Donetsk Regional Research Articles

Episootological features of tularemia in the Donetsk region

Objective: to evaluate epizootic monitoring of tularemia in the Donetsk region.Materials and methods: methods of retrospective, statistical, and comparative analysis were used. The sources of infection were investigated using serological and biological methods. The data of industry statistical reporting on form No. 40-annual of the department of especially dangerous infections of the Donetsk regional Sanitary and Epidemiological Station (since 2013 — SSESU, since 2015 — Republican Center for Sanitary and Epidemiological Surveillance of the State Sanitary and Epidemiological Service of the Ministry of Health of the DPR) were used. 20 "Maps of epizootological and epidemiological examination of the focus of zoonotic disease" (F.391/y) were studied.Results: since 1987, the number of enzootic territories in the Donetsk region has increased annually: from 2 settlements in 1987 to 79 (in 4 cities and 16 districts) in 2023. With the beginning of active hostilities, the epidemic process of tularemia in Donbass has sharply intensified. Antibody titers (1:80 and 1:160) for tularemia were detected in environmental samples: in the North Steppe zone — 6.2%, Donetsk-Kryazhnaya — 10.4%, Primorsko-steppe — 15.8%. In the study of mouse-like rodents, 6 cultures of Francisella tularensis holarctica biovar II era R were isolated, resistance of the strain to ampicillin, cefotaxime, erythromycin, clindamycin, polymyxin was established; sensitivity to gentamicin, fluoroquinolones, rifampicin, doxycycline, levomycetin.Conclusions: the activation of epizootic processes of tularemia in the DPR is associated with the conduct of hostilities. High titers of antibodies to tularemia in environmental samples are noted in the south of the Donetsk region.

Dedicated to the Memory of Academician Grigory Vasilievich Bondar and the 80th Anniversary of the Oncological Service of Donbass

The oncological service of Donbass has a rich history. The path of its formation began in 1943, when on September 9, 1943, Professor M.K. Afanasiev signed an order to restore the activities of the Stalin X-ray station and the oncological hospital.The first organizer of the radiological service in the Donbass is considered to be Ekaterina Vladimirovna Stelling, who was appointed in 1946 to the post of head of the oncological hospital in Stalino. The radiological service appeared in 1947, when the Regional Oncological Dispensary was organized. Soon the institution was renamed the Donetsk Regional Oncological Dispensary (DROD). Soon the institution was renamed the Donetsk Regional Oncological Dispensary. In 1955, DROD, in order to increase the number of beds, was transferred to the base of the Regional Clinical Hospital. M.I. Kalinin.Under the leadership of Grigory Vasilyevich Bondar, in September 1968, an oncology course was organized, the clinical base of which was DROD. August 19, 1975 Grigory Vasilyevich headed the Department of Oncology, established at the Donetsk State Medical Institute. M. Gorky. October 12, 1992 Donetsk Regional Oncology Center received the status of an antitumor center. Academician of the National Academy of Medical Sciences of Ukraine, Doctor of Medical Sciences, Professor Grigory Vasilyevich Bondar has been appointed its General Director.The center, which subsequently became the leading one in Ukraine, had the greatest experience in surgical and combined treatment of tumors of various localizations using the methods proposed in the clinic. In 2006, the first radiotherapy complex in Ukraine was installed in the Donetsk Regional Cancer Center.At the beginning of 2014, our teacher passed away. Students with dignity continue the work of Bondar Grigory Vasilyevich. At the end of 2014, on the basis of the Donetsk Regional Antitumor Center, the Republican Cancer Center of the Ministry of Health of the Donetsk People’s Republic was created, which was named after Professor Grigory Vasilyevich Bondar. The Center proudly bears the name of the great Teacher Grigory Vasilyevich Bondar! And in our present life, he is still a mentor and assistant!We are sure that the symbiosis of science and practice of a team of professionals who selflessly give their knowledge, experience and skills for the benefit of patients will give a powerful impetus to the further development of the oncological service of Donbass.

