Aim. To improve the results of treatment and prophylaxis of postoperative hypoparathyroidism by considering pathogenetic universal mechanisms of cell damage and processes of protection of the cells vital functions on the basis of the analysis of operated patients with pathology of the thyroid gland, as well as to prove the necessity of the prescription of preparations with antihypoxant-antioxidant action in the postoperative period.  Material and Methods. The research is based on the results of a comprehensive examination and treatment of 70 patients with different thyroid gland pathology who were inpatients at the Surgery Department of the Ivano-Frankivsk Central City Clinical Hospital and at the Ivano-Frankivsk Precarpathian Cancer Dispensary from 2014 to 2017. Among the examined patients there were 46 women (65.7%) and 24 men (34.3%). Hemithyroidectomy was performed in 26 out of 70 patients (37.1%), in 16 out of 70 patients (22.9%) - subtotal resection of thyroid gland lobe; in 14 out of 70 patients (20.0%) - thyroidectomy; in 14 out of 70 patients (20.0%) - thyroidectomy with central and peripheral lymph node dissection. Determining of the products of oxidative modification of proteins in blood serum was performed by reaction of proteins with 2.4-dinitrophenylhydrosine. The optical density was recorded using a spectrophotometer SF-16. Determination of catalase was performed using the method of A. Bakh and S. Zubkova. The statistical processing of the obtained results was performed using the standard program package "Statistica 6.0 for Windows" (StatSoft, USA). Results and Discussion. As a result of the study it was determined that an imbalance of systems of active forms of oxygen - antioxidant protection occurred in all patients in the postoperative period, but the pathological process was significantly deepened in patients with signs of hypoparathyroidism after surgery. Disturbance of the balance of peroxidation systems of lipid-oxidative modification of proteins on the one hand and antioxidant defense systems on the other hand were detected from the first day after the operation and were increased during the 3rd day, and in the absence of correction, they were significant during the 7th day of the postoperative period. A promising direction of complex therapy in patients with signs of postoperative hypoparathyroidism was the use of medicines with antioxidant effect. Therefore, in the postoperative period in patients operated for thyroid diseases, an increase in the products of the oxidative modification of proteins and lipid peroxidation, along with the reduction of catalase enzymes, superoxide dismutase, ceruloplasmin, was observed. Conclusions. In the postoperative period in patients operated on for thyroid gland diseases, the increase of oxide modification of proteins (OMP) products against the background of reduction of enzymes of antioxidant defense (AOD) could be traced. It was determined that imbalance of OMP-AOD system deepened in patients with presence of signs of hypoparathyroidism. It was determined that the maximum increase in OMP products occurred in patients within the 1st day of post-operative period, while the maximum decrease in AOD enzymes was observed in patients during the 6th-7th days, indicating an important role of oxidative stress in the pathogenesis of post-operative hypoparathyroidism. The use of drugs with antioxidant-antihypoxant action, namely the drug Citoflavin in the early postoperative period is a promising area of complex therapy for patients with signs of postoperative hypoparathyroidism.

Aim. To identify infertility prognostic factors of thepro-/ antioxidant system in men with left-side varicocele grade II-III. Materials and methods. The trial includes 67 patients with left-side varicocele grade II-III and concomitant changes in spermogram and / or infertility. During the follow up, three months after varicocelectomy, 62 patients were reexamined. The control group consisted of 25 virtually healthy men aged 19 to 33 years. Enzymes activity of pro-/antioxidant system in the blood plasma from periferal and from testicular veins, as well as in the spermatozoa were measured, before and 3 months after varicocelectomy. In particular, the activity of glutathione peroxidase, glutathione reductase and glutathione transferase, the concentration of reduced glutathione and malonic dialdehyde were determined. In addition, the activity of arginase, constitutive and inducible isoforms of nitric oxide synthase, the activity of ion-transport systems of sodium, potassium and calcium, magnesium adenosine triphosphatase in the spermatozoa were studied. Results and Discussion. The activity of glutathione antioxidant enzymes and the concentration of malonic dialdehyde as well as reduced glutathione in the serum of the internal spermatic veins in men with left side varicocele grade II-III were significantly different in comparison groups. Thus, a statistically significant reduction in the concentration  of the glutathione-peroxidase system enzymes and of reduced glutathione in the serum of the internal spermaticvein were observed against the background of a reliable increase in the level of malonic dialdehyde compared with the concentrations of these parameters in serum of peripheral venous blood, and even more so with norm. Therefore, the ROC analysis of the above enzymes’ activity of the pro-/antioxidant system in serum from the internal spermatic vein of patients with left side varicocele grade II-III revealed certain patterns. Concentrations of glutathione-peroxidase system enzymes and reduced glutathione in spermatozoa of patients with left side varicocele grade II-III by analogy with the differences observed in the serum of the internal spermatic vein of these same patients, were characterized by a significant lag behind the rates in practically healthy men. In contrast, the level of malonic dialdehyde statistically significantly exceeded the norm. The