Actuality. Functional gastrointestinal disorders (FGID) represent a significant public public health issue. The foundation of effective therapy for FGID with overlap syndrome - functional dyspepsia (FD, epigastric pain syndrome) with gastric hypersecretion and irritable bowel syndrome (IBS)-is considered to be pathogenetic therapy or the combined use of symptomatic medications. Aim. Assessment of the impact of pathophysiological therapy with the drug Kolofort and symptomatic treatments, including proton pump inhibitors (PPIs) and the myotropic antispasmodic mebeverine hydrochloride in prolonged-release capsules, on the clinical manifestations of FGIDs with overlap syndrome - FD (pain syndrome in the epigastric region) with gastric hypersecretion and IBS - includes evaluating effects on myoelectric activity of the gastrointestinal tract. Design. (conception) An open cohort-controlled comparative study on the effects of Kolofort, omeprazole, rabeprazole, and mebeverine hydrochloride in prolonged-release capsules on intestinal motility in patients with FGID and overlap syndrome - functional dyspepsia (FD, epigastric pain syndrome) with gastric hypersecretion and IBS. Materials and Methods. A total of 107 patients suffering from FGID with overlap syndrome - functional dyspepsia (FD, epigastric pain syndrome) with gastric hypersecretion and IBS - were examined. Results. A one-month course of Kolofort significantly improved the psychological status of IBS patients and enhanced intestinal myoelectric activity. Since there is no available literature on Kolofort’s effect on gastric secretion levels, PPIs and mebeverine hydrochloride were used in the treatment of patients with FGID - FD (epigastric pain syndrome) with gastric hypersecretion and IBS overlap syndrome. The use of PPIs, such as omeprazole and rabeprazole, in these patients eliminated gastric hypersecretion and abdominal pain. Rabeprazole demonstrated faster effects than omeprazole and also normalized gastrointestinal motility more efficiently. For patients with FGIDs - FD with gastric hypersecretion and overlap syndrome with IBS, a combined therapy of omeprazole and the myotropic antispasmodic mebeverine hydrochloride in prolonged-release capsules is recommended. This combination, within two weeks, resolved clinical symptoms in 97% of cases, improved the quality of life, and normalized intestinal motility and gastrointestinal myoelectric activity. However, monotherapy with rabeprazole at a daily dose of 20 mg more rapidly addressed symptoms of gastric hypersecretion and and normalized gastrointestinal motility.

Relevance. In patients with acute viral hepatitis A and B, favorable conditions are created for the development of dysbacteriosis. As a result, the toxic load on the liver increases. For effective treatment of acute viral hepatitis A and B, it is necessary to examine for intestinal dysbiosis before and after treatment and subsequent correction of identified disorders. Aim. To study the clinical course, functional state of the liver, intestinal microflora in patients with acute viral hepatitis A and B and the effectiveness of using bifidumbacterin forte for the correction of intestinal microflora. Materials and methods. The work used clinical and laboratory data from 54 patients with acute viral hepatitis A and B. The main group of patients received bifidumbacterin forte against the background of basic therapy. Patients in the comparison group were on traditional therapy. Clinical, biochemical, bacteriological parameters were observed before the start of therapy and 15 days after its start, serological markers - upon admission. Results. During the therapy, in patients of the main group, the disappearance of intoxication, lethargy, weakness, pain, and normalization of liver size were observed earlier in comparison with the control group. Symptoms of pigment metabolism disorders disappeared significantly earlier: yellowness of the skin, itching of the skin, changes in the color of urine and feces. A dynamic study of liver tests demonstrated a more rapid reverse development of biochemical disorders of the functional state of the liver in patients who received bifidumbacterin forte as part of complex treatment. Conclusion. The use of bifidumbacterin forte in patients with acute viral hepatitis A and B against the background of basic treatment has a positive effect on some clinical manifestations, biochemical parameters, and individual components of the intestinal microflora.

