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Crohn's disease (CD) is chronic recurrent bowel disease of unknown etiology, characterized by segmental transmural granulomatous inflammation, mainly with the development of local and systemic complications. Despite the active development of conservative therapy methods, the number of drug-resistant forms of CD and complications of the disease requiring surgical treatment continues to increase. The article reflects modern scientific ideas about the methods of diagnosis, conservative and surgical treatment of CD in children.

Eosinophilic esophagitis (EoE) is a disease with a nonspecific clinical picture, and characteristic changes in the mucous membrane of the esophagus often become an endoscopic finding. The final diagnosis is possible only on the basis of the results of the morphological examination. The article presents the results of examination and treatment of two patients hospitalized in the dermatological and gastroenterological departments of the National Medical Research Center of Children's Health with newly diagnosed EoE. In both cases, there were no typical clinical signs of EoE in patients, however, taking into account a number of characteristic endoscopic signs, a morphological study was carried out, the diagnosis of EoE was verified and pathogenetic treatment was prescribed with the achievement of clinical and laboratory remission.

В статье представлен обзор литературы по гипоксически-ишемической энцефалопатии (ГИЭ), которая развивается у младенцев после перенесенной перинатальной ишемии. Она остается существенной проблемой интенсивной терапии у новорожденных в связи с высоким уровнем смертности и неврологической инвалидности с детства, несмотря на достигнутые определенные успехи в отношении диагностики, мониторинга и методов лечения. Главной целью терапии следует считать обеспечение церебральной перфузии и предупреждение вторичных повреждений нейронов, в том числе развития апоптоза. Среди методов диагностики и мониторинга состояния центральной нервной системы у новорожденных ведущую роль играют: нейросонография с допплеровским определением паттернов мозгового кровотока, мониторинг NIRS в сочетании с амплитудно-интегрированной электроэнцефалографией. Сегодня единственным методом интенсивной терапии с доказанным нейропротективным действием остается терапевтическая гипотермия 33–35 °С в течение 72 часов. Ее эффективность пока остается недостаточной: она снижает долю комбинированного результата «смерть/тяжелое нарушение неврологического развития» с 65 до 40–50 %, поэтому продолжаются поиски методов лечения, которые могли бы улучшить последствия умеренной и тяжелой ГИЭ. Среди методов респираторной поддержки, перспективным выглядит применение Neurally Adjusted Ventilatory Assist. До сих пор не решен вопрос идеального раствора для восстановления дефицита объема циркулирующей крови у новорожденных. Кристаллоиды из-за низкого волемического коэффициента оказывают нестойкое воздействие на сердечный выброс. Использование альбумина ограничено из-за нарушенной проницаемости гематоэнцефалического барьера при ГИЭ. Рассмотрена возможность использования 6% гидроксиэтилкрахмала 130/0,42, поскольку последние исследования не продемонстрировали дополнительных рисков по сравнению с применением кристаллоидов. Основным препаратом кардиотропного действия пока считается допамин, однако несколько работ доказывают преимущества добутамина относительно его влияния на системную и церебральную гемодинамику. Поиск других лекарственных средств для вторичной нейропротекции пока показал определенные результаты по эритропоэтину, но количество исследуемых случаев небольшое. Другие препараты находятся преимущественно на стадии доклинических и клинических исследований I и II фазы.

Despite the positive developments in the sphere of ensuring the special needs of disabled children, a comprehensive socio-hygienic assessment of the conditions and lifestyles, as well as of their families, has not been carried out in the recent years. The purpose of the study is to identify, through a sociological survey, the problems that a disabled child encounters in his life, in order to further improve the provision of medical and social assistance to him. Materials and methods of research: 506 legal representatives of minors (aged 0–17 years) with the status of a disabled child were interviewed. Study design: single-center, non-randomized, uncontrolled. Results: the study of the living conditions of a disabled child in the family, the assessment by the parents of the state of his health, the problems arising during the registration of disability, in the provision of medical and rehabilitation assistance, and issues of medical and social support, made it possible to determine the position of this part of the child population in modern legal and medical and social conditions. The main problems were the large number of documents required for the registration of a disability, the long wait for the day of the examination, the remoteness of the location of the medical and social examination bureau, the shortage of specialist doctors, the problem with subsidized drugs, the lack of taking into account the individual needs of the child when carrying out rehabilitation programs, the need to contact different organizations and departments, lack of medical and social assistance, violation of rights in the provision of medical services to a disabled child. Conclusion: The acquired information is important for the further improvement of the provision of medical and social assistance to handicapped children and children with disabilities. The main task today is to develop mechanisms for fulfilling the declared rights and freedoms of persons with disabilities and the obligations undertaken by the state in relation to them. The principle of individualization of the provision of various benefits, depending on the condition of a disabled child, his needs, material security, remains relevant.

Aim: to establish the patterns of changes in leukocyte blood parameters to determine their diagnostic significance in the different activity of Crohn’s disease (CD) and ulcerative colitis (UC) in children. Materials and methods. 370 5-18-year children (198 boys, 172 girls) with inflammatory bowel disease (IBD) were examined. Leukocytic blood parameters, concentrations of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), faecal calprotectin (FC) levels were determined. Changes in clinical activity in Crohn’s disease (CD) and ulcerative colitis (UC) cases were determined using pediatric activity indices: PCDAI and PUCAI, respectively. Analysis of endoscopic activity in 160 CD and UC patients was determined using the scales: SES-CD and UCEIS, respectively. Results. It was found that with an increase in the clinical activity of CD in children, the absolute numbers of leukocytes, lymphocytes and monocytes did not change significantly. In contrast, a significant increase in neutrophil reactivity was noted. In patients with high endoscopic CD activity an increase in the absolute number of monocytes and neutrophil reactivity was found. In patients with high clinical activity of UC, an increase in the number of leukocytes and the absolute number of neutrophils was found. At the same time, the granularity and reactivity of neutrophils increased from remission to moderate and high clinical activity of UC. In children with high endoscopic UC activity, the number of leukocytes, the absolute number of neutrophils and monocytes increased. At the same time, the granularity of neutrophils significantly increased as the endoscopic activity of UC increased from remission to moderate activity. Leukocyte parameters in UC patients correlated moderately with FC level, and the absolute number of neutrophils was closely related to its content. The granularity and reactivity of neutrophils positively correlated with ESR and CRP levels in children with CD and CRP concentrations in children with UC. Conclusion. The established patterns of changes in the quantitative composition of leukocytes and their functional properties (reactivity and granularity) are directly determined by the different activity of IBD in children and have diagnostic value

It is assumed that serum concentrations of type I, III, IV collagen (Col I, Col III, Col IV) and hyaluronic acid (HA) can provide informative evidence for the diagnosis of liver fibrosis (LF) using non-invasive procedures, however, there is insufficient data on the subject in paediatrics. Objectives: to study characteristics of changes in concentrations of Col I, Col III, Col IV and HA in blood serum in accordance with the stages of liver fibrosis in children. Materials and methods of research: a prospective study was carried out, which included 80 patients aged 5 to 17 years with chronic liver diseases of various etiologies, who underwent marginal resection of liver tissue under laparoscopic control, then a morphological study of the obtained biopsy was performed with determination of the stage of fibrosis on the METAVIR scale and the content of Col I, Col III, Col IV and HA in blood serum by the method of enzyme immunoassay. Results: the assessment of the content of K-I in the blood serum allows differentiating the stage F1 and F3 from F4 (p=0,025, p=0,006), Col IV – F1 from F2 (p=0,011), F3 (p=0,002) and F4 (p

