METHODICAL ASPECTS OF THE DEPLOYMENT OF A MEDICAL REHABILITATION CENTER BASED ON THE MILITARY SPA ORGANIZATION

One of the areas of use of military sanatoriums in peacetime and wartime is the organization of medical rehabilitation centers (CMR) at their base. The medical staff of medical and preventive institutions at the stages of rehabilitation should have a clear understanding of the place and importance of medical measures in the overall task of protecting troops, effectively interact with other specialists in the tasks of providing military personnel, carrying out rehabilitation of the affected and sick for the rapid return of the reconvalescenes, medical rehabilitation of patients after routine operations, ensuring the observation regime and effective postcovid rehabilitation of patients.

REMOTE REHABILITATION: ROLE AND OPPORTUNITIES

Medical rehabilitation is a complex, long-term and financially costly process of restoring the physiological functions of the body after injuries and the consequences of past diseases. The need for an individual approach to each life situation necessitates the search and development of new technologies in the method of providing rehabilitation assistance. One of the principles of a successful rehabilitation process is continuity, which, in most cases, is disrupted after the transfer of patients to the outpatient stage. The 21st century, in contrast to the previous one, is distinguished by more accessible technologies for everyday and individual use. A separate category of patients are patients with the consequences of brain damage, socialization and the return of the ability to self-serve for whom is one of the most difficult in rehabilitation practice. One of these technologies is distance rehabilitation, which provides the principle of continuity, social and informational support for relatives who provide care for patients on an outpatient basis.

HLA AND CANCER

This review provides updated information on HLA class I and II antigens in cancer. The expression of HLA antigens in normal and tumor tissues, the physiological organization of the components of HLA antigen-processing machinery, the expression patterns of HLA antigens associated with the molecular and regulatory defects identified to date, as well as their functional and clinical significance, are described. This review summarizes clinical and experimental data on the complexity of immune escape mechanisms used by tumour cells to avoid T and natural killer cell responses. The variety of class I HLA phenotypes that can be produced by tumor cells during this process is presented. We also discuss here the potential capacity of metastatic lesions to recover MHC/HLA class I expression after immunotherapy, which depends on the reversible/ soft or irreversible/hard nature of the molecular mechanism responsible for the altered HLA class I phenotypes, and which determines the progression or regression of metastatic lesions in response to treatment. HLA сlass II genes play key roles in connecting innate and adaptive immunity in tumor rejection and when the escape route via HLA-I is already established. Antigens сlass II HLA expression in tumor cells and gives tumor cells the ability to present antigens, becoming less aggressive, and improves prognosis. Malignant tumors, as a genetic disease, are caused by structural alterations of the genome which can give rise to the expression of tumor-associated antigens in the form of either structurally altered molecules or of overexpressed normal molecules. Tumor associated antigens recognized by the immune system and induce a T-cell-mediated immune response. Outgrowing cancers use different strategies to evade destruction by the immune system. Immune evasion mechanisms affecting the expression and/or function of HLA-antigens are of special interest to tumor immunologists, since these molecules play a crucial role in the interaction of malignant cells with immune cells. This review describes the potential role of immunity control points in immunosuppression and therapeutic strategies for restoring the cytotoxicity of immune cells.

CIRCADIAN RHYTHM AND CHRONIC DISORDERS OF CONSCIOUSNESS

Among the possible points of therapeutic action and predicting the outcome in patients in a vegetative state and minimally conscious state, the analysis of circadian rhythms, such as the sleep-wake cycle, melatonin secretion, temperature trends, heart rate, and blood pressure, attracts more and more attention. In this review, we analyzed studies on circadian rhythms in patients with chronic disorders of consciousness, assessed the possible limitations of standard methods, proposed a concept for the development of an assessment of the sleep-wake cycle, and assessed the role of exogenous factors that are likely to be involved in the disturbance of circadian rhythms in intensive care units. Based on the results of the study, we came to the conclusion that for the full realization of the rehabilitation potential, it is necessary to develop methods for assessing circadian rhythms based on a multicomponent approach, including 24-hour monitoring using actigraphy for more accurate identification of the rest -activity cycle, video monitoring of the orofascial area to increase the reliability of oculographic assessment and revealing hidden patterns, analysis of the temperature curve, the level of melatonin, TSH, cortisol, as well as exogenous factors. It is necessary to use the information obtained for therapeutic, prognostic, diagnostic and rehabilitation purposes

