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The article presents the results of clinical and experimental research of Russian and foreign scientists on the use of modern non-drug technology-selective pulse electrotherapy for various diseases and justification of its use in rehabilitation programs after pelvic surgery.

Background. The high recurrence rate after surgical treatment of pelvic organ prolapse makes it necessary to improve therapeutic methods. Objective: to develop and scientifically substantiate the use of a rehabilitation complex, including general magnetotherapy, electromyostimulation with biofeedback in combination with fractional microablative therapy with a CO 2 laser, in patients of different age groups with rectocele after surgery. Methods. The article presents the treatment data for 100 women of childbearing, peri- and menopausal age with rectocele II–III degree, which were divided into 2 groups comparable in terms of clinical and functional characteristics (main and control), within each group they were divided by 2 subgroups: subgroup A included women of childbearing age, subgroup B included women of peri- and menopausal age. The patients of the main group in the early postoperative period after plastic surgery for rectocella (from 1 day) underwent a course of general magnetotherapy and in the late postoperative period (one month after the operation) they performed a set of measures consisting of a course of electromyostimulation with biological connection of the pelvic floor muscles and a special complex physiotherapy exercises and 2 intravaginal procedures of fractional microablative CO 2 laser therapy with an interval of 4–5 weeks. Patients in the control group after surgical treatment of rectocele in the late postoperative period received symptomatic therapy, including painkillers and antispasmodics, which served as a backdrop for patients of the main group. Results. As a result of the studies, it was found that regardless of the age and severity of uterine blood flow disorders in the uterine arteries in patients with rectocele, the most pronounced dynamics was observed in patients of the main group, which, in our opinion, is associated primarily with the vasoactive effects of general magnetotherapy, manifested in the removal of spasm from arteries and arterioles, improving the contractility of the veins and increasing venous outflow, which in combination with electrical stimulation, exercises to strengthen the muscles of the pelvis bottom and fractional microablative therapy allowed to obtain such a pronounced vasocorrigating effect. Conclusions. Due to the pathogenetic effect of the developed complex (electrical stimulation, exercises to strengthen the pelvic floor muscles and fractional microablative therapy) on one of the main mechanisms of the development of the disease, a pronounced vasocorrecting effect was obtained.

The expert consensus of the Russian communities discusses the issues of comprehensive medical rehabilitation of patients with coronavirus disease 2019 (COVID-19). COVID-19 is a contagious infectious disease that can cause pulmonary, cardiac, motor, metabolic, neurocognitive and mental disorders, that is, multiple organ dysfunction. COVID-19 survivors, especially after a severe clinical course, face serious psychological and physical problems, posttraumatic stress, cognitive dysfunction, nutritional deficiencies and exacerbation of concomitant chronic diseases. Some patients, regardless of the COVID-19 severity, have a long clinical course of the disease (“chronic-COVID”, “long COVID”). There is evidence of post-acute COVID-19 syndrome. In this regard, patients after COVID-19 will need rehabilitation measures. The expert consensus of the Russian communities presents general principles, stages and aspects of medical rehabilitation after COVID-19, indications and contraindications for rehabilitation interventions. The paper includes recommendations on comprehensive cardiac and pulmonary rehabilitation, as well as specifics of rehabilitation care for different COVID-19 courses within the national three-stage rehabilitation system.

To develop the optimized complex programs, including general magnetotherapy, fractional microablative therapy with a CO2 laser, electromyostimulation with biofeedback of the pelvic floor muscles, and a special exercise therapy complex in late rehabilitation programs for women of different age after reconstructive plastic surgery for rectocele.There were 200 women of childbearing, peri- and menopausal age with rectocele grade II-III and 20 healthy women of comparable age. All patients were divided into 4 groups by 50 womes: main group, two comparison groups and control group. Surgical treatment of rectocele was followed by long-term postoperative rehabilitation including symptomatic therapy, general magnetotherapy, and electromyostimulation with biofeedback of the pelvic floor muscles, intra-vaginal fractional microablative therapy with a CO2 laser and special complex of therapeutic physical education.General magnetotherapy in early (1 day) postoperative period and complex rehabilitation in long-term postoperative period (within a month after surgery) including 2 procedures of intra-vaginal microablative fractional therapy with carbon dioxide laser, electromyostimulation with biological connection of the pelvic floor muscles and special complex of therapeutic physical education ensured more significant improvement of uterine blood flow regardless age and baseline disorders in the uterine arteries in patients with rectocele. In our opinion, this is primarily due to vasoactive effects of general magnetotherapy, recovery of circulation via relief of spasm in the arteries and arterioles, improved vein contractility and venous outflow. These processes combined with electrical stimulation and therapeutic exercises of pelvic floor muscle followed by their reinforcement, as well as fractional microablative therapy ensured significant vascular effect.Представлены результаты лечения 200 женщин детородного, пери- и менопаузального возраста с ректоцеле II—III степени и 20 практически здоровых женщин сопоставимого возраста, результаты обследования которых принимали за значения «нормы». Все больные разделены 4 сопоставимые по клинико-функциональным характеристикам группы по 50 человек: основную, сравнения 1, сравнения 2 и контрольную, которым после оперативного лечения ректоцеле в позднем послеоперационном периоде применяли реабилитационные программы, симптоматическую терапию, включающую в разных сочетаниях курс общей магнитотерапии и электромиостимуляции с биологической связью мышц тазового дна, процедуры внутривлагалищной фракционной микроаблятивной терапии CO

