Pronounced Regression Research Articles

Modern technologies for medical rehabilitation of children with knee joint injuries

Pathology of the knee joint in children is a pressing problem in pediatric traumatology, orthopedics and pediatrics. The frequency of injuries to the knee joint is determined by the complexity of its structure, biomechanical features with a high probability of overload. At the same time, intra-articular injuries in children and adolescents, accounting for up to 7 % in the structure of inpatient pathology, are the cause of pronounced functional disorders of the lower limb and the risk of developing post-traumatic osteoarthritis Currently, physical factors are widely used at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint. The conducted studies have established the effectiveness of using local air cryotherapy in the early postoperative period, characterized by a pronounced anti-edematous, analgesic effect. Early regression of pain and elimination of microcirculatory disorders in the area of injury as a result of a course of pulsed low-frequency magnetic therapy at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint have been recorded. The beneficial effect of a pulsed low-frequency electrostatic field on indicators of orthopedic status, and thermography indicators in the area of injury in children with knee joint injuries has been established. Data were obtained on more pronounced regression of pain, earlier restoration of range of motion in the damaged joint and relief of signs of post-traumatic synovitis with the complex use of a pulsed low-frequency electrostatic field and robotic mechanotherapy in children with damage to the capsular ligamentous apparatus of the knee joint. The obtained clinical and functional results are of great importance for injuries of the knee joint with the risk of contractures in the postoperative period.

Metastatic Spinal Lesion with Minimal Epidural Compression: Surgical Treatment or Stereotactic Radiotherapy?

Introduction. The choice of treatment between extracranial stereotactic radiotherapy and surgery for metastatic vertebral body tumors with minimum or no epidural compression of the dura mater is yet to be clearly defined. Materials and methods. The study enrolled 41 patients who received treatment at the National Medical Research Centre for Oncology (Rostov-on-Don, Russia) from January 1, 2014 to December 31, 2022. The inclusion criterion was the presence of a metastatic vertebral tumor, with minimal or no epidural compression of the dura mater and the radicular infundibulum (ESCC 0–1b). Patients were divided into two groups: 21 patients (SBRT group) received only extracranial stereotactic radiation therapy and 20 patients who underwent surgery followed by adjuvant extracranial stereotactic radiation therapy 1 month after surgery (Op.+Аd.SBRT). Results. The early postoperative period revealed no deterioration in the neurological status of patients in the SBRT group, no improvement in the Karnofsky performance status and no regression of pain syndrome, in contrast to patients in the Op+Аd.SBRT group. In a month after the surgery, tumors continued to grow in 3 patients (21%) of the SBRT group and only in 1 patient (6%) of the Oр.+Аd.SBRT group. Discussion. In the early postoperative period, the Op.+Аd.SBRT group showed an improvement in the functional status and a significantly more pronounced regression of the pain syndrome in the patients of the SBRT group, which can be explained by direct decompression of the compressed spinal root and elimination of increasing instability of the spinal column. Conclusion. Surgical treatment complemented by adjuvant extracranial stereotactic radiation therapy constitutes the preferred treatment for patients with metastatic spinal lesion with minimal epidural spread, without epidural compression of the spinal cord, with severe pain syndrome and signs of increasing instability of the spinal column.

The results of clinical monitoring of phytotherapeutic correction in the presence of benign breast diseases

Benign breast diseases (BBDs) are the most common group of diseases among women that negatively affect their quality of life. In fact, these pathological conditions are diagnosed at least 10 times more often than breast cancer. Up to 30% of women with BBDs will need treatment at some point in their lives. A triple assessment which is performed using imaging methods of clinical examination (ultrasound examination, mammography) and histopathological examination after a puncture biopsy during the initial consultation allows to exclude breast cancer in the majority of patients. `The main clinical manifestation of BBDs is mastalgia. In recent years, a variety of natural herbal remedies have played a significant role in the symptom-modifying therapy of mastalgia.The objective: to study the possibility of using an innovative phytocomplex as a symptom-modifying agent in the presence of BBDs, which is manifested by mastalgia.Materials and methods. Clinical monitoring of 60 patients between the ages of 22 and 46 years old with BBDs of various genesis was carried out. The study group included 30 women who used a phytocomplex containing 3,3`-diindolylmethane (200 mg), vitex extract (100 mg), epigallocatechin (45 mg), broccoli extract (0.4 mg), 1 tablet twice daily for 90 days. The reference group included 30 women who used a dietary supplement with indole-3-carbinol (200 mg) according to a similar scheme.Assessment of clinical symptoms of BBDs, measurement of interleukin-6 level in blood serum, fine-needle aspiration biopsy of pathological foci and immunocytochemical analysis of biopsies, assessment of patients’ quality of life were performed before and after treatment.Results. The innovative phytocomplex (diindolylmethane – DIM, Agni casti fructus) compared to the indole-3-carbinol monopreparation demonstrated a higher efficiency in creating conditions for the elimination of clinical manifestations of BBDs: discomfort, swelling, pain at rest and during palpation.A pronounced regression of clinical symptoms was observed in the study group: a decreased frequency of patients with chest discomfort from 100 to 36.7%, a decrease in pain at rest and during pressure – from 53.3 to 13.3% and from 33.3 to 13.3%, respectively, swelling – from 46.7 to 16.7%. The index of the quality of life of patients, which was determined by the sum of the scores of the questionnaire filled out by the patients themselves, showed a more pronounced tendency to increase in the study group.Conclusions. The innovative phytocomplex can be recommended as a preparation for phytotherapeutic correction in order to help reduce the intensity and eliminate mastalgia and other symptoms of BBDs.

