This study aims to evaluate the level of plasma homocysteine in patients with acute post-resection hepatic failure, depending on the degree of the disease. Materials and Methods. The article presents the results of a study of plasma homocysteine levels in 40 patients with c different classes of acute post-resection liver failure. Indications for liver resection were: primary liver cancer 11 (27%), metastatic liver lesions 21 (53%), parasitic liver diseases 3 (7%), benign liver formations 5 (13%). Patients were divided into 3 groups - Patients with Post hepatectomy liver failure (PHLF) class developed in the postoperative period A, B and C. Results. Analysis of the data showed that the initially normal level of plasma homocysteine before liver resection (surgical treatment) and after has different developmental options. Depending on the class of post-resection hepatic failure, the level of plasma homocysteine changes and has deviations from the reference values. In a comparative analysis of the average homocysteine values in the group of patients with post-resection hepatic insufficiency of class A, after surgical treatment, they were significantly lower than in patients with PHLF B and C. In particular, in patients with class B and C PNF, there is a significant trend towards an increase in homocysteine levels after surgery. Hyperhomocysteinemia may be a risk factor for the development of acute liver failure after surgical treatment for focal liver disease. Possibly, its adverse effect on the function and restoration of the liver parenchyma, which requires further targeted study.

The purpose of the study was to analyze efficacy and tolerability of combined modality treatment including preoperative chemotherapy with gemcitabine/cisplatin in patients with stage II-III esophageal squamous cell carcinoma. Materials and methods. The study included 70 patients with stage II-III esophageal squamous cell carcinoma. All patients were divided into two groups. Group I (study group) consisted of 35 patients, who received 2 courses of preoperative chemotherapy followed by radical surgery. Group II (control group) comprised 35 patients who underwent surgery alone. The 2-year survival rates were analyzed. Results. Combined modality treatment including preoperative chemotherapy with gemcitabine/cisplatin was well tolerated. The 2-year disease-free survival rates were 71.8% and 39.4% in groups I and II, respectively (р<0.05). The overall 2-year survival rate was 81.3% in patients who received chemotherapy followed by surgery and 51.5% in patients who underwent surgery alone (р<0.05). Conclusion. Compared to surgery alone, combined modality treatment including preoperative chemotherapy with gemcitabine/cisplatin significantly reduced the frequency of local recurrence and distant metastases and increased 2-year survival rate in patients with stage II-III esophageal squamous cell carcinoma, including the presence of unfavorable prognostic factors, such as regional lymph node metastases (N+) and high-grade (G3) squamous cell carcinoma.

January 2, 2021 marks the 85th anniversary of Professor of the Department of Faculty Surgery of the Izhevsk State Medical Academy, Doctor of Medical Sciences, Member of the European Association of Intensive Care, Academician of the Russian Academy of Laser Sciences, member of the International Association of Hepatology Surgeons, Honored Doctor of the Russian Federation Sitnikov Veniamin Arsenyevich. This article is devoted to the study of his biography, the description of his merits and achievements in medicine throughout his life. It is very important to know and remember such people who have devoted their entire lives to science and helping people.

The aim: to study peculiarities of liver enzymes state and clinical status of patients with new coronavirus infection (COVID-19) of mild and moderate severity with background of excess body weight and obesity. Materials and methods: 166 patients with COVID-19 infection were included in an open prospective clinical study. The study group (group I) was 118 patients, average age 57.5 [47; 64] years with overweight and obesity (body mass index (BMI) - 31.2 [28.6; 34.9] kg/m2). The comparison group (II) was 48 patients (mean age 53 [41; 62] years) with normal body weight (BMI 23.9 [22.6; 24.6] kg/m2). Clinical-functional, laboratory indicators, data from instrumental research methods were studied. All patients underwent computed tomography (CT) of the chest organs. Results: Overweight and obese patients with COVID-19 (n = 118) showed a more significant increase in hepatic transaminases compared to the control group: ALT level was 28.05 [17.9; 45] vs 17,9 [13,6; 24.7] U/L (reference interval < 35U/L), p = 0.000001, ACT - 32 [24; 43,5] vs 24 [19; 28.9] U/l, p = 0.000019. Direct correlation of BMI value in patients with COVID 19 with CT lung lesion volume (r = 0.26, p < 0.05), ACT level (r = 0.25, p < 0.05), ALT (r = 0.31, p < 0.05), CRP (r = 0.34, p < 0.05), ESR (r = 0.28, p < 0.05), the level of proteinuria (r = 0.19, p < 0.05). The volume of lung lesions in overweight and obese patients was significantly higher and amounted to 15 [10; 22.5]% versus 12.5 [6.25; 20]% in patients with normal body weight (p = 0.03). The average level of CRP in patients of group I turned out to be significantly higher compared to group II (21.7 [7.9; 51,8] vs 8,5 [3,5; 22.7] mg/l; p = 0.00049). Conclusion. Patients with a new coronavirus infection (COVID-19) against the background of excess body weight and obesity compared to patients with normal body weight are characterized by: a larger volume of lung damage by CT, more significant proteinuria, higher rates of CRP, ALT, ACT, which positively correlate with the magnitude of BMI.

