The Effectiveness of TV Rehabilitation as a Component of a Comprehensive Home Rehabilitation Program for Patients Diagnosed with Coronary Heart Disease (Angina Pectoris, Functional Class I) and Obesity of the First Degree

Objective To detect the level of visfatin in the peripheral blood ofpafients with coronary atherosclerotic heart disease (coronary heart disease),and investigate the conelation between the level of visfatin and the lesion degree of coronary heart disease.Methods Two hundred and twenty patients who were diagnosed as coronary heart disease by coronary artery angiography from January to June 2011 (coronary heart disease group) were enrolled in this study,including 74 cases with stable angina pectoris(stable angina pectoris group),60 cases with unstable angina pectoris (unstable angina pectoris group),and 86 cases with acute myocardial infarction (myocardial infarction group).And 20 healthy persons with normal coronary artery angiography were selected as control group.The biochemical parameters of triglyceride (TG),total cholesterol (TC),high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were detected by biochemistry autoanalyzer.The level of serum visfatin was detected by ELISA analysis.The serum biochemical parameters and serum visfatin among all the groups were compared and the correlation between them was analyzed.ResuIts The level of serum visfatin of coronary heart disease group [(34.07 ±5.51) μg/L] was significantly higher than that of control group [(13.22 ±3.17) μg/L](P＜0.05).TC and LDL-C of different coronary heart disease groups had no significant differences compared with that of control group (P ＞ 0.05).TG,H DL-C and serum visfatin of stable angina pectoris group,unstable angina pectoris group and myocardial infarction group [(1.44 ±0.27) mmol/L,(1.16 ±0.12) mmol/L,(21.36 ± 3.35) μg/L; ( 1.84 ±0.32) mmol/L,(1.01 ± 0.08) mmol/L,(27.78 ±4.47) μg/L; (2.31 ±0.34)mmol/L,(0.93 ± 0.06) mmol/L,(33.14 ± 5.66) μ g/L] had statistical significance compared with those of control group [(0.93 ±0.25) mmol/L,(1.48 ± 0.24) mmol/L,(13.22 ±3.17) μg/L](P＜0.05 or ＜0.01).TG,C,ensini score and serum visfatin of unstable angina pectoris group were significantly higher than those of stable angina pectoris group and HDL-C was obviously lower than that of stable angina pectoris group (P ＜0.05).Gensini score and serum visfatin of myocardial infarction group were significantly higher than those of unstable angina pectoris group and HDL-C was obviously lower than that of unstable angina pectoris group (P ＜ 0.05).Spearman correlation analysis showed that the level of serum visfatin of coronary heart disease group was positively correlated with TG and Gensini score (P ＜0.05 or ＜0.01 ) and negatively correlatedwith HDL-C (P ＜ 0.01 ),and had no correlation with TC and LDL-C (P ＞ 0.05).Conclusions The highlevel expression of visfatin in the peripheral blood may be a risk factor of coronary heart disease.The changes of serum visfatin can reflect the lesion severity degree of coronary artery. Key words: Coronary disease; Visfatin; Severity of coronary artery disease

