[The use of electromyostimulation in motion in the treatment of post-traumatic edema of the ankle joint]. / Primenenie elektromiostimulyatsii v dvizhenii pri lechenii posttravmaticheskikh otekov golenostopnogo sustava.

Injuries of the ligamentous apparatus of the ankle joint are one of the most common injuries of the ODA. A large number of complications and a long period of disability require the development of modern methods of physiotherapy treatment that can reduce the number of relapses and reduce the duration of rehabilitation. OBJECTIVE: Evaluation of the effectiveness of the use of electromyostimulation in motion in the treatment of post-traumatic edema of the ankle joint. MATERIAL AND METHODS: 51 athletes with post-traumatic edema of the ankle joint were examined. The main complaints were the presence of pronounced edema in the area of injury, pain, restriction of movement in the joint. The patients were randomly divided into 2 groups: the 1st group (25 patients) received treatment with electromyostimulation in motion (while performing therapeutic gymnastics); the 2nd (control) group (26 patients) performed therapeutic gymnastics recommended for the treatment of patients with lymphovenous insufficiency. The method of laser Doppler flowmetry was used to study microcirculatory disorders in the area of injury. Peripheral hemodynamics was evaluated by the RVG method. The severity of edema was assessed by measuring the circumference of the lower leg in the lower third of the injured and healthy limb. The thickness of subcutaneous fat was assessed by ultrasound. The subjective feelings of athletes were evaluated using CIVIQ-2 questionnaires and pain syndrome assessment according to VAS. RESULTS AND CONCLUSION: The use of electromyostimulation in motion in patients with post-traumatic edema of the ankle joint helped to reduce pain, relieve soft tissue edema, increase the volume of movements in the affected joint, increase motor activity and improve the quality of life.

[Application of kinesis-taping and low frequency pulse magnetic therapy in medical rehabilitation of athletes with post-traumatic edema of the lower extremities]. / Primenenie kinezioteipirovaniya i nizkochastotnoi impul'snoi magnitoterapii v meditsinskoi reabilitatsii sportsmenov s posttravmaticheskim otekom nizhnikh konechnostei.

In the conditions of increasingly stringent anti-doping rules, the development of new non-drug methods of treatment and rehabilitation of athletes is of particular importance. OBJECTIVE: Development of new methods of medical rehabilitation of athletes after injury. MATERIAL AND METHODS: Thirty-three athletes with knee injuries were examined. The main complaints were the presence of pronounced edema in the area of injury. All patients were randomly divided into 2 groups: in group 1 (16 patients) lymphatic drainage kinesis-taping was performed; in the 2nd group (17 patients) - complex treatment including lymphatic drainage kinesis-taping and low-frequency pulse magnetic therapy. Using laser Doppler flowmetry a study of microcirculatory disorders in the area of injury was carried out. The severity of edema was assessed by measuring the circumference of the knee joint of the diseased and healthy limbs. The assessment of the subjective feelings of athletes using questionnaires CIVIQ2 andVAS. RESULTS AND CONCLUSION: Based on the obtained subjective and objective data, a medical complex was developed using lymphatic drainage kinesis-taping and low-frequency pulse magnetic therapy, which affects different steps in the pathogenesis of edema formation. Data obtained resultedin more pronounced positive effect during complex treatment compared with monotherapy with kinesis-taping.

Investigating epidemiologic trends and the geographic distribution of patients with anal squamous cell carcinoma throughout Canada.

Background: Anal cancer is a rare disease, constituting 0.5% of new cancer cases in the United States. The most common subtype is squamous cell carcinoma (scc). Studies in several developed nations have reported on an increasing incidence of anal cancer in recent decades, and various risk factors pertaining to the pathogenesis of the disease have been identified, including infection with the human papillomavirus, tobacco use, and immunosuppression. The epidemiology and distribution of anal scc throughout Canada remain poorly understood, however. Methods: Using 3 population-based cancer registries, a retrospective analysis of demographic data across Canada for 1992-2010 was performed. The incidence and mortality for anal scc was examined at the levels of provinces, cities, and the forward sortation area (FSA) component (first 3 characters) of postal codes. Results: During 1992-2010, 3720 individuals were diagnosed with anal scc in Canada; 64% were women. The overall national incidence rate was 6.3 cases per million population per year, with an average age at diagnosis of 60.4 years. The incidence increased over time, with significantly higher incidence rates documented in British Columbia and Nova Scotia (9.3 cases per million population each). Closer examination revealed clustering of cases in various urban centres and self-identified lgbtq communities in Toronto, Montreal, and Vancouver. Discussion: This study provides, for the first time, a comprehensive analysis of the burden of anal scc in Canada, identifying susceptible populations and shedding light onto novel avenues of research to lower the incidence of anal cancer throughout the country.

