Nanotechnology has emerged as a revolutionary approach in wound healing and scar reduction, offering precise, targeted, and efficient drug delivery systems. This review highlights recent advances in nanotechnology-based solutions, including nanoparticles, nanofibers, hydrogels, and nanoemulsions that address limitations of conventional therapies. These innovations enhance antimicrobial activity, promote angiogenesis, modulate inflammation, and deliver therapeutic agents with remarkable precision. The integration of nanotechnology with scar-reducing agents has transformative potential for collagen remodeling and fibrosis inhibition, improving both functional and esthetic outcomes. Furthermore, smart nanomaterials with biosensing capabilities enable real-time wound monitoring and dynamic treatment adjustments. While these advances are promising, challenges related to biocompatibility, cytotoxicity, and regulatory approval remain critical to address.

This review emphasizes the profound impact of nanotechnology in revolutionizing wound care and provides insights into future directions, including personalized therapies and artificial intelligence-integrated systems for optimized outcomes.

Background: Treatment of mediastinal masses poses a significant challenge in modern thoracic surgery. Video-assisted thoracic surgery (VATS) is gaining popularity due to its minimally invasive approach compared with traditional methods, such as thoracotomy and sternotomy.

Objective: To study differences in intraoperative and perioperative periods among patients who underwent VATS, thoracotomy, or sternotomy.

Material and methods: The study included a total of 616 patients with mediastinal masses who underwent surgery at the Republican Specialized Scientific Practical Medical Center of Surgery named after Academician V. Vakhidov (Tashkent, Uzbekistan): thoracotomy (n=420), sternotomy (n=84), and VATS (n=112). Propensity score matching was used for comparison to ensure balanced distribution across key preoperative characteristics.

Results. In the VATS group, surgery duration was significantly shorter (83.2±17.5 minutes) compared with thoracotomy (125.7±61.9 minutes, P <.001) and sternotomy (128.8±46.1 minutes, P <.001). Intraoperative blood loss was also lower in the VATS group (125.8±7.4 mL) compared with thoracotomy (350.4±11.4 mL, P <.001) and sternotomy (400.6±13.5 mL, P <.001). The mean duration of mechanical ventilation was 2.49±0.5 hours in the VATS group, which was significantly shorter than in the thoracotomy group (8.3±2.1 hours, P <.001) and the sternotomy group (10.1±3.3 hours, P <.001). Postoperative hospital stay was shorter in the VATS group (7.4±2.7 days) compared with thoracotomy (11.5±4.1 days) and sternotomy (11.7±4.3 days, P <.001). The rate of early postoperative complications was also significantly lower in the VATS group with 2 cases (2.6%) compared with 12 cases (15.6%) in the thoracotomy group and 14 cases (18.2%) in the sternotomy group (P =.006 and P =.002, respectively).

Conclusions: VATS demonstrated advantages over traditional methods, such asthoracotomy and sternotomy. It offers shorter surgery duration and hospital stay, decreased blood loss, and fewer complications.

Objective: To investigate the impact of delayed video-assisted thoracoscopic surgery (VATS) on the rate of postoperative complications and tuberculosis recurrence following pneumonectomy.

Materials and methods: A retrospective, open, cohort, nonrandomized, multicenter study conducted between 1984 and 2022 included 815 patients with destructive pulmonary tuberculosis who underwent pneumonectomy with delayed VATS thoracoplasty (group 1, 214 patients) or without it (group 2, 601 patients). Both groups were further divided into 3 subgroups based on multislice computed tomography findings of the remaining lung condition: А, no pathology; Б, foci or tuberculoma without cavitation; В, cavitation (CV+).

