Granulomatosis with polyangiitis (GPA, Wegener's granulomatosis) is a rare autoimmune disease, characterized by vasculitis of small and medium-sized vessels, as well as the formation of granulomas and the most frequent involvement of the upper respiratory tract, lungs, kidneys and eyes in the pathological process. In the absence of treatment, the disease progresses rapidly and is fatal. The onset of the disease is possible at any age. Pharmacotherapy is aimed at suppressing the immunopathological reactions underlying the disease in order to achieve complete remission associated with anti-neutrophil cytoplasmic antibodies of systemic vasculitis (ANCA-SV). The article deals with a difficult case for diagnosis of respiratory tract damage in GPA in a 60-year-old woman.

The research purpose : development of a mathematical model for predicting the risk of carotid atherosclerosis in young adults 30-49 years old of Slavic and Korean ethnicity. Materials and methods . 136 conditionally healthy people of Slavic (n-84) and Korean ethnicity (n-52) were evaluated. The survey was conducted according to the design of ESSE-RF study. A carotid arteries duplex scan has been conducted. The predictive model was developed using the logistic regression method. Results . Ethnic groups did not differ among themselves in terms of age, smoking prevalence and gender (p > 0.05). In KEG increased levels of apoB containing lipoproteins was revealed (level non-HDL-C in KEG was 5,0 ± 1,1 mmol/l versus 4.0 ± 0.9 mmol/l in SEG (p < 0,001), HDL and apoA did not differ between groups (p > 0,05).The prevalence atherosclerosis of the CA was 28.6% in SEG and 32.7% in KEG (p > 0,05). In average KEG had more pronounced atherosclerotic process in the CAthe total percentage of stenosis in the SEG 40 [20; 50] % vs 51 [29; 59] % in KEG, p =0,044, and the average % of stenoses is 22.5 [20; 25] % versus 25.5 [24.6; 29] % respectively, p = 0.029.Binary logistic regression method was used for developing a predictive model for determine the risk of developing carotid atherosclerosis, the area under the ROC curve was 0.848 ± 0.040 with 95% CI: 0.769–0.927. The model was statistically significant, p < 0,001. Conclusion . Above referenced model makes it possible to evaluate with high accuracy the risk of developing carotid atherosclerosis on a standard dispensary appointment basis.

In 2019, a retrospective analysis of medical records for 10 previous years (2019-2009) was conducted for 426 patients with confirmed malignant neoplasm (MN) of the stomach registered in 125 outpatient and polyclinic medical and preventive treatment facilities in 12 cities of the Russian Federation. The average age of patients at the time of diagnosis was 61.9 years, the life expectancy after diagnosis being 2.2 years. In 67.4% of patients the diagnosis was made at stages III and IV of the disease. All patients had a history of any upper digestive tract pathology. The record of H. pylori c examination was detected in 16.9% of patients, all of them with positive results. In 64,3% of esophagogastroduodenoscopy (EGDS) protocols there were visible changes in the gastric mucosa. Dynamic EGDS control was performed irregularly. During the whole period of observation, an average of 2.5 biopsies per patient were taken during EGDS. In the clinical diagnosis of “chronic gastritis” morphological examination was performed in 70.0% of patients. Classical “warning signs” were registered on the average 2.4 years before the diagnosis of gastric cancer. Dyspepsia syndrome was registered 4.6 years before cancer verification. The correlation between dyspepsia and the timing of cancer diagnosis was confirmed. Thus, the dyspepsia syndrome can be categorized as “early warning signs”. For the diagnosis of gastric adenocarcinoma, 3D correlation analysis showed a correlation between the number of biopsy samples taken, the number of “warning signs” and the number of years lived after the diagnosis of malignant neoplasms.

The historical article devoted to work of the one of the first faculties of the Department of postgraduate education of the Vladivostok state medical university. The basic directions of educational-methodical and scientific activity of faculty, stages of development of system of training and retraining of specialists are described. The faculty provides training on therapy and cardiology both on own base, and in other cities of Primorsky Krai and the Sakhalin area. Active research work on a theme «Clinical pathophysiology of the cardio-respiratory system» is conducted which results influence the practical public health.