Epidemiology of adult and pediatric Burkitt lymphoma in Canada: sequelae of the HIV epidemic.

Background: Although the pathogenesis and epidemiology of endemic Burkitt lymphoma (bl) have been extensively studied, the epidemiologic landscape of sporadic and immunodeficiency-associated bl in North America remains poorly understood. Methods: We used 3 distinct population-based cancer registries to retrospectively study bl incidence and mortality in Canada. Data for patient sex; age at the time of diagnosis; and reporting province, city, and forward sortation area (fsa, the first three characters of a postal code) were analyzed. Results: During 1992-2010, 1420 patients with bl in Canada were identified (incidence rate: 2.40 cases per million patient-years), of which 71.1% were male patients. Mean age at diagnosis was 55.5 ± 20.8 years. A bimodal incidence by age distribution was seen in both sexes, with pediatric- and adult-onset peaks. An analysis based on fsas identified select communities with statistically higher rates of adult bl. Several of those fsas were located within the 3 major metropolitan areas (Montreal, Vancouver, Toronto) and within self-identified lgbtq communities. The fsas with a higher socioeconomic status score were associated with lower rates of bl. Conclusions: Current results highlight the geographic and historic pattern of bl in Canada. The human immunodeficiency virus remains an important risk factor for adult bl.

[The modern trends in the treatment and prevention of lymphedema of the lower extremities]. / Sovremennye tendentsii v lechenii i profilaktike limfedemy nizhnikh konechnostei.

This article was designed to describe the main pathogenetic factors underlying the development of lymphedema of the lower extremities, the social implications of this condition, its prevalence throughout the world, and the impact of this disease on the quality of life of patients. In addition, the review presents the modern data on the management of patients with chronic lymphatic edema of the lower extremities. Special attention is given to the principles and methods of its combined conservative treatment, including the use of medications, compression therapy, physiotherapy, thalassotherapy, and balneotherapy. Moreover, the results of the analysis of the effectiveness of the treatment as a whole and of the individual methods, such as intermittent pneumatic compression (SPC), electrical myostimulation, laser therapy, magnetic-laser therapy (MLT) are reported with special reference to their outcomes when applied as isolated interventions and the components of the combined therapy. The review is devoted to the systematization of information about the currently available methods for the prevention and treatment of lymphadema of the lower extremities and the evaluation of the treatment regimens applied in this country and leading foreign clinical centres. Also considered are both the classical scheme of the combined treatment of lymphedema of the lower extremities and the schemes including novel therapeutic modalities. The most promising methods for the treatment of this condition including those proposed during a few recent years (such as kinesiotaping, LPG-engineering, and gravity therapy) are highlighted, and their influence on the generally accepted schemes of the combined treatment of lymphedema of the lower extremities is evaluated. The basic principles of modern pharmacotherapy and its role in the system of methods for the treatment of lymphedema of the lower extremities including phlebotomies, lymphokinesia, antibacterial drugs are considered.

Copy number variants analysis in a cohort of isolated and syndromic developmental delay/intellectual disability reveals novel genomic disorders, position effects and candidate disease genes.

