The importance of the literature and its own materials presented in the article is the significant prevalence of encephalopathy in patients with cirrhosis of the liver (it is 30-45 % among patients with severe encephalopathy). Minimal encephalopathy significantly reduces the quality of life of patients with liver cirrhosis. The international classification of clinical variants of chronic encephalopathy has not been sufficiently extended. The goal of the work is to select various clinical variants of chronic encephalopathy and to evaluate new pathogenetic methods of treatment aimed at increasing the effectiveness of therapy in patients with cirrhosis of the liver.

Background: atrophic gastritis (AG) associated with Helicobacter pylori (H. pylori-infection) is one of the precancerous lesions and associated with low level of serum pepsinogen I (PGI) and PGI/PGII ratio, which are also recognized like predictive markers for gastric cancer (GC) development. The aim of the study: to analyze the predictive value of biomarkers in the GC development in a prospective “case-control” study conducted in Caucasian population of Western Siberia (8 years follow-up). Material and Methods: GC cases and control were selected from population cohort of residents of Novosibirsk within the international HAPIEE project during 2003-2005 with inclusion of subjects (n=9360) of both sexes at the age of 45-69 years. Serum samples were stored at -70⁰С. GC cases received from Population Cancer Registry until 2012 were compared with the database of HAPIEE with selection of appropriate on sex and age control in the ratio 1:2. Finally, 156 serum samples (52 - the main group and 104 - control) were available for analysis, and biomarkers were measured. The following criteria for biomarkers of atrophic gastritis were used: PGI < 30 µg/l, PGII < 3 µg/l, PGI/PGII < 3, G-17 < 1 pmol/l. Results: The mean levels of PGI and PgI/PgII ratio in the GC group was lower in comparison with the control (p < 0.005 and p< 0.0001, respectively); no difference was shown in respect to the other biomarkers. The cut-off values of atrophy have appeared above the recommended parameters: for PGI-55 µg/l (р=0.0001; OR=4.1; 95 % CI 2.0-8.4) and PGI/PGII ratio-5 (р=0.0001; OR =5.8; 95 % CI 2.7-12.4). Conditional (fixed effects) logistic regression analysis with inclusion into the model sex, age of the patients, and all biomarkers of test system showed PGI/PGII ratio as the most powerful indicator in the model (OR=2.9; 95 % CI: 1.0-8.0). Conclusions: for the first time the predictive value of low indicators of PGI and PGI/PGII ratio in GC risk development in Caucasian population for 8 years follow-up was demonstrated.

The aim of the work is to estimate endoscopic and morphological peculiarities of the gastrointestinal tract proximal part against the background of acetylsalicilic acid intake, the acetylsalicilic acid in combination with clopidogrel and acetylsalicilic acid in combination with ticagrelor. Materials and methods. There were examined 65 patients taking the different variants of antiplatelet therapy. Data on fibroesophagogastroduodenoscopy and biopsy material were analyzed. Results. In the proximal parts of the gastrointestinal tract, various variants of antiplatelet therapy showed no endoscopic and morphological differences in the changes in the mucous tunic of the stomach and duodenum. In the group of patients taking acetylsalicylic acid and clopidogrel, esophagitis of varying severity, hyperplasia of basal layer, elongation of papillae and greatest polymorphocellular infiltration appeared to be more often.

The article is devoted to the study of chronic gastric erosions in the normal course of gastritis and against the background of cardiac pathology requiring receiving of antiplatelet drugs. In cohort investigation of 1426 patients age characteristics, the frequency of chronic erosive gastritis, clinical manifestations, endoscopic findings and microscopic changes were studied. The proportion of cardiac patients with chronic erosive gastritis makes of 9.3 % from the 12.1 % of all identified chronic erosions. Significant differences in the structure of age groups with chronic erosive gastritis, significantly lower incidence of dysplasia and metaplasia at cardiac patients, the symptoms accompanying inactive gastritis in all cases of chronic asymptomatic erosions in cardiac patients, the same frequency of contamination HP are revealed. The conclusion about same course of chronic erosive gastritis irrespective of cardiac pathology is drawn.

