Use of Virtual Reality Techniques to Rehabilitate Military Veterans with Post-Traumatic Stress Disorder (Review).

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder developing after a traumatic event like participation in combat activities. Objective diagnosis of combat PTSD and effective rehabilitation of war veterans is a current multifaceted problem with particularly high social costs. This review aims to evaluate the potential of virtual reality technique used as exposure therapy tool (VRET) to rehabilitate combat veterans and service members with PTSD. The review was written following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The final analysis includes 75 articles published in 2017-2022. VRET therapeutic effect mechanisms were examined along with protocols and scenarios of VRET combined with other interventions influencing PTSD treatment like pharmacotherapy, motion-assisted multi-modular memory desensitization and reconsolidation (3MDR), transcranial magnetic stimulation. The necessity is substantiated of psychophysiological measurements for objectification of PTSD clinical criteria and its dynamics during treatment. It was shown that inclusion of VRET to the package of PTSD rehabilitation interventions positively affects the results due to the enhanced effect of presence and greater experience personalization. Thus, VRET may be an effective, controlled, and cost-effective alternative for PTSD treatment in combatants, including those not responding to conventional therapy.

[Kinesiophobia in patients requiring hip and knee endoprosthetics: severity and provoking factors]. / Kineziofobiya u patsientov, nuzhdayushchikhsya v endoprotezirovanii tazobedrennogo i kolennogo sustavov: vyrazhennost' i provotsiruyushchie faktory.

Kinesiophobia (KP), or an irrational fear of physical activity, significantly hinders the active rehabilitation of patients with joint pathology. PURPOSE OF THE STUDY: To study the severity and risk factors of KP in patients requiring total hip and knee endoprosthetics (EP). MATERIAL AND METHODS: We examined 50 patients requiring total EP of the hip and knee joints. Pain syndrome was assessed in the preoperative and early postoperative periods in all patients using a visual analog scale, as well as the levels of kinesiophobia, anxiety, and depression using the Hospital Anxiety and Depression Scale and the Tampa Scale for Kinesiophobia (TSK). Quality of patients life was studied in the preoperative period (RAND SF36 questionnaire). RESULTS: In the majority of cases, both before and after EP, the level of KP corresponded to an average degree of severity. Both in the preoperative and in the early postoperative periods, not a single case of the absence of KP was detected (≤17 points according to the TSK); at the same time, a very high level of KP (≥55 points according to TSK) was also rarely recorded - in 3 patients in the postoperative period after EP of the hip joint. KP level significantly correlated with the duration of the pain syndrome, while the mental component of the KP, in addition to the duration of the pain syndrome, was influenced by the social status: in patients who had a steady job, the psychological component of the KP was expressed in a less degree. KP level was negatively correlated with such indicators of quality of life as vitality and physical functioning. In addition, the physical component of the KP significantly correlated with the pain intensity, the mental component - with role-playing behavior. CONCLUSION: Early detection of KP and timely correction of distorted ideas about physical activity are necessary for successful rehabilitation of patients requiring total joint endoprosthetics of the lower limb.

[Conservative treatment of chronic diseases of lower limb veins: major risks of poor patient compliance]. / Konservativnoe lechenie khronicheskikh zabolevanii ven nizhnikh konechnostei: osnovnye riski nizkoi priverzhennosti so storony patsienta.

Presented herein are the results of the Russian part of the International Research Programme 'VEIN ACT' aimed at studying approaches to conservative treatment of chronic vein diseases in the Russian Federation, assessing its efficacy and safety, as well as monitoring the patient compliance. Also discussed are the regimen and results of conservative therapy, depending on patients' gender, age and body mass index, as well as the level of adherence to various methods of treatment in the cohorts concerned. High efficacy of conservative therapy in all patients was confirmed. However, the regimen of drug therapy needs to be adjusted depending on the disease severity, especially in patients of a more advanced age and those with obesity. The lowest patient compliance was observed in relation to compression treatment. The existing situation may be improved by be means of appropriate recommendations and a possible decrease of the level and degree of compression. This should of course be done carefully and attentively, with obligatorily taking into consideration the patients' age and body mass index.

Kinematic constituents of the extreme head turn of Strix aluco estimated by means of CT-scanning.

