Modern medical technology

Anti-shock therapy for combat trauma in the pre-hospital setting: modern approaches and pathophysiological rationales

2026-01-14T09:41:40+02:00

Trauma remains one of the leading causes of mortality and long-term disability worldwide, and in the context of ongoing full-scale hostilities in Ukraine has acquired exceptional medical, and social significance. Massive hemorrhage and the development of hemorrhagic shock are the main causes of death among the wounded during, underscoring the need for contemporary, pathophysiologically grounded approaches to anti-shock therapy.

The aim of this work is to summarize and provide a pathophysiological analysis of modern approaches to prehospital anti-shock therapy for combat trauma, in accordance with the Damage Control Resuscitation concept.

Materials and methods. The study was based on a systematic review and critical analysis of current scientific publications from PubMed, Scopus, Web of Science, and the Cochrane Library, as well as international tactical medicine guidelines, including the Tactical Combat Casualty Care recommendations.

Results. Modern concepts of the pathogenesis of hemorrhagic shock in combat trauma are summarized through the lens of the “lethal triad” and the expanded “diamond of death”. It is demonstrated that early hemorrhage control, restricted fluid therapy, hemostatic resuscitation with blood components, prevention of hypothermia, correction of hypocalcemia, and adequate analgesia are interrelated components of effective prehospital care. Particular emphasis is placed on the role of tranexamic acid as a pathogenetically justified agent for early correction of traumatic coagulopathy. The rationale for its administration at the prehospital stage is substantiated, taking into account the critical time-dependence of its clinical efficacy.

Conclusions. Integration of Damage Control Resuscitation principles into prehospital care protocols for combat trauma reduces physiological decompensation, lowers mortality, and improves outcomes at subsequent stages of treatment and medical evacuation. Further advancement of military medicine should focus on the standardization and practical implementation of comprehensive anti-shock algorithms adapted to the realities of combat operations.

Pathomorphological ultrastructural changes in the placenta in coronavirus disease 2019 (COVID-19) during pregnancy: a literature review

2026-01-28T16:48:12+02:00

Aim. Based on the analysis of literature data, to investigate the pathomorphological and ultrastructural changes in the placenta associated with COVID-19 during pregnancy, with the identification of critical periods for fetal development.

Materials and methods. A search for original research articles was conducted in the scientometric databases PubMed, Web of Science, Scopus, and Google Scholar published between 2017 and 2025. The following search terms were used: COVID-19, SARS-CoV-2, placenta, pregnancy, chorionic villi, and placental telocytes. A total of 44 publications were selected to summarize current knowledge on the issue.

Results. According to the literature, during the acute phase of COVID-19 in pregnant women, 100 % of cases showed placentitis, signs of endothelial dysfunction, damage to the microcirculatory bed, edema of the chorionic villi stroma, nuclear apoptosis, narrowing of the vascular lumen, and destructive changes in telocytes. As the post-COVID interval lengthened, manifestations of placentitis decreased and vascular lumens were restored (in cases of COVID-19 during the third trimester). In contrast, cases of infection in the second trimester were characterized by arteriolosclerosis, stromal fibrosis of the villi, and delayed chorionic maturation.

Conclusions. Vertical transmission of SARS-CoV-2 from infected pregnant women to their fetuses has been demonstrated, with no established correlation between the severity of maternal illness and the extent of placental or fetal impairment. The SARS-CoV-2 virus causes endothelial dysfunction, microcirculatory disturbances, edema, and placentitis, acting as a morphogenetic factor in chorionic remodeling. The degree of placental pathomorphological changes and the consequences for the fetus were determined by the gestational age at which maternal infection occurs. The loss of regulatory control by structurally damaged telocytes over angiogenesis, vascular tone regulation, and apoptosis constitutes one of the mechanisms underlying the development of placental insufficiency.

Scanning procedure optimization for computed tomography and cone-beam computed tomography in cranio-maxillofacial surgeries: a systematic review

2025-10-21T14:09:56+03:00

Computed tomography (CT) and cone-beam computed tomography (CBCT) are essential imaging tools for visualization in cranio-maxillofacial (CMF) surgery, providing high-resolution, 3D anatomical data for diagnosis, surgical planning, and follow-up. CT offers broader anatomical coverage and soft tissue contrast, while CBCT provides detailed bone imaging at lower radiation doses. However, both modalities are prone to artifacts – beam hardening, scatter, motion, and metal interference – that reduce image accuracy. Optimization of scanning parameters and protocols is essential to balance diagnostic quality with radiation safety. In parallel, deep learning approaches such as convolutional and generative adversarial networks are being explored for artifact suppression and segmentation enhancement.

