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This article is devoted to examination of the German language island dialects specific dynamics in foreign language environment. Along with the nature of changes in the German national minority sub-dialects (in Russia), the degree of the original dialectal features loss is determined in this study. It was found that sub-dialects as elements of the language system continue to exist even outside the native language range. The authors define the German dialects in the territory of the Lower Volga region as variants of an authentic (German) language system in the extreme developmental conditions. This issue is of particular research interest, which determines the relevance of the article. It was found that island sub-dialects are affected both by the native language system, and by a foreign language and culture. Language relations are determined not only by coexistence of the two language systems, German and Russian, and bilingualism of the majority of the German ethnic group representatives, but by the complex specificity of the language processes in the past and even a more complicated current language situation. Lexical, morphological and phonetic levels of island sub-dialects in their dynamic development have been analyzed. The invariability of a number of dialect features is explained by the language systemic nature and archaization processes. The hypothesis that the national origin at turning points of a person’s life can lead to the increase in ethnic identification has found confirmation. Cultural and linguistic elements that were previously limited by law become a means of persuasion and cohesion. Minority representatives whose identity is threatened with loss, preserve and emphasize their ethnic cultural and language origin more often than the majoritarian society members.

The article proves that modern political discourse has obvious signs of hybridization and integration with PR-discourse that is defined by its reference structure. As the result of the process of hybridization the format of political PR-discourse is created. The author gives a definition of political PR-discourse and proves that political PR-discourse is a homogeneous entity due to the fact that it is based on the reference situation that includes both referents related to the current political situation, and referents, describing the situation of self-presentation of a positive image and reputation of the politician, when his personal qualities are discursivized. During formatting of the political PR-discourse there is a construction of a special worldview favorable to the politician. The construction of version of the social world in political PR-discourse takes place in isolation from the objective social world; a certain future, desirable world is constructed, in which the politician appears in the most favorable light.

The purpose of the study is to analyze effect of system of non-material incentives on psychological well-being of teachers in pandemic conditions. The research method of questionnaire survey of employees sampling (N = 193) was applied. The information obtained was completed by results of focus group study that made it possible to identify psychologically vulnerable groups of teachers. The results demonstrated that only every fifth teacher is completely satisfied with system of non-material incentives. The survey established that traditional forms of non-material incentives (birthday greetings, challenge prize for best structural unit) are losing their significance in pandemic conditions. The high workload, organizational changes in educational institutions reduce relevance of such measures of non-material incentives as inclusion in administrative personnel reserve for teachers. It is established that significant influence of shortcomings of motivational profile provoke occurrence of such violations as violation of team value unity; persistent prevalence of negative emotions; alienation, hiding lack of confidence in their abilities; deformation of systemic nature of mutual assistance; increase of anxiety and proneness to conflict in university teachers. For teachers, job stability turns out to be more important than career prospects. The top lines of rating in assessing system of non-material incentives are occupied by extension of term of employment contract, and participation in innovative projects. The recognition of colleagues and inclusion into creative teams is considered as one of the most effective measures to ensure psychological well-being of teacher.

Metchnikovellids (Microsporidia: Metchnikovellida) are poorly studied hyperparasitic microsporidia that live in gregarines inhabiting the intestines of marine invertebrates, mostly polychaetes. Our recent studies showed that diversity of metchnikovellids might be significantly higher than previously thought, even within a single host. Four species of metchnikovellids were found in the gregarines inhabiting the gut of the polychaete Pygospio elegans from littoral populations of the White and Barents Seas: the eugregarine Polyrhabdina pygospionis is the host for Metchnikovella incurvata and M. spiralis, while the archigregarine Selenidium pygospionis is the host for M. dogieli and M. dobrovolskiji. The most common species in the White Sea is M. incurvata, while M. dobrovolskiji prevails in the Barents Sea. Gregarines within a single worm could be infected with different metchnikovellid species. However, co-infection of one and the same gregarine with several species of metchnikovellids has never been observed. The difference in prevalence and intensity of metchnikovellid invasion apparently depends on the features of the life cycle and on the development strategies of individual species., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Objective: To explore the experts' opinion on the feasibility of using Mini-Kog, MMSE and GPCOG tests for screening assessment of cognitive impairment in elderly and senile patients at the primary stage of medical care, as well as to compare different characteristics of these tests according to experts' opinion., Material and Methods: The survey of specialists was carried out on the basis of 6 Medical Centers. Prior to the survey, specialists tested cognitive functions in elderly and senile patients during routine visits undergoing routine admission using Mini-Kog, MMSE and GPCOG tests, as well as interviewed their relatives using the corresponding section of the GPCOG. During the survey, specialists filled out a special physician checklist containing items for indicating socio-demographic information and questions regarding the use of tests for assessing cognitive functions in elderly and senile patients in daily clinical practice., Results: The survey involved 40 specialists from different cities of Russia (mean age±SD - 38.6±14.3 years, 82.5% - women). Elderly and senile patients accounted for the predominant proportion (76-100%) of all followed-up patients. All physicians considered it important to conduct a cognitive assessment in elderly patients and they have to use various cognitive tests in their practice. According to most experts, among the Mini-Kog, MMSE and GPCOG tests, all three tools are informative, convenient and suitable for screening cognitive impairment in geriatric patients. The MMSE test is more informative and convenient. Mini-Kog, compared to the other two tools, is the simplest and most time-efficient tool that is also better perceived by patients. An advantage of the GPCOG is the possibility of participation of informants in the assessment of cognitive functions in older patients., Conclusion: The findings could be used in further research focused on improving the approaches for early detection of cognitive impairment in geriatric patients by primary care physicians.

