[Neurological aspects of systemic lupus erythematosus in individuals with late ontogenetic debut.]

The review presents an analysis of publications on the features of the manifestation of systemic lupus erythematosus in the elderly. The article reflects the probable causes and mechanisms of the development of neurological manifestations of the disease. The clinical picture in elderly patients is described in detail, the features of immunological indicators are noted. This article discusses various variants of lesions of the nervous system in systemic lupus erythematosus, which differ in a wide range of clinical manifestations. Neuropsychic disorders of systemic lupus erythematosus are among the least studied aspects, and can be both a manifestation of the underlying disease, including those coinciding with the processes of immunosuppression, and undesirable phenomena against the background of ongoing treatment. At the same time, knowledge of the features of neurological manifestations in SLE with a debut in late ontogenesis in comparison with the data of laboratory and instrumental examination methods allows for early diagnosis and timely prescribing adequate therapy to elderly patients.

[Professor V.G.Korenchevsky - scientist, patriot, passionary.]

The article is devoted to the life and work of the Russian-British scientist, Professor of the Imperial Military Medical Academy in Saint-Peterburg and Head of the Oxford Gerontological Research Unit, Vladimir Georgievich Korenchevsky. Among the scientific achievements of V.G.Korenchevsky are the theory of endocrine aging and the concept of geroprotective hormone replacement therapy. V.G.Korenchevsky was the inspirator and organizer of congresses and societies of Russian academic organizations abroad, as well as the inspirator and organizer of the British Society for Research on Ageing and the International Association of Gerontology and Geriatrics.

[Ontogenetic forms of rheumatoid arthritis and behavioral type A.]

Disease onset and type A behavioral pattern (TABP) are important characteristics of the clinical manifestations of chronic diseases. The aim of this work is to study the prevalence and role of TABP in patients with rheumatoid arthritis (RA) with the onset of the disease at different periods of ontogenesis. 82 patients were examined, which were divided into groups depending on the age of RA onset. The first group included patients with RA onset at reproductive age (from 18 to 44 years). The second group included patients with the onset of RA in the middle age (from 45 to 59 years). The third group consisted of patients with the onset of RA in old age (from 60 to 74 years). The fourth group consisted of patients with the onset of RA in old age (75 years and older). Diagnosis of TABP was carried out using a special questionnaire. The group with a debut in the reproductive period had the largest number of patients with RA of the 1st and 2nd line of relationship, as well as the highest incidence of TABP, which was associated with a greater expression of such personal qualities as ambition and hostility. This group had the highest number of ankylosis, as well as the highest frequency of systemic lesions. The second group demonstrated classic rheumatoid patterns. The third group with debut in old age had the most favorable clinical picture, incl. the lowest immunological activity in terms of the сirculating immune complexes (CICs) level, associated with the lowest severity of articular syndrome, with the lowest number of erosions and the frequency of systemic manifestations. The fourth group with a debut in old age demonstrated the highest inflammatory activity and specific immunological activity in terms of rheumatoid factor and CICs levels, as well as the highest clinical severity of the articular syndrome. Thus, the ontogenetic debut of RA determines its clinical and laboratory features and is associated with the presence and characteristics of TABP.

[Features of the ontogenetic forms of rheumatoid arthritis associated with autoimmune thyroiditis.]

Ontogenetic debut of diseases can determine clinico-pathogenetic differences in disease variants. The aim of the study was to determine the clinical and laboratory features of the variants of rheumatoid arthritis (RA) associated with autoimmune thyroiditis (AIT) in patients with various ontogenetic debut of the disease. A total of 53 patients with a combination of RA and AIT (mean age 63,92±1,6 years, 92% of patients - women, duration of rheumatoid arthritis - 10,0±1,11 years, disease activity on the DAS28 scale - 5,67±0,14 points). Patients with the debut of joint syndrome in the reproductive period had the highest antibody titer to the cyclic citrullinated peptide (ACCP) and close correlation between the titer of rheumatoid factor (RF) and tobacco smoking experience. Patients with debut joint syndrome in the menopausal period were characterized by geroprotective status, having the largest number of centenarians in the family and a significant negative correlation between the titre of ACCP and this significative, and also the greatest vulnerability to the action of other trigger factors of arthritis, which was confirmed by a close correlation of specific rheumatoid immunological parameters with smoking experience and the presence of an infectious disease in the period preceding the articulate debut of the RA, and also least rate of glomerular filtration. Patients with the debut of the joint syndrome in the early involutionary period were characterized by the presence of a gerontological immunological phenotype, which was manifested by the highest level of RF in the serum, as well as by the faster course of the disease from the joint debut to the unfolded clinical picture. CONCLUSIONS: The ontogenetic analysis of the features of RA associated with AIT showed the presence of ontogenetic clinico-pathogenetic forms of the disease, which may further have implications for clinical practice.