Aim. To assess the prospects of using artificial intelligence technologies in predicting the outcomes and risks of cardiovascular diseases (CVD) in patients with hypertension (HTN).Material and methods. A software application was created for data mining from respondent profiles in a semi-automatic mode; libraries with data preprocessing were analyzed. We analyzed the main and additional parameters (35) of CVD risk factors in 2131 people as a part of ESSE-RF study (2014-2019). To create a forecasting model, a high-level language Python 2.7 was used using object-oriented programming and exception handling with multithreading support. Using randomization, learning (n=488) and test (n=245) samples were formed, which included data from patients with an established diagnosis of HTN.Results. The prevalence of HTN among subjects was 34,39%. There were following significant factors for predicting CVD: anthropometric parameters, smoking, biochemical profile (total cholesterol, ApoA, ApoB, glucose, D-dimer, C-reactive protein). As a result of a 5-year follow-up, CVD was found in 235 people (32,06%) with HTN and 187 people (13,38%) without HTN; mortality rates were 1,27% in subjects with HTN and 1,12% — without HTN. The absolute mortality risk among participants with HTN (0,037) was significantly higher (p<0,05) than in patients without HTN (0,017). To create a neural network (NN), the basic Sequential model from the Keras library was used. During machine learning, 26 variables important for the CVD development were used as input and 9 neurons — as output, which corresponded to the number of established cardiovascular events. The created NN had a predictive value of up to 97,9%, which exceeded the SCORE value (34,9%).Conclusion. The data obtained indicate the importance of risk factor phenotyping using anthropometric markers and biochemical profile for determining their significance in the top 20 predictors of CVD. The Python-based machine learning provides CVD prediction according to standard risk assessments.

Aim of review. To analyze the options of application of Lactobacillus reuteri DSMZ17648 (Pylopass™) within Helicobacter pylori eradication. Summary. H. pylori eradication therapy is considered as one of the optional spheres for clinical application of probiotic medications. According to available data certain strains of probiotics are effective in decreasing of gastrointestinal adverse effects rates, associated with eradication therapy while the other can potentiate the efficacy of H. pylori eradication itself. L. reuteri strain DSM17648 which was chosen from over 700 wildtype strains of Lactobacillus spp. possess the ability for selective adhesion to H. pylori in vivo in the gastric media. DSM17648 strain of L. reuteri form coaggregates with various H. pylori strains and serotypes both in vivo and in vitro. It was revealed that lyophilizate of this strain (PylopassTM) blocks adhesion of H. pylori to epithelial cells as well. Clinical trials demonstrate the effect of PylopassTMon gastric mucosa colonization by H. pylori according to the 13C urea breath test data and as well the increase in H. pylori eradication rate when the productis added the to triple therapy modes. Conclusion. Potential of PylopassTM combination to various H. pylori eradication therapy modes is a subject offutnet multicenter randomized clinical trials for assessment of optimal combination to antibiotic drugs, treatment duration and adverse effect rates. The value of monotherapy by this metabiotic at chronic H. pyloriassociated gastritis is a subject of further studies.

Aim of review. To analyze the options of application of Lactobacillus reuteri DSMZ17648 (Pylopass™) within Helicobacter pylori eradication. Summary. H. pylori eradication therapy is considered as one of the optional spheres for clinical application of probiotic medications. According to available data certain strains of probiotics are effective in decreasing of gastrointestinal adverse effects rates, associated with eradication therapy while the other can potentiate the efficacy of H. pylori eradication itself. L. reuteri strain DSM17648 which was chosen from over 700 wildtype strains of Lactobacillus spp. possess the ability for selective adhesion to H. pylori in vivo in the gastric media. DSM17648 strain of L. reuteri form coaggregates with various H. pylori strains and serotypes both in vivo and in vitro. It was revealed that lyophilizate of this strain (PylopassTM) blocks adhesion of H. pylori to epithelial cells as well. Clinical trials demonstrate the effect of PylopassTMon gastric mucosa colonization by H. pylori according to the 13C urea breath test data and as well the increase in H. pylori eradication rate when the productis added the to triple therapy modes. Conclusion. Potential of PylopassTM combination to various H. pylori eradication therapy modes is a subject offutnet multicenter randomized clinical trials for assessment of optimal combination to antibiotic drugs, treatment duration and adverse effect rates. The value of monotherapy by this metabiotic at chronic H. pyloriassociated gastritis is a subject of further studies.