The authors conducted a cross-sectional epidemiological study of a random sample of community-based older adults aged 65 years and older (n=611) to assess the impact of psychological resilience on the risk of developing atrial fibrillation (AF). To assess the degree of psychological resilience, the Sense of Coherence Scale (SOC) with 47 and more points was used. The prevalence of AF was 30,1% (n=184). Participants who scored 47 or more on the SOC, after adjusting for all confounders, had a 42,9% lower risk of AF. Thus, psychological resilience is one of the protective factors that reduce the risk of AF in older adults. The use of SOC with a cut-off point of less than 47 allow to identify older adults at risk of AF.

The use of implant prosthetics in the elderly and senile patients is highly relevant. Many clinicians advocate a wider introduction of immediate implant restorations in the elderly due to the fastest restoration of aesthetics and function. The purpose of the work is to study the efficacy of implant prosthetics in elderly patients with extended replacement structures with a small number of artificial supports. The patients underwent implant restoration of the mandible with an extended metal-polymer structure «Trefoil» with a prefabricated standard frame and three artificial supports. The overall implant survival rate was 96%. The cumulative survival rate of patients was 93%. The cumulative survival level of prostheses was 98,3%. The high implant and prosthesis survival rates, the good condition of the peri-implant mucosa and bone three years after restoration, as well as the high level of patient satisfaction and the significantly higher level of their quality of life, along with the high medical and economic efficiency of the method, allow us to consider it a promising standard of geriatric dentistry.

Material and Methods: Russian version of the General Practitioner's Assessment of Cognition (GPCOG) questionnaire-test was adapted in accordance with modern international recommendations, including the procedure of its consecutive translations, testing of the Russian version of the questionnaire as part of interviewing geriatric patients and their relatives, as well as expert evaluation of the Russian version by specialists and decentering., Results: The testing procedure involved 8 geriatric patients (age 61-77 years, men/women - 3/5), as well as their relatives/other close persons; 8 specialists participated in the questionnaire (age 24-52 years, all women). Based on the data of interviewing patients and their relatives, an acceptable indicator of the external validity of the Russian version of the tool was established, according to the results of the questionnaire of specialists, its substantive validity was confirmed. The results of testing the GPCOG questionnaire-test in the focus group of patients and the questionnaire of specialists made it possible to make changes for two tasks at the decentering stage, which made it possible to improve the equivalence of the instrument to its original version, taking into account the ethno-linguistic characteristics of the domestic population., Conclusions: In the process of linguistic and cultural adaptation, the final version of the GPCOG questionnaire-test In Russian was formed, equivalent to the original and corresponding to the ethnolinguistic features of the population. The use of GPCOG in domestic geriatric practice and scientific research is possible after testing the instrument in a population of elderly and senile patients with the participation of primary care specialists and evaluating the psychometric properties of the instrument - reliability, sensitivity and specificity within the validation procedure.

Objective: To study the results and efficiency of tracheobronchial stenting in patients with unresectable tumors complicated by stenosis of central airways., Material and Methods: We analyzed the results of tracheobronchial stenting in 23 patients with unresectable tumors complicated by stenosis of central airways between 2016 and 2021., Results: Technical and clinical success rate was 100%. No intraoperative complications were noted. Dyspnea regressed in all patients in early postoperative period. Moreover, there was objective improvement in lung ventilation with increase in lung capacity (from 2.1±0.4 to 2.7±0.5 l; p <0.05), forced expiratory volume (from 1.2±0.5 to 1.8±0.4 l; p <0.05), partial pressure of oxygen in arterial blood (from 47±7.4 to 85±6.3 mm Hg; p <0.05) and arterial oxygen saturation (from 86.1±8.2 to 93.1±5.1%; p <0.05). One patient developed massive bleeding due to tumor decay on the 3 rd day after surgery. In 2 patients, stent obturation with a «mucus plug» was observed after 2-3 postoperative days. In 3 months after surgery, 21.8% of patients had disturbances of external respiration accompanied by mild dyspnea due to granulation tissue growth. Stent migration in 3 months after endoscopic stenting was recorded in 1 patient. Three-month mortality was 26.1%., Conclusion: Tracheobronchial stenting is a safe and effective minimally invasive surgical intervention. As a part of palliative care, this procedure improves functional and clinical parameters of pulmonary ventilation and reduces the incidence of complications. Thus, quality of life in patients with unresectable tumors complicated by airway stenosis is improved.

Metchnikovellids are a deep-branching group of microsporidia, parasites of gregarines inhabiting the alimentary tract of polychaetes and some other invertebrates. The diversity and phylogeny of these hyperparasites remain poorly studied. Modern descriptions and molecular data are still lacking for many species. The results of a light microscopy study and molecular data for Metchnikovella spiralis Sokolova et al., 2014, a hyperparasite of the eugregarine Polyrhabdina sp., isolated from the polychaete Pygospio elegans, were obtained. The original description of M. spiralis was based primarily on the analysis of stained preparations and transmission electron microscopy images. Here, the species description was complemented with the results of in vivo observations and phylogenetic analysis based on the SSU rRNA gene. It was shown that in this species, free sporogony precedes sac-bound sporogony, as it occurs in the life cycle of most other metchnikovellids. Spore sacs are entwined with spirally wound cords, and possess only one polar plug. Phylogenetic analyses did not group M. spiralis with M. incurvata, another metchnikovellid from the same gregarine species, but placed it as a sister branch to Amphiacantha. The paraphyletic nature of the genus Metchnikovella was discussed. The taxonomic summary for M. spiralis was emended.

Senile asthenia syndrome (SAS) is a geriatric syndrome characterized by age-associated decline of the physiological reserve and function in multiple systems, which results in higher vulnerability to effects of endo- and exogenous factors and a high risk of unfavorable outcomes, loss of self-sufficiency, and death. Generally, SAS is observed in elderly patients with comorbidities. In cardiovascular diseases, SAS is associated with a poor prognosis, including a higher incidence of exacerbation and death both during acute events and in chronic disease. However, SAS is often not taken into account in developing diagnostic and therapeutic programs for managing elderly patients with cardiovascular diseases (CVD). This article analyzes available scientific information about SAS, algorithms for SAS diagnosis, and the scales that may be useful in developing individual plans for management of elderly patients with CVD.