Prediction of radiation complications by determining the blood oxidation processes in cervical cancer patients under chemoradiotherapy

Background. Radiotherapy (RT) is one of the principal methods in cancer management, and its administration in oncology practice is much wider nowadays because of the increased incidence of newly diagnosed cancer cases with wide spread and aggressive course of tumor process, and also in view of organ-sparing strategies in the combined treatment. However, the radiation reactions, especially local ones in rectum or bladder, can’t be completely avoided even using the most advanced radiotherapy facilities and dosimetry planning. Therefore, at present time not only technical modernization, but also the progress in radiobiology should be considered. Given the cytotoxic properties of some anticancer drugs, they are used in the combined therapy of cervical cancer (CC) to receive a radiosensitizing effect on the malignant cells. In particular, cisplatin inhibits reparative processes by affecting the enzymes involved in restoring the integrity of DNA or chromosome structure. Administration of the combined radiation and chemotherapy leads not only to an increase in the percentage of tumor regression, but also to an increase in the number of radiation injuries to healthy tissues. Therefore, prediction of such injuries, research and development of means of their prevention and treatment in the regimen of chemoradiotherapy (ChRT) of CC is extremely urgent and remains an unsolved problem to date. Purpose. Development of personalized approaches in ChRT in CC patients by studying its efficiency, assessing its toxicity, and predicting radiation injuries according to the data of blood oxidative processes in patients. Materials and methods. The combined radiotherapy (CRT) and ChRT were administered to the stage IIB–IIIB CC (T2b-3bN0-1M0) patients (n = 105) at the National Cancer Institute. Patients aged 25–75 years were divided into two groups: the study group and the comparison group. Complex clinical examination was conducted prior to treatment featuring the assay of tumor parameters, state of «critical organs». At the stage I of CRT regimen, conformal irradiation on pelvis minor was delivered at the electron linear accelerator «Clinac 2100 CD» with an energy of 6 MeV per area of pelvis minor with single radiation dose (SRD) of 2.0 Gy and total radiation dose (TRD) of up to 46 Gy. Patients in the study group received the CRT along with administration of chemoradiomodifying agent cisplatin 40 mg/m2 once a week intravenously (drip-feed), patients in the comparison group received no radiomodifier. At the stage II of CRT regimen, an intracavitary brachytherapy (ICBT) was administered to the CC patients at the gamma therapy equipment «AGAT-VU» using 60Co (high dose rate – HDR) sources in the mode of SRD of 5 Gy 2 times a week, 7–8 fractions, and TRD of 35–40 Gy at p. A. The TRD in total was 77–89 Gy at the p. A and 54–60 Gy at p. B. Administration of cisplatin 40 mg/m2 at the stage II of CRT was continued in the study group once a week intravenously (drip-feed), total dose of up to 200–300 mg. Radiobiological studies were performed on the peripheral blood samples from the CC patients (n = 39) before and after ChRT. The control group consisted of healthy women of the appropriate age. Blood was sampled into the special 6 ml Vacutainer type tubes with an anticoagulant according to the manufacturer’s instructions (BioReagent). Intensity of generation of О• 2– in PBL was evaluated by the chemiluminescence method using the lucigenin indicator, which, as a result of reacting with О• 2–, emits light quanta recorded by the device. Measurements were carried out on the AutoLumat LB 953 device (Germany) with appropriate corrections made to the methodology. Results and discussion. Effectiveness of CRT in CC patients was evaluated according to regression of the primary tumor focus (clinical, ultrasound, MRI or SCT data) and presence/absence of toxic manifestations of treatment following the criteria for evaluating the solid tumors regression according to the Response Evaluation Criteria in Solid Tumor (RECIST). Conclusions. The results of the study indicate that chemoradiotherapy contributes to pronounced regression of cervical tumors and does not increase toxicity of treatment due to timely correction of complications.

