Vol 17, No 1 (2026)

BACKGROUND: Currently, any surgeon can encounter a mine blast wound to the abdomen and must be prepared to provide qualified care. The nature of injuries in modern combat trauma has changed compared to previous military conflicts. Therefore, the principles of their diagnosis and treatment require clarification. aim: of this study was to analyze our clinical experience in providing medical care for patients with abdominal wounds sustained during a modern military conflict. Methods: This study evaluated the clinical management and outcomes of 231 patients with penetrating abdominal injuries sustained during combat operations. Native computed tomography was performed in all admitted casualties. Gastro-duodenoscopy and colonoscopy were carried out selectively, based on clinical indications. Depending on the severity of the patient’s condition, either a staged surgical approach or a single-stage surgical treatment was applied. Results: A total of 1,359 patients were initially suspected of having abdominal combat trauma. Following comprehensive diagnostic evaluation, internal organ injuries were excluded in 1,128 patients (83%). Laparotomy was performed in 224 patients (16.5%), laparoscopy—in 7 (0.5%). Isolated wounds were present in 40 (17.3%) wounded, combined—in 191 (82.7%). Penetrating abdominal trauma was combined with wounds to the chest, extremities, pelvis, head and spine. In 96 cases (41.5%), the participation of specialists of three or more surgical specialties was necessary. Patients sustaining small-fragment injuries often presented with an initially blurred clinical and instrumental picture during the first post-injury hours. Among penetrating abdominal wounds, only 5 cases (2.2 %) demonstrated no damage to underlying anatomical structures. In 98 (42.4%) cases, only minimal interventions were required, including suturing of hollow organ injuries and hemostasis with coagulation/suturing. There were no mortality rates in the immediate postoperative period. Conclusion: Penetrating abdominal wounds inflicted by modern fragmentation ordnance can be very difficult to recognize in the early stages. The best treatment outcomes can potentially be achieved only by bringing high-tech care closer to the scene of hostilities, early detection, and treatment of internal organ damage before peritonitis develops. If abdominal wounds are suspected, performing native CT scans on all patients and endoscopic examinations when indicated allows for a highly accurate diagnosis and selection of patients for whom laparotomy is indicated on an emergency basis. When choosing the extent of surgical intervention, it is important to consider the overall severity of the patient’s condition and remember that excessive surgical trauma will only harm the patient. Nevertheless, the application of a reduced-volume initial surgical intervention combined with a staged surgical management strategy is warranted only in selected cases of combat casualties. Strengthening collaboration between military and civilian healthcare systems and creating mechanisms for improved continuity of care are essential.

BACKGROUND: The spatiotemporal gait parameters are frequently impaired in post-stroke patients. The treatment involves rhythmic auditory stimulation. One disadvantage of existing approaches is the need for long-term treatment, which does not always provide a favorable outcome. AIM: The work aimed to assess the possibility of improving reciprocal gait in patients after ischemic stroke using a metronome during a single training session. METHODS: Patients (n=22) after ischemic stroke had a single training session using a metronome. Patients were divided into two groups based on the findings of a triplicate biomechanical study: “positive effect” (n=15; hemiparesis; subacute [n=11] and chronic [n=4] phases of stroke recovery) and “no effect” (n=7; hemiparesis; subacute [n=3] and chronic [n=4] phases of stroke recovery). RESULTS: The positive effect group showed the following significant changes: increased walking cycle for both limbs (p < 0.05), decreased walking cadence (p < 0.05), improved walking rhythmicity coefficient (p < 0.05), reduced single leg stance phase on the contralateral side (p < 0.05), and improved reciprocity (p < 0.05). CONCLUSION: Patients with walking asymmetry can benefit from a single metronome training session during different phases of stroke recovery. However, individual patient characteristics that may limit the method’s efficacy must be considered. Further research is needed to investigate the mechanisms of action and assess the long-term outcomes of rhythmic auditory stimulation to restore reciprocal coordination during walking.

BACKGROUND: Despite the visual accessibility, as of today, there are still persisting high rates of malignant tumors of the tongue newly diagnosed at later stages, which determines the complexity of treatment in this category of patients. The main variant of surgical treatment for locally advanced stages of tongue cancer remains the glossectomy with the resection of the oral cavity floor muscles, which results in the impairment of the swallowing and speaking functions. Due to that, still topical are the search and the development of new modern reconstructive methods to be used during the glossectomy for increasing the quality of life for the patient. AIM: To perform the clinical approbation of the method of tongue reconstruction after glossectomy using the re-vascularised dermal-muscle flap and the TiNi metal wire weft-knitted mesh. METHODS: The single-center prospective non-randomized research included 6 patients (3 men and 3 women aged from 38 to 56 years) with the locally advanced (Т3–Т4) stages of tongue cancer, which underwent the glossectomy with simultaneous reconstruction. The follow-up period ranged from 3 to 8 months. RESULTS: In all the operated patients, we managed to restore the shape of the tongue. Creating the anatomical shape of the tongue and of the oral cavity floor without the ptosis of the hyoid bone and with the used reconstructive flap has allowed for more comprehensively and at earlier times restoring the speaking and the swallowing functions. No inflammatory changes were reported in the area of the reconstruction and of the implantation of the titanium nickelide mesh in any of the patients. One case was reported as the local recurrence in 4 months after surgery. CONCLUSION: The developed reconstructive-surgical method allows for effectively and safely reconstructing the tongue and the oral cavity floor after glossectomy in oncology patients, to restore the swallowing and the speaking function without developing the significant postoperative complications.

