Modern medical technology

Kidney-preserving surgery for AAST grade IV penetrating renal trauma with ureteropelvic disruption: a military case report at Role 3

Thu, 26 Mar 2026 00:00:00 +0200

High-grade renal trauma (AAST IV and V) represents a significant challenge for surgeon in both civilian and military settings. Renal pelvic disruption with complete ureteral transection is uncommon and technically challenging for kidney repair, although an organ-preserving approach is possible in such cases to preserve renal function.

Aim. The aim of this report is to present a case of successful kidney-preserving surgical treatment of severe penetrating renal trauma (AAST IV) with ureteropelvic junction disruption in a combat environment. We highlight the feasibility of reconstructive surgery at Role 3 facilities and emphasize its value in organ preservation and long-term rehabilitation of military personnel.

Materials and methods. We report the case of a military service member who was admitted with stable hemodynamic parameters but developed, within three hours, a decline in hemoglobin concentration from 13.0 g/dL to 8.9 g/dL accompanied by hemodynamic instability. An exploratory laparotomy was performed to achieve hemostasis, surgical revision, and an organ-preserving intervention.

Results. The patient underwent resection of the lower pole of the right kidney with ligation of the inferior segmental vessels. Ureteral continuity was restored by end-to-end anastomosis with stenting. Postoperatively, the patient was stabilized, and renal function was preserved.

Conclusions. This case illustrates the feasibility of an organ-preserving strategy in severe renal trauma (AAST IV) with ureteropelvic junction injury under combat conditions. Reconstructive procedures performed at Role 3 facilities enable kidney preservation and maintenance of urinary tract function, which is of particular importance for the long-term rehabilitation of military personnel.

Comparative efficacy of combinations of endoscopic classifications and recurrence models for large colorectal laterally spreading tumors

V. S. Tkachov, O. M. Kiosov, A. V. Klymenko — Thu, 26 Mar 2026 00:00:00 +0200

Colorectal laterally spreading tumors (LST) are a distinct form of non-polypoid colorectal neoplasia that extend laterally along the mucosal surface and often exceed 20 mm in diameter. Despite advances in optical imaging technologies, diagnostic accuracy for large LSTs varies widely among classification systems, emphasizing the need to assess combined endoscopic approaches and recurrence prediction models to improve risk stratification and treatment planning.

Aim. To compare the diagnostic accuracy of combinations of combined endoscopic classifications and recurrence prediction models to identify the most effective approach for granular and non-granular subtypes of laterally spreading tumors.

Materials and methods. A single-center mixed retrospective-prospective study was conducted at the Medical Educational and Scientific Center “University Clinic” (Zaporizhzhia), including 110 patients with LSTs ≥20 mm (2015–2024). Granular (LST-G) and non-granular (LST-NG) lesions were assessed using JNET, Kudo, Modified Sano, and Hiroshima classifications. Six combinations of endoscopic classification systems were tested in parallel to determine diagnostic metrics. The histological evaluation of the resected neoplasia served as the reference standard. Resection techniques included endoscopic mucosal resection (EMR), piecemeal EMR, endoscopic submucosal dissection (ESD), and hybrid ESD. Recurrence was assessed at 6 months, with its prediction evaluated using the SMSA, SERT, and Baylor College of Medicine (BCM) models.

Results. The JNET + Hiroshima combination showed the highest diagnostic performance (LST-G: 81.82 % (95 % CI, 67.29–91.81 %) sensitivity, 90.91 % (95 % CI, 70.84–98.88 %) specificity, 84.29 % (95 % CI, 72.76–92.30 %) diagnostic accuracy; LST-NG: 86.67 % (95 % CI, 59.54–98.34) sensitivity, 100 % (95 % CI, 86.28–100.00) specificity, 95.00 % (95 % CI, 83.08–99.39 % diagnostic accuracy). JNET + Kudo served as a strong alternative. Progressive histological changes and recurrence were significantly more common among LST-G (68.6 %) than LST-NG (37.5 %). Recurrences were observed only in the LST-G group (8/70). BCM score ≥1 demonstrated the highest predictive ability for recurrence (AUC: 0.78), outperforming SMSA and SERT models which demonstrated poor discrimination (AUC: 0.31–0.37).

