Th e review-article presents modern ideas on characteristics of troponin proteins metabolism, which aff ect the results of analyzes. Much attention
is paid to mechanisms of troponins release from healthy and damaged due to various reasons cardiomyocytes. Actual information is provided regarding the
proteolytic degradation of troponins inside the cell and blood fl ow, which determine the diff erences between the results of troponin diagnosticum. Recent studies on non-invasive determination of troponins in urine and oral fluid have been reported. The signifi cance and possible causes of circadian fluctuations in cardiac troponin T concentration according to highly sensitive determination are discussed.

This review summarizes current ideas about such disease as acute disseminated encephalomyelitis. Epidemiology and immunopathogenetic mechanisms of acute brain demyelination development are studied in details. The aspects of diff erential diagnosis and pathogenetic treatment are shown.

Th ere is analysis of literature devoted to the study of health status of newborns who underwent perinatal hypoxia due to severe preeclampsia in mothers. Correlation of preeclampsia with fetus growth impairment, premature delivery, neonatal pathology, and delayed preeclampsia eff ect on intellectual development, on metabolism, and on cardiovascular system are discussed. Taking into consideration the role of vascular endothelial growth factor in preeclampsia formation and endothelial reparation, the interest to its level in newborns, its role in the formation of adaptive circulatory system reactions in newborns is obvious. In literature there is no general viewpoint on this issue, while in practical neonatology, the problem of reducing organs and tissues hypoxic damage degree in children of early neonatal period is still relevant.

The aim of the research is the study of clinical data and serum concentrations of MIP-1α, MIP-1β, RANTES, CCL11, IL-8 in children with acute obstructive
bronchitis.
Material and methods. We examined 53 children aged from 1 to 5 with acute obstructive bronchitis, including 25 children with episodic virus-induced
obstruction, 28 children with multi-trigger obstruction. Th e check group consisted of 13 practically healthy children compared with patients on the point of age and gender. Th e chemokines (MIP-1α, MIP-1β, RANTES, CCL11, IL-8) in blood serum were studied by enzyme-linked immunosorbent assay.
Results. While assessing the concentration of cytokines in peripheral blood serum in patients with acute obstructive bronchitis in general (n = 53 people), statistically higher level of MIP-1α, MIP-1β, RANTES, IL-8 was observed in comparison with the check group. It was found that MIP-1α concentration in group of children with multi-trigger obstruction is twice higher than in group of children with episodic virus-induced bronchi obstruction.
Conclusion. In children with acute obstructive bronchitis, there is statistically signifi cant increase in chemokines expression, initiating both Th 2 and Th 1 immune responses. A high level of MIP-1α can be considered an extra criterion for multi-trigger type of bronchial obstruction in infants

Th e aim of the research is to assess the eff ect of non-invasive lungs ventilation with positive airway pressure (CPAP - therapy) on the quality of life and vigilance in relation to systemic infl ammation in patients with chronic obstructive pulmonary disease combined with obstructive sleep apnea aft er exacerbation.
Material and methods. In 6-week open, prospective, comparative study, the eff ectiveness of CPAP therapy was evaluated in 65 patients aft er exacerbation of chronic obstructive pulmonary disease combined with obstructive sleep apnea with no need of long-term oxygen therapy.
Results. Aft er CPAP therapy, patients had the decrease in daytime sleepiness according to Epworth scale, as well as the improved life quality according to SF-36 questionnaire. Correlation between these indicators, duration of transient nocturnal hypoxemia, and markers of systemic infl ammation were determined.
Conclusion. CPAP therapy in patients with chronic obstructive pulmonary disease combined with obstructive sleep apnea aft er exacerbation is associated with the improvement of quality of life and wakefulness, which is associated with the decrease of systemic infl ammation

