[Advanced endoscopic vacuum therapy for anastomotic leakage in the upper gastrointestinal tract]. / Usovershenstvovannaya endoskopicheskaya vakuumnaya terapiya pri nesostoyatel'nosti anastomozov verkhnikh otdelov zheludochno-kishechnogo trakta.

OBJECTIVE: To evaluate the effectiveness and clinical aspects of advanced endoscopic vacuum therapy for esophagogastric, esophagointestinal and gastrointestinal anastomotic leakage, to identify disadvantages and further possibilities for its improvement. MATERIAL AND METHODS: The study included 69 people. Esophagodudodenal anastomotic leakage was detected in 34 patients (49.27%), gastroduodenal anastomotic leakage - in 30 patients (43.48%), esophagogastric anastomotic leakage - in 4 (7.25%) patients. Advanced endoscopic vacuum therapy was used for these complications. RESULTS: Vacuum therapy in patients with esophagodudodenal anastomotic leakage led to complete healing of defect in 31 (91.18%) cases. In 4 (14.8%) cases, minor bleeding was noted during replacement of vacuum dressing. There were no other complications. Three (8.82%) patients died from secondary complications. Treatment of gastroduodenal anastomotic failure resulted complete healing of defect in 24 (80%) patients. Six (20%) patients died including 4 (66.67%) cases associated with secondary complications. Vacuum therapy for esophagogastric anastomotic leakage resulted complete healing of defect in 4 (100%) patients. CONCLUSION: Advanced endoscopic vacuum therapy is a simple, effective and safe method of therapy for esophagogastric, esophagoduodenal and gastrointestinal anastomotic leakage.

[Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus].

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

[Russian consensus on current issues in the diagnosis and treatment of obstructive jaundice syndrome]. / Rossiiskii konsensus po aktual'nym voprosam diagnostiki i lecheniya sindroma mekhanicheskoi zheltukhi.

The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.

[Outcomes of minimally invasive biliary decompression in obstructive jaundice]. / Analiz rezul'tatov miniinvazivnoi dekompressii zhelchevyvodiashchikh putei pri mekhanicheskoi zheltukhe.

AIM: To study postoperative complications and mortality after minimally invasive biliary decompression in patients with mechanical jaundice. MATERIAL AND METHODS: Prospective analysis included 2.072 patients with mechanical jaundice who underwent differential biliary decompression depending on the cause, level of obstruction, severity of jaundice and patient's condition. RESULTS: Relief of bilirubinemia and stabilization of the state were achieved in 1696 patients of the main group (98,6%) and in 328 (93.18%) patients of the control group. Mortality was similar in both groups: 8 (0.46%) and 2 (0.56%) patients. The best results were obtained in the main group for in-hospital and post-hospital complications after retrograde interventions (χ2=4.440821; df=0.891435; p<0.05) and post-hospital complications after antegrade interventions (χ2=35.52869; df= 1; p<0.05). CONCLUSION: Differentiated approach to minimally invasive biliary decompression is followed by reduced postoperative morbidity.

[Endoscopic transpapillary lithoextraction in case of parapapillary diverticulum]. / Vozmozhnosti endoskopicheskoi chrespapillyarnoi khirurgii kholedokholitiaza pri divertikulakh papillyarnoi zony dvenadtsatiperstnoi kishki.

AIM: To present the experience of endoscopic transpapillary procedures in patients with parapapillary diverticulum. MATERIAL AND METHODS: Endoscopic transpapillary treatment of choledocholithiasis was performed in 16.8% (423) of patients with suspected bile ducts stones for the period from August 2010 to January 2015. There were parapapillary diverticulum in all cases. Patients' age was from 29 to 92 years, there were 121 men and 302 women. Endoscopic transpapillary bile drainage was made in 407 (96.3%) cases. One-stage treatment was performed in 352 (83.2%) patients. The results of endoscopic transpapillary procedures in patients with parapapillary diverticulum were analyzed. RESULTS: We revealed high efficacy of transpapillary interventions in these patients. Herewith visualization of large duodenal papilla, determination of ducts' anatomic relations with diverticular and intestinal walls and adherence to main methodical and technical aspects of procedure are very important for successful treatment.

[Experimental study of influence of lipophilic products of phytogenic origin on lipid metabolism in rats].

