Microchimerism (MC) is understood as the presence in the body of cells genetically different from the population of the individual, capable of existence and persistence, that is, reproduction and differentiation. This process is associated with the exchange of cellular material between mother and fetus. The consequences of the intrauterine acquisition of maternal MC (MMC) by the fetus are essentially different from the acquisition by the mother of fetal CM (FMC) in the mature state of the organism. Microchimerism has been implicated in the development of autoimmune diseases, but it also helps the body limit a particular disease. Since all these processes take place during the early development of the fetal immune system, the initial response of the immune system is the development of specific tolerance to maternal antigens. MMС can modify immune functions and reactivity through the nongenetic acquisition of cellular and subcellular material. Both FMС and MMС are quite common phenomena, which affects the body of the child and mother, the differentiation and functionality of the host cells. All this allows us to consider foreign cells as a potential target for drugs in the fight against autoimmune diseases or, conversely, stimulation of regeneration processes of damaged tissues. Issues of evolution and prospects for the prevention of various pathological conditions are considered from the standpoint of taking into account maternal and fetal chimerism syndrome.

Over the past 30 years, the incidence of childhood obesity has quadrupled, leading to a rise in metabolically associated fatty liver disease (MAFLD), which has multifactorial genesis. Numerous studies highlight a significant genetic contribution to the development and severity of MAFLD. Purpose of the study. Тo determine the distribution of alleles and genotypes of the rs8192678 C/T polymorphism of the PPARGC1A gene and its relationship with the development of MAFLD in obese children living in the Moscow region. Materials and methods. The study included 87 children with exogenous constitutional obesity. The children were divided into two groups: group I - obesity without MAFLD (n = 43), group II - obesity with MAFLD (n = 44). The association of genotypes with the risk of developing MAFLD was studied in various genetic models. Results. 43 (49.4%) children had genotypes containing the T allele: 4 (4.6%) - homozygous TT genotype, 39 (44.8%) - heterozygous CT genotype. The CC genotype was detected in 44 (50.6%) children. The frequency of allele C was 73%. Carriers of the T allele have almost twice the risk of developing MAFLD than сarriers of the C allele (OR = 2.08 (95% CI: 1.05-4.24), p = 0.041). Conclusion. Тhe rs8192678 polymorphism increases the risk of developing MAFLD already in childhood, and with the homozygous TT genotype, this risk more than doubles. Studying the genetic contribution to the development of MAFLD enables a comprehensive approach to assessing individual risks of each patient.

The aim of the study was to determine the heterogeneity of metabolic parameters in teenage boys diagnosed with “obesity due to excess calories” using cluster analysis. Materials and methods. One hundred and twenty-three randomly selected patients aged 14 to 17 years diagnosed with “obesity due to excess calories” were examined. The statistical analysis included descriptive and analytical methods, in particular aimed to identify clusters of biochemical indicators, including serum fasting glucose level, insulin level, total cholesterol level, low density lipoproteins (LDLP), very low-density lipoproteins (VLDL), high density lipoproteins (HDLP) and triglycerides. Results. Two clusters of observations have been identified. The first cluster consisted of 72 patients (58.5%) having fasting glucose levels slightly below average, insulin levels above average, total cholesterol, triglycerides, LDLP and VLDL above average, and HDLP levels below average (“metabolically unhealthy” obesity). The second cluster included 51 teenagers (41.5%) who presented with opposite trends in metabolic characteristics (“metabolically healthy” obesity). The adolescents from the first cluster were slightly older, had higher body mass, body mass index (BMI) and z-BMI scores, and higher HOMA-IR scores. Arterial hypertension and non-alcoholic fatty liver disease were diagnosed statistically significantly more frequently in adolescents from this cluster. Conclusion. Teenage boys with obesity are a heterogeneous group in terms of the values of major metabolic indicators.

Aim. To study the association of protein expression CDX2, CK20, CK7 in the epithelium of the gastric mucosa in schoolchildren with CagA H. pylori-associated gastritis. Material and methods. Gastroscopy was performed with the collection of biopsy material from the mucous membrane of the antrum and body of the stomach in 89 schoolchildren (7-17 years old) with gastroenterological complaints. The morphological method confirmed the diagnosis of gastritis and determined the presence of H. pylori. Gastric biopsies were examined immunohistochemically to identify the proteins CDX2, CK20, CK7 in the epithelium. Blood was also collected to determine the CagA strain of H. pylori using enzyme immunoassay. Results. In schoolchildren infected with CagA H. pylori, higher expression of CK7 was found in both parts of the stomach (in the body (p = 0.044), in the antrum (p = 0.014)) compared to uninfected children. Changes in the expression of CDX2 and CK20 in children infected with H. pylori CagA have not been established. CDX2 protein was detected more often among schoolchildren aged 12-17 years with H. pylori infection than in children without H. pylori (p = 0.062) and in children with CagA H. pylori (p = 0.017). In the group of younger children with CagA H. pylori, there were higher levels of CK7 expression in the epithelium of the antrum of the stomach, compared with uninfected children (p = 0.033). They also had higher CK7 in the body than in CagA H. pylori-associated gastritis in children of the older age group (p = 0.001). Boys with CagA H. pylori had the highest expression of CK7 in the gastric body, which was higher than in uninfected boys (p = 0.021). Conclusion. Thus, in children, the features of the association of CDX2, CK20, CK7 with CagA H. pylori-associated gastritis have been established, including depending on the age and gender of the child.

