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Diabetes mellitus is considered as a pathology, representing a chain of clinical events beginning as an impairment of carbohydrate metabolism, and resulting in a cardiovascular disease. The incidence and mortality from coronary heart disease in the patients with diabetes exceeds the expected levels with a simple summation of risks, indicating the direct influence of hyperglycemia on the atherosclerotic process. Explicit link between glycemic control and a reduced risk of micro− and macrovascular complications of diabetes has been proven. To date the ideology of early intervention is actively developing and is gaining more and more followers. New approaches suggest quiet preventive activity of both the patient and his/her doctor. Effective competent self−monitoring of glycemia is one of the fundamental factors in slowing down and preventing the development of cardiovascular complications of diabetes. In glycemia self−control, the patient becomes an active participant in the treatment process, sharing the responsibility with the doctor, but as well accordingly, increases adherence to compliance with the recommendations of the doctor. It is important to maintain a high quality of life for the patient. Full awareness of the patient's disease, knowledge of the technique of measuring blood glucose and the ability to correct a dysfunctional state provide good results to the patient.

Chronic lung disease is a serious problem in modern medicine, due to their prevalence and high rates of disability and mortality. In the structure of chronic diseases of the lungs leading positions belong to chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA). However, from 15 to 55 % of patients, especially those over the age of 40 and with associated tobacco history, had a combination of the symptoms of these diseases. Comorbidity of obstructive lung diseases and hypertension are important medical and social problems because of an increased morbidity, severity of complications, the tendency to a rise in mortality and loss of working capacity of patients. To study the state of systemic inflammation in such patients, we examined the patients with asthma − COPD − overlap syndrome, bronchial asthma and chronic obstructive disease on the hypertension background. The disease was diagnosed based on the data of anamnesis, objective examination, spirometry with a standard reversibility testing for bronchial obstruction with 400 mg salbutamol inhalation and laboratory study (clinical blood count with leukocytogram and determination of the eicosanoid LTB4 serum level by immune enzyme method). The survey was conducted during the remission period, which was characterized by stable clinical symptoms and external respiration indices. The obtained results showed that in the patients with chronic obstructive pulmonary disease on the background of hypertension there were specific changes in the systemic inflammation parameters, namely it concerned the leukocytogram in COPD, the increase in leukocyte count during relative reduction in lymphocytes was characteristic, while in bronchial asthma and asthma − COPD − overlap syndrome there was an elevation in eosinophils, not inherent to chronic patients it obstructive pulmonary disease. The serum level of LTB4 in the patients with hypertension and COPD disease was significantly higher than in those with hypertension only, it was further increased in the patients with bronchial asthma and reached the highest values in asthma − COPD − overlap−syndrome.

Among the metabolic responses to trauma a central position is occupied by the changes in carbohydrate metabolism, being an extremely negative factor in the course of traumatic disease on the background of insulin resistance in the patients with an increased body mass index. By means of multivariate analysis, there was studied the dynamics of nine leading metabolic syndrome indices, calculated on the basis of 1,344 assay sheets in 224 patients with an increased body mass index during polytrauma, which characterized this functional system within the intervals from one day to one year from the moment of injury occurrence. Integral indices were determined and the state of metabolic syndrome indices in a whole were mathematically modelled, a comparative analysis of those allowed to reveal both general patterns and certain features, characteristic for these patients depending on the body mass index at the time of polytrauma occurrence. The analysis of metabolic status in the patients with an increased body mass index during a polytrauma showed the changes depending on the terms of examination and initial counts of body mass index. By mathematical modeling, the manifested deviation in integral index was found if compared with the control both in the early period and in distant terms (one year from the moment of polytrauma occurrence) for all the patients examined. The significant role of metabolic disorders in the pathogenesis of trauma diseases in the patients with elevated body mass index during polytrauma was emphasized, that was a prerequisite for prescribing the proper therapy.

Today, as a result of the growing cardiovascular morbidity among the population of most countries, the number of surgical interventions in heart and large vessels is steadily increasing. The rapid development of medicine over the recent decades has allowed expanding the indications for the implementation of challenged surgeries in the patients with severe concomitant pathology. The most common access to such surgeries is median sternotomy. The problem of post−surgery sternotomy−associated complications has remained, i.e. failure of sternal sutures, infection of soft tissues of anterior chest and mediastinum, bleedings. The aim of the work was to improve the results of surgical treatment of cardiac patients subjected to median sternotomy surgery, by improving sternorrhaphy and intraoperative hemostasis. There was retrospectively analyzed 1,331 the medical histories of the patients suffered from a wide variety of cardiac surgical pathologies. After the implementation of longitudinal median sternotomy with access to heart, various methods of surgical hemostasis and osteosynthesis of the sternum were used. In most cases, the concomitant pathology of patient aggravated the course of the underlying disease and had a prognostic value for normal healing of the wound in post−surgery period. The results of this study make it possible to recommend, when performing sternotomy, the use of the proposed method of sternal metal ostheosynthesis in combination with the application of collagen−based hemostatic material.

