Aim. The analysis of epidemiological monitoring of respiratory tuberculosis in the Russian Federation, the Far Eastern Federal District and the Amur Region is carried out, which makes it possible to assess the levels and regional features of the spread of pathology among the population and territorial entities, the dynamics of morbidity and the effectiveness of preventive measures. Materials and methods. For the organization of the study, the methods of structural and comparative analysis, statistical and information-analytical methods, databases of the Ministry of Health of the Russian Federation and the Federal State Statistics Service of the Russian Federation (Rosstat) were used. Results. The analysis shows that tuberculosis is an important medico-social problem due to the high level of prevalence and adverse outcomes of its clinical course, representing a serious threat to human health and plays a large role in the formation of high social burden. At the same time, in recent years, in the territory of the Russian Federation as a whole and the Amur Region in particular, significant success has been achieved in the area of improving the efficiency and effectiveness of medical care for tuberculosis patients. Since 2010, primary incidence rates and the number of tuberculosis patients have decreased by 37 and 38%, respectively, and in the Amur Region – by 2.4 and 2.0 times. The share of destructive forms of pulmonary tuberculosis among newly diagnosed patients has decreased by 9.7% since 2005, and the microbiological coverage of patients with pulmonary tuberculosis in the region is almost 100%, while the level of bacterial excretion among newly diagnosed pulmonary tuberculosis in the Amur Region is the lowest among the subjects of the Far Eastern Federal District (16.1 per 100 000 population). The coverage of the population with routine inspections using fluorography methods in the Amur Region is the highest among the subjects of the Far Eastern Federal District and amounted to 94.0% in 2017. The effectiveness of treatment of patients with respiratory tuberculosis is significantly increased. As a result, the mortality rate of the population due to tuberculosis has decreased 3.9 times since 2005. At the same time, the Amur Region is included in the list of 8 subjects of the Russian Federation, where a high incidence of tuberculosis is combined with a high level of organization in the detection and treatment of the disease.

Introduction. According to the literature, involvement in the granulomatous inflammatory process of the pleura in thoracic sarcoidosis is an unusual occurrence. The range of occurrence is from 0.08 to 10%, the median is 3%. Most often (70%) pleural sarcoidosis manifests itself as a pleural effusion. For comparison, in the publications of pathologists, pleural involvement in sarcoidosis is observed much more often – in 35% of cases. Computed tomography and, above all, multispiral computed tomography (MSCT), with a wide range of tomographic image post-processing, offers great opportunities for improving the diagnosis of sarcoidosis. Aim. The desire to acquaint with new, diverse, not known to a wide range of radiologists and pulmonologists, a set of symptoms of pleural lesions in sarcoidosis, based on 3D-reformation of tomographic images. Materials and methods.A retrospective study analysis was carried out according to a special protocol to identify pleural pathology in 140 initially verified patients with thoracic sarcoidosis. As a tool for scientific research, the DICOM archive of the Far Eastern Scientific Center of Physiology and Pathology of Respiration from 2013 to 2020 was used, containing the results of MSCT examinations of 490 patients with sarcoidosis (85% morphologically verified), which a total of 1148 studies were performed in dynamics. Results. Pleural changes were detected in 48 of 140 (34.3%) retrospectively analyzed patients. Focal and plaque granulomatous changes in the pleura are predominantly registered. Pleural effusion was found in only two patients. It has been established that the main morphological elements, as is commonly believed (WASOG, Federal Clinical Guidelines for the Diagnosis and Treatment of Sarcoidosis), are not lymphadenopathy without pulmonary pleural changes (50% at stage I), but a combination of enlarged bronchopulmonary lymph nodes, granulomatous changes in the lung parenchyma and pleura (79% in stage II). According to our data, an increase in intrathoracic lymph nodes without pulmonary lesions (stage I) and granulomatous changes without an increase in intrathoracic lymph nodes (stage III) are a rather rare condition (6 and 7%, respectively), which is confirmed by the results of X-ray morphological studies with the maximum use of post-processing. Conclusion. The results of the completed assessment of the prevalence of the combined pulmonary-pleural form of sarcoidosis are more than 10 times (34.3%) higher than the data presented in the scientific literature, and to a greater extent correspond to the results of published pathological studies (35%). A significant correction of the staging of sarcoidosis, reflecting the dominance of the X-ray morphological basic structural elements characterizing thoracic sarcoidosis, was carried out.

