Background: The tendency of premature infants to develop an excessive inflammation in the intestines can lead to morbidities such as necrotizing enterocolitis (NEC) or sepsis. Lactoferrin theoretically can downregulate the intestinal inflammatory status of preterm newborns. In a randomized study, we investigated the effect of enteral bovine lactoferrin (bLF) supplementation on fecal calprotectin (FC) levels in premature infants.

Methods: The study included 26 preterm neonates with a gestational age of ≤ 32 weeks and a birthweight of ≤1500 g. All babies were aged less than 72 h and tolerating minimal enteral feeds. Eleven infants were receiving bLF at a dose of 100 mg/day with enteral feeds until postmenstrual age (PMA) of 36 weeks (lactoferrin group), 15 infants were receiving standard medical care (control group). Stool samples were collected twice: during the first 7 days of life (before administration of bLF) and at PMA of 36 weeks. FC measurements were done with an ELISA method.

Results: The baseline characteristics of the groups were not different. The initial median (IQR) FC level was lower in the lactoferrin group, but the difference was not statistically significant (264.9 (211.0–689.4) vs. 413.5 (274.2–800.0) μg/g, respectively, p > 0.05). At PMA of 36 weeks, FC concentrations increased in the lactoferrin group (p > 0.05) but were not different as compared to the control group (631.1 (232.0–800.0) vs 274.7 (144.8-599.6) μg/g, respectively, p > 0.05). Initial FC concentrations were higher in infants with early-onset sepsis (EOS) (rS = 0.44; p < 0.05) but did not correlate with the incidence of NEC or late-onset sepsis (LOS). FC levels were not significantly different in patients with NEC or LOS compared to infants without these morbidities, both initially and at PMA of 36 weeks. Supplementation with bLF did not affect the incidence of either NEC or sepsis.

Conclusions: Daily enteral intake bLF at a dose of 100 mg until PMA of 36 weeks was associated with the increase of FC levels but this effect was not statistically significant. FC levels during the first week of life do not predict the development of NEC or LOS but might be an additional tool for diagnosing EOS.

INTRODUCTION
Invasive mechanical ventilation (MV) remains a widely used respiratory support for the sickest very-low-birth-weight (VLBW) infants. However, prolonged exposure to this invasive treatment can be associated with adverse outcomes. It is essential to establish the factors which influence the duration of MV. The study aimed to determine the factors affecting the duration of MV in VLBW infants.
MATERIALS AND METHODS
Data obtained from a prospectively created computer database were used in a retrospective cohort study. The database included information about 1,086 VLBW infants < 32 weeks of gestation who were intubated and mechanically ventilated at any time during their hospital stay at Lviv Regional Clinical Hospital between January 2010 and December 2020.
RESULTS
The infants had a mean (SD) gestational age of 27.6 (2.2) weeks and birth weight of 1,007 (262) g. 43% of them were delivered by cesarean section, 26% from multiple pregnancies, 58% were intubated and ventilated at birth, and 49% were treated with surfactant. Severe intraventricular hemorrhages (IVH) occurred in 179 (16%), periventricular leukomalacia (PVL) in 60 (6%), bronchopulmonary dysplasia (BPD) in 135 (12%), and necrotizing enterocolitis (NEC) in 41 (4%) infants. In 49 (5%) cases, the BPD was severe. 678 (62%) patients survived until discharge. The median (IQR) duration of endotracheal MV was 47 (10-103) hours. BPD (rS = 0.32, p < 0.05), severe BPD (rS = 0.418, p < 0.05), pneumothorax (rS = 0.06, p = 0.05), severe IVH (rS = 0.255, p < 0.05), PVL (rS = 0.15, p < 0.05), sepsis (rS = 0.087, p < 0.05), NEC (rS = 0.088, p < 0.05), antibiotic therapy duration (rS = 0.168, p < 0.05), and smaller gestational age (rS = -0.118, p < 0.05) were reliably associated with longer duration of MV in VLBW infants.
Based on a one-way analysis of covariance, only severe BPD (F = 20.898, p < 0.0001) and PVL (F = 5.989, p < 0.05) significantly and independently increased the duration of MV.
CONCLUSIONS
Severe lung injury and brain injury are the main factors affecting the duration of MV in our 10-year cohort of VLBW infants.

