[Formation of paroxysmal brain activity in the liquidators of the consequences of the Chernobyl nuclear disaster].

OBJECTIVE: To investigate the effect of ionizing radiation on the formation of paroxysmal brain activity (PBA) in the liquidators of the consequences of the Chernobyl nuclear disaster in view of their age on the date of exposure to radiation. MATERIAL AND METHODS: EEG examinations were performed in 105 liquidators of the consequences of the nuclear disaster (LCND) and 90 people without radiation anamnesis (control group). RESULTS AND CONCLUSION: It has been determined that the formation of paroxysmal brain activity in LCND occurs 3.5 times more frequent (p<0.001) and 15-17 years earlier (p<0.001) than in the control group and mainly during the first 10 years after the exposure to radiation. The history of the exposure to ionizing radiation is associated with the increased risk of the development of convulsive PBA as focal seizures by 5.5 times (p<0.001), interictal epileptiform discharges (IED) in EEG by 3.3 times (p<0.001). Radiation effect on LCND under 30 years old increases (as compared to the control group) the risk of the formation of elevated paroxysmal brain activity by 19 times (p<0.001), convulsive epileptic seizures by 33.3 times (p<0.001), interictal epileptiform discharges in EEG by 12 times (p<0.001), asymptomatic focal epileptoid nidus in EEG by 9.3 times (p<0.001). Stimulating effect of ionizing radiation on the development of PBA related to the age on the date of exposure to radiation was found.

[The bioelectric activity of the brain in dyscirculatory encephalopathy and arterial hypertension developed in the Chernobyl nuclear disaster liquidators].

The long-term effects of the ionizing radiation on the bioelectric brain activity in the Chernobyl nuclear disaster liquidators with discirculatory encephalopathy and arterial hypertension were studied. We examined 195 male patients, aged from 30 to 65 years, with the clinical presentations of discirculatory encephalopathy, using electroencephalography: 105 patients were liquidators of the Chernobyl nuclear disaster (the main group) and 90 patients had no radiation anamnesis (the comparison group). It has been found that the development of discirculatory encephalopathy in liquidators of the Chernobyl nuclear disaster is mainly associated with the dysfunction of diencephalic and cortical structures. The specificity of the neurofunctional brain abnormalities in liquidators with discirculatory encephalopathy is characterized by the predominance of the low-amplitude and low-frequency alpha-activity or by the lack of alpha-rhythm and by its substitution for the high-frequency beta-rhythm with the presence of theta- and delta-activity and by the more significant flatness of the alpha-rhythm zonation. The presence of the radiation factor in the past history is correlated with the failure of the bioelectric brain activity in the alpha band (r=0.42) that increases risk of abnormal changes by a factor of 10 (p<0.001). The liquidators with arterial hypertension are characterized by the more frequent occurrence of the asymmetry of the recorded bioelectric potentials between the similar hemispheric areas, by the more significant difference in the external stimulus response of the brain (functional tests). The results indicate the more complicated and diffuse lesion of the brain in the liquidators of the Chernobyl nuclear disaster in the post-radiation period during the development of discirculatory encephalopathy and arterial hypertension.

[Physical training at ambulatory-polyclinical stage in complex rehabilitation and secondary prevention of patients with ischemic heart disease after acute incidents. Effect on physical working capacity, hemodynamics, blood lipids, clinical course and prognosis (Russian cooperative study)].

