Submitted: 19.2.2017 Accepted: 10.3.2017 Published online: 25.5.2017 REVIEW

13. Ferro MS, Rodrigues GM, De Sou- DOI: 10.12710/cardiometry.2017.5563 za RR. The role of mitochondria in physical activity and its adaptation on Pre-nosology diagnostics aging. Journal of Morphological Sci- ences. 2015;32(4):257–63. Roman М. Baevsky1*, Azalia P. Berseneva1 14. Robert L, Labat-Robert J. Stress in biology and , role in ag- 1 Institute of Biomedical Problems of the Russian Academy of Sciences ing. Pathologie Biologie. 1 September Russia, 123007, Moscow, Khoroshevskoye sh. 76A 2015;63(4–5):230–4. * Corresponding author: 15. McArdle A, Jackson MJ. Exercise, phone: +7 (499) 193-62-44, e-mail: [email protected] oxidative stress and ageing. Journal of . 2000;197(4):539–41. Abstract 16. Troen BR. The biology of aging. The present paper deals with prenosological diagnostics as methodology of an esti­ Mount Sinai Journal of Medicine. Jan- mation of functional states of an organism. Highlighted is its first practical application uary 2003;70(1):3-22. in space medicine, at long influence of stressful factors, including such factor unusual 17. Gordon T, Hegedus J, Tam SL. to terrestrial organisms as weightlessness. Demonstrated is the methodology’s wide Adaptive and maladaptive motor ax- recognition and use in various areas of medicine and . Health is consid­ onal sprouting in aging and motoneu- ered herein as process of the continuous adaptation of an organism to environment ron . Neurological Research. conditions. Thus, shown is the connection between transition from health to illness March 2004;26(2):174–85. and decrease in adaptable possibilities. Transition from health to illness, an exhaus­ 18. Miura Y. Oxidative stress, radia- tion and failure of mechanisms of adaptation are described in detail. The classifi­ tion-adaptive responses, and aging. cation dividing the prenosological states into physiological norm, prenosological, Journal of Radiation Research. Sep- premorbid and pathological states is used herein. Prenosological studies including tember 2004;45(3):357–72. diagnostics, screening and control are considered. 19. Gurov YV, Zaguskin SL. Chrono- diagnostic capabilities of the method Keywords of symbolic dynamics. Terapevtiches- Prenosological, Space medicine, Stress, Adaptation, Premorbid ky arhiv. 2011;83(4):23–6. [in Russian] 20. Zaguskin SL. Rhythms of a cage Imprint and health of the person. Rostov-on- Roman М. Baevsky, Azalia P. Berseneva. Pre-nosology diagnostics; Cardiometry; Don: SFU Publishing house, 2010. 292 No.10; May 2017; p.55–63; DOI: 10.12710/cardiometry.2017.5563. Available from: pages. [in Russian] www.cardiometry.net/issues/no10-may-2017/pre-nosology-diagnostics 21. Zaguskin SL, Bakuzova DV. Chro- nodiagnostics and a chronotherapy of Introduction medicine and physiology. It is signifi­ cognitive disorders in an atheroscle- Term "pre-nosological state" (R.M. cant that pre-nosology diagnostics rotic genesis in elderly people. Clinical Baevsky, V.P. Kaznacheev, 1978) heaved emerged and was first applied in space medicine. 2015;10:31–42. in sight in another volume of the Big medicine fully concentrated on the 22. Havinson VH, Anisimov VN. Pep- Medical Encyclopedia published more studies and monitoring of the health tide regulation and aging. SPb.: Nau- than 30 years ago. The book also gave of normal people during prolonged ka, 2003. 223 pages. [in Russian] the definition of pre-nosology diag- exposure to a multitude of stress fac- 23. Komarov FI, Rapoport SI, Za- nostics as a methodology of evaluat- tors, including microgravity, the most guskin SL. Interactive regimen of ing functional states of organism on extraordinary one for the human or- chronodiagnosis and biocontrolled the borderline between the norm and ganism. The traditional health defini- chronophysiotherapy in some inter- . Today, this methodology tion as absence of disease symptoms nal . Klinicheskaya Meditsina. has gained a broad enough recogni- could not satisfy space medicine, for 2000;78(8):17–22. tion and is much used in the areas of its major criteria of health is the abil-

