Факторы риска неблагоприятного прогноза у пациентов с ишемической болезнью сердца и возраст-ассоциированными синдромами при плановом коронарном шунтировании

Highlights. Patients with coronary artery disease and age-related disorders (sarcopenia, osteopenic syndrome, osteosarcopenia) who underwent elective on-pump coronary artery bypass grafting are at higher risk of developing cardiovascular complications, non-infectious complications, and death.Musculoskeletal disorders (sarcopenia, osteopenic syndrome, osteosarcopenia) in combination with traditional predictors (age, diabetes mellitus, prior myocardial infarction and stroke, cancer) are risk factors for unfavorable prognosis of postoperative period of coronary artery bypass grafting. Aim. To assess risk factors for unfavorable prognosis in patients with coronary artery disease (CAD) undergoing elective on-pump coronary artery bypass grafting, taking into account age-related disorders (sarcopenia, osteopenic syndrome, osteosarcopenia).Methods. This single-center study included 387 CAD patients admitted for elective coronary artery bypass grafting. Taking into account the diagnosed age-related disorders, four groups of patients were formed. The first group consisted of 52 (13.4%) patients with sarcopenia, the second group was comprised of 28 (7.2%) patients with osteopenia (osteopenia/osteoporosis), the third group included 25 (6.5%) patients with osteosarcopenia, and the fourth group consisted of 282 (72.9%) participants with coronary artery disease and without musculoskeletal disorders (MSD). Risk factors for a composite endpoint (myocardial infarction, stroke, paroxysmal atrial fibrillation, cardiac rhythm disturbances) and death, and noninfectious complications (resternotomy for bleeding, pneumothorax aspiration and thoracentesis) were assessed.Results. The composite endpoint occurred more frequently in patients with osteopenia (group I – 9.6%, group II – 32.1%, group III – 12%, group IV – 12.8%; p = 0.029), and non-infectious complications occurred more frequently in patients with sarcopenia and osteosarcopenia (group I – 17.3%, group II – 7.1%, group III – 12%, group IV – 5.3%; p = 0.002). MSD were associated with the risk of composite endpoint (odds ratio (OR) 1.73, p = 0.035), and osteopenia increased it three-fold (OR 3.01, p = 0.046). Moreover, MSD were associated with higher risk of non-infectious complications (OR 1.71, p = 0.026), especially in patients with sarcopenia (OR 2.02, p = 0.034). The assessment of risk factors for unfavorable prognosis highlighted the presence of osteopenic syndrome (100 CU), prior stroke (88 CU) and myocardial infarction (85 CU). The risk of non-infectious complications was associated with prior ischemic events (ranking level for myocardial infarction – 100 CU, stroke – 75 CU), and MSD (89 CU) and its types (osteosarcopenia – 77 CU, osteopenia – 69 CU, sarcopenia – 52 CU).Conclusion. Age-related disorders in combination with MSD increase the risk of a composite endpoint and non-infectious complications by one to three times.Основные положения. Пациенты с ишемической болезнью сердца и возраст-ассоциированными синдромами (саркопения, остеопенический синдром, остеосаркопения), перенесшие плановое коронарное шунтирование в условиях искусственного кровообращения, в большей степени подвержены сердечнососудистым осложнениям и смерти, а также неинфекционным осложнениям, связанным с хирургическим лечением.Наряду с традиционными предикторами (возраст, сахарный диабет, ранее перенесенный инфаркт миокарда и инсульт, онкопатология) исходное нарушение костно-мышечной функции и его варианты (саркопения, остеопенический синдром, остеосаркопения) относятся к факторам неблагоприятного течения госпитального периода планового коронарного шунтирования.Цель. Оценить факторы риска неблагоприятного прогноза у пациентов с ишемической болезнью сердца (ИБС) с учетом возраст-ассоциированных синдромов (саркопения, остеопенический синдром, остеосаркопения), направленных на плановое коронарное шунтирование в условиях искусственного кровообращения.Материалы и методы. Проведено одноцентровое исследование 387 больных ИБС, поступивших для планового коронарного шунтирования. С учетом диагностированных возраст-ассоциированных синдромов сформированы четыре группы. Первая группа – 52 (13,4%) пациента с изолированной саркопенией, вторая – 28 (7,2%) больных изолированной остеопенией (остеопения/остеопороз), третья – 25 (6,5%) пациентов с остеосаркопенией, четвертую группу составили 282 (72,9%) участника с ИБС без нарушений костно-мышечного статуса (КМС). Проанализированы факторы риска развития комбинированной конечной точки, объединявшей сердечно-сосудистые осложнения (инфаркт миокарда (ИМ), инсульт, пароксизм фибрилляции предсердий, нарушение проводимости) и смерть, а также неинфекционные осложнения (геморрагическое осложнение, потребовавшее рестернотомии, пневмо- и гидроторакс с плевральной пункцией).Результаты. Комбинированную конечную точку чаще регистрировали среди больных изолированной остеопенией (I группа – 9,6%, II группа – 32,1%, III группа – 12%, IV группа – 12,8%; р = 0,029), неинфекционные осложнения – у пациентов с изолированной саркопенией и остеосаркопенией (I группа – 17,3%, II группа – 7,1%, III группа – 12%, IV группа – 5,3%; р = 0,002). Нарушение КМС сопряжено с риском развития комбинированной конечной точки (отношение шансов (ОШ) 1,73, р = 0,035), при этом изолированная остеопения увеличивала этот риск в три раза (ОШ 3,01, р = 0,046). Также нарушение КМС ассоциировано с ростом неинфекционных осложнений (ОШ 1,71, р = 0,026), в частности при изолированной саркопении (ОШ 2,02, р = 0,034). Расчет рангов значимости вклада факторов в риск развития комбинированной конечной точки показал наличие остеопенического синдрома (100 у.е.), ранее перенесенного инсульта (88 у.е.) и ИМ (85 у.е.). Риск неинфекционных осложнений ассоциирован с перенесенными ранее ишемическими событиями (уровень рангов для ИМ – 100 у.е., для инсульта – 75 у.е.), а также с нарушениями КМС (89 у.е.) и его вариантами (остеосаркопения – 77 у.е., остеопения – 69 у.е., саркопения – 52 у.е.).Заключение. Возраст-ассоциированные состояния, сопровождающие нарушение КМС, увеличивают риск развития комбинированной конечной точки и неинфекционных осложнений в 1,7–3,1 раза

