[Features of central hemodynamics in patients with community - acquired pneumonia depending on the course of the disease and cardiovascular comorbidity].

AIM: The study of intracardiac hemodynamics and blood flow in the pulmonary circuit in patients with community - acquired pneumonia, depending on the presence of concomitant pathology of the cardiovascular system and the severity of the pathological process. MATERIALS AND METHODS: In 43 patients with community - acquired pneumonia (22 men, 21 women, mean age 67±17 years), the functional state of pulmonary - cardiac hemodynamics was assessed by echodoplerography. All subjects were divided into 2 groups: 1st group - 25 patients with community - acquired pneumonia (mean age 49±18 years) without concomitant pathology of the cardiovascular system and 2nd group - 18 patients with community - acquired pneumonia (mean age 70.1±11 years) with concomitant cardiovascular disease. RESULTS: The main ultrasound parameters did not differ from the normal values in patients from the 1st group. In patients from the 2nd group there was a significant deterioration of several pulmonary - cardiac hemodynamics parameters, decrease of left ventricular ejection fraction, significant myocardial hypertrophy of the left ventricle and left atrium size increase. Regarding the right heart chambers it was revealed dilatation of the right ventricle, increasing of the estimated systolic pressure in the right ventricle, deterioration of right ventricle myocardial diastolic function, increase of the: RV/LV size ratio, LV eccentricity index, RV myocardium thickness, diameter of the pulmonary artery, velocity of pulmonary regurgitation and the area right atrium size. In addition, the amplitude of systolic displacement of the tricuspid valve ring and the intensity of inspiratory collapse of the inferior vena cava decreased. Correlation analysis of clinical and laboratory parameters, which are markers of endogenous intoxication, oxygen saturation of arterial blood (SpO2), separately for two groups of patients with community - acquired pneumonia, showed a reliable correlation with a number of informative and used in the practice echocardiography parameters of pulmonary cardiac hemodynamics, characterizing systolic (systolic movement amplitude of the tricuspid valve ring - TAPSE), as well as diastolic function (E/A of the right ventricle) of the heart. CONCLUSION: The relationship between the severity of pulmonary - cardiac hemodynamics disturbances in patients with community - acquired pneumonia, having comorbid pathology, contributing to the deterioration of pulmonary - cardiac hemodynamics and more severe course of the disease with markers of the inflammatory process and oxygen saturation of arterial blood decrease is revealed.

Efficacy of Arbidol in the prevention of virus-induced exacerbations of bronchial asthma and chronic obstructive pulmonary disease.

AIM: To assess the efficacy and safety of Arbidol in the influenza and ARVI preventing in patients with asthma and chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: This study was an open label and prospective during epidemic period of 2016-2017 years. 100 outpatients aged 18 to 80 years with verified asthma and/or COPD, were enrolled to therapy group, and received oral umifenovir 200 mg once daily for 14 days and then 200 mg twice a week for 3 weeks.The medical records data for the same epidemic period of 2016-2017 seasons of the same patients during witch they received no prophylaxis was taken as a control. The data analysis was made by applying parametric and nonparametric statistical methods. RESULTS: Seasonal and post-exposure prophylaxis using umifenovir was associated with 2.6-times reduction in influenza and ARVI morbidity compared to control. In diseased patients (ARVI) of the therapy group the number of patients with mild illness prevailed (62.2%) and was significantly differed from control (37.1%). Severity of catarrhal symptoms and intoxication, was reduced with umifenovir prophylaxis course and were mild in 67.6% and 67.6% respectively of therapy group compared with 43.3% and 46.4% of control. Influenza and ARVI complications were only detected in control group (4 cases). The percentage of patients with incidents of underlying disease exacerbation was 42% in therapy group and 93% in control group. Also, exacerbation in the therapy group were mild in 59.5% and 34.4% in control group, while moderate exacerbation prevailed in control group and was in 59.1% of cases with was significantly higher then in therapy group (39.3%). Results in more frequent use of adjuvant in the control group compared with the therapy group (81.7% and 59.5% respectively). Patients of control group had a higher risk of hospitalizations due to underlying disease aggravation (11.8%), compared with therapy group (9.5%) but these differences were not significant. CONCLUSION: Seasonal and post-exposure prophylaxis with Arbidol reduce influenza and ARVI morbidity in patients with asthma and COPD during epidemic period, frequency and severity of chronic obstructive pulmonary disease aggravations resulting in decrease in the number of hospitalizations. Also, prophylaxis with Arbidol reduced the severity of catarrhal symptoms and intoxication.

