To assess the influence of postload airway hyperresponsiveness on the quality of life of patients, 109 patients with mild and moderate uncontrolled and partially controlled asthma were examined and divided into two groups: with and without bronchial hyperresponsiveness to physical load. The quality of life was assessed with the help of questionnaires SF-36 and AQLQ, the state of the emotions was determined with the Hospital Scale of Anxiety and Depression. The level of asthma control was found by the questionnaire of ACT. The lung function was evaluated with the help of the spirometry. The airway response to dosed physical exercises done at the research device OxyconPro (VIASYS Healthcare, Germany) was assessed. As a result of the study it was found out that the patients with asthma and airway hyperresponsiveness to physical load have a lower level of the general and specific quality of life, a worse control over the disease and unfavorable psycho-emotional state which influences the assessment of general and specific quality of life.

The aim of the study was to investigate the effect of chronic obstructive pulmonary disease (COPD) associated with coronary heart disease (CHD) on the quality of life (QL) of patients and their motivation to treatment. QL was studied in 136 patients with COPD associated with CHD (the main group), 56 patients with COPD (1^st group) and 60 patients with CHD (2^nd group). The average age of the patients was 55.4±2.2 years old, COPD duration was 13.1±2.1 years, CHD duration was 7.2±3.4 years, smoking history was 22.1±2.5 pack/years. To assess the QL, there were used Russian versions of QL questionnaires: standard "Brief medical questionnaire" (Medical Outcome Study SF-36) and specialized "Respiratory Questionnaire of St. George’s Hospital" (SGRQ). The motivation for treatment in the main group was assessed by the standard test-questionnaire MSF (Motivation for success and motivation for the fear of failure). It was found out that the patients of the main group by the majority of scales of the questionnaire SF-36 had a significant reduction in variables reflecting both physical and social health. According to the specialized questionnaire SGRQ, the specific health in patients with COPD, combined with CHD, suffered to a greater extent, which was proved by higher values of the scale "Total" in the main group against the 1^st comparison group (by 20.9%; p<0.01) and 2^nd comparison group (by 31.1%; p<0.001). According to MSF questionnaire, the proportion of patients in the main group with a "failure, and closer to treatment failure" was 57.4%. Thus, it was found out that the association of COPD and CHD is a significant factor in determining the intensiveness of decline of QL of patients and their motivation for successful treatment.

The aim of the study was to examine the influence of telmisartan on the condition of the diaphragm in patients with chronic obstructive pulmonary disease (COPD) at the stage of compensated chronic pulmonary heart (CPH). We examined 30 patients with COPD, complicated with CPH, who had the examination of pulmonary and intracardiac hemodynamics and the functional state of the diaphragm by means of ultrasound scanning. It was found that that the inclusion of telmisartan in the complex therapy of COPD patients with compensated CPH contributes to the normalization of systolic pressure in the pulmonary artery, the functional ability of the right ventricle, and values of the respiratory function. The application of telmisartan in a daily dose of 4 mg during 4 weeks while treating the patients with COPD complicated with compensated CPH leads to the improvement of the functional state of diaphragm, normalization of diaphragm excursion under forced respiration and contractility of diaphragm muscle, which gives an opportunity to increase the efficiency of treatment of these patients.

Modern medical diagnostic methods must demonstrate the results of patients’ examination to the full extent. Among all available medical research methods most extensive amount of image data can be obtained by X-ray thin-layer computer tomography (CT). Thin-layer CT is a type of X-ray examination, during which the recording is done layer by layer at different depths with a predetermined interval between the layers. The result is a set of two-dimensional shadow flat images of the longitudinal cross section of a human body. Currently in clinical practice, this method is used widely, however, in certain medical practice only flat longitudinal sections of the image of the human body are analyzed; a three-dimensional reconstruction is rarely used. But this three-dimensional interpretation of the results has a clear advantage, and primarily increases the accuracy and speed of diagnosis. Standard methods for three-dimensional reconstruction, built into the software that comes with the equipment for tomography, have a limited capacity. The aim of this study is to search for possible broadening of opportunities of volumetric interpretation of the results with other available imaging software. The article suggests an algorithm of image processing received with the thin layer CT which includes the following steps: setting the contrast, binarization, filtering, inversion, imaging, correction and calculation. The proposed algorithm can improve the information content of the method of thin layer X-ray CT through the construction of axonometric (three-dimensional) images of outer contours of the human bronchial tree similar to real life-size anatomical parameters without intervention, that is to say, noninvasively.

