Vol 90, No 2 (2018)


Personalized medicine in the treatment of inflammatory bowel diseases

Parfenov A.I., Knyazev O.V., Kagramanova A.V., Fadeeva N.A.


Personalized medicine (personalized medicine, individualized medicine) represents the totality of methods of prevention of a pathological condition, diagnosis and treatment in the event of its occurrence, based on individual patient characteristics. Such individual characteristics include genetic, epigenetic, and transcript, proteome, metabolomic and metagenomic markers, as well as a set of variable phenotypic traits - both of the patient's body and its separate tissues or cells. For example, treatment of inflammatory bowel diseases (IBD) can most clearly show the importance of applying personalized approaches. Currently in the treatment of patients with IBD paid great attention to genetic studies, monitoring of the concentration of the biological drugs and the level of antibodies to them, the role of microbiota as a predictor of effectiveness of therapy of IBD. Used clinical, laboratory, instrumental methods, as well as new biomarkers to assess the forecasting efficiency of conservative therapy in IBD patient. In the future treatment of patients with IBD will include a number of personalized data in order to better predict outcomes of the disease in each patient and more accurately select the appropriate treatment regimen.
Terapevticheskii arkhiv. 2018;90(2):4-11
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Important problems in the diagnosis and treatment of autoimmune hepatitis (based on the Russian consensus 2017)

Vinnitskaya E.V., Sandler Y.G., Bakulin I.G., Parfenov A.I., Ilchenko L.Y., Nikitin I.G., Bueverov A.O., Lopatkina T.N., Ignatova T.M., Syutkin V.Y., Raikhelson K.L., Khomeriki S.G., Gudkova R.B.


The analysis of publications devoted to the Russian Consensus on the Diagnostic and Treatment of Autoimmune Hepatitis (AIH), which was considered at the 43rd annual Scientific Session of the CNIIG From Traditions to Innovation (March 4, 2017) is carried out. The presence of clear algorithms and recommendations for the diagnosis and treatment of AIH significantly help the doctor in real clinical practice, but do not exclude a personified approach to the patient.
Terapevticheskii arkhiv. 2018;90(2):12-18
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Features of the functional activity of macrophage link of immunity with gastroesophageal reflux disease depending on the type of reluctate: in vitro model

Lyamina S.V., Maev I.V., Kalish S.V., Andreev D.N., Kladovikova O.V., Malyshev I.Y.


Aim. A generalized analysis of changes in functional activity of macrophages on the basis of phagocytic activity, cytokine profile, changes in the level of expression of surface markers characteristic of pro - or anti-inflammatory phenotype of the cells when exposed to reluctate. Materials and methods. Developed in vitro model of co-peritoneal macrophages of mice With57/BL6 (n=65) and reluctate patients with gastroesophageal reflux disease (GERD; n=65) having different pH values (three group comparison). Took into account the standard criteria phagocytic ability (absorption Staphylococcus aureus 9198, light microscopy), secretory activity (cytokine profile Th1/Th2, flow cytometry) and receptor characterization of macrophages (expression of CD25/80/163/206, flow cytometry). Results. The phagocytic activity of macrophages, calculated on the basis of the average number of bacteria ingested by one phagocyte, is not associated with the pH value of the added reluctate. It is established that the alkalinisation of reluctate leads to significant alteration in the expression of CD receptors - decrease M1 and increase M2. The index of total production of Th1/Тһ2 in groups progressively decreased with increasing pH of reluctate and amounted to 3.6 units in the group pH from 4.6 to 6.6; 2.8 units group a pH of 6.7-7.2 and 1.6 units in the group pH of 7.3 to 8.1, due to increased production of Th2 cytokines at offset reluctate pH to slightly alkaline side. The data obtained indicate the increase of expression and secretion of anti-inflammatory markers at an alkaline pH shift of reluctate. Analysis of the studied characteristics of the activity profile of macrophages in the proposed in vitro model justifies the need for considering the peculiarities of the functional activity of macrophages under the influence of reluctate different nature. The special importance of studying the cytokine profile and characteristics of the functional activity of macrophages in patients with GERD, given the nature of reluctate.
Terapevticheskii arkhiv. 2018;90(2):19-23
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Changes in the indices of prooxidant and antioxidant systems in blood plasma in men with atrophic gastritis and gastric cancer

Tsukanov V.V., Smirnova O.V., Kasparov E.V., Sinyakov A.A., Vasyutin A.V., Tonkikh Y.L.


