[Effect of renal artery stenting on the clinical and geriatric status of elderly patients with vasorenal hypertension.]

The study consists in determining the effect of renal artery stenting in patients with arterial hypertension in combination with renal artery stenosis on the dynamics of clinical and geriatric status in terms of such indicators as the number of drugs taken, cognitive status, determined by the MMSE scale, prevalence of the frequency of falls, psycho-emotional status by the Beck scale, the quality of sleep on the VAS scale, the index of age discrimination according to the E.Palmore ageism questionnaire, the quality of life according to the SF 36 questionnaire. The study involved 72 elderly patients with arterial hypertension in combination with renal artery stenosis. According to the results of the study, as a result of stenting of the renal arteries, there is a decrease in the number of drugs taken, an improvement in the cognitive status on the MMSE scale, a decrease in the frequency of falls, an improvement in the psycho-emotional status on the Beck scale, an improvement in the quality of sleep on the VAS scale, a decrease in the level of age discrimination, an increase in the quality of life according to questionnaire SF-36 on all scales.

[Signaling molecules as biomarkers for predicting implant survival in people of different ages.]

Most patients over 50 years of age are diagnosed with diseases of the dentoalveolar apparatus, in particular, bone tissue disorders, which leads to a decrease in the survival rate of implants. Identification of the causes, as well as the development of a methodology for predicting survival by minimally invasive methods, is relevant. The aim of the study was to study the markers of tight junctions in the buccal epithelium (BE) in people of different ages. BE scrapings were taken before and after implantation in patients divided into 5 age groups, from young to centenarians. Immunocytochemical method was used to study markers for tight junction proteins - claudin-1, -7 and 10. It has been shown that with age there is a decrease in the intensity of expression of adhesion molecules, in particular claudin -1, -7 and -10 in the mucous membranes, the minimum values were recorded in the group of centenarians. The study found that after dental implantation, there was a decrease in the expression of claudin-1 and -10 and an increase in the expression of claudin-7. Changes in the expression of claudins may indicate the development of a pathological process in the body, including the success of implantation, especially in people of older age groups.

[Secretory phenotype of the human endothelial cells associated with replicative and induced aging.]

The aging-associated secretory phenotype (SASP) is a heterogeneous phenotype of cells secreting pro-inflammatory cytokines, growth factors, apoptosis' regulatory molecules, and proteases. SASP is one of the three main hallmarks of senescent cells. Dysregulation of the synthesis of SASP-forming molecules leads to the development of age-associated diseases, including cardiovascular pathology. The aim of this study is to characterize the SASP of human endotheliocytes during replicative and induced aging. Isolated human umbilical vein endothelial cells HUVEC were used to model replicative and inflammation-induced aging. It has been established that the molecules that form SASP during replicative and inflammation-induced aging of HUVEC are molecules that control apoptosis (p16, p21, p53), adhesion (E-selectin, VCAM-1) and some cytokines (IL-1β, IL-6). With replicative aging of endotheliocytes, the synthesis of apoptosis' regulatory molecules increases to a greater extent. Inflammation-induced aging of HUVEC is characterized by a multiple increase in the synthesis of adhesion molecules and pro-inflammatory cytokines.

[Transcheter aortic valve implantation as a method of treatment of chronic heart failure in elderly and old patients: Literature review (part 2).]

The most common heart valve defect among the elderly and senile is aortic valve stenosis. The traditional method of treating severe aortic valve stenosis is open surgery to replace aortic valve. At the same time, a more modern, minimally invasive method of correcting aortic stenosis is transcatheter aortic valve implantation (TAVI). This intervention is primarily indicated for patients of old age suffering from severe chronic heart failure associated with aortic stenosis, who have a high surgical risk. Currently, TAVI has evolved from a complex and dangerous procedure into an effective and safe method of treatment thanks to the development of a new generation of devices. Currently, there are still topical issues of using TAVI in individual clinical cases (use of TAVI in the elderly (60-75 years), TAVI in centenarians (90 years or more), TAVI in frailty, the feasibility of performing TAVI with low surgical risk, etc.), as well as issues related to longevity valves used for TAVI and prognosis in terms of quality and life expectancy.

[Age-associated features of the expression level of apoptosis markers in cardiomyocytes of patients with dilated cardiomyopathy.]