Results: In group 1, postoperative complications occurred in 7 patients (3.27%); there was no hospital mortality, and the short-term effectiveness of the surgery was 95.79% (205 patients). In group 2, these parameters were 28.95%, 7.49%, and 85.36%, respectively. In group 1, the effectiveness at 1, 3, and 5 years after discharge was 98.54%, 95.51%, and 93.20%, respectively; 32 (15.53%) patients had recurrence or progression of tuberculosis. Eight patients (3.88%) died from tuberculosis, and 11 (5.24%) experienced late bronchopleural complications. The 5-year survival rate for group 1 was 93.96%. The long-term outcomes in group 2 were worse. The effectiveness at 1, 3, and 5 years was 91.33%, 89.81%, and 87.28%, respectively. Recurrence or progression of tuberculosis was observed in 74 patients (18.88%); 34 patients died from tuberculosis (8.67%), and 42 patients had late bronchopleural complications (10.71%). The 5-year survival rate was 85.52%.

Conclusions: Delayed VATS thoracoplasty significantly improves both short-term and long-term outcomes of pneumonectomy in patients with tuberculosis, especially in case of a destructive process affecting the remaining lung.

Background: Proximal ulna fractures, such as olecranon and Monteggia fractures, can be challenging to treat.

Objective: To assess the effectiveness of locking compression plates (LCP) in stabilizing and promoting early mobilization in these fractures.

Materials and methods: This is a prospective study conducted at Saveetha Medical College and Hospital from January 2022 to December 2023. Patients with compound fractures, pediatric fractures, proximal bilateral forearm fractures, and those considered medically incompetent for surgery were excluded from the study.

Results: Of 20 patients with olecranon and Monteggia fractures, the majority had comminuted olecranon fractures. Most cases did not have associated injuries, while a few had radial head or coronoid injuries. Fracture union times varied, with some cases taking 12, 16, or 18 weeks to heal. Most patients achieved good elbow range of motion, exceeding 100° in 75% of cases. One patient experienced an exposed implant, one developed an infection, and 3 cases had restricted terminal pronation and supination. Functional outcomes assessed using the Mayo Elbow Performance score were excellent in 16 patients and good in 4 patients.

Conclusions: That comminuted olecranon and proximal ulna fractures can be effectively treated with LCP, resulting in good union and excellent clinical outcomes.

Objective: To assess the validity of developed ultrasonographic criteria for diagnosing Clostridioides (formerly Clostridium) difficile (C difficile) colitis in COVID-19 and non-COVID-19 patients.

Materials and methods: We examined 253 patients (85 men and 168 women) aged 18-100 years with antibiotic-associated diarrhea (AAD). The diagnosis of C difficile colitis was verified in 86 of 136 COVID-19 patients and in 75 of 117 non-COVID-19 patients.

We used the developed ultrasonographic criteria for diagnosing C difficile colitis in the patients with AAD. Internal validation of cut-off values of colon wall thickness was performed by means of a bootstrap method using the main group according to the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines and the Prediction Model Risk of Bias Assessment Tool algorithm.

Results: The internal validation revealed that the determined cutoff values of colon wall thickness were resistant to data variation in the target population, confirming great generalizability of the proposed cutoff values.

Conclusions: The established ultrasonographic criteria for diagnosing C difficile colitis (colon wall thickness greater than 4.0 mm in COVID-19 patients with AAD and greater than 3.2 mm in non-COVID-19 patients with AAD) are valid and can be effectively used in clinical practice.

Objective: To determine key radiological features for differential diagnosis between traumatic myelopathy and Hirayama disease for the sake of forensic medical examination.

Materials and methods: The study included 17 patients (age, 17-26 years) with myelopathy at the C5-C7 level following traffic collisions. The patients were grouped into those with traumatic myelopathy (n=11) and those with signs of Hirayama disease on magnetic resonance imaging (MRI) (n=6). All the patients underwent cervical spine MRI in the T1- and T2-weighted, short tau inversion recovery, and diffusion-weighted imaging modes, as well as dynamic MRI in the neck flexion position. We analyzed the following: spinal cord compression, anterior horn atrophy, dynamic changes, lesion symmetry, and venous stasis.