Acute bronchitis - modern possibilities of mucactive therapy

Analysis of the clinical effectiveness and safety of erdosteine use in comparison with standard (real practice) mucoactive therapy in patients with acute bronchitis (АВ) in adults. The observational program included 100 adult patients with АВ, 50 of them (group 1) received erdosteine, the group 2 also included 50 patients who received acetylcysteine, bromhexine and other mucolytics (real clinical practice). The following were assessed: cough severity, average time for resolution of night and daytime cough, satisfaction with treatment, NO concentration in exhaled air, levels of C-reactive protein (CRP) and interleukin-6 (IL-6). The average duration of relief of severe daytime cough requiring continued therapy was: in group 1 - 3.7±0.46 days, night cough - 1.14±0.94 days. In the second group, daytime cough was relieved in 3.8±0.4 days, night cough - 1.08±0.7 days. The duration of mucoactive therapy in group 1 was 5.32±0.82 days, in group 2 this figure was 8.5±1.4 days (p<0.05). The number of АВ patients with a significant reduction in the severity of productive cough (1 point on cough severity scale) on the 6th day from the beginning of treatment in group 1 (erdosteine) amounted to 32 (64%), in group 2 - 27 (54%). Satisfaction with the treatment was higher in the group receiving erdosteine: according to the indicators "very satisfied" and "extremely satisfied" the patients of the group 1 - 42 - were the leaders in comparison with the group 2, where these positions were marked by 28 patients. The level of CRP in patients with АВ in group 1 was 24.7±21.24 mg/l, in group 2 - 16.37±16.5 mg/l, which indicates the viral etiology of the process and no need in the prescription of antimicrobial drugs. For the first time in Russian practice, the following were determined: the level of IL-6, which in the group 1 was 10.3±6.7 pc/ml; in the group 2 - 10.03±3.94 pc/ml; the level of exhaled NO in group 1 was 16.5±5.1 ppb, in group 2 - 14.9±4.6 ppb (the norm is up to 25 ppb). These indicators, against the background of mucoactive therapy, decreased to normal values by 6th day. The findings expand our understanding of АВ in adults. New results have been obtained on the role of CRP, IL-6 and NO in exhaled air during АВ. The use of erdosteine was accompanied by a significant mucoactive effect in the form of a pronounced regression of cough in patients with АВ compared to the comparison group in shorter term.

Physical factors in medical rehabilitation of children with damage to the capsulal-ligating apparatus of the knee joint

Pathology of the knee joint in children is a pressing problem in pediatric traumatology, orthopedics and pediatrics. The frequency of injuries to the knee joint is determined by the complexity of its structure, biomechanical features with a high probability of overload. At the same time, intra-articular injuries in children and adolescents, accounting for up to 7% in the structure of inpatient pathology, are the cause of pronounced functional disorders of the lower limb and the risk of developing post-traumatic osteoarthritis.&#x0D; Currently, physical factors are widely used at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint. The conducted studies have established the effectiveness of using local air cryotherapy in the early postoperative period, characterized by a pronounced anti-edematous, analgesic effect. Early regression of pain and elimination of microcirculatory disorders in the area of injury as a result of a course of pulsed low-frequency magnetic therapy at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint have been recorded. The beneficial effect of a pulsed low-frequency electrostatic field on indicators of orthopedic status, and thermography indicators in the area of injury in children with knee joint injuries has been established. Data were obtained on more pronounced regression of pain, earlier restoration of range of motion in the damaged joint and relief of signs of post-traumatic synovitis with the complex use of a pulsed low-frequency electrostatic field and robotic mechanotherapy in children with damage to the capsular ligamentous apparatus of the knee joint. The obtained clinical and functional results are of great importance for injuries of the knee joint with the risk of contractures in the postoperative period.

Optimization of treatment methods for hereditary acquired hearing loss

As a result of the research, it was shown that complex treatment with the preparation of cytoflavin leads to an improvement in cerebral circulation and coronary blood flow, activates metabolic processes in the central nervous system, contributes to a more pronounced regression of neurological symptoms in the main group 2 to 3 times compared to the control group.

