Search

Стаття присвячена дослідженню специфіки кримінальних проваджень за участі неповнолітніх осіб, в контексті норм національного законодавства та окремих наукових праць. Встановлено, що особливе процесуальне становище дітей в кримінальному судочинстві детерміноване віковими особливостями даних субʼєктів. Розглянуто актуальні міжнародні стандарти, що стосуються порядку кримінальної процесуальної діяльності у провадженнях за участю неповнолітніх осіб. Відмічається, що на національному рівні специфіка проваджень у справах неповнолітніх репрезентується насамперед у відокремленості законодавчого регулювання кримінальних процесуальних відносин за участі даних індивідів, про що свідчать положення глави 38 Кримінального процесуального кодексу України «Кримінальне провадження щодо неповнолітніх». У ході дослідження було проаналізовано думки вітчизняних науковців щодо найбільш проблемних питань, пов’язаних з процесуальними особливостями кримінальних проваджень щодо осіб, які не досягли повноліття. В результаті комплексного аналізу правових норм кримінально-процесуального законодавства було доведено, що окремі процедури та правила кримінального судочинства адаптуються саме до потреб неповнолітніх, хоча їхнім базисом є загальні правові норми. Зокрема про даний факт свідчить дуалістичне представництво інтересів неповнолітнього підозрюваного та обвинуваченого, особливий субʼєктний склад учасників провадження у кримінальних справах щодо неповнолітніх та окремі специфічні аспекти як на стадії досудового розслідування злочинів неповнолітніх, так і під час подальшого судового провадження. Також в статті було визначено ряд проблематичних аспектів пов’язаних з реалізацією даних положень на практичному рівні, в контексті чого запропоновано внесення певних доповнень та змін до Кримінально-процесуального кодексу України. Вважається за необхідне закріпити спеціальні засади кримінального провадження щодо неповнолітніх осіб на законодавчому рівні у вигляді окремої статті. У висновку акцентовано увагу на тому, що незважаючи на наявність окремих недоліків в правовому регулюванні провадження у справах щодо неповнолітніх, кримінально-процесуальне законодавство України розвивається в правильному напрямі.

Purpose of the study. The goal of the present study was to evaluate the effect of low dosed statins (rosuvastatin 10 mg/day) on the state of lipid and carbohydrate metabolism, insulin levels, vascular endothelial function, and markers of systemic inflammation in patients with ischemic heart disease in combination with diabetes mellitus. Materials and research methods. We examined 83 patients with ischemic heart disease and type 2 diabetes mellitus aged 44 to 78 years (mean age was (56,8 ± 3,4) years). For all patients, the fasting glucose level was determined, the HOMA index, the levels of total cholesterol, low density lipoproteins, very low density lipoproteins, high density lipoproteins and triglycerides in the blood, the concentration of C-reactive protein, and the content of pro-inflammatory cytokines in the blood serum were calculated. To study the function of the endothelium, dopplerography of the brachial artery was used according to the D.S. Celermajer. All patients received IHD therapy according to generally accepted standards. The drugs were used against the background of stable oral hypoglycemic therapy. As cholesterol-lowering therapy, rosuvastatin was prescribed at a dose of 10 mg/day for 3 months. Results. During the study, it was noted that in patients with coronary artery disease in combination with type 2 diabetes mellitus on the background of hyperand dyslipidemia, elevated levels of insulin and glucose, dysfunction of the vascular endothelium was revealed. Vascular endothelial dysfunction had a close correlation with markers of systemic inflammation, which was exacerbated by the presence of insulin resistance. While taking rosuvastatin at a dose of 10 mg/day, in addition to a sufficient lipid-correcting effect, there was a decrease in the level of IR, activity of systemic inflammation and improvement in the function of the vascular endothelium, which ensures the correction of additional risk factors in patients with coronary artery disease in combination with type 2 diabetes. Conclusions. In patients with ischemic heart disease in combination with type 2 diabetes mellitus on the background of hyperand dyslipidemia, elevated levels of insulin and glucose, dysfunction of the vascular endothelium was revealed. Dysfunction of the vascular endothelium is closely correlated with markers of systemic inflammation, which is exacerbated by the presence of insulin resistance. Against the background of taking rosuvastatin at a dose of 10 mg/day, in addition to a sufficient lipid-correcting effect, a decrease in the level of IR, activity of systemic inflammation and an improvement in the function of the vascular endothelium were noted, which ensures the correction of additional risk factors in patients with coronary artery disease in combination with type 2 diabetes.