Issue 10. May 2017 | Cardiometry | 55 ity of cosmonaut's organism to adapt Evaluation of health level 1) renewal of structures with energy to the spaceflight environment and In the turmoil of modern life most and matter expenditures; readiness to perform duties correctly people are subjected, to one or another 2) generation and expenditure of en- and completely. Health definition in degree of emotional or physical stress- ergy by control commands; the WHO Charter as state of complete es. This is particularly true for people 3) reception, processing and trans- physical, mental, and social well being dwelling in extreme climate, geo- mission of command (signal) infor- complies with the space medicine re- graphic and social environments. All mation for initiation of metabolism quirements and yet is not exhaustive. these produce stresses. Low stress level and energy exchange regulation; Evaluation of the health state of space- is always good to organism as it stimu- 4) temporal matching of structure, crew members must proceed not from lates the ability to adapt (adjust) to the energy and information-level func- the philosophical, qualitative defini- continuously changing outer world. tioning. tion but from the specific, practical However, an excessive stress, perma- one that will open up possibilities of nent emotional pressure, depression, Key principles of pre-nosology measurement and evaluation of the failures, heavy physical loads and in- diagnostics level of health [1–4]. adequate rest lead to severe straining Adjustment or adaptation to a chan­ Space medicine gave rise to a fun- of the regulatory systems of organism, ged environment is attained at the cost damentally new approach to health overstrain and eventual exaustion. of the functional resource or a certain evaluation in light of the present-day This classification was experimental- "biosocial pay". Every moment orga­ theory of adaptation and the doctrine ly substantiated in the first monograph nism spends life resources and then of homeostasis [5–7]. The essence of on pre-nosology diagnostics published renews them by, specifically, rest and this approach is that health is con- by V.P. Kaznacheev, R.M. Baevsky and sleep. Expenditure and renewal of the sidered to be a process of continuous A.P. Berseneva in 1981 [9]. With time resources by organism and its individ- adjustment of organism to its envi- the classification was elaborated fur- ual systems is actually what the life pro- ronment and the adaptive potential ther by space medicine and applied cess is. Adaptation, one of the funda- is the measure of health. Transition physiology. A 10-grade scale was pro- mental properties of organized matter, from health to disease is caused by a posed to evaluate four levels of health is a result and means for resolution of reduction of the adaptive potential, depending on the extent of regulatory internal and external contradictions of degradation of the ability to react systems straining [3]. life. Organized matter exists and forms adequately to social, labor, and usu- Our concept of pre-nosology diag- on the borderline between life and al everyday stresses. A large num- nostics places emphasis on the in- , health and disease through their ber of transitory or pre-nosological formational aspect of health on the collisions and intertransitions. "Pay" for states develop in-between health and ground that controlling mechanisms, adaptation that went beyond the limit of disease. Results of mass screening i.e. informational or regulatory, are of "biosocial budget" and demands extra showed that 50 to 80 % of population primary importance for the optimal efforts from organism cuses breakage have various prenosological states functioning of such complex biologi- of the adaptation mechanism. [8]. This means that the majority of cal system as human organism. Func- Fig. 1 shows the conceptual diagram people need not just medical or dis- tion of a living system is a behavior of health measurement. From the di- ease diagnostics but pre-nosology pattern that keeps integrity of struc- agram it is evident that homeostasis diagnostics, i.e. determination of de- tures and consists of successive levels maintenance requires involvement of gree of loss of adaptability or level of of metabolism, energy and informa- mechanisms responsible for mobiliza- deviation from the norm. With space tion exchange, and temporal organiza- tion of functional reserves, i.e. activa- medicine, methods and approach- tion (R.M. Baevsky, 1979, 2003, 2006). tion of relevant systems of regulation. es of pre-nosology diagnostics are Irrespective of whether we consider a Level of health or adaptive potential of among the most common and ad- cell, organ or whole organism, their organism are also dependent on indi- vancing instruments for evaluation of functioning can be described by a sin- vidual characteristics of organism and health level. gle algorithm that includes four stages: environmental factors affecting its life.

