[Synchronous primary multiple cancer: distal cholangiocarcinoma of the intrapancreatic common bile duct and intraductal papillary mucinous tumor associated with ductal adenocarcinoma of the pancreatic tail]. / Sinkhronnyi pervichno-mnozhestvennyi rak: distal'naya kholangiokartsinoma intrapankreaticheskoi chasti obshchego zhelchnogo protoka i vnutriprotokovaya papillyarnaya mutsinoznaya opukhol' v assotsiatsii s protokovoi adenokartsinomoi khvosta podzheludochnoi zhelezy.

We present a combination of distal cholangiocarcinoma of the intrapancreatic common bile duct and intraductal papillary mucinous tumor associated with ductal adenocarcinoma of the pancreatic tail. This clinical case is unique. When analyzing the literature, we found no any case of similar primary multiple malignant tumor. Importantly, final diagnosis of simultaneous malignant pancreatobiliary neoplasia is possible only via intraoperative biopsy after adequate morphological dissection and research of resected organ complex including molecular genetic analysis due to identical histological and immunohistochemical picture of ductal neoplasia.

Strain-induced charge ordering above room temperature in rare-earth manganites.

Most known mixed manganites containing rare-earth elements demonstrate a pronounced charge ordering (CO) state below room temperature. The behavior of the magnetic susceptibility and electronic magnetic resonance of polycrystalline Pr1-xSrxMnO3/YSZ (x = 0.2 and x = 0.4) films without a pronounced texture indicates the formation of the CO phase in the samples at temperatures close to and above room temperature. Moreover, this phase manifests itself with a typical sign of martensitic transformation. The same phenomenon has been traced for textured polycrystalline La0.7Sr0.3MnO3/YSZ films. Electron microscope data indicate the presence of internal strain within the films, which is probably responsible for the formation of the CO phase. It is assumed that the reasons for the appearance of such strain include the crystallite size and the boundary between them. The results obtained provide the basis for the development of new research and technological tasks for the generation of the high-temperature CO state in various polycrystalline rare-earth manganites, since this state contributes to the manifestation of interesting magnetocaloric, magnetoelectric and multiferroic properties. In addition, recent data has opened up new opportunities for studying the strain-induced phenomena in such materials.

Immunocompetent Mice As a Model for Preclinical Studies of mRNA Vaccine Immunogenicity.

Conducting preclinical studies of mRNA vaccines is complicated by the lack of relevant animal models of the human immune system. Immunocompetent mice are widely used in biomedical research. However, critical differences in the genetics and immune system of mice and humans prevent the study of unique human immune responses in mice. Within the framework of this work, the possibility of modeling the cytotoxic T-cell response to mRNA vaccines encoding the S-protein of the SARS-CoV-2 virus was investigated. High-affinity peptides from S-protein were analyzed for the most frequent allelic variants of human MHC-I, two immunocompetent mouse lines (C57BL/6, BALB/c) and an outbred mouse model of IRC. The results of computer modeling have shown that mouse models can be used in preclinical studies of mRNA vaccines against SARS-CoV-2. Mouse MHC-I is able to present virus peptides that are highly affine for human MHC-I. Moreover, the immunogenicity of some of them has already been confirmed by examining blood samples from patients who have had COVID-19.

[A rare variant in the TTR gene (p.E112K) is associated with systemic amyloidosis and a new symptom - skin hyperemia in response to ethanol intake: family segregation analysis, literature review, and a clinical case. Case report].

Transthyretin amyloidosis (ATTR-amyloidosis) is a systemic disorder associated with extracellular deposition in the tissues and organs of amyloid fibrils, transthyretin-containing insoluble protein-polysaccharide complexes. The change in transthyretin conformation, leading to its destabilization and amyloidogenicity, can be acquired (wild type, ATTRwt) and hereditary due to mutations in the TTR gene (variant, ATTRv) [1, 2]. Hereditary ATTR-amyloidosis has an earlier onset and greater phenotypic diversity. The age of the manifestation, the predominant phenotype, and the prognosis are often determined by the genetic variant. To date, more than 140 variants in the TTR gene have been identified; however, most of them are described in single patients and do not have clear evidence of pathogenicity. The prospects of a new pathogenetic treatment of ATTR-amyloidosis [3], especially effective in the early stages of the disease, increases the relevance of timely diagnosis, which is challenging due to physicians' lack of awareness. This article presents a clinical case of ATTRv-amyloidosis associated with a rare pathogenic variant in the TTR gene and a newly described skin symptom. This article is a literature review.

