5 th International Symposium “SMART LION”. Medical Imagining and Global Health,

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The symposium brought together scientists from Ukraine, Austria, Great Britain and the United States (fi g. 1).After a two-year break due to the COVID-19 pandemic, the meeting was held live in compliance with all anti-epidemic requirements.Some speakers attended it using Google Meet.Poster presentations were also delivered at the scientifi c forum.
In addition, the conference was streamed on YouTube and simultaneously interpreted, which helped expand the circle of its listeners in the medical community.The speaker also focused on the cellular and molecular mechanisms of COVID-19 pathogenesis.He noted that although epithelial cells are aff ected the fi rst, pathological changes in the endothelium constitute a major factor in the pathogenesis of COVID-19, as they induce multiple systemic damages in the human body.The scientist emphasized that signs and symptoms of acute COVID-19 are diff erent from those manifested in the case of long-term disease course.Professor Szabo substantiated the importance of treating COVID-19 as a new multifactor stressor for a human.He recalled the "triad of stress" described by Hans Selye, which was observed in experimental animals -the appearance of erosions and ulcers of the gastric mucosa, hypertrophy of adrenal glands, atrophy of the lymph nodes and thymus.He also focused on three stages of stress response: alarm, resistance and exhaustion.Professor Szabo noted the importance of cortisol content during each of these stages, which initially increases, and then drops at the stage of exhaustion.The scientist pointed out the diagnostic and therapeutic role of cortisol in patients with COVID-19, as COVID-19-associated stress syndrome has the greatest eff ect on the adrenal cortex, causing a marked increase in cortisol levels at the beginning of the disease and a critical decrease in patients in intensive care units.From the viewpoint of modern medical science, the correctness and signifi cance of Hans Selye's discoveries are notable, more than 80 years ago, he managed to describe features of stress responses that develop not only in experimental animals but also in humans.
The scientist dedicated special attention to the matter of hybrid immunity, which can occur in people who had COVID-19 and then got vaccinated, and the feasibility of using vaccines with diff erent mechanisms of eff ect (fi g. 3).
Summing up, Sandor Szabo noted that this infection may fade, but will never go away that's why scientifi c cooperation is important in studying physiological predictors of longterm eff ects of COVID-19 [1][2][3].
Khrystyna Lishchuk-Yakymovych, MD, PhD, Associate Professor of the Department of Immunology and Allergology of Danylo Halytsky Lviv National Medical University, briefly reminded the audience about the structure of SARS-CoV-2.She noted that spike protein, or S protein, is a major "player" in the process of infecting human cells with the virus.In 2021, the term Long COVID-19 appeared.If it develops, 50-90% of hospitalized people note one long-term symptom 2 months after the acute course of the disease.Changes in laboratory parameters that may be alerting in terms of further development of Long COVID-19 include lymphopenia, persistent thrombocytopenia, persistent elevation of D-dimer, low-density lipoprotein, troponin, cytokines, C-reactive protein content, that then takes a long time to get back to the normal values (fi g. 4).The generalized pathological process associated with COVID-19 is primarily related to an aggressive immune response to the virus.Recent data from The Lancet Rheumatology suggest the association of COVID-19 with systemic vasculitis.Khrystyna Lishchuk-Yakymovych specifi cally focused on the management of patients with Long COVID-19, in particular on the need to closely monitor such patients and any possible complications and immune rehabilitation.The speaker emphasized that low-molecular-weight heparins are preferred during the acute period of COVID-19, as in addition to the anticoagulant eff ect, they also have an anti-infl ammatory eff ect, which is important in case of damaged vascular endothelium.Summing up, Nelya Oryshchyn pointed out that the intermediate and long-term eff ects of COVID-19 are still unknown, especially for patients with PE in the past.Therefore, at discharge, the doctor should discuss with the patient the choice of anticoagulant, the time during which it should be taken and its potential side eff ects [5].
Speeches delivered by scientists from the Institute of Cancer Research at the Medical University of Vienna (Austria) sparked considerable interest in the audience.Professor Klaus Holzmann spoke about the importance of telomere length not only during aging, but also in the case of cancer (fi g. 6).He started his speech by recalling the structure of telomeres and their main role, which is to protect DNA.Telomere shortening is known to occur with each cell division, which ultimately leads to the cell losing its ability to divide, its aging and death.The "immortality" of tumor cells is based on the reactivation of telomere mainte-  In his conclusions, Klaus Holzmann expressed hope that blocking telomere maintenance mechanisms during cancer will be used as a therapeutic approach in the future [6].
Professor Siegfried Knasmüller, who is also Editor-in-Chief of Mutation Research (IF = 2.873) and Co-Editor of Food and Chemical Toxicology (IF = 6.023), started his speech noting the relevance of biomonitoring for the diagnosis of both health and disorders, including cancer (fi g. 7).He emphasized that although in recent years, signifi cant progress has been observed in the development of diagnostic and treatment methods, it should be borne in mind that prevention is always better and more cost-effective than treatment.In addition to valuable studies of the impact of various factors on the human body, other approaches have been developed, including those based on biomonitoring.With these research methods, we can see DNA damage, which is perhaps the most important factor in the development of cancer.
