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Being one of the main target organs in cardiovascular diseases, the vessels (primarily arteries) have for a long time been included in the zone of increased interest of the medical community. The vascular system regularly passes through a specific set of biological changes associated with chronological aging. Aging increases the duration of exposure to damaging factors and involution of recovery mechanisms, contributing to cumulative damage to the blood vessels and accelerating development of atherosclerosis. However, atherosclerotic changes that develop at a relatively young age can result from early vascular aging (EVA). EVA depends not only on the influence of the known risk factors (hypertension, diabetes, dyslipidemia, smoking, family history of cardiovascular diseases, metabolic syndrome), but also on the program originating from the prenatal period. Chronic kidney disease, inflammation, genetic and fetal programming, telomere biology, oxidative stress, salt dependence accelerate vascular aging. Thus, the study of the phenomenon of early vascular aging is a very promising direction of modern cardiology. Understanding the mechanisms of accelerated aging and timely identification of its markers will allow more effective treatment of the high−risk patients, thereby reducing the probability of cardiovascular catastrophes.

One of the important factors in heart failure pathogenesis is aldosterone, blood plasma concentration of which in such patients may exceed normal values by a factor of 20 due to an increase in its production and reduction of the clearance rate. Aldosterone acts as a water−salt metabolism regulator, contributing to retention of sodium and water, initiating the loss of potassium and magnesium ions and ultimately leading to hypervolemia and hemodynamic disorders. The presence of convincing evidence of the effectiveness of aldosterone antagonists in heart failure has been the basis for inclusion of this group of drugs in the recommendations on the management of patients with chronic heart failure. To study the efficacy of eplerenone a total of 15 patients with heart defects of various origin underwent dynamic observation within the period of 12 months after surgical treatment. The complex of diagnostic examination included physical examination, electrocardiography (ECG), echocardioscopy (ECHO) performed before surgical treatment, then at the stage of postoperative rehabilitation 1 month, 6 months and 12 months after the surgical treatment. The findings of the allowed the conclusion that eplerenone therapy leads to a more pronounced decrease in the size of the left ventricle in patients, who underwent valve replacement. Reduction of the size of the left atrium within 1 year after prosthetics occurs independently of therapy with drugs of the group of aldosterone receptors antagonists.

The most effective strategy in treatment of acute myocardial infarction is percutaneous coronary intervention with early restoration of coronary blood flow in the ischemic region of the myocardium. However, this approach does not always lead to reduction in the volume of necrotic myocardium and the earliest possible restoration of the contractility of the left ventricle, that is the patient recovery. Considering the biochemical changes that occur at the cellular level during implementation of the pathological mechanism "ischemia − reperfusion", the search for drug therapy aimed at protecting the myocardium from reperfusion injury is pathogenetically justified. To investigate the efficacy of ranolazine and quercetin in patients with STEMI after percutaneous coronary intervention and their effect on long−term treatment outcomes, 105 patients were inbvestigated. Percutaneous coronary intervention was performed on average 7,6±1,2 hours after the appearance of the first symptoms. Three treatment groups were distinguished: group 1 included the patients who were prescribed quercetin for 5 days immediately after randomisation; group 2 included the patients, who were prescribed ranolazine orally for 30 days; group 3 consisted of patients who received standard treatment before and after percutaneous cotronary intervention. Non−renewable flow was determined after recanalization of the infarct−related artery as a lack of optimal myocardial perfusion using the MBG scale (Myocardial Blush grade, MBG ≤ 2 b). The frequency of development of myocardial infarction complications (postinfarction angina, ventricular and supraventricular arrhythmias, acute aneurysm of the heart) were analyzed. The dynamics of forming heart muscle damage zone was studied on the basis of serial determination of the activity of the MB fraction of serum creatine phosphokinase in peripheral venous blood on the first 3 days after the heart attack. Our study demonstrates that inclusion of quercetin and ranolazine in the pharmacotherapy of patients with STEMI after percutaneous coronary intervention does not affect the restoration of myocardial perfusion but reduces serum activity of MB creatine phosphokinase as a marker of myocardial necrosis and reduces the incidence of postinfarction angina.

