The article tells about the causes and mechanisms of chronic obliterating diseases of lower limb arteries (CODLLA), diagnosis and current views on the treatment of the disease. CODLLA account for up to 20% of all cardiovascular pathologies, while the risk of the disease increases with age. Atherosclerosis is considered to be the main cause of CODLLA: obliterating atherosclerosis of arteries accounts for up to 90% of all cases of CODLLA. The early stages of this disease are asymptomatic; the unattended disease results in complaints of leg pain at rest or during exercise (intermittent claudication), convulsions and in severe cases - trophic ulcers. The basic principle of CODLLA therapy is continuity and use of all available pharmacological and non-pharmacological treatments. Alprostadil (Vazaprostan) is commonly used in the treatment of CODLLA. It is a synthetic prostaglandin Е1which dilates the arterioles and precapillary sphincters increasing tissue blood flow, with an anti-inflammatory and cytoprotective action.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease which occurs in 1-3% of patients [2, 11] after pulmonary embolism. The incidence of CTEPH is 5-10 cases per 1 million population per year. Similar to other diseases associated with pulmonary hypertension (PH), CTEPH is malignant and has a poor prognosis. [4, 6, 8] There are a number of objective difficulties in the diagnosis of the disease: complaints and symptoms are very non-specific, there are often no X-ray aor ECG changes, echocardiographic signs of overload of right heart chambers are observed in the final stages of the disease. [9, 3] A strong inclination of doctors to primarily seek problems in the left heart chambers also plays a part in this. As a result, a patient may be visiting various specialists for years and receive treatment from different ailments including heart failure, asthma, pulmonary fibrosis, obstructive bronchitis. We had a case where a female patient with CTEPH received prednisolone for asthma for a long time while she had normal spirometry!

The article presents the results of MERIDIAN-RO, a prospective cohort cross-sectional study with retrospective component. The study aimed to evaluate the incidence of ischemic heart disease, myocardial infarction and stroke in the working population of the Ryazan region, their association with risk factors, treatments and impact on mortality. In 2011, 1622 people (1220 urban and 402 rural) aged 25--64 years (mean age - 43,4 ± 11,4 years) 42.6% of which were males and 53.8% females, were included in the study. The cohort was observed for 36 months, the end points were evaluated annually. Considering the low incidence of CAD, myocardial infarction and stroke, the data were combined into one end point CAD/myocardial infarction/stroke. According to the study, the incidence of CAD/myocardial infarction/stroke was lower than on average in the Russian Federation. The main factors contributing to reaching the point of CAD/stroke/myocardial infarction were hypertension, CRP above 5 mg/l, fibrinogen above 4 g/l, apolipoprotein B above 180 mg/dl, anxiety/depression, family history of stroke and myocardial infarction, and obesity. CAD/myocardial infarction/stroke increased the burden on the healthcare system and the burden of CVD. This calls for the need to enhance treatment of these patients.

The article reviews a clinical cases of acute coronary syndrome in a patient with type 2 diabetes (T2D). The causes of progression of atherosclerosis in patients with T2D are considered which leads to myocardial ischemia against a background of multivessel coronary artery disease and is responsible for the high rate of restenosis after coronary interventions. Comorbidity of somatic diseases in cardiology practice is one of the key prognostic factors which determine the outcome of the underlying disease. The choice of hypoglycemic therapy and additive effects of drugs are discussed based on the results of randomized clinical trials.

Studies have demonstrated clinical efficacy of endoscopic laser submucosal chordarytenoidotomy - a surgical method for chronic paralytic laryngeal stenosis. Antibacterial inhalation therapy plays an important role in the complex rehabilitation of patients. It is an effective method of preventing complications and a local anti-inflammatory treatment which contributes to rapid recovery in the postoperative period. Summary. Provides a method of surgical treatment of chronic stenosis of the larynx and combination of paralytic etiology. Results of treatment of 22 patients with this pathology. Patients underwent endoscopic submucosal hordaritenoidotomiya using a diode laser. The obtained results allow us to conclude the treatment efficiency of the proposed method of treatment. This method can be used in clinical practice.