Abiotic factors of the water environment are essential for the life of hydrobionts. They are determined by two main criteria – the intensity of the impact factor and the tolerance of each species. The work aims to substantiate the adaptive capabilities of this summer's koi carp (Cyprinus carpio koi) under the influence of low and high temperatures, to compare the coefficients and breathing rhythms of the research objects. Experimental research was carried out in the conditions of the aquarium-basin complex of the Department of Ichthyology and Zoology of the Bila Tserkva National Agrarian University. Two aquariums with a volume of 800 dm3 were used for the experiment. Individuals of approximately the same size and weight (25–30 g) were divided into two groups. The first group of fish was kept at a temperature of 11–14 °C for 30 days, and the second group was kept at a temperature of 24–29 °C for 30 days. During the experiment, there were 20 specimens in each aquarium. This summer koi carp (Cyprinus carpio koi). Feeding was carried out with Alltech Coppens Pre Grower feed – 15EF, 2.0 mm. Composition of ingredients (%) per 1 g of feed: raw protein – 50; fats – 15; fiber – 0.80; ash – 8.6; phosphorus – 1.21. In experimental conditions, changes in consumption of koi carp (Cyprinus carpio koi) O2, the release of CO2 and NH3 (per 1 g of live weight in 1 hour) at temperatures of 11–14 °С and 24–29 °С were studied. The consumption of O2 and the release of NH3 in these summers of koi carp at low and high temperatures were compared. The change in respiration (RR) and ammonia (N/O) coefficients in “warm” and “cold” fish with increasing temperature was analyzed. The breathing rhythm and oxygen per breath at different environmental temperatures were determined. Based on the obtained data, the adaptive reactions of this year's koi carp to the influence of reduced and increased temperature indicators of the aquatic environment were determined.

Modern winemaking in Ukraine is being significantly transformed and is actively developing. Our state has now turned to the search for its own wines and grape varieties. For international recognition, it is important to develop your case of wines that will be able to show the diversity of wine regions from Southern Bessarabia and the Northern Black Sea Coast to Transcarpathia. There are more and more small winemakers who are experimenting with new varieties, such as Sukholimansky white, Citronny Magaracha, Zagrei, Johanniter, Zvalgate, Solaris, Aromatny, Telti Kuruk and various muscat varieties. The organoleptic profile of such wines should express the varietal characteristics of local grape varieties and the agro-climatic features of the terroir. At the same time, the modern technology of white table wines should be built on the principles of maximum preservation of varietal aroma and minimization of its oxidation during the technological process. The article reflects the results of theoretical studies of literary sources regarding the mechanisms of oxidative processes of various nature in the process of grape processing; the market of modern preparations for stabilizing wine materials is considered. According to the goal, the influence of the use of the enzyme preparation Viazim clarif one on the process of clarifying the wort was investigated. The effect of complex antioxidant pasting of wort with the stepwise application of "Tanal W4", "Polygreen" and "Granula" bentonite on aromatic compounds and the formation of the aromatic profile of the finished product was also studied. At the last stage of research, the organoleptic profile of white wine materials of the studied grape varieties was determined. It was established that the general trend of stabilization processes in modern winemaking is transferred to the wort stage. According to the results of practical tests, in the form of trial pastes of wort, it is proposed to use the enzyme preparation "Viazim clarif one" at the stage of extracting wort; the effect of complex antioxidant pasting of wort with stepwise application of "Tanal W4", "Polygreen" and "Granula" bentonite was studied. Practical recommendations have been developed for winemakers on the application of antioxidant wort pasting for domestic grape varieties Sukholimansky white and Citronny Magaracha, which are now gaining popularity in Ukraine.

