[Medical rehabilitation of gait disorders in multiple sclerosis]. / Meditsinskaya reabilitatsiya pri narusheniyakh khod'by u bol'nykh rasseyannym sklerozom.

The most common and important consequence of multiple sclerosis (MS) is impaired walking, which limits daily activities and increases the risk of falling. This article provides an overview of the main non-pharmacological methods of medical rehabilitation of gait disorders in people with MS (aerobic and strength training, robotic technologies, orthotics and functional electrical stimulation), which have an evidence base on systematic reviews and meta-analyses. Special attention is paid to the approach to rehabilitation in people with severe disabilities. Methods for determining gait parameters using tests and high-tech devices are considered, which serve as the basis for the routine assessment of the domains of the International Classification of Functioning (ICF) and the effectiveness of interventions.

[Molecular mechanisms of adaptive and therapeutic effects of physical activity in patients with cardiovascular diseases]. / Molekulyarnye mekhanizmy adaptatsionnykh i lechebnykh effektov fizicheskikh nagruzok u patsientov s serdechno-sosudistymi zabolevaniyami.

Physical activity is one of the main components of the rehabilitation of patients with cardiovascular disease (CVD). As shown by practice and the results of evidence-based studies, the beneficial effects of physical activity on disease outcomes in a number of cardiac nosologies are comparable to drug treatment. This gives the doctor another tool to influence the unfavorable epidemiological situation in developed countries with the spread of diseases of the cardiovascular system and CVD mortality. Reliable positive results of cardiorehabilitation (CR) were obtained using various methods. The goal of CR is to restore the optimal physiological, psychological and professional status, reduce the risk of CVD and mortality. In most current CVD guidelines worldwide, cardiac rehabilitation is a Class I recommendation. The molecular mechanisms described in the review, initiated by physical activity, underlie the multifactorial effect of the latter on the function of the cardiovascular system and the course of cardiac diseases. Physical exercise is an important component of the therapeutic management of patients with CVD, which is supported by the results of a meta-analysis of 63 studies associated with various forms of aerobic exercise of varying intensity (from 50 to 95% VO2) for 1 to 47 months, which showed that CR based on physical exercise improves cardiorespiratory endurance. Knowledge of the molecular basis of the influence of physical activity makes it possible to use biochemical markers to assess the effectiveness of rehabilitation programs.

[Chronic pelvic pain syndrome in women: diagnostic and therapeutic aspects].

Chronic pelvic pain syndrome (PPS) refers to pain of three to six months duration (or longer) that occurs below the umbilicus. PPS is considered a form of chronic regional pain syndrome or functional somatic pain syndrome. Multimodal ollaborative and patient-centered approach is critical component of treatment for women with CPPS. The current review encompasses the linical manifestations and therapeutic interventions for CPPS - a yet to be defined problem.

[Traditional nutrition and demography in the Arctic zone of Western Siberia].

High requirements for macro- and micronutrients of the organism of a pregnant woman living in the Far North are associated with the influence of extreme factors of high latitudes, and the needs of the mother and the growing fetus. Only the products of the unique food culture of the Arctic people - the Nenets, make it possible to meet the emerging needs. The aim of the work was to study the impact of traditional nutrition on the reproductive health of Nenets women living in the Arctic zone of Western Siberia. Material and methods. 619 indigenous inhabitants (Nenets) of the Yamal, Nadym and Taz districts of the Yamal-Nenets Autonomous Okrug at the age of 18-65 years were examined. The influence of the type of nutrition (traditional or imported products) on reproductive health indicators (the number of pregnancies, the number of children, the number of spontaneous abortions, frequency of gestosis, threats of termination of pregnancy, operative deliveries) for the period 2013-2018 was studied by analyzing official statistics and by questioning of the female population in own research. Results. The consumption of traditional products (venison, local fishery products, at least 3 times a week) by Nenets women was more often accompanied by a normal physiological course of pregnancy and childbirth (75.2 versus 64.2%, χ2=8.7; p=0.003). It led to a 1.5-fold decrease in the frequency of complications during pregnancy (gestosis, the threat of abortion) (χ2=5.8; p=0.01) and a 20% decrease in the frequency of delivery by cesarean section (χ2=16.6; p<0.001). As a result, a family whose diet was dominated by traditional products had a statistically significantly larger number of children (per child). Conclusion. The preservation of the consumption of reindeer and river fishery products by indigenous women will contribute to the sufficient intake of macro- and micronutrients, that will make it possible to gestate and give birth to a healthier generation of the Nenets society.

