[Pre-rehabilitation of oncological patients before extensive abdominal and thoracic surgery: a literature review]. / Prereabilitatsiya onkologicheskikh patsientov pered obshirnym khirurgicheskim vmeshatel'stvom v bryushnoi i grudnoi polostyakh: obzor literatury.

Surgery is one of the leading treatment methods of patients with primary or recurrent malignant neoplasms in the thoracic or abdominal cavity. Extensive abdominal interventions are accompanied by such adverse outcomes as blood loss, hypoxia, inflammation, blood clotting abnormality, emotional and cognitive disorders, that increases the incidence of serious complications and worsens the treatment outcome and life quality in weakened oncological patients. Multimodal pre-rehabilitation before surgery can significantly decrease the incidence and severity of postoperative complications. The rehabilitation complex includes exercise therapy, nutritional and psychological support, smoking cessation and pharmacotherapy. Currently, there are a number of questions facing rehabilitation specialists and oncologists, that are related to the determination of pre-rehabilitation optimal timing and process duration, the choice of specific physical exercises, determining the load intensity. This review presents a current view on understanding of surgical stress in extensive abdominal interventions, its effect on the oncological process course, summarizes the experience of last years in choosing pre-rehabilitation program taking into account pathogenetic mechanisms of surgical stress and individual patient's characteristics. Special attention is paid to the comparison of physical exercises' various types, their action mechanisms at different stages of pathological process, the issues of load dosing during pre-rehabilitation activities.

[Modern view on upper limb physical rehabilitation after stroke. Literature review]. / Sovremennyi podkhod k fizicheskoi reabilitatsii funktsii verkhnei konechnosti posle insul'ta. Obzor literatury.

Stroke is the world's second leading cause of death and the first cause of disability among all diseases. The most common complication of a stroke is a violation of the motor function of the limbs, which significantly worsens the quality of life and the level of self-care and independence of patients. Restoring the function of the upper limb is one of the priority tasks of rehabilitation after a stroke. A large number of factors, such as the location and size of the primary brain lesion, the presence of complications in the form of spasticity, impaired skin and proprioceptive sensitivity, and comorbidities, determine the patient's rehabilitation potential and the prognosis of ongoing rehabilitation measures. Of particular note are the timing of the start of rehabilitation measures, the duration and regularity of the treatment methods. A number of authors propose scales for assessing the rehabilitation prognosis, as well as algorithms for compiling rehabilitation programs for restoring the function of the upper limb. A fairly large number of rehabilitation methods and their combinations have been proposed, including special methods of kinesitherapy, robotic mechanotherapy with biofeedback, the use of physiotherapeutic factors, manual and reflex effects, as well as ready-made programs that include sequential and combined use of various methods. Dozens of studies have been devoted to comparative analysis and evaluation of the effectiveness of these methods. The purpose of this work is to review current research on a given topic and draw up our own conclusion on the appropriateness of using and combining these methods at various stages of rehabilitation in stroke patients.

[The relationship between the relative length of leukocyte telomeres and mtDNA copy number and acute coronary syndrome in a 15-year follow-up.]

We studied the relationship between the leucocyte telomere length (LTL) and the copy number of mitochondrial DNA (CNmtDNA) and the development of acute coronary syndrome during 15 years of follow-up. A random population sample was examined at baseline in 2003-2005 (n=9 360, men and women 45-69 years old, Novosibirsk, the HAPIEE project) and followed-up for 15 years. In the frame of nested case-control design, we selected cases - incident myocardial infarction/acute coronary syndrome (MI/ACS) among those free from baseline CVD (n=256) and sex- and age-stratified control among those free from baseline CVD and cancer and alive by the end of follow-up (n=799). The relative LTL and CNmtDNA were assessed using quantitative real-time PCR. Results. The carriers of shorter telomeres had increased 15-year risk of MI/ACS with adjusted OR=1,87 (95% CI 1,70-2,06) per 1 LTL decile independent of other factors. Fewer CNmtDNA was associated with increased risk of MI/ACS with adjusted OR=1,19 (95% CI 1,12-1,26) per 1 CNmtDNA decile. The identified associations were confirmed in tertile analysis and in stepwise analysis with continuous variables of both biomarkers. All associations persisted after adjusting for gender, age, and traditional CVD risk factors. Conclusion. The LTL and CNmtDNA were independent predictors of the 15-year risk of MI/ACS in the middle- and elderly Siberian (Caucasoid) population cohort. These findings highlight the need for further research to elucidate the mechanisms by which LTL and mtDNA copy number may affect human health.

