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Education modernization in the healthcare of Ukraine has formed new approaches to the training of the young professionals. The article describes the methods of the active teaching in the medical university clinical departments. Traditional lecturing used in teaching has the lowest retention rate; the use of simulation technique education as part of an instruction method may enhance retention and reinforce learning by creating a dynamic educational environment. The aim of the study was to analyze, generalize existing points of view in the education system, which affect the issue of necessity, effectiveness and features of the simulation programs use for medical students in the example of «Standardized patient» methodic. Object and methods. It were held an overview of modern literature on the implementation of simulation method in way of the «Standardized patient» methodic in medical education. Seven databases were used in the search: ERIC, Education Research Complete, Medline, Medline Complete, Academic Search Complete, The Cochrane Library and PubMed in period of 2007-2018. Using key words: standardized patient, students, active teaching method, professional training, medicine. Results and discussion. Students of medical universities often feel lack the experience of interacting with real patients. By mastering realistic scenarios with a standardized patient (SP), they accumulate experience, and teachers gain an opportunity to evaluate how students apply new knowledge in practice. Interaction with SP develops communication and professional skills, enabling students to get their first clinical experience. Using SP, students learn to collect anamnesis from a patient, conduct a physical examination on structured and effective principles, learn to ask questions related to medical, surgical and social anamnesis, make objective examination, estimate additional methods of investigation. SPs also help students of the senior courses to ensure integration of curriculum content in practical activity. There is a possibility apply their theoretical knowledge in practice, using them as tools in achieving a specific goal helping a sick person. This method of simulation training is developed to involve university staff as «standardized patients» for modeling clinical situations of differentiation and assistance in various diseases. The approximate structure and rules for writing a clinical scenario for SP are proposed. Conclusion. SP methodic is one of the effective ways to learn how to manage errors and how to work in accordance with modern algorithms. The advantage of this technique is that the student can really assess the level of his training, identify gaps in knowledge and skills, and make timely attempts to eliminate them. The inclusion of SP methodic in an educational program is a very effective teaching method.

Pulmonary hypertension is a frequent and severe complication of systemic sclerosis (SSc). SSc-PAH patients have a worse prognosis than patients with idiopathic PAH. We report a case of a patient with delayed SSc and PAH diagnostics. Limited SSc was established in a 61-year-woman with 20 years of Raynaud’s syndrome anamnesis. But diagnosis of SSc-PAH was determined in severe and late symptomatic stage with signs of right heart congestion, NYHA III FC and mPAP 48 mmHg. This emphasizes the need for clinicians to be aware of limited SSc and have a high index of PH suspicion in such patients.

Pulmonary arterial hypertension (PAH) is a serious condi­tion caused by the damage of the small pulmonary vessels, leading to the increase of pulmonary artery pressure, pulmonary vascular resistance, development of right ventricular failure and death. PAH is one of the actual problems of modern medicine due to low survival rate, rapid disability of the patients and a high cost of treatment. PAH is one of the leading causes of death in systemic sclerodermia (SSD). PAH associated with scleroderma is a unique phenotype combining the manifestations of both SSD and PAH, the pathogenetic mechanisms of which modify the clinical picture and the course of these conditions. Timely diagnosis and treatment of PAH show significant effect on survival rates, however, early detection of PAH is still difficult in SSD due to several factors. The main causes are restriction of modern screening methods and polyorganic involvement in SSD. In comparison with other subgroups of PAH the patients with SSD-PAH poorly answer to the specific PAH therapy. SSD-PAH, along with idiopathic pulmonary hypertension (IPAH), belongs to group I of pulmonary hypertension classification and according to modern consensus has a similar pathogenesis and clinical picture, however, differences in the response to therapy are observed in these groups, that indicates the role of other pathobiological mechanisms. Recent investigations explain these differences by such factors as autoimmune and inflammatory responses, more severe vascular remodeling and direct myocardial damage in the SSD. Drug therapy of PH in SSD is similar to that in IPAH and includes prostaglandins, endothelin receptor antagonists, calcium channel blockers, which are prescribed in cases of a positive vasoreactive test, PDE-5 inhibitors. In this literature review we showed traditional and new methods of PAH treatment and their relevance to SSD-PAH in accordance with randomized clinical trials.