Introduction. TRPA1 channels have been repeatedly studied in experimental models of inflammation. There are evidences in the modern literature confirming the expression of TRPA1 receptors on the alveolar epithelial cells. One of the known natural agonists of these channels is cinnamaldehyde (CA). Aim. To evaluate the effect of TRPA1 receptors on the development of an inflammatory response in A549 alveolar epithelial cells, as an in vitro model of inflammation in the respiratory tract. Materials and methods. The supernatant of A549 human adenocarcinoma cell culture was collected after exposure to various doses of CA and the levels of 13 cytokines were determined in the samples. Results. It has been found that A549 cells produce such cytokines as MCP1, IL6, IL8 and IL33. It was established that, when exposed to CA at low concentrations, the production of MCP-1, IL6 and IL8 increased, but high concentrations of CA conversely decreased production of the cytokines. Under preliminary exposition with TRPA1 selective antagonist (HC-030031) subsequent stimulation with 100 μM CA did not elicit increase in cytokines concentration. Conclusion. Thus, we demonstrated the peculiarities of TRPA1-mediated inflammatory response in in vitro model of A549 alveolar epithelium.

Aim. To evaluate the strength of the respiratory muscles (RM) in young people with community-acquired pneumonia (CAP) of varying severity and the completeness of its recovery during convalescence. Materials and methods. The study involved 104 men aged 18-23 years who were in hospital with a diagnosis of CAP. Non-severe CAP was diagnosed in 78 (75%) patients and severe CAP in 26 (25%). The strength indices of expiratory and inspiratory RM were recorded on a MicrоRPM device (CareFusion, Great Britain) at the height of the disease and during the period of convalescence. Anthropometric indicators were measured, the mass of skeletal muscles (MSM) was calculated according to the formula of J.Mateika, the ratio of MSM to total body mass (TBM), expressed as a percentage, is determined. The degree of fatigue of RM was studied by means of loading tests on incentive spirometer with adjustable expiratory and inspiratory resistance TheraPEP and Coach 2 (Smiths Medical, Great Britain). The fatigue index (FI) of expiratory and inspiratory RM was calculated as the ratio of the difference in the strength of the RM before and after the load to the initial value, expressed as a percentage. Results. At the height of the disease, the average values of the power characteristics of RM in patients with severe CAP compared to non-severe CAP shifted toward lower values. Moreover, the severity of the dysfunction of expiratory RM was more noticeable in comparison with inspiratory ones. The direct dependence of RM strength indicators on MSM was established. In convalescents, with an increase in MSM, a decrease in the FI was recorded, which demonstrated a greater resistance of RM to resistive breathing in this category of patients. Conclusion. The functional status of RM depends on the severity of CAP, but also on MSM, which indicates the important role of the muscle component in providing pulmonary ventilation. The use of adjustable expiratory and inspiratory resistance tests is a useful tool for assessing the completeness of the strength recovery of the RM after having CAP.

