The results presented here of creations and practical clinical application of innovation high - resolution rhythmocardiography (RCG). The RCG is intended for estimation of heart deregulations at different forms of a coronary artery disease, hypertension disease, cardiosurgery and other intervention treatments, at occupational diseases, clinical pharmacology and others by analyses of autonomic and humoral - metabolic regulation of the heart rate variability (HRV). The every variant of deregulation connected to pathogenesis of disease and influences to wave structure of HRV and may be used for intranosological diagnosis of disease and heart participation in it.

The article presents the study of 105 healthy young men 18 - 25 years. The aim of the study is to assess the state of autonomic regulation of sinus heart rhythm in young men: conscripts, students and cadets. Methods: the therapeutic examination, Vein Questionnaire, asthenic scale, hospital anxiety and depression scale HADS, and visual analogue pain scale, high - resolution rhythmocardiography at rest and mixed autonomic stress testing. Results: rhythmocardiography at rest showed longer RR - intervals in the group of cadets, which testifies to their greater physical aptitude. Among conscripts significantly lower heart rate variability and amplitude of respiratory arrhythmia at rest and in the Valsalva - Burker maneuver. Students showed more scores on the anxiety and depression scales, more symptoms of asthenia and autonomic dysfunction, headache and back pain. Cadets had no disorders of psycho - emotional and autonomic status, rhythmocardiography showed a high level of physical fitness and good adaptive capacity.

Carrying out medical rehabilitation after coronary artery bypass grafting in patients with coronary artery disease significantly improves the functional and adaptive parameters of the cardiorespiratory system in the process of rehabilitation.

Researches had studied in arrhythmology during 5 - 8 years for evaluation of high - resolution rhythmocardiography (RCG) possibilities for sinoatrial blockade differential diagnosis. 362 patients (pts) (270 with dysfunction of sinus node - DSN - and 92 with sick sinus syndrome - SSS). The differential signs were defined between at functional sinus breaches and morphological SSS. They have different autonomic background, DSN has more safe wave HRV structure, and at the SSS was define syndrome autonomic cardioneuropathy with stabilization of the HRV and life - dangerous arrhythmias, for example - atrial fibrillation. RCG shows hemodynamic meaning of every arrhythmic episode, that is very important in treatment.

Study results of assessing the effect of warm - up phenomenon on heart rate variability (HRV) in patients with angina pectoris are given in the article. Twenty males (aged 55,3±1,8 years) with stable angina pectoris underwent two consecutive treadmill-tests with 30 - min intervals. The most expressed changes were registered 30 min after provocation of myocardial ischemia which can be pathogenetically related with positive effect of the warm-up phenomenon on heart rate variability.

Purpose of the study. Based on a comprehensive assessment of the state of the cardiovascular system, establish predictors of acute heart failure (OSS) in patients with acute coronary syndrome (ACS). Materials and methods. The study included 73 patients diagnosed with ACS, mean age 63.4 ± 2.0. Of the number of hospitalized men were 56.2% (n = 41), women 43.8% (n = 32). The contribution of risk factors for cardiovascular diseases, indices of cardiac electrical activity, the structural and functional state of the myocardium, the severity of coronary artery stenosis from coronary angiography, markers of myocardial damage in the development of acute heart failure. Results of the study. Positive correlations between the development of OSH and duration of pain syndrome (r = 0.494, p <0.05), the interval between the onset of pain syndrome and the onset of antiplatelet therapy (r = 0.315, p <0.05), the degree of stenosis of coronary arteries in proximal (r = 0.455, p <0.05), signs of myocardial hypertrophy of the left ventricle (r = 0.504, p <0.05), the presence of dilatation of the left ventricular cavity (r = 0.552, p <0.05), ejection fraction (r =-0.399, p <0.05), the level of diastolic blood pressure (r =-0.217, p <0.005). An estimate of the relative risk of OCH development depending on the parameters of the studied factors was made. Reliable predictors of OCH development in the studied group of patients were the following factors: left ventricular hypertrophy of OR 1.6 (p <0.0001), intraventricular blockade - OP 2.3 (p <0.0017), troponin indicator of OR 5.4 ( p <0.0017), hemodynamically significant stenoses in the proximal regions of left coronary artery and right coronary artery OR 1.4 (p <0.05). The conclusion. Predictors of the risk of OSS development in the group of patients with ACS should be considered for the identification of high-risk groups for the timely decision-making of the tactics of patient management and the choice of adequate therapy.

