First Evidence of Microplastic Occurrence in the Marine and Freshwater Environments in a Remote Polar Region of the Kola Peninsula and a Correlation with Human Presence

Microplastics (MPs) have even been detected in remote environments, including high-latitude regions, where human activities are restricted or strongly limited. We investigated the surface water of the bays of the Barents Sea and the freshwater lakes that are located close to and several kilometers from a year-round resident field station in the remote tundra region of the Kola Peninsula. The microplastics' presence in aquatic environments in this region has not been indicated yet. Microplastics were detected in all samples collected from the Barents Sea (<4800 items·m^-3) and the lakes (<3900 items·m^-3). Fibers made from polyethylene terephthalate (PET)-the most common thermoplastic polymer of the polyester family-and semi-synthetic cellulosic rayon were the most dominant. This indicated that the source of fiber contamination may come from protective clothes, ropes, ship equipment, and fishing nets. Small microplastics can spread through current and atmospheric transport. The Norwegian Current is likely responsible for the lack of correlations found between MP contamination and the distance from the field station between the studied bays of the Barents Sea. On the contrary, a significant correlation with human presence was observed in the concentration of microfibers in the water of the tundra lakes. The number of MP fibers decreased with an increase in the distance from the field station. This is the first study, to the best of our knowledge, that reports such a correlation in a remote region. We also discuss implications for animals. Our results show that even the most isolated ecosystems are not free from microplastic pollution.

Dispersal of earthworms from the Rudny Altai (Kazakhstan) into Western Siberia

The aim of our study was to determine the current distribution, habitats, ecology, and possible dispersal routes of three species of the Rudny Altai (East Kazakhstan): Eisenia tracta, E. nana, and E. ventripapillata. We found that these species dispersed far beyond their original distribution into the flatland part of western Siberia (Russia) up to the central forest steppe of the Omsk oblast. E. tracta, E. nana, and E. ventripapillata were found in both floodplains and interfluvials. Hydrochory was the most plausible way of northward dispersal, while on interfluvials, they were probably introduced by humans. The studied species showed no preference for a particular habitat or river bank. The habitats were diverse and significantly different from the original ones in Rudny Altai. The factors that allowed E. tracta, E. nana, and E. ventripapillata to colonize western Siberia were probably their wide tolerance range to soil pH, temperature, density, and humidity, along with the decrease of winter soil freezing in recent decades. This is the first information about the occurrence of these species of earthworms in Siberia.

Species Delimitation of the Eisenia nordenskioldi Complex (Oligochaeta, Lumbricidae) Using Transcriptomic Data

Eisenia nordenskioldi (Eisen, 1879) is the only autochthonous Siberian earthworm with a large distribution that ranges from tundra to steppe and broadleaved forests. This species has a very high morphological, ecological, karyological, and genetic diversity, so it was proposed that E. nordenskioldi should be split into several species. However, the phylogeny of the complex was unclear due to the low resolution of the methods used and the high diversity that should have been taken into account. We investigated this question by (1) studying the diversity of the COI gene of E. nordenskioldi throughout its range and (2) sequencing transcriptomes of different genetic lineages to infer its phylogeny. We found that E. nordenskioldi is monophyletic and is split into two clades. The first one includes the pigmented genetic lineages widespread in the northern and western parts of the distribution, and the second one originating from the southern and southeastern part of the species' range and representing both pigmented and non-pigmented forms. We propose to split the E. nordenskioldi complex into two species, E. nordenskioldi and Eisenia sp. 1 (aff. E. nordenskioldi), corresponding to these two clades. The currently recognized non-pigmented subspecies E. n. pallida will be abolished as a polyphyletic and thus a non-natural taxon, while Eisenia sp. 1 will be expanded to include several lineages earlier recognized as E. n. nordenskioldi and E. n. pallida.

