Odessa Regional Research Articles

NEW MORPHOLOGICAL SIGNS OF PASSENGER CAR DRIVER’ AND PASSENGERS’ BODILY INJURIES IN CASE OF MODERN SAFETY EQUIPMENT USE

The article examines the impact of modern automobile safety features on injuries sustained by drivers and passengers during traffic accidents. Cases of injuries were analyzed, and the nature of damages caused by traditional and modern safety systems was studied. It was found that modern safety features significantly reduce the risk of severe injuries, although they can themselves cause bodily harm. The study highlights the prospects for further research into the effects of advanced safety systems, such as active headrests and special pedal bracket mechanisms. The aim of the study is to increase the efficacy of forensic medical examinations of persons injured as a result of a road accident inside passenger car compartment. Materials and methods. 247 cases of trauma in the driver’s and passengers’ compartments of cars equipped with modern safety features (without fatal outcomes) were studied based on archival materials of the Odessa Regional Bureau of Forensic Medical Examination for the years 2014-2024. The morphology of bodily injuries in drivers and passengers was analyzed. Results. In a comparative study of both the traditional and new safety equipment impact on passenger car driver and passengers morphological signs of bodily injuries in a road accident it was found that current means of driver and passengers protection allow to reduce significantly the risk of severe, including fatal, bodily injuries in cases of road accidents. It was proved that safety steering column can cause serious injuries, up to the fractures occurrence. The remaining means of protection do not lead to serious injuries formation; their effect causes bruises, abrasions and superficial wounds formation. Conclusions. The current means of driver and passengers protection inside the car cabin allow to reduce significantly the risk of serious, including fatal, bodily injuries in cases of road accidents. New means of protection provide both driver and passengers greater safety inside the car cabin from injury. Prospects for furthers researches we suppose are the probable protective influence investigation of a special (breakable) pedal assembly bracket and an active headrest on driver and passenger inside the car in case of a road accident.

Intraoperative indocyanine green angiography for predicting postoperative hypoparathyroidism.

Postoperative hypocalcemia is a common complication of thyroidectomy. This problem is most often associated with accidental devascularization or excision of the parathyroid glands (PG). Aim was to study near-infrared (NIR) fluorescent imaging with intraoperative PG indocyanine green (ICG) angiography to help identify and preserve PG during total thyroidectomy in order to avoid postoperative hypocalcemia. From 2017 to 2022, a total of 92 patients underwent total thyroidectomy at Odessa Regional Hospital. Indications for surgery were multinodular goiter (n = 42), thyroid cancer (n = 43), and Graves' disease (n = 7). By randomization all patients were divided into two groups: in the control group, 48 patients underwent standard total thyroidectomy, and in the main group, 44 patients underwent NIR-assisted total thyroidectomy with ICG angiography. Serum calcium and parathyroid hormone levels were compared between the two groups of patients in 1, 7-15days after surgery and then 3, 6months later. In the control group, based on a visual assessment of the PG, autotransplantation of the PG was conducted in only five cases. In the second group, autotransplantation was performed in 16 patients. The transient postoperative hypocalcemia was observed in 8 patients of the control group (16, 70%) and in the 2 patients of ICG group (4, 50%) on 5-10 postoperative days. In the first group, 2 patients at 3months after surgery had permanent hypocalcaemia. NIR fluorescent imaging with intraoperative PG ICG angiography is a safe and an easily repeatable method. This technique provides improved detecting and assessment of the perfusion of the PG. The need for autotransplantation of the PG can be determined more objectively using ICG imaging than simple visualization.

HISTORICAL CRUISE TOURISM IN UNESCO BIOSPHERE RESERVES: «CHERNOMORSKIY « & «DANUBE DELTA»

