Vol 3, No 1 (2021)

ORIGINAL STUDIES
Methods of Evaluation of Tolerance yo Physical Activity Based on Six-Minute Walking Test During Outpatient Rehabilitation of Patients with Ischemic Heart Disease
Mikhailovskaya T.V., Mishina I.E., Nazarova O.A., Dovgalyuk Y.V., Chistyakova J.V.
Abstract

Background. Even though the six-minute walking test is a simple and widely available tool for the evaluation of the functional capacity of cardiac patients, its interpretation is associated with some difficulties and contradictions. Aims: To evaluate the dynamics of tolerance to physical activity during outpatient rehabilitation of patients with ischemic heart disease using predicted values of distance in the six-minute walking test. Materials and methods. 97 patients (70 men and 27 women, average age 59.6 [50; 60] years) after acute coronary syndrome and after myocardial revascularization were included. The six-minute walking test was performed at the beginning of the 3-weeks stage of cardiac rehabilitation and before the patients’ discharge. The results of the test were reported as an absolute value, a change in absolute value, and the percentage of predicted values, estimated with the reference equation by Enright and colleagues. Results. The absolute value of distance in the six-minute walking test was increased significantly from 418 [385; 465] m to 485 [440; 525] m (p <0.001). The number of patients with a distance less than 300 m was decreased significantly (12 patients, 12% vs 2 patients, 2%, p <0.001). In most patients, the absolute increase in distance was 30 m and more (81 people, 84%). After comparing the perceived data with the calculated predicted values, it was revealed that the distance raised from 79 [71; 82]% to 92 [88; 96]% of the predicted values. And 56 patients (58%) had a distance equal to 90% or more from its predicted value. Conclusions. During the third stage of cardiac rehabilitation the significant increase of the absolute value of the six-minute walking test, the growth of the percentage of predicted values, and the decrease of patients with a distance less than 300 m were found. All these estimation methods may be used to demonstrate and prove favourable changes of tolerance to physical activity in patients with ischemic heart disease.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):4-10
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Closed Fractures of the Distal Part of the Shin Bones. Different Types and Methods of the Treatment in Adolescence. Short Period Results
Dorokhin A.I., Krupatkin A.I., Adrianova A.A., Khudik V.I., Sorokin D.S., Kuryshev D.A., Bukchin L.B.
Abstract

Background. Fractures of the distal leg bones in children, due to the peculiarities of localization, the presence of a growth zone, the proximity of the joint and the involvement of the ligamentous apparatus in the pathological process, present a difficult problem in the choice of treatment and rehabilitation. Aims: In order to our aims we create the diagnostic and treatment algorithm in the system of early rehabilitation after fractures in the distal part of the shin bone in adolescence. Methods. Our clinical investigation based on the treatment of 56 patients in the age 8–17 years. Cohort of patients consist from three age groups: 8–11 years (n=13), 12–14 years (n=28) and 15–17 years (n=15). Examination was done with X-rays, CT and Ultrasound, specialy in the cases where the damage of ligamentous apparatus was suspicious. The main method of treatment was surgical — osteosynthesis by pins, plates and screws. In the rehabilitation period the legs were immobilized by Plaster of Paris for 4–6 weeks. Results. In majority of cases the outcomes in the period of 6–8 weeks after trauma were good and satisfactory. The method of laser Doppler fluometry was performed in 16 cases in follow up period after trauma for examination of the regional blood circulation as a argumentation of regeneration process. Conclusion. The different choice in treatment of compound fractures of the distal part of the shin bones according to morphological changes in adolescence permits to aid good results in majority of caces.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):11-23
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REVIEWS
Cardiac Rehabilitation
Sarana A.M., Kamilova T.A., Lebedeva S.V., Vologzhanin D.A., Golota A.S., Makarenko S.V., Apalko S.V.
Abstract

