Aim. There was made the analysis of the organization and provision of a complex of organizational, methodological, diagnostic and preventive measures aimed at developing and improving pulmonological care to the population with the consolidated participation of health authorities, medical organizations, scientific and educational institutions, conducted on the basis of the regional target program "Respiratory health of the population of the Amur Region".

Materials and methods. For the organization of the study there were used the methods of structural and comparative analysis, predictive modeling, analysis of time series, statistical and information and analytical methods, databases of the Ministry of Health of the Russian Federation and the Federal State Statistics Service (Rosstat).

Results. It has been found out that the improvement and increase of the effectiveness of specialized medical care for the population should be aimed at strengthening and developing the personnel and material and technical potential of health care, introducing innovative technologies in the field of timely diagnosis, treatment and prevention of diseases. As a result of the analysis, it was shown that complex treatment-and-prophylactic and organizational-methodical work aimed at improving the quality of medical care to patients of the pulmonary profile is reflected in the dynamics of the population respiratory health indicators, which are the main indicators of the effectiveness of program activities. For the period from 2005 to 2017 mortality rates due to respiratory diseases decreased by 46.4%, including those from chronic respiratory diseases by 25.3%, and from pneumonia 3.4 times. At the same time, the mortality rate of the population in the age group younger than the working age is 3.4 times lower than the mortality rate in the Far Eastern Federal District and 2.6 times less than the similar indicators of the Russian Federation as a whole. Analysis of the dynamic series of primary diseases of the respiratory organs and the predictive model of dynamics showed that linear trends in the Amur Region are more progressive than the dynamics in the country as a whole, which indicates positive processes for the timely diagnosis of diseases and the availability of medical care to the patients of pulmonary profile.

Conclusion. Therefore, purposeful work to ensure the availability and quality of medical care for patients with a pulmonary profile, and the development of a system of respiratory health care using integrated regional programs, as shown by the analysis, are the basis for achieving positive results in the system of organizing pulmonological care for the population and improving the efficiency of medical care for patients with respiratory pathology.

Aim. To study the epidemiology of nosocomial pneumoniae (NP) in the Amur Region and according to the Amur Regional Clinical Hospital to study the characteristics of their course in a multidisciplinary hospital.

Materials and methods. On the basis of the Amur Regional Clinical Hospital, a prospective study was conducted to study the clinical features of the NP (118 patients); In addition to case histories, 456 samples of material (sputum, bronchial wash) were selected for the purpose of bacteriological research to study the characteristics of the microbiological landscape of the hospital (retrospective analysis). 70 case histories of patients diagnosed with NP who were treated in the City Clinical Hospital of Blagoveshchensk and 15 case histories of patients from the Central Regional Hospital of the Amur Region, where the regional vascular center functions, were studied in retrospect.

Results. The conclusion was made that in the Amur Region with a low population density in large areas, assistance to patients with severe somatic pathology is carried out mainly in the hospitals of the regional center, which explains the greater incidence of NP in the hospitals of the regional center hospitals. NPs are more likely to develop in elderly patients with a polymorbidic background (72%) who have risk factors for nosocomial infection (97.4%). In most cases, NPs were registered in those departments of the surgical and therapeutic profile where there were patients with severe somatic pathology who underwent serious invasive treatment methods or immunosuppressive therapy, were on bed rest or mechanical ventilation due to the underlying disease, or in patients with various options of consciousness disturbance. The main etiological factors for the development of NP were gram-negative bacteria (59.8%) with a predominance of microbial associations (58.5%). In specialized departments, causative microbial agents in early NP were: Streptococcus pneumoniae (36.4%), Klebsiella pneumoniae (11.8%), Staphylococcus aureus (2.5%), Pseudomonas aeruginosa (0.8%); with late NP - Klebsiella pneumoniae (28.3%), Pseudomonas aeruginosa (8.4%), Streptococcus pneumoniae (5.1%), Staphylococcus aureus (4.2%), Acinetobacter (2.5%). In the intensive care unit, causal microbial agents for early NP were diagnosed with: Streptococcus pneumoniae (7.8%), Pseudomonas aeruginosa (6.4%), Klebsiella pneumoniae (6.4%), Staphylococcus aureus (3.5%), Acinetobacter (0.7%); with late NP - Klebsiella pneumoniae (40%), Pseudomonas aeruginosa (20%), Staphylococcus aureus (3.5%), Streptococcus pneumoniae (2.5%), Acinetobacter (1.7%). Clinical and laboratory characteristics of NP in large hospitals of the region are given.

