The article represents argumentative issues of Chronic Obstructive Pulmonary Disease (COPD) treatment which is a global problem of modern medicine. According to WHO data COPD is the third leading cause of death worldwide, annually about 2.8 million people die because of this disease, and over 20 years this statistics never changed. In developed countries the highest costs for health systems in the treatment of respiratory diseases are associated with COPD which affect the course of this disease causing an irreversible progressive decline in lung function, deteriorating quality of life, increasing the frequency of readmissions and mortality. Thus, the prevention of exacerbations of COPD is of social and economic importance and should be a priority in the treatment of this disease.

The paper presents a review of publications on the problem of medication therapy continuity during patient's transfer between levels of healthcare and an impact of its failure on adverse drug events rate. One of the most efficient and cost-effective approach of improving drug therapy continuity is standardization of the medication reconciliation procedure which is recommended by the World Health Organization and implemented in many countries. The evidence of the medication reconciliation efficiency in improving the patient safety, reducing the risk of prescribing errors, preventable adverse drug events and financial burden on health care is discussed.

Objective: The objective is to assess immediate and delayed effects of three-months course therapy with a drug 'Cereton' (Choline alfoscerate) in patients with anamnestic syndrome of mild cognitive impairment (MCI). Methods: 50 patients with MCI got a three-month course therapy with Cereton (Choline alfoscerate), dosage 1200 mg/day. 15 patients during a year repeated similar course of therapy. Neuropsychological tests were used to evaluate immediate and delayed effects. Results: Statistically significant improvement is defined according to the majority of psychometric parameters as a result of single course. Though in 7-9 months after the end of therapy the final results of majority of tests worsened, the level of patients' cognitive functioning remained at higher level as compared to the beginning of the therapy. Getting the refresher course of treatment patients with MCI reached the same level of cognitive functioning which was after the first course of therapy. Conclusions: With course treatment with Cereton, a significant therapeutic effect was obtained in relation to the cognitive functioning of patients with MCI. The results indicate the promise of further studies of this drug in the framework of prospective therapeutic programs to determine its therapeutic potential in the implementation of preventive therapeutic strategies in individuals with a high risk of Alzheimer>s disease.

Objective: The study objective is to analyze the effectiveness and safety of semi-annual therapy with the use of drug Memantal in patients with moderate and severe dementia cause by Alzheimer's disease. Methods: The study was performed on a group of 30 patients with moderate and severe Alzheimer's disease aged from 55 to 84 y.o. A course of therapy with Memantal was given during 6 months. Treatment began with a dose of 5 mg, followed by an increase of 5 mg to achieve a therapeutic dose of 20 mg/day, 1 time in the morning. Evaluation of the effectiveness of therapy was carried out before the start of treatment and by the end of the 3^rd and 6^th months (MMSE, ADAS-Cog, NPI). The assessment of the impact on caregivers at home was performed according to RUD. Results: A positive effect was achieved in 63.3 % of cases by the end of the course of therapy. A significant improvement in the cognitive functioning of patients compared to the baseline (MMSE and ADAS-Cog) was observed by the end of the first month of the study. Over the next three months, there was a slight increase in the positive effect on cognitive functioning. The dynamics of the indicators of the corresponding points of the NPI/NH scale confirmed that the use of Memantal contributes to a significant reduction in the stress load on caregivers. Conclusions: The study showed that the use of Memantal in the conditions of semi-annual therapy in patients with Alzheimer>s disease at the stage of moderate and severe dementia improves not only cognitive and daily functioning, but also leads to the reduction of a wide range of non-cognitive mental disorders and thereby improves the quality of life of patients.

Objective: The study objective is to analyze the population features of arterial hypertension (AH) combined with chronic kidney disease (CKD) with the assessment of pharmacological and epidemiological aspects of antihypertensive therapy (AHT). Methods: Prospective study including questionnaire survey of 443 patients with diagnosed AH from different locations of Primorskiy territory. Average age of patients is 56.5. The stage of renal dysfunction was determined with the calculation formula of glomerular filtration rate (GFR) according to CKD-EPI. To evaluate results we used Rewiew Manager 5.3. Results: CKD of different severity was detected in all surveys. 391 patients (88.3 %) showed a decline of GFR of 2-5 stages. Stages 2 and 3a were detected most frequently - in 316 patients (71.3 % of the total number). Comparison between physicians' adherence to therapy of AH in the study PIFAGOR IV and in this work did not show any significant differences. Some regional features of cardioreal interactions in patients with AH were identified, in particular, a higher level of CKD 2 and 3a stages and a lower prevalence of minor renal dysfunction were determined. The priority combinations of AHT were combinations of inhibitors of angiotensin transforming enzyme and diuretic, angiotensin-2 receptor antagonist and diuretic; beta-adrenergic blocking agent were used most rarely. Conclusions: Regional features of AH include a higher prevalence of CKD of late stages and caused by differences in average age of patients and by climatic, social and demographical factors. Clinical practice of drug therapy of patients with AH combined with CKD meets common standards both in drug choice and dosing schedule. Diagnosis of CKD by the level of creatinine in the biochemical blood test using certain formulas and calculators and the correction of treatment regimens based on renal dysfunction increases the antihypertensive efficacy of drug treatment and has a nephroprotective effect.