УДК: 616-053.2:378.046.4[477]

Мета публікації – проаналізувати особливості післядипломної освіти в різних європейських країнах та запропонувати шляхи оптимізації розвитку медицини в Україні в умовах сьогодення. Матеріали і методи. Проведено огляд літератури за тематикою отримання медичної освіти в різних країнах, використано дані офіційних Інтернет-ресурсів та дані Міністерства охорони здоров’я України. Результати і обговорення. Наведено короткі відомості про сучасні особливості післядипломної освіти в Україні та світі. Проведено паралелі на різних етапах навчання, проаналізовано їх тривалість, напрями та основні характеристики. Термін підготовки практикуючого лікаря в Україні є одним із найкоротших у світі – 6–9 років, а найдовшим серед європейських країн – у Франції – 9–14 років. Висновки. У процесі реалізації реформування післядипломної освіти в Україні потрібно орієнтуватися на уніфікацію робочих навчальних програм та наближення стандартів післядипломної освіти. Упровадження поступової трансформації системи шляхом збільшення тривалості підготовки післядипломної підготовки дасть змогу наблизити рівень освіти до європейських стандартів і готувати конкурентних спеціалістів.
Ключові слова: післядипломна освіта, медицина, шляхи оптимізації, інтернатура, резидентура.

Development and progression of chronic kidney disease (CKD) in patients with renal cell carcinoma (RCC) after radical nephrectomy remains an extremely pressing contemporary issue.
Postoperative changes of the ultrasound resistance index (RI) in the contralateral kidney not affected by the tumor after surgical treatment of RCC, as well as correlations between changes in IR and in glomerular filtration rate (GFR) remain far from being comprehensively investigated.
The RI changes in the parenchyma of the intact (unaffected by the tumor) kidney before and after surgical treatment for RCC, and establishing correlations between RI changes and creatinine-dependent GFR remain unexplored issues.
Objective. To assess the correlation between RI and GFR in the kidney not affected by the RCC before and after radical nephrectomy.

Materials and methods. The study enrolled 49 patients. Group I included 37 patients with an initial diagnosis of RCC (on the right), Stage III of the disease, and without signs of chronic renal failure (GFR was ≥ 90 ml/min/1.73 m2).
In patients with RCC, six months after surgery, the RI increase in the contralateral kidney unaffected by the tumor was significantly associated with a significant reduction in GFR. Thus, RI can be potentially used to predict the development of CKD in this patient population.

Purpose: The goal of the study was an assessment of the diagnostic performance of diffusion-weighted images (DWI)
and apparent diffusion coefficient (ADC) of magnetic resonance imaging (MRI) in distinguishing local recurrence (LR)
of renal cell carcinoma (RCC) from benign conditions after partial nephrectomy.
Material and methods: Thirty-nine patients after partial nephrectomy for solid RCC were enrolled in the study. Patients
were followed up using MRI, which included DWI sequence (b = 800 s/mm2). All patients with MRI features of LR were included in the main group (n = 14) and patients without such features – into the group of comparison (n = 25).
Apparent diffusion coefficient (ADC) values of suspicious lesions were recorded. In all patients with signs of locally recurrent RCC, surgical treatment was performed followed by pathologic analysis.
Results: The mean ADC values of recurrent RCC demonstrated significantly higher numbers compared to benign fibrous tissues and were 1.64 ± 0.15 × 10-3 mm2/s vs. 1.02 ± 0.26 × 10-3 mm2/s (p < 0.001). The mean ADC values of RCCs’ LR and benign post-op changes in renal scar substantially differed from mean ADC values of healthy kidneys’ parenchyma; the latter was 2.58 ± 0.05 × 10-3 mm2/s (p < 0.001). In ROC analysis, the use of ADC with a threshold value of 1.28 × 10-3 mm2/s allowed us to differentiate local recurrence of RCC from benign postoperative changes with 100% sensitivity, 80% specificity, and accuracy: AUC = 0.980 (p < 0.001).
Conclusions: The apparent diffusion coefficient of DWI of MRI can be used as a potential imaging marker for the diagnosis of local recurrence of RCC.