ФИЗИОЛОГИЧЕСКИЕ АСПЕКТЫ КОЖНОГО ПОКРОВА ЧЕЛОВЕКА КАК ПРОЯВЛЕНИЕ АДАПТАЦИИ ПОД ВЛИЯНИЕМ РАЗЛИЧНЫХ ФАКТОРОВ
Ключевые слова:
кожа, адаптация, растяжимость, акустическая анизотропия, укорочение конечности, удлинение по Илизарову, спортсмены-борцы, структура кожи
Аннотация
Цель работы состояла в изучении растяжимости, акустической анизотропии и структуры кожного покрова нижней конечности в условиях пролонгированного растяжения при врожденном ее укорочении и у спортсменов – высококвалифицированных борцов греко-римского стиля. Материал и методы. Обследованы пациенты с врожденным укорочением нижней конечности (1-я группа) в возрасте 7–35 лет; высококвалифицированные спортсмены – борцы-единоборцы (2-я группа) и их сверстники-неспортсмены (3-я группа). Оценивали величину растяжимости и толщину кожи голени в процессе дистракции и после завершения лечения. В указанных группах определяли влияние положения конечности в пространстве на характер акустической анизотропии кожи с помощью акустического анализатора ASA, неинвазивно изучали структуру кожи с помощью ультрасонографии. Результаты. Установлена возрастная зависимость показателя растяжимости кожи пораженной голени: до начала дистракции в 1-й группе 12–14 лет параметр был максимальным, составив 2,1 %. После завершения лечения наибольшее его значение выявлено у пациентов 7–8 лет. Влияние дистракции приводило к закономерному снижению растяжимости. В группе подростков к 45-му дню дистракции растяжимость уменьшалась в 11,1 раза, составив 0,02 ± 0,01 %, а у взрослых к 60-му дню дистракции достигала 0,10 ± 0,06 %. Аппроксимация этого параметра в коже голени в зависимости от возраста описывается полиномиальным уравнением, а после уравнивания длины конечности – уравнением линейной зависимости. По данным ультрасонографии, толщина кожи удлиненной голени достоверно возрастала во все периоды лечения. Превышение толщины кожи нижней конечности наблюдалось у спортсменов-борцов относительно показателя в группе неспортсменов. Обнаружена трансформация акустической анизотропии в коже удлиняемой голени при изменении положения конечности в пространстве. Заключение. Механическое воздействие (дистракция) и физический стресс (регулярные спортивные тренировки) вызывают структурную и функциональную адаптацию кожи нижней конечности, а изменение положения конечности в пространстве – трансформацию акустической анизотропии.
Литература
1. Шевцов В.И., Гребенюк Л.А., Попков А.В., Гребенюк Е.Б. Динамика акустических свойств покровных тканей и содержание гидроксипролина при оперативном лечении врожденных аномалий конечностей. Вестник РАМН. 2009. № 6. С. 37–42. [Shevtsov V.I., Grebenyuk L.A., Popkov A.V., Grebenyuk E.B. [Dynamics of the Acoustic Properties of Integumentary Tissues and the Content of Hydroxyproline in the Surgical Treatment of Congenital Anomalies of the Limbs]. Vestnik RAMN [Bulletin of the Russian Academy of Medical Sciences], 2009, no. 6, pp. 37–42. (in Russ.)]
