Introduction. Currently, COVID-19, which is rapidly spreading around the world in the form of a pandemic, is a serious public health problem that poses a significant epidemiological and medico-social threat to the population and its quality of life, and affects all spheres of public life and economy. Aim. To assess the degree of influence of the pandemic of the new respiratory viral infection COVID-19 on the level of registered primary morbidity by classes of diseases, including the class "Diseases of the respiratory system" in the territory of the Far Eastern Federal District.

Materials and methods. To implement the tasks of the study, a complex of analytical, epidemiological and statistical studies was carried out. Methods used: epidemiological analysis and monitoring, statistical, comparative and correlation analysis and methods for analyzing time series. Epidemiological and statistical assessment of the incidence of the population was carried out on the basis of ICD-10 according to the data of the state statistical monitoring of the incidence of the population of the Russian Federation for 2019-2020 using the database of the Ministry of Health of the Russian Federation, the Central Research Institute of Organization and Informatization of Healthcare of the Ministry of Health of the Russian Federation.

Results. The pandemic of the new respiratory viral infection COVID-19 significantly changed the dynamics of the registered morbidity in the adult population, which dropped sharply in all ICD-10 classes, most intensively in the classes "Diseases of the endocrine system" (by 27.8%), "Diseases of the blood and hematopoietic organs" (by 22.6%), "Neoplasms" (by 21.1%), "Diseases of the circulatory system" (by 18.5%), with the exception of the class "Diseases of the respiratory system", the level of primary morbidity for which in the territory of the Far Eastern Federal District in 2020 increased by 23.9%. The most common and severe clinical manifestation of COVID-19 is bilateral pneumonia, the incidence of which among the adult population in the Far Eastern Federal District increased 2.7 times, and in the territory of the Russian Federation – 3.8 times. At the same time, the incidence of pneumonia in the child population decreased by 36.4%. Along with the growth of acute forms of respiratory pathology during the COVID-19 pandemic in the Far Eastern Federal District, the level of registered primary morbidity of chronic respiratory diseases decreased: chronic bronchitis (by 22.3%), bronchial

asthma (by 20.8%), COPD (by 3, 6%).

Conclusion. The negative dynamics of the growth of the registered morbidity of the population can have negative consequences due to the late detection and untimely diagnosis of chronic forms of pathology, including respiratory diseases, their progression and the development of life-threatening complications of the disease and, as a consequence, an increase in mortality from these causes of the population, who did not receive timely and adequate medical assistance.

Introduction. Currently, COVID-19, which is rapidly spreading around the world in the form of a pandemic, is a serious public health problem that poses a significant epidemiological and medico-social threat to the population and its quality of life, and affects all spheres of public life and economy. Aim. To assess the degree of influence of the pandemic of the new respiratory viral infection COVID-19 on the level of registered primary morbidity by classes of diseases, including the class "Diseases of the respiratory system" in the territory of the Far Eastern Federal District.

Materials and methods. To implement the tasks of the study, a complex of analytical, epidemiological and statistical studies was carried out. Methods used: epidemiological analysis and monitoring, statistical, comparative and correlation analysis and methods for analyzing time series. Epidemiological and statistical assessment of the incidence of the population was carried out on the basis of ICD-10 according to the data of the state statistical monitoring of the incidence of the population of the Russian Federation for 2019-2020 using the database of the Ministry of Health of the Russian Federation, the Central Research Institute of Organization and Informatization of Healthcare of the Ministry of Health of the Russian Federation.

Results. The pandemic of the new respiratory viral infection COVID-19 significantly changed the dynamics of the registered morbidity in the adult population, which dropped sharply in all ICD-10 classes, most intensively in the classes "Diseases of the endocrine system" (by 27.8%), "Diseases of the blood and hematopoietic organs" (by 22.6%), "Neoplasms" (by 21.1%), "Diseases of the circulatory system" (by 18.5%), with the exception of the class "Diseases of the respiratory system", the level of primary morbidity for which in the territory of the Far Eastern Federal District in 2020 increased by 23.9%. The most common and severe clinical manifestation of COVID-19 is bilateral pneumonia, the incidence of which among the adult population in the Far Eastern Federal District increased 2.7 times, and in the territory of the Russian Federation – 3.8 times. At the same time, the incidence of pneumonia in the child population decreased by 36.4%. Along with the growth of acute forms of respiratory pathology during the COVID-19 pandemic in the Far Eastern Federal District, the level of registered primary morbidity of chronic respiratory diseases decreased: chronic bronchitis (by 22.3%), bronchial

asthma (by 20.8%), COPD (by 3, 6%).

