Auscultation of the lungs is one of the oldest diagnostic methods invented by Rene Laenneck. Nowadays, auscultation hasn’t lost its clinical significance. However, the development of science and technical progress have brought a lot of new ideas about the pathogenesis and interpretation of lungs sounds. This, in turn, caused some changes in the nomenclature. Moreover, the nomenclature of lung sounds in several European countries does not differ significantly but does not fully correspond to the recommended terminology for the English language. In addition, the mechanisms underlying some respiratory murmurs are interpreted ambiguously at present. For example, the main respiratory sound is designated both as “vesicular” and as “normal” respiration because of persisting differences in explaining the pathogenesis of this murmur. There is also a considerable difference in the terminology of added sounds such as crackles, wheezing, rhonchi, as well as the difference in understanding of the underlying mechanisms.Aim. This review analyses the existing differences in the interpretation of lung auscultation and the terminology used to describe respiratory sounds in the Russian and foreign medical literature.Conclusion. Comparative analysis of Russian and foreign publications concerning the issues of lung auscultation demonstrates the existing differences in the terminology and understanding of the mechanisms that underly the main and adventitious respiratory sounds. Forming the common information space requires the unification of terminology and interpretation of physiological and pathological processes in the lungs responsible for the respiratory sounds. Recording the lung sounds with subsequent computer analysis will make it possible to objectify the auscultation data and classify the sounds more accurately.

Aim To study the effect of various types of respiratory muscle training (RMT) in patients with functional class (FC) II-III chronic heart failure (CHF) and more than 70% preserved diaphragm muscle mass. Material and methods 53 patients (28 men and 25 women) aged 50-75 years with NYHA FC II-III ischemic heart disease (IHD) and arterial hypertension with more than 70% preserved diaphragm muscle mass of >70% were randomized to one of four RMT types: static loads, dynamic loads, their combination, and breathing without applied resistance as a control. Peak oxygen consumption (VO2 peak) and maximum inspiratory pressure (MIP) were evaluated at baseline and in 6 months. Results All study groups showed significant improvement of physical endurance indexes compared to baseline values (р<0.05). In pairwise comparison, the groups significantly differed (р<0.01). The greatest improvement was observed for patients of dynamic and combined training groups. Furthermore, in the combined training group, results were significantly higher than in the group of isolated dynamic loads. The most significant (р <0.01), positive changes in the force of inspiratory muscles were observed in groups of dynamic and combined trainings with the best results displayed by patients of the combined training group. Conclusion With preserving more than 70 % of diaphragm muscle tissue (as determined by MIP >60 cm H2O), a combination of static and dynamic RMT is most effective for patients with FC II-III CHF.

AIM:To evaluate the effect of body composition on prediction of community-acquired pneumonia caused by Str. pneumoniae in patients with decompensated CHF.MATERIALS AND METHODS:The study included 216 patients. The pneumonia agent was identified by sputum culture. Body composition with determining lean body mass and fat mass was evaluated using a bio-impedance analysis; body mass index (BMI) was calculated. Patients with BMI 18.5-24.9 kg/m2 were included into the study. Statistical analysis of obtained data was performed using the IBM SPSS Statistics 20 software.RESULTS:The in-hospital mortality was 13.4 %; the one-year mortality was 29.6 %. Fat mass strongly, negatively correlated with a fatal outcome within a year, and the degree of lean body mass shortage moderately, positively correlated with the life span of patients.CONCLUSION:Body composition is significantly predictive for patients with decompensated CHF and community-acquired pneumonia caused by Str. pneumoniae.

Progressive weight loss is a frequent companion to somatic pathology. The risk of death is known to increase dramatically among those with a body mass index of less than 19 kg/m2. Even mild weight loss in the presence of severe diseases can have a substantial impact on the course of the disease. The paper presents current views on malnutrition, its prevalence in the presence of various somatic diseases, and clinical significance. It describes the basic pathogenetic components of weight loss and the possible ways of correcting nutritional status. Particular emphasis is placed on the methods of nutritional support that is currently regarded as one of the most important components of a comprehensive approach to treating patients with chronic diseases. The authors give recommendations for the assessment of the nutritional status of patients in clinical practice and algorithms for their malnutrition management.

Aim of the study was to assess mortality and rate of repetitive hospital admissions on days 30, 90, 180, 360, of observation as well as prevalence of concomitant diseases in patients with congestive heart failure (CHF). The register was formed in 41 centers of 20 cities of Russian Federation. Number of included patients with signs of chronic heart failure (CHF) was 2498. Data on 2404 was available for final analysis. Rehospitalization rate was 31, 11, 11, and 9.5% during 30 days, and during periods 31-90, 91-180, 181-360 days after discharge from hospital, respectively. Hospital mortality was 9%, 30 days and 1 year total mortality was 13 and 43%, respectively. Risk of death was most strongly affected by pneumonia, liver cirrhosis, and chronic kidney disease (mortality 49.5, 45.7, and 47.2%, respectively). Prognostic value of factors was ranked in the following order (descending): age, body mass index < 19 kg/m2, systolic blood pressure < 100 mm Hg, heart rate (HR) > 70 bpm, body temperature < 36.5 C. Each predictor was assigned weight of 1 point. Score 5 meant that risk of death with a high degree of probability approached 100%. Patients included into ORAKUL compared with those included in Euro HF register were more severely ill: in ORAKUL ejection fraction < 40% was observed 1.89 times more often, and more patients had "wet-cold" profile. Patients in ORAKUL had greater HR, smaller ejection fraction, lower glomerular filtration rate, and worse compliance to scientifically based treatment.

