Objective: To evaluate the applicability of the EuroLung1 risk stratification model and its modification in a population of patients undergoing anatomical lung resections for stage I–IIA non-small cell lung cancer (NSCLC), performed predominantly via videoassisted thoracoscopic surgery (VATS).

Materials and methods: A retrospective analysis of clinical data of 290 patients who underwent anatomical lung resections for stage I–IIA NSCLC was performed. The predicted risk of postoperative complications according to the EuroLung1 score was compared with the actual incidence of postoperative complications in the study cohort. Additionally, a modified scoring system was developed, which was used to evaluate the incidence of postoperative complications, including prolonged air leak through the pleural drainage system, cardiac arrhythmias, grade 1–3 respiratory failure, and complications of grade IIIA and higher according to the Clavien– Dindo classification.

Results: Comparison of the predicted risk of complications according to the EuroLung1 score with the actual incidence of postoperative complications revealed no correlation (p=0.303). Statistically significant associations were observed when assessing the risk using proposed modification of the EuroLung1 model: prolonged air leak through the pleural drainage system (p=0.017), cardiac arrhythmias (p=0.016), grade 1–3 respiratory failure (p=0.009), complications classified as grade IIIA or higher according to the Clavien–Dindo classification (p=0.027), and overall postoperative complications (p=0.008).

Conclusion: The EuroLung1 score demonstrates insufficient accuracy in predicting postoperative complications in patients undergoing surgery for stage I-IIA NSCLC stage; however, we have proposed an alternative approach to the application of this model, which demonstrated satisfactory predictive performance.

Background: Despite advances in surgical techniques for the treatment of differentiated thyroid cancer, the selection of the optimal surgical approach for thyroidectomy combined with modified radical neck dissection remains an important issue. The literature provides limited evidence regarding the use of modified surgical approaches for thyroidectomy performed in combination with modified radical neck dissection.

Objective: To improve treatment outcomes in patients with differentiated thyroid cancer requiring thyroidectomy with modified radical neck dissection through the use of a novel surgical approach in the cosmetically sensitive cervical region.

Materials and methods: A single-center, retrospective, non-randomized comparative cohort study was conducted. The outcomes of surgical treatment in patients with differentiated thyroid cancer who underwent thyroidectomy combined with type III modified radical neck dissection were analyzed. Patients were divided into two groups: the study group, in which surgery was performed using a modified surgical approach, and the control group, in which the conventional surgical approach was employed. Intraoperative parameters, early postoperative outcomes, length of hospital stay, surgical safety, cosmetic outcomes, and patient satisfaction were assessed using the Vancouver Scar Scale.

Results: A total of 233 patients were included in the study, of whom 85 (36.48%) comprised the study group undergoing surgery using the modified approach and 148 (63.52%) comprised the control group undergoing surgery using a conventional Kocher incision. The modified approach provided adequate surgical exposure to perform thyroidectomy combined with modified radical neck dissection of cervical lymph node levels I–V and VI. During the study period, the mean operative time for procedures performed using the modified approach decreased from 120.2 to 92.5 minutes, representing a 23.04% reduction. The mean incision length was 5 cm. The modified approach was associated with significantly lower postoperative pain, with a mean VAS score of 2.1 ± 0.8 compared with 3.1 ± 1.0 in the control group (p < 0.05). Mean intraoperative blood loss was reduced by 55 mL relative to the conventional approach. The mean length of hospital stay in the study group was 3.2 ± 0.9 days compared with 6.4 ± 1.5 days in the control group, consistent with current trends toward enhanced recovery after thyroidectomy (p < 0.001). Overall, 94% of patients in the study group were discharged on postoperative days 2–3. At 12 months after surgery, cosmetic outcomes assessed using the Vancouver Scar Scale were 14.2 ± 1.8 in the study group, compared with 7.6 ± 2.3 in the control group (p < 0.01), in accordance with contemporary approaches to postoperative scar assessment and aesthetic outcome evaluation. Postoperative complications in the study group included hypoparathyroidism in 3 patients (3.53%) and unilateral laryngeal paresis in 2 patients (2.35%). In the control group, hypoparathyroidism occurred in 6 patients (4.05%) and unilateral laryngeal paresis in 4 patients (2.7%). The overall incidence of early postoperative complications did not differ significantly between the groups (6% and 8%, respectively; p = 0.47).

Conclusion: The modified surgical approach for thyroidectomy combined with modified radical neck dissection is a safe and effective technique for the treatment of differentiated thyroid cancer in carefully selected patients. However, external validation in independent patient cohorts is required before clinical implementation.

