Bukovinian State Medical University

According to international anatomical nomenclature, sphincter structures across various organs and systems are uniformly designated by the term M. sphincter (A04.0.00.028), with the English equivalent “sphincter muscle” and the Ukrainian equivalent «miaz-zamykach». However, these structures do not exhibit a consistent circular arrangement of striated or smooth muscle fibres encircling the luminal junction between segments of the urinary or digestive tracts. The aim of the study was to elucidate the microscopic structural patterns and to systematise the morpho-functional characteristics of the closing apparatuses in the urinary and digestive systems during the prenatal period of human ontogenesis. Material and methods of the study. The study was conducted on 25 prefetuses (parieto-coccygeal length 12.0–80.0 mm) and 20 fetuses (parieto-coccygeal length 81.0–375.0 mm) using a combination of morphological techniques: vascular injection, preparation and analysis of serial histological sections, and three-dimensional computer reconstruction. The Biomedical Ethics Committee of Bukovinian State Medical University (Minutes No. 2, dated 16 October 2025) confirmed compliance with ethical and legal standards. The study forms part of the scheduled research project of the Department of Histology, Cytology and Embryology, Bukovinian State Medical University, entitled “Structural and functional features of tissues and organs in ontogenesis, patterns of variant, constitutional, sex-age, and comparative morphology of humans” (state registration No. 0121U110121; implementation period January 2021 – December 2025). Results. The closing apparatuses of the digestive and urinary systems in human fetuses demonstrate considerable structural diversity. Nevertheless, all share three principal components: muscular, vascular, and modification of mucosal surface relief. The relative prominence of each component varies according to the functional demands and topographic relationships of the specific closing segment. Given this evidence, replacement of the Ukrainian term «miaz-zamykach» with «sfinkter» is recommended to eliminate terminological ambiguity and enable more precise and comprehensive description of human closing structures. Conclusions. 1. Closing structures regulating the passage of contents between hollow organs of the urinary and digestive systems are characterised by three fundamental components: a muscular layer, a vascular network, and alterations in the relief of the mucosal lining. 2. The muscular component, manifesting as a sphincter muscle with circularly oriented bundles, is present in the orbicularis oculi muscle, external anal sphincter, and external urethral sphincter, where it integrates closely with adjacent musculature. The internal urethral sphincter and pyloric sphincter consist of localised thickenings and direct extensions of the circular muscle coat of the respective tubular organ. 3. At the junction of the common bile duct with the duodenum, and the ureter with the bladder, the closing mechanism is achieved through penetration of the intestinal or bladder muscular wall by the tubular structure, combined with submucosal vascular engorgement and modification of mucosal surface relief. 4. The neck of the gallbladder at its transition to the cystic duct, and the renal pelvis at its transition to the ureter, exhibit distinctive luminal configuration and structure due to mucosal protrusions that function as both active and passive resistive mechanisms, regulating fluid flow velocity via submucosal vascular filling.

Background. The renal glucose threshold (RGT) is traditionally regarded as a passive consequence of sodium-glucose cotransporter type 2 (SGLT2) saturation in the proximal tubules of the nephron. However, this explanation addresses only the molecular mechanism, leaving unanswered the fundamental physiological question: why did evolution set this threshold precisely at 8–10 mmol/L? We propose that the answer lies not in the limitations of transport systems, but in the active protection of osmotic homeostasis and cellular hydration. Objective. To propose a new conceptual model of the RGT based on the priority of protecting cellular hydration over preserving glucose as an energy substrate, and to demonstrate the pathophysiological relationship between glycaemic regulation and water-electrolyte metabolism in diabetes mellitus. Methods. A narrative review of current literature on renal physiology, osmoregulation, molecular biology of glucose transporters, and clinical diabetology was conducted. The search was performed in the PubMed, Scopus, and Web of Science databases. Results. The RGT (8–10 mmol/L) mathematically corresponds to the upper limit of normal plasma osmolality (295 mOsm/kg). Glucosuria is a physiologically programmed protective mechanism that prevents critical hyperosmolality and protects cells from osmotic stress. In type 2 diabetes mellitus (T2DM), the adaptive increase in maximum tubular glucose reabsorption (Tm_G) and RGT is a pathological phenomenon contributing to chronic hyperglycaemia and cellular dehydration. SGLT2 inhibitors restore the physiological threshold and the protective mechanism of glucosuria. Studies of the osmoregulatory function of the kidneys during the development of experimental diabetes mellitus confirm impairment of urinary osmotic concentration already at the early stages of the disease (Olenovych et al., 2020; Olenovych & Zukow, 2022; Olenovych et al., 2025). Conclusions. The RGT is an evolutionarily formed mechanism for the protection of cellular hydration. Understanding this principle opens new perspectives for interpreting the pathophysiology of diabetes mellitus and the mechanisms of action of modern glucose-lowering drugs

