[The role of comprehensive geriatric assessment in the treatment of cancer patients in elderly and senile age.]

Modern approaches to the organization of diagnosis and treatment of elderly and senile patients with malignant tumors allow to maintain the necessary level of health, improve the quality of life and increase life expectancy. Assessment of geriatric status in Oncology allows: to predict complications during the complex treatment, including drug treatment; to modify treatment to reduce the risk factors of adverse outcomes; to select patients for specialized treatment using standard schemes. So, timely assessment of geriatric syndromes and their correction can expand the indications for specialized treatment of elderly and senile patients.

[Optimization of cognitive rehabilitation of elderly patient with motor disorders on the basis of modern digital technologies.]

The problem of cognitive dysfunction in modern gerontological aid goes to the leading positions, complicating treatment and rehabilitation of concomitant motor disorders. The current trend in recent years is the search and development of models of cognitive rehabilitation of elderly patients on the basis of digital technology with the ability to transfer the effect on the motor and mental sphere. The literature sources of the last 5-7 years describe dozens of methods of cognitive rehabilitation, including on the basis of computer games, which demonstrate the importance of these techniques not only in improving the cognitive abilities of patients, but also in Preservation of social adaptation and daily functioning. At the same time negligible attention is paid to the problem of application of digital technologies in rehabilitation of cognitive disorders in patients with motor disorders and possible transfer of effect between spheres. This study shows the application of the algorithm of action with the participation of electronic devices as cognitive rehabilitation with compensatory mechanism in comorbid patients with motor and moderate cognitive impairment.

[The first results of assessment of clinical efficacy of melatonin and metformin in patients with disseminated skin melanoma receiving dacarbazine as first-line systemic therapy].

The aim of the study was to assess efficacy and safety of combined therapy with dacarbazine and melatonin or metformin in comparison with dacarbazine alone in the 1st line of therapy of cutaneous melanoma. Thirty-six patients with disseminated melanoma, therapy naïve, were included between March 2014 and December 2015. Patients received DTIC 1000 mg/m2 in day 1 of 28-day cycle either as monotherapy (group 1) or in combination with melatonin 3 mg PO daily (group 2) or metformin 850 mg 2 times a day PO daily (group 3). Thirty-four patients were randomized (15-in group 1, 8 - in group 2, 13 - in group 3) and received 119 cycles of therapy. Response rate was 11% in groups 1 and 2, and 8,3% - in group 3 (p=0,57). Median time to progression was 52, 79 and 63 days, respectively in the 1st, 2nd and 3rd group (р=0,468). Two patients from the 2nd and 3rd group showed delayed response to therapy. No adverse events of grade 3-4 were seen. Thus, DTIC with melatonin or metformin was well tolerated. No meaningful increase of adverse event incidence was seen. No benefit of either combination was shown in this interim analysis. Delayed responses in melatonin and metformin combination groups were registered. This suggests immunologic effect of both drugs and warrants further study.

[Impact of bariatric surgery on vitamin metabolisms in obese patients].

AIM: To investigate the impact of bariatric surgery (BS) on the level of vitamins in obese patients. SUBJECTS AND METHODS: One hundred obese patients (78 women and 22 men) aged 19 to 61 years were examined. Controlled gastric banding (CGB) was carried out in 20 patients (mean body mass index (BMI), 41.3 ± 8.2 kg/m2); gastric sleeve resection (GSR) in 40 patients, and gastric shunting (GS) in 40 (the mean BMI in these groups were 41.1 ± 17.8 and 45.9 ± 6.2 kg/m2, respectively). A control group consisted of 10 apparently healthy individuals (BMI, 24.9 ± 3.2 kg/m2). An enzyme immunoassay was used to determine the serum concentrations of vitamins B1, B2, B5, B6, B9, B12, C, and D, niacin, biotin, and retinol-binding protein (RBP) before and 1 year after surgery. RESULTS: All the three groups showed a considerable decrease in the levels of vitamins C, B5, B6, and D, and RBP both prior to and following BS. More than 50% of the patients who had undergone GSR had also a lower baseline niacin level. A year after CGB, GSR, and GS, the number of patents with deficiency of these vitamins remained the same or increased. The majority of patients with the same level of vitamin B2, niacin, and folic acid (FA) were observed to have its decrease a year postsurgery. The concentration of the other test vitamins was also reduced a year after all operations; however, it remained within the normal range. GS had no substantial impact on the concentrations of FA, vitamins B2, B12, B1, and biotin. The lower serum vitamin levels were not accompanied by clinical symptoms in most patients following BS. CONCLUSION: In 80% of the patients with obesity, the levels of vitamins C, B6, and D were decreased to a variable degree. After BS, there was a rise in the number of patients with low serum vitamin C, D, B6, B5, niacin, FA, and RBP concentrations, at the same time the number of patients with FA deficiency increased by more than twice. BS did not significantly affect the metabolism of vitamins B1 B2 B12, and biotin.