Background: Anastomotic leakage remains one of the most severe complications after esophagectomy and is associated with an increased rate of reinterventions, prolonged hospital stay, and higher postoperative mortality.

Objective: To evaluate the prognostic value of inflammatory markers in the early postoperative period in patients after subtotal esophagectomy and to develop a postoperative risk stratification model for anastomotic leakage.

Materials and methods: A multicenter retrospective comparative study was conducted. The analysis included 325 patients with morphologically verified malignant tumors of the esophagus and/or esophagogastric junction who underwent subtotal esophagectomy using the Ivor Lewis or McKeown approach. Clinical, anamnestic, tumor-related, intraoperative, and laboratory parameters were analyzed. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), and Creactive protein (CRP) levels were assessed preoperatively and on postoperative days 1 and 5.

Results: Anastomotic leakage was diagnosed in 48 of 325 patients (14.8%). In univariate analysis, anastomotic leakage was associated with the surgical approach (Ivor Lewis/McKeown), tumor location and length, severity of dysphagia, smoking status, Charlson Comorbidity Index, blood transfusion, and anemia status. Among the laboratory parameters, the most pronounced intergroup differences were observed on postoperative day 5: patients with anastomotic leakage had higher NLR, PLR, and CRP levels and lower PNI values. The final multivariable model included PNI5 (AOR 0.863; 95% CI 0.773–0.964; p = 0.009), PLR5 (AOR 1.009; 95% CI 1.005–1.012; p < 0.001), and CRP5 (AOR 1.007; 95% CI 1.001–1.012; p = 0.013). The model demonstrated excellent discriminative performance in the study cohort (AUC = 0.922; 95% CI 0.868–0.975; p < 0.001).

Conclusion: In patients after esophagectomy, CRP, PLR, and PNI on postoperative day 5 were independent predictors of anastomotic leakage. Increased CRP and PLR levels, along with decreased PNI values, were associated with a higher risk of this complication. The model based on these parameters demonstrated high discriminatory performance and may be used for early postoperative risk stratification. However, external validation in independent patient cohorts is required before clinical implementation.

Background: Postoperative neurocognitive disorders (PONCD) may develop after surgery, negatively affecting recovery, functional independence, quality of life, and increasing the risk of dementia, while also affecting patient survival. Patients undergoing corneal transplantation are particularly vulnerable to pre-existing cognitive impairment associated with visual dysfunction and other perioperative risk factors for PONCD. Consequently, anesthesiologists should perform perioperative risk stratification in these patients. Objective: To develop a predictive model for PONCD by identifying risk factors contributing to their development.

Materials and methods: The single-center prospective study included 190 patients undergoing elective penetrating keratoplasty. Recovery after anesthesia, quality of life, and the development of PONCD were assessed on postoperative days 7, 30, and 90. Patients with and without PONCD were compared regarding baseline characteristics, surgical variables, and anesthesia-related factors. Logistic regression analysis was performed to identify factors associated with PONCD, and a predictive model was developed based on multivariate analysis. The model was subsequently compared with similar predictive models.

Results: On postoperative day 7, PONCD were observed in 37.85% of patients, on day 30 in 19.46%, and on day 90 in 12.63%. The predictive model of PONCD demonstrates the following performance: AUROC=0.873, mean squared error=0.0265, 95% CI 0.817–0.917, p < 0.001.

Conclusions: Four independent factors were identified: patient age, Clinical Frailty Scale, initial cognitive impairment assessed using the MoCA-22 scale, and initial visual impairment. The developed predictive model demonstrated high accuracy (AUROC=0.873).

Background: Prosopalgia is a clinical term characterized by facial pain of various etiologies. It remains a significant challenge in modern medicine because of its high prevalence, substantial impairment of quality of life, and the complexity of diagnosis and treatment.

Objective: To evaluate the clinical efficacy of surgical treatment of prosopalgia using radiofrequency rhizotomy of the trigeminal nerve root.

Materials and methods: A single-center retrospective study was conducted to evaluate the outcomes of radiofrequency rhizotomy in patients with various types of prosopalgia. Clinical outcomes and complications were assessed. The obtained results were compared with published data.

Results: According to the inclusion and exclusion criteria, 54 patients were included in the study. The median follow-up period was 14 months (9; 17). The efficacy of radiofrequency rhizotomy was 77.78%; lack of clinical efficacy was 5.56%, and recurrence of prosopalgia was observed in 16.67% of cases. The complication rate was 5.56%, and all complications were reversible.

