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Respiratory muscle (RM) strength was studied in 85 men with exacerbations of chronic obstructive pulmonary disease (COPD). The strength indicators of expiratory (MEP) and inspiratory pressure (MIP, SNIP) in oral cavity were registered by means of the MicroRPM device (CareFusion, UK), as well as intranasal pressure levels by SNIP test. The measured MEP, MIP и SNIP values were compared to the proper indices. Serum concentrations of cytokines (IL-4, IL-6, IL-10, IL-17A, IL-21, TNFα, IFNγ and TGF-β) were determined. The results of the study were processed by means of canonical analysis and by clustering methods. Expiratory RM dysfunction was recorded in mild COPD, expiratory-inspiratory RM dysfunction was recorded in moderate COPD and the diaphragm dysfunction was recorded in severe COPD. Three groups of patients with different combinations of RM strength indicators and immune parameters were identified by means of cluster analysis. The cytokine profile in the first cluster was characterized by maximal concentrations of IL-17A, IL-21, TNFα and TGF-β, whereas RM strength indexes showed minimal values. In the second cluster, a decrease of RM strength indicators by 25-40% against control was associated with a sharp rise of IL-6, along with moderate increase of IL-21 and TGF-βconcentrations. In the third cluster, maximal levels of IL-6, IL-10 and IFNγwere registered, along with low levels of IL-17A, IL-21 and TGF-β concentrations, whereas MEP, MIP и SNIP values did not sufficiently differ from their levels in second cluster. The results of canonical and correlation analysis indicated to interconnections between either certain cytokines, or their pool with the RM strength indicators, dyspnea severity and functional state of COPD patients, thus suggesting involvement of cytokine-mediated mechanisms in pathogenesis of the respiratory muscle dysfunction.

OBJECTIVE. The authors evaluated the first European experience of fluorescence thoracoscopy with indocyanine green (ICG) in light spectrum which was approximated to near-infrared (NIR) in thoracoscopic segmentectomy (VATS segmentectomy). MATERIALS AND METHODS. The study covered 21 patients who underwent thoracoscopic segmentectomy during 2016. The ICG (0,15 mg/kg of body weight) was injected intravenously after dominant pulmonary artery ligation during operation. The boundary line between areas was marked by electrocautery at the border of fluorescence. RESULTS. The well-defined fluorescence borders were observed in 18 out of 21 patients (85,7 %). The median duration of intensive ICG staining was 95 sec and that was enough to mark intersegmental plane. The intraoperative verification was unsuccessful in 2 patients due to technical reasons. The first attempt of identification for the patient with severe COPD had unconvincing results and an additional ICG injection was used to achieve the precise fluorescence. There wasn’t revealed any complications associated with ICG injection. CONCLUSIONS. The ICG fluorescence is safe and effective method of segmental plane location. The implementation of this method significantly facilitates in thoracoscopic segmentectomy. The NIR fluorescence imaging systems allow clinicians to work with lower doses of ICG.