1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: gut microbiota, atherogenesis, cardiovascular diseases, cardiac treatment

Abstract:Gut microbiota (GM) is a peculiar marker of the macroorganism status, capable of responding to the age, physiological, dietary, climatic and geographical factors by changing the qualitative and quantitative compositions. The last decade is characterized by a signifi cant reassessment of the involvement of gut microbiota into the progression of chronic human diseases. This article presents an overview of recent experimental and clinical data on the role of gut microbiota in the development of atherosclerosis and cardiovascular diseases. An attempt has been made to analyze the mutual modifying eff ects of GM and the main types of drugs used in cardiology, as well as the limitations and directions of future research in this fi eld.

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Full text is published :
Karpunina N. S., Karpunina T. I. Gut microbiota in cardiologic patients: aggressive or defensive factor? Experimental and Clinical Gastroenterology. 2018;156(8): 4–9. DOI: 10.31146/1682-8658-ecg-156-8-4-9
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: cirrhosis of the liver, spirometry, phospholipids of exhaled air, pulmonary artery pressure, smoking, non-smoking

Abstract:Objective: To study the ventilation function of the lungs and the phospholipids of exhaled air in smoking and non-smoking patients with cirrhosis of the liver (CP) in a comparative aspect. Material and methods: 49 patients with portal hypertension (GHG) and 20 healthy volunteers were examined. Spirography was carried out with the help of the hardware-software complex “VALENTA”. The KVV was collected according to the recommendations of GI Sidorenko. in the morning after rinsing the mouth. The volume of KVB and the concentration of total phospholipids in 1 ml of KVB (OFL, mmol / L) were measured. Phospholipids were extracted by the Blur method. The statistics were implemented using the application software “Statistica for Windows, Release 6.0.” Results of the study and their discussion: In patients with CP, a signifi cant decrease in the ventilation capacity of the lungs was more pronounced in smokers, as well as a decrease in the amount of condensate in the exhaled air (KVV) and phospholipids in KVV. The average pressure in the pulmonary artery with CP was higher than in the healthy. Conclusion: Smokers with pulmonary embolism are more severely aff ected by pulmonary ventilation than non-smokers. There is no signifi cant diff erence in the decrease in the amount of phospholipids in the exhaled air from smokers and non-smoking patients with CP.

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Full text is published :
Barlamov P. N., Vorob’eva A.A., Zhelobov V. G., Kravtsova T. Yu. Ventilation function of lungs, content of phospholipids in condensate of outdoor air and pressure in pulmonary artery in smoking and non-smoking patients with liver cirrhosis. Experimental and Clinical Gastroenterology. 2018;156(8): 10–14. DOI: 10.3 1146/1682-8658-ecg-156-8-10-14
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)
2. E The Group of Companies “Medsi» (Perm, Russia)

Keywords: Steatohepatitis, alpha-2-macroglobulin, haptoglobin, apolipoprotein A1, elastography

Abstract:The aim of study was to estimate the features structurally functional condition of the liver in non-alcoholic steatohepatitis patients. Methods. This case-control study involved 30 patients with non-alcoholic steatohepatitis and 10 controls aged from 18 up to 60 years. All patients and controls were examined by ultrasound of the liver with defi nition steatosis degree; duplex scanning of abdominal cavity vessels; elastography of the liver with defi nition fi brosis stage on Metavir scale. The levels of the alpha-2-macroglobulin, haptoglobin and apolipoprotein A1 were determined. Results. We revealed S1-steatosis degree at 60%, S2 — at 23% and S3 — at 17% of patients. Fibrosis of the liver was mainly initial degrees: F0 — at 10%, F1 — at 60%, F2 — at 20%, F3 — at 10% of patients. The level of alpha-2-macroglobulin was reliable increase (3,89±0,96 g/l) in the group of patients with non-alcoholic steatohepatitis in comparison with control group — 2,35±1,11 g/l (р=0,001). The obtained data have allowed to create model fi brosis liver predictors in non-alcoholic steatohepatitis patients. Conclusions. Ultrasonic steatosis degree and concentration of alpha-2-macroglobulin in combination with the body weight index and activity of hepatitis can serve the markers of the adverse forecast in non-alcoholic steatohepatitis patients.

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Full text is published :
Trenogina K. V., Obukhova O. V., Mavlitova L. A. Clinical features of a course of the disease and structurally functional condition of the liver in non-alcoholic steatohepatitis patients. Experimental and Clinical Gastroenterology. 2018;156(8): 15–20.
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: liver fi brosis, liver cirrhosis, hemostasis

Abstract: The aim was to investigate hemostasis system in patients with liver fi brosis and cirrhosis. Materials and methods. We examined 10 patients with liver fi brosis, 25 patients with liver cirrhosis and 10 healthy people. Primary and secondary hemostasis and Hageman-factor-dependent fi brinolysis were studied. Results. Patients with liver fi brosis had decreased platelets aggregation with inductors, but normal platelet count. Also, they had increased thrombin time (TT) and activated partial thromboplastin time (APTT), but normal prothrombin index (PTI). Patients with liver cirrhosis had thrombocytopenia and decreased platelets aggregation, increased TT and APTT, but decreased PTI. Time of the Hageman-factor-dependent fi brinolysis was increased in patients with liver cirrhosis. Conclusion. Patients with liver fi brosis and cirrhosis have disturbances in primary and secondary hemostasis and patients with liver cirrhosis have decreased activity of Hageman-factor-dependent fi brinolysis. Probably, it could be determined by hepatocytes function failure and/or disseminated intravascular coagulation.

