SummaryThis article contains clinical guidelines and current approaches to diagnosis and treatment of idiopathic pulmonary fibrosis (IPF). The aims of devel opment this guidelines were to improve early detection and efficacy of pharmacological and non pharmacological therapy of IPF. Achieving these goals indicates improvement in medical care quality for these patients. These guidelines are intended to pulmonologists, therapeutists and other medical specialists, healthcare managers and other healthcare providers.

Treatment of patients with chronic obstructive pulmonary disease (COPD) is one of the most important tasks of clinical medicine due to high prevalence of and high mortality from COPD. Treatment of COPD as a heterogeneous disease requires different approaches depending on the severity and the clinical course of COPD. Clinical guidelines have become the principal document that regulates different aspects of management of COPD patients. Algorithms of management and clinical decision making are the crucial part of guidelines because they help achieving a balance between making the decision in different clinical situations and simple graphics. The simplified approach is important for implementation the algorithm into clinical practice. Different evidence-based therapeutic schemes proposed by experts of Russian Respiratory Society and other countries have been enclosed into this article with discussion about their strengths and limitations and possibility of practical use. The Russian algorithm reflects a current view on differentiated management of COPD patients and fits the requirements of Healthcare Ministry of Russian Federation and needs of achieving the optimal balance between high informative significance and a simple graphics of the scheme.

Analysis of samples of exhaled breath condensate (EBC) is a promising noninvasive method for the control of the status of the human respiratory system. In the present work, the proteome of the EBC samples received from a patient with lung dystrophy at different times before and after bilateral lung transplantation is analyzed by ion cyclotron resonance mass spectrometry. Qualitative protein composition of EBC samples obtained during the first month correlates with the clinical data on the acceptance of the transplanted lungs (allograft). Fifteen months after the lung surgery, the protein spectrum was similar to the normal composition of EBC proteins. This result agrees with the medical conclusion about normal lung functioning. The results suggest that the mass spectrometric monitoring of the protein spectra of EBC may be a tool for noninvasive pulmonological diagnostics.Key words: ion cyclotron resonance mass spectrometry, proteomic analysis, exhaled breath condensate, diagnostics of respiratory diseases.Recent instrumental advances in mass spectrometry (MS) and chromatography allow perfection of the meth ods of medical diagnostics based on the studies of the structure and function of biomacromolecules. The sensi tivity of the most recent mass spectrometers allows for the detection of femtomole concentration of proteins and pep tides with the dynamic range of concentrations of several orders of magnitude. The accuracy of mass determination of charged species with the state of the art methods reach es one millionth part of the ion mass. These characteristics are pertinent, in particular, to the Fourier transform ion cyclotron resonance mass spectrometers (FT ICR MS). Coupling of high performance liquid chromatography with FT ICR mass spectrometry ensures the high performance of the analysis and allows the quantitative analysis of the components of complex mixtures.In the present study, the potential of FT ICR chro mato mass spectrometry was employed for identification of the protein composition of the exhaled breath conden sate (EBC) of a person who had undergone lung surgery. The analysis of EBC is a promising method for the nonin vasive diagnosis of human respiratory system, but the prep aration of samples for the analysis significantly differs from that used for blood or urine. The method of EBC collec tion and analysis of protein composition by chromato mass spectrometry has previously been practized with ma terial obtained from healthy non smoking donors. Below we present the results of the qualitative analysis of EBC protein composition of a patient with bullous emphysema who underwent bilateral lung transplantation. Thorough medical monitoring of the patient in pre and post sur gery periods allowed us to obtain a unique set of samples of exhaled breath condensate.

The effect of incubation medium osmolality on the respiratory burst of human neutrophils was studied using luminol-dependent chemiluminescence (CL) as an indicator of burst activity. Neutrophils were stimulated with N-formyl-Met-Leu-Phe (FMLP), phorbol-12-myristate-13-acetate (PMA), the calcium ionophore A23187, thermoaggregated IgG (IgGn), and opsonized zymosan (OZ). It was shown that increasing the osmolality of the incubation medium from 320 up to 420 mosM decreased the A23187- and OZ-induced CL responses by 90%. Under the same conditions PMA-, FMLP- and IgGn-induced CL responses were decreased by 40-60%. A decrease of osmolality to 200 mosM resulted in a 2-3 fold decrease of the A23187-, PMA- and FMLP-induced CL and in a 60-80% increase of OZ- and IgGn-induced CL. It is suggested that osmolality-mediated alteration of cell volume is an important mechanism for regulating neutrophil activity.

