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Mirror is a well-established tool in the movement rehabilitation,providing real-time visual feedback to assist in the retraining.However, mirror visual feedback may be used also in therapy inits own right. The mirror therapy (MT) is a method based oncreating artificial visual feedback. MT was proposed for treatingpain syndrome, such as phantom pain and complex regionalpain syndrome of type 1 and 2, as well as for motor rehabilitationin stroke patients with hemiparesis and in patients after arm surgery.The main principle of MT is thought to be restoration ofdamaged feedback from ill/amputated limb. One of possiblemechanisms of MT is activation of mirror neurons, actingboth during execution and observation of action. Clear advantagesof MT are its simplicity, availability and, most importantly,its patient-directed character.

Transcranial magnetic stimulation (TMS) new method based on the neurons excitation by an alternating magnetic field. According literature high-frequency TMS could be effectiveness method in the treatment of drug-resistant central post-stroke pain (CPSP). The presented cases report describes the clinical observation of two patients with CPSP, with different localization and volume of thelesion. TMS was applied in the mode of high-frequency stimulation(10 Hz) to the primary motor cortex of the affected hemisphere.After stimulation, we record a significant reduction of painon a visual analog scale (VAS). It is shown that after the end ofTMS pain gradually returned to previous levels after 3-4 months.

Navigation transcranial magnetic stimulation of the brain(nTMS) NBS eXimia Nexstim new method based on thestimulation of neurons by an alternating magnetic field andrecording responses to stimulation with electromyography.Precise guidance of the stimulus to a particular area of the cerebralcortex the patient, repeat the stimulus, somatotopical mappingof motor areas are features of this method. These characteristicsare achieved by a special navigation system that comparespatients head with the anatomical MRI image and thelocation of stimulating magnetic coil. This review presents thecurrent possibilities of the navigation TMS method in the diagnosisand treatment of neurological diseases; our own localexperience with the system.

Guillain-Barre syndrome often requires administration in intensivecare unit but is associated with good prognosis. That usuallymeans partial or full regress of motor impairment. However,we found that many reconvalescents after Guillain-Barre syndromewere suffering from different sensory disorders for a longperiod of time. The analysis of the sensory impairment inpatients with severe forms of Guillain-Barre syndrome showeddiscordance between the results of clinical examination andneurophysiological tests. We also found that some kind of sensoryloss was present in patients with pure motor form. In thisarticle we review our experience of treatment with plantar imitatorof bearing load which seems positive in correction of sensorydisturbances in patients with severe forms of Guillain-Barre syndrome.

Brain-computer interfaces (BCIs) are invasive or non-invasivetechnologies allowing brain signals to be translated into commandsof the external devices. Nowadays this technology isactively developing for the use in rehabilitation of patients withneurological diseases. Such interfaces can serve as a means ofinteraction with the outside world for patients with the lockedin syndrome. Using BCI patients with movement disorderscould control robotic prostheses, wheelchairs and other externaltechnical devices. Interfaces with biofeedback can facilitate thereorganization of the damaged cortex. Patients with neurologicaldisorders were found to be able to use brain-computer interface.Nevertheless, it is necessary to perform larger controlled clinicalstudies for the evaluation of BCI effectiveness in neurorehabilitation.

Transcranial magnetic stimulation (TMS) is method of brainneurons stimulation by alternating magnetic field and measuringmotor-evoked potentials (MEPs) with electromyography monitoring.Recently, some new technologies were introduced, basedon classical TMS, which allowed noninvasive brain mapping ofcortical motor areas. Navigation transcranial magnetic stimulation(nTMS, NBS eXimia Nexstim) is one of them. In this articlewe describe our experience of m. abductor pollicis brevismotor area mapping in 29 healthy volunteers. Basic parametersof TMS were measured: MEP amplitude (408.49216.36 uV),latency (22.380.97 ms), passive motor threshold(40.084.68% for the left hemisphere, 48.719.16% for theright hemisphere). Maps of cortical areas were builded.

