Th e article presents a literature review on the problems of diagnosis and treatment of patients with liver cirrhosis complicated by portal hypertension, in light of the historical development and current capabilities. Special attention is paid to issues of hemostasis in these patients, namely the combination of Hypo- and hypercoagulation, searches require a special approach to drug therapy and choice of surgical treatment method.

This review reviews the efficacy and safety of therapy with tyrosine kinase inhibitors and pyrphenidone in idiopathic pulmonary fibrosis. The results of randomized trials of recent years are described in detail. The efficacy of taking tyrosine kinase inhibitors at the following key research points is considered: the annual rate of decrease in vital capacity of the lung, a 6-minute walk test, the quality of life of the patient, and the frequency of exacerbations. Systematic literature search was carried out on the databases Scopus, Web of Science, MedLine, elibrary and others.

Objective: the evaluation of the role of C–peptide and modified HOMA–index in different carbohydrate metabolism disturbances (CMD) during glucocorticoid therapy. Materials and methods: 193 patients were included: 63 patients with systemic lupus erythematosus (LE), 45 – with systemic vasculitis (SV); 76 – with chronic glomerulonephritis (CGN). 98 patients received glucocorticoid pulse–therapy (GC–PT) (1 course of 3 sessions) and 95 received oral GC. All patients underwent standard clinical and laboratory tests, glucose tolerance test (GTT), С–peptide evaluation, also HOMA–IR and HOMA–islet indices were calculated. Results: oral GCT revealed increased prevalence of CMG (impaired fasting glucose (IFG), impaired glucose tolerance (IGT), diabetes mellitus (DM)) in patients receiving oral GC compared to patients receiving GC–PT. Patients in both groups with DM and IFG demonstrated higher levels of C–peptide, OGTT and HOMA–IR index before treatment compared to patients without CMD and IFG, which confirms the presence of insulin resistance in that group of patients. Patients with DM had a decreased secretory beta–cell function, which was characterized by a decrease of HOMA–islet index. Conclusion: CMD occur more oft en in patients, receiving oral GC compared to GC–PT. HOMA–IR index can be utilized as a prognostic marker of CMD in patients receiving intensive GC therapy and prolonged oral GC therapy.

Objective: to study the tolerance of radiotherapy by adding the boost and the xenon-therapy during the whole brain radiotherapy (WBRT) in patients with single brain metastasis. Materials and methods: the study involved 60 patients divided in the 3 equal groups (20 people in each group) where the treatment varied according the methods of the adjuvant radiotherapy. The patients in the first group were assigned to receive WBRT alone, in the second group — WBRT and the boost to tumor bed, in the third group — WBRT and the boost in combination with the xenon-oxygen inhalations. The quality of life, the toxic and adaptation reaction, the psychological status and the electrical activity of the brain during the treatment were also included in the research. Results: the increase of side-effects of the treatment and the quantity of stress-reactions occurred during WBRT in combination with the boost. But the use of xenon allowed to level all the negative reactions and even to improve some of physiological and psychological parameters. The xenon-oxygen inhalations led to the decrease of intensity of situational anxiety and depression. There was also a reduction in delta-activity level according to EEG and a return of the other rhythms to baseline levels which was lacking in the other groups. Conclusions: the use of the xenon-therapy in combination with WBRT by the developed methods allows to improve the quality of life in patients with radiation treatment, as well as to reduce the degree of the intensity of side and toxic reactions. The results of objective methods at the trial demonstrate the stresseless and radioprotective effects of xenon.