The aim: To determine the diagnostic value of non-invasive methods of GERD diagnosis based on questionnaire data and a diagnostic test with a proton pump inhibitor (PPI) with Rabeprazole in patients with coronary heart disease (CHD). Materials and methods: 90 patients were under observation, namely, 68 patients with coronary heart disease with concomitant essential arterial hyperten¬sion (EAH), 6 patients with coronary artery disease + arrhythmias, and 18 - others diseases. All patients were surveyed according to the GerdQ questionnaire, followed by PPI testing with Rabeprazole, and body mass index (BMI) was calculated for all the patients. A BMI of 18.5-24.9 kg/m2 was considered as normal body weight, and a BMI > 24.9 kg/m2 was considered overweight. Results: Based on the results of the questionnaire, it was established that the most common complaints typical for GERD were noted by patients with CHD in combination with EAH. There were 48 of such patients and, depending on BMI, they were divided into 2 groups: 1st group (n=14) - patients with CHD+EAH+GERD with normal body weight and 2nd group (n=34) - overweight patients with CHD+EAH+GERD. In patients of group 1, typical symptoms of GERD prevailed (in 71.4% of patients), and in patients group 2, the distribution of typical and extra-esophageal symptoms did not differ significantly (52.9% vs. 47.1%). Among the extraesophageal manifestations, pain behind the sternum (in the projection of the esophagus) was significantly more often recorded in patients of group 1, and rhythm disturbances in patients of group 2 (43.8% and 75.0% of patients, respectively, p<0.05). The results of the GerdQ questionnaire showed a direct relationship between GERD, body weight and symptom score. Patients with GERD+normal body weight had a mean score of 6 for classic gastroesophageal reflux symptoms, while patients with GERD+increased body weight had a mean score of 7. The sensitivity of the questionnaire was 78.7%, and the specificity - 92.9%. According to the PPI test, in the 1st and 2nd groups, already in the first three days, 28.5% and 23.5% of patients noted the disappearance of heartburn and after 10 days - 85.7% and 64.7%, respectively. Over the entire period, that is, after 14 days of observation, 85.7% of patients in the 1st group and 73.5% in the 2nd group noted improvement. Conclusions: It has been established that questionnaires based on the GerdQ questionnaire followed by a PPI test with Rabeprazole in patients with coronary heart disease combined with essential arterial hypertension have a high diagnostic value and can be used for early diagnosis and effective treatment of GERD.

Objective. To study the effect of Thiotriazoline in patients with post-infarction chronic heart failure (CHF).&#x0D; Materials and methods. We examined 46 patients with ischemic heart disease (IHD) who had undergone myocardial infarction. The average age was 50.8±3.2 years; men – 32 (70 %), women – 14 (30 %). All patients were examined in the form of anamnesis and examination, general clinical and biochemical studies, electrocardiography. The assessment of CHF manifestations in patients of both groups was carried out according to the New York classification based on the results of the 6-minute walk test. The distribution into two groups was carried out according to the following parameters: the 1st group included 26 (56.5 %) patients (men – 19 [73.1 %], women – 7 [26.9 %]), who, along with basic therapy, received Thiotriazoline at a dose of 8.0 intravenously jet for 10 days; the 2nd (control) group included 22 (43.5 %) patients (men – 14 [63.6 %], women – 8 [36.4 %]) who received standard therapy (β-blockers, angiotensin-converting enzyme inhibitors, calcium antagonists, nitrates). Distribution by class of CHF at the time of inclusion in the study was observed in 1st group in 21 (80.7 %) patients: I functional class (FC) – 2 (9.5 %), II FC – 11 (52.4 %), III FC – 6 (28.6 %) and IV FC – 2 (9.5 %). In 2nd group – (77.3 %) patients: I FC – 3 (17.6 %), II FC – 6 (35.3 %), III FC – 7 (41.2 %) and IV FC – 1 (5.9 %) patients. According to the Minnesota questionnaire in group 1, the quality of life indicators (average value in points) were 71.1±1.8 points (p&lt;0.05). The 2nd group had 67.9±1.9 points (p&lt;0.05).&#x0D; Results and discussion. Positive hemodynamics and assessment of CHF manifestations by FC served as a clear statement of improvement in the quality of life. In the group receiving Thiotriazoline, the number of patients with II FC increased from 11 (42.3 %) to 14 (54 %), I FC – from 2 (9.5 %) to 6 (23 %) compared to the initial data due to patients from III FC and IV FC. The number of patients with III FC decreased to 2 (7.8 %) and IV FC – to 1 (3.8 %), and in the control group there was a slight negative dynamic (III FC – to 2 (9.5 %) and IV FC – without changes). The quality of life according to the Minnesota questionnaire indicated a positive trend. In group 1, the quality of life indicators improved from 71.1±1.8 to 53.3±0.6 points (p&lt;0.01); in group 2 – from 67.9±1.9 to 63.3±1.9 points (p&lt;0.05).&#x0D; Conclusions. Thiotriazoline is a cytoprotector of the highest class, in particular, a myocardoprotector, which, when used (from 10 days in a hospital and then up to 1 month), improves the metabolism of the heart muscle, stabilizing intracellular mechanisms. Thiotriazoline is indicated for all patients with IHD who have suffered a myocardial infarction in the early stages of CHF.

