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At present cardiovascular diseases ae the main cause of disability and mortality all over the world, including Ukraine, with that coronary artery disease is responsible for about 2/3 of cardiovascular deaths. Clinical and experimental research have shown that lipid metabolism disorders play an important role in atherosclerosis pathogenesis, which necessitates investigation of the factors participating in lipid metabolism regulation in patients with atherosclerosis of the coronary vessels. From this perspective, the study of the role of hormonal factors (thymus, thyroid, glands, adrenals, pancreas) in lipid metabolism disorders is important. For this purpose, complex investigation of the patients with coronary atherosclerosis was performed using general clinical methods, electrocardiography in 12 deviations, circadian monitoring, veloergometry, ultrasonography of the heart, selective coronaroangiography, biochemical blood test. The findings of the research suggest that the patients with increased degree of coronary stenosis have increased blood plasma low density lipoprotein cholesterol concentration, low high density lipoprotein cholesterol concentration, and increased atherogenicity coefficient. Hyperlipedemia was diagnosed in the majority of patients and was associated with increased level of low density lipoprotein cholesterol concentration. Direct correlation was revealed between the concentration of blood plasma lipoproteins (a) and the degree of atherosclerotic involvement. It was determined that increased of blood lipoproteins (a) level is due to the low molecular isoforms B, S1 and S2 with high athero− and thrombogeneity. To optimize the diagnosis and treatment of the patients with coronary atherosclerosis it is necessary to determine blood low density lipoprotein cholesterol and lipoproteid (a) as most atherogenic factors as well as functional state of the hormones taking part in metabolic processes regulation in the human organism.

Permanent pacing is the standard treatment of patients with heart rhythm disorders such as bradyarrhythmia and chronic heart failure. One of its positive effects is to improve the pumping function of the heart, which affects the blood pressure increase. With the increase in systolic blood pressure (SBP) the pulse pressure (PP) increases, which adversely affects hemodynamic, elastic properties of the main vessels and the function of the left ventricle (LV) and, in turn, requires modification of drug therapy. Setting and checking ECG parameters is an important task in the correct programming of the device, which, however, can affect the SBP, PP and heart rate. In the above article pacing parameters in five PP classes (very low PP −− less than 20 mm Hg, low PP −− from 20 to 40 mm Hg, normal PP −− from 40 to 60 mm Hg, high PP −− from 60 to 80 mm Hg, very high PP −− more than 80 mm Hg) in 201 patients at the annual stage after implantation of the pacemaker were studied. In the early postoperative period (3ЃE days) after 6 months and a year after implantation in DDD (R), VVI (R) modes and drug therapy, pacing parameters were evaluated depending on PP class: basic pacing rate, stimulation percentage of the right ventricle (RV) and LV, the impedance and the amplitude of the LV and RV electrodes and the detected and stimulated AV−delay. Parameters data were measured with the help of programmers to the implanted devices Medtronic, Vitatron, Sorin, St. Jude Medical. Average base frequency of stimulation was 62 beats per min in all PP classes at all stages of follow−up after pacemaker implantation. Reduction in impedance and amplitude of the LV and RV electrodes in all PP classes in VVI(R) and DDD(R) pacing modes, increase of the detected and stimulated AV−delay −− in class V and tendency to reduction in PP class III after pacemaker implantation in DDD(R) pacing mode were observed. Additional optimization of the passing parameters in patients with II, IV and V PP classes during first year after implantation is required.

Optimizing therapeutic approaches to the treatment of type 2 diabetes mellitus (DM) and its complications, primarily the cardiovascular ones, positively affects the quality of life of patients and its duration. However, even the ideal therapy of diabetes mellitus and the compensation of carbohydrate metabolism from the first days of the disease cannot provide regress of the complications that developed at the stage of impaired glucose tolerance (IGT) and not diagnosed diabetes. Therefore, research aimed at preventing the development of this disease or at least delaying its manifestation becomes extremely urgent. Phytotherapy is a method of choice in the treatment of initial manifestations of type 2 diabetes mellitus. In patients with IGT, in combination with regimen and diet, it can stop the further development of the disease. If a mild form of diabetes is detected, the timely administration of adequate phytotherapy provides compensation for metabolic disorders and also prevents the progression of the disease. The expediency of wider use of the dietary supplement Endopharm in patients with prediabetes, as well as in patients with type 2 diabetes mellitus both as a monotherapy in the presence of postprandial hyperglycemia, and as a second drug in the absence of persistent normoglycemia was proved.

