[Adaptation to dosed hypoxia-hyperoxia as a factor in improving the quality of life of elderly patients with cardiac pathology.]

In order to substantiate new approaches to maintain the quality of life of elderly patients with cardiac pathology, the current study is made to evaluate the effectiveness and safety of technology, based on the principles of adaptive medicine, the method of interval hypoxic-hyperoxic training (IHHT). It was proved the use of IHHT technology in elderly people with HIBS in the prescribed regime leads to a substantial increase in the subjective perception of the quality of life, their psycho-emotional status, the number of attacks of angina pectoris, which was accompanied by an increase in the level of physical working capacity, exercise tolerance, normalization of lipid and carbohydrate metabolism. Treatments by interval hypoxic-hyperoxic training are well tolerated, do not cause side effects; when developing optimal individualized regimens' principles IHHT can be used in the complex rehabilitation of elderly patients with cardiac and co-morbid pathology.

[Adaptation to Intermittent Hypoxia-Hyperoxia in the Rehabilitation of Patients With Ischemic Heart Disease: Exercise Tolerance and Quality of Life].

AIM: to assess effect of interval hypoxic-hyperoxic training (IT) on exercise tolerance and quality of life of patients with ischemic heart disease (IHD) receiving optimal medical therapy, as well as the safety of IHHT use. METHODS: Patients with stable IHD with functional class II and III angina (n=46) were randomized into two groups: IHHT (n=27, 15 treatments in 3 weeks), and IHHT imitation (n=19). Cardiopulmonary stress test was performed to evaluate the following parameters of exercise tolerance: peak oxygen consumption (VO2peak, VO2peak/kg), % of predicted peak oxygen consumption (%VO2 peak) and anaerobic threshold (VO2AT). MOS SF-36, SAQ, HADS questionnaires were used for assessment of quality of life (QL). RESULTS: Exercise tolerance (VO2peak/kg) after course of IHHT significantly increased (p=0.03) and remained significantly elevated during subsequent month (p=0.036). Marked improvement was also observed in patients subjective perception of QL. This was evidenced by dynamics of characteristics of physical functioning as well as of psychological state, significant increase of values on all scales of disease-specific questionnaire SAQ, reduction of depression and anxiety according to dynamics of HADS scores. These effects persisted in 1 month after IHHT. IHHT was safe and well tolerated. Side effects were minimal (transient slight dizziness, feeling of shortage of air) and did not require IHHT termination. CONCLUSION: We received clinical confirmation of safety and effectiveness in of IHHT in medically treated patients with stable angina. IHHT was associated with significant improvement of exercise tolerance, subjective perception of QL, reduction of number of angina attacks. Thus, IHHT has significant potential as component of complex treatment and rehabilitation of patients with stable angina.

[Pharmacological treatment of patients with chronic fatigue syndrome]. / Medikamentoznaia terapiia patsientov s sindromom khronicheskoi ustalosti.

AIM: To evaluate the efficacy and safety of human placenta extract - laennec infusions in the treatment of patients with confirmed diagnosis of 'Chronic fatigue syndrome' (CFS). MATERIAL AND METHODS: The study included 38 patients with CFS, randomized into 2 groups: patients of the experimental group (EG, n=24) were treated with 10 intravenous laennec infusions, 4 ml each, 2 times/week, for 5 weeks. The control group (CG) consisted of 14 patients. Treatment efficacy evaluated by the severity of chronic fatigue ('The degree of chronic fatigue' questionnaire), state anxiety, depression and anger (Spilberger test) and quality of life (SF-36v2), exercise tolerance (cardiopulmonary exercise test with gas analysis), blood parameters were assessed before, after, and 5 weeks of follow-up. RESULTS AND CONCLUSION: The EG patients showed a significant reduction in the index of chronic fatigue, which was accompanied by the significant decrease in state depression, anxiety, improvements in subjective assessment of quality of life, as well as a significant increase in physical performance indices (maximal oxygen consumption, anaerobic threshold, load time to failure, normalization of the lipid 'profile' immediately after course of infusions and in 5 weeks follow-up). No changes in chronic fatigue index and other recorded indicators were identified in CG. Laennec did not cause side effects, was well tolerated by all patients.

