[Intraoperative and early postoperative risk factors of development of acute cerebrovascular accident after coronary artery bypass grafting in the elderly age.]

The article presents data on the problem of ischemic heart disease, surgical myocardial revascularization, as well as the risk of developing acute cerebrovascular accident (ACVA) in elderly patients with coronary artery bypass grafting (CABG). The authors conducted a study to identify risk factors for the development of stroke in elderly patients. Predictors of ACVA development in the operational and early postoperative periods were identified. It has been proven that the time of extubation, an increase in PCO2 levels, and hyperlactatemia are reliable intraoperative and early postoperative predictors of stroke in elderly patients with CABG. The practical significance of the study lies in the application of its results to predict the development of perioperative stroke in elderly patients with CABG.

Beta coronaviruses and human endocrine system: new data (review of literature).

A new dangerous respiratory disease COVID-19 was first reported in China in December 2019, the pathogen SARS-Coronavirus 2 (SARS-CoV-2), belonging to the beta coronavirus genus, which, in addition to SARS-CoV-2, includes SARS-CoV-1 and MERS-CoV. The genome of SARS-CoV-2 is almost 80% similar to SARS-CoV-1 and 50% to MERS-CoV. The mechanisms of infection of SARS-CoV-1 and SARS-CoV-2 are also similar and occur through the binding of the virus to the type 2 angiotensin-converting enzyme protein (ACE2), which is widely represented in the human body with predominant expression in endocrine tissues. In this connection, SARS-CoV-1 and SARS-CoV-2 affect the organs of the endocrine system, causing damage and hormonal changes that affect the prognosis of the course of COVID-19. This literature review is devoted to the analysis of changes in the organs of the endocrine system that occur during infection with SARS-CoV-1 and SARS-CoV-2, as well as the potential effect of hormones on susceptibility to SARS-CoV-2.

Effect of Daily Rhythms of Cortisol Secretion on the Rate of Aging in Men.

The phenomenon of human aging is the result of a complex interaction among several factors in which the immune system plays a key role. Cortisol is a glucocorticoid secreted by the adrenal gland and has a specific secretion pattern. The current study aimed at identifying the cause and pathogenesis of premature aging using biological markers. This study was performed based on the results of clinical and instrumental examinations on 91 middle-aged men aged 45-59 years. VaseraVS-1500 sphygmomanometer based on standard methods was used to measure biological age. The relationship between biological age and circadian rhythms of cortisol secretion was calculated to elucidate the pathophysiological mechanisms of aging development. The recorded data showed that the violation of the circadian rhythms of cortisol secretion characterized by a consistently high level of the hormone throughout the day was typical among individuals with accelerated types of aging. Based on the obtained data, a formula for determining the biological age of the studied groups of patients was prepared by considering the circadian rhythm of cortisol secretion, which can be an additional tool for early detection of aging in men.

[Relationship of kidney functions with geriatric syndromes in elderly and old women.]

Against the background of aging, there is an increase in the number of diseases associated with age, geriatric syndromes that contribute to the development of disorders of physical and functional activity, the risk of disability and mortality increases. One of the widespread diseases is chronic kidney disease (CKD), which is dangerous not only in itself, but also as a factor in the progression of other age-associated diseases and geriatric syndromes, including frailty and sarcopenia. Among patients of older age groups, CKD is more common in women than in men. A number of researchers are studying the problems of polymorbidity, the development and progression of geriatric syndromes in patients with CKD in the pre-dialysis and dialysis stages. Undoubtedly, the negative role of severe late stages of CKD in the development of senile asthenia and sarcopenia, at the same time, the relationship of these geriatric syndromes with early pre-dialysis stages of CKD has been insufficiently studied. Therefore, it is of undoubted scientific interest to identify correlations between signs of sarcopenia and frailty in elderly and senile women, depending on renal function, stage of CKD.

[Risk factors of frailty in elderly women with the chronic non-infectious diseases.]