The article analyzes the application of the concepts of ‘procedure’, ‘proceedings’ and ‘process’ in administrative-offense relations with the aim of determining the feasibility of granting courts the authority to consider cases of administrative offenses. The concept of ‘administrative process’ is disclosed in three well-known key aspects, distinguishing its general and specific features. It is determined that the process and proceedings, in a broad sense (as the activity of state bodies in general), are correlated as general and specific. Aspects of the concept of ‘administrative proceedings’ are identified. It is established that proceedings are part of the process, which may be interrupted, change subjects, i.e., the process consists of several proceedings, being their totality. It is proposed to consider proceedings as a certain period of time allocated for the consideration of a specific case. Instead, the procedure is a set of norms and rules regulated by legislation for subjects of any legal order in the understanding of Article 19 of the Constitution of Ukraine and in the context of the new legislation on administrative procedure. The characteristics of administrative procedure are disclosed. It is concluded that the administrative process is universal for any set of proceedings of state bodies, and this concept does not affect further research on the issue of excluding the consideration of cases of administrative offenses from judicial competence. In turn, the introduction by the legislator of the term ‘administrative procedure’ excludes the possibility of equating its rules and norms with judicial proceedings. It is analyzed that judicial procedures are provided for by procedural codes but do not define the specifics of considering cases of administrative offenses. It is determined that the Code of Ukraine on Administrative Offenses does not meet the requirements for modern judicial procedures and is essentially more akin to a regulator of administrative procedure, which constituted the foundation of Soviet heritage. This dissonance is revealed through differences between judicial proceedings in the judicial process and the consideration of cases provided for in the Code of Ukraine on Administrative Offenses, including in decision forms, stages of consideration, etc. It is proposed to designate the consideration of cases of administrative offenses by the court as judicial proceedings and by other bodies as administrative procedure. [ABSTRACT FROM AUTHOR]

Purpose of the study. Was to identify the features of blood lipid spectrum and endothelium functional state in patients with rheumatoid arthritis (RA) and arterial hypertension (AH). Materials and methods. 83 patients were examined (40 with RA combined with AH, 23 with RA and 20 with AH). The blood lipid spectrum and endothelial function were studied in all patients. Results. The analysis of blood serum lipid parameters demonstrated that in patients with RA, regardless of the presence of AH, there was a significant increase of proatherogenic lipid profile parameters in comparison with those in healthy subjects. It was shown, that lower concentrations of high-density lipoproteins and higher atherogenic coefficient indices was a characteristic feature of the lipid profile in RA patients both with and without AH – in contrast to the same parameters of the lipid spectrum in patients with AH without RA. In the groups of patients with RA a significant increase of the brachial artery diameter at rest and decreased indices of endothelium-dependent vasodilation and endothelium-independent vasodilation were revealed. Subjects with RA in combination with AH had significantly lower indices according to the tests with both reactive hyperemia and nitroglycerin, while in patients with RA without AH, only NG-test was significantly lower. Conclusion. Dyslipidemia of atherogenic type and endothelial dysfunction develops at the initial stages of rheumatoid process and depends on the activity of the inflammatory process, the presence of extra-articular manifestations and rheumatoid factor seropositivity.

Complicated intestinal anastomoses: the risk factors, preventive measures

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 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.

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.

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.

