This article is devoted to 130th anniversary and publication of academic writings of Alexander Puchkov — Doctor of Med. Sci., Honored Doctor of Russian Soviet Federative Socialist Republic. He was permanent leader of Moscow Ambulance Station from 1923 to 1952. Data presented in Puchkov’s articles were used to compare performance of work of Moscow ambulance in it’s formative period and our days. This article shows specificities, characteristics and environment of Moscow ambulance in 1926 and 2016. For example, the number of brigades had increased by 67,9 times (from 15 in 1926 to 1018 in 2016). Average time of arrival to accident is 10-12 minutes is same for 1926 and 2016. The proportion of pediatric interventions (from birth to 15 years old) had increased. Analysis of indicators allows to look at development of Moscow ambulance station from it’s formative period to our days. Fundamental principles laid down by A. Puchkov last in many cases in work of Moscow Ambulance in our days. Ambulance doctors continue to provide medical assistance promptly in the framework spelt out more than 90 years ago.

The purpose of the research was studying of features of clinic, course, medical tactics and outcomes of infectious endocarditis in 25 patients suffering from “salt” drug addiction. Materials and methods: we examined 25 patients with infectious endocarditis, the host “salt” intravenously. To verify the diagnosis in addition to standard studies of blood, urine, sputum, was performed transthoracic EchoCG, x-ray study of the chest (twice, at admission and before discharge of the patient from the hospital). For certain indications used diagnostic fiber-optic bronchoscopy and computed tomography of the lungs, consulted a neurologist, cardiologist, infectious disease. Results and discussion: 84% of patients diagnosed with HIV. The acute course of the disease and presence of accompanying pathology of organs and systems was observed in the majority of patients, with a predominance of neurological changes (88%). Typical meager cardiac symptoms (noise in the region of the heart were heard in 12% of patients), frequent lung as a result of pulmonary embolism (64%). Identified infectious agents (in most cases Staphylococcus aureus -32%), the defeat of the heart valves according to the EchoCG (in 72% of patients vegetation on tricuspid valve with varying degrees of regurgitation). The choice of antimicrobial medicines was optimized (cephalosporins I-III generation, aminoglycosides, vancomycin). The positive outcome of a disease was observed in 84% of patients, mortality was 16%. Conclusions: for infectious endocarditis injecting a “salt” of the drug revealed the following: acute disease; pronounced General symptoms, atypical clinical picture, involvement of the heart valves, lungs result in pulmonary embolism, early development of multiple organ failure, high mortality. In comparison with injection drug users who inject other drugs, “salt” addicts are characterized by the frequent development of infectious endocarditis, which is apparently connected with the influence of “salt” on the immune system and joining the bright and varied neurological symptoms.

Objective: to determine the frequency of alleles and genotypes of gene polymorphism PON1 — Gln192Arg A> G and ApoC3 — 3238C> G in women with coronary heart disease (CHD) and diabetes mellitus type 2 (DM 2) and hypothyroidism, to determine the odds ratio (OR) and
relative risk (RR) of CHD depending on the genetic characteristics in this group of patients. Material and Methods: the studied 108 patients with stable angina II-III functional class, 35 of which have a combination of type 2 diabetes and hypothyroidism — 1 comparison group,
36 women were with type 2 diabetes — 2 comparison group, 37 women with hypothyroidism — Group 3 comparison. The control group included 42 patients with stable angina II-III functional class without pathology of carbohydrate metabolism and the normal function of the thyroid
gland. In addition, to eliminate the influence of hypothyroidism factor 4 comparison group was created (1 + 2 group), to avoid the influence of diabetes factor — 5 comparison group (1 + 3 group). Determined PON1 polymorphisms — Gln192Arg A> G and ApoC3 — 3238C> G by
polymerase chain reaction.

Results: in women with coronary heart disease combined with type 2 diabetes is more common homozygous carriers of AA genotype polymorphism Gln192Arg PON1 (p = 0.03 for group 2, P = 0.04 for the 4 groups, respectively), while OR was 9.8 ( 95% CI,
1,15-84,8) 2 group and 7.5 (95% CI, 0,9-60,4) for group 4, respectively. OR CHD was 2.11 (95% CI, 1.4-3.0) and 1.54 (95% CI, 1,2-1,95) 2 and group 4, respectively. In patients with coronary artery disease combined with type 2 diabetes showed more frequent carriers of the allele C (p = 0.02) and CG genotype polymorphism S3238G APOC3 (p = 0.01). OR 2 groups was 2.8 (95% CI, 1,0-7,8) for 4 groups — 2.7 (95% CI, 1,18-6,4). OR for CHD patients 4 groups was 1.5 (95% CI, 1,0-2,3).

