Background. This review is dedicated to analyzing modern approaches to the diagnosis and treatment of gunshot wounds to the abdomen sustained during the Special Military Operation (SMO). The relevance of this topic is determined by the high incidence of abdominal trauma (up to 16.2% of all injuries), persistent mortality rates (up to 80% in cases of combined trauma), and a significant number of postoperative complications (up to 65%), primarily associated with the development of peritonitis.

Main Contents. The work systematizes data from Russian literature reflecting the evolution of combat trauma. It demonstrates the predominance of shrapnel wounds (up to 85%) and combined injuries, which leads to extensive damage zones and multiple internal organ injuries. Key attention is paid to the pathogenesis of gunshot peritonitis, which is characterized by polymicrobial flora (microorganism associations in 94.8% of cases) and high antibiotic resistance, determining the severity of the postoperative period.

The review examines in detail modern surgical tactics based on the "damage control" strategy. The key role of vacuum-assisted laparostomy in treating peritonitis and preparing the abdominal cavity for closure is emphasized. Separate sections are devoted to diagnostic algorithms (MSCT, videolaparoscopy), the specifics of treating injuries to individual organs (pancreas, liver, spleen), as well as the analysis of causes and prevention of postoperative complications, including intestinal fistulas and abdominal compartment syndrome. The work also systematizes the criteria for abandoning primary radical intervention in favor of a staged approach, based on assessing the severity of the wounded patient's condition (shock, coagulopathy, acidosis) and the nature of the peritonitis.

Conclusions. The synthesis of current evidence indicates the necessity of implementing staged surgical tactics (damage control) with the active use of vacuum-assisted laparostomy as the standard of care for severe abdominal gunshot wounds complicated by peritonitis. Further improvement of diagnostic algorithms and prevention of postoperative complications is required, taking into account the antibiotic resistance of hospital strains of microorganisms.

Background. Blunt trauma of the thoracic aorta (TGA) remains a life-threatening condition with a high prehospital mortality rate, while the classic localization of damage is the isthmus area in the projection of the arterial ligament. The presence of volumetric neoplasms of the mediastinum can significantly change the biomechanics of injury and influence the choice of treatment tactics.

Description of the clinical case. The article presents an analysis of the clinical observation of a patient born in 1967 who suffered an explosive injury as a result of the detonation of a device under armored vehicles. The injury mechanism combined the impact of a shock wave and the subsequent inertial impact of the back against the armored roof. CT aortography revealed a pseudoaneurysm of the descending thoracic aorta (15x10 mm) in a typical location — the area of the arterial ligament. A special feature of the case was the presence of a verified chondrosarcoma of the Th4-Th7 vertebral bodies, intimately adjacent to the aortic wall. The authors detail the probable pathophysiological mechanism: the combined effect of "bone pinching" of the aorta between the sternum and the tumor conglomerate of the spine on the background of a hydrodynamic shock, which led to the formation of a pseudoaneurysm. Taking into account the stable condition of the patient and the presence of concomitant pathology, the consultation decided in favor of endovascular treatment. A stent graft with a two-layer polytetrafluoroethylene coating was implanted, followed by fenestration and stenting of the mouth of the left subclavian artery to preserve the main blood flow. No intra- and postoperative complications were recorded. The control MSCT confirmed the viability of the stent graft and the exclusion of the aneurysm from the bloodstream. The patient was discharged on the 4th day in a satisfactory condition.

Conclusion. This clinical case demonstrates the effectiveness of the endovascular strategy in complex forms of traumatic aortic injury, including in the presence of bulky paraaortic formations. The uniqueness of the observation lies in the combined pathogenesis of TGA (blast wave + secondary shock) against the background of asymptomatic chondrosarcoma, which underlines the importance of a multidisciplinary approach to diagnosis and intervention planning in patients with polytrauma. The use of seamless stent grafts and low-profile delivery systems makes it possible to minimize risks and achieve optimal clinical results even in conditions of altered mediastinal anatomy.