2. Bird J.A., Sánchez-Borges M., Ansotegui I.J., Ebisawa M., Ortega Martell J.A. Skin as an Immune Organ and Clinical Applications of Skin-Based Immunotherapy. World Allergy Or-gan J, 2018, vol. 11 (1), 38 p. DOI: 10.1186/s40413-018-0215-2. eCollection 2018
3. Braun T., Kahanov L. Community-Associated Methicillin-Resistant Staphylococcus Aureus Infection Rates and Management among Student-Athletes. Med Sci Sports Exerc, 2018, vol. 50 (9), pp. 1802–1809. DOI: 10.1249/MSS.0000000000001649
4. Dąbrowska A.K., Spano F., Derler S., Adlhart C., Spencer N.D., Rossi R.M. The Relationship Between Skin Function, Barrier Properties, and Body-Dependent Factors. Skin Res Technol, 2018, vol. 24 (2), pp. 165–174. DOI: 10.1111/srt.12424. Epub 2017 Oct 23
5. Engebretsen K.A., Johansen J.D., Kezic S., Linneberg A., Thyssen J.P. The Effect of Environmental Humidity and Temperature on Skin Barrier Function and Dermatitis. J Eur Acad Dermatol Venereol, 2016, vol. 30 (2), pp. 223–249. DOI: 10.1111/jdv.13301. Epub 2015 Oct 8
6. Grebenyuk L.A., Grebenyuk E.B. Express Diagnosis of Mechano-Biological Limb Skin Condition During Prolonged Dosed Stretching in Orthopedics. In book: Biomechanics and Biomaterials in Orthopedics (Editors: Poitout, Dominique G. (Ed.). – 2nd edition. Springer-Verlag-London, 2016, pp. 241–251. DOI: 10.1007/978-1-84882-664-9_21
7. Kalra A., Lowe A., Jumaily A.Al. An Overview of Factors Affecting the Skin's Young's Modulus. J Aging Sci, 2016, vol. 4 (2), 156 p. DOI: 10.4172/2329-8847.1000156
8. Kruglikov I.L., Scherer P.E. Skin Aging as a Mechanical Phenomenon: The Main Weak Links. Nutr Healthy Aging, 2018, vol. 4 (4), pp. 291–307. DOI: 10.3233/NHA-170037
9. Kruglikov I.L., Scherer P.E. General Theory of Skin Reinforcement. PLoS One, 2017, vol. 12 (8), e0182865. DOI: 10.1371/journal.pone.0182865. eCollection 2017.
10. Luebberding S., Kolbe L., Kerscher M. Influence of Sportive Activity on Skin Barrier Function: a Quantitative Evaluation of 60 Athletes. Int J Dermatol, 2013, vol. 52 (6), pp. 745–749. DOI: 10.1111/j.1365-4632. 2012.05852.x. Epub 2013 Mar 14.
11. Maiti R., Gerhardt L.C., Lee Z.S. et al. In Vivo Measurement of Skin Surface Strain and Sub-Surface Layer Deformation Induced by Natural Tissue Stretching. J Mech Behav Biomed Mater, 2016, vol. 62, pp. 556–569. DOI: 10.1016/j.jmbbm.2016.05.035. Epub 2016 Jun 5.
12. Many P.S. Preventing Community-Associated Methicillin-Resistant Staphylococcus Aureus Among Student Athletes. J Sch Nurs, 2008, vol. 24 (6), pp. 370–378. DOI: 10.1177/1059840508326448
13. Mueller M.J., Maluf K.S. Tissue Adaptation to Physical Stress: A Proposed “Physical Stress Theory” to Guide Physical Therapist Practice, Education, and Research. Physical Therapy, 2002, vol. 82, iss. 4, pp. 383–403. DOI: 10.1093/ptj/82.4.383
14. Pedersen L., Jemec G.B. Mechanical Properties and Barrier Function of Healthy Human Skin. Acta Derm Venereol, 2006, vol. 86(4), pp. 308–311. DOI: 10.2340/00015555-0080
15. Redziniak D.E., Diduch D.R., Turman K. et al. Methicillin-Resistant Staphylococcus Aureus (MRSA) in the Athlete. Int J Sports Med, 2009, vol. 30 (8), pp. 557–562. DOI: 10.1055/s-0029-1214382. Epub 2009 May 25.
16. Shah N., Cain G., Naji O., Goff J. Skin Infections in Athletes: Treating the Patient, Protecting the Team. J Fam Pract, 2013, vol. 62 (6), pp. 284–291.
17. Singh B., Maibach H. Climate and Skin Function: an Overview. Skin Res Technol, 2013, vol. 19 (3), pp. 207–212. DOI: 10.1111/srt.12043. Epub 2013 Mar 25.
18. Svoboda M., Bílková Z., Muthný T. Could Tight Junctions Regulate the Barrier Function of the Aged Skin? J DermatolSci, 2016, vol. 81(3), pp. 147–152. DOI: 10.1016/j.jdermsci.2015.11.009. Epub 2015 Nov 28.
