The article reviews contemporary data about influences of sex hormons (androgenes, estrogenes) and their nuclear receptors on development of hepatocellular carcinoma. Use of hepatoprotective drugs for treatment of chronic liver diseases and prophylactic of hepatocellular carcinoma should be correlated with potential hormonal effects of the treatment.

Introduction. Model for End-Stage Liver Disease (MELD) is a scoring system used to estimate the severity of chronic liver disease. Score is based on objective variables and predicts survival among different populations of patients. Study Aim. The aim of the study was to retrospectively analyze potential connection between MELD score and laboratory findings and complications of hepatitis C caused liver cirrhosis. Materials and Methods. A retrospective cross-sectional study based on data from Riga East Clinical University Hospital from the time period of 2010 to 2014 was performed. Original protocol and database were developed with consequential data statistical analysis using IBM SPSS Statistics ver.20.0. Results. In total 221 cirrhosis cases were enrolled in the study. 128 (58%) cases were male and 93 (42%) female. Mean age was 52.7 ± 13.4 years. Statistically significant correlation was found between leukocytes (r = 0.4, p < 0.001), blood urea (r = 0.4, p < 0.001), serum albumin (r = -0.4, p < 0.001), C-reactive protein (r = 0.4, p < 0.001) and MELD score. Higher leukocytes, higher urea, C-reactive protein and lower serum albumin rates give higher MELD score. At the time of hospitalization 208 (94%) of the patients had different complications of liver cirrhosis. Correlation between MELD score varied significantly with esophageal varices (r = 0.2, p < 0.05) and esophageal vein bleeding (r = 0.2, p < 0.05). Results show, if patient is present with esophageal varices and esophageal vein bleeding, MELD score is higher. Conclusion. Patients with higher leukocytes, blood urea nitrogen and lower serum albumin level are presenting higher MELD score. In patients who presented with esophageal varices and esophageal vein bleeding, higher MELD score was observed.

Objective: to compare the clinical, endoscopic picture and morphological changes of the intestinal mucosa in patients with primary sclerosing cholangitis (PSC). Materials and methods. 31 patients with PSC (women - 15 men - 16) were included in study group. The diagnosis of ulcerative colitis (UC) was established in 8 patients, Crohn’s disease (CD) - in 5, unclassified colitis (UCC) - in 7, and 11 patients had no clinical and endoscopic signs of IBD. The control group consisted of 30 patients with IBD: UC - 20 patients, CD - 10 persons. All the patients performed ileocolonoscopy (ICS) with multiple biopsy and histological examination of material. Results. The prevalence of IBD in patients with PSC was 64.5%. IBD with PSC was characterized by extensive colitis with mild clinical activity. Morphological activity of IBD associated with PSC was usually moderate and severe. Morphological activity of disease in IBD/PSC group was lower than in UC alone (p < 0.05). IBD onset came before PSC symptoms (p < 0.05). Distal gradient of inflammation in colon predominated in IBD/PSC group when disease starts with IBD symptoms, in case of PSC symptoms - proximal gradient was more frequent. In IBD/PSC group affected ileum were detected in a third of cases, including CD ileitis - 60%, backwash ileitis in UC (NCC) in 26.7%, that was significantly frequently than in UC alone (p = 0.02). Within the IBD/PSC group 30% of patients with colitis were without damaging of rectum. In all the patients with PSC without clinical, endoscopic signs of colitis polymorphocellular infiltration of mucosa were founded. Eosinophilic infiltration of mucosa in group of PSC met significantly more frequently than in other study groups. Fibrosis of intestinal mucosa was founded significantly more frequently in group of PSC without IBD compared with UC/PSC and UC patients, but not with CD group. Conclusions. For IBD in PSC extensive colitis without lesions of the rectum, backwash ileitis are common. There are some morphological differences in the intestinal lesions within the IBD/PSC patients depending on the type of disease onset. There is a dissociation between low clinical activity and intensive morphological inflammation. When PSC had no clinical features of IBD, a microscopic ileocolitis (characterized by eosinophilic infiltration and fibrosis of the intestinal mucosa) without nosological classification was founded in all patients.

