Aim. To determine and compare the work of breathing to overcome elastic resistance (Ael) in patients with bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) with similar changes in the elastic properties of the parenchyma in the same settings of ventilation disorders (grade 1). Materials and methods. Differences in the manifestations of similar changes in the elastic properties of the lungs in patients with BA and COPD were evaluated. To identify differences, a comparative study was conducted on Аel overcome in BA patients with positive bronchodilator (with salbutamol) and bronchoconstrictor (with methacholine) tests, with reduced and preserved bronchial conductance (groups 1 and 2, respectively), and in COPD patients with negative bronchodilator and bronchoconstrictor tests (group 3). All study patients showed a grade 1 lung ventilation disorder (a decrease in the one-second forced expiratory volume by 15–35%). The results were compared with each other and with the control group (group 4, healthy non-smokers). All study patients were comparable by age and sex. The respiration mechanics was studied using simultaneous registration of spirogram and transpulmonary pressure, and the parameters of bronchial conductance and ventilation were determined using body plethysmopressography using the Jager software and hardware system. Results and conclusion. In COPD patients, Ael was significantly increased (p0.05), whereas in both BA groups, it was unchanged. Increased elastic work of breathing in patients with COPD may be associated with the involvement of certain types of contractile elements, which are preserved in patients with BA at the initial stages of the disease.

The lecture considers the results of research conducted by Russian and foreign scientists concerning the characteristics of all types of metabolic disorders and hormonal imbalance in undifferentiated connective tissue dysplasia (CTD). Understanding the role of hormonal and metabolic disorders in the development and course of diseases associated with CTD is of great importance for the development of pathogenetically grounded algorithms for the diagnosis, treatment, and prevention of emergency conditions.

The article presents a clinical case describing a favorable clinical outcome of mycobacterial infection and pulmonary tuberculosis caused by coinfection of M. abscessus and M. tuberculosis in a patient with pulmonary manifestations of cystic fibrosis one year after delivery. This outcome was achieved due to timely diagnosis and treatment of pulmonary tuberculosis and non-tuberculous mycobacterial infection in the patient with cystic fibrosis. Due to the development of molecular identification of mycobacteria species in the Tomsk region, mycobacterial lung disease was verified, which was challenging in the recent past. Previously, all cases with microscopic examination results positive for mycobacteria were classified as tuberculosis.

An attempt was made to discover pathogenic links between gene polymorphism of interleukin-4 which is critical inflammatory cytokine, atopic features, respiratory function and bronchial hyperresponsiveness (BHR) in 70 families of atopic asthma patients. Spirometry, methacholine challenge test (MasterLab pro), serum total IgE level, serum IL-4 level (by the ELISA method), skin prick tests (Immuno Tek), IL-4 (-589C /T, G /C З'-utr) and IL-4RA (lleSOVal, Glu551Arg) genes polymorphism were investigated in 70 probands (11.6 ± 1.2 yrs) and 247 relatives (36.7 ± 1.2 yrs) from Tomsk region (Siberia). Significant associations of certain variants of polymorphous IL-4 and IL-4RA genes with bronchial airflow param eters (FEVt), atopic features (increased IgE level), and bronchial asthma severity were found. Patients with persistent mild, moderate, and severe asthma had their proper variations of polymorphism. The methacholine challenge test was an objective marker of BHR in this study but any associations between BHR and IL-4 and IL-4RA polymorphous variants were not found.

The review summarizes and analyzes the results of domestic and major foreign studies of recent years concerning gender characteristics of the epidemiology and development mechanisms of metabolic syndrome and urolithiasis as an associated disease. A deep understanding of gender aspects in the pathogenesis of these pathologies can form the basis for development of high-quality diagnostic algorithms and pathogenetically grounded approaches to treatment.

