Aim. The aim of this study was to evaluate a relationship between clinical and functional parameters, arterial stiffness and the left heart remodeling in patients with COPD and comorbid coronary artery disease (CAD).

Methods. Fifty COPD patients with or without comorbid CAD were includ ed. This was a prospective observational 52week study. Lung function was testing, noninvasive arteriography, echocardiography were used. Oxygen saturation and cytokine (IL6, IL8, TNFα) were measured.

Results. Severe and very severe COPD and CAD have common risk factors, such as smoking, hypoxemia, systemic inflammation, which can cause vascular wall remodeling. Increased arterial stiffness affects hemodynamics and impedes myocardial relaxation that in turn leads to diastolic dysfunction and reduced left heart contractility Direct relationships between systemic inflammation biomarkers, arterial stiffness, systolic and diastolic dysfunction were found in patients with severe and very severe COPD independ ently on comorbid CAD.

Influenza is an acute respiratory viral infection with high morbidity. The 2009 influenza pandemic known as "swine flu" was caused by А / H1N1 / 09 influenza virus and was characterized by several specific features including frequent injury of the lower respiratory tract with development of progressive pneumonia and acute respiratory distress syndrome (ARDS) in children, young and middleaged adults. Clinical course of pneumonia complicating swine flu and management of such patients have been discussed in these guidelines. Admission to a hospital ward and to ICU, antiviral drugs, therapy of pneumonia and ARDS including supplemental oxygen, respiratory support, noninvasive ventilation and extracorporal membrane oxygenation, and preventive measures were also reviewed

The aim of this study was to search tumor expression of thymidylate synthetase and some other immunomorphological markers and to determine their prognostic role for pulmonary adenocarcinoma.

Methods. Histological and immunohistochemical study of pulmonary adenocarcinoma has been conducted using several markers such as thymidylate synthetase, Ki67, p53, Bcl2, Bax.

Results. Thymidylate synthetase and cellular prolif eration activity marker Ki67 were revealed in 100 % of cases; p53, Bcl2 and Bax were revealed in 48 %, 7.9 % and 6.3 %, respectively. The results demonstrated a tendency to decrease 3year eventfree survival by 14 % (p = 0.1007) in patients with high thymidylate synthetase expression in comparison to patients with low expression.

Conclusion. Thymidylate synthetase could be used as a prognostic factor of pulmonary adenocarcinoma course.

The aim of the study was to compare clinical and functional features and healthrelated quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD) regarding to comorbid obesity as a phenotypic sign.

Methods. Patient classification was performed using Kmeans clustering analysis (MacQueen). It resulted in the classification of subjects into four clinical groups with marked differences in COPD symptoms.

Results. Subjects with obesity had severe airflow limitation and dyspnoea, frequent exacerbations, severely impaired HRQoL, poor survival, decreased physical activity, insulin resistance and increased systemic inflammation.

Conclusion. Thus, COPD with comorbid obesity could be considered as a distinct phenotype of COPD with severe symptoms.

Aim. The aim of this study was to evaluate clinical efficacy of a rehabilitation program for patients with bronchial asthma (BA) and comorbid metabolic syndrome (MS).

Methods. This randomized study involved 60 stable patients (15 males) with moderate BA and comorbid MS. The mean age of the participants was 49.81 ± 0.77 years. BA was diagnosed according to GINA, 2011. The patients randomly received standard medication therapy plus education and physical training or standard therapy only. Clinical symptoms of BA, lung function, quality of life and nutritional status were assessed at baseline and in 12 months.

Results. In 12 months, patients treated with rehabilitation program in addition to the standard therapy have demonstrated significant improvement in all parameters in comparison to patients treated with standard therapy only.

Conclusion. Implementation of this program focused on education and physical training was related to a significant reduction in BA exacerbation rate, number of emergency calls and hospitalizations due to BA, decrease in severity of daytime and nighttime asthma symptoms, improvement in lung function, and achievement the optimal BA control.

The aim of the study was to analyze respiratory viruses and cytokines in induced sputum samples, serum Mycoplasma pneumoniae antigens and antiMycoplasma and antiChlamydia antibodies in stable patients with bronchial asthma and chronic obstructive pulmonary disease (COPD) phenotype.

Methods. RNAs of rhinovirus, respiratory syncytial virus, metapneumovirus, types 1, 2, 3, and 4 influenza viruses, coronaviruses ОС43, Е229, NL63, and HKUI; DNA of group B, C and E adenoviruses and bocavirus were detected by realtime PCR with hybridization and fluorescent detection. Serum IgG, IgM and IgA antibodies against C. pneumoniae were detected with indirect microimmunofluorescence assay. Mycoplasma pneumoniae antigens were detected with aggregate hemagglutination method.

