The cellular composition of the induced sputum in 52 patients with mild partially controlled asthma was studied. By the results of the response to ultrasound inhalation with NaCl hypertonic solution the patients were divided in two groups: the first one had the patients with airway hyperresponsiveness to hyperosmolar stimulus (19 patients) and the second one had those who had no response to bronchial challenge (33 patients). The control group included 12 healthy people. With the help of mean cytochemical coefficient the contents of neutrophilic and eosinophilic myeloperoxidase in the sputum leucocytes were identified. The index of destruction and the parameter of intensiveness of leucocytes cytolysis were calculated. In the cytogram of the induced sputum of asthmatics there was an increase of leucocytes number and a decrease of macrophages number in comparison with healthy people. Cytogram of the sputum of patients of the first group corresponded to the mixed neutrophilic-eosinophilic phenotype with the domination of neutrophils, the biggest desquamation of epithelium, domination of intensiveness of neutrophils cytolysis against maximal mean cytochemical coefficient of neutrophilic myeloperoxidase. A close correlation was found between the number of neutrophils and the contents of myeloperoxidase in them in the patients of the first group. The significance of cytological parameters, of the level of intracellular neutrophilic myeloperoxidase and intensiveness of neutrophils cytolysis as the markers of response to hyperosmolar stimulus in asthma was shown.

To estimate the effect of osmotic airway hyperresponsiveness on the health-related quality of life 176 patients with asthma were examined; they were divided into two groups: with presence and absence of osmotic airway hyperresponsiveness. The quality of life was assessed with questionnaires SF-36 and AQLQ, the state of the emotional sphere by the Hospital Anxiety and Depression Scale. The level of asthma control was defined by ACT questionnaire. The lung function was estimated with the help of spirometry. As a result of the study it was found out that the asthmatics with osmotic airway hyperresponsiveness are characterized by a lower level of the general and specific quality of life, they have the worst asthma control and unfavorable psychoemotional background which influences both the control and the assessment of the general and specific quality of life.

The features of pulmonary and intracardiac hemodynamics in patients with the most spread chronic myeloproliferative diseases: chronic myeloid leukemia (CML), polycythemia vera (PV) and idiopathic myelofibrosis (IMF) were studied. It was found that during tumor progression, these patients had an increased pulmonary artery pressure; the disorders of systolic and diastolic function of the right and left ventricles progressed. The greatest changes were observed in the patients with CML under development of blast crisis. In the process of pathogenetic treatment of CML by tyrosine kinase inhibitors, in achieving complete cytogenetic and major molecular response the revealed changes are reversible. At PV and IMF the pursued cytostatic therapy had no significant effect on pulmonary and intracardiac hemodynamics.

Retrospective analysis of 122 records of patients with diagnosis of nosocomial pneumonia and treatment in the general intensive care unit (n=100) and intensive care unit of the Regional Vascular Center (n=22) of the Amur Regional Clinical Hospital was done. It was found out that nosocomial pneumonia developed predominantly in people over 60 years old. The majority of patients (99-100%) in both units had several risk factors of acquiring nosocomial pneumonia. The most significant in the general intensive care unit were previous antibacterial therapy (49%), bronchoscopy (92%), operations and anesthesia (50%), a horizontal position (52%), old age (48%), emergency tracheal intubation (48%), violation of consciousness (46%), and tube feeding (45%); in the intensive care unit of the Vascular Center they were a horizontal position (91%), old age (77%), bronchoscopy and the severity of the condition by the scale APACH of more than 16 points (54.5%), violation of consciousness (63%). By the duration of the disease most often late pneumonias were diagnosed: 99% in the general intensive care unit and 86% in the intensive care unit of the Vessel Center. Oligosymptomatic and hidden type of pneumonia course was registered in both units with equal frequency (in 50% of cases). Artificial lung ventilation was more often necessary for the patients from the general intensive care unit (75%). The lethal outcome was recorded with equal frequency in both units (45.5-50%). The attributive mortality was only 1%. By the results of microbiologic study of the sputum and bronchial aspirate Klebsiella pneumonia (44%) and Pseudomonas aeruginosa (31%) dominated in the general intensive care unit, whereas Klebsiella pneumonia (45%), Streptococcus pneumoniae (14%), Acinetobacter (9%), and Pseudomonas aeruginosa (9%) were most frequent in the intensive care unit of the Vessel Center. Among antibacterial drugs the most active ones to Klebsiella pneumonia in the general intensive care unit were amikacin (in 34.8% of cases), imipenem (48.4%); to Pseudomonas aeruginosa it was imipenem (36.6%), amikacin (30.0%); to Acinetobacter it was amikacin (25%). In the intensive care unit of the Vessel Center Klebsiella pneumonia was most sensitive to imipenem (45.5%), amikacin (36.6%), and amoxiclav (18.1%). Pseudomonas aeruginosa was in 100% of cases resistant to the studied antibiotics. Acinetobacter in 100% of cases was sensitive to amikacin and imipenem. Streptococcus pneumoniae was in 100% of cases sensitive to amoxiclav, in 66% to medaxon, acestin, linezolid and levofloxacin and in 33.3% to azithromycinum.

