A capability for effective tissue reparation is a living requirement for all multicellular organisms. Bone exits as a precisely orchestrated balance of bioactivities of bone forming osteoblasts and bone resorbing osteoclasts. The main feature of osteoblasts is their capability to produce massive
extracellular matrix enriched with calcium phosphate minerals. Hydroxyapatite and its composites represent the most common form of bone mineral providing mechanical strength and significant osteoinductive properties. Herein, hydroxyapatite and fluorapatite functionalized composite scaffolds based on electrospun polycaprolactone have been successfully fabricated. Physicochemical properties, biocompatibility and osteoinductivity of generated matrices have been validated. Both the hydroxyapatite and fluorapatite containing polycaprolactone composite scaffolds demonstrated good biocompatibility towards mesenchymal stem cells. Moreover, the presence of both hydroxyapatite and fluorapatite nanoparticles increased scaffolds’ wettability. Furthermore, incorporation of fluorapatite nanoparticles enhanced the ability of the composite scaffolds to interact and support
the mesenchymal stem cells attachment to their surfaces as compared to hydroxyapatite enriched composite scaffolds. The study of osteoinductive properties showed the capacity of fluorapatite and hydroxyapatite containing composite scaffolds to potentiate the stimulation of early stages of
mesenchymal stem cells’ osteoblast differentiation. Therefore, polycaprolactone based composite scaffolds functionalized with fluorapatite nanoparticles generates a promising platform for future bone tissue engineering applications.

In accordance to Rome IV Criteria irritable bowel syndrome (IBS) is classified into four subtypes: IBS with predominant constipation (IBS-C), IBS with predominant diarrhea (IBS-D), with mixed bowel habits (IBS-M) or IBS, unsubtyped. Some authors distinguish a post-infectious subtype of IBS, in which an acute episode of infectious gastroenteritis is a trigger of the disorder. In all the other cases, mostly psycho-emotional stress is the trigger factor, with this variant being defined as stress-associated subtype of IBS.  

Aim: to study the peculiarities of the formation and course of IBS in children, depending on the trigger factor. A total of 54 patients aged 6-12 years with a verified diagnosis of IBS according to Rome criteria IV have been examined. The trigger factor of the onset of IBS was established by the interrogation of patients and their parents. The levels of trait anxiety and somatization were assessed by Children's Form of the Manifest Anxiety Scale (CMAS) questionnaire and Somatoform Symptom Screening (SOMS) test respectively. The Catechol-O-methyltransferase (COMT) gene val158met polymorphism was estimated by the polymerase chain reaction. Enzyme immunoassay Ridascreen Calprotectin (R-Biopharm AG, Germany) was used for the quantitative determination of calprotectin in stool samples.

Results. We have diagnosed post-infectious subtype of IBS in 30 children. In this group we have found significantly higher concentration of fecal calprotectin (60.0 (35.6; 129.0) vs 31.2 (21.1; 58.7 mkg/g of feces)), which is consistent with pathogenesis of this subtype of IBS. On the contrary, we have discovered that psycho-emotional stress was the trigger factor of the onset of IBS in 22 patients (stress-associated subtype of IBS). Children with stress-associated IBS had higher levels of trait anxiety (25.1±5.7 vs. 18.7±6.4) and somatization (11.1 ± 4.0 vs. 8.6 ± 3.1) in comparison to patients with post-infectious subtype of the disorder. Furthermore, the analysis of the COMT gene polymorphism revealed, that almost the half patients (48%) with stress-associated IBS had 472 AA (Met/Met) genotype. Met/Met carriers have genetically determined low enzymatic activity of COMT, which may lead to decreased elimination of catecholamines and is associated with chronic stress. In contrast, only 31% of children with post-infectious subtype of IBS were found to have 472 AA (Met/Met) genotype.

Conclusions. Our study suggests that not only predominant bowel habit, but also trigger factor in the development of IBS determine the heterogeneity of the disorder. This approach may be used for classification of IBS in children, as it dictates treatment strategy.

Multisystem inflammatory syndrome in children (MIS-C) associated with Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) usually develops 1-1.5 months after mild or asymptomatic COVID-19 in countries with high incidence. MIS-C has a polymorphism of clinical manifestations, which include prolonged fever, polymorphic rash, non-purulent conjunctivitis, pneumonia complicated by distress syndrome, myocarditis, coronary artery disease, toxic shock syndrome, limb edema, polyserositis, severe abdominal syndrome with diarrhea and others. Establishing this diagnosis requires significant efforts to rule out diseases of other etiology. The aim of our study was to analyze the clinical and laboratory features of children with MIS-C associated with SARS-CoV-2 and severe abdominal syndrome. Six children with MIS-C associated with SARS-CoV-2 and severe abdominal syndrome were hospitalized in Lviv Regional Children’s Clinical Hospital “OHMATDYT”, Ukraine, from April 2020 to September 2021. For differential diagnosis IgM, IgG to SARS-CoV-2 by ELISA, RNA to SARS-CoV-2 by PCR, bacteriological tests of blood, urine and feces were performed. Furthermore, the diagnostic work up included chest radiography, echocardiography, ultrasound of the lungs and abdominal organs. Laboratory findings revealed an increase in the normal value of inflammatory markers and high levels of IgG to SARS-CoV-2. Administration of intravenous immunoglobulin at a dose of 1 to 2 g/kg body weight per day prevented further coronary artery disease in patients and provided regression in already affected coronary arteries. At the same time, regression of abdominal syndrome was observed. Early diagnosis of MIS-C in patients with SARS-CoV-2 and severe abdominal syndrome allows to define the appropriate treatment strategy.

