Zaporozhye Medical Journal

Modern guidelines for the management of patients with atrial fibrillation and comorbid conditions: a literature review

N. S. Mykhailovska, R. V. Lytvynenko, Ya. M. Mykhailovskyi, O. V. Shershnyova — Mon, 15 Dec 2025 00:00:00 +0200

Aim. To summarize and analyze current literature data on the management of patients with atrial fibrillation (AF) and comorbid conditions.

Materials and methods. A systematic analysis of scientific publications from databases including PubMed, Scopus, Web of Science, and Google Scholar was conducted for the period 2020–2025. Additionally, the latest clinical guidelines from the ESC (2024), AHA / ACC / HRS (2023), and Ukrainian national recommendations were reviewed. The selected sources focused on the diagnosis, treatment, and prevention of AF in patients with comorbid diseases. Only publications meeting the criteria of thematic relevance, full-text availability, and up-to-date clinical content were included.

Results. In most clinical cases, AF is a manifestation of a polymorbid condition, which significantly modifies its clinical course, increases the risk of complications, and reduces the effectiveness of both pharmacological and interventional therapies. Comorbidities such as arterial hypertension, coronary artery disease, heart failure, type 2 diabetes mellitus, chronic kidney disease, obesity, and obstructive sleep apnea are considered not only etiological factors of AF but also markers of overall cardiovascular risk and/or structural heart disease. Timely diagnosis of AF considering comorbid pathology and based on electrocardiographic, imaging, and clinical-laboratory parameters, combined with risk stratification using validated scales (CHA₂DS₂-VA, HAS-BLED, mEHRA, SAMe-TT₂R₂, etc.) is crucial for selecting an optimal therapeutic strategy and reducing complication rates. The 2024 ESC guidelines propose an integrated AF-CARE pathway for AF management, which includes not only rhythm control and anticoagulation therapy but also mandatory management of comorbid conditions, thus forming the foundation for preventing AF recurrence and progression.

Conclusions. Comorbid conditions significantly influence the prognosis of AF patients, the choice of treatment strategy, and its effectiveness. Early diagnosis, risk stratification, and targeted management of comorbidities, based on the AF-CARE approach, should be considered an integral part of comprehensive AF care, contributing to improved clinical outcomes, patient survival, and quality of life.

Modern approaches to the diagnosis and treatment of cervicogenic headache

A. H. Chernenko — Mon, 15 Dec 2025 00:00:00 +0200

The aim of this study is to provide a systematic review of the current scientific literature on cervicogenic headache (CGH), highlighting its epidemiological characteristics and pathophysiological mechanisms, summarizing contemporary approaches to diagnosis and treatment, and proposing a stepwise algorithm for patient management.

Materials and methods. A structured literature search was conducted from January 2021 to April 2025 using the databases Google Scholar, PubMed, Clinical Key, and the Cochrane Library. The following search terms were used: cervicogenic headache, epidemiology, cervicotrigeminal system, diagnostic criteria, physical therapy, interventional techniques, and surgical treatment. Only open-access, full-text articles meeting the PRISMA standards and basic clinical relevance were included.

Results. A systematized overview of recent literature on the epidemiology, pathophysiology, diagnosis, and treatment of CGH is presented. Particular attention is given to the analysis of diagnostic criteria, especially those outlined in the ICHD-3 and CHISG classifications, clinical examination, imaging modalities (MRI, CT), and the role of provocation tests and therapeutic nerve blocks. Modern diagnostic strategies integrating clinical features with causality assessments are discussed. The review evaluates multimodal treatment strategies ranging from physiotherapy, manual and physical therapy to interventional methods (nerve blocks, radiofrequency therapy) and interventional procedures for refractory cases. A stepwise diagnostic and therapeutic algorithm is proposed to improve diagnostic accuracy and facilitate a personalized approach to CGH management, ultimately enhancing patients’ quality of life.

