[Targeted use of comprehensive geriatric assessment tools in cardiology. Part II (literature review).]

This review presents a targeted examination of the application of comprehensive geriatric assessment tools across various cardiovascular pathologies, including acute coronary syndrome, myocardial infarction, acute and chronic heart failure, and aortic stenosis. It has been demonstrated that assessing patient frailty in cardiovascular pathology is crucial for determining both short-term and long-term prognosis, as well as for evaluating the risk of various complications during cardiac surgical interventions. Currently, there is active research into necessary measures aimed at improving outcomes in frail elderly patients with cardiovascular diseases, such as interdisciplinary rehabilitation and geriatric approaches. Frail patients with cardiovascular diseases should be considered as requiring a personalized approach in the provision of cardiological care, with a deep understanding of geriatric issues in the elderly, to reduce complications and improve prognosis.

[Prospects of qualitative and quantitative assessment of bowel perfusion by fluorescent angiography with indocyanine green in colorectal surgery. First experience]. / Perspektivy kachestvennoi i kolichestvennoi otsenki perfuzii kishki metodom flyuorestsentnoi angiografii s indotsianinom zelenym v kolorektal'noi khirurgii. Pervyi opyt.

OBJECTIVE: To assess the possibilities of fluorescent detection system in qualitative and quantitative assessment of bowel perfusion in colorectal resections. MATERIAL AND METHODS: From May to August 2023, a single-center pilot cross-sectional unblinded study with inclusion of 18 patients with colon cancer (of left-sided - 12, of right-sided - 6, mean age - 72.9 years, m/w - 61/39%) was conducted. All patients underwent laparoscopic colorectal resections with extracorporeal stage of bowel transection. The evaluation of the bowel's ICG perfusion was conducted to assist in decision making about the level of its resection. Qualitative (visual) assessment was carried out in all 18 patients, in one patient twice, quantitative assessment of perfusion was conducted in 8 patients (left-sided resections - 6, right-sided hemicolectomy - 2). The qualitative evaluation was performed in real time on the analysis of the color gradient. The time parameters and fluorescence intensity at different level proximally and distally from the resection line were quantitatively estimated: Tstart - time of occurrence of minimal fluorescence in the areas of interest after the ICG injection (sec); Tmax - time to achieve maximum fluorescence intensity after the ICG injection (sec); Tmax-start - time interval between Tstart and Tmax, Imax - level of maximum fluorescence intensity (I). RESULTS: Visual qualitative analysis of fluorescence revealed unsatisfactory perfusion characteristics (black, dark-gray color) in the area planned by the surgeon to anastomose the bowel in 3 of 18 patients (16.6%). When analyzing the quantitative data of this group of patients, there was a 2-6-fold decrease in Imax level, and one patient had an increase in Tmax-start at the level of intended resection compared to the bowel's sections in the favorable zone. In all cases, the final bowel transection was conducted in the area of good perfusion. There was no clinical evidence of anastomotic dehiscence in the study group. CONCLUSION: Intraoperative evaluation of bowel perfusion is an important component of safe anastomosis formation in colorectal surgery. The use of ICG-FA allows to conduct qualitative and quantitative assessment of tissue perfusion of the bowel in order to assist in making intraoperative decisions. Quantitative evaluation of fluorescence provides more objective information about perfusion parameters. Imax and Tmax-start are the most promising quantitative indicators of local bowel's perfusion. Nevertheless, the precise interpretation of the quantitative indicators of ICG perfusion needs to be clarified.

[The elaboration of approaches to medical rehabilitation of participants in warfare].

The article considers social hygienic characteristics of participants in warfare underwent treatment and rehabilitation in specialized medical organization. It is established that patients of neurological profile and with diseases of cardiovascular system predominated in the studied contingent. The high need for medical rehabilitation was determined according results of examination of participants in warfare by multidisciplinary rehabilitation team. The necessity of observance staging and continuity in carrying out rehabilitation measures at all levels is emphasized.

Analysis of mutations spectrum in the ATP7B gene in patients with Wilson disease using massively parallel sequencing.