The article discusses the molecular genetic basis of taste development which determines the peculiarity of perception of sweet, salty, sour, bitter and high-protein food (umami). The genes TAS1R3, FTO, GLUT2, FGF21, GNAT3 are responsible for individual perception of sugar volume. Serum FGF21 levels are significantly elevated in obese patients and in patients with type 2 diabetes mellitus which presumably indicates a state of resistance to FGF21. Given the role of refined sugars in the development of diseases, the use of foods with a reduced content or complete absence of added sugar is a worldwide trend, especially necessary in the nutrition of children. During genome-wide sequencing for 39 patients aged 15-18 years, FGF21 gene polymorphism was detected in 27 adolescents (69 %) without gender identity. Almost all patients with FGF21 gene polymorphism showed a high addiction to sweet foods. Currently, the existence of a sixth taste is being debated, it is ammonium chloride, whose receptors are regulated by the Otop1 gene which is also responsible for the identification of sour taste.

The article discusses the features of lesions of the digestive system in children with mitochondrial diseases. Mitochondria play an important role in cellular metabolism as they are responsible for producing the majority of cellular energy in the form of adenosine triphosphate. Mutations in mitochondrial genes responsible for the functioning of mitochondria can lead to various forms of mitochondrial diseases. These diseases may present with the following clinical symptoms: muscle weakness, movement disorders, neurological symptoms, impaired motility and absorption from the gastrointestinal tract. Diagnosis of mitochondrial diseases can be challenging due to genetic and clinical heterogeneity. Treatment currently remains a pressing problem, as research in this area is being actively conducted and new methods are emerging aimed at the therapy and treatment of these rare diseases.

Background. Early identification of pediatric central nervous system (CNS) tumors is important in relation to disease prognosis, as well as long-term treatment outcomes, which determine subsequent quality of life. The predominance of embryonal tumors (ETs) in early childhood actualizes the problem of timely verification of the diagnosis. Factors contributing to the extension of diagnostic time in the presented patient’s cohort include the inability to adequately verbalize complaints in young children, a wide range of clinical presentations, including nonspecific ones, the relatively low incidence of ET in the population and the low level of oncological alertness among specialists. This determines the need for a more careful assessment of the clinical manifestations and disease-associated symptoms by doctors of all specialties and, especially, primary care specialists. Aim. Analysis of clinical symptoms at the disease’s onset in pediatric CNS ET in order to determine their associations with the tumor’s characteristics (site, hystologic type) and the patient’s features. Materials and methods. A retrospective analysis of data from 124 pediatric patients with CNS ET who received treatment from 2010 to 2023 in the departments of pediatric oncology of the Almazov National Medical Research Center and the St. Petersburg Scientific Research Center for Medical Sciences (o) named after. N. P. Napalkov. The analyzed parameters were the age of manifestation, initial symptoms, duration of the anamnesis and the period before verification of the diagnosis, localization and histological type of tumors. For statistical analysis, Fisher’s exact test, modified Pearson test, Kruskal-Wallis and Mann-Whitney tests, as well as (to assess the duration of anamnesis) the Cox model were used. Results. The most common type of CNS ET in the study group was medulloblastoma (MB; 66.1%). The average age of patients, in general, was 61 months, boys predominated (58%). The median age varied depending on the histological tumor type: the maximum was 72 months in patients with medulloblastoma and the minimum was 9 months in children with atypical teratoid rhabdoid tumor (ATRT). Both medians are significantly different from the total median (29 months) of all other tumors (p = 6.53 ∙ 10-4 and p = 0.029, respectively). The most frequent symptoms in patients with ET were nausea and vomiting (68%), headache (50%), and gait disturbances (25.6%). Increased head circumference/bulging fontanel (p = 0.0016) and torticollis (p = 0.0057) were the most common symptoms associated with younger age. Headache (p = 1.30 ∙ 10-9), nausea and vomiting (p = 0.019), diplopia (p = 0.0057), weight loss (p = 0.017) and dizziness (p = 0.013) were associated with older age. Headache was predominated symptom in medulloblastoma (p = 2.60 ∙ 10-4) compared to other ETs, and less common in ATRT (p = 1.51 ∙ 10-4), which may be due to the patient’s age. Fontanel bulging in medulloblastoma, unlike other ET, was not observed, which is also associated with age. Seizures were observed in all cases of CNS neuroblastoma - significantly more often (p = 0.034) than in other ETs. The most common tumor location was the posterior cranial fossa (PCF) (83.6%). PCF localization was associated with headache (p = 0.05, borderline significance) and nausea/vomiting (p = 0.040). Parietal localization was associated with seizures (p = 0.041). Four patients in the cohort had asymptomatic disease’s manifestations. The diagnosis was established by a routine screening examination. The absence of symptoms was associated with location outside the PCF (p = 0.011) and with younger age (p = 0.053, borderline significance). The diagnosis was established in a significantly shorter time if children had symptoms such as nausea and vomiting (p=0.0017), paresis and paralysis (p=0.0059). Conclusion. In patients with CNS ETs, statistically significant relationships are revealed between age, histological type, tumor site and certain symptoms. Nevertheless, the absence of strictly specific clinical manifestation determines the indications for a careful assessment of the pediatric somatic and neurological status and timely neuroimaging in children when even potential symptoms typical for CNS tumors are identified.

