The aim of review. To demonstrate progress of the concept of functional designation of periodic activity of digestive system, multifunctionality of this biological rhythm and its possible clinical and diagnostic value.

Key points. Periodic activity of digestive system is one of 90-minute biorhythms of body of humans and animals in which motor and secretory functions of digestive organs and many parameters of other physiological systems change in natural pattern. The review presents main morphofunctional advances and chronology of their experimental and clinical establishment, of multifunctional role of digestive system periodic activity.

Conclusion. Opening and development of the doctrine about periodic activity of system of digestion is significant achievement of the Russian scientific school which have provided modern concept of polyfunctionality of this biorhythm.

The aim of review. To analyze and generalize the information on up-to-date treatment of the biliary peritonitis complicated by abdominal sepsis.

Key points. The urgency of this issue is caused by its high frequency in postoperative period in patients with gallstone disease. Options of the newest methods of treatment of biliary peritonitis complicated by abdominal sepsis are analyzed. Features of each method in algorithm of essential medical actions are stressed.

Conclusion. According to analysis, that was carried out, application of combined treatment of biliary peritonitis complicated by abdominal sepsis, is the only correct decision. The further improvement of treatment methods will promote achievement of the best results.

Aim of investigation. To estimate emotional disorders, personality features and features of intraceptive sensations in patients with irritable bowel syndrome (IBS), as well as the effect of revealed changes on disease severity.

Material and methods. Overall 30 patients with confirmed diagnosis of IBS were studied. Number of days of feeling sick for the last year, number of medical encounters for the same time, intensity of abdominal pain according to VAS, frequency of bowel movements per day (number of defecations per day at IBS-D and number of defecations per week at IBS-C) were taken into account in correlation to disease severity and severity of anxiety and depression according to respective scales, to personality features of patients, and also to pattern and volume of individual dictionary for description of internal somatic sensations. Profound investigation including application of questionnaires was carried out for assessment of: dominating personality traits of the patient, his/her emotional features (individual typological questionnaire – ITQ); structure and bulk of individual dictionary for description of internal somatic sensations (test of intraceptive sensation descriptors choice); presence of emotional disorders (respective scales of Hamilton test for anxiety and depression – HARS, HDRS).

Results. At analysis of anxiety level with symptoms determining disease severity, moderate positive correlation of total HARS score with severity of disorders of defecation at constipation and number of days with IBS symptoms for the last year (р=0,07) was revealed. At analysis of depression level (total score on HDRS) with symptoms representing severity of disease, statistically significant positive moderate correlation with severity of depressive disorder with degree of disorders of defecation (both for IBS-D, and for IBS-C) and quantity of days with IBS symptoms for the last year was found out (р=0,023; 0,025 and 0,026 respectively). Following correlations between ITQ questionnaire results and symptoms of disease severity were detected as statistical trend: moderate negative correlation between extraversion scale and number of IBS-related medical encounters for the last year (р=0,05), between anxiety scale and degree of disorders of defecation both at IBS-D, and at IBS -C (р=0,05; р=0,06); at the level of statistical significance moderate negative correlation between lability scale and quantity of IBS-related medical encounters (р=0,022) was revealed. At comparison of intensity of symptoms representing severity of disease, in groups of patients formed according to cluster analysis results of the test of intraceptive sensation descriptors choice, it was possible to reveal increase of severity of IBS symptoms from the 3rd to the 1st cluster.

Conclusion. Severity of IBS (quantity of medical encounters, total number of days of feeling sick per year, etc.) is determined by severity of anxiety and depressive disorders (by HARS and HDRS scales), disorder of social adaptation (by ITQ test) and distortion of body perception (by test of intraceptive sensation descriptors choice), that it is necessary to take into account at treatment prescription.

Aim of investigation. To detect phenotypic and genotypic features of the full-term newborns with delayed conjugation jaundice in relation to gender of the patient.

Material and methods. The group of full-term children (n=251) with delayed conjugation jaundice was investigated, that have been divided in two subgroups according to gender. All patients underwent complex clinical and laboratory, instrumental and immunologic investigation. Features of pregnancy and delivery course, weight and height scores and children disease spectrum, blood groups and Rhesus factor were investigated.

Results. It was known, that prevailing genotypic changes in boys – increased proportion of 0 (I) groups and decreased proportion of A (II) blood group, as well as increase of proportion of phenotypes 0 Rh + and decrease of A Rh + in boys prevail in comparison to girls and control group, while in girls environmental factors (complicated course of pregnancy and delivery) have more pronounced effect. Boys and girls differ by disease spectrum. Assessment of these diseases shows, that state of girls was more severe.

