Chronic thromboembolic pulmonary hypertension (CTEPH) is a precapillary form of pulmonary hypertension in which chronic obstruction of large/ middle pulmonary arteries and secondary changes in the microcirculatory bed of the lungs lead to a progressive increase in pulmonary vascular resistance and pulmonary artery pressure followed by the development of severe right heart failure. CTEPH is a unique form of pulmonary hypertension, because it is potentially treatable with surgical treatment. This review presents the main statements of the national guidelines on the diagnosis and treatment of CTEPH 2015, addresses the problematic issues associated with the tasks of early diagnosis and effective treatment such as pulmonary trombendarterectomy, rational supportive and specific therapy, balloon angioplasty of the pulmonary arteries and lung/ heartlung complex transplantation. Algorithms for diagnosing and managing CTEPH patients are also proposed as the requirements for an expert center for CTEPH.

The Far Eastern Federal District (FEFD) is recognized as a strategically important geopolitical zone of the Russian Federation with definite and clear goals and objectives, the economic well-being of our country largely depends on their solution. Accordingly, the optimum organization of medical care and combating the mortality of the population are particularly relevant for the Russian Far East. As perspective directions for improving the provision of therapeutic care to the population of the Far Eastern Federal District we can separate: improvement of the 3-level system of medical care, quality improvement in health survey, ramp-up of the hi-tech medical care, staff deployment in medical organizations, therapeutic medical services to the population according to the developed standards, creation of favorable conditions for professional development, continuing medical education for physicians of Far Eastern Federal District and wide use of specialized departments to train specialists.

Exacerbations of chronic obstructive pulmonary disease (COPD) are one of the factors determining the prognosis for patients with this disease. There is a hypodiagnosis of exacerbations of COPD in clinical practice, about 50% of which are not detected or not fixed by doctors, are often underestimated by the patients themselves. The need for correction of the prescribed basic therapy depending on the frequency and severity of exacerbations requires the availability of convenient, accurate and easy-to-use tools for the diagnosis of this condition. The existing variants of the questionnaires for identifying the preceding and current exacerbations are diverse and have a number of characteristics. The article contains data on existing instruments for the diagnosis of exacerbations, and also suggests a number of questions aimed at their retrospective detection. A reminder for patients with information on the role and manifestations of exacerbations of COPD, as well as actions in cases of their presence, is offered.

The review is devoted to a current problem of pulmonary thromboembolism. Epidemiology, risk factors, diagnostics of pulmonary thromboembolism are taken up in this article. The analysis of primary thrombosis which is a source of pulmonary thromboembolism is carried out. Localization of thrombosis in the system of superior and inferior vena cava is studied. The most frequent diseases which are the reason of primary thrombosis are considered. The most optimal protocol of scanning of multispiral computed angiopneumography is defined. The possibilities of multispiral computed angiopneumography in differential diagnosis of acute and chronic pulmonary thromboembolism are studied in this article.

Objective. The reaction of cardiac hemodynamics to apnea in young women with idiopathic arterial hypotension was studied. Methods. Two groups of women aged 18-25 were examined. Test group - 19 women with idiopathic arterial hypotension, and control group - 11 women with normal arterial tension. Apnea with parallel echocardiography was performed by holding the breath on exhalation for 20 seconds. Results. In women with arterial hypotension, apnea was accompanied by a decrease in the final diastolic and sylvic dimensions of the left ventricle. Conclusions. The reaction to apnea of cardiac hemodynamics in women with hypotension is caused by aggravation of hypoxia against the background of existing hyperoxidazotemia and may be an important pathogenetic mechanism of cardiovascular maladaptation.

Objective. The study objective is to evaluate the clinical and pathogenetic relationships of the inflammatory, oxidative and mixed molecular subtypes / endotypes of osteoarthritis. Methods. 65 patients with osteoarthritis of knee joints were examined: 8 men and 57 women, average age - 66.7 years, duration of the disease from 1 to 18 years. For the purpose of molecular phenotyping, the concentrations of interleukin-1 ß and oxidative-induced growth inhibitor-1 were determined in the blood serum and phenotypes of the osteoarthritis: inflammatory, oxidative and mixed were isolated. Results. Inflammatory endotypes occurred in 9, oxidative - in 28 and mixed - in 28 cases. The pain level, measured from the visual analogue scale, was the lowest in individuals with an inflammatory molecular subtype of the osteoarthritis. The overall score for the WOMAC questionnaire was significantly higher in patients with a mixed endotypes of the disease. The concentration of cartilage-associated protein was significantly lower in patients with inflammatory and oxidative molecular subtypes of osteoarthritis. The level of the Fas-ligand was significantly lower in the inflammatory subtype, and the level of endothelin-1 was lower in the oxidative subtype of the disease. The growth factor/differentiation-5 concentration was significantly higher in the group with the inflammatory osteoarthritis phenotype. Conclusions. The osteoarthritis is a heterogeneous disease; the variety of its manifestations depends on the molecular-transcriptom mechanisms and ways of responding to stress. Endotyping patients with osteoarthritis on molecular basis is justified from the clinical and pathogenetic point of view. Thus, the data obtained by us on the clinical and pathogenetic features of various molecular phenotypes of the osteoarthritis can form the basis of a personified approach in this disease.