Introduction. The interest in the study of anti-oxidized low-density lipoproteins (anti-oxLDL) is due to their association with the development and progression of atherosclerosis and metabolic syndrome. Purpose of the study. To study the level of antibodies of oxidized low-density lipoproteins (anti-oxLDL) in serum in obese children. Materials and Methods. 76 children aged 5 to 17 years participated in the study. A standard objective and laboratory examination was performed, including physical and sexual development, lipidogram and anti-oxLDL levels. To assess anthropometric data, the standard deviation coefficient was calculated using the Auxology application. The parameters of fat metabolism were determined according to the data of blood biochemical analysis. The content of anti-oxLDL was determined by immuno-enzymatic analysis using test kits “Biomedica”. Results. According to the results of the examination the patients were divided into three groups: group 1 included 36 children with constitutional-exogenous obesity and increased level of anti-oxLDL, group 2-30 patients with constitutional-exogenous obesity and normal level of anti-oxLDL, group 3-10 healthy children. The level of antibodies to oxidized low density lipoproteins (oxLDL) in obese children is 11.6 times higher compared to healthy children. The antibody titer in prepubertal children is 2206 [1809;2603] IU/mL, and in adolescents it is 1505.5 [1109;1902] IU/mL. The highest values of anti-oxLDL levels were observed in patients with 1st degree obesity 2623 [2245;3001] IU/mL and 3rd degree obesity 2914.5 [2678;3151] IU/mL. Conclusion. High of anti-oxLDL levels were found in pre-pubertal children with obesity, especially in 1st and 3rd degree obesity. In obese children, the level of anti-oxLDL has a direct correlation with the duration of the underlying disease and the increase in low-density lipoprotein (LDL) levels. Further studies are needed on the role of anti-OCOLDL as an early predictor of atherosclerosis in clidren with obesity.

Dysphagia as a symptom of dysfunction of the digestive system occurs in patients with various pathologies and in severe cases requires the formation of a nutrient fistula. The presence of a stoma is a source of additional pathological changes. Changes in the microbiota of gastrostomy patients is an issue that is practically not covered in the scientific literature. The purpose of the study is to determine characteristic changes in the microbiota of the oral cavity, stomach and intestines caused by nutritional stoma and their clinical significance. Materials and methods. The study included 20 children fed through a gastrostomy tube and 10 children fed by mouth. Group 1 consisted of patients with a gastrostomy installed in less than 1 year, group 2 - in periods of more than 1 year, group 3 - children without gastrostomy. All patients underwent a standard examination in a gastroenterological hospital and 16S rRNA sequencing of aspirates from 3 biotopes - mouth, stomach and intestines. An assessment of physical development and bioimpedance measurements was carried out, and a group of patients with sarcopenia was identified. Results. In all three biotopes of patients with gastrostomies, a pronounced disturbance of microbiological homeostasis was found. In the oral cavity, the number of anti-carious microorganisms is reduced and, on the contrary, the level of periodontogenic strains is increased. This fact is the cause of the occurrence of comorbid conditions and requires the appointment of local therapy with probiotic strains approved for use. Changes in the gastric microbiome after gastrostomy placement are characterized by a high degree of H. pylori contamination against the background of a decrease in anti-inflammatory protection. Determining the level of bacteria of the genera Prevotella, Parabacteroides, Porphyromonas in the stomach can become a marker of concomitant chronic inflammatory changes in the mucous membrane of the upper gastrointestinal tract, a high risk of developing peptic ulcers and its complications. The state of the gut microbiome correlates with underweight, BMI, proportion of fat mass and active cell mass. The development of sarcopenia in gastrostomy patients is one of the possible dangerous comorbid conditions, one of the diagnostic criteria of which is a decrease in the level of Phylum Fusobacteriota bacteria.