(Cooperation of the Scientific foreign languages Circle in honor of the Honorary President Mrs Halyna Semenivna Dimova (Shutko) «History of the Izmail Red Cross» and the Faculty of Geology and Geography оf Odesa I. I. Mechnikov National University) Problem statement and Purpose. The south of Ukraine has unique natural and historical treasures. The article analyzes the possibility of combining natural resources included in the World Network of UNESCO Biosphere Reserves and forgotten facts from the international history of the First World War, which took place in their water areas and adjacent territories, in cruise tourism. Taking into account the interest to the French language of the participants in the educational process, the Faculties of Romance and Germanic Philology, History and Philosophy, Geology and Geography, International relations, political and social studies the Circle explores various issues, including historical cruise tourism. The purpose of the article is to analyze the possibilities of combining the use of the direction of historical tourism of the work of the Scientific Circle related to niche local cruise tourism, the study of the possibility of including accumulated historical facts in the development of tourist routes of the domestic and international level within the interdisciplinary context of the French-language training of masters in the specialty 242 Tourism, specializations tourist service, with an orientation to the modern market of educational services. The task is to solve theoretical issues, in particular, to reveal the essence and content of local historical niche cruise tourism, the possibility of including local heroic historical heritage in existing cruise routes, both national and international, with scientific coverage and publication of the article in a specialized scientific publication on the specialty 242 Tourism. Data & Methods. The material is archival documents and publications of researchers-historians, local historians and museum workers of Odessa region, french language scientific academic publications of international official websites, where scientific international publications of the Circle are posted, which can be used by master’s, learning French. Since 2013, the Interdisciplinary University Circle in Foreign Languages «History of the Izmail Red Cross» began its activities thanks to the initiation and assistance of its Honorary Chairman (according to the European tradition – Honorary President) – Halyna Semenivna Dimova (Shutko), Chairman of the Izmail Organization of the Red Cross (2002–2018), Member of the Board of the Odessa Regional Organization of the Red Cross of Ukraine (2002–2018), holder of the highest distinction of the Red Cross Society of Ukraine – «Vis Humanitatis!», Honorary Distinction of the Odessa State Regional Administration, other awards. In 2021, unfortunately, she left this world, but her name continues to live in the activities and name of the Circle. Methods of analysis, analogy, deduction are used, as well as the axiomatic method and philosophical methods of explaining the inconsistency and complexity of the development of intercultural interactions. Results. The use of the Danube Delta and the 0-kilometer of the Black Sea for the development of historical cruise tourism on the principles of active promotion of the preservation of historical heritage, creating a sense of pride and responsibility among the local population, which coincided with the scientific research of cruise tourism at the second (master’s) level under the guidance of the Department of Economic and Social Geography and Tourism, which in the longer term can contribute to the development of the Tourism Development Program based on the use of this unique historical heritage of the area. The project of historical cruise tourism in the UNESCO biosphere reserves of the South of Ukraine of the Scientific Circle «History of the Izmail Red Cross» together with the Department of Tourism can become a unifying project, which will allow to present an original domestic tourist product. This will increase the economic component, a new impetus for the development and renewal of territories. In peacetime, it is Tourism, that will allow us to revive our country.

Expediency of the compressive hosiery application as a preventive method for the ventral hernias occurrence in patients after laparotomy

Objective. To study meticulously the scientific substantiation of the postoperative bandaging practice, to gather necessary information, concerning this practical procedure application, with estimation of its advantages.
 Materials and methods. The investigation, concerning the impact of compression hosiery in patients after laparotomy as a preventive method for the abdominal hernias occurrence was conducted in period from Sep. 2021 yr to Dec. 2022 yr on the base of Odessa Regional Clinical Hospital. Into the investigation 35 patients, ageing from 18 to 65 yrs old, were included, in whom a total median laparotomy was performed for surgical diseases. The patients were distributed into two Groups: the main (18 patients, in whom bandaging was applied) and a control one (17 patients without bandaging). The frequency of postoperative abdominal hernias occurrence and intensity of postoperative pain were estimated in the groups.
 Results. The data obtained have shown, that the groups investigated did not essentially differ in accordance to the abdominal hernias occurrence frequency and intensity of postoperative pain.
 Conclusion. The data obtained witness that bandaging do not influence the hernias occurrence significantly and do not impact postoperative pain unpredictably.

Diagnostic biopsy of sentinel lymph nodes in mammary gland cancer

Objective.To improve the diagnostic biopsy of sentinel lymph nodes in patients, suffering mammary gland cancer, using fluorescent lymphography, and to reduce the quantity of postoperative complications.
 Materials and methods. In 2016 – 2021yrs period on the base of Odessa Regional Clinical Hospital 400 patients, suffering mammary gland cancer Stages Т1–Т3N0М0, were operated on with application of fluorescent lymphography, using two dyers – the patent blue and indocyanine green. All the patients were distributed into two groups. In Group I (a control one) in 200 patients the sentinel lymph nodes biopsy was performed. The dyer patent blue was applied for the lymph nodes coloring.In Group II (the main) in 200 women–patients the sentinel lymph nodes biopsy, using the patent blue and fluorescent dyer indocyanine green, was performed. Both dyers were injected subdermally along the external areolar edge in the dose 2 ml of the dyer solution.
 Results. Total 5–year survival after axillary lymphodissection and after the sentinel lymph node biopsy have constituted 91and 92%, accordingly, while the recurrence–free 5–year survival – 82.2 and 83.9%, accordingly. Regional recurrence in sentinel lymph nodes on the affected mammary gland side was diagnosed in 1.1% of the women–patients. In 58% of the women–patients the sentinel lymph nodes were clear, and that’s why a subsequent lymphodissection was not indicated to perform. Metastatic lymph nodes were revealed in 42% of the women–patients.
 Conclusion. The method of diagnostic biopsy of sentinel lymph nodes in patients, suffering mammary gland cancer, using dyers, permits in majority of them to abandon traumatic operations in favor of organ–preserving interventions, thus reducing the postoperative complications rate significantly.