To understand the pathogenesis of dilated cardiomyopathy (DCMP), it is necessary to establish the molecular-cellular mechanisms of myocardial aging, including those associated with programmed cell death, the molecular mechanisms of which have not been practically studied. The aim of this work is to study markers of apoptosis in cardiomyocytes of patients with DCMP in vitro. We used the method of primary dissociated cell cultures and the method of immunofluorescence confocal laser microscopy. Cells of the 3rd and 14th passages, corresponding to «young» and «old» cultures, were used to simulate cellular senescence. Results. At the molecular level, aging of cardiomyocyte cells was accompanied by a twofold increase in the expression of p16INK4a compared to «young cultures» both in the control group and in the group with DCMP. It was also found that the expression of p16INK4a in cultures taken from patients with pathology was 2 times higher than in similar cultures from healthy patients. The expression of p21 was increased in the group with DCMP compared to the control; however, with aging of the culture, the expression of p21 did not change, remaining at a significant level. The most significant differences were obtained when comparing the expression of Bax in the cell culture of cardiomyocytes from the group with DCMP in a «young» culture compared with the norm, 3,2 times. Aging of myocardial cells at the molecular level was manifested in an increase in the expression of the Bax protein, which is the triggering mechanism of the mitochondrial apoptosis pathway. It is possible that this pathway of cell death is prevalent in DCMP.

[Age as one of the important criteria of prostate cancer diagnostic.]

At this moment differential diagnostic of the prostate cancer (PC) needs the new, more effective ways with regard of multifactor analysis. One of this factor is patient's age. Men older than 45 years old have expressed involution changes of prostate tissues. This fact must be take into account in valuation morphologic and laboratory criteria's in PC. The goal of the investigation is to take into account age-related changes of the prostate volume and laboratory criteria of blood analysis in PC. 632 patients in age from 42 to 88 years old were exanimated by trans rectal ultrasound examination (TRUS) method (volume parameters of the prostate) and by levels of prostate-specific antigen (PSA) and (-2) pro-PSA in blood. The increase of patient's age correlated with increase of the density of transient, peripheral and central zones of prostate. It correlates with the probability of the frequency of PC verification. Levels of PSA and 2-pro-PSA in blood of PC patients increase during the transition from middle to elderly age in 1,4-2,8 times. Thus the information, which was obtained during the examination of volume prostate characteristics by TRUS method and laboratory diagnostic of PC, must take to account patient's age.

[Transcheter aortic valve implantation as a method of treatment of chronic heart failure in elderly and old patients: Literature review (part 1).]

Aortic valve (AV) stenosis is the most common acquired valvular disease with an increasing prevalence due to an aging population, requiring surgical or endovascular intervention. Transcatheter Aortic Valve Implantation (TAVI) represents a real revolution in the field of interventional cardiology for the treatment of elderly or high-risk patients with severe symptomatic AV stenosis. TAVI allows for the correction of aortic defect in the most severe group of patients with chronic heart failure (CHF) with severe comorbidity, who are contraindicated for open surgery to replace AV, in order to interrupt the vicious circle in the progression of CHF, stimulate reverse myocardial remodeling, alleviate symptoms, improve the quality of life, and prognosis of patients, and also as a «bridge» to heart transplantation. With the development of next-generation devices, TAVI has evolved from a complex and dangerous procedure to an effective and safe technique. Currently, the greatest scientific interest is the study of valve durability and the possibility of expanding the indications for performing TAVI in categories of patients with low surgical risk, as well as in younger age groups.

Sirtuins as Possible Predictors of Aging and Alzheimer's Disease Development: Verification in the Hippocampus and Saliva

Verification of signaling molecules in the saliva is a non-invasive method of diagnosis and evaluation of treatment effectiveness in different pathologies. Sirtuins (SIRT), proteins from NAD-dependent histone deacetylases, are supposed to be involved in the pathogenesis of Alzheimerэs disease. Age-related decrease in sirtuins expression induces many pathophysiological processes that could lead to neurodegeneration. We studied the expression of SIRT1, SIRT3, SIRT5, and SIRT6 in the hippocampus and saliva of humans without neurological pathologies and in patients with Alzheimer's disease of elderly and senile age. In elderly and senile patients, the expression of SIRT1, SIRT3, and SIRT6 in the hippocampus and saliva was 1.5-4.9-fold reduced in comparison with healthy individuals of the corresponding age. In healthy senile persons, the expression of SIRT6 in the hippocampus and saliva was 2.5-4.5-fold lower than in healthy elderly individuals. Measurement of SIRT1, SIRT3, and SIRT6 concentration in the saliva can be used as an additional method for intravital non-invasive diagnosis of Alzheimer's disease in patients of advanced age. SIRT6 concentration in the saliva can be recommended as a marker for assessment of the rate of aging.

[Parametres of cardiopulmonary exercise testing in patients with lung and esophagus cancer according to their gender and age.]

Cardiopulmonary exercise testing is a diagnostic method, which can be used for oncological patients. It shows its perspectives in measuring reserve capacity of the human organism, determining the risk of postoperative complications, and long-term prognosis. The method is also useful for optimization of rehabilitation measures, which is actual for polymorbid aged patients. In this article we present data of cardiopulmonary exercise testing of 362 patients, men and women of different ages with lung and esophagus cancer. We performed a comparative analysis of aerobic ability of gerontological patients and patients from the other age groups. The patients showed higher ranges at rest in comparison to normal population, and lower rates on anaerobic threshold. Patients from the 40-49 age group showed the best values of aerobic exchange. Aged patients had lower oxygen uptake on anaerobic threshold than other groups. Women of all ages had higher values of peak oxygen uptake then men; aged patients showed better results in comparison to the normal ranges.