Histamine is a highly active for tissue metabolism biogenic-active substance. It is formed from histidine under influence of histidine decarboxylase. The enzyme of argininedehydrogenase releases it from heparin-arginine complex. A great quantity of histamine is developed in patients with asthma and discharged by eosinophils and mast cells which penetrate into the epithelial layer of bronchial mucosa. The aim of the work is to show the role of histamine in the development of morphofunctional changes in the bronchial mucosa of asthmatics using developed histochemical methods of the research. 50 patients with mild-to-moderate asthma were examined: bronchoscopy and biopsy of bronchial mucosa were done; biopsy materials were studied by histochemical methods. It was found out that at early stages of asthma development there are signs of chronic inflammatory process in the bronchial mucosa. Inflammatory infiltrate has a lot of eosinophils and mast cells; these cells have a lot of arginine in granules. Further studies allowed to find in the bronchial mucosa even at first stages of the disease an active histochemical response to arginine dehydrogenase, which proves an intensive process of release of eosinophils, mast cells and histamine from granules. Histamine at first is accumulated in a large amount in the apical pole of cells, which leads to the loss of ciliated epithelium by ciliary cells. The accumulation in the mucosa of epithelium of a great amount of histamine damages cellular membranes and leads to the formation of fatty acids peroxides which negatively affect the epithelial layer of mucosa. The small airway conductance gets worse and asthma becomes severe.

The concentration of cytokines in the blood serum of 108 women in the first trimester of gestation was studied. The first group included 25 women with physiological course of pregnancy, the second group consisted of 30 pregnant women with exacerbation of chronic simple bronchitis caused by influenza A(H3N2) (antibody titer was 1:16-1:64); the third group had 28 patients with the acute form of chronic simple bronchitis at influenza A(H3N2) (antibodies titer was 1:32-1:128) and the fourth group included 25 women with exacerbation of chronic simple bronchitis of influenza etiology (antibodies titer was 1:64-1:256) in the first trimester of pregnancy. It was shown that in the patients of the second group in comparison with the control there was the increase in the blood serum of contents of IL-4 till 17.7±1.72 pg/ml, TNF-α till 33.5±3.03 pg/ml and INF-γ till 29.6±2.39 pg/ml (in the control it was 12.9±1.16 pg/ml, р<0.05; 24.7±2.27 pg/ml, р<0.05; 22.3±2.08 pg/ml, р<0.05, respectively). In the patients of the third group in comparison with the second one there was no significant growth of cytokines concentration in the blood serum. In the fourth group in comparison with the second one there was a maximal increase of concentration of IL-4 till 33.8±2.31 pg/ml (р<0.001), TNF-α till 57.4±3.89 pg/ml (p<0.001) and INF-γ till 34.9±3.13 pg/ml (p<0.001), which shows an important pathogenic role in the exacerbation of chronic simple bronchitis of the growth of influenza antibodies associated with more intensive system inflammatory response in women in the first trimester of gestation.

