Njd 59 1

№59/2021
Norwegian Journal of development of the International Science
ISSN 3453-9875
VOL.1
It was established in November 2016 with support from the Norwegian Academy of Science.
DESCRIPTION
The Scientific journal “Norwegian Journal of development of the International Science” is issued 24 times a year
and is a scientific publication on topical problems of science.
Editor in chief – Karin Kristiansen (University of Oslo, Norway)
The assistant of theeditor in chief – Olof Hansen
• James Smith (University of Birmingham, UK)
• Kristian Nilsen (University Centre in Svalbard, Norway)
• Arne Jensen (Norwegian University of Science and Technology, Norway)
• Sander Svein (University of Tromsø, Norway)
• Lena Meyer (University of Gothenburg, Sweden)
• Hans Rasmussen (University of Southern Denmark, Denmark)
• Chantal Girard (ESC Rennes School of Business, France)
• Ann Claes (University of Groningen, Netherlands)
• Ingrid Karlsen (University of Oslo, Norway)
• Terje Gruterson (Norwegian Institute of Public Health, Norway)
• Sander Langfjord (University Hospital, Norway)
• Fredrik Mardosas (Oslo and Akershus University College, Norway)
• Emil Berger (Ministry of Agriculture and Food, Norway)
• Sofie Olsen (BioFokus, Norway)
• Rolf Ulrich Becker (University of Duisburg-Essen, Germany)
• Lutz Jäncke (University of Zürich, Switzerland)
• Elizabeth Davies (University of Glasgow, UK)
• Chan Jiang(Peking University, China) and other independent experts
1000 copies
Norwegian Journal of development of the International Science
Iduns gate 4A, 0178, Oslo, Norway
email: publish@njd-iscience.com
site: http://www.njd-iscience.com

CONTENT
ARCHITECTURE
Getun G., Bezklubenko I.,
Solomin A., Mashchenko A.
FEATURES OF THE INDUSTRIAL DEVELOPMENT OF
KIEV AT THE END 19TH CENTURY................................3
Diana Harding,
Anissa Lestari Kadiyono, Susi M.
MAINTAINING THE WELL-BEING OF THE URBAN
SOCIETY DURING A PANDEMIC SITUATION: THE
POSITIVE ACTIVITY BENEFACTION OF GARDENING
AND URBAN FARMING..............................................10
MEDICAL SCIENCES
Kalinovska O., Lazurenko V., Cherepova V.,
Starkova I., Tishchenko O., Stryukov D.
OVARIAN FUNCTION IN PATIENTS WHO UNDERWENT
THE UTERINE ARTERIES EMBOLIZATION...................15
Zarutskyi Ya., Aslanyan S.,
Kravchenko К., Vovk M., Honcharuk V.
THE USE OF NEGATIVE PRESSURE VACUUM THERAPY
IN THE TREATMENT OF SOFT TISSUE DEFECTS IN
THORACIC INJURY .....................................................17
Stukan L., Pshuk N., Kaminska A.
PREDICTORS OF PARENTAL ATTITUDE FORMATION IN
MOTHERS OF CHILDREN WITH AUTISTIC
DISORDERS ................................................................24
PHARMACEUTICS
Tsubanova N. Berdnyk O.
STUDY OF TOXICOLOGICAL PROFILE OF NEW
ANTIDIABETIC COMPOSITION "TIGLIBEN" ................28
Zuikina Ye., Polovko N.
BIOPHARMACEUTICAL JUSTIFICATION FOR THE
CHOICE OF EMULSION BASE IN VITRO ......................31
Posilkina O., Lisna A., Litvinova O.
CURRENT ASPECTS OF THE DEVELOPMENT OF
VACCINATION LOGISTICS ..........................................36
TECHNICAL SCIENCES
Mutallımova A.
THE USE OF MOMENT OF INERTIA IN RECOGNITION
OF INVARIANT IMAGES TO AFFINE
TRANSFORMATIONS .................................................44
Nadikto V., Zhuravel D.,
Chebanov A., Verechaga O.
IMPROVING THE EFFICIENCY OF PRESSING THE MALE
OF CASTOR SEEDS IN THE SCREW PRESS...................48

Norwegian Journal of development of the International Science No 59/2021 3
ARCHITECTURE
FEATURES OF THE INDUSTRIAL DEVELOPMENT OF KIEV AT THE END 19TH CENTURY
Getun G.,
Ph D. in Technical Sciences, Professor,
Professor at the Department of Architectural Structures
Kiev National University of Building
and Architecture, Ukraina
Bezklubenko I.,
Ph D., Associate Professor, Associate Professor
of the Design Information Technologies and
Applied Mathematics Department
Kiev National University of Building
and Architecture, Ukraina
Solomin A.,
Ph D. in Physics& Mathematics, Associate Professor,
Associate Professor of the Biosafety and Human Health Department
National Technical University of Ukraine "
Sikorsky Kievsky Polytechnic Institute", Ukraina
Mashchenko A.
XIV High School of Stanislaw Staszic
in Warsaw, Polska
CECHY ROZWOJU PRZEMYSŁOWEGO KIJOWA POD KONEC XIX WIEKU
Getun G.,
Bezklubenko I.,
Kijowski Narodowy Uniwersytet Budownictwa i Architektury, Ukraina
Solomin A.,
Narodowa Politechnika Ukrainy
"Sikorsky Kijowski Polytechnic Institute", Ukraina
Mashchenko A.
STASZIC XIV Liceum Ogólnoksztalcące, Polska
DOI: 10.24412/3453-9875-2021-59-1-3-10
Abstract
The article describes specifics of Kiev's construction and industrial architecture in the second half of the 19th
century. The research will cover the production complex of old-time Kiev - development of industry, construction
of bridges, railways and creation of the first engineering systems: water supply, sewage system, electric transport
(tram and cable car). The preconditions for construction and the appearance of an engineer profession were in-
cluded. Information about the construction and history of the Chain of Nicholas and Kiev Darnytsa railway bridges.
The article describes construction, engineering design and engineering achievements in the construction of the
first Kiev railway junction - drilled piles technology device to make the fundaments of buildings more strong and
the construction and operation characteristics of the first in Kiev municipal water supply and sewage system. The
article includes information about external, building plans and schemes that were built at the end of the 19th cen-
tury. Analysis of architectural forms and stylistic trends of buildings, technical achievements and urban planning
solutions, new construction and building materials, which left a significant mark and significantly influenced the
development of architecture in Ukraine.
Wprowadzenie
W artykule opisana jest przyroda i specyfika budownictwa i architektury przemysłowej Kijowa w drugiej
połowie XIX wieku. Badanie obejmuje kompleks produkcyjny starożytniego Kijowa-rozwój przemysłu, budowę
mostów zwodzonych, infrastrukturę kolejową i tworzenie pierwszych systemów inżynieryjnych: wodociągów,
kanalizacji, transportu elektrycznego (tramwaju i kolejki linowej). W artykule rozpatrzono warunki wstępne
rozwoju budownictwa oraz pojawienie się zawodu inżyniera. W pracy podane są dane dotyczące budowy i
późniejszej historii mostów kolejowych: Mykołajewskiego-łańcuchowego i Kijów Darnytca. W artykule opisane
są osiągnięcia inżynieryjno-technologiczne i budowlano-konstrukcyjne przy budowie pierwszego w Kijowie
węzła kolejowego - technologię pali wierconych do wzmocnienia fundamentów budynków i budowli wymyślona
przez inżyniera A. Strausa i opisane cechy budowy i eksploatacji pierwszej w Kijowie wodociągów i kanalizacji.
Przedstawione są rysunki obrazujące wygląd zewnętrzny, plany i schematy budynków, które zostały zbudowane
pod koniec XIX wieku. Praca analizuje formy architektonicznych i nurty stylistyczne budynków, konstrukcji i

4 Norwegian Journal of development of the International Science No 59/2021
urbanistyczne rozwiązania, wprowadzenie nowych konstrukcji i materiałów budowlanych, które pozostawiły
znaczący ślad i miały znaczący wpływ na rozwój budownictwa na Ukrainie.
Keywords: construction, bridges, railway station, drilled piles technology, water tower
Słowa kluczowe: budowa, most, stacja kolejowa, pale wiercone, wieża ciśnień
1. Wstęp
Środek XIX wieku na Ukrainie charakteryzuje się
zdecentralizowanym procesem budownictwa.
Osłabione i ostatecznie zniesione zostają kanony
klasycyzmu w Imperium Rosyjskim, do którego
należała Ukraina. Według cesarskich dekretów w
1847r. i 1851r. prawo zatwierdzania projektów
modelowych zostało przekazane do gubernatorów
generalnych i komisji budowlanych. Postanowieniem z
1858 r. obowiązkowe stosowanie "wzorcowych"
projektów zostało zniesione. Odtąd w budownictwie na
Ukrainie było wolno wszystko, co nie było zakazane.
Teraz głównym narzędziem regulującym jest "Status
budowlany", który był powszechnie obowiązujący w
całym Imperium. [1]
Decentralizacja budownictwa była procesom
naturalnym, który był spowodowany głębokimi
zmianami społecznymi i gospodarczymi w Imperium
Rosyjskim oraz wpływem Europy Zachodniej.
Czynnikami wewnętrznymi, które przyspieszyły
rozwój stosunków rynkowych, stały się reformy, które
rozpoczęły się w 1860 -1870r., zwłaszcza zniesienie
pańszczyzny. Rozwój przemysłu i handlu,
zróżnicowanie produkcji, rozszerzenie sieci kolejowej,
pojawienie się nowych urzędów przyczyniły się do
napływu ludności do miast, a wraz z tym - wzrosło
zapotrzebowanie na mieszkania. Rozwój przemysłu i
wprowadzenie nowych technologii w budowie
wzmocniły składową inżynieryjną, zaczął istnieć
zawód inżyniera. W 1865 roku Rosja utworzyła
Komitet Techniczny-Budowlany posiadający własne
filia na terenach państwa. Szeroko używane są nowe
materiały budowlane - żeliwo, żelbeton, stal.
Zwiększona jest produkcja tradycyjnych materiałów
budowlanych - cegły, dachówki, blachy, szkło [2].
Kapitalistyczna produkcja drugiej połowy XIX
wieku doprowadziła do zasadniczych zmian relacji
między budowniczym a klientem. Dyktat państwowy
zmienił się dyktatem klienta, który w oparciu o własne
możliwości finansowe, cel i smak sprawia, że
budowniczy biorą to wszystko pod uwagę. W filozofii
budowania na pierwszy plan wysuwają się zasady
racjonalnego funkcjonowania obiektu. Ze względu na
wyraźne zmiany opisane powyżej tempo budowy
zwiększyło się na całej Ukrainie [3].
2. Rozwój przemysłowy budowy w Kijowie w
XIX wieku.
Na rozwój przemysłowy w Kijowie znacząco
wpłynęła budowa pierwszego dużego mostu
łańcuchowego przez Dniepr za projektem i pod
przewodnictwem brytyjskiego inżyniera Charlesa
Vinyolya. Budowę mostu rozpoczęto w 1847 r., Istniał
od 1853 r. do 1920 r. (Rys.1).
Rys.1.Łańcuchowy most Kyjowa
Metalowe konstrukcje mostu zostały wykonane w
Wielkiej Brytanii w Birminghamie. Na pięciu
obłożonych granitem filarach „bykach” powstały
portale wyglądające jak półkoliste łuki z wieżami w
stylu angielskiego gotyku. Na wspornikach
umieszczono specjalne skrzynie, przez które
przeciągnięto łańcuchy z żelaznych ogniw. Płótno
mostu składało się z belek kratowych, które mocowane
były do łańcuchów za pomocą żelaznych prętów.
Podpory pośrednie opierały się na betonowych
fundamentach. Most o długości 776 m miał 16 m
szerokości i był jednym z największych osiągnięć
budowlanych tamtych czasów. Srebrny model mostu
został wystawiony na Światowej Wystawie w
Londynie w 1851 roku.
Dla statków przepływających rzeką most miał
ruchomą część przy prawym brzegu, które była
wprawiana w ruch za pomocą koła przy udziale tylko
czterech osób. Sekcje zwodzone mostu działały tylko
wiosną, gdy poziom wody znacznie wzrastał. W innych
okresach statki normalnie płynęły pod łańcuchami
Mostu Łańcuchowego. Pod koniec XIX wieku w
wyniku spłycenia Dniepru w obszarze mostu, a także
jego nie wielkiej szerokości, co stało się przeszkodą dla

