[The impact of psychological resilience, as a component of intrinsic capacity, on the risk of developing atrial fibrillation.]

The authors conducted a cross-sectional epidemiological study of a random sample of community-based older adults aged 65 years and older (n=611) to assess the impact of psychological resilience on the risk of developing atrial fibrillation (AF). To assess the degree of psychological resilience, the Sense of Coherence Scale (SOC) with 47 and more points was used. The prevalence of AF was 30,1% (n=184). Participants who scored 47 or more on the SOC, after adjusting for all confounders, had a 42,9% lower risk of AF. Thus, psychological resilience is one of the protective factors that reduce the risk of AF in older adults. The use of SOC with a cut-off point of less than 47 allow to identify older adults at risk of AF.

[The effect of the non-financial stimulation system on psychological health of higher school workers].

The purpose of the study is to analyze effect of system of non-material incentives on psychological well-being of teachers in pandemic conditions. The research method of questionnaire survey of employees sampling (N = 193) was applied. The information obtained was completed by results of focus group study that made it possible to identify psychologically vulnerable groups of teachers. The results demonstrated that only every fifth teacher is completely satisfied with system of non-material incentives. The survey established that traditional forms of non-material incentives (birthday greetings, challenge prize for best structural unit) are losing their significance in pandemic conditions. The high workload, organizational changes in educational institutions reduce relevance of such measures of non-material incentives as inclusion in administrative personnel reserve for teachers. It is established that significant influence of shortcomings of motivational profile provoke occurrence of such violations as violation of team value unity; persistent prevalence of negative emotions; alienation, hiding lack of confidence in their abilities; deformation of systemic nature of mutual assistance; increase of anxiety and proneness to conflict in university teachers. For teachers, job stability turns out to be more important than career prospects. The top lines of rating in assessing system of non-material incentives are occupied by extension of term of employment contract, and participation in innovative projects. The recognition of colleagues and inclusion into creative teams is considered as one of the most effective measures to ensure psychological well-being of teacher.

[A prospective single-cohort study of an immediate prefabricated three-implant-supported full-arch prosthesis for treatment edentulous mandible in elderly patients: 3-year report.]

The use of implant prosthetics in the elderly and senile patients is highly relevant. Many clinicians advocate a wider introduction of immediate implant restorations in the elderly due to the fastest restoration of aesthetics and function. The purpose of the work is to study the efficacy of implant prosthetics in elderly patients with extended replacement structures with a small number of artificial supports. The patients underwent implant restoration of the mandible with an extended metal-polymer structure «Trefoil¼ with a prefabricated standard frame and three artificial supports. The overall implant survival rate was 96%. The cumulative survival rate of patients was 93%. The cumulative survival level of prostheses was 98,3%. The high implant and prosthesis survival rates, the good condition of the peri-implant mucosa and bone three years after restoration, as well as the high level of patient satisfaction and the significantly higher level of their quality of life, along with the high medical and economic efficiency of the method, allow us to consider it a promising standard of geriatric dentistry.

[Tracheobronchial stenting in patients with non-resectable tumors complicated by airway stenosis]. / Endoskopicheskoe stentirovanie trakheobronkhial'nogo dereva u patsientov so stenoziruyushchei nerezektabel'noi opukhol'yu.

OBJECTIVE: To study the results and efficiency of tracheobronchial stenting in patients with unresectable tumors complicated by stenosis of central airways. MATERIAL AND METHODS: We analyzed the results of tracheobronchial stenting in 23 patients with unresectable tumors complicated by stenosis of central airways between 2016 and 2021. RESULTS: Technical and clinical success rate was 100%. No intraoperative complications were noted. Dyspnea regressed in all patients in early postoperative period. Moreover, there was objective improvement in lung ventilation with increase in lung capacity (from 2.1±0.4 to 2.7±0.5 l; p<0.05), forced expiratory volume (from 1.2±0.5 to 1.8±0.4 l; p<0.05), partial pressure of oxygen in arterial blood (from 47±7.4 to 85±6.3 mm Hg; p<0.05) and arterial oxygen saturation (from 86.1±8.2 to 93.1±5.1%; p<0.05). One patient developed massive bleeding due to tumor decay on the 3rd day after surgery. In 2 patients, stent obturation with a «mucus plug¼ was observed after 2-3 postoperative days. In 3 months after surgery, 21.8% of patients had disturbances of external respiration accompanied by mild dyspnea due to granulation tissue growth. Stent migration in 3 months after endoscopic stenting was recorded in 1 patient. Three-month mortality was 26.1%. CONCLUSION: Tracheobronchial stenting is a safe and effective minimally invasive surgical intervention. As a part of palliative care, this procedure improves functional and clinical parameters of pulmonary ventilation and reduces the incidence of complications. Thus, quality of life in patients with unresectable tumors complicated by airway stenosis is improved.