Aim. The aim of the study is to review and compare CT and CBCT to identify the most optimal scanning parameters for cranio-maxillofacial imaging, ensuring high diagnostic accuracy while minimizing radiation exposure and artifact impact.

Materials and methods. A systematic search of scientific studies was conducted in the PubMed, Scopus, IEEE Xplore, and Web of Science using keywords: CBCT optimization, CT artifact correction, cranio-maxillofacial imaging, and deep learning in CT / CBCT. Inclusion criteria: studies assessing scanning parameters, image quality, artifact correction techniques in CMF contexts. Clinical, in vitro, and ex vivo studies were included. In total, 85 papers were analyzed.

Results. Optimal parameters – voxel sizes of 0.075–0.125 mm for CBCT and slice thicknesses of 0.50–1.25 mm for CT – improved diagnostic accuracy and segmentation outcomes. CBCT was preferred for bone structures, while CT remained superior for soft tissue and trauma. Traditional correction methods showed Dice gains of 6–15 %. AI-based models demonstrated higher performance, reducing artifacts by up to 70 % and achieving Dice scores up to 0.95. However, clinical adoption remains limited due to regulatory and standardization barriers.

Conclusions. Optimizing scan parameters significantly improves diagnostic performance in CMF imaging. While AI-based artifact correction shows strong potential, integration into clinical workflows requires further validation and regulatory alignment.

PRP therapy as a stage of preparation of isolated gunshot wounds of the soft tissues of the limbs for autodermoplasty

2025-10-28T10:32:08+02:00

One of the main problems in reconstructive surgery is the closure of large gunshot wounds. Autodermoplasty is considered the gold standard. Given the injury mechanism, the duration of wound surface preparation is quite long. The use of platelet-rich plasma (PRP) therapy can accelerate the growth of granulations in wounds and shorten the duration of preparing patients for autodermoplasty.

The aim of the work is to determine the effectiveness of PRP therapy as a stage of preparation of isolated gunshot soft tissues wounds of the limbs for autodermoplasty.

Materials and methods. The study included 80 (100.0 %) patients with isolated soft tissue gunshot wounds of the limbs who were delivered to the R3 phase of evacuation. All patients were divided into two groups. The main group included 40 (50.0 %) patients who received platelet-enriched autoplasma injections in the preoperative period as a stage of preparation for autodermoplasty. The comparison group included 40 (50.0 %) patients who were treated according to the standard protocol and underwent autodermoplasty.

Results. Early granulations were found in the main group on day 10.4 (9.5; 13.4), in the comparison group on day 15.0 (12.5; 22.7), U = 397.0, p = 0.0012. The predominant area of the wound defect was covered by granulation in the main group on average on day 15.6 (12.9; 17.7) after hospitalization, in the comparison group on day 22.0 (14.0; 27.5), U = 324.0, p = 0.0011. Postoperative complications were found in the main group in 3 (7.5 %) patients, in the comparison group in 10 (25.0 %) patients, U = 660.0, p = 0.0357. Repeated surgical interventions were performed in 1 (2.5 %) patient in the main group and in 6 (15.0 %) patients in the control group.

Conclusions. The use of PRP therapy as a stage of wound preparation for autodermoplasty shortens the preoperative period. In the main group, autodermoplasty was performed on day 16.7 (13.4; 19.6), in the comparison group on day 25.8 (16.7; 29.6), U = 374.0, p = 0.0006. The period of patients’ hospital stay was also reduced. In the main group, the length of stay was 27.5 (24.5; 29.7) days, in the comparison group it was 35.4 (32.0; 38.2) days, U = 356.0, p = 0.0001.

The choice of elastic compression knitwear for decompensated chronic venous insufficiency

2025-10-28T11:03:05+02:00

Aim. To improve the results of treatment of patients with decompensated forms of chronic venous insufficiency, it is necessary to study changes in the volume velocity in the femoral artery and vein, changes in microcirculation in the lower third of the leg, and the severity of pain syndrome depending on the degree of external compression.

