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Current Issue. Articles

1(57) // 2017

 

 

1. ORIGINAL RESEARCHES

 

Surgical tactics in small posterior-basal aneurysms of left ventricle (RUS)

V. I. Ursulenko, O. K. Gogayeva, L. V. Jacob

SI «M. M. Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine», Kyiv

The aim —  to study occurrence and features of clinical picture of patients with posterior-basal aneurysms of the left ventricle (PBALV); based on the evaluation of long-term results to develop tactics for treating patients, to determine indications for resection of small aneurysms.
Materials and methods. M. M. In Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine for the period from 2000 till 2015, coronary artery bypass grafting (CABG) with resection of left ventricle aneurysm of anterior and posterior localization was performed for 1856 patients. PBALV were diagnosed in 136 (7.3 %) patients, resection of PBALV was performed in 85 (62.5 %) patients of this group. In 51 (37.5 %) patients, resection of PBALV was not performed because of its small size and muscular wall in the area of the aneurysmal sac.
Results and discussion. The clinical picture of patients with IHD complicated by posterior basal aneurysm manifests itself as the progression of heart failure. Diagnosis of PBALV is most informative in ventriculography. To determine the size of PBALV, we conventionally divide the left ventricle into three parts: apical, medial and basal. If the shadow of an aneurysm corresponds to the volume of the apex of the LV, it is regarded as a small one. PBALV of small size requires surgical correction in patients with connective tissue aneurysmal sac, in other cases, resection of PBALV is not indicated, but dynamic monitoring of aneurysm size and the degree of severity of mitral insufficiency is necessary.
Conclusions. PBALV of small size need surgical correction in patients with connective tissue aneurysmal sac, in other cases resection of PBALV is not indicated, but requires dynamic monitoring of the size of the aneurysm and the degree of expression of mitral insufficiency.

Keywords: post-infarction aneurysm, posterior-basal aneurysm, mitral insufficiency, aneurysm resection.

Original language: Russian

2. Original researches

 

Diagnostic capabilities of 2D-speckle-tracking echocardiography in assessment of right ventricular function in patients with acute pulmonary embolism (UKR)

V. Y. Tseluyko, S. M. Sukhova, L. M. Yakovleva, K. Yu. Kinoshenko

Kharkiv Medical Academy of Postgraduate Education

The aim — to investigate the sensitivity and specificity of parameters of 2D speckle-tracking echocardiography (2D STE) in assessment of the right ventricle (RV) dysfunction in patients with acute pulmonary embolism (PE).
Materials and methods. 104 patients with acute PE were examined. This diagnosis was verified by multislice computed tomographic angiography of pulmonary arteries. All patients underwent standard transthoracic ultrasound echocardiography (ECG) and 2D STE. The control group consisted of 15 persons with no evidence of RV dysfunction of any etiology.
Results and discussion. The analysis of 2D STE parameters in the examined patients with PE compared with the control group revealed that the most prominent RV contractile function decline occurred in the longitudinal direction. Calculated global RV longitudinal strain in the group of patients with PE was –5.8 ± 8.0 % and was significantly lower than in the control group — –23.9 ± 6.4 % ( < 0.001). ROC-analysis showed that the value of segmental ejection fraction of the apical RV segment lower than 65 % is informative for identifying RV dysfunction in patients with PE: sensitivity and specificity of this parameter are 64.9 and 100 % accordingly, ( < 0.000). The value of calculated criterion of global RV longitudinal strain in PE patients lower than –18.5 % with sensitivity of 72.5 % and specificity of 85.7 % may indicate RV dysfunction, ( < 0.0001).
Conclusions. Changes in parameters of longitudinal strain and displacement in patients with acute PE indicate a violation of RV myocardial contractility in longitudinal direction. The most informative parameters of 2D STE in RV dysfunction assessment in patients with acute PE are segmental ejection fraction of the apical RV segment (sensitivity 64.9 %, specificity 100 %; < 0.0001) and global RV longitudinal strain of the RV free wall (sensitivity 72.5 %, specificity 85.7 %; < 0.0001)

Keywords: pulmonary embolism, right ventricular dysfunction, 2D speckle-tracking echocardiography.