Сhanges in the deformation of the pulmonary vein ostia after radiofrequency and cryoballoon ablation in patients with paroxysmal atrial fibrillation

Aim. To study changes in pulmonary vein ostia strain after radiofrequency (RFA) and cryoballoon ablation (CBA) in patients with paroxysmal atrial fibrillation (AF) by intracardiac echocardiography.Methods. Patients with paroxysmal AF (n=41) aged 60.1±7.1 years and duration of the disease 7.7±4.8 years were included in the study. Pulmonary vein (PV) isolation was performed with RFA (n=23) and CBA (n=18). All patients underwent transthoracic and intraoperative intracardiac echocardiography. Longitudinal strain of PV ostia was assessed before and after isolation.Results. Groups were comparable in main clinical parameters. Regress of PV ostia strain after RFA and CBA was achieved in all of PV, which corresponded to complete PV isolation. Remarked trend toward a more pronounced regression of PV ostia longitudinal strain after CBA compared with RFA for left superior (10±0.7% and 6.1±0.8% respectively, p&lt;0.001) and right inferior PV (9.3±0.7% vs 7.3±0.6%, p&lt;0.001) requires continued observation and analysis of data in a larger group. There were no complications.Conclusion. PV isolation is accompanied by a significant change in their longitudinal strain using intracardiac echocardiography both after CBA and after RFA.

Nucleo CMP Forte™ for the treatment and rehabilitation of patients with carpal tunnel syndrome

Introduction: Carpal Tunnel Syndrome (CTS) is the most common and best well-known cause of peripheral nerve compression. To date, none of the studies have determined the optimal combination of pyrimidine nucleotides and electrical stimulation (ES) in CTS patients. The objective of the study was to evaluate the effectiveness of a novel product containing uridine and cytidine monophosphate (Nucleo CMP Forte™) in combination with ES for the treatment of CTS. Methods: This open-label, randomized, controlled study involved 60 patients with CTS at the Azerbaijan Medical University (Baku, Azerbaijan) and Research Institute of Medical Rehabilitation between 2017 and 2021 years. Patients were randomized to receive the exploratory treatment (Nucleo CMP Forte™ and ES) or single ES treatment for ten days. The combination treatment included two stages: Nucleo CMP Forte™ and ES for ten days (stage one), and Nucleo CMP Forte™ as monotherapy (stage two) for ten days. Results: In the exploratory group, the complete restoration of pain sensitivity was achieved by 17.1% of patients and the narrowing of the existing zone of hypesthesia by 74.3%. Positive Tinel test was revealed in 52.4% of patients after the first and 76.2% after the second stage in the exploratory group, versus 43.8% in the control group. Mean values in the Boston Carpal Tunnel Questionnaire significantly decreased in both groups. Conclusion: Nucleo CMP Forte™ in combination with ES contributes to a more pronounced regression of patients' complaints, clinical manifestations, severity, and neurophysiological indicators in mild-to-moderate CTS.

PHYSICAL FITNESS OF THE FUTURE WOMEN OFFICERS OF NATIONAL POLICE UNITS IN THE PROCESS OF LEARNING

The article examines the level of development of physical qualities and formation of motor skills and abilities of future female officers of the National Police units during their studies at a higher education institution of the Ministry of Internal Affairs with specific study conditions. Future female officers of the 1st-2nd courses of study (n=68) of the Lviv State University of Internal Affairs participated in the study. Two groups were formed: the first group included 1st-year university cadets (n=32), the second group included 2nd-year cadets (n=36), respectively. The study was conducted over the course of a year and was divided into 4 stages, during which control and verification classes were planned with the aim of studying the level of development of physical qualities and the formation of motor skills and abilities of future female officers of the National Police. Research methods: analysis of literary sources, pedagogical observation, pedagogical testing, methods of mathematical statistics. The scientific novelty of the obtained results lies in the practical verification of the effectiveness of the current system of physical training of future female officers of the National Police units in the process of training at a higher education institution of the Ministry of Internal Affairs with specific training conditions. According to the results of the study, the insufficient level of physical fitness of future female officers of the National Police units was revealed, which may not allow them to effectively engage in professional activities and, in the future, perform official tasks as assigned. In addition, negative dynamics in the development of physical qualities and the formation of motor skills and abilities of female cadets already in the 2nd year of study are noted. The most pronounced regression was found in the development of strength qualities (complex strength exercise) and endurance of future female officers (1000 m run).