Morphotypes and genetic diversity of Dendrobaena schmidti (Lumbricidae, Annelida)

Dendrobaena schmidti (Michaelsen, 1907) is a polymorphic earthworm species from the Caucasus and adjacent regions. Adult D. schmidti individuals have highly variable body size (from 1.5 to well over 10 cm) and color (from dark purple to total lack of pigmentation), so a lot of subspecies of D. schmidti have been described; however, the existence of most of them is currently under dispute. We studied the genetic diversity of D. schmidti from seven locations from the Western Caucasus using mitochondrial (a fragment of the cytochrome oxidase I gene) and nuclear (internal ribosomal transcribed spacer 2) DNA. For both genes studied, we found that our sample was split into two groups. The first group included somewhat bigger (3–7.5 cm) individuals that were only slightly pigmented or totally unpigmented (when fixed by ethanol). The second group contained small (1.7–3.5 cm) specimens with dark purple pigmentation. In one of the studied locations these two groups were found in sympatry. However, there were no absolute differences either in general appearance (pigmented/unpigmented, small/big) or among diagnostic characters. Although the two groups differed in size (the majority of individuals from the first group were 5–6 cm long, and of the second one, 2–3 cm), the studied samples overlapped to a certain degree. Pigmentation, despite apparent differences, was also unreliable, since it was heavily affected by fixation of the specimens. Thus, based on the obtained data we can conclude that D. schmidti consists of at least two species that have identical states of diagnostic characters, but differ in general appearance.

THE HEPATOPROTECTOR ROPREN FOR THE TREATMENT OF PATIENTS WITH NONALCOHOLIC STEATOHEPATITIS: A PROSPECTIVE OBSERVATIONAL STUDY

OBJECTIVES

New and effective drugs to improve liver function and fibrosis are urgently needed for patients with nonalcoholic steatohepatitis (NASH). This study examines the effectiveness of treatment of patients with NASH with the registered heparoprotector, Ropren~ Methods. This observational study used Ropren? in a post-registration setting to treat 20 females (38-56 years) with chronic NASH unresponsive to standard treatment. Ropren? is a biopolymer made up of polyprenols (analogue of dolichol) isolated from the green verdure of spruce (Picea abies (L) Karst). Ropren? was given orally, three times a day (54 mg/day). Measurements before and after treatment included symptoms and blood biochemistry (triglycerides, high-density lipoproteins, low-density lipoproteins, alanine transaminase, aspartate transaminase, alkaline phosphatase and gamma-glutamyl-transpeptidase). Liver fibrosis was measured with indirect ultrasound elastometry.

RESULTS

After 12 weeks of Ropren? treatment, improvements were found for blood lipids and clinical and biochemical signs, including reductions in total cholesterol and triglycerides (p <0.05). Ropren® also significantly decreased the liver fibrosis index (p <0.05). No side effects were observed.

CONCLUSIONS

Ropren® treatment increased the elasticity of the liver and might be useful to reduce the risk of cirrhosis. Although the sample size in this study was small, the results demonstrated that a randomised-controlled trial of Ropren? for NASH is warranted.

A REVIEW OF INTERNATIONAL AND NATIONAL CLINICAL GUIDELINES FOR THE DIAGNOSIS AND TREATMENT-OF NONALCOHOLIC FATTY LIVER DISEASE

The review presents comparative characteristics of domestic and foreign clinical guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease.

[[The Pathogenetic Approaches to the Chronic Liver Diseases Treatment].]

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

Mitochondrial DNA variation in Eisenia n. nordenskioldi (Lumbricidae) in Europe and Southern Urals

There are many peregrine European earthworm species that are found in Siberia. In contrast, it is generally considered that the only Siberian species, E. n. nordenskioldi, was capable to disperse in the reverse direction, from Siberia into Europe. We studied genetic diversity of E. n. nordenskioldi in Southern Urals and Eastern Europe using the mitochondrial cox1 gene. We found that E. n. nordenskioldi from that region represents a new genetic lineage distinct from the previously known populations of this species from Siberia. Molecular clock estimates suggest that this newly found lineage separated from the rest of the species in Lower Pleistocene. Within the studied sample, we detected two geographically restricted groups, which also diverged long before the Holocene, one found in the East European Plain and the other restricted to the Urals. Those two groups were found in sympatry in only one population. Therefore, our results do not support the traditional viewpoint, suggesting that E. n. nordenskioldi is definitely not a recent invader in Europe.

[SUCCESSFUL ORTHOTOPIC LIVER TRANSPLANTATION IN A PATIENT WITH HEPATOLENTICULAR DISEASE AND FULMINANT HEPATIC FAILURE]

The article presents a clinical case of hepatolenticular disease in young man with rapidly progressive liver disease fulminant hepatic failure and successful emergency orthotopic liver transplantation.