56 | Cardiometry | Issue 10. May 2017 The ability of adaptive mechanism to ensure stable adaptation to environ- ment hinges on the functional reserve (FR) of organism. High functional reserve provides an adequate level of functioning (LF) of the main systems without increasing the degree of ten- sion (DT). The dependence between FR, LF and DT can be expressed as a simple equation: LF = FR · DT.

The equation shows that to retain Figure 1. The conceptual diagram of health measurement adequate LF of organism or separate systems on the background of various ity analysis (HRV). It should be not- Besides, in addition to the traditional stresses, DT must grow in sync with ed that the method was designed by premorbid states we think it reason- FR reduction. The equation should space cardiologists and first applied able, along with early or initial patho- be regarded as a model describing in early orbital flights of animals and logical developments in organs and the ratio of adaptive and homeostat- humans. HRV was tested in different systems (pre-ulcerous, pre-hyperton- ic reactions of organism. The ratios disciplines of medicine and physiolo- ic, etc.), to refer to premobidity also of LF, DT and FR at different func- gy and now is broadly applied in re- such predecessors as overstrain and tional states can be quite diverse. searches of autonomic regulation and regulation depletion, manifested by The state of physiological norm can stress level [10–13]. Finally, the third non-specific signs of the general ad- be observed against both the normal argument for choosing DT and giv- aptation . and increased level of functioning. At ing priority to HRV is that they offer pre-nosological states, LF can be nor- the opportunity to perform intimate Classification of the mal or high or reduced depending on evaluation of the functional state of pre-nosological states FR. Premorbid states develop due to organism leaning upon knowledge State of the whole organism as a low FR and as a function of DT; they about the sequence in which levels result of functional system activities are characterized by either high or and mechanisms of regulation are is determined by the optimality of low LF. mobilized. command signals, ability of control Equation LF = DT x FR is a base As a rule, in case of a pre-nosolog- mechanisms to sustain equilibrium of the pre-nosological approach to ical state, level of functioning (LF) between organism and environment, health evaluation. The technology of of the main systems (cardiovascular, or its adaptation. The adaptive func- pre-nosology investigations should respiratory, digestive, excretory) does tion of organism requires energy and involve calculation of all three com- not alter much. That is the reason information and in this connection ponents of the equation. However, why the traditional clinical measure- we may speculate on the "cost of ad- the key position is occupied by the ments of pulse rate, blood pressure, aptation" as a function of the degree DT measurement. The main reason expiratory volume etc. do not help of regulation straining and expendi- is that this index is the most dynamic recognize states in-between the norm ture of the functional reserve. Adap- indicator of adaptation level. Anoth- and pathology. However, if homeo- tation-induced change in the level of er argument for the choice is that DT stasis is provoked by challenging en- functioning of a system or its com- is a key parameter in pre-nosology vironment and DT remains high for ponents does not necessarily break diagnostics, as it can be measured a long period of time, there is a risk homeostasis provided the regulatory using a comparatively simple and that organism will pass into a pre-no- mechanisms are not overstrained and proven method of heart rate variabil- sological or even premorbid state. the functional reserve is not depleted.

Issue 10. May 2017 | Cardiometry | 57 Table 1. Classification of the functional states in pre-nosology diagnostics Overstrain and depletion are the causes for adaptation failure and dis- No. Functional state ease. Pathological states as an after- Physiological norm 1 Satisfactory adaptation to environment. Sufficient functional potential of math of regulation disarrangement organism. Homeostasis is maintained with minimal regulation straining make grade four in the classification Pre-nosological states of pre-nosological states. A detail Organism-environment equilibrium is maintained through mobilization of the 2 functional reserve and, consequently, regulation straining. Adaptive potential of description of each of the four func- resting organism is lowered and adaptability to stresses is reduced. Homeostasis tional states is presented in table 1. is achieved only by regulation straining This classification was fairly widely Pre-morbid states Unsatisfactory adaptation. Low functional potential. Homeostasis only due accepted owing to the proposed anal- 3 to extreme regulation