[High-tone therapy in complex rehabilitation of patients with post-sternotomy syndrome after coronary artery bypass surgery. (Open-label, prospective, randomized controlled trial)]. / Vysokotonovaya terapiya v kompleksnoi reabilitatsii bol'nykh s poststernotomicheskim sindromom posle aortokoronarnogo shuntirovaniya. (Otkrytoe prospektivnoe randomizirovannoe kontroliruemoe issledovanie).

INTRODUCTION: At present it remains relevant to develop new rehabilitation technologies for patients with circulatory system diseases who have undergone a cardiac surgery to restore the functions of the cardiorespiratory system more quickly, improve physical and mental health, and prevent the development of the atherosclerotic process. AIM: To study the effectiveness and safety of the new rehabilitation technology for the inpatient stage of medical rehabilitation of patients with post-sternotomy syndrome after coronary artery bypass surgery (CABS) using high-tone therapy. MATERIAL AND METHODS: The study included 85 men (the average age was 56.8±2.46 years old) with post-sternotomy syndrome after CABS. They were divided into two groups by simple randomization: the first/main (42 patients) and the second/control (43 patients). The control group of the patients had a standard rehabilitation complex; the main group was additionally prescribed a high-tone therapy according to a local method. The immediate results of the treatment were assessed by the dynamics of the clinical picture, the six-minute walk test, respiratory function, echocardiography, the level of cytokines, C-reactive protein and natriuretic peptide (NT-proBNP); distant - by QOL endpoints (questionnaire MOS SF-36). RESULTS: The groups of the patients were comparable in all baseline parameters. After the course of the procedures in the main group of patients there were positive reliable (p<0.05-0.001) shifts in clinical (pain, shortness of breath, general weakness), functional (forced expiratory vital capacity, forced expiratory volume1, effusion separation) and laboratory parameters (leukocytes, interleukin-2 and 10, NT-proBNP). The intergroup analysis of long-term results registered significant (p<0.05) differences in the QOL of patients in the main group by subscales: the role of somatic problems, vitality and mental health. Compliance to the III stage of medical rehabilitation (outpatient/home) was noted with 95.2% of the patients in the first group and 93.0% in the second. CONCLUSION: The additional appointment of a high-tone therapy to the rehabilitation standard for the patients with post-sternotomy syndrome after CABS significantly improves the immediate and long-term results of the treatment (QOL) contributing to a more pronounced reverse development of inflammatory and edematous syndromes, an increase in physical activity and psychosomatic health. The absence of adverse reactions with all the patients indicates the safety of rehabilitation complexes.

[The effect of internal course intake of selenium-modified mineral water on bone mineral density after long-term diet-induced metabolic disorders in the experiment. (Randomized controlled trial)]. / Vliyanie vnutrennego kursovogo priema modifitsirovannykh selenom mineral'nykh vod na mineral'nuyu plotnost' kostnoi tkani posle dlitel'nogo diet-indutsirovannogo narusheniya metabolizma v eksperimente. (Randomizirovannoe kontroliruemoe issledovanie).