[THE CHANGE IN THE CONCENTRATION OF VITAMINS AFTER BARIATRIC SURGERY].

AIM: to study the concentration of vitamins in obese patients after bariatric surgery (BS). MATERIAL AND METHODS: A total of 100 obese patients aged 19 to 61 years (78 women, 22 men). 20 patients (mean body mass index (BMI)--41.3 ± 8.2 kg/m²) had adjustable gastric banding (AGB), 40 patients--sleeve gastrectomy (SG) and 40--gastric bypass (GB) (mean BMI Group 41.1 ± 17.8 kg/m², and 45.9 ± 6.2 kg/m², respectively). The control group consisted of 10 healthy subjects (BMI--24.9 ± 3.2 kg/m²). We determined the serum level of vitamins B1, B2, B5, B6, B9, B12, C, D, niacin, biotin, and retinol-binding protein (RBP) before surgery and 1 year after it. RESULTS: There was a significant reduction ofvitamins C, B6, B5, D and RBP both before and after BS. More than half of patients after SG, also had initial reduction of niacin. A year after BS (AGB, SG, GB) the number of patients with deficiency of these vitamins remained the same or increased. Most patients with normal or even elevated levels ofvitamin B2, niacin and folic acid, has been declining a year after BO. The concentration of the rest of the vitamins also significantly decreased a year after all operations, but their performance remained within normal limits. CONCLUSION: Levels of vitamins C, B6 and D were reduced in more than 70% patients with obesity. The number of patients with low levels of vitamin C D, B6, B5, niacin, folic acid and RBP increased after BS. BS does not have a significant effect on the metabolism ofvitamins B1, B2, B12 and biotin.

Power-controlled phase-matching and instability of CW propagation in multicore optical fibers with a central core.

We present modulation instability analysis including azimuthal perturbations of steady-state continuous wave (CW) propagation in multicore-fiber configurations with a central core. In systems with a central core, a steady CW evolution regime requires power-controlled phase matching, which offers interesting spatial-division applications. Our results have general applicability and are relevant to a range of physical and engineering systems, including high-power fiber lasers, optical transmission in multicore fiber, and systems of coupled nonlinear waveguides.

Anti-resorptive agents reduce the size of resorption cavities: a three-dimensional dynamic bone histomorphometry study.

Alterations in resorption cavities and bone remodeling events during anti-resorptive treatment are believed to contribute to reductions in fracture risk. Here, we examine changes in the size of individual remodeling events associated with treatment with a selective estrogen receptor modulator (raloxifene) or a bisphosphonate (risedronate). Adult female rats (6months of age) were submitted to ovariectomy (n=17) or sham surgery (SHAM, n=5). One month after surgery, the ovariectomized animals were separated into three groups: untreated (OVX, n=5), raloxifene treated (OVX+Ral, n=6) and risedronate treated (OVX+Ris, n=6). At 10months of age, the lumbar vertebrae were submitted to three-dimensional dynamic bone histomorphometry to examine the size (depth, breadth and volume) of individual resorption cavities and formation events. Maximum resorption cavity depth did not differ between the SHAM (23.66±1.87µm, mean±SD) and OVX (22.88±3.69µm) groups but was smaller in the OVX+Ral (14.96±2.30µm) and OVX+Ris (14.94±2.70µm) groups (p<0.01). Anti-resorptive treatment was associated with reductions in the surface area of resorption cavities and the volume occupied by each resorption cavity (p<0.01 each). The surface area and volume of individual formation events (double-labeled events) in the OVX+Ris group were reduced as compared to other groups (p<0.02). Raloxifene treated animals showed similar amounts of bone remodeling (ES/BS and dLS/BS) compared to sham-operated controls but smaller cavity size (depth, breadth and volume). The current study shows that anti-resorptive agents influence the size of resorption cavities and individual remodeling events and that the effect of anti-resorptives on individual remodeling events may not always be directly related to the degree of suppression of bone remodeling.

