[Predicting the results of rehabilitation treatment of patients with acute myocardial infarction who underwent coronary artery stenting: focus on the rehabilitation potential]. / Prognozirovanie rezul'tatov vosstanovitel'nogo lecheniya bol'nykh s ostrym infarktom miokarda, perenesshikh stentirovanie koronarnykh arterii: fokus na reabilitatsionnyi potentsial.

The search for ways to assess the rehabilitation potential (RP) in patients with acute myocardial infarction (AMI) who have undergone stenting remains relevant, which will allow personalizing approaches to prescribing treatment complexes necessary for a particular patient, increasing their effectiveness and reducing the likelihood of complications. OBJECTIVE: To develop a method for assessing RP in patients in the acute period of myocardial infarction and to evaluate its role in predicting the effectiveness of therapeutic measures in the early recovery period. MATERIAL AND METHODS: The study consisted of two parts. In the first part, a method for assessing the RP of patients with AMI was created using mathematical modeling methods. For this purpose, the analysis of discharge epicrisis of 137 patients (training sample) with AMI aged from 34 to 85 years (average age 59.4±2.1 years) was carried out. In the second part of the study, the results of rehabilitation measures were analyzed in these patients who, after the intensive care unit and intensive care unit, were transferred to the cardiology department of Angara Clinical Resort JSC. At the end of the II stage of rehabilitation, a multidisciplinary team evaluated the effectiveness of treatment of patients using integral indicators characterizing the clinical condition of a patient who has undergone acute coronary syndrome and stenting. RESULTS: In the first part of the study, devoted to the development of a mathematical model for assessing the RP of patients with AMI, an algorithm of methodology was created: a formalized patient map was formed, the evidence base was represented by 109 indicators; certain indicators were assigned the values of coefficients of linear classification functions, depending on which the patient fell into one of three groups: group 1 - high RP; group 2 - medium RP; group 3 - low RP. The second part of the study was devoted to determining the value of RP for predicting the effectiveness of therapeutic measures in the early recovery period (stage II of medical rehabilitation). When testing patients at the end of treatment at the resort, it was found that the greatest effect was observed in group 1 patients with high RP. A lesser effect was observed in patients of group 2 and, especially, group 3. CONCLUSION: The use of a method for assessing RP based on mathematical modeling in AMI patients who have undergone stenting allows predicting the results of medical rehabilitation of patients at stage II in the conditions of the resort.

[Rehabilitation potential of patients with ischemic stroke: the possibility of predicting the course of the disease and the results of rehabilitation treatment]. / Reabilitatsionnyi potentsial bol'nykh s ishemicheskim insul'tom: vozmozhnosti prognozirovaniya techeniya zabolevaniya i rezul'tatov vosstanovitel'nogo lecheniya.

The search for ways to assess the rehabilitation potential (RP) in patients with ischemic stroke (IS) remains relevant, which will allow personalizing approaches to prescribing the treatment complexes necessary for a particular patient, increasing their effectiveness and reducing the likelihood of complications. OBJECTIVE: To develop a method for assessing RP in patients in the acute period of IS and to evaluate its role in predicting the effectiveness of therapeutic measures in the early recovery period. MATERIAL AND METHODS: The study consisted of two parts. In the first part, using mathematical modeling methods, a method was created for assessing the RP of patients with acute IS. For this, we analyzed the discharge records of 102 patients (training sample) with IS aged 42 to 80 years (mean age 64.0±2.6 years). In the second part of the study, the results of rehabilitation measures were analyzed in these patients, who were transferred from the primary vascular department to the neurological department of Angara Clinical Resort. At the end of stage II of rehabilitation, a multidisciplinary team assessed the effectiveness of treatment of patients using integral indicators characterizing the clinical condition of a patient who had a stroke. RESULTS: In the first part of the study, devoted to the development of a mathematical model for assessing the RP of patients with IS, a methodology algorithm was created: a formalized patient card was created, the evidence base is represented by 85 indicators; certain indicators were assigned the values of the coefficients of linear classification functions, depending on which the patient fell into one of 4 groups: group 1 - satisfactory RP with limitations in rehabilitation measures; group 2 - satisfactory RP; group 3 - low RP; 4th group - high RP. The second part of the study was devoted to determining the value of RP for predicting the effectiveness of therapeutic measures in the early recovery period (stage II of medical rehabilitation). When testing patients at the end of treatment at the resort, it was found that the greatest effect was observed in patients of the 4th group with a high RP. A lesser effect was noted in patients of the 2nd group. The worst results were registered in the 1st and especially in the 3rd groups. CONCLUSION: The use of the method for assessing the RP of patients who have undergone IS, based on mathematical modeling, makes it possible to predict the results of medical rehabilitation of patients with IS at the II stage of rehabilitation in a resort.