INTRODUCTION: The phenomenon of therapeutic and prophylactic effect of natural mineral waters (MW) used to restore tissue tolerance to glucose and normalize basal insulin secretion in metabolic syndrome is well known. At the same time, the use of selenium-enriched MW is promising due to its multitarget action including participation in the regulation of the protein-synthesizing function of cells. AIM: To study the effect of internal course intake of selenium-modified mineral waters of different composition on bone mineral density after long-term diet-induced metabolic disorders in the experiment. MATERIAL AND METHODS: The study was carried out on outbred male white rats that were distributed into 3 control groups (CG) and 4 main groups (MG). In CG1 14 animals received laboratory food and drinking water; in CG2 14 animals were modeled for diet-induced metabolic disorders, and they were withdrawn from the experiment the day after the cancellation of the hypercaloric diet (180 days); after the cancellation of the hypercaloric diet 180 days later 14 animals with diet-induced metabolic disorders in CG3 had a standard diet (laboratory food and drinking water) for 30 days. In the experimental groups (EG), the animals similarly to CG3 were modeled diet-induced metabolic disorders, after the cancellation of the diet they had a standard diet and watering with MW. In MG1 18 animals were given MW1 (Essentuki-4); in MG2 19 animals had a course of MW1Se (Essentuki-4 enriched with selenium); in MG3 14 animals had a course of MW2 (Slavyanovskaya); in MG4 18 animals had a course of MB2Se (Slavyanovskaya enriched with selenium). The weight (body weight) of the animals was monitored monthly. Biochemical studies, densitometry and computed microtomography were used to determine the effectiveness of MW. RESULTS: The characteristics of spongy bone tissue of femoral metaphysis of the rats of the control groups revealed disorders of varying degrees, but, despite this, the bone tissue structure of the examined vertebral bodies in animals without a hyper caloric diet (CG1) was preserved. The analysis of the study results demonstrated a significant effectiveness of selenium-enriched MW in regulating metabolic processes (p<0.05-p<0.01), bone mineral density (p<0.05), reduced bone resorption (p<0.05), that is, the characteristics of spongy bone tissue of femoral metaphysis and vertebral bodies of animals showed a clear tendency to restore bone structure. CONCLUSION: The results of this study make it possible to predict an increase in the effectiveness of medical rehabilitation of patients with somatic diseases when selenium-enriched MW is included in the programmes.

[Natural therapeutic factors in medical rehabilitation of patients with post-COVID syndrome]. / Prirodnye lechebnye faktory v meditsinskoi reabilitatsii patsientov s postkovidnym sindromom.

The feasibility of using therapeutic physical factors in post-COVID syndrome is due to their sanogenetic effects that ensure the restoration of impaired bodily functions, which serves as the basis for their use at various stages of medical rehabilitation of this category of patients. OBJECTIVE: To develop a new medical technology for the 3rd outpatient stage of medical rehabilitation of the patients with post-COVID syndrome using natural therapeutic factors of Nalchik resort. MATERIAL AND METHODS: There has been carried out a controlled study in compliance with the principles of randomization to develop an outpatient medical rehabilitation program including 168 patients with post-COVID syndrome. All the patients were divided into four groups: the control group (n=40) was prescribed pharmacotherapy and physical therapy in the hall in accordance with federal clinical recommendations; comparison group 1 (n=43) had drinking mineral water in addition; comparison group 2 (n=43) received physical therapy on the route of Nalchik resort terrainkur in addition to the treatment in comparison group 1; the main group (n=42) included a group psychotherapy on the Terrainkur route in addition to the treatment in comparison group 2. RESULTS: The results of the comparative analysis showed the feasibility of the developed outpatient medical rehabilitation program for the patients suffering from post-COVID syndrome: the overall effectiveness of rehabilitation measures increased compared to other follow-up groups by 10-15% due to the improvement of external breathing function (p<0.05), cognitive status (p<0.01), increased exercise tolerance (p<0.01), physical recovery (p<0.01) and mental health (p<0.01). CONCLUSION: The summation and integration of sanogenetic effects of physical factors, psychocorrective techniques, and pharmacotherapy provide a significant improvement in the physical and mental status of the patients with post-COVID syndrome.

[Evaluation of resistance to transient occlusion of anterior mesenteric artery under the influence of the course of mineral water enriched with selenium (experimental research)]. / Otsenka ustoichivosti k tranzitornoi okklyuzii perednei bryzheechnoi arterii pod vliyaniem kursa mineral'noi vody, obogashchennoi selenom (eksperimental'noe issledovanie).

