685.34.042:612.014.46:547.962.3:616-001:54.024

The combined use of cellular, extracellular research methods for studying the toxic effect of shoe glues is an additional tool for screening and assessing the potential risks of their use. The aim of the work was to investigate the mechanisms of the toxic effect of shoe glues at the cellular, molecular and biochemical levels. Rubber, polychloroprene and polyurethane shoe glues were used. Three experimental approaches were applied: measurement of survival of mam­malian cells, a spectroscopic study of conformational changes of albumin, and a free radical measurement. Cytotoxicity testing was performed on murine fibroblasts Balb/c-3T3 line, human embryonic kidney cells HEK-293 and human keratinocytes of the HaCaT line treated for 24 and 72 hours with glues samples. A survival of treated cells was monitored using MTT-test. Changes in the spectral characteristics of albumin were monitored during exposure for 24 hours and 21 days with "fresh" and "dried" samples of glues. Content of free radicals was evaluated in the reaction with DPPH reagent. The cytotoxicity was increased with increasing exposure time, and depended on both the type of glue and the type of treated cells. The polyurethane glue demonstrated the most pronounced cytotoxic effect. Balb/c-3T3 fibroblasts were the most sensitive to the action of all types of glues, a reliable maximum increase in cell death was manifested in 72 hours exposure (28.9-19.1% of living cells).While cells of HEK-293 and НаСаТ lines were more resistant. At 24 hours contact, their viability was 99.12-79.22% and 99.0-56.9%, respectively. Increased exposure up to 72 hours reliably caused a decrease in the survival of these cell lines – 96.24-68.1% and 82.2-51.7%. The loss of the solvent didn’t affect the cytotoxic effect of the studied glues. Conformation changes in albumin were manifested during its long-term contact with both "fresh" and "dried" glues. Manifestations of the toxic effect of glues on biomolecules were increased in the sequence: rubber > polyurethane > polychloroprene. Shoe glues demonstrated an ability to generate free radicals in the sequence: rubber > polychloroprene > polyurethane. These manifestations were increased in a time period of 4 hours – 24 hours. That may create risks when they are used. The results can be used to determine the targets and mechanisms of the toxic effect of shoe glues and to obtain new knowledge in the field of research of industrial toxicants.

УДК 351.77:725.51

Актуальність. Професійне вигорання серед медичних працівників є серйозною проблемою, яка суттєво впливає як на ефективність функціонування медичної системи, так і на загальний стан ментального здоров’я в суспільстві. Огляд і метааналіз, проведений науковцями, засвідчив наявність стійкого зв’язку між синдромом професійного вигорання та зниженням кар’єрної мотивації лікарів, а також погіршенням якості медичної допомоги майже у чверті мільйона медичних працівників. Мета: метааналіз вітчизняних та зару-біжних наукових джерел щодо емоційного вигорання серед ерготерапевтів, психотерапевтів, які беруть участь у роботі мультидисциплінарних команд з надання медичної допомоги. Розробка профілактичних за-ходів щодо емоційного вигорання медичних працівників системи охорони здоров’я. Матеріали та мето-ди. Робота виконана шляхом систематичного огляду, метааналізу, контент-аналізу статей наукометричних баз Google Scholar, Web of Science, Scopus, PubMed, Science Direct. У роботі використаний бібліосеман-тичний метод. Пошук літератури здійснювався з використанням ключових слів: еmotional burnou, mental health, patient satisfaction, occupational therapist burnout, psychotherapist burnout. До цього огляду ввійшло 46 статей. Пошук здійснювали серед статей, опублікованих у період з 2015 по 2025 р. Результати. Синдром емоційного вигорання та деперсоналізації серед медичних працівників мультидисциплінарних команд має суттєвий вплив на функціонування системи охорони здоров’я. Він формується під впливом складної сукуп-ності психосоціальних чинників, зокрема: напруженого клінічного навантаження, браку часу, суперечли-вих вимог, низького рівня професійної автономії, складних міжособистісних стосунків або недостатньої підтримки з боку адміністрації, недостатнього клінічного досвіду, особливостей медичної підготовки, віку, сімейного стану, психологічної нестабільності, міжособистісної тривожності, а також негативного досвіду в дитинстві (психологічні або матеріальні труднощі). Висновки. Впровадження системного підходу є склад-ником як індивідуальних психотерапевтичних втручань (емоційна регуляція, техніки релаксації, тренінги зі стрес-менеджменту, копінг-стратегії), так і структурованих програм з оптимальним набором інституційних стратегій, адаптованих до потреб конкретних закладів.  

