The analysis of the implementation of prevention programs, using materials and methods of epidemiological and statistical monitoring of the population incidence of pneumonia and generalized regional experience of complex of organizational, methodological and control activities to prevention of pneumococcal disease in the territory of the Amur region. Pneumococcal conjugate vaccine "Prevenar-13" and flu vaccine were used for immunization against acute respiratory viral infections and pneumococcal infection. We take into account information about the rate of pneumonia and respiratory viral infections for the period from 2010 to 2015. To assess the effectiveness of vaccination we used indicators and specific criteria. Comparative statistical analysis revealed a high degree of efficiency of the regional programs with the use of methods of pneumococcal immunization: the coefficient of efficiency of preventive vaccination reaches 75-100% using the incidence of pneumonia as indicator. The incidence of pneumonia in vaccinated contingent decreased by 2.3 times for 2 years in the region.

The character of changes of inflammatory-cellular pattern of bronchial secretion in patients with asthma in association with cold airway hyperresponsiveness (CAHR) under the influence of standard therapy has been studied little. The aim of the present work is to study dynamics of cellular profile, neutrophilic component of bronchial inflammation under the combination therapy of asthmatics with CAHR. 12 asthma patients with CAHR were studied upon the number of cells of the induced sputum (IS), peroxidase, cytolytic and destructive activity of eosinophils and neutrophils in the sputum, lung function and asthma control with the help of questionnaire Asthma Control Test (АСТ) before and after the therapy with the combination of budesonide/formoterol. Before the therapy the patients had a low level of asthma control (14.4±1.2 points of ACT), FEV₁ was 87.4±3.3% from predicted values; in IS neutrophils prevailed (26.4±1.7%) over eosinophils (18.5±2.6%); the level of myeloperoxidase (mean cytochemical coefficient) was 65.9±5.4 pixels. After 48 weeks of the observation only in 58% of patients the criteria of good control of asthma and the improvement of lung function were achieved. In IS there was a decrease of eosinophils (11.4±3.2%; p=0.045); the intensiveness of eosinophils and neutrophils cytolysis dropped; intracellular concentration of myeloperoxidase grew (98.2±14.1 pixels; p=0.0637); destructive changes in granulocytes were registered but the number of neutrophils remained high (34.0±8.2%, р=0.34), which was considered as the factor of stable initiation of inflammation and oxidative stress. Thus, the use of anti-inflammatory treatment regime lasting 48 weeks with combination of budesonide/formoterol oriented to achieve clinical criteria of asthma control in patients with CAHR does not allow to achieve correction of the level of neutrophilic inflammatory component. Quantitative index of neutrophils in IS in these patients has prognostic value for the possible loss of achieved asthma control.

It is expected that in neonates that underwent prenatal chronic effect of nicotine the identification of the reduction of intensiveness of respiratory response to hypoxic exposure may be the cause of sudden infant death. The effect of cigarette smoke may differ from the effect of nicotine. The study was performed on brain stem spinal cord preparations (BSS) in the brain of newborn rats (n=38) in vitro . In the experimental group (EG) the modeling of passive smoking was carried out by fumigation of cigarette smoke of rat females from the 1^st to 20^th day of gestation. Hypoxia was simulated by an artificial cerebrospinal fluid saturated with a gas mixture of 5% CO₂ and 95% N₂. Hypoxic depression of BSS respiratory rhythm of the control group (CG) occurred at the 5^th minute; the restoration took place in 10 minutes at normoxia, at the same time there was an increase of the amplitude of the inspiratory discharges which did not return to baseline values (15 minutes). In preparations of CG at the 10^th minute of hypoxia the duration of inspiratory discharges decreased and restored after 10 minutes at normoxia. The increase of the ratio of the power of low-frequency and medium-frequency oscillations was observed in the CG at the 15^th minute of hypoxia with the restoration during 10 minutes. In the experimental group (EG) the increase of the duration of the respiratory cycle occurred at the 10th minute of hypoxia with the dynamics of recovery similar to that of CG. The increase of the amplitude of inspiratory discharges occurred at the 10th minute of hypoxia; a recovery period took 10 minutes. In the BSS of EG the reduction in the duration of the inspiratory discharges and the increase of the ratio of the power oscillations of low- and mid-range occurred at the 5th and 10th minutes of hypoxia and these parameters never returned to baseline values. Our data suggest that prenatal exposure to secondhand smoke has an effect on the mechanisms of central chemosensitivity in the offspring in the early postnatal period.