obtained results confirm the thesis about the exhaustion of the compensatory mechanisms of the glutathione antioxidant system and increase the intensity of lipoperoxidic processes in spermatozoa in men with left-side varicocele grade II-III. The reduction in serum of the internal testicular vein of glutathione peroxidase activity to £148,55 nmol GSH/min·g Hb, of glutathione reductase to £32.7 mcmol NADPH/min·g Hb, and glutathione transferase to £137 nmol GSH/min·g Hb, as well as reduced glutathione to£0.85 mmol/l with malondialdehyde growth greater than 7,9 mcmol/l should be attributed to the prognostic predictors of the probability of infertility development in patients with left-side varicocele grade II-III. Results showed, that the most significant predictors of the probability of infertility development in spermatozoa were decreased activities of arginase £46 pmol citrulline/min ·1 mg protein and inducible nitric oxide synthase >1,2 pmol citrulline/min·1 mg protein. Conclusions. The negative influence of the reactive oxygen species on the quality of the ejaculate remains a relevant issue. Therefore, the practical application of the data about antioxidant imbalance in patients with varicocele requires further, more detailed study. Changes in fertility status in patients with varicocele leads to decreased levels of antioxidant and increased levels of prooxidant enzymes in the blood and spermatozoa wich can be used as a predictors of maleinfertility. Indicators of the pro-/antioxidant system have proven themselves as predictors of infertility in patients with varicocele.

Aim. To determine the clinical and prognostic role of plasma level of stimulating growth factor inmiscellaneouscardiovascular pathology. Material and Methods. There was carried out a review of literature highlighting the clinical and prognostic role of the plasma level of the stimulating growth factor in cardiovascular pathology. Results and Discussion. Data from modern literature indicate that recent studies of various non-invasive biomarkers such as troponin I, natriuretic peptide, galectin-3, and stimulating growth factor expressed by gene 2 (ST2) are studied in great detail. ST2 is one of the main biomarkers, which signals the presence and severity of structural remodeling of the heart, especially in patients with acute myocardial infarction and heart failure. It is proved that ST2 possesses a wide range of biological effects, in particular, it plays an important role in the pathogenetic mechanisms of development of cardiovascular diseases. This biomarker is a powerful predictor of development of various cardiovascular diseases and has all the features to recommend determining itfor predicting cardiovascular disease in patients with no clinically significant symptoms. Conclusion. ST2 is a new biomarker that has proven to bea highly informative prognostic factor in patients with acute and chronic heart failure and coronary artery disease, including STEMI and NSTEMI. In the future, the widespread use of plasma level ST2 will allow predicting the development of various cardiovascular complications and death with high probability. The use of this biomarkerprovides a perspective for the development of preventive measures aimed at improving the quality of life of patients and reducing cardiovascular mortality, as well as loweringthe cost of treatment for cardiovascular diseases.

Aim of the study was to determine the role of the maternal genotype of the rs1801133 and rs1801131 loci of the MTHFR gene and rs2236225 of the MTHFD1 gene as the risk factor risk of congenital heart defects in offspring. Materials and Methods. The cases group consisted of 42 women who gave the fеtus with congenital defects of the heart and its large vessels. The control group included 85 women who gave birth to healthy children without a complicated genetic and obstetric history. The study used the polymerase chain reaction method, thermostable Taq polymerase oligonucleotide primers and restriction endonuclease (Thermo Fisher Scientific, USA). For the analysis of MTHFR 677C>T MTHFR 1298A>C and MTHFD1 1958G>A polymorphic loci, the RFLP method (restriction fragment length polymorphism) was used. Results and Discussion. According to the results of genetic testing and statistical calculations, the distribution of the genotypes and alleles of the polymorphic loci of MTHFR and MTHFD1 genes were compared with the control group. It was found that in cases group was significantly higher the frequency of the minor T allele of the polymorphic locus 677 C>T of the MTHFR gene (rs1801133) and the frequency of the TT genotype (p<0.05). It has been found that women with TT genotype, the risk of having a baby with congenital heart defects increases twice (p<0.05). For the other two polymorphic loci of the rs1801131MTHFR gene and rs2236225 of the MTHFD1 gene, no significant association was found with the risk of CHD of the fetus. Conclusions. According to the results of genetic testing, allelic and genotypic distribution at the loci of 677 C>T and 1298 A>C of the MTHFR gene and 1958G>A of the MTHFD1 gene in women with congenital heart defects of the fetus were established. It was found that the carrier of the T allele of polymorphic variant 677 C> T of the MTHFR gene in a woman doubles the risk of congenital heart defects of the fetus. Homozygous TT and the heterozygous CT genotype of the polymorphic variant C677T of the MTHFR gene in a woman are genetic factors for increased risk of formation congenital heart defects of offspring. To improve the system of preconception prevention and early diagnostics of the congenital heart defects, effective medical genetic counseling and prognosis of healthy offspring, it is proposed to include the determination of the genotype of the locus 677 C>T gene MTHFR of pregnant women as a risk of congenital heart defects of the fetus and required folic acid supplementation for prevention during the periconception period.

