[Vascular endothelial growth factor in elderly and senile age: clinical and pathogenetic relationships.]

The aim of the study was to study the role of serum vascular endothelial growth factor and to determine its clinical significance in elderly and senile patients. The study included 124 people (40 men and 84 women) aged 60 to 89 years, the average age was 68,8±7,4 years. Serum levels of vascular endothelial growth factor (VEGF) were studied in the work; blood lipid spectrum parameters, indicators of acute phase blood proteins: C-reactive protein (C-RP), fibrinogen; glomerular filtration rate (GFR) according to the CKD-EPI formula based on serum creatinine and according to the F. Hoek method using cystatin C. In general, 15,3% of the examined individuals had elevated serum levels of VEGF, more often in elderly patients. It was found that serum levels of VEGF are positively associated with the concentration of CRP (r=0,411), the number of platelets in peripheral blood (r=0,358) and positive with the concentration of serum cystatin C (r=0,211). In the subgroup of patients with an elevated serum VEGF level, the platelet count, the concentration of C-RP, fibrinogen, and cystatin C were significantly higher, and the calculated GFR according to F.Hoek was significantly lower. Patients with an elevated serum VEGF level, as a pro-inflammatory and prothrombogenic potential, especially if it is associated with the development of kidney dysfunction in the elderly and senile, should be considered as a risk group for atherothrombotic cardiovascular events.

[Chronic cerebral ischemia in therapeutic hospital patients]. / Khronicheskaya ishemiya mozga u patsientov terapevticheskogo statsionara.

OBJECTIVE: To study the features of clinical and functional manifestations of the syndrome of chronic cerebral ischemia (CCI) in therapeutic patients. MATERIAL AND METHODS: Patients (n=577) in therapeutic departments were selected by random sampling. Of these, 277 patients had verified CCI. RESULTS: Patients with CCI, compared with the control group, were older (61.7±9.6 years and 43.3±12.2 years, p<0.05), had a significant increase in body mass index (28.5±5.1 and 26.9±5.7 kg/m2, p<0.05), systolic level (140±20 and 127±17 mmHg, p<0.05) and diastolic blood pressure (87±10 and 82±11 mm Hg, p<0.05), platelet count in peripheral blood (278.0±70.7·109/l and 259.1±80.8·109/l, p<0.05), venous blood glucose (7.11±3.8 and 5.31±1.7 mmol/l, p<0.05), triglycerides (1.37 (1.01; 1.97) mmol/l and 1.34 (0.96; 1.96) mmol/l, p<0.05), uric acid (0.425±0.12 and 0.374±0.14 mmol/l, p<0.05), creatinine (82.7 (68.0; 114.0) µmol/l and 72.3 (61.8; 93.0) µmol/l, p<0.05) and cystatin C (1.24 (1.08;1.62) mg/l and 1.01 (0.87; 1.32) mg/l, p<0.05). Statistically significant decrease in the concentration of high-density lipoprotein cholesterol (1.0±0.28 mmol/l and 1.2±0.32 mmol/l, p<0.05), serum magnesium (0.90±0.15 and 0.94±0.13 mmol/l, p<0.05) and estimated GFR (57.9±24 and 72.6±26.8 ml/min, p<0.05) were characteristic of patients with CCI. Elevated levels of C-reactive protein and anemia were significantly more common in these patients. A close correlation was found between the concentrations of uric acid (r=0.786; p<0.001) and cystatin C (r=0.587; p<0.005) in blood serum and the thickness of the intima-media complex of the carotid arteries. CONCLUSION: In patients of a therapeutic hospital, CCI is associated with older age, weight gain, arterial hypertension, dyslipidemia, anemia, inflammation, hypomagnesemia, hyperuricemia, thickening of the intima-media complex of the carotid arteries, and a decrease in the functional state of the kidneys.

[Modern biomarkers of renal dysfunction in the elderly and senile age: clinical and prognostic significance.]

