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The authors consider the nutriciology aspects of therapeutical problems from the perspectives of the General theory of medicine developed by them — the theory of noosphere–anthropogenic harmony. The authors consider the evolution aspects new scientifi c data on the molecular biology, microbiology and biotechnology as a part of biological culture, which determines the relationship of a person with the internal and external world and is one of the main factors in the evolution of the biosphere. The article analyzes the problems of qualitative and quantitative changes in nutrition parameters during the formation of diseases, their prevention and treatment.

Introduction.Anemic syndrome (AS) is a common pathological condition in patients with chronic heart failure (CHF) and is recognized as an independent predictor of poor prognosis. A particular role is played by pathogenetically associated with CHF anemia. Mechanisms of its occurrence are being studied. An important role belongs to systemic inflammation, which is involved in the pathogenesis of anemia of chronic diseases (ACD). However, the contribution of cytokine-induced inflammation in patients with heart failure has not yet been fully investigated.Material and methods.A total of 873 cases of patients with CHF were prospectively analyzed on the basis of the cardiology department of the SBHCI NNR «Nizhny Novgorod Regional Clinical Hospital n.a. N.A. Semashko». The main group consisted of patients with anemia pathogenetically associated with heart failure (n = 96), the control group (CG) (n = 35) patients with heart failure without anemia. The indicators of ferrokinetics were assessed and the systemic inflammation was compared by indicators of interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and serum hepсidin.Results.Patients of the main group had signs of functional iron deficiency (ID) and significantly higher values of cytokines and hepsidin compared with the CG. The relationship between the level of cytokines and hepsidin with the severity of CHF, hemogobin and chronic kidney disease was revealed.Conclusion.An increase in the concentration of pro-inflammatory cytokines and hepcidin in patients with AS with decompensation of CHF is interrelated with functional ID and a decrease in hemoglobin level. This shows the role of cytokine-induced inflammation in the genesis of anemia in heart failure. The functional state of the kidneys makes a special contribution to these mechanisms. As CKD increases, the levels of inflammatory cytokines and hepcidin in these patients and their relationship with markers (CKD) increase.

