[Impact of the city recreation and sports environment on health of its residents].

Recreation and sports environment is an essential part of the urban space, which is the most important factor in improving and maintaining health of the citizens, contributing to better mental health, cognitive functions, lower overall mortality, higher life expectancy, lower morbidity and mortality from cardiovascular diseases, prevalence of obesity and type 2 diabetes, better pregnancy and birth outcomes. Recreation and sports environment of the urban space includes the city's greenery, recreational areas, areas for physical activities and sports, and waterfront areas. This study uses a correlation analysis to analyze the impact of the city recreation and sports environment on health of the working and post-working population. The study was conducted in 2019 on the example of large and huge urban cities of the Moscow region populated with more than 125,000 people. Based on the correlation analysis results, the authors have demonstrated the impact of the overall set of all sports facilities, sports structures, flat sports structures, swimming pools, sports halls, and public green spaces in cities on health of the post-working population. The study has also shown the impact of swimming pools, the overall set of all types of sports facilities, sports structures, flat sports structures, sports halls, and public green spaces in cities on health of the working-age population. The authors come to the conclusion that development and ongoing support and maintenance of the city recreation and sports environment serve as an important objective of the city administrations, resulting in the improved physical activity of the citizens and lower morbidity among the urban population.

[The priority directions of forming and supporting healthy life-style in megalopolis conditions].

The activities related to formation and maintenance of healthy life-style of population are to be carried out in accordance with the Strategy of prevention of chronic non-communicable diseases. The purpose of the study is to analyze current trends in the formation of healthy life-style of Moscow residents and to determine priority areas of its maintenance. Materials and methods. The analysis of the lifestyle of the Moscow population in conditions of actual infrastructure of urban environment was carried out as exemplified by two administrative Okrugs. According to dispenasarization data the prevalence risk factors of chronic non-communicable diseases. in Moscow residents was investigated. The Results. It is demonstrated that in actual conditions, the population is be provided with recommendations concerning development of stress resistance, proper diet and physical activity enhancement using really existing integrated prevention space. The specialists involved into issues of citizens following healthy life-style in their professional activities are to rely on the results of both study of characteristics of self-preservation behavior of population and analysis of the state of prevention infrastructure in particular municipality.

[The assessment of the clinical efficacy and tolerability of complex treatment of patients with acute low-back pain]. / Otsenka klinicheskoi effektivnosti i perenosimosti kompleksnoi terapii patsientov s ostroi bol'yu v nizhnei chasti spiny.

OBJECTIVE: To compare the efficacy and tolerability of different combinations of domestic generics meloxicam (amelotex), tolperisone (calmirex) and B vitamins (compligam B) in the treatment of acute low-back pain. MATERIAL AND METHODS: Ninety patients with acute low-back pain (ICD-10 M54.5) were studied. Indications and prescribing of the drugs was carried out under the international generic name. Pain was assessed using a visual analog pain scale in mm (VAS). To relieve pain, all patients received the non-steroidal anti-inflammatory drug with a favorable safety profile meloxicam (amelotex). With the aim of optimization, 3 therapy regimens were proposed: group 1 (n=30) received amelotex, calmirex, and B vitamins (compligam B). Group 2 (n=30) received amelotex and calmirex. Group 3 (n=30) was treated with amelotex and compligam B. With a decrease in pain by 50% or more from the baseline level and a VAS <40 mm, patients could reduce the dose of amelotex from 15 to 7.5 mg or stop taking it. RESULTS: During treatment, all groups showed a significant regression of pain according to VAS: in group 1 from 77 to 9 mm, in group 2 from 74 to 12 mm, in group 3 from 69 to 14 mm. The maximum statistically significant reduction in pain and the degree of muscle tone was observed in group 1. Adverse reactions occurred in all groups, but they were weak and transient, and did not require correction or discontinuation of therapy. Only one patient from group 3 had a persistent rise in blood pressure. The average duration of temporary disability was 5.8 days in group 1, 7.4 in group 2, and 9.5 days in group 3. High efficacy and good tolerability of all 3 therapy regimens were noted. The combination of amelotex, calmirex and compligam B received the highest rating in the opinion of doctors and patients. CONCLUSION: All 3 treatment regimens optimize therapy in patients with acute low-back pain, reduce the dose and timing of the NSAID administration as well as the risk of adverse reactions. The results indicate that the combination of amelotex, calmirex and compligam B is a synergy of three pain relief systems due to the effect on different pathogenetic mechanisms, thereby providing the maximum analgesic effect, shortening the course of treatment and duration of temporary disability, reducing the risk of relapse and chronicity of pain.