The aim is to study structural and functional condition of cell mitochondrial apparatus for evaluating the mitochondrial membrane potential (MMР) and the fatty acids (FA) composition of mitochondrial membranes of blood cells in patients with COPD; to establish the role of mitochondrial dysfunction in the mechanism of COPD. The study involved 27 patients with mild COPD, 21 with moderate COPD of a stable course, and 20 healthy people. MMР of leukocytes was assessed with cytofluorimetry. The composition of FA of mitochondrial membranes was studied with gas-liquid chromatography. As a result of the study it was found out that the worsening of the disease (moderate COPD) leads to the increase of the number of white blood cells with reduced MMP and appearance of deficit of the saturated monoenic and n-3 polyunsaturated fatty acids in the membrane of mitochondria. The revealed changes in the structural and functional state of mitochondria show a violation in energetic activity, membrane permeability and transport of substances, which is a sign of the formation of mitochondrial dysfunction and cell hypoxia development at respiratory diseases.

Chronobiological aspects of blood gas composition in 24 patients with COPD were studied. To achieve this goal, the gas composition of the arterialized capillary blood simultaneously with the investigation of respiratory function was studied with an interval of 6 hours over 2 days. In healthy individuals and patients with mild COPD two types of gas composition of blood biorhythm - daytime and nighttime - were found. In patients with moderate, severe and very severe disease 3 types of biorhythm of partial oxygen and carbon dioxide tension - morning time, noontime and evening time were registered. In healthy individuals and patients with mild COPD gas composition of blood was characterized by significant degrees of freedom in relation to functioning of the respiratory system, which indicated the stored processes of adaptation to changing conditions of the external and internal environment. In patients with moderate, severe and very severe COPD at the moment of acrophase of circadian rhythm of lung function maximum partial oxygen pressure in the arterialized capillary blood was observed. During the batiphaze of circadian rhythm of the respiratory system the highest values of the partial carbon dioxide tension were revealed. Thus, it was found out that with the growth of the severity of the disease in patients with COPD abnormal rhythms of blood gas composition are registered; the dependence of circadian rhythm of blood gas composition on the functioning of the respiratory apparatus increases.

Northeast Russia covers areas that significantly differ in extreme impact of natural and climatic factors. Despite the fact that the cities of Anadyr (64°44′00″N 177°31′00″E) and Magadan (59°34′00″N 150°48′00″E) are situated on the coast and experience equal specific influence of the sea climate, abiotic parameters of those environments affect residents of the areas in different ways. Respiratory system has proved to be the most exposed to such conditions and susceptible to potential pathology. Reasoning from this fact it became of interest to study main indices of lung function observed in male students of different northern regions. Computerized spirography was used to comparatively examine the lungs’ volume and flow parameters in 466 north-born male Caucasians in the 1^st-2^nd generation and 118 male Indigenes residing in Chukotka and Magadan region. As resulted from the study the examinees demonstrated significant differences depending on either place of residence or ethnic origin. The Indigenous subjects from Anadyr were the highest in volume parameters (VC 107%, FVC 112%) while maximal volume and flow indices were demonstrated by Indigenes of Magadan (MEF₅₀ 119%, MEF₇₅ 139%). The strongest structure of correlation between indices of lung function was found in Caucasians of Anadyr who demonstrated the parameters’ significant interdependence. Indigenes of Magadan region had much fewer correlations. Having analyzed the compensatory and adaptive processes, observed in both examined subjects residing in the same climatic area, we found those processes running the way of convergent adaptation that features the subjects’ lung function indices to become closer.