rozwoju żeglugi rzecznej, zdecydowano się na
rekonstrukcję mostu. W wyniku konkursu w 1897
(zaakceptowano projekt inżyniera Apollo Lossky z
Kijowa) w 1898 przeprowadzono rekonstrukcję mostu.
Sekcja ruchoma została zamieniona na stacjonarną,
nadbudowano arkę nad oporą środkową, płótno mostu
podniesiono o 3,4 m, a koryto rzeki pogłębiono.
Kontynuacją Mikołajowskigo mostu były
Rusanowskie mosty przez lewy zalew i cieśninę. W
1920 roku most został wysadzony, nie udało się
przywrócić mostu zgodnie z dawnym projektem [4].
W maju 1925 roku na filarach byłego
Łańcuchowego Mostu został otwarty nowy most
konstrukcji belkowej zgodnie z projektem E. Patona,
który został nazwany na cześć radzieckiego partyjnego
działacza Eugenii Bosch (Rys. 2). Nowy most, był o 4,2
m wyżej niż w poprzedniej wersji. Miał długość 776 m,
a szerokość 16 m. Zbudowany był z belek dwuteowych,
które pozostały nad brzegiem Dniepru po likwidacji w
1919 strategicznie ważnych mostów autostrady
Kijowskego rejonu. Ten most został ostatecznie
zniszczony 19 września 1941 r. przez wycofującą się
Armię Czerwoną i nie był już odbudowany.
Rys. 2. Most E.Bosz
Rozwój Kijowa pod koniec XIX wieku przyczynił
się do powstania i rozwoju infrastruktury kolejowej. Od
lat 70. XIX w. Kijów stopniowo stał się ważnym
węzłem kolejowym Południowo-Zachodniej kolei.
Znaczącym czynnikiem, który wpłynął na dalszy
rozwój miasta, była budowa w 1868-1870 roku w
dolinie rzeki Lybid pierwszego dworca kolejowego dla
pasażerów oraz z działem towarowym. Murowany
dwupiętrowy budynek dworca w Kijowie został
zbudowany w stylu neogotycznym przez architektora
S.A.Wiśniowskiego w 1870 (Rys.3) i demontowany w
1913 [5].
Rys. 3. a) - Dworzec Kolejowy: wygląd zewnętrzny;
b) - Dworzec Kolejowy: plan;

Świetnym technicznym osiągnięciem, które
wpłynęło na rozwój Kyjowa była budowa
Dnieprowskiego metalowego mostu na Kijowsko-
Kurskiej kolei (obecnie Darnytckij most kolejowy),
który został zbudowany w ramach projektu i pod
kierunkiem wojskowego inżyniera - kapitana A.
Struwe w 1868-1870 roku. Podczas budowy most ten
był najdłuższym mostem w Europie (rys. 4, a).
a) b)
Rys. 4. a. most Struwe; b. most Darnytckij
Most kolejowy Darnytckij miał 11 filarów i 12
przęseł o długości 89 metrów każde. Całkowita długość
mostu wynosiła 1067,6 m, posiadał jeden tor kolejowy.
Most został zbudowany na kesonach. 19 września 1941
r most został zniszczony przez uciekające wojska
radzieckie. Podczas niemieckiej okupacji most był
odbudowany, a ostatecznie zniszczony przez armię
niemiecką na początku listopada 1943 r. W 1946 - 1950
na południe o dawnego mostu zbudowano most
kolejowy Darnytsky z przęsłami łukowymi (rys. 4, b).
Ten most ma dwa tory kolejowe i został
zaprojektowany według schematu asymetrycznego.
Przy lewym brzegu znajdują się 3 przęsła dostosowane
do żeglugi o szerokości 106 metrów, nad którymi
znajdują się łukowe stalowe kratownice, w których
odbywa się ruch pociągów. Przęsła przy prawym
brzegu rzeki są zablokowane przez dwanaście
mniejszych (każde 53 m) żelbetowych kratownic.
Wszystkie filary mostu są masywne, monolityczne i
licowane granitem.
Podczas rozbudowy węzła kolejowego w Kijowie
w 1902-1907 wybudowano nową stację towarową -
rozbudowany kompleks inżynieryjny i transportowy na
terytorium długości 2 km, który był zajęty głównie
torami rozrządowymi i urządzeniami kolejowymi.
Biorąc pod uwagę wielką długość linii kolejowych i
skomplikowane warunki geologiczne, w trakcie
budowy stacji przeprowadzono specjalne zabiegi
techniczne. W szczególności koryto rzeki Lybid jest
przeniesione do kanału z kamiennymi murami. Ogólnie
cały obszar zasięgu stacji „Kijów-I” został
rozplanowany w trzech poziomach, gdzie nowa stacja
towarowa z systemem torów kolejowych zajęła trzeci
poziom. Pośredni poziom miał pełnić funkcję zajezdni.
Również znajdowały się tam warsztaty kolejowe i ich
magazyny. Na górnym poziomie rozmieszczono
budynek mieszkalny "Kolonii Kolejowej" [6].
Dworzec towarowy został wybudowany z
wykorzystaniem nowych dla tych czasów osiągnięć
inżynieryjnych i technologicznych. Miał całą
autonomiczną infrastrukturę, oświetlenie, ogrzewanie,
wodociągi, kanalizację i własną linię telefoniczną.
Wszystkie inżynieryjne i publiczne konstrukcje zostały
zbudowane na fundamentach palowych według
technologii A.Straussa, która później otrzymała
szeroką akceptację i zastosowanie w budownictwie na
słabych wilgotnych glebach na całym świecie.
Innowacyjna i skuteczna technologia pali wierconych
dla wzmocnienia fundamentów budynków i
konstrukcji kijowskiego inżyniera A. Straussa została
po raz pierwszy wprowadzona w 1899 roku właśnie
przy budowie budynków kijowskiego węzła
kolejowego. W 1909 roku inżynier A.Strauss otrzymał
amerykański patent na swój wynalazek [7].
Dla umieszczania pierwszych pali ręcznie
wiercono otwór o średnicy 200 ... 400 mm pod ochroną
obudowy (Rys. 5). Jako element tnący służyły cewki
wiertnicze lub dłuta. Aby podnieść i opuścić wiertarkę
nad miejscem tworzenia pali instalowano wieżę
(trójnóg). Osłona była zagłębiana wraz z wierceniem
gleby. Niewielki stopień mechanizacji ograniczał
długość słupów (10 -12 m). Główną zaletą metody
Straussa jest zagłębianie obudowy bez uderzeń.

Rys. 5.Schemat produkcji pali wierconych Straussa
a-wiercenie otworu; b-wylewanie betonu; c-ugniatanie betonu;
Jednocześnie wykorzystywano wiodące
osiągnięcia inżynieryjne przy budowie stacji
komercyjnych oraz zwracano szczególną uwagę na
aspekty estetyczne. Kompleks nowego dworca
kolejowego zbudowany został na zasadzie jedności
architektoniczno-stylistycznej w stylu modern.
Zaprojektowany był przez inżyniera budownictwa
cywilnego O. Werbickiego. Najciekawszym obiektem
jest „Biuro handlowe”, którego budowa została
zakończona w 1907 roku (Rys. 6).
a)
b) c)
d)
Rys. 6."Biuro handlowe” ; a-fasada główna; b-współczesny wygląd; c-plan; d – sala

Wszystkie pomieszczenia „Biura” są skupione
wokół centralnej sali operacyjnej, którą pokrywają
metalowe łukowe wiązary z latarniami górnego
oświetlenia. Prawie wszystkie fasady budynku zostały
ozdobione fryzami, ozdobionymi stylizowanymi liśćmi
kasztanowca, wykonanymi w płaskorzeźbie.
Na początku lat 1870 w Kyjowie mieszkało 75
tysięcy osób, a w 1897 r. - prawie 250 tys.
mieszkańców. Gwałtowny wzrost populacji przyczynił
się do rozwoju handlu, a wraz z nią przemysłu. Zaczęło
się aktywne zabudowywanie przedmieści Kijowa -
Solomianka, Szulawka, Zwirynec, Priorka.
Rozproszenie obszarów mieszkalnych na dość dużym
obszarze i skomplikowana rzeźba terenu komplikowały
komunikację między nimi. Aby połączyć centralne
regiony i stację kolejową w 1890 roku w Kijowie była
stworzona kolej miejska, najpierw na ciągu konnym -
„konka” (Rys. 7, a), a następnie na silniku parowym i
elektrycznym (Rys. 7, b, c). Autorem projektu kolei
miejskiej był kijowski inżynier A. Struve, który
stworzył akcyjne „Towarzystwo Kijowskiej kolei
miejskiej” [8].
a) b)
c)
Rys. 7. Kijowskie tramwaje a-tramwaj konny; b-tramwaj parowy; c-tramwaj elektryczny.
1 czerwca 1892 zaczął funkcjonować pierwszy
system tramwajów z napędem elektrycznym. Była to
pierwsza taka sieć byłego Imperium Rosyjskiego i
współczesnej Ukrainy. W 1913 r. Prawie cały Kijów
znajdował się w zasięgu nowej sieci.
Wprowadzenie scentralizowanych systemów
zaopatrzenia wody i kanalizacji miejskiej znacznie
poprawiły warunki życia w Kijowie.
Pierwszy scentralizowany ogólnomiejski system
sieci wodociągowej miasta został stworzony w 1870 -
1872 roku z inicjatywy inżyniera-pułkownika
A.Struwe. Była to druga sieć dostawy wody na
Ukrainie (pierwsza została wybudowana w Odessie w
1853 r. z wykorzystaniem źródeł Wielkiej Fontanny).
W 1872 roku w Kijowie uruchomiono pierwszy
rurociąg systemu długości 23,3 m, do którego
przyłączone były posiadłości zamożnych obywateli.
Woda z Dniepru przechodziła przez piaszczyste
angielskie filtry i docierała do sieci żeliwnych rur.
Dziesięć lat później długość sieci wodociągowej
wynosiła już 45 km. Jednocześnie budowane były
elementy kanalizacji nowoczesnego typu. W 1894 po
raz pierwszy uruchomiono w pełni oddzielony system
kanalizacji, gdzie ścieki były oczyszczane w filtrach
(Kurynivskie pola), a następnie trafiały do Dniepru.
Głównymi obiektami zaopatrzenia w wodę były dwie
przepompownie i trzy wieże ciśnień. Dolna
przepompownia, w pobliżu Kolumny prawa
magdeburskiego, posiadała studnię odbiorczą (ostatnio
ten budynek został zniesiony). Górna przepompownia
została wybudowana w pobliżu Wołodymyrskiego
Zejścia. W latach osiemdziesiątych XIX wieku
zbudowano w niej dwa odstojniki i filtr do uzdatniania
wody [9].