In the presented work, the role of modern biomarkers of kidney dysfunction in elderly (n=97) and senile (n=18) patients was investigated. A clinical and laboratory examination was performed with an assessment of the glomerular filtration rate (GFR) using the CKD-EPI formula. Serum levels of cystatin C and metabolism of beta-2-microglobulin (ß2-MG) were assessed. In the presented sample, the prevalence of a decrease in GFR <60 ml/min was 30,4% of cases. The frequency of individuals with elevated serum cystatin C, depending on the GFR category (CKD-EPI), was as follows: C1 - in 79,9%; C2 - in 77,6%; C3A - in 74%; C3B - in 80,6%; C4 - in 100%; C5 - in 100%. An increase in the serum level of ß2-MG was observed in 51,8 and 58,4% of patients, respectively, on C1 and C2 gradations of renal function. An increase in urinary ß2-MG excretion was found in 40,7% of patients at C1 and 41,5% at C2 gradations of renal function. The number of patients who had elevated levels of ß2-MG excretion in the urine at C3B and C4 gradations of GFR reduction was 75 and 88,6%, respectively. At the terminal stage of CKD, almost every patient showed an increase in ß2-MG excretion in the urine. A statistically significant relationship between the metabolism of ß2-MG and the nitrogen excretion function of the kidneys was established. In elderly and senile people, the determination of serum levels of cystatin C and ß2-MG makes it possible to detect a decrease in the filtration function of the kidneys at an earlier stage compared with the assessment of GFR calculated from the level of blood creatinine. Elevated levels of cystatin C and ß2-MG are additional risk factors for cardiovascular complications.

[Cerebrovascular complications in patients with malignant neoplasms]. / Tserebrovaskulyarnye oslozhneniya u bol'nykh so zlokachestvennymi novoobrazovaniyami.

Patients with malignant neoplasms have an increased risk of cerebrovascular complications (intratumoral hemorrhage, invasion of arterial and venous sinus by tumor mass or leptomeningeal infiltrates, and tumor embolism). The review discusses the role and importance of cisplatin and radiation therapy in the occurrence of cerebrovascular complications in patients with malignant neoplasms that may occur before, during or years after treatment. Descriptions of individual clinical observations of the lesions of the central nervous system in the treatment of cancer are provided. The type and mechanism of stroke, as well as the stage and pathology of the neoplasm, dictate the use of a multidisciplinary approach, which ensures proper management and helps to outline the prognosis in this category of patients.

Gene-to-gene interactions and the association of TP53, XRCC1, TNFα, HMMR, MDM2 and PALB2 with breast cancer in Kyrgyz females.

BACKGROUND: At present, little is known about the genetic background of breast cancer (BC) in Kyrgyz. Therefore, the aim of this study was to assess gene-to-gene interactions and the contribution of p.Arg72Pro (TP53 gene), p.Gln399Arg (XRCC1 gene), p.Arg194Trp (XRCC1 gene), g.4682G > A (TNFα gene), p.Val353Ala (HMMR gene), c.14 + 309 T > G (MDM2 gene) and g.38444 T > G (PALB2 gene) polymorphic loci in breast cancer (BC) risk in females of Kyrgyz ethnicity. METHODS: The case-control study comprised 103 females with histologically verified BC and 102 controls with no cancer. We used polymerase chain reaction-based restriction fragment length polymorphism to genotype polymorphic loci. RESULTS: Gln/Arg heterozygous variant of XRCC1 gene's p.Gln399Arg locus, as well as combined carriage of Arg/Gln//Arg/Pro of XRCC1/TP53; Arg/Gln//T/T of XRCC1/MDM2; Arg/Gln//G/G and Arg/Gln//G/A of XRCC1/TNFα, Arg/Gln//T/T of XRCC1/PALB2; Arg/Gln//Arg/Arg and Arg/Gln//Arg/Trp for p.Gln399Arg and p.Arg194Trp polymorphic loci of XRCC1 were associated with BC in Kyrgyz females. CONCLUSION: TP53, XRCC1, TNFα, HMMR, MDM2 and PALB2 genes' polymorphic site combinations appear to be candidate markers of genetic predisposition to BC in Kyrgyz population and prompt targeted personalized care.

[A choice of reconstructive plastic surgery with endoprosthesis of the breast after radical mastectomy]. / Vybor rekonstruktivno-plasticheskoi operatsii s éndoprotezirovaniem molochnoi zhelezy posle radikalnoi mastéktomii.

The creation of silicone endoprosthesis led to new approaches in solving the problems of plastic replacement of the breast after radical mastectomy. Two variants of reconstructive plastic operations with endoprosthetics of the breast were employed: group one--the formation of the seat of the endoprosthesis using a transposed musculocutaneous flap from the latissimus dorsi muscle; group two--the formation of the seat of the endoprosthesis by stretching the skin with a specially designed stretcher-expander and subsequent implantation of the endoprosthesis. The first method is rather injurious, sometimes cannot be performed because of anatomical contraindications, and is fraught with the development of necroses in the transposed tissues. Among 34 patients operated on by the first method two had marginal necrosis of the skin above the endoprosthesis. No complications were recorded among the 46 patients who underwent operation by the second method. The condition of the endoprosthesis and the tissues surrounding it was appraised in the immediate and late periods by radiological and ultrasonic examination. The variants of endoprosthetics of the breast which we applied may be employed with competence in clinical practice, but a reconstructive-plastic operation with the use of a skin expander is preferable.