The review presents an analysis of literature on the pathogenesis of chronic obstructive pulmonary disease and type 2 diabetes mellitus. The presence of these pathologies mutually complicates their course and worsens the prognosis. Relevance of studying the comorbidity of COPD and type 2 diabetes mellitus, the activity of apoptosis mechanisms in these pathologies is emphasized. The actual markers of dysregulation of apoptosis of cells in the lungs and the events associated with it were identified. Controlled apoptosis is considered today as the main mechanism for maintaining the optimal balance of cells in the focus of inflammation, limiting the expansion of activated clones and preventing the development of autoimmune reactions. To assess the programmed cell death, the number of lymphocytes and neutrophil granulocytes expressing the markers of apoptosis −− CD95, CD95L and Bcl2 −− was detected. Dysregulation of apoptosis of cells in the lungs and events associated with it can play an important role in the pathogenesis of COPD. In a physiological state, neutrophils die with apoptosis, followed by phagocytosis of apoptotic bodies by macrophages. Delayed apoptosis of leukocytes may lead to overproduction of oxygen metabolites and proteolytic enzymes that cause tissue damage. The cause of progression of type 2 diabetes mellitus is persistent hyperglycemia, which leads to the development of oxidative stress in many tissues and, as a consequence, to the development of complications of diabetes mellitus. Literature analysis showed that today the effect of apoptosis in the combined course of COPD and type 2 diabetes is poorly understood. Detection of new apoptosis markers can deepen the knowledge of the pathogenesis of these diseases as well as optimize the diagnosis and develop new approaches to the treatment of COPD patients with concomitant type 2 diabetes mellitus.

Coronary artery disease and diabetes mellitus are the most common comorbid pathologies in the structure of cardiovascular mortality. Recently, many researchers have paid great attention to the search for new markers of cardiovascular risk diagnosis and its relationship with the indices of carbohydrate metabolism in patients with combined pathology. One of them is sortilin, the level of which is associated with cholesterol metabolism, secretion of low density lipoproteins cholesterol and development of vascular lesions. To confirm the role of sortilin as a marker, a comprehensive examination of patients with comorbid pathology (coronary artery disease and type 2 diabetes mellitus) was performed. The patients were performed general clinical and instrumental examinations; the obtained data were compared. The results of the study prove the association of sortilin with progression of carbohydrate metabolism disorders in the examined patients. It was determined that sortilin level was higher in the presence of type 2 diabetes mellitus, and the course of coronary artery disease was accompanied by an increase in the degree of insulin resistance, hyperinsulinemia, hyperglycemia. The obtained data should be taken into account in the diagnosis of cardiovascular risk in patients with comorbid pathology.

Obesity pandemic has become a powerful stimulus for the rapid development of bariatric surgery. Among the wide spectrum of surgical methods of treating this disease, biliopancreatic bypass surgery modified by the well−known surgeons D. Hess (USA) and P. Marceau (Canada) is one of the most effective surgical interventions. The results of treatment of 100 patients with morbid obesity who were performed biliopancreatic shunt in the modification of Hess −− Marceau as the primary bariatric method in 2011ЃE015 were analyzed to investigate the ways to improve this technique. The main criteria for evaluating the efficacy of the bariatric surgery were the percentage of body weight loss and the percentage loss of body mass index surplus. Their initial values were determined before the surgery and observed in the dynamics for 60 months after the surgery. It was established that implementation of biliopancreatic bypass surgery allowed to achieve good and excellent results of body weight regression in all patients according to the classification of R. Reinhold (1982). The regression of excess body weight and body mass index excess 2 years after the operation was 80.7±20.6 % and 90.3±24.1 %, respectively, with subsequent steady preservation of the result in subsequent years of observation in the range of 77.0±36,6 % and 86.2±41.5 %. Implementation of biliopancreatic shunting in the Hess −− Marceau modification did not lead to body weight deficiency or recurrence of morbid obesity in any of the patients. Thus, the efficacy of this surgical technique was proven.

