National Academy Of Medical Sciences Research Articles

Ultrasound-guided accesses for regenerative injection therapy of hip and knee

Interventional diagnostic and therapeutic technologies have gained considerable popularity in many surgical specialties – cardiology, vascular surgery, neurosurgery, oncology, and in orthopedics and traumatology. But unlike other specialties, ultrasound became the driving force behind the development and implementation of interventional technologies in the treatment of diseases of the musculoskeletal system. In recent years, ultrasound-guided injections have gained significant popularity, as they have given an advantage in accuracy compared to injections without such navigation. The purpose of our study was the development of ultrasound navigation accesses to the hip and knee joints for the interventional application of regenerative technologies in their pathology. The material for the study was the results of ultrasound examination of the hip and knee joints of 486 patients with diseases and injuries of the hip and knee, who were treated in the scientific and practical department of tissue and cell therapy of the State Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine in the period from 2016 to 2023. The results. The following accesses to the knee joint under ultrasound navigation have been developed: suprapatellar longitudinal access for injections into the quadriceps tendon and patellofemoral joint, suprapatellar longitudinal access with knee bending for injections into the upper turn of the knee joint, infrapatellar longitudinal access for injections into the patellar ligament and deep infrapatellar bursa, infrapatellar transverse access for injections into Hoffa’s fat pad, lateral longitudinal access with knee bending for injections into the lateral meniscus, medial longitudinal access with bending in the knee for injections in the medial meniscus, medial transverse access for injections in the medial part of the joint space, lateral transverse access with bending in the knee joint for injections in the lateral part of the joint space, lateral longitudinal access for performing injections in the collateral fibular ligament, medial longitudinal access for performing injections in the collateral tibial ligament, infrapatellar diagonal access for performing injections in the “crow’s foot” area of the knee joint, infrapatellar medial longitudinal access for performing other injection into the medial meniscus and joint capsule, lateral longitudinal access for injections into the tendons of the biceps femoris and hamstrings. The following accesses have been developed for the hip joint: anterior longitudinal access for performing injections in the subcapsular-cervical space, anterior diagonal access for performing injections in the acetabular labrum, capsule-ligament apparatus of the hip and tendon of the rectus femoris muscle, lateral longitudinal access for performing injections in the paratrochanteric region. Conclusions. 13 ultrasonic navigation accesses have been developed for the administration of biotechnological products into the knee joint and 3 – into the hip join, which allow not only to detect damaged intra-articular and para-articular structures of the knee and hip joints, but also to deliver an orthobiologics products directly to them for maximum regenerative effect.

Etiopathogenetic factors of infective endocarditis in patients undergoing mitral valve surgery

Objective. To determine the etiopathogenetic risk factors for the development of infective endocarditis, taking into account demographic and gender characteristics in patients undergoing mitral valve surgery. Materials and methods. The study included 107 patients who underwent mitral valve surgery. There were 74 men and 33 women. The age of the patients ranged from 20 to 76 years, with a mean age of (50.6 ± 4.8) years. All patients had a history of infective endocarditis with subsequent mitral valve disease. All patients underwent mitral valve repair/prosthetics at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Data from the primary medical records (medical histories, primary medical records, physical, clinical, laboratory and instrumental examinations) were used as the basis for the analysis. Results. Depending on the surgical treatment performed, patients were divided into two groups: experimental – 67 patients who underwent organ–preserving surgery (mitral valve repair), and control – 40 patients who underwent mitral valve prosthetics. The peculiarities of age and gender distribution of patients with mitral valve disease in the setting of infective endocarditis were studied. The frequency of etiopathogenetic risk factors for the development of infective endocarditis, taking into account the sex of patients in both study groups, was determined. Conclusions. Determination of etiopathogenetic risk factors for the development of infective endocarditis is extremely important, as it allows to plan surgical treatment and rehabilitation period taking into account all anamnestic features of the patient.

The role of endoscopic ultrasound in assessment of physiological cardia insufficiency during diagnosis of hiatal hernia