[Ontogenetic characteristics of patients with erectile dysfunction with different types of aging.]

Age-related erectile dysfunction (ED) can be formed during ontogenesis in accordance with various mechanisms of the pathogenesis of aging in conjunction with a particular cluster of diseases. The aim of the work is to study ontogenetic features of ED patients in late ontogeny of various types of aging. 65 men over 45 with an explicit form of ED were examined. The first group consisted of patients with general-somatic diseases (GSD) arising mainly from the accumulation model of aging, and the second group included patients with age-associated diseases (AAD), arising primarily from the ontogenetic model of aging. Both variants of age-related ED are closely related to ontogenetic events, especially with the debut of obesity and the loss of morning erections, preceding the ED debut, on average over a decade of life. ED, combined with AAD, is most clinically and pathogenetically compromised. Thus, it is characterized by: earlier age of debut ED, dismetabolic pattern, low geroprotective pattern, poor quality of primary health, pronounced instability of gonadostat, weak sexual constitution, decreased sensitivity of hypothalamic-pituitary complex to feedback signals, the large proliferative pattern. ED associated with GSD had a later age of debut ED, developed much later from the debut of obesity, had a lower level of testicular volume with a more conserved incretory function, but a higher index of IPSS. Thus, the separation of two ED variants associated with different types of aging in conjunction with the use of ontogenetic analysis, allowed to identify significant differences in such clinical and pathogenetic forms, which is important for the development of ideas about the diagnosis and treatment of age-related ED.

[Clinical rhetoric in the high school].

Clinical rhetoric is a science concerned with consistent patterns of speech behavior in different situations of interaction with colleagues, patients, and specialists in various disciplines with a view to extending their practical applications for the enhancement of efficiency of meaningful contacts. The history of this science as a means of rational communication with patients and medical profession dates back to the times of Hippocrates. Its importance greatly increased under the present-day conditions of high-technology and therapeutically aggressive medicine. Clinical rhetoric is based on the principles of general rhetoric. A clinician must be prepared for he fruitful and constructive relations with a variety of partners including patients, healthy subjects, administrators, lawyers, businessmen, and colleagues. Four main peculiarities of clinical rhetoric are distinguished: any debate is possible only in the form of discussion, both the form and content of the opponent's arguments should be treated with respect, the speaker must himself draw attention to the weak points of his theses, all discussions must have the form of a "captain council" in which the shipboy is the first and the captain the last to speak. Traditional forms of clinical discussion include counselling, doctor's rounds, consilia, and demonstrations. Collective forms of stimulating creative thinking, such as brainstorming and foresight have especially good prospects. These approaches appear to be of special value for the solution of heuristic problems. Teaching clinical rhetoric should be initiated since term IV when students begin to understand the role of a doctor as a key figure in the organization of the diagnostic and therapeutic process. Further development of Hippocrates' traditions of collective communication may significantly promote the intellectual return from clinical and scientific discussions in medicine.

[The personality of the doctor as a corner stone in the temple of gerontology].