The article analyzes the main indicators of morbidity and mortality from cancer of the larynx in the period from 1998 to 2014 on the territory of the Amur region of Far Eastern Federal District. In the studied period of time, the incidence of malignant tumors of the larynx substantially decreased with the growth/loss in men of “rough indicators” by -11.89%, of standardized ones by -7.75%. In women, they were +98.31 and +77.77%, respectively. Mortality in contrast to the incidence throughout the years had a negative growth (loss) in absolute terms, “rude” and standardized indicators. The age and sex features of morbidity with larynx cancer were revealed; they show that the maximum number of cancer cases is in the age group of 50 years old and older. The multistage character of the process based on its prevalence was determined. The early stages (I-II) of laryngeal cancer were registered in 13.7% of patients. The quality of cancer services activity was studied by reliability index of accounting for this category of patients, which is usually lower than in other regions of the country (-0.45). The analysis of dynamics of mortality in the first year after diagnosis shows its reduction in cancer of the larynx by 11.0% over the period of 1998-2014. The number of patients who were registered five or more years ago decreased significantly. The estimation of primary care, which is not yet fully in line with current medicine, in the provision of specialized aid to cancer patients in the region was done.

The work shows the results of substance study of atmospheric suspensions contained in the snow of Blagoveshchensk during the season of 2013-2014. The distribution of suspended in the air particles of different origin in 19 areas with various anthropogenic impact was revealed. Big and mid-size motor transport centers are the main suppliers of the biggest part of microparticles (till 100 mkm) into the atmosphere. Suburban and park lands are the source of macroparticles (from 400 mkm). In the area of the shipyard with plating industry, nanoparticles of 50 nm and of high square of specific surface were found. It was shown that microdimensional pollution of the atmosphere of Blagoveshchensk can be assessed as moderate.

The aim of the research is to study the availability of vitamin D among children of different age and pregnant women living in the Amur region. 339 residents of Blagoveshchensk (279 children of different age and 60 adults) were examined. Among them there were 129 toddlers, 90 children of preschool age of 3-6 years old, 60 adolescents of 15-17 years old and 60 adults (pregnant women) of 18-40 years old. In the blood serum the content of the metabolite of vitamin D [25(OH)D] was studied by high performance liquid chromatography. The assessment of risk factors for failure and deficiency of vitamin D was conducted by clinical and anamnestic data. The first results of the study have been presented. They indicate a high frequency of various vitamin D deficiency in the population of the Amur region. Among 339 residents of the Amur region 92 (27.1%) had an adequate availability of vitamin D, 144 (42.4%) had an insufficiency of 25(OH)D; at the same time vitamin D deficiency was identified in 90 (26.5%) with 1/3 of the child population and 1/4 of pregnant women. The level of 25(OH)D within normal limits found in 37.5% of children in the first year of life decreased till 3.6 % by 3 years old, with its deficit increasing from 29.1% to 50%, persisting at this level (45.5 percent) in 3-6 year-old children, declining till 23.3% in adolescents and till 23.3% in pregnant women. The average vitamin D in the studied age periods was the highest in the first year of life (36.14±4.3 ng/ml), and the lowest in 2-3 year-old children (19.31±14.68 ng/ml), with a gradual increase in 3-6 years old (21.77±0.96 ng/ml); in 15-17 years old (23.89±0.66 ng/ml) and in pregnant women it has reached a level of 27.75±0.18 ng/ml, remaining below normal values. Respiratory infections, digestion, bone and joint systems pathologies are the most important risk factors contributing to the low status of 25 (OH) D; their prevention, alongside with the correction of vitamin D deficiency can improve the health of the population of the Amur region.

