Personalized approaches to the treatment of uterine leiomyoma

Aim. To study personalized approaches to the treatment of uterine fibroids taking into account type of the blood supply. Materials and methods. 190 women with pathology of the uterus and endometrium were included in the main group. 34 practically healthy female volunteers were included in the control group. Treatment results of the patients with pathology from 2011 till 2015 years were analyzed. Ultrasound diagnostics was performed following methodic of the color Doppler imaging (CDI) with Voluson Е8 machine (UK) using vaginal transducer with the frequency of 7.5 MHz and convex abdominal transducer with the frequency of 3.5 MHz. Examination was performed in the follicular phase of the menstrual cycle. Uterine fibroids were measured using transabdominal transducer in the case of a large uterus. Results. Features of the uterine fibroids blood supply, which influence the course of the disease, were identified. Classification of the uterine fibroids depending on the type of perfusion was presented. Personalized approach to the uterine leiomyoma treatment was proposed taking into account features of the individual blood circulation measured by Doppler imaging. Conclusions. Type of the uterine fibroid blood perfusion influences the disease course. High IR (0.7 and higher) was identified in the case of avascular and peripheral types of the angioarchitecture, which indicates a low level of the blood supply and need in dynamic observation and antiproliferative drugs. Uterine artery embolization and operative treatment for uterine fibroid should be considered when IR is 0.69 and less in patients with central and mixed types of vascularisation. IR 0.45 and less is symptom of sarcoma and fibroid destruction. Such patients should be referred to an oncogynecologists consultation

STATE SUPPORT IN PHYSICAL INFRASTRUCTURE UPDATING OF AGRICULTURAL ENTERPRISES

The basic constituents of state support of technical update of agriculture of Ukraine are considered in the article. The dynamics of expenses of the state budget on agriculture and the structure of basic market levers of state support of physical infrastructure of agricultural enterprises: financial leasing, partial indemnification of domestic agricultural machinery and reduction of prices for credits has been analyzed. Monitoring of current problems of granting and the ways of improvement of mechanism of state support have been offered. No doubt that the proper support from the side of the state is the motive force in activation of the process of technical update of agricultural enterprises.The basic constituents of state support of technical update of agriculture of Ukraine are considered in the article. The dynamics of expenses of the state budget on agriculture and the structure of basic market levers of state support of physical infrastructure of agricultural enterprises: financial leasing, partial indemnification of domestic agricultural machinery and reduction of prices for credits has been analyzed. Monitoring of current problems of granting and the ways of improvement of mechanism of state support have been offered. No doubt that the proper support from the side of the state is the motive force in activation of the process of technical update of agricultural enterprises

The Effect of a Frailty Management Program on the Rehabilitation of Elderly Patients after Surgical Treatment

The article performs the results of rehabilitation programs realized among senile patients after videolaparoscopic cholecystectomy, based on specific for geriatrics senile patients’ status assessment methods with determination of frailty and geriatric syndromes exten

Monitoring and Quality Control of Diesel Fraction Production Process

In this work the mathematical model of diesel fraction and atmospheric gasoil catalytic dewaxing process has been developed. Also the pattern of applying the created model to solving such problems as monitoring and quality control of diesel fraction production in the catalytic dewaxing process. It has been represented that to meet such challenges, the model should take into consideration thermodynamic and kinetic laws of hydrocarbon conversion on the catalyst surface, and instability factors that are specified by catalyst deactivation. The developed model allows controlling the quality of obtained diesel fraction depending on feed and temperature regime in the reactor. The value of model calculation absolute error does not exceed 2%, which corroborates the adequacy of the model to actual process. The computations using the model have shown that to provide the desired product yield (not less than 40% wt. of overall yield of the unit products) of programmed quality (cold filtering plugging point not higher than minus 34°C for winter diesel fuels and not lower than minus 40°C for arctic ones) at long-time catalyst operation (during 4 years), it is necessary to sustain the reactor temperature at the average level of 19°C higher than when working with fresh catalyst. This must be done to compensate catalyst activity loss due to its deactivation

УЛЬТРАЗВУКОВА ОЦІНКА ВАСКУЛЯРИЗАЦІЇ ЛЕЙОМІОМИ МАТКИ.

The data of comparative analysis of capabilities of complex ultrasound research of uterine arteries in the case of leiomyoma uteri and the data of uterine artery angiography were presented. The study involved 54 patients suffering from uterine leiomyoma who underwent uterine artery embolization (UAE). The effectiveness of the Color Doppler in relation to the angiography was: sensitivity - 83 %, specificity - 88 %, accuracy - 85 %. These results suggest that Colour Doppler can be successfully used in gynecologist practice.Представлены данные сравнительного анализа возможностей комплексного ультразвукового исследования артерий матки при лейомиоме матки и ангиографии маточных артерий. Проведено обследование 54 пациенток, страдающих лейомиомой матки, которым проводилась эмболизация маточных артерий (ЭМА). Результативность ЦДК в соотношении к ангиографии составила: чувствительность - 83 %, специфичность - 88 %, точность - 85 %, что позволяет с успехом использовать эту методику в практике врача-гинеколога.Представлені дані порівняльного аналізу можливостей комплексного ультразвукового дослідження артерій матки при лейоміомі матки та ангіографії маткових артерій. Проведено обстеження 54 пацієнток, хворих на лейоміому матки, яким проводилася емболізація маткових артерій (ЕМА). Результативність КДК у співвідношенні до ангіографії склала: чутливість - 83 %, специфічність - 88 %, точність - 85 %, що дозволяє з успіхом використовувати цю методику в практиці лікаря-гінеколога