Aim&nbsp;of the study - a scientific substantiation of trends in the development of non-communicable diseases (NCD) among the population of independent Ukraine and their age characteristics.&nbsp; Material and Methods.&nbsp;An epidemiological one-stage solid scientific research based on data from the Center for Medical Statistics of the Ministry of Health of Ukraine and the State Statistics Service of Ukraine for 1993 and 2017 with their compilation and processing in the Microsoft Office Excel spreadsheets package 2016. The retrospective, statistical, mathematical, abstract and graphic methods of study, as well as methods of copying, deductive awareness, structural-logical analysis taking into account the principles of systemicity are used. Results and Discussion.&nbsp;The consequences indicate an increase in 2017 as data of the NCD specific weight indicator (Р=39,7%) of the total number of all diseases in Ukraine (Sn=72689184) +1.5 and the total number of NCD (n=28622401) +74,4% or n=+12206502 cases and +2.1 the data of the indicator of the prevalence level of NCD (Р=67482%000) in comparison with the true information of the basic 1993. The first rating place in the general structure of NCD (n=28622401) in 2017 is occupied by the circulatory system diseases [I00-I99] (P=78.4%; n=22447510; Р=Р=52924%000); the second evaluation position - the diseases of the class of tumors [С00-D48] (P=6,2%; n=1774377; Р=4183%000); the third ranked position - diseases of the class of mental disorder and behavior [F00-F99] (P=5,8%; n=1673202; Р=3945%000). The chronic respiratory diseases [J40-J46] with indicators P=5,1%; n=1456383; Р=2004%000 occupy the fourth grade level, whereas diseases of diabetes mellitus [E10-E14] (Р=4,4%; n=1270929 and Р=2996%000) are on the last - the fifth position of the given rating. Among children under the age of 14 years, including in 2017, the NCD structure indicator is P=1,4%, with n=413802 diseases and prevalence levels P=6332%000, while among children aged 15-17 years, the specific weight of analyzed diseases is P=0.6%, with n=152552 cases and Р=14124%000, and among the adult population (18 and &gt; years), these indicators are respectively: Р=98,0%; n= 28056047 diseases; P=80622%000. Conclusions.&nbsp;The results clearly indicate the steady growth of NCD among the population of Ukraine during the investigated time period, which has a direct negative impact on the state of socio-economic well-being of society, resource support of defense and national economic complex of the state, and on the urgent introduction by the Ministry of Health of Ukraine to practical health care of the mechanisms of minimization of the event of the outlined pathology and its consequences for the population in the context of recommendations of WHO.&nbsp;

Aim.&nbsp;To develop a strategy of improvement of the effectiveness of infertility treatment by preparing endometrium in ART program. Materials and Method.&nbsp;The study was conducted from 01.01.2015 to 31.12.2016 in the Communal Institution "Regional Medical Centre of Human Reproduction" of Zaporizhzhya Regional Council. It involved 112 patients with 1-2 previous unsuccessful fertilization attempts in ART programs. The diagnostic stage included general examination approaches: extended range of ultrasound exploration; diagnostic hysteroscopy or the Pipelle &nbsp;endometrial biopsy; PCR diagnosis and detection of antisperm antibodies; and additional tests: Hyaluronan binding assay, identification of antibodies to Zonapellucida oocyte and the degree of the sperm DNA fragmentation. Taking into account the identified pathologies, 92 of the 112 patients were divided into four subgroups: I. 23 - with signs of chronic