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The objective was to study the effect of drug «Oxyphtem»1 on liver morphometric parameters in a systemic inflammatory response.Materials and methods. The experimental study was carried out on male Wistar rats (n = 26). The rats of the experimental group were injected with drug «Oxyphtem» intravenously once. Daily observation was carried out during14 days. Rats were taken out of the experiment on the 15th day under light ether anesthesia. Liver samples were fixed in 10 % neutral formalin in phosphate buffer for 24 hours. Histological preparations were studied using the Measure Pixels image analysis computer program based on a Leica 2000 light microscope.Results. In the intact group of rats, no violations of the liver parenchyma were detected: hepatocytes had clear boundaries, the lamellar structure was preserved and sinusoidal capillaries were not dilated. With the development of the systemic inflammatory response in the liver of rats of the control group, expansion and blood filling of the central veins and sinusoids, violation of the structure of the liver plates, and perinuclear edema of hepatocytes were noted. In the experimental group of rats with the use of drug «Oxyphtem», the preservation of the structure of the liver plates was observed, binuclear hepatocytes were found, and the sinusoids were not expanded. We hypothesize that hepatocyte proliferation and the increase in binuclear hepatic cells were indicative of the regenerative response to systemic inflammatory damage and metabolic demand.Conclusion. The use of drug «Oxyphtem» under conditions of the experimental systemic inflammatory response increases reparative regeneration and adaptation of the liver.

This article is presented in form of a current literature review on bacterial complications of the early post-liver transplantation period and promising areas for studying the effect of bacterial flora in patients after liver transplantation. The paper describes the problem of the emergence, spread, and pathogenesis of various bacterial complications, as well as current concepts of various bacterial complication’s impact on the results of liver transplantation. The results of ventilatorassociated pneumonia in patients after liver transplantation are given. A theoretical analysis of bacterial complications from the standpoint of microbiota effects on the biliary tree was carried out. The review also highlights a relatively new conceptual approach in examining the results of scientific research using the "Machine Learning Method”. The so-called CDC “Big Four” was chosen as the main infectious nomenclature in this article. However, catheter-associated bacterial complications, which pathogenesis has been sufficiently studied to date, have been replaced by a relatively new group of complications – bacteriobilia. This review also contains a brief statistical data collected in the frames of the NCT04281797 study. Own cohort data consisted of 57 patients who underwent orthotopic liver transplantation from a post-mortem donor. Surgical site infection was the most common bacterial complication of the early postoperative period. The most common causative agent of bacterial infection was Klebsiella pneumonia and Enterococcus.

The paper presents the world’s first clinical case of two full-term successive pregnancies in a patient following simultaneous liver-kidney transplantation with reno-portal transposition. Both pregnancies ended with the birth of healthy children and favorable course of postpartum and long-term periods. The features of management and childbirth are highlighted. Literature review on this problem is presented.

The paper shows the main stages of introduction and organization of liver transplantation in the Republic of Belarus, the procedure of examination of patients on the waiting list for liver transplantation, and the experience of the first 37 orthotopic liver transplantations made in the Republic of Belarus in April 3, 2008, to February 1, 2010.

Procalcitonin and c-reactive protein are routine inflammatary markers used in the perioperative period to detect surgical infectious complications. However, a number of studies have demonstrated that these laboratory markers appear less effective in identifying infectious complications in the early postoperative period in patients after liver transplantation, and their predictive power is limited. We hypothesized, that interleukin-6 could be a more reliable and precise marker of the development of infectious complications in this patient population.

Objective: to compare the degree of sympathetic blockade caused by thoracic epidural or bilateral paravertebral anesthesia. Superior mesenteric artery blood flow was measured calculating the coefficient of flow resistance (resistance index) as an indicator of the degree of sympathetic block in patients undergoing high-traumaticity operations on the upper abdominal organs under thoracic epidural or bilateral paravertebral anesthesia. The patients of both groups were noted to develop sympathetic blockade with a statistically significant reduction in vascular resistance (resistance index) of the superior mesenteric artery and with an increase in blood flow in the visceral bed. The degree of sympathetic blockade was statistically significantly higher in patients under epidural anesthesia. Conclusion. Bilateral thoracic paravertebral blockade decreases sympathetic nervous system activation and may be used during high-traumaticity surgery if there are existing or predictable contraindications to epidural anesthesia.

The article is dedicated to the problem of pregnancy management and delivery after simultaneous liver-kidney transplantation (SLKT). The article contains general historic and statistic information, and presents the first real world clinical case of favorable pregnancy outcome in patient after simultaneous liver-kidney transplantation with reno-portal transposition.

