Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine

Intervertebral disc degeneration (IVDD) is one of the leading causes of chronic low back pain and disability. The key pathogenetic mechanism of IVDD is chronic inflammation, which leads to extracellular matrix catabolism and the death of disc cells. It has been established that these changes are based on the activation of pro-inflammatory signaling cascades, particularly NF-κB, MAPK, and JAK/STAT pathways, as well as the induction of caspase-dependent apoptosis. Objective: To summarize current understanding of the molecular signaling pathways involved in degenerative processes within the intervertebral disc, and to elucidate the mechanisms of action of platelet-rich plasma (PRP) components capable of modulating these pathways. Materials and methods: A comprehensive analysis of contemporary experimental and clinical studies was performed to evaluate the effects of the main growth factors present in PRP (TGF-β, PDGF, IGF-1, FGF, CTGF, EGF, HGF) on signaling pathways in intervertebral disc cells associated with catabolism, apoptosis, and inflammation. Results: PRP-derived factors exert their effects through activation of the Smad, PI3K/AKT, MAPK, and JAK/STAT pathways while attenuating NF-κB activity, leading to decreased levels of pro-inflammatory cytokines (IL-1β, TNF-α) and metalloproteinases (MMPs, ADAMTS). These effects are accompanied by enhanced expression of type II collagen and aggrecan, stabilization of the extracellular matrix, restoration of tissue homeostasis and increased cell proliferation. Conclusions: PRP therapy demonstrates considerable potential as a pathogenetically oriented regenerative strategy for the treatment of IVDD. Its efficacy arises from a multimodal influence on inflammatory, catabolic, and apoptotic pathways. Further clinical research is warranted to standardize treatment protocols and confirm the long-term therapeutic effectiveness of PRP.

INTRODUCTION. The problem of treating viral and mixed infections of the genital organs in the human population has gained considerable relevance during the twentieth century. The burden of morbidity from sexual infections goes far beyond the physical health of people, has powerful social and economic consequences and causes serious reproductive problems. There are quite justified views on these diseases as conditions that lead to psychological stress, stigmatization and discrimination in society and often cause delay in diagnosis and treatment due to fear of social consequences. MATERIALS AND METHODS. The materials used in the work are scientific literature on the results of global and European studies of recent years, as well as the Guidelines of the European Association of Urologists 2025. RESULTS AND DISCUSSION. The article demonstrates the scientifically substantiated feasibility of using recombinant interferon alpha-2b as a component of the therapy of viral and mixed infections transmitted sexually. Among sexually transmitted infections, the herpes virus is considered the most common viral pathology, which is extremely contagious, characterized by the defeat of all segments of the population, although its symptomatic manifestations are not so common. The vast majority of herpes virus infections are characterized by an asymptomatic course, and in cases of clinical manifestations, the use of traditional antiviral drugs has contributed to improving the treatment of symptomatic manifestations of this disease. Immunodeficiency states arise due to hereditary genetic defects associated with a predisposition to severe infection in an isolated or mixed-infection variant, and this requires verification of primary immunodeficiency states, with determination of the degree of immune responses to viral contamination. According to modern scientific guidelines, immunological drugs are considered promising in terms of obtaining the best results in terms of reducing the activity of the viral process, its complications, and also reducing the percentage of relapses. Immunological therapy does not require phenotypic and/or genotypic testing for resistance to acyclovir and drugs of its group. The most common immunological drugs in the world are the group of synthetic recombinant interferons, and among them, the most well-known and effective is human recombinant interferon alpha-2b (rIFN-2A). The results of the use of immunotherapy in viral infection are demonstrated in the work. Recently, mixed forms, which include herpes virus, chlamydia, ureaplasmosis, mycoplasmosis, trichomoniasis, etc., have prevailed among sexually transmitted infections. The low standard of living of the population is a key socio-economic factor leading to a significant increase in STDs, and screening and prevention programs, together with the wide dissemination of information about sexual health, can reduce them. Immunotropic therapy in such cases can play an important role, as demonstrated in the work. Immunotropic drugs — regulators and modulators of immunity — are of particular importance in the treatment of chronic inflammatory diseases. This is associated with a violation of the immune response: local, cellular and humoral. In Ukraine, the drug Alfarekin® is registered — a dosage form of recombinant human interferon alpha-2b, synthesized by E. coli cells based on a gene encoding a product identical to human interferon alpha-2b, using phage-dependent genetic engineering biotechnology. Alfarekin®, like natural leukocyte interferon, has a wide spectrum of biological activity, which allows it to be used in the complex treatment of STDs. CONCLUSIONS. The use of recombinant human interferon alpha-2b drugs as part of the complex treatment of viral and chronic infectious and inflammatory diseases of the genital organs makes it possible to influence the indicators of local and general immunity, increase the effectiveness of antibacterial and other drugs, and also reduce their systemic toxic effects. The most effective representative of the group of recombinant human interferon alpha-2b drugs at present is Alfarekin®.

