The authors provide information about the factors affecting the quality of medical care, recent changes in the regulatory framework in medical education and its development in Russia compared with developed countries. For healthcare leaders are described the risks for the implementation of these changes in public health practice, are given recommendations for leveling the risks and further improve the quality of medical care in the Russian Federation.

The aim was to investigate the acid-base balance in the mouth and assess the risk of dental disease in practically healthy persons depending on the habitual diet. Materials and methods: The study involved 162 people, divided into three groups: with a mixed diet, with protein foods of animal origin and vegetarians. There were studied the pH value of oral fluid, dental, lingual plaque at stimulation with sucrose and urea. Results: In individuals, characterized by the habitual diet, there are statistically significant persistent changes in acid-base balance in the mouth, which provoke an increased risk of developing dental diseases. At normal mixed diet there is moving the acid-base balance towards weak acidosis that in the presence of other predisposing factors can lead to the risk of development of dental caries. There is a displacement of acid-base balance in the oral cavity to the alkaline side in case the long predominant consumption of protein foods of animal origin, that is dangerous in terms of formation of hard dental deposits and consequently of the development of inflammatory periodontal diseases. In vegetarians, there is a persistent shift of acid-alkaline balance in the mouth in the direction of acidosis, which is a risk factor for development of dental caries.

Aim: comparative analysis of uPA-Ag, uPA-act, tPA-Ag, tPA-act, PAI-1-Ag and PAI-1-act in tissues of esophageal squamous cell carcinoma (ESCC) in men (M) and women (W) to clarify some pathogenesis issues. Material and methods. Tumor tissue of ESCC and its perifocal area (19 M and 8 menopausal W aged 38 - 72 years, st II, G2, T2-3N0-1M0-1) were studied by ELISA using standard test kits. Results. ESCC tissue of M showed an increase in both uPA types from the resection line (RL), while in W only uPA-act was increased. tPA-Ag was decreased in tumors of W, tPA-act - in tumors of all patients. Levels of both PAI-1 types were higher in ESCC of M than in W. In M, tPA-Ag in perifocal area was lower than in RL, while in W, on the contrary, it was higher. tPA-Ag/tPA-act coefficient in M tumors was 5.7 times higher than in W; in perifocal area it was reduced in all patients, being at the same time in M lower than in W. Both PAI-1 types were increased in malignant tissues of all patients, prevailing in M tumors, and PAI-1-Ag in peritumoral tissue was higher in M than in W. Conclusions. Significant gender differences were found in expression of uPA, tPA and PAI-1 in tissues of esophageal squamous cell carcinoma. Presence of tumor-associated uPA, PAI-1 and tPA in men and uPA and PAI-1 in women is possible in tumor tissue of esophageal squamous cell carcinoma and its perifocal area. Determination of plasminogen regulation system in tissues of esophageal squamous cell carcinoma can be used for the selection and individualization of postoperative treatments.

Relevance. Currently, there is a need to study the genetic diversity of H.pylori in patients with variety of acid-related diseases to develop new strategies for the treatment of patients with H.pylori to predict high efficiency of treatment. Objective: To assess the effectiveness of schemes of eradication therapy in patients with chronic pancreatitis and concomitant H.pylori infection. Materials and methods. The study included 108 patients with H.pylori infection: 63 patients had chronic pancreatitis and were concomitant with H.pylori-infection and 45 patients were without chronic pancreatitis and had H.pylori infection with a chronic gastritis. All patients were determined by factors of pathogenicity of H.pylori by immunoblotting. After forming the group randomized patients received eradication therapy scheme I and the scheme I with inclusion of bismuth tripotassium dicitrate. Conclusions. The effectiveness of H.pylori eradication therapy is dependent on the genetic component of H.pylori. In the presence of H.pylori pathogenicity factors p33, p30, p26, p19, p17 in order to increase the effectiveness of treatment the scheme of eradication therapy I line drugs bismuth tri dicitrate should be included.

Background: Ulcerative colitis (UC) is a chronic immune inflammatory condition of the colon with an unknown aetiology, leading to disability and reduced quality of life of patients. UC primarily affects young adults. In most cases, inflammatory bowel disease (IBD) debuts at reproductive age. The incidence of UC and severe clinical course has increased overall across the world. The study of the mechanisms of pathogenesis and aetiology of this disease contributes to the development of new effective methods of treatment. Objective: The aim of our study was to develop technology of the surgery directed to induction of reversible ischemic damage, the erosive-ulceration of gut mucosae (descending colon) at rats of the WISTAR line. Materials and methods: Experimental research was done using male rats «Wistar» (n=40), their age was more than 6 months, weight of body is 280 - 350 grams. The animals were separated into 3 groups: 1 - (n=14) Sholimov’s operative method, 2 group (n=16) - model using special technology, 3 group (n=10) - Coopr’s H. S. induction ulcerative colitis. Observation was been done during 10 days. We offered special surgical technique: parietal ligation on every vasa recta of colon descendens of rats the length 3 cm along colon, on the apex vesicae and then vasa recta are cut. Then during 7 days 1% solution of dextran sulfate sodium (DSN) was given for experimental animals after postoperative period. By the histological biopsy of colon mucosa the results were estimated. Results/Conclusion: we have created erosive-ulceration of gut mucosae (descending colon) of rat with productive inflammation, vasculitis and plasmatic impregnation of the vessel walls and intimal thickening. Our model of ulcerative colitis can be used for the development and testing of new methods for the study and treatment of this pathology.