Background. The specific weight of genital prolapse among gynecological nosologies in Russia in the departments of operative gynecology ranges from 28 to 38.9% and in the structure of planned indications for surgical treatment ranks third after benign tumors and endometriosis. Aim. Development and implementation of new comprehensive rehabilitation programs for women with IIIII degree rectocele after surgical treatment. Methods. The article presents the treatment data for 100 women of different age groups with IIIII degree rectocele who, in the early postoperative period after plastic surgery for rectocell, used to improve the condition of the vaginal mucosa with general magnetotherapy, electromyostimulation with biological connection of the pelvic floor muscles, a special complex of physiotherapy exercises and intravaginal procedures of fractional microablative carbon dioxide laser therapy. The patients were divided into 2 groups comparable in terms of clinical and functional characteristics; within each group, depending on age, they were divided into 2 subgroups: women of childbearing age were included in subgroup A, and peri- and menopausal women were included in subgroup B. To assess the condition of the vaginal mucosa and maturity of the vaginal epithelium after surgery in patients included in the study, a pH-metry of the vaginal discharge was performed and the Vaginal Health Index was determined. Results. As a result of the studies, it was found that a more pronounced therapeutic effect was obtained with the use of the complex, which includes a course of general magnetotherapy from the first day after surgery, as well as a month after surgery, a course of electromyostimulation with biological connection of the pelvic floor muscles and a special complex of physiotherapy exercises and 2 intravaginal procedures of fractional microablative carbon dioxide laser therapy. Conclusion. The obtained results indicate a pronounced therapeutic effect of the complex, which includes a course of General magnetotherapy from the first day after surgery, a course of electromyostimulation with biological connection of pelvic floor muscles and a special complex of physical therapy, as well as 2 intravaginal procedures of fractionation microablative therapy with a carbon dioxide laser 1 month after surgery..

Medical rehabilitation is now a priority of the Russian Healthcare [Skvortsova V.I., 2012]. Rehabilitation centers are usually located in big cities and are not available for most patients. Therefore, one of the modern trends in the development of rehabilitation is a distantly controlled rehabilitation. We have developed a program of distant rehabilitation in Russia, based on our own achievements and experience of foreign colleagues. The article provides an overview of methods according to world literature studies. The survey shows that the problem of distant rehabilitation is relevant in our time, and requires additional clinical research and technological development.

A protocol for EEG biological feedback (BFB) at infra-low frequencies (

To study the effect of general magnetotherapy, muscle stimulation with biofeedback of pelvic floor muscles, and a special complex of physiotherapy exercises with and without fractional microablative COThere were 200 fertile females and women of perimenopausal and menopausal age with rectocele grade II-III. Various rehabilitation programs were used in delayed postoperative period in order to improve sexual function. Rehabilitation included various combinations general magnetotherapy, electrical muscle stimulation with biofeedback of pelvic floor muscles, intravaginal fractional microablative COPostoperative rehabilitation including general magnetotherapy, fractional microablative COИзучить влияние комплексного применения общей магнитотерапии, электромиостимуляции с биологической связью мышц тазового дна и специального комплекса лечебной физкультуры (ЛФК) в сочетании с фракционной микроаблятивной терапией COВ статье представлены данные лечения 200 женщин детородного, перименопаузального и менопаузального возраста с ректоцеле II—III степени. Пациенткам после оперативного лечения ректоцеле в позднем послеоперационном периоде с целью улучшения сексуальной функции применялись реабилитационные программы, включающие в разных сочетаниях общую магнитотерапию, процедуры внутривлагалищной фракционной микроаблятивной терапии COВ результате проведенных исследований установлено, что применение после оперативного вмешательства у пациенток с ректоцеле разработанного комплекса, состоящего из курсового применения общей магнитотерапии, фракционной микроаблятивной терапии CO