The aim of the research is to study the character and degree of intensiveness of changes in the motion activity of ciliated epithelium (CE) cilia of the bronchial mucosa at immediate effect of hyposmotic stimulus (distilled water) on bronchial biopsy material in the experiment in vitro . 39 patients with bronchial asthma including 14 men and 25 women were examined; all had bronchial fiberoptic scope examination with biopsy of middle lobe bronchus mucosa. For intravital analysis of functional activity of CE cilia the biopsy material was put into the chamber with Hank’s solution at indoor temperature (+25°С). The registration of the motion activity of CE cilia was done with the help of the microsope, the camera with in-built highly sensitive digital full-frame matrix of high definition and a computer. The recording of CE cilia beating was done immediately after the biopsy material was put on the object-plate in the Hank’s solution. Modeling of hypoosmotic stress was carried out by adding 0.01 ml of distilled water into 0.01 ml of Hank’s solution with the help of the dispenser; after that there was an immediate recording of cilia beating and it was repeated in the control moments of the experiment in 1, 2, 3 and 4 minutes. It was found out that the beat frequency of CE cilia fluctuated within the range from 12.2 till 2.7 Hz and was on average 8.73±1.27 Hz. When the distilled water was added into Hank’s solution, there was the decrease of cilia beating frequency till 6.51±1.71 Hz (р<0.001). After the 1^st minute of the experiment the frequency of beating decreased till 5.94±1.57 Hz (by 9%) in comparison with the initial values of the stress reaction. During the 2^nd, 3^rd and 4^th minutes of observation there was a steady tendency of cilia beating frequency decrease (by 13, 15 and 17%, respectively). By the fourth minute of observation the beating frequency was 5.33±1.29 Hz and was statistically different (р=0.035) from the initial value of stress reaction. Thus the results of the research show intensive changes in the motion activity of cilia at the influence of hyposmotic stimulus on bronchial biopsy material in the experiment in vitro . Obtained data allowed to develop the mathematical model which characterizes the behavior of cilia under osmotic stress.

The objective of the study was to explore the current epidemiology of tuberculosis in the Republic of Crimea following the analysis of the incidence, prevalence and mortality dynamics for the period 2004-2015. The official statistics was presented by the "Crimean Republican Clinical Center of Phthisiology and Pulmonology". During the study period, a persistent decrease in the incidence of all forms of tuberculosis was found on average by 13.1% was revealed, while the incidence of pulmonary tuberculosis decrease was affected to a lesser extent (6.2%). The process of the tuberculosis incidence reduction in the Crimea was slower compared with the all-Russian trend: in 2015 the tuberculosis incidence in the Republic of Crimea was 1.3 times higher than in Russia. There has been a positive tendency of tuberculosis prevalence decline by an average of 1.6 times in Crimea (216.9 cases per 100,000 population in 2004 and 135.1 cases per 100,000 population in 2015). The positive dynamics of the tuberculosis incidence and prevalence in the region is due, inter alia, to the anti-tuberculosis service funding increase in the Republic of Crimea, improvement of the material and technical base and provision with drugs and diagnostic tests. During the study period there was an increase in the proportion of patients who died before the first year of observation (200% growth rate) despite the trend of the mortality decline from all forms of tuberculosis in the Republic of Crimea. This fact can be related to the late detection of the pathology studied. The trend of the incidence, prevalence and mortality decrease by all tuberculosis forms among the population in Crimea for the period 2004-2015 reflects not only the outcome of the financing and drug supply improvement, but also demonstrates the effective organization of tuberculosis services in the region.