Background: Epidemiological studies performed in different countries have identified a number of trends that allow to predict the problems related to the prevalence of inflammatory bowel diseases (IBD), their severity and healthcare resources utilization. Aim: To present comparative results of two large epidemiological studies of IBD in the Russian Federation (RF), i.e. ESCApe and ESCApe-2. Materials and methods: Two multicenter cross-sectional cohort studies with a similar design were performed at three-year interval. The studies had the common aim: to identify social and demographic and clinical particulars of ulcerative colitis (UC) and Crohn’s disease (CD) in RF, as well as treatment options. Twenty (20) centers of gastroenterology from 17 RF regions participated in the ESCApe (2010–2011) and 8 centers from 7 RF regions in the ESCApe-2 study (2013–2014). Results: The ESCApe study included 1797 patients (1254 UC and 543 CD), whereas the ESCApe-2 included 1000 patients (667 UC and 333 CD). Patient demographic and social characteristics: In both studies, female: male ratio was similar in UC and CD. Patients’ age was almost identical: in UC, median age was 38 years and 40 years in ESCApe and ESCApe-2, respectively; in CD the corresponding values were 36 and 35 years. In ESCApe, the peak UC onset was at the age of 21 to 40 years, whereas in CD it was shifted towards younger age (22.5% of the patients manifested before 20 years) and the peak incidence was in three age groups (below 20 years, 21 to 30 and 31 to 40 years). A statistically significant difference between CD and UC was found only in the age group of 11 to 20 years (22.5% vs. 13.6%, respectively, p < 0.01). In ESCApe-2, median age of disease onset in UC and CD was approximately 30 years. In both studies, urban:rural ratio for UC and CD was 4:1. In ESCApe, the proportion of current smokers among CD patients was almost two-fold higher than among those with UC (15.6 and 8.8%, respectively, p < 0.001); the same trend was found in ESCApe-2 (15 and 7.3%, p < 0.001). Socioeconomic characteristics of patients in both studies were similar: 50 to 60% were at work (professional occupation and income levels were not studied); in ESCApe 30.9% of UC patients and 40.9% of CD patients had legal disability due to various reasons (including that related to UC and CD in 12,6 and 14.9%, respectively), whereas in ESCApe-2 the respective proportions were 35.7 and 51.1%. Clinical characteristics of patients: The time from the first UC symptoms to diagnosis was similar in both studies (median, 5 months in ESCApe and 4 months in ESCApe-2); in CD patients these parameters were significantly different in both studies (12 vs. 1 month). As for the severity of the disease, the UC patients in ESCApe had mild disease in 16%, moderate in 53%, and severe in 31%, whereas the respective proportions among the CD patients were 21, 44, and 35%. In ESCApe-2, there were no patients with severe disease; mild and moderate UC were diagnosed in 51.3 and 46.6% of the patients, respectively, and mild and moderate CD, in 52.3 and 47.3%. The frequency of left-side UC was similar: 38% in ESCApе and 34% in ESCApе-2. Proctitis was more frequent in the first study (33 vs. 11%, p < 0.01), and total UC was more frequent in the second study (29 vs. 55%, p < 0.02). There were no significant differences between ESCApe and ESCApe-2 in the main CD localizations: terminal ileitis was seen in 31.3 and 35.4% of the patients, respectively, ileocolitis in 33.4 and 37.8%, colitis in 25.6 and 32.1%. The upper gastrointestinal involvement In ESCApе was found 4.4%, and mixed involvement in 5.3%. In both studies, extra-intestinal manifestations were more frequent in CD, than in UC: in ESCApe, 33.1% and 23% (р < 0.05), and in ESCApe-2 in 41.7 and 29.4%, respectively (р < 0.05). Peripheral arthropathies were most frequent. Ankylosing spondylitis was found in CD only, and primary sclerosing cholangitis, only in UC. Aphthous stomatitis was significantly more prevalent in CD in both studies. There were no significant differences in all other extra-intestinal symptoms (eye and skin involvement). Treatment characteristics: Treatment options before the study entry, as well as at the study inclusion visit were analyzed. In ESCApe, the majority of the patients had not been given any treatment before the study entry (49.1% with UC and 40.5% with CD). Three years later the situation was changing: in ESCApe-2, the proportion of treatment-naïve patients was 2.5 to 3-fold lower (15.3% with UC and 14.4% with CD), which was most probably related to increasing awareness of physicians. Before the study entry, most patients (40 to 70%) had been treated with 5-aminosalicylic acid (5-ASA). Before the second study, the patients were more frequently treated with glucocorticosteroids (GCS), immunosuppressors and genetically engineered biological agents (GEBA), but with no significant differences from the first study. 5-ASA prevailed also among the agents that were administered during the inclusion visits in both studies (80 to 90% UC patients and about 70% of CD patients). Compared to ESCApe, in ESCApe-2 there was a trend towards lower rate of GCS administration in UC and CD, but the differences did not reach the significance level. It may be explained by the absence of severe IBD types in ESCApe-2. In ESCApe, immunosuppressors were rarely used (in 14.4% of the UC patients and in 26.8% of the CD patients); however, in ESCApe-2 there were administered more frequently: up to 35.9% of the UC patients and 55.1% of the CD patients (р < 0.01 for both cases). It was unknown if immunosuppressors were used as monotherapy or in combination with GCS. Three years later, the rate of GEBA administration was also higher, but this increase was significant only in CD: 28.3% in ESCApe-2 vs. 9.2% in ESCApe (р < 0.01). According to the results of ESCApe, in the UC patients steroid resistance was seen in 23% and steroid dependency in 21%, whereas in the CD patients these values were 24 and 27%, respectively. In ESCApe-2 these parameters were not assessed. Conclusion: Both studies showed a number of patterns coinciding with the world trends, such as age and gender distribution of UC and CD patients, age at manifestation, the proportion of urban to rural residents, smoking status, prevalence and types of extra-intestinal symptoms. Unlike in European countries, moderate and severe forms of UC with extensive involvement are prevalent in RF. Low prevalence of mild and limited types of IBD is to be explained by underdiagnosis. Of note is the high proportion of patients with UC and CD treated with 5-ASA, although in CD these agents have demonstrated low efficacy. The rates of immunosuppressors and GEBA administration significantly increased in the second study, most likely, due to the implementation of a system of educational measures. Nevertheless, the rate of GEBA use in IBD remains low, which is to be related to their insufficient availability. In total, steroid resistance / steroid dependency rate amount to almost half of UC and CD cases. In general, some positive changes in the patient management are obvious in the second study. However, monitoring these changes over time could only be possible if similar studies would be performed at regular intervals.