The combination of pelvic and abdominal injuries occurs in 26−50% of patients with a combined damage, and up to 55% of pelvic injuries are accompanied with an abdominal trauma. The results of surgical treatment of the patients with dominant abdominal injuries in combination with those of pelvis, as well as pelvic organs have been analyzed. In one clinical group, traditional surgical approach was used and the tactical errors were analyzed; in another, the surgeries were performed using novel techniques, which were applied to perform organ−saving surgeries with reinfusion of the effused blood. The treatment approach to the injuries of pelvic organs differed significantly in the affected individuals of both groups. Thus, in the first group with the injuries of bladder and urethra, it was possible to delay the surgical interventions for up to 12 hours from the moment of injury. In the patients of the second group, as a distinctive feature of surgical treatment of the injuries of bladder and urethra, along with the urine diversion, an adequate prevesical space drainage was considered. The results of investigations demonstrated that the decrease in mortality of the patients of this category from 42.5 % in the first group down to 25.0 % in the second, i.e., 1.7 times, was to a certain extent associated with the stabilization of severe pelvic fractures, which made it possible to achieve hemostasis, prevent the growth of retroperitoneal hematomas and timely perform surgeries in internal organs of abdominal cavity and retroperitoneal space, including the organs of genitourinary system.

Dilated cardiomyopathy (DCM) plays an important role among non−coronary heart diseases leading to the development of chronic heart failure. Transplantation of various types of stem cells improves the contractile function of the affected myocardium. Stem cells possess a proarrhythmogenic effect due to the impossibility of complete electromechanical integration of the transplanted cells with the recipient's myocardium, their delivery way and origin of the target substrate. To study the effect of cord blood stem cell transplantation in the patients with dilated cardiomyopathy on development of arrhythmias in the long−term period, 20 patients were examined, who were Holter−monitored daily at months 1, 3, 6, 12, 18. The choice of cord blood stem cells is associated with relative simplicity of their procurement, lack of risk for the donor, low contamination of neonatal cells with viruses, relatively low cost of transplantation. By the end of the prospective follow−up period (18 months) after transplantation of cord blood stem cells, a decrease in the relative number of high−gradation ventricular extrasystoles was recorded, being of an increased risk of fatal arrhythmological events from 40 to 17.6 % (class IVa) and from 45 to 11.9 % (class IVb) for Lown − Wolf (p < 0.05). The findings showed that the transplantation procedure itself did not increase the risk of ventricular extrasystoles. There were no adverse effects of cord blood stem cell transplantation, including proarrhythmogenesis, which may indicate the safety of this class of stem cells in the long−term observation period.

The actual problem of clinical combustiology is the development of effective approaches to treat dermal burns, being the majority of thermal lesions. Optimization of treatment methods for this type of burns will significantly improve the performance of the combustiology service at the inpatient and outpatient stages of treatment. To study the wound process of dermal burns with the combined use of synthetic wound dressings and a complex solution of antibacterial and stimulating action, the treatment results for 86 patients was analyzed. After sequential necrotomy, they underwent a three−stage treatment corresponding to the staging of the wound process. The areas of true deep dermal lesion, the epithelization timing and leukocyte index were compared. The proposed method for the local treatment of burns with the combined use of synthetic wound coatings and a complex solution of antiseptic and stimulating action is helpful in optimization of wound process in both superficial and deep burns, that was expressed in accelerating epithelialization and cleansing of burns in the patients of main group.

The presence of acute cholangitis in most cases stipulates the surgery staging. First of all, in such patients the biliary hypertension has to be eliminated, with following correction of the pathology which caused acute cholangitis. To substantiate the protocol of different types of surgical interventions in acute cholangitis, the results of surgeries in 150 patients, who underwent 241 stages of surgical interventions totally. The sequence and time of the surgery stages for the patients with cholangitis as well as the type of surgical intervention are determined individually, in accordance with the patient's condition and priority of pathological process. Mini−invasive and open methods are used in different sequences and at different time intervals, depending on the severity of the dominant pathology. In acute inflammatory process in biliary tract, it is not necessary to strive for a complete removal of concrements from hepathicohledocha, since, firstly, some of those patients operated by laparoscopic or open ways have already had the transpapillary drainage manipulations, and secondly, such drainage mini−invasive interventions with endoscopic removal of concrements or stenting can be performed after laparoscopic or open intervention in biliary tract.

