EFFECT OF THE COMBINED UTILIZATION OF STATIC PROGRESSIVE STRETCHING AND PHONOPHORESIS WITH HYDROCORTISONE IN REHABILITATION OF KNEE CONTRACTURES CAUSED BY ARTHROFIBROSIS.

Arthrofibrosis is the abnormal proliferation of fibrous tissue in a joint with an unclear etiopathogenesis that leads to loss of motion, pain, muscle weakness, swelling, and functional limitation. Various methods of therapy are utilized to treat the aforementioned pathology and among them are also aggressive approaches such as static progressive stretching. The goal of the current study was to establish the superiority of the effect of the combined utilization of static progressive stretching and hydrocortisone phonophoresis over standard therapeutic exercise programs for the rehabilitation process of knee contractures caused by arthrofibrosis. 29 patients between the ages of 18 and 60 (mean age 42±4.3 y.o.) participated in the prospective randomized controlled study, 19 male (65%) and 10 female (35%) with clinical signs of type III and IV contracture of the knee, extension limitation ˃10° and flexion deficit ˃25° when compared to the uninjured side. A minimum of 3 months had passed since the initial injury or the surgical intervention in all cases. 10 male and 5 female patients were randomly distributed to Group I (experimental group) while 9 male and 5 female patients were distributed into Group II (control group) accordingly. The patients from Group I underwent a 2-week long treatment course (10 procedures) with highly concentrated (10%) hydrocortisone phonophoresis before the inception of the standard rehabilitation program while the patients from Group II went through a rehabilitation course consisting solely of static progressive stretching and a home exercise program. The effect of static progressive stretching in the rehabilitation process of knee contractures caused by arthrofibrosis is greatly improved after the utilization of ultraphonophoresis with highly concentrated hydrocortisone alongside standard home exercise programs and this effect is especially apparent in the cases of patients with type III arthrofibrosis and knee flexion contractures.

PREVALENCE OF ASYMPTOMTIC VENTRICULAR PREEXCITATION AMONG GEORGIAN ATHLETES.

The aim of the study was to analyze the prevalence of asymptomatic VPP among young athletes when the screening protocol includes both resting and exercise ECG and determine the role of stress ESG testing in the detection of VPP among asymptomatic athletes. We conducted a cross-sectional retrospective study of 15.187 young Georgian athletes from 12 to 25 who underwent cardiac preparticipation screening at the TSMU Clinical Center of Sports Medicine and Rehabilitation from 2010 to 2019. From these 15187 subjects we analyzed rest and exercise ECGs of athletes referred to an electrophysiologist and identified 25 athletes among them with asymptomatic VPP. All ECGs (rest and exercise) with a diagnosis of asymptomatic VPP were included in the present study (athletes with manifested WPW were excluded from our study). Among these 15.187 athletes, VPP has been found in 25 (0.16%) male athletes (none of them had structural heart or genetic abnormalities). Mean age was 16 ± 1.2 years. From these 25 asymptomatic athletes 9 (36%) manifested preexcitation during exercise (Group1). 16 (64%) patients had preexcitation during rest: complete normalization of the QRS complex occured in 4 (16%) patients (Group 2); exercise produced no change in preexcitation in 7 or partial normalization of the QRS complex in 5 (total 12 (48%) - Group 3). The prevalence for asymptomatic VPP is 0.16% (1.6 per 1000 young athletes). Cardiac screening in the young athletic cohort may uncover pre-excitation. Evidence of an AP is significant even if the individual is asymptomatic at the time. The condition is potentially lethal if unrecognized but is amenable to a safe and permanent cure once diagnosed. Exercise testing can unmask intermittent ventricular preexcitation in asymptomatic athletes and can be effectively used to stratify risk in asymptomatic athletes with VPP.

ASSESSMENT OF EFFECTS OF NON-FUNCTIONAL OVERREACHING AND OVERTRAINING ON RESPONSES OF SKELETAL MUSCLE AND CARDIAC BIOMARKERS FOR MONITORING OF OVERTRAINING SYNDROME IN ATHLETES.