straining and mobilization of additional compensatory ogy with the traffic lights. The green mechanisms light gives the right to feel free and Failure (break) of adaptation mechanisms go the chosen way. In terms of health 4 Sharply reduced functional potential. Impaired homeostasis. Specific pathologic changes on organ and system levels the green means that at the moment there are no serious deviations to reserve of organism, stamina, initial may vary significantly with appli- care about. The yellow light signals to individual health level. cation areas in medicine and physi- take a pause and look closely about Transition from health to disease is ology. Much depends on purpose of before proceeding further. It means instigated by overstrain, exhaustion investigations. Therefore, methodol- that some changes have occurred and and break of adaptation. The sooner ogy and technology of pre-nosology that care must be taken to reestab- we predict this turn of event, the high- diagnostics in preventive medicine lish the normal health level. The red er will be chances to retain health. may have little similarity with those light alarms that it is time to visit the Thus, the problem comes down to in rehabilitative, sport, not to men- doctor for diagnostics and treatment. finding ways how to measure the level tion space medicine. Already in 1980s, a roughly similar of regulation strain in own organism In context of purpose, the pre-noso- to the "traffic lights" classification to be able to control health. Pre-no- logical investigations can be divided was applied advantageously in mass sology monitoring is a practical step into three groups: pre-nosology examinations [8, 9, and toward dynamic tracking of the regu- 1) pre-nosology diagnostics; 14]. The pre-nosology health evalua- lation system functions, and detection 2) pre-nosology screening tion campaigns were accepted by the of incipient signs of overstrain of or- 3) pre-nosology monitoring broad public. For instance, factory ganism, organs and systems. Instead In a broad sense, pre-nosology di- workers took them much more se- of waiting for disease symptoms, the agnostics is interpreted as making a riously than the traditional prophy- pre-nosology approach to evaluation so-called pre-nosology diagnosis or, lactic medical examinations aimed of health, functional state of organ- more exactly, evaluation of the func- at detecting diseases. Quantification ism is aimed at detecting regulation tional state of organism within the of the level of regulation strain is changes and take timely appropriate norm-pathology interval, between crucial for estimation of the reserve actions for health improvement and health and disease. Classification of potential or adaptability of organism. prophylaxis. the states given above can and must Any stress causes the reaction of reg- be modified to fit the needs of vari- ulation straining and mobilization Pre-nosology diagnostics: ous areas of medicine and physiology. of the functional reserve which hap- Methodology Modifications do not imply revision pens constantly. However, one and The theoretical developments above of fundamental but rather practical the same factor may strain regulation are objectified through methods and aspects of adapting principles and moderately in some people (working technologies of investigations. First terminology to the objectives of one level of functional straining) and in- of all, we should point it out that or another field of application. For crease sharply the regulation strain in methodology and all the more tech- instance, medicine and physiology of others. All depends on the functional nology of pre-nosology diagnostics labor are concerned with evaluation

58 | Cardiometry | Issue 10. May 2017 of human ability to work; preventive Pre-nosology monitoring is a dy- patients recovering from diseases. medicine, with determination of the namic functional state check of es- The key criterion of choosing a con- necessity and content of health im- sentially healthy people. In fact, this tingent is a request to evaluate health proving and prophylactic measures, is a process of tracking the state of but not to make diagnosis. This is and urgency of visiting a doctor; re- healthy human doing his job. The a matter of principle, as we work in habilitation medicine, with the prog- most illustrative example of pre-no- the field of prenosology. When we ress of recovery from a disease. In all sology monitoring is provided by apply the pre-nosological approach cases pre-nosology diagnostics serves space medicine that can be called to patients on the stage of recovery, to evaluate current functional state of the cradle of the prenosological ap- we proceed from the assumption that organism, level of deviation from the proach. In the course of long-term even a sick organism possesses some norm and how close the deviation ap- space mission cosmonauts, rigorous- store of adaptation potential and proaches to