Volga District Research Articles

Principles of Organization of Multidisciplinary Clinics and Pain Treatment Centers (Literature Review and Own Experience)

Pain is one of the most important problems of modern medicine. The high prevalence of pain causes significant material and social losses. As an effective measure to solve this problem, the idea of organizing a network of pain treatment centers and clinics was put forward. The purpose of the work is to describe the structure of the organization of multidisciplinary clinics and pain treatment centers. The article discusses the basic principles of the organization of pain treatment centers and the system of analgesic care. An example of the work of the pain center on the basis of a multidisciplinary hospital (Volga District Medical Center of the FMBA of Russia) is given. The authors shared the structure and organization of the work of this pain treatment center. They also presented the results of his work. Currently, there are no specialized pain centers in Russia. Now in many cities of Russia there is a process of formation of analgesic care. However, this process faces a number of difficulties.

Профилактика роговичных осложнений послеоперационного адъювантного применения антиметаболитов после непроникающей глубокой склерэктомии

Original article Prevention of corneal complications after post-operative application of antimetabolites following nonpenetrating deep sclerectomy S.N. Svetozarskii, A.N. Andreev, A.V. Shvaikin, S.V. Scherbakova, I.G. Smetankin Volga District Medical Center under the Federal Medical and Biological Agency, Nizhny Novgorod, Russian Federation Privolzhsky Research Medical University under the Ministr y of Health of Russia, Nizhny Novgorod, Russian Federation Purpose. To evaluate the clinical and functional effectiveness of the developed method for prevention of corneal complications of nonpenetrating deep sclerectomy (NPDS) with postoperative adjuvant use of 5-fluorouracil in comparison with the control group. Material and methods. Retrospective comparative study in 2 groups included patients with open angle glaucoma who were initially underwent NPDS and received at least 1 subconjunctival injection of 5-fluorouracil in the postoperative period. 1st group included 101 patients (101 eyes) who underwent subconjunctival injection of 5-fluorouracil after surgery using standard technique, 2nd group included 176 patients (176 eyes) who underwent subconjunctival injection of 5-fluorouracil with prophylaxis of corneal complications. Best corrected visual acuity (BCVA), intraocular pressure (IOP), frequency of corneal complications and number of visits to the doctor during the first 4 weeks after surgery were analyzed as criteria of efficacy and safety. Results. Comparison groups did not differ in demographic characteristics and preoperative BCVA and IOP parameters. Fluorescein stained corneal epithelium defects were statistically significantly more frequently observed in 1st group (38.6%) in comparison with 2nd group (7.4%) (p<0.001). Four weeks after NPDS, IOP decrease was 25.5% in 1st group and 31.5% in 2nd group (p=0.042). Mean BCVA loss was 1.9 lines in 1st group and 1.3 lines in 2nd group (p<0.001). The number of follow-up visits during the first month after surgery was 0.6 less in 2nd group than in 1st group (p=0.002). Conclusion. Prevention of corneal complications simply and effectively reduces the risk of corneal epithelial defects after subconjunctival injection of 5-fluorouracil as well as markedly improves the clinical and functional results of NPDS and reduces the need for outpatient visits. Key words: antimetabolites, open-angle glaucoma, corneal erosion, toxicity, prevention of complications

The Incidence and the Clinical Course of Retinal Complications of Intracameral Cefuroxime in Cataract Surgery