[Difficulties in differential diagnosis of the AL- and ATTR-cardiac amyloidosis. Case report].

The article presents a clinical case describing a complex differential diagnosis of cardiac amyloidosis types and verification of the diagnosis of AL-amyloidosis.

[The study of elemental picture in reliance on age and intensity of physical activity in male inhabitants of Magadan city.]

The study aimed at analyzing the mineral picture of young, middle-aged and elderly men of the city of Magadan having physical activity of a different intensity. The survey involved 235 men aged 18-44, 130 men at the age of 45-59, and 100 men 60-74 years old whose lifestyle varied with the intensity of physical activity. Hair samples were used to assess the content of 25 macro- and microelements (ME) with spectrometric methods on «Optima 2000 DV¼ and «NexION 300D units¼ («Perkin Elmer¼, USA). The analysis showed the so called northern type of ME imbalance experienced by all the examinees regardless of the age and intensity of physical activity with pronounced deficit in essential elements - Ca, Mg, Co, and Se. In case of men 60-74 years old age, we also observed lowered concentrations of Cr, V, and Si. At a younger age, physically active men exhibited significantly higher concentrations of Co, K, and P with lower variables of Cr, Li, V, I, Cd and Pb. The middle-aged subjects were high in P and low in Co, Fe, Mn, Al, Pb, and Sn. As for the elderly males, they tended to show reduced concentrations of As, Be, and Si. The total frequency of elemental deficiency was characteristic of all the age groups with low physical activity, and it was greatest at a younger age regardless of the intensity of physical activity. In addition to preventive measures on maintaining tone, metabolism, training of the heart muscle and blood vessels, the recommended physical activity should be of at least a moderate intensity as a natural physiological corrector to achieve the body bio elemental balance.

Intracellular Gemcitabine Monophosphate Levels Predict Chemotherapy Efficacy in Gemcitabine-Treated Patients with Bladder Cancer.

Gemcitabine monophosphate (dFdCMP), one of the intracellular forms of phosphorylated gemcitabine, determines its antitumor activity. A pharmaco-molecular model for determining relative gemcitabine monophosphate level based on the assessment of the activity of ENT1 and ENT2 channels as well as dCK and CDA enzymes in tumor tissue was developed. Relative gemcitabine monophosphate level is a more relevant predictive factor of gemcitabine resistance of bladder cancer as compared with the expression of individual markers related to dFdCMP formation.

Particles-Matrix Bond in ZnCoO:H and ZnCoAlO:H Films: Issues of Magnetism and Spin Injection.

ZnCoO:H and ZnCoAlO:H films were synthesized by radio frequency magnetron sputtering in a (1 - x)Ar + xH2 mixed atmosphere with x = 0.2-0.5. The films contain different amounts of metallic Co particles (from 7.6% and higher) ~4-7 nm in size. The magnetic and magneto-optical (MO) behavior of the films was analyzed in combination with their structural data. The samples exhibit high values of magnetization (up to 377 emu/cm3) and MO response at room temperature. Two situations are considered: (1) the film magnetism is associated only with isolated metal particles and (2) magnetism is present both in the oxide matrix and in metal inclusions. It has been established that the formation mechanism of the magnetic structure of ZnO:Co2+ is due to the spin-polarized conduction electrons of metal particles and zinc vacancies. It was also found that in the presence of two magnetic components in the films, these components are exchange-coupled. In this case, the exchange coupling generates a high spin polarization of the films. The spin-dependent transport properties of the samples have been studied. A high value of the negative magnetoresistance of the films at room temperature (~4%) was found. This behavior was explained in terms of the giant magnetoresistance model. Thus, the ZnCoO:H and ZnCoAlO:H films with high spin polarization can be considered as sources of spin injection.

[Elemental correlations within the system of mineral metabolism in male residents of Magadan having a variety of activity levels in the ontogeny.]