Introduction. The results of studies conducted in recent years in the area of the functional role and structural features of transient receptor potential (TRP) channels increasingly indicate their involvement in the pathogenesis of various diseases of the respiratory tract, such as asthma and chronic obstructive pulmonary disease. In particular, TRPA1 has repeatedly been studied in asthma and asthma-associated phenomena in vivo and in vitro. It is important to note that some researchers have found a significant effect of certain genetic features of this channel on the formation of various pathological conditions in humans.

Aim. The purpose of this study was to examine the possible relationship of TRPA1 polymorphisms with a predisposition to the formation of asthma in adults.

Materials and methods. A total of 512 subjects were included in the study, among them 427 patients with asthma and 85 people with chronic non-obstructive bronchitis. Eight single nucleotide polymorphisms (SNPs) of TRPA1 gene were genotyped by LATE-PCR method. Results. As a result of the associative analysis, the relationship of SNPs rs6996723 with asthma in adults was established. CC and CT genotypes prevailed in patients with asthma, while homozygous TT genotype, on the contrary, was more frequently observed in the control group as compared with asthmatics. The differences in the frequencies of genotypes were significant in the following genetic models: multiplicative (OR 1.68 95% CI [1.13-2.49], p=0.01), general (p=0.004), additive (p=0.01) and dominant (OR 4.10 95%CI [1.67-10.06], p=0.001).

Conclusion. Thus, it can be concluded that the presence of C allele for rs6996723 predisposes to a higher risk of asthma development among persons aged over 18 years. In case of additional verification of the results, the data on the presence of a specific allelic variant of rs6996723 SNP can be used to individually predict the risk of asthma development.

Introduction. Impulse oscillometry (IOS) is a novel method of assessing airway resistance. IOS has been introduced as an alternative technique to assess lung function.

Aim. To evaluate IOS for lung function assessment in patients with various severe degree of asthma.

Materials and methods. The study included patients (n=76) from 16 to 79 years old (mean age was 44±18; 52 (68%) for men and 24 (32%) for women) with asthma of various degree severity. IOS indices were compared with the indices of traditional pulmonary function tests (PFTs) such as spirometry, bodyplethys-mography and diffusing capacity of the lung.

Results. There were revealed the following changes of IOS: increasing of respiratory impedance (Zrs), respiratory resistance (Rrs), friction resistance (Rrs), its frequency dependence (Rrs5-Rrs20), square reactance (AX) and resonant frequency (fres), the decrease in reactance (Xrs) in 96% of patients with asthma. 12 out of 18 patients (67%) with traditional PFTs in normal values had deviations of IOS parameters Rrs, Xrs, АХ, (Rrs5-Rrs20). IOS parameters of patients with asthma showed significant correlations with parameters of spirometry and body-plethysmography.

Conclusion. IOS can be used for lung function assessment in patients with asthma. IOS may provide objective information in cases in which spirometry was normal.

Introduction. Mountain climbers’ activity is constantly accompanied by harsh ambient conditions. Changeable exogenous factors joint by reduced oxygen pressure considerably complicate athletes’ medical support and demand objective appraisal elaboration for the purpose of adaptation level timely correction.

Aim. To develop the athletes’ body adaptation level’s criteria under extreme conditions of sport work.

Materials and methods. Mathematical-statistical analysis of results of examenation of 62 climbers at the age of 30.5±3.6 years old was carried out using volumetric compression oscillometry method before, during and after sporting event.

