The review summarizes and analyzes the results of major foreign studies on the role of adipokine imbalance in the development of a severe course and complications of novel coronavirus infection (COVID-19). Adipokines are biologically active compounds produced by adipose tissue cells and involved in the regulation of metabolism and the functioning of the immune system. Obesity is a proven risk factor for severe COVID-19 due to high hormonal and metabolic activity of visceral adipose tissue. A deep understanding of COVID-19 pathogenesis from the point of view of the role of adipokine imbalance in it can provide the grounds for the development of effective pathogenetic approaches to the prevention of a severe course and complications of novel coronavirus infection.

In the interests of practical healthcare, routine classifications should be modified as rarely as possible. At the same time changes should be discarded only on sufficient grounds, for example, when there are no obvious advantages of a new classification over the existing ones or they can no longer be modified by introducing fundamental changes and amendments. In this regard, the evolution of approaches to the classification of chronic heart failure (CHF) is prominent. It becomes particularly relevant due to the fact that currently experts of the Russian Society of Cardiology (RSC) are actively discussing a new draft classification of CHF. The authors of the lecture gave a brief historical insight and reviewed the main classifications of CHF used in North America, Europe, and Russia. The new classification of CHF proposed by RSC experts, which is actually a modified classification of North American colleagues, does not have obvious advantages over the currently used CHF classification in Russia (since 2002). The latter is based on the classification by Vasilenko – Strazhesko which is familiar to domestic internists, since it has become an indispensable part of their clinical practice and has stood the test of time. In addition, its underlying principles provide the potential for its flexible modification.

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.

Recognizing the fact that isolated left ventricular (LV) diastolic dysfunction (DD) underlies approximately 50% of all heart failure cases requires a deep understanding of its principal mechanisms so that effective diagnostic and treatment strategies can be developed. Despite abundance of knowledge about the mechanisms underlying DD, many important questions regarding the pathophysiology of diastole remain unresolved. In particular, the role of endosarcomeric cytoskeleton pathology in the deterioration of the so-called active (relaxation of the LV myocardium and the atrioventricular pressure gradient at the beginning of diastole, closely related to it in a healthy heart) and passive (myocardial stiffness) characteristics of diastole needs to be clarified. The lecture briefly discusses the complex hierarchy of DD mechanisms (from the sarcomere to the whole heart) and covers the role of the giant protein titin in the latter, which is the main determinant of intracellular stiffness. Impairment of myocardial relaxation and deterioration of its wall compliance under a wide range of pathological conditions (pressure overload, ischemia, inflammation, cardiotoxic effects, oxidative stress, etc.) underlying DD can be explained by a shift in titin expression toward its more rigid N2B isoform, hypophosphorylation by protein kinases A and G or dephosphorylation by serine / threonine phosphatase 5 of its molecule in the extensible protein segment containing a unique N2B sequence, hyperphosphorylation of PEVK regions of titin by protein kinase C, as well as inhibition of the Ca 2 +-dependent titin – actin interaction. The results of deciphering these mechanisms can become a tool for developing new approaches to targeted therapy for diastolic heart failure that currently does not have effective treatment, on the one hand, and the key to understanding the therapeutic effects of drugs already used to treat chronic heart failure with preserved LV ejection fraction, on the other hand.

The review summarizes and analyzes the results of domestic and major foreign studies of recent years concerning the prevalence of metabolic syndrome components and the explanation of their role in the mechanisms of sarcoidosis development. A deep understanding of the pathogenesis of metabolic syndrome (MS) in terms of the role in it of risk factors for a severe course and complications of most socially sensitive noncommunicable diseases clustered within MS can underly the development of effective pathogen-specific approaches to MS treatment.