Materials and methods. The study included 36 patients with decompensated forms of chronic venous insufficiency, divided into two groups. The first group consisted of 15 patients with varicose disease (VD; 9 women, 6 men; mean age 56.0 ± 5.7 years). The second group included 21 patients with post-thrombotic syndrome (PTS; 12 women, 9 men; mean age 58.5 ± 6.4 years). All patients underwent ultrasound examination of the femoral vessels to determine arterial (AFV) and venous (VFV) blood flow velocity. Microcirculation was assessed by transcutaneous monitoring of oxygen (tcpO₂) and carbon dioxide (tcpCO₂) tension on the dorsum of the foot, with calculation of the regional perfusion index (RPI) according to the angiosome theory. Pain intensity was assessed using the CIVIQ-20 scale. The study was performed sequentially using compression stockings of classes I–IV.

Results. In patients of both groups, the use of class III and IV compression was accompanied by a statistically significant decrease in AFV and VFV, a critical drop in tcpO₂ (to 61.2 ± 1.3 mmHg in VD and 54.4 ± 1.2 mmHg in PTS), an increase in tcpCO₂ (to 56.2 ± 0.9 mmHg and 60.2 ± 0.7 mmHg, respectively), and an increase in pain syndrome (up to 4 points on the CIVIQ-20 scale). In patients with PTS, even class I–II compression resulted in a more pronounced decrease in microcirculatory parameters and more intense pain compared to the VD group. The RPI in patients with PTS without compression was below normal: by 17.3 % in the anterior tibial angiosome and by 23.2 % in the posterior tibial angiosome.

Conclusions. The use of elastic compression classes III and IV in patients with decompensated chronic venous insufficiency is accompanied by a statistically significant inhibition of arterial blood flow, a critical decrease in transcutaneous oxygen tension (tcpO₂), an increase in carbon dioxide tension (tcpCO₂), and causes intense pain, making its use potentially harmful to tissue perfusion.

Combined treatment of neurovegetative disorders in patients with ischemic heart disease with Long COVID-19 syndrome

2025-10-28T20:43:07+02:00

The aim of the study. To assess the dynamics of neurovegetative disorders in patients with coronary artery disease (CAD) with Long COVID-19 syndrome under the influence of combined treatment with the inclusion of exogenous L-arginine and phenibut in basic therapy.

Materials and methods. A prospective study with parallel distribution and elements of randomization included 31 patients with CAD: stable angina of exertion of functional class II–III (age 69.0 (64.0; 76.0) years)), who had suffered from moderate or severe COVID-19 coronavirus disease with manifestations of Long COVID-19 syndrome. Patients were divided into two groups depending on the prescribed treatment: group I (n = 15) – basic therapy for CAD was used; in group II (n = 16) a combination of L-arginine and phenibut was additionally prescribed against the background of basic therapy. Heart rate variability (HRV) parameters were assessed using 24-hour Holter ECG monitoring, degree of cognitive impairment – MoCa scale, anxiety-depressive – HADS scale, as well as their dynamics under the influence of the treatment.

Results. The use of combination therapy with the inclusion of exogenous L-arginine and phenibut in patients of group II contributed to an increase in the average integral indicator of cognitive status by 9.47 %, as well as a significant decrease in the level of anxiety-depressive symptoms: in the “Anxiety” subscale by 35.97 %, in the “Depression” subscale – by 20.81 % (p < 0.05). In the group receiving combination therapy with exogenous L-arginine and phenibut, a significant positive dynamics of most indicators of total HRV was determined: an increase in SDNNi by 1.22 times and 1.42 times, rMSSD, % by 1.56 times and 1.66 times, HRVT by 1.46 times and 1.40 in the daytime and nighttime periods, respectively. Analysis of HRV spectral indicators showed restoration of sympatho-parasympathetic balance and a significant decrease in the stress index by 1.89 and 2.03 times in the active and passive periods.