The purpose of the study. To compare the type of reflux and endoscopic pattern of distal esophagus of patients with a combination of GERD-chronic pancreatitis and monopathology of GERD. Materials and methods: 155 patients with GERD were examined. The first group consisted of 75 patients with a combination of GERD and chronic pancreatitis, the second with 80 patients with monopathology. The analysis was applied to the data of fibroesophagogastroduodenoscopy with biopsy, daily 24-hour pH-metry of the esophagus and the stomach, multispiral computed tomography of the abdomen. Results. The combination of GERD and chronic pancreatitis increases the likelihood of reflux with pH >7 and independently on the type of reflux worsen clearance of the esophagus, characterizing by a higher frequency of erosive esophagitis and Barrett’s esophagus.

The aim of this study was to investigate the relationship between polymorphisms H139R and I462V of genes EPHX1 and CYP1A1 in the development of acute pancreatitis (AP) in the Russian population. Whole blood samples were collected from 299 patients with acute pancreatitis and 238 healthy controls. Genotyping of the SNPs (rs2234922) EPHX1 gene and (rs1048943) CYP1A1 gene accomplished using PCR with allele discrimination using TaqMan-probes. It has been found that the allele 139H (OR = 1.34 95 % CI 1.03-1.75) associated with a reduced risk of acute pancreatitis. I462V polymorphism association with development of acute pancreatitis detected. Conducted stratified analysis of smoking and genotypes of polymorphisms H139R and I462V genes EPHX1 and CYP1A1 in the development of acute pancreatitis also found no differences in the groups of patients and healthy controls.

The aim is to develop recommendations for the use of nutritional schemes for palliative care for cancer patients. Material and methods. The severity of the condition, the degree of protein-energy deficiency and organ deficiency (according to the method of alimentary-vollemic diagnosis), the degree of nutritional risk, the stage of the process, the assessment of the intensity of intoxication, the state of the immune system and genomic prognosis were assessed in cancer patients. Criteria for assessment of homeostasis in all patients with oncopathology are divided into 3 main groups: 1) patients who could performed radical surgery and/or comprehensive treatment; 2) patients receiving at the time of providing support to various regimens; 3) patients requiring only palliative care. With this gradation, the use of information, literature data and own observations, we proposed for each group a specialized nutritional program. Results and discussion. Patients in need of palliative care were diagnosed with asthenia, early satiety, progressive weight loss, anorexia, tissue protein deficiency, the growth of pro-inflammatory cytokines and tumor-specific cachexia factors. For such patients, a program is proposed that includes a diet, sipping with the use of a caliper; In the case of probe alimentation, partially disintegrated formulations are recommended (for example, nutrihim). In severe patients, the nutritional effect was enhanced by progestogen preparations (megas, ondasetron), anti-catabolic agents (indomethacin, ibuprofen, EPA), anabolics (retabolil). Conclusions. The composition of the sipping rations should include nutrients that affect the molecular mechanisms of survival, apoptosis of tumor cells, proliferation, angiogenesis and invasion of tumor cells.