Effect of Natural Cytokine Complex on Metabolism of Smooth Muscle Cells in Myocardial Arteries under Normal Conditions and during Hemodynamic Overload.

Histoenzymological methods were employed to examine the effects of systemically administered natural cytokine complex including IL-1, IL-2, IL-6, TNFα, MIF, and TGFß on metabolism of smooth muscle cells in intramural myocardial arteries under physiological conditions and during acute hemodynamic overload of the heart. Natural cytokine complex markedly inhibited metabolism of vascular smooth muscle cells under control conditions and during acute experimental aortal stenosis. In vascular smooth muscle cells, deceleration of tricarboxylic acid cycle, redistribution of the fluxes in glycolytic cascade and its inhibition, down-regulation of oxidation of free fatty acids and their metabolites, and inhibition of the shuttle systems and biosynthetic processes were observed. Inhibition of metabolism in the vascular wall of myocardial arteries correlated with a decrease in their tone and could be partially determined by a decrease in contractile activity of smooth muscle cells. These findings do not exclude the involvement of other factors and mechanisms in down-regulation of metabolism in vascular myocytes in response to increased cytokines levels of in the blood, including their direct effect on biochemical processes in cells.

[The evaluation of prevalence risk factors of emotional burning-out syndrome in health care managers].

Professional activities of health care managers is connected with the impact of many stress factors as a result of which the burnout syndrome may develop. The aim of the study was to evaluate the incidence of this syndrome among the health care managers and risk factors responsible for its development. In the case group of managers (170 persons) burnout syndrome was detected in 24,7% and 44,7% displayed the initial (I-II) stages of it. With the help of methods of multivariate analysis (pattern recognition method) a complex of factors responsible for burnout syndrome development, and their grading due to the power of their influence. With the help of mathematical model, the potential efficiency of managerial scenarios developed for correction of some risk factors was determined.

[The evaluation of efficiency of rehabilitation activities concerning the disabled in the Russian Federation].

The system improving of medical and social expertise and rehabilitation is one of the basic concepts of the long-term socio-economic development of Russian Federation until 2020. The implementation of a complex of habilitation and rehabilitation measures covering the social sphere, including health care, professional employment and education, should be carried out at an early date, consistently with respect to the routing of the disabled and be individual in nature. The result of research, the main factors that determine its lack of effectiveness were identified.

Effects of Natural Cytokine Complex on the Myocardial Blood Flow in Normal and under Conditions of Increased Hemodynamic Load.

The effects of a natural complex of cytokines IL-1, IL-2, IL-6, TNF, MIF, and GTFß on myocardial blood flow were studied under control conditions and during acute experimental aortal stenosis. Systemic administration of the cytokine complex under control conditions led to moderate impairment of the blood flow in the myocardium associated with plethora and perivascular edema. The number of functioning vessels in the myocardium significantly increased under these conditions, which reflected enhancement of the coronary blood flow. The comparison of the myocardial blood flow under conditions of acute heart overload alone and in combination with systemic administration of the cytokine complex revealed similar changes. In both cases, moderate plethora in all compartments of the vascular network, moderate perivascular edema, and moderate blood stasis in the myocardial capillaries were seen. The only difference the increase in the density of functioning capillaries that was significantly more pronounced after cytokine administration. These data indicate that the increase in the blood cytokine level induced dilatation of myocardial vessels and intensification of blood flow in normal and under conditions of acute hemodynamic heart overload. Against the background of pronounced vasodilatation, the dyscirculatory changes in the myocardium were moderate. It was assumed that the increase in the duration or frequency of hypercytokinemia episodes can induce more severe blood flow disturbances in the myocardium.