Background. The article describes the methods of the 6 th year students active teaching in the medical university on the subject Internal diseases. Traditional lecturing used in teaching has the lowest retention rate; the use of games as part of an instruction method may enhance retention and reinforce learning by creating a dynamic educational environment. Aim.This study aims to systematically review the literature on educational business games medical students of the senior courses to identify trends and investigate assessment tools used to measure its learning outcomes. To develop and assess using method of business game own variant of educational tool for the 6th year students in the internal medicine discipline. Methods.Seven databases were used in the search: ERIC, Education Research Complete, Medline, Medline Complete, Academic Search Complete, The Cochrane Library and PubMed in period of 2007-2018. Using key words: business games, students, active teaching method, professional training, medicine. Results and discussion.Business game is a complex interactive technology, which allows based on the analysis of the simulated situation, to develop alternative solutions and projects based on a variety of interaction and cooperation between teachers and students, in conditions of different role interests, intellectual and emotional tension, competition and expert evaluation. The developed business game with 7-10 participants allows students to be involved in an atmosphere as close as possible to real medical practice, to form clinical thinking and increase responsibility before making decisions in various clinical situations, which significantly distinguishes this method of training and knowledge control from traditional ones. Business games cultivate personal qualities, accelerate the process of socialization, imitating situations that are real in future professions, develops the ability to search and work with information, allows you to significantly enhance the students creative abilities, promotes the experience exchange, develops the ability to team building, models the conditions of the professional environment, realizing the activity competence approach in training, allows activating the students cognitive activity, forming practical and professional skills of students. Therefore for the teacher this technology has practical sense because it helps them to carry out a purposeful choice of a corresponding training method or their combination for the decision of specific didactic problems. Conclusion. Gaming makes a positive impact on the teaching/learning process. However, existing assessment methodologies have been not fully captured the learning that may occur in these games. Robust research is needed to address the use of games that have been assessed objectively.

Abstract Introduction. Lung cancer (LС) is the most common cause of the so-called paraneoplastic syndrome (PNPS) development, caused by the complex immunoinflammatory, degenerative and vascular distant changes. The risk of LC development is increased in patients with gout which proves the connection between violations of purine metabolism and carcinogenesis. Paraneoplastic (neoplastic) gout is one of the relatively frequent manifestations of LC, but such a relationship of the diseases requires further study. The objective of the study: to compare the clinical and laboratory course of primary gout and disease in the LC patients compared with the tumor process clinical course in the other signs of PNPS presence and to identify risk factors. Materials and methods. 113 patients with gout (97 men and 16 women aged 33 to 79 years) were observed. They were divided into two groups: the first group consisted of 54 patients with primary gout and the second group consisted of 59 patients with paraneoplastic variant of LC. Whereas in the 1st group the ratio of men and women was 26:1, in the 2nd – only 3: 1, and the average age was 50 and 59 years, respectively. The clinical course of gout and tumor process in the 2nd (main) group was compared with that in 199 LC patients with PNPS (comparison group), which was diagnosed in 15.5 % of LC observations. Purine metabolism was assessed by blood levels of uric acid and oxypurinol, their renal clearance, serum activity of xanthine oxidase, xanthine deaminase, adenosine deaminase, and 5-nucleotidase. Results. Paraneoplastic (neoplastic) gout develops in 3.5 % of the LC patients and in 22.9 % of those with PNPS. It differs from the primary (idiopathic) gout by the greater frequency of the disease development in women, the hand joints involvement and the metabolic type of hyperuricemia, but less often observed urolithiasis, peripheral tophi, chronic form of arthritis and the absence of renal type of purine metabolism impairment. Patients with tumorous gout differ from other LC patients with PNPS by the absence of bilateral and median lobe localization of the lung process, but relatively frequent occurrence of Pancoast tumor, high levels of uric acid and xanthine oxidase in the blood. The development of paraneoplastic gout depends on the clinical course of the LC (tumor invasion into the thoracic wall and pericardium, the number of distant organs metastasis) and the power of chemotherapy, the use of alkylating antineoplastic agents and alkaloids. Treatment-associated myelodepression, radiation pneumofibrosis and acute thrombophlebitis development depends on paraneoplastic gout. The presence of gout does not worsen the survival of LC patients with PNPS. LC patients with hyperuricemia (> 420 μmol / l in men and > 360 μmol / L in women) should be prescribed with xanthine oxidase inhibitor - allopurinol in the complex of therapeutic measures. Conclusions. Paraneoplastic gout is a frequent PNPS manifestation in LC, its course has peculiarities compared with the primary gout and is closely related to the tumor process character and the power of chemotherapy, it can determine the complications development in the course of therapeutic interventions. The data presented in the study require further comparative analysis of the other signs of PNPS, comparison of tumor and idiopathic variants of the musculoskeletal system lesion, cutaneous vasculitis and autoimmune systemic syndromes, which might assist in developing of the additional prognostic criteria for the tumor process clinical course, increasing the efficiency of therapy and its control quality.