List of references:  
1.    Venous thromboembolism: diagnosis, treatment and prevention: interdisciplinary clinical recommendations. Kyiv, 2013. 63 . (Ukrainian).
2.    2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology.
3.    Feigenbaum H. Echocardiography. Lippincott Williams & Wilkins, 2012. 785 . ISBN/ISSN: 9780781795579.
4.    Forsha D, Risum N, Kropf A et al. Right Ventricular Mechanics using a Novel Comprehensive Three-View Echocardiographic Strain Analysis in a Normal Population. Journal of the American Society of Echocardiography. 2014;27(4):413-422. DOI: 10.1016/j.echo.2013.12.018.
5.    Guyton A, Hall J. Medical Physiology. 12th edition. Saunders, 2010:1120. ISBN-13:978-1416045748.
6.    Kasper W, Konstantinides S, Geibel A et al. Management strategies and determinates of outcome in acute major pulmonary embolism: results of a multi-center registry. Journal of the American College of Cardiology. 2012;30:1165-1171. DOI: 10.1016/S0735-1097 (97)00319-7.
7.    Kearon C, Akl EA. Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. Blood. 2014;123(12):1794-1801. DOI: 10.1182/blood-2013-12-512681.
8.    Lang RM, Badano LP, Mor-Avi V et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J. Cardiovascular Imaging. 2015;16(3):233-271. DOI: 10.1093/ehjci/jev014 233-271.
9.    Lang Roberto, Steven A. Goldstein, Itzhak Kronzon. et al. ASE’s Comprehensive Echocardiography. Elsevier Health Sciences, 2015-941 . ISBN-13:978-0323260114.
10.    Lodato JA, Ward RP, Lang RM. Echocardiographic predictors of pulmonary embolism in patients referred for helical CT. Echocardiography. 2008;25(6):584-590. DOI: 10.1111/j.1540-8175.2008.00665.
11.    Mauritz GJ, Marcus JT, Westerhof N et al. Prolonged right ventricular post-systolic isovolumic period in pulmonary arterial hypertension is not a reflection of diastolic dysfunction. Heart. 2011;97(6):473-478. DOI: 10.1136/hrt.2010.193375.
12.    Pollack CV, Schreiber D, Goldhaber SZ et al. Clinical characteristics, management of patients diagnosed with acute pulmonary embolism in the emergency department of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). Journal of the American College of Cardiology. 2011;57:700-706. DOI: 10.1016/j.jacc.2010.05.071.
13.    Sekhri V, Mehta N, Rawat N et al. Management of massive and nonmassive pulmonary embolism. Archives of Medical Science — 2012;8(6):957-969. DOI: 10.5114/aoms.2012.32402.
14.    Zhou X, Ben S, Chen H, Shi H. The prognostic value of pulmonary embolism severity index in acute pulmonary embolism: a meta-analysis. Respiratory Research. 2012;13(1):111. DOI: 10.1186/1465-9921-13-111.

Original language: Ukrainian

3. Original researches

 

Anomalies of coronary arteries in children (on autopsy material) (UKR)

O. I. Boiko

Danylo Halytsky Lviv National Medical University

The aim — to determine the frequency and distribution of coronary artery abnormalities in the structure of congenital heart defects in children for a 35-year period of observation (1981 — 2016) of autopsy material.
Materials and methods. 8952 autopsies were analyzed (children’s age was from 28 weeks of prenatal development to 14 years). 25 anomalies of coronary arteries were investigated. The male gender accounted for 14 cases (56 %). The autopsies were performed at Lviv Regional Pathology Bureau. Angiography was performed in the case of a single coronary artery. The mass containing midotrizoate sodium, methylene blue and gelatine was injected into the coronary artery.
Results and discussion. The frequency of anomalies of coronary arteries in children was 0.28 %. The share of the coronary artery anomalies among all congenital heart defects was 4.46 %. Anomalies of quantity, topographical origin, directions of coronary arteries were diagnosed. Different versions of coronary artery anomalies were found in congenital heart defects, hereditary and somatic diseases, as well as in isolation.
Conclusions. The frequency of anomalies of coronary arteries is underestimated, that is why the detailed examination of the coronary arteries should be an integral part of the autopsy, especially in cases of sudden death in childhood.