This research aimed to identify adaptation mechanisms in the structure of inter-element relations, and conducted the assessment study on the dynamics of the elemental composition in the hair samples of men in the city of Magadan. The research was performed based on the gerontological aspect and in the reliance on varying intensity of physical activity, by creating a bio-element net of bonds to maintain the overall functionality at the minimum optimum level. Two hundred and thirty-five men aged 18-44, one hundred and thirty men aged 45-59, and one hundred men aged 60-74, all having a variety of physical activity levels, were examined. By spectrometric methods with «Optima 2000 DV¼ and «NexION 300D¼ devices («Perkin Elmer¼, USA), we determined the amounts of 25 macro- and microelements in subjective hair samples. The results of our assessment study allowed for the suggestion that the trace element picture of correlations differs in men according as they differ in ages and the intensity of physical activity. The body elemental system of the examinees with reduced physical activity tends to be more stressed out compared to that of the subjects following an active life style who develop a stronger correlation structure and better variables of adaptability of their elemental system. At the same time, the age-related picture is the opposite: the total mineral deficiency in middle-aged and elderly men grows worse with increasing age while the adaptability of their elemental system improves. In this case, the total number of inter-element relations appears to not increase; it even comes down, but we can see the correlations become stronger. Probably, the minerals are not increasingly eliminated from the body owing to the growing strength of their mutual influence on each other, which prevents the pronounced lack of the minerals, and can be considered as a compensation mechanism for maintaining elemental homeostasis in older age groups.

[Congenital cholesteatoma of the mastoid process: cases of diagnosis and surgical treatment]. / Vrozhdennaya kholesteatoma sostsevidnogo otrostka visochnoi kosti: sluchai diagnostiki i khirurgicheskogo lecheniya.

A brief review of the epidemiology and pathogenesis of congenital cholesteatoma (CC) of the temporal bone pyramid is presented, classifications reflecting the degree of spread or localization of the process are considered. Variants of local CCs of the mastoid process don't fit into these classifications, as well as there is no statistics on the frequency of their detection and treatment due to the rarity of this pathology. Clinical cases of diagnosis, surgical treatment of CC of the mastoid process and its results are described. Clinical examples indicate a long-term asymptomatic course of CC of the mastoid process, accompanied by a pronounced destructive process in the mastoid process. Early surgical treatment makes it possible to remove the neoplasm as radically as possible and preserve hearing function.

[The effectiveness of transtympanic use of dexamethasone 4 mg in Meniere's disease, severe and moderate course of the disease]. / Effektivnost' transtimpanal'nogo primeneniya deksametazona 4 mg pri bolezni Men'era, tyazhelom i srednetyazhelom techenii zabolevaniya.

The results of transtympanic administration of 4 mg dexamethasone in 37 patients with moderate and severe Meniere's disease are presented. The endolymphatic hydrops was detected in all inner ear structures with predominant accumulation in vestibule and semicircular canals by MRI-visualization before therapy. After 1 month of 4 mg dexamethasone transtympanic therapy the hydrops degree decreased. Daily transtympanic administration of 4 mg dexamethasone for a month leads to reduction of vertigo attacks duration and expression in 92% of cases (follow-up period 24 months) and can be considered when conservative therapy is ineffective before destructive surgical interventions.

[Possibilities of morphological diagnosis of amyloid in the subcutaneous adipose tissue biopsy specimens]. / Vozmozhnosti morfologicheskoi diagnostiki amiloida v bioptatakh podkozhnoi zhirovoi kletchatki.

OBJECTIVE: To retrospectively analyze the results of histological examination of subcutaneous adipose tissue (SAT) biopsy specimens versus the diagnostic value of drugs manufactured by different procedures. MATERIAL AND METHODS: The investigators selected and analyzed the results of biopsy studies with the simultaneous production of two different types of tissue specimens (squashed native specimens, sections from the paraffin blocks) from the abdominal SAT biopsy specimens obtained from 118 patients. In each case, the tissue specimens were stained with Congo red and examined in polarized light, concurrently using the positive control. The criterion for amyloid was the ability of congophilic deposits to birefringence with a characteristic luminescence spectrum when examined in polarized light. RESULTS: Compared to the sections from the paraffin blocks, the native specimens were shown to be of high diagnostic value. The advantages of different types of tissue samples made from SAT biopsy specimens were formulated. CONCLUSION: The SAT biopsy specimens are characterized by the minimal risk to a patient and by the easy way of sampling and are a frequent subject for screening biopsies. In addition to the type of amyloid, the volume, quality, and method of processing the biopsy specimen are responsible for the diagnostic value of SAT examination. The study of squashed native specimens stained with Congo red is most informative when using polarized light.