The purpose of the study was to determine the changes in the functional and structural-functional state of the cardiovascular system of individuals with ischemic heart disease against the background of obesity. Materials and methods. 105 people of the diagnostic group were examined: 70 people with ischemic heart disease and obesity (1st diagnostic group) and 35 patients with ischemic heart disease without obesity (2nd diagnostic group), who were treated in the municipal non-commercial enterprise «City Clinical Hospital No. 27» of Kharkiv Regional Council. In the 1st diagnostic group, the majority of patients with I (26 (37.1%) degree of obesity, unlike II (24 (34.3%) and III (20 (28.6%). The control group was formed by 35 healthy persons without any diseases of the cardiovascular system. In the 1st diagnostic group there were 51 (72.9%) ill female and 19 (27.1%) male, in the 2nd – 24 (68.6%) male and 11 (31.4%) female. Age of the 1st and 2nd diagnostic groups amounted to 63.6±8.8 and 69.7±7.9 years respectively, and the control group – 35.2±4.9 years. Body weight and body weight index (p &lt; 0.001) was higher in the 1st diagnostic group (respectively 101.3±15.8 kg and 36.2±4.4 kg/m2) compared to the 2nd (respectively 71.9±8.8 kg and 24.2±1.4 kg/m2) and control (respectively 64.3±7.4 kg and 22.1±1.2 kg/m2). Results and discussion. The presence of arrhythmic disorders of cardiovascular system in coronary heart disease was noted, especially against the background of obesity. The predominance of the cardiovascular system characteristics of the functional state in coronary heart disease with obesity in comparison with the monocurrent coronary heart disease has been determined: accordingly, diastolic arterial pressure is 91.7±7.8 and 89.3±9.1 mmHg; heart frequency – 81.9±11.2 and 78.8±9.5 b/min and pulse 81.2±9.8 and 78.2±9.6 b/min. The advantage of cardiovascular system characteristics in obesity of the III degree in comparison with the II and I degrees is fixed: accordingly, systolic arterial pressure is 160.0±15.9, 158.8±16.1 and 152.7±11.8 mmHg; diastolic arterial pressure – 93.5±8.1, 91.9±8.8 and 90.19±6.6 mmHg; heart rate – 82.0±7.4, 81.4±10.6 and 82.3±14.2 b/min and pulse – 82.0±7.4, 81.0±10.3 and 80.8±11.2 b/min. Conclusion. A reliable possibility of provoking significant reductions in the characteristics of the heart functional state in patients with coronary heart disease and obesity compared with the control group was determined. There is a significant advantage of changes in the structural characteristics of the heart in coronary heart disease and obesity and monocurrent coronary heart disease in contrast to the control group. Significant (p &lt; 0.001) increase in aortic diameter was determined in patients with single coronary heart disease (3.30±0.33 cm) and on the background of obesity (3.22±0.29 cm) compared with the control group (2.86±0.14) and intentionally comparable values of E and A and their ratios in the 1st and 2nd groups (respectively E 0.71±0.18 and 0.69±0.17 cm/s (p = 0.463); A – 0.81±0.19 and 0.85±0.24 cm/s (p = 0.342) and E/A – 0.90±0.27 and 0.82±0.27 (p = 0.102). The predominance of the structural and functional state of the heart values in III and II degrees of obesity compared to I degree was intentionally determined