The authors discuss the theory of human superorganism and its microbiota (microbiome), whose mutualistic interactions is realized within the microbiota – gut – brain axis that includes endocrine, immune and neurohumoral pathways. The newest concepts of microbiome enterotypes and core microbiota are presented, which are important for understanding of the role of symbiotic microorganisms in human vital activities, for explanation of pathophysiology of many chronic human diseases (beyond gastrointestinal disorders), as well as for the search of effective therapeutic targets. As highly promising are considered the functional approaches to studies of microbiota that allowed to formulate the concept of phylometabolic (phylofunctional) core. This is a series of evolutionally stable microorganisms responsible for majority of the main microbiome functions, such as fermentation of polysaccharides (glycans), production of short-chain fatty acids (butyrate, propionate, acetate), hydrogen utilization, production of lactate, metabolism of aminoacids, bile acids, choline, production of vitamins and some biologically active substances – anti-inflammatory, anti-microbial, immunostimulatory. The authors are first to describe the main functional groups of microorganisms of gut microbiota phylometabolic core, providing key metabolic functions, as well as the leading characteristics of the phylometabolic core as such. The perspectives of modification of composition and functions of phylometabolic microbiota core are discussed based on metabiotics as a virtually new class of therapeutic agents. A hypothesis has been proposed that the ratios between main components of the key gut microbiota may reflect fundamental processed related to a mutualistic interactions between microbiota and human body, as well as they may serve as effective biological markers of dysbiotic states determining the development of various pathologic conditions. For example, the ratio between Bacteroides spp. and butyrate producing bacteria that indirectly indicates total numbers of microbial genes can be used both for assessment of chronic inflammation of various localization (starting from inflammatory bowel disease to fat tissue inflammation related to metabolic syndrome), and for control of treatment efficacy.

The wide use of titanium alloys is often due to their unique properties. Availability of a wide variety of mechanical, physical and chemical properties is associated with a large number of polymorphic modifications of titanium alloys. During the last decade, the metastable omega phase piques the largest interest among all titanium modifications. This study attempts to explain the different wear behavior of some titanium alloys with different Nb content during dry friction impact.

To assess prevalence of gastroesophageal reflux disease (GERD) in Russia in MEGRE trial in 6 cities of the Russian Federatiion (Kazan, Kemerovo, Krasnoyarsk, Ryazan, St-Petersburg, Saransk).Mayo Clinic questionnaire (USA) adapted for Russia was used to question 7812 people over 18 years of age from of random population sample. The symptoms (heartburn and regurgitation) were classified as frequent if they arose once a week and more often for the last 12 months, rare symptoms arose less often than once a week. The responders with frequent heartburn and/or regurgitation were regarded as persons with epidemiological quantitative criteria of GERD.Heartburn occurred in 47.5% responders: frequent in 9%, rare in 38.5%. Regurgitation occurred in 42.9%: frequent in 7.6%, rare in 35.3%. GERD prevalence was 13.3% (city range 11.3-14.3%). Frequent GERD symptoms are associated with frequent gaseous eructation (24.3%), chronic cough (22.9%), chest pain (15.1%), dysphonia (11.4%.). To stop heartburn, 88% responders took antacids, 32%--blockers of histamine H2-receptors and only 23%--inhibitors of proton pump. Only 52.8% responders with frequent chest pain and 29.3% those with frequent heartburn visited a doctor.The population-based trial MEGRE conducted by international methodology in 6 cities of Russia demonstrated that GERD prevalence is 13.3%. Most of the patients pay little attention to the symptoms, do not seek medical advice and, therefore, receive no adequate treatment.

Characteristics of Bacillus subtilis metabolites contained in supernatants of its broth cultures are described. Metabolites contained bacterium-produced biologically active components ensuring cells growth and propagation. These components had bacteriostatic and bactericidal effect on gram-positive and gram-negative pathogenic and conditionally pathogenic microflora of gastrointestinal tract of human and animals. Enzymes produced by the bacterium (amylase, protease, cellulose-decomposing enzyme, lipase, pectinase) increased antagonistic properties of preparation and promote its probiotic effect.

The article is a review of data, revealing scientifically proven approaches to correction of human microbiocenosis disturbances with the help of microbe probiotics, produced on the basis of synergic components and properties of B. subtilis culture 3.

The examination of 453 new cases of young-age gastroduodenal affections demonstrates that two-thirds of the patients have non-ulcerative dyspepsia presenting as a symptom complex associated with heterogeneous group of gastric and duodenal diseases with specific pathomorphological alterations in the absence of ulcers and cancer. The problem of nonulcerative dyspepsia needs further detailed specification studies.

Clinico-statistical evaluation of reparative process in 332 gastric ulcer and 294 duodenal ulcer patients revealed factors of objective value to its course. In order of significance the factors rank as follows: area of ulcer, localization, combination with certain mucosal erosions, total fasting acidity, free fasting hydrochloric acid, basal gastric secretion, cardial function, duodenogastric reflux, sex, age, number of cigarettes smoked daily. When studying treatment effects on regeneration in ulcer patients in is necessary to take into consideration basal clinico-endoscopic parameters.

Sucralfate (55 patients), cimetidine (25 patients), ranitidine (30 patients), antacids and cholinolytics (32 patients) were studied and compared in open clinical trials for the efficacy in the treatment of ulcer disease of the stomach and duodenum. During 5 weeks, ulcers completely healed in 100% of the patients given sucralfate (in 94.5% for 4 weeks), in 90% of the patients treated with ranitidine, in 84% on cimetidine, and in 78% of the patients undergoing treatment with antacids and cholinolytics.