Destruction of bronchial epithelium in patients with bronchial asthma (BA) is at the bottom of the mechanism of epithelial dysfunction, mucociliary insufficiency and bronchial remodeling. The aim of the work is to assess the character of changes that happen in the structural organization of cell elements and secretory activity of bronchial goblet epithelium in response to cold bronchial challenge in BA patients with cold airway hyperresponsiveness (CAHR). 28 patients with mild BA took part in the research. In the first day of the research the collection of the induced sputum was done, then the next day there was conducted a standard 3-minute test of isocapnic hyperventilation with cold (-20ºС) air (IHCA), after that the collection of sputum was done again. In cytograms of the sputum the percentage, the degree of destruction and cytolysis intensity of cell elements was determined; the contents of glycoproteins in goblet epithelial cells (GS) was studied. The first group included 14 patients with CAHR, the group of comparison (the 2^nd group) included 14 patients with BA who did not have airway response to IHCA (ΔFEV₁=-19.9±1.6 and -2.8±1.3%, respectively, р=0.00001). After IHCA in cytograms of the sputum of the patients with CAHR there was an increase of the number of neutrophils in relation to the basic one (from 39.9±2.8 till 54.0±2.3%, respectively, р=0.0004), the decrease of the number of macrophages (from 45.3±3.4 till 31.4±2.6%, р=0.005) without the changes of the number of eosinophils (10.0±2.2 and 10.4±1.6%, р=0.14) against intensified cytolysis (2.4±0.16 and 3.1±0.16%, р=0.0007). There was a decrease of the number of GC in relation to the initial one (from 0.22±0.02 till 0.16±0.02%; р=0.037) without significant changes of the number of epithelial cells (1.6±0.54 and 1.5±1.20%; р=0.97). The total index of destruction of GC was 0.45±0.02 and 0.51±0.02 (р=0.045); the index of cytolysis intensiveness of GC was 0.20±0.04 and 0.20±0.02 (р=0.27). A high number of GC that had a normal structure (0 and 1 class of destruction) as well as an increase of the number of cells in relation to initial values of the number of cells of II class against the absence of changes of III and IV classes of destruction were quite noticeable. Under cytochemical reaction the number of alcian blue stained GC actively synthesizing and secreting glycoproteins in response to IHCA increased in relation to the basic value (from 59.8±3.3 till 70.8±4.0%, р=0.0002, respectively). There was found a close correlation between the intensified production of GC glycoproteins in response to bronchial challenge and intensification of bronchial response (∆FEV₁) to IHCA (r=-0.37; р=0.029). Thus, in the patients with BA and CAHR a short-term cold air exposure leads to the increase of the number of neutrophils and the decrease of the number of GC under intensive production of glycoproteins in them.

The aim of the research is to develop a mathematical model of selection of phenotypes of bronchial asthma (BA) at a resort stage of medical rehabilitation. Materials and methods: 300 patients with BA who arrived at the climatic resort for medical rehabilitation; values of 64 indices of the research describing features of emergence and a course of a disease; the current clinic-functional state of patients; the discriminant analysis for the creation of a mathematical model . Results of the research: by the discriminant analysis there were created 7 statistically significant linear discriminant functions for the discernment of BA phenotypes; 23 indices of the research were under study: gender, asthma control, quantity of not allergic associated diseases, coughing during the day, character of the sputum, expressiveness of symptoms of asthma, use of rescue medication, the number of dry rattles in lungs, severity of hypostases, systolic and diastolic arterial blood pressure, shortness of breath, wheezing, reaction to the change of weather, allergic reactions, existence of symptoms of intoxication and feature of treatment of the last exacerbation, a dose of inhaled glucocorticosteroids, presence of emphysema and fibrosis in lungs at the X-ray examination, expressiveness of electrographic changes, FEF25-75%, 6-minute walk test. Conclusion: the procedure of the selection of 7 BA phenotypes at the resort stage of medical rehabilitation can be carried out by the use of the mathematical model consisting of 7 linear discriminant functions including 23 indices; the accuracy of the selection of the offered BA phenotypes of the developed mathematical model in general is 89.0%.

