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Objective: To evaluate the treatment outcomes of sporadic vestibular schwannomas (VS) to substantiate the choice of optimal treatment strategy considering quality of life indicators using the Penn Acoustic Neuroma Quality of Life Scale (PANQOL) and the Mayo Clinic Vestibular Schwannoma Quality of Life Index (Mayo VSQOL Index) scales in Ukraine. Materials and Methods: 1100 patients with VS were treated at the Subtentorial Neurooncology Department from 2001 to October 2023 and 373 were primarily considered for dynamic observation (“wait-and-scan”) at the Department of Ear Microsurgery and Otoneurosurgery of the Kolomiichenko Otolaryngology Institute. Data on 359 patients (some of whom underwent surgery in the mentioned departments) who received radiotherapy (RT) from 2010 to 2023 in the Radioneurosurgery Department are also provided. The PANQOL and Mayo VSQOL Index scales were implemented to assess the quality of life of patients with VS. Scientific publications from the PubMed database related to the study of the quality of life in patients with VS were analyzed. Results: The analysis was based on patient data from the database for the period 2017 - October 2023, 391 patients with VS were treated, including 359 who underwent surgical treatment (schwannomas resection), 4 – tarsorrhaphy after VS resection, and 28 who received combined treatment (surgery + radiotherapy). A separate group consisted of 359 patients who underwent radiotherapy (RT). Of 177 patients who underwent radiosurgical treatment, 65 (36.7%) had Stage III VS according to the classification of W.T. Koos, and 112 (63.3%) had stage IV VS. Primarily diagnosed tumors were treated in 110 (62.1%) and 67(37.9%) patients with residual postoperative. Follow-up data were obtained for 159 patients. At the Kolomiichenko Otolaryngology Institute, 373 patients were under observation with the primary "wait-and-scan" strategy, of whom 110 (29.5%) had their VS removed due to symptom progression or progressive course, and 24 (6.4%) underwent RT. Of the 27 patients in the Subtentorial Neurooncology Department study group, 7 (25.9%) underwent surgery, and 5 (18.5%) underwent RT. Conclusions: Global practice in assisting patients with VS indicates a shift towards dynamic follow-up and an increase in the frequency of using radiation treatment methods. Over the past years, strategy have been proposed that do not recommend the "wait-and-scan" mode due to the risk of life-threatening complications associated with tumor growth. However, there is very little data on long-term outcomes (more than 5 years) and quality of life. VS primarily detected by magnetic resonance imaging in Ukraine significantly larger (Koos III-IV) than those reported in the literature. The implementation of specialized scales for assessing the quality of life of VS patients in Ukraine will help improve outcomes by applying personalized criteria for treatment routes, increasing the level of awareness and responsibility of both patients and doctors.

Acute retinal pigment epitheliitis (ARPE; also known as Krill disease), a disease first described in the nineteen seventies, is characterized by fine pigment stippling in the macular area, surrounded by hypopigmented halo. The etiology of the disease is not yet known. The patient reported that he used to eat berries picked from the forest in the radioactive contaminated area in late June to early July, 2023. He complained of transient metamorphopsia and reduced vision in the left eye, and received eye examination including optical coherence tomography, general check-up, blood cell counts and whole body radionuclide content study. He was diagnosed with bilateral APRE. On the basis of measurements with the expert whole-body counter, the wholebody burden of Сs-137 for the patient was 505 Bq, and the estimated annual effective dose from internal radiation was 0.011 mSv/y. The estimated dose value was substantially lower than the basic dose limit for the population of 1 mSv/y as per requirement of the Law of Ukraine. Because APRE is a rare disease with an unknown etiology, careful attention deserves to be given to the finding of the disease in a patient who has sustained short-term exposure to ionizing radiation due to the incorporation of Сs-137 into his body tissues. For the first time it has become possible to assess adequately doses from internal radiation in a patient with APRE, which will allow to optimize efforts for further research on the etiology of this rare disorder.

The aim of the article is to scientifically substantiate the role of modern EU financing instruments in stimulating ecological development. The research methodology is based on the content analysis of ecological development financing instruments in the EU, their comparison and scientific generalization to substantiate further priorities for the implementation of the EU strategy «European Green Deal». The authors have examined the models of management of financial resources in the EU – direct, joint and indirect management. It is found that the EU Member States and their competent authorities develop their own national programs, coordinate the selection of projects, as well as ensure the operational management of such programs and the implementation of payments. The article shows that the most used financial instrument used within the framework of the EU programs and funds for the provision of financial resources are grants. It is determined that recently in some areas of the EU policies (first of all, in regional, entrepreneurial, and innovation) such instruments as budget guarantees and bank financing instruments (loans, credit guarantees, equity investments) have been actively developing, aimed mainly at profitable and economically viable projects. In the current planned financial period from 2021 to 2027, most EU financial programs and funds have an ecological component. At the same time, a number of the EU programs are created specifically for the purposes of sustainable development, greening of production, prevention and adaptation to climate change, as well as environmental protection, including the LIFE program, the Innovation Fund, the Just Transition Fund and the Modernization Fund. The authors show that the instruments for financing ecological development in the EU cover a wide range of potential beneficiaries, which include not only government agencies and the business sector, but also research institutions and public organizations.