The aim of this work is to study the possibility of using blood serum (BS) fatty acids (FA) and erythrocytes (ER) as diagnostic markers of the severity of NAFLD. Materials and methods. We examined 52 patients with NAFLD (51.8 ± 3.9 years), confirmed by the NLFS index, and 20 apparently healthy men (49.2 ± 4.5 years). The degree of liver fibrosis was established by indirect elastometry (FibroScan® 502 Echosens, France). 27 patients had an initial degree of fibrosis (F0-1), 25 had severe fibrosis (F2-4). The study of the composition of fatty acids of Er and BS was carried out using a GC / MS system based on three Agilent 7000B quadrupoles (USA). Results. Significant differences in the levels of fatty acids in blood serum and erythrocyte membranes in patients with NAFLD were revealed, associated with the degree of fibrosis and necroinflammatory activity. To distinguish between mild and severe fibrosis in NAFLD, the levels of saturated fatty acids (myristic, pentadecane, margarine) and omega-3 PUFAs (eicosapentaenoic, docosapentaenoic, docosahexaenoic) were found to be significant (p = 0.002-0.0003). Saturated and monounsaturated FAs (palmitelaidic, palmitoleic, vaccenic) played a key role in differentiating the degree of necroinflammatory activity (minimal versus pronounced) (p = 0.03-0.005). The created diagnostic panels (FA of blood serum and erythrocyte membranes) made it possible to differentiate patients with NAFLD with varying degrees of fibrosis. Correlations of FA levels in erythrocyte membranes and blood serum with manifestations of metabolic syndrome, indicators of liver damage in patients with NAFLD were revealed. Conclusions. The established differences in fatty acid profiles of blood serum and erythrocyte membranes in patients with NAFLD, associated with the degree of fibrosis, necroinflammatory activity, manifestations of metabolic syndrome and indicators of liver damage, should be considered as promising biomarkers for assessing the severity of NAFLD.

The aim of the study is to evaluate the effectiveness of menopausal hormone therapy (MHT) in combination with Ursodeoxycholic acid (UDCA) in patients with menopause syndrome in combination with cholestasis to prevent metabolic complications. Materials and methods: 47 patients with menopause syndrome and cholestasis were monitored. Assessment of the patient’s condition was made during four visits. Collection of clinical and anamnestic data, appointment of examination were performed during the 1-st visit. Second visit - assessment of examination results, assessment of inclusion and exclusion criteria, questionnaire survey, prescription of therapy. At the 3rd and 4th visits 3 (12 weeks and 24 weeks ± 3 days after the second visit), the dynamics of clinical and laboratory parameters was assessed, and satisfaction and compliance with therapy were also recorded according to the IMPSS scale. Results and discussion: The findings suggest that 1 mg of 17-estradiol and 2 mg of drospirenone in combination with Ursodeoxycholic acid have an effective cupping of symptoms of menopause syndrome, while normalizing the lipid profile of patients, having a positive effect on the hepatobiliary system. Conclusion. The results of the study showed that the patients have problems with estrogendeficiency conditions characteristic of MS in early postmenopausal period. An important factor that reduces the violation of lipid metabolism in patients with menopausal metabolic syndrome and cholestasis is the concomitant administration of UDCA when prescribing MHT for long-term use.

This analysis of 21,626 publications on fundamental and clinical studies of ornithine showed that the pharmacological effects of ornithine are due to its participation in the neutralization of ammonia in the urea cycle, amino acid metabolism, intracellular protein synthesis, inflammation and the functioning of T-cell immunity. The use of ornithine is promising for hyperammonemia, steatohepatosis and other liver pathologies, hepatic encephalopathy and sarcopenia. Ornithine maintains hormonal balance by promoting the production of insulin and growth hormone.

Aim. Assess the current diagnostic value of clinical laboratory markers of liver damage in chronic viral hepatitis C. Materials and methods. Comprehensive clinical examination of 194 patients with the diagnosis chronic hepatitis C and 73 almost healthy faces was conducted. Results. According to the clinical examination, 91% of patients have hepatomegaly. According to the results of elastography, the subgroup without fibrosis F0 49 (25%) people, with fibrosis of stages F1-F3-145 (75%) patients. The occurrence of HCV genotypes was: HCV-1-33%, HCV-2-12% and HCV-3-55%. The virusemia indicator showed large variations of values. During the research it was established that indirect indicators of a fibrosis of a liver: levels of AST and ALT, GGTP, a direct and general bilirubin, the APRI index are authentically exceeded by indexes of control group while the level of thrombocytes and de Ritis’s coefficient authentically decrease. Conclusions. The current course of chronic hepatitis C occurs with hepatomegalia, often associated with gastrointestinal and cardiovascular damage. The most common virus among patients is the HVC-3 genotype virus. When examining indirect markers of fibrosis in viral hepatitis C, the APRI test is an early predictor and has high predictive value. Platelet levels decrease with viral liver damage. As a consequence, the APRI index increases and the de Ritis ratio decreases.