The aim of the study was to study the state of health, the main classes of diseases in mono-, bi- and multinosology (polypathy) and stable combinations of leading nosological forms among the conductors of passenger cars of the South Ural railway at the Chelyabinsk station. In 102 men and 160 women aged 19 to 64 years, 100 % of cases were diagnosed with various diseases from I to XIX to international classification of diseases-10, where the leading place was occupied by persons with multinosology (85,3 % and 90,6 %). Analysis of nosological forms by classes of international classification of diseases - 10 in mono-, bi- and multinodularity showed that multinodularity men and women leading to the formation of the combined pathology are diseases of internal organs (IX, XI, IV and IX, X, IV classes to international classification of diseases-10, respectively). Methods of statistical analysis revealed the significant and sustainable combination of various forms of diseases that act as the underlying disease. It is shown that the first major diseases are most often combined with the second and third, represented, respectively, diseases IX, XIII and IV classes and diseases IX, IV and XI classes, confirming the idea of close etiopathogenetic relationship of endocrine and cardiovascular diseases and the interdependence of their effects in the development of multiple diseases.

One of the priorities in the world and in Russia is the prevalence of cardiovascular morbidity, mortality from it and disability of the able-bodied population. The increased disposition to the formation of cardiovascular diseases as complications of occupational diseases, or as a potentiating effect on the severity of clinical manifestations of self - emerging cardiac diseases has been proved in those working in contact with harmful production and professional factors. Etiopathogenetic relationship of cardiopathy in patients with occupational diseases with exposure to adverse factors of the working environment with standard methods of cardiac examination is difficult to prove. This is due to the lack of specific manifestations of the disease, especially in cases of intercurrent cardiovascular disease, leveling the border between cardiopathy, due to the influence of industrial and professional factors, and the part of it, which is associated with changes in age, non - professional diseases. It was initially assumed that the symptoms of differential diagnosis may be contained in the early dysregulatory manifestations of cardiovascular disease in occupational diseases. Harmful production factors contribute to the formation of peripheral autonomic dysregulation of the sinus node of the heart, which was determined by the study of heart rate variability.

In working in contact with harmful production and professional factors, an increased predisposition to the formation of cardiovascular diseases as a manifestation of comorbidity is proved. Etiopathogenetic relationship of cardiopathy in patients with occupational diseases with exposure to adverse factors of the working environment with standard methods of cardiac examination is difficult to prove. Probably, the symptoms of differential diagnosis can be detected in the early dysregulatory manifestations of cardiovascular disease in occupational diseases. Harmful production factors contribute to the formation of peripheral autonomic dysregulation of the sinus node of the heart, which was determined by the study of heart rate variability. With the help of electron microscopy, histological preparations of sinoatrial heart node were studied in patients with vibration disease, pneumoconiosis, chronic professional intoxication with manganese and fluorine compounds, who had Autonomous cardioneuropathy during their lifetime. Non - specific signs of the dystrophic process of ultrastructures in the sinus node of the heart, as a consequence of multi - organ damage in professional disease, were revealed.

Diseases of the heart and blood vessels occupy a leading place (47%) among all comorbidities in persons engaged in the extraction and enrichment of chrysotile asbestos. Based on the analysis of the dynamics of the respiratory and cardiovascular systems developed physiotherapy complexes for the treatment of cardiac arrhythmias in workers exposed to the dust of chrysotile asbestos. The proposed complexes cause improvement of functional parameters of respiratory and cardiovascular systems and can be used for non - drug therapy of patients with combined bronchopulmonary and cardiovascular pathology. The first complex is indicated in patients with chronic obstructive bronchitis in remission phase, having a pronounced electrical instability of the myocardium. The second treatment complex can be assigned to patients with chronic obstructive bronchitis in the acute phase, with signs of chronic pulmonary heart and concomitant cardiac dysrhythmias.