Передовая статья 389http://journal.pulmonology.ru Показатели смертности населения (ПСН) по при чине болезней органов дыхания (БОД) являются важными индикаторами качества медицинской по мощи, включающей профилактику, диагностику и лечение заболеваний, динамическое наблюдение и реабилитацию больных.БОД стабильно занимают лидирующее место в структуре общей заболеваемости населения Российской Федерации (РФ), составив в 2014 г. 29 455 225 случаев (54,2 % всех заболеваний) у детей, 3 403 (33,2 %) -у подростков, 23 394 842 (13,6 %) -у взрослых. В структуре заболеваемости БОД в 2014 г. на пневмонию приходилось 199 035 случаев у детей, 17 727 -у подростков, 398 564 -у взрослых (Статис тическая форма № 12 «Сведения о числе забо леваний, зарегистрированных у пациентов, про живающих в районе обслуживания медицинской организации» (2014); Приказ Росстата «Об утвержде нии формы от 25.12.14 № 723»).Отмечается тенденция к росту частоты БОД. Особенно это касается пневмоний, хронической обструктивной болезни легких (ХОБЛ), бронхиаль ной астмы (БА) и т. п. В России ПСН по причине БОД занимают 5 е место среди основных причин смерти, однако они выше показателей в европейских странах, Великобритании и США.Целями настоящего исследования явились ана лиз ПСН России от БОД в 2014-2015 гг. и разработ ка мер, направленных на ее снижение. Материал и методы РезюмеПроведен анализ показателей смертности населения (ПСН) России от болезней органов дыхания (БОД) за 2014 г. и за январь сентябрь 2015 г. по данным официальной статистической информации Минздрава России и Росстата. В 2014 г. в России (без учета Крымского федерального округа) ПСН от БОД составил 54,5, в т. ч. от пневмоний -27,2 на 100 тыс. населения. Самые высокие ПСН от пневмоний в 2014 г. регистрировались в Дальневосточном федеральном округе (40,5 на 100 тыс.). В структуре смертности населения России по причине БОД в 2014 г. пневмония составляла 49,9 % всех случаев, хронические болезни нижних дыхательных путей -43,2 %, в т. ч. хроническая обструктивная болезнь легких -40,39 %, бронхиальная астма -2,3 %. За 9 мес. 2015 г. ПСН от БОД составил 52,9, от пневмоний -24,6, от гриппа и острых респираторных заболеваний -0,3 на 100 тыс. С пневмонией связано 46,5 % смертей от БОД. Ключевые слова: смертность населения, пневмония, грипп, профилактика.

Active hydrogen inhalation (H(H2O)m) has powerful antioxidant and antiapoptotic effects. In recent years, it has been used in a number of experimental and clinical studies.Aim. To study the safety and effectiveness of inhalation of the “active form of hydrogen” (AFV;(H(H2O)m)) in the rehabilitation program of coronavirus disease 2019 (COVID-19) survivors during the recovery period.Material and methods. This randomized controlled parallel prospective study included 60 COVID-19 survivors with post-COVID-19 syndrome (ICD-10: U09.9) during the recovery period, with clinical manifestations of chronic fatigue syndrome (CFS), who received standard therapy in accordance with the management protocol of patients with CFS (ICD-10: G93.3): physiotherapy and medication therapy with drugs containing magnesium, B vitamins and L-carnitine. The patients were divided into 2 groups. The experimental group (n=30) included patients who received hydrogen inhalation for 90 minutes every day during 10 days (SUISONIA hydrogen inhalation device, Japan). The control group (n=30) consisted of patients who received standard therapy. In both groups, patients were comparable in sex and mean age: in the experimental group — 53 (22; 70) years, in the control group — 51 (25; 70) years. Biological markers of systemic inflammation, oxygen transport, lactate metabolism, intrapulmonary shunting, 6-minute walk test, and vascular endothelial function were determined in all patients on the 1st and 10th days of follow-up.Results. In the experimental group, a decrease in following parameters was revealed: stiffness index (SI), from 8,8±1,8 to 6,8±1,5 (p<0,0001); ALT, from 24,0±12,7 to 20,22±10,61 U/L (p<0,001); venous blood lactate, from 2,5±0,8 to 1,5±1,0 mmol/L (p<0,001); capillary blood lactate, from 2,9±0,8 to 2,0±0,8 mmol/L (p<0,0001); estimated pulmonary shunt fraction (Qs/Qt, Berggren equation, 1942) from 8,98±5,7 to 5,34±3,2 (p<0,01); white blood cells, from 6,64±1,57 to 5,92±1,32 109/L. In addition, we revealed an increase in the refractive index (RI) from 46,67±13,26% to 63,32±13,44% (p<0,0001), minimum blood oxygen saturation (SpO2) from 92,25±2,9 to 94,25±1, 56% (p<0,05), direct bilirubin from 2,99±1,41 to 3,39±1,34 pmol/L (p<0,01), partial oxygen tension (PvO2) from 26,9±5,0 to 34,8±5,6 mm Hg (p<0,0001), venous oxygen saturation (SvO2) from 51,8±020,6 to 61,1±018,1% (p<0,05), partial capillary oxygen tension (PcO2) from 48,7±15,4 to 63,8±21,2 mm Hg (p<0,01), capillary oxygen saturation (ScO2) from 82,2±4,2 to 86,2±4,8% (p<0,01), distance in 6 minute walk test from 429±45,0 to 569±60 m.Conclusion. Inhalation therapy with H(H2O)m in the rehabilitation program of COVID-19 survivors during the recovery period is a safe and highly effective method. Manifestations of silent hypoxemia and endothelial dysfunction decreased, while exercise tolerance increased. As for laboratory tests, a decrease in the white blood cell count, estimated pulmonary shunt fraction and lactate content parameters was revealed.