Functional magnetic resonance imaging (fMRI) is widelyapplicable for sensorimotor cortex mapping in human. Themost challenging fMRI task for researchers is the assessment oflocomotion. The aim of our study was to design of a passivemotor fMRI paradigm for assess supraspinal control of the skillof walking in normal subjects and in patients with motor neurologicdeficit after ischemic stroke. We conducted fMRI intwo groups of human subjects: first group 19 healthy subjects(10 females and 9 males, mean age = 38 [31,5; 60] years), secondgroup 18 ischemic stroke patients in early recovery period(first 6 months) (6 females, 12 males, mean age = 55,5[45,5; 64,5] years) with severe and moderate (mean Fugl-Meyer scale score = 22 [15; 28]).The protocol consisted ofblocked-design paradigm: plantar stimulation by imitation ofslow walking vs rest. Individual and group activation patternswere analyzed using statistical package SPM5. A significantactivation (pcorrect0.05 at cluster level) in first group wasobserved in the primary and secondary sensorimotor cortex,premotor and dorsolateral prefrontal cortex, in insula. Due tolesion localization second group was subdivided into corticalsubcotrical(CS) and subcortical (S) subgroups. In CS subgroupthere was reduce of activation size, more prominent inthe affected hemisphere, whereas in S subgroup the extensionof activation regions in both hemispheres was revealed, comparingto group 1. It was demonstrated that our passive motorfMRI paradigm of walking imitation with the use of plantarload imitator Korvit can be used to localize the ensorimotorbrain areas involved in locomotion in both healthy people andpatients. Concerning stroke patients, such an approach canhelp in understanding the mechanisms of supraspinal controlof the skill walking and optimal rehabilitation strategy.

Stroke is the one of the major causes of long-term disability.More than 50% of post-stroke patients have motor disorders ofvarious severity. In acute and subacute stage of stroke, in thepresence of motor disorders, abnormal synergies, known asWernicke-Mann posture, are developing rapidly, significantlydecreasing the quality of walking. In this article the effect ofrobotic therapy with the Lokomat system on the severity ofpathological synergies in 125 post-stroke patients is described.Clinical scales and video analysis motion capture system wereused for the assessment of clinical and biomechanical parametersof walking.

Among the newest technologies in rehabilitation of post-strokepatients a special place belongs to the robot-therapy, which,compared with other technologies, to a greater degree embodiesmain principles of the modern theory of motor learning. In thereview, the up-to-date condition of research on application ofthe robot-therapy in rehabilitation of post-stroke patients is analyzed. Discussed are advantages of the use of this new technology related to wide opportunities of modeling of training parameters, continuous computer analysis and control of patientsvoluntary participation, as well as to opportunity of carrying outlong trainings with high repeatability of movements close to aphysiological pattern. The prospects of development of therobotic systems in neurorehabilitation are considered.

The consequences of cerebrovascular diseases significantly reducethe quality of life of patients. Recovery of basic motor skills,such as the ability to reach the object, manipulate it, and coordinatethe movements of two hands is one of the top-prioritytasks in restoring patients living and social activity. Training inthe environment as close to the real one as possible, active involvementof the patient, as well as interactive feedback, whichallows patients to control the correct execution of motor tasksand adjust their own efforts are required for successful motorrecovery. The development of computer technology enabled theimprovement of conventional approaches to rehabilitation ofstroke patients. Virtual reality (VR) is extensively used to meetthese conditions and achieve successful targeted training for aspecific motor task. The technical basis of VR includes computermodeling and computer simulation, as well as three-dimensionalvisualization, which provides realistic visualization of movementson the screen. These technologies enable reconstructionof the appropriate working space for motor skill training, andprovide interactive feedback and high intensity of rehabilitation.This article provides information about the development of thesetechnologies in the field of motor rehabilitation of upper extremityfunction, comparative analysis of systems that are currentlyused or being developed, and prospects of VR development inneurorehabilitation.

Navigated rTMS is characterized by a great accuracy of localizingthe stimulated area, which opens up new prospects forneuroplasticity modulation. We conducted an interventionalrandomized double-blind sham-controlled study to evaluate theeffectiveness of navigated rTMS in post-stroke rehabilitation.We found that low-frequency stimulation reliably reduces severityof motor deficit and increases the Barthel Index of Activitiesof Daily Living. High-frequency stimulation reduces spasticity(Ashworth Scale) and severity of central post-stroke pain syndrome.Navigated repetitive transcranial magnetic stimulationeffectively supplements the conventional rehabilitation of poststrokepatients. Compared to routine TMS, the use of navigatedrTMS enables effective control of the neuroplastic processes andprovides new opportunities in development of personalized neurorehabilitationprograms.

The aim of study was to assess the feasibility of motor imagery supported brain-computer interface in patients with hemiparesis. 13 patients with central paresis of the hand and 15 healthy volunteers were learning to control EEG-based interface with feedback. No differences on interface control quality were found between patients and healthy subjects. The trainings were accompanied by the desynchronization of sensorimotor rhythm. In patients with cortical damage the source of EEG-activity was dislocated.