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  6. Pshenichnaya N. Y., Shatohin Y. V., Snezhko I. V., Burnasheva E. V. Trombocitarnye faktory razvitiya trombocitopenii u bolnyh hronicheskim gepatitom C [Platelet factors of thrombocytopenia development in patients with chronic hepatitis C]. Gematologiya i transfuziologiya – [Hematology and transfusiology], 2014, vol. 59, no. 1, pp. 58–59.

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Gulyaeva I. L., Bulatova I. A., Pestrenin L. D. Characteristics of indicators of the system of hemostasis in patients with fi brosis and cirrhosis of the liver. Experimental and Clinical Gastroenterology. 2018;156(8): 21–24. DOI: 10.31146/1682-8658-ecg-156-8-21-24
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: liver fi brosis, chronic hepatitis C, platelets, albumin

Abstract: The aim. The aim was to evaluate the diagnostic capabilities of determining the number of platelets and the concentration of albumin in the blood as an indirect test for assessing the severity of liver fi brosis in chronic hepatitis C (CHC). Materials and methods. There were examined 70 patients with CHC and 30 healthy persons. The number of platelets, the concentration of albumin, the ultrasonic elastography of the liver with the evaluation of the fi brosis stage by METAVIR were determined. Results. The platelet and albumin indices had an inverse strong relationship with the liver density index: r = –0.9 and r = –0.9, respectively. At a platelet level was more than 200×109/l and an albumin concentration was more than 47.3 g/l, fi brosis is excluded. The sensitivity and specifi city of the platelet count were 100% and 77.8%, for albumin levels these values t here were 100% and 73.3%. Moderate and severe fi brosis can be stratifi ed: when a platelet count is less than 200×109/l and an albumin concentration is less than 44.1 g/l it is correspond to fi brosis of stage 3–4. Conclusion. The number of platelets and the concentration of albumin in the blood satisfactorily refl ect the presence and severity of liver fi brosis in patients with CHC. These indicators can be used in wide clinical practice as indirect markers of fi brosis.

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Full text is published :
Shchekotova A. P., Bulatova I. A. Number of thrombocytes and concentration of albumin in blood — markers of liver fi brosis in chronic hepatitis C. Experimental and Clinical Gastroenterology. 2018;156(8): 25–28.
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: Oddi sphincter insuffi ciency, hepatobiliscintigraphy, duodenal dyskinesia

Abstract: Purpose of research. To evaluate the clinical signifi cance of the loss of the closure function of the Oddi sphincter. Materials and methods: 100 patients after cholelithiasis surgery were divided into two groups: 1 — group (main) — 86 patients after cholecystectomy; 2 — group (comparison) — 14 patients after cholecystectomy with drainage choledoch operations. The dynamics of bile fl ow was assessed by hepatobiliscintigraphy on a gamma camera using the radiopharmaceutical 99Tc-bromide for 90 minutes with choleretic test. Clinical manifestations, results of laboratory, ultrasound, x-ray and endoscopic examinations were analyzed. Results. According to hepatobiliscintigraphy, 20 (23, 2%) patients of group 1 had normal bile fl ow dynamics. 66 (76,8%) patients indicators of hepatobiliscintigraphy consistent with premature and accelerated galeotto, identical fi gures in the 2nd group, where 100% is set, the insuffi ciency of the sphincter of Oddi. Scintigraphic indicators of Oddi sphincter insuffi ciency correlated with signs of functional disorders of the duodenum (r=0.57, p <0.001) and duodenogastric refl ux (r= 0.74, p<0.01), as well as with radiological signs of duodenal dyskinesia (r= 0.73; p<0.01). In 73% of patients of group 1 with Oddi sphincter insuffi ciency and 86% — in the comparison group, diarrhea was observed, against 10% with normal bile passage (p<0.0001). Drug therapy of these disorders was supplemented with prokinetics. Conclusion. Oddi sphincter insuffi ciency after cholecystectomy develops in 77% of cases and acquires the most pronounced clinical signifi cance in patients with duodenal dyskinesia. The relationship of functional disorders of the biliary tract and duodenum should be considered when choosing a therapeutic tactic, supplementing therapy with drugs that regulate intestinal motility.

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Full text is published :
: Repin M. V., Mikryukov V. Yu. The clinical signifi cance of sphincter Oddi`s insuffi ciency after cholecystectomy. Experimental and Clinical Gastroenterology. 2018;156(8): 29–34.
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)
2. Regional Children’s Clinical Hospital (Perm, Russia)

Keywords: non-alcoholic fatty liver disease, obesity, diabetes, children, adolescents

Abstract: Currently, non-alcoholic fatty disease is one of the frequent liver diseases not only in adults, but also in adolescents and even children. The growth of this pathology is associated with an increase in the number of patients suff ering from obesity, diabetes, insulin resistance. Studies on fatty liver degeneration with insulin-dependent diabetes mellitus (type 1) are not enough. The aim of the study was to evaluate and compare laboratory and instrumental data in children with non-alcoholic fatty liver disease in endocrinological pathology.The article presents the results of a survey of 67 children and adolescents with fatty hepatosis (41 children with type 1 diabetes and 27 with obesity). It was shown that in children with obesity, an increase in alanine transaminase was signifi cantly more frequent in comparison with the group of children with diabetes (p=0,047). There was a trend towards a more frequent increase in triglycerides, cholesterol and low-density lipoproteins and children with diabetes, but no signifi cant diff erences were found in the groups. According to the results of ultrasound examination of the abdominal cavity organs, all patients showed signs characteristic of fatty hepatosis, without signifi cant diff erences in groups.

