ІННОВАЦІЙНІ ТЕХНОЛОГІЇ ПІДВИЩЕННЯ ЯКОСТІ ОСВІТНІХ ПРОЕКТІВ В СИСТЕМІ ЦИВІЛЬНОГО ЗАХИСТУ

The paper presents a system of dynamic factors that determine the quality of the educational projects for the educational establishments with special training requirements? One of which is innovative technologies. A place of interactive technologies among other important factors of the educational project environment is allocated. The advantages and features of the use of interactive computer simulators are determined. The concept of an index of competence is introduced.Представлено модель системи впливу динамічних чинників на якість освітніх проектів для навчальних закладів з особливими умовами навчання, одним із яких є інноваційні технології. Виділено місце інноваційних технологій серед інших визначних чинників освітнього проектного середовища та визначено місце множини її чинників в контексті взаємодії множин. Розглянуто переваги та особливості застосування інноваційних техно-логій в проектах підготовки сучасного рятувальника. Введено поняття індексу компетентнісності

ЗНАЧЕННЯ ПОКАЗНИКІВ ЛЕЙКОГРАМИ ДЛЯ ПРОВЕДЕННЯ ЦИТОГЕНЕТИЧНОГО АНАЛІЗУ КРОВІ ПРИ МІЄЛОФІБРОЗІ

Myelofibrosis is a rare almost incurable disease with lesions of blood-forming stem cells. Cytogenetic abnormalities are independent prognostic markers of unfavorable disease course in myelofibrosis. The method of cytogenetic analysis of the peripheral blood with specific stimulator - granulocyte colony-stimulating factor is used to avoid the need of puncture of bone marrow with fibrotic changes. The aim of the study was to find the criteria for obtaining high-quality metaphase chromosomes from peripheral blood for cytogenetic analysis in patients with myelofibrosis. Leukocyte features and the level of mitotic activity were analyzed in cytogenetic samples of blood obtained using the author's method for 45 patients with myelofibrosis. In 73.3% of patients a sufficient number of suitable for analyzing metaphase plates were obtained, and in 26.7% mitotic cell division in preparations for cytogenetic analysis were not found. Mitotic activity was high in 93.3% of patients with the presence of ≥1% blasts or promyelocytes in leukocyte formula. Metaphase chromosomes were obtained only in 50% of patients without these cells, but with the leukocytic shift to the left to myelocytes, metamyelocytes and/or ≥12% of band neutrophils (mitotic index was lower complicating the cytogenetic analysis). In the absence of significant left shift of leukocytes the sufficient number of metaphase plates for cytogenetic analysis was not found in any patient. Therefore, the cytogenetic studies of specifically stimulated peripheral blood instead of bone marrow is appropriate in the presence of blast cells and promyelocytes in leukocyte formula, and has limited use in case of major leukocyte shift to the left without these cells. Normal leukocyte morphology in the patient requires the study of metaphase chromosomes of bone marrow or the use of cytogenetic techniques with fluorescent hybridization.Миелофиброз является редким практически неизлечимым заболеванием с поражением кроветворных стволовых клеток. Цитогенетические аномалии являются маркерами неблагоприятного течения болезни. Во избежание необходимости пункции фиброзованого костного мозга используется авторская методика цитогенетического анализа периферической крови со специфическим стимулятором - гранулоцитарным колониестимулирующим фактором. Целью работы был поиск критериев получения качественных препаратов метафазных хромосом с периферической крови для цитогенетического анализа у больных миелофиброзом. Проанализированы показатели лейкоцитов и уровня митотической активности в цитогенетических препаратах крови 45 больных миелофиброзом. В 73,3% больных получено достаточное количество пригодных к цитогенетическому анализу метафазных пластинок, а у 26,7% - не удалось получить митотического деления клеток. Митотическая активность была высокой в 93,3% больных с ≥1% бластов или промиелоцитов в лейкоцитарной формуле. При наличии сдвига лейкоцитарной формулы влево без этих клеток до миелоцитов, метамиелоцитов и/или палочкоядерных нейтрофилов ≥12% получено метафазные хромосомы только у 50% больных, причем митотический индекс был ниже. При отсутствии значительного лейкоцитарного сдвига влево достаточного количества метафазных пластинок не получено ни у одного больного. Таким образом, ультразвуковое исследование специфически стимулированной периферической крови целесообразно при наличии в лейкоцитарной формуле бластных клеток и промиелоцитов, а также имеет ограниченное применение при значительном сдвиге лейкоцитарной формулы влево без выявления этих клеток. При нормальной лейкоцитарной формуле исследования метафазных хромосом крови нецелесообразно.Мієлофіброз є рідкісним практично невиліковним захворюванням із ураженням кровотворних стовбурових клітин. Цитогенетичні аномалії є маркерами несприятливого перебігу хвороби. Для уникнення необхідності пункції фіброзованого кісткового мозку використовується авторська методика цитогенетичного аналізу периферійної крові зі специфічним стимулятором - гранулоцитарним колонієстимулюючим фактором. Метою роботи був пошук критеріїв отримання якісних препаратів метафазних хромосом із периферійної крові для цитогенетичного аналізу в хворих на мієлофіброз. Проаналізовано показники лейкоцитів та рівня мітотичної активності в цитогенетичних препаратах крові 45-ти хворих на мієлофіброз. У 73,3% хворих одержано достатню кількість придатних до цитогенетичного аналізу метафазних пластинок, а у 26,7% - не вдалося отримати мітотичного поділу клітин. Мітотична активність висока в 93,3% хворих із ≥1% бластів або промієлоцитів у лейкоцитарній формулі. За наявності зсуву лейкоцитарної формули вліво без цих клітин до мієлоцитів, метамієлоцитів і/або паличкоядерних нейтрофілів ≥12% отримано метафазні хромосоми лише в 50% хворих, причому мітотичний індекс виявився нижчим. За відсутності значного лейкоцитарного зсуву вліво достатньої кількості метафазних пластинок не отримано в жодного хворого. Таким чином, цитогенетичне дослідження специфічно стимульованої периферійної крові доцільне за наявності в лейкоцитарній формулі бластних клітин та промієлоцитів, а також має обмежене застосування при значному зсуві лейкоцитарної формули вліво без виявлення цих клітин. При нормальній лейкоцитарній формулі дослідження метафазних хромосом крові недоцільне