The article defines the key aspects of methodical support of financial management of entrepreneurial universities in the conditions of digitalization, smart economy and development of educational tourism. Attention is focused on the fact that at this time Ukraine faced complex phenomena caused by the invasion of the Russian Federation on the territory of our state, which caused powerful changes in all sectors, industries and industries of Ukraine. It was noted that against the background of active digitalization and financial instability, migration shifts and the flow of human resources took place. In this context, there is a need for an active policy of creating and evaluating the effectiveness of the concept of financial management of entrepreneurial universities in the conditions of digitalization, smart economy and the development of educational tourism, taking into account the challenges faced by the modern economy of Ukraine. With the use of methods of production functions, the article proposes an assessment of the financial management of entrepreneurial universities. It was noted a need to increase the financial support of entrepreneurial universities, which is important for improving the quality of education and tax revenues at the regional and state levels. Attention is focused on the phenomenon of increased outflow of students outside of Ukraine with the simultaneous outflow of teaching staff abroad. It was noted that it is the effective financial policy of supporting entrepreneurial universities that can reduce negative phenomena in education.

Two rare cases of combined pathology, representing trigeminal neuralgia caused by cerebrovascular malformations (cavernous malformation, arteriovenous malformation), are detailed and analyzed. The study involved two patients, a 39-year-old woman and a 63-year-old man, with pain syndrome along the V2‒V3 branches of the left trigeminal nerve that was resistant to medical therapy. Neurological status otherwise unchanged. After thorough examination, neurosurgical treatment was performed in the form of microsurgical decompression of the trigeminal neuralgia via a retrosigmoid approach to the cerebellopontine angle and removal/mobilization of the cerebrovascular malformation, significantly improving the patients' overall condition and providing long-term pain-free postoperative periods: 5 years in the first and 6 months in the second cases. Trigeminal neuralgia may be the initial or sole manifestation of existing cerebrovascular malformations. Standard evaluation of patients with trigeminal neuralgia includes MRI of the brain using 3D sequences, particularly T2-weighted 3D DRIVE mode, for better visualization of vascular-nerve structures to identify the provocative factor, although this mode does not always provide complete reliable information regarding the microstructural features of the cerebellopontine angle. Accordingly, the surgeon must always be prepared for both standard microvascular decompression surgery and work with pathological vascular formations without disrupting blood flow in this area of the brainstem. Decompression of the trigeminal nerve root with maximal possible removal or isolation of the compressive factor plays an important role in the treatment of pain syndrome and is effective when properly performed.

Background. Several pathologies (such as diabetes mellitus, Parkinson’s and Alzheimer’s diseases, multiple sclerosis, etc.) are accompanied by degeneration of cholinergic neurons, which are key regulators of the contractile function of the gastrointestinal tract walls, leading to atony and paresis. An effective strategy for normalizing the lack of contractile function of visceral SM is the use of drugs - selective agonists of muscarinic acetylcholine receptors (mAChRs) of the M2 subtype. The high similarity of the structure of the agonist-binding sites of different subtypes of mAChRs causes problems to develop selective ligands for these receptors. Nowadays, there is an urgent necessity to develop selective agonists of M2 subtype receptors as pharmacological tools for laboratory research and promising drugs. The aim of the present research was to investigate the effect of the 8-[(4-benzylpipe­razin-1-yl)methyl]-3-(2-chlorophenyl)-7-hydroxy-chromen-4-one (compound 1), which was in silico predicted to bind mAChRs, on the contractile activity of rat caecum circular smooth muscle. Materials and Methods. The research was carried out on rats. The contractile activity was studied tensometrically in the isometric mode on preparations of the circular smooth muscles of the caecum of Wistar rats. The kinetic properties of individual spontaneous contractions of SM preparations were determined in accordance with the method of multivariate mechanokinetic analysis with the calculation of mechanokinetic parameters for the phases of contraction and relaxation: time (τ0, τC and τR), force (Fmax, FC and FR), velocity (VC and VR) and impulse (Imax, IC and IR). The kinetic properties of acetylcholine-induced contractions were analyzed by calculating the normalized maximum velocities of the contraction (Vnc) and relaxation (Vnr) phases. Results. It was found that compound 1 caused an increase in the amplitude of acetylcholine-induced contractions; this effect was eliminated by preincubation of SM with the mAChRs M2 subtype inhibitor AF-DX 116. It was revealed that compound 1 (0.1–50 μM) also has the ability to significantly activate the functional activity of colonic SM in a dose-dependent manner, increasing the force and frequency of spontaneous contractions, as well as their mechanokinetic parameters. It was found that the presence of compound 1 (0.1 μM) in the solution washing the smooth muscle for a long time leads to a significant increase in the amplitude and frequency of spontaneous contractions, which tends to reach a stationary mode after 40 minutes of its action. The effect of compound 1 was stable for at least an hour of application to the caecum, and was reversible and significantly eliminated by washing the SM. Conclusions. Compound 1 stimulates the contractile activity of the cecal smooth muscle and exhibits M2 cholinergic properties.

The aim of the article is to study the policy of public procurement and the scientific substantiation of its priorities in the context of the implementation of the digital transformation strategy in the EU and in Ukraine. The research methodology is based on the content analysis of the digitalization policy of public procurement used in the practice of both the EU and Ukraine, as well as in its scientific generalization to substantiate the priorities for the implementation of the digital transformation strategy. The authors examined the model of interaction of subjects of the public procurement market in the EU with the use of digital tools. It is found that the harmonized EU rules in the field of application of common digital public procurement instruments are designed to ensure fairness, transparency and non-discrimination in determining participants in public contracts, to which not only EU companies are admitted, but also the representatives of WTO Member States that have signed the Agreement on Government Procurement. The article discloses the stages of introduction of digital public procurement tools in the EU and in Ukraine. It is determined that in the EU, the process of digitalization of public procurement began in the second half of the 2000s with the introduction of an electronic diary of tenders, significantly intensifying in the second half of the 2010s with the adoption of a package of the EU directives in the field of public procurement and the phased introduction of digital tools (invoices, forms, applications for tenders, the European single procurement document, etc.). The current stage of transformation of digital public procurement tools in the EU was marked by the introduction of a single space for these public procurement in the EU from 2023. The priority directions of digital convergence of the public procurement systems of the EU and Ukraine are substantiated, including the development of cooperation tools for joint public procurement, promotion of competition, countering the corruption, as well as strengthening the professionalization of the public procurement systems.