Pulmonary arterial hypertension (PAH) is a serious condition caused by the damage to the small pulmonary vessels, leading to the increase of pulmonary artery pressure, pulmonary vascular resistance, development of right ventricular failure and death. PAH is one of the actual problems of modern medicine due to low survival rate, rapid disability of the patients and a high cost of treatment. PAH is one of the leading causes of death in systemic scleroderma (SSD). PAH associated with scleroderma is a unique phenotype combining the manifestations of both SSD and PAH, the pathogenetic mechanisms of which modify the clinical picture and the course of these conditions. Timely diagnosis and treatment of PAH show significant effect on survival rates, however, early detection of PAH is still difficult in SSD due to several factors. The main causes are restriction of modern screening methods and polyorganic involvement in SSD. In comparison with other subgroups of PAH the patients with SSD-PAH poorly answer to the specific PAH therapy. SSD-PAH, along with idiopathic pulmonary hypertension (IPAH), belongs to group I of pulmonary hypertension classification and according to modern consensus has a similar pathogenesis and clinical picture, however, differences in the response to therapy in these groups are observed, that indicates the role of other pathobiological mechanisms. Recent investigations explain these differences by such factors as autoimmune and inflammatory responses, more severe vascular remodeling and direct myocardial damage in the SSD. Drug therapy of PH in SSD is similar to that in IPAH and includes prostaglandins, endothelin receptor antagonists, calcium channel blockers, which are prescribed in cases of a positive vasoreactive test, PDE-5 inhibitors. In this literature review we showed traditional and new methods of PAH treatment and their relevance to SSD-PAH in accordance with randomized clinical trials.

Системная склеродермия (ССД) – аутоиммунное заболевание соединительной ткани, характеризующееся прогрессирующим фиброзом кожи и внутренних органов. Характерные клинические признаки ССД могут маскировать онкологические заболевания, а паранеопластический процесс, в свою очередь, маскируется симптомами ССД. Цель исследования – показать необходимость дифференциальной диагностики склеродермоподобного паранеопластического синдрома и ССД как фактора онкологического риска. Материалы и методы. Проведен обзор и анализ данных научно-медицинской литературы. Результаты исследований и их обсуждения. Иммунные реакции, участвующие в патогенезе ССД, могут способствовать развитию онкологической патологии; поэтому пациенты с факторами риска развития заболевания требуют наблюдения за возможным развитием неопластического процесса. Пациенты с ССД и аутоантителами к РНК-полимеразе III имеют значительный риск развития рака. Риск канцерогенеза наиболее высокий в первый год после постановки диагноза ССД. С другой стороны, симптомы ССД могут быть маской различных видов рака. Паранеопластический склеродермоподобный синдром, непосредственно не связан с первичной опухолью и ее метастазами, а обусловлен сложными вторичными воспалительно-дегенеративными изменениями системного, локального либо дистантного характера, зачастую протекающими в виде проявлений “перекреста” (overlap) ревматического и опухолевого заболеваний. Предполагается, что раковые клетки могут индуцировать синтез вещества, инициирующего фиброз кожи и внутренних органов. Дифференциация между идиопатической формой ССД, склеродермоподобным паранеопластическим синдромом и развитием рака на фоне ССД вызывает множество трудностей. В статье представлен анализ дифференциально-диагностических мероприятий, предлагается схема скрининга для ведения пациентов с диагнозом ССД, находящихся в группе риска развития малигнизации. Выводы. Результаты анализа источников литературы доказывают актуальность углубленного изучения пациента с впервые выявленным склеродермоподобным синдромом, особенно в пожилом возрасте.