Objective: To evaluate the diagnostic value of MMP-9, TIMP-1 and 2 as non-invasive markers of liver fibrosis in the NAFLD to improve the management of patients with this pathology. Materials and methods. We examined 99 patients with NAFLD and different stages of fibrosis, 83 men, 16 women, median age 45 (range 40-55) years. We assessed of risk factors for liver fibrosis in the NAFLD, anthropometric indicators, biochemical analysis of blood, abdominal ultrasonic studies, the levels of MMP-9, TIMP-1 and 2. Depending on the stage of fibrosis (0-4), established as a result of liver elastometry (Fibroscan), patients were divided into 5 groups: n = 27, n = 22, n = 23, n = 14, n = 13, respectively. Results. Between the groups in medical history, physical examination, calculation of BMI and the ratio of waist to hip volume (W/H) no significant differences were found. 64,6% of patients had abdominal obesity (BMI - 31,5 (29,1-33,9), W/H - 1,02 (1,01-1,05). Obesity and abdominal obesity (BMI, W/H) had a significant positive relationship of moderate streight (rs = (0,257), p < 0,04, rs = (0,301), p < 0,02, respectively), with the stage of liver fibrosis. The groups were significant differences in the level of glucose, total bilirubin (p < 0,04, p < 0,03, respectively). At the time of the examination, 57,5% of patients had steatosis, other patients had steatohepatitis. No significant differences in the level of liver function tests (ALT, AST) in the study groups were found. Significant differences were found in level of TIMP-2 (p < 0,04). TIMP-2 had a significant positive correlation with the severity of fibrosis in the hepatic tissue (rs = (0,349), p < 0,004). Conclusion. TIMP-2 may be considered as a potential non-invasive marker for the diagnosis of liver fibrosis in patients with NAFLD.

The aim of study was to evaluate changes of biochemical, immunological parameters and the state of the liver parenchyma in patients with metabolic syndrome. The correlation analysis have shown significant connections between serum concentration of TIMP-1 and tryglicerid level (p = 0,04) and increase activity of GGTP (р = 0,0475). The activity of GGTP correlated with increase of lipoproteids of low density in serum (р = 0,034). The intensity of liver tissue changes on sonography in accordance with mathematical analysis was 2,31 ± 0,23 points.

The Article is dedicated to the results of the clinical-biochemical, biophysical and pathomorphological study of liver in the patients with juvenile rheumatoid arthritis. Liver injury in 64.8 % of patients with JRA was found, showing signs of mesenchymal inflammation, hypoalbuminemia, hyperbilirubinemia, hyperenzymemia. The importance of elastography in the early diagnosis of liver fibrosis in patients with JRA was determined. Results of morphological studies of patients who died of liver JRA treated with methotrexate showed that in contrast to patients not receiving methotrexate noted the development of more severe disorganized, dystrophic and immunopathological processes with transition to the sclerotic and fibromatous changes.

Aim of the research: To study the dynamics of endothelial dysfunction (ED) laboratory markers depending on the functional state of the liver in patients with severe forms of liver cirrhosis (LC). Materials and methods. 387 patients with LC were examined. In order to study the laboratory indexes of ED, levels of antitrombin (AT) III, D-dimer, von Willebrand Factor (wWF), endothelin-1 (Et-1) were determined. The extent of liver damage was determined using C13-methacetin breath test (C13-MBT) and taking into account the results of specially designed tests (Forns, FibroIndex, FIB-4, APRI, HALT-C, MDA, GUCI, FPI). Results. Our investigations confirm the presence of ED in patients with LC. The analysis of the results shows a dependincy between the severity of ED laboratory indexes and the level of LC severity: a progressive aggravation of ED indexes in proportion to liver damage severity growth. Conclusions: 1. Vessel ED is observed in patients with LC, which is manifested in the derangement of its biological markers concentration, namely Et-1, vWF, AT III and D-dimer. 2. In patients with LC a dependincy between the ED indexes and level of liver damage severity according to Child-Pugh was determined, namely the progression of biochemical ED markers of blood serum depending on the severity of liver damage according to C13-MBT results combined with the results of specialy designed tests (Forns, FibroIndex, Fib-4, APRI, HALT-C, MDA, GUCI, FPI).