Ultrasound picture of the uterus and chorionic villi as well as the contents of cytokines in the blood serum of 132 women in the first trimester of pregnancy were studied. The first group (control) included 30 women with uncomplicated course of pregnancy; the second group had 36 pregnant women with influenza A(H3N2) with antibody titer 1:4-1:16; the third group had 34 pregnant women with influenza А(Н3N2) with antibody titer 1:8-1:32; the fourth group consisted of 32 pregnant women with influenza A(H3N2) with antibody titer 1:32-1:128. Ultrasound markers of the primary placental insufficiency were visualized in 16.7% of patients in the second group: the thickening of chorion in 8.3%, its thinning in 5.6% and chorion previa in 2.8%. In the first group this obstetrical pathology was observed in 10% of women: the thickening of chorion in 6.7% (р>0.05), its thinning in 3.3% (р>0.05) without any signs of chorion previa. At the same time there was a tendency to the growth in the blood serum of the contents of IL-4 till 16.2±1.39 pg/ml, TNF-α till 29.8±2.64 pg/ml and IFN-γ till 27.3±2.27 pg/ml (in the control it was 12.9±1.16 pg/ml, р>0.05; 24.7±2.27 pg/ml, р>0.05; and 22.3±2.08 pg/ml, р>0.05), respectively. In the third group the frequency of identification of echostructural signs of placental insufficiency and the level of cytokines did not differ from signs in the patients of the second group. In comparison with the first group in the forth group during the peak of the disease ultrasound signs of the primary placental insufficiency were identified in 65.7% of women: the thickening of chorion in 46.9% (р<0.01), its thinning in 6.3% (р>0.05) and chorion previa in 12.5% (р>0.05). The concentration of IL-4 increased by 73.6% (р<0.001), of TNF-α by 75.3% (р<0.001) and of IFN-γ by 73,1% (p<0.001). During reconvalenscence in the patients of the fourth group clinical-echographical markers of the primary placental insufficiency and the threats of premature delivery were revealed in 100% of the examined women. This suggest a very important pathogenetic significance of a system inflammatory response and hyperproduction of antivirus antibodies in the damage of blood vessels of unterus-chorial zone and syncytiotrophoblast as well as the development of the threat of miscarriage at influenza virus A(H3N2) in women at early stages of gestation.

The aim was to study the role of free radical processes in the destruction of structural lipids of the membrane of red blood cells of the peripheral blood of pregnant women who had in the III trimester of gestation the reactivation of cytomegalovirus infection with the titer of antibodies to cytomegalovirus IgG 1:1600. The peripheral blood of 45 pregnant women with exacerbation of cytomegalovirus infection (titer of IgG antibodies to cytomegalovirus was 1:1600) in the III trimester of gestation (the main group) was studied. The comparison group consisted of 45 women with physiological pregnancy. The results of this study suggested that the aggravation of cytomegalovirus infection during gestation is associated with activation of lipid peroxidation against the insolvency of antioxidant defense, which results in the increase of the lipolytic enzyme phospholipase A₂ (by 60%, p<0.001) and promotion of phosphatidylcholine hydrolysis (decrease in the concentration by 23%, p<0.001) with the formation of toxic products of arachidonic acid and lysophosphatidylcholine (by 51% above normal, p<0.001) which damage the membrane of red blood cells; disintegration of the lipid bilayer which changes viscosity properties and the ability to deform the membrane, which can then be the cause of hypoxia. The complex therapy of pregnant women with cytomegalovirus infection should include drugs with ω-3 polyunsaturated fatty acids, which will contribute to the reduction of platelet aggregation and blood viscosity reduction, suppression of thrombus formation and thus to the prevention of the development of complications of gestational period.

The study of toxicological and hygienic properties of the mixture from Hypericum perforatum (HP) and Rhodiola rosea (RR) for food use in the population was done. Investigations on the exclusion of the toxicity of a mixture of HP and RR have been conducted in accordance with generally accepted methodological approaches. The experiments were performed on experimental animals (white rats and rabbits) with identification of integral, physiological, hematological and histological indices recommended for such investigations. The animals were divided into control and experimental groups of 10 animals each. All animals were provided with a double control due to the presence of the control group and data recording before starting the experiment. A mixture of HP and RR was administered orally and intraperitoneally to each group of animals. Biochemical and morphological investigations of the blood of experimental animals at the 1^st and 15^th day of the monitoring were conducted. It was revealed that red blood cells, white blood cells, the cholinesterase of blood serum, the activity of catalase, lactic and pyruvic acid in the blood, sulfhydryl groups, serum protein and urea in the blood did not have significant deviations compared with the control group. The organs of decapitated animals did not have pathological changes. These results indicate that in the composition of the powdered food mixture of HP and RR there are no toxic substances, it is safe according to the criteria of ecological and hygienic human nutrition concept. The complex of toxicological and hygienic investigations on acute, subacute toxicity, cumulative properties, mutagenic, embryotoxic and local irritating action, carrying out microbiological analysis and organoleptic investigations indicates the absence of toxic substances, pathogenic microorganisms and their toxins in a mixture of HP and RR, which proves their harmlessness for warm-blooded organism.