Intraoperative diagnosis of «sentinel» lymph nodes in the patients with mammary gland cancer

Objective. To improve intraoperative determination of «sentinel» lymph nodes in patients, suffering mammary gland cancer.
 Materials and methods. In the 2016 – 2021 yrs period on the base of the Odessa Regional Clinical Hospital 200 patients, suffering mammary gland cancer Stages Т1–Т3N0М0, were operated, using two dyes: the blue patented dye and fluorescent dye indocyanine green. All the patients were distributed into two groups. In Group I in 100 patients the "sentinel" lymph nodes biopsy was conducted. The blue patented dye was used for the lymph nodes staining. The same was conducted in 100 patients of Group II with the "sentinel" lymph nodes biopsy. For the lymph nodes staining there were applied the blue patented dye and fluorescent dye indocyanine green, which were introduced intravenously into the upper extremity on the side of the affected mammary gland along outflow from the upper extremity to mammary gland.
 Results. General five–year survival after axillary lympho–dissection and after biopsy of «sentinel» lymph nodes have constituted 91 and 92%, accordingly, while recurrence–free five–year survival – 82.2 and 83.9% accordingly. Only in 1.1% patient a regional recurrence in «sentinel» lymph nodes on the affected mammary gland side was revealed. In 57% patients the unaffected «sentinel» lymph nodes were diagnosed, that's why further lympho–dissection was accomplished. In 43% women–patients there was revealed metastatic affection of the lymph nodes. Recurrence was registered in 0.2% patients as an isolated metastases in axillary lymph nodes.
 Conclusion. The method of the «sentinel» lymph nodes diagnosis in mammary gland cancer, using the dyes, permits to escape the performance of traumatic operations in favor of organ–preserving interventions with biopsy of «sentinel» lymph nodes.

Retrospective analysis of experience of treatment of complex choledocholithiasis

Objective. Estimation of the clinical results application, concerning various methods of the complex choledocholithiasis treatment.
 Materials and methods. The investigation was conducted on the base of Odessa Regional Clinical Hospital during 2018 - 2021 yrs. Retrospective analysis of clinical results in treatment of 69 patients with complex choledocholithiasis was accomplished.
 Results. The tactics of treatment choice in complex choledocholithiasis must be maximally individualized and depend on a patient state and presence of concurrent diseases. In severe state of a patient the treatment must be started with transhepatic drainage of biliary ducts. It permits to eliminate the cholangitis signs, to improve a patient state and to prepare him to more complex operative interventions.
 Conclusion. In complex choledocholithiasis it is expedient to perform a two-staged interventions with preliminary drainage of biliary ducts for the cholemia level lowering. Tactics of treatment of complex choledocholithiasis must be selected, taking into account the patient state and age, presence of concomitant pathology and the clinic-anatomic peculiarities of the disease course (dimensions of calculi, stenosis, diverticulas of common biliary duct, etc). The extended endoscopic interventions constitute the most secure option.

Efficiency of detection of lymph nodes in breast cancer

The objective: improve the quality of sentinel lymph nodes detection in patients with malignant neoplasms of the mammary glands.Materials and methods. At the period from 2009 to 2016, 400 patients with T1-T3N0M0 breast cancer were operated in Odessa Regional Clinical Hospital, using two dyes Patent Blue and ICG.The patients who had mastectomy with sentinel lymph node biopsy were diagnosed T2-T3N0M0 breast cancer more frequently. The exceptions were T3-T4 tumors, tumor diameter > 5 cm, invasion into the skin and chest wall, palpable axillary lymph nodes, 3 or more affected lymph nodes during sentinel lymph node biopsy.100 patients in the first group had sentinel lymph node biopsy. Lymph node staining was performed using Patent Blue dye.In the patients in the second group, sentinel lymph node biopsy was performed using Patent Blue dye and another fluorescent ICG dye, which was injected intravenously into the arm on the affected side of the mammary gland, along the outflow from the arm to the mammary gland.Results. The total five-year survival after axillary lymph node dissection and sentinel lymph node biopsy was 91 % and 92 %, respectively. The five-year recurrence-free survival after axillary lymph node dissection was approximately 82.2 %, and after the sentinel lymph node biopsy – 83.9 %. Regional recurrence in the sentinel lymph nodes on the affected side was determined only in 1.1 %. The time of observation of the patients was from 60 to 180 months. The recurrence was registered in 0.2 % patients as isolated metastases into the axillary lymph nodes. Not a single case of lymphostasis of the upper limbs from the side of the biopsy was registered. Conclusions. The simplicity of fluorescent dyes usage makes it possible to implement this method in the everyday work of oncologists-surgeons, the advantages of which are the absence of radiation exposure and quick intraoperative detection of lymph nodes.