The aim of this study was to investigate the frequency of polymorphic variants of genes CYP2E1 and GSTA1 in patients with pathology of the hepatobiliary system (PHS) and healthy individuals in the Republic of Bashkortostan, as well as an analysis of possible associations of genotypes of this gene with the development of PHS. Materials and methods: There were examined 81 patients with pathology of the hepatobiliary system. Was studied association analysis of polymorphic loci of genes CYP2E1 and GSTA1. Results: The study demonstrated that a marker of risk of developing the disease is AA genotype (OR = 2,09; 95% CI 1,07-4,10) polymorphic locus gene rs3957357 GSTA1.

Aim of investigation. The aim of the research is to study the clinical course of hepatitis C in children with different variants of the gene polymorphism of IL-28B. Materials and methods. We observed 94 children (46 girls and 48 boys) with chronic hepatitis C (CHC) in age from 3 to 17 years (mean age 10 years). There were significant differences in the distribution of allele frequencies in children with chronic hepatitis C and in the population. In children with chronic hepatitis C significantly increased the incidence of the T allele at the locus of the gene IL-28B rs12979860 C>T, which makes it possible to consider it as a predictor of antiviral therapy ineffective. Results. When analyzing the frequency of occurrence of a polymorphic variant T>G [rs8099917] IL-28B gene in children with chronic hepatitis C and healthy children revealed no differences in the distribution of alleles. Conclusion. Personalized approach to the appointment of HCV antiviral therapy in children is to carry out genetic studies to determine on the basis of predictive features of the course of HCV in children during the treatment.

The purpose of this study was to investigate the annual dynamics of the functional state of the liver of rats with experimental hepatitis on early period of intoxication. Materials and methods. This research was conducted for three years on 172 adult male rats Wistar. The toxic hepatitis was caused by subcutaneous injection three times a 50% oil solution of carbon tetrachloride. The studies were conducted in the winter (January), summer (June-July), spring (April) and autumn (October) on the 4th day after the last administration of the toxin. Activity of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), the level of total lipids (TL), total bilirubin (TB), malondialdehyde (MDA) and thymol (T) using standard sets of Biotest «Lachema» were determined in the blood serum. Statistic processing of primary chronograms of investigated parameters was performed with the program “сosinor analysis.” Results. It was found that in the control animals was dominated by annual and circannual rhythms of the liver functions and in the spectra of the studied parameters were observed several subdominant harmonic. The maxima of liver function detected to the different time intervals on an annual scale, that is, they were not coordinated with each other. On day 4 experimental hepatitis was increased the average annual of study functions (with the exception of ТL) and in their rhythmic organization was observed the inner synchronization by period and acrophase. In the spectra of the rhythms of the studied parameters mainly was determined by only the annual harmonic with acrophase in the autumn months. It can together indicate the development of a powerful pathological process in the liver.

Aim - the study of mechanisms of regulation of biliary tract motility by divisions of autonomic nervous system (ANS). Material and methods. Experiments were carried out on rabbits, chinchillas weighing 3.5-4 kg using gentle methods of treatment of experimental animals. Electromotor activity of electromotor (EMA) of the gallbladder and sphincter of Oddi was recorded. Irritation of the nerve produces an electrical pulse duration of 2 ms, the amplitude of 1.5-15 V, frequency of 10 Hz. Results. The mechanism of vagal inhibition of sphincter of Oddi motility and unidirectional stimulatory influence of ANS divisions on the motility of the gallbladder and sphincter of Oddi was studied. It was established that in the mechanism of vagal inhibition of sphincter of Oddi motility involved intramural adrenergic neurons synaptically connected with preganglionic parasympathetic fibers. At the stimulatory effect of vagus on biliary tract motility serotonergic intramural neurons are involved transmitting excitation to serotonin receptors of effector tissue.

