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Ischemic–reperfusion injury represents an extremely serious problem in the human population. It mainly affects the elderly population and currently used treatments have poor results. However, in nature there is a much more effective and relatively well-studied mechanism known as the ischemic tolerance phenomenon. If an organism is exposed to adverse conditions that do not destroy it, it responds by producing substances capable of protecting it from severe damage or death in the event of a repeated encounter with the same or a different dangerous environment. The problem with its use in the clinic is that its effectiveness decreases in the elderly and is practically lost with associated diseases and their concurrent treatment. Based on experimental animal studies and findings, it can be assumed that the activation of full tolerance—through successive exposure to two stressors in young, healthy individuals—will result in the formation of effectors of tolerance, which are spread throughout the body through the blood. Blood plasma thus activated and administered to a recipient who is unable to otherwise acquire tolerance, should be used as an immediate treatment for ischemia–reperfusion injury and a wide range of impending injuries in all individuals, since activated plasma contains effectors of ischemic tolerance. The purpose of this work is to show the possibilities of using ischemic tolerance in the clinical practice. Complete tolerance can be transferred from young, healthy, unmedicated donors to patients who have lost their ability to build tolerance in their own bodies.

Individual tissues have significantly different resistance to ischemia–reperfusion damage. There is still no adequate treatment for the consequences of ischemia–reperfusion damage. By utilizing ischemic tolerance, it is possible to achieve a significant reduction in the extent of the cell damage due to ischemia–reperfusion injury. Since ischemia–reperfusion damage usually occurs unexpectedly, the use of preconditioning is extremely limited. In contrast, postconditioning has wider possibilities for use in practice. In both cases, the activation of ischemic tolerance can also be achieved by the application of sublethal stress on a remote organ. Despite very encouraging and successful results in animal experiments, the clinical results have been disappointing so far. To avoid the factors that prevent the activation of ischemic tolerance, the solution has been to use blood plasma containing tolerance effectors. This plasma is taken from healthy donors in which, after exposure to two sublethal stresses within 48 h, effectors of ischemic tolerance occur in the plasma. Application of this activated plasma to recipient animals after the end of lethal ischemia prevents cell death and significantly reduces the consequences of ischemia–reperfusion damage. Until there is a clear chemical identification of the end products of ischemic tolerance, the simplest way of enhancing ischemic tolerance will be the preparation of activated plasma from young healthy donors with the possibility of its immediate use in recipients during the initial treatment.

Experimental animal models are indispensable for investigating disease mechanisms and therapeutic strategies. Esophageal resection remains the only curative treatment for esophageal cancer, but disruption of the esophagogastric anastomosis is associated with high morbidity and mortality. To better understand anastomotic healing and related complications, a simple and reproducible rodent model is required. In this study, we developed a novel, reliable technique for establishing esophagogastric anastomosis in rats. Hand-sewn end-to-end anastomoses were performed following esophageal dissection, with a 4-mm silicone catheter placed from the gastrotomy into the distal esophagus to facilitate suturing. Anastomoses were constructed with continuous nonabsorbable sutures in 10 male Sprague–Dawley rats. Histological evaluation of healing was performed 5 days postoperatively. Normal anastomotic healing was observed in 9 animals, while 1 rat developed leakage with sepsis and died shortly after revision on postoperative day 3. Histology confirmed physiological healing in successful cases. This study presents a simple, reproducible rat model of esophagogastric anastomosis healing, offering a valuable platform for bridging the gap between basic research and clinical applications.

The comprehensive locker-based classification system brought revolutionary insight into the treatment of often misdiagnosed forearm joint injuries. The authors of the classification scheme subsequently described a combination of simple elbow dislocations and forearm joint injuries (two- and three-locker injuries), but to date, no review of the literature on combined radiocarpal dislocation and forearm joint injuries has been undertaken. The combination of radiocarpal dislocation and forearm joint injury is a rare traumatic pattern, usually related to high-energy trauma. The aim of this study was to confirm the possible occurrence of a forearm joint injury and radiocarpal dislocation. We performed a systematic review of the existing literature, including case reports, to find combinations of radiocarpal dislocation and forearm joint injury. Only one case report was found. Based on the results of our search and the literature review, we recommend modifying the comprehensive locker-based classification system by adding injury patterns of combined forearm joint and neighboring joint injuries.

