scholarly journals The disorders of physical development of children residing in the conditions of low-level contamination of the atmospheric air and drinking water by metals (lead, manganese, nickel, chrome, cadmium) on the example of the Perm region

2019 ◽  
Vol 96 (1) ◽  
pp. 70-75
Author(s):  
Konstantin P. Luzhetskiy ◽  
O. Yu. Ustinova ◽  
A. Yu. Vandysheva ◽  
S. A. Vekovshinina
Keyword(s):  
Nervous System ◽  
Drinking Water ◽  
Negative Impact ◽  
Physical Development ◽  
Reference Level ◽  
Autonomous Nervous System ◽  
Blood Content ◽  
Complex Load ◽  
Atmospheric Air ◽  
Low Level

There was executed a clinical laboratory study of 183 children residing in the conditions of constant low-level impact of a complex of such consumed from atmospheric air and drinking water metals as lead, manganese, nickel, chrome, cadmium) and 46 children residing in the conditions of sanitary-hygienically wellbeing of the habitat. The evaluation of Total Hazard Indices (THI) for conditions of chemical substances entering with atmospheric air and drinking water have revealed the excess of accepted values (THI>1) regarding to disorders of the central nervous system in children (THI amounted for up to 4.93) and disorders ofendocrine system (up to THI of 1.13). The results of chemical-analytical researches showed the blood content of lead, manganese, nickel, chrome, cadmium in children living in conditions of low-dose complex load to exceed the reference level by 1.3-2.2 times. In persistent multi-medium polymetallic load the number of children having physical development disorders was found to increase up to 1.2-1.6 times (body weight deficiency - up to 16.5%). There is determined a verified direct probabilistic relationship of cause and effect ofphysical development disorders in children with high blood content of manganese, nickel, and chrome. Exceeding content of lead, manganese, nickel, and chrome (1.3-9.4 times higher than the reference level and the comparative group) in bio-media of children makes a negative impact on the central and autonomous nervous system, creates disorders in protein-synthetic processes in liver, form early shifts of hypothalamo-hypophyseal regulation with further deterioration of physical development indices.

scholarly journals ANALYSIS OF THE EFFECTIVENESS OF TECHNOLOGIES FOR CORRECTING DISORDERS OF THE PHYSICAL DEVELOPMENT IN CHILDREN LIVING IN LOW-LEVEL ATMOSPHERIC AIR POLLUTION AND DRINKING WATER WITH METALS (LEAD, MANGANESE, NICKEL, CHROMIUM, CADMIUM)

2018 ◽  
Vol 97 (1) ◽  
pp. 75-81
Author(s):  
Konstantin P. Luzhetsky ◽  
O. Yu. Ustinova ◽  
O. I. Goleva ◽  
I. E. Shtina
Keyword(s):  
Drinking Water ◽  
High Efficiency ◽  
Endocrine System ◽  
Well Being ◽  
Physical Development ◽  
Reference Level ◽  
Metal Compounds ◽  
Atmospheric Air ◽  
Low Level ◽  
The Impact

In the course of studying the impact of metal compounds on the functioning of the endocrine system and adaptation systems in children living in chronic low-level multi-environmental (atmospheric air, drinking water) effects of a complex of metals, the elevated content of lead, manganese, nickel, cadmium and chromium was established to be 1.5 - 9.4 times higher than the reference level and 1.3 - 2.2 times than indices of the comparison group). In this contingent, disorders of the physical development and malnutrition (ICD: E44-46) were detected by 1.2 - 1.7 times more often than in conditions of sanitary and hygienic well-being. In the course of the analysis of the effectiveness of methods of correction in children of physical development disorders and malnutrition (E44-46) associated with the effects of metals, there was shown the high efficiency of the complex application of elimination, membrane stabilizing, antioxidant and nootropic technologies, with methods of physiotherapy (Ultrasound therapy, inductothermy) and exercise therapy. With comparable economic costs with traditional approaches, the proposed correction technologies demonstrate a significant benefit (up to 3.3 times) for the economy of the country and the region. The prevented losses for Gross Domestic Product (GDP) for the observation group are 13246.0 rubles per person per year (2.25 rubles per 1 ruble of costs, in contrast to 0.7 rubles when using standard methods).