BACKGROUND: Array-comparative genomic hybridization (array-CGH) is a widely used technique to detect copy number variants (CNVs) associated with developmental delay/intellectual disability (DD/ID). AIMS: Identification of genomic disorders in DD/ID. MATERIALS AND METHODS: We performed a comprehensive array-CGH investigation of 1,015 consecutive cases with DD/ID and combined literature mining, genetic evidence, evolutionary constraint scores, and functional information in order to assess the pathogenicity of the CNVs. RESULTS: We identified non-benign CNVs in 29% of patients. Amongst the pathogenic variants (11%), detected with a yield consistent with the literature, we found rare genomic disorders and CNVs spanning known disease genes. We further identified and discussed 51 cases with likely pathogenic CNVs spanning novel candidate genes, including genes encoding synaptic components and/or proteins involved in corticogenesis. Additionally, we identified two deletions spanning potential Topological Associated Domain (TAD) boundaries probably affecting the regulatory landscape. DISCUSSION AND CONCLUSION: We show how phenotypic and genetic analyses of array-CGH data allow unraveling complex cases, identifying rare disease genes, and revealing unexpected position effects.

Nonhomologous Robertsonian translocations (NHRTs) and uniparental disomy (UPD) risk: an Italian multicentric prenatal survey.

OBJECTIVES: The risk of uniparental disomy (UPD) occurrence associated with the prenatal finding of balanced nonhomologous Robertsonian translocations (NHRTs) has been estimated only on limited empirical data. The aim of the study was to verify the estimate of the general risk, to get narrower confidence intervals by cumulating the data and to obtain risk estimates for specific translocation types. METHODS: We tested for UPD 160 prenatal specimens referred to the participant centers after the cytogenetic finding of NHRT. RESULTS: One case of upd(14)mat was found, associated with a 45,XX,der(14;22)mat fetal karyotype. The general empirical risk of UPD occurrence in NHRT carrier fetuses, corrected for the actual number of chromosomes analyzed, was 0.76% (95% CI 0.02-4.25%). Cumulative data with previous studies gives a general risk of UPD associated with NHRT of 0.80% (95% CI 0.17-2.34%). The UPD risk for the specific NHRT der(13;14) did not significantly differ from that of the other NHRTs taken together. CONCLUSION: The present survey confirms the previously estimated risk of occurrence of UPD in offspring of NHRT carriers as a low, but not negligible risk, worth being investigated in prenatal diagnosis.

[Epidemiological and clinical features of viral hepatitis in convicts of penitentiaries]. / Epidemiologicheskie i klinicheskie osobennosti virusnykh gepatitov u bol'nykh, nakhodiashchikhsia v ispravitel'nykh uchrezhdeniiakh.

AIM: Investigation of epidemiological and clinical features of viral hepatitides (VH) in convicts treated in clinics of penitentiaries. MATERIALS AND METHODS: VH were studied in 352 patients of the infection department of the special hospital in one of the penitentiaries of Russian Federation. 97 VH patients were followed up. Incidence of VH was also considered in 144 patients of the somatic department. Mean age of the patients was 24 years, mean duration of the last stay in the penitentiary 19 months. Forms of VH were diagnosed clinically, using EIA, ultrasound, laboratory tests. RESULTS: Serological markers HC-, HB-, HA- of viral infections were detected in 34.3, 32.3 and 11.4% of patients, respectively. VH of mixed etiology was found in 17.6% of cases. 52.1% of patients had previously injected narcotic drugs, 60.4% of them had concomitant infectious or parasitic diseases. 22.9% of the patients had serum proteins below 65 g/l. CONCLUSION: Convicts in the penitentiaries were infected primarily with hepatitis C, many of them had mixed infections and chronic hepatitis. More than half of them had associated infections infectious and/or parasitic diseases. At least one-fifth of the patients suffered from protein insufficiency. The causative agents can be transmitted through different routes, two or more at a time, iatrogenically among them. VH in convicts display special clinical features which allow to consider them as an independent syndrome.

Intra- and extracranial artery blood velocity during a sudden blood pressure decrease in humans.

