卷 44, 编号 4 (2025)

During armed conflicts, the incidence of ischemic stroke among military personnel increases substantially compared with peacetime. In addition to the elevated risk of combat-related injuries, military service members are exposed to intense physical and emotional stress and extreme environmental factors, which contribute to the toll of both common (atherosclerotic arterial changes, diabetes mellitus, obesity, cardiovascular diseases) and specific risk factors more typical of young adults (cardiac sources of embolism, non-inflammatory and inflammatory arteriopathies, coagulation disorders), as well as generate additional stroke risk factors unique to combat conditions. Firearm injuries have a special place in the pathogenesis of combat-related ischemic stroke. We have proposed and substantiated the term vasculocerebral injury. It is a distinct type of combat firearm injury, representing a cascade of sequential interrelated pathological changes occurring in the damaged major precerebral arteries (aorta, brachiocephalic trunk, common and internal carotid arteries, vertebral arteries), cerebral arteries, their vascular territories, blood cellular elements, and surrounding tissues as a result of the complex damaging effect of a high-energy projectile (shock wave, lateral impact energy, vortex flow), ultimately leading to pathophysiologically heterogeneous secondary acute cerebrovascular lesions, including ischemic stroke. Clinical cases of vasculocerebral injury are presented. Early identification of cervical and cranial vascular injuries contributes to timely and optimal treatment tactic selection (surgical, conservative, including differentiated antithrombotic therapy) and improves ischemic stroke prevention during combat operations.

BACKGROUND: Each year, 5–6 million injuries involving the nervous system are reported worldwide, of which 5%–9% are spinal cord injuries. Although these occur less frequently, the outcomes are severe: up to 100% of affected individuals develop disability or die. Muscle spasticity is one of the most common complications after spinal cord injury, particularly if the cervical and upper thoracic spine is involved. Spasticity develops as a result of damage to descending pathways and loss of inhibitory cortical control. Severe spasticity substantially limits rehabilitation, contributes to contractures and pressure ulcers, reduces quality of life, and increases socioeconomic burden, highlighting the need for more effective treatment methods.

AIM: This work aimed to assess the effectiveness of multilevel magnetic stimulation as a method for reducing the severity of muscle spasticity in patients with spastic mono- and paraplegia due to spinal cord injury.

METHODS: A comprehensive evaluation was performed in 30 patients with spinal cord injury who were assigned to either the main group or the control group. Spasticity was assessed using the Modified Ashworth Scale. The main group received standard of care combined with multilevel magnetic stimulation, whereas the control group received standard of care alone.

RESULTS: Data from 30 patients were analyzed. Four patients in the control group and three in the intervention group were excluded due to absence of spasticity. The mean Modified Ashworth Scale score decreased from 3.73 to 2.00 points in the main group and from 3.58 to 2.08 points in the control group. Although the reduction in both groups was statistically significant, clinical improvement was more pronounced when multilevel magnetic stimulation was used (Cohen’s d: 1.45 vs 0.91, respectively). Intergroup differences did not reach statistical significance, yet the effect size indicates a clear advantage of the experimental technique. The results support the feasibility of multilevel magnetic stimulation as part of comprehensive rehabilitation in spinal cord injury patients.

CONCLUSION: Multilevel magnetic stimulation combined with standard therapy provides a more clinically meaningful reduction in spasticity on the Modified Ashworth Scale compared with standard therapy alone. This method represents a promising area in rehabilitation after spinal cord injury and warrants further investigation.

