Laboratory Parameters of Bone Metabolism in Premature Infants and Children Born Using In Vitro Fertilization

Aim. To study the indicators of bone metabolism in premature babies born naturally and children born with IVF. Material and methods. The premature babies’ study was conducted, they were divided into 4 groups: depending on the method of birth and weight: 1st-children born with IVF, with very low weight; the second group – similar to the first, but children with extremely low weight; the third – children with very low weight, born naturally, with ; the fourth – similar to the 3rd, but with extremely low weight. The level of calcium, parathyroid hormone, calcitonin and C-terminal telopeptides of type I collagen was determined. Results and discussion. Diagnosis of vitamin D deficiency is possible only by measuring certain biochemical parameters, primarily the levels of its metabolites in the blood. Clinical symptoms of vitamin D deficiency in the form of rickets, osteomalacia, osteoporosis and extra-skeletal manifestations as a result of this vitamin deficiency occur over a long period of time. The most informative indicator of the body’s vitamin D supply is the content of calcidiol [25 (OH)D] in both serum and blood plasma. Vitamin D deficiency was detected in more than half (67.7±4.8%) of premature newborns in the first year of life. It seemed that in premature babies born in different ways, vitamin D deficiency was noted in 8 %, insufficiency – in 67.7 %, and the normal content in 27.5 %. In children at an early age, there is a violation of bone metabolism (an increase in the level of calcium, parathyroid hormone, calcitonin, on the one hand, and a decrease in the C-terminal telopeptides of type I collagen, on the other). These changes were associated with the weight of children, while aggressive disorders were noted in children with extremely low weight. In premature infants (with a body weight of less than 1500 g), monitoring of the level of vitamin D in the blood and C-terminal telopeptides of type 1 collagen should be recommended. Conclusion. Bone modeling has a great advantage due to the analysis of the blood serum biomarkers levels in premature infants, it enables to establish the features of osteogenesis.

Athletes’ Physical Performance in the System of the Sports Medicine Technologies Effectiveness Evaluation

Aim. To determine the effectiveness of the specific loading testing use in assessing the athletes’ physical performance. Material and methods. We present a post-hoc analysis of data from specific and nonspecific loading testing (bicycle ergometer, treadmill, rowing ergometer, and ski treadmill) of 23 oarsmen athletes (13 male (mean age 25.85±0.88 years) and 10 female (mean age 22.90±1.20 years); 125 track and field athletes (75 male athletes (mean age 24.74±0.91) and 50 female athletes (mean age 23.81±1.35)), 38 ski athletes (22 male athletes (mean age 21.3±2.4) and 16 female athletes (mean age 19.6±1.8)). Results and discussion. When assessing the physical performance of track and field athletes of various positions using a bicycle ergometer and a treadmill, the maximum oxygen consumption (MOC) parameter for throwers and jumpers was in the range of 29-55 ml/min/kg (it is more appropriate to use a statoergometer), for runners – 39-75 ml/min/kg (testing on a treadmill is preferable). The greatest efficiency and physiological validity was obtained by load testing using a rowing ergometer for rowing athletes and a ski roller treadmill for athletes of ski sports (the ratio of heart rate at the anaerobic metabolism threshold level to the heart rate “on failure” is ~ 97%). With bicycle ergometry, low values of MOC were obtained in athletes training for endurance, and, including on the treadmill, in athletes with the main strength load and implies the work of the muscles of the upper shoulder girdle and back. The functional and reserve capabilities of the athlete are not reflected in the data obtained that makes impossible to judge the level of his/her functional readiness. Conclusion. Sports medicine technologies reflecting the dynamic characteristics of athletes’ physical performance should be evaluated from the point of view of informativeness and efficiency of their application depending on the type of sport. Conclusion about the effectiveness of sports medicine technologies should be made considering the results of the functional and physical performance testing under the exertion, specific to a particular sport.