Against the background of an aging population, there is an increase in the frequency and prevalence of chronic non-infectious diseases with age. The syndrome of frailty, the frequency of which also increases with aging, is considered as a prognostic factor for the adverse outcomes of chronic diseases and mortality among geriatric patients. Moreover, in women, frailty is more common than in men. An earlier diagnosis and identification of signs of frailty is necessary to prevent the progression of both the syndrome itself and multiple age-associated chronic diseases.

Hypovitaminosis D in the elderly: relationship with sarcopenia and dementia (review of literature).

The growth in the world population of elderly and senile people provokes interest in the processes and mechanisms leading to aging and age-associated diseases. Hypovitaminosis D is common in geriatric patients and has been suggested by a number of authors as a cause of diseases such as dementia and sarcopenia. This literature review is devoted to the analysis of the role of vitamin D in the development of the above diseases, their prevention and treatment.

[What is primary: frailty or sarcopenia? (literature review).]

Among the many geriatric syndromes, undoubtedly, one of the first places is, in other words, the leading positions are occupied by frailty and sarcopenia. Despite their wide coverage in the modern scientific medical literature, the question of the relationship of these geriatric syndromes with each other is still relevant. Which of the above syndromes is primary and which is secondary? Do they compete with each other, mutually burden each other, do not depend on each other, or are they united by common pathological mechanisms? This literature review is devoted to these issues.

Chronic hyponatremia in the elderly: association with geriatric syndromes (review of literature).

Hyponatremia is more common in the elderly. A number of studies suggest that even mild chronic hyponatremia is a serious danger, increasing the risks of developing geriatric syndromes, falls, low bone density, fractures, cognitive impairment, and death of all causes. Although the mechanism for the development of such complications is currently not completely clear. Questions remain about the need and methods for correcting this condition, although there is some evidence that the correction of hyponatremia improves cognitive functions, postural balance, minimizing the risk of falls and fractures. These issues are addressed in this review of the literature.

[Specificity of anemic syndrome in geriatric patients with chronic kidney disease.]

Anemic syndrome is detected in 10-25% of geriatric patients, and with increasing age, there is a tendency to increase the incidence of the disease. Among the diseases that lead to the development of anemia, kidney pathology plays an important role. Progressive deterioration of kidney function in old age is associated with an increased risk of fractures, sarcopenia, and the development of cognitive impairment. Also, nephrogenic anemia aggravates the prognosis in patients with cardiovascular diseases, which is associated with an increase in myocardial ischemia, an increase in tissue hypoxia, a progression of left ventricular hypertrophy, and a decrease in left ventricular systolic function.

[Specificity of estimation and prognostic value of glomerular filtration rate in older age groups with cardiovascular pathology.]

The demographic situation in recent decades has been characterized by a progressive increase in the proportion of older age groups in both developed countries and the Russian Federation. The main contribution to morbidity and mortality of people over 60 years of age is made by diseases of the circulatory system. Early development and progression of cardiovascular diseases contributes to kidney dysfunction, often developing against the background of morphological changes occurring with age in the kidneys, called "senile kidney". Reduction of glomerular filtration rate in elderly patients is not mandatory and in most cases occurs as a result of an existing pathological process. The combined effect of changes in GFR and cardiovascular disease on the prognosis of older patients remains poorly understood, which determines the relevance of the study of chronic kidney disease in geriatric patients.

[Calcium and vitamin K: effects on bone tissue and vascular remodeling (literature review).]

Calcium preparations are included in the treatment and prevention regimens for low bone mineral density. However, recent scientific studies have shown that additional calcium intake can increase the risk of heart disease, which is associated with the deposition of calcium in the endothelium of blood vessels. The significance of vascular wall mineralization is not limited to local accumulation of calcium deposits, but is largely determined by their activating effect on the progression of atherosclerosis. Vitamin K plays an important role in calcium homeostasis, reduces arterial calcification and arterial stiffness and, as a result, has a protective effect when taking calcium. This literature review provides current information about the calcium paradox, discusses the main molecular mechanisms of vascular calcification, and considers therapeutic strategies for vitamin К2 treatment.

[The sarcopenia: a multicomponent strategy for therapy (review of literature).]