The species Metchnikovella dogieli (Paskerova et al. Protistology 10:148-157, 2016) belongs to one of the early diverging microsporidian groups, the metchnikovellids (Microsporidia: Metchnikovellidae). In relation to typical ('core') microsporidia, this group is considered primitive. The spores of metchnikovellids have no classical polar sac-anchoring disk complex, no coiled polar tube, no posterior vacuole, and no polaroplast. Instead, they possess a short thick manubrium that expands into a manubrial cistern. These organisms are hyperparasites; they infect gregarines that parasitise marine invertebrates. M. dogieli is a parasite of the archigregarine Selenidium pygospionis (Paskerova et al. Protist 169:826-852, 2018), which parasitises the polychaete Pygospio elegans. This species was discovered in samples collected in the silt littoral zone at the coast of the White Sea, North-West Russia, and was described based on light microscopy. No molecular data are available for this species, and the publicly accessible genomic data for metchnikovellids are limited to two species: M. incurvata Caullery & Mesnil, 1914 and Amphiamblys sp. WSBS2006. In the present study, we applied single-cell genomics methods with whole-genome amplification to perform next-generation sequencing of M. dogieli genomic DNA. We performed a phylogenetic analysis based on the SSU rRNA gene and reconstructed a multigene phylogeny using a concatenated alignment that included 46 conserved single-copy protein domains. The analyses recovered a fully supported clade of metchnikovellids as a basal group to the core microsporidia. Two members of the genus Metchnikovella did not form a clade in our tree. This may indicate that this genus is paraphyletic and requires revision.

Falls increase the risk of injury, disability, and death in the elderly. Atrial fibrillation (AF) is one of the risk factors for falls in old age, however, the relationship between «silent» AF and falls has not been investigated. The study included patients (n=131) from 60 years and older who admitted in the City geriatric medical and social center. Previously diagnosed AF was detected in 13,7% (n=18) of the study participants, and «silent» AF was detected in 11,5% (n=15). Both forms of AF were associated with a 4-fold increase in the incidence of falls in old age: (95% CI) 4,26 (1,18-15,40) for previously detected AF and 4,56 (1,25-16,66) for «silent» AF. AF screening revealed 16,9% (95% CI 6,7-26,8%; p<0,001) more patients at risk of falls. Thus, «silent» AF, as well as previously diagnosed, are independent risk factors for falls. Conducting AF screening allows to identify more elderly patients who are at risk of falls.

Purpose: elaboration of algorithm for selection of patients with resistant arterial hypertension (AH) for Catheter-Based Renal Sympathetic Denervation (CBRSD)., Materials and Methods: We examined 284 patients with resistant AH. On stage 1 we excluded most frequent causes of secondary AH. In 247 patients (86.9 %) we established secondary character of AH, in 37 patients (13.1 %) AH was found to be essential. On stage 2 patients with essential AH were given 3-5 component hypotensive therapy. At the background of this therapy we conducted 24‑hour ambulatory blood pressure monitoring (ABPM). CBRSD procedure was considered indicated if according to ABPM average 24‑hour blood pressure (BP) was above 150 and 100 mm Hg, and 24‑hour elevated BP load exceeded 60 %. In 13 of 37 patients (35 %) BP level satisfied these conditions. For CBRSD we used high frequency generator. Ablation was performed using the Symplicity Catheter. Results were assessed in 1, 2, 9, 12, and 28 months., Results: Target BP level at the background of minimal doses of hypotensive drugs was achieved in 11 patients (85 %), what was confirmed by ABPM data. Levels of mean 24-4 hour systolic and diastolic BP significantly decreased from 173.9±14.9 to 143±21.3, р&lt;0.05, and from 108.2±8.7 to 91.4±13.8 mm Hg., р&lt;0.05, respectively. Index of elevated systolic BP time decreased from 78.2±14.6 to 49.8±29.6 %, р&lt;0.05. Best effect was achieved in patients with AH duration before the procedure less than 7 years. None of the patients had episodes of cerebral vascular insufficiency or heart failure progression., Conclusion: While determining indications to bilateral CBRSD one should be governed by such criteria as exclusion of symptomatic AH and objective proofs of AH resistance (according to ABPM at the background of hypotensive therapy).

The abdominal type of cryptorchism was modeled on random-bred albino rats by replacing both testes from the scrotum into the abdominal cavity for 3 weeks; thereupon they were manipulated into the scrotum. In control rats, no additional surgery was performed. In experimental rats, the testicular tissue obtained from 1-2-day rat pups was transplanted under testicular tunica albuginea. Prior to orchiopexy, the weight of testes decreased by 62.5-64.1%. In 6 month after the surgery, it increased by 36.1% in the control group, whereas in experimental rats the weight of testes elevated by 123.2% and approximated the normal value. Histologically, the control group demonstrated persistent disturbance in spermatogenesis with emptiness of numerous seminiferous tubules where only Sertoli cells could be revealed and with pronounced dystrophic alterations in the spermatogenous epithelium of the partially preserved tubules where spermatogenesis was blocked at the spermatogonial level. In contrast, the transplantation region of the experimental testes exhibited formation of novel mature testicular tissue enclosed by a connective tissue capsule incorporating the seminiferous tubules with differentiated epithelium and with the clusters of Leydig cells in the stroma. In 6 month, spermatogenesis was observed in most seminiferous tubules of the host testicular tissue, which had spermatozoa in the lumens. To the moment of orchiopexy, the blood testosterone decreased by about 2.5-fold. In control group it remained diminished during entire observation period (up to 6 month), while in the experiment group its level normalized completely as early as in 2 month and remained even elevated to the end of observation period.