Results: Traumatic myelopathy is characterized by focal T2-hyperintensities, soft tissue edema, impaired intervertebral disk integrity, and no changes in neck flexion. Hirayama disease is manifested by symmetrical atrophy of the anterior horns, ventral displacement of the posterior dural sac on flexion, hyperintensity of the epidural venous plexus on T2-weighted images, and no compression changes in the neutral position. The mean lesion area in traumatic myelopathy was 12.4±1.3 mm2, whereas in Hirayama disease, 8.2±0.9 mm2 (P =.03). The sensitivity and specificity of dynamic MRI in the diagnosis of Hirayama disease was 85% and 92%, respectively. Discussion: Differential diagnosis between traumatic myelopathy and Hirayama disease is critical for forensic medical examination due to similar radiological features. Dynamic MRI revealed key differences, allowing to accurately distinguish between these conditions. Hirayama disease occurs in young patients (≤25 years old), has characteristic changes in the neck flexion, and is not associated with traumatic effects.

Conclusions: Traumatic myelopathy and Hirayama disease have overlapping radiological findings but differ in some key features. Ventral displacement of the dural sac and venous stasis on dynamic MRI are specific markers of Hirayama disease. Hirayama disease is not linked to a traumatic episode, which should be taken into account during forensic assessment of the traumatic etiology. Dynamic MRI should be included in the standard for myelopathy diagnosis to improve the accuracy of differential diagnosis.

Background: In anthropology age of skeletal remains can be estimated without specific equipment by the degree of serrate suture obliteration; however, standard methods of obliteration measurement cannot be used to calculate age of a skull with a fragmented or damaged calvaria, which significantly complicates age estimation.

Objective: To assess validity of a new method for age estimation relying on data of lambdoid suture obliteration on skulls of both sexes from the craniological collection at the Department of Normal Anatomy of Kuban State Medical University (Krasnodar, Russian Federation) and compare with that of a conventional method.

Materials and methods: We determined sex and age of 41 skulls using craniometry. Based on the sex and calvaria condition, the skulls were divided into 2 groups and further subdivided by sex: male and female skulls with preserved calvariae (age was estimated by Zvyagin’s standard regression equations [N=20]) and male and female skulls without calvariae (age was estimated by a new equation taking into account lambdoid suture obliteration [N=21]). The skulls with calvariae were subjected to double independent craniometry to find absolute and relative errors. Quantitative indicators of suture obliteration and the estimated age were assessed for normal distribution using the Kolmogorov-Smirnov test. Data collection, correction, and systematization were conducted using Microsoft Access 2016 and Microsoft Excel 2016 (Microsoft Corp, USA). Statistical analysis was performed using Statistica 10.0 (StatSoft Inc, USA).

Results and discussion: We determined age and sex of 36 skulls (87.80%) using craniometry. When comparing age values calculated using the standard regression equations and the new equation for the lambdoid suture, the absolute and relative errors for male skulls were 3.05% and 6.09%, respectively. For female skulls, the absolute and relative errors were 9.39% and 19.42%, respectively.

Conclusions: Equations that take into account lambdoid suture obliteration enable to estimate age of male and female skulls, including fragmented skulls, and can be used in anatomical and paleoanthropological studies, as well as in medical and forensic identification.

Introduction: Cardiovascular dysfunction and septic cardiomyopathy are the main causes of mortality in children with septic shock. Objective: To investigate characteristics of the hemodynamic status of children with septic shock on day 1 of pediatric intensive care unit (PICU) stay, depending on the outcome.

Materials and methods: Our single-center, retrospective and prospective observational study included a total of 55 children (age, 1 to 18 years) with septic shock. Sepsis was mainly caused by community-acquired pneumonia and peritonitis. We evaluated the cardiac index, systemic vascular resistance index (SVRI), modified shock index, levels of troponin I, creatine phosphokinase-MB, N-terminal pro–brain natriuretic peptide (NT-proBNP), and lactate, and characteristics of catecholamine support on day 1 of PICU stay.