It is known that diabetes mellitus, as a rule, is accompanied by a lesion of the cardiovascular system. In persons suffering from diabetes for more than 20 years, the incidence involvement of the lower limb arteries exceeds 80 %. More than half of all nontraumatic amputations of the lower extremities are performed in patients with diabetes, often repeatedly, and postoperative lethality in these patients remains high. The results of surgical treatment of patients with ischemic form of diabetic foot syndrome with the lesion of the arteries of the popliteo−tibial segments who were treated at hospital N1 (Kyiv) within 2001−2009, Center for Vascular surgery of Feophania Hospital within 2010−2016 were analyzed. Materials and methods. The analysis of the results of surgical treatment of 275 patients with type 2 diabetes mellitus with ischemic form of diabetic foot syndrome with a stenotic−occlusive lesion of the arteries of the popliteo−tibial segments with chronic critical ischemia of the lower limbs treated in Clinical Hospital N1 in Kyiv during The investigation showed that primary patency of the arterial reconstruction zone in patients who underwent an open arterial reconstruction for the purpose of correction of chronic critical ischemia of the lower limbs was 94,4 %, secondary patency − 97,6 %, the proportion of high amputations was 2,4 %, mortality − 4,0 %. Primary patency of the arterial reconstruction zone in patients who were performed restoration of patency of the popliteo−tibial segments using balloon angioplasty amounted to 85,9 %, the secondary patency was 96,0 %, the proportion of high amputations was 4,0 %, mortality − 1.3 %. The findings of the investigation allow the conclusion that endovascular methods of surgical treatment of stenotic−occlusive lesions of the arteries of the popliteo−tibial segments with critical ischemia in patients with diabetes mellitus are appropriate for use in elderly and old patients with severe comorbid background.

At present, the issues of topographic−anatomical features of the postprandial acid pocket when choosing an antireflux operation has not been sufficiently investigated. The state of the postprandial acid pocket after various antireflux operations and its role in the development of pathological gastroesophageal reflux recurrence in the postoperative period also remain topical. Topographic and anatomical features of the postprandial acid pocket and its role in development of gastroesophageal reflux in patients with complicated forms of peptic ulcer disease were investigated. To diagnose gastroesophageal reflux daily multichannel esophago−pH−impedance monitoring was used. To assess the role of the postprandial acid pocket, fragments of the pH−impedance−monitoring charts reflecting the period of daily meals and the postprandial period (up to 2 hours) in patients with different levels of postprandial acid pocket location relative to the diaphragm were selected. Comparative analysis of the obtained data in patients with complicated forms of peptic ulcer disease and different location of the postprandial acid pocket showed that the most favorable conditions for development of acid gastroesophageal reflux are formed when the postprandial acid pocket is located above the diaphragm in the hernial cavity. In the postprandial period, a significant increase (p < 0,05) of the reflux time was established in patients with concomitant hiatal hernia. Thus, our investigation confirmed the existence of postprandial acid pocket and its role in acid gastroesophageal reflux in this group of patients. The total time (p < 0,05) of acid reflux in the postprandial period and their number (p > 0,05) depends on the size of the postprandial acid pocket and its position relative to the diaphragm. The risk of acid gastroesophageal reflux is higher in patients with complicated form of peptic ulcer disease and accompanying hiatal hernia.

The urgency of burns issue is determined by their frequency, complexity, duration, high cost and a significant number of unsatisfactory results of treatment of extensive deep burns. The most important issue of diagnosis is differentiation of superficial and deep burns, as they are fundamentally different in local and general manifestations and methods of treatment. Elastography and elastometry, the methods for qualitative and quantitative analysis of elastic properties of tissues are used with this purpose. To assess the possibility and reliability of elastometry in determining the depth of burn damage at the stages of early local and infusion−drug treatment of thermal trauma, compression elastography was performed in 37 patients with thermal burns using ultrasonic compression elastography and shear wave elastography. It was established that elastography allows assessing the state of the affected tissues and assess the dynamics of necrobiotic processes, promptly detect ischemia increase in the zones due to an increase in interstitial pressure in them and establish indications for performing drainage operations of necro− and fasciotomy for the purpose of decompression.

Abnormal uterine bleeding of the pubertal period is a disease associated with functional disorders of the hypothalamic−pituitary−gonadal system and biorhythm disorders during formation of the female reproductive system. Timely diagnosis and adequate treatment play an important role in prevention of the process recurrence, which positively effects development of normal reproductive function in the future. From the age of 14−15 years, vagina microbiocenosis in healthy teenage girls corresponds to the microflora of the vagina of women of reproductive age. Disorders of the normal microbiocenosis of the genital tract depress local immune responses against a background of reduced immunobiological protection. To improve the diagnosis and treatment of this disease, taking into account the study of the microbiological composition of the vaginal secretion, 98 girls−teenagers aged 11−17 were investigated. Bacteriological study of the state of the vaginal microbiocenosis was carried out, the species and quantitative composition of the bacterial vaginal microflora were determined. Microscopy revealed a high number of leukocytes in the vaginal secretion in one of five patients, which indicates the presence of an inflammatory process in the vagina. Bacteriological study against a background of abnormal uterine bleeding demonstrated opportunistic microorganisms, which corresponds to the intermediate type of the biotope of the vagina. To verify the diagnosis, it is advisable to investigate the nature of the vaginal secretion for developing the tactics of complex therapy. As a result of the study, it was found that it is expedient to perform examination and timely correction of the microbiocenosis of the urogenital tract as well as to use probiotics in the treatment regimen to correct the microflora of the vagina.

