Introduction. The comorbidity of chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) significantly worsens the clinical course of these pathologies, which determines the need for careful hemodynamic monitoring during coronary artery bypass grafting (CABG). Aim. To evaluate the parameters of central and pulmonary hemodynamics during the performance of CABG under conditions of cardiopulmonary bypass (CPB) in patients with comorbidity of IHD and COPD. Materials and methods. Two groups of patients with IHD before and after CABG were examined. The first group included 11 patients with coronary heart disease in combination with COPD II-III severity without exacerbation, the second group included 29 patients with coronary heart disease without pulmonary pathology. Volumetric and hemodynamic parameters were measured by transpulmonary thermodilution using a Dräger Delta XL monitor and the Pulsion PiCCO Plus module (Germany) at three stages of the study: after the start of artificial lung ventilation; completion of the CPB procedure; 24 hours after IR. Results. For patients with comorbidity of coronary heart disease and COPD, a specific set of volumic and hemodynamic parameters was characteristic that distinguishes them from persons with coronary artery disease without pulmonary pathology. In the early postoperative period, this was manifested by the formation of a hypokinetic type of blood circulation, an increase in systemic vascular resistance, a less noticeable decrease in the global final diastolic volume, intrathoracic and pulmonary blood volumes. In addition, in patients with cardio-respiratory comorbidity, the maximum values of the indices of extravascular water in the lungs and permeability of the pulmonary vessels were recorded. Timely diagnosis of these disorders contributed to the restoration of pulmonary hemodynamics and water balance. Conclusion. When conducting CABG in patients with comorbidity of IHD and COPD, it is advisable to use the method of transpulmonary thermodilution, which provides more accurate control of hemodynamics and a personalized approach to correcting its disorders.

Aim. To study the peculiarities of the comorbidity of chronic myeloid leukemia (CML) with chronic obstructive pulmonary disease (COPD). Materials and methods. 10 patients with CML and with concomitant disease COPD were examined; all had a history of long-term smoking; the smoking person index (SI) was 31.8±5.7 packs/year. CML therapy was carried out with the first generation tyrosine kinase inhibitor imatinib. In accordance with the classification of COPD severity (GOLD 2011), 6 patients of the II stage and 4 patients of the III stage were diagnosed in the main group. The control group included 20 people without hematological, bronchopulmonary and cardiological pathologies, non-smokers, by sex and age corresponding to CML patients. The second control group included 20 patients with COPD without concomitant hemoblastosis: 13 patients with stage II, 7 patients with stage III, all had a history of longterm smoking, SI was 31.9±5.0 pack/year. The third control group consisted of 20 patients with CML without concomitant bronchopulmonary pathology. Spirography, a study of the gas composition of the blood, X-ray, bronchoscopic examinations, a comprehensive ultrasound examination of the heart with determination of the parameters of pulmonary and central hemodynamics were performed for all those included in the study. In patients of the main and second control groups, a comparative study of the dynamics of stopping the main manifestations of exacerbation of COPD during treatment was conducted. Results. It was established that the course of COPD against the background of CML is aggravated and is characterized by the progression of pulmonary hypertension, impaired hemodynamics of the pulmonary circulation, systolic and diastolic dysfunction of the right ventricle. When full cytogenetic and large molecular responses of CML are achieved, the dynamics of the main clinical manifestations of COPD in CML does not differ from the dynamics of the corresponding symptoms in patients with COPD without hemoblastosis. The presence of a concomitant disease - COPD and its treatment does not significantly affect the course of CML and modern therapy with tyrosine kinase inhibitors. No effect of imatinib therapy on the development of exacerbations of COPD was noted. Conclusion. The combination of CML and COPD does not require any correction of the treatment of both diseases and their treatment for comorbidity can be carried out in full in accordance with the protocols.