The aim was to study the effects of non-functional overreaching and overtraining on responses of biomarkers of the skeletal muscle cell (CK-NAC) and cardiomyocyte injury (cTnI and CK-MB) and their use in monitoring OTS. In 43 athletes with non-functional overreaching (NFO)/overtraining syndrome (OTS) and 40 athletes without NFO/OTS -control athletes (CA) off-season measurements of creatine kinaze (CK-NAC and CK-MB) were performed, followed by peak-season evaluation of the dynamic of CK-NAC, CK-MB and cardiac troponin I (cTnI) changes. CK and cTnI levels were obtained 24 hrs before the strenuous exercise appropriate to the sport-specific peak-season intensity, immediately after completion of the work-load, after 6, 48, and 72hrs. Baseline and post-exercise clinical assessment and echocardiography were performed in 6 and 48 hrs after strenuous session. Similar rising trend of CK-NAC, CK-MB, and cTnI levels was observed immediately after exercise, reaching peak values after 6 hours in all athletes, though, significantly greater in NFO/OTS athletes than in controls. After 48 hours of recovery in athletes with NFO/OTS CK-NAC, CK-MB, and cTnI values were significantly higher than on entry, showing slower recovery. CK-NAC fell within the "possible overtraining and muscle damage" levels in OTS athletes, even after 72 hours of recovery. Most of the athletes noted continuous trauma during game/combat contact events, though, mostly recovered after 48 or 72 hours. Two year follow-up showed no signs of full recovery in the OTS athletes. Echocardiography didn't reveal any sustained alterations of systolic and diastolic functions, or clinically threatening myocardial damage, only minor diastolic changes due to adaptation to the post-exercise haemodynamic. Elevated values of cardiac markers after strenuous exercise can be linked to increased cellular permeability and cardiac troponin leakage, amplified by oxidative stress existent in OTS athletes. In our study sport-specific intensive exercise caused mild injury to skeletal muscle and transient increase of the CK-MB and cTnI, without irreversible pathophysiological and clinical consequences, suggesting mostly benign cardiac involvement, though amplified by existent oxidative stress in athletes with OTS. Monitoring responses via alterations of biochemical parameters can be helpful to guide athletic training, and prevent OTS or interrupt NFO to OTS progression.

UTILIZATION OF HYDROCORTISONE ACETATE PHONOPHORESIS IN COMBINATION WITH THERAPEUTIC EXERCISE IN THE REHABILITATION MANAGEMENT OF FUNCTIONAL LIMITATIONS CAUSED BY KNEE ARTHROFIBROSIS.

Arthrofibrosis is a joint pathology during which excess collagen is produced resulting in movement limitation, inflammation and pain. Itis caused by repeated injuries or surgical interventions, which is frequently managed by using certain medications such as glucocorticosteroids.The goal of our research was to study the effect of therapeutic exercise and hydrocortisone acetate (HA) phonophoresis combination therapy on the management of the rehabilitation process of knee joint functional limitations caused by arthrofibrosis and to establish the optimal parameters of ultrasound needed to achieve therapeutic effect.25 male patients between the ages of 18 and 50 (mean age 39±3.4 years) with moderate contracture of the knee and limitation of knee flexion, which varied between 70° and 90° participated in the randomized controlled experimental research. In addition, modified Cincinnati questionnaire scale (MCSc) was used. The following 3-week rehabilitation programs were developed: : I - the control group was assigned an individual home exercise program (HEP) 5 times a week; the experimental group II was assigned a treatment program which included the same exercise in addition to phonophoresis with 10% hydrocortisone gel (mixed ultrasound gel), duration - 10 minutes, frequency - 1.0 MHz, duty cycle - 50% (Pulsed), 1.0 W/cm2 high intensity ultrasound (HEP+PWHi); the experimental group III was assigned an almost identical program to the group II with the difference being 100% (Constant) duty cycle of the ultrasound (HEP+CWHi). As for groups IV and V - these groups were assigned the same home exercise programs alongside 10 minutes of low intensity 0.5 W/cm2, 1.0MHz, 50% (HEP+PWLi) and 100% (HEP+CWLi) ultrasound accordingly with 10% hydrocortisone gel, 15 procedures total.The results of the study revealed that using phonophoresis with high concentration hydrocortisone acetate that's mixed with ultrasound gel alongside therapeutic exercise in the treatment and rehabilitation of moderate post-traumatic or post-operative extension contracture of the knee caused by arthrofibrosis can be successful, which could enable us to achieve 40-50% of progress regarding knee flexion and functioning in 3 weeks in case 1.0 Mhz, 1 W/cm2, 50% pulsed ultrasound is utilized during 10 minutes, 5 times per week.

ASSESSMENT OF RISKS OF DEVOLEPMENT OF ARTHROFIBROSIS AND PREVENTION OF KNEE EXTENSION DEFICIT SUBSEQUENT TO AN ANTERIOR CRUTIATE LIGAMENT RECONSTRUCTION.