The process of cyst formation in the ovaries is a common condition that develops in polycystic ovary syndrome (PCOS) and changes the structure and function of the ovarian tissue. The purpose of this study was to determine the diagnostic value of the clinical−hormonal and echographic criteria of PCOS. The study involved 90 patients, of them 65 had PCOS (main group) and 15 were otherwise healthy (controls). Analysis of parameters of complex gynecological and ultrasound examination of 65 patients demonstrated that in 46 cases (70,8 %) uterine size was less than normal (grade 1 and 2 hypoplasia), and in 19 (29,2 %) − within the limits of normal. In women with PCOS, the ovary volume was almost 3 times greater than in healthy individuals (p < 0,01). The presence of a developing dominant follicle in women of the basic group with PCOS was determined only in 8,8 % of cases, in the controls it was 85 %. The thickness of the ovarian capsule in women with PCOS was also significantly increased (p < 0,001). In women with PCOS, in comparison with the controls, there was a significant increase in the level of prolactin, testosterone (p < 0,05), DHEA−C (p < 0,01), LH (p < 0,01), LH / FSH (p < 0,001), estradiol (p < 0,01), and a decrease in progesterone concentration (p < 0,01). There were no significant changes in the thyroid homeostasis (p > 0,05), which indicates that the thyroid gland does not affect PCOS development in women. Diagnostic criteria of PCOS in women of reproductive age are development of primary infertility, menstrual cycle disorder, hirsutism, obesity, hyperandrogenia, increased ovary volume, absence of maturation of dominant follicles, primary and secondary infertility.

Preimplantation genetic testing is a method for detecting embryos with genetic or chromosomal abnormalities. Further transfer of embryos without genetic or chromosomal abnormalities enables prevention of the birth of a child with genetic diseases, reduction of the level of reproductive loss during pregnancy, as well as increase of the efficiency of auxiliary reproductive technologies cycles. Frequently the cause of chromosomal abnormalities is chromosome non−disjunction in the process of maturation of the sex cells. When conducting IVF, the first stages of the life of the embryo occur in vitro (outside the mother's body), therefore, it is possible to explore the chromosomes. This allows selection of embryos to be transferred to the uterine cavity with a normal chromosomal set, which, in turn, will significantly increase the chances of a healthy pregnancy. Genetic testing can be carried out using various molecular genetic methods, such as polymerase chain reaction, fluorescence hybridization, comparative genomic hybridization, next generation sequencing (NGS). The choice of diagnostic tactics is determined in each case on the basis of infertility history, the status of the body of the mother, the embryos and their number. To determine aneuploidy frequency in different age groups of patients and evaluate the efficacy of conducting preimplantation genetic testing (PGT−A) in programs of in vitro fertilization in older women of reproductive age 131 patients were investigated. PGT−A was performed following IVF procedures in all three groups of patients by means of intracytoplasmic sperm injection (ICSI). The obtained data showed that the frequency of obtaining aneuploid embryos progressively decreased with the age of the woman. But, in spite of the fact that the total number of aneuploid embryos decreased with age, this did not affect the ability to implant them. Importantly, implantation rates together with the incidence of developing pregnancies were found to be several times higher in the group where PGT−A was used in comparison to the group without genetic testing. Based on the results obtained, it is possible to conclude that the use of PGT−A in the group of patients of advanced reproductive age with the purpose to improve the clinical efficacy of treatment in the cycles of IVF with a selective transfer of one embryo.

