[Assessment of the progression dynamics of chronic kidney disease in elderly patients with type 2 diabetes mellitus.]

The aim of work is identification and evaluation of clinical factors influencing the dynamics of progression of chronic kidney disease in elderly patients with type 2 diabetes. In a population sample of elderly patients with type 2 diabetes, a cross-sectional observational study of clinical indicators of the standard program of dispensary observation was performed. Primary medical data were collected using the AWPE 2.0 program. 118 protocols of outpatient consultations, including 69 clinical indicators, were selected according to the compliance criteria. To assess the dynamics of the progression of chronic kidney disease, the original calculated diagnostic parameter «Glomerular filtration rate reduction index¼ (GFR RI) was used. A detailed clinical justification of the calculated diagnostic parameter GFR RI is given; correlations between quantitative and qualitative clinical indicators and GFR RI in a sample of elderly patients with type 2 diabetes are determined; statistically significant differences in clinical factors were revealed in groups identified by the rate of progression of CKD with a threshold value of 3,83 ml/min on 1,73 m2 per year, including medicamental. The proposed diagnostic parameter GFR RI allows us to give an objective assessment of the dynamics of the progression of CKD in elderly patients with type 2 diabetes; when identifying the groups of «slow¼ and «fast¼ progression of CKD, significant differences in the following clinical factors were revealed: the level of glycemia, BMI, the experience of diabetes and insulin therapy, the total dose of insulin and sulfonylureas, the presence of concomitant hypertension.

[Frequency of selected chronic noncommunicable diseases in older patients with senile asthenia syndrome.]

An important area of medical and social research is prospective studies of a cohort of older patients with chronic non-communicable diseases aimed at studying the level of mortality, taking into account the presence/absence of senile asthenia syndrome. A prospective clinical and epidemiological study was conducted on 1 261 people aged 80 years and older receiving medical care on an outpatient basis. Three groups of patients were formed: without senile asthenia syndrome (7,6%), in a state of pre-asthenia (23,5%), with senile asthenia (68,9%). After a calendar year, an analysis was made of the causes of death of respondents in all three groups. A high statistically significant incidence of chronic diseases in patients with senile asthenia syndrome compared with those without signs of this syndrome was noted in arterial hypertension, chronic heart failure, osteoarthritis, age-related macular degeneration, chronic kidney disease, dementia, cancer, anemia, uncomplicated diabetes mellitus. In the structure of causes of death in patients aged 80 years and older, diseases of the circulatory system, nervous system, neoplasms, liver diseases, and diabetes mellitus predominated. The odds ratio of the risk of dying within a year in patients without frailty syndrome is 0,32 (compared to patients with frailty, in which the risk is taken as 1).

[Medical and social status of patients over 80 years old subject to single or joint residence.]

The study of the living conditions of the elderly living alone or together with other family relatives is relevant to the organization of medical and social care and the strengthening of coordination between medical and social services. We analysed information of 1 261 people aged 80 years and older in ambulatory care settings, of whom 40% lived alone and 60% lived in the family. The proportion of single residents increases with age. It was determined several socio-demographic characteristics of patients, including age, gender, and household composition, calculated the prevalence of senile asthenia syndrome and the main chronic non-infectious diseases for single and family patients, and identified gender differences. Single men in the «Age is not a hindrance¼ screening more often revealed senile asthenia and had more severe pain syndrome compared to men living in a family. In contrast to men, senile asthenia and pain summation were more frequently registered for women living in a family than for women living alone. For the organization of medical and social care, it is important to consider the relationship between gender and marital status, as well as how this relationship changes over time.

Plasma pharmacokinetics and tissue distribution of L-lysine α-oxidase from Trichoderma cf. aureoviride RIFAI VKM F- 4268D in mice.

L-lysine α-oxidase (LO) is an L-amino acid oxidase with antitumor, antimicrobial and antiviral properties. Pharmacokinetic (PK) studies were carried out by measuring LO concentration in plasma and tissue samples by enzyme immunoassay. L-lysine concentration in samples was measured spectrophotometrically using LO. After single i.v. injection of 1.0, 1.5, 3.0 mg/kg the circulating T1/2 of enzyme in mice varied from 51 to 74 min and the AUC0-inf values were 6.54 ± 0.46, 8.66 ± 0.59, 9.47 ± 1.45 µg/ml × h, respectively. LO was distributed in tissues and determined within 48 h after administration with maximal accumulation in liver and heart tissues. Mean time to reach the maximum concentration was highest for the liver-9 h, kidney-1 h and 15 min for the tissues of heart, spleen and brain. T1/2 of LO in tissues ranged from 7.75 ± 0.73 to 26.10 ± 2.60 h. In mice, plasma L-lysine decreased by 79% 15 min after LO administration in dose 1.6 mg/kg. The serum L-lysine levels remained very low from 1 to 9 h (< 25 µM, 17%), indicating an acute lack of L-lysine in animals for at least 9 h. Concentration of L-lysine in serum restored only 24 h after LO administration. The results of LO PK study show that it might be considered as a promising enzyme for further investigation as a potential anticancer agent.