To analyze extreme sideways turn of the head in owls, a total fresh specimen of Strix aluco was frozen in respective posture and CT-scanned. The maximum turn to one side was found to be 360°, provided that the head is drawn into the shoulders. 160° of this full turn are ensured by the neck axial rotation (this includes ~90° twist of the head relative to epistropheus and, posterior to it, less than 15° per every cervical joint), and the rest 200° are ensured by combination of dorsal and lateral flexion. The 15° limit is overcome in five joints in respect of dorsiflexion, and in six joints in respect of lateral flexion. So large a degree of lateral mobility is unusual among birds, and is appreciated as a crucial adaptation to extreme head turning.

Fluxes of energy, H2O, and CO2 between the atmosphere and the monsoon tropical forest in Southern Vietnam.

The 2.5-year dynamics of heat, water and carbon dioxide fluxes in the tropical monsoon semi-evergreen forest in Southern Vietnam obtained by means of continuous eddy covariance observations using standard procedures of FLUXNET global network are analyzed. The features of wet seasons during the measurement period were close to long-term average ones, but dry seasons had a great heterogeneity. The maximal duration of the period with little precipitation was 4 months. The annual radiation balance in the south of Vietnam exceeded the balance at all stations of FLUXNET in tropical forests, except one. Annual evapotranspiration in monsoon forest of south of Vietnam is approximately equal to the evaporation of the rain forests of Central Amazonia. During the wet season evapotranspiration spent 80% of the radiation balance, and in the driest months this value decreased to 50%. In the dry season reduction of evapotranspiration and gross primary production was relatively small due to photosynthesizing trees of 2-4 canopy sub-layers. For the first time a large net sink of carbon dioxide from the atmosphere in the monsoon forest ecosystem was identified.

[Melatonin in the correction of sleep in post-stroke patients].

AIM: To assess an effect of melatonin on quality of life and effectiveness of rehabilitation in patients with ischemic stroke (IS) suffered from insomnia due to sleep initiation disturbance. MATERIAL AND METHODS: Sixty post-stroke patients with insomnia were stratified into two groups matched for characteristics assessed in the study. Patients of the main group received melatonin during 21 days. In the first three days after admission and 21 days after the first examination, we administered the MMSE, the Rankin scale, FOSQ, NIHSS, EuroQol, the Epworth sleepiness scale (ESS) and used instrumental methods of examination (computed and magnetic-resonance tomography, electroencephalography, polysomnography). RESULTS: After 3 weeks, there was a reduction (p<0.05) in ESS scores in the main group compared to the control group (5.7 and 10 scores, respectively). Significant between-group differences were identified for polysomnographic parameters: latency to sleep was 17.8 min in the main group and 20.5 min in the control group (p<0.05), the number of microactivations was 15 and 18, respectively (p<0.05). There was a trend towards more rapid recovery in the main group (on average 8.4 days) compared to the control group (10.2 days), but the differences did not reach the level of statistical significance p<0.05. CONCLUSION: Melatonin reduced sleepiness (measured with the ESS), latency to sleep and number of wakings (microactivations) and was likely to promote the recovery in IS patients with insomnia due to sleep initiation disturbance.

[Peculiarities of treatment of chronic venous diseases in Russia. Preliminary results of the "VEIN ACT Program"].

Presented herein are the results of the Russian part of the International Research Program "VEIN ACT" aimed at studying the structure of variants of conservative treatment for chronic venous diseases in the Russian Federation, assessing its efficacy and safety, as well as monitoring of patient compliance. The obtained findings demonstrated high popularity, among both physicians and patients, of phlebotrophic drugs, determining high patient's adherence thereto. Recommendations on correction of the lifestyle were complied with by more than 80% of patients, however frequently not in the full scale. Noted was sufficiently low compliance to compression therapy, manifesting itself as a decrease in the class of compression and irregular use thereof in more than 30% of patients. Usefulness of conservative therapy was objectively proved, consisting in satisfaction with treatment and a statistically significant decrease in severity of symptoms of chronic venous diseases in the overwhelming majority of patients.

Electrical muscle stimulation with Veinoplus® device in the treatment of venous ulcers.