scholarly journals SCIENTIFIC AND METHODOLOGICAL ASPECTS AND PRACTICAL EXPERIENCE FOR THE FORMATION OF THE EVIDENTIAL BASE OF HAZARD TO HEALTH IN THE POPULATION IN THE ZONE OF INFLUENCE OF WASTE FROM THE PAST ECONOMIC ACTIVITY

2019 ◽  
Vol 96 (11) ◽  
pp. 1038-1044 ◽  
Author(s):  
N. V. Zaitseva ◽  
Irina V. May ◽  
S. V. Klein ◽  
S. S. Khankharev ◽  
A. A. Boloshinova
Keyword(s):  
Heavy Metals ◽  
Drinking Water ◽  
Negative Impact ◽  
Health Hazard ◽  
Harmful Effect ◽  
Morbidity Rate ◽  
Atmospheric Air ◽  
The Past ◽  
Zone Of Influence

There are described an algorithm and methods for collecting the evidential base for causing hazard to the health of the population of Zakamensk (the Republic of Buryatia) in the zone of influence of the waste of the past activities of the Dzhidinsky tungsten-molybdenum combine. The source of danger is lying sands, containing a complex of toxic heavy metals - lead, cadmium, manganese, nickel, chromium, etc. The algorithm for the formation of the evidential base included: a general analysis of the sanitary and hygienic situation; assessment in the dynamics of the quality of atmospheric air, drinking water, soil, food; assessment of the risk to the health of the population; epidemiological studies; in-depth clinical surveys of a representative group of city residents (280 people). In the blood of the examinees, heavy metals were identified as biological markers of the exposure. There was evaluated a complex of the response (effect) adequate to effects of laboratory markers. By methods of mathematical statistics there was established the presence of reliable relationships in the system “source of hazard - the quality of the environment - exposure to risk factors - health status.” The hazard to the health of a citizen, due to the negative impact of the factor, was considered to be proven if it was possible to build a continuous step-by-step logical chain of relationships between the source of the harmful effect, the quality of the habitat and the establishment of the fact of the disease. The quality of the habitat of the population of Zakamensk was shown to give rise in unacceptable risks to the health of residents. The main influencing factor is the pollution of atmospheric air, local food products and drinking water from public and private wells. Risks are realized in terms of a level of the primary morbidity rate of the population of the respiratory diseases, endocrine system, digestive organs that is relatively high compared to the matched area. The relationship between health hazard and environmental factors has been fully proved in 14% of the surveyed persons. At the same time, the territory was shown not be characterized as a zone of “ecological disaster” or “an emergency environmental situation”.

scholarly journals BIOLOGICAL MARKERS OF NON-CARCEROGENIC NEGATIVE IMPACTS ON THE CENTRAL NERVOUS SYSTEM OF CHILDREN IN THE AREA WITH EXPOSURE TO ALUMINUM PRODUCTION EMISSIONS

2018 ◽  
Vol 97 (5) ◽  
pp. 461-469
Author(s):  
I. G. Zhdanova-Zaplesvichko ◽  
Marina A. Zemlyanova ◽  
Yu. V. Koldibekova
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Aluminum Content ◽  
Negative Impact ◽  
Neuron Specific Enolase ◽  
Aluminum Production ◽  
Atmospheric Air ◽  
Hyperactivity Disorder ◽  
The Central Nervous System