Results of transanal endoscopic resections in rectal cancer

Introduction. Rectal cancer is the most widespread form of cancer in different countries of the world, without regard to gender, and reaches 8–9% of the total number of all cancers. It is necessary to further improve and study modern methods of both surgical and combined integrated approach to the treatment of patients with rectal cancer. Lymphatic cancer spread is one of the most important causes of local recurrence of rectal cancer and an unfavorable prognostic.
 Aim of the study: to study and improve the results of treatment of patients with rectal cancer during transanal endoscopic microsurgery with staining “sentinel” lymph nodes.
 Materials and methods. In the period from 2009 to 2021, 92 patients with rectal cancer were operated on at the Odessa Regional Clinical Hospital using transanal endoscopic resections. All 92 patients were divided into 2 groups. In group I, 45 patients were diagnosed stage I rectal cancer (T1-2N0M0. In group II, 47 patients were diagnosed stage II rectal cancer (T3N0M0) before surgery. In group I, a standard TEM procedure was performed. In group II, taking into account the presence of stage II RC in patients, and the high possibility of recurrence and metastasis, after performing local excision of tumors using the TEM method, we improved this method.
 Results. The average time of the hospital stay was (3.4±1.7) days (from 2 to 6 days). The lower edge of the tumor was at the average height of (9.5±4.2) cm from the anal canal (from 5 to 18 cm), the average size of the tumor was from (2.8±1.7) cm (from 1.5 to 4 cm). The average follow-up period ranged from 12 to 60 months. Recurrence of rectal cancer was found in 6 (6.5%) patients, group I.
 Conclusions. One of the most important prognostic factors of the development of the RC local recurrence is the regional lymph nodes involvement. Identification and target study of the “sentinel” LN in patients with RC most likely make it possible to assess the stage of the disease and apply an adequate scheme of the complex treatment.

Polymorphism of CYP3A4*1G gene as a predictor of the hepatotoxicity of antituberculosis therapy

The risk of anti-tuberculosis (ATB) drug-induced liver injury could be determined by genotype polymorphism of the xenobiotic-metabolizing enzymes. The aim of presented research was the investigation of an impact of CYP3A4*1G polymorphism on liver function in patients with TB during anti-tuberculosis therapy. There were analyzed case histories of 105 patients with newly diagnosed pulmonary TB at Odessa Regional TB Hospital in 2012-2014. We have considered their medical records at the beginning and at the end of inpatient treatment including activity of biochemical indices such as total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutathione transferase (GGT). The genotype CYP3A4*1G, 20230G>A was detected by PCR. At the beginning of the treatment the level of studied biochemical indices was almost the same regardless of CYP3A4*1G genotype. After the conducted in-patient treatment the biochemical indices in fast metabolizers insignificantly increased, while the level of bilirubin dropped by 10.4% (p<0.05). In slow metabolizers after in-patient treatment the serum total bilirubin level increased by 8.0% (p<0.05), the activity of ALT raised by 67.2% (p<0.05), AST – by 37.4% (p>0.05), also the number of the patients with ALT and AST level beyond normal almost doubled. After completion of in-patient treatment in moderate and slow metabolizers serum GGT activity increased by 2.5 times (p<0.05) and 1.3 times (p>0.05) correspondently, among fast metabolizers – on the contrary, the num­ber of the individuals with increased GGT level dropped (p<0.05). Thus in slow metabolizers according to CYP3A4*1G genotype after completion of in-patient stage of anti-TB treatment the level of cytolysis and toxicity in­dexes was much higher than in fast metabolizers. That is why detection of CYP3A4*1G genotype of TB patients at the beginning of TB treatment could help to recognize a group of the individuals with increased risk of liver injury during therapy.

Odessa period in the creative activity of the famous Ukrainian librarian L. Khavkinа

The proposed research is substantively and conceptually related to research on the history of domestic library science and is directly devoted to the methodological and educational activities of the famous Ukrainian librarian L. Khavkinа in Odessa 1925 year. The article uses authentic materials stored in the funds of the Odessa Regional State Archive and in the funds of the Book Museum of the Odessa State Scientific Library. Among them are such unique documents as the minutes of the meetings of the presidium of the Library Association of Odessa in 1925 year, the report of the Bibinspektura on conducting a seminar with the participation of L. Khavkinа and, finally, own financial receipts made by L. Khavkinа. These documents state that the information provided during the methodological meetings by L. Khavkinа made an unforgettable impression on the Odessa library community and encouraged it to further the fruitful development of the Odessa library business and prompted the centralization of Soviet libraries in the Odessa region and further centralized exchange of methodological, scientific and educational, library and bibliographic literature and information. However, unfortunately, L. Khavkinа's stay in Odessa and holding a library seminar was accidental and took place on the recommendation of Agitprom Gubkom and the Odessa library community did not make a special professional impression on L. Khavkinа, so in the field of professional research interests of the famous librarian further was not included.