[NONALCOHOLIC FATTY LIVER DISEASE: DIAGNOSTIC, SYMPTOMS, TREATMENT. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015]

According to the World Health Organization, it is recorded steady growth of the number of chronic liver diseases, including nonalcoholic fatty liver disease (NAFLD), in recent years. As an independent nosological entity, NAFLD is one of the risk factors for cardiovascular diseases, associated with abdominal-visceral obesity, peripheral insulin resistance (IR), and is regarded as the hepatic component of Metabolic syndrome (MS). Nowadays there are no generally accepted national standards for diagnosis and treatment of NAFLD for physicians, gen- eral practitioners, gastroenterologists in Russia. This was the essential reason in their development. The main reason of The guidelines development is the absence of generally accepted national standards for diagnosis and treatment of NAFLD for physicians, general practitioners, gastroenterologists in Russia. These guidelines are based on the global and local data of treatment experience of NAFLD, recently published in reviews, analytical studies in the literature. Guidelines are intended for physicians, general practitioners, gastroenterologists and contain the description of the preferred approaches to the provision of diagnostic, curative and preventive care of patients NAFLD. The quality of recommendations was grading according to the GRADE approach.

[AUTOIMMUNE LIVER DISEASES: CLINICAL FEATURES, DIAGNOSIS, TREATMENT. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015]

The group of liver autoimmune diseases (LAD) includes autoimmune hepatitis (AIH), Primary biliary cirrhosis (PBC) and Primary sclerosing cholangitis (PSC) The guidelines on clinical diagnosis and management of patients based on a review and analysis of recent publications on this topic in the global and domestic literature and on the authors'experience in treating patients with autoimmune liver disease.

[WILSON'S DISEASE (HEPATOLENTICULAR DEGENERATION, DYSTROPHIA HEPATOCEREBRALIS) DIAGNOSIS, TREATMENT AND DISPENSARY OBSERVATION. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015]

Wilson's disease (hepatolenticular degeneration, dystrophia hepatocerebralis)--a chronic, progressive disease with a genetically determined autosomal recessive mode of inheritance. The violence in metabolism of copper with its excessive accumulation in visceral organs and central nervous system is the basis of the disease. The guidelines on clinical diagnosis and management of patients based on a Review and analysis of recent publications on this topic in the global and Domestic literature and on the authors' experience in treating patients with Wilson's disease.

[Whipple's disease in a patient with infantile cerebral palsy and hepatitis B virus cirrhosis]

The paper describes a patient who has developed Whipple's disease in the presence of infantile cerebral palsy and hepatitis B virus cirrhosis. After 5-year treatment with co-trimoxazole (480 mg b.i.d.), the clinical manifestations subsided and PAS-positive macrophages were no longer detectable in the small intestinal mucosal biopsy specimens. Subsequent worsening of the patient's condition was associated with the progression of liver cirrhosis.

[Case of primary biliary cirrhosis combined with GERD and complicated by peptic strictures of the esophagus]

The clinical case of the two diseases combination such as primary biliary cirrhosis and peptic stricture of the esophagus (complicated GERD) in one patient is presented in the article.

[Celiac disease is a 33-year-old man with periodic disease]

The article presents a clinical case of a 33-year-old Armenian man, who suffered from two rare diseases: Familial Mediterranean fever and celiac. The diagnosis of Familial Mediterranean fever: abdominal-feverish form, is confirmed by genetic markers. The morphological study of duodenal mucosa's specimens confirms the celiac.

[Treatment of chronic viral hepatitis: achievements and prospects]

The review focuses on the current state of the problem of chronic viral hepatitis (CVH),B and C. Presents an analysis of the effectiveness of schemes of antiviral therapy (AVT) of chronic HCV-infection and current understanding of the treatment tactics of patients with inadequate response to therapy. Particular attention is paid to the nearest perspectives in treatment of chronic hepatitis C (CH C). The questions of the effectiveness of AVT chronic HBV-infection, the results of the comparative effectiveness of interferon (IFN) and nucleoside analogs (AN) in the treatment of chronic hepatitis B (CH B) are observed in the article. Special attention is paid to the treatment of chronic viral infections at the stage of liver cirrhosis (LC).

[Clinical significance of intravital morphological investigation of the liver]

AIM

To demonstrate great importance of intravital morphological examination of the liver for differential diagnosis of chronic diffuse diseases (CDD) of the liver.

MATERIAL AND METHODS

A complete clinical examination, needle or intraoperative biopsy of the liver were made in 1045 patients with chronic diseases of the liver. Structural features of hepatic tissue were studied histologically. Variational statistics was used for analysis.