Introduction. The priority indicator of the influence of chemical factors of the environment on the health of the population of Russia is the pollution of atmospheric air, the composition of which is largely determined by regional features of production. Material and methods. A comparative hygienic assessment of the quality of the atmospheric air of the territory with the placement of aluminum production and the territory without similar sources of emissions was conducted; a chemical-analytical and clinical laboratory examination of 135 children was carried out, with an assessment of the negative effects from the nervous system in the case of aerogenic exposure to aluminum and manganese. Results. In the conditions of the existing quality of atmospheric air in the residential area in the zone of influence of aluminum production which forms an aerogenic exposure of substances (aluminum and manganese), possessing of the unidirectional negative impact on the central nervous system, at the level of 0.0015g/(kg∙day) the share of aluminum is 93.3%, which indicates its primary impact on the population. Children of the observation group 1 showed urine aluminum content by 3.1 times more than in comparison to observation subgroup 2 and 6.9 times in relation to the comparison group (p = 0.0001). The concentration of aluminum as a marker of inhalation exposure is substantiated, and its value more than 0.053 mg/dm3 in urine may indicate an increased risk of neurotoxic exposure. An increased prevalence (1.6-5.5 times) of the negative impact on the CNS in the form of the asthenic autonomous syndrome, as a predictor of attention deficit and hyperactivity disorder, has been shown to be associated with the aerogenic exposure to aluminum. In children with an elevated aluminum content in urine comparing to the reference level, revealed laboratory abnormalities and indices were proved to be associated with an elevated concentration of aluminum in the urine relative to the children of the comparison group: an increase in the level of neuron-specific enolase in the serum indicating an increase in the activity of damage to the blood-brain barrier; an increase in the glutamic acid content by 1.3 times, characterizing the imbalance of the neurotransmitters of the central nervous system; reduction in serum phosphorus, reflecting the antagonistic effect of aluminum, followed by an increase in the level of ionized calcium in the blood. The contribution of aluminum to the biochemical and functional indices deviation from the physiological norm accounted for from 10% to 58%. On the basis of a consistent chain of reliable dependencies, a complex of biomarkers of the asthenic autonomous syndrome and attention deficit and hyperactivity disorder associated with an elevated aluminum content in urine, including glutamic acid, neuron-specific enolase, and phosphorus is substantiated.

EVALUATION OF CHILDREN PREVENTION TECHNOLOGY PHYSICAL DEVELOPMENT DISORDERS AND MALNUTRITION (E44-46) ASSOCIATED WITH EXPOSURE METALS (LEAD, MANGANESE, NICKEL, CADMIUM, CHROMIUM)

2017 ◽  
pp. 38-42
Author(s):  
I.E. Shtina ◽  
K.P. Luzhetsky ◽  
O.Yu. Ustinova
Keyword(s):  
Drinking Water ◽  
Physical Therapy ◽  
Clinical Efficacy ◽  
Physical Development ◽  
Low Level ◽  
Combined Use ◽  
Neuroprotective Action ◽  
Nickel Cadmium

Violations of physical development and undernutrition in children (ICD: E44-46), living in conditions of chronic the multimedia (air, drinking water), low-level exposure to a complex of metals (lead, manganese, nickel, cadmium, chromium). The analysis of the effectiveness of prevention technologies in children disorders of physical development and undernutrition (E44-46), associated with exposure to lead, manganese, nickel, cadmium and chromium. Prove the high clinical efficacy of combined use of drugs with an elimination, membrane stabilizing, antioxidant and neuroprotective action, with physical therapy methods (TNCH inductothermy) and physical therapy.

scholarly journals Cytokine profile in children exposed to chloroform and vanadium

2021 ◽  
Vol 100 (5) ◽  
pp. 489-494
Author(s):  
Oleg V. Dolgikh ◽  
Dina G. Dianova
Keyword(s):  
Drinking Water ◽  
Well Being ◽  
Reference Interval ◽  
Vanadium Content ◽  
Cytokine Profile ◽  
Oral Exposure ◽  
Blood Contamination ◽  
Atmospheric Air ◽  
Low Level ◽  
Study Results

Introduction. Pollution of drinking water and atmospheric air by anthropogenic haptens forms an imbalance of adaptive capacities of the immune system in children. The purpose of the work is to identify the features of the cytokine profile in children exposed to vanadium and chlorine-containing compounds (for example, chloroform). Materials and methods. We examined 283 children who live in conditions of chronic low-level peroral exposure to drinking water hyperchlorinated products. The control was a contingent of 224 children consuming drinking water of chloroform of adequate quality. We also examined 215 children living in conditions of chronic aerogenic low-level exposure to vanadium, the control being a contingent of 131 children living in the territory of conditional sanitary and hygienic well-being without any stationary sources of vanadium contamination of the atmospheric air. Chemical-analytical and immunoenzymometric methods were used in the study. Results. In children living under chronic oral exposure to drinking water hyperchlorination products, chloroform was identified in the blood, which normally should not be detected. In children living in an area with elevated levels of aerogenic vanadium load, the vanadium content in the blood was found to be statistically significant (p < 0.001) 4.4 times higher than the upper limit of the reference interval. We have established that under conditions of blood contamination with chloroform Th2-shift of cytokine profile occurs - concentration cytokines IL4, IL6 increases statistically significantly, frequency of excess was 2.2 and 4.3 times in comparison with the values obtained in unexposed children ( p ≤ 0,001-0,031); under conditions of contamination of biological media with vanadium, a decrease in Th1 cytokine production was observed - the expression of the proinflammatory cytokine TNFα was statistically significantly depressed, the multiple of the decrease was 2.2 times as compared to the results obtained in children not exposed to vanadium ( p = 0.032). Conclusions. The presented results show the contamination of chloroform and vanadium to cause a multidirectional nature of changes in the cytokine profile of serum in exposed children with technogenic gaptenes, forming in the future various mechanisms of deterioration of immune response: activation of humoral (Th2-dependent), associated with chloroform contamination or cell suppression (Th1-dependent), associated with excess contamination of vanadium.