Aim. To determine the incidence and the clinical course of retinal complications of intracameral administration of cefuroxime in minimally invasive cataract surgery.Methods. From 2016 to 2021, a prospective clinical study was conducted at the Volga District Medical Center of the Federal Medical and Biological Agency of Russia, which included patients with cataract in one or two eyes to be surgically treated. All patients received 1 mg of cefuroxime injected into the anterior chamber at the end of surgery. All patients underwent ophthalmological examination including evaluation of best corrected visual acuity with determination of logarithm of minimum angle of resolution (logMAR), tonometry, biomicroscopy, and ophthalmoscopy. Each patient before and the day after surgery underwent optical coherence tomography of the retina on a spectral optical tomograph RTVue-100 (Optovue). The dynamics of the condition was evaluated on days 3 and 7 after surgery.Results. Five cases of retinal complications of intracameral cefuroxime injection were identified during the 5-year study period. According to data of optical coherence tomography, retinal edema was localized in the internal nuclear layer of the retina, and the height of serous retinal detachment in the fovea area on the next day after surgery was 315.0 ± 11.0 µm and reduced statistically significantly to 59.8 ± 42.3 µm on the 3rd day after the intervention (p = 0.043). One week later, all patients had complete retinal adherence and recovery of visual function. Retinal edema did not recur in the long term after surgery.Conclusion. Serous retinal detachment with macular edema is the most common clinically relevant complication of intracameral antibiotic prophylaxis, which develops both in compliance with the dilution protocol and in overdose, and has a favourable prognosis.

Регионы России в новых экономических условиях

In the first three months of the sanctions’ crisis, regions connected with the global market were hit harder: these are the exporters of oil, gas, metals, and regions of the manufacturing industries with a high share of imported components. The influence of specialization has increased; in industry the decline is stronger in the regions of the automotive industry, oil and gas production, ferrous metallurgy. The decline in retail sales is stronger in the agglomerations of the largest cities due to the departure of foreign companies and in some regions with low incomes, where the population is faster reducing consumption. The decline or stagnation of personal income tax revenues in May 2022 manifested in the regions of the fuel complex, metallurgy, in some depressed regions and in underdeveloped Republics, where the share of shadow business may increase. The risks of part-time employment are higher in the industrial regions of the Center, the Volga district and part of the Urals. The employment reduction risks in the market services are higher in agglomerations and other major cities, in part of the depressed regions; in resort regions they are mitigated by increased home tourism. The risks of regional budgets tax revenues decline are strongest in more developed and export-oriented regions. The Southern agrarian regions and the Far East (with the exception of Sakhalin) are going through the crisis more mildly due to the home demand for food products and its exports, and for the Far Eastern regions — due to orientation to the Asian markets, especially China. Moscow is likely to go through a new crisis, like the two previous ones, softer than other regions, especially in terms of the dynamics of household incomes and the budget revenues.

Эпидемиология онкологических заболеваний в Нижегородской области в 2017–2019 годах

As we know, neoplasms are characterized by high prevalence. The purpose of this study was to analyse the dynamics of cancers in the Nizhny Novgorod Region in 2017–2019. Materials and methods. The object of this research were the residents of the city of Nizhny Novgorod and the Nizhny Novgorod Region who sought medical help at Polyclinic No. 3 of the Volga District Medical Centre, Russia’s Federal Medical-Biological Agency (Nizhny Novgorod). Computed tomography was used to diagnose neoplasms. Results. In 2017, 50,470 diseases were identified, of which 2548 were neoplasms (599 malignant, and the rest benign). In 2018, 57,012 diseases were diagnosed, of which 2710 neoplasms, 639 being malignant. In 2019, the statistics was rather similar: a total of 55,110 diseases, of which 2705 neoplasms (661 malignant). Thus, the total number of diagnosed diseases, neoplasms included, was somewhat less in 2017, which can be explained by certain improvement in diagnostics and reporting, as well as a more active participation of the population in screening in 2018–2019. The absolute number of malignant neoplasms, although not much, still grows annually, and they are typically diagnosed after the age of 55–60 years. In general, the most often attacked is the digestive system, which is indicated by a steady increase in the number of new diagnoses by 1.5–2 % each year. Fortunately, there is also a positive trend, i.e. the number of malignant tumours of the excretory system, skin and female repr oductive system is falling. For citation: Saburtsev S.A., Chemodanov P.G. Epidemiology of Oncological Diseases in the Nizhny Novgorod Region in 2017–2019. Journal of Medical and Biological Research, 2021, vol. 9, no. 4, pp. 417–425. DOI: 10.37482/2687-1491-Z079

Total gastrosplenectomy with distal pancreatectomy for local advanced gastric adenocarcinoma