Aim: To develop evidence-based recommendations for primary care physicians and general practitioners (GP) on choosing the proper management tactics and making valuable & quick diagnostic decisions at outpatient phase for patients with symptoms of dyspepsia, and also reveal possible oncology on time. Summary of recommendations: Approximately 40% of the patients in Russia presenting to primary care with symptoms of dyspepsia. A doctor has to focus on the warning signs, which may require an urgent additional examination & the consultation with a surgeon/onco-surgeon or other specialists if required. With regard to a risk of cancer, a doctor should be more cautious in patients over 45 years of age. Early diagnosis of oncology depends mainly on cautiousness of GP, primary care physicians and their knowledge, future tactics with regard to the patients. From the mandatory diagnostic tests during the first visit, esophagogastroduodenoscopy and H. pylori diagnostics helps to exclude any organic esophagus and stomach pathology, possible oncology. While waiting for endoscopy results, a physician should use the preliminary diagnoses “Uninvestigated Dyspepsia” (ICD-10 К 31.9) (disease of stomach and duodenum, unspecified). After exclusion of all warning signs, therapy of dyspepsia should be in accordance to the order of the Ministry of Health No 248 which gives an option to use proton pump inhibitors (omeprazole or rabeprazole 20 mg daily) in combination with prokinetic (domperidone 30 mg daily). Fixed drug combination of omeprazole 20 mg and modified-release domperidone 30 mg/daily (Omez® DSR) is medically reasonable. Conclusion: The introduction of this recommendation into clinical practice will help clinicians to prevent diagnostic mistakes, unreasonable use of expensive diagnostic examinations and inappropriate treatment leads to improvement in the overall prognosis and quality of life for the patients.

The rapidly growing incidence of obesity and diabetes mellitus, especially in developed countries, stimulates medical experts to closely study the epidemiology of non-alcoholic fatty liver disease (NAFLD). According to the published results of the epidemiological study DIREG 2, the prevalence of NAFLD in outpatients inRussiaincreased over the period from 2007 to 2015 and amounted to 37.3%. In the present report, the population of patients with NAFLD in the Far East Federal District (FEFD) was studied as part of the multicentre epidemiological study DIREG 2.The aim. To analyze the data on FEFD obtained in the DIREG 2 study and compare those with the DIREG 2 data on the entireRussia.Materials and Methods. The prospective disease registry study: epidemiological, observational, cross-sectional, multicentre study on the prevalence of NAFLD in outpatients. The total number of participating patients in FEFD was 2500, including 900 males and 1600 females. Epidemiological data were collected within two routine patient visits to the participating research centers.Results. The major result of this study is that the prevalence of NAFLD in FEFD was significantly lower than that in the entireRussia (21.4% vs 37.3%). Although the rank distribution of the concomitant diseases in FEFD patients was comparable to that in the across-Russia population, the prevalence of metabolic syndrome, menopausal syndrome and hypertriglyceridemia was significantly higher in the FEFD population.Conclusion. Despite the lower prevalence of NAFLD there is a significantly higher prevalence of disorders associated with NAFLD in the FEFD patients as compared with the acrossRussian patients from DIREG2. A set of measures preventing these risk factors from converting into full-scale disease is needed.

