Voprosy kurortologii, fizioterapii, i lechebnoi fizicheskoi kultury最新文献

Premature aging of a person is caused by many reasons, among which great importance is given to chronic somatic diseases. Their presence is largely accompanied by numerous pathological reactions, which are quite difficult to correct by the use of drugs, which, as a rule, have specific therapeutic effects. At the same time, combined physiotherapy is devoid of these disadvantages and can activate sanogenetic processes.

Objective: To analyze predictors of pathological manifestations of premature aging and to evaluate predictors of the effectiveness of combined physiotherapy to reduce the rate of premature aging.

Material and methods: The studies were conducted at the Scientific and Clinical Center 1 of the B.V. Petrovsky Russian Scientific Center of Surgery with the participation of 80 patients (46 men and 34 women) aged 20 to 90 years. After signing voluntary informed consent for a special study with the processing of their personal data, all patients underwent a comprehensive clinical, laboratory and functional examination. Using the method of simple fixed randomization, patients were divided into two groups. The comparison group (n=40) received moderate physical activity, reduced calorie intake and vitamin therapy. Patients of the main group (n=40) additionally received a physiotherapeutic complex, which included multimodal effects using the Alpha LED Oxy Light-Spa device, hyper-hypoxytherapy, pressotherapy, dry carbon dioxide baths. Preventive courses were repeated twice with an interval of 6 months. All studies were conducted before and 6 months after the completion of each preventive course. Multiple linear and logistic regression analysis was used to identify predictors.

Results: Premature aging processes are associated with the presence of chronic somatic pathology, which disrupts insulin regulation of carbohydrate and lipid metabolism, increases the rate of aging and is accompanied by activation of inflammation processes and a decrease in the relative length of telomeres. Correlation and regression analysis made it possible to isolate the main predictors of premature aging, the regression of which became one of the goals of physiotherapeutic effects on these parameters. It has been proven that the effectiveness of combined physiotherapy increases with more significant disorders caused by the presence of chronic somatic pathology.

Conclusion: The leading role of insulin resistance in the formation of pathological reactions characterizing premature aging in patients with chronic somatic diseases has been revealed. Analysis of dynamic processes in the use of combined physiotherapy and predictors of its effectiveness allowed us to assume that physiotherapeutic effects have a therapeutic effect to a greater extent than a preventive one.

In the early 20^th century, the term «selfish brain» appeared in scientific literature, around which theory was formed, finding its proof in the work of doctors and scientists. The basic principle of the theory is that the superior hierarchy of the brain, whose needs are prioritized, results in the primary satisfaction of one's own needs, often to the detriment of the functioning of other organs and systems. The origins of the theory of «selfish brain», according to researchers, lie in the work of neurosurgery pioneer Harvey Cushing, who discovered a reflex named after him and consisting in increasing arterial pressure at high intracranial pressure. Later, the field of action of this phenomenon was expanded by specialists who showed that an increase in arterial pressure can occur not only in critical situations and arise not only at high intracranial pressure, but also as a result of hypoxia of the brain. It was also found that the remodeling of intracranial vessels in hypertensive disease may be not only a consequence, but also a cause. Currently, similar patterns have been established in relation to other processes - exchange, immune and others. It was found that the priority of brain energy needs in different situations can affect insulin resistance and glucose tolerance. These effects can be realized through various mechanisms, but the advantage is through vegetative (autonomous) nervous system, mainly through sympathetic link, and also through simulation of the functioning of parasympathetic link. It is known that there is currently a rapidly increasing number of pathologies associated with degenerative-dystrophic processes of the spine, and other factors that disrupt the blood flow in the vertex-basilar zone of the Willis circle, Correction of these processes with the help of a set of manual techniques and physical methods (A. Yu. Shishonin's method with correction of aerobic-anaerobic energy balance in the reflex zones of the brain stem) Can have a good effect on the treatment of hypertensive disease and other chronic non-communicable diseases.

Thermal lesions in children leave behind cicatricial contractions, contractures, deformations of the wrists, feet, face. Sanatorium-resort treatment using balneotherapy is an integral part of rehabilitation measures in such patients.

Objective: To analyze the results of hydrogen sulfide balneotherapy in children with consequences of thermal injury.