Aim. To study changes in the indices of prooxidant and antioxidant systems in plasma in men with atrophic gastritis and gastric cancer. Materials and methods. The study included 60 healthy men, 42 patients with atrophic gastritis and 50 men, nicardipine patients with gastric cancer stage II according to TNM. All patients underwent serological diagnosis of diffuse atrophic gastritis (definition of pepsinogens and gastrin-17) and Helicobacter pylori infection. The diagnosis of "atrophic gastritis" was verified by morphological examination of biopsy specimens obtained during fibroesophagogastroduodenoscopy. Diagnosis of gastric cancer was carried out in the Krasnoyarsk regional oncologic dispensary on the basis of a comprehensive instrumental and morphological examination. All patients spectrophotometric methods in plasma was determined the content of diene conjugates (DC), malonic dialdehyde (MDA), glutathione-S-transferase (GST), glutathione peroxidase (GPO), superoxide dismutase (SOD) and catalase. Results. The concentration of SOD, GST, GPO and catalase had no significant differences in patients with atrophic gastritis and gastric cancer and prevailed in comparison with healthy persons. Patients with cancer of the stomach content in the blood plasma DK 2.7 times and MDA at 35.2 times higher than healthy individuals, indicating severe oxidative stress in patients with cancer. In patients with atrophic gastritis was observed similar but less pronounced pattern. Conclusion. The results indicate the presence of oxidative stress in men with atrophic gastritis and gastric cancer.
Terapevticheskii arkhiv. 2018;90(2):24-27
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Comorbid for gastroduodenal ulcers in the aspect of calcium imbalance and blockers of slow calcium channels in their treatment

Fomina L.A.


Improvement of methods of prevention and treatment led to an increase in the number of patients with comorbid occurring chronic disease that requires effective integrated therapy to reduce the polypharmacy. Aim. Find out the calcium content of the blood reflecting its balance and functional status the calcium regulatory system when it is comorbid for gastroduodenal ulcers (GDU), developed on the background of chronic erosive gastritis (CEG), chronic erosive duodenitis (CED), arterial hypertension (AH) and osteo-articular pathology with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and the impact of his changes on the activity ulzerogennogo process, the state of regional microcirculation and the functions of the stomach. To determine the pathogenetic justification for and effectiveness of blockers of slow calcium channels (BSCaC) in complex treatment. Materials and methods. Examined 132 patients with GDU. All patients were divided into groups: the 1st (n=49) - patients with recurrent of peptic ulcer disease (PUD) and CEG/CED; the 2nd (n=23) - with recurrence of PUD and AH, the 3rd (n=14) - with GDU and osteoarticular pathology, taking NSAIDs. Patients of these three groups for the treatment of erosive ulcerous lesions of gastroduodenal zone (GDZ) has been appointed complex therapy with inclusion of nifedipine. The 4th (control) group consisted of 56 patients with recurrent BU without concomitant pathology, applying integrated therapy with nifedipine. The results and discussion. The PU relapse, comorbid her over with erosive gastroduodenitis, hypertension, GDU with of osteoarticular pathology and taking NSAIDs is accompanied by a calcium imbalance with increased levels of calcium in the blood, contributing to increase of acid-peptic factor in the formation of hypermotor dyskinesia stomach, disruption of regional microcirculation and repair processes, activation of ulcerogenesis in GDZ. Inclusion in the complex therapy of GDU of nifedipine leads to the recovery of calcium balance, functions of the stomach and regional microcirculation, accelerates the timing and increases the percentage of scarring ulcers. Conclusion. GDU accompanied by dysfunction the calcium regulatory system with increasing levels of blood calcium, contributing to the formation of the major pathogenetic mechanisms of ulcerogenesis. BSCaC application in complex therapy of GDU is pathogenetically justified and clinically effective, reduces the excessive drug treatment in the treatment.
Terapevticheskii arkhiv. 2018;90(2):28-34
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Evropeyskiy registr Helicobacter pylori (Hp-EuReg): analiz dannykh 2360 bol'nykh, poluchavshikh terapiyu pervoy linii v Rossii