AIM: To investigate efficacy of early and long term physical training (PT) of moderate intensity in conditions of practical health care in Russia in patients with ischemic heart disease (IHD) of able to work age - survivors of acute coronary events. MATERIAL AND METHODS: Three hundred ninety two patients were enrolled in this study. They were randomized into intervention group " O" (n=197) and control group " C" (n=195). Inclusion period was 3- 8 weeks from onset of myocardial infarction (MI), unstable angina (UA), or intervention on coronary arteries. Patients were followed up for 1 year and efficacy of intervention was assessed by results of laboratory (levels of lipids), instrumental (ECG, exercise test on veloergometer, echocardiography), and clinical examination. In the group " O" regimen of PT with work loads of moderate intensity (50-60% of power achieved during exercise test) was used. Duration of FT was 45 - 60 min, frequency - 3 times a week. All patients received standard therapy for IHD and a lipid lowering drug when indicated. RESULTS: Proofs of efficacy of PT in the given contingent of patients were obtained. This was manifested by significant increase of physical working capacity: prolongation of exercise time (+31.7%, p<0.001), increases of volume of work performed (+74.3%, p<0.001) and efficiency of cardiac work according to results of exercise tests. All parameters were significantly different from those in the group " C" . Structural functional parameters of the heart also improved in the group " O" : left ventricular (LV) stroke volume increased 4.5% (p<0.005), ejection fraction increased 7.2% (p<0.001), diastolic LV volume decreased 2.5% (p<0.05), systolic LV volume decreased 8.1% (p<0.001). In the group " C" stroke volume and LV ejection fraction rose to a lesser degree - by 5.5% (p<0.01) and 2.9% (p<0.05), respectively. Differences between groups in dynamics of these parameters turned out to be significant (p<0.05). Moreover in group " C" LV diastolic volume increased 2.3% (p<0.05) and systolic volume did not change, while left atrium increased 3.4% (p<0.002). At intergroup comparison differences in dynamics of these parameters were significant (p<0.005). Analysis of lipid profile after 1 year showed no changes in patients of group " C" , while in group " O" it revealed significant (3.6%) lowering of total (T) cholesterol (CH) (p<0.05 compared with baseline and change in group " C" ) and elevation of high density lipoprotein (HDL) CH (+12.3%, p<0.001; compared with group " C" p<0.005). Atherogeneity index TCH/HDLCH decreased 8.5% in the group " O" (p<0.01), and increased 12% (p<0.02) in the group " C" , difference between groups was statistically significant (p<0.001). In the group " O" body mass index decreased 2.8% (p<0.001), and frequency of attacks of angina decreased 50.8% (p<0.001; compared with group " C" p<0.001). Statistically significant differences were registered between the following parameters of composite end point and surrogate points: total number of cardiovascular events - 26 (14.8%) vs 47 (27%), p<0.01; number of cardiovascular catastrophes - 5 (3%) vs 15 (8.7%), p<0.05; number of days out of work because of exacerbation of IHD per 1 person/year - 2.4 vs 4.2, p<0.05 in groups " O" and " C" , respectively. Thus in the group " O" positive effect of PT on the course and outcomes of the disease was registered compared with the group " C" . CONCLUSION: The data obtained are indicative of sufficient efficacy of the used program of PT and feasibility of its application in practice of ambulatory rehabilitation of patients with IHD - survivors of acute coronary events. It also can be looked upon as a method of secondary prevention as results of the study showed its positive impact on risk factors and outcomes of the disease.

[Exercise in outpatient complex rehabilitation and secondary prophylaxis in patients with ischemic heart disease after acute coronary events (a cooperative trial in Russia)].

AIM: To assess efficacy of early and long-term exercise in patients with ischemic heart disease (IHD) after acute coronary events (acute myocardial infarction--AMI, unstable angina--UA, coronary artery bypass grafting--CABG) in wide outpatient medical practice of Russia. MATERIAL AND METHODS: Three to eight weeks after the acute coronary event (ACE) 373 patients from different clinics of RF regions were randomized into two groups: the study group (n = 188) and a control one (n = 185). Both groups received standard therapy, the study group performed also a special exercise program (moderate exercise for maximum 1 hour 3 times a week for a year). The efficacy of the treatment was assessed by clinical, device and biochemical findings during 6-month follow-up. RESULTS: Physical work capacity, total amount of performed work (PW) in stress test rose in the study group by 26.5% (p < 0.01) and 59.4% (p < 0.01), respectively; HRmax and BPSmax x HRmax increased by 6.4 and 9.8%, respectively, p < 0.01); PW/Hrpeak rose by 48.6% (p < 0.01), PW/DP peak--by 45.9% (p < 0.01). Left ventricular ejection fraction increased by 5.6% (p < 0.05), LV stroke volume--by 3.4% (p < 0.05). In 6 months, controls demonstrated a 4.7% (p < 0.05) rise in HDLP cholesterol, total cholesterol lowered in the study group by 6.4% (p < 0.01), body mass index--by 1.9%, number of anginal attacks--by 0.9%. CONCLUSION: The proposed exercise program is effective and can be applied in outpatients after acute coronary events. The program can be also used as a method of secondary prophylaxis as it lowers total cholesterol, atherogenic index and body mass index.

[Effect of electromagnetic irradiation of the millimetric range on hemodynamics in patients with arterial hypertension]. / Vliianie élektromagnitnogo izlucheniia millimetrovogo diapazona na gemodinamiky u bol'nykh arterial'noi gipertoniei.