The aim was to identify the sensitivity of functional methods for studying of respiratory organs in patients with chronic obstructive pulmonary disease (COPD) to a pathogenic environmental impact. There was studied the state of lung function (spirography, bodyplethysmography, pulse oximetry, determination of CO in exhaled air) in 66 patients living in different environmental conditions in Vladivostok and having COPD of different severity. The environmental quality was assessed by the level of air pollution caused by gas components and suspended particulate matter. The meteorological dependence was determined by meteorological parameters on the day of patient’s examination, 1-2 days before and after it. The respiratory system's response to the change in environmental quality was identified using a statistical model that allows predicting the values of the dependent variable Y_i (respiratory function) under the impact of the independent variable X_i (environmental factor). It was found out that in mild COPD the methods "determination of CO in exhaled air" and "bodyplethysmography" are the most sensitive to the climatic impact. As the disease progresses, the compensatory mechanisms of respiratory system to climatic effects are violated, while the response of technogenic factors to the pathogenic action increases. The "determining CO in exhaled air" method is the most sensitive to the man-made pollution. Bodyplethysmography allows revealing the formation of "air trapping" and signs of hyperinflation under the influence of unfavorable environmental factors in COPD patients at early stages of the disease. The recommended set of methods makes it possible to assess the risk of COPD progression under the exposure to unfavorable climatic and technogenic factors.

The aim is to study the interrelationships between the state of pulmonary, intracardiac hemodynamics and renal blood flow in patients with chronic obstructive pulmonary disease (COPD) complicated with the chronic cor pulmonale (CCP). 75 patients with COPD complicated with compensated CCP who had the study of pulmonary, intracardiac and renal hemodynamics with the method of ultrasound duplex scanning were examined. The patients were divided into 2 groups: the 1^st group included 45 patients with COPD with pulmonary hypertension (PH) without clinical signs of right ventricle insufficiency; the 2^nd group included 30 patients with COPD and PH complicated with right ventricle insufficiency. It was found out that the patients with COPD alongside with the progression of the disease and development of the heart insufficiency had an increase of renal vessel resistance (р<0.01) and a decrease of the velocity of renal blood flow (р<0.001). In the first group of patients there was found a consistent correlation between the increase of the vessel resistance in renal arteries and growth of general peripheral vessel resistance (р<0.001), of systolic pressure in the pulmonary artery (р<0.001) and diastolic dysfunction of the left ventricle (LV) (р<0.001), suggested the influence of these predictors on the velocity of the arterial blood flow in kidneys. In the 2^nd group there was registered a strong correlation between the decrease of ejection fraction (EF) of LV and the increase of pulsation and resistive indices of arcuate arteries (r=0.69; p<0.01 and r=0.71; p<0.01, respectively), as well as the increase of end-diastolic volume, end-systolic volume of LV and speed parameters of the renal blood flow at all levels (r=0.67; p<0.01). The study of the relationship between the parameters of hemodynamics of the right ventricle (RV) and the state of the renal blood flow revealed a consistent correlation between the decrease of EF of RV and the decrease of diastolic rate at all levels of renal arteries (p<0.001), the increase of resistive (p<0.01) and pulsation indices (p<0.01) of the arterial system of kidneys. These correlations reflect a negative influence of both a left ventricle and right ventricle insufficiency on the state of the renal blood flow.

The aim of the study was to investigate coronary arteries damage during ST-elevation myocardial infarction (STEMI) manifestation in patients with chronic obstructive pulmonary disease (COPD). The protocols of coronary angiography of 90 patients who suffered STEMI were analyzed. The patients were divided into two groups depending on the presence of COPD. The first group (50 people) was formed from the patients who had ST elevation myocardial infarction (STEMI) and COPD. The second group (40 people) had STEMI and no COPD. It was found that in case of COPD and STEMI comorbidity the number of coronary stenosis is bigger than in case of mono AMI patients. In the group of patients with COPD and STEMI the angiographic picture of atherosclerosis damage of coronary arteries demonstrates the prevalence of medium and distal stenosis of major branches and coronary arteries of the second order unlike the group with isolated STEMI. The number of extended stenosis in the group with the comorbid pathology is also higher. The patients with STEMI have the same number of hemodynamically important stenosis as the other group. The correlation between the change of the vessel channel and smoking anamnesis, the level of the systematic inflammation marker (CRP) and the level of lipids in patients with COPD and STEMI was studied. The severity of coronary atherosclerosis directly correlates with CRP level, smoking anamnesis, level of cholesterol, LDLP. The number of distal stenosis, including those that are hemodynamically important, has reverse correlation with the level of HDLP.