Objective. To reveal the peculiarities of distribution and potential interrelations of tobacco smoking with other cardiovascular risk's factors in the population of Primorsky Krai in different age groups. Methods. 2117 people, living in the Primorsky Territory, were examined during a multicentre epidemiological study. All patients completed the questionnaire, conducted an instrumental examination, and venous blood sampling was performed to determine the lipid spectrum and other major biochemical parameters that affect cardiovascular risk. Results. There was a direct relationship between the weight and circumference of the waist, the level of triglycerides on age and smoking status revealed in the course of the study. The indices of systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein, apolipoprotein B, glucose values were correlated with age and did not depend on smoking status. The indices of apolipoprotein A and uric acid were influenced by the status of smoking and did not depend on age. In other biochemical indicators, the dependence on smoking status and age was not revealed. Conclusions. Currently being considered personalized prognostic and predictive approach to the prevention of premature aging and cardiovascular risk, based on the active participation of the patient. Tobacco Smoking is associated with impaired metabolic processes, in particular a change in the number of lipid metabolism and uric acid. With the aim of individualization of prevention approaches can have the value of monitoring indicators triglycerides, apolipoproteins, uric acid, in connection with a possible participation of this factor in the formation of adverse metabolic phenotype. Exceptionally important is the need for the implementation of primary prevention programs aimed at promoting a healthy lifestyle, quitting Smoking and other addictions as the general population and individual levels.

Objective. Based on epidemiological monitoring for 2008-2016 the characteristics of contingents of patients with a combination of tuberculosis and HIV infection in the territory of Primorsky territory are given. Methods. The forms of federal statistical survey were used. Results. A high incidence and prevalence of co-infection has been established, indicating a tense epidemic situation. The proven leading position of the parenteral route of HIV-infection is determined by a significant number of consumers of psychoactive substances in contingent patients with co-infection leading to social misadaptation of patients. Conclusions. The current situation calls for joint coordinated efforts of phthisiatricians, infectious disease specialists of the AIDS Center to prevent the development of tuberculosis in HIV-infected patients.

Objective. Cardiovascular diseases and mortality from them are the most actual problem of healthcare in most countries in the world including Russia. Accounting of ethnicity is considered as one of the effective ways of approaches personification to predicting cardiovascular risk. Methods. We examined 145 patients aged from 22 to 49 years old, permanently residing in Primorsky Region and Sakhalin Region. All patients underwent an assessment of the mechanical properties of aortic stiffness by noninvasive arteriography. There were analized the aortic pulse wave velocity (PWVa), the augmentation index (AIx), the value of systolic, diastolic and central and pulse arterial pressure. There were also analyzed the shape of the pulse waves, were determined the systolic and diastolic coronary perfusion index area ratio (SAI/DAI) and the left ventricular ejection time. Results. Height, weight, body mass index and waist circumference were significantly higher among smokers compared with smokers of Korean ethnicity, but among the non-smoking individuals only height and weight showed significant differences between ethnic groups. The PWVa was significantly higher among smokers of Slavic ethnicity compared to non-smokers, however among smokers and non-smokers persons of Korean ethnicity such differences were not observed. AIx was significantly higher among people of Korean ethnicity, both smokers and non-smokers in comparison with the Slavs in similar subgroups. Correlation links were revealed: PWVa is connected with the status of smoking among people of Slavic ethnicity, but in the Korean population, the history of smoking was correlated with SAI/DAI. AIx showed strong correlation with amplification pressure and compliance index of central and peripheral systolic pressure in both ethnic groups. Conclusions. Currently, there is a period of accumulation of data on the ethnic peculiarities of cardiovascular risk, described a number of differences which are recommended to be considered when predicting risk taking into account ethnicity. We determined reliable ethnic differences in the characteristics of aortic stiffness in persons of European (Slavic) and South Asian (Korean) ethnicity, related and not related to the status of smoking. There were described more definite changes in the aortic mechanical properties in the smokers group of Slavic ethnicity in comparison with the Koreans.

