Blood Serum Zonulin in Colorectal Cancer, Autoimmune Bowel Diseases, and Irritable Bowel Syndrome.

Zonulin content in blood serum of patients with colorectal cancer (CRC; n=152; 30-84 years) and patients with large bowel adenomas (n=32; 39-82 years) was measured by standardized kit IDK Zonulin ELISA (Immundiagnostik AG). The healthy control group (n=50) comprised volunteers (27 women, 23 men; 25-68 years); pathological control group (n=84) - patients (55 women, 29 men;18-84 years) with irritable bowel syndrome (n=29), Crohn's disease (n=5), and ulcero-necrotic colitis (n=50). In comparison to healthy control group, the level of zonulin was significantly increased in CRC patients (p<0.0000001) and in patients with benign large bowel tumors (p<0.004), as well as in patients with inflammatory intestine diseases and with irritable bowel syndrome (p<0.0002). Zonulin level in blood serum of CRC patients was slightly, but significantly higher (p<0.05) than in the group of pathological control. ROC curve construction revealed that at optimal zonulin cut-off level (52.2 ng/ml), the diagnostic sensitivity of CRC detection was 66.7% and specificity relative to healthy control was 81.8%. The specificity relative to the combined control group (healthy control+non-tumor bowel diseases) was only 68.9%. Thus, no acceptable cut-off levels for differentiation between malignant and benign tumors, as well as between tumor and non-tumor large bowel pathologies were found. Analysis of the associations between serum zonulin level and the main clinical and pathological characteristics of CRC demonstrated that the level of this marker increased with disease progression (p<0.01; Kruskal-Wallis test), but was not associated with individual criteria of the TNM system, tumor localization, histological structure, and malignancy grade.

Helicobacter pylori infection: place of serological and cultural diagnostics in clinical guidelines.

The purpose of this work was to familiarize doctors with the methods and significance of serological and cultural diagnostics of H. pylori infection on the example of the test for diagnosing the state of the gastric mucosa «Gastropanel¼. Blood serum tests were performed for 1057 patients and 122 healthy people aged 18-64 years: pepsinogen I (PG I), pepsinogen II (PG II), gastrin-17 (G-17), basal/stimulated), antibodies (IgGHp) to H. pylori (Biohit Oyj, Finland). The medians of the studied group indicators did not exceed the reference intervals. 398 (34%) patients have negative H. pylori status (IgGHp-). 275 (26%) patients with serum PG I≤70 mcg/ml were identified. The ratio of PG I/II≤3 in 84 (8%), 36 of them (43% of the group PG I/II≤3) - IgGHp-.

[Changes in the intestinal microbiota as a risk factor for dyslipidemia, atherosclerosis and the role of probiotics in their prevention].

The review presents an analysis of studies on the role of the intestinal microbiota and microbiome in lipid metabolism and the development of dyslipidemia, atherosclerosis and cardiovascular diseases. The role of the intestine as a metabolic organ with a multifactorial strain evolution, involved in lipid metabolism, cholesterol homeostasis and enterohepatic circulation is shown. The influence of microbial imbalance on the development of dyslipidemia and atherosclerosis is considered. Special attention is paid to preventive therapy with hypolipidemic probiotics. It is shown that the use of probiotics with hypolipidemic properties and consisting of a mixture of such strains asLactobacillus plantarumCECT7527, CET7528 and CECT7529, mixtures ofLactobacillus acidophilusLa-5,Bifidobacterium lactisBB-12,Bifidobacterium animalis lactisBB-12 contribute to reducing the level of LDL-C, CCS, TG, are safe and well tolerated, can be used as an adjuvant non-drug therapy in combination with hypolipidemic drugs for dyslipidemia, multifocal atherosclerosis.

[The relationship between doctors' points of view and indicators that characterize citizens' access to primary health care in Moscow].

This article presents the results of a study on the relationship between indicators of accessibility of citizens to primary health care (PHC), based on the data of the Unified medical informational analytical system of Moscow (EMIAS) and the results of the survey of physicians of medical institutions of the state healthcare system, providing primary care to adults. The analysis of scientific publications has shown that when assessing the availability and quality of medical care, taking into account public opinion, the main attention is paid to sociological surveys of citizens and less often the opinion of medical personnel who provide medical care to citizens is studied. The analysis of the information from foreign sources has shown that the availability of primary health care is a hot topic in many countries all over the world, including the countries with a high level of GDP per capita. The survey of medical men, which was attended by more than 500 doctors, was conducted in six medical organizations in Moscow that provide primary health care to adults. The questionnaire contained 26 questions, the answers to which reflect the personal opinion of doctors about their attitude to the improvement of their professional skills, satisfaction with working conditions, the organization of PHC and its accessibility to the population, etc. EMIAS The data were used to calculate individual indicators that characterize the population's access to PHC. The results of this scientific study confirmed the existence of a high correlation between the responses of doctors and indicators calculated on the basis of EMIAS data, which indicates the feasibility of using the opinion of medical personnel to make timely and effective management decisions aimed at optimizing organizational processes to ensure public access to medical care.