Verification of Single Nucleotide Polymorphisms rs34554140, rs6670279, and rs6874185 as Novel Molecular Genetic Markers of Sudden Cardiac Death.

The aim of the study was to explore the association between sudden cardiac death (SCD) and single nucleotide polymorphisms (SNPs) rs34554140, rs6670279, and rs6874185 from the list of potential molecular genetic markers of SCD, obtained in our earlier genome-wide allelotyping on pooled DNA samples. Materials and Methods: The study is based on the case-control principle. The SCD group included 438 deceased residents of Novosibirsk (average age - 53.2±9.1 years; men - 72.7%, women - 28.3%) with the main postmortem diagnoses of acute circulatory failure or acute coronary failure, which met the criteria of SCD established by the European Society of Cardiology. The control group included 435 live subjects enrolled in the international projects HAPIEE and MONICA (average age - 53.2±8.9 years; men - 70.0%, women - 30.0%). DNA was isolated by phenol-chloroform extraction from the myocardial tissue in the SCD group and from the venous blood in the control group. Genotyping was performed by polymerase chain reaction with subsequent analysis of restriction fragment length polymorphism in a polyacrylamide gel. Results: The frequencies of the genotypes of SNPs rs34554140, rs6670279, and rs6874185 in the control group correspond to those predicted by the Hardy-Weinberg equilibrium (c2=0.98, 0.009, 3.39, respectively). The AA genotype of rs34554140 is associated with an increased risk of SCD (p=0.002; OR=1.85; 95% CI 1.26-2.71). The AT genotype has a protective effect against SCD (p=0.001; OR=0.53; 95% CI 0.36-0.78). In subgroups separated by gender and age, the differences persist in the subgroups of men, women, and individuals under 50 years old (p<0.05). The AA genotype of rs6670279 is associated with an increased risk of SCD (p=0.005; OR=1.54; 95% CI 1.15-2.06). The AT genotype has a protective effect against SCD (p=0.047; OR=0.73; 95% CI 0.54-0.98). When distributed by sex and age, the differences persist in the subgroups of men, individuals above 50 years old, and men above 50 years old (p<0.05). There were no significant differences in the frequencies of genotypes and alleles of rs6874185 between the SCD and control groups, even after the subgroups specified by gender and age were compared (p>0.05). Conclusion: The association of single nucleotide polymorphisms rs34554140 and rs6670279 with SCD was confirmed. In contrast, no association of rs6874185 with SCD was detected.

Interim Results of the BYHEART Observational Study: Exogenous Phosphocreatine Effect on the Quality of life of Patients with Chronic Heart Failure.

Aim      Improvement of quality of life is one of the most important goals for the treatment of patients with chronic heart failure (CHF). This study searched for ways to increase the efficiency of CHF treatment based on parameters of quality of life in CHF patients during and after the treatment with exogenous phosphocreatine (EP).Material and methods  The effect of a single course of EP treatment on quality of life of patients with functional class (FC) II-IV CHF with reduced or mid-range left ventricular ejection fraction was studied as a part of the all-Russia prospective observational study BYHEART. The presence of FC II-IV CHF and a left ventricular ejection fraction <50 % were confirmed by results of 6-min walk test (6MWT) and findings of echocardiography after stabilization of the background therapy.Results An interim data analysis showed that the course of EP treatment was associated with a significant improvement of quality-of-life indexes as determined by the Minnesota Living with Heart Failure Questionnaire (LHFQ) total score. These indexes significantly increased and remained at a satisfactory level for 6 mos. following completion of the treatment course. Also, the treatment significantly beneficially influenced the clinical condition of patients (heart failure severity scale), results of 6MWT, and the increase in left ventricular ejection fraction.Conclusion      The conclusions based on results of the interim analysis should be confirmed by results of the completed study. Complete results are planned to be published in 2022.

