The lifestyle of people nowadays and poor diet are factors affecting the increasing incidence of digestive diseases in people all over the world. The search for new methods of early diagnosis of the disease is an urgent issue of modern medicine. In the last decade, much attention has been paid to various biological markers that can be used to assess the risk of disease development, the response to therapy, and the possible development of complications. Biomarkers in clinical medicine can be used as additional tools not only to improve early diagnosis of gastrointestinal diseases but also to assess the effectiveness of therapy.The aim of this lecture was to analyze and systematize biomarkers in various gastrointestinal diseases.

Aim. The aim of the study was to study the frequency of occurrence of exposure to harmful occupational factors in patients with sarcoidosis of the respiratory organs, depending on the course of the disease. Materials and methods. An open prospective study included 121 patients with sarcoidosis of the respiratory system from the age of 21 to 66 years, from 2007-2019. The diagnosis was histologically confirmed in all patients. Patients underwent a set of laboratory and instrumental examinations, studied profane history. The presence of a history of contact with harmful and dangerous production factors was clarified. To determine the effect of a harmful production factor on the course of sarcoidosis, patients were divided into 2 clinical groups: the first group consisted of 85 (70.2%) patients with a favorable course of the disease, the second group included 36 (29.8%) patients with an unfavorable course sarcoidosis (standardization coefficient between groups 2.4:1). Results and discussion. Among the examined patients of working age prevailed (87%). Patient groups were comparable by age, but statistically differed by gender (chi2=9.75, p=0.0018). Frequency analysis of the occurrence of harmful occupational factors in sarcoidosis of the respiratory organs showed that the most frequently encountered factors in all the studied groups were contact with chemical hazards. Conclusion. The presence of contact with harmful production factors increases the risk of an unfavorable course of sarcoidosis by more than 2 times.

Aim. To study clinical and morphological phenotypes in different variants of the course of intrathoracic sarcoidosis and isolate new phenotypes.Materials and methods. The study included 121 patients with intrathoracic sarcoidosis aged 21–66 years (50.4% were men, 49.6% were women, the average age at the time of the disease onset was 38 years) over the period 2007– 2019. During the examination, patients’ complaints were studied thoroughly, and the diagnosis was histologically verified in all cases. During an extended histological examination, the quantitative and qualitative composition of biopsy specimens was investigated. The number of granulomas in the field of vision and the content of giant cells, macrophages, lymphocytes, neutrophils, and eosinophils in them were studied. Qualitative parameters were assessed for the presence of hyalinosis, Schaumann bodies, necrosis, stamping, calcification, fibrosis, and vasculitis. All patients were retrospectively divided into two clinical groups depending on the outcomes of the disease: group 1 included patients with a favorable course of sarcoidosis, proceeding without relapses and signs of progression; group 2 encompassed patients with an unfavorable course of the disease with relapses and progression, requiring long-term administration of systemic glucocorticoids.Results. The analysis showed that among all general clinical manifestations, only the presence of dyspnea, skin manifestations, and weight loss occurred significantly more often in the patients with an unfavorable course of intrathoracic sarcoidosis (р = 0.04; 0.02; and 0.01, respectively). Among morphological parameters, a large number of macrophages was significantly more frequent in the biopsy specimens in this group of patients (р < 0.01).

As a rule, heart damage in patients with sarcoidosis of respiratory organs (SOD) is not diagnosed in time, so a very important and urgent task is to identify common heart rhythm and conduction disorders.The aim of the studywas to investigate the main clinical manifestations of sarcoidosis in SOD, depending on the peculiarities of the disease course and to compare the frequency and severity of pulmonary and extrapulmonary manifestations of sarcoidosis, including myocardial lesions and electrocardiographic (ECG) signs of heart rhythm disorders.Methods. In the period 2006– 2016, the pilot open prospective uncontrolled study conducted at the Pulmonology Department of the Regional State Autonomous Healthcare Institution "Tomsk Regional Clinical Hospital" included patients (n = 84) aged 20–67 years with the diagnosis of SOD. Patients were divided into 2 clinical groups: the 1st comprised 45 (53.5%) patients with a favorable course of sarcoidosis, the second one included 39 (46.4%) patients with an unfavorable course of the disease. A full range of studies was carried out, including the analysis of medical history and clinical and epidemiological data, instrumental methods (including ECG and Holter ECG monitoring (HM), pathomorphological study of lung biopsy samples.Results. According to the data of frequency analysis of occurrence of pulmonary and extrapulmonary clinical manifestations in ODS, it was shown that the leading clinical manifestations, most frequently occurring in patients of both groups, included asthenia syndrome (72.6%), bronchial syndrome (66.7%) and fever syndrome (33%). In 33% of cases, clinical manifestations of myocardial damage were detected. In 41 (51.2%) patients in both groups, changes on ECG were recorded at rest. Regardless of the course of the disease, in 23.5% of patients of both clinical groups, according to the results of the HM ECG, rhythm and conduction disturbances were found – a combination of ventricular arrhythmias and conduction disorders (ventricular extrasystole and right His bundle branch block of various degrees) and a combination of supraventricular arrhythmias and conduction disturbances (supraventricular extrasystole and right His bundle branch block of various degrees).Conclusion. Thus, regardless of the severity of the disease course, SOD patients are concerned about complaints from both respiratory system and extrapulmonary manifestations, including cardiac complaints, as well as heart rhythm and conduction disorders (according to the results of ECG and HM ECG), the frequency of which, according to the comparative analysis, has not significantly changed in both clinical groups, which indicates the non-specific character of clinical manifestations.

