No abstract

The modern stage of medical development requires a multidisciplinary approach to studying the impact of treatment on human life. The social aspects are of great importance because the goal of treatment is to preserve or/and improve life. Therefore, the term "quality of life" is increasingly used in the world medical literature. The objectification of this indicator and its adaptation in practical medicine is a priority task. The concept of "quality of life" first appeared in 1958. In the future, this concept was developed in a research carried out by a group of professors at MIT (Massachusetts Institute of Technology) under Prof. R. Bauer in 1966. These researches initiated the quality of life study. In 1996, the WHO developed a definition of quality of life as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. The purpose of studying the quality of life in the medical field was to introduce treatment protocols and standardize medical care. An important criterion for evaluating the quality of treatment was to compare changes in the patient’s quality of life before and after using a particular medical protocol. The main methods of studying changes in the patient’s quality of life were the use of special questionnaires. The most common general-purpose questionnaires for assessing changes in quality of life are SF-36, WHOQoL-100, Sickness Impact Profile, Nottingham Health Profile, EuroQoL-5D, EORTC QLQ-C30. In Ukraine, as of 2020, there is no local questionnaire for either general or specialized purposes. But there are translations of the main questionnaires, for example, SF-36, EORTC QLQ-C30. Developing own questionnaire that fully complies with the standards of the MAPI Research Institute requires multi-center and multidisciplinary research. The study of changes in the quality of life is an integral part of a comprehensive analysis of new methods of the diagnosis, treatment and prevention of diseases. Analysis of changes in the quality of life using different approaches to treatment is possible provided that general and special purpose questionnaires and available clinical data are used. Using advanced statistical processing of the questionnaire survey allows you to increase the reliability of the research. There is a need to develop own specialized adapted nosological questionnaires for quality of life analysis. Assessment of the quality of life should become one of the main criteria for the effectiveness of medical care, as well as an independent indicator of the condition of patients during medical and social expertise, determining the prognosis, treatment tactics, and developing rehabilitation programs.

Background. Medullary thyroid cancer is a topical disease that is often accompanied by metastases. The danger of this pathology requires timely and adequate surgery. Objective to assess the prognostic value and informativeness of some clinical indicators with the selection of the most optimal and reliable potential factors in the development of the mathematical equation for calculating the personal probability of detecting metastases of medullary thyroid cancer in the absence of clinical and instrumental signs in the preoperative stage. Materials and methods. Patients with medullary thyroid carcinoma with and without locoregional metastases participated in this study. To verify metastatic deposits, a pathomorphological study was performed using the TNM classification (UICC). StatPlus Pro v.7.6, EpiTools and MedCalc statistical calculators were used for statistical processing of results. Data Mining technologies were used to assess the degree of impact of potential predictors using the data mining add-on for MS Office. To assess the diagnostic value of the test, ROC analysis was performed and the corresponding characteristic curve was constructed with the calculation of the area under it (according to the DeLong method). For the operational characteristics of the tests, 95 % confidence interval was calculated according to the Wilson method. The results were considered statistically significant at p < 0.05. Results. Basal calcitonin, patient sex, multifocality, and total tumor size have been shown to be significant in the a priori of the medullary thyroid cancer metastatic risk assessment. These indicators can be used not only as predictors of unfavourable prognosis, but also as indicators for individual determination of the surgery scope. Conclusions. The method of binary logistic regression to assess latent metastasis showed lower sensitivity (0.77 vs 0.89) and higher specificity (0.90 vs 0.64) in contrast to the monofactorial prognosis based on preoperative calcitonin levels. Further improvement of the model requires additional analysis of erroneous test results in the applied training sample. The proposed prognostic model due to calculations in MS Excel allows you to easily and quickly obtain information, so it can be used as an additional diagnostic tool when choosing a method of surgical treatment.

Background. Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerve injury, still the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%.

Background. The urgency of the study is due to the need to find effective methods for the diagnosis and treatment of medullary thyroid cancer. Basal calcitonin is a biomarker that determines both the presence of this disease and the level of metastasis. Howe­ver, above-threshold calcitonin levels have a low prognostic value of the positive result. The study was aimed to analyze the importance of additional factors (besides calcitonin) in predicting the medullary thyroid cancer metastasis: age, sex, tumor focus, tumor volume (total volume). Materials and me­thods. A retrospective monocenter analysis was performed using the records of 194 patients treated for medullary thyroid cancer. The study involved 143 patients with primary forms of the di­sease. The required characteristics of the tumor were assessed in the postoperative period based on the pathomorphological exa­mination. Results. The association between age and metastasis was not found, but a moderate relationship between sex and metastasis has been shown. The ratio of the chances of metastases detected in male patients is estimated at 3 : 1. It is proved that in the presence of tumor multifocality, the likelihood of metastasis detection increa­ses. With an odds ratio of 2.368, the multifocal factor shows a weak but statistically significant strong association with the presence of metastases. Total tumor size is associated with metastasis. More than half (54.5 %) of cases are in the range of tumor sizes smaller than the selected cut-off threshold, with 16.7% metastasi­zing. On the other hand, the share of cases of exceeding the cut-off threshold (Cut-off = 1.9 cm; AUC = 0.703, Se = 0.745, Sp = 0.680) is 45.5 %, and metastasis is observed in 53.8 % of patients in this range. Conclusions. No association was found between age and metastasis. Male gender is a risk factor for metastasis. Multifocality is a risk factor for metastasis with a weak connection. The total size of the tumor is associated with metastasis with medium strength.