The fundamentals of gerontology are not fundamental science and not dialectical materialism, but, in our opinion, particularly respect for elders. The very same attitude toward the elderly in the society has changed to the best party not so long ago, when the material ability had appeared to adequately support the elderly and implement the monotheistic values, such as the value to God of every life. Thanks to the presence in St. Petersburg at 1889 year well-organized places for medical care of oldster professor S. P. Botkin was able to implement the world's first large-scale complex research of old age, surveyed more than two thousand old people. Today's liberal model of providing education without upbringing is fraught with the most terrible consequences. We must not forget a number of artifacts in medicine, when the doctor in different civilizations ignored the Hippocratic Oath. These are Josef Mengele and Karl Brandt, the physicians of "Unit 731", Leiba Shatunovskii, the doctors of the clinic "Medicus", and many others. These facts force to carefully scrutinize the current time. So in the British newspapers the information appear about the dead from hunger and thirst old people in expensive nursing homes. It seems necessary to go back to the moral roots of medicine. The pride of the Russian medicine is a life-physician Eugene S. Botkin, who ascended to Calvary with his crowned patient, Emperor Nicholas II, because he could not change his word of honor. Thus, in the Russian tradition, glorious Hippocratic writings oath strengthened by noble honor. Knight code of the Russian nobleman, described us as "4D" (in Russian): duty, virtue, goodness and leisure, is the best formula for education and self-improvement noble doctor. Thus, it is proposed to pay attention to the unity of education and upbringing in preparing the next generation of doctors, which should strengthen the guarantees of the preservation of high moral relations to the old people and gains of fundamental gerontology.

[Quality of life and hypoglycemia burden in patients with type 2 diabetes mellitus on basal-bolus insulin therapy].

This paper presents the results of the observational program "Parameters of life quality, symptoms of hypoglycemia and treatment satisfaction in patients with type 2 diabetes mellitus on basal-bolus insulin therapy" (2012-2014). The analysis included 1000 patients. It showed that their quality of life was below that of the general population due to compromised physical, role physical, and role emotional functioning (p < 0.001). Hypoglycemia is a serious challenge to the treatment of patients with type 2 diabetes mellitus on basal-bolus insulin therapy. They are characterized by impaired physical, psychological, and social functioning compared with the patients without hypoglycemic episodes (p < 0.01). Patients experiencing mild hypoglycemic episodes were not significantly different from those without them. In patients experiencing severe hypoglycemic episodes the quality of life was much worse (ES = 0.22-0.51). The profile of hypoglycemic episodes differed in different forms of hypoglycemia. The spectrum of symptoms and problems related to hypoglycemia was broader in patients with severe and/or nocturnal hypoglycemia. Patients free from hypoglycemia were less afraid of it than those used to have hypoglycemic episodes (p < 0.001). The stronger the fear, the more pronounced disturbances in social functioning, vitality, psychic and general health (p = 0.0001). It is concluded that evaluation of quality of life and hypoglycemia-related symptoms in patients with type 2 diabetes mellitus on basal-bolus insulin therapy allows for comprehensive estimation of the effectiveness of therapy on an individual basis.

[Quality of life and problems posed by hypoglycemia in type 2 diabetes mellitus during oral hypoglycemic therapy].

Quality of life characteristics, hypoglycemic episodes and patients' attitude toward them were estimated in the patients with type 2 diabetes mellitus based on the modern recommendations for the patient-oriented treatment with metformin in combination with sulfonylurea derivatives (M+S) therapy, traditional approach, n = 83) and metformin in combination with vildagliptin (M+V therapy, innovative approach, n = 111). M+V therapy ensured a higher quality of life than M+S therapy based on all SF-36 scales. Quality of life parameters corresponded to population norms in most patients given M+V therapy and only in 52% of those treated with M+S. The frequency of hypoglycemic episodes, related concerns, and other problems associated with this condition were less apparent in case of M+V therapy. Transition from M+S to M+V therapy resulted in the improvement of quality of life and reduction in the frequency of hypoglycemia. Quality of life did not change after transition to M+S therapy while the frequency of hypoglycemia and the number of related problems increased. HbA1c levels were similar in both groups (0.8% difference). According to patients' reports M+V therapy is more efficient than M+S; these data allow to comprehensively evaluate the efficacy of therapy and monitor the health state of diabetic patients in the course of treatment.

[Gerontology crisis: to a question about primary health in the XXth century].