Introduction. Effective drug therapy for cancer patients with chronic pain syndrome (CPS) of high intensity is one of the priorities of modern healthcare. Currently, non-narcotic and narcotic analgesics are used for pain relief according to a three-steps scheme. In the absence of contraindications, it is preferable to prescribe medications per os and prolonged forms, which will allow the patient to maintain selfcare and comfort.Aim. To study the pharmacokinetic properties of a drug with a prolonged mechanism of action «Morphine hydrochloride», in a film-coated tablet formof a dosage 30 mg, in cancer patients with severe CPS.Materials and methods. For the analysis of the pharmacokinetics of the studied drug after single and multiple doses of 20 patients who received 10-day analgesic therapy with the studied drug «Morphine hydrochloride», long-acting film-coated 30 mgtablets. manufacturer FSUE Moscow Endocrine Plant, Russia. Route of administration: per os. The study duration was 17 days: screening duration up to 7 days; duration of therapy up to 10 days.Results and discussion. The concentration of morphine in plasma was determined by HPLC-tandem mass spectrometry, within 12 hours after taking the study drug (1 of long-acting, film-coated tablet 30 mg). The following pharmacokinetic parameters were obtained on Day 5: T1/2 – 6.08 ± 4.37 hours and 14.46 ± 30.86 hours, Tmax – 2.5 ± 1.86 hours, Cmax – 43.91 ± 27.24 ng/ml. Values of pharmacokinetic parameters averaged over all days are presented. It was found that T1/2 for the studied drug T1/2 is 9.21 ± 14.94 hours, Tmax 2.87 ± 2.36 hours. The average maximum concentration (Cmax) on the day of the study drug was 36.52 ng/ml.Conclusion. As a result of the study of pharmacokinetics, it was found that the drug «Morphine hydrochloride», long-acting tablets film-coated with a of 30 mg was found in serum after oral administration after 15 minutes and reaches a maximum concentration in the blood in 3 hours, the half-life is on average 9 hours, the maximum concentration is 36.52 ng/ml.

ДИАГНОСТИЧЕСКОЕ ЗНАЧЕНИЕ ЭЛАСТИЧЕСКОГО СОПРОТИВЛЕНИЯ ПРИ БРОНХИАЛЬНОЙ АСТМЕ И ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЕГКИХ А.В.Тетенева1, К.Ф.Тетенев1, Т.Н.Бодрова1, И.Д.Беспалова1, В.В.Ларченко1, Н.А.Сердюков2, К.В.Потапов1 1Федеральное государственное бюджетное образовательное учреждение высшего образования «Сибирский государственный медицинский университет» Министерства здравоохранения Российской Федерации, 634000, г. Томск, Московский тракт, 2 2Военно-врачебная комиссия военного комиссариата Томской области, 634000, п. Предтеченск, ул. Мелиоративная, 1

ВЕНТИЛЯЦИОННАЯ ФУНКЦИЯ ЛЕГКИХ У ПАЦИЕНТОВ С ДИСПЛАЗИЕЙ СОЕДИНИТЕЛЬНОЙ ТКАНИ И ДЕФИЦИТОМ МАССЫ ТЕЛАТетенева А.В. 1 , Бодрова Т

The article provides a review of key studies of the hypothesis about an independent pulmonary mechanical activity: from phylogenic analysis of respiratory movements in amphibians and mammals to respiratory mechanics research. The airflow interruption method revealed negative elastic lung hysteresis. Given the basic physical laws (the first and the second laws of thermodynamics), this paradox was considered as evidence of the independent mechanical activity of the lungs. Predominance of breathing-related pressure fluctuations in an obstructed bronchus over the intrathoracic pressure amplitude was considered as a manifestation of the regional pulmonary mechanical activity. Experimental studies of respiratory mechanics allowed formulation a hypothesis about three levels of pulmonary mechanical activity. The integral pulmonary mechanical activity provides inspiratory and expiratory movements. Smooth muscles of the bronchial wall keep the bronchial lumen during expiration and preclude valvular obstruction of the bronchus (the second level of the mechanical activity). The inspiratory action of the smooth muscles in distal parts of the lungs is a functional component along with surfactant that provides the consistency of alveoli during expirations (the third component).