Surgical treatment the main option for local advanced gastric adenocarcinoma (LAGA). For tumors with invading on body and tail of pancreas, distal pancreatectomy (DPE) may be necessary to achieve negative margin resection (pR0). The aim of this study was to evaluate the short- and long-term outcomes of total gastrosplenectomy (TGSE) + DPE vs. TGSE for LAGC. The retrospective analysis of patients who underwent TGSE + DPE and TGSE between January 2017 and December 2019 years in the Volga District Medical Center. The resection margin, postoperative complications, overall survival outcomes were analyzed. 94 patients who underwent total gastrosplenectomy with or without distal pancreatectomy for LAGA were enrolled (72 TGSE and 22 TGSE-DPE). Histopathologic final analysis of TGSE + DPE group confirmed invasion (pT4b) in 63.6%. pR1 resection was in 13.6% vs. 2.8% in TGSE group (p = 0.082). Clavien-Dindo grade IIIb were observed 9.1% vs. 4.2% (p = 0.023). The 1-year overall survival rate were 40.9% in TGSE + DPE vs. 90.3% in TGSE (p < 0.001). Total gastrosplenectomy with distal pancreatectomy was associated with high pR1 resection and postoperative complications; patients should be carefully selected because long-term survival remains poor.

Formation of the personnel reserve: world practice and Russian reality

The article offers an overview of various approaches to the management succession pool, taking into account international and local theory and practice. In medical institutions, both Western and Russian, various methods of identifying, developing and retaining personnel are practiced for the purpose of talent developing and forming a succession pool. The authors highlight the integral experience of the Greater Volga District Medical Center of the FMBA of Russia, which practices both forming an exclusive list of employees to fill vacant executive positions, as well as applying inclusive methodology for creating the relevant environment for talent development in the framework of the socalled «horizontal career» approach.

Financial Tips on the Need to Identify Active Degassing Structures When Planning Territory Development Using the Functional Zoning Method

The article demonstrates financial instructions and ring degassing structures decoded by the author's technique in the northeast and southeast of Kazan. The structures of various types were identified in areas of the territories of the Volga and Soviet districts of the city and mapped on the functional zones of Kazan of these areas. Residential areas Nagorny, Aki, Quarry of the Sovetsky district, and Mirny, Ferma-2 of the Volga district of Kazan were selected as the research territories. This matter overly helps visually identify areas of the city that are in potential jeopardy of non-human impact. The article indicates the hypothesis about the need to consider the active structures of hydrogen degassing during the development of the territory from analyzing the functional zoning scheme of the studied territory, and provides a detailed comparative analysis of the distribution of ring structures in residential and green functional zones.

Climatic Changes on the Territory of the Volga Federal District

Climatic changes in the Middle Volga District observed from 1828 to 2018 are examined. Long-term air temperature variations are monitored using observation data from Meteorological Observatory of Kazan University (MO KU) (1828-2018), and from 5 meteorological stations located in Orenburg, Penza, Perm, Saratov, Ufa (1885—2018). Spatiotemporal variability of the air temperature and atmospheric precipitations is researched in the Volga Federal District (VFD) on the basis of data from 200 meteorological stations (1954-2018) and NCEP/NCAR, ERA-Interim, ERA5 reanalysis data (1979-2018). The general tendency towards the air temperature rise has been identified for the period considered (in Kazan the annual air temperature mean increased by 4°ccccc from 1828 to 2018). It has also been revealed that the number of days with the minimum temperature (below -20°ccccc) tends to decrease throughout the year, while the number of days with the maximum temperature (over 25°ccccc) tends to increase. The dynamics of the low-frequency component with the period exceeding 15 years is studied for normalized air temperature and atmospheric precipitation anomalies in the VFD between 1954 and 2018. Distribution of great air temperature anomalies within the studied period is evaluated.

Possibilities of using neodymium laser (ND:YAG) in gynecological practice

The article is devoted to the possibilities of using laser technologies in the treatment of urogynecological diseases on the example of the experience of doctors of the Volga district medical center of the FMBA of Russia.