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In experiments on white outbred male rats, a freshly removed (20 experiments) or cryopreserved (10 experiments) testicle from newborn rats (1-2 days after birth) was transplanted under the renal capsule after bilateral orchiectomy. In all experiments with transplantation of freshly removed testicle, it was engrafted. In 3 months, histological examination revealed the formation of mature seminiferous tubules, but spermatogenesis was blocked at the stage of spermatogonia; groups of proliferating Leydig cells in the loose connective tissue between the tubules were also seen. In 6 and 12 months, the status of the seminiferous tubules remained unchanged, but structures typical of the epididymis and developing vas deferens were revealed. The number of proliferating Leydig cells increased. The initially low testosterone concentration in the blood of castrated males increased significantly as soon as in 1 month after transplantation and grew up to 3 months, remaining at a level ~50% of normal. Engraftment of cryopreserved neonatal testicular tissue was observed in 60% cases, however, engrafted tissue, similar to the fresh one, retained the ability for organogenesis with the formation of mature seminiferous tubules, epididymis, and groups of proliferating Leydig cells. The dynamics of blood testosterone concentration in rats with cryopreserved and fresh transplantation was similar. Subcapsular transplantation did not adversely affect the kidneys, which was seen from normal histological structure of the kidneys and creatinine and urea concentrations in the blood.

The Aim of the Study: To evaluate the prevalence and clinico-functional features of myocardial dysfunction in persons 65 years or older in the primary care seting., Materials and Methods: The prospective cohort study "Crystal" included participants 65 years and older. The arm of "Crystal" study evaluated a random sample size of 284 people. All participants were performed echocardiography using portable digital ultrasound scanner Mindray M5 ultrasound transducer of 2.5-3.5 MHz. It was also evaluated the clinical manifestations of heart failure (HF) on the scale SHOCKS, medical history and anthropometric data and parameters of the geriatric examination. Were determined muscle strength, walking speed, emotional status (Geriatric Depression Scale) and cognitive status (MiniMental State Examination). Assessment of dependence on external assistance was carried out based on the Barthel Index (Barthel Index)., Results: The prevalence of all forms of myocardial dysfunction was 80.3%, among them of 73.2% of participants had clinical manifestations of heart failure, which was not associated with type or severity of structural and functional abnormalities of the myocardium. Symptoms and signs of HF were characterized by low sensitivity for detection in older people with MD and may be associated with other conditions. The most common complaint was shortness of breath (59%), with high sensitivity for the diagnosis (89%) but low specifcity (51%). Patients with clinical manifestations of HF are more likely to have a BMI of over 30 kg/m2, cognitive disorders, suspected depression, lower walking speed and low grip strength by dynamometry. In addition, participants with symptoms were older age (75,3±5.6 years vs 72,7±5.5 years, p.

The authors examined efficacy of carotid endarterectomy (CEA) in treatment of patients suffering from vertebrobasilar insufficiency (VBI) without significant involvement of the vertebral arteries. The study included a total of 297 patients with VBI and diagnosed as having stenosis of the bifurcation of the carotid arteries amounting to 70% and more, with no significant involvement of the vertebral arteries revealed. All patients underwent CEA: eversion CEA was performed in 226 (76.1%) cases and the classical one in 71 (23.9%) cases. On postoperative day 10, clinical improvement in the form of decreased severity of VBI was observed in 152 (51.2%) patients. One year after surgery, improvement persisted in 135 (45.5%) patients and after 3 years in 125 (42%) patients. Prognostic factors of unsatisfactory clinical outcomes were determined. It was demonstrated that in VBS, CEA is clinically efficient only if the circle of Willis is closed and there is no history of stroke in the vertebrobasilar basin. Besides, the outcome of the operation appeared to have been influenced by such factor as the duration of hypertension and diabetes mellitus. No effect of either cardiac arrhythmia or the technique of CEA on the results of treatment was observed.

Aim: To estimate the frequency of fungal sensitization and the incidence of allergic bronchopulmonary aspergillosis (ABPA) in asthmatic patients., Subjects and Methods: A total of 140 asthmatic patients were examined. They underwent allergologic (skin tests for fungal allergens, estimation of total and fungal allergen-specific IgE levels) and mycological (microscopy and inoculation of respiratory biosubstrates) examinations. Chest computed tomography, when indicated, was done. A group of patients with ABPA and that of patients with severe asthma and fungal sensitization were identified., Results: The frequency of fungal sensitization in asthmatic patients was 36%; the main allergenic fungi were Aspergillus and Alternaria. The incidence of ABPA was as high as 4% in the patients with asthma and 11% in those with severe asthma and fungal sensitization., Conclusion: The given current diagnostic criteria will assist practitioners to identify ABPA, to prevent its progression, and to initiate specific anti-inflammatory and antifungal therapy in due time.

The aim of the study was to determine peculiarities of the course of resistant arterial hypertension (AH) in the remote period after performing the operation of carotid endarterectomy in patients presenting with haemodynamically significant (more than 70%) stenosis of the carotid bifurcation. The study included a total of 105 patients. The course of AH was evaluated in the immediate (2-7 days) and remote (3-7 years) periods after the operation of carotid endarterectomy. Ninety-two (87.6%) patients presenting prior to the operation with resistant AH were postoperatively found to have persistent stabilization of arterial pressure and its milder course. A good clinical effect (possibility of reaching the target arterial pressure) in the remote period was noted to preserve in 65.7% of patients. The proportion of patients with grade III AH decreased from 43.8% (prior to operation) to 5.8% in the remote postoperative period (p<0.001). It was also determined that the degree of the antihypertensive effect after the performed operation of carotid endarterectomy depended upon the duration of a previous medical history of arterial hypertension before surgery: the sooner the operation is performed the more pronounced its antihypertensive effect is.