Background. The management of combat-related injuries to the major limb arteries remains a significant challenge in military field surgery due to the high energy of the injuring agent, extensive tissue destruction, and prolonged ischemia. Standard protocols do not always account for the specific characteristics of blast trauma, necessitating their adaptation.

Purpose. To improve surgical outcomes in patients with major limb artery injuries by optimizing surgical tactics and postoperative management in a Level 2 military field hospital.

Materials and methods. An analysis was conducted on the treatment of 26 wounded patients (males, age up to 44 years) with shrapnel (80.8%) and mine-blast (19.2%) injuries. The mean prehospital time with a tourniquet applied was 14.5±3.5 hours. Uncompensated ischemia according to the Kornilov classification was diagnosed in 73.1% of cases. All patients underwent radical primary surgical debridement with excision of non-viable tissue, followed by either end-to-end anastomosis (34.6%) or autogenous vein grafting (65.4%). Mandatory thrombectomy from the distal bed and preventive fasciotomy (96.1%) were performed in all cases. Postoperatively, unfractionated heparin (5000 IU subcutaneously three times daily for 7-14 days) was administered without laboratory monitoring.

Results. During the follow-up period, there were no instances of reconstruction site thrombosis, bleeding, limb amputation, or mortality. None of the patients who underwent fasciotomy developed compartment syndrome. Despite anemia being present in 100% of patients, heparin administration did not lead to hemorrhagic complications.

Conclusion. The proposed protocol, which includes radical primary surgical debridement, preventive fasciotomy, and extended anticoagulation with unfractionated heparin, minimizes the risk of thrombosis and enables limb salvage even in severe combat injuries with prolonged ischemia.

Background. The management of combat-related injuries to the major limb arteries remains a significant challenge in military field surgery due to the high energy of the injuring agent, extensive tissue destruction, and prolonged ischemia. Standard protocols do not always account for the specific characteristics of blast trauma, necessitating their adaptation.

Purpose. To improve surgical outcomes in patients with major limb artery injuries by optimizing surgical tactics and postoperative management in a Level 2 military field hospital.

Materials and methods. An analysis was conducted on the treatment of 26 wounded patients (males, age up to 44 years) with shrapnel (80.8%) and mine-blast (19.2%) injuries. The mean prehospital time with a tourniquet applied was 14.5±3.5 hours. Uncompensated ischemia according to the Kornilov classification was diagnosed in 73.1% of cases. All patients underwent radical primary surgical debridement with excision of non-viable tissue, followed by either end-to-end anastomosis (34.6%) or autogenous vein grafting (65.4%). Mandatory thrombectomy from the distal bed and preventive fasciotomy (96.1%) were performed in all cases. Postoperatively, unfractionated heparin (5000 IU subcutaneously three times daily for 7-14 days) was administered without laboratory monitoring.

Results. During the follow-up period, there were no instances of reconstruction site thrombosis, bleeding, limb amputation, or mortality. None of the patients who underwent fasciotomy developed compartment syndrome. Despite anemia being present in 100% of patients, heparin administration did not lead to hemorrhagic complications.

Conclusion. The proposed protocol, which includes radical primary surgical debridement, preventive fasciotomy, and extended anticoagulation with unfractionated heparin, minimizes the risk of thrombosis and enables limb salvage even in severe combat injuries with prolonged ischemia.

Background. Diabetic foot syndrome complicated by osteomyelitis represents one of the most severe and dangerous consequences of diabetes mellitus, often resulting in limb amputation. Chronic inflammation and dysregulation of cytokine activity (IL‑1β, TNFα, IL‑6) play a leading role in the pathogenesis of this condition. This highlights the importance of developing innovative therapeutic approaches, among which ultrasonic cavitation appears to be a promising direction.

Purpose. To investigate the role of ultrasonic cavitation in the comprehensive treatment of patients with diabetic foot syndrome complicated by osteomyelitis.

Materials and methods. The study included 74 patients diagnosed with diabetic foot syndrome complicated by osteomyelitis. All participants were divided into two groups. The main group (n = 37) received standard therapy supplemented with ultrasonic cavitation treatment of osteomyelitic foci, while the comparison group (n = 37) underwent standard therapy only. The levels of inflammatory cytokines IL‑1β, TNFα, and IL‑6 were measured using the ELISA method before the start of treatment and again on days 10-12.