The Analysis of Economic Efficiency of Medical Services for Kidney and Liver Transplantation from Live Donors in a Transplantation Center (Through the Example of Volga District Medical Center, FMBA of Russia)

The relevance of the article is connected with the need for competent financial planning of the activities of medical organizations, which is especially significant in the provision of high-tech medical care. The organ transplantation is performed in addition to the capital of Russia only in a few regional medical centers, therefore the analysis of the adequacy of the financial quota for such an operation with its real cost price has not been carried out yet. Aim: to determine the adequacy of the financing of transplantation of human organs at the expense of the federal budget quotas for high-tech medical care to the real cost of this type of medical care. Research methods. The calculation of the cost of kidney and liver transplantation in case of intravital and posthumous donation was carried out by direct costs in the Volga district medical Center. It was found that the size of the quota for these operations is lower than their cost in the context of a regional organ transplantation center. Conclusion: the results indicate that it is mandatory for managers to assess the cost of organ transplants in the implementation of financial planning to improve the economic efficiency of medical organizations.

Intraocular lens power in Russian population: distribution analysis

To analyze the distribution of implanted IOL power and optimize the IOL procurement system. Retrospective analysis of cataract surgeries performed from 2014 to 2015 in the ophthalmic department of Volga District Medical Centre of the FMBA was conducted. Inclusion criteria: age from 20 to 99 years, no refractive surgery in patient's medical history, primary IOL implantation with an A-constant of 118.4, achievement of planned refraction. The studied parameters were IOL power, gender and age of patients. To assess the effectiveness of the procurement system, we analyzed the number of additional «unplanned» purchases and exchanges of IOLs over the course of 5 years (2014-2018). According to the inclusion criteria, 1009 medical records were selected, the age of the patients was 68.7±10.9 years. The distribution of IOL power was similar, but different from the normal, characterized by the mismatch of the median and the mean, left-sided asymmetry and peaked shape. Comparison of 2014 and 2015 samples showed no significant differences and low variability of IOL power. Regression analysis revealed a weak correlation between the IOL power and age and no correlation with gender, a trend was observed for IOL power to increase in patients after 50 years. The use of a procurement planning system based on a mathematical model of the IOL power distribution allows reduction of the additional purchases and exchanges of IOLs with the supplier from 5-7% to 1-2% of the total purchases. The specific features of the IOL power distribution are related to the distribution of biometry parameters in the population. The use of a scientifically based procurement system reduces staff time and laboring costs, releasing economical and time resources.

Geographical vocabulary of the Tornovsky dialect of the Moksha-Mordovian language

Geographical vocabulary existing in ethno-linguistic environment, has a significant impact on the formation of its toponymic nomenclature. This influence is manifested both in the form of toponymic formants and in the basics of geographical names originating from this ethno-linguistic environment. The relevance of this work is definted by the fact that until now geographical vocabulary of the Tornovsky dialect of the Moksha-Mordovian language, as well as other Samara-Bends dialects, was not the subject of special study, and was not introduced into academic and research circulation. The purpose of this article is description and lexico-semantic and etymological analysis of geographical vocabulary of the Tornovsky dialect of the Moksha-Mordovian language. General theoretical and methodological basis of the research was made up of the works of Russian and international researchers on the toponymy and dialectology of the Mordovian languages. Vocabulary data is based on the materials of field research that the author conducted in the village Tornovoe of the Volga district of the Samara region during the field-work in 2017 and 2018. The main methods of linguistic research are descriptive and comparative methods. They were used in the collection and analysis of linguistic material. The results of the study showed that the geographical vocabulary of the Tornovsky dialect of the Moksha-Mordovian language fully reflects all the phonetic and accentual features of this dialect. It was also revealed that there is a fundamental difference between the composition of geographical vocabulary of the Tornovsky dialect and the same vocabulary of the neighboring dialects of the Moksha-Mordvin language, Shelehmetsky and Bahilovsky. A significant part of the geographical vocabulary in tthe Tornovsky dialect is borrowed from the Russian and Turkic Kipchak languages which reflects ethnolinguistic history of its speakers.

