Objective — to investigate levels of L-carnitine in the blood serum of patients with ischemic heart disease (IHD) depending on the presence or absence of non-alcoholic steatohepatitis (NASH).
Materials and methods. The study involved 68 IHD patients aged 37 to 69 years, from them 17 women (25 %) and 51 men (75 %). The IHD duration was 2 to 20 years. The patients were allocated into 2 groups: group I (n = 32) consisted of patients with IHD and concomitant NASH; group II (n = 36) included patients with IHD without NASH. The control group consists of 20 almost healthy subjects without lipid metabolism disorders.
Results. In patients of the I and II groups, the total cholesterol level was higher in 1.4 and 1.3 times (p < 0.05), low-density lipoproteins’ (LDL) level in 2 and 1.9 times (p < 0.05), triglycerides (TG) in 1.8 and 1.6 times (p < 0.02) correspondingly, but the level of high-density lipoproteins (HDL) was lower in 1.4 and 1.3 times (p < 0.05) than in healthy controls. The significant increase in 2.4 times of the serum L-Carnitine level was revealed in the patients of group II vs healthy controls. (5.62 ± 1.16 versus 2.35 ± 0.72 pg/ml; p < 0.05). The direct correlation was established between blood serum levels of L-Carnitine and TG (r = +0.6).
Conclusions. In patients with IHD and lipid metabolism disorders the increased blood serum levels of L-Carnitine were observed as a response on the high lipids levels in blood serum (TG and cholesterol of low-density lipoproteins), that make the ground fir the use of L-Carnitine in the complex therapy of patients with dyslipidemia.

Keywords: non-alcoholic steatohepatitis, ischemic heart disease, dyslipidemia, L-carnitine.

Objective — to determine the levels of inflammation markers, including C-reactive protein (CRP) and tumour necrosis factor-α (TNF-α) in patients with chronic pancreatitis and subjects with combined course of chronic pancreatitis (ChP) and type 2 diabetes mellitus (DM 2).
Materials and methods. The investigation involved 20 patients with the combined ChP and DM 2 course (6 men and 14 women, the mean age (55.25 ± 1.34) years, the mean ChP duration was (5.45 ± 0.74) years, DM 2 duration was (7.85 ± 0.92) years), and 14 patients with ChP (9 men and 5 women with the mean age (50.36 ± 3.53) years, the mean ChP duration (9.50 ± 1.79) years). The control group consisted of 20 healthy individuals. The TNF-α levels were determined with immunoassay method using a set of reagents «Vector-best» (Russia), the blood CRP levels were measured with latex method with induces analysis with the use of «NVL Granum» set (Ukraine).
Results. Patients with the combined ChP and DM 2 course had significantly higher levels of CRP and TNF-α (p < 0.05) than subjects with isolated pancreatitis. The direct correlation between CRP and TNF-α levels has been established in both groups (p < 0.05)
Conclusions. The results of the study suggest that CRP and TNF-α levels are important diagnostic markers of inflammation in patients with chronic pancreatitis combined with type 2 diabetes mellitus.

Keywords: C-reactive protein, tumour necrosis factor-α, chronic pancreatitis, type 2 diabetes mellitus.