The article presents the results of biochemical evaluation of metabolic effects of lipophilic products of plant origin among which such oils as linseed, black nuts and walnuts oils as well as medicine «Phosphogliv¼ were selected as the most promising ones. The influence of the studied substances on lipid metabolism in experiment on male rats (170­220 g body weight) with modeled acute hepatotoxicity with carbon tetrachloride (that was achieved by subcutaneous injection of 50% oil solution of carbon tetrachloride ­ 0.5 ml/100 g of the body mass once a day during 3 days) has been investigated. Liver function was assessed by triacylglycerols content in the serum, total, esterified and nonesterified cholesterol, cholesterol in the lipoproteins of high, low and very low density, as well as by the nonesterified cholesterol and phospholipids content in the hemolysate of red blood cells. Carbon tetrachloride hepatotoxic damage was accompanied by the development of severe hypercholesterolemia associated both with the increase in total cholesterol and its content in low density lipoproteins alongside the reducing of the cholesterol concentration in high density lipoproteins, resulted in secondary dyslipoproteinemia. Inhibition of the esterification of cholesterol processes as well as the decrease in the triacylglycerols concentration was observed. It is connected with the triacylglycerols endogenous synthesis blocking in the liver, resulted from its toxic damage. It is also confirmed by cholesterol content reducing in the lipoproteins of very low density. In erythrocytes of rats with CCl4 intoxication phospholipid content decreased while the amount of nonesterified cholesterol that is a component of cell membranes, influencing the proteins and lipids diffusion, which reduces the mobility of the fatty acid residues of phospholipids, increased. The injection of the black nuts and walnuts oils as well as flax oil (intragastric injections 0.2 ml daily in the morning before the main feeding from the 7th to the 30th day of the experiment, n=25 in each group) to rats with liver failure induced by carbon tetrachloride, contributed to the partial restoration of liver tissue structure and statistically reliable decrease of lipid metabolism. Decrease in the total cholesterol content by 17.5% in the group of animals treated with linseed oil was observed; LDL cholesterol also decreased under the influence of walnuts and black nuts oils by 36.7 and 40.6% respectively. The increase in the content of phospholipids in erythrocytes of rats when administered by the studied lipophilic products has made it possible to prove the improvement of the cell membranes rheological properties. The results of the study of the influence of linseed, black nuts and walnuts oils as well as medicine «Phosphogliv¼ on animals with hepatotoxicity by CCl4 have proved positive effect of these lipophilic substances on lipid metabolism.

[EXPERIMENTAL FOUNDATION FOR LINSEED AND WALNUT OILS APPLICATION IN GASTROENTEROLOGY].

In the article the influence of the hepatotropic effect of linseed and walnut oils on the lipid composition of the rats' blood serum under CCl4 intoxication has been presented. Lipid metabolism was characterised by the assessment of total cholesterol content in the blood serum, non-etherified cholesterol, cholesterol ethers, cholesterol lipoproteids of high-, low- and very low- density as well as triaclglycerins. In rats with experimental severe liver insufficiency associated with cholesterol increase in low-density lipoproteid fraction alongside its decrease in high-density lipoproteid fraction hypercholesterolemia was progressing. Cholesterol etherification inhibition (by 31.1%) was also observed. The tendency to less intensive disorders (by 1.7-2.0) as well as the tendency to lipid metabolism normalisation in animals have been revealed under the influence of lipophilic substances studied.

[Comparative characteristics of the isotopic D/H composition and antioxidant activity of freshly squeezed juices from fruits and vegetables grown in different geographical regions].

Data presented in this paper reflect changes in antioxidant activity, the content of prooxidant factors and deuterium concentration in freshly squeezed juices from fruits and vegetables grown in different climatic regions (10 samples of juices from wholesale and retail trade network of 8 kinds of vegetables and fruits, 28 manufacturers from 14 countries). Determination of the concentration of deuterium was performed using a nuclear magnetic resonance spectrometer. Total antioxidant activity of fresh juices was determined amperometrically after dilution in 2.2 mM H3PO4 in a ratio of 1:100. Prooxidant performance was evaluated by a maximum and area of flash of chemiluminescence induced by the introduction of 0.3% hydrogen peroxide. It was found that the antioxidant activity of fresh juice from fruits and vegetables grown within the same climatic region can differ by several times. In this case, most of the fruits and vegetables of russian producers were not inferior, than antioxidant activity of the fresh juices from the same plant products grown abroad. It should be noted that the indicators of the antioxidant activity of fresh juice from Russian pears exceeded this indicator of all fresh juices from pears, imported from Argentina, South Africa and the United States of America by 21.1, 30.4 and 32.7%, respectively. In assessing the prooxidant properties of fresh juices should be noted the almost complete absence of factors with prooxidant nature only in 36% of the studied fresh juices, whose maximum performance and area of flash of chemiluminescence were less than 0.1%, including a pear and apple juices from the russian production. It should be noted that the area of chemiluminescence of the juice from potatoes, grown in Russia, was at 103.1 and 115.2% lower than in juice obtained respectively from potatoes produced in Israel and Egypt (p<0.05), indicating a higher safety of consumption of potatoes produced in Russia. When studying--the isotopic D/H composition of fresh juices it was found that the highest deuterium content was in the juice from the pears, imported from Argentina (deltaD = -72% per hundred), while the lowest concentration of deuterium was observed in the juice from the Egyptian potatoes (delta = -358% per hundred). In general, significantly lower deuterium content was determined in fresh juices made from potatoes and cabbage grown in different countries, in comparison with other fresh juices from fruits and vegetables. The smallest range of differences in the isotopic D/H was composed in freshjuices from tomato, pomegranate and oranges of Turkish manufacturers (deuterium concentration ranged in them from -221 to -214% per hundred), that can be used to confirm the geographical origin of fruits and vegetables grown in Turkey. The data reflecting the antioxidant activity, the content of prooxidant factors and deuterium concentration in the juices, allow us to recommend the latter as additional criteria when assessing the quality of food products.