Introduction. Severe community-acquired pneumonia is one of the most important medical problems
due to its prevalence and high mortality. A total of 705 lethal cases with severe community-acquired pneumonia for 2014-2017 were analyzed on the Krasnoyarsk territory. Aim. To determine the risk factors for the development of deaths in severe community-acquired pneumonia in the Krasnoyarsk territory over a given period. Results. When analyzing patients with severe community-acquired pneumonia, the prevalence of men was found – 461 cases, the average age of the patients was 62 years old. After analyzing patients’ adherence to smoking, injecting drug use, alcohol abuse, it was found out that 180 patients smoked (25.53±1.64%), 177 (25.1±1.6%) patients abused alcohol, 58 injected drugs (8.2±1.0%). In 75.18±1.63% cases, bilateral lung lesions were recorded. Almost half (53.76%) of patients had comorbidities: chronic diseases of the cardiovascular system in 30.21%, chronic lung diseases in 15.46%, diabetes in 8.79%, chronic viral hepatitis and liver cirrhosis 4.54%, HIV infection in 6.81%. In patients aged 18-44 years, HIV infection, chronic viral hepatitis, and liver cirrhosis were more common. Starting at the age of 45, chronic diseases of the cardiovascular system were more frequently recorded. As a result of the analysis of patient management, it was found out that along with an underestimation of the severity of the condition, antibiotic therapy, which corresponds to the clinical guidelines, was prescribed only in 53% of cases. Conclusion. It is important in the supervision of patients with severe community-acquired pneumonia to assess all risk factors, as well as analyze the comorbidities which will lead to the correct choice of therapy in accordance with clinical guidelines.

Aim. To study indicators of quality of life and adherence to treatment of patients with severe bronchial
asthma. Materials and methods. The study included 120 patients with severe bronchial asthma with uncontrolled course of the disease, taking basic anti-inflammatory therapy. Adherence to the therapy was assessed using a modified MoriskyGreen questionnaire and a questionnaire «Test of the Adherence to Inhalers – TAI». The quality of life was assessed using an AQLQ questionnaire. Results. The study showed: according to the Morisky–Green adherence questionnaire in patients with severe asthma there was low intentional adherence to the basic anti-inflammatory therapy, which is formed mainly due to the missing of the drug in good health inattention to the clock medication and skipping of the medication. According
to the questionnaire «Test of the Adherence to Inhalers» it was found out that most patients are committed to therapy and ere was no unintentional non-commitment to the doctor’s therapy. Conclusion. In assessing the quality of life of patients with severe bronchial asthma it was revealed that the greatest impact asthma symptoms have on the emotional state, daily activity of the patient and the overall quality of life.

Aim. To study the state of renal hemodynamics in patients with chronic obstructive pulmonary disease (COPD), to analyze the indicators and to propose a more simple in practical application method for diagnosing renal blood flow insufficiency in patients with COPD using the regression equation. Materials and methods. The study included 75 patients with COPD. The main clinical and biochemical parameters, respiratory function, and electrocardiography were studied, the gas composition of arterialized blood was determined; fiber bronchoscopy and chest X-ray, Doppler echocardiography and duplex scanning of renal arteries were performed. The state of renal excretory function was determined by glomerular filtration rate and creatinine clearance. Results. A new method for diagnosing renal blood  flow insufficiency in patients with COPD is presented. The essence of the method is to determine the end-systolic volume of the right ventricle according to Doppler echocardiography, smoking history, left ventricular ejection fraction, urea and creatinine in the blood and solution of the regression equation. The numerical value of the equation in 65 and more points allows diagnosing the presence of signs of renal blood flow insufficiency, if it is less than 65 points there are no signs. Previously, 75 patients with COPD were correlated using the following variables: smoking history, end-systolic volume of the right ventricle, left ventricular ejection fraction, urea and creatinine levels in biochemical blood analysis. The multiple determination coefficient (R2) was 0.80 (80.0%), which confirms the reliability of the model forecast. Conclusion. This method can be used to diagnose early signs of renal blood flow insufficiency in COPD patients with the aim of a differentiated approach to the choice of treatment and prevention measures and improve the prognosis of the disease.