Keywords: coronary artery anomalies, childhood, congenital heart disease.

Original language: Ukrainian

4. Original researches

 

Dysadypokinemia in patients with postinfarction cardiosclerosis and type 2 diabetes mellitus: relationship with LEPR Q223R gene polymorphisms (UKR)

A. A. Al Salim, M. A. Stanislavchuk, N. V. Zaichko

National Pirogov Memorial Medical University, Vinnytsya

The aim —  to establish the prevalence of dysadypokinemia in patients with coronary heart disease (CHD) and postinfarction cardiosclerosis depending on the comorbidity with type 2 diabetes mellitus (DM) and to investigate its relationship with polymorphism of LEPR Q223R leptin receptors gene.
Materials and methods. The study involved 147 patients with stable CHD and postinfarction cardiosclerosis (100 % men), mean age 52.0 years. In 64 (43.5 %) patients, CHD was combined with type 2 DM. CHD was diagnosed according to recommendations of AHA/ACC (2014) and ESC (2013). LEPR Q223R gene polymorphisms was determined by polymerase chain reaction in Real-Time mode. The levels of leptin and adiponectin in serum were determined by ELISA. The ratio of adiponectin and leptin content (lg A/L) was evaluated.
Results and discussion. In patients with postinfarction cardiosclerosis, the frequencies of hyperleptinemy, hipoadyponektinemy and dysadipokinemy were 79.6; 57.1 and 87.8 %, respectively. Violation of adipokine’s status was more frequently revealed in allele R carriers and was more pronounced in the presence of type 2 DM. In RR homozygotes with CHD and type 2 DM, the leptin level was by 50.4 and 49.3 % higher, adiponectin levels — by 33.0 and 23.7 % lower, and the ratios of lg A/L — by 14.1 and 12.2 % lower than in QQ homozygotes with type 2 DM and RR homozygotes without DM, respectively.
Conclusions. In patients with CHD, the increase in frequency and severity of dysadipokinemy is associated with type 2 DM and LEPR Q223R gene polymorphism. The carrier state of genotype of RR gene is unmodified factor of dysadipokinemy in patients with CHD and comorbidity with type 2 DM.

Keywords: coronary heart disease, leptin receptors, polymorphism, leptin, adiponectin.

Original language: Ukrainian

5. Original researches

 

Characteristics of morphological changes in artery wall after its deobliteration in patients with chronic critical ischemia of lower extremities (UKR)

V. V. Boyko1, V. . Prasol1, G. I. Gubina-Vakulik2, K. V. Miasoiedov2

1 SI «V. T. Zaitsev Institute of General and Emergency Surgery of National Academy of Medical Sciences of Ukraine», Kharkiv
2 Kharkiv National Medical University

The aim — to evaluate and compare the changes in the walls of atherosclerotically altered arteries of patients with chronic critical ischemia of the lower extremities after deobliteration of their lumen with the use of open and hydraulic endarterectomy.
Materials and methods. Histological and morphometric examination of 40 sections of arteries isolated from amputated lower extremities of patients with chronic critical ischemia during the first 24 hours was performed to evaluate and compare morphological changes in the artery walls after the deobliteration of their lumen using the classical and proposed hydraulic endarterectomy techniques.
Results and discussion. In the study group, the depth of endarterectomy in appropriate arterial segments was greater than in the comparison group on average by 56 %, which means that the residual media layer was smaller than in the control group. The structure of the arterial wall after its deobliteration was different too. In the study group, the separation of the plaque was not accompanied by saving in the artery wall of atherosclerotically changed structures, i.e. on the border of healthy layer.
Conclusions. The study shows a statistically significant difference in the morphological structure of the residual wall of the artery after the deobliteration of its lumen between the main and the comparison groups. The differences were revealed both in the morphological composition of the artery wall and in its thickness. After the use of hydraulic deobliteration, the residual wall of the artery was smaller than the artery wall after the traditional open endarterectomy, and there were almost no structures with atherosclerotic changes in its composition

Keywords: hydraulic endarterectomy, deobliteration, critical ischemia, morphometry.