[Physiotherapeutic service of the Irkutsk region: present status, problems, and prospect]. / Fizioterapevticheskaya sluzhba Irkutskoi oblasti: sovremennoe sostoyanie, problemy i perspektivy.

INTRODUCTION: Improving the organizational forms of physiotherapy services in the context of the formation of the novel specialty of physical and rehabilitation medicine poses urgent tasks for practical public health. At the same time, ensuring the proper quality of medical care, the high level of safety, customer satisfaction from the new service presents a multifaceted and complex problem that cannot be solved without analyzing the current situation in the units of the physiotherapy network. OBJECTIVE: To study the parameters of the activity of physiotherapy units of treatment-and-prophylactic facilities in the Irkutsk Region to assess the dynamics of their development and further prospects. MATERIAL AND METHODS: The authors analyzed the data of state statistical annual reporting on the work of physiotherapy departments (PTDs) and physiotherapy rooms (PTRs), which had been submitted to the Medical Information Analysis Center, Ministry of Health of the Irkutsk Region, and information on physiotherapeutic medical care in the treatment-and-prophylactic facilities of the Irkutsk Region in the period 2010 to 2017. RESULTS: The quantitative indicators of the activities of PTD and PTR employees were investigated; the qualitative components of their activities were assessed; the problems of physiotherapeutic management were revealed and the ways of their solution were defined. Since 2014, there have been negative changes in the development of physiotherapy: the material and technical base is worsening; the number of doctors and nurses is being reduced; the specialists' qualification is decreasing, and the coverage of patients with physiotherapies is reducing. CONCLUSION: Physiotherapy is currently undergoing a period of stagnation. Along with the existing systemic economic problems of modern public health, the deepening of this negative situation in physiotherapy is promoted by the protracted period of the formation of the new specialty of physical and rehabilitation medicine physician, the absence of its legal base, federal state educational standards, which creates a number of misunderstandings of its promises and demand for physiotherapists in near future.

[State of vegetative regulation in workers exposed to vibration at work during industrial implementation of hi-tech pneumoinstruments].

The study was conducted on aircraft-building enterprise during production microcycle (before working shift start, during last working hour and in an hour after the shift end)--spectral analysis covered variability of heart rhythm in 70 male assembler riveters aged 25-59, divided into 2 groups in accordance with industrial equipment used. The group 1 used standard vibroinstrument, the group 2--pneumoinstruments with low vibration velocity parameters. Triple study during the working shift revealed in group 2 an adequate reaction of vegetative nervous system to vibration, in group 1 a negative trend was seen with centralization of regulatory processes and absence of adequate recovery in an hour after work.

[Complex use of naphthalane and nonselective chromotherapy in gonarthrosis treatment in rolling stock workers].

Complex treatment using naphthalane applications with nonselective chromotherapy covered 64 engine operators of locomotive crews, aged 40-69 years, having 1-3 stage knee osteoarthrosis. Findings are that optimized treatment schedules effectively reduce intensity of pain, improve functional state of the joints involved, increase life quality of the patients, have no side effects. Comparative analysis of the treatment results showed that efficiency of combined naphthalane and nonselective chromotherapy exceeds isolated naphthalane effects.

[Prenosologic criteria of health disorders and cardiovascular risk factors in workers engaged into nuclear industry].

Prophylactic study among workers engaged into main production of Siberian chemical enterprise (Seversk city) revealed high frequency of cardiovascular risk factors (overweight, hypodynamia, dyslipidemia, arterial hypertension), low level of adaptational potential and integral somatic health parameter as prenosologic criteria of cardiovascular diseases. The results necessitate recommendations to supplement periodic medical examinations with studies aimed to reveal early criteria of health disorders, and determine priority directions to specify prophylactic measures in nuclear industry workers.

Prospective cohort comparison of bioactive glass implants and conchal cartilage in reconstruction of the posterior canal wall during tympanomastoidectomy.