Despite the fact that the key role of the liver in the formation of the immune response to injury is not in doubt, the mechanisms of weakening the immune response to infectious and noninfectious lesions in patients with hepatic failure remain unclear. We propose an original hypothesis of forming the ways to limit the amplitude of the systemic inflammatory response in patients with the end-stage liver disease. The basis of the hypothesis is the idea that as a result of reducing the intensity of the natural stimulation of membrane mCD14 receptors by the ligands of infectious nature, the basic mechanism of the systemic immune response induction by liver macrophages (Kupffer cells) is interrupted. According to the proposed hypothesis, in condition of liver failure, the synthesis of lipopolysaccharide-binding protein by hepatocytes is reduced. This leads to a decreased amplitude and intensity of the protective immune responses. This fact explains a number of clinical phenomena observed in patients with liver failure/dysfunction that consist in a reduced reactivity of the organism to the damage inflicted by infectious and noninfectious agents. The authors consider it possible to use this hypothesis in the search for new trends to prevent the immune system hyper-reactivity in sepsis, and to improve the therapeutic strategies for the management of patients at high risk of infectious complications after liver transplantation.

Aim. To evaluate the associations of genotypes of clinically relevant nucleotides rs11536865, rs913930 and rs5030717 of the TLR-4 gene with the risk of development and severity of early allograft dysfunction after liver transplantation. Materials and methods. A case-control study enrolling 71 patients was organized. Inclusion criteria: DBD liver transplantation. Exclusion criteria: living related liver transplantation, reduced graft transplantation, recipient’s age fewer than 18. Results. Within rs5030717 there were identifi ed three genotypes: AA (81.6%) and two genotypes with the minor G-allele: AG (12.6%) and GG (5.6%). Within rs913930 there identi- fi ed three genotypes: TT (59.1%) and two genotypes with the minor C-allele: C/T (29.5%) and CC (11.2%). The rs11536865 studying revealed no polymorphism (GG genotype). The early allograft liver dysfunction (EAD) developed in 19.7% of patients, the severe EAD in 11.2% of patients, septic complications in 14%, acute cellular rejection in 23.9% of cases. The C/T genotype of the TLR-4 gene in the SNP rs913930 sequence was closely associated with the EAD development (OR 4.8 to 1; p = 0.047; 95% CI 1–23.4). Рatients with the donor’s liver C/T genotype had a reliably higher proportion (%) of the HMGB1 positive hepatocytes in the donor’s bioptate, 21 (17–29%) vs the СС+TT genotypes, 16 (10–19%) (Mann–Whitney test, p = 0.01). The CD68 expression in the liver bioptate at the donor’s stage was reliably higher in the carriers of heterozygotes in the SNP rs913930 (C/T genotype) and in the SNP rs5030717 (AG genotype), (Mann–Whitney test, p = 0.03). Signifi cant positive correlation between the CD68 expression in the donor’s liver bioptates and the IL-23 level in the hepatic vein has been determined in an hour after the portal reperfusion (ρ = 0.62; p = 0.04) as well as between the HMGB1 expression in the donor’s liver bioptates and the АSТ level in 24 hours after the reperfusion (r = 0.4; p = 0.02). The HMGB1 staining in the donor’s liver bioptates was higher in the EAD patients, 21 (20; 29) cells/mm2 in comparison with the patients without EAD, 16 (12; 18) (Mann–Whitney test, p = 0.0036). Conclusion. The early allograft liver dysfunction is associated with the genetic predisposition caused by the TLR-4 gene polymorphism and is implemented via the HMGB1, Kupffer cells and IL-23 activation.

Major surgical procedures induce a number of pathophysiological responses, which may lead to a significant increase in perioperative complications, delayed recovery and rehabilitation, and longer hospital stays. Fast-track surgery, also known as enhanced recovery after surgery (ERAS) or as multimodal surgery, aims at decreasing the frequency of postoperative complications, creating optimal conditions for earlier postoperative recovery and return to normal life activities.The implementation of fast-track programs results in a reduced treatment duration without increase in readmissions. In this article, we have described our experience in the application of fast track program components to improve the outcomes after liver transplantation.