Conclusion: Radiofrequency rhizotomy is a minimally invasive, cost-effective, and safe treatment method for prosopalgia of various etiologies. It is recommended for treatment of choice for elderly patients and/or patients with morbid obesity.

Objective: To perform a comparative analysis of the efficacy of the no-touch and bridge techniques in femoropopliteal bypass using a small-diameter reversed autologous vein grafts based on primary graft patency, revision rates, postoperative complications, and limb functional status, as well as to evaluate the impact of the proposed venous conduit classification on group comparability and data interpretation.

Materials and methods: A retrospective cohort study included 162 patients with chronic limb-threatening ischemia (CLTI). Patients in Group 1 (n=89) underwent autologous vein harvesting using the no-touch technique, whereas patients in Group 2 (n=73) underwent the bridge technique. All patients underwent below-knee femoropopliteal bypass grafting using a reversed great saphenous vein graft. Patient stratification was performed according to an author-developed venous conduit classification. Small-diameter grafts predominated in both groups: 52.8% in the study group and 38.3% in the control group. The groups were comparable in terms of age distribution and comorbidities.

Results: No statistically significant differences in primary graft patency were observed between the groups at hospital discharge. However, significant differences were identified during long-term follow-up. At 1 year, the probability of maintaining graft patency was 4.82 times higher in the study group [95% CI: 2,17–11,4; p=0,0001], and at 2 years, it was 7.4 times higher [95% CI: 2.91–20.3; p<0.0001] compared to the control group. The risk of postoperative complications, including major amputation, was significantly lower in the no-touch group. The odds ratio for postoperative complications was 0.15 [95% CI: 0.06–0.34; p<0.0001] at 1 year and 0.18 [95% CI: 0.07–0.46; p=0.0004] at 2 years. Limb functional status was also significantly better in the study group at 1 year (OR=8.68 [95% CI: 3.04–31.4], p<0.0001) and at 2 years (OR=10.4 [95% CI: 3.1–48.2], p=0,0001) postoperatively.

Conclusions:

1. Femoropopliteal bypass using the no-touch technique with a small-diameter venous graft demonstrates superior clinical efficacy in terms of 2-year graft patency and limb salvage compared to the bridge technique.
2. The developed venous conduit classification has high methodological value, enabling objective preoperative assessment of autologous vein anatomy, formation of statistically homogeneous comparison groups, and minimization of the impact of anatomical factors on the outcomes of clinical studies assessing venous graft patency.

Anesthesiology and intensive care medicine is one of the medical specialties in which professional practice is associated with frequent stress and the development of burnout syndrome.

Objective: To assess the level of stress in anesthesiologists and intensivist according to the characteristics of their professional practice and length of clinical experience.

Materials and methods: An anonymous survey was conducted among 138 anesthesiologists and intensivists, including 79 (57.2%) women and 59 (42.8%) men. The questionnaire included 11 items assessing the social status, length of clinical experience, and professional practice characteristics. A modified stress index including Booth and Schaeffer stress causes/signs was used to assess stress levels.

Results: Among the respondents, 73 (52.9%) were residents/trainee physicians, 19 (13.8%) had less than five years of experience, 13 (9.4%) had 5-10 years, 2 (1.4%) had 10-15 years, 4 (2.8%) – 15-20 years and 28 (20.3%) specialists had more than 20 years. A total of 101 (73.2%) physicians worked in the anesthesiology and intensive care department of a multidisciplinary hospital, whereas 15 (10.9%) were employed in a general intensive care unit. Overall, 89 (64.5%) respondents were married. The median stress score was 0.34 (0.25-0.43), indicating a moderate level of stress. The lowest stress level was recorded among physicians aged 45-55 years (0.29); however, no statistically significant differences were found between age groups. The lowest stress scores were observed among physicians working in anesthesiology and intensive care departments (0.32), whereas the highest scores were observed among physicians working in specialized intensive care units (0.43). Weak but statistically significant negative correlations were found between stress levels and family status, as well as between stress levels and having a hobby (R = -0.23; R = -0.17).

Conclusion: The severity of stress among anesthesiologists and intensivists is not associated with the age and length of professional experience of the specialists. The lowest stress index was observed among physicians aged 45-55 years working in anesthesiology and intensive care units.