Cardiac rehabilitation based on exercise therapy is a valuable treatment for patients with a broad spectrum of cardiovascular diseases. Current guidelines support its use in patients with stable chronic heart failure and coronary artery disease, after myocardial infarction, acute coronary syndrome, coronary artery bypass grafting, coronary stent placement, and valve surgery. Its use in these conditions is supported by a robust body of research demonstrating improved clinical outcomes. The significant clinical improvement obtained through the regular training in patients with cardiovascular diseases is the result of a complex interplay of different effects: 1) improved cardiopulmonary efficiency and pulmonary functional capacity; 2) amelioration of myocardial perfusion by reducing endothelial dysfunction and by inducing new vessel formation; 3) improved myocardial contractility; 4) counteract the muscle wasting and cachexia; 5) reduction of the systemic inflammation; 6) attenuation of the sympathoexcitation, a typical feature of CHF, even in the persistence of cardiac dysfunction. Despite this evidence, cardiac rehabilitation referral and attendance remains low and interventions to increase its use need to be developed.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):24-39
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Reconstruction of Valular Bones Defects Using CAD/CAM Technology at the Stage of Rehabilitation: State of the Problem
Vorobyev A.N., Pryanikov I.V., Yakovleva A.V., Shaybak A.A.
Abstract

The number of victims with difficult defects of the skull bones, which should restore the integrity of the skull is growing annually, both in connection with the increase in severe traumatic brain injury (TBI), and in connection with the expansion of indications for decompressive craniotomy not only in traumatic brain injury, but also vascular disease, neuro-Oncology for the relief of hypertension-dislocation syndrome. Cranioplasty at the stage of early rehabilitation of patients after decopressive craniotomy is an important condition for effective rehabilitation measures. Currently, titanium, polyether ethyl ketone (PEEK), polymethyl methacrylate (PMMA) and hydroxyapatite are actively used as the material for the implant. Unfortunately, none of the synthetic materials used meet the conditions of the «perfect implant» by 100%. CAD/CAM 3D printing technologies are used to achieve absolute accuracy of the implant that replicates the missing part of the patient’s skull bone, which is especially important in the presence of extensive and complex defects. The use of this technology at the preoperative stage directly in the medical institution where the cranioplasty will be performed avoids additional logistics, reduces the time from the patient’s admission to the hospital before the operation and reduces the cost of manufacturing implants, making them more accessible to healthcare institutions. also, the absence of the need for intraoperative implant adjustment significantly reduces the operation time, reduces the risk of infectious complications and complications associated with prolonged general anesthesia. The favorable course of the postoperative period allows you to resume rehabilitation activities on the third or fourth day after cranioplasty.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):40-47
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Regenerative Rehabilitation for Bone Tissue Damage
Golota A.S., Makarenko S.V., Sсherbak S.G., Kamilova T.A.
Abstract

The article is devoted to the analysis of the current state of regenerative and rehabilitative treatments in orthopedics, the possibilities of restoring of bone lost due to injuries or diseases. An overview of the main methods and approaches to enable effective regenerative and rehabilitation measures is given. The study of the molecular genetic basis of mechanotransduction and mechanotherapy will allow the identification of genes and molecules, the expression levels of which can serve as biomarkers of the effectiveness of regenerative-rehabilitation measures. These mechanisms are potential therapeutic targets for stimulating of regeneration of bones. A special section is devoted to the study of the characteristics of cellular technologies in the treatment of injuries and diseases of these tissues. The focus of the article is on the choice of an individual approach, both when conducting basic scientific research and developing rehabilitation programs. All this will significantly improve patient outcomes.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):48-62
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High-Frequency Ventilation in the Treatment of Acute Respiratory Failure
Perepelitsa S.A., Kuzovlev A.N.
Abstract

The need for respiratory therapy can reach 90% depending on the category of the intensive care unit and intensive care unit (ICU). Currently is a wide selection of respiratory therapy methods, including fully controlled mechanical ventilation and assist ventilation. The widespread use of mechanical ventilation and its varieties significantly reduced the mortality of ICU patients. However, the mortality of patients from acute respiratory distress syndrome, nosocomial pneumonia, and newborns with respiratory disorders remains high. High-frequency mechanical ventilation (HFMV) is an alternative treatment for severe respiratory failure, but the frequency of use is not yet sufficient. Three main types of HF ventilation is currently available: high-frequency positive pressure ventilation (HFPPV), high-frequency jet ventilation (HFJV) and high-frequency oscillatory ventilation (HFOV). There is an opportunity to choose a specific mode which will be most applicable for a particular patient. The use of the HFOV method allows the successful treatment of newborns with severe respiratory failure due to primary surfactant deficiency, meconial aspiration or multiple organ failure. Recently high amount of publications appeared on the possibilities of non-invasive HFMV in both adult patients and in pediatrics. This mini-review is devoted to this problem.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):63-73
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Biomarkers and Target Therapy for Lung Cancer
Shneider O.V., Kamilova T.A., Golota A.S., Sarana A.M., Sсherbak S.G.
Abstract

