Indicators of quality of life, the level of asthma control and the risk of exacerbations in 78 patients of a young age with moderate asthma taking a basic anti-inflammatory therapy and not having an exacerbation of the disease for at least two months before including to the study were assessed. The survey was conducted using special questionnaires AQLQ, SF-36, ACT, ACQ. Morisky-Green test was used to assess adherence to treatment. Lung function was studied using spirometry, bodypletismography. Young patients with moderate asthma had an insufficient level of disease control. Full control of asthma was recorded in 14.1% of patients; partially-controlled asthma was noted in 59%; uncontrolled asthma was registered in 26.9%. Decrease of asthma is accompanied by a decrease in the quality of life indices based on the results of questionnaires AQLQ, SF-36. Clinical and functional parameters, quality of life and adherence to therapy are interrelated with the level of control over the symptoms of asthma.

Investigation of timing organization of lung function in patients with chronic obstructive pulmonary disease of different severity is an important problem in the diagnosis of desynchronosis. We aimed to study circadian rhythms of lung function in patients with severe chronic obstructive pulmonary disease. As a result, not only quantitative, but also qualitative disorders of lung function were revealed. There were registered three types of biorhythms: day, evening and morning. Minimum values of lung function parameters were recorded in patients with pathological morning type of biorhythms. In patients with the severe course against the background of lower medians of spirographic indices, statistically significant differences were also revealed in patients with day and evening types of biorhythms, which indicated a decrease in the adaptive capabilities of the respiratory system.

The aim of the study is to investigate the clinical features of acute myocardial infarction (AMI) manifestation in patients with COPD. 46 male patients with AMI and COPD comorbidity were examined. The first group (26 people) included the patients who had myocardial infarction with ST elevation and COPD. The second group (20 people) had AMI with ST elevation and no COPD anamnesis. The examination included electrocardiography (ECG), echocardiography, coronary angiography, spirography, arterial blood gases measurement. The following results were obtained: in a case of COPD and AMI comorbidity a smoking is the common risk factor. Patients, who had COPD, often demonstrate an asthmatic variant of AMI manifestation, the greater number of complications such as fatal arrhythmia, pulmonary edema, and clinical death. The presence of COPD has a negative influence on AMI course: in patients with COPD during the development of AMI, a higher level of markers of systemic inflammation is detected, a greater severity of hypoxemia indices, which in turn reduces the myocardium contractility in the early recovery period. The patients with COPD and AMI comorbidity have a multivessel lesion of the coronary bed, that can make the further prognosis worse.

The research objective is to study the epidemiological situation on tuberculosis (TB) in the Republic of Crimea (RC) on the basis of territorial differentiation of TB morbidity and mortality trend during 2004-2015 with the use of multidimensional statistics method. We applied k-means clustering. The official statistics of TB morbidity and mortality for the period of 2004-2015 were provided by the "Crimean Republican Clinical Center of Phthisiology and Pulmonology". The grouping of Crimean territories on the TB morbidity and mortality rate trend into 4 clusters was optimal. In the analysis of the research finding the steady decline of the TB morbidity and mortality in all clusters was generally found. The most favourable situation and trend of rates studied occurred in Alushta, Armyansk and Sudak cities, Sovetsky and Chernomorsky districts (the 3^rd cluster) where TB morbidity and mortality rate were below the regional mean values. The highest rates above Crimean mean values and unstable trend were identified in the Dzhankoy, Krasnogvardeysky and Krasnoperekopsky districts integrated into 4^th cluster. In general for the studied period the trend of TB morbidity decline in cluster 1 (Kerch, Yalta, Yevpatoria and Feodosia cities, Belogorsky and Saky districts) was revealed. TB mortality trend corresponded to average Crimean one with low exceedance. In general the TB morbidity and mortality trend corresponded to the all-Crimean trend in lower values in cluster 2 (Simferopol city, Bakhchisarai, Kirovsky, Leninsky, Nizhnegorsky, Pervomaysky, Razdolnensky and Simferopol districts). The negative trend of TB morbidity and mortality in a number of RC territories can testify to problems in the work of Phthisiology service that required further analysis for correction management decisions.