CHILDREN’S BILINGUALISM. PROBLEMS IN NATURAL LEARNING RUSSIAN AND BULGARIAN LANGUAGES

The article deals with the problem of children’s bilingualism whose first language is Bulgarian, and the second is Russian. In polylingual Transnistrian region bilingual children meet some difficulties in their language assimilation (in this case, we mean Russian and Bulgarian languages). These difficulties are: the effect of Parkansky dialect on Bulgarian literary language; errors in spelling, in pronunciation of certain words and expressions. On the other hand, as the language of communication in family continues to be Bulgarian, Russian language skills are limited to everyday speech.Our goal is to understand the mechanism of children’s bilingualism developing. We would like to find out, what are the ways and the social causes of bilingualism. This research is based on speech records (bilingual children aged from 3 to 10 ages). As a result, we offer exemplary exercises for working with bilingual children. Finally, we’ve discussed the pros and cons of children’s bilingualism in polylingual Transnistrian society

Radiology methods of the sarcopenia diagnosis

One of the processes that accompany the aging of the body and the decline in the quality of life of older people is sarcopenia or loss of muscle tissue and the associated restriction of mobility. The identification of this condition in patients at the stage when there is only an initial decrease in muscle mass without a decrease in muscle strength is of great importance for determining the cause of the disease and the timely start of treatment. This review describes the capabilities of the methods of radiation diagnosis in assessing the quantity and quality of muscle tissue and their shortcomings from the standpoint of verification and dynamic observation of sarcopenia. The lack of a unified standard for the instrumental diagnosis of this pathology and the alertness of specialists regarding sarcopenia during routine examination is one of the main reasons for the insufficient detection of muscle loss in the cohort of elderly patients. This review is of interest to a wide range of clinical physicians and radiologists, who are found in their practice with patients of older age groups

Prevalence of Musculoskeletal Disorders in Patients with Coronary Artery Disease

Aim. To study the prevalence of musculoskeletal disorders in patients with stable coronary artery disease (CAD).Material and methods. Patients with stable CAD (n=387) were included in the study. The subjects were admitted to the hospital for planned myocardial revascularization (ages of 50-82). The median age was 65 [59;69] years. Most of the sample consisted of males - 283 (73.1%). 323 (83.5%) patients had arterial hypertension (AH), 57.1% - history of myocardial infarction, and a quarter of the patients had type 2 diabetes mellitus (DM). The study of musculoskeletal system included the identification of sarcopenia in accordance with The European Working Group on Sarcopenia in Older People (EWGSOP, 2019); verification of osteopenia/osteoporosis according to the WHO criteria (2008); diagnosing osteosarcopenia in case of sarcopenia and osteopenia/osteoporosis coexistence.Results. At the initial screening of sarcopenia in accordance with EWGSOP, clinical signs (according to the Strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire) were detected in 41.3% of cases, but further examination (dynamometry, quantitative assessment of skeletal muscle) confirmed this diagnosis only in 19.9% of patients with CAD. Among the examined patients with CAD a low T-score according to DEXA was found in 53 (13.7%) of cases, and osteopenia was diagnosed 10 times more often than osteoporosis (90.6% vs. 9.4%). Furthermore, due to combination of low bone density (osteopenia/osteoporosis) and reduced muscle mass and strength (sarcopenia), osteosarcopenia was verified in one patient. Thus, the study revealed the prevalence of particular types of musculoskeletal disorders in 105 (27.1%) patients with stable CAD. The most common type of musculoskeletal disorder was sarcopenia - 52 cases (13.4%); osteopenia/osteoporosis was detected in 28 patients (7.2%), osteosarcopenia in 25 (6.5%). The most pronounced clinical manifestation of sarcopenia and osteopenia/osteoporosis, reflected by a higher score on the SARC-F questionnaire, low handgrip strength, small area of muscle tissue, low musculoskeletal index, as well as low values of bone mineral density, were observed in patients with osteosarcopenia. Patients with osteopenia/osteoporosis did not differ significantly from patients without musculoskeletal conditions in most parameters, with the exception of the T-score, the average SARC-F score, and muscle strength in men. The conducted correlation analysis revealed not only the relationship between the parameters of musculoskeletal function, but also their association with age, duration of AH, CAD, and type 2 DM.Conclusion. Several types of musculoskeletal disorders were found in a third of patients with CAD. Sarcopenia was revealed to be the most frequent type of musculoskeletal disorder