ОБГРУНТУВАННЯ СТРАТЕГІЇ РОЗВИТКУ ПАРКОВО-РЕКРЕАЦІЙНИХ КОМПЛЕКСІВ В СИСТЕМІ СТАЛОГО РОЗВИТКУ ТЕРИТОРІЙ

Goal. The purpose of the article is the study of modern trends in the functioning of parks and recreation areas and the formation of scientific and methodological bases for the justification of the strategy for the development of park and recreation complexes in the system of sustainable development of territories. Method. The solution of the set research tasks within the framework of the goal is implemented by using a systematic approach, methods of statistical processing of information, methods of analysis and synthesis, a dialectical approach to determine the prerequisites and basis for developing a strategy for the development of park and recreation complexes in the system of sustainable development of territories. The results. According to the results of the study of modern trends in the functioning of parks and recreation areas, the thesis is substantiated that the significant destruction of natural objects as a result of active hostilities not only leads to the loss of Ukraine's natural potential and a number of negative environmental consequences, in particular, in the form of environmental pollution, but also to a decrease national well-being, which is manifested in the deterioration of the financial and economic results of the functioning of territories and cities, the living conditions and the performance of professional functions of the community located in such locations. The analysis of statistical data showed that the last decade was accompanied by the active creation of regional landscape parks and the activation of actions by the state and local communities in the field of transferring territories and urban zones to the status of those of nature conservation importance. In these conditions, park zones received a special status, which allows to ensure the renovation of natural objects and to push and develop natural objects. As a result of active hostilities, which is accompanied by the destruction of the infrastructure of cities, the reduction of the areas of nature-protected territories, the financial, economic and social results of business entities are reduced. Therefore, in the work, taking into account the objective need to develop an effective toolkit for substantiating the strategy of the development of park and recreation complexes in the system of sustainable development of territories, recommendations for choosing a strategy, decision-making criteria and algorithms for their implementation with the simultaneous achievement of positive environmental results and the growth of economic indicators of economic processes on territory As a result, the scientific and methodological principles of substantiating the strategy of development of park and recreation complexes in the system of sustainable development of territories were formed. It was noted that the proposed developments are aimed at realizing the socio-economic and ecological potential of restoration of park areas, in particular at the level of the city and territories. Prospective directions for the development of parks have been formed, which will contribute to such processes and the formation of effective economic policy in the field of organizational and economic provision of sustainable development of city parks and other recreational and landscape areas. The information basis for achieving the set goal is the official statistical data of the State Statistics Service of Ukraine, the Donetsk Regional State Administration, the results of research in the field of development of cities, territories, parks and recreation areas, carried out by domestic and foreign scientists, official sources of information on the financial and economic results of the functioning of regional of landscape parks of Ukraine, provisions of strategies for the development of cities and regions of Ukraine, provisions of the Sustainable Development Strategy of Ukraine until 2030. Scientific novelty. Refined scientific and methodical principles for the justification of the strategy for the development of park and recreation complexes in the system of sustainable development of territories are formed taking into account the current state of natural resources of Ukraine, and in particular the Donetsk region, and the consequences of active hostilities, which are accompanied by the irreversible destruction of a significant range of natural objects, and form the basis for clarification of the main provisions of strategies for the development of cities and territories on the basis of sustainability, which will contribute to the growth of national well-being and obtaining significant socio-economic results for improving the environmental conditions of economic activity.

Дослідження ЕЕГ-предикторів нейромедіаторної і нейрогліальної активності, особливостей перебудови міжцентральних відносин мозку у пацієнтів з тяжкою ЧМТ

Метою цього дослідження було вивчення впливу Цитофлавіну на перебудову міжцентральних відносин мозку, зміни нейромедіаторної і нейрогліальної активності в пацієнтів із тяжкою черепно-мозковою травмою (ЧМТ). Матеріал і методи дослідження. Дослідження проводилося в 2011–2014 роках у ДОКТМО на базі кафедри анестезіології та інтенсивної терапії ФПО Донецького національного медичного університету ім. Горького. Обстежено 60 пацієнтів із діагнозом «тяжка черепно-мозкова травма». Дизайн дослідження: відкрите проспективне дослідження за типом «випадок-контроль», що проводиться в групі пацієнтів із тяжкою ЧМТ. Рівень порушення свідомості при надходженні до стаціонару від 4 до 8 балів за шкалою коми Глазго, вік від 20 до 70 років. 1-ша група складалася з 30 пацієнтів, які отримували терапію за стандартним протоколом. 2-га група — з 30 хворих, які отримували, крім терапії по протоколу, препарат Цитофлавін із першої доби після отримання травми у вигляді інфузійного розчину 5 мл в 100 мл фізіологічного розчину 1 раз на добу (в 1-й групі — плацебо) внутрішньовенно повільно крапельно протягом 7 діб. Досліджували електричну активність мозку у хворих із тяжкою ЧМТ методами кількісної електроенцефалографії за допомогою інтегрального кількісного аналізу, внутрішьно- і міжпівкульної когерентності досліджуваних частотних діапазонів. Результати та обговорення. На першому етапі дослідження падіння рівнів міжпівкульної когерентності, виявлене в обох групах хворих із тяжкою ЧМТ, з вираженою синхронізацією біопотенціалів неокортексу справа (посилення внутрішньопівкульної когерентності потиличної кори з центральними і фронтальними ділянками (С4-О2 і Fр2-T4)) відображало крайню напруженість гомеостазу ЦНС і домінування неспецифічної аварійної адаптації з ознаками зриву адаптаційних можливостей. У хворих із тяжкою ЧМТ встановлено нейрофізіологічні ЕЕГ-предиктори феномена функціонального роз’єднання півкуль: істотне ослаблення міжпівкульної взаємодії в альфа-частотному діапазоні ЕЕГ у всіх симетричних відділах мозку — Fp1-Fp2, T3-T4, C3-C4, O1-O2 відведеннях, що відображає гальмівний стан кори. Проявом феномена роз’єднання зв’язків між підкірковими гангліями і корою головного мозку є виражене зниження рівнів міжпівкульної когерентності в симетричних лобових відведеннях (Fp1-Fp2), центральних (С3-С4) і потиличних відділах (О1-О2) в діапазонах тета-, альфа1-, альфаS-, бета1-, бета2-хвиль, що свідчить про дисфункцію регуляторних систем медіобазальних відділів фронтальної кори і про падіння напруженості в системах диенцефального рівня. На першому етапі дослідження в обох групах хворих із тяжкою ЧМТ встановлено вихідне зниження активності всіх досліджуваних нейромедіаторних систем практично у всіх досліджуваних відділах кори, що відображає глибоке виснаження стресреалізуючих і стреслімітуючих реакцій ЦНС. У хворих із тяжкою ЧМТ, які отримували Цитофлавін, предикторами трансформації стрес-реакції з періоду аварійної адаптації в період довгострокової адаптації є збільшення значення когерентності в альфа-діапазоні ЕЕГ-частот в центральній корі (С3-С4), проекційній зоні неспецифічного таламуса, відновлення активності верхньостовбурових структур мозку і лімбічної системи (посилення міжпівкульних діагональних когерентних зв’язків (C3-О2, С4-O1) фонової ЕЕГ в альфа-діапазоні). У хворих із тяжкою ЧМТ інтенсивна терапія з застосуванням Цитофлавіну протягом тижня відновлювала нейромедіаторний баланс, поетапно модулюючи активність адренергічної, серотонінергічної і дофамінергічної, холінергічної нейромедіаторних систем, коли стресреалізуючі реакції в процесі відновлення функцій ЦНС змінювалися стреслімітуючими реакціями, більш відповідними необхідному рівню гомеостазу. Висновки. Застосування Цитофлавіну забезпечувало енергетичну складову адекватних стресреалізуючих і стреслімітуючих процесів при тяжкій ЧМТ, їх поетапне включення у відновлення гомеостазу ЦНС. У групі пацієнтів із тяжкою ЧМТ, які отримували додатково до стандартного протоколу лікування Цитофлавін, значуще зростав шанс відновлення свідомості до 11 і більше балів за шкалою коми Глазго (ОR ± 95% ДІ = 0,22 (0,054–0,914)), значуще знижувався ризик смерті ((RR) ± 95% ДІ = 3 (1,09–8,2)) вже на 3-тю добу терапії.