Obesity is associated with elevated morbidity and mortality, one of the causes of those is an increased risk of cardiovascular disease resulted from dyslipidaemia. High levels of triglycerides and low density lipoprotein cholesterol, high density lipoprotein low cholesterol are often found in obese patients. When improving the lipid profile of patients with obesity, the bariatric surgery is effective, however, its results differ significantly depending on the procedure. To study the effect of mini−gastric bypass on lipid metabolism indices in the patients with morbid obesity, the results of treatment of 37 patients, who underwent laparoscopic mini−bypass of the stomach according to R. Rutledge method were retrospectively evaluated. The performed study showed the marked effect of such a surgery on the lipid profile correction in the patients with obesity, i.e. there was a significant decrease in atherogenic and increased antiatherogenic fractions of cholesterol. Reduced levels of triglycerides by 34.8 % and increase in high density lipoproteins by 17.9 % led to a reduced incidence of dyslipidaemia by 29.7 % and, in turn, of cardiovascular diseases.

Placental insufficiency is a complex clinical syndrome caused by the disordered compensatory and adaptive mechanisms that ensure the fetus normal growth and development, the result of fetus and placenta response to various pathological conditions of mother's body, which manifests, as a rule, in the complex of disorders of endocrine, trophic, metabolic and transport functions of the placenta. Clinically placental insufficiency is manifested in the delay of fetal growth and its hypoxia. Prenatal screening is used to diagnose placental insufficiency and delayed fetal growth, including identifying pregnant women of the high−risk groups, assessing the height of uterine fundus, biochemical screening, ultrasound examination, estimating the amount of amniotic fluid and the placenta maturity degree with ultrasound fetometry, dopplerometry, cardiotocography, amniocentesis, chorionic villus biopsy, placentocentesis, cordocentesis, followed by karyotyping. Treatment of these pathologies can include medications as well as can be drug−free. The therapy should be aimed at improving the uteroplacental and fetal−placental blood flow, intensification of gas exchange, correction of rheological and coagulation properties of blood, eliminating hypovolemia and hypoproteinemia, normalization of vascular tone and contractile activity of uterus, antioxidant defense strengthening, optimizing the metabolic processes.

Understanding the basics of cell growth induction, especially under conditions of tumor tissue transformation, is an integral part of a proper approach to the management of the patients with endometrial hyperplasia. The further study of pathogenetic and molecular genetic mechanisms of this disease development is a promising direction of reducing the frequency of hyper− and neoplastic processes of endometrium. The purpose of the study was to investigate the role of biomolecular markers in pathogenesis of development of hyperplastic processes and matching the extent of their activity to morphological changes in endometrium. For the study 69 patients with endometrial hyperplasia comprising the main group were examined. The control group included 20 women admitted to the hospital with uterine bleeding for curettage without endometrial hyperplasia. To assess the molecular biological features of endometrial hyperplasia, the immunohistochemical method was used to determine the expression of the markers of proliferation (Ki−67) and apoptosis (p53), as well as estrogen (ER−α) and progesterone receptors (PGR). According to the histological examination results of the scrapings from the uterus, the patients with endometrial hyperplasia were divided into 2 groups: the first one made the patients with simple endometrial hyperplasia and the second group consisted of the women with complex hyperplasia. It has been proven that the determination of biomolecular markers Ki−67, p53 and sex steroid hormone receptors ER−α and PGR allowed not only to predict the course of endometrial hyperplasia, but also to evaluate the treatment effectiveness. An immunohistochemical study made it possible to identify the groups of risk for the recurrence of hyperplastic processes, the development of possible endometrial malignancy, and to promptly assign the surgery to patients.