The purpose of the research is to analyze foreign scientific publications on research on markers of vitamin B₁₂ deficiency. Materials and methods of research. A literary review of foreign scientific publications was conducted. The research was searched using the PubMed database using queries on the following topics: vitamin B₁₂ deficiency, markers of vitamin B₁₂ deficiency, cobalamin deficiency, markers of cobalamin deficiency, indicators of cobalamin deficiency in the body. In addition, a search was conducted using data from the scientific electronic library elibrary.ru. Results and discussion. In the course of studying the data presented in foreign scientific publications, we came to the conclusion that the main indicators of vitamin B₁₂ deficiency in the human body are a number of markers: holotranscobalamin, homocysteine, methylmalonic acid. However, these markers have a number of features, and therefore they have not received widespread clinical recognition. The results of the study. The results of the study allow us to assess the urgent need to search for new reliable and accessible markers of vitamin B₁₂ deficiency.

Purpose of the study. Study of the characteristics of the course of the new coronavirus infection COVID-19 in chronic kidney disease (CKD). Materials and methods. A total of 182 patients who were in the State Budgetary Institution “Emergency Medical Care Hospital” (Cheboksary) with a confirmed diagnosis of COVID-19 were examined. Results. A high incidence of CKD in hospitalized patients is shown. In CKD, there is a high mortality from COVID-19, statistically significant for CKD stage 3, but not for CKD stages 1-2. A number of clinical and laboratory parameters associated with an increased risk of adverse outcome have been identified. CKD is an independent risk factor that increases the risk of death when combined with these parameters. The positive effect of Janus kinase inhibitors is reflected when they are prescribed in the group under 65 years of age and in the first days of patient admission. Conclusion. The results of the study indicate the necessity of studying kidney function in patients with a new coronavirus infection. Patients with chronic kidney disease stages 3-4 require close dynamic monitoring as a risk group for severe disease, affecting survival.

The article contains a description of generalized sarcoidosis diagnosed morphologically after cholecystectomy for phlegmonous cholecystitis.

The aim of this study is a comparative assessment of the microcirculation of the prosthetic bed when using removable dentures of various designs. Materials and methods: 90 people were examined, divided into 3 groups. Depending on the group, patients were treated with partial removable dentures made of acrylic (Group B), thermoplastic materials (Group B), and dentures of an original design (Group A). Patients underwent laser Doppler flowmetry 1, 3 and 6 months after prosthetics. At the same time, the area of mechanical damage and areas of excess pressure of the prosthesis base were identified. Results: in a comparative assessment of the microcirculation of the prosthetic bed before prosthetics, no statistically significant differences were observed between the groups (p> 0.05). When examined at 3 (p = 0.00087) and 6 months (p <0.000001) after prosthetics, statistically significant differences were observed. According to the results of the final examination at month 6, flowmetry indicators in group “A” were 19.6; in group “B” 21.8; in group “B” - 20.3 rel. perf. units When assessing the area of mechanical damage and areas of excess pressure of the mucous membrane, based on the results of the final examination at month 6, their values were greatest in group “B” - 1.2 and 3.2 mm², respectively, while the smallest were in group “A” - 0.5 and 1.5 mm². Conclusion: a greater decrease in the intensity of microcirculation of the mucous membrane of the prosthetic bed in patients from group “A”, coupled with other observations, indicates a lesser degree of severity of the inflammatory process in the area of the prosthetic bed and a more physiological distribution of the chewing load, achieved due to the shock-absorbing properties of the elastic lining in the base the proposed prosthesis.

To date, eating disorders (anorexia nervosa, bulimia) have become widespread among the population. Alexithymia is considered to be one of the main features of patients with an eating disorder. In this regard, the purpose of this study was to identify and register the components of alexithymia in patients with an eating disorder, conceptually reflecting the features of this phenomenon. The research methods included: the Toronto Alexithymic Scale (TAS-20), the Lyusin Emotional Intelligence Test, the Karpov Reflexivity Questionnaire, the Giessen Questionnaire of Somatic Complaints (GBB), the Method «Identification of essential features». The methods of data processing and analysis were carried out using the IBM SPSS Statistics 26 program, which used the Spearman rank correlation coefficient and the Mann-Whitney U-criterion. As a result, it was revealed that patients with an eating disorder are characterized by a general deficiency of emotional regulation, which reflects the inability to identify, understand and describe emotions. At the same time, patients diagnosed with anorexia nervosa demonstrated a reduced ability to reflect, and were also characterized by a predominance of a specific situational style of thinking over an abstract logical one. The revealed features of the phenomenon of alexithymia in patients with an eating disorder can later be used in an integrated approach to the preparation and implementation of psychotherapeutic interventions, thereby increasing the effectiveness of therapeutic measures.