Objective. To identify the mechanisms of the relationship between the effect of zonulin protein on the intestinal wall and the occurrence of infantile colic based on the study of scientific sources. Materials and Methods. Scientific articles were searched in PubMed, Scopus, Web of Science, and F1000Research databases. Ninety-six sources published between 1991 and 2023 were selected. Results. The history of the discovery of the zonulin protein is presented, together with a modern view of the structure of the dense intercellular junctions of the intestinal epithelium, and the processes by which the effect of zonulin on altering the permeability of the intestinal barrier is realised are described. The data of several studies in which increased levels of zonulin were found in groups of children with colic and with GI dysfunction are presented. There is a review of works in which the connection of zonulin with extraintestinal pathology - psychiatric disorders, endocrine, autoimmune, cardiopulmonary, allergic, infectious diseases - has been noted. Zonulin is a promising pharmacological target - to date, there is a specific zonulin inhibitor molecule showing efficacy in the treatment of celiac disease and multisystemic inflammatory syndrome in children. Conclusion. The analysis of publications shows the undoubted relevance of the study of zonulin as a factor affecting the permeability of the intestinal wall and a number of other processes. Its role in the formation of intestinal colic requires more detailed study, as discoveries in this area can be actively integrated into clinical practice.

One of the most important trace elements of the human body is iron. This trace element is the most common on earth, with about a third of the world’s population suffering from iron deficiency. According to WHO, the incidence of iron deficiency in the population can range from moderate - 5-19.9%, to high-more than 40%. The main causes of iron deficiency are: insufficient intake from food, impaired absorption or pathological losses. Allergic diseases can cause the formation of iron deficiency as a result of all of the above causes. At the moment, the relationship between iron deficiency and the development of allergic reactions is being investigated. It is known that functional iron deficiency contributes to the development of allergies and exacerbates the course of symptoms in people with allergies. In this article, we summarize the data on the effect of iron deficiency on the immune processes of the human body and predisposition to the formation of atopy.

A close relationship between obesity and iron metabolism has been proven. Aim. To study the features of iron metabolism in obese children by evaluating dietary iron intake and the level of laboratory markers of iron status, with the goal of improving prevention and correction of identified disorders in this cohort of children. Materials and methods. The actual dietary iron intake was assessed in 75 obese children aged 7-17 years using the Optimal Nutrition 5.0 software. A set of clinical and laboratory research methods was performed in 30 children to identify iron deficiency, as well as a questionnaire on the symptoms of iron deficiency. Results. One third of children have insufficient iron intake with food. Most of the examined children complained and had clinical symptoms characteristic of iron deficiency in the body. 86.7% of obese children had one or more signs of iron deficiency. Laboratory diagnostics using only a general clinical blood test showed insufficient detection of iron deficiency: only in 13.3% of children this analysis showed the presence of abnormalities characteristic of iron deficiency. In the other children, it was detected after a biochemical blood test. Conclusions. The majority of obese children show both clinical and laboratory evidence of iron deficiency, which may contribute to the pathogenesis of obesity-related conditions. Biochemical blood tests are essential for accurate diagnosis of iron deficiency, as standard clinical blood test may not always show the presence of iron deficiency. The high prevalence of iron deficiency indicates the need for targeted nutritional iron support for obesity in children.

Objective: to evaluate the metabolic parameters of the cardiovascular system in nephrotic syndrome in children Material and methods: 110 children hospitalized with nephrotic syndrome in the nephrology department of the Samarkand Regional Children’s Multidisciplinary Medical Center were examined. Results: Renocardial syndrome with nephrotic syndrome develops in 64.8% of cases, the majority of patients are children 3-6 years of age (44.1%), with a predominance of boys (58.8%). In a cardiometric study in patients with nephrotic syndrome, renocardial syndrome is manifested by significant changes in metabolic and adaptation parameters: oxygen and lactate content - by 1.5 times, creatine phosphate - by 20%, tension index - by 4.8 times and vascular stiffness index - by 5.2 times. Conclusion: Deviation of cardiometry indicators in different age groups indicates a decrease in the intensity of blood circulation in organs and systems, indicating a significant load on the cardiovascular system in nephrotic syndrome.