Tubal−peritoneal infertility, removal of both fallopian tubes, the development of ovarian insufficiency syndrome during the post−surgery period in the patients with tubal pregnancy are indications for in vitro fertilization. The low ovarian response during in vitro fertilization programs is an important issue in modern reproductive medicine. Due to the high frequency and growth trend, as the proportion of "poor responders" among women without tubal ligation and late reproductive age with infertility increases, the efficiency of in vitro fertilization programs decreases. It is known that the use in clinical practice of placental cryoextract during in vitro fertilization programs in women, who have undergone inflammatory diseases of uterus, has contributed to a significant increase in their effectiveness. The purpose of this study was to assess the effectiveness of the recovery of reproductive function in the patients with no effect after laparoscopic treatment of progressive tubal pregnancy, followed by the use of assisted reproductive technologies. In vitro fertilization procedures were used in 181 patients, while in one group they were carried out according to standard technique, in another the patients were preliminarily introduced with 2.0 ml placental cryoextract intramuscularly after 2 days (5 injections). To evaluate the effectiveness of assisted reproductive technologies in the groups of patients the follow−up data of 60 practically healthy women were investigated. A comparative assessment of the results obtained revealed that the use of placental cryoextract as a part of in vitro fertilization protocols contributed to a 1.4−fold increase in advanced uterine pregnancies.

Over the past two decades, endoscopic surgery has been widely used in surgical gynecology. With the use of endoscopic cameras, it became an indispensable diagnostic, therapeutic and surgical method. In order to study the expediency of using diagnostic laparoscopy, it was performed in 15 patients with stage II ovary cancer (T3a−cNxM0) to determine the malignancy extent, as well as the tumor sampling was performed. All the patients had a diagnosis based on a comprehensive examination, which included bimanual examination, clinical, echographic, computer−tomographic and cytological examinations. The patients satisfactorily survived surgical intervention, after which the drainage of the abdominal cavity was carried out for further intraperitoneal neoadjuvant chemotherapy. There were performed 15 diagnostic laparoscopies, including 1 hystero−oophorectomy and the large omentum resection, 3 adnexectomies, 7 tumor biopsies and 4 examinations of the pelvic organs and abdominal cavity. Among 7 biopsies of tumor 3 were non−informative, in 2 cases in diagnostic laparoscopy, after the examination of pelvic organs and abdominal cavity, laparotomy was performed due to the tumor curability. During laparoscopy, two complications in the form of bleeding from the vessels of the ovarian tumor were recorded after taking the biopsy specimen, resulted in further laparotomy for the patient. Diagnostic laparoscopy has allowed with a high accuracy to assess the malignancy distribution rate, to histologically verify the diagnosis, to perform immunohistochemical study and to provide the conditions for the further intraperitoneal neoadjuvant chemotherapy.

Neoadjuvant chemotherapy after breast cancer is performed to reduce the size of the primary tumor in order to create favorable conditions when performing organ−saving surgery; it provides the achievement of a complete morphological regression of the tumor process and metastatic lymph nodes. To reveal the relationship between the manifestation of tumor regression at different neoadjuvant chemotherapy protocols and distant results of treatment of the patients of this category, as well as some prognostic markers of treatment effectiveness, a study was performed, which comprised 139 patients with diagnosed breast cancer (T1−2 N2−3M0, T3N1−3M0, T4N0−3M0) aged from 29 to 64 years. Clinical response after neoadjuvant therapy was evaluated by physical and instrumental methods every two cycles. To determine the biological subtype of tumor, the indices of the level of estrogen and progesterone receptors, HER2 / neu expression and the extent of histological malignancy (H), determined by immunohistochemistry, were used. It was established that treatment with the TAS regimen provided the best results as compared with the TS regimen. The study found that the combination of detection of high expression of topoisomerase II−alpha with low expression of beta−tubulin class III was a reliable predictive sign of achieving a complete morphological regression in response to taxane−containing chemotherapy.

Epilepsy is one of the most common diseases, leading to life limitation and social maladaptation in Ukraine. The search for new tools for studying and preventing the emergence of negative consequences of epilepsy is one of the most pressing tasks at the present time. In order to improve the provision of medical care and monitoring the status of children with paroxysmal conditions, a depersonalized register of the patients was created in the city of Kharkiv and Kharkiv region. From 2015, the register included 1,592 children who had undergone paroxysmal states of epileptic and other genesis (acute symptomatic attacks, febrile convulsions, respiratory paroxysms etc.). It has been shown that the register of children with epilepsy assists to improve the diagnostics, to prevent cases of false diagnosis, to identify the main etiological factors that can affect the disease course, to enhance the provision of medical care to patients, to estimate the number of patients receiving treatment and its effectiveness, to specify the economic costs of treatment and to monitor the patient's condition. As well this register makes it possible to improve the medical and social prognosis of the patients, the quality of their lives and lives of their families, to promote preventing the serious consequences of disease and disability.

