Ternopil State Medical University

Introduction: Central sensitization explains the mismatch between structural damage or inflammation and pain intensity in chronic musculoskeletal diseases. It defines the phenotype of fibromyalgia and contributes to persistent pain in osteoarthritis, rheumatoid arthritis, and psoriatic arthritis. Objective: To characterize the role of central sensitization in nociplastic pain in fibromyalgia, osteoarthritis, rheumatoid arthritis, and psoriatic arthritis. Materials and Methods: A structured search of PubMed, Scopus, Web of Science, and Google Scholar (1990-2025) identified openaccess, evidence-based publications addressing pain pathophysiology, diagnosis, and treatment in these conditions. Results: Central sensitization manifests as hyperalgesia, allodynia, expanded receptive fields, and impaired endogenous pain inhibition. It predominates in fibromyalgia and contributes to persistent pain in osteoarthritis and rheumatoid arthritis that may not correlate with inflammation or structural damage. Screening tools such as the Widespread Pain Index and Symptom Severity Scale, together with quantitative sensory testing and algometry, help identify nociplastic pain features. Neuroimmune mechanisms, including microglial activation and imbalance between excitatory and inhibitory neurotransmission, may contribute to the mismatch between pain intensity and clinical findings. Conclusion: Chronic pain reflects inflammatory, mechanical, and nociplastic mechanisms in rheumatoid arthritis, osteoarthritis, and fibromyalgia, respectively. Recognition of central sensitization improves assessment and supports mechanism-based management.

Following the global recovery from the COVID-19 pandemic, wars and conflicts have escalated to levels unseen since the Cold War. It is well known that conflict is accompanied not only by significant losses among both military personnel and civilians but also by rising levels of stress and stress-related disorders within the general population. Stress is bidirectionally connected with the state of the gut microbiota through the gut-brain axis. Dietary factors and eating behaviours also play crucial roles in shaping gut microbiota composition. On the one hand, conflict negatively affects food availability and dietary patterns, leading to reduced meal frequency and potentially diminishing microbiota diversity. On the other hand, stress-induced alterations in eating behaviour, such as bulimia or anorexia, can further impair gut microbiota composition. Additionally, individuals in conflict zones face heightened risks of infectious diseases due to disrupted vaccination schedules, poor sanitation, and limited access to clean drinking water. Stress-related immune changes may increase susceptibility to infections and raise the likelihood of adverse outcomes. Moreover, the frequent use of antibiotics to treat infections during conflicts contributes to reduced gut microbiota diversity. This review narratively examines the complex interactions among stress, immune responses, dietary patterns, infectious diseases, and gut microbiota in conflict-affected areas, and provides new perspectives on the role of artificial intelligence in modelling such comorbid pathologies.

Background. Chronic wounds pose a serious clinical and economic burden, and their effective treatment requires the development of new biomaterials that promote tissue regeneration. Acellular dermal matrices (ADMs) represent a promising regenerative strategy; however, their biological properties largely depend on the manu­facturing protocol. Objective. To compare the biocompatibility and cytotoxicity of two porcine acellular dermal matrix variants, dry (d-ADM) and wet (w-ADM), and to evaluate the therapeutic efficacy of the biocompatible matrix in an experimental porcine model of chronic full-thickness wounds. Methods. Biocompatibility was assessed in vitro using human umbilical cord-derived mesenchymal stem cells (hU-MSCs) by evaluating cell morphology, viability, proliferation, and lactate dehydrogenase (LDH) release. The therapeutic efficacy of the selected ADM was investigated in a porcine chronic full-thickness excisional wound model and compared with non-adhesive dressings and Promogran Prisma. Wound healing was evaluated after 28 days using histological, immunohistochemical (TNF-α, TGF-β, Ki-67), and morphometric analyses. Results. The wet ADM preserved hU-MSC morphology, viability, and proliferative capacity, whereas the dry ADM induced marked cytotoxicity, increased LDH release, and extensive cell death. In vivo, treatment with w-ADM significantly accelerated wound healing compared with both control dressings, resulting in complete and stable re-epithelialization, minimal inflammatory infiltration, organized collagen remodeling, and improved tissue architecture. Immunohistochemical analysis demonstrated significantly lower expression of TNF-α, TGF-β, and Ki-67, indicating resolution of inflammation and transition toward tissue remodeling and regene­rative stabilization. Conclusions. Wet acellular dermal matrix demonstrated excellent biocompatibility and superior regenerative performance, whereas the dry matrix exhibited unacceptable cytotoxicity. Wet ADM represents a promising scaffold for regenerative treatment of chronic wounds and warrants further investigation as a clinically applicable biomaterial, including in combination with mesenchymal stem cell-based therapies. Keywords: acellular dermal matrix, biocompatibility, chronic wounds, cytotoxicity, human umbilical mesenchymal stem cells, lyophilization, morpholo­gy

Paediatric stroke (PS) is an uncommon but serious medical emergency and a major cause of long-term disability in children around the world. It affects approximately 1 in 25,000 children per year, with the incidence seen more in the neonatal period. PS is different from adult stroke in both aetiology and clinical presentation. Causes can vary from congenital heart disease, cerebral arteriopathies, to vascular malformations. Clinical features vary with age, ranging from seizures and non-specific systemic symptoms in infants to focal neurological deficits in older children, and are associated with delayed diagnosis. MRI, along with vascular imaging techniques, is the preferred diagnostic modality in children due to its superior sensitivity. Neurorehabilitation is fundamental to improving functional recovery and quality of life post-PS. The heightened neuroplasticity of the developing brain highlights the importance of early, intensive, and task-oriented rehabilitation. Emerging non-pharmacological interventions are structured physical exercise, occupational and cognitive therapy, neuromuscular electrical stimulation, robotic-assisted rehabilitation, and virtual reality. This review highlights current advances in PS management with a focus on neurorehabilitation and non-pharmacological management.