Sarcopenia is an age-related loss of muscle mass, accompanied by a decrease in muscle function and/or strength, is increasingly recognized as a major risk factor for adverse outcomes in the weak elderly. The proven Association between hypodynamia, low-calorie diet, insufficient protein intake, and sarcopenia in older individuals suggests that exercise and targeted dietary supplements may have a significant therapeutic effect on the treatment and prevention of this condition. In this literature review, we summarize available data on the positive effects of various therapeutic interventions on muscle tissue.

[Intestinal microbiota: relationship to age-associated diseases (review of literature).]

In connection with the increase in life expectancy, the number of people of older age groups is increasing, and with it the age of associated diseases, which are of tremendous medical and social importance. Such diseases include Alzheimer's disease, osteoporosis, sarcopenia, atherosclerosis and other cardiovascular pathology. The role of the gut microbiota in the pathogenesis of these nosologies is widely discussed in the literature. In addition, a number of studies have shown the effectiveness of the use of probiotics and prebiotics in the treatment of these diseases. The review of the literature summarizes the current understanding of the role of the intestinal microbiota in the development, prevention, and treatment of major age-related diseases.

[Aging and growthhormone: assumptions and facts (review of literature).]

Growth hormone is a powerful metabolic hormone with pleiotropic effects, which is positioned as a "source of youth". Somatotropin has various functions: stimulation of bone growth, regulation of carbohydrate, protein, lipid metabolism, metabolic function of the liver and energy balance. At the cellular level, somatotropic hormone regulates cell growth, differentiation, apoptosis, and cytoskeleton reorganization. The review article presents the results of topical studies that reflect the relationship of growth hormone deficiency or resistance to it with the development of aging and diseases associated with age, as well as with an increase in life expectancy.

[Gerontology and geriatry in the Samara region: past, present, future.]

he article presents the stages of the formation of gerontology and geriatrics in the Samara region, the review of scientific research, the teaching and methodical work at the department of geriatrics and age-related endocrinology. Prospective directions of fundamental, clinical and social gerontology are marked. The stages of the implementation of the pilot project «Care territory¼ 2017-2019 years in the Samara region are reflected.

[The impact of lipid metabolism on the rate of aging of patients with arterial hypertension.]

Now atherosclerosis is even more often positioned as the natural hereditary determined process determining the rate of aging of an organism and life expectancy. Research objective: to study correlation interrelations between indicators of a lipidic profile and rate of aging of men with an arterial hypertension. We have conducted a one-stage research of 123 male patients (middle age 52,4±0,60 years). The main group (I) was made by patients with the arterial hypertension (AH) of the II stage of high risk. The control (II) group was made by 60 patients without kliniko-tool symptoms of cardiovascular pathology. The research of a lipid profile was conducted on the biochemical autoanalyzer «Humastar 600¼ (Human GMBH, Germany) with studying of the general cholesterol (OHS), lipoproteid of the low density (LDL), lipoproteid of the high density (LPVP), triglycerides (TG), calculation of the aterogennost coefficient (AC) was also carried out. Rate of aging decided on the basis of integrated assessment of the biological age (BA) on use of a technique of the Kiev Scientific Research Institute Gerontology. Patients with AG have a direct correlation dependence of moderate force between biological age and lipid exchange traces with OHS indicators (r=0,364, p=0,003), LDL (r=0,359, p=0,004), TG (r=0,324, p=0,010) and KA (r=0,488, p<0,001). The return correlation communication is noted with LPVP (-0,446, р<0,001). Patients have groups of control the direct correlation dependence of moderate force of BV and lipidic range is noted also for atherogenous fractions of lipoproteid and KA, feedback - for LPVP (-0,623, р<0,001). On the basis of the carried-out mathematical modeling formulas for determination of biological age of the considered groups of patients taking into account indicators of a lipidic profile have been made. The correlation analysis which is carried out by us reflects a dislipidemiya contribution to development of the accelerated aging of an organism, and the executed mathematical modeling allows to carry out diagnostics of the accelerated aging of patients by means of indicators of lipid exchange.

[Evaluation of the effectiveness and safety of compression hosiery «Mediven Plus¼ in the treatment of elderly patients with chronic venous diseases of the lower extremities].