Objective Extraocular muscles have complex development processes. The present study aimed to analyze the presence of myosin, dystrophin, and collagen IV in the strabismus-affected extraocular muscle. Methods This research was an observational case–control study. Myosin, dystrophin, and collagen IV were detected by histological and immunohistochemical analyses of extraocular muscle samples from concomitant strabismus patients and controls. A semi-quantitative grading method and statistical analysis were used. Results In the strabismus-affected extraocular muscle, morphological analysis demonstrated different-sized muscle fibers. Immature muscle fibers and an increased amount of connective tissue were also noted. Strong positive correlations were identified between myosin and collagen IV and between dystrophin and collagen IV. Conclusions The presence of newly formed muscle fibers, increased connective tissue, and variable diameters of skeletal striated muscle fibers indicate the decreased quality of extraocular muscles in strabismus cases. Reduced levels of myosin and dystrophin and a near absence of collagen IV in strabismus-affected skeletal striated muscle fibers characterized the muscular dystrophy of strabismus. Adjuvant therapy aimed at normalizing the metabolism of these muscles may be appropriate alongside concomitant strabismus treatment.

The aim of the article is to study the practice of formation of situational network management in Ukraine and the scientific substantiation of the economic mechanism for its provision. The research methodology is based on the analysis of the theoretical and legal foundations of the formation of a network of situational centers of public authorities in Ukraine and their scientific generalization to substantiate the constituent elements of the economic mechanism for ensuring situational network management. The authors show that the coordination of the sources of resourceing of situational centers with the methods of their use in accordance with the defined goals of their functioning, as well as the formation of the necessary and sufficient material and resource base provides for the formation of an economic mechanism for situational network management of public authorities. The article substantiates the role and place of situational network management in the activities of public authorities and identifies the constituent elements of the economic mechanism for its provision, including: goals and principles of activity; supporting and functional components; factors of its formation and the parameters of evaluation. The authors specify that the formation of an economic mechanism for ensuring situational network management should be carried out on the basis of modern approaches to the organization of the public administration system in compliance with its classical principles. It is determined that the budget financing of the activities of the network of situational centers of public authorities is carried out without specification within the framework of the program-target method. In order to improve budgeting mechanisms in the implementation of network management, recommendations on the introduction of special budget programs for public authorities are provided.

Solitary occipital bone plasmacytoma at the level of the confluence of sinuses is a rare condition. We report a case of an unusual combination of occipital bone plasmacytoma, ocular motility abnormalities, and papilledema. To the best of our knowledge, no case has been reported in the literature on such a combination of nosology, location and clinical course.

The present research investigates the nitriding kinetics of the near-beta-titanium alloy of Ti-Al-Nb-Fe-Zr-Mo-V system at 750, 800, and 850°C in gaseous nitrogen at 10 5 Pa for 2, 4, and 8 h. The parabolic coefficient kp of the layer’s growth rate and the nitriding activation energy E are set as the kinetic parameters of the nitrided layer’s growth. The activation energy for the formation of a nitride layer is ~108 kJ/mol. The authors discuss the morphology of the nitride layers as well as their roughness and surface hardness. The study determines the effective diffusion coefficient for the growth of diffusion layers in the temperature range of 750...850°C: Def = D0 × exp (– E/RT), where D0 = 0.0177 m 2/s; E = 215.7 kJ/mol. The friction coefficient of the disk from near-beta-titanium alloy with a bronze block is lowered by significantly more than 10 times after gas nitriding, and the temperature in the friction zone is reduced by 2.5 times.

Sporadic outbreaks of human cases of West Nile virus (WNV), primarily vectored by Culex quinquefasciatus Say in suburban and urban areas, have been reported since introduction of the virus into Florida in 2001. Miami-Dade County, Florida is part of one of the largest metropolitan areas in the United States, supports Cx. quinquefasciatus year-round, and recently experienced over 60 human cases of WNV during one outbreak. To facilitate more effective integrated vector management and public health protection, we used the Centers for Disease Control and Prevention (CDC) bottle bioassay method to evaluate the susceptibility of adult Cx. quinquefasciatus collected from 29 locations throughout Miami-Dade County to pyrethroid and organophosphate adulticide active ingredients (AIs) used by Miami-Dade County Mosquito Control. We also determined the frequency of the 1014 knockdown resistance (kdr) mutation for Cx. quinquefasciatus from a subset of 17 locations. We detected resistance to two pyrethroid AIs in all tested locations (permethrin: 27 locations, deltamethrin: 28 locations). The 1014F allele was widely distributed throughout all 17 locations sampled; however, 29.4% of these locations lacked 1014F homozygotes even though phenotypic pyrethroid resistance was present. Organophosphate resistance was more variable; 20.7% of the locations tested were susceptible to malathion, and 33.3% of the populations were susceptible to naled. We subsequently conducted a field trial of ReMoa Tri, a recently approved multiple AI adulticide formulation labelled for resistant mosquitoes, against a mixed location field population of Miami-Dade Cx. quinquefasciatus. Average 24-hr mortality was 65.1 ± 7.2% and 48-hr mortality increased to 85.3 ± 9.1%, indicating good control of these resistant Cx. quinquefasciatus. This current study shows that insecticide resistance is common in local Cx. quinquefasciatus but effective options are available to maintain control during active disease transmission in Miami-Dade County.