In-hospital hemorrhagic stroke is a subtype of acute cerebrovascular disease of hemorrhagic origin that includes all forms of non-traumatic intracranial hemorrhage (including subarachnoid hemorrhage) occurring in patients hospitalized for diagnostic evaluation or treatment of another condition, or admitted for a diagnostic or therapeutic procedure. Unlike in-hospital ischemic stroke, the epidemiology of in-hospital hemorrhagic stroke remains insufficiently studied. In-hospital hemorrhagic stroke is a relatively rare competing condition, yet is characterized by a high rate of adverse outcomes (mortality may reach 50%), which may significantly contribute to in-hospital mortality and, similar to in-hospital ischemic stroke, is highly relevant and requires active investigation. In addition to common and specific risk factors, unique risk factors directly related to diagnostic and therapeutic procedures performed in the hospital setting play an important role in the pathogenesis of in-hospital hemorrhagic stroke. This article discusses the most frequent medical procedures associated with the highest risk of in-hospital hemorrhagic stroke, including endovascular surgical interventions, systemic thrombolytic therapy, and antithrombotic therapy. Based on the analysis of risk factors, currently relevant options for differentiated prevention are presented. Recognition of in-hospital hemorrhagic stroke as a distinct clinical condition will enable more effective targeted prevention, reduce in-hospital mortality, and improve clinical outcomes of in-hospital hemorrhagic stroke.

BACKGROUND: Vascular myelopathy remains diagnostically challenging due to its polymorphic clinical presentation and the lack of clear differential diagnostic criteria, which leads to delayed diagnosis and worse outcomes. Although vascular risk factors are known to contribute to this condition, their combined interaction and relative contribution to spinal cord infarction are insufficiently understood.

AIM: This work aimed to systematize known and newly identified clinically significant risk factors for ischemic spinal cord injury and to develop a prognostic model of vascular myelopathy.

METHODS: A prospective and retrospective cohort study included 177 patients, divided into a spinal cord infarction group (n = 77) and a comparison group with other acute and subacute myelopathies (n = 100). Inclusion criteria were clinical and instrumental signs of myelopathy confirmed by magnetic resonance imaging, with subsequent stratification by etiology. The primary endpoint was identification of independent predictors of vascular spinal cord injury using multivariate logistic regression analysis.

RESULTS: Significant between-group differences were found in favor of the main group regarding atherosclerosis (75.3% vs 22.0%, p < 0.0001), aortic condition (50.6% vs 7.0%, p < 0.0001), hypercoagulable states (26.0% vs 2.0%, p < 0.0001), spinal cord arteriovenous malformations (20.8% vs 3.0%, p = 0.0002), and iatrogenic interventions (18.2% vs 3.0%, p = 0.001). Multivariate analysis identified four independent predictors of vascular myelopathy: aortic condition (OR = 28.1), thrombophilia (OR = 36.4), venous anomalies (OR = 21.4), and uncomplicated spinal trauma (OR = 11). These formed a prognostic model with AUC = 0.88, sensitivity of 87.0%, and specificity of 84.0%.

CONCLUSION: This study confirms the key role of macrovascular and thrombophilic factors in the pathogenesis of vascular myelopathy and proposes a clinically significant prognostic model for early diagnosis of this condition. The findings support the need for comprehensive angiographic and hemostasiologic assessment in patients with myelopathy of unclear origin.

BACKGROUND: In 10%–30% of patients, the clinical course of facial nerve neuropathy progresses to a chronic stage with only partial recovery of facial muscle function and development of complications, including synkinesis and contractures. Current treatment approaches remain insufficiently effective.

AIM: To examine the clinical characteristics of facial nerve neuropathy during the late recovery period, select reflexotherapy-based treatment approaches, and assess treatment outcomes.

METHODS: Thirty-four patients aged 19–80 years (mean age: 49.9 ± 12.1 years) with facial nerve neuropathy (15 men and 19 women) were examined. Patients were divided into three groups according to clinical features: group 1 (22 individuals) with compression–ischemic neuropathy; group 2 (6 individuals) with infection-mediated neuropathy; group 3 (6 individuals) with history of traumatic facial nerve injury. All patients underwent clinical and instrumental evaluation using the House–Brackmann Facial Nerve Grading Scale, the Sunnybrook Facial Grading System for assessment of severity of paresis and pathological synkinesis, and electroneuromyography. Combined treatment included a course of acupuncture with a 4-month follow-up period.

