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Objective: to study the plasma levels of steroid hormones and the rates of neurological recovery in the early postresuscitative peri od after 10 min cardiac arrest in albino male and female rats in the control group and in the study group receiving estradiol + dehy droepiandrosterone. Materials and methods. Forty eight animals of both sexes that had experienced under ether anesthesia a 10 min cardiac arrest due to intrathoracic ligation of its vascular fascicle were examined. After standard cardiopulmonary resuscitation, placebo was intramuscularly injected in 31 animals and 17 animals received estradiol and dehydroepiandrosterone in a dose of 0.1 mg and 5 mg per 100 g of ginodian depot (Shering, Germany) used for prolonged correction of the postcastration syndrome in women. Then the general and neurological statuses were evaluated in the animals. Enzyme immunoassay was used to determine the plasma concentration of 7 sex steroids in normalcy (18 intact animals), in the control animals in the untreated animals (n=31) on days 2 and 16 following resuscitation and in the hormone treated (n=17) animals only on day 16. Results. The processes of dying and cardiovascular resuscitation did not differ significantly in the male and female groups. During the days which followed, there was a more rapid neurological recovery in female rats as compared with male rats in both the control group and the hormonal treatment group with the accelerated external recovery in the latter. There were significant gender differences in the plasma hormonal profile in normalcy and in the postresuscitative period in the controls, which were leveled after treatment. Conclusion. The gender differences in the results of postresuscitative recovery are associated with the specific features of the pro file of endogenous reproductive steroids in the organism. Functional recovery following clinical death may be accelerated by exogenous sex steroids.

The purpose of the article is to determine the ways of development of hotel and restaurant business in the period of post-war reconstruction of Ukraine. The research methodology is based on the use of general scientific and specific methods, in particular: analysis and synthesis, induction and deduction, modeling, systematization and generalization.The scientific novelty of the obtained results lies in the substantiation and proposals for the creation of smart cities within hotel and restaurant complexes. Conclusions. The article establishes that the hotel and restaurant business suffers significant losses during the war. It is proved that in the post-war period it is necessary to develop development strategies that will counteract internal and external risks. The main strategies for the development of the hotel and restaurant business in the postwar period are systematized. In particular, two groups of development strategies have been identified: the strategy of maintaining a positive image in the market and the strategy of overcoming the negative post-war consequences. There are 10 signs on the basis of which it is possible to assert the existence of smart cities within the hotel and restaurant business. The strategy for the development of the hotel and restaurant business should be formed taking into account current development trends. To do this, it is necessary to develop approaches that would reduce the level of risk caused by the emergence of negative customer expectations. To do this, a marketing and sales strategy must be used. The main role will be played by corporate culture, which will be the core of future strategic changes. Important for implementation is the innovation strategy, the implementation of which should take place through the creation of smart cities within the hotel and restaurant complex. This approach minimizes contact with the external environment and promotes a positive impression of the quality of services. Key words: hotel and restaurant business, strategies of hotel and restaurant business development, business risks, hotel and restaurant complexes, smart city.

