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The aim of the study was to evaluate the clinical manifestations and survival of patients with giant cell arteritis (GCA).Methods. A retrospective study included 166 patients with newly diagnosed GCA. Clinical, laboratory and instrumental data, three sets of classification criteria were used to confirm the diagnosis: the American College of Rheumatology (ACR) 1990, the revised ACR criteria of 2016 and/or the new ACR and European Alliance of Associations for Rheumatology (EULAR) 2022 criteria. Some of the patients underwent instrumental investigations: temporal artery ultrasound Doppler (n=61), contrast-enhanced computed tomography (CT) (n=5), CT angiography (n=6), magnetic resonance imaging (n=4), magnetic resonance angiography (n=3) and 18F-FDG positron emission tomography/CT (n=47). Overall and recurrence-free survival were analyzed using survival tables, Kaplan – Meier method.Results. The most frequent first manifestations of GCA were headache (81.8%), weakness (64%), fever (63.8%) and symptoms of rheumatic polymyalgia (56.6%). Changes of temporal arteries in color duplex scanning were detected in 44 out of 61 patients. GCs therapy was performed in all patients who agreed to be treated (n=158), methotrexate was used in 49 out of 158 patients, leflunomide – in 9 patients. In 45 (28.5%) out of 158 patients a stable remission was achieved as a result of GCs monotherapy, in 120 (75.9%) patients long-term maintenance therapy with GCs was required to prevent exacerbations, including 71 (44.9%) patients – in combination with methotrexate or other immunosuppressive drugs. The follow-up period of patients with a history of relapses was 21.0 (8.0–54.0) months. Relapses developed in 73 (46.2%) patients. The overall one-year survival rate was 97.1% [95% confidence interval (CI): 94.3; 99.9], and the five-year survival rate of patients was 94.6% [95% CI: 90.2; 99.0]. The one-year relapse-free survival rate was 86.4% [95% CI: 80.5; 92.3], and the five-year relapse-free survival rate was 52.4% [95% CI: 42.0; 62.8]. 12 (7.2%) of 166 patients died. The cause of death was myocardial infarction in two patients, stroke in two patients, and breast cancer in one patient; in the remaining seven cases, the cause of death was not determined.Conclusion. Given the high frequency of disease exacerbation, patients with GCA require long-term follow-up, especially during the first year after diagnosis.

In recent decades, the prevalence of osteoarthritis (OA), one of the most disabling diseases, has increased worldwide, which imposes a significant burden on society. At the international multidisciplinary meeting, experts of various specialties (rheumatology, neurology, endocrinology, geriatrics, rehabilitation, traumatology and orthopedics) from Russia, Uzbekistan, and Kazakhstan discussed the importance of an individualized approach to the treatment of patients with OA, taking into account comorbidities, identified the most important and common clinical phenotypes of the disease, discussed known symptom- and structure-modifying effects of a combination of glucosamine and chondroitin sulfate, and new data on additional (pleiotropic) effects of these drugs that may have a positive impact on the course of comorbid diseases and conditions. The resolution of the Expert Council summarizes the results of the discussion and focuses on issues that are important for the further development of therapeutic approaches and recommendations for the management of such patients.

Osteoarthritis (OA) is the most common joint disease due to the increasing life expectancy of the world's population. Every 2nd patient over the age of 50 suffers from knee or hip OA, and this is directly related to the increased burden on healthcare. Accumulated data on the comorbid profile of patients with OA dictate the need to identify disease phenotypes in order to provide personalized care. Individual clinical manifestations of OA also require a differential approach: the pain treatment requires consideration of the patient's psycho-emotional profile and the possibility of involving nociceptive pathways in the process. However, due to the ambiguity of existing clinical guidelines, most experts note a number of difficulties in prescribing treatment for patients with OA.The resolution presents an agreed opinion of experts on the algorithms for managing patients with OA, starting from the primary level, with the gradual involvement of related specialists. Some issues of a personalized approach are considered depending on the presence of comorbid pathology and the severity of individual symptoms of the disease. The prospects of the combined use of pharmacological and non-drug methods of treatment are noted; emphasis was placed on the importance of rehabilitation measures at the first level of medical care, provided to patients with OA, long before the development of structural changes.The proposed algorithms for managing patients can be considered as the basis for future recommendations for managing patients with this pathology.

Abstract The active channels in AlGaN/GaN‐based heterostructures are studied under different applied electrical fields to identify the Joule heating factors affecting the temperature values in the channels. The temperature in active channels of two different lengths (30 and 180 µm) is characterized using optical methods, and electrical methods are used as a reference. The technique of optical thermometry is based on the data of micro‐photoluminescence and micro‐Raman experiments. The electrical method is based on the measurements of current–voltage characteristics for comparison. It is shown that photoluminescence‐ and electrical‐based temperature values demonstrate similar behavior and good correlation. The Raman‐based method, exploiting the temperature dependence of the frequency position of E2high vibrational band in GaN, shows a significant deviation compared with electrical‐ and luminescence‐based methods. This deviation is shown to be related to the residual mechanical strain in the layered structure and the formation of hot phonons. The influence of hot phonons and mechanical strain effects increases at high electrical load (>5 kV cm−1) and at high temperatures (>400 °C), respectively.