Cardiovascular diseases (CVD), including coronary heart disease (CHD), continue to be the major causes of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Both CHD and T2DM are the most dangerous and widely spread conditions. According to research data, a high overall prevalence of CVD in type 2 DM has been established, with CHD as the most prevalent CVD type. Objective — to determine the prognostic possibilities of estimation the risks of the development of coronary heart disease and type 2 diabetes comorbidity and to work out an appropriate prognostic model. Materials and methods. A randomized controlled single‑center prospective case‑control study was conducted, Examinations involved 100 patients, allocated into two groups: subjects of the 1st group (n=30) had isolated CAD, and patients from the 2nd group (n=70) had CAD against the T2DM background. The control group consisted of 20 practically healthy subjects. Assessments included sirtuin‑1 and 8‑isoprostane levels. Statistical analysis of the obtained data was performed using the IBM SPSS 25.0 application program package for Windows. Results. The following significant predictors of the development of CHD and T2DM comorbidity were determined: patients’ age (increased the probability by 7.1%) and body mass index (BMI, which increased the probability by 13.3%). The higher risk of CHD and T2DM was defined with the increasing 8‑isoprostane levels and decreasing sirtuin‑1 levels by 2.1% and 79.4%, respectively. In comparison with II functional class (FC) angina pectoris, the presence of III FC significantly (p=0.005) associated with a 66.3% decrease in the probability of the developing of CHD and T2DM comorbidity. In the combined analysis, the overall effect on the probability of developing CHD and T2DM comorbidity was determined with an increase in age by 8.1%, BMI by 18.9%, 8‑isoprostane by 2.6%, and a decrease in sirtuin‑1 by 81.0%, and presence of ІІІ FC of angina pectoris — by 82.8%. A mathematical equation for predicting the development of the comorbid course of CHD and T2DM has been worked out. Conclusions. Patients’ age, body mass index, levels of 8‑isoprostane and sirtuin‑1, presence of III FC angina pectoris have been established as the most important predictors of the development of coronary heart disease and type 2 diabetes comorbidity.

Introduction. From an early age, patients with cerebral palsy (CP) require long-term, individual rehabilitation assistance to maintain impaired functions, develop self-service, social activity, and improve the quality of life (QOL). Changes in the QOL indices make it possible to adequately and timely determine the effectiveness of the ongoing medical rehabilitation in CP patients. Aim: to determine the effectiveness of short-term and long-term rehabilitation programs for CP patients. Materials and methods. One hundred nine 5 to 18 years CP patients were examined. Of these, the 1st group consisted of 34 children who were rehabilitated under a long-term comprehensive program within the framework of the First Step project. The 2nd group consisted of 75 CP patients underwent a single rehabilitation course for 28 days. The comparison group consisted of 115 conditionally healthy children of the same age. The leading criterion for evaluating the effectiveness of rehabilitation programs was the quality of life in patients, determined by questioning the legal representatives of patients using the Russian version of the Health Utilities Index (HUI) questionnaire for children from 5 to 12 years old, as well as the Proxy version for over 12 years children by self-assessment (HUI23S2RU.15Q, Self-version). Results. The total quality of life in CP patients was found to be low compared with conditionally healthy children in such aspects as speech, the ability to move, fine motor skills, and cognitive development. When analyzing the trend in multi-attribute utilita­rian indices (HUI3) of QOL in CP patients in the 1st and 2nd groups after 12 months. from the beginning of the first rehabilitation, significant positive changes in overall quality of life were determined in patients with cerebral palsy of the 1st group who received comprehensive rehabilitation compared with the level in patients of the 2nd group who underwent rehabilitation once. In CP patients from the 1st group, there was revealed a significant improvement in quality of life in the aspects of “Ability to move”, “Cognitive development” and “Pain”. The analysis of the cost-benefit data showed that the cost per 1 QALY in CP patients of the 2nd group rehabilitated under the short-term program is less. However, in patients with cerebral palsy from the 1st group, a higher usefulness (effectiveness) of a long-term rehabilitation program has been established. Conclusion. A long-term comprehensive rehabilitation program for patients with cerebral palsy is effective and significantly improves the quality of life of sick children and their families.