Over the past decades, the country has not improved the basic indicators of medical care for cancer patients. This determines the relevance of the problem and the appropriateness of a multifaceted approach to its solution, with a comprehensive analysis of a number of information bases including data on the territorial and temporal features of cancer pathology, which are the basis for the study of the epidemiology of malignant neoplasms of the oral cavity in a particular area. The aim of this research was the development of scientifically substantiated measures to assess the level of territorial dependence of the main morbidity and mortality rates for cancer of various parts of the oral cavity in a separate region of the Russian Federation. In the process of work, morbidity and mortality indicators reporting forms of statistical recording of cancer patients and regulating documents of higher organizations were used. The data of twenty-year observations on the dynamics of changes in the numerical values of the parameters of the pathology studied were processed. The main indicators of rendering medical aid to the population with oncological diseases of the oral cavity in the Amur region are given. It was revealed that the maximum number of cases falls on older age groups. In dynamics, changes in the number of patients with initial manifestations of the disease are traced, with their increase in advanced stages of the disease. The activity of identifying patients with a significant increase in mortality in the first year from the time of diagnosis significantly decreased. Alongside with a number of positive things in the work of the oncological service, there was a significant decrease in the death rate for all localizations of malignant tumors of the oral cavity. The quality of the activity of the service on the index of accumulation of groups in this category of patients, which is traditionally comparable with other regions of the country, is indicated. The results of the study are recommended by the authors for use in the practical activities of the cancer service of the Amur Region in the development of priority areas for targeted medico-social and economic programs. Thus, despite the great work of the healthcare authorities of the Amur Region, aimed at reducing morbidity and mortality from malignant neoplasms, their level remains high with the trend of an annual increase in statistical indicators.

The aim of the study was to analyze the relationship between early miscarriage and specific immune response parameters in CMV-seropositive pregnant women. Retrospective analysis included 150 women in the first trimester of pregnancy, 100 of them were CMV-seropositive (main group) and 50 were CMV-seronegative (control group). At the first stage of the study, all pregnant women from the main group were divided into two subgroups: with exacerbation of cytomegalovirus (CMV) infection and with the latent course of the disease. At the second stage, all women of the main group were divided into subgroups, depending on the outcome of pregnancy: an incipient abortion with pregnancy termination at the gestational age out of 12 weeks and with prolonged pregnancy. The assessment of CMV infection activity markers in biological material (blood, cervical canal lining, buccal epithelium scraping, villous chorion) was performed by seroimmunological methods and PCR analysis. The direct dependence of the frequency of miscarriage and the nature of clinical manifestations on a specific immune response was established in the course of a study of CMV-seropositive women in the first trimester of pregnancy. Markers of highly active infection were detected in CMV-seropositive women, whose pregnancy ended in spontaneous abortion for up to 12 weeks of pregnancy. At a lower level of activity of specific immune response parameters, the threatened abortion with prolongation of pregnancy was diagnosed in 60% of cases; with the latent course of the disease, the risk of pregnancy complications was minimal (in 18%) and statistically did not differ from the control group (in 15%). The obtained data made it possible to develop an algorithm for assigning CMV-seropositive women to risk groups for developing a threatened miscarriage in early pregnancy.

The aim of study was to establish the dependence of the threatened early miscarriage on the level of placental growth factor (PlGF) in the blood of pregnant women with different activity of cytomegalovirus (CMV) infection. There was conducted a prospective study by case-control type of 100 women at 9-11 weeks of gestation, among whom 83 were CMV-seropositive and 17 were CMV-seronegative. Further categorization into subgroups was performed taking into account the markers of CMV replication activity and the nature of pregnancy complications. Markers of highly active CMV infection and a significant decrease of PlGF in the blood (p<0.001) of CMV-seropositive women whose pregnancy ended with spontaneous abortion at 10-11 weeks of gestation were revealed in 15.7% of cases. In 53% of cases, pregnancy was complicated by the threatened miscarriage, but with subsequent prolongation. In this subgroup with less expressed activity of CMV, PlGF values were higher (p<0.01). In 31.3% of cases, the latent course of the disease was diagnosed, where the level of the enzyme did not significantly differ from those in the control group, which correlated with the minimal risk of development of the threatened miscarriage. Morphological study of the villous chorion from CMV-seropositive women with spontaneous miscarriage revealed cytomegalic cells in the trophoblast, multiple avascular and necrotic villi. The obtained data shows the CMV dependent inhibition of secretion of the PlGF by trophoblast cells, which is determined by the level of viral activity and leads to the violation of placental morphology and reduction of placental blood flow, intrauterine growth restriction and at the high viral load - to fetal death induced by it.

