Introduction. Heart failure increases the severity of symptoms and worsens the prognosis of chronic obstructive pulmonary disease (COPD) in smokers. Professional COPD is a separate phenotype, which suggests dif erences in the pat ern of comorbidity. Professional COPD in combination with heart failure has not been studied enough.
T e aim of the study was to determine the relationship of heart failure c clinical, functional and hygienic characteristics of professional COPD.
Materials and methods. T e one-center observational study included 115 patients with occupational chronic obstructive pulmonary disease (OCOPD). T e comparison group of 103 patients with COPD, smokers of tobacco. T e diagnosis of COPD met the criterion of GOLD 2011–2019. OCOPD patients were exposed to aromatic hydrocarbons with an excess of MPC in the air of working zone is 1.5 to 6 times, or of inorganic dust in the range of 2 to 9.5 MPC. Heart failure was diagnosed on the basis of any signs of myocardial dysfunction in echocardiography and/or elevation of the N-terminal precursor of cerebral natriuretic peptide (NT-pro-BNP) serum more than 125 PG/ml. the Groups were comparable in sex, age, durationof COPD, duration of action of exogenous etiological factor, causes of heart failure. Clinical and functional characteristics of COPD and heart failure were evaluated. For comparisons between groups for quantitative parameters used covariance analysis or test Kruskall-Wallis for comparison, the share of χ2 criterion. Relationships were determined by logistic regression.
Results. In patients with OCOPD, the heart failure rate was higher  — 63 (54.8%) cases compared to 38 (36.9%) in the group of COPD Smoking (p=0.009). Biventricular failure prevailed (44 (38.3%) patients) with preserved ejection fraction(47 (40.9%) cases). Right ventricular failure was detected in 15 (13.0%) of the subjects, lef ventricular failure — in 4 (3.5%), p=0.002. Echocardiography revealed severe pulmonary hypertension and diastolic myocardial dysfunction in the OCOPD group. OCOPD in combination with heart failure was characterized by CAT index values of more than 10 points, low exercise tolerance, a signif cant rate of decline in FEV1, a decrease in the partial tension of arterial blood oxygen, severe exacerbations of COPD. In multivariate analysis of the development of heart failure in patients with OCOPD predicted: length of service, systolic pressure in the pulmonary artery, partial oxygen tension of arterial blood, the test distance of six-minute walk.
Conclusions. 1. OCOPD is characterized by a probability of heart failure — 54.8%. Biventricular failure with preserved ejection f action and predominant violation of diastolic myocardial function prevails. 2. T e subphenotype of OCOPD in combination with heart failure is characterized by severe symptoms, hypoxemia of rest, severe exacerbations of COPD.

Introduction. Presents results of a study of polymorphisms of repair genes of double-strand breaks DNA breaks: XRCC7 (rs7003908), ATM (rs664677), repair «inconsistencies» DNA MLH1 (rs1799977) in miners and workers of asbestos factories professionally due to broncho-pulmonary pathology.
T e aim of the study was to research the frequency distribution of genotypes of DNA repair genes: XRCC7 (rs7003908), ATM (rs664677) and MLH1 (rs1799977) in workers of harmful and dangerous industries to identify markers of increased risk of bronchopulmonary pathology.
Materials and methods. In 90 people with bronchopulmonary pathology and 124 respondents who worked in the same working conditions but had no history of diseases of the respiratory system, polymerase chain reaction in real time studied the polymorphism of DNA repair genes: XRCC7 (rs7003908), ATM (rs664677) and MLH1 (rs1799977).
Results. It was found that the genotypes ATM×T/T and MLH1×A/G are associated with the risk of bronchopulmonary pathology. Genotypes that contribute to resistance to the development of respiratory system pathology were also established: ATM×A/A, ATM× A/T and MLH1×A/A.
Conclusion. Genotypes associated with the risk of bronchopulmonary pathology were established: ATM×T/T (р≤0.01, χ2=6.61; OR=2.48; 95%CI: 1.16–5.31) and MLH1×A/G (p≤0.002, χ2=9.00; OR=2.32; 95%CI: 1.29–4.21). Also determined the genotypes that contribute to resistance to the development of diseases of the respiratory system: ATM×a/A (OR=0,83; 95%CI: 0,45–1,54), ATM×A/T (OR=0,67; 95% CI: 0,38–1,21) and MLH1× a/A (р≤0,003, χ2=8,73; OR=0,43; 95% CI: 0,24–0,79).

