BACKGROUND: Rehabilitation of patients with severe residual deficits after an acute cerebrovascular accident (stroke) is frequently insufficiently effective, necessitating the search for new therapeutic approaches. Hypoxic conditioning using intermittent hypoxic–hyperoxic exposures (IHHE) has demonstrated efficacy in improving physical and mental performance in various patient populations. However, this approach has not previously been applied in post-stroke rehabilitation. AIM: The study aimed to evaluate the efficacy and safety of incorporating IHHE into comprehensive rehabilitation programs for patients in the late post-stroke period (≥ 6 months) regarding exercise tolerance, psychoemotional state, and cognitive status. METHODS: This prospective study included 50 patients who had an ischemic or hemorrhagic stroke ≥ 6 months ago. Patients were randomized to either the treatment group (n = 20) or the control group (n = 30). The treatment group received a standard 3-week rehabilitation program plus 10–12 IHHE procedures (hypoxic phase, FiO₂ = 0.11–0.12; hyperoxic phase, FiO₂ = 0.35–0.40). The control group received the standard rehabilitation program only. The following parameters were assessed before and after the intervention: six-minute walk test (6MWT) score, work performed (W), Borg scale score, heart rate, blood pressure, oxygen saturation, psychoemotional state (DASS-21, Epworth Sleepiness Scale), quality of life (SF-12), functional independence (Barthel Index), and cognitive function (USEFO test). RESULTS: The treatment group showed a more pronounced increase in exercise tolerance, with an increase in 6MWT distance of 58.9 ± 24.3 m vs. 15.8 ± 18.7 m (p = 0.005) and work performed of 7.7 ± 3.8 vs. 3.7 ± 3.1 (p = 0.018). A clinically relevant improvement (≥ 35 m) was achieved in 60% of patients in the treatment group compared with 16.7% in the control group. Furthermore, a greater reduction in depression, anxiety, and stress severity according to DASS-21 (p 0.05), decreased daytime sleepiness, increased SF-12 scores, and improved Barthel index were observed. IHHE procedures were well tolerated; adverse effects were minimal and transient, occurring during the first 1–3 procedures. CONCLUSION: Adding a personalized IHHE course to standard post-stroke rehabilitation resulted in pronounced improvements in exercise tolerance, psychoemotional state, quality of life, and functional independence. The method was safe and well tolerated. Larger-scale studies are required to confirm long-term efficacy.

INTRODUCTION. Chronic occupational lung diseases (COLD) represent a serious medical and social problem associated with a high degree of comorbidity and systemic disorders, including cardiometabolic changes, pronounced oxidative stress, chronic inflammation, autonomous and immune dysregulation, and leading to disability and reduced quality of life. Hypoxic conditioning (HC), in particular, intermittent hypoxic-hyperoxic exposures (IHHE), which can improve adaptation mechanisms and reduce inflammatory processes, is a promising method of rehabilitation of patients with COLD, along with basic medication and physiotherapy. AIM. To evaluate the efficacy and safety of IHHE application in the programs of complex rehabilitation of patients with COLD. MATERIALS AND METHODS. A single-center blind randomized placebo-controlled study with participation of 60 patients (32 men, age 58,2 ± 14,1 years, desiase’s duration 15,9 ± 2,8 years) with COLD (occupational bronchial asthma — 59.3 %), occupational chronic bronchitis — 18.5 %, occupational chronic obstructive pulmonary disease — 11.1 %) and occupational exogenous allergic alveolitis — 11.1 %), divided into two groups was conducted: the main group received 12 sessions of IHHE in 3 weeks, control group — placebo procedures. Both groups underwent standard medical and physiotherapeutic rehabilitation. Clinical, functional and laboratory parameters before and after the rehabilitation course were evaluated. RESULTS AND DISCUSSION. In the IHHE group there was a significant improvement of hypoxic resistance (according to Stange’s and Gench’s tests, hypoxic test), reduction of broncho-obstructive manifestations, improvement of external respiratory function indices and reduction of blood pressure. There was also an increase in exercise tolerance according to the six-minute walk test (6MWT) (an increase of 11.9 ± 8.6 % from baseline), a decrease in the severity of dyspnea and subjective assessments of exercise severity according to the Borg scale. In the control group, the positive dynamics in the indicators of hypoxic tolerance, broncho-obstruction, and 6MWT tolerance were significantly less pronounced. The results of the study confirm that IHHE procedures can serve as a significant addition to the standard rehabilitation of patients with COLD, contributing to the improvement of clinical and functional parameters, correction of comorbid disorders. CONCLUSION. IHHE is a safe and effective method to be added to standard rehabilitation of patients with COLD, leading to more pronounced improvements of hypoxic resistance, exercise tolerance, reduction of broncho-obstruction and normalization of blood pressure.