In most cases, COVID-19 has a favorable outcome. However, the risk of developing critical forms of the disease, including secondary hemophagocytic lymphohistiocytosis HLH (cytokine storm syndrome), remains high. This dictates the interest in studying pathogenetic mechanisms, features of the clinical picture, laboratory and instrumental criteria for covid-19 disease. The article analyzes the causes of acute respiratory distress syndrome and multiple organ failure as manifestations of HLH. The necessity of monitoring signs of hyperinflammation (ferritin, C-reactive protein, etc., biomarkers of inflammation) and activation of thrombosis is substantiated, in order to make timely decisions about the beginning of pathogenetic therapy. However, there are limitations for routine testing of the level of Pro-inflammatory cytokines. Information about the diagnostic criteria of HLH is summarized, and the expediency of these criteria for establishing secondary HLH, which has complicated the course of COVID-19, is emphasized.

Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHAD) is a hereditary disease referred to the group of disorders of mitochondrial β-oxidation of fatty acids with autosomal recessive inheritance. The main symptoms include hypoglycemia, hepatic steatosis, cardiomyopathy, cardiac arrhythmias, progressive muscle hypotension. We present a case of successful diagnosis and treatment of a long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHAD) with the use of 100% medium chain triglycerides’ oil product. The importance of the possibly earliest verification of the diagnosis and initiation of diet therapy using medium-chain triglyceride oils is emphasized, which allows to reduce the disease manifestations and determines the need to include diseases of mitochondrial fatty acids β-oxidation into the neonatal screening program.

Timely diagnosis and monitoring of ulcerative colitis (UC) in children is extremely relevant. In recent years, much attention has been paid to improving noninvasive UC diagnosis methods, which are available and convenient in the practice of a doctor. In this regard, we analyzed the significance of changes in noninvasive laboratory parameters of sick children with different clinical and endoscopic UC activity. Materials and methods. A prospective analysis of data of 80 patients diagnosed with UC at the age of 1 to 18 years with varying degrees of clinical and endoscopic activity of the disease was performed. Results. Significant changes in the studied laboratory parameters’ levels were revealed depending on the degree of clinical and endoscopic UC activity in children. The changes in fecal calprotectin content, levels of albumin, hemoglobin, and platelets were particularly substantial and informative in the blood of sick children when comparing remission with moderate and high clinical and endoscopic UC activity. A decrease in platelet counts was also found when UC activity increased. Conclusion. The studied laboratory parameters are informative noninvasive markers of UC activity in children. These indices can be used in the diagnosis of UC activity and monitoring of the course of the disease.

Introduction. Serum concentrations of collagens I, III, IV types (K-I, K-III, K-IV) and hyaluronic acid (HA) are reported to be informative in terms of noninvasive diagnosis liver fibrosis stages. In pediatrics, there is not enough data on this. Purpose was to assess the diagnostic value of direct biomarkers in predicting the stage of fibrosis in children with chronic liver diseases (CLD). Materials and methods. A prospective single-center study included 80 children with CLD . All patients underwent marginal resection of liver tissue under laparoscopic control. The serum K-I, K-IV, and HA concentration were measured by enzyme immunoassay. The authors applied ROC curve analysis to assess quantitative signs’ diagnostic significance in predicting a specific outcome. Results.The optimal KI value for the diagnosis of cirrhosis was 144.24 ng/ml, with AUROC: 0.758 ± 0.101 with 95% CI: 0.560-0.957, sensitivity and specificity 65.2% and 77.8%, respectively. The optimal K-IV values for the diagnosis of moderate fibrosis and cirrhosis were 11.29 ng/ml and 27.40 ng/ml, respectively, with AUROC 0.807 ± 0.092 with 95% CI: 0.627-0.987, 0.685 ± 0.062 with 95% CI: 0.567-0.810, sensitivity 82.4% and 61.15%, specificity 66.7%, and 64.7%, respectively. The optimal BG values for the diagnosis of weak and moderate fibrosis were 34.9 ng/ml and 36.5 ng/ml, for cirrhosis 38.3 ng/ml, with AUROC 0.912 ± 0.050 with 95% CI: 0.815-1.00; 0.849 ± 0.064 with 95% CI: 0.723-0.974, and 0.825 ± 0.048 with 95% CI: 0.730-0.920, respectively. Sensitivity was 84.6% at all stages, specificity - 77.8%, 61.5% and 70.6%, respectively. Conclusions. LF biomarkers have diagnostic significance in the detection of the stages of liver fibrosis. LF biomarkers are informative, reproducible noninvasive indices in the diagnosis of liver fibrosis in children.

Inflammatory bowel diseases (IBD), like allergic diseases, are referred to «diseases of civilization», and their prevalence is growing throughout the world, including in the pediatric population. Both diseases refer to immunopathological conditions and have not only some common pathogenesis, but also similar clinical picture. It is also known about common factors that contribute to the predisposition to both groups of diseases – both genetic and environmental – vitamin D deficiency, changes in the intestinal microbiota composition etc. However, the mechanisms of observed relationship between IBD and food allergy (FA) are not fully understood. In this review, devoted to the current state of the problem, the pathogenetic and clinical parallels between FA and IBD are considered in detail. FA gastrointestinal symptoms may not differ from IBD onset, and the endoscopic picture may mimic the symptoms seen in patients with IBD. Indeed, the verification of gastrointestinal FA is still difficult due to the lack of reliable laboratory diagnostic methods. Besides misdiagnosis, comorbidity between FA and IBD is described. The complex pathogenetic mechanism of both IBD and allergic reactions is based on eosinophils, helper Th2 and Th17 cells, and transforming growth factor β. The common pathogenetic mechanisms lead to similar clinical manifestations, when not only the digestive system, but also the respiratory system and skin can be affected, although this is much less common in IBD. An important role is played by intestinal barrier state and intestinal microbiota – it was revealed that in children with certain genotypes, intestinal dysbiosis can cause immune abnormalities, leading to both allergic diseases and IBD.