Enhancement the eff ec- tiveness of therapy of the new COVID-19 coronavirus infection using interferon alpha-2b in adults

In order to assess the clinical eff ectiveness of COVID-19 complex therapy in adults, 140 patients with a confi rmed diagnosis of a new coronavirus infection, clinical symptoms and lung damage from 25 to 75 % (mild and moderate form) hospitalized in budgetary healthcare institutions of the Omsk region were included in an open prospective observational study. Patients were evenly divided into two groups: 1 — received standard therapy in accordance with the Temporary Guidelines "Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)" approved by the Ministry of Health of the Russian Federation and interferon alpha-2b preparations (Viferon ® rectal suppositories 3,000,000 IU and Viferon ® gel for external and topical use of 36,000 IU/g); 2 — received only standard therapy. In group 1 patients, elimination of the SARS-CoV-2 antigen from the nasopharyngeal mucosa occurred 2 days earlier than in group 2 patients. Also, patients receiving standard therapy and interferon alpha-2b preparations improved on average 4.5 days earlier, most of the main symptoms of the disease were stopped by the 6th day of therapy. It was noted that in patients receiving complex standard therapy with adding of interferon alpha-2b preparations, a more pronounced regression of lung tissue damage was observed, especially in patients with a high degree of their lesion according to CT data before hospitalization. By the end of treatment in group 1, the proportion of patients with lung tissue lesions of grade CT-3 signifi cantly decreased by 17%, while in group 2, the proportion of patients with CT-3 increased by 13 %. Analysis of the dynamics of laboratory parameters and the main markers of infl ammation in the therapy groups also confi rms the positive eff ect of the inclusion of interferon alpha-2b drugs in the standard therapy. No adverse events associated with the use of interferon alpha-2b preparations were registered. Thus, in patients receiving standard therapy and interferon alpha-2b preparations, recovery occurred in a shorter time. In the end, this contributed to a faster discharge from the hospital and a reduction in the burden on the bed fund and medical staff . The results obtained give grounds to recommend the inclusion of interferon alpha-2b preparations (Viferon ® rectal suppositories 3,000,000 IU and Viferon ® gel for external and topical use 36,000 IU/g) in standard COVID-19 therapy regimens in adult patients with mild and moderate forms of the disease.

Pulse Low-Frequency Electrostatic Field Application for Injuries of Knee Joint Capsular Ligament Apparatus in Children: a Prospective Randomized Comparative Study

INTRODUCTION. Rehabilitation of children with knee joint injuries is very relevant due to a high prevalence of such a localization of injuries leading to loss of limb function and often requiring surgical treatment and intensive rehabilitation. AIM. To establish scientifically the isolated use of low-frequency pulsed electrostatic field and in combination with robotic mechanotherapy in treatment of the knee joint capsular ligamentous apparatus injuries in children. MATERIAL AND METHODS. 60 children aged 13 to 18 years with damage to the capsular ligamentous apparatus of the knee joint were included in the clinical study. The study group was represented by 30 children receiving a combined effect of the low-frequency pulsed electrostatic field and robotic mechanotherapy. A comparison group of 30 children was exposed to the low-frequency pulsed electrostatic field. Medical rehabilitation was prescribed in the early post-immobilization period after arthroscopic operations. To determine the effectiveness of medical rehabilitation techniques, we used orthopedic status assessment, a subjacent determination of the severity of pain syndrome according to the VAS, clinical assessment of motor deficit, laser Doppler flowmetry, ultrasound examination of knee joints, infrared thermography, and psychological testing using the Spielberg-Hanin scale. RESULTS AND DISCUSSION. A prospective open randomized comparative study revealed a more pronounced regression of pain syndrome, earlier restoration of the motions in the injured joint, and relief of posttraumatic synovitis signs when using two physical factors in children with damage to the capsule-ligament apparatus of the knee joint in combination. The clinical and functional results obtained are of great importance in injuries of the knee joint with the risk of contracture formation in the postoperative period. CONCLUSION. High therapeutic efficacy, good tolerability of procedures, and the absence of adverse reactions substantiate expediency of the low frequency pulsed electrostatic field introduction in combination with robotic mechanotherapy for injuries of the capsular ligamentous apparatus of the knee joint in children into the practice of children’s medical and preventive medical organizations.

