Age-related readjustments of caucasian men’s functional reserves in the North

Цель работы - определение доли лиц, характеризующихся отклонениями физиологических параметров от нормативных диапазонов, и формирование паттернов функциональных резервов у подростков, юношей, мужчин среднего возраста и лиц пожилого возраста. Впервые проведена оценка динамики функциональных резервов на основе отклонений от нормативных референсов некоторых показателей физического развития, сердечно-сосудистой системы, биохимического и микроэлементного профиля, а также характеристик основного обмена и дыхания в онтогенетическом аспекте на основе построения паттернов степени напряжения анализируемых систем у лиц мужского пола, постоянно проживающих на Севере. Дан прогноз возрастного изменения изученных морфофизиологических параметров у лиц пожилого возраста. Результаты исследования показали, что паттерны отклонения анализируемых параметров свидетельствуют о нарастании напряжения функций систем в возрастном аспекте. Это проявляется в кумуляции отклонений в виде возрастных изменений показателей физического развития (увеличение ИМТ), сердечно-сосудистой системы (увеличение доли лиц с высоким нормальным АД и артериальной гипертензией по САД и ДАД), нарастания степени нарушений углеводного обмена (увеличение индекса инсулинорезистентности и гипергликемии натощак), возрастания степени дислипидемии относительно липидного обмена, трансформации нарушений микроэлементного профиля (усилении степени дефицита и возрастного избытка химических элементов). Это наблюдали на фоне снижения основного обмена веществ и показателей функции внешнего дыхания у современных жителей-северян старшего возраста. This study determined proportion of males whose physiological parameters were out of standard ranges and made patterns of their functional reserves to see dynamics in the row of teenagers, young adults, middle-aged adults, older adults. For the first time, dynamics of functional reserves was evaluated based on deviations from standard values existing for physical development, cardiovascular system, biochemical and trace element pictures, as well as characteristics of basic metabolism and breathing in ontogenetic aspect. The evaluation was performed by creating patterns of tension in subjective body systems under the North extremes to make predictive age-related changes older adults morphophysiological indicators. The results the patterns exhibited increasingly dysregulated functioning in the age aspect. That could be seen in age-related stress observed in physical development variables (accelerated body mass index), cardiovascular system (higher proportion of people with high normal blood pressure and arterial hypertension in systolic and diastolic blood pressure), carbohydrate metabolism disorders (higher index of insulin resistance and fasting hyperglycemia), more pronounced dyslipidemia, microelement disorders such as more severe age-related deficiency or excess. Those deviations existed together with worsening in basic metabolism and external respiration function in modern northerners of working age.

Clinical, radiologic, and morphological diagnosis of hypersensitivity pneumonitis

Aim. To study the relationship between clinical, radiologic, and morphological features in nonfibrotic and fibrotic hypersensitivity pneumonitis.Materials and methods. Clinical symptoms, data of high-resolution computed tomography, parameters of external respiration, and histological changes in the lung tissue obtained via open and transbronchial biopsies were studied retrospectively in 175 patients with hypersensitivity pneumonitis (HP). Statistical analysis was performed using the Statistica software.Results. We found that the clinical error rate in the diagnosis of HP was 84.5%, among pathologists – 92%. Among all the variants of HP, the most common was fibrotic HP. It was shown that non-necrotizing granulomas and giant cells in the cavities of the alveoli, microcells, and interalveolar septa were more typical of nonfibrotic HP. In fibrotic HP, peribronchial fibrosis, smooth muscle metaplasia in fibrotic areas, and the presence of fibroblastic foci in the walls of terminal bronchioles are signs of differential diagnosis with usual interstitial pneumonia. The classical triad of histological signs was observed in 19.2% of patients with nonfibrotic HP and in 5.6% of patients with fibrotic HP.Conclusion. Diagnosis of HP is complex and should be based on a multidisciplinary approach involving clinicians (pulmonologists), radiologists, functional diagnostics specialists, and pathologists. In this case, it is imperative to take into account and identify factors causing development of the disease, as well as the age of patients.

The effect of osteopathic correction on the function of external respiration in patients after COVID -19 coronavirus pneumonia