The research was carried out at the Research Centre of the Dnipro State Agrarian and Economic University in Pokrov city. Sampling was carried out in 2013–2015 on a variant of artificial soil (technosols) formed on loess-like loam, red-brown clay, green-grey clay, technological mixture of rocks, and also formed on loess-like loam with a humus-rich 70 cm top soil layer. To investigate the spatiotemporal variation in the abundance, species richness and species composition of invertebrate assemblages within the experimental polygon, the animals were sampled using pitfall traps. In total, 60 pitfall traps were operated simultaneously during each sampling period. Each year the pitfalls were emptied 26 times every 7–9 days. Invertebrates (Arthropoda and Mollusca) of 6 classes, 13 orders, 50 families and 202 species or parataxonomic units were recorded. Diplopoda was most abundant taxonomic group, though it was represented by only one species Rossiulus kessleri (Lohmander, 1927). Coleoptera and Araneae were the most numerous taxonomic groups. Readily available water for plants, precipitation, wind speed, atmospheric temperature (daily minimum, daily maximum, daily mean), atmospheric humidity and atmospheric pressure were used as environmental predictors. Two dimension geographic coordinates of the sampling locations were used to generate a set of orthogonal eigenvector-based spatial variables. Time series of sampling dates were used to generate a set of orthogonal eigenvector-based temporal variables. The moisture content in the technosols was revealed to be the most important factor determining the temporal dynamics of the terrestrial invertebrate community in conditions of semi-arid climate and the ecosystem which formed as a result of the reclamation process. Following soil moisture, the factor most strongly affecting invertebrates in the technosols was temperature. From the total set of the invertebrates, two relatively homogeneous species groups in terms of thermal preferences were extracted: the microtemperature and mesotemperature groups. The microtemperature species are more tolerant to the thermal factor, and the mesotemperature species are more sensitive. The Huisman-Olff-Fresco approach expanded by Jansen-Oksanen provides a wide set of ecologically relevant models which are able to explain species response. The species response to temperature is affected by a complex of other environmental, temporal and spatial factors. The effect of other factors on the species response must be previously extracted to find real estimations of the species temperature optima and tolerance. The approaches to solving this problem may be the object of future investigation.

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.

Objective. Application of the proliferative activity marker Ki-67 for analysis of the results of neoadjuvant polychemotherapy, using regional or systemic ways of delivery of pharmacological preparations, for the patients, suffering locally spread mammary gland cancer (LS MGC). Materials and methods. Retrospective analysis of the data, concerning 90 women-patients, suffering LS MGC, who obtained complex treatment, based on regional and systemic ways of the preparations administration. Results. Dynamics of proliferative activity of a LS MGC as a result of neoadjuvant polychemotherapy, analyzed by the Ki-67 level determination, have demonstrated a statistically significant advantage of regional ways of the preparation injection, comparing with systemic ways of administration. Correlation of tumoral metastatic potential with level of Ki-67 was revealed, using detailed investigation. Conclusion. It is possible to estimate tumoral proliferative activity and the neoadjuvant polychemotherapy efficacy, using Ki-67 analysis, and in such a way to select the optimal tactics of complex treatment.

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. Materials and methods. The study included 930 venous blood samples. JAK2 V617F mutation was detected by using the allele - specific real time polymerase chain reaction. Results. 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. Conclusion. 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.