Possibilities of medical treatment of infantile hemangiomas in Russia

Introduction. Infantile hemangiomas (IH) are the most common benign vascular tumor of children of the first year and are an interdisciplinary problem of neonatologists, pediatricians, pediatric cardiologists, oncologists, pediatric surgeons, dermatologists. Depending on the age of child, phase of pathological process, size, and localization of the IH, the management tactics of such children can be conservative (pharmaceuticals therapy) or invasive (laser therapy, surgical methods). Laser therapy with a pulsed dye laser has proven itself well to correct and minimize residual phenomena because of spontaneous involution and after the completion of pharmaceuticals treatment.The purpose of the study is to analyze the experience of using Hemangiol® (oral solution) for the treatment of children with IH, obtained in 10 medical hospitals in 6 cities of Russia.Materials and methods. Treatment with Hemangiol® was carried out in 6 cities of Russia on the basis of 10 medical hospitals (Children’s CityClinical Hospital named after Z.A. Bashlyaeva of Moscow City Health Department, Research Institute of Pediatric Oncology and Hematology of N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia (Moscow), Russian Children’s Clinical Hospital of the N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia (Moscow), Children’s City Clinical Hospital named after N.F. Filatov of Moscow City Health Department, Saint Petersburg Clinical Scientific and Practical Center of Specialized Medical Assistance (Oncological) (S.-Petersburg), Almazov National Medical Research Centre, Ministry of Health of Russia (S.-Petersburg), Rostov Regional Clinical Hospital (Rostov-on-Don), Stavropol Regional Children’s Clinical Hospital (Stavropol), Samara Regional Clinical Hospital named after V.D. Seredavin, Children’s Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan (Kazan) in the Departments of Pediatric Cardiology, Surgery, Oncology, Pediatrics from January 2020 to December 2021. Therapy with Hemangiol® was received by 49 children with IH for at least 3 months. Before the start of treatment, the patients’ heart rate and blood pressure were measured, general and biochemical blood tests were performed, electrocardiography and ultrasound IH were performed. According to the indications, ultrasound of the liver and thyroid gland was performed to determine the parameters of the thyroid status. Before the start of therapy and during dynamic observation, photo documentation was performed against the background of treatment. In the absence of contraindications to treatment, Hemangiol® was prescribed. During a six-month course of treatment with Hemangiol®, effectiveness was evaluated based on the results of a clinical examination and based on photographs. The appearance of possible adverse reactions was monitored.Results. In 33 (67.3 %) children with IH, therapy with Hemangiol® was completed within 6 months. The effect of treatment in the form of a pronounced regression of vascular tumor was achieved in 25 (75.8 %) of 33 patients. In 16 (32.7 %) of 49 children, treatment with Hemangiol® was continued for more than 6 months. The first symptoms of improvement were observed from the second to 10 days after the start of Hemangiol® therapy in 45 patients, which was (91.8 %). Rebound syndrome (recurrence of IH) was detected in 2 (6.0 %) of 33 children who completed therapy. Transit adverse reactions (decreased heart rate, increased excitability, lethargy) on therapy of Hemangiol® were observed in 8 (16.3 %) children. The duration of therapy with Hemangiol® depended on the prevalence, the depth of the IH lesion, as well as on the presence of prematurity in a child with IH (r = 0.533, p &lt; 0.05). Successful laser treatment with a pulsed laser on a dye after the completion of systemic Hemangiol® therapy, were on 5 children of Research Institute of Pediatric Oncology and Hematology at N.N. Blokhin National Medical Research Centre of Oncology, Ministry of Health of Russia.Conclusion. The results of the using of Hemangiol® as a modern means of systemic pharmacotherapy of IH therapy in 10 medical hospitals in 6 cities of Russia have demonstrated its high efficiency and safety.

Microbeam Radiation Therapy Controls Local Growth of Radioresistant Melanoma and Treats Out-of-Field Locoregional Metastasis

Synchrotron-generated microbeam radiation therapy (MRT) represents an innovative preclinical type of cancer radiation therapy with an excellent therapeutic ratio. Beyond local control, metastatic spread is another important endpoint to assess the effectiveness of radiation therapy treatment. Currently, no data exist on an association between MRT and metastasis. Here, we evaluated the ability of MRT to delay B16F10 murine melanoma progression and locoregional metastatic spread. We assessed the primary tumor response and the extent of metastasis in sentinel lymph nodes in 2 cohorts of C57BL/6J mice, one receiving a single MRT and another receiving 2 MRT treatments delivered with a 10-day interval. We compared these 2 cohorts with synchrotron broad beam-irradiated and nonirradiated mice. In addition, using multiplex quantitative platforms, we measured plasma concentrations of 34 pro- and anti-inflammatory cytokines and frequencies of immune cell subsets infiltrating primary tumors that received either 1 or 2 MRT treatments. Two MRT treatments were significantly more effective for local control than a single MRT. Remarkably, the second MRT also triggered a pronounced regression of out-of-radiation field locoregional metastasis. Augmentation of CXCL5, CXCL12, and CCL22 levels after the second MRT indicated that inhibition of melanoma progression could be associated with increased activity of antitumor neutrophils and T-cells. Indeed, we demonstrated elevated infiltration of neutrophils and activated T-cells in the tumors after the second MRT. Our study highlights the importance of monitoring metastasis after MRT and provides the first MRT fractionation schedule that promotes local and locoregional control with the potential to manage distant metastasis.