Th e aim of the research. Currently, comorbidity is considered to be a factor that mainly determines bronchial asthma (BA) treatment and its prognosis. Available literature data on autoimmune pathology of thyroid gland (TG) infl uence on clinical BA course are ambiguous and not numerous. Th erefore, the aim of our study was to clarify the infl uence of hypo- and hyperfunction of thyroid gland on asthma course and on immunological features of patients with asthma combined with thyroid pathology.
Material and methods. 60 patients were examined in 5 equal groups: with BA; with hypothyroidism; with thyrotoxicosis; with BA and hypothyroidism (BAH); wit BA and thyrotoxicosis (BAT). Patients were examined for concentration of total IgE in blood serum by two-site enzyme-linked immunosorbent assay (ISA), as well as for concentration of interleukins INF-γ, IL-1, IL-4, IL-6 in serum by solid-phase ISA.
Results. Exacerbations were more oft en observed in BAH group compared to BA group (6.2 ± 0.3 times / year compared to 4.5 ± 0.6 times / year, p = 0.04); remission duration was longer in group of isolated BA compared to the groups with combined pathology (8.6 ± 0.9 weeks in the BAG group and 9.3 ± 0.4 weeks in BAT group compared to 12.1 ± 0.8 weeks in BA group, p = 0.02 and p = 0.03, respectively). Th e serum IgE concentration was maximum in BAP group compared with the group of isolated AD and the BAG group (266.7 ± 17.3; 159.4 ± 3.8 and 122.5 ± 9.8 p = 0.01 and p = 0.01, respectively). Th e ratio of IL-4 / INF-γ was minimum in BAH group compared to BA and BAT groups (1.1 ± 0.1; 2.72 ± 0.04 and 2.73 ± 0.47 p = 0.01 and p = 0.01, respectively).
Conclusion. Both hyper- and hypo function worsen the course of AD. Hypothyroidism with AD reduces Th 2-polarization of immunity typical for asthma. Thyrotoxicosis with AD enhances the predominance of Th 2-dependent immune responses

The aim of the research is to describe the structure of psychological phenomena in patients with cystic fi brosis and in their parents at diff erent stages of the disease. Features and influence degree of individual psychological aspects on treatment duration, life quality and patients’ life expectancy are studied.
Material and methods. We observed 384 people during 4 years, including 100 patients and 284 parents: 68 adult patients from 18 to 60 years old, 30 males and 38 females; 32 children from 4 to 18 years old, 17 boys and 14 girls. From 284 parents, aged 22 to 64, 82 had individual consultations, 202 parents participated in group meetings. Individual, group, family consultations were given. Test, projective, bodily, and bridge techniques are used. In hospital, in office and remotely. In all 8 federal
districts of the Russian Federation.
Results. We observed patients at all stages of disease development, starting with diagnostics and including terminal, subterminal stages and the period after lung transplantation. Including 13 patients awaiting lung transplantation, 7 people aft er transplantation and 8 people in terminal stage who died at the age of 18 to 27 years. According to our observations, all psychological symptoms in patients with cystic fi brosis are typical to the same of various chronic diseases, except for two aspects: mental and external body structure changes. Especially signifi cant psychological aspects according to our observations are: suffi cient level of patient socialization and
no signifi cant restrictions for social life; no parents’ depression; no passing fear of child’s death among parents; adaptive image of personal future [1]; passing period of gender identification up to 15 years [2]; good level of body appropriation; no symptoms of psychological rejection of lungs aft er transplantation; no symptoms of signaling loss from transplanted lungs.
Conclusion The influence of psychological adaptation on the disease and its treatment has an eff ect on all stages of disease course. It serves either as a help or an obstacle in adherence to therapy, maintaining personal emotional viability while waiting for organ transplantation, early adaptation aft er transplantation, and even life expectancy. Therefore, as long as cystic fi brosis remains a disease that threatens infant’s early death and shortens life expectancy, psychological aspects will play a significant role in helping patients, their families and doctors. Th erefore, further research in clarifying the impact of these phenomena on patients’ life and treatment is important