Culex quinquefasciatus is an important target for vector control because of its ability to transmit pathogens that cause disease. Most populations are resistant to pyrethroids and often to organophosphates, the two most common classes of active ingredients used by public health agencies. A knockdown resistance (kdr) mutation, resulting in an amino acid change from a leucine to phenylalanine in the voltage gated sodium channel, is one mechanism contributing to the pyrethroid resistant phenotype. Enzymatic resistance has also been shown to play a very important role. Recent studies have shown strong resistance in populations even when kdr is relatively low, which indicates that factors other than kdr may be larger contributors to resistance. In this study, we examined, on a statewide scale (over 70 populations), the strength of the correlation between resistance in the CDC bottle bioassay and the kdr genotypes and allele frequencies. Spearman correlation analysis showed only moderate (−0.51) or weak (−0.29) correlation between the kdr genotype and permethrin or deltamethrin resistance, respectively. The frequency of the kdr allele was an even weaker correlate than genotype. These results indicate that assessing kdr in populations of Culex quinquefasciatus is not a good surrogate for phenotypic resistance testing.

The purpose of the article is the scientific substantiation of the content and structure of the financial-economic mechanism of resolving the intercountry conflict and the peculiarities of its application in the conditions of the Russian-Ukrainian war. The research methodology is based on the quantitative and qualitative analysis of financial and economic instruments used in Ukraine in the development of the State policy to resolve the Russian-Ukrainian conflict, and their scientific generalization to substantiate the components of the financial and economic mechanism for its implementation. The authors have examined the financial and economic resources of Ukraine in the field of defense and compared them with the capabilities of the Russian Federation, the mechanisms of distribution of expenditures of the State Budget of Ukraine on national defense and public order, the role of budget programs in financing security measures are analyzed. In addition, an analysis of the instruments of economic influence used by Ukraine to limit the capabilities of the Russian Federation, in particular economic sanctions, was carried out. The levers of economic support for Ukraine used by the international community are characterized. The structure of the financial-economic mechanism of resolving the intercountry conflict, which includes certain directions, goals, subjects, objects, instruments and forms of the State influence, is substantiated. It is shown that economic incentives and restrictions have both a direct and indirect impact both on the possibilities of Russia’s military actions and on the possibilities of military counteraction on the part of Ukraine. Blocking the economic activity of the Russian Federation entails a multiplicative restrictive effect for its economy and the federal budget. Such economic restraint reduces the possibility of financial support for hostilities and affects the decline in the standard of living of Russians. Instead, economic assistance to Ukraine stimulates its economy and supports its financial resources both directly and indirectly through the market mechanism.

Hemangioblastomas are benign tumors that develop from the vessels of the central nervous system and can be a manifestation of autosomal dominant von Hippel-Lindau disease. Statistically, they account for 1.5‒2.5% of all intracranial tumors and 2‒15% of spinal cord tumor lesions. There are very few publications on the intramedullary localization of these neoplasms.The patient, 45 years old, a serviceman, presented with complaints of headache, slight unsteadiness of gait, as well as slight weakness in the right extremities, more pronounced in the right upper extremity, periodic numbness of the upper extremities, which progressed and made further service impossible. On neurological examination: pupils D=S, light reflexes were brisk, eye movement was fully preserved and horizontal nystagmus. BNI - PS - I, BNI - NS - I. HB - I. GR - I. Swallowing and phonation were fully preserved. There was a slight hemiparesis on the right. Hemihypesthesia on the right was more prominent in the upper extremity. Ataxia of mixed genesis. Pelvic organs function was preserved. Periodic constipation for up to 7 days. Magnetic resonance imaging revealed a multifocal brain lesion. Supratentorially, a cystic mass measuring 2.60×2.12×2.14 cm with a solid component up to 1.5 cm in the diameter was detected in the of the thickened corpus callosum. Intramedullary cystic-solid lesion of the medulla oblongata extending to the cervical spinal cord with conventional dimensions of the solid component 1.76×1.23×1.57 cm and the cystic component was 1.52×1.62×1.22 cm. Magnetic resonance imaging of the cervicothoracic region of the spinal cord revealed significant hydromyelitic expansion of the central canal from the C2 level to the Th3 level (up to 10mm in the diameter). Endovascular embolization of the neoplasm with a liquid embolic agent (Phil) and following microsurgical en bloc tumor resection were performed.Hemangioblastomas with an intramedullary location are extremely difficult and risky for the surgical removal. The presence of a cystic component in the hemangioblastoma structure or perifocally gives a chance to remove such a neoplasm avoiding risk of functional deterioration. Preoperative endovascular obliteration of hemangioblastoma vascularity is considered as an effective measure, although it is associated with a risk of cerebral ischemia in corresponding brain structures. Another crucial issues of intramedullary hemangioblastoma surgery includes multimodal intraoperative neuromonitoring and maximum possible intraoperative magnification to minimize injury of adjacent brain structures. Present practice shows that multiple intramedullary cysts in the spinal cord commonly regressing after neoplasm removal and leads to improvement of neurological deficit within a relatively short period of time.Conclusions. Hemangioblastomas with intramedullary growth and perifocal cyst can be surgically removed with a good functional result and comprehensive approach includes preoperative selective angiography with endovascular embolization, multimodal intraoperative neuromonitoring and appropriate microsurgical technique.

