The object of the research is a special-purpose communication system. The relevance of the research lies in the need for complex management of resources of special-purpose communication systems. The resources of the special-purpose communication system are defined as: spatial, temporal, frequency and hardware resources. Destabilizing factors include: intentional interference; denial-of-service cyber attacks and fire damage to individual elements of the special-purpose communication system. The method of complex management of resources of special-purpose communication systems was improved. The difference between the proposed method and the known ones is that the specified method contains improved procedures: ‒ determination of the impact of destabilizing factors on the special-purpose communication system; ‒ description of special-purpose communication systems of various architectures; ‒ determination of the rational route of information transmission and operation mode of communication devices in the general special-purpose communication system; ‒ consideration of uncertainty about the state of the special-purpose communication system; ‒ determination of the number of necessary forces and means of communication, which must be increased for the full functioning of the special communication system. The improved method provides a gain of 20‒26 % compared to classical approaches to the management of resources of special-purpose communication systems. The improved method can be used at the control points of the communication system of groups of troops (forces) while planning the organization of communication and at the stage of operational management of the communication system.

The aims of the study were: (1) to evaluate the Ukrainian reality of survival in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH); and (2) to determine predictors of death. A total of 281 patients were enrolled (52 [18.5%] with CTEPH, 229 [81.5%] with PAH). Long-term survival (Kaplan–Meier) and its predictors (Stepwise binary logistic regression and Cox's proportional hazards analyses) were evaluated in adult patients with PH (diagnosed by right heart catheterization [RHC]) within a prospective registry at a single referral center in Kyiv, Ukraine. Follow-up period was up to 51 months. The Kaplan–Meier survival rate for the total cohort was 93.3%, 86.8%, and 81.5% at one, two, and three years, respectively. Survival was better in patients with congenital heart diseases (CHD) in comparison with idiopathic PAH (long rank P = 0.002), connective tissue diseases (CTD; long rank P = 0.001) and CTEPH (long rank P = 0.04). Univariate Cox's predictors of death were: functional class IV (odds ratio [OR] = 4.94; 95% confidence interval [CI] = 2.12–11.48), presence of ascites (OR = 4.52; 95% CI = 2.21–9.24), PAH-CTD (OR = 3.07; 95% CI = 1.07–8.87), PAH-CHD (OR = 0.28; 95% CI = 0.11–0.68), HR on treatment > 105 beats per min (OR = 7.85; 95% CI = 1.83–33.69), office systolic BP < 100 mmHg (OR = 2.78; 95% CI = 1.26–6.1), 6MWT on treatment < 340 m (OR = 3.47; 95% CI = 1.01–12.35), NT-proBNP > 300 pg/mL (OR = 4.98; 95% CI = 1.49–16.6), right atrium square > 22 cm2 (OR = 14.2; 95% CI = 1.92–104.89), right ventricular square in diastole (OR = 1.08; 95% CI = 1.03–1.14), right ventricular square in systole (OR = 1.08; 95% CI = 1.02–1.11), mean pressure in right atrium per each 1-mmHg increase (OR = 1.02; 95% CI = 1.02–1.19). In multivariate Cox regression analyses only presence of ascites, office systolic BP < 100 mmHg, CHD etiology of PH, and NT-proBNP > 300 pg/mL were associated with survival.

Objective This study is the first attempt to use cardio-ankle vascular index (CAVI) for the evaluation of systemic arterial stiffness in patients with IPAH. Methods 112 patients were included in the study: group 1 – 45 patients with new diagnosed IPAH, group 2 – 32 patients with arterial hypertension, control group – 35 healthy persons adjusted by age. Right heart catheterization, ECG, a 6-minute walk test (6 MWT), echocardiography, blood pressure (BP) measurement and ambulatory BP monitoring, pulse wave elastic artery stiffness (PWVe) [segment carotid-femoral arteries] and muscular artery stiffness (PWVm) [segment carotid-radial arteries], CAVI, N-terminal pro-B-type natriuretic peptide (NT-proBNP) level were provided. The Spearman correlation, a linear regression and multivariable binary logistic analysis were performed to indicate the predictors associated with PWV and CAVI. Results The PWVm and PWVe were the highest in hypertensive patients – 10.3±1.5 and 11.42±1.70 m/s. The control group and IPAH did not have significant differences in aorta BP, but PWVm/PWVe values were significantly (P&lt;0.003/0.008) higher in IPAH patients than in the control group - 8.1±1.9/8.49±1.92 vs 6.63±1.34/7.29±0.87 m/s. The CAVIs on both sides were significantly lower in the healthy subjects (5.91±0.99/5.98±0.87 right/left side). Patients with IPAH did not differ from the arterial hypertension patients by CAVIs in comparison with the control group - 7.40±1.32/7.22±1.32 vs 7.19±0.78/7.2±1.1. PWVe did not correlate with any parameters except uric acid. PWVm correlated with uric acid (r=0.58, P&lt;0.001), NT-proBNP (r=0.33, P=0.03) and male gender (r=0.37, P=0.013) at Spearman analysis, but not at multifactorial linear regression analysis. The CAVI correlated with age and parameters characterized functional capacity (6 MWT distance) and right ventricle function (NT-proBNP, TAPSE) at Spearman analysis and with age and TAPSE at multifactorial linear regression analysis. At binary logistic regression analysis CAVI &gt;8.0 at right or/and left side had a correlation with age, 6MWT distance, TAPSE, but an independent correlation was only with age (β=1.104, P=0.008, CI 1.026–1.189) and TAPSE (β=0.66, P=0.016, CI 0.47–0.93). Conclusion In spite of equal and at normal range BP level the age adjusted patients with IPAH had significantly stiffer arteries than the healthy persons and they were comparable with the arterial hypertensive patients. Arterial stiffness evaluated by CAVI correlated with age and TAPSE in IPAH patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Academy of Medical science of Ukraine