Bordin D.S., Embutnieks Y.V., Vologzhanina L.G., Il'chishina T.A., Voinovan I.N., Sarsenbaeva A.S., Alekseenko S.A., Zaitsev O.V., Abdulkhakov R.A., Osipenko M.F., Livzan M.A., Tsukanov V.V., Burkov S.G., Bakulina N.V., Dekhnich N.N., Tarasova L.V., Plotnikova E.Y., Maev I.V., Kucheryavyi Y.A., Baryshnikova N.V., Butov M.A., Kolbasnikov S.V., Pakhomova A.L., Zhestkova T.V., Baranovskii A.Y., Abdulkhakov S.R., Ageeva E.A., Lyalyukova E.A., Vasyutin A.V., Golubev N.N., Savilova I.V., Morkovkina L.V., Kononova A.G., Megraud F., O’Morain C., Ramas M., Nyssen O.P., McNicholl A.G., Gisbert J.P.


On behalf of the scientific Committee and researchers Hp-EuReg European Registry on the management of Helicobacter pylori infection («Hp-EuReg») - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations. Materials and methods. The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg» in 2013-2017, who were underwent 1st line eradication therapy. Results. The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effectiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clarithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Еradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment. Conclusion. Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.
Terapevticheskii arkhiv. 2018;90(2):35-42
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The role of small intestine in pathogenesis of common variable immune deficiency

Krums L.M., Parfenov A.I., Gudkova R.B., Bykova S.V., Sabelnikova E.A.


The article presents the results of examination of 32 patients with common variable immune deficiency (barn) with involvement in the pathological process of the digestive system. The features of the clinical picture, the content of immunoglobulins in the blood serum, morphological structure of the mucosa of small intestine as well as treatment. Special attention is paid to the small intestine in the pathogenesis of the barn.
Terapevticheskii arkhiv. 2018;90(2):43-46
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Mesenchymal stromal cells of bone marrow and azathioprine in Crohn's disease therapy

Knyazev O.V., Kagramanova A.V., Fadeeva N.A., Lishchinskaya A.A., Boldyreva O.N., Noskova K.K., Gudkova R.B., Konoplyannikov A.G., Parfenov A.I.


Crohn's disease (CD) is a chronic, recurring disease of the gastrointestinal tract of unclear etiology. One of the new approaches to CD therapy is the use of the possibilities of stem cells, in particular, mesenchymal stromal cells (MSCs). Currently, the use of MSC in clinical practice for the treatment of chronic inflammatory and autoimmune diseases is being studied in patients who receive concomitant therapy with other immunomodulatory medications. Aim. To evaluate the effectiveness of MSCs therapy in patients with CD receiving azathioprine (AZA). Materials and methods. The study included 34 patients with inflammatory (luminal) form of CD. The 1st group of patients (n=15) received anti-inflammatory therapy using MSCs culture in combination with AZA. The 2nd group (n=19) received MSCs without AZA. The severity of the attack was assessed in points in accordance with the of Crohn's disease activity index (CDAI). Immunoglobulins (IgA, IgG, IgM), interleukins (IL) 1β, 4, 10, tumor necrosis factor-α (TNF-α), interferon-γ (INF-γ), transforming growth factor-1β (TGF-1β), C-reactive protein (CRP), platelets and erythrocyte sedimentation rate (ESR) at 2, 6 and 12 months from the beginning of MSCs therapy. Results. The initial mean CDAI in the 1st group was 337.6±17.1 points, in the 2nd group - 332.7±11.0 points (p=0.3). In both groups of patients there was a significant decrease in CDAI after 2 months. From the beginning of therapy MSCs: in the 1st group to 118.9±12.4 points, in the 2nd - 120.3±14.1 points (p=0.7), after 6 months - 110.3±11.1 and 114.3±11.8 points (p=0.8), respectively. After 12 months CDAI in the 1st group was 99.9±10.8 points, in the 2nd group it was 100.6±12.1 points (p=0.8). The level of IgA, IgG, IgM was significantly lower in the group of patients with a longer history of the disease and long-term ASA. After the introduction of MSC in both groups of patients with BC, there was a tendency for the growth of pro - and anti-inflammatory cytokines, with a significantly lower level of pro-inflammatory cytokines - INF-γ, TNF-α, IL-1β - in the 1st group, indicating potentiation of the immunosuppressive effect of MSCs and AZA, which provides a more pronounced anti-inflammatory effect. Conclusion. Transplantation of MSCs promotes an increase in the serum of patients with CD initially reduced concentration of IG, cytokines and restoring their balance as the onset of clinical remission. The combination with AZA has a more pronounced anti-inflammatory effect.
Terapevticheskii arkhiv. 2018;90(2):47-52
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Ultrasound examination with contrast in the diagnosis of inflammatory bowel disease. The results of the pilot study

Fomin V.V., Ternovoy S.K., Makhov V.M., Isaykina M.A., Dzhenzhera N.A., Turko T.V., Ugryumova L.N., Babenko O.V.