Ipidacrine in combination therapy regimens of functional constipation.

AIM: Analysis of the treatment response rates of different therapy regimens of functional constipation, including Ipidacrine, a cholinesterase inhibitor, based on assessment of adaptation and compensatory mechanisms in the therapy forecast. MATERIALS AND METHODS: 77 functional slow-transit constipation patients were examined after therapy regimens of functional constipation, the mean age is 44.30±14.58 y.o. RESULTS: The treatment response rates of different therapies with Ipidacrine depends on the patient's initial adaptation and compensatory mechanisms (ACM index); certain aspects allowing to predict the expected result depending on the current mental state were identified; the severity of the state of functional constipation, ACM index and MMPI test psychometric indicators are correlated; adaptation and compensatory mechanisms of functional constipation patients were found to be reduced; the prognosis of the treatment response rates and, accordingly, the choice of the therapy regimen depend on the patient's adaptation potential (index). CONCLUSION: Therapy regimens for functional constipation patients should be selected on the basis of the original ACM index, behavioral pattern, degree of compliance and the patient's age.

[Chronic hypoxia state as one of the factors of increased fluorescence of endogenous porphyrins in alive biological tissues].

The hypothesis about the influence of chronic hypoxia in soft alive tissues on the intensity of He-Ne laser-induced fluorescence of endogenous porphyrins in tissues in the red region of the optical spectrum is discussed. Some theoretical prerequisites for enormous accumulation of porphyrins in soft tissues in a number of pathological cases and diseases are presented. A method for conducting clinical experimental trials to verify the hypothesis with the use of up-to-date laser noninvasive fluorescent diagnostics is proposed. Both the theoretical reasoning and new clinical experimental data show that chronic hypoxia can be one of the factors responsible for the appearance of a strong and abnormal laser-induced fluorescent signal from biotissues in the spectrum range 600-800 nm, which is associated with abnormally high accumulation of endogenous porphyrins in tissues.

[A vasoregulating function of the major vessels of the upper limbs in patients with vibration disease].

AIM: To investigate a vasoregulating function of the endothelium of the upper limbs' major arteries in patients with vibration disease (VD); to determine VD role in pathogenesis of vascular disorders. MATERIAL AND METHODS: A total of 54 VD men free of cardiovascular disease (age 42.4 +/- 0.98 years) with mean occupational local vibration contact 19.4 +/- 1.12 years entered the study. Diameter of the brachial and radial arteries and hemodynamics in them were measured with triplex scanning of the vessels. Hemodynamics in smaller vessels was examined with dopplerography. A vasoregulating function of vascular endothelium was assessed with a postocclusion test with reactive hyperemia, cold and nitroglycerin tests on sites distant from the sites exposed to vibration and close to such sites. RESULTS: Abnormal endothelium-dependent responses at distal parts of the radial artery as marked vasoconstriction in the phase of ischemia and in response to cold, inhibition of systolic and volume speed of blood flow in reactive hyperemia were found. The strongest changes were seen in finger hand arteries. No disturbances of endothelium-independent reactions in nitroglycerin test were seen. CONCLUSION: Vascular disturbances in the action of local vibration on the workers' hands are explained not only by systemic impacts but also by local disorders of endothelial function of hand vessels.

[Significance of laser dopplerometry in diagnostics of upper extremity occupational angiopathy].