The study aimed to search for mutations in the ATP7B gene using massively parallel sequencing in patients with Wilson disease in the Tomsk region. For 42 patients with suspected Wilson's disease (aged from 1 to 33 years) was performed molecular genetic analysis. Enrichment of the interest genome regions was carried out by the long-range PCR. DNA libraries with ligated adapters were constructed with Nextera DNA Flex (Illumina, USA) kit. Sequencing was performed on the Illumina MiSeq platform (Illumina, USA). As a result of this work, we identified 9 pathogenic genetic variants. All variants were previously described in the literature and were found in patients with Wilson's disease. Five missense mutations, one splice site mutation, and 3 frameshift mutations were identified. In patients with Wilson's disease in the Tomsk region, the most common variant was c.3207C>A, this variant is the most common both in the Russian Federation and in other European populations. Also, a pathogenic variant c.3036dupC was found, which is probably endemic to the Russian Federation.

[Analysis of disability among the elderly and senile on the example of the Rostov region.]

The article analyzes the dynamics of the main indicators of disability among people older than working age in the Rostov region. The trend decline in surveys of persons in this age group, including reducing the number of first and repeatedly recognized as disabled, on the background of growth in the region's population share of persons above working age. At the same time, there was an increase in accumulated disability.

[The particular medical social problems of individuals of elderly and senile age as exemplified by the Rostov Oblast].

The article analyzes dynamics of main indices of disability in population older than able-bodied age in the Rostov Oblast. The trend of decreasing of scope of examinations of individuals of the mentioned age group, including decreasing the number of first and iteratively recognized as the disabled, against the background of increasing in the population structure of percentage of individuals older than able-bodied age. At the same time, increasing of accumulated disability was established in the studied category of population.

[Some aspects of improving the medical and social rehabilitation of the elderly who permanently live in general-type boarding schools.]

The article reflects the age and gender structure of the contingent of elderly people living in a General boarding house. The most common diseases in this category of persons, the presence of a disability group and individual programs for rehabilitation (habilitation) of the disabled person were established. The need for medical care, including medicines, was studied. There is a need to improve measures for medical and social rehabilitation, including in improving the employment of this contingent of people and the development of their leisure time. Examples of positive experience in this area among other regions of the Russian Federation are given.

[Patient age and CYP2D6*4/CYP2D6*3 genotype on maximal heart rate in patients after acute coronary syndrome treated with bisoprolol.]

We have analyzed influence of genetic variants CYP2D6*3 (2549delA) and CYP2D6*4 (1846G>A), as well as other factors on effects of bisoprolol in patients with acute coronary syndrome. The study included 97 patients with acute coronary syndrome. Mean age was 63±10 years; 60 men and 37 women. We have found association between carriage of CYP2D6*4 (1846G>A) and maximal heart rate at exertion (R-0,21; р<0,05). When the correction for potential confounders was made, age was the only significant predictor of maximal heart rate (ß=0,6; SE=0,07; p<0,001). At the same time it was found that CYP2D6*4 was associated with more advanced age of the patients (r=0,2; p<0,05).

[The problematic issues of personnel to ensure the delivery of geriatric care.]

The article reflects the problems of personnel provision of geriatric care. this reflects a serious concern about the staffing of the geriatric service. The need to improve the system of training geriatric doctors, including the need to popularize this specialty among medical personnel and the population, is pointed out.

[Problems of diagnostics and treatment of transtiretinum amyloidosis with destruction of the heart in the elderly: Clinical experience.]

The article presents a modern understanding of the treatment of cardiac amyloidosis, provides data on the frequency of occurrence, classification and variants of clinical manifestations of transthyretin amyloidosis. This pathology is a slowly progressive disease, the symptoms of which usually appear in the elderly and senile age. This diagnosis may become more common in the future as the population ages and diagnostic methods improve. As an illustration, a description of the clinical case of transtritin amyloidosis of the heart in a 77-year-old patient, which occurred with a primary lesion of the heart and symptoms of chronic heart failure, is given. It shows the difficulties in the lifetime diagnosis of transthyretin amyloidosis.

TUMOR MICROENVIRONMENT REGULATION BY HYPOXIA-INDICIBLE FACTORS (HIFs), AND p53 FAMILY PROTEINS.