Cleft lip and palate are the most common congenital malformations which require early primary cleft surgery in all infants. The surgical treatment of cleft lip and palate deformities results in the formation of scar tissue. However, the scarred tissue has sparsely been immunohistochemically evaluated to date. Herein, we report the differences in the cellular expression of various proteins in the scar and nearby healthy tissue of a 35-year-old patient who underwent cleft correction surgery during infancy. The scar tissue showed basal cell proliferation, prominent cysts, and fibrotic connective tissue. An increased expression of both interleukin 1α (IL-1α) and IL-10 in the scar tissue was noted, although the balance favored an anti-inflammatory environment. No differences in the expression of matrix metallopeptidase-2 (MMP-2) and TIMP-2 were found whilst an increased expression of PAX-9 and MSX-1 was observed in the scar tissue, which co-localized with RYK expression. Temporal studies like the present one can aid in advancing our understanding of the longitudinal processes governing wound healing morpho-pathogenesis in cleft-affected patients.

The ingrained tendency to implement information and communication technologies (ICT) in EU enterprises over the last decade has caused dramatic changes in the labor market. Since the de­mand for ICT personnel is growing, there is still a need to create a comprehensive strategy to effectively manage ICT specialists when restructuring enterprises. The aim of the research is to identify transferring processes between low‑ and high‑skilled ICT personnel and predict the employment rate in the ICT field until 2025. A Markov chain was used as the method of anal­ysis. Using statistical data about the employment rate of ICT personnel by education attainment level, we have built a Markov chain model that describes the processes of ICT personnel with different levels of education. Data from 2005 to 2019 was used to build forecasting because of the absence of the latest information. We demonstrate that with the help of digitalization, the employment rate of ICT staff in 2025 will increase by 64% compared to 2018. The research verifies that ICT personnel will be in great demand until 2023 and, importantly, low‑ and mid­dle‑skilled personnel will be in demand, as well as high‑skilled personnel. The employment rate in the ICT field will be at its highest level in 2022 as the favorable economic conditions for ICT adoption will help it. The growing demand for low‑ and medium‑skilled ICT staff are met both by staff relocation processes and by the increasing digitalization of business units and public sec­tor institutions. The added value of the analysis is the prediction that the largest growth in ICT personnel employment will occur by 2023, but employment growth will slow down after that. The main obstacle to employment growth through digitalization is the global economic crisis because of different reasons.

A review of the regularities of the influence of interstitial elements (oxygen, nitrogen) on the properties of zirconium alloys was presented. It was noted that in the scientific and technical literature dates the main attention is paid to the bulk alloying of zirconium alloys with oxygen and nitrogen at high temperatures. It was shown that zirconium with nitrogen and oxygen forms a number of stable compounds of suboxides and subnitrides. The physico-mechanical characteristics of zirconium after heat treatment under media containing both oxygen and nitrogen components on the properties of zirconium alloys were analysed. Наведено літературний огляд закономірностей впливу елементів проникнення (кисню, азоту) на властивості цирконієвих сплавів. Наголошено, що у науково-технічній літературі основну увагу приділено об'ємному легуванню цирконієвих сплавів киснем та азотом. Показано, що цирконій з азотом та киснем утворює ряд стабільних сполук субоксидів та субнітридів. Наведено фізико-механічні характеристики цирконію після обробки в середовищах, що містять одночасно кисневу та азотну компоненти.

Abstract Background The role of elevated pre-diagnostic C-reactive protein (CRP) concentrations on mortality in individuals with colorectal cancer (CRC) remains unclear. Methods We investigated the association between pre-diagnostic high-sensitivity CRP concentrations and CRP genetic variation associated with circulating CRP and CRC-specific and all-cause mortality based on data from 1,235 individuals with CRC within the European Prospective Investigation into Cancer and Nutrition cohort using multivariable-adjusted Cox proportional hazards regression. Results During a median follow-up of 9.3 years, 455 CRC-specific deaths were recorded, out of 590 deaths from all causes. Pre-diagnostic CRP concentrations were not associated with CRC-specific (hazard ratio, HR highest versus lowest quintile 0.92, 95% confidence interval, CI 0.66, 1.28) or all-cause mortality (HR 0.91, 95% CI 0.68, 1.21). Genetic predisposition to higher CRP (weighted score based on alleles of four CRP SNPs associated with higher circulating CRP) was not significantly associated with CRC-specific mortality (HR per CRP-score unit 0.95, 95% CI 0.86, 1.05) or all-cause mortality (HR 0.98, 95% CI 0.90, 1.07). Among four investigated CRP genetic variants, only SNP rs1205 was significantly associated with CRC-specific (comparing the CT and CC genotypes with TT genotype, HR 0.54, 95% CI 0.35, 0.83 and HR 0.58, 95% CI 0.38, 0.88, respectively) and all-cause mortality (HR 0.58, 95% CI 0.40, 0.85 and 0.64, 95% CI 0.44, 0.92, respectively). Conclusions The results of this prospective cohort study do not support a role of pre-diagnostic CRP concentrations on mortality in individuals with CRC. The observed associations with rs1205 deserve further scientific attention.