Conclusions. A structured, multimodal approach to the diagnosis and management of CGH enhances diagnostic precision and therapeutic outcomes. The implementation of evidence-based clinical algorithms in accordance with international guidelines, combined with individualized selection of therapeutic modalities, from conservative to interventional and surgical, contributes to improved patient outcomes and quality of life.

Acute obstructive large-bowel obstruction in older patients: current diagnostic and treatment methods (a literature review)

M. M. Mylytsia, V. V. Kotelevets — Mon, 15 Dec 2025 00:00:00 +0200

Intestinal obstruction is the most common complication of colon cancer. Today, one of the ways to improve treatment outcomes in older patients is to use a multidisciplinary approach with a wide range of clinical and diagnostic methods to determine the patient’s functional status and diagnose comorbidities. This requires the use of an individualized treatment approach to colon obstruction.

Aim. To review current evidence from the scientific literature on methods of diagnosis and treatment for acute obstructive colonic obstruction in older patients over the last 8 years.

Materials and methods. The work is based on the processing of the results and analysis of modern clinical practice guidelines, published clinical studies on the latest methods of diagnosis and treatment of acute obstructive colon obstruction in elderly and geriatric patients on the platforms MEDLINE, Google Scholar, PubMed, EMBASE and the Cochrane Database available between 2016 and 2024.

Results. One of the best methods for diagnosing colon obstruction is computed tomography, which is considered the “gold standard” for diagnosis. In stable patients, direct visualization of colon obstruction should be considered if colonoscopy is accessible. Biopsy is recommended prior to planned surgical intervention. The methodology used in most studies regarding minimally invasive approaches in the elderly has an uncertain degree of selection bias, which may partially explain some of the reported improved outcomes associated with laparoscopy. A multimodal approach using endoscopic and laparoscopic procedures has demonstrated favorable short-term outcomes when placing a stent as a bridge to surgery, providing a less invasive alternative to multistage open surgery.

Conclusions. Acute intestinal obstruction often necessitates emergency surgical intervention. Thanks to advances in surgical and systemic therapy, as well as a better understanding of the obstruction process biology, an increasing number of patients may achieve long-term survival. Minimally invasive surgical techniques are safe for elderly patients, however, further research is warranted.

The relationship between the extent of valve damage and pre-existing intracardiac pathology in children with infective endocarditis

O. H. Senko, V. V. Lazoryshynets — Mon, 15 Dec 2025 00:00:00 +0200

Aim. To identify an association between the extent of heart valve damage and pre-existing intracardiac pathology in children with infective endocarditis.

Materials and methods. The study included pediatric patients with a mean age of 8.9 ± 3.3 years (age range: 3.0 to 14.8 years). All participants had a history of infective endocarditis, as defined by the modified Duke criteria, with involvement of the heart’s valvular apparatus. All patients underwent reconstructive heart valve surgeries at the Department of Surgical Treatment of Congenital Heart Defects in Newborns and Young Children at the SI “Amosov National Institute of Cardiovascular Surgery, National Academy of Medical Sciences of Ukraine”. The data for analysis were extracted from primary medical records, including medical history charts, operative protocols, and clinical and instrumental examination data. All patients (or their parents) provided informed voluntary consent.

Results. The paper presents findings on the anatomical features of congenital heart defects that preceded the development of infective endocarditis. Non-cyanotic congenital heart defects were found to be the predominant pre-existing pathology (92.4 %) compared to cyanotic defects (7.6 %). Lesions of the heart’s valvular apparatus were also analyzed, which influenced the type of surgical intervention (organ-sparing vs. prosthetic replacement). Aortic valve lesions were significantly more frequent (29.6 %) than mitral (χ² = 9.68; p = 0.002) and tricuspid (χ² = 20.70; p = 0.0001) lesions. An association was found between the extent of heart valve damage and the pre-existing intracardiac pathology.