Результати виділення та генотипування вірусів кору, які циркулювали у 2012–2017 роках в Одеській області

Актуальність. Циркуляція різних штамів вірусу кору тісно пов’язана з регіоном та рівнем захворюваності, оскільки циркулюючі штами можуть змінюватись в період епідемічних спалахів та в міжепідемічні періоди. За даними ВООЗ, найбільш поширеним під час епідемічних спалахів у всьому світі є генотип B3. Тому типування циркулюючих штамів вірусу кору, особливо під час епідемічного спалаху, є важливим процесом, у тому числі й з метою прогнозування розвитку епідемії. Метою даного дослідження була ідентифікація та визначення генотипу циркулюючих в Україні штамів вірусу кору в період 2012–2019 років. Матеріали та методи. Була використана та проаналізована звітна документація ДУ «Одеський обласний лабораторний центр» МОЗУ в Одеській області за 2012–2019 роки щодо дослідження матеріалів від хворих з підозрою на кір з використанням молекулярно-біологічних, генетичних, аналітичних та статистичних підходів. Відповідно до стандартного протоколу ВООЗ для секвенування та проведення філогенетичного аналізу від пацієнтів виділяли циркулюючі штами вірусу кору з використанням спеціальної культури клітин Vero/SLAM, а після культивування з отриманого вірус-вміщуючого матеріалу виділяли РНК вірусу кору та проводили ЗТ-ПЛР. Отриману кДНК відправляли на генотипування, яке проводилось у референс-лабораторії ВООЗ з діагностики кору та краснухи в м. Люксембурзі. Результати. За період 2012–2014 років було виділено 20 штамів вірусу кору з 45 проб (сеча та носоглоткові змиви) від хворих з діагнозом «кір». У 2015–2016 роках виділення вірусу не проводилось через одиничні випадки захворювання. У 2017 році було виділено 24 штами вірусу зі 164 проб. Висновки. Отримані в ДУ «Одеський обласний лабораторний центр» результати свідчать, що у міжепідемічний період 2012–2014 років у регіоні циркулював переважно генотип D4, а починаючи з 2017 року, коли спостерігається підвищення кількості захворілих, пов’язане з новим епідемічним спалахом, на півдні України циркулює переважно генотип В3, генетичної лінії MVs/Kabul.AFG/20.2014/3 B3. Як бачимо, ці дані цілком збігаються з даними, наведеними у літературних джерелах, щодо циркуляції генотипів, які зустрічались у певний час в Європейському регіоні залежно від кількості захворілих.

Nonel approaches in the field of gastric cancer surgical treatment

The aim of the study: to estimate the impact of different cellular phenotype of gastric tumors on the survival of patients treated according to standard protocols.
 Object and methods of research.The work presents the results of a study conducted on the basis of two medical institutions - the National Cancer Institute and the abdominal oncology and surgery department of the Odessa Regional Oncology Center. 221 patients underwent surgery for gastric cancer (GC) in the period 2007-2013. The average age of patients was 60.88 ± 10.5 years, men - 180, women - 41. Of the total number of operated, 143 patients underwent surgery in the amount of gastrectomy, 78 - subtotal distal resection.
 Results. All patients included in the study underwent radical surgery. Tumors removed during surgery were examined using histological, cytological, immunohistochemical methods and genetic tests. The obtained results are monitored for the presence/absence of clinical parallels and mathematical correlations. It was concluded that some combinations of immunohistochemical (IHC) markers were effective in separating groups of patients with different biology of gastric cancer.
 Conclusions. Performing more advanced operations (including the use of D2 lymph dissections) is the most effective option for surgical treatment of microsatellite-unstable and Epstein-Barr virus-associated gastric cancer.