[Clinical aspects of asymptomatic arrhythmia in elderly patients with left breast cancer at the stage of radiation therapy.]

Insufficient knowledge age peculiarities of the clinical course of cardiac arrhythmias occurring asymptomatically as a manifestation of cardiotoxicity in women with breast cancer at the stage of radiation therapy, determines the high demand for research on this problem. The aim of the study was to identify and evaluate asymptomatic cardiac arrhythmias in elderly women with left breast cancer at the stage of radiation therapy. 48 women without a history of severe cardiovascular disease with HER2neu negative cancer of the left breast at the stage of 3D conformal radiotherapy were examined. Mean age 67 (64; 69). All patients at the previous stages were carried out mastectomy Madden followed by therapy with doxorubicin. The examination included ECG registration, 24-hour ECG monitoring and echocardiography. Before radiation therapy, asymptomatic arrhythmias were detected in 43 (89,6%) patients. After radiation therapy significantly increased the number of pathological supraventricular and ventricular arrhythmias as a manifestation of cardiotoxicity.

[Optimization of the invasive strategy for acute coronary syndrome in patients of the older age group.]

A study is presented on the effectiveness and safety of various anticoagulants used in patients of an older age group with acute coronary syndrome during percutaneous coronary interventions. Bivalirudin was shown to be highly effective in comparison with unfractionated heparin and monafram in relation to the amount of bleeding that occurs in the postoperative period and adverse cardiovascular complications.

[Determination of cytokines and adhesion molecules in elderly and senile patients with aortic valve calcification.]

A laboratory study of the cytokine profile and the content of the intercellular adhesion molecules was performed in 38 patients with initial signs of aortic hemilunus calcification. It has been determined that the content of IL-6 and IL-8 had significantly higher values compared with the control group, which indicates the direct role of nonspecific chronic inflammation in the development of calcifying aortic valve damage. A significantly lower content of sE-selectin was also identified, which may indicate the absence of activation of adhesion molecules at the initial stage of aortic valve calcification. Further study of the dynamics of sE- and sP-selectins content in the process of development of acceleration of blood flow in the aortic valve and the formation of stenosis is needed.

[Indicators of lipid exchange as early markers of development calcific aortic valve disease.]

A comprehensive study of lipidograms of 36 patients with initial signs of calcification of aortic semilunium was performed. It was determined that the content of apolipoprotein A-1 was significantly lower in comparison with the control groups, which requires further studies of the evaluation of the effect on the process of early development of calcification of drugs capable to increasing its content. If the concentration of apolipoprotein A-1 is less than 1,1 mg/dl and/or the apoB/apoA ratio is increased by more than 1, it is advisable to recommend dispensary follow-up with regular (no less than 1 time in 5 years) echocardiographic study with a detailed study of the functional state of the aortic valve.

Matrix Metalloproteinases MMP-1 and MMP-9 and Their Inhibitor TIMP-1 as Markers of Dilated Cardiomyopathy in Patients of Different Age

We studied the expression of MMP-2, MMP-9, and inhibitor TIMP-1 in myocardial autopsy samples from subjects of different age and in cardiomyocyte cultures in the norm and in dilated cardiomyopathy. In autopsy samples of normal myocardium and in cardiomyocyte cultures, expression of molecules involved in extracellular matrix remodeling did not change during aging. In dilation cardiomyopathy, expression of MMP-2, MMP-9, and TIMP-1 and their ratios in autopsy material and in cultures was elevated by 1.5-9 times. Remodeling of extracellular matrix plays an important role in the pathogenesis of dilated cardiomyopathy. MMP-2, MMP-9, and their inhibitor TIMP-1 and the MMP/TIMP ratios can be regarded as promising predictors of dilated cardiomyopathy and used for evaluation of the effectiveness of treatment of this conditions in patients of different ages.

[Prospects of buccal epithelium application for noninvasive diagnosis of coronary heart disease in people of different age.]

