[Effect of hardware balance trainings on postural control, risk of falls and cognitive function on elderly people with chronic cerebral ischemia. (Randomized controlled trial)]. / Vliyanie apparatnykh metodik trenirovki balansa na risk padenii, postural'nyi kontrol' i kognitivnye funktsii u pozhilykh lyudei s khronicheskoi ishemiei golovnogo mozga. (Randomizirovannoe kontroliruemoe issledovanie).

INTRODUCTION: As a prevention of falls in elderly people with chronic cerebral ischemia, it is necessary to carry out rehabilitation measures with the inclusion of training aimed at improving statolocomotor and cognitive functions, improving proprioceptive sensitivity and reaction speed to external stimuli. AIMS: To compare the effectiveness of inclusion of hardware balance training on Huber («LPG-Systems¼, France) and C-mill («Physiomed Elektromedizin AG¼, Germany) simulators in complex postural control rehabilitation programs for elderly patients with chronic cerebral ischemia (CCI). MATERIAL AND METHODS: The study included 48 patients (19 men, 29 women), 81% of whom had moderate cognitive impairment. The median age was 76.2±8.5 years. The median Morse scale score before rehabilitation was 50.2 (CI 74-80). The patients were divided into three groups by randomization method: the patients of the 1st comparison group (n=16) were assigned to the Huber stabilizer; the patients of the 2nd comparison group (n=16) underwent training on the track with BOS-video reconstruction of walking «C-mill¼; the patients of the control group (n=16) underwent the course of therapeutic gymnastics according to the developed method. The duration of the course in each group amounted to 8 therapeutic procedures. In the dynamics of the conducted trainings we evaluated: the risk of falls, parameters of postural disorders in statics and dynamics, as well as criteria determining cognitive dysfunction and quality of life of patients. RESULTS: A pronounced improvement of static and dynamic postural indices was observed in the first comparison group, where there was a significant improvement of stabilometric indices: «SL¼ (p=0.001), amplitude of saggital sway (p=0.014), walking speed (p=0.001) and percentage of hitting the marks (p=0.001). The second comparison group showed significant improvement in dynamic balance parameters: walking speed (p=0.001), stride width (p=0.006), percentage of hitting the marks (p=0.001). CONCLUSION: Training on rehabilitation simulators according to the applied methods contributed to the improvement of fall risk related indicators as well as the effectiveness of improving motor performance in older adults with HIM compared to the control group. However, training on the stable-platform induced more significant clinical effects on both static and dynamic balance.

[Analysis of the effectiveness of various methods of rehabilitation of patients with subacromial impingement syndrome]. / Analiz effektivnosti primeneniya razlichnykh metodov reabilitatsii patsientov s subakromial'nym impindzhment-sindromom.

INTRODUCTION: Subacromial impingement syndrome is a common pathology that leads to a persistent decrease in the functioning of the affected limb and, as a consequence, a decrease in the quality of life and work ability of patients. According to various authors, the study of the effectiveness of treatment and rehabilitation of this pathology is quite widely presented in the literature: surgical, including arthroscopic operations, rehabilitation using various factors of physical therapy, manual and other practices. However, the issue of assessing the effectiveness of movement therapy, both alone and in combination with other therapeutic methods, remains relevant. AIM: To evaluate the effectiveness of therapeutic gymnastics procedures, both monotherapy and in combination with manual massage according to the therapeutic method and extracorporeal shock wave therapy (ESWT), in patients with subacromial impingement syndrome of the shoulder, in order to reduce pain and improve the function of the shoulder joint. MATERIAL AND METHODS: The study included 70 patients whose age was 42.18±10.42 years. Patients were divided into two main groups: group 1 (n=34) and group 2 (n=36). All patients received a course of treatment, including 10 procedures of therapeutic exercises, with recommendations at the end of the course for continuation in the form of independent studies using the proven methodology. The duration of the course of therapeutic exercises (in the form of procedures with a physical therapy instructor and subsequent independent studies) was 30 days. Patients in group 2 were divided into three subgroups: subgroup 2A, in which PH procedures were combined with massage of the cervical-collar area and the upper limb area of the affected side; subgroup 2B, where PH gymnastics was carried out in combination with extracorporeal shock wave therapy (ESWT) procedures; subgroup 2C - a comprehensive program including LH procedures, manual massage and shock wave therapy. RESULTS: 3 months after the end of the course of rehabilitation measures, patients of all groups showed a significant improvement in scores on the ASES and VAS scales, but there were no reliably significant differences between the results of different groups. CONCLUSION: The study indicates that movement therapy is an effective method of rehabilitation for patients with subacromial impingement syndrome, and conducting complex programs in which PH is combined with other rehabilitation methods (massage, shock wave therapy) doesn't have statistically significant advantages over PH alone within a 3-month observation period.

