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Introduction : Despite the long-term use of intramuscular and intraosseous lidocaine trigger point injections (LTPI) in the treatment of patients with low back pain, there have been no studies examining their efficiency in treatment of residual pain after degenerative lumbar spinal stenosis (DLSS) decompression surgery. The purpose of our research is to examine the LTPI efficiency in the treatment of residual lumbar pain after DLSS decompression surgery and to compare the analgesic and recovery effects of intramuscular and intraosseous LTPI administered in the L4-S1 region and in the posterior superior iliac spine (PSIS) after treatment and during four months of follow-up. Materials and Methods : We observed 99 patients (F:50, M:49) aged 42 to 59 years with residual neurological disorders after DLSS decompression surgery. In all patients, the pain syndrome exceeded 6 points on the VAS and averaged 7.2 ± 0.11 points. The control group ( n = 21) underwent only pharmacotherapy. In addition to pharmacotherapy, the LTPI group underwent intramuscular LTPI in L4-S1 ( n = 20), intramuscular LTPI in the PSIS ( n = 19), intraosseous LTPI in L5, S1 ( n = 20), and intraosseous LTPI in the PSIS ( n = 19). A neurological examination was carried out before treatment, 7 days after completion of treatment, and at the end of the second and fourth months of the follow-up period. Results : In the control group, intramuscular LTPI in L4-S1 subgroup, intramuscular LTPI in PSIS subgroup, intraosseous LTPI in L5, S1 subgroup, and intraosseous LTPI in PSIS subgroup, the severity of pain decreased after treatment by 27.1% ( p ≤ 0.05), 41.7% ( p ≤ 0.01), 50.7% ( p ≤ 0.01), 69% ( p ≤ 0.01), and 84.7% ( p ≤ 0.01), respectively, and at the end of the second month of follow-up, by 14.3% ( p > 1), 29.2% ( p ≤ 0.05), 38% ( p ≤ 0.01), 53.5% ( p ≤ 0.01), and 72.2% ( p ≤ 0.01), respectively. Reduction of neurogenic claudication, regression of sensory deficit, increase of daily step activity, and improvement of quality of life after treatment were noted in intramuscular LTPI subgroups by 19.6% ( p ≤ 0.05), 36.4 ( p ≤ 0.05), 40.3% ( p ≤ 0.01), and 21.0% ( p ≤ 0.05), respectively, and in interosseous LTPI subgroups by 48.6% ( p ≤ 0.01), 67.4% ( p ≤ 0.01), 68.3% ( p ≤ 0.01), and 46% ( p ≤ 0.01), respectively. Conclusions : LTPI is highly effective in the treatment of patients with residual pain after DLSS decompression surgery. High analgesic effect, significant regression of sensory deficits and gait disorders, and remarkable improvement of daily step activity and quality of life are noted not only after the end of LTPI treatment but also continue for at least 2 months after treatment. Intraosseous LTPI is more effective than intramuscular LTPI by 92%, and LTPI in PSIS is more effective than LTPI in L4-S1 by 28.6%.

Introduction: Subacromial impingement syndrome is a common pathology that leads to a persistent decrease in the functioning of the affected limb and, as a consequence, a decrease in the quality of life and work ability of patients. According to various authors, the study of the effectiveness of treatment and rehabilitation of this pathology is quite widely presented in the literature: surgical, including arthroscopic operations, rehabilitation using various factors of physical therapy, manual and other practices. However, the issue of assessing the effectiveness of movement therapy, both alone and in combination with other therapeutic methods, remains relevant., Aim: To evaluate the effectiveness of therapeutic gymnastics procedures, both monotherapy and in combination with manual massage according to the therapeutic method and extracorporeal shock wave therapy (ESWT), in patients with subacromial impingement syndrome of the shoulder, in order to reduce pain and improve the function of the shoulder joint., Material and Methods: The study included 70 patients whose age was 42.18±10.42 years. Patients were divided into two main groups: group 1 ( n =34) and group 2 ( n =36). All patients received a course of treatment, including 10 procedures of therapeutic exercises, with recommendations at the end of the course for continuation in the form of independent studies using the proven methodology. The duration of the course of therapeutic exercises (in the form of procedures with a physical therapy instructor and subsequent independent studies) was 30 days. Patients in group 2 were divided into three subgroups: subgroup 2A, in which PH procedures were combined with massage of the cervical-collar area and the upper limb area of the affected side; subgroup 2B, where PH gymnastics was carried out in combination with extracorporeal shock wave therapy (ESWT) procedures; subgroup 2C - a comprehensive program including LH procedures, manual massage and shock wave therapy., Results: 3 months after the end of the course of rehabilitation measures, patients of all groups showed a significant improvement in scores on the ASES and VAS scales, but there were no reliably significant differences between the results of different groups., Conclusion: The study indicates that movement therapy is an effective method of rehabilitation for patients with subacromial impingement syndrome, and conducting complex programs in which PH is combined with other rehabilitation methods (massage, shock wave therapy) doesn't have statistically significant advantages over PH alone within a 3-month observation period.