Important changes regarding the understanding of the pathogenesis of chronic heart failure (CHF) marked the beginning of the millennium, and its first decade was called the decade of diastology. Even though numerous studies convincingly proved that deterioration of the left ventricular (LV) filling pressure often precedes impairment of its systolic function and a number of factors affect (especially at the onset) mainly the diastolic function without changing the conditions of blood ejection, modern classifications and approaches to CHF treatment are primarily based on the results of LV ejection fraction (EF) assessment. In recent years, diastolic heart failure (DHF) has been often overlooked and replaced by the ambiguous term “CHF with preserved EF”. However, sometimes authors use the term DHF extensively, since CHF based on myocardial insufficiency develops only via two mechanisms (systolic and / or diastolic dysfunction), and excluding one of the mechanisms allows to identify the underlying one. The term DHF can be used in clinical practice and cannot be replaced by the diagnosis of CHF with preserved EF. CHF with preserved EF is a broader concept which includes a full spectrum of cardiovascular diseases, complicated by the development of CHF without depression of the global LV contractility and requiring differentiated approaches to therapy. In addition, the results of repeated studies on LVEF in many patients may require reclassification of this CHF phenotype, which is established following the analysis of the baseline value of global LV contractility. We join M.R. Zile in the appeal to stop discriminating against the term “DHF” and present the boundaries of its correct application.

Aim . To evaluate the possibility of using lung ultrasound for diagnosing COVID-19 pneumonia in patients of the respiratory hospital of Siberian State Medical University (SSMU). Materials and methods . An analysis of lung ultrasound data was carried out in 39 patients (17 men and 22 women aged 33–78 years) with COVID-19 pneumonia. Lung ultrasound was performed in all patients in addition to radiography performed at the prehospital stage and in 15 patients who underwent computed tomography (CT) of the lungs. Results . In the majority (61.6%) of cases, during the ultrasound examination, COVID-19 pneumonia manifested itself as interstitial lung disease. The white lung phenomenon and a combination of the aforementioned interstitial changes were recorded with the same frequency (5.1%), while pulmonary consolidation in addition to interstitial changes was visualized in 10.2% of cases. Interstitial lung disease was bilateral in 83.3% of patients and unilateral in 16.7% of cases. The inferior lobes of the lungs were affected in 60.0% of cases, middle lobe – in 30.0% of cases, and superior lobes – in 15.0% of patients. The ultrasound examination detected changes in the lungs in 32 patients, while radiographic changes were present in 35 cases. Bilateral inflammation was more often detected by radiography than by ultrasound. When comparing the data of lung ultrasound and CT, the agreement between the methods was found in 66.7% of cases, and the discrepancy between the findings of the two methods was observed mainly in patients with a large number of affected segments of the lungs and localization of the disease in the superior lobes according to CT. Conclusion . Lung ultrasound is a valuable tool that can be used to stratify risk in patients at any stage of diagnosis and treatment in the context of the COVID-19 pandemic due to availability, speed of implementation, and the absence of a need for patient transportation.

Purpose. The aim of the study was to investigate the subpopulation composition and prooxidant activity of adipose tissue cells in the big omentum of patients with metabolic syndrome.Material and Methods. A fragment of white adipose tissue obtained from the greater omentum during planned endoscopic cholecystectomy in 37 female patients aged 48 (34; 65) years was used as a material for the study. The main group was represented by patients with metabolic syndrome (n = 31) diagnosed according to current recommendations for management of patients with metabolic syndrome. Six patients without signs of metabolic syndrome, comparable with the main group in terms of age and gender, made up the comparison group. The subpopulation composition of the adipose tissue cells in the greater omentum was determined by immunohistochemical analysis. The content of reactive oxygen species in the isolated cell pools of adipocytes and mesenchymal stromal cells was identified using flow cytometry.Results. Comparison of the mean values in the groups showed a statistically significant prevalence in patients with metabolic syndrome only in the level of cells expressing CD68 (macrophage marker) on their surface (p < 0.05). Correlation analysis allowed to detect a positive relationship between morphometric indicators determining the severity of infiltrative changes of adipose tissue (the number of infiltrates) and the relative number of cells presenting CD3 (r = 0.357, p < 0.05), CD36 (r = 0.575, p < 0.05), and CD68 (r = 0.374, p < 0.05) on their surface, respectively. A comparative analysis of the level of reactive oxygen species in adipose tissue cells showed statistically significantly (p < 0.05) higher values of reactive oxygen species in patients with metabolic syndrome compared with the control group both in adipocytes and in mesenchymal stromal cells.Conclusion. The presence of a positive correlation between the relative numbers of cells presenting CD3, CD36, and CD68 markers and the morphometric parameters reflecting the severity of infiltrative manifestations suggested that the mentioned cell lymphocyte and macrophage populations were involved in the development of infiltration in the adipose tissue in metabolic syndrome. The pro-inflammatory phenotype of adipose tissue in metabolic syndrome was characterized not only by a number of morphological features, but also by enhanced prooxidant activity of the adipocytes and mesenchymal stromal cells.