The introduction of the open abdomen technique for laparostomies has presented new problems, including the method of temporary coverage and the primary and delayed closure of the laparostomy. Numerous techniques for the delayed closure of a laparostomy have been described in the literature, but closure of a laparostomy with a colostomy present is a more technically challenging situation. The combination of negative pressure wound therapy and mesh-mediated fascial traction is now considered the method of choice. This paper presents a modification of the negative pressure wound therapy and mesh-mediated fascial traction techniques, by which laparostomy closure can be easily and quickly achieved by applying mesh as a whole and applying traction on the excess part. The traction on different parts of the mesh can be easily adjusted to avoid colostomy compression.

Purpose Mild traumatic brain injury (mTBI) is one of the most common trauma-related diagnoses treated in emergency departments, especially among the geriatric population. Higher age alone is often an indication for a computed tomography (CT) scan, even when, approximately 90% of these scans do not reveal intracranial injuries. Incorporation of new diagnostic parameters into indication schemes for CT scans could improve the efficiency and reduce unnecessary imaging. The primary outcome of this study was to evaluate the association of acute behavioral changes among elderly patients treated for mTBI with the prevalence of intracranial injuries diagnosed by CT scans. Methods A retrospective cross-sectional study was conducted at Louis Pasteur University Hospital in Košice. All patients aged 65 and older who presented during the period of 12 months with suspected mTBI and underwent CT imaging were included in the study. Electronic health records were used as a data source. Results A total of 586 patients were included in the study. Acute behavioral changes were observed among 60 (10.2%) patients. Intracranial injury was diagnosed in 35 patients (6.0%). There was a statistically significant association between acute behavioral changes and the presence of intracranial injuries ( p  < 0.05), with those exhibiting behavioral changes having higher odds of injury (OR: 6.51; 3.01–13.7; p  < 0.001). Conclusion Elderly patients with mTBI who present with acute behavioral changes are more likely to have intracranial injuries detected by CT scans. Incorporating these symptoms into indication schemes for head CT scans may improve strategies aimed at more effective and judicious use of imaging. Trial registration Clinical trial number: Not applicable, retrospectively registered.

Background Mild traumatic brain injury (mTBI) is a common diagnosis among elderly patients treated in emergency departments. It is often complicated by age-related physiological changes such as brain atrophy, cognitive impairment, and frailty. While sex differences are increasingly recognized in TBI pathophysiology and clinical management, limited research has explored their impact on geriatric mTBI complicated by intracranial bleeding. This study aimed to investigate sex-stratified patterns in injury mechanisms, clinical presentation, and associated injuries among older adults with mTBI. Methods We conducted a retrospective, single-center cohort study of geriatric patients (≥ 65 years) hospitalized at the Louis Pasteur University Hospital in Košice, Slovakia with mTBI complicated by intracranial bleeding over a 30-month period (July 2022– December 2024). Patient data were extracted from electronic health records, including demographic characteristics, injury mechanisms, symptomatology, radiological findings, and clinical outcomes. Statistical analysis was performed using descriptive and comparative methods. Results A total of 117 patients (55 females, 62 males) met the inclusion criteria. The median age was 77.0 years (IQR: 12.0), with females presenting at a higher median age than males (80 vs. 75.5 years). Causes of injury differed significantly between sexes ( p  < 0.001); while mechanical falls were predominant in both groups, alcohol-related injuries were significantly more common in males (37.1% vs. 7.3%). Symptom presentation also varied, with females exhibiting a higher prevalence of multiple symptoms, while males more frequently reported amnesia or loss of consciousness ( p  = 0.029). Additional injuries showed sex-related differences, with skull fractures more prevalent in males (41.9% vs. 21.8%) and pelvic (0 vs. 7.3%) or upper limb fractures (0 vs. 12.7%) more common in females ( p  = 0.005). Conclusion Sex-based differences in the presentation and symptomatology of geriatric patients with mTBI and intracranial bleeding highlight the need for tailored diagnostic and management approaches. Recognizing these differences could improve clinical assessment and individualized care. Further research is needed to refine sex-specific diagnostic and therapeutic strategies in this vulnerable population.