[Recovery of social and everyday skills after a complex of functional spatially oriented rehabilitation in elderly patients with cerebral stroke]. / Otsenka effektivnosti vosstanovleniya sotsial'no-bytovykh navykov s ispol'zovaniem kompleksa funktsional'noi prostranstvenno-orientirovannoi reabilitatsii u pozhilykh patsientov s tserebral'nym insul'tom.

OBJECTIVE: To analyze the effectiveness of social recovery (trip to the store by bus and making purchases) in elderly patients with stroke in the right middle cerebral artery undergoing a course of specialized trainings in a complex of functional spatially oriented rehabilitation. MATERIAL AND METHODS: The study involved 44 patients with previous stroke (mean age 70.8±3.1 years) randomized into 2 equal groups: main group - basic standard of rehabilitation (exercises with instructor, mechanotherapeutic technique with cyclic simulators, massage of paretic limbs) and training of social adaptation in a complex of functional spatially oriented rehabilitation; control group - basic standard of rehabilitation alone. Duration of rehabilitation course was 14 days. To determine mean norm of timing of complex training of socially significant skill, we asked 23 volunteers without severe comorbidities to perform tasks of functional spatially oriented rehabilitation. RESULTS: After complex rehabilitation program, we found significant dynamics of time necessary for the following actions: "take a bag and hang it over shoulder", "open the pockets of the bag with a zipper (2 pockets)", "take the jacket off the hanger and put it on", "take the products from the basket and put in the pocket". Moreover, the main group was characterized by significantly lower impairment of daily activity (Barthel score 66.3±4.5 vs. baseline 45.7±4.9, p<0.05), improvement of functional independence (FIM score 76.7±1.5 vs. baseline 65.2±3.1, p>0.05). These values turned out to be significantly better than in the control group. CONCLUSION: These results indicate the effectiveness of functional spatially oriented rehabilitation in elderly patients with cerebral stroke. This approach increases personal independence in daily life and improves overall quality of life.

[Influence of complex rehabilitation programs on the uterine blood flow in patients of different age after plastic surgery for rectocele]. / Vliyanie reabilitatsionnykh kompleksnykh programm na pokazateli matochnogo krovotoka po dannym 3D-ekhodopplerografii u patsientok raznykh vozrastnykh grupp posle plasticheskoi operatsii po povodu rektotsele.

OBJECTIVE: To develop the optimized complex programs, including general magnetotherapy, fractional microablative therapy with a CO2 laser, electromyostimulation with biofeedback of the pelvic floor muscles, and a special exercise therapy complex in late rehabilitation programs for women of different age after reconstructive plastic surgery for rectocele. MATERIAL AND METHODS: There were 200 women of childbearing, peri- and menopausal age with rectocele grade II-III and 20 healthy women of comparable age. All patients were divided into 4 groups by 50 womes: main group, two comparison groups and control group. Surgical treatment of rectocele was followed by long-term postoperative rehabilitation including symptomatic therapy, general magnetotherapy, and electromyostimulation with biofeedback of the pelvic floor muscles, intra-vaginal fractional microablative therapy with a CO2 laser and special complex of therapeutic physical education. RESULTS: General magnetotherapy in early (1 day) postoperative period and complex rehabilitation in long-term postoperative period (within a month after surgery) including 2 procedures of intra-vaginal microablative fractional therapy with carbon dioxide laser, electromyostimulation with biological connection of the pelvic floor muscles and special complex of therapeutic physical education ensured more significant improvement of uterine blood flow regardless age and baseline disorders in the uterine arteries in patients with rectocele. In our opinion, this is primarily due to vasoactive effects of general magnetotherapy, recovery of circulation via relief of spasm in the arteries and arterioles, improved vein contractility and venous outflow. These processes combined with electrical stimulation and therapeutic exercises of pelvic floor muscle followed by their reinforcement, as well as fractional microablative therapy ensured significant vascular effect.