Background. The aim of the study: to determine the role of endoscopic ultrasound (EUS) in assessing the failure of the physiological cardia in the diagnosis of hiatal hernias (HH). Materials and methods. At the Department of Digestive Surgery of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” in 2023, we have performed surgical treatment of 33 patients with HH: axial HH were diagnosed in 21 (63.6 %) cases (I type), paraesophageal HH — in 12 (36.4 %) patients (II type) (ICD-10 code is K44). Control group included 20 practically healthy people. Results. All patients underwent an X-ray and endoscopic examination of the esophagus, stomach, duodenum, and EUS. All 33 (100.0 %) patients underwent an X-ray to confirm the diagnosis and an endoscopic examination to detect changes in the esophageal mucosa. EUS was performed in 31 (93.9 %) patients. The thickness of the esophageal wall was assessed using EUS, which made it possible to determine the state of the structures of the phy­siological cardia in HH: the displacement of part of the stomach above the diaphragm, location of the gastroesophageal junction relative to the legs of the diaphragm and relative to each other; the distance between the legs of the diaphragm (area of the HH) and their length; the cross-sectional area of the HH (hernial sac). The data obtained during EUS influenced the choice of the method for surgical correction of the physiological cardia with HH. Conclusions. Thus, with HH, EUS makes it possible to evaluate pathological changes of the main structures in the failure of the physiological cardia, to improve diagnosis for the types of HH, the location of the gastroesophageal junction, with determination of dimensions of the esophageal hiatus, the distance between the legs of the physiological cardia, localization and cross-section of the hernial sac, which influenced the choice of the surgery for physiological cardia in HH.

Surgical Service Utilization and In-Patient Satisfaction in Surgical Service.

The patient satisfaction study is an important and commonly used valid indicator for service quality improvement in healthcare institutions. The aim of this study was to assess the service utilization and patient satisfaction in patients admitted under surgical service in Bir Hospital. A prospective cross sectional analytical study was conducted in Bir Hospital, National Academy of Medical Sciences from February 2021 till June 2023. The patient satisfaction data was collected using the SAPS scale after obtaining ethical clearance from the Institutional Review Board. Data were entered and analyzed in Statistical Package for the Social Sciences version 20.0. There were 152 patients included in the study categorized into conservative treatment group, elective surgery group and emergency surgery group. 32.9%(50) patients were "very satisfied", 62.5%(95) patients were "satisfied", 2.6%(4) were "neither satisfied nor dissatisfied" and 2%(3) were "dissatisfied" with the effect of their treatment/care. The mean satisfaction score in conservative treatment group was 22.13 ±2.53 as compared to the mean satisfaction in elective surgery group which was 21.11± 2.55 (P=0.036) and the mean satisfaction score in emergency surgery group which was 21.66 ±2.68 (P=0.64). The mean score and proportion of patient satisfaction regarding service utilization in patients admitted under surgical service were high with satisfaction score higher in emergency surgery group among the operative groups in Bir Hospital, National Academy of Medical Sciences.

Clinic and treatment of intramedullary ependymomas

Objective — to improve the results of treatment of patients with intramedullary ependymomas. Materials and methods. The results of treatment of 29 patients (14 men and 15 women aged 18 to 64 years) with intramedullary ependymomas operated on at the Romodanov Institute of Neurosurgery of the National Academy of Medical Sciences of Ukraine were analysed. All patients who were scheduled for surgery underwent magnetic resonance imaging (MRI) with paramagnetic contrast agent. The preoperative and postoperative neurological status was assessed using the modified McCormick scale. Results. Microsurgical technique for removal of spinal cord tumors was used in all 29 observations. According to the volume of tumor removal, operations with total (12 observations), subtotal (9 observations) and partial (8 observations) removal were distinguished. Removal of at least 95 % of the tumor volume, which was confirmed by visualization with a microscope during surgery and early postoperative MRI, was considered total. At the time of discharge from the hospital, in 11 patients (37.9 %) the neurological condition improved compared to the preoperative period, in 13 (44.8 %) it remained unchanged, and in 5 (17.2 %) there was an increase in neurological symptoms. 12 patients were examined 12—36 months after the operation. Improvement compared to the preoperative period was found in 10 patients, and no changes in 2. There were no cases of worsening of neurological symptoms during this period. MRI performed before discharge from the hospital showed almost normal spinal cord diameter in the area of surgical procedures, and MRI performed ≥ 3 months after total tumour removal showed atrophic changes in the spinal cord with ependymoma localisation at the thoracic level. Conclusions. Intramedullary ependymomas can be totally removed, and surgical intervention must be carried out immediately after the diagnosis before the appearance of signs of increasing neurological deficit. Thanks to the use of microsurgical techniques and an intraoperative microscope, it is possible to achieve positive functional results during the total removal of intramedullary tumors.