AIM: The aim of the study was to analyze the results of the electrical muscle stimulation (EMS) usage in patients with venous ulcers developed on top of a post-thrombotic syndrome (PTS). METHODS: Sixty patients (60 legs) with active venous ulcer (C6EsAsdpPr according to CEAP classification) were divided into two groups. In addition to the background therapy consisting of a standardized compression with ULCER X and intake of micronized purified flavonoid fraction (MPFF 1000 mg daily), all the patients in the main group underwent EMS with Veinoplus® V.I. for at least 3 times a day. Follow-up examinations were performed on days 30, 60 and 90. These included pain severity assessment with 100-mm Visual Analogue Scale (VAS), disease severity measurement with VCSS (Venous Clinical Severity Score) and ankle circumference above malleolus, as well as recording number of healed venous ulcers. RESULTS: At day 90 pain severity was reduced in both main and control groups. However, according to VAS pain reduction rates were significantly higher in patients of the main group (from 8.7 ± 0.6 to 1.9 ± 0.3 in the main group and 8.4 ± 0.6 to 3.9 ± 0.5 in the control group). At the end of the study, ankle circumference decreased from 270.9 ± 4.6 mm to 257.1 ± 4.2 mm in the main and from 269.7 ± 5.3 mm to 263.4 ± 5.2 in the control group. VCSS before treatment was 7.3 ± 0.6 in the main group and 6.8 ± 0.5 in the control group. By day 90 VCSS significantly decreased to 2.3 ± 0.4 and 4.6 ± 0.5 in the main and control groups respectively. Healing rates were significantly higher in the main group. On day 90, the number of open venous ulcers in the main group was 3 times lower than in the control group (4 vs. 12). CONCLUSION: EMS demonstrated high efficacy and good tolerability and provided significant reduction in pain severity, VCSS score and ankle edema, as well as a 3-fold increase in the number of healed venous ulcers.

[Treatment of sleep disorders in patients with mild cranial-brain injury in the early rehabilitation period].

OBJECTIVE: To study the effect of melatonin (melaxen) on sleep disorders in patients with mild cranial-brain injury (CBI) in the early rehabilitation period. MATERIAL AND METHODS: Sixty patients were randomized to equal groups treated or not treated with melaxen. Along with neurological and somatic examination, polysomnography and scales for measurement depression and quality of life ( ESS, BDI, EuroQol etc) were used. RESULTS AND CONCLUSION: Melatonin improved sleep (sleep latency, number of wakings per night etc) and decreased the severity of depression in the early rehabilitation period after mild CBI. Further research is needed to fully understand the effect of melatonin on sleep disorders in CBI, in particular in its later stages.

[Activation of neurohormonal system as an independent mechanism of heart remodeling in patients with chronic obstructive pulmonary disease].

AIM: To evaluate the contribution of activation of cytokines and renin-angiotensin-aldosterone system to heart remodeling in patients with chronic obstructive pulmonary disease in the course of a 2 year study and to estimate its relation to severe pulmonary hypertension. MATERIALS AND METHODS: 117 patients with COPD underwent measurement of TNFα, IL-6 levels and renin levels, spirometry and echocardiography (mean pressure in pulmonary artery, MPPA)). The data obtainedwere compared with the degree of remodeling of right and left ventricles. After 2 years 30 and 33 of the 63 patients were referred to groups with aggressive and moderate remodeling of the right ventricle respectively. Regressive analysis was used to detect predictors of aggressive remodeling. RESULTS: Initial remodeling severity and rate showed stronger correlation with TNFα, IL-6 levels and renin levels than with MPPA. Multifactor analysis demonstrated that renin activity and creatinine level were the most reliable predictors of remodeling (p = 0.041 and 0.049 respectively). CONCLUSION: Neurohormonal and imunno-inflammatory changes stimulate remodeling of right and left heart chambers. They independently affect myocardium and their influence is only partly mediated through exacerbation of pulmonary hypertension.

[Chronic venous oedema (C3 according to CEAP): new international guidelines and consensuses].

The review based on analysing the results of epidemiological studies, as well as international guidelines and consensuses published in 2011-2012 reflects the present-day data concerning prevalence, principles of diagnosis and treatment of chronic venous oedema. This is followed by determining the role of compression and drug therapy in treatment thereof from the positions of evidence-based medicine.

[The combined drug ascoril in the treatment of patients with chronic obstructive pulmonary disease concurrent with coronary heart disease].