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Full text is published :
Furman E. G., Koryukina I. P., Zarnitsyna N. Yu., Ponomareva M. S., Chistousova G. V., Akhmedov R. M. Non-alcoholic fatty liver disease with endocrine diseases in children and adolescents. Experimental and Clinical Gastroenterology. 2018;156(8): 35–40. DOI: 10.31146/1682-8658-ecg-156-8-35-40
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: child nutrition, macro- and micronutrients, correction of nutrition

Abstract: The assessment of early infant nutrition and its infl uence on the anthropometric indicators (mass, body height) and the development of nutritional-related diseases in catamnesis was performed. Alimentary diaries of 61 children (from 6 to 36 months) were analyzed. Children by age were divided into three groups. Low energy value of the diet was determined in the three groups (1138,3±249,6 kcal) and a violation of the ratio of macro- and micronutrients was found. Prior to the correction of nutrition, 77,8% of the children had a number of background nutrition-related diseases. Nutrition correction was conducted in macro-and micronutrient. After diet correction in 11.2% of children was observed negative dynamics in the anthropometric parameters, anthropometric indices of 44.4% of children were normalized. After correction of the nutrition the number of children with alimentary-dependent diseases decreased (from 77,8% to 27,8%). It was determined that children of early age had insuffi cient basic macro- and micronurtients in the diet. After the correction of day nutrition 44.4% of the children had investigated positive dynamics of anthropometric indices and reduction of nutrition-related diseases.

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Full text is published :
Lundina G. V., Repetskaya M. N., Toropova E. A., Golovina V. V. Modern aspects of early infant nutrition. Experimental and Clinical Gastroenterology. 2018;156(8): 41–44.
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: peptic duodenal ulcer, arterial hypertension, hemostasis

Abstract: The aim of the work is to study the indicators of coagulation and anticoagulant hemostasis, as well as fi brinolysis in patients with duodenal ulcer (DU) and arterial hypertension (AH) in order to predict and prevent possible complications. Materials and methods. The main group consisted of 18 patients with DU and AH 1–2 degree, stage II, high (3) group of cardiovascular risk (mean age 47.36±5.41 years). Comparison groups consisted of 22 patients with DU (mean age 40.53±4.28 years), 20 patients with AH (mean age 48.72±6.32 years) and 10 healthy people. Coagulation, anticoagulation and fi brinolytic components of hemostasis system were evaluated. Results. The hemostasis system in patients with UD and AH is characterized, it´s manifested by hypercoagulation, paracoagulation and a defi ciency of fi brinolysis, which may be due to metabolic liver dysfunction

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Zarivchatsky M. F., Kravtsova T. Yu. Plasma factors of hemostasis in the peptic ulcer disease associated with arterial hypertension. Experimental and Clinical Gastroenterology. 2018;156(8): 45–49. DOI: 10.31146/1682-8658-ecg-156-8-45-49
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: intestinal stones, thick and rectum, diagnosis, treatment

Abstract: The aim of the study was to study the issues of prevalence, etiopathogenesis, clinic, diagnosis and treatment of intestinal stone disease. Materials and methods. For 25 years, 25 patients (13 men, 12 women) with intestinal stones were observed. Patients of elderly and senile age prevailed (15 people). Enterolites had 5 patients, coprolites — 20. A total of 36 stones with a size of 2.5 to 22 cm were found in patients (26 concrements were 6 cm or more). For diagnosis, we used multi-detector computed tomography, fi bro colonoscopy, ultrasound, irrigography, and other methods. Results. Stones most often formed in the sigmoid and rectum. Chronic colonic stasis, congenital and acquired diseases of the intestine, the reception of indigestible and extraneous substances for the intestine (chalk, barium, magnesium and aluminum salts) played a leading role in the formation of intestinal stones. In 20 patients, stones caused complications, of which the most severe were perforation of the gut (in 3) and acute intestinal obstruction (in 7). The best method of diagnosis was multidetector CT. Improving the diagnosis and developed diff erentiated treatment tactics allowed to improve the results of treatment and achieve recovery in all 25 patients

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Full text is published :
Davidov M. I., Subbotin V. M., Nikonova O. E. Intestinal stones. Experimental and Clinical Gastroenterology. 2018;156(8): 50–54. DOI:10.31146/1682-8658-ecg-156-8-50-54
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)
2. Department of Surgery № 2 with a course of Hematology and Blood Transfusion Faculty of additional professional education

Keywords: needle liver biopsy, liver cirrhosis, malignant neoplasms of the liver, liver cancer, chronic hepatitis, indications and contraindications

Abstract: The aim was to evaluate the results of applying ultrasound guided percutaneous liver biopsy in combination with the improvement of diagnostics of patients with focal liver diseases. Materials and Methods. An analysis of the results of targeted puncture liver biopsy of 466 patients with focal liver diseases for 2013–2017 was conducted. The eff ectiveness of the method was assessed by the sensitivity, presence and character of postoperative complications and mortality. Results. The use of needle liver biopsy has a high sensitivity (79.4%), diagnostic value and relative safety (postoperative complications — 1.5%, mortality 0.4%) with strict adherence to manipulation techniques and contraindications.