It was shown that Tacrolimus (Tac) can suppress infl ammation and immune response involved in liver ischemia-reperfusion injury (IRI) (Kristo I., Transpl Int., 2011). Aim. We hypothesize that back-table arterial and portal liver perfusion with Tac can infl uence the incidence and severity of early allograft dysfunction (EAD). A prospective randomized study was conducted (ClinicalTrials.gov Identifi er: NCT01887171).Materials and methods. Criteria of the inclusion: First liver transplantation from DBD donor with sequential portal-arterial reperfusion. At back-table portal vein and hepatic artery were perfused each by 500 ml of HTK solution containing 20 ng/ml Tac during 10–15 min followed by portal fl ushing with 200 ml 5% solution of Albumin containing 20 ng/ml Tac and by resting of liver in effl uent. No Tac was added in the control group. Primary Outcome: EAD (Olthoff KM, et al. Liver Transpl. 2010) and severe EAD (P.R.Salvalaggio, et al. Transpl. Proceedings, 2012).Results. No difference was found between groups (main vs. control) in terms of MELD (16 vs. 16), steatosis (10 vs. 10%), ballooning (45 vs. 40%) of liver grafts, recipient age (50 vs. 50 y.o.), warm ischemia time (50 vs.50 min) and total ischemia time (482.5 vs. 485.0 min). Median donor age was higher in the main group (44.5 vs. 39.0 y.o.). The overall rate of EAD was 27.9%. EAD rate was signifi cantly lower in the main group (6/43 vs. 18/43; p = 0.003). The rate of moderate-to-severe EAD was lower in the main group (1/43 vs. 10/43; p = 0.009). The median levels of AST and ALT in 24 h after reperfusion were signifi cantly lower in the intervention group (1004 vs. 1596; p = 0.03 and 449 vs. 759; p = 0.057).Conclusion. Portal and arterial back-table liver perfusion with HTK solution with Tacrolimus may contribute to lower EAD incidence and severity.

Aim. The purpose of our work was to estimate the impact of preconditioning with acetylcysteine and sevoflurane on ischemia-reperfusion injury of cadaveric donor liver with marginal features. Methods and results. In this prospective randomized controlled trial we recruited 21 heart beating donors with brain death. We assigned 11 donors to the study group, and 10 donors to the control group. Morphological characteristics of ischemia- reperfusion injury in both groups were analyzed. Conclusion. Use of pharmacological preconditioning with acetylcysteine and sevoflurane resulted in necrosis and hepatocyte apoptosis reduction as compared to the control group, thereby had a protective effect against ischemia-reperfusion injury.

Central pontine myelinolysis (CPM) is the rare, but extremely severe complication after orthotopic liver trans- plantation. The reason for CPM is currently not precisely defined. However, the rapid correction of hyponatremia is considered as the main etiological factor. In this paper we present two clinical cases of CPM in patients under- went orthotopic liver transplantation. We also discuss the pathophysiology, epidemiology, clinical presentation, treatment options and preventive measures of CPM.

The article discusses the existing methods of cooling reciprocating compressors, where special attention is paid to liquid systems in which the motion of the coolant is carried out not from an external pump, but due to fluctuations in gas pressure or rarefaction. An analysis of the designs of pumpless cooling systems is carried out, advantages and disadvantages are identified, directions for their further improvement are identified.

The article discusses the main methods for calculating seals of hybrid power machines. The analysis of works on the designs of hybrid power machines is carried out. The main types of piston seals of pumps, compressors and hybrid power machines are considered, with an emphasis on the main advantages and disadvantages of each type of seal, as well as recommendations on the choice of seals for hybrid power machines. Based on the analysis of the work on the research of piston seals, the main methods for calculating the seals of hybrid power machines are considered and the most suitable one is determined.

Introduction. When driving cars in winter on intercity routes, problems may arise if the highways are covered with snow as a result of heavy snowfalls, which can last for several days or more, and movement during this period becomes impossible. An analysis of statistical data on weather events in winter has shown that in many regions, the closure of trails as a result of prolonged snowfalls can reach up to fifteen percent. In this case, an autonomous energy source, which it receives through the use of environmental properties, can provide significant assistance in improving the situation and increasing safety. The paper considers the technical solution and carries out a theoretical analysis of its characteristics aimed at solving the problem of autonomous power supply of the car interior in severe weather conditions.Materials and methods. The paper presents a technical solution and a theoretical analysis of its characteristics aimed at solving the problem of autonomous power supply of the car interior in severe weather conditions.Results. Based on the results of the information search, the design of a compact low-power wind power plant is proposed. The calculation of the heat loss of the car interior, the characteristics of a compact wind power plant was performed and the generated power required to heat the car interior in an extreme situation was determined.Discussion and conclusions. It has been established that the presented design of a low-power wind power plant can be used as a prototype for the development of an industrial design of an autonomous energy source for heating a car in extreme conditions. Similar installations can be used in other industries, for example, tourism, agriculture, and geological exploration.