Aim. The article is devoted to the study of the prevalence of risk factors (RF) for osteoporosis (OP) and the features of osteopenic syndrome (OS) in males with chronic obstructive pulmonary disease (COPD). Materials and methods. The object of the study was 100 men with moderate and severe COPD, the average age was 57.3±9.13 years old, the duration of COPD was 15.9±4.5 years old, and 30 people did not have COPD of a similar age. The frequency and structure of the risk factors for OP and osteoporotic fractures were studied using the developed questionnaire, which included risk factors  included in the FRAX algorithm, individual risk factors included in the one-minute test recommended by the International Fund for OP (2008) (physical activity, milk and dairy use products, time spent in the sun) and additional questions (intensity and duration of smoking). Bone mineral density (BMD) was determined by double X-ray absorptiometry (DXA) on a LUNAR 8743 densitometer (GE Medical Systems Lunar, USA). The results were evaluated by the T- and Z-criteria in standard deviations from the peak bone mass (CD), according to the recommendations of WHO (1994). Results. In men with COPD, OS was detected in 66% of cases, OP was diagnosed in 36% patients, osteopenia in 30% patients. Only osteopenia occurred in the control group – in 10% of cases (p <0.001). The average values of the T- and Zcriteria in patients with COPD according to DRA fit into the category of severe osteopenia, amounting to -1.86±0.14 SD and -1.92±0.16 SD, respectively. It was found that the profile of behavioral risk factors for OP in men with COPD significantly differed from the profile of the control group in terms of the frequency of active smokers (p<0.01), physical inactivity (p<0.001), inadequate consumption of milk and dairy products without calcium replacement (p< 0.01). Such a risk factor as insufficient exposure to the sun (less than 10 minutes per day) without vitamin D substitution was detected only in the group of patients with COPD in 32% of cases (p<0.001). A significant proportion of patients with COPD (86%) had 2 or more risk factors for OP at the same time. Such modifiable factors as a hereditary history and weight loss were detected only in the group of patients: in 3 and 6% of cases, respectively. Correlation analysis showed a negative relationship between the T-criterion of the lumbar spine (r = -0.23; p <0.05) and the smoker's index (r = -0.63; p<0.001). It was determined that the absolute risk of the main typical fractures associated with OP was 1.8 times higher than in those without COPD (p <0.01).

Introduction. This work is devoted to the study of the fractional composition of solid suspended particles in the atmospheric air of the Khabarovsk territory (Khabarovsk, Komsomolsk-on-Amur, Sovetskaya Gavan, Nikolaevskon-Amur). Aim. To detect in the air the content of microparticles of atmospheric suspensions that have an impact on air quality, climate, people, and animals. Materials and methods. Atmospheric suspensions were studied in snow that was collected during snowfalls to exclude its secondary pollution by anthropogenic aerosols. Snowmelt was analyzed on a laser particle analyzer Fritsch Analysette 22 NanoTech (Germany) which allows one measurement to establish the distribution of particles in size, as well as to determine their shape. Results. In all the observed settlements, a moderately high percentage of the suspension fraction with a diameter of up to 10 micrometers was recorded, which can pose a danger to human health. In general, the content of this fraction varies widely: from 4.7% to 49%. At the same time, the highest percentage of particles with a diameter of up to 10 micrometers was observed in the samples taken in Nikolaevsk-on-Amur. The results of the analysis of samples in Khabarovsk 2018 are compared with the results of the analysis of samples taken at the same stations in 2011. According to the results of two measurements of the content of suspended substances in the air of Khabarovsk, held with a difference of 7 years, it is clear that air quality in this city has not undergone significant changes. Conclusion. On the basis of our own data, statistical and literary sources, the conclusion is made about the influence of anthropogenic factors on the content of fine fraction of solid particles in the surface air of the cities of the Khabarovsk territory, which contribute to an increase in the risk of respiratory diseases.