disease. ly selected healthy people, are regu- functional reserve to regain normal Pre-nosology screening is selection larly subjected to medical and phys- health state. In essence, treatment of people with functional states of or- iological examinations. The reason is has the goal to mobilize the function- ganism that need to be improved, may to see the trend and extent of shifts in al reserve of organism, to stimulate not permit to work, require secondary the functional state of cosmonauts. If its adaptation potential. However, the care in medical institution etc. Public the functional state shifts toward pa- point is that being unable to assess healthcare is short of these methods thology is paralleled by DT growth, results of its effort the level to which and technologies; instead, it has to intervention is urgent including re- health has regained (less straining handle perplexing medical and social lease of workloads, change in diet of regulation systems, growth of the issues using crude inaccurate. For ex- or training program, prescription of functional reserve), traditional med- ample, working capacity examination prophylactic , etc. Pre-no- icine still uses the criteria of disease. relies on the nosological approach sology monitoring can be beneficial Therefore, pre-nosology diagnostics unsuitable for separation of groups of to health check of shift personnel helps traditional medicine to control normal people with pronounced regu- operating complex systems, evalua- health recovery using the arsenal of lation strain; they are in the premorbid tion of recovery from severe disease, own methods to evaluate the prog- state though disease symptoms are still functional state of sportsmen prepar- ress from disease to health or from unapparent. Time must pass till break ing for tournaments, etc. pathology to the norm. In all cases of adaptation when the need to limit Methodology and especially tech- pre-nosological investigation is a workload will be obvious. Pre-nosolo- nology of pre-nosology diagnostics process of recognition guided by a gy screening on this stage has received vary significantly with type of in- simple logical rule and sophisticated wide acceptance in preventive med- vestigation. Methodology is gener- mathematical techniques. It is always icine, mass health examination, and ally understood as a basic scheme of noninvasive, comfortable and quick. medical flight certification. The first investigation, stages and methods. These characteristics of the pre-no- practical steps of pre-nosology diag- Technology is specific procedures, sological methodology are of funda- nostics were made in pre-nosology details of investigation and descrip- mental importance because object of screening. Effectiveness of the meth- tion of instruments, methods of data investigation is healthy human. As od was demonstrated in nationwide processing and analysis. Technologies long as one is healthy and does not health examination campaigns con- are often patented and licensed, as feel symptoms of disease, one is not ducted in the USSR in 1970-80s [8, 9]. they provide a complete tangible or mentally ready to any, even a very Pre-nosology screening can be useful information result. We shall now con- simple medical procedure. in different industries where it is im- sider methodology of pre-nosological Innumerable recreation centers and portant to identify employees with investigations and outline some of the fitness clubs attract clients with the undesirably high levels of regulation technologies from this standpoint. promise to improve quality of life and straining, lowered functional reserve Object of pre-nosology investiga- to raise mood by reducing diet, tak- or risk of pathology. tions is healthy people or sometimes ing supplements to aid sleep or per-

Issue 10. May 2017 | Cardiometry | 59 forming exercises that will increase the cardiovascular functioning by usually take 2 to 3 minutes each; ECG strength and elasticity of muscles. As complex parameter FCI (functional recording for HRV analysis takes 5 a rule, all these do not imply suffi- change index) deduced from simple minutes. Filling out the question- cient monitoring or evaluation of the traditional measurements of pulse naire also is not a problem. The ques- initial functional status of organism. rate and blood pressure. tionnaire must contain no more than Healthy person must be motivated Pre-nosology diagnostics technolo- 15–20 questions with multiple choice for a specific type of examination. gies are diverse and to a large degree answers. Information collection must Unfortunately, healthy life style gets dependent on type of pre-nosologi- utilize dedicated software tools as implanted very slowly. Some com- cal investigation. In addition to the much as possible including databases panies, private in particular, launch main indices of pre-nosology diag- storing individual files with results of wellness programs for high-priced nostics (FL, DT, FR), consideration measurements. and qualified staff. Health of senior must be also given to the cause-and- In the pre-nosology approach, the officers and generals has been stan- effect factors such as environment, primary health criterion is level of ad- dardized first in the US army and lifestyle and anamnesis. This eхplains aptation potential of organism rather now in Russian army. In sport, health the presence of questionnaires and than presence or absence of diseas- maintenance is a pivot for success. socio-ecological survey among the es. The ability to withstand external There are some though still few co- pre-nosology diagnostics technol- stress factors and to maintain normal horts of people who regard pre-no- ogies. Flow chart of any technology functioning of the vital body systems, sology investigations as important can be divided into three parts, i.e. as well as relative equilibrium with and indispensable. For others, com- information collection (1); process- the environment is the main health fort, noninvasiveness and short time ing and analysis (2); data evaluation indicator. Mechanisms compensat- of investigation are motivators for and conclusions (3). Algorithm of ing deviations developing in differ- brooding on whether give preference pre-nosology diagnostics imple- ent systems underlie the enormous to costly and time-consuming clin- ments the abstract theorems above variety of adaptive reactions. Actively ical examination which is effective in the form of conclusion concerning and continuously working regula- only when there are symptoms of a the functional state and adaptation tion systems optimize interrelations disease or pre-nosological investiga- potential of organism. between organism and affecting fac- tion that can delay disease. To begin with, we should note that tors. In other words, deviations that We must not hold back an import- information collection during pre-no- traditional medicine qualifies as dis- ant principle of pre-nosology diag- sological investigations is arranged in eases and refers to appropriate noso- nostics which is use of data-intensive a comfortable, quick and highly pro- logical class, the for the pre-nosology methods of investigation. This means ductive manner. In contrast to patients approach are the reason for concern that a very short and methodically in hospitals and outpatient clinics, about the ability of organism to sus- simple investigation must generate objects of pre-nosology diagnostics tain balance with its environment. If massive and valuable information are, as a rule, healthy people. Their the functional reserve is sufficient, sufficient for stating conclusions interest in this examination is driven, organism does not need treatment about regulation activities, function- on the one hand, by the form and con- but support of an adequate level of al reserve and functioning of the vital tent of conclusions they receive and, adaptation potential. body systems. The principle lays the on the other, simplicity and comfort The pre-nosology diagnostics clas- ground for development of concrete of technologies. Mass examination, sification of the functional states by technologies. An obvious example of specifically, is often performed at pro- level of adaptation to environment how the principle works is a broad duction site during work time and, makes it possible to distribute the application of heart rate variability therefore, requires comfortable and total flow of people coming for mass analysis in pre-nosological investi- time-efficient technologies. medical examination into four cat- gations. Another example is design- Measurements of height, body weight, egories depending on their need in ing the method to evaluate level of muscle strength and blood pressure medical aid. Medical investigations

60 | Cardiometry | Issue 10. May 2017 are required only to those who have dations. This was supported by the ered to be health disorders that can been referred to the category with results of examining bus drivers [18, be removed by various actions on broken adaptation and some people 19] and pilots using hard- and soft- whole organism, since a single organ in premorbid state who have seri- ware system Ecosan-2007, and data pathology is linked with disorders on ous health complaints or face with from project Mars-500 [20-28]. We the level of whole organism. sharply deteriorated environments. succeeded in demonstrating a high In Russia and majority of the West Mass pre-nosology investigations [9, correlation of the functional state of countries doctor's duty is, first and 15-17] showed that no more than 20- normal people with effecting factors foremost, to diagnose correctly. This 30% really need medical diagnostics (regional climate, working environ- means precise location of a patho- and treatment. Consequently, appli- ment, psychophysiological parame- logic process and its characterization cation of the pre-nosology approach ters). Transition