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Rheumatoid arthritis is a chronic autoimmune disease that affects the synovial membrane of the joints and leads to progressive articular damage, disability and reduced quality of life. Despite the emergence of more innovative therapeutic strategies that have improved the duration of remission, rheumatoid arthritis is associated with high levels of comorbidities, infections, malignancies and cardiovascular disease. It is known that some pathogenic proinflammatory mediators in rheumatoid arthritis, such as interleukin-1β (IL-1β) and tumour necrosis factor, may play a central role in the development of cardiovascular disease. Interestingly, various preclinical and clinical studies have shown that biologic agents, who are widely used in the therapy of patients with rheumatoid arthritis, may be effective in the therapy of cardiovascular diseases as well. For this purpose we have studied adipocytokines. Adipocytokines are pleiotropic molecules that are mainly released by white adipose tissue and immune cells. Adipocytokines modulate the function of different tissues and cells, and, in addition to energy homeostasis and metabolism, enhance inflammation, immune response and tissue damage. Adipocytokines may contribute to the proinflammatory conditions in patients with rheumatoid arthritis and the development of bone damage. In addition, they may be associated with the development of cardiovascular disease. In this study, we considered the already known evidence about adipocytokines in the pathogenesis of rheumatoid arthritis, because they are also actively involved in the pathogenesis of cardiovascular disease and are possible biomarkers of prognosis and treatment outcomes, because of their potential, as a possible new therapeutic target.

Аrterіаl hypertensіon – іs one of the most аcute medіcаl аnd socіаl problems іn the world. Despіte the obvіous successes іn the treаtment of hypertensіon, the totаl number of hypertensіve pаtіents іn the world hаs exceeded 1 bіllіon people аnd іs steаdіly іncreаsіng; by 2022, аccordіng to аpproxіmаte estіmаtes, іt mаy аmount to 1.5 bіllіon cаses. Аt the sаme tіme, hypertensіon іs the leаdіng cаuse of deаth of the populаtіon (12.8%), whіch іs 7.5 mіllіon people per yeаr. Іn turn, а hypertensіve crіsіs іs аn аcute, pronounced іncreаse іn blood pressure, аccompаnіed by clіnіcаl symptoms аnd requіrіng аn іmmedіаte controlled decreаse from the purpose of preventіng or lіmіtіng dаmаge to tаrget orgаns. Bаsed on thіs defіnіtіon, іt іs іmportаnt to emphаsіze once аgаіn thаt іt іs unаcceptаble to clаssіfy epіsodes of аn аcute pronounced іncreаse іn blood pressure thаt аre not аccompаnіed by clіnіcаl symptoms to hypertensіve crіsіs. Іn аddіtіon, іt іs іmportаnt not to refer to hypertensіve crіsіs аs cаses of аcute myocаrdіаl іnfаrctіon, аcute cerebrovаsculаr аccіdent, аccompаnіed by а secondаry pronounced іncreаse іn blood pressure (due to pаіn syndrome, аcute cerebrаl іschemіа, etc.). Thus, the hypertensіve crіsіs should іnclude those cаses when аn аcute pronounced іncreаse іn blood pressure precedes аnd іs the cаuse of аcute dаmаge to tаrget orgаns. The іssue of treаtment of аrterіаl hypertensіon аnd hypertensіve crіses does not lose іts relevаnce now. The possіbіlіtіes of rаpіd аnd effectіve relіef of crіses аt the prehospіtаl stаge hаve іncreаsed severаl tіmes wіth the аdvent of the drug ebrаntіl. The mаіn goаls of the treаtment of hypertensіve crіsіs аre relіef of the crіsіs, post-crіsіs stаbіlіzаtіon, аnd preventіon of repeаted hypertensіve crіses.