Сучасні тенденції в лікуванні раку шлунка, ускладненого канцероматозом очеревини

Виконання поєднання гастректомії (ГЕ), перитонеоектомії (ПЕ) і внутрішньочеревної гіпертермічної хіміоперфузії (ВЧГТХП) при раку шлунка (РШ) є частиною специфічної медичної ідеології, яку впровадила група ентузіастів, об’єднаних під егідою PSOGI ​​(Peritoneal Surface Oncology Group International – Всесвітня медична спільнота з вивчення перитонеального канцероматозу). Очікується, що з часом ГЕ/ПЕ/ВЧГТХП стане стандартом комбінованого лікування хворих на канцероматоз при РШ. У статті представлено досвід Одеського центру реконструктивної та пластичної медицини і Одеського національного медичного університету щодо використання методики внутрішньочеревної гіпертермічної хіміоперфузії (ВЧГТХП або процедури HIPEC), у т.ч. в лікуванні хворих на перитонеально-дисемінований рак шлунка. Коротко представлено огляд деяких етапів розвитку хірургії раку шлунка. Мета дослідження – вивчити і дослідити виживання хворих на канцероматоз при використанні стандартної внутрішньовенної хіміотерапії і процедури HIPEC. Матеріали і методи. У дослідження включено 47 осіб, яких прооперовано з приводу канцероматозу очеревини в період 2015–2017 рр. У клініці реконструктивної та пластичної медицини Одеського національного медичного університету. Досліджували тільки радикально або умовно-радикально прооперованих хворих. Середній вік – 54,9 року, чоловіків – 14, жінок – 33. В усіх випадках діагноз було верифіковано гістологічно. Для порівняння виживання хворих після ПЕ/ВЧГТХП було набрано ретроспективну групу порівняння, в яку включили 22 хворих на канцероматоз черевної порожнини, для лікування яких застосовували тільки внутрішньовенну системну хіміотерапію (СХ). Результати досліджень та їх обговорення. Проведене власне спостереження, засноване на аналізі історій хвороби 47 хворих, яким провели ВЧГТХП при раку шлунка, раку яєчників, колоректальному раку і деяких інших видах злоякісної патології черевної порожнини. Порівнювали виживання хворих після процедури HIPEC і пацієнтів із канцероматозом черевної порожнини, яким виконали тільки внутрішньовенну системну хіміотерапію (СХ). Виживання хворих після виконання циторедуктивних операцій (у статті використано Міжнародну абревіатуру CRS – cytoreductive surgery), в т.ч. з приводу раку шлунка, була незначно гірше, ніж після СХ. Інтерес представляє можлівість індивідуалізації схеми ВЧГТХП з точки зору призначення певного хіміопрепарату. У зв’язку з цим оформлено патент UA 121792 U від 11.12.2017. Машуков А. О., Максімовський В. Є., Четвериков С. Г., Лук’янчук О. В., Осадчий Д. М., Заволока С. О., Роша Л. Г., Пирогов В. В. Спосіб лікування раку шлунка, ускладненого канцероматозом черевної порожнини. При цьому застосовано індівідуальний підхід процедури HIPEC до виконання залежно від експресії того чи іншого маркера в пухлинній тканині. Перед процедурою виконують лапароскопію із забором достатньої кількості матеріалу з пухлинної тканини, з подальшим його імуногістохімічним дослідженням на основні маркера чутливості терапії: TOP2A, ERCC1, TS. Висновки. З огляду на міжнародні дані й дані деяких вітчизняних онкологічних центрів (Львівський онкологічний регіональний лікувально-діагностичний центр), необхідний більш ретельний відбір хворих, ґрунтуючись на значенні перитонеального індексу канцероматозу (PCI – peritoneal carcinomatosis index) і рівні планованої циторедукції.

Мета. Порівняти безпосередні та віддалені результати лікування хворих з місцево-розповсюдженим раком молочної залози (МР РМЗ) з використанням різних способів введення препаратів поліхіміотерапії (ПХТ). Матеріали і методи. Дослідження проведено на основі вибіркового аналізу медичних карт 112 стаціонарних хворих з МР РМЗ стадії T4A-DN0-3M0, які отримували комплексне протипухлинне лікування на базі Донецького обласного протипухлинного центру та Університетської клініки Одеського національного медичного університету в 2000 - 2017 рр. До контрольної групи увійшли 65 (58%) пацієнток з неоперабельними формами МР РМЗ, яким у неоад’ювантному режимі була проведена системна ПХТ (СПХТ). До досліджуваної групи увійшли 47 (42%) пацієнток з неоперабельними формами МР РМЗ, яким як неоад’ювантний курс була проведена ендолімфатична ПХТ (ЕЛПХТ). Результати. За показниками три- та пۥятирічної виживаності між контрольною і досліджуваною групами не було статистично значущої відмінності. Безпосередні результати лікування пацієнток, яким проведена ЕЛПХТ у неоад’ювантому режимі, кращі, ніж результати лікування пацієнток, яким проведена СПХТ, без статистично значущої переваги. Висновки. Безпосередні і віддалені результати комплексного лікування МР РМЗ у разі несприятливого прогнозу пухлинного росту з проведенням ЕЛПХТ у неоад'ювантному режимі і виконанням радикального оперативного втручання кращі в порівнянні з результатами лікування за аналогічною схемою, але з проведенням СПХТ на передопераційному етапі, без статистично значущої переваги.

