Vol 14, No 2 (2021)

Background. Obesity is widely recognized as a disease that acquires the scale of an epidemic and is accompanied by a number of comorbidities, one of which is non-alcoholic fatty liver disease (NAFLD), while the issue of the impact of bariatric interventions on its course remains a subject of discussion, which determines the relevance of this study.
Aims. Тo evaluate the impact of combined bariatric interventions - laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic mini-gastric bypass (LMGB-OAGB), - on the course of NAFLD and to determine the criteria that affect the dynamics of NAFLD after thеsе bariatric interventions.
Materials and methods. The study included 56 patients who had one of 2 types of bariatric interventions performed between 2014 and 2017: LRYGB (26 (46,4%) patients) and LMGB-OAGB (30 (53,6%) patients). All patients underwent intraoperative liver biopsy, a range of laboratory and instrumental studies, FibroTest were calculated in dynamics. The frequency of complications in the postoperative period was estimated. The period of observation was 2 years.
Results. In the group of laparoscopic Roux-en-Y gastric bypass 12 (46.2%) patients showed signs of liver fibrosis according to histological research, and 8 (30.8%) - signs of non - alcoholic steatohepatitis (NASH). There was an increase in transaminases in 5(19,2%), gamma-glutamyltranspeptidase (GGTP) in 19 (73.1%), and total bilirubin in 8 (30.8%) subjects. 20 (76.9%) participants had increased alkaline phosphatase (ALP), 22 (84.6%) had reduced high – density lipoproteins (HDL) and increased triglycerides (TG). According to the results of ultrasound examination of the liver, 19 (73.1%) patients had enlarged liver size, 26 (100%) - diffuse heterogeneity, and 25 (96.2%) - hyperechogenicity.
In the group of laparoscopic mini-gastric bypass, there were signs of liver fibrosis in 14 (46.7%) and NASH - in 14 (46.7%) patients. An increase in tranasminases was observed in 8 (26.7%), GGTP – in 22 (73.3%), and total bilirubin – in 6 (20%) patients. 9 (30%) of participants had increased ALP, 26 (86.7%) patients had reduced HDL and increased TG. 21 (70%) patients had enlarged liver size, 29 (96.7%) - diffuse heterogeneity, and 28 (93.3%) - hyperechogenicity.
6 months after both types of interventions, there was a decrease in the clinical and biochemical characteristics of non-alcoholic fatty liver disease, which was transient and regressed by 1 year after surgery.
After laparoscopic Roux-en-Y gastric bypass %EBMIL in 1 year was 75.25 [65.85-84.36] %. Normalization of transaminases was observed in 84.6%, cholestasis indicators – in 87.2%, and FibroTest -in 46.2% of cases. % EBMIL 1 year after laparoscopic mini-gastric bypass was 74.77 [67.28-78.89] %. Normalization of transaminases was observed in 83.3%, cholestasis indicators – in 78.9%, and FibroTest -in 43.3% of cases.
Combined bariatric interventions were shown to be more effective in participants under 45 years of age compared to those over 45 years of age and in patients with initial stages of fibrosis F0-F2 by METAVIR compared to participants with stages F3-F4 by METAVIR. Patients with a BMI of more than 40 kg / m2 achieved higher FibroTest values after six months compared to subjects with a BMI of up to 40 kg/m2 and in fewer cases - FibroTest normalization by 1 year after surgery, respectively. The effectiveness of operations on the course of NAFLD was comparable.
The results of the intervention on signs of non-alcoholic fatty liver disease were preserved for 2 years of postoperative follow-up. The mortality rate during the entire follow-up period was 0%. 47 (83,9%) patients were followed up to 2 years.
Conclusion. Тhere was a high efficiency of RYGB and MGB-OAGB in patients with non-alcoholic fatty liver disease, while a transient aggravation of the course of non-alcoholic fatty liver disease was detected 6 months after the operation.
Keywords: non-alcoholic fatty liver disease; obesity; metabolic syndrome; bariatric surgery; LRYGB; LMGB-OAGB; FibroTest; surgical intervention

Relevance. Among the complications of traumatic spinal cord disease (SCD) pressure ulcers occupy a special place, with incidence reaching 68% and showing no tendency for decreasing. Literature reviews one of the main reasons for the formation of decubital ulcers is enteral insufficiency, the timely detection of which is still a common problem for many medical specialties, and laboratory indicators pointing to its manifestation remain in the zone of a controversial issue. New knowledge regarding laboratory predictors of pressure ulcer formation in the acute period of trauma will reduce the risk of decubital ulcerative defects.
Purpose of the study. Based on the analysis of laboratory blood levels in the acute and early periods of hip joint injury, to identify predictors of the formation of pressure ulcers in patients with spinal trauma.
Materials and methods. 68 case histories of adult patients with hip injury were retrospectively analyzed. The victims were treated in the City Clinical Hospital No. 39 of the Kanavinsky District of Nizhny Novgorod for the period from 2013 to 2020.
Results and discussion. A comparative analysis of blood levels on the first day after injury showed that patients with subsequently developed bedsores at the early stages of treatment got hypoproteinemia and a decrease in serum creatinine levels more often than patients without bedsores. In addition, white blood cell count in patients with pressure ulcers was elevated, compared to normal values and patients without pressure ulcers white blood cell count. For a year creatinine and total protein values in patients of the main group tended to be or completely became normal, which is most likely associated with adequately administered enteral nutrition. The white blood cell count of the study group decreased to the normal range.
Conclusion. Increased white blood cell, a decrease creatinine levels and total protein values in patients with HSC in the first hours after injury confirms the catabolic orientation of metabolism in the acute period of spinal cord injury, so it leads to conclusion that the early intensive therapy aimed at arresting protein losses and inflammation is needed, which in turn will prevent the formation of pressure ulcers in the early period of traumatic spinal cord disease.