The community-acquired pneumonia (CAP) is a very widespread disease and one of frequent causes of death. The stable relation of seasonal dynamics of indicators of a case rate of CAP with incidence of acute respiratory viral infection and flu becomes perceptible. One of the modern trends of decreasing the incidence and mortality at CAP is immunization with anti-influenza vaccines. Flu immunizations are included in the National calendar of preventive immunization of the Russian Federation. According to official data of the Ministry of Health of the Amur region, in 2015, 2016 and 2017 there were vaccinated 39.7%, 45.4% and 46.2% of population, respectively. CAP case rate in the group immunized with anti-influenza vaccine and in the group not immunized were analyzed. The decrease of the case rate of CAP in patients immunized from flu by 2.4 times in comparison with the people who were not vaccinated from flu was revealed. Against the background of mass vaccination against flu there was a change of clinical implications of CAP: the number of people with mild forms of illness enlarged. Lethality decreased: from 179 immunized people only one patient died, whereas from 393 not immunized people 28 patients had a lethal outcome. The case rate of CAP in people of the senior age groups decreased from 32.2% in 2009-2014 till 21.7% in 2015, from 17.8% in 2016 till 15.9% in 2017. Thus, immunization against flu is followed by an essential decrease of indicators of a case rate of CAP, relief of a disease and improvement of a disease outcome.

The aim of the research is to improve the diagnosis of disturbances of cell energy in children with chronic nonspecific pulmonary diseases (CNPD) in the remission stage by the methods of detection of cytochemical changes of the energy status and recording the percentage of immune-competent cells of blood with the low membrane potential of mitochondria (MPM). 77 children were examined, including 66 (83%) with lung malformations, and 11 children (17%) with chronic nonspecific lung diseases as an outcome of acute/chronic lung diseases. The presence of energy deficient states was assessed by the level of activity of oxidative-reduction enzymes of succinate dehydrogenase, alpha-glycerophosphate dehydrogenase, lactic dehydrogenase in lymphocytes of the peripheral blood and percent ratio of lymphocytes with low MPM. It was found out that in 53.2% of the examined children even in the remission stage there were identified the signs of mitochondrial insufficiency when the parameters of metabolic activity of enzymes in lymphocytes were significantly lower than the norm. The cluster analysis of the obtained data allowed identifying the parameters typical for energy deficient states of the organism of the child that demand the correction by energotropic medications.

The aim of the study was to evaluate the Moraxella catarrhalis nasopharyngeal carriage prevalence in children of different age groups with a recurrent course of respiratory diseases and perform a comparative analysis of bacterial carriage levels as well as peculiarities of within-year distribution of nasopharyngeal carriage in 2016-2017 years. Bacteriological assessment was performed for 1769 children aged 0 to 14 years old including 1082 children examined in 2016 and 687 children examined in 2017. During the two years of observation the average level of M. catarrhalis carriage for the entire study group was equal to 11.5±0.76%. Nasopharyngeal carriage was detected in children of all age groups with the lowest index in children of 7-14 years (4.1±1.03%) and highest levels of bacterial carriage in children of 2-6 years old (13.8±0.98%). Similarities in distribution of M. catarrhalis nasopharyngeal carriage levels in susceptible age groups were detected during 2016 and 2017 years. The analysis of M. catarrhalis carriage levels dynamics revealed within-year undulation of the index - low levels were detected in February and July and high levels in October and November. The research revealed statistically significant and profound concordance of within-year distribution of M. catarrhalis carriage levels in children during 2016 and 2017 years.

The aim is to study the features of changes of free-radical status, antioxidant protection and morphologic changes of erythrocytes of the peripheral blood of pregnant women of the first trimester with exacerbation of cytomegalovirus infection (CMVI). 35 pregnant women with exacerbation of CMVI in the first trimester of gestation (the main group) and 35 pregnant women without this pathology of the same age and term as the patients of the main group were examined. Erythrocytes of the venous blood stabilized by heparine as well as blood plasma became the material of the study. There has been studied the condition of lipid peroxidation (LP) by the contents of diene conjugates and active products reacting with thiobarbituric acid; the state of nonenzymatic antioxidant protection by the contents of α-tocopherol as well as of the enzyme of erythrocytes (superoxide dismutase); morphologic changes of erythrocytes. It was found out that the exacerbation of CMVI in the first trimester of pregnancy is associated with activation of LP processes which include modification of not only primary, reverse stages of this process - the increase of the concentration of diene conjugates (p<0.001), but they lead to an increased formation of secondary active products reacting with thiobarbituric acid (p<0.001), intensifying the destructive action on the membrane of erythrocytes. Primary and secondary products of LP against the decrease of concentration of erythrocyte superoxide dismutase (p<0.001) and α-tocopherol (p<0.001) are accumulated in increasing concentrations and become potential factors of erythrocytes damage causing their functional and metabolic inferiority. Metabolic disturbances and damages of cellular membranes lead to the increase of population of echinocytes, target-like and degenerative forms of erythrocytes, which can be accompanied by a high probability of intravascular hemolysis and contribute to the development of hemic hypoxia complicating the infectious process and the course of pregnancy. Within the present hyperoxidation and suppression of antioxidant protection that lead to the worsening of the rheology of blood, women with exacerbation of CMVI in the first trimester of pregnancy should be prescribed the medicine stabilizing the lipid exchange.

