Опыт применения экстракорпоральной мембранной оксигенации у детей с бивентрикулярной физиологией в послеоперационном периоде

Aim. To assess the efficacy and safety of venoarterial ECMO in the early postoperative period after congenital heart surgery in children with biventricular physiology, to evaluate the recovery of ventricular contractile function, and to determine predictors able to predict the outcome of treatment and the prognosis of the disease.Methods. 15 medical records of pediatric patients treated in the period from 2016 to 2018 were retrospectively reviewed in a single-center study. The short-term outcomes of venoarterial ECMO in the early postoperative period were examined. Patients aged 1 month to 18 years were selected for the study. The median age of patients undergoing congenital heart surgery was 5 months (from 1 month to 4 years). 60% of them were male.Results. ECMO was started in the postoperative period due to inability to go off-pump in 5 OR patients (33.3%), postoperative circulatory arrest in 4 patients (26.7%), and low cardiac output syndrome in 6 patients (40%). The median body weight was 5.7 kg (from 3.7 to 15.6 kg). 14 patients underwent biventricular surgery. One patient underwent palliative repair, and then was referred to the total repair. The mean cardiopulmonary bypass time was 103.6 (±62.3) minutes with the aortic cross-clamp time of 51.9 (±27.3) minutes. 12 patients (80%) were disconnected from ECMO. The overall hospital survival was 66.7% (10 patients). The mean duration of ECMO support in survivors was 118.4 (±37.5) hours.Conclusion. The survival of patients improves with the steeper learning curve. ECMO contributes to the improved ventricular contractile function. Prolonged ECMO increases the number of specific complications associated with the procedure and affects survival. Our single-center experience in pediatric ECMO is generally consistent with the national and global trends in the use of mechanical support for intensive care.Цель. Проанализировать применение веноартериальной ЭКМО в раннем периоде после коррекции врожденного порока сердца у детей с бивентрикулярной физиологией, оценить динамику восстановления сократительной функции желудочков и установить предикторы, влияющие на исход лечения и прогноз заболевания.Материалы и методы. Проведен ретроспективный одноцентровой анализ лечения 15 пациентов педиатрической группы и представлены краткосрочные результаты применения веноартериальной ЭКМО в раннем послеоперационном периоде с 2016 по 2018 г. В анализ включены все больные в возрасте от 1 мес. до 18 лет. Медиана возраста на момент коррекции составила 5 мес. (от 1 мес. до 4 лет), 60% детей были мужского пола.Результаты. Причиной подключения ЭКМО в послеоперационном периоде у 5 (33,3%) больных явилась невозможность отлучения от ИК, у 4 (26,7%) - остановка кровообращения в послеоперационном периоде, в 6 (40%) случаях -рефрактерный синдром низкого сердечного выброса. Медиана массы тела составила 5,7 (от 3,7 до 15,6) кг. 14 пациентам выполнена бивентрикулярная коррекция, один пациент перенес паллиативную коррекцию, в последующем ему выполнена радикальная операция. Среднее время искусственного кровообращения составило 103,6 (±62,3) мин, время окклюзии аорты -51,9 (±27,3) мин. 12 пациентов (80%) были отключены от ЭКМО. Общая госпитальная выживаемость составила 66,7% (10 пациентов). Среднее время ЭКМО у пациентов, которых удалось отключить, 118,4 (±37,5) ч.Заключение. Показатель выживаемости при ЭКМО, по нашему мнению, улучшается с увеличением количества выполненных процедур и накоплением опыта специалистами. Сократительная способность желудочков после ЭКМО достоверно улучшается. Продолжительное ЭКМО увеличивает количество связанных с процедурой осложнений, что негативно влияет на выживаемость. Представленный опыт применения ЭКМО у педиатрических пациентов по кардиальным показаниям отражает общероссийскую и мировую тенденцию использования механической поддержки кровообращения

Методика и непосредственные результаты селективной контролируемой церебральной и миокардиальной перфузии при обструкции дуги аорты у детей