Cardiovascular diseases caused by atherosclerosis, in many countries of the world are one of the most important social and economic problems due to the high morbidity and mortality rate of the working population. Recently, the immunological theory of atherosclerosis and coronary heart disease (CHD) has been actively developed, and the search for markers of inflammation characterizing immuno- and atherogenesis has been conducted. Buccal epithelium (BE) can be used as biological material for in vivo molecular-cellular studies, allowing to diagnose CHD by inflammation markers. The purpose of the work was a comparative study of the expression of IL-1β, IL-6, IL-10, MCP-1 and GDF-15 in BE in patients of different ages with CHD and without cardiovascular disease. The material of BE in healthy donors and patients with 2nd stage CHD was divided into groups according to age classification of the WHO: the 1st - middle-aged people (45-59 years) and the 2nd - elderly people (60-74 years). Control material was obtained from people of middle and old age without cardiovascular disease. According to the immunocytochemical study, the area of IL-1β expression in BE is 3 times higher in middle-aged people with CHD, and in 4,4 times higher in elderly people compared to healthy individuals of the same age group. The area of IL-6 expression in middle-aged and elderly people with CHD was in 7,9 and 7,4 times higher, respectively, than in the control group. In middle-aged and elderly patients with CHD, IL-10 expression was in 1,6 and 2,8 times higher, respectively, compared to healthy donors of the same age group. The expression of MCP-1 in BE of middle-aged and elderly people in normal and ischemic heart disease did not differ. GDF-15 expression is in 6,8 and 6,6 times higher in middle-aged and elderly people with CHD than in healthy people of the same age. The findings showed that the expression of the cytokines IL-1β, IL-6, IL-10 and GDF-15 increase in BE in patients with CHD of middle-aged and elderly people compared with persons of the same age group without cardiovascular disease. Thus, BE can serve as an informative material for noninvasive molecular diagnosis of CHD in people of different ages.

[Hybrid vascular interventions on the peripheral arteries in the treatment of critical ischemia in elderly patients.]

Peripheral arterial disease has a huge contribution to the overall mortality rate of the population, especially in the group of patients of old and old age. The likelihood of an adverse outcome is increased against a background with other possible nosological forms. In particular, the combination of peripheral atherosclerosis with diabetes mellitus very often manifests itself in the form of a multilevel lesion of the lower limb arteries. The treatment of such patients is very difficult, since the use of only open or endovascular approaches has its own contraindications and limitations, and cannot be used throughout the course of the lesion. The way out of this situation is the use of a hybrid approach, which consists in the combination of an open surgical reconstruction on the upper floors of the lesion and balloon angioplasty on the arteries of the lower leg. This approach allows you to use the advantages of both methods and achieve good results of treatment. The article presents the experience of treatment using a hybrid approach in elderly and senile patients with multilevel lesion of the lower limb arteries on the background of diabetes mellitus.

[Modern look at endovascular treatment bleeding the gastrointestinal tract in elderly patients.]

A literature review of the publications of foreign authors on the treatment of non-varicose bleeding from the upper gastrointestinal tract of elderly and senile patients is presented. The authors showed a modern view of the possibilities of endovascular hemostasis in comparison with a surgical operation with inefficiency of endoscopic hemostasis and characterized patients in whom it is possible this will be most effective.

[Endovascular intervention in central venous stenosis and obstructions in the middle aged and elderly hemodialysis patients: a Single-center Experience.]

Central vein stenosis and obstruction is one of the main risk factors in vascular access failure among hemodialysis patients. The elderly patients are in a particularly group because of some problems of arteriovenous fistula creation and maintenance. To evaluate the effectiveness and safety of percutaneous transluminal angioplasty for the treatment of central vein stenosis and obstruction in the middle aged and elderly hemodialysis patients. Forty eight hemodialysis patients with central vein stenosis and obstruction were treated from 2010 to 2016. The patients were divided into two groups, younger 60 years (27 people) and older 60 years (21 people). Fifty three vascular accesses were treated in common (the first group is twenty nine pieces, the second group is twenty one pieces). The first group: the technical success was 85%, the primary patency rates were from 1 to 24 months with an average month of 7,7, the secondary patency rates were from 1 to 30 months with an average month of 11,2. The second group: the technical success was 98%, the primary patency rates were from 4 to 13 months with an average month of 7,2, the secondary patency rates were from 1 to 49 months with an average month of 13. There two complications, one in every group. One case of unsuccessful left brachiocephalic vein recanalization was in the middle aged group. The percutaneous interventions are effective and safety in central vein stenosis and obstruction among hemodialysis patients in all ages for saving hemodialysis vascular access for long period of time.

[Embolization of prostate arteries - an alternative technology for treatmetment of prostatic adenoma in patients with diabetes mellitus.]

The article details the examination plan and recommendations for the endovascular treatment of patients with prostate adenoma with concomitant diabetes mellitus. The results of the work of the Department of Andrology and Urology at the Endocrinological Research Center for prostate artery embolization are also displayed. A clinical case of care for a patient with prostate adenoma and severe diabetes mellitus is presented.

[Actuality of pathomorphogenesis investment in calcific aortic valve stenosis.]

The increasing of lifetime industrial countries population leads to widespreading diseases of age. Dramatic growth of sclerodegenerative heart valve diseases in last decades is one of the best examples. We observed 814 patients of different gender and age with acquired heart valve diseases using echocardiography. We found out that the most common heart valve disease is degenerative aortic stenosis. Unfortunately, nowadays in Russia no more than 20% of the necessary operations on aortic valve are performed, the main reason of it is, more likely, insufficient and untimely diagnosis of the defect. However, the surgery of vice serves only as a mechanical elimination of the problem, without affecting the causes which led to its development. So we need modern data about sclerodegenerative heart valve diseases epidemiology and discloses actuality of the problem.

