Musculoskeletal Connective Tissue Research Articles

Exercise entrainment of musculoskeletal connective tissue clocks.

The musculoskeletal system, crucial for movement and support, relies on the delicate balance of connective tissue homeostasis. Maintaining this equilibrium is essential for tissue health and function. There has been increasing evidence in the last decade that shows the circadian clock as a master regulator of extracellular matrix (ECM) homeostasis in several connective tissue clocks. Very recently, exercise has emerged as a significant entrainment factor for cartilage and intervertebral disc circadian rhythms. Understanding the implications of exercise on connective tissue peripheral clocks holds promise for enhancing tissue health and disease prevention. Exercise-induced factors such as heat, glucocorticoid release, mechanical loading, and inter-tissue crosstalk may play pivotal roles in entraining the circadian rhythm of connective tissues. This mini review underscores the importance of elucidating the mechanisms through which exercise influences circadian rhythms in connective tissues to optimize ECM homeostasis. Leveraging exercise as a modulator of circadian rhythms in connective tissues may offer novel therapeutic approaches to physical training for preventing musculoskeletal disorders and enhancing recovery.

Study of morbidity with temporary disability of the population of the Samara region employed in various professions

One of the criteria that characterize the quality of health of the working population is the incidence of temporary disability. It is characterized by the prevalence of cases of the disease among employees who served as a valid reason for not showing up at the workplace. The main task of research on morbidity with temporary disability is the formation of an analytical block of information, its further justification and the proposal on a scientific basis of a set of measures aimed at reducing the morbidity of the population at the federal, regional and territorial levels, as well as at the level of a certain sphere of labor activity. Purpose of the study is to study the level of morbidity with temporary disability of the population of the Samara region and individual professional groups to determine the leading groups of pathologies. The accounting form No. 16-VN «Information on the causes of temporary disability» for 2015–2020 was used, a survey of 140 medical workers and 60 social workers was conducted. Statistical and sociological methods of analysis are applied. In 2020, in the Samara region, there was a significant increase in the incidence rate compared to 2019: for all reasons — by 36.3 % in cases and 54.9 % in days, due to illness— by 46 % in cases and 62.6 % in days. A similar trend was observed for the indicators for the city of Samara. The indicator of the duration of cases of disability in the Samara region and the city of Samara for 2020 compared to 2019 also tended to increase for all reasons (by 13.7 % and 13.9 %, respectively) and for the reasons of illness (by 11.9 % and 11.2 %, respectively). Respiratory diseases (81.6 %), infectious and parasitic diseases (27.7 %), and diseases of the musculoskeletal system (11.4 %) were dominant in the structure of morbidity with temporary disability in medical workers. Employees of social service centers had respiratory diseases in the 1st place (75.7 %), circulatory diseases in the 2nd place (49.3 %), and diseases of the musculoskeletal system and connective tissue in the 3rd place (27.4 %). A comparative analysis of the indicators of morbidity with temporary disability of the population of the Samara region in the dynamics for 2015–2019 and for 2020 revealed a significant increase in morbidity associated with the COVID-19 pandemic. Differences in the structure of morbidity of medical personnel and employees of social service centers, studied for the period 2015–2019, were established.

The impact of collagen protein ingestion on musculoskeletal connective tissue remodeling: a narrative review.

Collagen is the central structural component of extracellular connective tissue, which provides elastic qualities to tissues. For skeletal muscle, extracellular connective tissue transmits contractile force to the tendons and bones. Connective tissue proteins are in a constant state of remodeling and have been shown to express a high level of plasticity. Dietary-protein ingestion increases muscle protein synthesis rates. High-quality, rapidly digestible proteins are generally considered the preferred protein source to maximally stimulate myofibrillar (contractile) protein synthesis rates. In contrast, recent evidence demonstrates that protein ingestion does not increase muscle connective tissue protein synthesis. The absence of an increase in muscle connective tissue protein synthesis after protein ingestion may be explained by insufficient provision of glycine and/or proline. Dietary collagen contains large amounts of glycine and proline and, therefore, has been proposed to provide the precursors required to facilitate connective tissue protein synthesis. This literature review provides a comprehensive evaluation of the current knowledge on the proposed benefits of dietary collagen consumption to stimulate connective tissue remodeling to improve health and functional performance.