Conclusions. Organ-sparing operations significantly prevailed in the comparison group. However, in the main group, mitral valve replacement significantly outnumbered organ-sparing procedures (χ² = 4.55; p = 0.03). The risk of valve replacement in the main group was found to be 2.5 times higher compared to patients without congenital heart defects (OR = 2.50; 95 % CI: 0.64–9.65; p = 0.1).

Features of Holter ECG monitoring indicators and structural and functional cardiac remodeling in patients with Q-wave myocardial infarction in the acute period after primary coronary intervention

D. A. Lashkul, Yu. V. Savchenko — Mon, 15 Dec 2025 00:00:00 +0200

Aim. To identify the features of Holter ECG monitoring indicators and structural and functional cardiac remodeling in patients with Q-wave myocardial infarction (Q-MI) in the acute period after primary coronary intervention (PCI).

Materials and methods. In total, 78 patients with acute Q-MI were divided into 2 groups: group 1 – patients (n = 42) who underwent PCI during the acute period of Q-MI (median age 62 (52; 71) years); group 2 – patients (n = 36) who received standard pharmacological therapy (median age 67.5 (61.5; 75.0) years).

Results. The mean corrected QT interval (QTc) was 404 (391; 423) ms and 418 (397; 445) ms in groups 1 and 2, respectively. Group 1 demonstrated a significantly lower incidence of left ventricular (LV) akinesia (14 vs. 21 cases, p = 0.03), a significantly higher number of patients with normal ejection fraction (EF) (30 vs. 19, p = 0.01), and fewer patients with reduced EF (1 vs. 8, p = 0.01). A trend toward a shorter QTc was observed in group 1 (by 3.35%, p = 0.05). QTc duration correlated with the number of ST-segment episodes (r = 0.36, p < 0.05), the duration of tachycardia episodes (r = 0.37, p < 0.05; r = 0.43, p < 0.05), the number of premature ventricular contractions (PVCs) during the day and night (r = 0.52, p < 0.05; r = 0.51, p < 0.05), and the number of single and paired PVCs (r = 0.49, p < 0.05; r = 0.45, p < 0.05). The presence of LV akinesia correlated with episodes of supraventricular arrhythmias (r = 0.35, p < 0.05), while the presence of LV aneurysm correlated with the number of PVCs during both daytime and nighttime periods (r = 0.35, p < 0.05; r = 0.38, p < 0.05). In both groups, patients with significantly or moderately reduced heart rate variability (HRV) were observed: 13 vs. 16 (p = 0.2). In both study periods, an increase in the relative value of the very low frequency (VLF) component (>30 % of total power, TR) and a decrease in the high-frequency (HF) component (<15 %) were noted. The number of patients with RMSSD <20 ms was similar between groups: 19 (45 %) vs. 16 (44 %), p = 1.0.

Conclusions. In all patients with acute Q-MI, regulatory system tension was observed, characterized by predominance of the sympathetic component of HRV. A high proportion of the VLF component in total power indicated elevated psycho-emotional stress levels. Patients receiving standard pharmacological therapy demonstrated QTc prolongation and reduced autonomic nervous system flexibility compared with PCI-treated patients. In patients after PCI, the number of PVCs and ischemic episodes showed a direct relationship with QTc duration. Moreover, these patients had significantly fewer cases of LV akinesia, a greater number of patients with normal EF, and fewer cases of reduced EF compared with the drug therapy group.

Changes in hematological inflammatory markers in patients with unstable angina and post-COVID-19 syndrome: impact of smoking

Kh. M. Khamuliak, T. M. Solomenchuk — Mon, 15 Dec 2025 00:00:00 +0200

To evaluate changes in key hematological parameters and levels of leukocyte inflammatory markers in patients with unstable angina (UA), stratified by post-COVID-19 syndrome status and smoking history.