[Antibiotic resistance of Helicobacter pylori in the European part of the Russian Federation: first results].

AIM: Determine the primary antibiotic resistance of Helicobacter pylori (H. pylori) strains isolated from patients living in the European part of the Russian Federation. MATERIALS AND METHODS: As part of a clinical laboratory study, from 2015 to 2018, 27 gastrobiopsy samples obtained from H. pylori-infected patients were analyzed. H. pylori infection was verified using a rapid urease test or a 13C-urea breath test. The values of the minimum inhibitory concentration (MIC) of antibiotics were determined by the diffusion method using E-test strips (BioMerieux, France) according to the recommendations of the manufacturer. The sensitivity of the isolates was determined for 6 antibacterial drugs (amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, rifampicin). RESULTS: According to the data obtained, resistance to amoxicillin was 0%, clarithromycin 11.1%, metronidazole 59.3%, levofloxacin 3.7%, tetracycline 0%, and rifampicin 14.8%. Dual resistance to clarithromycin and metronidazole was recorded in two isolates (7.4%). CONCLUSION: Thus, the first results of the evaluation of H. pylori antibiotic resistance in the European part of the Russian Federation indicate a low resistance of the microorganism to clarithromycin and quite high to metronidazole.

[Current issues in the rehabilitation of stroke patients against the background of a new coronavirus infection (COVID-19). Resolution of the Council of Experts]. / Aktual'nye voprosy reabilitatsii patsientov s insul'tom na fone novoi koronavirusnoi infektsii (COVID-19). Rezolyutsiya Soveta ekspertov.

The pandemic of the new coronavirus infection caused by SARS-CoV-2 has forced to reconsider the methods of rehabilitation of patients with emergency conditions, including neurology. The Council of Experts of Neurologists and Rehabilitation Therapists gathered to develop unified approaches to manage stroke patients based on a discussion of practical experience and, taking into account the scientific information on COVID-19 that was available by the time of the meeting. Stroke is a serious disabling condition that requires maximum rehabilitation efforts at all stages of medical care. In the context of the SARS-CoV-2 coronavirus epidemic, the process of medical rehabilitation and the routing of patients with stroke is undergoing major changes. Combining COVID-19 and stroke requires new approaches to rehabilitation and patient management. During the meeting, a resolution was developed in which the experts formulated the tactics of medical rehabilitation of patients with stroke and COVID-19 at the first and second stages. The arguments of the importance and practicability of carrying out measures of medical rehabilitation at the third stage is given and the need to continue consultations on the indicated topic is revealed.

[The effectiveness of combined laser therapy in patients with trophic leg ulcer and chronic venous insufficiency]. / Effektivnost' kombinirovannoi lazernoi terapii patsientov s troficheskimi yazvami nizhnikh konechnostei na fone khronicheskoi venoznoi nedostatochnosti.

New prospects associated with the use of laser radiation of different wavelengths in the ultraviolet (365 nm) and the green emission spectrum (525 nm) have appeared in recent years. The high prevalence of the trophic leg ulcers necessitates the search for more effective methods of conservative treatment. PURPOSE OF THE STUDY: Development and scientific justification for the low-intensity laser radiation of different wavelengths combined use in patients with trophic leg ulcers and chronic venous insufficiency (CVI). MATERIAL AND METHODS: 102 patients with trophic leg ulcers and CVI were examined. They were divided into 3 equal groups using simple randomization. Patients in the control group received only traditional conservative therapy; comparison group - traditional conservative therapy and an intravenous laser blood irradiation (ILBI) (λ - 635 nm); the main group - traditional conservative therapy and different wavelengths laser therapy (LT) course. RESULTS AND CONCLUSION: A more significant improvement in the clinical condition occurred under the influence of the course application of combined different wavelengths laser therapy in patients with trophic venous leg ulcers. Compared to patients who received traditional conservative therapy and in combination with ILBI 635 nm, the speed of reparative regeneration of trophic ulcers increased, the time for cleansing trophic ulcers from devitalized tissues was reduced. Computer capillaroscopy data showed that the positive effect of laser exposure on all parts of the microcirculation underlies its therapeutic efficacy.