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Zarivchatskiy M. F., Kamenskikh E. D., Mugatarov I. N. Experience of using needle biopsy in focal liver disease. Experimental and Clinical Gastroenterology. 2018;156(8): 55–58.
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)
2. Perm Krai Clinical Hospital (Perm, Russia)

Keywords: esophageal cancer, esophagectomy, esophagojejumal bypass, esophagealstent

Abstract: The aim was to evaluate the eff ectiveness of esophagectomy and palliative operations for the treatment of locally advanced esophageal cancer. Methods and materials: 106 adolescent participants with locally advanced esophageal cancer and adenocarcinoma of cardioesophageal junction underwent esophagectomy and esophagojejumal bypass. Results. In 85 cases of locally advanced esophageal cancer T4 esophagectomy was combined with resection of pancreas, paraesophageal fat, pleura, diaphragm, omentum, transverse colon, aorta adventitia. Twenty fi ve patients with disseminated process and distant metastasis underwent esophagectomy and resection of solitary liver, lung, omentum metastasis. In 6 cases original esophagojejumal bypass was performed, using laparotomy and circular stapler. We consider, that this technique reduces surgical invasion in the management of locally advanced esophageal cancer. Endoscopic self-expanding esophagealstents were placed in 241 cases of advanced esophageal cancer. There were fi ve (2,1%) esophageal perforations. Postoperative morbidity after esophagectomy was 8,2% (7). Median survival rate increased from 4 to 12 months. Postoperative morbidity after esophagectomy and resection of solitary metastasis was 9,5% (2). Median survival rate increased from 3 to 7,5 months. Conclusion. We concluded that esophagectomy with resection of involved organs or metastasis in the management of advanced esophageal cancer T4a, M1 increased median survival rate.

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Plaksin S. A., Artmeladze R. A., Sablin E. E. Results of resection and bypass surgery in advanced cancer of the esophagus. Experimental and Clinical Gastroenterology. 2018;156(8): 59–63.DOI: 10.31146/1682-8658-ecg-156-8-59-63
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: colorectal cancer, alkaline phosphatase, electrochemical method, biochips

Abstract: Objective: To evaluate (morphologically) the eff ectiveness of the electrochemical method with biosensors applying to study the content of ALP in biopsies of tumors and intact colon mucosa. Materials and methods: Using the electrochemical method with nanotechnological biosensors, the concentration of alkaline phosphatase in biopsy specimens of colorectal carcinomas and intact colon mucosa, obtained from endoscopy from 24 patients were examined. Based on the results of a subsequent histological and immunohistochemical study of biopsy specimens, the eff ectiveness of the electrochemical method was evaluated. Results: The average value of the current, obtained in the study of fresh tumor biopsies was 0.0492 ± 0. 0007 μA, in case of biopsy specimens of the intact colon mucosa was 0.1197 ± 0.019 μA. Similar results were obtained in the study of biopsies, fi xed in formalin: tumor tissue — 0.033 ± 0.0005 μA, intact mucosa — 0.0596 ± 0.0008 μA. The histological structure of tumors corresponded to adenocarcinoma of various degrees of diff erentiation. A positive correlation of the results of electrochemical and histological / immunohistochemical studies was observed in all patients. Immunohistochemical study of biopsy specimens with antibodies to non-specifi c alkaline phosphatase revealed high expression of enzyme in the cell membranes of the glandular crypt’s colon epithelium and a weak “background” staining of the cytoplasm and cell membranes of tumor cells. Conclusion: An electrochemical study with biosensors can be used to assess the alkaline phosphatase content in tumor biopsies and intact colon mucosa. Diff erences in the content of alkaline phosphatase in the tissue of colon adenocarcinoma and the unmodifi ed mucosa are statistically signifi cant. The existing diff erences in the study of fresh and fi xed in formalin biopsy samples indicate the advisability of non-fi xed material using.

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Full text is published :
Belkin A. N., Freynd G. G. Morphological evaluation of eff ectiveness of electochemical method with nanotechnological biosensors using for alkaline phosphotase detection in colorectal carcinoma biopsies. Experimental and Clinical Gastroenterology. 2018;156(8): 64–67. DOI: 10.31146/1682-8658-ecg-156-8-64-67
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)
2. Perm State National Research University (Perm, Russia)
3. Perm Institute of the Federal Penal Service (Perm, Russia)

Keywords: interleukin-2 receptor expression, NSAID-pancreatopathy, nimesulide

Abstract: Objective: to study the involvement of regulatory cytokine-interleukin-2 in the pathogenesis of NSAID-pancreatopathy induced by prolonged intake of nimesulide, using immunohistochemical methods. Materials and methods: the study was carried out on laboratory animals (rats) who received nimesulide by the oral route for 21 days at diff erent dosages: 0.5 mg / kg (therapeutic), 2.5 mg / kg and 5 mg / kg. Evaluation of the eff ect of the drug was made on the basis of histological examination of pancreatic tissue and manifestation of immunohistochemical expression of interleukin-2 (IL-2Rα) receptors. To identify the expression of receptors, labeled antibodies IL-2Rα (poly), species-specifi c to rat tissue antigens, were used. Results: histological studies revealed pathomorphological changes characteristic of toxic pancreatic lesions. Assessment of the degree of lesions showed a pronounced dose-dependent eff ect. The manifestation of immunohistochemical expression of IL-2Rα was determined by semi-quantitative methods, the intensity of staining and the number of positively stained cells were evaluated. It was found that the expression of IL-2Rα is localized in the endocrine islets of Langerhans. In animals of experimental groups receiving high doses of nimesulide, a signifi cant increase in the intensity of staining of endocrine islets as well as connective tissue components was revealed, which is due to the high intensity of expression of IL-2Rα. Conclusion: increased expression of IL-2Rα, refl ecting islet cell damage, may be due to deterioration of tissue nutrition of islands due to hemodynamic disorders and dystrophic processes in the parenchyma of the gland and the development of an autoimmune component of the infl ammatory process.