The main symptoms of osteoarthritis (OA) are pain and dysfunction of the joints. Neuropathic pain (NP) occurs in more than half of patients with OA, it is refractory in nature and is the cause for seeking medical advice more frequently, poor quality of life and disability.Objective: to evaluate the frequency of NP and its relationship with geriatric syndromes (GS) in patients with OA aged 65 years and older. Patients and methods. The subanalysis of the study EVKALIPT included 2286 patients with OA and chronic pain syndrome. All patients underwent a comprehensive geriatric assessment (CGA) and diagnostics of NP using the DN4 questionnaire.Results and discussion. The prevalence of NP in patients with OA was 22.7%. Patients with OA and NP more often experienced pain of any localization with a large number of tender points, they had a higher frequency and intensity of pain syndrome, they more often took analgesics and noted limitations in daily life. When conducting a correlation analysis, correlations of medium strength were found between the sum of scores according to DN4 questionnaire and the pain intensity assessment on a numerical rating scale at the time of examination (r=0.26; p

Objective: To study the levels of heat shock protein 70 (HSP70) and annexin V-dependent apoptosis of cells in myocardial infarction (MI) with a different course of the disease and in the setting of chronic obstructive pulmonary disease (COPD).Materials and Methods: Sixty-five patients with MI were examined; 37 of them developed MI in the setting of COPD, and 28 patient had MI without COPD. The subjects were divided into subgroups depending on the presence of ST segment elevation. The control group included 30 somatically healthy individuals.Results: In all examined patients with MI and in patients with MI with COPD, the number of annexin V-associated apoptotic cells and the level of HSP70 was statistically significantly higher than in healthy individuals. The value of the studied biomarkers was statistically significantly higher than in patients without COPD. In patients with MI with ST segment elevation, the values of the studied biomarkers were statistically significantly higher in patients without ST segment elevation in all the examined patients.Conclusions: Higher values of the studied biomarkers in the group of comorbid patients compared with those with MI without COPD may be associated with intensified apoptosis in the setting of chronic systemic inflammation, which worsens the clinical course of both diseases. The greater significance of the levels of HSP70 and annexin V-dependent cell apoptosis in patients with MI with ST segment elevation compared with patients without ST segment elevation is due to the volume of myocardial lesion.

Objective: to assess the structure and influence of chronic pain (CP) on the functional status of patients with geriatric syndromes.Patients and methods. The study included 370 geriatric patients who were divided into two groups. Group A included 300 patients (mean age 75.1±8.25 years) with CP, and group B – 70 subjects of comparable age (75.1±7.75 years) without CP. All study participants were found to have polymorbidity: the Charlson index was 5.55±1.59 points in group A and 5.56±1.64 points in group B (p=0.963). All patients underwent a comprehensive geriatric assessment (CGE) to determine the functional status and diagnose geriatric syndromes.Results and discussion. According to the CGE data, senile asthenia syndrome was detected in 127 (42.3%) patients with CP and in 20 (28.6%) patients without CP (p=0.035). The average number of geriatric syndromes in group A was 7.06±2.68, in group B – 5.2±1.8 (p

The review examines the epidemiology and clinical manifestations of COVID-19 long-term neurological effects, main pathobiochemical mechanisms, and integrated circuits of redox status impairment in COVID-19, such as the decrease of adenosine triphosphate production, fatty acids levels, acylcarnitine, and amino acids, impairment of oxidative phosphorylation and glycolysis, hypometabolic state, redox imbalance with the increase of peroxides and superoxides, isoprostanes, the decrease of α-tocopherol, substances reacting with thiobarbituric acid, increased nitrosative stress with the increase of inducible synthase of nitric oxide, nitric oxide, peroxynitrite, and nitrate. Neuroprotective approaches aimed at suppressing excitotoxicity, oxidative stress, and neuroinflammation are presented. Recent data on the relationship between mechanisms of chondroitin sulfate and its derivatives (chondroitin sulfate glycoprotein disaccharide) neuroprotective effects and characteristics of their chemical structure are analyzed. The mechanism of action and neuroprotective effects of chondroitin sulfate and its derivatives in fatigue syndrome in patients with SARS-CoV2 infection are discussed (regulation of the PKC/PI3K/Akt activity, the increase of heme oxygenase-1 level, the decrease of reactive oxygen species). The position that chondroitin sulfate and its derivatives can become promising drugs to prevent the long-term neurological effects of COVID-19 is reasoned.

The review of medical literature is devoted to modern data in the field of diagnosis and treatment of osteoarthritis using endo- and phenotyping. It includes the latest data on the epidemiology of osteoarthritis of different localizations, modern definitions and classifications of osteoarthritis endotypes and phenotypes, pathobiochemical patterns and pathomorphological parallels of disease phenotypes, new methodological approaches to the phenotyping of osteoarthritis (prognostic, prescriptive phenotyping, alternative methods), as well as modern advances in pharmacotherapy of the disease based on data from selected randomized controlled trials and meta-analyzes.