Daily variability of arterial stiffness of patients with arterial hypertension depending on the category of cardiovascular risk

The study of the daily variability of arterial stiffness indicators, depending on the category of cardiovascular risk.Materials and methods.The study consistently included patients with essential hypertension who were admitted to the cardiology department of the Volga district medical center from November 1, 2015 to October 1, 2017. The study involved 134 patients with an average age of 52±1 years. Depending on the category of total cardiovascular risk, the patients were divided into 3 groups from I (lowest risk) to III (highest risk). The analysis was carried out on ABPM for 12-14 days (BPLab system of "Peter Telegin" firm). Determined: glomerular filtration rate (GFR), the thickness of the intima-media of the common carotid arteries, analysis of the lipid spectrum. For statistical analysis of clinical and instrumental data, a T-criterion for independent samples was used and an ANOVA analysis was performed. A correlation analysis was performed.Results.Patients of group III had the highest level of av. SBP (рI-III =0.010; pII-III =0.020) and mean pulse BP (PBP) (рI-III =0.002; pII-III =0.002), also more unfavorable the indicators cALALx (pI-II=0.025; рI-III =0.004), varAlx (рI-III =0.004) and av. ASI (рI-III =0.034). When comparing the data of patients of groups II and III, adjusted for gender and age, it was found that statistically significant differences between the groups of varPAD (pII-III =0.008), AASI (рI-III =0.043), varAlx (pII-III=0.049), as well as a pronounced tendency for varASI (pII-III=0.050). Markers of target organ damage (TIM, LVML, GFR) were more pronounced in the high-risk group. As the risk group increased, the level of HDL decreased (рI-III =0.002; pII-III I=0.0001), the level of TG increased (рI-III =0.007; pII-III =0.009) and the CA (рI-III =0.015). The total cholesterol level was lower in patients of group III compared to group II (pII-III=0.004). Statistically signifi nt relationships of arterial wall stiffness indicators with age were found: crAlx (0.467, p&lt;0.001), varAlx (0.272, p&lt;0.01), cpASI (0.227, p&lt;0.01), varASI (0.407, p&lt;0.001). In addition, women showed significant correlations of medium and high strength between age and mean values of mean SPD (r = 0.490, p&lt;0.05), varPAD (r=0.540, p&lt;0.05), avAS (r=0.460, p&lt;0.05) and varASI (r=0.620, p&lt;0.05). VarASI and WedSASI were most closely associated with the level of SRSAD and SRPAD. Only cASI was associated with GFR, and only varASI was associated with the parameters of the lipid spectrum (HSLPVP, TG, KA and LVMI.Conclusion.The most statistically significant dynamics was observed when evaluating varASI, which varied in the sequence I gr. &lt;II gr. &lt; III gr. Corrected by sex and age, the analysis showed a greater variability in arterial stiffness in high-risk patients.

The results of surgical treatment in patients with liver alveococcosis in a hepato-pancreato-biliary center (a 10-years’ experience)

Background: Aggressive course of liver alveococcosis makes it possible to designate it as a “parasitic liver cancer”. The main treatment method for the disease is surgery. The parasitic mass is resected according to R0 principles, with concomitant plastic surgery of the major vessels and bile ducts to increase resectability.Aim: To assess the potential of surgical treatment in patients with advanced liver alveococcosis using transplantation techniques.Materials and methods: We retrospectively analyzed in- and outpatient medical files of 62 subjects with confirmed liver alveococcosis, who had been treated in the Volga District Medical Centre (Nizhny Novgorod, Russia) from 2008 to 2018. Thirty two (32) patients had advanced liver alveococcosis with involvement of afferent and efferent vasculature and biliary tract. Surgical procedures were used in 50/62 patients (or 4.2% of the total number of liver resections performed during this time interval, n = 1197). Complications occurred in 46% (23 / 50) of the cases. Twenty nine (29, or 58%) patients had been operated before (mostly cytoreductive resections and/or explorative laparotomies). Distant lung metastases were found in 2 (4%) patients.Results: Fifty (50) patients had curative surgical procedures: liver resections in 45, deceased donor orthotopic liver transplantations in 5. Most common were extensive liver resections (more than 4 segments). Resection and reconstruction of the main vessels were necessary in 50% (25 cases) of the patients, including v. cava inferior in 25 cases and the portal vein in 24 cases. In 31 patients, resection and reconstruction of extra-hepatic bile ducts was performed, and in 17 (33%) patients resections of the neighboring organs, such as diaphragm, lung, right adrenal, duodenum, stomach, and colon. In 4 cases, resections were performed ex situ ex vivo, followed by auto-transplantation, including 2 cases with reverse auto-transplantation of the left lateral sector to the right. The incidence of liver failure events grade A and B (by International Study Group of Liver Surgery, ISGLS) did not exceed 10% (4 patients). Complications were seen in 25 cases, including Clavien – Dindo Grade II in 5, Grade IIIb in 13, Grade IVb in 2, and Grade V in 5. The number of bile leakage events (ISGLS) class B was 6 and class C 10. All patients underwent obligatory adjuvant anti-parasitic therapy.Conclusion: At present, surgical treatment of liver alveococcosis remains a method of choice, that requires that the hepato-pancreato-biliary center would have in place a well-developed transplantation program, adequate equipment and well-trained surgical and anesthetic teams.