The aim – to present to the medical community the functioning algorithm of the heart team concept in the diagnosis and surgical treatment of chronic thromboembolic pulmonary hypertension (CTEPH) in Ukraine. The concept of the CTEPH team implies a multi-disciplinary approach to the diagnosis and, consequently, surgical treatment of CTEPH with the participation of a radiologist, a pulmonologist, a cardiologist, a hematologist, a neurologist, and a cardiac surgeon. Considering the low incidence of the disease, the need for high-tech diagnostic tools, including CT angiography and angiopulmonography, as well as challenges of evaluating the operability of patients and the technical complexity of operations, patients with CTEPH are get together in the so-called reference centers. Within the framework of the CTEPH team concept, specific protocols and «road maps» have been developed for both diagnosis and treatment of the disease. In order to eliminate subjectivity in determining the operability of a patient with CTEPH, a special algorithm has been developed, which is applied to a clinical case for illustration. Monitoring patients with pulmonary embolism who are qualifed for a newly coined definition – postembolic pulmonary syndrome, has become a new task of the reference centers. The new syndrome is suggested to include CTEPH, as well as a similar, but not identical pathological condition, named chronic thromboembolic lung disease. The treatment of choice for CTEPH is pulmonary thrombendarterectomy. Mandatory elements of the surgical protocol include the creation of a «dry» operating field by means of a temporary circulatory arrest under deep hypothermia of 18 °C. Operations for distal lesions of the pulmonary arteries have become a recent achievement. The success of the operation depends on the anatomical type of the lesions, the degree of distal arteriopathy, the extent of the intervention, and the comorbid factors. Immediate and long-term results of the operation are evaluated as good and very good. The long-term survival of patients after surgery is significantly higher than of those who were administered medical treatment.Conclusions. Patients with suspected CTEPH should be referred to a reference expert center for diagnosis verification and operability determining. The standard diagnosis of CTEPH is angiopulmonography with simultaneous measurement of pressure in the right heart; the standard treatment is pulmonary thrombendarterectomy.

Ключевые слова: легочная гипертензия, катетеризация правых отделов сердца, тест 6-минутной ходьбы. Objective description of clinical characteristics of patients, their physiological and hemodynamic parameters during right heart catheterization in the center of pulmonary hypertension in Ukraine. Material and methods. The procedure fof the right heart catheterization according to national and international protocols was performed in 108 patients with intermediate or high probability of pulmonary hypertension according to expert echocardiography. Physiological evaluation at the time of diagnosis includes a 6-minute walk test, a NTpro-BNP level, and an expert echocardiography with expanded protocol and an assessment of the right ventricular function. Results. We confirmed the presence of pulmonary hypertension in 94 patients (90.4%). During the diagnosis, 67% of patients with pulmonary hypertension had functional class III and 8%-functional class IV, 75% of patients had functional class III or IV. 67 patients underwent right heart catheterization before administering specific therapy for pulmonary hypertension, and the remaining 27 patients had already received specific therapy without confirmation of diagnosis. Our experience has shown that the lack of accurate hemodynamic measurements leads to a misleading diagnosis or inappropriate use of drugs specific to pulmonary hypertension, which can lead the patient to seek alternative treatments that have no proven efficacy. Conclusions. Catheterization of the right heart is the only way to reliable diagnosis of pulmonary hypertension and the risk of serious complications. It is necessary for the diagnosis of pulmonary hypertension, assessment of pulmonary hemodynamic condition and estimation of further prognosis.