Digestive tract anastomosis suture failure is one of the most critical postoperative complications in thoracoabdominal surgery. Until now the researchers have searched for the ways of optimizing treatment of patients with this complication. The desire to find cheap and safe, but at the same time effective methods of treatment of this category of patients led to development and deployment in clinical practice of methods of endoprosthesis replacement. According to the literature, this complication is observed in 3.3ЃE.9 % of cases with a mortality of 78.6ЃE0.0 %. The main tasks of the treatment for suture failure are elimination of the connection between the hollow organ and adjacent tissues, adequate sanation of the area around the failure, general antibacterial therapy, correction of homeostasis disorders. The clinical section of a research is based on the analysis of the results of treatment of 68 patients treated at V. T. Zaytsev Institute of General and Emergency Surgery in 2006ЃE016. Anastomosis failure in all patients occurred in the early postoperative period. The main method for diagnosing of anastomosis suture failure was radiological. The main method of treatment in one group of patients was transplantation of a transnasal probe, in the other group surgical tactics were used for early diagnosis of failure and treatment using mini−invasive technologies, primarily stenting of the failure area. After successful implementation of the stent the clinical effect was reached in 66.3 % of patients. Stenting of the esophagus with self−straightening devices with coating and antireflux valves is a method of choice in treatment of patients with esophageal anastomosis failure. It allows to avoid traumatic operations, especially in weakened patients and to save the life of the patients with these critical complications.

At present organ−preserving ovarian surgery with video endosurgery is considered to be a routine intervention. If it is necessary to stop bleeding, various types of coagulation are used (bipolar, argon−plasma, ligature hemostasis), but their effect on the ovarian reserve has not been investigated in detail. With this end in view, the study of ovarian reserve parameters in patients with endometrioid and dermoid ovarian formations before and after operations using bipolar, argon−plasma coagulation, ligature hemostasis by imposing intraovarian suture was carried out. According to echography findings, the nature of the tumor and its size were determined at the preoperative stage. One year after the operation, the parameters of the ovarian reserve were investigated: the volume of the ovary, the number of antral follicles, intraovarian blood flow and folliculogenesis in the operated and intact ovaries. The analysis of the obtained findings showed that in all patients after surgical treatment, regardless of the nature of the formation and the type of hemostasis used, disorder of the morphofunctional state of the ovarian tissue was present when compared with the preoperative results. The level of the ovarian reserve reduction depended on the morphological nature of the formation in the ovary, its size and location, as well as the age of the patient. In patients of later reproductive age, the criteria studied were reduced to a greater extent regardless of the method of bleeding control. It was concluded that it is necessary to minimize any type of thermal effect on the tissues, especially in nulliparous patients. An individual approach and choice of hemostasis method are extremely important in women with diagnosed endometrioid formations, since endometriosis itself leads to reduction in the primordial pool.

To determine the most effective complex treatment for patients with progressive tubal pregnancy, clinical trials were conducted. A comparative evaluation of the effect of surgical organ−preserving treatment of tubal pregnancy using radio wave energy, anti−adhesion polyethylene oxide drugs with carboxymethyl cellulose and rehabilitation techniques: physiotherapy including intrauterine electrophoresis and stimulation of fallopian tubes by the method of V. M. Strugatsky at al. In the postoperative period, as well as additional administration of placenta cryoextraction. The reproductive function of the patients was studied one and a half years after the end of the rehabilitation course. The results of treatment of clinical groups were compared with the indicators of the pregnancy onset (uterine and ectopic) in healthy women. The results of this study allow us to conclude that the emergence of a progressive tubal pregnancy is facilitated by the presence in the history of frequent inflammatory diseases of female genital organs, postpartum purulent−septic diseases, the presence of endometriosis, and previous gynecological and surgical operations. The use of radio wave energy in the complex of treatment for patients with progressive tubal pregnancy, antiadhesion drug PEO with SMS and CP in the postoperative period allows reliable increase in the number of patients with restored reproductive function and reduction of the frequency of recurrent tubal pregnancy development.