Background: The study of non-invasive biomarkers of neurodegeneration in tear fluid is an important task in modern ophthalmology and laboratory diagnostics, allowing for the assessment of local and potentially systemic processes in neurodegenerative diseases.

Objective: To assess the diagnostic significance of measuring neurotrophic factor levels in patients with systemic (alcohol addiction syndrome) and local (glaucoma) neurodegenerative processes..

Materials and methods: A total of 24 patients with alcohol dependence syndrome (Group 1) and 45 patients with primary open-angle glaucoma (Group 2: subgroups 2A (stages 1–2), 2B (stage 3), 2C (suspected)), as well as corresponding control groups (1K, 2K), were examined. Levels of BDNF, GDNF, CNTF, and NGFb were measured in serum, tear fluid, and aqueous humor. Statistical analysis was performed using StatPlus software (ANOVA, Pearson correlation, ROC analysis).

Results: In systemic intoxication (Group 1), a 2.8-fold decrease in serum BDNF levels was observed, with no significant correlations with tear fluid composition. In contrast, consistent changes were observed across all biological fluids in patients with glaucoma. In subgroup 2C, a marked reduction in systemic GDNF (by 57-fold, p<0.001) and a stage-dependent decrease in CNTF levels in tear fluid (by 33–50%) were found. A strong correlation was demonstrated between the CNTF levels in aqueous humor and tear fluid (R=0.51, p<0.001). ROC analysis of CNTF in tear fluid in differentiating suspected glaucoma (2C) from controls (2K) demonstrated excellent diagnostic performance: AUC=0.94; cutoff value – 14.3 pg/ml; sensitivity and specificity were 87% each.

Conclusion: Tear fluid is a highly informative indicator of local neurodegeneration in glaucoma, reflecting deficiency of growth factors in the deep ocular structures, but is not representative of systemic neurotoxicity. The obtained data support the implementation of CNTF level assessment in tear fluid as a highly accurate, non-invasive, and biologically grounded method for early glaucoma screening, enabling the detection of pathological changes at the preclinical stage.

Objective: To improve the surgical technique in the treatment of deep burns of the face and neck in order to enhance treatment outcomes.

Materials and methods: A total of 210 patients with deep burns of the face and neck were treated and evaluated at the Combustiology Department of the Samarkand Branch of Republican Research Centre of Emergency Medicine in 2010-2022. The patients were divided into two groups, and the treatment outcomes were analyzed.

The study group comprised 108 (51.4%) patients who were treated using the following surgical approaches: early necrectomy for deep burns of the face and neck, and placement of split-thickness autologous skin graft on granulating wounds parallel to the direction of the underlying muscle fibers. In patients with deep burns involving 0.1%–1.5% of the total body surface area, single-stage necrectomy followed by autodermoplasty was performed. In the control group, 102 (48.6%) patients received conventional treatment. The patients’ ages ranged from 4 months to 70 years, with a mean age of 20 ± 3.0 years.

Results: The use of early necrectomy in patients of the study group promoted the formation of granulation tissue in deep facial and neck burns by days 12–14, enhanced wound cleansing, and enable skin grafting on days 14–17 after injury. The application of singlestage necrectomy and autodermoplasty reduced the duration of treatment from 21.5 ± 2.4 to 16.5 ± 1.5 days and decreased the incidence of postoperative complications from 62.7% to 24.1%.

Conclusion: Early surgical necrectomy in the treatment of deep facial and neck burns is a highly effective method. This approach enables earlier skin grafting and shortens the treatment period; it not only enhances wound cleansing but also decreases the incidence of postoperative complications following skin grafting. The treatment duration was significantly reduced by an average of 8-10 days, which is important for early patient rehabilitation. The incidence of postoperative complications decreased from 62.7% to 24.1%. Furthermore, this method reduces pain and discomfort associated with daily dressing changes and wound care procedures, decreases the severity of pigmentary changes, and contributes to improved aesthetic outcomes, representing an important aspect of burn care in this patient population.

Background: Cervical cancer remains a major public health challenge in Uzbekistan, with 2,654 new cases diagnosed in 2022. The premenopausal period (40–55 years) represents a particularly difficult stage for cervical cancer detection, as epithelial atrophy and migration of the transformation zone into the endocervical canal reduce the sensitivity of conventional cytology.

Objective: To characterize morphometric, ultrastructural, nanotopographic, and immunohistochemical features of precancerous cervical lesions in premenopausal women, and to identify, at an assessment of hypothesis-generating analysis, parameters that distinguish benign cervical lesions from cervical intraepithelial neoplasia (CIN).