Dwadzieścia pięć lat niepodległej Ukrainy: czy jest na drodze zrównoważonego rozwoju?

The article is dedicated to the analysis of problems and perspectives of sustainable and inclusive development of Ukraine, at the present state of its functioning. The main pillars of sustainable development, such as political, socio-economic, ecological, health and demographic were analyzed in space-time dimension. Ukraine declares compliance with the sustainable development principles and aims to change towards the implementation of this social ideology, however, in reality the implementation of sustainable development concepts is occurring very slowly and unsystematically. Therefore, Ukraine on its way to sustainable development and inclusive development is facing a complex range of typical and untypical social problems. A certain uniqueness of the situation and the geopolitical importance of Ukraine constantly puts in the spotlight the question of its support on the way to sustainable development on behalf of democratic countries. However, this support should be encouraged by the Ukrainian population consolidation towards the democratic choice and the decisive actions of the Ukrainian government towards the reforms recently implemented in the countries of Central and Eastern Europe to overcome the legacy of the authoritarian regimes.Artykuł poświęcony jest analizie problemów oraz perspektyw rozwoju zrównoważonego i inkluzywnego na Ukrainie, na obecnym etapie funkcjonowania państwa. Przeanalizowano główne filary rozwoju zrównoważonego na Ukrainie w ujęciu przestrzenno-czasowym, takie jak polityczny, społeczno-ekonomiczny, ekologiczny oraz zdrowotno-demograficzny. Ukraina deklaruje dotrzymanie zasad stałego rozwoju i zamiar wdrożenia ich założeń do różnych sfer życia społecznego, jednak realizacja koncepcji rozwoju zrównoważonego przebiega w sposób bardzo powolny i nieusystematyzowany. Na drodze do stałego rozwoju Ukraina napotkała na szereg typowych i nietypowych problemów społecznych. Pewna unikatowość sytuacji oraz geopolityczne znaczenie Ukrainy powodują zainteresowanie wsparcia Ukrainy na jej drodze do stałego rozwoju ze strony państw demokratycznych. Jednak wsparcie to powinno opierać się na konsolidacji wewnętrznej ludności Ukrainy w jej wyborze na rzecz demokracji oraz zdecydowanym działaniu władz ukraińskich w kierunku reform, które przeprowadziły nie tak dawno inne kraje Europy środkowo-wschodniej na rzecz wygaszenia wpływów panowania reżimów autokratycznych. Słowa kluczowe: rozwój zrównoważony, rozwój inkluzywny, Ukrain

