Features of therapeutic correction of GERD: focus on cytoprotection (with a clinical case)

Тo date, the possible links of the pathogenesis of this disease have been well studied and described, which predetermine certain approaches to the treatment of various variants of gastroesophageal reflux disease (GERD). Effective drug therapy for GERD includes proton pump inhibitors (PPI). However, PPI monotherapy is not always effective. One approach is to increase the PPI dose. At the same time, combination therapy with the addition of drugs that affect the protective properties of the esophageal mucosa seems to be more rational. It is known that in the development of GERD, the violation of cytoprotection of the esophageal mucosa is one of the key links in pathogenesis. Consequently, the issue of combination therapy of PPIs with drugs that increase the protective properties of the mucous barrier along with acid suppression becomes relevant. An example of such an approach is the appointment of rebamipide, the action of which is to regulate the synthesis of prostaglandins through COX-2 mediated mechanisms, influence on endothelial growth factor, increase the expression of tight intercellular contact proteins in epithelial cells of the mucous membrane, reduce the level of interleukin-8 and free oxygen radicals, directed to protect the mucous membrane of the gastrointestinal tract and restore its natural barrier properties. The effectiveness of the combination of PPI and rebamipide contributes to a greater regression of complaints in patients with GERD and a lower frequency of disease relapses than with PPI monotherapy. This article provides a review of the literature on the features of GERD therapy, primarily with an emphasis on the correction of the cytoprotective properties of the esophageal mucosa, including against the background of the use of nonsteroidal anti-inflammatory drugs (NSAID), and a clinical case analysis with a discussion of rational pharmacological correction.

Pathomorphological changes in the early postnatal period in a calf with abomasum rupture

The main cause of the disease and death of calves in the early postembryonic period of development is a feeding disorder. The aim of the work was to analyze macro-and micromorphological changes in the digestive system of a calf with a rennet rupture. To achieve this goal, standard macro-and microscopic research methods were used. Macroscopic examination revealed thickening, erosion of the mucous membrane of the esophageal gutter rollers, accumulation of contents in the scar, mesh and book, hyperemia of the mucous membranes; thinning and rupture of the rennet wall; pronounced hyperemia of the mucous membrane of the small intestine, thickening of the mucous membrane of the thick section; an increase in mesenteric lymph nodes and a change in their consistency. Microscopically, the thickness of the epithelium, submucosal and muscle layer is most developed in the abomasum and was, respectively, 0.68-0.72 mm, 0.23-0.32 mm and 0.98-1.05 mm. Villi were found in the folds of the scar, numerous well – developed longitudinally oriented protrusions were found in the book, lymphocellular clusters and bottom glands were found in the rennet; folds with well – developed crypts were found in the colon. Thus, as a result of feeding coarse feed, the deceased calf has catarrhal erosive lesions of the esophageal trough; serous-catarrhal abomasitis with signs of hemorrhagic with dilation and perforation in the cardiac part; hemorrhagic omasitis against the background of a book blockage; catarrhal reticulitis; catarrhal ruminitis and catarrhal enterocolitis.

The use of polyetheretherketone for the manufacture of removable implant dentures

INTRODUCTION: The industry of temporary prosthetics for dental implantation in the postoperative period at the present stage of the development of dentistry has achieved significant results. However, up to now, there are still cases of insufficient effectiveness of temporary prosthetics, which is expressed in a reduced service life and a violation of the retention of temporary structures, the need for a relatively large number of corrections of their basis, as well as inflammatory and atrophic changes in the mucous membrane of the prosthetic bed and loss of bone tissue in the jaws in the projection of the mechanical pressure of the prosthesis. AIM: To determine the effectiveness of the use of polyetheretherketone for the manufacture of immediate prostheses based on temporary dental implants. MATERIALS AND METHODS: Dental implants in the upper jaw were installed in 76 patients with a diagnosis of full absence of teeth. For temporary rehabilitation for the period of osteointegration, temporary implants were installed in the amount of 2 pieces and temporary removable dentures were made. RESULTS: The use of polyetheretherketone revealed a 25% decrease in dentures breakdowns, an increase in the number of temporary implants viability by 37.5%, and a decrease in bone tissue atrophy by 19% to 22%. CONCLUSIONS: It is advisable to use polyetheretherketone for the manufacture of removable implant dentures.