Introduction: In order to optimize rehabilitation measures for post-traumatic stress disorder (PTSD) it is advisable to use natural therapeutic factors in the medical rehabilitation programmes of this category of patients, which is due to the pronounced psycho-corrective effects of climatic landscape therapy and nitrogen-thermal waters., Aim: To study psycho-corrective effects of a new rehabilitation technique for the patients suffering from PTSD using natural therapeutic factors of Nalchik resort., Material and Methods: Thera has been carried out a randomized controlled trial that included 74 patients with PTSD. Two groups were formed by simple randomization: in the control group (CG/ n =38) the patients had standardized pharmacotherapy, physical training and individual psychocorrection in accordance with federal clinical recommendations; in the main group (MG/ n =36) terrencourt in the natural park of Nalchik resort and nitrogen-thermal baths were additionally prescribed. The effectiveness of rehabilitation measures was monitored using a questionnaire to assess the therapeutic dynamics of PTSD, the Beck Hopelessness scale, as well as the Neurotech Kolibri wireless BFB complex (Russia)., Results: A comparative analysis of monitoring of psycho-emotional status indicators proved the feasibility of the developed medical rehabilitation programme for PTSD patients. A significant improvement in psychoemotional status was observed according to the questionnaire for assessing the therapeutic dynamics of PTSD (on average by 2 times, p <0.01), according to the Beck hopelessness scale, according to which the clinically assessed suicidal risk and hopelessness level were reduced by 1.7 ( p <0.01) times with the patients in the MG. According to the analysis of brain biopotentials during the primary training, the patients had insufficient control over the course of mental activity (63%), and at the end of the course the indicator improved to 97% ( p <0.01). In the CG positive dynamics on both scales of psychological testing and analysis of brain biopotentials was significantly lower (by 12-15%, p <0.05- p <0.01)., Conclusion: After including in the standardized rehabilitation programme controlled walking in the mid-mountain Natural Park and nitrogen-thermal baths of Nalchik resort, there was a significant improvement in the psycho-emotional status of the patients suffering from PTSD, which indicates their psychocorrective effects and provides great opportunities to improve the effectiveness of medical rehabilitation.

Objective: To analyze the quality of life in patients receiving immunotherapy and overall response rate in case of additional magnetotherapy., Material and Methods: The study included 3 cohorts of patients ( n =48) with various disseminated malignancies (melanoma, lung cancer, kidney cancer) who received immunotherapy. In the study groups, all patients additionally took courses of rehabilitation based on magnetotherapy. In the control cohorts, patients underwent courses of immunotherapy without additional magnetic therapy. Treatment efficacy was assessed according to iRECIST 1.1 criteria. The Russian version of the EORTC QLQ-C30 questionnaire was used to study the quality of life. We analyzed adverse events using the CTCAE 5.0 criteria., Results: In patients with melanoma, the most common response to systemic treatment was stabilization (41.7% in the study group and 30.8% in the control group). The objective response rate was higher in the study group (33.3% vs. 23.1%). There was also significant improvement in the quality of life after treatment in the study group (by 23.5%). In the control group, the indicator worsened by 4.8%. Overall health improved by 12.8% in the study group and 10.3% in the control group. In patients with lung cancer, response to systemic treatment with stabilization was achieved in 33.3% of patients in the study group and 20% of patients in the control group. The objective response rate was 33.3% and 20%, respectively. Analysis of the study group revealed improvement of overall health by 9.6% and overall quality of life by 38.6%. In the control group, overall health improved by 4.8% and quality of life remained the same. In patients with kidney cancer, the objective response rate was 40% and 42.9%, respectively. Disease stabilization was achieved in 40% and 28.6% of patients, respectively. Overall health improved by 16.7% and 6.3%, overall quality of life - by 19% and 9.1%, respectively., Conclusion: Magnetic therapy during the course of immunotherapy improved the overall quality of life and reduced severity of adverse events. Further study of magnetotherapy as an accompanying rehabilitation technique is required.

Objective: To evaluate an efficacy of lipoaspirate-based products in pathologic scarring management., Material and Methods: There were 118 patients with external scars. Depending on scar type, localization and need for soft tissue augmentation, three different methods were used for lipoaspirate-based product preparation: 15-minute sedimentation, centrifugation at 1200 g for 3 minutes and emulsification with a channel diameter of 1.2 mm. Results were assessed using the Manchester Scar Scale (MSS) and photographing., Results: According to MSS analysis, the following results were obtained: before treatment - 11.6 (9.3-13.3) scores, 3 months after treatment - 6.5 (5.1-7.2) scores, 6 months after treatment - 5.2 (4.5-6.1) scores. Significant differences were obtained for baseline values and both control points. Stable results were obtained in long-term follow-up period (12-24 months). No major adverse effects were observed. Minor complications were registered in 10.1% of patients., Conclusion: Injections of lipoaspirate-based products is an effective option for the treatment of patients with pathologic scarring. This approach is intermediate between conservative and conventional surgical treatment.

Objective: To evaluate an efficiency and safety of perioperative fast track management in reconstructive esophageal surgery., Material and Methods: Perioperative fast track management protocol in reconstructive esophageal surgery has been applied since 2014 at the Department of Thoracoabdominal Surgery and Oncology of the Petrovsky Russian Scientific Center of Surgery. These patients (2017-2020) were included in the main group ( n =75). Patients who underwent traditional perioperative care (2010-2013) were enrolled in the control group ( n =63). The primary outcome was postoperative hospital-stay. We also evaluated ICU stay, incidence of complications according to Clavien-Dindo grading system with particular registration of respiratory complications, mortality, enteral and oral feeding onset., Results: There were no significant between-group differences in sex, age, ASA grade, body mass index. Fast track management reduced hospital-stay from 14 (12; 17) days in the control group to 11 (8; 22) days in the main group ( p =0.008). Mean ICU-stay decreased up to 1 (0.8; 2) day in the main group compared to the control group (4.1 (3.5; 5.6) days, p <0.0001). Pneumonia was noted in 5 patients after fast track recovery and 15 patients in the control group ( p =0.004). No patients died in the main group, 3 (4.8%) patients - in the control group ( p =1)., Conclusion: Modern perioperative fast track management protocol is safe and effective for extensive reconstructive esophageal interventions. This approach reduces hospital-stay and ICU stay, as well as the incidence of respiratory complications.