The history of Ukrainian Association of Researchers of Religion to the 25th anniversary of establising

In this issue, the founder of the Donetsk regional branch of the Ukrainian Association of Religious Studies (UAR), theologian, candidate of historical sciences, senior researcher of the Department of Religious Studies of the GS Skovoroda Institute of Philosophy of the National Academy of Sciences of Ukraine, President of the Center for Religious Studies member of the Expert Council on Freedom of Conscience and Religious Organizations under the Ministry of Culture of Ukraine, member of the Strategic Council under the Minister of Culture and Information Policy of Ukraine. I. Kozlovsky worked for more than 25 years in the Donetsk Regional State Administration as a chief specialist and head of the department for religions, in the early 1990s he established the College of Religious Studies at Donetsk Open University, which was later transformed into the Faculty of Philosophy and Religious Studies of the State University of Information. intelligence (DUiISHI), and has done much to promote interfaith and interreligious dialogue and cooperation in the Donetsk region, whose religious map is very diverse. At the beginning of the Russian-Ukrainian war, I. Kozlovsky became one of the organizers of the interfaith prayer marathon "Prayer for Ukraine", which took place in Donetsk from early March to November 2014, which was attended by members of the Donetsk branch of the UAR. Until 2016, some members of the UAR, led by I. Kozlovsky, who still remained in the occupied territories, collected data on the state of religious freedom in Donetsk and the region. In 2016, I. Kozlovsky was imprisoned by a terrorist group of the so-called "Donetsk People's Republic" and was held captive for almost 2 years (700 days).

АНАЛІЗ СТРУКТУРИ ТА ДИНАМІКИ ВИТРАТ У НАВЧАЛЬНО-МЕТОДИЧНОМУ ЦЕНТРІ КУЛЬТУРИ

The article analyzes the structure and dynamics of costs of the Municipal Institution of Culture "Donetsk Regional Educational and Methodological Center of Culture" in Kramatorsk. Accounting in budgetary institutions is a system of control over the availability and movement of budgetary and extrabudgetary funds, is based on generally accepted principles, performs management, information, control functions and has certain features. The main purpose of the Center is to train and improve the staff of clubs, educational institutions of culture and art, parks of culture and recreation, tourism, the introduction of new forms of management, conducting various cultural and artistic events and growth of artistic creativity. Thus, most of it is allocated to the costs associated with the provision of services and the purchase of materials and equipment for cultural and artistic events. The organization has established a memorial-order form of accounting using the software package "Athens: Salary" and "Fit-budget" to account for records of business transactions in the accounting registers. When determining the amount of expenditures, budgetary institutions should take into account the objective need for funds, based on their basic production indicators and contingents set for institutions, the amount of work performed, staffing, the need for individual programs and planned measures to reduce expenditures in the planning period. All expenditures included in the draft estimate must be substantiated by appropriate calculations for each economic classification code. This means that when drafting the budget, budget institutions provide a detailed breakdown of expenditures for each code of economic classification of expenditures to justify the amount of expenditures. The purpose of the analysis of the implementation of cost estimates is to assess the effectiveness of the allocated material, labor and financial resources, identify deviations of actual expenditures from the estimated allocations, as well as quantify the impact of factors that caused these deviations. It is the analysis of the structure and dynamics of expenditures of the educational and methodical center of culture will help to study in detail the main expenditures of the budget organization.