The intra- and extracerebral Doppler artery blood velocity responses to a 10-mmHg abrupt blood pressure (BP) decrease in ten healthy men were studied. This decrease was obtained using two cuffs placed over both thighs. First, cuffs were inflated to pressures greater than the arterial BP for 5 min. Next, they were deflated to 60 mmHg in order to prevent venous return from the legs. We obtained a decrease in mean arterial BP of from 101 (10) to 90 (10) mmHg [mean (SD), P < 0.01] without modifications in the heart rate [HR, 88 (14) beats min-1]. Middle cerebral artery mean blood velocity (MCAmv) decreased immediately from 50 (10) to 42 (12) cm s-1 (P < 0.05). Simultaneously, temporal superficial artery mean blood velocity (TSAmv) decreased from 11 (3) to 7 (2) cm s-1 (P < 0.05) and common carotid artery blood flow (CCAbf) decreased from 305 (23) to 233 (33) ml min-1 (P < 0.05). After 5 s, MCAmv and CCAbf returned to baseline values, whereas TSAmv [8 (2) cm s-1], mean arterial BP [86 (10) mmHg] remained low and HR increased [92 (12) beats min-1]. TSAmv, BP and HR returned to baseline values in 1 min. These data confirm that cerebral blood flow (CBF) is very rapidly regulated but that blood flow in extracranial territories is not and that it follows the arterial BP changes.

Evidence of fetal cerebral vasodilatation induced by submaximal maternal dynamic exercise in human pregnancy.

To investigate the relationship between maternal exercise and fetal circulatory responses in humans during the third trimester of pregnancy, changes in uterine, umbilical and fetal cerebral circulations were measured by pulsed-Doppler ultrasound method in 14 healthy volunteer pregnant women before and just after a moderate non-exhaustive exercise. Maternal heart rate increased significantly reaching 80% of the theoretical maximal heart rate (TMHR) while uterine resistance indices did not change. The fetal heart rate and umbilical mean velocity were unchanged while umbilical resistance index decreased slightly (0.58 +/- 0.06 versus 0.62 +/- 0.07, P < 0.05). The fetal internal carotid artery mean velocity increased (23.2 +/- 5.3 versus 20.4 +/- 4.1 cm/s, P < 0.02) and the cerebral resistance index decreased (0.71 +/- 0.11 versus 0.80 +/- 0.10, P < 0.01). We conclude that submaximal maternal exercise at 80% of TMHR does not significantly alter uterine perfusion but involves a slight fetal cerebral vasodilation which could be due to a moderate fetal hemoglobin desaturation.

[Non-invasive test for aortic compliance in man]. / Détermination non invasive de la compliance aortique chez l'homme.

We determined the compliance of the aortic "Windkessel" using a non-invasive method. The occlusion of the lower extremities (5 min, 180 mm Hg) elicited reactive hyperemia. An abrupt change in pressure in the occluding cuffs from 180 to 60 mm Hg increased femoral blood flow (measured by pulsed Doppler) and decreased blood pressure (measured by Penaz continuous method). During abrupt decrease in blood pressure, the compliance was calculated as a ratio of the blood volume flowing out of the aorta via the femoral arteries to the decrease of blood pressure. The measurements were made repeatedly in eight healthy men, and in patients with essential hypertension (ten patients with essential hypertension, IInd degree-WHO without treatment and six patients with essential hypertension, IInd degree-WHO treated with slow released verapamil). Compliance in the first group was 1.18 +/- 0.25 ml. mm Hg-1, in the second 0.96 +/- 0.21 ml. mm Hg-1, and in the third group 0.90 +/- 0.11 ml. mm Hg-1. We found a negative correlation between compliance and arterial blood pressure. However the relative large scatter requires repeated measurements.

Vasomotor effects of transcutaneous CO2 in stage II peripheral occlusive arterial disease.

Vasomotor effects of skin exposure to carbon dioxide (CO2) have been described in normal subjects. It was of interest, therefore, to determine whether percutaneous CO2 is of therapeutic benefit. In a randomized, double-blind study, 10 patients with lower limb arteriopathy (stage II) were investigated before and after local exposure for twenty minutes to CO2-rich spa gas or to water-vapor-saturated air at the same temperature as that CO2-rich spa gas. Brachial and femoral blood flows, brachial and posterior tibial artery pressures, heart rate, and chest and foot transcutaneous oxygen tensions (tcPO2) were determined. Femoral blood flow, tibial pressure, and foot tcPO2 were significantly increased after exposure of the skin to CO2-rich spa gas. This effect was not accompanied with systemic hemodynamic modifications. Water-vapor-saturated air had no effect. These results suggest that transfer of CO2 across the skin can have beneficial local vasomotor effects in patients with lower limb stage II arteriopathy.