Materials and methods. A total of 147 patients with UA were included in the study. Group I included 87 patients with post-COVID-19 syndrome, and Group II consisted of 60 patients without post-COVID-19 syndrome. Each group was subdivided by smoking status: IA and IIA (smokers), IB and IIB (non-smokers). The following parameters were assessed in all subgroups: main hematological indicators and leukocyte inflammatory markers: neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), systemic immune inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI).

Results. Mean levels of MLR (37.93 %), SIRI (55.90 %), and AISI (53.99 %) were significantly higher in subgroup IA (smokers with post-COVID-19 syndrome) compared to subgroup IIA (smokers without post-COVID-19 syndrome). In subgroup IA, the proportion of patients exceeding optimal threshold values for MLR, SII, SIRI, and AISI was also 20–35 % significantly higher than in subgroup IIA. Among non-smokers with post-COVID-19 syndrome (subgroup IB), mean levels of NLR, SII, SIRI, and AISI were 33–40 % significantly higher than in subgroup of non-smokers without post-COVID-19 syndrome (subgroup IIB). Additionally, the percentage of individuals exceeding optimal thresholds for NLR, MLR, PLR, SII, and AISI was 20–30 % higher in subgroup IB than in subgroup IIB. The highest mean levels of NLR (50.0 %), MLR (37.9 %), as well as SII, SIRI, and AISI (52–62 %) were observed in subgroup IA compared to subgroup IIB.

Conclusions. Patients with post-COVID-19 syndrome demonstrated significantly higher levels of leukocyte inflammatory markers. In both smoker subgroups (IA and IIA) compared to non-smoker subgroups (IB and IIB), NLR, MLR, SII, SIRI, and AISI levels were significantly elevated by 33–55 %. The most pronounced changes in blood inflammatory markers and the highest proportions of patients exceeding optimal thresholds (NLR, MLR, PLR, SII, SIRI) were recorded in subgroup IA (smokers with post-COVID-19 syndrome).

Gastric volvulus: modern aspects of diagnosis and treatment

O. Yu. Usenko, O. S. Tyvonchuk, I. V. Babii, S. V. Ivchenko — Mon, 15 Dec 2025 00:00:00 +0200

Aim. To determine the optimal surgical treatment strategy for gastric volvulus in patients with paraesophageal hernias and to evaluate the effectiveness of different surgical techniques, specifically fundoplication versus gastropexy.

Materials and methods. Between 2020 and 2024, 145 patients with paraesophageal hernias underwent surgery at the Department of Thoracoabdominal Surgery, State Institution “O. O. Shalimov National Scientific Center for Surgery and Transplantation” of the National Academy of Medical Sciences of Ukraine. Gastric volvulus was diagnosed in 20 patients (13.7 %), including 18 cases of chronic volvulus and 2 cases of acute volvulus. According to the C. Singleton classification, 18 cases were organoaxial gastric volvulus, 1 case was mesenteroaxial, and 1 case was the combined type. Gastric volvulus was associated with type III paraesophageal hernias in 16 patients and with type IV hernias in 4 patients. Two clinical cases of surgical treatment for gastric volvulus are presented.

Results. Among the 20 patients with gastric volvulus, the mean length of hospital stay was 3 ± 1 days. Intraoperative complications included pneumothorax in 1 (5 %) patient who underwent fundoplication. One patient (5 %) in the fundoplication group experienced early postoperative gastroparesis. No cases of postoperative gastroparesis were observed in patients who underwent gastropexy. No recurrence of gastric volvulus was reported during a long-term follow-up of up to 2 years after either fundoplication or gastropexy. One patient (5 %) experienced an anatomical hiatal hernia recurrence after fundoplication without progression of gastroesophageal reflux disease. A comparison of long-term outcomes (esophagogastroduodenoscopy and upper GI radiography) between the fundoplication and gastropexy groups revealed no significant differences in the incidence of erosive lesions or gastroparesis.