Objective: analysis of the type-specific prevalence of high-risk HPV in dependence on gender, age, the presence of cancer. Material and methods: 424 patients of the RRIO were examined. Urogenital smears in women and in men, urine in men were tested for HPV DNA using PCR. Results: The relative share of HPV-positive patients was 34.4% in women and 39.9% in men. The percentage of HPV-positive patients decreased in older women and increased in men. HPV was registered more oft en in women younger than 25 and older than 45 years old and in men aged 26-45 years. Multiple-type HPV infection was registered more oft en in young patients. HPV 16 was the most prevalent in men and women; next most prevalent types were HPV 31, 52, 18 and 56 in women and HPV 52, 56, 45 and 18 in men. HPV 51 was found in women only. HPV infections were registered in cancer patients 1.9 times more oft en than in patients with inflammatory diseases. A high viral load prevailed in women with cancer; viral load with varying clinical significance was equally frequent in patients with inflammatory diseases. Combinations of simultaneous infection with HPV and STI agents in women with cancer amounted to 70.6% of the total number of STI-positive patients and 41.5% in women with inflammatory diseases, in men – 66.7% and 38.1%, respectively. Conclusions: The obtained results allowed to reveal gender and age differences in the HPV prevalence in dependence on gender, age and the presence of cancer.

Objective: lymph node metastases occur in 90% of cases in patients with gastric adenocarcinoma, and survival is less than 15% in the late stages of disease. Therefore, the purpose of the study was to screening markers for predicting the likelihood of metastases developing in gastric adenocarcinoma. Materials and methods: for the study 47 patients with diagnosis of gastric adenocarcinoma were used (with the localized tumor form T3-4N0M0 (n = 18) and the locally distributed form T3-4N1-3M0 (n = 29)). The copy number variation of 16 genes (APC, AURKA, CCND1, C-MYC, GKN1, HER2, IRX1, MDM2, MET, NFKB, OCT1, P53, PIK3CA, POU5F1B, S6K2 and HV2) was determined by RT-PCR. Immunohistochemical studies were performed on sections of paraffin blocks using monoclonal antibodies to p53, Bcl-2, Ki-67 and Her2. Results: the loss of duplicity of HV2 locus was most frequent CNV in samples of stomach adenocarcinoma, but CNV significant change in the T3-4N0M0 group relative to T3-4N1-3M0 was not detected. A significant increase of CNV in the T3-4N1-3M0 group relative to T3-4N0M0 was found in 2 of 16 loci - NFKB and HER2 in 1.75 and 1.90 times (p<0.0005), respectively. Th e value of p53 expression in the tumor cells nuclei in the group without metastases was lower by 52% compared to the expression in the metastatic group (p<0.05). Low proliferative activity prevailed in the group without metastases in contrast to the group with metastases, in which Her2 overexpression was also observed in 43% of cases in contrast to 20% of cases in the group without metastases. Conclusions: it was showed that the relative copies number of NFKB1 and HER2 in combination with the immunohistochemical parameters of Ki67 and HER2 in gastric tumors can be a prognostic marker of metastasis, and algorithm for predicting metastases development in gastric adenocarcinoma is formed on basis of this.

Objectives: immunohistochemical study of the expression of molecular and biological markers (p53, bcl-2 and ki-67) in esophageal tumors of various stages and grades, and evaluation of the markers in the disease prognosis. Material and methods: the study included 30 patients of a retrospective group with stage II-III squamous cell carcinoma of the esophagus. Immunohistochemical study of paraffi n sections was performed using primary mouse monoclonal antibodies against p53, bcl-2 and ki67, and Reveal Polyvalent HRP-DAB Detection System. Results: diff erences in the rates and expression of molecular and biological markers (p53, bcl-2 and ki-67), controlling apoptosis and proliferation, depended on the tumor stage and grade. Conclusions: fdvanced cancer of the esophagus demonstrated an increase in rates and expression of p53+ and ki-67, as well as in the proliferative activity of tumor cells. Bcl-2 expression was more frequent and intensive in stage II tumors, compared to stage III. Esophageal tumors of higher grades were characterized with higher rates and expression of p53 and ki-67, and conversely for the bcl-2 expression. Th e revealed diff erences can be used in the disease prognosis.