Nosological structure and dynamics of adult population disability in the Republic of Moldova

Nosological structure and dynamics of adult population disability in the Republic of Moldova Purpose. To study the current nosological structure and dynamics of the general and primary disability of the adult population in the Republic of Moldova. Materials and methods. Analysis of official statistics data (statistica.md, cnddcm.msmps.gov.md) for 2015-2019. Results. In 2015-2019, there was a wave-like change in the number of adults recognized as disabled for the first time in the republic and its increase in 2019 by ⅔ relative to 2018 (13713 and 8350, respectively). The structure of general disability, taking into account the degree of severity, changed little during the study period. In 2019, it was dominated by moderate disability - 47.1%; severe and severe disability was established in 38.0% and 14.9% of cases, respectively. The nosological structure of disability in general also changed little. In 2019, the main causes of disability in the adult population were tumors 20.0%, cardiovascular diseases - 18%, and diseases of the musculoskeletal system and connective tissue - 14.6%. At the same time, in 2019, respiratory diseases were the cause of disability in 2.7% of cases, or 1.4 times more often compared to 2018. Conclusions. In recent years, the main causes of disability in the republic are tumors, cardiovascular diseases, diseases of the musculoskeletal system and connective tissue, the proportion of respiratory diseases does not exceed 2.7%. In the structure of disability, moderate disability prevails.

ЗАБОЛЕВАЕМОСТЬ С ВРЕМЕННОЙ УТРАТОЙ ТРУДОСПОСОБНОСТИ РАБОТНИКОВ, ЗАНЯТЫХ ПРИ ПРОИЗВОДСТВЕ ПРОТИВООПУХОЛЕВЫХ ЛЕКАРСТВЕННЫХ СРЕДСТВ

The article presents the results of the analysis of the incidence of temporary disability (hereinafter – TD) of year-round workers employed in the production of anticancer drugs. Оbjectives: to study the dynamics and structure of morbidity with temporary disability of workers employed in the production of antitumor drugs. Materials and methods. For the study of the incidence with TD for the period from 2015 to 2019, two groups of workers were formed (exposed – 486 year-round person-years and unexposed - 1458 year-round person-years). The material for the study was the data of 3497 sheets of temporary disability for the period under study. Conclusion: According to the results of the analysis of indicators of morbidity with temporary disability in the exposed group in dynamics for the studied period, a tendency to an increase in the number of sick people was found. The level of morbidity among the workers of the exposed group was assessed as below average. It has been established that the leading place in the structure of morbidity with temporary disability of workers is occupied by diseases of the respiratory system, diseases of the musculoskeletal system and connective tissue, trauma and poisoning. Statistically significant differences in morbidity rates among workers of the compared groups by gender were revealed, and age groups with maximum and minimum values of temporary disability indicators were established.

Culture and characterization of various porcine integumentary-connective tissue-derived mesenchymal stromal cells to facilitate tissue adhesion to percutaneous metal implants

BackgroundTransdermal osseointegrated prosthesis have relatively high infection rates leading to implant revision or failure. A principle cause for this complication is the absence of a durable impervious biomechanical seal at the interface of the hard structure (implant) and adjacent soft tissues. This study explores the possibility of recapitulating an analogous cellular musculoskeletal-connective tissue interface, which is present at naturally occurring integumentary tissues where a hard structure exits the skin, such as the nail bed, hoof, and tooth.MethodsPorcine mesenchymal stromal cells (pMSCs) were derived from nine different porcine integumentary and connective tissues: hoof-associated superficial flexor tendon, molar-associated periodontal ligament, Achilles tendon, adipose tissue and skin dermis from the hind limb and abdominal regions, bone marrow and muscle. For all nine pMSCs, the phenotype, multi-lineage differentiation potential and their adhesiveness to clinical grade titanium was characterized. Transcriptomic analysis of 11 common genes encoding cytoskeletal proteins VIM (Vimentin), cell–cell and cell–matrix adhesion genes (Vinculin, Integrin β1, Integrin β2, CD9, CD151), and for ECM genes (Collagen-1a1, Collagen-4a1, Fibronectin, Laminin-α5, Contactin-3) in early passaged cells was performed using qRT-PCR.ResultsAll tissue-derived pMSCs were characterized as mesenchymal origin by adherence to plastic, expression of cell surface markers including CD29, CD44, CD90, and CD105, and lack of hematopoietic (CD11b) and endothelial (CD31) markers. All pMSCs differentiated into osteoblasts, adipocytes and chondrocytes, albeit at varying degrees, under specific culture conditions. Among the eleven adhesion genes evaluated, the cytoskeletal intermediate filament vimentin was found highly expressed in pMSC isolated from all tissues, followed by genes for the extracellular matrix proteins Fibronectin and Collagen-1a1. Expression of Vimentin was the highest in Achilles tendon, while Fibronectin and Col1agen-1a1 were highest in molar and hoof-associated superficial flexor tendon bone marrow, respectively. Achilles tendon ranked the highest in both multilineage differentiation and adhesion assessments to titanium metal.ConclusionsThese findings support further preclinical research of these tissue specific-derived MSCs in vivo in a transdermal osseointegration implant model.