Modern environmental conditions greatly increased the level of radical forming processes in the body. Cold exposure stimulates the generation of reactive oxygen species inducing peroxidation of lipids as a result of hypoxia development. In experimental conditions the possibility to correct free radical lipid oxidation of rats’ organism membranes was studied with the introduction of nikolizin. The animals were divided into 3 groups and each of them had 40 rats: intact animals which were held in standard conditions of vivarium; the control group in which rats were exposed to cold during three hours daily; the experimental group in which before cooling animals had a daily intake of nikolizin in a dose of 30 mg/kg. It was found out that a daily cold exposure during three hours contributes to the increase of lipid hydroperoxides level (by 18-50%), of diene conjugate (by 33-80%), and of malonic dialdehyde (by 22-37%) against the decrease of antioxidant system activity in the blood of intact animals. The introduction of nikolizin to rats in the conditions of cold exposure contributes to the significant decrease in the blood of lipid hydroperoxides by 14-22%, of diene conjugates by 26-44%, of malonic dialdehyde by 20-25% in comparison with the rats of the control group. While analyzing the effect of nikolizin on the activity of the components of antioxidant system it was shown that the level of ceruloplasmin in the blood of animals was significantly higher by 39-57%, of vitamin E by 22-33%, of catalase by 23-33% in comparison with the same parameters of the rats of the control group. So, the application of nikolizin in the conditions of long cold exposure on the organism of animals under experiment leads to stabilization of the processes of peroxidation against the increase of antioxidant system activity.

The search and development of methods for correction of oxidative stress in conditions of exposure to adverse environmental factors is a topical problem of modern medicine. In experimental conditions the possibility to correct free radical lipid oxidation of rats’ cell membranes was studied with the oral introduction of the tincture of herb convolvulus that contains the complex of natural antioxidants. The animals were divided into 3 groups and each of them had 30 rats: intact animals which were held in standard conditions of vivarium; the control group in which rats were exposed to ultraviolet radiation during three minutes daily; the experimental group in which before ultraviolet radiation animals had a daily oral intake of the tincture in a dose of 5 ml/kg. It was found out that a daily ultraviolet radiation of experimental animals during three minutes contributes to the increase of lipid hydroperoxides level (by 17-24%), of diene conjugate (by 21-23%) and of malonic dialdehyde (by 29-34%) against the decrease of antioxidant system activity in the blood of intact animals. The introduction of the tincture to rats in the conditions of oxidative stress contributes to the significant decrease in the blood of lipid hydroperoxides by 12-17%, of diene conjugates by 13%, malonic dialdehyde by 21-28% in comparison with the rats of the control group. While analyzing the effect of the tincture on the activity of the components of antioxidant system it was shown that the level of ceruloplasmin in the blood of animals was significantly higher by 20-25%, of vitamin E by 12-21%, of catalase by 12-20% in comparison with the rats of the control group. So, the application of the mentioned tincture in the conditions of oxidative stress induced by the influence of ultraviolet rays leads to the stabilization of the processes of peroxidation against the increase of antioxidant system activity.

The article is devoted to the research of atmospheric suspensions of Belogorsk town (the Amur region) by means of laser granulometry. It is shown that the volume fraction of ecologically significant microparticles (less than 10 microns) in the air of Belogorsk is from 19.8 to 39.9%, and particles from 10 to 50 microns make from 39.8 to 75.4%. These data are assessed as unfavorable background for the development of respiratory diseases. The part of the largest particles (from 400 microns and above) doesn't exceed 16.5%. The conclusion is drawn that on the territory of the small town without large sources of dusting there are a lot of particles in the atmospheric suspension potentially hazardous to the health of a person. The town with the population about 70000 people is the territory with broad fluctuations of particles distribution in the atmospheric suspension.

The article is devoted to the research of atmospheric suspensions in Bolshoi Kamen town (Primorsky Region, Russia) by means of laser granulometry. It is shown that the atmosphere of this town is scarcely polluted with particles under 10 µm (PM₁₀). Only at 3 sampling points out of 11 we found dangerous to health microparticles in significant quantities: from 24.8 to 34.6%. Large particles sized above 400 µm prevail in the majority of districts of the town amounting to 79.2%. We can conclude that the town of Bolshoi Kamen can be called “safe” from the standpoint of the presence of particles under 10 µm in the atmosphere.

A brief review of the literature devoted to the defeat of the respiratory system in systemic lupus erythematosus (SLE) is presented. The characteristics of the most common diseases, i.e. pleurisy, the defeat of the diaphragm, upper respiratory tract and pulmonary vessels is given. Particular attention is paid to lupus pneumonitis and pulmonary (alveolar) hemorrhage. As an example, here is the case from the authors’ personal therapeutic practice. In the young patient at the acute stage of SLE the leading clinical manifestation was a lung disease manifested by acute respiratory failure, hemoptysis, anemia, and the X-ray picture of bilateral interstitial and alveolar lesions of the lung tissue. Based on the identification of the laboratory picture of active SLE, lupus lung damage of hemorrhagic alveolitis type was diagnosed. After treatment with glucocorticoids (pulse therapy and long-term use of high doses per os ), pulse therapy with cyclophosphamide and cascade plasma filtration the regression of pulmonary manifestations of SLE was achieved.