The frequency of the combination of coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD) is highlighted in the work, and it is concluded that there is a fairly significant stratum of patients, namely 25,9%, with combined pathology of the respiratory system and cardiovascular. On the basis of the therapeutic department of the Poltava central regional clinical hospital, 97 patients (84 men and 13 women) with a combination of COPD and CHD were examined: stable angina pectoris, grade II, which were hospitalized due to exacerbation of respiratory pathology. They were divided into 2 groups. Group 1 patients (51 people) received only basic therapy (β2-agonists, anticholinergics, methylxanthines, inhaled glucocorticosteroids, phosphodiesterase-4 inhibitors). In addition to basic therapy, patients of the 2nd group (46 people) were additionally prescribed L-arginine («Tivomax») in the form of a 4,2% solution of 100 ml intravenously once a day for 10 days. As a result of the treatment, a positive dynamics of the regression of clinical manifestations of acute exacerbation of COPD was revealed in both study groups. However, in the second group of subjects who receive L-arginine on the basis of basic therapy, clinical indicators, indicators of the function of external respiration and exercise tolerance, indicators of cardiohemodynamics significantly (p

Osteoarthritis (OA) is a common, poly-etiological disease of the joints, the occurrence and development of which is associated with a number of genetic, endogenous (hormonal balance, immune disorders, oxidative stress) and exogenous factors (trauma, overload). The combination of metabolic syndrome (MS) and OA is one of the most pressing medical and social issues for healthcare today. This is due to both their extremely high prevalence and high comorbidity with other conditions and diseases that have a significant impact on the quality of life of patients. The aim of our work was to study the pleurotropic effect of rosuvastatin on the pain intense and disease intensity in the course of OA in patients with comorbid MS, as well as its effect on blood pressure (BP), heart rate (HR), level of anthropometric indicators and lipidogram indicators. 30 patients were examined for OA and MS. Patients were divided into two age-matched groups. Rosuvastatin was prescribed to group I (n = 15) in a dose of 20 mg once a day for 12 days. The criteria for assessing the therapy efficacy included pain severity, articular and anthropometric parameters, laboratory and instrumental parameters, the level of quality of life. Patients were examined twice: before the therapy and on the day 12 of the therapy. It has been established that the rozuvastatin prescribed for this category of patients can reduce pain, improve joint function, lower the intensity of the disease and improve the quality of life of patients. In addition, rozustastatin does not affect the level of systolic and diastolic blood pressure, and can be prescribed for patients with concomitant arterial hypertension.

The Baksan Underground Scintillation Telescope has been operating under the program of searching for neutrino bursts since the middle of 1980. The target is two parts of the facility with the total mass of 240 t. The actual observation time over the period from June 30, 1980, to December 31, 2016, is 31.27 years. No candidate for the stellar core collapse has been detected during the observation period. The upper bound for the mean rate of the supernova core collapse in our Galaxy is 0.074 y $$^{{ - 1}}$$ (90% CL).

An experiment for measuring the flux of cosmic gamma rays with energy above 100 TeV is currently being prepared at the Baksan Neutrino Observatory of the Institute for Nuclear Research, Russian Academy of Sciences. For this purpose, based on the Carpet-2 shower array which has been operating for many years, the Carpet-3 multipurpose shower array is being constructed. In particular, the preparation of the experiment supposes an increase in the area of the muon detector (MD) and ground part of the array. For ground modules of the Carpet-3 array, a scintillation detector with a liquid scintillator in a plastic package has been elaborated. In this work, descriptions of the Carpet-3 array and working characteristics of the new scintillation detector are presented.

An experiment for measuring the flux of diffuse cosmic gamma rays with energies above 100 TeV (the Carpet-3 experiment) is now being prepared at the Baksan Neutrino Observatory, Institute for Nuclear Research, Russian Academy of Sciences. The preparation of the experiment entails an increase in the area both of the muon detector and of the surface part of the air shower array. This work presents an estimate of the experiment sensitivity to showers generated by primary gamma quanta for different configurations of the array. According to experimental data of the Carpet-2 array for 9.2 years of pure data acquisition time, preliminary estimates for the upper limit of the diffuse cosmic gamma ray flux with energies above 930 PeV have been obtained.

The characteristics of fast neutrons produced by cosmic-ray muons at the Baksan Underground Scintillation Telescope (BUST) are investigated. A novel approach to the problem consists in estimating the neutron flux by the production rate of the unstable radioactive nuclide 12B in the (n, p) reaction on carbon nuclei of the BUST organic scintillator. The processing of the data collected in 2002–2015 yielded $${N_{{{12}_B}}} = 337 \pm 2.5$$ events consistent with those of the reaction 12C(n, p)12B. For the BUST internal planes, the background of fast neutrons with E > 28.6 MeV is experimentally estimated as Φ ∝ 10−11cm–2 s–1. This is lower than the theoretically predicted total neutron flux by nearly two orders of magnitude. The disagreement with predictions is attributed to the suppression of neutron flux in the external scintillator planes of the detector.