Results: Overall mortality was 21.8% (n = 12). In terms of the outcome, the most unfavorable combination (Р = .00015) was high SVRI (>1411 dyn∙s/cm⁵/m²) with low or even normal cardiac index (≤3.5 L/min/m²). The NT-proBNP level above 3263 ng/L showed a high odds ratio (OR) and high likelihood of death (OR, 128.3; Р = .004). Vasopressor doses of dopamine above 5 mcg/ kg/min by the end of day 1 were associated with a high OR of death (OR, 71.5; P < .0001). There were no significant differences between fluid loading both in the first hour and on day 1 (Р = .820 and Р = .211, respectively). Fluid balance on day 1 was comparable in both groups (P = .970).

Conclusions: Selective hemodynamic support to normalize the cardiac index (>3.5 L/min/m²) and SVRI (800-1400 dyn∙s/cm⁵/m²) is the key management factor that reduces mortality in children with septic shock.

Introduction: Hemostasis in parenchymal organs remains an issue in abdominal surgery. Effective hemostasis in modern operating rooms is achieved by various local hemostatic agents, which are often composite.

Objective: To investigate structural characteristics of novel composite hemostatic sponges.

Materials and methods: We compared samples of novel hemostatic sponges (with different weight ratios [15:85, 25:75, and 50:50] of marine collagen to sodium carboxymethylcellulose [Na-CMC]) developed by our team with local hemostatic agents used in clinical practice. There was a total of 7 study groups. All the samples were studied in transmitted light and underwent microphotography with subsequent morphometry. We performed scanning electron microscopy and measured fiber thickness (μm) and pore area (mm²).

Results: The largest pore areas were found in the group of samples developed by our team (with the lowest content of marine collagen, 15%), which was higher than in groups with sponges already introduced into clinical practice (1.5 times higher compared with groups 4 and 7 and 2.7 times higher than in group 6). In terms of fiber thickness, the highest values were observed in group 3 (Na-CMC/marine collagen ratio of 50:50).

Conclusions: The optimal ratio of collagen/Na-CMC in hemostatic sponges is 50:50, resulting in sufficient porosity and fiber thickness. Owing to these structural characteristics the sample demonstrated its high efficacy in animal studies.

Background: Bronchial fistulas (BF) are a dangerous complication of thoracic surgery accompanied with a high mortality rate. Long-term conservative treatment of BF is ineffective, and surgery can lead to repeated complications. Although cell therapy is considered a safe and effective method for stimulating regeneration and has found its use in many fields of medicine, its application in thoracic surgery is limited.

Objective: To evaluate effectiveness of a cell product (autologous platelet lysate+allogeneic fibroblasts) in enhancing BF healing and to prove its safety.

Materials and methods: Our study included 91 patients from thoracic units of the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) who were divided into 2 groupes: standard therapy (34 patients) and cell therapy (57 patients).

Results: In the group receiving cell therapy, BFs healed in 93% of the patients, with no death cases. In the control group, BFs healed only in 50% of the patients (59% of them, after reoperation), and the overall mortality was 35.3%. During the follow-up, no cancer progression was observed in 47.4% of the main group patients and 20.6% of the controls, proving safety of the cell product and absence of an oncogenic effect.

Conclusions: Our findings indicate that the cell product is effective in tissue regeneration compared with the standard therapy. The data on its safety and effectiveness can lay the foundation for future large-scale studies to improve clinical treatment outcomes.

Objective: To compare cost-effectiveness of rehabilitation models for patients with urinary incontinence following radical prostatectomy.

Materials and methods: We evaluated direct costs of rehabilitation as part of the existing approach in patients with urinary incontinence following radical prostatectomy in the Yaroslavl Region and developed a rehabilitation strategy (artificial urethral sphincter placement). We conducted a comparative analysis of the direct costs of the strategies.