Introduction. T e leading place in the structure of occupational morbidity of agricultural machine operators is occupied by vertebroneurological diseases, the development of which can be associated with the impact of ergonomic factors of labor activity.
T e aim of the study is to assess the ergonomic factors of working conditions on mobile agricultural machinery and to identify their impact on the formation of health disorders of agricultural machine operators.
Materials and methods. Complex physiological and ergonomic researches at operation of tractors and combine harvesters of old samples of domestic production including an assessment of the organization of workplaces on compliance to requirements of ergonomics and anthropometric data of workers, temporary, statodynamic, biomechanical characteristics of working poses and movements, a functional condition of machine operators (130 people aged 20–45 years with professional experience of work not less than three years) in dynamics of a work shift are carried out. Anthropometric studies were conducted among male machine operators (663 people) aged 18–59 years and with experience in the profession for more than three years.
Results. The discrepancy between the size and space-layout parameters of workplaces ergonomic requirements and anthropometric data of machine operators, causing the formation of uncomfortable working positions, increasing physical activity and the severity of the labor process. A high degree of correlation between changes in the parameters of the neuromuscular system and the severity of the discrepancy between the ergonomic parameters of anthropometric characteristics of machine operators (r=0,7). T e results of the research allowed to determine the priority measures for the prevention of vertebroneurological diseases in agricultural machine operators.
Conclusions. T e organization of workplaces on domestic tractors and combine harvesters of old samples does not meet the ergonomic requirements and anthropometric data of machine operators, which is the reason for the formation of an uncomfortable working posture, increased statodynamic physical activity, early development of fatigue and fatigue in the process, which can cause the development of pathological conditions of the spine and ligamentous apparatus. Ergonomic improvement of workplaces is one of the priority measures to preserve the health of agricultural machine operators.

Introduction. In the production of aluminum, one of the main adverse factors is the air pollution of the working area with f uorine-containing compounds and dust-gas-aerosol mixture, the impact of which can lead to health problems in workers. When establishing the connection of morbidity with the profession, it is important to assess the exposure loads of harmful substances. T is aspect of research in the aluminum industry is not suf iiently covered in the literature.
T e aim of the study is to quantify the exposure loads of priority toxicants in workers of the main professions of aluminum production, depending on the applied technologies of aluminum electrolysis.
Materials and methods. Exposure loads (EL) of chemicals at workers of aluminum production were calculated taking into account the data of a long-term assessment of the working area air for the content of the main harmful substances in workshops with technology of self-baking anode (TSA) and modernized using technology of prebaked anode (TPA).
Results. It has been established that with the use of the traditional electrolysis technology (TSA), the average annual EL indicators in the professions of the electrolysis cell, anodechik and crane operators f uctuated noticeably in the dynamics of long-term observation, exceeding the indicators of the control EL. It is shown that the modernized electrolysis technology (TPA) allows to reduce the EL indicators of chemicals, with the exception of hydrof uoride — one of the priority components of the chemical factor. T e actual EL indicators of this substance in the professional groups did not depend on the applied electrolysis technology and, as before, exceeded the EL control indicators.
Conclusions: Calculations of EL by harmful substances in the production of aluminum have shown that when using TSA, electrolysis cells and anodetes experience the greatest EL, exceeding control indicators, and the lowest  — crane operators. T e transition to a modernized TPA leads to a decrease in the EL indicators, with the exception of the hydrof uoride, a priority component of the chemical factor.