A review of the literature on the problem of one of the rare manifestations of systemic diseases - pulmonary arterial hypertension is presented. The necessity of early and thorough differential diagnosis, verification of the diagnosis using invasive methods for assessing central hemodynamics is substantiated. A model for screening patients with systemic scle­roderma, which simplifies the determination of indications to set the research methods that allow to verify the diagnosis is proposed. Modern approaches to drug therapy are described, and questions of improving the patients’ survival with this prognostically unfavorable pathology are discussed.

Background. Two forms of ankylosing spondylitis (AS) are distinguished: juvenile and adult, depending on debut age of the disease. The diagnosis of juvenile AS (JAS) is one of the most urgent problems in a pediatric rheumatology. The peculiarities of AS course that onsets in childhood and adulthood are manifested by differences in the nature of a spinal column disturbance. At the same time, the evolution of JAS in adulthood remains unexplored. The goals and objectives of research: to study clinical and X-ray symptoms of spondylopathy and sacroiliitis course, to assess their characteristics in the disease that onset in childhood and adulthood. Material and methods. 217 patients with AS (193 men and 24 women) with an average age of 38 years were examined. The fast-progressing course of the disease was detected in 21% of cases, moderate and high degree of activity – in 79% of cases, the ІІ-ІІІ stage in 82%, and polyarthritis – in 65%. JAS was detected in 16% of cases (all boys), among them the third stage occurred twice more likely than among the other patients. Results. The clinical and radiologic signs of spondylopathy and sacroiliitis are observed in 95% and 97% of the total number of AS cases, respectively, among all patients with JAS lumbago was detected 4,3 times more frequently, sciatic muscles hypotrophy – 7,8 times, "the string symptom" - 2,9 times", the calcification of the spinal cord - 2,3 times, whereas the prevalence of spinal column injury, the severity of cervico-spondylopathy and sacroiliitis among patients with the disease debut in the adulthood is significantly greater, and the involvement in the process of the lumbar and thoracic spine are detected correspondingly twice as often and by 19%, occurrence of dorsalgia is 4 times as often, the limitation of body lateral bendover by 59%, while there are ambiguous dispersion-correlation links with extraarticular (systemic) manifestations of the disease, and the high prevalence of a peripheral articular syndrome regarding spondylopathy in JAS is a negative prognosis sign, and for the remaining patients there are indices of the Lansbury index and the index of arthro­pathy progression. Conclusion: the onset of AS in adulthood is a risk factor for the severe course of spondylopathy.

The aim of the study – to evaluate the effectiveness of pathogenetic therapy in patients with ankylosing spondylitis (AS) and the prognostic value of the initial levels of osteoassociated hormones and chemical elements in hair and blood. Materials and methods. 79 patients with AS (95 % of men and 5 % of women at the age of 38.3 ± 1.3 years) were under observation. The duration of the clinical manifestation was 11.4 ± 0.8 years, the I degree of the disease activity was detected in 32 % of the cases, II – 39 %, III – 29 %, seropositivity for HLA-B27 was diagnosed in 88 % of the surveyed, for antibodies to cyclic citrulline peptide – in 3.6 % of cases, for rheumatoid factor – in 6.3 % of cases. Osteodeficiency in the form of osteopenia and osteoporosis occurred in 49 % of AS observations. Patients were examined with two-energy X-ray osteodensitometry of the proximal femoral part. Blood levels of parathyroid hormone (PH), osteocalcin (OC), calcitonin (CT) and alkaline phosphatase (AP) were studied in blood. Osteoassociated chemical elements (Ca, Co, Cu, Fe, Li, Mg, Mn, P, Pb, Sr, Zn) were estimated in blood and hair. Results. There was no effect of the treatment in 4% of the patients, the mild improvement was detected in 21% of the examined patients, the improvement – in 70 %, significant improvement – in 4 %. In AS, there is an increase in the content of PH, OC and the activity of AP in blood with decrease of CT, which is accompanied by increase in Li, Mg, Pb and Sr concentrations in blood with decrease in Ca, Fe, Mn, P parameters. In hair, the level of Pb increases with the inhibition of Ca, Co, Li and Sr, the indices of which correlate with PH, OC, CT and AP, relate to the degree of disease activity, the severity of bone-destructive joint changes and the presence of extraarticular (systemic) signs of the autoimmune process. The initial indices in blood of PT, Co and Mg and in hair of Ca, Fe, Mg, Mn, P, Pb and Sr influence on the effectiveness of pathogenetic medicamentous basic treatment of AS patients. Sulfasalazine and leflunomide play a part in the integral dynamics of bone metabolism parameters, which, along with the parallel prescription of calcemin and ranelate Sr, affect the overall elemental compound of the organism. Under the influence of complex pathogenetic basis therapy, Ca concentration in blood increases and Mg content in hair decreases, and against the background of the additional prescription of calcemin and ranelate Sr, the level of Sr is restored in hair. The combined use of calcemine and ranelate Sr is necessery to all AS patients with osteodeficiency (osteoporosis, osteopenia). Prognostically favorable criteria for the subsequent pathogenetic basis therapy of the disease can be Mg concentration in blood 250 μg / g, while the blood level of the PH >60 pg / ml is a prognosis negative factor in the effectiveness of further treatment. Conclusions. The effectiveness of basic therapy in patients with AS depends on the initial state of bone metabolism. The presented data will allow to improve the quality of medical technology in the future for early diagnosis and predicting the further course of individual manifestations of the disease, to optimize the nature of rehabilitation activities in patients with osteopenia/osteoporosis, to improve control over the effectiveness of treatment.