The article describes the features of the heart rate variability in COPD. 82 male patients with COPD and 37 paticipants without COPD aged 45-74 years were enrolled in the study. We analyzed the following parameters of heart rate variability: RR, SDNN, ARA, m, s, l, VLF %, LF %, HF % in patients with and without COPD. We found that parasympathetic influences reduced and humoral - metabolic regulation of the activity of the sinus node increased in COPD compared to participants without COPD. We detected very low-frequency waves with upward deviation from the main RCG waves corresponding to the bronchoobstructive syndrome in patients with COPD.

Purpose of research. To study the relationship of varying degrees of stenotic lesions of the coronary arteries (CA) with the results of myocardial perfusion scintigraphy in railway workers before and after percutaneous coronary intervention (PCI). Material and methods. The study included 130 patients with SC stenosis more than 50% of the lumen (according to the results of invasive coronary angiography), all underwent single - photon emission computed tomography (SPECT) of the myocardium according to the two - day Protocol "stress + rest”. When comparing the obtained data, the patients were divided into groups according to the degree of SC stenosis. Results. In 83 patients (group 1), SC stenosis was detected from 50 to 85%, in 47 patients (group 2) SC were stenosed by 85% or more. In ofect persistent defect of myocardial perfusion occurred in 32% of cases, reversible defect of perfusion (deterioration of perfusion in the sample with the load) - in 51%, deterioration of myocardial perfusion at rest (compared with the load) - in 17% of cases. In 56% of patients of the 1st group the deterioration of myocardial perfusion was revealed in the load test. In 60% of patients of group 2 myocardial perfusion disorders were persistent or worse than in the load test. Silent myocardial ischemia was diagnosed in 74% of patients of group 1 and 98% of patients of group 2. Every third patient with SMI conducted percutaneous coronary intervention (PCI), of whom half after PCI held SPECT of the myocardium. There were no cases of worsening myocardial perfusion in group 2 after PCI. In group 1, 6 cases out of 9 showed deterioration of myocardial perfusion or no effect of PCI. Conclusion. Stenotic lesions of KA less than 85% was associated with a higher incidence of deterioration of myocardial perfusion in the test with a load, whereas the CA stenosis more than 85% more likely to worsen the myocardial perfusion alone. All cases of worsening myocardial perfusion after PCI were observed in patients with SC stenosis less than 85%.

With the aim of studying the effect of disorders of carbohydrate and lipid - tion exchange and associated cardiovascular disease at the time of development of occupational fluorosis assessed the prevalence of this disease among workers in aluminum production. A significant dissociation of carbohydrate and lipid metabolism indices against the background of high prevalence of overweight, obesity, arterial hypertension in workers in contact with elevated concentrations of inorganic fluorine compounds was established in comparison with patients of the comparison group who are not exposed to toxic substances (р=0,003, t=3,159). The increase in fasting glycemia was revealed already with the work experience of up to 10 years, which can testify to the danger of early development of type 2 diabetes in workers of aluminum production and the need for timely preventive measures in this category of workers. At the same time, patients with occupational fluorosis had significantly higher prevalence of carbohydrate metabolism disorders compared to trained workers without occupational fluorosis (р=0,006). It was revealed that professional fluorosis develops significantly earlier in workers with concomitant cardiovascular disease and metabolic changes.

Due to the widespread introduction into current cardiology practice new visualization methods for transitory myocardial ischemia diagnosis, the feasibility routine exercise ECG tests is being questioned. The purpose of this investigation was to assess the diagnostic significance of submaximal ex-ercise ECG tests in 46 patients (55,1±8,5 years). The tests results were compared with coronaroangi-ography findings. Exercise tests sensitivity was 84.0%, specificity - 52.38%, positive predictive value - 67.74% and negative predictive value - 73.33%. Patients with positive tests had more mul-tivessel coronary artery disease (32,3% vs 6,7%, p=0,01) and significantly lower the level of exercise tolerance. Thus, in current practice exercise ECG tests remains a highly informative method of transitory myocardial ischemia diagnosis.

