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A combination of factors, including Western European eating habits, physical inactivity and genetic predisposition, lead to a dramatic increase in adipose tissue mass. A special place is occupied by abdominal obesity, in which there is an accumulation of adipose tissue in the mesentery of the small intestine and the omentum. Developing in conditions of visceral obesity, insulin resistance, dyslipidemia and systemic inflammation are one of the key components of the pathogenesis of type 2 diabetes mellitus, cardiovascular diseases, non-alcoholic fatty liver and pancreas disease, polycystic ovary disease, some forms of cancer (breast cancer, endometrial cancer, colonic and direct intestines). At the same time, the pathogenetic role of adipose tissue is not limited to its participation in the formation of the cardiometabolic continuum and oncogenesis. The most important role of metabolically active fat in the pathogenesis of many respiratory diseases is known, including bronchial asthma, obstructive sleep apnea and pulmonary hypertension. This paper presents an overview of current data on immunological, pathophysiological and clinical features of the phenotype of the combination of respiratory diseases with overweight and obesity.Совокупность факторов, среди которых западноевропейские особенности пищевого поведения, гиподинамия и генетическая предрасположенность, приводит к драматическому увеличению массы жировой ткани. Особое место занимает абдоминальное ожирение, при котором происходит аккумуляция жировой ткани в брыжейке тонкой кишки и сальнике. Развивающиеся в условиях висцерального ожирения инсулинорезистентность, дислипидемия и системное воспаление являются одними из ключевых компонентов патогенеза сахарного диабета 2-го типа, кардиоваскулярных заболеваний, неалкогольной жировой болезни печени и поджелудочной железы, поликистоза яичников, некоторых форм онкологических заболеваний (рак молочной железы, эндометрия, толстой и прямой кишки). Вместе с тем патогенетическая роль жировой ткани не ограничивается участием в онкогенезе и формировании кардиометаболического континуума. Установлено участие жировой ткани в патогенезе многих респираторных заболеваний, в числе которых бронхиальная астма, обструктивное апноэ сна и легочная гипертензия. В работе представлен обзор современных данных по иммунологическим, патофизиологическим и клиническим особенностям фенотипа сочетания респираторных заболеваний с избыточной массой тела и ожирением.

Background The incidence of acute pancreatitis (AP) is characterized by circannual and geographical variation. The aim of this study was to describe seasonal variation and trends in hospitalizations for AP in the USA with respect to AP etiology. Methods The Nationwide Inpatient Sample data (2000–2016) from the Healthcare Cost and Utilization Project were used. The study population included all primary hospitalizations for AP. Biliary AP (BAP) and alcohol-induced AP (AAP) were distinguished by diagnostic and procedural ICD codes. Seasonal trend decomposition was performed. Results There was a linear increase in annual incidence (per 100 000 population) of AAP in the USA (from 17.0 in 2000 to 22.9 in 2016), while incidence of BAP, equaled 19.9 in 2000, peaked at 22.1 in 2006 and decreased to 17.4 in 2016. AP incidence demonstrated 18% annual incidence amplitude with summer peak and winter trough, more prominent in AAP. In 2016, within AAP, the highest incidence (per 100 000 population) was noted among African-Americans (up to 50.4), followed by males aged 56–70 years (26.5) and Asians of low income (25.5); within BAP, above the average incidence was observed in Hispanic (up to 25.8) and Asian (up to 25.0) population. The most consistent and rapid increase in AP incidence was noted in males aged 56–70 years with an alcoholic etiology (average 6% annual incidence growth). Conclusions The incidence and annual trends of AP vary significantly among demographic and socioeconomic groups and this knowledge may be useful for the planning of healthcare resources and identification of at-risk populations.

Background Complicated acute appendicitis (CAA) has been linked to extremes of age, racial and socioeconomic disparities, public insurance, and remote residency. CAA rate has been used from 2005 to 2018 as a health care quality metric, with the assumption that delay in treatment was a main cause of perforation. We studied factors that could contribute to CAA focusing on modifiable factors which could be altered as part of a health care delivery system. Materials and Methods All primary admissions for acute appendicitis (AA) from the 2010 Nationwide Inpatient Sample were linked to 2010 state-level physician density data. CAA was distinguished by codes for perforation, generalized peritonitis, or intra-abdominal abscess. A multivariable logistic regression model for CAA prediction was built. Results A total of 288 556 patients were admitted with AA and 86 272 (29.9%) had CAA. Independent factors, linked to CAA, included age outside the 10-39 range (odds ratio (OR) = 2.1-2.4 and all P < .001), male gender (OR = 1.2), malnutrition (OR = 6.2), diabetes mellitus (OR = 2.1), chronic anemias (OR = 1.9), nonprivate insurances (OR 1.2-1.5), nonmetropolitan patient’s residence (OR = 1.15), and Midwest region (OR = 1.2). Patient income and physician coverage were not significant factors after adjustment for all other covariates. Highest CAA fraction of 39.6% was noted in rural patients admitted to urban teaching facilities. Discussion Although provider coverage at the state level may seem adequate and not related to increased CAA rates, the distance patients traveled for their definitive surgical care correlated with higher rates of CAA. Adjusting physician distribution into nonurban settings closer to patients could decrease rates of CAA by diminishing time to definitive care.

The review is devoted to the urgent problem of modern pulmonology: the differential diagnosis of idiopathic pulmonary fibrosis (ILF). ILF occupies a special place among many interstitial lung diseases for a number of reasons: 1) it is a deadly disease; 2) early diagnosis and adequate antifibrotic therapy significantly extend the life expectancy of patients; 3) anti-inflammatory drugs (corticosteroids) and cytostatics with ILF that are widely used in other forms of interstitial lung diseases are ineffective and accelerate the progression of the process; 4) the commonality of the main clinical signs (increasing respiratory failure) of various interstitial lung diseases. The list of respiratory diseases with which ILF should be differentiated is huge, and if with diffuse lung lesions of a known nature (disseminated pulmonary tuberculosis, pneumoconiosis, etc.) with a certain experience/qualification, the diagnosis is relatively simple, then the isolation of ILF from the group of idiopathic interstitial pneumonias always represents certain difficulties. The main methods used in the diagnosis of ILF are summarized taking into account current international and national recommendations.Обзор посвящен актуальной проблеме современной пульмонологии: дифференциальной диагностике идиопатического легочного фиброза (ИЛФ). ИЛФ занимает особое место среди множества интерстициальных болезней легких по ряду причин: 1) это смертельная болезнь; 2) ранняя диагностика и адекватная антифибротическая терапия существенно удлиняют продолжительность жизни больных; 3) широко применяемые при других формах интерстициальных болезней легких противовоспалительные препараты (кортикостероиды) и цитостатики при ИЛФ неэффективны и ускоряют прогрессирование процесса; 4) общность основных клинических признаков (нарастающая дыхательная недостаточность) различных интерстициальных болезней легких. Перечень заболеваний органов дыхания, с которыми следует дифференцировать ИЛФ, огромен, и если с диффузными поражениями легких известной природы (диссеминированный туберкулез легких, пневмокониозы и др.) при определенном опыте/квалификации диагностика относительно проста, то выделение ИЛФ из группы идиопатических интерстициальных пневмоний всегда представляет определенные трудности. Суммируются основные методы, используемые в диагностике ИЛФ, с учетом современных международных и национальных рекомендаций.