The incidence of leukemia in children in various regions of the Russian Federation ranges from 1.9 to 4.1 per 100 000 of children aged 0 to 14 years. If the average annual morbidity of children is below the Russian (3.03) or European (4.0) standard, it is possible that some cases of leukemia and other oncological and oncohematological diseases are not reported. Clinical-laboratory and instrumental manifestations of malignant diseases can be similar to other conditions. It should be borne in mind that the most frequent childhood diseases are infections. Fever combined with bone pain, unexplained hepato- and/or splenomegaly, lymphadenopathy, changes in the cellular composition of blood and increased LDH should be the reasons to exclude malignancy.

Androgen suppression strategy has become the key treatment of advanced prostate cancer. Historically, testosterone level below 1.73 nmol/l (50 ng/dl) was regarded as the castrate level. The current data shows that in an attempt to improve the therapeutic outcome, the new target for chemical castration is testosterone level below 0.69 nmol/l (20 ng/dl). Testosterone surges and suboptimal castrate level due to LHRH analogue therapy result in a porrer control for prostate cancer. Obese men have higher levels of testosterone during treatment with LHRH analogues than patients with a normal body mass index. The study of androgen ablation consists in identifying those agents which would allow to achieve and maintain the lowest possible levels of testosterone.

429 patients with histologically confirmed prostate cancer undergoing various treatment from 1995 till 2014 were studied retrospectively. Overall survival with the baseline PSA less than 30 ng/ml averaged 50.5 months; with higher rates of PSA, the lifespan was reduced to 28 months regardless of treatment. The cause of death of 150 (35%) patients with PSA below 30ng/ml was not an oncological disease. Even with the initial PSA more than 30 ng/ml, 39 patients (9.1%) died from comorbidities. PSA above 30 ng/ml is a poor prognostic factor requiring a more aggressive approach to the treatment of these patients. Gleason score above 7 points is associated with a worse life expectancy forecast as well as a considerable decrease in the quality of life. PSA level determination continues to play a key role in the early detection of prostate cancer.

Hormonal therapy is the key method in the treatment of locally advanced and metastatic APC. 142 patients with APC treated with LHRH analogues were followed up from December 2011 till December 2014. The efficacy and tolerability of Buserelin-depo was compared with other LHRH analogues. Both Buserelin and such expensive foreign drugs as goserelin, leuprorelin and triptorelin demonstrated high efficacy and tolerability in the treatment of hormone-dependent APC.

First generation EGFR inhibitors have significantly improved the outcomes of drug treatment of patients with metastatic NSCLC, as well as notably increased the frequency of achieving objective response and time to progression of the disease. Today, the arsenal of efficient drugs is enlarged by the introduction into clinical practice of the second-generation EGFR inhibitor - afatinib. According to clinical studies, its full therapeutic effect is determined not only by the status of activating mutation but also its type. Afatinib also significantly increases the overall survival median in case of exon 19 EGFR mutation. This is an extremely important factor in the choice of adequate treatment. Afatinib is also effective in developing resistance to first-generation EGFR inhibitors and is an alternative to second-line therapy. It is hard to overestimate the benefits of the drug which allows for a meaningful delay in chemotherapy for such patients.

Colorectal cancer is one of the most widespread cancers globally. Over the past decade, there has been a significant progress in the treatment of metastatic colorectal cancer. However, an increase in the range of effective anticancer drugs is associated with a number of difficulties in determining the adequate drug treatment regimens for patients with metastatic colorectal cancer. The article describes the current aspects of II line treatment of metastatic colorectal cancer, guidelines for the selection of chemotherapy regimens and appointment of targeted drugs.

Introduction of toremifene into clinical practice significantly enhances the potential of current endocrine therapy for luminal subtypes of breast cancer. Toremifene demonstrates same or greater efficacy compare with tamoxifen but has a more favorable spectrum of side effects including thromboembolic complications. These benefits can significantly reduce the number of cases of irrational discontinuation of therapy. The possibility of safe use of high doses of toremifene including the preoperative therapy regimens which are now being studied also seems promising.