Timely radiation therapy (RT) has become the basis for increasing the effectiveness of patients with lung cancer (LC) treatment and survival. RT is currently being used for most of such patients, although there are no reliable criteria to predict the effectiveness of radiotherapy at the moment. A large number of serious complications of radiation therapy require its improvement. Recently, the importance of positron emission tomography (PET) for LC visualization and monitoring of treatment results has been considered, as well as for the elucidation of the optimal format in the process of RT planning. The purpose of study: to investigate the nature of the RT complications in various options of the LC course, to identify the risk factors and to assess the role of the preliminary PET with fluoride-dehydroglucose in order to reduce the number of side effects of irradiation. Materials and methods. 1071 patients with LC at the ages from 24 to 86 years (mean age 59 years) were observed (83 % of men and 17 % of women). None of the patients with LC has been previously operated. The central form of LC was noted in 79 % of the examined, peripheral – in 21 %, small cell histological variant – in 18 % of cases, and non-small cell – in 82 %, IIIA–IV stages were detected in 95 % of patients’ number. 33 % of patients received radical radiation therapy for the primary tumor, 53 % – palliative lung irradiation, 14 % – palliative radiotherapy of distant metastases. A group of 25 LC patients was formed who were RT planned with the help of PET/CT (computed tomography). The ratio of upper lobe, middle lobe, middle upper, lower lobe, middle lower and mediastinal localization was 7:6:5:4:2:1, non-small cell forms of LC were noted in ¾ of the patients’ number, and small-cell forms in ¼, the ratio of IIIA, IIIB and IV disease stages was 4:4:3. The cyclotron "Siemens-RDS-Eclipse-RD" (Germany), combined tomograph PET/CT "Biograph-64-TruePoint-Siemens (Germany) were used. Results. The side effects of radiation therapy were identified in 23 % of LC cases (22 % men and 32 % women). Among the main complications of LC it has been found (in descending order): myelodepression, pulmonary hypertension, acute radiation pneumonitis, hemoptysis, acute vascular insufficiency, radiation esophagitis, acute coronary syndrome, pulmonary fibrosis, acute cerebrovascular accident, pulmonary edema, thromboembolism of the pulmonary artery branches. The integral nature of the radiotherapy complications is associated with radiotherapy for primary tumor and palliative for distant metastases, has sexual dimorphism (radiation pneumofibrosis, esophagitis, acute vascular insufficiency, pulmonary edema) and is determined by the irradiation power (development of myelodepression, radiation esophagitis). The use of a metabolic image in PET/CT allowed us to specify the area of irradiation by including a peritumorous zone in the target. It has significantly increased the carcinocidal effect of radiation in all patients and ensured a higher survival rate of patients, avoiding cases of acute radiation pneumonitis, esophagitis and pulmonary fibrosis. Conclusions. The integral nature of the radiochemotherapy complications in LC is observed practically in every fourth patient with LC, it is associated with radical RT for the primary tumor and palliative for distant metastases, has gender specific features and is determined by the irradiation rate. PET/CT provides an increase in the radiation exposure effectiveness with a decrease in its effects on healthy lung tissue, and as the result the incidence of RT side effects is reduced. cancer of lungs; radiation therapy; positron-emission tomography