Fresh Water Aquatic Training in Patients with Upright Posture Maintaining Disorders

The use of the fresh water aquatic training course, as a more gentle training method, may allow patients to ensure effective restoration of muscle functions responsible for maintaining an upright body position. A more accurate control of the course results can be performed using a virtual analysis carried out using the «Habilect» system that allows to determine the body parts attitude. Aim. To study the effect of training in fresh water using the Habilect system based on the Microsoft Kinect infrared sensor (video stabilometry) on motor functions that contribute to maintaining an upright body posture in patients with mild gait disturbances. Material and methods. An open descriptive study was conducted including 12 patients (7 men, 5 women), aged 40 to 62 years, with upright posture maintaining disorders, which correspond to the functional diagnosis encoded by the ICF «Gait Stereotype Functions» B770.1 – mild violations (5–24%). A group of subjects (n = 12), in addition to basic therapy and training with an exercise therapy instructor, underwent aquatic training in fresh water for two weeks (30 minutes, 6 days a week). Assessment methods: the research was carried out using the Habilect gait video analysis system before and after the rehabilitation course. The χ2 test was used to assess the significance of differences between groups of qualitative variables. When analyzing quantitative variables, the Shapiro-Wilk’s (W) test was performed. For abnormal distribution, the data is in Me format [Q25-Q75]. The Wilcoxon T-test was used to assess the significance of differences in quantitative variables of the two studied groups. The processing of the obtained research results was carried out using the Statistica for Windows, v. 8.0 (StatSoft Inc., USA) and Microsoft Excel (Microsoft, USA). The significance of the differences was considered established at p <0.05. Result and discussion. When examining the amplitude of body deflection along the X-axis before training, they were 3.25 cm [-98 cm; 93.9 cm], after – -9.96 cm [-100.92 cm; -81.96 cm], on the Y-axis before training – -29.01 cm [-29.01 cm; 13.76 cm], after –-30.59 cm [-30.59 cm; 31.09 cm], on the Z-axis before training – 388.1 cm [369.22 cm; 393.39 cm], after training – 380.96 cm [377.98cm, 400.05 cm], deviation of the body movement vector before training 16.45 cm [7.46 cm; 338.67 cm], after training – 324.7 cm [324.7 cm; 342.56 cm]. When examining the amplitude of head deflection along the X-axis before training, they were -0.92 cm [-1.24 cm; -0.92 cm], after – 1.5 cm [-10.19 cm; 2.38 cm], Y-axis before training – 125.33 cm [61.13 cm; 128.94 cm], after – 107.42 cm [52.49 cm; 107.42 cm], along the Z-axis before training – -8.59 cm [-8.97 cm; -5.33 cm], after training – -14.89 cm [-14.89 cm, -3.45cm]. When calculating the increase in deviation (deviations of the main body axes from the initial value) using the Wilcoxon T-test revealed statistically significant deviations in the X-axis (an increase of 306.5%, p = 0.0504), the Z-axis (an increase of 112.68%, p =0.0225) and the Body Angle parameter (an increase of 1973.86% p = 0.0323). When calculating the increase in the deviation of the head axes from the initial value using the Wilcoxon T-test, statistically significant deviations were revealed along the X axis (increase of 163.04%, p = 0.0280), the Y axis (increase of 85.71%, p = 0.0199) and the parameter Z (an increase of 173.34% p = 0.0292). The study revealed a decrease in the body axes deviations amplitude in all 3 planes, which indicates an improvement in the work of all brain parts that are responsible for the coordination of motor functions and their vegetative support, an improvement in functional interaction within individual muscle chains. The reduction in the head and neck muscles in compensatory balancing participation during walking and maintaining a vertical body posture mainly due to the muscles of the lower extremities and pelvis contributes to the prevention of arterial and venous circulation disorders in the head and neck and makes training not only more effective, but also safer. Conclusion. Due to the decrease in the amplitude of deviations along all three axes (Z, Y, X), the course of aquatic training contributes to the correction of upright posture maintaining disorders, a statistically significant decrease in the amplitude of head and neck movements.