OBJECTIVE: To evaluate the effect of the preventive course of drinking mineral water enriched with selenium on the processes of resistance to the damaging action of reversible occlusion of the anterior mesenteric artery based on the comparison of intestinal morphological changes in the experiment. MATERIAL AND METHODS: There has been modeled ischemic reperfusion injury of the intestinal wall according to H. Ikeda and co-authors using reversible occlusion of the anterior mesenteric artery with 33 outbred male rats. The rats were divided into four groups by block randomization: the 1st group - intact animals (n=7) - without an exposure; the control group - sham operated animals (n=6); the group of comparison (n=7) - with a model-operation; the experimental group (n=11) - animals with a model operation that had courses of intragastric watering of bottled sulfate-chloride-hydrocarbonate-sodium low-mineralized (2.2 g/l) drinking mineral water «Psyzh¼ enriched with selenium. Biopsies of the small intestine were taken for histological examination. RESULTS: Histological examination of the small intestine of experimental animals determines various degrees of severity of damage: on average, the animals of the experimental group on the scale of C.J. Chiu (1970) had the lowest degree of severity of pathological changes, the animals of the group of comparison - 1.4 times higher (p=0.02). That is, the effect of a preventive course of mineral water «Psyzh¼ enriched with selenium was manifested in the formation of resistance to the damaging effect of reversible occlusion of the anterior mesenteric artery; in the presence of ischemic reperfusion damage to the intestinal wall, comparable in severity to changes with the animals without prevention, the most significant positive effect was realized in the containment of reactive changes. CONCLUSION: The effect of the preventive course of drinking mineral water «Psyzh¼ enriched with selenium manifested itself in the formation of resistance to the damaging effect of reversible occlusion of the anterior mesenteric artery, which is the basis for introducing this technique into clinical practice in order to prevent the development of reperfusion injuries of the intestine.

[The substantiation of the application of the high-intensity pulsed magnetic field for the combined treatment of biliary sludge]. / Obosnovanie primeneniia vysokointensivnogo impul'snogo magnitnogo polia v kompleksnoi terapii biliarnogo sladzha.

Despite the considerable achievements in the field of gastroenterology, there is still high incidence of diseases of the organs of the hepatobiliary system which necessitates the development of new therapeutic techniques for their management. Nowadays, high-intensity pulsed magnetic therapy is considered to be a highly efficacious method characterized by well-pronounced and many-sided action on the processes proceeding in the organism as a new preformed factor producing neurostimulatory, vasodilatory, trophic, and hypoalgesic effects. It appears to be effective with respect to biliary sludge (BS) since it can promote depletion of stagnant contents of the gall bladder and also intensify its contractile function. AIM: The objective of the present study was to evaluate the effectiveness of the application of the high-intensity pulsed magnetic field in the combination with the intake of mineral water (MW) and rational pharmacotherapy as the components of the combined treatment of biliary sludge. METHODS: The study included 117 patients presenting with biliary sludge (BS) who were randomly allocated to three groups. Group 1 was comprised of 38 patients and served as the control group. These patients received medicamentous therapy (hymecromone - 200 mg 3 times daily during two weeks and ursodeoxycholic acid at a dose of 10-15 mg/kg a day during a period from 3 to 6 months). The second group consisted of 40 patients and served as the group of comparison. The patients of this group received medicamentous therapy in the combination with the intake of 'Sernovodskaya' hydrocarbonate-chloride-sulphate sodium mineral water (from a spring in the Chechen republic). The third group was composed of 39 patients and constituted the main study group. These patients completed a course of therapy with the use of the high-intensity pulsed magnetic field applied to the gall bladder region. Each patient underwent 10 sessions of magnetic therapy after the completion of the treatment with hymecromone and 'Sernovodskaya' mineral water. The treatment was carried out with simultaneous monitoring dynamics of the clinical symptoms of biliary sludge, the ultrasound examination of the abdominal organs with the evaluation of the contractile function of the gall bladder, the level of bilirubin in the cystic bile, bile acids, cholesterol, and cholate-cholesteric coefficient. RESULTS: The combined treatment of the patients suffering from BS including the application of the high-intensity pulsed magnetic field alleviated the clinical symptoms of the disease much faster than medicamentous therapy combined with the intake of 'Sernovodskaya' mineral water. Moreover, it promoted the restoration of the motor activity of the gall bladder and accelerated the evacuation of the hyperechoic particles. CONCLUSION: The course of the combined treatment of the patients presenting with biliary sludge including the application of the high-intensity pulsed magnetic field in the combination with the intake of mineral water (MW) and rational pharmacotherapy significantly relieved abdominal pains, alleviated the symptoms of biliary dyspepsia, and improved the motor function of the biliary tract. These therapeutic effects persisted as long as 3 months. The results of the present study give evidence of the necessity of prescription of an optimum dose of ursodeoxycholic acid to the patients suffering from biliary sludge.