Aim: Prognostic factors detection and analysis of long-term results of microvascular decompression for trigeminal neuralgia. Materials and methods. 161 cases of trigeminal neuralgia (TN) treatment by MVD technique without preliminary invasive interventions within 10 years were analyzed. Two blocks of information were designed which included objective case data (8 factors) and patient satisfaction survey (5 questions). Follow-up minimal cut-off was 1 year (median 5.8 years). The primary end point is the proportion of pain free patients and BNI (Barrow Neurological Institute) score at last follow-up. The secondary end point is the assessment of possible risk factors of treatment failure: symptoms duration, decompression type, affected nerve branches, neurovascular conflict visible on MRI, different indications for surgery. Logit-regression analysis was carried out. Significance level was set at p

Background: Even if current technologies are used in removal of a skull-base epidermoid cyst, the maintenance of function of the cranial nerves is still an important issue. Purpose: To assess changes in ophthalmological abnormalities after surgery for skull base epidermoid cysts. Material and Methods: We retrospectively reviewed the medical records of 21 patients who underwent surgery for epidermoid skull base cysts and had either ophthalmological abnormalities (abnormal visual, ocular motor functions and/or abnormal blood supply to the eye) or an involvement of the cranial nerves (CN; i.e., the ophthalmic, ocular motor, trigeminal, abducens and/or facial nerves). The surgical strategy was to aim for total tumor removal in order to prevent the development of postoperative meningitis and reduce the risk of tumor recurrence. Cranial nerve manipulations were performed under the highest available microscope magnification and with the use of endoscope imaging. In addition, intraoperative monitoring of the relevant cranial nerves was performed. All surgical procedures were video recorded. Long-term outcomes of surgery were determined either by outpatient examination or via a phone call using a standard checklist. Results: Total removal was achieved in 7 patients (33.3%), near total removal in 2 patients (9.5%), and subtotal removal in 12 patients (57.2%). Ocular motor functions were normal after surgery in 11 patients (52.4%). In addition, abnormalities in the early postoperative period were observed in 10 patients (47.6%), but the functions subsequently normalized in 3 patients and improved but not normalized in 7 patients. All the three patients with trigeminal neuralgia showed regression of pain syndrome. Conclusion: We determined the ophthalmological abnormalities that had been present before and after surgery, and the time required for function recovery. We found that endoscopic-assisted radical removal of the epidermoid cyst under the highest available microscope magnification with intraoperative cranial nerve monitoring was safe and effective for preserving cranial nerve functions in the late time points after surgery.

Introduction We proposed to consider the brain and eye as a target of ionizing radiation exposure. Prevention of potential radiation-associated cerebroophtalmic effects are crucial for successful long-term space missions; interventional radiology; medical, occupational and accidental irradiation Objectives Determination of radiation-associated cerebroophtalmic effects in the long term after irradiation in adulthood and in utero. Methods Neuropsychiatric, ophtalmological, neurophysiological and neuropsychological assessment of irradiated in adulthood (57 Chernobyl accident clean-up workers, liquidators), 52 persons exposed in utero as a result of the Chernobyl accident, comparison group (51 combatants of the Antiterrorist operation in Donbass), and 53 healthy people. Results Radiation-associated cerebroophthalmic pathology is characterized by high neuropsychiatric and ophthalmic comorbidity, which increases in proportion to the radiation dose, and is mainly represented by chronic vascular and degenerative diseases of the brain and retina, mild cognitive impairment (after irradiation in adulthood), as well as disorders of the autonomic nervous system; non-psychotic organic mental disorders; neurotic, stress-related and somatoform disorders; vascular and dystrophic processes in the retina (after in utero exposure). Characteristic of both radiological scenarios remains intellectual disharmony due to a decrease in the verbal IQ. The delay and attenuation of cerebral visual afferentation processing were observed in prenatally exposed. Conclusions Radiation-associated cerebroophtalmic effects in the long term after irradiation in adulthood and in utero could be mainly classified as a “small vessel disease of the brain and eye” of vascular-degenerative nature and possible latent demyelination after irradiation in utero. Disclosure No significant relationships.

This is a clinical case of a 24-year-old woman with the unrescetable cystic tumor of the medulla because of eloquent area involved and severe neurological symptoms caused by the recurrent cystic component. The patient underwent emptying the cyst twice previously by means of safe entry zone myelotomy. Later there was a recurrence of the cyst with a significant neurological and oweral deterioration which is typical for such neoplasms. Recurrent cystic mass-effect was resolved with the help of newly designed device implanted. It provided simultaneous stable cisternal drainage and an opportunity for active aspiration via Ommaya reservoir.

Несмотря на проявление определенного интереса к религии в перестроечные годы российский Дальний Восток к началу 1990-х годов продолжал оставаться самым секулярным регионом страны, значительная часть его населения не имела опыта «жизни в Боге». Принятие ФЗ «О свободе вероисповеданий» (1990) и подписание Президентом РСФСР Б.Н. Ельциным 20 сентября 1991 Указа № 123 «Об открытии г. Владивостока для посещения иностранными гражданами» привели к тому, что российский Дальний Восток в 1990-е годы становится одним из излюбленных мест работы иностранных миссионеров, прибывающих в регион из США, Республики Корея, Японии, Австралии, Новой Зеландии, Канады, КНР и других стран. Значительная часть миссионеров, работающих на Дальнем Востоке России, были представителями протестантских и католических религиозных организаций. Материальная и моральная помощь иностранных миссионеров и миссионерских организаций местным протестантским общинам (баптистов, евангельских христиан, христиан веры евангельской (пятидесятников) и адвентистов седьмого дня) способствовала тому, что дальневосточные протестанты смогли в 1990-е годы не только начать массовую евангелизацию населения Дальнего Востока, но и добиться в этом значительных успехов, обогнав по количеству религиозных общин Русскую православную церковь. Миссионерское служение на территории российского Дальнего Востока представителей различных христианских конфессий из сопредельных стран способствовало, с одной стороны, росту протестантских и католических общин и групп, помогало дальневосточным верующим в организации благотворительной и милосердной деятельности; с другой – иногда приводило к конфликтным ситуациям. Позиции баптизма, евангельского христианства, пятидесятничества и адвентизма на Дальнем Востоке России были прочны и в советское время, в постсоветской России они должны восприниматься как традиционные религии, в дополнение к более традиционным, исторически признанным.

