Heterogeneity of respiratory tract inflammation determines the clinical course and control of mild asthma. The aim of the research was to study the relationship between clinical and functional parameters and the form of bronchial inflammation in patients with mild persistent asthma against the background of standard basic anti-inflammatory therapy. In 198 patients with mild asthma (the mean age was 41.5±0.7 years old) against the background of maintenance therapy with low doses of inhaled glucocorticosteroids (ICS at a dose ≤500 mcg/day by beclomethasone dipropionate), there were determined the level of asthma control according to the questionnaire Asthma Control Test (ACT), lung function, airway reaction to 3-minute isocapnic hyperventilation with cold (-20ºC) air; there was done the collection of induced sputum (IS). The content of cells in cytograms of IS was assessed. The activity of myeloperoxidase (MPO) (in pixels) was measured by cytochemical method in neutrophilic and eosinophilic granulocytes. Group 1 (n=43; 22%) included patients with the eosinophilic pattern of bronchial inflammation, group 2 (n=155; 78%) included patients with mixed pattern of inflammation. In group 2, unlike the patients of group 1, in the inflammatory profile of infiltrate against the background of high neutrophil content (34.6±1.1 and 10.8±0.5%, respectively; p=0.000001), there was found an increased level of eosinophils (17.0±1.1 vs. 21.2±1.8%, respectively; p=0.048), and there was revealed a higher intragranular deposition of MPO (85.8±3.5 vs. 77.0±3.2 pixels, respectively; p=0.057). The mixed type of inflammation with the dominant neutrophil component and the greatest activity of MPO was associated with more pronounced clinical symptoms of the disease and low level of asthma control (16.0±0.7 vs. 18.7±0.4 ACT points, respectively; p=0.004), lung function decrease (FEV₁ was 89.4±1.4 vs. 97.9±2.2%, respectively; p=0.005) and degree of FEV₁ drop in response to bronchial provocation by cold air (-10.1±1.1 vs. -3.4±1.1%, respectively; p=0.002), due to insufficient anti-inflammatory effect of the used controller therapy. A discriminant equation is proposed, which can serve as an additional criterion for the effectiveness of anti-inflammatory therapy.

This article represents the results of long-term observations, devoted to the problems of chronic non-specific pulmonary diseases (CNPD) in children. In dynamics, for the period 2007-2017, high morbidity and invalidation levels were registered. For the improvement of treatment quality and regular check-in definite estimation of CNPD structure is necessary. Well-time diagnostic of the concrete clinical variant and individual approaches are very important in such patients. The main risk factors for the formation and structure of CNPD in children were studied. The main group of 522 cases (45.8%) consisted of patients with lung malformations complicated by secondary bacterial process. On the basis of clinical and morphological comparisons, there was noted the possibility of developing tissue dysplasia in children, not provided by the approved classification of clinical forms of bronchopulmonary diseases in children. It is also noted that disorders of lung growth and development in children with secondary forms of CNPD, along with defects in the development of anatomical structures, are accompanied by the formation of interstitial processes in the lungs. Different clinical variants of CNPD in children as outcomes of bronchopulmonary dysplasia were noted in 22.8% of cases. There were studied possible causes of the formation of conditionally primary chronic forms of CNPD (23.7% of observations) as the outcome of complicated forms of community-acquired pneumonia, taking into account genetically determined predisposition to chronization of the process, the peculiarity of immune intercellular interactions, disturbance of energy supply of immunocompetent blood cells, the formation of tissue dysplasia of pulmonary tissue. Genetically determined lung diseases were identified in 7.7% of cases. Children with allergic lung diseases and hereditary diseases were not included in the development. The presented structure of CNPD in children is due to the regional peculiarity of hospitalized children, possibly underdiagnosed genetically determined lung diseases. The etiological structure of CNPD was studied, which determines the possibility of targeted antibiotic therapy and specific immunotherapy. The effectiveness of treatment and quality of life depends on the quality of topical diagnosis, clinical, etiological variant of CNPD in children.