Aim. Assessment of diagnostic significance of informativeness and security of ultrasonography with contrast enhancement drug SonoVue in the diagnosis of Crohn's disease (CD) and ulcerative colitis (UC). Materials and methods. The pilot conducted a prospective study which involved 15 patients with inflammatory bowel disease (IBD). All patients gave written consent to participate in the study and processing of personal data. The study included adult patients with an established diagnosis of UC and CD, with proven clinical activity of the disease. Activity was evaluated based on clinical and laboratory data on the scale of best (CDAI >150) for patients with CD and on a scale of Trulove-Witts (2-3 stage) and the Mayo index (DAI) for patients with UC. All the patients underwent colonoscopy with biopsy, ultrasound examination of abdominal cavity organs with the study of the vascularization of the intestinal wall (color Doppler, power Doppler, contrast study). Results. The use of contrast showed additional features in the instrumental evaluation of activity of inflammatory process, identification of complications and assessment of prognosis. Conclusion. The results of ultrasound of the bowel with contrast can be used to assess the activity and stage of disease in patients with UC or CD.
Terapevticheskii arkhiv. 2018;90(2):53-58
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The cardiovascular system in patients with functional and inflammatory bowel diseases

Maev I.V., Kazulin A.N., Andreev D.N.


Aim. Identification of subclinical and metamanifests state changes of cardiovascular system in patients with functional and inflammatory bowel diseases (IBD) without a background of cardiac pathology. Materials and methods. Was examined 79 patients with colon diseases, 20 patients were diagnosed with irritable bowel syndrome (IBS) with diarrhea, 37 - with undifferentiated colitis (UdC) and 22 patients with ulcerative colitis (UC). As a control group were examined in 50 healthy subjects. All patients received treatment in accordance with international and national guidelines. Prescribed medications had effect on the function of the cardiovascular system. Patients with contacting the hospital and against the onset of remission was performed ultrasound of the heart. Determines the size of the left atrium, heart rate, end-diastolic volume, end-systolic volume, ejection fraction (EF), cardiac index (CI), total peripheral vascular resistance, the presence of right heart failure, blood flow, the area of the right atrium and right ventricle in systole and diastole, and calculated the proportion of contractility of the right atrium and right ventricle. Determined systolic pressure in PA (SPPA), the average pressure in PA (APPA). Results. Clinical manifestations of cardiac syndrome was identified in 75,0% of patients with IBS, 54,1% of patients NK and 68,2% patients with UC. When performing correlation analysis in the patients with UdC and UC was noted the relationship of hemodynamic parameters and disease severity was more pronounced in UC. So, when comparing the duration of the disease and levels of the MLC - r=0,52 and r=0,73 (p<0,05), EF - r=-0,51 and r=-0,71 (p<0,05), CI - r=0,49 and r=0,70 (p<0,05), heart rate - r=0,47, r=0,68 (p<0,05); duration of stay in hospital and the magnitudes of MLC - r=0,54 and r=0,77 (p<0,05), EF - r=-0,51 and r=-0,71 (p<0.05), CI - r=0,55 and r=0,73 (p<0,05), heart rate - r=0,47, r=0,63 (p<0,05). For patients with UC, we noted the presence of correlation when the average frequency of exacerbations per year and the values of the MLC - r=0,53 (p<0,05), EF - r=-0,55 (p<0,05), heart rate: r=0,54 (p<0,05); severity of UC and EF (r=-0,67; p<0,05). A statistically significant correlation of changes in EF and value SPPA and APPA, aggravated by the deepening severity of the disease. So, for IBS - r=-0,46, and r=-0,48 (p<0,05); for NK - r=-0,51 and r=-0,59 (p<0,05); for the UC - r=-0,62, and r=-0,67 (p<0,05). In the analysis of duration of hospitalization, and values SPPA and APPA for patients with IBS - r=0.48 and r=0.46 (p<0,05); with UdC - r=0,50 and r=0,53 (p<0,05); with UC - r=0,59 and r=0,62 (p<0,05). Sick UC was characterized by the greatest dilatation of RA and RV with access from outside the variations of the norms of 90.9 and 68.2 per cent, a significant decrease dRA and dRV. Discovered correlation of the squares of PP and SDL - r=0,48, r=0,54 and r=0,61 (p<0,05); APPA - r=0,50, r=0,56 and r=0,63 (p<0,05); RV areas and levels SPPA - r=0,45, r=0,50 and r=0.52 (p<0,05); and APPA - r=0,46, r=0,47 r=0,53 (p<0,05). When analyzing the values of the squares of the pancreas and MLC - r=0,47 r=0,54 and r=0,61 (p<0,05), levels of EF and dRV - r=0,41, r=0,50 and r=0,56 (p<0,05). Conclusion. Cardiac syndrome in patients with IBS and IBD without a background of cardiac pathology can occur in the form of subclinical or manifested weakly, but persistent changes that may not be recognized, but in the future may complicate the course of the underlying disease, necessitating research to develop tactics to correct them.
Terapevticheskii arkhiv. 2018;90(2):59-64
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Familial adenomatosis of the colon: current state of the problem