The dynamics of docosahexaenoic acid in 96 pregnant women in I, II and III trimesters of gestation during the reactivation of chronic cytomegalovirus infection (CMVI) was studied by gas-liquid chromatography. The comparison group consisted of women with physiological pregnancy, comparable in age and stage of gestation with the main group. The material for research was peripheral blood (plasma and erythrocyte membrane) which was taken from the ulnar vein in the morning on an empty stomach. Heparin was used as an anticoagulant. The study found that with the reactivation of chronic CMVI (IgG antibody titer to CMV 1:1600), the content of docosahexaenoic acid in plasma of peripheral blood of pregnant women decreased in the first trimester by 31% (p<0.001), in the II trimester by 25% (p<0.001), and by 38% (p<0.001) by the end of the gestation period, in comparison with the control group. In the erythrocyte membrane, the content of this acid decreased by 29% in the first trimester (p<0.001), by 16% in the second trimester (p<0.001), and by 29% (p<0.001) in the III trimester, in comparison with the control group. The revealed dynamics of changes in the concentration of docosahexaenoic acid in pregnant women with CMVI will contribute to insufficient transfer of this acid from the mother's blood to the fetal blood through the placenta. Therefore, our studies show that the optimal balance in the blood and a sufficient dietary intake of docosahexaenoic acid is necessary for the normal maturation and functioning of a healthy body. Products containing docosahexaenoic acid should take a special place in the diet of pregnant women, as it affects the formation of the fetus. However, given that the food sources of the acids of the ω-3 family are rather limited and the ratio ω-6/ω-3 in the diet of a modern person is far from optimal, we recommend that women with reactivation of CMVI during gestation should have biologically active dietary supplements that enrich the diet with polyunsaturated fatty acids.

Organometric parameters of the thymus gland in 156 full-term newborns were studied. The patients under examination were divided into 5 groups. The first group (control) included 30 newborns from mothers with physiological course of pregnancy. The second group (comparison) had 30 newborns from mothers with latent cytomegalovirus infection (CMVI) diagnosed in the first trimester of gestation. The third group (main) consisted of 33 children whose mothers suffered reactivation of chronic CMVI (IgM antibodies to CMVI were 1:200 and 1:400 without 4 times growth of IgG antibody titers to CMV 1:200-1:400). In the fourth group there were 32 newborns from mothers with reactivation of chronic CMVI (IgM antibodies to CMVI were 1:200 and 1:400 with 4 times growth of IgG antibody titers to CMV 1:200-1:800). The fifth group included 31 babies from mothers who suffered reactivation of chronic CMVI (IgM antibodies to CMVI were 1:200 and 1:400, there was 4 times growth of IgG antibody titers to CMV 1:200-1:400) in the first trimester of gestation. While comparing the values of length, breadth, front-back size, mass, the volume of thymus and the ratio of organ mass to the body mass of the newborn in the first, second, third and fourth groups there were not found any differences in the above-mentioned values. In the fifth group in comparison with the first one there was a decrease in the length of thymus (3.7±0.12 and 4.1±0.08 cm, respectively, р<0.01), the mass of the organ (8.6±0.43 and 10.0±0.35 g, respectively, р<0.05) and its volume (6.2±0.31 and 7.2±0.24 cm³, respectively, р<0.01). Thus full-term newborns who developed against the reactivation of chronic CMVI with high titers of anti-virus antibodies of IgG to CMV in their mothers at early stages of gestation had the suppression of the growth of the thymus gland caused by the disturbance of its organogenesis regulation mechanisms.

The purpose of the study was to reveal the mechanisms of development of placental insufficiency in pregnant women with menstrual dysfunction in puberty. 120 women with menstrual dysfunction in puberty (the study group) and 40 with the correct timing of menstruation (the control group) were examined. Placental hormones (estriol, progesterone), angiogenic growth factors (PLGF, VEGF-R1) were studied. The ultrasound investigation was performed in the 11-14^th, 18-21^st, 30-34^th and 36-40^th weeks; Doppler study of blood flow in the uterine arteries, the artery in the umbilical cord and in the middle cerebral artery of the fetus was carried out. It was found out that when the ability of endometrial implantation in pregnant women of studied group decreases, the expression of PLGF also gets lower in comparison with the control group (46.42 pg/ml vs. 81.44 pg/ml; p<0.05), villous vascular angiogenesis breaks, the concentration of estriol and progesterone decreases, premature ripening of the placenta and blood flow disturbance occur in the system of mother-placenta-fetus, and chronic placental insufficiency develops.

