[Prevention of the development of geriatric syndromes and acute functional deficiency in patients with frailty.]

One of the most difficult tasks in medical practice is pharmacotherapy in elderly and senile patients. The complexity of pharmacotherapy in elderly patients is due to age-related physiological changes, high frequency of multimorbidity. The age of patients no longer precludes surgical intervention, and surgical procedures are often performed on elderly patients with complex comorbidities. Over the past 15 years, the number of emergency hospitalizations has increased significantly worldwide.

[Implantation of a fenestriated stent-graft in a patient with thoracic aortic aneurysm]. / Implantatsiya fenestrirovannogo stent-grafta u patsienta s anevrizmoi grudnogo otdela aorty.

The authors present endovascular treatment of a patient with stenosis of the left anterior descending artery, chronic DeBakey type III aortic dissection and thoracic aortic aneurysm. The first stage was percutaneous coronary intervention with stenting of the left anterior descending artery. The second stage implied implantation of a fenestrated stent-graft. The follow-up CT angiography after 6 months revealed occlusion of the left subclavian artery that required stenting. Control CT angiography confirmed adequate stent-graft placement without endoleaks and stenosis of the artery. The choice of these reconstructions and stages of interventions are substantiated. The authors concluded effectiveness of treatment strategy, as well as the need for preventive subclavian artery stenting after implantation of a fenestrated graft.

[Treatment of a patient with acute thoracoabdominal aortic dissection complicated by haemothorax]. / Lechenie patsienta s ostroi dissektsiei torakoabdominal'nogo otdela aorty, oslozhnennoi gemotoraksom.

Total left-sided haemothorax is a rare and severe complication of acute DeBakey type III aortic dissection. The primary aim of treatment is immediate arrest of haemorrhage and stabilization of the haemodynamic status of the patient. Endovascular isolation of the ruptured thoracic portion of the aorta using a stent graft (TEVAR) has recently become the 'gold standard' in treatment of acute, rupture-complicated aortic dissections of this localization. Described in the article is a clinical case report concerning successful endovascular treatment of a seriously ill patient with dissection of the thoracoabdominal portion of the aorta, rupture and massive haemorrhage into the left pleural cavity. The patient underwent endoprosthetic repair of the descending aorta in the setting of a hybrid operating room under local anaesthesia, followed by drainage of the left pleural cavity. The postoperative period was uneventful with no complications. The patient was discharged in a satisfactory condition on day 10 after the emergency surgical intervention. An important advantage of TEVAR for aortic ruptures is a minimally invasive nature of the procedure, consisting in no need to perform either sternothoracotomy or to connect a heart-lung machine, thus decreasing surgical wound, reducing the risk of perioperative life-threatening haemorrhage, and contributing to early activation of the patient.

[On stomatological service in the Voronezh Oblast].

The article considers characteristics of organization of dental care for adult and children population in the territory of a large subject of the Russian Federation. In accordance with the action plan of the Health Department of the Voronezh Oblast, as well as in order to improve organization of dental services and statistical reporting and accounting in the autonomous health institution of the Voronezh Oblast, meetings concerning organization of dental services are organized. The issues are discussed concerning primary prevention of dental diseases in population of the Voronezh Oblast within the framework of the state program of the the Russian Federation "Health Care Development", organization and implementation of continuous medical education in dentistry, preparation and handing in annual report on dentistry in accordance with latest requirements of the Federal statistical monitoring in health care, new requirements of application of documents for preferential prosthetic dentistry in families of servicemen who perished during military service in peacetime. The consideration of actual state of scientific medicine and practical direction of population health promotion of the population, invariably focuses on actuality of dental research. The analysis of publications established significance of especially dynamic monitoring of medical social indices, conditions and style of life, level and structure of dental morbidity demographic situation. The necessity of analysis of dental morbidity for evaluation of overall population health is emphasized. Also, data of social hygienic monitoring of population of the Voronezh Oblast for 2015-2017 was used.

[Hibrid surgical treatment of an aortic arch aneurysm]. / Gibridnoe khirurgicheskoe lechenie anevrizmy dugi aorty.