[Age-related transformation of some lipid indicators under physical activity of varying intensity in male northerners.]

The study analyzed cholesterol-lipoprotein pictures of men aged 18-44, 45-59, and over 60 who followed different intensity of motor activity. For the objective, the AU680 analyzer enzymatic method was applied to determine the blood serum concentration levels of total cholesterol (CHC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglycerides (TG) as well as to assess the atherogenicity of the lipid profile using the calculating coefficient. The imbalance in lipid metabolism was observed through all the studied parameters and differed between examined groups immensely: it existed in 14% of young men, 20% of middle-aged subjects and 1% of the elderly of those from the intense activity group vs. 26, 40 and 21% of those from the sedentary lifestyle group. Decreased physical activity results in elevated concentrations of cholesterol and LDL at the age of 45-59, while those who perform exercises develop these symptoms after 60 years of age. The lipid profile of subjects with sedentary lifestyle appears to be more atherogenic, with higher average blood concentrations of cholesterol, LDL and TG, and lower HDL. In general, among 45-59 aged volunteers of the Magadan survey who exhibit various activity levels, there is a significant percentage of individuals with IIa phenotype of dyslipidemia, which is considered atherogenic and aggravating the risk of atherosclerosis. This age should be referred to a risk group. The effectiveness of prevention of lipid metabolism disorders with increasing physical activity appears to be highest in older age.

[Neuroimaging of the endolymphatic hydrops of the labyrinth in severe and moderately severe Meniere's disease]. / Neirovizualizatsiya endolimfaticheskogo gidropsa labirinta pri tyazhelom i srednetyazhelom techenii bolezni Men'era.

The results of magnetic resonance imaging (MRI) of the inner ear 24 hours after intratympanic administration of 1 ml of diluted (1:7) contrast substance for gadolinium-based MRI in 43 patients with moderate and severe Meniere's disease course are presented. It has been revealed that in case of severe and moderate course of Meniere's disease endolymphatic hydrops is presented in all departments of labyrinth: cochlea, vestibule, semicircular canals, but is most pronounced in vestibular department of labyrinth: horizontal semicircular canal and vestibule. The neuroimaging method according to the presented protocol is safe and can be applied in a wide practice both to assess the presence and localization, and the degree of expression of the endolymphatic hydrops.

ANXIOUSNESS AND QUALITY OF SLEEP IN CHILDREN WHO WERE IN QUARANTINE DURING THE COVID-19 PANDEMIC. / TRYVOZhNIST' TA IaKIST' SNU U DITEI, IaKI PEREBUVALY NA KARANTYNI PID ChAS PANDEMIÏ COVID-19.

OBJECTIVE: to assess the level of anxiety and characterize the quality of sleep in children living in radioactively con-taminated areas in comparison with children who were not affected by the Chornobyl-affected contingents that werequarantined in connection with the COVID-19 pandemic. MATERIALS AND METHODS: The indicators of the level of anxiety were studied using the scale of self-assessment of thelevel of anxiety Ch.D. Spielberger, sleep quality was assessed using a standardized questionnaire for self-completionof PSQI and 137Cs content was measured in children. The main group consisted of 96 children who were quarantineddue to the COVID-19 pandemic and permanently lived in radioactively contaminated areas of Zhytomyr and Rivneregions with a soil contamination density of 137Cs from 18 kBq/m2 to 235 kBq/m2. The age of children ranged from10 to 17 years. Among them were 33 boys and 63 girls. The comparison group consisted of 52 children of similar age,including 26 boys and 26 girls. These children lived permanently in Kyiv and were not victims of the Chornobyl dis-aster. RESULTS: It was found that children who were quarantined for COVID-19 (both residents of radioactively contami-nated areas and children who do not belong to the contingents affected by the Chornobyl disaster) had an increasedlevel of reactive (RA) and personal anxiety (PA). The comparative analysis showed that children of the same sex ofthe main group and the comparison group did not differ in terms of PA and RA. At the same time, studies have shownthat girls, both in the main group and in the comparison group, were characterized by higher levels of PA and RAthan boys. It was determined that poor sleep quality was common in both children living in radioactively contami-nated areas (42.71 %) and children in the comparison group (42.44 %). Among the sleep disorders in children ofboth observation groups, «day dysfunction¼ was most often detected. CONCLUSIONS: There was a direct correlation between the overall PSQI score and the level of reactive, personal anx-iety and the overall PSQI score. Using regression analysis, the presence of a linear association of the level of incorporated 137Cs (Bq) with the indicator of personal anxiety of children living in radioactively contaminated territory (b = -0.716, p < 0.001) was proved.

