[Non-drug technologies in restoring endometrial receptivity as a cause of impaired fertility in women of reproductive age. (Literature review)]. / Nemedikamentoznye tekhnologii v vosstanovlenii retseptivnosti endometriya kak prichiny narusheniya fertil'nosti u zhenshchin reproduktivnogo vozrasta. (Obzor literatury).

Globally, 13% of the population has difficulty conceiving. In Russia, the proportion of infertile marriages ranges from 8 to 17.5%, with half of all forms of female infertility being the uterine form. The main etiological factors for impaired endometrial receptivity are infectious diseases leading to the development of chronic endometritis (most often found in tuboperitoneal infertility), dishormonal background associated with the development of hyperplastic processes in endocrine infertility, uterine fibroids, chronic endometritis and endometriosis. The frequency of detection of uterine cavity diseases in patients with repeated unsuccessful IVF programs ranges from 18 to 50%. The review examines the etiological factors and other causes of endometrial pathology leading to the development of chronic endometritis, possible mechanisms for the development of impaired growth and receptivity of the endometrium, and, as a consequence, the impossibility of pregnancy. Therapeutic strategies for restoring endometrial thickness and receptivity using pharmacological and non-pharmacological methods are described. Based on the analysis of literature data, it is shown that the use of physiotherapeutic factors in treatment programs that have pronounced anti-inflammatory, immuno- and hormone-modulating, reparative-regenerative, metabolic, vasocorrective and defibrosing effects allows for a relatively short period of time to improve endometrial receptivity, normalize hormonal levels and restore fertility in women of reproductive age, which ensures the possibility of successful embryo implantation, fetal development and childbirth.

[High-tone therapy in complex rehabilitation of patients with post-sternotomy syndrome after coronary artery bypass surgery. (Open-label, prospective, randomized controlled trial)]. / Vysokotonovaya terapiya v kompleksnoi reabilitatsii bol'nykh s poststernotomicheskim sindromom posle aortokoronarnogo shuntirovaniya. (Otkrytoe prospektivnoe randomizirovannoe kontroliruemoe issledovanie).

INTRODUCTION: At present it remains relevant to develop new rehabilitation technologies for patients with circulatory system diseases who have undergone a cardiac surgery to restore the functions of the cardiorespiratory system more quickly, improve physical and mental health, and prevent the development of the atherosclerotic process. AIM: To study the effectiveness and safety of the new rehabilitation technology for the inpatient stage of medical rehabilitation of patients with post-sternotomy syndrome after coronary artery bypass surgery (CABS) using high-tone therapy. MATERIAL AND METHODS: The study included 85 men (the average age was 56.8±2.46 years old) with post-sternotomy syndrome after CABS. They were divided into two groups by simple randomization: the first/main (42 patients) and the second/control (43 patients). The control group of the patients had a standard rehabilitation complex; the main group was additionally prescribed a high-tone therapy according to a local method. The immediate results of the treatment were assessed by the dynamics of the clinical picture, the six-minute walk test, respiratory function, echocardiography, the level of cytokines, C-reactive protein and natriuretic peptide (NT-proBNP); distant - by QOL endpoints (questionnaire MOS SF-36). RESULTS: The groups of the patients were comparable in all baseline parameters. After the course of the procedures in the main group of patients there were positive reliable (p<0.05-0.001) shifts in clinical (pain, shortness of breath, general weakness), functional (forced expiratory vital capacity, forced expiratory volume1, effusion separation) and laboratory parameters (leukocytes, interleukin-2 and 10, NT-proBNP). The intergroup analysis of long-term results registered significant (p<0.05) differences in the QOL of patients in the main group by subscales: the role of somatic problems, vitality and mental health. Compliance to the III stage of medical rehabilitation (outpatient/home) was noted with 95.2% of the patients in the first group and 93.0% in the second. CONCLUSION: The additional appointment of a high-tone therapy to the rehabilitation standard for the patients with post-sternotomy syndrome after CABS significantly improves the immediate and long-term results of the treatment (QOL) contributing to a more pronounced reverse development of inflammatory and edematous syndromes, an increase in physical activity and psychosomatic health. The absence of adverse reactions with all the patients indicates the safety of rehabilitation complexes.

[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.

[Modern approaches to developing a system of valid methods for monitoring individual health and maintaining active longevity]. / Sovremennye podkhody k razrabotke sistemy validnykh metodov monitoringa individual'nogo zdorov'ya i podderzhaniya aktivnogo dolgoletiya.