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Full text is published :
Lazarenko L. V., Kosareva P. V., Samodelkin E. I. Pathogenetic aspects of experimental pancreatopathy induced by nimesulid. Experimental and Clinical Gastroenterology. 2018;156(8): 68–72. DOI: 10.31146/1682-8658-ecg-156-8-68-72
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1. E Federal Scientifi c Center for Medical and Preventive Health Risk Management Technologies (614990, Perm, Russia)
2. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: Oxidative stress, malondialdehyde, glutathione transferase, catalase, glutathione reductase, glutathione peroxidase, chronic hepatitis

Abstract: Aims. The paper studies the polymorphism of antioxidant system genes, CAT, GSTP1, GPX4, in patients with chronic hepatitis C. Materials and methods. The paper examines 83 patients in the age from 18 to 70 with chronic hepatitis C in the reactivation phase and 30 healthy individuals. Real-time PCR methods are used to analyze polymorphic types of the studied genes, the DNA sequence of catalase genes CAT (rs1001179), glutathione-S-transferase GSTP1 (rs1695), glutathione peroxidase-4 GPX4 (rs713041) was used as the primers. Results. Correlative relationships between separate polymorphisms of genes and indicators of biochemical analysis of blood were found. For example, a polymorphic type of the gene GPX4 is associated with the lowest level of activity of glutathione reductase in heterozygotes, the activity of alkaline phosphatase is linked with the GSTP1 gene polymorphism, the level of catalase activity in blood serum correlates with the presence of a polymorphic type of the gene catalase CAT. Conclusions. Identifi cation of candidate genes in patients with HCV is predictive for changes in the activity of several enzymes of the antioxidant system (GR, catalase) and enzymes that characterize toxic liver damage (AST, gamma-GTP), and therefore allows to predict the course of HCV in these patients.

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Full text is published :
Krivtsov A. V., Ulitina P. V. Genes of the antioxidant system of CAT, GSTP1, GPX4 at patients with chronic viral hepatitis C. Experimental and Clinical Gastroenterology. 2018;156(8): 73–77. DO I: 10.31146/1682-8658-ecg-156-8-73-77
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)
2. Federal Research Center of preventive health management health risk Rospotrebnadzor (Perm, Russia)

Keywords: ulcerative colitis, vascular endothelial growth factor, polymorphism of the vascular endothelial growth factor gene

Abstract: Objective. To assess the functional signifi cance of the –634G/C polymorphism of the vascular endothelial growth factor gene VEGFA (rs 2010963) in the progression of ulcerative colitis (UC) in patients in the Perm Krai. Materials and methods. 70 patients with UC in the active phase of the disease and 50 healthy donors were examined. The level of serum VEGF and the polymorphism of the VEGFA gene in the –634G/C region were studied. Results. The signifi cant increase of vascular endothelial growth factor VEGF, whose concentration was 239,40 (137,70– 554,30) pg/ml was determined; it was 2.8 times higher than in the control group. A signifi cant relationship between the level of VEGF in the serum and the severity of the attack of the UC and the index of endoscopic activity (IEA) (r = 0.39 and r = 0.45, respectively) was revealed. The distribution of genotypes and alleles of the –634G/C region of the VEGFA gene at position rs 2010963 did not reveal signifi cant diff erences in patients with UC and healthy individuals in the Perm Krai. However, in assessing the occurrence of allelic variations of the VEGFA gene with diff erent endoscopic activity of the UC, a minor allele C and an unfavorable homozygote CC associated with severe progressive UC fl ow are established. Conclusions. The risk of developing an unfavorable course of the UC, prone to relapse and progression, is associated with the carriage of allele C and homozygotes CC of the VEGFA –634 G/C gene, which should be taken into account in predicting the course of the disease and choosing a treatment strategy.

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Tretyakova Y. I., Bulatova I. A., Shchekotova A. P., Krivtsov A. V. The impact of polymorphism of the vascular endothelial growth factor gene VEGFA –634G/C (rs 2010963) on the progression of ulcerative colitis. Experimental and Clinical Gastroenterology. 2018;156(8): 78–82.DOI: 10.31146/1682-8658-ecg-156-8-78-82
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)
2. Perm City Clinical Hospital № 4 (Perm, Russia)

Keywords: procalcitonin, bile, cholangitis e

Abstract: Procalcitonin concentration (PC) was determined in the simultaneously obtained samples of blood serum and bile. 56 patients were examined on 1–3 day after the operation. The subjects were divided into two groups. The main group contain of 31 patients with cholangitis and the comparison group includes 25 patients without infl ammation of the bile ducts. The PC level was determined by enzyme immunoassay method with the test systems with sensitivity according to the manufacturer — 0.01 ng/ml. The PC concentration in blood serum fl uctuated within wide limits: from 0.005 ng/ml to 10.11 ng/ml and was signifi cantly higher in the main group (p <0.000001). The PC level in bile was lower in comparison with serum and varied from undetectably low (