Precision (target) medicine is proposed as a new strategy to identify and develop new highly selective drugs against specific targets for the disease and more precise tailoring of medicines to the target populations of patients. Precision medicine can be an important approach to create more novel and safer therapeutics (tyrosine kinase inhibitors, tumour specific monoclonal antibodies) for patients with gene mutation, aberrations, or protein over-expression. Precision medicine requires an understanding mutational processes, and heterogeneity between cancer cells during tumor evolution. The present review briefly define various heterogeneities and potential associations with drug efficacy and resistance, emphasize the importance to develop functional biomarkers to monitor drug efficacy and resistance, and define opportunities and challenges of precision medicine for clinical practice.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):74-94
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A Psychological Portrait of a Teenager in the Posttraumatic Confusional State
Bykova V.I., Tyutyukina A.I., Sidneva Y.G., Valiullina S.A.
Abstract

The Russian statistics demonstrate that in Russia, brain injuries are increasing every year what is particularly tragic if to speak about children. After traumatic brain injury (TBI), the process of consciousness restoration develops in stages. In Russian science, stages of mental recovery in adults are described by the neuropsychiatric group of researchers from Burdenko Institute of Neurosurgery. The authors have introduced the term «amnestic confusion» to designate the stage at which there is a possibility to have the verbal contact with amnestic defects and disorders of orientation in time and space. In foreign literature, this stage is defined as «post-traumatic state of confused consciousness» (PTCS). In children (adolescents), the state of confused consciousness after traumatic brain injury is met in about 80%. The aim of the study was to make a detailed description and phenomenological analysis of some psychological characteristics of the confused state in adolescents after brain injury what will add to the overall picture of medical and neuropsychological examinations. 62 teenagers in the confused consciousness state after TBI were taken into the study. The authors present their observations and analysis of such psychological phenomena as behavioral and emotional characteristics, social intelligence, gender and age identification.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):95-103
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Biomarkers of Carotid Stenosis
Sсherbak S.G., Kamilova T.A., Lebedeva S.V., Vologzhanin D.A., Golota A.S., Makarenko S.V., Apalko S.V.
Abstract

Early recognition of rupture-prone atherosclerotic lesions in patients with high-graded carotid stenosis is an important clinical problem for preventing ischemic stroke. Various pathophysiological mechanisms are responsible for the progression and instability of plaques, such as changes in lipid composition, infiltration by immunoinflammatory cells and degradation of the extracellular matrix of the vascular wall by matrix metalloproteinases, enhanced inflammatory response and plaque neovascularization. These features are the main cause of plaque rupture and, as a consequence, neurologic symptoms. Therefore, matrix metalloproteinases and inflammatory factors can serve as possible markers for patients with severe unstable stenosis of carotid arteries. Due to the heterogeneity of atherosclerotic lesions, only one biomarker is not enough to reliably predict the development of a stroke. The use of a combination of biomarkers is better correlated with clinical data and, therefore, exceeds the analysis of individual factors. To increase the overall sensitivity and specificity and more reliable diagnosis of stroke in patients with symptomatic and asymptomatic carotid stenosis, the biomarker panel should include independent biomarkers. Further preclinical experiments and clinical trials are needed to assess the significance and precise definition of the threshold levels of such biomarkers before they can be used in clinical practice.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):104-130
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MESSAGES & CASE REPORTS
Experience in the Rehabilitation of Patients After Removal of Malignant Neoplasms of the Central Nervous System: A Clinical Case
Stern M.V., Polkovnikova E.V., Petrova M.V.
Abstract

