The Co-Pilot Project: An International Neurosurgical Collaboration in Ukraine.

OBJECTIVE: We aim to provide a thorough description of the efforts and outcomes of the Co-Pilot Project in Ukraine, which facilitates neurosurgical collaboration between American and Ukrainian physicians. METHODS: The Co-Pilot Project, which operates under its parent nonprofit organization, Razom, organized multiple trips for American physicians to Ukraine. Activities included consulting in clinic, assisting with neurosurgical operations, and providing didactic lectures. Further efforts have included coordinating training opportunities for Ukrainian surgeons. We retrospectively reviewed all operations performed by Ukrainian partner physicians alongside American co-pilot physicians across Ukraine since August 2016. RESULTS: Teams of Ukrainian and American physicians operated on 78 patients (24 children and 54 adults) for a total of 84 procedures in 5 different cities (Kyiv, Lutsk, Lviv, Odessa, and Stryi) of Ukraine. Operations were classified into the following categories: adult brain tumors (n = 39), adult spine tumors (n = 1), epilepsy (n = 9), pain (n = 2), pediatric brain tumors (n = 11), vascular/endovascular (n = 10), and miscellaneous (n = 12). Four illustrative cases are described in detail. Of the patients with brain tumors, 43.5% (20/46) had giant tumors, and gross total resection or near-total resection was achieved in 78.3% (36/46). CONCLUSIONS: Profound disparities in neurosurgical care exist globally, which has led to the formation of collaborative relationships between physicians from various countries. We hope that the work of the Co-Pilot Project in Ukraine can serve as a template for effective international neurosurgical collaboration in other low-to-middle-income countries.

[Destructive changes in epicardial arteries and coronary microcirculation in women with non st elevation acute coronary syndrome, depending on hormonal status].

OBJECTIVE: Introduction: Acute forms of cardiovascular are a major problem in the structure of morbidity and mortality, especially among perimenopausal women. The most important is nature and features of the damage of the coronary arteries on the basis of the development of estrogen deficiency in perimenopausal women with non ST elevation acute coronary syndrome and the frequent absence of visual lesions of the coronary arteries, which require a detailed study. The aim: To conduct lesions of epicardial arteries and coronary microcirculation in women with non ST elevation acute coronary syndrome, depending on the level of female sex hormones. PATIENTS AND METHODS: Materials and methods: 101 women aged 35-76 years old (average age 59.1 ± 1.06) with with non ST elevation acute coronary syndrome were examined. The levels of female sex hormones were determined and coronary angiography was performed. Depending on the hormonal status, the patients were divided into two subgroups: IA subgroup (n = 60) - women with LH / FSH index <1, estradiol level <80 pmol / l (estrogen deficiency). IB subgroup (n = 41) - Patients with LH / FSH> 1 and estradiol> 80 pmol / L (relatively preserved estrogen background). All patients were treated with coronary angiography. The extent and localization of atherosclerotic lesions were determined and the depth of destruction of the coronary plaque using the ulceration index. Microcirculation was studied at the time of filling coronary sinus, depending on the level of sex hormones. The statistical analysis is conducted using modern packages of applications Microsoft Excel 2016 and Statistica 10. RESULTS: Results: In women with estrogen deficiency (IA), severe hemodynamically significant coronary artery disease (60.0% (IA) versus 43.9% (IB) is more likely to be registered. UI is significantly lower in women of the IA subgroup (0.721 ± 0.013 units (IA) versus 0.842 ± 0.017 units (IB), which indicates deeper destructive changes in the affected coronary arteries on the basis of estrogen deficiency. 56.1% of IB subgroup patients did not have hemodynamic lesions of the coronary arteries. 61.6% of IA and 75.6% (IB) subgroups showed signs of significant coronary microcirculation impairment in the form of slow-release of contrast and increased CSFT mean. Among subjects with intact CA, the slow-release of contrast (> 6 systoles) and the higher mean CSFT (5.63 ± 0.16 s) were significantly higher in the subgroup of women with a preserved hormonal background (86.9%), compared to patients with non ST elevation acute coronary syndrome with an estrogen deficiency (41.6%), among which the average CSFT was 4.26 ± 0.29 s. CONCLUSION: Conclusions: Estrogen deficiency in women with non ST elevation acute coronary syndrome leads to severe diffuse coronary injuries: the formation of multiple hemodynamically significant stenoses and thrombosis on the basis of the most pronounced ulceration of atherosclerotic plaques in the major coronary arteries, while in women with a relatively preserved hormonal status, the development of non ST elevation acute coronary syndrome is accompanied whith the appearance of gross violations myocardial perfusion and microcirculation, which becomes the basis for the development of acute coronary circulatory disorders.