scholarly journals Substantiation of the biomarker profile of negative indicators in children under conditions of the combined influence of environmental and educational factors

2020 ◽  
Vol 99 (11) ◽  
pp. 1236-1245
Author(s):  
Yuliya V. Koldibekova ◽  
Marina A. Zemlyanova ◽  
Nina V. Zaitseva ◽  
Mikhail J. Tsinker ◽  
Viktor M. Ukhabov
Keyword(s):  
Nervous System ◽  
Negative Impact ◽  
Inhalation Exposure ◽  
Educational Process ◽  
Combined Effect ◽  
Atmospheric Air ◽  
Digestive Organs ◽  
Comorbid Diseases ◽  
Educational Factors

Introduction. The low quality of environmental and educational factors negatively impact on children’s health in primary school. Data and methods. The objects of the study were indices of the content of chemicals in the atmospheric air and classrooms, drinking water; indices of the intensity of the educational process, biochemical indices of negative effects in children aged of 7-10 years, exposed to the combined effects of factors of the educational environment and hygienic conditions at the initial stage of education with various types of training programs. Results. An unsatisfactory quality of atmospheric air in the territories of educational institutions and classrooms was found for the content of phenol and formaldehyde, the constant presence of nickel and chromium. Phenol in the blood was substantiated as a marker of inhalation exposure and index marker of educational load factors - the use of technical teaching means in the educational process, intellectual and emotional loads, the monotony of loads. The connection with the combined effect of dissimilar factors has been established for classes of comorbid diseases of the nervous system and digestive organs. Two indices have been substantiated as biomarkers of the comorbidity in schoolchildren under the combined effect of dissimilar factors: acetylcholinesterase and pepsinogen I in blood serum. Discussion. The work established sequential continuous logical chain of links ‘the combined effect of environment, the educational factors - a change in indices of negative impact’. So far, the shown likelihood of comorbid diseases of the nervous system and digestive organs makes it possible to predict an increase in the overall incidence of diseases in junior schoolchildren under aerogenic exposure and educational load (the level of additional cases is about 300 per year). Conclusion. The chemical environmental and educational factors and biomarkers of comorbidity should be taken into account when developing measures aimed at minimizing the risks of the gain in the comorbidity involving the nervous system and digestive organs under the combined impact of dissimilar factors.

scholarly journals PECULIARITIES OF THE REGULATION OF THE IMMUNE SYSTEM IN CHILDREN RESIDING IN CONDITIONS OF STRONTIUM GEOCHEMICAL PROVINCE

2018 ◽  
Vol 97 (1) ◽  
pp. 25-29
Author(s):  
D. G. Dianova ◽  
Oleg V. Dolgikh ◽  
A. V. Krivtsov ◽  
O. O. Sinitsyna ◽  
E. A. Otavina
Keyword(s):  
Drinking Water ◽  
Immune System ◽  
Annexin V ◽  
Well Being ◽  
Reference Level ◽  
Control Group ◽  
Strontium Content ◽  
Blood Content ◽  
Stable Strontium ◽  
Geochemical Province