Vivid vision and artistic decision as constituents of stage-director intention of A. Dobrunova and K. Dobrunov (on the example of presentations of Donetsk Regional Russian Legitimate Drama, Mariupol)

Vivid vision and artistic decision as constituents of stage-director intention of A. Dobrunova and K. Dobrunov (on the example of presentations of Donetsk Regional Russian Legitimate Drama, Mariupol)

REVIVAL OF A LANGUAGE NATIONAL CONSCIOUSNESS OF THE UKRAINIANS OF DONETSK REGION UNDER CONDITIONS OF “PERESTROIKA” AND DURING THE FIRST YEARS OF INDEPENDENT UKRAINE

The aim of the research consists in elucidating the nature and main aspects of the development of a language identity and national consciousness of the Ukrainians of Donetsk region during the period of “perestroika” and the first years of independence of Ukraine, in the context of modern ethno-national problems. The research methodology is based primarily on the principle of historicism, concretized by the approach to historical phenomena and processes from the standpoint of dynamics, the study of the relationships between them and their interdependence. The use of this principle allows us to study the dynamics of the historical process from the point of view of its past and development trends in the future. A number of general historical methods have been used, namely: comparative-historical, historical comparative studies, retrospective. The latter, in particular, provides for the reconstruction of certain phenomena in the process of the revival of a cultural and national identity of the Ukrainians of Donetsk region in the context of perestroika and the first years of independent Ukraine. This allows us to construct separate models for the development of a national consciousness in our time, using, at the same time, some historical patterns and traditions. The scientific novelty consists in analyzing the process of the revival of a language identity and national consciousness of the Ukrainians of Donetsk region in the context of “perestroika” and the first years of independent Ukraine. This allows us to design individual models for the development of a cultural and national identity under modern conditions. The Conclusions. The process of reviving the cultural and national identity of the Ukrainians of Donetsk region in the context of “perestroika” and the first years of independent Ukraine became an interdependent phenomenon with the emergence in Donetsk region of a number of cultural national and socio-political organizations, primarily, Donetsk regional organization of Taras Shevchenko the Ukrainian Language Society. Despite the active process of Russification and denationalization, which has been carried out since the 1930-ies, the Ukrainian identity in Donetsk region still prevailed for some time. However, a targeted Russification policy aimed at destroying the language identity and national consciousness of the Ukrainian, naturally led to the confusion of all the peoples of the Soviet Union on the principles of the so-called internationalism into one, artificially formed, “homo sovieticus”. Thanks to public organizations and cultural national societies in Donetsk region at the end of the 1980-ies – beginning of the 1990-ies, the process of Ukrainization of the identity of the region population began. However, a number of factors prevented this. In particular, the predominantly individualistic orientation of ethnic self-expression of the Ukrainians of Donetsk region prevented the widespread development of their language identification and national identity. Also, as a result of a massive Russification and planting of chauvinistic stereotypes, the Ukrainians were deliberately turned into a second-class ethnic mass, the outcasts. The leaders of such a policy were mainly the former party-Komsomol functionaries, who, thanks to connections with criminals and oligarchic circles, reached leading positions in almost all authority structures during the 1990-ies. And, naturally, it was they, who stood at the origins of separatism long before the spring of 2014.

ПОРІВНЯЛЬНИЙ АНАЛІЗ ФУНКЦІОНАЛЬНОГО СТАНУ СЕНСОМОТОРНИХ СИСТЕМ КВАЛІФІКОВАНИХ МЕТАЛЬНИКІВ МОЛОТУ (ЗДОРОВИХ І З ВАДАМИ СЛУХУ)

Introduction. Adaptation of the athlete's organism with auditory deprivation to training and competitive activity is ensured by the active participation of the central nervous system, sensory systems, among which the important role is played by visual, vestibular, kinesthetic, tactile-vibration analyzers, which ensure the quality of movement. In this regard, studying the activity of sensorimotor systems of healthy athletes and hearing impaired will determine the ways of correction of the motor activity of the latter. The objective - study and comparative analysis of physiological features of sensorimotor systems of qualified hammer throwers (healthy and hearing impaired). Materials and methods. Research methods: analysis, generalization and systematization of data scientific and methodological literature; psychophysiological methods (simple visual-motor reaction; reaction to a moving object; tepping test; choice and discrimination reaction; critical part of light flickering; attention assessment); methods of mathematical statistics. Nine female athletes specializing in hammer throwing participated in the study: 7 of them are masters of sports of Ukraine, 2 - masters of sports of international class (5 female athletes have hearing impairments, 4 are healthy). The studies were conducted in October-November 2019 at the Donetsk Regional Children's and Youth Sports School for Persons with Disabilities (Mariupol). Results. The studies suggest that the thrower hammer with hearing problems (especially in persons with bilateral sensorineural deafness), in most cases there is a lack of speed of receiving and processing visual information, poor concentration and stability of attention, increasing the number of errors compared to almost healthy athletes. It should also be noted in hammer throwers with hearing impairment that there is an imbalance of nerve processes with a predominance of inhibition, their weakness and inertia. Conclusions. The data obtained confirm the need for the development of a training program, the basis of which is a deliberate impact on visual and vestibular analyzers in order to correct existing abnormalities and compensate for hearing impairment by further improving the functioning of the motor analyzer. Key words: sensorimotor systems, functional state, hammer throwers, hearing defects.