Influence of posture on middle cerebral artery mean flow velocity in humans.

We determined middle cerebral artery, common carotid artery and temporal superficial artery Doppler derived flow velocities in ten subjects for 10 min after change in posture. Maximal changes were observed after about 3 min. The 10 degrees head-down tilt position increased blood velocities in the common carotid artery by 13% (SD 4)% (P < 0.001), in the middle cerebral artery by 6% (SD 3)% (P < 0.001) and in the superficial temporal artery by 70% (SD 26)% (P < 0.001). In the standing position, there was an 18% (SD 9)% (P < 0.001) decrease in the common carotid blood velocities, with 14% (SD 6)% (P < 0.001) and 53% (SD 23)% (P < 0.001) reductions in the middle cerebral and superficial temporal artery velocities, respectively. At 9 min after the changes in posture, velocities in the middle cerebral artery were at the value of supine rest, whereas the common carotid blood velocity was not completely restored and deviations in the temporal artery velocity persisted. The data would suggest that cerebral blood flow is regulated with some delay and that such regulation is partially reflected in the common artery blood flow, since changes in a branch of the external carotid artery flow velocity remained.

[The characteristics of the prevention of HB viral infection in hemodialysis units]. / Osobennosti profilaktiki HB-virusnoi infektsii v otdeleniiakh gemodializa.

Patients and medical personnel of some hemodialysis centres of the north-west region of the Russian Federation were examined for HB-virus infection markers using enzyme immunoassays. Subjects free of HB markers were immunized with ENGEPIX-B vaccine. Immunogenicity of the vaccine was assessed one month and one year after the immunization. Epidemiological HB factors in hemodialysis centers were studied on the simulation computer model. HB-virus-containing blood transfusion factor is not the only determinant of HB-virus infection prevalence. The virus can be transmitted via hemodialysis facilities. Immunization effects proved inferior in the hemodialysis unit patients. It is stated that vaccinoprophylactic policy in the patients of the dialysis centers and relevant equipment need serious improvement to prevent hepatitis B outbreaks.

[The characteristics of the epidemic process in hepatitis B, C and D in hemodialysis units and the experience of the vaccinal prevention of HB viral infection in a delimited population]. / Osobennosti épidemicheskogo protsessa gepatitov B, C i D v otdeleniiakh gemodializa i opyt vaktsinoprofilaktiki HB-virusnoi infektsii v ogranichennoi populiatsii.

Patients and medical staff of hemodialysis centers were screened for HBV, HCV and HDV markers. The incidence of mixed infection in patients reached 34.8%, while in medical personnel it was only 3.4%. There was an increasing rate of HBV markers in persons who have been immunized with ENGERIX-B vaccine according to standard schedules one month, one year and three years after the vaccination. Administration of Cuban vaccine using modified schedules is perspective for wide immunoprophylaxis in medical staff. Immunization policy for hemodialysis patients needs further perfection.

[Risk of infection with hepatitis B and C viruses of medical workers, patients in the hemodialysis ward, and vaccine prophylaxis of hepatitis B infection in these populations]. / Risk infitsirovaniia virusami gepatita B i C meditsinskikh rabotnikov, bol'nykh otdelenii gemodializa i vaktsionoprofilaktika u nikh gepatit B-virusnoi infektsii.

Markers of hepatitis B (HBsAg, anti-HBs) and C (anti-HCV) were detected in 1990-1992 by enzyme immunoassay in 1581 medical workers, 230 last-year students of medical schools, 269 patients hospitalized at hemoperfusion wards, and 701 blood donors. Hepatitis B markers were detected in medical workers two times more frequently than in donors (HBsAg in 4.7 and 2.2% of these, respectively, anti-HBs in 26.2 and 14.0%), and anti-HCV were found almost three times more frequently (in 3.1 and 1.1%, respectively). The incidence of these markers in students of medical schools was the same as in donors. Hepatitis B markers (HBsAg, anti-HBs) were detected in 39.0% of patients of hemoperfusion departments, HBsAg being present in 11.9%, and antiHCV in 25%. A direct relationship was revealed between the incidence of hepatitis B and C markers and duration of treatment at dialysis centers or length of service at therapeutic institutions. Three vaccinations with Engerix B 944 vaccine were administered to 944 medical workers and 162 medical students and four vaccinations in double doses to 40 patients of hemoperfusion centers who had no hepatitis B markers; a month after immunization anti-HBs in protective titers were detected in 91.4, 93.9, and 76.1% of them, respectively, and a year after vaccination these values were 77.2, 82.5, and 53.3%. No cases of hepatitis B, detection of HBsAg, or postvaccination complications in the vaccines were recorded.