Over 10 million operations are performed each year in Russia. A successful surgical treatment demands assessment and mitigation of perioperative risks, one of which is anemia. Patients with low hemoglobin are at greater risk of developing complications and adverse outcomes. These patients more often stay longer at hospitals, have more in-hospital events and readmissions.Perioperative anemia may be present before surgery, low hemoglobin levels can result from surgery, and can persist after hospital discharge. Preoperative anemia is associated with inferior surgical outcomes and is also an independent risk factor for perioperative complications (acute kidney injury, infectious, thromboembolic, cardiovascular events) and death. Postoperative anemia impairs recovery and increases the risk of reoperations and readmissions.Absolute and functional iron deficiency is the most common cause of anemia in the perioperative period. The prescription of iron supplements is indicated in the presence of iron deficiency. If the operation is scheduled to be performed in 6 weeks and longer, the prescription of oral iron forms is recommended. If less than 6 weeks remain before surgery, parenteral iron therapy is prescribed. If hemoglobin levels increase insignificantly during such therapy, high-dose iron supplements are indicated. When it comes to emergency surgery and the anemia is not severe, it is recommended to intravenously administer high-dose iron supplements immediately before surgery. In case of severe anemia, blood transfusion is indicated. According to the patient’s blood management concept, blood transfusion should be minimized, including due to the use of high-dose iron supplements, one of which is ferric carboxymaltose.The choice of treatment for anemia in the postoperative period depends on its severity, the patient’s comorbidities, the type of surgery and the presence of surgical events. In most cases, early intravenous iron therapy is recommended, giving priority to single administration of high-dose iron supplements. Blood transfusion is indicated to patients who have severe anemia, are actively bleeding, and to patients with a severe anemia after the bleeding has been stopped. Iron therapy continues at the outpatient stage of treatment for a long time until the hemoglobin and ferritin levels are normalized, reflecting the replenishment of iron stores in the depot organs.

The article is devoted to an urgent issue - rheumatoid arthritis (RA). The symptoms of arthritis appear in women during menopause. Literature data show that it is often during period of poor reproductive function that the disease first manifests itself in women. RA significantly affects the prognosis of women’s life expectancy and quality. The clinical and pathogenetic relationships between autoimmune diseases (one of which is RA) and the features of menopause remain poorly understood and require research. Basically, papers devoted to the problem present epidemiological studies and the study of the relationships between sex hormones levels and inflammatory mediators that are specific to RA.A literature review on the features of the onset and course of rheumatoid arthritis in menopausal women is presented. The most accepted in the literature explanations characterizing the relationship between changes during menopause and RA are arguments about the protective effect of estrogens on the cells of the musculoskeletal system and the ability of estrogens to influence the intensity of inflammation (systemic inflammation of low intensity associated with age). In the case of the development of rheumatoid arthritis in old age, higher levels of IL-6 and lower TNFa are revealed. This fact gives rise to the choice of basic therapy in favor of a humanized monoclonal antibody to the human interleukin-6 receptor - tocilizumab.The review may be of interest to both practising rheumatologists, neurologists, and gynecologists and general practitioners.

Osteoarthritis (OA) is the most common pathology of the musculoskeletal system and is a serious medical and social problem. OA is of particular importance in elderly and senile people due to the high frequency of comorbid pathology. Pain relief is a priority in the formation of individual therapeutic programs for patients with OA, starting from their first request for medical assistance. At the same time, due to the ambiguity of existing clinical recommendations, most experts note a number of difficulties in prescribing treatment for patients with OA.The article presents a consensus position of experts regarding a complex approach to the choice of therapy in patients with OA at the initial visit to the doctor. The article discusses: current clinical guidelines for the management of patients with OA; most common problems in the management of patients with OA in real clinical practice; goals of treatment strategies for OA taking into account the risk factors for its progression; an algorithm of pain relief during initial treatment in patients with OA; prevention of OA exacerbations with the use of basic structure-modifying drugs; recommendations for the choice of non-steroidal anti-inflammatory drugs.According to experts, a rational approach to the treatment of OA is based on the combined use of non-drug and pharmacological methods with constant monitoring of therapy regimens and side effects. These recommendations can be considered disease-modifying strategies that in many cases allow improving functional status and achieving long-term remission in patients with OA.

The article presents current data on synovitis (inflammation of the synovial membrane), which is often the only clinical manifestation of osteoarthritis (OA), and considered to be one of the risk factors for the OA development. Synovitis severity correlates with the severity of OA symptoms. The assessment of the prevalence of synovitis presents significant difficulties and depends on the nature and severity of the disease, the cohort in question, diagnostic method, and therapy. The classification based on etiological, clinical and histological characteristics of synovitis is presented. Examination of synovial tissue characteristics and its changes during inflammatory response can significantly expand the possibilities for therapy and prognosis. The use of symptomatic delayed-action drugs (SYSADOA) is considered as the basic treatment of OA. Chondroitin sulfate (Chondroquard®) is one of the well established drugs, it has symptom- and structural-modifying properties. The article presents the results of studies confirming its effectiveness in reducing the severity of knee synovitis.

