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The paper analyzes an evidence base for the pharmacotherapy of irritable bowel syndrome (IBS) A large number of randomized placebo-controlled trials (RPCTs) systematized in a number of meta-analyses suggest that monotherapy regimens with spasmolytics, antidepressants, dietary fibers, polyethylene glycol, rifaximin, probiotics, and mesalamine are effective. Only some RPCTs evaluate the efficiency of combined pharmacotherapy versus placebo for IBS. Since the basis for the pathophysiology of the latter is motility and functional disorders, visceral hypersensitivity, and, probably, impaired microbiota, we anticipate that the need to use combined approaches to treating the majority of patients with IBS, by covering a few components of its pathogenesis, is relevant. Thus, to choose pharmacotherapy for IBS in each specific case is a challenge as this is determined by the form of IBS, the availability of an approved medicine on the domestic market, the indications for use, possible long-term use, high safety, and efficacy evidence drawn from RPCTs.Представлен анализ доказательной базы по фармакотерапии синдрома раздраженного кишечника (СРК). Большое число рандомизированных плацебо-контролируемых исследований (РКИ), систематизированных в ряд метаанализов, свидетельствуют об эффективности монорежимов лечения - спазмолитической терапии, антидепрессантов, пищевых волокон, полиэтиленгликоля, рифаксимина, пробиотиков и месалазина. Только отдельные РКИ оценивают эффективность комбинированной фармакотерапии СРК по сравнению с плацебо. Поскольку основа патофизиологии СРК - нарушение моторики и функции, висцеральная гиперчувствительность и, вероятно, нарушение микробиоты, мы предполагаем, что для большинства больных СРК актуальна необходимость комбинированных подходов в лечении с охватом нескольких звеньев патогенеза СРК. Таким образом, выбор фармакотерапии СРК в каждом конкретном случае является сложным решением, поскольку определяется формой СРК, доступностью апробированного лекарственного средства на внутреннем рынке, наличием показаний к применению, возможности длительного применения, высокой безопасности и свидетельств эффективности согласно результатам РКИ.

UDC 535.21:678.067 In studying the reaction of laser radiation with composite materials, it is important to determine the absorption factors, threshold of decomposition, and loss of mass of the materials investigated. A theoretical model which allows estimating these values for some composite materials based on a polyethylene matrix with different powdered fillers (Table 1) with a particle diameter of 1-20 #m is described in the present article. The results of the calculations are compared with the experimental data obtained in [1, 2]. The experimental values of the factors ,Uexpt and Rexpt from [1], obtained for radiation intensities of I 0 < 0.01 MW/cm 2 for a neodymium laser with a pulse duration of 2 msec, are reported in Table 1. Macroscopic decomposition of the materials begins, the reflection factor R decreases, the absorption factor ~ increases (by tens of times for some materials), and a crater forms on the irradiated surface of the samples with a further increase in I o. The dependences of the depth of the craters formed and specific loss of mass on the intensity of the laser radiation are reported in [2]. The proposed model of decomposition of composite material is based on the experimental data which show that absorption of radiation in the bulk of the Samples studied basically takes place on filler particles, whose heating causes decomposition of the surrounding polyethylene matrix. In this case, it is possible to estimate the dimensional absorption factor in the Bouguer--Lambert law in terms of the section cr (m 2) of absorption of light by the particles and their concentration N (m -3) in the material: = oN. (1)