[One-time effects of drinking mineral water and tap water enriched with silver nanoparticles on the biochemical markers of liver condition and metabolic parameters in healthy rats].

AIM:  The objective of the present research was to study the influence of tap water enriched with silver nanoparticles (NP) as well as that of «Krasnoarmeysky¼ and «Essentuki №17¼ mineral waters after their single administration through the oral gavage to the rats on the metabolism of carbohydrates and lipids, the biochemical markers of the liver condition, and the endocrine profile in the healthy animals. MATERIAL AND METHODS:  The laboratory animals (130 male Wistar rats) were allocated to thirteen groups comprised of 10 rats each as follows: 1st group (n=10) intact animals, 2nd group (5 minutes after the administration of silver NP (n=10), 3rd group (15 minutes after the of silver NP), 4th group (60 minutes after the administration of silver NP), 5th group (n=10) (5 minutes after the introduction of the «Krasnoarmeysky¼ mineral water), 6th group (n=10) (15 min after the introduction of the «Krasnoarmeysky¼ mineral water), 7th group (n=10), (60 minutes after the introduction of the «Krasnoarmeysky¼ mineral water) 8th group (n=10) (5 minutes after the introduction of the «Essentuki № 17¼ mineral water), 9th group (n=10) (15 min after the introduction of the «Essentuki № 7¼ mineral water) , 10th group (n=10) (60 minutes after the introduction of the «Essentuki №17¼ mineral water), 11th group (n=10) (5 minutes after administration of tap water (control),12th group (n=10) (15 minutes after administration of tap water (control), and 13th (n=10) group 60 minutes after administration of tap water (control). RESULTS:  The study has demonstrated that the tap water enriched with silver nanoparticles similar to the mineral waters caused stress reactions that are inferior to those induced by «Essentuki №17¼ mineral water in terms of the magnitude; however, the effect provoked by the tap water was of longer duration. Moreover, the tap water enriched with silver nanoparticles stimulates prooxidant reactions, and inhibit the activity of antioxidant protection. Silver nanoparticles appear to produce some destructive effect on the hepatocytes. CONCLUSION:  The silver nanoparticles present in the tap water have a significant biological potential of their own. Moreover, their one-time action is apt to alter the biological potential of the water into which they are administered. The single intake of the tap water enriched with silver nanoparticles by the healthy laboratory animals produces the response that resembles that of the drinking mineral water.

[The effectiveness of the spa and health resort-based treatment with the application of Essentuki-type drinking mineral waters for the management of non-alcoholic fatty liver disease in the patients presenting with type 2 diabetes mellitus].

The objective of the present study was to estimate the effectiveness of the spa and health resort-based treatment of non-alcoholic fatty liver disease in 40 patients at the mean age of 48,8 ± 5.7 years suffering from type 2 diabetes mellitus. All of them received combined therapy including the application of potable Essentuki-Novaya mineral water (20 patients) or Essentuki No 4 water (20 patients). This therapeutic modality resulted in positive dynamics of clinical symptoms of the disease, the functional liver tests, and parameters of intra-hepatic hemodynamics, lipid peroxidation homeostasis, and the hormonal status. It is concluded that the spa and health resort-based treatment with the application of local drinking Essentuki-type mineral waters for the management of non-alcoholic fatty liver disease in the patients presenting with type 2 diabetes mellitus leads to the improvement of the main functions of the liver, stabilizes carbohydrate and lipid metabolism, and prevents progression of the pathological process.

[The spa-and-health resort-based rehabilitation of the patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation].