Materials and methods: A total of 402 premenopausal women aged 40–65 years were enrolled, including a benign cervical lesion Group I (n = 289), comprising cervical ectopy, squamous metaplasia, and Nabothian cysts, and a histologically confirmed CIN Group II (n = 113: CIN I, n = 48; CIN II, n = 35; CIN III, n = 30). Formalin-fixed, paraffin-embedded tissue specimens from the entire cohort underwent histomorphometric and immunohistochemical analyses (p16INK4a, Ki-67, p53). Separate, substantially smaller sub-samples of fresh or glutaraldehyde-fixed tissue were analyzed by scanning electron microscopy with energy-dispersive spectroscopy (SEM-EDS; 7 benign and 25 CIN specimens) and atomic force microscopy (AFM; 7 benign and 24 CIN specimens). Group comparisons were performed using the Mann–Whitney U test for continuous variables and the χ² test for categorical variables. p < 0.05 was considered statistically significant, 95% CI were reported for all group-level comparisons of continuous variables.

Results: Epithelial thickness (64.2 ± 52.4 µm in Group I vs. 362.5 ± 35.0 µm in Group II), nuclear area (25.1 ± 5.3 vs. 206.0 ± 13.7 µm2) and the nuclear-to-cytoplasmic ratio (0.4 ± 0.1 vs. 0.8 ± 0.1) were significantly different between groups (p < 0.001) and increased progressively across CIN I to CIN III. In the SEM sub-sample, the distance of capillaries from the epithelial surface increased from 3.79 ± 2.00 µm in benign tissue to 352.14 ± 111.38 µm in CIN III. In the AFM sub-sample, surface relief height decreased from 1.13 ± 0.28 µm in benign tissue to 0.74 ± 0.27 µm in CIN III. EDS elemental microanalysis demonstrated calcium accumulation and phosphorus depletion in stromal tissue across CIN grades. Immunohistochemical markers (p16INK4a, Ki-67, and p53) differed significantly between Group I and pooled Group II (CIN I-III); however, grade-specific immunohistochemical analyses were not available, representing a limitation of the study.

Conclusion: Morphometric, ultrastructural and nanotopographic parameters differ substantially between benign cervical lesions and CIN in this premenopausal cohort and warrant prospective validation. Further studies with histologically normal controls, grade-stratified immunohistochemical analyses, and larger nanoscale sub-samples, are required before diagnostic thresholds can be proposed for clinical application.

Background: Hemorrhage control at the prehospital stage remains a critical challenge in disaster medicine. Tactical hemostatic dressings are considered the optimal solution for temporary hemostasis; however, their comparative efficacy under standardized in vivo conditions has been insufficiently investigated.

Objective: To compare the hemostatic efficacy and performance characteristics of five tactical wound dressings with different mechanisms of action using a standardized in vivo model of superficial soft tissue injury.

Materials and methods: In an acute experimental study, 60 standardized superficial soft tissue wounds (5 × 5 cm) were created in 10 Landrace pigs. Five hemostatic dressings (HemoFlex Combat, Hemostop, Apollo, Hepoglos, and a collagen sponge) were evaluated and compared with a standard gauze dressing (control). Time to hemostasis, blood loss volume, adhesive properties (3-point scale), and tissue trauma associated with dressing removal were assessed. Statistical analysis was performed using linear mixedeffects models and nonparametric tests with adjustment for multiple comparisons (Holm’s method).

Results: The shortest time to hemostasis was observed for Hemostop (45 [40; 52] s), while the longest among active agents was recorded for the collagen sponge (120 [110; 128] s). All specialized dressings significantly outperformed the control dressing (180 [172; 188] s; p<0.01). Blood loss volume was correlated with time to hemostasis (Spearman’s ρ=0.87; p<0.001). Maximum adhesion (3 points) was observed for HemoFlex Combat and the collagen sponge; however, their removal was associated with rebleeding in 60% and 40% of cases, respectively. Apollo and Hepoglos dressings demonstrated moderate adhesion (2 points) with no cases of rebleeding after removal.

Conclusions: The procoagulant agent (Hemostop) provided the shortest time to hemostasis; adhesive matrices (HemoFlex Combat and collagen sponge) formed a stable clot; however, their removal was associated with rebleeding in 60% and 40% of cases, respectively; osmotic dressings (Apollo and Hepoglos) demonstrated longer time to hemostasis (85–95 s) but were not associated with rebleeding after removal. A promising direction for future research is the comparative evaluation of the efficacy of these agents under conditions of experimentally induced coagulopathy.