Objective: the aim of the study was to investigate laboratory markers of inflammation in patients with stable ischemic heart disease, to estimate their interrelation with symptoms of depression. Matherials and methods: 46 men aged from 46 to 75 years hospitalized for the conservative (n = 20) and surgical (n = 26) treatment of ischemic heart disease participated in the study. An evaluation of inflammatory markers (absolute quantity of leukocytes and neutrophils, monocyte/HDL ratio and neutrophil/lymphocyte ratio) was performed. Depressive symptoms were measured using the CES-D scale. Conclusions: symptoms of depression were found in 8 patients (17,37%). 13% of them had symptoms of mild depression, 4,37% - symptoms of severe depression. The monocyte/HDL ratio was significantly higher in patients with ischemic heart disease comparing to healthy individuals. The monocyte/HDL ratio was significantly increased in patients with depressive symptoms, previously implanted stent, restenosis of the coronary stent in anamnesis. Level of leukocytes was higher during the early period after the procedure of percutaneous coronary intervention with stenting and in patients with stent restenosis. Number of neutrophils and the neutrophil/lymphocyte ratio were significantly higher in patients with depression symptoms, during the early period after stent implantation and also with previous restenosis of the stent. Systemic inflammation estimated using routine laboratory tests was significantly higher in both patients with complicated ischemic heart disease, and with symptoms of depressive disorder. Routine laboratory indicators can be informative in assessing inflammation in patients with ischemic heart disease. Symptoms of depression and stent restenosis can be followed by increased inflammatory markers.

Objective: to assess the influence and eff ectiveness of multimodal anesthesia and analgesia from the standpoint of personalization of compensatory mechanisms of blood circulation adaptation in oncogynecologic patients in the postoperative period. Materials and methods: a study was conducted in patients who underwent surgical interventions on pelvic organs for oncogynecological diseases. The total number of patients was 39 people. Based on anesthesia with sevoflurane at low concentrations and spinal analgesia, all patients underwent multimodal anesthesia. To determine the nature of the functioning of the circulatory system, the adaptive potential was determined by the index of functional changes. For the relief of pain syndrome in patients in the postoperative period, the administration of ketoprofen and nefopam hydrochloride, used according to the doctor’s prescription or in the patient-controlled analgesia mode, as well as the regional blockade of the nerves innervating the anterior abdominal wall (Transversus Abdominis Plane block) was provided. Results: it was revealed that multimodal anesthesia and analgesia, depending on the level of the adaptation potential, differently affects the adaptation and regulatory mechanisms of the systemic circulation of patients, and its vegetative tone, which can cause the risk of complications in the postoperative period. Conclusions: multimodal anesthesia and analgesia, including a combination of central, regional non-narcotic analgesics and blockades, allows to preserve the reserves of systemic circulation and optimize its vegetative component, is effective and safe in oncogynecologic patients with the stress of regulatory mechanisms of adaptation. The use of multimodal anesthesia and analgesia in oncogynecologic patients with unsatisfactory adaptation is a risk factor for the disruption of the regulatory and compensatory mechanisms of hemodynamics and the vegetative tone of the systemic circulation, contributing to the limitation of its work in the first 24 hours of the postoperative period.

Objective.  Creation of portosystemic shunts (TIPS operation) leads frequently to aggravation of hepatic encephalopathy (HE). Aim of the study is to improve results of prophylaxis and treatment of HE after TIPS procedure in patients with complications of portal hypertension due to liver cirrhosis.

Material and Methods. 207 patients underwent TIPS procedure in our clinic in 2007-17. Indications for TIPS placement were life-threatening complications of portal hypertension: variceal esophageal bleeding (in 156) and refractory ascites (in 51). Patients were divided in 3 groups comparable by main clinical characteristics. Indexes of portal hemodynamics, such as pre- and post-TIPS blood pressure in portal vein, and portosystemic gradient (PSG) were studied.