Complications of transanal endoscopic resection in cancer recti

Objective. To study іntra- and postoperative complications in transanal endoscopic resection in patients, suffering cancer recti and to reduce this quantity.
 Materials and methods. Through the period 2009 - 2021 yrs on the base of Odessa Regional Clinical Hospital 184 patients, suffering cancer recti, were operated, using transanal endoscopic resection. The patients’ age was from 42 to 86 yrs old. The patients were distributed into two groups. In 90 patients of the first group the cancer recti diagnosis of stage I (T1-2N0M0) was established. In 94 patients of the second group the diagnosis of cancer recti stage ІІ (T3N0M0) was established.
 Results. Purulent-septic, thromboembolic and urological complications were absent in all 184 patients, as well as severe intraoperative complications and mortality. The average stationary stay of the patients have constitited (3.4 ± 1.7) days (from 2 to 6 days). The average lower edge of the tumour was situated at a distance (9.5 ± 4.2) cm (from 5 to 16 cm) from the anal channell, and the average dimensions of tumour - (2.8 ± 1.7) cm (from 1.5 to 4 cm). While studying of the histological investigations results there was noted, that in all the patients the tumour was excised in the healthy tissues borders in accordance to oncological technique. Period of follow-up have constituted from 12 to 60 mo. Cancer recti recurrence was revealed in 12 (13.3%) patients of the first group. Cancer recurrence have had occur in patients, who have rejected from conduction of chemo- and radiotherapy. The patients with recurrences were reoperated, using classic low anterior rectal resection with total mesorectumectomy.
 Conclusion. While conduction of preoperative neoadjuvant chemo- and radiotherapy the tumour dimensions are reduced significantly, as well as quantity of іntra- and postoperative complications in performance of transanal endoscopic resection. The disease prognosis for cancer recti depends directly on presence of metastases in regional «sentinel» lymphatic nodes.

Можливості омегаметрії в оцінці функціонального стану спортсменок, які спеціалізуються в карате

The purpose of the study was to investigate the peculiarities of changes in the general functional condition of the brain of highly qualified female athletes specializing in karate, in terms of omega potential indicators and to assess the adaptive capability of the central nervous system during physical load. Materials and methods. The study involved 14 highly qualified female athletes aged 17-22 years – representatives of the Odessa Regional Karate Federation. Determination of the dynamics of infraslow bioelectrical processes of the brain, namely omegapotential, was carried out according to the method of O. G. Sychov et al. (1980) at rest, after performing a test in one squat, with dosed physical load in a closed cycle (with reverse) and during the recovery period after exercise. Results and discussion. According to the results of anthropometric and physiometric measurements, the height of the studied girls specializing in karate, on average, was 164.43±0.86 cm, and body weight – 56.36±2.23 kg. The thorax circumference at rest was 84.86±1.57 cm, at the inhale – 89.57±1.49 cm, at the exhale – 82.5±1.57 cm. The average value of vital capacity of the lungs was 3457.14±101.93 ml, wrist dynamometry – 23.36±1.02 kg, back dynamometry – 63.57±3.53 kg. The analysis of the results of the study of infraslow brain processes showed that in the initial state the omega potential value ranged from 10 to 59 mV, which indicated the optimal baseline level in most female athletes before exercise. In the state of relative rest, the average omega potential values (21-40 mV) were found in 79% of the surveyed girls, high (41-60 mV) and low (up to 20 mV) – in 14% and 7%, respectively. The results of study of omega potential dynamics when tested in one squat indicate isolated cases of adequate responses and optimal activation of adaptive systems of the body to the functional load. In most female athletes, the violation of chemo-metabolic, neurohumoral and hormonal processes were observed after performing the test of one squat. The peculiarities of omega-potential dynamics, which were noted during the performance of dosed physical load in a closed cycle (with reverse), indicate a gradual decrease in the studied indicators relative to the initial state during the performance of bicycle ergometric load, especially during the period of reverse (heart rate = 150-155 beats / min) and at the end of testing. At the same time, the depth of shifts also increased, which reflects the significant tension on the central nervous system and other body systems of female athletes in response to physical load. After performing exercise at the 2nd and 5th minutes of rest, no recovery of infraslow bioelectrical processes to the initial level was recorded, which indicates the development of overstrain of adaptive mechanisms. Conclusion. Testing of qualified female athletes specializing in karate, using a functional test conducted in one squat, according to the data of average group indicators of omega potential revealed a violation of chemo-metabolic, neurohumoral and hormonal processes. The study of individual data shows that in most of the surveyed there are various violations of these body systems. The dynamics of infraslow bioelectrical processes in the brain of female athletes during testing using bicycle ergometric load in a closed cycle (with reverse) is characterized by a steady decrease in omega potential throughout the test, which reflects the overstrain of regulatory mechanisms and deep mobilization of functional capabilities. The restoration of the level of omega potential to the initial level at the 5th minute of the post-exercise period does not occur

Hematological and biochemical features with tuberculosis and bacterial lymphadenitis in children