Every year, more than 200 thousand new cases of renal cell carcinoma (RCC) are registered worldwide. 25% of patients at primary examination are diagnosed with metastatic RCC (mRCC), and 20--40% of patients after radical surgery later demonstrate cancer progression and metastases. Thus, the incidence of locally advanced mRCC remains high. Tyrosine kinase inhibitors demonstrated efficacy in the treatment of mRCC in randomized trials comparing investigational drug with cytokine therapy or placebo. The randomized phase 3 AHIS trial was among the first studies directly comparing targeted therapies in which the efficacy of axitinib was directly compared with that of sorafenib in patients with mRCC which progressed after 1-line systemic therapy. 723 patients with mRCC were included in the trial who were randomized 1:1 to receive axitinib (n = 361) and sorafenib (n = 362). 389 (54%) patients earlier received sunitinib, 251 (35%) - cytokines, 59 (8%) - bevacizumab, and 24 (3%) - temsirolimus. The overall median survival was 20.1 months for the axitinib group and 19.2 months for the sorafenib group (p = 0.374). Median progression-free survival in the total population was significantly longer in the axitinib group compared to the sorafenib group (6.7 and 4.7 months, р < 0.0001) (р < 0.0001). After a detailed analysis, high incidence of arterial hypertension (17%) induced by axitinib proved to be a reliable predictor of the effectiveness of targeted therapy. Median overall survival in patients who developed hypertension 12 weeks after randomization and had diastolic blood pressure (BP) ≥ 90 mm Hg was significantly longer than in patients with diastolic blood pressure <90 mm Hg: 20.7 vs. 12.9 monthsin the axitinib group (p = 0.0116) and 20.2 vs 14.8 months in the sorafenib group (р = 0.0020). Axitinib is one of the first targeted therapies that demonstrated efficacy in a comparison with another targeted therapy - sorafenib - in the randomized phase 3 AXIS trial in patients with mRCC which progressed after 1-line systemic therapy. Axitinib, compared with sorafenib, significantly increased median progression-free survival regardless of the first-line therapy (cytokine or tyrosine kinase inhibitor therapy, p <0.0001). Axitinib has a satisfactory safety profile, and hypertension induced by the use of axitinib is valid marker of the effectiveness of targeted therapy. Compliance with guidelines for optimizing axitinib dosage and management of hypertension in patients with mRCC helps to achieve the best survival rates.

Management of acute intestinal infections remains relevant because of their high incidence, clinical aggravation of certain forms of infection, development of resistance of pathogens to traditional etiotropic medications, and an increase in side effects of antibiotic therapy. Excessive use of antibiotic therapy, even in less severe infections, as well as inadequate use of chemotherapy, may contribute to the development of dysbacteriosis manifested in antibiotic-associated diarrhea. In this case, bacteriophages could be an alternative to antibiotics in the treatment of bacterial diarrhea. Both infectionists and general practitioners should be prepared to develop a set of actions for the prevention and treatment of acute intestinal infections through bacteriophages and step-by-step diet therapy.

The research work attempted to answer the question whether an effective personalized glucose-lowering therapy, particularly with metformin, is possible in patients with type 2 diabetes based on single nucleotide polymorphism of the three genes (endothelial nitric oxide synthase, 8-oxoguanine DNA glycosylase and p53). Metformin efficacy could depend, in particular, on the presence of polymorphism in these genes.

The article tells about the pharmacology of nitrates and their place in comprehensive treatment of coronary artery disease. The mechanisms of action of organic nitrates, specifically the short-acting metered dose spray isosorbide dinitrate (ID), are demonstrated. Indications and contraindications for use in various forms of coronary artery disease are analyzed.

For many years, colorectal cancer has been one of the most common tumor diseases in the world. However, treatment outcomes for patients with metastatic colorectal cancer have long remained quite poor. The development of targeted therapy had a significant impact on the improvement of long-term results of treatment of patients with metastatic colorectal cancer. The article provides basic recommendations on the use of targeted therapies in the second-line treatment of disseminated colorectal cancer, mechanism of action, efficacy, toxicity and specific applications. The authors tell about the new targeted agents which are now studied in clinical trials.