УДК: 612.015.11:616.69-008.1:616-001

Introduction. Most military personnel survive serious injuries, but many are left to live with long-term sexual and reproductive disorders. The injuries often result in psychological trauma and post-traumatic stress disorder, which negatively affect behavioral health and sexual function. There is emerging evidence linking erectile dysfunction (ED) to oxidative stress. Overall, combat trauma is characterized by a broad response of the body to harmful effects involving all body systems, leading to significant changes in the pro-oxidant-antioxidant balance.

Materials and Methods. The study was conducted on peripheral blood lymphocytes and serum of men with ED due to combat trauma (shrapnel and bullet wounds) and healthy men (control group). Both the study and control groups were divided into two age groups (young and middle age groups). Antioxidant activity was studied by measuring glutathione peroxidase (GP), glutathione reductase (GR) and glutathione-S-transferase (GsT).

Results. A comparison of the groups using the Kruskal–Wallis method revealed a significant decrease in the GPx and GR activity in blood lymphocytes and serum in men with ED due to combat trauma compared with healthy men of corresponding age groups. It was shown that GPx activity in peripheral blood lymphocytes of patients of the young age group was 1.64-fold lower, and in patients of the middle age group 1.70-fold lower than in the control group (P <0.001). Similar changes were observed in blood serum. GR activity in blood lymphocytes in patients of the young and middle age groups was 1.42-fold lower than in healthy men (P <0.001). In blood serum, GR activity in patients of the young age group was 1.70-fold (P <0.001) and in patients of the middle age group 1.56-fold lower than in healthy men (P <0.001). GsT activity in blood lymphocytes in both age groups increases by 1.2-fold, however these changes were not significant (P >0.05).

Conclusion. Erectile dysfunction caused by combat trauma is accompanied by a significant decrease in the activities of antioxidant defense enzymes – glutathione peroxidase and glutathione reductase. There is no difference between age groups of patients with erectile dysfunction due to combat trauma. However, the activity of glutathione S-transferase practically does not change, although there is a tendency for its increase.

Introduction: Assessment and treatment of open soft tissue injuries, in particular thermal injuries, is an important issue in surgery, as the correct choice of treatment tactics depends on the accurate determination of the wound size and depth. Reliable assessment of burn wounds allows for treatment adjustments, data storage for scientific research and improved prognosis, reducing the length of hospital stay of patients.

Objectives: Review the methods of assessing the size and depth of a skin defect and, in particular, a burn wound.

Materials and methods: To conduct the review, we analyzed literary sources in English and Ukrainian found on PubMed, Cochrane Library, ResearchGate, MEDLINE, Scopus, and Web of Science databases. Searches were performed using MeSH keywords covering burn depth, measurement of skin defects, and non-invasive imaging techniques. The analysis included publications from 2000 to 2024, but primary sources were also considered for a complete description of methods.

Results: Analysis of methods for determining planimetric characteristics and depth of burn wounds revealed certain disadvantages, including difficulty in use and high cost. Most of these techniques require considerable time and resources, which limits their practical application in clinical settings.

Conclusions: Further research should prioritize the development and implementation of more accessible, user-friendly, and cost-effective techniques for the evaluation of burn wounds. The ideal solution would be the introduction of new technologies or improvement of existing approaches to ensure the accuracy of measurements, ease of operation, and seamless integration into existing treatment protocols. This will significantly improve the diagnosis and treatment of patients with burns.

Introduction. Soluble suppression of tumorigenicity 2 (sST2) and galectin-3 are considered markers of myocardial hypertrophy and fibrosis. Changes in their concentrations are observed in cardiovascular diseases, including arterial hypertension.

The aim. To determine threshold values of hypertrophy and fibrosis biomarkers, namely sST2 and galectin-3, in patients with arterial hypertension.

Materials and methods. A prospective study was conducted on 82 patients with arterial hypertension (AH). Patients were stratified into two groups based on left ventricular mass index (LVMI) values: Group 1 with left ventricular hypertrophy (LVMI > 115 g/m² for men and 90 g/m² for women, n=33) and Group 2 with normal LVMI values (n=27).

Results. Patients with left ventricular hypertrophy exhibited significantly elevated sST2 and galectin-3 levels. Direct correlations were observed between LVMI and sST2 values (r=0.6397; p=0.000) and galectin-3 (r=0.5113; p=0.001). Both biomarkers correlated with various cardiac parameters, including interventricular septal thickness at end-diastole, left atrial diameter, left ventricular end-diastolic diameter, and posterior wall thickness at end-diastole (specifically with sST2). With a selected sST2 value of 17.0 ng/ml, the diagnostic method demonstrated 88.33% accuracy, 92.59% specificity, 93.3% positive predictive value, and 83.33% negative predictive value for hypertrophy. At the chosen galectin-3 level of 29.0 ng/ml, the proposed method achieved 72.22% accuracy, 73.68% sensitivity, 70.59% specificity, 73.68% positive predictive value, and 70.59% negative predictive value.