Massive bleeding remains one of the leading causes of death among military personnel in armed conflicts, which leads to a constant need to improve the means of temporary bleeding control. The combat application tourniquet continues to be the standard in tactical medicine due to its proven clinical effectiveness, high speed of application and reliability during hostilities. Its use significantly reduces mortality in injuries with critical bleeding from the extremities, especially at the pre-hospital stage of medical care. The purpose was to analyze the impact of using tourniquets by military personnel in cases of massive/critical bleedings, traumatic amputations of limbs, and to assess the timeliness of the conversion in the world and in Ukraine. Particular attention is paid to the rationale for the expediency and inexpediency of using tourniquets, the duration of application, as well as the study of possible complications associated with their excessive or untimely use during intense hostilities and delays in evacuating the wounded. Materials and methods. The work was carried out through a systematic review, meta-analysis, content analysis of articles in the scientometric databases Scopus, PubMed, ResearchGate. The literature search was carried out using the following keywords: “tourniquet”, “stop the bleeding”. The study included descriptions of clinical cases of applying tourniquets by the servicemen of the Armed Forces of Ukraine, retrospective analyses and literature reviews. After reviewing the articles and reading their full texts, 8 sources were selected. The search covered the period from 2012 to 2025. The study was conducted based on one surgical hospital (Role 2) in April-May 2024 and April-May 2025. The use of means to temporary stop critical bleeding, its appropriateness, duration and risks of complications were analyzed in 135 servicemen who were in the combat zone. Results and conclusions. The duration of hemostasis in most cases (60.0 in 2025 %, an increase by 10 % vs. 2024) exceeds 2 hours, and the duration of tourniquet use exceeding 3 hours (compared to 2024, the frequency has increased by 5.0 % in 2025) indicates a prolonged evacuation of the wounded as a result of intense hostilities, which, in turn, increases the risk of ischemic complications and requires careful clinical monitoring. In 70.0 % of cases, one tourniquet is enough to stop the bleeding, while in 30.0 %, two or more tourniquets are required, which indicates the more severe nature of the wounds caused by the modernization and increased destructive power of modern weapons. Ischemic complications are recorded in almost half of the cases, the main reason for which is the prolonged application of a tourniquet.

616-001. 32 - 001. 45 - 007. 286- 06 : 616. 833 - 009. 7] - 085. 2/ . 3 ]
- 085]: 355

A longitudinal study of 145 military personnel with neuropathic residual limb pain after combat-related amputation demonstrated clinically significant pain in 60% of patients five months after amputation, with symptomatic neuroma predominating. PTSD was one of the most important contributors to neuropathic postamputation pain. A stable moderate direct correlation was found between pain intensity and PTSD symptoms; combat-related PTSD was associated with a 1.9-fold increase in the probability of neuropathic residual limb pain. Rehabilitation should be based on clinical pain phenotyping and a multidisciplinary therapeutic strategy.