Conclusion. The negative dynamics of the growth of the registered morbidity of the population can have negative consequences due to the late detection and untimely diagnosis of chronic forms of pathology, including respiratory diseases, their progression and the development of life-threatening complications of the disease and, as a consequence, an increase in mortality from these causes of the population, who did not receive timely and adequate medical assistance.

Aim. Etiological diagnosis and epidemiological evaluation of long lasting and massive cite of respiratory infections and pneumonia developed in Birobidzhan asylum for psychoneurological patients (BAPP) during March-April of 2018.

Materials and methods. Epidemiological analysis of 166 people included 150 out of 523 patients of BAPP (28.7%) and 16 BAPP staff members. Pneumonia was registered in 36 out of 166 surveyed people (21.7%), acute respiratory viral infection and influenza was diagnosed in 130 people (78.3%). All infected people were hospitalized. Lethal cases were registered. PCR analysis was performed for all infected persons in order to identify nucleic acids of viral, atypical respiratory pathogens and several bacterial causative agents. Microbiological studies were performed using the classical method. Bacteriological examination of 26 staff members was performed as well as sanitary-bacteriological inspection of hospital environment (75 samples) and chemical analysis of disinfecting solutions (30 samples).

Results. Laboratory confirmed cases of influenza type B and A were revealed in 69 people (41.6%) out of 166 examined patients. Single cases of rhinovirus infection (0.6%) were identified. High levels of S. pneumoniae (55.6%) and H. influenzae (from 44.4 to 16.1% at different stages of the study) were detected. Bacteriological evaluation of 54 patients of BAPP revealed low levels of S. pneumoniae carriage (5.6%) and presence of H. influenzae (3.6%). S. aureus (37.0±6.6%), K. pneumoniae (9.3%), Candida spp. (24.1%) as well as single cases of Enterobacter spp., S. marcescens, Citrobacter spp., non-fermenting Grammnegative bacteria without markers of drug resistance were detected. Bacteriological and virological examination of two autopsy materials obtained from patients died from pneumoniae showed presence of influenza B RNA, DNA of S. pneumoniae and H. influenzaе in one case and К. pneumoniae that ESBL-produced in other. Strains of such type can be formed in hospital environment or in conditions of private community. Circulation of bacterial pathogens was surveyed in one of the institutions that provided medical aid for supervisees of the asylum. Laboratory examination of hospital personnel revealed clinically relevant pathogens (S. aureus, K. pneumoniae, Acinetobacter spp. without markers of drug resistance) in 11 out of 26 staff members (42.3%). Hospital environment evaluation showed presence of bacterial flora in 11.9% of samples including E. coli, A. baumannii and one strain of P. aeruginosa that produced carbapenemases. Violation of disinfection regimen was detected in 60% of disinfection solution samples that had reduced concentration of active agent. Revealed violations characterize hospital environment as potentially dangerous that can cause formation of healthcare-associated infections.

Conclusion. Foci of viral-bacterial respiratory infections and pneumonia had developed in BAPP. Presence of multiple risk factors among supervised group of people determined large-scale involvement and duration of the outbreak involving supervisees and personnel of the asylum. Repeated hospitalization of patients in hospitals of the city in which several factors that presumably contributed to formation of healthcare-associated infections played an important role in sustaining the epidemiological process.

Introduction. A change in the level of relative humidity of the inhaled air can lead to the appearance of symptoms of airway hyperresponsiveness (AHR) in patients with asthma. Allelic variations of the TRPV genes encoding osmotic receptors may serve as an internal factor predisposing to the development of respiratory manifestations in response to an osmotic trigger.

Aim. The aim of the study was to establish the contribution of some single nucleotide polymorphisms (SNPs) of TRPV1 and TRPV4 to the development of osmotic AHR in asthma patients.

Materials and methods. Three hundred patients with mild and moderate asthma were enrolled in the study. Osmotic AHR was diagnosed using bronchoprovocation tests with inhalation of distilled water, hypertonic saline (4.5% NaCl) or by treadmill exercise challenge test. Three SNPs (rs222747, rs224534 и rs8065080) of TRPV1 and two SNPs (rs6606743, rs7971845) of TRPV4 were geno- typed.