The main goals of COPD therapy are to achieve clinical stability with minimal clinical manifestations and low risk of relapse. The proposed COPD control concept by analogy with asthma has not been quite well characterized yet. COPD control is defined as "the long - term maintenance of a clinical situation with a low impact of symptoms on the patient's life and absence of exacerbations." The situation of clinical control in COPD is considered desirable and potentially achievable for most patients with COPD. Pharmacotherapeutic options for COPD are constantly expanding. The control concept may be useful when the decision on treatment of COPD is made for dynamic adjustment of the therapy volume.Основными целями терапии хронической обструктивной болезни легких (ХОБЛ) является достижение клинической стабильности с наименьшим количеством симптомов и низким риском обострений. Предложенная концепция контроля ХОБЛ по аналогии с бронхиальной астмой пока недостаточно хорошо охарактеризована. Контроль ХОБЛ определяется как «долгосрочное поддержание клинической ситуации с низким воздействием симптомов на жизнь пациента и отсутствием обострений». Ситуация клинического контроля при ХОБЛ рассматривается как желательная и потенциально достижимая для большинства пациентов с ХОБЛ. Возможности фармакологической терапии ХОБЛ постоянно расширяются. Концепция контроля может быть полезна для принятия решения о лечении ХОБЛ для динамической корректировки объема терапии.

T cells play a vital role in combatting SARS-CoV-2 and forming long-term memory responses. Whereas extensive structural information is available on neutralizing antibodies against SARS-CoV-2, such information on SARS-CoV-2-specific T-cell receptors (TCRs) bound to their peptide–MHC targets is lacking. Here we determine the structures of a public and a private TCR from COVID-19 convalescent patients in complex with HLA-A2 and two SARS-CoV-2 spike protein epitopes (YLQ and RLQ). The structures reveal the basis for selection of particular TRAV and TRBV germline genes by the public but not the private TCR, and for the ability of the TCRs to recognize natural variants of RLQ but not YLQ. Neither TCR recognizes homologous epitopes from human seasonal coronaviruses. By elucidating the mechanism for TCR recognition of an immunodominant yet variable epitope (YLQ) and a conserved but less commonly targeted epitope (RLQ), this study can inform prospective efforts to design vaccines to elicit pan-coronavirus immunity., Structural immunology is critical in understanding the interplay between the immune response and the infective agent but such studies in T cells and SARS-CoV-2 lag behind those of antibodies and B-cell receptors. Here the authors assess recognition of SARS-CoV-2 spike epitopes and their natural variants by public and private T cell receptors.

Purpose Imposter phenomenon refers to feelings of inadequacy due to inability to internalize evident success. While high achievers such as physicians have been known to exhibit imposter phenomenon, there is limited literature specific to radiologists. Our purpose was to (1) investigate imposter phenomenon in radiologists and assess correlation with burnout, and (2) pilot an intervention aimed at addressing imposter phenomenon through improvisational theater techniques. Methods Part 1 - Clinical radiology faculty at a single large academic medical center completed an anonymous survey with questions related to demographics, burnout (derived from the validated Mini-Z assessment tool), and imposter phenomenon. Part 2 - A one-hour interactive workshop on imposter phenomenon was organized for the radiology department at the same institution. The workshop included the Clance Imposter Phenomenon Scale (CIPS). A post-workshop survey rating was also performed. Results Part 1 - Of 30 clinical radiology faculty who participated in the survey, 83% reported feelings of imposter phenomenon during their career. There was significant (p = 0.024) correlation between imposter phenomenon and burnout. Part 2 - Of 21 members of the Department of Radiology who completed the CIPS in the interactive workshop, 71% exhibited frequent or intense symptoms of imposter phenomenon. On the post-workshop survey asking participants to rate the workshop, the mean score was 4.4 and the mode score was 5 on a scale of 1 (poor) to 5 (excellent). Conclusion Imposter phenomenon affects radiologists and is correlated with burnout. Innovative interventions to address imposter phenomenon such as workshops utilizing medical improvisational techniques are well-received.

Coaching methods are aimed at motivating people to achieve career or social skills. Therewith, coaching acts only as an additional form of career development for persons engaged in certain professions. The novelty of the study lies in the need to apply coaching methods not only during the period of active career implementation, but also during its interruption. This study is aimed at implementing the program for the development of career competence, the main tasks of which are to independently regulate professional life in a wide range of development vectors. The leading methods are the theoretical method of analysis and empirical methods of questioning and observation, which allow to study the impact of coaching on a person's professional development. The study shows that career development opportunities should be based on the psychological readiness of a person and, if necessary, on the correction of such readiness by means of psychological methods.

The article presents the results of comparative study of dispute resolution mechanisms related to the improper provision of medical services. On the basis of consumer model of physician-patient relationship basic options of pretrial and alternative mechanisms of settlements of disputes related to inadequate rendering of paid medical services are considered. On the basis of legal design for consumers and medical personnel the simple and evident statement of possible alternatives of mechanisms of settlement of disputes is presented. Te preferable design is consecutive application of all pretrial and alternative mechanisms of settlement of disputes. In case when there is no desirable result is the final decision is taken by court. It is concluded that the settlement of most disputes (90%) using pretrial and alternative dispute resolution mechanisms will significantly reduce time to resolve conflicts, as well as minimize unfavorable moral and economic consequences for consumers and providers of medical services.

BACKGROUND: The efficacy and safety of benralizumab, an interleukin-5 receptor alpha-directed cytolytic monoclonal antibody, for the prevention of exacerbations in patients with moderate to very severe chronic obstructive pulmonary disease (COPD) are not known.METHODS: In the GALATHEA and TERRANOVA trials, we enrolled patients with COPD (at a ratio of approximately 2:1 on the basis of eosinophil count [≥220 per cubic millimeter vs. RESULTS: In GALATHEA, the estimates of the annualized exacerbation rate were 1.19 per year (95% confidence interval [CI], 1.04 to 1.36) in the 30-mg benralizumab group, 1.03 per year (95% CI, 0.90 to 1.19) in the 100-mg benralizumab group, and 1.24 per year (95% CI, 1.08 to 1.42) in the placebo group; the rate ratio as compared with placebo was 0.96 for 30 mg of benralizumab (P = 0.65) and 0.83 for 100 mg of benralizumab (P = 0.05). In TERRANOVA, the estimates of the annualized exacerbation rate for 10 mg, 30 mg, and 100 mg of benralizumab and for placebo were 0.99 per year (95% CI, 0.87 to 1.13), 1.21 per year (95% CI, 1.08 to 1.37), 1.09 per year (95% CI, 0.96 to 1.23), and 1.17 per year (95% CI, 1.04 to 1.32), respectively; the corresponding rate ratios were 0.85 (P = 0.06), 1.04 (P = 0.66), and 0.93 (P = 0.40). At 56 weeks, none of the annualized COPD exacerbation rate ratios for any dose of benralizumab as compared with placebo reached significance in either trial. Types and frequencies of adverse events were similar with benralizumab and placebo.CONCLUSIONS: Add-on benralizumab was not associated with a lower annualized rate of COPD exacerbations than placebo among patients with moderate to very severe COPD, a history of frequent moderate or severe exacerbations, and blood eosinophil counts of 220 per cubic millimeter or greater (Funded by AstraZeneca [GALATHEA and TERRANOVA] and Kyowa Hakko Kirin [GALATHEA]; GALATHEA and TERRANOVA ClinicalTrials.gov numbers, NCT02138916 and NCT02155660.).