[ROLE OF MAST CELLS IN BRONCHIAL CONTRACTION IN NONALLERGIC OBSTRUCTIVE LUNG PATHOLOGY].

In model of chronic obstructive pulmonary disease induced in rats by 60-day intermittent exposure to nitrogen dioxide mast cells participation in the mechanism of bronchial smooth muscle contractile activity patterns was evaluated. Since the 31st day, one group of rats was inhaled with sodium cromoglycate every day before the nitrogen dioxide exposure to stabilize the mast cell membrane. The other group (control) hasn't been treated. Isometric contraction of the bronchial isolated preparations in response to nerve or smooth muscle stimulation were determined. Inhibition of mast cell degranulation and the release of endogenous histamine by stabilizing cell membranes prevented the development of bronchial smooth muscle hyperactivity caused by prolonged inhalation of nitrogen dioxide. It is believed that a mechanism to increase the contractile activity of the bronchial wall smooth muscles is mediated by activation of the transmembrane adenosine receptor in resident mast cells, leading to their partial degranulation with release of histamine, acting on the histamine Hl-receptors with the launch of reflex pathways through intramural ganglion neurons.

[ANTIINFLAMMATORY AND REGENERATIVE EFFECT OF PEPTIDE THERAPY IN THE MODEL OF OBSTRUCTIVE LUNG PATHOLOGY].

The effect of the tetrapeptide bronchogen on the structural and functional state of the bronchial epithelium and inflammatory activity in the lungs was studied in the chronic obstructive pulmonary disease (COPD) model, created in rats by a 60-day intermittent exposure to nitrogen dioxide. The cell composition and cytokine-enzyme profile of bronchoalveolar lavage fluid (BALF), the content of secretory immunoglobulin A and surfactant protein B in BALF were determined. Following the course of peptide treatment the decreased activity of neutrophilic inflammation with the normalization of cellular composition and profile of pro-inflammatory cytokines and enzymes in the bronchoalveolar space was observed. The structure of bronchial epithelium, disturbed during formation of COPD model, was restored and accompanied by restoration of its functional activity as evidenced by an increase of secretory immunoglobulin A (local immunity marker) and surfactant protein B, responsible for reducing the alveolar surface tension.

[EFFECT OF MAST CELL DEGRANULATION BLOCKADE ON THE INFLAMMATION OUTCOME IN THE MODEL OF OBSTRUCTIVE LUNG PATHOLOGY].

Effect of mast cell degranulation blockade on the inflammatory response and character of the lung tissue structure-functional changes were evaluated in the chronic obstructive pulmonary disease model produced in rats by 60-day intermittent exposure to nitrogen dioxide. The membrane stabilizer sodium cromoglicate was used to blockade of mast cell degranulation. Lung tissue sections were stained with toluidine blue to identify mast cells. Bronchoalveolar lavage fluid (BALF) cytogram was determined. The levels of mast cell tryptase and chymase, proinflammatory cytokine TNF-α, surfactant protein B were measured in BALF. Suppression of mast cell degranulation prevented the release of proteases in the bronchoalveolar space and reduced activity of the inflammatory process. The influx of inflammatory cells and TNF-α concentration decreased. There was no interstitial inflammatory infiltration. Bronchoalveolar epithelium structure was recovered that is the basis of its functional usefulness. The results confirm the active involvement of mast cells in the development of the inflammatory process in obstructive pulmonary diseases and allow us to consider them as a possible therapeutic target.

[ENDOTHELIAL DYSFUNCTION AND OBSTRUCTIVE LUNG PATHOLOGY].

Relationship of endothelial dysfunction and obstructive pulmonary diseases is a complex and poorly understood. Vascular endothelium is a multifunctional autonomous endocrine organ. The review discusses the various functions of the endothelium, causes, mechanisms and possible markers of endothelial dysfunction. The contribution of pulmonary vessel endothelial dysfunction in the initiation and progression of chronic obstructive pulmonary disease and asthma is considered. The existing approaches to the restoration of the structural and functional integrity of the vascular endothelium are discussed.