Results. Carriage of the AA genotype for rs6606743 was associated with a lower probability of developing hypo-osmotic-induced bronchospasm. This result was confirmed in recessive (OR 0.43 95% CI [0.19; 0.94], p=0.02) and Logadditive (OR 0.62 95% CI [0.4; 0.96], p=0.03) inheritance models. Besides, in patients with the AA genotype, a less pronounced decrease in all basic parameters of lung function was observed as compared with GG and ΔG genotypes (ΔFVC, ΔPEF and ΔFEF₇₅ - p<0.01; ΔFEV₁ ΔFEV₁/FVC, ΔFEF₅₀ and ΔMMEF - p<0.001).

Conclusion. A protective effect of the AA genotype for rs6606743 of TRPV4 was revealed in relation to the formation of hypoosmotic AHR.

Introduction. Cold air-induced bronchoconstriction in patients with asthma, leading to a breakdown in disease control, is one of the most serious problems in the northern countries of the world.

Aim. To assess the seasonal dynamics of the airway response (ΔFEV_1CA) to cold bronchoprovocation in asthma patients with cold airway hyperresponsiveness (CAHR).

Materials and methods. Out of 513 asthma patients who underwent primary bronchoprovocation testing, 273 patients (140 women; 133 men) with diagnosed CAHR took part in the retrospective analysis. The design objectification of clinical data using the Asthma Control Test questionnaire (ACT, Quality Metric Inc., 2002), a screening questionnaire for identifying clinical symptoms of response to low ambient temperature in everyday life; assessment of the lung function; bronchoprovocation test of 3-minute isocapnic hyperventilation with cold (-20ºC) air (IHCA).

Results. At the time of testing, the average age of patients was 34.8±0.87 years, FEV₁ 88.5±1.3% of predicted, FEV₁/VC 70.9±0.7%; ACT 16 (12; 19) points. On average in the group, ΔFEV_1CA was -19.2±0.6%. The frequency of CAHR detection in the winter was 22%, spring – 34%, summer – 22%, autumn – 24% (p>0.05). The minimum changes in FEV₁ in response to IHCA were recorded in May-June (mean value ΔFEV_1CA -16.2±1.3 and -14.5±1.6%, respectively) and were significantly less in comparison with February (-21.9±2.3%, p˂0.05) and April (-23.0±2.36%, p˂0.01). A correlation has been found between the monthly mean values of meteorological parameters and CAHR, as well as the value of ACT in points and ΔFEV₁ (r=0.16; p=0.018).

Conclusion. Seasonal changes in the strength of the action of meteorological factors produce a change in the response of the airways to cold bronchoprovocation, and contribute to the loss of asthma control. The maximum values of CAHR fall on February-April, August, November. The data obtained reflect the presence of a complex  interaction of physical environmental factors in the induction of seasonal fluctuations of CAHR, which requires a search for specific mechanisms for the formation of altered airway reactivity associated with the characteristics of molecular reception of low temperatures and humidity in the human airways.

Aim. To compare the nature and degree of influence of different types of airway hyperresponsiveness (AHR) on the general and specific quality of life (QoL) of patients with asthma and control over the disease.

Materials and methods. 234 patients with mild-to-moderate asthma, aged from 18 to 60 years old, were interviewed and examined. Depending on the presence of one or another type of AHR, 4 groups were formed: group 1 included 60 patients with cold AHR, group 2 – 75 patients with hypoosmotic AHR, group 3 – 35 patients with hyperosmotic AHR, group 4 – 64 patients with exercise-induced bronchoconstriction (EIB). QoL and the state of the emotional sphere were assessed using the SF-36, AQLQ, HADS questionnaires. The level of asthma control was determined using the ACT questionnaire. Lung function was assessed by spirometry.

Results. When comparing QoL between groups, statistical differences were obtained for most of the SF-36 scales, with the exception of the domains “Role Physical” (RP) and “Bodily Pain” (BP), and their presence and significance varied depending on the types of AHR being compared. The lowest QoL indices were found in group 1 of patients with cold AHR according to the domains “Physical Activity” (PA), RP, BP, and “Role Emotional” (RE). The lowest indices for the domains “General Health” (GH), “Vitality” (V) and “Mental health” (MH) were found in the respondents of the 2nd group. Most of the highest QoL indicators in the compared groups were found in patients of group 4 with EIB in the domains PA, RP, V, RE, and MH. When carrying out a comparative analysis, the maximum number of significant differences was found between the groups with cold AHR and EIB. A comparative study of QoL using a special AQLQ questionnaire showed the lowest indices for the “Activity” and “Symptoms” domains in groups 1 and 2 of asthma patients. In addition, in group 1, the minimum QoL values were recorded for the “General QoL” domain (3.6±0.2 points), and in group 2, for the “Environment” domain (2.9±0.3 compared with 3.9±0.2 points in group 3, p<0.01).