In various sectors of the economy, heavy physical labor remains a leading risk factor for injury, the development of occupational and occupational diseases, including musculoskeletal system. A signif cant proportion of pathologies are diseases of the musculoskeletal system of the shoulder girdle, leading to temporary disability, loss of working time and increased economic costs. T e use of industrial exoskeletons will increase the level of automation of production operations and is relevant in industries where the employee is an integral part of the labor process. T e introduction of industrial exoskeletons will reduce the burden of labor by optimal redistribution of load on various parts of the musculoskeletal system. T e industrial exoskeleton is an external mechanical support structure that at aches to the human body by means of cuf s and is designed to assist in performing production movements. T e most ef ective for unloading the muscles of the upper body of the employee are industrial exoskeletons aimed at holding a heavy tool and maintaining an optimal working posture. Most of the available industrial exoskeletons tested at the enterprises are passive, in the future it is necessary to develop light mobile active exoskeletons with dimensions optimal for the working space. T e actual direction of research is the substantiation and development of requirements for the design of industrial exoskeletons, standardized criteria and methods for assessing their safety and ef iiency of protecting the employee from the ef ects of physical overload, which is a harmful production factor.

 Emergency medical workers can be at ributed to specialists of extreme prof le of activity, as their work is associated with a variety of stress factors. 44 paramedics of the Arkhangelsk region (mean age 38.1±10.8 years, M±σ) were examined in order to identify the features of occupational stress in the activities of emergency medical personnel (NSR). T e following methods we used: scale of organizational stress, Mak-Lin, the questionnaire «At itude to work and professional burn-out» Vinokur V.A., test Ch. Spielberger, coping test of R. Lazarus and S. Volkman, a method of studying the risk appetite Shmelev A.G., projective test «Nonexistent animal», a method of assessing the psychological atmosphere in the team. It is established that during the performance of professional duties more than 2/3 of paramedics emergency medical care are of en faced with stressful situations; every third employee is threatened with life or danger of injury, injury in the process. More than half of the respondents have a high level of professional stress and burnout, 40.5% — use non-adaptive coping strategies in the f ght against intractable situations, and 1/5 — there is a high rate of situational anxiety and aggressiveness. T e directions of prevention of occupational stress in paramedics ambulance.

Working conditions of employees of mining enterprises are characterized by class 3 (harmful) 2–4 degrees, which determine the level of occupational disease. T e highest rate of occupational morbidity (111.2 cases per 10 thousand workers who have undergone periodic medical examinations) occurs in mine workers, and it is signif cantly higher than in quarry workers. In underground workers in the structure of occupational disease, the f rst place is occupied by diseases of the bronchopulmonary system (30.1%), in quarry workers — vibration disease (48.3%). T ese enterprises have shown an increasing trend in recent years of deaths in the workplace, mainly from diseases of the cardiovascular system.

A method for measuring the mass of dust inhaled per change at multiple one-time concentration measurements is presented. It is shown that the results obtained using the average concentration are unreliable. Recommendations for a reliable measurement of the mass of dust that enters the lungs per shif .

