The state and prospects of development of problem-based learning in higher education

© 2016 Ibragimov, Ibragimova and Bakulina.Relevance of the work due to the need to resolve the contradiction between the new requirements for future professionals associated with the presence of experts formed by the ability to see, to identify and find solutions to problems that arise in their professional activity and the lack of readiness of teachers to implement the learning process of these requirements. The purpose of the article is to substantiate the thesis that the problem-based learning in a modern high school is objectively demanded as a basic foundation training. The methodological basis of the study was a systematic, competence and problem approaches. We used methods of study, analysis and synthesis of innovative experience of high school, the requirements of employers to the graduates, the latest scientific and educational literature in the field of didactics of vocational schools. The main results are that: The basic requirements for a modern model of learning in higher education; It justified the conclusion that in today's higher education Problem-based learning should be seen as a basic type of training that allows you to integrate educational opportunities and other learning technologies; revealed three major trends in the development of problem-based learning: the formation of an active problem-interactive learning technology, which is based on the interaction of at least three core technologies-the problem, and an interactive computer-based training; extension of the core of didactic teaching aids the creation of problematic situations in order to create all sorts of competencies; active development of integrative forms of realization of problem-based learning (problem-situational, problem-activity, problem-modular, task-design, problem-targeted, problem-playing, etc.). Materials may be useful to those skilled in the field of didactics of general and higher education, post-graduate students, university professors and secondary education system

Прогностическая сила МРТ-критериев в диагностике синдрома восстановления иммунитета у ВИЧ-инфицированных пациентов на примере сравнения классификации методом решающих деревьев и ROC-анализ

Introduction. Immune reconstitution inflammatory syndrome involving the central nervous system (CNS-IRIS) is a dangerous complication in HIV-infected patients on antiretroviral therapy (ART). The radiologic features of this syndrome have been little studied and are presented in isolated works. The diagnosis is difficult because there are no generally accepted criteria for IRIS. Our study is devoted to radiology of IRIS. Based on the results of brain MRI, together with clinical and laboratory data, MRI criteria for IRIS were formulated.Purpose and goals. To determine the prognostic value of MRI signs of CNS-IRIS using in a cohort of HIV-positive patients with neurological symptoms.Materials and methods. The analysis includes data from 68 HIV-infected patients who underwent brain MRI. In 14 of them were diagnosed IRIS with involvement of the central nervous system. To determine the diagnostic efficiency of the formulated MRI criteria, the STATISTICA program was used, decision trees were built, and a ROC analysis was performed.Results. Five decision tree models were built with different predictive values. The models took into account the categorical predictors (MRI criteria) in different order and quantity. The best performance has model #5, which can be considered a clinically useful predictive model.Conclusion. Brain MRI is an essential diagnostic step in HIV-infected patients on ART. It is necessary to expand the indications and conditions for radiological studies of the brain in patients with suspected immune reconstitution inflammatory syndrome.Введение. Синдром восстановления иммунитета с вовлечением центральной нервной системы (ЦНС-СВИ) является опасным осложнением у ВИЧ-инфицированных пациентов, принимающих антиретровирусную терапию (АРТ). Лучевая семиотика данного синдрома мало изучена и представлена в единичных работах. Отсутствуют общепринятые критерии СВИ, что затрудняет диагностику. Наше исследование посвящено изучению лучевой картины СВИ. По результатам МРТ головного мозга в совокупности с клиническими и лабораторными данными были сформулированы МРТ-критерии диагноза СВИ.Цели и задачи. Определить прогностическую силу совокупности лучевых признаков, выявляемых при ЦНС-СВИ с помощью МРТ головного мозга в когорте ВИЧ-положительных пациентов с неврологической симптоматикой.Материалы и методы. В анализ включены данные 68 ВИЧ-инфицированных пациентов, которым была выполнена МРТ головного мозга. У 14 из них был диагностирован СВИ с вовлечением ЦНС. Для определения диагностической эффективности сформулированных МРТ-критериев была использована программа STATISTICA, построены деревья решений, проведен ROC-анализ.Результаты. Были построены 5 моделей деревьев решений, обладающие различной прогнозирующей ценностью. Модели учитывали категориальные предикторы (МРТ-критерии) в различном порядке и количестве. Наилучшими характеристиками обладала модель № 5, которую можно считать клинически полезной прогностической моделью.Заключение. Проведение МРТ головного мозга у ВИЧ-инфицированных пациентов, принимающих АРТ, является неотъемлемым этапом диагностики. Необходимо расширение показаний и условий для проведения радиологических исследований головного мозга при подозрении на синдром восстановления иммунитета