Objective. Investigation of the importance of microbiota in the violation of digestive, absorption and motor function of the small intestine (SI) in the metabolic syndrome (MS). Materials and methods. 58 patients with MS were examined. To assess the processes of digestion and absorption in the intestine, stress tests were carried out with mono-, di- and polycarbohydrates. The motor-evacuator function of SI was studied with the help of gastroenteromonitor “Gastroscan-GEM”. In the definition of small intestinal bacterial overgrowth (SIBO) in the SI, a hydrogen breathing test with lactulose was used. The state of the colon’s microbiocenosis was determined by sowing feces on various selective nutrient media. Results. In MS, there was a violation of all stages of the hydrolysis-resorption process in the SI. Depression of cavity and parietal hydrolysis of carbohydrates, increased absorption of glucose in the proximal part of the SI was noted. When conducting peripheral electrogastroenterocolography in most patients with MS there was a violation of the motor function of the intestine, aggravated in the postprandial period. In 40 % of patients, SIBO was detected, and in 72 % of cases it is localized in the distal part of the SI against the background of insufficient ileocecal valve and impaired propulsive motility of the intestine. A regularity is established between the severity of SIBO and the violation of digestion, absorption and motor functions of the SI. The conclusion. A new information on the conjugation of the functional state of SI and intestinal microbiocenosis in patients with MS has been obtained.

Introduction. It is known that biologically active substances (serotonin, acetylcholine) participate in the regulation of motor activity of the intestine in patients with inflammatory bowel diseases (IBD). The aim of the study was to determine the concentration of neurotransmitters of acetylcholine and serotonin in the serum at IBD. Material and methods. 69 patients with IBD were examined. The control group consisted of 30 volunteers regularly undergoing a prophylactic check-up. The concentration of Ach and serotonin in serum was determined. Statistical processing of the results was carried out using a nonparametric analog of the variance analysis. Result and discussion. The concentration of 5-HT in the blood of patients with IBD: 0.39 ± 0.05 μg. So, it is established that the presence of the disease promotes an increase in the concentration of Ac and serotonin. There is a violation of the neuronal regulation of the functional activity of the digestive system as a vicious circle. In patients, in contrast to the control group, there is a high initial level of neurotransmitter concentration. Conclusion. In the chain of cause-effect relationships, the main link is identified, this is the level of concentration of neurotransmitters. Patients have a high quantitative composition of neurotransmitters. Perhaps the determination of the concentration of BAS will allow us to find the line between adaptation and disease.

The results of the single-center study of the intestinal actinomycosis patients, treated at the Research Institute of mycological clinic in 2005-2016. Age of patients from 8 to 81 year, median - 42 (36,5÷52). Risk factors for intestinal actinomycosis were acute appendicitis with perforation (OR= 3.857[1.527-28.242]). Appendix (64 %), omentum (64 %) are the most common abdominal sites of actinomycosis. Patients may present with non-specific symptoms such as fever (100 %), abdominal pain (91 %), weight loss (36 %). The formation of spontaneous draining of purulent material was in 27 % cases. The time from onset to diagnosis varied from a few weeks to two years (median - 27 +/- 2 days). Surgical resection of infected tissue and long-term antibiotic therapy will be effective in the treatment of abdominal actinomycosis - 94 %

Objective of the Paper: Quantitative comparison of neutrophil extracellular traps (NETs) in blood between type 2 diabetes mellitus patients with purulent necrotic complications at various locations and healthy volunteers. Key Points: NETs concentration in patient blood was, on average, higher than that for healthy subjects. NETs blood concentration in the latter and in patients (n = 5) with high levels of NETs increased as HbA1c increased. For other patients, NETs concentration decreased as HbA1c increased, indicating the existence of a compensatory mechanism to inhibit NETosis in conditions of inflammation in type 2 diabetes mellitus. High NETs levels and a positive correlation between this parameter and HbA1c were observed in patients with phlegmon, vast infected wound, gangrene of lower leg, purulent pyogenic mediastinitis. Infected wounds, abscess, gangrene of finger were predominant among other patients. Analysis of the two clinical examples shows the relationship between inflammation severity, including wound healing speed, and NETs concentration in patient blood. Conclusion: This study suggests that monitoring blood levels of NETs alongside HbA1 levels in healthy subjects and type 2 diabetes mellitus patients with allow more accurate assessment of the risk of various complications, the disease severity and the duration of post-surgical treatment