The mechanisms of reorganization of motor systems at the poststroke patients after rehabilitation were studied using the method functional magnetic resonance imaging (fMRI). At patients after standard rehabilitation therapy, irrespective of localization of stroke, the increase in intensity of the basic activity zones in sensomotor areas and in the field of a hemisphere of a cerebellum as for paretic, so for a healthy hand was revealed. At patients after EMG biofeedback training of the precision grip the reorganization of functional motor system consists in more significant increase of intensity of activation of the basic zones only in lesioned hemisphere; expressiveness of these changes did not depend on localization of stroke. The degree of restoration of movements of hand after EMG biofeedback training was authentically above, than after a course of standard rehabilitation therapy. Thus, fMRI and the clinical analysis have shown that EMG biofeedback training of the precision grip have the goal-directed and effective influence upon processes of functional reorganization of motor systems.

Functional MRI (fMRI) was applied to study mechanisms of unctional reorganization of motor systems after ischemic stroke(IS) as the result of rehabilitation. Two groups of patients with ISwere recruited: 16 patients on standard restorative therapy (basicgroup) and 16 patients on functional training EMG biofeedback(comparison group). In addition, functional training wasgiven to 14 healthy individuals (normal control). In controls, anincrease in signal intensity from main activation zones andappearance of characteristic additional activation zones in cerebellarhemispheres, corpus callosum and premotor cortex wasnoted. In patients after basic rehabilitation, an increase in signalintensity from main activation zones in sensorimotor area andcerebellar hemispheres was revealed for both affected andnonaffected hand, irrespective of IS localization. In patientsafter functional training, the reorganization of functional motorsystem consisted in an increase in signal intensity of main activationzones only in the ipsilesional hemisphere; expressivenessof these changes did not depend on IS localization. The degreeof motor recovery of the hand after functional training was significantlyhigher than after the basic course of rehabilitationtherapy. So, neuroimaging (fMRI) and clinical analysis showeddirectional and effective influence of the functional trainingmethod on the processes of motor system reorganization.

Discussed are basic achievements in the studies of neuronalplasticity with the use of modern neuroimaging methods and,first of all, functional MRI. The role of various afferent inputs inthese processes is emphasized. Novel neurorehabilitation technologiessuch as constraintinduced therapy (CI therapy),LOCOMAT system, the robotic therapy etc., are considered asthe source of intensive goaldirected afferentation. Data concerningthe possibility of the use of neuromuscular electrostimulationat the first hours after ischemic stroke are presented. Theunique methods of intrapharyngeal electrostimulation in thetreatment of dysphagia of different etiologies are discussed.Efficiency of transcranial electrostimulation in central poststrokepain syndrome is described. Data on possibilities of theEMG feedback in training of the precision grip, one of the basicmotor hand skills, are presented. The details of learning of differentpostural tasks using postural sway feedback in patientswith poststroke hemiparesis, Parkinsons disease and spinocerebellarataxias are discussed. Data on efficiency of alphastimulatingtraining in patients with central poststroke pain syndromeand with clinical prevalence of affective disturbances are presented.Finally, prospects of one of the most interesting novelrehabilitation technologies, the technology based on virtualreality, are discussed.

All countries now share a long-term vision of the importance of implementing technology development and transfer to improve climate resilience and reduce greenhouse gas emissions. Metallurgical enterprises play a significant role in achieving this goal, since they produce a large amount of carbon dioxide emissions into the atmosphere. In connection with the changing operating conditions and changing markets of presence, the issues of ensuring their investment attractiveness are acquiring obvious importance in the framework of the finances of Russian metallurgical companies. The object of the study is an assessment of the investment attractiveness of Russian metallurgical companies. The subject of the study is the relationship between the investment attractiveness of metallurgical companies and the results of their environmental protection activities. The purpose of this study is to identify the interdependence of environmental metrics and the investment attractiveness of steel companies. The methodological basis is a regression analysis of the impact of environmental metrics on the investment attractiveness of metallurgical companies. The authors chose the following indicators of environmental performance: CO2 emissions, energy consumption, water recycling, waste. To assess the investment attractiveness of metallurgical companies, the following indicators were used: revenue, EBITDA, investment in R&D. The authors concluded that the environmental activities of companies have a significant impact on their investment attractiveness. The scientific novelty of the study lies in identifying the interdependence of environmental protection activities and the investment attractiveness of Russian metallurgy companies. The results of the study can be used by both Russian steel companies and institutional investors as part of the development of an investment strategy.