[Clinical significance of radiological methods for diagnosing endolymphatic hydrops in Ménière's disease]. / Klinicheskaya znachimost' luchevykh metodov diagnostiki endolimfaticheskogo gidropsa pri bolezni Men'era.

Ménière's disease is a chronic disorder of the inner ear, a permanent sing of which is endolymphatic hydrops. For the diagnosis of Ménière's disease in clinical practice, criteria that are primarily based on the clinical picture. However, instrumental methods for diagnosing Ménière's disease, aimed at identifying endolymphatic hydrops, continue to be developed and improved. Radiation diagnostics contribute significant contribution and aimed at identifying the characteristic signs of Ménière's disease. Recently, it has become possible to visualize endolymphatic hydrops using MRI of the temporal bones. This publication presents an analysis of the current state of this topical aspect of the problem of diagnosing Ménière's disease. The purpose of this review is to conduct a comparative analysis of radiation methods for diagnosing Ménière's disease. MATERIAL AND METHODS: The study included publications in English and Russian found in the PubMed, eLibrary database related to the diagnosis of Meniere's disease. RESULTS: A comparative analysis of computed tomography of the temporal bones, magnetic resonance imaging of the temporal bones and diagnostic possibilities for detecting signs characteristic of Ménière's disease are presented. The most diagnostically significant method of studying Ménière's disease is identified. CONCLUSION: MRI of the temporal bones with contrast enhancement is a promising method that can be used to develop an effective treatment algorithm.

[Combination of CT and MRT in the diagnostic of middle ear cholesteatoma. Fusion technology is precise localization tool]. / Sovmeshchenie rentgenovskoi komp'yuternoi i magnitno-rezonansnoi tomografii v diagnostike kholesteatomy srednego ukha. Tekhnologiya Fusion ­ instrument tochnoi lokalizatsii.

Computed tomography (CT) and magnetic resonance imaging (MRI) methods of the middle ear cholesteatoma diagnostic have its advantages and disadvantages. Fusion technology is a post-processing process of CT and MRI images. Its main advantage is the localization of MR-hyperintensive cholesteatoma within the bony anatomical structures obtained on CT, which provides the surgeon with important information both before planning the primary surgical intervention and during a second revision for recurrent cholesteatoma.

Fluorescent angiography in colorectal surgery, the influence of augmented reality in the operating room on the anastomotic leakage after low rectal resection.

INTRODUCTION: Near-infrared (NIR) fluorescence angiography (FA) is an augmented reality (AR) technique. When used in the operating room, it allows colorectal surgeons to visualize and evaluate intestinal blood flow in real time, identify lymph nodes, ureters, or peritoneal metastases. Evaluation of perfusion with FA in augmented reality mode has an impact on reducing the ALR (anastomotic leakage rate) in rectal resections. METHODS: Data analysis of patients after minimally invasive surgery (MIS) for middle and lower rectal adenocarcinoma with total mesorectal excision (TME) using fluorescent angiography (FA) with indocyanine green (ICG) (100 patients, 20152019) were subsequently compared with a historical control group (100 patients) operated on for the same diagnosis before the introduction of the FA-ICG method (20122015) using minimally invasive approach (MIS). The patients were operated on consequently at one workplace. RESULTS: In fifteen patients (15%), the resection line was shifted due to insufficient perfusion detected by FA-ICG. The incidence of AL was lower in the group with FA compared to the group without FA (9% vs. 19%, p=0.042, χ test). A retrospective analysis of the group revealed a significant risk factor (RF) for the anastomotic leak, namely diabetes (p=0.036) and, among others, a protective factor, application of the transanal drain (NoCoil) (p=0.032). CONCLUSION: The introduction of new procedures and the use of new technologies, such as the use of the FA method in the AR mode in resections of the rectum with TME for cancer can lead to a reduction in the incidence of anastomotic leakage.