Abstract Promising biologically active substances are derivatives of imidazole and quinazoline, which are part of the structure of known antifungal drugs and substances with anti-TB and antimicrobial activity. In addition, it should be noted that information on the synthesis and properties of quinoline derivatives containing a fragment of 2-aminoalkylimidazole is practically absent. Proceeding from this, the issue of developing new preparative methods for the synthesis of quinazoline derivatives with a fragment of 2-aminoalkylimidazole appears. Aim. Expanding the synthetic potential of 2-aminoalkilimidazoliv, the study of reactivity and synthesis of new derivatives of 3- [2- (1H-imidazole-2-yl) -alkyl] -2-thioxo-2,3-dyhidrohinazolin-4 (1H)-ones. Materials and methods. Methods of organic synthesis; Physical and physical-chemical methods of analysis of organic compounds (NMR spectroscopy 1H, elemental analysis). Results. The work analyzes the structures that are most promising as potential antimicrobial agents. For the synthesis of new biologically active compounds, we have chosen the strategy of combining quinazoline fragments with an imidazole residue in one molecule. Such an approach, in our opinion, should contribute to increasing the lipophilic properties of the final molecule, which is one of the key requirements for antimicrobial agents. 3-Substituted 2-thioxoquinazolin-4-one was prepared by reacting 2-(α,β-aminoalkyl) imidazoles and with methyl ester of 2-isothiocyanato-benzoic acid. Control of the formation of reaction products was carried out by TCHX. The structure of the 2-thioxoquinazolin-4-one obtained was confirmed by 1H-NMR spectroscopy. The multiplicity and location of the protons are fully consistent with the proposed structure of the compounds. Conclusions. The possibility of using new aminoalkylimidazoles derivatives as an amine component in the reaction of heterocyclicization with o-isothiocyanatoester is investigated. The synthesis of 3- [2- (1H-imidazol-2-yl) -alkyl] -2-thioxo-2,3-dihydroquinazolin-4 (1H) -one was synthesized for the first time.

Мета. Порівняти показники комплексної оцінки якості життя (ЯЖ) пацієнток з несприятливими місцево-розповсюдженими формами раку молочної залози (РМЗ) до та після проведення внутрішньовенної системної поліхіміотерапії (СПХТ) та селективної ендолімфатичної поліхіміотерапії (ЕЛПХТ) в неоад’ювантному режимі. Матеріали і методи. Дослідження проведено на основі вибіркового аналізу карток 112 пацієнток з місцево-розповсюдженим (МР) РМЗ T4A-DN0-3M0, які отримували комплексну протипухлинну терапію на базі Донецького обласного протипухлинного центру та Університетської клініки Одеського національного медичного університету в 2000 - 2017 рр. та яким було запропоновано взяти участь в анкетуванні на різних етапах передопераційного лікування. До контрольної групи увійшли 65 (58%) пацієнток з неоперабельними формами МР РМЗ, яким у неоад’ювантному режимі була проведена СПХТ; до досліджуваної - 47 (42%) пацієнток з неоперабельними формами МР РМЗ, яким як неоад’ювантний курс була проведена ЕЛПХТ. Результати. За інтегральними показниками ЯЖ та якості здоров’я (ЯЗ) між пацієнтками контрольної та досліджуваної груп не спостерігали статистично достовірної відмінності. Детальний аналіз показників симптоматичних шкал виявив відмінність між групами, яка не перевищувала критичної. За результатами проведено дослідження серед пацієнток, які отримували ЕЛПХТ у неоад’ювантному режимі. Суб’єктивні оцінки проведеного лікування в абсолютних цифрах мали кращі референтні значення без статистичної переваги. Висновки. Дослідження інтегративного показника ЯЖ та його дискретних елементів є ергономічним та економічним засобом евристичної оцінки стану здоров’я хворих з МР РМЗ для подальшої розробки більш раціональних та зручних способів вирішення нагальних питань сучасної онкології шляхом підвищення комплаєнсу та пошуку компромісу між лікарем та пацієнтом.

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.

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.