Introduction. The airway constriction due to bronchospasm can lead to more pronounced disturbances of regional ventilation and limit gas exchange in patients with bronchial asthma. Aim. To study the features of the mechanics of respiration and gas exchange in asthma patients with different types of reaction to cold and hypoosmolar stimuli. Materials and methods. The design involved a comprehensive four-day examination of 367 patients with persistent asthma with an analysis of the baseline spirometric parameters and their dynamics for the administration of a β₂ -agonist, after bronchoprovocation testing – isocapnic hyperventilation with cold air (-20ºC) (IHCA), inhalation of ultrasonically nebulized distilled water (IDW). Lung was assessed using bodyplethysmography, capnovolumetry, measurements of the diffusion capacity of the lungs. Results. A comparative analysis was carried out after the distribution of patients into groups according to the types of response to the IHCA and IDW samples. Group 1 included patients with airway hyperresponsiveness to both stimuli (cold and osmotic); group 2 – patients with cold airway hyperresponsiveness, group 3 – patients with osmotic airway hyperresponsiveness, group 4 – patients who did not respond to both stimuli. The patients of group 1 controlled asthma symptoms to a lesser extent, smoked more often, had lower baseline values of bronchial patency indices and a high increase in FEV1 per inhalation of a short-acting β₂ -agonist; in 71% of patients, increased bronchial resistance was registered, which in one third was combined with high residual volume. In these patients, a close relationship was found between the capnovolumetry indicator (dMM/dV₃ ) and the diffusion capacity of the lungs (TL_CO) (Rs=0.42; p˂0.05), as well as with FEV₁ (Rs=-0.23; p˂0.05) and MOC_25-75 (Rs=-0.24; p˂0.05). Conclusion. Asthma patients with combined airway hyperresponsiveness to cold and osmotic stimuli are characterized by more significant disturbances in the mechanics of respiration and gas exchange, affecting both the peripheral and central parts of the respiratory tract.

Aim. A priority method of long-term local anesthesia of the superior laryngeal nerve in the treatment of bronchial asthma is proposed. Materials and methods. For long-term relief of bronchospasm in patients with asthma, blockade of the superior laryngeal nerve was performed with a 0.5% solution of novocaine mixed with ethyl rectified 96º alcohol. This method has been tested in the clinic in 8 patients (experimental group). The control group consisted of 7 patients who received only 0.5% novocaine solution in the region of the superior laryngeal nerve. All 15 patients were diagnosed with bronchial asthma of infectious-allergic genesis of moderate severity. Results. After the traditional novocaine blockade in all patients in the control group, the clinical and spirographic indicators of the course of asthma improved, but this improvement was short-term (up to 15 days). After long-term local anesthesia in the patients of the main group, the episodes of bronchospasm disappeared in all patients, and the indicators of the lung function after 15 days of examination were significantly higher than the baseline and in patients in the control group. All patients in the main group were examined after 4 months: in 2 patients, asthma attacks occurred once a day, in the rest of the patients no asthma attacks were noted, the spirographic parameters were significantly higher than before treatment. Conclusion. The effectiveness of the developed method of long-term local anesthesia (prolonged blockade) of the superior laryngeal nerve with 0.5% novocaine solution mixed with ethyl rectified 96º alcohol, confirmed by clinical and spirographic methods, has been demonstrated.

Aim. To study the change in the systemic inflammatory response in women in the third trimester of pregnancy complicated by exacerbation of cytomegalovirus infection (CMVI). Materials and methods. The study involved 120 women with a physiological course of gestation and with a pregnancy complicated by CMVI. The first group was represented by 30 seronegative women at 31-34 weeks of gestation, the second – by 30 pregnant women with a latent course of CMVI and placental insufficiency, the third – 30 women with exacerbation of CMVI and placental insufficiency; and the fourth – 30 patients with exacerbation of CMVI, initiating the development of placental insufficiency and threatened miscarriage. Results. In the blood serum of women in the first group, the TNF-α content was 14.7 (12.1-32.0) pg/mL, IFN-γ – 128.7 (117.0-172.5) pg/mL, IL-1β – 20.3 (13.8-35.3) pg/mL, IL-6 – 2,57 (2,10-2,73) pg/mL, IL-4 – 37,8 (30,0- 55,4) pg/mL and IL-2 – 34,3 (29,4-41,3) pg/mL. The patients of the second group, in comparison with the first one, were diagnosed with an increase in the median TNF-α to 29.5 (14.4-43.1) pg/mL (p=0.0168) and IL-2 – 40.7 (33.2-47.9) pg/mL (p=0.0169) against the background of the absence of significant differences in the concentration of IFN-γ, IL-1β, IL-6 and IL-4. In the third group, compared with the second one, the concentration of TNF-α increased by 2.74 times (p=0.000001), IFN-γ – by 1.69 times (p=0.000001), IL-1β – by 3.16 times (p=0.000001), IL-6 – 2.17 times (p=0.000001), IL-2 – 2.2 times (p=0.000001) and there were no differences in the concentration of IL-4 (p=0.994). In the fourth group, compared with the third one, an increase in TNF-α level was diagnosed by 1.03 times (p=0.028), IFN-γ – by 1.18 times (p=0.017), IL-1β – by 1.64 times (p=0.000001), IL-6 – by 1.49 times (p=0.0035), IL-2 – by 1.32 times (p=0.000001) against the background of a drop in IL-4 level by 1.52 times (p=0.00031). Conclusion. Increase in serum concentration of pro-inflammatory cytokines (TNF-α, IFN-γ, IL-1β, IL-6 and IL-2) against the background of a decrease in the level of anti-inflammatory cytokine (IL-4) in women with exacerbation of CMVI in the third trimester of gestation, complicated by placental insufficiency, plays an important role in the pathogenesis of threatened preterm labor.