The role of food allergy (FA) in the development of clinical reactions to food in patients with inflammatory bowel disease (IBD) is being studied and remains highly controversial. However, it is obvious that for personalized therapy of this category of patients, it is necessary to consider all possible forms of food hypersensitivity. Objective of the research: to develop a questionnaire to identify latent forms of cow's milk protein allergy (CMPA) in children with IBD and to evaluate the effectiveness of its use. Materials and methods: 376 children were questioned: 176 children with IBD in remission and/or with a low degree of disease activity (1st group); 100 with confirmed CMPA (2nd group); 100 without FA manifestations (3rd group). Statistical analysis was performed using the SPSS (Statistical Package for the Social Sciences Inc., USA) version 26.0. Data analysis included standard descriptive and analytical statistics. Results: using a structured questionnaire for collecting anamnesis, it was found that the frequency of allergic reactions to food in the family history of children with IBD and in the group of patients with CMPA did not differ significantly. The introduction of dairy products into complementary foods earlier than at the age of 6 months in IBD patients was noted statistically significantly more often than in children with CMPA and children in the comparison group; the most significant difference was noted in patients with Crohn's disease (CD). In the early history, among children with IBD 83 (47,1%) had skin rashes, 121 (68,7%) regurgitation, 138 (78,4%) colic, 68 (38,6%) constipation. %), blood in stool – 53 (30,1%), mucus (in significant amounts) in stool – 70 (39,7%), loose stool – 77 (43,7%), delayed weight gain was noted in 25 (14,2%) children. At the same time, regurgitation and colic in children with IBD in the first year of life were noted statistically significantly more often than in children with CMPA and children in the comparison group. The frequency of symptoms such as blood and mucus in the stool, diarrhea and delayed weight gain in the first year of life did not statistically significantly differ in children with IBD and in the group of children with CMPA, but was significantly more frequent than in group 3. The median of the indicator according to the results of the questionnaire survey in children with CD was 57 points [52; 62], with ulcerative colitis (UC) – 54 points [50; 57], with PA – 61 points [58; 64], in the 3rd group – 10 points [8; 14]. At a threshold value (cutoff point) of 55 points, the sensitivity and specificity of the method were 79% and 74%, respectively. The area under the ROC curve, corresponding to the relationship between the presence of a subclinical form of allergy and the scores of the questionnaire, was 0,819±0,022 with 95% CI: 0,776–0,862. The resulting model was statistically significant (p

Objective. To evaluate the significance of therapeutic drug monitoring of adalimumab (ADA) concentration levels and antibodies to it in inflammatory bowel disease (IBD) in children. Patients and methods. In this study, 103 children with IBD (24 patients with ulcerative colitis (UC) and 79 with Crohn’s disease (CD)) aged 3–18 years were examined during maintenance therapy with ADA (100 mg/mL in 0.4 mL). Body weight, duration of disease and therapy, use of azathioprine (AZA), achievement of clinical and endoscopic remission, albumin levels, residual levels of ADA and antibodies to the drug, circulating cytokine levels in serum were assessed. Results. A significant decrease in ADA levels in children in the absence of clinical remission in CD (5.21 [3.32; 7.43] μg/mL in remission) and in UC (2.42 [0.42; 4.51] μg/mL, p = 0.001) was shown. A high-quality separation model for residual ADA levels for exacerbation/remission conditions for clinical and endoscopic activity for children with CD and UC was obtained through ROC-analysis. The minimum residual ADA levels for maintaining clinical remission in children with CD were 8.1 μg/mL and 10.5 μg/mL for mucosal healing. In children with UC, as well as in children weighing

Objective. To evaluate the prognostic value of serum levels of infliximab (IFX) and anti-IFX antibodies for predicting treatment efficacy in children with inflammatory bowel disease (IBD). Patients and methods. This study included 123 children with IBD (65 patients with ulcerative colitis (UC) and 58 patients with Crohn's disease (CD)) aged between 3 and 18 years. Children were examined upon the completion of an induction course of therapy and then after 1 year of therapy and between 1 and 3 years of treatment. The induction course was administered according to the scheme of 0–2–6 weeks; maintenance therapy was administered with 6-week and 8-week intervals. The residual level of IFX and the level of anti-IFX antibodies in serum were measured using enzyme-linked immunosorbent assay. Results. We observed a significant increase in the IFX level during clinical remission of CD (remission – 5.21 [3.32; 7.43] μg/mL; exacerbation – 2.42 [0.42; 4.51] μg/mL, p = 0.001) and UC (remission – 4.57 [3.4; 6.74] μg/mL; exacerbation – 0.63 [0.4; 3.27] μg/mL, p = 0.000). ROC analysis demonstrated high accuracy of our model based on measuring residual IFX level for distinguishing between exacerbation and remission in both CD patients (AUC = 0.812) and UC patients (AUC = 0.851). The optimal minimum level of IFX for maintaining clinical remission was 3.7 μg/mL in children with CD and 3.4 μg/mL in children with UC. Anti-IFX antibodies were detected in 18% of patients; children with exacerbation were 4.7 times more likely to have detectable level of anti-IFX antibodies than those in clinical remission. Conclusion. Monitoring of serum levels of IFX and anti-IFX antibodies is a promising method for predicting treatment efficacy and its optimization in children with IBD. Key words: inflammatory bowel disease, tumor necrosis factor-α, infliximab, residual level of infliximab, anti-infliximab antibodies

Objective. To analyze the connection between the complex of platelet indices in complete blood count test with the clinical and endoscopic activity scores for Crohn's disease (CD) and ulcerative colitis (UC) in pediatric patients and to determine their most informative threshold values. Patients and methods. In this study, 370 children aged 5 to 18 years with diagnosed CD (n = 150) and UC (n = 220) were examined. The clinical activity of UC was assessed according to PUCAI, CD – according to PCDAI; the assessment of endoscopic activity in children with UC was carried out according to UCEIS and CD – according to SES-CD. The study included platelet indices of 630 complete blood count tests (270 in patients with CD and 360 in patients with UC): platelet count (PLT), mean platelet volume (MPV), platelet large cell ratio (P-LCR) and platelet distribution width (PDW). Results. Increased platelet count and decreased platelet indices were noted as the clinical and endoscopic activity of CD and UC in children increased. A positive correlation between the clinical and endoscopic activity indices in inflammatory bowel diseases and platelet count and negative correlations with platelet indices were revealed. ROC analysis showed that the informative value of platelet indices in assessing the endoscopic activity of CD and UC is higher than in assessing the clinical activity. The optimal threshold values for platelet count (cut-off) for determining the endoscopic activity of CD and UC were 340 × 109/L and 350 × 109/L (Se 77%, Sp 69% and Se 63%, Sp 67%, respectively). The specificity of determing the endoscopic activity of 99% was obtained for platelet count of 459 × 109/L and 390 × 109/L for CD and UC, respectively. In children with CD, the indicators MPV

Objective. To study vitamin D status in children with inflammatory bowel diseases (IBD) depending on the diagnosis, gender, age and a season of examination. Patients and methods. The study included 244 children (130 boys and 114 girls) aged 3 to 18 years. The patients were divided into 2 groups depending on the nosological form of disease: Crohn’s disease (CD) – 130 children, ulcerative colitis (UC) – 114 children. Blood vitamin D levels were determined by the method of competitive electrochemiluminescence. Results. Normal levels of vitamin D (>30 ng/ml) were found only in 11.1% of children with IBD (in 11.5% with CD and 10.5% with UC). Vitamin D status corresponded to deficiency levels in 65.9% of cases, of them 15.2% had deep deficiency (

Noonan-like syndrome with loose anagen hair is a rare inherited disease caused by heterozygous mutation in theSHOC2gene. The disease was first described in 1991. The main clinical manifestations of the disease are phenotype features similar to those observed in Noonan syndrome: orbital hypertelorism, eyelid ptosis, low-set, and posteriorly rotated auricles, as well as skin and hair lesions, development delay, loose anagen hair, cardiovascular disorders, and mental retardation. It has an autosomal dominant mode of inheritance. We have described three clinical cases of this disease for the first time in Russia. All children in this group had a Noonan-like phenotype, macrocephaly, wide, short neck, hair and skin lesions, congenital heart disease, development delay of different severity, and hypotonia. One child had hypertrophic cardiomyopathy, nonobstructive form, aneurysmal dilatation of interatrial septum, minor dilation of the pulmonary artery and atria, apical aneurysm other cases showed a congenital defect of the urinary system. These patients have thin, sparse, slowly growing hair, dark skin. One girl was diagnosed with multiple capillary haemangiomas on her head and trunk. Pathogenic nucleotide variant c.4AG, p.S2G in heterozygous state of the SHOC2 gene was revealed in all our patients. The same was described previously in patients with this syndrome. Differential diagnosis at suspicion on Noonan-like syndrome with loose anagen hair should be carried out with Noonan syndrome, Cardiofaciocutaneous syndrome (CFC), Costello syndrome.