Urgent Cardiosurgical Treatment of a Military Servant with a Moving Thrombus in the Area of the Left Ventricular Apical Aneurysm (Case Report)

Against the background of military operations, post-traumatic stress disorder, the progression of the atherosclerotic process is observed, which can lead to myocardial infarction even in young people. Left ventricular aneurysm (LVA) in military personnel is the result of untimely revascularization of an infarct-related artery, gunshot wound to the heart, chest trauma, etc. The presence of a dyskinetic area promotes formation of blood clots in the LVA cavity. LVA thrombosis is associated with an increased risk of embolism, ischemic stroke, and death.
 Case description. A 37-year-old military servant A. was urgently hospitalized to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a mobile thrombus in the area of LVA, size 4.5 x 3 cm, with signs of lysis and a threat of separation according to echo data. The patient was found to suffer Q-wave myocardial infarction 5 months ago; at the time of examination there was decompensation of the condition and a decrease in the left ventricular contractility to 34%. The patient underwent urgent operation: on-pump coronary artery bypass grafting, LVA resection with thrombectomy. The duration of the operation was 7 hours, the aortic cross-clamp time was 53 minutes, the perfusion time was 93 minutes, the blood loss was 500 ml. The postoperative period was uneventful. The patient was discharged on the 7th day with improvement, the ejection fraction was 40%.
 Conclusion. The lack of an opportunity to conduct timely electrocardiography and echo for military personnel with acute chest pain reduces the chances of diagnosis and treatment of myocardial infarction within the therapeutic window, which leads to the occurrence of complicated forms of coronary heart disease, namely LVA. Echo is of crucial importance in deciding on emergency cardiac surgery for thrombosed LVA.

Immediate results of biliodigestive reconstruction in patients with peripheral cholangiocarcinoma with invasion of visceral veins

Objective. To evaluate the immediate results of biliodigestive reconstruction in patients with peripheral cholangiocarcinoma with invasion of the visceral veins.
 Materials and methods. From 2004 to 2018, 28 patients with peripheral cholangiocarcinoma with invasion of the visceral veins were radically operated at the Department of Liver Transplantation and Surgery of the Shalimov National Institute of Surgery and Transplantation of the National Academy of Medical Sciences of Ukraine (now the Shalimov National Scientific Centre of Surgery and Transplantation of the National Academy of Medical Sciences of Ukraine). The main group consisted of 8 (28.6%) patients who underwent biliodigestive reconstruction simultaneously with resection and reconstruction of visceral veins, the control group consisted of 20 (71.4%) patients who underwent resection and reconstruction of visceral veins, and biliodigestive reconstruction was not performed.
 Results. Postoperative clinically significant (grade IIIa­IV according to the Clavien­Dindo classification) complications during the 90­day postoperative period were noted in 12.5% of patients in the main group and 25% of patients in the control group (p=0.002), postoperative liver failure according to the criteria of the International Study Group on Liver Surgery ­ in 25 and 30%, respectively (p=0.415). Repeat surgery was performed in 12.5 and 10% of patients, respectively (p=0.923). There was no postoperative mortality in both study groups.
 Conclusions. The immediate results of biliodigestive reconstruction in patients with peripheral cholangiocarcinoma with invasion of the visceral veins are satisfactory.

The structure of clinical and psychopathological consequences of coronavirus disease COVID-19 in people with a history of mental disorders

The impact of the COVID-19 pandemic on mental health indicates the need to define psychopathological manifestations to highlight diagnostic criteria. The purpose of the study is to determine the structural features of clinical and psychopathological manifestations of mental disorders after the coronavirus disease COVID-19 in people with a history of mental disorders. In the Department of Border Psychiatry of the State Institution “Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine", 95 patients with a history of mental disorders who had suffered the coronavirus disease COVID-19 were examined. The group examined included patients with recurrent depressive disorders (F32), with mental disorders of organic origin (F06.3, F06.4) and with neurotic, stress-related and somatoform disorders (F41.1, F42.3), F48.0). It was determined that the clinical manifestations of mental disorders in the examined patients are characterized by a predominance of affective symptoms in combination with pronounced specific cognitive, ideational, and somato-vegetative disorders, as well as disorders of the effector-volitional sphere. The results of a psychodiagnostics study (on the MADRS, HARS, GAD-7 and CGI-S scales) showed that the structure of clinical manifestations in these patients was characterized by a predominance of affective disorders of the anxiety-depressive spectrum of varying severity, which had certain differences among nosological groups. Determining the clinical and psychopathological features of the structure of mental disorders after suffering from COVID-19 is important not only for their diagnosis, but also for early and adequate therapy, taking into account the identified features that can act as targets for therapeutic intervention. Key words: clinical-psychopathological consequences, mental disorders, coronavirus disease COVID-19