Original language: Ukrainian

6. Original researches

 

ATP-dependent potassium channels as total target of cardioprotective effect of curcumin and fluorinated analogue of diazoxide in oxidative stress conditions (UKR)

. V. Tarasova1, . . Lynnyk2, . M. Mankovska2, L. V. Bratus2, V. I. Nosar2, . G. Strokina1, . M. Karvatsky1

1 . . Bogomolets National Medical University, Kyiv
2 . . Bogomolets Institute of Physiology of National Academy of Science of Ukraine, Kyiv

The aim — to study the functional performance of the myocardium, oxidative phosphorylation in the mitochondria of the heart and the effects produced on them by potential cardioprotectors — natural substance of curcumin and synthetic substance (fluorine-containing analog of pharmacological preparation — activator of ATP-dependent potassium channels of diazoxide) in doxorubicin model of oxidative stress.
Materials and methods. Cardiomyocytes were isolated from the ventricles of heart of 1 — 2-day-old neonatal rats. 0.5 µM/L of doxorubicin hydrochloride were added into the culture along with 20 µM of curcumin or with 40 µM of fluorine-containing analogue of diazoxide. Isolated cardiomyocytes contractions were recorded with the use of IonOptix system. Respiration and oxidative phosphorylation in mitochondria were studied.
Results and discussion. The use of curcumin and analogue of diazoxide at the background of doxorubicin increased the amplitude of cardiomyocytes contraction from (4.07 ± 0.51) to (6.65 ± 0.37) and (5.5 ± 0.8) % and caused the normalization of contractions rhythmicity which was previously violated by doxorubicin. Doxorubicin caused the decrease of respiratory control, coefficient of phosphorylation and potassium ions entrance into the mitochondria matrix. Both fluorinated analog of diazoxide and curcumin on the background of doxorubicin increased these figures. Potassium ions transport into mitochondria was decreased by 27.7 % under doxorubicin action, by 11.5 % under the common action of doxorubicin and curcumin, by 20 % under the inhibitor of ATP-dependent potassium channels against the background of combination of doxorubicin and curcumin.
Conclusions. The use of curcumin and fluorine-containing analogue of diazoxide increases the amplitude and restores the rhythmicity of spontaneous cardiomyocyte contractions in oxidative stress conditions, normalizes the parameters of energy supply in myocardium mitochondria. This property of theirs is realized, in particular, through the activation of ATP-dependent potassium channels.

Keywords: ATP-dependent potassium channels, doxorubicin, curcumin, fluorine-containing analogue of diazoxide, isolated neonatal cardiomyocytes, mitochondria, oxidative phosphorylation.

Original language: Ukrainian

7. Original researches

 

Galectin-3 as biomarker of heart failure in patients with hypertrophic cardiomyopathy (RUS)

V. Y. Tseluyko, K. Yu. Kinoshenko, S. Daghar

Kharkiv Medical Academy of Postgraduate Education

The aim — to study the relationship between the level of galectin-3, the severity of heart failure (HF) and its progression during prospective observation of patients with hypertrophic cardiomyopathy (HCMP).
Materials and methods. We studied clinical-anamnestic and instrumental data of 90 patients with HCMP including 76 of those who were examined again after (12 ± 3) months of treatment. The methods of examination were: 6-minute walk test, electrocardiography, echocardiography, daily ECG monitoring, and measurement of galectin-3 level in the serum by ELISA.
Results and discussion. Galectin-3 level was characterized by considerable variability and was independent of hemodynamic form of the disease and the degree of hypertrophy, but was associated with anginal syndrome, the severity of heart failure, its functional class determined by the 6-minute walk test and the severity of arrhythmias. Higher levels of galectin-3 were associated with more significant signs of cardiac remodeling. The increase of level of galectin-3 led to higher incidence of restrictive diastolic dysfunction. The repeated study found statistically significant correlation (rs = 0.686, p < 0.001) between the levels of galectin-3 and the progression of HCMP.
Conclusions. The level of galectin-3 in patients with HCMP increases with the progression of heart failure. Along with some clinical and instrumental parameters, the increase in the level of galectin-3 in the dynamics should be regarded as a predictor of unfavorable course of HCMP.