Objective: To evaluate the dynamics of growth factors during healing of an experimental foot wound in laboratory animals with alloxan-induced diabetes in a chronic in vivo model.

Materials and methods: The experimental study included 190 male rats weighing 190–250 g, in which diabetes mellitus was induced by alloxan administration, followed by mechanical injury to the tissues of the right hind paw to establish an experimental diabetic foot model. The animals were divided into groups according to the therapeutic intervention (60 animals per group), whereas 10 animals constituted intact group. The main study group received composite collagen treatment, the comparison group was treated with Levomekol ointment, and the control group received no treatment. Plasma levels of VEGF-A164 and IGF-1 were assessed on days 1, 3, 7, 10, and 14 after induction of the foot injury. Macroscopic wound healing was also evaluated and documented by photographic recording. Statistical analysis was performed using the nonparametric Kruskal-Wallis test for multiple-group comparisons, followed by post hoc pairwise comparisons of mean ranks between groups. The Wilcoxon test was also applied.

Results: Application of composite collagen (collagen+quercetin) in an experimental diabetic foot model demonstrated that plasma VEGF-A (cytokine) levels in rats of the main study group reached the highest values (7.40 and 8.31 pg/mL) on days 3 and 7 of the experiment, compared with the other animal groups. This finding indicates a positive stimulatory effect of the composite material on tissue regeneration through enhanced regulation of angiogenesis. In the experimental diabetic foot model, plasma levels of insulin-like growth factor (IGF-1) in rats of the main study group reached 92.15 and 105.15 ng/mL on days 7 and 14 of the experiment, respectively, demonstrating the pronounced reparative effect of composite collagen (collagen + quercetin) on tissue growth.

Conclusion: Treatment of diabetic foot wound defects with composite collagen (collagen + quercetin) demonstrated that acute exudative inflammation around the wound regressed earlier (by day 7) compared with the other groups. A statistically significant increase in VEGF-A and IGF-1 levels in the blood of animals from the main study group indicated a positive effect of the investigated material on growth factors involved in wound healing. The achievement of normal values for these parameters by the end of the experiment indicates its effectiveness, but the fact of normalization itself requires a deeper study of the influence of these factors on wound healing processes in the setting of diabetes mellitus.

Background: Advances in modern military technology have resulted in an increased incidence of severe combat-related traumatic brain injuries. Penetrating cranial and brain injuries affect both military personnel and civilians, highlighting their significant medical and societal impact. Such injuries may result in severe neurological deficits and profound disability, while secondary complications may further exacerbate the patient’s condition and increase the risk of mortality. The management of retained foreign bodies remains controversial. Their removal using conventional navigation techniques, including anatomical landmarks and intraoperative fluoroscopy, may result in suboptimal surgical trajectories, leading to additional injury to the surrounding brain tissue, prolonged operative time, increased radiation exposure for both the patient and the surgical team, and postoperative complications such as intracerebral hematoma and cerebral ischemia. The application of augmented reality technology combined with minimally invasive instruments may significantly reduce the risk of perioperative complications.

Clinical case: This study presents a clinical case of retained foreign body removal using augmented reality and endoscope after a penetrating head injury. The patient was treated at the Neurosurgical Center of Main Military Clinical Hospital named after Academician N.N. Burdenko. During postoperative follow-up, favorable clinical outcomes were observed, with no progression of neurological deficits. Based on this clinical case, indications for the application of this technology in the management of combat-related head injuries were proposed. These indications may be further expanded with the wider implementation of this approach in clinical practice. Future prospective for the development of this approach are also discussed.

A 36-year-old serviceman sustained a mine-blast injury with partial avulsion of the left upper extremity at the mid-forearm level while performing a combat mission in the Special Military Operation zone. The patient was evacuated to a military field hospital (Level 2) within an hour. Radiographic examination revealed a comminuted fracture of the radius and ulna of the left forearm. Physical examination demonstrated an extensive soft tissue defect and complete disruption of medial forearm neurovascular bundle. The hand and distal forearm remained attached to the limb solely by the soft tissues of the lateral aspect of the forearm. Extensive primary debridement was performed under endotracheal anesthesia, followed by reconstruction of the radial artery using a segment of the ulnar artery as an interposition graft, restoration of the muscular integrity of the volar aspect of the forearm, and application of a military external fixation device. Postoperatively, the left hand was pink and warm with satisfactory radial artery pulsation, and weak active finger movements were observed. One hour after surgery, the patient was evacuated to a specialized medical center for further treatment and rehabilitation.