Diagnosis of endometrial hyperplasia in routine gynecological practice

Objective. To estimate the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) in diagnosis of endometrial hyperplasia using transvaginal ultrasonography (TVS) versus histopathological findings. Materials and methods. This is a retrospective study of 156 patients who underwent hysteroresectoscopy or diagnostic curettage. A comparative analysis of the preoperative diagnosis according to the TVS and postoperative diagnosis according to the histopathological conclusion was performed. All the patients were divided into 2 groups based on the TVS results before the procedure. Group 1 included 71 women with preoperative diagnosis of endometrial hyperplasia. Group 2 consisted of 85 women who underwent hysteroresectoscopy or diagnostic curettage for some other reasons. Using the statistical and mathematical methods, we determined the diagnostic value of TVS for diagnosis of both endometrial hyperplasia and pathology requiring subsequent invasive intervention into the uterine cavity. Results. According to histopathological findings, endometrial hyperplasia was found only in 35 (49.30 % PPV) out of the 71 patients who were positively diagnosed using TVS. The other 36 patients (50.70 %) had a negative histopathological diagnosis. The women of Group 2 were diagnosed correctly (absence of endometrial hyperplasia) in 52 cases (61.18 % NPV), but findings were positive in 33 (38.82 %) women according to histopathological examination. The sensitivity of TVS in the diagnosis of endometrial hyperplasia was 51.47 % (95 %CI 39.03–63.78) and the specificity was 59.09 % (95 %CI 48.09–69.46). However, the absence of indications for invasive intrauterine intervention was observed only in 4.22 % of women in Group 1 and in 2.35 % in Group 2. Conclusions. TVS has a low diagnostic value to identify an endometrial hyperplasia. TVS has a high diagnostic value for determination of intrauterine pathology which requires further hysteroresectoscopy or diagnostic curettage. Low diagnostic value of TVS in the diagnosis of endometrial hyperplasia necessitates an additional analysis considering the qualification of specialists performing ultrasound, the adequacy of the MOH Order No. 676 fulfillment, warranting reflection of parameters such as the endometrium structure, polypoid inclusions, sound conductivity, outer contour of the M-echo and uterine cavity surface as well as the endometrial-uterine ratio calculation in peri-and post-menopausal patients

Monitoring and Quality Control of Diesel Fraction Production Process

In this work the mathematical model of diesel fraction and atmospheric gasoil catalytic dewaxing process has been developed. Also the pattern of applying the created model to solving such problems as monitoring and quality control of diesel fraction production in the catalytic dewaxing process. It has been represented that to meet such challenges, the model should take into consideration thermodynamic and kinetic laws of hydrocarbon conversion on the catalyst surface, and instability factors that are specified by catalyst deactivation. The developed model allows controlling the quality of obtained diesel fraction depending on feed and temperature regime in the reactor. The value of model calculation absolute error does not exceed 2%, which corroborates the adequacy of the model to actual process. The computations using the model have shown that to provide the desired product yield (not less than 40% wt. of overall yield of the unit products) of programmed quality (cold filtering plugging point not higher than minus 34°C for winter diesel fuels and not lower than minus 40°C for arctic ones) at long-time catalyst operation (during 4 years), it is necessary to sustain the reactor temperature at the average level of 19°C higher than when working with fresh catalyst. This must be done to compensate catalyst activity loss due to its deactivation

Intershock observations during STIP intervals 17 and 18

The Prognoz-10/Intercosmos satellite (Intershock Project) carried out observations from Earth orbit from 26 April 1985 until 11 November 1985, covering STIP Intervals XVII and XVIII. Data obtained during the systematic measurements in the course of STIP Interval XVII and part of XVIII are presented; i.e., hourly averages of the solar wind velocity, temperature and ion concentration, ion flux changes (10 to the -1 to 10 to the -3 Hz), plasma wave parameters, energetic particles flux, magnetic fields, etc. Special attention is paid to solar wind distrubances causing abrupt and large effects on the shape of the bow shock (i.e., on 2 May 1985 and 14 September 1985). Generally, the observation period was very close to a minimum of solar activity and was quiet without significant interplanetary shocks

Avoiding errors in the diagnosis of polypoidal choroidal vasculopathy in patients with age-related macular degeneration (Part 1)

Background: Poor availability of indocyanine green angiography (ICGA) raises the question of how to improve the diagnosis of polypoidal choroidal vasculopathy (PCV) using alternative imaging modalities, optical coherence tomography (OCT) and OCR angiography (OCTA). Purpose: To optimize the diagnosis of PCV in patients with age-related macular degeneration (AMD) using non-invasive methods, OCT and OCTA. Material and Methods: One hundred and sixty-nine patients (228 eyes) with neovascular AMD underwent OCT and OCTA study as per the proposed algorithm to differentiate between PCV and other types of subretinal neovascularization. Of these, 14 patients (8.28%; 14 eyes) were found to have PCV. Results: Major and additional signs of PCV, secondary neovascularization and activity of the process on OCT were determined. In addition, we determined the signs of PCV on OCTA manu-al and automatic segmentation which will be helpful in accurate differential diagnosis of the disease. On the basis of these data, we developed a step-by-step algorithm of the OCT and OC-TA diagnosis of PCV in patients suspected of the disease, which allows the accurate diagnosis when ICGA is unavailable. Conclusion: Systematic step-by-step interpretation of OCT and OCTA scans allow the reliable differential diagnosis of PCV in patients with exudative AMD