Aim. To assess rate of familiarity and specifics of treatment with statins among the citizens of economically active age with various cardiovascular risk by the data from epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases in Different Russian Federation Regions). Material and methods. In the work the data from ESSE-RF study was used,  of representative  selection  of non-organized  male and  female inhabitants aged 25-64 y.o. from 13 regions, investigated during 2012-2014. Responded ~80%. The study included questionning by standard scale that included data on the anamnesis, etc. Lipid profile, including total cholesterol  (TC), cholesterol  of lipoproteids low and high density were measured at SSRCPM and RSPCC. Results. Analysis of the whole selection showed that 20% of men and 32% of women knew their TC, and 13,6% and 18,2% were even familiar having increased  level of TC. Part of those with high and very high risk was 31,3%, incl. men — 42,2%, women — 30,9%. Statins took ~7,0% of patients from this risk category. Effectiveness of treatment (target levels reached  of low density cholesterol) in these groups of men and women was 14,4% and 4,8%, respectively. Conclusion. The data obtained in populational study points on insufficient knowledge and low rate of statin treatment  of the persons with high and very high cardiovascular  risk in RF, which confirms the anxiety provoking data of registries and other studies. The data dictates necessity  of development  and implementation of specific educational programs for citizens, of physician improvement and availability of cheap but effective lipid-lowering medications.

Life quality (LQ) is an integrated parameter of the health, applied for integral characterization of population health, and as the parameter of healthcare interventions effectiveness.Aim. To assess LQ in Russian population at the age 25-64 y. o. in general and in various socio-economical groups using EQ-5D, by the results of ESSE-RF (2012-2013) study.Material and methods. LQ was assessed on representative selections of inhabitants of 13 Russian Federation regions, aged 25-64 (males 8327, females 13497) with response 80%. LQ was assessed via international questionnaire EUROQOL — EQ-5D: 1) no decline; 2) mild decline; 3) significant decline; scoring also performed with visualanalogue scale (VAS). Integral LQ by EUROQOL performed with Shaw JW et al. method (ranging from 0,0 (death) to 1,0 (perfect health)).Result. EQ-5D index of Russian population was 0,87 with no gender difference. By the increase of the age LQ declines. Educational gradient of LQ was significant only in VAS (p<0,05). Wealth level negatively associated with LQ. Most common (p<0,0005) were disorders by the components pain/discomfort and anxiety/depression. Part of those with lower LQ among males is lesser than in females, by all 5 factors of the LQ, and in all educational states. Regional specifics of LQ by EQ-5D index: from 0,82 in Vladikcaucas to 0,95 in Orenburg (p<0,0005). There was significant correlation of EQ-5D index with unemployment level (0,4) and consumer prices index (0,29) in regions.Conclusion. Monitoring of LQ is necessary condition for assessment of efficacy of population health improvement interventions, and the LQ values obtained will be useful as populational norms for health condition assessment in addition to morbidity and mortality factors.

Aim. To assess rate of familiarity and specifics of treatment with statins among the citizens of economically active age with various cardiovascular risk by the data from epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases in Different Russian Federation Regions). Material and methods. In the work the data from ESSE-RF study was used, of representative selection of non-organized male and female inhabitants aged 25-64 y.o. from 13 regions, investigated during 2012-2014. Responded ~80%. The study included questionning by standard scale that included data on the anamnesis, etc. Lipid profile, including total cholesterol (TC), cholesterol of lipoproteids low and high density were measured at SSRCPM and RSPCC.Results. Analysis of the whole selection showed that 20% of men and 32% of women knew their TC, and 13,6% and 18,2% were even familiar having increased level of TC. Part of those with high and very high risk was 31,3%, incl. men — 42,2%, women — 30,9%. Statins took ~7,0% of patients from this risk category. Effectiveness of treatment (target levels reached of low density cholesterol) in these groups of men and women was 14,4% and 4,8%, respectively.Conclusion. The data obtained in populational study points on insufficient knowledge and low rate of statin treatment of the persons with high and very high cardiovascular risk in RF, which confirms the anxiety provoking data of registries and other studies. The data dictates necessity of development and implementation of specific educational programs for citizens, of physician improvement and availability of cheap but effective lipid-lowering medications.