Conclusions. The combination of JNET + Hiroshima or JNET + Kudo classifications optimizes histologic prediction in both granular and non-granular large LSTs. LST-Gs demonstrate a higher risk for advanced histology and recurrence. The BCM model is preferable for recurrence prediction in large granular LSTs.

Multiparametric cardiac magnetic resonance imaging for risk stratification of adverse clinical outcomes in dilated cardiomyopathy: the role of native T1, T2 mapping and extracellular volume

Raad Tammo, H. Ye. Morkovkina, A. V. Sydorova, Ye. Ye. Tsasiuk, N. M. Rudenko — Thu, 26 Mar 2026 00:00:00 +0200

Aim: to evaluate the association of quantitative cardiac magnetic resonance (CMR) parameters – native T1 mapping, extracellular volume fraction (ECV), and T2 mapping – with adverse clinical outcomes in adults and children with dilated cardiomyopathy (DCM).

Materials and methods. Seventy-six patients with DCM (48 adults and 28 children) underwent multiparametric CMR at 1.5 Tesla. Left ventricular volumes and function, late gadolinium enhancement (LGE), native T1 and T2 mapping, and ECV were assessed. The primary composite endpoint was death or heart transplantation. Correlation analysis, Kaplan–Meier survival analysis, and univariable Cox proportional hazards models were applied.

Results. In adults, native T1 and ECV values were significantly elevated compared with reference ranges. In simple intergroup comparison, quantitative parameters of myocardial tissue characteristics did not differ between patients with and without adverse events. However, in time-to-event analysis, higher ECV values and continuous native T1 mapping were associated with an increased risk of death or heart transplantation The main predictors of events remained a decrease in ejection fraction and an increase in left ventricular volume indices. In the pediatric cohort, native T1 and ECV were elevated relative to age-specific reference values, indicating early diffuse myocardial remodeling. Nevertheless, these parameters were not significantly associated with adverse clinical events. Left ventricular systolic dysfunction was the main determinant of prognosis in children. T2-mapping did not demonstrate a significant association with clinical events in either adults or children.

Conclusions. Quantitative CMR parameters (T1 mapping and ECV) reflect diffuse structural changes in the myocardium in dilated cardiomyopathy. In all patients, the risk of adverse clinical events (death or heart transplantation) was primarily associated with the severity of left ventricular remodeling and reduced ejection fraction, while quantitative parameters of myocardial tissue characteristics (T1-, T2-mapping, ECV) did not show significant differences in a simple intergroup comparison but may have additional value in long-term risk stratification.

Computerized posturography in evaluation of proprioceptive-oriented rehabilitation after anterior cruciate ligament reconstruction

M. L. Golovakha, Ye. O. Bilykh, S. O. Maslennikov — Thu, 26 Mar 2026 00:00:00 +0200

Knee joint injuries are among the most common injuries of the musculoskeletal system, with anterior cruciate ligament (ACL) ruptures representing the second most common knee pathology after meniscus tears. These injuries not only compromise knee stability but also predispose patients to chronic instability, secondary meniscal damage, and early development of osteoarthritis. The restoration of proprioception plays a critical role in regaining functional stability following ACL reconstruction.

Aim. The aim of this study is to assess biomechanical parameters of the knee joint function after ACL reconstruction using stabilometric assessment and to study the effectiveness of a rehabilitation program that includes balance and proprioception training.

Materials and methods. The study was conducted at Zaporizhzhia State Medical and Pharmaceutical University between September 2024 and April 2025. A total of 42 patients who underwent arthroscopic ACL autograft reconstruction were enrolled. All patients underwent MRI diagnostics and participated in structured rehabilitation. The main group received an enhanced program with targeted proprioceptive and balance exercises, while the control group followed the standard rehabilitation protocol. Computerized stabilometric assessment was used to quantify weight distribution and postural stability.