The study of tissue IgG4 in the mucous membrane of the colon in patients with inflammatory bowel disease

Background. Inflammatory bowel disease (IBD) is a global problem today, with a growing prevalence in the world. It significantly increases the economic burden on the health care system. Recently, many studies indicate the important role of immunoglobulin G4 (IgG4) in the formation of chronic inflammation in IBD and the possibility of using it as a biomarker of the inflammatory process. The purpose was to improve the diagnosis of chronic inflammatory bowel diseases by studying the status of IgG4-positive plasma cells in the mucous membrane of the colon in patients with ulcerative colitis (UC) and Crohn’s disease (CD). Materials and methods. We have examined 34 patients with IBD, 25 with UC and 9 with CD, of them 20 women and 14 men, with an average age of (38.8 ± 3.0) and (38.2 ± 3.7) years, respectively. Patients were divided into groups depending on the noso­logy and severity of the disease. All patients underwent endoscopic examination of the colon to establish or clarify the diagnosis, and biopsy specimens were taken for histological and immunohistochemical examination. Results. In 13 (38.3 %) of 34 examined patients, a positive result for the presence of tissue IgG4 (≥ 10 cells in the field of view) was found. Among patients with UC, 48 % have a positive result of immunohistochemical examination of tissue IgG4, in people with CD, this figure is 11.1 %. This gives us reason to say that in UC, elevation of tissue IgG4 levels occurs 4.4 times more often. Positive tissue IgG4 in patients with moderate UC was found 1.1 times more often than in severe UC. Among patients with mildly active disease, tissue IgG4 was not detected. Conclusions. In UC, IgG4-positive cells in the mucous layer of the colon are more common than in CD, which makes it possible to use this indicator for the differential diagnosis of ulcerative colitis and Crohn’s disease. Positive tissue IgG4 is more common in moderate form than in severe one.

Morphometric characteristics of the mucous membrane and the cartilaginous component of the larynx are normal at different times during the experimental opioid effect and during withdrawal

Background. The problem of uncontrolled use of opioid drugs is extremely relevant based on the data of domestic and world statistics which are covered in the scientific literature. That is why the study of indicators of morphometric characteristics of the laryngeal mucosa under opioid exposure under experimental opioid exposure will be of interest to both morphologists and practical otorhinolaryngologists. Objective: To study the morphometric parameters of the laryngeal mucosa in normal at different times of the experimental opioid effect and its cancellation. Methods. The material of the study were sexually mature, outbred rats - males in the amount of 61 animals, weighing 80 - 135 g, aged 4.5 - 7.5 months. Histological specimens were prepared according to conventional methods. All morphometric studies were performed using primary (unedited) photographs taken on a Meiji MT4300 LE microscope, Canon EOS 550D x100 lens. All statistical calculations were performed using RStudio v. 1.2.5042. Results. Throughout the experiment, the change of morphometric parameters of the laryngeal mucosa with signs of wavy growth and decline was clearly observed at all times. More positive was the dynamics of morphometric parameters after the abolition of the opioid analgesic, which hypothetically suggests the process of recovery of the mucosa, even after prolonged administration of the opioid.

CONDITIONAL TISSUE CONDITION IN PATIENTS WITH PROSTHETIC DENTISTS IN THE PROCESS OF ORTHOPEDIC TREATMENT WITH PROSTHESES MODIFIED BY NANOMATER

The main cause of prosthetic stomatitis belongs to the chemical and toxic action of the residual monomer of the prosthesis base, which is a protoplasmic poison. Occurrence of prosthetic stomatitis depends not only on quality of production of prosthesis in laboratory though at non-observance of technology indicators of residual monomer can reach 2-5%, but also at individual intolerance at its minimum concentration in a prosthesis after polymerization - 0,2-0 .5%. The aim of our study was to increase the effectiveness of orthopedic treatment of patients with prosthetic stomatitis by coating the plastic of removable prostheses with nanoscale materials. Materials and methods. To solve this goal, we studied the condition of the tissues of the prosthetic place of patients with prosthetic stomatitis with prosthetic removable prostheses with modified plastic. Orthopedic dental treatment of 50 people was examined and performed, including 25 people (the second group, prostheses were not covered with nanoparticles) and 25 people (the third group, prostheses were covered with nanoparticles). The first control group consisted of 10 people without signs of pathology. Prior to treatment, all patients had removable acrylic plastic dentures. The reason for seeking orthopedic care was a violation of masticatory function and the inability to use previously made prostheses due to the development of pain in the soft tissues of the prosthetic place. Complaints of pain were observed in all patients of varying intensity, impaired fixation and stabilization of the prosthesis due to swelling of the mucous membrane of the soft tissues of the prosthetic place, heartburn and dryness were observed in 90% of patients. Complaints were also about speech and aesthetic defects. Patients of III group after two weeks of using prostheses were coated with the inner surface of the prosthesis, which is in direct contact with the mucous membrane of the prosthetic place with molecules of fullerene C60, by magnetron sputtering. For this purpose, the prostheses were removed from the patients for several days and returned after the coating with the nanomaterial, after which the observation was continued. The results. After coating the prostheses in patients of group III with Fullerene C60, we observed the disappearance of inflammation of the mucous membrane under the prosthesis and patients noted the absence of discomfort. Рatients in II group had a negative dynamics in 80% and had diffuse inflammation of the mucous membrane under the prosthesis. Within 3 months of use, 18 patients (72%) in II group reported that they stopped using removable dentures during the day, due to unpleasant pain under the prosthesis, and used only during meals and during conversations. In contrast to II group, patients in III group did not notice discomfort when using plate prostheses. Conclusions. Obtained in the course of the work convincingly prove the effectiveness of the use of removable plate prostheses with nanocoating for the treatment and prevention of prosthetic stomatitis in patients. This is evidenced by the data of objective examination and the disappearance of complaints from patients.