[Comparative evaluation of antioxidant activity and content of prooxidant factors in different classes of foods].

By using the biophysical methods (chemiluminescence, amperometry) in laboratory in vitro experiments it was demonstrated that the study of antioxidant and pro-oxidant activities of different food groups allows to perform a preliminary assessment of their pro-oxidant-antioxidant capacity. It have been shown that some food prevails ability to exert pro-oxidant effects (in vitro) due to the short-term induction of free radical oxidation. Thus, among the fresh juices the increase of the maximum of flash chemiluminescence has been detected in avocado (1080, 89%) and pearjuices (136,33%), whereas the lowest ability to enhance the intensity of free radical processes has been marked for pomegranate (1,63%), orange (9, 68%) and apples juices (12, 84%). Among milk products it has been marked for sour milk (9, 06%) and yogurt (15, 11-16,02%), that allows the use of the past to correct pro-oxidant-antioxidant balance diet for people with potential danger gain peroxide processes, such as special physiological states, sport endurance, mental and emotional overload. The ability to increase the intensity of free radical oxidation have been also identified for snacks, especially buns, biscuits, bread sticks, showing the risk of formation of oxidative stress in the body during their prolonged use, particularly under the above described conditions. In some cases, foods (processed cheese and cheese curds) showed dominance factors sustained oxidative effect (in 2,1-20,7%), that indicates the possibility of an imbalance in the pro-oxidant-antioxidant system after its prolonged use in the diet, even in small quantities, especially in individuals with a reduced level of antioxidant potential of the nonspecific defense system. Investigation of antioxidant activity of foods revealed significant predominance of reducing equivalents in all freshly squeezed and some packaged fruit juices, as well as dairy products, indicating their possibility to increase the capacity of reducing components of nonspecific protection system. The presence in a number of products used for snacking (chips, puffed rice) of sufficiently high levels of antioxidant activity demonstrates the content of substances that act as proton donator having significant reducing ability. It is sufficient for high energy value of such products, indicating on the possibility of involvement of their recovery factors in plastic processes with subsequent enhancement, such as lipogenesis, that may be a prerequisite for the development of obesity, atherosclerosis and otherpathological processes. Using an integrated approach will enable a timely and appropriate to correct the ratio of pro- and antioxidant indicators of diet in order to improve the adaptive capacity of the organism in a particular physiological or pathological conditions involving oxidative metabolism disorders.

[Determination of deuterium concentration in foods and influence of water with modified isotopic composition on oxidation parameters and heavy hydrogen isotopes content in experimental animals].

The article presents the results of the study of the deuterium (D) content in food products as well as the influence of deuterium depleted water (DDW) on the concentration of heavy hydrogen isotopes in the blood and lyophilized tissues of rats. The most significant difference in the content of D was found between potato and pork fat, which indexes the standard delta notation (δ) D in promille, related to the international standard SMOW (Standard Mean Ocean of Water) amounted to -83,2 per thousand and -250,7 per thousand, respectively (p<0,05). Among the investigated samples of water deuterium concentration ranged from -75,5 per thousand (Narzan) to +72,1 per thousand (Kubai), that indicates the ability of some food products to increase the concentration of heavy hydrogen atoms in the body. The data obtained in the experimental modeling of the diet of male Wistar rats in the age of 5-6 mo (weight 235 ± 16 g) using DDW (δD = -743,2 per thousand) instead of drinking water (δD = -37,0 per thousand) with identical mineral composition showed that after 2 weeks significant (p <0,05) formation of isotopic (deuterium-protium, D/H) gradient in the body is possible. Changing the direction of isotopic D/H gradient in laboratory animals in comparison with its physiological indicators (72-127 per thousand, "plasma>>tissue") is due to different rates ofisotopic exchange reactions in plasma and tissues (liver, kidney, heart), which can be explained by entering into the composition of a modified diet of organic substrates with more than DDW concentration D, which are involved in the construction of cellular structures and eventually lead to a redistribution of D and change direction of D/H gradient "plasma<