Results: The use of absorbent products for rehabilitation of patients with urinary incontinence following radical prostatectomy requires an average of 293300 (US $2650) per patient annually. The rehabilitation strategy with artificial urinary sphincter placement costs 486215 (US $4420) and results in a 65% increase in costs in the first year. However, in the second year of the rehabilitation program, artificial urinary sphincter placement has an obvious economic advantage, and within 10 years rehabilitation of a working-age patient using this strategy can save 2400000 (US $22244) (inflation expectations were not accounted for).

Conclusions: The implementation of the rehabilitation program involving artificial urinary sphincter placement for patients with urinary incontinence following radical prostatectomy has significant social and economic impacts.

Objective: To synthesize carboxymethyl chitosans (CMCS) from local raw material Apis mellifera, study their physicochemical properties, determine molecular weight and biological activity, and make CMCS-based antibacterial biodegradable polymer compositions.

Methods: CMCS was synthesized from dead bees; its molecular weight was determined by viscometry, and the degree of acetylation was established by coductometric titration. Its physicochemical properties were studied using infrared, nuclear magnetic resonance, and X-ray spectroscopy, and the results obtained were compared with quantum chemical calculations. The study presents the results of histological analysis to investigate the biological activity of CMCS.

Results: For the first time, O-CMCS was synthesized from Apis mellifera chitosan, and we determined its optimal conditions: sodium hydroxide concentration, alkylating agent ratio, process temperature and duration, and kinetic parameters.

For the first time, ointments for burn wounds based on Apis mellifera O-CMCS were prepared and tested on white rats.

The sodium hydroxide concentration was found to be 30%; the required temperature for the reaction was 650 °C; the polymer formation reaction process lasted 3 hours; the ratio of chitosan to monochloroacetic acid was 1:1, and the ratio of chitosan to isopropyl alcohol was 1:50.

Conclusions: The CMCS-based ointment has an antimicrobial effect and a unique antiseptic property. It does not disrupt the physiological functions of the skin or cause allergic reactions and toxicological problems.

Objective: To evaluate a correlation of clinically relevant markers between a patient-derived xenograft (PDX) model and triple-negative breast cancer (TNBC).

Materials and methods: For the PDX model of TNBC, we used tumor tissue from patient E. who presented with right-sided breast cancer at the National Medical Research Centre for Oncology (Rostov-on-Don, Russian Federation). The tumor fragments were subcutaneously implanted into BALB/c nude mice; thus, the first-generation xenograft was obtained. The xenogeneic model was studied on the fourth generation. The PDX model tissues and the patient’s tumor were analyzed by histological, immunohistochemical, and molecular genetic methods. For the immunohistochemical study we used antibodies against ER (estrogen receptor), PR (progesterone receptor), HER2/neu (human epidermal growth factor receptor 2), and Ki-67 (proliferation marker). Molecular genetic testing of the BRCA1 and BRCA2 genes was performed using real-time polymerase chain reaction.

Results: The histological examination demonstrated a correlation between the histotype of the original tumor tissue and the xenograft. Immunohistochemical analysis of the tumor samples revealed no expression of ER, PR, and HER2 markers. We identified 80% of Ki-67-expressing cells in the patient’s tumor and 90% in the xenograft. Furthermore, no mutations in the BRCA1 and BRCA2 genes were found in the patient’s tumor and the corresponding xenograft.

Conclusions: We evaluated clinically relevant markers in the PDX model of TNBC and found the correlation with the corresponding characteristics of the patient’s tumor. Thus, we generated the PDX model that can be utilized for both fundamental and preclinical research in oncology, eg, to study antitumor efficacy of novel drugs in TNBC and identify mechanisms of sensitivity or resistance to various therapeutic interventions.

When surgical treatment is limited in patients with stage IIIA-IIIB non–small cell lung cancer (NSCLC), multimodality treatment can improve long-term outcomes: neoadjuvant chemotherapy to reduce the tumor size followed by radical surgery.