Based on the analysis of the long-term morbidity of tuberculosis in Russia and the Amur Region, it has been established that its uplifts are performed in cycles of 25-30 years. Taking into account the literature data and our own experiments, it is assumed that each successive outbreak of tuberculosis is caused by coincident activation of L-forms of mycobacteria contained in the body of vaccinated and revaccinated children, adolescents and adults, and by dermal phenotypes inhabiting various environmental sites. To identify the "hidden reserve of mycobacteria" it is recommended to use the method of prints and the transfer of bacteriological laboratories to molecular genetic studies.

The aim of the research is to study the activity of hydrolytic enzymes in epithelium of rats’ trachea under total cooling of the organism. The analysis of the obtained data showed that with a daily three hour total cold exposure of rabbits during 28 days at the temperature of -25~-28ºC, a significant increase in the activity of acidic phosphomonoesterase at the apical pole of the epithelial cells of the tracheal mucosa was observed. Under these experimental conditions, alkaline phosphatase is active in the basal pole of the epithelium and in granules of mast cells migrating through the tracheal epithelium into the lumen of the trachea. There are reasons to believe that the continuation of the adverse effect of low temperatures leads to deep and persistent disturbance of the enzymatic organization of hydrolytic enzymes of epithelial cells, pronounced destabilization of lysosome membranes and the development of destructive changes in ciliate epitheliocytes.

To date, the role of dysfunction of the bronchial ciliated epithelium (BCE) in the formation of mucociliary disorders during cold exposure has not been fully established. The aim of the study was to investigate the nature and severity of changes in the ciliary motility of the BCE under the influence of a cold stimulus in vitro . Ten volunteers with asthma underwent a bronchoscopy with biopsy of the lobar bronchus mucosa. The biopsy specimens were placed in a Hank’s balanced salt solution (HBSS) on a slide, located on the thermal stage, used to simulate the effect of various temperature on the BCE. Ciliary beat frequency (CBF, Hz) was recorded using a microscope, high-sensitivity digital camera and computer with specially developed software. The initial recording of CBF was performed at 24ºC, after which the temperature of HBSS was gradually increased to physiological level and repeated recording was made at the control points (28ºC and 36ºC). Then, the temperature of the solution was lowered and CBF was registered again at 28ºC, 21ºC and 17ºC. The initial CBF of the BCE varied from 6.74 to 3.77 Hz with average of 5.25±1.48 Hz (M±m). There was a statistically significant increase in CBF when the solution was heated: at 28ºC it was 6.33±1.36 Hz (p=0.004) and remained at this level up to 36ºC - 7.14±1.33 Hz (p=0.002). A gradual decrease in the solution temperature produced a reduction in CBF in comparison with the physiological conditions: 28ºC - 6.12±1.31 Hz (p=0.121), 21ºC - 5.27±1.32 Hz (p=0.001) and 17ºC - 3.95±1.18 Hz (p=0.0001). By the end of the experiment, CBF of the BCE decreased almost 2-fold in comparison with the physiological conditions. A mathematical model that characterizes the behavior of BCE cilia under cold stress was developed. Thus, the results of the study demonstrate a marked decrease in the motor activity of the BCE cilia under cold stress, which underlines a significant contribution of the functional disturbance of BCE to the pathophysiological mechanisms of hypersecretory disorders induced by inhalation of cold air.

The contents of anti-influenza antibodies, secretory immunoglobulin A (sIgA) and circulating immune complexes (CIC) were studied in 145 women in the second trimester of pregnancy. All women were divided into 5 groups. The first group included 30 women with the physiologic course of pregnancy. The second one consisted of 30 patients with chronic simple bronchitis (CB) in remission. The third group had 30 patients with the exacerbation of CB caused by influenza A(H3N2) (antibody titers were 1:16-1:64); the fourth group included 30 patients with CB, whose exacerbation was caused by influenza (antibody titers were 1:32-1:128). It was found out that in the second group there were higher concentrations of sIgA (7.34±0.37 mg/L) and CIC (0.191±0.006 units of optical density), than in the first group (5.86±0.43 mg/L, р<0.05 and 0.095±0.003 units of optical density, respectively, р<0.001). It can probably be explained by the stimulating influence of persistent virus infection on the local immunity and its important role in the development of autoimmune responses in pregnant women. In the fifth group unlike the third group there were registered minimal contents of sIgA: 3.86±0.25 mg/L (р<0.001) and maximal level of CIC: 0.232±0.006 units of optical density (р<0.001). The revealed changes suggested the decrease of local immune protection of airways and autoimmune alteration of a woman’s body caused by high intensity of humoral immunity to influenza virus А(Н3N2) under exacerbation of chronic simple bronchitis in patients in the second trimester of gestation.

