The aim of the present work is to compare the inflammation phenotypes in patients with asthma depending on the presence of airway hyperresponsiveness to hyposmolar and cold stimuli. In 49 patients the level of asthma control, lung function, airway response to ultrasonically nebulized distilled water inhalation (DWI) and isocapnic hyperventilation with cold air (IHCA), cellular composition of the induced sputum were assessed. To find phenotypical differences in the character of inflammation, the patients were divided into 4 groups: the 1^st group was with airway hyperresponsiveness to both stimuli (osmotic and cold); the 2^nd group was with isolated bronchial hyperresponsiveness to DWI; the 3^rd group was with isolated response to IHCA; the 4^th group was without any response to both triggers. The patients of the 2^nd and the 3^rd groups were found to have a mixed cellular phenotype of inflammation with the domination of neutrophilic component. Eosinophilic-neutrophilic phenotype of inflammation was in the patients of the 1^st group with the concomitant airway response to hyposmolar and cold stimuli. Eosinophilic phenotype of inflammation was typical for the patients of the 4^th group without bronchial hyperresponsiveness to the triggers. The significance of the formation of cytograms of induced sputum and cellular phenotypes of inflammation has been shown as prognostic markers of asthma course and the efficiency of medical therapy

To define clinical-functional features of formation of airway response to hyperosmotic stimulus, 89 patients with asthma (56 women and 33 men) were examined. The protocol of the study included a detailed interview, objective examination of the patients to specify the severity of the disease and the features of its course, questioning to assess clinical signs of airway response to physical exercises and ecological stimuli, the study of the lung function by spirometry, and bronchial challenge test with hypertonic solution by inhalation with 4.5% solution of NaCl. From the whole number of examined patients 48% patients have exaggerated airway response to hyposmolar stimulus which at bronchial challenge test with hypertonic solution is revealed through intensive clinical symptoms: shortness of breath and attack-like cough with sputum. In 80% of cases these patients have a high sensitivity of bronchi to climatic factors such as low temperature of the air and its high humidity, which worsens the course of asthma.

In order to study the risk factors of uncontrolled asthma in pregnant women clinical and functional characteristics of the disease in the dynamics of the gestational period were studied in 365 patients. The results show that the deterioration of asthma during pregnancy was in 178 (48.8%) patients, there was no significant response in 123 (33.7%) and there was improvement in 64 (17.5%). Exacerbation of asthma during pregnancy was observed in 277 patients (76%), which indicates a lack of disease control. Predictors of asthma worsening in the gestation period indicating the absence of control of the disease were: the severity of asthma, the presence of allergic rhinitis, chronic diseases of upper respiratory tract, acute viral infection. Uncontrolled asthma was more common among the patients with low social-economic status (rural residents, those with poor material and living conditions, low levels of education, non-registered marriage).

The parameters of humoral immunity to respiratory viruses and to the virus of cytomegalia as well as the contents of secretory immunoglobulin А(sIgA), interleukin-4 (IL-4), tumor necrosis factor-α (TNF-α) and interferon-γ (INF-γ) at asthma were studied in 57 women in the third trimester of pregnancy. The first group consisted of 29 patients with mild asthma, the second one included 28 women with moderate asthma. The control group had 30 women with physiologic course of the gestation process. It is shown that in the second group 39.3% women had the reactivation of chronic cytomegalovirus infection (in the first group it was in 6.9%, р<0.05). At moderate asthma there was the decrease of sIgA till 3.1±0.26 mg/l, its concentration in healthy pregnant women was 5.7±0.49 mg/l (р<0.01). In pregnant women with mild asthma there was an increase of the concentration of IL-4 till 56.1±5.01 pg/ml, TNF-α till 171.2±11.07 pg/ml, as well as of INF-γ till 48.9±4.21 pg/ml (in the control group it was 36.7±2.05 pg/ml, p<0.001; 63.7±4.51 pg/ml, p<0.001; 46.8±3.92 pg/ml, р<0.01, respectively). In the second group in comparison with the first one there was the increase of concentration of IL-4 till 73.9±5.65 pg/ml (р<0.05) and TNF-α till 272.4±15.82 pg/ml (p<0.01), as well the decrease of INF-γ till 35.7±3.87 pg/ml (р<0.05). Identified lower values of sIgA and INF-γ suggest the decrease of antivirus immunity in women with moderate asthma in the third trimester of pregnancy.