19. Waller J.M., Maibach H.I. Age and Skin Structure and Function, a Quantitative Approach (I): Blood Flow, pH, Thickness, and Ultrasound Echogenicity. Skin Res Technol, 2005, vol. 11 (4), pp. 221–235. DOI: 10.1111/j.0909-725X.2005.00151.x
2. Bird J.A., Sánchez-Borges M., Ansotegui I.J., Ebisawa M., Ortega Martell J.A. Skin as an Immune Organ and Clinical Applications of Skin-Based Immunotherapy. World Allergy Or-gan J, 2018, vol. 11 (1), 38 p. DOI: 10.1186/s40413-018-0215-2. eCollection 2018
3. Braun T., Kahanov L. Community-Associated Methicillin-Resistant Staphylococcus Aureus Infection Rates and Management among Student-Athletes. Med Sci Sports Exerc, 2018, vol. 50 (9), pp. 1802–1809. DOI: 10.1249/MSS.0000000000001649
4. Dąbrowska A.K., Spano F., Derler S., Adlhart C., Spencer N.D., Rossi R.M. The Relationship Between Skin Function, Barrier Properties, and Body-Dependent Factors. Skin Res Technol, 2018, vol. 24 (2), pp. 165–174. DOI: 10.1111/srt.12424. Epub 2017 Oct 23
5. Engebretsen K.A., Johansen J.D., Kezic S., Linneberg A., Thyssen J.P. The Effect of Environmental Humidity and Temperature on Skin Barrier Function and Dermatitis. J Eur Acad Dermatol Venereol, 2016, vol. 30 (2), pp. 223–249. DOI: 10.1111/jdv.13301. Epub 2015 Oct 8
6. Grebenyuk L.A., Grebenyuk E.B. Express Diagnosis of Mechano-Biological Limb Skin Condition During Prolonged Dosed Stretching in Orthopedics. In book: Biomechanics and Biomaterials in Orthopedics (Editors: Poitout, Dominique G. (Ed.). – 2nd edition. Springer-Verlag-London, 2016, pp. 241–251. DOI: 10.1007/978-1-84882-664-9_21
7. Kalra A., Lowe A., Jumaily A.Al. An Overview of Factors Affecting the Skin's Young's Modulus. J Aging Sci, 2016, vol. 4 (2), 156 p. DOI: 10.4172/2329-8847.1000156
8. Kruglikov I.L., Scherer P.E. Skin Aging as a Mechanical Phenomenon: The Main Weak Links. Nutr Healthy Aging, 2018, vol. 4 (4), pp. 291–307. DOI: 10.3233/NHA-170037
9. Kruglikov I.L., Scherer P.E. General Theory of Skin Reinforcement. PLoS One, 2017, vol. 12 (8), e0182865. DOI: 10.1371/journal.pone.0182865. eCollection 2017.
10. Luebberding S., Kolbe L., Kerscher M. Influence of Sportive Activity on Skin Barrier Function: a Quantitative Evaluation of 60 Athletes. Int J Dermatol, 2013, vol. 52 (6), pp. 745–749. DOI: 10.1111/j.1365-4632. 2012.05852.x. Epub 2013 Mar 14.
11. Maiti R., Gerhardt L.C., Lee Z.S. et al. In Vivo Measurement of Skin Surface Strain and Sub-Surface Layer Deformation Induced by Natural Tissue Stretching. J Mech Behav Biomed Mater, 2016, vol. 62, pp. 556–569. DOI: 10.1016/j.jmbbm.2016.05.035. Epub 2016 Jun 5.
12. Many P.S. Preventing Community-Associated Methicillin-Resistant Staphylococcus Aureus Among Student Athletes. J Sch Nurs, 2008, vol. 24 (6), pp. 370–378. DOI: 10.1177/1059840508326448
13. Mueller M.J., Maluf K.S. Tissue Adaptation to Physical Stress: A Proposed “Physical Stress Theory” to Guide Physical Therapist Practice, Education, and Research. Physical Therapy, 2002, vol. 82, iss. 4, pp. 383–403. DOI: 10.1093/ptj/82.4.383
14. Pedersen L., Jemec G.B. Mechanical Properties and Barrier Function of Healthy Human Skin. Acta Derm Venereol, 2006, vol. 86(4), pp. 308–311. DOI: 10.2340/00015555-0080
15. Redziniak D.E., Diduch D.R., Turman K. et al. Methicillin-Resistant Staphylococcus Aureus (MRSA) in the Athlete. Int J Sports Med, 2009, vol. 30 (8), pp. 557–562. DOI: 10.1055/s-0029-1214382. Epub 2009 May 25.