This publication presents the results of a study aimed at assessing the justification of the use of compression hosiery «Mediven Plus¼ among patients in the older age group on the basis of demographic, anthropometric data (gender, age, weight of the patient; the volume of the lower leg, upper thigh), clinical examination, data of instrumental examination (duplex ultrasound, volumetry, legometry), data of laboratory tests (fibrinogen, soluble fibrin-monomer complexes). The effectiveness of therapeutic effects of compression underwear is proved for all parameters.

[The treatment of elderly and senile patients with venous trophic ulcers and type 2 diabetes mellitus.]

The effectiveness of the inclusion of sulodexide in the pharmacotherapy of complex treatment of patients (n=52) elderly and senile with a combination of chronic diseases of the veins complicated by refractory trophic ulcers of the lower extremities, and type 2 diabetes mellitus was studied. Patients were randomly randomized in the 1st (n=26) and the 2nd (n=26) groups, the statistical differences between them in age (t1-2=0,2, p1-2=0,833), sex (χ21-2=0,008, p1-2=0,991), nosology (χ21-2=0,004, р1-2=0,993); the anamnesis of chronic diseases of veins (t1-2=0,14, p1-2=0,893); duration of trophic ulcers (t1-2=0,21, p1-2=0,827); planimetric parameters of trophic ulcers (t1-2=0,18, p1-2=0,865) were not recorded. Patients of the 1st group received treatment with sulodexide according to the standard schedule for 50 days. The primary outcome of the study is the complete closure of the trophic ulcer after 1 month. Secondary outcomes are epithelization after 2 months and dynamic planimetric indices within 12 months. The effectiveness of the use of sulodexide was assessed according to the VCSS scale, dynamic changes in the malleolar volume and changes in planimetric parameters. A statistically significant improvement in the overall VSCC score was observed in both the 1st (p=0,002) and the 2nd (p=0,0016) groups in all study outcomes. At the same time, a statistically significant improvement in the VSCC scores was more pronounced in the 1st group (p<0,05). After 2 and 6 months, a statistically significant decrease in the malleolar volume of the affected lower extremity was recorded both in the 1st (t=4,17, p=0,001) and in the 2nd (t=2,4, p=0,37) groups. Clinically and statistically significant decrease in malleolar volume was more pronounced in the 1st group (p<0,05). After 30 days, trophic ulcers were closed in 9 (34,6%) cases in the 1st group and in 5 (19,2%) patients in the 2nd group (p<0,05). On day 60 epithelization was achieved in 22 (84,6%) and 12 (46,1%) patients, respectively. The time of complete epithelization in patients of the 1st and the 2nd groups was 51,2±1,6 and 78,4±2,6 days (p<0,05). The conclusion is made that sulodexide is an effective and pathogenetically grounded pharmacological preparation for the treatment of patients of elderly and senile age with chronic clinical disease C6 of clinical class and type 2 diabetes mellitus.

[EFFECT OF CIRCADIAN RHYTHM OF CORTISOL SECRETION ON INDICATORS OF BIOLOGICAL AGE OF COMBAT VETERANS].

The article presents the correlation analysis of indicators of biological age and circadian rhythm of cortisol secretion, the level of mental adaptation and quality of life of combat veterans. A strong correlation between the level of mental adaptation and quality of life of the contingent in consideration was revealed. The results of the correlation analysis show that the main predictor determining the rate of aging of war veterans is the difference between morning and evening secretion of cortisol in the blood, while for patients who were not taking part in the fighting, the leading factors of accelerated aging can be called the quality of life and the concentration of cortisol in plasma in the evening.

[Complex estimation of the state of health, quality of life, level of psychological adaptation and rates of senescence of war veterans, suffering from arterial hypertension].

The article presents some aspects of the health status of the veterans of the Samara region. Intercommunication is marked between the level of social adaptation, quality of life and rate aging combatants. The study shows the effect of chronic posttraumatic stress disorder on the occurrence of psychosomatic pathology and development of senescence combat veterans suffering from arterial hypertension.