W Ogrodzie carskim (obecnie Park Chreszczatyj)
zbudowano dwie wieże ciśnień o wysokości 20
metrów, które miały podziemny kamienny zbiornik na
1 mln. 350 tysięcy litrów wody. Mieli trzy kondygnacje
mieszkalne i żelazne zbiorniki na dachu o pojemności
160 tysięcy litrów. Trzecia wieża ciśnień została
wzniesiona na górnym tarasie Wołodymyra, niedaleko
klasztoru Michajłowskiego. Wieża Michajłowska była
o 4 metry wyższa o wież w ogrodzie carskim i miała
zbiornik o pojemności 220 tysięcy litrów. Dno
zbiorników każdej z trzech wież było o 105 metrów
wyżej niż poziom Dniepru.
Przetrwała tylko jedna z trzech wież ciśnień [10].
W tym budynku, którego architektem był O. Shile,
znajduje się teraz Water Information Center (Rys. 8, a).
Niedaleko, w parku miejskim, zrekonstruowano
kolejną wieżę. Pod tą wieżą znajdują się główna część
dawnego olbrzymiego zbiornika wodnego. Teraz na
terenie zbiornika i wieży znajduje się klub nocny
"Projekt carski" (Rys. 8, c).
a) b) c)
Rys. 8.Wieża ciśnień a-Water Information Center; b-plan; c-klub nocny"Projekt carski".
Fontanny stały się największą ozdobą kijowskich
skwerów, parków i placów [11]. Zgodnie z projektem
arch. O. Shile w 1898 - 1900 latach opracowano dwa
rodzaje fontann: duże i małe. Pierwsza z wielkich
fontann pojawiła się na placu Carskim (obecnie plac
Europejski). Później został usunięty, ale wg tego
właśnie wzoru zainstalowano jeszcze sześć dużych
fontann odlanych w fabryce O. Termena. Małe
fontanny nie zostały zachowane, a pięć z dużych
fontann dotychczas działa: na placu Zolotoworitskim,
na placu Iwana Franko; w parkach Maryjinskim i
Miejskim, w parku na rogu ulic Gonczara i Michaiła
Kotsiubinskiego (Rys. 9).
Rys.9. Wielka fontanna. Park Maryjinskij, Kijów.
W 1908 r. epidemia duru brzusznego i cholery w
mieście zdyskredytowała pomysł zaopatrzenia w wodę
z rzeki bez dezynfekcji wody pitnej. Na prośbę
społeczności miejskiej przedsiębiorstwo wodociągowe
zaprzestało pobór wody pitnej z Dniepru i Kijów
przeszedł na artezyjskie zaopatrzenie w wodę
Stopniowo w architekturze i budownictwie
Ukrainy ustanawiają się racjonalne idee wykorzystania
nowych materiałów budowlanych i konstrukcji,

swobodnego wyboru stylu oraz stosowania
narodowych osobliwości i tradycji. Szeroko
wprowadzane są konstrukcje z cegły i żelbetu, nowe
formy konstrukcji stalowych w mostach i budynkach
publicznych.
3. Wnioski
Urbanizacja Kijowa w drugiej połowie XIX wieku
stała się początkiem zupełnie nowego sposobu
mieszkania w mieście, wiek ten był bardzo bogaty na
innowacje w budownictwie przemysłowym. Do
ważnych wydarzeń, które miały miejsce na terenie
miasta trzeba zaliczyć stworzenie systemów
technicznych o dużym zasięgu (wodociągi, kanalizacja,
prąd) oraz wprowadzenia pierwszego transportu
publicznego (tramwaj). Przemysłowymi innowacjami,
które miały wielkie znaczenie dla ogólnego rozwoju
miasta, są fundamentalne projekty inżynieryjne
zagospodarowania należącej do miasta części Dniepru
i budowa pierwszej zatoki handlowej w pobliżu
Podołu. Z ogólnomiejskich osiągnięć inżynierii
najbardziej znaczące były: wprowadzenie pierwszego
wyciągu elektrycznego (kolejka linowa), budowa
mostów i wiaduktów, organizacja ulicznych autostrad,
opracowanie innowacyjnej i efektywnej technologii
pali wierconych do wzmacniania fundamentów
budynków i budowli na słabych glebach, wzmocnienie
zboczy Kijowa i wybudowanie granitowego nabrzeża.
WYKAZ LITERATURY:
1. Ukraina i Mołdawia: Informator-przewodnik /
Aut. tekst i skład. G. Logvin - M: Art; Lipsk; Edicion,
1982. - 454 s.
2. Virotskyj W.D, Getun G.W. Historia Inżynie-
rii i Architektury Ukrainy: Podręcznik / W.D. Virot-
skyj, Getun G.W. - K: KNUBA, 2015. - 160 s.
3. Płoskyj W.O., Getun G.W., Virotskyj W.D.
Architektura budynków. Tom 3. Historia architektury i
budownictwa: Podręcznik dla wyższych instytucji
edukacyjnych. / Edited Getun G.W. - wydanie drugie,
poprawione i zaktualizowane / Flat W.A., Getun G.W.,
Virotskyij W.D. – K: "Lear-K", 2016 - 816 s.
4. Kyjów: Podręcznik encyklopedyczny / wyd.
A.W. Kudrytsky. - K.: Cel. Redaktor Ukraińskiej En-
cyklopedii Radzieckiej, 1981- 332s.
5. Ivleva W.P. Zabytki rozwoju przemysłowego
Kijowa pod koniec XIX - początku XX wieku. - K:
Press-KIT, 2008 - 248 s.
6. Ukraińska Encyklopedia Radziecka: 12 vols /
Edytowane przez M. P. Bazhan i inni. – K: URE, 1978
-300 s.
7. Аseew J. S., Vechersky W.W., Godovanyuk
O. M. i inni. Historia ukraińskiej architektury. /
Edytowane przez W. Timofiyenko. - K: Technics,
2003. - 472.
8. Zbiór historycznych i kulturalnych zabytków
Ukrainy. Kijów - Tom 1, część 1. - K., Ukrainian
Encyclopedia, 1999. - 608 s.
9. Logvin H. N. Na Ukrainie. Starożytne zabytki
artystyczne. - К: Art, 1968.- 462с.
10. Historia sztuki ukraińskiej: 6 t. /Edytowane
przez M. P. Bazhan i inni. - K: URE, 1966 - 1970.
11. Ukrainian Encyclopedia, 2004. - 1214 str.
MAINTAINING THE WELL-BEING OF THE URBAN SOCIETY DURING A PANDEMIC
SITUATION: THE POSITIVE ACTIVITY BENEFACTION OF GARDENING AND URBAN
FARMING
Diana Harding,
Padjadjaran University, Faculty of Psychology
Anissa Lestari Kadiyono,
Padjadjaran University, Faculty of Psychology
Susi M.
Padjadjaran University, Faculty of Arts
DOI: 10.24412/3453-9875-2021-59-1-10-14
Abstract
The urban areas in Indonesia are growing rapidly, in which several sustainability issues arise including food
security, land-use change, environmental quality, and the well-being of the urban society. The pandemic era of
COVID-19 also adds pressure through the reality of people who are encouraged to stay at home and follow health
protocols. Therefore, an understanding of alternative activities that can contribute to environmental sustainability
and a healthy lifestyle that urban communities can do is needed. In this study, the writing team highlighted the
concepts of urban farming and gardening to facilitate the development of movements to advance community wel-
fare and environmental sustainability. This study uses the approach of literature review and we compiled the results
to highlight the state-of-the-art for urban farming and gardening concepts in Indonesia, focusing on its influence
to improve the well-being aspect. It is understood that the urban farming and gardening movement is not only
giving benefits in the form of economical incentives as an alternative livelihood, environment conservation, and
socio-culture movement, but there is also the insight of improving the well-being of the urban population within
their routine and the isolation during the pandemic era. The initiative from the community and the support from
the government and various stakeholders play an important role to facilitate the urban farming and gardening
movement in Indonesia.
Keywords: Gardening, Urban Farming, Pandemic, Well-Being, Sustainability

Introduction
The development of urban areas and the rapid rate
of urbanization are the causes of urban problems in the
form of food access, increased urban burden in the as-
pect of poverty, limited employment, and decreased en-
vironmental quality (Anggrayni et al., 2015; Cahya,
2016; Fauzi et al., 2016; Indraprahasta, 2013). Refer-
ring to one of the points of the principles of Sustainable
Development Goals related to sustainable cities and
communities, various greening concepts become a ref-
erence to overcome the challenges of urban areas.
The concept of green infrastructure as one of the
focuses of sustainable urban development emphasizes
the importance of green infrastructure in urban environ-
ments through gardening, green roofs, and greening on
the road. At the same time, urban farming is an alterna-
tive in terms of sustainable urban development (Fauzi
et al., 2016). By definition, urban agriculture is an cur-
rent condition of the Covid-19 pandemic puts pressure
and changes people's behavior in dealing with it.
Based on the above considerations, this study aims
to discuss various researches related to urban agricul-
ture in Indonesia, as well as its contribution in welfare
aspects to urban agricultural practitioners. Through a
comprehensive and in-depth review, it is expected that
this research can be a reference for various future re-
searches in understanding a variety of perspectives
from research related to urban agriculture that need to
be researched more thoroughly as an alternative to sus-
tainable programs.
Method
This study uses a descriptive qualitative approach
in the form of a literature review of various existing
studies. This study presents a variety of studies related
to urban agriculture and gardening in various regions in
Indonesia, researchers use the search engines on google
scholar in compiling various studies and reports. Two
aspects are the focus: (a) research approaches and top-
ics, as well as (b) challenges and insights for future re-
search. Besides, this study also discusses the utilization
of gardening activities to improve the well-being and
happiness of urban communities.
Result
1. Systems Approach and Regional Case
Study
The common approach to the topic of urban agri-
cultural research in Indonesia often discusses urban ag-
ricultural systems using a case study approach. The city
of Surabaya with a high level of urbanization causes the
issue of food access and urban agriculture to be used as
a strategy to improve food access (Anggrayni et al.,
2015). Urban agriculture programs are also utilized in
the Green City and Special Economic Zone Program in
Palu City which is hit by effort to process and distribute
food commodities in urban areas (Amir and Saidin,
2020), and one of the differences between urban and
village agriculture is the consideration of urban system
integrase in the form of economic systems and urban
ecosystems in agricultural activities (Cahya, 2016).
Although the various benefits of urban agriculture
have been discussed, the implementation is still experi-
encing obstacles in various regions of Indonesia. On the
other hand, there is one point of view of urban agricul-
ture from an interesting psychological aspect to be re-
viewed in more depth.
Well-being is an individual's satisfaction with life
and aspects of his life. Overall, individual psychologi-
cal well-being can be measured through several differ-
ent approaches (Obrien et al., 2012; Peel, Berry,
Schirmer, 2016). The World Health Organization
(2014) in Peel, Berry, Schirmer, (2016) provides an un-
derstanding that mental health is an individual's ability
to overcome problems and adapt to pressures in their
environment. Of course, the the issue of increasing pop-
ulation. Therefore, urban agriculture becomes an alter-
native intervention by utilizing the potential of river ar-
eas as productive areas (Hamzens and Moestopo,
2018).
For the Jakarta area, the issue of urbanization rate,
population growth, and infrastructure development af-
fects the environment and food issues so that land use
is needed for productive horticultural activities (Cahya,
2016; Indraprahasta, 2013; Indrawati, 2017). There are
several challenges to urban agriculture in Jakarta. The
interventions from the government and stakeholders are
needed to address the status of urban agriculture in the
ecological, economic, and social dimensions that have
not reached the level of sustainability (Cahya, 2016), as
well as the status of urban agriculture in the Spatial Plan
that needs to be clarified with the status of green open
space (Indraprahasta, 2013).
Another area in Indonesia that gets enough atten-
tion in urban agriculture is Bandung. One of the per-
spectives of urban agriculture in Bandung is the devel-
opment of citizens' concern for the environment
through a community approach. Bandung city has a
community of Bandung Berkebun (Bandung Garden-
ing) with various programs such as urban farming,
school urban farming, street urban farming, and cam-
pus urban farming that plays a role in the education of
environmentally caring character (Prasetiyo and Budi-
mansyah, 2016). On the other hand, urban agriculture
programs in Bandung also show a positive impact on
the education, economy, and society as a vehicle for
mingling citizens and fostering cooperation and social
interaction (Prasetiyo et al., 2016).
There are four influential key factors in the urban
agricultural system: market access, economic income,
socio-demographic factors, and land ownership. Also,
urban agriculture integration with the regional agenda
is needed and treated as an element of urban govern-
ance (Martin-Moreau and Menasce, 2019). At the same
time, it is necessary to consider developing strategies
for urban agricultural systems through technical, organ-
izational, and policy, and institutional support (Sastro,
2013).
2. Agricultural Practice Approach
Another perspective of urban agriculture that is the
focus of the study is the development of practice. Amir
and Saidin (2020) explained about commonly planted
plants such as vegetables, lettuce, kale, tomatoes, cay-
enne pepper, and onions. Urban agricultural practices
in Indonesia itself began after the economic crisis of the
1997-1998 period conducted by utilizing yards and
abandoned land with an area of 10 m2
or 100-500 m2