from prenosology to on the cell and even subcell levels. In in mass medical examinations would premorbidity and consequent growth doctors' opinion, only precise diag- let more effective use of the health- of disease risks are accompanied by nosis gives reason to prescribe treat- care strength and resources. an increase in organism vulnerability ment, typically drugs. They disregard to changed conditions. For example, the fact that the "aimed pharmaco- Pre-nosology diagnostics as seasonal rise in common cold inci- logical blow" to the site of patholo- a fundament for medicine in dence involves mostly people in pre- gy impacts the entire organism and future morbid and pre-nosology states due may cause an irreparable damage to Practice of the pre-nosology investi- to low adaptation potential. In recent healthy organs and systems. gations shows clearly that recognition years, space medicine has been en- Methods of pre-nosology diag- and evaluation of functional states of riched with the concept of adaptation nostics showed that no matter the organism in-between the norm and risk as a criterion of pathology prob- treatment mode, it begins with mo- pathology require cutting-edge tech- ability [29, 30]. In light of this con- bilization of the functional reserve of niques and technologies. In this con- cept, pre-nosology monitoring is a organism (straining) and only after- text, leadership still belongs to space dynamic estimation of individual ad- wards, in a while, reaches local effects, medicine concentrated on enhance- aptation risk aimed to reveal negative provided a correct individual dosage ment of health evaluation method- trends in health state and to predict and period of treatment. The reverse ology in long-duration orbital and possible pathologic developments. transition from disease to health is exploration missions. It is natural Advancement of pre-nosology di- no less complicated. Sometime in fu- that the present-day technologies agnostics is objective necessity, as it ture medicine will have technologies are incomparably better than 30-40 may build a bridge between the West- of assessing the therapy efficacy and years ago. In its turn, pre-nosology ern and Oriental models of medi- conducting dynamic pre-nosology diagnostics has also made a leap for- cine. The Russian healthcare system monitoring of rehabilitation. ward. Now we discuss not so much reproduces the so-called Western Medicine of the future must be sure recognition of functional states, as model, i.e. medicine is oriented at di- focused on maintaining health of their probability, pathology risk es- agnostics and treatment of concrete healthy people. Methods and means timation, and prognostication of a diseases on the nosology principle. of treating diseases will, of course be probable decline of the adaptation All types of pathology are related to perfected; however, priority will be potential. The concepts of pre-no- specific organs and systems; medical set on the energetic development of sology screening and pre-nosology specialties become more and more methods of health maintenance and monitoring have been reconsidered. narrow. It is well known that Orien- improvement that could be integrat- On the evidence gathered at the end tal medicine (Tibetan and Chinese in ed into the healthcare system. This is of the last century, screening is fo- particular) sees human organism as where the theoretical and practical cused on differentiation of pre-noso- a comprehensive whole. Its primary knowledge of pre-nosology diagnos- logical and premorbid states as they goal is to study health and ways to tics will gain recognition and fur- require different health recommen- keep it. Different pains are consid- therance.

Issue 10. May 2017 | Cardiometry | 61 Statement on ethical issues al Space Station. Journal of Applied 16. Denisov LA, Berseneva AP, Baevsky Research involving people and/or ani­ Physiology. July 2007;103(1):156-61. RM, et al. Pre-nosological approach mals is in full compliance with cur- 7. Chernikova A, Baevsky R, Funtova in evaluation of population morbid- rent national and international ethi- I. Adaptation risks in space medicine. ity and mortality. Gigiena i sanitaria. cal standards. Proceedings of the International As- 2009;6:77–80. [in Russian] tronautical Congress, IAC Volume 1, 17. Baevsky, R. Speaking in Plain Lan- Conflict of interest 2012, Pages 172–176. guage. Annals of Emergency Medicine. None declared. 8. Baevsky RM, Bogoyavlensky EN, April 2008;51(4):450–1. Popenchenko VV. Prognostic impor- 18. Baevskii RM, Berseneva AP, Bersenev Author contributions tanct of ballistocardiography in mass pro- EY, Eshmanova AK. Use of principles of The authors read the ICMJE criteria phylactic examinations of young people. prenosological diagnosis for assessing the for authorship and approved the final Bibliotheca cardiologica. 1975;33:6–8. functional state of the body under stress manuscript. 