Conclusion. This study has demonstrated the multifaceted effect of AHR on health-related QoL, dependent on sensitivity to a particular physical stimulus and the season of maximum trigger action. The subjective assessment of psychosocial functioning is most differentiated according to the GH domain of the SF-36 questionnaire. The greatest negative impact on the QoL indices is exerted by the cold and hypoosmotic AHR, the least – by the EIB. The assessment of QoL allows to get a full picture of the perception of the patient's health level at the moment and in the given conditions.

Introduction. In patients with uncontrolled asthma, the stress-induced production of glucocorticosteroids in response to a cold bronchoprovocation test is increased, which is associated with an increase in the level of thyroidstimulating hormone (TSH), characteristic of the syndrome of subclinical hypothyroidism (SH). The peculiarities of thyroid hormone metabolism and changes in pituitary-adrenal homeostasis that develop in asthma in a goiter-endemic region under the influence of cold stress factors on the respiratory system are poorly studied.

Aim. To assess the activity of the pituitary-thyroid and pituitary-adrenal systems in response to bronchoprovocation with cold air in asthma patients with cold airway hyperresponsiveness (CAHR) and SH living in conditions of goiter endemic in the Amur Region.

Materials and methods. In 34 asthma patients with CAHR, without symptoms of thyroid diseases, the level of disease control was assessed using the Asthma Control Test (ACT) questionnaire. Lung function and airway reaction to a cold stimulus (ΔFEV_1IHCA) during 3-minute isocapnic hyperventilation with cold (-20ºC) air (IHCA) were measured. Methods of immunological diagnostics in the blood of patients before and after the IHCA test were used to measure the concentrations of thyroid-stimulating (TSH) and adrenocorticotropic (ACTH) hormones, common and active forms of thyroxine (T4) and triiodothyronine (T3), thyroglobulin (TG), autoantibodies to thyroperoxidase (AB-TPO), cortisol. The content of cyclic adenosine monophosphate (cAMP) was determined in leukocytes.

Results. The patients were divided into two groups: group 1 included 25 patients with an initially low (<4.0) TSH level (2.39±0.18 mU/L), group 2 included 9 patients with an initially high (>4, 0) TSH level (4.80±0.46 mU/L, p<0.0001). The ACT control level in groups 1 and 2 was 16.6±1.0 and 15.3±1.5 points (p>0.05), base FEV1 was 95.8±3.3 and 81.0±5.4% (p=0.026), ΔFEV_1IHCA -11.9±0.96 and -13.5±2.7 (p>0.05), respectively. In group 1, in response to IHCA, the level of free T4 increased from 14.2±0.70 to 15.2±0.71 pmol/L (p<0.05), free T3 from 3.73±0.24 to 4.15±0.21 nmol/L (p<0.05). In group 2, a lower level of free T4 was recorded, both before (12.2±1.52 pmol/L) and after IHCA (11.6±1.60 pmol/L, p=0.041). In addition, in group 2 patients, the cortisol concentration at baseline and after IHCA (516.6±31.6 and 397.4±40.4 nmol/L, p<0.05) was significantly lower than in group 1 (628.3±27.5 and 608.3±34.1 nmol/L, p=0.042; p=0.002, respectively). A close correlation was found between ΔFEV₁ and the T4 level before (r=0.54; p<0.01) and after the test (r=0.41; p<0.05), with the amount of cAMP up to (r=0.58; p=0.008) and after the test (r=0.47; p=0.009), as well as the correlation between ΔМEF₅₀ and the initial level of cortisol in the blood serum (r=0.50; p=0.002).

Conclusion. In asthma patients with CAHR living in the region of cold climate and goiter endemic, the presence of SH can be considered as a prognostic sign of the development of dysadaptation of the respiratory system to cold exposure.

Aim. Evaluation of nanostructural and micromechanical characteristics of erythrocytes and their relationship with the parameters of oxygen transport in patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) under artificial circulation (AC).

Materials and methods. The study involved 30 men with IHD aged 53 to 67 years with a median of 63 years, who underwent planned CABG with AC at the clinic of the Far Eastern Federal University. Blood sampling from patients was carried out before the AC and one day after it from a venous catheter located in the right atrium. Erythrocytes were scanned using a Bioscope Catalyst atomic force microscope (AFM) (Bruker, USA) in combination with an Axiovert 200 inverted microscope (Zeiss, Germany). The micromechanical properties of cell membranes were investigated with the PFQNM-LC-A-CAL cantilevers. The following were recorded: the diameter of erythrocytes, the height of their side, area, volume, membrane rigidity, strength of its adhesion, Young's modulus, elastic deformation. To assess oxygen transport, the oxygen delivery index (DO₂I), consumption (VO₂I), and extraction ratio (O₂ER) were calculated.