To assess the influence of hypoxia on the state of mucociliary system in 50 patients with moderate asthma the values of gas-transport function of the peripheral blood and the structure of the bronchial tree epithelium which reflect the morphofunctional state of mucociliary system were studied. The results of the research showed that the patients with moderate asthma had a decreased level of рО₂ till 63.9±1.50 mm of mercury in the peripheral arterial blood and in the erythrocytes there was a high content of 2.3-BPG till 6.52±0.4 mcm/ml at the decrease of ATP till 0.48±0.02 mcm/ml. At the same time in the bronchial mucosa there is a suppression of succinate dehydrogenase and ATP activity in the cilia and mucosa cells. There is also an accumulation of histamine and peroxidation products in the mucosa cells. These changes in the mucosa lead to the oppression of activity of mucociliary system of airways.

Using the method of ultrasound scanning the contractile ability of the diaphragm in patients with chronic leukemia was studied. A morphological examination of the diaphragm in these patients was done after autopsy. It was found out that in patients with significant enlargement of the spleen and liver (chronic lymphocytic leukemia, chronic myelogenous leukemia, idiopathic myelofibrosis) the leading role in the disturbance of the functional capacity of the diaphragm belongs to the compression syndrome. Dystrophic changes in the diaphragm can also be caused by specific leukemic infiltration, leukostasis in small vessels with the violation of microcirculation at hyperleukocytosis, platelet aggregates in small vessels at myeloproliferative diseases in the case of hyperthrombocytosis. The damage of the diaphragm excursion at multiple myeloma is caused by its lymphoid and plasma cell infiltration, the presence of protein stasis in small vessels with the violation of microcirculation and reduced contractility of the diaphragm due to intensive osteodestruction process in the chest; uremic damage occurs as a result of renal failure. In patients with polycythemia vera the leading role in the dysfunction of the diaphragm belongs to the compression syndrome due to an enlarged spleen and liver and impaired microcirculation. The full restoration of the diaphragm excursion is only possible in patients with chronic myeloid leukemia after targeted therapy with tyrosine kinase inhibitors and achievement of complete clinical hematological, cytogenetic and major molecular responses. For other chronic leukemia it is possible to achieve improvement, but not a complete normalization of the functional capacity of the diaphragm.

A retrospective analysis of 118 medical cases of the patients with nosocomial pneumonia who were treated in special departments of a multi-specialty in-patient hospital was done to identify the features of the clinical picture and the course of the disease and to define the most frequent causative microbic agent which causes nosocomial pneumonia, its antibiotic resistance and specter of sensitivity to antibiotics. It was found out that nosocomial pneumonia in 47% developed in senior people (the average age was 55 years old) with severe concomitant pathology; the majority of patients (97%) had one or several risk factors of getting nosocomial infection. Delayed pneumonias (88%) with the typical course of the disease (33.4%) were dominated. Preceding antibiotic therapy as a risk factor of nosocomial pneumonia and causative agent polyresistance development was used in 55% of cases; cephalosporin antibiotics were used oftener (74%). The lethal outcome was in 33%; the cases of nonattributive lethality (31%) dominated. Non-diagnosed cases of nosocomial pneumonia were quite frequent. In 19.4% of cases it was revealed by the results of autopsy; probably because there was hidden and oligosymptomatic course of the disease. In 23.7% of cases pneumonia was roentgen-negative, it was diagnosed only by the clinical data. If there was roentgen-positive pneumonia, then unilateral pneumonia dominated (62%). At bacteriologic study of sputum and bronchial aspirate a polymicrobic character of nosocomial pneumonia was found in 75% of patients. The most frequent causative agent of pneumonia were Klebsiella pneumoniae (34.2%), Streptococcus pneumoniae (21.4%), Pseudomonas aeruginosa (15.0%). In 27.1% there was causative agents resistance to antibiotics.