Life expectancy In Russia in 2023, according to preliminary data, exceeded 73 years, returning to the pre-pandemic level. The increase in life expectancy is associated both with an improvement in the quality of medical care In Russia and with a more responsible attitude towards the health of citizens, which is confirmed by an improvement in the quality of nutrition, a decrease in alcohol consumption and an increase in the number of people involved in sports. At the same time, there are many signs of aging, both cellular and molecular, some of the main ones are genome stability, telomere shortening, epigenetic alterations, impaired proteostasis and nutrient recognition, mitochondrial dysfunction, depletion of the stem cell pool and changes in intercellular interactions, extracellular matrix rigidity, as well as retrotransposon activation and chronic inflammation. For these reasons, in modern healthcare, the tasks of preventing premature aging and treating age-related diseases are becoming priorities. MATERIAL AND METHODS: In total, at the first stage of work (in 2023), we examined 80 people, whose average age was 59.6±0.7 years. When analyzing and assessing data, the study adopted a division into age groups (WHO). The following indicators were studied: HbA1, fructosamine, HDL cholesterol, LDL cholesterol, insulin, homocysteine, C-peptide, TSH, free T4, prolactin, total testosterone, cortisol, arginine, asymmetric dimethylarginine, leptin, TNF-a, ferritin, interleukin 1 and 6, telomere length, creatinine, uric acid and urea. RESULTS: As a result of the study, it was revealed that the aging process of the body affects many indicators, while the main markers that changed in men aged 18 to 44 years were total testosterone, leptin and telomere length; aged 44 to 60 years - HbA1, fructosamine, HDL cholesterol, homocysteine, C-peptide, total testosterone, leptin and telomere length; from 60 to 75 years - fructosamine, HDL cholesterol and telomere length and for 75-90 years - HbA1, HDL cholesterol, insulin, total testosterone, leptin and telomere length, interleukin 6 and uric acid. In women aged 18 to 44 years, only an increase in leptin was observed against the background of shortening telomere length; at the age of 44 to 60 years, the main markers that changed were total testosterone, leptin and telomere length; for the age group 60-75 years - indicators of HbA1, homocysteine, C-peptide, prolactin, total testosterone and leptin, interleukin 6 and uric acid, telomere length was shorter by only 2%; in the age group of 75-90 years, the main markers that changed were insulin, total testosterone, leptin, interleukin 6, while the indicators of uric acid, urea and telomere length differed from the reference values by 2-4%. Shortening of telomere length in all age groups, both men and women, indicates the presence of signs of premature aging. In an individual analysis, data were obtained on a more dramatic shortening of telomeres in 16 subjects in the presence of impaired glucose tolerance and insulin secretion, especially in comparison with healthy subjects, which was confirmed by the data of glycated hemoglobin (HbA1c), while, with shortening of telomere length, the HbA1 indicator was significantly higher (6.8±0.5) than in individuals with long telomeres and no chronic pathology (5.1±0.4). CONCLUSION: A system of highly valid methods and panels of markers has been developed that indicate the presence of aging processes, taking into account gender and age characteristics, which can be used to identify premature aging processes, monitor individual health and maintain active longevity, as well as for the prevention of age-associated diseases.

[Possibilities of physiotherapy methods for improving the microcirculation of the affected limb in patients with spasticity after acute cerebral circulation during the late recovery period]. / Vozmozhnosti metodov fizioterapii dlya uluchsheniya mikrotsirkulyatsii porazhennoi konechnosti u bol'nykh so spastichnost'yu, perenesshikh ostroe narushenie mozgovogo krovoobrashcheniya, v pozdnii vosstanovitel'nyi period.

The significant prevalence of acute cerebral circulatory disorders, the complexity and persistence of disorders of the functions of the upper and lower extremities, which are accompanied by prolonged and persistent disability, is an important medical and social problem. OBJECTIVE: Development of optimized programs of medical rehabilitation in patients after acute cerebrovascular accident in the late recovery period. MATERIAL AND METHODS: The study included 200 patients who suffered acute cerebral circulatory disorders, with increased muscle tone in the lower extremity by the type of spasticity in the late recovery period, who were divided into five groups comparable in clinical and functional characteristics and age: the 1st group (n=40) - patients who, in addition to the standard complex of therapy and rehabilitation, the same in all five groups and including therapeutic physical culture, medical massage and kinesiotherapy, received low-frequency electrostatic massage, complex multimodal effects from the Alpha-capsule apparatus, training on a multifunctional biofeedback (BFB) platform and training of the stereotype of walking on to the track by the method of imposition; the 2nd group (n=40) - patients who, in addition to the standard complex, received low-frequency electrostatic massage from the Khivamat apparatus and exposure to broadband modulation currents; the 3rd group (n=40) - patients who, in addition to the standard complex, received a complex multimodal effect from the Alpha-capsule; the 4th group (n=40) - patients who, in addition to the standard complex, received training on a multifunctional platform with barefoot and training of the stereotype of walking on the track by the method of imposition; the 5th group (n=40) - patients who received only a standard complex of therapy and rehabilitation. RESULTS: At all control points (after the course of treatment, after 6 and 12 months), in addition to general clinical and neurological studies, microcirculation parameters were evaluated by laser Doppler flowmetry. In dynamics, it was revealed that in the 1st, 2nd, and 4th groups there was a significant improvement in microcirculation in the affected limbs, to a lesser extent, this significant improvement in microcirculation was noted in the 3rd group; in patients of the 5th group, only a positive trend was noted. CONCLUSION: Inclusion in the standard rehabilitation complex of low-frequency electrostatic massage, multimodal physiotherapy and training on a multifunctional platform with BFB COBS in combination with walking stereotype training with video instruction using the system with BFB C-Mill in patients who have suffered acute cerebrovascular accident, with motor disorders in the form of hemiparesis with increased muscle tone of the lower extremity in the late recovery period causes a significant improvement in microcirculation in the arteriolar-venular bed of the affected lower extremities, which may underlie the improvement of static-locomotor indicators and contribute to the expansion of the volume of movements in the joints of the lower extremities.