Results. In the main group, there was a significant decrease in the levels of pro‑inflammatory cytokines: IL‑1β by 3.06‑fold, TNFα by 2.51‑fold, and IL‑6 by 1.7‑fold compared with baseline values (p < 0.001). The incidence of postoperative complications, particularly phlegmon, was significantly lower in the main group compared with the control group (8.1 % vs 14.8 %, p = 0.04). In addition, the average duration of hospitalization was reduced from 21.4 ± 3.8 to 15.2 ± 2.1 bed‑days.

Conclusion. The use of ultrasonic cavitation demonstrated a pronounced immunomodulatory effect, manifested by a reduction in pro‑inflammatory cytokines and improved clinical outcomes. Incorporating this technique into the comprehensive treatment of diabetic foot syndrome complicated by osteomyelitis appears justified, as it contributes to faster wound healing and lower rates of postoperative complications.

Background. Penetrating wounds of the brachiocephalic trunk are rare but potentially fatal injuries. CT angiography is the gold standard for the diagnosis of these injuries. Multiple post-traumatic pseudoaneurysms of the brachiocephalic trunk in combination with combined wounds in other areas of the body can complicate the postoperative course after open surgical interventions. The choice between open surgery and endovascular treatment is determined by the location and nature of the injury, the hemodynamic stability of the patient and the comorbid background.

Purpose. To present a clinical case of endovascular treatment of two post-traumatic pseudoaneurysms of the brachiocephalic trunk in a patient with a neck injury and demonstrate the use of the "kissing balloon" technique in bifurcation of the brachiocephalic trunk.

Materials and methods. A clinical case of a 41-year-old man who received a combined shrapnel wound to the neck and limbs is presented. CT angiography revealed two false aneurysms of the brachiocephalic trunk, an intramural hematoma of the mouth of the right subclavian artery, and a foreign body (metal fragment) in the mediastinum.

Results. The use of modern endovascular technologies has made it possible to restore the integrity of the brachiocephalic trunk using the "kissing balloon" technique to optimize the result in the bifurcation zone and eliminate the threat of pseudoaneurysm rupture.

Conclusions. Endovascular implantation of a stent graft is an effective and safe method of treating multiple post-traumatic pseudoaneurysms of the brachiocephalic trunk in combat shrapnel wounds. The presented case demonstrates the successful application of the "kissing balloon" technique in bifurcation of the brachiocephalic artery to ensure complete shutdown of aneurysms and maintain patency of all distal branches.

Background. According to our observations, the pathogenesis of cystic-inflammatory transformation (CIT) of the duodenum (DU) in chronic pancreatitis (CP) is associated with pancreatic ductal hypertension (PDH) and the presence of residual ductal tissue elements in the duodenal wall.

Purpose. To confirm our proposed theory using an interesting clinical case as an example.

Study Material and Methods. The study material was a clinical case of recurrent CIT of the duodenum associated with pancreatic stent dysfunction. Computed tomography and duodenoscopy data were the primary study methods.

Results. Removal of the PDH resulted in regression of the cysts and inflammatory infiltrate.

Conclusions. This clinical case confirms the association between PDH and striated pancreatitis and demonstrates the possibility of regression of CIT of the duodenum in patients with CP.

Background. The skin is one of the most radiosensitive tissues due to the high proliferative activity of basal layer keratinocytes and hair follicle cells. Analysis of morphological changes in the skin following sublethal radiation doses is highly relevant.

Purpose. To characterize the morphological changes in the skin of mice after a single total gamma irradiation dose of 7 Gy on day 7 of the experiment.

Materials and methods. The experimental study was conducted on 12 adult male mice, which were divided into 2 groups (6 animals each): the main group — animals were exposed to γ-rays (7 Gy); the control group — intact animals. The animals were euthanized 7 days after irradiation. Histological sections were stained with hematoxylin and eosin and examined by light microscopy using an Olympus CX43 microscope (Japan).