Worldwide in recent years there has been a big interest in the problem of diagnosis and treatment of asthma in the gestation period, occurring, according to various sources, in 1-13.8% of pregnant women. The aim of the work was to determine the clinical and functional characteristics of the course of asthma during pregnancy and the postpartum period, including patients with repeated pregnancies and childbirth. 102 patients with asthma were examined in dynamics of pregnancy and the postpartum period lasting from 3 months to 3 years. There were used clinical and medical history data, integrated monitoring of clinical syndromes, testing using Asthma Control Test (AST^TM), research of lung function, day monitoring of airway conductance parameters, evaluation of the impact of birth stress on adaptation reserves and the condition of the natural resistance of the body by the blood count. Dynamics of asthma course in the gestation period looked as follows: worsening of the course was observed in 44% of patients, often with non-allergic and mixed forms of the disease; without significant dynamics there were 39.2% of patients, improvement was observed in 9.8%, mainly at mild persistent allergic asthma. In the postpartum period 34.3% of patients showed improvement, 41.2% did not have any dynamics, and 24.5% had worsening of symptoms, mainly they were with moderate and severe asthma. The influence of some factors on the asthma dynamics during gestation and the postpartum period was found out. They were the severity of the disease, the presence of extra pulmonary allergic diseases, multivalent sensitization, chronic diseases of upper respiratory tract, ARVI and the way medical recommendations were followed by patients.

The contents of anti-inflammatory and pro-inflammatory cytokines in 95 women in the first trimester of gestation were studied. The first (control) group included 25 women with physiologic course of pregnancy; the second group consisted of 25 patients with exacerbation of chronic simple bronchitis caused by influenza virus B (antibody titers were 1:16-1:64); the third group consisted of 24 pregnant women with exacerbation of chronic simple bronchitis under influenza virus В (antibody titers were 1:32-1:128); the fourth group consisted of 21 women with exacerbation of chronic simple bronchitis induced by influenza virus B (antibody titers were 1:64-1:256) at early stages of gestation. In the patients of the second group in comparison with the patients of the first group there was an increase of IL-4 till 19.7±2.17 pg/ml, of TNF-α till 33.4±3.09 pg/ml and of INF-γ till 30.9±2.64 pg/ml (in the control it was 12.9±1.16 pg/ml, р<0.01; 24.7±2.27 pg/ml, р<0.05 and 22.3±2.08 pg/ml, р<0.05, respectively). In the third group in comparison with the second group there was no growth of anti-inflammatory and pro-inflammatory cytokines. In the fourth group in comparison with the second group there was the biggest increase of IL-4 till 27.7±2.42 pg/ml (р<0.05), of TNF-α till 43.6±2.79 pg/ml (p<0.05) and of INF-γ till 40.7±2.96 pg/ml (p<0.05). This suggest the paramount importance of the growth of anti-virus antibodies titers in the pathogenesis of exacerbation of chronic simple bronchitis under influenza virus B in women at early stages of gestation.

In order to study the lipid metabolism of a mother-newborn system, there were examined 35 women in labor who had the exacerbation of chronic cytomegalovirus infection with the titer of IgG antibodies to cytomegalovirus 1:1600 in the III trimester of gestation and the same number of newborns (the main group). The control group consisted of 35 healthy pregnant women and their newborns. In maternal blood plasma and neonatal umbilical cord blood, total cholesterol content, triglyceride, lipoproteid cholesterol of high (HDL) and low (LDL) density were studied; in the membrane of erythrocytes the concentration of arachidonic acid and lysophosphatidylcholine was examined. It was found that in comparison with the control group at exacerbation of cytomegalovirus infection during gestation there was a significant transformation of lipid metabolism not only in the mother's blood, but in the blood of the umbilical cord of newborn children, which was revealed through the reduction of the content of total cholesterol (in mother it was by 21%, in the newborn it was by 35%, p<0.001) and cholesterol of LDL (in mother by 24%, in the newborn by 36%, p<0.001); through an increase in the concentration of triglycerides (in mother by 28%, in newborn by 21%, p<0.001); cholesterol of HDL (in mother by 24%, in the newborn by 46%, p<0.001) and chaotropic fractions of phospholipid bilayer of membranes of red blood cells - lysophosphatidylcholine (in mother by 69%, in the newborn by 76%, p<0.001); arachidonic acid (in mother by 62%, in the newborn by 34%, p<0.001). The disturbance of the lipid composition contributes to pathogenesis of CMV infection and allows further conceptual approaches to prevention and treatment of viral infection during pregnancy. The study results suggest the feasibility and necessity of including drugs with antioxidant, antihypoxic action and the ability to regulate lipid metabolism in the complex therapy of pregnant women.