Aim. To study the impact of maternal obesity on children’s health in the first year of life. Materials and methods. The study included 90 children: group 1-54 children from obese mothers (maternal body mass index before pregnancy ≥ 30 kg/m²); Group 2-36 children from mothers with a normal body mass index (18.5-24.9 kg/m²). All children were assessed for the course of the perinatal period and health status during the first year of life during dynamic observation. Research results. It was found that newborns from obese mothers were significantly more likely to have a body weight of more than 4000 grams (20.4% and 10.6%, p = 0.026). The perinatal period in this group of children was more often accompanied by asphyxia of newborns (11.0% and 1.6%; p = 0.003), requiring artificial ventilation (10.2% and 1.6%; p = 0.003) and therapy in conditions intensive care units (10.9% and 1.6%; p = 0.002). During dynamic observation, it was noted that in children from obese mothers, anomalies in the development of the urinary system were more common (40.7% and 25.0%, p = 0.03). These children were statistically significantly more likely to suffer from acute respiratory viral infections (32.1% and 19.4%, p = 0.03), acute intestinal infections (24.1% and 11.1%, p = 0.02) and urinary tract (20.4% and 11.1%, p = 0.04). They were diagnosed with a higher frequency of mild anemia (24.1% and 8.3%, p = 0.03) and atopic dermatitis (38.9% and 25.0%, p = 0.02). Conclusion. The results obtained demonstrate the significant influence of maternal obesity in the development of adverse perinatal outcomes, such as: disorders of postnatal adaptation, asphyxia, an increase in the frequency of developmental anomalies and morbidity in children during the first year of life and indicate the risks of developing comorbid conditions in children in the future.

Introduction. In recent years, there has been not only an increase in the incidence of cholelithiasis, but also the problem of comorbid conditions for this pathology in practical healthcare. Determining the main groups of chronic somatic diseases can identify a contingent of children where the development of cholelithiasis can be expected with a high degree of probability. Purpose of the study. To study the frequency of comorbid diseases in children with cholelithiasis. Materials and methods. The study included 146 children with cholelithiasis; according to the comorbidity index, all children were divided into three groups. The average age of the observed patients was 9.05±4.7 years, of which 61 were boys (41.8%) and 85 girls (58.2%). The obtained data were processed by MS Exel, IBM SPSS Statistics 19.0, the significance level for accepting significant differences was accepted at p ≤ 0.05. Results and discussion. The children we observed with cholelithiasis were hospitalized in a specialized gastroenterology department in 58% of cases; in 42% of cases, the detection of a stone in the gall bladder was the result of a diagnostic finding. In the group of children with cholelithiasis who have 4 or more concomitant diseases, diseases of the liver and biliary tract (X² = 12.86, p ≤ 0.02), blood diseases (X² = 8.83, p ≤ 0.012) and endocrine diseases are significantly more common. violations (X² = 8.35, p ≤ 0.05). Conclusion. According to the results of our observations, gastroenterological manifestations are leading in children with cholelithiasis. Metabolic disorders place endocrinological diseases in second place in terms of the frequency of comorbidity. The proposed laboratory and instrumental diagnostic algorithm will ensure early detection of cholelithiasis in children.

The purpose of the study. The study of the constitutional features of the course of gastric ulcer in children. Materials and methods. 102 children aged 12-17 years with a diagnosis of “gastric ulcer” were examined. A clinical and instrumental verification of the diagnosis, its complications, and an assessment of the type of constitution using the Pinier index was carried out using endoscopic examination. Results and conclusion. The dominance of children with gastric ulcer, having an asthenic type of constitution in comparison with normal and hypersthenics, has been established. Complications of gastric ulcer in the form of perforation of the stomach wall with the development of peritonitis, gastric bleeding were significantly more common in normosthenic patients, one and a half to two times less common in asthenics, never noted in hypersthenics, in whom concomitant reflux esophagitis was often detected.

