The influence of walking in an exoskeleton on rehabilitation of patients with spinal cord injury consequences

Objective: to substantiate the expediency of including training walking in an exoskeleton in the complex rehabilitation of patients with severe motor dysfunctions of the lower limbs due to spinal cord injury (SCI).Methods: 120 patients (84 men and 36 women, age 37.1 ± 8.40 years) with the consequences of SCI at the level of thoracic and lumbar spine who were in the hospital at the second stage of medical rehabilitation were examined. The duration of injury ranged from 1 year to 19 years (77.8 ± 4.05 months). All patients were divided into two groups (80 and 40 patients), comparable by sex, age, duration and severity of injury. Training walking in exoskeleton have been added in the group I rehabilitation program. ASIA, SCIM III scales and SF-36 quality of life questionnaire were used to evaluate the effectiveness of the rehabilitation measures.Results: there was an increase in the total score on SCIM III by 3.20 ± 0.50 (p = 0.05) in group I, which indicates an increase in the level of functioning and daily activity of patients. Positive dynamics was revealed when assessing the quality of life using SF-36 questionnaire: sum index reflecting the psychological component of health increased from 56,0 to 59,5 points (p = 0,05). Group II also showed positive dynamics of the analyzed indicators, but the changes by the end of the rehabilitation course were not statistically significant.Conclusion: the use of exoskeleton training walking at the second stage of medical rehabilitation increases the effectiveness of rehabilitation measures and improves the quality of life of patients with severe motor dysfunctions of the lower limbs due to spinal cord injury (SCI)

Russian clinical practice guidelines «congenital adrenal hyperplasia»

Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive diseases characterized by a defect in one of the enzymes or transport proteins involved in the cortisol synthesis in the adrenal cortex. The most common form of CAH, which occurs in more than 90% of cases, is a 21-hydroxylase enzyme deficiency. The latter is subdivided into nonclassical and classic (salt-losing and virilizing) forms. The prevalence of classic forms of 21-hydroxylase deficiency ranges from 1: 14,000 to 1:18,000 live births worldwide. According to the data of neonatal screening in the Russian Federation, the prevalence of the disease in some regions ranges from 1: 5000 to 1: 12000, in the country as a whole - 1: 9638 live newborns. The non-classical form of CAH occurs more often - from 1: 500 to 1: 1000 among the general population. In second place is the hypertensive form of CAH - a deficiency of 11β-hydroxylase, which, according to the literature, occurs in about 1 per 100,000 newborns. These clinical guidelines were compiled by a professional community of narrow specialists, approved by the expert council of the Ministry of Health of the Russian Federation, and updated the previous version published in 2016. The clinical guidelines are based on systematic reviews, meta-analyses and original articles, and scientific work on this issue in the Russian Federation and other countries. The purpose of this document is to provide clinicians with the most up-to-date, evidence-based guidelines for the CAH diagnosis and treatmen

Влияние интрамиокардиальной инъекции аутологичных клеток костного мозга, обработанных эритропоэтином, на перфузию миокарда по данным ОФЭКТ с 99mТc-МИБИ в отдаленный период наблюдения