Modulating Effect of Peptide Therapy on the Morphofunctional State of Bronchial Epithelium in Rats with Obstructive Lung Pathology.

On the model of chronic obstructive pulmonary disease, the effect of therapy with low-molecular-weight peptides on restructuring and functional activity of bronchial epithelium for restoring the immune and barrier function of the lungs and prevention of inflammatory process progression was studied. Chronic obstructive pulmonary disease was modeled in rats by 60-day intermittent exposure to NO2. Administration of tetrapeptide Bronchogen for 1 month eliminates symptoms of remodeling of the bronchial epithelium and lung tissue typical of chronic obstructive pulmonary disease (goblet cell hyperplasia, squamous metaplasia, lymphocytic infiltration and emphysema, and restoration of ciliated cells). Enhanced production of secretory IgA, a local immunity marker, attested to normalization of functional activity of bronchial epithelium, while normalization of cell composition and profile of proinflammatory cytokines in the bronchoalveolar space reflected reduction of neutrophilic inflammation.

[MODIFICATION OF ALVEOLAR MACROPHAGE POOL UNDER INFLUENCE OF PEPTIDE THERAPY IN THE BLEOMYCIN PNEUMOFIBROSIS MODEL].

Effect of peptide therapy on morphological and functional characteristics of alveolar macrophages and role of their phenotypic reprogramming in modulation of pulmonary fibrosing process were evaluated on the rat's model of pulmonary fibrosis, initiated by intratracheal administration of bleomycin. Status of alveolar macrophages was evaluated on the basis of electron microscopic studies and phagocytic activity. In lung tissue of control animals widespread diffuse interstitial fibrosis was determined. Alveolar macrophage cytoplasm was filled geterophagosomes with surfactant fragments, lipid droplets and cholesterol crystals; foam cells were a third of macrophage pool. After the course of peptide therapy the young cell with rare geterophagosomes and lipid droplets, without cholesterol crystals and increased phagocytic activity prevailed in macrophage population. There were rare sites of fibrosis in lungs; connective tissue contained much less collagen fibers than in the control; there was a growing proliferation of the bronchial epithelium. It may be assumed that under the influence of the peptide therapy a certain balance in the alveolar macrophage population was established with a predominance of M2 phenotype for the formation of the optimal ratio of cellular and humoral immune response, providing effective remedy of bronchial epithelium and prevention of lung tissue remodeling with the interstitial fibrosis formation.

[Effect of endotelioprotectors on the tone of pulmonary arteries and bronchi in the model of obstructive lung pathology].

In the model of chronic obstructive pulmonary disease (COPD), produced in rats by 60-day exposure to nitrogen dioxide, the effect of drugs with endotelioprotector properties (sulodexide and rosuvastatin) on the functional state of small pulmonary arteries and bronchi was studied. We evaluated the contractile activity of smooth muscle strips of the bronchi caused by stimulation of the nerves or muscles, and changes in tone of isolated pulmonary artery rings at the application of reagents-vasodilators. The use of sulodexide promoted restoration NO-dependent mechanism of vasodilatation and improved ß-adrenergic regulation of the pulmonary artery tone. The use of rosuvastatin had no effect on the dilator activity of pulmonary arteries. Both drugs improved the functional status of the bronchial smooth muscles and intrabronchial nervous system that controls the contractile activity of smooth muscle structures of the airways. The results of the study suggest that the one-way relaxing effect of sulodexide on pulmonary arterial and bronchial smooth muscles enables the recovery of coordinated regulation of the tone of these structures, which is essential for maintaining the optimal ratio of ventilation and pulmonary blood flow for efficient gas exchange.

[Cell-molecular mechanisms of nitrogen dioxide-induced damaging effect on bronchial epithelium].

Nitrogen dioxide and reactive nitrogen species play a key role in the development environment related diseases by initiation of cell death and damage of bronchoalveolar epithelium. This review examines the possible cell-molecular mechanisms of nitrogen dioxide-induced damaging effect on bronchial epithelium.

[Effect of different therapy options on bronchial contraction in rats with modeled obstructive pulmonary disease].