Except affecting cancer cells, hypoxia and HIF-dependant signaling lead to changes in tumor microenvironment, which plays an important role in cancer progression. Tumor microenvironment modification can influence the immune response, tumor growth and metastases. On the other hand it is well known that more than half cases of all cancers are characterized by mutation in the gene encoding tumor suppressor p53. Inactivation of p53 is necessary for cancer progression on the late stages. Therefore an existence of reciprocal regulation between HIF proteins family and p53 proteins family may be an important factor determining course of disease. In this review we attempt to make a general picture of changes that take place in different components of tumor microenvironment in response to hypoxia and HIFs and impact of the p53 family genes on these processes.

Interaction of Serum Antibodies from Breast Cancer Patients with Synthetic Peptides.

The blood serum of tumor patients contains antibodies recognizing tumor-associated antigens and other molecular products of tumor growth. We studied the interaction of blood antibodies from breast cancer patients with synthetic peptides that were applied on the microchip surface. The serum from healthy volunteers and breast cancer patients was shown to contain antibodies that interact with various peptides. Statistically significant between-group differences were observed in the level of binding with 122 informative peptides (0.01% of the total number of peptides on a microchip). Analysis of antibodies that interact with the peptide panel holds much promise for the diagnostics of breast cancer.

Discovery of Novel Isatin-Based p53 Inducers.

A series of isatin Schiff base derivatives were identified during in silico screening of the small molecule library for novel activators of p53. The compounds selected based on molecular docking results were further validated by a high-content screening assay using U2OS human osteosarcoma cells with an integrated EGFP-expressing p53-dependent reporter. The hit compounds activated and stabilized p53, as shown by Western blotting, at higher rates than the well-known positive control Nutlin-3. Thus, the p53-activating compounds identified by this approach represent useful molecular probes for various cancer studies.

Improving the performance of small amputations in complicated forms of diabetic foot.

The aim of the study was comparative assessment of the effectiveness of typical and atypical amputations at the level of footstep in patients with the most complicated course of the diabetic foot syndrome (DFS). The patients suffering from diabetes mellitus type 2 and purulo-necrotic complications of the DFS, treated in the surgical department of the № 1 Pirogov National Surgical and Medical Center of the Sankt Petersburg Clinical Complex were investigated. The study group included 68 patients who underwent atypical surgical interventions taking into account blood flow angiosomes of footstep tissues. Operative interventions at the level of footstep were carried out to 47 patients of the control group. Obligatory angiography was performed in all patients. Operative intervention was carried out under emergency conditions before conduction of angiography only to those patients who were admitted with acute purulent processes in the area of lower extremities. In all other cases individual peculiarities of blood circulation disorder in lower extremities determined the choice of tactics of operative treatment. In 76% and 46% correspondingly, for each group after angiography balloon angioplasty was carried out for reconstruction of the main blood flow. The average duration of the in-patient treatment in study group was 14,4±2,3. In the control group - 18,2±3,1. Conduction of post-operative angiography and when necessary angioplasty in the footstep tissues is prescribed before operative intervention to patients with purulo-necrotic complications of DFS. Application of the principle of angiosome blood flow based on the data of duplex sonography of arteries and angiography enables to choose the most rational tactics of the operative treatment. 3. Application of atypical technique of amputations in the area of footstep after postoperative complications enables to reduce the length of inpatient treatment and to improve postoperative mobility and ability for independent movement of patients.

Adhesion, growth, and proliferation of endothelial cells on biopolymer extracellular film matrices.

We analyzed the influence of initial properties of biopolymer fi lm extracellular matrices made of chitosan on adhesion of swine embryonic kidney epithelium-like cells, their morphology, growth, and proliferation. It was found that adhesion index of cells on the studied matrices was similar, but cell morphology had significant qualitative differences. Round non-flattened cells were described in endothelial cell cultures on chitosan-based matrices. Local variations in charge density on matrices induced by the presence of chitin nanofibers led to the appearance of flattened spindle-shaped and non-flattened sphericalal cells. Long-term culturing on biopolymer extracellular fi lm matrices was associated by the formation of spatial conglomerates of sphericalal cells.

[The polymorphism of genes of synthesis and metabolism of estrogens and the risk of breast cancer].