The study of efficacy of combined therapy including exposure to millimetric electromagnetic radiation (MER) in hypertensive patients has found a corrective hemodynamic effect of such treatment which appeared more potent than pharmacotherapy alone or combinations with sinusoidal modulated currents and placebo electromagnetic radiation. In hypokinetic and eukinetic types of hemodynamics MER raises cardiac output, lowers peripheral vascular resistance; in the hyperkinetic type there was a fall in the stroke and cardiac indices, compensatory rise of vascular resistance. The above changes in the course of treatment result in decline of both systolic and diastolic pressure and conversion of "extreme" types of hemodynamics in eukinetic in 11% patients. In hypertensive patients with eukinetic and hyperkinetic type of hemodynamics the best hemodynamic efficacy was achieved in combined therapy with 5.6 mm radiation.

[Effect of complex sanatorium treatment including magnetotherapy on hemodynamics in patients with arterial hypertension]. / Vliianie kompleksnogo sanatornogo lecheniia s primeneniem magnitoterapii na gemodinamiku bol'nykh arterial'noi gipertoniei.

Forty nine patients with arterial hypertension of stage I-II received combined sanatorium treatment. Of them, 21 had adjuvant total magnetotherapy. All the patients were examined for parameters of central, cerebral hemodynamics and microcirculation. The adjuvant magnetotherapy produced a beneficial effect on hypertension: clinical symptoms attenuated, arterial pressure became more stable, hemodynamics improved, duration of hospitalization reduced, requirement in hypotensive drugs diminished.

[Physical rehabilitation in the complex hospital therapy of patients with chronic low cardiac output]. / Fizicheskaia reabilitatsiia v kompleksnom statsionarnom lechenii bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu.

AIM: To study action of medication in combination with free-choice bicycle exercise on cerebral and peripheral hemodynamics in patients with chronic heart failure (CHF) of functional class II-III. MATERIAL AND METHODS: At admission to hospital and at discharge 100 patients with CHF of NYHA functional class (FC) II-III hospitalized for progression of CHF have undergone clinical examination, Doppler echocardiography and biomicroscopy of conjunctival vessels. The patients were randomized into two groups: group 1 of 60 patients received standard drugs and exercised on bicycle: group 2 of 40 patients received standard drugs only. RESULTS: The patients of group 2 achieved better hemodynamic effect, greater lowering of total peripheral vascular resistance. In patients with CHF FC II cardiac output increased due to improvement of left ventricular systolic function (end-systolic and end-diastolic volumes reduced by 20.3 and 38.7%, respectively, ejection fraction increased by 13.7%); in patients with FC III--due to improvement of diastolic function (end-diastolic volume reduced by 8.3%). Bicycle exercise in combined treatment of FC II CHF provides improvement in perivascular and intravascular components of microcirculation by 46.7 and 24.3%, respectively. In FC III CHF intravascular microcirculation improved by 24.3%. CONCLUSION: Bicycle exercise of patients with CHF of FC II and III used as an adjuvant to standard drugs has an additional positive effect on central hemodynamics and microcirculation.

[Microbiology of the buccal mucosa in elderly patients with general somatic diseases]. / Mikroflora slizistoi obolochki polosti rta u pozhilykh lits pri obshesomaticheskoi patologii.

Sixty-two patients with cardiovascular, gastrointestinal, and endocrine diseases aged over 60 years and 27 healthy young people aged 16-18 years (controls) were examined in order to evaluate the qualitative composition and dissemination of oral microflora in elderly people with general somatic diseases. Microbiological study revealed changes in the qualitative composition and dissemination of the oral mucosa microflora, which depended on patient's age, disease, and treatment administered for somatic disease.

[Central hemodynamics as dependent on the method of bicycle exercise in sanatorium patients who have had a myocardial infarct]. / Tsentral'naia gemodinamika v zavisimosti ot metodiki velotrenirovok v sanatorii u bol'nykh, perenesshikh infarkt miokarda.

AIM: To study central hemodynamics response to bicycle exercise with optimal pedalling rate (OPR) and in free-choice regimen of pedalling as regards the initial pedalling rate in postmyocardial infarction (PMI) patients on sanatorium treatment. MATERIALS AND METHODS: Bicycle ergometry and tetrapolar rheography examinations were performed in 124 PMI male patients. Bicycle exercise was carried out in three regimens: a) optimal pedalling rate (1), b) muscular load chosen by the patient at the first training kept further for daily training (2), c) free-choice daily load (3). RESULTS: In OPR 30 and 45 rpm, patients on regimen 3 improved their myocardial contractility both at rest and exercise. In OPR 60 rpm, exercise in regimen 1 was more effective. Regimen 2 was not effective. CONCLUSION: Hemodynamic effects were most pronounced (improved myocardial contractility in more effective cardiac performance) in the regimen of OPR 60 rpm.