The review presents main provisions of the concept confirming that multiple sclerosis (MS) is a systemic disease. The information confirming the disturbance of the immune system and factors of nonspecific protection, the sequence of their emergence with participation of cellular and humoral links of immunity in the various types of the disease course is given. The role of immune disturbances in initiation of proinflammatory cytokines is indicated. Risk factors of MS development (viral and other chronic infections, improper feeding, namely vitamin D insufficiency, frequent labor, stresses, contamination of the environment, harmful habits, genetic predisposition) are described. The association of the immune system with the state of blood brain barrier (BBB), cerebral vascular system, depending on the age and sex, autonomous nervous system (the state of its supra−segmental and segmental links), (prolongation of cardiac intervals, decrease of their heart rhythm variability indices (HRV) with the tension of regulatory mechanisms and activity of subcortical sympathetic centers, the increase of more pronounced neurologic deficiency in the great vagal activity) ensuring compensatory−trophic influences both on the various structures of the brain and the state of other organs and systems are stated. Variants of disturbance of "wake−sleep" cycle and the changes of bioelectrogenesis of the brain depending on the types of MS course are described. The data on MS as a multi−systemic disease with a great percentage of development of co−morbid conditions of the cardiovascular, endocrine, urinary, osteomuscular systems, connective tissue, gastrointestinal tract and respiratory organs are given.

Owing to the success of modern critical care medicine, the number of patients surviving after severe craniocerebral trauma increases annually. But the emerging post−traumatic disorders of consciousness without adequate early rehabilitation terminate lethally. Therefore, it is necessary to search for diagnostic criteria based on the severity of organic lesions of the brain substance according to X−ray computed tomography, which allows predicting patients recovery from coma after severe craniocerebral trauma. To determine informativity of computer−tomographic investigation in patients after CCT at different stages of post−comatose post−traumatic consciousness restoration, 220 patients in cerebral coma for at least 10 days from the moment of CCT were examined. Brain CT was performed three times within 12 months after injury to each patient in bone and parenchymal modes using standard positions. According to CT, the probability of recovery from coma with a higher level of post−comatose consciousness in severe CCT was higher in patients with combination of severe focal lesions with slight diffuse changes. In the presence of combination of severe focal and severe diffuse post−traumatic brain changes, the majority of patients remained in a vegetative state, with the exception of 6,12 % of patients who, during a year after a severe CCT, reached the stage of akinetic mutism. Thus, X−ray CT with the analysis of focal and diffuse changes in the brain at different stages in patients after severe CCT reveals new capabilities of the method in predicting the recovery of the level of post−comatose consciousness.

The most common variants of cardiac pain are psychogenic cardialgias, while this phenomenon itself belongs to the group of various affective and autonomic disorders pathogenetically associated with pain in the heart. This determines the relevance of timely and accurate diagnosis of non−cardiogenic psychovegetative cardialgias, the choice of the correct and pathogenetically valid tactics of their treatment. The purpose of this study was to invesyigate the level of anxiety (trait and state), quality of life by questionnaire SF−36, the state of the autonomic nervous system of medical students during the session and the final tests, which were prescribed Corvalment. The study involved 100 undergraduate students from Kharkiv National Medical University, who during the period of emotional strain experienced pain in the heart after a thorough clinical and instrumental examination, considered as psychovegetative cardialgias. Half of them as a treatment and prevention of psychogenic cardialgia were prescribed the drug Corvalment 1 capsule 3 times a day sublingually for 7 days. After the course of the drug administration, the students did not have cardiac complaints, trait anxiety was reduced by Spielberger−Khanin scale, and the quality of life improved by SF−36 questionnaire. The students who did not take Corvalment experienced pain and discomfort in the region of the heart, increased anxiety, mood lability, insomnia. Thus, Corvalment demonstrated high efficacy in treatment of psychogenic cardialgias, contributed to lowering anxiety and improving the quality of life. The drug is safe, since its administration tid for seven days did not produce any side effects in the investigated persons. Corvalment can be recommended as a drug for emergency aid to the patients with psychogenic cardialgias.

Surgery is an effective method to correct and prevent cerebrovascular insufficiency progress in chronic cerebrovascular disease, in particular occlusive−stenotic pathology of the brachiocephalic artery. Its main purpose is to increase the flow of blood to the brain tissue in the areas with hypoperfusion, which prevents stroke development. The most widely used and most common methods aimed at improving cerebral circulation in this pathology are carotid endarterectomy and creation of extraintracranial microvascular bypass. To evaluate the results of the study of cerebral hemodynamics in patients with occlusal−stenotic pathology of the brachiocephalic arteries before and after creation of extraintracranial microvascular bypass with perfusion multispiral computed tomography and duplex vascular sonography of the head and neck, the results of surgical treatment in 12 patients were analyzed before and after microvascular bypass placement. Effectiveness of surgical intervention was evaluated according to the data of neuropsychological examinations, duplex sonography of the head and neck vessels, multispiral computed tomography, selective cerebral angiography. Extraintracranial bypass was created between the superficial temporal and middle cerebral arteries. Extraintracranial bypass efficacy was confirmed by the data of case history and cerebral perfusion results. Perfusion multispiral computed tomography and duplex sonography of the head and neck vessels are important methods for detecting hemodynamically significant pathology of cerebral vessels at the preoperative stage in patients with steno−occlusive pathology of the brachiocephalic arteries in monitoring the cerebral hemodynamics state in the postoperative period with the purpose to evaluate the long−term results of surgical correction