Background In the recent years, the overall trends in hospital admission and mortality of interstitial lung disease (ILD) are unknown. In addition, there was some evidence that interstitial lung disease death rate highest in the winter but this finding was only available in one study. This study will investigate the trend and seasonal variations in hospital admission and mortality rates of ILD from 2006 to 2016. Method From the Nationwide Inpatient Sample database, we collected all cases with the International Classification of Diseases (ICD)-9 or ICD-10 codes of ILD excluding identifiable external causes (drug, organic or inorganic dusts) from 2006 to 2016. Hospitalization rates of each year were calculated based on U.S Census population data. Monthly hospitalization and in-hospital mortality rates were analyzed by seasonal and trend decomposition. Subgroups of idiopathic interstitial fibrosis (IPF), acute respiratory failure (ARF), pneumonia were analyzed. Results From 2006 to 2016, all-cause hospital admission rate of patients with interstitial lung disease (ILD) and IPF-only subgroup declined but their overall mortality remained unchanged (except IPF subgroup and acute respiratory failure subgroup). Acute respiratory failure related admission account for 23% of all causes and pneumonia 17.6%. Mortality of ILD in general and subgroup of ILD with ARF was highest in winter, up to 8.13% ± 0.60 and 26.3% ± 10.2% respectively. The seasonal variations of hospital admission and mortality of ILD in general was not changed when infectious pneumonia cases were ruled out. All cause admission rates were highest in months from January to April. Subgroup analysis also showed seasonal variations with highest hospitalization rates for all subgroups (IPF, ARF, pneumonia) in the months from December to April (winter to early Spring). Conclusion From 2006 to 2016, admission rates of ILD of all causes and IPF subgroup declined but in-hospital mortality of ILD of all causes remained unchanged. Mortality of IPF subgroup and acute respiratory failure subgroup trended down. All-cause hospital admissions and mortality of ILD have a strong seasonal variation. Hospitalization rates for all subgroups (IPF, ARF, pneumonia) were highest in the months from December to April.

Glioblastoma is one of the most aggressive human brain tumors. Even following all the modern protocols of complex treatment, the median patient survival typically does not exceed 15 months. This review analyzes the main reasons for glioblastoma resistance to therapy, as well as attempts at categorizing the main approaches to increasing chemotherapy efficiency. Special emphasis is placed on the specific group of compounds, known as marine alkaloids and their synthetic derivatives exerting a general antitumor effect on glioblastoma cells. The unique mechanisms of marine alkaloid influence on the tumor cells prompt considering them as a promising basis for creating new chemotherapeutic agents for glioblastoma treatment.

Show the possibilities of diagnosing non - tuberculous mycobacteriosis of the lungs (NTML) in the practice of the pulmonologist.A survey of 90 patients with a confirmed diagnosis of non - tuberculous mycobacteriosis of the lungs (NTML) was presented. The diagnosis of pulmonary mycobacteriosis was established in accordance with the criteria proposed in 2007 by the American Thoracic Society and the American Society of Infectious Diseases (ATS/IDRS). Among the patients, 55 (61.1%) women prevailed, the average age was 51.2±15.3 years. Patients were evaluated complaints, the presence of concomitant diseases of the lungs, was carried out computed tomography of the chest high - resolution (HRCT), a culture study of sputum, in the absence of sputum or a single determination of the NTM culture in it, a study was conducted on materials of bronchoalveolar washout (ALS/BAL), or lung biopsies. Statistical processing of the research results was performed using descriptive statistics using Microsoft® Excel for Windows xp® on a personal computer.As a result of the study, it was revealed that before the diagnosis of NTML was established, 66.7% of patients were long observed for chronic lung diseases (chronic obstructive pulmonary disease, chronic bronchitis), and in 55.6% of cases (50 people) were registered with a phthisiologist about pulmonary tuberculosis. According to the CT scan of OGK, dissemination was determined in 66.7% of cases, in 48.9% - bronchiectasis, single or multiple destruction cavities - 46.7% of cases. In 72.2% of cases, non - tuberculous mycobacteria (NTM) were found in sputum, in 33.3% - in ALS and in 22.2% of NTMs were found in the surgical material. In 14.4% of cases, only surgery allowed to establish the diagnosis of mycobacteriosis.Цель исследования. Показать возможности диагностики нетуберкулезных микобактериозов легких (НТМЛ) в практике пульмонолога. Материалы и методы. Представлены материалы обследования 90 пациентов с подтвержденным диагнозом НТМЛ. Диагноз микобактериоза легких установлен в соответствии с предложенными в 2007 г. критериями Американского торакального общества и Американского общества инфекционных болезней (ATS/IDRS). Среди пациентов преобладали женщины - 55 (61,1%) человек, средний возраст составил 51,2±15,3 года. У пациентов оценивали жалобы, наличие сопутствующих заболеваний легких, проводили компьютерную томографию высокого разрешения органов грудной клетки (КТ ОГК), культуральное исследование мокроты, в случае отсутствия мокроты или однократного определения в ней культуры нетуберкулезных микобактерий (НТМБ) проводилось исследование материалов бронхоальвеолярного смыва (БАС/БАЛ) или биоптатов легких. Статистическая обработка результатов исследования выполнена методом описательной статистики с использованием Microsoft® Excel для Windows хр® на персональном компьютере. Результаты и заключение. В результате проведенного исследования выявлено, что до установления диагноза НТМЛ 66,7% пациентов длительно наблюдались по поводу хронических заболеваний легких (хроническая обструктивная болезнь легких, хронический бронхит), а в 55,6% случаев (50 человек) находились на учете у врача - фтизиатра по поводу туберкулеза легких. По данным КТ ОГК в 66,7% случаев определялась диссеминация, в 48,9% - бронхоэктазии, в 46,7% - одиночные или множественные полости деструкции. В 72,2% случаев НТМБ были найдены в мокроте, в 33,3% - в БАС и в 22,2% обнаружены в операционном материале. В 14,4% случаев только оперативное вмешательство позволило установить диагноз микобактериоза.