Objective: analysis of the osteoarthritis (OA) comorbidity taking into account the microelement status and genetic polymorphisms of the examined patients, determination of the prospects for the OA prevention and therapy.Material and methods. A cross-sectional study of a multiethnic cohort (n=655, mean age 43±14 years, 95% CI 29–70) formed on the basis of the Institute of Microelements database, was carried out. For all participants, the content of the 62 elements of the Element Periodic Table profile in hair was identified and variants of 120 nucleotide polymorphisms associated with various pathologies were definedResults. The study found that 18 of the 27 ICD-10 diagnoses examined were comorbid with OA. Osteoarthritis was comorbid with pathologies with a pronounced component of inflammation (ulcerative colitis, atherosclerosis, unspecified encephalopathy, obesity, diabetes mellitus, essential (primary) hypertension, urine calculus, acute myocardial infarction, cholelithiasis, etc.). The core of OA comorbidity was established, which included following pathologies: chronic cerebral ischemia, diabetes mellitus, thrombophlebitis, atherosclerosis, cholelithiasis. Seven profiles of the most frequent combinations of these diagnoses were identified. The presence of 2 out of 5 of these pathologies was recorded in 92% of patients with OA (n=50) and only in 2% of control patients (n=600), which corresponded to an extreme increase in the risk of OA (OR 56.3, 95% CI 17.4–181.6, p

Objective: study the duration of establishment of functional stability to non-specific stress in wrestlers.Materials and Methods. Nineteen athletes in martial arts, mid-age 23 ± 3 years of age, participated in the study. The qualification level of the subjects ranged from first sport grade to Master of Sport. A series of sports training was organized within 4 weeks. Each train consisted of a smooth-running load of 40 minutes at a speed corresponding to the anaerobic exchange threshold (AET). The indicators of the duration of reaching the AET level by heart rate (HR), the power of the low frequency and high frequency component of the spectrum were analyzed.Results. The effect of urgent adaptation, in the form of an extension of the duration the heart rate on the anaerobic threshold level from 29 to 32 mines and the increase in the regulation of vegetative nervous system by increasing the total power of the spectrum observed on the third day of the training cycle. From the third to ninth days of the study, fatigue occurs, as can be seen from the lowering of the anaerobic threshold time to 21 minutes, as well as the lowering of the high-frequency part of the vegetative nervous system regulatory spectrum. The emergency adaptation ends by 9 days of observation, after four high-intensity exercises, which manifests itself in stabilizing the regulation of the heart rate, vegetative nervous system goes from a reflex level to a lower one — a humeral metabolic level. The time to reach the HR in the aerobic threshold will stabilize at 21–23 minutes.Conclusions. Functional stability to the non-specific aerobic load in the wrestlers emerged by the twentyseventh day of the study after ten highly intensive aerobic exercises, which confirmed by the results of the time dynamics of the tine of HR in aerobic threshold and analysis of spectrum results of HRV.

The article focuses on the review of a pharmacotherapeutic approach to the therapy of hand osteoarthritis (HO). Apart from non-steroid antiinflammatory drugs (NSAID), promising therapeutic means of HO therapy include steroid drugs, chondroitin sulfate (CS), glucosamine sulfate (GS), and vitamin D. Transdermal application of NSAID and steroid drugs reduces the side effects without a decrease in the effectiveness of the therapy. Reconstructive therapy of cartilaginous and connective tissue of hands includes a long-term application of CS/GS, and in the acute period, injections of CS/GS.

Aim. A meta-analysis of 8 controlled studies (n=771, age 53.6±6.2 years) of tie use of tie Chondroguard (100 mg i.m. first 3 injections, from tie 4th injection - 200 mg i.m., EOD, course 20-30 injections) in the complex therapy of osteoarthritis (OA).Materials and Methods. Tie meta-analysis according to tie fixed-effects model included all published clinical studies on tie efficacy and safety of the CG drug in OA). The effectiveness of therapy was assessed using the VAS, Lequesne, WOMAC scales/indices. For each study, information was collected on 23 features. Data analysis was carried out using the MEDSTUDY and "R" software packages.Results. Meta-analysis confirmed significant associations between the use of Chondroguard (CG. and pain reduction assessed by the visual analog scale (V)S. - CG: a decrease in pain intensity by -28.3 points, control: -11.6; p=0.042. There was a significant reduction in pain according to VAS at night (CG: -20.1; control: -9.9; p=0.05018., while sitting or lying down (CG: -15.5; control: -7.6; p=0.01656., when walking (CG: -28.2; control: -17.0; p=0.04957). The use of CG led to a significant decrease in the scores of the Lequesne index (CG: -4.3; control: -1.4; p=0.0349., and of the WOMAC index (CG: -338.4; control: -219.8; p=0.004., including WOMAC "function" (CG: -247.8; control: -96; p=0.0027., and WOMAC "stiffness" (CG: -25.4; control: -11.2; p=0.0462.. The incidence of side effects did not differ significantly from the control.Conclusion. Chondroguard is an effective treatment for osteoarthritis and has a good safety profile.