Professor Knasmüller presented two methods that allow studying the impact of lifestyle, nutrition, and working conditions on human DNA.
The fi rst method is the Comet Assay, which is based on determining the migration of DNA in the electrical fi eld, while the second is based on the analysis of micronuclei and is aimed at determining chromosomal damage.The professor elaborated on the methodology of this research and shared the results of his many years of work.In particular, when studying the eff ects of nutrition, a decrease in the Comet Assay was identifi ed in obese people 6 months after bariatric surgery, also protective eff ects of coff ee and xanthohumol were identifi ed.High levels of mouth cancer are observed in the countries with a tradition of chewing betel pepper, khat, and coca leaves, which led to a study that showed a close link between the frequency of the appearance of micronuclei, the level of damage and the tradition of chewing toxic substances.The scientist also noted the prospects of these methods for assessing the impact of working conditions on the human body.Recent studies have shown that the incidence of micronuclei increases with malignant cell transformation.The higher the risk of cancer, the higher is the incidence of micronuclei.Determining this indicator can probably serve as an additional diagnostic method to identify people at increased risk of developing cancer.
Summing up, S. Knasmüller noted that these relatively simple and inexpensive research methods can be used in clinical practice to diagnose and predict the development of certain forms of cancer, including cervical or bladder cancer [7,8].
Though diffi cult to understand, the topic of deep learning is fascinating and relevant.Its basics were presented in a speech delivered by Ivan Wolansky (Center for Quantitative and In-  tegrative Biomedical Analysis at Sloan-Kettering Memorial Hospital, USA).He noted that a Convolutional Neural Network is the best type of model for the analysis of visual images.This mathematical model enables the collection of essential information from hundreds or thousands of pixels at once, rather than from each of them separately.This reduces the number of parameters, hence increasing statistical efficiency and reducing computational time while helping to obtain unique real-time imaging through the implementation of artifi cial intelligence elements [9,10].
Professor Vassyl Lonchyna stressed the need to understand the basic principles of artificial intelligence in the study of pathologies using imaging methods in the fi elds of ophthalmology, neurology, oncology, cardiology and others.
Proceeding to speeches concerning signifi cant achievements in the fi eld of diagnostic radiology, the speech by Doctor of Physical and Mathematical Sciences Roman Plyatsko (Y. S. Pidstryhach Institute for Applied Problems of Mechanics and Mathematics of the National Academy of Sciences of Ukraine) should not be overlooked [11].He presented the history of X-ray invention extensively and interestingly and focused the audience's attention on the role of Professor Ivan Puluj in this important discovery (fi g. 8).
Professor Leo Wolansky thanked the symposium organizers, as well as the association "Friends of Radiology in Ukraine."The Professor's speech started with the history of the creation and development of this association.In 1992, a group of radiologists of Ukrainian descent set up "Friends of Radiology in Ukraine", and Paul Capp, an American of Ukrainian descent, has become its founder, who was then Executive Director at the American Board of Radiology.In 1996, the tradition of holding conferences to train Ukrainian radiologists was established.Leo Wolansky highlighted that the key in this work is to have good partners, and no one could be better than Professor Yuriy Ivaniv.
Since its founding, almost 4,000 Ukrainian physicians have had the unique opportunity to learn from their American colleagues.During this time of forced distance learning, this opportunity is also available, as over 60 lectures delivered by speakers at conferences are publicly available on the "Friends of Radiology in Ukraine" Facebook page and on the website friendsofradiologyinukraine.org,created by Ivan Wolansky.
Afterwards, Professor shared his rich practical experience in the fi eld of diagnostic radiology of ophthalmological diseases and orbital disorders (fi g. 9).He demonstrated over 50 CTs and MRIs of pathologies of the lacrimal gland, eyeball, extraocular muscles, optic nerve, etc., which is an invaluable contribution to the development of knowledge and skills of young radiologists [12].
In his speech, Professor Yuriy Ivaniv elaborated on the topic of peculiarities of diagnosing and treating of peripartum cardiomyopathy.According to the German registry, 15% of patients with this diagnosis require a heart transplant.Potential causative factors include intense ox-  Standard treatment includes the need to inhibit prolactin, which is achieved using bromocriptine, administration of beta-blockers and ACE inhibitors, as well as other drugs needed to treat congestive cardiac failure (fi g. 10).
The scientist detailed the results of his diagnostic experience and treatment of this pathology for the last 9 years of practice (2012-2021).He highlighted the mechanisms of cardiorenal effi cacy of inhibitors of sodium-glucose cotransporters 2 (SGLT2), in particular, empaglifl ozin, which causes positive dynamics in patients with peripartum cardiomyopathy.To prevent the relapse of cardiac decompensation, treatment should last more than 6 months after complete recovery.In the absence of consecutive pregnancy after complete recovery, the risk of cardiac decompensation relapse is minimum.