Expression of Signal Molecules in Culture of Human Endothelial Cells in Atherosclerosis and Restenosis

We compared the expression of signal molecules in the culture of human endothelial cells under normal conditions and in atherosclerosis and restenosis. Expression of connexin-37 and sirtuin-1 in atherosclerosis and restenosis surpassed the normal by 2 and 5 times, respectively, and expression of endothelin-1 3-fold surpassed the normal. In restenosis, changes in the expression connexin-37 and endothelin-1 became more pronounced in comparison with atherosclerosis. Connexin-37 and endothelin-1 can serve as predictive markers for prognosis of post-stenting complications in patients with atherosclerosis.

[The development of chronic heart failure in elderly patients with low ejection fraction at baseline in the acute phase of myocardial infarction]

There was performed analysis according to 5-year follow incidence of heart failure in patients with acute myocardial infarction (AMI) with low ejection fraction in A; the characteristics of chronic heart failure (CHF) in elderly and senile were determined; the value of a number of clinical and morphological parameters for prediction of CHF were studied. The study included 135 patients of Intensive Care Unit with a diagnosis AMI showing according to the initial echocardiography reduced ejection fraction in the first 24-48 hours. In the course of monitoring patients, routine methods of clinical examination were used, the main quantitative technique was echocardiography, qualitative indicators were assessed including by collecting anamnesis and filling out questionnaires for heart failure, and then standard statistical methods were used. In the process of observation it was found that patients with acute myocardial infarction in acute elderly age worsens the prognosis of heart failure and mortality forecast, low ejection fraction in the acute period is a negative predictor of heart failure in all age groups, but more pronounced in the elderly. Development and growth of CHF after AMI occurs, despite the growth of ejection fraction (EF) in both age groups. CHF dynamics depends on the systolic and diastolic dysfunction. In the older age group plays a decisive role systolic dysfunction.

[Aging of the myocardium and dilated cardiomyopathy: morphological and molecular aspects]

The review considers various aspects of myocardium aging in normal and dilated cardiomyopathy (DC). There is a partial fibrosis of the heart tissue due to accumulation of collagen type 1, and accumulation of amyloid during normal aging. Men myocardial aging is accompanied by loss of cardiomyocytes and increased volume of the remaining cells, whereas in women this effect is absent. There is an expression of nuclear proteins decrease (lamin A and C), the accumulation of lipofuscin, increased content of reactive oxygen species, reduction of protein synthesis Sirt1 in cardiomyocytes with aging. Sirt1 has a cardioprotective effect, supports the balance of lipid metabolism, inhibits the development of inflammation and the formation of atherosclerotic plaques. Reduction of its expression not only indicates the accelerated pace of myocardial aging, but can be a predictor of the development of DC. In DC occurs stretching of the heart cavities and systolic dysfunction, predominantly in the left ventricle. DC is characterized by the development of inflammation in the myocardium. Its markers is increased expression of ICAM-1 adhesion molecule, MMP-2, MMP-9 matrix metalloproteinases, TIMP-1 tissue inhibitor of matrix metalloproteinases and decreased expression of MMP-1 matrix metalloproteinase.

[Molecular aspects of vasoprotective peptide KED activity during atherosclerosis and restenosis]

Peptide KED (Lys-Glu-Asp) has vasoprotective effects and is effective substance in treatment of of atherosclerosis and other cardio-vascular disorders in elderly people. One of the probable mechanisms of biological activity of this peptide is epigenetic genes regulation. These genes can coding proteins, which are markers of endothelium functional activity. The goal of investigation was to study the KED peptide effect on signal molecules expression in normal, atherosclerotic and restenotic endothelium in vitro. It was shown, that KED peptide has normalized endothelin-1 expression, which increased during atherosclerosis and restenosis. KED peptide also restorates cells interactions by connexin expression. Geroprotective effect of KED peptide is realized by increasing of sirtuin1 expression, which has took part in DNA reparation.

[Bilateral stenoses of carotids. The surgical treatment in acute period of ischemic stroke in patients of different age groups]

The study included 138 patients who had 193 reconstructive operations on carotid arteries (CA) in the acute period of ischemic stroke. The 1st group included 22 patients with bilateral stenosis, age under 60 years; the 2nd group - 33 patients with a bilateral stenosis at the age more than 60 years; the 3rd group consisted of 83 patients with bilateral stenosis of the ipsilateral CA were operated in an acute period of ischemic stroke, but with contraindications and/or refused the surgery on the contralateral CA. Brain computer tomography, ultrasound duplex scanning of the CA with the assessment degree of stenosis and structure of plaques, also MSCT-AG of the head and neck vessels were performed for all patients. Cerebral oximeter was used for assessing adequate cerebral perfusion during cross-clamping of the CA. Indications for the installation of a temporary intraluminal shunt during cross-clamping of the CA performed according to the method.