The history of the oldest Department of theSiberianStateMedicalUniversity– Department of Propedeutics of Internal Diseases has been presented

The article analyzes literature data, results of the authors’ own clinical trials and experimental studies as well as research studies performed by the Laboratory of Respiratory Mechanics of the Department of Propedeutics of Internal Medicine, Siberian Medical University, in order to examine the determinants of bronchial permeability. The most important determinant of bronchial permeability is valve obstruction of the bronchial tubes. In the isolated normal and emphysematous lungs, this process is similarly triggered at the slightest increase of pressure in the Donders bell above the level of atmospheric pressure. For the first time ever, the authors advance the hypothesis that, in intra-vitam setting, valve bronchial obstruction is confronted by two levels of the mechanical lung activity: 1 – expiratory action of the lungs that increases alveolar pressure; and 2 – active expiratory bronchial expansion that maintains the bronchial lumen, if the intrathoracic pressure increases.

The article is devoted to the study of morphological changes of the adrenal glands in arterial hyperten-sion. Adrenals investigated persons who do not suffer in life and suffering from hypertension during the life of hypertension and died from various causes – is incompatible with the life of a mechanical trauma, cerebral hemorrhage, and acute left ventricular failure. In each case, each of the adrenal glands were assessed: the presence and severity of focal and diffuse mononuclear infiltration, the number of lympho-cytes, monocytes, plasma cells and fibroblasts arranged in the respective zones of the cortex and medulla, the severity of hyperemia and edema of various structural parts, the number of zones cortex and medulla endocrinocytes with pycnotic nuclei in the reticular zone evaluated the distribution of secretory cells with lipofuscin and the degree of saturation of the cytoplasm of the secretory cells, in secretory cells of medul-la evaluated nuclear-cytoplasmic ratio, the severity of vacuolization and basophils cytoplasm revealed a number of regularities of morphological changes depending from the various clinical manifestations of hypertension, defining the ultimate option of dying. At the heart tanatogenesis version are more pro-nounced morphological features hyperfunctions glomerular zone – namely delipidization left and right glands. The beam and netted areas contralateral glands embodiment of dying of a heart compared to the brain, is more pronounced hyperemia. When cardiac variant tanatogenesis more pronounced focal lym-phoid infiltration and vacuolization in secretory cells of left adrenal medulla.

Two functional levels of mechanical energy intrapulmonary source have been viewed in this article for the first time. The first level is located into the perialveolar space. This level provides inspiratory and expiratory activity of the lungs together with respiratory muscles. Due to this, the inspiratory alveolar pressure is lower than the intrapleural pressure and the expiratory alveolar pressure is higher than the intrapleural pressure. This is deter mined by work of breathing measured as negative elastic hysteresis area and allows overcoming some nonelastic resistance of the lungs. The lung activity on overcoming the elastic resistance is estimated by multiplying the total work of breathing by a functional coefficient of lung elasticity (FCLE). The latter is calculated by dividing the total lung compliance by the dynamic lung compliance and reflects change in the elastic lung tension from spontaneous breathing level to the total lung compliance level. FCLE approximates 1 in healthy subjects and in patients with normal lung elastic recoil (LER). LER is lower and the total lung capacity is higher in lung obstructive diseases. Consequently, the total lung compliance could increase and FCLE could grow up to 10 in such cases (for instance, in severe emphysema). This leads to increasing lung activity on overcoming the elastic resistance up to 10 kgf × m / min or higher. Actually, this huge work of breathing is not performed due to the 2nd level of lung mechanical activity that is an active dilation of the large airways on expiration; this mechanism prevents valvular bronchial obstruction.