The paper analyzes 7 cases of common variable immune deficiency (CVID), a primary immunodeficiency disease. All the cases were detected in outpatients over the age of 40 years. The diagnosis was based on their history data and general clinical findings with due regard for the results of previously conducted functional studies, expert opinions, and the results of immunological studies including the quantitative and functional indices of T and B cells, phagocytes and the levels of immunoglobulins. The analysis showed that the early signs of impaired immunity in all the patients were seen by physicians of various specialties in both outpatient and inpatient settings. Generalizing of all information about the patient could become the basis for a simple and accessible practical public-health study of immunoglobulins levels significantly sooner than this diagnosis being verified. This testifies that the physicians of various specialties are partially aware of the clinical signs of immunodeficiency states and that there is a need for a clinical immunologist in adult healthcare facilities. This is especially important since the early clinical manifestations of both primary immunodeficiency disorders that are increasingly frequently detected and nonhereditary - secondary ones can be very similar. The timely verification of the diagnosis is necessary for prescribing adequate therapy with intravenous immunoglobulins to prevent severe chronic pyoinflammatory lung disease and disability in patients with CVID.

Aim: to define clear individual indications for different operations for diffuse toxic goiter by research of immunological markers of thyrotoxicosis recurrence probability., Material and Methods: Long-term results of survey and treatment of 215 patients with diffuse toxic goiter are presented. Patients were divided into 2 groups. The 1st group consisted of 31 patienrs who underwent conventional partial thyroidectomy. Group 2 included 184 patients. They were divided into 2 subgroups depending on type of surgery. Subgroup A included 59 patients after partial thyroidectomy and subgroup B - 125 patients after total thyroidectomy. In group 2 surgery was defined based on only level of antibodies against TSH-receptors., Results: Recurrence incidence was 16 and 0% in groups 1 and 2 respectively., Conclusion: In patients with diffuse toxic goiter partial thyroidectomy is possible if normal titer of antibodies against TSH-receptors is present (<1.5 U/l). Total thyroidectomy is advisable in titer ≥1.5 U/l.

The review is dedicated to studying the effect of perioperative use of statins while performing vascular operations, examining possible aftermaths of statins discontinuation in the perioperative period and discussing safety of perioperative use of statins. Cardiovascular complications constitute the most common cause of perioperative mortality while performing major noncardiac operations. Clinical studies demonstrated a favourable effect of statins on the cardiovascular complications rate in the perioperative period, therefore use of statins for prevention of cardiovascular diseases seems substantiated appropriate. Acting upon the levels of blood serum lipids, statins also influence various signal cellular pathways, exerting anti-inflammatory, antithrombotic and vasodilating effects. Thus, they may be used not only for patients with lipid metabolism impairments. However, currently required are further studies in order to determine optimal dosage, as well as the terms and duration of therapy with statins in the perioperative period.

We studied the delayed effects of prenatal exposure to hypoxia on the susceptibility of rats to seizures. The later was estimated using graded electroshock. The experiments were performed in two groups of 1.5-year-old male Wistar rats. The experimental group consisted of the animals that were exposed to hypoxia on day 14 of prenatal development, and the control group consisted of the animals that developed under the normal conditions. In the rats subjected to prenatal hypoxia, seizure episodes induced by weak currents in the range of 10-40 mA and their average duration were more pronounced as compared to the control animals.

Objective: Endogenous cardiotonic steroids, including marinobufagenin (MBG), stimulate vascular synthesis of collagen. Because mineralocorticoid antagonists competitively antagonize effect of cardiotonic steroids on the Na/K-ATPase, we hypothesized that spironolactone would reverse the profibrotic effects of MBG., Methods: Experiment 1: Explants of thoracic aortae and aortic vascular smooth muscle cells from Wistar rats were cultured for 24 h in the presence of vehicle or MBG (100 nmol/l) with or without canrenone (10 μmol/l), an active metabolite of spironolactone. Experiment 2: In 16 patients (56 ± 2 years) with resistant hypertension on a combined (lisinopril/amlodipine/hydrochlorothiazide) therapy, we determined arterial pressure, pulse wave velocity, plasma MBG, and erythrocyte Na/K-ATPase before and 6 months after addition of placebo (n = 8) or spironolactone (50 mg/day; n = 8) to the therapy., Results: In rat aortic explants and in vascular smooth muscle cells, pretreatment with MBG resulted in a two-fold rise in collagen-1, and a marked reduction in the sensitivity of the aortic rings to the vasorelaxant effect of sodium nitroprusside following endothelin-1-induced constriction (EC50 = 480 ± 67 vs. 23 ± 3 nmol/l in vehicle-treated rings; P < 0.01). Canrenone blocked effects of MBG on collagen synthesis and restored sensitivity of vascular rings to sodium nitroprusside (EC50 = 17 ± 1 nmol/l). Resistant hypertension patients exhibited elevated plasma MBG (0.42 ± 0.07 vs. 0.24 ± 0.03 nmol/l; P = 0.01) and reduced Na/K-ATPase activity (1.9 ± 0.15 vs. 2.8 ± 0.2 μmol Pi/ml per h, P < 0.01) vs. seven healthy individuals. Six-month administration of spironolactone, unlike placebo treatment, was associated with a decrease in pulse wave velocity and arterial pressure, and with restoration of Na/K-ATPase activity in the presence of unchanged MBG levels., Conclusion: MBG-induced vascular fibrosis is a likely target for spironolactone.

Cognitive impairment in six-week -old rats has been studied in the lithium-pilocarpine model of adolescent temporal lobe epilepsy in humans. The pilocarpine-treated rats (n =21) exhibited (a) a decreased exploratory activity in comparison with control rats (n = 20) in the open field (OP) test and (b) a slower extinction of exploratory behavior in repeated OP tests. The Morris Water Maze (MWM) test showed that the effect of training was less pronounced in the pilocarpine-treated rats, which demonstrated disruption of predominantly short-term memory. Therefore, our study has shown that lithium-pilocarpine seizures induce substantial changes in exploratory behavior and spatial memory in adolescent rats. OP and MWM tests can be used in the search of drugs reducing cognitive impairments associated with temporal lobe epilepsy.