[The potential of physiotherapy technologies in the rehabilitation of patients with non-exudative form of age-related macular degeneration (drusen)]. / Vozmozhnosti primeneniya fizioterapevticheskikh tekhnologii v oftal'moreabilitatsii patsientov s neekssudativnoi formoi vozrastnoi makulyarnoi degeneratsii (druzy).

Age-related macular degeneration (AMD) is currently the leading cause of vision loss in the elderly population worldwide. Despite the experience of using physiotherapeutic methods of treatment for non-exudative form of age-related macular degeneration, as well as the lack of clear criteria for its indication and evaluation of its effectiveness, the question of its advisability remains open. PURPOSE: Evaluation of the effectiveness of rehabilitation complex involving physiotherapy in the form of infrared and magnetic stimulation of the retina, aerogenation with Heliox21 and dry needling in patients with non-exudative AMD (drusen). MATERIAL AND METHODS: The study included 84 patients (168 eyes), among them 50 men and 74 women with stage 1 non-exudative AMD, aged 60 to 70 years old (average age 60±3.7 years), who were divided into 2 groups with comparable clinical and functional characteristics. Group 1 included 42 patients (84 eyes) who underwent ophthalmic neurostimulation consisting of daily infrared-magnetic stimulation of the retina for 10 days, 10 procedures of daily aerogenation with Heliox21 and 10 daily procedures of acupuncture. Group 2 included 42 patients (84 eyes) who received only basic parenteral therapy (Nutrof forte 1 tablet per day during the entire observation period), which was also the medication background in the main group. Visual acuity (VA), retinal OCT parameters, local photosensitivity and bioelectrical potential indices were assessed with mfERG. The control time points were before therapy, after 2 weeks, 3 months, 6 months and 12 months. RESULTS: After undergoing therapy with the described physiotherapeutic regimen, a positive effect on functional characteristics was noted - the level of light sensitivity of the central zone of the retina and the amplitude of the electrical biopotential have improved. The indicators of maximally corrected visual acuity and the structure of the ellipsoidal zone of the retina and the choroid did not change during the entire observation period. CONCLUSION: In patients with non-exudative form of AMD the developed ophthalmic rehabilitation complex involving infrared-magnetic stimulation of the retina, aerogenation with Heliox21 and dry needling promotes improvement of functional characteristics of the central retina in the form of increased maximal light sensitivity of the central retinal area and increased amplitude of bio-electrical potential.

[Influence of therapeutic exercises and hardware massage in electrostatic field on lung damage in patients with novel coronavirus pneumonia]. / Otsenka vliyaniya lechebnoi gimnastiki i apparatnogo massazha v elektrostaticheskom pole na stepen' porazheniya legkikh u patsientov s pnevmoniei pri novoi koronavirusnoi infektsii.

OBJECTIVE: To analyze the efficacy and safety of therapeutic exercises and chest hardware massage in electrostatic field in patients with COVID-associated viral pneumonia. MATERIAL AND METHODS: We retrospectively analyzed 1551 patients admitted to the Clinical Hospital No. 1 (MEDSI Group JSC) with COVID-associated pneumonia between April 01, 2020 and June 15, 2021 (ICD-10 U07.1 and U07.2). Considering inclusion and exclusion criteria, we enrolled 153 patients. All patients were divided into comparable groups and subgroups depending on the methods of rehabilitation treatment and CT stage of viral pneumonia. Lung damage was assessed semi-automatically using Philips Portal v11 COPD software. Rehabilitation measures included therapeutic exercises and chest hardware massage in electrostatic field. therapeutic exercises. RESULTS: Therapeutic exercises significantly reduced severity of lung damage in patients with viral pneumonia CT-2 and no oxygen support (from 28.05% [28; 29.5] at admission to 15.3% [14.2; 19.3] at discharge). It was not observed in patients without rehabilitation treatment and in patients undergoing therapeutic exercises and massage in electrostatic field. CONCLUSION: Therapeutic exercises in patients with COVID-19 and baseline lung damage > 25% and < 50% (CT-2 stage) significantly reduce severity of lung damage at discharge compared to the control group.