[Diagnostic value of serum markers of fibrosis in chronic liver diseases].

AIM: To estimate the diagnostic value (DV) of direct markers of liver fibrosis, such as type IV collagen (C-IV), hyaluronic acid (HA), tissue inhibitor of metalloproteinases-1 (TIMP-1) in combination with indirect markers of fibrosis, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (gamma-GTP), alkaline phosphatase (ALP), platelets, tumor necrosis factor-alpha (TNF-alpha) in evaluating liver fibrosis. SUBJECTS AND METHODS: Sixty-seven patients with chronic diffuse liver diseases were examined. ALT, AST, gamma-GTP, and ALP were determined as indirect indicators of fibrosis. The levels of TIMP-1, HA, C-IV, and TNF-alpha were estimated by ELISA; the stage of fibrosis was determined by the results of indirect liver ultrasound fibroelastography (FE). RESULTS: According to the results of FE, the patients were divided into 2 groups: 1) (n = 25) F < or = 2 METAVIR and 2) (n = 42) F3-F4. While estimating DV of severe fibrosis stages (F3-F4), the area under the ROC curve (AUC) increased for platelets, HA, and C-IV. DV of ALT, AST declined with the higher degree of fibrosis. The highest ratio of test specificity and sensitivity (TSp and TSen) and AUC were observed for AST and HA. ALT and platelets showed low TSen, and TNF-alpha and TIMP-1 had no TSp. For evaluation of fibrosis (F4), a HA increase of over 57.7 ng/ml had 92.6% TSen and 67.5% TSp; for a C-IV elevation of above 133.1mkg/l, TSen was 85.2%, TSp was 57.5%; for a TIMP-1 rise from 24.4 ng/ml, TSen was 74.1% and TSp was 62.5%. For the diagnosis of fibrosis (F4) with a HA rise of more than 57.7 ng/ml, DV of a positive test was 65.8 (48.65-80.4; 95% CI) and that of a negative test was 93.1 (76.8-99.2; 95% CI). Thus, the negative rather than positive test results are of great diagnostic value for evaluation of the degree of fibrosis. CONCLUSION: The results of the investigation convincingly suggest that examination of the serum markers of fibrosis allows one to estimate with a high probability its presence and severity in patients with hepatic cirrhosis. The so-called direct markers (substances reflecting the biochemistry and regulation of fibrogenesis) are undoubtedly of great diagnostic value.

Three-dimensional characterization of resorption cavity size and location in human vertebral trabecular bone.

The number and size of resorption cavities in cancellous bone are believed to influence rates of bone loss, local tissue stress and strain and potentially whole bone strength. Traditional two-dimensional approaches to measuring resorption cavities in cancellous bone report the percent of the bone surface covered by cavities or osteoclasts, but cannot measure cavity number or size. Here we use three-dimensional imaging (voxel size 0.7×0.7×5.0 µm) to characterize resorption cavity location, number and size in human vertebral cancellous bone from nine elderly donors (7 male, 2 female, ages 47-80 years). Cavities were 30.10 ± 8.56 µm in maximum depth, 80.60 ± 22.23∗10(3) µm(2) in surface area and 614.16 ± 311.93∗10(3) µm(3) in volume (mean ± SD). The average number of cavities per unit tissue volume (N.Cv/TV) was 1.25 ± 0.77 mm(-3). The ratio of maximum cavity depth to local trabecular thickness was 30.46 ± 7.03% and maximum cavity depth was greater on thicker trabeculae (p<0.05, r(2)=0.14). Half of the resorption cavities were located entirely on nodes (the intersection of two or more trabeculae) within the trabecular structure. Cavities that were not entirely on nodes were predominately on plate-like trabeculae oriented in the cranial-caudal (longitudinal) direction. Cavities on plate-like trabeculae were larger in maximum cavity depth, cavity surface area and cavity volume than cavities on rod-like trabeculae (p<0.05). We conclude from these findings that cavity size and location are related to local trabecular microarchitecture.

Mechanical failure begins preferentially near resorption cavities in human vertebral cancellous bone under compression.

