In the postgenome era, clinical medicine is characterized by development of personalized genotypingbased approach to treatment. Clinical stud ies published in 2013–2014 and approved by FDA (Food and Drug Administration, USA) have been analyzed in this review. These include 8 clini cal studies on hematology / oncology, 3 clinical studies on endocrinology, 2 clinical studies on gastroenterology, infection diseases, respiratory dis eases, cardiology, gynecology / obstetrics, neurology and novel diagnostic procedures each and one clinical study on psychiatrics. The analysis demonstrated further development of evidencebased medicine that provided personalized genotypingbased therapy.

Severe communityacquired pneumonia (CAP) is a particular type of the disease with high mortality and healthcare cost. The need in such practi cal guidelines is due to a high frequency of misdiagnosis of severe CAP and frequent cases of inappropriate administration of antibiotics in Russian Federation. These guidelines run epidemiology and etiology of severe CAP including current findings of antibacterial resistance of pathogens; pathogenesis; diagnosis; general management of patients including antibacterial and nonantibacterial treatment and respiratory support; and prevention. Adherence of practitioners to this document is expected to improve outcomes of severe CAP in adults. These guidelines could underlie local clinical guidelines, protocols and medical care standards of management of adult patients with severe CAP in RF.

Aim. The aim of this study was an analysis of published data in order to develop evidencebased clinical recommendations on chemotherapy of newly diagnosed pulmonary tuberculosis with high primary and secondary multidrug resistance.

Methods. Metaanalysis and systematic review was carried out of all published randomized clinical trials on this topic.

Results. Several experimental, bacteriological and clinical trials, which had performed in 1998–2003, showed a high efficacy of fluoroquinolones in patients with newly diagnosed pulmonary tuberculosis; a new effective chemotherapeutic regimen for regions with high rate of multidrug resistant tuberculosis was developed and could be administered before results of drug resistance tests are obtained. This regimen consisted of of isoniazid, rifampicin, pyrazynamide, etambutol, fluoroquinolone and kanamycin or amikacin; it was welltolerated and did not increase a rate of antibacteri al resistance of Mycobacterium tuberculosis.

Conclusion. Given primary (5–10 %) and secondary (15–30 %) multidrug resistance of Mycobacterium tuberculosis in Russian Federation, the most effective chemotherapeutic regimen for patients with pulmonary tuberculosis is the combination of isoniazid, rifampicin, pyrazynamide, etam butol, fluoroquinolone and kanamycin or amikacin. A proven microbiological method for individual control of drug sensitivity of M.tuberculosis and response to chemotherapy is culturing of sputum or another biomaterial on solid or liquid media using the BACTEC MGIT equipment.

Interstitial lung disease in elderly are one of the most important issues of geriatric pneumology. Among them, idiopathic pulmonary fibrosis (IPF) is the most important clinical problem with increasing rate as ageing. In elderly, the rate of IPF is higher than in younger populations. Epidemiologic data are shown in the article and pathogenesis of the disease is discussed considering senile changes in the lungs, course and prognosis on a ground of agerelated comorbidity, diagnosis focused on the most reliable and safe methods and pathogenetic welltolerated treatment approach.

An acute exacerbation of chronic obstructive pulmonary disease (COPD) plays an important role in the disease progression and significantly reduces the patients' quality of life. The aim of this review was to summarize published findings about a possible role of biomarkers in diagnosis, management and predicting outcomes in COPD patients. Creactive protein and serum amyloid A are the most investigated biomarkers in this field. Measurement of copeptin and proadrenomedullin may be useful in predicting shortterm outcomes. Biomarkeroriented management of patients with acute exacerbation of COPD could be important for choosing medications.

Chronic obstructive pulmonary disease (COPD) is one of the main causes of morbidity and mortality worldwide. Time to time, the natural progres sive course of COPD is interfered by exacerbations which lead to further lung function worsening. Adequate antibacterial therapy could diminish unfavorable inflammation effects and prolong time to the next exacerbation in patients with Anthonisen's type 1 and type 2 exacerbations. Given the leading role of Haemophilus influenzae and Streptococcus pneumonia as causative agents in COPD exacerbations, amoxicillin is recommended as the first choice drug in lowrisk patients with nonsevere COPD exacerbation. Amoxicillin is also active against 97% of H. influenzae strains in Russia. In patients with poor tolerance of penicillins, if not related to IgE, administration of cefixime, which is highly active against H. influenza and moderately active against S. pneumonia, is reasonable. In case of βlactam intolerance respiratory fluoroquinolones could be considered as alternative drugs.