Prospects of using adaptive phagotherapy (Phage therapy) in the rehabilitation of post-Covid 19 patients (editorial).

The work is devoted to the organization of postcovid rehabilitation by developing a strategy of adative phage therapy, which is the production and application of a complex of bacteriophages for a specific medical institution/department based on an up-to-date collection of hospital bacterial strains isolated from the biomaterial of patients of the same institution. Bacteriophages were actively used in the world in the 20-40s of the twentieth century in various fields of medicine, but the rapid development of phage resistance in each individual case limited their use. The use of complex preparations of bacteriophages from the collection pure lines of bacteriophages of the SPC "MikroMir" a set of various phages aimed at restoring the human microbiome after a covid infection allowed to sharply reduce the number of antibiotics used in intensive care units and reduce antibiotic resistance with proven safety of phage therapy.

Progressive resistance power training for gait and balance rehabilitation in multiple sclerosis: a pilot single-arm study.

Aims: The aim of the study was to evaluate the effectiveness of 4-weeks inpatient power training protocol on parameters of gait and balance in pwMS. Materials and methods. 26 subjects aged 18 65 years and Expanded Disability Status Scale (EDSS) score 2.0 to 6.5 Receiving standard rehabilitation with PRT was applied for 30 minutes, 5 days a week for 4 weeks in addition to other rehabilitation methods. The primary endpoint was the time of 6-minute walking test (6MWT) at week 4 (W4) compared to week 1 (W1). Secondary outcomes included the time in Timed 25-foot walking test (T25FW), Timed Up-n-Go test (TUG), 5 times sit-to-stand test (5TSST), Expanded disability status scale score (EDSS), muscle strength. Results. After the 4-week course of rehabilitation a significant improvement was reached in all tests. The most prominent was the improvement in the 6MWT with 20/25 (80%) patients showing the increase in the distance walked above the minimal clinically important difference (MCID). Changes in other tests were less manifest: 3/25 (12%) of patients improved above MCID in both TUG and 5TSST, 6/25 (24%) patients - in T25FW. After a 4-week course of rehabilitation, a significant improvement was acquired in the 6MWT. Changes in other tests were significantly less manifest. Muscle in hip flexors improved significantly on the left side (mean (SD) at W1 - 3,96 (0,67) vs W4 - 4,72 (0,46), p=0,04)) and showed the trend to significance of the right side: W1 - 3,68 (0,8); W4 - 4,52 (0,65), p=0,08. Conclusions: The most significant effect was achieved in the primary outcome that was the distance walked in 6MWT. Less disabled patients can show better improvement in further studies, as was defined by T25FW test. Regular exercise can improve daily activity using a program that patients can easily do at home on their own.

Information Technology in Hospitalization Management in a Federal Medical Organization

The article presents the experience of organizing the management process of planned hospitalization at the Federal Center for Traumatology, Orthopedics and Arthroplasty (Cheboksary). Automation of the process of hospital admission planning, including monitoring of hospital admissions failures and the length of patient stay in the PA, organization of information support for the staff of the Center's admission department based on the developed MIS "Medialog" module, related to patient registration and registration of documents specific to the federal medical center in the PA, allowed for ongoing monitoring of hospitalization, reducing the proportion of patients waiting in the emergency department for more than 3 hours, improving the quality of patient flow planning and management.