Phase I/III full clinical trials of investigational new drugs (INDs) and generic bioequivalence studies are conducted using experimental drugs or clinical examples. Clinical examples are most often produced either on pilot plant or on specialized semiwork-scale plants that do not directly involve development of technology. In some cases, full (serial) production might be used for this purpose. Its advantage is non-commercial clinical examples production during the stage of clinical trials and then commercial release (after a medicine registration). Special attention is paid to quality assurance of Clinical examples as it plays an important role in guarantee of trial subjects protection and scientific validity of results. Clinical examples production, in turn, is connected with certain difficulties in comparison with serial production release. This is the result of inadequate optimization of technological processes and control procedures used in the case of the compendial requirements absence toward active substances and dosage forms. Difficulties also arise with production packaging and marking. Moreover, potential negative influence on the personnel involved in manufacture requires better understanding. Consequently, clinical examplesс production should be performed in strict observance of the high-performance quality system principles. This article contains a review and comparison of quality and production requirements for drugs in clinical trials; the high importance of international harmonization in proceedings of full clinical trials with investigational new/innovative molecules is also highlighted. The information is based on Russian and foreign regulatory documentation.

Background. Intraoperative bile duct injury is a serious and potentially life-threatening complication in post-operative period. The treatment of surgical trauma is complex and multiple. The incidence of disability is up to 50 % and duration of treatment is up to 42 weeks. Objective. To estimate the feasibilities of endoscopic treatment of iatrogenic biliary strictures. Material and methods. The series of 19 patients underwent endoscopic treatment of iatrogenic biliary strictures in a period from 2014 to 2017. Treatment protocol included: ERCP, balloon and bougie dilation of strictures followed by stenting with several plastic stents or stenting with one full cover metallic stent. After primary endoscopic procedure all patients underwent step-wise restenting procedures with increasing number of plastic stents. Results. The technical success rate of endoscopic procedures is 100 %. The step-wise endoscopic stenting was completed in 12 out of 16 followed-up patients. The clinical success rate which imlicates full release of the stricture was in 12 out of 12 patients with complete endoscopic treatment. The intraoperative complication included bleeding in one patient, which required stenting with SEMS for hemostasis. The late postoperative complication included new stricture at the upper level was observed in two patients. The recurrent choledoholithiasis was observed in one patients. Conclusion. Endoscopic procedures are effective and safe treatment option for iatrigenic biliary strictures, but more prolonged studies are needed for appropriate assessment of the long-term results.

In the clinic of General surgery Department of Novosibirsk State Medical University from 2005 to 2014 were observed in 43 patients with diverticular disease of the colon. Complications of diverticular disease with acute diverticulitis, paradigmatically infiltrates, abscesses, perforations, peritonitis - 31 patients aged 24 to 84 years. Diverticular disease complicated by bleeding, 12 cases (all women), ranging in age from 63 to 77 years. Acute diverticulitis was found in 11 patients, paradiverticular infiltrates, abscesses, perforation, peritonitis in 20. Conservative treatment in 11 patients was effective. It included infusion therapy, use of broad-spectrum antibiotics, antispasmodics, enteral nutrition mixtures. 20 patients were operated urgent. n 4 cases the draining operations are performed from laparotomy, because laparoscopy was not possible because of the early migrated in open surgery. The average age of the patients in this group was 64.5 + 8,54 years. Acute diverticulitis they have developed for the first time and was consistent with Hinchey III. 8 patients underwent resection of the obstructive, the average age was of 56.10 + 5.43 years. Recurrent diverticulitis have a high complication rate. In Hinchey II-III laparoscopic lavage and drainage are the alternative to Hartmann’s operation.