AIM: To evaluate the clinical efficacy of the combined drug ascoril (Glenmark, India) in patients with grade I-Ii chronic obstructive pulmonary disease (COPD) concurrent with coronary heart disease (CHD). SUBJECTS AND METHODS: Sixty patients, including 12 (20%) women and 48 (80%) men, aged 43 to 68 years (mean age 55.1 +9.9 years), with COPD were examined. The patients were divided into 2 groups. Group 1 used the combined broncholytic and expectorant drug ascoril and Group 2 took mucolytic agent ambroxol. The follow-up period was 7 days. RESULTS: On day 2 of ascoril treatment, all the patients showed a significant reduction in the intensity of cough that was completely relieved in 26 (87%) patients by treatment day 7. Prior to ascoril treatment, heart rate (HR) was 64.4+/-5.5 beats/min. A significant increase in HR to 72.7+/-10.1 beats/min was observed 20 min after the first drug intake (p < 0.05) and a decrease to 68.6+/-10.5 beats/min was seen after 60 min. On treatment day 7, HR was 63.0+/-6.5 beats/min, which was similar to that before ascoril treatment (p = 0.6). CONCLUSION: In the patients with COPD concurrent with CHD, the combined drug ascoril exerts broncholytic and expectorant effects, with no pronounced negative action on HR.

[Tropical monsoon forests of Vietnam (results of 20 years of phytoecological research)].

This study was carried out during the period 1989-2011. The following areas were included: Vietnam, Laos, Cambodia, Indonesia, and Malaysia. Climax tropical forest and anthropogenically transformed ecosystems, including those damaged by the chemical warfare program of the United States in Vietnam, were investigated. Some regularities in the structure dynamics and functioning of forests ecosystems under a tropical monsoon climate have been revealed. The principles of classification of tropical forests have been elaborated. The major results of investigation of the tropical monsoon forests in Vietnam are given.

[Bioflavonoids and their significance in angiology: focus on diosmin].

The article deals with historical information dedicated to the discovery of bioflavonoids and their effect on the human cardiovascular system, also considering the modern classification of phlebotrophic agents, followed by generalization and analysis of their mechanisms of action, as well as detailed discussion of different forms of diosmin. Summing up contains generalization of the Russian, European, and American guidelines on using phlebotrophic drugs for various forms and stages of chronic venous diseases.

Kinematics of chiropteran shoulder girdle in flight.

New data on the mechanisms of movements of the shoulder girdle and humerus of bats are described; potential mobility is compared to the movements actually used in flight. The study was performed on the basis of morphological and functional analysis of anatomical specimens of 15 species, high speed and high definition filming of two species and X-ray survey of Rousettus aegyptiacus flight. Our observations indicate that any excursions of the shoulder girdle in bats have relatively small input in the wing amplitude. Shoulder girdle movements resemble kinematics of a crank mechanism: clavicle plays the role of crank, and scapula-the role of connecting rod. Previously described osseous "locking mechanisms" in shoulder joint of advanced bats do not affect the movements, actually used in flight. The wing beats in bats are performed predominantly by movements of humerus relative to shoulder girdle, although these movements occupy the caudal-most sector of available shoulder mobility.

[Participation of leucocytes in pathogenesis of primary forms of lower limb chronic venous disease].

AIM: The purpose of the study was to test the hypothesis on participation of WBCs in damaging the venous wall in patients presenting with primary forms of lower limb chronic venous diseases LLCVD . MATERIAL AND METHODS: The study included a total of fifteen consecutively selected patients (13 women and 2 men) diagnosed as having grade C2-C-4 LLCVD according to the CEAP classification. Static loading (30 minutes in the sitting position) was followed by simultaneous sampling of blood from the varicose vein of the cms and ulnar vein. The total blood count including determination of both the absolute values and percentage of blood formed elements was performed using the automated haematological counter «Advia 7¼ («Bayer¼, USA). The obtained findings were statistically processed using the Microsoft Office Excel software by means of the pared two-sample τ-test for the average values. RESULTS: The number of leukocytes and their subpopulations in blood samples obtained from the crural varicose veins turned out to be significantly less as compared with that in blood sampled from the ulnar vein. Thus, blood sampled from the crural varicose veins demonstrated a decrease in the counts of WBC by 9.6% in fourteen (93.3%) patients, that of neutrophils by 4.9% in twelve (80%) patients, that of lymphocytes by 16,8% in fifteen (100%) patients, and that oi monocytes by 24% in twelve (80%) patients. The mentioned differences were statistically significant at a = 0.05. The eosinophilic counts in blood sampled from the upper and lower extremities appeared similar in 66.7% of the examined subjects. In 33.3% of cases the eosinophilic count in blood samples from crural varicose vein was by 16.7% lower than that for blood samples form the ulnar vein. No differences for the rest parameters of the clinical blood count were revealed. CONCLUSION: The absolute lymphocytic count in the blood samples taken after the 30-minute static loading from the crural varicose veins was significantly lower as compared with that in blood sampled form the cubital vein. The counts for RBCs and blood platelets, as well as other qualitative haematological indices (haemoglobin, haematocrit, average volume of the RBC, erythrocytic diameter, etc.) in blood sampled form crural and ulnar veins in the same patient were identical, thus strongly suggesting the lack of either haemodynamic or haemorheological phenomena capable of leading to redistribution of the blood formed elements in varicose veins. Hence a decrease in the counts of leukocytes and their subpopulations in blood sampled from crural varicose veins might be associated with the «leukocytic trap¼ phenomenon.