(Fauzi et al., 2016). In South Jakarta, there are urban
agricultural practices in various forms through the uti-
lization of yardland, community land, mosque land, of-
fice land, and school land with various types of produc-
tive crops (fruits), protective crops, and ornamental
plants (Indrawati, 2017).
The technological approach to urban agriculture
has also caught the attention of some researchers. The
utilization of aspects of the Internet of Things (IoT) is
discussed as a tool to monitor soil moisture conditions
(Taqwa et al., 2020), and smart farming models to con-
trol pH and nutrient levels automatically through the
use of smartphone applications (Zuraiyah et al., 2019).
3. Health and Education Studies
The impact of gardening activities, which are also
part of urban agriculture, is an interesting discussion for
some researchers. This can be seen from the variety of
studies related to gardening activities associated with
the field of health and education. Urban agricultural
studies have expanded, and are not only related to agri-
culture, but also associated with their contribution to
community and community health issues (Amir and
Saidin, 2020). One common approach is in the corridor
of gardening therapy activities. Gardening therapy is
known as an effective alternative method in dealing
with cases of elderly people with hypertension (Mag-
firah and Alifariki, 2018). In other studies with elderly
respondents, the application of horticultural therapy
and farming activities is known to increase self-effi-
cacy in the form of social persuasion and mastery ex-
periences, as well as the emergence of happiness when
looking at plant growth (Silitonga et al., 2017). The
same therapy was also applied to inmate respondents
who showed the results of horticultural therapy activi-
ties can lower the level of aggression (Waibi, 2016). As
for the field of education, gardening activities are
known to improve the character of environmental care
(Marietta and Darmawani, 2019), and the mingling of
different types of citizens with different backgrounds in
the gardening community can have a positive impact to
share their abilities and experiences (Prasetiyo et al.,
2016).
Discussion
Discussing the situation and phenomenon of urban
agriculture in Indonesia today which is one of the alter-
native interventions of various urban problems, espe-
cially aspects of food security and environmental qual-
ity is interesting. At the same time, it is undeniable that
urban agricultural activities still encounter various
challenges that need to be considered in their imple-
mentation. The management aspect is highlighted be-
cause generally it is not done professionally and is still
done based on the principle of pleasure and channeling
the hobby of planting (Amir and Saidin, 2020). Never-
theless, it can be argued that hobbies are the gateway
for urban communities to start productive gardening
and utilizing yardland. Utilization of yard land for hor-
ticultural activities can provide benefits to landowners
from productive crops, as well as environmental contri-
butions in terms of oxygen fulfillment and mitigation
of soil and air pollution (Indrawati, 2017).
The next challenge is the utilization of urban agri-
culture in the food security supply aspect. Nasution
(2015) in his research revealed an interesting phenom-
enon of the rise of the urban agricultural movement
which has a different background to the food sover-
eignty movement. As an alternative to supplying, the
government needs to understand and embrace the exist-
ence of gardening communities in urban areas espe-
cially to meet access to healthy food needs. Surabaya's
agriculture office in the urban farming program sug-
gests that one of the objectives of the program is to as-
sist the poor in meeting the consumption of nutritious
food (Junainah, 2016). As the phenomenon of urban ag-
riculture evolves, it is worth noting how the sector can
contribute to a large framework of urban health.
The third challenge of urban agriculture is compe-
tition with the existence of the agricultural products
market. The background of urban agriculture that
played an important role in the economic crisis of the
period 1997-1998 occurred due to the phenomenon of
food prices and the rising unemployment rate (Martin-
Moreau and Menasce, 2019). Through this phenome-
non, it is known that gardening and urban agriculture
are alternative sources of income, especially in times of
crisis. Reflecting on the area in Palu City, the local food
system that is cultivated and produced in urban areas,
is also marketed to consumers in urban areas (Hamzens
and Moestopo, 2018). Similar systems can be utilized
to ensure market availability for urban agricultural
products. Community support and stakeholders such as
distribution agents and methyl stores can further sup-
port urban agricultural systems marketed to the wider
community while at the same time ensuring high qual-
ity for marketed products. It should also be noted how
urban agriculture can be fully integrated with village
agriculture, and the supply of the two sectors can fill
each other. It takes the role of the government to ensure
the balance of supply and market prices for the protec-
tion of producers.
The last challenge is the role of urban agriculture
during the COVID-19 pandemic. The research from
Vibriyanti (2020) describes gardening activities that are
categorized as controlled actions that can play an im-
portant role in pandemic conditions as strategies to deal
with anxiety, stress, and panic. Gardening activities can
be seen as activities that use the five senses and are car-
ried out today, to reduce the thoughts that cause stress
(Bondy, 2019). It is important to note the contribution
that the urban agricultural sector can make regarding
the impact of mental health, especially in the condition
of the COVID-19 pandemic that requires some people
to change lifestyles, one example of which is social dis-
tancing and work-from-home (WFH). Gardening activ-
ities by utilizing the yard can be an interesting means
for families in reducing the level of saturation caused
by the monotonous lifestyle of work-from-home. At the
same time, gardening activities can be a social vehicle
for parents and children to engage and learn new ones.
Farming activities are known to develop the value of
responsibility, problem-solving, and acceptance (Silin-
tonga et al., 2017). Psychologically, farming activities
make for pleasant interactions between people and their
environment (Jack, 2012; Poe et al., 2016, Raymond et
al., 2010; Saxby 2017). The opportunity to have contact

with nature also provides a sense of calm from the anx-
ieties experienced (Carlisle et al., 2009; Roberts et al.,
2015; Drescher, 2014; Saxby 2017). Not only related to
nature, but it is also physically related to the current en-
vironment so that this can provide a sense of power,
part of the community, and provide a positive value of
the activities undertaken, thus giving rise to psycholog-
ical well-being (Saxby, 2017).
Conclusion
Urban agriculture is a research topic that becomes
an interesting discussion for the academic community
in Indonesia. This can be seen from various dimensions
of research, in terms of management, economics, agri-
culture, health, social, and engineering. Case studies
are a fairly common form of research for urban agricul-
ture in Indonesia, but the authors argue to emphasize
the importance of national perspectives and overall sys-
tems so that the various sectors involved in urban agri-
culture become clear. The study also put forward the
idea of gardening in urban agricultural corridors as an
alternative intervention in pandemic conditions as a
program that has the potential to invite people to use
the yard for productive activities, as well as facilitate
social interaction and maintain health. It takes further
research from both the fields of psychology and agri-
culture to find out the influence of gardening on mental
health and well-being, as well as breakthroughs from
the field of agriculture to provide opportunities for ur-
ban communities that have limited land but can still
participate in urban agriculture
REFERENCES:
1. Amir, H.M., Saidin. (2020). Pengembangan
Urban Farming Dalam Rangka Pemberdayaan
Masyarakat di Kota Kendari (Urban Farming Develop-
ment in Order to Empower Communities in Kendari
City). Journal of Neo Societal, 5(3), 227-237.
2. Anggrayni, F.M., Andrias, D.R., Adriani, M.
(2015). Ketahanan Pangan dan Coping Strategy Rumah
Tangga Urban Farming Pertanian dan Perikanan Kota
Surabaya (Food Security and Coping Strategy of Urban
Farming in Agriculture and Fisheries Surabaya). Media
Gizi Indonesia, 10(2), 173-178.
3. Bondy, M., & Cole, D. (2019). Farmers' health
and well-being in the context of changing farming prac-
tice: a qualitative study. European Journal of Public
Health, 29(4), ckz186-597.
4. Cahya, D.L. (2016). Analysis of urban agricul-
ture sustainability in Metropolitan Jakarta (case study:
urban agriculture in Duri Kosambi). Procedia - Social
and Behavioral Sciences 227, 95-100.
5. Fauzi, A.R., Ichniarsyah, A.N., Agustin, H.
(2016). Pertanian Perkotaan: Urgensi, Peranan, dan
Praktik Terbaik (Urban Agriculture: Urgency, Role,
and Best Practices). Journal of Agrotechnology, 10(1).
6. Hamzens, W.P.S., Moestopo, M.W. (2018).
Pengembangan Potensi Pertanian Perkotaan di Kawa-
san Sungai Palu (Development of Urban Agricultural
Potential in Palu River Area). Journal of Urban Devel-
opment, 6(1).
7. Indraprahasta, G.I. (2012). The potential of ur-
ban agriculture development in Jakarta. Procedia Envi-
ronmental Sciences 17, 11-19.
8. Indrawati, E. (2017). Urban farming model in
South Jakarta. IOP Conf. Series: Earth and Environ-
mental Science 106.
9. Junainah, W., Kanto, S., Soenyono. (2016).
Program Urban Farming Sebagai Model Penanggulan-
gan Kemiskinan Masyarakat Perkotaan (Urban Farm-
ing Program as a Model for Poverty Alleviation of Ur-
ban Communities). Wacana, 19(3), 148-156.
10. Magfirah, Alifariki, L.O. (2018). Pengaruh
Terapi Berkebun Terhadap Perubahan Tekanan Darah
Pada Lansia Dengan Hipertensi di Panti Sosial Tresna
Werdha Minaula Kendari (Effect of Gardening Ther-
apy On Blood Pressure Changes In Elderly With Hy-
pertension at Tresna Werdha Minaula Kendari Social
Housing). Journal of Islamic Nursing, 3(2), 7-15.
11. Marietta, A.D., Darmawani, E., Kons, M. Pd.
(2019). Meningkatkan Karakter Peduli Lingkungan
Melalui Kegiatan Berkebun Kelompok B di RA Perwa-
nida 4 Jakabaring Palembang (Improving Environmen-
tal Awareness Character Through Group B Gardening
Activities in RA Perwanida 4 Jakabaring Palembang).
Journal of PERNIK PAUD, 2(2).
12. Martin-Moreau, M., Menasce, D. (2019).
Field Actions Science Reports. Special Issue 20 Urban
Agriculture: Another Way to Feed Cities. ISSN: 1867-
139X.
13. Nasution, Z. (2015). Indonesian Urban Farm-
ing Communities and Food Sovereignty (Master's The-
sis). ISS: Master Thesis.
14. Peel, D., Berry, H. L., & Schirmer, J. (2016).
Farm exit intention and well-being: a study of Austral-
ian farmers. Journal of rural studies, 47, 41-51.
15. Prasetiyo, W.H., Budimansyah, D. (2016).
Warga Negara dan Ekologi: Studi Kasus Pengem-
bangan Warga Negara Peduli Lingkungan Dalam
Komunitas Bandung Berkebun (Citizens and Ecology:
Case Study of Development of Citizens Caring for the
Environment In Bandung Gardening Community).
Journal of Humanities, 4(4), 177-186.
16. Prasetiyo, W.H., Budimansyah, D., Roslidah,
N. (2016). Urban Farming as A Civic Virtue Develop-
ment in The Environmental Field. International Journal
of Environmental & Science Education, 11(10), 3139-
3146.
17. Sastro, Y. (2013). Pertanian Perkotaan: Pelu-
ang, Tantangan, dan Strategi Pengembangan (Urban
Agriculture: Opportunities, Challenges, and Develop-
ment Strategies). Buletin of Urban Agriculture, 3(1),
29-36.
18. Saxby, H., Gkartzios, M., & Scott, K. (2018).
‘Farming on the edge’: wellbeing and participation in
agri‐environmental schemes. Sociologia ruralist, 58(2),
392-411.
19. Silitonga, A.N., Satiadarma, M.P., Risnawaty,
W. (2017). Penerapan Hortikultura Terapi Untuk
Meningkatkan Self-Efficacy Pada Lansia (The Appli-
cation of Horticultural Therapy To Improve Self-Effi-
cacy In The Elderly). Muara Journal of Social Sciences,
Humanities, and Arts, 1(2), 399-405.
20. Taqwa, A., Lindawati, Faiz, A. (2020). Opti-
malisasi Urban Farming menggunakan System Moni-

toring Soil Moisture (Urban Farming Optimization us-
ing Soil Moisture Monitoring System). BEES, 1(1), 58-
64.
21. Vibriyanti, D. (2020). Kesehatan Mental
Masyarakat: Mengelola Kecemasan di Tengah Pan-
demi COVID-19 (Community Mental Health: Manag-
ing Anxiety in the Midst of the COVID-19 Pandemic).
Journal of Indonesian Population, 69-74.
22. Waibi. (2016). Pengaruh Horticulture Therapy
Terhadap Tingkat Agresi Narapidana: Sebuah Analisa
Rasch Model (The Effect of Horticulture Therapy on
Inmate Aggression Levels: A Rasch Model Analysis).
JDC, 1(1), 15-36.
23. Zuraiyah, T.A., Suriansyah, M.I., Akbar, A.P.
(2019). Smart Urban Farming Berbasis Internet of
Things (IoT). Information Management for Educators
and Professionals, 3(2), 139-150.