Kit O.I., Gevorkyan Y.A., Soldatkina N.V., Haragezov D.A., Efimova I.Y., Poluektov S.I., Kaymakchi D.O.


The urgency of the problem of familial adenomatosis of the colon (FAC) is caused both by the severity of the disease with the inevitable development of cancer without timely treatment, and the involvement of the patient's blood relatives in this problem. Due to the rare incidence of this disease, many issues require discussion. Aim. To determine the possibility of timely treatment of FAC patients maintaining a satisfactory quality of life. Materials and methods. The data on 5 FAC patients and 12 their blood relatives were studied. Clinical, endoscopic and genetic characteristics of the disease and treatment were analyzed. Results. demonstrated that family history, genetic and endoscopic examinations allow diagnosis of FAC. Colectomy with rectal resection and the creation of a small intestine reservoir with reservoir-rectal anastomosis provide a sufficient quality of life for patients. Examination of the patient's blood relatives reveals new patients requiring additional examination and treatment. Conclusion. The problem of FAC is multidisciplinary and involves therapists, gastroenterologists, pediatricians, geneticists, endoscopists, radiologists, surgeons and oncologists. Only a timely diagnosis can help the patient to undergo radical treatment before the development of colon cancer.
Terapevticheskii arkhiv. 2018;90(2):65-68
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Intrahepatic cholestasis in nonalcoholic fatty liver disease

Shipovskaya A.A., Dudanova O.P.


Aim. to determine the frequency of intrahepatic cholestasis and its impact on the clinical features of the different forms of non-alcoholic fatty liver disease (NAFLD). Materials and methods. The study involved 163 patients with NAFLD: 92 (56.4%) with hepatic steatosis (HS), 56 (34.4%) with steatohepatitis (SH) and 15 (9.2%) with liver cirrhosis (LC). Diagnosis is based on clinical, laboratory, ultrasound and histological data. Insulin, tumor necrosis factor α (TNF-α), fragments of cytokeratin-18 (FCK-18) were determined by ELISA. The index of insulin resistance (HOMA-IR) was calculated. NAFLD fibrosis score (NAFLD-FS) was determined, taking into account the patient's age, body mass index, presence or absence of carbohydrate metabolism disturbances, levels of ASAT, ALAT, albumin and blood platelets. Results. Cholestatic syndrome was detected in 49 (30.1%) NAFLD patients: in 23 (25%) with HS, in 19 (33.9%) with SH and in 7 (46.7%) with LC. Patients with HS, SH and LC with signs of cholestasis as compared to patients with the same forms of NAFLD without cholestasis had significantly higher levels of the following indicators: aminotransferases, triglycerides, HOMA-IR, TNF-α, FCK-18, NAFLD-FS, - the number of platelets is reduced, indirectly confirming the more rapid development of fibrosis in cholestasis. These findings were consistent with published data on the violation in cholestasis regulatory functions of bile acids, which are ligands of hepatocyte nuclear receptor, responsible for normal homeostasis. Сonclusion. In all forms of NAFLD with cholestasis were detected more pronounced liver cell inflammation, hepatocyte necrosis and apoptosis, fibrosis, disturbance of carbohydrate and lipid metabolism, which contributed to a progressive course of NAFLD and confirmed the need for medical correction of cholestasis, starting with the earliest form of NAFLD - hepatosteatosis.
Terapevticheskii arkhiv. 2018;90(2):69-74
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Epidemiological aspects of morbidity in the class of digestive organs in Kazakhstan

Ibraeva L.K., Amanbekova A.U., Zhanbasinova N.M., Sexenova L.S., Rybalkina D.H., Salimbayeva B.M., Drobchenko E.A., Gazizova A.O.


