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

Non-pharmacological treatment methods are widely used in clinical practice to improve microcirculation and tissue trophism. Capillaroscopy is a non-invasive method of microcirculatory bed visualization, allowing to objectively assess the effectiveness of various therapeutic interventions.

Objective: Analysis of modern scientific publications devoted to the application of capillaroscopy for assessing the effectiveness of non-pharmacological treatment methods.

Material and methods: A systematic review of scientific articles published between 2010 and 2024 in the databases PubMed, eLibrary, CyberLeninka, Scopus, Web of Science.

Results: Evidence was obtained of the effectiveness of capillaroscopy for assessing the initial state of microcirculation, monitoring the dynamics of changes, objectifying the effectiveness and predicting the results of treatment using physiotherapy, massage, therapeutic physical training, hirudotherapy, reflexotherapy and other non-drug methods.

Conclusion: Capillaroscopy is a valuable tool for objective assessment of the effectiveness of non-pharmacological treatment methods and can be recommended for widespread use in clinical practice.

Capillaroscopy is a non-invasive method for visualizing the microcirculatory system using modern digital equipment. This review presents the historical development of the method-from the first microscopic observations of nailfold capillaries in the 17^th century to the creation of high-precision videocapillaroscopes. Special attention is paid to the clinical application of the method in rheumatology for diagnosing systemic sclerosis and the differential diagnosis of Raynaud's phenomenon. The prospects of using capillaroscopy in neurological practice for assessing microcirculatory disorders in migraine and neuropathies are discussed. The importance of standardizing the method according to EULAR recommendations and the integration of artificial intelligence technologies for automating the analysis of capillaroscopic images is emphasized. Capillaroscopy demonstrates potential as an effective diagnostic tool in various fields of medicine.

Non-pharmacological intervention in mental diseases is of interest to researchers as an opportunity to reduce the number of side effects from psychopharmacotherapy. One of the central issues is the possibility of physically influencing brain wave activity in order to affect its functioning. For a long time, this issue remained unstudied. The situation has changed dramatically with the recent development of noninvasive brain stimulation techniques that open up new perspectives for neuroscience, allowing researchers to confirm their correlation theories for the first time by directly manipulating brain function through external influences. One of the methods of such exposure is transcranial electrical stimulation (tACS), a method of electrical stimulation of the brain in which currents act on the intact human scalp to directly interfere with the electrical activity of the brain. It is assumed that neural involvement and plasticity mediate the behavioral effects of tACS in patients with mental pathology. The purpose of this review was to study the current state of the problem, describe the latest developments in the field of tACS, and provide observations of the online and offline effects of tACS use in the treatment of mental disorders. To achieve this goal, we analyzed 180 publications In Russian and foreign libraries, descriptions of inventions related to electrotherapy, and reviewed the results of randomized controlled trials on this topic. Most of the described methods have a strong evidence base and might be included in guidelines for treatment of mental disorders in the near future.

Management of the early rehabilitation (passive, assisted, active) risks will allow to minimize complications and increase safety of patients with sepsis.

Objective: To develop a prognostic model of patient with sepsis readiness to early mobilization with assistance.

Material and methods: A single-center retrospective cohort observational study with analysis of 780 electronic medical records of patients with sepsis from the «Intensive therapy of patients with severe community-acquired pneumonia» base of the North-Western State Medical University named after I. I. Mechnikov in the period from 2013 to 2022 was carried out. Statistical analysis by binary logistic regression method and ROC-analysis were performed using Jamovi 2.3.21 and IBM SPSS Statistics 26 softwares package.

Results: The study includes the data of 519 patients with sepsis. Patients are divided into 2 study groups according to the score on the Intensive Care Unit Mobility Scale (IMS): IMS 0/1 (281 patients) and IMS ≥2 (238 patients). The predictors of IMS ≥2 for patients with sepsis have been determined: score on the APACHE II assessment scale of patient's state severity ≤20.0 (adjusted odds ratio (AOR) 6.38; 95% CI 3.01-13.5; p<0.001), score on the CCI Charlson comorbidity index ≤3.0 (AOR 3.84; 95% CI 1.72-8.58; p=0.001), score on the mNUTRIC critical state risk scale ≤5.0 (AOR 2.81; 95% CI 1.33-5.96; p=0.007), PO₂/FiO₂ index >119.0 mm Hg (AOR 104; 95% CI 29.59-365.6; p<0.001), albumin level >25.0 g/l (AOR 2.37; 95% CI 1.11-5.06; p=0.025). The prognostic model that considers 82.3% of factors determining the dispersion of IMS ≥2 probability has been developed. Area under ROC-curve amounted to 0.967±0.007 (95% CI 0.952-0.982). Sensitivity and specificity of IMS ≥2 prognostic model in patients with sepsis at 65% threshold were 92.0 and 92.6%, respectively, and accuracy - 92.3%.

Conclusion: The prognostic model of patient with sepsis readiness to early mobilization with assistance has been developed based on IMS ≥2 independent predictors. This model allows to use individual approach to early mobilization with assistance and identify patients who are ready to increase physical exertion without worsening clinical condition.

Amenorrhea of female athletes is a part of complex multifactorial syndrome - triad of sportswoman, components of which are eating disorders, menstrual disorders and low bone density, which are one of the manifestations of relative energy deficiency in sport (RED-S) syndrome. There is a lack of studies on this pathology In Russian literature, that suggests a low level of awareness among female athletes and coaches about the importance of correcting this pathology and its possible complications.