Changes in the lungs, heart and kidneys are found in all animals with experimental systemic autoimmune rheumatic disease and respectively in 47%, 47% and 40% of cases of intact rats in a hostile environment with xenobiotics air pollution (ammonia + benzene + formalin), herewith in every third or fourth individual lesions of visceral vessels developed. The negative environmental situation increases the frequency of morphological signs of the disease, such as proliferation of endothelial vessels of the heart by 68% and renal arterioles by 52%, in addition, there are direct correlations of angiopathy degree in individual organs;this depends on the nature of pathological process modeling and demonstrates air pollution as a risk factor of disease in humans. The impact of pulmonary vessels sclerosis on the development of bronhosclerosis, perivascular infiltration of the heart muscle on the lymphocyte-macrophage infiltration of the stroma of the myocardium and sclerosis of renal arterioles on the degree of nephroslerosis of stroma isdirectly associated, with the model of systemic autoimmune rheumatic diseases whereas air pollution by xenobiotics determines dependences of the degree of cellular infiltration of alveolar septa from perivascular pulmonary infiltration, the development of cardiomyocytes hypertrophy from proliferation of the heart endothelial vessels, increase of kidney mesangial matrix from the proliferation of endothelial glomerular capillaries.

The incidence of ankylosing spondylitis (AS) in population amounts to 0.3 %, which is significantly more likely to develop at the age of 20–30 years. There are two forms of AS – juvenile and adults, depending on the age of the disease debut. The problem of juvenile AS (JAS) diagnostics is one of the most relevant in pediatric rheumatology, and the evolution of this disease remains unexplored in adulthood. The aim of the study – to learn the frequency and nature of separate clinical signs of CNS and PNS lesions in patients with AS , and to evaluate their special features in the disease beginning in childhood and adulthood. Materials and Methods. 217 patients with AS (193 males and 24 females) with an average age of 38 years were examined. The rapidly progression course is detected in 21 % of patients, moderate and high activity rate – in 79 %, stage II–III – in 82 %, polyarthritis – in 65 %. JAS was noted in 16 % of cases (all boys), in which stage III took place twice as often than other patients. Results and Discussion. Changes in PNS are observed in 4.9 times more often among patients with JAS , and CNS is 2 times less often than in cases of the disease debut in adulthood, moreover among the patients of the 1st group, the severity of CNS disturbance is associated with the involvement of the cervical spine and the prevalence of spondylopathy, PNS is associated with the availability of tendovaginitis, arthritis of the "root joints" (shoulder, hip) and changes in the thoracic spine, while in the 2nd group it is associated with the parameters of the integral index of arthritis activity and the x-ray stage of the disease, with disturbance of "root" and sacroiliac joints, wherein the age of the disease onset affects the development of asthenic vegetative and corticonuclear syndrome, the emergence of radiculopathy, cervicocranialgia and metacarpal canal syndrome, and in the pathogenetic architectonics of the CNS pathology the level of immunoglobulin-A plays a greater role, and in PNS the serum interleukin 1-β contents, which, in addition, in cases of JAC determine the occurrence of cervicocranialgia, and in the remaining observations of AS – the Morton's metatarsalgia. Conclusions. AS with different age of the disease debut is a risk factor for the development of certain symptoms of the CNS and PNS disturbances, which in these groups have their pathogenetic features.

Thea uthorsstudied the content off reeand combine daminoacidin blood plasma of patients with erythrocytic abnormalities. Negative correlation has been found bet ween the amount off reeandcombined amino acids. The possibility of using amino acid analysis as a means of investigation of the mechanisms of pathological processesan dasadiagnostic indicator isdiscussed.