The study sample comprised 75 patients, median age 66 years (43 [57,3%] women), admitted within 24 hours after ischemic stroke onset. Breathing during sleep was monitored with an ambulatory device, which monitors nasal airflow and pulse oximetry. We selected patients at sleep apneaverified by respiratory monitoring to the first group (n=54) and patients without sleep - disordered breathing to the second group (n=21). Subgroup analysis found, among other things that a reverse dipper pattern does not change according to AHI. But the results indicate increased systolic BP load and low saturations associated with increased AHI in patients with stroke.

Introduction. Comorbid pathology significantly affects the prognosis and course of the underlying disease. One of the most well - known methods for assessing the long-term prognosis of polymorbid patients in clinical practice is the Charlson index. Objective: to evaluate the features of comorbidity, the Charlson comorbidity index in patients with acute coronary syndrome, taking into account sex and age. Materials and methods. The study included 1143 patients with acute coronary syndrome who received treatment at Cardiology Department No. 2 of the State Regional Clinical Hospital “Chelyabinsk Regional Clinical Hospital”. Depending on the concomitant pathology, patients are divided into the main classes of chronic non - infectious diseases - diseases of the circulatory system, diseases of the respiratory system, diseases of the endocrine system, diseases of the digestive system. In assessing comorbidity, patients were divided into two groups - up to 5 points and 5 points and higher in the main classes of chronic non - communicable diseases. Evaluation of two - year survival carried out by the method of Kaplan - Meier. Statistical analysis is performed using Microsoft Office applications and SPSS Statistics (version 20.0). Results. Male patients were hospitalized more often in comparison with women. On average one patient had two diseases from the whole group of patients. The most frequent concomitant diseases in all patients were diseases of the circulatory system, in second place - diseases of the endocrine system, in third place - diseases of the digestive system. Taking into account the clinical form of acute coronary syndrome and chronic non - communicable diseases, the average value of the Charlson comorbidity index is higher in patients with myocardial infarction compared with unstable angina. The Charlson comorbidity index above 5 points was observed more often in women, regardless of chronic non - infectious disease and the clinical form of ACS. Conclusions. Charlson's high comorbidity index is observed in all patients with diseases of the endocrine system and respiratory diseases, regardless of the clinical form of acute coronary syndrome, gender and age. Two - year survival of patients with acute coronary syndrome with diseases of the digestive system is lower than in combination with other chronic non - infectious diseases.

Chronic obstructive pulmonary disease (COPD) has a varying frequency and severity of exacer-bations. The fixed combination of tiotropium / olodaterol (TIO/OLO) demonstrate a reduction of risk moderate and severe exacerbations compare to tiotropium (TIO) in patients with COPD. Ti-otropium-olodaterol reduced the rate of exacerbations treated with systemic corticosteroids (SCS) alone, and reduced the rate of exacerbations treated with SCS and antibiotics compared with tiotropium.. There was no difference in the number of adverse events including major ad - verse cardiac events between TIO/OLO and tiotropium groups.

Results of researches presented here about special investigation of patients with cerebral tu - mors before and after radiation therapy. There was used high-resolution rhythmocardiography (RCG) with statistic and spectral analyses of a heart rate variability wave structure by apparatus - program complex CAP-RC-01-“Micor” (FD-02262005/2447-06). The analysis of RCGs showed a status deterioration in patients after the radiation therapy.

The aim of the study was to improve the results of treatment of long-term non-healing postoperative wounds by intra-tissue application of alpha interferon in patients with melanoma. Material and methods of research. For the treatment of long-term non - healing wounds of patients with melanoma (T1 - 2N0M0), a solution of alpha interferon was introduced into the bottom and along the edges of the wound (the main group-37 people), and in the control (n=35), traditional wound treatment was continued. clinical and cytological parameters of the wound process were evaluated. results. The marked differences in the terms of wound cleansing and granulation appearance are shown - a decrease of 3 and 2 times, respectively, in comparison with the control group. In the main group, the time of final wound healing is 2.5 times lower than in the control group. On the 3rd day in the main group cytologically revealed a pattern of marked decrease in the inflammatory process. After 10 days after the start of alpha-interferon, there was a positive dynamics of the wound process (a decrease in the number of leukocytes and lymphocytes and an increase in connective tissue cells and macrophages). On the 14th day after the start of treatment in the main group cytological picture reflects the activation of reparative processes. In a cytological study in the control group, the above changes occur at a later date, which corresponds to the clinical picture of the course of the wound process. Conclusions. The interstitial application of interferon for the treatment of long-termnon-healin gpost operative wounds of patients with skin melanoma cansignificantly shorten the healing time of the postoperative wound by stimulatingloca limmuneresponses, followed by the development of active granulations and rapid epithelization of the wound