Diagnostic of psychoemotional and cognitive impairments in acute ischemic stroke

Aims: to assess the severity of cognitive, psychoemotional, behavioral disorders, the level of self-control and prevalence of certain coping strategies in patients with lesions of the right and left cerebral hemispheres after acute ischemic stroke. Materials and methods: The study included 60 patients with a diagnosis of ischemic stroke. Depending on the location of the stroke, patients were divided into two groups: Group 1 - 30 patients with lesions of the right hemisphere, Group 2 - 30 patients with lesions of the left hemisphere. The study was conducted on the 7th day of treatment and included: assessment of the cognitive status according to the Montreal scale (with additional scales for assessing the functions of the right hemisphere); assessment of the level of distress, depression, anxiety and somatization using the Four DimensionalSymptomQuestionnaire; assessment of mental and physical asthenia according to the MFI-20 scale, level of self-control using the Rotter'sLocus of Control Scale and coping strategies modality using E. Heim coping questionnaire. Results: The study established the prevalence of depression, a tendency towards non-adaptive coping strategies, ideational praxis related disorders understanding of metaphors and low level of self-control in relation to health in patients with lesions of the right hemisphere. Patients with ischemic stroke localized in the left hemisphere are characterized by a high level of mental asthenia, a choice of adaptive and relatively adaptive coping strategies, and a low level of self-control in respect to interpersonal relationships. Conclusions: The results of the study show that in the acute period of stroke there are qualitative and quantitative differences in neuropsychiatric symptoms of patients with lesions of the right and left cerebral hemispheres. The predominance of depression, cognitive impairments, and non-adaptive coping strategies in patients with lesions of the right hemisphere even with minimal or moderate motor deficits justifies early examination of the patient's behavioral, neuropsychiatric, and cognitive syndromes. The results of the study indicate the need to develop individual psychological rehabilitation programs for patients with lesions of the right and left cerebral hemispheres during the acute period of stroke.

CEREBRAL PALSY BIOMARKER

Cerebral palsy is a neurological disorder that is attributed to non-progressive injury or malformation that occurred in the developing fetal or infant brain. The motor disorders in cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, behaviour, and by epilepsy. Cerebral palsy is a complex disorder that is likely to be of multifactorial origin. Epidemiological studies have shown that the origins of most CP are prior to labor. A number of clinical risk factors for cerebral palsy have been described in the literature including preterm birth, low birth weight, inflammation, maternal infection during pregnancy and placenta pathology. Hypoxia at birth may be primary or secondary to preexisting pathology, but the currently known clinical risk factors do not explain the majority of cases. Many of these risk factors may have a genetic component. Several single nucleotide polymorphisms, DNA copy number variations and epigenetic patterns increase genetic susceptibility for cerebral palsy. Whole genome sequencing and gene expression studies may extend the percentage of cases with a genetic pathway. Clinical risk factors could act as triggers for CP where there is genetic susceptibility. These new findings should refocus research about the causes of these complex and varied neurodevelopmental disorders on the search for biomarkers of the risk of cerebral palsy. Genomics, proteomics and metabolomics have huge potential for deepening our understanding of many complex diseases by identifying diagnostic and prognostic panels of biomarkers, especially in various neurological disorders, including cerebral palsy.

Development of paradigms for the diagnosis of "covert cognition" and cognitive motor dissociation in patients with chronic disorders of consciousness

The detection of signs of consciousness in patients with chronic disorders of consciousness is a complex clinical task. In recent decades, instrumental methods have been used to improve the accuracy of diagnostics. The phenomenon of covert cognition and cognitive-motor dissociation have been demonstrated in a small proportion of patients in studies using instrumental methods in combination with different paradigms. This article describes the main features of the diagnostic paradigms used for such purposes. Currently, the development of its own complex of paradigms is held at the Research Center of Neurology collaboratively with group of neuropsychologists from Lomonosov Moscow State University. The general characteristics of this complex of paradigms are indicated. The practical significance of detecting the phenomenon of covert cognition and cognitive-motor dissociation in patients with chronic disorders of consciousness is discussed.