[Features of the metabolic composition of spermal plasma in different morphofunctional pathologies of the ejaculate.]

As part of the work, an assessment was made of the state of the metabolic characteristics of sperm plasma in various morphofunctional ejaculate pathologies. Physico-chemical, metabolic and morphological parameters of the ejaculate were evaluated. The diagnostic protocol included a standard sperm analysis with classification of ejaculate parameters and determination of biochemical parameters of sperm plasma on an automatic biochemical analyzer. The study of the qualitative and quantitative characteristics of metabolic parameters. The total number of surveyed was XX people. After studying the morphological features of the cell composition, the obtained samples were divided into four groups: samples with normospermia, samples with oligoasthenoteratozoospermia, samples with azoospermia, and samples with cryptozoospermia. In each group, the parameters of protein, carbohydrate, lipid and mineral metabolism were studied. As a result, it was found that with the progression of pathology, the catabolic mechanism of energy consumption begins to prevail, due to a decrease in the concentration in the sperm plasma of protein components, transaminases, as well as the growth of non-protein nitrogenous inclusions. It is noted that the growth of glucose, despite the inhibition of transmembrane routes of intake by reducing the concentration of alkaline phosphatase and lipid-transport systems, is associated with the forced inclusion of insulating mechanisms for the penetration of glucose into the sperm plasma from the blood through the hemato-sperm barrier. At the same time, an increase in the content of lipids in the sperm plasma, as well as the growth of creatinine in the initial stages of the development of pathology, can be characterized by a compensatory response aimed at maintaining the viability of minimal amounts of spermatozoa. Well, the disorder of mineral metabolism in general characterizes the violation of metabolic processes in all forms of ejaculate pathology. Identified features of the metabolism in the sperm plasma may further allow to identify more informative laboratory markers of male infertility.

ST-Elevation Myocardial Infarction in Patients With Malignancies.

Acute myocardial infarction (MI), the most severe complication of coronary artery disease, develops in 2-4% of patients with various malignancies. PURPOSE: to explore the specific properties of ST-segment elevation myocardial infarction (STEMI) course in patients with cancer and its effect on short-term outcome. MATERIALS AND METHODS: We included in this study 45 patients with STEMI and history of cancer hospitalized in the period from 01.01.2015 to 01.01.2017 (group I; 58% men, mean age 69.07±11.60 years). In the comparison group (group II) we selected 90 age and gender matched persons (58% men, mean age 68.16±11.75 years) from patients with STEMI without oncological diseases. RESULTS: There were no differences between groups in main risk factors of cardiovascular diseases, except greater proportion of patients with damage of peripheral arteries in group 1 (22.2% compared with 5.6% in group 2, p=0.025). There were also no differences between groups in clinical characteristics at admission. However values of the following parameters were significantly lower in group I: concentration of hemoglobin (115.56±23.07 vs. 133.70±16.45 g/l in group 2, р<0.001), red blood cell count (3.95±0.66x1012/l vs. 5.57±0.72x1012/l in group 2, р<0.001), platelets (93±0.97x109/l vs 186±18.3x109/l in group 2, p<0.001), total cholesterol (4.12±2.17 vs. 6.24±2.56 mmol/L in group 2, р<0.001). There were differences in the frequency of use of antiplatelet drugs: at prehospital stage acetylsalicylic acid was given to 48.9% and 77.8% of patients in groups 1 and 2, respectively (p=0.044); clopidogrel and ticagrelor were also significantly more rarely used in group 1. There was no difference in use of thrombolysis and percutaneous coronary interventions (4.4 and 53.3% vs 5.6 and 56.6% in groups 1 and 2, respectively). In group 2 greater portion of patients was given statins (68.9 vs. 77.8%, p=0.021) and angiotensin-converting enzyme inhibitors (55.6 vs. 82.2%, p=0.008). Inhospital mortality was the same in both groups (4.4%). Occurrence of complications (bleeding, pulmonary edema, cardiogenic shock), and frequency of use of intra-aortic balloon counterpulsation, temporary cardiac pacing were similar. However in group 1 greater portion of patients had ventricular tachyarrhythmias (15.6 vs 2.2% in group 2, р=0.007); the presence of cancer was the only independent predictor of their emergence in multiple logistic regression (OR 8.11 [1.11-40.83], p=0.011). CONCLUSIONS: Rates of application of myocardial reperfusion in STEMI patients with and without history of cancer were the same. Despite similar hospital mortality revealed peculiarities of STEMI course could affect long-term outcomes. Confirmation of this hypothesis requires planned prospective studies.