The emerging vicious cycle of mutual influence of lymphoid and collagen−synthesizing cells in the patients with focal scleroderma at the acute stage as a result of the dysfunction of main immunocompetent organ, i.e. thymus, leads to the progression of fibrous process with the formation of immunoendocrine dysfunction syndrome. With complex structural and functional organization of the thymus, it is possible that the mediator factors, clones of differentiated lymphocytes, contribute to the development of an uncontrolled cytokine cascade. In the patients with focal scleroderma at acute stage, there were studied the indices of cell immunity, i.e. expression of surface markers of differentiation (CD), depending on their condition. A significant increase in the expression of differentiation marker CD2 + active T−lymphocytes involved in the stimulation of B−cells was found. The activity of proteins of the complement system and phagocytic function of neutrophil granulocytes have an important prognostic value, since insufficient activity, excessive lymphocytotoxicity, as well as a high titer of antibodies to DNA are a negative prognostic test, indicating the formation of immune endocrine dysfunction syndrome. All the patients with focal scleroderma showed a significant increase in antibodies to native DNA, associated with pronounced autoimmune reactions. In the patients with dysfunctional states of thymus, the antibodies to P−protein and actin myofibrils of thymus myoid cells were revealed, which indicated the formation of the immunoendocrine dysfunction syndrome with the involvement of active T−lymphocyte clones, increased humoral sensitization and lymphocytotoxicity.

One of the important tasks of modern hepatology is the timely determining the presence of fibrosis and clarification of its stage in the patients with chronic hepatitis C. Liver fibrosis is a consequence of an excessive deposition and accumulation of extracellular matrix components in it as a result of the activation of stellate cells. Early qualitative and quantitative diagnosis of the severity of fibrotic changes in the patients is needed not only to decide on the feasibility and duration of etiotropic therapy, assess its effectiveness, but also to establish the overall prognosis. Despite the fact that needle biopsy is still the "gold standard" for diagnosing morphological changes in liver, serological markers of fibrosis are more accessible and popular in practical use. By their origin, they are divided into direct, directly related to metabolism of extracellular matrix, and indirect, i.e. laboratory indices, reflecting the functional state of liver. The first ones include hyaluronic acid, cytokeratin−18, procollagen peptides, collagens, matrix metalloproteinases and their tissue inhibitors, laminin, and the second includes transferases, blood clotting factors, cytokines, etc. A number of tests based on direct (MP3, ELF), indirect (APRI, AAR, Model 3, FibroTest, etc.) markers of fibrosis and their combination (SHASTA, FIBROSpect, Zeng's score, Hepascore, Fibrometer) has been developed. Each of them has a different diagnostic value. Despite the variety of methods for non−invasive diagnosis of fibrosis in the patients with chronic hepatitis C, each of them, along with the advantages, has certain disadvantages, which dictates the need to continue the further search for biochemical equivalents of the severity of fibrotic changes of liver in such patients.

In recent decades, molecular genetic research methods, in particular, the polymerase chain reaction, have been used to improve the quality of etiological diagnosis of neuroinfections by clinicians. To assess the effectiveness of identification of N. meningitidis and Str. Pneumoniae in the patients with purulent bacterial meningitis at the local and systemic levels using the method of polymerase chain reaction 103 patients were examined in dynamics. In accordance with the diagnosis, the patients were divided into three groups: patients with etiologically undifferentiated purulent meningitis, in those the pathogen was not detected during bacteriological examination of cerebrospinal fluid and serum; patients with meningococcal meningitis for those N. meningitidis was detected in cerebrospinal fluid using bacteriological examination and the method of polymerase chain reaction; patients with pneumococcal meningitis, confirmed by the bacteriological method and polymerase chain reaction. The results of the study showed that when determining the etiological interpretation in patients with purulent bacterial meningitis, DNA detection of N. meningitidis and Str. pneumoniae in cerebrospinal fluid using the polymerase chain reaction was more specific than in serum. The information capacity of the serum polymerase chain reaction was higher in patients with acute meningitis meningococcal etiology if compared with pneumococcal meningitis. To improve the efficiency of the diagnosis of purulent bacterial meningitis using molecular genetic methods, it is advisable to study both cerebrospinal fluid and blood serum. Research data on blood serum of the patients with meningococcal and pneumococcal meningitis confirmed the pathogenesis of purulent bacterial meningitis: the pathogen was found more often and longer in the blood during meningococcal meningitis and rarely and briefly in pneumococcal meningitis. Further study of the effectiveness of molecular−genetic technologies for diagnosis of purulent bacterial meningitis using various biological materials of the patients will allow identifying a larger spectrum of pathogens of this group of diseases, and, possibly, the polymerase chain reaction will be the "platinum standard" in their diagnosis.