[Silent atrial fibrillation as a risk factor for falls in the elderly.]

Falls increase the risk of injury, disability, and death in the elderly. Atrial fibrillation (AF) is one of the risk factors for falls in old age, however, the relationship between «silent¼ AF and falls has not been investigated. The study included patients (n=131) from 60 years and older who admitted in the City geriatric medical and social center. Previously diagnosed AF was detected in 13,7% (n=18) of the study participants, and «silent¼ AF was detected in 11,5% (n=15). Both forms of AF were associated with a 4-fold increase in the incidence of falls in old age: (95% CI) 4,26 (1,18-15,40) for previously detected AF and 4,56 (1,25-16,66) for «silent¼ AF. AF screening revealed 16,9% (95% CI 6,7-26,8%; p<0,001) more patients at risk of falls. Thus, «silent¼ AF, as well as previously diagnosed, are independent risk factors for falls. Conducting AF screening allows to identify more elderly patients who are at risk of falls.

Comprehensive geriatric assessment in elderly and senile patients with cardiovascular diseases. Expert opinion of the Russian Association of Gerontologists and Geriatricians.

Senile asthenia syndrome (SAS) is a geriatric syndrome characterized by age-associated decline of the physiological reserve and function in multiple systems, which results in higher vulnerability to effects of endo- and exogenous factors and a high risk of unfavorable outcomes, loss of self-sufficiency, and death. Generally, SAS is observed in elderly patients with comorbidities. In cardiovascular diseases, SAS is associated with a poor prognosis, including a higher incidence of exacerbation and death both during acute events and in chronic disease. However, SAS is often not taken into account in developing diagnostic and therapeutic programs for managing elderly patients with cardiovascular diseases (CVD). This article analyzes available scientific information about SAS, algorithms for SAS diagnosis, and the scales that may be useful in developing individual plans for management of elderly patients with CVD.

Stimulation of Spermatogenesis and Synthesis of Testosterone by Allotransplantation of Neonatal Testicular Tissue under Tunica Albuginea of Cryptorchid Testis.

The abdominal type of cryptorchism was modeled on random-bred albino rats by replacing both testes from the scrotum into the abdominal cavity for 3 weeks; thereupon they were manipulated into the scrotum. In control rats, no additional surgery was performed. In experimental rats, the testicular tissue obtained from 1-2-day rat pups was transplanted under testicular tunica albuginea. Prior to orchiopexy, the weight of testes decreased by 62.5-64.1%. In 6 month after the surgery, it increased by 36.1% in the control group, whereas in experimental rats the weight of testes elevated by 123.2% and approximated the normal value. Histologically, the control group demonstrated persistent disturbance in spermatogenesis with emptiness of numerous seminiferous tubules where only Sertoli cells could be revealed and with pronounced dystrophic alterations in the spermatogenous epithelium of the partially preserved tubules where spermatogenesis was blocked at the spermatogonial level. In contrast, the transplantation region of the experimental testes exhibited formation of novel mature testicular tissue enclosed by a connective tissue capsule incorporating the seminiferous tubules with differentiated epithelium and with the clusters of Leydig cells in the stroma. In 6 month, spermatogenesis was observed in most seminiferous tubules of the host testicular tissue, which had spermatozoa in the lumens. To the moment of orchiopexy, the blood testosterone decreased by about 2.5-fold. In control group it remained diminished during entire observation period (up to 6 month), while in the experiment group its level normalized completely as early as in 2 month and remained even elevated to the end of observation period.

[Selection of Patients with Resistant Arterial Hypertension for the Catheter-Based Renal Sympathetic Denervation].