The amount of bone turnover in the body has been implicated as a factor that can influence fracture risk and bone strength. Here we test the idea that remodeling cavities promote local tissue failure by determining if microscopic tissue damage (microdamage) caused by controlled loading in vitro is more likely to form near resorption cavities. Specimens of human vertebral cancellous bone (L4, 7 male and 2 female, age 70±10, mean±SD) were loaded in compression to the yield point, stained for microscopic tissue damage and submitted to three-dimensional fluorescent imaging using serial milling (image voxel size 0.7×0.7×5.0 µm). We found the resulting damage volume per bone volume (DV/BV) was correlated with percent eroded surface (p<0.01, r(2)=0.65), demonstrating that whole specimen measures of resorption cavities and microdamage are related. Locations of microdamage were more than two times as likely to have a neighboring resorption cavity than randomly selected sites without microdamage (relative risk 2.39, 95% confidence interval of relative risk: 2.09-2.73), indicating a spatial association between resorption cavities and microdamage at the local level. Individual microdamage sites were 48,700 (40,100; 62,700) µm(3) in size (median, 25th and 75th percentiles). That microdamage was associated with resorption cavities when measured at the whole specimen level as well as at the local level provides strong evidence that resorption cavities play a role in mechanical failure processes of cancellous bone and therefore have the potential to influence resistance to clinical fracture.

[Antiproliferative activity of diclofenac at tumor cell cultures].

It is known that for risk group's importance of early diagnostics and prevention of a cancer of a thick section of the intestines. The view was expressed that the use of nonsteroidal anti-inflammatory drugs prospectively. The article presents the data obtained after the determination of the effect on the domestic drug diclofenac on the ability of the lines of tumor cells of the human colon multiply this antiproliferativoe action on the dose of the drug. Used photometric method for determination antiproliferativoe action. In vitro determined the effect of the national drug diclofenac on the ability of the lines of tumor cells of the human colon multiply, and is set in a dose-dependent effect. It is established that under the action of NSAIDS metabolic activity of cells can both strengthen and weaken that depends on the line of tumor cells and the concentration of the drug.

[Protein that binds fatty acids (I-FABP)--a new perspective evidence for injury of the small intestine].

The article presents literature data on the diagnostic value of the new indicator of the epithelial damage of the small intestine--I-FABP (protein binding fatty acids) and the results of our investigation of this indicator in 63 patients with functional bowel disease, and 20--the control group presented patients with erosive gastritis. Also presented diagnostic value of this indicator and defined the boundaries of normal values for this indicator.

[Modeling damage of the mucous membrane of the gastrointestinal tract in rats].

We studied the effect of NSAIDs on the stomach lining and intestines. Animals received the selective and nonselective NSAIDs. Revision of the abdominal cavity was performed after 24 hours and 14 days. In the mucosa was determined by the levels of prostaglandins and measured the index of damage. Lowering the synthesis of PG in the mucosa of the gastrointestinal tract contributes to the formation damage. After 24 hours when receiving non-selective COX inhibitors and selective inhibitors of COX-2 revealed the presence of mucous membrane lesions that are smaller than in groups of animals treated with selective NSAIDs. After 14 days of reception remains a low level of GHGs in the group of animals treated with nonselective NSAIDs. Visually mucosal damage are insignificant, but in the submucosal layer preserved microcirculatory blood flow disturbances.

[Hormonal component of the gastrointestinal diseases pathogenesis].

This article summarizes results of numerous experimental and clinical studies conducted in the laboratory of gastrointestinal hormones CSRIG that was made to examine the endocrine status and metabolic changes in the digestive system with its physiological and pathological conditions.

[Stages of chronic pancreatitis development].