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Оригинальные исследованияПроблема заболеваемости внебольничной пневмо нией (ВП) мужчин молодого возраста в организо ванных коллективах является исключительно акту альной как в мирное время, так и в периоды локальных войн и вооруженных конфликтов. Среди военнослужащих наибольший уровень заболевае мости ВП регистрируется у нового пополнения с двукратными сезонными подъемами, на которые приходится > 80 % всех случаев заболевания [1]. В период военных операций на Северном Кавказе РезюмеStreptococcus pneumoniaе занимает лидирующее место в этиологии внебольничной пневмонии (ВП) у взрослых, в связи с этим вакци нации уделяется особое место в профилактике ВП. Цель. Изучение клинико эпидемиологических особенностей пневмонии у мужчин 18-26 лет (n = 114), привитых 23 валентной полисахаридной пневмококковой вакциной Пневмо 23 (ППВ 23) (Sanofi Pasteur, Франция) в срок > 30 дней, и у невакцинированных (n = 151). Материалы и методы. Обследование включало анкетирование, клиническое иссле дование с оценкой симптомов в баллах, анализ крови, микробиологическое исследование мокроты, определение антигена капсулы S. pneumoniaе в моче методом иммунохроматографии с помощью теста Binax NOW Streptococcus pneumoniae (Alere Inc., США), иссле дование С реактивного белка количественным методом, микрофлоры носоглотки при помощи полимеразной цепной реакции, рентге нографию грудной клетки и пульсоксиметрию. Результаты. Установлено, что факторами риска пневмонии у мужчин являются низкие антропометрические показатели (масса тела, индекс массы тела, окружность грудной клетки), хронические болезни верхних дыхатель ных путей, перенесенные повторные пневмонии, отсутствие вакцинации против S. pneumoniaе и курение. Риск пневмонии в первые 100 дней службы у невакцинированных составлял 6,96 (95% ный доверительный интервал -3,39-14,58; p < 0,001) по сравнению с вакци нированными, а клинические проявления болезни были более тяжелыми. При вакцинации против S. pneumoniae сроки болезни сокра щались в среднем на 2,2 койко дня. S. SummaryStreptococcus pneumoniae is the leading pathogen of community acquired pneumonia (CAP) in adults. Therefore, vaccination is an important pre ventive measure against CAP. Methods. Clinical and epidemiological features of CAP were studied in young conscript soldiers (n = 114) aged 18 to 26 years who had been vaccinated using the 23 valent polysaccharide pneumococcal vaccine PPV23 (Sanofi Pasteur, France) in previous 30 days and in unvaccinated patients (n = 151). Clinical examination, laboratory blood tests, sputum microbiological examination, quantitative C reactive protein (CRP) measurement, molecular examination of nasopharyngeal smears using polymerase chain reaction (PCR), chest X ray and pulse oximetry were used. Pneumococcal antigen was determined in urine using immunochromatography (Binax NOW S. pneumoniae test, USA