Features of diseases of the musculoskeletal and peripheral nervous systems in workers of metallurgical production in modern conditions

Manufacturing industries, including metallurgy, are the backbone of the country’s economy. A number of technological operations involve the impact of physical overload, heating microclimate, static load, and often entails the development of diseases of the musculoskeletal and peripheral nervous systems. The clinical picture of such patients is dominated by pain in various parts of the spinal column, in some cases, combined localization. The analysis of the results of the examination of the connection of diseases of the musculoskeletal and peripheral nervous systems with the profession, carried out by employees of a large metallurgical enterprise of the Republic of Bashkortostan (RB), using the archival material of the FBUN clinic «Ufa Research Institute of Occupational Medicine and Human Ecology» was carried out. The group of the main professions of the enterprise includes: wire drawing machine, wire rewinder, caliper, pyrometrist, laboratory assistant for physical and mechanical tests, automatic machine for cold landing machines, mechanic-repairman, sorter-delivery of metal. During the analyzed period, in 117 cases, the workers of the enterprise confirmed the professional etiology of the disease. The nosological structure in 60 % of cases of the first established occupational diseases is represented by diseases of the musculoskeletal system and connective tissue. A significant part of diseases of occupational etiology was detected in persons aged 50 to 59 years. Workers of the studied professional groups are at the highest risk of developing diseases of the musculoskeletal and peripheral nervous systems of professional etiology, which is due to the specific conditions of their professional activity. Establishing a connection between the disease and the profession is characterized by late detection, at the stage of pronounced clinical symptoms with the formation of persistent disability.

Hospital Patients’ migration among Italian Regions

Abstract Background At the beginning of the 2000s the federalization of the Italian National Health Service gave to the Regions greater financial and political responsibility: 21 Regional Health Services were set up with administrative and planning independence. They are in a potential competitive regime, since the citizens are free to choose their place of treatment. The aim of our research was to analyze fulfillment of needs for hospital services on site and Patients' migration to hospitals of other Regions. Methods We conducted an observational cross sectional study on Hospital Discharge Cards provided by the Ministry of Health, upon specific request, from 2013 to 2017. The subjects of the analysis (catchment areas) were the hospital networks of Italian Regions. Interregional flows were carried out from data of Residents, Attractions and Escapes, which were developed through Attraction and Escape Indexes. Graphic representation was produced with Gandy's Nomogram. Results In the studied period, we observed an important decrease in hospitalizations and a simultaneous increase in interregional mobility. At the same time, admissions to hospital managed by Local Health Authorities and to Private Clinics increased. According to the Major Diagnostic Categories the main causes of hospitalizations in mobility were Musculoskeletal System And Connective Tissue Diseases (MDC 8), Cardiovascular System Diseases (MDC 5), Nervous System Diseases (MDC 1) and Digestive System Diseases (MDC 6). There were discrepancies between the Regions of Northern/Central Italy (higher Attraction Indexes) and Southern Italy (higher Escape Indexes). According to Gandy's Nomogram only nine Regions showed a good public hospital planning: Lombardy, A.P. of Bolzano, Veneto, Friuli V.G., E. Romagna, Tuscany, Umbria, Latium and Molise. Conclusions The North/Centre Regions have a public hospital planning able to be better to meet the care needs of their citizens and to attract Patients than the South ones. Key messages The study of Patients’ mobility is relevant in order to evaluate equity and quality of care provided by different Italian Regions. Patients' mobility has also an important economic implications.

