Introduction. The issues of dynamic and functional anatomy of the neck are of considerable practical and theoretical interest. This is due to the peculiarities of the displacement of the musculofascial layers when changing the position of the head in space, the description of which presents significant difficulties. Particular practical importance has therefore the study of dynamic phenomena of this area as well as the analysis of morphological and biomechanical changes leading to the development of somatic dysfunction of the neck. Aim. Based on the topographic and anatomical studies, as well as with the help of finite element modeling, to study the patterns of displacement of the muscular-fascial layers of the neck when turning the head by 20º and 50º. Materials and methods. The topographic and anatomical study used the results of 18 MRIs, the analysis of which was carried out using the Vidar Dicom Viewer software. To build a finite element model, data from a CT study of a patient were used, which has not any pathological changes in the organs and musculoskeletal system of the neck. As a result of the subsequent processing of the CT study data, a personalized anthropomorphic finite element model of the neck region was constructed, with the help of which a series of virtual topographic and anatomical studies were performed, repeating in general terms the topographic and anatomical part of the work. Results. 1. The values of rotational and angular displacement of all fascia of the neck are nonlinear. 2. The fascia of the neck are displaced relative to each other when turning the head due to the difference in the values of angular displacement. 3. The magnitude of the angular displacement of the 2nd fascia of the neck at the level C2-C3, C3-C4 and C4-C5 when turning the head 20º, as well as at the level C4-C5 when turning the head 50º exceeds the value of the angle of rotation of the head relative to the trunk. 4. The direction of rotational and angular displacement for all fasciae at the level C6-C7 corresponds to the direction of rotation of the head, with the exception of the dorsal part of the 4th fascia of the neck, which at this level, together with the esophagus, shifts in the opposite direction relative to the axis of symmetry. 5. Fasciae located at a greater distance from the center of the intervertebral disc are characterized by large values of angular and rotational displacement. 6. The rate of change in the ratio of rotational and angular displacements is higher at the level of the lower segments. 7. The results of measurements of the rotational displacement of the fascial layers of the anthropomorphic finite element model demonstrate a positive correlation with the data of the topographic and anatomical study. Conclusion. The patterns of displacement of the neck musculofacial layers should be taken into account when modeling somatic dysfunction of the neck, as well as in the process of diagnosis and planning of osteopathic effects.

Aim: to analyze the scientific literature on the role of various factors in the mechanisms of development of functional constipation and to summarize the current data on its leading pathogenetic mechanisms.Key points. Constipation occurs in 15 % of the adult population in the world and leads to a significant decrease in the quality of life, and in combination with some other symptoms may indicate the presence of an organic pathology of the gastrointestinal tract. The pathogenetic basis of functional constipation (FC) with slow intestinal transit is a decrease in colonic motor function, which is confirmed by the results of high-resolution manometry. FC is characterized by disturbances in such motor patterns of the colon as low and high amplitude propagating contractions, segmental non-propagating contractions, and general increases in pressure. The main FC mechanisms associated with neurogenic dysregulation include impaired function of the gray and white matter of the brain, as well as an increase in the tone of the sympathetic nervous system with a concomitant decrease in the influence of cholinergic nerves innervating the large intestine. A key role in the FC development belongs to a decrease in the pool of interstitial cells, which play the role of an intestinal pacemaker, due to slowing of their self-renewal. FC-associated changes in the enteric nervous system include a relative excess of the contribution of inhibitory influences and a decrease in the activity of cholinergic and serotonergic neurons that stimulate intestinal motility. A certain role in the occurrence of reduced motor function of the colon may have an imbalance in the production of intestinal hormones synthesized by enteroendocrine cells, namely, a deficiency of motility stimulants, which include motilin, gastrin, ghrelin and cholecystokinin, as well as a relative excess of hormones that suppress motility (somatostatin and vasoactive intestinal polypeptide). Changes in the composition of the intestinal microbiota can also contribute to the FC occurrence, which is associated with a dysfunction of the metabolite profile produced by intestinal bacteria.Conclusions. Functional constipation is a classic multifactorial disease, in the etiology of which the adverse effects of the genotype are combined with multiple acquired risk factors. A more complete understanding of the molecular mechanisms of the FC development can serve as the basis for the emergence of new effective treatments for this common pathology.

OBJECTIVE Evaluation of the effect of Neuromidine on the dynamics of pain syndrome in the treatment of patients with discogenic lumbosacral radiculopathy. MATERIAL AND METHODS Patients with a confirmed diagnosis of discogenic lumbosacral radiculopathy no more than one year old and moderate intensity of pain syndrome on a visual analog scale were included in the main group (OH, n=62, age — 53.1±15.6 yrs) and the comparison group (HS, n=40, age — 53.7±12.9 yrs). OG patients received Neuromidine (15 mg/1 mL 1 once a day IM for 10 days, then 20 mg 3 times a day for 8 weeks) in addition to the standard drug therapy, HS patients received only standard drug therapy. The duration of the study was 8 weeks. The degree of decrease in the intensity and dynamics of pain syndrome, activity and frequency of pain in the lumbar spine, changes in the level of physical activity, and the severity of emotional disorders were evaluated. The level of inflammatory markers in the blood and the dynamics of monosynaptic spinal H-reflex parameters were evaluated. RESULTS Before the study, there were no statistically significant differences there were no results of clinical and laboratory-instrumental examination between groups. After 8 weeks, the reduction of pain by VAS in the main group was statistically significant in contrast to the comparison group (p=0.0001). In the main group there was a statistically significant increase in the mean cognitive impairment score (p=0.0029), as well as an improvement in psycho-emotional state with a significant decrease in GAD-7 (p=0.0002) and PHQ-9 (p=0.0096). After 8 weeks of therapy, IL-6 level in the main group was statistically significantly lower (p=0.0027) than in the comparison group. The results of H-reflex study revealed an increase in its amplitude and some shortening of latency at the end of Neuromidine therapy. The drug had no undesirable side effects and was well tolerated. CONCLUSION Administration of Neuromidine 15 mg/1 ml once a day intramuscularly for 10 days followed by 20 mg 3 times a day for 8 weeks has an effective analgesic effect as adjuvant therapy in patients with discogenic lumbosacral radiculopathy. The inclusion of Neuromidine in the complex treatment of patients with pain syndrome in discogenic radiculopathy is superior in efficacy to standard drug therapy.