Background Failure to perform same-admission cholecystectomy (SA-CCY) for mild, acute, biliary pancreatitis (MABP) is a recognized risk factor for recurrence and readmission. However, rates of SA-CCY are low and factors associated with these low rates require elucidation. Methods Primary MAPB admissions were pooled from NIS 2000–2014 (weighted n = 578 258). Patients with chronic pancreatitis, pancreatic masses, alcohol-related disorders, hypertriglyceridemia, acute cholecystitis and AP-related organ dysfunction or complications were excluded. Annual rates of SA-CCY were calculated. Regression model for prediction of SA-CCY was built on 2010–2011 subset (weighted n = 74 169), yielding 96.3% of complete observations. Results Nationwide rate of SA-CCY in the U.S. was 40.8%. In multivariate analysis, SA-CCY was positively associated with BMI>30 (OR = 1.4, 95%CI 1.2–1.6), Asian ethnicity (vs. Black; OR = 1.2, 95%CI 1.0–1.5), private insurance (vs. Medicare; OR = 1.1, 95%CI 1.0–1.3), large (vs. small; OR = 1.3, 95%CI 1.2–1.4) urban hospitals (vs. rural; OR = 1.5 95%CI 1.3–1.7) of the South (vs. Northeast; OR = 1.5, 95%CI 1.3–1.7), as well as with chronic cholecystitis (OR = 17.0, 95%CI 15.4–18.7) and abdominal-wall hernias (OR = 5.2; 95%CI 3.0–8.9); the latter two predictors were not included in the final model. SA-CCY was negatively associated with age >40 (OR = 0.72; 95%CI 0.66–0.79), male gender (OR = 0.86, 95%CI 0.80–0.93), dementia (OR = 0.88, 95%CI 0.72–1.1), chronic comorbidities (OR = 0.64; 95%CI 0.54–0.77) and ostomies (OR = 0.51; 95%CI 0.31–0.86). Conclusion Adherence to SA-CCY guidelines for MABP remains inadequate. Independent geographic variation in SA-CCY rates may be related to reimbursement differences, ownership of AP patients, accessibility to surgical care, or cultural characteristics of the patient population.

Background After the Institute of Medicine (IOM) report To Err Is Human highlighted the impact of medical errors, the Agency for Healthcare Research and Quality (AHRQ) developed Patient-Safety Indicators (PSI) to improve quality by identifying potential inpatient safety problems. PSI-15 was created to study accidental punctures and lacerations (APL), but PSI-15 may underestimate APLs in populations of patients. This study compares PSI-15 with a more inclusive approach using a novel composite of secondary diagnostic and procedural codes. Methods We used Nationwide Inpatient Sample (NIS) data (2000–2012) from AHRQ's Healthcare Cost and Utilization Project (H-CUP). We analyzed PSI-15-positive and -negative cholecystectomies. Cross tabulations identified codes that were significantly more frequent among PSI-15-positive cases; these secondary diagnostic and procedural codes were selected as candidate members of a composite marker (CM) of APL. We chose cholecystectomy patients for study because this is one of the most common general operations, and the large size of NIS allows for meaningful analysis of infrequent occurrences such as APL rates. Results CM identified 1.13 times more APLs than did PSI-15. Patients with CM-detected APLs were significantly older and had worse mortality, comorbidities, lengths of stay, and charges than those detected with PSI-15. Further comparison of these two approaches revealed that time-series analysis for both APL markers revealed parallel trends, with inflections in 2007, and lowest APL rates in July. Conclusions Although CM may yield more false positives, it appears more inclusive, identifying more clinically significant APLs, than PSI-15. Both measures presented similar trends over time, arguing against inflation in PSI-15 reporting. While arguably less specific, CM may increase sensitivity for detecting APL events during cholecystectomies. These results may inform the interpretation of other large population studies of APLs following abdominal operations.

Background External carotid artery (ECA) stenosis is an independent mortality predictor. Additionally, concomitant ECA and internal carotid artery (ICA) stenosis progression has been associated with an increased risk of ipsilateral ischemic events in asymptomatic patients. Universally accepted ECA duplex velocity criteria, for the prediction of stenosis, do not exist. Methods Consecutive patients undergoing angiography and carotid duplex assessments were compared (n = 140). ICA, common carotid artery (CCA), and ECA peak systolic velocities (PSVs) were recorded. ECA/CCA PSV ratio was calculated. These parameters were compared with angiographic ECA measurements. Receiver–operator curve analysis was used to determine optimal criteria in identifying ECA stenosis of >50%. Results In patients with little ipsilateral ICA disease, for the detection of ECA stenosis of ≥50%, an ECA PSV >148 cm/sec provided a sensitivity of 80%, specificity of 76.2%, and an overall accuracy of 77.1%. An ECA/CCA PSV ratio of 1.45 demonstrated a sensitivity of 73.7%, specificity of 66.7%, and an accuracy of 68.2%.In patients with ICA stenosis ≥50%, for the detection of ECA stenosis of ≥50%, an ECA PSV >179 cm/sec provided a sensitivity of 50%, specificity of 79.6%, and overall accuracy of 71.3%. An ECA/CCA PSV ratio of ≥1.89 provided a sensitivity of 71.9%, specificity of 72.7%, and overall accuracy of 72.5%. Conclusions ECA PSV and ECA/CCA PSV ratios appear as useful metrics for the prediction of unilateral high-grade ECA stenosis.

Observational studies indicate that overutilization of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD). Overprescription and the high risk of serious ICS-related adverse events make withdrawal of this treatment necessary in patients for whom the treatment-related risks outweigh the expected benefits. Elaboration of an optimal, universal, user-friendly algorithm for withdrawal of ICS therapy has been identified as an important clinical need. This article reviews the available evidence on the efficacy, risks, and indications of ICS in COPD, as well as the benefits of ICS treatment withdrawal in patients for whom its use is not recommended by current guidelines. After discussing proposed approaches to ICS withdrawal published by professional associations and individual authors, we present a new algorithm developed by consensus of an international group of experts in the field of COPD. This relatively simple algorithm is based on consideration and integrated assessment of the most relevant factors (markers) influencing decision-making, such a history of exacerbations, peripheral blood eosinophil count, presence of infection, and risk of community-acquired pneumonia.

Medical support of the Petsamo-Kirkenes Offensive. W consider the organizational aspects of the healthcare support of Petsamo-Kirkenes Offensive in the Arctic. The conditions and factors that influenced the preparation and conduct of operations are analysed. It is shown that success and effectiveness of medical support of the operation are based on good planning, build-up of forces and means of medical service and manoeuvre, timely evacuation of the wounded and sick, experience of interaction and mutual reinforcement of the Army Medical Services, and the fleet can be used in the development of plans for medical support of diverse groups of troops (forces) in the Far North of Russia.