Aim: to identify and explore the structure of comorbid psychopathological disorders in patients with type 2nd diabetes mellitus (DM). Materials and methods: 543 patients with type 2nd DM were included into the study. The average age of patients was (56.2 ± 0.65) years. The patients were divided into three groups according to the severity of DM. The first clinical group (CG-1) included 57 patients with type 2nd DM of mild severity, who was treated in outpatient department; the average age in the group was (51.8 ± 1.28) years. The second clinical group (CG-2) made up of 312 patients with type 2nd DM, moderate severity, they were in inpatient department; the median age of the group was (55.1 ± 1.12) years. The third clinical group (CG-3) included 174 patients with type 2nd DM, severe degrees of severity, they undergone inpatient treatment too; average age in the group was (61.8 ± 0.85) years. Research methods: clinical-anamnesis, clinical- psychopathological, statistical. Research results. The study established the incidence of non-psychotic mental disorders of varying severity in patients with type 2nd DM at the level of 94.11 %, among them, for 91.16 % – of psychogenic origin. Proportional correlation between the severity of type 2nd DM and the absence of comorbid psychopathological manifestations was detected (rs = -0.3416, p < 0.01). It is revealed that the dominant psychopathological syndromes among all patients with type 2nd DM were psychoorganic (62.43 %), dyssomnia (60.86 %), asthenic (55.58 %) and anxiety (43.05 %) syndromes. Structure of the dominant psychopathological syndromes was established depending on severity of type 2nd DM: in CG-1 dominated dyssomnia (36.84 %), anxiety (31.58 %), psychoorganic (21.05 %) syndromes; in CG-2 – psychoorganic (65.38 %), asthenic (40.38 %), dyssomnia (38.46 %), anxiety (37, and 82 %) syndromes; in CG-3 – dyssomnia (97.70 %), asthenic (89.08 %), organic mental (70.69 %), anxious 48.28 %) syndromes. Significant prevalence among all study groups was detected for hysterical (χ2 = 13.416, p < 0.01) and phobic syndromes (χ2 = 6.161, p < 0.05) in g CG-1 compared to CG-2 and CG-3; and asthenia (χ2 = 162.663, p < 0.01), anxiety (χ2 = 7.177, p < 0.05), depression (χ2 = 13.298, p < 0.01), dyssomnia (χ2 = 171.058, p < 0.01), hypochondric (χ2 = 19.331, p < 0.01), psychoorganic (χ2 = 47.830, p < 0.01) syndromes in CG-3 compared to CG-1 and CG-2. Direct correlation between the severity of type 2nd DM and the presence of the clinical picture asthenic (rs = 0.4033, p < 0.01) and psychoorganic (rs = 0.2344, p < 0.01) syndromes was identified; and inverse correlation between the severity of type 2nd DM and the presence of the clinical manifestation of patients with hysterical syndrome (rs = -0.1444, p < 0.01). Conclusion. The study established the frequency of occurrence and genesis of nonpsychotic mental disorders of varying severity in patients with type 2 DM. Correlation between the severity of type 2nd DM and comorbid psychopathological symptoms was revealed. The identified dominant psychopathological syndromes among patients with type 2nd DM, as well as the structure of psychopathological disorders depended on the severity of type 2nd DM.

Aim: to investigate and establish the specific complains violations in patients with diabetes mellitus (DM) of 2nd type. Materials and methods: 543 patients with DM of 2nd type were examined; the disease duration ranged from 2 to 27 years, average – (14.58 ± 1.82) years. Research methods: clinical-anamnestic, clinical-psychopathological, psycho diagnostic, statistical. Research results. We found that compliance to therapy in patients with DM of 2nd type was broken in 90.49 % of cases. We highlighted three options for compliance violations to DM therapy of 2nd type: dismedication (to 68.14 %), disdiet (88.40 %) and disexercise (90.49 %). The sub-variants of dismedication compliance violations to DM therapy of 2nd type was hyper-curation type (8.29 %), which was developed according to surplus of appointments execution and hypo-curation type (59.85 %), which was developed according to deficiency of appointments execution. Among them it was possible to distinguish a third – mixed version (7.37 %), which brings together episodes of the surplus and the deficit of medical drugs usage. The sub-options of disdiet option of compliance violations was hyper-curation type (1.66 %), which manifested itself in pathologically excessive rejection of food and hypo-curation type (86.74 %), which manifested itself in a disregard for the restrictions in the diet. Disexercise variant of compliance violations was possible to divide into hyper-curation type (4,24 %), manifested in excessive physical activity and, in its turn, had three subtypes – inceptional (1.66 %), sub-hyper-curation (1.10 %) and procurationis (1.47 %), and hypo-curation type of compliance violations (87.48 %), which manifested itself in a disregard of physical exertion. Dominance of disdiet and disexercise compliance violations among patients with DM of 2nd type (χ2 = 117.258, p < 0.01), dismedication option among patients of all hyper-curation types of compliance violations with DM of 2nd type (χ2 = 26.936, p < 0.01), disdiet and disexercise options among patients of all hypo-curation types of compliance violations with DM of 2nd type (χ2 = 156.922, p < 0.01) and hypo-curation type of compliance violation for all of its variants have been established. The factors of compliance violations for each of the variants and types have been determined.

