The demographic shift towards an increasing number of older and oldest-old individuals is a global phenomenon. This trend has been accompanied by a rise in surgical interventions targeting individuals aged 65 years and above.

However, the traditional clinical approach to treating single diseases often proves insufficient for geriatric patients due to multiple factors, such as the presence of multiple chronic conditions, the use of multiple medications, physical frailty, malnutrition, cognitive impairments, and diminished physiological function. With age, metabolic processes tend to slow down, leading to reduced efficiency and diminished ability to cope with stressors.

These factors, coupled with the increasing frequency of surgical interventions, pose a significant risk of postoperative complications and even mortality.

 Consequently, a comprehensive approach is essential for geriatric surgical patients. This approach encompasses preoperative assessment, meticulous surgical planning, and complex postoperative care. A multidisciplinary team of medical professionals is indispensable for providing comprehensive care throughout the treatment course.

RELEVANCE: Sarcopenia is one of the leading geriatric syndromes that increases the risk of disability, falls and injuries. This syndrome is of particular importance for centenarians aged 90 years and older, for whom a detailed analysis of the course of sarcopenia has not previously been carried out and the hormonal and metabolic characteristics of this condition have not been described.

AIM OF THE STUDY: To analyze the features of hormonal and metabolic status in nonagenarians with sarcopenia and to identify factors that increase the risk of developing this condition

MATERIALS AND METHODS: The study included 2221 people over the age of 90 years. Study participants underwent a comprehensive geriatric assessment during a visit with a doctor and nurse, as well as blood tests to measure a number of metabolic and hormonal parameters. Statistical data analysis was carried out using the R programming language  version 4.2.2.

RESULTS: Apolipoprotein A1, free triiodothyronine, vitamin D, albumin, C-reactive protein, hemoglobin, red blood cells and hematocrit were significantly associated with the presence of sarcopenia. In a survival analysis of people with sarcopenia, the strongest protective factors for participants with sarcopenia were any physical activity and increasing free T3. Malnutrition is the leading destructive factor.

CONCLUSION: Hormonal metabolic status, in particular low concentrations of vitamin D, triiodothyronine, albumin, and apolipoprotein A1, largely determines the presence of sarcopenia in centenarians, but when assessing risks, it is necessary to take into account a number of other important parameters, such as physical activity and nutritional  status.

BACKGROUND. Managing older individuals becomes challenging due to the coexistence of multiple chronic diseases, ultimately diminishing both their quality and duration of life. Different comorbidity scales are used to assess the severity of comorbidity. However, the severity of comorbidity in sarcopenic has not been well studied.

AIM. To analyze the prevalence and configuration of chronic conditions in individuals with sarcopenia and measure the severity of comorbidities utilizing different scales.

MATERIALS AND METHODS. The research comprised 230 subjects who were 65 years old and above (with a median age of 75 [68; 79] years), who underwent evaluation at a medical institution in St. Petersburg. Sarcopenia was diagnosed based on the criteria set by the European Working Group on Sarcopenia 2 revision (EWGSOP2, 2018). Comorbidity was assessed with the CIRS-G scale (Cumulative Illness Rating Scale for Geriatrics) and the Charlson comorbidity index.

RESULTS. The number of comorbidities did not vary significantly between sarcopenic and non-sarcopenic patients, irrespective of gender (p > 0.05). There was a negative correlation between muscle strength and CKD (ρ = –0.323,  p = 0.031), anemia (ρ = –0.249, p = 0.045), and a positive relationship with obesity (ρ = 0.175, p = 0.032). The risk of sarcopenia increased in people with severe comorbidity according to the Charlson index (OR = 5.178; 95% CI 1.597–14.128; p = 0.0030). Severe comorbidity according to the Carlson index was associated with low muscle mass (b = –0.129; 95% CI –0.142; –0.116,  p < 0.0001), low muscle strength (b = –0.388; 95% CI –0.757; –0.019, p = 0.039) and low physical performance (b = –0.343; 95% CI –0.565; –0.122, p = 0.0025).

CONCLUSION. The study showed that comorbid pathology plays a crucial role in diminishing muscle mass and function, and in the progression of sarcopenia among individuals aged 65 and older.

BACKGROUND. Vitamin D influences the preservation and maintenance of skeletal muscle function. However, the effectiveness of cholecalciferol in enhancing muscle mass and improving skeletal muscle function has been the subject of varied opinions in existing studies.