Due to the broad spectrum of influence of polyunsaturated fatty acids of ω-6 family on the development of the fetus and newborn child, the composition of arachidonic fatty acid and its predecessor linoleic fatty acid were studied in blood of the umbilical cord blood of newborns from mothers with chronic reactivation of cytomegalovirus infection. 82 newborns were examined; among them there were 42 infants (the main group) from mothers who had cytomegalovirus infection (titer of IgG antibodies to cytomegalovirus was 1:1600) in the III trimester. The control group included 42 newborns from healthy women. In the umbilical cord blood of newborns the contents of arachidonic and linoleic fatty acids were identified with gas-liquid chromatography. The study found out that the reactivation of cytomegalovirus infection in the mother (titer of IgG antibodies to cytomegalovirus 1:1600) leads to an increase in the content of linoleic acid by 56% (p<0.001) and of the predecessor of pro-inflammatory eicosanoids - arachidonic acid by 34% (p<0.001) in the cord blood of newborns; it is one of the causes of disturbance of the structural and functional organization of the umbilical artery vessels. Identified changes in umbilical cord blood and umbilical artery endothelium can cause disturbances of the elastic properties of vessels, stagnation and thrombosis of blood vessels and, consequently, disturbances of blood flow between mother and fetus, which can then serve as a factor in the development of fetal hypoxia.

The contents of β-subunit of chorionic gonadotropin (β-CG), estriol, progesterone, dehydroepiandrosterone (DEAS), placental lactogen and cortisol were studied in 164 women of child-bearing age at the 7-9^th weeks of pregnancy. The first group (control) consisted of 30 women with physiologic course of pregnancy. The second group (comparison) had 32 patients with the threat of premature delivery of non-infectious etiology. The third group included 36 patients with influenza virus А(Н3N2) (anti-virus antibody titers were 1:4-1:16); the fourth group had 34 women with influenza virus А(Н3N2) (antibody titers were 1:8-1:32); in the fifth group there were 32 patients with influenza virus А(Н3N2) (antibody titers were 1:32-1:128) and the threat of premature delivery in the period of reconvalescence. The patients of the fifth group had the decrease of the level of β-CG till 40.5±2.0 mМЕ/ml, of estriol till 3.4±0.21 nmole/l, of progesterone till 35.1±3.13 nmole/l, of DEAS till 7.3±0.68 nmole/l, of placental lactogen till 12.1±1.0 nmole/l, as well as the increase of cortisol till 738.7±22.08 nmole/l in comparison with 73.0±2.0 mМЕ/ml (р<0.001), 5.9±0.33 nmole/l (р<0.001), 70.6±4.14 nmole/l (р<0.001); 7.3±0.68 nmole/l (р<0.001), 12.1±1.0 nmole/l (р<0.001) and 567.8±24.02 nmole/l (р<0.001) in the first group, respectively. The differences of hormonal status in the fifth and third group consisted of the drop of concentration of β-CG by 22.8% (р<0.001), of estriol by 26.1% (р<0.01), of progesterone by 32.1% (р<0.001) and placental lactogen by 32.4% (р<0.001). At the same time there were no significant changes in the concentration of DEAS and there were registered higher indicators of cortisol, i.e. the increase by 11.5% (р<0.05), which suggested the significance of the growth of antivirus antibody titers in the suppression of synthesis of hormones in ovaries and in syncytiotrophoblast as a result of direct and indirect negative influence of influenza infection.

The publication provides an overview of the literature devoted to modern methods of diagnosis of malignant pleural mesothelioma (MPM). The analysis of medical records of 14 MPM patients who were treated in the Amur regional clinical hospital in 2009-2014 was done. One case is dealt with in detail. Difficulties in diagnosing MPM happen due to the following factors: the early symptoms of this tumor are not specific, and patients often seek help in the advanced stages; the difficulty of differentiation between benign diseases of the pleura and metastasis of other tumors in the pleura; not full availability of computed tomography (CT) and a VATS biopsy; insufficient awareness of primary care physicians about the features of MPM course. To improve the diagnosis of MPM it is recommended to perform CT of the chest as the primary method of diagnosis in individuals of 50 years old, especially in those exposed to asbestos in the past.