9. Kaznacheev VP, Baevsky RM, Berse- conditions as exemplified by bus drivers. neva AP. Pre-nosological diagnostics Human Physiology. 2009;35(1):34–42. References in the practice of mass examinations 19. Baevsky RM, Berseneva AP, Berse­ 1. Baevsky RM. To the problem of pre- of population. Leningrad. Medicine. nev EY, et al. Evaluation of develop- diction of human functional state in 1980. 225 p. [in Russian] ment of the cardiovascular pathology conditions of long-term space mission. 10. Baevsky RM, Moser M, Nikulina risk in bus drivers. Functional diag- Physiology. 1972; 6:819. [in Russian] GA. Autonomic regulation of circula- nostics. 2009;2:38–47. [in Russian] 2. Kaznacheev VP, Baevsky RM. In- tion and cardiac contractility during 20. Baevsky RM, Baranov VM, Pash- dividual peculiarities of human ad- a 14-month space flight. Acta Astro- chenko AV. Functional state evaluation aptation reactions and the problem of nautica. January 1998;42(1-8):159–73. and prediction problems during flight prenosological diagnostics. In: Adap- 11. Mayorov OY, Baevsky RM. Applica­ to the mars. AIAA 57th Internation- tation and problems of general pathol- tion of space technologies for valua- al Astronautical Congress, IAC 2006. ogy. Proceedings of All-Union Con- tion of a stress level Studies in Health Volume 5, 2006, Pages 3073–3076. ference. 1974. p. 9–14. [in Russian] Technology and Informatics. 1999; 68: 352–6. 21. Baevsky RM, Bersenev ЕY, Luchits- 3. Adamovich BA, Baevsky RM, Berse- 12. Goldberger AL, Bungo MW, Baevsky kaya ЕS, et al. Individual peculiarities neva AP, Funtova II. State-of-the-art au- RM. Heart rate dynamics during long- of adaptation reactions in experiment tomatic evaluation of the health status in term space flight: Report on Mir cos- “Mars-105”. Tekhnologii zhivykh sis- space medicine and preventive medicine. monauts. American Heart Journal. July tem. 2009;6(8):61–6. [in Russian] Kosmicheskaya Biologiya i Aviakosmi- 1994;128(1):202–4. 22. Baevsky RM, Baranov VM, Bogo- cheskaya Meditsina. 1990;24(4):11–8. 13. Baevsky RM. Noninvasive meth- molov VV, et al. Assessment and predic- 4. Baevsky RM, Berseneva AP. Pre-no- ods in space cardiology. Journal of tion of health status of the Mars mission sological diagnostics in health state Cardiovascular Diagnosis and Proce- crew members. Aviakosmicheskaya i Eko- evaluation. Валеология. 1993; p. 131. dures. 1997;14(3):161–71. logicheskaya Meditsina. 2006;40(4):22–30. [in Russian] 14 Baevsky RМ, Berseneva AP, Baevsky 23. Chernikova A, Baevsky R, Funto- 5. Baevsky RM, Larina IM. Function- PA, Master M. Application of principles va I. Adaptation risks in space medi- al state periodic oscillations and long of space medicine to health monitor- cine. Proceedings of the International space flight adaptation problem. AIAA ing of the aging population. Cardiom- Astronautical Congress, IAC Volume 57th International Astronautical Con- etry. May 2015;6:22–9. DOI:10.12710/ 1, 2012, Pages 172–176. gress, IAC 2006. Volume 1, 2006, Pages cardiometry.2015.6.2229. 24. Pugachev VI, Baevsky RM, Berse- 413–417. 15. Baevsky RM, Berseneva AP. The- neva AP, et al. Long-run eco-medical 6. Baevsky RM, Baranov VM, Funto- oretical fundamentals of pre-noso- monitoring in North America using va II. Autonomic cardiovascular and logical diagnostics. Pre-nosology and the Heart Wizard Mars-500 system. respiratory control during prolonged healthy life style. 2008;2:2. [in Rus- Aviakosmicheskaya i Ekologicheska- spaceflights aboard the Internation- sian] ya Meditsina. 2013;47(6):39–45.

62 | Cardiometry | Issue 10. May 2017 25. Pugachev VI, Baevsky RM, Berse- 27. Bersenev EY, Rusanov VB, May 2013;2:74-87. DOI: 10.12710/ neva AP. Long-term eco-medical Chernikova AG. Vegetative regu- cardiometry.2013.2.7487. monitoring using the Heart Wizard lation of blood circulation in the 29. Baevsky RM, Bersenev ЕY, Or- Mars-500 system in North Ameri- Martian crew individuals in the lov ОI, Ushakov IB, Chernikova AG. ca. Human Physiology. December Mars 500 project. Cardiometry. May Problem of evaluation of human adap- 2015;41(7):802–7. 2013;2:62-73. DOI: 10.12710/cardi- tational capabilities in airspace physi- 26. Baevsky RМ, Bersenev EY, ometry.2013.2.6273. ology. Russian Journal of Physiology. Chernikova AG. Issues of health 28. Baevsky RM, Berseneva AP, 2012; 98(1):95-107. [in Russian] evaluation during simulated space Slepchenkova IN, Chernikova 30. Chernikova A, Baevsky R. Prob- mission to Mars. Part 1. Research AG. Assessment of adaptation re- lem of individual norm and assess- methodology and methods used in actions in the participants of the ment of adaptation risks in space and experiment Mars-500. Cardiometry. long-term medical & ecological on earth. Proceedings of the Interna- May 2013;2:7–18. DOI: 10.12710/car- investigations during the exper- tional Astronautical Congress, IAC diometry. 2013.2.718. iment Mars-500. Cardiometry. Volume 1, 2014, Pages 93–97

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