The new cosmic-ray experiment EMMA operates at the depth of 75 m (50 GeV cutoff energy for vertical muons; 210 m.w.e.) in the Pyhasalmi mine, Finland. The underground infrastructure consists of a network of eleven stations equipped with multi-layer, position-sensitive detectors. EMMA is designed for cosmic-ray composition studies around the energy range of the knee, i.e., for primary particles with energies between 1 and 10 PeV. In order to yield significant new results EMMA must be able to record data in the full configuration for about three years. The key to the success of the experiment is the performance of its tracking stations. In this paper we describe the layout of EMMA and construction of the two main detector types used for muon tracking: the high-resolution drift chambers and fast scintillation detector arrays. We also show the measured tracking efficiencies, position and angular resolutions, and sensitivity of drift chambers to the air pressure. The measured angular muon distributions are well reproduced by CORSIKA simulations folded with the known density distribution of the overburden. The single muon flux at the depth of 210 m.w.e. is (1.29 ± 0.06) m − 2 s − 1 . This value was determined from the reconstructed tracks registered by a six-layer array of position-sensitive drift chambers.

The Baksan Underground Scintillation Telescope has operated within the program of searching for neutrino bursts since the mid-1980s. We present the current status of the experiment and some results related to the investigation of background events and the stability of facility operation. Over the period from June 30, 1980, to December 31, 2016, the pure observation time was 31.27 years. No neutrino burst candidate event from the explosion of a core-collapse supernova in the Galaxy was recorded in this time. This sets an upper bound of 0.074 yr–1 on the mean frequency of gravitational stellar collapses in the Galaxy at a 90% confidence level.

An experiment for measuring the flux of cosmic diffuse gamma rays with energies above 100 TeV (the Carpet-3 air shower array) is now being prepared at the Baksan Neutrino Observatory, Institute for Nuclear Research, Russian Academy of Sciences. The preparations entail a substantial increase of the areas of both the muon detector and the surface air shower array. The experiment’s sensitivity to showers generated by primary gamma rays is estimated for different configurations of the array. In addition, preliminary estimates of the upper limit on the flux of diffuse gamma rays with energies higher than 1.3 PeV, derived using experimental data from the old Carpet-2 array, are presented for a net exposure time of 9.2 years.

Preliminary results of a neutron background measurement at the Baksan underground scintillation telescope (BUST) are presented. The external planes of the BUST are fully covered with standard scintillation detectors shielding the internal planes and suppressing thus background events due to cosmogenic and local radioactivity. The shielded internal planes were used as target for the neutron flux registration. The experimental method is based on the delayed coincidences between signals from any of the BUST counters. It is assumed that the first signal is due to inelastic interaction of a neutron with the organic scintillator, while the second signal comes from the decay of an unstable radioactive isotope formed when the fast neutron interacts with the 12C nuclei. Using the Monte-Carlo method (GEANT4) we also simulated propagation of neutrons through a layer of scintillator. The experimentally found muon induced neutron flux is j =1.3-0.3+0.7 ×10-10cm-2s-1 for neutron energies E ≥ 22MeV, which is in a qualitative agreement with similar measurements of other underground laboratories as well as with predictions of the GEANT4.

The current status of the experiment on recording neutrino bursts from core collapse stars is presented. The actual observational time is 29.76 years. An upper bound of the mean frequency of core collapse supernovae in our Galaxy is f col < 0.077 year–1 (90% CL).