total hip replacement has long ago become the «golden standard» for the treatment of dysplastic coxarthrosis in thousands of the patients receiving it every year. In the meantime, the analysis of the specialized literature gives evidence of the lack of a systematic and personified approach to the rehabilitation treatment.The objective of the present study was to improve medical rehabilitation of the patients following the total hip replacement and to develop the personalized programs for walking modality reconstruction taking into consideration the age and the body weight of the patients.A total of 240 patients were available for the observation including 184 women and 56 men. They were divided into three study groups and one control group, with the differentiation into the following three subgroups: one comprised of the patients of moderate acerage age and body weight, the other containing the obese patients (BMI35), and the third one involving the elderly patients (age70 years); each subgroup consisted of 20 patients. All the patients received the early basic rehabilitation treatment, those in the study groups had to perform in addition the robotic training based on the use of hardware techniques supplemented by passive mechanotherapy and electromyostimulation designed to restore the walking stereotype with three types of devices: body weight unloading, video-reconstruction associated with biological feedback and robototherapy.The comparative analysis of the effectiveness of various methods of gait reconstruction has demonstrated the high effectiveness of the application of the hardware technique in the patients of moderate acerage age and body weight. At the same time, the elderly patients had a significantly higher rate of successful walking reconstruction efficiency under the influence of the video-associated training with biological feedback (3 times that achieved with training using the device for unloading the body weight and 4 times compared with the result of a course of robotic walk. The evaluation of the application of the techniques for the gait stereotype reconstruction in the obese patients gave evidence of the advantage of the Lokomat robotic trainings that produced 6 times better results than unloading of the body weight and 5 times better ones than the video-associated training with biological feedback.The results of the present study are on the whole comparable with the data reported by other authors although its design was different from that of the majority of the published studies in that our patients were allocated to different subgroups for the further personalization of the methods applied to restore the gait stereotype. The factors limiting the use of the results of this study include the medium-high level of the patients' welfare most of whom are residents of the city of Moscow and Moscow region characterized by a relatively high quality and accessibility of health care. It means that the results of such studies as the one described in the present article are directly related to the quality and accessibility of health care and can be extrapolated only to the socially safe and well-to-do patients.All the hardware techniques are equally effective in the patients of moderate average age and body weight. The elderly patients showed the best results using the video-reconstruction associated with biological feedback, while the Locomat technique was especially useful for the obese patients.Актуальность тотального эндопротезирования тазобедренного сустава не вызывает сомнений, так как данный вид хирургического вмешательства давно является «золотым стандартом» лечения диспластического коксартроза. Анализ специализированной литературы указывает на отсутствие системного и персонифицированного подходов к реабилитационному лечению. Цель — улучшить результаты медицинской реабилитации больных после тотального эндопротезирования тазобедренного сустава за счет персонифицированного подбора аппаратных методик в зависимости от возраста и массы тела пациентов. Пациенты и методы. В исследование были включены 240 человек, из них 60 пациентов вошли в контрольную группу и 180 больных — в три основные группы наблюдения с дифференциацией на подгруппы: пациенты со средними параметрами возраста и массы тела, обследуемые с ожирением и лица пожилого возраста. Все пациенты получали базовую программу ранней реабилитации, больным основных групп дополнительно назначали аппаратные тренировки восстановления стереотипа ходьбы на 3 типах устройств (разгрузка массы тела; видеореконструкция, ассоциированная с биологической обратной связью; робототерапия). Результаты. Сравнительный анализ эффективности применения различных методик реконструкции стереотипа ходьбы показал, что у пациентов со средними параметрами были достигнуты лучшие результаты при применении любой аппаратной методики. В то же время у пожилых пациентов были отмечены достоверно более высокие показатели эффективности реконструкции ходьбы при применении тренировки, ассоциированной с биологической обратной связью: в 3 раза по сравнению с методикой тренировки в устройстве разгрузки массы тела и в 4 раза по сравнению с курсом роботизированной ходьбы. Оценка применения методик реконструкции стереотипа ходьбы у пациентов с ожирением выявила преимущество роботизированных тренировок: в 6 раз по сравнению с использованием устройства разгрузки массы тела и в 5 раз по сравнению с тренировкой, ассоциированной с биологической обратной связью. Обсуждение. Полученные результаты в целом сопоставимы с данными, опубликованными другими авторами, однако в нашем исследовании была проведена дифференциация пациентов для дальнейшей индивидуализации методик по восстановлению стереотипа ходьбы. К числу факторов, ограничивающих применение результатов исследования, можно отнести средне-высокий уровень благосостояния, медицинского послеоперационного ухода больных, чьим местом жительства в подавляющем большинстве случаев являются Москва и Московская область, отличающиеся сравнительно высокими показателями доступности и качества медицинской помощи. Таким образом, результаты исследования находятся в прямой зависимости от качества оказания медицинской помощи и могут быть экстраполированы только на контактных, социально благополучных пациентов. Заключение. У пациентов со средними параметрами возраста и массы тела выбор методики реконструкции стереотипа ходьбы не влияет на результат. У пациентов старческого возраста наиболее эффективна ассоциированная тренировка с биологической обратной связью, а у больных с ожирением предпочтительнее роботизированная методика.