Aim. To give an immunomorphological assessment of the systemic inflammatory response in newborns with congenital cytomegalovirus infection. Materials and methods. A study of the concentration of TNF-α in serum of umbilical cord blood, as well as the structure of blood vessels of the pulmonary circulation and loose fibrous connective tissue of the lungs in 41 dead full-term newborns with various antenatal anamneses was carried out. The first group consisted of 25 children from mothers who during pregnancy did not have herpesvirus, cytomegalovirus and acute respiratory viral infections, moderate and severe somatic and obstetric pathology. The death of newborns occurred on 2-5 days of life in the setting of birth trauma, intranatal, postnatal hypoxia, atelectasis and hyaline membranes of the lungs. The second group was represented by 16 newborns diagnosed with congenital cytomegalovirus infection. The reason for their death on days 2-5 of life was cerebral ischemia of moderate and severe degrees, hypertensive-hydrocephalic and convulsive syndromes, pseudocysts of the vascular plexus, subependymal and subarachnoid hemorrhages, monocytosis, vesiculosis, pneumonia, hepatitis and meningoencephalitis. Antenatal viral invasion was observed against the background of prolonged intrauterine hypoxia and chronic subcompensated and decompensated placental insufficiency. Results. In newborns of the second group, the concentration of TNF-α in the umbilical cord blood increased to 47.3±2.25 pg/mL (in the first group – 26.4±2.23 pg/mL, p<0.001). In contrast to the first group, aggregates and hemolysis of erythrocytes, microthrombi, leukocytes, edema of endothelial cells, hyperchromia of their nucleus, as well as desquamation of endotheliocytes into the lumen of blood vessels, were frequent morphological findings in the small-caliber pulmonary arteries in full-term newborns of the second group. In the setting of thickening of the intima of these vessels, dystrophic changes in smooth muscle cells were revealed, and in the adventitia, the tortuosity of collagen fibers. In the perivascular loose fibrous connective tissue, edema, dissociation of collagen fibers and areas of their excessive development, single hemorrhages and accumulations of monocytic-lymphocytic cellular elements were recorded. In the lungs, aspiration and edematous-hemorrhagic pneumopathies, as well as pneumonia, were more common. Conclusion. In case of systemic inflammatory response in newborns with congenital cytomegalovirus infection, markers of endothelial pathology and structural and functional rearrangement of connective tissue are more common in small branches of the pulmonary artery, which increase the predisposition of children to pulmonary hypertension in the postnatal period of their development..

