The aim – to determine polymorphisms of the nitric oxide synthase gene -786T>C rs 2070744 and the association of the corresponding genotypes with the severity of left ventricle (LV) diastolic dysfunction (DD), pulmonary hypertension (PH) and elastic properties of the arteries in patients with arterial hypertension (AH) and heart failure (HF) with preserved ejection fraction (EF). Materials and methods. We included 69 patients (pts) with AH and HF with preserved EF (31 female (41.9 %) and 33 male (58.1 %)), aged 67.4±10.2 years; II–III class NYHA, hemodynamically stable. According to Shah’s criteria, the «aging» phenotype was identified in 11 (15.9 %) pts, «obesity» – 14 (20.3 %) pts, «coronary artery disease» – 16 (23.2 %) pts, «pulmonary hypertension» – 17 (24.6 %) pts (with a significant predominance of patients with CC genotype), «arterial hypertension» – 17 (24.6 %) pts. Results and discussion. «Wild» homozygous TT genotype was found in 34 pts (49.3 %, TT group), heterozygous TC genotype – in 21 pts (30.4 %, TC group) and «mutant» homozygous CC genotype – in 14 pts (20.3 %, CC group). The groups did not differ in gender (male 19 or 55.9 %, 12 or 60 % and 11 or 61.1 %, p>0.05) and average age (67.1±8.9, 65.4±10.6 and 64.9±10.3 years p>0.05), and in prevalence of comorbidities. The worst result of 6-minute walk test was in the CC group compared with TT and TC (371.8±77.7, 385.7±85.4 and 314.3±69.1, p>0.05), as well as higher NT-proBNP level (668.1±317.8, 636.9±433.2 and 806.9±369.7, p>0.05), greater LVMI (187.4±37.1, 182.2±25.7 and 195.2±28.5, p>0.05). There was markedly more pronounced DD LV in the CC group compared with TT and TC, according to average e’ (p>0.05) and E/e’ (p>0.05). SPAP was the highest in the CC group (p>0.05), as well as PCWP and TPG (p>0.05). Patients of the CC group had worse elastic properties of arteries according to AIx75 (p>0.001) and PWVc-f (p>0.05), with a decrease in SAC (by 38.2 and 29 % compared to TT and TC (p>0.05) and an increase in Ea, respectively, by 21 and 9 % (p>0.05). According to the cuff test in patients of the CC group, compared with those in the TT and TC groups, worsening of endotelium-dependent vasodilation, respectively by 19.8 and 17.3 % (p>0.05) was revealed. Conclusions. Compared to other polymorphisms, the CC genotype of the NOS3 rs 2070744 gene is associated with greater severity of DD LV, LH and impaired LV diastolic function and elastic properties of systemic arteries, according to pulse wave analysis in patients with AH and HF with preserved EF.

кандидат педагогічних наук, старший викладач кафедри соціальної роботи, соціальної педагогіки та психології Центральноукраїнського державного педагогічного університету імені В. В. Винниченка ПРОФЕСІЙНА САМОРЕАЛІЗАЦІЯ МАЙБУТНІХ СОЦІАЛЬНИХ ПРАЦІВНИКІВ У статті розглянуто теоретичні аспекти професійної самореалізації майбутнього соціального працівника. Професійна самореалізація визначається взаємним впливом індивідуальних особливостей людини та соціального середовища в процесі здійснення трудової діяльності. Це засвоєння людиною професійних цінностей, набуття професійного досвіду, професійних та соціальних зв'язків, реалізація своїх здібностей, інтересів та потреб в процесі здійснення професійної діяльності. Професійне самовизначення є частиною особистісного, вони нерозривно пов'язані та взаємодіють один з одним. Спочатку особистість визначає цінності, мотиви та потреби, які орієнтують її на вибір професії. Такі особистісні чинники, як уміння організовувати свою діяльність, досягати успіху у взаємодії з людьми, гнучкість поведінки та незадоволеність собою стимулюють розвиток потреби до професійного зростання. Людина засвоює знання, вміння та навички, які необхідні для вирішення професійних завдань. А вже потім починає реалізовувати нагромаджений інтелектуальний досвід в межах професійного потенціалу, формує професійну майстерність і компетентність. Професійна самореалізація майбутніх соціальних працівників має свої особливості. Робота соціального працівника передбачає ідентифікацію особистості з професією, злиття з діяльністю, за якого професійні риси починають проявлятися в усіх інших сферах життєдіяльності й визначають характер ставлення особистості до навколишнього середовища. Також у статті визначено структуру професійної самореалізації майбутнього соціального працівника (професійне самовизначення, професійний розвиток, професійне становлення) та функції (ціннісно-орієнтаційна, виховна, гедоністична, пізнавальна, технологічна, комунікативна, управлінська, правова, духовно-моральна, естетична, валеологічна, розвивальна та економічна). Ключові слова: самореалізація, професійна самореалізація, соціальна робота, соціальний працівник, функції професійної самореалізації, структура професійної самореалізації.