Progesterone is a natural steroid hormone that has many functions in the organism, regulating the work of non-reproductive and reproductive tissues. The article describes the mechanism of hormone effects. The data about genomic and nongenomic effects of progesterone through intracellular and plasma membrane's receptors are presented. Specific effects of progesterone in various tissues depend on the ratio of receptors and their coregulators. Progesterone is the main hormone of pregnancy; therefore a large section is devoted to its action in that period. The hormone functions include participation in the ovulation and implantation processes, decidual transformation of endometrial tissue, inhibition of uterine contractility, suppression of the mother immune system, the accumulation of nutrients for fetal growth, development of the mammary glands, co-operation in the development of the embryo tissues. Several mechanisms of preventing myometrial contractility and transition mechanism of maternal immune system to function in conditions of pregnancy are considered in detail. Besides the hormone role during pregnancy, the regulation of other important functions of the human body is described.

The effectiveness of medical care in most cases depends on the quality of informational exchange between the doctor and the patient. Often, selected models of the therapeutic interaction, which are the basis for the doctor-patient relationship and form a common psychological background of this communication are very important. The article presents a brief review of the main models of the therapeutic interaction in the foreign and domestic literature. Also we determined the most preferable of them. We showed the important role of doctor’s communicative competence, as well as the fact that possession of communicative skills allow them to solve medical-diagnostic and organizational problems more effectively while treating the patient. Also we studied the main components of effective interaction, promoting the formation of trust between the patient and the doctor.

The review reveals modern concepts of morphology and biochemistry of the intercellular substance of connective tissue of the skin dermis, as well as the characteristic of its cellular composition (fibroblasts, mast cells, histiocytes). The main physical factors influencing the aging process have been studied. It has been shown that age-related skin changes are associated with the decrease in the number of fibroblasts and the amount of collagen, changes in its structure and the relation between its different types of collagens.

One of the methods to evaluate lung function is body plethysmography. Body plethysmography allows to measure indicators that cannot be obtained during spirometry, that is: total lung capacity (TLC), bronchial resistance (Raw), and functional residual capacity (FRC). FRC measured by body plethysmography reflects thoracic gas volume (TGV or V_TG), and includes both ventilated and poorly ventilated volume. Plethysmographic measurements are based on the principle of the relationship between pressure and volume at constant temperature and fixed amount of gas. This principle states that the absolute pressure exerted by a given mass of an ideal gas is inversely proportional to the volume it occupies if the temperature and amount of gas remain unchanged within a closed system (Boyle-Mariotte Law). In body plethysmography, the following parameters: TGV, vital capacity (VC), expiratory reserve volume (ERV), tidal volume (TV), inspiratory reserve volume (IRV), inspiratory capacity (IC), Raw are obtained. TLC, residual volume (RV) and its share in total lung capacity can be calculated. Reduced TLC allows to diagnose restrictive disorders of pulmonary ventilation. The RV and its share in TLC increase together with airway obstruction indicates air trapping. The TGV increase together with airway obstruction indicates hyperinflation. In the analysis of lung volumes predictive values, which are calculated by the formulas recommended by ATS/ERS statement, are used. The results are expressed as a percentage of the predicted value. Thus, body plethysmography is an important addition to spirometry and image methods of research, allowing to assess the functional state of the lungs more objectively; it helps to conduct the differential diagnosis and control the course of the disease.

Main modern methods of etiological diagnosis of respiratory diseases in children according to national and foreign literature were studied. Relevant pathogens of pneumonia in children were presented. Diagnostic value and prospect of molecular diagnostic methods, i.e. PCR and PCR-real-time were demonstrated. The estimation of the possibility of their use in clinical bacteriological laboratory was done. It was shown that the use of "gold standard", i.e. sputum (bronchoalveolar lavage) bacteriological studies by the standard method remains relevant and accessible and serves as a source of important information about local drug resistance of the main causative agent of pneumonia - Streptococcus pneumoniae .