Glycogen storage disease is the hereditary carbohydrate metabolism pathology which is caused by mutations in various genes encoding enzymes responsible for glycogenesis and glycogenolysis. Excessive glycogen deposition in various tissues cells (mostly in liver and muscles) occurs due to enzyme defects. The authors present recent epidemiological data and features of glycogen storage disease etiology and pathogenesis. Clinical characteristics of different types of this disease are also presented. The data on laboratory-instrumental and morphological signs of glycogen storage disease in children, as well as data on its treatment methods is provided in accordance with the developed clinical guidelines. The article provides relevant information on disease types with predominant liver involvement, besides the variety of clinical forms of glycogenosis.

Inflammatory bowel diseases (IBD), such as Crohn’s disease (CD) and ulcerative colitis (UC), are characterized by chronically recurring inflammation of intestinal wall and are associated with a significant decrease in the quality of life. A spectrum of genetic variants associated with Crohn’s disease is described. Intestinal dysbiosis (DB) may be the triggering factor of the disease. Glycoprotein 2 (GP2), the main protein of pancreatic zymogen granules, is secreted into the intestines with digestive enzymes. Anti-GP2 antibodies were found in the serum of patients with CD. The aim of the present study was to investigate the levels of anti-GP2 antibodies in serum and feces of children with IBD compared with the DB group. Serums and coprofiltrates from 110 children (64 boys and 46 girls) at the age of 12.3 (2.6-17.9) years were studied; 36 patients with CD, 30 patients with UC. A comparison group consisted of 44 patients with DB. IgG and IgA antibodies against GP2 were tested with ELISA. Nonparametric statistics methods are applied, the results are presented as percentages and medians (Me (Q0.25-Q0.75)). The serum levels of anti-GP2 IgA antibodies were 9.97 (3.35-13.45) U/ml for the CD patients, 6.08 (2.71-14.26) U/ml for UC and 2. 94 (2.29-6.41) U/ml for DB. The levels of anti-GP2 IgG antibodies in serum were 6.16 (3.26-18.4) U/ml for CD, 5.26 (2.97-7.52) U/ml for UC, and for DB 5.23 (2.53-8.85) U/ml. The cut-off threshold concentration for anti-GP2 IgG antibodies was 13.8 U/ml, with sensitivity of 63.2%, specificity 100%, and for IgA 5.63 U/ml, with sensitivity of 60.5% and specificity of 78.8%, thus being lower than the calculated cut-off for adults (20 U/ml). The levels of anti-GP2 IgG in coprofiltrates in children of comparison group were 1.99 (1.26-3.04) U/ml; in the patients with CD, 23.5 (16.15-29.3) U/ml, and in children with UC, 20.45 (13.63-25.5) units/ml (p < 0.001). The cut-off value amounted 8.0 U/ml, with 100% sensitivity and 100% specificity. Concentrations of anti-GP2 IgA in coprofiltrates of patients with IBD did not significantly differ from DB patients. Moreover, the concentration of sIgA in the coprofiltrates of patients with IBD was significantly higher than their level in DB group. The anti-GP2 IgA/sIgA ratio was significantly lower in patients with CD (0.326 (0.23-0.512)), and UC (0.327 (0.205-0.435)), than in patients with DB (2.332 (1.575-3.523)) (p < 0.001); the cut-off level was 0.784, with a sensitivity of 97.7% and specificity of 98.6%. It is discussed, whether fecal anti-GP2 IgA antibodies should be considered as protective, supporting intestinal homeostasis, whereas anti-GP2 IgG antibodies are pathogenetically significant for development of IBD. Thus, using a non-invasive method for determining anti-GP2 antibodies in stool, when exceeding the cut-off for IgG, and reduction of IgA/sIgA ratio below the cut-off, one may differentiate IBD from DB with a similar symptoms at the onset of disease, with 100% sensitivity and 100% specificity.

Fibrosis and cirrhosis are traditionally diagnosed by making a biopsy. However, in recent decades, scientists around the world have shown that the accepted “gold standard of diagnosis” – morphological assessment of biopsy – has a number of limitations. The search for non-invasive techniques to diagnose fibrosis has led to the development of many scales using laboratory indices. Non-invasive diagnostic techniques are safer for the patient than liver biopsy. In addition, they can be repeated in a dynamic to assess the condition of the liver over time. Most currently available non-invasive diagnostic techniques are considerably cheaper than the accepted “gold standard”. Their practical use is increasing every year, and in a number of countries the frequency of liver biopsies in viral hepatitis B and C is steadily decreasing due to the development of serum and imaging diagnostic systems. Recent studies show that the assessment of the degree of fibrosis by non-invasive methods is as accurate as a morphological study. In recent years, a number of serum markers have been considered as non-invasive diagnostics of the stages of liver fibrosis, among which the largest number of studies are devoted to hyaluronic acid, type IV collagen, and their combination with various common laboratory tests. The latest non-invasive techniques will make a significant paradigm shift in the evaluation of liver fibrosis in the near future. In this review we have analyzed widely used as well as experimental laboratory techniques used in the diagnosis of liver fibrosis.

The article describes a clinical case presentation of PEEP adjustment under lung ultrasound control in a newborn with respiratory distress syndrome during artificial respiration. Diagnostic value for B-line reduction and appearance of A-lines as predictors of lung atelectasis opening is demonstrated. The practice of low-volume lung recruitment which is achieved by functional residual capacity increasing rather than raising of inspiratory peak pressure can be considered safer as to the risk of ventilator-associated lung injury and the development of severe air leakage syndrome. In addition, the absence of significant fluctuations in the partial pressure of carbon dioxide is prognostically more positive in terms of reducing cerebral perfusion. Nevertheless, additional evidence based data needs to be collected before any further conclusions can be drawn.

Chronic liver diseases in children are characterized by a progressive course and lead to fibrotic changes in the organ up to cirrhotic transformation. Therapy effectiveness and patient’s quality of life depend on timely verified diagnosis and stage of the process. Morphological examination of hepatobiopsies remains a key issue in the diagnostics of histopathological changes in the liver; however, biopsy sampling is associated with a risk of complications and does not exclude insufficiently informative biopsies. This article discusses three clinical cases of patients in whom a personalized choice of the way of biopsy sampling allowed to avoid life-threatening complications and to obtain the most informative biopsy material.