Presented in the article is a clinical case report regarding hybrid surgical management of a saccular aneurysm of the aortic arch: simultaneous right-left-carotid-left-subclavian bypass grafting and endovascular isolation of the aneurysm. Taking into consideration the findings of multislice computed tomography-aortography (MSCT aortography) prior to surgery, the anatomical location of the aneurysm with the involvement of the ostium of the left subclavian artery, close location of the proximal branches of the aortic arch at an acute angle relative to each other required performing simultaneous debranching in order to enlarge the proximal zone of fixation of a stent graft at the level of the brachiocephalic trunk (BCT). The postoperative period proved uneventful, with as rapid rehabilitation as possible. From our own experience, with this one being not the first similar operation performed in the Centre, it may be supposed that carrying out simultaneous hybrid interventions in treatment of aneurysms of the aortic arch with the use of different variants of switching its branches may decrease the frequency of postoperative complications for patients of high surgical risk, reduce the length of hospital stay and, consequently, economic expenditures for treatment.

[ANEMIC SYNDROME IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA].

Community-acquired pneumonia remains a most widespread acute infectious disease of socio-economic significance all over the world. Up to 30% of the patients present with anemia responsible for the unfavourable prognosis and elevated mortality. Not infrequently, anemia is not diagnosed during the hospital stay und therefore remains uncorrected. Severe anemia results in enhanced hypercapnia and slowed maturation of red blood cells in the bone marrow which facilitates the development of ischemic syndrome. Hepcidin, a mediator of inflammation and iron-regulatory hormone, plays an important role in the clinical course of community-acquired pneumonia. Hepsidin production increases during inflammation; it suppresses erythtropoiesis and depletes the iron depot leading to so-called anemia of inflammation. Hypoxia and anemia activate erythtropoiesis, and the released erythropoietin inhibits hepsidin production. During pneumonia resolution, hepsidin promotes recovery from anemia by activating iron absorption. The curreni literature contains few data on the use of hepcidin as a diagnostic marker of anemia. The necessity oftreating anemia in patients with pneumonia under hospital conditions is a matter of discussion. Direct involvement of hepcidin in iron metabolism creates a prerequisite for the treatment of anemia. Medicamental suppression of its activity by stimulating erythtropoiesis can facilitate normalization of iron metabolism and restoration of hemoglobin level.

[The diagnostic value of systemic inflammation biomarkers in chronic obstructive pulmonary disease].

Chronic obstructive pulmonary disease (COPD) is a cause of appreciable social and economic losses. Airway inflammation is the main factor at the early stages of COPD pathogenesis and persists for many years after cessation of the action of provoking factors. In the last years, researchers have shown much interest in biomarkers associated with various diseases including COPD. Biomarkers of COPD are related to pathophysiology ofthe disease and inflammatory processes in the lungs. This review is designed to summarize the currently available data on systemic COPD biomarkers, their use for the assessment of activity of the disease and the possible role in the formation of COPD phenotype. Most systemic biomarkers are not specific for COPD. Moreove, evaluation of their significance encounters difficulties due to the presence of concomitant pathologies, in the first place cardiovascular diseases. Nevertheless, studies involving a large number of patients with COPD provided information about the role of biomarkers in the activity of COPD and formation of its phenotype with systemic inflammation. The introduction ofbiomarkers in protocols ofexamination ofCOPD patients needs further substantiation.

Plastic efficiency of different implants used for repair of soft and bone tissue defects.

The results of clinical and experimental morphological studies of regenerates forming after replacement of large defects of the abdominal wall and tibia with implants from different materials (polytetrafluoroethylene, reperene, prolene, titanium, and titanium nickelide) are analyzed. Study of the regenerate histology and fibroarchitectonics has shown good prospects of mesh constructions from titanium nickelide for effective surgical repair of these defects. The use of this implant seems to be theoretically well-based and promising, particularly under conditions of suppurative infection and low individual reparative regenerative potential.

[Duodenogastric reflux in humans]. / Duodenogastral'nyi refliuks u cheloveka.

Human duodenogastric reflux (DGR) was comprehensively studied via measurement of gastric juice bile acid levels, manometric, endoscopic and X-ray study in health and benign gastrointestinal diseases and during exercise. DRG is shown to fall in the physiological events that have a biologically determined circadian rhythm. There was an association of DGR with gastric secretion. The "refluctant dilution effect" was established which along with elimination provides a relative constancy of the concentrations of bile ACIDS FROM 0.025 TO 0.422 NG/ML. DGR regulation is effected by the coordinated motor and evacuatory performance of the gastroduodenal junction and duodenum which is described as a lock two-way system. It is concluded that DGR is involved in the formation of the internal gastric environment and hence plays a role in gastric digestion. The findings may be used in studies of the physiology of digestion and in clinical practice.