Capillary hemangiomas (CH) are benign proliferative vascular neoplasms commonly present in skin and soft tissues but rarely found intracranially. We describe a case of a 14-year-old male patient with histologically proven CH of the optic nerve, who underwent surgical resection of the lesion due to progressive visual loss. Imaging studies revealed a cystic-solid formation in the suprasellar region lateralized to the right and located above the pituitary gland. This case shows that CH may originate from the optic nerve, leading to its gradual compression and causing optic neuropathy. While the correct differential diagnosis on the MRI may be difficult, surgical treatment is warranted in cases of progressive visual decline.

This scientific work is dedicated to the development of an intelligent system for diagnosing vestibular schwannoma. A new approach to texture analysis of magnetic resonance imaging images of schwanomas has been proposed as a method for assessing the growth of swelling. The use of this approach will help to avoid the risks of the progression of the neoplasm and immediately eliminate the need for surgical intervention. At the boundaries of the research, a number of classes of texture descriptors were put together, including: first-order statistics (intensity histograms), grey-color consistency matrix, dovzhin sequence matrix Gray Rivne, zone size matrix, Gray Rivn deposit matrix, as well as hvillet-transformed signs. The comprehensive analysis of these descriptors made it possible to formalize the internal microstructure of the fluff and implement an effective model for predicting its growth.

INTRODUCTION. Overactive bladder syndrome (OABS) is one of the most urgent problems of modern urogynecology, based on the rather wide prevalence of the pathology. Overactive bladder syndrome (OABS, urgency syndrome) is urinary urgency, which is usually combined with pollakiuria and nocturia, with or without urge incontinence in the absence of urinary tract infection and other obvious pathology. OABS negatively affects the quality of life of men and women. The purpose of this work is to present modern ideas about the physiology and pathophysiology of OABS, demonstrate the etiology, pathogenesis, classification, diagnosis and modern treatment of this pathology according to the guidelines of the European Association of Urologists 2025. MATERIALS AND METHODS. The materials used in the work were scientific literature on the results of global and European studies of recent years, as well as the Guidelines of the European Association of Urologists 2025. RESULTS AND THEIR DISCUSSION. The article demonstrates an individual therapeutic approach to each patient with OABS and shows the place of anticholinergic drugs in the therapy of the syndrome, proves the importance of diagnosing chronic concomitant diseases that cause and aggravate the course of OABS, and shows the need for timely diagnosis, therapy and prevention. The article indicates the importance of a correctly collected history, correct filling in of a urination diary and study of urodynamic indicators. The paper describes the methods of treatment of OABS, in particular, demonstrates the importance of a healthy lifestyle, elimination of bad habits, physical inactivity, normalization of weight. The article indicates the role of behavioral therapy, methods of urinary retention, timed urination, bladder training, cognitive-behavioral therapy, pelvic floor muscle training, various types of electrical stimulation, acupuncture. An important point of the work is the determination of specific indications and contraindications for drug and surgical treatment of OABS. The paper shows recommendations for different groups of drugs for the drug treatment of OABS, presents differences in pharmacological and clinical effectiveness of their use. The goal of pharmacological treatment is to improve the quality of life of patients suffering from OABS. Several groups of pharmaceutical drugs are used for the treatment of OABS. Anticholinergic (antimuscarinic) drugs (M-cholinoblockers) are the «gold standard» of drug therapy for OABS. The most modern drug in this group at present is solifenacin. On the Ukrainian pharmaceutical market it is represented by the drug URGBALD of the pharmaceutical company HETERO. Solifenacin is a competitive, specific antagonist of cholinergic receptors and is used for the symptomatic treatment of urge urinary incontinence and/or frequent urination, as well as urgent urges to urinate, characteristic of patients with OABS syndrome. The use of solifenacin for OABS therapy is highly effective in improving symptoms of hyperactive urination, reducing episodes of urinary incontinence, reducing daily urges to urinate, and increasing the average volume of urination. Another group of drugs for the treatment of OABS are Beta-3 receptor antagonists, which are expressed on the smooth muscle cells of the detrusor, and their stimulation causes relaxation of the detrusor. A very important factor in the use of M-cholinolytics and beta-3 antagonists is their effect on cognitive functions, especially in elderly patients. The next group of drugs is estrogens. Treatment of urinary incontinence in women with estrogens is effective using oral, transdermal and vaginal routes of administration. If drug therapy for OABS is ineffective, the EAU 2025 Guidelines recommend various methods of surgical treatment, including: injection of botulinum toxin A into the bladder wall, sacral nerve stimulation, laser therapy. As well as cystoplasty/urinary diversion by various methods (augmentation cystoplasty, detrusor myectomy). Urinary diversion remains a reconstructive option for patients with intractable urinary incontinence after multiple pelvic procedures, radiation therapy, or pelvic pathology resulting in irreversible sphincter insufficiency. Options include iliac canal diversion, orthotopic neobladder, and heterotopic neobladder with continent canal catheterization. The 2025 EAU guidelines emphasize the importance of lifelong, individually tailored follow-up of patients with OABS, depending on the type of treatment prescribed. CONCLUSIONS. The «gold standard» of drug therapy for OABS is anticholinergic (antimuscarinic) drugs, which are effective in improving OABS symptoms, reducing episodes urinary incontinence, reduction of daily urge to urinate and increase of average volume of urination and have high compliance. One of the most effective drugs of the group of M-cholinergic blockers is SOLIFENACIN, presented on the Ukrainian market of medicines under the name URGBALD by the pharmaceutical company HETERO. According to the data of numerous above-mentioned studies, it can be recommended for therapy in patients with OABS both as monotherapy and in complex treatment.