Aim. Develop a differential management at the patients with suspected sphincter of Oddi dysfunction after cholecystectomy. Materials and methods. 169 patients after cholecystectomy, divided into 2 groups. 1st group - 60 patients after repeated surgery formed as a comparison group. They multivariate analysis of clinical, laboratory and ultrasonic data revealed the most significant signs of organic causes of cholestasis, expressed in scores. 2nd group - 109 patients with a suspected sphincter of Oddi dysfunction, who did not have symptoms of organic pathology. Types of bile outflow were assessed by hepatobiliary scintigraphy (GBSG). In cases of doubtful diagnoses computer tomography, magnetic resonance cholangiopancreatography, and/or retrograde cholangiopancreatography are performed. Results. According to the scoring system, patients 1st group scored 4 or more (8,7 ± 3,87) points. GBSG performed only in 7 (11.6%) patients, and in all cases the cholestatic type of bile outflow was detected. The amount of estimated points in the 2nd group was 2-3 points (2,43 ± 0,34; p < 0.05). GBSG performed in all patients and three types of bile outflow were revealed: normal - in 21 (19.2%) patients, cholestatic in 8 (7.3%), and accelerated - in 80 (73.3%) patients. When refining the diagnosis in 10 (9%) patients had hidden organic disorders of bile outflow, served as an indication for surgery. Conclusion. Scoring system for the assessment of the suspected sphincter of Oddi dysfunction allows to differentiate of patients for invasive research and surgery. In our study group of 109 patients received less than 4 points, they have dominated the functional disorders, but the results of a detailed examination, 9% of patients had latent organic changes that have become indications for surgical treatment.

The aim was to improved results of treatment of patients with threatened or held bleeding from esophageal varices on the background of liver cirrhosis. Materials and Methods: The analysis of the survey results and endoscopic treatment of 40 patients with liver cirrhosis complicated by threatened or held bleeding from esophageal varices. The effectiveness of the treatment was assessed by the dynamics of recourse degree esophageal varices, presence and character of postoperative complications and mortality. Results. Application of endoscopic ligation as primary and secondary prevention of bleeding from esophageal varices can improve the immediate and long-term results of treatment of patients with liver cirrhosis complicated by portal hypertension. Prevention of bleeding from esophageal varices is a dynamic endomonitoringe supplemented with repeated courses of endoscopic ligation.

Aim: to study and compare the results of reconstructive and restoretive operations for strictures and bile duct injuries in patients operated by traditional methods and with the use of microsurgical techniques. Materials and methods: analysis of 181 and reconstructive restore operations reconstruction works produced on the occasion of strictures (111) and intraoperational damage (16) of the bile ducts, strictures choledocho-duodenal anastomosis and choledochocele (20), congenital cysts of the bile ducts (10), chronic indurative pancreatitis (15), the Fatherof papilla stenosis (5), syndrome Mirizzi 4 types (4). In the formation biliodigestive anastomoses traditional technique applied in 116 patients, microsurgical by 65. Results: a comparative evaluation of results of surgical treatment of patients operated on traditional way and with the use of microsurgery technique showed a reduction in the number of postoperative complications in patients undergoing microsurgical operations, such as the insolvency of the seams biliodigestive anastomosis, hepatic failure, acute cholangitis, stricture of the biliodigestive anastomosis. Conclusion: to improve the results of reconstructive operations on the extrahepatic bile ducts contributes microsurgical techniks, which provides minimal trauma to the tissues, histologically accurate adaptation of homogeneous layers sew bodies, contributes healing of biliodigestive anastomosis primary tension. In the absence of conditions for the imposition of microsurgical bilitigating anastomosis without frame drainage should prima adopt changeable transhepatic drainage as in reconstructive and restorative operations.

Aim. To evaluate lung function in patients with liver cirrhosis of the liver with conservative therapy and surgery tunneling liver. Materials and methods. The study involved 55 patients with liver cirrhosis with portal hypertension. Patients were randomized into 2 groups. In the first group (n = 40) patients received medication. Patients of the second group (n = 15) was performed tunneling liver shunt operation. Resalts. In patients with liver cirrhosis observed clinical and functional remodeling of the lung appears shortness of breath, coughing, wheezing, and restrictive ventilatory disorders. Conclusions. In patients with cirrhosis of the liver after tunneling is observed normalization of lung ventilation. After conservative treatment reliable normalization of lung function occurs.