Иммунобиологические препараты в терапии ревматических заболеваний

Ревматические заболевания (РЗ) являются одними из самых распространенных хронических заболеваний опорно-двигательного аппарата и соединительной ткани, которые встречаются как у взрослых, так и у детей. Причиной этих патологических состояний могут быть изменения в функционировании иммунной системы, воспаление, инфекции и другие факторы. В некоторых случаях они приводят к инвалидности и оказывают значительное влияние на качество и продолжительность жизни. Существуют нефармакологические и фармакологические методы лечения РЗ. Первая линия (нефармакологическая) лечения большинства РЗ состоит в изменении образа жизни (физические упражнения, правильное питание, отказ от курения). К фармакологическому стандартному лечению относятся нестероидные противовоспалительные препараты (НПВП), глюкокортикоиды, противоревматические препараты, которые подавляют реакцию острой фазы, способствуют снижению уровня аутоантител. К сожалению, хотя НПВП и помогают контролировать симптомы РЗ, уменьшая боль, отек и воспаление, тем не менее они не замедляют прогрессирование заболевания. Это относится и к глюкокортикоидам, которые являются противовоспалительными гормонами, связанными с кортизолом — стероидом, вырабатываемым естественным путем в организме. Несмотря на свои преимущества, глюкокортикоиды дают значительные побочные эффекты, включающие диабет, остеопороз, гипертонию, катаракту и подверженность инфекциям. За последние годы получены новые данные о патогенезе ревматических заболеваний, что способствовало возможности создания инновационных иммунобиологических препаратов. Разработка таких лекарственных средств произвела революцию в терапевтическом подходе при хронических ревматических заболеваниях, особенно у пациентов, устойчивых к стандартному лечению. Механизм действия этих иммунобиологических препаратов основан на целенаправленном ингибировании специфических или молекулярных мишеней, непосредственно вовлеченных в патогенез заболевания. К ним относятся блокаторы фактора некроза опухоли, антагонисты интерлейкинов-1, -6, -17А, блокаторы CD20, CD80/CD86, ингибитор Т-клеточной костимуляции. Их использование позволяет улучшить прогноз и достичь клинической ремиссии у значительного количества пациентов.

Analysis of the results of medical examination of citizens of draft age

In the context of the reform of the Armed Forces of the Russian Federation, the issues of recruiting troops with healthy, physically developed and mentally stable young conscripts are of paramount importance. Only citizens "A" - fit for military service and "B" fit for military service with minor restrictions are subject to conscription. When analyzing the results of medical examination of persons of military age, it was found that over the studied period of time, fitness for military service for health reasons decreased by 3.8% (from 78.3% in 2016 to 74.5% in 2020). However, despite the general decrease in fitness for military service, there is an increase in the fitness for military service "A" by 13.5% (from 23.4% in 2016 to 36.9% in 2020). Every year, during the period of work of the draft commissions, a significant number of citizens (more than 10%) were sent for additional examination to medical organizations. As a rule, the examination of conscripts was carried out on an outpatient basis (up to 85%) and much less often in an inpatient setting (up to 15%). The first place was occupied by diseases of the musculoskeletal system and connective tissue, which accounted for 24.9%. Mental and behavioral disorders ranked second with an indicator of 18.7%. The third place was taken by diseases of the circulatory system - 14.9%. Diseases of the eye and adnexa ranked fourth - 8.2%. Diseases of the digestive system were less common, accounting for only 4.5%. Thus, in total, the listed diseases accounted for 71.2% and were the main ones in determining the fitness of conscripts for military service for health reasons.

Analysis of work-related accidents and ill-health in Brazil since the introduction of the accident prevention factor

BackgroundSince 2004, Brazil has had a national policy for occupational health and safety. This policy means companies’ tax burden is altered according to the numbers of work-related accidents and ill-health amongst their workers. In 2010, a multiplication factor was introduced to this policy, called the Accident Prevention Factor. The idea of this new multiplication factor is to encourage individual employers to take initiatives to prevent accidents and ill health in the workplace. This study was designed to investigate the incidence of work-related accidents and ill-health in Brazil according to their causes, their severity, and the economic activity in which they occur, and to compare the data before and after the introduction of the Accident Prevention Factor.MethodsAn ecological study was conducted by analyzing the time series of work-related accidents/ill-health between 2008 and 2014 from the Brazilian social security system (Previdência Social) statistical yearbooks. Incidences were calculated per cause, economic activity, and severity of the accident/ill-health. Data from before and after the introduction of the Accident Prevention Factor were compared using the Mann-Whitney test per cause and per economic activity. Statistical analyses were made using the SPSS software, with significance set at 5%.ResultsA reduction in the incidence of work-related accidents/ill-health was found across all the groups of causes analyzed, except for the groups “external causes of morbidity and mortality” and “factors influencing health status and contact with health services.” Greater reductions were found for diseases of the musculoskeletal system and connective tissue and diseases of the nervous system. Reductions in work-related accidents/ill-health were found in the different economic activities and in the different severity groups. The highest reduction after the introduction of the Accident Prevention Factor was in manufacturing and production (p < 0.05).ConclusionsOverall, the incidence of accidents/ill-health was found to be on decline, except those with external causes of morbidity and mortality and those involving factors influencing health status and contact with health services. The biggest reduction was found in manufacturing and production. However, generally speaking progress still needs to be made in accident prevention and occupational health across a whole range of work environments.