[Kinematic parameters of gait in patients with supra- or subtentorial focus location during the early rehabilitation period after ischemic stroke]. / Kinematicheskie parametry pokhodki pri supra- i subtentorial'noi lokalizatsii ochaga v rannem vosstanovitel'nom periode ishemicheskogo insul'ta.

OBJECTIVE: To study kinematic gait parameters during early rehabilitation period in patients with supra- or subtentorial ischemic stroke (IS). MATERIAL AND METHODS: We examined 24 patients (11 women, 13 men, age 61.3±8.2) 4-6 weeks after stroke onset. 15 patients had supratentorial IS (middle cerebral artery location), 9 patients had subtentorial IS (brainstem and cerebellum). NIHSS score was 6.4±0.6/6.1±0.8, modified Ashwort scale score - 0.5±0.6/0.4±0.7, hand paresis - 3.4±0.9/3.7±0.7, leg paresis - 4.1±0.7/4.0±0.8 points. Kinematic gait parameters were recorded on video analysis system Physiomed Smart (Physiomed, Germany, Davis protocol). RESULTS: Gait kinematic parameters in paretic and in unaffected leg were changed in both groups. Patients with supratentorial lesion had on paretic side exaggerated pelvic obliquity, an excessive internal rotation and amplitude of movements in the paretic hip joint, and an insufficient plantar extension on both sides. Patients with subtentorial stroke had exaggerated pelvic tilt forward, excessive flexion and insufficient extension of the hip joint, insufficient extension of the knee joint, excessive plantar flexion, and insufficient plantar extension on both sides. CONCLUSION: Patients with supra- or subtentorial IS with muscle weakness less than 3-4 points and slightly changed or normal muscle tone differed in kinematic parameters in pelvic motions and in joints of paretic and unaffected lower extremity. These results highlight the importance of differentiating rehabilitation techniques according to supra- or subtentorial focus location and cerebellar involvement.

[Balneotherapy and modification of risk factors in cardiovascular disease prevention programs]. / Bal'neoterapiia i modifikatsiia faktorov riska v programmakh profilaktiki serdechno-sosudistykh zabolevanii.

Cardiovascular disease (CVD) is the leading cause of death in the Russian Federation, as in many other countries. Taking into consideration the observed increase in the spread of risk factors, modern demographic trends (an increase in the proportion of elderly people), and a high economic burden of circulatory system diseases, the search for new forms and effective strategies of prevention is becoming relevant. OBJECTIVE: To provide the data available in the scientific literature on the effectiveness of the measures to modify risk factors and lifestyle, which are implemented during balneotherapy under both resort and in non-resort conditions, and to define areas for further investigators in this field. Investigations evaluating the effectiveness of these measures were sought in the Embase, PubMed, PEDro, Web of Science, eLIBRARY databases in January 2012 to August 2018. The analysis included seven trials that showed an improvement of estimated endpoints (blood pressure, body mass index, lipid profile, physical activity, and morbidity and mortality rates). The generalization of results of the analyzed trials was limited by the high heterogeneity of their protocols and methodological quality, which does not allow for a final conclusion on the effectiveness of preventive measures implemented during balneotherapy. Future research should provide more evidence of the benefits of this approach. The analysis will be able to take into account the existing experience and to develop a strategy to enhance the effectiveness of cardiovascular disease prevention programs based on high-quality randomized clinical trials.

[A relationship between the movement pattern and lesion location in the early rehabilitation period after ischemic stroke]. / Sviaz' dvigatel'nogo stereotipa i lokalizatsii ochaga v rannem vosstanovitel'nom periode legkogo ishemicheskogo insul'ta.