Objective To evaluate the efficacy and safety of cardiac shock wave therapy (CSWT) in coronary heart disease in elderly patients. Methods Eleven patients with refractory angina pectoris were enrolled. The ischemic area was determined by the 99mTechnetium-MIBI single-photon emission computed tomography (SPECT) and coronary angiography, and treated with CSWT. The CSWT were performed during treatment of 3 months, with 9 times totally. The clinical evaluations included the clinical symptoms, Canadian Cardiovascular Society (CCS) class scores, New York Heart Association class (NYHA), Seattle angina questionnaire (SAQ), 6-min walking distance and the use of dosage of nitroglycerin, left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF). The amelioration of ischemic myocardial was analyzed by SPECT. The safety of CSWT was evaluated by changes in clinical symptoms, ECG monitoring, blood pressure and oxygen saturation, blood levels of creatine kinase, creatine kinase myocardial band isoenzymes (CK-MB), troponin T (TnT), alanine transfer enzyme (ALT), creatinine (CR), brain natriuretic peptide and high sensitive C reactive protein (hs CRP). Results The CCS class scores, NYHA, 6-min walking distance and the dosage of nitroglycerin were significantly improved at 4 and 12 months after treatment as compared with pretreatment. The steady state of angina pectoris and the frequency score in SAQ were significantly improved. The 21 cardio-vessel segments were treated, and the improvement rate of resting myocardial perfusion was 46.2% (6/13), the effective rate was 38.5% (5/13), and the obvious effective rate was 7.8% (1/13) after treatment. The improvement rate of loaded myocardial perfusion was 57.1% (12/21), the effective rate was 47.6% (10/21), and the obvious effective rate after treatment was 9.5% (2/21). There were no significant changes in levels of CK, CK-MB, TNT, ALT, Cr, BNP and hs CRP, heart rate, systolic blood pressure, diastolic blood pressure and oxygen saturation after treatment as compared with pretreatment. Conclusions The CSWT is a safe and effective treatment for coronary heart disease in the elderly, and the curative effect could maintain at least one year. Key words: Coronary disease; Radionuclide imaging; Extracorporeal cardiac shock wave

INTRODUCTION. Stroke is the leading cause of disability of the population. In addition to motor disorders, cognitive and affective disorders contribute to the development of disability. The development of effective neurorehabilitation programs aimed not only at reducing the severity of motor deficits, but also at timely correction of psychoemotional disorders in stroke patients is very relevant for restorative medicine. In view of the proven positive therapeutic effect of physical exercises on anxiety and depression, their protective effect on cognitive functions, it is of interest to study the effect of motor rehabilitation on psychoemotional disorders in stroke patients. AIM. To study the effect of sensorimotor rehabilitation on affective and cognitive disorders in patients in the recovery period of stroke in comparison with a complex psychotherapeutic technique. MATERIALS AND METHODS. The study examined 2 groups of patients in the recovery period of ischemic stroke (up to 2 years) with the presence of anxiety and/or depressive disorders, comparable in gender, age, duration and focus of stroke localization, severity of neurological deficit. The 1st group — 24 patients — received a course of sensorimotor rehabilitation without targeted impact on affective disorders; the 2nd group — 25 patients — a course of complex medical and psychological adaptation lasting 18 days. The effectiveness of rehabilitation was assessed using validated scales and questionnaires (Rivermead Mobility Index, 6-point muscle strength assessment scale, modified Ashfort spasticity scale; Berg balance scales, Beck depression, Spielberger-Khanin anxiety, MMSE, MoCA; Schulte Table Methodology, SS-QOL Stroke Quality of Life Assessment Scale). Statistical analysis was carried out using the StatTech v. 2.8.8 program (developed by Stattech LLC, Russia). RESULTS AND DISCUSSION. The preliminary assessment carried out in both groups showed a twofold predominance of anxiety states over depressive ones, concomitant cognitive impairments were detected in 88 % of patients, among whom attention disorders were most often recorded (there was no intergroup difference in these indicators). After completing the course of both sensorimotor and medico-psychological rehabilitation, both groups showed a significant decrease in the level of situational and personal anxiety on the Spielberger-Khanin scale, positive dynamics on the MoСа scale, the SS-QOL questionnaire, while a significant decrease in the level of depression on the Beck scale was registered only in patients of the 2nd group on against the background of the use of specialized psychotherapeutic techniques. CONCLUSION. Motor rehabilitation is positively comparable with complex medical and psychological adaptation, it affects anxiety and cognitive functions in patients with ischemic stroke, it can be considered as one of the effective ways to correct anxiety states and prevent cognitive impairment in these patients, while in the treatment of depression the priority is should be given to specialized medical and psychological intervention.