In conclusion, measuring sST2 and galectin-3 biomarkers facilitates the evaluation of left ventricular hypertrophy, serving as an additional tool in assessing cardiac dysfunction and indicating diverse developmental pathways.

As a result of severe injuries and post-traumatic stress disorder, sexual dysfunction and fertility disorders are among the complications men experience. The mechanisms of the effects of combat trauma are complex and include an imbalance of the immune system, which leads to severe inflammatory reactions and other immunomodifying effects after injury. An early r e sponse to an acute inflammatory injury, such as wound healing, is the production of nitric oxide (NO) as a result of L-arginine metabolism. NO is an important regulator of cellular functions throughout the wound healing process, stimulating fibroblasts to produce collagen, promoting matrix deposition, remodeling, and angiogenesis. However, insufficient or excessive NO synthesis negatively affects wound healing. The aim of the study was to investigate the prognostic power of arginase activity parameters and individual NO synthase isoforms as potential biomarkers of nitrosative stress in men with combat trauma. The study e x amined 68 men with combat trauma, including 42 men aged 20 – 39 years and 26 men aged 40 – 53 years. Criteria for inclusion in the control groups: 30 healthy men aged 20 – 39 years and 18 men aged 40 – 53 years with normal levels of cNOs, iNOs and arg i nase activity, somatically healthy, without sexual dysfunction. In all groups, the activity of NO synthases and arginase as markers of nitrosative stress was measured spectrophotometrically in blood serum and lymphocyte samples. The prognostic power of the parameters of cNOS, iNOS and arginase activity in the combat trauma and control groups was determined by the receiver opera t ing characteristic curve (ROC curve). Based on the ROC analysis, the threshold value of cNOS activity in blood lymphocytes was determined, which is an integral highly sensitive criterion for unfavorable prognosis in combat trauma. For men aged 20 – 39 years, this figure is ≤37.5 nmol NADPH(H + )/min. mg with a sensitivity of 61.9% and a maximum specificity of 100 . 0 %, while for the group of men aged 40 – 53 years, the cutoff value is ≤38.4 nmol NADPH(H + )/min. mg with a sensitivity of 65. 4 % and a maximum specificity. In the ROC analysis of iNOS activity in lymphocytes of men with combat trauma in relation to healthy men, an excellent model quality was obtained with the maximum area under the ROC curve for patients of both age groups. The lymphocyte arginase activity in the two age groups of men with combat trauma were characterized by the very good diagnostic accuracy of the test. Thus, the parameters of oxidative-nitrosative stress, in particular the activity of constitutive and inducible isoforms of NO synthase and arginase in blood serum and lymphocytes can be potential markers in distinguishing pathological changes in men affected by combat (bullet and shrapnel wounds). The inducible isoform of NO synthase has been shown in studies to be a highly sensitive and highly specific marker regardless of the age of men.

Background: Botulinum toxin type A has become an increasingly used tool in the preoperative management of giant abdominal wall hernias. Its primary objective is to “downstage” the hernia by inducing temporary paralysis of the lateral abdominal wall muscles, thereby increasing their compliance and enabling safer fascial closure. While the muscular and anatomical benefits of this approach are well documented, the potential effects on pulmonary function remain poorly studied, despite the involvement of the targeted muscles in the process of breathing.

Objective: This study aimed to evaluate the impact of botulinum toxin type A on respiratory system function, using spirometry to assess whether any observed changes reflect true improvement, mechanical compensation, or potential impairment.

Methods: This prospective, observational study included 37 patients with large abdominal wall hernias and a Loss of Domain component. All patients received 300 units of botulinum toxin type A injected bilaterally into the external, internal oblique, and transversus abdominis muscles under ultrasound guidance. Spirometry was performed before the injection and again on the day of surgery. Evaluated parameters included forced vital capacity, forced expiratory volume in one second, the ratio of forced expiratory volume to forced vital capacity, peak expiratory flow, maximum mid-expiratory flow, maximal expiratory flow at 75, 50, and 25 percent of forced vital capacity, forced inspiratory vital capacity. Results were analyzed using paired statistical tests with a significance threshold of p < 0.05.

Results: No statistically significant changes were observed in forced vital capacity or forced expiratory volume in one second. However, statistically significant increases were recorded in maximum mid-expiratory flow and maximal expiratory flow at 50 percent of lung volume. Peak expiratory flow showed a trend toward improvement but did not reach statistical significance. These changes appear to reflect altered expiratory dynamics due to increased diaphragmatic excursion, rather than improved ventilation. Forced inspiratory vital capacity decreased slightly. Only two patients reported subjective changes in breathing.

Conclusion: Botulinum toxin type A does not impair core lung volumes but induces mechanical changes that may affect airflow velocity. Standard spirometry may not fully reflect these dynamics, and further investigation is warranted to better understand respiratory outcomes in this patient group.