The aim of the research is to present the comparative analysis of nasopharyngeal carrier state of principal bacterial pathogens among children of the risk group and to elucidate the dynamics of development of non-nosocomial pneumonia among population of Khabarovsk region from 2011 through 2014. 20586 people (including 10200 children) were vaccinated using anti-pneumococcal Prevenar-13 vaccine. The comparative analysis of nasopharyngeal microflora of risk group 220 children (frequently ill children and the children from organized collective), who were studied before (2013) and after the flood (2014), is presented. The children from organized collective (62-68 children) were examined 3 times: before vaccination, 8-10 months after vaccination and 1 year after vaccination. The analysis of community-acquired pneumonia morbidity from 2011 to 2014 was performed. As a result of the research, the tendency to have a high level of pathogens among frequently ill children who were affected by the flood was revealed. The children from organized collective had a higher rate of carrier state of pathogens. It was found out that the level of pathogens significantly decreased 8-10 months and one year after vaccination. A long carrier state (during 8-10 and 12 months) of pneumococcus was revealed in the same children from a number of people discharging bacteria (41%). The level of morbidity with community-acquired pneumonia among population affected by the flood decreased by 22% after vaccination.

The aim of the study is to characterize Candida species in Candida carriers among adults and frequently sick children. A bacteriological study of 556 pharyngeal smears taken from the same number of patients (adults and frequently sick children) was performed. The frequency of detection of Candida species, seeding rate of the smears, species of yeasts and sensitivity of isolated species to six antimycotic agents were studied. Candida species were found in 16.8% of the smears (95 of 566) and most frequently were observed in children of 7-14 years old (24.3%). Massive pharyngeal seeding by Candida was found in 26.3% of the smears (25 of 95) and it was most frequently detected in children of 1-3 years old (38%). Among detected Candida species Candida albicans was present in 83.3%, Candida glabrata in 10.5%, and Candida tropicalis in 6.3%. Low-level resistance (from 3.8% to 22.8%) to six tested antimycotic agents of Candida albicans was revealed. Drug resistance to fluconazole was 35.4% and to itraconazole 70.9%. This study aims to draw the attention of the physicians to the role of Candida species in pharyngeal pathology and to determine an individual treatment for every infected patient. Patients with massive seeding rate are warranted for thorough clinical examination to exclude the possibility of the development of candidiasis.

The present study analyzes the main indicators of morbidity and mortality from cancer of trachea, bronchi and lung obtained for fifteen years in climate-geochemical provinces of the Amur region with extreme continental climate, iodine deficiency and the difference in the environment of the content of certain minerals that are inhibitors or promoters of tumor growth in three landscape zones of the region: north (north-west), central and southern. Age and sex dependent features of morbidity and mortality in the study area were revealed in comparison with those in the western regions of Russia. The estimation of the quality of diagnosis in determining the extent of tumor process, that is to say establishing the stage of the disease was given. The activities of oncology service in the assessment of the accuracy of registration of patients with cancer of trachea, bronchi and lung and in the organization of quality health care to these patients by studying contingents accumulation index were analyzed. The results of the dynamics of morphological study of tumors of trachea, bronchi and lung were processed, the data of mortality in the first year after diagnosis were studied, and the sequence in the accumulation of patients who have been registered for more than 5 years was found.