Dystrophinopathies — a group of hereditary X-linked neuromuscular diseases characterized by worsening fibrofatty degeneration of skeletal muscles, muscular weakness, low exercise tolerance, as well as orthopedic, cardiovascular and respiratory complications. Study of the effectiveness of physical medical rehabilitation in patients with neuromuscular diseases, evaluation of the influence of external and internal factors on functional capabilities and effectiveness of the conducted rehabilitation are highly relevant. Objective. To evaluate the effectiveness of physical medical rehabilitation of patients with dystrophinopathies at the outpatient stages of the disease’s course and the influence of anthropometric characteristics and functional status of patients’ motor capabilities. Material and methods. The study included 47 patients with genetically confirmed Duchenne muscular dystrophy (DMD) (the 1st group — 32 patients at an early outpatient stage, mean age 7.0±0.2 years; the 2nd group — 15 patients at a late outpatient stage, mean age 9.0±0.2 years) and 17 patients with Becker muscular dystrophy (BMD) (the 3rd group, mean age 12.0±1.2 years). All patients performed aerobic exercises 3 times a week, the duration of rehabilitation course was 4 months. The distance of 6-minute walk test (6MWT) with fatigue assessment on the visual analogue scale, the speed of rising from the floor with assessment of the functional class on a 6-point scale, the functional capacities on the Motor Function Measure (MFM) scale, dimension D1 (standing and transfers) were evaluated at baseline and after 2 and 4 months. Results. Positive dynamics has been revealed in the form of elongating 6MWT distance, increasing speed of tests for time performance with increase of test’s functional class, improvement of motor functions on the MFM scale at the end of case follow-up in the 1st and 3rd groups (p&lt;0.01). A high correlation of the patients’ motor capabilities with reduction of strength and speed indicators, moderate relationship with age and anthropometric indicators have been found (p&lt;0.01). Conclusions. Performance of aerobic exercises without weight combined with exercises on an ergocycle allows to improve motor capabilities in patients with DMD at the early stages and in patients with BMD. Exercising at the late stages of DMD can slow down the disease’s progression. The dynamics of motor capabilities’ indicators in regular performance of dynamic aerobic exercises are more influenced by the initial functional status, less — by age and concomitant overweight and high body mass index.

Оцінювання нутрітивного статусу у дітей з гострою дихальною недостатністю: проспективне обсерваційне когортне дослідження

The psychometric properties of four quality of life instruments used in cardiovascular populations.

In the fall of 1979, the National Heart, Lung, and Blood Institute held a conference on the decline in coronary heart disease (CHD) death rates. It was apparent that in the previous 10 to 15 years, the epidemic crested and began to fall.1 The reasons for this decline were unclear, but many hypotheses were offered. Explanations ranged from death classification artifact, new coronary care units, and coronary surgery to broad social change. Many were more than willing to take credit for this change, but few data were available. A search for explanations began. Article p 598 Three major themes emerged as possible explanations: (1) primary prevention through risk factor reduction, including public health measures such as reduction in cigarettes and clinical approaches such as lipid and blood pressure management; (2) modern care for acute coronary syndromes, including emergency services, coronary care units, and revascularization strategies; and (3) secondary prevention in those with known CHD, including revascularization, medications, and lifestyle approaches. Each of these has substantial clinical trial evidence to support its utility in reducing new cases (incidence), recurrent events, and/or death. Early attempts to understand the causes were hampered by a lack of data. Stern2 suggested that a decline in mortality was related to improved diet, reduced smoking, …