Last decades the phenomenon of ageing population at the expense of reduction of birth rate and continuous growth of life expectancy is observed and moreover the life expectancy increase has almost linear character. In our opinion, this growth will stop the next years and there will be a considerable reduction of life expectancy. Roughly it should occur after 2010 year when the persons born in second half of the XXth century, i.e. after 1950 year, will start to enter advanced age. The reason of this drama consist in our opinion in catastrophic deterioration of primary health at persons born in second half of XXth century owing to action of "stop-evolution" factors and inhabitancy crisis. "Primary health" as definition in this text means combination of congenital predisposition to diseases (pathogenicity) with congenital possibility to autorecovery (sanogenicity). So the quality of primary health depends on features of the person genome and features of the person antenatal period of life including the delivery. Among factors of "stop-evolution" breaking natural selection consequently of sharp decrease in number of birth and fertility in population and as consequence worsening quality of congenital sanogenicity we consider first of all social factors. Among factors operating due to crisis of an inhabitancy and as consequence increase of congenital pathogenicity we consider anthropogenic factors (success of medicine, changes of food, technogenic factors). The analysis of own data of diabetic patients born during various periods of the XXth century (before 1908, in 1909-1923, 1924-1938, 1939-1953 yrs) has demonstrated the essential reduction of number of long-livers in a family (30,7; 35,0; 25,4; 27,8% accordingly), and on the other hand the sharp increase in frequency of cases of a family diabetes during the century (20,0; 5,9; 36,8; 64,7% accordingly). Thus, the action of some factors described by us has been already shown in first half of XXth century. To overcome the given "gerontology crisis" apparently, the interdisciplinary approach including joint researches with the subsequent development of recommendations, with participation not only gerontologists/geriatrists, but also pediatrists, andrologists/gynecologists, endocrinologists, genetics, ecologists and sociologists is necessary.

[S. P. Botkin--the founder of the domestic clinical gerontology].

The first in the world large-scale gerontology investigation where 2620 elderly patients were examined was carried out by guidance professor S. P. Botkin in St.-Petersburg. The results were published in 1890 in the special book and consisted of 93 papers, including 102 tables.

[Diabetes mellitus in elderly: comorbid characteristics of patients with different ontogenetic forms of the disease].

Diabetes in elderly is the interdisciplinary problem of diabetology and gerontology. Unlike adults the specific feature of these patients is comorbidities. On the other hand well known is the influence both age and aging on clinical sings of diabetes. The aim of the study was to investigate prevalence and structure comorbid chronic diseases in elderly patients with different ontogenetic forms of diabetes mellitus type 2 (DM2). We examined 169 elderly women with clinical diagnosis "DM2" (mean age--69.8 yrs., mean BMI--29.5 kg/m2, mean HbA1c--7.03%). The stratification was made by ontogenetic stage of diabetes onset and there were five ontogenetic forms of DM2: menstrual (Ms), early-postmenopausal (EPM), late-postmenopausal (LPM), early-involutional (EI) and late-involutional (LI). Anthropometrical, biochemical and immunochemical assays (HbA1c) were made by standard methods. Gognitive index (CGI) and affective index (AFI) were calculated by SCAG scale as mentalmnestic and affective disturbances accordingly. Comorbid index (CI) was calculated as a sum of concomitant diseases. The most comorbid serious was the early-postmenopausal group (CI--6.04 +/- 0.5), mainly by hypertension (92%) coronary heart disease (80%) and osteoarthritis (80%). The lightest comorbid status was in the late-involutional group (CI--4.5 +/- 0.3), with the minimum of gastroenterological diseases (39.5%), kidney diseases (26.3%), thyroid disorders (23.7%) and exclusively the group had valid negative relationship between age and CI (r = -0.550, p = 0.000). As a whole in the elderly diabetic cohort the magnitude of CI correlated positively with BMI (r = +0.344, p = 0.000), frequency of family diabetes (r = +0.204, p = 0.009), AFI (r = +0.161, p = 0.040), menarche (r = +0.175, p = 0.025) and no significantly with CGI (p > 0.05). Thus early ontogenetic forms of DM2 had more comorbidities, especially those with onset DM2 during first 5 years after menopause. And on the contrary, the latest ontogenetic forms with onset DM2 during 20 years after menopause had minimum concomitant diseases. Also early ontogenetic phase (EPM and El) groups had higher magnitudes of CI, frequency of family diabetes and low frequency of familial longevity than late ontogenetic phase (LPM and LI) groups, which allow us to consider early ontogenetic phase DM2 as a phenomena of accelerated aging.

[Diabetes mellitus in elderly: geroprotective and antidiabetic properties of delta-sleep induced peptide]. / Sakharnyi diabet u pozhilykh: geroprotektivnye i protivodiabeticheskie svoistva preparata del'ta-son indutsiruiushchego peptida.