A pathogenetic explanation for the development of erosive and ulcerative lesions of the duodenal bulb was provided in 19 smoking patients with chronic non-atrophic gastritis. Three patients had previously suffered from peptic ulcer disease, and 10 patients had confirmed chronic non-atrophic gastritis with high levels of Helicobacter pylori infection, for which they had undergone anti-Helicobacter therapy. Over the past 2-3 years, due to military conflict in Ukraine, the patients had increased their daily cigarette intake (from 0.5-1 pack to 1.5-2 packs). When conducting an examination using two different methods (urease test and microscopy of stained smears-prints), an active form of HP infection was not detected, however, when conducting a breath test, a high increase in exhaled ammonia was obtained (the average level was 17.33 ± 0.42 mm), the source of which was smoking and which became the basis for the formation of erosive-ulcerative bulbitis.

Aim. To assess the level of awareness of students (clinical pharmacists) of advanced training in the specialization “Clinical Pharmacy” about adverse reactions of beta-lactam antibiotics and the level of cross-reactivity between these drugs. Materials and methods. We developed a questionnaire and conducted an anonymous voluntary remote survey of 34 students specializing in “Clinical Pharmacy”. The survey instrument was a questionnaire containing multiple-choice questions to assess knowledge about the adverse reactions of beta-lactam antibiotics, which prescription was a significant component of all prescriptions of antimicrobial drugs, and the conditions for their prevention. The reliability and validity of the questionnaire questions were previously assessed by experts from the group who did not participate in the survey. Results. The survey included participants working as clinical pharmacists in clinical healthcare institutions. It was determined that 62 % of respondents had up to 3 years of work experience in the specified position, 32 % had more than 10 years of work experience, and 6 % of respondents had 3 to 5 years of experience as a clinical pharmacist. It was found that clinical pharmacists were well aware of the groups of beta-lactam antibiotics, and most of them were well aware of the adverse reactions of these drugs. Most respondents identified the significance of allergic reactions and the presence of a high risk of cross-reactivity between groups of beta-lactam antibiotics, which was not consistent with current scientific data. Only 53 % of respondents correctly knew that the main factor in allergic reactions to cephalosporins was the side chains of the chemical structure of the drugs, and 59 % of respondents correctly named cephalosporins with side chains similar to penicillins, and therefore, there might be significant cross-reactivity between these agents. The majority of 85 % of respondents mistakenly believed that the frequency of cross-reactivity between penicillins and carbapenems was significant, and at the same time, the majority of 73 % participants were correctly aware of the low risk of cross-reactivity between penicillins and monobactams, while 50 % of clinical pharmacists correctly indicated ceftazidime as a drug that had cross-reactivity with aztreonam. Conclusions. The results obtained show that clinical pharmacists are well aware of the adverse reactions of beta-lactam antibiotics and the lack of accurate knowledge about the factors and the risk of cross-reactivity between these drugs, which indicates the feasibility of constant updating and improvement of knowledge already at the stage of postgraduate education.