Possibilities of osteopathic correction methods using in the treatment of dorsopathy at the cervicothoracic level

Dorsopathy and associated pain syndromes are among the most common diseases of the musculoskeletal system and connective tissue. Despite the relatively high level of the problem knowledge, the dorsopathies treatment still remains a fairly serious task for clinicians. A combination of medication and non-medication treatment methods is optimal. Some studies have previously demonstrated the clinical efficacy of osteopathic correction methods using in the complex therapy of patients with dorsopathies. The issues of isolated application and mutual compatibility of various non-drug methods have not yet been studied enough. The article describes a case from practice devoted to the isolated use (monotherapy) of osteopathic correction in a patient with dorsopathy, and discusses the features of individual regional somatic dysfunctions identification and filling out an osteopathic conclusion.

ФАКТОРЫ, ОПРЕДЕЛЯЮЩИЕ ИСХОД БЕРЕМЕННОСТИ И ЗДОРОВЬЕ ДЕТЕЙ, РОЖДЕННЫХ ОТ ЖЕНЩИН С ЗАБОЛЕВАНИЯМИ МОЧЕПОЛОВОЙ СИСТЕМЫ ПРИ ПОМОЩИ ВСПОМОГАТЕЛЬНЫХ РЕПРОДУКТИВНЫХ ТЕХНОЛОГИЙ

Objective of the research: identification of risk factors that potentially affect the outcomes of pregnancies achieved by assisted reproductive technologies (ART), with an assessment of the health status of children born to women with genitourinary system (GUS) diseases. Materials and methods: a retrospective uncontrolled non-randomized multicenter study of 821 women and 836 children under the age of 3 years. Results: gynecological history of women has little effect on pregnancy outcomes achieved by ART (Matthews coefficient &lt;0,2). Children born to mothers with GUS diseases are statistically significantly more likely to have some infectious and parasitic diseases (p=0,0002), mental and behavioral disorders (p=0,009), diseases of the nervous system (p=0,031), respiratory system (p=0,009), oral cavity, salivary glands and digestion (p=0,002), musculoskeletal system and connective tissue (p=0,001), genitourinary system (p=0,009), certain conditions arising in the perinatal period (p=0,009), as well as trauma, poisoning, and some other consequences of external causes (p=0,009) than children from mothers without GUS diseases. Conclusion: children born by ART from women with GUS pathology are a risk group for the development of diseases in early age.

Оценка состояния здоровья детей Смоленской области (на примере экологически обусловленных заболеваний)

The article discusses approaches to assessing the health status of children on the example of a model research region—the Smolensk region. A description of the data set for an 18-year observation period is given in order to identify territorial differences in the incidence rates of ecologically caused diseases. When assessing the health of the population at the regional level, first of all, it is necessary to select a population group, formalize and standardize the base of parameters characterizing health, and also apply such data processing methods that will allow unambiguous interpretation of the results. All these requirements can be taken into account by applying mathematical and cartographic modeling. The cartographic component is a continuation and development of a mathematical model that ensures the processing of initial data in accordance with the goals and objectives of medical and geographical research. The subsequent cartographic interpretation of mathematical calculations leads to the creation of spatial visualization, which also serves as a tool for multilateral analysis of the results. For the analysis were taken indicators of the general morbidity of children, following the International Classification of Diseases, in the following classes: respiratory diseases; diseases of the digestive system; diseases of the skin and subcutaneous tissue; diseases of the musculoskeletal system and connective tissue. As a result, the ranking of the studied territorial units (25 municipal districts and 15 cities) was obtained according to four morbidity indicators. Based on these data, a series of maps was created, reflecting the spatial distribution of health characteristics over an 18-year observation period. The results obtained using absolute indicators revealed a gap in the values of the integral indices. The application of the methodology can contribute to the formulation of goals and objectives of strategies for the socio-economic development of regions and municipalities, measures to improve the health of children.

Avaliação musculoesquelética pediátrica por meio de duas ferramentas de triagem: o questionário para detecção precoce de artropatia crônica (DPA-12) e o pGALS (pediatric gait, legs, arms and spine)

INTRODUCTION: There are limitations in the teaching and training of the musculoskeletal exam for the general practitioner, but two screening tools have become available in recent years. OBJECTIVES: Evaluate feasibility and concordance of two musculoskeletal screening tools, the 12-item questionnaire for early arthritis detection of (DPA-12) and the musculoskeletal examination pGALS (pediatric, gait, arms, legs and spine), in the same patient, during the routine practice. METHODS: Participants between 5 and 18 years of age were examined by a trained resident, performing pGALS maneuvers and applying DPA-12 for parents. The diagnoses, descriptive analysis and scores were analyzed, categorizing the pGALS maneuvers as normal or abnormal and DPA-12 scores greater or lower than six. The internal consistency was calculated by Cronbach alpha coefficient and the correlation between categorical measures by kappa statistics. RESULTS: Sixtyseven participants were included, 40 (59.7%) were boys. Forty (59.7%) had at least one abnormal pGALS manoeuver. The diagnoses were classified as musculoskeletal (juvenile idiopathic arthritis and connective tissue diseases, flat feet, hypermobility syndrome, mechanical limb pain) and nonmusculoskeletal (cellulitis and constipation). There were 65 valid questionnaires, 21 (32.3%) scored greater or ecqual to 6, indicating higher probability of musculoskeletal diagnoses. The internal consistency scoreswere 0.79 and 0.87, respectively. The comparison of normal and abnormal variables results, resulted in low agreement by the Cohen kappa coefficient (0.31). CONCLUSION: The application of both tools in the same patients performed well, showing simplicity and feasibility, for identifying functional or structural abnormalities, regardless of the diagnosis. In practice, both tools may be useful and complementary for screening.