Merkel skin carcinoma is a rare primary malignant skin tumor with epithelial and neuroendocrine differentiation and one of the most aggressive cancers. Merkel skin cancer refers to rare diseases. The peak incidence falls on the age of 65ЃE9 years; in men the disease occurs twice as often as in women. One of the risk factors for Merkel skin carcinoma is ultraviolet irradiation. The increase in the risk of Merkel skin carcinoma development is influenced by the state of immunosuppression. Thus, Merkel skin carcinoma in AIDS patients is 2.3 times more frequent than in the unaffected population, 5 times more frequent in patients after organ transplantation. In 80 % of the samples of the examined tumors, papillomavirus was isolated. Merkel skin carcinoma is characterized by the scarcity of clinical manifestations, and often their absence. A characteristic feature is the early lymphogenous spread of the tumor cells. Rapidly growing nodules, satellites may appear near the primary neoplasia. Remote metastases are observed in 33ЃE0 % of patients. Three histological models of Merkel skin carcinoma can be distinguished: trabecular, intermediate and intercellular. Merkel skin carcinoma is characterized by high mitotic activity. Merkel skin carcinomas express antibodies −− CytokeratinAE1/AE3, Pan−Cytokeratin, Cytokeratin 20, EMA, Chromogranin, Synaptophysin, NSE. The most specific of the epithelial markers is Cytokeratin 20. If histological evidence is available in favor of Merkel skin carcinoma, immunohistochemical examination is necessary. Due to the rare incidence of carcinoma of Merkel skin carcinoma, the standards of therapy have not been developed. Surgical excision of the tumor is the basic treatment in all cases, when possible. Radiotherapy at a dose of 60ЃE6 Gy is recommended. Chemotherapy is preferable in patients with metastases. Good results were obtained using immuno−oncologic therapy (anti−PDI and anti−PD−L1). In 2015, the first data on the successful use of an anti−PD1 drug (pembolizumab) appeared. Treatment of patients with Merkel skin carcinoma should be individualized, take into account all prognostic factors and include all existing methods.

Development of new methods of treatment of patients with ovarian cancer based on the achievements of fundamental science is an urgent issue. According to the researchers, treatment with neoadjuvant chemotherapy at the first stage can improve the tumor resectability, increase the frequency of optimal cytoreductive operations in patients with advanced ovarian cancer. The prognosis of the disease depends not only on its stage and the strategy of antitumor treatment, but also a number of factors, including molecular ones, that determine the biological properties of ovarian cancer. To determine the group of increased risk of relapses and metastases in patients with stage III−IV ovarian cancer, immunohistological examination of the levels of expression of molecular−biological markers in the tumor after neoadjuvant chemotherapy was performed. Depending on the type of combination treatment, the patients were divided into two groups: group 1 was performed surgical treatment followed by adjuvant chemotherapy. In group 2 the treatment was started with neoadjuvant chemotherapy (1ЃE cycles) followed by surgical treatment and adjuvant chemotherapy. Investigation of molecular−biological markers in tumors of patients with stage III−IV ovarian cancer has prognostic value for determination of high−risk groups depending on the type of relapse (genitalization of the process in the abdominal cavity with certain metastases, locoregional and marker relapses), which allows individualizing antitumor therapy modes. Relationship between the level of molecular−biological markers expression in the tumor of patients and the type of ovarian cancer recurrence. Thus, at generalization of the process, expression of VEGF and Bcl−2 is absent and high expression of mt p53 and Kі−67 is observed. On the contrary, in patients with locoregional and marker relapses, high expression of Bcl−2 protein and mt p53 occurs, but the parameters of proliferative activity and the growth factor of the vascular endothelium differ. The obtained data allow to determine molecular−biological markers most important for disease prediction in patients with ovarian cancer and to correct treatment methods.

Chemotherapy is one of the most widely used methods of treatment for metastatic cancer diseases. However, the effectiveness of chemotherapy, especially in treating solid tumors, is limited. Recently the interest in the use of a combination of various antitumor strategies, including chemotherapy, radiotherapy, targeted therapy and immunotherapy has grown. The recent works indicate that along with direct cytotoxic effect on the tumor cells, some chemotherapeutic agents exhibit immunomodulatory effects. Immunotropic properties of chemotherapeutic drugs related to their ability to cause immunogenic death of the tumor cells, to counteract immunosuppressive mechanisms, to exert direct or indirect effects on immune effector cells, as well as to cause transient lymphodepletion are featured. Activation of immuno−mediated mechanisms under the action of chemotherapeutic agents may contribute to enhancement of antitumor effects of immunotherapy and to achievement of better therapeutic results. This review presents the data of clinical trials of antitumor therapy combining chemotherapy with vaccination, cellular immunotherapy and blockade of immunЃEcheckpoints. The combined treatment regimens contributed to improvement of tumor response, increase in the survival of cancer patients, but had a greater toxic effect compared to monotherapy. Solution of the questions on the optimal way of combining chemo− and immunotherapy, choice of the dose and chemotherapy regimen, as well as detection of biomarkers that allow prediction of the response to combined treatment will allow to determine the role of combined strategies in the treatment of oncological diseases.