Introduction. The 2019 coronavirus infection (COVID-19) pandemic caused by a novel coronavirus strain (SARS-CoV-2) posed a serious threat to public health around the world. Postcoid syndrome (post-COVID-19 condition, according to ICD-10 code U09 State after COVID-19 or Postcoid state, Postcoid syndrome) is a pathological condition after a coronavirus infection, accompanied by cardio-respiratory, neurological, musculoskeletal, metabolic disorders. According to a number of studies, osteopathic methods of correction increase the lymph flow, immunological protection of the body, help to reduce pain, reduce the restriction of mobility in the chest, and therefore improve the function of external respiration. There are practically no studies that allow assessing the effect of osteopathic correction methods on the function of external respiration at the modern evidence-based level in patients who have undergone COVID pneumonia.The aim was to study the effect of a single procedure of osteopathic correction on the function of external respiration in patients during the rehabilitation period after coronavirus pneumonia.Materials and methods. On the basis of the Primorsky Institute of Vertebroneurology and Manual Medicine (Vladivostok) the rehabilitation of patients after coronavirus pneumonia was carried out using osteopathic correction. The study included 73 patients over the age of 60 years with varying degrees of lung damage and impaired respiratory function. To assess the function of external respiration, spirometry was performed and the vital capacity of the lungs was assessed; pulse oximetry was performed to measure the saturation of arterial blood hemoglobin with oxygen (SpO2). Osteopathic testing and treatment were carried out according to clinical guidelines, and the biomechanics of the chest was additionally investigated. The Statistica-10 software package was used for the statistical analysis of the obtained data.Results. Osteopathic examination revealed the presence of local somatic dysfunctions in 98,8 % of patients (spinal dysfunction, rib dysfunction, diaphragm dysfunction). 87,6 % of patients were diagnosed with regional somatic dysfunctions of thoracic region. Global somatic dysfunctions were diagnosed in 78,4 % of patients. After a single procedure of osteopathic correction, patients had a statistically significant improvement of the external respiration function, manifested in an increase in vital capacity from 78,27±2,79 to 85,36±3,38 % (p=0,0006). Also, the effectiveness of osteopathic correction is confirmed by a significant increase in the average hemoglobin saturation of arterial blood with oxygen. Thus, in patients with low SpO2 levels, the index increased from 94,21±0,21 to 95,09±0,3 % (p=0,02). After a single osteopathic correction procedure, the number of patients with local somatic dysfunctions decreased from 98,8 to 17,7 %; global somatic dysfunctions were revealed only in 16,3 % of patients. All patients noted an improvement in their general condition, a decrease in symptoms of respiratory discomfort and shortness of breath, and an increase in chest excursion.Conclusion. A single procedure of somatic dysfunctions' osteopathic correction in patients after coronavirus pneumonia leads to a statistically significant improvement in respiratory function. The vital capacity and the oxygen saturation of the blood increase in patients. This is caused by the increase of the mobility of the chest (increase in its excursion), diaphragm, ribs, spine. The obtained results allow recommend the inclusion of osteopathic correction in the rehabilitation programs for patients who have undergone coronavirus infection.

Age features of O2 mass transfer regimes in adolescents’ body at rest

The results of complex studies of the quantitative relationship between the stage-by-stage mass transfer of O2 and the efficiency of cardiorespiratory system functioning in relation to its consumption in adolescents’ body under conditions of relative rest are presented. The results obtained show that in adolescents, the modes of mass transfer of O2 in the body and the nature of the respiratory and circulatory systems functioning in relation to its consumption have a number of age-related differences compared with adult men. So, in adolescents, the external respiration system at rest functions less economically than in adults. Each liter of O2 consumed by adolescents is extracted from almost 3 liters more than in adults the amount of air ventilated per minute through the lungs. The volumetric indicators of blood circulation are also higher in adolescents, which may indicate the influence of neuro-humoral rearrangements in the body during the pubertal period. The coefficient of oxygen utilization by tissues from arterial blood in adolescents turned out to be significantly higher, which may characterize a higher tension of tissue metabolic processes.

The Participation of the Organism Adaptation Mechanisms to the Lack of Oxygen According to the Assessment of the Fethemoglobin Content in the Peripheral Blood of Patients with Community-acquired Pneumonia