Dorsopathy: back pain management

Background. Dorsopathy is a group of diseases of the musculoskeletal system and connective tissue associated with degenerative diseases of the spine. Risk groups for the development of dorsopathies include people with a sedentary lifestyle, people working in difficult conditions, athletes, military personnel, people with obesity. Clinical classification of dorsopathies involves their division according to the affected level (cervical, thoracic, lumbosacral).&#x0D; Objective. To describe the management of patients with back pain.&#x0D; Materials and methods. Analysis of literature data on this topic.&#x0D; Results and discussion. Cervicocranialgias, related to dorsopathies, include vertebral artery syndrome (VAS) and extravasal artery compression (EAC). VAS is a complex of cerebral, vascular and autonomic disorders that occur due to the damage of the sympathetic plexus of vertebral artery, deformation of the wall or changes in its lumen. In turn, EAC involves the compression of blood vessels by bone abnormalities, muscles, osteophytes of the cervical vertebrae, scars, tumors, and so on. Lower back pain (LBP) is one of the most common dorsopathies. Its prevalence has doubled in the last decade. The mechanism of aseptic inflammation in dorsopathies includes such links as the release of proinflammatory mediators, activation of peripheral nociceptors, production of cyclooxygenase-2 and the formation of prostaglandins. Pain in dorsopathies is classified into nociceptive (caused by the excitation of nociceptors in damaged tissues), neuropathic (caused by damage to the central or peripheral nervous system) and psychogenic (caused by primary mental disorders). By duration, LBP is classified into acute (&lt;6 weeks), subacute (6-12 weeks) and chronic (&gt;3 months). According to the etiology, the following subspecies are distinguished: radicular (disc herniation, spondylosis, vertebral canal stenosis), specific (cancer, infection, fracture, equine tail syndrome) and nonspecific (myogenic disorders, facet syndrome). In the presence of so-called symptoms of red flags, it is recommended to conduct imaging examinations according to the indications. Such symptoms include pain development at the age of &lt;20 years or &gt;55 years, recent back injury, progressive character, deterioration or lack of dynamics after keeping horizontal position, prolonged use of glucocorticoids, history of malignant tumors, osteoporosis, intravenous drugs injection, immunodeficiency, weight loss, fever, focal neurological symptoms, pain on palpation of the spine, spinal deformity. The symptoms of yellow flags predict pain chronization. The latter include certain work-related circumstances, beliefs, behaviors, and affective symptoms. The main causes of non-specific back pain include muscular-tonic pain syndrome (MTPS), myofascial pain syndrome (MFPS), arthropathies. Microcirculatory disorders, caused primarily by the reflex muscle spasm, play a significant role in the development of pain in these conditions. MTPS develops on the background of degenerative-dystrophic changes in the spine, ligaments and muscles as a result of exposure to provoking factors (significant physical exertion, injuries, sudden movements, prolonged stay in a static position, general or local hypothermia). Chronization of MTPS leads to the development of MTFS. Ischemic muscle spasm leads to the spasm of arteries and dilation of venules with impaired microcirculation and accumulation of inflammatory mediators. In turn, radicular ischemia develops with radicular pain. Venous plexus, which is compressed at the stage of stenosis without signs of direct compression of the root, is the most vulnerable structure of the intervertebral space. Treatment of LBP includes bed rest, sleep on a hard surface, the use of non-specific anti-inflammatory drugs, local administration of local anesthetics, muscle relaxants, B vitamins, therapeutic exercises and surgical treatment. Restoration of microcirculation makes it possible to influence the pathogenesis of radiculoischemia. Drugs that improve microcirculation and hemodynamics are included in the domestic clinical protocol for the treatment of dorsalgia. Reosorbilact (“Yuria-Pharm”) improves substance exchange between blood and tissues and helps to remove metabolic products. These effects are based on the opening of precapillary sphincters on the background of this solution use. For dorsalgia, it is also advisable to prescribe Latren (“Yuria-Pharm”) – a combination of pentoxifidine and Ringer’s lactate. Latren inhibits the aggregation of blood cells, increases the elasticity of erythrocytes, promotes vasodilation, normalizes the electrolyte composition of blood plasma. To eliminate endothelial dysfunction, Tivortin (“Yuria-Pharm”) is prescribed, which promotes vasodilation. The use of the listed above infusion drugs influences the pathogenesis of the process, eliminating dorsalgia.&#x0D; Conclusions. 1. LBP is one of the most common dorsopathies. 2. Pain in dorsopathies is classified into nociceptive, neuropathic and psychogenic. 3. Microcirculatory disorders play a significant role in the development of nonspecific LBP. 4. Combined use of Reosorbilact, Latren and Tivortin influences the pathogenesis of the process, eliminating dorsalgia.

