Hepatic encephalopathy (HE) remains one of the most serious complications of liver cirrhosis. Its clinical spectrum sometimes creates difficulties in the optimal diagnosis at the patient’s bedside ...and treatment. To present new data on the field of clinical management of cirrhotic patients with hepatic encephalopathy. The role of ammonia in the diagnosis of HE is still under discussion. In clinical practice, in patients with suspected overt HE, normal ammonia concentration can be used to exclude this diagnosis. In contrast, a high concentration of ammonia in the absence of clinical signs of HE should not serve as a criterion for this diagnosis and as a guide for treatment. A separate issue for discussion is the covert HE. The simplest and most affordable test for screening for covert HE and evaluating the effectiveness of therapy is the animal naming test, which can be done on bedside by physician or caregivers. Patients with covert HE need treatment that is similar in approach to overt HE. The diagnosis of overt HE and the methods of its therapy are well known. According to Russian recommendations, depending on the disease course in a certain patient, lactulose, rifaximin, L-ornithine L-aspartate can be used as first-line drugs, which is applicable to the treatment of both overt and latent PE. The main issues on the management of HE in liver cirrhosis relate to the diagnostic role of ammonia, optimal diagnosis and treatment strategy for covert HE, therapy of choice for both overt and latent HE. There are expert opinions and consensus documents on all these issues. Treatment of overt and latent PE is carried out according to the same principles. Drugs of choice: lactulose, rifaximin and L-Ornithine L-Aspartate.
The problem of modern medicine and modern society is a comorbid patient with metabolic disorders. Hypothetical portrait of such a patient: over 40 years old, overweight, arterial hypertension, ...coronary atherosclerosis, impaired carbohydrate and lipid metabolism, liver steatosis or steato-hepatitis, often with changes in the function of the musculoskeletal system. Rational pharmacotherapy of this patient is of fundamental importance. The article analyzes, from the point of view of polypotency, efficacy and safety, the main drugs used in Russia for treatment of non-alcoholic fatty liver disease in comorbid patients. Attention is paid to vitamin E, glycyrrhizin, ursodeoxycholic acid. Domestic and foreign studies of these drugs are analyzed, and the scope of their rational use is shown: reducing the risk of cardiovascular complications, a positive effect on the lipid spectrum, reducing the activity of serum transaminases and other hepatotropic effects. Their side effects are also considered, which should be taken into account when choosing the treatment of a comorbid patient. We have analyzed the efficacy and safety of new molecules that are in clinical trials and/or have not yet been registered in our country, e.g. obeticholic acid, cenicriviroc, tropifexor, etc. The ability of some molecules to act as biological enhancers is also highlighted, which is important to consider when prescribing combination therapy. Doctors are recommended to carefully consider and take into account all the features of a comorbid patient and choose for this category of patients safe drugs of hepatotropic action with simultaneous positive effect on the cardiovascular system. Among other things, it will avoid polypragmasy.
Based on the equivalent single-layer linear theory for laminated shells, free and forced vibrations of thin cylindrical sandwich panels with magnetorheological core are studied. Five variants of ...available magnetorheological elastomers differing in their composition and physical properties are considered for smart viscoelastic core. Coupled differential equations in terms of displacements based on the generalized kinematic hypotheses of Timoshenko accounting for transverse shears with coefficients depending on the complex shear modulus for a smart core are used to govern vibrations of cylindrical panels. Assuming conditions of simple support for straight and curvilinear edges, solutions in the explicit form describing natural modes as well as an equation with respect to the required complex eigenfrequencies are found. To predict the shell response to an external harmonic force, the general solution of non-homogeneous governing equations is derived in the form of series in natural modes. To estimate damping capability of magnetorheological elastomers under consideration, the principle tunable parameters, the lowest natural frequencies and associated logarithmic decrements are calculated for the same panels with different magnetorheological elastomers under the action of a magnetic field of different intensities. Finally, the amplitude–frequency plots for magnetorheological elastomer-based panels of different opening angles with and without magnetic field are presented.
The purpose of the review is to analyze the data of the latest scientific studies assessing the diagnostic and predictive value of the indicator of the ratio of neutrophils to ...lymphocytes (NLR) in patients with diseases of the gastrointestinal tract and liver. Patients with non-alcoholic fatty liver disease (NAFLD) have the increased ratio of neutrophils to lymphocytes correlated with the severity of fibrosis and the activity of the disease, and also made it possible to differentiate patients with steatosis and non-alcoholic steatohepatitis (NASH). NLR of patients with liver cirrhosis has shown its prognostic significance in the development of death, comparable to the MELD and Child – Pugh scales, and in some studies even surpassed them. Contradictory data have been obtained regarding its predictive value at risk of infectious complications in this category of patients. In patients with Crohn’s disease (CD) and ulcerative colitis (UC), an increased value of NLR was associated with the activity of the disease. NLR serves as a predictor of death and a more severe course of acute pancreatitis. In patients with acute appendicitis, NLR has shown its diagnostic significance in identifying its severe forms. NLR has also shown its prognostic value in the development of death among patients with gastrointestinal cancer. NLR serves as a marker of systemic inflammation, which can be calculated using the parameters of the simple clinical bloode test, which is available in everyday clinical practice. The value of NLR is due to its non-invasiveness and low cost. The analysis of the literature showed its predictive and diagnostic value in certain diseases of the gastrointestinal tract and liver. The higher the indicator under study, the worse the prognosis of the disease and/or life of the patient. However, there is no consensus on the gradation of NLR and cut-off levels fluctuate in various studies, and their results are often contradictory. Also, most studies are retrospective, so it is necessary to conduct major prospective studies in this direction.
In recent years many works are aimed at finding a method of controllable switching between hydrophilicity and hydrophobicity of a surface. The hydrophilic surface state is generally determined by its ...energy. Change in the surface energy can be realized in several different ways. Here we report the ability to control the surface wettability of zirconium dioxide nano-coatings by changing the composition of actinic light. Such unique photoinduced hydrophilic behavior of ZrO2 surface is ascribed to the formation of different active surface states under photoexcitation in intrinsic and extrinsic ZrO2 absorption regions. The sequential effect of different actinic lights on the surface hydrophilicity of zirconia is found to be repeatable and reversibly switchable from a highly hydrophilic state to a more hydrophobic state. The observed light-controllable reversible and reproducible switching of hydrophilicity opens new possible ways for the application of ZrO2 based materials.
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