Morphotypes and genetic diversity of Dendrobaena schmidti (Lumbricidae, Annelida).

Dendrobaena schmidti (Michaelsen, 1907) is a polymorphic earthworm species from the Caucasus and adjacent regions. Adult D. schmidti individuals have highly variable body size (from 1.5 to well over 10 cm) and color (from dark purple to total lack of pigmentation), so a lot of subspecies of D. schmidti have been described; however, the existence of most of them is currently under dispute. We studied the genetic diversity of D. schmidti from seven locations from the Western Caucasus using mitochondrial (a fragment of the cytochrome oxidase I gene) and nuclear (internal ribosomal transcribed spacer 2) DNA. For both genes studied, we found that our sample was split into two groups. The first group included somewhat bigger (3-7.5 cm) individuals that were only slightly pigmented or totally unpigmented (when fixed by ethanol). The second group contained small (1.7-3.5 cm) specimens with dark purple pigmentation. In one of the studied locations these two groups were found in sympatry. However, there were no absolute differences either in general appearance (pigmented/unpigmented, small/big) or among diagnostic characters. Although the two groups differed in size (the majority of individuals from the first group were 5-6 cm long, and of the second one, 2-3 cm), the studied samples overlapped to a certain degree. Pigmentation, despite apparent differences, was also unreliable, since it was heavily affected by fixation of the specimens. Thus, based on the obtained data we can conclude that D. schmidti consists of at least two species that have identical states of diagnostic characters, but differ in general appearance.

[[The Pathogenetic Approaches to the Chronic Liver Diseases Treatment].]

The paper reflects the issues of pathogenesis of the chronic liver diseases (CLD). The role of the cell membrane lipid peroxidation as well as oxidative stress and fibrosis formation in the development and progression of liver lesions of various aetiologies. are represented in details. Particular attention is given to the justification of pathogenetic approaches to the treatment of liver disease. Presented the evidence base of successful application of the standardized silymarin as a part of the drug Legalon in the CLD of different etiology.

THE HEPATOPROTECTOR ROPREN FOR THE TREATMENT OF PATIENTS WITH NONALCOHOLIC STEATOHEPATITIS: A PROSPECTIVE OBSERVATIONAL STUDY.

OBJECTIVES: New and effective drugs to improve liver function and fibrosis are urgently needed for patients with nonalcoholic steatohepatitis (NASH). This study examines the effectiveness of treatment of patients with NASH with the registered heparoprotector, Ropren~ Methods. This observational study used Ropren? in a post-registration setting to treat 20 females (38-56 years) with chronic NASH unresponsive to standard treatment. Ropren? is a biopolymer made up of polyprenols (analogue of dolichol) isolated from the green verdure of spruce (Picea abies (L) Karst). Ropren? was given orally, three times a day (54 mg/day). Measurements before and after treatment included symptoms and blood biochemistry (triglycerides, high-density lipoproteins, low-density lipoproteins, alanine transaminase, aspartate transaminase, alkaline phosphatase and gamma-glutamyl-transpeptidase). Liver fibrosis was measured with indirect ultrasound elastometry. RESULTS: After 12 weeks of Ropren? treatment, improvements were found for blood lipids and clinical and biochemical signs, including reductions in total cholesterol and triglycerides (p <0.05). Ropren® also significantly decreased the liver fibrosis index (p <0.05). No side effects were observed. CONCLUSIONS: Ropren® treatment increased the elasticity of the liver and might be useful to reduce the risk of cirrhosis. Although the sample size in this study was small, the results demonstrated that a randomised-controlled trial of Ropren? for NASH is warranted.

A REVIEW OF INTERNATIONAL AND NATIONAL CLINICAL GUIDELINES FOR THE DIAGNOSIS AND TREATMENT-OF NONALCOHOLIC FATTY LIVER DISEASE.

The review presents comparative characteristics of domestic and foreign clinical guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease.

[SUCCESSFUL ORTHOTOPIC LIVER TRANSPLANTATION IN A PATIENT WITH HEPATOLENTICULAR DISEASE AND FULMINANT HEPATIC FAILURE].

The article presents a clinical case of hepatolenticular disease in young man with rapidly progressive liver disease fulminant hepatic failure and successful emergency orthotopic liver transplantation.

[NONALCOHOLIC FATTY LIVER DISEASE: DIAGNOSTIC, SYMPTOMS, TREATMENT. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015].