PURPOSE: elaboration of algorithm for selection of patients with resistant arterial hypertension (AH) for Catheter-Based Renal Sympathetic Denervation (CBRSD). MATERIALS AND METHODS: We examined 284 patients with resistant AH. On stage 1 we excluded most frequent causes of secondary AH. In 247 patients (86.9 %) we established secondary character of AH, in 37 patients (13.1 %) AH was found to be essential. On stage 2 patients with essential AH were given 3-5 component hypotensive therapy. At the background of this therapy we conducted 24­hour ambulatory blood pressure monitoring (ABPM). CBRSD procedure was considered indicated if according to ABPM average 24­hour blood pressure (BP) was above 150 and 100 mm Hg, and 24­hour elevated BP load exceeded 60 %. In 13 of 37 patients (35 %) BP level satisfied these conditions. For CBRSD we used high frequency generator. Ablation was performed using the Symplicity Catheter. Results were assessed in 1, 2, 9, 12, and 28 months. RESULTS: Target BP level at the background of minimal doses of hypotensive drugs was achieved in 11 patients (85 %), what was confirmed by ABPM data. Levels of mean 24-4 hour systolic and diastolic BP significantly decreased from 173.9±14.9 to 143±21.3, р<0.05, and from 108.2±8.7 to 91.4±13.8 mm Hg., р<0.05, respectively. Index of elevated systolic BP time decreased from 78.2±14.6 to 49.8±29.6 %, р<0.05. Best effect was achieved in patients with AH duration before the procedure less than 7 years. None of the patients had episodes of cerebral vascular insufficiency or heart failure progression. CONCLUSION: While determining indications to bilateral CBRSD one should be governed by such criteria as exclusion of symptomatic AH and objective proofs of AH resistance (according to ABPM at the background of hypotensive therapy).

[Can the pre-dialysis period in stage IV chronic kidney disease be prolonged?] / Mozhno li prodlit' dodializnyi period pri IV stadii khronicheskoi bolezni pochek?

Analysed herein are the results of treating a total of 29 patients presenting with stage IV chronic kidney disease (CKD) induced by ischaemic nephropathy. All patients had renal artery stenosis more than 80%, decreased glomerular filtration rate (GFR) below 30 ml/min/1.73m2 and were regarded by the nephrologists as potential candidates for programmed haemodialysis. After preparation aimed at preventing contrast-induced nephropathy all patients underwent stenting of the stenosed renal arteries. In the early postoperative period, 21 patients were found to have stabilization of the GFR with a tendency to increase. One woman developed acute renal failure requiring renal replacement therapy by means of haemodialysis. During the follow-up period from 1 to 5 years, 26 patients showed no progression of azotemia. CKD changed to stage III in 15 patients (p<0.005). Twenty-three (84%) patients during the follow-up period developed no new cardiovascular events. Hence, performing renal revascularization for renal artery stenosis >80% revealed in patients with stage IV CKD promotes prolongation of the dialysis-free period.

Ectopic Organogenesis after Allotransplantation of Freshly Removed or Cryopreserved Neonatal Testicle under the Renal Capsule in Rats.

In experiments on white outbred male rats, a freshly removed (20 experiments) or cryopreserved (10 experiments) testicle from newborn rats (1-2 days after birth) was transplanted under the renal capsule after bilateral orchiectomy. In all experiments with transplantation of freshly removed testicle, it was engrafted. In 3 months, histological examination revealed the formation of mature seminiferous tubules, but spermatogenesis was blocked at the stage of spermatogonia; groups of proliferating Leydig cells in the loose connective tissue between the tubules were also seen. In 6 and 12 months, the status of the seminiferous tubules remained unchanged, but structures typical of the epididymis and developing vas deferens were revealed. The number of proliferating Leydig cells increased. The initially low testosterone concentration in the blood of castrated males increased significantly as soon as in 1 month after transplantation and grew up to 3 months, remaining at a level ~50% of normal. Engraftment of cryopreserved neonatal testicular tissue was observed in 60% cases, however, engrafted tissue, similar to the fresh one, retained the ability for organogenesis with the formation of mature seminiferous tubules, epididymis, and groups of proliferating Leydig cells. The dynamics of blood testosterone concentration in rats with cryopreserved and fresh transplantation was similar. Subcapsular transplantation did not adversely affect the kidneys, which was seen from normal histological structure of the kidneys and creatinine and urea concentrations in the blood.

[The clinical features of heart failure in elderly and old age].

THE AIM OF THE STUDY: To evaluate the prevalence and clinico-functional features of myocardial dysfunction in persons 65 years or older in the primary care seting. MATERIALS AND METHODS: The prospective cohort study "Crystal" included participants 65 years and older. The arm of "Crystal" study evaluated a random sample size of 284 people. All participants were performed echocardiography using portable digital ultrasound scanner Mindray M5 ultrasound transducer of 2.5-3.5 MHz. It was also evaluated the clinical manifestations of heart failure (HF) on the scale SHOCKS, medical history and anthropometric data and parameters of the geriatric examination. Were determined muscle strength, walking speed, emotional status (Geriatric Depression Scale) and cognitive status (MiniMental State Examination). Assessment of dependence on external assistance was carried out based on the Barthel Index (Barthel Index). RESULTS: The prevalence of all forms of myocardial dysfunction was 80.3%, among them of 73.2% of participants had clinical manifestations of heart failure, which was not associated with type or severity of structural and functional abnormalities of the myocardium. Symptoms and signs of HF were characterized by low sensitivity for detection in older people with MD and may be associated with other conditions. The most common complaint was shortness of breath (59%), with high sensitivity for the diagnosis (89%) but low specifcity (51%). Patients with clinical manifestations of HF are more likely to have a BMI of over 30 kg/m2, cognitive disorders, suspected depression, lower walking speed and low grip strength by dynamometry. In addition, participants with symptoms were older age (75,3±5.6 years vs 72,7±5.5 years, p.