RESULTS

Viral markers were detected in 373 patients (HCV in 53%, TTV in 10%, HBV in 16%, HGV in 6%, CMV in 3%). Chronic hepatitis (CH) was caused by combined viral infection in 12% cases. CH variants were verified morphologically in 64% patients with provisional diagnosis CH. Objective evaluation of structural changes severity rested on algorithms of semiquantitative determination of the index of histological activity and fibrosis index. Hepatic cirrhosis of viral or alcohol etiology was detected in 4.8%, primary biliary cirrhosis--in 11.2%, non-alcoholic fatty disease of the liver--in 11.2% patients. Impaired glucose tolerance is an essential factor predisposing to non-alcohol fatty disease of the liver. Detection of vacuole-like nuclei in periportal hepatocytes is an early morphological sign of the fatty disease. Three percent of the patients had signs of minimal portal cholangitis. This correlated with TTV detection.

CONCLUSION

Life-time morphological examination of the liver specifies activity and stage of the process in chronic hepatitis, confirms or detects abnormalities in hepatic architectonics, identifies clinically significant changes in cellular and intercellular components of hepatic tissue, detects and verifies rare hepatic affection. Such information is of importance for optimization of treatment policy and improvement of prognosis in CDD of the liver.

[Diagnosis and treatment of intrahepatic cholestasis in chronic diseases of the liver]

AIM

To improve diagnosis of intrahepatic cholestasis (IHC) basing on clinicobiochemical picture in chronic hepatic diseases (CHD) of different etiology with cholestasis and to develop a differential approach to treatment.

MATERIAL AND METHODS

We examined 875 CHD patients with IHC with evaluation of the levels of the enzymes, biliary acids (BA), lipids, characteristics of hemostasis and phosphocalcium metabolism in blood. We also studied correlations and changes of the above parameters in IHC of different etiology. A comparative analysis of efficacy of mono- and combined treatment of CHD patients with IHC was made.

RESULTS

We revealed correlations between the levels of the enzymes, bilirubin, lipids and BA concentration in blood serum; unfavourable prognostic value of aggravating cholemia; no correlations between content of serum BA, duration of IHC and intensity of skin itching (SI). We propose to establish "the degree of IHC severity" with 4 degrees of this severity. Characteristics of impairment of hemostasis and phosphocalcium metabolism in IHC of different etiology depending on the degree of IHC severity are presented. Efficacy and universality of combined treatment with ursodeoxicholic acid and ademetionin in moderate and severe IHC of different etiology are shown.

CONCLUSION

Introduction of the definition "the degree of IHC severity" allowed us to classify IHC by severity. This enables adequate assessment of the patient's condition, prognosis the risk of complications and their severity, a differential approach to treatment and, finally, improvement of the disease outcome prognosis.

[Difficulties in vivo diagnosis of mucinous adenocarcinoma of vermiform appendix with metastasis in the navel]

The article presents a clinical case of mucinous adenocarcinoma in vivo diagnosis of vermiform appendix with metastasis in the navel. Neoplasms vermiform appendix--an extremely rare tumor pathology: the total share of all malignant tumors are less than 1%. Mucinous carcinoma is a rare tumor, according to various authors the frequency of its occurrence ranges from 3 to 10% of all malignancies. By Localization mucinous carcinoma more frequently is found in the colon and rectum (about 20% of cases), ovary (5-10% of all malignant ovarian tumors), stomach, uterus and also in the pancreas (only about 2%). Metastasis in the navel is a very rare disease and is known as Sister Mary Joseph's Nodule, the primary site often localized in the digestive tract (52%), much less--in the female reproductive organs (28%), unspecified localization is approximately 15-20% of cases. The difficulty of diagnosis in the present case was that, in spite of life conducted during survey of the colon, organic pathology was not identified. The presence of hepatosplenomegaly and ascites at the initial examination gave cause to the erroneous diagnostic conception of the presence of liver cirrhosis. It is also was not paid due attention to the presence of changes in the umbilical ring, which were regarded as an umbilical hernia. To verify the diagnosis allowed the infiltrate biopsy of the umbilical region, followed by histological examination of the preparation and identification of a characteristic picture of mucinous cancers.