Lipid synthesis function of the liver was studied by the contents of total cholesterol, lipoproteins of high density, lipoproteins of low density and triglycerides in 270 women in the second trimester of pregnancy. The first group (control) included 30 women with a physiological course of pregnancy. The main group consisted of the patients of the second, third, fourth and fifth groups with chronic cytomegalovirus infection (CMVI). Each of them were divided into two subgroups: subgroup A included the women with progressing pregnancy which terminated with the delivery in term; subgroup B - the patients with miscarriage threat whose treatment led to prolongation of the pregnancy and delivery at the 38-40^th weeks of gestation. The second group included 60 women with latent chronic CMVI. The third group included patients with reactivation of chronic CMVI (antibody titers of IgM to CMV were 1:200-1:400, antibody titers of IgG to CMV were 1:200-1:400, avidity index of IgG antibodies was more than 65%). The fourth group included 60 patients with acute phase of chronic CMVI (antibody titers of IgM to CMV were 1:200-1:400, antibody titers of IgG to CMV were 1:200-1:800, avidity index of IgG to CMV was more than 65%), the fifth group had 60 patients with reactivation of chronic CMVI (antibody titers of IgM to CMV were 1:200-1:400, antibody titers of IgG to CMV were 1:400-1:1600, avidity index of IgG antibodies was more than 65%). When comparing the parameters of the first group with such-like ones of 2A and 2B subgroups there were not found any changes in the contents of total cholesterol, lipoproteins of high density and lipoproteins of low density and triglycerides; whereas in 3A subgroup there were revealed lower values of lipoproteins of low density (3.55±0.09 mmole/L; р<0.01), and in subgroup 3B there was a decrease of concentration of total cholesterol till 6.33±0.14 mmole/L (in control it was 6.7±0.09 mmole/L; р<0.05) and lipoproteins of low density till 3.43±0.10 mmole/L (in control it was 3.93±0.09 mmole/L; р<0.001). In the patients of subgroup 4B in comparison with the first group there were registered lower values of total cholesterol (6.20±0.15 mmole/L; р<0.01) and there was a growth of lipoproteins of high density till 2.04±0.13 mmole/L (р<0.05). In subgroup 5B there was a drop of concentration of total cholesterol till 5.93±0.14 mmole/L (р<0.001 in comparison with the first group; р<0.05 in comparison with subgroup 2B); there was a decrease of lipoproteins of low density in comparison with the first group till 2.73±0.09 mmole/L (р<0.001), as well as the increase of concentration of lipoproteins of high density till 2.06±0.10 mmole/L (p<0.01) and triglycerides till 1.96±0.05 mmole/L (р<0.01). The changes in the concentration of lipids in the serum of peripheral blood proved a very important role of the acute virus infection with 4-time growth of antibodies of IgG to CMVI in the suppression of lipid synthesis function of the liver and development of miscarriage.