MEDICAL SCIENCES
OVARIAN FUNCTION IN PATIENTS WHO UNDERWENT THE UTERINE ARTERIES
EMBOLIZATION
Kalinovska O.,
Candidate of Medical Sciences, Associate Professor, Associate Professor of the Department of Obstetrics
and Gynecology №2, Kharkiv National Medical University
Lazurenko V.,
Doctor of Medical Sciences, Professor, Head of the Department of Obstetrics and Gynecology №2, Kharkiv
National Medical University
Cherepova V.,
Starkova I.,
Tishchenko O.,
Candidate of Medical Sciences, Assistant of the Department of Obstetrics and Gynecology №2, Kharkiv
Stryukov D.
Candidate of Medical Sciences, Assistant of the Department of Obstetrics and Gynecology №2, Kharkiv
DOI: 10.24412/3453-9875-2021-59-1-15-16
Abstract
The effect of uterine artery embolization on the ovarian function and blood flow in the ovaries was studied
immediately after surgery and during the long-term postoperative period. Interruption of blood flow in the ovarian
arteries immediately after UAE was noted. Restoration of blood flow was observed in women during 6-12 months
of the postoperative period.
Keywords: uterine artery embolization, ovarian blood flow, ovarian arteries, postoperative period
The introduction of new minimally invasive sur-
gery techniques made uterine artery embolization
(UAE) an alternative to traditional hysterectomy and
myomectomy [1; 2. p. 260-261; 3, p. 99-100]. In the
past few years, UAE has been applied in Obstetrics: this
method is especially important for hypo-atonic postpar-
tum hemorrhage [4, p. 436]. It was also first applied in
Ukraine in the postpartum period as a preventive stage
of the integral method of treatment of the true fused pla-
centa. The proposed method of integral therapy was pa-
tented (Patent of Ukraine for utility model No. 96783
“Method of treatment of placental invasion”, dated 10
Feruary 2015).
The purpose and objectives of the research. The
aim of the research was to study and assess the effect
of UAE on the blood flow in the ovaries and on the
ovarian function in general. There are contradictory re-
ports on this subject in the literature [6, p. 694; 7, p.
510]. Taking into consideration the anatomical features
of the ovarian blood supply: the ovarian artery (OA)
and the ovarian branch of the uterine artery, it is possi-
ble for the emboli to enter the ovarian vessels [7, p. 512-
513].
Research design. We examined and treated 220
patients with uterine leiomyoma, whose average age
was 32,7 ± 8,9. Axiom Artis MP angiograph (“Sie-
mens”, Germany) was used to perform the emboliza-
tion surgery.
The uterine arteries were accessed according to the
standard Seldinger technique with the use of polyvinyl
alcohol (PVA) and “Biosphere” beads. The state of the
blood flow in the ovarian arteries after the treatment
was assessed by transvaginal sonography with CFM
(color flow mapping) immediately before and after
UAE.
Research results and their discussion. Accord-
ing to the sonography made immediately after the sur-
gery, all the women showed interruption of blood flow
in the ovarian arteries, which is comparable with that in
other authors’ results [4, p. 934-935]. In cases of invol-
untary embolization (due to the utero-ovarian arterial
anastomoses), the function of the ovary decreases,
which is clinically expressed in anovulation [5, p. 435-
436; 7, p. 512].
One may judge about the restoration of the blood
flow in the OA due to the direct visualization of the
blood flow during CFM (color flow mapping), as well
as by the presence of echographic signs of adequate fol-
liculogenesis, perifollicular blood flow, formation of
the corpus luteum with characteristic peripheral blood
flow [2, p. 260]

A B C
A) ovary without signs of blood flow in the OA; B) a few weeks after the surgery, the blood flow in the ovarian
artery is restored, but there are no signs of perifollicular vascular changes that are characteristic of ovulation;
C) ovary with restored blood flow in the ovarian artery and restored ovulatory function; adequate perifollicular
blood flow is visualized.
The median follow-up after UAE equaled 28
weeks (from18 to 42 weeks). The index of resistance
(IR) allows us to view the adequate blood supply to the
ovary during the periovulatory period. Doppler exami-
nation indicated that after 6 months, 16 % of patients
showed no arterial blood flow in the ovarian arteries,
while it was restored in 59 % of patients. During the
first months after the surgery, the IR values were mon-
otonic: 0,55 - 0,62, and did not reduce to the pre-ovula-
tory level.
Blood flow parameters were reduced in 25 % of
patients (compared to the preoperative parameters). In
this group 6 % of women showed reflux of singular em-
boli into the ovaries. They showed typical origin of
uterine and ovarian arteries. Even in the presence of
small hyperechoic inclusions of PVA in the ovarium
stroma, recorded by the sonography and color Doppler
mapping, no violation of microcirculation in the ovaries
was registered, as well as the violation of their function.
Ovarian dysfunction in patients, who underwent
UAE, is parenthetic [3, p. 101-102; 4, p. 929-931). Res-
toration of blood flow in the ovarian arteries after UAE
occurs in the postoperative period from 6 to 13 months.
After 12 months, blood flow restored in more than 90
% of patients, who had been operated on.
12 % of women got pregnant, and 23 cases of
childbirth were reported.
Findings. The cumulative analysis of the results
showed that restoration of the blood flow in the ovarian
arteries after UAE occurs in the first year after surgery.
The preservation of fertility, the capability to get preg-
nant and to deliver healthy children is a reliable confir-
mation of the correct choice of the method of treatment.
REFERENCES:
1. Masciocchi C, Arrigoni F, Ferrari F, Giordano
AV, Iafrate S, Capretti I et al. Uterine fibroid therapy
using interventional radiology mini-invasive
treatments: current perspective. Med Oncol. Apr
2017;34:52. DOI: https://doi.org/10.1007/s12032-017-
0906-5.
2. Hromova AM, Hromova OL, Ketova OM. Rol
ultrazvukovykh parametriv pry vybori reproduktyvno-
plastychnykh operatsiy pry leiomiomakh matky.
Visnyk problem biolohii i medytsyny. 2014;2(3):260-
2. [in Ukrainian]
3. Lytvynenko OV. Kharakterystyka perebihu
postembolizatsiynoho syndromu u zhinok z
leyomiomoyu matky ta suputnimy somatychnymy
zakhvoryuvannyamy. Aktualni problemy suchasnoi
medytsyny. 2011;11.4-1(36):99-102. [in Ukrainian]
4. Oyelese Y, Smulian JC. Placenta previa, pla-
centa accreta, and vasa previa. Obstet Gynecol 2006;
107: 927–941.
5. Japaraj RP, Mimin TS, Mukudan K. Antenatal
diagnosis of placenta previa accreta in patients with
previous cesarean scar. J Obstet Gynaecol Res 2007;
33: 431–437.
6. Fishman SG, Chasen ST. Risk factors for
emergent preterm delivery in women with placenta pre-
via and ultrasound ﬁndings suspicious for placenta ac-
creta. J Perinat Med 2011; 39: 693–696.
7. D'Antonio F., Iacovella C., Bhide A. Prenatal
identification of invasive placentation using ultra-
sound: systematic review and meta-analysis. Ultra-
sound in Obstetrics & Gynecology. 2013; 42(5): 509-
517.

THE USE OF NEGATIVE PRESSURE VACUUM THERAPY IN THE TREATMENT OF SOFT
TISSUE DEFECTS IN THORACIC INJURY
Zarutskyi Ya..
MD, DSci, Professor, Chief of the department of military surgery,
Ukrainian military medical academy (Kyiv, Ukraine)
Aslanyan S.
Ph.D., Associate Professor (docent), Associate Professor of the department of military Surgery,
Ukrainian military medical Academy (Kyiv, Ukraine)
Kravchenko К..
PhD, Senior Ordinator of the Clinic of thoracic surgery,
National military medical clinical center (Kyiv, Ukraine)
Vovk M.
Adjunct of the department of military surgery,
Honcharuk V.
Tutor of the department of military surgery,
DOI: 10.24412/3453-9875-2021-59-1-17-23
Abstract
Thoracic injury accounts for 6-8% of all traumatic injuries and belongs to the category of particularly severe
lesions of the body. About 90% of victims with thoracic injury are of working age, whose treatment and rehabili-
tation are quite long due to the large number of purulent-septic complications (up to 20%), which often lead to
disability or cause high mortality (17-30%). In peacetime, closed thoracic injuries are more common in the road
accidents and in industries that are accompanied by multiple rib fractures and damage to internal organs. The
mortality of the closed thoracic injury reaches 5-17%, and with a severe injury - 40%. In modern military armed
conflicts, the frequency of combat thoracic injury (CTI) is 8-12% [2]. During the JFO (Joint Forces Operations)
in Eastern Ukraine, CTI accounted for 11.7% of the combat casualties of the surgical profile, from which 79.4%
were nonpenetrating, and 20.6% were penetrating and usually with damage to internal organs [1]. Severe CTI is
accompanied by massive blood loss, traumatic shock, acute respiratory failure, other complications and high mor-
tality to 37% [8]. Large and very large wounds of the chest damages not only skin and hypodermic cellulose, but
also fascia, muscles and other important anatomic structures of the chest. In such cases, these are soft tissue defects.
Treatment of gunshot wounds of the chest wall complicated by purulent process has a number of features, which
are the development of infection in the wound and the occurrence of complex soft tissue defects, which is deter-
mined by the phase of the wound process. Peculiarities of the course of the wound process in this category of
wounded are the development of traumatic disease, which affects the prolongation of all phases of the wound
process and the accession of surgical infection [1,2,6].
During the JFO 9.3% of wounded with CTI, who had significant damage of the chest soft tissues. The pecu-
liarities of combat surgical injury of the chest during the JFO in eastern Ukraine that they were all high-energy,
received by bullets with high flight speed. Such injuries were characterized by the formation of a soft tissue defect,
multiple fragmentary fractures with a bone defect. Combat surgical injury of the chest, given the different ballistic
characteristics by the wounding shells, refers to severe damage of the chest, which in addition to the occurrence
of defects in the chest wall causes severe damage of the chest internal organs. Despite the large number of such
wounded with significant soft tissue defects, a clear classification of wounds based on their metric parameters has
not yet been [3].
In the complex of systemic surgical treatment of wounded and injured with soft tissue defects in thoracic
injury an important place is occupied by the treatment of complications both postoperatively and clinically by the
chest: the development of purulent-necrotic processes, pleural empyema, broncho-pleural fistulas, infection chest
wall wounds. Treatment of such wounds at CTI and a thoracic injury of peace time with soft tissues damage
includes primary, repeated and secondary surgical debridements with the subsequent imposing of bandages. There-
fore, the purpose of surgical treatment of such patients with soft tissue defects is fast closure in the simplest way
with minimal losses, which involves the widespread concept of "reconstructive ladder", which reflects the distri-
bution of plastic wound closure depending on the technical complexity of surgery [5]. This allows to replace small,
large soft tissue defects in almost every anatomical area from the imposition of linear sutures to displaced pieces
of soft tissue resistant to functional loads.
Modern principles of the treatment of wound defects of soft tissues of the chest are based on the following
provisions: reduction of necrobiotic processes in damaged tissues, reduction of infectious complications, reduction
of treatment time, reduction of disability of the wounded.
One of the modern world standards in the treatment of chest wounds with large soft tissue defects is the
widespread using of VAC therapy (Vacuum Assisted Closure), or more known as NPWT (Negative pressure
wound therapy), the treatment of soft tissue wounds by the negative pressure with the formation of vacuum dress-
ings in the wounds (VAC-dressings) [4]. In the complex surgical treatment, this method allows to effectively clean