The article is devoted to the study of the psychological characteristics of patients with pancreatitis in order to determine possible targets for psychological correction. Increased rates of anxiety, sensitivity, egocentrism, as well as differences with the comparison sample in a number of coping strategies were revealed. The results obtained can be used to carry out psychocorrectional work in order to form the necessary level of adherence to treatment in patients with pancreatitis.

Aim of the investigation. To evaluate associations of polymorphic variants of TNF (G308A), XPC (Lys939Gln), MTHFR (Ala222Val) genes with some biological features of gastric cancer. Materials and Methods. We evaluated polymorphic gene variants in 74 patients with verified gastric cancer or gastriesophageal junction cancer (Siewert III). Genotyping was performed by DNA isolation from venous blood leukocytes of the subjects followed by PCR with electrophoretic detection of the result. The association of polymorphic variants of genes with such biological features of the tumor as localization of the process, morphological type, degree of differentiation, type of tumor growth, presence or absence of lymphovascular or perineural invasion was evaluated. Results. Lys/Gln genotype of XPC gene (Lys939Gln) are 3.3 times more likely to develop gastric body cancer (p=0.04). Genotype GG of TNF gene (G308A) 5.3 times increases the development of gastric adenocarcinoma in comparison with other histological types (p=0.018), genotype GA of the same gene 5.2 times more often develop tumor with high-grade differentiation degree (p=0.032). Val/Val genotype of the MTHFR gene (Ala222Val) are significantly less likely to develop lymphatic/vascular invasion compared to carriers of the other genotype (p=0,029). Conclusion. The obtained data suggest that the genetic status of the patient itself may affect the biological characteristics of gastric cancer, which in turn may lead to a change in the patient’s treatment tactics.

The aim of the study was to evaluate the expression profile and search for markers of progression in tumor tissue in colorectal cancer. Materials and Methods - Tumor tissue samples obtained from videocolonoscopy in patients with verified colorectal cancer served as the material for the study. A total of 37 specimens were involved in the study. Of these, there were 14 samples with a “favorable” prognosis and 23 with an “unfavorable” prognosis. The quality and quantity of ribonucleic acid in the eluted solution were evaluated using an IMPLEN nanospectrophotometer (Germany). A SurePrint G3 HumanGeneExpv3 ArrayKit microarray kit (Agilent, USA) was used to assess gene expression. Microarrays were scanned on an InnoScan 1100 AL (USA) with subsequent image processing using Mapix Software (USA). For the procedure of searching for differentially expressed genes, we used the Moderated t-statistics method, which is implemented in the limma package. Results - Based on the scatter plot, the most divergent genes in samples with and without progression were selected. The following markers were selected: Marker9 (GZMB), Marker5 (CXCL11), Marker3 (SYNE4), Marker20 (MIR4432HG), Marker19 (ZDHHC11), Marker11 (COL17A1), Marker13 (ZDHHC11B), Marker17 (AGR3). Low-expressing genes mainly affected DNA replication and cell cycle pathways, whereas high-expressing genes affected metabolic pathways. Conclusions - We found an association of long-term outcomes with the expression of the gene combination ZDHHC11, MIR4432HG, and GZMB. Further study of this gene combination and increased sampling will allow the construction of a test system for predicting the course and response to treatment of patients with colorectal cancer.

Research Objective: To evaluate the effectiveness of separation plastic in reducing intra-abdominal hypertension in midline ventral hernia surgery in an experimental setting. Materials and Methods. Research Subjects: 15 pigs weighing 30-35 kg with an original model of midline ventral hernia. In the acute experiment, intra-abdominal hypertension was created at 40 mmHg and the aponeurosis tension was set at 3.6 N. A comparative analysis was conducted to assess the impact of separation plastics of the anterior abdominal wall by Ramirez, Carbonell, and Novitsky on intra-abdominal pressure and central hemodynamics. Results: A direct correlation was found between intra-abdominal pressure and aponeurosis tension. Ramirez separation plastic of the anterior abdominal wall reduced intra-abdominal pressure by 50.5±1.1%, Carbonell by 53.5±2.8%, and Novitsky by 59±3.3%. Conclusion: The original model of midline ventral hernia in the acute experiment can be used to study intra-abdominal hypertension and ways to reduce it. Separation plastics decrease intra-abdominal pressure, improve central hemodynamic parameters, and blood oxygen saturation. The most effective separation plastic of the anterior abdominal wall is the posterior component according to Novitsky.