Objective. The analysis of the effectiveness of titanium implants based on the BT-6 alloy with calcium-phosphate coating at fractures of the femur on the background of systemic osteoporosis in the experiment was carried out. Methods. The work was performed on 27 rats of Wistar males, in 24 of which, divided into four groups, glucocorticoid-induced osteoporosis was reproduced, followed by modeling of the closed fracture of the diaphyseal part of the femur. In two groups of animals, fixation of fragments was performed by the method of closed intramedullary retrograde osteosynthesis using uncoated titanium implants and coated with hydroxyapatite. Comparison groups were formed by animals, the healing of fractures in which passed without the use of implants, and animals with osteoporosis without fracture. The control group included three healthy animals. On the 14^th, 30^th and 60^th day of the experiment, a histological and morphometric assessment of the bone tissue condition was performed. Results. The use of implants coated with hydroxyapatite in osteosynthesis in conditions of osteoporosis led to an earlier regeneration of bone tissue. Thus, the thickness of the cortical bone and thickness of trabeculae were significantly higher in rats with osteosynthesis covered with implants. On the 14^th day of the experiment, the coarse-fibrous connective tissue appeared in the fracture zone of the designated group of animals, which on the 30^th day began to transform into the lamellar bone, and on the 60^th day the bone loss was completely restored. If an uncovered implant was placed on the 60^th day, foci of imperfect osteogenesis and osteoid with a low degree of mineralization were preserved in the fracture zone, and in animals with which the implant was not installed, the fibreticular tissue was preserved. Conclusions. The dynamics of the bone tissue condition in fractures in rats with the model of osteoporosis testifies to the acceleration of the regeneration process due to the use of titanium implants coated with hydroxyapatite. So we may regard the use of such devices as a promising way to improve the results of fracture treatment in conditions of systemic osteoporosis.

Objective. Aim: to study the frequency of alleles and genotypes of polymorphisms of the C-reactive protein (CRP) gene (С1444Т, С1846Т; С3872Т; A717G) in women with ischemic heart disease (IHD) and osteoporosis. Methods. 205 postmenopausal women aged from 60 to 76 years, living in the Trans-Baikal Territory, Russian nationality were examined. In 162 women, the diagnosis of IHD was verified, among them 76 postmenopausal osteoporosis (the first clinical group) was detected. 86 women with IHD (without osteoporosis) made up the second clinical group. 43 women of the control group did not have a risk of cardiovascular diseases and osteoporosis. Molecular genetic investigation was performed by polymerase chain reaction. Results. A statistically significant difference in the distribution of alleles and genotypes for CRP polymorphisms: C3872T and C1444T was found in women with IHD comparison with healthy individuals. The T allele and the homozygous TT genotype of the polymorphic region C3872T were more often detected among healthy individuals. For polymorphism С1444Т it was established that in patients with IHD allele T and genotype TT were more frequent and associated with an increase in the risk of IHD by 1.5 times. We have not identified the relationship between the presence of osteoporosis and the studied polymorphisms of CRP. We studied the distribution of alleles and genotypes depending on the localization of fractures. It was established that C1444T polymorphism is associated with fractures of the radial bone, polymorphism С1846Т is associated with an increased risk of vertebral fractures. Conclusions. C3872T and C1444T polymorphisms of the CRP gene are associated with IHD. In carriers of T allele and CT genotype of C1444T polymorphism, the risk of IHD increased 1.5 times. We did not find any differences in the distribution of alleles and genotypes of the studied polymorphisms when comparing women who have a combination of IHD and osteoporosis with women with IHD. The risk of development of fractures of the radial bone is associated with polymorphism C1444T. For women with CC genotype, the risk is increased by 1.5 times. The risk of vertebral fractures is associated with polymorphism C1846T. The carriers of CT genotype risk increased by 4.5 times.

Objective. The aim of this work was to determine the probability and development time of cerebral stroke from the effects of disease predictors. Methods. The study is based on data, taken between 2008-2013 which involves 7959 workers of engine-crew brigades (Transbaikalian railroad, Russia) who were inspected for risk factors, lesions of end-organs cardiovascular diseases by determining the number of predictors of cerebral stroke. Results. Probability and development time of cerebral stroke was determined by analyzing both: overall effects of all predictors of this disease and effects of each predictor separately. Conclusions. The obtained knowledge has practical value for prediction, prevention and treatment of cerebral stroke.