Efficacy of cytoflavin in optimizing the pharmacotherapy of traumatic brain injury

Objective. To study the efficacy of Cytoflavinum optimizing the pharmacotherapy of traumatic brain injury.Material and methods. We examined 45 patients with mild to moderate traumatic brain injury aged 25 to 54 years. The patients were divided into two groups depending on the prescribed treatment. The first index group included 25 patients with traumatic brain injury who received complex therapy: Cytoflavinum against the background of standard therapy in accordance with clinical guidelines for the treatment of traumatic brain injury. Cytoflavinum was injected intravenously, once a day, 10 ml in 200 ml of 0.9% sodium chloride solution at a rate of 60–80 drops/min (3–4 ml/min) daily for 7 days. The second control group included 20 patients with traumatic brain injury who received only standard therapy. In accordance with the purpose of the study, laboratory blood parameters and their correlation with the parameters of the antioxidant status were determined, and the dynamics of the clinical condition of patients was assessed.Results and conclusion. The administration of Cytoflavinum to patients contributed to a more pronounced positive dynamics of laboratory blood parameters in comparison with the control. Optimization of the pharmacotherapy of traumatic brain injury by the administration of Cytoflavinum made it possible to achieve a more pronounced regression of clinical symptoms and reduce the duration of hospitalization in comparison with the control group of patients.

Mutational Spectrum of the CFTR Gene in the Kazakhstan Population

To study the frequency and spectrum of CFTR gene variants in different ethnic groups of Kazakhstan. We reviewed the records of 58 patients with cystic fibrosis. All the patients underwent molecular genetic analysis to reveal genotype-phenotype correlations. The median (IQR) age of the patients was 5.4 year (7 months, 18 year); 40% were diagnosed at the age of 5-10 year. The study identified 28 specific variants: p.Phe508del, the variant most common in the European population, was detected in 30 patients (51.7%). Variants other than p.Phe508del were revealed in 31% (21 patients). We found a number of specific variants characteristic of the Kazakhstani population. A pronounced regression of disease symptoms was detected in patients with mild mutations; whereas in patients with severe mutations, therapy produced very little effect.

Correction of intestinal microbial composition disturbances as a potential link in complex therapy of patients with COVID-19

The article reflects the potential for correcting intestinal microbiota disorders in the complex therapy of patients with COVID-19. It has been noted that the inclusion of dietary fiber in the diet contributes to protection against disruption of the integrity of the intestinal barrier and may limit bacterial translocation into the systemic circulation. The possibility of using psyllium (Mucofalk) is reflected, the action of which is realized both through its sorption, cytoprotective and anti-inflammatory properties in viral lesions of the gastrointestinal tract, and through stimulation of the own beneficial intestinal microbiota. The paper presents studies of the prospects for the use of probiotics, synbiotics in the complex therapy of patients with COVID-19. Detailed data are provided on the mechanisms of the positive effect of short-chain fatty acid preparations on reducing the severity of the disease in patients with COVID-19. It was noted that taking the drug Zacofalk leads to a significant increase in its own butyrate-producing microbiota (Faecalibacterium prausnitzii) and suppression of the growth of opportunistic flora with pro-inflammatory activity. The results of a recent study are presented showing that in patients with a mild course of COVID infection with respiratory and intestinal symptoms, the administration of Zakofalk for 30 days (3 tablets per day) led to significantly faster stool normalization (by day 7), persistent normalization of the frequency and consistency of stools by the 21st day and a significantly more pronounced regression of bloating and abdominal pain, as well as a decrease in the risk of developing post-infectious irritable bowel syndrome.

Low-intensity laser irradiation in the rehabilitation of patients after radical surgical or combined treatment for head and neck tumors

Purpose: to evaluate the effectiveness of low-level laser radiation in the complex rehabilitation of patients with head and neck tumors after radical surgical treatment as well as to assess the influence of the discussed treatment on the quality of their life.Material and methods. 134 patients with head and neck cancer aged 23–78 years (mean age – 54.24 ± 12.7 years ) were taken into the study. There were 39 (29.1 %) men and 95 (70.9 %) women. All patients were divided into three groups. In Group 1 (n = 45), patients received traditional rehabilitation treatment (physical exercises, massage, medication); in Group 2 (n = 45), patients had a course of traditional rehabilitation plus low-level laser therapy (LLLT); in Group 3 (n = 44), patients had only several LLLT courses as rehabilitation therapy. For laser therapy, laser device “Azor 2K-02” (laser hazard of class II, GOST 12.1.040-83) was used.Results. During the treatment, most of the patients noted early disappearance or noticeable decrease in pain and numbness intensity at the site of the surgical; skin sensitivity and increase of the muscular tone in the shoulder girdle and upper limb at the site of the surgical were restored as well. The most pronounced regression of complaints after rehabilitation therapy was observed in patients who had LLLT in combination with other rehabilitative measures.Conclusion. Radical surgical or combined treatment of patients with malignant tumors of head and neck causes functional disorders of tissues and organs at the site of treatment. Rehabilitation therapy with LLLT in red and/or infrared spectrum range ensures adequate restoration of impaired functions what improves the quality of life of such patients.