Conclusion: the association of genotype polymorphisms Gln192Arg PON1 and S3238G APOC3 in women with coronary heart disease in the background with type 2 diabetes. The presence of the homozygous genotype PON1-AA increases the risk of coronary heart disease in women with type 2 diabetes by 1.5-2 times, carriage heterozygous genotype ApoC3-CG increases the risk of coronary heart disease 1.5 times. Association of polymorphisms with hypothyroidism submitted against the background of coronary heart disease has been identified.

Anthropogenic impact leads not only to contamination of environmental components, but also to the negative impact on the human body, especially blood is very sensitive to the effects of unfavorable environmental factors. Therefore, the goal of the work is to study the influence of the ethylmethylhydroxypyrine malate on the absolute quantity of erythrocyte islets in the condition of sulfur dioxides impact on the different stages of ontogeny. 90 white mongrel male rats were used as materials and methods in the study, from which 3 groups of species were formed. Rats of different ages were examined for the experiment. For 5 days they were kept in a hermetically closed seeding chamber for the same period of time and under the same conditions as the experimental ones, but without the presence of a sulfur-containing gas. Natural industrial sulfur-containing gas was applied as the toxic agent of the Astrakhan gas-condensate field. According to the studies, it was found that the use of the ethylmethylhydroxypyrine malate against the background of intoxication gaseous sulfur pollutants leads to a relative
normalization of the proliferation and maturation of erythrocytes at all stages of the studied ontogeny. This allows us to consider this preparation as an effective means of neutralizing the negative effects of this toxicants influence. Also it was found that the young animals have a positive effect of the ethylmethylhydroxypyrine malate, and the old animals do not show a statistically significant effect. Therefore, the presented results indicate the possibility of increasing the body’s resistance to chemical components of gas with the help of antihypoxic and antioxidant action of the ethylmethylhydroxypyrine malate

Objective: due to the high prevalence of smoking among russians, as well as the important role of the enzymes containing zinc during the formation of pathogenic responses in chronic obstructive lung disease, the aim of the work was to study the concentrations of zinc pools in smokers and nonsmokers.
Materials and Methods: The distribution of the groups of smokers, smokers and non-smokers (with and without in the near surroundings of smokers) was made after the analysis of a questionnaire, which included questions on the presence of chronic diseases, the status and experience of smoking, the number of daily cigarettes smoked and the fact inhalation second-hand smoke in the street, home or work; vital capacity was measured with a dry portable spirometer, measuring the concentration of zinc produced by calorimetry. Statistical processing is performed using Microsoft Excel 2010 and Statistica 6.0 software and the use of H-Kruskal-Wallis test. Results: It was shown that the lowest concentration of total and free zinc active in
tobacco smoking. Statistically significant differences (p = 0.0001) in the level of general, free and bound zinc in smokers, non-smokers and former smokers, passive, and the lack of significant differences in the overall level of zinc in individuals with and without smoking in the immediate vicinity. An inverse correlation between smoking index and concentrations of total and bound zinc.

Conclusion: The total concentration of zinc and its pools
can be regarded as an indicator of the effect of smoking on the body.

Aim. Assessment of biological age and the rate of aging of patients with undifferentiated connective tissue dysplasia.

Materials and methods. 89 women with 6 or more undifferentiated connective tissue dysplasia phenes and 42 women of the control group with less than 6 undifferentiated connective tissue dysplasia phenes had their biological age determined using the method of V.P. Voitenko. — Tokar A.V. — Chebotarev D.F. (year 1984). External phenotypic signs of undifferentiated connective tissue dysplasia were evaluated during general examination, anthropometry, heart and abdominal organs ultrasonography using «Hitachi F37» device. After calculating biological age, expected biological age was determined using the following formula: eBA = 0,581хCA+17,24 where CA is calendar age. Then the aging rate coefficient was defined (ARC = BA/eBA), which illustrates the number of times the biological age of the examinee is greater or less than expected biological age of her peers.

Results. Patients of the main group had a gap (about 8 years) between calendar age and biological age, a positive difference between biological age and expected biological age, as well as aging rate coefficient > 1.

Conclusions. Women with undifferentiated connective tissue dysplasia have accelerated aging mechanisms.

Goal. Determination of the relationship between the concentration of VAP-1 and the clinical and morphological parameters of the structural reorganization of the renal tissue.