endometritis and cervical antisperm antibodies; II. 12 - with abnormalities of the steroid receptors' expression; III.27 - with endometrium pathology; IV. 30 - with a combination of inflammatory and hyperplastic processes in the endometrium. Twenty patients without any pathology of endometrium were included into the fifth, control group. At the stage of preparation to ART programs, courses of curative plasmapheresis (CP) and ozone therapy were prescribed to all patients. Depending on the indications, additional treatments were administered: HRT, GM-CSF, hCG, and Nicergoline administration. Results and Discussion.&nbsp;By applying an individualized&nbsp;approach, we have developed algorithms for preliminary treatment of endometrium in ART program for each of the selected groups of patients, in addition to CP and ozone therapy: I - complex specific treatment, and also: in case of inflammatory markers' detection - combined oral contraceptives (COCs), and in the presence of ACA - condom therapy; II - COCs or a cycle of HRT, irrigation by HCG, intrauterine administration of G-CSF and drugs improving rheological properties of the blood; III - metabolic and cyclic hormone therapy, irrigation by HCG and intrauterine administration of G-CSF; IV - etiopathogenetic therapy: pharmacological, hormonal therapy, and surgical treatment. According to the results of the clinical work on the comprehensive preparation of endometrium for fertilization in ART programs, clinical pregnancy occurred in: 19 patients (67%) in Group I; 3 patients (25%) in Group ІІ; 10 patients (45%) in Group ІІІ; 19 patients (63 %) in Group IV; and 8 patients (40%) of Group V (control). Conclusions.&nbsp;The implementation of modern techniques and technologies based on the developed strategy of conducting the preparatory stage of the ART program and the optimization of the embryological stage increases the effectiveness of the IVF / ICSI / ET cycles by 15.7% and allows achieving the incidence of clinical pregnancy of 52.7%.

Aim.&nbsp;Estimation of the functional status dynamics of patients with non Q-wave myocardial infarction using a 6-minute walk test depending on the treatment in the acute period during the 6-month follow-up period. Materials and Methods.&nbsp;We examined 77 patients (63.6% males) with non Q-wave of myocardial infarction at the age from 50 to 79 (on average 64.1±1.0) years. Hospital strategy was designed in accordance with the standards of treatment of the acute coronary syndrome without ST-elevation. The assessment of the functional condition of patients was performed using a 6-minute walk test. Results and Discussion.&nbsp;It was determined that percutaneous angioplasty in patients with non Q-wave myocardial infarction in acute period is accompanied by a significant improvement in the functional state of patients during 3 and 6 months, which is characterized by a significant increase in the value of the distance traveled by 10.6% and 23.9%, respectively (p&lt;0.0001) and a decrease of the average functional class size by 16.2% and 27.9%, respectively (p&lt;0.002). In patients with non Q-wave myocardial infarction who did not receive invasive treatment in the acute period, no positive dynamics of the functional state of patients was obtained, only the tendency to increase the value of the distance traveled by 1,2% (p=0,13) in the 3rd and a tendency to decrease the indicator by 0.5% (p=0.51) in the 6th month. Conclusions.&nbsp;A significant decrease in the mean value of the functional class of heart failure in these patients is determined only for 3 months at 7.9% (p=0.04), while in the 6th month only a tendency towards a decrease of 1.7 is recorded % (p=0.78) compared to the original value.