Introduction. A common type of palliative intervention is the imposition of nutritional fistulas for enteral nutrition in dysphagia. The operation of choice is gastrostomy, in which the gastric stage of digestion is preserved. This is more physiological and reduces the risk of developing dumping syndrome and metabolic disorders that can develop with the introduction of nutrition into the jejunum directly. Ejunostomy is applied when gastrostomy is technically impossible due to damage to the stomach, or as a stage in another operation. The infrequent use of jejunostomy leads to a lack of awareness among medical professionals about the specifics of care and nutrition through jejunostomy, which differ significantly from the standard recommendations for gastrostomy. The aim is to study. Offer advice on care and nutrition through the jejunostomy. Materials and Methods. The recommendations are based on literature data and the clinical experience of the authors who perform these operations, teach patients and their relatives care, nutrition through the jejunostomy, and manage these patients at the outpatient stage. The results and their discussion. The article provides recommendations for the care of jejunostomy, depending on the type of jejunostomy and feeding tube. The technique of feeding through the jejunostomy is described in the details, while an original method for the slow introduction of the nutrient mixture in the absence of special systems for drip nutrition is proposed. General recommendations on the selection of a nutrient mixture for feeding through the jejunostomy are given. Conclusion. Fistula care and feeding of patients with jejunostomy are differ from similar activities carried out in patients with gastrostomy. The proposed article will improve the orientation of medical workers in the problem and may serve as the beginning of the development of domestic recommendations for the care of the fistula and nutrition of patients with jejunostomy.

Modern methods of treating choledocholithiasis (CDC) are varied and are mainly focused on minimally invasive endoscopic technologies. The variety of these methods indicates the absence of a “gold standard”, and each of them has its own advantages and disadvantages. In this regard, the search for new surgical solutions to this problem is still relevant. This study presents a retrospective analysis of the treatment of 168 patients with HDL (2019-2023), who underwent laparoscopic surgery (LO) in 26 patients (15.5%) and surgical interventions through a minilaparotomy approach (MLA) in 142 patients (84.5%), and the average age was 59.0 ± 2.6 years, the ratio of men to women was 1:2.8 (p <0.05). A diagnostic and treatment algorithm was developed for HDL in combination with cholecystolithiasis. Magnetic resonance cholangiopancreatography (MRI UCG) has been recorded to be highly sensitive in preoperative research methods - 89.2%, ultrasound (US) - 93.8%, intraoperative ultrasound (IOUS) - 99.4%. The result of the development, scientific substantiation and implementation of the presented algorithm was a reduction in the number of conversions for ALD to 2.8%, for LO - to 5.6%, and mortality - to 2.9%.

The authors presented their own clinical observation of an aneurysm of the left portal vein branch in a teenager with a long-term asymptomatic course. Reduced serum concentrations of ceruloplasmin and α-1-antitrpsin made diagnostic search difficult, which could lead to incorrect therapeutic decisions. However, the results of imaging methods allowed us to establish the root cause of liver damage and its cirrhotic transformation. Vascular aneurysms of the portal vein system are a very rare pathology, and it should be taken into account in the differential diagnostic algorithm while excluding other, more obvious causes of liver pathology.

The current problem of neonatal and pediatric surgery remains the tactics of surgical treatment and postoperative management of patients with perforated peritonitis. Mortality with perforation of the stomach and intestines in children in the newborn period reaches about 40-80 %. The combination of the syndrome of increased intra-abdominal pressure and multiple organ failure causes the extremely serious condition of patients. In this connection, new approaches to the surgical treatment of such patients are currently being actively developed. For this, new medical devices are tested in experimental practice, but the problem of such studies, first of all, lies in the lack of an adequate model of the pathological process. The aim of the work is to analyze the methods of experimental modeling of intestinal perforations described in the public domain. For this, a study was conducted of the most significant scientific publications of such databases as Google Scholar, PubMed, Scopus, eLIBRARY. The present work provides a detailed description of existing options for modeling perforations of various parts of the gastrointestinal tract (stomach, small intestine and colon), depending on the goals of the experiment. Several rather rare techniques based on the introduction of microorganisms are also presented. In addition, the article describes the method proposed by the authors for modeling perforation using laparoscopic access.

More than 240 observations were analyzed. Patients are conditionally divided into three groups: 1) primary with a smooth postoperative course, A special group consists of patients with combined developmental defects. In most cases, these are so-called regional defects of the urinary tract, sacrococcygeal region. Individual attention should be paid to the issue of social adaptation and rehabilitation of children suffering from malformations of the colon and rectum. Rehabilitation of proctological patients of childhood is a complex medical and social problem that requires the integration of knowledge and actions of specialists from many services subordinate to various departments. The aim of this work: The purpose of this work is to evaluate the effectiveness of the rehabilitation of pediatric patients with proctological anomalies.