[Generalized B-cell lymphoma, marginal zone masked by chronic liver disease]

This article describes a case of diagnosis of generalized B-cell lymphoma of marginal zone cells, which debuted with hepatolienal syndrome. Presented the latest information on etiology, pathogenesis, clinical manifestations, diagnostic methods and treatment of non-Hodgkin's lymphoma.

[Features of the HCV-infection in the elderly patients]

The problem of chronic HCV-infection in the elderly patients is poorly known. During the HCV-infection and progression of fibrosis in chronic liver diseases depends on age of the patient.

[3rd place in the competition of scientific work in hepatology in 2010. Treatment of patients with overlap of primary biliary cirrhosis and autoimmune hepatitis]

This paper analyzes the results of different treatments overlap (OS) of primary biliary cirrhosis (PBC) and autoimmune hepatitis (AIH): ursodeoxycholic acid monotherapy (UDCA) monotherapy with prednisolone (PD), the combination of PD with UDCA. Results of treatment of 16 OS patients with glucocorticoid last generation--budesonide (BS) in combination with UDCA. The treatment results were estimated in reducing severity of intrahepatic cholestasis (IHC), proposed by the author, as well as the degree of reduction of the biochemical activity of enzymes. Evaluated the quality of life by SF-36 questionnaire. In addition, the efficacy of budesonide in combination with UDCA was assessed by morphological examination of liver tissue in the dynamics after 6 months of treatment. The paper convincingly demonstrate that combination therapy OS is more effective in monotherapy reducing clinical and biochemical disease activity, as well as positive effects on quality of life. The advantages of the use of budesonide in combination with UDCA prior systemic glucocorticoids: a high efficiency and low risk of side effects.

[Various mechanisms of heart failure in liver diseases]

The article is a review of the literature on the problem of heart disease in liver cirrhosis of different etiologies (alcohol, amyloidosis, hemochromatosis, viral lesions of the heart). Examined in detail the pathogenesis of cirrhotic cardiomyopathy and diagnosis, occurring in cirrhosis of any etiology. This article presents a noninvasive methods of diagnosis of myocardial fibrosis using serum markers of fibrosis, myocardial fibrosis degree of calculation on the basis of echocardiography and ECG.

[Realities and prospects for the use of cell technologies for the treatment of chronic diffuse liver diseases]

Chronic liver disease (CLD) leads to disability annually hundreds of thousands of patients worldwide. Originating as a rule, at a young age (20-40 years), they are always significantly degrade the quality of life of patients, making them socially significant. Moreover, the conventional treatment (hepatoprotectors, antiviral drugs, corticosteroids, immunosuppressive medication) not always lead to achieving the desired effect, and therefore is constantly searching for alternative treatments. Cell therapy with embryonic fetal, mononuclear, mesenchymal stromal cells is the most advanced front of modern biotechnology and medicine. Using the SC with the purpose of treatment in chronic liver diseases is the possibility of disturbed regulation of cell-cell interactions in the liver, the impact on the mechanisms of cell death (necrosis - apoptosis) and fibrogenesis, which makes this method the most relevant and promising in hepatology. The article presents an analysis of the results of studies conducted in the field of stem cell technologies by leading domestic and foreign scholars in the treatment of liver diseases. Were studied questions of transdifferentiation, the mechanisms of stem cells in hepatology, as well as the possible risks of this therapy (pro-oncogene action, increased fibrosis). Also was presented our own experience of applying cellular technology in experimental models of acute toxic hepatitis in animals.

[The state of the vascular bed of the small intestine in patients with portal hypertension]

AIM

To evaluate the condition of vascular channel of small bowel in patients with portal hypertension.

MATERIALS AND METHODS

We examined 60 patients from 17 to 70 years, 30 with cirrhosis of different etiologies and 30 with other gastrointestinal diseases, amounted control group. Patients were divided into 2 groups: the main and control: group 1--primary--patients with cirrhosis and portal hypertension. Group 2--control--patients without liver disease and portal hypertension who underwent videocapsule endoscopy.

RESULTS

On the results of research, we can conclude that all patients with liver cirrhosis and portal hypertension have various vascular changes of small bowel. We examined patients in the course of the work revealed the following: 1. Varicose vein expansion and increased vascular pattern in 70% of patients. 2. Arteriovenous malformation in 12% of patients. 3. Angiodisplaziya 11%. 4. Delafua defect in 4%. 5. Bleeding in 3%. The combination of vascular disease in patients with liver disease and portal hypertension syndrome accounted for 70%. In the control group of patients vascular channel pathology dated only in 2% of cases in the form of strengthening of vascular pattern of small bowel.