[Influence of the Donor of Hydrogen Sulfide GYY4137 on the Activation of Human Neutrophils by E. coli Lipopolysaccharides].

Lipopolysaccharides (LPS), components of the cell wall of gram-negative bacteria, activate neutrophils that trigger pathological processes, including gram-negative sepsis. LPS inhibit spontaneous apoptosis of neutrophils that leads to inflammation. In this work we tested the action of H2S donor (GYY4137) on the activation of human neutrophils by E. coli LPS. We estimated the changes in redox status (ROS level, intracellularglutathione, NO), apoptosis and mitochondrial potential of neutrophils under the LPS action in the presence and absence of GYY4137. GYY4137 reduces the ROS level, slightly reduces GSH, does not influence the NO level and has no apoptogenic effect. LPS induce the increasing of ROS level and inhibit spontaneous apoptosis of neutrophils. We found that GYY4137 prevents the growth of ROS caused by LPS and leads to a reduction of LPS-induced inhibition of neutrophil apoptosis. Thus the mechanism of GYY4137 protection against inflammation, triggered by bacterial infection, is concerned with the neutralization of LPS effect on neutrophils.

[The differential algorithm for the prescription of the stabilizing training to the patients following replacement arthroplasty of the lower extremities]. / Algoritm differentsirovannogo naznacheniia stabilotreninga dlia patsientov posle éndoprotezirovaniia sustavov nizhnikh konechnostei.

BACKGROUND: The biological feedback-based stability (balance) training is used for the rehabilitation of the patients following replacement arthroplasty of the lower extremities with the purpose of restoration of their postural balance. AIM: The objective of the present study was to develop a differential algorithm for the prescription of the stability training to the patients after they had undergone the endoprosthetic replacement of the joints of the lower extremities. MATERIAL AND METHODS: The study included 48 patients presenting with the following nosological forms: hip arthrosis with total replacement arthroplasty and gonarthrosis with total replacement arthroplasty. All the patients underwent the biofeedback-based stability training with the use of the dynamic balance Pro-Kin system ('Technobody', Italy) using the 'Skiing' No. 10 computer game during 20 minutes every day. The clinical and instrumental methods were employed for the purpose. RESULTS: The rehabilitation subgroups of the patients who had undergone the were distinguished for the first time based on the identification of the main risk factors. It was shown that the main factors having the most pronounced influence on the recovery of postural balance under the conditions of stability training with biological feedback include the age, the time after surgery, the results of evaluation using the Spielberger-Hanin anxiety scale and the Bek depression scale, the level of co-morbidity, the risk of falling estimated from the Morse-Fall scale, and the results of the digit-symbol test based on the Wegsler intelligence scale. CONCLUSION: The distinguishing between rehabilitation subgroups allowed to develop the differentiated algorithm for the prescription of the stability training with biological feedback for the purpose of restoration of the patients' postural balance following total replacement arthroplasty of the lower extremities.

[Results of a randomized double blind multicenter placebo-controlled, in parallel groups trial of the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (EPICA)]. / Rezul'taty randomizirovannogo dvoinogo slepogo mul'titsentrovogo platsebo-kontroliruemogo v parallel'nykh gruppakh issledovaniia éffektivnosti i bezopasnosti meksidola pri dlitel'noi posledovatel'noi terapii u patsientov v ostrom i rannem vosstanovitel'nom periodakh polusharnogo ishemicheskogo insul'ta (ÉPIKA).

AIM: To evaluate the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (IS). MATERIAL AND METHODS: A randomized double blind multicenter placebo-controlled, in parallel groups trial included 151 patients (62 men and 89 women) with hemispheric IS. Using a method of simple randomization, 150 patients (62 men and 88 women), aged 40-79 years, were randomized into two groups. Patients of Group I were treated with mexidol: 500 mg/day IV infusion for 10 days, followed by 125 mg tid (375 mg/day) PO for 8 weeks. Patients of Group II received the placebo according to the same scheme. The total duration of patients' participation in trial ranged from 67 to 71 days. RESULTS: By the end of treatment, the mean score on the modified Rankin scale (mRS) was lower in Group I compared to Group II (p=0.04). In Group I, the decrease in mRS mean score (Visit 1-5) was more prominent (p=0.023), percentage of patients with 0-2 scores by mRS scale (Visit 5) was higher (p=0.039), mean NIHSS score lower (p=0.035) in Visit 5 compared to group II. By the end of treatment, the decrease in mean NIHSS score in patients with diabetes mellitus was more prominent in Group I in comparison with Group II (p=0.038). In Group I, the dynamic of improvement of quality of life was more prominent and started from Visit 2 in general population and subpopulation of patients with diabetes mellitus. The share of patients with no problems with movement in space was higher in Group I (p=0.022). There were no statistically significant differences in frequency of side effects in patients of both groups. CONCLUSION: It is recommended to include mexidol in therapy of patients with IS in the acute and early rehabilitation stages.