Objective — to investigate the peculiarities of the biochemical markers of liver fibrosis in patients with non-alcoholic steatohepatitis (NASH), obesity of I — II degree and chronic kidney disease (CKD) of І — ІІІ stage; to establish Heparhizine effects on the state of carbohydrate-protein components of the connective tissue of the extracellular matrix of the liver and kidneys.
Materials and methods. The study involved 98 patients with NASH against the background of I — II degree obesity, from them 52 NASH patients without accompanying CKD (1st group), and 46 patients with NASH and comorbid CKD of I — III stage (2nd group). The control group consisted of 20 age- and sex-matched practically healthy persons (PHPs). NASH patients on both groups received Heparhizine treatment (glycyrrhizin 40 mg, glycine 400 mg, L-cysteine hydrochloride 20 mg) (Valartin Pharma) by intravenous administration of 20 ml of the drug for 10 days followed by enteral administration of 2 tablets of Heparhizine (1 tablet: glycyrrhizin 25 mg, glycine — 25 mg, methionine — 25 mg) 3 times a day for 80 days. NASH patients with obesity and chronic kidney disease of the І — ІІІ stage, in addition to Heparhizine received the basic therapy for І— ­ІІІ stage CKD (chronic pyelonephritis).
Results. In patients with non-alcoholic steatohepatitis against the background of obesity and І­—ІІІ stage CKD, the presence of fibrotic changes in the liver tissue has been established, which according to the biochemical index of fibrosis, exceeds those in patients with non-alcoholic steatohepatitis without comorbidity. In patients NASH patients with obesity, the significant increase in the synthesis of collagen and glycosaminoglycans was revealed, which was accompanied with an ineffective resorption of newly formed collagen due to inhibition of the collagenolytic activity of blood plasma, due to significant activation of proteinase inhibitors (α2-MG) and significant imbalance in the system of connective tissue metabolism. Under the conditions of the comorbidity of non-alcoholic steatohepatitis with chronic kidney disease I — III stage, collagen synthesis and resorption are activated, but the anabolism processes predominate, in spite of the compensatory activation of collagenolysis, a substantial hyperproduction of actinic-phase proteins, fibronectin, glycosaminoglycans, fibroblast growth factor and lead to progressive fibrosis of the liver and disturbance of its functions. Heparhizine therapy during 3 months contributed to the achievement of the collagen ana- and catabolism balance by means of collagenosis activation, depression of activation of inhibitors of proteolysis, reduction in the secretion of fibroblast growth factor and increased levels of inflammatory markers, as well as degradation of the liver fucoglycoproteins. Altogether, the above mentioned factors resulted in the reduction of liver fibrosis index in 1.5 — 2.0 times (as per fibro test data).
Сonclusions. The used of Heparhizine during 3 months contributed to the achievement of the collagen ana- and catabolism balance by means of collagenosis activation, depression of activation of inhibitors of proteolysis, reduction in the secretion of fibroblast growth factor and increased levels of inflammatory markers, as well as degradation of the liver fucoglycoproteins. Altogether, the above mentioned factors resulted in the reduction of liver fibrosis index (as per fibro test data).

Keywords: non-alcoholic steatohepatitis, chronic kidney disease, liver fibrosis, Heparhizine.

Objective — to evaluate the possibility of prediction of the course of alcoholic liver cirrhosis (ALC) against the background of the exacerbation of chronic bronchitis (CB) using the discriminating Meddrey function (DMF) and indices MELD, CLIF-SOFA, CLIF-C ACLF and CLIF-AD ACLF.
Materials and methods. The examinations involved 100 patients with ALC of B and C Child-Pugh classes, from them 48 patients without CB (group І), 52 patients with ALC combined with CB (group ІІ). The control group consisted of 20 practically healthy individuals. The prognosis of the course was assessed based on DMF and indices MELD, CLIF-SOFA, CLIF-C ACLF, CLIF-AD ACLF according to the normative documents of the Ministry of Health of Ukraine and the European association for the study of the liver guidelines (EASL).
Results. Chronic bronchitis exacerbation in ALC patients was accompanied by progressive ALC course with increasing frequency of class C in 2.11 times (p < 0.05). There has been noted the growth of liver failure (86.54 %), along with the development of multiple organ failure, namely cerebral (23.71 %), cardiovascular (26.91 %), renal (12.98 %) with increasing of CLIF-SOFA index up to 44.12 % (р < 0.05). The patients of group ІІ patients demonstrated an increase in the MELD index by 30.51 %, DMF index — by 27.65 % as compared to group І patients (p < 0.05). The use of prognostic indicators CLIF-C ACLF and CLIF-AD ACLF resulted in the establishing of the following rates of the increase in mortality risk in the group ІІ patients as compared to group І patients:in 7.6 times within the period of 1 month (p < 0.05), in 4.0 times during 3 months (p < 0.05), in 2.7 times for 6 months (p < 0.001), and in 1.9 times for 12 months (p < 0.001).
Conclusions. The use ofDMF and indices MELD, CLIF-SOFA, CLIF-C ACLF and CLIF-AD ACLF contributed to the early prognosis of progressive ALC course against the background of chronic bronchitis with the increase in hepatic and the development of multiple organ failure and increased mortality risk within 1, 3, 6 and 12 months.

Keywords: alcoholic liver cirrhosis, chronic bronchitis, course, prognosis, indices.