Iron deficiency anemia (IDA) is the most common type of anemic disorder, accounting for 41.5% of cases. According to the WHO, the clear lack of iron is fixed at 30% of the world’s population, but 2 times more likely to observe a latent iron deficiency. The article discusses the diagnosis of iron deficiency anemia in the practice of a gastroenterologist. A list of diseases of the gastrointestinal tract and algorithms for detecting iron deficiency anemia in them are presented.

The experimental and clinic data supporting S- ademetionin application in NAFLD complex therapy were presented. The therapy corrects an oxidative stress in hepatocytes and transforms the nutrition behavior in patients with excessive body weight when depressive syndrome is developed.

Eating behavior is a complex interaction of physiological, psychological, social, and genetic factors that affect the time of eating, the amount of food consumed, and food preferences. Obesity has reached epidemic proportions in the world and it is the leading cause of morbidity and mortality. According to an analysis of 20 prospective studies, the years of life lost due to obesity have now exceeded the years of life lost due to smoking. The epidemic of obesity in the world determines the relevance of research aimed at identifying the factors that contribute to the emergence of this pathological condition. We studied mainly foreign literature on the effect of estrogens on women’s eating behavior and the physiology of adipose tissue. After puberty, women are at greater risk of developing eating disorders than men, possibly due to a more labile psyche. Estrogens contribute to the accumulation of subcutaneous fat, and low estrogen level in menopausal women contributes to an increase in the amount of visceral fat. It is believed that the anorectic effects of estrogens are mediated by the central nervous system, this statement is based on the fact that direct injections of estradiol into the paraventricular nucleus or the arcuate/ventromedial nucleus are most effective for reducing food intake, body weight and increasing motor activity. There is every reason to believe that further clinical, women-focused studies that provide a better understanding of the intracellular signaling pathways responsible for the estrogenic control of food intake will provide new insights into the mechanisms responsible for the greater prevalence of obesity and eating disorders in women.

Primary liver tumors are one of the most common types of malignant neoplasms. Surgical excision is still the most effective treatment in the early stages of the disease, however in most cases early diagnosis is difficult. Moreover, even if the treatment is carried out according to a radical program, the risk of relapse remains extremely high. In this regard, the search for new strategies for the treatment of liver malignancies that differ from traditional methods of treatment is not terminated. One of such promising approaches is immunotherapy. The present review is devoted to the current understanding of the mechanisms of action and the available clinical experience in the use of immunotherapy approaches in the treatment of liver malignancies. Combining different types of immunotherapy or combining immunotherapy with traditional therapeutic approaches can facilitate a synergistic effect and contribute to the development of personalized medicine.

A new approach to the diagnosis of PE has been the identification of latent and overt PE in recent years. The detailed assessment of the stages of PE presented in the paper actually reflects the severity of the disease. The diagnosis of latent PE is established based on the results of at least two psychometric tests repeated in dynamics, and the data of one computerized test. The diagnosis of apparent PE is often made by “excluding” other possible causes of brain dysfunction. It is shown that effective therapy of PE is based not only on the features of the pathogenesis, but is impossible without taking into account the various variants of the course of PE, the severity of the disease. Based on randomized controlled trials conducted in recent years, an effective strategy for the treatment of various forms of PE has been developed: episodic, recurrent. Recurrent, therapy-resistant, and obvious PE in the presence of hepatic insufficiency is an indication for liver transplantation.

This article observes the main trends in the diagnosis of non-alcoholic hepatic steatosis, which have been observed in world practice recently. From a practical point of view, one of the most significant events was the introduction of a new term “metabolically associated fatty liver disease” (MAFLD), which partly replaced the previously used term “primary non-alcoholic fatty liver disease”. The new nomenclature induces clear diagnostic criteria for MAFLD, and this disease has ceased to be a diagnosis of exclusion, as a result. In the near future, the practical aspects of the application of this nomenclature and new diagnostic criteria are to be evaluated. The second important trend is the increasing role of direct serum markers of liver fibrosis in the diagnosis and prognosis of MAFLD. Thus, collagen type 3 propeptide (PRO-C3), as well as M2BPGi (Mac2 Binding Proteine Glycosylation isomer), look very promising, since research data have demonstrated a higher diagnostic value of these markers in comparison with indirect fibrosis indices, which are most often used in clinical practice. In addition, the search continues for new direct serum markers of fibrosis, which would be more sensitive for detecting liver fibrosis of stages 1-2. In general, one should expect a gradual replacement by serological markers of fibrosis of technically more complex and expensive diagnostic methods, such as magnetic resonance elastography and fibroelastometry.

Purpose. Study of the course of labor of a pregnant woman with pancreatic necrosis, parapancreatitis and serous-fibrinous diffuse enzymatic peritonitis. Materials and methods. The article presents a clinical case that describes the course of pregnancy with pancreatic pathology. Surgical delivery and surgical treatment of pathologies detected intraoperatively are described. The peculiarities of drug therapy are shown. The article is intended for obstetricians-gynecologists, gastroenterologists and surgeons.