Introduction. One of the priorities of the regional policy of the Khabarovsk Territory is the preservation of the health of the indigenous peoples of the North. The full content of essential elements and the minimum presence of toxic and radioactive elements is one of the most important components of the normal functioning of the organism. Aim. To identify the features of the elemental composition of hair and blood serum in the body of adolescents of different ethnic groups of the North of the Khabarovsk region against the background of increased uranium and thorium content. Materials and methods. The survey of adolescents (n=121) was done: Nivkhs, Evenks and Russians. The content of Fe, Cu, Mo, Zn, Co, Se, Th, and U in hair and blood serum was found by atomic emission spectroscopy. Results. An elemental imbalance was found in all groups: an excess of Fe, Cu, Mo, Th, U and a deficiency of Co, Se was detected in the blood serum of Nivkhs and Evens; deficiency of elements was found in the blood serum of Russians; the content of U is excessive in all groups. The concentration of Fe, Th, U was excessive, Cu, Se was deficient in the hair. The dependence between the elemental composition of biosustrates and the nutritional composition of the diet was identified. Significant correlations between the high content of Th and U and imbalance of essential elements was found out. A high concentration of Th and U in biosubstrates is one of the risk factors for the violation of elemental homeostasis in adolescents in Khabarovsk Territory. Conclusion. The determination of features of microelement status allows to identify risk groups for the development of disadaptation states of the Nivkhs and Evens and determine the necessary correction measures.

Introduction. The important issues for pediatric pulmonological practice are considered to be congenital malformations of the bronchopulmonary system (CLM). However, the true place of CLM in the structure of all chronic lung diseases has not been determined so far. Aim. Analysis of the frequency and structure of CLM in children of the Amur Region. Materials and methods. The data of clinical observations for 287 patients for the period from 2000 to 2018 were taken. Inclusion criteria were nosological units related to Q32-34 paragraphs of The International Statistical Classification of Diseases and Related Health Problems (ICD-10). Patients groups were formed by complete method. Children with a diagnosis confirmed during the diagnostic program for these patients were considered as observation units. Results. The quantity of children with congenital lung malformations is 30% of the children with chronic nonspecific lung diseases observed in the clinic. CLM were detected in 93% of the examined children. Major part of these malformations is associated with underdevelopment of bronchopulmonary structures (69.7%). Tracheal and bronchial CLM were detected in 5.6% of cases. Pulmonary vascular malformations were diagnosed in 1.4% of patients. 7 cases of congenital lung malformations were diagnosed antenatally (2.3%). 52 children required surgical treatment (18.1%). Conclusion. Due to the fact that CLM form the basis for the secondary formation of chronic inflammation, the study of its frequency and structure contributes to improving the quality of medical care for patients, which significantly improves the quality of life, reduces the incidence of exacerbations, disability and mortality rate from complications of CLM.

Aim. To assess the demographic potential of the Amur Region based on the study of the number, gender and age composition, and the state of health of the population since 2010 and to identify priority concepts for the maintenance and restoration of population. Materials and methods. The eight-year  analysis of the number, gender and age composition and health of the population, including the morbidity rate of pregnant women and children aged 0-14 years old was made for the period from 2010 to 2018 according to figures provided by the Federal State Statistics Service of the Amur Region and form No.32 – «The morbidity of pregnant women, parturient women, puerperants and newborns», formed by the Medical Information and Analytical Center of the Ministry of Health of the Amur Region. Results. The population of the Amur Region has decreased by 4.4% since 2010 and amounted to 798.4 thousand people in 2018. In the Amur Region there was revealed an increasing number of women in the age groups 5-9 and 10-14 years old by 18.7%. The highest fertility rate was observed in women aged 20-24 years old, 25-29 years old and 30-34 years old, there was also the increase in the fertility rate in 30-34 years old, 35-39 years old and 40-44 years old. The total fertility rate for the study period increased to 1.71. These data indicate that there is a potential for population recovery in the Amur Region in the near future. However, there is an increase in somatic pathology in the adult population: diseases of the respiratory system, genitourinary system and circulatory system; in women there are malignant neoplasms of the breast, cervix and body of uterus. Somatic diseases during pregnancy that complicate its course are diagnosed with high frequency: anemia, diabetes mellitus, hypertensive disorders. There is an increase in the morbidity of children aged 0-14 years old in the main classes of diseases by 17%, more often in respiratory and digestive diseases. Conclusion. Early diagnosis and timely treatment of this pathology, including treatment at the stage of pregnancy planning, will have an impact on the health of present and future generations living in the Amur Region.