[Influence of non-drug complex programs on severity of pain syndrome, psychoemotional status and quality of life in patients with urolithiasis before and after percutaneous nephroscopy]. / Osobennosti vliyaniya nemedikamentoznykh kompleksnykh programm na vyrazhennost' bolevogo sindroma, psikhoemotsional'nyi status i kachestvo zhizni patsientov s mochekamennoi bolezn'yu do i posle perkutannoi nefroskopii.

OBJECTIVE: To study the effect of non-drug complex programs including intravenous laser blood irradiation (ILBI) combined with ozone therapy and light therapy on severity of pain syndrome, psychoemotional status and quality of life in patients with urolithiasis before and after percutaneous nephroscopy. MATERIAL AND METHODS: The study included 90 patients with urolithiasis aged 28-62 years (mean 37.6±4.5 years). Patients were divided into 3 groups comparable in age, sex, clinical and functional characteristics: group 1 (n=30) - standard therapy with a course of ILBI combined with ozone therapy (6 procedures) in preoperative period and polarized light therapy and ILBI (6 procedures) in early postoperative period (the next day after surgery); group 2 (n=30) - ILBI combined with ozone therapy in early postoperative period along standard therapy; group 3 (n=30) - standard postoperative therapy (antispasmodics, antibiotic therapy based on bacterial culture of urine, non-steroidal anti-inflammatory drugs). To assess the effectiveness of treatment, we used 11-point numerical rating scale (NRS), 10-point SAM test (well-being, activity and mood) and short version of the SF-12 health questionnaire. RESULTS: Mean NRS score of pain prior to treatment was 5.9±0.8 points. After the course of rehabilitation in the 1st group, there was a significant decrease in intensity of pain (up to NRS score 1.1±0.1, p<0.001). In the 2nd group, analgesic effect was less significant (2.3±0.2 points; p<0.01). In the 3rd group, this value was 3.6±0.2 (p<0.001). The most significant dynamics of all indicators in SAM test was recorded in the 1st group (the indicators reached the values of healthy individuals). In the 2nd group, all indicators were 12.7-17.9% less than in the 1st group. In the 3rd group, the values were 32.4-39.4% less than in the 1st group ( p<0.05). According to the SF-12 questionnaire, 6.7% of patients reported low quality of life after treatment (compared to 83.3 and 53.3% in the 2nd and 3rd groups, respectively), 23.3% of patients reported high quality of life (10% in the 2nd group, no patients in the 3rd group). CONCLUSION: Two courses of non-drug rehabilitation including ILBI and ozone therapy in preoperative period and polarized light with ILBI in early postoperative period after percutaneous nephroscopy contribute to analgesic and psychocorrective effects. This significantly improves the quality of life of patients with urolithiasis before and after intervention.

[Results of the application of complex physiotherapeutic neurostimulation in optical neuropathies of various genesis]. / Rezul'taty primeneniya kompleksnoi fizioterapevticheskoi neirostimulyatsii pri opticheskikh neiropatiyakh sosudistogo geneza.

Optical neuropathies (ON) are the outcome of many diseases of various origins. The main ones are classified as inflammatory, vascular and traumatic ON. ON lead to subatrophy of the optic nerve, but even after the completion of treatment, it is possible to improve visual functions by using physiotherapeutic means of ophthalmic rehabilitation. OBJECTIVE: To evaluate the effectiveness of complex physiotherapeutic neuro-ophthalmostimulation in case of ON of vascular origin. MATERIAL AND METHODS: The study included 60 patients (120 eyes) with a verified diagnosis of optic neuropathy of vascular origin, who were divided into 2 groups comparable in age, gender and anatomical and functional characteristics: the main group of 30 patients (60 eyes) and the control group - 30 patients (60 eyes), including 24 men and 36 women, mean age was 66.2±4.1 years, disease duration was 4.1±1.7 years. All patients underwent courses of conservative treatment with vitamins according to the available ophthalmological standards, repeating them 1-2 times a year, the last of which was six months before the present study. Physiotherapy courses and patients did not pass. 20 healthy volunteers were taken to create basic indicators of the «norm¼ of the applied research methods. Patients of the main group used a set of procedures: transcranial magnetic electrical stimulation, endonasal electrophoresis with the drug neuroprotector Semax 0.1%, oxybaric chamber and acupuncture. Patients in the control group were prescribed basic therapy, including taking the vitamin complex BEROCCA for 3 months. Breakpoints: before treatment and at times: 1st week, 12 weeks and 24 weeks after the course of treatment, according to the standard recommendations for international multicenter studies. The following were assessed: visual field boundaries (dilation meridians; in deg.), light sensitivity (MS, MD; in dB), indicators of the state of the retinal ganglion layer (GCS thickness, volume loss): Avg CCG (in µm), FLV, GLV (in %). RESULTS: When evaluating the results in patients of the main group who received complex neurostimulation, the therapeutic efficacy in a week after the end of treatment was 94%, in 12 weeks - in 88% and in 24 weeks - 83%, while in patients of the control group for all studied indicators showed only a positive trend and therapeutic efficacy did not exceed 30-42%. CONCLUSION: Under the influence of the developed neurostimulating complex, the activity of nerve cells objectively increases, leading to a significant increase in the boundaries of the field of view and light sensitivity and a decrease in global losses of the retinal ganglion complex and optic nerve.