Conclusions. Adding exogenous L-arginine and phenibut to the basic therapy in patients with CAD who have had COVID-19 contributes to a significant reduction in anxiety and depressive symptoms, improvement of cognitive function, and stabilization of autonomic regulation of cardiac activity, which indicates a positive neuromodulatory effect of the combination therapy.

Identification of microRNA signatures in thyroid cancer

2026-02-27T09:28:26+02:00

Aim: to identify differentially expressed microRNAs (miRNAs) in papillary and follicular thyroid cancer (TC) and to evaluate their potential as diagnostic and prognostic biomarkers.

Materials and methods. Three GEO datasets were analyzed: GSE104006 (20 samples of papillary TC and 6 normal tissues), GSE191117 (50 samples of papillary TC and 50 normal samples), and GSE62054 (17 samples of follicular carcinoma and 8 benign tumors). Differentially expressed miRNAs were identified with |log2FC| >1 and p < 0.05 with subsequent FDR correction DIANA miRPath v. 3 was used to assess signaling pathways, miRNet v. 2.0 to identify target genes, and ShinyGO v. 0.82 for functional annotation. Prognostic significance was evaluated using ENCORI database.

Results. Six miRNAs were selected: hsa-miR-15a-5p, hsa-miR-146b-5p, hsa-miR-199b-5p, hsa-miR-221-5p, hsa-miR-222-3p, and hsa-miR-484. They potentially regulate over 2,000 target genes, including RET, CCND1, TP53, HIF1A, IL6, and IL1B, which are associated with the development and progression of malignant tumors. GEO analysis revealed their involvement in the regulation of metabolism, biosynthesis, protein modification, as well as in the binding functions of transcription factors, DNA, and RNA. Nineteen KEGG signaling pathways were identified, 13 of which are closely associated with carcinogenesis. Prognostic analysis indicated that low expression of hsa-miR-146b-5p and hsa-miR-221-5p correlate with significantly poorer overall survival in TC patients.

Conclusions. The proposed panel of six miRNAs may have significant potential for the differential diagnosis of papillary and follicular thyroid cancer, risk stratification, and prognosis; hsa-miR-146b-5p and hsa-miR-221-5p demonstrated the greatest prognostic value. Further experimental studies are needed for the clinical validation of these biomarkers.

Problematic issues in the isolation of adipose-derived mesenchymal stromal cells: new methodological aspects (pilot research)

2026-01-28T17:01:52+02:00

Isolation of mesenchymal stromal cells (MSCs) from adipose tissue is a relevant topic in regenerative medicine and cell therapy. MSCs have significant potential for treating various diseases due to their ability to differentiate, self-renew, and secrete biologically active molecules. However, the isolation process faces challenges like variations in tissue collection methods, quality, sample transportation, laboratory sterility, and incubation stability. Insufficient coverage of these issues in scientific publications complicates their resolution, particularly under the conditions in Ukraine.

The aim is to identify and discuss the key problems associated with the isolation of adipose-derived mesenchymal stromal cells, as well as the experimental search for potential solutions to overcome these obstacles for the optimization of the isolation methodology.

Materials and methods. A literature review was conducted using PubMed and Google Scholar, selecting key publications on isolation methods, MSCs characteristics, and good manufacturing practice (GMP) principles. Inclusion criteria: full-text articles on adipose MSCs isolation, comparison of enzymatic methods of isolation, GMP standardization, and cell characteristics. Following this, a pilot study was conducted using lipoaspirate and fragments of subcutaneous adipose tissue (SAT) with the patients’ consent. Processing in Zaporizhzhia State Medical and Pharmaceutical University’s GMP-compliant lab: mechanical grinding (for SAT), DPBS washing with antibiotics, enzymatic digestion (collagenase or trypsin) at 37 °C, 600 g centrifugation, filtration, DMEM / FBS cultivation. Viability was assessed in Goryaev chamber with trypan blue; passaging at 60–70 % confluency.

Results. Abdominal lipoaspirate yielded larger MSCs volumes with higher proliferation than thigh or excised SAT. Collagenase is considered the “gold standard” in terms of efficiency, but trypsin has been shown to be a cost-effective alternative with similar viability, adhesion, and differentiation (chondro-, osteo-, adipogenic). Cultivation with medium changes supported growth; passaging prevented senescence.