Background. Early rehabilitation of patients after removal of neoplasms is an urgent task of modern rehabilitation. Clinical case description. This clinical example describes an example of rehabilitation and dynamics of recovery in a patient after removal of glioblastoma. After removal of a malignant neoplasm of the central nervous system, the patient underwent a course of rehabilitation measures within the framework of hospitalization at the Federal Research Center for Clinical Center of the Russian Federation. Conclusion. Patients after removal of malignant neoplasms are shown early active rehabilitation in order to compensate for neurological and mental deficits after removal of neoplasms of the central nervous system.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):131-138
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New Approach to the Surgical Treatment of Cardioesophageal Cancer in the Context of the COVID-19 Pandemic (Case Report)
Khorobryh T.V., Agadzhanov V.G., Klaushuk A.E., Osmanov E.G., Yakovlev A.А.
Abstract

Background. The wide and rapid spread of the new coronavirus infection, unfortunately, makes its own adjustments in clinical practice, including in the promotion of specialized care for oncological patients. Clinical case description. The authors demonstrated an example of a successful radical treatment of adenocarcinoma of the esophageal-gastric junction, complicated by dysphagia and recurrent bleeding from the tumor. Аn integrated approach, gastrostomy, adequate correction of concomitant diseases and timely vaccination against COVID-19 made it possible to carry out a full-fledged intervention in a timely manner. Conclusions. Radical treatment of patients with gastrointestinal toncological diseases in a severe viral pandemic is possible. Emergency vaccination significantly reduces the risk of developing severe respiratory and other disorders.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):139-141
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New methods and technologies, discussions
Optimization of Step-By-Step Care for Patients in Intensive Care Units Based on Grade 6 of the Rehabilitation Routing Scale
Belkin A.A., Rudnik E.N., Belkin V.A., Pinchuk E.A., Lipovka N.S.
Abstract

Introduction. Evaluation of ICU patients on specialized scales, such as the modified Rankin scale (mRS) and the rehabilitation routing scale (RRS), allows you to determine the degree of dependence on outside help in connection with the development of PICS syndrome, to decide on the level of complexity of the upcoming rehabilitation, and to route the patient to the appropriate rehabilitation center or palliative care department. Aims: Analysis of the experience of application RRS in the system of routing patients in intensive care units for rehabilitation treatment. Methods. As a result of the application of the routing algorithm based on the application of both scales, 224 patients with the level of dependence of RRS 5–6 (mRS 5) were selected for the examination of the rehabilitation potential and the re-habilitation attempt during 2019. Results. At the end of the rehabilitation course, 60 patients showed a decrease in the level of dependence to 3–4 points for both mRS and RRS. In 164 patients, the rating on the Rankin scale did not change (mRS 5), while the score on the RRS score of dependence in 135 decreased to 5 points. By the time of discharge, 29 patients with CNS continued to meet the criteria of RRS 6. All of them were verticalized to the level of landing in the chair and included in the remote tele patronage. During the quarterly visits, 9 patients showed signs of realizing their positive prognosis, underwent repeated rehabilitation courses during 2020–2021, and reduced the level of dependence to RRS 4–5. In practical terms, a decrease in the grade of SRM to 5 indicated that the patient was ready to stay at home, while patients with SRM 6 remained in need of highly qualified care, requiring at least a referral to the palliative care unit. From the point of view of the mRS scale, both described patient categories corresponded to 5 points, i. e., based on the assessment of the patient’s condition according to mRS, it was not possible to draw conclusions about further patient management tactics. Conclusions. Thus, the experience of using the RRS scale demonstrated its effectiveness in routing patients with acute cerebral injury and showed greater sensitivity and specificity in comparison with mRS.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):142-148
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Rehabilitation Route for a Child with Cerebral Palsy: the Experience of Chuvashia
Yakovleva S.K., Andreeva V.E., Preobrazhenskaya E.V., Petrova R.V., Milova O.I., Shafeykina E.V., Makarova E.V.
Abstract