According to the World Health Organization, it is recorded steady growth of the number of chronic liver diseases, including nonalcoholic fatty liver disease (NAFLD), in recent years. As an independent nosological entity, NAFLD is one of the risk factors for cardiovascular diseases, associated with abdominal-visceral obesity, peripheral insulin resistance (IR), and is regarded as the hepatic component of Metabolic syndrome (MS). Nowadays there are no generally accepted national standards for diagnosis and treatment of NAFLD for physicians, gen- eral practitioners, gastroenterologists in Russia. This was the essential reason in their development. The main reason of The guidelines development is the absence of generally accepted national standards for diagnosis and treatment of NAFLD for physicians, general practitioners, gastroenterologists in Russia. These guidelines are based on the global and local data of treatment experience of NAFLD, recently published in reviews, analytical studies in the literature. Guidelines are intended for physicians, general practitioners, gastroenterologists and contain the description of the preferred approaches to the provision of diagnostic, curative and preventive care of patients NAFLD. The quality of recommendations was grading according to the GRADE approach.

[AUTOIMMUNE LIVER DISEASES: CLINICAL FEATURES, DIAGNOSIS, TREATMENT. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015].

The group of liver autoimmune diseases (LAD) includes autoimmune hepatitis (AIH), Primary biliary cirrhosis (PBC) and Primary sclerosing cholangitis (PSC) The guidelines on clinical diagnosis and management of patients based on a review and analysis of recent publications on this topic in the global and domestic literature and on the authors'experience in treating patients with autoimmune liver disease.

[WILSON'S DISEASE (HEPATOLENTICULAR DEGENERATION, DYSTROPHIA HEPATOCEREBRALIS) DIAGNOSIS, TREATMENT AND DISPENSARY OBSERVATION. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015].

Wilson's disease (hepatolenticular degeneration, dystrophia hepatocerebralis)--a chronic, progressive disease with a genetically determined autosomal recessive mode of inheritance. The violence in metabolism of copper with its excessive accumulation in visceral organs and central nervous system is the basis of the disease. The guidelines on clinical diagnosis and management of patients based on a Review and analysis of recent publications on this topic in the global and Domestic literature and on the authors' experience in treating patients with Wilson's disease.

[Whipple's disease in a patient with infantile cerebral palsy and hepatitis B virus cirrhosis].

The paper describes a patient who has developed Whipple's disease in the presence of infantile cerebral palsy and hepatitis B virus cirrhosis. After 5-year treatment with co-trimoxazole (480 mg b.i.d.), the clinical manifestations subsided and PAS-positive macrophages were no longer detectable in the small intestinal mucosal biopsy specimens. Subsequent worsening of the patient's condition was associated with the progression of liver cirrhosis.

[Case of primary biliary cirrhosis combined with GERD and complicated by peptic strictures of the esophagus].

The clinical case of the two diseases combination such as primary biliary cirrhosis and peptic stricture of the esophagus (complicated GERD) in one patient is presented in the article.

[Celiac disease is a 33-year-old man with periodic disease].

The article presents a clinical case of a 33-year-old Armenian man, who suffered from two rare diseases: Familial Mediterranean fever and celiac. The diagnosis of Familial Mediterranean fever: abdominal-feverish form, is confirmed by genetic markers. The morphological study of duodenal mucosa's specimens confirms the celiac.

[Treatment of chronic viral hepatitis: achievements and prospects].

The review focuses on the current state of the problem of chronic viral hepatitis (CVH),B and C. Presents an analysis of the effectiveness of schemes of antiviral therapy (AVT) of chronic HCV-infection and current understanding of the treatment tactics of patients with inadequate response to therapy. Particular attention is paid to the nearest perspectives in treatment of chronic hepatitis C (CH C). The questions of the effectiveness of AVT chronic HBV-infection, the results of the comparative effectiveness of interferon (IFN) and nucleoside analogs (AN) in the treatment of chronic hepatitis B (CH B) are observed in the article. Special attention is paid to the treatment of chronic viral infections at the stage of liver cirrhosis (LC).

[Realities and prospects for the use of cell technologies for the treatment of chronic diffuse liver diseases].