[Modern surgical technologies in the treatment of patients with chronic paraproctitis]. / Sovremennye khirurgicheskie tekhnologii v lechenii bol'nykh khronicheskim paraproktitom.

The development of minimally invasive surgical technologies in the treatment of chronic paraproctitis is a promising young trend in coloproctology. Increasingly, in clinical practice, coloproctologists use laser technologies in the outpatient treatment of extra- and transsphincteric pararectal fistulas, in particular, laser technology FiLaC (Fistula Laser Closure). OBJECTIVE: Conducting a comparative retrospective and prospective cohort study of immediate and long-term results of treatment of complicated transsphincteric and extrasphincteric fistulas using the developed modified FiLaC technology with the «traditional¼ FiLaC technology, and standard excision of the fistulous tract with plasty of the internal fistula opening with a full-thickness flap of the rectal wall. MATERIAL AND METHODS: The study included 270 patients with trans- and extrasphincter pararectal fistulas, which were divided into three groups. In group 1 (n=90) the traditional FiLaC technology was used for the treatment of fistulas, in group 2 (n=90) the modified FiLaC technology was used, providing for the opening of purulent streaks and laser coagulation (FiLaC) of the intrasphincter part of the fistula with a Biolitec laser, 12 W, 100 J/cm, in group 3 (n=90), excision of the fistula tract with plastic surgery of the internal fistula opening with a full-thickness flap of the rectal wall was used. RESULTS: The results of treatment in patients of the three groups were monitored for 19-36 months. after surgery (median 31 months). The analysis of the results showed that in group 2 (modified FiLaC technology) healing of fistulas occurred faster (7.3±0.5 weeks versus 12.6±0.7 weeks) compared to group 3 (excision of the fistula with plasty of the internal fistula opening). The indicators of sphincterometry in the long-term period in patients of the 2nd group were restored in relation to the initial ones, and in the th group 3 they were reduced compared to the initial values. Postoperative complications were most common in patients of group 3 (32.2%), and least often in patients of group 2 - 8.9%. At the same time, late postoperative complications were most common (24.4%) in patients of group 1. None of the patients in group 2 had late postoperative complications, while 11.1% of postoperative complications were recorded in group 3. In patients who underwent excision of the AC (group 3), relapses were most common: early - 15.6%, late - in 21.1%. The least frequent relapses were observed in patients who underwent modified FiLaC technology (Group 2): 6.7% - early relapses and 11.1% - late relapses. CONCLUSION: The use of the modified FiLaC technology in the treatment of trans- and extrasphincteric fistulas of the rectum made it possible to minimize postoperative complications, fully preserve the function of anal holding, and achieve healing of fistulas in 82.5% of cases with a median follow-up of 31 months.

[Modern approaches to the rehabilitation of patients with chronic paraproctitis in the early postoperative period]. / Sovremennye podkhody k reabilitatsii bol'nykh khronicheskim paraproktitom v rannem posleoperatsionnom periode.