Results. Patients in the main group demonstrated significantly improved postural control. Weight distribution was more balanced (52.8 % dominant vs. 47.2 % injured limb, p < 0.05) compared with the control group (59.3 % vs. 40.7 %, p < 0.05). The mean stabilometric support coefficient reached 0.89 in the main group versus 0.71 in control group, indicating better restoration of stability and proprioception, p < 0.05.

Conclusions. Computerized posturography enabled objective assessment of postural control after ACL reconstruction. Six month after surgery, patients who underwent rehabilitation with additional balance and proprioceptive training demonstrated significantly more symmetrical weight distribution and better stabilometric stability parameters compared to those who received standard rehabilitation.

Morphological parameters of patellar position depending on the joint line obliquity in knee osteoarthritis

O. O. Kostrub, R. I. Blonskyi, L. O. Kylymniuk, V. O. Movchaniuk — Thu, 26 Mar 2026 00:00:00 +0200

Aim. To analyze the differences in the morphological parameters of patellar position depending on the joint line obliquity, as determined using the authors’ proprietary method, in patients with medial knee osteoarthritis.

Materials and methods. Radiographic indices of patellar position were analyzed in 45 patients with medial knee osteoarthritis (n = 62 knees). The mean age of the patients was 63.84 ± 8.21 years. The following radiographic indices were calculated: Insall–Salvati, Caton–Deschamps, Grelsamer–Meadows, and Blackburne–Peel. Lateral knee radiographs were obtained with the joint flexed at 30°. The modified joint line obliquity (mJLO) angle was assessed according to the authors’ original method. An mJLO value of <177° was classified as apex distal (AD), 177–183° as apex neutral (AN), and >183° as apex proximal (AP). Statistical analysis was performed using Statistica 13 and RStudio software. The level of statistical significance was set at p ≤ 0.05.

Results. AD was identified in 43 (69.35 %) cases, AN in 16 (25.81 %), and AP in 3 (4.84 %). The mean mJLO value was 172.40 ± 4.05° in the AD group, 179.25 ± 1.81° in the AN group, and 187.33 ± 2.52° in the AP group (p < 0.00001). Significant differences were found among the groups in the mean values of the Insall–Salvati (p = 0.04), Caton–Deschamps (p = 0.01), and Blackburne–Peel (p = 0.01) indices. Signs of patella alta were more frequently observed in the AP group, whereas normal or low patellar positions predominated in the AD and AN groups. A higher patellar position was demonstrated in patients with a more proximal joint line inclination, confirmed by significant correlations: Insall–Salvati ratio (τ = +0.24, p = 0.006), Caton–Deschamps index (τ = +0.18, p = 0.04), Grelsamer–Meadows index (τ = +0.23, p = 0.009), and Blackburne–Peel ratio (τ = +0.27, p = 0.002). Predictive indicators of AD included: Insall–Salvati ratio 0.8–1.2 (OR = 4.39, CI (1.44–15.02), p = 0.009), Grelsamer–Meadows index <2 (OR = 4.39, CI (1.44–15.02), p = 0.009), and Blackburne–Peel ratio <0.8 (OR = 4.01, CI (1.31–12.89), p = 0.02). Probable predictors of AP were: Caton–Deschamps index >1.2 (OR = 833.00, CI (32.60–273970.85), p = 0.000004) and Blackburne–Peel ratio >1.0 (OR = 86.33, CI (6.90–12346.04), p = 0.0003).

Conclusions. Morphological parameters of patellar position are sensitive indicators of biomechanical alterations in medial knee osteoarthritis that depend on mJLO values. This supports their inclusion in a comprehensive radiometric program for personalized surgical planning.