Sarcoidosis may show a different course from spontaneous regression to chronic recurrent forms. The search for prognosis criteria remains relevant for the disease. The aim was to study the relationship between granuloma morphology and clinical course of sarcoidosis. Materials: A morphological study of lungs obtained during VATS biopsies was performed in 121 patients with sarcoidosis onset. It included the formula of cellular elements, the number of granulomas, giant multinucleated cells, the presence of hyalinosis, necrosis, calcification, stamped granuloma, and etc. According to the 9-11 year period of observation patients were divided into 2 groups: favorable course group (spontaneous regression, stabilization), chronic relapsing course group. For statistics nonparametric Mann-Whitney’s, Chi-square tests, an analysis of the confidence intervals were used. Results: Data expressed as median, p<0.01 Statistically significant differences were found in elements of the cellular formula. Other parameters did not show the difference between the groups. Confidence intervals analysis revealed a favorable course morphotype (Mph <70%, Lc > 28%, Lc/Mph index > 0.38). An adverse course morphotype was characterized by Mph > 81%, Lc <15%, Lc/Mph index <0.18. Associations with clinical manifestations were found for each morphotype. About 30% of patients have intermediate morphological parameters and a diverse course. Conclusion: The sarcoidosis course can be predicted in the onset based on the cell formula of the granuloma nearly in 70% of cases.

The aim of this work was to study changes in mechanical lung properties in cases of COPD in general and in different zones depending on the body position. Materials and methods. The research was performed in 37 patients with chronic obstructive pulmonary disease (COPD) in the vertical and horizontal positions (VP and HP). Results. The analysis of integral respiration mechanics has revealed a reduction in dynamic lung compliance and an increase in total non-elastic lung resistance during expiration (TNRexp) in HP vs. VP. At the same time, despite the increase in TNRexp in HP, the total work of breathing did not increase. Unlike healthy individuals, the COPD patients were characterized by the absence of differences in regional mechanical properties in both VP and HP. There were no differences in the respiration mechanics of the left lung, and the zones of the right lung only differed in the parameters of regional non-elastic work of breathing (NWBr) that was increasing from top downwards: the indicators of NWBr during expiration and NWBr in the lower zone were higher as opposed to those of the upper zone in VP. As for HP, NWBr during inspiration, NWBr during expiration and NWBr were higher. Conclusion. The data obtained contradict the prevailing opinion about an escalation in regional differences in ventilation and respiration mechanics under the influence of emerging focal and diffuse inflammatory-sclerotic pathological changes in lungs and emphysema.

In the lungs of 76 patients with verified sarcoidosis, 28 chemical elements were identified with neutron activation analysis. High levels of Ca, Fe, Cr, Co, Cs, Eu, Lu, Th, Hf, Au, and U and low level of Na compared to the control samples were determined in sarcoidosis. There were no significant differences in the content of Zn, Rb, La, Sm, Sr, Nd, As, Br, Ag, Tb, Sc, Ta, Sb, Ba, and Yb. Spearman correlation analysis shows multiple positive associations, with the maximum being in pairs as follows: Fe-Cr, Eu-La, Ce-Lu, Hf-Cr, Sc-Zn, Fe-Hf, Ce-Co, and Sb-Cr. These studies support the hypothesis that sarcoidosis is a response of the organism in the form of granulomatous inflammation when exposed to heavy metals and rare earth elements in the environment. We assume that the role of calcium and iron is to separate granulomas from the tissues of the body.

The article describes the experience of development and implementation of e-learning courses in the field of phthisiology for specialists of the system of additional professional education at the relevant department of a medical university. It specifies the organizational stages for training of phthisiologists and other specialties during professional development courses using distance learning technologies and assesses the demand for created electronic educational developments within the Moodle distance learning system.

In the literature review, modern views on the features of pathogenesis and diagnosis of pulmonary hypertension associated with portal hypertension and sarcoidosis of respiratory organs are presented. A variety of views is due to the lack of a convincing evidence base underlying the algorithm for diagnosis and treatment of this pathology. Pulmonary hypertension is one of the most complex cardiological problems and represents a pathological condition that is based on increasing resistance to blood flow in a small circle of blood circulation at any of site. Unlike the systemic arteries, there is no direct access to the pulmonary artery for measuring blood pressure by non-invasive methods, so the diagnosis of pulmonary hypertension in the early stages, before the formation of a lesion in the target organ, which is the right ventricle of the heart, is practically impossible. In actual clinical practice, pulmonary hypertension is at best diagnosed at the stage of latent right ventricular dysfunction, which is manifested by dilatation of its cavity and / or hypertrophy of its walls, at worst at the stage of right ventricular heart failure. At present, there has been a trend towards an improvement in the diagnosis of pulmonary hypertension (LH) in various diseases. This is the reason for the special interest in this interdisciplinary problem.