A review on use of an anticholinergic drug tiotropium bromide (TB) in patients with bronchial asthma (BA) is presented in this article. An analysis of published data including placebocontrolled, randomized clinical trials showed that administration of TB is effective and safe in patients with BA. In patients with uncontrolled BA, addition of TB to the standard therapy was more effective than doubling a dose of inhaled corticosteroids (ICS). In patients with BA that was poorly controlled with combination of ICS plus longacting β2agonists, addition of TB via Respimat® improved lung function, reduced number of severe exacerbations and increased time to first exacerbation.

Viruses can cause interferon imbalance and inhibit cellular and phagocytic responses. Persistent viral and bacterial infections, such as Mycoplasma, Chlamydia, etc., can stimulate atopy and cause exacerbations of chronic respiratory diseases. A high efficacy of inosine pranobex (Groprinosin) has been demonstrated for treatment and prevention (immunological rehabilitation) of recurrent respiratory viral infections in adults and children.

Aim. The aim of this study was to investigate structural and functional characteristics (morphology, membrane stiffness, adhesion) of blood neu trophils in patients with COPD and pulmonary hypertension (PH) using atomic force microscopy. Methods. This was a local open comparative study involving 30 in patients with severe COPD. Of them, 15 patients had PH and 15 patients had normal pulmonary artery pressure. Complete blood cell count was performed in the 1st day of admission. Pulse oxymetry, spirometry, echocardiographic examination were used in all patients. Neutrophils were separated from venous blood. Surfaces of 10–12 cells were scanned and lateral section curves were constructed to meas ure the cell height and maximal height of cytoplasmic granules. Nuclear and cell areas were also calculated using Pico Image Basic 5.1 software. The membrane elastic properties and adhesion strength of native neutrophils were evaluated using force spectrometry. Results. Neutrophil adhesion strength was significantly higher in patients with COPD + PH compared to this parameter in patients with COPD and normal pulmonary artery pressure. In patients with COPD + PH neutrophils had less nuclear segments and significantly higher cell phasic height, increased cytoplasm granularity adhesion strength and membrane stiffness. Conclusion. The results demonstrated that structural and functional changes in blood neutrophils were more significant in patients with COPD and PH.

Aim. The aim of this study was to investigate safety and clinical efficacy of 13valent conjugated pneumococcal vaccine (PCV13) and 23valent poly saccharide pneumococcal vaccine (PPV23) in patients with chronic obstructive pulmonary disease (COPD) and asthma and to assess impact of vac
cination on quality on life. 

Methods. This was a prospective comparative study. Clinical efficacy and safety were evaluated using data on systemic and local adverse reactions during a month after vaccination, changes in lung function and quality of life (QoL in 6 months after vaccination. Lung function was assessed before and 1 and 6 months after vaccination. QoL was measured before and 6 months after vaccination using CAT test in COPD patients and ACQ ques tionnaire in asthma patients. 

Results. The study involved 58 patients with COPD and 59 patients with asthma. Of them, 33 and 34 patients, respectively, were vaccinated with PCV13 and 25 patients of each group were vaccinated with PPV23. A rate of systemic and local adverse reactions did not differ significantly between patients vaccinated with PCV13 or PPV23. Patients with both COPD and asthma vaccinated with PCV13 demonstrated more significant increase in FEV1. QoL improved in all vaccinated patients. Worsening of the disease was not noted in any patient.

Conclusion. In patients with COPD and asthma, lung function tended to improvement and QoL significantly improved in 6 months after vaccina tion with PCV13 or PPV23. Both vaccines were well tolerated.

Aim. The primary aim of this study was to evaluate a role of virtual bronchoscopy as a part of multidetector computed tomography (MDCT) for diag
nosis of bronchiectasis and its complications. The second aim was to determine a role of minimalintensity projection (minIP) and 3dimensional reconstructions for assessment of structure of trachea and bronchi.