Results. In patients with asthma plus COPD phenotype, three respiratory viruses were detected in sputum, such as rhinovirus, respiratory syncytial virus and adenovirus; antigens of and / or antibodies against M. pneumoniae and Chlamydia pneumoniae were also detected in blood sera. The respiratory infections were associated with imbalanced ratio of interferon
types I, II, III and MxA antiviral protein. In patients with no expression of IFNβ gene, IFNα RNA was detected in 58.3% of samples and IFNλ RNA was detected in 42.9 % of samples. Decreased functional activities of IFNα and IFNγ were found.

Comparative data on clinical efficacy of pneumococcal vaccination with 13valent conjugate vaccine (PCV13) or 23valent polysaccharide vaccine (PPV23) in asthma patients have been reported in the article.

Aim. The was to evaluate clinical efficacy of PCV13 and PPV23 in patients with
asthma.

Methods. Clinical efficacy of vaccination was evaluated using exacerbation rate, need in antibiotics and hospitalizations. We estimated number of exacerbations, number of antibacterial courses and number of hospitalizations for asthma exacerbation in a year before and after vaccination.

Results. The study involved 58 asthma patients. Of them, 33 patients received a single dose of PCV13 intramuscularly and 25 patients received a single dose of PPV23 intramuscularly. Baseline characteristics were similar in both groups. In a year after the vaccination, number of exacerbation and hospitalizations due to asthma and need in antibiotics significantly reduced.

Conclusion. Vaccination of asthma patients with PCV13 or PPV23 vaccines was highly efficient with the benefit of PCV13. Further studies of microbiological, immunological and other effects of "Prevenar13" and "Pneumo23" in patients with asthma are needed.

Aim. A goal of this noninterventional prospective multicenter observational program was to evaluate efficacy and safety of josamycin in patients with nonsevere communityacquired pneumonia (CAP) in routine clinical practice.

Methods. Patients (n = 104) with radiological signs of pneumonia were treated with josamycin (Wilprafen® Solutab®, dispersible tablets 1 000 mg). Complete resolution of CAP was achieved in 95.6 % of patients, a clinically significant improvement was seen in 3.3 % of patients and a lack of effect was seen in 1 (1.1 %) patient. Radiological followup did not reveal worsening in any patients.

The results of this study have demonstrated that josamycin was highly effective (> 95 %) and had a good safety profile in outpatients with nonsevere CAP.

Aim. The study was aimed at investigation of etiology of communityacquired pneumonia (CAP) in children in relation to age.

Methods.
Chlamydophila pneumoniae, Mycoplasma pneumoniaе, respiratory viruses, Epstein–Barr virus, cytomegalovirus and human herpes virus type 6 were searched using bacteriological, serological and molecular methods.

Results. We examined 145 hospitalized children aged 1 month to 17 years with
respiratory infection complicated by moderate CAP. Viruses were detected in 62 % of children under 4 years old, in 43 % of children of 4 to 7 years old and in 17 % of schoolage children. A rate of mixed viralbacterial CAP decreased with aging and was found in 30 % of children under 4 years old and in 4 % of schoolage children.

Conclusion. Viral infection, mainly respiratory syncytial virus and cytomegalovirus, prevailed in the etiology of CAP in children under 4 years; C. pneumoniae and M. pneumoniae prevailed in schoolage children.

Aim. One of the key issues of management of a patient with communityacquired pneumonia (CAP) is an adequate initial assessment of severity. This is especially important during CAP epidemic outbreaks among young patients in closed communities. Currently, several scales are used allowing a rational choice of a place of therapy on the basis of risk of poor outcome. These scales have advantages and disadvantages but they have not been studied in CAP patients in closed communities.

Methods. A comparative analysis of diagnostic values of CRB65 and SMRTCO scales in 274 young patients in closed communities was performed. Procalcitonin (PCT) and Creactive protein (CRP) were measured. Discriminative values of the
scales were estimated with the ROCanalysis.

Results. CRB65 and SMRTCO scores were significantly related to PCT level. The correlation between SMRTCO score and PCT was closer compared to correlation between CRB65 score and PCT.

Conclusion. The results have shown obvious perspectives in improvement SMRTCO score by adding PCT that could increase its sensitivity.

Aim. Carboxyhemoglobin dissociation rate strongly depends on the blood acidity (Bohr's effect). Therefore, CO concentration in the exhaled air increases as a result of lactate production after highintensity exercise. We studied a relationship between CO concentration in the exhaled air and lactate concentration in the blood after highintensity exercise in athletes.