Development of Wound Dressing for Regenerative Medicine

The understanding of the pathophysiological mechanisms of the wound process deepened with the development of science. The technological base that was creating has enabled to serve the clinical needs of tissue repair. These factors, combined with the growing need for healing of infected and chronic wounds, have led to the expansion of the market for wound dressings materials supplies. In this connection, there is a need to generalize and update information about new types of dressings. This review provides an up-to-date understanding of the wound process: cellular and signaling mechanisms of repair, characteristics of the optimal microclimate of the wound bed, morphofunctional re-arrangements of tissues during the healing process. Based on these data, the requirements for the modern wound dressings are formulated. Existing wound dressings have been classified as interacting with body tissue. The bio-functional characteristics of the synthetic and natural polymers used in the dressing are described, including their effect on regenerative processes. A classification of the active medicinal ingredients used in the manufacture of dressings is given, the characteristics of their use on the background of the pathological wound process are considered.

Modern Approaches to Diagnostics and Correction of Aging Biomarkers

From the biomedicine point of, view ageing is a natural process, characterized by a gradual decrease in the physiological integrity and adaptive abilities of the body, leading to a violation of its functions and an increase in the risk of death with age. Demographic aging of the population is a serious socio-economic problem, both in Russia and around the world. The main cellular and molecular signs of aging include genome instability, telomere shortening, epigenetic alterations, impaired proteostasis, impaired nutrient recognition, mitochondrial dysfunction, cellular aging, the stem cell pool depletion and changes in intercellular interaction, extracellular matrix rigidity, as well as activation of retrotransposons and chronic inflammation. For these reasons, in modern healthcare, preventing premature aging and treating age-related diseases is becoming a priority task. This review presents modern approaches to the quantitative assessment of the aging process using aging biomarkers as functional parameters reflecting the biological organism age at the molecular, cellular, and organismal levels. This work also considers the actual non-drug and drug interventions allowing to slow down the development of age-associated pathological processes, allowing you to increase the quality and duration of life.

Post CO VID-19 Encephalopathy Treatment

Aim. To evaluate the severity of encephalopathy and the efficacy of the second stage of rehabilitation in patients with post-infectious encephalopathy. Material and methods. The study included 92 patients with post-infectious encephalopathy, who underwent the second stage of rehabilitation after СOVID-19 infection. All patients were divided into 2 groups: those, who were referred to rehabilitation after the end of the treatment (n=54) and those, who refused to undergo rehabilitation (n=38). In all cases the severity of coronavirus infection, percentage of pulmonary involvement (based on chest CT-findings) and the presence of comorbid pathology were assessed. The severity of the prevailing syndromes was assessed using the International Classification of Functioning, Disability and Health (ICF). Patient status dynamics was assessed using Rehabilitation routing scale (RRS), Rivermead, Holden and Hauser scales. Results and discussion. Post-infectious encephalopathy was mainly accompanied by vestibular ataxia syndrome in 51 (55.4%) patients (in 51.9% and 60.5% patients in groups 1 and 2, respectively) and cerebro-asthenic syndrome in 73 (79.3%) patients (in 72.2% and 89.5% patients in groups 1 and 2, respectively). Comprehensive rehabilitation process is characterized by staging aimed at compensating for all components of pathogenesis that affected during the period of severe course of COVID-19 infection. Rehabilitation was an effective measure for the compensation of neurologic complications of COVID-19 infection. After 2 weeks, cerebro-asthenic syndrome was observed in 24.1% patients in group 1 and 71.0% in group 2 (p <0.05), vestibular ataxia syndrome – in 18.5% and 28.9% (p<0.05) of patients in groups 1 and 2, respectively. The current pandemic is highly likely to be accompanied by a significant increase in the prevalence of encephalopathy affecting the ability to return to daily functioning. Conclusion. The main manifestations of post-covid encephalopathy are cerebro-asthenic (79.3%) and vestibular ataxia (55.4%) syndromes. Therapeutic and rehabilitation measures carried out at the 2nd stage of rehabilitation is an effective measure to compensate for the severity of post-covid encephalopathy.

