THE CONCENTRATION OF ACETYLCHOLINE AND THE LEVEL CHOLINESTERASE ACTIVITY IN THE SERUM OF PATIENTS WITH GASTRIC ULCER, DUODENAL ULCER AND ALCOHOLIC CHRONIC PANCREATITIS.

INTRODUCTION: There are a lot of pathogenic factors involved in development of polyetiologic diseases. Acetylcholine is known as first-order mediator and plays important role in development and maintenance of pathological processes. In this article we provide data on concentration of acetylcholine (Ah) in blood serum of patients with stomach ulcer (SU), duodenal ulcer (DU), alcoholic chronic pancreatitis (ACP) and control group.as well as activity of cholinesterase (Che). The aim of this study was to identify a role played by Ah in pathological process during a disease, that may complicate a course of the disease as poor prognostic factor. RESULTS AND DISCUSSION: We found that there are significant differences in Ah concentration and Che activity between SU, DU, ACP and control. In control group we divide concentration of Ah into three groups: low - 0.46 to 1.0 mlMol/l (60% of individuals), moderate - mlMol 02-1,5/I (30%) and high - more than 1.5 Ah mlMol/I (10%). CONCLUSION: We suppose that Che activity and Ah concentration depend on localization of pathological process. It is possible that there are hidden differences in Ah concentration and Che activity between GU and DU.

IMMUNOMODULATORY EFFECT OF ALLOGENEIC MESENCHYMAL STEM CELLS OF RATS.

INTRODUCTION: Recently, more and more attracted the attention of cell therapy, which requires a study of the efficacy and safety of allogeneic MSCs transplantation in acute and chronic inflammatory reactions. The aim of our study was to examine the effectiveness of transplantation of allogeneic mesenchymal bone marrow stromal cells for the healing of surgical wounds the glandular stomach in rats. MATERIAL AND METHODS: Using white Wistar rats. Producing cell transplantation mononuclear fraction derived from rat bone marrow aspirate. Injected cells 8 and 9 th passage. The dose of cells administered to 3-th and / or 7-th days 3,5h106 cells / ml twice or 5,0h106 cells / ml dose. Autopsy on day 10-th and 17-th. The serum ELISA determined the content of the pro- and anti-inflammatory cytokines IL1ß, TNFα, IFNy, IL-4. RESULTS AND DISCUSSION: Introduction MSCs contributed to the decline of the immune mediators of inflammation IL1P, TNFa, IFNy, increase anti-inflammatory IL4. Quality improved healing. CONCLUSION: Rapid curative effect of stem cells may be associated with the formation of blood immune cells (macrophages) that produce substances that restore damaged tissue. They restore the balance between Th1 and Th2.

[BIOLOGICAL RESERVOIRS AS A THE RESPONSE OF THE ORGANISM TO INJURY AND PROOF FOR METABOLIC CORRECTION IN GASTRODUODENAL HEMORRHAGE IN PATIENTS WITH HIGH OPERATING-ANESTHETIC RISK].

In the authors opinion in the process of self-regulation the human body creates some biological reservoirs in response to damage (disturbance of homeostasis) for constant internal environment In cases of decompensation and depletion of these pools metabolic correction is necessary. This opinion was based on the results of the endoscopic metabolic hemostasis in ulcer gastroduodenal bleeding in patients with high operational and anesthetic risk.

[Cell adhesion molecules in evaluation of Crohn's disease therapy].