The aim — to establish the clinical significance of the phenotype‑based approach to assessing patients with verified heart failure (HF) with preserved left ventricular (LV) ejection (LV) fraction and its relationship with the character and severity of morphofunctional changes in the heart and blood vessels.Materials and methods. The study involved 120 patients diagnosed with HF and preserved LVEF of IIA or IIB stage, II or III functional class by NYHA, with LV EF ≥ 50 % and signs of LV diastolic dysfunction according to transthoracal echocardiography data. The patients underwent general clinical examination, determination of the level of N‑terminal fragment of the brain natriuretic peptide precursor, transthoracal doppler sonography, applanation tonometry, 6‑minute walk test. The frequency of non‑cardiac and cardiac comorbid states was analyzed.Results and discussion. Patients were divided into four groups: phenotype «aging» (n = 26), «obesity» (n = 23), «coronary artery disease» (n = 27), «pulmonary hypertension» (n = 27). The control group included 17 patients with arterial hypertension without criteria specific to other phenotypes of HF with preserved EF, matched by age and blood pressure. Central systolic blood pressure in patients with phenotypes of «aging» (2), «obesity» (3), «coronary artery disease» (4), «pulmonary hypertension» (5) and patients of the control group (1) was 140.5 ± 8.9, 140.1 ± 11.4, 131.6 ± 13.2, 137.9 ± 8.8 and 136.5 ± 11.0 mm Hg, respectively (p1 — 2, 1 — 3, 1 — 4, 1 — 5, 2 — 4, 3 — 4 < 0.05), central pulse arterial pressure — 68.1 ± 9.1, 57.4 ± 12.6, 53.9 ± 11.5, 49.7 ± 7.9 and 59.1 ± 12.9 mm Hg (p1 — 2, 1 — 5, 2 — 3, 2 — 4, 2 — 5 < 0.05), pulse wave velocity — 12.4 ± 1.8, 12.3 ± 1.4, 12.8 ± 1.6, 13.3 ± 6.7 and 11.8 ± 1.2 m/s (all p < 0.05), augmentation index is standardized to the heart rate rate of 75 per 1 min — 37.4 ± 7.9, 34.9 ± 8.3, 39.7 ± 8.7, 48.9 ± 5.7 and 36.9 ± 6.4 (p1 — 4 < 0.05; p1 — 5, 2 — 5, 3 — 5, 4 — 5 < 0.01), augmentation pressure — 20.3 ± 4.4, 19.8. ± 5.2, 19.8 ± 4.8, 25.0 ± 2.9 and 21.3 ± 4.0 (p1 — 5, 2 — 5, 3 — 5, 4 — 5 < 0.01), the index of myocardial mass of LV — 180.4 ± 34.1, 196.7 ± 45.7, 195.0 ± 28.5, 186.9 ± 25.4 and 173.1 ± 32.9 g/m2 (p1 — 2, 1 — 3, 1 — 4, 1 — 5, 2 — 3, 2 — 4, 3 — 5, 4 — 5 < 0.05), left atrium volume index — 39.5 ± 7.4, 42.7 ± 6.9, 39.0 ± 3.8, 49.1 ± 10.3 and 38.8 ± 4.9 ml/m2 (p2 — 3, p3 — 4, 1 — 5, 2 — 5, 4 — 5 < 0.01, p1 — 3, 3 — 5 < 0.05), E/e¢ at rest — 14.1 ± 0.7, 14.3 ± 2.2, 14.2 ± 1.3, 15.9 ± 2.3 and 13.8 ± 3.2 (p1 — 2, 1 — 4, 1 — 4, 1 — 5, 2 — 5, 3 — 5, 4 — 5 < 0.05), the time of isovolumic relaxation — 95.5 ± 13.7, 84.4 ± 20.5, 95.1 ± 12.6, 84.7 ± 12.5 and 101.6 ± 13.2 ms (p1 — 3, 1 — 4, 1 — 5, 2 — 3, 2 — 5, 3 — 5, 4 — 5 < 0.05), e¢ser — 6.1  ±  1.8, 5.5 ± 1.1, 5.0 ± 1.0, 4.6 ± 0.7 and 6.4 ± 1.5 cm/s (p1 — 5, 2 — 5, 3 — 5 < 0.01, p1 — 3, 1 — 4, 4 — 5 < 0.05), the distance of 6 minute walk — 371.5 ± 81.9, 362.9 ± 81.0, 350.7 ± 50.2, 310.4 ± 67.2 and 472.9 ± 78.4 m (p1 — 5, 2 — 4, 3 — 4, 2 — 5, 3 — 5 < 0.01, p1 — 2, 1 — 3, 1 — 4, 4 — 5 < 0.05), the level of N‑terminal fragment of the brain natriuretic peptide precursor — 462.5 ± 237.3, (605. 