Results. In one day after CABG, a decrease in DO₂I, VO₂I, and O₂ER was recorded by 14%, 33%, and 16%, respectively, which indicated a limitation in the gas transport function of the blood. Analysis of the AFM characteristics of erythrocytes showed an increase in their area by 35%, in diameter by 6%, in volume by 19%, and the height of the side by 5 times. At the same time, multidirectional changes in the micromechanical properties of erythrocyte membranes were noted: Young's modulus and stiffness decreased by 3.2 and 2 times, respectively; the adhesion force increased by 2.7 times, and the elastic deformation – by 2.2 times. Correlation analysis showed the presence of reliable relationships between indicators of oxygen transport and biomechanical parameters of erythrocyte membranes.

Conclusion. A comprehensive analysis of the nanostructural parameters of erythrocytes and oxygen transport expands the understanding of the pathophysiological mechanisms of postperfusion disorders in patients with coronary artery disease after CABG under conditions of cardiopulmonary bypass.

Introduction. Childhood tuberculosis (TB) control is relevant due to the peculiarities of its course in this age group, and the TB incidence in children is an important prognostic epidemiological indicator.

Aim. Use of multivariate statistical analysis to estimate and predict childhood TB indicators in the Republic of Crimea (RC).

Materials and methods. The official TB statistics in the Republic of Crimea for 2014-2018 are used. The calculated means of the indicators are checked for normality using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Pearson correlation analysis is applied to determine pair correlation relationships. Stepwise multiple regression analysis is carried out to determine group conditionality of the indicators, where coefficients, with which significant pairwise correlations are found, are selected as independent variables. Based on the results, multiple regression equations are made to predict the values of dependent variables. The data is processed using Statistica 10.0 software.

Results. For childhood TB incidence, strong direct correlations are established with the incidence and prevalence of pulmonary TB among children. The paired correlation coefficient between the incidence of childhood TB and childhood lung TB and the detection of active TB patients in preventive examinations of children varied in the range of 0.63-0.72. For the prevalence of TB among children, strong direct correlations were found with the incidence of TB and pulmonary TB in children. Multiple correlation coefficients for the incidence and prevalence of childhood TB exceeded the values of paired correlation coefficients and were in the range of 0.93 to 0.98 (p<0.001), indicating greater significance of group conditionality of the indicators. Determination coefficients R² were between 0.87 and 0.96. Multiple regression models were built for the childhood TB incidence, childhood lung TB incidence, childhood TB prevalence, childhood lung TB prevalence.

Conclusion. The found strong direct pairwise correlations for childhood TB incidence and prevalence and childhood pulmonary TB incidence and prevalence can serve as prognostic criteria and reflect the quality of antituberculosis interventions. High values of paired correlation coefficient between childhood TB incidence and childhood pulmonary TB and detection of patients with active TB in preventive examinations of children are a criterion of quality of both TB services and primary care, which can prevent the spread of TB and improve the epidemic situation of TB in Crimea. The calculated multiple regression models for the studied indicators can serve the needs of practical forecasting in Healthcare.

Aim. To verify contribution of intrauterine infections to early neonatal mortality, using autopsy and molecular genetic findings.

Materials and methods. The study was carried out at the premises of the Research Institute of Maternity and Childhood Protection and the Pathology Department of the Khabarovsk Perinatal Center. An analysis was made of the data on medical history, pregnancy course and outcome, morphological placental study in seven cases of early neonatal death. Genomes of Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma species (Ureaplasma urealyticum + Ureaplasma parvum), Streptococcus agalactiae, Staphylococcus spp., Pseudomonas aeruginosa, Klebsiella pneumoniae, Haemophilus influenza, Listeria monocytogenes, Cytomegalovirus, Herpes simplex virus, Human herpesvirus type 4, and Human herpesvirus type 6 were detected by polymerase chain reaction (PCR) in samples of placental tissue.

Results. Samples of six out of seven placentas (85.7%) in early neonatal death cases were found to present with genomes of opportunistic microorganisms, which are part of biocenosis of the woman’s urogenital tract and enter the placenta and the fetus by an ascending pathway (S. agalactiae, Ureaplasma spp., M. hominis), as well as genomes of opportunistic herpesviruses (Cytomegalovirus, Human herpesvirus type 6), which constantly persist and reproduce in human lymphocytes and are transmitted mainly by a transplacental route. Infectious and inflammatory changes in placenta and membranes resulting in respiratory disorders, fetal hypoxia and asphyxia were found in all cases of opportunistic pathogen detection.