Material and methods: A single-center observational retrospective non-controlled study was carried out, in which sanatorium-resort treatment concerning post-burn scars in 812 children aged 5-17 years was analyzed. Hydrogen sulfide balneotherapy was prescribed to patients depending on the age in mild (5-6 years) or moderate-to-high (7-17 years) exposure modes. The imported hydrogen sulfide mineral water from the T-2000 well of the Matsesta field with the H₂S total concentration of 410-420 mg/l was used for treatment. The applications were performed to children alternate days, 8 procedures of balneotherapy per course.

Results: Lightening of the affected areas of the skin, reduction of the sensation of contraction and tension of the scars, which became softer, more elastic and more mobile with regard to the subjacent tissues have been noted in patients after the course of balneotherapy. The head mobility increased after applications in the presence of scars. The large joints' range of motion grew up. In addition, an increase in the mobility of the fingers of wrists and feet, a decrease in the stiffness of movements, increase or recovery of the affected skin's tactile sensitivity have been observed. Children well tolerated procedures, adverse events were seen in 0.7% of cases in the form of mild reactions at the beginning of the applications' course, namely of balneological (0.6%) and toxico-allergic (0.1%) nature.

Conclusion: Hydrogen sulfide balneotherapy in combination with rehabilitation exercises and other sanatorium-resort factors is an effective mean of post-burn scars correction in children.

Post-stroke cognitive impairments are widespread and significantly reduce the quality of life and rehabilitation prognosis of patients. Clinical observations show a serious variability of cognitive impairments in patients after acute cerebrovascular accident. Thus, the classification of above mentioned disorders, based on which it would be possible to determine the order of individualization of a cognitive rehabilitation program, is currently not available in literature.

Objective: To scientifically establish the differentiated approach to cognitive rehabilitation by verification of patients groups, differing in the structure of post-stroke complications.

Material and methods: Cognitive status of 45 patients in the early rehabilitation period after ischemic stroke (26 (57.8%) women, 19 (42.2%) men aged 63.0±8.0 years), who underwent inpatient treatment stage of medical rehabilitation was studied by means of «Short neuropsychological examination of cognitive sphere (SNECS)» methodology. Indicators of neurodynamics according to the domains of the International Classification of Functioning, Disability and Health were considered as well.

Results: The conducted neuropsychological study revealed 4 groups of patients, 3 of which had a significant cognitive functions' deficiency, manifested in the 1st group by reduced indicators of psychomotor control level (neurodynamic impairments, asthenia, exhaustion), executive functions, ability to analytical-synthetic activity, attention and working memory; in the 2nd group - by reduced ability to perform graphical test tasks on constructional praxis and reproduction of sequences' set; in the 4th group - by reduced indicators of «unfinished images» test task performance, reflecting state of visual object gnosis. Cognitive functions' state in the persons of the 3rd group was assessed as satisfactory.

Conclusion: The present study provides an attempt to classify cognitive disorders in patients who underwent stroke aimed at the formation of differentiated cognitive rehabilitation programs. As a result, 4 groups of patients, differing in the structure of post-stroke complications, were verified, and the directions of rehabilitation work for each of them were indicated in the cognitive functions investigation using «SNECS» methodology.

The problem of rational activation of functions of the central nervous system of a human remains highly relevant.

Objective: To analyze scientific data on the use of transcranial exposure method in obesity.

Results: The literature review presents current data on the effectiveness of non-invasive hardware brain neurostimulation in obese patients. The results of studies by domestic and foreign authors on the use of techniques of transcranial magnetic stimulation, transcranial magnetotherapy, transcranial electrical stimulation and their combinations in the comprehensive treatment of obesity in patients of different ages are presented. The data of studies on changes in dynamics of clinical and laboratory indicators, change in eating behavior in patients with obesity and metabolic syndrome after the course application of transcranial therapy by means of hardware exposure of magnetic and/or electric fields on the central nervous system are described.

Conclusion: The use of transcranial techniques has a positive effect on all levels of dysregulation in patients with obesity, both central and peripheral.

Lymphedema is a chronic disabling disease that affects 250 million people worldwide. To this date, it has been proven that treatment of this category of patients should be truly integrated - combining surgical, therapeutic methods and recovery procedures.