Introduction. The article considers the issues of forming a reserve of antibacterial agents designed to eliminate medical and sanitary consequences of emergencies from the perspective of national drug security.Aim. To determine the degree of import substitution of antibacterial agents included in the regional drug reserve.Materials and methods. We carried out a content analysis of data from regulatory documents and research papers related to formation of drug reserves, a logical and structural analysis of the range of antibacterial agents included in the reserve of the Tomsk region, and an analysis of data from the National Drug Register. In the study, we used the Anatomical Therapeutic Chemical (ATC) Classification System of drugs.Results and discussion. It was established that for 19 international nonproprietary names (INN) of antibacterial agents belonging to the group of antibacterials for systemic use (ATC code J01) and forming the reserve of the Tomsk region, 294 brand names (BN) were registered on the pharmaceutical market of the Russian Federation in 2021. The share of registered domestic BN was 49.3 %, and the degree of import dependence of domestic drug manufacturing on foreign-made active pharmaceutical ingredients (APIs) was 81.4 %. It was found that 6 Russian enterprises manufacture APIs that supply production of 10 antibacterial agents included in the drug reserve. A classification of medicines by strategic availability for replenishing the drug reserve was developed. A map on strategic availability of domestically manufactured antibacterial agents included in the reserve was drawn up.Conclusion. We demonstrated high dependence of antibacterial reserve formation on import of this group of medicines and APIs to the Russian Federation. The classification of medicines which takes into account the possibility of replenishing the drug reserve in emergency conditions and if import of medicines stops can be recommended for use by the center for disaster medicine to optimize the nomenclature of drug reserves at various levels from the perspective of national drug security promotion.

The aim of the study reported here was to investigate impairments on the learning of voluntary control of the center of pressures using visual feedback in patients with lesions of the corticospinal and nigrostriatal systems. Participants were 33 patients with Parkinson's disease and 20 patients with hemipareses due to circulatory lesions in the basin of the middle cerebral artery. Subjects stood on a stabilometric platform and used two computer games over 10 days to learn to shift the body relative to the foot to move the centre of pressures, indicated by the position of a cursor on the screen, with the target and to move the target to a specified part of the screen. The games differed in terms of the postural tasks. In one, the direction of movement of the center of pressures was not known to the subjects, and subjects learned a general strategy for posture control; the other formed a strictly defined postural coordination. Both groups of patients were found to have impairments of voluntary control of the position of the center of pressures. There were no differences between groups of patients, in terms of the severity of the initial performance deficit in the task involving shifts of the center of pressures in different directions (the general strategy for controlling the center of pressures), while learning of this task was more difficult for patients with Parkinson's disease. The initial deficit in the fine postural coordination task was more marked in patients with Parkinsonism, though learning in these patients was significantly better than in patients with hemipareses. It is suggested that the mechanisms of involvement of the nigrostriatal and corticospinal systems in learning the voluntary control of posture have elements in common as well as unique elements. [ABSTRACT FROM AUTHOR]

The capability for the unconscious control of the upright posture in elderly people is impaired, which increases the risk of falls and traumata. The impairment of the unconscious control of posture is partially compensated by the fixation of voluntary attention on the maintenance of an appropriate posture. Elderly people fall predominantly during the performance of movements that demand additional voluntary postural control, for example, unstable support conditions. Thus, voluntary postural control assumes importance in elderly persons. Since it is unclear whether this function changes with age, the aim of this work was to study age-related features of the learning voluntary postural control using visual feedback by center-of-pressure position. The results of the study showed that voluntary postural control is a complex multicomponent process that includes, at least, the following functions: selection of a strategy of postural control, its actualization, and precision of its regulation. With aging, strategy selection in healthy people impairs, but both elderly and middle-aged people can learn this function as successfully as the young. At the same time, despite the absence of an initial deficit in the accuracy of postural setting in elderly people, training of this function becomes substantially more difficult with age. [ABSTRACT FROM AUTHOR]

Characteristic features of upright posture maintenance and mechanisms of postural disorders in poststroke hemiparetic patients were studied using a bilateral force platform. The following features of postural disorders were revealed in the patients tested: an increase in the velocity and amplitude of the center-of-pressure (CP) sway as compared to in healthy subjects, an absolute decrease in the half-cycles of the CP sway, asymmetry of weight bearing by both feet, and a shift of the center of pressure of an affected foot towards the toe. The disturbance of stability of the vertical posture in such patients is to a greater extent associated with weight-bearing asymmetry. It was shown that the character of the CP sway is mainly determined by a disorder of the sensory motor control, whereas damage to the efferent pathways is responsible for the postural asymmetry. Increase in the muscle tone restricts the sway amplitude. Thus, several forms of postural instability are characteristic of hemiparetic patients. Predominantly sensory, motor, or tonic disorders are responsible for these disturbances of stability. [ABSTRACT FROM AUTHOR]