This article presents a literature review devoted to a brief history of the development of tissue engineering, samples of modern matrices that can be used for programmed effects on the reparative processes of damaged tissues after injuries, wounds, and surgical interventions. A frequency analysis of literary sources located in open scientific repositories in Russian and English with a search depth of 5 years was carried out. In order to generate search queries, we used keywords and phrases that related to one of the areas of tissue engineering - the development and experimental testing of polymer matrices for the purposes of reconstructive surgery, in particular, for filling defects and restoring lost tissues of the hollow organs of the abdominal cavity. Results: when conducting a frequency analysis of Russian scientific electronic libraries, the most frequently used words relative to other terms were “tissue engineering” (869), “cellular technologies” (758), “matrix” (716), the rare ones were “tissue engineering design” (255), “gel” (84), “sponge” (55). Among foreign databases in English, “cell technologies” (7009), “tissue engineering” (2400), “membrane” (2282) predominated; “gel” (116), “sponge” (158), “tissue engineered structure” were less common “(421). Conclusions: frequency analysis showed that the most common keywords in open scientific repositories in Russian and English are “cellular technologies” and “tissue engineering,” which may be due to the generality of these concepts. These words and phrases are more often found in English-language scientific literature. The first is 9.2 times, and the second is 2.7 times.

In children, autoimmune liver diseases can manifest in a variety of forms, including autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and the co-occurrence of AIH and PSC - the “overlap syndrome.” Early recognition of overlap syndrome is important. Diagnosis of sclerosing cholangitis largely depends on the cholangiographic picture showing single or multiple strictures with dilatation of the biliary tract. The problems of etiology, pathogenesis, diagnosis and treatment of overlap syndrome in children are shown. A clinical example of seronegative autoimmune hepatitis and sclerosing cholangitis as part of a cross syndrome in a child is given.

Celiac disease poses a serious diagnostic problem due to significant clinical polymorphism with a high frequency of atypical forms. The problem of comorbidity for celiac disease is relevant due to the possible involvement of almost all organs and systems in the pathological process. In this regard, the question arises of which symptoms are a manifestation of the disease, which are complications, and which symptoms are associated with comorbid conditions. The clinical polymorphism of celiac disease is obviously associated with damage to many organs in this disease. They all have a common starting point - an immunopathological process leading to malabsorption and secondary metabolic disorders, which are essentially a manifestation of the disease, but not complications, as is sometimes interpreted. A complication can be considered the oncological consequences of the disease, which develop after prolonged non-compliance of a gluten-free diet. The combination of celiac disease with associated diseases, primarily autoimmune diseases, should be considered as a manifestation of comorbidity.

The comorbidity is an urgent scientific and practical problem of modern pediatrics. The practical significance of combined pathology in children is determined by its widespread occurrence and universal impact on all aspects of a child’s health and treatment options. In patients with congenital heart defects, outcomes are influenced by numerous non-cardiac and genetic factors. In childhood and adolescent bronchial asthma, concomitant diseases are a common cause of adverse outcomes, such as poor disease control, frequent seizures, decreased quality of life and increased healthcare costs. A stable interdependence between the state of the gastrointestinal tract and the development of allergic or autoimmune diseases has been proven. The article describes a clinical case of late diagnosis of concomitant pathology in a child with chronic gastritis with clinical symptoms, diagnostic criteria and drug treatment options. The understanding the etiology and pathogenesis of concomitant conditions in children will help identify risk groups for the formation of chronic noncommunicable diseases and develop a plan for their prevention.

The mechanisms of formation of the intestinal microbiota, its influence on the health of the child, participation in physiological and pathological processes are considered. Microorganisms enter the body of the fetus in utero, then the newborn child receives the microflora from the mother during childbirth. The results of molecular genetic studies indicate that the process of microbial colonization of a child is determined by the characteristics of nutrition. Of great importance in the formation of normal microflora belongs to breastfeeding. The gut microbiota interacts with various parts of the body, influencing the pathogenesis of many local and systemic diseases. The most important mechanisms for the formation of diseases in children depending on anomalies in the structure of the microbiome are considered. Understanding the processes of formation of intestinal microflora allows us to develop effective methods for the prevention and correction of microecological and motor disorders in the age aspect.

Inflammatory bowel diseases (IBD) are a certain group of pathologic conditions of the gastrointestinal tract (GIT), including Crohn’s disease (CD) and ulcerative colitis (UC). In the modern world, vigilance for these diseases is growing, because their characteristic feature is the involvement of other organs in the pathological inflammatory process, as well as the development of local and systemic complications. As a rule, in children CCD occurs mainly at the age of 12-16 years. Recently, the attention of the medical world has been drawn to the issue of extraintestinal manifestations of CD. Pathological manifestations associated with lesions of the skin and mucous membranes, eyes, bone and joint system, pancreas, negatively affect both physical and psychological health of the child. Such pathology associated with pancreatic malfunction, such as acute pancreatitis (AP) often occurs in patients with inflammatory bowel disease and is one of the main causes of hospitalization for diseases of the digestive system. According to statistics, the incidence ranges from 15 to 40 cases per 100,000 per year in European countries. According to the Gastroenterological Society, there are different variations in the course of acute pancreatitis, whether occurring in patients with IBS due to the disease itself or as a side effect of drug therapy. However, IBD patients are at increased risk of developing both acute and chronic pancreatitis. In this review, we consider the relationship and mutual influence of these two pathologies.