Aim. To study epidemiological aspects of disease, class of diseases of the digestive system in the region of the relative risk in Kazakhstan. Materials and methods. Studied epidemiological parameters are first identified in the incidence and prevalence of class XI ICD in regions of Kazakhstan with the identification of risk relative to the average national level. In a dysfunctional region Kyzylorda region analyzed the performance of its regions and compared with data from medical examination of the population and the survey. Results. A significant excess of the average national incidence rate between 1990 and 2015, was noted for 3 of the 14 regions of Kazakhstan (West-Kazakhstan, Kyzylorda, Mangystau). According to the dynamics of the unfavorable situation on the high level of incidence currently is in the Kyzylorda region (COA). From the areas of the COA maximum, the incidence of diseases of the digestive system registered in Kazalinsk district which exceeded the level at RK 4.8 times. The data on examination and survey of the complaints of the population exceeded the epidemiological indicators. In the area identified as the leading neoplasms of the digestive system in the structure of cancer incidence and exceeded the national average on the related class of blood diseases. Unfavorable situation on the incidence of the digestive system in Kyzylorda region of Kazakhstan is associated with the cancer and blood diseases, this is partly due to the presence of pollutants in the environment.
Terapevticheskii arkhiv. 2018;90(2):75-78
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Cellular and molecular mechanisms of inflammation of esophageal mucosa under different clinical course of gastroesophageal reflux disease and its complications

Lyamina S.V., Maev I.V., Kladovikova O.V., Malyshev I.Y.


The review presents modern data on the cellular and molecular mechanisms of inflammatory changes of esophageal mucosa exposed to different types of reluctate (gastric, biliary or duodenal/mixed). The authors describe data on key mediators of inflammation in gastroesophageal reflux disease (GERD) and their major cellular sources, changes of the immune profile of patients. Discusses the possible impact of changes in the cellular and molecular components in the development of the inflammatory response in the esophagus on the clinical features of GERD and its therapy-refractory forms.
Terapevticheskii arkhiv. 2018;90(2):79-84
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Clinical-morphological parallels of the PNPLA3 gene polymorphism in patients with nonalcoholic fatty liver disease

Tikhomirova A.S., Kislyakov V.A., Baykova I.E., Nikitin I.G.


Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, and its detection in the general population has reached a global scale. Despite the fact that in the early stages the disease is characterized by a relatively mild period, the development during its natural course of nonalcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma causes deterioration of long-term forecast. Growing evidence indicates that NAFLD is a complex, multifaceted etiology, involving many factors, including genetic. In the present review, we focused on the genetic component of NAFLD, namely, the role of the PNPLA3 gene polymorphism in the development and course of the disease, and States its progression, such as non-alcoholic steatohepatitis, liver cirrhosis and hepatocellular carcinoma.
Terapevticheskii arkhiv. 2018;90(2):85-88
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Minimal hepatic encephalopathy: current clinical and pathogenetic aspects

Damulin I.V.


The review considers modern ideas about the clinic and pathogenesis of minimal hepatic encephalopathy (MHE). It is discussed the present of cognitive impairment in this category of patients. The data of functional MRI are analyzed, and these results allow taking a fresh look at the origin of clinical disorders in this condition. The importance of cerebral connections disruption is emphasized. It is focused on the fact that in the functioning of the central nervous system the spontaneous activity of the brain has a significant importance. Separately is analyzed “the resting state”. It is concluded that MHE, despite its minimal manifestations, is a clinically significant condition requiring attention of a specialists. With that, it is often not diagnosed on time in clinical practice, which could lead to more severe damage of the cerebral functions. As evidenced by the data obtained at the present time, quite extensive changes in the neuronal activity are underlid of the cognitive deficit.
Terapevticheskii arkhiv. 2018;90(2):89-93
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Optimizing therapy of liver diseases not associated with viral infection

Svistunov A.A., Osadchuk M.A., Kireeva N.V., Osadchuk M.M.