The aim of the study was to determine whether the presence of psoriatic arthritis is associated with greater comorbidity, in particular cardiovascular morbidity, compared to psoriasis without arthritis. 56 patients with psoriatic arthritis were recruited from the rheumatology department of «Poltava Regional Clinical Hospital n.a. M.V. Skliphosovskyi of Poltava Regional Council» and 38 psoriasis without arthritis patients from the outpatient department of «Poltava Regional Clinical Hospital n.a. M.V. Skliphosovskyi of Poltava Regional Council». The clinical database was used to identify the prevalence of cardiovascular and other comorbidities in both psoriatic arthritis and psoriasis without arthritis patients. Univariate and multivariate logistic regression analyses were conducted to estimate odds ratios, comparing the odds of ever having a given comorbid disease in psoriatic arthritis patients with those in psoriasis without arthritis patients. Covariates included age, sex, education, smoking status, severity and duration of psoriasis, medication status, and other comorbidities. According to the research the prevalence of hypertension, obesity, hyperlipidemia, type 2 diabetes mellitus and at least one cardiovascular event in patients with psoriatic arthritis was 36,9%, 31,1%, 20,3%, 11,09% and 8,7% respectively. This was significantly higher than in psoriasis without arthritis patients with unadjusted odds ratios ranging from 1,55 to 2,58. In the multivariate analyses, hypertension remained significantly elevated (corrected probability factor 2,18). Psoriatic arthritis was also significantly associated with infections not treated with antibiotics (presumably viral), neurologic conditions, gastrointestinal disorders, and liver disease (adjusted odds ratios 2,79; 4,75; 21,47; and 7,68, respectively). Infections treated with antibiotics and depression / anxiety were relatively common in psoriatic arthritis with a prevalence of 31,8% and 19,3%, respectively. However, this was not significantly different from psoriasis without arthritis after multivariate adjustments. According to the study was founded that inflammatory joint disease (psoriatic arthritis) may play a main role in the development of both cardiovascular and other comorbidities in patients with psoriatic arthritis.

The origin of gamma-ray bursts is still one of the unresolved problems in physics. They are short, intense, and non-repeating flashes of MeV gamma-rays with a wide range of spectral and temporal properties. Also these bursts are perhaps sources of neutrino emission. Unlike the photons, which may scatter or be absorbed, the neutrinos, due to their small interaction cross section, arrive at the Earth unaffected. This paper describes experimental methods for detection of low energy neutrinos in the range from 20 MeV to 100MeV at the Baksan Underground Scintillation Telescope. In the analysis we search neutrinos in time coincidence with a gamma-ray burst. We use filtered data collected at the Telescope during 2012. We also use the catalogue of gamma-ray bursts of the SWIFT satellite experiment.

The search for muon neutrinos with energy ≥1 GeV correlated with Gamma-Ray Bursts (GRBs) has been carried out at the Baksan Underground Scintillation Telescope (BUST). Between 1978 December and 2013 December more than 1500 localized gamma-ray bursts occurred in the field of view of the BUST were coincided with the BUST operation periods. No neutrino signal from GRBs was detected. Upper limits on associated gamma-ray burst neutrino production are presented.

The current status of the experiment on recording neutrino bursts is presented. As the target, we use two parts of the facility with the total mass of 240 tons. Over the period of June 30, 1980 to December 31, 2016, the actual observational time is 31.27 years. No candidate for the stellar core collapse has been detected during the observation period. An upper bound of the mean frequency of core collapse supernovae in our Galaxy is f < 0.074 per year (90% CL).

An experiment for measuring the flux of gamma rays of cosmic origin with energy above 100 TeV (the Carpet-3 experiment) is currently being prepared at the Baksan Neutrino Observatory. The experimental setup suggests substantial increase of the areas of both muon detector and surface air shower array. We present some results of calculations of selection efficiency of air showers from primary gamma rays for different configurations of the array. It is demonstrated that by increasing the muon detector area up to 615 m$^2$ (the maximum possible value) one can reach with the Carpet-3 the world-best sensitivity to 100 TeV gamma rays. The preliminary values of upper limits on the flux of cosmic diffuse gamma rays with energy higher than 930 TeV are also presented, derived from experimental data of the Carpet-2 shower array for a net exposure time of 9.2 years.