Epilepsy is a disease that manifests by repeated unprovoked attacks caused by excessive neuronal discharges in the cerebral cortex. Apart from the seizures, the main characteristics of epilepsy include cognitive disorders. They are defects of memory, attention, speech, orientation, cognition, intellect, agnosia and apraxia. Patients with epilepsy have to take anticonvulsant therapy for a long period of time, which alone can have a negative impact on the cognitive field. To evaluate the effectiveness of the calcium hopantenate drug (Kognum) in the treatment of cognitive disorders at epilepsy the patients with generalized tonic−clinic convulsions and secondary generalized seizures, who received anticonvulsant monotherapy with valproic acid drugs and lamotrigine group for more than five years were examined. All patients were administered Kognum for three months. Before and after administration of Kognum to assess the degree of cognitive impairments, Mini−mental state examination and Wisconsin card sorting test (WCST) were used. Kongum demonstrated high effectiveness in treatment of cognitive disorders at epilepsy after a single three−month course both in patients with generalized tonic−clinic seizures, and with secondary generalized seizures. Kongum effectively interacted with anticonvulsants (valproic acid drugs and lamotrigine group). The drug did not cause significant side effects, which indicates the safety and appropriateness of its administration with antiepileptic drugs. Today, prevention of cognitive disorders should be considered in the context of the most important tasks of pharmacotherapy of epilepsy. Further accumulation of the experience, as well as the use of GACS drugs as an optimal tool for solving this problem, will contribute to improving the quality of life of patients with epilepsy and their maximum medical and social adaptation.

Today acute craniocerebral trauma is an important medical and social problem. The advances of modern neurosurgery, neurotraumatology and resuscitation make it possible to preserve the lives of such patients, but most often the inability to return the brain its function, i.e. to ensure mental activity. This is due to the fact that the patients are in a post−traumatic unconscious state: vegetative or a state of minimal manifestation of consciousness. A key role in restoring consciousness is played by behavioral reactions associated with the cerebral cortex, thalamus, ascending reticular formation. An important issue is the study of the mechanisms underlying the formation of long unconscious states. This may be imbalance between various neurotransmitter systems, disorders in the interaction of large neuronal connections of the anterior brain, middle spiny neurons, interactions between noradrenergic and dopamine brain systems, etc. It is known that restoration of consciousness is often not accompanied by a significant change in the level of general metabolic activity of the brain; in this case, reactivation of cortico−thalamocortical bonds is due to axonal sprouting, restitution of synaptic activity and neurogenesis within the framework of neuroplasticity. The most informative in determining the metabolic death of the brain are super threshold critical values of such biochemical parameters of the liquor and the venous blood flowing out of the brain as lactate and pyruvate, phenol with a sharp decrease in pH with the predominance of critical levels of these parameters in the liquor compared to the blood. Thus, the knowledge of the anatomical, physiological, pathophysiological, metabolic and neurotransmitter mechanisms forming the structural and functional integrity of the brain underlying all mental activity are very important for resuscitators, neurosurgeons, neurologists, rehabilitation therapists, psychiatrists, psychologists who work with the patients requiring restoration of the brain function at CCT.