In the model of chronic obstructive pulmonary disease, produced in rats by 60-day exposure to nitrogen dioxide, the effect of different options of combination therapy (corticosteroids, anticholinergics, adrenergic agonists) on the functional state of the bronchi was studied. The contractile activity of strips of the bronchi caused by nerve or smooth muscle stimulation was evaluated. Corticosteroid monotherapy resulted in deterioration of the functional state of the bronchial wall neuromuscular apparatus due to corticosteroid resistance, evolving under the influence of long-term exposure to nitrogen dioxide. Application of M-anticholinergic tiotropium had a beneficial effect on the functional state of the bronchi smooth muscles, leading to the full restoration of the bronchial wall contractile activity and removal the morphological manifestations of inflammatory lung tissue remodeling. Most effective in terms of impact on the functional state of the bronchial wall neuromuscular apparatus was corticosteroid therapy combined with M-cholinolytik or beta2-adrenoagonist.

Protective effect of fenspiride on the bronchi in rats with chronic obstructive pulmonary disease.

We studied the effect of a non-steroidal anti-inflammatory drug fenspiride on contractive activity of bronchial smooth muscles on the model of chronic obstructive pulmonary disease of rats induced by 60-day exposure to nitrogen dioxide. The administration of fenspiride during the acute stage of the disease (day 15) abolished the constricting effect of the pollutant on the bronchial smooth muscles. Dilatation effect of fenspiride in a low dose (0.15 mg/kg) was mediated by its interaction with nerve endings of bronchial capsaicin-sensitive nerve C-fibers. The interaction of drug with receptors of C-fibers prevented neurogenic inflammation, which was confirmed by the absence of structural changes in the lungs typical of this pathology. The broncholytic effect of fenspiride in a high dose (15 mg/kg) was mediated by not only afferent pathways, but also its direct relaxing action on smooth muscle cells. The observed anti-inflammatory and bronchodilatation effect of fenspiride in very low doses can be used for prevention of chronic obstructive pulmonary disease in risk-group patients contacting with aggressive environmental factors.

[Changes in pulmonary arteries dilatation reserve during chronic obstructive pulmonary disease model formation].

Model of chronic obstructive pulmonary disease (COPD) was induced in rats by nitrogen dioxide inhalation for 60 days. The effect of reagents-vasodilators on the isolated pulmonary arteries with a diameter less than 0.5 mm was studied in 15, 30 and 60 days of COPD induction. All vasodilators (beta-adrenoreceptor agonist izopreterenol, nitric oxide donor nitrosorbid, acetylcholine, activator of C-fibers capsaicin, corticosteroid beclometasone) dose-dependently decreased vascular tone of pulmonary arteries isolated from intact rats. On extension nitrogen dioxide exposure pulmonary arteries responded to the impact of all vasodilators by smaller relaxation. Dose-dependence of dilatation reaction disappeared. In the process of COPD model formation functioning of almost all pulmonary arterial wall neurotransmitter systems were broken. This led to decrease in vasodilators influence on vascular tone and could facilitate the development of pulmonary hypertension which is typical of COPD.

Experimental modelling of chronic obstructive pulmonary disease.

A method for experimental reproduction of stages of chronic obstructive pulmonary disease formation (from acute inflammation to bronchopulmonary tissue restructuring characteristic of this disease) is presented. Lung injury and inflammation were induced by nitrogen dioxide. Hyperplasia and hypersecretion of goblet cells, squamous cell metaplasia of the ciliary epithelium, emphysema, and focal fibrosis served as the morphological substrate for the formation of bronchial obstruction. The adequacy of the model is confirmed by signs characteristic of chronic obstructive pulmonary disease: hyperexpression of CD3 lymphocytes in the bronchial wall and parenchyma, manifold increased production of TNFα and TGFß, high concentrations of circulating pathogenic immune complexes. Persistence of the structural and functional shifts throughout 6 months after exposure to nitrogen dioxide indicated a chronic course of the resultant pathological process.

[Determination of circulation disturbance in the rat lungs in modelling of chronic obstructive disease].

Development of chronic obstructive pulmonary disease (COPD) involves not only the bronchial and respiratory areas of the lungs, but also the system of pulmonary circulation, which begins with the defeat of capillary blood flow. One of radiological methods of studying lung microcirculatory functions is perfusion scintigraphy. We designed the technique of radiological examination and identified its abilities in determination of the role of vascular dysfunctions in experimental model of development of COPD. We assessed the results of pharmacological agents that affect the microcirculatory bed of the lungs and smooth muscles of pulmonary arteries in rats. Studies have shown the promise of the possibility of using the drug sulodexide for studying impaired endothelial function in clinical practice.

