Exercise-induced bronchoconstriction mostly presents in patients with asthma, although it is generally recognized that physical activity provokes, but not causes asthma. The lecture discusses the pathogenesis of the syndrome of exercise-induced bronchoconstriction, its diagnosis which includes bicycle ergometry or treadmill test, as well as registration of the flow-volume curve of forced exhalation before and at different time intervals during recovery after exercise challenge test. Besides, indications, and contraindications to the test are listed as well as methodology and the interpretation of the results are considered in detail. A clinical example of the detection of exercise-induced bronchoconstriction in a young adult patient is also given.

The article discusses the possibilities of functional assessment of the state of the respiratory function of the lungs in patients with bronchial asthma.

The purpose of the study: a comparative assessment of the information content of capnometry, spirometry, the method of multiple breath nitrogen washout and the diffusion test in patients with asthma.

Results and conclusions: 2 groups of patients were examined: I — 30 patients with asthma of 3–4 degrees of severity, II — 30 healthy volunteers. Capnometry showed a statistically significant increase in the slope of the alveolar phase in patients with asthma compared to the control group with quiet breathing, both before and after the use of a bronchodilator. According to spirometry data, in patients, the FEV1 /FVC ratio was statistically significantly lower compared to the control group, both before and after bronchodilator use. In a comparative analysis of the diffusion capacity of the lungs, there was a trend towards lower DLCO values in patients with asthma. A statistically significant difference was obtained in relation to the lung clearance index between the group of patients with asthma and the control group, in which the index was significantly lower. There were no statistically significant differences between the FRC (%) estimates obtained using the diffusion test and the method of the multiple breath nitrogen washout in patients with asthma. Thus, the informative methods in patients with asthma were not only the method of spirometry, but also the method of capnometry and the method of multiple breath nitrogen washout, which revealed uneven ventilation and distribution of ventilation-perfusion ratios in the lungs.

A literature review is presented the phenomenon of “the pulse oximetry gap”, including its definition, causes, and clinical significance. The history of pulse oximetry, methods for determining the main functional and dysfunctional derivatives of hemoglobin, physical and methodological principles for determining the functional and fractional saturation of hemoglobin with oxygen are considered in detail.

The complete left bundle branch block (CLBBB) leads to the development of severe heart failure and requires resynchronization therapy(CRT). It is known that one third of patients do not respond to CRT. In this regard, it is necessary to search new diagnostic criteria for patient selection for CRT.

Aim. Determination of the criteria for CLBBB using three-dimensional vectorcardiography data with analysis of the rate of vector loop formation.

Material and research methods. The study included 137 patients. The main group consisted of 57 patients with CLBBB, which was based on D. G. Strauss et al. (2011) criteria. Causes of CLBBB and comorbidities were not considered. The control group included 80 healthy individuals. All patients underwent synchronous registration of 12 standard ECG leads and reconstruction of a three-dimensional vectorcardiogram (VCG) using the McFee-Parungao system.

Research results. The following signs are characteristic for CLBBB according to three-dimensional VCG data: • fracture of the spatial vector loop due to a change in the direction of the excitation front in its middle part; • reduction in planarity index (PI) less than 80%; • a sharp, by a factor of 2 or more, decrease in the speed of tracing a spatial vector loop in its middle part with the formation of a “claw-shaped” curve with two peaks R and L.

Conclusion. Three-dimensional VCG allows you to reliably determine the «true» CLBBB, based on the “fracture” of the spatial vector loop with a reduction in PI less than 80% and a significant decrease in the speed of tracing the vector loop in its middle part with the formation of a “clawshaped” curve and carry out a differential diagnosis with “false” СLBBB, in which changes on the ECG are associated with a combination of left ventricular hypertrophy and left anterior fascicular block, when there is no “fracture” of the loop, a reduction in PI, and the routing speed decreases at the end of the loop without forming a “claw-shaped” curve.

Objective. To develop a standartized approach to the diagnosis of the subclinical course of chronic heart failure using a combination of transthoracic echocardiography, liver elastometry and stress test in cardiac patients.

Materials and methods: All patients (n=97) were examined according to a single diagnostic algorithm: physical examination, transthoracic echocardiography and ultrasound elastometry of the liver. In addition to the main studies for patients of group No. 2 with questionable (borderline) results, according to instrumental studies, a stress test was additionally conducted to determine the latent course of heart failure. All 3 groups of patients were also dynamically examined after 3 and 6 months.