and prepare to close the wounds of the chest soft tissues by stimulating granulation and reducing the area of the
wound defect - dermotension [6]. Therefore, the main purpose of the treatment of such wounds is to reduce the
frequency of purulent complications, reduce the duration of treatment and fast returning wounded to service, or to
recovering and other working activities. [7].
Keywords: combat surgical injury, combat thoracic injury, soft tissue deffects, negative pressure wound
therapy.
Objective: to improve the results of complex sur-
gical treatment of wounded and injured with soft tissue
defects (STD) of thoracic wall in thoracic injury by ap-
plication the negative pressure of vacuum therapy.
Маterials and methods. The results of complex
surgical treatment of 127 wounded and injured with de-
fects of soft tissues of the chest wall in the period 2014-
2019 were analyzed. Wounds and a closed injury were
sustained both by wounded military servicemen during
the JFO - combat surgical injury of the chest, and by
civilians - a peacetime injury. All patients entered to the
treatment facilities with bullet, shrapnel and explosive
injuries of the chest, complicated by the inflammatory
process and the formation of a defect in the chest soft
tissues. Also included in the general study array were
civilians who received a severe closed thoracic injury,
who were subject to thoracotomy, during the postoper-
ative period, who were also complicated by the puru-
lent-inflammatory process of the wound with formation
a defect in the soft tissues of the chest. Criteria for in-
clusion in the study: wounded and injured in the chest,
the course of an injury or wound process in which was
accompanied by the formation of a medium, large or
extra-large soft tissue defect and violation of the integ-
rity of the chest wall.
Two clinical groups were formed: main and com-
parison groups. The groups of the wounded and injured
were comparable in the age, in the severity of the in-
jury, the character of the wound channel, the number
and localization of wounds,
The main group of clinical observation included
54 people with soft tissue defects and violation of the
integrity of the chest wall due to injury of the chest in
the treatment of which differentiated surgical treatment
was used depending on the objective assessment of the
severity of the injury, determining the leading injuries,
which were used with negative pressure therapy by ap-
plying vacuum therapy in combination with different
physical and chemical factors.
The comparison group of clinical observations in-
cluded 73 wounded and injured, who were treated ac-
cording to the traditional scheme (emergency and
planned surgical interventions, daily dressings with an-
tiseptics and ointment components, staged surgical
treatments). All patients, depending on the severity of
the injury were admitted to the surgical clinic in not
heavy, severe and extremely severe severity. The age
of the wounded ranged from 18 to 62 years and aver-
aged 40.85 ± 4.29 years in the main group and 40.48 ±
3.50 years in the comparison group.
Table 1
Characteristics of wounded and injured by age
Age
Main group Comparison group
n % n %
18-29 12 22,2 15 20,5
30-39 15 27,8 23 31,5
40-49 15 27,8 20 27,4
50-59 3 5,6 4 5,5
More 60 9 16,7 11 15,1
Average age 40,85±4,29* 40, 48±3,50*
Totally 54 100% 73 100%
* - age observation groups are comparable (t Student = 0,07; р = 0,943)
The majority of patients in both groups of clinical
observations related to people of working age.
The ratio of patients in the groups of clinical ob-
servation of the mechanism of injury of the chest did
not differ. The ratio of gunshot wounds to closed inju-
ries was about 50/50 (table 2).
Table 2
Characteristics of wounded and injured depending from the mechanism of injury
2
/ p
n % n %
Gunshot wounds:
- bullets
- fragments (multiple)
28
12
16
51,9
22,2
29,6
33
10
23
45,2
13,7
31,5
0,549 / 0,46*
Closed injury 26 48,1 40 54,8
Totally 54 100 73 100
* - calculation of the value of p by Pearson's criterion x2

In both groups, among the gunshot wounds, the
vast majority were multiple shrapnel: 16 (29.6%) in the
main group and 23 (31.5%) in the comparison group,
which often had the character of an explosive combined
wound with primary widespread chest wall damage.
Bullet wounds: 12 (22.2%) in the main group and 10
(13.7%) in the comparison group, always had a pene-
trating nature, also 9 (16.7%) and 9 (12.3%) in the
groups accordingly – through wounds. The course of all
wounds was complicated by a purulent-inflammatory
process in the gunshot wound (exit hole), thoracotomy
wound (in cases when thoracotomy was performed for
urgent indications) or combined in both wounds. There-
fore, the combination of primary defects of gunshot
wound and secondary defects as a consequence of pu-
rulent-inflammatory and necrotic processes in the
wound formed the final defect of the chest wall tissues,
as the object of our study and curative effect.
With closed mechanism of injury: 26 (48.1%) in
the main group and 40 (54.8%) in the comparison
group, all patients underwent immediate or urgent thor-
acotomy according to the relevant clinical indications
(massive hemothorax, chest instability, curled hemo-
thorax, etc.), and defects in the tissues of the chest wall
were the result of complicated by purulent-necrotic
process of the thoracotomy wound. As part of the pro-
vision of emergency and urgent surgical care, all pa-
tients of the study groups in the acute period of trau-
matic illness underwent surgical operations. In this
case, thoracentesis (from one or 2 sides) was performed
in all patients. Thoracotomy was performed in 29
(53.7%) patients in the main group and 49 (67.1%) in
the comparison group. In cases of gunshot wounds, pri-
mary surgical treatment of the inlet and outlet holes was
also performed.
Data on the localization of chest wall tissue de-
fects in the wounded and injured were important for ef-
fective planning of the treatment process (table 3).
Table 3
Distribution of wounded and injured in groups for location of defects in the chest tissues
Localization of damage
Main group
(n=54)
Comparison group
(n=73)
Totally
(n=127)
Number % Number % Number %
Anterior surface of the chest 4 7,4 7 9,6 11 8,7
Anterior-lateral surface of the chest 27 50,0 40 54,8 67 52,8
Lateral surface of the chest 9 16,7 10 13,7 19 15,0
The posterior surface of the chest 12 22,2 7 9,6 19 15,0
Two-focus defect - anterior-lateral and pos-
terior surface
2 3,7 9 12,3 11 8,7
In both groups of clinical observation anterolateral
defects of a thorax as a result of the complicated course
of anterolateral thoracotomies prevailed – 52,8%.
Defects of the anterior, lateral and posterior sur-
faces were the result of a complicated course of gunshot
wounds - 38.7%, and bifocal defects - a synchronous
complicated course of anterior-lateral thoracotomy
wound and gunshot wound - located at a distance from
the thoracotomy. There was an area of undamaged tis-
sue between the wound defects. The greatest difficulty
in the treatment of localization were wounds that were
located on the posterior surface of the chest: it was due
to the difficulty of maintaining aseptics, wound care,
and also a large array of damaged tissues.
In all victims in our sample thoracic injury was ac-
companied by damage to the internal organs of the
chest. But at the time the inclusion of patients in the
study, the acute manifestations of most of these injuries
have already been stopped, and did not directly affect
the treatment of wound defects of the chest wall. Ana-
tomical and morphological features of these injuries
and their specific weight in the subgroup of gunshot
wounds differed from the subgroup with a closed mech-
anism of injury (table 4).
Table 4
Characteristics of damage of organs and structures of the chest in the study groups
n % n %
Gunshot wounds:
- fractures ≤ 3 ribs
- - fractures> 3 ribs
- - bifocal fractures of the ribs (inlet and outlet holes)
- - lung injury
- - hemothorax
- - hemopneumothorax
28
2
18
8
26
5
23
7,1
64,3
28,5
92,9
17,9
82,1
33
4
22
7
29
9
24
12,1
66,7
22,6
87,9
27,3
72,7
Closed injury
- - fractures> 3 ribs
- - multiple bilateral fractures of the ribs
- - unstable chest
- - lung contusion
- - heart attack
- - hemothorax
- - hemopneumothorax
26
17
4
5
24
10
1
25
65,4
15,4
19,2
92,3
38,4
3,8
96,2
40
22
12
6
40
19
4
36
55,0
30,0
15,0
100
47,5
10,0
90,0
Totally 54 - 73 -

Most patients in the study group with thoracic in-
jury had combined character: 46 (85.2%) in the main
group and 62 (84.9%) in the comparison group, but the
thoracic component was always leading.
Table 5 presents the distribution of patients by the
number of damaged anatomical and functional areas.
Table 5
Characteristics of the study array by the number of damaged anatomical and functional areas (AFA)
AFA damage
p
n % n %
One 8 14,8 11 15,1 0,969*
Two 27 50,0 38 52,1 0,819*
Three or more 19 35,2 24 32,8 0,786*
Totally 54 100% 73 100
Despite the comparability of groups by the number
of damaged AFA, there was a need to compare them by
severity of injury. For this, we chose two anatomical
scales - based on determining the degree of morpholog-
ical damage to organs and tissue structures: Anatomic
trauma score (ATS) – allows to assess the severity of
isolated and combined injury, taking into account the
severity of its individual components, and Injury Sever-
ity Score (ISS) – designed to assess mostly combined
injuries, but the most widely used anatomical scale of
injury severity in the world. The use of two scales in-
creases the reliability of the results. In addition, they
have the same number of comparable nominal grada-
tions (tables 6 and 7).
Table 6
Criteria for assessing the severity of injuries in patients in the study array
The severity of the injury ATS ISS Forecast for life
not heavy ≤ 24 ≤15 favorable
heavy 25 – 41 16-25 questionable
extremely heavy ≥ 42 >25 unfavorable
Table 7
Severity of injury and the ratio of groups by severity of injury
The severity of the injury
р
n % n %
ATS severity 23,1±2,8 24,8±2,1
t = 0,63*;
р = 0,49
ISS severity 15,9±1,3 16,8±1,4
t = 0,47*;
р = 0,64
Not heavy 22 40,7 26 35,6
х2
= 0,347**
р=0,56
Heavy 28 51,9 43 58,9
х2
= 0,625**
р=0,43
Extremely heavy 4 7,4 4 5,5
х2 = 0,195**
р=0,66
Totally 54 100% 73 100
* Calculation according to Student's t test
** Calculation by criterion x2
The vast majority of patients in the study groups
were seriously injured - a total of 71 (55.9%) and vic-
tims with not heavy injuries - 48 (37.8%), while there
were few victims with extremely severe injuries - 8
(6.3%). This is due to the high mortality of the latter
category of patients in the acute period of traumatic ill-
ness, and they were simply not included in the study
according to the inclusion / exclusion criteria.
Thus, the age, mechanism of injury, the character
of defects in the tissues of the chest wall, the conse-
quences and complications of thoracic injury, and also
the severity of the injury of the clinical observation
group were homogeneous and comparable. That is, the
results of their management and surgical treatment can
be compared and statistically processed.
Results. The method of treatment with negative
pressure in the complex surgical treatment of soft tissue
defects of the chest wall is one of the main methods of
preparing wounds for closure, which is a set of
measures aimed at creating conditions in which the
wound defect can be closed with minimal risk of com-
plications and minimal losses in functional terms. The
main condition for successful wound healing is the
transition of the wound process to the second (repara-
tion) phase. It is established that treatment by vacuum
therapy with negative pressure gives some advantages.
It improves the course of all stages of the wound pro-
cess, which is characterized by a decrease in local in-
terstitial soft tissue edema, improved tissue microcircu-
lation, increased local blood and lymph circulation, re-
duced microbial contamination in the wound, reducing