Conclusions. The original study allows to conclude, that children with delayed conjugation jaundice in neonatal period belong to risk group for development of complications at action of harmful external factors over the liver.

The aim of review. To discuss potentials of application of new NS3/NS4 protease inhibitor faldaprevir at chronic hepatitis C with genotype 1 HCV, including patients without response to previous antiviral therapy, liver cirrhosis, and to estimate its antiviral activity in the range of treatment modes without interferon.

Key points. Significant progress was achieved in development of new modes of antiviral treatment of patients with the 1st HCV genotype due to introduction of the third agent possessing direct antiviral action. Faldaprevir (BI-201335) is NS3/4A protease inhibitor with long-term half-life period that allows once per day dosing. The combination of faldaprevir to interferon and ribavirin has essentially increased efficacy of treatment at previously untreated patients with hepatitis C genotype 1 (according to results of SILEN-C1 study, frequency of SVR achievement was 82% in group receiving faldaprevir in comparison to 56% of patients, who received placebo). Addition of faldaprevir to treatment mode has allowed to increase frequency of SVR (to 50%) in patients with unsuccessful course of standard antiviral therapy. Peak efficiency of triple mode with inclusion of faldaprevir was marked in patients with 1b genotype and «favorable» genotype Il28B СС (SVR up to 95%). In 88% of previously untreated patients it was possible to reduce treatment duration for triple algorithm (with faldaprevir application) to 12 wks with the subsequent transition to interferon and ribavirin for 12 wks (according to data of STARTVerso1 study). Faldaprevir has demonstrated equally good tolerability, high safety and antiviral activity in patients at different stages of fibrosis and liver cirrhosis in the range of interferon-free treatment modes.

Conclusion. Clinical investigations demonstrated that combination of faldaprevir with interferon and ribavirin essentially increases treatment response rate both in previously untreated patients with 1-st genotype, and in patients with unsuccessful experience of antiviral therapy; it allows to reduce treatment duration in certain groups of patients. The drug possesses high safety profile and good tolerability, including patients with liver cirrhosis spectrum of treatment modes without interferon.

The aim of review. To analyze problem of alcohol abuse and dangerous consequences related to it in Russian population, to demonstrate possible ways of its decision.

The basic contents. According to official statistics, alcohol is one of leading factors of mortality in Russian population, making 11,9%. Almost in half of deceased population (47,7%) lethal outcome was caused by fatal changes of internal organs, in one fifth (21,7%) – by accidents. Moreover, 35% of patients with alcoholism die in the age most effective for various forms of activity (i.e. 20–50 years). Combined efforts of government institutions, medical community, professional organizations are necessary for resolution of this issue. Position of the State is very clear – to reduce the harm of alcohol to the population by the year 2020. Medical community, viz. internist doctors, should be ready to take active part in the decision of alcohol dependence problem, and not just to pay attention to somatic issues related to their specialty. The proper motivation of the patient by doctor is extremely actual for those, who take alcohol in dozes dangerous for health, as well as for those who drinks too much and too fast. For these purposes there are specially developed techniques – motivational interviews, in particular technique of brief interventions. Special techniques are applied in motivational interview: empathy (realized compassion to current emotional status of the other person), reflective listening (conducting thematically directed dialogue between psychologist and the patient to obtain data), resistance following, account of actual readiness for changes and actual needs, achievement of specific targets with assessment of specific effects. Pharmaceutical therapy of alcohol-induced dependency made a major step forward as well with introduction of new class of drugs – opioid system modulators represented by nalmefene and naltrexone. Opioid receptors are involved in development of alcohol-induced dependency. Nalmefene, blocking these receptors, reduces supporting effect of alcohol which ceases to deliver expected pleasure.

Conclusion. Successful campaign against alcoholism is possible only at application of all resources: strategy of the state, involvement of internist doctors in problem decision (application of motivational conversation technic), pharmaceutical therapy directed on reduction of amount alcoholic drinks.

Aim of investigation. To estimate outcomes of toxic hepatites (TH) after intake of alcohol surrogates («Mozhzhevelovy» spirit for external use) with development of original prognostic model of patients survival.

Material and methods. Retrospective analysis of clinical and laboratory data and survival rates of 80 patients (men 54, women 26, age 32 to 49 years), admitted to the hospital in 2006–2007, with evaluation of outcomes in 2012 was carried out. Statistical analysis of the data was carried out by Statistica-6 and Medcalc (using logistical regression and ROC-curves plotting) software packages. For evaluation of the disease prognosis MELD index and Hy's Law were determined, as well as R ratio (ratio of hepatocellular and-or cholestatic lesions).