Objective: To study the influence of intermittent pneumatic compression (IPC) on microvasculature in patients with lymphedema of the lower extremities.

Material and methods: Prospective randomized clinical trial included the observation of 60 patients with lower extremities' lymphedema of stages I-III, divided into 2 groups. The 1st group consisted of 30 patients who received IPC in addition to the baseline therapy (lymphotonic agents for 3 weeks and elastic compression using therapeutic garment of the 3^rd compression class for 1 month); the 2^nd group included 30 patients who received only baseline therapy. Laser doppler flowmetry (LDF) was applied to study microhemodynamics.

Results: Most patients complained of swelling and heaviness sensation in the affected extremity, increased fatigue at admission. The presence of dense, painless swellings in the foot arch and tibia was revealed during physical examination. The difference in circumference of lower third of the tibia with a healthy extremity was equal 4.1±1.73 cm on average. The data obtained from LDF indicated that patients with lymphedema had impaired endothelial function, arterioles spasticity and decreased level of capillary perfusion. The 1st group patients had improvement of all LDF indicators after the treatment course. The 2^nd group patients had a positive dynamics only in two LDF indicators.

Conclusion: Patients with lymphedema of the lower extremities had changes in all microvasculature components according to the LDF. The inclusion of IPC in a comprehensive rehabilitation program for this category of patients led to the elimination of impaired endothelial function that contributed to vasodilatation of arterioles and microhemodynamics improvement in general. Regression of the disease's clinical symptoms was found in a greater degree in patients receiving IPC compared to control group.

Obesity, being a global epidemic of the 21st century, increases the likelihood of various diseases and conditions that are associated with increased mortality. Given the risks associated with obesity throughout life, identifying early predictors of its development is a priority task of prevention.

Objective: Assessment of the prognostic significance of laboratory parameters, functional tests and instrumental examination data for the early diagnosis of obesity and associated metabolic disorders.

Material and methods: The studies were conducted at the Scientific and Clinical Center 1 of the B.V. Petrovsky Russian Scientific Center of Surgery with the participation of 77 patients (43 men and 34 women) aged 33 to 65 years. After signing voluntary informed consent for a special study with the processing of their personal data, all patients underwent a comprehensive clinical, laboratory and functional examination. The study design provided for a three-time examination of patients with an interval of 6 and 12 months. To search for predictors of early diagnosis of obesity and metabolic disorders, we used an algorithm for constructing a mathematical model of multiple regression. The dynamics of the body mass index and the insulin resistance index served as the resulting feature.

Results: To build a mathematical predictive model, a matrix of independent variables was formed, including parameters characterizing the biochemical status of patients, the severity of systemic inflammation, body composition, as well as arterial stiffness and vascular condition based on the results of ultrasound duplex scanning of the brachiocephalic arteries. The choice of the most informative set of independent variables that act as predictors provides for achieving the maximum additive effect in explaining the variance of the resulting feature. The construction of the actual mathematical multiple regression model was based on the results of the selection of independent factors carried out using the method of sequential hypothesis testing. As a result of applying the algorithm of sequential hypothesis testing, three independent variables (predictors) were identified to predict the degree of BMI increase and four variables to predict the development of metabolic disorders. The accuracy of the developed model, verified at the final stage of the study, showed its high information content.

Conclusion: Two clusters of predictors were identified: the cluster of predictors for the risk of obesity development includes the systemic inflammatory response index, the triglyceride-glucose index and the blood leptin level. The cluster of biomarkers of metabolic disorders consists of the atherogenicity coefficient, the blood malondialdehyde level, the systemic inflammation index and the body roundness index.

Back pain is one of the most urgent healthcare problems in many countries of the world. The high prevalence of the disease among persons of working age, the high disability indices and the high economic losses determine the relevance of this problem and its epidemiological and socio-economic significance.

Objective: To analyze sources of scientific and technical literature and study materials of meta-analyses, systematic reviews on the issues of evaluation of the spinal traction effectiveness (dry and underwater, horizontal and vertical) in the treatment of patients with degenerative spine diseases.

Material and methods: An analysis of 67 sources, including 54 periodical articles, 5 meta-analyses and 8 systematic reviews was conducted. The search depth was 20 years.