Chronic liver disease (CLD) leads to disability annually hundreds of thousands of patients worldwide. Originating as a rule, at a young age (20-40 years), they are always significantly degrade the quality of life of patients, making them socially significant. Moreover, the conventional treatment (hepatoprotectors, antiviral drugs, corticosteroids, immunosuppressive medication) not always lead to achieving the desired effect, and therefore is constantly searching for alternative treatments. Cell therapy with embryonic fetal, mononuclear, mesenchymal stromal cells is the most advanced front of modern biotechnology and medicine. Using the SC with the purpose of treatment in chronic liver diseases is the possibility of disturbed regulation of cell-cell interactions in the liver, the impact on the mechanisms of cell death (necrosis - apoptosis) and fibrogenesis, which makes this method the most relevant and promising in hepatology. The article presents an analysis of the results of studies conducted in the field of stem cell technologies by leading domestic and foreign scholars in the treatment of liver diseases. Were studied questions of transdifferentiation, the mechanisms of stem cells in hepatology, as well as the possible risks of this therapy (pro-oncogene action, increased fibrosis). Also was presented our own experience of applying cellular technology in experimental models of acute toxic hepatitis in animals.

[Features of the HCV-infection in the elderly patients].

The problem of chronic HCV-infection in the elderly patients is poorly known. During the HCV-infection and progression of fibrosis in chronic liver diseases depends on age of the patient.

[Generalized B-cell lymphoma, marginal zone masked by chronic liver disease].

This article describes a case of diagnosis of generalized B-cell lymphoma of marginal zone cells, which debuted with hepatolienal syndrome. Presented the latest information on etiology, pathogenesis, clinical manifestations, diagnostic methods and treatment of non-Hodgkin's lymphoma.

[Clinical significance of intravital morphological investigation of the liver].

AIM: To demonstrate great importance of intravital morphological examination of the liver for differential diagnosis of chronic diffuse diseases (CDD) of the liver. MATERIAL AND METHODS: A complete clinical examination, needle or intraoperative biopsy of the liver were made in 1045 patients with chronic diseases of the liver. Structural features of hepatic tissue were studied histologically. Variational statistics was used for analysis. RESULTS: Viral markers were detected in 373 patients (HCV in 53%, TTV in 10%, HBV in 16%, HGV in 6%, CMV in 3%). Chronic hepatitis (CH) was caused by combined viral infection in 12% cases. CH variants were verified morphologically in 64% patients with provisional diagnosis CH. Objective evaluation of structural changes severity rested on algorithms of semiquantitative determination of the index of histological activity and fibrosis index. Hepatic cirrhosis of viral or alcohol etiology was detected in 4.8%, primary biliary cirrhosis--in 11.2%, non-alcoholic fatty disease of the liver--in 11.2% patients. Impaired glucose tolerance is an essential factor predisposing to non-alcohol fatty disease of the liver. Detection of vacuole-like nuclei in periportal hepatocytes is an early morphological sign of the fatty disease. Three percent of the patients had signs of minimal portal cholangitis. This correlated with TTV detection. CONCLUSION: Life-time morphological examination of the liver specifies activity and stage of the process in chronic hepatitis, confirms or detects abnormalities in hepatic architectonics, identifies clinically significant changes in cellular and intercellular components of hepatic tissue, detects and verifies rare hepatic affection. Such information is of importance for optimization of treatment policy and improvement of prognosis in CDD of the liver.

[Intrahepatic cholestasis in chronic liver diseases].

The syndrome of cholestasis is a common manifestation of chronic liver disease (CLD) of any etiology: alcoholic, viral, drug, metabolic, etc. The basis of the formation of cholestasis is a violation of the synthesis, secretion or bile outflow. Accession intrahepatic cholestasis (field surgery) for chronic liver disease alters its course, aggravates the condition of the patient, reduces the immune system, leads to development of severe septic complications, significantly reduces the quality of life (QoL) and worsens the prognosis. In published data, as well as the results of original research aimed at improving the diagnosis and treatment of syndrome of field surgery. Was given the definition of the severity of field surgery, defined the criteria for severity, identified the severity of field surgery. Clarified the influence of field surgery in the state of the plasma level of coagulation, as well as the phosphorus-calcium metabolism in CLD of various etiologies. The advantages and versatility combined antiholestaticheskoy field surgery therapy for moderate and severe degree of different etiologies. An algorithm for treatment of field surgery, suggesting a differential approach to therapy depending on the severity of field surgery.