[Modern anti-thrombotic drugs, accompanied by percutaneous coronary intervention in the treatment of acute coronary syndrome with ST segment elevation on the electrocardiogram in patients of older age groups]

In the review published data on what modern antithrombotic drugs are used to support percutaneous coronary intervention in the treatment of acute coronary syndrome with ST segment elevation on the electrocardiogram in patients of older age groups. It was shown the effectiveness and safety of new pharmacological combinations using both anticoagulants and antiplatelet agents as in patients with acute coronary syndrome in elderly. It was highlighted also the need to find new combinations of anticoagulants and antiplatelet agents, to improve the prognosis in elderly persons subjected to percutaneous coronary intervention in patients with ACS.

[Treatment of elderly patients with combination of coronary artery disease and aortic valve pathology]

Increasingly, there are patients with concomitant coronary artery disease and aortic valve, especially in elderly patients, who often have severe comorbidities and high surgical risk, which is undoubtedly a certain effect on the choice of method and tactics of treatment. Today, there are several approaches to the treatment of patients in this category, and all of them have certain advantages and disadvantages.

[THE ROLE OF ENDOTHELIAL SIGNAL MOLECULES IN PATHOGENESIS OF AGE-ASSOCIATED DISEASES]

The article gives a summary of endothelial signal molecules that take part in homeostasis regulation and age-associated pathology development. Regulation of the endothelium function is realized by the system of signal molecules (NO, NOS, prostacyclin, thrombomodulin, tromboxan, antithrombin, endothelins, fibronectin, Willebrand's factor et al.). The change of their synthesis is the reason for the development of hypertonic disease, atherosclerosis, ischemic heart disease, myocardial infarction and other age-related pathology. The investigation of molecular mechanisms of endothelium functional activity is very important for creating new methods of diagnostics and treatment of cardio-vascular system age-associated pathology.

[Signal molecules of endometrium: gerontological and general pathhological aspects]

The review describes neuro-immuno-endocrine signal molecules expression in human endometrial cells in the normal conditions, in the pathology and during aging. Human endometrial cells synthesizes estrogen, progesterone, estradiol, progestin, cell adhesion molecules (integrines α1β1, α4β1, αVβ3, L-selectin, Е-catgerin, MUC1), grow factors (TGF, EGF, HB-EGF, IGF), cytokines (IL-1, IL-2, INF-α, IL-12, СХСL10, CXCL11, CXCR3), various immune cells markers (CD68, CD105, CD163, CD16, CD56, CD4, CD8), heat shock proteins (HSP60, HSP70, HSP90, VEGF, MMP). Changes of this molecules expression level are the base of the social significant diseases as endometriosis, endometrial cancer and infertility. Thus, the investigation of neuro-immuno-endocrine interactions in endometrial cells can be used for new drugs creating, in differential diagnostics of endometrial cancer and increasing of extracorporal fertilization success.

[CAROTID STENTING EXPERIENCE IN THE ACUTE PHASE OF ISCHEMIC STROKE IN PATIENTS OF ELDERLY AND SENILE AGE]

Age has been shown to be a predictor of neurological complications during carotid stenting (CS). However, carotid stenting in acute period of ischemic stroke has recently been demonstrated safely in patients over 70 and even 80 years. Early intervention is desirable in patients presenting with stroke referable to carotid artery stenosis because of the high incidence of recurrent ischemic events. However, he optimal timing to perform CS in the acute phase of ischemic stroke in elderly remains unclear due to the threat of perioperative complications. In our hospital (Aleksandrovskaya) was searched for consecutive cases of extracranial internal CS procedures performed for symptomatic atherosclerotic carotid stenosis in the acute phase of ischemic stroke in a total of 65 elderly patients. The primary outcome was not statistically different among groups stratified based on intervention timing, with a combined incidence of stroke, MI or death of 5.9 % in patients treated within 2 days, 0% in patients treated between days 3 and 7, 15% in patients treated between days 8 and 14 and 0% in patients treated between days 15 and 30. Our results support the conclusion that early CS (within 2 days) carries no additional risks compared with CAS after 2 days or any other timing of the intervention up to 30 days in elderly.

[ANEMIC SYNDROME AND ITS SPECIFICS IN SENIOR PATIENTS]

Clinical practice confirms high frequency of anemic syndrome. Anemia is diagnosed more often in senior patients than on the average. The most prevalent type of anemia in senior groups are iron deficiency anemia and B12-deficiency anemia, anemia of chronic diseases and anemia caused by kidney diseases. The cause of anemic syndrome in 25% of senior patients remains unclear. Anemia leads to impairment of life quality, increased morbidity and mortality in senior people except for patients with anemia of unknown origin.