Introduction. The pharmaceutical drugs used in the treatment of osteoarthritis (OA) differ not only in the mechanisms of anti-inflammatory action but also in the effects on the human microbiome.Purpose. Evaluation of the influence of some drugs used in the therapy of OA on the human microbiome by the method of chemoinformation analysis.Materials and methods. Сomparative chemomicrobiome analysis of glucosamine sulfate (GS), diclofenac, acetylsalicylic acid (ASA), and three prebiotics (lactose, lactulose, fructose) as molecules of comparison. For each substance, estimates of the area under the curve (AUC) were obtained for a representative sampling of human microbiota (38 commensal bacteria). The minimum inhibitory concentrations (MIC) were established for more than 120 pathogenic bacteria.Results. On average, according to a representative sampling of microbiota, the profile of the action of GS on the microbiome was almost identical to the profile of the action of lactose (AUC=0.23±0.18). The most effective growth of the microbiome was provided by fructose and lactulose (AUC=0.58±0.21). The effects of diclofenac and ASA on the commensals of microbiome were comparable to the effects of GS (AUC=0.27±0.22). However, the analysis of the obtained MIC values for pathogenic bacteria showed that diclofenac supported the growth of the pathogenic flora (MIC=35±1.4 μg/ml) to a greater extent than GS (MIC=16±1.5 μg/ml) and ASA (MIC=23±2.2 μg/ml).Conclusion. The effects of GS on the microbiome are comparable to the effects of the prebiotic lactose whereas the inhibitory effect of GS and ASA on pathogenic bacteria is more pronounced than that of diclofenac. The inhibition of pathogenic bacteria by the GS helps to reduce inflammation.

Objective: To study and analyze serum levels of interleukins (IL): IL-1β, IL-2 and IL-6 in patients with myocardial infarction and chronic obstructive pulmonary disease.Materials and methods: In 85 people were examined: 28 patients with myocardial infarction, 37 patients with comorbid pathology (myocardial infarction and chronic obstructive pulmonary disease) and 20 somatically healthy volunteers as a control group. Determination of IL-1β, IL-2 and IL-6 levels was basing on enzyme immunoassay.Results: The median and inter-percentile range of IL-1β, IL-2 and IL-6 in the donors did not differ significantly from the data of the manufacturer. In the group of patients with myocardial infarction and in patients with comorbid pathology a statistically significant increase in the level of median and inter-percentile range of cytokines was revealing compared with the control group. The highest levels of IL-1β, IL-2 and IL-6 were detecting in the group of patients with comorbid pathology. IL-6 was found to be an independent marker of increased risk of STEMI and an increase in its concentration later than 12 hours after hospitalization is associated with the risk of future cardiovascular death or new myocardial infarction.Conclusion: Analysis of the dynamics of the level of IL-1β, IL-2 and IL-6 has a high prognostic value in patients with myocardial infarction and in patients with comorbid pathology.

in 3 mL on patients with knee osteoarthritis (OA) in a multicenter prospective study. Materials and methods. 79 outpatients (predominantly females 81.0%) from 5 RF constituent territories with primary tibiofemoral KellgrenLawrence score grade II or III knee OA, 40 mm pain intensity during walking on visual analogue scale (VAS), requiring NSAIDs intake (for at least 30 days during 3 months prior to enrollment) were included into the study after signing the informed consent form. Mean age was 60.38.7 years, mean BMI 29.24.7 kg/m2, disease duration 6 (310) years. Grade II OA was documented in 68.4% of patients, Grade III in 31.6%. The study lasted for 6 months. Efficacy and safety evaluations were made based on VAS pain assessment, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [WOMAC pain (0500), WOMAC function (01700), WOMAC stiffness (0200)], VAS patients health status, EQ-5D-based assessment of patients quality of life, global physicians and patients efficacy assessment, and daily NSAIDs requirements. Results. Obtained results demonstrate statistically significant VAS pain reduction during walking already in 1 week after intra-articular injection of the combination [respectively, 62 (5572) and 41 (3251) mm, р0.0001]. Moreover, pain continued to subside during all 3 months of follow up [in 1 month 28 (2042), in 3 month 22 (1437) mm]. A significant pan reduction achieved at Mo 3 persisted until Mo 6 20 (1442) mm, without documented pain increase. Similar trends were observed with total WOMAC score [1125 (8991540) at baseline, and 552 (309837) mm by the end of the study, p0.0001], and all WOMAC sub-scores [268 (189312) baseline WOMAC pain, 91 (48171) mm by the end of the study p0.0001; stiffness 101 (59130) and 40 (2061) mm, p0.0001; function 802 (6471095) and 402 (191638) mm, p0.0001, respectively]. Median time to the onset of therapeutic effect was 7 (518) days. Statistically significant improvement of patients quality of life by EQ-5D and general health status was observed during all follow up period [respectively, 0.52 (-0.020.59) and 0.69 (0.590.80), р0.0001; 48 (3060) and 72 (6080) mm, р0.0001]. One injection of the drug resulted in dose reduction or discontinuation of NSAIDs therapy: at baseline 76 patients (96.2%) were taking NSAIDs, in one week 31 (39.2%) patients discontinued NSAIDs, in 1 month 72.2%, in 3 months 73.4%, and by the end of the study at Mo 6 54.4% were not taking NSAIDs. These data were consistent with physicians and patients global assessment of the efficacy of treatment, who stated significant improvement and improvement in the majority of cases, with only few no effect or worsening cases documented in analyzed population. Adverse events, such as worsening of pain and/or swelling of the joint, were documented in 8 patients (10.1%); they resolved spontaneously or following NSAIDs intake. Conclusion. These results suggest that intra-articular injections of hyaluronic acid plus chondroitin sulfate in patients with knee OA are efficient and safe. A single injection of the drug resulted in statistically significant reduction of pain and stiffness, reduction in NSAIDs intake, as well as improvement in patients quality of life and function.