There was made a study of the features of apoptosis in children drinking potable water with an increased content of stable strontium of natural origin. The percentage of non-standard samples of strontium content in the water on the observation territory was 16.7%, which corresponded to the exceedance of the maximum permissible concentration of strontium in drinking water at the level of 1.2 MPC (up to 8.4 mg/l). In children living in the strontium geochemical province, the blood content of strontium (0.1 mg/dm3) was established statistically significant higher (p = 0.02) in comparison with the results obtained from children living in the territory of relative sanitary and hygienic well-being (0.028 mg/dm3). There was made an estimation of parameters of the dependence between the concentration of strontium in drinking water and the concentration of strontium in the blood was estimated, there was obtained a reliable dependence (b0 = 0.04, b1 = 0.012, R2 = 0.44, F = 310, p = 0.00001) of the increase in the blood content of strontium by the 1.3 times relative to the reference level from the concentration of strontium in water. In the exposure range of 7.84 ± 0.62 mg/L per 1 mg/L increase in strontium in water, its concentration in the blood was established to increase by 0.012 mg/dm3. In children living in the strontium geochemical province (1.5-0.8 times) by the method of flow cytometry, there were established to statistically significant decline the (relative and absolute values) number of CD95+ lymphocytes (p = 0.04-0.001) by 3.8 times, the expression of p53, bcl-2, Bax and the amount of Annexin V-FITC+PI- cells dying via the path of apoptosis, as well as the content of Annexin V-FITC+PI+ cells, dying via necrosis was statistically significantly (p = 0.001) elevated, in comparison with the control group. The obtained results prove the prolonged excessive effect on the children’s organism of stable strontium supplied with drinking water to lead to changes in the functioning of the immune system, characterized by a violation of the regulation of cell death - inhibition of apoptosis and activation of necrosis. The ranges of values of strontium in the blood corresponding to the ranges at the level of 0.1 [0.04-0.11] mg/dm3 are given in the ranges of apoptotic regulation (relative content,%): CD95+ - 17.50 [15.48; 22.03], p53 - 0.53 [0.22; 0.98], bcl-2 0.24 [0.21; 0.36], bax = 5.66 [4.67; 7.84], AnnexinV-FITC+PI- cells: 0.67 [0.56; 0.88], AnnexinV-FITC+ PI+ cells: 10.58 [9.54; 16.11]. The indices of apoptotic regulation of CD95+, p53, bcl-2, Annexin V-FITC+ PI- are recommended to be used as indices of early disorders of the immune status, and also for the monitoring the effectiveness of preventive measures in the territories of strontium geochemical provinces.

ENVIRONMENTAL IMPACT OF COAL MINING

2020 ◽  
Author(s):  
Наталья Алексеевна Бойко ◽  
Наталья Владимировна Ромашева
Keyword(s):  
Environmental Impact ◽  
Organizational Structure ◽  
Coal Mining ◽  
Negative Impact ◽  
Coal Industry ◽  
Coal Production ◽  
Atmospheric Air

Представлена характеристика угольной отрасли России по таким направлениям как организационная структура, объем и регионы добычи, потребители угля. Выявлены положительные тенденции, определены проблемы в развитии угольной промышленности. Исследованы негативное воздействие угольного производство на такие компоненты окружающей среды, как атмосферный воздух, водные ресурсы, земная поверхность. The characteristic of the Russian coal industry in such areas as the organizational structure, volume and regions of production, coal consumers has been presented. Positive trends and problems in the development of the coal industry have been identified. The negative impact of coal production on environmental components such as atmospheric air, water, the earth’s surface has been investigated.

Adrenergic and Cholinergic Uterine Innervation and the Impact on Reproduction in Aged Women

2020 ◽  
Vol 26 (3) ◽  
pp. 358-362 ◽  
Author(s):  
Ioannis P. Kosmas ◽  
Antonio Malvasi ◽  
Daniele Vergara ◽  
Ospan A. Mynbaev ◽  
Radmila Sparic ◽  
...  
Keyword(s):  
Negative Impact ◽  
Smooth Muscles ◽  
Nerve Fibers ◽  
The Body ◽  
Autonomous Nervous System ◽  
Childbearing Age ◽  
Assisted Reproductive Technique ◽  
Aged Patients ◽  
Post Menopause ◽  
The Impact