Маріупольський державний університет як центр трансформації міста Маріуполь

The article examines the process of transformation of Ukrainian universities into centers of community transformation in the conditions of decentralization on the example of Mariupol State University (MSU). The conditions in which MSU operates after 2014-2015 are considered. The defining directions of the university development that influence the development of the community are analyzed, in particular: the work of the educational center "Donbass-Ukraine" MSU, research, implementation of international research projects of the university, training of foreign students. The contribution of Mariupol City Council and Donetsk Regional State Administration to the development of MSU is analyzed. The article draws the following conclusions: firstly, modern Ukrainian universities in the context of decentralization are becoming centers of community transformation. Secondly, in 2014–2015, the universities of Donetsk and Luhansk oblasts found themselves in completely new conditions. Three universities have moved to Mariupol (8 in total today), competition between the institutions of higher education has increased enormously, as the number of graduates is about 2,000 each year, there is an outflow of students from MSU, including foreign ones, international contacts, trips and events have been limited. Thirdly, in an effort to ensure transparency of governance and attract financial resources for development from international institutions, the city develops and implements strategies for its development. Universities actively provide the necessary scientific and professional expertise in the preparation of such documents. The example of Mariupol also shows that universities are given an important part of the Strategy to increase the number of foreign students, increase the number of students to 10% of the population, develop the material and technical base of the institutions of higher education, and create conditions for the most talented graduates to stay in Mariupol. The implementation of these provisions ultimately provides additional revenues to the city budget, training of highly qualified specialists for the economy of the city and region, attracting the results of scientific research of university scientists for the needs of the city and region and more. The implementation of these provisions ultimately provides additional revenues to the city budget, training of highly qualified specialists for the economy of the city and region, attracting the results of scientific research of university scientists for the needs of the city and region and more. Fourthly, MSU, in its new environment, has transformed threats into opportunities by making community development and transformation one of its main tasks. These issues were included in the MSU Development Strategy until 2025. Fifthly, the defining areas of university development that affect the development of the community, including socio-economic, its transformation, contribute to the reintegration of the occupied territories is the work of the educational center "Donbass-Ukraine" MSU, research, scientific support of police power and local government, international university projects, training of foreign students. The university also serves as a base for important international, socio-political forums, conferences, etc., which help to attract attention to the city and the region, attract investment, international expertise and more. Sixthly, the university today performs many functions and offers many opportunities. In addition, one of the most valuable is the opportunity for dialogue with everyone. Moreover, this is what is needed to solve the problem of reintegration and development of the region. Seventhly, the Mariupol City Council and the Donetsk Regional State Administration, recognizing the role of the university in the socio-economic, socio-political development of the territories, the transformation of communities in every way contributes to the activities of MSU.

Дослідження безпосередніх та віддалених результатів комплексного лікування хворих з місцево-розповсюдженим раком молочної залози з використанням системної та ендолімфатичної поліхіміотерапії в неоад'ювантному режимі

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.