Aim. To assess the effect of intermittent hypoxic-hyperoxic exposures (IHHE) on the outcomes of on-pump cardiac surgery.Material and methods. This prospective, single-center, randomized, controlled study was conducted in 110 patients with heart valve defects and/or aortic pathology from the cardiac surgery clinic of the I. M. Sechenov First Moscow State Medical University. The total sample was randomly divided into a group of patients who underwent IHHE (n=66) and a control group of patients who underwent placebo procedures with ambient air (n=44). The frequency and structure of intra-and postoperative complications were analyzed within 30 days after surgery. The presence of cognitive impairment, as well as serum troponin I and lactate concentrations were analyzed before and after surgery.Results. Peri- and early postoperative complications such as cardiac death, non-fatal infarction and acute heart failure occurred significantly less frequently in patients treated with IHHE compared with placebo group (1,6% vs 16,7%, p=0,009; 1,6% vs 16,7%, p=0,009; 6,3% vs 33,3%, p<0,001, respectively). The median troponin I values 24 hours after surgery were 1,068 ng/ml (0,388-1,397 ng/ml) in the IHHE group and were significantly lower compared to the control group (1,980 ng/ml (1,068-3,239 ng/ml)). The serum lactate level after surgery was 1,8±0,7 mmol/l in the IHHE group and was significantly lower compared to the control group — 2,4±1,2 (p=0,05). Cognitive function, assessed by MOCA and MMSE tests, turned out to be significantly higher in patients who underwent a preoperative IHHE. No significant complications or serious adverse events were observed during the IHHE procedures.Conclusion. The use of individually adapted hypoxic preconditioning procedures reduces the incidence of peri- and postoperative complications, which is accompanied by a lower ischemia-reperfusion myocardial injury during artificial circulation with preservation of cognitive functions. IHHE procedures ramp up prehabilitation of patients referred for on-pump surgery of heart defects and aortic pathology.

Occupational pulmonary diseases (OPDs) pose a significant global health challenge, contributing to high mortality rates. This review delves into the pathophysiology of hypoxia and the safety of intermittent hypoxic conditioning (IHC) in OPD patients. By examining sources such as PubMed, Relemed, NLM, Scopus, and Google Scholar, the review evaluates the efficacy of IHC in clinical outcomes for OPD patients. It highlights the complexities of cardiovascular and respiratory regulation dysfunctions in OPDs, focusing on respiratory control abnormalities and the impact of intermittent hypoxic exposures. Key areas include the physiological effects of hypoxia, the role of hypoxia-inducible factor-1 alpha (HIF-1α) in occupational lung diseases, and the links between brain ischemia, stroke, and OPDs. The review also explores the interaction between intermittent hypoxic exposures, mitochondrial energetics, and lung physiology. The potential of IHE to improve clinical manifestations and underlying pathophysiology in OPD patients is thoroughly examined. This comprehensive analysis aims to benefit molecular pathologists, pulmonologists, clinicians, and physicians by enhancing understanding of IHE's clinical benefits, from research to patient care, and improving clinical outcomes for OPD patients.

The introduction of digital technologies into the learning process for medical university students represents a new paradigm in medical education since high level of criteria for assessing the quality of learning of a medical student require the application of modern technologies in training fundamental disciplines and, in particular, anatomy. Thanks to virtual technologies, conditions are created for modeling and integrating the student into conditions close to real ones, which increases the interest and involvement of students in the educational process and, as a result, a subjective improvement in the process of assimilation of the material. Traditional education based on dissection materials cannot fully provide for the massive training of students, as biological materials cannot be restored or preserved and are quickly damaged. 3D models are devoid of these limitations.Aim: to evaluate the effectiveness of digital dissection in the educational trajectory of clinical anatomy using interactive anatomical tables and the need of students for the active use of these aids.Materials and methods. Four groups of students were formed: three groups were studying the material using various anatomical tables and one group used the traditional method. To control the effectiveness of the educational process, before the start of training, entrance testing was conducted in all groups. At the end of classes on individual topics, participants completed exit testing, as well as a questionnaire.Results. The analysis of learning outcomes shows a significantly higher level of absorption of the material among students in groups where 3D anatomical models were used during classes. This indicates that students’ subjective experience of the learning process has improved due to their increased involvement in the class and their interest in innovative teaching methods.Conclusion. We plan to study learning outcomes in more detail to identify any differences in the formation of general and professional competencies among students. This information will help us make informed decisions about the widespread use of anatomical models in educational practice.