Purpose. To evaluate the changes of myocardial perfusion using 99mТс-MIBI single-photon emission computed tomography (SPECT) after the intramyocardial implantation of erythropoietin preconditioned autologous bone marrow cells (ABMC) in laser channels during coronary artery disease (CAD) surgery.Materials and methods. Randomized study of 40 patients (mean age 58.0 ± 6.9, 9 females) with diffuse and (or) distal right coronary artery disease (RCA). Patients of the study group (n = 23) underwent coronary artery bypass grafting (CABG) of the left coronary artery (LCA) system and intramyocardial implantation of erythropoietin preconditioned ABMC in the left ventricular (LV) inferior wall. Patients of the control group (n = 17) underwent CABG of the LCA system only. 99mТс-MIBI SPECT performed 1–2 days before and 12 months after surgery.Results. In study group after 12-month follow-up the summed stress score in a typical RCA supply area (SSSRCA) improved from 7.0 [5.5; 10.5] to 4.0 [1.0; 5.5] (p <0.01), summed rest score (SRSRCA) improved from 3.0 [0.0; 7.0] to 1.0 [0.0; 3.5] (p <0.01), and summed different score (SDSRCA) improved from 3.0 [1.0; 4.0] to 1.0 [0.0; 2.0] (p = 0.03). Control group patients after 12-month follow-up showed significant improvement of SSS RCA only – from 8.0 [6.0; 12.0] to 5.0 [4.0; 7.0] (p <0.01).Conclusion. After 12-month follow-up in patients with diffuse and (or) distal RCA disease, the procedure of intramyocardial implantation of the erythropoietin preconditioned ABMC in laser channels is demonstrated to be safe and induces the improvement of myocardial perfusion.  Цель – оценить изменения миокардиальной перфузии по данным однофотонной эмиссионной компьютерной томографии (ОФЭКТ) с 99mТс-МИБИ после применения трансмиокардиальной лазерной реваскуляризации в сочетании с имплантацией прекондиционированных эритропоэтином аутологичных клеток костного мозга (АККМ) в хирургии ишемической болезни сердца (ИБС).Материалы и методы. Больные ИБС (n = 40, средний возраст (58,0 ± 6,9) лет, 9 женщин) с диффузным и (или) дистальным поражением правой коронарной артерии (ПКА) рандомизированы на две группы. Пациентам из группы исследования (n = 23) выполнено аортокоронарное шунтирование (АКШ) системы левой коронарной артерии (ЛКА) c имплантацией прекондиционированных эритропоэтином АККМ в область нижней стенки левого желудочка (ЛЖ), пациентам из группы контроля (n = 17) выполнено АКШ системы ЛКА. Оценка показателей перфузии миокарда (SSS, SRS, SDS) по данным ОФЭКТ с 99mТс-МИБИ проведена за 1–2 сут до и через 12 мес после оперативного лечения.Результаты. При прицельной оценке перфузии миокарда в типичном бассейне кровоснабжения ПКА у пациентов из группы исследования выявили уменьшение SSSRCA с 7,0 [5,5; 10,5] до 4,0 [1,0; 5,5] (p < 0,01), SRSRCA с 3,0 [0,0; 7,0] до 1,0 [0,0; 3,5] (p < 0,01) и SDSRCA с 3,0 [1,0; 4,0] до 1,0 [0,0; 2,0] (p = 0,03). У пациентов из группы контроля в бассейне кровоснабжения ПКА выявили значимое уменьшение только SSSRCA c 8,0 [6,0; 12,0] до 5,0 [4,0; 7,0] (p < 0,01).Заключение. В отдаленные сроки наблюдения процедура трансмиокардиальной лазерной реваскуляризации в сочетании с имплантацией прекондиционированных эритропоэтином АККМ вызывает улучшение перфузии миокарда у пациентов с диффузным и (или) дистальным поражением ПКА

Клинико-функциональная оценка интрамиокардиальной имплантации аутологичных клеток костного мозга, обработанных эритропоэтином, в хирургии ИБС (6-месячные результаты)

Aim. Clinical and functional evaluation of the implantation of autologous bone marrow cells treated with erythropoietin in laser channels during coronary bypass grafting in patients with end-stage coronary lesion.Materials and methods. 60 patients with coronary artery disease with diffuse and (or) distal right coronary artery disease were randomized into two groups: patients of group 1 (n = 30) underwent coronary bypass grafting, implantation of autologous bone marrow cells treated with erythropoietin in laser channels, patients of the 2nd group (n = 30) were operated with coronary bypass grafting of the left coronary artery system. Assessment of the clinical status, myocardial perfusion and contractility was performed initially, 6 months after the operation.Results. Six months after the operation, there was a more pronounced decrease in angina pectoris (CCS) in the main group compared to the control group, also we revealed a 6-minute walk test scores improvement. Based on two-stage scintigraphy (Tc99) in the main group before the surgical treatment, a rest perfusion defect was 8.5% [3.5, 18.5], a stress-induced perfusion defect – 7.0% [6.0, 12, 3]. In the control group, the rest defect was 9.1% [5.6, 12.4], the stress-induced perfusion defect was 7.3% [6.1, 8.7]. 6 months after surgery rest perfusion defect at the indirect revascularization group was 6.0% [2.5, 16.5] (p = 0.008), a stress-induced defect was 4.0% [1.5, 6.3] (p = 0.05). In the control group, the rest defect was 8.7% [5.3, 10.3], the stress-induced perfusion defect was 6.8% [5.3, 9.1] (p = 0.21). The results of scintigraphy with MIBG showed a left ventricle innervation defect (PID) significant decrease in the main group: initially 15.4% [14.2, 16.3], after 6 months 11.7% [9.3, 13, 2] (p = 0.045). In the control group, there was an unreliable decrease in PID: initially 14.3% [10.2, 17.3], after 6 months 13.8% [9.1, 14.2] (p = 0.14).Conclusion. Our preliminary results revealed more pronounced effect of the new indirect revascularization method expressed as in myocardial perfusion improve, myocardial sympathetic innervation restoration and clinical status improvement in comparison with control group.Цель. Клинико-функциональная оценка эффекта применения трансмиокардиальной лазерной реваскуляризации в сочетании с имплантацией прекондиционированных эритропоэтином клеток аутологичного костного мозга в хирургии ишемической болезни сердца.Материалы и методы. Больные ИБС с диффузным и(или) дистальным поражением правой коронарной артерии (n = 60) рандомизированы на две группы: пациентам 1-й группы (n = 30) выполнено коронарное шунтирование, c имплантацией прекондиционированных эритропоэтином клеток аутологичного костного мозга в область нижней стенки левого желудочка, пациентам 2-й группы (группа контроля, n = 30) выполнено коронарное шунтирование системы левой коронарной артерии. Оценка клинического статуса, перфузии и сократительной способности миокарда выполнена исходно, через 6 месяцев после операции.Результаты. Через 6 месяцев после операции выявлено более выраженное снижение функционального класса (ФК) стенокардии (ССS) в основной группе по сравнению с группой контроля, улучшение показателей теста 6-минутной ходьбы. По результатам двухэтапной сцинтиграфии миокарда с технетрилом (Тс99) М в основной группе до хирургического лечения отмечен стойкий дефект перфузии 8,5% [3,5; 18,5], стресс-индуцированный дефект перфузии 7,0% [6,0; 12,3]. В контрольной группе – стабильный дефект 9,1% [5,6; 12,4], стресс-индуцированный дефект перфузии 7,3% [6,1; 8,7]. Через 6 месяцев в основной группе стойкий дефект перфузии составил 6,0% [2,5; 16,5] (p = 0,008), стресс-индуцированный дефект – до 4,0% [1,5; 6,3] (p = 0,05). В контрольной группе – стабильный дефект 8,7% [5,3; 10,3], стресс-индуцированный дефект перфузии 6,8% [5,3; 9,1] (р = 0,21). Результаты сцинтиграфии с МIBG демонстрируют значимое уменьшение площади дефекта иннервации (ПДИ) в сегментах нижней стенки левого желудочка в основной группе: исходно 15,4% [14,2; 16,3], через 6 месяцев 11,7% [9,3; 13,2] (р = 0,045). В контрольной группе выявлено недостоверное уменьшение ПДИ: исходно 14,3% [10,2; 17,3], через 6 месяцев 13,8% [9,1; 14,2] (р = 0,14).Заключение. Исследование продемонстрировало улучшение перфузии в зоне непрямой реваскуляризации, восстановление симпатической иннервации миокарда, лучшие показатели ФК (CCS), теста 6-минутной ходьбы у пациентов в основной группе