Objective of the study: to investigate the frequency of menopausal transition symptoms in women aged 40–52 years under chronic stress due to the war in Ukraine.Materials and methods. An online survey of women aged 40–52 years presenting with menstrual cycle disturbances was conducted on the initiative of the Association of Gynecologists-Endocrinologists of Ukraine. Between May and September 2024, 1685 questionnaires were collected, of which 1374 were complete and included in the analysis. The standardized online questionnaire included items on place of residence, clinical profile, menopausal symptoms, and somatic health characteristics. Parametric statistical methods were used for data analysis.Results. Most respondents were aged 46–52 years (59.6%). Overweight was observed in 45.9% and obesity in 24.2%. Menstrual cycle disturbances persisted for 2–11 months in 87.4% of respondents, with 76.6% attributing these changes to severe stress.Over 80% of women in both age groups reported fatigue, decreased activity, and irritability; anxiety and panic attacks occurred in 29–52% of cases. Sleep disturbances were present in the majority (73–75%), and cognitive difficulties affected more than half of respondents regardless of age.Genitourinary menopausal syndrome symptoms were reported by over 50% of women, while sexual disorders (decreased libido and loss of interest in sexual activity) were noted by about two-thirds of respondents.Conclusions. The study demonstrated a high prevalence and inverted pattern of climacteric symptoms, with the early onset of cognitive dysfunction and manifestations of genitourinary menopausal syndrome already at a young age (40–45 years). This indicates that chronic psycho-emotional stress of war is a significant aggravating factor that potentially accelerates and intensifies the clinical manifestations of the menopausal transition in women in Ukraine. The obtained results justify the need to reconsider management approaches for patients in this age group, with an emphasis on proactive identification of complaints, educational efforts, and timely initiation of therapy to prevent the progression of menopausal disorders.

Fractured porous media (FPM) in theoretical investigations is considered as a system of fractures and adjacent porous blocks (matrix). In such media, solute transport occurs mainly through the fracture system with mass transfer in porous blocks. In this work, the problem of solute transport through an element of FPM is studied, taking into account the memory effects. The medium consists of a single fracture and a porous block (matrix) bordering it. The problem was solved numerically using the finite difference method with Caputo’s definition of fractional derivatives. Based on the numerical results, concentration profiles in the fracture and matrix were obtained. The influence of the fractional order of derivatives on the distribution of concentration is shown. The current, total and summing flow rates of the solute from the fracture into the matrix were also determined.