Introduction. Сommunity-acquired pneumonia (COP) is a global socio-medical problem. At emergence of pneumonia by any genesis, hypoxia develops. Oxygen homeostasis of the body is provided by the coordinated interaction of external respiration, circulatory system and oxygen-transport system of the blood. Hypoxia, due to the malfunction of the external respiratory system, causes the formation of compensatory changes, in the implementation of which involved components of the oxygen transport system. Molecular genetic mechanisms play an important role in the body's adaptation to oxygen deficiency. Fetal hemoglobin (FetHb), having an increased affinity for oxygen, makes a significant contribution to the body's adaptation to new conditions with altered gaseous environment in the presence of pathological processes occurring with hypoxia. In this regard, it is interest to determine FetHb in adults with COP to study its effect on the diagnosis, prognosis and outcome of the disease. The aim of the study. To determinate the participation of the organism adaptation mechanisms to the lack of oxygen according to the assessment of the content of fetal hemoglobin in the peripheral blood of patients with community-acquired pneumonia. Materials and methods. We examined 34 adult patients (18 women and 16 men) with COP, aged 18 to 80 years, who were in the therapeutic department of the City Clinical Hospital № 25 in Kharkiv. The control group was formed of 20 healthy individuals. Spirography was performed on the diagnostic complex "Valenta"; hematological examinations – on the analyzer "ADVIA 60"; measurement of pO2 and pCO2, oxygen saturation, content of fetal hemoglobin – on the device "RAPIDLAB865". Results. In patients with community-acquired pneumonia, there was a decrease of the ventilatory function of external respiration, which is confirmed by a marked decrease in partial oxygen pressure. Oxygen saturation of blood was reduced in the group of patients with COP, but the difference was not statistically significant 94.8 ± 1.0 %. This indicates the presence of compensatory mechanisms aimed at maintaining adequate blood oxygen saturation. Significant increase in pH (from 7.40 to 7.53) and decrease in standard bicarbonate (from 1.27 to 0.68 mmol/l) resulting from violation of the gas composition of the blood can be regarded as a manifestation of partially compensated respiratory alkalosis. In patients with COP, there was a reduction in the total time of hemolysis, a shift of the maximum erythrogram to the left and an increase in the maximum itself, indicating a sharp decline in erythrocyte resistance. The proportion of erythrocytes with reduced resistance was twice as large as similar forms in the control group and the number of highly resistant cells in patients with COP sharply decreased. Obviously, oxygen starvation-mediated stress erythropoiesis is accompanied by the entry into the circulation of functionally defective erythrocytes. They are subject to accelerated elimination from the vascular bed, which causes a decrease in the quantitative indicators of red blood (erythrocyte content, hemoglobin) while maintaining corpuscular parameters (Mean Corpuscular Volume, Mean Cell Hemoglobin Concentration). At the same time, the analysis of individual hemoglobin fractions revealed an increase in the proportion of fetal hemoglobin (from 2.90 ± 0.31 % in the group of healthy individuals to 5.43 ± 1.05 % in patients with COP) (p less than 0.05). Conclusions. Changes in the parameters of acid hemolysis, fetal hemoglobin in the peripheral blood of patients with community-acquired pneumonia with impaired pulmonary ventilation function indicate their participation in the mechanisms of adaptation to oxygen deficiency and they have informative potential. Elevated fetal hemoglobin in peripheral blood in these patients can be used as an indicator of hypoxia, accompanied by impaired oxygen delivery to tissues, which should be used as an additional criterion for diagnosing tissue hypoxia and justify the timely appointment of antihypoxia drugs. Keywords: hypoxia, community-acquired pneumonia, red blood cells, fetal hemoglobin.

DYNAMICS OF IMMUNOLOGICAL AND FUNCTIONAL INDICATORS IN THE COURSE OF TREATING EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Repeated exacerbations of chronic obstructive pulmonary disease cause progression of this disease and result in its unfavorable outcome. Prevention of the first exacerbation of chronic obstructive pulmonary disease and alleviation of exacerbations are key goals in the treatment of the disease. Due to the fact that immune mechanisms occupy the central place in the pathogenesis of chronic obstructive pulmonary disease, the aim of the study was to study immunological parameters in patients with chronic obstructive pulmonary disease at the beginning of exacerbation and in the period of exacerbation termination, as well as the way how changes in immunological indicators affect the dynamics of pulmonary functional parameters in the process of treating patients with exacerbation of chronic obstructive pulmonary disease. The study included 116 patients hospitalized in the pulmonology department due to the first exacerbation of chronic obstructive pulmonary disease. In addition to the standard set of studies, patients underwent lymphocyte phenotyping using CD3, CD4, CD8, CD20 monoclonal antibodies, evaluation of neutrophils' phagocytic activity in a latex test, determination of immunoglobulins – IgG, IgA, IgM concentrations, circulating immune complexes and cytokines (interleukin (IL)-1β, IL-4, IL-8, interferon-γ (IFN-γ) in the serum. The above-described range of studies was carried out on the 2nd day of inpatient treatment and on the 10th–12th days of treatment. The results of the study showed that COPD exacerbation is associated with quantitative insufficiency of the cellular link in adaptive immunity against the background of activation of its humoral link. The features of the cytokine profile in patients with chronic obstructive pulmonary disease in exacerbation stage testified to the activated production of proinflammatory cytokines (IL-1ß, IL-8) and the main cytokines associated with the activation of humoral (IL-4) and cellular (IFN-γ) components of adaptive immunity. At this, the function of the cellular link was activated to a greater extent, as indicated by an increase in the ratio of IFN-γ/ IL-4. Analysis of indicators of external respiration function enabled us to establish that all speed indicators in patients were lower than in healthy ones. The functional parameters of the lungs, as well as immunological parameters, did not undergo significant changes as a result of treatment, which determines further progression of the disease.