To study the changes in movement pattern during the early rehabilitation period in patients after carotid/vertebro-basilar ischemic stroke. MATERIAL AND METHODS: The authors studied 11 patients (6 women, 5 men, mean age 57.2±5.2) 4-6 weeks after stroke onset. NIHSS on admission was 6.2±0.8, arm/hand weakness 3.9±0.7/3.7±0.8, leg/foot weakness 4.3±0.6/4.0±0.5. The lesion was located in the carotid artery (7 patients) and in the vertebro-basilar system (4 patients). All patients were examined on admission and at discharge (interval 13±4 days). The changes were assessed using FIM scale, Ashwort scale, TUG test, nine-hole peg test (NHPT), Berg balance scale, 20-point vestibular disorder score scale, MMSE, Beck depression inventory, and Spielberger anxiety questionnaire. Also kinematic and kinetic profiles of the step cycle and gait were analyzed by video analysis system Physiomed Smart (Physiomed, Germany, Davis protocol). RESULTS: All patients demonstrated improvement in FIM scale, Ashwort scale, TUG test, NHP test, Berg balance scale and 20-point vestibular disorder score scale. Patients with vertebro-basilar stroke had balance disturbance, which was assessed with 20-point vestibular disorder score scale. All patients had changes in spatiotemporal gait performance, kinematic and kinetic profiles of the walking cycle: shortening of the step length and widening of the step width, prolongation of step cycle, and decreased step speed. These changes were more obvious in patients with vertebro-basilar stroke. Also patients with vertebro-basilar stroke had pelvic tilt forward, while patients with carotid lesion had pelvic obliquity. CONCLUSION: Lesion location in patients with mild stroke may influence the spatiotemporal gait characteristics and kinematic and kinetic profiles. These features should be taken into account while planning rehabilitation strategy.

[Diagnosis and treatment of migraine: Recommendations of the Russian experts]. / Diagnostika i lechenie migreni: rekomendatsii rossiiskikh ékspertov.

These recommendations on the diagnosis and treatment of migraine were elaborated by Russian headache experts in accordance with the evidence-based practice. Together with the latest classification, diagnostic principles and criteria of different clinical sub-forms the consensus contains basic data on migraine epidemiology, pathophysiological mechanisms, differential diagnosis and most effective and evidence based approaches to pharmacological and non-pharmacological management of migraine patients.

[The relationship between the parameters of cognitive potential P300 and emotional/affective state of patients with chronic pain].

OBJECTIVE: To study emotional state and parameters of cognitive evoked potentials (P300) to target emotional stimuli in patients with chronic back pain. MATERIAL AND METHODS: A study included 62 patients. Trait and state anxiety was measured using the Spilberger-Khanin questionnaire. Cognitive evoked potentials were investigated. RESULTS AND CONCLUSION: The changes in parameters and topographic distribution of cognitive evoked potentials to target emotional stimuli in patients with chronic back pain with different emotional/affective states were identified. Recording of P300 elicited by emotional stimuli allows to evaluate the characteristics of chronification of pain syndromes.

[Treatment of emotional and cognitive disorders in patients with chronic cerebral ischemia].

OBJECTIVE: To study clinical efficacy of the drug divasa in patients with chronic cerebral ischemia. MATERIAL AND METHODS: One hundred and forty-two patients, mean age 58,6±8,8 years, were treated during 11,9±0,2 weeks. Neurological examination and evaluation of a patient's status with psychometric scales were performed. RESULTS: The drug reduced anxiety, depressive and asthenic disorders beginning from the 4th week of treatment. The positive effect of treatment on cognitive functions appeared later. CONCLUSION: Divasa proved to be an effective drug in the complex treatment of patients with chronic disturbances of cerebral blood circulation.

[Diagnostics and treatment of daily headache].

The authors present the results of the voluntary questioning of 235 neurologists on what methods should be applied to the diagnostics of chronic daily headache (CDH). Of these, 72.8% named eye ground evaluation, 61% named scull and cervical radiograms, and 50.2% considered computed tomography and magnetic resonance imaging to be necessary. Electroencephalography and electroneuromyography were considered to be of less value and were mentioned by 21.3% and 10.2% of the questioned, respectively. In CDH treatment 75.3% of the neurologists used antidepressants and anxiolytics, 37% used cavinton, and 36.6% used pyracetam.