Highlights. Congenital heart defects in combination with aortic arch hypoplasia or coarctation of aorta are quite common in cardiac surgeon’s practice. The protection of internal organs is an important point in the treatment of these defects. Several methods have been proposed from hypothermic arrest to selective perfusion of various vascular regions. Given the variety of techniques, the effectiveness and advantages of each one are still a topic of debates. The article reflects the experience of using cerebro-myocardial perfusion in children with surgical correction of the aortic arch pathology.Aim. To analyze the prospects of regional selective controlled cerebral and myocardial perfusion method in surgical correction of aortic arch obstruction in children.Methods. A retrospective single-center analysis of the treatment in 29 pediatric patients was carried out and immediate results of cerebral-myocardial perfusion used in children with surgical correction of aortic arch obstruction in the period from 2016 to 2020 are presented. Median age was 6 days (1 day – 15 years old). Median weight was 3.6 kg (1.8–47 kg). 15 patients were girls, 14 patients were boys. The inclusion criteria for all the patients were cerebro-myocardial perfusion for aortic arch reconstruction.Results.Cardiopulmonary bypass time median was 78 minutes (43–206 minutes). The average time of cerebro-myocardial perfusion was 22.4 + –6.4 min (12–35 min). The median duration of the surgery was 3.1 hours (2.25–5.5 hours). The median time for mechanical ventilation was 101 hours (6–744 hours), in the ICU – 8.5 days (1–31 days). The average time of hospital stay was 18.2 days + –6.7 days (7–31 days). Early postoperative mortality was 3.4%. Renal replacement therapy was required for 2 newborns (7%). Operational risks, according to the Aristotle Score, were significantly higher in newborns (χ2 = 3.9277, df = 1, p-value = 0.0475). There were no cardiac events associated with myocardial perfusion. The type of cardioplegia (blood or “Kustadiol”) did not significantly affect the pumping function of the heart, assessed by transthoracic echocardiography on day 1 after the surgery (χ2 = 0.27273, df = 1, p-value = 0.6015). Acute ischemic cerebrovascular accident occurred in 1 patient (3.5%).Conclusion. The technique of controlled selective cerebro-myocardial perfusion is reproducible without any additional resource costs. We can confidently say that the time of surgery and cardiopulmonary bypass is much shorter than in case of using deep hypothermic arrest or isolated selective cerebral perfusion, as soon as there is less time needed for cooling and re-warming the body. Also, the time of cardiac arrest was reduced or completely eliminated (with isolated reconstruction of the aortic arch). The technique is effective and safely reproducible in both newborns and older children. The results for mortality and complications are encouraging but must be further evaluated and compared.Основные положения. Врожденные пороки сердца в сочетании с гипоплазией дуги и коарктацией аорты – частое явление в практике кардиохирургов. При лечении данных пороков важную роль играет защита внутренних органов. Предложено несколько способов протекции: от гипотермического ареста до селективных перфузий различных сосудистых бассейнов. С учетом разнообразия методик эффективность и преимущества каждой из них остаются дискутабельными. В статье отражен опыт использования церебро-миокардиальной перфузии у детей при хирургической коррекции патологии дуги аорты.Цель. Проанализировать перспективность использования метода регионарной селективной контролируемой церебральной и миокардиальной перфузии при хирургической коррекции обструкции дуги аорты у детей.Материалы и методы. Проведен ретроспективный одноцентровой анализ лечения 29 пациентов педиатрической группы. Представлены непосредственные результаты применения церебро-миокардиальной перфузии у детей с хирургической коррекцией обструкции дуги аорты в период с 2016 по 2020 г. Медиана возраста составила 6 (1 день – 15 лет) дней, медиана веса – 3,6 (1,8–47) кг; среди них 15 девочек и 14 мальчиков. Критерии включения – все больные с церебро-миокардиальной перфузией для реконструкции дуги аорты.Результаты. Медиана времени искусственного кровообращения – 78 (43–206) мин. Среднее время церебро-миокардиальной перфузии – 22,4±6,4 (12–35) мин. Медиана продолжительности операции – 3,1 (2,25–5,5) ч. Медиана длительности искусственной вентиляции легких – 101 (6–744) ч, пребывания в отделении реанимации и интенсивной терапии – 8,5 (1–31) дня. Среднее время нахождения в стационаре составило 18,2±6,7 (7–31) дня. Ранняя послеоперационная летальность – 3,4%. Заместительная почечная терапия потребовалась двум (7%) новорожденным. Оперативные риски согласно Aristotle score достоверно выше у новорожденных (χ2 = 3,9277, df = 1, p = 0,0475). Не выявлено кардиальных событий, связанных с перфузией миокарда. Тип кардиоплегии (кровяная или «Кустадиол») значимо не влиял на насосную функцию сердца, оцененную с помощью эхокардиографии трансторакально на 1-е сут. после операции (χ2 = 0,27273, df = 1, p = 0,6015). Острое нарушение мозгового кровообращения по ишемическому типу отмечено у одного (3,5%) пациента.Заключение. Контролируемая селективная церебро-миокардиальная перфузия воспроизводима без дополнительных ресурсных затрат. При использовании данного метода продолжительность операции и искусственного кровообращения значительно ниже в сравнении с глубоким гипотермическим арестом или изолированной селективной церебральной перфузией, поскольку на охлаждение и согревание организма уходит меньше времени. Также снижается или вообще исключается (при изолированной реконструкции дуги аорты) время кардиального ареста. Методика эффективна и безопасно воспроизводима как у новорожденных, так и детей более старшего возраста. Результаты летальности и осложнений внушают оптимизм, но требуют дальнейшей оценки и сравнения.