Keywords: hypertrophic cardiomyopathy, galectin-3, heart failure.

Original language: Russian

8. Original researches

 

Effect of long-term low-dose azithromycin treatment on inflammatory processes and atherosclerosis in patients with coronary heart disease (RUS)

O. V. Skochko, I. P. Kaidashev

Ukrainian Medical Dental Academy, Poltava

The aim —  to assess the clinical efficacy and safety of long low-dose azithromycin treatment of inflammatory diseases of dentoalveolar apparatus and the impact of this therapy on the inflammatory and atherosclerotic processes in patients with inflammatory diseases of the oral cavity and coronary heart disease.
Materials and methods. The study involved 43 patients aged 45 — 68 years with inflammatory diseases of the oral cavity and coronary heart disease. After clinical and laboratory examination two groups were formed: 1st (main) group of patients in addition to the complex therapy took azithromycin at a dose of 500 mg/day for 3 days, then 500 mg per week for 6 months (n = 20); 2nd (comparison) group continued to receive standard complex of drug therapy (n = 23).
Results and discussion. According to veloergometry, patients receiving azithromycin therapy during the six-month observation had changes in threshold load power and angina functional class (p <0.05). The use of long-term low-dose treatment with azithromycin was associated with a decrease in the size of atherosclerotic plaques in the vessels of the neck (p <0.05), reduction in the thickness of intima-media (p <0.05). The group of patients who took azithromycin for 6 months had an effective reduction of inflammation in periodontal tissues, complete (Actinobacillus actinomycetemcomitans, Prevotella intermedia and Bacteroides forsyhus) or partial (Porphyromonas gingivalis) eradication of parodontal pathogens of dentogingival liquid of periodontal pocket. The use of azithromycin for inflammatory diseases of dentomaxilar system in patients with coronary heart disease after 6 months was associated with a statistically significant reduction in markers of systemic inflammation (ESR, high-sensitivity C-reactive protein), lipid spectrum (total cholesterol, low-density lipoprotein cholesterol) and increase in indicators of tissue inhibitor of metalloproteinase-1.
Conclusions. The obtained results give reason to assume that the positive effect of azithromycin on the atherosclerotic process in patients with inflammatory diseases of dentomaxilar apparatus and coronary heart disease may be caused by the restriction of one of the most powerful sources of inflammation and atherogenesis of vessels, namely parodontopathogenic microorganisms, including those that circulate in the blood, and talk about the prospects of further research.

Keywords: azithromycin, coronary heart disease, inflammatory diseases of oral cavity, parodontopathogenic microflora, atherosclerosis, inflammation.

Original language: Russian

9. CLINICAL CASE

 

Clinical case of combined aneurysmal lesion of iliac and femoral arteries with false posttraumatic aneurysm and arterio-venous fistula, deep vein thrombosis (RUS)

V. O. Prasol1, 2, Yu. V. Ivanova1, I. S. Puliaieva1, A. Yu. Tkachuk1, O. A. Zarudniy1, R. V. Artamonov1, K. V. Miasoiedov2, A. N. Kozachenko1

1 SI «V. T. Zaitsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine», Kharkiv
2 Kharkiv National Medical University

Peripheral arterial aneurysms are usually asymptomatic. The most common clinical manifestations (30 %) occur in the presence of complications: thrombosis or embolism (rarely aneurysm ruptures). The clinical manifestations of the false aneurysm and traumatic arteriovenous fistula depend on their location and size. False aneurysm is usually manifested as visible tumor, edema, pain due to compression of surrounding structures, distal ischemia and external bleeding. Posttraumatic arteriovenous fistula usually manifests itself at a later stage via systemic and local symptoms, such as swelling, secondary varicose changes, venous ulcers — manifestations of chronic venous insufficiency, as also as heart failure due to overload of the right heart. The article describes a case of combined aneurysmal lesion of iliac and femoral arteries with false posttraumatic aneurysm and arterio-venous fistula, occlusive deep vein thrombosis

Keywords: femoral arter aneurysm, false posttraumatic aneurysm, arterio-venous fistula.