The aim of the research was to study a morphological structure of airway and respiratory parts of lungs in 36 full-term newborns who died at the 2-5^th day of life. The main group included 16 died newborns with the inborn cytomegalovirus infection who were diagnosed with moderate to severe cerebral ischemia with hypertension-hydrocephalic syndrome, pseudocysts of the blood vessels plexus, subependymal and subarachnoid haemorrhages, monocytosis, vesiculitis, pneumonia, hepatitis and meningocephalitis against intrauterine hypoxia and chronic subcompensated placental insufficiency. The comparison group consisted of 20 newborns whose mothers during the gestation period did not have acute respiratory viral infections, moderate and severe somatic and obstetrical pathology. The cause of their death was a birth trauma, intranatal and postnatal hypoxia. Describing lungs the following morphologic features were emphasized: 1) the changes of the general composition of the organ; 2) the state of the lumen of the large, medial and small bronchi; 3) the reaction of the epithelial lining, conjunctive tissue and the blood channel of the bronchial tree and aero-hematic barrier. As a result of the studies it was found out that in the newborns of the main group in comparison with the children of the comparison group in the lumen of large bronchi there was a rare case of mucus, there were often found erythrocytes and desquamated epithelial cells. Only infected children were found to have leucocytes. More intensified were alterative processes in epithelial cells; there were often found cells of the bronchial epithelium without ciliary structures, desquamation of highly differential ciliary and goblet cells, cell elements with a small hyperchromic nucleus and light cytoplasm in the cambial layer, sharply expressed vascular congestion, proliferative changes in the bronchial epithelium as well as hydropic-hemorrhagic and aspiration syndromes. Pneumonia and signs of the virus metamorphosis were diagnosed only in the main group.

The paper presents the results of laser granulometry study of atmospheric particles contained in the snow in the northern part of Altaiskiy State Nature Biosphere Reserve collected in winter 2016. The results of the study prove that the north of the Alay nature reserve is relatively safe ecologically. Harmful for living beings microparticels (of no more than 10 μm in size) were in the atmosphere in a limited number and were no more than 19.1%. At the same time the maximal concentration of fine substances was observed in places of a man living, which proves an anthropogenic cause of particles formation.

The aim of the research is to make a comparative evaluation of the results of treatment of cervical cancer in patients who had the radiation therapy with the application of the modes of sequential and parallel methods of bringing the dose to the pathological focus. The results of combined radiation therapy in 120 patients with cervical cancer were analyzed. Depending on the treatment tactics, the patients were divided into 2 groups of 60 patients who underwent a sequential or parallel method of bringing the dose to the lesion and regional metastasis routes, when the total focal dose in both cases matched the optimally required parameters - 80-85 Gr in the primary tumor and points "A" and 60 Gr in points "B". Distance radiation therapy was carried out 5 times a week, followed by a break of 3-5 weeks and a further application of the intracavitary method. In the second case, a daily distance therapy was carried out to a total focal dose of 18 Gr, after which the number of sessions per week decreased to 3 times and in some days (2 times a week) there was done an intracavitary treatment. The following results were obtained: an objective therapeutic effect was observed in 108 (90%) patients. Full tumor regression was recorded in 95 (87.9%), partial - in 12.1%, and failures were detected in 10% of women. During the three-year follow-up period, 20.0% of patients of the first group and 10.9% of the second group showed progression of the disease manifested by recurrence in the irradiation zones, recurrence+metastases and metastases of the primary tumor, usually in the inguinal and paraaortic lymph nodes, pelvic bones, liver, lungs. The median of remission duration in the first group was 20 months with a three-year survival rate of 68.0%, and in the second it was 26 and 82.0%, respectively. Complications in the form of mucous response to radiation exposure, radiation cystitis, proctitis, enterocolitis in the second group of patients were significantly less common than in the first. Thus, for the treatment of patients with cervical cancer, the most effective is the use of combined radiation therapy in parallel irradiation.