Innovative Technologies Improving the Quality of Educational Projects in Civil Defence System

The paper presents a system of dynamic factors that determine the quality of the educational projects for the educational establishments with special training requirements? One of which is innovative technologies. A place of interactive technologies among other important factors of the educational project environment is allocated. The advantages and features of the use of interactive computer simulators are determined. The concept of an index of competence is introduced

Informative Value of Combination of Molecular Genetic and Cytogenetic Diagnostic Methods in Myelofibrosis

Introduction. Myelofibrosis is a rare disease affecting myeloid progenitor stem cells. According to the modern criteria of myelofibrosis diagnostics, the confirmation of the clonality of pathological myeloproliferative process is needed. However, the unique pathognomonic marker for this disease is not revealed. Point missense mutation of JAK2 gene in exon 12 – the JAK2V617F mutation, and karyotype abnormalities are the most frequently found in myelofibrosis patients. In case of additional anomalies the disease prognosis worsens dramatically, in particular, because of higher risk of the transformation to acute leukemia. The purpose of the study was to identify informative combination of molecular genetic and cytogenetic clonal markers for diagnosis and prognosis of myelofibrosis. Materials and research methods. 37 patients were recruited in the study (33 with primary myelofibrosis and 4 with secondary post-polycythemia vera myelofibrosis). Cytogenetic studies were performed for 34 patients. All the patients underwent molecular genetic studies of blood to detect the JAK2V167F mutation. The mutational status of JAK2 gene was reexamined in 10 patients from 1 to 2 years after the initial examination. Results of the investigation and their discussion. The presence of the mutation JAK2V167F was confirmed in 59.5 % of the patients. Chromosomal abnormalities were revealed in 38.2 % of patients. The spectrum of abnormalities included deletions and translocations of chromosome 1, deletions of 5q and 20q, trisomies of chromosomes 3, 8, 9 and 12, monosomies of chromosomes 3, 5, 7, 9, 11, 13, 15 and 17, appearance of іsochromosome 17q, and polyploidy. 4 patients had a complex karyotype. The coincidence of investigated point mutation and karyotype abnormalities was revealed in the total of 8 (21.6 %) patients. The presence of the mutant allele V617F was associated with higher frequency of cytogenetical abnormalities. The complete molecular response to the therapy with hydroxyurea and interferon-α was not achieved in any of the 10 patients who underwent the molecular genetic reexamination. The overall mortality of the patients with JAK2V167F mutation was 27.3 % in 24 months. In the absence of the mutation the mortality rate was slightly lower and constituted 20. 0%. Сytogenetic abnormalities were the only detected clonal markers that allowed to confirm the chronic myeloproliferative process in 13.5 % of patients. Conclusions. Simultaneous cytogenetic analysis and the identification of JAK2V167F mutation increased the rate of clonal confirmation of the pathological process in myelofibrosis patients to 73.0 %, in contrast to 38.2–59.5 % using only one method of investigation. The presence of such cytogenetic anomalies as polyploidy and trisomy of chromosome 9 could result in increase of the copy number of JAK2 gene mutant alleles in pathological cells. The patients having both no detectable level of “wild type” allele of JAK2 gene and considerable quantity of lymphocytes in the blood, could possibly be of higher risk of further transformation of myelofibrosis to acute lymphoid, and not only myeloid leukemia

Clinical trial: a novel high-dose 1 g mesalamine suppository (Salofalk) once daily is as efficacious as a 500-mg suppository thrice daily in active ulcerative proctitis.