the severity of wound exudation, which is necessary to
stimulate angiogenesis, enhance fibrinolysis and im-
prove the functioning of growth factors for normal
wound healing.
Vacuum therapy with negative pressure was per-
formed using devices KCI, HEACO, GomCo, in com-
bination with irrigation with solutions of antiseptics,
antibiotics, oxygen insufflation, ultrasonic cavitation
for additional stimulation of repair processes. The tech-
nique of vacuum therapy is universal and has been used
in various phases of the wound process to prevent in-
fection, and in cases of treatment of infectious compli-
cations. Also, the method of applying negative pressure
was used as a temporary stage for preparation of wound
defects for plastic closure and after reconstructive sur-
gery, as a method of wound management in the postop-
erative period.
All wounded and injured in the comparison group
(73 patients) used traditional wound healing tactics. Af-
ter preoperative preparation, surgical treatment of
wounds was performed. It included the opening of
wounds, removal of foreign bodies, non-viable tissues,
active washing with antiseptic solutions. Wound sur-
faces of the soft tissues of the chest were tamponade
with gauze wipes with solutions of antiseptics. Band-
ages were replaced 1-2 times a day. Various solutions
of antiseptics were used, such as betadine, decasan.
When the signs of the inflammatory process were re-
duced, the wound was cleaned, and the amount of exu-
date was reduced, the defects were closed with the help
of local tissues and skin plasticity methods.
In the main group (54 patients) the method of neg-
ative pressure was used. Indications for the use of vac-
uum therapy for chest injuries were infected chest wall
wounds, chest wall defects with open pneumothorax,
the presence of a chest wall wound in combination with
pleural empyema and as a stage of temporary wound
closure in preparation for thoracoplastic. Contraindica-
tions to the application of a vacuum bandage were ne-
crotic tissue, bleeding in the wound area, unexamined
fistulas. The initial use of this method in the complex
surgical treatment of soft tissue wound defects is most
effective, in our opinion, in the period that corre-
sponded to the second phase of the wound process (3-
7th day). Carrying out vacuum drainage of wounds
once or several times was carried out in a constant or
intermittent mode. Repeated sessions of vacuum ther-
apy varied depending on the clinical manifestations.
Replacement of bandages was performed in 3-4 days.
Criteria for positive use of NPWT were the following
factors: reduction local tissue edema, wound cleaning
from necrotized tissues, fibrin plaques, purulent con-
tents, formation of young forms of granulation tissue,
reduction of purulent secretions from wounds, im-
provement of clinical blood test.
When the wound defects of the soft tissues of the
chest wall were temporarily closed, liquid sutures were
applied, which were covered on the outside with a
gauze napkin, and the skin was protected with a tread.
A polyurethane sponge was applied on top, which was
sutured to the edges of the wound for more secure fix-
ation. In the presence of large and deep vast defects of
the soft tissues of the chest wall, the sponge was laid in
several layers for completely closure them. In the pres-
ence of non-viability of the ribs with signs of osteomy-
elitis at the bottom of the wound defects of the chest,
they were perforated, or according to the indications,
the outer cortical plate of the rib was removed and soft
tissue defects were closed with a polyurethane sponge.
This accelerated the elimination of osteomyelitis, stim-
ulated regional blood flow and growth of granulation
tissue.
Picture 1.
Infected wound with a defect in the soft tissues of the front of the chest. Osteomyelitis V-VI ribs on the left.

Picture 2. Surgical treatment of the wound with resection of the V rib on the left.
Picture 3. Imposition of a functioning VAC bandage on the wound defect of soft tissues at treatment of a gunshot
fragment wound at CTI.
After autodermoplastic in some cases, in order to
fully closure the defects of the soft tissues of the chest
and secure fixation of the split autodermograft with a
complex relief of the wound surface used the applica-
tion of polyvinyl alcohol vacuum dressings with absor-
bent and bacteriostatic effect with negative pressure. It
is helped to heal wound defects, evacuate wound exu-
date and prevent graft injury. A feature of the applica-
tion of vacuum therapy with negative pressure on the
chest was the constant monitoring of its implementa-
tion, as there was a risk of bleeding.
All patients in both groups of clinical observation
underwent general drug therapy, which was aimed at
compensating for general disorders. Antibacterial ther-
apy was performed in all patients with an antibiotico-
gram.
The study found that the course of wound healing
in wounded with defects of the soft tissues of the chest
wall in thoracic injury had significant differences de-
pending from microbial contamination (clean, contam-
inated, purulent wounds), the mechanism of injury and
its location. Already in the first sessions of vacuum
therapy in the main group there were significant
changes, manifested by increase in exudation from the
wound and changes the character of secretions from pu-
rulent to serous. For 5-7 days during which vacuum
therapy was performed, in most patients the elimination
of the intoxication syndrome was observed, the wound
was cleared from purulent and necrotic secretions. In
addition, to a large extent the process of eliminating in-
toxication contributed to the rapid reduction of micro-
bial contamination of the wound [10].
In contrast to the comparison group in the main
group at the local level, the characteristic features were
the appearance of active forms of granulation on the
surface of the wound defect on average 6-8 days of
treatment, which meant reducing the duration of phase
I inflammation and its faster transition to phase II of the
wound process.
Characteristic changes occurred on the part of
blood parameters, which were initially manifested by
leukocytosis with a shift of the leukocyte formula to the
left and the appearance of young forms of neutrophils,
then the number of leukocytes to 7-9 days decreased to
normal.
This positive dynamics of these indicators in the
shortest possible time of complex treatment of wound
defects of soft tissues of the chest wall using VAC ther-
apy was characterized by cleaning the wound surface,
removing the causative agent of purulent infection, and
early appearance of active granulations, followed by
signs of marginal epithelialization. Characteristic signs
of stoping the using NPWT were the change of the ex-
udation phase to the phase of proliferation, wound
cleaning, reduction of microbial contamination and im-
provement of microcirculation, which was character-
ized by improved local circulation.
During the second week of treatment there was
also a further normalization of clinical blood counts -
decreased white blood cell count and the percentage of

rod neutrophils. As a result of the favorable develop-
ment of the treatment process, the length of stay of pa-
tients of the main group in the hospital was (15.75 ±
4.27) bed-day.
Thus, based on research and treatment results, the
data indicate significant advantages in the positive and
effective treatment of patients with large defects of the
soft tissues of the chest wall with thoracic injury using
VAC dressings, characterized by reduced duration of
treatment, accelerated reduction of bacterial wound
contamination, reduction of local tissue edema, im-
provement of local lymph and blood circulation.
Conclusiones.
1. The use of negative pressure vacuum therapy in
complex surgical treatment of soft tissue defects of the
chest wall as a result of gunshot wounds and injuries
leads to improvement of microcirculation in soft tis-
sues, fluid evacuation and reducing interstitial edema,
reduction of wound defect and its preparation for the
plastic closure of tissues.
2. The use of vacuum therapy for closure wound
defects of the thoracic injury, and also postoperative
wounds has a positive curative effect not only on the
wound defect, but also on the internal organs of the tho-
racic cavity.
3. Thus, the success in the treatment of patients
with wound defects of the soft tissues of the chest wall
of various etiologies is due not only to high-quality sur-
gery with plastic closure, but also the constant use of
comprehensive surgical treatment with adequate anti-
bacterial therapy and active involvement and constant
monitoring NPWT, which allows in the shortest terms
to reduce the duration of treatment, the number of com-
plications and improve the functional results of the
wounded and injured at the level of medical care.
REFERENCES:
1. Military field surgery / ed. Y.L. Zarutskyi,
V.Ya. Bilyi. - K .: Phoenix, 2018. - 552 p.
2. Instructions of military field surgery / S.A.
Aslanyan, V.Ya.Bilyi, I.S. Bogdan [etc.]; for order.
Ya.L. Zarutskyi, A.A. Shudrak. - К .: Chalchynska N.
V., 2014. - 400 p.
3. Military field surgery: a textbook / Ya.L.
Zarutskyi, V.M. Zaporozhyan, V.Ya. Bilyi [etc.], ed.
Y.L. Zarutskyi, V.M. Zaporozhye. - Odessa: ONMedU,
2016. - P.359-389.
4. M.A. Kashtalyan, S.V. Tertishny, K.L.
Masunov, "The use of VAC therapy in the treatment of
gunshot wounds" Bulletin of Marine Medicine, No. 1
2, p. 187–192, 2016.
5. Optimization of stage surgical treatment of the
wounded on the basis of metric classification of soft
tissue defects / Ya.L. Zarutskyi, I.B. Plis, S.O. Korol,
A.O. Kompaniets // Clinical Surgery. - 2018. - №2. -
P.55 - 57.
6. Immediate and Early Tissue Expander Place-
mentf or Acute Closure of Scalp Wounds / A. Turko,
G. Fuzaylov, V. L. Savchyn, D. Driscoll // Annals of
Plastic Surgery. – 2013. – Vol. 71, N 2. – P. 160–165.
7. Hirshberg A. Top Knife: The Art and Craft of
Trauma Surgery / A. Hirshberg, K.L. Mattox. –
Shrewsbury, UK: tfm Publishing Ltd, 2005.
8. Buchanan P.J. Evidence-Based Medicine:
Wound Closure / P.J. Buchanan, T. A. Kung, P.S.
Cederna // Plastic and Reconstructive Surgery. – 2014.
– Vol. 134. – P.1391 – 1404.
9. Patent of Ukraine for a utility model №
128624 dated September 25, 2018. A method of
measuring the area of skin defects in their diagnosis and
treatment. Inventors: Aslanyan S.A., Zarutskyi Y.L.,
Karpenko K.K., Korol S.O., Fomin O.O., Vovk M.S.,
Goncharuk V.S., Musenko O.Ya., Gangal I.I.
10. Patent of Ukraine for a utility model №
132410 dated February 25, 2019. Method of irrigation-
injection therapy of purulent soft tissue wounds.
Inventors: Aslanyan S.A., Zarutsky Y.L., Sapa S.A.,
Fomin O.O., Kompaniets A.O., Sidoruk D.P., Vovk
M.S., Goncharuk V.S., Musenko O.Ya., Dmytruk E.P.,
Lavrenchuk O.A.