1 Відділення радіонейрохірургії, Інститут нейрохірургії ім. акад. А.П. Ромоданова НАМН України, м. Київ, Україна 2 Відділення невідкладної судинної нейрохірургії, Інститут нейрохірургії ім. акад. А.П. Ромоданова НАМН України, м. Київ, Україна Вплив післяопераційного синдрому поліорганної недостатності на раннþ летальність при хірургічному лікуванні гострого порушення кровообігу головного мозку за геморагічним типом Вступ. Внутрішньочерепні крововиливи складають 10-15% гострого порушення кровообігу головного мозку (ГПКГМ). Летальність при консервативному лікуванні в перші 30 діб досягає 35%. У теперішній час використовують також хірургічні методи лікування, які нерідко супроводжуються синдромом поліорганної недостатності (СПОН). Ці дані не знайшли відображення в літературі.Матеріали і методи. Обстежені 224 пацієнта, яким здійснене хірургічне лікування геморагічного ін-сульту, 119 з них живі, 105 -померли. В ранньому післяопераційному періоді для оцінки тяжкості СПОН використовували шкалу SOFA і критерії R. Bone для SIRS.Результати. Навіть короткочасне погіршення показників (за шкалою SOFA 3 бали і більше) спричиняє підвищення летальності. У хворих, які померли, середні показники СПОН (ШКГ, PaO 2 /FiO 2 , АТ сер. ) були в стадії вираженої недостатності, а показники ЧСС, ЧД, температура тіла -відповідали SIRS. У хворих, які вижили, зазначені показники SIRS були в межах норми, показники СПОН -у стадії дисфункції. Різниця між показниками СПОН и SIRS у хворих, які вижили, і тих, які померли, достовірно збільшувалася про-тягом раннього післяопераційного періоду. До предикторів летальності, що виявлялись у 5-10 разів частіше за несприятливого прогнозу і мали високу достовірність (Р<0,001), належать церебральна (ШКГ 9 балів і менше), легенева (індекс оксигенації PaO 2 /FiO 2 200 і менше), серцева (АТ сер. нижче 70 мм рт.ст., інфузія до-паміна більше 5 мкг×кг), ниркова (креатинін крові 300 мкмоль/л і більше) недостатність та сума балів 10 і більше за шкалою SOFA. За наявності показників SIRS (тахікардія, тахіпное, гіпертермія, лейкоцитоз) летальність значно вища. Клþчові слова: геморагічний інсульт, летальність, церебральні та екстрацеребральні фактори, синдром системної запальної відповіді, дисфункція органів, синдром полиорганної недостатності.За даними Всесвітньої організації охорони здоров'я, частота виникнення інсульту у різних краї-нах становить від 150 до 740 на 100 тис. населення. В Україні щороку інсульт виникає майже у 100 тис. хворих [1]. Інсульт може бути геморагічним або ішемічним. В етіології ішемічного інсульту провідна роль належить емболії та тромбозу судин мозку, геморагічного -розрив артеріальних аневризм (АА), артеріовенозних мальформацій (АВМ), у пацієнтів при гіпертонічній хворобі і атеросклеротичному ураженні судин головного мозку -крововиливи у білу речовину мозку з утворенням гіпертензійних інсульт-гематом.Внутрішньочерепні нетравматичні крововиливи виявляють з частотою 10-15% в структурі ГПКГМ. Летальність при консервативному лікуванні в перші 30 діб досягає 35% [2,3]. В останні роки при гемо-раг...

The aim of surgical treatment of any cerebral aneurysm is to achieve its total exclusion from the bloodstream. Although the progress in the development and implementation of microsurgical and the latest endovascular technologies, in many cases, the treatment of complex cerebral aneurysms is not an easy task. Unsatisfactory results of the exclusion of complicated cerebral aneurysms are due to many factors, for instance: gigantic size, fusiform or dolichoectatic configuration of the cerebral aneurysm, the presence of atherosclerotic changes, anatomical features of the departure of functionally important arteries directly from the cerebral aneurysm. Such cerebral aneurysms are quite problematic both for microsurgical remodeling clipping and for endovascular exclusion. At the current stage, the introduction and use of the microanastomosis technique provides additional options and expands the possibilities of surgical treatment of complex cerebral aneurysms.Objective ‒ to analyze the possibilities and results of surgical treatment of complicated cerebral aneurysms using the technique of surgical revascularization (bypass surgery).Materials and methods. An analysis of the results of the examination and surgical treatment of 16 patients with complicated cerebral aneurysms for the period from 2016 to 2020, who were treated and operated on in the emergency vascular neurosurgery department with the X-ray operating department Romodanov Institute of Neurosurgery of NAMS of Ukraine. All patients diagnosed with complicated cerebral aneurysms had gigantic sizes. All cases of surgical intervention included placement of extra-intracranial microanastomosis or intra-intracranial anastomosis, sometimes a combination of it, to ensure normal blood supply to the vessel of complicated cerebral aneurysm that were planned to be devascularized. In 14 observations, one-time anastomosis and exclusion of complicated cerebral aneurysms were performed. In 2 observations, the first stage was an anastomosis without exclusion of the complicated cerebral aneurysms due to insufficient vascularization of the distal arterial branch for deconstructive exclusion of aneurysm.Results. Satisfactory results of surgical treatment (grade 1 and 2 of Modified Rankin Scale (MRS)) in the general group of patients were observed in 13 (81 %) patients with complicated cerebral aneurysms. Unsatisfactory results of surgical treatment occurred in 3 (19 %) observations. Profound disability (MRS grade 5) as a result of surgical treatment was recorded in 1 (6 %) patient. Cases that ended fatally occurred in 2 (13 %) observations of the total group of patients. In the group of patients with surgical revascularization and excluded complicated cerebral aneurysms, satisfactory results were observed in 13 (92.9 %) patients. Fatal results of surgical treatment were recorded in 2 patients with a hemorrhagic course of complicated cerebral aneurysms, in which surgical revascularization was performed as first stage and scheduled removal of complicated cerebral aneurysms was planned.Conclusions. The introduction and use of the microanastomosis technique expands the possibilities of surgical treatment of complicated cerebral aneurysms. Revascularization surgical interventions are highly effective in the prevention of ischemic complications when complicated cerebral aneurysms are excluded. Recommendations (indications) for revascularization should be considered in impossibility and high risks of ischemic complications during remodeling clipping or endovascular exclusion of complicated cerebral aneurysms.