Results: In patients of groups 1 and 3, the results of instrumental studies did not differ dynamically at 3 study points: 0 months — 3 months — 6 months: in patients with CHF 1 according to elastography, the indicators were within F0-F1, which corresponded to the absence of clinically significant fibrosis, for patients of group 3, the indicator It remained within F3-F4, which indicated a prolonged course of the disease, as well as venous stagnation and/or true fibrosis with subsequent transition to cirrhosis. In group No. 2 (CHF 2A-B, II–IIIFK), where a stress test was performed, the results in dynamics differed statistically significantly depending on the difference in elastometry indicators before and after physical activity: in patients with a difference of less than 15% after six months, the result remained within the same values, in a cohort of patients with a difference of 15–25% in dynamics, there was an increase in the results of liver elastometry, in the group with a difference of >25%, there was a marked increase in liver elastometry and a decrease in the left ventricular ejection fraction according to echocardiography; in addition, 45% of them have passed into the decompensation stage.

Conclusion. For dynamic control of the functional state of the liver, as well as the detection of subclinical forms of CHF in cardiac patients, the use of the combined TTE+2D-SWE+test with a load test is an interesting and promising alternative to invasive manipulations, which will provide a differential approach to the diagnosis of CHF in patients at different stages of the disease.

Purpose. To estimate early decrease of cerebrovascular function in the course of ultrasonic bicycle exercise dynamic change of peak velocity and resistant index of brain blood circulation at patients with an arterial hypertension.

Methods: The group of patients with an arterial hypertension of the I–II degree (No. 1, n=23) and group of conditionally healthy faces (No. 2, n=27) comparable age is examined 53 [47–58] years. In the course of the Doppler research of the middle brain artery the peak velocity (V_ps) and resistant index (RI) in a supine position was registered, sitting also during bicycle exercise.

Results: In a supine position of V_ps was equal 79 [77–82] cm/s and 82 [79,5–85] cm/s, respectively, RI was identical — 0,62 [0,58–0,64]. In a sitting position on the stationary bicycle V_ps decreased in the main group by 13,5% [11,2–15,5], and in group of control — for 5% [3,8–7,2]. In the course of bicycle exercise of average intensity, which corresponded to 70% of threshold power, growth of V_ps at patients with AG was 30% [27,4–32,6] of reference orthostatic values, and in group of control — 44% [38–48,2] (p<0,0001). Similarly also peripheral vascular resistance increased, RI increased by 15,8% [13,9–20,8] and for 18,8% [15–22,6], respectively. At peak of bicycle exercise reduction of Vps in the main group for 15% [7,2–10] of the maximum values, and in group of control — for 11% [8,4–12,2] was observed, at this RI significantly did not change. Conclusion. Adequate increase peak velocity in an middle brain artery not less than 30% in the course of exercises, unproductive increase peak velocity at patients with an arterial hypertension of the I–II degree indicates decrease in vasomotor cerebrovascular function> <0,0001). Similarly also peripheral vascular resistance increased, RI increased by 15,8% [13,9–20,8] and for 18,8% [15–22,6], respectively. At peak of bicycle exercise reduction of V_ps in the main group for 15% [7,2–10] of the maximum values, and in group of control — for 11% [8,4–12,2] was observed, at this RI significantly did not change.

Conclusion. Adequate increase peak velocity in an middle brain artery not less than 30% in the course of exercises, unproductive increase peak velocity at patients with an arterial hypertension of the I–II degree indicates decrease in vasomotor cerebrovascular function.

Neurolipomatosis is a rare benign tumor of peripheral nerves. The nerves of the upper extremities are more often involved, in most cases, the median nerves in the carpal canal. Children and young people suffer mainly. The article describes a case of fibrolipomatous hamarthroma of the median nerve in a 24-year-old patient, the ultrasound image is compared with the results of intraoperative observation. Despite the characteristic clinical and pathomorphological picture of this condition, the issues of diagnosis and differential diagnosis remain relevant. A special role is given to ultrasound as a non-invasive, widespread method of lifetime diagnosis of the condition of peripheral nerves. The median nerve, due to its superficial location, is available for visualization, and understanding the ultrasound semiotics of fibrolipomatous hamartoma will allow timely determination of it at the stage of initial clinical manifestations and avoid unnecessary and aggravating neurological deficits of examination methods such as biopsy.

The aim of the research: to conduct an analytical review of modern scientific literature on the use of infrared thermography in rehabilitation after anterior cruciate ligament surgery.

Materials and methods: an analysis of foreign and domestic sources on this topic was carried out.

Results: our analysis indicates that using the infrared thermography method it is possible to effectively quantify load assimilation with the ability to quickly regulate it, which is a pressing issue in the postoperative management of patients after anterior cruciate ligament surgery and requires further study.