Prognostic value of methylation status of MGMT gene promoter in patients with glioblastoma after combination treatment.

e14025 Background: The effectiveness of radiation therapy in the classical and stereotactic treatment regimens of the primary glioblastoma multiforme was analyzed and compared. Methods: 87 patients with primary glioblastoma multiforme were hospitalized during the study period. 17 patients of them were in the treatment group (stereotactic radiotherapy, dose per fraction 2 Gy, 60 Gy total dose, CTV 2.0 cm, PTV 0.1 cm - group 1), and 70 patients were in the control group (conventionally fractionated radiotherapy, dose per fraction 2 Gy, 60 Gy total dose, CTV 2.0 cm, PTV 0.5 cm - group 2). Patients of both groups were treated with alkylating agents as the third stage of complex treatment. MGMT methylation was evaluated by pyrosequencing. Results: The use of stereotactic radiation therapy allowed to conduct a full course of treatment without interruption, whereas in the second group, due to the development of adverse reactions, the course was interrupted for 7 patients (10%). The advantage of stereotactic radiation therapy was a less pronounced increase and rapid regression of neurological deficits during treatment, manifested by better local control for 6 months. Hypermethylation of MGMT was detected in 39% of glioblastoma cases and was not detected in non-tumor tissue. The presence of promoter methylation disrupts DNA repair and is associated with longer survival in glioblastoma patients receiving alkylating agents. Note that the median survival of patients with MGMT hypermethylation in the group 1 was 285 days (IQR = 323.75), and in the group without hypermethylation was significantly more than 338.5 days (IQR = 476) (p = 0.045). A similar trend was observed in the second group: in patients with hypermethylated MGMT, the median survival was 271 days (IQR = 337), the result is different from patients without hypermethylated MGMT – 342 days (IQR = 493) (p = 0.039). Conclusions: As a result, the application of the stereotactic approach of radiation therapy in the complex treatment of patients with glioblastoma and their classification by the MGMT methylation status with a cut-off point of 10% has the basis for improving the effectiveness and tolerability of radiation therapy and contributes to the overall survival of patients.

Tolperisone in the combination treatment of muscular tonic syndrome in individuals with a high level of physical activity

Introduction. Dorsalgia is one of the most common diseases in individuals practising regular physical training and sports Rationale. Because of the growth of the number of physically active individuals expected to rise by 2024, the improvement of drug and physical rehabilitation methods comes into sharp focus.The objective of the study is to evaluate the clinical efficacy of the use of a centrally acting muscle tolperisone-containing relaxant in the combined treatment of dorsalgia accompanied by a muscular tonic syndrome.Materials and methods. In the study, two groups of patients (30 people each) with muscular tonic syndrome received therapy that included NSAIDs and a neurotropic vitamin complex (in the comparison group), and additionally a centrally acting muscle relaxant (in the treatment group).The treatment outcome was assessed by changes in complaints and the objective neurological status of patients, the degree of muscle soreness upon palpation, and the evaluation of pain syndrome using a visual analogue scale.The shear wave elastography (SWE) of defunct muscles was used as an objective assessment method.Earlier in clinical practice, muscle tension in patients was usually assessed using manual palpation, i.e., only qualitatively and subjectively. SWE is an operator-independent, relatively reproducible, and quantitative method for assessing tendons and muscles. SWE was used in this study to obtain more objective assessment and comparison of the elasticity of “affected” and “healthy” symmetrical back muscles before and after the use of drugs.Results. The study showed a high clinical efficacy of tolperisone in the combination therapy of the lower back pain accompanied by muscular tonic syndrome, which was confirmed by a more significant decreased muscle-tonic syndrome based on the evaluation of complaints and the degree of muscle soreness upon palpation, a more pronounced regression of pain syndrome according to VAS in the treatment group of patients vs the comparison group. According to the elastography findings before and after treatment, the group receiving tolperisone showed a more significant decrease in muscular tonic syndrome.Сonclusion. The study confirmed the clinical efficacy of tolperisone manufactured by Sotex pharmaceutical company. On these grounds we recommend that the drug is used in combination therapy for dorsalgias (dorsopathies) accompanied by a muscular tonic (myofascial) syndrome both in patients without a proper level of physical activity, and in those practising regular physical training and sports.