УДК:616-001.32-001.45-007.286-06:616.833-009.7]-085.2/.3

Біль після бойової травми пов’язаний з більш інтенсивним проявом посттравматичного стресового розладу та депресії у понад 35% ветеранів. Вплив психологічних факторів у результатах лікування після ампутації все більше визнається, проте зв’язок між нейропатичним болем кукси та симптомами розладів ментального здоров’я в ранньому відновному періоді після бойового поранення залишається недостатньо вивченим. Мета роботи — оцінити характер зв’язку між типами постампутаційного болю та ПТСР, депресією у військовослужбовців внаслідок бойових ампутацій у російсько-українській війні. Проаналізовано 145 військовослужбовців. Частка пацієнтів із клінічно вираженим нейропатичним болем кукси становила 64,8%; виявлено прямий помірний зв’язок болю із симптомами ПТСР та депресії. Встановлено двонаправлений зв’язок і значну коморбідність розладів ментального здоров’я з нейропатичним болем кукси. Для ефективнішого лікування постампутаційного болю терапія повинна включати корекцію посттравматичних психічних розладів.

Background. Pain following combat trauma has been shown to be associated with in creased rates of posttraumatic stress disorder and depression in over 35% of veterans.  The role of psychological factors on outcomes after combat related amputation is increas ingly acknowledged, the association between neuropathic residual limb pain and symp toms of mental health disorders in the early rehabilitation period after combat trauma re
mains poorly analyzed. Purpose – To assess the relationship between postamputation pain phenotypes and both 
PTSD and depressive disorder among military servicemembers after combat-related am
putation during the Russian-Ukrainian war.
Materials and Methods. 145 servicemembers with combat related limb loss, treated at the  3rd-4th level Military Clinical Center of the Western Region during the period 2022–2026,  were included in the analysis. Pain types assessed were neuropathic residual limb pain  (nRLP) and phantom limb pain (PLP) with NRS, DN-4. Psychological distress parameters  evaluated were PTSD and depressive symptoms with PCL-M, PHQ-9 questionnaires. Two 
groups were formed for analysis: a control group (N=51) with a neuropathic pain level of  0–3, and a research group (N=94) with a pain level of 4–10. A correlation, log-binomial  analyses of postamputation pain and mental health issues were conducted.
Results. The prevalence of clinically significant nRLP (moderate-to-severe) was 64.8%  [95% CI: 60.8–68.8] in the cohort of patients with mean 5 months after amputation. Co morbidity of PTSD was identified in 46.8% [95% CI: 41.7–51.9] of patients with clinically  significant postamputation pain, while depressive disorder was observed in 59.6% [95%  CI: 54.5–64.7] of pain cases. Across the entire cohort of patients after combat-related limb 
amputation, clinical signs of probable PTSD were present in 31.7% [95% CI: 27.8–35.6] of  individuals, and depressive disorder in 44.8% [95% CI: 40.7–48.9] of cases. A direct mod erate correlation was observed between neuropathic RLP and symptoms of both PTSD (r  = 0.5±0.1, P level < 0.001) and depression (r = 0.5±0.2, P level < 0.001). PLP demonstrat ed the weakest association with mental health disorders. Individuals with clinical signs of 
PTSD experienced nRLP level of 6,0 (5,0-7,0) that was 1.9 times higher [95% CI: 1.5–2.3]  (P level < 0.05) than those without PTSD. The relative risk of exacerbating nRLP in patients  with depressive symptoms was 1.8 [95% CI: 1.4–2.3] (P level < 0.05). Furthermore, the  presence of neuropathic RLP was found to aggravate the severity of PTSD symptoms by  RR of 12.1 [95% CI: 3.1–47.6] and depressive disorders by 3.4 [95% CI: 1.8–6.3]. Notably, 
the comorbidity of neuropathic RLP and phantom limb pain did not further increase the risk  of mental health disorder.
Conclusions. A bidirectional relationship and high comorbidity rates between neuropathic  residual limb pain and mental health issues confirmed to be significant in early rehabili tation period for servicemembers after combat injury. Nearly twofold increase in the risk  of clinically significant nRLP among patients following combat-related psychotrauma un derscores the mutual aggravation between nRLP chronification and mental health issues 
5 months after combat-related amputation. For more effective postamputation pain man agement followed by successful social readaptation, therapy should include methods and  medications for posttraumatic mental health issues.