AIM. This study aims to evaluate the effects of vitamin D₃ supplementation on muscle strength and physical performance in community-dwelling patients diagnosed with sarcopenia.

MATERIALS AND METHODS. The research included 202 subjects aged 65 years and older (median age — 75 [68; 79] years) who were examined at a medical institution in St. Petersburg. Sarcopenia was diagnosed based on the European Working Group on Sarcopenia 2 revision (EWGSOP2, 2018) criteria. Levels of 25(OH)D were measured at the screening phase and again after 3 and 12 months of follow-up among those who consented to continue their participation. The effectiveness vitamin D₃ supplementation was evaluated using various dosing regimens after 12 months.

RESULTS. Vitamin D deficiency was found to be significantly more prevalent in sarcopenic patients compared to their non-sarcopenic counterparts (72.7 vs. 53.0%, p = 0.007). This deficiency was associated with decreased muscle strength (OR = 2.613; 95% CI 1.993–3.270; p = 0.00116) and impaired physical performance, as indicated by the SPPB tests (OR = 1.905; 95% CI 1.342–2.710; p = 0.00034) and the «Timed Up and Go» test (OR = 1.364; 95% CI 1.003–1.853; p = 0.047). Following 3 months of native vitamin D₃ supplementation with various dosing regimens, 87.5% to 98.5% of patients experienced an increase in 25(OH)D levels exceeding 30 ng/ml (p < 0.001), with 83.3% to 97.1% maintaining these levels at the 12-month mark. After one year of treatment, muscle strength improved in 82.8% of sarcopenic patients (p < 0.001), while 69.0% showed enhancements in physical performance (p < 0.001).

CONCLUSION. Native vitamin D₃ supplementation significantly enhances muscle strength and physical performance in patients with sarcopenia.

INTRIDUCTION. Diverse functional limitations, such as visual deficits and sarcopenic obesity, result in reduced activity levels in the daily routines of these patients. However, when assessing the basic functional activity of patients with sarcopenic obesity and visual impairment, it is essential to take into consideration, first and foremost, specific changes in daily activities caused by ophthalmologic pathology, which can be difficult to identify using existing scales such as the Barthel scale, which do not reflect the impairments that have occurred to the visual organ and the resulting visual deficit.

OBJECTIVE. The study was conducted to validate a test assessing the basic functional activity of patients with visual impairment, with a specific focus on individuals with ophthalmological pathology and sarcopenic obesity.

METHODS. A study was conducted on 125 older patients with sarcopenic obesity and cataracts, as well as 138 patients with sarcopenic obesity and primary glaucoma of similar age. The research excluded individuals with frailty or severe cognitive impairment. Diagnosis of sarcopenic obesity was determined following the guidelines recommended by The European Working Group on Sarcopenia in Older People (EWGSOP, 2018). The authors utilized a previously tested and validated assessment tool to study the daily activities of these patient groups and their basic functional activity in visual impairments. The proposed test consisted of 8 questions that are most commonly associated with visual impairments: how easy or difficult it is to thread a needle, read text, cut paper of a certain size, trim nails, distinguish numbers on a phone, write text, count money, and distinguish the colors of clothing items. Each question had the same answer gradation: easy (0 points); difficult to do, but I can handle it (1 point); I can't do it (2 points). The maximum number of points on this test corresponded to 16 points. Depending on the number of points, activities in daily life were classified into: mild dependence (0–6 points), moderate (average) — 7–10 points, pronounced (complete) dependence — 11–16 points.

RESULTS. The study of patients with sarcopenic obesity, cataracts, and glaucoma in their daily activities with our created test identified statistically significant differences in basic functionalities within the examined groups. Threading a needle causes the greatest dependence on others in patients with sarcopenic obesity and cataracts (1,84 ± 0,03 points) with a statistically significant difference both in relation to patients with sarcopenic obesity and glaucoma (1,52 ± 0,02 points) (p < 0,01). Severe limitations of activity in the daily life of patients with sarcopenic obesity and cataracts are caused by nail clipping (1,75 ± 0,03 points) versus 1,43 ± 0,04 points in glaucoma (p < 0,01). Despite the significant differences in average scores for these types of activities in everyday life, these types of restrictions dominate in both groups.

CONCLUSION. The use of our test for assessing the basic functional activity in patients with ophthalmic disorders and sarcopenic obesity has allowed us to identify the main limitations and specific characteristics in these patients with visual impairments of various origins and sarcopenic obesity.