The method of social and hygienic analysis was used to identify the features of ecology-related diseases (of the respiratory system, urogenital system, skin) prevalence in the period of 2007-2011. The study was done in the anticipation of APEC Summit 2012. It allowed to review a number of approaches to evaluate the health of key population groups (children, adolescents, adults) living in the settlements and areas with a variety of environmental and social characteristics. The aim of the study was to establish the patterns of ecology-related diseases prevalence in the new socio-economic conditions. The results showed regional characteristics of the prevalence of ecology related respiratory, skin and urogenital diseases of major groups. The analysis of the dynamics of respiratory diseases morbidity among adult population of the province helped to identify the growth in the incidence rates by 13-19% per year. In conditions of rural areas of continental climate respiratory diseases morbidity among the adult population is much lower (almost 2 times) than that of the urban population. The study of the dynamics of juvenile respiratory diseases showed a significant growth in 2009-2010 in all studied areas. The morbidity of child population is 10 times higher in Vladivostok and 5 times higher in the continental areas than the morbidity of adults. The low baseline morbidity of urogenital system is observed in children of environmentally friendly rural areas (the seaside Khasan and continental areas of Kirov) and in adolescents of the Kirov region. The high morbidity of skin diseases is revealed in the teen group of rural ecologically unfavorable Khorolsky continental area and in all children's groups on rural and urban territories. The genitourinary and the skin morbidity is more often caused by the influence of social factors in rural areas, whereas the morbidity of respiratory diseases depends on the habitat polymorphism. Under unfavorable climatic conditions of living in all age groups alongside with a significant rise in rates of ecology- related morbidity, there was also revealed a new trend toward better health in the region in modern conditions.

The article is devoted to the research of atmospheric suspensions of the Arctic settlements - Salekhard and Labytnangi by the method of laser granulometry. It is shown that the weighed particles of three main dimensional classes are contained in the lowest layer of atmospheric air in small cities and villages: they are less than 10, 10-50 and more than 700 microns. Most often there are particles less than 10 microns in size (from 17.6 to 55.7%) and they are potentially hazardous to the human health. The particles from 10 to 50 microns take the second place in the frequency of detection. Large particles (from 400 microns and above) are found less often.

The data obtained from the Far-Eastern Institution of Hydrometeorology and Environment Monitoring during 2009-2014 prove the insufficiency of solar insolation for prophylaxis of hypovitaminosis D in pregnant women. The aim of the study is to reveal the frequency and the peculiarities of D-deficit state in healthy pregnant women who live in the Amur region and to define the risk factors that contribute to its development. During the study of the contents of vitamin D in the blood serum in 60 women (the mean age is 25.55±0.63 years old) it was found out that its level on average was 27.75±1.18 ng/ml. The values 25(OH)D3 were low (<29 ng/ml) in 34 (56.6%) pregnant women (the first group); in 26 (43.3%) women (the second group) the values corresponded to the norm (30-100 ng/ml). The mean value of phosphorus, total calcium, alkaline phosphatase in the blood serum in pregnant women of the 1^st and 2^nd groups was within the norm; there were not significant differences between the groups. Among revealed risk factors of vitamin D insufficiency development in healthy pregnant women the most significant were the age of future mothers older than 25 years old (χ²=15.37; p<0.001); the prophylaxis of hypovitaminosis by insufficient doze of 25(OH)D3 or not taking of vitamin D (χ²=22.27; p<0.001); the presence of pathology of osteoarticular system (χ²=10.15; p<0.001), of gastrointestinal tract (χ²=8.37; p<0.01), of respiratory system (χ²=4.95; p<0.05); during pregnancy apparent toxicosis and threatened miscarriage in the 1^st and 3^rd trimesters of pregnancy (χ²=4.81; p<0.05); gestosis (χ²=3.97; p<0.05); acute respiratory infections with the high temperature of body and catarrhal symptoms (χ²=5.10; p<0.05); smoking during or before pregnancy (χ²=9.54; p<0.01); anxiety and insomnia (χ²=4.76; p<0.05); caries, enamel defect and absence of teeth (χ²=3.97; p<0.05); red dermographism (χ²=4.76; p<0.05). The ways to prevent and correct D-deficit condition in pregnant women and newborns were found out.