Presented herein is a clinical case report of successful stagewise surgical treatment of a patient with atherosclerotic occlusion of the main trunk of the renal artery of the single kidney. Clinically, the patient had signs of ischaemic renal disease in the form of pronounced azotemia being characteristic of the terminal stage of renal insufficiency, as well as malignant arterial hypertension. Besides, the patient had previously endured ischaemic stroke in the vertebrobaslar basin. The patient was subjected to stagewise surgical intervention, i.e., stenting of the upper-pole renal artery followed by open operation--prosthetic repair of the left renal artery with a synthetic prosthesis. Three months thereafter, the patient underwent carotid endarterectomy and operation of transposition of the subclavian artery. The postoperative period turned out uneventful. Currently, no progression of azotemia is observed, neither are there any indications for carrying out restorative therapy of the renal function.

Background: Immunoneutralization of elevated circulating levels of endogenous digitalis-like Na/K-ATPase inhibitors (i.e. cardiotonic steroids (CTS)) represents a novel approach in the treatment of preeclampsia (PE). Recently we demonstrated that DigiFab (Fab fragments of affinity-purified ovine digoxin antibody) restores PE-induced inhibition of Na/K-ATPase in erythrocytes ex vivo. Previously magnesium ions were shown to antagonize digitalis-induced toxicity, which is mediated by Na/K-ATPase inhibition. We hypothesized that magnesium sulfate would potentiate the effect of DigiFab in the reversal of CTS-induced Na/K-ATPase inhibition., Methods: To test this hypothesis, we studied the ex vivo effect of DigiFab on Na/K-ATPase activity in erythrocytes from patients with PE in the absence and in the presence of 3 mmol/L magnesium sulfate., Results: Compared with 11 normotensive pregnant subjects (29 ± 1 years; gestational age = 39.0 ± 0.2 weeks; blood pressure = 111 ± 2/73 ± 2 mm Hg), the 12 patients with PE (30 ± 1 years; gestational age = 37.9 ± 0.3 weeks; blood pressure = 159 ± 5/99 ± 3 mm Hg) had plasma levels of marino-bufagenin increased 3-fold (1.38 ± 0.40 vs. 0.38 ± 0.10 nmol/L; P < 0.01) and activity of Na/K-ATPase in erythrocytes was inhibited (1.16 ± 0.11 vs. 2.80 ± 0.20 μmol Pi/ml/h; P < 0.01). Ex vivo, DigiFab (1 µg/ml) restored erythrocyte Na/K-ATPase activity (1.72 ± 0.13 µmol Pi/ml/h; P < 0.01), and 3 mmol magnesium sulfate potentiated the effect of DigiFab (2.30 ± 0.20 µmol Pi/ml/h; P < 0.01)., Conclusions: Magnesium is capable of increasing the efficacy of immunoneutralization of marinobufagenin-induced Na/K-ATPase inhibition., (© Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd 2013. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

299 patients with spontaneous pneumothorax were treated. All patients were divided in two groups. Patients of the first group (n=182) received thoracic puncture and/or drainage. The second group (n=117) has surgery, directed at liquidation of the source of pneumothorax, i.e., they received either atypical lung resection or subtotal parietal pleurectomy. The recurrent pneumothorax was registered in 24 (13.2%) patients of the first group and in 4 (3.4%) patients of the second. Authors state that radical surgical procedure for the spontaneous pneumothorax is an atypical lung resection with parietal pleurectomy. The use of active surgical tactics allows to decrease the number of recurrencies on 9.8%.

The research was aimed on the study the clinical characteristics and course of myocardial dysfunction in patients older than 65 years. From the population database of polyclinic No 95 of Kolpino District of St. Petersburg, 284 patients of 65 years and older were randomly selected (89 men and 195 women). To determine the structural and functional abnormalities of myocardial echocardiography was used. The severity of clinical signs of myocardial dysfunction (DM) was evaluated on a scale of assessment of clinical status for heart failure (HF). The prevalence of all forms of myocardial dysfunction in a population of people aged 65 years and over was 80.3%, including 73.2% of participants having clinical manifestations of heart failure. The clinical manifestations of heart failure were not associated with the type or severity of the structural and functional disorders of the myocardium. More than 26.8% of people aged 65 and older were asymptomatic, but the significant part of them developed symptoms and signs of heart failure in a short time. However, the correlation between the progression of myocardial dysfunction and clinical symptoms was not established. The conclusion was made about the feasibility of echocardiographic screening of people aged 65 and older in a comprehensive geriatric assessment.

Elevated levels of endogenous Na/K-ATPase (NKA) inhibitors, cardiotonic steroids (CTSs) including marinobufagenin (MBG), contribute to pathogenesis of preeclampsia (PE) and represent a target for immunoneutralization by Digibind (Ovine Digoxin Immune Antibody, Glaxo-Smith Kline). Because Digibind is no longer commercially available, we studied whether DigiFab (BTG International Ltd, UK) can substitute Digibind for immunoneutralization of CTS in patients with PE. We compared DigiFab, Digibind, and anti-MBG monoclonal antibody (mAb) with respect to their ability to interact with CTS in PE plasma and to restore NKA activity in erythrocytes from patients with PE. Using immunoassays based on DigiFab, Digibind, and anti-MBG mAb, we studied the elution profile of CTS following high-performance liquid chromatography (HPLC) fractionation of PE plasma. Totally, 7 patients with mild PE (28 ± 2 years; gestational age, 39 ± 0.5 weeks; blood pressure 156 ± 5/94 ± 2 mm Hg) and 6 normotensive pregnant participants (28 ± 1 years; gestational age, 39 ± 0.4 weeks; blood pressure 111 ± 2/73 ± 2 mm Hg) were enrolled. Preeclampsia was associated with a substantial inhibition of erythrocyte NKA (1.47 ± 0.17 vs 2.65 ± 0.16 µmol Pi/mL per h in control group, P < .001). Ex vivo, at 10 µg/mL concentration, which is consistent with the clinical dosing of Digibind administered previously in PE, DigiFab and Digibind as well as anti-MBG mAb (0.5 µg/mL) restored erythrocyte NKA activity. Following HPLC fractionation of pooled PE and control plasma, PE-associated increase in CTS material was detected by Digibind (176 vs 75 pmoles), DigiFab (221 vs 70 pmoles), and anti-MBG mAb (1056 vs 421 pmoles). Therefore, because DigiFab interacts with CTS from PE plasma and reverses PE-induced NKA inhibition, it can substitute Digibind for immunoneutralization of CTS in patients with PE.