Understanding the hallmarks of the immune response to SARS-CoV-2 is critical for fighting the COVID-19 pandemic. We assessed antibody and T cell reactivity in convalescent COVID-19 patients and healthy donors sampled both prior to and during the pandemic. Healthy donors examined during the pandemic exhibited increased numbers of SARS-CoV-2-specific T cells, but no humoral response. Their probable exposure to the virus resulted in either asymptomatic infection without antibody secretion, or activation of pre-existing immunity. In convalescent patients, we observed a public and diverse T cell response to SARS-CoV-2 epitopes, revealing T cell receptor (TCR) motifs with germline-encoded features. Bulk CD4+ and CD8+ T cell responses to the spike glycoprotein were mediated by groups of homologous TCRs, some of them shared across multiple donors. Overall, our results demonstrate that the T cell response to SARS-CoV-2, including the identified set of TCRs, can serve as a useful biomarker for surveying antiviral immunity., Graphical Abstract, Highlights Healthy donors sampled in 2020 had an increased T cell response to SARS-CoV-2 SARS-CoV-2 glycoprotein S-specific TCR repertoire features public CDR3 motifs Two epitopes are recognized by the majority of the HLA-A2+ COVID-19 convalescents, Shomuradova et al. assessed the immune response to SARS-CoV-2 in convalescent patients and healthy donors. Antigen-specific T cells were increased in convalescents and in donors sampled during the pandemic. The work identified two public epitopes from S-glycoprotein. T cell receptor repertoire profiling of S-glycoprotein specific lymphocytes revealed public CDR3 motifs.

BACKGROUND The purpose of this study was to evaluate the impact of prior unilateral chest wall radiotherapy on reconstructive outcomes among patients undergoing bilateral immediate breast reconstruction. METHODS A retrospective evaluation of patients with a history of unilateral chest wall radiotherapy was performed. In each patient, the previously irradiated and reconstructed breast was compared to the contralateral nonirradiated side, which served as an internal control. Descriptive and bivariate statistics were computed. Multiple regression statistics were computed to identify adjusted associations between chest wall radiotherapy and complications. RESULTS Seventy patients were included in the study. The mean follow-up period was 51.8 months (range, 10 to 113 months). Thirty-eight patients underwent implant-based breast reconstruction; 32 patients underwent abdominal autologous flap reconstruction. Previously irradiated breast had a significantly higher rate of overall complications (51 percent versus 27 percent; p < 0.0001), infection (13 percent versus 6 percent; p = 0.026), and major skin necrosis (9 percent versus 3 percent; p = 0.046). After adjusting for age, body mass index, reconstruction method, and medical comorbidities, prior chest wall radiotherapy was a significant risk factor for breast-related complications (OR, 2.98; p < 0.0001), infection (OR, 2.59; p = 0.027), and major skin necrosis (OR, 3.47; p = 0.0266). There were no differences between implant-based and autologous reconstructions with regard to complications (p = 0.76). CONCLUSION Prior chest wall radiotherapy is associated with a 3-fold increased risk of postoperative complications following immediate breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.

To substantiate the advisability of using cytoflavin to correct postoperative cognitive dysfunction (POCD) in patients undergoing video laparoscopic cholecystectomy (VLCE) under conditions of inhalation anesthesia with sevoflurane.The data of two representative groups of patients (Neuropsychological testing in group I patients revealed the development of moderate POCD. The inclusion of Cytoflavin in the treatment regimen in the II group of patients contributed to an improvement in the state of HMF, accompanied by a decrease in the level of anxiety and depression.The inclusion of Cytoflavin in treatment regimens helps prevent the development of POKD and is accompanied by an improvement in the state of higher mental functions, which is manifested by a decrease in the level of anxiety and depression, favorably affecting the emotional background of patients.Изучить динамику состояния высших психических функций и клиническую эффективность Цитофлавина с целью терапии послеоперационной когнитивной дисфункции (ПОКД) у пациентов, перенесших видеолапароскопическую холецистэктомию (ВЛХЭ) в условиях ингаляционной анестезии севофлураном.Обследованы 60 пациентов, которым в условиях ингаляционной анестезии севофлураном была выполнена видеолапароскопическая холецистэктомия. Оценка состояния высших психических функций проводилась с помощью нейропсихологического тестирования по шкалам тревоги и депрессии HADS, а также МоСА и FAB. В 1-ю группу вошли 19 пациентов, которым коррекция ПОКД не проводилась, во 2-ю — 41 пациент, которому с целью коррекции когнитивных расстройств был назначен Цитофлавин (20 мл на 250 мл 0,9% раствора натрия хлорида внутривенно капельно однократно перед операцией, далее в течение 4 сут послеоперационного периода).Проведение нейропсихологического тестирования выявило у пациентов 1-й группы развитие умеренной ПОКД. Включение Цитофлавина в схему терапии у пациентов 2-й группы способствовало улучшению состояния высших психических функций, сопровождалось снижением уровня тревоги и депрессии.Включение Цитофлавина в схемы терапии способствует профилактике развития ПОКД и сопровождается улучшением состояния высших психических функций, что проявляется снижением уровня тревоги и депрессии, благоприятно сказываясь на эмоциональном фоне пациентов.

In recent years, steadily increasing the number of operations for morbid obesity. One of the most frequently performed worldwide operations at this pathology is the sleeve gastrectomy are approximately 28% of all bariatric surgeries per year It must be stressed that obesity is accompanied by hard changes andfunctional disorders of all body systems, including the respiratory and cardiovascular The aim: to study the effect of respiratory support options combined with high thoracic epidural analgesia, as a component of anesthetic management on central hemodynamics during anesthesia providing endoscopic gastroplasty in patients with morbid obesity.a randomized study of 37 patients with morbid obesity who underwent endoscopic sleeve gastroplasty under anesthesia combined with high thoracic epidural analgesia. Depending on the choice of tactics respiratory support patients were divided into two groups; In group 1 (n-17), the traditional mode of ventilation in group 2 (n-20) modified the ventilation mode. Intraoperative central hemodynamic parameters, external respiration were monitored; acid-base balance is achieved partly by recycling carbon dioxide in a closed breathing circuit using NICO 7300 system (Novametrix Medical Systems Inc. USA), based on the Fick principle.the use of ventilation mode with inversion of the respiratory cycle, high-level application of PEEP titration in stages so you can optimize the parameters of external respiration, gas exchange without adverse effects on the central hemodynamics. The continued elevated levels PaCO₂, PvCO₂, when applying carboxiperitoneum, did not cause gross changes in acid-base balance.

To determine the incidence of spreading bladder transitional cell carcinoma and primary adenocarcinoma to the prostate in patients with bladder cancer undergoing radical cystectomy.From 1995 to 2016, 283 men underwent radical cystectomy with removal of the bladder, perivesical tissue, prostate, seminal vesicles and pelvic lymph nodes. Prostate sparing cystectomy was performed in 45 (13.7%) patients. The whole prostate and the apex of the prostate were preserved in 21 (6.4%) and 24 (7.3%) patients, respectively.The spread of transitional cell cancer of the bladder to the prostate occurred in 50 (15.2%) patients. Twelve (3.6%) patients were found to have primary prostate adenocarcinoma. Clinically significant prostate cancer was diagnosed in 4 (33.3%) patients.We believe that the high oncological risk of prostate sparing cystectomy, despite some functional advantages, dictates the need for complete removal of the prostate in the surgical treatment of bladder cancer.