The authors analyzed the problem of diuretic resistance (DR) in patients with chronic heart failure (CHF). Most of the symptoms and signs of CHF are associated with hypervolemia and vascular congestion in the systemic and pulmonary circulation. The severity of the latter is the main factor which negatively affects the overall assessment of life satisfaction in patients with CHF. Since the patient, even at the incurable stage of CHF, primarily expects a rapid decrease in the severity of manifestations of decompensation from the prescribed therapy, achieving euvolemia is the essence of its short-term objective. Without diuretics, these immediate effects, according to which most CHF patients judge the qualifications of the doctor, are almost impossible to achieve. Unfortunately, apparently, not a single clinician was able to avoid disappointment in the effectiveness of CHF therapy associated with DR in their practice. As a rule, DR reflects the progressive course of CHF and is often associated with a poor prognosis. The review consistently covers the issues of terminology, diagnosis, pathogenesis, and prevention of DR, which aggravates CHF, and discusses measures aimed at restoring sensitivity to diuretics.

Aim. To perform a scintigraphic assessment of the bronchopulmonary system and pulmonary microcirculation in patients with connective tissue dysplasia.Materials and methods. The study included 31 male patients of conscription age with connective tissue dysplasia (CTD), diagnosed according to the 2019 clinical guidelines (average age (19.6 ± 2.6 years)), and 25 practically healthy individuals comparable in gender and age, who formed a control group. All patients underwent planar pulmonary ventilation – perfusion scintigraphy with determination of pulmonary alveolar – capillary permeability.Results. In patients with CTD, the apical to basal perfusion gradient (U/LQ) was on average 24% lower than in the control group (p = 0.046), and alveolar – capillary permeability was higher in both lungs, both at minute 10 and at minute 30.Conclusion. Static pulmonary ventilation – perfusion scintigraphy allows to identify functional disorders in patients with CTD at the preclinical stage: a decrease in the perfusion gradient on average by 24% compared with the control group and an increase in alveolar – capillary membrane permeability.

Cystic fibrosis is one of the urgent medical and social problems of health care systems in most countries due to fairly high prevalence, development of multi-organ lesions, and poor outcomes.Due to modern advances in the diagnosis and treatment of cystic fibrosis, not only has the average life expectancy of patients increased, but their quality of life has also improved, and it has become possible to maintain pregnancy and childbearing. Since cystic fibrosis can adversely affect the course of pregnancy, childbirth, and health of both mother and child, proper management of women with cystic fibrosis during pregnancy and childbirth is of particular relevance. The presented clinical case is an example of competent supervision at all stages of monitoring of a patient with cystic fibrosis during pregnancy and childbirth.

Unprecedented advances of recent decades in clinical pharmacology, cardiac surgery, arrhythmology, and cardiac pacing have significantly improved the prognosis in patients with chronic heart failure (CHF). However, unfortunately, heart failure continues to be associated with high mortality. The solution to this problem consists in simultaneous comprehensive use in clinical practice of all relevant capabilities of continuously improving methods of heart failure treatment proven to be effective in randomized controlled trials (especially when confirmed by the results of studies in real clinical practice), on the one hand, and in development and implementation of innovative approaches to CHF treatment, on the other hand. This is especially relevant for CHF patients with mildly reduced and preserved left ventricular ejection fraction, as poor evidence base for the possibility of improving the prognosis in such patients cannot justify inaction and leaving them without hope of a clinical improvement in their condition. The lecture consistently covers the general principles of CHF treatment and a set of measures aimed at inotropic stimulation and unloading (neurohormonal, volumetric, hemodynamic, and immune) of the heart and outlines some promising areas of disease-modifying therapy.