Localization of community-acquired pneumonia (CAP) is its independent clinical sign which has not received proper coverage in the medical literature. The aim of the study is to compare the topical and clinical characteristics of unilateral lobar and segmental CAP in young men. Materials and methods: topical and clinical features of lobar, bi- and monosegmental CAP were studied in 6332 young military men. It was found out that monosegmental CAPs (mCAP) are more variable in their clinical and laboratory manifestations than their bisegamental and lobar variants not identified at the segmental level. The frequency of occurrence of mCAP of a specific localization directly correlates with the frequency of sputum expectoration, the severity of systemic and local neutrophilic inflammation. The 5th and 10th segments of both lungs are the zones of the most frequent localization of mCAP associated with a relatively high severity of systemic neutrophil reaction, and the 6th and 8th segments are the zones of a relatively longer course of mCAP and the predominance of signs of local inflammation. In bisegmental CAP, there is a general trend of a more pronounced systemic inflammatory response to the criterion of blood neutrophils level than in mCAP. The revealed regularities can contribute to a more accurate prediction of the mCAP course in the population of young men.

The dynamics of parameters of cytokine status in patients with allergic rhinitis in view of efficiency of allergen-specific immunotherapy (ASIT) was studied in this work. 62 subjects with moderate persistent rhinitis at the age of 18-40 years old were included in the study. For specific diagnosis and treatment there we used standard allergens. ASIT was performed by the classical scheme. The concentrations of IL-4, IL-5, IL-6, IL-8 in the blood serum were measured by the enzyme immunoassay. A good or excellent effect of treatment with ASIT was achieved in 62.9% of cases, and satisfactory one in 37.1% of cases. The analysis of the dynamics of IL-4, IL-5, IL-6, IL-8 concentrations showed that the efficiency of ASIT in patients with allergic rhinitis depends on the ability of the immune system to activation by low doses of the allergen, quite fast suppression of proinflammatory cytokines induced by them, and active functioning of the system of anti-inflammatory cytokines.

The method for prediction of asthma in patients with polypous rhinosinusitis was developed. It consists of determination of the average mass molecules (AMM, optical density units), measurement of exhaled and inhaled air temperature (T exh, ºC), and (T inh, ºC), and determination of the temperature difference (ΔТ, ºC) between the inhaled and exhaled air temperatures and with the help of the discriminant equation: D = +5.028 × T exh - 0.405×ΔT - 8.910 × AMM , where the discriminant function (D) boundary value is 152.16. At D greater than or equal to the discriminant function boundary value, the absence of asthma in patients with polypous rhinosinusitis is predicted; at D less than the discriminant function boundary value, the development of asthma is predicted.

Taking into account new approaches in medicine of the 21^st century (personalization, prediction, prevention and participation), biogeochemical features of the Amur region, and inhomogeneity of ethnic makeup, the purpose of the work was to determine the occurrence frequency of genes of detoxification system predisposition (glutathione S-transferases - GST) among the population of the Amur region. Ethnic and environmental components were taken into account. Risk groups of pregnant women were formed. Substantiation of a personalized approach to a set of preventive measures for the development of pathological conditions was made. Evaluation of gene polymorphism of phase II xenobiotic biotransformation (GSTT1, GSTM1) was carried out by polymerase chain reaction using diagnostic kits produced by the Center of Molecular Genetics (Moscow). 255 pregnant women of newly-arrived and indigenous population from urban areas (Khabarovsk city) and rural areas of the Amur region (Nanai district) were examined. All examined women were divided into 3 groups: 1 group - urban newcomers, representatives of the (European) Slavic race (n=128); 2 group - rural newcomers, representatives of the (European) Slavic race (n=67); 3 group - rural indigenous of the Mongoloid race (the Nanais), who represent small-numbered peoples of the North, Siberia and the Far East of the Russian Federation from places of traditional residence (n=60). A comparative analysis of the obtained results was carried out in the observed groups. The results were also compared with the data provided by the authors of other regions of the Russian Federation similar in climatic and geographical characteristics (Eastern, Western and Northern Siberia). An ethnic feature of the detoxification system (GSTT1 and GSTM1) of the Amur region indigenous women (nanaian women) was revealed, which is a high frequency of combined deletion polymorphism. The study not only contributes to the scientific and theoretical knowledge, but it is also the basis for the development of additional methods of prevention and correction of disorders associated with exo- and endogenous influence on women in preconception and gestational periods.