Materials and methods. The study included 80 patients with primary chronic glomerulonephritis in the period of exacerbation. The predominant morphological variants were IgA-nephropathy (42 patients) and focal-segmental glomerulosclerosis (16 patients). All patients underwent general clinical examination, with the establishment of stages of CKD, and nephrobiopsy was performed. Based on the results of morphological analysis, the parameters of remodeling of renal tissue were taken into account. A blood sample was taken to study the concentration of Vascular Adhesion-
1 protein (VAP-1). Nine months after the patients were admitted to the study and treated according to standard therapy, several indicators were re-recorded.

Results. It was found that the age, duration of the disease, urea, proteinuria of a single and a daily portion of urine were inversely proportional to the level of VAP-1. Moreover, a signifi cant difference was found between the groups of patients ranked by median VAP-1, by prevalence in the group of
patients with higher VAP-1 concentration of nephritic syndrome, IgA nephropathy, cases with mesangium expansion, mesangial and endothelial hypercellularity, endothelial swelling, IgA immune deposits In mesangium and capillary loops.

Conclusion. As a result of the study, the prognostic signifi cance of VAP-1 concentration in patients with chronic glomerulonephritis was demonstrated. The formulas and the table of risk stratifi cation for the development of morphological reconstruction of kidney tissue are presented. It was found that the concentration of VAP-1 is statistically signifi cantly increased in the early stages of glomerulonephritis, with the predominance of infl ammatory and proliferative changes. At the stage of fi brous restructuring of renal tissue, there was no reliable difference. When analyzing the material obtained, it was concluded that it is necessary to determine the level of VAP-1 in patients with chronic glomerulonephritis, especially IgA-nephropathy, in the early stages of the disease, in order to predict its course.

The basic theory of the pathogenesis of inflammatory bowel disease (IBD) is currently considered a violation of immune activation and immune response against its own antigens to the intestinal flora in genetically predisposed individuals. “The gold standard” diagnosis of UC is colonoscopy with biopsy morphological study. Due to the invasiveness, complexity in the preparing and conducting, the high cost of endoscopy there is a need in the application of laboratory biomarkers UC, with which you can select a group of persons subject to an in-depth examination of the instrumental. The
review highlights the modern view of the pathogenesis of the disease, the ability to use a variety of laboratory biomarkers in the diagnosis of UC, for monitoring the effectiveness of the therapy, as predictors of severe course of UC, therapeutic response prediction and early detection of recurrence

Purpose of the study. Examine gender characteristics of lesion of precerebral arteries and their relationship with renal dysfunction in patients with chronic glomerulonephritis at predialysis stage of the disease.Material and methods.The study included 306 patients with chronic glomerulonephritis aged 17 to 71 years. Group 1 — male (n = 210), group 2 — women (n = 96). All patients, in addition to general clinical testing methods, had noninvasive assessment of structural changes in precerebral arteries. Results and conclusion. In patients with chronic glomerulonephritis, structural changes in precerebral arteries are detected at predialysis stage and do not showsignificant difference depending on gender. Male individuals had
hypoproteinemia, subnephrotic proteinuria, clinically relevant hypertriglyceridemia and higher rates of precerebral arteries’ thickness, compared to female patients. At the same time, female individuals showed significantly worse parameters of peripheral blood and renal function, compared to male patients. Negative correlation between glomerular filtration rate and thickness of common and internal carotid artery was found both in general group and in individual male group. The results of the study suggest that in order to prevent vascular complications in the future, patients with chronic glomerulonephritis on the pre-dialysis stage of CKD need to study carotid arteries, as well as in a comprehensive analysis of renal function

In the course of intensive therapy for central venous catheterization is a high risk of mechanical complications. The probability of damage to the nervus vagus in the catheterization internal jugular vein is very high, but the lack of vigilance of medical personnel and damage to the knowledge of the clinical picture does not allow prevent and register this type of complication. The purpose of research — the use of ultrasound in the diagnosis of the location of the n.vagus to prevent damage during puncture and catheterization IJV. In the process of intensive care at various emergencies in 100 children aged from 2 weeks to 17 years, conducted IJV ultrasound to identify anatomic relationships of the internal jugular vein, carotid artery and n.vagus . At 30 children ultrasound preceded IJV catheterization (static method) and then selecting the most safe vascular access to the IJV. Dynamic method of ultrasound guidance during IJV catheterization was performed аt 26 саses. We made a retrospective analysis of a series of stationary cards of patients in the intensive care ward with suspected damage to the vagus nerve as a result of catheterization (attempts) IJV. Results — when the preliminary ultrasound
neurovascular bundle all the children had rendered the vagus nerve. Selection of the optimal, secure access to the IJV on the basis of static methods and ultrasound assisted of catheterization allowed to successfully catheterize IJV and avoided mechanical complications, including damage of the nervus vagus. Retrospective analysis of stationary cards of patients allow to think about the presence of such complications are not recorded according to medical records.