The paper demonstrates the results of the application of laser dopplerometry supplemented with respiratory, thermal and occlusive functional tests, as a new non-invasive method of microcirculation evaluation. Initially the majority of patients have spastic or hyperemic microcirculation disturbances in the skin of the fingers. Functional tests allow specification of the mechanisms of these disturbances, such as microhemodynamic inertness and the suppression of slow circulatory rhythms, which demonstrate the presence of myogenic tonus disorder and prove that vibration has direct influence on vascular wall cells. The manifestation of neurogenic component is the dominance of sympatic vasomotor reflex. The paper also demonstrates the dominance of vasoconstrictor effect over vasodilatatory one.

[Increased neuromuscular excitability syndrome in vibration disease]. / Sindrom povyshennoi nervno-myshechnoi vozbudimosti pri vibratsionnoi bolezni.

The article deals with specification of criteria to use needle electromyography in diagnosis of increased neuromuscular excitability syndrome in patients with vibration disease caused by local vibration.

[New approach to determining sensitive innervation zones]. / Novyi podkhod k opredeleniiu zon chuvstvitel'noi innervatsii.

Despite a vast body of studies carried out over the past years, there is no single definite opinion about the topography of sensitive innervation zones. The reason, underlying such a situation, is analyzed in the report. Based on laser dopplerfluorometry and evoked somato-sensory potentials, an original method for determining autonomic innervation zones is described. High sensitivity of the method allows measuring dermatome topography in the absence of corresponding clinical disorders.

[Ultrasound characteristics of common carotid arteries in Chernobyl clean-up crew members long after the accident]. / Ul'trazvukovaia kharakteristika obshchikh sonnykh arterii likvidatorov posledstvii avarii na Chernobyl'skoi AES v otdalënnom periode.

AIM: Detection of early atherosclerosis and some mechanisms of dyscirculatory encephalopathy development late after the Chernobyl accident. MATERIAL AND METHODS: 57 men (mean age 45.9 +/- 1.18 years) exposed to ionizing radiation after the Chernobyl accident in 1986-1987 (random sample) and 28 healthy men (control) entered the trial. Their examination included ECG, echocardiography, veloergometry (on demand), 24-h monitoring of arterial pressure and Holter monitoring, B-mode ultrasonic scanning in combination with dopplerography and color mapping of blood flow (triplex scanning) of the right and left common carotid arteries on the unit Vingmed CFM (Diasonic Sonotron, Germany) using 7.5 MHz sensor. Blood serum was examined for total cholesterol and triglycerides. RESULTS: Clinical manifestations of atherosclerosis--ischemic heart disease--were detected in 11 examinees (19.3%). Thickening of the complex intima-media which is thought an early marker of atherosclerosis was identified in 28 examinees (49.1%), stenoses and atherosclerotic plaques--in 17(30%) examinees. Three of them had hemodynamically significant stenoses. Increased blood flow in common carotid arteries combined with enhanced pump function of the left ventricle. CONCLUSION: Atherosclerotic vascular alterations detected in the Chernobyl wreckers were encountered 2 times more frequently than clinical symptoms of atherosclerosis. One of the mechanisms of dyscirculatory encephalopathy in them is high blood volume circulating in common carotid arteries in combination with left ventricular pump hyperfunction.

[B-mode ultrasonography scanning main arteries of upper limbs in vibration disease patients]. / Ul'trazvukovoe issledovanie v B-rezhime magistral'nykh arterii verkhnikh konechnostei u bol'nykh vibratsionnoi bolezn'iu.

The objective was to use B-mode ultrasonography for assessing vascular walls of upper limbs main arteries in vibration disease patients. Imaging of the arterial walls revealed changes concerning increased intima-media complex (IMC). Ratio of IMC to vascular diameter was considerably higher in vibration disease patients--0.233 +/- 0.013 vs control value of 0.156 +/- 0.014 (p < 0.01). Vibration could result in destruction of some endothelial cells and significant release of endothelial growth factors.