Plasma methionine depletion and pharmacokinetic properties in mice of methionine γ-lyase from Citrobacter freundii, Clostridium tetani and Clostridium sporogenes.

PK studies were carried out after a single i.v. administration of 500 and 1000 U/kg by measuring of MGL activity in plasma samples. L-methionine concentration was measured by mass spectrometry. After single i.v. injection of 500U/kg the circulating T1/2 of enzymes in mice varies from 73 to 123min. The AUC0-tinf values determined for MGL 500U/kg from C. freundii, C. tetani and C. sporogenes are 8.21±0.28, 9.04±0.33 and 13.88±0.39U/(ml×h), respectively. Comparison of PK parameters of three MGL sources in the dose of 500U/kg indicated the MGL C. sporogenes to have better PK parameters: clearance 0.83(95%CI: 0.779-0.871) - was lower than C. tetanii 1.27(95%CI: 1.18-1.36) and C. freundii 1.39(95%CI: 1.30-1.49). Mice plasma methionine decreased to undetectable level 10min after MGL 1000 U/kg injection. After MGL C. sporogenes 500U/kg injection plasma methionine level completely omitted after 10min till 6h, assuming the sustainability of negligible levels of methionine (<5µM) in plasma of mice for about 6h. The recovery of methionine concentration showed the advantageous efficiency of MGL from C. sporogenes: 95% 0.010-0.022 vs 0.023-0.061 for MGL C. freundii and 0.036-0.056 for MGL C. tetani. There are no significant differences between methionine cleavage after MGL C. tetani and MGL C. sporogenes i.v. injection at all doses. MGL from C. sporogenes may be considered as promising enzyme for further investigation as potential anticancer agent.

[THE INFLUENCE OF INFORMATION LOAD ON THE TIMECOURSE OF SPECTRAL PARAMETERS OF HEART RATE VARIABILITY IN STUDENTS WITH DIFFERENT CHRONOTYPES].

In the study, distinctions in daily timecourse of spectral parameters of the heart rate variability (HRV) at rest wakefulness and at information load in students with different chronotypes are revealed. The most pronounced changes in the general spectral power of HRV due to fluctuations of all parameters, but especially the VLF, LF, HF waves and the LF/HF index were found in students with a daily chronotype at rest and after implementation of load tests during the different periods of the school day. In persons with an evening chronotype in conditions of rest, the greatest variability was found in a spectral HF component of HRV, and responses to information load were found during the day in different combinations of changes of LF and HF components and the LF/HF index. In students with a morning chronotype during rest wakefulness, considerable fluctuations of a proportion of LF waves were observed, whereas in response to information load during certain periods of the day, representation of LF and HF components of the spectrum was changed. The wide variability of HRV spectral parameters in students with daily activity, compared to students with early and late activities, reflects the advantages of persons with a daily chronotype in terms of adaptation to different operation modes and irregular stress information in the course of the day.

[Habitat and incidence of respiratory organs diseases in the Samara population].

There was performed the assessment of habitat quality for Samara population. Risk factors for prevalence of respiratory diseases (pneumonia, allergic rhinitis, asthma) in children, teenagers and adults were revealed to be formaldehyde, phenol, hydrogen sulfide in the ambient, cadmium and copper in the soil.

[The impact of social and psychological factors on the formation of health students during training in the higher educational institution].

There was performed an assessment of anthropometric indices of physical development and functional parameters of the cardiovascular system, psychological and social status in 770 students of the higher educational institutions in the city ofSamara. There was revealed the presence of I-III degree obesity in 13.2% of young males and underweight in 19.1% of young females. Stress and disruption of the processes of the adaptation process were shown to be observed in 7.6% and 6.1% of students, respectively. There was found a tendency to hypertension in 12.6% of young males. Revealed changes are related to lifestyle of the modern student. The main factors for the improvement of the life quality is the duration of sleep and ultimate nutrition. Initially, the lower level of physical and functional capabilities is compensated by virtue of the correct organization of social and psychological factors and prevents possible deviations from the part of health.

[Outpatient treatment of irritable colon syndrome: quality of diagnosis and treatment]. / Otsenka polnotsennosti diagnostiki i éffektivnosti lecheniia bol'nykh s sindromom razdrazhennogo kishechnika v poliklinike.

40 patients with irritable colon syndrome were treated outpatiently: 26 patients by gastroenterologist and 14 ones by therapist. Management of such patients by gastroenterologist significantly lowered frequency of their hospitalizations and sick leave duration as compared to those treated by therapist.