In cases of subarachnoid hemorrhage associated with multiple cerebral aneurysms, the primary clinical challenge is to identify the ruptured aneurysm. In most cases, the ruptured aneurysm is the larger aneurysm with an irregular shape and diverticula.

Occasional cases are encountered in clinical practice in which rupture occurs in the smallest aneurysm with a regular shape. This article presents a clinical case of rupture of a miliary aneurysm (up to 2 mm in size) located at the A2–A3 junction of the left anterior cerebral artery in a patient who was also found to have four larger aneurysms. These included an irregular, bilobulated aneurysm of the anterior communicating artery.

The use of hydrogen peroxide (H2O2) may result in serious systemic complications, including neurological sequelae such as acute embolic stroke. This article presents the case of a 34-year-old patient in whom a patent foramen ovale was not identified preoperatively, leading to the development of paradoxical embolism with a favorable outcome after the use of a 3% hydrogen peroxide solution for chemical pleurodesis.

Background: Acute small intestine ulcers represent a rare complication following gastrointestinal surgery. Nevertheless, the frequency of their occurrence tends to increase.

Objective: To highlight the issue of acute postoperative small intestine ulcers and to present two clinical cases of this complication.

Materials and methods: A literature search was conducted using the scientific electronic library eLIBRARY.RU and the PubMed database, employing the following keywords: acute small intestine ulcers, inflammatory bowel diseases, postoperative period, pelvic small intestinal reservoir and their Russian-language equivalents. The publications from the past 10 years were included in the review.

Results: Two clinical cases of acute small bowel ischemia in the postoperative period complicated by perforated ulcers were presented. In the first case the cause was a pathology associated with the formation of an ileoreservoanal anastomosis. In the second case it was multifocal atherosclerosis.

Conclusion: Diagnostic approaches and surgical strategies for acute postoperative perforated small intestine ulcers require further investigation, discussion, and evaluation.

Mesenchymal stem cells (MSCs) and their derived extracellular vesicles (EVs) are of particular interest in the field of regenerative medicine. This review compares different approaches to the application of MSCs, MSC-EVs in various experimental models, with particular emphasis on their biodistribution. Local administration of the cell-based product appears to be more effective; therefore, the development of new implantation strategies for the topical application of MSCs and EVs remains an important area of research. Hydrogels represent unique biomaterials that have been extensively investigated as delivery systems for drugs, a wide range of biomolecules, and cells.

This review evaluates preclinical studies investigating the use of MSCs and MSC-EVs in hydrogels, as well as the safety and feasibility of this strategy. In addition, the major polymers used for hydrogel fabrication are reviewed and analyzed.

Background: Accurate statistics on mortality from biliary tract cancer in Russia are unavailable. Biliary tract cancer is characterized by an extremely unfavorable prognosis, with a 5-year survival rate of approximately 2%. Therefore, the identification of precancerous conditions and the early detection of biliary tract cancer should be prioritized in healthcare.

Objective: To analyze the scientific literature on diffuse and focal pathology of the gallbladder wall.

Materials and methods: This review was based on publications evaluating diffuse and focal pathology of the gallbladder wall. Results: The review describes diffuse changes and focal lesions of the gallbladder wall. Ultrasonography is the primary modality for the detection and characterization of biliary tract pathology.

Conclusion: For more effective application of ultrasound diagnostic methods, standardization of the examination using a structured protocol is required. This facilitates multidisciplinary management of patients with biliary tract pathology, enables timely prevention, and improves identification of risk factors for biliary tract cancer.

This review aims to identify the advantages and limitations of the treatment strategies for atrophic femoral nonunion and is based on the analysis of 358 publications (from 1973 to 2025). The literature search was conducted using the PubMed (MEDLINE) and eLibrary databases in accordance with the PRISMA guidelines for systematic reviews. The analysis demonstrated that the majority of the publications consist of single case reports or small case series. No universally accepted standard for the treatment for this condition has been established, and there is insufficient high-quality evidence to support the selection of an optimal treatment strategy. The pathophysiological and pathomorphological characteristics of fracture healing associated with the development of hypertrophic and atrophic nonunion suggest that the preferred treatment is excision of the nonunion, followed by single-stage reconstruction with autologous bone grafting and achievement of absolute mechanical stability, including through combined osteosynthesis.