Masc2, a C5-DNA-methyltransferase from Ascobolus immersus with similarity to methyltransferases of higher organisms.

The filamentous fungus Ascobolus immersus represents an eukaryotic model organism to study genetic phenomena linked to DNA methylation. Following our previous characterization of a gene, masc1 from A. immersus, encoding the 'de novo' C5-DNA-methyltransferase (MTase), we report here the identification of a second MTase gene, masc2. The deduced peptide sequence of Masc2 is similar to previously identified eukaryotic MTases and distinct from Masc1 by having a large N-terminal domain in addition to the ubiquitous C-terminal catalytic domain. Following cloning of the gene, Masc2 was overexpressed and purified. Masc2 shows MTase activity with double stranded DNAs. Structural and biochemical properties of Masc2 suggest that it may function as a 'maintenance' MTase. With this finding, A. immersus represents so far the only eukaryotic organism in which two possibly synergistically operating MTases have been identified.

[Two site-specific endonucleases from the thermophilic OV Bacillus species strain]. / Dve sait-spetsificheskie éndonukleazy iz termofil'nogo shtamma Bacillus species OV.

Two site-specific endonucleases, BspOVI and BspOVII, were isolated from a thermophilic strain Bacillus species OV. The activities of both enzymes are maximal at 48 degrees C and do not depend on ATP and S-adenosyl-L-methionine. BspOVI recognizes the sequence [sequence: see text] and cleaves it as indicated by arrows. Thus, BspOVI is a IIN-subclass endonuclease isoshizomer of Eam1105I. BspOVI is very stable during storage. The enzyme can be used for direct T/A cloning of PCR products. BspOVII recognizes and cleaves the sequence [sequence: see text]; thus, BspOVII is an isoshizomer of CIaI. The cleavage by BspOVII is blocked by dam methylation of adenine inside the recognition site.

[Site-specific endonuclease BspKT8 from the thermophilic strain KT8 of Bacillus species]. / Sait-spetsificheskaia éndonukleaza BspKT8 iz termofil'nogo shtamma Bacillus species KT8.

A site-specific endonuclease capable of recognizing the sequence 5'-AAGCTT-3' was detected and purified to homogeneity from the thermophilic strain of Bacillus species KT8. The endonuclease has a molecular mass of 34 kDa and is found in solution in a monomeric form. The activity of BspKT8 does not depend on ATP and is not stimulated by S-adenosyl-L-methionine. The enzyme displays the highest activity with a broad range of temperatures (37 degrees-48 degrees C). Since DNA cleavage occurs in accordance with the scheme: [formula: see text] the enzyme can be assigned to the class-II of restriction endonucleases and represents an isoschizomer of HindIII.

BspLUII III, a bifunctional restriction and modification enzyme from a thermophilic strain Bacillus species LUII.

BspLUII III, an isomer of FinI (1) and BsmFI (2), was found to cleave DNA at two points 10, 11 and 14, 15 bp in the different strands away from the recognition site, and in the presence of SAM it exhibits the adenine specific methyltransferase activity.Images

[A new site specific endonuclease-methylase from a thermophilic strain of Bacillus species LU11]. / Novaia sait-spetsificheskaia éndonukleaza-metilaza iz termofil'nogo shtamma Bacillus species LU11.

A new site-specific endonuclease BspLU11III was purified to homogeneity from a thermophilic strain Bacillus species LU11. BspLU11III recognizes the 5'-GGGAC-3' sequence on the double-stranded DNA and cleaves the 10/14 and 11/15 nucleotides in different strands away from the recognition site. The enzyme exists in solution as a monomer with a molecular mass of about 93 kDa. When incubated with S-adenosyl-L-methionine, BspLU11III displays a DNA-methyltransferase activity. The adenine residue is methylated inside the recognition site 5'-GGGAC-3' in the only strand. The restriction activity does not change in the presence of ATP but is stimulated by 80 microM S-adenosyl-L-methionine (4-fold). Magnesium cations are needed for the restriction activity. Sodium chloride stimulates the "star" activity of BspLU11III. According to its properties, BspLU11III can be classified as a type IV endonuclease.