INTRODUCTION. The development of post-COVID syndrome is accompanied by an increase in markers of systemic inflammation, a violation of the detoxification function of the liver, caused by both direct viral damage to hepatocytes and an increased iatrogenic load on the hepatobiliary system due to polypharmacy. AIM. Studying the use of the drug Laennec in the rehabilitation period as a hepatoprotector and immunomodulator in patients with post-COVID syndrome. MATERIALS AND METHODS. The study included 40 patients with post-COVID syndrome aged 30 to 60 years, with steatosis and steatohepatitis (increased levels of liver transaminases). The clinical effectiveness of Laennec was assessed based on the dynamics of pro-inflammatory biomarkers, liver metabolism indicators, as well as functional tests and psychological questionnaires. RESULTS. The inclusion of Laennec in the rehabilitation program for patients with post-COVID syndrome leads to a more pronounced improvement in lipid metabolism parameters, correction of liver metabolism parameters, a decrease in the level of pro-inflammatory biomarkers, and an improvement in the quality of life of patients than in the control group. DISCUSSION. Significantly significant positive dynamics in the severity of complaints of general weakness and sleep disturbance, as well as indicators of memory impairment and impaired concentration in the main group could indicate the achievement of anabolic, neurotrophic and bioenergetic effects of the Laennec drug. A significantly significant decrease in the level of liver transaminases in the main group indicates the hepatoprotective effect of the drug Laennec, due to the amino acids, vitamins and microelements included in the drug, which support the reactions of phases 1 and 2 of liver detoxification. Normalization of elevated pro-inflammatory markers (ferritin, IL-6, CRP) in patients of the main group may indicate the presence of anti-inflammatory and immunoregulatory effects of the Laennec drug. CONCLUSIONS. A course prescription of the drug Laennec for the purpose of correcting pro-inflammatory markers and hepatoprotection can be recommended for use in complex non-drug rehabilitation to increase its clinical effectiveness, as well as improve subjective indicators of the quality of life of patients with post-COVID syndrome.

In this meta-analysis, we aimed to evaluate the prevalence of occupational hypersensitivity pneumonitis (OHP) among different occupations globally. Our search was conducted on MEDLINE via PubMed, Scopus, Web of Science, and Cochrane CENTRAL from inception to September 2023. Eligible studies were observational in nature and focused on several specific occupations. A total of 46 articles were included (n = 2,826,420 participants). The overall prevalence of OHP was found to be 4.2% (95% CI: 2.1% to 8.0%), but this varied significantly based on occupation and geographic location. Printers had the highest OHP prevalence at 57.14%, followed by tobacco workers (26.32%), and water-related workers (24.10%). South America showed the highest prevalence of 16.71%, compared to Asia (15.19%), and North America (8.52%). Significant variations in OHP prevalence by occupation and region were found, with the highest rates in printers and tobacco workers. Age and smoking were identified as contributing factors to the prevalence variability.

Functional movement disorders (FMD) are widespread and have a significant negative impact on the quality of life of patients. The pathogenesis is not completely clear, but currently there is ongoing research on searching for biological markers using methods such as functional magnetic resonance imaging and electroencephalography (EEG). Objective: detection of the features of the amplitude-frequency characteristics of the readiness potential (RP) formed during FMD. Material and methods. We examined 22 patients with a clinically diagnosed FMD and 22 healthy volunteers (all participants were right-handed). Both patients and the control group underwent an EEG in Erickson's Flanker paradigm with registration of the RP. RP was recorded in the projection area of the precentral gyrus (electrodes C3/C4/C5/C6 in the standard 10–20 overlay scheme). Results. Comparative analysis of RP parameters showed the presence of significant frequency-amplitude differences between the main group and the control group in the right hemisphere in the absence of significant differences in the left hemisphere. At the same time, significant differences were demonstrated between the FMR group and the control group both in terms of the latent period (time to the onset of RP): 33.66±23.69 ms versus 276.28±176.1 ms (p<0.05), and its amplitude: -0.85±0.294 μV versus -0.35±0.26 μV (p<0.05). Conclusion. The results of the present study suggest that neurophysiological parameters such as RP can be considered as a potential diagnostic marker to improve the diagnosis of FMR.