[The importance of the blood transfusion factor in the epidemic process in hepatitis C in the patients of chronic hemodialysis units studied using a computer simulation model]. / Issledovanie znachimosti faktora gemotransfuzii v épidemicheskom protsesse pri gepatitie C u patsientov otdelenii khronicheskogo gemodializa s pomoshch'iu imitatsionnoi komp'iuternoi modeli.

Examinations for the presence of antibody to hepatitis C virus (HCV) were carried out in 144 patients of chronic hemodialysis wards and 83 blood donors. The anti-HCV were found in 26.4% of the patients and only in 1.2% of the blood donors. A definite increase in the incidence of HCV infection in the patients of hemodialysis wards was established in relation to the duration of the treatment, namely from 17.4% in the patients treated for up to 1 year to 37.5% in those treated for 6 years or more. Significant differences were observed in the rate of anti-HCV findings in the patients with kidney transplantation and in those who had not experience this operation. The results obtained by an imitation computer model indicated that the hemotransfusion factor is not the only one determining the high rate of HCV infection in patients of chronic hemodialysis wards, however its influence on the intensity of the epidemic process in hepatitis C in these wards was sufficiently high.

Relationship between birth weight and umbilical Doppler blood flow velocity waveforms during the third trimester of pregnancy.

OBJECTIVES: The Doppler ultrasound method for recording blood flow velocity waveforms in the fetal umbilical arteries is now widely used as an indicator of fetal well-being. This study was conducted to investigate the impact of umbilical placental resistance level on fetal growth development. METHODS: Maximal flow velocity waveforms were recorded from the umbilical artery in 108 pregnant women including 50 with normal pregnancies, 3 with previous death in utero, and 55 with moderate arterial hypertension corrected by resting only. All the newborn infants had a normal birth weight (BW between the 10th and the 90th percentile for the gestational age at birth). Doppler measurements were performed between 25 to 38 weeks of gestation. The placental resistance index (PRI) derived from blood flow velocity measurements was determined. RESULTS: Data were grouped in two-week intervals according to the age of gestation at Doppler examination. We found an inverse close relationship between BW and PRI which can be described by a linear function of PRI in each interval. BW increased with the decrease in PRI. CONCLUSIONS: Our findings suggest that umbilical placental resistance level determines fetal growth development and birth weight during pregnancies without placental insufficiency.

Simultaneous ultrasonic measurement of carotid blood flow and intracerebral haemodynamics in man.

Common carotid blood flow and middle cerebral artery velocities were determined simultaneously by using a range gated Doppler velocimeter and transcranial apparatus in ten subjects. Middle cerebral artery velocities were used as an index of cerebral resistance. Different gas mixture concentrations were breathed in order to change cerebral haemodynamic conditions. In each condition there was a simultaneous modification of blood gases and cervicocerebral haemodynamics in common carotid blood flow and cerebral vascular resistance index. Carotid blood flow and the resistance index in middle cerebral artery changed also on opposite side. Acute hypercapnia in normoxia increases common carotid blood flow by 33% and simultaneously decreases cerebral resistance index by 11%. Normocapnic hyperoxia was associated with a fall in common carotid blood flow by 13% and with an increase in cerebral resistance index by 7%. There was a inter-subject statistically significant relation between common carotid blood flow and index of cerebral resistances (0.78 < r < 0.98). However there was an individual reactivity with large scatter when data from different subjects were pooled. Nevertheless the results provide evidence that changes in middle cerebral artery resistance indices are reflected by common carotid blood flow modifications.