Results. As a result of the obtained data of volumetric compression oscillometry indicators’ analysis, mountain climbers were divided into three groups of kinetic blood circulation types, which were hypokinetic, eukinetic and hyperkinetic. Climbers with hyperkinetic blood type were not admitted to take part in sporting event. Statistically significant (p<0.05) signs allowing to determine athlete’s organism adaptation level to external environment exogenous factors were specified. These features are diastolic blood pressure, lateral systolic blood pressure, average hemodynamic arterial pressure, arterial pulse pressure, energy consumption indicators for the movement of one liter of blood, total peripheral vascular resistance, specific peripheral vascular resistance, systolic pressure and linear circulation time.

Conclusion. The analysis of volumetric compression oscillometry revealed significant (p<0.05) criteria for evaluating the level of adaptation, where the change of adaptation level from the optimum condition to the violation of the regulation mechanisms of the organism was accompanied by an increase in myocardial contractility, heart rate, blood pressure, minute volume of blood flow and a decrease in stroke volume. These changes were confirmed by the transition to a more energy-intensive type of regulation of blood circulation at rest. Correlation between the increased intensity of the training process in the conditions of mountain climate and the increase of long-term hemodynamics was found, and the lack of timely correction of the adaptation level of organism contributed to the increase in infectious morbidity.

Aim. To assess the effect of cytomegalovirus infection (CMVI) on the content of myristic acid and sphingomyelin in the membrane of blood red blood cells of the umbilical cord of newborns.

Materials and methods. There were examined 25 newborns from mothers with exacerbation of chronic CMVI in the third trimester of gestation (the main group); the control group consisted of 20 newborns from healthy mothers. Clinical diagnosis (exacerbation of chronic CMVI) was established in a comprehensive study of peripheral blood for the presence of cytomegalovirus DNA, IgM or four times or more increase in the titer of IgG antibodies in paired sera in dynamics after 10 days, as well as the avidity index (more than 65%). Verification of cytomegalovirus, determination of type-specific antibodies, and avidity index were carried out by ELISA methods; detection of cytomegalovirus DNA was done by PCR methods. The material for the study was the umbilical cord blood erythrocyte membrane. Lipids from umbilical cord blood were extracted by Folch method. The content of myristic acid in the erythrocyte membrane of the umbilical cord in newborns was determined by gas-liquid chromatography; the concentration of sphingomyelin was found by thin-layer chromatography. Microviscosity of erythrocyte membranes was measured by lateral diffusion of pyrene hydrophobic fluorescent probe.

Results. It is established that the exacerbation of chronic CMVI in women in the third trimester of pregnancy (the antibody titer of IgG to cytomegalovirus 1:1600) was associated with the increased content of the myristic acid in the erythrocyte membrane in the umbilical cord blood of their newborns compared to the control group by 32% (from 1.64±0.007 vs. 1.24±0.008%, respectively, p<0.001) and sphingomyelin by 25% (24.20±0.12 vs. 19.40±0.09%, respectively, p<0.001), which leads to an increase of microviscosity of erythrocyte membranes - the reduction of eximerization pyrene coefficient to 0.48±0.004 rel. units (in the control group it was 0.76±0.005 rel. units, p<0.001).

Conclusion. The increase in the content of myristic acid and sphingomyelin in the erythrocyte membrane of the umbilical cord during growth in the mother of the titer of antibodies of immunoglobulin class G to cytomegalovirus 1:1600 increases the microviscosity of the lipid bilayer of the erythrocyte membrane and may be one of the factors contributing to the formation of hypoxia of the newborn child.

Aim. To study morphofunctional state of the placenta infected with Mycoplasma genitalium.

Materials and methods. Histological, morphometric and molecular genetic studies of 34 placentas from women with preterm birth were carried out. Histological examination was performed according to the standard method with hematoxilin-eosin staining. Morphometry was done using the image analysis system based on the microscope "Carl Zeiss" using the program "Axio Vision". Placental infection was studied by PCR. The genome of the following pathogens was identified: Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma spp., Cytomegalovirus, Herpes simplex virus, Herpes human virus 4 type, Herpes human virus 6 type, Chlamydia trachomatis, Parvovirus B19, Listeria monocytogenes, Streptococcus spp., Streptococcus agalactiae, Staphylococcus aureus, Pseudomonas aeruginosa, Haemophilus influenzae.