CONCLUSION

Videocapsule endoscopy is a highly informative diagnostic method for assessing the condition of vascular channel of the intestine in patients with portal hypertension. Carrying out videocapsule endoscopy is highly effective and comfortable for patients, which greatly improves their quality of life. Timely detection of vascular disease in patients with portal hypertension using videocapsule endoscopy can prevent such severe complications as gastrointestinal bleeding especially from the deep divisions of bowel which are not available to other research methods.

[Intrahepatic cholestasis in chronic liver diseases]

The syndrome of cholestasis is a common manifestation of chronic liver disease (CLD) of any etiology: alcoholic, viral, drug, metabolic, etc. The basis of the formation of cholestasis is a violation of the synthesis, secretion or bile outflow. Accession intrahepatic cholestasis (field surgery) for chronic liver disease alters its course, aggravates the condition of the patient, reduces the immune system, leads to development of severe septic complications, significantly reduces the quality of life (QoL) and worsens the prognosis. In published data, as well as the results of original research aimed at improving the diagnosis and treatment of syndrome of field surgery. Was given the definition of the severity of field surgery, defined the criteria for severity, identified the severity of field surgery. Clarified the influence of field surgery in the state of the plasma level of coagulation, as well as the phosphorus-calcium metabolism in CLD of various etiologies. The advantages and versatility combined antiholestaticheskoy field surgery therapy for moderate and severe degree of different etiologies. An algorithm for treatment of field surgery, suggesting a differential approach to therapy depending on the severity of field surgery.

[The diagnostic significance of ultrasound elastometry in evaluation of fibrosis in chronic diffuse liver diseases]

THE PURPOSE OF THE STUDY

Determination of the diagnostic value of ultrasound elastometry of liver (UEL) in the assessment of liver fibrosis in patients with chronic diffuse liver diseases (CDLD).

MATERIAL AND METHODS

The study involved 316 patients with various etiologies of the CDLD, with the underwent both liver biopsy, the UEL, and evaluation of fibrosis (F) according to the Metavir classification.

RESULTS

The maximum diagnostic accuracy of the UEL was obtained in determining of the 4-th stage of fibrosis according to the Metavir. The accuracy of the method was 91% with a sensitivity of 100%. The lowest sensitivity of the UEL determined in patients with nonalcoholic fatty liver disease (NAFLD): F1 - 25%, F2 - 33%, F3 and F4 - 50%. The High body mass index (BMI = 30,1 +/- 3,8 kg/m2) is a factor which is limiting the use of elastometry for patients NAFLD. The low sensitivity for F1 and F2 - 14,3% and 10%, respectively, 100% for F4, with a BMI = 24,4 +/- 5,1 kg/m2 was obtained in primary biliary cirrhosis (PBC). In the alcoholic liver disease (ALD) obtained high sensitivity (100%) for F2 and F4. In the CDLD of viral etiology the sensitivity of UEL was 33-71,4% in the early stages of fibrosis (F1 and F2) with high specificity - 100% and 93.5% respectively.

CONCLUSION

The use of the UEL allows the diagnosis of fibrosis in chronic liver diseases of different etiologies as an alternative to needle biopsy of the liver.

[Capillary collusion of gastric mucosa in patients with Helicobacter pylori gastritis and portal hypertension]

INTRODUCTION

Prominent mucosal vasodilatation mediated by increased production of nitric oxide is thought to be manifestation of portal hypertensive gastropathy (PHG) in patients with chronic diffuse liver diseases. Recently was shown that Helicobacter pylori (Hp) infection could stimulate nitric oxide activity.

AIM

To investigate if chronic Hp infection is involved in development of gastric mucosal capillary dilatation in patients with PHG.

METHODS

The study was performed on 56 patients with PHG evaluated by upper endoscopy. The gastric biopsy was obtained from antrum and corpus. Hp status was assessed by rapid urease test and histology. Gastric mucosal capillary network (GMCN) assessed on histological sections immunostained for CD34, specific marker for endothelial cells. Nikon-CP995 camera and digital image analyzing system (DMI-1) was used for morphometry.