Objective: To analyze the studies on the RED-S problem in sportswomen.

Material and methods: A review of studies in the Pubmed and RSCI databases on the problem of triad of female athletes and athletic amenorrhea was carried out. We analyzed 52 sources of literature devoted to own studies and consensus agreements on the RED-S problem.

Results: Correction of the sportswomen triad in its different manifestations should be performed by a multidisciplinary team, including gynecologist, endocrinologist, coach, dietician or nutritionist. The essential components of RED-S treatment are nutrition transition towards increased caloric value, correction of eating disorders, reduction of physical exertion, development of individual training programs, selection of certain exercises to increase muscle and bone mass and, in some cases, drug therapy strictly if medically required and with mandatory consideration of current standards of the anti-doping regulations.

Conclusion: Timely diagnosis and willingness of female athlete and coach to comply with all medical recommendations lead to a favorable prognosis: it is possible to normalize mental health, improve endocrine profile and metabolism. Prevention of the pathology involves in-depth medical examination, as well as regular medical check-up of female athletes.

Therapy methods for essential arterial hypertension (EAH) associated with the impact on the cervical spine and, in particular, step-by-step manual-physical correction with the formation of a stable muscular corset in the cervical spine according to the method of A.Yu. Shishonin, are used in representatives of both sexes.As a result, it is of interest to assess gender differences that can determine the features of the course, manifestations of pathology and response to the methods of treatment used.

Objective: Study of changes in blood flow parameters in the vertebrobasilar basin under the influence of manual-physical correction according to the author's method of A.Yu. Shishonin.

Material and methods: A total of 112 patients suffering from EAG were examined, including 49 men (aged 63.3±9.2 years) and 63 women (aged 62.1±8.3 years) with signs of clinically expressed degenerative-dystrophic processes in the cervical spine and arterial pressure (AP) corresponding to high normal AP (prehypertension), or EAG of the 1st degree. Methods of examination and treatment. All patients received the procedure of manual-physical correction according to the method of A.Yu. Shishonin. Blood flow studies in the cervical vertebral arteries were carried out using the method of ultrasound Dopplerography of the brachiocephalic arteries.

Results: In both women and men, the most significant improvements were seen in the terminal blood flow velocity (ED), the average blood flow velocity (TEMEAN), peak blood flow values (PS, TAMAX), the systolic-diastolic ratio (S/D), and the pulsation index (p<0.001).However, greater changes were observed in men, who showed the most noticeable changes in the terminal diastolic blood flow velocity (17.70 times higher, compared to 11.85 times higher in women), time-averaged maximum blood flow velocity (5.72 times higher in men, compared to 4.44 times higher in women), and the Goesling index (3.29 times higher in men, compared to 2.13 times higher in women).

Conclusions: The obtained results may indicate a more pronounced response of speed indicators, greater preservation and reactivity of the elastic properties of arteries in representatives of the male population of a comparable age category.

Sleep disorders (short sleep duration, insomnia, obstructive sleep apnea and circadian rhythm disorders) negatively affect microcirculation, causing endothelial dysfunction, decreased capillary density, and increased inflammation. Nailfold capillaroscopy can detect structural changes in microvessels (tortuosity, avascular zones) and serves as an early marker of vascular impairment. The correction of sleep disorders (e.g., CPAP therapy, sleep schedule normalization) improves microcirculation, and capillaroscopy can be used to monitor treatment effectiveness.

Phantom pain syndrome (PPS) has attracted the attention of scientists and physicians for many years. In recent decades, the number of patients with PPS has increased due to the growing number of victims of local conflicts, natural disasters, and industrial accidents, as well as the rise in occlusive vascular diseases of the lower extremities. Given the pathogenesis of PPS, treatment for this condition is aimed at suppressing the pathological activity of peripheral pacemakers and hyperexcitable neuronal aggregates and activating the antinociceptive system. Bioacoustic correction, an innovative technique that has demonstrated its effectiveness in the complex treatment of functional CNS disorders and the consequences of organic brain damage, is currently one of the most promising approaches to treating PPS.

Objective: To assess the severity of phantom pain syndrome in patients with amputated limbs following mine blast injury using a course of bioacoustic correction.

Material and methods: The study was conducted at Branch No. 2 of the A.A. Vishnevsky National Medical Research Center for Military-Mechanical Engineering of the Russian Ministry of Defense. 60 patients with phantom pain syndrome participated in the study. Using a simple fixed randomization method, all patients were divided into 2 groups: a control group (n=30) and an intervention group (n=30). The control group received only basic drug therapy (BMT) according to the protocol. Patients in the intervention group, in addition to BMT, received BAC procedures (10 25-minute sessions daily). The effectiveness of phantom pain syndrome therapy and concomitant psychophysiological status disorders was assessed based on the dynamics of the following parameters: neurological examination data, phantom pain syndrome severity, visual analog pain scale (VAS); DN4 questionnaire; Pain Detect questionnaire; McGill Pain Questionnaire short form; Epworth sleep quality questionnaire.

Results: The treatment regimen in the control and study groups demonstrated significant positive dynamics across all pain assessment scales. However, a comparative analysis of the obtained results revealed a significant advantage of additional BAC therapy. The use of this non-drug technology contributed to a significant reduction in the severity of neuropathic pain and the proportion of patients with abnormal sleepiness.

Conclusion: The use of the BAC technique promotes a more pronounced analgesic effect, which is achieved through adaptive reorganization of thalamocortical detectors in the affected limbs by modulating neuroplasticity processes.