Обоснование. Разнообразие патоморфологических проявлений хронических болезней печени (ХБП) у детей обусловливает необходимость до-статочного для достоверной морфологической оценки размера гепатобиоптата. Выраженные фибротические изменения ткани печени и наличие высокой частоты встречаемости гемостатических нарушений увеличивают риск развития осложнений при проведении биопсии. Ввиду этого ме-тод биопсии печени должен быть выбран в соответствии с необходимым для точной верификации диагноза количеством биопсийного материала, являясь максимально эффективным и в то же время наиболее безопасным относительно рисков развития осложнений как во время проведения биопсии, так и в послеоперационном периоде. Материалы и методы. В проведенное одноцентровое двунаправленное (ретро- и проспективное) исследование были включены 175 пациентов с ХБП: 75 детям, составившим основную группу, биопсию печени проводили методом краевой резекции, и 100 пациентам с ХБП, включенным в группу сравнения, ранее была выполнена пункционная биопсия. Проводили сравнительный анализ длительности выполнения биопсии, наличия и характера осложнений, количества содержащихся портальных трактов в полученных образцах, числа фрагментированных и неинформативных биоптатов при поведении пункционной биопсии и краевой резекции ткани печени под лапароскопическим контролем. Результаты. Проведение краевой резекции гепатобиоптата занимало в среднем 21,7 мин. Осложнений не отмечалось. Проведение пункционной биопсии занимало в среднем 19,4 мин. В 4 случаях отмечалось развитие осложнений (2 случая кровотечения из места пункции, однократно – на-рушение целостности стенки желчного пузыря с развитием локального билиарного перитонита, развитие пневмоторакса вследствие поврежде-ния легкого). Согласно критерию Манна–Уитни выявлены статистически достоверные различия количества портальных трактов в основной и группе сравнения (p=0,000). Количество портальных трактов при проведении краевой резекции гепатобиоптата составило в среднем 93, при про-ведении пункции – 5. Информативность биоптатов в основной группе составила 100%. Фрагментации биопсийного материала не отмечалось. В группе сравнения информативность биоптатов составила 86%, 20% биоптатов оказались фрагментированными. Ключевые слова: хронические болезни печени, биопсия печени, дети. Для цитирования: Хроленко П.В., Яцык С.П., Дьяконова Е.Ю. и др. Эффективность и безопасность эндохирургической биопсии у детей с хрони-ческими болезнями печени. Педиатрия. Consilium Medicum. 2020; 1: 77–81. DOI: 10.26442/26586630.2020.1.200050

Among the mathematical models of marine ecosystems, the simulation model of the Sea of Azov occupies a special place both in terms of the time of creation, and in the detail and adequacy of the description of the ecosystem, and in recognition in the scientific community. The preconditions for the emergence of the idea of system analysis and modeling of the ecosystem of the Sea of Azov, associated with a catastrophic decline by the beginning of the 70s of the last century, of its former record fish productivity are described. The main stages of creating a model are described, the provision of the created models with primary information of field observations over the components of the ecological system of the sea, carried out for 20–40 years by employees of the Azov Research Institute of Fisheries (AzNIIRKh). The choice of the environmental factors taken into account, the ecosystem components taken into account, is substantiated, the blocks of the model are listed, the interaction of which is the reproduction of the functioning of the ecological system of the sea. The reasons for choosing the time step are presented, the technology of conducting simulation experiments with the model is described. It was noted that a comprehensive testing of the intermediate results of modeling the ecosystem of the Sea of Azov was carried out at numerous scientific seminars and conferences, including the annual All-Russian conference “Mathematical Modeling in Problems of Environmental Management” established in 1973 and continuing to this day. The main scientific and practical results obtained are described, including the formulation of the generalized Le Chatelier – Brown principle for the Sea of Azov ecosystem, the definition of the concepts of “critical surfaces” and “critical modes” in the parameter space of the ecosystem model. The reactions of the ecosystem to disturbances of the tuning parameters are analyzed, the principle of localization of disturbances is formulated, the ecosystem of the Sea of Azov was considered as a control system

Liver fibrosis is a progressive pathological process that develops in chronic liver disease. This pathology can lead to cirrhosis. Liver biopsy remains the gold standard for evaluation of liver fibrosis, currently, though, non-invasive diagnostic methods are being actively introduced into clinical practice. Unlike liver biopsies, most non-invasive instrumental techniques are easy to perform, accessible, and repeatable, making them more convenient for evaluating dynamic fibrotic change. The review summarizes the main principles of non-invasive instrumental techinques for assessment of liver fibrosis severity, which have been studied and put into practice in recent years. The most widely used techniques in clinical practice are based on principles of elastography — it indirectly determines the organ tissue density. The techniques are characterized by different sensitivity and specificity in the diagnosis of fibrosis. The main issues arise when differentiating the disease stages. For some techniques, the limitation of use is ascites, excessive subcutaneous fat, whereas the main limiting factor for others is the high cost of the procedure. Meanwhile, there is every reason to believe that non-invasive techniques can take the main place in the diagnosis of liver fibrosis and replace biopsy in the foreseeable future. KEYWORDS: liver fibrosis, chronic liver diseases, non-invasive diagnostic techniques, elastography, liver biopsy, magnetic resonance imaging, ultrasound. FOR CITATION: Kulebina E.A., Surkov A.N., Usoltseva O.V. Non-invasive diagnostics of liver fibrosis: recent data on the possibilities of instrumental techniques. Russian Medical Review. 2020;4(5):297–301. DOI: 10.32364/2587-6821-2020-4-5-297-301.

Chronic liver disease (CLD) is characterized by a progressive course, the formation of fibrosis and cirrhosis. Existing echographic criteria for assessing pathological changes fail to allow to determine accurately the severity of fibrosis, and sometimes, cirrhosis. A liver biopsy carries the risk of non-informative biopsies and the development of complications. In this regard, additional diagnostic criteria are needed to judge the state of the liver tissue, in particular, its surface structures, in both cases without liver involvement and CLD patients. Materials and methods. 75 CLD patients were included in the main group and 73 children without liver pathology - in the control group. An ultrasound system of the expert class was used to perform an echographic assessment of the surface structures of the liver: the thickness of the Glisson’s capsule, the presence of its stratification and nodularity, increased subcapsular blood flow, and the shape of the edge of the liver. In order to assess the severity of pathological changes, all patients of the main group underwent an edge biopsy of the liver under laparoscopic control, followed by histological examination of biopsy specimens. The obtained ultrasound data in CLD patients were compared with the results of a morphological study. Fibrosis stages were calculated using the METAVIR scale. Results. The thickness of the liver capsule in patients of the main group was found to be significantly greater than in the control group (p = 0.000). The degree of thickening of the surface structures in CLD patients increases significantly with the age when compared with healthy children. Significant differences were found in the incidence of stratification and heterogeneity of the surface structures of the liver in CLD children. The presence of echographic changes in the liver capsule was detected in 29 out of the 75 patients of the main group. In these patients, rounding of the edge of the liver was often noted - 27 cases and stratification of the surface structures - 26 cases. Changes in the surface structures of the liver were detected primarily in patients with cirrhosis (stage F4). Stratification of the surface structures of the liver was often noted in them, and capsule heterogeneity and asynchronous movement of the capsule and visceral peritoneum were detected in more than half of cases among all echographic changes in CLD children. Conclusion The echographic heterogeneity of the liver capsule and the asynchronous movements of the capsule and visceral peritoneum in CLD children are informative criteria for organ pathology and can be used for diagnosis.

