Central Clinical Hospital

During wartime, complex injuries to the foot and ankle account for approximately 5–8% of all combat injuries, of which up to 80% are blast-related. These injuries are often associated with severe damage to other organs and systems and may be life-threatening.Combat-related foot and ankle injuries are characterized by extremely high-energy mechanisms, including shrapnel and mine-explosive trauma. Consequently, they are more frequently open injuries with extensive soft tissue and bone damage and a high risk of infection, requiring urgent specialized surgical care. The decision to amputate a severely injured limb is made individually and has to consider the patient’s overall condition and medical resources.The treatment of such complex injuries is typically staged due to the severity of soft tissue damage and cannot be accomplished in a single surgical procedure. Management of severe foot and ankle trauma requires a multidisciplinary approach, often involving plastic surgeons for reconstruction and closure of extensile soft tissue defects.The primary goal in the treatment of complex ballistic injuries of the foot is to prevent severe complications and to achieve the earliest possible restoration of limb function. This article presents our wartime experience and treatment approach in patients with combat-related injuries of the foot and ankle.

Abstract Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease that remains a major challenge in otolaryngology. This review aims to summarize the current knowledge on CRSwNP and provide an overview of available treatment methods. We conducted a PubMed database search and identified 86 publications relevant to this paper. CRSwNP is characterized by persistent sinonasal symptoms lasting more than 12 weeks (congestion, rhinorrhea, hyposmia) and bilateral polyps, confirmed by endoscopy or computed tomography showing inflammation. The estimated prevalence of CRSwNP ranges up to 4% in the general population and predominantly affects middle-aged patients. In most cases, CRSwNP is driven by a type 2 inflammatory response. Common comorbidities include asthma and aspirin-exacerbated respiratory disease. Management follows a stepwise approach, and treatment selection depends on disease severity, previous treatment response, and type 2 biomarkers. Treatment typically begins with saline irrigation and intranasal corticosteroids. Refractory cases may require short courses of systemic steroids, endoscopic sinus surgery (ESS), or biologics (dupilumab, mepolizumab, omalizumab, and tezepelumab) targeting type 2 inflammation. Future research should focus on improved phenotyping and cost-effectiveness.

Objective. To evaluate the long-term efficacy and safety of hyaluronic acid fillers using a comprehensive assessment of laboratory and ultrasound markers of the immune and inflammatory response, tissue integration and biodegradation of the material, as well as aesthetic improvements according to standardized scales. Material and methods. This 12-month single-center, prospective, non-comparative study included healthy female volunteers aged 25–55 years (n=20) with clinical indications for the nasolabial fold correction. Participants received injections of a hyaluronic acid filler (24 mg/mL) in a total volume of 1–2 mL. Efficacy and safety outcomes were evaluated at several time points using a number of methods, such as 3D facial scanning, ultrasound imaging, laboratory diagnostics, etc. Results. Ultrasound imaging after filler injection revealed an increase in the total soft tissue thickness and subcutaneous fat layer thickness, both of which gradually returned to baseline over the follow-up period as the filler progressively resorbed. No inflammatory or infiltrative changes were detected at any follow-up point. According to the GAIS scores, the most pronounced aesthetic improvement was noted both by physicians (4.0) and participants (3.9) immediately after the procedure, followed by a gradual reduction in effect over the follow-up period. At all timepoints (7 days, 1, 6, and 12 months), no clinically significant inflammatory changes or pathological immune responses were detected based on immunological parameter assessment. Conclusion. Injection of a hyaluronic acid filler into the nasolabial fold area showed high efficacy and safety, without significant changes in the immune and inflammatory status of the participants.

NTRK gene fusions are rare but crucial oncogenic drivers across various solid tumors. They are more frequent in rare cancers, such as secretory carcinomas and found less commonly in common malignancies such as colorectal cancer, NSCLC, thyroid carcinoma, pancreatic carcinoma, and cholangiocarcinoma. Multiple mo­lecular assays, including IHC, FISH, RT-PCR, and NGS, are used to detect these fusions. Results of clinical trials and studies have shown that TRK inhibitors demonstrate meaningful anti-tumor activity against NTRK-positive cancers. The FDA has already approved larotrectinib and entrectinib, first-generation TRK inhibitors. They often demonstrate a higher overall response rate and longer duration of response compared with previous treatment options. Moreover, repotrectinib has been successfully used in patients with NSCLC and other NTRK-positive cancers with and without previous exposure to TRK inhibitors. For patients who are nonresponsive or progress­ing during treatment, clinical trials are conducted to investigate the resistance mechanisms and efficacy of new generations of inhibitors, including selitrectinib, taletrectinib, among others. This review comprehensively discusses NTRK biology, diagnostic approaches, clinical efficacy of TRK inhibitors across different solid tumor types, and emerging treatments addressing resistance.

Background. Keratoconus (KC) is a progressive, asymmetric corneal ectasia driven by inherited extracellular matrix variation that establishes a baseline biomechanical phenotype on which eye rubbing and atopy precipitate disease. Aim. To synthesize current evidence on the genetic architecture, the biomechanical phenotype, and the diagnostic strategies that integrate them. Materials and methods. A structured search of PubMed, Scopus, Web of Science, Google Scholar and bioRxiv covered primary research and meta-analyses on KC genetics, biomechanics, epidemiology, environmental risk, imaging and machine-learning diagnostics (1996–2026, plus selected earlier seminal papers). Results. Tomography-era prevalence reaches 1:375 in Northern European registries and over 1% in Scheimpflug-screened cohorts. GWAS implicates matrix-organizing loci (ZNF469, LOX, COL5A1, WNT10A) and corneal-thickness genes shared with Mendelian connective-tissue disease; a corneal-hysteresis GWAS bridges the genetic and biomechanical strands. In vivo metrics (corneal hysteresis, stress-strain index, Brillouin shift) and combined tomographic-biomechanical indices achieve AUCs above 0.99 for manifest disease and for detecting subclinical KC below the tomographic floor. Conclusions. Integrating genetic risk, biomechanical phenotyping and AI-based imaging enables earlier diagnosis, sharper risk stratification and better-timed cross-linking; multi-ancestry genetic studies and prospective biomechanical cohorts are research priorities.