Possibilities of using neodymium laser to improve the condition of vaginal mucosa in women of various ages with initial stages of genital prolapse

Genital prolapse is a sort of epidemic and is registered today in 30% to 56% of women of both reproductive and menopausal ages. Until now, the initial stages of prolapse were not taken into account; as a rule, the correction began immediately with surgical treatment, the results of which were not always satisfactory, and the recurrence rate with plastic correction with one’s own tissues ranged from 37 to 45%. One of the main manifestations of prolapse of the vaginal walls, especially n perimenopause, is vulvovaginal mucosal atrophy, which directly depends on the pH in the vagina. The study is devoted to the analysis of the effectiveness of using neodymium laser to improve the condition of the vaginal mucosa in women of different age groups with initial degrees of genital prolapse. Purpose: scientific substantiation of using neodymium laser in patients of different age groups with grade I–II cysto-rectocele. Material and research methods. Studies were carried out in 69 women aged 31 to 52 years with cysto-rectocele of grade I–II (ICD-10 code N81.6), with the duration of the disease from 4 to 15 years. All patients, depending on their age and the method of treatment used, were divided into 2 groups comparable in terms of clinical and functional characteristics — the main and control groups, each of which had 2 subgroups. In the main group: subgroup 1 included 27 patients of reproductive age with grade I–II cysto-rectocele, who underwent a neodymium laser course with Magic Gyno, consisting of 3 intravaginal procedures with an interval of 28 days; subgroup 2 included 22 patients of perimenopausal and menopausal age with grade I–II cysto-rectocele, who underwent a course of 3 intravaginal procedures with Magic Gyno neodymium laser with an interval of 28 days. The control group included 20 patients with grade I–II cysto-rectocele, who underwent a special complex of exercise therapy; depending on their age, they were also divided into two subgroups: 1 (10 patients) — of reproductive age, 2 (10 patients) — of perimenopausal and menopausal age. The results obtained indicate a pronounced effect of the course application of intravaginal exposure by a neodymium laser on the state of the vulvovaginal mucosa in patients with grade I–II cysto-rectocele, of both reproductive and, most importantly, peri-menopausal age, which was manifested in the normalization of the pH of vaginal discharge and elimination of signs of atrophy of the mucous membrane of the vulva and vagina and was confirmed by the data of pH-metry and the Vaginal Health Index Score. Conclusion. The course use of a neodymium laser in patients of different age groups with grade I–II cysto-rectocele contributes to the formation of a pronounced tropho-stimulating effect, which is manifested in the normalization of the pH of the vaginal discharge and the elimination of signs of atrophy of the mucous membrane of the vulva and vagina.

Prevention of inflammatory changes in the denture-bearing mucous membrane

Relevance. Advanced clinical and cytological studies have not been conducted yet to examine denture adhesive effect on the prevention of inflammatory changes in the mucous membrane of the prosthetic bed, and thus, the prevention of denture-related stomatitis. Purpose: to assess the clinical and functional condition of the oral mucosa beneath the denture during the adaptation period using a denture adhesive cream to prevent inflammation of the denture bed mucous membrane.Materials and methods. The study clinically and cytologically (washing, scraping) assessed the condition of oral mucosa beneath complete acrylic dentures on days 14-16 and 28-30 of the adaptation period in 15 fully edentulous patients (main group), who used an adhesive cream after they were delivered their dentures, and in 21 fully edentulous patients (control group) who did not use the cream during the denture adaptation period. All the patients were elderly.Results. At different times of the adaptation period, the study more frequently detected inflammatory changes in the denture-bearing mucosa in subjects who did not use the denture adhesive cream. The cytological study confirmed the results of the oral clinical examination, as, at the end of the adaptation period, the number of cellular elements and various microorganisms was significantly lower in the main group than in the controls, which proved the effectiveness of the denture adhesive cream for the prevention of denture stomatitis.Conclusions. Regardless of sex, patients with complete acrylic dentures, who used a denture adhesive cream, had a lower bacterial accumulation on the prosthetic bed and inflammatory changes during the adaptation period, which allowed us to recommend the adhesive cream for the prevention of denture stomatitis.