Мета дослідження – аналіз педагогічної ефективності курсів передатестаційного циклу для лікарів з фаху “Загальна практика – сімейна медицина”, що проводилися на базі кафедри сімейної медицини і терапії навчально-наукового інституту післядипломної освіти та на філії кафедри у м. Кременчук.Матеріали та методи дослідження. Оцінка ефективності використаних педагогічних технологій проводилася наприкінці циклу шляхом проведення тестування за допомогою ліцензованої комп’ютерної програми “Elex” (пропонувалося 150 питань 2-3 рівня складності з відповідного фаху) і шляхом перевірки опанування практичних навичок згідно зі стандартизованими картами практичних навичок та підведення підсумків з анонімним анкетуванням. Важливою особливістю навчального процесу в галузі післядипломної медичної освіти також є тісне поєднання теоретичної та практичної підготовки фахівців, тому велике значення має саме комплексність навчання: використання дистанційних форм на етапі теоретичної підготовки та відпрацювання практичних навичок на клінічних базах стажування. Це є переконливим поясненням наявності заочної частини навчання та пояснює перевагу дистанційної освіти, коли слухачі віддалені від бази навчального закладу. Дистанційні форми освіти не можуть існувати самостійно та використовуються у поєднанні з класичними формами навчання.Результати й обговорення. Показана ефективність використання дистанційних форм навчання за даними результатів тестування та опанування практичних навичок.Висновки. Дистанційна освіта на післядипломному етапі навчання лікарів-інтернів та лікарів-курсантів є самостійна цілеспрямована робота з використанням сучасних інформаційних технологій, ефективність якої залежить від методологічно структурованого викладачем процесу та інформаційно-комунікаційних можливостей вищого навчального закладу. Надані рекомендації щодо впровадження елементів дистанційного навчання в практику роботи Навчально-наукового інституту післядипломної освіти.

A method is proposed for automatic tuning and stabilization of the energy threshold in scintillation detectors by maintaining the constancy of the average detector counting rate from Γ rays of natural radiation background or cosmic rays. Stabilization is automatically performed by controlling the photodetector supply voltage, which makes it possible to stabilize the detector threshold with an error of 0.73–2.40%, depending on the used circuitry. The stabilization electronics for scintillation detectors with avalanche multipixel photodiodes and photomultipliers is described. A circuit ensuring the increased precision of threshold stabilization is also proposed.

The current status of the experiment on recording neutrino bursts from core collapse stars is presented. The actual observational time T (from June 30, 1980 until December 31, 2009) is 25.58 years. An upper bound of the mean frequency of gravitational collapse in our Galaxy fcol < 0.090 year−1 at a 90% confidence level. The results of studying single events at the facility in the case of muon inelastic interaction of cosmic rays with the matter of the detector are presented.

The energy spectra and temporal characteristics of high-energy gamma-ray bursts from evaporating primordial black holes have been calculated using various evaporation models. The currently existing theoretical uncertainties in the shape of the evaporated photon spectrum are discussed. The data from the Andyrchy and Carpet-2 arrays of the Baksan Neutrino Observatory (Institute for Nuclear Research, Russian Academy of Sciences) obtained in the mode of detection of a single cosmic-ray component are used to search for cosmic gamma-ray bursts with a primary photon energy of about 8 GeV. New upper limits have been obtained for the number density of evaporating black holes in a local region of space with a characteristic size of ∼10−3 pc for various evaporation models.

At present an experiment for measuring the flux of cosmic diffuse gamma rays with energy higher than 100 TeV (experiment "Carpet-3") is being prepared at the Baksan Neutrino Observatory of the Institute for Nuclear Research, Russian Academy of Sciences. The preparation of the experiment implies considerable enlargement of the area of both muon detector and surface part of the shower array. At the moment the plastic scintillation counters with a total continuous area of 410 m2 are installed in the muon detector (MD) underground tunnels, and they are totally equipped with electronics. Adjusting of the counters and their electronic circuits is in progress. Six modules of shower detectors (out of twenty planned to be installed) have already been placed on the surface of the MD absorber. A new liquid scintillation detector is developed for modules of the ground –surface part of the array, whose characteristics are presented. It is shown that the "Carpet-3" air shower array will have the best sensitivity to the flux of primary gamma rays with energies in the range 100TeV – 1PeV, being quite competitive in gamma-ray astronomy at such energies.

The Andyrchy facility was created for studying the energy spectrum and nuclear composition of primary cosmic rays in the region of a knee in the cosmic-ray spectrum. The position of this facility above the Baksan underground scintillation telescope allows simultaneous detection of electron-photon and high-energy muon components of extensive air showers. The parameters of this facility also allow it to be used for solving a number of other problems of cosmic-ray physics. Data since 1996 have been collected for several physical problems. The facility is described, and its performance characteristics are presented.