The aim of the study is to determine the nature of the consequences of non-respiratory lung function disorders and their influence on the hemostatic system in chronic inhalation of industrial hydrogen sulfide gas (HS). There were studied the parameters of hemostasis system (the number and function of platelet, total clotting time, level of soluble fibrin-monomer complex and D-dimer, speed of XIIа-dependent euglobulin lysis, the activity of Willebrand factor and factors VIII, protein C and inhibitor of tissue plasminogen activator-1 (TPA-1), the content of antithrombin III and plasminogen) in 146 white laboratory male rats taking into account the artery-venous difference. Blood collection was carried out from the abdominal aorta (pars abdominalis aortae) ("after the lungs") and from the posterior vena cava (vena cava caudalis) ("to the lungs", that excludes the influence of the liver). The rats were divided into 9 groups: four groups were experimental, which were exposed to HS for one month (20 animals), two months (20 animals), three months (19 animals) and four months (19 animals). HS was fed into chambers at a concentration of 70±2.34 mg/m³ by static method (once). Inhalation of rats with gas lasted for 4 hours a day, 5 days a week. The control groups were rats placed in cells with a normal air composition in a similar mode for a period of one, two, three and four months (12 individuals each). The reference parameters of the hemostatic system were determined before the experiment in a group of 20 rats. It was found that the artery-venous difference in the indicators of soluble fibrin-monomer complex (p<0.05), the content of antithrombin III (p<0.05), the activity of protein C (p<0.01) is more pronounced in the groups of the 1^st month of exposure to HS. Increased activity of platelets (p<0.05), of Willebrand factor (p<0.05) and TPA-1 (p<0.001), as well as slowing of fibrinolysis (p<0.05) indicates the damage to the endothelium of pulmonary capillaries by the 4^th month of HS inhalation and the decrease of ability of the lungs to regulate hemostasiological balance.

In order to study the seasonal effects on the energy supply of immunocompetent blood cells (IBC) in pregnant women living in different conditions of the Amur region, and to substantiate additional methods of diagnosis, prevention and treatment of the identified disorders, a study of the mitochondrial membrane potential (MMP) by flow laser cytometry was conducted in 198 subjects. The data of different types of IBC (lymphocytes, granulocytes and monocytes) at early gestation of women living in urban (Khabarovsk) and rural (Jewish Autonomous region) areas of the Amur region were analyzed. Eight (8) groups were formed according to seasons: winter, spring, summer and autumn. The results of a comprehensive survey indicate some features of intracellular bioenergy processes of IBC depending on the environmental conditions in different seasonal periods. Conditions of women from urban areas are characterized by a significant increase in lymphocytes with reduced MMP which was more pronounced in winter, and by a tendency to increase monocytes in spring-and-summer season. The state of low energy supply of IBC in rural residents differs significantly by means of granulocytes in all presented periods of a year, combinations of various types of IBC in winters and tendency to simultaneous increase in the number of all IBCs with the reduced MMP. The number of IBC with optimal MMP content in urban environment was observed in pregnant women in autumn (23.3%), in rural areas in summer (57.1%). Thus, the study has shown the need to expand the range of diagnostic methods for the formation of pregnancy complications risk groups. Determination of the substrate-energy value in the cells of the immune system is an indication for the individual selection of complex vitamin and mineral medications taking into account seasonal changes. MMP studies allow to monitor the dynamics and evaluate the effectiveness of preventive and therapeutic prescriptions.