Taking into account the increase in the level of cardiovascular diseases in recent decades, the clinician faces the task of attempting to make the fastest possible diagnosis of the pathology at its earliest stages. That is why the aim of our work was to identify the main groups of biological markers, and to separate the role of each of them in the assessment of the risk of development, progression and possible complications of cardiovascular diseases. We have given the main working classification of markers of cardiovascular processes with the allocation of their main types, as well as the basic criteria for the “ideal” biological marker. Finally, an attempt was made to structure biomarkers depending on their molecular mechanisms of pathogenesis in the development of a particular pathology. All these data should help the clinician at the stage of early diagnosis of cardiovascular disease.

Sarcoidosis is a systemic disease characterized by the development of chronic immune inflammation and formation of granulomas. It is important to know clinical, morphological and immunologic variants of the course of this disease in order to investigate the pathomorphologic parameters of the granuloma.Of late negative trends have been observed in the changes of sarcoidosis pathomorphology. Due to the above it is important to investigate predictors for the course of this disease, including specific parameters of granulematous inflammatory process in various clinical variants not only from the point of view of diagnostics but further management tactics for those suffering from this disease.

Aim: to study relationship between parameters of intracardiac hemodynamics assessed by Doppler echocardiography and functional activity of endothelium, hepatic blood flow and severity of portal hypertension in patients with cirrhosis of the liver (CL) of different etiology. Results. We found that changes of structural and functional parameters of the heart in LC depended on the stage of compensation of portal hypertension and were accompanied by rearrangement of parameters of intracardiac hemodynamics. Pulmonary arterial hypertension (PAH) was found in 11.1% of patients with LC. PAH was moderate and was more frequent in patients with end-stage disease (Child-Pugh class C) compared with those with initial stage of LC (21.4% and 6.3%, p<0.05, respectively). Conclusion. Disorders of vasoregulating endothelial function in patients with CL were related to parameters of cardiopulmonary hemodynamics and functional state of the right ventricle and were more pronounced in patients with PAH.

Aim of investigation. To estimate the role of polymorphic variants of genes IL4 (C-590T), IL4RA (I50V), TNF (G-308A) and SLC11A1 (D543N) in chronic viral hepatitis progression. Material and methods. Overall 121 patients with chronic viral hepatitis C and B. Results. Study results have demonstrated, that of all investigated polymorphic variants of genes IL4 (C-590T), IL4RA (I50V), TNF (G-308A) and SLC11A1 (D543N) in patients with chronic liver diseases of various etiology the «Val/Val» IL4RA gene variant (II50Val) is associated with HBV-infection chronization. The allele «A» gene TNF-α (G-308A) is protective for chronic viral hepatitis and is associated with a low level of production by mononuclear cells of TNF-α and IL-12, high secretion of IL-4 and low degree of collagenopathy in the liver. Genotype «CT» of IL4 (C-590T) gene is an adverse marker for progression of chronic viral hepatitis B. There was significant correlation of polymorphic variants TNF (G-308A) and IL4 (C-590T) genes with production of the key interleukins, that determine type of immune response (Th-1, Th-2) and products of collagen metabolism that testifies genetic determination of system immune response and collagen formation processes in the liver at chronic viral hepatitis.

AIM OF INVESTIGATION:To estimate the role of polymorphic variants of genes IL4 (C-590T), IL4RA (I50V), TNF (G-308A) and SLC1IAI (D543N) in chronic viral hepatitis progression. MATERIAL AND METHODS:Overall 121 patients with chronic viral hepatitis C and B. RESULTS:Study results have demonstrated, that of all investigated polymorphic variants of genes IL4 (C-590T), IL4RA (150V), TNF (G-308A) and SLC11A1 (D543N) in patients with chronic liver diseases of various etiology the <> IL4RA gene variant (II50Val) is associated with HBV-infection chronization. The allele <> gene TNF-α (G-308A) is protective for chronic viral hepatitis and is associated with a low level of production by mononuclear cells of TNF-α and IL-12, high secretion of IL-4 and low degree of collagenopathy in the liver. Genotype <> of IL4 (C-590T) gene is an adverse marker for progression of chronic viral hepatitis B. There was significant correlation of polymorphic variants TNF (G-308A) and IL4 (C-590T) genes with production of the key interleukins, that determine type of immune response (Th-1, Th-2) and products of collagen metabolism that testifies genetic determination of system immune response and collagen formation processes in the liver at chronic viral hepatitis.