[ENT care in the context of the new coronavirus infection COVID-19]. / Aktual'nye voprosy okazaniya spetsializirovannoi lor-pomoshchi v usloviyakh novoi koronavirusnoi infektsii COVID-19.

The spread of the pandemic of the new coronavirus infection COVID-19 inevitably makes adjustments to the medical care. Given that the main route of transmission is airborne, otorhinolaryngologists are at increased risk of infection. Based on the literature data of leading otorhinolaryngologists, as well as their own experience working with patients with the new coronavirus infection COVID-19, the authors present relevant recommendations on the organization of specialized otorhinolaryngological care in the context of the COVID-19 pandemic. The authors consider the etiology, pathogenesis, and clinical manifestations of COVID-19. The features of the examination of ENT, diagnostic and therapeutic procedures, including the use of silicone hydrotamps to stop the front and rear nose bleeds, developed in L.I. Sverzhevskiy OHRIM, and indications for hospitalization in the ENT hospital. Features of operations on the otorhinolaryngological profile during a COVID pandemic are also described. Summing up, the authors indicate that during the pandemic of the new coronavirus infection COVID-19, otorhinolaryngologists need to adhere to two fundamental principles aimed at preventing the spread of infection: the use of modern effective personal protective equipment and the use of examination methods (surgical treatment methods) that prevent the formation of biological aerosols.

[The analysis of functioning of endoscopic service of curative preventive institutions of the Moscow Health Care Department].

The article presents analysis of endoscopy departments of curative preventive institutions of the practice in the institutions Moscow Health Care Department in 2018. The endoscopy equipment support of corresponding departments and medical rooms were analyzed. The comparative study of diagnostic endoscopy procedures (esophagogastroduodenoscopy, bronchoscopy, colonoscopy, rectosigmoidoscopy, intestinoscopy, capsule endoscopy) and therapeutic procedures (endoscopic hemostasis, endoscopic removal of foreign bodies, endoscopic submucous dissection, stenting, balloon dilation) was implemented. The indices of quality of endoscopic procedures and adequate personnel support of endoscopy departments were analyzed. The analysis of study results permitted to formulate main directions of optimization of endoscopic service, quality improvement and mechanisms of regular quality.

[Low Fermentable Oligo-, Di- and Monosaccharides and Polyols (FODMAP) diet in the treatment of patients with irritable bowel syndrome: basic principles and methodology].

Fermentable oligo-, di-, monosacc harides, and polyols (FODMAP) are a large class of small nondigestible carbohydrates, which are poorly absorbed in the small bowel. The microscopic size, high osmotic activity, and the higher fermentation of unabsorbed FODMAPs by colonic bacteria lead to bloating, abdominal pain, and flatulence in patients with irritable bowel syndrome. Therefore, low FODMAP diet appears to be promising treatment approach in the management of patients with irritable bowel syndrome (IBS). In this review, we analyzed available publications on efficacy and safety of low FODMAP diet in the treatment of IBS patients. Based on the current data we outlined basic principles and methodology of low FODMAP diet usage in clinical practice, and constructed the detailed list of low and high FODMAP products for designing a food regimen in patients with IBS.

[The methodological approaches to formation of rating evaluation of activities of medical organizations and health care systems in Russia and abroad].

The article presents information on methodological approaches to creation of the ratings in the health sector and the study on the use of the various demographic indicators and indicators of population health used by the world health organization to evaluate the effectiveness of health systems in different countries. The opinions of experts on the purpose of ratings and scientific and methodological approaches to their creation are given. The article describes the results of rating formation of medical organizations of the state health system of the city of Moscow on the basis of the results of the implementation of the quality standard of resource management.

[The planning of values of indices of quality of resource management in medical organizations of the Moscow state medical care system].

The article presents the results of planning the values of indices of resource management quality in medical organizations of the Moscow state health system, that participated i the project of implementation of the quality standard of resource management in 2016-2017. The approaches of medical organizations to assessment of resources and opportunities of increasing efficiency of management of financial and human resources are described.

[Probiotic using as a part of complex therapy of disbiotic violations at some intestinal diseases].