PREDICTORS OF PARENTAL ATTITUDE FORMATION IN MOTHERS OF CHILDREN WITH
AUTISTIC DISORDERS
Stukan L..
MD, PhD, Associated professor, Department of Medical Psychology and Psychiatry with the Course of
Postgraduate Education of National Pirogov Memorial University, Vinnytsya, Ukraine
Pshuk N..
MD, PhD, DSci, Professor, Head of Medical Psychology and Psychiatry Department with the Course of
Postgraduate Education, National Pirogov Memorial Medical University, Vinnytsya
Kaminska A.
MD, PhD, Associated professor, Department of Medical Psychology and Psychiatry with the Course of
Postgraduate Education of National Pirogov Memorial University, Vinnytsya, Ukraine
DOI: 10.24412/3453-9875-2021-59-1-24-27
Abstract
Mental health disorders in children is an urgent problem in Ukraine and worldwide. Public attention to med-
ical and psychosocial problems of families, where children with autism spectrum disorders are brought up, is still
insufficient. The aim of our study was to find out key predictors of maternal attitudes towards children with autism
spectrum disorders and to outline areas of psychotherapeutic correction of maladaptive forms of caregiving and
upbringing.
35 mothers of children, diagnosed with childhood autism (F 84.0) and atypical autism (F 84.1) were included
into this study. Control group included 20 mothers, who had healthy children (the first group of health), corre-
sponding to the age of the main group women. Parental Attitude Research Instrument (PARI) by E. Schaefer and
K. Bell in adaptation of T.V. Neshcheret and Parental Attitudes Questionnaire (by A.Y. Varga, V.V. Stolin) were
used as psychological testing tools.
Changes in upbringing strategies of mothers, found out by psychological testing, indicated the inaccuracy of
mother's behavior, inability or unwillingness to feel and understand the needs of the child and change their own
behavior appropriately to meet these needs, unconstructive forms of mother-child relationship, expressed in sym-
biotic relationship and authoritarian style of upbringing. Thus, revealed changes of child-parent relations in fami-
lies, where child has autistic disorder, are a component of family dysfunction and have negative impact on socio-
psychological adaptation of children and parents. At the same time, mother of a child with autistic disorder can
quite effectively help her child to overcome many problems through their own changes. That is why the study of
relationships in families, and especially mother's attitude to the child with autism, is a necessary component in
terms of development, organizing and implementing into clinical practice sources of medical and psychological
support and psychotherapeutic correction of families with children with autism spectrum disorders.
Keywords: autism spectrum disorders, mothers, parental attitude, medical-psychological support system,
family burden.
The issue of mental health disorders in children as
a result of disontogenesis of mental development is an
urgent problem nowadays. Among the disorders of psy-
chological development, a significant place is taken by
autism spectrum disorders (ASD), the interest in which
is constantly growing among modern scientists due to
the increasing prevalence of these disorders worldwide
in general and in Ukraine in particular [1,3]. Mean-
while, public attention to medical and social problems
of children with autistic disorders and especially to
families, where children with ASD are brought up is in-
sufficient. Problems exist both at the stages of ASD di-
agnostics and in the subsequent management of such
children [2,5]. Lack of high-quality system of medical
and psychological support, pedagogical and speech
training correction for such children in most regions of
the country, especially for children under the age of 5-
6 years old, deficit of social and psychological support
programs for families with children with autism spec-
trum disorders, lead to these families being actually left
alone with their difficulties and autistic children do not
having the opportunity to be fully integrated into soci-
ety [4,6].
The main burden of care and upbringing of child
with ASD is usually put on mother, that often causes
manifestations of psycho-emotional maladaptation in
forms of depressive or dysthymic responses, irritability,
anxiety, unconstructive behavioral patterns in mothers
of autistic children [8,9].
In modern clinical psychology, there is a shortage
of research on the problem of maternal attitude towards
children with ASD, while existing programs of help for
parents of children with ASD are in the process of con-
tinuous improvement. Therefore, it is necessary to de-
velop and test the content and methods of psychological
aid to mothers who have children with ASD.
Given the above, the aim of our study was to study
the predictors of maternal attitudes towards children
with ASD and to outline areas of psychotherapeutic
correction of maladaptive forms of upbringing.
Materials and methods. To achieve this goal, a
clinical and psychological examination of 35 mothers
of children, diagnosed with childhood autism (F 84.0) -
27 persons, and atypical autism (F 84.1) - 8 persons,
was performed. The age of mothers ranged from 24 to
35 years (mean age in the group was 28 ± 2.6 years).

Among the surveyed, 12 persons (48%) had higher ed-
ucation and 13 (52%) - secondary special education. At
the time of the survey, 8 women (32%) were married.
In 18 people (72%) the child with ASD was the only
one in the family, in 7 mothers (28%) - the second born
child. 20 mothers (80%) did not work at the time of the
survey and 17 (68%) said they were forced to leave
their work due to the child's illness.
Control group included 20 mothers, who raised
healthy children (the first group of health), correspond-
ing to the age of the main group women.
A detailed analysis of family and personal infor-
mation was done, with special attention paid to inter-
personal relations both in family environment in gen-
eral and with the child in particular. To study mother's
attitude to different aspects of family life and mother's
attitude towards child, Parental Attitude Research In-
strument (PARI) by E. Schaefer and K. Bell in adapta-
tion of T.V. Neshcheret and Parental Attitudes Ques-
tionnaire (A.Y. Varga, V.V. Stolin) were used [10]. The
reliability of results of the study was assessed using
methods of mathematical statistics (Student's t-test and
Mann-Whitney U-test).
Results of the research. Study of general specif-
ics of intrafamily relations, features of maternal attitude
to child upbringing and organization of family life in
general according to PARI (Table 1) showed, that
mothers of the main group had higher averages for all
parameters, that characterize attitude to family role in
general and on parameters of parental authority and
self-sacrifice, the difference between the main and the
control groups was statistically significant, which may
indicate that family life of such women is complex and
full of various difficulties and problems. Women of
main group are not interested in anything that goes be-
yond their everyday life and family responsibilities,
they feel like "victim" and do not even allow them-
selves to think that something in their lives can be
changed for the better. They try to fully control and
limit outside influence on the child, thus emphasizing
their own role. Strict control in the upbringing of a
healthy child almost always leads to increased isola-
tion, reduces motivation. Found with the help of PARI
method upbringing tendencies in forms of authoritari-
anism, mother domination, her strictness, suppression
of child's will in mothers of children with autism clearly
lead to strengthening of those features in behavior and
perception of others, that exist in the child.
Mothers of children with autistic disorders had
emotional contact disorders with the child, and a more
pronounced emotional distance, compared to the con-
trol group. This was expressed in difficulties in com-
munication with the child, lack of ability to explain and
express their feelings about situation and stimulate
child's activity, building relationships with child from
the standpoint of parental dominance in contrast to the
relationship of partnership and equality. All this leads
to increased irritability and increased tension in moth-
ers.
Table 1
Features of parental directions according to PARI method in mothers of children with ASD
№ Scale
Main group
( n=35)
М  m
Control group
( n=20)
М  m
р
Assessment of attitudes towards family roles
1 Dependence on the family 14,7± 02 12,0± 0,4 >0,05
2 Feeling of self-sacrifice 15,0± 0,3 10,3± 0,5 <0,05
3 Marital conflicts 13,1± 0,6 9,7± 0,6 >0,05
4 Super-authority of parents 16,0± 0,2 12,0± 0,4 <0,05
5 Dissatisfaction with the role of housewife 14,4± 0,4 11,7± 0,4 >0,05
6 Dependence of the mother 14,7± 0,7 10,3± 0,6 >0,05
7 Mother's dominance 14,8± 0,4 8,7± 0,3 >0,05
8 Lack of help from husband 18,6± 0,2 14,7± 0,4 >0,05
Assessment of optimal emotional contact with the child
9 Verbalization 14,3± 05 18,3± 0,4 >0,05
10 Partnership 13,1± 0,6 18,7± 0,4 <0,05
11 Development of the child's activity 11,4± 0,2 16,3± 0,3 >0,05
12 Equality 11,9± 0,3 16,3± 0,4 >0,05
Assessment of excessive emotional distance with the child
13 Irritability 15,0± 0,4 9,0± 0,6 <0,05
14 Excessive strictness 12,8± 0,2 13,0± 0,3 >0,05
15 Contact avoidance 12,1± 0,7 9,3± 0,4 >0,05
Assessment of excessive concentration in the child
16 Hyperprotection 14,6± 0,2 10,7± 0,5 >0,05
17 Freedom suppressions 15,0± 0,3 11± 0,6 >0,05
18 Fear of offending 16,3± 0,6 12,3± 0,7 >0,05
19 Exclusion of extra-family influences 13,9± 0,4 11,7± 0,4 >0,05
20 Aggressiveness suppression 15,0± 0,7 12,7± 0,6 >0,05
21 Sexuality suppression 14,0± 0,4 12,7± 0,7 >0,05
22 Excessive intrusion into the child's world 16,7± 0,6 9,0± 0,5 <0,05
23 Desire to accelerate development of child 14,7± 0,3 9,3± 0,4 >0,05

Analyzing the results obtained in by the Parental
Attitudes Questionnaire by A.Y. Varga, V.V. Stolin,
we noticed that mothers of healthy children mostly per-
ceive their child as it is, respect the child's individuality,
approve child`s plans and interests, that is indicated by
the high proportion of averages (70%) and the absence
of high scores on the scale of "Acceptance - Rejection".
A completely different picture is observed in
mothers of autistic children. 52% of respondents have
a high rate on this scale, which may indicate that moth-
ers can not fully understand the disease of the child and
accept it. The mother believes that her child has no
chance to live a full life, she is a loser and will be forced
to take care of child for lifetime. The mother does not
trust her child, does not respect it and is often even
ashamed.
According to the scale of "Cooperation", 65% of
mothers of healthy children showed high rates, which
indicates that they are interested in plans and affairs of
their children, proud of their child. They tend to ap-
prove the manifestations of initiative and independence
in their children. In the group of mothers of autistic
children, all respondents had averages on this scale,
which indicates that mothers in most cases do not show
initiative to deal with the child. They are passive and do
not focus their efforts on discovering their child's
strengths, abilities and development.
Table 2
Styles of attitude to the child (by A.Y. Varga, V.V. Stolin)
Scales
Scores interpreta-
tion
Mothers of children with
ASD, %
Mothers of healthy chil-
dren, %
«Acceptance - Rejection»
High scores 52 0
Medium scores 32 70
Low scores 16 30
«Cooperation»
High scores 0 65
Medium scores 100 35
Low scores 0 0
«Symbiosis»
High scores 52 0
Medium scores 48 100
Low scores 0 0
«Authoritarian hypersocializa-
tion»
High scores 32 0
Medium scores 68 30
Low scores 0 70
«Little loser»
High scores 36 0
Medium scores 64 60
Low scores 0 40
Indicators on the "Symbiosis" scale show that the
majority of mothers of children with autism (52%) have
high rates, and the rest (48%) - medium, which indi-
cates a symbiotic relationship with the child. Mother
tries to satisfy all the needs of the child, to separate it
from the problems. Often, such mothers perform even
basic tasks (dressing, making the bed, etc.), that the
child can perform on their own, explaining that it is eas-
ier and faster.
Mothers, because of their excessive anxiety for the
child (not to offend it, not to harm it), without realizing
that, contribute to social isolation of their child even
more. Regarding the indicators on this scale in the con-
trol group, all 20 surveyed mothers (100%) showed av-
erages, which also indicates excessive anxiety for their
child and restrictions on the independence and auton-
omy of the child.
68% - average scores and 32% - high scores on the
scale of "Authoritarian hypersocialization" in mothers
of children with autism indicates that all mothers ad-
here to authoritarian methods of upbringing, which is
confirmed by PARI method. In group of mothers of
healthy children, 70% show low scores on this scale,
which indicates that most mothers contribute to the de-
velopment of child's personality, give the opportunity
to express their views, make their own decisions, and
so on.
According to the "Little loser" scale, majority of
mothers in main group (64%) show average scores and
the rest (36%) - high, which can be explained by the
child's disability and indicate, that the mothers of autis-
tic children attribute personal and social disability to
them, having no trust in their possible achievements
and successes. 60% of mothers in control group got me-
dium scores on this scale, which may indicate that they
perceive their children as if they were younger than
they really are and they think that the child is not
adapted enough to life and can be easily affected by the
environment negatively. Interests, thoughts, feelings of
child are not taken seriously by the mother.
Summarizing the results of clinical-psychological
examination and psychological testing of mothers,
whose children suffer from autistic disorders, we can
show that there are unconstructive forms of mother-
child relationship, which are expressed in symbiotic re-
lationship with the child and at the same time authori-
tarian style of upbringing. Deficit of emotional contact
and severity of emotional distance indicate lack of un-
derstanding of their child`s needs and ignorance of gen-
eral psychological and behavioral characteristics of
children with autism. Mothers demonstrated attempts
to organize the child's behavior intuitively, based on
their own, familiar to them notions, while often unin-
tentionally inflicting offence to the child.
Changes in educational strategies of mothers,
found out by psychological testing, indicated the inac-
curacy of mother's behavior, inability or unwillingness

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