Histamine intolerance is a disorder associated with impaired ability to absorb ingested histamine. Histaminosis occurs in 1-3% of the population. This condition was described at the beginning of the 21st century. This article provides an overview of histamine intolerance, mainly devoted to clinical manifestations, diagnosis and treatment.

Hereditary pancreatitis is a genetically determined disease that occurs in 1-10% of adult patients with chronic pancreatitis and in more than 50% of pediatric patients. Patients with hereditary pancreatitis have an increased risk of developing complications, pancreatic cancer, therefore early detection is important for screening for the occurrence of malignant neoplasm. The purpose of the review was to analyze the literature data on modern approaches to the diagnosis of hereditary pancreatitis and to familiarize with diagnostic methods. Methods A literature search was conducted in the databases PubMed, Web of Science, UpToDate, genetic databases using keywords. The data of 80 articles and the expert opinion of specialists providing care to patients with pancreatitis were used. Conclusion Carrying out molecular genetic diagnostics plays an important role in the study of pathogenesis, assessment of variants of the course of the disease. The article presents the currently known aspects that are important for working with patients with hereditary pancreatitis.

Obesity is a heterogeneous group of hereditary and acquired diseases associated with excessive accumulation of adipose tissue in the body. One example of syndromic obesity in children is Bardet-Biedl syndrome. This is a rare autosomal recessive disease from the group of ciliopathies, characterized by retinal dystrophy, obesity, polydactyly, mental retardation, hypogonadism, and renal dysfunction. The article presents two clinical cases of Bardet-Biedl syndrome. Diagnostic criteria for the disease are given, and the need for molecular genetic research methods in the early stages of the diagnostic search is shown. Promising directions in the treatment of the syndrome are considered.

The purpose of the article is to demonstrate a clinical case of Crohn’s disease in an 8-year-old child. Materials and methods: The given clinical example is a case of a non-classical variant of the course of Crohn’s disease in an 8-year-old child who debuted with an upper respiratory tract lesion in combination with abdominal pain against the background of long courses of antibacterial therapy. Conclusion: This clinical case demonstrates the complexity of the diagnostic search, the need for careful history collection and differential diagnosis.

This clinical case demonstrates the complexity of managing a comorbid patient with antibiotic-associated diarrhea. We observed a patient who, during therapy, developed extremely early premature birth with a live premature fetus (at 25-26 weeks), antibiotic-associated (Clostridium difficile) intractable diarrhea, pseudomembranous colitis, and acute dynamic intestinal obstruction. After treatment for 14 days, the patient’s condition improved.

Primary Immunodeficiencies (PID) are a group of congenital immune system disorders caused by the loss, reduction, or impaired functioning of one or more components of the immune system. This article presents a detailed characterization of Bruton’s disease, the most common manifestation of inherited agammaglobulinemia, as well as modern approaches to its diagnosis and treatment. A clinical observation of the manifestation of primary immunodeficiency in a 3-year-old boy is described, while the diagnosis of “Primary Immunodeficiency: Bruton’s disease” was only established at the age of 8. The results of an 8-year follow-up of the patient are presented, and the difficulties of early diagnosis are analyzed. It is shown that a sequential diagnostic search allowed for the diagnosis of PID and the determination of the appropriate therapeutic strategy.

Objective: To examine a clinical case of congenital cytomegalovirus (CMV) infection with subsequent hepatitis development in a child with a complicated medical history. Materials and Methods: The study was based on the analysis of modern literature devoted to the problem of cytomegalovirus infection in pregnant women and newborns in Russian and English, as well as the case history of a child with intrauterine cytomegalovirus infection. Results: The article presents a clinical case of a child infected with CMV, complicated by cholestasis syndrome. The child was born into a family with a history of multiple maternal diseases, premature births, and multiple complications during pregnancy. The research results indicated the presence of CMV and changes in blood biochemical parameters characteristic of cholestatic hepatitis. Therapy led to an improvement in the condition, followed by a relapse after discharge from the hospital, associated with the features of the course of CMV hepatitis in a child with a complicated obstetric and gynecological history of the mother, prematurity, and neonatal period pathology. Conclusion: The article emphasizes the difficulties of diagnosing and treating congenital CMV infection and its associated hepatological complications, as well as the need for long-term monitoring for patients with a complicated medical history.