The goal of our research was to study the impact of various risk-factors on the development of arthrofibrosis in patients with knee extension restriction on an early stage. The aforementioned research was carried out in the Sports Medicine and Rehabilitation Clinical Center and First University Clinic of Tbilisi State Medical University during the 2016-2020 y.y. and it is based upon the findings derived from the retrospective analysis of 38 male patient cases (mean age 25.42±5.85) with undergone ACL reconstruction and the assessment of importance of the impact of various risk-factors on developing a clinically confirmed knee arthrofibrosis. In order to identify the important role of pain as a risk factor in the development of knee arthrofibrosis, the patients were divided into 2 groups (A and B). Group A consisted of 17 patients with confirmed arthrofibrosis while group B consisted of 21 patients whose rehabilitation process resulted in complete eradication of knee join extension deficit. During the comparison of data on the average level of pain between the patients from groups A and B a reliable difference was identified (p=0.048). The presence of pain is in direct correlation with arthrofibrosis development process in the knee (R= -0.65), therefore, together with joint ROM (Range of motion) restriction, it can be considered as one of the most noteworthy preconditions among the risk-factors that were part of our research. To increase the efficiency of the rehabilitation process after a ACL reconstruction procedure when knee extension deficit alongside with pain is present, according to the Creaky Joints Pain - CJP scale ≥4, it is most appropriate to incorporate more aggressive interventions into the rehabilitation program and, at the same time, to utilize pain management methods actively during the early stage (after 2 weeks) in order to eradicate knee extension restriction and prevent arthrofibrosis.

IMPLICATION OF RELATIONSHIP BETWEEN OXIDATIVE STRESS AND ANTIOXIDANT STATUS IN BLOOD SERUM.

Aim of the study was to examine the relationship between oxidative stress and overtraining syndrome in athletes by evaluation in serum oxidative and antioxidant status. In 43 athletes with non-functional overreaching (NFO)/overtraining syndrome(OTS) and 40 athletes without NFO/OTS -control athletes (CA), diacron-reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP) in serum, as well as ratio of d-ROMs and BAP test measurements - marker of oxidative stress, were assessed. Baseline data collection performed in both groups of athletes - with NFO/OTS and CA, followed by data collection in athletes with NFO/OTS after 28 days of rest. In athletes suspicious for OTS all measurements were performed after 2 more months of rest. Results of the study showed higher baseline d-ROMs in NFO/OTS athletes than in athletes without NFO/OTS, whereas antioxidant potential in CA was significantly higher, than in NFO/OTS athletes, After 28 days of rest there was significant decrease in d-ROM values in both: athletes with NFO and with OTS, as well as normalization of antioxidant status in athletes with NFO. Total 3 month of rest showed improvement in the oxidative status of athletes with OTS, reaching normal values, though antioxidant status remained without significant improvement, showing subnormal BAP values and decreased BAP/d-ROM ratio. The results demonstrate increased oxidative stress in overtraining state, creating disbalance between d-ROM production and antioxidant capacity. Thus, prolonged imbalance between oxidant production and antioxidant protection via attenuation of antioxidant capacity can be a cause of overtraining in highly trained athletes. In this study most frequently NFO and OTS were seen in wrestling, which needs further investigation and regular medical monitoring.

THE EFFECTS OF NON-FUNCTIONAL OVERREACHING AND OVERTRAINING ON AUTONOMIC NERVOUS SYSTEM FUNCTION IN HIGHLY TRAINED ATHLETES.

Aim of the study was to compare the ANS functioning, as measured by heart rate variability (HRV), in athletes with non-functional overreaching (NFO) and overtraining syndrome (OTS) and in athletes without NFO/OTS. In 43 athletes with NFO/OTS, 40 athletes without NFO/OTS, as well as in 35 sedentary subjects the ANS function was evaluated with the Autonomic Balance Test, based on the HRV analysis of resting heart rate recordings. Results of the study show lower HRV and lower vagal influence along with increased sympathetic cardiovascular control in athletes with non-functional overreaching and particularly in athletes with overtraining, than in highly trained athletes without NFO/OTS. "Stress Response" in athletes with NFO, as well as in some athletes with OTS, showing sympathetic dominance, considered as a sign of physical or mental fatigue and chronic stress, whereas "Total Autonomic Dystonia" in most of the athletes with OTS (67%) reflects more advanced stage of maladaptation associated with depressed regulatory function of the ANS, both sympathetic, as well as vagal influences. Most frequently NFO and OTS were seen in wrestling, which needs further investigation and regular medical monitoring. Thus, results of the study show progression of autonomic imbalance and depression of regulatory function of the autonomic nervous system in athletes with OTS. The cardiac autonomic imbalance observed in overtrained athletes implies changes in HRV and therefore would consider that heart rate variability may provide useful information in detection of overtraining in athletes and can be a valuable adjacent tool for optimising athlete's training program as well as for timely diagnosis and prevention of progression of NFO/OTS.