Results: The ability of the spinal traction method to influence on the pain intensity, functional state, general improvement or return to work in patients with degenerative spine diseases has been identified. There has been a statistically significant regression of lumbar and radicular pain under the influence of «dry» horizontal tractions of the spine (13389 patients with degenerative spine diseases received them), including in combination with physiotherapy (vibration, impulse currents, laser therapy), and there has been an improvement in the motor function of the spine, a decrease in the disability rate in patients with herniated disks. These results were also obvious in short-term observation (up to 3 months after intervention). Underwater traction (5533 patients received it) had a positive impact on pain syndrome at rest and during activity, increased the activity of patients. All registered effects were related to short-term effect for up to 3 months after the intervention.

Conclusion: The evidence, based on the materials of meta-analyses and systematic reviews of medium and low quality, that «dry» and underwater spinal traction can be considered as a therapeutic tool for short-term (within 3 months) reducing pain and disability in patients with lumbar pain and lumbar radiculopathy, is presented.

An intratissual electrical stimulation, accompanied by irritation of their central neurons, is used to recover the function of damaged peripheral nerves. Treatment results exceeded those with the use of cutaneous electrical stimulation, which is confirmed by comparative results of trial animal experiments. The time and quality of peripheral nerves' function recovery in comparison of intratissual and cutaneous electrical stimulation methods remain unknown.

Objective: To evaluate the time and quality of peripheral nerves' functions recovery after their suturing and conducting two different methods of electrical stimulation, namely intratissual and cutaneous, in projection of central neurons of damaged spinal nerves in the postoperative period.

Material and methods: The basic technical parameters of the method of peripheral nerves' functions recovery in the postoperative period were ptacticed. Postoperative rehabilitation treatment was performed in 77 patients with traumatic peripheral nerves' injuries at the level of the forearm: in 42 with intratissual electrical stimulation, in 35 - using cutaneous one with similar characteristics of electrical current and concomitant pharmacological therapy. The follow-up duration was 2 years.

Results: A significant (in 4-6 times) reduction in time of treatment and a greater improvement in qualitative indicators when using intratissual electrical stimulation compared to the use of cutaneous stimulation were obtained. The effectiveness of the restorative therapy was dependent on the number of procedures, and a complete recovery of the damaged peripheral nerves' functions was observed after three courses of intratissual electrical stimulation.

Conclusion: The time and degree of recovery of peripheral nerves' functions depends on the functional activity of their central neurons at the level of the spinal cord. The activation of these neurons by low-frequency electrical current allows to activate their trophic function. Thus, the cutaneous electrical stimulation does not cause the necessary level of irritation of the neurons due to the fact that the skin is a barrier to electrical current, which reduces its impact in 200-500 times. The intratissual electrical stimulation allows to solve the problem by supplying the needle-electrode much closer to the «target». The proposed method of intratissual electrical stimulation has shown its advantage over cutaneous electrical stimulation, significantly reducing the duration of the restorative treatment and increasing its qualitative indicators.

The development of health care system, including medical rehabilitation, in the Russian Federation is required updating nomenclature of simple and complex medical services and establishing its detailed list. The latter should integrate international experience and features of domestic health care system.

Objective: To analyze the structure of International Classification of Health Interventions (ICHI) of World Health Organization (WHO) and the possibilities of its practical application in domestic medical rehabilitation system.

Material and methods: The role of ICHI and its structural logical correlations with other classifications of the WHO international classifications section has been determined. Analysis of ICHI application areas, comparison of ICHI codes and new nomenclature of medical services were performed.

Results: Analysis of ICHI and new nomenclature project of medical services in the Russian Federation showed, that ICHI formed the basis for the development of a new medical services nomenclature, including a section on medical rehabilitation. The basic principles of ICHI (structure by axes: aim, action, means; codes uniqueness; hierarchical method of classification formation) and ICHI fragment associated with purposes for systems and organism functions are presented in the new nomenclature of medical services. It has been established that ICHI can be a basis for developing domestic list of rehabilitation services, the formation of which is planned in the near future.

Conclusion: The development of medical services nomenclature in the Russian Federation will significantly increase the availability, funding and effectiveness of medical rehabilitation assistance.