Idiopathic pulmonary fibrosis (IPF) is a severe lung disease, with death occurring within 2-5 years after its onset. IPF affects people in the second half of life. Its causes are unknown. Before 1999, IPF was out from the group of idiopathic interstitial lung diseases as a separate nosological entity. Practitioners very often (80%) make diagnostic errors in IPF and prescribe antibiotics, anti-inflammatory drugs, which worsen the course of this disease. The distinctive feature of the pathogenesis of IPF is the absence of inflammation, which is clinically manifested by the inefficacy of glucocorticosteroids and other anti-inflammatory drugs. Pharmacological agents for the treatment of IPF have been designed since 2000. One of them has been registered and permitted for use in the Russian Federation. This paper is a review of an update on the problem of IPF, which should facilitate the appropriate orientation of physicians in diagnosing and treating this severe disease.Идиопатический фиброз легких (ИФЛ) - тяжелое заболевание легких со смертельным исходом в течение 2-5 лет от начала болезни. ИФЛ поражает людей во второй половине жизни. Причины ИФЛ неизвестны. До 1999 г. ИЛФ выделен из группы идиопатических интерстициальных болезней легких в отдельную нозологическую форму. Практикующие врачи очень часто (до 80%) допускают диагностические ошибки при ИФЛ и назначают антибиотики, противовоспалительные средства, усугубляющие течение заболевания. Отличительная черта патогенеза ИФЛ - отсутствие воспаления, что клинически проявляется неэффективностью глюкокортикостероидов и других противовоспалительных средств. Начиная с 2000 г. разрабатываются фармакологические средства для лечения ИФЛ. Один из них зарегистрирован и разрешен к применению в Российской Федерации. Настоящая статья представляет обзор современных данных по проблеме ИФЛ, что должно способствовать правильной ориентации врачей в проблемах диагностики и лечения этого тяжелого заболевания.

Once people reach 40 years of age, they have a decrease in their pool of pluripotent stem cells, and an increased risk for development of oncological diseases.The first part of the study was conducted in 11 patients aging 54 to 76 years old with cancer of the kidney, bladder, or prostate in stages III-IV of the disease. The second part of the study was conducted in four patients aged 60-82 years old, who were given from 4 to 7 transfusions of mononuclear fraction of peripheral blood from young donors 19-23 years old, with the same sex and blood types as the recipients, in order to restore cell regeneration.In the first part of the study, 1 month after chemotherapy or targeted therapy, all 11 cancer patients had leukopenia accompanied by an increase in the contents of FGFb in the blood by 1.74 times on average. Four of these patients had an increase in the level of human VEGF-A of 1.25 times on average, while three patients had an increase in the level of human EGF of 1.13 times on average. In the second part of the study, 3-6 months after the completion of a cycle of 4-7 blood transfusions of mononuclear fraction of periphery blood, four patients had an in increase in the contents of hematopoietic progenitor cells CD34+ of periphery blood by 3.25 times on average, to the level normal in young people, while the level of FGFb decreased by 1.78 times on average. Among two patients, the level of human VEGF-A decreased by 1.48 times on average, while for three patients the level of human EGF decreased by 4.12 times on average. In the buccal epithelium, all four patients had a decrease in the expression of p53 by 6.02 times on average, while three of them had a decrease in the expression of Bcl-2 by 60.0 times on average.Violation of tissue renewal is a major cause of carcinogenesis in people older than 40 years old. Excessive stimulation of mitotic activity among people over 40 can be reduced to normal levels by restoring the pool of pluripotent stem cells through transfusion of mononuclear fraction of peripheral blood from young donors 18-23 years old with the same blood groups and sex as the recipient (RF patent number 2350340).

We present a simple and effective method to obtain refined control of the molecular structure of silk biomaterials through physical temperature-controlled water vapor annealing (TCWVA). The silk materials can be prepared with control of crystallinity, from a low content using conditions at 4°C (alpha-helix dominated silk I structure), to highest content of ~60% crystallinity at 100°C (beta-sheet dominated silk II structure). This new physical approach covers the range of structures previously reported to govern crystallization during the fabrication of silk materials, yet offers a simpler, green chemistry, approach with tight control of reproducibility. The transition kinetics, thermal, mechanical, and biodegradation properties of the silk films prepared at different temperatures were investigated and compared by Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), uniaxial tensile studies, and enzymatic degradation studies. The results revealed that this new physical processing method accurately controls structure, in turn providing control of mechanical properties, thermal stability, enzyme degradation rate, and human mesenchymal stem cell interactions. The mechanistic basis for the control is through the temperature controlled regulation of water vapor, to control crystallization. Control of silk structure via TCWVA represents a significant improvement in the fabrication of silk-based biomaterials, where control of structure-property relationships is key to regulating material properties. This new approach to control crystallization also provides an entirely new green approach, avoiding common methods which use organic solvents (methanol, ethanol) or organic acids. The method described here for silk proteins would also be universal for many other structural proteins (and likely other biopolymers), where water controls chain interactions related to material properties.

Comparison of the state of 83 patients with histologically confirmed sarcoidosis observed with a 10 year interval revealed remission in 47% of the cases. The main factors having negative effect on prognosis of the disease included extrapulmonary symptoms, the use ofcorticosteroids (at all stages, especially at stage I and in Lofgren syndrome) and antituberculosis drugs, positive TB test. Risk factors of relapses were stage II sarcoidosis, the use of systemic corticosteroids in patients with Lofgren syndrome and antituberculosis drugs, initially low FEV1/FVLC ratio and the number of lymphocytes in peripheral blood.

238 patients with atherosclerosis of carotid arteries after reconstructive operations under different types of anesthesia were enrolled in the study. Neuropsychological survey with Montreal cognitive assessment scale, frontal assessment battery and clock drawing test was performed in dynamics. Minimal cognitive dysfunction was mentioned in patients with symptomatic and asymptomatic stenosis after combined anesthesia with regional anesthesia. Postoperative cognitive dysfunction was developed after sevoflurane and propofol anesthesia in patients with asymptomatic stenosis. After inhalation anesthesia it was more severe. Prevention of postoperative cognitive dysfunction with ceraxon was clinically effective. This therapy can facilitate mental functions recovery and improve quality of life.

To evaluate the efficiency of stepwise treatment in patients with isolated thermal inhalation injury (TIJ).The study enrolled 101 patients with isolated TIJ. A study group (n=56) was treated at the Pulmonology Department after managing at the Burn Center (BC); a control group (n=45) received no systematic treatment after discharging from BC. The magnitude of respiratory symptoms (according to the rating system) and external respiratory function (ERF) was evaluated and fibrobronchoscopy was made in all the included patients at their discharge from BC. On admission to the Pulmonology Department, the study group patients underwent evaluation of the magnitude of respiratory symptoms, EFR, and lung diffusing capacity, determination of blood gas composition and exercise tolerance, and chest computed tomography. Respiratory symptoms, ERF, and exercise tolerance were evaluated in all the included patients one month after hospital discharge.Examination at the Pulmonology Department established preserved respiratory manifestations in patients who had to continue therapy. The use of beta2-agonists or inhaled steroids used in combination or alone need, mucoregulators or antibiotics revealed the efficiency of a stepwise approach to managing patients with TIJ.There is evidence that it is expedient to perform two-stage treatment in patients with TIJ, by transferring them from BC to a specialized pulmonology hospital, which substantially enhances the efficiency of medical care for this contingent of patients.

