Посттравматическое стрессовое расстройство (ПТСР) -это симптомокомплекс, наблюдающийся у лиц, переживших травматический стресс. Патофизиология ПТСР связана с преобладанием процессов перевозбуждения. Предположительно, в основе патологических изменений при ПТСР лежит феномен эксайтотоксичности. Последствием эксайтотоксичности является оксидативный стресс (ОС). Исследовали возможность коррекции ОС путём применения органического Se у пациентов с риском развития пост-травматического стресс-синдрома. Проспективное рандомизированное исследование, проведённое у лиц Латвийского контингента международных операций до и после участия в миротворческой миссии, показало, что у пациентов, принимавших Se, степень выраженности клинической симптоматики ПТСР, определяемой в пунктах анкеты PCL-M, снизилась на 5,85% по отношению к исходному, а также на 46,03% по отношению к исходному снизилась распространенность ПТСР (Prevalence Rate). Выявлена статистически значимая корреляция между параметрами ОС, распространённостью ПТСР и клинической выраженностью симптомов ПТСР.Ключевые слова: селен, оксидативный стресс, эксайтотоксичность, посттравматическое стрессовое расстройство.
IntroductionHigh rates of musculoskeletal injuries such as plantar fasciitis and stress fractures have been observed among physically active military personnel. During service time, infantry soldiers use issued boots daily that should be a proper fit and provide comfort to effectively prevent injuries and decrease lower extremity pain. This study compares the subjective infantry boot size with optimal size and investigates perceived boot comfort for different boot parts among soldiers with and without a history of lower leg, ankle, and foot overuse injury. Materials/MethodsDuring the cross-sectional study, 227 (males, n=213; females, n=14) active-duty infantry soldiers at a mean age of 29.5 years old, and with an average service time of 7.2 years were assessed for a history of overuse injury, footprint length, appropriate shoe size, and footwear comfort. Males with a history of overuse injury (n=32) and non-injured age-matched controls (n=34) were selected for detailed testing and establishing the possible relationship between footwear comfort and lower leg overuse injury.Results No relationship was found between footwear comfort and history of lower leg overuse injury. N=38 (57.6%) of study subjects were wearing an inappropriate shoe size daily. Inappropriate shoe size usage affected footwear comfort ratings significantly.ConclusionsStudy results showed that improper boot size was significantly related to comfort ratings but was not associated with a history of lower leg overuse injury.
Footwear usage could be a promising focus in reducing musculoskeletal injury risk in lower extremities commonly observed among the military. The goal of this research was to find potential gait-related risk factors for lower leg overuse injuries. Cases (n = 32) were active-duty infantry soldiers who had suffered an overuse injury in the previous six months of service before enrolling in the study. The control group (n = 32) included infantry soldiers of the same age and gender who did not have a history of lower leg overuse injury. In the gait laboratory, individuals were asked to walk on a 5-m walkway. Rearfoot eversion, ankle plantar/dorsiflexion and stride parameters were evaluated for barefoot and shod conditions. Barefoot walking was associated with higher stride time variability among cases. According to the conditional regression analysis, stride time variability greater than 1.95% (AUC = 0.77, 95% CI (0.648 to 0.883), p < 0.001) during barefoot gait could predict lower leg overuse injury. Increased barefoot gait variability should be considered as a possible predictive factor for lower leg overuse injury in the military, and gait with military boots masked stride-related differences between soldiers with and without lower leg overuse injury.
Increased excitotoxity in response to stressors leads to oxidative stress (OS) due to accumulation of excess reactive oxygen/nitrogen species. Neuronal membrane phospholipids are especially susceptible to oxidative damage, which alters signal transduction mechanisms. The Contingent of International Operations (CIO) has been subjected to various extreme stressors that could cause Posttraumatic Stress Disorder (PTSD). Former studies suggest that heterogeneity due to gender, race, age, nutritional condition and variable deployment factors and stressors produce challenges in studying these processes. The research aim was to assess OS levels in the PTSD risk group in CIO. In a prospective study, 143 participants who were Latvian CIO, regular personnel, males, Europeans, average age of 27.4, with the same tasks during the mission, were examined two months before and immediately after a six-month Peace Support Mission (PSM) in Afghanistan. PCL-M questionnaire, valid Latvian language “Military” version was used for PTSD evaluation. Glutathione peroxidase (GPx), superoxide dismutase (SOD) and lipid peroxidation intensity and malondialdehyde (MDA) as OS indicators in blood were determined. Data were processed using SPSS 20.0. The MDA baseline was 2.5582 μM, which after PSM increased by 24.36% (3.1815 μM). The GPx baseline was 8061.98 U/L, which after PSM decreased by 9.35% (7308.31 U/L). The SOD baseline was 1449.20 U/gHB, which after PSM increased by 2.89% (1491.03 U/gHB). The PTSD symptom severity (total PCL-M score) baseline was 22.90 points, which after PSM increased by 14.45% (26.21 points). The PTSD Prevalence rate (PR) baseline was 0.0357, which after PSM increased by 147.06% (0.0882). We conclude that there is positive correlation between increase of OS, PTSD symptoms severity level, and PTSD PR in a group of patients with risk of PTSD - CIO. PTSD PR depends on MDA intensity and OS severity. OS and increased free radical level beyond excitotoxity, is a possible causal factor for clinical manifestation of PTSD
Background A high incidence of lower leg overuse injury has been observed among military populations. Footwear usage could be promising in reducing the risk of injury from overuse of the lower extremities. The purpose of this study was to identify possible gait-related risk factors for lower leg overuse injuries when walking barefoot and in military boots. MethodsCases (n=32) were active-duty infantry soldiers from Latvian Land Forces with a history of overuse injury during the last 6 months of service before entering the study. During the study period, the cases recovered completely from the injury, did not report any functional limits, and were able to participate in all kinds of physical activities. Controls (n=32) of the same age and gender were free of injury in the same time period. Study participants were instructed to walk on a 5-meter walkway in the gait laboratory. Joint angle calculations and spatiotemporal gait parameters were evaluated for barefoot and shod conditions.Results Gait-related parameters during shod and barefoot conditions differ in both groups. The barefoot stride time and the stride time variability were statistically different between cases and controls. Conditional regression analysis showed that stride time variability during barefoot gait statistically significantly predicted the risk of lower leg overuse injury. ROC analysis showed an AUC of 0.77 (p<0.01; 95% CI 0.65-0.88), a sensitivity of 56%, and a specificity of 88%, with an optimal cut-off value for stride time variability of 1.95%.ConclusionsThe risk of injury was independent of the gait-related characteristics during shod gait. Stride time variability has low sensitivity, but if the variability value during the barefoot walk is less than 1.95%, it can be considered a negative risk factor for lower leg overuse injury among infantry soldiers.
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