In order to study the role of urogenital mycoplasmas on the course and outcomes of pregnancy, depending on its quantitative assessment using the real-time PCR, 159 rural women of the Amur region were examined. Infection with Ureaplasma species (spp.) was revealed in 51.2% of cases, among them in clinically significant concentrations (in the form of monoinfection or in combination with other opportunistic microorganisms) it was found in 39.0% of cases. Mycoplasma hominis in clinically significant concentration was determined in 15.1% of pregnant women, among them in 8.8% it was in combination with Ureaplasma spp. The effects of massive infection of the genital tract with urogenital mycoplasmas on the course and outcomes of pregnancy were evaluated in 85 patients. Four groups of pregnant women were formed according to the results of clinical and laboratory examinations. Group 1 (n=19) included pregnant women with convenional normocenosis ( Lactobaccilus spp. ≥10⁶ GE/mL, Ureaplasma spp ≥10⁴ GE/mL); group 2 (n=23) included patients with identified urogenital mycoplasma ( Ureaplasma spp and Mycoplasma hominis ) in clinically significant concentrations in combination with other opportunistic microorganisms ( Streptococcus agalactiae , Enterobacteriaceae , Staphylococcus spp., Gardnerella vaginalis , Bacteroides spp. and others). Pregnant women with vaginal dysbiosis ( Lactobacillus sp. ≤10⁶ GE/mL) and the absence of urogenital mycoplasmas were included in group 3 (n=13). The control group included 30 pregnant women with normal vaginal flora and the absence of urogenital mycoplasmas. The exclusion criteria were the identification of unconditional pathogens ( Chlamydia trachomatis , Neisseria gonorrhoeae , Trichomonas vaginalis , Мycoplasma genitalium ) and the activation of herpesvirus infections ( HSV and CMV ). As a result of the study, pregnant women in the main groups were 4.7-7 times more often to be diagnosed with fetal growth retardation syndrome; 2.0-3.2 times more often to have placental insufficiency compared with subjects in the control group. Premature birth in women of group 1 was registered 3.3 times more often than in the control group. In the same group, there was a tendency to increase the number of pregnant women with a long anhydrous period and premature discharge of amniotic fluid.

In this study, morphometric features of terminal villi in term and preterm placentas were compared. Placentas of 13 patients whose pregnancy ended in premature birth and placentas of 35 women with physiological pregnancy and delivery at term were studied. Morphometric assessment was made with Carl Zeiss Axio Imager microscope using an image analysis software package. The number of capillaries in terminal villi of preterm placentas was found to be decreased, while the vessels-to-syncytiotrophoblast distance was found to be increased. These result in a decreased gas exchange between maternal blood and placental tissue, hypoxia and can cause early termination of pregnancy. Mean values of cross-sectional area, vertical dimension and perimeter of terminal villi in preterm placentas are found to be greater than those in term placentas, which contributed to an increase in gas exchange area and can be regarded as a compensatory reaction at a tissue level.