The problem of torsional vibrations is relevant for reciprocating compressors due to the occurrence of alternating torques that create additional torsional stresses during operation. Such vibrations are particularly dangerous in resonance frequencies when the first natural vibration frequency coincides with the harmonic component of the lower order of forced vibrations. This article analyzes the methods described in the literature for calculating natural torsional frequencies of crankshafts of multirow reciprocating compressors. Recommendations are given on selecting an appropriate calculation method at various design stages. The analytical dependencies that describe three various methods are presented: the iterative method based on moments equation, the method of continued fractions (Tersky’s method) and the matrix method. The stages of calculation are described analytically, and the calculation results are compared. The developed computational software is presented.

At some works, it has been shown there are signs of damage and endothelium dysfunction in patients with chronic viral hepatitis (CVH) and liver cirrhosis of viral etiology the severity of these conditions depends on the severity of the pathological process. Evaluation of the role of angiogenic factors and endothelial dysfunction in persistent of CVH in children and adolescents. 35 patients were examined: of which 11 with chronic hepatitis B (CHB) and 24 with chronic hepatitis C (CHC). The reference group consisted of 120 practically healthy persons of the corresponding age and sex. VEGF-A, angiotensin (ANG), soluble receptors of VEGF-A (sVEGF-R1 и sVEGF-R2) and trombomodulin (TM) have been investigated in serum by enzyme immunoassay using special kits (BCM Diagnostics, USA). Other endothelial dysfunction markers as von Willebrand factor (vWf) was determined in blood plasma by immunoturbidimetry (Siemens, Germany), plasminogen (PLG) was investigated due to extended coagulation. In children with CVH, regardless of etiology, the concentration of VEGF-A was significantly lower, and sVEGF-R2, sVEGF-R1 and TM was higher than in children without liver disease (p

We aimed to study the influence of prolonged administration of fentanyl on postoperative pain, intra­ab­dominal pressure and mechanical lungs’ changes that may happen in neonates in early post­operative period. 30 newborns (in the period from January 2017 to May 2021) with gastroschisis were divided into two groups ac­cordingly to the method of analgesia (14 – morphine hydrochloride; 16 – prolonged infusion of fentanyl). Lungs’ mechanical characteristics, effectiveness of post­operative analgesia, abdominal wall relaxation was studied by monitoring of dynamic compliance (Cdyn), pressure and flow­volume loops, capnography. Apprising analgesia sta­tus, we measured hemodynamic, SаO2, blood level of cortizol, C­reactive protein (CRP), glucose, analyzed post­operative pain syndrome using visual analogue scales (VAS). Intra­abdominal pressure (IAP) was controlled by Cron. For statistic analysis we used Student’s t­test. In the group with morphine, thete was the increase of IAP by 11–12 cm H2O, being stable during some period of time, and also variable levels of pain according to VAS, the in­creasing of CRP from 0.8 ± 0.25 mg/dl by 5 mg/dl, cortisol by 674.4 nmol/l, and blood glucosae rate – 7.4 mmol/l. Periods with high traumatic effects and poor analgesia (morphine group) reasoned the increasing IAP, step by step dynamic compliance decreasing in 3.4 times, resistance increasing in 2.42 times and PIP rising till 22 cm H2O. Di­rect correlation between IAP increase and lungs’ mechanical changes took place. The study has demonstrated that prolonged administration of fentanyl prevented high increase of IAP, CRP, levels of glucose and cortizol and changes of VAS data, lungs’ mechanical characteristics., В исследовании изучается влияние контину­альной инфузии фентанила на послеоперационную боль, внутрибрюшное давление и механические изме­нения в легких, которые могут возникнуть у новоро­жденных в раннем послеоперационном периоде. По ме­тоду обезболивания 30 новорожденных (январь 2017 – май 2021 г.) с гастрошизисом были разделены на две группы (14­ти был назначен морфина гидро хлорид; 16­ти – континуальная инфузия фентанила). Ме­ханические характеристики легких, эффективность послеоперационной анальгезии, релаксации брюшной стенки изучались путем мониторинга динамического комплайенса, петель давления и потока­объема, кап­нографии. Для оценки качества обезболивания измеря­лись параметры гемодинамики, сатурация кислорода в крови, уровень кортизола, С­реактивного белка, глю­козы, проводилась оценка послеоперационного болево­го синдрома с помощью визуальных аналоговых шкал. Внутрибрюшное давление (IAP) контролировалось при помощи Cron. Для статистического анализа использо­вался t­критерий Стьюдента. В группе пациентов, по­лучавших морфин, отмечалось увеличение IAP на 11–12 см H2O, уровня кортизола и глюкозы в крови. Эти эффекты были связаны с травматичностью операции и недостаточной анальгезией, что стало причиной увеличения IAP, постепенного снижения динамическо­го комплайенса, увеличения резистентности легких. Отмечается прямая корреляция между увеличением IAP и механическими изменениями в легких. Исследова­ние показало, что применение континуальной инфузии фентанила предотвращает все вышеперечисленные нежелательные эффекты., У дослідженні вивчається вплив континуаль­ної інфузії фентанілу на післяопераційний біль, вну­трішньочеревний тиск і механічні зміни в легенях, які можуть виникнути у новонароджених у ранньому піс­ляопераційному періоді. За методом знеболення 30 но­вонароджених (січень 2017 – травень 2021 г.) з га­строшизисом були розділені на дві групи (14­ти було призначено морфіну гідрохлорид; 16­ти – континуаль­на інфузія фентанілу). Механічні характеристики ле­гень, ефективність післяопераційної аналгезії, релак­сації черевної стінки вивчалися шляхом моніторингу динамічного комплаєнсу, петель тиску і петель пото­ку­об’єму, капнографії. Для оцінки якості знеболюван­ня вимірювалися параметри гемодинаміки, сатурація кисню в крові, рівень кортизолу, С­реактивного білка, глюкози, проводилася оцінка післяопераційного больо­вого синдрому за допомогою візуальних аналогових шкал. Внутрішньочеревний тиск (IAP) контролювався за допомогою Cron. Для статистичного аналізу ви­користовувався t­критерій Стьюдента. У групі паці­єнтів, які отримували морфін, відзначалося збільшен­ня IAP на 11–12 см H2O, рівня кортизолу та глюкози в крові. Ці ефекти були пов’язані з травматичністю операції і недостатньою анальгезією, що стало при­чиною збільшення IAP, поступового зниження динаміч­ного комплаєнсу, підвищення резистентності легень. Відзначається пряма кореляція між збільшенням IAP та механічними змінами в легенях. Дослідження по­казало, що застосування континуальної інфузії фен­танілу запобігає всім перерахованим вище небажаним ефектам.