Objective — to improve approaches to differential diagnosis of lymphadenitis by identifying features of hematological and biochemical parameters of blood of children with nonspecific bacterial and specific tuberculous lymphadenitis.
 Materials and methods. Under our supervision were 45 children aged 1 to 5 years with an increase in lymph nodes (LN), who were treated in the surgical department of the Odessa Regional Children’s Clinical Hospital for the period from 2017 to 2018. Patients were assessed for general condition and affected lymph node lesions, as well as blood sampling for general and biochemical studies. Additionally, the calculation of integrated hematological indices of immunological tolerance of the organism was performed, namely the index of neutrophils to lymphocytes ratio (NLR); lymphocyte to monocyte ratio (LMR); neutrophil to monocyte ratio (NMR); lymphocyte to eosinophil ratio (LER). For comparison with the norm used the data of these indicators, established in healthy children.
 Results and discussion. All patients were divided into 2 clinical groups. The first group (СG-1) included 25 children with lymphadenitis caused by BCG vaccination, the second (СG-2) — 20 patients with acute purulent lymphadenitis. The study found that the condition of most children (75 %) of the second group was more severe compared with patients with CG-1, which was manifested by more pronounced manifestations of intoxication and local condition of the affected LN.Evaluation of a general blood test showed that the average number of leukocytes with specific lymphadenitis in most (80.8 %) patients was within normal limits, with purulent; on the contrary, in 71.4 % of children there was a tendency to increase. The calculations of hematological indices revealed a decrease in NLR, and, with BCG lymphadenitis, it decreased by half (to 0.96) compared with bacterial lymphade­nit (to 1.88), which indicates an increase in specific immunological reactivity in children of CG-1. ISNM in most patients with lymphadenit remained low throughout the course of the disease. This indicates the timely activation of the macrophage defense system of the body. LMR with tuberculous lymphadenit grew, while with bacterial lymphadenit, on the contrary, it decreased by half, which indicates earlier mobilization of lymphocytes as an effector immunity in children with BCG lymphadenitis. LER in all forms of the disease tended to increase, which indicates the predominance of a delayed-type hypersensitivity reaction in children of both groups.Analysis of blood biochemical parameters in patients of both clinical groups did not reveal clear differences in children with bacterial and tuberculous lymphadenitis.
 Conclusions. At specific defeat of LN unlike nonspecific, the clinical and laboratory picture with lack of expressive leukocytes reaction is noted. Determining the indices of the ratio of blood leukocytes makes it possible to more deeply assess the level of immunological reactivity and the general condition of the child, which increases the informative value of clinical blood tests. Analysis of blood biochemical parameters in patients with specific and nonspecific lymphadenitis, although it has no specific differential diagnostic value, however, is an important component of assessing the quality of treatment and the patient’s condition as a whole.

Combined therapy with Medotilin/Elfunat for the prevention and treatment of neuropsychiatric complications after open-heart surgery

After open-heart surgery, postoperative neuropsychiatric complications often develop: stroke — in 4.8 % of cases, diffuse encephalopathy — in 12 %, behavior changes — in 5–40 %, cognitive impairment — in 12–79 %, mental disorders — in 13–64 %. The causes of their development are acetylcholine deficiency with subsequent dysfunction of the cholinergic system and oxidative stress, which result from hypoxia, hypoperfusion, and a systemic inflammatory reaction. In this regard, the appointment of drugs that restore the acetylcholine synthesis – choline alfoscerate (Medotilin), and drugs that suppress oxidative stress – mexidol (Elfunate) is considered a promising direction for the prevention and treatment of neuropsychiatric complications. The study conducted on the basis of the regional cardiac surgery center of the Odessa Regional Hospital demonstrated that the combined use of Medotilin and Elfunate can reduce the frequency of neuropsychiatric complications, as well as reduce the duration of treatment in the hospital.

QUALITY OF LIFE FOR CHILDREN WITH GROWTH HORMONE DEFICIENCY: SIGNIFICANCE OF CLINICAL, PSYCHOEMOTIONAL AND SOCIO-DEMOGRAPHIC FACTORS

The work is devoted to assessing the quality of life (QоL) of children with growth hormone deficiency (GHD) and determining the correlation between the QoL and clinical, psycho-emotional and socio-demographic factors. A prospective observational cohort study was carried out at the «Odessa Regional Children's Clinical Hospital» among 46 prepubertal children with GHD and 80 healthy children matched for sex and age. The QоL was determined using Peds QL4.0 questionnaires, which were completed by children and their parents. Total psycho-emotional problems, internalizing and externalizing problems were investigated using 2-factor model of the «Strengths and Difficulties Questionaire (SDQ)», which was completed by the child's parents. The indices of the Peds QL4.0 and SDQ scale were fixed at baseline (T0) and after 12 months (T12) therapy with recombinant human growth hormone (rHGH) at an average dose of 0.033 mg/kg/day. The difference between the observed means ± SD in two independent samples were assessed using t-tests and «p» values. The relationship between clinical, psychological, socio-demographic factors and QoL of children with GHD was assessed by the calculation of Spearman’s correlation coefficient (rs).It was found that GHD was the cause for the decrease in the QoLaccording to the «total score» of the Peds QL4.0 scale for children and acccording to the subscales «physical health», «psychosocial health», «emotional functioning», «social functioning», «school functioning». The overall assessment in the SDQ «total difficulties» score increased and the conceptualization of internalizing problems occurred in children with GHD. The 12-months rHGH therapy contributes to the improvement of QoL in children with GHD, the normalization of the psycho-emotional state and the decrease in SDQ «total difficulties» and in «internalizing problems» scores.