RESULTS

Marked vasodilatation was observed in antrum mucosa of Hp- patients with PHG and Hp+ patients without PHG (p < 0.05), relative volume of vessels was also increased, but number of vessels was not changed significantly. The relative volume and number of vessels in corpus mucosa were significantly higher in Hp- with PHG and Hp+ without PHG (p < 0.01). The mean size of vessels in corpus mucosa was decreased in Hp- with PHG (p < 0.05), but was not changed in Hp+ patients. Morphometric parameters in Hp+ with PHG was not changed significantly as compared to Hp+ without PHG or Hp- patients.

CONCLUSION

Hp provokes the same morphometric changes in GMCN as PHG. Hp may be one of factors important for regulation of GMCN function and structure. No additive effect between Hp infection and PHG on GMCN was observed in patients with PHG.

[Effectiveness of the new plant hepatoprotector--Ropren in patients with non-alcoholic steatohepatitis]

Liver damage causes serious metabolic disorders, immune response, detoxification functions and antimicrobial protection. Therefore, the problem of finding new high effective drugs for the restoration and normalization of liver function is extremely urgent. This article presents a new domestic plant hepatoprotector Ropren, which is a biopolymer polyprenols isolated from the green of pine and spruce, and an analog of the endogenous lipid--dolichol. Presented the Ropren efficiency in patients with nonalcoholic steatohepatitis. The drug reduces the clinical and biochemical disease activity, contributes to the normalization of lipid profile. The resulting decrease in the index treatment of fibrosis, determined by indirect transient elastometry, indicates an increase in the elasticity of the liver and reducing the risk of developing cirrhosis.

[Liver fibroelastometria in the elderly patients]

AIM

To reveal the influence of age-related changes in the liver and elasticity according to fibroelastometria to determine the effectiveness of this method in the diagnosis of liver fibrosis in chronic diffuse liver diseases in the elderly patients.

MATERIALS AND METHODS

The study included 431 patients with chronic diffuse liver diseases (HDLD) aged 60 to 74 years. Of these, 56 patients had chronic liver disease. All patients underwent comprehensive clinical, instrumental and laboratory examination, indirect ultrasonic liver elastometry (fibroelastometria).

RESULTS

All patients were identified in 5 groups (g): I gr. had HDLD viral etiology (n = 84), II gr--alcoholic etiology (n = 38), III gr.--non-alcoholic fatty liver disease (NAFLD) (n = 206) - IV gr.--chronic cholestatic hepatitis and primary biliary cirrhosis (n = 38), V gr. (n = 65), patients that after full thorough examination of data for chronic liver disease hadn't received. According to the results of fibroelastometria elasticity of the liver in group V corresponded to METAVIR F0 and amounted to 4.9 +/- 1.3 kPa. The highest efficiency of liver fibroelastometria was obtained in the determination of stage 4 fibrosis METAVIR in I-IV grams, while the accuracy of the method was 92% with a sensitivity of 100%.

CONCLUSION

Age-related changes in the liver in the absence of HDLD in elderly patients have no significant effect on its elasticity. The obtained data allow to evaluate the results of liver fibroelastometria in elderly patients with various etiologies of HDLD on the same criteria as for patients of younger age groups.

[Features of the course of chronic liver disease in the elderly patients]

Chronic liver disease (CLD), often occurring with blurred symptomatic occupy not the last place in the morbidity of the elderly patients. We systematized the available literature data on the peculiarities of the morphological structure of the liver and its functional status in persons over age group, presented results of their research. Established that the incidence of CLD in patients with elderly reaches 2%, while long-term asymptomatic disease in 15.4% of patients with minimal clinical manifestations--in 46% of cases. The high (29.9%), the frequency of infection of hepatotropic viruses in the elderly. During 4 years of observation of the natural history of HCV-infection in elderly formation of CP was observed in 7.3% of patients, hepatocellular carcinoma (HCC)--in 5.1% of cases. Monotherapy with interferon-alpha (IFN-alpha) within 3 months older accompanied by a decrease of biochemical activity in 60% of cases, the development of early virological response--in 33.3% of sustained virological response--in 6.7%. The incidence of side effects (depressed mood--40%, depression--20% change in hematological parameters--26.7-40%) was higher than in young patients. The use of ursodeoxycholic acid (UDCA) at a dose of 12-15 mg/kg/day for 3 months in elderly patients (n = 25) with chronic HCV-infection in the 70.6-80% of the cases resulted in significant reduction in biochemical activity, as well as asthenic severity, pain and dyspeptic syndromes.