Results. All patients had clinical signs of severe TH with prominent treatment-resistant cholestatic syndrome. Within the first month of disease 16 (20%) patients died of liver failure, during following period – 13 patients (19%). Calculation of MELD index and Hy's Law showed their low informative value at this group of patients, R index in 78% of cases indicated mixed lesion and did not affect prognosis. Original prognostic model of survival rate of patients was: blood leukocyte count (OR 4,8, 95%-CI 1,12— 20,55; р=0,03) and creatinine (OR 1,1, 95% CI 0,99– 1,22; р=0,09), prognostic value of the model was 93,3%. Level of direct bilirubin (AUROC 0,79; CI 0,58–0,83) and WBC (AUROC 0,93; CI 0,83-0,98) were prognostically significant.

Conclusions. According to authors’ model, the most significant predictors of lethal outcome at TH were severity of inflammatory response, hyperbilirubinemia and hepatorenal syndrome.

Aim of investigation. To carry out integrated analysis of the liver cirrhosis group of patients and indications for transplantation with evaluation of leading causes and factors affecting shifting liver transplantation in the Waiting list.

Material and methods. All patients with liver cirrhosis admitted to the Sverdlovsk regional hepatological center in 2005 to 2010, were evaluated for option of inclusion to the Waiting list.

Results. Most often alcoholism (21,6%) and cardiovascular diseases (14,0%) prevented inclusion to the Waiting list of potential recipient. These or other concomitant diseases become an impediment for enrollment to the waiting list in 2/3 patients having indications for liver transplantation.

Conclusions. Development and management of the Waiting list for liver transplantation is a complex, multiplane task and requires careful, complex and very versatile investigation of the patient before surgery, dynamic rating of severity of status and urgency class of operation performance, duly while maximally effective detection and treatment of accompanying diseases.

The aim of review. To summarize and analyze main causative factors determining inefficacy of modern algorithms of antihelicobacter therapy.

Key points. Efficacy of eradication therapy (ET) can depend on a lot of factors which generally can be divided in three main groups in relation to origin: factors determined by microorganism (bacteria); factors determined by macroorganism (patient); the factors determined by doctor. Hence, in clinical practice cases a single patient may have combination of several independent factors determining failure of provided treatment.

Conclusion. Efficacy ET depends upon wide spectrum of heterogeneous mechanisms. For the present moment, the primary factor determining inefficacy of treatment, is increase of H. pylori antibiotic resistance to the basic drugs, applied in modes of the first line of ET.

Aim of investigation. To study pathogenic mechanisms and morphological signs of rectal mucosa reparation after rectal mucosectomy and application of cellbased biotechnologies at surgical treatment of familial adenomatosis coli (FAC).

Material and methods. The new method of FAC surgical treatment which provides preservation of part of the mucosa-deprived rectum is presented. For reconstruction of mucosa of the rectum cell-based allotransplantation was applied. Morphological mechanisms of mucosal reparation were investigated in 34 FAC patients (main and control groups).

Results. The reparation of mucosa in demucosated rectum at application of cell-based transplantation develops in shorter terms in comparison to control group. It is carried out by largeintestinal, smallintestinal types, by squamous cell differentiation and by combination of all types. At reparation cells with signs of stem cells take part.

Conclusions. Original method can be applied for treatment of FAC as it delays polyps and rectal cancer development for many years.

Aim of investigation. To study potential of tumor necrosis factor-alpha inhibitor Remicade to prevent complications and unfavorable course of ulcerative colitis.

Material and methods. Therapeutic role of Remicade was investigated in one of three compared groups (24 patients) with unfavourable prognosis (frequent relapses, continuous course, steroid-dependency, steroid resistance) and risk of complications.

Results. Early onset of anticytokine therapy by Remicade has allowed to decrease frequency of unfavourable course from 83,3% (comparison group) and 78,3% (control group) to 12,5% and to prevent complications. Data of investigation prove, that so-called «top down» therapy with application of Remicade improves quality of life scores of patients in comparison to placebo (in 1 year) for over 18%, for 25,4% (in 2 years) and for 27,8% (in 3 years). Beneficial effect of anticytokine therapy in ulcerative colitis patients was revealed by parameters of general health, viability, mental health and social functioning.

Conclusions. In cases of the prognosis of complications and unfavourable course of disease Remicade treatment should be started in maximally early terms.