Glucosamine is part of the human metabolome required for the biosynthesis of polymer glycosaminoglycans in connective tissue. In addition, the glucosamine molecule itself has anti-inflammatory and regenerative properties. This paper presents the results of a systematic analysis of fundamental and clinical studies, which indicate the anticoagulant and antiaggregatory effects of a highly purified pharmaceutical substance of microcrystalline glucosamine sulfate (mGS). The main molecular mechanisms of its antithrombotic effects are most probably the mGS molecular mimicry of heparan sulfate activity, the activation of CD44 receptor, and the inactivation of the NF-KB signaling pathways in platelets. A quantitative chemoreactome study has shown that the antithrombotic effects of mGS in the human reactome are due to the inhibition of: ’) proper platelet aggregation; 2) platelet adhesion and activation receptors; 3) endogenous synthesis of thromboxanes; 4) coagulation by reducing the activity of coagulation factors.

Chronic pain among the elderly aged 60 years and above is one of the «big» geriatric syndromes, and has great prognostic significance in relation to cognitive, functional and physical status.The loss of muscle strength, mass (sarcopenia) is one of the important components of chronic pain syndromes in elderly patients. Pathological findings were demonstrated by own observation of 116 patients in the geriatric unit aged 75,667.98 years (110 women, 94.8%). Most patients had a combination of several geriatric syndromes, an average of which accounted for 6.6. Among them, there were falls - 72 (62.1%), chronic pain - 85 (73.3%), senile asthenia - 51 (43.9%), etc. In most cases, chronic pain was due to osteoarthritis. According to the dynamometry data, a decrease in muscle strength was found in 45.9% of cases, without chronic pain syndrome in 9.7% of cases among patients with chronic pain syndrome. Thus, prevalence rates of decreased muscle strength were higher in patients with chronic pain, than in patients without pain. In addition, a significantly lower walking speed was found, which indicates a poor prognosis in patients of older age groups.Sarcopenia and chronic pain treatment programs for elderly patients contain a number of evidence points: therapeutic exercises, adequate intake of calories and protein, vitamin D3, reduction of the number of drugs, chondroitin sulfate (Chondrogard), glucosamine sulfate (Sustagard Artro). This program, being multicomponent, should be long and regular.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most effective medications in modern pharmacotherapy. At the same time, it has been established that NSAIDs can cause cardiovascular diseases. Glucosamine sulfate (GS) is used in the therapy of osteoarthritis and, according to experimental data; it can exert an antithrombotic effect. This paper evaluates the antithrombotic effects of GS and a number of NSAIDs (such as, acetylsalicylic acid (ASA), dexketoprofen, diclofenac, and meloxicam) through chemoreactome analysis. It has been found that the antithrombotic effects of GS can be on average only 1.5—3 times weaker than those of the NSAIDs studied. The findings may suggest that GS can enhance the antithrombotic effect of ASA, in particular in the presence of cardiovascular disease in patients with osteoarthritis.

In the process of technogenesis during placers mining, rocks and minerals extracted from the bowels change their composition and properties, adapting to new environmental conditions. Release, dissolution, transfer, regeneration and reduction (coarsening) of gold-bearing phases occur. The authors studied some parameters of the distribution and forms of the location of gold and platinoids in different mines of the Urals, Siberia, Canada, and Uzbekistan. Fine gold particles in technogenic placers have been investigated. Recommendations for managing the formation of high concentrations of gold in technogenic and mineral formations have been developed.

A novel coronavirus infection SARS-CoV-2 (COVID19) is especially dangerous for elderly and senile patients. Preventive measures for elderly people should cover three areas: 1) direct prevention of the viral infection, 2) preservation of the functional status and prevention of geriatric syndromes, including the use of social support measures, 3) control of comorbidities. The clinical pattern of COVID-19 in older patients may be atypical, while the mildness of symptoms (no fever, cough, shortness of breath) may not correspond to the severity of the prognosis. Delirium may be the first manifestation of COVID-19, which requires special care in its screening. Management of elderly and senile patients with COVID19 should include measures for delirium prevention, the detection and improvement of nutrition. The risk of malnutrition with sarcopenia increases with hospitalization of a patient, especially when using artificial ventilation, is associated with an unfavorable prognosis during hospitalization, accelerates the progression of senile asthenia and reduces the quality of life. Geriatric assessment is the cornerstone of determining the management of an elderly patient.