The purpose of the work is to analyze the results of laboratory, microbiological and instrumental studies to search for screening criteria for the difference between aseptic and septic instability of endoprosthesis components after knee and hip joint arthroplasty. The materials contained 146 cases of revision arthroplasty of the knee and hip joints, performed under the conditions of Federal State Budgetary Institution Federal Center of Traumatology, Orthopedics and endoprosthesis replacement of Ministry of Health of the Russian Federation (Cheboksary) for a 3-year period, including cases of aseptic instability - 69, septic instability - 77. By methods for laboratory diagnosis were used to evaluate the blood levels of leukocytes, stab neutrophils, ESR, C - reactive protein (CRP), presepsin, procalcitonin, D-dimer, interleukin-6. Using ultrasound (ultrasonic) examination of the periprosthetic zone, the presence of fluid, granulation tissue in the joint cavity, altered lymph nodes was determined. Before the operation, the level of cytosis and cellular composition were determined in the synovial fluid; tissue bioptates, removed components of implants (after ULTRASONIC treatment) with sowing on the microflora were studied intraoperatively. Intraoperative tissue biopsies were used to make smears-prints on the glass, with gram staining, estimating the number of leukocytes and neutrophils in the field of vision. Results. Determination of indicators of ESR, presepsin and interleukin-6, the level of which goes beyond the generally recognized normal values in the presence of infection, can be recommended as a screening test in the diagnosis of the infectious nature of instability of the components of the endoprosthesis of large joints. The second stage of differential diagnosis of septic and aseptic instability can be the detection of lymphadenopathy. The third (final) stage of determining the infectious nature of instability is an invasive technique to determine the level of cytosis with the calculation of neutrophils in the synovial fluid.

Duodenomanometrical parameters and clinical results of active duodenal decompression on 65 operated patients with middle severe and severe biliary pancreatitis in 1st A-B phase, were studied. Revealed, that duodenal decompression provided duodenal pressure normalization towards 5 postoperative day, and decreased the frequency of necrotic pancreatitis infection and its widespread suppurative complications since 2-4 times.

In the study of the influence of polypropylene mesh on the state of tissues surrounding the spermatic cord, the implant was experimentally administered to 20 dogs. Inflammatory infiltration and adhesions in the implantation zone were not revealed, collagenogenesis is minimal. Fixation of the endoprosthesis to the peritoneum is rather weak. There was a continuous layer of mesothelium, its thickness was the same throughout the cut of the drug, the fenestration zones were not on the entire surface. At the same time, fibroplastic changes in the surrounding tissues were noted. Thus, the implant performs the frame function, being a matrix for the germination of its own fibrous fibers. Contact of the endoprosthesis with the elements of the spermatic cord, due to the layer of the peritoneum, is absent and, as a result, polypropylene mesh does not cause severe inflammatory reactions in the elements of the spermatic cord.