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На відміну від дорослих, діти не так часто інфікуються SARS-CoV-2, захворювання має легкий перебіг, а летальні випадки є поодинокими. Проте в дітей описано нове захворювання, асоційоване із SARS-CoV-2, – мультисистемний запальний синдром (MIS-C). Більшість дітей з MIS-C у світі – чорношкірі або азіатської національності.
Мета – проаналізувати особливості перебігу MIS-C у дітей Львівської області.
Матеріали та методи. Проаналізовано медичну документацію 16 дітей за період із вересня 2020 року до січня 2021 року, яких лікували в Комунальному некомерційному підприємстві Львівської обласної ради «Львівська обласна дитяча клінічна лікарня «ОХМАТДИТ», із діагнозом MIS-C, асоційованим із SARS-CoV-2.
Результати. MIS-C діагностувався в 16 дітей (середній вік – 8,2±0,065 року, дівчатка:хлопчики – 1:0,6). Жоден із пацієнтів не був «першоджерелом SARS-CoV-2» у сім’ї, а захворів на коронавірусну хворобу після контакту з хворими родичами. Захворювання виникло в 4 (25%) дітей на тлі гострого перебігу коронавірусної хвороби, ще в 4 (25%) дітей – упродовж першого місяця, у 8 (50%) дітей – більш як через місяць після гострої інфекції SARS-CoV-2. У всіх дітей відмічалися фебрильна гарячка і загальна слабкість. Окрім цього, у переважної більшості пацієнтів клінічний перебіг MIS-C характеризувався типовими висипаннями на шкірі й кон’юнктивітом (13 дітей – 81,5%), пастозністю обличчя і набряками дистальних частин кінцівок (11 дітей – 68,75%). Біль у м’язах спостерігався в 9 (56%) дітей, гіперестезія – у 4 (25%) дітей і шлунково-кишкові симптоми – у 8 (50%) пацієнтів. Міокардит діагностувався в 4 (25%) дітей, поширені лінійно-коронарні артерії (2 дітей – 12,5%) та малі аневризми (1 дитина – 6,25%) – у 3 (18,75%) пацієнтів. Усі ці зміни нормалізувалися за 1 місяць після виписки зі стаціонару.
Висновки. Синдром мультисистемної запальної відповіді виникає до 48-го дня після перенесеної гострої коронавірусної хвороби і характеризується типовою клінічною картиною. Лікування людським імуноглобуліном у дозі 1-2 г/кг, глюкокортикостероїдами в дозі 1-2 мг/кг, аспірином 3-5 мг/кг на тлі антибактеріальної терапії є ефективним для превенції змін у коронарних артеріях і для одужання всіх пацієнтів.
Дослідження проведено відповідно до вимог із біоетики, викладених у Гельсінській декларації, та ухвалено комісією з питань етики наукових досліджень, експериментальних розробок і наукових творів Львівського національного медичного університету імені Данила Галицького. На проведення досліджень отримано інформовану згоду батьків дітей.

Unlike adults, children are less likely to get infected SARS-CoV-2, their disease has a mild form and fatal cases are rather rare. However, a new
disease associated with SARS-CoV-2, the multisystem inflammatory syndrome (MIS-C), has been described in children. Most children with
MIS-C in the world are blacks or asians.
Purpose — to analyze of peculiarities of MIS-C in children of Lviv region.
Materials and methods. We have analyzed medical records of 16 children who were treated in Communal Non-Commercial Establishment
of Lviv Regional Council «Lviv Regional Children Clinical Hospital «OKHMATDYT» in the period from September 2020 to January 2021 with the
diagnosis of MIS-C, associated with SARS-CoV-2.
Results. MIS-C was diagnosed in 16 children (average age was 8.2±0.065 years, girls:boys = 1:0.6). None of our patients was the «primary
source of SARS-CoV-2» in the household but contracted coronavirus disease after a contact with the sick relatives. The disease occurred
in 4 (25%) children against the background of acute coronavirus disease, in 4 (25%) more children during the first month and 8 (50%) children
more than a month after acute SARS-CoV-2 infection. All children has febrile fever and general weakness. Besides, in most of the patients clinical progression of MIS-C was characterized by typical skin rashes and conjunctivitis (13 children — 81.5%), facial swelling and edema of distal
parts of extremities (11 children — 68.75%). Muscle pain was present in 9 (56%) children, hyperesthesia — in 4 (25%) children, gastrointestinal
symptoms — in 8 (50%) our patients. Myocarditis was diagnosed in 4 (25%) children, linear dilatation of coronary arteries (2 children — 12.5%)
and small aneurysms (1 child — 6.25%) — in 3 (18.75%) our patients. All these changes returned to normal 1 month after discharge from the
hospital.
Conclusions. MIS-C response before the 48th day after acute coronavirus disease and is characterized by typical clinical course. Treatment
with human immunoglobulin at the dose of 1–2 g/kg, glucocorticosteroids at the dose of 1–2 mg/kg, aspirin 3–5 mg/kg against the background of antibacterial therapy is effective for the prevention of changes in the coronary arteries and for the recovery of all patients.
The research was conducted in accordance with the principles of bioethics set out in the WMA Declaration of Helsinki and Universal Declaration
on Bioethics and was approved by the Commission on Ethics of Scientific Research, Experimental Developments and Scientific Works of Danylo Halytsky Lviv National Medical University. The informed consent of the patients was obtained for conducting the studies.