The treatment of inflammatory bowel diseases (IBD), which include ulcerative colitis (UC) and Crohn's disease (CD) is one of actual problems of modern gastroenterology and coloproctology. In recent years a great attention is paid to the molecules of adhesion. Adhesion proteins play a significant role in the development of inflammation in patients with IBD. They cause the migration of cells from the capillaries into the center of inflammation, i.e. do much to increase the inflammatory infiltration of the mucosa and homing of lymphocytes. Changes in the levels of adhesion factors under the influence of biological therapy have been insufficiently studied. So the aim of our study was to determine the diagnostic value of adhesion molecules--integrin-sVCAM-1 and selectins P-, E-, L- for the assessment of the effectiveness of therapy in patients with UC and CD and prognosis of the disease. 15 patients with IBD were examined (15 patients with Crohn's disease (CD)). 9 patients were treated using infliximab 5 mg/kg according to the standard scheme (0-2-6 and then every 8 weeks). 3 patients with IBD received anti-inflammatory therapy with the introduction of the culture of MSC in the number of 150 x 108 cells suspended in 200 ml of physiological solution with the addition of heparin (10 IU/ml). 3 patients received azathioprine (2 mg/kg) and glucocorticosteroids (GCS) 1 mg/kg. The clinical symptoms, the level of leukocytes, erythrocyte sedimentation rate, C-reactive protein and also were analyzed before and after the treatment with infliximab and transplantation of MSC. The status of the colonic mucosa was evaluated using colonoscopy with biopsy. The concentration of adhesion molecules L-selectin, E-selectin, P-selectin, integrin-sVCAM-1 in blood serum was analyzed using immunoenzyme method twice before the beginning of treatment and after 2 months. It is established that after the standard therapy with the use of corticosteroids and azathioprine clinical and laboratory signs of IBD activity and increased levels of adhesion molecules remained in all patients. It is reliably determined that under the influence of infliximab the levels of P-selectin, E-selectin and integrin-sVCAM-1 decrease to 8.9 +/- 1.0 ng/ml, 5.5 +/- 1.7 ng/ml, 9.5 +/- 4.4 ng/ml, respectively (p < 0.001) in all patients with IBD. This point to the suppression of the synthesis of the main inflammatory cytokine alpha-TNF. Transplantation of MSC causes significant decrease of P-selectin, E-selectin to 6.9 +/- 1.1 ng/ml and 5.7 +/- 1.3 ng/ml, respectively (p < 0.001). Integrin-sVCAM-1 has decreased slightly to 12.2 +/- 2.2 ng/ml, p > 0.1. This is associated with the onset of the maximum therapeutic effect only in 1-2 months after transplantation. The levels of P-selectin, E-selectin, integrin-sVCAM-1, reflecting the acute phase of inflammation, decreased after MSC transplantation and infliximab induction therapy. The level of L-selectin, reflecting a chronic autoimmune inflammation, practically does not decrease after the MSC transplantation (8.9 +/- 0.5 ng/ml, p < 0.05) and infliximab induction therapy (9.6 +/- 0.8 ng/ml, p > 0.1). These include the appointment of long-term infliximab therapy and repeated MSC transplantations. P-selectin, E-selectin, L-selectin, integrin-sVCAM-1 are modern markers of inflammation and may be used to assess the effectiveness of standard and biological therapy in patients with IBD, and to predict the course of the disease.

[Principal characteristics of the endoscopic programmed hemostasis in ulcerative gastroduodenal bleedings in patients with high operational-anesthesiological risk].

Application of the endoscopic programmed hemostasis for patients with ulcer gastroduodenal bleedings and with high operational-anesthetic risk provided metabolic rehabilitation (5% solutions of glucose and ascorbic acid) for the purpose of prevention of recurrence of the bleedings which have arisen after a hemostasis at 5.5% of patients.

[Clinical variants of chronic urticaria associated with Helicobacter pylori].