[Effects of combined administration of ripronat and rotavit royal on the working capacity of the young football players].

The goal of the study was evaluation of the impact of the pharmaceutical preparations Ripronat and Rotavit Royal on the physical working capacity and psychomotor performance of the young football players during their basic preparatory period of physical conditioning. Blinded placebo controlled study was performed on 50 male football players (mean age 19,8 ± 3,2 years). The football players were divided into three groups: study group (n=30), placebo group (n=10) and control group (n=10). Study group in turn were divided in two subgroups: subgroup A (n=15, receiving ripronat and rotavit royal) and subgroup B (n=15, receiving only ripronat). In all groups following tests were performed before and after four weeks of the medical administration: 1.Watt max bicycle test. 2. Wingate cykletest. 3. Psychomotor performance including reaction time and relaxation abilities. Results of our study allow us to conclude that ripronat increase the aerobic capacity and psychomotor performance of football players, and it would be recommended for administration during early stages of training, when main emphasis is made on aerobic performance.

Left ventricular morphological changes due to vigorous physical activity in highly trained football players and wrestlers: relationship with aerobic capacity.

The heart undergoes profound changes in response to systematic athletic training. Several adaptations of cardiac shape and function occur with athletic training to improve the heart's function as a pump and thereby increase aerobic capacity. Maximal oxygen consumption or VO2 max is regularly used as an index of physical fitness but the issue of which of the left ventricular structural parameter correlates with VO2 max remained unresolved. The aim of the study was to examine the effects of the long-term intensive physical training on cardiac responses in highly trained athletes-football players and wrestlers- and reveal the structural parameter of the heart which better correlates with aerobic capacity. We studied a group of highly trained male athletes, 221 football players and 51 wrestlers, and 48 healthy male sedentary controls. The research has included M and 2D-echocardiography, resting ECG and stress-testing. The data indicate that highly trained male athletes had higher value of maximal oxygen uptake PWC(170) and PWC(170)/kg than untrained male controls; they exhibit greater left ventricular internal dimension, left ventricular wall thickness, relative wall thickness, left ventricular mass and mass index compared to the untrained controls. The amount of physiologic hypertrophy that occurs in the athletes is related to the intensity and duration of the exercise and is directly related to the fitness level or V02 max. It was concluded that VO2max is the variable that better correlates with the LVMI.

Electrocardiographic patterns and systolic and diastolic functions of the heart in the highly trained football players with increased left ventricular mass.

Over the past several years interest regarding the causes of sudden deaths in young trained athletes has heightened in the medical community. 36% of sudden cardiac death (SCD) in young competitive athletes is due to hypertrophic cadiomyopathy (HCM), while 10% of SCD cases in sports are due to increased cardiac mass without signs of HCM. The goal of this study was to evaluate systolic and diastolic functions, and to determine the clinical significance of electrocardiographic patterns in highly trained football players with increased left ventricular mass index (LVMI) > 125g/m(2). 221 highly trained male football players were studied, among them 46 with increased LVMI. M, 2D, Doppler echocardiography and resting and exercise electrocardiography were performed. Various cardiovascular abnormalities were found by echocardiography in 12 athletes (5,4%). Systolic and diastolic functions of the heart were within normal limits. Increased left ventricular mass in the football players was often associated with abnormal ECG patterns (47,8%). Abnormal ECGs were found in 85,7% of football players with concentric hypertrophy. The group of athletes with both increased LVMI and abnormal ECG patterns need further evaluation and observation. ECG and echocardiography should be included in the PPS protocol of the highly trained football players to prevent SCD in young athletes.

[Hygienic assessment of meat products normalized as to mineral contents]. / Gigienicheskaia otsenka miasnogo izdeliia, normalizovannogo po mineral'nomu sostavu.

The influence of the protein-mineral preparation, made of meat-and-bone remnants, on the nutrient and biological value of meat foodstuffs has been studied. It has been shown, that the use of such a preparation in sausages (1-3%) does not reduce their biological value, produces a positive influence on the chemical content of foodstuffs in terms of the mineral component (Ca/P ratio), making them physiologically more optimal. Positive influence of the protein-mineral preparation made of meat-and-bone remnants on mineral metabolism has been established.