The Black Sea Region Energy Cooperation: Current Trends and Prospects

The Black Sea region is one of the most complex regions in terms of energy development. It hosts several major powers and some developing countries that need to cut energy costs. In general, the region is controversial. It is influenced by external actors, and therefore regional stability is very difficult to achieve. In addition, institutional players such as the EU, the Belt and Road Initiative, the Black Sea Trade and Development Bank, etc., have their own vision of the future of the Black Sea region. The article is aimed at assessing the regional balance of power and estimating the interests of the countries of the region. Based on this assessment, the authors have classified the countries in the region, predicted potential alliances, and provided recommendations on how the countries should behave in the region. The key findings comprise the rejection of the two hypotheses: the countries of the region cooperate mainly through similar institutions; and the countries of the region can efficiently cooperate within the framework of a single strategy. The novelty of the article is in a new look on the regional distribution of power and new strategies for cooperation between countries in the region.Keywords: The Black Sea region, energy sector, strategy, institutions, balance of powerJEL Classifications: F59, Q48DOI: https://doi.org/10.32479/ijeep.11247</p

Нейрорадиологические признаки синдрома восстановления иммунитета при ВИЧ-инфекции

The introduction of antiretroviral therapy has changed the human immunodeficiency virus pandemic. Some patients with HIV infection after starting or resuming ART develop a paradoxical worsening of clinical status, called Immune Reсоnstitution Inflammatory Syndrome (IRIS). However, if clinical and laboratory criteria for the diagnosis of this syndrome have been formulated, IRIS neuroradiological criteria do not exist yet. The present study presents neuroradiological features and diagnostic algorithm for identification of IRIS involving central nervous system.Внедрение антиретровирусной терапии изменило характер пандемии вируса иммунодефицита человека. У некоторых пациентов с ВИЧ-инфекцией после начала или возобновления АРВТ развивается парадоксальное ухудшение клинического статуса, названное синдромом восстановления иммунитета. Однако если клинико- лабораторные критерии диагноза данного синдрома сформулированы, то радиологических критериев не существует. В настоящем исследовании сформулирован диагностический алгоритм выявления синдрома восстановления иммунитета с вовлечением ЦНС, определены его нейрорадиологические особенности

Biochemical and technological properties of moose (<i>Alces alces</i>) recombinant chymosin

Recombinant chymosins (rСhns) of the cow and the camel are currently considered as standard milk coagulants for cheese-making. The search for a new type of milk-clotting enzymes that may exist in nature and can surpass the existing “cheese-making” standards is an urgent biotechnological task. Within this study, we for the first time constructed an expression vector allowing production of a recombinant analog of moose chymosin in the expression system of Escherichia coli (strain SHuffle express). We built a model of the spatial structure of moose chymosin and compared the topography of positive and negative surface charges with the correspondent structures of cow and camel chymosins. We found that the distribution of charges on the surface of moose chymosin has common features with that of cow and camel chymosins. However, the moose enzyme carries a unique positively charged patch, which is likely to affect its interaction with the substrate. Biochemical and technological properties of the moose rChn were studied. Commercial rСhns of cow and camel were used as comparison enzymes. In some technological parameters, the moose rChn proved to be superior to the reference enzymes. Сompared with the cow and camel rСhns, the moose chymosin specific activity is less dependent on the changes in CaCl2 concentration in the range of 1–5 mM and pH in the range of 6–7, which is an attractive technological property. The total proteolytic activity of the moose rСhn occupies an intermediate position between the rСhns of cow and camel. The combination of biochemical and technological properties of the moose rСhn argues for further study of this enzyme