The purpose of the study is an analysis of the consumption of antibacterial drugs in the therapy of salpingoophoritis in hospital settings and evaluation of changes in the real clinical practice of antibiotic therapy after the introduction of the “Order of medical care for the profile “obstetrics and gynecology...”.Materials and methods. In a retrospective study, an assessment was made of the prescriptions of antibacterial drugs in the therapy of salpingoophritis in specialized treatment and prophylactic institutions of the city of Tomsk in the period 2010–2014. The analysis included 160 case histories. The structure of prescriptions was evaluated on the basis of the application of anatomical-therapeutic-chemical classification and international non-proprietary names (INN), the structural improvement factor K. Gatev was calculated. To quantify the consumption of medications, the calculated daily dose (PDD) was used.Results. Comparative analysis of antibacterial therapy of salpingoophoritis in hospital before and after the introduction of the “Order of medical care for the profile of «obstetrics and gynecology...”. Leading groups of antibacterial drugs were identified. А comparative analysis of the frequency of assignment of various INN was made. The К. Gate’s coefficient was 0.281. The calculation of the average prescribed daily doses of antibacterial drugs was performed.Conclusion. The review of the consumption of antibacterial drugs for salpingoophoritis therapy in hospital settings before and after the introduction of the “Order of medical care for the profile “obstetrics and gynecology...”, showed that the range of antibacterial drugs used increased from 18 to 24 INN, mainly due to the inclusion of modern medicines. In the structure of appointments in 2013–2014, the proportion of drugs not recommended for use by the «Order of medical care for the profile of «obstetrics and gynecology» was 37.5%. It was found that PDD clarithromycin, clindamycin and cefotaxime did not meet the recommended dosing regimens specified in the clinical recommendations for antibiotic therapy. The gap between actual clinical practice and existing clinical recommendations determines the need for in-depth pharmacoepidemiological evaluation to identify the causes and develop measures of an organizational and educational nature to optimize the use of medications.

Pharmacoepidemiological and pharmacoeconomical analysis of endometrit drug therapy at special treatment-and-prophylactic institutions of the city of Tomsk. Estimate the intensity of the appointment of antibacterial drugs endometrit therapy using the methodology of the WHO ATC/DDD, calculated indicators of the intensity of the consumption of drugs in the course of treatment per patient. It was shown that 70% of the established daily dose had to beta-lactam antibiotics and macrolide. For the most common options for antibiotic therapy established nosology of the indicators of clinical efficacy. The calculation of the cost of the schemes of antibiotic therapy, which showed that the cost of treatment is maximal during therapy with ceftriaxone + clarithromycin (4902 RUR); further descending follow: amoxicillin / clavulanic acid + roxithromycin (4658 RUR); benzylpenicillin and gentamicin (4231 RUR). Economic efficiency of antibacterial treatments endometritis a “cost – effectiveness”. The cost of the patient, achieved remission, made during therapy with amoxicillin/clavulanic acid and roxithromycin (5416 RUR), During therapy with ceftriaxone and clarithromycin (6052 RUR), the treatment of benzylpenicillin and gentamicin (14420 RUR). Pharmacoeconomic evaluation results showed that the least acceptable scheme of antibacterial therapy of endometrit in the hospital is the combination of benzyl penicillin and gentamicin. Тhe antibiotic therapy for endometrit may be recommended by a combination of amoxicillin / clavulanic acid and roxithromycin and clarithromycin and ceftriaxone, for which there was no statistically significant differences in clinical efficacy and cost of antibiotic therapy.

Practice of treatment standard application experiences the certain difficulties. On the one hand, the most treatment standards lay on insufficient economical base, on the other hand, the limitation of health protection in bankroll leads to the insufficient treatment efficiency.An analysis of diagnostic study costs in Tomsk special treatment-and-prophylactic institutions has been made on the example of inflammatory pelvis minor organ diseases.The results of the investigation have shown that the character of diagnostic study of patients with inflammatory pelvis minor organ diseases differed significantly from the treatment standard. At the same time this fact defines not only the necessity of expense increase for diagnostic study but, first of all, the necessity of changes of diagnostic study structure that has been proved by modern pharmaeconomical methods.