Methods. MDCT was performed in 16sliced scanner Toshiba Aquilion 16 and 320sliced scanner Aquilion ONE. To evaluate central and distal air ways, threshold values of –400 HU to –600 HU and –750 HU were used, respectively. A software was used for virtual bronchoscopy with simulta neous postprocessing reformation of native images (minIP and maxIP images) and 3dimensional reconstructions. Results of virtual bronchoscopy were compared with fiberoptic bronchoscopy findings.

Results. Virtual bronchoscopy allowed investigation of inner surfaces of trachea, carina, main, segmental and subsegmental bronchi (with the small est diameter of 1–2 cm). Bronchiectasis was seen as deformities of bronchial lumen. Nontumoral bronchial stenosis did not impede visualization of more distal part of the bronchus during virtual bronchoscopy compared to fiberobronchoscopy. Visualization of bronchial inner surface depended on extent of bronchiectasis and could reach subsegmental bronchi of 5–6 generation.

Conclusion. MDCT virtual bronchoscopy technique based on combined evaluation of minIPimages, 3Dreformations and virtual bronchoscopy has been developed. This technique allows complete assessment of structure of trachea and bronchi in patients with bronchiectasis or osteochon droplastic tracheobronchopathy.

The purpose of the study was to investigate respiratory metabolism of nitric oxide (NO) and urinary LT E4 excretion in exerciseinduced bronchoconstriction (EIB)positive and EIB-negative skiers and biathlonists in different periods of training season.

Materials and methods. 92 athletes were examined in precompetitive period and 78 in competitive period of annual training cycle (mean age, 17.5 ± 2.3 years). A control group included 64 healthy non sporty individuals of similar age. EIB was diagnosed using an indirect exercise fieldtest at subfreezing ambient temperature (MasterScreen Pneumo, Jaeger). Pre and postexercise fractional exhaled NO level (FeNO), exjhaled breath condensate (EBC) levels of NO2/NO3 (R&D Systems, USA) and 3-nitrotyrosine (Hycult biotech, Netherlands) were studied. Urinary LT Е4 excretion (Assay Designs, USA) was investigated by ELISA.

Results. NO2/NO3 and 3-nitrotyrosine levels in EBC were significantly different in athletes and control group. Skiers and biathlonists demonstrated significantly higher 3-nitrotyrosine level and lower NO2/NO3 level in the competitive period compared to the precompetitive period. EIB-positive athletes had lower baseline FeNO, higher levels of NO metabolites in the EBC. However, significant differences were found only in preexercise NO2 level. Urinary LT E4 was significantly higher in athletes than in controls and did not differ between EIB-positive and EIB-negative athletes. There was a negative relationship between pre and postexercise FEV1 and urinary cysLT E4 level.

Conclusion. Repetitive intensive exercise in subfreezing ambient temperature could modify respiratory NO metabolism and cysLT production in athletes.

Aim. The aim of this study was to investigate frequency and spectrum of primary multidrug resistance of Mycobacterium tuberculosis in TB patients hospitalized in penitentiary and civil hospitals of Krasnoyarsk region.

Methods. Bacteriological findings of 443 patients were analyzed. Sensitivity of M. tuberculosis strains to anti-tuberculosis drugs was shown in absolute concentrations.

Results. High primary drug resistance of M. tuberculosis was found both in penitentiary and civil hospitals (70.6 % and 44.1 %, respectively) with prevalence of multidrug resistance (MDR) that was twice higher in penitentiary settings (48.1 % vs 24.7 %). In penitentiary settings, MDR was higher for the first-line anti-tuberculosis drugs. Generally, primary drug resistance of M. tuberculosis including MDR was significantly higher in Krasnoyarsk region compared to published data both for penitentiary and civil hospitals of Russia and certain Russian regions. In prisoners with newly diagnosed pulmonary tuberculosis, resistance to basic anti-tuberculosis drugs, particularly to isoniazid and rifampicin, was significantly higher.

Conclusion. High primary drug resistance of M. tuberculosis including MDR in penitentiary and civil settings of Krasnoyarsk region demonstrates severe epidemiological situation in this region of Russia and requires development new chemotherapeutic regimens for patients with newly diagnosed pulmonary tuberculosis based upon the regional characteristics.