The lipid contents and the level of endotoxicosis at moderate cerebral ischemia in 125 full-term newborns from mothers with latent course and reactivation of chronic cytomegalovirus infection (CMVI) against chronic herpes-virus infection in the second trimester of pregnancy were studied. The first group consisted of 30 healthy newborns. The second group had 30 children of 38-40 weeks old with ischemia of cervical cord, whose mothers did not have antibodies of IgM to cytomegalia virus (CMV) and antibodies of IgG to CMV. The antibodies of IgG to the virus of simple herpes of the 1^st type were revealed serologically in these children. The third group had 32 patients with moderate cerebral ischemia from mothers with latent course of chronic CMVI. The forth group included 31 newborns with moderate cerebral ischemia, whose mothers had reactivation of chronic CMVI (antibody titer of IgM to CMV was 1:200-1:400 without four times growth of antibody titers of IgG to CMV 1:200-1:800). The sixth group consisted of 32 newborns whose mothers had reactivation of chronic CMV (antibodies titer of IgG to CMV was 1:200-1:400, antibodies titers of IgG to CMV 1:400-1:1600 under avidity index of IgG to CMV 56-70%). It was found out that in the serum of the umbilical blood in the children of the sixth group there was the drop of concentration of general cholesterol till 1.69±0.010 mmole/l, lipoproteins of high density till 0.83±0.05 mmole/l against the growth of lipoproteins of low density till 0.68±0.05 mmole/l and mean molecular peptides till 0.336±0.011 units of optical density and of seromucoid till 0.111±0.003 units of optical density in comparison with the first group, 1.99±0.010 mmole/l (р<0.05); 1.22±0.073 mmole/l (р<0.001); 0.67±0.050 mmole/l (р<0.05); 0.270±0.004 units of optical density (р<0.001); 0.086±0.001 units of optical density (р<0.001), respectively. We suggested a significant damage of lipid synthesizing function of the liver against the growth of endotoxemia at cerebral pathology in newborns at the growth of the immune response of their mothers to CMV during pregnancy.

The purpose of the study is to investigate the influence of exchange rate inhalation mixture based on propolis and royal jelly "Аpingalin" on the degree of endogenous intoxication in experimental pulmonary edema in rats. Blood, urine and histologic liver sections of 90 white male rats weighing 0.15 to 0.2 kg were studied. The animals were divided into groups: intact animals; control animals in which adrenal pulmonary edema was replicated; experience animals which first had pulmonary edema replicated and which then inhaled "Аpingalin" (10 days by 10 minutes). The intake of all types of biological material was carried out at the 11^th day after the beginning of the experiment. The degree of endogenous intoxication was assessed by the protein profile of the dried drop of blood serum. Kidneys functional activity was assessed by the concentration of middle molecules in plasma and urine of experimental animals. The effect of "Apingalin" on liver cells in pulmonary edema was studied by histological specimen and the quantity of total protein and fibrinogen in plasma. It was found out that at the adrenal experimental pulmonary edema in rats endogenous intoxication developed; it was revealed through the increase in the number of middle molecules on erythrocytes and in plasma, with its decrease in the urine, and in the change of the normal ratio between albumins and globulins in serum in comparison with intact animals; a morphological picture of the liver tissue was damaged (degeneration of hepatocytes). Course inhalation of the mixture based on propolis and royal jelly "Аpingalin" allowed to reduce the level of endogenous intoxication in alterative animals, which was shown through the decrease of overall toxicity of the blood (the decrease in the number of middle molecules on erythrocytes and in plasma, the normalization of the protein composition of serum), improvement of histology of the liver (the restoration of blood flow, expressed mitotic activity of the cells) and normalization of kidney function.