It was studied 238 patients after the reconstructive surgeries of atherosclerotic stenosing lesions of carotid arteries using different types of anesthesia. Neuropsychological testing included MMSE, the Frontal Assessment battery and the Clock drawing test. Regional anesthesia in the combination with reduced general anesthesia caused the less pronounced cognitive deficits in patients with symptomatic or asymptomatic stenoses. Inhalation anesthesia with sevofluorane led to the more pronounced cognitive impairment compared to total intravenous anesthesia with propofol. Ceraxon was used for the correction of cognitive impairments. This treatment increased the recovery of brain functions and quality of life of patients.

The paper describes the causes of mucostasis and the mechanisms of its development. It presents classifications of mucolytic drugs. A group of combination mucolytic drugs is identified by indicating the standard of their design and usage. The characteristics of the drugs including the combination agent ascoril are described in detail and information on the successful results of its use is given.

The article demonstrates that both highly developed bioethical consciousness and legal awareness and high level of bioethical and legal culture among obstetrician-gynecologists are important factors of enhancement of medical care quality. This postulate is discussed on the example of issues related to the induced abortion. The approaches to this issues applied in various countries are considered.

The article characterizes current strategy of treatment of chronic obstructive pulmonary disease (COPD), contains epidemiological data, draws attention to various phenotypes of COPD which determine individual approach to therapy. Individual treatment programs must consider stage of the disease, its progression, comorbid pathology. Pharmacological and non-pharmacological treatment methods are outlined. It is important to give therapists advanced training in COPD diagnosis and treatment.

The purpose of the study was to choose an optimal anesthetic method to ensure adequate cerebral blood flow and to reduce the number of perioperative complications during carotid endarterectomy. Total intravenous anesthesia with diprivan, combined cervical plexus block anesthesia, and inhaled sevoflurane anesthesia were assessed in 190 patients undergoing carotid endarterectomy. The study of cerebral blood flow and central hemodynamic parameters indicated that deprivan anesthesia suppressed the major hemodynamic parameters, causing associated cerebral circulation depression. The use of cervical plexus block as a major component of anesthesia after Pashchuk stabilized the mean blood pressure and cardiac index, causing the optimization of cerebral blood flow parameters with a considerable postload increase. During sevoflurane anesthesia, the most physiological conditions for the performance of the circulatory system were found at all stages of surgical treatment, which predetermined the stable parameters of central hemodynamics and cerebral blood flow. The studies revealed that deprivan anesthesia was followed by a considerable number of both cardiac and neurological complications. The patients with cervical plexus block had fewer neurological disorders, but the increased postload accompanying these changes caused an increase in the number of cardiac complications. The most optimal parameters of cerebral blood flow and central hemodynamics during sevoflurane anesthesia induced a statistically significant reduction in the number of cardiac and neurological complications.

Total intravenous anesthesia with diprivan and inhaled sevoflurane was assessed in 130 patients undergoing carotid endartectomy. The parameters of hemodynamics and cerebral circulation and the markers of brain lesion were studied. Sevoflurane anesthesia was shown to induce less depression of hemodynamic parameters and to maintain the more optimal level of cerebral circulation, limiting brain ischemic and reperfusion lesions and causing a fewer number of postoperative complications.

Total intravenous anesthesia with propofol and inhalation sevofluran was assessed in 130 patients with carotid endarterectomy. The parameters of brain blood circulation, brain damage markers were studied. It was shown that sevofluran anesthesia caused less depression of the hemodynamic parameters, supported more optimum level of brain blood flow that limited ischemic and reperfusion damage of the brain and was accompanied by a fewer number of postoperative complications.

Fibrosing alveolitides (FA) are common diseases, as yet insufficiently known to practitioners. In most cases, objective and subjective difficulties arise in diagnosing FA in the outpatient setting. The course of FA has been analyzed in 48 patients from their first visit to a polyclinic to admission to a specialized pulmonology unit. There is a high rate of outpatient diagnostic errors that may be accounted for by the similarity of many lung diseases, at their onset in particular, by small-scale studies and district therapists' little experience in working with patients with FA. The results of comprehensive examinations of patients with FA in a specialized clinic are given.

The effectiveness and safety of treatment with vobenzyme supplemented to the standard antibiotic therapy have been compared in 60 patients. Addition of vobenzyme to the standard antibiotic therapy significantly reduces the number and degree of respiratory symptoms has a pronounced effect on the activity of inflammation, leads to a more complete reversal of pulmonary parenchymatous infiltration on a roentgenogram, contributes to the achievement of the maximum efficiency of treatment, and substantially diminishes residual respiratory symptoms of pneumonia economically expediently and safety at a late follow-up.

After 3 weeks or more of treatment, 36 patients who were found to have X-ray signs of pneumonia (pulmonary infiltrative changes, fever, productive cough, weakness) were randomized into two matched groups (a study group and a control one). 77.7 and 55% of control and study group patients changed and continued antibacterial therapy. The study group patients were additionally given intravenous infusions of 400 ml of ozonized sodium chloride solution (pO3) containing 1.6 microg/ml of O3 twice weakly for 21 days. Blood ozonization considerably accelerated the resolution time of X-ray infiltrative changes so that they were undetectable in all study group patients by week 4 while they were only in 61.1% of the control groups. Blood ozonization used in combination with antibiotics permitted caused a sputum negative reaction against Chlamydia and Mycoplasma 2-3 weeks earlier. Infusions of pO3 just after the first ozonization made it possible to eliminate a clinical sign of chronic infection, such as weakness, to accelerate productive cough relief on day 10, and to reduce the number of fever patients. Ozone therapy for protracted pneumonias substantially enhances the efficiency of antibiotic treatment.

The paper gives data on the prevalence of nonspecific lung disease in patients with pulmonary tuberculosis, the specific features of diagnosis and treatment of their concomitance in 3453 patients with pulmonary tuberculosis. It shows the low detection rate of nonspecific lung diseases in patients with pulmonary diseases. The high error rate has been established in the diagnosis of pulmonary tuberculosis at health care facilities. There is evidence that the use of current therapy for bronchial obstructive syndrome with inhaled cholinolytics and beta2-agonists in patients with pulmonary tuberculosis causes a reduction in the intensity of respiratory symptoms and an increase in forced expiratory volume in one second.

The quality of the diagnosis and treatment of lung diseases was assessed in the polyclinics of the Northern Administrative District of Moscow by 2 methods: (1) selective examination of 960 case histories of bronchial asthma and chronic obstructive pulmonary diseases and (2) questionnaire survey and spirometry of 2132 patients aged 35 to 75 years who have visited a polyclinic for no respiratory diseases. Random check of the case histories revealed a large number of diagnostic and medical errors suggesting the undertraining of therapists in pulmonology. The performed cycles of educational programs could considerably reduce the number of the errors found on recheck. Questionnaire survey and spirometry could increase the number of diagnosed cases of chronic lung diseases by 10 times.