Results. Overall, post-TIPS HE within 6 weeks was different in each of 3 groups: 29,3% at 1^st, 18,8% at 2^nd, 13,2% at 3^rd as result of individual algorithm of treatment based on intensive measures of complex treatment at 2^nd and 3^rd groups. High prognostic value of pre-TIPS PSG more than 18 mm Hg and difference between pre- and post-TIPS PSG more than 8 mm Hg was established. It required more intensive therapy in 2^nd and 3^rd groups which resulted

Objective: the work purpose is improvement the quality specialized medical care for newborn with a birth trauma of a skeleton. Materials and methods: surveyed 34 full-term newborns with perinatal damage of the skeleton, which were treated in the department of surgery (Voronezh) for newborns from 3 years. Among them 12 (35 %) children with fractures of the humerus, 2 (6 %) femur fractures, 20 (59 %) with fractures of the clavicle. Used clinical methods are: assessment of the local status, blood pressure and pulse rate, hourly urine output, assessment of pain syndrome pain scale NIPS, laboratory methods (general analysis of blood and urine, acid-base balance), radiation (x-rays, ultrasound of the brain), instrumental (ECG). Results: the main symptoms in long bone fractures are a swelling in the projection of the fracture, limitation of motion; fractures of the clavicle – crepitus, limitation of motion of the upper limb. 19 (56 %) of patients had systolic blood pressure; tachycardia in 25 (74 %), bradycardia in 3 (9 %). The decrease in hourly urine output was noted in one case in a patient with femur fracture (0.8 ml/kg/h). All newborns experienced pain, while 19 (56 %) – severe pain (7-10 on the scale NIPS), 5 (15 %) – moderate pain (4-6 points), 10 (29 %) - mild pain (0-3 points). Distribution leukocytosis – 13 (38 %), metabolic acidosis in 10 (29 %) children. Fractures of the clavicle on radiographs in 14 (41 %) — fracture in the middle third with displacement, 1 (3 %) — bilateral fracture of the clavicle without displacement, 5 (15 %) — fracture of the middle third without displacement; trauma femur 2 (6 %) fracture in the middle third of the right femur with displacement along the length; the trauma of the humerus — 4 (12 %) fracture in the middle third with displacement along the length of, 8 (24 %) — fracture in the middle third without displacement. According to the ECG, the majority noted the shortening of the electrical systole, increasing systolic index. Conclusion: the taped changes from cardiovascular system according to clinical data of the central hemodynamics, an ECG and also indicators of a pain syndrome at newborns with a birth trauma of a skeleton confirm need of an integrated approach to diagnostics and treatment of little patients.

Objective: to study the effect of intraluminal coronary shunts to immediate results of surgical treatment of ischemic heart disease in patients at high surgical risk with a reduced fraction of left ventricular ejection. Materials and methods: a retrospective analysis of case histories of 96 patients with coronary heart disease and decreased ejection fraction of the left ventricle who underwent surgery coronary artery bypass grafting. The patients were divided into 2 groups: the study group included 47 patients operated in the parallel artificial blood circulation, which when performing the distal anastomoses used temporary intracoronary shunts; the control group comprised 49 patients, also operated in the parallel artificial blood, but when performing distal anastomoses did not use intracoronary shunts. Monitoring of patients was performed until 12 months after surgery. Results: both groups of patients were matched for clinical and demographic indicators. In the analysis of intraoperative and postoperative period revealed the difference in the incidence of cardiac arrhythmias, other parameters were comparable. Conclusions: thus, in patients with reduced ejection fraction left ventricular intracoronary shunts is advisable to use for reasons and not in all cases, operations myocardial revascularization in the parallel artificial circulation.

Jaundice is one of the most frequent metabolic disorders detected in the newborn period. Neonatal jaundice is most likely to be physiological, it is a transient condition and does not require treatment, at the same time it can be a symptom of a serious disease which requires diagnosis and therapy. It is presented a clinical case of conjugational jaundice in newborn from mother with diabetes, with manifestations of hemorrhagic disease. The peculiarity of this case is a complicated course of this disease with hypoxic lesions of the central nervous system and partial intestinal obstruction. In this observation it is shown the effectiveness of the therapy with early diagnosis of the disease and the complications before the appearance of the developed clinical picture.

Clinical observation of an aneurysm of the left ventricle in a patient of 39 years is presented. A feature of this case is the young age of the patient and the large size of the aneurysm of the left ventricle. Currently, treatment of this disease should include both therapeutic and surgical methods of treatment. The preferred surgical method of treatment is the LV plasty according to Dora. In this observation, clinical improvement of the patient’s condition after surgical treatment was noted.