Features of diagnostics and treatment of chronic heart failure in elderly and senile patients. Expert opinion of the Society of Experts in Heart Failure, Russian Association of Gerontologists, and Euroasian Association of Therapists.

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[Efficacy of carotid endarterectomy in patients with vertebrobasilar insufficiency without significant lesion of vertebral arteries]. / Éffektivnost' karotidnoi éndarteréktomii u bol'nykh s vertebro-baziliarnoi nedostatochnost'iu bez znachimogo porazheniia pozvonochnykh arterii.

The authors examined efficacy of carotid endarterectomy (CEA) in treatment of patients suffering from vertebrobasilar insufficiency (VBI) without significant involvement of the vertebral arteries. The study included a total of 297 patients with VBI and diagnosed as having stenosis of the bifurcation of the carotid arteries amounting to 70% and more, with no significant involvement of the vertebral arteries revealed. All patients underwent CEA: eversion CEA was performed in 226 (76.1%) cases and the classical one in 71 (23.9%) cases. On postoperative day 10, clinical improvement in the form of decreased severity of VBI was observed in 152 (51.2%) patients. One year after surgery, improvement persisted in 135 (45.5%) patients and after 3 years in 125 (42%) patients. Prognostic factors of unsatisfactory clinical outcomes were determined. It was demonstrated that in VBS, CEA is clinically efficient only if the circle of Willis is closed and there is no history of stroke in the vertebrobasilar basin. Besides, the outcome of the operation appeared to have been influenced by such factor as the duration of hypertension and diabetes mellitus. No effect of either cardiac arrhythmia or the technique of CEA on the results of treatment was observed.

[Allergic bronchopulmonary aspergillosis in patients with asthma: Results of a prospective study]. / Allergicheskii bronkholegochnyi aspergillez u bol'nykh bronkhial'noi astmoi: rezul'taty prospektivnogo issledovaniia.

AIM: To estimate the frequency of fungal sensitization and the incidence of allergic bronchopulmonary aspergillosis (ABPA) in asthmatic patients. SUBJECTS AND METHODS: A total of 140 asthmatic patients were examined. They underwent allergologic (skin tests for fungal allergens, estimation of total and fungal allergen-specific IgE levels) and mycological (microscopy and inoculation of respiratory biosubstrates) examinations. Chest computed tomography, when indicated, was done. A group of patients with ABPA and that of patients with severe asthma and fungal sensitization were identified. RESULTS: The frequency of fungal sensitization in asthmatic patients was 36%; the main allergenic fungi were Aspergillus and Alternaria. The incidence of ABPA was as high as 4% in the patients with asthma and 11% in those with severe asthma and fungal sensitization. CONCLUSION: The given current diagnostic criteria will assist practitioners to identify ABPA, to prevent its progression, and to initiate specific anti-inflammatory and antifungal therapy in due time.

[Treatment of resistant arterial hypertension in the remote period after carotid endarterectomy]. / Techenie rezistentnoi arterial'noi gipertenzii v otdalennom periode posle operatsii karotidnoi éndarteréktomii.

The aim of the study was to determine peculiarities of the course of resistant arterial hypertension (AH) in the remote period after performing the operation of carotid endarterectomy in patients presenting with haemodynamically significant (more than 70%) stenosis of the carotid bifurcation. The study included a total of 105 patients. The course of AH was evaluated in the immediate (2-7 days) and remote (3-7 years) periods after the operation of carotid endarterectomy. Ninety-two (87.6%) patients presenting prior to the operation with resistant AH were postoperatively found to have persistent stabilization of arterial pressure and its milder course. A good clinical effect (possibility of reaching the target arterial pressure) in the remote period was noted to preserve in 65.7% of patients. The proportion of patients with grade III AH decreased from 43.8% (prior to operation) to 5.8% in the remote postoperative period (p<0.001). It was also determined that the degree of the antihypertensive effect after the performed operation of carotid endarterectomy depended upon the duration of a previous medical history of arterial hypertension before surgery: the sooner the operation is performed the more pronounced its antihypertensive effect is.