[Polyvirus hepatitides (prevalence, diagnosis, characteristics of virusological process)]

AIM

To ascertain prevalence of chronic hepatitides (CH) of polyvirus etiology and to characterize a course of such polyvirus CH.

MATERIAL AND METHODS

A total of 15000 patients with chronic diseases of the liver (CDL) of different etiology were examined for markers of hepatotropic viruses, 312 patients with CH aged 18-59 years were examined clinically, biochemically, virusologically and morphologically.

RESULTS

CH of polyvirus etiology are rather prevalent. A replicative form of HBV has a significant effect on the activity of the pathological process in mixed hepatitis. Incidence of chronic HBV and HCV infection rises with age. Viral hepatitis A in drug addicts runs an atypical course.

CONCLUSION

Adequate epidemiological analysis, diagnosis and antiviral treatment, follow-up of CDL of mixed viral etiology, monitoring of drug addiction, healthy life style are able to reduce prevalence of mixed hepatitis.

[Current understanding of primary biliary cirrhosis]

AIM

To examine characteristics of the course of primary biliary cirrhosis (PBC).

MATERIAL AND METHODS

The study of 150 PBC patients aged 26-82 years used clinical, biochemical, immunological and morphological methods.

RESULTS

Antimitochondrial antibodies of type M2 (AMAM2) were detected in 85.4% patients with PBC. A positive correlation was found between clinicobiochemical activity of the disease and number of AMAM2. AMAM2-positive patients more frequently had extrahepatic manifestations, overlap syndrome, higher biochemical and immunological activity vs AMAM2-negative patients.

CONCLUSION

The following variants of PBC course were identified: classic AMAM2-positive, AMAM2-negative, overlapping of PBC and autoimmune hepatitis. Concentration of AMAM2 has diagnostic and prognostic value in PBC.

[Cytokines in primary biliary cirrhosis (diagnostic and prognostic value)]

AIM

To study concentrations of serum pro- and anti-inflammatory cytokines (CK), CK correlations with clinicobiochemical activity, diagnostic and prognostic implications in primary biliary cirrhosis (PBC).

MATERIAL AND METHODS

Enzyme immunoassay has been used to study content of IL-1 beta, IL-4, IL-6, IL-8, TNF-alpha, INF-gamma in peripheral blood of 96 women aged 26 to 82 years (mean age 56.2 +/- 12.6 years) with PBC (kits "Protein Contour", "Cytokine", St-Petersburg). The control group consisted of 20 healthy women matched by age.

RESULTS

PBC is associated with changes in serum CK content correlating with the disease activity and stage. Elevated levels of proinflammatory IL-6, TNF-alpha, INF-gamma and anti-inflammatory IL-4.

CONCLUSION

Definition of the cytokine spectrum in PBC has made a prognostic significance as it allows judging about the disease activity, stage and prognosis.

Peripheral blood lymphocytes DNA in patients with chronic liver diseases

AIM: Of this investigation is to reveal the damage to peripheral blood lymphocytes (PBL) DNA in the patients with chronic liver diseases.

MATERIALS AND METHODS: Sixteen-nine patients with chronic liver diseases (37 patients with chronic viral hepatitis, 2 patients with liver cirrhosis of mixed etiology (alcohol + virus G), 30 women with primary biliary cirrhosis-PBC) were examined. The condition of DNA structure of PBL was measured by the fluorescence analysis of DNA unwinding (FADU) technique with modification. Changes of fluorescence (in %) reflected the DNA distractions degree (the presence of DNA single-stranded breaks and alkalinelabile sights).

RESULTS AND CONCLUSION: The quantity of DNA single-stranded breaks and alkalinelabile sights in DNA in all patients with chronic viral hepatitis didn’t differ from the control group, excluding the patients with chronic hepatitis (CH) C + G. Patients with HGV and TTV monoinfection had demonstrated the increase of the DNA single-stranded breaks PBL quantity. This fact may be connected with hypothesis about the viruses replication in white blood cells discussed in the literature. Tendency to increase quantity of DNA PBL damages in the patients with primary biliary cirrhosis (PBC) accordingly to the alkaline phosphatase activity increase was revealed. Significant decrease of the DNA single-stranded breaks and alkalinelabile sights in the PBC patients that were treated with prednison was demonstrated. Probably, the tendency to increase the quantity of DNA single stranded breaks and alkalinelabile sights in lymphocytes of the PBC patients was depended on the surplus of the blood bile acid content.