Effect of the amino acids L-arginine and N-acetyl-L-cysteine on the functional characteristics of cardiovascular system parameters in rats with experimental type 1 diabetes mellitus

Ye. V. Kadzharian, M. Yu. Kolesnyk, M. I. Isachenko, Yu. M. Kolesnyk — Thu, 26 Mar 2026 00:00:00 +0200

The aim was to investigate the effects of L-arginine and N-acetyl-L-cysteine on the structural and functional characteristics of cardiovascular system parameters in rats with experimental type 1 diabetes mellitus (DM1).

Methods and techniques. DM1 was induced in old male Wistar rats by a single 45 mg/kg streptozotocin. After 6 weeks, animals with DM1 were divided into 3 subgroups: without amino acid administration, rats with L-arginine and rats with N-acetyl-L-cysteine. To achieve the aim, blood pressure measurements and echocardiography were performed.

Results. In rats with DM1, a significant increase in systolic (by 24 %) and diastolic (by 17 %) blood pressure was observed at the 6^th week of the experiment. Left ventricular dilatation was also found, accompanied by an increase in end-diastolic (by 20 %) and end-systolic (by 61 %) volumes, as well as a decrease in ejection fraction (by 6 %). At week 8, in rats without correction, blood pressure continued to increase (systolic by 7 %, diastolic by 9 %), and systolic dysfunction also progressed. Administration of L-arginine for 2 weeks normalized blood pressure (decrease by 12–16 %) and reduced left ventricular dilatation. L-arginine also improved systolic function (increase in ejection fraction by 6 %). N-acetyl-L-cysteine also reduced pressure but had no significant effect on echocardiographic parameters.

Conclusions. Against the background of the development of experimental type 1 diabetes mellitus in rats, cardiomyopathy with dilatation of the left ventricle and a decrease in its systolic function is formed by the 6^th week. These changes occur in parallel with a significant increase in blood pressure and a decrease in heart rate. In rats with experimental diabetes mellitus, after 8 weeks, signs of left ventricular dilatation remained without statistically significant changes compared to the indicators of the 6^th week, however, progression of systolic dysfunction was observed against the background of a further increase in blood pressure. Administration of L-arginine to rats with diabetes mellitus for 2 weeks statistically significantly reduced blood pressure and decreased manifestations of left ventricular dilatation comparable to rats with diabetes mellitus of 8 weeks duration without correction. Administration of N-acetyl-L-cysteine reduced blood pressure in the corresponding subgroup, however, no statistically significant effect on echocardiographic parameters was found compared to the 8-week group without correction.

Chemical composition and antibacterial activity of essential oil of Juniperus virginiana L.

V. M. Odyntsova, N. L. Kolycheva, O. M. Denysenko, V. I. Mozul, V. V. Holovkin — Thu, 26 Mar 2026 00:00:00 +0200

A topical issue in modern pharmacy is the study of new types of medicinal plant raw materials and the development of pharmaceuticals based on them. Considerable interest is aroused by promising species of the genus Juniperus, which are cultivated in Ukraine and are widely used in folk medicine, homeopathy, and cosmetology, but remain insufficiently studied.

Aim: to investigate the component composition and determine the antimicrobial activity of the essential oil of Juniperus virginiana L. as an additional source for new antimicrobial herbal medicines.

Materials and methods. The object of the study was the essential oil of Juniperus virginiana cultivated at the educational and experimental plot of medicinal plants of Zaporizhzhia State Medical and Pharmaceutical University. The essential oil was obtained by hydrodistillation. The qualitative and quantitative composition of volatile compounds was determined using gas chromatography – mass spectrometry (GC-MS) on an Agilent 7890B chromatograph. The study of antimicrobial activity of Juniperus virginiana essential oil (experimental sample) and the reference preparation (essential oil of Juniperus communis) was carried out by the disc diffusion method in vitro using standard test strains of microorganisms from various groups: Staphylococcus aureus ATCC 29213/NCTC12973 (Gram-positive cocci), Bacillus subtilis ATCC 6633 (Gram-positive spore-forming rods), Escherichia coli ATCC 25922 (Gram-negative enterobacteria), Pseudomonas aeruginosa ATCC 27853 (non-fermenting Gram-negative microorganisms), and Candida albicans ATCC 885-653 (yeast-like fungi of the genus Candida).