Digital twins are promising tool for personalized medicine in traumatology and orthopedics. Their use enables virtual modeling of joint pathology and treatment based on patient-specific biomechanical characteristics. A systematic review was conducted in accordance with PRISMA guidelines to evaluate the application of digital twins in traumatology and orthopedics, with a focus on joint imaging techniques and cost-effectiveness. Data search was performed in PubMed, Scopus, Web of Science, Springer, Elsevier, eLibrary.RU, and CyberLeninka databases (2020–2025), focusing on joint digital twins, imaging techniques, and cost-effectiveness. The review included 10 studies. Key imaging modalities were 3D computed tomography for assessing bone geometry, magnetic resonance imaging with T2 mapping for cartilage evaluation, and computed tomography arthrography as indicated (e.g., in femoroacetabular impingement) for visualization of chondrolabral defects. Applications of digital twins were demonstrated in preoperative planning, osteoarthritis simulation, and economic evaluation of robotic-assisted interventions. Advantages of digital twins include improved diagnostic accuracy and treatment personalization although clinical integration, standardization, and regulatory aspects remain challenging. Digital twins in orthopedics is a promising direction; however, their widespread implementation requires further clinical and economic validation.

Ischemic stroke remains a major medical, social, and economic concern due to high disability rates and substantial treatment and rehabilitation costs. Reperfusion therapy (thrombolysis and thrombectomy) is one of the most effective therapeutic options, considerably reducing mortality and disability rates. However, 2%–7% of thrombolysis cases are associated with symptomatic hemorrhagic transformation, which causes clinical deterioration and limits rehabilitation. Hemorrhagic transformation is caused by a disruption of the blood-brain barrier, which has a protective function and is characterized by selective permeability. The blood-brain barrier is formed by endothelial cells, astrocytes, pericytes, neurons, and the extracellular matrix. Tight junction proteins in endothelial cells are essential for maintaining blood-brain barrier integrity. In ischemic stroke, neuroinflammatory mechanisms are activated, leading to the degradation of tight junction proteins and extracellular matrix components, which results in increased blood-brain barrier permeability and dysfunction. Reperfusion therapy may exacerbate blood-brain barrier injury due to reactive hyperemia caused by impaired cerebral autoregulation. Existing imaging markers of hemorrhagic transformation (infarct volume, hyper dense middle cerebral artery sign on computed tomography, severity of leukoaraiosis, presence and extent of collateral circulation, etc.) are not always easily accessible or interpretable. Therefore, there is ongoing interest in identifying simple and reliable biomarkers that can serve as laboratory indicators. These include routine parameters (serum glucose, urinary albumin, lipid profile parameters, thromboelastography indices, B-type natriuretic peptide) as well as more specific markers such as matrix metalloproteinases, tight junction proteins, intercellular and vascular adhesion molecules, and endogenous fibrinolysis inhibitors. This review discusses promising biomarkers and their role in the pathogenesis of hemorrhagic transformation, with a particular emphasis on their sensitivity, specificity, and the availability of threshold values.

BACKGROUND: Superior mesenteric artery syndrome, being a rare pathology, requires clinical vigilance among doctors of all specialties. The clinical manifestations of this condition are nonspecific and highly variable. When diagnosed promptly, conservative therapy demonstrates high efficacy in the majority of clinical cases. The approach is directed towards identifying the root cause of the condition and its resolution. Surgical intervention is recommended in cases of progressive duodenal obstruction. CLINICAL CASE DESCRIPTION: This case study presents the clinical management of an 18 year old male patient who had undergone two reconstructive procedures to address compression of the duodenum between the superior mesenteric artery and the aorta. After these interventions, dyspepsia and asthenia worsened. A multidisciplinary approach allowed rapid preparation for another surgery, which resolved duodenal obstruction and restored food passage. This positively affected the patient’s occupational and social rehabilitation. CONCLUSION: The present case demonstrates that anterior transposition of the horizontal segment of the duodenum relative to the superior mesenteric vasculature is a safe and effective technique for surgical correction of aortomesenteric compression syndrome.

BACKGROUND: Atrioesophageal fistula is a rare complication following radiofrequency catheter ablation for atrial fibrillation and is associated with high mortality. Clinical manifestations of atrioesophageal fistula are nonspecific and may include fever, neurological symptoms, and sepsis, which complicates timely diagnosis. A literature search was conducted in international databases PubMed, Google Scholar and eLibrary for the last five years (2019–2024) using the keywords “atrioesophageal fistula” and “complications of radiofrequency catheter ablation.” Thirty articles were selected for review. CLINICAL CASE DESCRIPTION: The aim of this publication is to present a rare case of atrioesophageal fistula development after radiofrequency catheter ablation in a 53-year-old female patient. The features of the clinical course, diagnostic challenges, as well as possible approaches to early recognition, prevention, and treatment of this complication were analyzed. CONCLUSION: Even when diagnosed early, atrioesophageal fistula carries an exceedingly poor prognosis. This underscores the critical need for sustained clinical vigilance, improved prevention strategies, and the establishment of standardized management guidelines for suspected cases of this lethal complication.