INTRIDUCTION. The development of visual deficits due to glaucoma significantly limits vitality among older patients.  However, the impact of primary open-angle glaucoma and sarcopenic obesity on patient resilience remains virtually unexplored.

OBJECTIVE. To assess the impact of sarcopenic obesity and primary glaucoma on resilience in older patients.

METHODS. Two groups of patients participated in the study: older patients with sarcopenic obesity and primary glaucoma, as well as patients of the same age with primary glaucoma but without sarcopenic obesity received inpatient treatment at S.N. Fedorov National Medical Research Center “Eye Microsurgery” in Tambov. The study on sarcopenic obesity was conducted using the standards of reduced muscle strength, decreased muscle mass, and increased body mass index.  To study the resilience of patients, the Connor-Davidson Resilience Scale-25, validated in the Russian Federation, was used.

RESULTS. To a large extent, individuals with primary open-angle glaucoma aged 60-74 and individuals with primary open-angle glaucoma combined with sarcopenic obesity also aged 60-74 differed significantly in terms of the subdomains of security in relationships and positive acceptance of change. A statistically significant difference was also observed between the two groups in terms of another important subdomain, individual perseverance and competence, as measured by average scores in each group.  At the same time, there was a decrease in age-related resilience, as measured by the final parameter on the Connor-Davidson Resilience Scale-25. Additionally, the average value for the integral parameter used to measure resilience in the study decreased by 23.4 points in the group aged 60-74 with glaucoma, with a statistically significant difference.

CONCLUSION. Sarcopenic obesity in combination with glaucoma statistically significant and to a greater extent reduces the resilience of patients than glaucoma alone.  Among the domains under consideration, in patients with sarcopenic obesity and glaucoma, vitality decreases in the domains of resilience to adverse influences, trust in personal abilities, spirituality, and level of self-control.        

The modern understanding of sarcopenia proposes considering this condition not only as an age-related reduction in muscle mass and function, but also as a result of secondary damage caused by various chronic inflammatory and metabolic conditions. Research has shown that sarcopenia affects 25-70% of patients with chronic liver diseases, particularly men in Western populations. This condition leads to a deterioration in clinical outcomes and quality of life.  Therefore, understanding the clinical and pathogenic relationships between sarcopenia and liver diseases is crucial for the development of new diagnostic strategies and therapeutic interventions, aimed at improving the functional status and increasing the life expectancy of affected patients. 

The purpose of this review is to analyze and present data from open access scientific sources on the clinical and pathophysiological relationships between sarcopenia and the most common liver diseases, as well as relevant therapeutic approaches to address these disorders.

METHODS. Foreign and domestic scientific publications on this topic from the past 15 years were studied using electronic libraries such as PubMed, ScienceDirect and elibrary.

CONCLUSION. The generalization and analysis of scientific information highlight the importance and relevance of this issue, emphasizing the need for further research on muscle tissue damage within the context of various pathogenic mechanisms occurring in chronic liver diseases. Sarcopenia has the potential to become a new therapeutic target in hepatology. Early detection and prevention may hold the most promising treatment strategy for patients with a range of liver diseases.

The interaction between bone and muscle tissues extends beyond simple mechanical relations. Bone tissue performs an endocrine function and generates active metabolites and hormones that influence skeletal muscle, insulin sensitivity, adipose tissue, and metabolism in general. With aging, the risk of osteopenia, osteoporosis, and sarcopenia increases. The relationship between osteoporosis, sarcopenia, and aging in humans is of interest, as well as therapeutic and preventative measures aimed at avoiding these pathological conditions.

Carotid endarterectomy (CEA) is the mainstay of treatment for carotid artery stenosis for the prevention of ischemic strokes. The variant anatomy of the structure of the brachiocephalic arteries, namely the high bifurcation of the common carotid artery, requires a careful approach to planning surgical intervention. A multidisciplinary approach requires a clear and informative diagnostic algorithm for the examination of patients with high bifurcation of the carotid arteries, involving the collaboration of a radiologist and a vascular surgeon. An attempt to classify variant structural features of the carotid artery bifurcation can help to reduce discrepancies in the diagnosis and the risk of complications associated with surgical intervention. Based on their own experience in managing patients with carotid artery stenosis, the authors have proposed a new guideline for determining and localizing the high bifurcation of the carotid arteries.