Introduction. The high prevalence and increase in cases of seeking medical help for pain in dorsopathies determines the relevance of this problem. Among all the conditions included in the study of health care costs, non-specific musculoskeletal back pain ranks first in the world. A special place belongs to cervicothoracic dorsopathy (CTD), which are most common in developed countries and are characterized by a variety of clinical forms. In our opinion, a comprehensive method of treating CTD with the mandatory use of non-drug methods of therapy is the most optimal.Aim. Determination of the relationship between the pathogenetic form of CTD (verification of pain triggers) and a personalized method of treating patients, containing a combination of drug therapy and a rehabilitation complex of physiotherapeutic, psychotherapeutic effects.Materials and methods. Patients with CTD were included in the study. Neurological status assessment and biomechanical tests were carried out for accurate clinical verification of pathogenetic forms of CTD. Depending on the choice of treatment, respondents were stratified into comparable groups. The main group included patients to whom the original technique was applied, which implied a combination of drug therapy, a complex of rehabilitation physiotherapy and psychotherapeutic effects (n = 155), the control group (n = 65) – respondents who received a standard course of therapy. The statistical analysis included a comparative assessment of the intensity of pain syndrome, static-dynamic and reflex disorders before and after therapy.Results. Both methods have shown their effectiveness. The original technique more effectively reduced the intensity of pain syndrome, reduced the frequency of reflex disorders (p < 0.05), significantly reduced static-dynamic disorders in all subgroups (p < 0.05), while the standard significantly reduced them only in the subgroup with uncomplicated forms of CTD, without achieving a therapeutic effect in complicated CTD.Conclusion. The original method of therapy of patients with HCG has confirmed its effectiveness.

Introduction. Phantom pain syndrome (PhPS) occurs in up to 60—70% of cases of limb amputation. PhPS is classified as a variant of chronic neuropathic pain (NP). Opioids, gabapentin and pregabalin are often prescribed, but in many cases they are ineffective. Cases of successful use of botulinum neurotoxin A (BoNT) are described, but no correct studies or statistical data have been provided yet. The aim of the study is to study the structure of PhPS and the effectiveness of its treatment of BoNT. Material and methods. 47 male patients aged 20—51 years with PhPS (2—5 months after amputation), pain according to Visual Analogue Scale (VAS) ≥5 points or ≥3 points with pain dyssomnia were examined. All patients received combined analgesic therapy, which did not change. Patients were randomized into 2 groups that received subcutaneously: the 1st group (n=24) incobotulotoxin (incoBoNT) (100—350 IU), the 2nd group (n=23) 2% lidocaine solution (160—200 mg). Injections were performed in 1.5—2 cm increments of 3—5 IU at each point. The number of injection points and the total dosage depended on the area of the stump. Control points of the study: 3, 7, 14, 21, 90, and 180 days. VAS, DN4, Pain Detect, LANSS, HADS, nerve ultrasound, pain diary were used. Pain extremes, average values were estimated, and the original daily pain index (DPI) was calculated. Results. PhPS debut after 5.41±0.08 days, VASmax pain per day 7.2±0.08 points, DPI 67.4±0.4 points, 17.76±0.15 hours of pain per day, pain dyssomnia 4.82±0.1 hours. HADS is within the normal range in 90% of cases. Neuroma was found in 38% of ultrasound patients. 89% of NP were associated with cases of neuroma. After the absence of lidocaine effect on days 3 and 7, the 2nd group was withdrawn from the study. Patients were included in the 1st group. The effect of using BoNT on 3—7 days was up to 50%, by the 21st a 90% reduction in all major pain-related indicators (p<0.0001). There was no effect in 6 patients, all of them had neuromas. The 1st of them was diagnosed with BoNT resistance. The 1st of them underwent intra- and preineural administration of 50 units of incoBoNT with 50% efficacy after 3—7 days under ultrasound. After 90—180 days, PhPS persisted in 3 patients and returned in 1 patient (out of 41 patients): VASmax and DPI were 30% of the original, 2—3 hours a day, none of the patients reported pain dissomnia. 15 patients were evaluated for the effect of PhPS on the use of the prosthesis. For 9 of them, the PhPS excluded the possibility of using it. 5—9 days after the introduction of BoNT, they all started using the prosthesis. Conclusions. The use of incoBoNT in the treatment of PhPS is highly effective and safe, even against the background of pharmacoresistant cases. The use of local anesthetics in PhPS is proven to be ineffective. Subcutaneous administration of BoNT is simple and sufficient in 89%, except for some cases with neuroma, when intra- and perineural administration can be used. We verified neuromas in 38% of PhPS cases. 89% of NB cases were associated with neuromas. The use of BoNT reduces the duration of prosthetics.