Objectives: Evaluate differences in depressive symptoms, compare sociodemographic and health-related variables associated with depressive symptoms and report level of impact of depressive symptoms on daily activities., Methods: Cross-sectional study using a self-administered questionnaire and Patient Health Questionnaire-9 (PHQ-9) diagnostic survey on 1115 patients aged 60-93 years who attended a primary care clinic in Korea, Russia or USA., Results: At least mild depression (PHQ-9 score of ≥ 5) occurred in 28% of Koreans, 65% of Russian and 27% of US participants. Russians scored more depressed on all PHQ-9 items (P < 0.01) and more suicidal thoughts (P < 0.001), while Koreans had less feelings of worthlessness (P < 0.001). Depression predictors included poorer self-rated health [odds ratio (OR) 2.47, 95% confidence interval (CI) 1.84-3.33, P < 0.0001], chronic diseases (OR 1.34, CI 1.21-1.48, P < 0.0001), female gender (OR 1.56, CI 1.15-2.12, P = 0.0046) and religious attendance (OR 0.88, CI 0.79-0.97, P = 0.0099) for all subjects. Being employed was protective in Korea (OR 0.41, CI 0.21-0.77, P = 0.0061) and being married (OR 0.42, CI 0.27-0.66, P = 0.0002) and of older age (OR 0.95, CI 0.93-0.98, P = 0.0006) protective in US participants. Vascular disease was associated with depressive symptoms in Russia (OR 3.47, CI 1.23-9.80, P = 0.0187). In regression analyses stratified by country for a given level of depressive symptoms, the Russian sample had less impact on daily activities (Russia R (2) = 0.107 versus Korea R (2) = 0.211 and US R (2) = 0.419) P = 0.029., Conclusions: Depressive symptoms were more common in Russia than in Korea and USA but had less impact on daily functioning. Cultural or environmental factors may account for this finding.

Background: Previous reports demonstrated that digitalis-like cardiotonic steroids (CTS) contribute to the pathogenesis of end-stage renal disease. The goal of the present study was to define the nature of CTS in patients with chronic kidney disease (CKD) and in partially nephrectomized (PNx) rats., Methods: In patients with CKD and in healthy controls, we determined plasma levels of marinobufagenin (MBG) and endogenous ouabain (EO) and erythrocyte Na/K-ATPase activity in the absence and in the presence of 3E9 anti-MBG monoclonal antibody (mAb) and Digibind. Levels of MBG and EO were also determined in sham-operated Sprague-Dawley rats and in rats following 4 weeks of PNx., Results: In 25 patients with CKD plasma, MBG but not EO was increased (0.86 ± 0.07 versus 0.28 ± 0.02 nmol/L, P < 0.01) and erythrocyte Na/K-ATPase was inhibited (1.24 ± 0.10 versus 2.80 ± 0.09 μmol Pi/mL/h, P < 0.01) as compared to that in 19 healthy subjects. Ex vivo, 3E9 mAb restored Na/K-ATPase in erythrocytes from patients with CKD but did not affect Na/K-ATPase from control subjects. Following chromatographic fractionation of uremic versus normal plasma, a competitive immunoassay based on anti-MBG mAb detected a 3-fold increase in the level of endogenous material having retention time similar to that seen with MBG. A similar pattern of CTS changes was observed in uremic rats. As compared to sham-operated animals, PNx rats exhibited 3-fold elevated levels of MBG but not that of EO., Conclusions: In chronic renal failure, elevated levels of a bufadienolide CTS, MBG, contribute to Na/K-ATPase inhibition and may represent a potential target for therapy.

Objectives: To categorize the health problems of older Russians and identify the number of frail older adults using different approaches., Design: Cross-sectional study., Setting: The Kolpino district of St. Petersburg., Participants: A random sample of 611 community-dwelling adults aged 65 and older was selected from a population-based register and stratified into two age groups (65-74, ≥75)., Measurements: Anthropometry, medical history, nutritional status, Physical Performance Battery, activities of daily living, grip strength, spirometry, renal function, 15-item Geriatric Depression Scale, Mini-Mental State Examination, and sense of coherence., Results: The female:male ratio was 2.5:1; 19% were malnourished or at risk for malnutrition, and 78.6% presented with one to three chronic pathologies, with no differences according to age or sex. Problems with hearing (60.7%), vision (89.5%), and incontinence (40.9%) were highly prevalent. Moreover, 25.9% of the younger group (65-74) and 42.5% of the older group (≥75) were found to be at risk for depression. Mild to severe cognitive impairment was found in 34.5% of the participants, and 14.4% of those aged 65 to 74 and 33.0% of those aged 75 and older reported dependence in daily living activities. The prevalence of frailty assessed using different models varied from 21.1% to 43.9%. The Fried model revealed the strongest associations with the frailty outcomes (dependence and performance). No significant differences between the sexes were found in either age group (P=.82), although the percentage of frail women increased with age (P=.001)., Conclusion: The findings emphasize the need for attention and resources to be shifted from disease-oriented to functional approaches in the older Russian population. The population studied is consistent with the Fried model, in which one in five older adults can be labeled as frail., (© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.)