The research goal was to formulate and substantiate the hypothesis explaining support for an expiratory air flow in case of pulmonary emphysema. The research method consisted in comparing the mechanical properties of lungs in practically healthy individuals (37 individuals, mean age – (30.4 ± 1.7) y.o.) and COPD patients with pronounced lung emphysema (30 patients, mean age – (52.1 ± 2.3) y.o.) as well as those of isolated normal lungs (n = 14) and isolated lungs of patients who died of COPD (n = 5). Pulmo-nary mechanics was studied via the simultaneous measurement of transpulmonary pressure and lung ven-tilation volume. General lung hysteresis and elastic lung hysteresis were calculated. The mechanical properties of isolated lungs were studied using passive ventilation under the Donders bell. The air flow was interrupted in order to measure alveolar pressure and develop an elastic lung hysteresis curve. Pres-sure in the Donders bell was changed by means of a special pump in automatic and manual modes. The research has not revealed any fundamental differences between the mechanical properties of the normal and emphysematous lungs. A minimum increase in the pressure inside the Donders bell over atmospheric pressure used to stop air ejection in both normal and the emphysematous lungs as the result of flap-valve bronchial obstruction. In living beings, air is ejected from lungs with an increase in pressure under the conditions of forced expiration. Pressure increases up to (38.6 ± 2.71) cm H2O in healthy individuals and up to (20.5 ± 1.86) cm H2O in COPD patients. Probably, an expiratory air flow is supported by active expiratory bronchial dilatation that counteracts flap-valve bronchial obstruction. The hypothesis is based on the confirmed ability of the lungs to perform inspiratory actions (in addition to the action of respiratory muscles) and the theory of mechanical lung activity.

In article the history of creation of the doctrine about respiratory movements of lungs, history of classical mechanics of breathing is stated. Supervision of the paradoxical facts which became a basis for hypothesis creation, then the theory of mechanical activity of lungs are presented. The facts proving mechanical activity of lungs on an inspiration and an expiration are given. Options of interaction of intra pulmonary and extra pulmonary sources of mechanical energy are considered. Theoretical justification for development of the new direction of studying of physiology of mechanical movements of the internal which does not have own skeleton is stated.

The basic stages of development of electro-physiology and electrocardiography, 17 portraits and years of life of scientists, developing the fundamental aspects of electro-physiology, and also applied direction clinical electrocardiography, are presented in the article. By the most large scientists, developing fundamental direction in electro-physiology were P. Arrhenius, V.Yu. Chagovec, Yu. Bernshteyn, A. Khodzhkin and E. Khaksli. In development of the applied direction in electrocardiography the role is great of V. Eyntkhoven, A.V. Samoilov and N. Holter. In period of formation of formation of electrophysiology, electrocardiography and at present scientists in ours country preferently working in applied direction.

Analysis of the current literature showed that in publications, in our opinion, there is no master: a scientific analysis of the reasons behind the decline in the quality of knowledge of the doctor, as well as the scientific basis of modern pedagogical technologies introduced in the process of training future doctors to address this problem. Objective and subjective factors are having a negative effect on the quality of the doctor's knowledge. The generally accepted methods of assessing the quality of knowledge – testing and rating system – have their limitations. Testing reflects the level of knowledge about the thinking style of the originator of test tasks. Ranking system for assessing knowledge increasingly characterized by diligence in studying medicine. It is proposed to upgrade the quality of medical knowledge in the teaching of the theory of integration of diagnostics. Amount of knowledge to evaluate the content of educational narrative history of the disease. The quality of the knowledge to assess the content of professional clinical picture comment in the history of the disease.

The paper presents the results of assessing general and elastic lung hysteresis in 21 healthy volunteers and 28 patients with community-acquired pneumonia. Negative elastic hysteresis was detected in 14 healthy volunteers and 18 patients with community-acquired pneumonia. For the first time ever, it was demonstrated that, under the conditions of an interrupted air flow, 4 healthy volunteers and 2 patients with community-acquired pneumonia were characterized with the inversion of not only elastic but also general lung hysteresis. In case of pneumonia, despite the increase in tissue friction resulting from the generalized escalation of the alveolar-capillary permeability, the inversion of both elastic and general lung hysteresis takes place as often as in healthy people. It can be explained with the intensification of the mechanical activity of the lungs as a compensatory reaction in the mechanical system of the external respiration organs in case of pneumonia.