Introduction. The question of the body's immune reactivity when using mesh implants for plastic surgery of the chest frame remains not fully understood.
Aims. The effect of the polypropylene mesh endoprosthesis "Surgipro" on systemic and local cytokine production after reconstruction of the chest frame was evaluated.
Materials and methods. The work was performed on male Wistar rats weighing 250 ± 50 grams (n=21). The main group consisted of rats with musculo-aponeurotic plasty (n=9), the comparison group consisted of animals that underwent chest plasty after removal of the posterior segment of the IV rib measuring 1.0 cm and overlapping over the mesh (n=9). Healthy rats without surgery served as control (n=3). The animals were taken out of the experiment on days 1, 10 and 30 after the operation. Determination of cytokines TNF-α, IFN-γ and IL-10 in the blood serum and biopsy of the postoperative scar was performed by the method of enzyme-linked immunosorbent assay.
Results. It was found that in the experiment, the plastic of the chest frame affects the systemic and local production of cytokines TNF-α, IFN-γ and IL-10. A more intense increase in serum and local anti-inflammatory cytokines was recorded with the use of the implant (p˃0.05). At the same time, the production of anti-inflammatory IL-10 was recorded at values below the control (p˃0.05).
Conclusions. The conducted experimental study revealed that the use of a mesh endoprosthesis in the restoration of a defect in the thoracic frame causes more pronounced systemic and local production of cytokines TNF-α, IFN-γ and reduces the production of IL-10.

To date, there are quite a large number of reports of the use of stem cells in the treatment of various diseases in humans. However, the authors do not provide credible evidence that the introduced stem cells come directly into the target organ. Without a clear understanding of the location of the introduced stem cells, it is difficult to reliably assess the effect of their use. The article gives its own observation about the possibility of imaging in the human body autologous mesenchymal stem cells introduced through the portal vein of the liver to a patient suffering from cirrhosis. Iron oxide nanoparticles were used as labels. A rather simple question was previously solved: how to create a label of such size that the viability of the stem cell was preserved and it could be visualized in the human body when performing magnetic resonance imaging of abdominal organs. Following in vitro studies, the most appropriate stem cell marking embodiment was chosen to provide both adequate imaging and cell viability. After administration of marked table cells, magnetic resonance imaging of abdominal organs was performed to the patient. The introduced stem cells were visualised only in hepatic tissue. According to clinical and biochemical blood tests - no deviations were detected. There were no complications against the background of this procedure. The patient was discharged for outpatient treatment in satisfactory condition.

The article presents a minimally invasive method for treating strictures of a biliodigestive anastomosis, which consists in creating access to the intestinal lumen without entering the abdominal cavity. A guideline in this is the scar on the anterior abdominal wall, which remained after the removal of the circular drainage or Volker's drainage. In this way, in our clinic, 10 patients were operated on after an operation to form a biliodigestive anastomosis on a disconnected RF loop. A clinical case with a follow-up period of more than 10 years is presented. There was no recurrence of strictures, and according to the data of clinical, echographic and biochemical examinations, all of them had a good long-term result.

Importance. Surgical procedures have a lot of stress, causing significant violation of the non specific defense mechanisms of the body and the immune system, which requires the use of different pharmacological agents in order to increase natural resistance to infection.
Purpose. An analytical review of experimental and clinical research in the direction of studying the effectiveness of the impact of enteral xymedon on reparative process of surgical wounds and tissue non-specific resistance of the organism to infection for the prevention of inflammatory wound complications.
Materials and methods. The analysis of experimental and clinical data, dealing with the question of studying the effect of enteral and topical xymedon to repair tissue in the area of the surgical wound and the non-specific resistance to infection. The criteria for the effectiveness of the drug were clinical and laboratory parameters, and statistic methods.
Results and their discussion. The analysis of experimental and clinical studies have shown that enteral and topical use xymedon in surgical patients stimulates wound healing surgical site and increases nonspecific resistance to infection by increasing the functional activity of neutrophils, their backup potentials normalize the concentration of a bioactive and immunoreactive fibronectin in blood plasma, improve antimicrobial activity of wound.
Conclusions. Xymedon is recommended as an effective means of pharmacological support of wound healing in surgical patients to prevent postoperative wound complications.

Currently, the problem of antibiotic resistance of the most pathogenic microorganisms is very relevant, and therefore it is necessary to search for new ways to eliminate pathogens of the infectious process in chronic soft tissue wounds. The article presents generalized data from published scientific studies that substantiate the clinical potential of using bacteriophages for the rehabilitation of chronic soft tissue wounds. The results of domestic and foreign studies confirm the safety and effectiveness of the use of bacteriophages in the treatment of chronic soft tissue wounds. The main problems limiting the spread of phage therapy are the high specificity of phages and the technical complexity of their immobilization in the area of clinical interest. Further research is needed and promising in the field of phage therapy in order to improve the results of treatment of chronic soft tissue wounds.