Специализированная медицинская помощь пострадавшим при аварии на Чернобыльской АЭС: особенности организации, виды и объемы, ведущие классы заболеваний

The purpose of the study is to summarize the experience and identify the features of the organization and provision of specialized medical care (SpMP) to victims of the Chernobyl accident on the basis of the A. M. Nikiforov All-Russian centre of emergency and radiation medicine of EMERCOM of Russia. Materials and methods of research. Materials of the study were the data on types and volume of specialized medical assistance in 2014-2020 on the basis of the Centre; on the leading classes of diseases demanding specialized medical care in remote period to those affected by the Chernobyl accident. Research results and their analysis. 1. The system of organization of specialized medical care for victims of the Chernobyl accident in the framework of the Union State of Russia – Belarus includes 5 main stages: planning, coordination, information and analytical, hospital and final – analytical stages. 2. The main reasons for hospitalization of victims of the Chernobyl accident were diseases of the circulatory system, of the digestive system and of the musculoskeletal system and connective tissue. 3. When providing therapeutic SpMP, special attention was paid to the diagnosis and correction of comorbid pathology; when providing surgical SpMP, to individual selection of anesthetic aids, the use of minimally invasive endoscopic surgical interventions and prevention of postoperative complications. 4. The main reasons for medical rehabilitation were diseases of the Central nervous system and sensory organs, diseases of the cardiovascular system, musculoskeletal system and peripheral nervous system.

Rates of dismissal due to health reasons among conscripts in the Republic of Belarus depending on service periods (2003–2018)

Relevance. One of the most reliable and robust indicators of the health of military personnel is dismissal due to health reasons, it is practically not affected by external distortions, and dismissal-related nosologies are determined in hospital and subsequently approved by military medical experts.Intention. Analysis of the dismissal rate due to health reasons among conscripts in the Republic of Belarus for 16 years (2003-2018).Methodology. We conducted a statistical analysis of annual medical reports about the state of health and morbidity of conscripts (form N 3/MED) and annual reports about medical examination (form N 5/CVVK). Dismissal rates for the entire service time and for the periods I (0–6 months), II (7–12 months) and III (13–18 months) were identified and analyzed. Dismissal-related nosologies were correlated with the codes of the International Statistical Classification of Diseases, Behavioral Disorders and Injuries, 10th revision (ICD-10).Results and Discussion. The average annual dismissal rate for conscripts from the Armed Forces of the Republic of Belarus for 16 years from 2003 to 2018 amounted to (15.62 ± 0.58) ‰, including (8.11 ± 0.36) ‰ in the first period of service, (5.24 ± 0.28) ‰ in the II period and (2.27 ± 0.09) ‰ in the III period, i.e. 51.9, 33.5 and 14.6 %, respectively in the structure of dismissal for the entire period of service. The main reasons for the dismissal of conscripts from the Armed Forces of the Republic of Belarus were mental and behavioral disorders (ICD-10 chapter V), digestive diseases (chapter XI), diseases of the musculoskeletal system and connective tissue (chapter XIII), cardiovascular system diseases (chapter IX) and skin and subcutaneous tissue diseases (chapter XII) with levels of (4.74 ± 0.35), (2.74 ± 0.31), (2.13 ± 0.18), (1.80 ± 0.30) and (0.73 ± 0.09) ‰, respectively. In the structure of dismissal, the rates of these diseases amounted to 77.7 %. When analyzing the leading classes, during the periods of service the military-epidemiological significance of dismissals due to mental disorders and behavioral disorders (chapter V), cardiovascular system diseases (chapter IX), skin and subcutaneous tissue diseases (chapter XII) turned out to decrease, and military-epidemiological significance of dismissals due to diseases of the digestive system (chapter XI) increased. In addition, during periods of service the number of dismissals of conscripts with certain infectious and parasitic diseases (chapter I), with injuries, poisoning and some other consequences of external causes (chapter XIX) increased. Most commonly, conscripts were dismissed from the Armed Forces of the Republic of Belarus due to diseases of the esophagus, stomach and duodenum (K20–K31 according to ICD-10), personality and behavioral disorders in adulthood (F60– F69), neurotic, associated with stress, and somatoform disorders (F40–F48), other heart diseases (pericarditis, endocarditis, etc., I30–I52) and mood disorders (affective disorders, F30–F39). In the structure of dismissal, percentages amounted to 13.7, 9.1, 6.3, 4.1 and 4.1 %, respectively; in total – 37.3 %.Conclusion. The medical and statistical indicators of dismissal can help calculate the likelihood of health disorders associated with daily life and military service, and determine the strategy of the medical service in taking measures for recreation and rehabilitation of potential and actual conscripts.