Th e aim of the research. In Omsk region, as well as in many other regions of the country, there is an increase in the incidence of HIV infection, which aff ected the growth of tuberculosis in this group of patients. Th e aim of the research is to assess the structure of deceased patients in TB dispensary in the period from 2012 to 2015.
Material and methods. All cases of lethal outcome (n = 591) were analyzed in TB dispensary patients in the period from 2012 to 2015. Due to the existence of distribution that diff ers from normal one, descriptive statistics methods were applied with nonparametric criterion calculation - Kruskal-Wallis rank analysis of variance. Th e results were considered signifi cant at p <0.05.
Results. Annual increase in death rate among patients of the specialized institution was revealed. Th e dynamics showed an increase registering fatal outcomes in patients aged 20 to 50 years. Th e data based on gender option were not reliable. Th e dynamics showed a decrease in the number of patients with lung tissue destruction, however, the proportion of HIV infected patients increased. Among the deceased patients, tuberculosis of central nervous system and generalized tuberculosis were oft en registered, that aff ected the death cause. Moreover, there is an increase in the number of lethal outcomes associated with the development of malignant neoplasms and other causes.
Conclusion. Thus, the analysis of lethal cases of TB dispensary revealed the following: an increase of patients with HIV infection combined with tuberculosis, while a specifi c lesion was mostly generalized. Progression of immunosuppression was a common cause of death. In some cases, death was due to background pathology and malignant diseases.

The aim of the research is the analysis of epidemiology and clinical course of skin tuberculosis in Western Siberia.
Material and methods. To solve the set tasks, we studied the histories (00/3 y form) of patients with skin tuberculosis on the basis of SBHCI NSOR NKRTBD from 1931 to 2014 using a retrospective method of collecting statistical material. Methods of measurements ordering and grouping, data distribution, and structural analysis were applied for statistical processing of information.
Results. Th ere are 5 following forms in the structure of skin tuberculosis in Novosibirsk region: papulonecrotic (36 %), TB lupus (24 %), indurative erythema (20 %), verruciform TB (12 %) and scrofuloderma (8 %). Th e duration of patients’ dispensary registration lasted from 5 months to 71 years. In most cases this pathology was typical for females (84 %). Young people from 18 to 44 years old (40 %) took the leading position in age structure. In 36 % of cases, “skin tuberculosis” was diagnosed aft er histological examination of tissue biopsy materials and after cancellation of previously verifi ed clinical diagnosis (basal cell carcinoma, epidermal
cysts, sarcoidosis, calf fi broma, lipoma, Kaposi’s sarcoma, allergic dermatitis). Basal cell carcinoma, observed in 33.3 % of patients with skin tuberculosis, was the most common false clinical diagnosis. When evaluating false diagnostic cases, it was noted that erythema induratum of Bazin (33.3 %) was more oft en falsely recognized.
Conclusion. Th e research has shown that the structure of skin tuberculosis in Novosibirsk region included 5 forms of this disease

Th e aim of the research is to study the dynamics of prevalence of anxiety disorders in Krasnoyarsk city from 2006 to 2012, taking into account gender option; to assess correlation of anxiety and socio-demographic, biological, and behavioral risk factors for cardiovascular disease (CVD).
Material and methods. Th e survey involved 2 samplings, formed by random number generation of patients who were permanent residents of Krasnoyarsk city, aged 25-64 years in 2006 and 2012. Anxiety level was estimated according to HADS hospital scale.
Results. According to the analysis data of 2006, the level of anxiety “above the norm” was found in 38.1 % of males and 47.0 % of females (χ2 = 2.3, p = 0.131). In 2012, an increased level of anxiety was registered in every fourth male (28.4 %) and every second female (50.6 %, χ2 = 52.0, p0.05) out of 1,120 outpatients. Significant homogeneous correlation of anxiety with age and moderate alcohol consumption were found among males. Among females, similar correlation of anxiety and age, arterial hypertension (AH), as well as low duration of sleep was observed. A multifactor regression analysis was carried out. It established signifi cant combined effect of low sleep duration, moderate alcohol consumption and age option on possibility of clinical anxiety development among females.
Conclusion. For the period from 2006 to 2012 in the territory of Krasnoyarsk city there was a decrease tendency in anxiety disorders frequency among males; among females, the prevalence of anxiety has not changed signifi cantly and still remains at a high level. In the age group of 25-64-year-olds, the gender factor significantly determines the influence of sleep duration, moderate alcohol consumption and age option on anxiety development.