[Adaptation to intermittent hypoxia-hyperoxia improves cognitive performance and exercise tolerance in elderly].

For improvements in exercise tolerance and cognitive function in geriatric patients Multimodal training programs (MTP) are used as combination of physiotherapy, occupational therapy and cardiovascular training. Intermittent Hypoxic-Hyperoxic Training (IHHT), a modified type of intermittent hypoxic training (IHT) is proposed to be included in MTP to elicit more pronounced beneficial effects in exercise tolerance and cognitive functions of geriatric patients likely by an additional pathway than a single MTP. Thirty four patients of the Geriatric Day Clinic aged between 64 and 92 years participated in the placebo controlled clinical trial. They were randomly assigned to receive MTP plus IHHT (experimental group - EG) or MTP plus placebo-breathing through a machine face mask (control group - CG) in a double blind fashion. Before and after the interventions course cognitive performance was assessed by the Dementia-Detection-Test (DemTect) and the Clock-Drawing-Test (CDT), and functional exercise capacity - by the total distance of 6-Minute-Walk-Test (6MWT). After IHHT combined with MTP cognitive performance (DemTect) increased significantly when compared to NG (+16,7 % vs. +0,39 %, p<0,001). The CDT indicated similar results with a significant increase in the EG while the score of the CG even decreased (+10,7 % vs. -8%, p=0,031). Concerning the functional exercise capacity, both groups improved the total distance in the 6MWT but with a significantly larger increase in the EG compared to the CG (+24,1 % vs. +10,8 %, p=0,021). In addition, there was a significant relationship between the changes of the 6MWT and the DemTect Scores and the CDT. IHHT contributed significantly to improvements in cognitive performance and exercise capacity in elderly performing MTP. IHHT sessions are considered to be easily applicable to and well tolerated by geriatric patients up to 92 years.

[Microcirculatory reactivity features in almost healthy people during acute moderate hypoxia and hyperoxia modeling].

The dynamics of the microvascular circulation and tissue oxygenation in the hypoxic test and subsequent hyperoxia are considered. In 30 healthy young men indicators of microcirculation and tissue oxygenation (laser Doppler flowmetry, and the optical tissue oximetry) during the hypoxic test - HT (10 min breathing by gas mixture with 10% O2 followed by hyperoxia (30% O2) were registered. It is found that the HT does not entail changes in the relative level of tissue oxygen saturation (SO2), but leads to a relative degree of tissue oxygen extraction significant reduction (δSaO2-SO2) with a rapid recovery in the hyperoxic phase. This is accompanied by activation of neurogenic sympathetic-related vasomotor mechanisms, as well as the endothelium-dependent microvascular tone component with a reduction in blood shunting (BSh) mostly in the hyperoxic phase and not during hypoxia. The nature of the microcirculatory response to hypoxia depends on the initial individual resistance--sensitivity level to hypoxia. Among the subjects sensitive to hypoxia HT led to a significant reduction in SaO2 and δSaO2-SO2 in the absence of changes in the microcirculation regulation. Among the subjects resistant to hypoxia HT leads to the nutritive blood flow activation by increasing the initially decreased endothelium-dependent and neurogenic sympathetic components in regulation of microhaemodynamics activity, reduction of blood shunting. At the same time δSaO2-SO2 has not significantly changed, and the activation of micro blood circulation remains in the hyperoxic recovery stage. Identified functional criteria for contribution of endothelial and neurogenic vasomotor component in the regulation of microhemodynamics in HT substantiate the contribution of the microcirculatory part and confirm the important role of hyperoxic phase in the body' hypoxia-hyperoxia adaptive response.

[The microcirculatory blood flow and autonomic regulation's functional state in young people with different levels of subjectively experienced psychological stress].