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Sosnin D. Yu., Zubareva N. A., Popova N. N., Renzhin A. V. Blood and bile procalcitonin concentration in patients with acute cholangitis. Experimental and Clinical Gastroenterology. 2018;156(8): 83–87.
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: narcotic intoxication, hepatitis, fi brosis

Abstract: World statistics shows a widespread and steady increase in the number of patients with addiction among whom, according to many domestic and foreign authors, an increasing proportion falls on patients with diseases caused by the use of drugs from the opium group. The article presents an overview of scientifi c publications devoted to the peculiarities of reactive liver changes in people who use acetylated opiates — heroin. The features of the course, progression of the pathological process during narcotic intoxication, as well as mixed variants in combination with viral hepatitis are considered.

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Full text is published :
Shchekotova A. P., Nevzorova M. S., Bulatova I. A., Chepkasova N. I., Botalov N. S. Features of liver disease in narcotic intoxication. Experimental and Clinical Gastroenterology. 2018;156(8): 88–93.
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: morphology, nonparasitic liver cysts, dysembryogenesis, liver

Abstract: Literature review refl ects modern view on morphogenesis of nonparasitic liver cysts. Morphological characteristic and embryogenesis varies with diff erent variants of dysontogenetic cysts are presented.

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Full text is published :
Freynd G. G., Zhivaeva E. V. Morphogenetic variants of nonparasitic liver cysts. Experimental and Clinical Gastroenterology. 2018;156(8): 94–98.DOI: 10.31146/1682-8658-ecg-156-8-94-98
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)
2. Perm Krai Clinical Hospital

Keywords: liver resection, bile leakage, biliary complications

Abstract: The aim of the literature review was to present the modern statement of frequency, classifi cations, management and risk factors of bile leakage after hepatectomy. Objectives. Our retrospective study includes 363 consecutive patients that underwent liver resection. Results. The incidence of bile leakage was found to be 7,7%: bilomas appeared in 5,2% and external bile fi stulas — in 2,5%. Ten from 19 bilomas were treated by percutaneous puncture under ultrasound control. Procedure was repeated from one to four times. Nine patients were treated with percutaneous drainage. After that 8 external bile leakages were stopped during 4–12 weeks. One patient had the dilatation of common bile duct. She underwent endoscopic papillotomy. Among nine patients with external bile leakage six were treated conservatively. Central type leakage (2) that was in communication with bile duct of the fourth segment was treated with endoscopic retrograde 7 and 10 Fr stent with 9 and 11 cm length. Stent was placed to left and common bile ducts. Bile leakage stopped during 2–3 days. One patient was reoperated. Multivariate analysis indentifi ed only one independent factor that was signifi cantly correlated with the occurrence of bile leakage: right hepatectomy. More meticulous management is needed to prevent bile leakage in high-risk patients. Conclusion. Endoscopic retrograde stent appeared quick and successful in cases of central type leakage that was in communication with segmental bile duct.

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Full text is published :
Kotelnikova L. P., Grebenkina S. V., Trushnikov D. V. Bile leakage after liver resection. Experimental and Clinical Gastroenterology. 2018;156(8): 99–106.
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1. Federal public budgetary educational institution of higher education “Omsk State Medical University” of the Ministry of Healthcare of the Russia (Omsk, Russia)
2. Omsk State Agrarian University P. A. Stolypin (Omsk, Russia)

Keywords: liver transplantation, risk factors, diabetes mellitus

Abstract: There is a higher prevalence of performed transplants of solid organs in Russia. Liver transplantation (LT) is the most eff ective way to treat liver diseases at advanced stages, and for many patients –the only eff ective one. Marked improvement in the surgery leads to the advances in LT techniques and the increase of overall number of LTs performed. However the number of recipients with metabolic disorders requiring medical interventions increases as well. LT can be accompanied by several complications. The most common one is diabetes mellitus (DM). New onset DM after LT increases the risk of transplant rejection, infection, adverse cardiovascular outcomes and reduces the survival of patients. An early diagnostics of carbohydrate metabolism disturbances in patients who underwent LT might be achieved with rigorous identifi cation of the risk factors associated with DM development after and proper screening performed before the intervention. Beyond these, in a particular group of solid organs recipients a rational administration of drug therapy for DM, which is based on evidence of treatment outcome, safety and drug interactions with immunosuppressive therapy, should improve the number of adverse outcomes and contribute to eff ective blood glucose control in a postoperative period after LT.

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Druk I. V., Drokina O. V., Lyalyukova E. A., Ryapolova E. A., Vysokogorskiy V. E., Moliboga E. A. New-onset diabetes after liver transplantation: epidemiology, risk factors, medical therapy at the outpatient stage. Experimental and Clinical Gastroenterology. 2018;156(8): 107–115.DOI: 10.31146/1682-8658-ecg-156-8-107-115
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1. South Ural state medical University, Ministry of health of Russia (Chelyabinsk, Russia)

Keywords: antituberculosis drug, hepatotoxicity, drug-induced liver injury

Abstract: The development of hepatotoxic reactions is one of the most common and clinically signifi cant side eff ects of antituberculosis drugs (АTP). The article presents information about risk factors, pathogenetic mechanisms of the drug-induced liver injury (DILI) in chemotherapy of tuberculosis. The characteristic of АTP, with a higher incidence of hepatotoxic reactions, is given. The main principles of diagnosis and treatment of DILI induced by ATP are given. The relevance of the use of hepatoprotectors to prevent unwanted reactions of chemotherapy for tuberculosis has been noted.