Cystic meningioma of the brain

ABSTRACTMeningiomas with a cystic component are quite rare and account for 1.7–7.3 % of all intracranial meningiomas. The incidence of cystic meningioma in adults is 2–4 % of all meningiomas. Women have a higher incidence rate in comparison to men. Between 2014 and 2019, at the State Institution Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine, we collected data for a database of cystic meningioma cases. The data included preoperative imaging, surgery notes, and pathology reports. Over the course of 6 years, 1408 meningioma cases have been observed, and 1326 of those instances have undergone surgical treatment for intracranial meningioma. 73 (5.5 %) cases of cyst-associated meningiomas have been analyzed: 26 (2.0 %) of true cysts (primary), 47 (3.5 %) cases of pseudocysts (secondary). Nauta type IV was the most common cyst type accounting for 52.1 %, whereas atypical (27.4 %) and anaplastic (17.8 %) meningioma types were the most common histological subtypes. All patients were monitored for 24 months; only 73 patients had access to long-term monitoring, which lasted for an average of 49 months (range 36–96 months). The majority of atypical (2.7 %) and anaplastic (5.5 %) types of pseudocystic meningioma relapsed after radical tumor surgery removal. The preoperative diagnosis needs to be integrated with the examination performance, the surgical treatment is selected based on the Nauta classification, and most of the surgical operations can result in the complete resection of the tumor.

Outcome of Monopolar versus Bipolar Transurethral Resection of Prostate

Introduction: Transurethral resection of the prostate is the gold standard surgical treatment for benign prostatic hyperplasia with the lower urinary tract symptoms. Bipolar system is a new in technology to lower the adverse effects of monopolar system. This study was designed to find out clinic-demographic data and peri-operative outcomes of the monopolar versus bipolar transurethral resection of prostate. Methods: This prospective comparative study was conducted from June 2022 to March 2023, in the Department of Urology of Bir Hospital, National Academy of Medical Sciences, Nepal. Ethical approval of research was taken from Institutional Review Board, NAMS: Ref No. 735/2079/80. Microsoft Excel was used for descriptive analysis for clinic-demographic and outcome variable data, were presented in frequencies and percentages and their relation were analyzed by chi-square test/fisher’s exact test. A p-value of <0.05 statistically significant. Result: A total 80 patients were compared, bipolar(40 cases) and monopolar(40 cases). There were no differences in the incidence of hyponatremia, clot retention and evacuation rate, re-catheterization rate, mean hemoglobin loss, and mean length of hospital stay. The longer duration of operation time (>60 min) was observed in bipolar transurethral resection ( p=0.001). The transurethral resection syndrome was found only in M-TURP. Conclusion: Both monopolar and bipolar transurethral resection of prostate showed no statistical differences in the amount of resected prostatic tissue, the incidence of hyponatremia, length of hospital stays, blood transfusion rate, re-catheterization rate, clot retention and evacuation rate. The shorter duration of surgery and the trans-urethral resection syndrome was observed in M-TURP.

Long term studying of uranium and radium-226 activity in drinking water in some regions of Ukraine and assessment of corresponding hypotetical irradiation doses

The article summarizes the activity concentrations data of 226Ra and the sum of uranium isotopes (∑U) in samples of drinking underground water for different regions of Ukraine studied during 1998–2023 in the radiation monitoring laboratory of the State Institution "O.M. Marzieiev Institute of Public Health National Academy of Medical Sciences of Ukraine. Arithmetic mean and standard deviations, minimum and maximum values for 226Ra and ∑U activity concentrations are presented for the entire 1240 sample set and for each region separately. Collected data show that the established state permissible level for drinking water of 1.0 Bq/l is exceeded for 226Ra in 1.1% of the studied samples, and for ∑U—in 3.9% correspondingly. The detected high levels of 226Ra and ∑U activity concentrations correspond to certain regions belonging to the Ukrainian crystalline shield territory. A comparison of the current data with the data of previous studies held during of 1989–1991 indicates a significant difference: for the previous studies the average and standard deviations are much higher. We attribute this to the fact that the centralized sampling of previous studies was random, and it was related exclusively to communal water supply systems. At the same time, the current sample set covers a much larger number of regions, different water consumers; the data set includes the results of repeated studies for a large number of sources, in particular, sources with purified water. Hypothetical exposure doses caused by consumption of 226Ra and ∑U in water for the current sample set were estimated for different age groups for each sample studied, as is, without taking into account the pattern of water consumption. The corresponding dose exceeds the WHO recommended value of 0.1 mSv per year for children under the age of one year for 220 cases (17.7%). This dose limit excess for other age groups corresponds—for children: aged 12–17 years—13.1%, aged 1–2 years—7.4%, 7–12 years old—5.6%, 2–7 years old—3.9% and for adults—4.1%.