Results. As a result of GC-MS, 57 compounds belonging to 6 different chemical classes were identified. The dominant components were Limonene (14.83 %), Naphthalene, 1,2,3,4,4a,5,6,8a-octahydro-7 (12.65 %), and Safrole (12.42 %). The results of the in vitro disc diffusion method demonstrated a pronounced antibacterial activity of Juniperus virginiana essential oil against the reference strains of Gram-positive microorganisms: Staphylococcus aureus ATCC 29213/NCTC12973 (Gram-positive cocci) and Bacillus subtilis ATCC 6633 (Gram-positive spore-forming rods). High antifungal activity was also established against the reference strain of Candida albicans ATCC 885-653. The tested sample exhibited moderate antibacterial activity against the Gram-negative test strains Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853.

Conclusions. The qualitative composition and quantitative content of volatile compounds in the essential oil of Juniperus virginiana were studied using GC-MS. A total of 57 components were identified in the essential oil, the major ones being Limonene (14.83 %), Naphthalene 1,2,3,4,4a,5,6,8a-octahydro-7 (12.65 %), and Safrole (12.42 %). Experimental testing of Juniperus virginiana essential oil for microbiological purity showed no microbial growth on the surface or within the nutrient media, allowing further investigation of its antimicrobial activity.

Metabolic and psychosomatic features in type 2 diabetes mellitus and their impact on quality of life in patients during wartime

S. L. Podsevakhina, O. S. Chabanna, O. I. Palamarchuk, M. Ya. Dotsenko — Thu, 26 Mar 2026 00:00:00 +0200

Aim: to analyze metabolic changes, psychosomatic features, and the impact of wartime stressors on the quality of life in patients with type 2 diabetes mellitus (T2DM).

Materials and methods. A systematic review of scientific literature published between 2020 and 2025 was conducted, including publications indexed in PubMed and Scopus databases. An analytical review of studies on metabolic disorders, psychosomatic changes, and quality of life indicators in T2DM patients during armed conflict was performed. The influence of chronic stress, post-traumatic stress disorder, and social constraints on disease progression and quality of life was evaluated.

Results. The course of T2DM during armed conflict significantly worsens under the influence of multiple interrelated factors. Limited access to medical care, shortage of medications, disrupted nutrition, decreased physical activity, and high levels of psycho-emotional stress substantially impair disease compensation. Patients exhibit significant increases in glycated hemoglobin levels and higher rates of diabetic complications. In addition to metabolic disturbances, patients demonstrate a high prevalence of psycho-emotional disorders: depression, anxiety, post-traumatic stress disorder, psychogenic hyperglycemia, cognitive impairments, and functional somatic disorders. Chronic stress activates the hypothalamic-pituitary-adrenal axis, promoting the secretion of counter-regulatory hormones (cortisol, adrenaline), which aggravates insulin resistance, activates inflammatory processes, and complicates the course of diabetes. Particular attention is given to the quality of life of T2DM patients during wartime. Psychosocial factors (loss of housing, social connections, constant threat to life, and reduced social support) significantly decrease physical, emotional, and cognitive functioning, as well as life satisfaction. The use of validated psychometric scales enables objective assessment of patients’ psycho-emotional state and quality of life, serving as a basis for the development of individualized strategies for comprehensive medical and psychosocial support in crisis situations.

Conclusions. T2DM in wartime is characterized by a complicated metabolic course, which is caused by both physiological and psycho-emotional factors. The combination of metabolic, psychosomatic, and social factors requires a personalized comprehensive approach to patient management with the involvement of interdisciplinary teams.

The role of body plethysmography in modern respiratory diagnostics: a literature review

Ya. M. Mykhailovskyi — Thu, 26 Mar 2026 00:00:00 +0200

Aim. To systematize current knowledge on the methodological principles of body plethysmography, summarize data on reference parameters, and analyze recent trends of its application in the diagnosis of respiratory diseases.