RESULTS: Based on clinical neurological examination, postneuritic contractures and synkinesis were identified in all patients. Electroneuromyography demonstrated mixed severe nerve fiber damage. The Sunnybrook Facial Grading System was the most appropriate scale for assessing the trends of contractures and synkinesis. Acupuncture demonstrated clinical value for rehabilitation of patients with long-term consequences of facial nerve neuropathy. Its use enables influence on neuroplasticity processes. The reflexology method of proprioceptive stimulation developed by Shishkina enables modulation of pathological cortical processes and provides positive changes in the treatment of complications during late recovery of facial nerve neuropathy. Correction of facial nerve neuropathy complications such as contractures and synkinesis requires long-term treatment and repeated acupuncture courses.

CONCLUSION: Acupuncture combined with physical rehabilitation methods is an effective approach to treating complications of facial nerve neuropathy. Therapeutic exercises focused on muscle relaxation and stretching alone are not always sufficient to improve facial symmetry. Acupuncture within combination therapy allows achieving a sustained, significant clinical effect in correcting moderate and severe complications (muscle hypertonia and synkinesis).

BACKGROUND: This study presents the results of morphological genus-level identification of mosquitoes and molecular-genetic species-level identification of female Anopheles mosquitoes — the primary malaria vectors — collected in the Can Gio Biosphere Reserve, Ho Chi Minh Province. In addition, five species of human malaria parasites of the genus Plasmodium (P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi) were screened in the collected material.

AIM: To assess the species composition of vectors responsible for the most relevant and socially significant vector-borne infections in southern Vietnam during the dry and rainy seasons, and to identify active malaria foci.

METHODS: Arthropod collection was carried out in October 2024 and May 2025 in the Can Gio Biosphere Reserve (Ho Chi Minh Province). Adult hematophagous dipterans were collected using aspirators from hosts, entomological nets from vegetation, as well as from external surfaces of residential and utility buildings. Immature stages were collected by filtering water samples from natural and artificial water bodies suitable for mosquito breeding. Species identification of arthropods was performed based on morphological characteristics using dichotomous keys. Mosquito species identification and Plasmodium detection were conducted using polymerase chain reaction (PCR). Confirmation of Plasmodium ovale was performed by Sanger sequencing.

RESULTS: A total of 414 Anopheles mosquitoes were identified, of which 356 specimens (86%) belonged to An. epiroticus. DNA of Plasmodium parasites was detected in 32 mosquito samples: 17 (53.1%) positive for P. falciparum and 15 (46.9%) for P. ovale.

CONCLUSION: Despite a general decline in malaria incidence in Vietnam, foci of “forest malaria” remain active. In coastal areas of southern Vietnam, An. epiroticus plays an important role in maintaining active malaria transmission. In addition to spreading the causative agent of tropical malaria (P. falciparum), these vectors may also contribute to the transmission of P. ovale, thus sustaining foci of tertian malaria and potentially leading to cases of mixed infections.

Gastroesophageal reflux disease remains one of the most pressing issues in modern gastroenterology due to its high prevalence, chronic course, and risk of severe complications, including Barrett esophagus. This review summarizes research published between 2014 and 2024 in international (PubMed, Web of Science) and Russian (Russian Science Citation Index) scientific databases addressing epidemiology, pathophysiology, and treatment of gastroesophageal reflux disease. Epidemiological data demonstrate a global increase in disease burden—from 442 million cases in 1990 to 784 million in 2019—with marked regional variability (from 2.5% in China to 45.4% in the Middle East). In the Russian Federation, gastroesophageal reflux disease prevalence reaches 25.6%, with the highest rates observed in individuals older than 50 years. Key risk factors include abdominal obesity, tobacco smoking, and use of nonsteroidal anti-inflammatory drugs. Management of gastroesophageal reflux disease includes both non-pharmacologic approaches (lifestyle modification, diet therapy, breathing exercises) and pharmacotherapy. Proton pump inhibitors remain the standard of care; however, their long-term use is associated with risk of adverse effects. Promising areas include combination regimens incorporating antacids, alginates, esophagoprotective agents, and novel potassium-competitive acid blockers, which demonstrate advantages in treatment of resistant gastroesophageal reflux disease. Special attention is given to non-pharmacologic treatment strategies. Optimization of pharmaceutical counseling remains an important challenge aimed at minimizing self-medication and improving treatment adherence. The findings underscore the need to develop personalized therapeutic strategies considering clinical heterogeneity of gastroesophageal reflux disease, as well as the incorporation of innovative methods into clinical practice. Review results confirm the importance of a multidisciplinary approach to reduce healthcare system burden and improve patient quality of life.