In a review article considers issues of efficiency and tactics of the purpose of fat-soluble vitamins, as in cholestatic and noncholestatic liver disease, as well as water-soluble vitamins, particularly vitamin C cholelithiasis. Oxidative stress due to chronic inflammation is one of the major conversion mechanisms of liver fibrosis in cirrhosis. The imbalance between production of reactive oxygen species and antioxidant defense causes a number of pathophysiological changes in the liver, including activation of hepatic stellate cells. The carriers of the I148M PNPLA3 mutation was not observed concentration reduction in liver vitamin A with increasing severity of the disease, but the observed decrease in the level of circulating retinyl palmitate and retinol-binding protein. To the appointment of vitamin A in liver disease should be approached with caution. Hypervitaminosis A leads to accelerated liver fibrosis and stimulates carcinogenesis. Currently actively studied the possibility of using vitamin E as an antioxidant, in patients with non-alcoholic fatty liver disease. His presence in the membranes phospholipid bilayer allows cells to prevent non-enzymatic oxidation of cell components by free radicals. Vitamin E can suppress the profibrotic processes. In patients with chronic cholestatic liver disease is common, vitamin K deficiency, even when administered, and is associated with the degree of cholestasis and severity of disease. The vitamin D deficiency, liver disease is also associated with the severity of disease correlated with the severity of liver failure and infectious complications. Vitamin D is an independent prognostic parameter for mortality risk in patients with liver cirrhosis.

The review presents the whole range of modern methods of hemostasis and prevention of bleeding in patients with portal hypertension, assessed the effectiveness of each.

Probiotics for decades were leading in the arsenal of tools for correction of intestinal microbiocenosis. However, the response of representatives of intestinal microbiota to enteral intake of probiotics is variable, and in some individuals may be missing. Despite the fact that scientists still disagree on the necessity of forced settlement of normal microbiota at intestinal dysbiosis, large number of medicinal products, functional foods, dietary supplements, which efficiency is not always straightforward, is available for sale. The results of comparative experimental study of the effectiveness of 18 modern preparations for correction of intestinal microbiocenosis at antibiotic-associated dysbiosis in animals are presented. Conclusion is done on the need to evaluate efficacy and safety of tools developed for intestinal microbiota correction in animal experiments, followed by confirmation of clinical trials.

It is the data of literature on existing classifications and systems of assessment and prognosis of hepatocellular carcinoma (HCC). In some classifications takes into account only the characteristics of the tumor tissue, in others are used biochemical and clinical characteristics in addition. Some systems allow to predict the survival of patients regardless of the stage of the disease, while others are most effective for the individual stages. The international TNM classification is generally accepted for the development of treatment methods and determining the forecast mainly for resectable HCC forms. The Japanese staging system (JIS) is mainly recommended for operable patients. Italian scale (CLIP), on the contrary, is intended to analyze HCC, which is not subject to surgical treatment. The Barcelona classification of liver cancer (BCLC) is considered the most universal, because it takes into account the stage of disease, the condition of the liver parenchyma and does not depend on the method of treatment and the patient’s place of residence. Therefore, the choice of staging system and assessment of disease prognosis should be based on the clinical and morphological features of the disease, taking into account features of application of various scales.

The article presents two clinical observations of patients with different course genetically verified primary hemochromatosis.

Objective: To analyze the cases of intrahepatic cholangiocarcinoma posthumous diagnosis in patients with concomitant atherosclerotic lesions of the femoral arteries. Key points: The present report describes the clinical observation of a rare tumor - intrahepatic cholangiocarcinoma. Difficulties of its early diagnosis is a combination of symptoms of tumor progression with pain in the lumbar spine, the latter in the presence of concomitant femoral arteries of atherosclerotic lesions, characterized by pain similar localization has led to delay cancer research. Conclusion: Upgrading differential diagnostic procedures with a combination of pain in the lumbar spine with symptoms of tumor progression through the use of a computer and / or positron emission tomography study of plasma levels onkomarkёra CA-19-9, magnetic resonance contrast holangiopankreatikografii, would in this clinical case in a timely manner to make the correct diagnosis.

Congenital anomalies of biliary tract development are frequent causes of lingering course of physiologic jaundice which need timely verification of diagnosis followed by surgical treatment. Clinical observation of biliary atresia in a 10-month-old girl permits to accent pediatricians’ attention to peculiarities of clinical picture, diagnosis and techniques for treatment of this pathology.