Aim. To assess the condition of the nasal and pharyngeal mucosa in pregnant women with chronic simple bronchitis in remission. Materials and methods. A retrospective analysis of the results of anterior rhinoscopy, pharyngoscopy and examination of regional lymph nodes was performed in 100 women in the second trimester of pregnancy, uncomplicated and complicated by chronic simple bronchitis in remission. The first group consisted of 30 women with physiological pregnancy, the second hag 38 patients with chronic simple bronchitis without exacerbation, and the third included 32 women with chronic simple bronchitis in remission and clinical echographic signs of threatened miscarriage. Results. It was found out that patients of the first group, compared with the second and third ones, did not show hemorrhages on the mucous membrane of the posterior wall of the pharynx, had moderate hyperemia of the mucous membrane of the tonsils, their sclerosis and caseosis in the lacunae. In the third group compared to the second, in women there was increased the frequency of visualization of moderate edema of the nasal mucosa (p<0.05), pharynx (p<0.01) and soft palate (p<0.001), moderate hyperemia of the nasal mucosa (p<0.05), pharynx (p<0.01) and soft palate (p<0.01), single lymphoid granulations on the posterior wall of the pharynx (p<0.05), enlarged tonsils (p<0.01), edema of their mucosa (p<0.05), the expansion of lacunae (p<0.01), as well as the increase in mobile and painless occipital and submandibular lymph nodes (p<0.05). Conclusion. The above changes in the mucous membrane of the nose and pharynx, as well as the lymphoepithelial apparatus in chronic simple bronchitis without exacerbation indicate the important role of reducing the local immune protection of the upper respiratory tract in women in the pathogenesis of the threat of miscarriage.

Aim. To study NO-synthase activity and nitrite-anion indices in umbilical vein endothelium in exacerbation of cytomegalovirus infection in the third trimester of pregnancy. Materials and methods. To study NO-synthase activity in the endothelium and the content of nitrite-anion in the umbilical cord homogenate obtained during childbirth at 38-39 weeks of pregnancy from 65 CMV-seropositive women with exacerbation of infection in the third trimester of pregnancy (the main group) and from 32 CMV-seronegative women (the control group). The material for the study was the endothelium of the umbilical cord vessels adjacent to the placenta. The content of nitrite anion in umbilical cord homogenate was studied by enzyme immunoassay. The activity of NO-synthase in the umbilical vein endothelium was studied by histochemical method followed by cytophotometric data processing. For morphological studies, semi-thin sections of umbilical vessels were used. Results. The study revealed 1.6 increase (p<0.001) in the activity of NO-synthase in the endothelium of the umbilical cord vein from CMV-seropositive women with exacerbation of infection in the third trimester of pregnancy compared to the group of CMV-seronegative women. The content of nitrite anion in the umbilical cord homogenate increased 4 times (p<0.001). Morphological examination revealed discomplexation and desquamation of endothelial cells, interstitial edema of the muscle layer, marginal standing and migration of leukocytes into the vascular wall and adjacent gelatin of Wharton. There was an expansion of the lumen of the umbilical cord veins. Conclusion. Based on the results of the study, it was shown that an increase in the activity of NO-synthase and the content of nitriteanion in the endothelium of the umbilical cord vein in exacerbation of CMV infection in the third trimester of pregnancy is associated with the development of inflammation, prolonging endothelial dysfunction, which can contribute to the obstruction of venous blood flow.

Aim. The analysis of effectiveness of antioxidant system of blood under adaptogenic nutrition and overall cold influence of rat’s organism was conducted in experimental conditions. Materials and methods. The rats were divided into five groups each having ten individuals: first group – intact animals were put in standard conditions of vivarium; second group – controlling, where the animals went through cold influence (every day in the morning the animals were put for three hours in climate camera within temperature -15ºС with humidity 50%); the third, fourth and fifth groups – experimental animals were fed before the exposure to climate camera with biologically active substances of Hypericum perforatum and Rhodiola rosea in the dosage of 30 mg/kg, 150 mg/kg, 300 mg/kg, respectively. Results. It was identified that cold influence reduces the level and components’ activity of antioxidant system of blood of experimental animals in different scope during all days of experiment. The introduction of phytocombination from Hypericum perforatum and Rhodiola rosea at a dose of 150-300 mg/kg in the food of animals exposed to low temperatures restores the concentration of ceruloplasmin in the blood of rats by 37.4-53.2%; significantly (29.9-35.2%) increases the content of vitamin E in relation to the control data; at the end of the fourth week of the experiment, the activity of tocopherol significantly exceeded the initial level by 10.9%, amounting to 32.8±1.0 mcg/ml; restores the level of catalase to 23.9-25.8% in comparison with control values and exceeds data of intact group of animals by 9.8%; on all days of the experiment, it helps to restore the content of glucose-6-phosphate dehydrogenase, increasing the accumulation of this enzyme by 4.6 and 5.9%, respectively, by the third and fourth week of the study. Conclusion. Feeding experimental animals a complex of biologically active substances from Hypericum perforatum and Rhodiola rosea at a dose of 150-300 mg/kg had a regulatory effect on the content of ceruloplasmin, catalase, glucose-6-phosphate dehydrogenase and tocopherol in the blood of rats during prolonged cold exposure.