Aim. The influence of controlled breathing on the human body from the energetic point of view is considered. Materials and methods. To describe some properties of a bioorganism, the laws of behavior of a gas discharge as a thermodynamically similar system are used. From the gas-discharge analogy, the stability of biological tissues from degeneration is associated with the intensity of energy transfer in the body, which affects the formation of gradients of a critical value. The transition to a reduced energy exchange through controlled oxygen starvation presupposes activation of the processes of regeneration of biostructures in a moderate hypoxic state. Results. For the practical implementation of the moderate breathing procedure, which follows from the gas-discharge analogy, it is proposed to use a hypoxic incubator chamber for oximetric and bioimpedance control. Healing and restorative effect of moderate breathing is associated with the combined effect of hypoxic influence and relaxation of the body. As a criterion for the optimal transition to a moderate hypoxic state, artificially stimulated yawning is proposed. Some theories about the purpose of yawning are discussed. The evolutionary conditioning of yawning is derived from the need for a collective safety signal for relaxation and rest. It is assumed that the main physiological purpose of yawning is to accompany the processes of energy relaxation in the body. Yawning occurs reflexively with physical relaxation and can be sustained voluntarily under conscious control. The excretory function of yawning is noted. The discussion of the operational response to hypoxia from the standpoint of thermodynamics is carried out. The possibility of prolonged action from short-term hypoxic procedures is associated with the exponential nature of the main dependences of energy exchange in the body on time. As a preparatory training, a periodic respiratory procedure of “voluntary yawning (oscitation)” is proposed, the concomitant result of which is the normalization of the concentration of oxygen O₂ and carbon dioxide CO₂ in the tissues, and activation of tissue respiration. The body’s response to the hypoxic procedure was measured using pulse oximetry and bioimpedance methods.

Aim. A retrospective study of the efficacy and safety of the use of the Advate® (Oсtoсog alpha) factor VIII (FVIII) drug for the preventive treatment and reduction of acute bleeding episodes in patients with hemophilia A living in the Amur Region. Materials and methods. A retrospective observational monocentric initiative study of the results of the use of the Advate® was performed, which was carried out as part of routine clinical practice (2017-2019). Two comparison groups were formed; each included 14 patients with severe and moderate forms of hemophilia. Each group consists of 2 subgroups: A – 5 patients over the age of 18 years with hemophilic arthropathy, receiving tertiary prophylaxis (1A – with the Advate and 2A – with other foreign drugs FVIII); B – 9 patients under the age of 18 years, without signs of irreversible joint damage, receiving primary and secondary prophylaxis (1B – with Advate and 2B with other foreign drugs FVIII). The work used the results of an individual interview and clinical examination of patients with hemophilia A, data from outpatient records and diaries kept by patients or their parents and in which certain events were recorded during the period of prophylactic treatment with coagulation factor VIII (FVIII) drugs. Results. As a result of the study, data were obtained that the Advate during both prophylactic therapy and reduction of acute bleeding is not inferior in effectiveness to other FVIII concentrates. In patients of subgroup 1A (with the presence of hemophilic arthropathy), it was possible to reduce the frequency of bleeding compared to the period when these patients received therapy “on demand” by 97%, which corresponds to patients from subgroup 2A. Preventive therapy with commercial FVIII drugs, including Advate, started in childhood, made it possible to avoid severe, life-threatening options for bleeding and the development of orthopedic pathology. Advate therapy for patients with hemophilia A was not accompanied by the development of toxic, thrombogenic and immunogenic reactions. Conclusion. Advate® can be effectively used for the prevention and reduction of acute bleeding in patients with hemophilia.

Introduction. The peculiarity of the clinical course of asthma in obese children allowed to identify a special phenotype, when the presence and severity of obesity determine a more severe course of asthma, which can serve as a criterion for predicting the worst response to asthma therapy. Asthma, like obesity, is recognized as a classic example of multi-factorial diseases, which are based on a fairly complex gene network. Investigating the genetic basis of both of these complex traits and linking them to the asthma phenotype should improve our understanding of the overall genetic basis of these pathological disorders. Aim. Review of the literature containing research data on available candidate genes that match asthma and obesity to present the current state of the issue, understand the direction of research, and solve problems. Materials and methods. The analysis of publications containing the results of the study of the effect of ADRB2 gene polymorphisms on the course of asthma in obese patients was carried out. Results. The analysis data shows that in general, the literature data on this problem is contradictory. It is emphasized that the strength of the relationship between the presence of predisposition gene polymorphisms is not always sufficient to explain the relationship between asthma and obesity, which leaves many unresolved issues that require further study. Conclusion. The analysis of genetic markers of asthma and obesity indicates the need for a comprehensive approach to research, which will contribute to the improvement and optimization of diagnostic and therapeutic measures.