[Influence of various rehabilitation complexes on sexual function in fertile females and women of perimenopausal and menopausal age after surgery for rectocele]. / Otsenka vliyaniya razlichnykh reabilitatsionnykh kompleksov na seksual'nuyu funktsiyu u patsientok detorodnogo i perimenopauzal'nogo i menopauzal'nogo vozrasta posle operatsii po povodu rektotsele.

OBJECTIVE: To study the effect of general magnetotherapy, muscle stimulation with biofeedback of pelvic floor muscles, and a special complex of physiotherapy exercises with and without fractional microablative CO2-laser therapy on sexual status in females after plastic surgery for rectocele. MATERIAL AND METHODS: There were 200 fertile females and women of perimenopausal and menopausal age with rectocele grade II-III. Various rehabilitation programs were used in delayed postoperative period in order to improve sexual function. Rehabilitation included various combinations general magnetotherapy, electrical muscle stimulation with biofeedback of pelvic floor muscles, intravaginal fractional microablative CO2-laser therapy and a special complex of exercise therapy. RESULTS AND CONCLUSION: Postoperative rehabilitation including general magnetotherapy, fractional microablative CO2-laser therapy, muscle stimulation with biofeedback of pelvic floor muscles and a special exercise therapy significantly improves sexual function in patients with rectocele. This is true for fertile females and women of perimenopausal and menopausal age. Significant data on PISQ-12 questionnaire (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire) and Female Sexual Function Index of (FSFI) confirmed these results.

[The hardware techniques for the restoration of the gait stereotype in the patients following total hip replacement: the personalized approach].

BACKGROUND: total hip replacement has long ago become the «golden standard¼ for the treatment of dysplastic coxarthrosis in thousands of the patients receiving it every year. In the meantime, the analysis of the specialized literature gives evidence of the lack of a systematic and personified approach to the rehabilitation treatment. AIM: The objective of the present study was to improve medical rehabilitation of the patients following the total hip replacement and to develop the personalized programs for walking modality reconstruction taking into consideration the age and the body weight of the patients. PATIENTS AND METHODS: A total of 240 patients were available for the observation including 184 women and 56 men. They were divided into three study groups and one control group, with the differentiation into the following three subgroups: one comprised of the patients of moderate acerage age and body weight, the other containing the obese patients (BMI>35), and the third one involving the elderly patients (age >70 years); each subgroup consisted of 20 patients. All the patients received the early basic rehabilitation treatment, those in the study groups had to perform in addition the robotic training based on the use of hardware techniques supplemented by passive mechanotherapy and electromyostimulation designed to restore the walking stereotype with three types of devices: body weight unloading, video-reconstruction associated with biological feedback and robototherapy. RESULTS: The comparative analysis of the effectiveness of various methods of gait reconstruction has demonstrated the high effectiveness of the application of the hardware technique in the patients of moderate acerage age and body weight. At the same time, the elderly patients had a significantly higher rate of successful walking reconstruction efficiency under the influence of the video-associated training with biological feedback (3 times that achieved with training using the device for unloading the body weight and 4 times compared with the result of a course of robotic walk. The evaluation of the application of the techniques for the gait stereotype reconstruction in the obese patients gave evidence of the advantage of the Lokomat robotic trainings that produced 6 times better results than unloading of the body weight and 5 times better ones than the video-associated training with biological feedback. DISCUSSION: The results of the present study are on the whole comparable with the data reported by other authors although its design was different from that of the majority of the published studies in that our patients were allocated to different subgroups for the further personalization of the methods applied to restore the gait stereotype. The factors limiting the use of the results of this study include the medium-high level of the patients' welfare most of whom are residents of the city of Moscow and Moscow region characterized by a relatively high quality and accessibility of health care. It means that the results of such studies as the one described in the present article are directly related to the quality and accessibility of health care and can be extrapolated only to the socially safe and well-to-do patients. CONCLUSIONS: All the hardware techniques are equally effective in the patients of moderate average age and body weight. The elderly patients showed the best results using the video-reconstruction associated with biological feedback, while the Locomat technique was especially useful for the obese patients.