The aim of the research is to study possible causes of territorial diff erences in the incidence of type 2 diabetes among the adult population of the Republic of Sakha (Yakutia).
Material and methods. For analysis, we used statistical data from the Yakut Republic Medical Information and Analytical Center of the Ministry of Healthcare and the territorial body of the Federal State Statistics Service of the Republic of Sakha (Yakutia) for the period of 2003-2017. To grade fl uctuations levels of dynamic series, the periods were enlarged with calculation of average period. Using correlation and cluster analysis, we studied relationship between type 2 diabetes incidence and age-gender, ethnic structure, health resources, obesity incidence among the inhabitants of Yakutia municipal units.
Results. According to 2017 data, the prevalence of type 2 diabetes among adult population of the Republic of Sakha (Yakutia) was 40.3 (95% CI: 39.5-40.5) per 1000 population, the incidence was 2.2 (95% CI: 2.0 -2.3), respectively. The dynamics of prevalence indicators is estimated as statistically signifi cant increase in prevalence of type 2 diabetes (type 2 DM) among the population of the republic.
Conclusion. Along with the work on diabetes detection, more active measures are needed to increase physical activity and to change eating habits of the population, that in general will improve health state of each individual, including delay or prevention of type 2 diabetes development.

Th e aim of the research is to identify the occurrence frequency of polymorphic variant rs2476601 of PTPN22 gene, to assess its relationship with peculiarities of clinical myasthenia course in patients living in Krasnoyarsk Territory.
Material and methods. 50 patients of both genders aged 19 to 80 years (46.2 ± 1.59 years) were examined. Th e check group included 170 people (94 males, 78 females) with no other autoimmune, neuromuscular pathologies, or diseases of thyroid gland, adrenal glands, diabetes, bronchial asthma. Th e determination of SN rs2476601 form of PTPN22 gene was carried out by means of PCR-RT.
Results. Th e carriage frequency of T allele in PTPN22 gene in the main group was 14%, in the check group it was 9.7% (p = 0.19, OR 1.57 95%, CI 0.8-3.07). The incidence of homozygous TT genotype in the main group is 4%, in the check group it was 0% (OR 17.58; 95% CI 0.83-37.2), p <0.05. Carriage of T allele in PTPN22 gene in patients is 16.8 times (OR 16.8; 95% CI 2-144; p = 0.03) increases the risk of disease developing before the age of 44. In carriers of T allele in PTPN22 gene crises in history were registered 36% (OR 2.9; 95% CI 0.9-7.76; p = 0.02) more oft en; patients were disabled from group I-II (OR 5.04; 95% 1.07-20.8; p = 0.04) 5 times more oft en compared with patients carrying C allele. The antibody titer to AxP is 16.2 nmol / L [12.3; 18.4], i.e. 1.75 times higher (p = 0.016) than carriers of the C
allele. A signifi cant predominance of patients requiring cytostatics (p = 0.03) and IVIg (p = 0.031) was revealed, that may be an indicator of myasthenia severity course in patients carrying T allele of PTPN22 gene. Myasthenia severity in patients carrying ONG rs2476601 of PTPN22 gene was confi rmed by high values of decrement test for ENMG (higher by 24.8%). In patients carrying T allele of PTPN22 gene, a predominance of patients requiring appointment of cytostatics (p = 0.03) and IVIg (p = 0.031) was revealed.
Conclusion. SN rs2476601 form of PTPN22 gene in patients with myasthenia increases the risk of developing myasthenia up to 44 (OS16.8; 95% CI 2-144; p = 0.03) with severe generalized course and a predominant number of crises in history (OS 2.9; 95% CI 0.9-7.76; p = 0.02) with the need for more frequent administration of cytostatics and IVIg