Today in the world there is a high prevalence of asthma, and the mild severity occupies a leading position in the structure of morbidity. A mild asthma is a pathology that, with a prolonged asymptomatic course, can lead to severe exacerbations, and even death. Despite this, at present there are difficulties leading to an insufficient and untimely diagnosis of asthma, as a result of which exacerbations are often recorded in patients with a mild severity of the disease. The literature review examined the clinical features of mild asthma, as well as the modern principles of treatment of patients with mild disease severity. In addition, a review of recent studies aimed at studying morphological and pathophysiological changes in mild asthma is presented. Mild asthma, as a rule, is stable, but sometimes it can spontaneously develop into extremely severe, and the causes of such changes remain unclear. The analysis of the studies revealed endogenous and exogenous factors that affect the induction of bronchial asthma and exacerbate its course. It is also important that bronchial obstruction, apparently, appears from the first years of life and persists in the future, in connection with which it is important to understand the value of diagnosis measures and the effectiveness of interventions in the early stages of bronchial obstruction to prevent disease progression. In this regard, the problems of early diagnosis of mild asthma and the timely appointment of appropriate therapy remain today important and relevant.

The article presents the most significant literature data on the influence of hardening of a person on the possibilities of adaptive reactions of the body to low ambient temperatures. The most important functions of temperature receptors as an afferent link in the transmission of information, its correct processing and an adequate response of the body to the action of unfavorable environmental factors are shown. The review considers the main physiological reactions of the body to short-term and long-term exposure to cold. The processes of metabolic, vegetative, hormonal changes that help a person to adapt in terms of professional activity and living in harsh climatic conditions are described. The main principles of the hardening and training influence of environmental factors on a person are highlighted. The analysis of the literature data on the methods and methods of training the body’s resistance in case of its various dysfunctions in cold conditions is given. The positive effect of cold on the human body was studied. The article analyzes modern health-improving and cold training technologies. Methods are presented that combine cold training procedures with the use of drugs and physical exercises for faster and more effective adaptation to low temperatures.

The review summarizes the results of modern research in the field of cell therapy for skin burns. The relevance of conducting these studies both in Russia and in the world is described. The methods of influence on the skin regeneration after burns in addition to cell therapy are indicated. A history reference on the development of cell therapy for burn skin lesions is given. The documents governing the conduct of cell therapy in Russia are presented. The advantages and disadvantages of cell technology using keratinocytes are described. The methods of cell therapy for skin burns using fibroblasts are analyzed. The role of three-dimensional tissue-engineered structures – scaffolds in the regeneration of the skin is described. Their classification is given by the duration of wound coverage (permanent, semi-permanent and temporary), by composition (cellular, acellular), by type of material (synthetic, biological, which are divided into allogeneic and autologous). The main representatives of each group that are used in research as therapy in the treatment of skin burns are described: Biobrane, Integra, Dermagraft, TransCyte, Hyalograft 3D, Laser skin epidermal replacement, TissueTech autograft system. The data on the experimental testing of each of the representatives are presented. The issue of improving vascularization of tissue-engineering structures using bioreactors was also raised. According to the results of the review, it was concluded that the use of three-dimensional structures in the treatment of burn skin lesions shows the greatest efficacy and safety among pronounced cell therapy options in clinical practice. At the same time, the existing drawbacks of the analyzed samples require further study and analysis.

Spirometry is one of the world most common methods of functional diagnostics of the respiratory system. Obtained by this method data play an important role in determining the type of ventilation disorders, clinical diagnosis, evaluating the effectiveness of treatment and prognosis. Therefore, special attention is paid to the technical standards of the study, which is well standardized. Spirometry guidelines are reviewed periodically. In 2019, spirometry quality standards developed by the American Thoracic Society and the European Respiratory Society were published, which updated the indications and contraindications for spirometry, criteria for the quality and reproducibility of technically acceptable maneuvers. The article presents the main parameters and the algorithm for interpreting spirometry results. An important role is played by the selection of a set of predicted values, which define the range of normal values for the population. In 2012, new universal equations were developed − Global Lung Function Initiative 2012, which allow calculating the reference value of spirometry in a wide age range (from 3 to 95 years). A modern approach to determining the degree of deviations from normal values is described, which must be determined using the lower limit of the norm and the z-score. The role of spirometry in obstructive ventilation disorders is emphasized.