The article examines issues of punishment and other means of criminal law protection of sexual freedom and sexual integrity of individuals in Ukraine, in particular with regard to ordinary offences. The author focuses on the general concept of criminal law response to sexual offenses, analyzing not only the formal definition of crimes, but also the effectiveness of sanctions in real practice. Attention is drawn to systemic shortcomings in the criminalization of such acts in the Criminal Code of Ukraine, revealing inconsistencies in sanctions between different articles and violations of the principles of proportionality and logic of criminal law policy. The author emphasizes that current legislative decisions do not always correlate with the level of public danger of such offenses and do not form an effective preventive mechanism. Particular attention is paid to a critical analysis of the composition of such acts as solicitation of a child for sexual purposes (Article 156-1 of the Criminal Code), coercion into sexual intercourse (Article 154 of the Criminal Code), and distribution of child pornography (Article 301-1 of the Criminal Code), since, in the author's opinion, these articles contain the most problems in terms of both classification and justification of sanctions. The need to review penalties in order to ensure their adequacy, consistency, and ability to prevent recidivism is justified. The importance of restoring the balance between the punitive component and the application of alternative measures of a criminal law nature is emphasized. A separate section of the study is devoted to the legal nature of probation, which the author proposes to consider not as a punishment, but as an independent measure of a criminal law nature. The article also reveals other means of criminal law protection, in particular measures against legal entities, restrictive and coercive measures of a medical nature, and special confiscation. The article provides scientific justification for the proposal to introduce compulsory chemical castration as a medical measure for persons diagnosed with pedophilia, but not as a form of punishment, taking into account international experience and the principle of respect for human rights. The work contains specific and reasoned proposals for improving the current legislation in the field of combating sexual crimes.

Tooth distalisation is an important stage of orthodontic treatment, the effectiveness of which is usually as-sessed using traditional radiographic methods, most commonly cone-beam computed tomography. The aim of this study was to evaluate the effectiveness of tooth distalisation in children using a new digital method based on the comparison of intraoral scans. A total of 56 children undergoing orthodontic treatment were ex-amined and divided into two groups. The main group included patients treated with an individual distaliser, while the comparison group consisted of patients who underwent distalisation using the Carriere Motion 3D appliance. Intraoral scans were obtained using the 3Shape TRIOS system. Digital measurements were per-formed by superimposing digital models in the OnyxCeph software, followed by analysis in the Ortho Ana-lyzer programme (3Shape). The study showed that the average distal tooth movement in both groups ranged from 2.82 ± 0.16 to 3.23 ± 0.17 mm in the canine region and from 2.52 ± 0.18 to 3.23 ± 0.24 mm in the molar region, with no statistically significant differences between the groups. The results indicate comparable clini-cal effectiveness of both the individual distaliser and the Carriere Motion 3D appliance. Digital analysis of in-traoral models over time is an effective quantitative method for assessing tooth distalisation during orthodon-tic treatment and does not involve exposure to ionizing radiation compared to conventional radiographic methods.

One of the promising areas in the development of artificial intelligence is the creation of computer vision technology – a system that enables computerized systems to acquire, analyze, and interpret information from photos, videos, or digital images. This opens up extensive opportunities for process automation across various fields, including robotics, autonomous transportation, industry, and medicine. One of the key challenges in computer vision research is the problem of visual position recognition – assessing a robot’s coordinates and orientation based on video or photo data obtained from its cameras. In robotic systems, precise position recognition is critical for navigation, adaptation to environmental changes, and interaction with objects. The article attempts to formulate the problem in terms of approximating the probability density function of the robot’s states within the space of input data. In addition to theoretical aspects, the study examines a set of algorithms currently in use – both classical approaches and neural network-based models – their universality, and their integration potential with other computer vision technologies. The interpretation of these algorithms is presented from the perspective of dimensionality reduction in the input data space during localization. Furthermore, a list of relevant datasets for training and testing visual position recognition models is provided, along with key metrics for evaluating their performance. Thus, the study not only summarizes modern approaches to solving this problem but also outlines directions for further technological advancements that can ensure more efficient and accurate robot localization in space.

