[Long-term probiotic administration for irritable bowel syndrome: a legal need].

BACKGROUND: Irritable bowel syndrome (IBS) is one of the most common functional diseases of the gastrointestinal tract. Violations in the intestinal microbiocenosis play a significant role in the pathogenesis of this suffering. The probiotic strain Bifidobacterium longum 35624® has a strong evidence base for use in the management of patients with IBS. The duration of probiotic therapy and the need for repeated courses of probiotics require further study, which determined the need for this observational study. AIM: To compare the results of prolonged (12 weeks) and usual duration of courses of probiotic Bifidobacterium longum 35624® in patients with IBS. MATERIALS AND METHODS: 42 patients with a verified diagnosis of IBS of moderate and severe severity who met the inclusion criteria were recruited into the study. Patients were prescribed probiotic Bifidobacterium longum 35624® at a dose of 1 capsule (1×109 CFU), 1 time per day for 12 weeks. The course of the disease was assessed using the visual analogue scale, visceral sensitivity index (VSI), IBS symptom severity scale (IBS-SSS), quality of life indicators were assessed using the IBS-QoL questionnaire scales. Evaluation of indicators was carried out at the inclusion visit, on days 14, 28, 56, 84 of probiotic intake and on day 112 (28 days after the last dose of Bifidobacterium longum 35624®). RESULTS: The results obtained confirmed the ability of the probiotic Bifidobacterium longum 35624® to positively influence the course of IBS. The addition of the main therapy with a probiotic made it possible to achieve a significant decrease in the severity of abdominal pain, bloating, and stool disorders. The severity of IBS significantly decreased according to the results of IBS-SSS. Reliable positive dynamics of indicators on the scales IBS-QoL, VSI is shown. The most pronounced changes were observed by the end of the third month of taking Bifidobacterium longum 35624®. Thus, according to the IBS-SSS indicators, only by the end of the third month of observation, some patients achieved remission of the disease. All described changes were persistent and persisted one month after the end of the probiotic intake. CONCLUSION: The addition of a prolonged course of the probiotic Bifidobacterium longum 35624® to the basic therapy in patients with IBS allows a more pronounced and lasting effect to be achieved. A "post-probiotic" effect was shown - a decrease in VSI after the end of the intake of the probiotic strain. Given the chronic relapsing course of IBS, the use of repeated probiotic courses was proposed to prevent exacerbation of the disease.

[Diagnostics and treatment of intraductal papillary mucinous pancreas neoplasm].

A clinical case of a 71-year-old patient with intraductal papillary mucinous neoplasia (IPMN) is presented. The diagnosis was established using endoscopic retrograde cholangiopancreatography, magnetic resonance imaging, computed tomography. Asymptomatic course, absence of pain syndrome, obstruction, exocrine and endocrine pancreatic failure, relatively satisfactory general health, but the presence of structural changes: an increase cyst in the head of the pancreas measuring 27×23 mm, expansion of the main pancreatic duct up to 13 mm raised doubts about the choice of treatment tactics, the need for surgical intervention. To exclude the risk of malignancy and the choice of treatment tactics, a fine-needle aspiration biopsy was performed, a cytological examination of the material, an expert opinion determined the scope of the surgical intervention. IPMN is a rather rare tumor of the pancreas. For a long time, IPMN flow "under the guise" of chronic pancreatitis. Depending on the type of degree of dysplasia and invasiveness of IPMN, the tactics of treatment and the volume of surgical intervention are determined. High-tech methods provide high information content in the diagnosis of IPMN. But only a morphological study allows you to determine the tactics of treatment.

Evaluation of the effectiveness of personalised therapy for the patients with irritable bowel syndrome.

Intestinal microbiota correction in the therapy of irritable bowel syndrome (IBS) is an important medical problem. We conducted a laboratory and pilot clinical trial to investigate the effect of autoprobiotic bacteria, indigenous bifidobacteria and enterococci isolated from faeces and grown on artificial media to use as personified food additives in IBS treatment. Convincing evidence of the clinical efficacy of autoprobiotic was demonstrated by the disappearance of dyspeptic symptoms. The microbiome of patients with IBS was compared to a group of healthy volunteers and changes in the microbiome after autoprobiotic use were detected by quantitative polymerase chain reaction and 16S rRNA metagenome analysis. The possibility of reducing opportunistic microorganisms in the treatment of IBS with autoprobiotics has been convincingly proven. The quantitative content of enterococci in the intestinal microbiota was higher in IBS patients than in healthy volunteers and increased after therapy. An increase in the relative abundance of genera Coprococcus, Blautia and a decrease in the relative abundance of Paraprevotella spp. were found at the end of therapy. A metabolome study which was performed by gas chromatography and mass spectrometry demonstrated an increase in the content of oxalic acid, a decrease of dodecanoate, lauric acid, and other metabolome components after taking autoprobiotics. Some of these parameters correlated with the relative abundances of Paraprevotella spp., Enterococcus spp., and Coprococcus spp. representative of the microbiome. Apparently, they reflected the peculiarities of metabolic compensation and changes in the microbiota. Therefore, the use of autoprobiotics for treatment of IBS may lead to a stable positive clinical effect, associated with compensatory changes in the intestinal microbiota, and accompanied by corresponding changes in metabolic processes in the organism.

[Epithelial protective therapy in comorbid diseases. Practical Guidelines for Physicians].

This document was produced with the support of the National Medical Association for the Study of Comorbidities (NASС). In 2021 the first multidisciplinary National Consensus on the pathophysiological and clinical aspects of Increased Epithelial Permeability Syndrome was published. The proposed guidelines are developed on the basis of this Consensus, by the same team of experts. Twenty-eight Practical Guidelines for Physicians statements were adopted by the Expert Council using the "delphic" method. Such main groups of epithelial protective drugs as proton pump inhibitors, bismuth drugs and probiotics are discussed in these Guidelines from the positions of evidence-based medicine. The clinical and pharmacological characteristics of such a universal epithelial protector as rebamipide, acting at the preepithelial, epithelial and subepithelial levels, throughout gastrointestinal tract, are presented in detail.

Triangles on a triangular lattice: Insights into self-assembly in two dimensions driven by shape complementarity.

A series of models for reversible filling of a triangular lattice with equilateral triangles has been developed and investigated. There are eight distinct models that vary in the set of prohibitions. In zeroth approximation, these models allow one to estimate the influence of the particles' shape and complementarity of their pair configurations on the self-assembly of dense monolayers formed by reversible filling. The most symmetrical models were found to be equivalent to hard-disk models on the hexagonal lattice. When any contact of hard triangles by vertices is prohibited, the dense monolayers are disordered, and their entropy tends to the constant. If only one pair configuration is prohibited, the close-packed layer appears through the continuous phase transition. In other cases, the weak first-order transition resulting in the self-assembly of close-packed layers is observed.