МЕЖДИСЦИПЛИНАРНЫЙ ПЕРСОНАЛИЗИРОВАННЫЙ ПОДХОД И ТЕХНОЛОГИИ ИЗУЧЕНИЯ ГОЛОВНОГО МОЗГА ПРИ ВИЧИНФЕКЦИИ

There was made an attempt to link interdisciplinary research methodically, from clinical diagnostic techniques, modern instrumental, laboratory and basic research to their implementation in practice. The experience of several partner groups studying the brain in HIV infection was analyzed and summarized. It was based on an interdisciplinary approach, the goals and authorities of infectious disease specialists,  psychiatrists, neurologists, radiologists, laboratory doctors, clinical examination algorithm, the role of history and interview, express-diagnostic of cognitive functions, specialized psychiatric, neurological  diagnosis, conclusion of clinical psychologists, indications for radiology methods. The choice and analysis of radiological and instrumental methods, the volume and structure of laboratory methods of central nervous system study were justified. The role of molecular genetic studies of HIV in blood and cerebrospinal fluid, the identification of drug-resistant forms of the virus was determined when choosing the therapy.Сделана попытка методически связать междисциплинарные исследования, начиная с клинических диагностических приемов, современных инструментальных, лабораторных и фундаментальных исследований до их реализации в практике. Проанализирован и обобщен опыт нескольких партнерских коллективов по методологии изучения головного мозга при ВИЧ-инфекции. В основу легли междисциплинарный подход, задачи и полномочия инфекционистов, наркологов-психиатров, неврологов, радиологов, врачей лабораторной службы, алгоритм клинического обследования, роль анамнеза и опроса, экспресс-диагностики когнитивных функций, специализированный диагноз психиатрический, неврологический, заключение клинических психологов, показания для радиологических исследований. Обоснованы выбор и анализ радиологических и инструментальных методов оценки ЦНС, объем и структура лабораторных методов для оценки процессов в ЦНС. Определена роль молекулярно-генетических исследований ВИЧ в крови и спинномозговой жидкости, выявления фармакорезистентных форм вируса, учет при выборе терапии

Новая мутация в гене TYMP: клинико-морфологическая характеристика пациента с синдромом MNGIE

Mitochondrial neurogastrointestinal encephalomyopathy is an extremely rare (1–9:1 000 000, Orphanet, 2021) multisystem genetic disease caused by mutations in the TYMP gene encoding the enzyme thymidine phosphorylase.The article presents the data of a thirteen‑year survey on 40‑year‑old patient D. with clinical manifestations of mitochondrial neurogastrointestinal encephalomyopathy syndrome associated with the previously undescribed missense mutation c.1301G&gt;T (p.Gly434Val) of the TYMP gene. Detailed clinical picture (gastrointestinal dysfunction, cachexia, blepharoptosis, ophthalmoparesis, peripheral polyneuropathy and leukoaraiosis), electroneuromyography data (demyelination with secondary axonopathy), high blood serum level of dihydrothymine together with normal levels of thymidine and deoxyuridine made it possible to verify the diagnosis. Histopathological examination revealed atrophy of the longitudinal (outer) muscle layer of the small and large intestines and a significant decrease in the number of CD117+ cells (telocytes), signs of damage to the striated skeletal muscles of a mixed nature with a predominance of the myogenic pattern, as well the destruction of the myelin sheaths of peripheral nerves. Histochemical examination did not reveal “ragged red fibers” characteristic of mitochondrial pathology. Transmission electron microscopy demonstrated the presence of megalomitochondria in the myocardium.Синдром митохондриальной нейрогастроинтестинальной энцефаломиопатии – редкое (1–9:1000000, Orphanet, 2021) генетическое мультисистемное заболевание, обусловленное мутациями в ядерном гене TYMP, кодирующем фермент тимидинфосфорилазу.Представлены данные 13‑летнего наблюдения пациентки Д., 40 лет, с синдромом митохондриальной нейрогастроинтестинальной энцефаломиопатии, связанным с ранее не описанной миссенс‑заменой c.1301G&gt;T (p.Gly434Val) в гене TYMP. Диагноз синдрома митохондриальной нейрогастроинтестинальной энцефаломиопатии был поставлен на основании клинических проявлений (дисфункция желудочно‑кишечного тракта, кахексия, блефароптоз, офтальмопарез, периферическая полинейропатия и лейкоэнцефалопатия), результатов электронейромиографии (демиелинизация с вторичной аксонопатией), а также повышения уровня дигидротимина в сыворотке крови при нормальных уровнях тимидина и дезоксиуридина. Патогистологическое исследование выявило атрофию продольного (наружного) мышечного слоя тонкой и толстой кишок и значимое уменьшение количества CD117+‑клеток (телоцитов), поражение скелетных мышц смешанного характера с преобладанием миогенного паттерна, а также деструкцию миелиновых оболочек периферических нервов. Исследование S100‑положительных вегетативных образований кишечной стенки не выявило патологических изменений. При гистохимическом исследовании не были обнаружены «рваные красные волокна», характерные для митохондриопатий. Трансмиссионная электронная микроскопия продемонстрировала наличие полиморфизма митохондрий кардиомиоцитов и мегаломитохондрий лейомиоцитов кишечника

Russian consensus on exoand endocrine pancreatic insufficiency after surgical treatment

The Russian consensus on exo - and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo - and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons

Rehabilitation after COVID-19. Resolution of the International Expert Council of the Eurasian Association of Therapists and the Russian Society of Cardiology

By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period