Purpose of the study. To study the effectiveness of bariatric surgeries for reproductive health of patients suffering from morbid obesity. Materials and methods. The medical history of 270 patients suffering from morbid obesity with a violation of the reproductive function was studied. Patients were divided into two groups: 181 of them women, 89 men with a BMI of 45-65 kg / m2. The age of the operated women was from 18 to 58 years old, 7 of them (3.9% of the group of 181 patients) were postmenopausal. Out of 174 patients of 45 - of childbearing age, they complained of a violation of the ovarian - menstrual function. The number of operated men was 89 people aged 18 to 60 years. In the postoperative period, hormone concentrations were studied: testosterone, estrogen, progesterone. The obtained data were compared with the original values. Results. The following signs of clinical improvement of the reproductive system were found: in 36 patients (92%) normalization of the cycle duration occurred. The following group of 31 (91%) patients noted a return to the normal duration of menstrual bleeding. In the last group, menorrhagia disappeared in 11 patients (79%).Treatment led to a normalization of the concentration of hormones studied. Estradiol indicators after a year of the postoperative period decreased to 462 ± 128.4 pmol / l (p <0.01). Similarly, testosterone levels fell to 0.89 ± 0.71 nmol / L (p <0.01). The progesterone content increased to 43 ± 8.3 nmol / l (p <0.01). In 89 male patients with morbid obesity, there was a violation of the background of sex hormones in the form of hypoterosteronemia to 5.34 ± 1.91 nmol / L., hypoprogesteronemia 0.12 ± 0.09 nmol / L and hyperestrogenemia 278 ± 53.8 Pkmol / l. In a laboratory study one year after the operation, the indices were as follows: 1.53 ± 0.92 nmol / L to 5.34 ± 1.91 nmol / L (p <0.01), as did progesterone with 0.12 ± 0, 09 nmol / l to 2.31 ± 0.83 nmol / l (p <0.01). It is important that the concentration of estradiol 278 ± 53.8 Pkmol / l decreased to 72.3 ± 21.2 Pkmol / l (p <0.01). Discussions. Treatment of patients with both sexes surgically led to a stable, positive result, improving the quality of life. Thanks to bariatric surgery, the patients returned to normal after a certain time, reproductive function was also restored. Reduction of visceral adipose tissue in the patients led to normalization of the hormonal background, which is proved by laboratory tests of blood. And as a consequence of the restoration of reproductive function. The conclusion. Surgical treatment in people with morbid obesity and metabolic syndrome gives good results. Modern surgery allows you to solve problems of infertility associated with excess fat tissue and a broken hormonal background.

Data of the etiology, pathogenesis and clinical picture of a rare dermatosis from the group of mucinosis are presented. The description is given of the typical clinical manifestations of scleromyxedema (Arndt - Gottron Syndrome) at 61-year-old patient who applied for consultation to the doctor-dermatologist. The diagnosis was confirmed by pathomorphological examination of the biopsy of the affected skin.

In order to develop a system of events, financing for development in the field of information technology in 2017 - 2018. A survey of 274 district doctors was conducted. 67,2 - from the heads of health facilities, 64,6 - in courses to upgrade the qualification, 52,7 - from professional journals, 47,1 - from monographs, textbooks. The main difficulties in obtaining information: 65 doctors indicated a lack of time to search for information, 43 - do not know where to find the necessary information on the Internet, 32 respondents indicated the absence of the Internet and 17 doctors indicated financial difficulties associated with the acquisition of information. Based on the research materials, a system of measures was developed to improve the information support of district doctors.

The article presents the results of two sociological studies carried out in 2014 and 2018 on self-assessment by doctors of the Sverdlovsk region of their social status and prestige of the profession t is established that most of them evaluate their social status as low, and only two-thirds consider their profession prestigious. The main way to increase the income of doctors is additional part-time work. According to the data obtained in the survey, its value by 2018 compared to 2014 has increased, but the ratio of average wages in the region has not changed - 1.2 and 1.3 times, respectively. Doctors attribute the increase in their social status to the increase in wages and pensions, as well as the strengthening of legal protection of their professional activities.

The objects of the study were erythrocytes and buccal epithelium cells. Hemolysis of erythrocytes and microelectrophoretic mobility of cells in artesian water supersaturated with nitrogen, oxygen, argon, carbon dioxide and oxygen were investigated. It was experimentally established that water with gas nanobubbles has a cytoprotective and membrane-resistant effect in the conditions of osmotic and toxic effects on both red blood cells and epithelial cells of the buccal epithelium, while having an activating effect on the cell, its compartments (core) and plasma membrane. The intensity of cell response depends on the nature of the gas phase nanomaterialy: nanomaterialy phase Ar activates cells to a lesser extent than the phase of air and O2. This dependence correlates with the solubility of gases. The activity is also due to the duration of water treatment.