Along with the classical methods of surgical treatment of rectal fistulas, new minimally invasive technologies have appeared using video endoscopic support for processing the fistulous tract and closing the internal fistula opening, intrasphincter ligation of the fistulous tract LIFT, however, they do not exclude relapses in the late postoperative period. The FiLaC (Fistula Laser Closure) laser technology based on the use of a radial flexible laser light guide, which does not cause damage to the anal canal mucosa, pain in the postoperative period, rectal postoperative bleeding and strictures, is quite promising in the further development of outpatient minimally invasive surgery for anal fistulas. anal canal. However, even with this technique, complications and relapses were observed in 10-12% of cases, which dictates the need to develop not only a patient-oriented approach to the surgical treatment of patients with chronic paraproctitis, but also to develop postoperative rehabilitation programs in the early postoperative period. OBJECTIVE: To study the effect of complex rehabilitation programs used in the early postoperative period on the efficacy of the therapy in patients with pararectal fistulas. MATERIAL AND METHODS: The study included 90 patients with chronic paraproctitis, (the average age was 43±3.4 years, the average duration of the disease was 5.1±1.5 years), who underwent a surgery using the modified FiLac technology. The patients were divided into 3 groups (30 patients in each group) depending on the rehabilitation method used during the postoperative period (2 days after the surgery): 1st group underwent a 4-component rehabilitation complex (intravenous ozone therapy, rectal laser therapy, recto-tibialmyostimulation of the pelvic floor muscles and biofeedback therapy); 2nd group underwent a 2-component rehabilitation complex (intravenous ozone therapy and rectal laser therapy); 3rd group has received a standard medical complex, which served as a background in 1st group and 2nd group. Therapeutic efficacy was assessed according to the assessment of pain syndrome (on the VAS scale), the results of anal sphincterometry (the Peritron 9600 device), the incidence of postoperative complications and relapses at different follow-up periods (up to 5 years). RESULTS: A comparative analysis of the nature of the course of the postoperative period, depending on the type of postoperative rehabilitation was carried out. In multiple comparisons using the parametric ANOVA method, it was found that there were statistically significant differences between the 1st group and the 3rd group in terms of pain intensity, duration of pain, the timing of wound healing, the frequency of complications, and the timing of return to work. The results in the 2nd group were slightly lower than in the 1st group, but they also differed significantly from the data of the 3rd group. During the analysis of the early and late p/o complications and relapses in patients with chronic paraproctitis after surgery the most significant were obtained from the 1st group (only 1 case of early p/o complications and relapse within 1 to 5 years), while in the 3rd group there were 2 (6.6%) cases of early p/o complications, 2 cases (6.6%) of relapses within a period of up to 1 year and 6 (20%) cases in the period from 1 to 5 years. In patients of the 2nd group, results close to the results of the 1st group were obtained: 2 (6.6%), 2 (6.6%) and 3 (9.9%) cases respectively. CONCLUSION: The use of expanded rehabilitation complexes among the patients with chronic paraproctitis in the early postoperative period after surgery, including intravenous ozone therapy, rectal laser therapy, recto-tibialmyostimulation and bifidobac therapy, made it possible to significantly improve therapeutic efficacy, which was confirmed by faster pain relief, fewer early and late p/o complications. The data obtained indicate the need for the use of rehabilitation programs in the early postoperative period for the treatment and prevention of complications after surgery.

[Application of physical therapy methods in the early rehabilitation period after surgical interventions in patients with inflammatory diseases of the maxillofacial region]. / Primenenie metodov fizioterapii v rannem reabilitatsionnom periode posle operativnykh vmeshatel'stv u bol'nykh s vospalitel'nymi zabolevaniyami chelyustno-litsevoi oblasti.

The increase in the number of purulent wound complications in the treatment of various surgical diseases in maxillofacial surgery determines the high importance of the medico-social problem of modern medicine. In this connection, the search for new approaches is urgent, including the complex application of 2 or more factors to increase the effectiveness of treatment and prevention of inflammatory diseases of the maxillofacial region. OBJECTIVE: To study the effect of a comprehensive physiotherapy program, including a low-frequency alternating electrostatic field and broadband electromagnetic therapy, on the severity of pain and local inflammation in patients with inflammatory diseases of the maxillofacial region. MATERIAL AND RESEARCH METHODS: 60 patients with acute pyoinflammatory diseases of the maxillofacial region (phlegmons, abscesses, abscessing boils of the maxillofacial region), mean age 41.2±3.5 years, who were divided into 2 groups: main - 30 patients who underwent a course of complex application of broadband electromagnetic therapy and a low-frequency alternating electrostatic field and control - 30 patients who received drug therapy (antibiotics, drugs of the metronidazole group, antihistamines, multivitamins, detoxification therapy, local treatment of the wound process), which served as a background in the main group. RESULTS: The combined use of a low-frequency alternating electrostatic field and broadband electromagnetic therapy contributes to a faster and more pronounced relief of the inflammatory process in the area of the pathological focus and pain syndrome in patients with inflammatory diseases of the maxillofacial region, which is confirmed by the data of an objective examination and indicators of the visual analogue scale VAS. CONCLUSION: The developed complex, which includes a low-frequency alternating electrostatic field and broadband electromagnetic therapy, has pronounced anti-inflammatory and analgesic effects in patients with inflammatory diseases of the maxillofacial region, which makes it possible to recommend it for use in wide surgical practice.

[Ocular iontophoresis]. / Lekarstvennyi elektroforez v oftal'mologii.

Iontophoresis in medicine is a combined pharmacological and physical method of treatment that unites the therapeutic effect of an electric current with the pharmacological effect of medicinal substances administered at the same time via an electric current. The article describes the physical basis of the therapeutic effect of direct electric current on biological tissues, and highlights the physical and chemical mechanisms of target administration of pharmaceutical substances into the human body through intact skin or mucous membrane by means of direct electric current. In addition, it presents the results of international as well as Russian domestic scientific studies on the clinical effectiveness of iontophoresis in ophthalmology.

[Evaluation of the effectiveness of using broadband modulation currents in medical rehabilitation of patients after acute cerebrovascular accident]. / Otsenka effektivnosti primeneniya tokov shirokopolosnoi modulyatsii v meditsinskoi reabilitatsii patsientov posle ostrogo narusheniya mozgovogo krovoobrashcheniya.