The active development of technology since the middle of the 20th century has changed the requirements for education in view of the demand for knowledge-intensive specialties. The current approach is focused on the intersubjectivity and complexity of problem solving, the project organization of training and the practical orientation of learning courses. The training of specialists capable of solving qualitatively new tasks is possible only in a special environment where personal and professional competencies are formed. The transformation of education in medicine has led to the active integration of research and clinical experience. A significant impetus for the transition to a new level is provided by the development of cognitive competencies, critical thinking, which is closely interrelated with evidence-based medicine. Novel training programs make it possible to receive research, management, entrepreneurial and communication competencies inaddition to classical clinical education. At present, the future belongs to interdisciplinary teams based on developed clusters.

In this study, we conducted a comparative analysis of the responses to hypoxia of microcirculation (MCR) parameters of the temporal areas of the head in male and female subjects. The study was conducted in 20 healthy volunteers aged 18–19 (10 male and 10 female). The state of short-term hypoxia was induced using a ReOxy Cardio normobaric device (S.A. Aimediq, Luxembourg). Synchronous measurements of MCR parameters of symmetrical temporal regions of the head in the basal state and immediately after short-term hypoxic exposure were carried out by laser Doppler flowmetry. Statistical characteristics of perfusion of both sides of the measurement and correlation characteristics of the relationships between changes in the MCR parameters of the symmetric sides of the observation were evaluated. The results show sex differences in reactions to hypoxic effects. In 80% of men, hypoxia led to an increase in left perfusion; in 20%, to a decrease. In women, the opposite pattern was observed: in 10%, perfusion on the left increased, and in 90%, it decreased. The results of the research revealed the features of left–right asymmetry in the regulation of MCR parameters of the temporal regions of the heads of males and females. The physiological mechanisms underlying the differences in the regulation of MCR parameters of the symmetrical regions of the male and female brain require further study.

Adaptive shifts in systemic hemodynamic parameters and energy consumption were evaluated in 15 healthy young men in response to a single procedure of passive hyperthermia (PH) and during a course of ten such procedures. PH procedures with a duration of 40 min were performed in an infrared body heating capsule at 65–80°C, with the head remaining outside the capsule. Heart rate, blood pressure, and SрО2 were analyzed. Oxygen and energy consumption were measured by indirect calorimetry. The sweating rate and the physiological strain index (PSI) were calculated. It was found that PH procedures were accompanied by an increase in energy consumption (in comparison with placebo procedures), but without a pronounced stress response of systemic hemodynamics. PSI values during PH corresponded to moderate heat stress. During the course, adaptive shifts occurred in the form of a decrease in energy consumption and an increase in the sweating rate. In the tenth procedure the relationship between the degree of increase in body temperature and the level of energy consumption was revealed.

Purpose. To study the effect of short-term hypoxic exposure on correlation between microcirculatory parameters (MCR) of symmetric areas of the human head. Materials and methods. MCR parameters of 10 healthy male volunteer were measured by laser Doppler flowmetry method. Short-term hypoxic exposure was produced according to the hypoxic test method using the ReOxy Cardio unit (S. A. Aimediq). We assessed the perfusion metrics left and right areas of interest, neurogenic, myogenic, respiratory and cardiac contributors to vascular tone and correlations between baseline parameters and after hypoxic exposure. Results. We revealed the specificity of regional circulation system rearranging induced by hypoxic load. The specificity is caused by functional asymmetry of correlations between different vascular tone contributors in symmetrical head areas. Strong correlation declining under the hypoxic loads between baseline perfusion on left/right was found. The perfusion changes of symmetrical temporal areas under the hypoxic loads correlate negatively with the baseline perfusion of both the same and the opposite side. Conclusion. Short-term hypoxic load rearranges the balance of different vascular tone contributors regulatory role in MCR of symmetric head areas to maintain the sustainable activity of the whole MRC.

— A new computational and experimental method for assessing the stability of oscillatory processes occurring in the microcirculation (MCR) system is proposed. The technique is based on the analysis of the stability of a differential equations system describing fluctuations in the MCR parameters of blood in symmetrical temporal head regions of humans. Using this technique, we have investigated the change in the stability of MCR parameters of the symmetrical temporal head regions under hypoxic conditions. The study has involved 10 healthy male volunteers (18–19 years). The state of short-term hypoxia has been induced using a normobaric ReOxy Cardio device (S.A. Aimediq, Luxembourg) certified in the Russian Federation for obtaining hypoxic and hyperoxic gas mixtures based on biofeedback with a built-in pulse oximetric sensor (Masimo Rad-5, United States). Synchronous measurements of MCR parameters of symmetrical temporal head regions at the basal state and immediately after short-term hypoxic exposure have been carried out by the method of laser Doppler flowmetry (LDF) using a two-channel LAKK–02 device (LAZMA Research and Development enterprise, Russia). It has been shown that short-term hypoxic effects change the numerical values of the stability parameters in all subjects within the boundaries of stability levels. However, the response to hypoxic exposure has been very individual in different subjects. The proposed method allows for personalized assessments of the fitness level and resistance to hypoxic influences in different subject groups.