Methods. CO concentration was measured by Smokerlyzer® (Bedfont Scientific Ltd, GB) with previous breath hold; lactate concentration was measured by Accutrend® Lactate (Roche Diagnosics GmbH, Germany).

Results. Nine elite cyclists were involved, mean (± SD) age, 25.0 ± 2.8 years; mean height, 175.0 ± 4.5 cm; mean weight, 76.5 ± 5.8 kg; the maximal oxygen uptake, 65.6 ± 4.5 ml / min / kg before and after cyclerace training. CO concentration ratio was significantly related to lactate concentration. After the training, there were 3.5fold increase in lactate concentration (from 2 to 7 mmol / L) and 2.5fold increase in CO concentration (from 3 to 10 ppm).

Conclusion. Our findings provide a basis for development of novel noninvasive express methods for anaerobic threshold detection and could be useful in elite athletes training, fitness and aerobics.

The paper represents a systematic review of current etiological diagnostic methods in childhood communityacquired pneumonia based on studies and guidelines of recent years. The authors compare sensitivity and specificity of different diagnostic methods, advantages and limitations of different routine microbiological diagnostic approaches. According to most opinions molecular methods are very valuable, quick and easy to use but should be combined with culturing and other routine tests for better interpretation of results.

Currently, acute respiratory infection (ARI) and Herpes virus infection are widely prevalent in children and adults. Clinical presentations and course, characterization of ARI and Herpes virus infection, groups of immunomodilating drugs and current individualized treatment approach are reviewed in this article.

The aim of this work was to analyze current aspects of basic therapy for asthma according to GINA, 2014, in preschool children. The principal strategy of basic therapy for preschool asthmatic children has been reviewed in the article. Treatment of childhood asthma includes longterm antiinflammatory therapy. Inhaled corticosteroids are considered as the firstline therapy. Treatment efficacy depends on the drugs administered to the patient and the optimal delivery into the airways.

Spirometry is the principal method of diagnosis and evaluation of severity and therapeutic efficacy in patients with chronic obstructive pulmonary disease (COPD). According to the current definition of this disease the main pathophysiological sign of COPD is persistent and generally progres sive airflow limitation. This article will reviews common spirometric parameters used for COPD diagnosis and a diagnostic value of FEV1 / FVC ratio used in absolute values or as the lower limit of its normal range. Spirometry allows detecting pulmonary hyperinflation, particularly using the inspiratory capacity; this possibility is very important but is not widely applied. This is a probable reason of COPD underestimation and late diagnosis. Underestimation of COPD is thought to be due to low spirometry implementation in primary care practice as majority of COPD patients seek medical care in the advanced disease when pulmonary function has already been lost significantly. A great problem for wide implementation of spirometry in general practice is difficulty to learn adequate spirometric testing and interpretation of test results. Notwithstanding a new integral assessment of COPD underlying the current COPD classification spirometric parameters (FEV1 < 50 %pred.) often are the leading criteria to predict a high risk of future exacerbations. Recent data have been demonstrated that early spirometric diagnosis of COPD in primary care is the most effective strategy providing more sufficient therapy results.

Hemoptysis is a rare complication of idiopathic pulmonary arterial hypertension (PAH). A clinical case of idiopathic PAH manifested with recurrent hemoptysis during pregnancy has been described in the paper. Diagnostic approach and optimal management of such patients were also discussed. Pulmonary hemorrhage requires active therapeutic interventions including surgical treatment. Endovascular embolization of bronchial arteries is the firstline treatment but this requires initial detection of area of interest, intervention volume and intraoperative risk. Lung transplantation should also be considered.

Myasthenia gravis is a progressive autoimmune disease with underlying disorder of neurotransmission from neurons to muscular fibers. Clinical presentations are pathological muscle fatigue leading to paralysis and paresis. Current knowledge of pathophysiological heterogeneity of myasthenia could explain different treatment effects in different patients: complete recovery, insignificant improvement, ineffectiveness or exacerbation with myasthenic crisis. In 60–80% of patients, improvement could be achieved with thymectomy. One of postoperative problems is an absence of a single strategy for therapy with anticholinesterase drugs. The aim of this article was to demonstrate a clinical case of sufficient administration of anticholinesterase drugs in a woman with early complications after simultaneous thymectomy and O.V.Nikolayev's subtotal thyroidectomy.

All abstracts on sarcoidosis presented in the European Respiratory Congress 2014 at Munich have been reviewed in this article. Most abstracts dealt with mechanisms of inflammation and genetic susceptibility in sarcoidosis. Several abstracts focused on image diagnosis particularly on MRI in cardiac sarcoidosis. Abstracts on treatment of sarcoidosis discussed reduction in steroid exposure on the patients. Russian scientists presented publications from Moscow, St.Petersburg, and Novosibirsk.