Diseases of intestines are among the most widespread in this connection their effective prevention and treatment represents a priority problem of practical health care. Nowadays the set of the indisputable evidence that the microbiota of intestines played a key role in pathogenesis of many diseases has been obtained. Aim - the analysis of the available data on a role of microflora and efficiency of probiotic cultures for treatment of irritable bowel syndrome, the necrotic enterocolitis, Krone's disease. Based on the data, which is available in literature, the main aspects of biological properties of probiotic bacteria, first in the context of their regulating influence on inflammatory immune reaction have been discussed. The question of strain-specific effect of probiotics has been considered. The basic provisions concerning change of a fecal microbiota, prospect and difficulty of realization of this technique have been presented in the article. Conclusion. Despite of wide use of pro- and prebiotics in clinic for treatment of diseases of digestive tract, a large number of the questions connected with selection of concrete strains for each patient, a dosage and duration of therapy for achievement of steady remission still remains.

[Therapeutic aspects of the choice of antithrombotic therapy in patients with multifocal lesions of peripheral arteries].

The article discusses the features of the development and course of the atherosclerotic process in various vascular basins. Variability of factors such as local hemodynamics, differences in the structure of the arteries can influence the formation of atherosclerotic plaque and the progression of the atherosclerotic process. A better understanding of the nature and causes of these differences can help improve the tactics of treatment and prevention of vascular complications. Analysis of the results of the COMPASS study (cardiovascular outomes for people using anticoagulation stategies - evaluation of cardiovascular outcomes in patients receiving anticoagulant therapy) showed for the first time the effectiveness of combination therapy using rivaroxaban direct anticoagulant at a dose of 2.5 mg 2 times a day in combination with acetylsalicylic acid at a dose of 100 mg per day. It was shown that, against the background of combination therapy, patients with coronary heart disease or atherosclerotic peripheral artery disease showed a significant decrease in the incidence of events of the primary end point of efficacy: a reduced risk of stroke, cardiovascular mortality and myocardial infarction, and also a reduction in the risk of major lower amputations extremities and total mortality in patients with stable forms of atherosclerosis. The emergence of combination therapy can help to achieve both an improvement in the overall prognosis and the prognosis of limb preservation in patients with multifocal arterial lesion.

[The clinical efficacy of allergen-specific immunotherapy with water-salt extracts and adjuvant allergens for atopic asthma with household sensitization]. / Klinicheskaia éffektivnost' allergenspetsificheskoi immunoterapii vodno-solevymi ékstraktami i ad''iuvantnymi allergenami pri atopicheskoi bronkhial'noi astme s bytovoi sensibilizatsiei.

AIM: To evaluate the clinical and economic efficiency of allergen-specific immunotherapy (ASIT); to comparatively analyze the efficiency of various therapy regimens for atopic asthma. SUBJECTS AND METHODS: The clinical and economic efficiency of asthma therapy using ASIT with water-salt allergen extracts or the adjuvant drug alustal 'mite allergen' and only with medicines were comparatively analyzed. The investigation enrolled 156 patients with mild and moderate atopic asthma, household allergy. In Group 1 (n = 57), ASIT was performed using the classical scheme by subcutaneous injection of house dust mite allergen (JSC 'I.I. Mechnikov Biomed', Russia). In Group 2 (n = 43), ASIT was conducted using the alustal 'mite allergen' (Stallergenes, France). Group 3 (n = 56) received only medical therapy. RESULTS: ASIT with both water-salt allergen extracts and the adjuvant allergen alustal is an effective treatment for mild and moderate atopic asthma. ASIT greatly reduces the need for anti-inflammatory treatment and the use of symptomatic drugs and improves the physical and psychoemotional indicators of quality of life in patients. The economic benefit of ASIT is delayed, but its use significantly reduces financing costs. CONCLUSION: ASIT is a reasonable, highly effective and ultimately cost-effective treatment in patients with atopic asthma. A variety of drugs for ASIT can choose schemes that are convenient and acceptable for each patient, which allows wider use of this treatment.

[A comparative assessment of the life quality of patients after various surgeries because of complicated duodenal ulcer]. / Sravnite'naia otsenka kachestva zhizni bol'nykh posle razlichnykh vidov operativnogo lecheniia po povodu oslozhnennoi duodenal'noi iazvy.

Showings of studying the life quality with the aid of the SF-36 questionnaire can be used for assessing long-term results of various types of surgeries at complicated duodenal ulcer. Unlike stomach resections, functional surgeries provide a higher life quality of patients. Such differences become more apparent as time after the surgery passes by.

[Ways to optimize therapy of acid-dependent diseases]. / Puti optimizatsii terapii bol'nykh kisloto-zavisimymi zabolevaniiami.

The range of antisecretory preparations used by a gastroenterologist now includes a new reliable preparation. Nexium, which allows solving the problem of optimization of treatment of patients with acid-dependent diseases.