Application of the International Classification of Functioning, Disabilities and Health in the Rehabilitation Process

With the development of high technologies in medicine, the diagnostic process is improving, the methods of treating patients are refining, the percentage of patients who survived after serious injuries, diseases and/or conditions is increasing. The issue of the patients` quality of life that received primary medical, specialized, including high-tech medical care is becoming a priority for health care. Rehabilitation is defined as one of the critical interventions “enabling people with disabilities to achieve and maintain maximum independence, full physical, mental, social and professional ability and full inclusion and participation in all aspects of life”. The problems and prospects of rehabilitation medicine for the future arise due to critical changes in demographics, life expectancy, a variation in approaches to assessing disability, an increase in the prevalence of long-term health disorders, especially in connection with the new coronavirus infection, technological progress, as well as changes in health care costs and changes in society’s requirements for well-being and quality of life, including health. The object of the study is the process of organizing medical rehabilitation of patients with cerebral stroke at the second phase of rehabilitation process in a 24-hour inpatient medical rehabilitation department for patients with impaired function, structures, limited activity and participation due to damage to the central nervous system based on the application of the International Classification of Functioning, Disabilities and Health (ICF) for the rehabilitation diagnosis description (the degree of disturbance of structure, function, limitation of activity and participation, the degree of influence of environmental factors) and the formation of the medical rehabilitation program on its basis.

On the Question of the Reflexotherapy Action Mechanisms in the Ischemic Stroke Acute Period (Literature Review)

A high degree of disability in stroke patients, along with severe social and economic losses, determine the enduring urgency of the problem of early rehabilitation for post-stroke patients. Despite the proven effectiveness of the various reflexotherapy techniques in rehabilitation of patients with ischemic stroke, the underlying mechanisms remain unclear. The aim of the review was to analyze the mechanisms of the acupuncture intervention effect on the main links of the ischemic stroke pathogenesis, on neurological deficit and the volume of cerebral infarction (based on publications in international databases). The use of acupuncture in the acute period of ischemic stroke can improve the ability to cerebrovascular reserve, reduce the severity of arterial stiffness and endothelial dysfunction, induce neuroprotection, inhibit cell apoptosis and stimulate neuroplasticity, alleviate the inflammatory response in acute cerebral ischemia, regulate mediators of inflammation and oxidative stress etc., thus improving cerebral blood flow. The analysis of literature data has shown that acupuncture induces multilevel regulation through complex mechanisms, and one factor may not be enough to explain the positive effect against cerebral ischemia.

Nordic Walking in Rehabilitation of Women with Stress Urinary Incontinence after Sling Operations