ETHNIC SPECIFICS OF THE MAIN CARDIOVASCULAR RISK FACTORS PREVALENCE AMONG RURAL INHABITANTS OF A RUSSIAN REGION AND REGIONS OF KYRGYZSTAN AND KAZAKHSTAN

Aim . To investigate on the prevalence of the main cardiovascular RF among inhabitants of rural regions in three countries: Russia, Kyrgyzstan, Kazakhstan, with the analysis of ethnic specifics (by the data from Interepid study). Material and methods . The study has been conducted under the framework of international project “Interepid”. Into analysis, the representative selections included, of rural inhabitants from Volga district of Samara Region of Russia (n=1050), from Chuysky Region of Kyrgyzstan Republic (n=1341) and Karaganda Region of Kazakhstan Republic (n=1807), age 25-64 y. o. Under the framework of “Interepid”, the investigation included questionnaires by special chart, objective data and laboratory tests. Smoking was set if at least one cigarette per day. Arterial hypertension was set by criteria of increased BP and in normal BP if on treatment. Obesity criteria: body mass index ≥30 kg/m2 as body mass in kilograms divided by height in meters squared. Results. Among the three analyzed countries, smoking was most prevalent in the Russians in Kazakhstan, and the lowest — in Russia. Russian men smoked more commonly comparing to native inhabitants in Kazakhstan, as in Kyrgyzstan. Arterial hypertension prevalence in the five analyzed groups showed the most prevalence among Russian population in Kyrgyzstan. In Kazakhstan and Kyrgyzstan, among men the mean SBP values were significantly higher in Russians. Obesity was the most prevalent among rural inhabitants of Kyrgyzstan, among men and women of Kyrgyz nationality, and the peak of this parameter was at 50-59 y. o.; obesity prevalence declined after 60 y. o. Conclusion. There remains high prevalence of CVD risk factors on the postsoviet area. The data obtained, points on ethnic differences of the main CVD risk factors inside the countries. It was shown that at populational level the Russians, living in rural areas of Middle Asia countries have more risk factors comparing to the Russians living in Russia (Samarskaya Region).

Приволжский федеральный округ: архаизация и неотрадиционализм в социокультурной жизни регионов округа