Superior Sagittal Sinus (SSS) meningiomas present a particular surgical challenge due to their close proximity to vital venous structures. Although microsurgical resection remains the primary treatment method, the use of adjuvant radiosurgery is becoming increasingly important in cases of incomplete (subtotal) tumor resection. The study aimed to investigate the modalities of surgical treatment for SSS meningiomas and to substantiate the rationale for radiosurgical treatment. The study included 68 patients operated on between 2019 and 2024. Total resection of the SSS meningioma (Simpson grade I–II) was performed in 49 patients (72%), while 19 patients (28%) underwent subtotal resection with a residual tumor component left in the SSS lumen. The study was conducted in compliance with bioethical principles, specifically the World Medical Association's Declaration of Helsinki (1964–2024), and was approved by the Ethics Committee of the State Institution "Romodanov Institute of Neurosurgery of the National Academy of Medical Sciences of Ukraine" (Protocol No.5, December 13, 2017), with informed consent obtained from all patients. Among early complications in patients after total SSS resection, the following were recorded: paraplegia in 2 cases (3%), tetraplegia in 1 (1%), structural secondary generalized epilepsy in 1 (1%), and venous infarction in 1 (1%). The 6-month Magnetic Resonance Imaging follow-up revealed no continued growth of the tumor or residual elements of the SSS meningioma in any of the patients. It was concluded that microsurgical resection remains the main treatment method for SSS meningiomas, ensuring a high rate of recurrence-free periods in patients. Combined treatment, including microsurgery and radiosurgery, demonstrated its effectiveness in preserving patients' quality of life, reducing the risks of tumor recurrence and severe postoperative complications. Keywords: venous drainage, thrombosis, postoperative complications, recurrence-free survival.

Background. The present study analyzes the diagnostic and prognostic validity of determining nitric oxide (NO) metabolites in the pathogenesis of odontogenic inflammatory diseases of the maxillofacial region. Odontogenic inflammatory diseases of the maxillofacial region in the adult population are the main etiologic cause of adentia in people over 30 years of age. The etiopathogenesis of secondary immunodeficiency in these nosological forms is associated with hyperproduction of nitric oxide; however, the role of NO-associated pathogenetic mechanisms in odontogenic inflammatory diseases of the maxillofacial region remains insufficiently verified. Purpose – to investigate the possibility of using the determination of NO metabolites in clinical dental practice for the diagnosis, prevention, and prognosis of the course of inflammatory diseases of the maxillofacial region. Materials and Methods. A prospective observational study was conducted involving 207 patients aged 26–80 years (121 women, 86 men) with verified odontogenic inflammatory diseases of the jaw: apical chronic periodontitis (n=144), acute purulent periodontitis (n=40), marginal periodontitis (n=23). The reference group consisted of 20 healthy volunteers of appropriate age and gender. Biochemical detection of the concentration of total NO metabolites was performed by the method of L.C. Green, nitrite anion (NO3–) – by the method of T.V. Zvyagina, and the content of nitrate (NO2–) was calculated by the difference in the indicators of total metabolites and nitrite. Longitudinal monitoring of NO metabolites before surgery, after surgery, as well as on days 3–5, 6–9 and 12–14 of the postoperative period. Results. In patients of all nosological groups in the preoperative period, a statistically significant (p<0.05) increase in the concentration of NO metabolites was found. Surgical intervention induced a significant potentiation of the imbalance in the NO system, especially pronounced in patients with acute purulent periostitis. With a favorable clinical course, a gradual normalization of the concentration of NO metabolites in the oral fluid was observed in the dynamics, which correlated (r=0.78; p<0.001) witha positive clinical course of inflammatory and destructive processes of the alveolar bone. Conclusions. Determination of NO metabolites in the oral fluid is essential in the study of pathogenetic mechanisms of inflammatory dental diseases and can be used as a highly sensitive and rapidly responding diagnostic and prognostic marker. A correlation between the clinical course of inflammatory and destructive diseases of the alveolar bone and impaired NO metabolism has been established. The proposed method for the study of NO metabolites in oral fluid optimizes the assessment of the immunological status of dental patients and can serve as a valid method of rapid diagnosis, prediction of the course of the postoperative period and a predictor of the need to correct the therapeutic algorithm to prevent complications.