Postgenomic analysis of the effects of active ingredients of drugs involves the evaluation of the effects of relevant molecules on the transcription of genes (transcriptomes), on the changes in the activity of proteins (proteomes), and on the activity of molecular cascades (reactomes). The paper gives the results of applying the current chemoinformational approaches to the postgenomic analysis of the effects of glucosamine sulfate (GS). The main result of the investigation is to simultaneously establish the synergistic effect of GS on transcriptomes, proteomes, and reactomes. In particular, GS assists in reducing not only the transcription of genes involved in the NF-κB proinflammatory signaling cascade (NFKB2, TNFRSF1B, PYCARD, TRAF2, TNFSF12, etc.), but also the activity of proteomic proteins that transmit a signal at different levels of the NF-κB cascade (CD44, TLR4, ICAM1, NF-κB, JAK/STAT, etc.). The complex anti-inflammatory effect of GS in reducing the synthesis of proinflammatory cytokines and weakening their effects on the cells is pathogenetic in the treatment of not only osteoarthritis, but also comorbidities accompanied by chronic inflammation.

Abstract. The demographic aging of the population of the earth observed in recent years is associated, inter alia, with the advent of new effective and safe medicines. However, the availability of highly effective drugs on the market also has a reverse side — the appearance of adverse drug reactions (ADRs), in particular as a result of drug-drug interactions. The use of non-pharmacological methods of treatment and prevention of diseases seems particularly relevant for patients of the older age group, as it allows not only to reduce the drug burden, to reduce the risk of ADRs but also to improve the patient’s state in case of diseases that have no effective pharmacotherapy and pharmacological prophylaxis. The aim of the study was to systematize and analyze data on non-pharmacological treatment methods in order to increase the safety of pharmacotherapy and prevent polypragmasia in elderly patients by informing health care providers about non-drug methods of correcting significant geriatric problems. The approaches to the correction of some major geriatric problems (delirium, sarcopenia, pain syndrome), including cognitive training, physical activity, diet, frequent reorientation of patients, placement of patients in specially equipped rooms («delirium room») were presented. The use of non-pharmacological approaches can significantly improve the safety of drug therapy, reduce the risks of ADRs, improve the patient’s prognosis and quality of life, and also effectively prevent polypharmacy.

Glucosamine sulfate (GS) is essential for the regeneration of cartilaginous tissue and, in addition, it has anti-inflammatory properties comparable to those of nonsteroidal anti-inflammatory drugs (NSAIDs). Clinical trials indicate the synergism between GS and NSAIDs in osteoarthritis (OA) and other joint diseases.Objective: to estimate the degree of synergism between different combinations of GS and NSAIDs.Material and methods. A differential chemoreactome analysis was employed to evaluate the effects of GS and seven agents from the class of NSAIDs, such as ketorolac, nimesulide, diclofenac, meloxicam, dexketoprofen, celecoxib, and etoricoxib, for estimating the degree of synergism between different combinations of GS and NSAIDs.Results and discussion. Dexketoprofen is shown to enhance most effectively the anti-inflammatory properties of GS as compared to ketorolac that does this to a lesser extent. The drug should be practically used as follows: the most effective combination (GS + dexketoprofen (or GS + ketorolak) is taken at week 1 of treatment for rapid pain elimination; thereafter there may be a combination of GS and NSAIDs, the intake of which is associated with minimal adverse reactions for a longer time.Conclusion. The investigation has shown that the coadministration of GS and NSAIDs is promising in treating joint diseases.

Aim. To determine the significance of the study of neopterin as a marker of the endo-genetic toxicity syndrome in patients with myocardial infarction on the background of chronic obstructive pulmonary disease.Materials and methods. 64 patients with cardiovascular and respiratory pathology and 29 somatically healthy individuals of the Astrakhan region as the con-controlling group were examined. Patients were divided into 3 groups: the first 20 patients with myocardial infarction, the second group – 21 patients with chronic obstructive pulmonary disease and the third 23 patients with a combination of these diseases.Results. In patients with chronic obstructive pulmonary disease in combination with infarction of myocardium revealed the highest values of neopterin in blood serum in comparison with patients with monoiodotyrosine and somatically healthy individuals. Comparison of the values of neopterin with a number of recognized clinical and laboratory markers of endogenous intoxication revealed a positive correlation with heart rate, lactic acid, leukocyte index of intoxication and the ratio of neutrophils/leukocytes.Conclusion. In the course of the study, the clinical diagnostic value of the study of neopterin as a marker of endogenous intoxication in patients in Parkton myocardial on the background of chronic obstructive pulmonary disease has been proved.

Chronic pain in joints and back is almost constant component of the comorbidities. The comorbidities are caused by the systemic inflammation syndrome, which activity affects the degree of pathology mediating the progression of chronic pain as well. The pathogenesis pattern of systemic inflammation differs in having the whole range of transcriptional proteins, which activity is associated with the level of synthesis of pro-inflammatory mediators. Many recent studies showed that vitamin D3 deficiency and insufficiency increases the activity of these transcriptional proteins, increasing the progression and intensity of comorbidity components, including pain syndrome. Fundamental research demonstrates anti-inflammatory and anti-erosive vitamin D3 effects in cartilage and bone tissue.