UNLABELLED: Delta-sleep induced peptide (DSIP) has a wide range of positive regulator properties. It is known as antioxidant, immunomodulator, antistressor and other, that important as for diabetes, and for aging mechanisms. Aim of the study was to investigate effects of treatment by DSIP-containing drug "Deltaran" in elderly diabetic patients. MATERIALS AND METHODS: As the pilot study we examined 11 elderly diabetic patients (mean age 66.3 yr, BMI--28.5 kg/m2, duration of diabetes 12.5 yr). All patients receive 20 doses of DSIP-containing drug "Deltaran" daily. Tests was before and after 60 days after beginning treatment. Blood samples took before and after 60 minutes after standard carbohydrates breakfast. RESULTS: After treatment were observed improvement of the parameters of quality of life on SCAG scale as the impairment of recent memory (p=0.003), mood depression (p=0.019), emotional lability (p=0.002) and anxiety (p=0.000). Also were observed improvement of quality of sleep and felling between meals in treating patients (p=0.010). Another positive tendencies consist of decrease of BP (ns), increase of ABI (ns), increase of pallestesia (p=0.017), decrease of MAU frequency (p=0.011) and decrease of glycaemia levels after load (p=0.033). And also after treatment were observed decrease of basal and reactive levels in blood of growth hormone (p=0.034 and p=0.005 accord.), insulin (ns), cortisol (ns) and on the contrary increase of dehydroepiandrosterone sulfate levels (ns). Main positive change observed in patients received only diabetic diet, where was a decrease of insulin resistance and in patients with latent autoimmune diabetes (type LADA), where was a increase insulin secretion and decrease of daily dose of insulin requiring. CONCLUSIONS: The pilot trial indicate beneficial antidiabetic and geroprotective effects of DSIP-contaning drug "Deltaran" in elderly diabetic patients.

[Diabetes mellitus in the elderly: succinic acid compounds in treating diabetic neuropathies]. / Sakharnyi diabet u pozhilykh: soedineniia iantarnoi kisloty v lechenii diabeticheskoi neiropatii.

To investigate the influence of the succinic acid treatment on geriatric patients with type 2 diabetes. Succinic Acid has some positive biological properties. One of its is a neglecting of an aerobic glycolysis. In this study we evaluated the efficacy of the combination of the succinic acid ("MITOMIN") on treating of diabetic neuropathy of geriatric patients with type 2 diabetes. The analysis was carried out using 26 patients (aged 60-76 years). The duration of diabetes was 9.15 +/- 1.43 years. Biomedical parameters were measured by standard methods; microalbuminuria was measured by "Micral-Test". Quality of life (psychosocial disorders) was estimated with the help of "SANDOZ"-scale for geriatric assessment. The therapy was assigned 1.5 g of mitomin per day during a month. All patients were examined on having late diabetic complications: 7.69%--had diabetic retinopathy; 11.54%--diabetic nephropathy; 73.08%--diabetic neuropathy; 46.15%--chronic failure of brain vessels; 11.5%--macroangiopathy of lower extremities and 100%--had ischeamic heart disease of different levels. Mitomin therapy improved basal and postprandial glycemic control (NS), variance of pallesthesia (p < 0.001), parameters of quality of life, i.e. depression (p < 0.001), anxiety (p < 0.01), short memory (p < 0.05) and emotionality (p < 0.001). Mitomin therapy plays a positive role in management of elderly patients with type 2 diabetes. It improves glycemic control, pallestesia and quality of life. Combination of succinic acid renders central and peripheral neuropathy protective efficacy.

[Adrenal steroids in patients with breast cancer and in women with age-related impaired glucose tolerance]. / Nadpochechnikovye steroidy u bol'nykh rakom molochnoi zhelezy i u zhenshchin s vozrastnymi narusheniiami tolerantnosti k gliukoze.

Age-associated decline in dehydroepiandrosterone concentration is often considered a carcinogenesis promoter. Inverse correlation have been found between insulin (r = -0,887: p < 0,05). age (r = -0,464; p < 0,01), cortisol (r = -0,667; p < 0,01) and dehydroepiandrosterone levels in the blood of healthy females with normal glucose tolerance. Said correlations were less pronounced in female controls with impaired glucose tolerance and were totally absent in cases of primary breast cancer.