Summing up, Professor Yuriy Ivaniv emphasized that peripartum cardiomyopathy is a rare disease, and it is diagnosed even less often, so it should be borne in mind that the basis of timely diagnosis is a high level of suspicion [13].
Professor Andriy Netliukh's report was generously illustrated and based on rich clinical experience (fi g. 11).The Professor focused on methods of diagnosis and treatment of subarachnoid hemorrhage due to the rupture of the intracranial arterial aneurysm, and its rupture peak occurs in the fourth or fi fth decade of life.He pointed out that a signifi cant part of aneurysms is acquired, although it is common to consider an aneurysm a congenital pathology.It is comforting that modern diagnostics allows identifying such patients in the prehemorrhagic period.
If subarachnoid hemorrhage occurs anyway, transcranial dopplerography is used to monitor vascular spasms.The prognosis of such conditions is based on the Fisher scale.The method of choice for the treatment is endovascular embolization, founded by Guido Guglielmi.Professor Andriy Netliukh noted that vascular malformations constitute one of the most complex neurosurgical pathologies requiring a combination of endovascular, transcranial, and radiosurgical methods.It should be remembered that there are no two identical malformations and all the more relevant here are Charles Drake's words that in terms of arteriovenous malformations, several issues remain unresolved, namely their pathogenesis, pathomorphology, epidemiology, diagnosis, and treatment [14].
Dr Yuriy Mylyan presented a report on "The use of CT in assessment of intraperitoneal carcinomatosis at preoperative stage and during chemotherapy in cases of disseminated ovarian cancer."He highlighted that the cardinal problem in the treatment of ovarian cancer is the latent cell dissemination that occurs at the early stages of the disease, even in conditions  to valuable resources and current materials that are being continuously updated.The project envisages the creation of a scientifi c journal, which will serve as a platform for discussing the latest achievements in the fi eld of scientifi c editing.Ongoing webinars, masterclasses, annual congresses will allow exchanging views, knowledge, and experiences in the fi eld of scientifi c journalism, which is the key to continuous professional development.Summing up, Olena Zimba noted that the organization is open and sincerely invites everyone interested in reviewing, editing and writing scientifi c articles.
In his speech, Associate Professor Armen Gasparyan focused on the importance of active dissemination of their scientifi c publications by authors on social networks (ResearchGate, Twitter, Facebook, Instagram), which is not just a promotion tool, but also a platform for discussing and visualizing scientifi c prospects.He pointed out the need for cooperation with editors' associations (COPE, Council of Science Editors, ICM-JE, WAME, etc.), which provides the opportunity to develop and promote scientifi c journals.The scientist also specifi cally focused on the UCSE, the creation of which is an important step required to bring Ukrainian scientifi c journalism to the modern global level.He highlighted the main points of drafting review articles, original research and other types of articles for their successful publication in journals indexed by international scientometric databases (fi g. 14).
Summing up, he stressed that the author's awareness of modern requirements for writing scientifi c papers, compliance with ethical standards and the choice of the appropriate target journal are key to success in this fi eld [16].
The presentation of results of their research by opinion leaders in the fi elds of medicine, their discussions with doctors and young scientists contributed to fi nding consensus on key issues of the discussion, the emergence of new ideas and ways to achieve them.
After the speeches, the best poster presentation was selected (fi g.
Organizers of the SMART LION 2021 symposium: Valentyna Chopyak (Professor, Chair of the Department of Immunology and Allergology at Danylo Halytsky Lviv National Medical University, Chair of the Medical Commission of The Shevchenko Scientifi c Society), Oksana Zay-achkivska (Professor, Chair of the Department of Normal Physiology of Danylo Halytsky Lviv National Medical University), Vassyl Lonchyna (Professor, University of Chicago Pritzker School of Medicine, Ukrainian Catholic University).Team of moderators: Professor Tetyana Nehrych and Associate Professors Serhii Holota, Mykhailo Sorokivskyi, Nelya Oryshchyn, Olesya Hodovana.The symposium started with a welcoming speech delivered by its founders -Professors Oksana Zayachkivska and Vassyl Lonchyna (fi g. 2).Professor Sandor Szabo of the University of California took the fl oor fi rst.At the beginning of his speech, he focused on the role of the symposium venue, as the Central European region is the place where the biography of many scientists, whose names are now well-known around the world, started.Specifi cally, Hans Selye -the founder of the doctrine on stress, Katalin Kariko, whose discoveries underly the creation of mRNA vaccines and others.At the outset, Professor Sandor Szabo provided the latest statistics on the spread of

Figure 3 .
Figure 3. Professor Sandor Szabo describes the concept of hybrid immunity

Figure 7 .Figure 6 .
Figure 7. Professor Siegfried Knasmüller speaks on the use of biomonitoring approaches for the detection of human cancer

Figure 9 .Figure 8 .
Figure 9. Professor Leo Wolansky shares his experience in the fi eld of X-ray diagnostics of ophthalmological diseases and pathology of the orbit

Figure 11 .
Figure 11.Speech by Professor Andriy Netliukh on imaging methods in neurosurgery