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Dolgushina A. I., Volchegorsky I. A., Novoselov P. N., Ushkareva E. V., Olevskaya E. R., Kuznetsova A. S. Antituberculosis drug-induced hepatotoxicity. Experimental and Clinical Gastroenterology. 2018;156(8): 116–124.DOI: 10.31146/1682-8658-ecg-156-8-116-124
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)
2. Perm Regional Hospital (614990, Perm, Russia)

Keywords: hepatotoxicity, psychotropic drugs

Abstract: Now in psychiatric practice the big range of both traditional, and modern psychotherapeutic drugs is used. Many of them are capable to cause a damage to a liver which can proceed as it is asymptomatic, and to have a serious fulminantny current. Especially it touches the patients having risk factors of drugs hepatotoxic. In this regard at the choice of psychotropic drug in each case it is necessary to consider a background structurally functional condition of a liver of the patient, to compare these data with potential risks of hepatotoxic of this drug, without losing sight also of a possibility of an idiosyncrasy. The algorithm of maintaining patients with the taped hepatotoxic has to include use of potentially possible hepatotropic drugs, according to mechanisms of their corrective action and also measures of prevention of repeated hepatotoxic reactions.

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Full text is published :
Khlynova O. V., Smirnova E. N., Komarovskaya N. L. Private issues of hepatotoxicity of psychotropic drugs. Experimental and Clinical Gastroenterology. 2018;156(8): 125–131. DOI:10.31146/1682-8658-ecg-156-8-125-131
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: estrogenic and gestational drugs, hepatotoxicity

Abstract: The article presents data of the effi ciency of exogenous sex hormones use in the maintenance of women’s health, their classifi cation, and also the mechanism of action of exogenous estrogens and gestagens from the point of view of “fi rst passage through the liver” was studied in detail. Understanding the importance of hormone therapy for women, a great attention is paid to the problem of ensuring its safety, specifi cally, of the target organ — the liver. The risk factors of hepatotoxicity of exogenous sex hormones are discussed in details, the tactic of early diagnosis, treatment and prevention of liver damage on the background of hormone therapy with estrogenic and gestational drugs is defi ned.

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Full text is published :
Vologzhanina L. G., Borodina E. N. Liver — is the target organ of the hormone therapy in women. Experimental and Clinical Gastroenterology. 2018;156(8): 132–139.
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)
2. Regional children’s clinical hospital (614066, Perm, Russia)

Keywords: hereditary tyrosinemia, mutation p.Gln 64 His, FAH gene, liver cirrhosis

Abstract: Hereditary tyrosinemia is a rare genetic disease, the diagnosis of which is diffi cult. The clinical case of a 5-year-old child with hereditary tyrosinemia presented, with the mutation p.Gln 64 His in the FAH gene in the homozygous state. Clinical manifestations of the disease proceeded with cirrhosis and portal hypertension, kidney pathology and deformation of the bones.

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Full text is published :
Vinokurova L. N., Shadrina V. V., Furman E. G., Cheremnyh L. I., Prozumentik V. R. Tyrosinemia type B liver and kidney have a 5-year-old child. Experimental and Clinical Gastroenterology. 2018;156(8): 140–145.
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: portal hypertension, pregnancy, hypersplenism, varicose veins of the esophagus and stomach

Abstract: At present, there is a tendency to increase the number of women with portal hypertension of diff erent genesis planning pregnancy. Extrahepatic portal hypertension, in most cases associated with congenital disorders of the portal vein thrombosis or vascular portal and forming pools of portal hypertension occurs in childhood. Patients with malformations of the portal vein during pregnancy have a higher risk of complications such as hypersplenism and bleeding from varicose veins of the esophagus and stomach, which is the main cause of maternal mortality in this pathology. The article presents a clinical case of a successful outcome of pregnancy in patients with extrahepatic portal hypertension due to congenital malformation of the portal vein and its branches, korregirovat (splenorenal anastomosis, double tunneling of the right lobe of the liver Isheninu) complicated with esophageal varices 1–2 items, portal gastropathy, splenomegaly, dvuhrostkovym hypersplenism (anemia, secondary thrombocytopenia provocative hemorrhagic syndrome).

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Full text is published :
Padrul M. M., Olina A. A., Sadykova G. K., Semyagina L. M., Turova E. V., Chirinkina E. V., Zaplatina V. S., Meteleva T. A., Sadykova D. K. The pregnancy in a patient with extrahepatic portal hypertension. Experimental and Clinical Gastroenterology. 2018;156(8): 146–151.
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1. Perm Regional Clinical Hospital (Perm, Russia)
2. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: Pregnancy, cirrhosis, portal hypertension, hypersplenism, delivery

Abstract: There are cases of diff erent outcomes of a pregnancy in women with a cirrhosis of a virus etiology complicated by portal hypertension presented in the article. An existence of the cirrhosis complicated by the accruing portal hypertension and a hypersplenism (thrombocytopenia) which led to formation and a rupture of a hematoma of a spleen are pregnancy failure factors. An existence only of a portal hypertension without hypersplenism at an early delivery gives chance of the successful outcome for mother and a fetus.