Systemic autoimmune rheumatic diseases are accompanied by an endogenous intoxication syndrome (EIS), but its clinical and pathogenetic significance in systemic sclerosis (SSc) is unknown. The aim of the work – to evaluate the role of EIS in the frequency and severity of separate clinical signs in SSD, significance in the pathogenetic constructions of the disease, the selection of the most informative prognostic criteria. Materials and Methods. The study included 63 patients aged 16 to 67 years (mean age – 42 years), among whom there were 11 % men and 89 % women. In 43 % of cases there was a limited form of SSc, 57 % – diffuse, disease duration averaged 11 years, I degree of activity of pathological process is set in 41 % of all patients, II – 38 %, III – 21 %. Positivity SSD by the presence in serum anti-topoisomerase antibodies (aScl70) installed in 78 % of cases, antibodies to native deoxyribonucleic acid (aDNA) in 64 % and antibodies to cardiolipin in 18 %. Results and Discussion. 12 blood parameters were studied (diene conjugates, malondialdehyde, xanthine oxidase, ammonia, urea, creatinine, uric acid, nitrite, the average mass of different factions molecule. All parameters were evaluated at 1 point, in case of their parameters > M + SD (where M – the median, the SD – standard deviation) – were evaluated in 2 points, while > M + 2SD – in 3 points. The sum of balls divided by the number of investigated parameters, thereby obtaining an index of endogenous intoxication, and when it exceeded 1 indicates the presence of SEI. In addition, further defined integrated surfactant index according to the level of equilibrium (static) surface blood tension. EIS occurs in 70 % of SS patients, which was caused by increase in blood levels of aminopeptid, peptide, nucleotide and containing aromatic chromatophores fractions of middle compounds, nonprotein nitrogen and products of lipid peroxidation, involved in the pathogenesis of scleroderma cardiomyopathy and vascular encephalopathy. In turn, the EIS with SSc can cause damage of skin, lungs, heart, liver, kidneys and nervous system. The content of nitrogenous compounds such as EIS components has significant direct correlation with the level of aScl70 in blood and the index of the severity of the EIS – with aDNA. Conclusions: EIS develops in most patients with SSc and is involved in its pathogenesis, wherein hyperasotemia is the risk factor central nervous system lesion, the accumulation average molecular weight in the organism – the liver and heart, and a surfactant index bigger than 4 is prognosis negative criteria for cutaneous syndrome.

The article is dealt with the selecting methodology of overvoltage arresters for DC traction line.

On the base of numeric investigations on mathematical models of stationary electric field the basic electric performances of insulating suspensions from porcelain and polymeric insulators for contact nets of alternating and direct current are compared.

Systemic scleroderma (SSD) (systemic sclerosis) is a unique rheumatic disease because it presents the challenge of managing a chronic multisystem autoimmune disease with a widespread obliterative vasculopathy of small arteries associated with varying degrees of tissue fibrosis. All organs having connective tissue and blood vessels can be involved in the pathological process. The progressive clinical course of SSD leads to the development of irreversible fibrotic changes, resulting in dysfunction of the affected organs. A distinctive feature of SSD is the clinical heterogeneity of subgroups of patients, which varies depending on the severity of the disease, the involvement of various organs and systems and the prognosis. The physician should carefully examine each SSD patient to understand the specific manifestations and the level of disease activity to prescribe appropriate therapy. At present, the use of treatment algorithms is a modern strategy for patients’ management, especially after unsuccessful use of the first line drugs. In early active diffuse scleroderma with predominant skin lesion, methotrexate (MTХ) should be preferred as the first line drug, and with its ineffectiveness or intolerance, the second line drug is mofetil mycophenolate (MMF), if it’s ineffective, the third line drug is intravenous cyclophosphamide. It should be noted that with severe skin lesions, the first line drug is MMF, and MTХ — the second one, if MMF if ineffective. To date, calcium channel blockers (CCBs), mainly nifedipine, are the first line drugs for the treatment of SSD-associated Raynaud’s syndrome. If these drugs are ineffective, phosphodiesterase-5 inhibitors (iFDE-5) should be added, the next step in therapy is to prescribe angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. In case of combination therapy by CCBs and iFDE-5 ineffectiveness in Raynaud’s syndrome, prostanoids should be added. The first line drug for the arthritis treatment, as well as for skin lesions, is MTX; when it is ineffective or the process has high inflammatory activity, glucocorticoids and nonsteroidal anti-inflammatory drugs should be added. Hydroxychloroquine is the third line drug and is added to the therapy if the above agents were ineffective. Biological agents (rituximab and tocilizumab) are the fourth line drugs in musculoskeletal involvement. [ABSTRACT FROM AUTHOR]

This paper presents an algorithm, designed to maximize the energy reserve of satellites, based on the method of Lagrange multipliers, which allows calculating a timeline that will ensure the minimum energy loss. Given the classification for subsystems - members of energy balance, their approximate timelines and features of their including in the algorithm. Shown the principles of formation for maximizing expression and system limitations. Showing results for assessing the proposed algorithm on the satellite KPI POLYTAN-1. References 3, tables 2. [ABSTRACT FROM AUTHOR]