Aim. To investigate the association between periodontal hemodynamic disturbances and systemic endothelial dysfunction (ED); to assess the effectiveness of various toothpastes for periodontal disease prevention in patients with nicotine dependence. Material and methods. In total, 120 young individuals aged 22—28 years were divided into 2 groups, according to the presence or absence of nicotine dependence. All participants underwent ED assessment with the EndoPAT device. Microcirculation (MC) was assessed with the high-frequency Doppler ultrasound system MinimaxDoppler-K. Patients with nicotine dependence were divided into 2 subgroups. Subgroup A was recommended to use the R.O.C.S. toothpaste Anti-Tobacco (WDS Laboratories) twice a day, while Subgroup B participants were recommended to use the toothpaste Colgate Advanced Whitening with polishing micro-crystals (ColgatePalmolive Poland) twice a day. Results. Significant between-group differences were observed for reactive hyperemia index and augmentation index. ED severity was higher in smoking participants. Velocity and volume parameters of periodontal MC were lower in smokers. The use of each specialized toothpaste was associated with improved periodontal MC, decreased prevalence of periodontal pathology-related complaints, reduced periodontal pocket depth, and decreased periodontal index values; however, the Anti-Tobacco toothpaste was more effective. Conclusion. Young smokers demonstrated а more severe ED and disturbed periodontal MC, which manifested in a more advanced periodontal disease.

The paper gives information on osteoporosis (OP) as a cause of back pain. In OP the latter is stated to be induced by not only osteoporotic fractures, but also other pathological changes associated with bone mineral density loss. Data on the management of back pain due to OP are presented and the efficacies of alendronate and vitamin D3 are noted

Aim. To study testosterone undecanoate effects on some modifiable cardiovascular risk factors in men with metabolic syndrome (MS).Material and methods. Androgen status screening (anthropometry, total and free testosterone level measurement) was performed in 35-75-year-old men with cardiovascular disease (CVD). In 50 MS patients, a double-blind, randomized, placebo-controlled trial of testosterone undecanoate was performed, focusing on hypogonadism clinics, erectile function (EF), quality of life (QoL), lipid profile (LP), inflammatory markers: C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6).Results. In men with CVD, clinical and laboratory androgen deficiency was observed in 67,8%, more often in those with visceral obesity. By Week 30 of testosterone treatment, androgen deficiency became less manifested clinically; EF, QoL, and LP also improved. Baseline levels of inflammatory markers pointed to elevated CVD risk. Testosterone undecanoate therapy was associated with significant, 2-fold reduction in CRP concentration, and 1.2-fold decrease in TNF-alpha and IL-6 levels.Conclusion. In men with CVD, hypogonadism was widely prevalent; testosterone level was age-independent in combined pathology. Testosterone level normalization facilitated improvements in LP and QoL. Testosterone undecanoate therapy was safe and well-tolerated.

The article deals with the issues of risk management of information projects. We propose not a deductive approach traditionally used in risk analysis, based on knowledge of the main provisions and their concretization in a real situation, but an inductive approach that requires data accumula- tion and the construction of training data sets as a result of a retrospective analysis of the progress and implementation of individual projects. It is proposed to use methods of trajectory analysis of sequences of events, each of which characterizes the state of risk of project implementation. To test this approach, random sequences of risk events are generated and data analysis methods are applied to these sequences.

PURPOSE. To address the problems of the functioning of the SES. To develop algorithms for evaluating the parameters of the efficiency of the functioning of the systems of intra-plant power supply. To investigate the operability of low-voltage shop networks of radial, trunk and mixed structure in optimal operating conditions of the equipment when modeling the impact of external factors, such as the root-mean-square load factor of the equipment, the temperature of the shop room and the calculated time interval on the operating parameters of the system. As the operating parameters of the system are accepted: the value of the equivalent resistance of the low-voltage electrical network. the amount of active power loss and the amount of electricity loss in the low-voltage network. METHODS. Probabilistic and statistical methods for evaluating the functional parameters of systems were used to solve the tasks. RESULTS. The article considers the features of the functioning of low-voltage networks of intra-plant power supply systems. Models are developed and the performance characteristics of low-voltage electrical networks of various topologies are calculated depending on the main circuit and operating parameters of electrical equipment when the values of the limits of the intensity of external influences change. CONCLUSION. The use of probabilistic methods allows us to take into account the dynamics of the main parameters of in-plant power supply systems when evaluating the effectiveness of their functioning. The calculations showed how the performance characteristics of such systems change depending on the intervals of variation of external factors in the operating conditions. The results obtained allow us to recommend the use of the developed models for effective control of circuit and mode parameters of low-voltage electrical networks to improve the quality of power supply to consumers.It is assumed that for external parameters of a random nature, the normal distribution is reliable. Algorithms for calculating the performance characteristics of in-plant power supply systems of various topologies and designs at different values of the limits of the intensity of external influences of the operating parameters are developed. At the same time, it is established that with an increase (decrease) in the intervals of changes in external parameters, their permissible intensity decreases (increases) in relation to the maximum intensity value for various operating modes of the equipment.