Aim: Figuring out the occurrence of vestibular schwannomas (VS) and their management tendencies in Ukraine.Materials and methods: Data about VS detection and treatment were collected among all Ukrainian neurosurgical and radiological facilities which are enrolled in providing care for these patients. Together with those who were treated overseas the total number in 2016-2018 was 903 people. There were 665 cases (73.6 %) treated surgically, 124 cases (13.8 %) irradiated and 114 (12.6 %) observed via serial imaging.Results: The prevalence of VS in Ukraine is about 7.27 per 1 million people which corresponds to data around the world (CBTRUS trial suggested VS incidence 10-20 people per 1 million during 2004-2009).Most of verified VSs were treated surgically (73.6 %), lesser part was irradiated (13.8 %) and 12.7 % were followed-up by wait-and-scan strategy. Our data regarding surgical management was higher than worldwide. At the same time, the volume of detected tumors was much larger in comparison to published data. Seventy-three per cent of all cases were Koos T4 tumors as a possible result of poor diagnosis and lack of alertness making surgical interventions more common and difficult.Total and subtotal resection rate was 79 % as the result of combined microsurgical and endoscopic techniques under intraoperative electrophysiological neuromonitoring guidance. The facial nerve was preserved in 94.2 % of cases, cochlear — in 8.5 % of cases. The average mortality rate during 2016-2018 in Ukraine was 3.1 % with 1.3 % in Subtentorial Neurooncology Department of the Romodanov Neurosurgery Institute.Conclusions: For further improvements and development of optimal management strategies for patients with VS, it is necessary to improve earlier diagnosis and reasonable to provide neurosurgical care in high-volume centers based on the profound expertise with further advances in technologies for functionally favorable outcomes.

Temporomandibular joint ankylosis (TMJA) is a rare, but debilitating, condition that leads to TMJ joint hypomobility. Surgery is the mainstay for treatment, which is accompanied by rehabilitative and psychological support. Despite the advances in surgical techniques, the recurrence of TMJA post-surgery has been reported as a common complication. Therefore, it becomes essential to investigate and understand the histo-morpho-pathological processes governing these ankylotic changes. Given the lack of such studies in the literature, herein we present a case of a girl child who underwent primary surgery at the age of six years, followed by a second surgery at the age of twelve years. Ankylotic tissue samples collected during both surgeries were studied using various immunohistochemical markers for tissue remodeling, inflammation, antimicrobial activity, and transcriptional regulation. The expression of MMP-2 and -9 was downregulated in repeated surgery materials, whilst MMP-13 was rarely detected in both tissues. Strong MMP-8, TIMP-2, and TIMP-4 expressions were noted in both tissues, showing their anti-inflammatory and protective roles. Moderately strong expression of bFGF, FGFR-1, IL-1α, and TNF-α could indicate sustained tissue growth in the background of inflammation (wound healing). Interestingly, the expression of β-defensin-2 was found to be constant in both tissues, thereby indicating possible ECM remodeling and collagen breakdown. Finally, a moderate expression of RUNX-2, coupled with a low expression of WNT-1 and -3a, could indicate a slow and delayed bone regeneration process. Our results showcase the complex myriad of pathways that could be involved in the progression of TMJA and post-surgery healing processes. Immunopathological studies could aid in improving the diagnosis, treatment, and prognosis for patients affected with TMJA.

The article defines that there are different interpretations to determine the essence of the concept of competitive strategy of the enterprise. It is proved that the content of the provisions of these formulations can be classified on various grounds and distinguish appropriate scientific approaches. The following scientific approaches to this issue are identified: 1) the approach based on the planning of competitive development activities, methods and mechanism of resource management, processes, the characteristics of targets (planning and target approach); 2) scientific approach related to the definition of this concept through the prism of the sign of creating competitive advantages or signs of differences in results from competitors (competitive advantage approach) (meaning that the implementation of this strategy ensures the emergence of certain competitive advantages in the market); 3) scientific approach, which characterizes this concept in the context of the benchmark on the basis of development efficiency (effective approach). A universal approach to the definition of this phenomenon, which takes into account the characteristics of the three approaches. It is determined that the competitive strategy of the enterprise is a dynamic long-term purposeful planned set of interrelated measures, subordinated to the general purpose of the enterprise, based on internal capabilities of the enterprise, aimed at achieving and maintaining the desired level of competitiveness, competitive advantage, stable competitive position, high financial and economic results. enterprises and are able to neutralize the influence of competitive forces. It is proved that the most optimal for the formation of competitive strategy is a comprehensive approach, which is based on: positioning competitive strategy in the overall development strategy (if the company is focused on growth, stabilization or reduction of competitive strategy should be created given these positions); formation of all parameters of its implementation on indicators of internal opportunities, prospects and external factors of influence; market conditions set for the forecast period. The author 's approach to the scheme of possibilities of choice of competitive strategies is formulated, based on the provisions of the theory of enterprise development, signs of locality and complexity of strategies, their innovation. It is established that the presented scheme of possibilities of choice of competitive strategies of enterprises depending on the theory of development has practical value as it can be used in practice at implementation of this procedure depending on a condition of development of subjects.