A comprehensive comparative analysis of hemodynamics, microcirculation (the method of laser Doppler flowmetry with occlusal probe and the optical tissue oxymetry), blood circulation neuro-humoral regulation (analysis of heart rate variability - HRV) between almost healthy young people with different levels of subjectively experienced emotional stress is given. Depending on the degree of everyday stress (acute and/or chronic) the character of neuro-autonomic regulation of blood circulation, as well as the state of the microcirculatory blood flow and its regulation are substantially different. Moderate stress is accompanied sympathetic-parasympathetic regulatory mechanisms co-activation with augmented HRV baroreflex regulation circuits that compensate hemodynamic changes and is not accompanied by hypertensive reactions. An increase in the activity of neurogenic and myogenic tone microhemodynamics in the examinees with moderate stress is discovered, which determines a high probability of blood shunting in tested tissue and decrease of relative oxygen extraction. Moderate levels of stress are also associated with increase in a latency of post-occlusive vasoreactive hyperemia, which is considered to be an initial sign of the endothelium-mediated dysfunction of microcirculation.

[Adaptation to hypoxia and hyperoxia improves physical endurance: the role of reactive oxygen species and redox-signaling].

We have conducted theoretical foundation, experimental analysis and a pilot study of a new method of adaptation to hypoxia and hyperoxia in the prevention of hypoxic and stress-induced disorders and improving the body's tolerance to physical stress. It has been shown in the experimental part that a combination of physical exercise with adaptation to hypoxia-hyperoxia significantly increased tolerance to acute physical load (APL) and its active phase. Analysis of lipid peroxidation processes, antioxidant enzymes and HSPs showed that short-term training for physical exercise by itself compensates the stressor, but not the hypoxic component of the APL, the combination of training with adaptation to hypoxia-hyperoxia completely normalizes the stressor and hypoxic components of APL. The pilot study has been performed to evaluate the effectiveness of hypoxic-hyperoxic training course in qualified young athletes with over-training syndrome. After completing the course of hypoxia-hyperoxia adaptation, 14 sessions, accompanied by light mode sports training, the athletes set the normalization of autonomic balance, increased resistance to acute hypoxia in hypoxic test, increased physical performance--increased PWC170, maximal oxygen consumption (VO2max) parameters, their relative values to body mass, diminished shift of rate pressure product in the load. Thus, we confirmed experimental findings that hypoxic-hyperoxic training optimizes hypoxic (increased athletes resistance to proper hypoxia) and stress (myocardium economy in acute physical stress testing) components in systemic adaptation and restoration of athletes' with over-training syndrome.

[Interval hypoxic-hyperoxic training in the treatment of the metabolic syndrome].

AIM: to investigate the possibility of a new method--interval hypo-hyperoxic training (IHHT)--in the correction of the individual components of metabolic syndrome. MATERIALS AND METHODS: The study included 35 patients with metabolic syndrome (alimentary obesity 1-3rd stage [BMI over 30 kg/m2], violation of carbohydrate tolerance or diabetes mellitus type II, hypertension and dyslipidemia). All patients were random separated into three groups: control (11 pers., basic therapy), trial 1 (13 pers. who have undergone 12 procedures of the IHHT) and trial 2 (11 pers. who have undergone IHHT in parallel with systemic hyperthermia and vibrating massage hardware). Course duration was 21 days average. Prior to the course procedures IHHT and the 3-day 4 upon completion all patients were fully examined. This examination included history taking, assessment of diet, psychometric testing, counseling psychologist to determine the type of feeding behavior, anthropometric measurements; body impendansemetria, biochemical study of blood determining the level of total cholesterol, HDL, LDL, TG, fasting plasma glucose (GP), 6-minute walk test to assess physical performance. Was established that the use of hypo-hyperoxic exercise (alone or in combination with systemic hyperthermia and hardware vibratory) leads to a significant reduction in body weight. It mainly arise by reducing fat mass accompanied by a reduction of total cholesterol, LDL, GPN, optimization of blood pressure, increased hypoxic stability, physical endurance, improved mental status. At individual selection of the course structure, dosing of hypoxic effects, combined with other physiotherapy method has some promise in treatment and rehabilitation of patients with metabolic syndrome.