The genetic polymorphism of enzymes of synthesis and metabolism of estrogens can input into predisposition to breast cancer. The purpose of actual study was to analyze the associations of polymorphic loci CYP17/B1rs10556836, CYP1A 1rs1048943, CYP1A2rs762551, CYP19A1rs2470152 and CYP17A1rs743572 with risk of development of breast cancer in Russian residents of the Western-Siberian region of Russia. The rates of alleles and genotypes of the given loci were determined in sampling of women suffering with breast cancer (n = 670 females) and in control group (480 females without oncological diseases). The sub-groups of patients with breast cancer in pre-menopause--and post-menopause were analyzed separately. The border-line association of locus CYP17A1rs743572 is demonstrated with increasing of risk of breast cancer during pre-menopause (allele C: p = 0.04). Among the rest of polymorphic loci no association was detected.

Associations between SNPs within antioxidant genes and the risk of prostate cancer in the Siberian region of Russia.

In the present study we investigated the association of a number of polymorphic changes in antioxidant system genes (SNPs rs1050450 in the GPX1 gene, rs1695 and rs1138272 in the GSTP1 gene and rs4880 in the MnSOD gene) with the risk of prostate cancer. The association of disease stage and PSA levels with specific genotypes was also analyzed. A study was conducted with the participation of 736 Russian men. We compared the frequency of occurrence of the studied alleles in patients with prostate cancer (392) to a control group (344) of men without a history of cancer. Genotyping was performed by real-time PCR. Comparison of frequencies of alleles and genotypes were performed using logistic regression analysis. No statistically significant association with the risk of prostate cancer was found for any of the SNPs studied (p > 0.05). For SNP rs1695 in the GSTP1 gene, a correlation with cancer disease stage was observed: a GG genotype is significantly more common in patients with PCa in the 3rd and 4th stage than 1st and 2nd (OR[95%CI] = 2.66[1.15-6.18], p = 0.02). Both studied SNPs of GSTP1 gene are associated with the level of PSA: the GG rs1695 and the TT rs1138272 genotypes are associated with higher PSA levels (p = 1.5*10(-3)).

Delta deletion 4977 in mitochondrial DNA in patients with idiopathic Parkinson's disease.

AIM: To determine the presence of delta deletion 4977 in mitochondrial DNA in patients with Idiopathic Parkinson's disease (IPD). MATERIAL AND METHODS: This has been a prospective, clinically genetic study, lasting for whole two years. The clinical part of this study was made at the University Clinic of Neurology in Skopje, Unit for extrapyramidal diseases. The laboratory-genetic part of the study was elaborated at the Laboratory for molecular biology at the Institute for Biology, Faculty of Sciences, University "Sts. Cyril and Methodius". This study comprised a total of 32 subjects with a clinically verified diagnosis for idiopathic Parkinson's disease; 18 men and 14 women (with mean age of 52.7 years). Control group consisted of 31 randomly selected, literally healthy persons, at similar age, with similar gender distribution, and no clinical and anamnestic data for parkinsonism or similar clinical entities. RESULTS: Objective neurologic results of all 32 investigated subjects (100%) showed presence of rigor, tremor and bradykinesia.The difference tested between the investigated and control group, concerning the present or absent deletion and heteroplasmia, has been highly statistically significant (p=0.001). CONCLUSION: It could be concluded with a great statistical significance that deletion 4977 in mitochondrial genome has been registered more frequently in the group of patients with IPD (Tab. 10, Fig. 6, Ref. 36).

[Cytoprotectors and their application in sports medicine].

The article presents data of literature review on potential use of cytoprotectors in sports medicine (exemplified by Mildronat medication). This group of medications improve metabolism and energy supply in tissues. One of leading indications to Mildronat use is state of low mental and physical performance, including that of athletes.

[Method of individual evaluation of athletes' tolerance of maximal physical exertion under exposure to changed hypoxic and hypothermal environment].

The article covers a program determining order and method of gradual examination of highly qualified athletes engaged into winter sports in Sports Medicine and Rehabilitation Center in Bournazian FMBC of the FMBA of Russia, to assess physical performance and individual tolerance in changed climate (hypoxic and hypothermal) conditions.