16. Shah N., Cain G., Naji O., Goff J. Skin Infections in Athletes: Treating the Patient, Protecting the Team. J Fam Pract, 2013, vol. 62 (6), pp. 284–291.
17. Singh B., Maibach H. Climate and Skin Function: an Overview. Skin Res Technol, 2013, vol. 19 (3), pp. 207–212. DOI: 10.1111/srt.12043. Epub 2013 Mar 25.
18. Svoboda M., Bílková Z., Muthný T. Could Tight Junctions Regulate the Barrier Function of the Aged Skin? J DermatolSci, 2016, vol. 81(3), pp. 147–152. DOI: 10.1016/j.jdermsci.2015.11.009. Epub 2015 Nov 28.
19. Waller J.M., Maibach H.I. Age and Skin Structure and Function, a Quantitative Approach (I): Blood Flow, pH, Thickness, and Ultrasound Echogenicity. Skin Res Technol, 2005, vol. 11 (4), pp. 221–235. DOI: 10.1111/j.0909-725X.2005.00151.x
2. Bird J.A., Sánchez-Borges M., Ansotegui I.J., Ebisawa M., Ortega Martell J.A. Skin as an Immune Organ and Clinical Applications of Skin-Based Immunotherapy. World Allergy Or-gan J, 2018, vol. 11 (1), 38 p. DOI: 10.1186/s40413-018-0215-2. eCollection 2018
3. Braun T., Kahanov L. Community-Associated Methicillin-Resistant Staphylococcus Aureus Infection Rates and Management among Student-Athletes. Med Sci Sports Exerc, 2018, vol. 50 (9), pp. 1802–1809. DOI: 10.1249/MSS.0000000000001649
4. Dąbrowska A.K., Spano F., Derler S., Adlhart C., Spencer N.D., Rossi R.M. The Relationship Between Skin Function, Barrier Properties, and Body-Dependent Factors. Skin Res Technol, 2018, vol. 24 (2), pp. 165–174. DOI: 10.1111/srt.12424. Epub 2017 Oct 23
5. Engebretsen K.A., Johansen J.D., Kezic S., Linneberg A., Thyssen J.P. The Effect of Environmental Humidity and Temperature on Skin Barrier Function and Dermatitis. J Eur Acad Dermatol Venereol, 2016, vol. 30 (2), pp. 223–249. DOI: 10.1111/jdv.13301. Epub 2015 Oct 8
6. Grebenyuk L.A., Grebenyuk E.B. Express Diagnosis of Mechano-Biological Limb Skin Condition During Prolonged Dosed Stretching in Orthopedics. In book: Biomechanics and Biomaterials in Orthopedics (Editors: Poitout, Dominique G. (Ed.). – 2nd edition. Springer-Verlag-London, 2016, pp. 241–251. DOI: 10.1007/978-1-84882-664-9_21
7. Kalra A., Lowe A., Jumaily A.Al. An Overview of Factors Affecting the Skin's Young's Modulus. J Aging Sci, 2016, vol. 4 (2), 156 p. DOI: 10.4172/2329-8847.1000156
8. Kruglikov I.L., Scherer P.E. Skin Aging as a Mechanical Phenomenon: The Main Weak Links. Nutr Healthy Aging, 2018, vol. 4 (4), pp. 291–307. DOI: 10.3233/NHA-170037
9. Kruglikov I.L., Scherer P.E. General Theory of Skin Reinforcement. PLoS One, 2017, vol. 12 (8), e0182865. DOI: 10.1371/journal.pone.0182865. eCollection 2017.
10. Luebberding S., Kolbe L., Kerscher M. Influence of Sportive Activity on Skin Barrier Function: a Quantitative Evaluation of 60 Athletes. Int J Dermatol, 2013, vol. 52 (6), pp. 745–749. DOI: 10.1111/j.1365-4632. 2012.05852.x. Epub 2013 Mar 14.
11. Maiti R., Gerhardt L.C., Lee Z.S. et al. In Vivo Measurement of Skin Surface Strain and Sub-Surface Layer Deformation Induced by Natural Tissue Stretching. J Mech Behav Biomed Mater, 2016, vol. 62, pp. 556–569. DOI: 10.1016/j.jmbbm.2016.05.035. Epub 2016 Jun 5.