: In recent years, the development of Assisted Reproductive Technique, the egg and embryo donation changed substantially the role of the uterus in recent years. It provided a higher chance for a pregnancy even in women over 45 years or post-menopause. In fact, the number of aged patients and in peri/post-menopause in pregnancy is nowadays increasing, but it increases obstetrical and neonatal related problems. The human uterus is richly innervated and modified especially during pregnancy and labor, and it is endowed with different sensory, parasympathetic, sympathetic and peptidergic neurofibers. They are differently distributed in uterine fundus, body and cervix, and they are mainly observed in the stroma and around arterial vessel walls in the myometrial and endometrial layers. Many neurotransmitters playing important roles in reproductive physiology are released after stimulation by adrenergic or cholinergic nerve fibers (the so called sympathetic/parasympathetic co-transmission). Immunohistochemical study demonstrated the localization and quantitative distribution of neurofibers in the fundus, the body and cervix of young women of childbearing age. : Adrenergic and cholinergic effects of the autonomous nervous system are the most implicated in the uterine functionality. In such aged women, the Adrenergic and AChE neurofibers distribution in the fundus, body and cervix is progressively reduced by increasing age. Adrenergic and AChE neurotransmitters were closely associated with the uterine arteries and myometrial smooth muscles, and they reduced markedly by ageing. The Adrenergic and AChE neurofibers decreasing has a dramatical and negative impact on uterine physiology, as the reduction of pregnancy chance and uterine growth, and the increase of abortion risk and prematurity.

ASSESSMENT OF PHYSIOLOGICAL PARAMETERS OF THE TRIGEMINAL AND COCHLEOVESTIBULAR SYSTEMS IN TEMPOROMANDIBULAR JOINT PAIN DYSFUNCTION

2020 ◽  
Vol 17 (2) ◽  
pp. 110-120
Author(s):  
N.D. Sorokina ◽  
◽  
L.R. Shahalieva ◽  
S.S. Pertsov ◽  
L.V. Polma ◽  
...  
Keyword(s):  
Nervous System ◽  
Evoked Potentials ◽  
Temporomandibular Joint ◽  
Differential Diagnostics ◽  
Autonomous Nervous System ◽  
Dental Diseases ◽  
Grade Ii ◽  
The Right ◽  
Distal Occlusion ◽  
The Brain

One of the most common causes of chronic pain in the facial region, including in the trigeminal nerve link, which is not associated with dental diseases, is pain dysfunction of the temporomandibular joint. At the same time, there is evidence in the literature that there are relationships between pain dysfunction of the temporomandibular joint, abnormal occlusion, cervical-muscular tonic phenomena, postural disorders, dysfunction of the Autonomous nervous system and cochleovestibular manifestations. At the same time, neurophysiological indicators of functional disorders in the maxillofacial region and intersystem interactions in pain dysfunction of the temporomandibular joint are insufficiently studied.Goal. The aim of the work is to evaluate the neurophysiological features of trigeminal afferentation in terms of trigeminal somatosensory evoked potentials (TSWP) and the auditory conducting system of the brain in terms of acoustic stem evoked potentials (ASVP) in distal occlusion of the dentition with pain dysfunction of the temporomandibular joint (TMJ) in comparison with physiological occlusion in students 18-21 years old. Material and methods. The main study included 41 students with distal occlusion (21 girls and 20 boys), (grade II Engl, symmetrically right and left in 14 people, and grade II Engl on the left and grade I on the right in 12 people, grade I on the left and grade II on the right in 15 people). All respondents with distal occlusion and who were practically healthy signed an informed consent to participate in the study. We used complex orthodontic methods of examination, subjective degree of severity and intensity of pain in the TMJ, assessment of the Autonomous nervous system (samples and tests), and neurophysiological methods for assessing TSVP and ASVP. Results. Significant differences in ASEP parameters were found in the group of respondents with distal occlusion in the form of a decrease in the latency period of peak I, III, and V compared to physiological occlusion, that correlated with the subjective assessment (in points) of cochleovestibular disorders. According to the TSVP study, a decrease in the duration of latent periods was found, which indicates an increased excitability of non-specific brain stem structures at the medullo-ponto-mesencephalic level compared to the control group. Conclusions. The results obtained are supposed to be used for differential diagnostics, including such dental diseases as TMJ pain dysfunction, occlusion abnormalities accompanied by pain syndrome. Additional functional diagnostics of multi-modal VP of the brain (acoustic evoked potentials, trigeminal evoked potentials) can be performed in conjunction with indicators of autonomic nervous system dysfunction, with parameters of severity of clinical symptoms of cochleovestibular disorders, musculoskeletal dysfunction the maxillofacial area, with indicators of pain, which will determine the tactics and effectiveness of subsequent treatment.

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