Aim. To study effect of concomitant diseases and symptoms forming patient's phenotype on prognosis of decompensated systolic heart failure. Material and methods. We analyzed data of the Pavlovsky register, which was formed in 2009 and included 1001 patients (42% men, 58% women, mean age 69.4 +/- 11.8 years) with decompensation of chronic heart failure (CHF). Analysis covered 1 year of follow-up with control points on days 30, 90, 180, and 360 after discharge from hospital. Results. The following factors were found to be early predictors of mortality: level of blood urea rise (48% of deaths occurred among patients with 7.5 mg/di elevation of urea concentration during 3-6 months), anemia (first 30 days mortality was 20%), heart rate (HR) (mortality of patients with discharge HR>70 bpm was substantially higher than that of patients with HR<70 bpm). Late predictor of mortality was chronic obstructive pulmonary disease (after day 100 mortality rose in patients on inhalation therapy, this rise became significant after day 170 of follow-up). Some predictors were operational during whole period of follow-up: level of creatinine rise (42% of deaths occurred during first 90 days of follow-up), glomerular filtration rate (GFR) (among patients GFR<60 ml/min/1,73m(2) mortality was significantly higher throughout period of follow-up), deficit of lean body mass (69% of deaths occurred during first 180 days of observation). Conclusion. Classification of patients with decompensation of CHF according to principle of phenotypes enables a physician to implement prognostic assessment at early stages.

Data from numerous epidemiological studies indicate that in many developed countries, heart failure is one of the most common, progressive and predictive of adverse complications of diseases of the cardiovascular system. At the moment, that is a rather acute problem of cardiac rehabilitation of such patients. The purpose of our study was to investigate the effect of various forms of structured learning in special schools for CHF patients on the clinical course and prognosis. Materials and Methods: This study consisted of two phases, including 158 patients with chronic heart failure II–III FC. Evaluated the survival of the knowledge, clinical status, distance of a 6-minute walk, Minnesota QoL questionnaire, adherence to therapy, the frequency of hospital admissions for heart failure decompensation, referral to the clinic, the frequency of deaths, the level of CRP, LV function the results of echocardiography. The results: the use of interactive learning will significantly improve patient compliance to treatment (D=5%), which in turn significantly improved the clinical condition of patients, quality of life, performance test, 6-minute walk, and left ventricular function, as well as reduced the number of hospitalizations with circulatory decompensation (1,6-times), and uptake to the clinic (up to 0,5 times a month). Thus, the use of interactive patient education is an integral part of the cardiorehabilitation events in patients with CHF.

Beneficial effects of exercise trainingcultivated at normal temperature (37°C) or submitted to heat shock (HS) at 42 °C for 2h.Then, the cells remained for an additional 6h recovery period at 37 °C for the further analysis of intracellular HSP70 by Western blot (SDS-PAGE).Results: HSP70 expression increased after MIT and HIT training both before and after performing exercise (p<0.01).When the cells were submitted to the second challenge (HS), the same profile was observed in MIT group in all situations whereas in HIT group a significant increase was observed in heat-shocked cells only after the last exercise session of the training when compared with the first session (Fig. 1). Conclusion:The immune response and the cytoprotection varied with the intensity of exercise.The MIT caused the best response on HSP70 expression by peripheral BMC from patients with CHF.

The problem of osteoporosis treatment is very urgent for professionals around the world, but in different countries different strategies are adopted to address this issue. This article presents a comparison of domestic and European approach to the diagnosis and treatment of osteoporosis. Differences in the organization of the process of diagnosis and treatment are available. But on some issues, opinions of experts agree, particularly in Russia and in Europe bisphosphonates recognized as “gold standard” of treatment of osteoporosis. The panelists recognize Foroza® as affordable medicine with high efficacy and safety.