Idiopathic interstitial pneumonias are well-known to be mainly characterized by restrictive ventilation dysfunctions and a diminished lung diffuse capacity. No separate significance is generally attached to bronchial obstructive disorders that may be detected along with restrictive ones in some patients. The made analysis of the ventilation capacity of the lung in 53 patients with idiopathic interstitial pneumonias has revealed impaired bronchial patency in 47.2% of the cases, which gives grounds to study this problem in future.

The clinical efficiency of inhalational antibacterial therapy for Stage II chronic obstructive pulmonary disease (COPD) was evaluated in 100 patients who had been randomized to an inhalational fusafungine group (n = 50) and a systemic (per os or parenteral) antibiotics group (n = 50). Inhalational antibacterial therapy for exacerbations of Stage II COPD was found to be as effective as systemic use of antibiotics. Moreover, side effects of inhalational therapy were much less pronounced.

In four adult healthy subjects in 18 experiments, we studied Brain-Computer-Interface recognition of different intended words by P300 wave in the VEP. The set of optimal characteristics of visual stimulation which rise reliability of recognition up to 100 %, as well as effective registration locus (Pz) were determined. It was found that the best processing criteria for letter recognition were: P300 square and superposition of all three criteria (P300 amplitude, square and covariation coefficient).

A suspension of multidrug resistant clinical Mycobacterium tuberculosis (MBT) strain, at a concentration of 1 x 10(8) microbes per ml, resistant to streptomycin (S), rifampicin (R), isoniazid (I), and kanamycin (K), was in vitro treated for 60 minutes with dissolved ozone (pO3) at a concentration of 0.5-4 microg/ml). Then it was placed in the Lowenstein-Jensen media containing various concentrations of S, I, R, and K. Following 3 months, drug susceptibility was determined by the number of cultured colonies and MBT was used to prepare a suspension at the same concentration, which was again treated with pO3 by the same procedure and placed to the media containing the drugs. A session was thrice repeated. After each pO3 treatment, MBT resistance to I decreased and it completely disappeared after triple treatment. Each pO3 treatment caused a reduction in MBT resistance to R, but it was high (640 microg/ml). After double pO3 treatment MBT resistance to S decreased, but it was recovered after its third ozone treatment. All pO3-untreated control cultures showed a growth of more than 100 colonies. Sixty-eight BALC/s mice were in vivo inoculated via intravenous injections of the clinical MBT strain resistant to S, I, R, and K. The mice were divided into 5 groups: 1) intact mice; 2) those inoculated and untreated; 3) those treated with 1; 4) those treated with I and peritoneally given pO3, 0.5-4 microg/ml); and 5) those given pO3. The animals began dying at month 4 of inoculation. By month 5, all mice, other than intact and pO3-treated ones, died. Passage of MBT from the month by month 4 showed a reduction in their resistance to I in the groups treated with pO3. When the mice were treated with I alone, damages to their livers and spleens were greater than when they were untreated. With co-administration of I and pO3, the damage was least. Treatment provoked a rapid change of MBT to granular and L-forms and MBT was undetectable in its typical form after 1-2-month therapy. The altered MBT formed an untypical histological pattern of tuberculous inflammation in mice in the presence of characteristic cellular cooperation. Clinical studies indicated that 1-6-month concurrent use of chemotherapy and pO3 in patients with drug-resistant tuberculosis eliminated drug resistance of isolated MBT to one of the drugs (I, R, K) in 97.3%, MBT became at once susceptible to I, R, and K in 47.2%. I and/or R were successfully used in the treatment of more than a third of the patients. The studies have demonstrated that most patients with drug-resistant pulmonary tuberculosis can be treated with the most effective drugs provided that systemic intravenous injection of pO3 is made.

Objective: This study aimed to compare the clinical efficacy of two anti-inflammatory medications (fenspiride and inhaled beclomethasone [beclomethasone dipropionate]) in patients with stable chronic obstructive pulmonary disease (COPD) over 6 months. Design, methods and patients: This was a randomised comparison of 58 patients with COPD, divided into five treatment groups: fenspiride (stages 1 and 2), beclomethasone (stage 2), and two control groups (stages 1 and 2). In addition, 64 patients with exacerbations of COPD were evaluated over a 2-week treatment period during which they received either fenspiride or prednisolone. Clinical signs and symptoms of COPD were evaluated every 2 months (aggregated numerical index of signs and symptoms), as were lung function tests (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], FEV1/FVC) and a 6-minute walking test. Results: Statistically significant reductions in all evaluated COPD signs and symptoms were achieved with fenspiride in stage 1 COPD. Fenspiride therapy significantly reduced the indices of sputum parameters (8-fold decrease), incidence of dry rales (6-fold decrease), dyspnoea (4-fold decrease) and cough (2.5-fold decrease). In comparison with beclomethasone, fenspiride was superior in stage 2 COPD. In patients with stage 2 COPD, reductions were less marked, but remained significantly superior in the fenspiride group in comparison with the beclomethasone group and the control groups. In patients with exacerbations of COPD, fenspiride had equivalent efficacy to that of systemic corticosteroids. Conclusion: Anti-inflammatory therapy with fenspiride in addition to bronchodilators significantly improved clinical signs and symptoms, external respiratory function tests and physical activity tests in patients with stage 1 COPD. Adjunctive fenspiride therapy was superior to inhaled beclomethasone in stage 2 COPD. Anti-inflammatory therapy in COPD may be more effective at an early stage of this disease.

The paper describes the diversity of manifestations of sarcoidosis, which determines the extent of this process. The present study revealed skin and joint lesions in most cases and identified the involvement of peripheral lymph nodes, eyes, heart, thyroid, kidney, spleen, liver, and pancreas. Sarcoidosis of the pleura, pericardium, subcutaneous fat, and ovaries was most common. The systemic manifestations of sarcoidosis were found only in half of the examinees, which is most likely to suggest the complexity of diagnosis, the poor awareness of the most accessible and most used study methods, and the frequency of spontaneous remissions.

To study clinicolaboratory signs of respiratory infection in patients with bronchial asthma (BA).Respiratory infection and its influence on BA were studied in 108 BA patients (66 female and 42 male, mean age 51.0 +/- 15.2 years) with symptoms of bronchitis and non-nosocomial (n = 71) and nosocomial (n = 37) pneumonia. The patients referred for medical care and started antibacterial therapy (ABT) after 4.7 +/- 2.8 days of respiratory infection (RI). Before assignment to the trial BA exacerbation ran for 9.8 +/- 6.0 days.RI preceded BA exacerbation in 62% patients with pneumonia. BA exacerbation preceded RI in 66% patients with bronchitis. RI ran with moderate and severe intoxication. Severity of BA exacerbation correlated with severity of RI Antibacterial treatment was uneffective and the drugs were changed for others in 18% bronchitis and 16% pneumonia patients. Laboratory signs of inflammation were more obvious in pneumonias than in bronchitis and did not depend on the disease severity. External respiration function at RI onset was significantly affected in all the patients.Respiratory infections aggravate the course of BA and damage external respiration function.