[Effects of polymodal rhythmic sensory influences on human' CNS state and autonomic functions].

It is shown in the paper, polymodal rhythmic sensory influences (light, sound, vibrating-tactile etc), in combination being measures of neuro-correction, can be used for correction of a human psychophysiological condition. Efficiency of a method is shown in positive effects on mental sphere of a person, causing decrease in level of uneasiness and improvement of subjective self-assessment, in influence on cognitive and autonomic functions. Polymodal rhythmic sensory influences are means of increase in human intellectual activity efficiency: attention' concentration is increased in proportion with the increase of parasympathetic activity induced by sensory polymodal stimuli.

[The novel method of assessment of individual total cardiovascular risk for the population of Russia].

Novel innovative technology of assessment of level of total cardiovascular risk with consideration of a broad list of parameters of the state of individual health and its determining factors is described. The proposed model of risk is based on results of 20-year prospective observation of large contingents of population of Russia. For the first time the model of risk was constructed taking into account in addition to traditional risk factors and clinical characteristics peculiarities of population of Russia, in particular level of education. It was found in prospective studies that level of education in this country appeared to be an independent marker of risk and that traditional risk factors (behavioral, biochemical etc) had different prognostic value at different levels of education. Novel scale of risk and elaborated on its basis computer program of risk assessment allow to widen indications to its application, elevate accuracy of estimation of risk of development of fatal cardiovascular diseases for population of Russia, to obtain for a concrete patient parameters of absolute as well as relative risk (in % of excess or lowering of risk relative to its average statistical value for population with same age, sex, and level of education). The elaborated technology of estimation of total individual risk was tested on various contingents of patients with verified diagnoses of cardiovascular diseases as well as in groups of relatively healthy volunteers. Medical technology of risk assessment by novel scale is designed for application during primary screening of various population groups and can be fulfilled by both physicians and intermediate medical personnel. At present the computer program for assessment of cardiovascular risk based on this novel method is being prepared for clinical testing and subsequent implementation.

[Individual heart functioning variability under exposure to equal physical factors in patients with different vegetative system tone].

The article describes changes in heart rhythm variability (HRV) as a response to equal complex physical factors (hyperthermia of 60 degrees C with low relative humidity of 8 to 15%, air ionization, thalasso, and relaxing music). The subjects of the study were 28 individuals having no verified chronic diseases, who underwent a course of five recovery procedures using exposure to a complex of weak physical factors realized in Ionic House technology (Japan). The study found that changes in heart functioning as a response to equal physical factors depended on the initial vegetative system tone. Patients with normotonic and sympathicotonic heart regulation displayed the activation of parasympathetic vegetative nervous system as a result of a single exposure to a complex of physical factors, whereas in vagotonic patients sympathetic heart regulation was activated under the same conditions.

[The electrophysiologycal and information aspects of stress development].

In the first part of this paper the modern concepts of stress and possibility of diagnostics of early stress manifestations are considered. Though significant advances of researches of this problem many methodological and methodical aspects are continued to be discussed. The categorical proff are stage development of adaptation processes and there classification [H. Selye]. A long-term studies of adaptation processes of students in semesters and exams have been conducted by authors with specially development and to accumulate new data. The second part of this paper is the survey of these results published in different time. The polyparametric technology including some electrophysiological methods with the system analysis using artificial intelligence algorithms and methods of pattern recognition permitted to show some regular dependences in relationships of electrophysiological parameters and there variations under stress development. It was shown for diagnostics of stress stages in necessary to assess not only absolute values of parameters but also there relationships, which are new diagnostics signs considering as information connections between physiological systems. The main characteristic of functional state of an organism is balance of parameter's relationships in totality, representing invariant for healthy persons. In condition of disharmony of parameter relationships there are aroused the strain, overstrain functional state or failure of adaptation in depends on a degree of misbalance. The represented new data don't contradict to known reasons and mechanisms of stress and accumulated data of its variety manifestations. As the work-hypothesis the information-wave model of appearance of psychosomatic reactions of stress is introduced.