Комбинированное лечение больных немелкоклеточным раком легкого

Резюме. Комбинированное лечение немелкоклеточного рака легкого, сочетающее применение пред- и послеоперационной химиолучевой терапии и пластической резекции позволяет провести полноценное лечение больных и обеспечить сравнимые с пневмонэктомиями ближайшие и отдаленные результаты лечения пациентов.Цель. Оценить эффективность применения комбинированного лечения у больных немелкоклеточным раком легкого IA-IIIA стадий.Материалы и методы. Результаты метаанализов и рандомизированных исследований последних лет свидетельствуют о том, что послеоперационная лучевая терапия увеличивает общую и безрецидивную выживаемость при III стадии (Т1–3N2) НМРЛ. В то же время, химиолучевая терапия при комбинированном лечении снижает частоту местного рецидивирования и отдалённого метастазирования, увеличивая медиану выживаемости при III стадии операбельного НМРЛ. Это позволяет рекомендовать пред- и послеоперационную химиолучевую терапию для лечения НМРЛ III A стадии. При I–II стадиях (N0 и N1) эффективность до- и послеоперационного химиолучевого лечения пока не доказана и вопрос о целесообразности её проведения решается индивидуально, исходя из позиций клиники.С 2000 по 2016 год в ДОПЦ и РОЦ им. проф. Г. В. Бондаря МЗ ДНР по поводу немелкоклеточного рака легкого выполнено 112 ПРЛ и 218 ПЭ. При I стадии (T1а, b-T2aN0M0) выполнены 50 (45%) ПРЛ и 45 (21%) ПЭ, II стадии(T2а, b-N1M0, T3N0M0) — 31 (28%) ПРЛ и 74 (40%) ПЭ, III стадии(T1а, b-T2a, bN2M0, T3N1–2M0, T4N0–1M0) — 31 (28%) ПРЛ и 99 (45%) ПЭ. Плоскоклеточный рак выявлен у 91 (81,3%) больных в группе ПРЛ и 167 (77%) в группе ПЭ; аденокарцинома у 9 (8%) больных в группе ПРЛ и у 40 (18,3%) больных в группе ПЭ, недифференцированный рак у 12 (10,6%) больных в группе ПРЛ и у 11 (5%) больных в группе ПЭ. Пластическую верхнюю лобэктомию справа выполнили 52 (46%) больным, нижнюю лобэктомию — 10 (9%), верхнюю билобэктомию — 5 (4,5%), нижнюю билобэктомию — 5 (4,5%), среднюю лобэктомию — 2 (1,8%). Верхние лобэктомии слева выполнены 30 (27%) больным, нижние лобэктомии — 8 (7%) больным. 10 (9%) пациентам выполнены комбинированные ангиобронхопластические операции. Всего справа выполнено 74 (66%) ПРЛ и слева 38 (34%), соответственно. Клиновидных резекций 68 (61%), циркулярных резекций 44 (39%). Справа ПЭ было выполнено 74 (34%), слева 144 (66%). Комбинированные ПРЛ выполнены 6 (5,3%) больным, в группе ПЭ 18 (8,3%) больным. По полу и возрасту группы идентичны и сравнимы: средний возраст составил в группе БПРЛ 58,9±7,5, в группе ПЭ — 58,2±7,8. Мужчин в группе БПРЛ — 106 (94,6%), в группе ПЭ — 203 (93,1%). Женщин в группе БПРЛ — 6 (5,4%), в группе ПЭ — 15 (6,9%).Результаты и обсуждение. После ПРЛ умерли 2 (1,8%) больных: в первом случае вследствие эмпиемы плевры в результате альвеолярной фистулы; во втором случае от инфаркта миокарда. Послеоперационные осложнения развились после ПРЛ у 35 (31%) больных, практически все они купированы консервативно, только в одном случае выполнена реторакотомия по поводу внутриплеврального кровотечения. Как показали результаты наших исследований, при комбинированном лечении, вынужденный отступ менее 7,0 мм. от видимого края опухоли не обязательно предопределяет развитие рецидива опухоли. В 8 (7%) после операции гистологически выявлены опухолевые клетки по линии пересечения бронха (R1) — эти больные обязательно получили адъювантную химиолучевую терапию. Частота (R1) в группе ПЭ составила 3 (1,3%). Рецидив в зоне межбронхиального анастомоза был выявлен через 6 и 8 месяцев у 2 больных, после первичных R0-операций. Эти больные повторно оперированы, им выполнены пневмонэктомии (ПЭ). Один из больных умер на 7 сутки после операции от острого инфаркта миокарда, второй перенес эмпиему плевры и прожил 97 месяцев, после чего выпал из-под нашего наблюдения.У 2 (1,5%) больных, после операции, была установлена недостаточность швов межбронхиального анастомоза, в обоих случаях завершившаяся заживлением, и больные вскоре выписаны с выздоровлением.Максимальная смертность после комбинированной терапии с резекцией легкого и пневмонэктомии отмечалась в первые 20 месяцев, затем показатели выравнивались, всегда оставаясь выше после ПРЛ как компонента комбинированной терапии. Необходимо заметить, что достоверно более высокие результаты выживаемости отмечены только при I стадии опухолевого процесса (T1а, b-T2aN0M0), при II стадии (T2а, b-N1M0, T3N0M0) достоверно более высокие результаты выживаемости относятся лишь к 5-летней выживаемости, при более распространенном опухолевом процессе IIIA стадии (T1а, b-T2a, bN2M0, T3N1–2M0, T4N0–1M0) выживаемость отличались в пользу больных после ПЭ, но имеющаяся разница математически недостоверна.Выводы и практические рекомендации. Рак легкого остается нерешенной медицинской проблемой, операбельными оказываются 15–20% из всех первично выявленных больных. За 40 лет, несмотря на постоянный поиск методов хирургического и комбинированного лечения, определение способов скрининга, ситуация с эффективностью диагностики, лечения и профилактики возникновения рака легкого практически не изменились.Пред- и послеоперационная химиолучевая терапия, в качестве компонентов комбинированной терапии, позволяют выполнять органосохраняющие резекции легких в тех случаях, когда ПЭ не показана в связи с высоким риском развития осложнений в послеоперационном периоде. При этом, как отмечают многие авторы, непосредственные и отдаленные результаты и «качество жизни» пациентов не ухудшаются.Комбинированная химиолучевая терапия в сочетании с радикальными ПРЛ при раке легкого могут быть методом выбора в программе комбинированной терапии больных I — IIIА стадий заболевания.Показания к назначению пред- и послеоперационной химиолучевой терапии в этой группе больных должны определяться коллегиально на основании оценки дополнительных факторов прогноза, в том числе: N+, небольшой отступ от линии резекции бронха до края опухоли, низкая дифференцировка опухоли и т. д.