BACKGROUND: Mesalamine suppositories are first-line therapy in active ulcerative proctitis; the standard regime still recommends multiple doses per day. The primary objective of this study was to show the noninferiority of once-daily administration of a novel 1 g mesalamine suppository versus thrice-daily administration of the 0.5 g mesalamine suppository. METHODS: This was a single-blind (investigator-blinded), randomized, multicenter, comparative, Phase III clinical trial. Patients with mild to moderately active ulcerative proctitis inserted either one mesalamine 1 g suppository at bedtime or one mesalamine 0.5 g suppository thrice daily over a 6-week period. The primary endpoint was rate of remission (Disease Activity Index below 4). RESULTS: In all, 354 patients were evaluable for safety and per-protocol analysis. The new regimen demonstrated noninferiority: The percentage of patients with remission was 87.9% for the once-daily 1 g mesalamine suppository and 90.7% for the thrice-daily 0.5 g mesalamine suppository. Each regimen resulted in prompt cessation of clinical symptoms (e.g., median time to ≤3 stools per day (all without blood): 5 days in the 1 g mesalamine once-daily and 7 days in the 0.5 g mesalamine thrice-daily group). Patients preferred applying suppositories once a day. CONCLUSIONS: In active ulcerative proctitis the once-daily administration of a 1 g mesalamine suppository is as effective and safe, yet considerably more convenient, than the standard thrice-daily administration of a 0.5 g mesalamine suppository

Budesonide Suppositories Are Effective and Safe for Treating Acute Ulcerative Proctitis

© 2019 AGA Institute Background & Aims: Although proctitis is the most limited form of ulcerative colitis, it causes unpleasant symptoms. Topical mesalamine, the standard treatment, is not always effective. We conducted a randomized phase 2 trial to determine the efficacy and safety of 2 doses of a budesonide suppository vs mesalamine suppositories vs combined budesonide and mesalamine suppositories for proctitis. Methods: We performed a prospective, double-blind, double-dummy, multicenter trial in 337 patients with active proctitis to compare the efficacies of 4 different suppository treatments. Patients were randomly assigned to groups given 2 mg budesonide suppositories (2 mg BUS; n = 89 patients), 4 mg BUS (n = 79), 1 g mesalamine suppositories (1 g MES; n = 81), or the combination of 2 mg BUS and 1 g MES (n = 88). The study was performed from November 2013 through July 2015 at 36 study sites in Europe and Russia. The primary end point was the time to resolution of clinical symptoms, defined as the first of 3 consecutive days with a score of 0 for rectal bleeding and stool frequency. Results: The mean time to resolution of symptoms in the 4 mg BUS (29.8 days) and combination of 2 mg BUS and 1 g MES (29.3 days) groups resembled that of the standard 1 g MES treatment (29.2 days), but was significantly longer in the 2 mg BUS group (35.5 days). Furthermore, proportions of patients with deep, clinical, and endoscopic remission, as well as mucosal healing, were similar among the 1 g MES, 4 mg BUS, and combination therapy groups, but significantly lower in the group that received 2 mg BUS. No safety signals were observed, and the patients’ treatment acceptance was high (67%–85% of patients). Conclusions: In a multicenter randomized trial, we found that the efficacy and safety of 4 mg BUS in treatment of active proctitis did not differ significantly from those of 1 g MES. Budesonide suppositories offer an alternative therapy to mesalamine for topical treatment of proctitis. Clinicaltrialsregister.eu no: 2012-003362-41

Budesonide Suppositories Are Effective and Safe for Treating Acute Ulcerative Proctitis