Identifying key questions in the ecology and evolution of cancer

The application of evolutionary and ecological principles to cancer prevention and treatment, as well as recognizing cancer as a selection force in nature, has gained impetus over the last 50 years. Following the initial theoretical approaches that combined knowledge from interdisciplinary fields, it became clear that using the eco‐evolutionary framework is of key importance to understand cancer. We are now at a pivotal point where accumulating evidence starts to steer the future directions of the discipline and allows us to underpin the key challenges that remain to be addressed. Here, we aim to assess current advancements in the field and to suggest future directions for research. First, we summarize cancer research areas that, so far, have assimilated ecological and evolutionary principles into their approaches and illustrate their key importance. Then, we assembled 33 experts and identified 84 key questions, organized around nine major themes, to pave the foundations for research to come. We highlight the urgent need for broadening the portfolio of research directions to stimulate novel approaches at the interface of oncology and ecological and evolutionary sciences. We conclude that progressive and efficient cross‐disciplinary collaborations that draw on the expertise of the fields of ecology, evolution and cancer are essential in order to efficiently address current and future questions about cancer

Pandemic COVID-19: Features of the mechanism of drug action

Main drugs used to treat COVID-19 and its complications are reviewed. Brief information about the molecular mechanisms of action of etiotropic, pathogenetic and symptomatic palliative drugs is given. A comparative analysis of data available on the efficacy and safety of drugs and the risks of drug interactions is carried out. There are currently no proven effective treatments for COVID-19. Rapidly expanding knowledge about the nature of SARS-CoV-2 is creating conditions for increase in the number of potential drug targets for the treatment of COVID-19

Uterine myoma: new and perspective options for medicinal treatment

The review provides information on the medical treatment of uterine fibroids (MM) in a comparative aspect. MM are one of the most common gynecological diseases requiring surgical intervention in the presence of symptoms. As a drug treatment, gestagens and their combinations with estrogens, which did not demonstrate reliable efficacy, were the first to be proposed. Later, obvious advantages of using GnRH agonists/antagonists that cause the effect of “central” chemical castration were discovered, and therefore their use is limited to 6 months, and they are successfully used to prepare patients for surgery. Recently, non-peptide orally active GnRH receptor antagonists have been proposed that are in the early stages of clinical trials. However, changes in the dosage form and route of administration of drugs that inhibit the activity of GRH do not improve their safety profile. Another breakthrough in MM therapy has been the use of selective progesterone receptor modulators, previously called “antiprogestins.” The drugs of this group have comparable efficacy and better tolerance to AGnRH, which makes the possible long-term treatment of uterine fibroids, especially in premenopausal women, using these drugs