The purpose of the review. Outline the main points of consensus III Working Group Italian for the diagnosis and treatment of H.pylori-infection. The work of the Working Group III was the clarification of certain provisions of the Maastricht IV consensus, and, namely, the nature of H.pylori relationship with gastroesophageal reflux disease, functional dyspepsia, NSAID / aspirin gastropathy, extra-gastric diseases, detailed scope of the invasive and non-invasive methods of investigation, treatment algorithms updated H.pylori-infection antibiotic growth conditions. Indented understanding of the role of H.pylori eradication in the prevention of gastric cancer.

The aim of the study was to increase the efficiency of the treatment of acute ethanol intoxication in patients with alcoholic fatty liver disease. The article presents the results which received during the investigation and treatment of 166 patients with acute ethanol intoxication on the background of alcoholic fatty liver disease Patients were assessed by the severity scale APACHE-II. Were studied the dynamics of clinical, laboratory, biochemical parameters, the state of the antioxidant system activity and lipid peroxidation. The study found the effect of the combination hepatoprotective drug remaxol on the many links of metabolism, which was confirmed by the dynamics of biochemical parameters. There was a quick correction of hyperlactatemia, an effective reduction of ALT activity, the absence of reduction of albumin and urea concentration in the somatic period of ethanol poisoning. Period of using remaxol there was improvement in the clinical course of the disease, which manifested by the reduce the incidence of delirium tremens and shorten the duration of treatment of patients.

Objective: To optimize the diagnostic and therapeutic approaches in polymorbid patients with fatty hepatosis in the practice of general practitioner. The medical tactics of treatment of polymorbidit patient with fatty liver, is considered in regards of the course of concomitant diseases, especially the cardiovascular system. Substantiates the necessity of determination of, in relation to the patient's prognosis, not only the degree of steatosis, but also the liver fibrosis stage changes, developing due to apoptosis of hepatocytes that leads to the progression of endothelial dysfunction A working version of the treatment of hepatic steatosis, designed to reduce progression of fatty degeneration, reducing the risk of steatohepatitis and fibrosis body changes is proposed in the paper. Ursodeoxycholic acid and glycyrrhizin are the most promising medication.

The review presents an analysis of current data on the epidemiology, etiology, clinical and genetic characteristics of congenital anorectal malformations (AM). According to international registers of congenital malformations prevalence of the AM varies from 2 to 5 per 10,000 births. There was no change in the prevalence over time of AM (absence of temporal trends). Most studies have indicated the predominance of males among patients with AM. Approximately 40 - 70% of patients with AM have congenital malformations of other organs and systems. The data on the participation of genetic and environmental factors in the origin of the AM. A brief clinical and genetic characteristics of the most common syndromes (association) with the AM.

The paper reflects the issues of pathogenesis of the chronic liver diseases (CLD). The role of the cell membrane lipid peroxidation as well as oxidative stress and fibrosis formation in the development and progression of liver lesions of various aetiologies. are represented in details. Particular attention is given to the justification of pathogenetic approaches to the treatment of liver disease. Presented the evidence base of successful application of the standardized silymarin as a part of the drug Legalon in the CLD of different etiology.

The purpose of the review is to analyze modern data on pathogenesis, principles of treatment and future prospects treatment of nonalcoholic fatty liver disease (NAFLD). Modern ideas about the role of insulin resistance, oxidative stress gene polymorphisms in the pathogenesis of disease progression. This has led in recent years to a new strategy of treatment of the disease. Examines the role of physical load, modified diet, the weight loss. Substantiates the primary role of the use of insulin sensitizers, and agents with cytoprotective and antioxidant effect. The lack of the only effective drug for the treatment of NAFLD justifies the appropriateness of the appointment of combination therapy with exposure to various aspects of the pathogenesis. Elaborates on new drugs under clinical study.

Working in conditions of physical and psychological overload, occupational hazard makes health workers vulnerable to the development of burnout syndrome. Currently, 67.6% of physicians in Russia suffer from emotional burnout syndrome. This syndrome is characterized by a certain symptoms, which have their predictors. Prevention and treatment of emotional burnout syndrome - a complex problem that can be solved with the participation of heads of medical institutions, full-time psychologists and psychotherapists with the direct involvement of health professionals

The Purpose. To present the history of surgical gastroenterology in Perm krai. Materials and methods. Narrative, historical, genetic, comparative and structural. Results. In the early 20th century the main method of surgical treatment of peptic ulcer was gastroenteroanastomosis. A significant number of recurrences resulted to distal gastrectomy implementation in the 30s in the Clinic of hospital surgery of Perm medical institute, led by professor M. V. Shats. It was also performed in major cities of the region: Lysva, Kungur, Berezniki, Kizel, Osa. Treatment of ulcer perforation and bleeding was accomplished at the department of surgical diseases of pediatric faculty, led by Professor V. N. Repin. He also developed vagotomy and methods of diagnostics and treatment of diseases of operated stomach. Comorbidity was also researched. The combination of liver and biliary tract diseases was researched in the Hospital surgical clinic of Perm, initially led by Professor S. Yu. Minkin and then by academician E. A. Wagner (L. F. Palatova). The results of surgical treatment of cholelithiasis, depending on morphological and biochemical abnormalities in liver and chemical composition of gallstones were studied (L. P. Kotelnikova). Indications for surgery in cholelithiasis in conjunction with pathology of stomach, duodenum and liver were defined (A. V. Popov). The results of surgical treatment of biliary pancreatitis and cholangitis (L. B. Guschensky), and diseases of stomach, duodenum and pancreas with cholelithiasis were obtained (D. V. Shvarev). Conclusion. The priority trends of research of Perm scientists were treatment of post-resection syndrome, arteriomesenterial obstruction, pathogenesis of gallstone disease and its combination with other disorders of the digestive system.