Mіжнародний конгрес Європейського респіраторного товариства 2023: Презентація українських здобутків

Abstract. From September 9 to 13, 2023, the hybrid Congress of the European Respiratory Society (ERS) was held in Milan (Italy) for the second time. In 2023, more than 20.000 people attended the Congress, participating both in person and online. The aim: to analyze abstracts of scientific works on pulmonology and phthysiology that were presented by Ukrainian scientists at the ERS International Congress 2023. Materials and methods. The data regarding the abstracts of scientific reports were obtained from the Congress website and the online program of the personal account of an ERS member, doctor of medical sciences, professor Galyna Gumeniuk. Results. Scientists from Ukraine presented 52 scientific reports at the Congress: 45 on pulmonology and 7 on phthisiology, which is 1.28 % (52 out of 4 067) of all posters submitted to this forum. The largest number of Ukrainian papers — 15 — was devoted to the problems of COVID-19, 14 to the issues of chronic obstructive pulmonary disease, 3 to the issues of bronchial asthma, 3 to tobacco smoking and two related to bronchiectasis. In 2023, both international cooperation and interaction of Ukrainian pulmonologists of various institutions in joint work within the countries continued. Conclusions. The main directions of scientific developments in respiratory medicine in Ukraine are issues of broncho-obstructive pulmonary diseases and COVID-19. The most active participation in the event were taken by the scientists from the Dnipro State Medical University, Yanovsky National institute of phthisiology and pulmonology National Academy of Medical Sciences of Ukraine, Vinnytsya National Pirogov Memorial Medical University, and Ivano-Frankivsk National Medical University.

Effect of Increasing Occlusal Vertical Dimension on Smile Parameters

Introduction: Increasing Occlusal Vertical Dimension (OVD) becomes important aspect of complex prosthodontic treatment for maintaining balance between form of oral structures and function of stomatognathic system. The purpose of this study is to determine the effect of increasing OVD on various smile parameters during posed smile. Methodology: This observational descriptive study included 30 patients, 14 male and 16 females, visiting dental department of National Academy of Medical Sciences (NAMS), Bir Hospital. Four polyvinyl siloxane bite records were fabricated on stone cast mounted on a semi-adjustable articulator increasing OVD by +1 mm, +2 mm, +3 mm and +4 mm taking incisal pin as a reference. Photographs of posed smile were taken at OVD of +0 mm, +1 mm, +2 mm, +3 mm and +4 mm using a DSLR camera mounted on a tripod. Head position was stabilized using a head positioning device of a cephalometric unit during photography. Adobe photoshop CS6 extended was used to calculate the various measurement in pixel which was converted into mm with help of conversion ratio obtained. Data were then processed and analyzed using SPSS software at the 5 % significance level. Result: One-way repeated measures ANOVA found statistically significant differences in interlabial gap height, incisal edge to lower lip distance, smile index and display zone area with increasing OVD. No statistically significant differences were found for intercommisural width and incisal edge to upper lip distance. Conclusion: Within the limitations of this study, the excessive increase of OVD may lead to excessive interlabial gap height, incisal edge to lower lip distance, and display zone area. Also, the increase of OVD may lead to reduced smile index. No change may be expected in the position of the upper lip with increase of OVD. In addition, a change in the intercommisural width of the smile should not be expected with increasing OVD.

Functional outcome after transperitoneal laparoscopic pyeloplasty at a tertiary care center, Nepal

Introduction: Pyeloplasty is the gold standard surgical treatment for Pelvic-Ureteric Junction Obstruction (PUJO). Laparoscopic pyeloplasty has gained popularity in recent years because it is less invasive, has better cosmesis, and reduces hospital stays with an equivalent success rate compared to open pyeloplasty. This study was designed to find out the success rate of laparoscopic transperitoneal pyeloplasty in cases with unilateral PUJO. Method: This was a retrospective study, which included four years of data on patients who underwent laparoscopic pyeloplasty from 1 Jan 2019 to 31 Dec 2022 in the Department of Urology, Bir Hospital, National Academy of Medical Sciences, Nepal. Ethical approval was obtained. Microsoft Excel was used for descriptive analysis, frequency, and percentage of clinical and demographic data for age, gender, and site. Pre- and post-operative data of differential renal function (DRF) based on the radio-isotope renography and their association were compared using the χ2 test. A p-value of <0.05 was considered statistically significant. Result: Out of 25 cases, renal function improvement was observed in 18(72%), stable in 6(24%), and deteriorated in 1(4%) cases based on DRF analysis. Male to female ratio was 13:12, the mean age was 26 y (8-60 y), and the left side was 14(60%). A mean improvement of DRF of 3.1% was observed in the age group of >30 y, and a mean improvement of DRF of 4.3% was also observed in the cases with DRF ≤30%. Conclusion: The laparoscopic pyeloplasty showed excellent functional outcomes in the majority of the cases with PUJO.