Conclusion. This is indicative of the ability of the said opportunistic organisms to contribute to the pathogenesis of neonatal death. Contribution of intrauterine infections to early neonatal death cases is made up of both congenital neonatal infection cases and cases of infectious and inflammatory processes in placenta and membranes leading to respiratory distress, the immediate cause of death.

Aim. To assess the change in the concentration of endothelin-1 (ET-1) and the state of uteroplacental blood flow in women in the third trimester of gestation with exacerbation of cytomegalovirus infection (CMVI) in the second trimester of pregnancy.

Materials and methods. A comprehensive examination of 120 women with pregnancies uncomplicated and complicated by exacerbation of CMVI in the second trimester of gestation was carried out. The first group consisted of 30 women with a seronegative CMVI normal pregnancy, the second group – 30 patients with a latent course of CMVI and the development of chronic compensated placental insufficiency (CCPI), the third – 30 women with exacerbation of CMVI and CCPI, and the fourth – 30 patients with exacerbation of CMVI and chronic subcompensated placental insufficiency (CSPI).

Results. With the development of CCPI at 30-34 weeks of gestation in women of the second group, compared with the first, the concentration of ET-1 in blood serum increased to 1.16±0.09 fmol/L (in the control – 0.86±0.08 fmol/L, p<0,05). There was an increase in the systolic-diastolic ratio (SDR) in the right uterine artery (RUA) by 1.40 times (p=0.000001) and in the left uterine artery (LUA) by 1.46 times (p=0.000001), which illustrated the important role of endothelial activation in increasing resistance in the uterine artery basin. In the third group, in comparison with the first and second ones, an increase in the concentration of ET-1 was recorded to 1.57±0.13 fmol/L (p<0.001 and p<0.05, respectively), reflecting a more pronounced activation of the endothelium. In women of the third group, in comparison with the first and second groups, there was an increase in SDR in the RUA by 1.43 times (p=0.000001) and 1.01 times (p=0.046), respectively. Comparison of blood flow in the LUA in women in the third group in comparison with that in the first and second groups showed an increase in SDR by 1.47 times (p=0.000001) and 1.01 times (p=0.0462), respectively. At the same time, a strong positive correlation was recorded between the SDR in the RUA and the level of ET-1 (r=076; p<0.001), which is a marker of an endothelium-dependent increase in vascular resistance. In women of the fourth group, the level of ET-1 was 2.15±0.17 fmol/L, which is significantly higher compared with group 1 (5.08 times, p=0.000001), with the second group (4.08 times, p=0.000001) and in comparison with the third group (1.23 times, p=0.0029). SDR in RUA in the fourth group compared to the first one increased by 1.62 times (p=0.000001), and compared to the second – by 1.15 times (p=0.00002). At the same time, in patients of the fourth group in comparison with the third group, SDR in RUA increased by 1.13 times (p=0.024). In the fourth group, in contrast to the first one, there was an increase in SDR in LUA by 1.58 times (p=0.000001), and in comparison, with the second group, SDR in LUA was 1.07 times higher (p=0.00021). Patients of the fourth group, in comparison with the third one, had higher SDR indices in the LUA (1.06 times, p=0.0207). There was a stronger relationship between the SDR value in RUA and the concentration of ET-1 (r=0.86; p<0.001) and a weak correlation between SDR in LUA and ET-1 (r=0.47; p<0.01), which reflects the influence of endothelial dysfunction in response to an increase in the tone of the uterine arteries.

Conclusion. The development of CSPI in the third trimester of gestation in women who underwent an exacerbation of CMVI in the second trimester of pregnancy, in contrast to CCPI with a similar infectious pathology in pregnant women, is characterized by a more pronounced increase in vascular resistance in the uterine artery basin against the background of endothelial dysfunction.

Introduction. It is now generally acknowledged that cytomegalovirus infection (CMVI) is one of the main causes of miscarriage. However, the mechanism of this effect has not been sufficiently studied. At the same time, the influence of acids of the ɷ-3 family and α-tocopherol (αTP) on the placentation process through a pro-angiogenic action is shown.

Aim. To study the concentration of αTP and ɷ-3 family acids in the peripheral blood and establish their role in miscarriage in CMV-seropositive women with CMVI reactivation.