Results. In the control group, the skin exhibited typical mammalian structure with preserved architecture of the epidermis, dermis, and hypodermis; hair follicles were in the anagen phase, and no inflammatory infiltration was observed. In the main group, statistically significant changes were revealed (p<0.001 for all parameters): the epidermis thinned by one third, the dermis — almost twofold, and the hypodermis — more than twofold. The number of basal keratinocytes decreased by approximately one third, and mitotic activity virtually disappeared. Signs of impaired differentiation (hyperkeratosis, parakeratosis, spongiosis) were noted. The number of preserved hair follicles decreased 2.7-fold (p<0.001). Sebaceous glands were partially atrophic, and edema and lipolysis of adipocytes were observed in the hypodermis.

Conclusion. A single gamma irradiation dose of 7 Gy in mice induces a typical pattern of acute radiation dermatitis on day 7, with the most pronounced changes occurring in the basal layer of the epidermis and hair follicles. These findings may serve as a basis for further studies on the pathogenesis of radiation dermatitis.

Background. The clinical picture of acute peritonitis in HIV-infected patients has its own specific features, is atypical, asymptomatic, and masked by opportunistic and concomitant diseases. Therefore, it is very important for surgeons to have tools in their arsenal to help diagnose this pathology in a cohort of patients with HIV infection.

Main Contents. The article analyzes domestic and foreign sources in the scientific electronic library eLIBRARY.RU and in the electronic databases PubMed, Medline and Scopus on the use of inflammatory markers in acute peritonitis in people living with HIV. The analysis demonstrates the great potential of some markers of inflammation as predictors of acute peritonitis in the general population, however, questions about the effectiveness of these biomarkers in this nosology in HIV-infected patients remain somewhat unclear. The ultimate goal of the review is to identify the existing lack of knowledge in the use of inflammatory markers (C-reactive protein, procalcitonin, and neutrophil-lymphocyte ratio) as laboratory predictors of acute peritonitis in patients with HIV infection.

Conclusions. This review will open up opportunities for the development of future studies to improve the effectiveness of diagnosis of a given pathology.

Background. In contemporary clinical practice, establishing a rehabilitation diagnosis for patients with neurogenic lower urinary tract dysfunction due to spinal cord injury is challenging because the nosological diagnosis based on the International Classification of Diseases 10th Revision (ICD-10) is insufficient for rehabilitation planning. The International Classification of Functioning, Disability and Health (ICF) can fill this gap, however, its systematic application in neuro-urology has not been documented to date.

Aim. To demonstrate the application of the ICF in formulating a rehabilitation diagnosis for neurogenic lower urinary tract dysfunction, illustrated by a clinical case.

Materials and methods. We present a clinical case of a 35-year-old female patient following spinal cord injury at the Th9–Th10 level, with lower spastic paraplegia and neurogenic lower urinary tract dysfunction. Rehabilitation was conducted by a multidisciplinary team. Neuro-urological treatment included training in intermittent self-catheterization and repeated intradetrusor injections of botulinum toxin. Assessments were performed before and after a three-week restorative course using ICF domains and the Canadian Occupational Performance Measure (COPM).

Results. An integrative ICF profile was developed. Although no change was observed in the b620.4 "Urination functions" domain, significant improvements were achieved in activity domains. The d530 "Toileting" domain changed from d530.44 to d530.04, indicating a transition from complete dependence to independence with the use of assistive devices. The d570 "Self-care" domain changed from d570.24 to d570.00. Botulinum therapy transformed from a neutral environmental factor to a pronounced facilitator (e1101: .0 → .+4), ensuring safe urodynamic status. COPM dynamics confirmed clinically significant improvements in performance and satisfaction with key daily activities.

Conclusion. The use of the ICF allows for differentiation between irreversible impairments and compensable limitations, formulation of measurable rehabilitation goals, and coordination of a multidisciplinary team, making it a promising tool for establishing a rehabilitation diagnosis in neuro-urology.