Morphofunctional state of lymphatic corpuscles of the spleen in the conditions of experimental hypercholesteremia was studied. 20 rabbits of Chinchilla breed participated in the experiment. During 14 days they took the distilled water emulsion of cholesterol in the dose of 0.25 g of cholesterol per 1 kg of an animal. There was fast growth of cholesterol contents in the spleen homogenate. At the third day of the experiment the cholesterol contents increased till 460.0±18.0 mg%, and by the 14^th day of the experiment it was till 1201.0±131.2 mg%. The frozen sections were studied upon the activity of acid phosphomonoesterase by Gomori’s method at pH 6.2. It was found out that excessive admission of cholesterol into the spleen led to the growth of T-lymphocytes number around the artery of the lymphatic corpuscle and there was a sharp response to acid phosphomonoesterase. The marginal zone of the corpuscle increased. It had an intensive response to acid phosphomonoesterase at pH6.2 both in lymphocytes and in the reticular stromа of the spleen. The increase of the activity of acid phosphomonoesterase at hypercholesteremia in the spleen suggests the latter participates actively in the utilization of cholesterol in the organism.

A very rare disease, family (domestic) asbestosis, is presented. An interesting feature of this disease is that none of the members of this family has ever worked at the factory of mining and manufacturing asbestos, but all of them for some time (from 6 till 12 years old) lived in the place where the factory was located. They were 29, 54 and 57 years old. The observation was done for 7 years (since 2009 till 2015). To evaluate the dynamics of the disease and to exclude one of the most serious complications, pleural mesothelioma, a multispiral computed tomography (MCT) was done once a year. The patients were examined in the advisory policlinics, sometimes in the in-patient clinic. All of them had minor clinical manifestations and according to roentgenograms obtained at the preliminary stages of the clinic observation the revealed changes were interpreted as pulmonary fibrosis. First time asbestosis with massive pleural mesothelioma was diagnosed in the members of this family in the advisory policlinic of Far-Eastern Scientific Center of Physiology and Pathology of Respiration. This proves that traditional roentgenology is inferior to modern tomography especially with multidetector system of registration and post processing imaging. The other typical feature of the observation is that this type of asbestosis can be considered to be domestic pneumoconiosis; it can be concluded that neither our patients nor any other people living in that village and having asbestosis were not informed about the harmful influence of this mineral on the body of a man beyond the place of its manufacturing. The same claims can be delegated to medical stuff and the directors of these factories who did not provide workers and villagers with necessary information. The use of the special software at MCT helped to identify some coarse wide-spread defects of pleura in the form of fibrosis and lamellar calcinosis and to evaluate qualitatively pathologic changes of pleura and register topographometrically the damage of its front, dorsal, lateral and diaphragm parts. There were not found any changes in bronchial-parenchymatous structures at MCT studies. The picture does not change at stable yearly clinical-roentgenologic examinations.

Hypersensitive pneumonitis can have different clinical course and outcome: the disease can be completely reversible or lead to irreversible damages of pulmonary structure, which depends on many factors: character of an exposition of an antigen, the nature of the inhaled dust and the immune answer of the patient. In this review the questions of pathogenesis, diagnostics, features of a clinical course of this disease and the basic principles of adequate therapy are considered.

The lecture outlines the basic mechanisms of antibacterial immunity which depend on the chemical nature of pathogen antigens, its intra- or extracellular localization and other properties. It provides a detailed description of complex factors of natural innate and adaptive immune systems, properties of their interaction with gram-positive and gram-negative bacteria. It also includes the principle of antitoxic immunity formation, different methods of exotoxin neutralizing. Attention is paid to immunopathological states of bacterial infections. The main methods of diagnosis of bacterial infection are summarized. The modern conception of antibacterial immunity formation on the basis of opposition to defense mechanisms of the host and mutating microbes will help to determine the right tactics in the diagnosis, treatment, and competent conduct of preventive vaccination.