Materials and methods. A case-control study included 64 women in the first trimester of pregnancy (7-10 weeks), of which 36 were CMV-seropositive with CMVI reactivation (main group) and 28 were CMV-seronegative (control group). CMVI was diagnosed by the determination of class M and G antibodies by ELISA, as well as CMV DNA detected by PCR. The concentration of ɷ-3 acids of the family (eicosapentaenoic – EPA, docosahexaenoic – DHA) in blood serum was studied by capillary gas-liquid chromatography (J.P.Carreau, J.P.Dubacq). The αTP concentration was determined by the fluorometric method (L.G.Hansen, W.I.Warwich).

Results. In women of the main group, a significant (p<0.001) decrease in the concentration of αTP to 1.32±0.025 μg/mL was observed in the peripheral blood compared to the same indicator in the control group (1.49±0.029 μg/mL). At the same time, the levels of EPA and DHA were also statistically significant (p<0.001) lower than the same indicator in the control group and amounted to 1.09±0.012 and 6.09±0.015%, respectively (in the control, 1.29±0.071 and 8.80±0.071%, respectively). Conclusion. The obtained results of the study allow us to establish the important role of disorders in the content of α-TF, EPA and DHA in the pathogenesis of miscarriage during reactivation of CMVI in the early periods of gestation, which can serve as a basis for expanding diagnostic and therapeutic measures in this pathology of pregnant women.

Aim. Morphological analysis of the deployment of histogenetic information of pulmonary parenchyma at the stages of late embryogenesis and fetogenesis in laboratory rats within the limits of the norm of reaction with verification according to morphometric criteria of individual morphotypes.

Materials and methods. Comparative morphological study of histogenesis of endodermal derivatives of the lungs of rats at critical periods of intrauterine development – late embryogenesis (day 14 of gestation), and late fetogenesis (day 20 of gestation) was performed using morphometric identification of plane parameters and a complex of plane form factors of epithelial structures of the lung. Morphometric studies were carried out in the Morphometer program on semi-thin sections of the rat lung.

Results. Two critical stages of histogenesis of entodermal beginnings of fetal lungs are described – pseudoglandular and canalicular. The options of discordance of individual development within the response norm are justified. The lungs of the fetus at the pseudoglandular stage and the canalicular stage show significant fluctuations in the plane values of the pulmonary parenchyma, the presence in different individuals of variants of the plane values of entodermal derivatives, which indicated individual morphotypes of the development of the rat lung. At the pseudoglandular stage, in fetus with type I, called “compact”, the total area of the tubular system and the total perimeter are significantly inferior (p<0.001) to the same indicators of the lung II morphotype, designated as “air”. The values of one tubule (the outer perimeter, its area, the dimensions of the X-projection and Y-projection, the length of the epithelial tubes) in type I, on the contrary, are significantly larger than in type II (p<0.01). Among form factors, reliable differences have elongation (FE), squareness (FQ) and equivalent radius (FR) (p<0.01), less significant compactness (FF) and roundness (FC) (p<0.05). The discordance of development is established by a number of reliable values at the stage of late fetogenesis: the area of the tubule (p<0.01), the area of the epithelium of the preacinar department (p<0.001), the value of the outer perimeter of the tubule, the length and, to a lesser extent, the width of the tubule (p<0.05) significantly exceed such type II indicators. In this regard, the dimensions of X- and Y-projections for type I are also increased (p<0.05).

Conclusion. As a result of morphological studies, the development of entodermal derivatives of pulmonary parenchyma at the pseudoglandular stage (day 14 of gestation) and the canalicular stage (day 20 of gestation) in rat fetus was verified; morphometric criteria for assessing the histogenesis of entodermal parenchyma units at critical stages of development have been introduced; comparative analysis of morphometric indices of different individuals in gestation dynamics; individual variants of two morphotypes are objectified – “compact-I” and “air-II” in the process of histogenesis of the fetal lungs.

Introduction. Airway hyperresponsiveness to osmotic stimuli is often found among patients with asthma. It is assumed that the transient receptor potential channels of vanilloid subfamily (TRPV) may play a key role in the onset of this phenomenon.

Aim. Review of modern world literature data on osmotic airway hyperresponsiveness and the role of TRPV channels in its development.

Materials and methods. This review summarizes the data from articles published over the past five years found in PubMed and Google Scholar. However, earlier publications were also included if necessary.