Objective — to study the state of the autonomic nervous system in patients with gastroesophageal reflux disease (GERD) without combined pathology and with comorbid bronchial asthma (BA).
Materials and methods. The study involved 90 patients with GERD who were divided into two groups depending on the BA presence. The first group included 38 patients with GERD without a combined pathology, aged 20 to 45 years (the mean age 32.4 ± 3.4 years), among them 23 (60.5 %) men and 15 women (15.5 %). The second group included 52 patients (32 men (61.5 %), 20 women (38.5 %)) with GERD and BA of mild to moderate severity, aged 20 to 45 years, the mean age (33.1 ± 8.1) years. The compared groups were sex- and age-matched. The GERD diagnosis was established according to the Montreal Consensus (2006), taking into account the results obtained with esophagogastroduodenoscopy, fluoroscopy of the esophagus and stomach, and data of pH-metry. Verification of the diagnosis of asthma, its severity, was carried out in accordance with the recommendations of the WHO (GJNA), and the order of the Ministry of Health of Ukraine (2013), which included spirography and radiography of chest organs. The evaluation of the state of the vegetative nervous system was carried out according to the level of the total score of the questionnaire A. M. Wein (2003). The nature of vegetative dystonia was estimated by the magnitude of the vegetative Kerdo index.
Results. It has been established that the patients of both groups had a manifested syndrome of autonomic dysfunction, since the total score of the A. M. Wein questionnaire was 29.4 ± 3.5 points in patients of the first group, and 38.6 ± 4.2 points in patients of the second group. The difference in comparison with the norm (12.1 ± 1.2) in both groups was statistically significant (p < 0.001). These changes in indices indicated an increase in the tone of the sympathetic nervous system in patients of the first group, and in patients of the second group, the predominance of parasympathetic tone. In 36 patients, a non-erosive form of GERD was diagnosed in fibrogastroscopy, and in 2 patients erosion of the esophagus was detected. Acidity of gastric juice was increased in all patients. In 17 patients (32.7 %) of the second group, erosive and 35 (67.3 %) non-erosive form of GERD were detected. Acidity of gastric juice among these patients was higher than in patients with GERD without co-pathology. Simultaneously, these patients had a cough (76.9 %), drowsiness increased at night (65.3 %), a feeling of lack of air (in 48, 1 %) and restriction of respiratory excursions (in 30.7 %). Moreover, the more the tone of the parasympathetic nervous system increased in these patients, the clinical manifestations of not only GERD, but also of concomitant asthma, grew brighter in these patients.
Conclusions. Imbalance in the autonomic nervous system with a predominance of the tone of the parasympathetic department may be one of the factors in the formation of comorbidity of GERD and asthma.

Keywords: gastroesophageal reflux disease, bronchial asthma, comorbidity, autonomic nervous system.

Objective — to investigate effects of the additional administration of flower pollen on the parameters of heart rate variability (HRV) in the rehabilitation course of pediatric patients with functional disorders of biliary tract (FDBT).
Materials and methods. The investigation involved 42 patients with FDBT aged 12 to 17 years. Depending on the nature of dysmotor function manifestations, children were allocated into two groups: with hyperkinetic type of FDBT (n = 16) and hypokinetic type (n = 26). To assess the autonomic status, the HRV analysis was conducted at the baseline and after the treatment. The complex rehabilitation course during 1 month included correction of the nutrition regiment with the use of pollen and respective motion regimen with performance of special exercises.
Results. The significance difference of the majority of HRV parameters between hyperkinetic and hypokinetic FDBT types have been established in children, testifying the different tension and ratio of the activities of the autonomous nervous system departments. The peculiarities of the HRV, typical for the hyperkinetic and hypokinetic disorders in the biliary tract motility, have been established in children. The positive effects of the investigated rehabilitation course on the vegetative status have been established in pediatric patients with FDBT.
Conclusions. After the completion of the rehabilitation course, including the nutrition correction and motion exercises, the reduction in the differences of both time-related and spectral HRV parameters have been determined. This result can be explained as the normalization of the functional state of the vegetative nervous system, as well as harmonization of the ratio of sympathetic and parasympathetic influences and strengthening of the adaptive reserves.

Keywords: functional disorders of biliary tract, autonomic dysfunction, heart rate variability, non-drug treatment, flower pollen.