Electromuscular stimulation with VEINOPLUS® for the treatment of chronic venous edema.

AIM: Electromuscular stimulation (EMS) with VEINOPLUS® has recently emerged as a new technique to activate the calf muscle pump, improving the symptoms of venous disease. The aim of the study was to evaluate efficacy of EMS and its impact on evening edema, venous pain, venous outflow and patients quality of life. METHODS: Thirty patients (32 legs) aged 19-50 (mean 45.2±1.3) classified CEAP C3 with chronic evening venous edema took part in the study (22 limbs: C3, S, Ep, Asp, Pr and 10 limbs: C3, S, Es, Aspd, Pr). All patients were treated with CE-registered VEINOPLUS® neuromuscular stimulator for 30 days. 3 sessions per day (each session lasted for 20 minutes) for the first 10 days, the next 10 days 2 sessions per day and one session per day for the last 10 days. The main evaluated criteria for venous edema was the circumference of the supramaleoal shin segment, measured twice with a tape measure; in the evening the day before and then 5 days after the treatment. All measurements were taken during the interval between 6 and 8 o'clock P.M. All the patients were asked to evaluate venous pain using the Visual Analog Scale, and to fill in a CIVIQ questionnaire (validated for Russian patients) for the Quality Of Life (QOL) measurement. Also venous refilling time (RT) was measured by digital PPG. That was also made twice - before the treatment and in 35 days after the treatment. No other treatments were used. RESULTS: The EMS treatment was well tolerated by patients. There were no drop outs and patients had no need to change their lifestyles. After the treatment, total or partial reduction of evening edema was shown in 93.8% of limbs, the circumference of the lower leg diminished by 20.3mm (P<0.001), the number of painful legs reduced from 28 to 12 and the severity score of venous pain was cut from 8.3 ±1.1 to 3.8 points ±0.9 (P<0.001), QOL improved significantly as the score dropped from 34.5 ±7.8 to 17.2 points ±4.6 (P<0.001) and RT increased from 17.3 ±0.9 to 21.5 seconds ±1.1 (P<0.001). Three months after VEINOPLUS® treatment, total remission of symptoms was observed in 50% of legs, despite there being no other treatments. CONCLUSION: VEINOPLUS® stimulation is an effective and well-tolerated therapeutic method for the treatment of chronic venous disease. The introduced scheme of EMS application was shown to be useful for treatment of chronic edema, for reducing pain and improving quality of life. It can be used as an additional mean in treatment and to prevent symptoms of CVI. This study also reveals that stimulation of calf muscles with VEINOPLUS® can improve venous outflow and symptoms of CVI. This finding should be investigated and confirmed in further studies.

[Echocardiography with physical exercise in patients with stable angina pectoris concurrent with chronic obstructive pulmonary disease: safety, informative value, and performance conditions].

AIM: To define the safety, informative value, and performance conditions of exercise echocardiography (EchoCG) in patients with stable angina (SA) concurrent with chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: Forty patients aged 45 to 66 years (mean age 54.8 +/- 4.9 years) with Functional Class (FC) II-III SA concurrent with COPD and 40 patients aged 46 to 65 years (mean 56.6 +/- 4.9 years) with FC II-III SA without COPD were examined. All the patients underwent exercise EchoCG during the chosen therapy. RESULTS: Exercise EchoCG is safe in patients with SA with COPD. To enhance the informative value of this test and to achieve the ischemic threshold in patients of this category require the use of adequate bronchodilator therapy. In this case, the informative value of the technique is 75%. CONCLUSION: Exercise EchoCG in patients with SA concurrent with COPD may serve as a reliable tool in determining exercise endurance during antianginal, bronchodilator therapy and in assessing its adequacy.