Structure and Functions of Human Serum Albumin in Normal Conditions and in Patients with Liver Cirrhosis

The aim: to highlight the main points of albumin synthesis, posttranslational modifications and functions in normal conditions and in patients with liver cirrhosis.Key points. Albumin is the most abundant protein in blood plasma. Along with oncotic properties, albumin performs transport, antioxidant, immunomodulatory and endothelioprotective functions. Serum albumin in patient with liver cirrhosis undergoes modifications, leading to functional impairment. Human serum albumin is a compaund of human mercaptalbumin with cysteine residues having a reducing ability, and oxidized human non-mercaptalbumin. The proportion of irreversibly oxidized non-mercaptalbumin-2 with impaired functional activity increases in liver cirrhosis.Conclusion. The conformational structure of the albumin molecule plays an important role in maintaining its non-oncotic functions. Non-oncotic functions depend on albumin conformation. Further investigation of albumin conformation and albumin functions in patients with hepatic insufficiency can serve as an additional criterion for assessing the severity of cirrhosis and predictor of complications may become an additional criterion to new clinical applications and treatment strategies of liver failure

LABOR NORMING FOR PHYSICIANS BASED ON STAFF STANDARDS (BY THE EXAMPLE OF PATHOLOGISTS)

Among the unsolved problems of domestic health care are the issues of labor standards. The employer has the right to determine the amount of work performed (both in the direction of reduction and increase), taking into account the specific situation. Meanwhile, staff standards of relevant medical organizations and their structural subdivisions can be used to normalize the work of physicians of certain specialties. This method of rationing is applicable only for those medical specialties for which staff standards have been approved. In the article the method of norming of physicians' work, proposed by the authors, based on the use of staff standards, is considered. As an example, we propose the implementation of the proposed methodology for the standardization of the work of pathologists, taking into account the standards of the pathoanatomical bureau (department) approved by the Order of the Ministry of Health of the Russian Federation as of March 24, 2016 No. 178n «On the rules for pathoanatomical research». At the same time, when calculating the load norms, a coefficient is applied, compulsorily taking into account the load standards per rate of the pathologist doctor in accordance with Order No. 178n as of March 24, 2016, the type of load and the category of complexity of the work performed. The proposed approach can also be applied to physicians of other specialties, for which statutory standards have been legislatively approved, expressed in the appropriate units of workload. The article also provides all the necessary standards for the relevant calculations and presents the legislative base (orders of the Ministry of Health of the Russian Federation) for the period 2015-2016, which contains staff standards for physicians of other specialties

Спектр изменений внутрисуставных структур при гемофилической артропатии по данным магнитно-резонансной томографии

The results of joints's magnetic resonance imaging of 10 patients with severe form of hemophilic artropathy are discussing in this article. The purpose of research was to study the state of soft tissue and bone intraarticulare's structures in present group of patients. The form of bones, condition of an articulate cartilage, the joint’s tendons and ligaments, synovium, presence of an intraarticulate exudate, presence and extent of adjournment haemosiderin, and also signal characteristics of a marrow were estimated.В статье обсуждаются результаты магнитно-резонансной томографии суставов у 10 больных гемофилической артропатией с тяжелой формой заболевания. Исследование проводилось с целью детального изучения состояния мягкотканных и костных внутрисуставных структур у данной группы пациентов. Оценивались форма костей, состояние суставного хряща, сухожильно-связочного аппарата, синовия, определялось наличие внутрисуставного выпота, наличие и протяженность отложения гемосидерина, а также сигнальные характеристики костного мозга

Liver and Nutrition. An Optimal Diet for Non-Alcoholic Fatty Liver Disease

Aim. This review study is aimed at characterizing the nutrition of patients with non-alcoholic fatty liver disease (NAFLD).General findings. A high-calorie diet, followed even for a short period of time, can lead to an increase in the lipid content in hepatocytes and an increase in ALT values. These changes occur much earlier than weight gain, glucose metabolism disorders and other clinically obvious changes. So far, only the Mediterranean diet (or the Mediterranean type of food) has been scientifically confirmed as beneficial for human health. It is recommended for patients with NAFLD both by Russian and international clinical guidelines. The molecular mechanisms of beneficial effects on human health have been confirmed for such Mediterranean diet components as polyphenols, carotenoids, oleic acid, polyunsaturated fatty acids and dietary fiber. The enrichment of the Mediterranean diet with olive oil (+10 g) reduces the risk of diabetes mellitus by 40 %. The addition of Omega-3 fatty acids to food reduces the risk of hepatocellular cancer. A balanced ratio of omega 3 and omega 6 in the diet is more important than the absolute amount of individual fatty acids. Vegetables and fruit contain two main classes of antioxidants: polyphenols and carotenoids. In patients with NAFLD, they exhibit an anti-inflammatory and antifibrotic effect both in vivo and in vitro. Food produced from whole grain has a lower energy potential as compared to that produced from refined grain. Meat contains various nutrients, such as proteins, iron, zinc, B12 vitamin, as well as sodium, saturated fatty acids and cholesterol, which serve as risk factors for the development of NAFLD and other cardio-metabolic disorders. In this paper, we present a clinical observation of a 51-year-old patient with NAFLD and cardio-metabolic disorders. Practical recommendations are given on changes in his lifestyle and the choice of optimal therapy with the application of multifunctional drugs affecting all disease aspects.Conclusion. The concepts of ‘correct or healthy’ nutrition and ‘lifestyle modification’ are increasingly attracting much attention both in terms of the prevention and treatment of liver diseases. Proper nutrition is important for a good life prognosis in patients with non-alcoholic fatty liver disease (NAFLD)