Objective — to study effects of the administration of Eucarbon laxative (F. Trenka, Austria) on the metabolic profile of elderly patients with metabolic syndrome with account of the inflammatory factor.
Materials and methods. The investigations involved 15 patients (14 women and 1 man) aged 60 years and more (the mean age was 67.2 ± 1.6 years) with metabolic syndrome defined by the International Diabetes Federation criteria (2005) and chronic constipation. The following investigations have been performed: anthropometric characteristics, body composition indices, lipid and glucose metabolism profile, level of tumor necrosis factor alfa (TNF-α), cancer-specific markers: carbohydrate antigen 19-9 and carcinoembryonic antigen, and microbiome composition in the feces samples. Patients were administered Eucarbon in the individually adjusted-doses depending on the achieved laxative effect during 2 weeks per months for over 6 consecutive months.
Results. Eucarbon administration promotes the reduction of blood serum levels of TNF-α (from 3.95 ± 0.40 to 1.22 ± 0.3 pg/ml after a half of a year of observation, p < 0.00001), testifying the attenuation of pro-inflammatory reaction. Six months of drug administration did not change or aggravate metabolic profile or intestinal microbiota composition, and did not affect the cancer-specific markers levels. The positive dose-dependent effects of the drug have been established as regards the levels of HDL cholesterol and the metabolic age.
Conclusions. A good tolerance of Eucarbon preparation makes the ground to recommend it for the routine administration in the clinical practice for elderly patients with metabolic syndrome and chronic constipation.

Keywords: metabolic syndrome, elderly subjects, Eucarbon, inflammation, tumor necrosis factor, chronic constipation.

Objective — to evaluate the genetic predisposition of the Ukrainian population of patients with ulcerative colitis (UC), to compare and analyze the genetic polymorphism in patients with early and late onset of ulcerative colitis.
Materials and methods. The genetic investigations were performed on 92 UC patients from Kyiv, Chernihiv, Donetsk, Lugansk, Poltava Khmelnitsky, Vinnytsia and Lviv regions, The early disease onset was revealed in 54 (58.7 %) patients, and late onset in 38 (41.3 %) patients. The control group consisted of 28 practically healthy people.
Results. The following polymorphisms have been revealed in the investigated subjects: Arg753Gln of the TLR2 gene; Phe412Leu gene TLR3; Asp299Gly and Thr399Ile of the TLR4 gene; C-819T, G-1082A and C-592A of the IL10 gene. It has been established that аccording to our data, that single-nucleotide genes polymorphisms (А allele and АА SNP Asp299Gly genotype of TLR4 gene, С allele and СС SNP Thr399Ile genotype of gene TLR4) resulted in the activation of inflammation (first of all due to microbes’ stimulation) in comparison with healthy subjects. In elderly patients with a late UC debut, the Thr399Ile polymorphism of the TLR4 gene, as well as its combinations with Asp299Gly of TLR4 gene and Arg753Gln gene of TLR2 were detected significantly more often.
Conclusions. In the Ukrainian population of patients with UC, at both early and late disease onset, the gene polymorphisms of Toll-like receptors (TLR2, TLR3, TLR4) as well as their combinations were reveled significantly more often. They promoted activation of inflammation. Probably the carriership of these polymorphisms increases the likelihood of the UC development in patients aged over 50 years.

Keywords: ulcerative colitis, genetic polymorphisms.

Objective — to examine the association between eating behaviour (EB) and nutrigenetic characteristics of patients with non-alcoholic fatty liver disease (NAFLD) in combination with hypertension (H) against visceral obesity (VO).
Materials and methods. The study involved 26 patients with NAFLD in combination with H against the VO background, aged (51.0 ± 2.4) years. The peculiarities of EB were investigated in all patients with the help of DEBQ questionnaire) and the actual nutrition (AN) (with a questionnaire, developed for the purposes of this survey). The determining of nucleotide polymorphism of genes PPARG2 and ADRB3 was performed with polymerase chain reaction using a set test metabolism Liteh (OOO NPF).
Results. In patients with NAFLD and H against the VO background, three types of EB violation have been established with a significant prevalence of the external type over emotiogenic and restrictive (61.5 %, 26.9 % and 11.5 %, respectively). All examined patients were the carriers of polymorphisms of Pro12Ala and Trp64Arg; from them Pro/Pro homozygotes (carriers of the SS allele) were 73 %, Pro/Ala heterozygotes (allelic UGs) 27 %, and homozygotes Trp/Trp (carriers of the TT allele) — 88.5 %, heterozygotes Trp/Arg (carriers of TC alleles) — 11.5 %. The maximal degree of EB violation was found in patients with Pro/Pro homozygotes and Trp/Arg heterozygote.
Conclusions. The results showed that in patients the disorders in nutrition should be taken into account along with the genetic predisposition to an increased risk of development and progression of metabolic disorders. The violations in nutrition behaviour require the timely correction with account of the revealed polymorphisms and types of EB. The increased intake of food with high amounts of carbohydrates and fats, salty food, fast-food were predominant in the diet of the surveyed patients, carriers of the polymorphisms Pro12Ala and Trp64Arg. The patients of this category must restrict the excessive fats and carbohydrates intake.