External respiration and gas exchange in conditions of maximum load at different levels of the body's aerobic capacity

The study of the characteristics of the reactions of the links of external respiration and gas exchange at various stages of performing a step-increasing load and at maximum load with various aerobic capabilities of the body was carried out. The data obtained indicate that the level of aerobic capabilities of the body determines the characteristics of the reactions of the links of external respiration and gas exchange at various stages of performing a step-increasing load and at maximum load. Key words: functional reserves of organism, gas transportation system, maximum oxygen consumption, aerobic capacity of organism, gas exchange.

Adaptive chemoreceptor plasticity and reactivity of the cardio-respiratory system in athletes under hypoxic loads

An exploration of 110 healthy men (not involved in sports and athletes) with the use of hypoxic loads was carried out. It is established that the specifics of the regulation of gas exchange depend on the nature of training loads (aerobic or mixed), which are manifested in the parameters of chemoreflector reactivity, the pattern of external respiration, gas exchange and activity of the autonomic nervous system under hypoxic load. As sports qualifications grow, the mechanisms of intersystem integration of the functions of the cardio-respiratory system are improved, which is manifested in an increase in cardiorespiratory coherence. Key words: athletes, hypoxia, cardiorespiratory system, gas exchange of the body, chemoreceptor reactivity.

Evaluating the Effectiveness of Distance Learning Physical Education for Disabled Students

The article discusses the effectiveness of the application of the distance learning program at the level of the functional state and reserve capacities of the organism of students with disabilities: for 12 students of 17-19 years old with idiopathic structural scoliosis of II and III degrees of S-shaped type, engaged in a full-time program (stage I) and for the same students studying remotely (stage II), it was studied the functional indicators of the cardiovascular and autonomic nervous system, the function of external respiration, the tone of the paravertebral muscles of the back and neck, as well as indicators of strength and endurance. Then a comparison was made of the studied indicators of stages I and II. It is shown that distance learning has a negative impact on the health of students: hypertonicity of the muscles of the back and neck significantly increases almost twice (the most sensitive is the cervicothoracic region), there is a shift of autonomic tone by 10.73% towards sympathicotonia: heart rate blood pressure increased by 19.06% by 7.9%, respiratory rate by 7.92%, tidal and minute volumes by 17.8-20%, respectively. At the same time, strength endurance and the level of performance decrease by 11.7%. Such changes contribute to the tension of neurohumoral mechanisms of self-regulation, which leads to a decrease in the stock of functional reserves and significantly narrows the range of possible adaptive responses. It is shown that the informatization of the educational system in the edu cational process of students with disabilities should be of a mixed type, where the traditional form of classes remains the leading one.

The use of transdermal therapeutic systems for chemical pleurodesis in a patient with prolonged air leakage after lung resection for cancer

This clinical observation demonstrates a method of a motivated use of a transdermal therapeutic system (TTS) based on fentanyl for chemical pleurodesis in a patient with prolonged air leakage after lung resection for cancer. The most common complication after elective lung resections is an alveolar-pleural fistula or prolonged air leakage. This clinical phenomenon occurs as a result of communication between the alveoli of the lung parenchyma distal to the segmental bronchus and the pleural cavity. In most cases, air leakage through the drains is eliminated spontaneously, but the frequency of prolonged pneumostasis absence in the postoperative period can reach 25 %, which has a negative effect on the outcomes of surgical interventions due to the development of pneumonia and empyema. Long-term drainage of the pleural cavity does not always end with aerostasis and requires repeated invasive interventions. One of the ways to achieve the tightness of the lung tissue involves various methods of chemical pleurodesis, which is a surgical manipulation – the introduction of a sclerosing chemical substance into the pleural cavity by spraying medical talc through a trocar or a injecting tetracycline solution into the pleural drains. The chemical causes aseptic inflammation and adhesions between the visceral and parietal pleura, followed by obliteration of the pleural cavity. The sclerosant introduction is accompanied by severe pain that can provoke respiratory and/or hemodynamic deficits, up to apnea and life-threatening heart rhythm disturbances. Pain relief during chemical pleurodesis is obviously an important factor in the prevention of a number of complications in patients undergoing surgery for lung cancer. Bolus intravenous injections of narcotic analgesics lead to an analgesic effect, but a short-term one due to the absence of a depot in the body and a sharp drop in the drug concentration in the blood serum. Unfortunately, this method of introducing narcotic drugs can cause various complications in weakened and elderly cancer patients, such as respiratory depression and cardiac arrest. The TTS action is characterized with continuous dosing and the creation of a constant concentration of the narcotic drug over a certain period of time. This method provides a multilevel and systematic approach to pain relief, reduces toxicity and minimizes the inhibition of the central mechanisms of external respiration regulation without causing respiratory and cardiac disorders in patients who underwent lung resection.