Relevance: Objective assessment of cerebral hemodynamics in patients with acute trauma received in combat conditions is a necessary condition for effective comprehensive treatment of sensorineural hearing disorders in such patients. Purpose: to study the quantitative and qualitative indicators of cerebral blood circulation in servicemen who received repeated acute trauma in real combat conditions, taking into account the state of auditory function. Materials and methods: Rheoencephalography indicators were analyzed in 75 patients with repeated acute trauma, who were divided into three groups of 25 people each depending on the severity of sensorineural deafness: mild, moderate and severe hearing impairment according to the international classification - 1st, 2nd and 3rd groups, respectively. Fifteen healthy individuals with normal hearing served as controls. We analyzed a total of 90 rheoencephalograms. The examination was carried out with the help of a computer rheograph of the company "DX - systems" (Ukraine). Results and discussion: According to the data of subjective audiometry, the subjects had sensorineural deafness with a descending, often abrupt, type of audiometric curve. Normal indicators of the state of cerebral blood circulation according to REG were not registered in any patient with repeated combat acute trauma. The examined patients had changes in the tone of cerebral vessels and obstruction of venous outflow, as well as a decrease in pulse blood filling, both in the carotid and in the vertebral-basilar systems. Thus, venous outflow obstruction occurred in the 1st group in 58,42 %, in the 2nd group – 86,91 %, in the 3rd group – 89,93 %. Cases of decreased tone: in the 1st group in 27,18 %, in the 2nd group – 18,12 %, in the 3rd group – 18,72 %. Unstable vascular tone was registered in 39,85 % of patients in the 1st group, 46,35 % in the 2nd group, and 49,85 % in the 3rd group. Reduction of pulse blood filling in the 1st group was recorded in 69,12 % of cases, in patients of the 2nd group – in 89,76 %, in patients of the 3rd group – in 94,36 %. Cerebral blood circulation disorders in the examined patients with repeated acute trauma, especially in the vertebral-basilar system, were evidenced by changes in the quantitative indicators α, dicrotic (DKI), diastolic (DSI) and rheographic (Pi) indexes of the REG curve in both systems of cerebral blood supply. Thus, in the carotid system in subgroups B, the DKI was in the 1st group – 48,26±0,85 %, in the 2nd group – 48,29±1,02 %, in the 3rd group – 58,34±0,50 %; DSI was 49,39±0,85 % in the 1st group, 49,40±1,04 % in the 2nd group, and 59,73±1,01 % in the 3rd group. Note that we observed a decrease in Ri in all studied groups and subgroups of patients with repeated combat acute trauma, regardless of the degree of auditory function impairment or decrease or increase in the tone of cerebral vessels. So, in the vertebral-basilar system, the Ri in subgroups B in the 1st group was 0,75±0,04, in the 2nd group – 0,53±0,05, in the 3rd group – 0,58±0,05. Thus, in patients with sensorineural hearing disorders after repeated combat acute trauma, there are significant deviations from the norm in the state of cerebral blood circulation according to REG, especially in the vertebral-basilar system, more pronounced in deeper lesions of the auditory analyzer. Conclusions 1. In patients with sensorineural hearing disorders after repeated combat acute trauma, there are substantial deviations from the norm in the state of cerebral blood circulation according to REG data, more pronounced in deeper lesions of the auditory analyzer. 2. Decreases in Ri occur in all studied patients with repeated combat trauma, regardless of the degree of impaired auditory function or decrease or increase in the tone of cerebral vessels. 3. According to REG data, servicemen with repeated combat acute trauma have impaired cerebral blood circulation, with the predominant complications being venous outflow, decreased pulse blood flow, and a tendency to decrease tone, or unstable tone of cerebral vessels. Significant (р&lt;0,05) deviations from the norm in DKI and Ri indicators indicate pronounced cerebral blood circulation disorders in repeated combat acute trauma, especially in severe auditory disorders. Keywords: sensorineural disorders, cerebral hemodynamic, acute trauma, cardiovascular system.