OBJECTIVE: To compare the effectiveness of bioactive glass implants and conchal cartilage in reconstructing the posterior canal wall during tympanomastoidectomy. STUDY DESIGN: Prospective cohort clinical study. SETTING: Teaching hospital. PATIENTS: Patients with clinically diagnosed chronic suppurative otitis media and cholesteatoma awaiting tympanomastoidectomy were recruited. INTERVENTION: All patients underwent tympanomastoidectomy by the same surgeon. A first cohort of 12 patients underwent posterior canal wall reconstruction with autogenous conchal cartilage. A second cohort of 12 patients underwent such reconstruction with prefabricated bioactive glass. MAIN OUTCOME MEASURES: Primary- All patients underwent out-patient review at 1, 3, 6 and 12 months postoperatively, after which a second-look procedure was performed. Reconstructions were inspected for evidence of epithelialization, granulation, infection, stenosis, depression and extrusion. Secondary- All patients had perioperative serial pure-tone audiometry to check for any change in hearing levels upto 1 year postoperatively. RESULTS: By 1 year postoperatively, both reconstructive graft materials showed good epithelialization, no granulation, no infection, no ear canal stenosis, no depression and no extrusion. At operative second-looks, bioactive glass particularly showed good tissue bonding, including both neovascularization and connective tissue integration. Overall clinical outcome was equivalent for both materials. Both graft materials showed no statistically significant difference in postoperative hearing levels. CONCLUSIONS: Bioactive glass and conchal cartilage showed equivalent clinical outcome in reconstructing the posterior canal wall without significantly affecting hearing levels. As bioactive glass does not require second site morbidity and thus also reduces operative time, we prefer it for reconstructing the posterior canal wall following tympanomastoidectomy.

[Method for the determination of the biological age and aging rate in man].

Multiple linear regression was used to develop a mathematical model of biological age in healthy subjects. Aging rate was found to slow down in elderly persons compared with young and middle-aged ones. In men below 60 years, it was lower than in women. The aging rate increased in patients with coronary heart disease and hypertensive disease.

Extremely heat tolerant photo-symbiosis in a shallow marine benthic foraminifera.

Bleaching, the loss of algal symbionts, occurs in marine photosymbiotic organisms at water temperatures minimally exceeding average summer SST (sea surface temperatures). Pre-adaptation allows organisms to persist under warmer conditions, providing the tolerance can be carried to new habitats. Here we provide evidence for the existence of such adaptation in the benthic foraminifera Pararotalia calcariformata. This species occurs at a thermally polluted site in the Mediterranean, where water temperatures reach a maxima daily average of 36 °C during the summer. To test whether this occurrence represents a widespread adaptation, we conducted manipulative experiments exposing this species from an unpolluted site to elevated temperatures (20-42 °C). It was kept in co-culture with the more thermally sensitive foraminifera Amphistegina lobifera in two experiments (20-36 °C). Reduced photosynthetic activity in A. lobifera occurred at 32 °C whereas photochemical stress in P. calcariformata was first observed during exposure to 36 °C. Pararotalia calcariformata survived all treatment conditions and grew under 36 °C. The photosymbiosis in P. calcariformata is unusually thermally tolerant. These observations imply that marine eukaryote-eukaryote photosymbiosis can respond to elevated temperatures by drawing on a pool of naturally occurring pre-adaptations. It also provides a perspective on the massive occurrence of symbiont-bearing foraminifera in the early Cenozoic hothouse climate.

[Surgical treatment of cancer of the stomach in patients over 70 years].

Surgical treatment was performed in 322 patients over 70 years with cancer of the stomach. Radical operation was made in 220 (68.3%) patients: subtotal distal resection -- in 137, subtotal proximal resection -- in 18, gastrectomy -- in 55, extirpation of the gastric stump -- in 10. Symptomatic and test surgeries were performed in 102 (31.7%) patients. Postoperative complications were seen in 16,1+/-2,1% cases, lethality was 6.8+/-1.4%. Complications after radical resections were seen in 16.4+/-2.5% patients, lethality was 5.0+/-1.5%. The rate of purulent complications was maximal (8.4%). Cardiovascular complications and coagulopathies (4.7%) were the main causes of lethal outcome (in 11 of 15 patients). Score scale of assessment of postoperative risk was developed. Five-years survival in stage I cancer of the stomach was 62.8%, stage II -- 42.6%, III -- 16.7%. Immediate and long-term results demonstrate necessity of radical surgical treatment of patients with cancer of the stomach over 70 years depending on the disease stage and risk factors.

Hearing investigation in relation to the duration of acoustic signals.

The present study was designed to test the peculiarities of hearing perception on dependence of acoustic signal duration both in normal hearing subjects and in those with conductive and sensorineural deafness. It was found that in patients with pure conductive hearing impairment the shortest time necessary for tonal sensation of the sound signal corresponded to normal values. However, in 35 out of 63 patients investigated with cochlear deafness, it was found that the signal had to be of longer duration before pitch could be distinguished from a click.

An evaluation of BERA for hearing screening in high-risk neonates.

Brain stem electric response audiometry (BERA) is evaluated for early detection of hearing loss in high-risk newborns selected from a general hospital population. They receive screening BERA in the nursery and detailed frequency-specific BERA in the Audiology clinic, just before discharge. Three months later, testing is repeated and recommendations are made. From 1364 assessments, 321 at-risk babies were identified; 234 received predischarge tests, and 200 had follow-up tests. Screening BERA with 40 dB nHL clicks is appropriate in the nursery. Screening sensitivity is good, and only 8% of babies failed. Several of these had mild hearing loss, resolving in the first trimester. Follow-up BERA confirmed hearing loss in 8 babies. Parental compliance is high, and the program is well-accepted. In conjunction with the high-risk register, BERA is useful both for screening and for quantitative audiometry in the infant.