The contents of the tumor necrosis factor-alpha (TNF-α) in the serum of the umbilical blood as well as ultrasound and morphologic composition of liquor ways of the brain at severe cerebral ischemia was studied in 103 full-term newborns. The first group included 30 newborns from mothers with a physiologic course of pregnancy (subgroup A) and 20 dead newborns with antenatal anamnesis with uncomplicated virus infection, severe somatic pathology and late gestosis in their mothers during gestation (subgroup B); the second one included 28 newborns with severe cerebral ischemia against intrauterine parainfluenza infection (parainfuenza of 1 and 3 type), and 18 of them died at 3-6^th day. The third group consisted of 25 newborns with severe cerebral ischemia against antenatal mixed-respiratory virus infection (parainfluenza of 1 and 3 types and influenza A(H3N2), and 16 of them died at the 2-4 days). It was found out that in the patients of the third group the contents of TNF-α increased till 62.7±2.14 pg/L (in the first and second groups it was 17.6±1.53 pg/L, р₁<0.001 and 34.6±2.04 pg/L, respectively, р₁<0.001). High values of pro-inflammatory cytokine were caused by the development of system inflammation reaction as a result of direct and mediated influence of some respiratory viruses. In the third group periventricular ischemia was found statistically oftener in 88% of newborns and brain immaturity in 48% of children (in the second group it was 32.1 and 10.7% of newborns, respectively); under pathomorphological study there were revealed big haematomas, subarachnoid haemorrhages, full-blown hyperemia and haematomas in the vascular plexus, karyorhexis, severe perivascular and pericellular edema, vasculitis as well as big focuses of atelectasis, aspirating pneumopathy and pneumonia. This suggested an important role of antenatal mixed-respiratory virus infection and pro-inflammatory cytokines in the improvement of penetrance of blood vessels wall under severe cerebral ischemia in newborns.

In order to study the effectiveness of reflexotherapy in correction of immunological disorders in an acute period of ischemic stroke, 45 patients were clinical and immunological examined (on the 2^nd day of patients’s stay in hospital and 15 days after the beginning of the course of early rehabilitation). In the main group of patients (30 people), whose basic complex of rehabilitation measures was optimized by the inclusion of reflexotherapy, there was a significant improvement in a number of indicators of cellular and humoral immunity: reduction of leukocytes in peripheral blood (p˂0.05), an increase in lymphocyte count (p˂0.05), relative and absolute values of T-lymphocytes (CD3+) content (р˂0.01 and р˂0.05, respectively), immunoregulatory cells of T-helpers (CD4+) (р˂0.05), decrease in the number of B-lymphocytes to normal values (р˂0.01), and an increase in IgG level (р˂0.05). In the control group (15 people), where standard treatment was conducted, there was no pronounced dynamics of the indices. Thus, a comprehensive clinical and immunological study of the effectiveness of non-drug correction of immunological disorders in the acute period of ischemic stroke demonstrated high efficiency of acupuncture, with relative simplicity and safety of its application.

The analysis of the results of a study investigating the effectiveness of various modifications of prevailing drug treatment regimens of malignant lymphomas (non-Hodgkin's lymphoma and Hodgkin's lymphoma) is presented. The choice of optimal treatment is a complex problem, especially in patients with a high degree of tumor cells chemoresistance. The authors discuss the treatment options of different types of lymphomas using not only standard regimens, but also those that include drugs, depending on the age characteristics and individual tolerance, which allows in some cases significantly reduce the time of a relapse-free course and lower incidence of side effects of cytostatics on different organs and tissues. Intensified therapy for all aggressive non-Hodgkin's lymphomas with a high proliferative index allows 90% of the time to obtain a complete clinical and hematological remission. In Hodgkin's lymphomas the use of such programs helps to increase the duration of recurrence-free interval by persistent complete remission. The proposed regimen is highly effective in the treatment of patients with concomitant viral hepatitis and HIV infection. Drug therapy with the use of the proposed programs is a safe method of drug exposure, its side effects are minimal, and it is well tolerated by patients.

In the study using the questionnaire EORTC-QLQ C30 there was done a comparative analysis of the quality of life of 35 patients with renal cancer (stage T1-2N0M0) who underwent organ-preserving surgery or open access radical nephrectomy. The initial parameters of quality of life of patients with kidney cancer were higher under organ-preserving surgery; important advantages covered general health status, role and social functions, fatigue and reduced appetite and sleep disorders. In the postoperative period in patients after organ-preserving surgery there remained higher general health status, physical and emotional functions, while the use of open access lowered the quality of life in both groups in functional scales due to the severity of pain and the reduction of social functions. The widespread introduction of endoscopic organ-preserving surgery for kidney cancer can improve the quality of life and contributes to rapid rehabilitation.