The aim of the work is to study the activity of lipoperoxidation processes and antioxidant protection system in the umbilical cord blood of newborns from CMV-seropositive women with exacerbation of infection in the third trimester of pregnancy. Lipid peroxidation activity and antioxidant status in 30 newborns from CMV-seropositive women with exacerbation of infection in the third trimester of pregnancy and in 25 from CMV-seronegative women were studied. Erythrocytes were used to determine the products of oxidative modification of lipids; antioxidant status was evaluated in the blood plasma of the umbilical vein. The content of TBK-active products was determined by fluorometric method, lysophosphatidylcholine by thin-layer chromatography, arachidonic acid by gas-liquid chromatography. Antioxidant status was assessed by α-tocopherol content and superoxide dismutase activity. Registration of optical densities and fluorescence was carried out using a spectrofluorometer. The study found an increase in the content of red blood cells of the umbilical cord of newborns from CMV-seropositive women with an exacerbation of infection in the third trimester of pregnancy of TAC-active products in 2.1 times (р˂0.001), of lysophosphatidylcholine in 1.9 times (р˂0.001) and of arachidonic acid in 1.5 times (р˂0.001). The antioxidant status of umbilical cord blood was characterized by 1.5 times decrease in α-tocopherol (p<0.01) and 1.3 times decrease in superoxide dismutase activity (р˂0.001) compared with similar indices in the group of newborns from CMV-seronegative women. The results of the study show that the exacerbation of cytomegalovirus infection in the third trimester of pregnancy is accompanied by the development of oxidative stress and tension in the system of antioxidant protection in the blood of the umbilical cord of newborns due to increased consumption of α-tocopherol and suppression of superoxide dismutase activity.

The search and development of methods for correction of oxidative stress in conditions of exposure to adverse environmental factors is an actual problem of modern medicine. In experimental conditions the possibility to correct free radical lipid oxidation of rats’ organism membranes was studied with the introduction of the succinic acid and of the succinate containing medication called Reamberin (Polysan, St. Petersburg). The animals were divided into 4 groups and each of them had 20 rats: the group with intact animals which were held in standard conditions of vivarium; the control group in which rats were exposed to ultraviolet radiation during three minutes daily; the experimental group in which before ultraviolet radiation animals had a daily intraabdominal intake of the succinic acid in a dose of 100 mg/kg; the experimental group in which before ultraviolet radiation animals had a daily intraabdominal intake of Reamberin in a dose of 100 mg/kg (20 ml/kg). It was found out that in the blood of experimental animals a daily ultraviolet radiation during three minutes contributes to the increase of lipid hydroperoxides level (by 48-53%), of diene conjugate (by 43-48%), and of malonic dialdehyde (by 48-61%) against the decrease of antioxidant system activity in the blood of intact animals. The introduction of the succinic acid to rats contributes to the significant decrease in the blood of lipid hydroperoxides by 15-16%, of diene conjugates by 9-16%, and of malonic dialdehyde by 15% in comparison with the rats of the control group. The introduction of the succinate containing Reamberin to rats in the conditions of oxidative stress contributes to the significant decrease of lipid hydroperoxides in the blood by 27-28%, of diene conjugates by 23-28%, and of malonic dialdehyde by 26-29% in comparison with the rats of the control group. While analyzing the effect of the succinate containing drugs on the activity of the components of antioxidant system it was shown that the level of ceruloplasmin in the blood of animals was significantly higher by 25-32%, of vitamin E by 28-33% in comparison with the rats of the control group. So, the application of the succinate containing antioxidants in the conditions of ultraviolet radiation under experiment leads to the stabilization of the processes of peroxidation against the increase of antioxidant system activity. The intraabdominal introduction in laboratory animals of Reamberin in a dose of 100 mg/kg of succinate prevents the accumulation of lipoperoxidation products and increases the activity of main components of the antioxidant system in rats’ blood plasma, which indirectly exceeds similar effect of succinic acid in a dose of 100 mg/kg in the conditions of oxidative stress.

A brief review on respiratory damages in systemic scleroderma (SDS) is presented. The characteristic of the most frequent pathology - interstitial lung injury (ILI) is given. Pulmonary hypertension, pleural lesions, tuberculosis, secondary tumors are also described. Multispiral computed tomography in patients with SDS allows not only to identify the characteristic symptoms of ILI, but also to assess the extent of the lesion and the stage of development of the pathological process in the lungs for the timely treatment of ILI. In the two given clinical observations, lung involvement or ILI was the debut of systemic scleroderma and was ahead of other clinical symptoms of the disease; the course of alveolitis was progressive in nature, there was a significant decrease of lung volumes and an increase of fibrosis.