INTRODUCTION: Chronic urticaria (CU) is one of the toughest problems. The main difficulty is the search for an etiological factor in 70-90% of cases the cause of chronic urticaria remains unclear. In the development and persistence of CU recently paid great importance to the role of Helicobacter pylori infection (HP), which is the most common bacterial infection in humans. However, the influence of HP eradication on the course of CU is poorly understood. AIM: to improve the diagnosis and treatment of urticaria patients with Helicobacter-associated diseases of the upper gastrointestinal tract. MATERIALS AND METHODS: The study included 184 patients with clinical manifestations of urticaria and HP-associated gastroduodenal pathology in the age of 18. RESULTS: Infection with HP was more frequently detected in patients with chronic idiopathic urticaria in comparison with patients with allergic urticaria (73% and 56% respectively, p < 0.05). In patients with allergic and chronic idiopathic urticaria HP-associating chronic gastritis were detected respectively in 90% and 81% of cases, gastric ulcer (4% and 11%) and duodenal ulcers (6% and 13%) in the first and second groups, respectively (p < 0.05). HP eradication was achieved in 69.2% of patients in the group with AU and 61.8% of patients with CU, while in 20.5% of patients with CU didn't recur in the year. The influence of HP eradication on the course of allergic urticaria isn't established. In order to achieve stable remission CU by HP eradication in patients with diseases of the digestive tract of prognostically important is the combination of the following factors: the initial elevated levels of antibodies to HP (IgG-AP) in the range of 1:360 to 1:900, serum cytokines: interleukin 1beta in the range (68-22 pg/ml) and TNF alpha (84-50 pg/ml), reduced levels of total IgE from 0 to 38 IU/ml. CONCLUSION: To patients with HP-associated gastrointestinal diseases, combined with idiopathic urticaria is shown holding Helicobacter therapy, because it leads to remission of allergies at 20.5% of patients remaining--to reduce the frequency of exacerbations. To patients with allergic urticaria an HP eradication for the treatment and prevention of AK is not reasonable.

[Modeling damage of the mucous membrane of the gastrointestinal tract in rats].

We studied the effect of NSAIDs on the stomach lining and intestines. Animals received the selective and nonselective NSAIDs. Revision of the abdominal cavity was performed after 24 hours and 14 days. In the mucosa was determined by the levels of prostaglandins and measured the index of damage. Lowering the synthesis of PG in the mucosa of the gastrointestinal tract contributes to the formation damage. After 24 hours when receiving non-selective COX inhibitors and selective inhibitors of COX-2 revealed the presence of mucous membrane lesions that are smaller than in groups of animals treated with selective NSAIDs. After 14 days of reception remains a low level of GHGs in the group of animals treated with nonselective NSAIDs. Visually mucosal damage are insignificant, but in the submucosal layer preserved microcirculatory blood flow disturbances.

[Stages of chronic pancreatitis development].

AIM: To ascertain correlations between pancreatic secretion disturbances and stage and complications of chronic pancreatitis (CP). MATERIAL AND METHODS: The examination covered 81 CP patients (32 females, 49 males, mean age 55.9 +/- 1.8 years). Alcohol pancreatitis (AP) was diagnosed in 52 of them, biliary pancreatitis--in 29, complicated pancreatitis--in 25 patients. The control group consisted of 22 patients without symptoms of gastrointestinal disease. RESULTS: By the results of clinical, device, laboratory and morphological tests we recognize 3 variants of CP course. Variant A: duration under 5 years, distinct pain syndrome, pancreatic fecal elastase (E-1) level insignificantly decreased, elevated blood levels of acetylcholine (Ac), serotonin (5-NT), cholecystokinin (CCK), secretin is subnormal. Pancreatic tissue is inflamed and swollen. Variant B: duration 5-10 years, E-1 under 100 mcg/g, moderate pain syndrome, prevalence of 5-NT as a stimulator of pancreatic secretory activity. CCK is high and secretin is low. Further progress of fibrous changes by ultrasound investigation, abdominal CT leads to calcinosis in pancreatic tissue. Variant C: duration 10 years and longer, weak pain syndrome, further rise of 5-NT concentration, decompensation of regulatory mechanisms of secretory pancreatic activity, CCK is high, secretin is subnormal. CONCLUSION: Changes in correlations between neuromediators and hormones in CP reflect adaptation aimed at retension of secretory pancreatic activity in significant fibrous changes of pancreatic tissue.