During transmission of the data, it can be intercepted and modified. Such behavior is called the MITM (Man In The Middle) attack. Despite the usage of encryption in public networks, such attacks may happen because of the botnets. They pose a particular threat to local networks, where the data is usually transmitted in an unencrypted form. During the previous studies, the “chunking” model and method have been developed for payload authentication. They have been proven to have increased performance in comparison to the widely used methods, such as “Buffering to File” or “Buffering to Memory”. The support of the ECDSA algorithm has been added to the “chunking” method. The most widespread protocol for data transmission is HTTP, which is used in a wide variety of applications. Previously, the “Chunking” method was implemented for every version of the HTTP protocol. However, because of the structure of the HTTP/1 protocol, not all the benefits of the “chunking” method could be used. The new model of payload authentication for HTTP/2 and HTTP/3 protocols has been developed. The modified method for HTTP/2(3) has been implemented in the software library. The new library has been further tested on the subject of compatibility with the existing HTTP/2 client libraries and web-browsers. The new method may be used in web browsers, but modification of the source code is required.

A device for wireless powering of battery-free implants with 500-mW power consumption is considered. The design of the device is described. The device provides relatively high stability of operation (power drop less than 10%) in the case of coil misalignment typical of medical applications (up to 20 mm). The results of engineering tests and tests with a tissue-like phantom (isotonic solution) are presented.

Intiduction. Perinatal hypoxic ischemic encephalopathy (HIE) is associated with approximately one-quarter of global neonatal deaths. Dysregulated cerebral blood flow may be a key component for secondary neurologic injury in HIE. The load of fluids to increase intravascular volume is the point of care in infants because the cerebral blood flow in neonatal period depends mainly on the cardiac output but the choice of fluids is still debatable.Objective. To determine the impact of 6% hydroxyethyl starch (HES) 130/0.42 in a balanced crystalloid solution on brain perfusion in term neonates with severe hypoxic-ischemic encephalopathy.Materials and methods. Single-center, prospective, simple, randomized controlled study was performed in 205 full-term infants with hypoxic-ischemic encephalopathy grade II and grade III by Sarnat score in the period of 2012-2016. Depending on fluids for volume resuscitation, all infants were randomly divided into HES and control groups. In HES group 45 term infants with moderate to severe hypoxic-ischemic encephalopathy were treated at the 1st DOL with 6% hydroxyethyl starch (HES) 130/0.42 in a balanced crystalloid solution at a dose of 10 ml/kg. The control group included 160 term neonates with hypoxic-ischemic encephalopathy undergoing routine intensive care with normal saline at a dose of 20 ml/kg as the loading volume if needed. To assess the impact of 6% HES on systemic and cerebral hemodynamics, such criteria as mean blood pressure (MBP) and transfontanel Doppler indices RI, PI and CPP were obtained at the 1st, 2nd and 3rd DOL.Results. Using of 6% HES 130/0.42 at the dose of 10 ml/kg of body weight for volume replacement in neonates with moderate to severe HIE at the 1st DOL led to increasing of Resistive Index (RI) in front cerebral artery 2nd DOL (p = 0.025) and 3rd DOL (p = 0.023).Conclusion. Administration of 6% HES 130/0.42 in a balanced crystalloid solution in term newborns with severe hypoxic-ischemic encephalopathy for volume resuscitation results in significant improvement of cerebral blood flow, specifically increasing of Doppler Resistive Index in front cerebral arteries.

The article is devoted to solving a practical problem: the choice of equipment for pre-treatment of salt water that feeds the desalination plant. The preliminary stage of desalination is the purification of water from sand particles, which can significantly reduce productivity and even damage the desalination plant, which is situated at the next stage. For pre-treatment, settling tanks, hydrocyclones, sand filters, etc. are used. The main dimensions of hydrocyclones of standard designs are calculated based on well-known recommendations. Modern computer simulation systems allow you to create three-dimensional models of the apparatus being studied, and then calculate the velocity and pressure fields in them. It was necessary to estimate the amount of sand contained in the feed water. To solve this problem, an experimental hydrocyclone was developed and manufactured. The hydrocyclone was numerically simulated and the sand capture coefficient was estimated under various operating conditions. It has been established that an experimental hydrocyclone reliably captures grains of sand 50 microns in size and above. The average daily mass of trapped sand was experimentally determined. Numerical modeling made it possible with reasonable accuracy to estimate the sand capture coefficient by an experimental hydrocyclone. During the tests, the mass of sand entering the pipeline per day was determined. The hydrocyclone reliably captures sand particles of 50 microns or more. At the same time, a significant part of particles less than 50 microns is not captured by the hydrocyclone, which is why a sand filter was chosen for industrial use. In the future, it is advisable to use a serial connection of a hydrocyclone and a sand filter, but such a solution requires additional technical and economic calculation. It is concluded that in the case under consideration, it is advisable to use a sand filter for preliminary water treatment

Ultrasound examination (ultrasound) takes the first place first among visual methods for analyzing the state of the liver parenchyma. Despite the improvement of ultrasound technology, it does not provide the necessary diagnostic accuracy in determining the stages of liver fibrosis. In this regard, it is necessary to search for additional diagnostic criteria to judge the state of the liver tissue and its superficial structures, primarily liver capsules.Materials and methods: the state of the liver capsule was assessed in 73 children of four age groups (2-18 years) without pathological changes in the hepatobiliary system, which were performed by ultrasound of the abdominal organs during preventive examinations. The structure of the capsule of the liver and visceral peritoneum was evaluated. Results. Direct dependence of the thickness of the liver capsule on the age of children was established (rs = 0.577, p = 0.0000). The capsule and visceral peritoneum represented a single and even echogenic structure (95.9%). Stratification of the leaves was detected in 8 children. A change in the shape of the edge of the right lobe of the liver was observed in 4 children. An increase in the severity of subcapsular blood flow in the liver was not detected in any healthy child.

Closure of hemodynamically significant patent ductus arterios (HSPDA) is one of the most important questions in modern neonatal intensive care, especially for preterm babies. Long-term functioning of the hemodynamically significant arterial duct leads to a large number of complications in premature babies, such as: bronchopulmonary dysplasia, periventricular leucomalacia, intraventricular hemorrhage, retinopathy of the premature. To prevent all these complications, the PDA should be closed pharmacologically or surgically as soon as possible without any hesitation. COX inhibitors are commonly used nowa days. Ibuprofen and indomethacin show the equal efficacy and no significant adverse events. But some patients still need surgical treatment. The aim of the study was to determine the feasibility, effectiveness and safety of using various volumes of infusion in combination with COX inhibitors and to determine its effect on the timing of the closure of PDA. 91 premature infants with a gestational age of 26-31 weeks with manifestations of respiratory distress syndrome and НSPDA were studied retrospectively. Premies were divided into 2 groups. Research groups were representative as to gestational age, gender, and weight (1205.0±435.0g). Therapy for PDA closure included the use of various volumes of restrictive or liberal infusion therapy (from 50 to 100 ml/kg/day) and COX inhibitors (indomethacin, ibuprofen). The volume of infusion therapy was limited in the first group. Preemies received 53.5±6.4ml/kg/day on DOL1 and 2. From the third day urine excretion increased and the volume of infusion therapy also raised to 63.6±5.6ml/kg/day, and on day 5 – to 89.7±6.8ml/kg/day. In the second group there was no strict limitation of the volume of infusion therapy (especially in the first 5 days). Delayed period of PDA closure (on average from 14.55±0.56 DOL) was associated with absence of limitation of the infusion volume. In the first group, volume of infusion therapy was restricted in the first 5 days, and the closure of the ductus arteriosus occurred extremely early (on 2.35±0.48 DOL). COX inhibitors were prescribed according to the standard scheme: in the first 3 days indomethacin was administered orally in doses of 0.2/0.1/0.1mg/kg/day. If the premature baby had symptoms of intestinal paresis ( this restricted oral administration of indomethacin), ibuprofen was prescribed in a three-day course in doses of 10/5/5mg/kg/day intravenously or 20/10/10mg/kg/day in rectal form. In all groups, standard PDA closure therapy was used. In the more remote periods (14 and 28 days), there was no fundamental difference in the volume of infusion in all groups. For early PDA closure limitation of infusion therapy in the first 3-5 days in combination with COX is principle.