FEATURES OF THE MANIFESTATION OF REHABILITATIVE ACTIVITY IN PATIENTS WITH PRINCIPAL DISABLING PATHOLOGIES

The article presents the results of a psychological study of patients with principal disabling pathologies that form the main structure of disability in the Russian Federation due to malignant neoplasms: diseases of the circulatory system; diseases of the musculoskeletal system and connective tissue; diseases of the endocrine system and metabolic disorders (diabetes mellitus of the first and second types). The article presents the results of studying a sample of patients by various psychological parameters, provides statistical comparisons of psychological characteristics of patients depending on the specifics of their social situation, in which patients either claim to be disabled and are under conditions of medical and social expertise, implying the possibility of changing social status, or patients of the same nosological categories, who do not claim to be disabled and who are rehabilitating on the basis of their own personal and socio-environmental resources outside of the "disabled" status. Psychological techniques are presented, the specificity of emotional and personal parameters is analyzed and characterized, including personality frustration and experience of the significance of the disease in the spheres of life, self-esteem indicators, identification characteristics, strategies that provide rehabilitation adherence, which characterize the activity of patients in the compared groups in many ways. The conceptual position that defines the activity of patients as «rehabilitative» has been substantiated. The results of the study revealed statistically significant differences in psychological indicators in the compared groups of patients rehabilitating outside the "disabled" status and patients claiming to be disabled. The indicators obtained in the study indicate that the personal self-regulation of patients rehabilitating outside the «disabled» status qualitatively differs from the self-regulation of patients claiming disability, in terms of stable self-esteem and belief in the ability to realize life in significant areas of social functioning, in the ability of perspective planning of the future, in active self-realization of social roles, active participation in interpersonal, leisure, professional, household and other spheres, high responsibility for one's health, against the background of stable emotional perception of the current social situation of the disease.

Dynamics of sickness rate in 15–17- year-old girls in the Russian Federation

The children’s health condition in the Russian Federation, including adolescents, has been characterized by negative trends in the past thirty years.Objective. To identify the main trends in sickness rate (both total and registered for the first time) in 15–17-year-old girls in the Russian Federation, as well as to track the quantity and dynamics of chronicity of diseases by classes and types.Material and methods. The authors analyzed the data of form №12 of the federal statistics in 2000–2017 using the descriptive statistics method.Results. The researchers revealed a significant increase both in the total sickness rate from 1613,8 to 2532,5 per 1,000 girls (by 56,9%) and in the sickness rate registered for the first time from 967,5 to 1577,3 per 1,000 girls (by 63,0%). The increase in total incidence is observed in the most classes of diseases: neoplasms (2,4 times), injuries, poisoning and some other consequences of external causes (2,4 times), congenital anomalies (malformations; 2,3 times), cardiovascular diseases (2 times), diseases of the musculoskeletal system and connective tissue (2 times). Also there was revealed the increase in the incidence registered for the first time in the overwhelming majority of classes of diseases, for example: injuries, poisoning and some other consequences of external causes (2,5 times), diseases of the nervous system (2,2 times), cardiovascular diseases (2 times), neoplasms (2 times), diseases of the ear and mastoid process (2 times), diseases of the musculoskeletal system and connective tissue (1,9 times). High index of the chronicity for all classes of diseases reflect the initially high level of chronic pathology in 15–17-year-old girls, which is an unfavorable characteristic of their health condition. Having analyzed the chronization index the authors revealed its maximum growth for congenital anomalies (malformations; by 31,1%) and neoplasms (by 23,0%), and for certain nosologies: menstrual disorders (5,8 times) and renal failure (4,2 times).Conclusion. The health of children, and especially adolescents, determines the national health in the nearest future; therefore, its preservation and improvement require thorough attention.