Results. The genome of perinatal infections was found in 21 placentas of 34 (61.8%). M. genitalium DNA was detected in one placenta as monoinfection (2.9%), in another it was in combination with S. agalactiae (2.9%). In addition, the DNA of Ureaplasma spp. was determined in 32.3% and M. hominis DNA in 23.5% of cases in mono-and combined infections. Single placentas had DNA of S. agalactiae, Cytomegalovirus, human Herpes virus type 4. No other infectious agents were identified. In the placenta infected with M. genitalium, pathohistological examination revealed signs of subcompensated chronic placental insufficiency, inflammatory changes in the membranes, malformations of the afterbirth. Morphometric study of terminal villi of the placenta infected with M. genitalium showed a decrease in the content of vessels in the terminal villi, a decrease in the area, of vertical and horizontal dimensions, the perimeter of the villi compared with the average values of the terminal villi of uninfected placenta.

Conclusion. Features of vascularization of the placenta infected with M. genitalium indicate a decrease in gas exchange and developing hypoxia of the placenta, which may be one of the components in polyetiological nature of miscarriage. The use of the morphometric characteristics of the terminal villi of the placenta allows to objectify the data on the state of the terminal villi, and to predict the risk of intrauterine infection of the newborn.

Introduction. The study of the possibility of increasing mental performance with phytoadaptogens during the learning process of individuals enrolled in institutions of higher education seems quite perspective taking into account the lack of toxicity, adverse effects of herbal preparations and polivalentes of pharmacological actions, including antioxidant activity.

Aim. To study the effect of the drug Leuzea carthamoides on indicators of mental health and antioxidant status in students-volunteers of the third studying year.

Materials and methods. The controlled open randomized study included 20 volunteer students in the third year of the Amur State Medical Academy. The study participants were randomized into two groups, each of 10 people: in the control group, students did not take Leuzea; in the experimental group, students daily took 2 tablets of Leuzea orally 2 times a day for 25 days. The study of cognitive sphere included the use of simple pathopsychological tests: Schulte tables and a test for memorizing 10 words. The intensity of lipid peroxidation processes was assessed by studying the content of lipid hydroperoxides, diene conjugates, Malon dialdehyde and antioxidant system components (ceruloplasmin, vitamin E, catalase) in blood plasma.

Results. There was found the presence of nootropic activity of Leuzea carthamoides: daily intake of medication by students helps to improve memory and faster memorization of a certain amount of material, reducing the level of exhaustion of voluntary attention in comparison with the same indicators in the control group of volunteers. In the analysis of the influence of Leuzea carthamoides on the antioxidant status of the students, it was concluded that the introduction of phytoadaptogens contributes to a statistically significant decrease in plasma content of lipid hydroperoxides by 12%, of diene conjugates and malonic dialdehyde by 18% against the increase of ceruloplasmin activity by 11%, vitamin E by 12%, catalase by 13% compared to the same indicators in the control group of volunteers.

Conclusion. The use of Leuzea carthamoides by students- volunteers leads to stabilization of the processes of peroxidation against the increase of the activity of the main components of the antioxidant system, indicating clinical validity and potential of the use of Leuzea carthamoides by students of higher educational institutions.

Lung cancer is the most common cancer pathology. But, despite this, it is in most cases diagnosed late, when surgical treatment is impossible or ineffective. This is due to the lack of clinical manifestations of the disease in the early stages. Some localization of lung cancer, in particular, cancer of the apical segment of the lung occurs with neurological symptoms (Pancoast syndrome, Horner syndrome), excruciating pain in the upper limb on the side of the lesion, which makes the diagnosis even more difficult. The present report demonstrates two cases of apical lung cancer with differences in clinical manifestations, united by late diagnosis.

Amniotic fluid embolism (ICD-10 code - O88) is one of the direct causes of maternal mortality. It occurs as a result of ingress of components of the amniotic fluid into the bloodstream of the mother. It requires a quick diagnosis and a complex interdisciplinary approach to treatment. The absence of special diagnostic tests leads to a sudden and unexplained death of a pregnant woman, a woman in labor or a puerperal. The early beginning of intensive care may determine a favorable outcome. A clinical case of amniotic embolism during pregnancy with a fatal outcome and morphological verification of the diagnosis is presented.