[Mesenchymal stromal cells transplantation in acute and chronic pancreatitis in rats].

Before using MSC transplantation in the clinic to conduct preclinical studies MSCs to animals with acute and chronic pancreatitis. Work out the timing and dose of MSCs. The rationale of MSCs transplantation for the regeneration of damaged pancreatic tissue. The essence of the experiments is to establish the existence of common pathogenetic mechanisms for the development of pathological processes and sanogenesis toxic damage of pancreatic tissue. The study was work out in the rat model of acute and chronic pancreatitis, to explore beneficial and adverse effects of allogeneic stem cells for regenerative-reduction processes. For cell transplantation using allogenic stromal cell fraction of bone marrow, the cell suspension was injected at a dose of 2 x 10(6) and 5 x 10(6) cells.

[The damaging role of endogenous nitric oxide in the development of the experimental DSS-induced colitis in rats].

An experimental study on rats to determine the role of inducible NO production in the pathogenesis of inflammation of the mucous membrane of the colon. The introduction of DSS induces the formation of lesions of the colon mucosa of different severity, which is accompanied by increased synthesis of NO and the stable metabolite of NO - citrulline. Inhibition of NO-synthase reduces the release of NO and the formation of lesions of the colon. The Conduct of experimental research on animals will allow further study of the role of NO in the dynamics of damage development and the medication protective role of inhibition of NO-synthase.

[Endoscopy combined hemostasis. Pathogenetic mechanisms of therapeutic action in gastroduodenal ulcers, complicated by severe blood loss and hemorrhagic shock].

On the basis of results of research the pathomorphology severe blood loss and haemorrhagic shock at 38 patients who have died from ulcer gastroduodenal of bleedings, with the purpose of preventive maintains of relapses of bleedings am established by authors necessity of carrying out of the general, and also local metabolic rehabilitation during the endoscopic haemostasis at massive bleedings at the patients with high risk of surgical treatment.

[Autoimmune reaction component in chronic pancreatitis: clinical and experimental study].

UNLABELLED: The study was undertaken to identify the relationship between inflammatory and autoimmune processes in chronic pancreatitis and to determine the prognostic significance of autoantibodies to antigens of acinar cells and hepatocytes, immunoglobulin G1-4. MATERIALS AND METHODS: In 85 patients with CP (43 men, 42 women) were studied autoantibodies to antigens of acinar and liver cells, IgG1-4. Of these, 43 patients HP was characterized by complications (cysts, calcification, pseudotumoral form), 40 patients--HP without complications, 2 patients were diagnosed chronic autoimmune pancreatitis (CAP), confirmed histologically. 20 people-- the control group. Experimental studies on animals, reproduction of acute and chronic pancreatitis. RESULTS: Maximize the level of autoantibodies--32.4 +/- 5.6 U / ml (control--10.5 +/- 2.5 U / ml) (p < or = 0.01), as well as IgG4--24 mg/ml in normal (0.8 +/- 0.08 mg/ml)--was recorded in patients with autoimmune pancreatitis. The average value of autoantibodies--in patients with CP complications: 24.2 +/- 3.8 U/ml (p < or = 0.01). The minimum value of autoantibodies--in patients with CP without complications: 18.6 +/- 2.6 U/ml (p < or = 0.05). CONCLUSION: The course of autoimmune pancreatitis accompanied by an increase of autoantibodies to antigens of acinar and liver cells, as well as serum IgG1-4, especially IgG4, which reflects the intensity of the autoimmune responses in this disease. In addition, the exacerbation of chronic pancreatitis with complications is clearly defined autoimmune component of disease. Experimental studies with preimmunization of animals allogeneic tissues have convincingly demonstrated that the formation of antibodies is not only to the antigens, reflecting the specific characteristics of these tissues, but also to general cell structures of other tissues.

[Conservative treatment of giant gastric ulcer].