Life quality (LQ) is an integrated parameter of the health, applied for integral characterization of population health, and as the parameter of healthcare interventions effectiveness. Aim. To assess LQ in Russian population at the age 25-64 y. o. in general and in various socio-economical groups using EQ-5D, by the results of ESSE-RF (2012-2013) study. Material and methods. LQ was assessed on representative selections of inhabitants of 13 Russian Federation regions, aged 25-64 (males 8327, females 13497) with response 80%. LQ was assessed via international questionnaire EUROQOL — EQ-5D: 1) no decline; 2) mild decline; 3) significant decline; scoring also performed with visualanalogue scale (VAS). Integral LQ by EUROQOL performed with Shaw JW et al. method (ranging from 0,0 (death) to 1,0 (perfect health)). Result. EQ-5D index of Russian population was 0,87 with no  gender difference. By the increase of the age LQ declines. Educational gradient of LQ was significant only in VAS (p<0,05). Wealth level negatively associated with LQ. Most common (p<0,0005) were disorders by the components pain/discomfort and anxiety/depression. Part of those with lower LQ among males is lesser than in females, by all 5 factors of the LQ, and in all educational states. Regional specifics of LQ by EQ-5D index: from 0,82 in Vladikcaucas to 0,95 in Orenburg (p<0,0005). There was significant correlation of EQ-5D index with unemployment level (0,4) and consumer prices index (0,29) in regions. Conclusion. Monitoring of LQ is necessary condition for assessment of efficacy of population health improvement interventions, and the LQ values obtained will be useful as populational norms for health condition assessment in addition to morbidity and mortality factors.

Aim. To study the prevalence of ischemic heart disease as one of the most common cardiovascular disorders, together with arterial hypertension (AH), diabetes mellitus (DM) and liver diseases (LD) in adult (25-64 y.o.) population of selected RF regions, the variance of those with gender and age, and association of cardiovascular risk factors (FR).Material and methods. Into analysis we included the results of representative selections studies from 13 RF regions, studied according to the program of multicenter study ESSE-RF during the years 2012­2014; totally 21923 patients studied. Investigation included standard questioning, including anamnesis. For statistics we used applied software SAS.Results. In men the prevalence of IHD is associated with the growth of comorbidity from 0 in the age group 25-34 y. to 77% in the age 55-64 y., almost duplicating every decade. For women there is analogic tendency, less prominent. In men there are significant associations only with AH, which increases the risk of IHD 2,5 times, though in women together with AH the associations are significant for LD. Comorbidities with DM do not influence the prevalence of IHD in men and women. At the same time, any association with two diseases increases the risk of IHD >304 times. The most negative is the association of all three diseases, with which IHD is 8,7 times more prevalent, than in their absence. Using multidimensional logistic regression after correction for the age and comorbidity in the patients with IHD of both genders, there are associations revealed of high density cholesterol lipoproteids (HDL) in blood and abdominal obesity. In men there are also positive associations with smoking and negative — with increased cholesterol.Conclusion. Comorbidities of IHD with AH, DM and LD in adult population are common, are associated with the general FR, are increasing with the age. Taking modern tendencies of population ageing, it is plausible to expect an increase of the prevalence of comorbidities, that requires a necessity of the healthcare services to these changes.

Aim. To study social and economic gradients — educational and occupational statuses, wealth level, behavioral risk factors (FR) in Russian population by the ESSE-RF data.Material and methods. The data for the analysis consisted of representative selections of 13 regions of RF (n=22906) participants of the study, incl. men (n=8353) and women (n=13553) of 25-64 y.o., with response 80%. We calculated the odds ratios for the presence of behavioral FR: smoking, excessive alcohol consumption, insufficient physical activity (IPA), nonrational food consumption, anxiety and depressive disorders, — in persons from different social and economic groups by education level, type of inhabitation, professional status, wealth level.Results. Higher education was associated with better FR profile, except IPA (negative association) and alcohol consumption (absence of association). "White in general had less FR probability than Blue, excl. IPA and psychoemotional deviations (in men). As for the wealth association with the FR there is backward gradient, i.e. lesser the income, higher the risk of FR presence, excl. IPA and excessive alcohol intake in women. For example, in very wealthy men the odds ratio for depressive states was 3,09 [95% CI 2,08-4,57] comparing to the persons with low income. The type of territory of inhabitance was associated with less behavioral FR in Russian population, as significant associations are found only for depression and excessive salt consumption in both genders and IPA in men. Conclusion. The significant social and economic gradients of behavioral FR prevalence are found, the direction of those is not necessary the same as in European countries. The analysis of association with social and economic parameters would help to develop the directed preventive interventions.