Liver and Nutrition. An Optimal Diet for Non-Alcoholic Fatty Liver Disease

Aim. This review study is aimed at characterizing the nutrition of patients with non-alcoholic fatty liver disease (NAFLD).General findings. A high-calorie diet, followed even for a short period of time, can lead to an increase in the lipid content in hepatocytes and an increase in ALT values. These changes occur much earlier than weight gain, glucose metabolism disorders and other clinically obvious changes. So far, only the Mediterranean diet (or the Mediterranean type of food) has been scientifically confirmed as beneficial for human health. It is recommended for patients with NAFLD both by Russian and international clinical guidelines. The molecular mechanisms of beneficial effects on human health have been confirmed for such Mediterranean diet components as polyphenols, carotenoids, oleic acid, polyunsaturated fatty acids and dietary fiber. The enrichment of the Mediterranean diet with olive oil (+10 g) reduces the risk of diabetes mellitus by 40 %. The addition of Omega-3 fatty acids to food reduces the risk of hepatocellular cancer. A balanced ratio of omega 3 and omega 6 in the diet is more important than the absolute amount of individual fatty acids. Vegetables and fruit contain two main classes of antioxidants: polyphenols and carotenoids. In patients with NAFLD, they exhibit an anti-inflammatory and antifibrotic effect both in vivo and in vitro. Food produced from whole grain has a lower energy potential as compared to that produced from refined grain. Meat contains various nutrients, such as proteins, iron, zinc, B12 vitamin, as well as sodium, saturated fatty acids and cholesterol, which serve as risk factors for the development of NAFLD and other cardio-metabolic disorders. In this paper, we present a clinical observation of a 51-year-old patient with NAFLD and cardio-metabolic disorders. Practical recommendations are given on changes in his lifestyle and the choice of optimal therapy with the application of multifunctional drugs affecting all disease aspects.Conclusion. The concepts of ‘correct or healthy’ nutrition and ‘lifestyle modification’ are increasingly attracting much attention both in terms of the prevention and treatment of liver diseases. Proper nutrition is important for a good life prognosis in patients with non-alcoholic fatty liver disease (NAFLD)

Options of dyslipidemia treatment at non-alcoholic fatty liver disease

Aim of review. To consider different treatment options for dyslipidemia in non-alcoholic fatty liver disease (NAFLD). Summary. NAFLD occurs in 20-30% of adult population. In the Russian Federation its rate is estimated as high as 37,1%. In the most of NAFLD cases severe disorder of lipid metabolism takes place. In large clinical trials it was demonstrated that the dyslipidemia significantly increases cardiovascular risks and worsens life expectancy in these patients. In the present overview treatment options of several therapeutic agents for dyslipidemia treatment at NAFLD are discussed: phenofibrate, omega-3 polyunsaturated fatty acids (omega-3-PUFAs) and S-adenosylmethionine (SAM). Results of numerous experiments and several clinical trials form the basis for phenofibrate administration for NAFLD patients. In animal experiments the positive role of phenofibrate as PPARα agonist was demonstrated (Peroxisome proliferator activated receptor alpha) for NAFLD prevention and treatment. Results of several studies published at the moment demonstrate that at NAFLD lipid metabolism markers, and serum transaminase levels normalize, sensitivity to insulin increases, the liver histology pattern improves at phenofibrate treatment. Specification of efficacy and safety of application of the drug requires more large-scale clinical studies. Omega-3-PUFAs is one more option in the lipid metabolism disorders treatment in this group of patients. These substances play important role in lipid metabolism regulating expression of the genes (including PPARα) involved in lipid and glucose metabolism. Available clinical trials demonstrate high therapeutical effect of these agents at NAFLD. In the review results of the experimental studies investigating the role of SAM in NAFLD pathogenesis and disorders of lipid metabolism is presented. Conclusion. Now data on a pathogenesis of lipid metabolism disorders at NAFLD are accumulated. The bulk of experimental data and series of clinical trials allow to assume positive affect of such drugs as phenofibrate, omega-3-PUFA and SAMe for treatment of dyslipidemia. Further high-grade studies in this area is necessary