The aim of the research is investigation of morphological characteristics of experimental B-16 melanoma cells in C57 / BL6 mice-line on a check diet (nutrition is unlimited) and on a diet with 30 % calorie limitation.
Material and methods. C57 / BL6 mice-lines were subinoculated with 5x105 B-16 melanoma cells in 0.5 ml of Hanks solution subcutaneously. Aft er tumor
transplantation, the check group received basic diet (ad libitum); the experimental group had limiting calorie intake in 70 % of the diet, satisfying physiological needs of animals. The material was taken on the 22nd day of the development of tumor process. Cytomorphometric studies of histological preparations of tumor tissue materials included measuring the area of tumor cells and their nuclei with calculation of nuclear-cytoplasmic ratio, measurement of numerical density and mitotic activity of tumor cells (mitotic index).
Results. In case of calorie limitation of nutrition by 30 % of the diet corresponding to physiological needs, there was a decrease in mitotic activity of tumor cells and a decrease in their number per tumor unit area compared to tumor cells of experimental melanoma of animals fed without limitation of calories intake.
Conclusion. Th e revealed patterns of mitotic regime and numerical density of cells indicate inhibition of tumor progression while limiting calories intake in
experimental model of B-16 melanoma.

The aim of the research is to study the eff ect of mediastinal lymphatic dissection volume on postoperative period in patients with lung cancer.
Material and methods. Th e results of surgical treatment of 180 patients with non-small cell lung cancer were analyzed. 102 patients had systematic mediastinal bilateral lymphatic dissection; minimum volume of systematic mediastinal lymphatic dissection was performed in 78 cases. In postoperative period, blood loss volume, amount of the removed through pleural drainages and the exudation period, number and nature of postoperative complications were evaluated.
Results. The results’ analysis revealed statistically insignifi cant increase in the volume and duration of pleural drainage exudation in the group with systematic bilateral mediastinal lymphatic dissection. When analyzing postoperative complications in the group with systematic bilateral lymphatic dissection, surgical complications developed in 7.8 % in the group with minimal volume of lymphatic dissection in 3.8 % of cases. Th e overall mortality rate was 2.2 %.
Conclusion. It has been shown that implementation of systematic bilateral lymphatic dissection introduces certain peculiarities into postoperative period in patients after surgical treatment of lung cancer, but this does not cause life-threatening complications.

The aim of the research is analysis of reconstructive surgical treatment of strictures of lower and middle third of the ureter eff ectiveness, using Boari method, as well as construction of prognostic model of relapse probability due to various factors.
Material and methods. A prospective study was carried out in 20 patients whose diagnosis was stricture of lower and middle third of the ureter who underwent treatment in the period of 2016-2018 in urology department of RSBIHC ICCH No. 1. All patients underwent reconstructive surgery by means of Boari method. The average patients’ age was 59.4 (± 15.7). Th e harmonic mean duration of the disease was 31.5, while the median was 365 (31; 547) days. Sexual distribution was statistically steady: 7 (35 %) males and 13 (65 %) females (p = 0.270). Strictures of lower third of the ureter were detected in 19 (95 %) patients, and the middle one - in 1 (5 %) patient (p = 0,0006). Anamnestic search revealed probable causes of stricture: chronic ureteritis - 3 (15 %) patients, intestinal operations - 5 (25 %) patients, gynecological operations - 3 (15 %) patients, urological interventions - 8 (40 %) patients, radiation therapy - 1 (5 %) patient.
Results. Boari reconstructive surgery was successful in 15 (75 %) patients. Based on multivariate logistic regression analysis, it was found that if a patient has diabetes, the relapse probability aft er Boari surgery increases by 2.4 times.
Conclusion. Ureter reconstruction according to Boari technique in most cases allows getting rid of ureterohydronephrosis, regardless of the cause, disease duration and somatic status of the patient. Patients with concomitant diabetes require special attention of clinician in connection with the proven negative impact of this disease on the outcome of treatment

The article gives basic information about etiology, epidemiology, morphology, clinical types of systemic granulomatosis-sarcoidosis course. The presented
clinical case of acute course of sarcoidosis, Heerfordt-Waldenstrom syndrome, reflects difficulties in diagnosing the generalized sarcoidosis course, features of
diagnostics and treatment of such patients.