The article is about urgent problems of medical rehabilitation of patients with chronic respiratory diseases. In recent years great changes were made both in understanding of the essence of medical rehabilitation and in making programs for patients with pulmonary diseases. This article covers the problem of a modern view on rehabilitation and its advantages. Basic techniques and principles of respiratory rehabilitation were discussed. The results about the efficiency of physical trainings during rehabilitation of patients with chronic obstructive pulmonary disease and asthma were summarized. The reasonability of wider application of physiotherapy rehabilitation techniques is shown. It is also mentioned that while making a prevention program for rehabilitation there is a necessity to consider regional specific of prevalence and death rate from chronic respiratory diseases. Possibilities for rehabilitation of patients with pulmonary diseases in the south of the Far East of Russia are presented.

Timely diagnostics and adequate therapy of community-acquired pneumonia (CAP) are the most important problems of the internal pathology. The effectiveness of the CAP treatment is possible only in timely diagnostics, adequate estimation of the severity of patient’s state which may be the reason for hospitalization of the patient; timely beginning of the treatment, efficient choice of antibacterial therapy depending on the possible agent. The basic things to determine the place and volume of treatment are timely identification of patients with severe course of the disease. The main symptoms of severe CAP (SCAP) are the respiratory insufficiency, severe sepsis or septic shock and also the prevalence of pulmonary infiltrates. The article contains modern data about etiology of SCAP, changes in the spectrum of CAP agents revealed due to modern methods, sensibility of CAP agents to antibacterial drugs (ABD). Indications to the administration of ABD and principles of empiric choice of ABD in the case of unknown CAP agents are also described in the article. Rational combinations of ABD based on the proposed etiological factor of SCAP, which are the base of efficient therapy of SCAP, are also given. Modern methods of therapy of conditions which complicate the duration of SCAP, i.e. bacterial shock, intoxication syndrome, multiorgan insufficiency, respiratory insufficiency and also methods of prophylaxis of candidiasis and prevention of SCAP are indicated in the article.

Background comorbidity in patients with chronic obstructive pulmonary disease (COPD) is burdened by no less than for cardiovascular disease. COPD, in turn, on a number of clinical-laboratory and instrumental indices worsens the clinical course of the absolute majority of known disease today. Large epidemiological studies have shown the effects of obesity to appear with serious diseases such as diabetes, hypertension, coronary heart disease, chronic heart failure. Chronic inflammation contributing to the development of irreversible bronchial obstruction and changes in the lung parenchyma is the most important in the pathogenesis of COPD. Among the major mediators of chronic systemic inflammation pro-inflammatory interleukins produced by adipose tissue and contributing to the development and progression of insulin resistance are identified. According to current data, insulin resistance worsens endothelial dysfunction due to the accumulation of free fatty acids, increased levels of proinflammatory adipocines and tumor necrosis factor-alpha. Today thrombotic complications of COPD in general and of pulmonary thromboembolism in particular are a very common occurrence that requires further scientific developments. Comorbidity with abdominal obesity common in patients with COPD in 31% of cases was established to be the main component of a hypercoagulable syndrome. Thus, the study of mechanisms of interaction of systemic inflammatory responses associated with acute exacerbation of COPD in patients with concomitant obesity and chronic heart failure will allow to improve the methods of prevention and treatment of complications of the comorbid disease.

The study of lung diffusion capacity (or transfer factor (D_L), where D_L is a measure of the ability of the lungs to transfer oxygen from the alveolar gas into the blood) is one of the most important methods (the second after spirometry) to estimate the lung function. It is included in the standard medical examination of interstitial and disseminated lung diseases. The lecture discusses theoretical aspects of the gas exchange across the alveolar-capillary interface, describes in detail the methodology of the study of lung diffusion capacity for carbon monoxide by the single-breath technique, since this is the most common methodology used around the world, recommended by the American Thoracic Society (ATS) and the European Respiratory Society (ERS). In addition, the lecture discusses the main errors of single-breath maneuver technique, gives the scale of the severity of decrease in D_L, describes the main pathological processes that reduce the area of the diffusion surface or increase the diffusion distance by increasing the thickness of the alveolar-capillary membrane, and thus cause a lung diffusion capacity decrease, i.e. a reduction of transfer factor, as well as the list of conditions under which there is an increase of the transfer factor.