The article provides an overview of existing research of the manifestations of archaization and neo-traditionalism in the regions which are part of the Volga Federal District (Ulyanovsk, Kirov, Nizhny Novgorod, Samara, Penza, Saratov oblasts, the Republics of Bashkortostan, Mari El, Mordovia, Tatarstan, Udmurtia, Chuvashia, and Perm Krai). The selection and systematization of literature is being done by a research team from the Institute of Fundamental and Applied Studies, Moscow University for the Humanities, in partnership with colleagues from other research centers throughout Russia. The materials are published as part of the research database “Russian Models of Archaization and Neo-traditionalism in the Conditions of Modernization” ( www.neoregion.ru ). In the Volga Federal District, like in the rest of the country, social transformation began in the 1990s. Tatarstan has been known for the most conspicuous effort to change the federal relations. A significant rise in regional identification has been observed here, with the structures of power undergoing “Tatarization” followed by “clanization”. A similar picture could be noted in other regions as well. Among the archaization trends developing under the conditions of modernization, we have singled out the prevalence of family self-government rather than the social one. Religious archaization in the regions of the Volga District was especially conspicuous in the areas where early forms of religious beliefs have always prevailed, e.g. among the Finnic (Mordva, Mari, Udmurts) and Turkic (Chuvashes, Kriashens) peoples. The archaic religious practices that have been preserved until now have formed the basis of neo-traditionalist religious forms. The religious beliefs of the Volga peoples have been centered around two main foci: an agrarian cult linked to rural communities and the family/tribal cult of ancestors. Nevertheless, the Russian Orthodox Church has come to be the overall dominating power in the region. An upsurge in politicized ethnic identity that began in the early 1990s has demanded that the regional elites come up with new ideological constructs. A search for pre-Islamic traditions has commenced, mostly taking the shape of folk history. Ideas of neo-traditionalism are being actively developed by scholars and artists in Russia’s ethnic republics; they get the support of regional governments and find their way into ethnic festivals. Among the Russian population of the ethnic republics, the folk traditions of the agricultural year are gaining a second life.

Some Problems of Organizing Residential Treatment for Single Elderly People in Rural Areas

In spite of a large number of works on gerontology and geriatrics interrogation, medico-social aspects of loneliness of elderly and old people are insufficiently studied. The purpose of the study carried out in Volga district of Kuybyshev region was to make medical and demographic and socio-hygienic characteristics of elderly persons living alone in rural areas.

THE EVOLUTION OF VARIATION AND DISTRIBUTIONAL PATTERNS IN EUROPEAN POPULATIONS OF THE THREE-SPINED STICKLEBACK, GASTEROSTEUS ACULEATUS

The three forms of the three-spined stickleback, Gasterosteus aculeatus L., distinguished by the different development of the lateral bony plates and named trachurus, semiarmatus, and leiurus, are distributed in the cold and temperate zones of the northern hemisphere. The European distribution extends from the Black Sea, southern Italy, and the Iberian peninsula to the north coasts of Scotland, Ireland, and Norway and to the White Sea, up 'to Novaya Zemlya, and furthermore to Iceland. The eastern boundary of the European distribution runs from about the river Dvina to the river Dnieper and to the Crimea, the Volga district being excluded. Zoogeographically speaking, the striking feature of the main distribution of Gasterosteus aculeatus is doubtless a marine one. Only along the coasts is there coherent distribution. The modern distributional pattern of the species in fresh water can be explained in all known localities as the result of immigration from the sea. In a paper on the Gasterosteidae, Bertin (1925) advanced the hypothesis of a genetical homogeneity of all European G. aculeatus populations from north to south, and concluded that the development of the bony armature is directly dependent on external factors, mainly temperature and salinity. According to Bertin the welldeveloped armature of the trachurus type is caused by low temperature and high salinity, whereas high temperature and low salinity produce the weakly armored leiurus type, the semiarmatus type being intermediate. As shown subsequently (Heuts, 1947a, b; Miinzing, 1959), Bertin's concept is a considerable oversimplification. Corresponding genotypes underlie the three phenotypes trachurus, semiarmatus, and leiurus. A slight variation of plate number under the influence of external factors within one type has recently been demonstrated by Lindsey (1962), but no indications could be found for a direct influence of external factors to produce one or the other of the three types. The names trachurus, semiarmatus, and leiurus, originally given by Cuvier and Valenciennes (1829), are used here not in a taxonomic or subspecific sense but only to characterize the three forms of bony armature occurring in the species Gasterosteus aculeatus. Actually, G. trachurus is the old name for the fully plated form, which should be called G. aculeatus aculeatus. G. leiurus, the essentially naked type, should stand taxonomically as G. aculeatus leiurus. The latter name, however, we accept with some reservation, as we are not sure of the genetic and systematic homogeneity of all European leiurus populations. G. semiarmatus is not a taxonomic entity but rather represents intergrades (probably hybrids) between the fully plated G. a. aculeatus and G. a. leiurus.