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 2nd DM was extended.

Aim – to analyze the peculiarities of asthenic manifestations in patients with type 2nd diabetes mellitus (DM) in clinical and psychological perspective. Materials and methods. We examined in 543 patients with type 2nd DM. The first clinical group (CG-1) was 57 patients with type 2nd DM of mild severity; the average age in the group was (51,80±1,28) years. The second clinical group (CG-2) made up of 312 patients with type 2nd DM, moderate severity; mean age in the group was (55,10±1,12) years. The third clinical group (CG-3) included 174 patients with type 2nd DM, severe degree of severity; the average age in the group was (61.80±0,85) years. Research methods: clinical-anamnestic, clinical-psychopathological, statistical. Results. The marked prevalence of asthenic syndrome in patients wath type 2nd DM 52,30%, which is almost half among all surveyed type 2nd DM. Discovered the direct correlation of asthenic symptoms with the severity of the type 2nd DM (rs = 0.4033, p

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.

Implementing algorithms of the organization and evaluation of individual self-study students work of VI course aims to acquire well educational material that was not included in the theme. According to the work program on surgical diseases it was allocated 119 (46%) hours of self-study work from 259 total hours for students of 6 course. To prepare for practical training was given 71 hours (60%) of that time, and 48 hours (40%) should be used so that the student study himself the curriculum issues that have not been put to practical training topics. Individual self-study students work allows to learn educational material that was not included in the themes of practical training, to learn practical skills (curation of patients, primary surgical treatment, assistance during operation, the registration of medical documentation), to learn modern methods of professional information from the internet, what is a contemporary form of knowledge acquisition during self-study.

The accumulated clinical experience and analysis of our own results of treatment of patients with severe forms of acute widespread purulent peritonitis, speaks about the growing urgency of this problem. The aim of this study was determination of the most optimal medium sanation during execution programs of the abdominal cavity sanitation in acute diffuse purulent peritonitis. Was studied the treatment results of 79 patients with severe forms of acute widespread purulent peritonitis. After laparotomy and performing a biopsy was conducted qualitative and quantitative morphological study of the inflammatory process in the peritoneum on the background of the landmark of the abdominal cavity sanitation of two groups of patients with acute widespread purulent peritonitis before and after carrying out the programmatic sanitation of the abdominal cavity, using a solution of octenidine dihydrochloride and saline solution. In the result of study, authors came to the conclusion, that the application, as it seemed different sanation mediums do not affect on the basic morphometric parameters of the studied biopsies of the peritoneum after sanitation of abdominal cavity. This confirms the theory of "mechanical purification" of the abdominal cavity, and sanitation of the abdominal cavity does not depend on the qualitative composition of the sanation medium.

У статті здійснено порівняння фінансової стійкості банківських систем країн Європи на основі застосування найбільш вживаних підходів до оцінювання її рівня; визначено основні тенденції зміни рівня фінансової стійкості банківських систем в даних країнах протягом останніх років; проаналізовано поточні заходи з боку державних органів та регуляторів в країнах Європи, спрямовані на підвищення рівня фінансової стійкості банківської системи.

Plasty of the stenosed terminal sygmostoma, using the rotated flap