Based on the literature data and our own observations, the features of the lung damage in patients with drug dependence have been studied. It was found out that the pulmonary manifestations of drug addiction are secondary, depend on the type of drug used and ways of drug administration. In most cases, pneumonia develops, characterized by an aggressive course, often complicated by the formation of destructive cavities, suppuration and empyema of the pleura, respiratory failure. Pneumonia is often a manifestation of sepsis (in most cases, injecting drug users) and is accompanied by other syndromes: bacterial endocarditis, renal, hepatic insufficiency, and other manifestations of multiple organ pathology. Interstitial pneumonia can develop with the development of pneumofibrosis, bullous pulmonary degeneration, granulomatous inflammation, pulmonary edema. In a number of cases (more often with inhalational drug use) toxic alveolitis may develop. The defeat of the lungs can be irreversible and lead to death. Three clinical observations from the personal practice of the authors are presented.

Any professional medical activity carries the danger of complications. According to the ICD-10, any pathological process which resulted from a medical action is iatrogenesis. Now, when the aggression of therapy surpasses the severity of the disease, the problem of iatrogenesis is of particular importance. The complications caused by catheterization of a subclavian vein make 2.7-11.2% cases of iatrogenesis, serious complications - 1.2%. The hemothorax is an infrequent complication of this manipulation, its frequency doesn't exceed 0.4-0.6%. The hemothorax with a lethal outcome is a medical casuistry. This work is devoted to one case of traumatic iatrogenesis, i.e. to a complication of a puncture of a subclavian vein by hemothorax with the volume not less than 4.5 liters, with development of an acute respiratory failure and a lethal outcome.

This work is devoted to the review of genetic researches in the field of etiology and development of depressive disorders. The interest to depression is caused by high prevalence and increasing frequency of this disease in the world and its negative influence on the ability to work and social activity of a man. Depression is a heterogenic disorder, in the pathogenesis of which both genetic factors and the conditions of micro-and macroenvironment play an important role. The study of polymorphisms of gene-candidates as well as consequences from the totaling of these effects can help to define the degree of disposition to depressive disorders. According to modern theories, a special role in pathogenesis and dynamics of depression belong to the pathology of molecular components of neurochemical structures of central nervous system and genes that code them. The most known genes, for which the correlation with anxiety, depression or their separate symptoms was found, are the genes of 5-serotonin transporters HIT, noradrenalin NET, dopamines DAT1 and D4DR, neurotropic brain factor BDHF, serotonin receptors of HTR1A, HTR2A, genes of enzymes of tryptophan hydroxylase TPH, catechol-O-methyl transferase COMT, methylene tetra hydro folate reductase MTHFR, genes of anti-inflammatory mediators IL-6, IL-1beta, TNF-a, CRP, genes participating in the immune response PSMB4 and TBX21, rare variants of gene NKPD1 and others. The study of the genetic background in relation with affective manifestations seems to be important and promising. In-time and accurate diagnosis of the disposition to depressive disorders can be the most important one in successful prophylactics and effective treatment of patients.

The review summarizes and presents the results of studies of the biological role of the vascular endothelium in the body, the universal mechanisms of regulation of its activity and the disturbances of functions in various pathologies. The role of vasoconstrictive and vasodilating factors in the development of endothelial dysfunction is shown. The importance of hypoxia in the development of vascular endothelial dysfunction and the role of hormones in the regulation of vascular endothelium functions is considered. A particular attention is paid to universal mechanisms of endothelium involvement in the onset and development of pathological conditions during pregnancy. The role of endothelial dysfunction in the pathogenesis of gestosis development is discussed. There were summarized the data about the study of endothelial mechanisms of regulation of contractile reactions of the vessels of placenta.

The review presents the modern concept of the oral microbiome, its species diversity, the properties of microbial associations and their effect on the immunobiological resistance of the organism, development of chronic inflammation and two leading infectious and inflammatory diseases (dental caries and periodontal diseases). There is briefly summarized information about the presence and nature of the relationship between the composition of periodontal microorganisms and concomitant somatic diseases: in atherosclerotic plaques in cardiovascular diseases, with pathology of the gastrointestinal tract, respiratory system and other organs and systems.