306 Health-related quality of life using the HeartQoL, a new questionnaire for patients with angina, myocardial infarction or ischemic heart failure N B Neil B Oldridge, S Hofer, H Mcgee, H Saner University of Wisconsin School of Medicine & Public Health and Aurora Cardiovascular Services, Milwaukee, United States of America, Innsbruck Medical University, Department of Medical Psychology, Innsbruck, Austria, Royal College of Surgeons in Ireland, Dublin, Ireland, Swiss Cardiovascular Center Bern, Inselspital, Bern, Switzerland Topic: Psychosocial factors/Quality of life (Rehabilitation & Implementation) Objective: The objective of this analysis was to compare HRQL in patients with angina, myocardial infarction [MI] or ischemic heart failure [IHF] using a new IHD-specific questionnaire, the HeartQoL. Methods: The new 14-item IHD-specific core HRQL instrument, the HeartQoL questionnaire [scored on 4-point scale, 0 = least impact on HRQL and 3 most impact on HRQL], was used to estimate the impact on HRQL in patients with documented angina, MI or IHF in 22 countries where 15 different languages are spoken. Results: In the group as a whole [n=6,281], the mean HeartQoL score was 0.50 [ 0.6] and HeartQoL scores differed significantly [p<0.001] by diagnosis; patients with MI [n=2,337] reported the least impact on HRQL [HeartQoL score, 0.35], patients with angina [n=2,082] reported an intermediate impact on HRQL [HeartQoL score, 0.51] and patients with IHF [n=1,862] reported the greatest impact on HRQL [HeartQoL scores, 0.67]. When the 22 countries were divided into language regions as Western Europe [Austria, Belgium, France, Germany, The Netherlands, Switzerland], Eastern Europe [Hungary, Poland, Russia, Ukraine], Mediterranean [Italy, Portugal, Spain, Cuba], Scandinavia [Denmark, Norway, Sweden] and English-speaking [Australia, Canada, UK, Ireland, USA], we found that Western European patients reported the least impact on HRQL [0.48] and Eastern European patients the most impact [0.57] [p<0.003] with no significant differences between the Western European, English-speaking [0.51], Mediterranean [0.52] and Scandinavian [0.52] patients. Further, we observed a consistent and significant [p<0.001] pattern by diagnosis in each language region with patients with MI reporting less impact on HRQL than patients with angina who in turn reported less impact on HRQL than patients with IHF. Conclusion: This analysis is the first direct between-diagnosis comparison of HRQL using a IHD disease-specific questionnaire in patients with angina, MI or IHF. The HeartQoL scores consistently demonstrated that patients with IHF reported the greatest impact on their HRQL, patients with angina reported an intermediate impact on their HRQL and patients with MI reported the least impact on their HRQL.

Актуальность. Физические тренировки в настоящее время являются неотъемлемой частью программы реабилитации больных ХСН. Однако проведение стандартных физических тренировок у больных ХСН III-IV ФК и легочной гипертензией не всегда возможно из-за тяжести их состояния. Цель. Изучить возможность применения тренировок дыхательных мышц у больных с тяжелой ХСН и легочной гипертензией. Материалы и методы. В исследование включены 59 больных ИБС, осложненной ХСН III-IV ФК, средний возраст которых составил 64,5±6,3 года. Больные были разделены на 2 группы. Пациенты 1 группы (п=30) получали стандартное лечение и выполняли дыхательные упражнения для тренировки дыхательных мышц. Пациенты 2 группы (n=29) получали только стандартное медикаментозное лечение. Исходно и каждые 3 мес в течение 1 года оценивались клиническое состояние пациентов и толерантность к физическим нагрузкам по результатам 6-мин теста ходьбы, ЭхоКГ методом регистрировалось среднее давление в легочной артерии, контролировались частота госпитализаций в связи с декомпенсацией ХСН и частота смертельных исходов. Для тренировок дыхательных мышц использовали дыхательные тренажеры Threshold IMT и Threshold PEP, с помощью которых создавалось сопротивление воздушной струе во время вдоха и выдоха соответственно. Тренировки проводили ежедневно по 20 мин 1-2 раза в день. Контролировались регулярность и правильность проведения тренировок. Результаты. Включение тренировок дыхательной мускулатуры в программу реабилитации больных ХСН позволило стабилизировать среднее давление в легочной артерии. Его исходный уровень составил 57,2±10,2 мм рт.ст., через 6 мес-53,2±11,4 мм рт.ст. (р>0,05), а через 12 мес- 54,5±7,9 мм рт.ст. (р>0,05). Улучшились показатели 6-мин теста: исходно - 159,3±9,4 м, через 6 мес - 188,9±11,5 м (р=0,05) и через 12 мес - 186,5±10,1 м (р=0,054). В группе больных, получавших только медикаментозное лечение, наблюдался рост давления в легочной артерии от исходного 55,8±7,3 мм рт.ст. до 64,6±8,4 мм рт. ст. спустя 6 мес (р>0,05) и до 79, 8±9,1 мм рт.ст. в конце исследования (р=0,042). Существенной динамики результатов 6-мин теста не было: исходно - 164,7±16,7 м, через 6 мес - 159,9±17,1 м, через 12 мес - 160,6±13,2 м (р>0,5). За время наблюдения в 1 группе зарегистрированы 19 (63%) госпитализаций в связи с декомпенсацией ХСН, во 2 группе - 24 (82,7%), р