Objective. The study objective is to assess the tuberculosis epidemiological situation including that of multiple drug resistance in Primorsky territory. Methods. The data of epidemiological monitoring of Primorsky Regional Tuberculosis Dispensary were analyzed. The main epidemiological indicators - morbidity, prevalence and mortality from tuberculosis from 2003 to 2016 were studied. Results. A significant decrease in the indicator of the total incidence of tuberculosis among the population of Primorsky territory was noted. At the same time, the incidence here exceeded the average for Russia by 2-2.5 times. At the same time, there is an alarming trend towards an increase in the share of multidrug-resistant tuberculosis. The reason for the tension of the situation are social and economic, climatic conditions, significant migration flows. Conclusion. Reduction of the prevalence of tuberculosis, due to the increased effectiveness of therapy, contributed to reducing the risk of exogenous super-infection and reducing morbidity. To effectively combat tuberculosis, comprehensive evidence-based measures, further integration and continuity in the work of the TB services and the general medical network are needed.

Objective. Arterial hypertension (AH) is one of the most common diseases in the world and the most significant morbidity and mortality cause in working age individuals. According to the results of a multicenter epidemiological study ESSE-RF with the participation 15571 patients from ten country regions, in recent years the prevalence of hypertension in the population increased from 39.7 to 43.4%. Methods. The research included 395 individuals aged 25 to 60 years, of whom 215 patients with hypertension. All participants measured the height, weight, waist circumference, body mass index, counting the index of the smoker, determined the lipid profile and adipokine levels in serum by enzyme immunoassay. Results. In patients with hypertension compared with the control group showed a significant decrease in serum adiponectin, the content of resistin had opposite results. The lowest adiponectin concentration obtained in combinations of risk factors hypertension and smoking. Relationship between the smoking intensity and resistin concentration and adiponectin had been identified. Conclusions. The data indicated a higher factors combination contribution in the development of metabolic problems, diabetes and coronary heart disease. It is revealed that for the better definition the risk of cardiovascular accidents in individuals with traditional risk factors combination (hypertension and smoking) should to consider the adipokines definition in the serum, in particular adiponectin and resistin.

Objective. The study objective is to analyze the prevalence of left ventricular myocardial damage in patients with chronic obstruc tive pulmonary disease (COPD) and the role of systemic inflammation in their genesis. Methods. 145 COPD patients were examined, 85 of them also suffered from coronary heart disease (angina pectoris), aged 42 to 75 years. The function of external respiration, the level of hypoxemia and the concentration of proinflammatory cytokines in the blood serum were evaluated, and computer electrocardiotopography was performed. Results. A significant prevalence of myocardial lesions is found not only in the right but also in the left ventricle in patients with COPD, including when it is combined with coronary heart disease. In the presence of hypoxemia, signs of systemic inflammation were more pronounced. Conclusions. In the development of myocardial damage in patients with COPD, in addition to hypoxemia, a particular role is played by systemic inflammation.

The problem of impossibility to save many human lives as a result of road accidents remains relevant and unresolved at the present time. Based on the statistical data on road accidents in the North-West Federal District for January-June 2017, some organizational measures were proposed for the timely provision of first and medical assistance to victims in road accident.

An assessment of the quality of care for patients with acute coronary syndrome (ACS) in the territory of Primorsky territory and the analysis of risk factors for acute vascular disasters were carried out. The system of routing of persons with ACS to primary vascular departments and regional vascular center were analyzed. In patients with ACS with ST segment elevation, the electrocardiogram used primary percutaneous coronary intervention or pharmaco-invasive therapy. In determining the tactics of managing patients without ST-segment elevation, stratification of the risk of adverse outcome was used, on the basis of which the delayed invasive approach was recognized as the primary strategy in the first 24-72 hours after the initiation of ACS. Among the risk factors for cardiovascular disasters, hypertension (82 %), dyslipidemia (68 %), smoking (38 %), obesity (33 %) and diabetes mellitus (22 %) were more common. The authors conclude that medical care for ACS in Primorsky territory is in accordance with the recommendations of the Ministry of Health of the Russian Federation, in more than 50 % of cases of ACS with the elevation of the ST segment, percutaneous revascularization of the myocardium is performed. It is planned to improve routing schemes and continue measures to correct risk factors for cardiovascular disasters.

Given the clinical survey of the alveolar proteinosis in a man of 36 years old. The complexity of X-ray and biopsy diagnosis of the disease is demonstrated. After the diagnosis was made correctly, bronchoalveolar lavage made it possible to improve the patient's condition in a short time.

The experience of using four objective acoustic methods for the diagnosis of pneumonia in children of school-age and adults is considered. The conclusion is made that all used acoustic methods are effective and safe for detecting a pathological focus in community-acquired bacterial pneumonia. The examined acoustic methods do not differ for diagnostic sensitivity and specificity. When compared with the subjective method of identifying the focus of pneumonia, objective acoustic methods have an obvious advantage.