Introduction. The use of antiepileptic drugs causes an increase in the formation of free radicals and a
change in antioxidant status. As a result, effectiveness decreases or functional tolerance to anticonvulsants develops, and side effects are observed. Aim. To study the parameters of pro-and antioxidant system in epilepsy monotherapy in children. Materials and methods. On the basis of the Amur Regional Children's Clinical Hospital there conducted a controlled randomized open study of parameters of pro- and antioxidant system in children with epilepsy. The patients were randomized into 2 groups and each of them had 15 children: the group 1 where patients daily orally took carbamazepine at a average therapeutic dose of 500 mg; the group 2, patients daily orally took valproic acid at a dose of 25 mg/kg. The control group consisted of 15 healthy children, comparable by sex and age. Antioxidant status was evaluated by the levels of lipid hydroperoxides, conjugated dienes, and malondialdehyde and by the activity of the main components of the antioxidant system (ceruloplasmin, vitamin E, catalase) in the blood of patients. Results. The administration of carbamazepine to patients significantly increased the plasma levels of lipid hydroperoxides by 22%, conjugated dienes by 23%, and malondialdehyde by 33% compared with the children in the control group. The analysis of the effect of carbamazepine on the activity of the antioxidant system components revealed that the blood concentrations of ceruloplasmin, vitamin E and catalase were 33%, 26% and 16%, respectively, lower than those in the control group. The administration of valproic acid to patients significantly increased the plasma levels of lipid hydroperoxides by 21%, conjugated dienes by 28%, and malondialdehyde by 33%  compared with the children in the control group. The analysis of the effect of valproic acid on the
activity of the antioxidant system components established that the blood concentrations of ceruloplasmin, vitamin E and catalase were 35%, 18% and 17%, respectively, lower than those in the control group. Conclusion. The incorporation of antioxidants into the treatment of children with epilepsy should be considered pathogenetically justified, clinically reasonable, and promising.

The article presents a brief review of the literature on the role of growth factors in the processes of trophoblast invasion and their association with the pathological course of pregnancy. The importance of vascular endothelial growth factor, placental growth factor and vessels receptors, transforming growth factor, insulin-like growth factor in the development and differentiation of the placenta during physiological pregnancy are shown. There has been described violations that allow to assert the involvement of vascular growth factors and their receptors in the pathogenesis of placental insufficiency, preeclampsia, spontaneous miscarriage, fetal growth retardation. The analysis of the literature data concerning the role of growth factors in the processes of trophoblast invasion and various complications of the gestational period allowed to draw a conclusion about the insufficient study of this issue.

The article analyzes the results of recent studies, forming the modern concept of the pathogenesis of chronic obstructive pulmonary disease (COPD) as a disease with an autoimmune component, with an emphasis on the special role of bronchial epithelium and macrophages in the organization of the primary immune response. Of great interest is the evidence of the receptor function of some transient receptor potential (TRP) channels in relation to cigarette smoke and particulate matter – the main etiological factors of COPD. It was found that these channels can be expressed on epithelium and cells of innate immunity,  and can also exert a modulating effect on the course of the inflammatory reaction. At present, relatively little attention is paid to the study of the possible role of TRP channels in COPD, despite the available facts indicate their key role in this disease, especially at its initial stages. This review is aimed at systematizing the results of the studies conducted in this field.