BACKGROUND: One of the leading factors complicating social adaptation after ischemic stroke is cognitive and motor impairment. AIM: This study aimed to evaluate the effect of rehabilitation using virtual reality technologies and the influence of the main clinical and functional parameters on virtual reality (VR) therapy in patients with different degrees of cognitive decline in the acute period of ischemic stroke. MATERIALS AND METHODS: This study examined 170 patients diagnosed with ischemic stroke with cognitive decline according to the Montreal Cognitive Assessment. Depending on the volume of therapy, the patients were divided into two groups: group 1 included 120 patients who received additional therapy using VR technologies (62 patients with moderate cognitive impairment, 58 patients with dementia), and group 2 consisted of 50 patients who received only basic therapy and standard methods of early rehabilitation. In group 1, on days 4–5 following basic therapy, rehabilitation using VR was performed. The Barthel Index (BI) scale, Rankin Scale (mRS), and National Institute of Health Stroke Scale (NIHSS) were used to examine cognitive and functional status, and tests were performed to assess cognitive functions, as well as neuroimaging scales ASPECTS, STRIVE, and MTA. The effectiveness of rehabilitation (ΔRE) was measured by the indicator of changes in the parameters of the VR system before and after treatment. RESULTS: A more significant improvement of the patient’s independence and regression of perceptual and executive functions was demonstrated in group 1 than in the control group. In patients with MCI, significant improvement was observed in all cognitive and functional parameters except semantic information processing, attention, and constructive praxis. In patients with dementia, improvement was noted in NIHSS, speech and amnestic disorders. In group 1, ΔRE was found to be associated with the parameters of perception, attention, semantic information processing, IQCODE, and NIHSS and the presence of hypertension and repeated stroke. In patients with MCI, ΔRE was correlated with lesion size, attention level, BI, mRS, and NIHSS and with age, sex, degree of IQCODE and STRIVE, semantic aphasia, and perceptual impairment in patients with dementia. CONCLUSION: The present study revealed a polymorphism of factors influencing the effectiveness of VR therapy in patients with varying degrees of cognitive decline. Modern approaches to VR rehabilitation of patients with post-stroke cognitive impairment require the development of individual methods of rehabilitation using immersion environment focused on the structure, etiology, and severity of cognitive deficit considering the degree of the patient’s functional state.

Objective To investigate the efficacy and safety of enhanced external counter pulsation(EECP)in treatment of coronary heart disease in patients aged 80 years and older. Methods The 336 consecutive elderly patients with coronary heart disease were treated in our hospital from May 2016 to October 2017 in a prospective study.The 168 coronary heart disease patients aged 80 years and older were divide into a control group(n=84)receiving conventional therapy(anti-platelet drugs, angiotensin converting enzyme inhibitors, angiotensin-receptor blocker, β-blockers, calcium antagonists, nitrates, statins), and EECP group(n=84)receiving enhanced external counter pulsation 0.5 h/time, 2 times per day, 36 days as a course as add-on therapy to conventional therapy.And 168 patients aged 60~79 years received the same therapy as those in EECP group.After one course of EECP treatment, the therapeutic effects were evaluated by Seattle angina questionnaire(SAQ)and Pittsburgh sleep quality index(PSQI), and the incidence of major adverse cardiovascular events and readmission rate were compared between groups of the EECP vs.control group and group of patients aged 60-79 years. Results The scores of SAQ and PSQI were better in the EECP group than in the control group after one course of EECP treatment, as follows: physical limitation(35.7±10.7 vs.26.0±12.1), anginal stability(53.3±22.9 vs.33.9±18.9), anginal frequency(39.6± 6.5 vs.30.4±21.1), treatment satisfaction(38.0±6.0 vs.33.7±4.7), subjective sleep quality(1.0±0.7 vs.2.5±0.7), sleep latency(1.3±0.6 vs.2.4±0.5), sleep duration(0.9±0.6 vs.2.3±0.6), habitual sleep efficiency(1.1±0.6 vs.2.5±0.6), sleep disturbances(1.2±0.4 vs.2.2±0.6), use of sleeping medication(1.2±0.6 vs.2.2±0.6), and daytime dysfunction score was 1.3±0.5 vs.2.3±0.6(P 0.05). Conclusions EECP treatment is relatively safe and effective for coronary heart disease patients aged 80 years and older. Key words: Aged, 80 and over; Coronary heart disease; Counterpulsation