9 ± 242.2), 626.3 ± 203.9, 1069.9 ± 315.3 and 287.1 ± 134.4 ng/ml (all p < 0.01), the number of patients with HF of III function class by NYHA — 13 (50.0 %), 12 (52.2 %), 17 (62.9 %), 16 (59.3 %) (p1 — 2, 1 — 3, 1 — 4, 1 — 5 < 0.05).Conclusions. The phenotype of «aging» most clearly reflects an increase in rigidity of the aorta, which leads to an increase in central aortic pressure and more pronounced diastolic dysfunction. The phenotype of «obesity» is characterized by considerable volume overload, LV hypertrophy and its diastolic dysfunction with higher filling pressures. The «coronary artery disease» phenotype is more often developed in men, is accompanied by diastolic dysfunction of LV mainly due to myocardial ischemia, a smaller volume of viable cardiomyocytes, and aortic stiffness, which in this case is conditioned by atherosclerotic calcification. The «pulmonary hypertension» phenotype is more characteristic of women and is accompanied by a significant increase in post‑loading on the LV, more pronounced structural changes in the myocardium with the involvement of the right heart, as well as the initial systolic dysfunction of the LV.

The aim — to determine the frequency of different combinations of criteria of heart failure (HF) with preserved ventricular ejection fraction (EF), established by the European Society of Cardiology (ESC) in 2016, in symptomatic patients with arterial hypertension (AH) in clinical practice and to assess their relationship to the clinical profile and the structural and functional state of the heart and arteries.Materials and methods. The study included 103 patients aged 43 to 85 years, with symptoms and signs of HF, AH and LVEF ³ 50 %, which had signs of diastolic dysfunction (DD) according to Doppler EchoCG data. The level of N­terminal fragment of the brain natriuretic peptide (NT­proBNP) was assessed by an enzyme immunoassay. The pulse wave velocity (carotid­femoral) (PWVcf) was assessed using applanation tonometry. Using ECG, the back wall thickness (BWT) of the left ventricle (LV) and interventricular septal thickness (IST), end­diastolic index (EDI) and end­systolic index (ESI) of the LV, left ventricular myocardial index (LVMI), left atrium volume index (LAVI) and left ventricular ejection fraction (LVEF). Early (E) and late diastolic left ventricular filling velocity (A), E/A ratio, diastolic speed of septal and lateral motion of fibrous mitral valve ring, the mean value e¢, the relation Е/e¢, tricuspidal regurgitation velocity (TRV), the deceleration time of early diastolic filling (DT) and left ventricular isovolumic relaxation time (IVRT), and systolic pulmonary artery pressure (SPAP) — with the use of Doppler EchoCG were evaluated. Patients with ratio E/e¢ 9 — 13 at rest underwent diastolic stress test.Results and discussion. According to the ESC algorithm, HF was absent in 11 (10.6 %) patients (group 1); 28 (30.4 %) patients had structural criteria and no functional criteria (group 2); 64 (69.5 %) patients had three structural and functional criteria of HF according to ESC algorithm (group 3). High left ventricular filling pressure (LVFP) was found in all 35 (54.6 %) patients of group 3 without atrial fibrillation (AF) and in 7 (26.9 %) patients of group 3. Normal left ventricular filling pressure was found in all patients of group 1 and 7 (26.9 %) patients of group 2. Left ventricular filling pressure could not be identified in 4 (36.3 %) patients of group 1 and 12 (46.1 %) patients of group 2 (all p < 0.01). AF was present in 29 (45.3 %) patients of group 3 and in 2 patients (7.1 %) of group 2 (p < 0.01). Increase in SPAP was noted in 52 (81.2 %) patients of group 3 and 4 (14.2 %) patients of group 2 (p < 