[Accelerated postoperative rehabilitation in patients undergoing pancreatoduodenectomy]. / Uskorennaia posleoperatsionnaia reabilitatsiia patsientov, perenesshikh pankreatoduodenal'nuiu rezektsiiu.

AIM: To assess safety and clinical-economic effectiveness of complex postoperative rehabilitation after pancreatoduodenectomy. MATERIAL AND METHODS: 73 patients were included in the study. Main group consisted of 39 patients who underwent accelerated postoperative rehabilitation that was developed in our clinic. In the control group of 34 patients this protocol was not applied. The main components of rehabilitation were multicomponent analgesia, early enteral nutrition, physical rehabilitation by using of exercise therapy and physiotherapy. RESULTS: There were no significant differences in the incidence of postoperative complications and mortality (58.8% and 74.3%; p=0.213, 5.8% and 7.7%; p=0.678, respectively). Median of postoperative hospital-stay in the study group was 13 days (9; 16), in the control group - 15 days (9; 24). An estimated economic effect in the study group was 558 764, 84 rubles. CONCLUSION: Accelerated postoperative rehabilitation after pancreatoduodenectomy is safe and does not lead to increased number of postoperative complications and mortality. Developed protocol has clinical advantages and is cost-effective.

[Clinical aspects of the service of acute postoperative pain treatment].

PURPOSE OF THE STUDY: To analyze work results of the service of acute postoperative pain treatment in the orthopedic hospital. DISIGN: Single-center retrospective observational cohort study. PATIENTS AND METHODS: We studied 1343 patients underwent total hip arthroplasty (64%), total knee arthroplasty (33%), and revision surgeries (3%). The average age of the patients was 59 ± 12 years, and body mass index was 30 ± 6. All patients received triple pain therapy in postoperative period which included pracetamol, NSA IDs or specific ciclooxygenase-2 inhibitor and epidural analgesia or peripheral blockade and patient controlled intravenous or epidural analgesia. The pain intensity was recorded four times a day--every 6 hours during 2 days after surgeries. RESULTS: All patients received oral or intravenous analgesics. 90% of patients received prolonged epidural infusion, 10%--prolonged block of the femoral nerve after total knee arthroplasty. Patient controlled analgesia was used in 6-10% of patients. Average pain intensity was 20 mm according to VAS. Pain intensity over 40 mm was observed in 8-13% of patients at 1st day after surgery and in 2-15% at 2nd day after surgery. Deep vein thrombosis was found in 5.7% of patients, and bleeding in 0.2%. Length of stay in a hospital after total hip arthroplasty and total knee arthroplasty was 6 ± 2 days and 10 ± 8 days after revision surgeries. CONCLUSIONS: The work of the service of acute postoperative pain treatment in the orthopedic hospital, the use of multimodal treatment protocols and mandatory clinical monitoring provide proper control of postoperative pain, patient satisfaction, and allow to accelerate early recovery and reduce the time of postoperative hospital stay after total replacement of large joints.

Mechanisms underlying diquertin-mediated regulation of neutrophil function in patients with non-insulin-dependent diabetes mellitus.

We studied the effects of dihydroquercetin (3.3.4.5.7-pentahydroxyflavanone, a new Russian patented preparation) on functional activity of polymorphonuclear neutrophils from patients with non-insulin-dependent diabetes mellitus. Flavonoids (quercetin and its derivative dihydroquercetin) dose-dependently suppressed generation of anion radicals and hypochlorous acid and production of malonic dialdehyde during oxidation of neutrophil membranes. Dihydroquercetin decreased activities of protein kinase C and myeloperoxidase in activated polymorphonuclear neutrophils and could bind transition metals (Fe2+). These properties determine the ability of dihydroquercetin to decrease in vitro functional activity of polymorphonuclear neutrophils from patients with non-insulin-dependent diabetes mellitus.