Conclusions. Gastric volvulus associated with a paraesophageal hiatal hernia is a rare but potentially life-threatening complication that requires prompt diagnosis and often a multi-stage treatment approach. Multislice computed tomography with contrast enhancement is the most informative imaging modality for diagnosing gastric volvulus. Laparoscopic access is the preferred surgical approach for treating all types of hiatal hernias, including those complicated by gastric volvulus. The optimal treatment includes laparoscopic mediastinal dissection with esophageal mobilization and transposition into the abdominal cavity, cruroplasty, and fundoplication. However, in elderly patients with significant comorbidities, less invasive procedures, such as gastropexy, may be more appropriate.

Experience in the treatment of gastric fistulas associated with combat abdominal trauma

S. O. Kosulnikov, O. M. Biesiedin, S. O. Tarnapolskyi, K. V. Kravchenko — Mon, 15 Dec 2025 00:00:00 +0200

External gastric fistulas have always been a complication of gastric surgery. Russia’s full-scale invasion of Ukraine has led to an increase in the number of wounded patients presenting with this pathology. The course and characteristics of this condition, namely, the severity and multifocality of the injuries, the duration and unfavorable results of previous treatment, the timing of the primary surgical intervention, and the extremely high resource intensity of the pathology, make this study relevant.

Aim: to analyze the experience of treating gunshot gastric fistulas using a multidisciplinary approach in the context of combat abdominal trauma.

Materials and methods. The experience of treating 111 patients with gunshot fistulas from 2022 to July 2025 is presented. A model of interaction between endoscopic and surgical methods targeting the external gastric defect, combined with optimal dual-probe intubation is shown.

Results. The proposed approach for treating external gunshot gastric fistulas, which includes the authors’ technique of gastric fistula myoplasty using a displaced rectus abdominis muscle flap combined with vacuum therapy, resulted in a complete cessation of fistula discharge through the drains one day after treatment in 86 (77 %) patients, as confirmed by fistulography. Nine (10 %) patients with multiple severe wounds and severe sepsis died.

Conclusions. To improve the treatment outcomes for gastric fistulas, the technique of gastric fistula myoplasty using a displaced rectus abdominis muscle flap in combination with transabdominal vacuum therapy and, in some cases, endoscopic vacuum therapy can be effectively utilized. The proposed approach for treating gunshot gastric fistulas is expected to improve the treatment outcomes for wounded servicemen of the Armed Forces of Ukraine.

Ultrastructural features of pancreatic islets in rats with experimental pathology

T. V. Ivanenko, Yu. M. Kolesnyk, A. V. Abramov — Mon, 15 Dec 2025 00:00:00 +0200

In type 1 diabetes mellitus, the primary pathological alterations in the endocrine apparatus arise from the progressive loss of beta-cells, whereas beta-cell dysfunction is the key pathogenic factor in type 2 diabetes mellitus.

The aim of this study was to perform a quantitative assessment of the pancreatic islet architecture in normotensive Wistar rats under conditions of streptozotocin-induced diabetes mellitus, during hypoxic training, and in spontaneously hypertensive rats (SHRs).

Materials and methods. The experiment was conducted on 35 albino Wistar rats and 10 SHRs aged 5–6 months. The animals were divided into four groups: Group 1 (n = 10) – control Wistar rats; Group 2 (n = 15) – Wistar rats with streptozotocin-induced diabetes mellitus by a single intraperitoneal injection of streptozotocin (Sigma-Chemical, USA) at a dose of 50 mg/kg dissolved in 0.5 mL of 0.2 M citrate buffer (pH = 4.5). Only animals with fasting blood glucose exceeded 10.0 mmol/L at week 4 after streptozotocin administration were included in the study. Group 3 (n = 10) – SHR rats with hereditary arterial hypertension; Group 4 (n = 10) – Wistar rats subjected to a 15-day hypoxic training regimen according to the protocol: 15 consecutive days, 6 hours daily during days 1–5 at simulated altitudes ranging from 1 to 5 kilometers above sea level followed by 10 days at 6 km above sea level in a barochamber. Insulin and glucagon in pancreatic islet cells were detected using the immunofluorescence method with Insulin Antibody, clone 2D11-H5 (sc-8033 AF546), and Glucagon Antibody, clone K79bB10 (sc-57171 FITC) (Santa Cruz Biotechnology, USA). Immunofluorescent imaging was performed using an AxioImager-M2 fluorescence microscope (Carl Zeiss, Germany) equipped with an AxioCam-HRm digital camera (Carl Zeiss, Germany).

