after dyssomnia and psychoorganic syndromes. A direct correlation of asthenic syndrome and the severity of DM type 2 ( г = 0.68, p < 0.05) was established. Risk factors for the occurrence of asthenic syndrome in patients with DM type 2 were moderate and severe degrees of DM type 2, obesity, discirculatory encephalopathy, heart failure. In CG-1 and CG-2 the dominance of such a component of fatigue as "mental fatigue" was revealed, whereas the "physical fatigue" component has reached dominant values only in CG-3. Conclusions . The peculiarities of asthenic syndrome in patients with DM type 2, and the frequency of its occurrence among the investigated population were studied. Correlation of asthenic syndrome with severity of DM type 2 and concomitant somatic pathology were established. Organic etiology of asthenic syndrome in patients with DM type 2was proved. Understanding of the stages of asthenic syndrome development in patients with type 2 nd DM was extended.