Objective: The study objective is to determine the role of cytokines, hepcidin and soluble transferrin receptor (sTfR) in anemia pathogenesis in patients with malignant neoplasms and to suggest a working version of the pathogenetic classification of anemia of chronic diseases. Methods: 63 patients with stage II-IV of a malignant neoplasm were examined. Anemia (1^st group) was diagnosed in 41 people, in 22 cases no signs of anemia were found (2^nd group). A comparative analysis of the metabolism of iron, C-reactive protein (CRP), hepcidin, sTfR, as well as interleukins (IL) 6 and 10 and tumor necrosis factor a (TNFa) was performed. Results: Patients with anemia compared with group 2 in the serum of peripheral blood showed lower levels of iron, total iron binding capacity, transferrin saturation coefficient with iron, and higher concentrations of CRP, hepcidin, sTfR, IL6, IL10 and TNFa. Conclusions: Based on the correlation analysis, a multicomponent genesis of anemia in malignant tumors was demonstrated. A working version of the classification of anemia of chronic diseases based on the leading pathogenetic factor is proposed: 1) primary iron deficiency, 2) disruption of the regulatory mechanisms of erythropoiesis, 3) insufficient erythropoietin production.

Objective: The study objective was to confirm experimentally a preventive effectiveness of juice and oil meal of Empetrum nigrum fruits in glucocorticoid-induced osteoporosis. Methods: Steroid osteoporosis was simulated in animals by intragastric administration of prednisolone suspension in a daily dose of 5 mg/kg for 30 days. Experimental rats were injected intragastrically with juice (1 ml/200 g) and oil meal of Empetrum nigrum (1.4 g/kg) up to an hour before meals. The levels of calcium and phosphorus in the blood serum were determined on the 10^th and 30^th days, histological sections of the rat femur were prepared and bone tissue analysis was performed. Results: As a result of the experiment, effective dynamics of calcium- phosphorus metabolism was observed with the administration of Empetrum nigrum juice to animals after 10 and 30 days and with the administration of Empetrum nigrum oil meal - after 30 days of experiment. Histological studies confirmed the effect of juice and oil meal on bone tissue. Conclusions: The positive dynamics of mineral metabolism and regenerative processes in bone tissue was revealed. By the end of the experiment, control was observed to suppress the processes of osteosynthesis, while bone resorption increased. Osteoblasts appeared in the experimental groups and recovery took place.

Objective: The dynamics of the structural organization of the rat ovarian microvasculature was studied at different times of a day with estradiol impact. Methods: The work was performed on the ovaries of two groups of mature Wistar female rats: control (n=24), whose animals were examined at 2, 6, 10, 14, 18, 22 hours, and experimental (n=20) -after administration of an oily estradiol solution dipropionate at night (2 and 6 hours) and day (14 and 18 hours) time. The alkaline phosphatase and NADPH-diaphorase activity in the vessel wall, the total length of enzyme-positive vessels in the ovarian cortex, and the relative density of mast cells were calculated. Results: In the night and morning hours, the capillaries in the cortical substance of the ovaries were characterized by an intense reaction to alkaline phosphatase and NADPH-diaphorase, and the density of such vessels was relatively high. In the daytime and evening hours, enzyme-positive vessels were less common, and capillaries with low or moderate enzyme activity prevailed among them. In addition to capillaries, on sections stained for NADPH-diaphorase, mast cells were detected in the interfollicular zones and stroma of the ovaries. The administration of estradiol caused an increase in the activity of alkaline phosphatase and NADPH-diaphorase in the capillary wall, an increase in the density of the perifollycular vascular network and mast cells. The values of enzyme activity and the number of mast cells increased by 8-12 %, more than the total length of the microvasculature. Conclusions: The administration of estradiol is accompanied by a restructuring of the vascular plexus of the ovarian cortex with an increase in the activity of alkaline phosphatase and NADPH-diaphorase in the wall of microvessels, an increase in the density of the enzyme-positive capillary network and the number of mast cells, among which degranulated forms are often occur. Changes in the structural elements of the ovary are more pronounced with the administration of estradiol in the daytime.