Results. In control Wistar rats, the specific density of pancreatic islets in the pancreas was 230 ± 3 cm^–2. The islet structure was predominantly composed of small islets, while other types of islets, including solitary endocrinocytes, exhibited approximately equal distribution densities. Induction of experimental diabetes in Wistar rats by a single streptozotocin injection led to a reduction in the total number of islets to 117 ± 5 cm^–2, i. e., a twofold decrease compared to the control group. Within the structure of the endocrine apparatus, nearly 50 % were small islets, the number of which exceeded that of control rats by 17 %, whereas the number of larger islets was significantly reduced. The genetic factor leading to hereditary hypertension in SHRs caused a 40 % decline in islet density (140 ± 3 cm^–2) compared to controls, which nevertheless remained 10 % higher than in diabetic animals (p < 0.05), partially explaining the maintenance of normoglycemia in SHRs. Prolonged hypoxic training in Wistar rats did not significantly alter the total number of islets (241 ± 5 cm^–2) but increased the number of both β⁺/α^– and β^–/α⁺ islets, as well as solitary endocrinocytes by 31 % (p < 0.05) compared to controls.

Conclusions. The endocrine pancreas is composed predominantly of “classical” islets containing beta- and alpha-cells. Small islets (≤1500 μm²) constituted approximately one-third of all islets. The total specific density of islets in control and hypoxia-trained Wistar rats was nearly twice that of diabetic or hypertensive SHRs. Clusters of solitary alpha-endocrinocytes were fourfold more numerous than solitary beta-endocrinocytes. In the pancreas of normal Wistar rats, an equal number of small islets with β⁺/α⁻ and β⁻/α⁺ phenotypes were found. Pancreatic islet β⁻/α⁺ phenotype predominated in diabetic rats, whereas in hypoxia-trained Wistar rats, the population of β⁺/α⁻ islets was sixfold higher than that of islets with β⁻/α⁺ phenotype, and this phenotype was absent in diabetic rats.

Predictive factors for metabolic profile alterations following radioactive iodine treatment in hyperthyroidism

A. E. Mammadova — Mon, 15 Dec 2025 00:00:00 +0200

Radioactive iodine (RAI) therapy is an effective treatment for hyperthyroidism, particularly Graves’ disease and toxic adenoma. Although its efficacy in normalizing thyroid hormone levels is well-established, predictive biomarkers for long-term metabolic effects remain underexplored.

Aim. To examine post-RAI metabolic changes and assess the predictive value of baseline TSH and metabolic indices for metabolic risk in patients with Graves’ disease and toxic adenoma.

Materials and methods. This prospective study included 83 patients (Graves’ disease, n = 62; toxic adenoma, n = 21), aged 25–65 years, who underwent RAI therapy. Participants were stratified by pre-treatment TSH levels: Group A (≤0.01 mIU/L) and Group B (>0.01 mIU/L). Metabolic parameters (glucose, insulin, HOMA-IR, leptin, TyG index, lipid profile, and BMI) were assessed before and 12 months after treatment. Statistical analyses included Mann–Whitney U and Wilcoxon signed-rank test, and ROC curve analysis.

Results. Group A, with suppressed baseline TSH, exhibited significantly higher post-treatment insulin resistance (HOMA-IR: 4.77 vs. 3.09, p < 0.001), fasting insulin (p < 0.001), TyG index (p = 0.005), and fasting glucose (p = 0.006), despite comparable BMI between groups. Leptin levels were higher in Group A but not statistically significant. Wilcoxon tests revealed significant improvements in hormonal and metabolic parameters in both groups. ROC analysis identified LDL (AUC = 0.662, p = 0.027) and HDL (AUC = 0.665, p = 0.024) as significant predictors of metabolic outcomes, while leptin showed borderline significance (AUC = 0.631, p = 0.074).