It is known that urinary incontinence remains one of the most common diseases in women, representing a serious medical and social problem. Practice shows that sling operations without subsequent rehabilitation measures, especially in the long term, do not solve the problem. In urogynecology, the use of physical exercises and physiotherapeutic methods is aimed at restoring impaired urinary functions. A relatively new approach to the rehabilitation of women after sling operations is the inclusion of Nordic walking (NW) into the rehabilitation program. Certain experience in this field has been accumulated in Sverdlovsk Regional Clinical Hospital № 1 (Yekaterinburg). Aim. To improve the efficiency of treatment of female stress urinary incontinence using the technique of NW in rehabilitation programs after sling operations. Material and methods. In Sverdlovsk Regional Clinical Hospital № 1 in Yekaterinburg, NW is included in rehabilitation programs for women with stress urinary incontinence after sling operations. Experience in planning and conducting a four-week course of NW under the physiotherapist guidance has been accumulated. Patients after sling operations (n= 85) were randomized into two groups. Rehabilitation program of patients of the first group (n = 37) included a 4-week course of NW on the background of basic therapy (antibacterial therapy, antispasmodics, anticoagulants), while in the second group (n = 48) only basic therapy was realized. The dynamics of clinical manifestations of stress urinary incontinence was studied, uroflowmetry parameters, PAD-test data, cough test were evaluated; the answers of the patients to the questions of the international questionnaires PFDI-20, PFIQ-7 were analyzed. Results and discussion. The variability of the currently used methods of rehabilitation of patients with stress urinary incontinence requires objectification of the results. The study showed that Nordic walking (NW) is a pathogenetically justified and clinically effective method for rehabilitation of women with stress urinary incontinence after sling operations. The analysis of the rehabilitation activities data based on the dynamics of leading clinical symptoms, PAD test, cough test, uroflowmetry parameters revealed significant differences (p<0.05) between two groups at all follow-up periods: a month, three and nine months. Postoperative objective evaluation of the treatment results correlate with patients’ subjective data: women who completed a course of NW rated their quality of life significantly higher than patients of the control group under the rehabilitation program without inclusion of therapeutic physical factors. The structure of NW classes is based on the understanding that the body response to the physical factors impact is provided by various organs and systems. The inclusion of NW in rehabilitation programs requires adherence to the basic principles of achieving training status. Conclusion. The expediency of NW including in the complex treatment of patients with stress urinary incontinence is due to the regression of main clinical symptoms, reliably significant dynamics of instrumental parameters and test results in comparison with the group that received only basic therapy. The implementation of the therapeutic effect is based on the principle of unity of syndromicpathogenetic and clinical-functional approaches. Clinical-functional approaches is the basis for the implementation of the therapeutic effect.

Constitutional Approach as a Factor of Sports Injury Prevention

A career in professional sports depends on a number of factors related both directly to the athlete’s body and to the influence of external factors. Age, sport, health, personal trainer, training conditions, etc. – all this is important to achieve the result. However, the athlete’s constitutional features are significant and fundamental for achieving the result. These are not just morphological signs, but also a tendency to the occurrence of injuries and individual psychological characteristics as well as their correspondence to the functional capabilities of the athlete’s body. It is the individual mental characteristics that determine the type of response to the result of the competition (especially negative), the motivational aspect for achieving the result and recovering from injuries. This is important, since injuries are one of the primary problems of sports (regardless of the type), and the number of injuries and traumatological pathologies reaches 44% of the total number of nosologies. Aim. To substantiate the possibility and expediency of using integrative medicine methods in the rehabilitation treatment of sports injuries of the ankle joint. Material and methods. The research object was 38 male athletes involved in game sports, 18 – 26 years old with moderate ankle injuries, sports experience – 10 – 18 years, sports qualifications from the 1st category to the master of sports (MS). The patients were randomly divided into two groups. In the main group – 20 athletes – the rehabilitation schemes included: classical acupuncture, homotoxicology, hirudotherapy, post-isometric relaxation. To comfortably accompany the recovery process, a collegial model of the relationship between a doctor and an athlete was used. The control group consisted of 18 athletes with applied standard recovery rehabilitation scheme. Results and discussion. In athletes in both groups, the clinical manifestations of the disease were stopped at the same time (within6–8 days). Functional recovery of the injured joint in the main group was observed by the 16th day, in the control group – by the 22nd day. Athletes of the main observation group started competitive activity on average after 23 days, in the control group – after 28 days. Conclusion. The use of integrative medicine methods in athletes allowed to shorten the recovery period, reduce the dosage of painkillers, sedatives, anti-inflammatory drugs, accelerate the psychological adaptation of the athlete to the changed life situation and provide relief for injured athletes to undergo rehabilitation treatment, practically preserving overall physical performance.