0.01). The dilatation of the right ventricle (RV) was more pronounced in group 3 than in groups 2 and 1 (p < 0.01 and p < 0.05). Patients of groups 1 and 2 were comparable according to PWVcf, patients of group 3 had higher values of this indicator than those of groups 2 and 1 (all p < 0.01). E/e¢ while exercise stress was more than 13 in 78.5 % patients of group 2 and in 18.2 % of group 1 (p < 0.01). Groups 2 and 3 had high levels of NT­proBNP — 438.4 ± 97.2 and 1057.3 ± 157.0 pg/ml, accordingly, in group 1 its level was 199.7 ± 17.2 pg/ml (all p < 0.01).Conclusions. In 70 % of patients with hypertension and clinical signs of HF, both structural and functional criteria of diagnosis of HF with preserved LV EF were defined according to the recommendations of the ESC (2016), which was associated with an increase in LV feeling pressure, AF — in 45 %, pulmonary hypertension — in 52 (81.2 %), with right ventricle dilatation — in 81 % and 27 % increase in PWVcf in compared with age and sex matched patients with AH without HF. AH patients with only two structural criteria of heart failure with a preserved LVEF in the absence of functional criteria (30 % of cases) differ from patients with AH without HF in terms of the level of NT­proBNP, an increase in E/e’ while exercise (85 % of cases) and comparable severity of clinical signs of heart failure.

The aim —f the work is to make a comparative analysis of the parameters of bone remodeling, lipid and calcium­phosphor exchange and 25(ОH)D3 level in elderly women with uncomplicated arterial hypertension (AH) and without it.Materials and methods. The study included 44 patients with stage I — II AH, of 1 — 2nd degree (mean age — 69.1 ± 0.7 years, average duration of the postmenopausal period — 18.4 ± 0.9 years) and 30 practically healthy women (mean age — 69.3 ± 1.2 years, the average duration of the postmenopausal period was 19.4 ± 1.2 years. All patients underwent general clinical and laboratory examination with determination of lipid level in blood, 25(ОH)D3, parathyroid hormone, propeptidprocollagen of type I (P1NP), b­terminal telopeptides of collagen type I (b­STx), ionized calcium and phosphorus in serum, daily monitoring of arterial pressure, echocardiography and applanation tonometry.Results and discussion. In patients of the main group, compared with the control group, hypercholesteremia was revealed (total cholesterol — 6.3 ± 0.2 and 4.6 ± 0.1 mmol/l, low density lipoproteins — 3.8 ± 0.8 and 2.1 ± 1.2 mmol/l, triglycerides — 1.8 ± 0.1 and 1.0 ± 0.1 mmol/l, all p < 0.001), insufficiency and deficiency 25(ОH)D3 (23.76 ± 1.1 and 28.2 ± 2.1 ng/ml, p < 0.05), secondary hyperparathyroidism (parathyroid hormone — 64.6 ± 3.9 and 39.6 ± 1.1 ng/ml, p < 0.001), accelerated resorption of bone tissue (b­CTx — 0.57 ± 0.03 and 0.45 ± 0.03 ng/ml, p < 0.01). A direct proportional correlation between the level of total cholesterol, low density lipoproteins and P1NP (r = +0.417 and r = +0.481, all p < 0.01) indicates a link between hypercholesterolemia and bone remodeling activity in elderly patients with uncomplicated hypertension.Conclusions. In elderly women with controlled uncomplicated hypertension, in contrast to healthy women of the corresponding age, an increase in vascular stiffness according to applanation tonometry is associated with a decrease in the level of 25(ОH)D3, secondary hyperparathyroidism and an increase in the content of markers of bone resorption.