[Rehabilitation of the patients presenting with the operated spine syndrome during the complicated postoperative period after discectomy].

This article presents an analytical review of the literature concerning the problem of rehabilitation of the patients following the surgical treatment of hernias of intervertebral disks. The relevance of this problem and the importance of the related research activities in the context of neurorehabilitation are beyond any doubt. Despite the obvious progress in the modernization of the methods and technologies for medical rehabilitation, the number of re-operations in connection with the recurrences of herniated discs remains too high and the overall success thus far achieved in this field falls short of expectations. The authors discuss in detail the need for and the contemporary approaches to the rehabilitative treatment of the patients undergoing vertebral microdiscectomy including medication therapy, physiotherapy an therapeutic physical exercises. The variants of the application of magnetic stimulation during the early period of the rehabilitative treatment of the patients following the minimally invasive interventions for discogenic radiculopathy are considered.

[Rehabilitation of the patients following the endoprosthetic replacement of the joints of the lower extremities].

The present article is the analytical review of the literature pertaining to the problem of rehabilitation of the patients following the endoprosthetic replacement of joints of the lower extremities. The relevance of the problem of interest for medical rehabilitation is beyond any doubt. The traditional methods for the rehabilitation of the patients do not always lead to the desired results. The authors discuss in detail the need for and the contemporary approaches to the rehabilitation of the patients who had undergone reconstructive surgery and arthroplasty of the joints of the lower extremities. The pathogenetically-based three-stage algorithm for medical rehabilitation is proposed.

[Preclinical studies of drugs on animal stroke models]. / Doklinicheskie issledovaniia lekarstvennykh sredstv na biologicheskikh modeliakh insul'ta.

Preclinical studies are studies using experimental models of stroke in animals as well as on neurons, cell neuronal cultures and surviving brain slices. They directed both towards testing the efficacy and evaluation of the mechanisms of action of drugs, and the study of the mechanisms of ischemic damage to search for new targets for stroke treatment. This article shows the basic principles of the organization and planning of animal models of ischemic stroke. Modeling of cerebral ischemia on the different models and animal species, the modern principles of assessment of brain damage are considered as well.

[Approaches to the clinical classification of the functional status in patients with stroke].

The article presents the results of original investigation that included a detailed clinical analysis of 203 patients with stroke undergoing rehabilitation. The significance of pathogenic type of stroke and localization of the lesion in the brain are demonstrated. <> are distinguished among the patients with ischemic stroke of hemispheric and stem localization, and hemorrhagic hemispheric stroke. For each ((rehabilitation subgroup) a detailed description of the key indicators of the neurological status, results of cognitive and psychological tests based on general and local rehabilitation scales are presented. The prognostic value of the (rehabilitation activities profile) scale for stroke patients is estimated.

[BEHAVIOR, MEMORY AND IMMUNOLOGICAL STATUS IN MICE MODEL OF DESYNCHRONOSIS].

Interstrain differences in behavior and parameters of the immune system of CBA and C57BL/6 mice with round the clock coverage (KO) were investigated. Open field, light/dark, acoustic startle response, forced swimming, elevated plus-maze, passive avoidance were used for measuring emotional behavior and memory. The number of lymphocyte subpopulations CD3+, CD4+8-, CD4-8+, CD4+8+, CD19+, CD3+hi spleen and thymus, the ratio of cells in different phases of the cell cycle was determined by flow cytometry. C57BL/6J mice strictly increased anxiety in response to the KO compared to CBA mice. Moreover, KO-treated C57BL/6J mice impaired the passive avoidance learning. We found that KO evoked significant changes in the cellular composition of the thymus and decrease of thymocytes proliferation in C57BL/6J mice. In opposite KO-treated CBA mice showed change of splenic cellular structure with increased % CD19+ cells and the proliferation of splenocytes. Our study demonstrated genotype-dependent reactions of the nervous and immune systems in response chronic constant light.