AIM: To ascertain correlations between pancreatic secretion disturbances and stage and complications of chronic pancreatitis (CP). MATERIAL AND METHODS: The examination covered 81 CP patients (32 females, 49 males, mean age 55.9 +/- 1.8 years). Alcohol pancreatitis (AP) was diagnosed in 52 of them, biliary pancreatitis--in 29, complicated pancreatitis--in 25 patients. The control group consisted of 22 patients without symptoms of gastrointestinal disease. RESULTS: By the results of clinical, device, laboratory and morphological tests we recognize 3 variants of CP course. Variant A: duration under 5 years, distinct pain syndrome, pancreatic fecal elastase (E-1) level insignificantly decreased, elevated blood levels of acetylcholine (Ac), serotonin (5-NT), cholecystokinin (CCK), secretin is subnormal. Pancreatic tissue is inflamed and swollen. Variant B: duration 5-10 years, E-1 under 100 mcg/g, moderate pain syndrome, prevalence of 5-NT as a stimulator of pancreatic secretory activity. CCK is high and secretin is low. Further progress of fibrous changes by ultrasound investigation, abdominal CT leads to calcinosis in pancreatic tissue. Variant C: duration 10 years and longer, weak pain syndrome, further rise of 5-NT concentration, decompensation of regulatory mechanisms of secretory pancreatic activity, CCK is high, secretin is subnormal. CONCLUSION: Changes in correlations between neuromediators and hormones in CP reflect adaptation aimed at retension of secretory pancreatic activity in significant fibrous changes of pancreatic tissue.

[Clinical and diagnostic significance of gepsidin level in the regulation of iron metabolism in patients with inflammatory bowel disease].

UNLABELLED: Gepsidin is an iron regulatory protein that inhibits ferroportin, limiting the transport of iron into the cell of the small intestine villi and blocking the exit of iron from macrophages, that often leads to disruption of iron homeostasis, iron deficiency and the development of anemia. The Aim was to study the levels of gepsidin in patients with IBD and determine its prognostic significance for the development of anemia. We examined 80 patients with IBD, 45 (56%) men and 35 (44%) women with the average age of 39,0 +/- 15,8 years. In 40 patients with anemia and 40 patients with IBD without anemia syndrome, studies were conducted in the status of iron metabolism, the level of gepsidin, TNF, C-reactive protein. CONCLUSION: IBD with systemic inflammatory response leads to increased levels gepsidina and increases the risk of anemia in IBD. Determination of gepsidin in IBD patients enables identify patients at risk for anemia and to clarify the effectiveness of the basic treatment of the disease.

[The role of hormones and types of food behavior in the development of metabolic syndrome].

THE AIM: To investigate the role of hormones and the types of FB in the development of morbid obesity (MO), to develop a treatment policy for MO to examine the diagnostic predictive value of the FB hormones and FB modifications. MATERIALS AND METHODS: Were investigated 67 patients: 28 (42%) males and 39 (58%) female aged 18 to 60 years under the scheme: medical history, questionnaire on the questionnaire SF-36, score types of FB, the study of the anthropometric data (OT/OB, BMI), the definition of the FB hormones with subsequent control of BMI, OT/OB dynamics, types and FB hormones. RESULTS: In patients older than 50 years were dominated abdominal FB, in patients younger than 50 years - all three types of FB in approximately equal proportions. After the decline in MT was observed pattern between the FB modification and age of the patient. There was an increase of leptin and ghrelin and decrease in serotonin at all three types of FB. After weight correction was a decreased leptin, ghrelin, and increased serotonin, but the achievement of normal numbers are not marked. The paradoxical result is related to a violation of reciprocal relations of hormones. CONCLUSIONS: In patients with MO FB hormone levels (Leptin, Ghrelin) elevated to normal values, reduced levels of serotonin, there is an infringement of their reciprocal correlations. The approach to patients should be lengthy and complex, involving multidisciplinary team aimed at FB correcting the with the rejection of improper food stereotype. In the treatment of MO must used different methods: reducing diet, physiotherapy effects, drug therapy and their combination with the selection of individual programs, taking into contraindications account. For the above techniques inefficiency is necessary to use surgical treatment. Correction of FB in patients older than 50 years is the most difficult task (due to the presence of concomitant diseases). Necessary to draw attention and to start treatment at a young age.

[Thyroid dysfunction and soft fatty liver disease].

This review discusses the correlation of thyroid dysfunction and non-alcoholic fatty liver disease.

[Changes in concentration of cholecystokinin-pancreozymin in patients with cholelithiasis before and after cholecystectomy].

The level of cholecystokinin and secretin in 50 patients after cholecystectomy (from 1 to 10 years ago) was analyzed to study connection between cholecystectomy and gastrointestinal hormones concentration. 30 patients with gall bladder stone disease were included into the group of comparison. Cholecystokinin and secretin concentration in the groups of research was compared with indicated hormones concentration in the group of control formed of healthy volunteers. After anamnestical clinical and diagnostical features in every group had been studied we concluded, that cholecystokinin level changes depending on period after operation and outflow of bile conditions.