Background. The medical speech therapist is an integral part of the multidisciplinary rehabilitation team (MDRT) of the inpatient medical rehabilitation department (IMR) for patients with impaired central nervous system (CNS) function. The medical speech therapist's activities are aimed at both restoring socially significant communication skills and normalizing the vital function of swallowing, which directly affects the quality of life and overall rehabilitation outcomes. The development of effective personalized speech and swallowing recovery programs requires a specialist to have a standardized diagnostic toolkit (MASA, BODS-1, L.I. Wasserman scale, Dysarthria Assessment Scale, CRS-R, etc.), the ability to formulate a rehabilitation diagnosis in the ICF categories, set goals for the rehabilitation stage, and work with medical documentation. Well-coordinated teamwork and collaboration between a medical speech therapist and MDRC specialists and other consulting doctors ensure a comprehensive approach to patient care.

Main Contents. To analyze the role of a medical speech therapist in the second stage of medical rehabilitation for patients with CNS disorders based on the analysis of data from hospitalized patients in 2023-2025.

Materials and methods. A retrospective analysis of data on the work of a medical speech therapist for 2023-2025 was conducted. All the analyzed data was obtained from the medical records of inpatient patients.

Results. The majority of patients hospitalized for medical rehabilitation required medical speech-language therapy. Swallowing and speech disorders were diagnosed in different years in an average of 78% of patients with central nervous system (CNS) dysfunction. Among the speech-language pathology diagnoses, the following prevailed: aphasia (26%), dysarthria (29%), and dysphagia (4%). Among all patients with aphasia, mixed forms predominated in 63.5% of cases. In cases of dysarthria, moderate to severe degrees of impairment accounted for up to 6% of cases. The combination of dysphagia and dysarthria was observed in different periods in 14.5% of cases. A significant proportion of patients with dysphagia had severe swallowing impairments. In 6% of patients with dysphagia, indications for airway and digestive tract separation were identified. A total of 5.7% of patients required the selection of alternative feeding methods (placement of a nasogastric tube or gastrostomy).

Conclusion. A promising area for improving speech therapy services is the implementation and standardization of protocols for early diagnosis of speech and swallowing disorders, as well as the development of algorithms for subsequent correction of impaired functions. These approaches optimize the process of restoring higher mental functions (speech) and swallowing, improving the quality of life for patients, and contributing to better prognosis and prevention of secondary complications.

Background. In dental practice, disorders of the temporomandibular joint (TMJ) and masticatory muscles are highly prevalent, affecting up to 80% of the population. Nevertheless, their diagnosis often remains subjective, relying primarily on palpation and patient-reported complaints. Existing isolated diagnostic methods fail to provide a comprehensive assessment of the functional state of the masticatory musculature, which necessitates the development of new objective diagnostic approaches.

Main Contents. In accordance with the aim and objectives of the study, an analysis of the scientific literature on surface electromyography and myotonometry was conducted, including their hardware implementation and clinical relevance in the diagnosis of masticatory muscle disorders. Sex- and age-related differences in the electrical and mechanical activity of the masticatory muscles were examined based on anatomical reference sources and clinical data.

Conclusion. The design of a diagnostic device integrating surface electromyography and myotonometry represents a relevant and promising direction in the development of objective diagnostic dentistry. Synchronous registration of electrical and mechanical activity of the masticatory muscles within a single temporal cycle enables, for the first time, a holistic biomechanical assessment of their functional state.

Background. Non-obstructive azoospermia (NOA) is one of the most complex forms of male infertility, occurring in 10–15% of infertile men. Microdissection testicular sperm extraction (microTESE) is the "gold standard" for obtaining autologous gametes; however, the success rate varies from 40% to 65%, necessitating the search for highly accurate prognostic factors.

Purpose. To systematize current approaches to predicting the success of microTESE in patients with NOA.

Materials and methods. An analytical review of the literature was conducted with a focus on publications from the last ten years (2016–2026). Studies assessing the prognostic significance of FSH, inhibin B, AMH, their ratio, histological indices (Johnsen score), testicular microenvironment, morphometric nomograms, as well as studies on the application of machine learning algorithms (gradient boosting, Random Forest, neural networks) for predicting microTESE outcomes were analyzed.