Background: Radiation cataracts are an acknowledged biological effect of radiation exposure. It has been demonstrated previously that, the mode value for the latent period for the identified post-Chornobyl cases of radiation cataract was 9 years. We present a case of radiation cataract with typical clinical features that manifested 29 years after radiation exposure. Material and Methods: A female patient, born in 1937, worked in the exclusion zone of the Chornobyl Nuclear Power Plant in early May of 1986; she is now under our regular supervision. Because over years, the patient had had the annual routine eye examination (including, but not limited to biomicroscopy, lens examination and red reflex photography using a fundus camera), the time of onset of specific lens opacity could be placed within a period of several months. Results: On examination performed on December 15, 2014, the right lens showed mild peripheral cortical opacity without signs of radiation cataract, and with vacuoli seen in the anterior subcapsular lens region. On examination performed on August 8, 2015, the right eye showed a mild, specific, posterior, central subcapsular opacification. Conclusion: We presented a case of radiation cataract, documented by fundus camera photography, with typical clinical features that manifested 29 years after radiation exposure. Detecting a radiation cataract so late after radiation exposure indicates that the changes in the eye exposed to radiation can be very durable.

Hyaline cartilage is an important tracheal structure, yet little is known about its molecular composition, complicating investigation of pathologies and replacement options. Our aim was to research tracheal hyaline cartilage structure, protective tissue factors and variations in healthy humans. The tissue material was obtained from 10 cadavers obtained from the Riga Stradins University Institute of Anatomy and Anthropology archive. Tissues were stained with Bismarck brown and PAS for glycosaminoglycans, and immunohistochemistry was performed for HBD-2, HBD-3, HBD-4, IL-10 and LL-37. The slides were inspected by light microscopy and Spearman’s rank correlation coefficient was calculated. The extracellular matrix was positive across hyaline cartilage for PAS, yet Bismarck brown marked positive proliferation and growth zones. Numerous positive cells for both factors were found in all zones. All of the antimicrobial defence molecules and cytokines were found in a moderate number of cells, except in the mature cell zone with few positive cells. Spearman’s rank correlation coefficient revealed strong and moderate correlations between studied factors. Hyaline cartilage is a tracheal defence structure with a moderate number of antimicrobial defence protein and cytokine immunoreactive cells as well as numerous glycosaminoglycan positive cells. The extracellular matrix glycosaminoglycans provide structural scaffolding and intercellular signalling. The correlations between the studied factors confirm the synergistic activity of them.

Objective. To determine the indications for surgical intervention and treatment tactic for metastatic infratentorial tumors.Materials and methods. The study included 162 patients with metastatic tumors of the infratentorial location treated from 1995 to 2018. One hundred and two patients (79.7 %) underwent total removal along the perifocal zone of tumor growth, 9 (7 %) — subtotal removal and 8 (6.3 %) — partial removal. In 5 (3.9 %) patients tumor removal was combined with CSF-shunting; in 4 (3.1 %) cases, surgical assistance was limited to the installation of a CSF-shunt system.Results. The most frequent sources of metastasis to the posterior cranial fossa were lungs — 42 (32.8 %) patients, the mammary gland — 19 (14.8 %) and melanoma — 15 (11.7 %). A separate large group consisted of patients with unknown primary focus (32 patients, 25 %).Out of 43 patients with known catamnesis there were 37 (86 %) patients with solitary metastases and 6 (14 %) persons with multiple metastases (including supra-infratentorial). The average survival after surgery in patients with solitary metastases was 8.4 ± 1.5 months, with multiple (including sub-supratentorial) 5.1 ± 0.8 months. Survival more than 1 year was observed in 13 (30.2 %) patients (1 patient (2.3 %) with multiple metastases).Conclusions. Patients with infratentorial metastases as well as with multiple metastatic brain lesions should be considered for surgery even if KPS < 70, especially due to CSF obstruction. Posterior fossa decompression with CSF flow restoration leads to survival prolongation, patients condition improvement and affords for further radiotherapy, chemotherapy or radiosurgery.

Experimental evidence has implicated genotoxic Escherichia coli (E. coli) and enterotoxigenic Bacteroides fragilis (ETBF) in the development of colorectal cancer (CRC). However, evidence from epidemiological studies is sparse. We therefore assessed the association of serological markers of E. coli and ETBF exposure with odds of developing CRC in the European Prospective Investigation into Nutrition and Cancer (EPIC) study. Serum samples of incident CRC cases and matched controls (n = 442 pairs) were analyzed for immunoglobulin (Ig) A and G antibody responses to seven E. coli proteins and two isoforms of the ETBF toxin via multiplex serology. Multivariable-adjusted conditional logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association of sero-positivity to E. coli and ETBF with CRC. The IgA-positivity of any of the tested E. coli antigens was associated with higher odds of developing CRC (OR: 1.42; 95% CI: 1.05–1.91). Dual-positivity for both IgA and IgG to E. coli and ETBF was associated with >1.7-fold higher odds of developing CRC, with a significant association only for IgG (OR: 1.75; 95% CI: 1.04, 2.94). This association was more pronounced when restricted to the proximal colon cancers (OR: 2.62; 95% CI: 1.09, 6.29) compared to those of the distal colon (OR: 1.24; 95% CI: 0.51, 3.00) (pheterogeneity = 0.095). Sero-positivity to E. coli and ETBF was associated with CRC development, suggesting that co-infection of these bacterial species may contribute to colorectal carcinogenesis. These findings warrant further exploration in larger prospective studies and within different population groups.