© 2019 AGA Institute Background & Aims: Although proctitis is the most limited form of ulcerative colitis, it causes unpleasant symptoms. Topical mesalamine, the standard treatment, is not always effective. We conducted a randomized phase 2 trial to determine the efficacy and safety of 2 doses of a budesonide suppository vs mesalamine suppositories vs combined budesonide and mesalamine suppositories for proctitis. Methods: We performed a prospective, double-blind, double-dummy, multicenter trial in 337 patients with active proctitis to compare the efficacies of 4 different suppository treatments. Patients were randomly assigned to groups given 2 mg budesonide suppositories (2 mg BUS; n = 89 patients), 4 mg BUS (n = 79), 1 g mesalamine suppositories (1 g MES; n = 81), or the combination of 2 mg BUS and 1 g MES (n = 88). The study was performed from November 2013 through July 2015 at 36 study sites in Europe and Russia. The primary end point was the time to resolution of clinical symptoms, defined as the first of 3 consecutive days with a score of 0 for rectal bleeding and stool frequency. Results: The mean time to resolution of symptoms in the 4 mg BUS (29.8 days) and combination of 2 mg BUS and 1 g MES (29.3 days) groups resembled that of the standard 1 g MES treatment (29.2 days), but was significantly longer in the 2 mg BUS group (35.5 days). Furthermore, proportions of patients with deep, clinical, and endoscopic remission, as well as mucosal healing, were similar among the 1 g MES, 4 mg BUS, and combination therapy groups, but significantly lower in the group that received 2 mg BUS. No safety signals were observed, and the patients’ treatment acceptance was high (67%–85% of patients). Conclusions: In a multicenter randomized trial, we found that the efficacy and safety of 4 mg BUS in treatment of active proctitis did not differ significantly from those of 1 g MES. Budesonide suppositories offer an alternative therapy to mesalamine for topical treatment of proctitis. Clinicaltrialsregister.eu no: 2012-003362-41

Ustekinumab as induction and maintenance therapy for ulcerative colitis

BACKGROUND The efficacy of ustekinumab, an antagonist of the p40 subunit of interleukin-12 and interleukin-23, as induction and maintenance therapy in patients with ulcerative colitis is unknown. METHODS We evaluated ustekinumab as 8-week induction therapy and 44-week maintenance therapy in patients with moderate-to-severe ulcerative colitis. A total of 961 patients were randomly assigned to receive an intravenous induction dose of ustekinumab (either 130 mg [320 patients] or a weight-range\u2013based dose that approximated 6 mg per kilogram of body weight [322]) or placebo (319). Patients who had a response to induction therapy 8 weeks after administration of intravenous ustekinumab were randomly assigned again to receive subcutaneous maintenance injections of 90 mg of ustekinumab (either every 12 weeks [172 patients] or every 8 weeks [176]) or placebo (175). The primary end point in the induction trial (week 8) and the maintenance trial (week 44) was clinical remission (defined as a total score of 642 on the Mayo scale [range, 0 to 12, with higher scores indicating more severe disease] and no subscore >1 [range, 0 to 3] on any of the four Mayo scale components). RESULTS The percentage of patients who had clinical remission at week 8 among patients who received intravenous ustekinumab at a dose of 130 mg (15.6%) or 6 mg per kilogram (15.5%) was significantly higher than that among patients who received placebo (5.3%) (P<0.001 for both comparisons). Among patients who had a response to induction therapy with ustekinumab and underwent a second randomization, the percentage of patients who had clinical remission at week 44 was significantly higher among patients assigned to 90 mg of subcutaneous ustekinumab every 12 weeks (38.4%) or every 8 weeks (43.8%) than among those assigned to placebo (24.0%) (P=0.002 and P<0.001, respectively). The incidence of serious adverse events with ustekinumab was similar to that with placebo. Through 52 weeks of exposure, there were two deaths (one each from acute respiratory distress syndrome and hemorrhage from esophageal varices) and seven cases of cancer (one each of prostate, colon, renal papillary, and rectal cancer and three nonmelanoma skin cancers) among 825 patients who received ustekinumab and no deaths and one case of cancer (testicular cancer) among 319 patients who received placebo. CONCLUSIONS Ustekinumab was more effective than placebo for inducing and maintaining remission in patients with moderate-to-severe ulcerative colitis