Aim.&nbsp;Based on the proposed methods, to improve the quality of surgical treatment of patients with diabetic foot syndrome by improving the method of surgical treatment of the stump and fixation of the skin after phalangeal amputation. Materials and Methods.&nbsp;The analysis of the results of treatment of 114 patients treated in the surgical department of the TL of Ternopil during 2014-18 years for purulent-necrotic lesions of toes in type II diabetes mellitus was carried out. The age of patients ranged from 44 to 75 years. The following methods are supported by patents for utility model. Results and Discussion.&nbsp;Usually, during small amputations, the necrotic part of the bone phalanx of the finger is removed with the help of Liuer or Liston cutters. The indicated methods have certain disadvantages, as they cause additional traumatization of healthy tissue within which amputation is carried out. Removing necrotic tissue with manual mechanical amputation tools requires the application of force and compression, which leaves microcracks and splinters at the immediate location of the instrument on the healthy residual bone tissue and also injures the surrounding tissue, adversely affecting the wound healing process and treatment as a whole. However, the fixation of the skin after the amputation of the phalanx of the finger is preceded by the removal of the necrotic part of the phalanx or the entire phalanx, the cleansing of the open wound surface of fine particles of destructive tissue, treatment of the wound with an antiseptic on a water basis (chlorhexidine, decasan), removal of liquid tissues, blood, lymph and amorphous component, wound tamponade, or seam fixation. The methods of surgical treatment of the foot and the fixation of the skin flap proposed by us improve the existing other methods, where the execution of amputation of the dead part of the phalanx of the finger or even the heads of the metatarsals is carried out using a cut-off metal disk rotating at a speed of 20,000 rpm (revolutions per minute), followed by gradual polishing of the cutoff point of healthy bone tissue. The fixation of the skin flap is carried out by seamless method after preliminary treatment with certain aqueous solutions of antiseptics and an even distribution of the amorphous component, which is formed as a result of mechanical treatment of the stump with a corundum grinding nozzle up to 10 mm in diameter in the form of a layer for 1-2 minutes at a speed of 10,000 rpm.&nbsp; Conclusion.&nbsp;The proposed method of amputation of the phalanx of the finger is characterized by rapid and qualitative cut off of the dead part of the phalanx, absence of additional traumatization of the stump of the bone and surrounding tissues. The method of fixing the skin flap after the amputation of the phalanx of the finger allows preserving the liquid tissues on the wound surface that provide nutrition and fixation of the transplanted skin flap closing the wound. This approach to treatment of purulent-necrotic wounds in patients with diabetic foot syndrome provides significant acceleration of wound healing, reduces the risk of implantation infection, eliminates additional tissue injuries during overlaying and sewing, and, accordingly, reduces the patient's stay in hospital treatment to 5 to10 &nbsp;days.

Liver cirrhosis is usually accompanied by extrahepatic syntropic lesions, among which cardiomyopathy is one of the most common. To date, both the definition and the criteria of syntropic cirrhotic cardiomyopathy have been formulated. However, information on the exploration of the relationship between the changes of the heart in these patients and the class of severity of cirrhosis in is not found in the available literature. Aim.&nbsp;To describe the ultrasound features of the heart in patients with syntropic cardiomyopathy and to find out their features related to the severity of the main liver disease. Material and Methods.&nbsp;After receiving the consent on conduction of the complex examination in randomized way with the previous stratification on the presence of the cirrhosis there were selected 603 patients (445 men, 158 women, age 49,2±10,6 years). The patients were stratified into two subgroups: 113 patients with cirrhosis and without circulatory system disorder of which 23 patients were randomly included in the comparison group; 490 patients with cirrhosis and extrahepatic circulatory system disorder from which, in a randomized manner we chose the patients for the experimental group - 66 patients with cirrhosis and cardiomyopathy). The cirrhotic patients in the experimental group were classified according to the criteria of C. G. Child and R. N. Pugh (23 patients in class A, 22 - in B and 21 - in C). The control group consisted of 19 healthy volunteers of the same gender and age. Ultrasound was conducted according to the standard procedure - lying on the left side using the "SAMSUNG H-60" Device. The obtained material was processed using the EViews program (Quantitative Micro Software). Results and Discussion.&nbsp;Our analysis made it possible to reveal a number of structural characteristics of cardiomyopathy: significantly lower end-diastolic volume of the right ventricle and significantly higher end-diastolic left ventricular volume; sizes of right and left ventricle in the systole; sizes of the left ventricle and interventricular septum, which was manifested by pathological myocardial remodeling; normal systolic function at rest in patients of the experimental group achieved due to high stroke volume and, accordingly, high minute blood volume and cardiac indices; diastolic dysfunction and the high C. Tei index. we also found that the structure and function of the heart varied along with the increase of the cirrhosis severity. Namely, the interventricular septum and the left ventricle were found to be hypertrophied and subsequently dilated; systolic function in all classes - within normal ranges, and diastolic - sharply decreased in case of the cirrhosis exacerbation. All this is as a result of the overload of the heart with increasing blood volume and disturbance of metabolic processes in the myocardium. Conclusions.&nbsp;&nbsp;Patients with liver cirrhosis and syntropic cardiomyopathy have specific changes in the structure of the myocardium resulting in the occurrence of pathologic variants of heart remodeling, normal systolic function at rest and diastolic dysfunction. The structure and function of the heart is related to the liver cirrhosis severity &nbsp;- the revealed structural and functional disturbances increase along with exacerbation of the underlying liver disease. The obtained information will help to optimize the diagnosis and treatment of patients with liver cirrhosis and syntropic cardiomyopathy.