The efficacy of the reconstruction of the external robotic walking (RRH) on the device "Lokomat" in patients after total knee arthroplasty (TKA) in the early postoperative period (priori). The patients were divided into two groups: the study group (n=112) in patients whose priori to train walk on robotic device (EDM) and control group (n = 80), where the restoration was carried out in an active stereotype motoring instructor-led exercise therapy without use of mechanized equipment. Comparative analysis of the test results revealed more efficient recovery stereotype walk from the main group. In the analysis of the main group in the dynamics dinamoplantgrafii showed improvement in economic structure step, restoring the symmetry of the load while walking between the lower limbs, improved suspension function of the operated limb. According to the analysis parameter of the trajectory of migration center under the feet, we noted an increase in the effective axial load on the operated leg in the main group 1161.29 267.49 g/cm2 compared with the control group 460.28 52.42 g/cm2 (p ≤ 0,05). In the main group also showed a decrease of anxiety and increasing motivation. Conducted an X-ray - control the implanted joint in the long-term (12 months after surgery) did not show any signs of instability in the case of prosthetic components. Thus, conducting robotic training walk in patients in the early postoperative period is an effective and safe method of rehabilitation.

To assess safety and clinical-economic effectiveness of complex postoperative rehabilitation after pancreatoduodenectomy.73 patients were included in the study. Main group consisted of 39 patients who underwent accelerated postoperative rehabilitation that was developed in our clinic. In the control group of 34 patients this protocol was not applied. The main components of rehabilitation were multicomponent analgesia, early enteral nutrition, physical rehabilitation by using of exercise therapy and physiotherapy.There were no significant differences in the incidence of postoperative complications and mortality (58.8% and 74.3%; p=0.213, 5.8% and 7.7%; p=0.678, respectively). Median of postoperative hospital-stay in the study group was 13 days (9; 16), in the control group - 15 days (9; 24). An estimated economic effect in the study group was 558 764, 84 rubles.Accelerated postoperative rehabilitation after pancreatoduodenectomy is safe and does not lead to increased number of postoperative complications and mortality. Developed protocol has clinical advantages and is cost-effective.Цель исследования - оценить безопасность и клинико-экономическую эффективность комплексного протокола послеоперационной реабилитации у пациентов, перенесших панкреатодуоденальную резекцию (ПДР). Материал и методы. В исследование включены 73 пациента: 39 пациентов, в терапии которых применялся разработанный в клинике протокол ускоренной послеоперационной реабилитации, составили основную группу. В группу контроля вошли 34 пациента, при лечении которых указанный протокол не применяли. Основными компонентами разработанного и применяемого в клинике протокола были многокомпонентная аналгезия, раннее энтеральное питание, физическая реабилитация за счет применения средств лечебной физкультуры и физиотерапии. Результаты. Статистически значимых различий в частоте послеоперационных осложнений и случаев летального исхода не выявлено (58,8 и 74,3%, p=0,213; 5,8 и 7,7%, p=0,678 соответственно). Медиана послеоперационного койко-дня в исследуемой группе составила 13 (9; 16), в группе контроля - 5 (9; 24). Ориентировочный экономический эффект в исследуемой группе составил 558 764 руб. 84 коп. Выводы. Программа ускоренной послеоперационной реабилитации пациентов, перенесших ПДР, безопасна и не приводит к увеличению частоты послеоперационных осложнений и случаев летального исхода. Разработанный протокол обладает клиническими преимуществами и экономически эффективен.

We present a study showing advantages of EVLT at 1.56 μm wavelength in comparison with 0.97 μm. In particulat, the water and blood absorption at 1.56 μm give better EVLT conditions than at 0.81-1.5 μm.