Presented herein is a successful outcome of stagewise surgical management of a young adult suffering from nonspecific aortoarteritis accompanied renal artery lesions. The patient was subjected to a stagewise intervention consisting of stenting of the renal arteries and an open operation, i.e. bilateral aortorenal bypass grafting performed with the synthetic stent B-Braun.

Using the "Crystal" study as an example of an epidemiological study that investigates global health of the elderly, the potential of a comprehensive geriatric assessment in primary care is illustrated. The results of the first cross-sectional data collection are presented in this paper with emphasis on the global health picture of the elderly; the average age was 75.08 +/- 5.96 years. In our study population one out of four participants was a male. Elderly mostly have a normal nutritional status with an average BMI of 28.6 +/- 4.94 kg/m2. On average, each participant has 2 +/- 1.27 pathologies, often cardiovascular. One out of four presents anemia. One third has symptoms of depression. In 44.4% of the patients a mild cognitive impairment was revealed. A more severe cognitive deficit was found in 26.2% of elderly. Every other old person has difficulties to keep balance in supine position for more than 10 seconds. One out of four elderly is partially dependent in their daily activity. Comprehensive geriatric assessment has the potential to identify priority issues in elderly health care and to inspire a management strategy. Further research is needed to create a simple instruments and an effective model to identify real health care needs of the elderly and to improve the quality of care and the successful collaboration between geriatricians and general practitioners.

The article deals with surgical treatment of patients presenting with resistant arterial hypertension and detected pathology in the adrenal glands. The authors analysed the outcomes of surgical management of 97 patients with resistant arterial hypertension, also determining the factors contributing to prediction of the antihypertensive effect of adrenalectomy depending on morphological damage to the adrenal glands.

Described herein is a successful therapeutic outcome in a female patient presenting with resistant arterial hypertension secondary to a gigantic intraorganic aneurysm of the right renal artery. Treatment consisted of intravascular prosthetic repair of the parenchymatous portion of the renal artery, eventually making itpossible to entirely bypass the aneurysmatic sac and to restore the lumen of the renal artery, followed by normalization of arterial pressure.

Contractile activity of the iliac and sigmoid intestines versus detrusor activity, reabsorption and secretory activity of the iliac and sigmoid intestinal mucosa in contact with urine were studied in 30 rats. It was found that isolated segments of the iliac and sigmoid intestines have spontaneous contractile activity (stronger in the iliac intestine) while bladder segment contracted only in response to electric stimulation. A contraction-stimulating effect of acetylcholine and a relaxing effect of noradrenaline in experiments with the iliac intestine were close to their effects on the detrusor. The sigmoid intestine responded weaker to the above mediators. The iliac mucosa actively reabsorbed urinary urea, creatinin, glucose causing elevation of their concentrations in blood as well as K, Na, Ca, CI, P and secreted protein in urine leading to hypoproteinemia. The sigmoid mucosa showed weaker metabolic activity. The results of the study demonstrate importance of consideration of biological properties of different intestinal regions for choice of a cystoplasty method after cystectomy.

A retrospective analysis of 365 completed patient records received by the duty surgical hospital with perforated gastric ulcer and duodenal ulcer. All the patients were operated on urgently. Diagnosis of purulent peritonitis was set 17% of patients, "serous"--47.4%, "seroplastic"- 35.6%. 75.3%, perform suturing of perforated openings, regardless of the form of peritonitis. The remaining 24.7%--interventions that address as a perforation, and the impact on the pathogenesis of peptic ulcer. When radical surgery, which were performed in selected patients even with purulent peritonitis, deaths were reported. And when suturing the ulcer defect lethality was 14.5%. In this group of patients were comparable in age and severity of general condition. It is concluded that that the operations of suturing perforated ulcers were used unnecessarily broad, and the majority of patients admitted to hospital with a perforated stomach ulcer and duodenum may increase the volume of surgical benefit for radical treatment of complications as well as most of peptic ulcer.

This cross-sectional cohort study describes older patients' perceptions about depression and characteristics associated with acceptance of treatments. The majority of the 109 respondents consider depression as disease, which should be treated. Many patients cited affordability as an obstacle and considered self-treatment options including alcohol intake for depression control.

Endogenous inhibitors of the Na/K-ATPase (NKA) and diabetes mellitus (DM) are both risk factors for preeclampsia and NaCl sensitive hypertension. Our goal was to test the hypothesis that NaCl supplementation, induces preeclampsia-like symptoms in pregnant rats with DM via stimulation of marinobufagenin (MBG), a natriuretic and vasoconstrictor inhibitor of the NKA. Type 2 DM in female Sprague-Dawley rats was induced by administration of 65mg/kg streptozotocin at day 4 post-partum. In intact rats, pregnancy was associated with a twofold increase in MBG levels and a mild impairment in glucose tolerance. Pregnant rats with DM exhibited fetal macrosomia, greater impairment of glucose tolerance, and higher levels of MBG as compared to that in normal pregnant rats. As compared to intact pregnant rats, NaCl supplementation of diabetic pregnant rats (drinking 1.8% NaCl during days 12-19 of pregnancy) was associated with an increase in systolic blood pressure, decreased fetal and placental weight, fivefold elevation of MBG excretion, and 42% inhibition of NKA in erythrocytes. In nonpregnant rats, in vivo pretreatment with anti-MBG antibody produced an exaggerated response of plasma levels of glucose and insulin in oral glucose tolerance test. These results suggest that MBG is a common factor in the pathogenesis of DM and preeclampsia, and that regulation of glucose tolerance may be one of the physiological functions of endogenous cardiotonic steroids.