Electrocochleography and brain-stem potentials in Ramsay Hunt syndrome.

Audiometric investigations and electrophysiologic recordings of cochlear and brain-stem auditory evoked potentials (BAEPs) were performed in 13 patients to elucidate further the type of hearing disorders in Ramsay Hunt syndrome. Transtympanic electrocochleography showed no enhancement of summating potential and did not suggest secondary endolymphatic hydrops. The recording of BAEPs was clearly abnormal in several of the 13 patients. The striking feature of the abnormalities in these patients was the prolongation of the latencies of waves III and V with the preservation of wave I, which clearly suggests retrocochlear involvement. In all the patients tested, abnormalities of the BAEPs were present only on the affected side. It is possible, on the basis of BAEP findings, to suggest that in Ramsay Hunt syndrome both cochlear and retrocochlear involvement may occur.

Occult sphenoid sinusitis presenting clinically as parotid swelling: a case report.

A case of occult sphenoid sinusitis was diagnosed by an MRI scan in a patient who presented clinically with meningism and unilateral parotid swelling. Although the patient improved with a prolonged course of antibiotics complete resolution occurred only after surgical drainage of the affected sinus.

First branchial cleft sinus presenting with cholesteatoma.

Disorders of the first branchial cleft are rare and often present difficulties in diagnosis. A case is reported that presented with the clinical and histological features of cholesteatoma. The embryology, diagnosis and treatment of branchial arch defects are also reviewed. The case highlights the fact that a high index of suspicion should be aroused for patients with a discharging ear in the presence of an intact tympanic membrane.

An unusual cause of cochlear implant failure.

We present a cochlear implant failure previously unidentified and unreported. Following successful implantation and activation of a Cochlear Mini 22 system, a distressing barrage of crackling noises was heard by the patient despite repeated programming with threshold and comfort level adjustment. The implant soon became nonfunctional and integrity testing showed deficient electrical responses and abnormal surface measured wave forms. Investigation of the explant, following reimplantation with an identical system, showed a defective trim capacitor, an electric component of the internal circuit in the stimulator. Paired Student's t-test showed a marginally significant increase (p = 0.047) in effective threshold level and a highly significant decrease (p = 0.0002) in maximum comfort level for the second implant compared to the first implant.

Solitary plasmacytoma of the skull base presenting with unilateral sensorineural hearing loss.

Solitary plasmacytoma of the skull base is a rare entity with only a few reported cases in the literature. We review the literature and present our experience with this lesion that produced ipsilateral sensorineural hearing loss, vertigo and ipsilateral sixth nerve palsy.

Naproxen in otitis media with effusion.

The levels of prostaglandin E2 (PGE2) were measured in aspirates of the effusion fluid from children suffering from secretory otitis media. The effects of naproxen 5 mg./kg. twice daily for eight weeks on the condition were studied in a placebo-controlled double-blind trial. Nineteen middle-ear aspirates from 13 children, six of whom had bilateral aspirations were examined. Detectable levels of PGE2 (greater than 1.0 ng. per ml.) were present in seven aspirates from seven children and ranged from PGE2 1.0 to 14.4 ng. per ml. In four of the six patients who had bilateral aspirations, PGE2 was detectable in the aspirate from one ear but not the other. However, the severity of otalgia and hearing loss was almost identical in the ears with detectable levels of PGE2 and those without. In a separate trial of naproxen, 11 patients received active drug and 13 received placebo. Naproxen had no significant effect on otalgia or hearing loss compared to placebo. These findings suggest that it is unlikely that non-steroidal anti-inflammatory drugs will be of therapeutic benefit in secretory otitis media.

The clinical application of computed tomography in the assessment of laryngo-pharyngeal carcinoma. (Preliminary report).

Computed axial tomography of the larynx offers a unique view of laryngeal structures which cannot be obtained by any other technique. Its applications are discussed and cases presented to demonstrate its usefulness.

A case of malignant otitis externa following mastoidectomy.

We present a case of a 63-year-old diabetic male who developed malignant otitis externa following mastoidectomy. Extensive skull base osteomyelitis caused thrombosis of the jugular bulb and subsequent paralysis of cranial nerves VII, IX, X and XII. He was treated aggressively with intravenous antibiotics and debridement of granulation tissue in the mastoid bowl with full recovery of the cranial nerve palsies associated with recanalization of the jugular bulb. We believe this is the first reported case of malignant otitis externa to occur following mastoidectomy with complete recovery of the cranial nerve paresis.