This study presents a comprehensive historical and scientific analysis of the evolution of blood pressure measurement methods, dedicated to the 120th anniversary of the fundamental discovery made by Russian physician Nikolai S. Korotkoff. In 1905, he introduced the auscultatory method, which became a turning point in the development of cardiology and general medical diagnostics. The work covers more than two centuries of scientific progress—from the first invasive experiments by Stephen Hales in the 18th century, when blood pressure measurement required direct vascular access in animals, through the fundamental contributions by Bernoulli and Poiseuille that established the theoretical basis for understanding blood flow, to the development of the first non-invasive sphygmomanometers in the 19th century. Special attention is given to the contributions by Vierordt, Marey, and Riva-Rocci, whose developments created the technological foundation for Korotkoff’s discovery. A central part of this study is devoted to the detailed analysis of the revolutionary auscultatory method, which was initially met with skepticism by the medical society, but due to its simplicity, accuracy, and reproducibility, rapidly gained worldwide recognition and became the gold standard in clinical practice. From a modern scientific standpoint, the hemodynamic and biomechanical basis of Korotkoff sounds is described, explaining the physical nature of their appearance related to the transition of blood flow from laminar to turbulent during gradual arterial decompression. Advantages and limitations of the method are analyzed, considering it not only as a historical phenomenon but also as a current diagnostic tool retaining relevance in contemporary medicine. Particular emphasis is placed on the influence of the Korotkoff method on subsequent technologies for blood pressure measurement, including the oscillometric method, which dominates modern automatic and semi-automatic blood pressure meters but still requires calibration and validation against the auscultatory reference standard. The study highlights that Korotkoff’s discovery remains one of the most significant contributions of a Russian scientist to global medical science, preserving its practical and methodological value even 120 years after its introduction.

The article presents a case of duplication of the inferior vena cava detected as an incidental finding in a 62-year-old patient who underwent computed tomography of the chest and abdomen for rectal cancer. Imaging revealed duplication of the inferior vena cava, with the left trunk exceeding both the right trunk and the aorta-crossing trunk in diameter. Both trunks were formed by anastomosing common iliac veins. Duplication of the left renal artery and vein was also noted; the lower left renal vein drained directly into the left trunk of the inferior vena cava, which then joined the upper renal vein and crossed the aorta as a single trunk before merging with the right inferior vena cava. The further course of the inferior vena cava to the right atrium was anatomically normal. The currently existing classification of inferior vena cava duplication does not provide a definitive description for the variant identified in this patient, creating difficulty in formulation of the medical conclusion. The observed anatomy most closely corresponded to Type III duplication, in which the right trunk normally exceeds the left and the aorta-crossing trunk in diameter. Based on the radiologic features and morphometric measurements of the duplicated inferior vena cava trunks, we assume that this represents a rare mirror-image anatomic variant of Type III duplication, in which the left trunk has the greatest diameter. Scientific data review revealed two additional reports describing similar duplication cases (three previously reported patients in total). In one publication this variant was suggested as a Type IV duplication, whereas in another, classification was not provided. Whether this anatomical pattern should be considered an independent Type IV duplication or a mirror-image modification of Type III remains debatable and merits discussion from an anatomical nomenclature standpoint. However, larger patient samples would be required, which is challenging owing to the rarity of the present anatomic variant.