Comparative characteristics of quality of life in patients, suffering locally-spread mammary gland cancer after conduction of regional and intravenous chemotherapy

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.

ЕКОНОМІЧНІ ПЕРЕДУМОВИ ОНОВЛЕННЯ ТА РЕАЛІЗАЦІЇ СТРАТЕГІЇ РОЗВИТКУ ДОНЕЦЬКОЇ ОБЛАСТІ НА ПЕРІОД ДО 2020 року

The article defines the economic preconditions of updating and implementing of the Donetsk region strategy development for the period till 2020. Provided a brief characterization of the region, the tendencies of socio-economic development of the region, identified the current problems, defined the mechanism of strategic goals and milestones realization, and defined the indicators (prognostic indicators) to monitor and evaluate the effectiveness of regional strategy imple mentation. REFERENCES1. The Verkhovna Rada of Ukraine (2005), The Law of Ukraine: On stimulation of development of regions, Ofitsijnyj visnyk Ukrainy, vol. 40, p. 25.2. Cabinet of Ministers of Ukraine (2014), Resolution of the Cabinet of Ministers of Ukraine: On assertion of State strategy of regional development on a period to 2020 year, Uriadovyj kur’ier, vol. 160, p. 7.3. Cabinet of Ministers of Ukraine (2015), Resolution of the Cabinet of Ministers of Ukraine: An order of development of regional strategies of development and plans of measures is on their realization, and also leadthrough of monitoring and estimation of effectiveness of realization of the noted regional strategies and plans of measures, Ofitsijnyj visnyk Ukrainy, vol. 92., p. 111.4. The Verkhovna Rada of Ukraine (2015), The Law of Ukraine: On principles of public regional policy, Vidomosti Verkhovnoi Rady Ukrainy, vol. 13, p. 721.5. Cabinet of Ministers of Ukraine (2015), Resolution of the Cabinet of Ministers of Ukraine: On assertion ofOrder and Method of leadthrough of monitoring and estimation of effectiveness of realization of public regional policy, Uriadovyj kur’ier, vol. 210., p. 8.6. Cabinet of Ministers of Ukraine (2015), Resolution of the Cabinet of Ministers of Ukraine: Some questions of realization in 2015-2017 years of State strategy of regional development on a period to 2020 year, Uriadovyj kur’ier, vol. 196, p. 7.7. The official site of Donetsk Regional State Administration (2016), available at: http://ovu.com.ua/articles/486-derzhavniy-komitetstatistiki-ukrayini/publisher (Accessed 28 April 2016).8. Cabinet of Ministers of Ukraine (2015), Order of the Cabinet of Ministers of Ukraine: On assertion of perspective plan of forming of territories of societies of the Donetsk area, available at: http://zakon4.rada.gov.ua/laws/show/1029-2015-%D1%80 (Accessed 28 April 2016).9. Holovne upravlinnia statystyky u Donets’kij oblasti (2016), available at: http://www.donetskstat.gov.ua/statinform1/index.php (Accessed 28 April 2016).10. The official site of Donetsk Regional State Administration (2016), The Donetsk oblast Regional Development Strategy — 2020, available at: http://donoda.gov.ua/?lang=ua&sec=03.04&iface=Public&cmd=view&args=id:22709 (Accessed 28 April 2016).11. Cabinet of Ministers of Ukraine (2014), Resolution of the Cabinet of Ministers of Ukraine: On approval of Prognosis of economic and social development of Ukraine on 2016 and basic macroindexes of economic and social development of Ukraine on 2017-2019, Uriadovyj kur’ier, vol. 146, p. 7.

THE METHOD OF TREATMENT OF PATIENTS WITH LOCALLY-ADVANCED BREAST CANCER

A method of care of patients with locally-advanced breast cancer consisting of using regional selective intraarterial chemotherapy in the schedule of the complex (palliative) treatment is presented. Results of treatment showed an advantage in comparison with the application of traditional methods of the breast cancer treatment. The methodology on intra-arterial introduction of chemotherapeutic agents developed at Donetsk Regional Antitumoral Center and University clinic of Odessa showed its undisputable contribution into development of modern oncology through decrease of primary tumoral locus, transition from inoperable state into the state at which it is possible to perform the radical volume of surgical interference to patient. The special attention is paid to development of new methods of treating BC patients (regional forms of disease) with unfavorable factors for forecast of tumor growth.

Preparing for Euro 2012: developing a hazard risk assessment.