Every year in the world more than 15 million patients suffer from acute cerebrovascular accident. A special role in the organization of medical care for patients after acute cerebrovascular accident should be assigned to measures to improve the prevention of clinical manifestations and comprehensive rehabilitation. OBJECTIVE: To study the effect of broadband modulation currents on the manifestations of spasticity and on cognitive functions in patients after an ischemic stroke in the late recovery period. MATERIAL AND METHODS: The article presents data on the effectiveness of the use of broadband modulation currents in the late recovery period of medical rehabilitation of patients with ischemic stroke. The study included 80 patients who underwent ischemic stroke with movement disorders in the form of hemiparesis and increased muscle tone by the type of spasticity in the late recovery period. Control group patients (40 people) underwent standard drug therapy and medical rehabilitation, patients of the main group (40 people) received broadband modulation currents against the background of standard drug therapy and medical rehabilitation. The severity of spasticity and impaired motor function of the arm and leg was assessed according to the modified Ashfort Spasticity Scale (MAS) and goniometry parameters; the analysis of indicators of impairment of cognitive functions according to the data of the Montreal Cognitive Assessment Scale (MoCA) was carried out. RESULTS: After the course of treatment in patients of the main group, at all control points, there was a statistically significant positive dynamics of a decrease in spasticity, both in the proximal and in the distal parts of the upper limb, according to the modified Ashforth Spasticity Scale (MAS), while in the patients of the control group, only positive trend. After the course of treatment, a significant advantage of the influence of the developed method on cognitive impairment of functions in patients of the main group, who received broadband modulation currents, was revealed. This was confirmed by the increase in the total indicator of the MoCA scale to 26.7±0.6 points, which corresponded to the reference values. In patients of the control group, less pronounced results were obtained, the total indicator of the MoCA scale was 25.1±1.0 points, which was below the norm. CONCLUSION: The data obtained indicate that the inclusion of broadband modulation currents in the medical rehabilitation program contributes to a significant decrease in the severity of spasticity, increases the range of motion in the affected limb, and has a positive effect on the cognitive functions of patients.

[The use of transdermal electroneurostimulation in the rehabilitation of patients after surgical decompression of the carpal tunnel]. / Primenenie transdermal'noi elektroneirostimulyatsii pri reabilitatsii patsientov posle khirurgicheskoi dekompressii karpal'nogo kanala.

Most of the clinical and neurophysiological disorders of the median nerve that persisted in patients after surgical decompression of the carpal tunnel (DCT) are associated not with acute compression of the nerve, but with myelinoaxonopathic disorders in the structure of the nerve that developed as a result of prolonged compression. OBJECTIVE: To study the effectiveness of transdermal electroneurostimulation (TENS) in the rehabilitation of patients with residual neurological deficit after surgical DCT. MATERIAL AND METHODS: We observed 45 patients after DCT (6-12 months), aged 30 to 50 years (mean age 42±3 years). All patients were diagnosed with primary carpal tunnel syndrome with a lesion of the dominant hand, of which 15 patients received pharmacotherapy; 15 patients - in addition to pharmacotherapy, received a course of low-frequency high-amplitude TENS (NTENS) and 15 patients - a course of high-frequency low-amplitude TENS (VTENS). RESULTS: The regression of positive sensory symptoms was more pronounced against the background of VTENS and NTENS than after the use of pharmacotherapy, on average 6.6 times (p<0.01). At the same time, VTENS turned out to be more effective than NTENS by 28.5% (p<0.05). In the long-term follow-up period (2 months), the severity of positive sensory symptoms decreased in patients who received VTENS and NTENS, by an average of 58.1% compared with the baseline values before treatment (p<0.05). The severity of Tinel's symptom in patients who received a course of VTENS decreased by 44%, after a course of NTENS - by 67%, and after pharmacotherapy - by 14%. It was found that NTENS compared with VTENS was 51% more effective in reducing Tinel's symptom (p<0.05) and by 64% - Falen's symptom (p<0.05). The decrease in the time to perform the Jebsen-Taylor test (JTT) after the use of pharmacotherapy was on average 9% (p>1.00), and after TENS - 23% (p<0.05). When comparing VTENS and NTENS among themselves, NTENS turned out to be more effective on average by 68% (p<0.05). An improvement in electro-kymographic parameters was revealed only after the use of VTENS. At the same time, the decrease in the residual latency was 21.3% and the increase in the amplitude of the M-response was 14.3%. CONCLUSION: Transdermal electroneurostimulation is a highly effective method used in the complex treatment of patients with residual neurological disorders after undergoing surgical decompression of the carpal tunnel. The maximum regression of positive sensory symptoms develops against the background of high-frequency low-amplitude transcutaneous electroneurostimulation, and the maximum anti-inflammatory effect, the greatest improvement in the function of small hand muscles and statistically significant neurophysiological restoration of the function of the median nerve are revealed after the application of a course of low-frequency high-amplitude transcutaneous electroneurostimulation. At the same time, positive dynamics after low-frequency high-amplitude transcutaneous electroneurostimulation and high-frequency low-amplitude transcutaneous electroneurostimulation persists in the long-term period.