Keywords: eating behaviour, nutriogenetic characteristics, non-alcoholic fatty liver disease, hypertension, visceral obesity, personalized medicine.

Objective — to establish the peculiarities of lipid metabolism, specific for the pancreatic steatosis (PS) in paediatric patients with excessive body weight and obesity, and to determine their relationship with the structural changes of the pancreas.
Materials and methods. Examinations involved 45 children aged 8 to 17 years. Depending on the presence of obesity/overweight and pancreatic steatosis children were divided into three groups. The 1 group consisted of 22 children without PS and with PS and existing obesity/overweight; 2 group included 15 children with obesity/overweight with no PS signs, and the 3 group consisted of 8 children with normal weight who had no PS signs. The blood serum samples were tested for total cholesterol (TC), triglycerides (TG), HDL cholesterol (HDL cholesterol), followed by calculation of the content of lipoproteins — low (LDL) and very low density (VLDL), atherogenic coefficient (AC), non-HDL cholesterol. The abdomen ultrasonography was performed using apparatus Toshiba Xario (Japan).
Results. Dyslipidemia was diagnosed in 66.4 % of patients. The comparison with controls showed that children with PS had significant differences in lipid profile compared with the control group, patients of the 1group were characterized by almost 2-fold higher levels of AC, higher levels of TG (in 1.6 times), LDL (in 1.5 times), VLDL (in 1.6 times) and lower rates of HDL (in 1.5 times) (p < 0.05). In PS patients in comparison with obese children without PS, the LDL and non-HDL levels were significantly increased (p < 0.05). The data of regression analysis (adjusted for the presence of hepatic steatosis and obesity) demonstrated the significant association between LDL cholesterol level and presence of PS (B = 0.81; p < 0.05).
Conclusions. The increased TG, VLDL, LDL and decreased HDL fractions in children with PS compared with patients with normal weight, indicating a high atherogenic potential of paediatric patients with PS. The significant increase in LDL and non-HDL fractions has been established in children with PS in comparison with the children with obesity/overweight and without PS. These data suggest the possibility of the use of LDL as a marker of ectopic fat accumulation, including the pancreatic steatosis in children.

Keywords: pancreatic steatosis, pancreatic fat, dyslipidemia, children.

The article presents data on the causes of the defecatory disorders, mechanisms of normal defecation, pathogenetic aspects of the constipation occurrence, definition of «functional constipation», according to the Rome criteria IV. The role of the drug Zafacol has been demonstrated as a stimulator of the contractile capacity of the intestinal wall due to the inulin, included in its composition, as well as a colon protector, possessing anti-inflammatory, carcinogenic, immunomodulatory, pre- and probiotic actions.

Keywords: constipation, Zafacol, colon, butyrate, irritable bowel syndrome.

The article presents general concepts of the IgG4-associated disease, two types of autoimmune pancreatitis, major and additional histopathological criteria, as well as the diagnostic scheme for IgG4-associated disease with the use of histological criteria. The authors described a clinical case of such disease that involved the pancreas and biliary tract. The conclusions derived from this clinical observation have been worded.

Keywords: type I autoimmune pancreatitis, IgG4, diagnostics, immunohistochemistry, treatment.

The strong arguments exist for manipulating with microbiota to treat inflammatory bowel diseases (IBDs). Although experimental studies on animal models of intestinal inflammation produced promising results, the trials involving humans were disappointing. In contrast to the investigations of microbiota role at IBDs, its involvement in the development of irritable bowel syndrome (IBS) started to be considered only recently, but the early stage results proved to be encouraging. As pharmaceutical companies develop insufficient amount of truly novel agents for treatment of these disorders, the consumers are looki ng for safer, long-term strategies to fight against their chronic symptoms. The author gave the rationale for microbiota modulating, aimed on the treatment of IBD and IBS, and discussed whether the current concepts are too simple, overstated or simply under-researched. The difficulties with microbiota terminology and technologies, as well as differences among patients and the heterogeneity of these diseases, pose additional challenges in developing of the IBD and IBS treatments, based on the microbiota modifications.

Keywords: probiotics, prebiotics, transplantation of fecal microbiota, pharmabiotics.