According to the modern data, up to 80 % of the population experience chronic pain associated with the spine throughout their life; 15ЃE0 % of them suffer from pain syndromes at the cervical level, which in half of the cases is accompanied by dizziness and coordination disorder. The high prevalence of these symptoms is associated with violation of statics and biomechanics in the motor segments of the cervical spine. The basis of these disorders is a variety of changes in vertebras, intervertebral joints and musculoskeletal system, which are the most important extravascular cause of blood flow disorders in the vertebrobasilar system. To study the clinical course of spondylogenous vertebrobasilar insufficiency in young patients developing against the background of muscular−reflex, neurovascular and radicular syndromes of the osteochondrosis of the cervical spine all patients underwent functional radiography of the cervical spine with flexion and extension, MRI, as well as Doppler ultrasound examination of the vessels of the neck and main arteries of the head using functional rotational loads, as well as duplex scanning of the cervical vessels. As a result, it was revealed that subjective manifestations predominated at earlier stages of vertebrobasilar insufficiency: orthostatic dizziness, situational increase in arterial pressure, weight loss, visual disturbances; With the stage of the disease, systemic dizziness, palpitation, cardialgia, tinnitus feeling of lack of air, darkness in the eyes, wiggling while walking, conditions accompanied by loss of consciousness are more frequent. These subjective manifestations are confirmed by the increase in neurological deficit in patients with late stages of vertebrobasilar insufficiency due to cochleovestibular, cerebellar−atactic, neurodystrophic disorders, pyramidal and cerebrospinal hypertension syndromes.

Diffuse toxic goiter is one of the most common autoimmune diseases of the endocrine system accounting for 80 % of all cases of thyrotoxicosis. The incidence peak is observed at the age of 30ЃE0 years, women suffer five times more often than men. Diffuse toxic goiter is a hereditary disease; 70 % of patients have one or two relatives with thyroid disorders. To study the frequency and types of intermarriage among the population of Republic of Azerbaijan, a study of more than 2,600 patients with hyperthyroidism was conducted. All of them were treated in the Central Hospital of Seamen (Baku) in 2009ЃE017. Each patient underwent ultrasound examination of the thyroid gland, scan with technetium−99. The sex and age structure of patients with hyperthyroidism was compiled, taking into account the bimodal age distribution. In women born in 1944ЃE970, the peak incidence falls on birth dates within the period of 1958ЃE961; in women born in 1973ЃE997, the peak incidence rate was observed in 1982ЃE985. The surveyed included girls born in 2000ЃE017. Hyperthyroidism in men was most common in the age group born between 1949 and 1991. The lowest number of patients occurred at the dates of birth in 1967ЃE970. The types of intermarriages included those between the cousins, second cousins, uncle and niece, third cousins. The coefficient of inbreeding in patients was 4.2 times higher in comparison with that in the group of healthy persons participating in the study, which indicates the influence of intermarriages on the incidence of hyperthyroidism in the offspring

In Ukraine, total population exposure dose is 5.9 mSv/year−1, the contribution of the natural component is much higher and reaches 3.5 mSv/year−1. The share of radon−222 in it accounts for 2.4 mSv/year−1. In this regard, information on the main factors of population exposure in certain regions of the country is very important for developing measures to reduce them. This problem is especially relevant for Zaporizhzhia region, where the largest in Europe Zaporizhzhia NPP is located. The article deals with investigation of the levels and structure of population exposure doses due to natural radiation sources. The purpose of the work was to study the existing levels of gamma−background in the territory of Zaporizhzhia region in open areas and in residential buildings, with further assessment of possible doses of exposure to the population from the sources of natural origin. Dosimetry, statistics and computational methods were used. To determine the population doses due to natural sources, the results of measurements of radon−222 in indoor air, activity of natural radionuclides in building materials, water of the artesian well, as well as gamma−ray background in the premises and in the territory were used. Measurement of radon−222 was carried out by passive track radonometry. The number of measurements of gamma−background in the open area was 1257, absorbed dose rate in the houses made 848. The number of samples tested for the content of radionuclides in building materials made 5798, in portable water of artesian the wells −− 297. The number of measurements of radon−222 in the air facilities made 693. It was established that due to natural radiation, averaged over the years 2010ЃE014, absorbed dose rate in the air in open areas was 11.3 mR·h−1. Levels of gamma background measured in the premises were equal to 12.2 mR·h−1. Averaged total exposure dose due to external exposure indoors and outdoors was 0.64 mSv per year−1. 80 % of the dose determines the exposure indoors. Averaged population exposure dose due to radon−222 in the portable water of the artesian wells was 0.13 mSv per year −1. It was found that total average annual effective population exposure dose from the main natural sources reached 4.3 mSv, which was almost 1.8 times higher than the world average value and 19.4 % more than the average Ukrainian value. The largest contribution to the dose was made by radon−222 − 76 %.