Application of knowledge about ischemic tolerance to clinic requires the solid understanding of mechanism of creation of this phenomenon. This review summarizes research that has been carried out in many laboratories over a long period of time, but the main focus will be on own experimental research. The main emphasis is devoted to the possibility of preparing full tolerance in the donor's body and its transfer to the patient in the form of activated blood plasma. Such plasma could be administered as soon as the patient is transported to the hospital and would take effect immediately after administration to the patient's bloodstream. One chapter is also devoted to anticonditioning, i.e. the possibility of preventing the activation of tolerance. Anticonditioning could be used to treat oncologic patients. We expect that this method could increase effectiveness of cancer treatment. Cross-tolerance with a wide range of diverse stressors gives us the courage to assume that activated plasma can significantly help with a wide range of pathological events.

Although ischemic preconditioning of the heart and brain is a well-documented neuroprotective phenomenon, the mechanism underlying the increased resistance to severe ischemia induced by a preceding mild ischemic exposure remains unclear. In this study we have determined the effect of ischemic preconditioning on ischemia/reperfusion-associated translation inhibition in the neocortex and hippocampus of the rat. We studied the effect of the duration on the sublethal ischemic episode (3, 4, 5 or 8 min), as well as the amount of time elapsed between sublethal and lethal ischemia on the cell death 7 days after the last ischemic episode. In addition, the rate of protein synthesis in vitro and expression of the 72-kD heat shock protein (hsp) were determined under the different experimental conditions. Our results suggest that two different mechanisms are essential for the acquisition of ischemic tolerance, at least in the CA1 sector of hippocampus. The first mechanism implies a highly significant reduction in translation inhibition after lethal ischemia, especially at an early time of reperfusion, in both vulnerable and nonvulnerable neurons. For the acquisition of full tolerance, a second mechanism, highly dependent on the time interval between preconditioning (sublethal ischemia) and lethal ischemia, is absolutely necessary; this second mechanism involves synthesis of protective proteins, which prevent the delayed death of vulnerable neurons.

IntroductionThe purpose of this study was to determine factors that affect the early failure of femoral neck fracture healing after internal fixation with a dynamic locking plate implant.Patients and methodsRetrospective analysis of all cases of femoral neck fracture (FNF) primarily treated with dynamic locking plate implant from 04/2014 to 04/2017 with a minimum of 6 month follow-up. For the purpose of the study age, sex and time from admission to surgery were retrieved from the hospital medical database. Patient’s pre- and postoperative hip radiographs were reviewed by the authors. Radiographically detected fracture healing failure (non-union and screw cut-out) was recorded.ResultsFor the period of the study, there were 77 consecutive FNF (76 patients) treated with the dynamic locking plate implant. Eight (10%) patients were lost to follow-up, 13 (17%) patients died within 6 months after surgery. Healing failure was identified in 23 (41%) of remaining 56 cases. Three of four (75% failure rate) failures were observed in cases with fair-quality reduction and two of two (100% failure rate) failures were noticed in the case of none telescoping screw located within subchondral bone. Multiple logistic regression showed an increased risk of fracture failure in cases with at least one completely collapsed telescoping screw (OR = 73.2; 95% CI 9.4–568.5, p < 0.01), while telescoping screws’ location around centre of the femoral head reduces the risk of failure (OR = 14.7; 95% CI 1.6–135.1, p = 0.02).ConclusionIn our group of patients, fracture healing failure of the FNF treated with dynamic locking plate reached 41%. This high failure rate was associated with poor fracture reduction, not subchondrally and centrally placed telescoping screws and in the case of complete collapse on at least one of the telescoping screws.