Giant retroperitoneal liposarcoma with spread to the upper third of the left thigh

Background. Large tumors, such as giant liposarcoma, are a challenge for modern medicine because of difficulty of treatment and possible impact on functions of the adjacent tissues and organs. The review of this clinical case may help develop new strategies and approaches to treatment of similar pathologies. Purpose. Review of the clinical case has a goal to educate medical specialists and students by helping to expand their understanding of rare oncologic diseases and to prove high effectiveness of surgery in locally advanced types of retroperitoneal liposarcomas using the clinical case as an example. Materials and methods. Female patient C., 56 years old, sought for medical help in the clinical unit of State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine» in June 2021. The following diagnosis was established: retroperitoneal liposarcoma with spread to the left thigh, St. II–ІІІ сТ3N0M0. An en-bloc surgery (removal of the retroperitoneal tumor with mobilization of the left ureter, intraabdominal removal of the thigh part of the tumor of the left thigh from beneath the inguinal ligament) was performed after the standard preoperative preparation. The surgery went without complications. The wound healed primarily. The follow-up period of the patient was 16 months. Clinical laboratory examination did not show any local recurrences and distant metastases. Results. For retroperitoneal sarcoma, the goal of surgery is to achieve the complete resection of the tumor (R0). Partial removal (R2) tumor should be strongly avoided, as this has been demonstrated to have higher recurrence risk and a detrimental effect on oncologic outcomes. The tumor involvement of organs and structures does necessitate concomitant resection. Resection of one or more adjacent organs is carried out in 58–87% of all cases of primary RPS. Most commonly, ipsilateral nephrectomy and partial colectomy are also performed. In cases of hypothetical necessity of removing all adjacent organs, an extended or compartmental approach to resection is recommended. The main idea is to resect not only evidently affected organs but also surfaces to obtain circumferential «soft tissue margins». This approach is controversial but data from some sarcoma care centers in Italy and France indicate its effectiveness. Conclusions. Treating RPS in specialized centers of oncosurgery with surgical planning based on CT and MRI data is of vital importance, especially using assessment by related surgical specialists. In large RPS, achieving a classic R0 resection level is a challenge, even in a compartmental approach, therefore division of resections into R2 and R0/R1 is reasonable. The choice of approach determines success of the surgery due to the narrowness of the surgical field.

Features of using CT and MRI in planning radiation therapy in patients with squamous cell carcinoma of the head and neck

Background. Squamous cell carcinoma of the head and neck (SCCHN) holds a significant position in global oncology. The quality of radiotherapy greatly depends on the accuracy of diagnostic procedures and radiation dosing, as even a minor increase in radiation volume can significantly raise the risk of radiation toxicity. Modern visualization methods and dose calculation algorithms are key in ensuring treatment effectiveness and reducing side effects, thereby improving patients’ quality of life. Purpose. To enhance the effectiveness of radiotherapy for SCCHN through the optimization of topometric preparation using modern visualization methods. Materials and Methods. The study was conducted at the State of Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine», from January 2020 to October 2022. The study group comprised 41 cases where radiotherapy planning was performed using both CT and MRI. The comparison group included 64 cases using only CT. Radiation planning was carried out on TPS Eclipse, and irradiation was performed on a Clinac 600C linear accelerator in a classical fractionation mode with a daily dose of 2 Gy to a total dose of 66–70 Gy. Results. The clinical effectiveness of radiotherapy was not dependent on the method of planning, and a reduction in radiation volume by 11% using MRI did not affect the outcomes. It was noted that the development of grade III radiation dermatitis in patients with stage III–IV SCCHN was 2.4 times higher when using only CT compared to using both CT and MRI, which is thought to be due to a larger radiation volume. Grade III radiation mucositis was observed 2.25 times more frequently in the comparison group than in the study group. In patients with stage I–II SCCHN, there was no significant difference in effectiveness and toxicity, hence the use of MRI at these stages is not justified. Conclusions. It is necessary to use MRI with CT for planning radiotherapy in patients with stage III–IV SCCHN. This reduces the risk of grade III radiation dermatitis and mucositis compared to using only CT. For planning radiotherapy in patients with stage I–II disease, the use of CT alone is sufficient.

Factors affecting the survival of patients with glioblastoma treated with standard and hypofractionated radiation regimens