In the article the clinical observation of a rare combination of ulcerative colitis with von Willebrand’s disease in 33-year-old patient. Comorbidity require specific types of the disease, taking into account the peculiarities of its course, monitoring the main hematological parameters for the prevention of massive blood loss during the treatment of ulcerative colitis, helped damage colonic mucosa (Activity II by Schroeder) and the possibility of spontaneous gastrointestinal bleeding. The article demonstrated features of the diagnostic and treatment process, described
diagnosis, assessment of severity of main and concomitant diseases, as well as the dynamics of the patient’s condition during treatment. The choice of treatment tactics was complicated because of the multi-directional impact of both diseases on hemostasis, but the definition of the
main hematological parameters allowed to forecast a stable course and not to use drug therapy of von Willebrand disease. The organization of the medical process in ulcerative colitis, associated with von Willebrand’s disease, a comprehensive approach that includes Standard treatment for ulcerative colitis srednetyazhёlogo flow was used: systemic glucocorticosteroids mesalazine sulfosalazin locally and orally, as well as other products in accordance with current clinical guidelines. Close cooperation between two specialists (gastroenterologist and hematologist) in charge of one patient allowed to achieve clinical and laboratory remission

The publication presents a clinical case of hereditary hemorrhagic telangiectasia in a woman of 75 years. In the first part of the article, literature data on the incidence and features of Rundu-Osler-Weber disease are presented, modern diagnostic principles based on the Curaçao criteria
(1999) are reviewed, which allow to define the diagnosis as “reliable”, with three criteria, “probable” — with Two criteria (most often the family nature of the disease and spontaneous nasal bleeding) and “doubtful”, with one criterion of the above. Methods of treating hereditary
hemorrhagic telangiectasia are considered, the authors draw attention to the fact that the choice of the method of therapy depends on the degree of damage to the target organ. Symptomatic methods of treatment suggest slight relief for patients, but hereditary hemorrhagic telangiectasia
remains a progressive, severe and potentially life-threatening pathology. The second part of the article presents a clinical observation with late verification of the patient’s P., 75 years of age. The data of medical history, including anamnesis, catamnesis, photographs of macro- and
micro-preparations are given. The presented observation illustrates the severe course of hereditary hemorrhagic telangiectasia, manifested by severe hemorrhagic syndrome, due to vascular malformations, the gradual involvement of internal organs in the pathological process with the formation of arteriovenous shunts, aneurysms. The manifestation of hereditary hemorrhagic telangiectasia in the described clinical case was manifested as abundant nasal, uterine bleeding, skin telangiectasias, followed by involvement in the pathological process of the lungs, organs of the gastrointestinal tract. The authors were able to observe a variant of the course and manifestation of visceral vascular anomalies. This clinical case illustrates the need to take into account the totality of all the symptoms of the disease in hereditary hemorrhagic telangiectasia for early detection of the disease, dynamic observation of the patient and the timely administration of therapy

The article is devoted to the problem of central precocious puberty — one of the orphan diseases. The modern classification, etiopathogenesis, clinic, diagnosis and differential diagnosis, treatment, prognosis and prevention of the disease are presented. Precocious puberty is much more common in girls than in boys, and the most common pathogenetic option is idiopathic. The pathogenesis is the early activation of the hypothalamic-pituitarysex gland axis, which causes the development of puberty clinically similar to the physiological one. Excess sex hormones lead to the closure of the epiphyses and low final growth. The key diagnostic measure is a test with gonadotropin-releasing hormone, as well as visualizing studies of the brain, adrenals and gonads. The main hormonal criterion for the central form of precocious puberty is a significant increase in luteinizing hormone in response to stimulation with luliberin — more than 10 mU/ml. Gonadotropin-releasing hormone analogues are used for the treatment of central precocious puberty, the continuous injection of which blocks receptors on gonadotropic cells of the pituitary gland, which causes a decrease in the secretion of gonadotropins and, accordingly, sex steroids. Regress of secondary sexual characteristics is observed after 3 months of therapy, decrease
in the rate of growth to normal values after 1-1,5 years, decrease in the ratio of bone age to chronological, which improves the growth forecast — by the end of the 3rd year of treatment. Therapy is continued until the onset of puberty, as its cessation causes the resumption of the disease. Treatment is most effective at an early onset, when the bone age does not exceed 12 years. The forecast is favorable in most cases