The article presents the methodology of an experimental study of the influence of micro-sized suspended particulate matter of the atmospheric air on alveolar macrophages in Wistar rats. This set of methods has been designed to study the mechanisms of the impact of air suspensions of urbanized territories belonging to various fractions on the body and can be used for scientific research in the field of pathological physiology, medical ecology and hygiene.

The article is devoted to the use of non-drug therapy for asthma in patients with obesity. The widely used non-pharmacological methods are described in terms of their effect on the main pathogenetic links of asthma-obesity phenotype. The analysis of the effectiveness of the integrated use of natural and preformed physical factors is done. It is shown that non-drug technologies can prevent the progression of diseases and improve the quality of life for patients with asthma and obesity. The presented data have demonstrated the need to develop new combined methods of applying basic therapy and non-drug methods, innovative physiotherapy technologies.

In Russia, mortality from respiratory diseases remains high, despite some success in their prevention, diagnosis and treatment. According to official statistics, in 2014-2015, the mortality rate from respiratory diseases was 54.5 per 100 thousand. Outpatient health care is of great importance to prevent negative outcomes in respiratory diseases. Domestic recommendations and some recent research on the management of patients with respiratory diseases at the outpatient stage have been studied. The article highlights the fundamental aspects of diagnosis and treatment of the most socially significant respiratory diseases: acute bronchitis, community-acquired pneumonia, acute respiratory viral infections, including influenza, chronic obstructive pulmonary disease and asthma at the outpatient stage; attention is focused on the selection of drugs taking into account the regional sensitivity of pathogens to antibacterial drugs; there are recommended combinations of bronchodilators depending on whether patients with chronic obstructive pulmonary disease belong to a class ABCD and whether asthma patients depend on the control of the disease. Indications for hospitalization are presented. The role of vaccination with influenza and pneumococcal vaccines for the prevention of respiratory diseases was determined.

The review is devoted to the role of thioredoxin and glutathione antioxidant systems in protection of the body against oxidative stress caused by exposure to micro-sized solid suspended particles of atmospheric air. The features of components and parameters of solid suspended particles determining their oxidative properties have been described. The focus is on intracellular and molecular mechanisms affecting many antioxidant reactions. The issues of regulation, modulation and maintenance of cellular redox homeostasis by key reducing thiols have been considered.

The article is a two-part review of the literature in which modern data on the receptors of estrogens are analyzed. The first part of the review describes the types of estrogen receptors, their mechanisms of action and regulation. This part of the literature review focuses on the role of estrogen receptors during pregnancy. Particular attention is paid to the significance of estrogen receptors in the process of endometrial transformation during gestation. The role of receptors in ensuring the blood flow of the uterus is viewed. It is shown how estrogen receptors contribute to the labor. The evidence of receptor localization in different areas of the reproductive tract is recorded, hypotheses of the supposed role of different types of estrogen receptors in the placenta are presented. Analysis of literature data on the receptors in various complications of pregnancy allowed to conclude that this issue needs further study.

The study of materials of regional federal and executive authorities over the past ten years shows that the recognition of the environmental situation in the Amur Region is satisfactory, smoothing out the degree of danger of the consequences of past and current economic activity and weak administrative and economic control over the state of the atmosphere, water and soil. In reality, the environmental situation is stressful (conflict) and presents a significant risk for the population. Constant stationary sources and all types of vehicles emit into the atmosphere and surface water the same suspended particles of unknown composition, liquid and gaseous substances, including benzopyrene, formaldehyde and heavy metals. Due to the long-term impact of the unfavorable environment on the population, the birth rate has decreased; the mortality from circulatory diseases and cancers has increased; the incidence of children and adults from the pathology of the respiratory and digestive systems has increased; most people are not provided with high-quality drinking water; the water supply network contains high concentrations of Co, Cr, Mn, Pb and other metals; the mineral “portrait” of the residents of Blagoveshchensk has changed. Landfills of production and consumption wastes, bacterial soil contamination and forest fires have adversely affected the wildlife species abundance.