The aim of the study was to assess the efficiency of corneotherapy with Far Eastern phytomineral medicinal products in the rehabilitation of children with atopic dermatitis. 96 patients at the age of 10-16 years old with atopic dermatitis in remission were observed during the year. In the remission period 75 children (the basic group) had the baths with torphopeloid extract and emollient with bentonits and silicon water of the “Kuldur” mineral spring. In 21 patients (the comparison group) indifferent ointments were used. Corneometry, sebumetry, transepidermal water loss, microhemocirculation and microbiom of skin were investigated. As a result of the study it was found out that a series of actions had a favorable effect on the patients of the main group. Not a single case of atopic dermatitis severe exacerbation was registered during a year. The first relapses in a mitigate form were noted in 9-10 months in 33.8% of patients. The positive dynamics of the values under research preserved. In the comparison group recurrences were noted in 80.9% patients in 4-5 months and 4 patients were hospitalized. The studied values didn’t change or had a negative tendency. Thus, corneotherapy with Far Eastern phytomineral medicinal products is effective in rehabilitation of patients with atopic dermatitis and hampers inflammatory remodeling of the skin.

A brief review of the literature devoted to the rare eosin-filed granulomatous necrotizing vasculitis Churg-Strauss syndrome is given. Two clinical cases of this disease are presented from the personal practice of the authors. The complexity of diagnostics was emphasized; it contributed to the fact that the disease lasted for a long time under the guise of other nosologies which later turned out to be syndromes of vasculitis Churg-Strauss. When pulmonary infiltrates occur in patients with asthma with allergic rhinitis or rhinosinusopathy in combination with high eosinophilia of peripheral blood and neurologic symptoms, it is necessary to suspect the Churg-Strauss syndrome and conduct appropriate diagnostic measures.

Idiopathic pulmonary hypertension is a rare disease of unknown etiology characterized by a marked increase in pulmonary vascular resistance and pulmonary artery pressure, with often progressive course and rapid development of the right ventricle decompensation and fatal prognosis. Retrospective analysis of case histories of 4 patients with idiopathic pulmonary hypertension was conducted in the period from 2011 to 2016 in the Amur Regional Clinical Hospital. Despite the rarity of this disease, it is necessary to remain aware of idiopathic pulmonary hypertension in the event of dyspnea of unclear etiology and prescribe echocardiography with measurement the pressure in the pulmonary artery at rest and under physical load.

The aim of this paper is to analyze the reasons for the high prevalence of chronic bronchopulmonary diseases (asthma and chronic obstructive pulmonary disease) in the world. The article observes the difficulties that appear in the process of comparing of the results of epidemiological data obtained in different countries. The role of environmental, climatic- geographic and socio-economical aspects of the region of residence of patients with chronic respiratory diseases is studied. The dynamics and reasons for increasing of morbidity, disability and mortality from these diseases in different areas of residence are assessed. The prospects of reducing these indicators for the society are considered. The necessity of developing programs for reducing the negative impact of the environmental factors on the human health and improved quality of life is shown.

Current data on progesterone metabolism in placenta are presented in the article. Enzymes involved in the conversion of gestogens: aldo-keto reductases (AKR1D1, AKR1C1, AKR1C2, AKR1C3, SRD5A1, SRD5A2), 3β- and 17β-hydroxysteroid dehydrogenases were studied. Existing opinions on their essential role in the maintenance of pregnancy were presented. The main metabolites of progesterone in placenta, namely 20α-dihydroprogesterone and 5α-dihydroprogesterone were presented. In addition, special attention was paid to other two metabolites actively studied at present: 5β-dihydroprogesterone and allopregnenolone. Their central role was emphasized: 5β-dihydroprogesterone maintains myometrium tonus at quiescent interval, and allopregnenolon is a key neuroactive steroid during the fetal life. It was concluded that further research is needed to study progesterone metabolism in placenta.

The results of our own researches conducted in the out-patient advisory clinic of FEC PPR are presented in this work. Standard multispiral computed tomography (MSCT) research included topographic marking in frontal and sagittal projections, native (without intravenous contrast) study of the chest in soft-tissue and pulmonary regimes. The obtained data was compared with the results of traditional roentgenography, linear tomography and pathomorphological findings. Maximal and adequate use of image postprocessing allowed for the first time without intravenous contrast strengthening to obtain distinct and convenient for practical work roentgeno-morphologic structural images (arteries, veins and bronchial tree) of lungs roots. 3-dimentional reconstruction also gives an opportunity to rotate 3D-image behind the screen of the monitor in all flats, study the composition and topography of structural elements of lungs roots in detail. Developed technologies of X-ray diagnostics, their successful application during our own practice for many years let us recommend these developments to practical healthcare and especially, which is very important, to out-patient advisory clinics. This short atlas can be useful not only for X-ray diagnosis specialists, but to many other specialists: pulmonologists, general practitioners, thoracic surgeons and even to anatomists and forensic pathologists.