Materials and methods. A literature search and selection of scientific sources were conducted in PubMed, Scopus, Web of Science, Embase, and Cochrane Library, as well as in Ukrainian databases, including the Vernadsky National Library of Ukraine and the Ukrainian Medical Scientific Index (UMSI). The analysis included publications mainly from the last five years (2020–2025) covering methodological, normative, and clinical aspects of body plethysmography. Original studies, systematic reviews, meta-analyses, clinical guidelines, and position statements of ERS, ATS, and GOLD were analyzed.

Results. Body plethysmography has demonstrated high accuracy and reproducibility in measuring lung volumes and airway resistance parameters. Airway resistance indices show higher sensitivity compared to spirometric parameters in detecting bronchial obstruction, airway hyperreactivity, and treatment response. The combination of changes in specific airway conductance and functional residual capacity is a more sensitive method for assessing bronchial obstruction reversibility than changes in forced expiratory volume in one second. Body plethysmography is valuable for diagnosing small airway disease, an early component in the pathogenesis of chronic obstructive pulmonary disease, bronchial asthma, and interstitial lung diseases, which may remain undetected by standard spirometry. The method enables identification of the “air trapping” phenomenon and lung hyperinflation, which are essential for patient phenotyping within the “treatable traits” concept. In the post-COVID period, body plethysmography is effective for assessing restrictive changes, the degree of hyperinflation, and recovery dynamics of lung function.

Conclusions. Body plethysmography is the “gold standard” of noninvasive lung function assessment, providing a comprehensive evaluation of lung volumes and airway resistance. The method is important for early diagnosis, personalized treatment approaches, and monitoring of patients with chronic respiratory diseases, including long-COVID.

Creatine as an essential pharmaconutrient in the practice of training athletes in martial arts

Thu, 26 Mar 2026 00:00:00 +0200

Aim: to form modern ideas about the properties of creatine as a pharmaconutrient, its biological role in the body, and rational dosage during physical exertion.

Materials and methods. To determine the level of development of the research problem, a search was conducted in the databases MEDLINE, PubMed, Scopus, Directory of Open Access Journals and ScienceDirect; the keywords used included physical exercise, creatine supplementation, oxidative stress, mitochondria, energy metabolism. We focused on English-language articles published between 2019 and 2025.

Results. The use of creatine loading schemes during high-intensity interval training provides an increase in physical fitness indicators by an average of 10–20 % due to an increase in the concentration of muscle phosphocreatine. According to modern ideas, creatine belongs, on the one hand, to the group of myostatin inhibitors, and on the other hand, to the protectors of mitochondrial function. The results of 50 studies showed that compared to placebo, creatine, both alone and in combination with bicarbonate, produced a statistically significant increase in average and peak power in martial artists. Increasing cellular creatine levels promoted metabolic channeling, demonstrated antiapoptotic properties, promoted the survival of dopaminergic neurons, and produced a pronounced antidepressant effect, helping athletes remain psychologically stable during training, and before competitions.

Conclusions. Thus, from the literature data, it becomes clear that the course use of creatine leads to a significant increase in the efficiency of the training process, and this makes it an indispensable tool for improving the indicators of physical and functional fitness, as well as the overall quality of life of athletes. Creatine is a universal ergogenic food supplement, but due to its predominantly positive effect on the body with chiefly aerobic energy supply, typical of Olympic martial arts, it is fully suitable for improving the effectiveness of the training process in boxing, judo, taekwondo, jiu-jitsu (jujutsu), fencing, etc. The neuroprotective and antidepressant effects of ergogenic supplements with creatine are very important in sports such as martial arts, as they contribute to the development of discipline, emotional control, mental stability, and help athletes’ brains become more resistant to stress, especially before competitions. The course use of such a pharmaconutrient as creatine can rightfully be attributed to health-saving technologies – a new direction in sports pharmacology, and nutriology.