Conclusions. Optimization of the methodology for isolating mesenchymal stromal cells of adipogenic origin under GMP-compliant conditions can be achieved by using lipoaspirate from the abdominal area, using trypsinization as an effective and cost-effective alternative to collagenase for enzymatic isolation, and strictly adhering to cultivation, passage, and quality control protocols.

Effect of combined quercetin and resveratrol administration on oxidative-nitrosative stress markers in the liver of rats under conditions of surgical trauma following prolonged stress

2026-02-27T09:53:09+02:00

Aim. This study aimed to investigate the effects of combined quercetin and resveratrol administration on markers of oxidative and nitrosative stress in the liver of rats subjected to surgical trauma following prolonged stress exposure.

Materials and methods. The study was conducted on 35 adult male Wistar rats, which were randomly assigned to five experimental groups: intact animals (control, Group 1); rats subjected to single prolonged stress (SPS) followed by laparotomy (Group 2); animals exposed to SPS and laparotomy and treated with a water-soluble form of quercetin (20 mg/kg body weight, Group 3), resveratrol (5 mg/kg body weight, Group 4), and a combination of quercetin and resveratrol (Group 5). Hepatic oxidative-nitrosative stress was assessed by measuring superoxide anion radical (O₂•^–) production, total nitric oxide synthase (NOS) activity, the activities of constitutive and inducible NOS isoforms (cNOS and iNOS), and the concentration of peroxynitrites of alkali and alkaline-earth metals.

Results. Combined exposure to SPS and surgical trauma induced a marked oxidative-nitrosative imbalance in the liver, manifested by excessive superoxide and peroxynitrite production, mitochondrial redox dysfunction, iNOS overactivation, and profound cNOS uncoupling. Monotherapy with either water-soluble quercetin or resveratrol partially alleviated these stress-induced alterations by reducing O₂•^– generation, suppressing iNOS activity, and improving cNOS coupling, confirming their hepatoprotective effects under conditions of combined psycho-emotional and surgical stress. In contrast, combined quercetin-resveratrol administration provided substantially greater protection, resulting in near-complete normalization of mitochondrial O₂•^– production, full restoration of cNOS activity and coupling, and a marked reduction in hepatic peroxynitrite accumulation.

Conclusions. These findings indicate a synergistic interaction between the two polyphenols, quercetin and resveratrol in restoring hepatic redox and nitric oxide homeostasis.

Two cases of open and video-assisted thoracoscopic approaches to superior vena cava in combat trauma in Ukraine

2026-04-16T14:41:08+03:00

Aim: to analyze the clinical features and surgical outcomes of combat-related superior vena cava injuries and to determine the optimal operative strategy considering the mechanism of injury, severity of the patient’s condition, and associated thoracic damage.

Materials and methods. The article presents two clinical cases of combat trauma involving injury to the superior vena cava treated in Zaporizhzhia Military Hospital, Ukraine. Both patients sustained penetrating thoracic injuries caused by explosive fragments during hostilities. Clinical data, imaging findings, intraoperative observations, surgical techniques, and postoperative outcomes were analyzed. Two different surgical approaches were used depending on the patient’s clinical condition, injury characteristics, and anatomical localization of the vascular damage: open surgical repair and video-assisted thoracoscopic surgery. Particular attention was paid to the mechanism of injury, associated thoracic damage, hemodynamic stability, and the feasibility of minimally invasive intervention in combat trauma settings.

Results. In the first case, the patient underwent open surgical repair of the superior vena cava due to the severity of injury and associated thoracic damage. In the second case, a video-assisted thoracoscopic approach was successfully used for removal of the foreign body and repair of the vascular wall. Both patients survived and demonstrated favorable postoperative outcomes without major complications. These cases illustrate that modern combat injuries caused by low-velocity fragments may allow delayed surgical management due to temporary sealing of the vascular defect by the fragment itself. This phenomenon may facilitate planned surgical intervention after evacuation to a specialized medical facility.

Conclusions. Injuries of the superior vena cava in combat trauma are rare but potentially life-threatening conditions that require prompt diagnosis and individualized surgical management. Both open surgery and video-assisted thoracoscopic techniques can be effective treatment options. The choice of surgical approach should depend on the patient’s physiological status, the mechanism of injury, the extent of associated thoracic damage, and the overall survivability potential.