[Broncholytic effect of prednisolon in the rats inhaled with nitrogen dioxide].

In the rat model of chronic obstructive pulmonary disease, the dilatation effect of prednisolon was most obvious after 15 days of nitrogen dioxide inhalation. In a longer inhalation, the dilatation effect decreases, and on the 90th day of the inhalation prednisolon enhances contraction of the trachea and bronchi. Prednisolon seems to act upon the respiratory tract via interaction with endings of afferent C-fibres. In prolonged inhalation of nitrogen dioxide, resistance against corticosteroids develops as the result of the C-fibre ending inactivation.

[The role of expired air moisture condensate in assessment of pulmonary inflammation in patients with chronic obstructive pulmonary disease].

AIM: To study biochemical composition of expired air condensate (EAC) in patients with chronic obstructive pulmonary disease (COPD) in relation to a phase and severity of the disease and its treatment. MATERIAL AND METHODS: EAC was investigated in 18 COPD patients and 9 healthy subjects. Basic broncholytic therapy with ipratropium bromide was combined with beclomethasone and fenspiride in 11 and 7 patients, respectively. The condensate was lyophilised, the residue was solved and analysed on the biochemical analyzer Casis (Beringer Manheim, Rosch). EAC was examined for albumin, C-reactive protein, glucose, cholesterol, triglycerides, urea, uric acid, alkaline phosphatase (AP), lactate dehydrogenase, gamma-glutamyl transferase, total calcium, magnesium. RESULTS: Compared to healthy subjects, COPD patients' EAC contains significantly higher levels of albumin, C-reactive protein, calcium, bilirubin and more active AP. Quantitative composition of EAC depends on COPD phase and severity. A negative correlation exists between FEV+AEA-1 and albumin concentration, FEV+AEA-1 and CRP concentration. The anti-inflammatory therapy decreases EAC content of both protein and lipid metabolism products, enzyme activity reflecting attenuation of oxidant and inflammatory processes, stabilization of cell membranes in the respiratory zone. CONCLUSION: EAC composition reflects metabolic processes in the lungs and can be used for assessment of airway affection, activity of the inflammatory process and COPD treatment efficacy.

[Alteration of trachea and bronchi smooth muscles constriction under long inhalation of dioxide nitrogen by rats].

On insulated preparation of trachea and bronchi, change of the smooth muscles constriction was studied in rats inhaling dioxide nitrogen during 15, 30 and 60 days. The inhalation enhanced 1.5-fold and bronchi 2.5-fold responses of tracheal smooth muscles to stimulation of preganglionic nerve. The delay of the response in both events increased 1.3-fold. Long repeated stimulation caused a further increase of the constriction of tracheas and bronchi (1.32-fold). Blocking receptor with Novocain (1.0 mcg/ml) reduced the amplitude of the constriction and enhanced the response delay. After 30 days of inhalation, repeated nerve stimulations enhanced the amplitude of the constriction up to 120%, but after 60 days it reduced the amplitude of the constriction to 71 and 77% in preparations of tracheas and bronchi, respectively. In our opinion, long inhalation of dioxide nitrogen broke functioning of local lung nervous system controlling activity of the smooth muscles. The research results indicate important role of neuron functional module in pathology of the respiratory ways caused inhalation of dioxide nitrogen.

[Functional disturbances in the nervous structures of the respiratory tract in rats following nitrogen dioxide inhalation].

The functional state of rat's airway smooth muscle was not changed after nitrogen dioxide inhalation for 30 days. The smooth muscle contraction increased only at second stimulation of preganglionic nervous fibers. Removal of mucosa or Novocain blockade of receptors decreased control smooth contraction at nerve and muscle fiber stimulation but the repeated stimulation of nerve increased the muscle contraction. The processing of trachea and bronchus preparations by prednisolon (1-10 microg/ml) decreased muscle reactions to 12% only at nerve stimulation. Prednisolon didn't change reactions of preparations with removed or blockaded receptors induced by nerve stimulation, but prednisolon (10 microg/ml) increased contraction at muscle stimulation. The relax effect of prednisolon on airway smooth muscle realizes via tracheobronchial receptors. High doses of prednisolon may direct effect on muscle increasing its contraction.