«Complex» choledocholithiasis in practice of regional centre of endoscopic surgery

Objective. Estimation of rate of various causes of «complex» choledocholithiasis (CL) in practice of regional centre of endoscopic surgery. Materials and methods. The investigation was conducted on the base of Department of Surgery in Odessa Regional Clinical Hospital in 2019-2021 yrs. Experience of endoscopic operative interventions, performed in 198 patients with clinical signs of CL, was analyzed. Results. In 45 (22.7%) patients while ultrasonographic investigation a solitary calculus was revealed, while in the others –multiple calculi. Average value of the common biliary duct diameter have constituted (10.5 ± 0.8) mm. In all the patients distal localization of calculi was present, which coexisted in 31 (15.7%) with supraduodenal localization. In 1 woman-patient a valve calculus was revealed, which caused several accidents of biliary colic in anamnesis. Thus, multiple CL was present in majority of the patients. In 53 (26.8%) patients “complex” CL was diagnosed. While analyzing the causes rate of «complex” CL there was established its mostly frequent form (71.7%) occurring after previous multiple attempts of endoscopic interventions. Also frequent forms have appeared in technical complexities while approaching duodenal papilla magna (9.2%), cases of periampullar duodenal diverticulosis (5.8%) and tubular stenosis of common biliary duct (5.0%). Complete endoscopic papillosphincterotomy with the calculi extraction by one séance was performed in 27 (13.6%) patients. In 15 (7.6%) patients the procedure of a one-staged extraction of calculi failed as a consequence of the complications occurrence, presence of multiple big calculi. In these patients repeated seances of endoscopic papillosphincterotomy were done with extraction of calculi, which in 5 (2.5%) patients have demonstrated inefficacy, leading to performance of relithoextraction (up to 3 seances). Conclusion. Rate of “complex” CL constitutes 26.8%, its mostly frequent cause is previous multiple attempts of local endoscopic interventions. Rate of perioperative morbidity, while doing endoscopic interventions, do not exceed 15%, and mostly frequent complication is an acute pancreatitis. In part of the patients with “complex” CL it is expedient to apply laparoscopic and combined interventions.

Rehabilitation in patients with involutional-dystrophic skin changes

The study was aimed to assess the effectiveness of rehabilitation in patients with involutional-dystrophic skin changesMaterial and methods. The study was performed in the clinical department of the Ukrainian Research Institute of Medical Rehabilitation and Balneology of the Ministry of Health of Ukraine, as well as the Odessa Regional Clinical Medical Center of the Ministry of Health of Ukraine and the Kherson Regional Clinical Hospital in 2016-2020.287 women of middle age (average age 46.47 ± 1.97 year) with signs of functional changes in the skin were involved in the study. All patients required rehabilitation of impaired skin function (code b810 by ICF, LA22123-6 by LOINC).General sample (n=287) was randomly divided into two groups. Patients in the control group (n = 187) received cosmetic measures in the form of ultrasonic peeling, cleansing, nourishing facial masks. Patients of the main group (n = 100) were injected intradermally and subcutaneously with platelet-enriched autoplasma up to 5 ml, which was obtained by double centrifugation.Ultrasound scanning of the skin and laser Doppler flowmetry (LDF) were used to assess the structural features of the epidermis, dermis and subcutaneous fat. Dynamic control of skin structures included the study of the initial state of the skin at certain points of the face (center of the cheek, center of the forehead, outer corner of the eye), which we set as standard. Assessment of the effectiveness of the rehabilitation was performed before first procedure and in 3 and 6 months after it completion. Statistical processing was performed using software Statistica 13.0 (TIBCO, USA)Results. After 3 months of follow-up after PRP-therapy revealed even greater significant differences in the structural and functional parameters of the skin compared to baseline. There was an increase in the thickness of the epidermis by 16.7%, the level of hydration increased by 26.9%, the level of TEV by 29.5%, the oiliness of the skin or the level of seboregulation increased by 16.8% (p ≤ 0.05). Important characteristics of the protective effect of PRP therapy were an increase in the elastic properties of the skin by 31.8% and an increase in the microcirculatory network by 23.1% compared to baseline before the procedure of PRP therapy (p ≤ 0.05).Conclusion. The proposed method can be used as a stand-alone complex conservative therapeutic method of treatment and is used after surgery to rejuvenate the skin of the face and neck in people over 40 years. It has been shown that the effectiveness of restoring the functional state of the musculoskeletal corset of the face increases when using PRP at the same time as massage. It is substantiated that the combination of activation massage and regenerative stimulation by the introduction of PRP should be carried out simultaneously during treatment throughout the course.