Cervical cancer (CC) is one of the leading gynecologic oncologic diseases that poses a threat to the health and lives of women worldwide. In Ukraine, this pathology retains a consistently high proportion in the overall structure of malignant neoplasms, especially among women of reproductive and perimenopausal age. The aim of the study is to analyze the proportion of cervical cancer among all registered cases of malignant neoplasms in Ukraine during 2014-2023, to identify regional and age-specific features of the epidemiological situation, and to identify priorities for improving the screening system and organizing preventive work in the context of modern challenges. Methods. The study is based on the analysis of statistical reports of the Ministry of Health of Ukraine for the period 2014-2023. The methods of retrospective descriptive analysis, comparison of relative and absolute indicators, determination of the proportion of cervical cancer among all cancers in the country, and in the context of five regions (West, East, North, South, and Center) were used. The age structure of morbidity was studied separately, with emphasis on the 25-44 year old group as the most affected. Results. Over the ten-year period, 645,361 cases of malignant tumors were registered in Ukraine, of which 36,810 were cervical cancer, which is an average of 5.7% of the total. The proportion of cervical cancer in the structure of cancer decreased from 5.9% in 2014-2017 to 5.1% in 2023. The highest incidence was observed in the age group of 30-39 years (more than 18% of cases within this age group), indicating a high risk in women of reproductive age. In the regional context, the highest proportion of cervical cancer was recorded in the Western region - 6.4%, which may be due to better registration or specific social factors. The lowest rate is in the Central region (5.1%). Conclusions. Cervical cancer continues to account for a significant proportion of cancer morbidity in Ukraine, especially among young and middle-aged women. The identified dynamics indicates the presence of systemic problems in the field of early detection and prevention. In the context of epidemiological and military challenges, the need to develop a national system of organized cervical cancer screening remains relevant.

Regulation of drug availability is one of the most important areas of state policy in the pharmaceutical market. The use of various methods of price regulation allows achieving the desired socio-economic results, but the complexity of the processes taking place in the pharmaceutical market and in the state necessitates the constant revision of existing approaches and measures. The aim: to conduct an analysis of macroeconomic indicators characterizing the state of development of healthcare systems in countries that are reference for the domestic pharmaceutical market. Materials and methods. General theoretical (historical, formal, graphical, hypothetical-deductive, etc.) and applied (organizational-economic, mathematical-statistical, etc.) research methods were used. The subject of the research was the World Bank health indicators, which are integrated with WHO data, and data from the Organization for Economic Cooperation and Development for reference countries (Poland, Slovakia, the Czech Republic, Latvia, Hungary, Romania, Moldova, Bulgaria) and in Ukraine. Results. It was found that for the vast majority of indicators characterizing the state of health care financing, domestic indicators significantly differed from the average values for the group of reference countries. For indicators of domestic health care expenditures (four indicators), domestic data had critically low values (52.12% –% in current healthcare spending, expenditures per capita, including at purchasing power parity of the population – $ 192.81 and $ 570.60, respectively). Only for the indicator of domestic public health care expenditures as a% of general government expenditures, Ukrainian indicators (10.56%) were within the fluctuation range of the corresponding data for the group of reference countries. A comparative analysis of current healthcare expenditures (3 indicators) showed that out of the three indicators, the values of two in Ukraine were close to the minimum values in the group of reference countries. These are current healthcare expenditures per capita, including at purchasing power parity. In Ukraine, the values of these indicators were $369.90 and $1095.06, which were 3.72 and 2.49 times lower than the average values for the group of reference countries. According to the indicators characterizing the participation of private capital and citizens in healthcare expenditures (5 indicators), it was established that per capita private expenditures in Ukraine were $177.10, which was 1.88 times lower than the average for the group of reference countries ($332.58). In terms of private and out-of-pocket expenditures as a% of current healthcare expenditures, domestic data had the highest values compared to reference countries. Thus, private and out-of-pocket expenditures in Ukraine were 1.76 and 1.88 times higher than the average values for reference countries (27.07% and 24.04%, respectively). Domestic out-of-pocket expenditures calculated per capita ($167.54) and at purchasing power parity ($ 495.88) were 44,49% and 17,51% lower than the corresponding average values for the group of reference countries ($301.82 and $ 601.10, respectively). It was found that within the group of reference countries, the drug consumption index varied. This index ranged from $523.0 (Poland) to $883.0 (Bulgaria). The average consumption value in Ukraine for 2021-2023 was ($112.33), which was 5.79 times less than the corresponding data for the group of reference countries. In addition, in the group of reference countries, there are fundamental differences in the structure of population spending on medicines by funding sources (state, private revenues, and health insurance funds). Conclusions. Significant differences in macroeconomic indicators characterizing the state of healthcare financing in the reference countries and in Ukraine have been identified. This necessitates further research on the topic and a review of the group of reference countries used in the domestic pharmaceutical market to regulate the socio-economic accessibility of medicines for the population