The aim of the research was to determine the features of large intestinal microbiocenosis during the vegetation of bacteria of the genus Klebsiella in children with functional disorders of the gastrointestinal tract in different age periods of the first year of life. The material for the study is based on 210 coprological samples isolated from infants of both sexes with functional disorders of the gastrointestinal tract and indication of Klebsiella spp. in the titer of 10⁵-10⁸ CFU/g. The children were grouped according to the age: 1^st - children from 1 to 3 months old, 2^nd - children from three to six months old, 3^rd - children from 6 to 12 months old. All of them were divided into two groups for comparison, depending on the type of isolated Klebsiella species: K. pneumoniae (n=105) and K. oxytoca (n=105). The investigation of the intestinal microflora was performed in accordance with conventional methodology, and the assessment of the results was done according to Industry Standard. Identified bacteria were divided by their morphologic, tinctorial, cultural and biochemical properties. As a result of the study, dysbiotic disturbances of the 3^rd degree were observed in children, complicated by the proliferation of bacteria of the genus Klebsiella , especially by its diagnostically important bacterial agent K. oxytoca . Most critical for the development of functional disorders of the gastrointestinal tract for the children of the first year of life is the age of 3-6 months. Long-term persistence of the Klebsiella spp. in high titer (10⁵-10⁸ CFU/g) in the large intestine of the children with functional disorders of the gastrointestinal tract dictates the need for selective decontamination of the Klebsiella from the gut microbiota.

A brief review of the literature is devoted to the peculiarities of the clinical picture, diagnosis and treatment of Wegener's granulomatosis. The clinical observation of the patient with Wegener's granulomatosis is made from the personal practice of the authors. A complex differential diagnosis was made between pneumonia of different etiology, tuberculosis, lung cancer and granulomatous disease. Taking into account anamnesis and clinical picture of the disease (acute onset with fever, arthralgia, nasal and oral mucosa damage, lungs, kidneys, Raynaud's syndrome, hemorrhagic eruptions, digital vasculitis), histological examination of transbronchial lung tissue biopsy material diagnosed: Wegener's granulomatosis, a generalized form, with the lesions of the upper respiratory tract, tracheobronchial tree, lungs, heart, kidneys, an acute course. Despite adequate treatment, the disease progressed with the addition of various complications, and a lethal outcome was ascertained.

This systematic review was undertaken to define the urgency of studying the problem of cytomegalovirus infection due to the high frequency of detection of specific antibodies among women of childbearing age and the negative consequences of cytomegalovirus for the fetus and newborn. Despite the advances in modern medicine in the study of etiopathogenesis and diagnosis of cytomegalovirus infection during pregnancy, there is currently no trend towards a reduction in the incidence of obstetric pathologies and fetal damage. Physiological features of the functioning of the immune system in pregnancy are discussed; they create the prerequisites for the emergence or activation of long time persistent cytomegalovirus infection and intrauterine fetal damage. Complications in newborns are much more common if the primary cytomegalovirus infection was detected in the first trimester of pregnancy. Cytomegalovirus infection is accompanied by the development of immunodeficiency, but pathophysiological mechanisms of cytomegalovirus infection with the damaging effect in the first trimester of pregnancy need to be detailed. The pathophysiological mechanism of mismatch of immune regulation in pathological pregnancy and in the presence of cytomegalovirus infection is Th-1/Th-2 imbalance which can serve as a target for the development of pathogenetically oriented therapy of pregnant women with cytomegalovirus infection. It is suggested that the specification of these mechanisms will reduce the frequency of obstetric pathologies.

In the review of the literature, data on the possibility of adaptation reactions of a warm-blooded organism to cold and heat stress are described in detail. The scientific experience of application of adaptogenic products in the correction of overheating and cooling of the organism is discussed. The theoretical problems of the toxic effect of the temperature factor of the environment on cognitive abilities of laboratory animals and humans are revealed. The article presents the historical data about the study of these issues over the last 50 years.