Background Once used by mountaineers to facilitate rapid adaptations to altitude and by athletes to improve their aerobic capacity, exposure to hypoxia has been proven to affect various physiological, clinically relevant parameters. A form of conditioning known as Intermittent Hypoxia Conditioning (IHC) consists of repeated exposures to intermittent hypoxia, combined with normoxia and hyperoxia, which has been shown to have potential as a treatment to improve cardio-metabolic risks profile in cardiac patients but results across studies are inconsistent. This systematic review and meta-analysis aimed to evaluate the clinical effectiveness of IHC. Methods Four electronic databases (PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) were searched (from inception to December 2019) to retrieve all studies focused on IHC in elderly patients with cardiovascular disease. A meta-analysis of functional, efficacy and safety outcomes in cardiac patients was completed to compare IHC to sham treatments. Results Fourteen studies with 320 patients in the Interval Hypoxia-normoxia Group (IHNG) or Interval Hypoxia-hyperoxia training Group (IHHG) and 111 patients in the control group were included in our meta-analysis. IHNT and IHHT were associated with significant reduction in heart rate, SBP, and DBP at rest after treatment [MD= -5.35 beat/min, 95% CI (-9.19 to -1.50), p=0.006], [MD= -13.72 mmHg, 95% CI (-18.31 to -9.132), p<0.001], and [MD= -7.882 mmHg, 95% CI (-13.163 to -2.601), p=0.003], respectively. There were no significant complications or serious adverse events related to IHNT/IHHT. Conclusion The current evidence suggested that the use of the IHNT/IHHT program in elderly patients with CVDs can be safe and effective in terms of heart rate and elevated blood pressure. However, currently, there is no supporting evidence that IHNT/IHHT can significantly improve hematological parameters or lipid profile. Exercise tolerance increased at the end of the course of hypoxic conditioning within IHC group, but did not differ from controls. Further research is needed.

It is a well-known fact that mental activity of the brain can be presented by two different states, i.e., the true state and the false state. A promising method of the electroencephalogram (EEG) wavelet transform has been developed over recent years. Using this method, we evaluated the principle possibility for direct objective registration of mental activity in the human brain. Previously we developed and described (published) a new experimental model and software for recognizing the true and false mental responses of a person with the EEG wavelet transform. The developed experimental model and software-and-data support allowed us to compare (by EEG parameters) two mental states of brain activity, one of which is the false state, while another is the true state. The goal of this study is to develop an absolutely new information technology for recognizing the true and false states in mental activity of the brain by means of the EEG wavelet transform. Our study showed that the true and false states of the brain can be distinguished using the method of continuous wavelet transform and calculation of the EEG wavelet energy. It was revealed that the main differences between truthful and false mental responses are observed in the delta and alpha ranges of the EEG. In the EEG delta rhythm, the wavelet energy is much higher under conditions of the false response as compared to that in the true response. In the EEG alpha rhythm, the wavelet energy is significantly higher with the true answer than in the false one. These data open a new principal possibility of revealing the true and false mental state of the brain by means of continuous wavelet transform and calculation of the EEG wavelet energy.

The reactions of microcirculation parameters of symmetrical areas of the human head to hypoxic loads were studied. The study was conducted in 10 healthy male volunteers aged 18-19 years. Short-term hypoxia was modeled using a ReOxy Cardio normobaric device (S. A. Aimediq). Synchronous measurements of microcirculation parameters in symmetrical temporal regions of the head at the basal state and immediately after short-term hypoxic exposure were carried out by the method of laser Doppler flowmetry. We evaluated statistical characteristics of perfusion of both sides, as well as regression characteristics of the relationship between changes in the microcirculation parameters and the initial values of these parameters. It was shown that the reaction of the microcirculation parameters in symmetrical regions of the head to hypoxia depends on the initial microcirculation parameters in ipsi- and contralateral sides. 3D graphs were constructed and regression equations describing these relationships were formulated. A new method of geometric sensing is proposed, which allows predicting the direction of reactions to hypoxic effects. The obtained data illustrate the specificity of regulation of microcirculation of paired organs determined by the presence of functional asymmetry. A new method of geometric zoning is proposed, which allows solving the problems of personalized assessments of the state of the microcirculation system in patients.