Intervertebral discs protrusions, often beginning in the childhood and adolescence, are one of the most common causes of cervicogenic headaches. The diagnostic features of cervicogenic headaches are the signs of involvement of the cervical spine: possibility of mechanical provocation of the headache attack by iatrogenic and/or subjective action; reduction in the volume of movements; diffuse ipsilateral pain syndrome in the region of the neck, shoulder girdle, arm of nonradicular nature, or (rarely) pain in these areas of radicular origin. In the existing publications the data on comparison of the results of ultrasound examination of intervertebral disks protrusions in the cervical spine in adolescents and young patients with cervicogenic headaches are absent. With this purpose, ultrasound examination of intervertebral cervical disks protrusions in the cervical spine was performed in 86 teenagers and young patients with cervicogenic headaches. The study was conducted at the level of the cervical spinal disks in sagittal and axial projections. Relationships between the sizes of intervertebral discs and the vertebral canal, the anterior and posterior dural space, as well as the state of the pulp nucleus and the fibrous ring were determined. The results of the study showed that in adolescents and young patients with cervicogenic headaches, median protrusions with the most frequent localization in the spinal cord segments C2−3, C3−4 predominated. The leading quantitative signs of protrusion of intervertebral discs are increase in the index of intervertebral discs/vertebral channels, decrease in the indices of the anterior and posterior dural space, and the anterior dural space/vertebral canal. In patients with cervicogenic headaches in the context of protrusions, changes in the pulp nucleus with a marked increase in prevalence in young people are detected in comparison with the adolescent group.

According to the International Labor Organization, about 2,3 million men and women die annually as a result of workplace accidents or job−related illnesses, which means an average of 6,000 people a day. The analysis of occupational injuries and occupational diseases in Ukraine over the past years has shown that, despite the measures taken by the state and employers to create safe working conditions in the workplace, the level of injuries remains rather high. Retrospective analysis of the indicators of occupational injuries in Ukraine and Dnipropetrovsk region for 2017 was carried out on the basis of statistical data of victims of industrial accidents, in which the acts on the form of the H−1 were compiled. The analysis of the obtained indicators shows that the level of occupational injuries remains high. Quantitative and qualitative indicators of occupational injuries in Dnipropetrovsk region reflect the general state of this problem in the country. The need to address the urgent problem of industrialized countries, reducing the level of injury in the workplace, is possible only with a comprehensive approach to the problem. Effective safety management can be achieved by building an effective system for managing occupational risks at different levels. The solution to this requires development and implementation of scientific and methodological provision of safety based on management of occupational risks at different levels of management, taking into account the best practices of foreign countries.

In the recent few years a clear tendency to the increase of diseases of female reproductive system, the important factor of origin of which is untimely administration of the course of rehabilitation measures, in particular after operative interventions on the reproductive organs, has been observed. A large number of patients are women of reproductive age, socially active, capable of working, who need sanatorium−resort rehabilitation. The urgency of rehabilitation treatment for women who survived operative interventions on the reproductive organs, is conditioned, first of all, by restoration of specific functions of woman organism (reproductive, sexual, menstrual) and is aimed at normalization of adaptation−compensation mechanisms, increase of general immune reactivity of the organism, maintenance and achievement of maximal level of capacity of woman. Achievement of primary clinical objective of restorative treatment of patients in a subacute period after operative interventions on the reproductive organs in the conditions of sanatorium resort "Clinical health Rresort "Berezovski Mineralni Vody"" consists in prevention of development of accompanying diseases and prevention of chronic disease conplications and adhesions formation, increase of regeneration processes, improvement of the tissue trophism and prevention of such complications as allergic reactions, systemic dysbacteriosis, metabolic disorders. The legislative provisions, that regulate realization of rehabilitation treatment in the conditions of sanatorium, basic principles of organization of medical rehabilitation, modern possibilities and achievements in realization of the indicated goal, meaningful advantages of sanatorium−resort "Clinical Health Resort "Berezovski Mineralni Vody"" in realization of rehabilitation treatment ofgynaecological patients in a subacute period after operative interventions on the reproductive organs are presented.