Objective: The objective is to study the role of hyaline cartilage remodeling disorders in the early stages of osteoarthrosis. Methods: We examined 73 female patients with early knee osteoarthrosis symptoms and 20 healthy women (average age 52 y.o). All patients were examined with magnetic resonance imaging, sonography for knee joints; blood serum levels were determined for interleukin-1ß, neopterin, highly sensitive C-reactive protein, osteocalcin, CrossLaps, pyridinoline, oligomeric cartilage matrix protein (Human Cartilage Oligomaric Matrix Protein - COMP) and cartilage glycoprotein YKL-40. Results: We noted an increase of interleukin-1ß level at normal values of C-reactive protein and neopretin in blood serum. Markers of remodeling of cartilage and bone tissue (osteocalcin, Cross-Laps, pyridinoline, COMP and cartilage glycoprotein YKL-40) showed a significant increase of concentration compared with control values. Conclusions: Cytokine imbalance with pronounced hyperproduction of interleukin-1ß plays a leading role in the pathogenesis of the early stages of primary osteoarthritis of the knee joints. Degenerative and dystrophic and inflammatory processes affecting the subchondral bone, synovium, hyaline cartilage, medial menisci, and also separate components of capsular ligamentous apparatus these joints develop against the remodeling disorders of bone and cartilage tissues.

Objective: The objective is to conduct a clinical and economic analysis of effectiveness of recombinant human erythropoietin (rhEPO), used to treat anemia in adult patients with dialysis-dependent terminal chronic kidney disease. Methods: The study takes into account the direct medical costs of therapy with rhEpO: epoetin-alpha (Eralfon), darbepoetin-alpha (Aranesp) and epoetin-beta (methoxypolyethylene glycol, Mircera) for both intravenous and subcutaneous administration. A "cost minimization" analysis has been performed for equivalent doses of erythropoietin. Results: With equal effectiveness of the studied drugs "Eralfon" 2500 IU intravenous turned out to be less expensive medicinal technology in relation to equivalent doses of "Aranesp" 20 μg and "Mircera" 75 цд and 75+50 цд - by 29 and 26 and 4 %, respectively. The transfer of patients to subcutaneous administration can reduce the weekly dose of epoetin-alpha by 20-30 % by reducing the frequency of taking the drug to twice a week, which reduces the cost of drug therapy. A subcutaneous administration of «Eralfon» 2500 IU is a cost-effective drug technology: savings can range from 58,380 to 117,156 rubles per patient per year. Conclusions: Intravenous and subcutaneous administration of Eralfon 2500 IU can be considered more economical drug technology relative to Aranesp and Myrcera.

Objective: Oncological patients are at high risk of thrombotic complications, which worsen the outcomes of antitumor treatment and occupy one of the leading places among the causes of death. The aim of this study was to evaluate the efficacy and safety of the use of anticoagulant direct action of domestic production of Enixum (enoxaparin sodium) for the prevention and treatment of thrombosis in cancer patients. Methods: The system of hemostasis and the frequency of thrombotic complications in 210 oncological and gynecological patients undergoing surgical treatment were studied. 80 people (group 1) received Enixum for 7-15 days of the postoperative period. Group 2 (130 people) - patients who did not receive medication prophylaxis of thrombotic complications (control group). Also, 30 oncological patients with acute thrombosis and pulmonary embolism, were studied. Results: The use of low molecular weight heparin Enixum in the postoperative period and in patients with acute thrombosis and pulmonary embolism significantly reduces the intensity of intravascular coagulation, the frequency of venous thrombosis and prevents fatal thromboembolism, which expands the possibilities of anticancer treatment and improves the quality of life of cancer patients. Conclusions: Enixum is an effective and safe drug for the prevention and treatment of thrombosis in oncology clinic.

