Vol 3, No 4 (2021)

REVIEWS

Circadian Rhythms and Chronic Consciousness

Kanarskii M.M., Stern M.V., Vorobieva I.S., Gorshkov K.M., Krylova T.N., Gorlachev M.M., Gudojnikova V.V., Kopylov P.M., Mirzaev F. ., Borisov I.V., Nekrasova Y.Y.

Abstract

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.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(4):340-347
pages 340-347 views

HLA and Cancer

Kamilova T.A., Golota A.S., Vologzhanin D.A., Shneider O.V., Sсherbak S.G.

Abstract

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.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(4):348-392
pages 348-392 views

New methods and technologies, discussions

Methodical Aspects of the Deployment of a Medical Rehabilitation Center Based on the Military SPA Organization

Shakula A.V., Trebina N.P., Kosov V.A., Svist N.V.

Abstract

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.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(4):393-398
pages 393-398 views

Remote Rehabilitation: Role and Opportunities

Borisov I.V., Bondar V.A., Kanarsky M.M., Nekrasova Y.Y., Reutova N.V., Borisova N.P., Matafonova S.N., Yurasova M.P., Yevstifeyev V.V.

Abstract

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.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(4):399-408
pages 399-408 views

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