Purpose of the study. Improving of results of treatment of the intestinal anastomosis failure. Material and methods. The method of treatment failure intestinal anastomosis is to move the jejunal loops with anastomotic leak on the anterior abdominal wall with the combination of nasointestinal and retrograde intubation of the jejunum through the ileostomy. It was used in 5 patients of the main group. In 11 patients with the comparison group it was used without retrograde intubation of the jejunum. Results. In the group with using of the nasogastric intubation and retrograde intestinal all 5 operated patients recovered. Conclusion. The main advantages of combined intestinal intubation are the earlier recovery of intestinal paresis and following self-healing of intestinal fistula.

The aim of the investigation was to study the spectrum of proteolytic enzymes and their distribution by molecular mass and type of active centers in the urine and serum of patients with acute pancreatitis. Materials and methods. The study included 48 patients with acute pancreatitis and 19 healthy volunteers. In patients and in healthy was determined presence and activity of proteolytic enzymes in urine and serum gelatin gel zymography method. Results. In the urine of patients with acute pancreatitis, no enzymes with proteolytic activity were found. All healthy volunteers we showed the presence of three protease with molecular masses of 170, 144 and 121 kDa, patients had an additional protease - 121 kDa (n=24), 53 kDa, 42 kDa (n=5) and 23-26 kDa (n=18) in serum. The protease 121 kDa was presented in 50 % of patients of mild, moderate and severe degrees of severity. Protease 53kDa, 42kDa and 23-26 kDa were more often in severe patients. Protease activity of 170 kDa and 112 kDa was significantly higher (p <0.05) than in healthy volunteers and decreased during the treatment. Protease that were absent in healthy volunteers (121, 23и 26 kDa) also decreased its activity in the treatment process, but the convalescence of patient was not accompanied by the disappearance of their activity. Conclusions. In sera of patients with acute pancreatitis, a broader spectrum of proteases was found in comparison with healthy volunteers. In the urine of patients with acute pancreatitis, no enzymes with proteolytic activity were found.

We examined 107 healthy people and 256 patients with diseases of the digestive system. In healthy symbiotic digestion (SP) made the whole microflora inhabiting the digestive tract, including 395 phylogenetic groups, more than 5,000 types of microorganisms with a total weight of 2.5-3 kg. Violation of the SP associated with disease and dysbiosis of various departments of the digestive tract. Presents data about the risk factors, pathogenesis, clinical manifestations, classification, diagnosis and treatment of SD.

The study included 31 patients aged 18 to 50 years (mean age 35.8 years) with functional constipation. Of these, 25.8 % of males and 74.2 % of women. The diagnosis was established according to the clinical picture of the Rome IV criteria. All patients there was no “alarm symptoms”. When performing a colonoscopy or barium enema revealed no important pathology of the colon. All patients for 15 days was prescribed mineral water “Zayechickaya Gorkaya” in a dose of 100 ml for the night. Overall, 74.2 % of patients evaluated the effectiveness of mineral water “Zayechickaya Gorkaya“ as “well”, 16,1 % - “satisfactory” and 9.7 % was not fully achieved effect. On a background of reception of mineral water “Zayechickaya Gorkaya“ there were no significant adverse reactions. 29 % of patients reported periodic appearance of mild diarrhea, but only two of them described it as a negative phenomenon. Course reception natural high mineral sulphate-magnesium water “Zayechickaya Gorkaya“ leads to statistically significant decrease of the main symptoms of functional constipation. Most patients appreciate the laxative effect of mineral water as “good”. While no significant adverse reactions. The use of mineral water “Zayechickaya Gorkaya“ can be the first-line treatment therapy for functional constipation prior to use of laxatives, and if necessary, perhaps in combination with them.

The article describes a history of discovery and description of the main and accessory pancreatic ducts. The authors cited historical data about the murder of Wirsung, complexities of justice related to the naming of Wirsung and Santorini pancreatic ducts, as well as a modern view on these issues. Brief information about Vater, who described the major duodenal papilla, and Oddi, who studied the structure and function of biliopancreatic sphincter, is also presented. The article is illustrated with portraits of anatomists who contributed to the discovery of the pancreatic ducts, sphincter and duodenal papilla.