The authors of the article have analyzed the problem of advanced heart failure (AHF). Despite significant and, without exaggeration, revolutionary achievements in clinical pharmacology, cardiac surgery, and implantation arrhythmology, the number of patients with chronic heart failure (CHF) in many countries is not decreasing, and in some states, for example, in Russia, it is increasing. At the same time, unfortunately, immediate and long-term results of the so-called optimal therapy of CHF are often disappointing for both the patient and the doctor. In 2007, experts from The Heart Failure Association of the European Society of Cardiology proposed the term advanced heart failure (AHF) to refer to CHF in which optimal drug therapy, as well as cardiac resynchronization therapy, are not effective, which causes repeated hospitalizations and justifies the need for advanced treatment methods such as heart transplantation and mechanical circulatory support, and/or transition to palliative care. The opinions of experts from the established cardiological communities in the Old and New Worlds on the definition, diagnostic criteria, and treatment of AHF have been changing over time. Unfortunately, this evolution has not yet arrived at a consensus. The lecture consistently addresses the issues of terminology, diagnosis, prognostic stratification, and routing of patients with AHF, as well as short- and long-term strategies for treating these patients. therapy; ICD − implantable cardioverter-defibrillator; LVEF − left ventricular ejection fraction; NYHA − New York Heart Association; RAS – renin- angiotensin system; SBP− systolic blood pressure; SCr − serum creatinine.

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.

Idiopathic pulmonary fibrosis (IPF) is one of the most common diseases in the group of interstitial lung diseases, which is characterized by persistent progression and poor prognosis. Over the past decade, experts have made significant progress in developing a diagnostic algorithm for IPF patients. This algorithm includes analysis of clinical, laboratory, and instrumental data, primarily the results of high-resolution computed tomography (HRCT). Precise adherence to the diagnostic algorithm and correct interpretation of HRCT data are prerequisites for IPF diagnosis. Specialists of the Tomsk region have developed routing of patients with suspected IPF. The presented clinical case is a successful example of adhering to this algorithm. Wide implementation of modern diagnostic algorithms into diagnosis and treatment of IPF and quality improvement of imaging methods, primarily HRCT, carried out as a part of the differential diagnosis, open up prospects for early diagnosis of this pathology. A timely prescribed antifibrotic therapy (nintedanib, pirfenidone) in IPF allows to slow down pathological progression and improves the prognosis.

The authors of this article have analyzed the problem of diagnostic conclusion unification in patients with chronic heart failure (CHF). The root of this problematic situation in which practitioners find themselves is that, despite the large number of different regulatory documents, there is no consensus on what is considered correct and what is wrong when formulating a diagnostic conclusion in a patient with CHF. The many-faced syndrome is designated differently: CHF, congestive heart failure, chronic circulatory failure. There are difficulties in determining the stage of CHF in patients receiving optimal drug therapy or in those who are in a state of compensation after a successful surgical correction. When assessing the functional status in a patient with CHF, a distinct subjectivity should be taken into account in determining which limited physical activity is slight or, conversely, marked, as well as what kind of physical exertion is normal for the patient. This subjectivity naturally leads to low reproducibility of the assessment results of the CHF functional class in the same patient by different doctors. CHF should also be classified according to the value of a left ventricular ejection fraction. The diagnosis should also take into account the state characteristics of a diastolic function of the left ventricle (especially in patients with CHF and preserved left ventricular ejection fraction). The authors give examples of diagnostic conclusions, including cases of comorbid pathology.

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

The authors of the study analyze various definitions of chronic heart failure (CHF). CHF, having many faces, despite the consensus concerning the paradigm of its pathogenesis, is given different definitions, using both the syndromic and nosological approaches. Most authors share a view of CHF as the final stage (outcome or complication) of many diseases in which there is impairment of ventricular filling or ejection of blood, i.e. as a syndrome, and not an independent nosological form. Nevertheless, at the beginning of the XXI century leading Russian specialists in heart failure presented a reasoned point of view on CHF not only as the final stage of the cardiovascular continuum, complicating the course of a disease of the cardiovascular system, but also as an independent nosological form. This approach, which contradicts the standard rules for the formulation of the final clinical and pathological diagnoses, as well as the agreed positions of the International Statistical Classification of Diseases and Related Health Problems, has been the subject of reasonable criticism. Since the identification of the underlying cause of heart failure is crucial for therapeutic reasons, the only correct view is that of CHF as a syndrome, the detailed description of which in clinical diagnosis is an important intranosological characteristic that allows building the most effective differentiated therapy and accurately determining the prognosis of the disease.