[The neurophysiological basis of the effectiveness of transcranial methods for the treatment of neuropathic pain].

The present article reports the data concerning the prevalence of chronic pain syndromes in clinical practice. The importance of addressing the problem of finding effective treatment modalities for the patients presenting with these conditions is emphasized. The mechanisms of neuropathic pain are analyzed. The possible pathogenetically sound substantiations for the pharmacological and non-pharmacological treatment of chronic pain are discussed. The article highlights the results of recent meta-analyses of the comparative effectiveness of transcranial methods. The mail lines of further investigations in the field of monotherapy and combined treatment of neuropathic pain are outlined.

[The modern approaches to the prediction of the state of the higher mental functions during post-stroke rehabilitation of the patients].

UNLABELLED: Based on the results of our original study, we came to the conclusion that such readily available and objective method as electroencephalography for the examination of the patients with ischemic stroke may be useful for the analysis of the parameters of the alpha rhythm with a view to predicting the development of cognitive disorders (CD) which is important for the timely prescription of medicamental therapy and correction of the approaches to the rehabilitative treatment of these patients. MATERIAL AND METHODS: the present study involved 26 patients with ischemic stroke receiving there habilitative treatment and 35 healthy volunteers comprising the control group. All participant of the study underwent the neurological examination and neuropsychological testing; the stroke patients were additionally examined with the use of electroencephalography. RESULTS: It was shown that the increase of the alpha rhythm amplitude in the anterocentral brain regions to more than 60 mV and its reduction to below 20 mV reflected the disturbed hierarchical regulation of the functioning of cerebral structures in the form of the dominant synchronized state of the brain. Its most pronounced clinical manifestations were cognitive disorders. The disturbances to the physiological gradient and the alteration of the alpha rhythm amplitude (to below 20 mV and above 60 mV) in the anterocentral brain regions accounted for the higher than 70% probability of detecting moderate CD in the patients with ischemic stroke. The amplitude of alpha rhythm in the anterocentral brain regions may serve as an indicator of the effectiveness of the consolidation of information in the process of memorization and of the speed of information retrieval; moreover, it is an objective characteristic of the patients' emotional state. It is concluded that the estimation of the amplitude of alpha rhythm in the anterocentral brain regions is needed to predict the course of CD in the patients presenting with ischemic stroke including those receiving the rehabilitative treatment. CONCLUSION: The detailed analysis of the electroencephalograms of the patients makes possible the well-timed correction of the individual rehabilitation program and the enhancement of the effectiveness of recovery of both cognitive and motor functions.

[The modern approaches to the prognostication of rehabilitation of the patients after stroke on an individual basis: a review of the literature and the results of original investigations].

This article was designed to analyze the results of the investigations with the purpose of elucidation of the prognostic factors relevant to the rehabilitation of the patients who survived after stroke. Special attention is given to the role of demographic (age and sex) factors and the data of the clinical, neurological, psychological, cognitive, and instrumental examination of the patients. The results of the original studies based on the treatment of 203 stroke patients are discussed in the context of modern concepts of the significance of the factors contributing to the recovery of the patients in the course of the post-stroke rehabilitation. The prognostic value of the selected factors, such as leukoareosis (for the patients presenting with hemorrhagic stroke), has been demonstrated for the first time. The new data on the duration of the rehabilitation period are presented with reference to its dependence on the type of stroke and localization of the lesions. Specifically, it is estimated to be 2 years for the patients who suffered from ischemic stroke in the brain stem, 31 months for those with ischemic stroke of the hemispherical localization, and 38 months for the patients presenting with hemorrhagic stroke (hemispherical hematoma). In addition, the data on the magnitude of the post-ischemic atrophic changes of prognostic values are presented.