Results. Isolated hormonal markers were found to have limited prognostic value, whereas the combination of FSH, inhibin B, and AMH, as well as the inhibin B/AMH ratio (cut-off >12.08), demonstrate higher accuracy (sensitivity 72.3%, specificity 83.3%). Histological assessment, including Johnsen score ≥8 and the morphometric nomogram (cut-off >0.489), can increase prognostic specificity to 77.5%. A high density of mast cells in the testicular stroma (>39/mm²) indicates pronounced suppression of spermatogenesis and justifies the transition to sperm donation.

Conclusions. A personalized approach integrating hormonal, histological data and AI optimizes patient selection for microTESE, reducing the number of ineffective biopsies; validation of multi-omics biomarkers and the implementation of no-code AI into clinical practice are promising directions.

Background. The pandemic of coronavirus disease COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a major obstacle for the performing of current medical activities throughout the world in XXI. Infection with SARS-CoV-2 has systemic damages to lungs, heart, and kidney, nervous and reproductive systems. Many published studies to date have pointed out that COVID-19 could also affect fertility and disrupt the functions of the reproductive system.

Main content. This literature review presents current scientific data on the short-term and potential long-term consequences of COVID-19 on male fertility, including an analysis of the reversibility of impairments and the risk of infertility. The possible impairment of the male reproductive system is because angiotensin-converting enzyme 2 (ACE2) receptors are in an increased number in the testes, seminiferous duct cells, spermatogonia, Leydig cells and Sertoli cells. COVID-19 infection affects sperm quality, DNA fragmentation index (DFI) and hormonal status.

Conclusion. The numerous scientific data confirm the impairment of spermatogenesis during the Covid-19 infection. The timing and extent of reproductive function recovery after infection in the long-term period remain unknown. The uncertainty of long-term consequences, amid a global trend of declining spermatogenesis, underscores the high clinical and social significance of this problem.

Background. The evolution of surgical treatment for urolithiasis has shifted from open surgery to minimally invasive methods, among which retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are the current standard of care.

Purpose. To conduct a comparative analysis of the efficacy, safety, and clinical outcomes of RIRS and PCNL.

Materials and methods. A review of the literature was performed, analyzing data on indications, techniques, postoperative outcomes, and complications of RIRS and PCNL. Special attention was paid to comparing the Stone-Free Rate (SFR), complication rates, and intra- and postoperative parameters.

Results. PCNL demonstrates a statistically significantly higher primary SFR compared to RIRS (up to 94% vs. 73–82%) for stones 1–2 cm, particularly those located in the lower pole. However, RIRS is associated with significantly less invasiveness: reduced blood loss (decrease in hemoglobin, p<0.05), lower transfusion rates, shorter hospital stay (1–1.3 days vs. 2–3 days for PCNL), and less postoperative pain. For stones >2 cm, PCNL remains the "gold standard," while for stones <2 cm, RIRS is the treatment of choice due to its optimal balance of efficacy and safety.

Conclusion. Modern surgical management of urolithiasis is based on risk stratification and an individualized approach. PCNL remains the most effective method for large and complex stones, whereas RIRS is a preferred minimally invasive alternative for smaller stones, providing a comparable final SFR with a better safety profile and faster patient recovery.

Background. Acquired phimosis is a cicatricial narrowing of the foreskin in a man whose glans penis had previously been freely exposed. Unlike physiological phimosis observed in childhood, acquired phimosis does not resolve spontaneously, responds poorly to conservative therapy, and requires surgical treatment — circumcision.

Purpose. To analyze elective and emergency surgical interventions in patients with acquired phimosis hospitalized in the urological department No. 1 of the Stavropol City Clinical Emergency Hospital for the period 2020–2025.

Materials and methods. A retrospective analysis of 124 patients with phimosis was performed, divided into two groups: elective hospitalization (n=98; 79.0%) and emergency hospitalization (n=26; 21.0%). The degree of phimosis, etiological factors, and the scope of surgical intervention were evaluated.