Background. Glioblastoma has the worst prognosis and is the most common primary tumor of the central nervous system (CNS) among adults. Since it is multimodal treatment that increases survival chances of patients with glioblastoma, the analysis of factors that affect survival is a necessary precondition for developing more effective therapeutic approaches for this cohort. Such analysis makes it possible to determine the subgroups of patients which demonstrate the biggest therapeutic benefit from certain types of multimodal treatment, thus leading to implementation of personalized neuro-oncological treatment. Purpose. To analyze factors affecting cancer-specific survival (CSS) of patients with glioblastoma in stratification of the cohort according to the regimen of adjuvant radiation therapy into groups of standard and hypofractionated treatment regimens. Materials and methods. The single-center non-randomized study is based on the analysis of the results of the cohort of 159 patients with primarily diagnosed glioblastoma that were treated over the period from 2014 to 2020 at the State Institution «Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine». According to the regimen of radiation therapy, the patients of the cohort (n=159) were stratified into two groups: standard regimen group – 49 (30.8%) patients (30 fractions, total radiation dose of 60.0 Gy) and hypofractionated regimen group – 110 (69.2%) patients (15 fractions, total radiation dose of 52.5 Gy). The survival of the patients was analyzed by the Kaplan–Meier method. The log-rank test was used for comparing Kaplan–Meier survival curves for different studied groups. For the purpose of studying impact of independent variables on the survival, we used regression analysis according to semiparametric proportional hazards model. Hazard ratio was calculated with 95% confidence intervals (CI). Results and discussion. The median CSS in the total cohort was 16.6 (95% CI 14.1–17.8 months) months in median follow-up time of 23.8 (95% CI 21.9–27.3) months. In standard regimen group, the median CSS was 15.7 (95% CI 14.1–17.8) months in median follow-up time of 24.4 (95% CI 23.1–25.3) months. In hypofractionated regimen group, the median CSS was 17.5 (95% CI 14.6–19.7) months in median follow-up time of 22.3 (95% CI 21.3 – 27.2) months. According to the logrank test (taking into consideration cautions about its use), no statistically significant difference in CSS of patients of both groups was determined р=0.07>0.05. For analysis of the impact of clinical factors (age, sex, radicality of the surgical treatment, chemotherapeutic treatment, functional status according to the Karnofsky scale) on the CSS of both groups, they were considered as the ones that may have different base hazard. Statistically significant impact of all studied covariates on the CSS was registered (p70 points, ceteris paribus. For male patients, the hazard of death is 1.7 times higher (р=0.016267; HR 1.7; 95% CI 1.1–2.5) than for female patients, ceteris paribus. Absence of chemotherapy in adjuvant treatment increases hazard of death by 2.37 times (HR 2.37; 95% CI 1.6–3.2), ceteris paribus. The hazard of death decreases, ceteris paribus, by 82% in chemotherapy with temozolomide and by 47% when the patient is younger than 60 years old (HR 0.53; 95% CI 0.4–0.8). Conclusions. This analysis is a stage of the study of differentiated treatment effect in groups of standard and hypofractionated regimens of radiation therapy in patients with glioblastoma. These data can be used for an in-depth subgroup analysis and serve as the basis for development of personalized approaches in treatment of neuro-oncological patients.

Можливості еластографії зсувної хвилі в діагностиці фіброзу печінки та моніторингу автоімунних захворювань печінки в дітей

Autoimmune liver disease (ALD) in children, when not diagnosed and treated timely, are characterised by a progressive course leading to liver cirrhosis. Monitoring the progression of the disease is crucial for evaluating the effectiveness of treatment in ALD patients. We believe that the use of ultrasound elastography is not only valuable for diagnosing liver fibrosis but also for monitoring the course of ALD in children, representing a promising research method. Purpose - to assess the feasibility of using shear wave elastography for diagnosing liver fibrosis and monitoring the course of ALD in children. Materials and methods. In 108 children with ALD aged 3-18 years, examined at the Department of Pediatric Hepatology of the SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O. Lukyanova of the National Academy of Medical Sciences of Ukraine», from 2019 to 2023, ultrasound shear wave elastography (2D-SWE) parameters were evaluated before treatment (baseline) and at 6, 12, 24, and 36 months of therapy, depending on the stage of liver fibrosis determined by histological method using the Metavir scoring system (F0-F4) in all children. Statistical analysis was performed using GraphPad Prism 9 version 10.0.0. Results. The mean age of the children was 11 years (range 8-13.8 years), with 91% (n=98) having liver fibrosis stage ≥F2 according to Metavir. There was a significant correlation between complete biochemical remission and median 2D-SWE at 12, 24, and 36 months of treatment (p=0.0002; p=0.002; p=0.0004, respectively). The area under the ROC curve (AUC) for diagnosing liver fibrosis stage ≥F3 and F4 at 0, 6, 12, 24 and 36 months of treatment was 0.81; 0.78; 0.67; 0.81; 0.75 and 0.80; 0.91; 0.84; 0.89; 0.92, respectively. The optimal cutoff value for median 2D-SWE was 10.1 kPa; 8.9 kPa; 9.1 kPa; 8.9 kPa; 7.0 kPa and 14.0 kPa; 10.5 kPa; 10.2 kPa; 9.7 kPa; 8.1 kPa, respectively. Conclusions. Shear wave elastography is an effective method for diagnosing fibrosis ≥F3 and cirrhosis in children with ALD. Reduction in 2D-SWE values in children with ALD during treatment is a predictor of its effectiveness. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Evaluation of Changes in the Quality of Life Using the U22 Questionnaire after Cavotricuspid Isthmus Ablation