Aim: to identify clinical and laboratory predictors of bleeding from the esophageal veins in patients with liver cirrhosis and evaluate their practical significance. Materials and methods. The study materials were the results of an examination of 50 patients treated in the gastroenterology department for liver cirrhosis and 160 patients in surgical departments hospitalized for bleeding from esophageal varices due to liver cirrhosis. All patients were subjected to a standard set of general clinical examinations, ultrasound examination of the abdominal organs, and videoesophagogastroduodenoscopy. Results. When comparing patients with cirrhosis of the liver with and without bleeding from the veins of the esophagus, a statistically significant difference was revealed between the groups in the gender and age composition, blood bilirubin level, and de Ritis coefficient. At the same time, no differences were found in the etiology and severity of liver cirrhosis, blood protein levels, the diameter of the portal and splenic veins, and the proportion of patients with ascites. Conclusions. The detection of a de Ritis coefficient equal to or exceeding 1.8 in a patient with liver cirrhosis can be considered a predictor of a high risk of bleeding from the esophageal veins (sensitivity of the parameter 60.87%, specificity 93.94%) and can be recommended for identifying those in need of priority measures primary prevention.

In surgical practice, the human pancreas is conventionally divided into two major anatomical and surgical segments: the right (cephalo-cervical) and the left (corpore-caudal). Both of these segments are abundantly supplied with blood. The artery-first approach is widely used in pancreatic resections to avoid venous stasis and achieve reduced blood loss. The dorsal pancreatic artery participates in the blood supply of both segments with its branches, which makes its anatomical study relevant and promising for clinical medicine. The aim was to describe the main branches of the dorsal pancreatic artery and to determine the frequency of their occurrence in the studied cases. Materials and Methods. The work was performed on archival fixed material (n = 60) of duodenum-pancreas-spleen organ complexes with extra-organ vessels taken from the collection of the Department of Anatomy, RyazSMU. All organ complexes belonged to mature age people without pronounced pathology of the organs of the investigated area. The division by sex was not performed. Results. The dorsal pancreatic artery was identified in all cases studied. Most often (n = 40; 67%) it originated from the branches of the ventral trunk, less often (n = 18; 30%) it was a branch of the superior mesenteric artery and in two cases (3%). Despite the place of origin, its trunk diameter averaged 1.8 mm (min 1.6; max 2.0). The branches of this artery were most often directed towards the gland body (85% of cases), less often - towards the head (15%). Conclusion. The dorsal pancreatic artery is the main artery feeding the body and tail of the human pancreas. In the present study, its branches were more frequently recorded towards the body of the gland, despite the origin of the vessel. Despite the accumulated anatomical and clinical knowledge about the peculiarities of the origin and branching of the human dorsal pancreatic artery, the understanding of the principles of the direction of its branches remains open to researchers.

Galactosemia is a rare hereditary disease associated with impaired galactose metabolism, which is characterized by a wide range of clinical syndromes. Most long-term observations are devoted to the study of neurological, ophthalmological and reproductive disorders. Liver damage in galactosemia is one of the central manifestations of the disease, determining the severity and prognosis of the disease, mainly in the neonatal period. The lack of timely dietary correction in the neonatal period leads to severe liver damage with the development of cirrhosis, portal hypertension and liver failure. An information search has shown that prolonged and catamnestic studies on the condition of the liver in children with various variants of galactosemia, in particular, against the background of dietary correction, are few. Most studies show significant reversibility of hepatopathy on the background of diet (even with severe manifestation), however, the number of such publications is not large and the issue requires further research.

Progressive familial intrahepatic cholestasis is one of the causes of direct hyperbilirubinemia in young children and the need for its diagnosis arises after the exclusion of such more common causes of cholestasis as biliary atresia, Alajille syndrome, as well as infectious and medicinal hepatopathies. The basic diagnostic feature that allows us to suspect the pathology in question is the absence of an increase in the level of γ-glutamine trans peptidase. To date, 12 types of progressive familial intrahepatic cholestasis have been described. For most of them, both severe cases with neonatal manifestation and rapid progression to cirrhosis, as well as variants with late development and a relatively benign course, are described. The article presents brief genetic and phenotypic characteristics of all 12 types of pathology. The author presents his own observation of a patient whose clinical and laboratory picture corresponded to Byler’s syndrome, but the identified genetic characteristics did not correspond to any of the known types.