Results. In the group of patients admitted electively, grade I–II phimosis predominated (90.8%), with recurrent balanoposthitis (57.1%) being the leading etiological cause. Circumcision was performed in all 98 (79.0%) patients, with no complications recorded (0%). In the emergency group, all patients (100%) had grade IV phimosis with urination disorders. The most common cause of phimosis in patients seeking emergency medical care was diabetes mellitus (46.2%). In these patients, circumcision was performed in 92.3% of cases; 3.8% required delayed surgery due to purulent balanoposthitis, and 3.8% required cystostomy due to irreversible detrusor atony. Patients with diabetes mellitus were hospitalized emergently for phimosis 2.36 times more often than patients without diabetes (RR = 2.36; 95% CI: 1.21–4.60).

Conclusion. Elective circumcision for grade I–III phimosis is safe (0% complications) and prevents the development of terminal grade IV phimosis, paraphimosis, and irreversible functional disorders of the urinary bladder. Diabetes mellitus, detected in 46.2% of patients in the emergency group, serves as a key risk factor for complicated phimosis and requires mandatory screening in all adult men with this pathology.

Introduction. Surgical correction of perceived or true penile shortening remains a challenging task in reconstructive urology-andrology. A significant proportion of patients seeking penile lengthening present with normal anatomical parameters but suffer from psychological distress related to size perception, while a smaller cohort has objective shortening due to congenital anomalies (hypospadias, epispadias) or acquired conditions (Peyronie's disease, fibrosis post-radical prostatectomy).

Main content. This review is dedicated to analyzing modern minimally invasive surgical strategies for penile length correction. Data on percutaneous ligamentolysis (PL) and penile lengthening procedures with penile prosthesis (PLP-PP) techniques are presented. It is shown that PL provides a visible length gain averaging 1.5-2.5 cm but is associated with a risk of retraction (up to 30% at 2-3 years) and dynamic instability (15-20%). The mechanisms of intervention efficacy are discussed, including suspensory ligament release, tunical expansion, and sliding techniques. Special attention is paid to patient selection criteria: baseline stretched penile length (SPL) <7 cm, BMI<30 kg/m², preserved erectile function, as well as mandatory psychosexual assessment to identify dysmorphophobia, which is associated with a high risk of dissatisfaction (>70%) even after technically successful surgery.

Conclusion. Minimally invasive strategies (PL, PLP-PP) are valuable tools for penile length correction but require strict differentiation of indications. PL is indicated for relative shortening, while PLP-PP is indicated for true shortening with erectile dysfunction. Efficacy and safety are directly dependent on meticulous multidisciplinary patient selection, realistic expectations, and preoperative preparation.

Background. The article examines the criminal law, procedural, and forensic medical aspects of providing first aid by persons who have the right to do so or who are legally obliged to provide it under various circumstances. It provides a legal assessment of the sequence of measures performed and the medical consequences associated with the provision of aid.

Main Contents. The conducted analysis of the practice and theory of legal thought has shown that for a citizen who does not possess specialized knowledge in the field of jurisprudence, when performing actions connected with procedures of providing assistance, it is difficult at the scene of an incident to give a clear answer as to where the line lies between a civic act and a legal duty, between a mistake and criminal inaction.

Conclusions. The authors analyze the possibility of applying legal norms to variable situations and conditions in which first aid is provided. Furthermore, the legal consequences of failing to provide first aid or providing it improperly are examined.

Background. Cryolipolysis (CL) and microfocused ultrasound with visualization (MFU-V) are effective and safe methods for the correction of excessive subcutaneous fat (SCF) in the submental and submandibular areas. However, data on the effectiveness of their combined use in the lower third of the face remain limited.

Purpose. To evaluate the efficacy of cryolipolysis as monotherapy and in combination with MFU-V for improving skin quality and reducing subcutaneous fat volume.

Materials and methods. A prospective multicenter comparative non-randomized cohort study included 108 patients aged 35–65 years. Participants were divided into two groups: group 1 (CL, n=54) received cryolipolysis only; group 2 (CL+MFU-V, n=54) received cryolipolysis followed by MFU-V after 3 months. Treatment efficacy was assessed using GAIS, SCF severity scales, caliper measurements, and the total aging index (TAI).