Background: The complications and risks associated with the use of autologous, allogeneic, and xenogeneic materials for bone grafting motivate researchers to explore innovative approaches for the repair of bone defects. One such strategy is the use of decellularized donor bone material. Assessment of the residual donor genetic material in the decellularized bone matrix is considered a critical step in the development of such bone grafting materials.

Objective: Тo identify and systematically evaluate published data on the quantitative DNA content in studies investigating bone decellularization methods.

Materials and methods: A search for relevant publications was conducted using the Google Scholar database (https://scholar.google.ru/). Results: Of the 18 publications reviewed on the development of acellular osteoplastic materials based on decellularized bone, exact residual DNA values were reported in 8 studies. In 14 of the 18 analyzed studies, the researchers achieved the generally target level of donor genetic material removal.

Discussion: The significant differences in the quantitative DNA content between native and decellularized bone demonstrated in the present review may be attributable to the use of different methods and/or nucleic acid detection kits in the included publications, as well as to challenges in normalizing the weight of processed tissue relative to native tissue.

Conclusion: Standardization of quality assessment parameters for bone graft materials based on decellularized donor bone tissue is required. Particular attention should be given to the completeness of DNA extraction from native and processed biomaterials to ensure an objective evaluation of decellularization efficiency.

Background: Diagnostic imaging in pregnant trauma patients enables the timely identification of life-threatening injuries to both the mother and the fetus. A wide range of imaging modalities provides rapid and comprehensive assessment of the severity and nature and extent of injuries, as well as associated complications and sequelae.

Objective: To highlight the importance of imaging modalities in the evaluation of pregnant trauma patients and to assess the contribution of each imaging technique to the detection and determination of the severity of maternal and fetal injuries.

Materials and methods: This review presents data obtained from available sources, including PubMed and Scopus, published up to December 2025. The search was conducted using the following keywords: pregnancy, trauma, polytrauma, computed tomography, magnetic resonance imaging, ultrasonography, radiography, diagnostic imaging, and radiation safety.

Results: The review of the medical scientific literature describes the diagnostic capabilities of imaging modalities in detecting and assessing the severity of traumatic injuries in pregnant patients and identifies diagnostic criteria that comply with radiation safety principles.

Discussion: This study analyzed published articles describing diagnostic imaging approaches for traumatic injuries in pregnant patients and the associated imaging findings. The obtained data confirm that trauma remains one of the leading causes of non-obstetric maternal and perinatal morbidity and mortality, with diagnostic imaging representing a crucial component of medical care.

Conclusion: Imaging modalities, including ultrasonography, radiography, computed tomography, and magnetic resonance imaging, are essential components of the comprehensive evaluation of pregnant patients with various types of trauma and have a significant impact on subsequent clinical management.

Background: Female infertility is a multifactorial condition with significant medical and social implications. Despite advances in the diagnosis and treatment of infertility, reliable biomarkers for early detection and selection of personalized therapy remain limited. Objective: To evaluate the role of metabolomic biomarkers in the pathogenesis, diagnosis, and treatment of female infertility, and to assess the potential for integrating metabolomic analysis into clinical practice to improve reproductive outcomes.

Materials and methods: A literature review was conducted using articles published up to May 2025 in PubMed, Google Scholar, and eLibrary databases. The search strategy was developed in accordance with the PRISMA guidelines. A total of 222 records were identified. After the removal of 72 duplicates, 150 records were screened. Following title and abstract screening, 90 publications were excluded, and 60 articles underwent full-text assessment. After excluding 10 publications that did not meet the eligibility criteria, 50 studies were included in the final review.

Results: The analysis of the data demonstrated that metabolomic markers enable the identification of metabolic dysfunctions associated with endocrine and physiological disturbances in infertility, allowing for more accurate early detection of pathological processes. The application of metabolomic analysis into comprehensive diagnosis may improve prognostic assessment and support the development of personalized therapeutic approaches. Several metabolites were identified as potential predictive biomarkers of therapeutic response to various treatment modalities, including assisted reproductive technologies.

Conclusion: This review demonstrates that a comprehensive approach to the investigation of metabolomic markers provides new opportunities for improving the diagnosis and enhancing the effectiveness of treatment for female infertility. The findings of previous studies highlight the potential of integrating metabolomics into clinical practice to enable personalized fertility management and improve patient outcomes. Further development of metabolomic analysis and standardization of data interpretation methods may significantly accelerate the implementation of these technologies into routine clinical practice.