12. Many P.S. Preventing Community-Associated Methicillin-Resistant Staphylococcus Aureus Among Student Athletes. J Sch Nurs, 2008, vol. 24 (6), pp. 370–378. DOI: 10.1177/1059840508326448
13. Mueller M.J., Maluf K.S. Tissue Adaptation to Physical Stress: A Proposed “Physical Stress Theory” to Guide Physical Therapist Practice, Education, and Research. Physical Therapy, 2002, vol. 82, iss. 4, pp. 383–403. DOI: 10.1093/ptj/82.4.383
14. Pedersen L., Jemec G.B. Mechanical Properties and Barrier Function of Healthy Human Skin. Acta Derm Venereol, 2006, vol. 86(4), pp. 308–311. DOI: 10.2340/00015555-0080
15. Redziniak D.E., Diduch D.R., Turman K. et al. Methicillin-Resistant Staphylococcus Aureus (MRSA) in the Athlete. Int J Sports Med, 2009, vol. 30 (8), pp. 557–562. DOI: 10.1055/s-0029-1214382. Epub 2009 May 25.
16. Shah N., Cain G., Naji O., Goff J. Skin Infections in Athletes: Treating the Patient, Protecting the Team. J Fam Pract, 2013, vol. 62 (6), pp. 284–291.
17. Singh B., Maibach H. Climate and Skin Function: an Overview. Skin Res Technol, 2013, vol. 19 (3), pp. 207–212. DOI: 10.1111/srt.12043. Epub 2013 Mar 25.
18. Svoboda M., Bílková Z., Muthný T. Could Tight Junctions Regulate the Barrier Function of the Aged Skin? J DermatolSci, 2016, vol. 81(3), pp. 147–152. DOI: 10.1016/j.jdermsci.2015.11.009. Epub 2015 Nov 28.
19. Waller J.M., Maibach H.I. Age and Skin Structure and Function, a Quantitative Approach (I): Blood Flow, pH, Thickness, and Ultrasound Echogenicity. Skin Res Technol, 2005, vol. 11 (4), pp. 221–235. DOI: 10.1111/j.0909-725X.2005.00151.x
References
1. Шевцов В.И., Гребенюк Л.А., Попков А.В., Гребенюк Е.Б. Динамика акустических свойств покровных тканей и содержание гидроксипролина при оперативном лечении врожденных аномалий конечностей. Вестник РАМН. 2009. № 6. С. 37–42. [Shevtsov V.I., Grebenyuk L.A., Popkov A.V., Grebenyuk E.B. [Dynamics of the Acoustic Properties of Integumentary Tissues and the Content of Hydroxyproline in the Surgical Treatment of Congenital Anomalies of the Limbs]. Vestnik RAMN [Bulletin of the Russian Academy of Medical Sciences], 2009, no. 6, pp. 37–42. (in Russ.)]2. Bird J.A., Sánchez-Borges M., Ansotegui I.J., Ebisawa M., Ortega Martell J.A. Skin as an Immune Organ and Clinical Applications of Skin-Based Immunotherapy. World Allergy Or-gan J, 2018, vol. 11 (1), 38 p. DOI: 10.1186/s40413-018-0215-2. eCollection 2018
3. Braun T., Kahanov L. Community-Associated Methicillin-Resistant Staphylococcus Aureus Infection Rates and Management among Student-Athletes. Med Sci Sports Exerc, 2018, vol. 50 (9), pp. 1802–1809. DOI: 10.1249/MSS.0000000000001649
4. Dąbrowska A.K., Spano F., Derler S., Adlhart C., Spencer N.D., Rossi R.M. The Relationship Between Skin Function, Barrier Properties, and Body-Dependent Factors. Skin Res Technol, 2018, vol. 24 (2), pp. 165–174. DOI: 10.1111/srt.12424. Epub 2017 Oct 23
5. Engebretsen K.A., Johansen J.D., Kezic S., Linneberg A., Thyssen J.P. The Effect of Environmental Humidity and Temperature on Skin Barrier Function and Dermatitis. J Eur Acad Dermatol Venereol, 2016, vol. 30 (2), pp. 223–249. DOI: 10.1111/jdv.13301. Epub 2015 Oct 8
6. Grebenyuk L.A., Grebenyuk E.B. Express Diagnosis of Mechano-Biological Limb Skin Condition During Prolonged Dosed Stretching in Orthopedics. In book: Biomechanics and Biomaterials in Orthopedics (Editors: Poitout, Dominique G. (Ed.). – 2nd edition. Springer-Verlag-London, 2016, pp. 241–251. DOI: 10.1007/978-1-84882-664-9_21
7. Kalra A., Lowe A., Jumaily A.Al. An Overview of Factors Affecting the Skin's Young's Modulus. J Aging Sci, 2016, vol. 4 (2), 156 p. DOI: 10.4172/2329-8847.1000156
8. Kruglikov I.L., Scherer P.E. Skin Aging as a Mechanical Phenomenon: The Main Weak Links. Nutr Healthy Aging, 2018, vol. 4 (4), pp. 291–307. DOI: 10.3233/NHA-170037
9. Kruglikov I.L., Scherer P.E. General Theory of Skin Reinforcement. PLoS One, 2017, vol. 12 (8), e0182865. DOI: 10.1371/journal.pone.0182865. eCollection 2017.