Results. Both groups demonstrated a statistically significant reduction in SCF severity and skinfold thickness. The combined protocol was associated with more pronounced improvements in several parameters. The most notable differences between the groups were observed at 6 months and persisted up to 12 months.

Conclusion. The combined use of cryolipolysis and MFU-V provides a more pronounced and sustained clinical effect compared to monotherapy.

Background. A structural review of available scientific publications and clinical guidelines reveals a significant imbalance: virtually all existing treatment regimens and guidelines for managing patients with rosacea focus exclusively on dermatological care for the face. Care strategies for other skin segments remain largely unaddressed. Despite the anatomical and physiological unity of the integumentary system and shared pathogenetic mechanisms, bodily skin remains largely unaddressed. However, the logic of pathogenetic therapy requires recognition that systemic epidermal barrier dysfunction in rosacea is likely not limited to the face. Increased transepidermal water loss, altered lipid profile, and decreased levels of natural moisturizing factors may be widespread, necessitating extending barrier-restoring care principles to the patient's entire body.

Purpose. To study the clinical efficacy of the therapeutic body cream from the Passaggio line in patients with different subtypes of rosacea.

Materials and methods. To study and analyze the data obtained on the effects of a therapeutic body cream, a sample of 420 patients with various rosacea subtypes was recruited. Treatment results were monitored from 2020 to 2025. Sixty patients were male and 360 were female. Patient ages ranged from 20 to 80 years.

Results.

1. More pronounced positive dynamics were observed in group 1. After therapy, 180 patients (81.8%) showed improvement in group 1, while in group 2, only 118 patients (59.0%) did so.
2. Reduction in DISS scores. In group 1, the average DISS score decreased from 21.8 to 9.6 (by 56.0%), while in group 2 it decreased from 21.2 to 12.5 (by 41.0%). The differences are statistically significant (p<0.01).
3. Restoration of skin hydration. Corneometry scores in group 1 increased from 41.8 to 52.4 units (an increase of 25.4%), while in group 2 they increased from 42.4 to 48.0 units. (13.2% increase). The most significant recovery was observed in patients with initially severe disease in group 1 (+47.1%).
4. Clinically significant difference. The difference in the improvement rate between groups was 22.8% in favor of group 1, confirming the higher efficacy of the therapeutic strategy used in group 1.

Conclusion. The high effectiveness of the therapeutic body cream from the Passaggio line has been proven in patients with different subtypes of rosacea based on 14 diagnostic indexes of the symptom scale and corneometry data.

Background. This literature review analyzes the use of keratin and its products in biomedicine, including drug delivery systems, wound healing, and tissue engineering.

Main Contents. This review covers the structure, properties, history of study, and methods of isolation of keratin. Particular attention is paid to recent advances in the application of keratin biomaterials in the form of three-dimensional scaffolds, films, fibers, and hydrogels.

Conclusions. Keratin biomaterials possess unique properties due to their composition and structure, ensuring their biocompatibility, biodegradability, and positive interactions with cells. The availability of keratin from inexpensive sources makes it a promising material for biomedicine. Despite these advantages, keratin biomaterials are still underrepresented on the market. To expand their application, in-depth study of the cellular mechanisms of tissue regeneration under the influence of keratin products and investigation of the interaction of keratin with other polymers are necessary.

Background. All facial structures are subject to age-related changes: skin, subcutaneous adipose tissue, the musculo-aponeurotic system, and bone structures. Depending on the predominant aging of a particular area, and taking into account the constitutional features of the face, different types of aging can be identified.

Materials and methods. Currently, the classification of age-related changes by I.I. Kolgunenko is used to determine the type of aging, which distinguishes 5 morphotypes. When prescribing correction for age-related changes, it is necessary to consider which variant of age-related changes the patient belongs to. For example, filler correction will be limited in cases of the deformational type of aging, and the tired morphotype will require more careful selection of parameters for apparatus-based treatment methods to avoid reducing subcutaneous adipose tissue.

Results. The article presents clinical recommendations for working with artificial intelligence-powered monopolar microneedle RF-lifting, depending on the morphotypes of aging.

Conclusions. These recommendations contribute to effective and safe practice for physicians.