A procedure for measuring energy releases in scintillation detectors by using a logarithmic RC converter in combination with a device that suppresses photomultiplier tube afterpulses is described. The total range of measured energies is 5.8 MeV to 11.6 GeV. The afterpulse suppression ratio is more than 200. The output pulse of the RC converter is synchronized with the leading edge of the anode signal from the photomultiplier tube.

Two circuits of wide-range converters of the dynode current amplitude of photomultiplier tubes (PMTs) into duration are presented. They are intended for measuring the energy released in large scintillation detectors. The first-type converter has a protective switch at the input, which eliminates the influence of PMT afterpulses on the conversion process. The second-type converter is weakly sensitive to PMT afterpulses, and its output pulse is synchronized with the leading edge of the input signal. Both devices have a dynamic range of 2 × 103.

The system of anti-lightning protection measures set up under the high mountain conditions of the Andyrchi facility at the Baksan Neutrino Observatory of the RAS INR is described. A number of practical recommendations for the anti-lightning protection of the electronic equipment at physics installations that have long lines of communication between their physical quantity sensors and recording instruments are given.

The project of the Baksan Underground Scintil- lation Telescope (BUST) upgrade is presented. Additional outer layers of the detectors with fine spatial resolution will be mounted around BUST. Optimal dimensions of a counter, 0.125m◊ 0.125m◊ 0.03m were chosen with a simulation program. The functional diagram of BUSTs DAQ additional layers is presented. Modernization allows us to study the knee region using muon number spectrum measurements. BUST located underground at a depth of 850 m of wa- ter equivalent was designed to solve a number of physical problems which predetermined its construction and location (Alekseev et al., 1998). The telescope is a four-store building with dimensions of 16.7m◊ 16.7m◊ 11.1m and consists of four horizontal and four vertical planes. The total number of detectors is 3180. The analysis of the muon groups registered by BUST gives us an opportunity to obtain information about spectrum and composition of primary cosmic rays in the energy range of 1013 1016 eV (Petkov et al., 2008). The coordinates of fired detectors give the initial information for identification parameters of muon groups (arrival direction and number of muon tracks). In general, the number of muons cross- ing the telescope, n, and the number of the reconstructed muon tracks in a selected event, ntr, should not necessar- ily coincide with each other. When two or more muons are crossing BUST close enough to each other (comparable with the size of the detector), the number of reconstructed muon tracks will be less than the number of muons crossing BUST. Construction of additional external scintillation layers pro

An innovative method for studying the properties of extensive air showers (EASes) that is based on the detection of thermal neutrons generated by high energy hadrons under a soil absorber of 500 g cm−2 is proposed and tested. It is shown that underground hadronic calorimeter can be performed with special scintillation detectors developed by the authors. The method could be quite useful in gamma shower selection and investigations of EAS properties, primary cosmic ray mass composition, EAS core location, and so on.

The state of the art and the project of modernization of the extensive-air-shower array Carpet-2 of the Baksan Neutrino Observatory of the Institute for Nuclear Research, Russian Academy of Sciences are described. The modernized array will allow the performance of detailed study of variations in the cosmic ray intensity, the energy spectra and composition of primary cosmic rays in the energy range 1013–1016 eV, and the anisotropy of primary cosmic rays with energies above 1013 eV.

Current status and results of the experiment on recording neutrino bursts are presented. The observation time (since 1980) is 22.6 years. The upper bound of collapse frequency in our Galaxy is 0.10 y i1 (90% CL).

Temporal and energy characteristics of the very-high-energy gamma-ray bursts from evaporating primordial black holes have been calculated by assuming that the photospheric and chromospheric effects are negligible. The technique of searching for such bursts on shower arrays is described. We show that the burst time profile and the array dead time should be taken into account to interpret experimental data. Based on data from the Andyrchy array of the Baksan Neutrino Observatory (Institute for Nuclear Research, Russian Academy of Sciences), we have obtained an upper limit on the number density of evaporating primordial black holes in a local region of space with a scale size of ~10^{-3} pc. Comparison with the results of previous experiments is made., Comment: 6 pages, 6 figures

Search for neutrino bursts from collapsing stars with the Baksan underground scintillation telescope has been carried out since 1980. In this study, the experimental data obtained during the period from 2001 to 2005 inclusive are analyzed. The upper limit of the mean frequency of collapses in the Galaxy over the entire period of observations (the total live time is 21.83 yr) was found to be 0.105 yr−1.