[Common variable immunodeficiency in adults]. / Obshchaya variabel'naya immunnaya nedostatochnost' u vzroslykh.

The paper analyzes 7 cases of common variable immune deficiency (CVID), a primary immunodeficiency disease. All the cases were detected in outpatients over the age of 40 years. The diagnosis was based on their history data and general clinical findings with due regard for the results of previously conducted functional studies, expert opinions, and the results of immunological studies including the quantitative and functional indices of T and B cells, phagocytes and the levels of immunoglobulins. The analysis showed that the early signs of impaired immunity in all the patients were seen by physicians of various specialties in both outpatient and inpatient settings. Generalizing of all information about the patient could become the basis for a simple and accessible practical public-health study of immunoglobulins levels significantly sooner than this diagnosis being verified. This testifies that the physicians of various specialties are partially aware of the clinical signs of immunodeficiency states and that there is a need for a clinical immunologist in adult healthcare facilities. This is especially important since the early clinical manifestations of both primary immunodeficiency disorders that are increasingly frequently detected and nonhereditary - secondary ones can be very similar. The timely verification of the diagnosis is necessary for prescribing adequate therapy with intravenous immunoglobulins to prevent severe chronic pyoinflammatory lung disease and disability in patients with CVID.

[Perioperative use of statins in vascular surgery].

The review is dedicated to studying the effect of perioperative use of statins while performing vascular operations, examining possible aftermaths of statins discontinuation in the perioperative period and discussing safety of perioperative use of statins. Cardiovascular complications constitute the most common cause of perioperative mortality while performing major noncardiac operations. Clinical studies demonstrated a favourable effect of statins on the cardiovascular complications rate in the perioperative period, therefore use of statins for prevention of cardiovascular diseases seems substantiated appropriate. Acting upon the levels of blood serum lipids, statins also influence various signal cellular pathways, exerting anti-inflammatory, antithrombotic and vasodilating effects. Thus, they may be used not only for patients with lipid metabolism impairments. However, currently required are further studies in order to determine optimal dosage, as well as the terms and duration of therapy with statins in the perioperative period.

[The choice of surgery in patients with diffuse toxic goiter]. / Vybor ob''ema operatsii u bol'nykh diffuznym toksicheskim zobom (s kommentariem).

AIM: to define clear individual indications for different operations for diffuse toxic goiter by research of immunological markers of thyrotoxicosis recurrence probability. MATERIAL AND METHODS: Long-term results of survey and treatment of 215 patients with diffuse toxic goiter are presented. Patients were divided into 2 groups. The 1st group consisted of 31 patienrs who underwent conventional partial thyroidectomy. Group 2 included 184 patients. They were divided into 2 subgroups depending on type of surgery. Subgroup A included 59 patients after partial thyroidectomy and subgroup B - 125 patients after total thyroidectomy. In group 2 surgery was defined based on only level of antibodies against TSH-receptors. RESULTS: Recurrence incidence was 16 and 0% in groups 1 and 2 respectively. CONCLUSION: In patients with diffuse toxic goiter partial thyroidectomy is possible if normal titer of antibodies against TSH-receptors is present (<1.5 U/l). Total thyroidectomy is advisable in titer ≥1.5 U/l.

Delayed effect of prenatal exposure to hypoxia on the susceptibility of rats to electric seizures.

We studied the delayed effects of prenatal exposure to hypoxia on the susceptibility of rats to seizures. The later was estimated using graded electroshock. The experiments were performed in two groups of 1.5-year-old male Wistar rats. The experimental group consisted of the animals that were exposed to hypoxia on day 14 of prenatal development, and the control group consisted of the animals that developed under the normal conditions. In the rats subjected to prenatal hypoxia, seizure episodes induced by weak currents in the range of 10-40 mA and their average duration were more pronounced as compared to the control animals.

Impairment of exploratory behavior and spatial memory in adolescent rats in lithium-pilocarpine model of temporal lobe epilepsy.

Cognitive impairment in six-week -old rats has been studied in the lithium-pilocarpine model of adolescent temporal lobe epilepsy in humans. The pilocarpine-treated rats (n =21) exhibited (a) a decreased exploratory activity in comparison with control rats (n = 20) in the open field (OP) test and (b) a slower extinction of exploratory behavior in repeated OP tests. The Morris Water Maze (MWM) test showed that the effect of training was less pronounced in the pilocarpine-treated rats, which demonstrated disruption of predominantly short-term memory. Therefore, our study has shown that lithium-pilocarpine seizures induce substantial changes in exploratory behavior and spatial memory in adolescent rats. OP and MWM tests can be used in the search of drugs reducing cognitive impairments associated with temporal lobe epilepsy.