Target. To study the level of blood lactate in children with strangulated inguinal hernias (SIH). Material and methods. 46 boys with UPG under the age of 3 years were examined. The examination included anamnesis, examination, laboratory data, including blood lactate, ultrasound, Doppler sonography, examination of biopsy and surgical material. Results. Blood lactate in children of group 1 (up to 12 hours from the moment of strangulation) was 1.8±0.3 mmol/l, in children of group 2 (from 12 to 24 hours) - 2.5±0.2 mmol/l, in children of group 3 (after 24 hours) - 2.8±0.3 mmol/l. All children were operated on. In 6 children, bowel resection was performed; in 6, testicular infarction was detected. Discussion. A significant excess of normal blood lactate levels occurred in children with strangulated inguinal hernias who were admitted later than 12 hours from the moment of strangulation. Conclusion. The study of blood lactate in children with strangulated inguinal hernias can be used in the diagnosis of intestinal and testicular ischemia.

Aim of the study. To study the clinic, diagnosis and treatment of gastric tumors in children. Materials and methods. 13 children with stomach tumors were examined. Anamnesis collection, examination, analysis of laboratory, instrumental and radiological (including CT) data were performed. The biosimilar and operational material was studied. Results and discussion. Of the 13 children with gastric tumors, 12 were diagnosed with benign tumors: 3 had teratomas, 4 had hemangiomas, and 5 had glandular polyps. One boy was diagnosed with stomach cancer. Diseases are a casuistic find. The treatment is surgical. 3 clinical observations are given. Conclusion. The main symptom of gastric tumors in children is a palpable tumor in the epigastric region. Oncological alertness, endoscopy, ultrasound and CT are a reserve for improving diagnosis. The treatment is surgical.

Nitric oxide II (NO) is a signaling molecule that has a wide range of physiological effects, including the regulation of gastrointestinal processes. The liver actively expresses the clinically significant transporters OATP1A2 and OATP1B1, which are involved in the influx of biologically active and medicinal substances. That is why it seems relevant to determine the pathways of regulation of hepatic transporters under the influence of NO. Aim. To study the effect of NO on the relative amount and expression of the transporters OATP1A2 and OATP1B1 in vitro in HepG2 cells. Materials and methods. The study was performed on a culture of HepG2 cells, which were cultured in 6-well plates at 37 °C and 5% CO2 in Dulbecco’s modified Eagle’s medium (DMEM) with a high glucose content (4500 mg/l) containing L-glutamine (4 mM), 10% fetal bovine serum, 100 U/ml penicillin and 100 mg/ml streptomycin (all components from Sigma-Aldrich, Germany). S-nitrosoglutathione (Sigma-Aldrich, Germany) was added to the culture medium at concentrations of 1, 10, 50, 100 and 500 µM, incubated for 24 and 72 hours. Water for injection (solvent) was added to control cells in an equivalent volume S-nitrosoglutathione). The relative amounts of OATP1A2 and OATP1B1 proteins were assessed by Western blot, and the expression of SLCO1A2 and SLCO1B1 by real-time PCR. The results of the study. In the course of this study, it was shown that the addition of S-nitrosoglutathione in the concentration range of 10-500 μM and exposure duration of 24 and 72 hours causes an increase in the intracellular level of nitric oxide metabolites, which indicates the adequacy of the use of this NO donor. At the same time, under the influence of NO, there was an increase in the relative amount of the studied transporters - OATP1A2 at an exposure period of 24 hours and S-nitrosoglutathione concentrations of 50 and 100 μM, OATP1B1-24 and 72 hours, at concentrations of 10-500 μM, a similar trend was noted for the expression genes SLCO1A2 and SLCO1B1. Conclusion. The NO donor - S-nitrosoglutathione causes an increase in the relative amount of OATP family transporters - OATP1A2 and OATP1B1, due to increased expression of the SLCO1A2 and SLCO1B1 genes, in vitro in HepG2 cells.