Conclusions. RAI treatment in hyperthyroid patients is associated with substantial metabolic changes, particularly in those with suppressed pre-treatment TSH levels. Insulin resistance and adipokine dysregulation are more pronounced in this subgroup, with LDL and HDL values identified as significant post-RAI metabolic predictors. These findings underscore the need for metabolic risk stratification and targeted follow-up in patients undergoing RAI therapy.

Features of serum Ki-67 and APRIL level alterations in women with endometrial hyperplasia combined with arterial hypertension

Ya. V. Zemlianyi, N. A. Zemliana — Mon, 15 Dec 2025 00:00:00 +0200

Aim. To assess serum levels of the proliferation markers Ki-67 and APRIL in women with endometrial hyperplasia (EH) combined with arterial hypertension (AH), and their correlation with clinical, medical history, and morphofunctional parameters of the endometrium.

Materials and methods. The study included 75 women with EH and simple or complex endometrial hyperplasia without atypia who received treatment at the Gynecology Department of Municipal Non-Commercial Enterprise “City Hospital No. 7” of Zaporizhzhia City Council. Patients were divided into two groups based on the presence of AH: 44 women with AH (mean age 36.40 ± 1.56 years) and 31 women without AH (mean age 34.20 ± 1.34 years). The groups were comparable by age and morphological characteristics of hyperplasia. The control group included 20 apparently healthy women who had no reproductive of extragenital pathology. All patients underwent ultrasound examination (MyLab50, Esaote, Italy) and video hysteroscopy (Karl Storz, Germany). Serum levels of Ki-67 and APRIL were determined by ELISA (Elabscience, USA). Blood pressure was measured according to ESC (2024) guidelines. Statistical analysis was performed using Statistica for Windows 13; differences were considered significant at p < 0.05.

Results. Among women with EH and concomitant AH, grade I hypertension was found in 47.7 %, grade II – in 40.9 %, and grade III – in 11.4 %. Serum Ki-67 levels were significantly higher in both EH groups, with and without AH, compared to controls (p < 0.05), with the highest levels observed in patients with EH and AH (p < 0.05). Serum APRIL levels were also significantly elevated in both EH groups compared to controls (p < 0.05), with no significant difference between hypertensive and normotensive EH patients. Correlation analysis revealed a significant positive association between serum Ki-67 levels and disease duration (+0.41; p < 0.05), endometrial thickness (M-echo) (+0.52; p < 0.05), and systolic blood pressure (+0.56; p < 0.05). Serum APRIL levels correlated positively with patient age (+0.42; p < 0.05) and disease duration (+0.44; p < 0.05).

Conclusions. APRIL levels are elevated in endometrial hyperplasia irrespective of the presence of arterial hypertension. The highest Ki-67 levels were observed in patients with endometrial hyperplasia and concomitant arterial hypertension. The Ki-67 levels were significantly correlated with M-mode endometrial thickness, systolic blood pressure, and disease history duration; the APRIL levels were correlated with age and the hyperplastic processes duration.

Evaluation of the NanoGraft biomaterial immunogenicity in maxillary sinus augmentation

O. S. Kosinov, O. M. Mishchenko — Mon, 15 Dec 2025 00:00:00 +0200

Aim. This study aimed to evaluate the immunogenicity of the Nano Graft biomaterial in biopsies obtained from the maxillary sinus augmentation zone using morphological and immunohistochemical assessment of the cellular response.