10. Luebberding S., Kolbe L., Kerscher M. Influence of Sportive Activity on Skin Barrier Function: a Quantitative Evaluation of 60 Athletes. Int J Dermatol, 2013, vol. 52 (6), pp. 745–749. DOI: 10.1111/j.1365-4632. 2012.05852.x. Epub 2013 Mar 14.
11. Maiti R., Gerhardt L.C., Lee Z.S. et al. In Vivo Measurement of Skin Surface Strain and Sub-Surface Layer Deformation Induced by Natural Tissue Stretching. J Mech Behav Biomed Mater, 2016, vol. 62, pp. 556–569. DOI: 10.1016/j.jmbbm.2016.05.035. Epub 2016 Jun 5.
12. Many P.S. Preventing Community-Associated Methicillin-Resistant Staphylococcus Aureus Among Student Athletes. J Sch Nurs, 2008, vol. 24 (6), pp. 370–378. DOI: 10.1177/1059840508326448
13. Mueller M.J., Maluf K.S. Tissue Adaptation to Physical Stress: A Proposed “Physical Stress Theory” to Guide Physical Therapist Practice, Education, and Research. Physical Therapy, 2002, vol. 82, iss. 4, pp. 383–403. DOI: 10.1093/ptj/82.4.383
14. Pedersen L., Jemec G.B. Mechanical Properties and Barrier Function of Healthy Human Skin. Acta Derm Venereol, 2006, vol. 86(4), pp. 308–311. DOI: 10.2340/00015555-0080
15. Redziniak D.E., Diduch D.R., Turman K. et al. Methicillin-Resistant Staphylococcus Aureus (MRSA) in the Athlete. Int J Sports Med, 2009, vol. 30 (8), pp. 557–562. DOI: 10.1055/s-0029-1214382. Epub 2009 May 25.
16. Shah N., Cain G., Naji O., Goff J. Skin Infections in Athletes: Treating the Patient, Protecting the Team. J Fam Pract, 2013, vol. 62 (6), pp. 284–291.
17. Singh B., Maibach H. Climate and Skin Function: an Overview. Skin Res Technol, 2013, vol. 19 (3), pp. 207–212. DOI: 10.1111/srt.12043. Epub 2013 Mar 25.
18. Svoboda M., Bílková Z., Muthný T. Could Tight Junctions Regulate the Barrier Function of the Aged Skin? J DermatolSci, 2016, vol. 81(3), pp. 147–152. DOI: 10.1016/j.jdermsci.2015.11.009. Epub 2015 Nov 28.
19. Waller J.M., Maibach H.I. Age and Skin Structure and Function, a Quantitative Approach (I): Blood Flow, pH, Thickness, and Ultrasound Echogenicity. Skin Res Technol, 2005, vol. 11 (4), pp. 221–235. DOI: 10.1111/j.0909-725X.2005.00151.x
Опубликован
2019-07-15
Как цитировать
Гребенюк, Л., Грязных, А., Кучин, Р., & Корюкин, Д. (2019). ФИЗИОЛОГИЧЕСКИЕ АСПЕКТЫ КОЖНОГО ПОКРОВА ЧЕЛОВЕКА КАК ПРОЯВЛЕНИЕ АДАПТАЦИИ ПОД ВЛИЯНИЕМ РАЗЛИЧНЫХ ФАКТОРОВ. Человек. Спорт. Медицина, 19(2), 117-124. https://doi.org/10.14529/hsm190215
Выпуск
Раздел
Восстановительная и спортивная медицина
Copyright (c) 2019 Человек. Спорт. Медицина
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