OBJECTIVE OF THE STUDY: To develop a new medical technology for the spa-and-health resort-based treatment of the patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation. MATERIAL AND METHODS: A total of 100 patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation were available for the examination that included detailed investigations of the clinical picture, characteristics of the immune status, and psychological testing before and after a course of the spa-and-health resort-based treatment. The effectiveness of two therapeutic modalities was evaluated. One of them (control) prescribed to 50 patients consisted of standard antiulcer pharmacotherapy in combination with Essentuki Novaya drinking mineral water and carbon dioxide mineral baths, the other given to 50 patients included radon baths instead of carbon dioxide mineral baths. RESULTS AND DISCUSSION: The combined application of drinking mineral waters, radon baths, and standard antiulcer pharmacotherapy produced the most conspicuous clinical effect in the framework of spa-and-health resort-based rehabilitation of the patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation as confirmed by positive dynamics of their psychoemotional status in 97.7% of the cases, regression of pain syndrome (91.5%), and improvement of humoral and cellular immunity (94%). An important result of the spa-and-health resort-based rehabilitation is the intensification of the reparative processes in gastroduodenal mucosa responsible for the healing of ulcers and erosions in 94.7% of the patients. CONCLUSION: The spa-and-health resort-based rehabilitation is a pathogenetically sound and efficacious approach to the management of the patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation.

[Rehabilitation of the patients suffering from chronic calculous pyelonephritis].

The objective of the present study was to develop a new technology for the balneotherapeutic treatment of the patients with urolithiasis by means of combined application of mineral water, mineral baths (1 therapeutic complex), sinusoidal modulated current (SMC-phoresis of nicotinamide), and preparations inhibiting urine concrement formation. The overall efficacy of this combined balneo-, physio-, radio-, and pharmacotherapy of the patients presenting with secondary calculous pyelonephritis amounted to 94% compared with 73.4% using balneotherapy alone (p1-2 < 0.05). Summation of positive effects of balneo-, physio-, radio-, and pharmacotherapies promoted normalization of the functional state of the kidneys and the upper urinary tracts which in its turn contributed to the improvement of the patient's quality of life.

[The use of mineral waters for the rehabilitative treatment of the patients with non-alcoholic lesions of the liver in the hospital environment].

A method has been developed for the correction of metabolic, hepato-biliary, and ischemic disorders in the patients with chronic nonalcoholic lesions of the liver by means of combined treatment using pharmaceutical agents (ursosan and Omega-3), Tib-2 drinking mineral water, and sinusoidal modulated currents (SMC) electrophoresis of this water in the right hypochondrial region. This therapy ensured pathogenetically sound modulation of the functional state of the liver and the biliary tract; moreover, it reduced the severity of regional ischemia, improved rheologic properties of the blood, normalized lipid metabolism and peroxidation, influenced production ofpro-inflammatory cytokines.

[Balneotherapeutics of non-alcoholic fatty liver disease with the use of the Essentuki-type drinking mineral waters].

The objective of the present work was to estimate the effectiveness of combined spa-and-resort treatment with the use of the Essentuki-type drinking mineral waters for the patients presenting with non-alcoholic fatty liver disease. A total of 40 patients presening with non-alcoholic fatty liver disease (NOFLD) were available for the examination. The study has demonstrated positive dynamics of clinical symptoms and results of liver functional tests, characteristics of intrahepatic dynamics, lipid metabolism, antioxidant hemostais, and the hormonal status of the patients with non-alcoholic fatty liver disease. The intake of the Essentuki-type drinking mineral waters promoted normalization of adiponectin and leptin levels in conjunction with the reduction in the degree of insulin resistance, i.e., the key pathogenetic factors responsible for hepatic steatosis and non-alcoholic steatohepatitis. It is concluded that the Essentuki-type drinking mineral waters may be recommended for the inclusion in the combined treatment and prevention of the progression of non-alcoholic fatty liver disease.

[The influence of spa and resort-based therapy on the incorporated cesium elimination rate in children presenting with environmental disadaptation syndrome].