Clinical supervision of successful conservative treatment of the patient with a huge stomach ulcer with use in the course of performance endoscopic a metabolic homeostasis of solutions of glucose and ascorbic acid of 5%, and also pH-chromoscopy and capillary gastrointestinal a tube is presented.

[Cytokine imbalance correction and regeneration stimulation of persistent autoimmune stomach ulcers with help of periulcer transplantation of mononuclear cells of autological bone marrow].

The efficiency of correction of cytokine disbalance and peptic ulcer regeneration has been studied using the model of chronic peptic ulcer at use based on mononuclear fraction cells (MFC) of autologous bone marrow (BM). MFCs are shown to remove cytokine disbalance, reduce systemic inflammation reaction and accelerate peptic ulcer regeneration.

[Etiology and pathogenesis of duodenal mucosa lesion in chronic pancreatitis].

AIM: To measure content of neuromediators (acetylcholine-Ach, serotonin-5-NT) and gastrointestinal hormones (cholecystokinine-CCK and secretin) in the blood serum of patients with chronic pancreatitis (CP); to study protective properties of the mucus in the duodenum in CP. MATERIAL AND METHODS: CCK and secretin concentrations were estimated by enzyme immunoassay, Ach and 5-NT were measured biochemically basally and after standard meal in 65 CP patients and in the control group. Proteolytic activity of the mucus was assessed by Anson's method. An inhibitory property of the mucus was studied by residual proteolytic activity of pepsine after its incubation with mucus. RESULTS: In AP patients the response of biologically active substrates to standard meal changed: 5-NT concentration rose from 0.40 +/- 0.07 to 0.55 +/- 0.05 mcg/ml (p < 0.05) while Ach dropped from 1.7 +/- 0.3 to 1.6 +/- 0.3 mmol/l (p > 0.05). BP patients responded to the standard meal with 5-HT concentration rise from 0.28 +/- 0.04 to 0.43 +/- 0.05 mcg/ml (p < 0.05), Ach changed insignificantly (from 1.5 +/- 0.12 to 1.45 +/- 0.21 mmol/l, p > 0.05, reselectively). CCK after standard meal significantly rose both in AP and BP. AP and BP patients had strong direct correlation between concentrations of 5-HT and CCK (r = 0.875439) and weak negative correlation with Ach level (r = -0.2209). In AP and BP patients secretin level weakly negatively correlated both with 5-NT and Ach levels (r = -0.4839 and r = -0.33207, respectively). Reduction of secretin secretion diminished secretion of bicarbonates and mucus with simultaneous change in the quality of mucous gel. CONCLUSION: In CP of various etiology there are changes in the level and proportions of neuromediators and hormones causing alterations in the regulation system. These disorders correlate with disturbances in pancreatic excretory function and destructive tissue changes. Bicarbonates secretion decreases and changes quality of the secreted mucus.

[Exocrine function of the pancreas at chronic pancreatitis: diagnosis an drug correction].

Estimation of respiratory test with 13C- mixed triglytcherides and gastrointestinal hormones effeciancy for the diagnosis of extrasecretory pancreatic with chronic pancreatitis was the aim of this examination. Test 13C- mixed triglytcherides was examined vercus test with pancreatic elastase of feces (E-1). 45 patients with chronic pancreatitis and 20 patients in 2 control groups were examined. The resuets testify to the lowering of pancreatic exocrine function in the patients with complicated chronic pancreatitis. The levels of E-1 and CPRDF (360) were trustworthy low the patients with complicated chronic pancreatitis versus the patients with chronic pancreatitis without complications and in control groups (p < 0.05). Correlative analysis the levels of E-1 and CPRDF (360) had demonstrated high degrel of results similarity. Persons correlation index was r = 0.64 (p < 0.001). The secretines level after standart breakfast in the patients with chronic pancreatitis was lowering, but was increasing in the healthy persons. Secretine lowering may lead to the bicarbonates secretion lowering. These results testify to the necessity of fermental treatment in the patients with chronic pancreatitis accordingly the pancreatitis stage.