Goodpasture syndrome belongs to infrequent diseases and is shown by a hemorrhagic pulmonitis and glomerulonephritis (is more often proliferative), and extremely adverse course (the lethal outcome comes within 6 months - 1.5 years). Children and people of young age have this pathology mainly. We show a casuistic case of a long course (about 3 years) of Goodpasture syndrome in the person of 65 years old.

A brief review on the epidemiology, clinical picture, diagnostic assessment and treatment of respiratory mycoplasmosis in children is presented. Based on the data offered by the pediatric department of the clinical unit and on examination results given by the laboratory of molecular genetic research methods, the peculiarities of mycoplasmosis extension among children in Khabarovsk in recent years have been noted. The example of the case of mycoplasmosis infection in a family, when 3 out of 4 members of the same family were diagnosed with one of the most serious forms of respiratory mycoplasmosis - community-acquired pneumonia, is described. Different variants of the major disease course depending on the age, premorbid background and therapy are described. The efficiency of the use of macrolides for the treatment of Mycoplasma pneumonia under significant etiological verification of the pathogen using PCR is described.

The article presents modern data on the mechanism of progesterone action. Genomic and non-genomic ways of hormone action realized through different types of receptors (nuclear and membrane-associated) are considered. In addition, auxiliary proteins are described; in their functioning ATP binding plays an important role. It is emphasized that the specific effects of progesterone in various tissues depend on the set of receptors and their co-regulators. A special emphasis is made on the functions of the progesterone receptors in the endometrium and myometrium. The results of the study of progesterone receptors in placenta are summarized. It was concluded that there is a necessity in the further research of progesterone receptors in complicated pregnancy with a decrease in the implementation of progesterone effects.

The problem of prevention of complicated course of pregnancy and childbirth takes a leading place in modern obstetrics and perinatology. The authors conducted a profound analysis of numerous clinical studies in the area of folate metabolism in general, its role in the reproductive health of women, gestational complications, and the formation of fetal pathology. The significance of folic acid deficiency which is related to diet peculiarities, to insufficient enzymes intake, as well as to defects in folate exchange genes, which determine the reduced enzyme activity, is evaluated. In recent years, there has been much evidence that mutant homozygous (TT) and heterozygous (CT) genotypes are much more common among women with complicated pregnancies. Genetic deficiency of the key enzyme of the folate cycle - methylene-tetra-hydro-folate-reductase (MTHFR) is one of the reasons of hyperhomocysteinemia that has a pronounced toxic effect, damages the endothelial lining of the blood vessels and triggers a disorder of the processes of coagulation. Hyperhomocysteinemia has a big influence on the development of pregnancy complications, which depend on microcirculation, starting with spontaneous miscarriage in the first trimester of pregnancy and ending with preeclampsia, premature placental abruption and intrauterine fetal death. The consequences of the folate cycle problems at different stages can be congenital malformations of the fetus, especially defects of the neural tube. The importance of folic acid in the pathogenetic mechanisms of anemia is described. An interesting question is the role of low-functional alleles of folate genes in reproductive function disorders: under condition of infertility and miscarriage. The presented literature review is a reasonable conclusion for the need of further study of folate metabolism, taking into account genetic predisposition and other components.

Current methods of treatment of chronic obstructive pulmonary disease are not effective enough and lead to the progression of the disease and disability of the patient. One of the promising methods of chronic obstructive pulmonary disease therapy is the use of the possibilities of regenerative medicine, in particular, mesenchymal stem cells. The review demonstrates the achievements of research groups developing approaches to chronic obstructive pulmonary disease therapy based on mesenchymal stem cells. Our attention was focused on the problems and possible ways to show the mechanism of action of mesenchymal stem cells. The issues of safety of mesenchymal stem cells application are also discussed.