A total of 50 children presenting with environmental disadaptation syndrome have been treated based at N.K. Krupskaya health resort (Zheleznovodsk). The therapy included the consumption of mineral water with low salt content from the Slavyansky spring at a dose of 3-5 cub.ml per 1 kg b.w. 30 min before meal, thrice daily. Its influence on the radionuclide elimination rate from the organism of the patients previously exposed to enhanced levels of background radiation was estimated from the results of spectrometric and radiochemical analysis of their urine. It was shown that introduction of drinking mineral water into the program of combined spa and resort-based therapy causes a 2-3-fold increase in the cesium excretion rate and thereby reduces the internal radiation load.

[Magnetotherapy in the combined health resort-based treatment of irritated bowel syndrome].

The authors describe a combined method for the treatment of irritated bowel syndrome with the use of magnetotherapy, drinking mineral waters, and radon baths. It was shown that prescription of preformed physical factors improves the psycho-emotional status of the patients due to normalization of the motor-evacuative function of the gastrointestinal tract. The overall result of this therapeutic modality is the improvement of the quality of life of the patients.

[Radon therapy as a component of spa-and-resort treatment of patients with functional hyperprolactinemia].

A method for the treatment of patients with functional hypoprolactinemia attributable to adhesive processes in the small pelvis has been developed based on the use of radon therapy in combination with acupuncture. Inclusion of this approach in combined spa-and-resort therapy increases its overall effectiveness by 18-20%, facilitates correction of hypoprolactinemia, elimination of hypoluteinism, recovery of regular menstruations and fertility. Taken together, these effects substantially improve the patients' quality of life.

[Diagnosis and treatment of patients with primary "empty" sella turcica syndrome at the stage of sanatorium-and-spa rehabilitation].

The authors report the first attempt to develop the treatment strategy for patients with primary "empty" sella turcica syndrome based at a health resort facility. It is shown that combined therapy including radon baths and acupuncture at specific auricular points makes it possible to improve functioning of the pituitary-ovarian system, decrease body weight, normalize blood prolactin level, eliminate visceral obesity, enhance tissue sensitivity to insulin, reduce hyperinsulimenia and fertility problems (anovulation, hyperandrogenism, and hypoluteinism) associated with insulin resistance.

[Modern methods of balneotherapy of digestive pathology at the Caucasian Mineral Waters spa-and-resort complex].

Scientists of Pyatigorsky State Research Institute of Balneotherapeutics are actively engaged in developing new medical technologies for rehabilitative treatment of patients with a variety of pathological conditions based on the current knowledge about mechanisms of action of natural therapeutic factors. Most of these original methods are included in the State Inventory of novel medical technologies by the Federal Supervisory Health and Social Development Service. The proposed medical technologies based on the application of natural and man-made physical factors improved general effect of balneotherapy by 15-20% and accelerated recovery from the disease. Specifically, the length of post-treatment remission increased to 7-12 months and duration of temporary disability decreased 2.5-3 times. Sick list payouts and economic expenditures of the state and the patients for medicinal preparations were reduced 3-4-fold while the quality of life and clinical prognosis significantly improved.

[Effect of algal preparations on immunological and biochemical characteristics of rats with adjuvant arthritis].

Investigations with the use of a rat model of adjuvant arthritis have demonstrated long-term immune, biochemical, and anti-inflammatory effects of preparations based on green and brown marine algae from the Anapa region (the Black Sea). Comparative studies showed that the algal preparations are in many cases as efficient in terms of various biological actions as local therapeutic muds.

[Sanatorium-and-spa treatment of children with mucoviscidosis and pancreatic lesions].

Over 5 years ago, the Yunost' sanatorium, Essentuki, and the Russian Centre of Mucoviscidosis, Moscow, began to jointly implement a rehabilitation program for children with mucoviscidosis. The data obtained made it possible for the first time to propose incorporation of drinking carbonate mineral water in the combined sanatorium-and-spa treatment of such patients. The new method allowed effectiveness of this therapy to be improved by 16-18%.