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  2. Sandhu B.S., Sanyal A. J. Pregnancy and liver disease. GastroenterolClin North Am 2003;32:1:407–436
  3. Shekhtman M. M. Khronicheskiy gepatit i tsirroz pecheni u beremennykh [Chronic hepatitis and cirrhosis in pregnant women]. Ginekologiya – [Gynecology], 2004, no 03, pp. 141–144.
  4. Borisov A. E., Kashchenko V. A. Tsirroz pecheni i portal’naya gipertenziya [Cirrhosis and portal hypertension]. SPb, Sintez Buk, 2009, 154. p.

Full text is published :
Padrul M. M., Semyagina L. M., Sadykova G. K., Turova E. V., Semyagin I. A. Outcomes of a pregnancy at the cirrhosis of a virus etiology complicated by portal hypertension. Experimental and Clinical Gastroenterology. 2018;156(8): 152–156.
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)
2. Tumen state medical University (Tumen, Russia)
3. Federal State Bugetary Scientifi c Institution “The Research Institute of Obstetrics, Gynecology and Reproductology named after D. O. Ott”

Keywords: liver hemangioma, estrogen, menopausal hormone therapy, premature menopause

Abstract: Hemangioma of the liver is one of the most common benign liver tumors. The tumor has a mesenchymal origin and is a conglomerate of blood vessels. It is more common in women 30–60 years old. Risk factors also include the use of a number of medications (including estrogens) and high parity. This article describes a clinical case of a patient with liver hemangioma and prolonged menopausal hormone therapy at premature menopause.

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Olina A. A., Meteleva T. A.1, Sadykova G. K., Shevlyukova T. P. Hemangioma liver and premature menopause. Experimental and Clinical Gastroenterology. 2018;156(8): 157–159.
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1. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: toxocarosis, ferret, newborn

Abstract: The paper presents clinical observation of acquired toxocariasis in an infant in the period of newborns. Infection occurred from 5 to 22 days of life. The source of the invasion was a ferret, a female at the age of 2 years. It lived in the apartment as the pet. From the 23rd day of life the clinic developed in the form of 3 syndromes: dyspeptic, intoxication and catarrhal. In the blood test in 27 days of life, eosinophilia 25% (abs. 4250 cells), leukocytosis 17.0 x109/L. At the age of 1 month 20 days eosinophilia was 41%. The titer of antibodies to toxocarosis in the infant was 1:1600 in three analyzes. At the mother of the infant, the result of ELISA was negative twice. Therefore, we made the conclusion about the acquired nature of the invasion. At the time of diagnosis of toxocarosis at the age of 1.5 months, we decided to refrain from specifi c antinematodic therapy. This therapy can give the high risk of fulminant form of toxic hepatitis in infants. At the age of 4 months, the result of the control ELISA was negative. We can suppose self-healing, the natural sanitation of the child’s body from helminthic invasion. In catamnesis in 2 years 4 months was recommended to repeat ELISA on toxocarosis.

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: Vshivtceva N. B., Repetckaya M. N., Toropova E. A. Acquired toxocariasis in a newborn. Experimental and Clinical Gastroenterology. 2018;156(8): 160–163.
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1. The federal state budgetary institution «National Medical Research Center for Surgery. A. V. Vishnevsky «of the Ministry of Health of the Russian Federation (Moscow, Russia)
2. E. A. Vagner Perm State Medical University (614990, Perm, Russia)

Keywords: scientifi c school, breast trauma, combined trauma, combined trauma, angiosurgery, phthisiosurgery, surgical hepatology

Abstract: Purpose of the study. To present an analysis of the history of life and scientifi c activity of the founder of the Perm Surgical Scientifi c School, Academician of the Academy of Medical Sciences of the USSR, Professor Evgeny Antonovich Wagner. Materials and methods. The study used biographical, narrative, historical-genetic, comparative and structural methods. Results. In the subsidiaries of the scientifi c school of Academician Ye. A. Wagner made the following conclusions. Proven advantages simultaneous correction of blood fl ow in various anatomic and functional basins patients with multifocal lesions in diseases of the aorta and major arteries (SG Suhanov, Filomenko NI, NA Lihacheva) and the use of endovascular interventions (VA Vasilets). Algorithm was proposed diff erential diagnosis of jaundice (L. F. Palatova) and developed the concept of the pathogenesis of gallstones by comparing the clinical data with impaired bile composition, biochemical changes, morphologic changes, the composition of stones and microbial landscape (L. F. Palatova, L. P. Kotelnikova, T. I. Subbotina, N. A. Zubareva). Synthesis of the treatment of TB patients in the penitentiary system allowed to recommend an active surgical approach, supplemented by intensive preoperative therapy and correction of complex disorders of homeostasis (V. A. Cherkasov, A. M. Epstein). Сonclusions. The scientifi c school of Academician Ye. A. Wagner made a great contribution to the study of breast trauma, angio- and phthisiosurgery, hepatology and other fi elds of medicine.

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Nechaev O. I., Palatova L. F. Academician of the academy of medical sciences of the USSR Evgeny Antonovich Wagner — surgeon, scientist, organizer of medical education (1918–1998) to the 100th anniversary of the birthday. Experimental and Clinical Gastroenterology. 2018;156(8): 164–169.
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