Abstract. Atrial tachyarrhythmias are the most common forms of heart rhythm disorders. According to literature sources, isolated atrial flutter (AFL) is observed in 88 people per 100,000 population. Most quality-of-life assessment methods have been developed and used primarily to assess atrial fibrillation. In this context, the U22 questionnaire becomes a significant protocol aimed at quantifying paroxysmal symptoms associated with tachyarrhythmias.
 The aim. To evaluate changes in the quality of life in patients with typical AFL after radiofrequency ablation (RFA) and bidirectional conduction block through the cavotricuspid isthmus.
 Materials and methods. The study is based on the analysis of the results of the treatment of a group of 135 patients at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 2014 to 2021. The patients had three follow-up examinations, which were subject to analysis and static processing: before RFA (n=135), after 1 month (n=122) and after 1 year (n=81). All the patients were interviewed concerning their arrhythmia-related symptoms, which were assessed according to the U22 protocol.
 Results. Before the procedure, the patients noted a low level of well-being (4.3±1.0 points). During the follow-up visit 1 month after RFA, the patients rated their general condition during this period at 8.9±0.7 points. The registered changes were statistically significant compared to the initial state (p<0.0001). Thus, the radical elimination of AFL led to rapid improvement in the psycho-emotional and physical condition of the patients as early as within 1 month. Similar changes were observed during the assessment after 1 year, when the patients assessed their condition at 9.3±0.7 points (p<0.0001); there was statistically significant difference compared to the initial condition and the results at the first follow-up examination. These results confirm the stability of the positive trend during the medium-term follow-up.
 Conclusions. The U22 questionnaire found symptomatic improvement in patients undergoing RFA of cavotricuspid isthmus. The U22 questionnaire can be considered as another, additional control tool for patients who underwent RFA. The peculiarity of its application is the specificity of the assessment of paroxysmal symptoms and complaints, which are specifically related to rhythm disturbances, and the possibility of a simple analysis of the dynamics for a long time after the intervention.

Catheter Ablation of Paroxysmal and Persistent Atrial Fibrillation in Patients with Secondary Atrial Septal Defect. Evaluation of the Results and Impact on the Quality of Life

Introduction. The presence of atrial fibrillation (AF) in patients with secondary atrial septal defect (ASD) has significant impact on their quality of life (QoL) and reduces life expectancy. Current guidelines recommend catheter ablation (CA) for patients with AF in case of medical treatment failure, however, its use in patients with AF and ASD is still poorly studied.
 The aim. To study the efficacy and safety of CA and its impact on the QoL in patients with AF and secondary ASD.
 Materials and methods. In 2003-2023, 1408 patients with secondary ASD were treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Of these, 54 patients who had AF and underwent the CA procedure were included in group 1 of our study. There were 36 (66.7%) men and 18 (33.3%) women aged 24-76 years (mean age 61.4 ± 9.8 years). Four (9.3%) patients had persistent AF and 50 (90.7%) patients had paroxysmal AF. Fifty-six patients with paroxysmal or persistent AF and with the comparable age, duration of symptoms and associated pathology but without ASD were examined as group 2. The type and results of surgical interventions were analyzed according to surgical reports. The results of the treatment and QoL were assessed using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire during the follow-up period 1, 2 and 3 months after the procedure.
 Results. Pulmonary vein isolation was performed in all 54 (100%) patients of the group 1, as well as cavotricuspid isthmus ablation in 26 (48.2%) cases, cavotricuspid isthmus ablation and left atrial linear ablation in 2 (3.6%) cases. Type, length and complication of the procedure were comparable to those in the group 2. Fourty-four (81.5%) patients with ASD were free from AF 3 months after procedure, and their results did not differ from those obtained in the group 2 (p > 0.05). Average QoL indicators according to AFEQT significantly improved in both groups of patients who underwent CA. The differences in post-treatment QoL between patients of both groups were insignificant (p > 0.05).
 Conclusions. CA was found to be safe and beneficial in patients with AF and secondary ASD. The rate of procedural complications and cure rate in patients with AF and secondary ASD (81.5%) were compatible to those in patients without ASD (80.5%). AF has negative effect on the main indicators of the patient’s life. In patients with secondary AF with ASD who underwent CA, a significant improvement in AF symptoms and QoL according to the AFEQT questionnaire (total score 56.1 ± 2.7 before the procedure vs. 78.7 ± 4.0 at follow-up) was noted.