Risk assessment is a vital step in the disaster-preparedness continuum as it is the foundation of subsequent phases, including mitigation, response, and recovery. To develop a risk assessment tool geared specifically towards the Union of European Football Associations (UEFA) Euro 2012. In partnership with the Donetsk National Medical University, Donetsk Research and Development Institute of Traumatology and Orthopedics, Donetsk Regional Public Health Administration, and the Ministry of Emergency of Ukraine, a table-based tool was created, which, based on historical evidence, identifies relevant potential threats, evaluates their impacts and likelihoods on graded scales based on previous available data, identifies potential mitigating shortcomings, and recommends further mitigation measures. This risk assessment tool has been applied in the vulnerability-assessment-phase of the UEFA Euro 2012. Twenty-three sub-types of potential hazards were identified and analyzed. Ten specific hazards were recognized as likely to very likely to occur, including natural disasters, bombing and blast events, road traffic collisions, and disorderly conduct. Preventative measures, such as increased stadium security and zero tolerance for impaired driving, were recommended. Mitigating factors were suggested, including clear, incident-specific preparedness plans and enhanced inter-agency communication. This hazard risk assessment tool is a simple aid in vulnerability assessment, essential for disaster preparedness and response, and may be applied broadly to future international events.

Exstrophy of bladder: verdict or the realities of life in patient of reproductive age?

Exstrophy of bladder is a rare congenital malformation of the bladder with the lack of its front wall and, consequently, the anterior abdominal wall, which is often accompanied by epispadias, inguinal hernia, prolapse of the rectum, anomalies of the upper urinary tract. Its exstrophy of bladder frequency ranges on average from 1:10 000 to 1:50 000 newborns, in boys 3-6 times more often than girls. Without surgical treatment half of children with this disorder do not live to the age of 10, and 75% die in age 15.This article describes a clinical case of a patient M., 18 years old, who was admitted to the gynecological department number 1 of the Donetsk Regional center for maternal and child health for forming of vagina. The patient had a congenital malformation of the genitourinary system in the form of bladder exstrophy, at age 2 and 5 she had reconstructing operations to form the front abdominal wall of local fabrics, made at age 7 reconstruction of bladder neck has not led to a controlled urinate. Internal genital organs with no pathology except atresia of the vagina. After careful examination, using modern laboratory, instrumental and apparatus research methods patient M. was performed laparotomy in a volume: old postoperative scar excision; formation of rectal bladder, ureterorectostomia and bringing down the sigmoid colon by Duhamel; vaginoplasty.Surveillance for 75 days after the operation showed the following results: control urination and defecation, lack of urine leakage from the anterior abdominal wall and the presence of formed vagina, improving the quality of life and patient’s reproductive plans.This considered a clinical case illustrates the high efficiency of treatment of bladder exstrophy with individual methodological approach to the selection of an adequate surgical tactics.

Актуальные вопросы острых кишечных инфекций в последние годы

Цель: изучение клинико-эпидемиологических особенностей острых кишечных инфекций у детей Донецкой области.Материал и методы. Работа выполнена на академической базе детских инфекционных отделений Донецкой области и Донецкого областного лабораторного центра Госсанэпидслужбы Украины. Сравнительный анализ этиологически установленных острых кишечных инфекций у детей проведен за период 1996–2012 гг.

Volodymyr Garriyovych Klimovitsky

The article deals with the 60th birthday of V.G. Klimovitsky: Doctor of Medical Science, Professor, winner of the State Prize of Ukraine in Science and Engineering, Honoured Doctor of Ukraine, Director of the Research Institute of Traumatology and Orthopaedics, Head of the Department of Traumatology, Orthopaedics and Surgery in Extreme Situations of Donetsk National Medical University of Maxim Gorky, Chief Physician of the Donetsk Regional Traumatological Hospital.

P-158 - Anxiety disorders of patients suffering from different cancer localization

A problem of anxiety disorders in patients, who suffer from malignant neoplasms is one of the priorities in psycho-oncology. A research purpose is detection of the anxiety disorders in the patients with different cancer localization. Methods used The research was conducted on the base of Donetsk Regional Antitumoral Center. For a screening of the anxiety disorders in 450 patients with cancer we used the Hospital Anxiety and Depression Scale, in the positive case we applied the Hamilton Anxiety Scale and the structured clinical interview with diagnostic criteria of ICD-10. Results The anxiety were revealed in 141 (31,3 ± 2,19%) patients with malignant neoplasms. The anxiety disorders were presented mainly as a reaction to severe stress and adjustment disorders (F43) as the mixed anxiety and depressive reactions (F 43.22) and the reactions with predominant disturbance of other emotions such as anxiety, worry, tensions and anger (F 43.23) and the somatogenic anxiety disorders (F 06.4). Clinically the most typical for the cancer patients are almost constant feeling worried and impossibility to relax, irritability and insomnia. The oncologic patients experience fear of pain, disfigurement, disability and they suffer from obsessive representations about character of the disease and consequences of antitumor treatment, fear of possible intraoperative death and development of the remote complications, uncertainty in restoration of the functions of their organism broken by operative intervention. Conclusions High frequency of anxiety disorders in the patients suffering from different cancer localization determines actuality of organization of renderings specialized help in cancer care departments.