PSYCHOLOGICAL STATE AND TYPOLOGICAL PERSONALITY FEATURES OF CHILDREN RESIDENTS OF RADIOACTIVELY CONTAMINATED TERRITORIES IN THE REMOTE PERIOD OF CHORNOBYL СATASTROPHE. / PSYKhOLOGIChNYI STAN TA TYPOLOGIChNI RYSY OSOBYSTOSTI DITEI ­ MEShKANTsIV RADIOAKTYVNO ZABRUDNENYKh TERYTORII U VIDDALENYI PERIOD ChORNOBYL'S'KOÏ KATASTROFY.

OBJECTIVE: To evaluate the psycho-emotional state of children-residents of radioactively contaminated territoriesand to characterize the typological features of their personality in the remote period of the Chornobyl catastrophe. MATERIALS AND METHODS: Psycho-emotional status and typological personality traits were determined in 96 childrenaged 12 to 17 years, who resided in radioactively contaminated territories with a soil contamination density of 137Csabove 185 kBq/m-2, and were admitted for examination and treatment in the pediatric departments of the NRCRMclinic. Psycho-emotional state of children was determined using the test «non-existent animal¼, which was assessedin points on symptom complexes: anxiety, aggression and neuro-mental exhaustion. The questionnaire of A. Bassand A. Darkey was used to discriminate various aspects of the aggression symptom complex. In all children, the content of incorporated 137Cs was determined using a whole body counter. RESULTS: The results of the evaluation of the psycho-emotional state of children - residents of radioactively contaminated territories in the remote period of the Chornobyl catastrophe according to the test «non-existent animal¼showed, that the state of anxiety was registered in all 96 children (100 %); state of aggression - in 60 children(62.5 %); exhaustion - in 57 children (59.37 %). Depending on the prevalence of the one or another symptom complexes, or their combination, 5 groups of observations were formed and the personality traits of children characteristic for each group were determined. In the largest group I with the predominance of anxiety symptom complex(45,83 % of the total sample) were noted: stable tendency to perceive many life-threatening situations and environment, pessimistic assessment of one's own life perspective, constant high level of anxiety. Girls were in majorityin this group. For group II, which showed a combination of high rates of two symptom complexes - anxiety andaggression (18.75 % of the total sample), the characteristic personality traits were a constant high level of emotional tension, a tendency to perceive the environment with distrust and a sense of guilt that arouses. In group IIIof children (14.58 % of the total sample), the symptom complex of aggression with feelings of alienation, isolationand hostile attitude towards the environment prevailed. Group IV of children (16.67 % of the total sample), with thecombination of signs of exhaustion and anxiety, had poor ability to concentrate, memory and attention deficit disorders, decreased learning ability, constant fatigue and irritability, apathy, inactivity, and inertia. Group V (only 4.17 %of the total sample) was characterized by low (less than 2 points) indices of all three symptom complexes. Girls weremuch more prone to anxiety, boys were more aggressive, sometimes accompanied by anxiety. Symptom complex ofexhaustion was determined with the same frequency in both boys and girls. CONCLUSION: Assessment of psycho-emotional sphere of children - residents of radioactively contaminated territories in the remote period of the Chornobyl catastrophe according to the «non-existent animal¼ test revealed in of100 % of children the presence of anxiety signs, in the vast majority - the state of aggression and exhaustion. Therewere no probable associations between the content of incorporated 137Cs (in the range from 111 to 7024 Bq) and thepeculiarities of the psycho-emotional state of children.

[A case of diagnostics and surgical treatment of a patient with a neuroma of the facial nerve]. / Sluchai diagnostiki i khirurgicheskogo lecheniya patsienta s nevrinomoi litsevogo nerva.

The article provides a brief overview of the epidemiology of facial nerve neuromas (FNN, schwannomas), its clinical signs, methods of diagnostic and treatment and indications for their use. A rare clinical case of diagnostics, surgical treatment of FNN with intracranial spread and its results are described in detail. The presented case demonstrates a possible low-symptom course of FNN with intracranial spread. The use of a combined surgical approach (translabyrinthine and extradural subtemporal) in conjunction with neurosurgeons makes it possible to remove FNN with intracranial spread with simultaneous intratemporal neuroplasty of the nerve trunk from the tympanic part of the canal to the bottom of the internal auditory canal with a fragment of the sural nerve with an improvement in the function of the affected nerve.