Objective: The study objective was a comparative assessment of power characteristic of respiratory muscles in 72 patients with ischemic stroke in different combinations of comorbidity. Methods: Levels of maximal inspiratory and expiratory pressure in oral cavity, maximal speed of its rate of its rise during inspiration and expiration, the level of intranasal pressure, as well as their ratio indices. Results: Decrease in strength of expiratory and inspiratory respiratory muscles is recorded in early and late rehabilitation periods of ischemic stroke, the severity of which depended on the severity of neurological impairment and clinical variant of comorbidity. Hypofunction of accessory inspiratory muscles was common for patients suffered a stroke in congestive heart failure; a diaphragmatic dysfunction of respiratory muscles prevailed in patients with metabolic syndrome. A decrease of expiratory muscles strength prevailed in the combination of ischemic stroke with chronic obstructive pulmonary disease of 1 and 2 stages. Conclusions: The severity of comorbidity pathology significantly affects the strength of respiratory muscles. The interrelation of the strength characteristics of muscle tissue with the parameters of bronchial patency, smoking index, skeletal muscle mass and the severity of shortness of breath is noted.

Objective: The study was to reveal the interrelations of the dental arch widths of the upper jaw with certain linear parameters of the facial section of the mesocranial skull type. Methods: The work was performed on 144 preparations of skulls of people of mature age of both sexes with physiological occlusion of teeth. The following parameters of the facial part of the skull were studied: the upper face height, the face width, the height of the dental alveolar part of the maxilla, the height of the intergnatic part. The width of the dental arch was measured between canines, premolars and molars. Results: As a result of the study, the minimum and maximum confidence limits for the widths of the dental arches at different levels of measurement, as well as the parameters of the facial part of the skull, were determined. The range of these boundaries is set. It was revealed that the parameters of the upper face height, face width in men and women significantly exceed over similar indicators of vestibular dental arches at all levels of measurement. The height of the intergnatic part of the facial part of the skull was less than the width of the dental arches in men only. Conclusions: Thus, the width of the vestibular and palatal dental arches is less than the width of the face, but exceeds the height of the dental alveolar part at all levels of measurement. The index of the width of the vestibular dental arch in the region of the canines is less than the upper height of the face and the intergnatic part. When approaching the distal parts of the dental arch, an inverse relationship is observed. In this case, the palatal denture width is less than the face data at all measurement levels. The obtained data showed the interrelation of the width of the dental arches of persons of mature age with the parameters of the facial part of the skull. However, sex differences are poorly expressed.

Objective: The objective is to assess the possibility of the usage of medications of citicoline range (neipilet) to reduce cognitive and obsessive-compulsive in patients with chronic brain ischemia. Methods: The study was performed on two groups of patients with chronic cerebral ischemia: the main and control patients aged 54 to 75 years. In the presence of somatic pathology, patients of the two groups matched each other. Patients of the main group received Neupilept orally at 1000 mg per day for 30 days in combination with antiplatelet and vascular agents. The control group received only traditional therapy with the above groups of drugs. The neurocognitive status was assessed using the Schulte test and the MoCA scale. The effectiveness of the treatment of anxiety and depressive disorders was determined on the scales of depression and anxiety Hamilton (HDRS and HARS). Results: Patients who received Neupilept showed improved attention, accelerated thinking, Neupilept showed a positive effect on mental and somatic anxiety. Patients in the control group did not subjectively indicate improved cognitive functions, objective testing also showed no significant positive results. Conclusions: The study on scales and questionnaires, which determines the level of positive dynamics of cognitive functions (Schulte's test, MoSA-test), anxiety and depression (HARS and HDRS) indicates a positive therapeutic effect of Neupilept. The use of Neupilept for the correction of the clinical picture of chronic cerebral ischemia improves the quality of life of patients, contributes to the activation of cognitive functions and normalizes psycho-emotional disorders.

Objective: We studied an antioxidant status and phospholipid blood plasma composition of patients with chronic brain ischemia during individual use of 2-ethyl-6-methyl-3-hydroxypyri-dine succinate ('Neurox'), citicoline ('Neipelept'). Methods: The study included 40 patients aged 54-72 y.o. with chronic brain ischemia 2 stage in the decompensating phase. The 1st group (14 patients) took 'Neurox' in addition to a basic regimen, the 2nd group (13 patients) - 'Neipelept', the 3d group (13 patients) - a combination of these drugs. The control group -14 healthy people aged 24-42 y.o. Results: Having used a combination therapy with the drugs 'Neurox' and 'Neipelept', a significant increase of superoxide dismutase activity in blood plasma after the end of treatment was registered. A significant increase of reduced SH-groups number was detected after the treatment with 'Neurox. Having studied quantitative and qualitative composition of blood phospholipids in patients taking 'Neurox', significant changes in their mass was not detected; meanwhile having used'Neipelept' and the combinations of these drugs, there was an increase of content and total mass of phospholipids. Conclusions: Clinical data and results of biochemical analysis signify the applicability of ethylmethylhydroxypyridine succinate and citicoline, and also their combinations as part of neuroprotective therapy of chronic brain ischemia.