Materials and methods. The study included 22 patients with partial posterior edentulism who underwent open maxillary sinus floor elevation using the Nano Graft biomaterial. Biopsy samples collected at the time of implant placement were fixed, decalcified, and processed for histological and immunohistochemical analysis with the following markers: CD8 (cytotoxic T lymphocytes), FOXP3 (regulatory T cells), CD68 (macrophages/osteoclasts), CD163 (M2 macrophages), SATB2 (osteogenic cells), and CD34 (endothelial cells). Inflammatory activity was assessed using a semi-quantitative scale.

Results. Histological examination revealed fibrous connective tissue containing fibroblasts, microvascular structures, and signs of osteon formation and bone remodeling. Immunohistochemistry demonstrated a low-grade lymphohistiocytic infiltrate with scarce CD8⁺ cells and no detectable FOXP3⁺ regulatory T cells, indicating the absence of a pronounced immune response. An abundant presence of CD163⁺ M2 macrophages suggested polarization toward a regenerative phenotype. Strong SATB2 expression confirmed osteoinductive activity, while numerous CD34⁺ endothelial cells indicated active angiogenesis.

Conclusions. The Nano Graft biomaterial exhibited low immunogenicity, characterized by a mild CD8⁺ T-cell response, absence of FOXP3⁺ regulatory T cells, and predominance of anti-inflammatory M2 macrophages. Its osteogenic potential and pro-angiogenic effects support its biocompatibility and clinical applicability for maxillary sinus augmentation.

Comprehensive psychophysiological assessment as a tool for enhancing public health system readiness in emergencies

I. V. Kuzin, A. M. Hrynzovskyi, S. I. Kalashchenko — Mon, 15 Dec 2025 00:00:00 +0200

The increasing frequency of chemical, biological, radiological, and nuclear emergencies necessitates a high level of preparedness among rapid response teams. One of the key conditions for operational effectiveness is psychophysiological assessment, which is crucial for determining the ability of specialists to operate under conditions of time and information deficit, high stress, and risk.

Aim. To assess the psychophysiological status of rapid response personnel (core and reserve groups) to establish quantitative and qualitative criteria for professional selection and improve operational effectiveness.

Materials and methods. A total of 381 personnel (284 women, 97 men), with an age range of 25–72 years, were enrolled in the study. The participants were employees of the Centers for Disease Control and Prevention and the Public Health Center. The study was conducted in 2023–2024 using the PFO-1 (Psycholot-1) computerized psychophysiological assessment system. A comprehensive psychophysiological testing battery consisting of eight assessments was employed. The comparison methods included: Simple Visuomotor Reaction (Square), Complex Visuomotor Reaction (Triangle–Circle), Pendulum, Clocks, Table, Attention Switching, Extreme Conditions, Prolonged-Stimulus Complex Visuomotor Reaction, and Individual Strategy Assessment. Statistical analysis was performed using the D’Agostino-Pearson test, Kruskal-Wallis test, Dunn’s post hoc test, and Mann-Whitney U test in IBM SPSS Statistics (version 22) and Microsoft Excel 2016.

Results. Eight key psychophysiological criteria were identified as determinants of specialists’ effectiveness in high-risk conditions: balance of nervous processes, attention concentration, attention switching, spatial orientation, psychodynamics, resistance to monotony, stress tolerance, and risk-taking behavior. The most effective were groups 3 and 4, demonstrating high performance in attention concentration, psychodynamics, and cognitive flexibility. The proposed effectiveness scale enabled the ranking of participants and defined quantitative threshold values that may serve as normative indicators for professional selection.

Conclusions. Comprehensive psychophysiological assessment is an essential prerequisite for the effective functioning of rapid response teams in emergencies. The developed evaluation system, based on eight criteria with defined thresholds, ensures objectivity and standardization of personnel selection. The highest level of readiness was demonstrated by specialists with a predominance of excitatory nervous processes, high attention concentration, minimal errors, and sufficient stress tolerance. The findings may serve as a basis for updating the regulatory framework for professional selection of public health personnel and for strengthening the effectiveness of the emergency response system.