Objective ‒ to analyze the results of surgical treatment of basilar artery (BA) bifurcation arterial aneurysms (AA), taking into account the method of BA obliteration, the type of disease, to summarize the results of surgical treatment of BA.Materials and methods. A retrospective analysis of the results of a comprehensive examination and surgical treatment of 132 patients with AA of BA bifurcation in a group of 387 operated patients with posterior cerebral circulation aneurysms, who were hospitalized and operated in the vascular departments of the State Institution Romodanov Neurosurgery Institute National Academy of Medical Sciences of Ukraine in the period from 1998 to 2019 years is made. Patients were divided into groups according to the type of disease and the method of surgical treatment of AA of BA bifurcation. The analysis of the results of surgical treatment AA of BA bifurcation was performed taking into account the method of  occlusion and the clinical type.Results. The balloon occlusion technique was used in 16 (12.1 %) patients with AA of BA bifurcation, including hemorrhagic and other types of disease. Radical exclusion of AA of BA bifurcation was achieved only in 1 (6.25 %) patients of this group. Exclusion of AA of BA bifurcation at level IIR was also recorded in only 1 (6.25 %) patient. In 4 (25.0 %) patients, the level of AA occlusion corresponded to IIIR. In 10 (62.5 %) patients, after surgery using the balloon occlusion technique, AA of BA bifurcation remained not excluded. Satisfactory functional results of treatment using the balloon occlusion technique, according to mRs, were obtained in 7 (43.7 %) patients of this group, without taking into account the radicality of AA of BA bifurcation exclusion. Transcranial technique, taking into account hemorrhagic and other types of flow, was used in 5 (3.8 %) patients with AA of BA bifurcation. In 4 (80.0 %) patients of this group, radical exclusion from the bloodstream was achieved by clipping (occlusion level ‒ IR). In 1 (20.0 %) wrapping of aneurysm walls were strengthened (occlusion level ‒ AA of BA bifurcation is strengthened). Satisfactory functional treatment results in this group were obtained in 3 (60.0 %) observations. Using modern methods of aneurysm coil embolization, 111 (84.0 %) patients with AA of BA bifurcation were operated. Radical exclusion of AA from the bloodstream at the level of IR was achieved in 40 (36.0 %) patients. The level of occlusion IIR was observed in 48 (43.2 %) patients. In 26 (23.4 %) cases, the level of occlusion corresponded to IIIR. In 1 (0.9 %) case, the aneurysm was excluded at level IIID. Satisfactory functional results, according to mRs, in this group were obtained in 89 (80.2 %) observations.Conclusions. The main method of treatment of AA of BA bifurcation, regardless of the type of disease, should be considered endovascular with the use of modern methods of endovascular obliteration of aneurysm. Methods of transcranial clipping of aneurysms are possible in the surgical treatment of AA of BA bifurcation, but it is advisable to use them when it is impossible to perform endovascular intervention with modern methods of obliteration. The balloon occlusion technique is extremely ineffective in terms of radical shutdown and quality of life of operated patients with  AA of BA bifurcation and can only be considered as a subject of the historical aspect of endovascular treatment of  AA of BA bifurcation.