[The results of phase III multicenter open randomized controlled study REM-Chol-III-16 in patients with intrahepatic cholestasis syndrome caused by chronic diffuse liver diseases].

AIM: To assess the safety and efficacy of Remaxol, solution for infusion, compared with parenteral form of S-adenosyl-L-methionine, in the treatment of patients with intrahepatic cholestasis syndrome accompanying chronic diffuse liver diseases of various etiology. MATERIALS AND METHODS: In a multicenter open-label comparative study of the safety and efficacy of Remaxol (inosine + meglumine + methionine + nicotinamide + succinic acid) 317 patients aged 18 to 65 years were randomized into 2 groups: patients of the experimental group (n=168) received intravenous Remaxol, solution for infusion, 400 ml, and patients of the control group (n=149) Heptral (S-adenosyl-L-methionine) 800 mg. The duration of treatment was 10 days. The primary efficacy endpoint was the proportion of patients who responded to therapy, as demonstrated by dynamics of laboratory parameters of liver functional status: decrease in gamma glutamyl transpeptidase level by 40%, and/or alkaline phosphatase level by 30%, and/or decrease total bilirubin level by 30% from baseline by the end of the treatment course. RESULTS: The proportion of responders was 51% in the Remaxol group vs. 44.9% in the Heptral group (p=0.303); the lower limit of the one-sided 95% confidence interval for the difference in the proportions of responders was -4.01%, which exceeds the non-inferiority margin pre-defined by the study protocol, thus, the non-inferiority hypothesis was proven, i.e. Remaxol at a dose of 400 ml/day demonstrates similar efficacy to Heptral at a dose of 800 mg/day in patients with intrahepatic cholestasis syndrome associated with chronic diffuse liver diseases. Similar positive trends in the levels of transaminases, total bilirubin and the severity of pruritus were revealed in both treatment groups. We did not reveal statistically significant between-group differences in the frequency of adverse events definitely related to the study treatment. CONCLUSION: Administration of Remaxol as a part of the pathogenetic therapy of patients with intrahepatic cholestasis syndrome who need hepatoprotection is justified.

[Gastroesophageal reflux disease in children].

The last decade is characterized by increasing of the pathology of the gastrointestinal (GI) tract in both adults and children. Among this diseases the first place according to frequency and variety of diseased organs and systems is at the acid developed diseases as gastroesophageal reflux disease (GERD). In this article provided comments to existing classifications of GERD in children, questions about diagnosis, treatment and rehabilitation of children with gastroesophageal reflux disease according to our large clinical experience.

[Ultrastructural characteristics of branch sphincters and precortical arteries in the rabbit pial arterial system]. / Ul'trastrukturnye osobennosti sfinkterov otvetvlenii i prekortikal'nykh arterii v pial'noi arterial'noi sisteme u krolikov

Structural peculiarities of pial arteries and their active microvascular segments-sphincters in offshoots and precortical arteries have been investigated, using electron and light microscopy. Our studies have revealed that these vascular segments, which can independently change their lumen, possess multiple myoendothelial junctions, as well as neuro-muscular contacts. This gives evidence of their independent responses that might be determined by structural peculiarities and innervation of their walls.

[Structural and functional characteristics of arteries and veins in the common frog]. / Strukturno-funktsional'naia kharakteristika aretrii i ven travianoi liagushki.

Histochemical, electron-microscopic, pharmacological and physiological studies of structural and functional features of the frog blood vessels revealed a difference in the peripheral neural apparata of different vessels as expressed by different grades of the contractile responses to exogenous substances and electrical stimulation: the better innervated a vessel the better response is mediated by the alpha-adrenoreceptors. The beta-adrenoreceptors have only been found in innervated vessels. The data obtained suggest that vessels of amphibia are in general similar to vessels of vertebrates but the species specifics associated with behaviour and environment of animals determine a number of specific features in structural-functional organization of vessels. The diversity of structure and functioning of blood vessels found in amphibia attests a differentiation of mechanisms of vessel regulation in different areas of the vascular bed.

[Trophic function of vascular nerves]. / O troficheskoi funktsii sosudistykh nervov.

Ultrastructural study of the rabbit central ear artery in different periods after unilateral sympathectomy (from 2 days to 9 months) revealed that the sympathetic denervation led to obvious destructive changes in cells of all layers of the vascular wall. The earliest degenerative changes occurred in the endothelial cells, then--in the muscular sheath. The changes involve alterations of mitochondria in the endop0lasimic reticulum, destruction of contractile apparatus in the myocytes, and complete disintegration of some smooth muscle cells. After regeneration of the sympathetic nerves, a gradual restitution of the structure of vascular wall's elements occurs.