[The effect of combined treatment using bicycle exercise with a free choice of the load parameters on the hemodynamics in peptic ulcer patients]. / Vliianie kompleksnogo lecheniia s primeneniem velotrenirovok so svobodnym vyborom parametrov nagruzki na gemodinamiku bol'nykh iazvennoi bolezn'iu.

AIM: To study the role of bicycle exercise in combined treatment of gastric and duodenal ulcer, its effect on central hemodynamics and microcirculation. MATERIALS AND METHODS: 94 patients with gastric and duodenal ulcer. 64 patients received conventional antiulcer treatment plus exercised on bicycle ergometer in free regimen of training. 30 patients on the routine treatment only served as control. RESULTS: Doppler echocardiography demonstrated that ulcer patients have eukinetic hemodynamic type more frequently. After combined treatment with bicycle exercise hyper- and hypokinetic hemodynamic types transformed into the eukinetic one, while the eukinetic type remained unchanged. Bicycle exercise contributed to normalization of microcirculation (as shown by conjunctival biomicroscopy), especially in location of ulcer in the duodenum. CONCLUSION: Introduction of bicycle exercise in the treatment of ulcer promoted acceleration of ulcer defects healing, especially in patients with hyperkinetic hemodynamics and duodenal ulcer.

[Bicycle training by the method of the "free choice" of physical loading in the combined treatment of hypertension patients]. / Velotrenirovki po metodike "svobodnogo vybora" fizicheskoi nagruzki v kompleksnom lechenii patsientov s gopertonicheskoi bolezn'iu.

The trends in central hemodynamics and muscular performance were investigated in 107 patients with essential hypertension stage I and II. The intensity of bicycle exercise was either preset (50% of individual exercise tolerance) or decided individually by each examinee (39 and 68 patients of group 1 and 2, respectively). 12 bicycle trainings have improved myocardial contractility at rest and threshold muscular load, exercise tolerance in group 2. Group 1 hemodynamic and performance parameters changed insignificantly.

[The role of physical training on the bicycle ergometer with an optimal pedalling rate in enhancing the efficacy of the sanatorium rehabilitation of patients who have had a myocardial infarct]. / Rol' fizicheskikh trenirovok na veloérgometre s optimal'noi chastotoi pedalirovaniia v povyshenii éffektivnosti sanatornoi reabilitatsii bol'nykh, perenesshikh infarkt miokarda.

The impact of physical training on a bicycle treadmill was examined in 171 patients with prior myocardial infarction by using individual pedalling rates at a sanatorium stage. During sanatorium rehabilitation, the proposed bicycle training allowed the authors to obtain the best clinical effects, more pronounced positive ECG dynamics, improved cardiac function with a simultaneous decrease in peripheral resistance, i.e. the economization and optimization of circulatory performance and considerably higher exercise tolerance. The positive effect of physical training with the optimum pedalling rate in patients with myocardial infarction at a sanatorium rehabilitative stage retained within 6 months and this was followed by a reduction in the number of anginal episodes, lower temporary disability and hospitalizations by thrice, restoration of the working capacity of a greater number (by 1.5 times) of patients than other patient groups.

[Hemostatic status in patients after surviving myocardial infarction]. / Sostoianie gemostaza u bol'nykh, pereneschikh infarkt miokarda.

Hemostasis system parameters were studied in 97 male patients who survived myocardial infarction, before and after single dosed bicycle exercise; the control group consisted of 38 normal subjects. The results of the study have evidenced that thrombogenic changes in hemostasis are precursors of coronary heart disease exacerbation. The authors have recommended the analysis of hemostasis parameters under conditions of single dosed bicycle exercise for the prognosis of complications at the polyclinical stage of rehabilitation.

[Adaptability of patients to freely selected and forced physical exercise after myocardial infarction]. / Adaptatsiia bol'nykh, perenesshikh infarkt miokarda, k svobodno izbiraemoi i naviazannoi fizicheskoi nagruzke.

In 45 patients with myocardial infarction in the rehabilitative period in health resort centers, bicycle ergometric tests with forced routine continuously gradually increasing exercise or without forced graded exercise in accordance with the "free option" motor motivation test were performed at the beginning and at the end of treatment. The work performed at the beginning and at the end of treatment. The work performed with free option is characterized by substantial differences in its volume, duration, intensity, and rate. Free option exercise is submaximal, close to tolerant, but simultaneously shows lower values in heart rates, systolic blood pressure, "double product" and cost-effective index. The free option exercise test is a more sensitive indicator of alterations in the status of a patient with myocardial infarction during health resort rehabilitation.