[Ultrasonographic evaluation of major vessels in patients with vibration disease]. / Ul'trasonograficheskoe issledovanie nekotorykh magistral'nykh sosudov u bol'nykh vibratsionnoi bolezn'iu.

Common carotic arteries, odd visceral branches of abdominal aorta were subgected to ultrasound Doppler examination and color duplex ultrasound in 100 vibration disease patients and 57 liquidators of Chernobyl power accident consequences. Stenosis of various degree and thickened vascular wall were revealed in 23.6 +/- 4.5% of vibration disease patients and in 46.2 +/- 7.98% of liquidators (p < 0.05). These data prove that the liquidators being younger (4 years average age difference) than the vibration disease patients demonstrate more significant atherosclerotic changes of vascular wall.

[Clinical morphological aspects of chronic gastroduodenitis in patients with vibration disease]. / Kliniko-morfologicheskaia kharakteristika khronicheskogo gastroduodenita u bol'nykh vibratsionnoi bolezn'iu.

The article covers data of endoscopy, histologic and bacteriologic study of gastric lavage in 55 vibration disease patients (random select). Duodenal peptic ulcer was found in 1 patient, gastric polyp--in 1 patient, erosive gastroduodenitis in 14 (25.45%) patients, chronic gastroduodenitis without destruction of mucosa--in 39 (70.91%) patients. Contamination with Helicobacter pylori appeared in 97% of cases, being significant and subject to therapy only in 35.29% of patients.

[The functional status of the myocardium in patients with vibration disease from the impact of the local vibration]. / Funktsional'noe sostoianie miokarda u bol'nykh vibratsionnoi bolezn'iu lokal'noi vibratsii.

ECG, echo-CG and poly-CG examination of 61 workers with vibration disease revealed in most subjects hyperkinetic type of blood circulation, reduced variability of cardiac rhythm in orthostatic test and increased weight of left ventricle myocardium in 60.3% of the subjects. The authors consider the changes functional.

[The results of a morphological study of the gastric and duodenal mucosae in patients with vibration-induced disease]. / Rezul'taty morfologicheskogo issledovaniia slizistoi obolochki zheludka i dvenadtsatiperstnoi kishki u bol'nykh vibratsionnoi bolezn'iu.

AIM: Morphological study of gastric and duodenal mucosa in patients with vibration disease. MATERIALS AND METHODS: 64 patients with vibration disease stage I and II were examined endoscopically, histologically, bacterioscopically and morphometrically irrespective of the presence or absence of gastrointestinal complaints. RESULTS: Erosive gastroduodenitis, non-erosive gastroduodenitis and gastritis, polyps in the stomach and gastric ulcer were diagnosed in 19(29.7%), 40(62.5%), 2(3.2%) and 1(1.6%) patients, respectively. Small intestinal metaplasia occurred in 22% of patients. Helicobacter pylori occurred most frequently in the antral part of the stomach (90.24%). Advanced dissemination often combined with metaplasia of the small bowel. Morphometrically, there were slight differences from relevant values in patients with chronic gastroduodenitis who were not exposed to occupational hazards. Vibration disease patients exhibited impairment of duodenal vessels (large endothelial nuclei, thick arteriolar walls) 2 times more frequently than controls. CONCLUSION: In vibration disease, gastric and duodenal mucosa, as a rule, shows signs of chronic gastroduodenitis.

[Evaluation of the central nervous system activity according to the data of a psychophysiological "Rhythmotest" device in workers engaged in manufacture of construction plastics]. / Otsenka deiatel'nosti tsentral'noi nervnoi sistemy po dannym psikhofiziologicheskogo pribora "Ritmotest" u rabochikh pri proizvodstve stroiplastmass.

The paper deals with some topical problems in monitoring the central nervous system of workers contacting with chemicals in the manufacture of building plastics. The use of psychophysiological "Ritmotest" devices is demonstrated to enhance the diagnostic efficiency of occupational diseases in this group of patients.