Original language: Russian

10. CLINICAL CASE

 

Rare anomaly of lung development arteriovenous malformation of lower lobe of right lung (UKR)

Yu. V. Panichkin1, A. V. Makarov2, B. V. Batsak1, R. B. Demchenko1, A. Yu. Gavrylyshyn1, T. I. Dedkova1, V. V. Grabarchuk1, N. V. Vorobyeva1, R. M. Vytovsky1

1 SI «M. M. Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine», Kyiv
2 P. L. Shupyk National Academy of Postgraduate Education, Kyiv

Arteriovenous malformation of the lungs (AVML) is a rare congenital vascular anomaly characterized by the presence of direct communication between pulmonary artery branches and pulmonary veins and discharge of venous blood into the arterial system. The occurrence of the defect does not exceed 2 — 3 cases per 100 000 of population. Despite the predominantly congenital character of AVML, only 10 % of cases of clinical manifestations of the pathology arise in childhood. In the remaining patients, the disease manifests itself in the second, third and fourth decades of life. However, the classic signs of arterial hypoxemia such as cyanosis, shortness of breath, weakness, deformation of the distal phalanges of fingers and nails, are determined only in 30 % of patients. The final diagnosis is based on computed tomography and reduction in saturation of arterial blood. In view of rare occurrence of the disease and difficulties of diagnosis in childhood, we present a clinical case of our own practice of diagnosis and treatment of a patient with arteriovenous malformation of the lower lobe of the right lung.

Keywords: arteriovenous malformation of lungs, endovascular embolization, occluder.

Original language: Ukrainian

11. Reviews

 

Gunshot wounds of main vessels of lower extremities. Key points of diagnosis and treatment (UKR)

V. G. Mishalov1, B. M. Koval1, Yu. V. Nahalyuk1, E. V. Tsema1, V. M. Rogowski2, A. I. Batiuk1

1 O. O. Bogomolets National Medical University, Kyiv
2 National Military Medical Clinical Center «Main Military Clinical Hospital», Kyiv

Gunshot wounds of the vessels remain a relevant and complex area of vascular surgery from diagnostic, therapeutic and organizational points of view. The success of treatment is determined by timely diagnosis and qualified medical aid. Treatment of patients with injury of great vessels should be performed in specialized institutions. Surgical approach depends on the extent and severity of ischemia. However, even recovery operations lead to unsatisfactory results caused by late detection of damage, organizational, tactical and technical errors.

Keywords: stages of medical evacuation, angiography, bypass surgery, prosthetics.

Original language: Ukrainian

12. Reviews

 

Function of lymphatic endothelium during certain diseases (UKR)

S. M. Genyk

Ivano-Frankivsk National Medical University

Literature review is provided pertaining to state of dysfunction of lymphatic endothelium that develops during a variety of pathologic conditions. Its importance was stressed in treatment of chronic edema of different etiology as also its effect on resorptive, transport and monitoring function of lymphatic system. This review describes the role of lymphatic system in transcapillary arterio-venous fluid exchange in interstitial space, and how it can be influenced by phlebodynamic, metabolic, inflammatory and other factors. The use of certain flavonoids and vasoprotectors in treatment of chronic edema of different etiology is analysed.

Keywords: endothelium, lymphatic, edema, microcirculation.

Original language: Ukrainian

13. Reviews

 

Modern view on gender features in adults with congenital heart and great vessels defects (UKR)

I. G. Lebid

SI «Scientific and Practical Medical Center for Children’s Cardiology and Cardiac Surgery of Ministry of Health of Ukraine», Kyiv

The literature review highlights gender features related to prevalence, course and outcome of surgery for congenital defects of heart and main vessels in adults. It is shown that despite the high prevalence of complicated heart defects in men, women mortality from this disease is higher. Particular attention is paid to certain defects and abnormalities, such as atrial septal defect, aortic valve pathology, pulmonary hypertension syndrome, irregular heartbeat. Sex differences among adult patients with congenital heart defects have great clinical and fundamental theoretical importance for understanding the long-term results of cardiac surgery and prognosis of life expectancy of non-operated women and men.

Keywords: congenital heart defects, sex, adults.

Original language: Ukrainian


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