[Orthostatic reactions in prognosis of the risks of arterial hypertension as a component of metabolic syndrome]

It was shown that parameters of metabolic syndrome as predictors of lethal vascular outcomes of arterial hypertension (AH) in Belarus are significantly different fiom those proposed in WHO recommendations (1999). The glucose level of informative value in WHO recommendations is 6.1 mmol/l versus 5.6 mmol/l in Belarus, total cholesterol 5.0 and 5.9 mmol/l respectively. A more detailed verification of the value of both parameters is needed for the patients in Belarus and Russia depending on age and sex using non-linear models. We used a comprehensive approach to prognosis of the risk of vascular lethal outcomes of AH as a component of metabolic syndrome with the evaluation of results of clinical and laboratory examination as well as orthostatic reactions in patients of different age groups. Construction of the prognostic algorithm "Classification tree" taking account of orthostatic reactions enhances the correctness of lethal outcome prognosis up to 81.8%. The study revealed the prognostic value of systolic and diastolic arterial pressure in the supine position (15 min of active aortostatic sample) for prognostication of vascular lethal outcomes. Further studies are needed on the role of orthostatic reactions in AH patients of old age together with clinical and laboratory parameters in the prognostication of outcomes of various cardiovascular diseases.

[Features of carotid stenting in elderly: predictors of adverse outcomes (review of literature)]

This article presents the review of literature devoted to studying of features of carotid angioplasty and stenting (CAS) in older patients. Age has been shown to be a predictor of neurological complications during CAS. However, it has been demonstrated recently that carotid stenting can be performed safely in patients over 70 and even 80 years. According to researchers, predictors of mortality were remote (≥ 6 months) transient ischemic attack or cerebrovascular accident, smoking history, creatinine clearance and hemoglobin level. Better selection of patients using the predictors of mortality may help to reduce unwarranted procedures and to optimize survival likelihood. Furthermore, CAS could be safely performed in elderly patients if certain anatomical and clinical markers such as excessive vascular tortuosity, heavy concentric calcification of the lesion and decreased cerebral reserve were avoided. However, additional randomized trial data are needed.

[Endovascular treatment of bifurcation lesions of the coronary arteries in elderly patients: a literature review N-2]

Intervention in bifurcation coronary arteries disease is complicated kind of endovascular treatment of coronary heart disease, especially in patients of elderly and senile age. Recently, in the practice of the operating surgeon there is a large choice of bifurcation coronary artery stents. This report contains the views, features and shortcomings of the presented bifurcation structures. Despite the fact that in the Russian Federation bifurcation stents are rarely implanted, their use can greatly simplify and accelerate interventional procedures, along with the decrease of peri- and postoperative complications.

[The efficacy of peptide bioregulators of vessels in lower limbs chronic arterial insufficiency treatment in old and elderly people]

Atherosclerosis is a leading cause of obliterating diseases of the arteries in 80-90% of cases. The main pathogenetic mechanism is endothelial dysfunction, leading to hypertension, diabetes, congestive heart failure. The desire of modern society to improve the quality of life increases interest of human health in general and sexual health in particular, because the erectile function is an important factor in the quality of life, which makes us look for more effective methods of diagnosis, treatment and rehabilitation. The objective of the study was to assess the effectiveness of vasoactive tripeptide Vezugen in patients with vasculogenic erectile dysfunction as manifestation of atherosclerosis. Treatment results of erectile dysfunction in 41 patients were studied. A comparative analysis of clinical and instrumental parameters of blood flow in the main penile arteries before and after monotherapy was undertaken. The results show that the blood flow through the main artery of the penis after Vezugen treatment significantly improved both clinical and by objective indicators.

[Evaluation of the clinical, psychological and socio-environmental factors, affecting disability of elderly people undergoing surgical myocardial revascularization]

Factors significant for clinical-and-labor prognosis in elderly patients with ischemic heart disease after surgical myocardial revascularization are considered in the article. The authors demonstrate that for each level of the problem there are their own significant factors. Besides, the most essential correlations between investigated factors are marked out. The results obtained will enable to determine more correctly clinical-and-labor prognosis for patients with ischemic heart disease and develop their efficient rehabilitation programs. It is demonstrated that elderly patients have some features of vital activity restriction which are necessary to take into account while medical social expertise and rehabilitation program development.

[Peculiarities of arterial access in endovascular surgery in elderly patients]

In elderly patients, when performing endovascular cathlabs manipulation the radial and cubital accesses is preferable. We propose a new arterial access on the back surface of the hand in the anatomical snuffbox. Artery catheterization of the hand in the anatomical snuffbox preserves intact the radial artery in the forearm for subsequent potential surgical interventions.