Results. The influence of natural osmotic triggers on the formation of bronchoconstriction in patients with asthma has been demonstrated. The effects that occur in the airways, depending on the functional state of TRPV1, TRPV2 and TRPV4 osmosensitive receptors are described, and the mechanisms that mediate the development of bronchial hyperresponsiveness with the participation of these channels are partially disclosed.

Conclusion. It is safe to assume that TRPV channels are directly or indirectly associated with airway hyperresponsiveness to osmotic stimuli. Signaling cascades triggered by TRPV activation largely explain the effects of osmotic influence on the airways and the occurrence of bronchoconstriction. It could be suggested that TRPV1 signaling mediates the development of bronchospasm to hyperosmolar stimuli, while TRPV2 and TRPV4 are most likely involved in hypoosmotic-induced bronchoconstriction. Further study of the role of TRPV1, TRPV2 and TRPV4 in osmotic airway hyperresponsiveness is relevant and promising in terms of pharmacological management of this condition.

Introduction. Cardiovascular disease is the leading cause of morbidity, disability and mortality in modern society. Coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD) are the most common comorbid pathology that worsens the quality of life and prospective prognosis of patients.

Aim. The literature review is focused on postoperative outcomes of patients with COPD undergoing coronary artery bypass grafting surgery (CABG).

Results. The review presents national and international data the prevalence of COPD in patients having CABG. The issues of risk stratification of comorbid patients in cardiac surgery are considered. It is shown that patients with CAD in combination with COPD are more at risk of various complications after CABG. COPD increases the chances of a complicated course of the in-hospital period by 2.1 times and risk of death in the long-term period after CAPG by 1.8 times. Patients with COPD are at a higher risk of developing postoperative pneumonia, respiratory failure, stroke, kidney failure, and wound infection of the sternum. Long-term 5-year and 10-year survival after CABG is lower in patients with COPD. The longterm adverse prognosis depends on the severity of the bronchial obstruction. Achievements in the field of cardiac surgery have had a significant impact on the results of surgical interventions in the comorbid course of CAD and COPD. Intensive pulmonary rehabilitation after surgery and effective drug therapy can improve the outcomes after CABG in patients with COPD. Hybrid coronary revascularization and minimally invasive coronary surgery appear to be viable alternatives to conventional CABG, offering a less invasive approach to coronary revascularization, which may be especially beneficial to high-risk patients with COPD.

Introduction. The review discloses the results of scientific works related to a modern high-tech method for conducting morphological studies in biology and medicine – confocal laser scanning microscopy. This method, in combination with immunofluorescence histochemistry, can be used in a variety of studies: from rapid visualization of dynamic processes in living cells to thorough morphological analysis of tissues, spatial distribution of macromolecules in fixed or living cells, automatic collection of three-dimensional data, visualization of several labeled samples and measurement of physiological processes in living cells and tissues of organs.

Aim. To determine the current possibilities and prospects of confocal laser scanning microscopy in morphological studies.

Results. When analyzing scientific literature data, the opportunities and prospects of using confocal laser scanning microscopy in biomedical and morphological studies are presented. The use of the confocal diagnostic method in gynecology, molecular biology, endocrinology, endoscopy is shown. Particular attention is paid to the application of this research method in embryology. In addition, information about the role of confocal microscopy in the study of microbial pathogenesis in a three-dimensional context is provided. Data on the history, basic principles, technical innovations and advantages of confocal laser scanning microscopy are presented.

Conclusion. The study of modern scientific literature has shown the importance of using confocal laser scanning microscopy in modern scientific research and diagnosis of diseases in a clinical setting, which will allow to take a new look at some aspects in modern morphology and medicine.

The issue of reforming not only the healthcare system as a whole, but also the system of training medical and pharmaceutical personnel is relevant today. The main direction of the National Project "Healthcare" is the solution of the issue of providing healthcare institutions with qualified personnel, the introduction of a system of continuing medical education (the National Project "Healthcare", the federal project "Providing medical organizations of the healthcare system with qualified personnel"). In this regard, the requirements for persons who have mastered educational programs and are engaged in medical activities on the territory of Russia have changed. Admission to medical activity, according to modern trends, should be objective, uniform and universal throughout the country. The aim of this article is familiarization of specialists with higher medical and pharmaceutical education with the legislative framework and methodology for conducting the accreditation procedure for specialists. Primary, primary specialized and periodic accreditation is a complex organizational, methodological and engineering process that requires a competent approach in terms of planning, organization and implementation. The training of employees of accreditation centers according to the programs of training specialists in medical simulation training, as well as close interaction with the accreditation commission, certainly allows us to solve these problems and flawlessly ensure that all stages of accreditation of specialists are carried out.