Introduction. In pulmonology dust bronchitis is regarded as a primary process that is not associated with coniotic pneumonia. Modern studies point to the pathogenetic and pathomorphological unity of friendly coniotic manifestations in the lungs and bronchi, leading to the understanding of pneumosclerosis from the position of epithelial-mesenchymal transformation.
T e purpose of this study was to histogenetic aspects coniotic process of coal industry employees having dif erent work experience in the conditions of dusty working environment.
Materials and methods. Histological and morphometric study of lung and bronchial compartments obtained during forensic examinations of 80 miners of dif erent experience groups and 20 persons of the control group was carried out. In addition, an immunohistochemical study of biopsy and autopsy materials of the bronchi of 60 miners with work experience from 5 to 30 years was carried out to determine non-core proteins vimentin, desmin and actin in the epithelial component.
Results. It is revealed that the interalveolar partitions of miners with experience from 1 year to 5 years are thickened. The development of peribronchial f brosis is noted, the muscle layer of the air-conducting structures is hypertrophied, the basalmembrane is thickened. In the bronchi epithelium f at ened. Pulmonary vessels with hypertrophy of media, endothelial cells increased. In perivascular spaces there is a proliferation of f brous tissue. T e pleura is slightly thickened. Coal dust deposition is observed in all structures. In miners with work experience from 5 to 10 years, the changes progress, the epithelium of the bronchi with subatrophy phenomena. With an increase in internship up to 10–20 years in the respiratory part of the lungs, small areas of sclerosis are formed. In the wall of the bronchi there is a proliferation of connective tissue f bers. Miners with experience more than 20 years in the lung tissue develops a pronounced f brosis. T e air-conducting structures are characterized by hypertrophy of the muscular plate, thickening of the basal membrane, f brosis of the peribronchial tissue and the bronchial wall, the mucous membrane is sharply f at ened. T e pulmonary vessels have thickened walls due to hypertrophic and f brotic changes of the deformation. T e pleura is f brous, thickened. The immunohistochemical study of the bronchi of miners showed that, depending on the length of work in the mucous membrane, the area of expression of vimentin, desmin and actin increases.
Conclusion. T e simultaneous development of the same type of pathological changes in the bronchi, vessels of the small circle of blood circulation and respiratory tissue indicates a pathogenetic community of changes in pneumoconiosis. As a result of the immunohistochemical reactions for the detection of non-specif c epithelial cells of the bronchi proteins obtained clear of selective coloring Chromogen. Based on the calculated percentage of their expression area, we can talk about the degree of f brous transformation.

The results of comparative studies of the long-term ef ect (dynamics) of polymetallic dust containing 0.6% copper in the shops of Balkhash mining and metallurgical combine on the liver of rats are presented. These data on the action of dust with a predominant copper content of 0.6% give reason to assert that in the liver for 30 days there were changes in the structure, which were ref ected by metabolic rearrangements and are characterized as a failure of adaptation. The phenomena of hepatitis also took place on day 90, but these changes led to a decrease in the rate of metabolic processes. Microscopic examination showed that long-term exposure to polymetallic dust with a copper concentration of 0.6% in the body leads to signif cant changes in the liver reactive character, followed by transformation into hepatitis portal type. There is an accumulation of copper in the cytoplasm of hepatocytes; on day 90, the number of dust particles in rat hepatocytes increases by 2.25 times compared to 30 days of the experiment. T is can be explained by the inhibition of the phagocytic function of liver macrophages and ways to eliminate dust from the body. The lat er, in turn, leads to functional and metabolic damage to the structural component of the organ. It should be noted that an important role in the neutralization and removal of copper from the cell belongs to lysosomes. T ere is an assumption that copper damages lysosomal membranes and stimulates the release of enzymes from lysosomes due to a decrease in the number of mitochondria in the cell or inhibition of their enzymes.
Thus, the ef ects of polymetallic dust with a copper concentration of 0.6% in the body in the early stages leads to changes in the liver, in the form of reactive hepatitis with subsequent transformation into portal-type hepatitis. The use of alimentary corrections slows down the development of post-necrotic f brosis in the liver, and there was a signif cant decrease in the volume fraction of f brotic liver tissue.

The analysis of the loss of years by YLL (Years of Life Lost) from the mortality of the population in the age and sex aspect of nosology class of diseases of the circulatory system in industrial regions of East Kazakhstan and Karaganda regions of the Republic of Kazakhstan (RK). In the dynamics for 2011–2014, a decrease in mortality was established, which is associated with an increase in the quality of medical care.