The most common cause of neurological disability in childhood is cerebral palsy. The objectives of the treatment of children with cerebral palsy are the acquisition and maintenance of new motor skills; prevention of the development of contractures and other secondary orthopedic complications; decrease in the level of pain; improving the level of childcare. At the same time, the provision of treatment and rehabilitation assistance to children with cerebral palsy requires an integrated, systematic approach. The article describes the route of rehabilitation of children with cerebral palsy in the Chuvash Republic from the moment of diagnosis until reaching the age of 18. The study was carried out on the basis of an analysis of data from the regional register of children with cerebral palsy at all stages of treatment and rehabilitation (habilitation). The first stage includes the identification of risk groups for cerebral palsy, conservative, surgical specialized medical care. The register of children with cerebral palsy made it possible to keep records of patients at the stages of treatment and rehabilitation with an assessment of the results. At the second stage, high-tech conservative and surgical treatment is carried out. After operations, patients are sent for rehabilitation to a 24-hour hospital or to a Rehabilitation Center for Children (over 3 years, 1.5 thousand children were treated, 25.7% — after operations). The third stage is organized at the outpatient clinic level and in specialized sanatoriums. For 2014–2018 the coverage of children with cerebral palsy with conservative treatment increased 1.9 times, with botulinum therapy — 2.6 times, the proportion of those who received surgery decreased to 22.4%. 92.7% of patients of the Register are covered by conservative treatment. 33.3% of operated children were referred for sanatorium-resort treatment. The control section of the rehabilitation results showed an increase in the proportion of children with improved gait quality, the ability to stand independently, walk (with support), and an increase in the average level of physical activity. A multi-level system of interagency interaction in the provision of treatment and rehabilitation assistance to children with cerebral palsy in Chuvash Republic made it possible to ensure a sufficient amount of basic and availability of highly qualified medical care, effective management and control of the stages of rehabilitation.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):149-158
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Underwater Vacuum Whirlpool in Medical Rehabilitation of Patients with Postcovid Syndrome
Shakula A.V., Miroshnikov A.I.
Abstract

Postcovid syndrome is included in the International Classifier of ICD-10 Diseases in the formulation «Post COVID-19 condition» — these are symptoms, Lasting more than 12 weeks, unexplained by an alternative diagnosis, able to change over time, disappear and re-emerge, affecting many body systems. By the coronavirus infection, the air vesicle are damaged, reduction of erythrocytes and hemoglobin, inflammation of the walls of blood vessels. Using the underwater vacuum hydromassage in the complex medical rehabilitation programs for patients who have undergone COVID-19 allows to infuse microcirculation and lymph flow, which has a beneficial effect on the skin, musculoskeletal systemand internal organs.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):159-162
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Organization of Specialized Medical Care for Patients with the New Coronavirus Infection COVID-19 on the Basis of a Multidisciplinary Hospital
Esipov A.V., Pavlov A.I., Nemytin Y.V., Solovov A.V., Khaev A.V.
Abstract

The first experience of organizing specialized care for patients with the novel coronavirus infection COVID-19 on the basis of the leading multidisciplinary hospital of the Ministry of Defense of Russia — FSBI «3rd Central Military Clinical Hospital named after A. A. Vishnevsky». Aims: to scientifically substantiate and develop organizational and methodological recommendations for re-profiling a multidisciplinary hospital to create a multifunctional medical center for the treatment of the new coronavirus infection COVID-19. Based on the regulatory and organizational and methodological documents (Orders and Resolutions of the Government of the Russian Federation, orders of the Ministry of Health of the Russian Federation, directives and orders of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation), a set of measures was taken to create a multifunctional medical center for the treatment of the new coronavirus infection COVID-19. Algorithms for organizational, diagnostic and therapeutic resource-saving technologies, as well as standard operating procedures for assisting patients with the novel coronavirus infection COVID-19, have been developed and tested. Within the framework of the «medical association» of the Federal State Budgetary Institution «3 CVKG im. A. A. Vishnevsky», the Ministry of Defense of Russia created a system for the provision of specialized medical care to patients with the new coronavirus infection COVID-19 with the established routing and provision of specialized medical care with elements of high-tech medical care, including extracorporeal membrane oxygenation, biological anti-cytokine therapy. Conclusion. The accumulated experience in the work of the newly created center for the treatment of patients with the new coronavirus infection COVID-19 can be used for further medical activities of medical organizations of military and civilian health care.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):163-169
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Spa Organizations: the Possibility and Effectiveness of Use During Regime-restrictive Measures on the Non-proliferation of Coronavirus Infection
Sobolev A.V., Gulevaty G.V., Kuznetsov V.M., Shakula A.V.
Abstract

The work summarizes the first results on the organization of regime-restrictive measures on the non-proliferation of the new coronarovirus infection in the conditions of the spa organization. The use of spa organizations for a special period of regime-restrictive measures to non-proliferation of new coronarovirus infection is verypromising.The experience and recommendations developed can be used in the organization of observatories.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(1):170-172
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