Objective: The study objective is to determine the effectiveness of functional laboratory device Crystallina to standardize pre-analytical stage of crystallography of oral fluid. Methods: We took oral fluid samples from 96 children aged 9-11 y.o. Saliva samples were examined with a standard method in a control group (48 people); we used the device Crystallina to examine samples in an experimental group (48 people). Results: The frequency of a standard qualitative sample of a saliva drop and facies was 90 % in the experimental group, and it was 45 %o in the control group. Conclusions: Leveling a horizontal surface with the additional equipment of Crystallina enables to take a drop of mixed saliva that meet the standards. The use of insulating cover blocks the insertion of foreign particles into the drop, and it enables to avoid artifacts. Obtained data provides evidence of high effectiveness of a portable laboratory device Crystallina to standardize a pre-analytical stage of crystallography of any biological fluid.

Literature review presents issues of personal culture formation of students via an institution of mentorship. The study analyzes the historical aspects of social and cultural phenomenon of the mentorship origin and its influence on culture subjects. It considers the role of mentors in teaching and educational process of medical university. A structure of the components in the future physician's activities is proposed, through which the teacher-mentor can influence the culture of the personality of the medical student.

The study describes a clinical case of radiation-induced intracranial meningioma in a woman aged 35 y.o., 22 years later after the removal of angioreticuloma of the right parietal lobe and X-Ray therapy (total dose 68Gy). It is emphasized that patients, who received an X-Ray therapy for a primary tumor of the brain, are at-risk of radiation-induced tumors for the whole life.

The study describes a clinical observation of autoimmune polyglandular syndrome type 1 in a boy aged 11 y.o. The disease manifested a chronic adrenal insufficiency and symptoms of subclinical hypoparathyroidism. The diagnosis was confirmed after molecular and genetic test. Child's condition became normal due to replacement therapy.

Pompe disease (type 2 glycogenosis) is a rare hereditary disease with autosomal recessive inheritance mechanism associated with systemic damage to muscle and nerve cells with a lack of acidic alpha-glucosidase in the body, which is necessary for the decomposition of glycogen. Diagnosis of Pompe disease was confirmed only after medical and genetic study in the presented clinical observation. The child is received pathogenetic therapy.

After obtaining the diploma of the doctor Voino-Yasenetsky was improved in clinic, P. I. Dyakonov and at the Institute of topographic anatomy and operative surgery at F.A. Reina, and then returned to the practice of the surgeon. In 1905-1914 V.F. Voyno-Yasenetsky worked as a country doctor in hospitals Simbirsk, Kursk and Vladimir provinces, and in the years of the first world war was a surgeon and chief physician of the infirmary for the wounded. The article noted that in 1915 Voyno-Yasenetsky issued in St. Petersburg the book «Regional anesthesia» with his own illustrations, and in 1916 he defended at Moscow University his doctoral thesis on regional anesthesia: the dissertation was awarded the University of Warsaw. In 1917 - 1930s he worked in Tashkent - the first doctor-surgeon of the city hospital, and from March 1917 - chief doctor. Since 1920 Voyno-Yasenetsky became a professor of topographical anatomy and operative surgery of newly discovered Turkestan University. Analyzes his contributions to practical surgery. Stated that he owns the delete operation affected purulent process in the sacroiliac joint, the posterior part of the Ilium (pelvic resection for Voyno-Yasenetsky), an incision in the popliteal fossa, supplementing arthrotomy purulent chase (cut Voyno-Yasenetsky). He worked on other problems of clinical surgery. Voyno-Yasenetsky belongs to the original closure method of the wound located on the periphery of the diaphragm (method Voyno-Yasenetsky). He has proposed a way of mobilization of the spleen and ligation of blood vessels during splenectomy (method Voyno-Yasenetsky). He described important for surgeons topographic-anatomical landmarks - the projection of the sciatic nerve on the skin back of the thigh (line Voyno-Yasenetsky) and the place of exit of the sciatic nerve under the gluteal folds (dot Voyno-Yasenetsky). The book «Sketches of purulent surgery» (1943) and «Late of resection for infected gunshot wounds of the joints» (1944) in 1946 he was awarded the Stalin prize of the first degree.

Health care management and services for children during post-war period, when the 4^th five-year-plan of the USSR national economy development was approved (1946-1950), was characterized by a range of measures to improve the health of the children's population of Primorsky territory. Materials of State archive of Primorsky territory enable to assess the development of children's health care in Primorsky territory after the Great Patriotic War.