[Endovascular revascularization of the carotid area in elderly patients in acute ishemic stroke: the current view of the problem (review of literature)]

This article presents the review of literature devoted to studying of safety and efficacy of early carotid angioplasty and stenting (CAS) in older patients in acute stroke. CAS has been shown to be a non-inferior treatment to carotid endarterectomy for the prevention of recurrent strokes with equivalent rates of major complications (stroke, myocardial infarction and death). Early revascularization is desirable in patients presenting with stroke or transient ischemic attack (TIA) referable to carotid artery stenosis because of the high incidence of recurrent ischemic events. In fact CAS, in the acute stage, remains challenging because of risk perioperative complications and hyperperfusion syndrome or cerebral hemorrhagic infarction after revascularization. In the past years, few researches (Setacci C., 2008; Battocchio C., 2012; Wach M., 2013, et al.) indicate that this procedure can be relatively safe, including elderly patients, even when performed early after a TIA or stroke. However, additional studies of safety and efficacy of early CAS must be undertaken to define the role of endovascular revascularization of the extracranial carotid arteries in the early management of acute stroke.

[Endovascular treatment of bifurcation lesions of the coronary arteries in patients of elderly age: a review of the literature No 1]

Stenting of coronary artery bifurcation lesions is one of the most difficult types of interventional procedures for coronary heart disease. The frequency of coronary artery bifurcation lesion occurs up to 20%. The article reflects a wide variety of types of classifications of coronary bifurcations compared with the basic classification for A. Medina. Having considered the arts of bifurcations stenting, from a provisional Tstenting to complex procedures culote and crush stenting, we advocate the use of bifurcation structures, especially in elderly and senile.

[Hybrid methods in the treatment of heart disease in elderly and senile patients]

Hybrid technologies are becoming increasingly strong position in modern cardiac surgery. New standards and expanding the indications for use of these techniques are delivered. The advantages of hybrid interventions are to a substantial reduction in trauma patients during surgery, reducing the risk of both intra- and postoperative complications, death, the most important for the elderly and senile age.

[The expression of differential and matrix remodelling factors in human buccal epithelium in aging]

The expression of signaling molecules MMP2, MMP9, ERBB3, CXCL12, Nkx2.5, CD90 (the markers of remodeling intracellular matrix and cell differentiation) in human buccal epithelium in ageing has been studied. The expression of molecular markers MMP2, MMP9, CD90 end ERBB3 has shown a decrease during ageing, especially in old people compared with persons of mature age. These data have demonstrated, that buccal epithelium may be considered as a perspective object to study the aging processes in organism as a whole (on the decrease of cell for differentiation and remodeling intracellular matrix).

[Features of antiagregant and anticoagulant therapy at a hybrid revascularization of a myocardium in elderly and senile patients]

The hybrid revascularization of a myocardium combines advantages of mammaro-coronary shunting and stenting of coronary arteries and represents the perspective direction in coronary heart disease treatment. This technique is of most value in patients of advanced and senile age, and also in patients of high surgical risk as it shows small injury, which enables to reduce and facilitate the postoperative period. However today, there is no single standard for the execution of these operations, in particular it is not clear, which scheme of antiagregant and anticoagulant therapy is worth adhering for greater efficiency of the procedures and patient safety.

[Buccal epithelium as an object for testing of biological age and the speed of aging]

Testing of biological age and the speed of aging is one of the main goal of gerontology and predictive medicine. This review summarizes the ability of using buccal epithelium as target of non-invasive investigation of aging diagnostics. Buccal epithelium used for thelomere test and morphological characteristics of its nucleus demonstrate the speed of aging. The electrophysiological investigation of buccal cells nucleus are the markers of biological age of a human. In future it can be possible to use buccal epithelium for immunogistochemical investigation with goal to diagnose cellular senescence.

[Coronary stenting in elderly patients with acute myocardial infarction (review)]

Cardiovascular disease and coronary heart disease are now the leading causes of death and disability in elderly and senile age. Patients with acute coronary syndrome (ACS) and myocardial-infarction (MI) constitute a large portion of emergency hospital admissions among patients with cardiovascular diseases. According to numerous studies, the coronary artery stenting in MI is an effective procedure for the superior results of all the hither to known methods of treatment of ACS. However, the role of endovascular treatment in the acute period of MI in Russia remains underestimated due to lack of awareness of cardiologists and specialists in primary care on this issue. Review of leading Russian and foreign advice and articles on the algorithm of patient care in elderly with ACS and systematization of the information can objectively evaluate the benefits of interventional procedures in the shortest time in AMI.

[The role of vasoactive peptid in lower limbs chronic arterial insufficiency treatment]

Atherosclerosis has lead to lower limbs chronic occlusive arterial disease in 80-90 % of cases. The progress of atherosclerosis is vascular wall self-regulation process violation, and its correction can be made by completion of missing endogenous peptides.

OBJECTIVE

assessment of the possibility to use the vasoactive peptid of Vezugen as monotherapy in patients underwent surgery for chronic lower limbs ischemia. The results of surgical treatment of lower limbs chronic arterial insufficiency in 41 patients were studied. A comparative analysis of clinical and ultrasonic parameters of blood flow in the lower limbs before and after monotherapy was undertaken.

RESULTS

Blood flow in the lower limbs after treatment by Vezugen monotherapy significantly improves both on clinical and on the ultrasonic parameters.