In recent years, the combination of standard induction chemotherapy with immune checkpoint inhibitors has been the subject of active debate in the literature. Some studies demonstrate the efficacy of neoadjuvant chemoimmunotherapy, whereas other authors note additional difficulties of surgery after it.

In this case report we demonstrate features of surgery in a male patient with stage IIIB central NSCLC after chemoimmunotherapy and discuss difficulties of surgery associated with a minimally invasive video-assisted thoracoscopic surgery approach in complex anatomical lung resection and methods for preventing intraoperative and postoperative complications.

Objective: To demonstrate capabilities of multislice computed tomography (CT) in detailing a congenital heart disease (CHD), tetralogy of Fallot (TOF), in an infant.

Case report: We report a case of suspected TOF in a 3-month-old patient who underwent transthoracic echocardiography (TTE) at an initial hospitalization site and was admitted to the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) for further examination and treatment planning. The examination was supplemented with CT and computed tomographic angiography (CTA).

Results: TTE diagnosed TOF, patent ductus arteriosus, functional foramen ovale, right-sided aortic arch, and major aortopulmonary collateral arteries. CT and CTA revealed biventricular origin of the aorta, infundibular pulmonary stenosis, right ventricular outflow tract stenosis, and abnormal origin of the left pulmonary artery and the right subclavian artery.

Discussion: TTE is the primary screening method for TOF; however, its data are insufficient for planning surgical treatment. As a clarifying method, CTA is needed to detail the CHD, objectively assess the aorta, pulmonary veins and arteries, and exclude an extracardiac pathology.

Conclusions: The success of CHD surgical correction in children lies in the preoperative assessment of all anatomical features that determine the sequence of treatment and potential surgical risks. Using a single imaging method is insufficient to obtain reliable and accurate results when choosing a surgical strategy for patients with complex CHDs. Chest CTA has proven to be a highly effective method in assessing the CHD and clinically significant anatomical features.

Drug therapy is an integral part of cancer treatment, which, despite its positive effects on tumor cells, can negatively affect healthy body tissues. Various treatments and antitumor drugs can cause colitis. Its complications can be serious and even result in death. Awareness and knowledge of imaging features of drug-induced colitis in cancer patients can assist in early detection of its complications and thus improve patient management and outcomes.

The objective of this article is to provide a comprehensive analysis of urinary tract obstruction—one of the most common emergency conditions. We discuss modern diagnostic methods, surgical methods, and possible complications during treatment.

The article highlights modern endoscopic drainage techniques for acute and chronic urinary tract obstruction and compares various treatment methods and their effectiveness, depending on the chosen approach.

The literature review covers current research on the prevalence of obstructive uropathy in the population, clinical manifestations, and the most common causes of supravesical and/or infravesical obstruction.

Background: Dyschloremia is a common electrolyte imbalance that exacerbates many critical conditions in children.

Objective: To analyze etiology and pathogenic mechanisms of dyschloremia, its impact on an outcome of pediatric critical conditions based on literature data.

Materials and methods: We searched for and analyzed publications in the Cochrane Library, PubMed, and Medscape using the following keywords: dyschloremia, hypochloremia, hyperchloremia, children, adolescents, intensive care, critical conditions. A total of 45 sources were selected for review. To be included in the review, a paper had to describe the etiology and impact of dyschloremia on the course of critical conditions in children and adolescents. The exclusion criterion was the information on the etiology and impact of dyschloremia on the disease course in seriously ill adults and older people.

Results: Dyschloremia is quite often discovered in seriously ill children and adolescents treated in intensive care units. Hypochloremia caused by a variety of etiological factors can increase mortality in patients with acute heart failure and acute kidney injury. Hyperchloremia, which develops from excessive saline infusion, hyperchloremic acidosis, and kidney failure, increases mortality in critically ill patients, primarily in cases of severe trauma and sepsis.

Conclusions: Disturbed chloride balance plays an important role in pediatric intensive care. The chloride levels should be closely monitored in critically ill children.