Object. Causes of failure of endodontic treatment and causes of tooth extraction with a diagnosis of chronic apical periodontitis. Purpose ― to analyze the causes of failure of endodontic treatment and the causes of tooth extraction with a diagnosis of chronic apical periodontitis to determine ways to improve the effectiveness of conservative treatment. Methodology. A retrospective analysis of 864 medical records of a dental patient and 532 results of x-ray examinations of patients who underwent tooth extraction was carried out. 198 dentists-therapists of the city of Tyumen and the South of the Tyumen region were interviewed to determine the shortcomings of endodontic treatment. During the survey, doctors expressed their subjective opinion about the main reasons for the failure of therapeutic treatment of teeth with apical periodontitis and the reasons for their subsequent tooth extraction. Results. According to the survey, the failure of conservative treatment is most often associated with non-compliance with treatment protocols and the complexity of the anatomical structure of the root canals, as well as the inability to adequately clean the root canal system. A retrospective analysis of the data related to tooth extraction revealed that the main cause of tooth extraction is chronic apical periodontitis, which accounts for 69 %. The main reason for the removal of teeth diagnosed with chronic apical periodontitis was a significant destruction of the crown. Summary. In the course of this work, we justified the need to improve existing methods of conservative treatment of apical periodontitis. Improvement of endodontic treatment should be aimed at the development and implementation of effective methods of root canal cleaning and irrigation solution activation. In order to improve the prognosis of endodontic treatment and reduce the proportion of tooth extractions for periodontitis, it is necessary to improve the quality of the final restoration and to monitor its tightness.

By methods of ultrasound (US) diagnostics there were examined 177 children at the age offrom 2 months to 17 years, with liver cirrhosis (LC) in the outcome of chronic hepatitis (CH) of various etiologies. It was found that, irrespective of the etiological factor there is noted a large number of general ultrasound characters typical for stages of the formation of the LC: «streaking» of the hepatic image, cirrhotic nodes, splenomegaly and signs ofportal hypertension. The rate of the formation of LC was analyzed in dependence on the etiological factor. It was established that often, and in a short time LS develops in the outcome of CHD, autoimmune hepatitis and cryptogenic chronic hepatitis. In the examination of 135 children there were included invasive (biopsy) and non-invasive ultrasound methodologies for the quantitative assessment of the liver parenchyma structure: Acoustic Structure Quantification (ASQ) and Transient elastography (TEP). Based on a comparative analysis of US and morphological data SP values> 2.77 and elasticity> 13.90 were established to indicate LC (F4) according to METAVIR system. There were established additional diagnostic criteria for the assessment of the severity of the state of LC patients: density index (DI) increased significantly as far as the disease progresses. The use of non-invasive techniques dramatically expands the diagnostic capabilities of a traditional ultrasound examination of the liver.

Glycogen storage disease (GSD) is a rare form of the pathology in children caused by genetically determined pathological changes of the formation or cleavage of glycogen. Depending on the disorders of functions of enzymes involved in glycogen metabolism, there are known up to 15 GSD types, among them there are isolated liver, muscular and mixed forms. There are presented data of the immunoassay analysis of changes in concentrations of the array of proteins considered as biomarkers of apoptosis: sAPO-1/FAS receptor, sFAS-L, cytochrome C, annexin V, caspase-8, caspase-9 and TNF-α in the serum of GSD with the prevailed liver damage (I, III, VI and IX types). There was established the excess of the concentration of cytochrome C in the serum of GSD children by 2,7 times sAPO-1/FAS receptor - 8,9 times, sFAS-L - 2,5 times, annexin V - 4,8 times and TNF-α - 2,9 times in comparison with reference values. Whereby the excess in the cytochrome C content, sAPO-1/FAS receptor, sFAS-L annexin V and the serum was observed in all patients, that indicating to the higher activity of apoptosis in GSD. In this connection GSD in children can be considered as a form of pathology associated with the pronounced apoptosis that contributes to the progression of structural changes in the liver.

Treatment of the glycogen storage disease (GSD) type I with uncooked cornstarch (UCS) allows to maintain long-term normoglycemia, however, the efficacy of the treatment declines due to the insufficient compliance of children patients and their parents. There were determined clinical and laboratory features of the course of GSD type I in children on the long-term comprehensive therapy. There was performed a retrospective analysis of case histories data on 19 GSD children, including 8 patients with subtype Ia and 11 cases - with subtype Ib. All children received the treatment with both UCS and hepatoprotectors. It was established that during the treatment liver sizes did not change significantly, the fasting blood glucose concentration increased by 2.8 times to 4.21 mmol/l, lactate content decreased by 1.9 times to 5.1 mmol/L, ALT activity decreased by 2.5 times, AST - by 3.3 times, and GGT - by 1.8 times if compared to the level before the treatment. In children with GSD subtype Ib blood concentrations of triglycerides prior to the treatment were 2 times higher than baseline values andfailed to change on the comprehensive therapy. Blood levels of cholesterol and uric acid after the treatment also were not significantly dependent on the duration of the therapy. The authors suggest that comprehensive course therapy of GSD type I by means of prescription to children UCS in combination with hepatoprotectors contributes to the compensation of carbohydrate metabolism and provides the relief of cytolysis and cholestasis, but disturbances of the purine and lipid metabolism in patients persist.

Diagnostic value of computed tomography (CT) of the liver imaging in children with glycogen storage disease (GSD) is still poorly understood, in this connection, there were examined 59 patients with essential hypertension (study group) and 27 - with Wilson's disease (WD) (control group). In dependence on the type of GSD patients of the main group were divided into 3 groups: 1st with GSD Type I (n = 18), 2nd - with GSD type III (n = 21), the third - with the GSD type VI/IX (n = 20). Reference group was consisted of 107 children without liver disease. CT of the abdominal cavity on multislice computed tomography Light Speed 16 and 750 HD (GE, USA) was performed in all cases. The pronounced hepatomegaly with predominant increase in the left lobe and the index of I segment was established to be the common diagnostic CT sign, typical for all types of GSD. The change in the X-ray density of the liver parenchyma, dependent on the type of disease is also the feature of the CT-picture of liver parenchyma. In GD type I there was often noted the decline in the X-ray density of the liver parenchyma, while in GSD types III and VI there was identified a significant increase in the density of the organ tissue, which was related with morphological changes in the liver parenchyma, caused by the deposition of glycogen in hepatocytes, fat and protein dystrophy. The authors believe that CT of the abdominal cavity can be an alternative, non-invasive, relatively inexpensive and accessible way to diagnose GD, which is especially important in pediatric practice.