[Prospects of drinking mineral water in the rehabilitation of patients with coronavirus (COVID-19) infection: analysis of the main sanogenetic mechanisms]. / Perspektivy primeneniya pit'evykh mineral'nykh vod v reabilitatsii patsientov s koronavirusnoi (COVID-19) infektsiei: analiz osnovnykh sanogeneticheskikh mekhanizmov.

This review provides an analysis of the main mechanisms of the therapeutic and prophylactic effects of drinking mineral water concerning the rehabilitation of new coronavirus infection convalescents. When considering the sanogenetic potential of mineral water for drinking, it was noted that in the mechanisms of their systemic effects, a major role belongs to the nonspecific hormone-stimulating effect in the form of a pronounced activation of the gastroenteropancreatic endocrine system, capable of integrating substance and energy exchange following the current needs of the body and excrete vasoactive factors modulating the vital functional systems activity. The maximum effect of this system is promoted by the intake of mineral water with a high content of hydrocarbonate ions, magnesium, and sodium, as well as carbon dioxide saturation, but with general mineralization of water within the range from 5-6 to 11-13 g/L. The observed stimulating effect of mineral water on the adaptation processes allowed us to theoretically substantiate and convincingly prove the benefits of using this natural healing factor for the primary prevention of disorders in various functional systems and their hormonal regulation. The effects of drinking mineral water on various inflammatory states, resistance to hypoxia, microcirculatory tissue perfusion, and the state of the cardiovascular system were shown. It is concluded that the potential effectiveness of drinking mineral water as a part of comprehensive programs of medical rehabilitation of new coronavirus infection convalescents.

[Pharmacological and physiotherapeutic methods of treating non-exudative age-related macular degeneration]. / Farmakologicheskie i fizioterapevticheskie metody lecheniya neekssudativnoi formy vozrastnoi makulyarnoi degeneratsii.

The non-exudative form of age-related macular degeneration (AMD) is a disease with long-term progression for which effective treatments have not been found. Many studies are being conducted to find effective drugs to prevent the appearance of drusen and increase in RPE atrophy area, which could help avoid this more dangerous form of AMD. The main drugs (nutraceuticals) that are used to treat the dry form of AMD are lutein, zeaxanthin and omega-3 fatty acids. Additionally, treatment may include nanosecond laser therapy for drusen in advanced AMD, panretinal subthreshold micropulse laser exposure for atrophic AMD, as well as microcurrent stimulation. Further research in this area should be aimed at understanding all the pathogenetic mechanisms associated with the development of AMD, and developing new approaches to the treatment of this disease including physiotherapy.

[Modern treatment of different forms of optic nerve atrophy]. / Sovremennye sposoby terapii razlichnykh form atrofii zritel'nogo nerva.

Optic nerve atrophy (ONA) is one of the most common causes of blindness and low vision in the world. The disease occurs in 60-68% of cases. The causes of optic nerve atrophy are diverse: inflammatory and vascular diseases of the optic nerve and retina, glaucoma, atherosclerosis of the main vessels of head and neck, diseases of central nervous system, intoxication of various etiologies, as well as congenital and hereditary diseases. The literature review presents data on the diagnosis and classification of optic nerve atrophy, as well as on drug and non-drug treatment in combination with physiotherapy.

[Modern technologies of regenerative rehabilitation in the treatment of patients with abnormal scars]. / Sovremennye tekhnologii regenerativnoi reabilitatsii v lechenii patsientov s patologicheskimi rubtsovymi izmeneniyami.

OBJECTIVE: To evaluate an efficacy of lipoaspirate-based products in pathologic scarring management. MATERIAL AND METHODS: There were 118 patients with external scars. Depending on scar type, localization and need for soft tissue augmentation, three different methods were used for lipoaspirate-based product preparation: 15-minute sedimentation, centrifugation at 1200 g for 3 minutes and emulsification with a channel diameter of 1.2 mm. Results were assessed using the Manchester Scar Scale (MSS) and photographing. RESULTS: According to MSS analysis, the following results were obtained: before treatment - 11.6 (9.3-13.3) scores, 3 months after treatment - 6.5 (5.1-7.2) scores, 6 months after treatment - 5.2 (4.5-6.1) scores. Significant differences were obtained for baseline values and both control points. Stable results were obtained in long-term follow-up period (12-24 months). No major adverse effects were observed. Minor complications were registered in 10.1% of patients. CONCLUSION: Injections of lipoaspirate-based products is an effective option for the treatment of patients with pathologic scarring. This approach is intermediate between conservative and conventional surgical treatment.

[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.