A.I. Burnasyan Federal Medical Biophysical Center clinical bulletin

To avoid under- or overdiagnosis of hypertension, the clinician needs to have firm confidence in the measurement tool. Recently, numerous automatic cuff-based sphygmomanometers have become this tool. The solution to this problem appears to be a wider introduction of device validation (accuracy check) activities in research structures. This review presents a number of aspects that are relevant to the ongoing work to develop a global universal standard for such validation.

Klinefelter syndrome is the most common chromosomal abnormality among others and is manifested mainly by hypogonadism, gynecomastia, and infertility. Against the background of KS, oncological diseases can develop, more often nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) due to genetic reparations, as well as osteoporosis as a result of androgen deficiency.
This article describes a clinical case of a patient with Klinefelter syndrome and the onset of Hodgkin’s lymphoma (HL) in order to assess the risk of osteopenia/osteoporosis in this patient. A patient with previously diagnosed KS went to the doctor complaining of weakness, fatigue, weight loss, local enlargement of the inguinal lymph nodes. The patient was diagnosed with NLPHL and standard pathogenetic therapy was performed. Taking into account the presence of risk factors for osteoporosis (the presence of Klinefelter syndrome, HL, chemotherapy), the patient underwent two-energy densitometry in the lumbar spine, neck and proximal femur in order to assess the condition of bone tissue. As a result, a decrease in bone mineral density was found in all measurement areas.
This clinical case describes a rather rare combination of three significantly different nosologies. Interestingly, two of them, namely HL and Klinefelter syndrome, contribute to the development of the third through various mechanisms. The presence of a decrease in bone density in this patient necessitates prevention. Despite the rare occurrence of such combined pathologies, the issue of timely diagnosis and prevention of complications from the musculoskeletal system in this category of patients remains relevant today

The purpose of the study: to improve the method of surgical treatment of patients with scaphoid nonunion.
Material and methods: the results of treatment of 30 patients operated on for scaphoid nonunion of the hand, which arose after conservative treatment (not treatment) of fractures, surgical treatment for 2018-2021 were analyzed.
The patients were divided into two groups: 15 patients with scaphoid nonunion who underwent free bone autoplasty as a surgical aid, fixation of bone fragments with a headless screw – a control group; 15 patients with fscaphoid nonunion, who underwent free bone autoplasty as surgical treatment, supplemented with non-free plastic surgery with a periosteal flap on the metacarpal artery – the main (experimental) group of patients. The possibility of using periosteal flaps isolated from the first and second metacarpal bones was evaluated.
To assess the results of treatment, X-ray monitoring of scaphoid nonunion consolidation was used at 8, 12 weeks and 6 months after surgery; computed tomography of wrist joints was performed at 4 months after surgery in order to assess the degree of bone graft reconstruction.
Hand function was assessed before and after surgery using the DASH Upper Limb Disability Questionnaire and the Visual Analog Pain Scale (VAS).
Results of the study: in the experimental group, scaphoid nonunion consolidation was achieved in 13 out of 15 patients (86.6%) compared with the control group (10 out of 15 patients – 66.7%).
According to the severity of the pain syndrome and the final functional result, comparable indicators were obtained in both groups.
Discussion: given the small sample of patients who participated in the work, the study has moderate reliability. However, the data obtained allow us to hope for the effectiveness of the proposed method of surgical treatment used in patients of the main study group.

The problem of treating elderly patients is one of the most pressing in modern clinical medicine.
Colorectal cancer is one of the main causes of mortality from malignant neoplasms in Russia and other developed countries. At the same time, the incidence of tumors of the colon and rectum steadily increases with age. Before starting treatment for elderly patients, it is necessary to carefully weigh the potential risks and the possibility of achieving positive results of antitumor therapy.
Objective: To summarize the literature on the use of a comprehensive geriatric assessment, including the Cancer and Aging Research Group (CARG) toxicity assessment, to predict the risk of adverse events during anticancer drug treatment in elderly patients diagnosed with colorectal cancer.
Materials and methods: The search for scientific sources was carried out in PubMed / Medline / UpToDate using the following keywords: “malignant tumors”, “metastatic colorectal cancer”, “senile age”, “antitumor drug therapy”. The time horizon covered 2016–2023. Using a time filter, the most relevant and innovative research papers on the issues of chemotherapy treatment of elderly and senile patients were selected.
Results: Most current evidence demonstrates the importance of performing a comprehensive geriatric assessment (CGA), Cancer and Aging Research Group (CARG) toxicity assessment in elderly and geriatric patients. Information obtained from geriatric assessment should be used to predict and manage treatment toxicity. And also for assessing and predicting overall survival.
Activities based on CGA can reduce the toxicity of chemotherapy, improve the quality of life of patients, and increase compliance with medical recommendations. Undoubtedly, a comprehensive geriatric assessment (CGA) can help achieve the necessary balance between the potential effectiveness and adverse events of chemotherapy.
The choice of treatment tactics for an elderly and senile cancer patient should be based on the patient’s functional status (PS), general somatic status according to the ECOG scale, and the risk of toxicity according to the CARG scale.
In the presence of colorectal cancer, patients with good functional status who need antitumor systemic effects can be prescribed polychemotherapy with FOLFOX, XELOX, FOLFIRI doublets with the addition of targeted drugs: bevacizumab or cetuximab (depending on the results of gene profiling of the tumor).
Patients who are not candidates for polychemotherapy in standard doses, who have a general somatic status on the ECOG scale of 1-2 and an average risk of developing toxicity of grade 3 on the CARG scale, can undergo PCT with FOLFOX, XELOX, FOLFIRI doublets with a reduction in the starting dose by 20%, or monochemotherapy with antimetabolites: capecitabine, 5-fluorouracil; topoisomerase I inhibitor irinotecan.
Patients with poor functional status, general somatic status on the ECOG scale 3-4, and a high risk of developing toxicity on the CARG scale are not candidates for systemic combination chemotherapy. Particular attention should be paid to maintenance therapy in this subgroup of patients. However, if the decrease in PS level is directly related to malignancy and PS ≥2, the possibility of monochemotherapy by infusion of a combination of 5-fluorouracil and leucovorin FU/LV can be evaluated.

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