The review demonstrated results and prospects of non-pharmacological and drug therapy patients with liver disease, not associated with a viral infection. The presented data emphasize the relevance of studying the problem of effective therapy of diseases of the liver and its role in improving the course and outcomes of liver disease.
Terapevticheskii arkhiv. 2018;90(2):94-99
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Magnetic resonance imaging in recognition of ectopic pancreatic tissue (Clinical observation)

Kotlyarov P.M.


A rare clinical observation of retroperitoneal ectopy of pancreatic tissue with diligence to the kidney and jejunum is presented. For the first time, semiotics of ectopia is described according to the data of magnetic resonance imaging, which allows to determine with a high degree of reliability the belonging of the revealed structures to the tissues of the pancreas.
Terapevticheskii arkhiv. 2018;90(2):100-103
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Clinical observation pseudoobstruction syndrome of the stomach's output part and small intestine of a patient with systematic lupus erythematosis

Gilyarov M.Y., Shostak N.A., Kotova D.P., Schekochikhin D.Y., Kasha Y.O.


Stomach's output part and small intestine, combining with damaging of the urinary tract is a rare systemic lupus eritematosus (SLE) manifestation. The patient is 32 years old, suffering from SLE with damaged join, blood system, secondary antiphospholipid syndrome with pulmonary embolism in the history and formation of high postembolic pulmonary hypertension on therapy with hydroxychloroquine and low doses of corticosteroids, was hospitalized because of persistent nausea, vomiting, loss of more than 10 kg body weight 1.5 months. The research have shown the obstruction's formation of the stomach's output part, small bowel obstruction at several levels, as well as thickening of the bladder wall and the unilateral expansion of the ureter. Against the backdrop of strengthening of immunosuppressive therapy these lesions completely regressed.
Terapevticheskii arkhiv. 2018;90(2):104-107
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Superinfection of hepatitis E as a factor in the development of acute hepatic encephalopathy on the background of HBV-cirrhosis of the liver

Baramzina S.V., Lyubeznova O.N., Bondarenko A.L., Protasov A.V.


The article presents an analysis of the clinical case of superinfection of autochthonous acute hepatitis E against the background of HBV-cirrhosis of the liver. HEV infection was diagnosed in a 39 year old man who did not travel outside the region and the country for a long time and used unboiled water. The peculiarity of the disease in the non-endemic region was: a severe course of hepatitis E against the background of HBV etiology, with the development of the clinic for acute hepatic insufficiency and encephalopathy, the presence of severe cytolysis syndrome, cholestasis, hepatic-cell insufficiency and prolonged convalescence. Timely treatment of the patient for medical aid and intensive pathogenetic therapy of hepatit-E superinfection with compensated HBV-cirrhosis allowed to save the patient's life. However, the prognosis for the patient's later life is unfavorable, due to submissive liver necrosis and the risk of rapid decompensation of cirrhosis. When deciphering undifferentiated in Russia acute hepatitis in persons with cirrhosis of another etiology (viral, alcoholic, medicinal), it is necessary to include the definition of HEVRNA and HEV IgM and G. in the survey design.
Terapevticheskii arkhiv. 2018;90(2):108-110
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Nekrolog. Nikolay Alekseevich Mukhin, 4.12.1936 - 28.01.2018

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28 января 2018 г. после тяжелой болезни на 82-м году жизни скончался выдающийся отечественный терапевт, заведующий кафедрой внутренних, профессиональных болезней и пульмонологии, директор клиники нефрологии, внутренних и профессиональных болезней Первого Московского государственного медицинского университета им. И.М. Сеченова, заведущий кафедрой внутренних болезней Московского государственного университета им. М.В. Ломоносова, вице-президент Российского научного медицинского общества терапевтов, президент Научного общества нефрологов России, лауреат Государственных премий СССР, заслуженный деятель науки РФ, академик РАН, доктор медицинских наук, профессор Николай Алексеевич Мухин. Николай Алексеевич был прекрасным педагогом, воспитавшим большое число учеников и подготовившим несколько учебников по внутренним болезням для студентов и многочисленные руководства для врачей. Научные интересы Н.А. Мухина характеризовались широтой охвата и фундаментальностью изучаемых проблем, новизной и глубиной их решения. При этом Николай Алексеевич был прекрасным врачом, всю свою жизнь посвятившим служению медицине. Уход Николая Алексеевича стал невосполнимой потерей для его близких, коллег, учеников и пациентов. Он навсегда останется в нашей памяти…
Terapevticheskii arkhiv. 2018;90(2):116
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