Individual educational paths as factor of enhancing of future teachers training quality

The relevance of the issue under study is conditioned by the importance of enhancing the pedagogical education quality and by the following necessity of implementation of an individual approach and individual educational paths of learning. The article is aimed at studying issues of implementing individual educational paths in the framework of the teaching of pedagogical specialty students for making the quality of their training higher. Ten students of the RSVPU took part in the study. As a result of the analysis, the most effective methods and forms of using individual learning paths in teacher training have been identified.La relevancia del tema en estudio está condicionada por la importancia de mejorar la calidad de la educación pedagógica y por la siguiente necesidad de implementar un enfoque individual y caminos educativos individuales de aprendizaje. El artículo tiene como objetivo estudiar cuestiones de implementación de caminos educativos individuales en el marco de la enseñanza de estudiantes de especialidad pedagógica para mejorar la calidad de su formación. Diez estudiantes de la RSVPU participaron en el estudio. Como resultado del análisis, se han identificado los métodos y formas más efectivos de utilizar las rutas de aprendizaje individuales en la formación del profesorado

Use of the LMS Moodle for an effective implementation of an innovative policy in higher educational institutions

This article considers the opportunities of using Moodle LMS (learning management system) tools to ensure the effective implementation of an innovative policy of the higher educational institution. In the framework of digital transformation of social space an important and relevant topic for higher educational institutions is the creation of high-quality information and communication environment, which shall correspond to the contemporary state of science and technology development, global educational standards and information society needs. The advantages of the Moodle system are studied. Moodle system provides for a comprehensive educational process through its extensive educational content, a system for control, monitoring and evaluating the knowledge quality. The authors compare the four-phased model of knowledge management with the capacities of LMS Moodle educational environment. The latter is capable of simulating professional actions in a virtual educational space that allows the university to train advanced specialists and ensure a high level of their professional skills based on hard and soft skills. The perceptive and cognitive attitude of university students and teachers towards the implementation of the LMS Moodle educational platform was researched. The research has brought out the subjective assessment model of the innovative process with clear meaningful factors of changes' perception. Such a model allows understanding the collective attitude to the university's policy and highlighting mental settings necessary for working with human resources within the social adaptation and diffusion of innovation. The synergy of technological and managerial innovations has been updated to ensure completeness and efficiency in presenting a professional educational product based on the LMS Moodle platform. © 2020 Kassel University Press GmbH

Mobile-Learning Platform for the Development of Entrepreneurial Competences of the Students

The aim of the study was to determine the effectiveness of using a mobile learning platform for students’ entrepreneurial competence improvement. The platform was implemented by the Russian State Vocational Pedagogical University and the Financial University under the Government of the Russian Federation. It allowed users to publish assignments, exchange ideas, generate photo and video content, demonstrate creative developments, and receive feedback. The research process enrolled 70 experimental group students, 25 control group students, 2 instructors, and 2 administrators from the considered educational institutions, as well as 3 practitioners invited to review projects. As a result of this examination (Cronbach’s alpha ranged from 0.678 to 0.714), it was noted that 41.4% of all research participants rather agreed that the experiment goals were accomplished and noted personal progress in mastering entrepreneurial competences, whereas 53.4% agreed unequivocally that the experiment was fully successful. Analysis of entrepreneurial competences and deviations from repeated competence evaluations before and after the experiment revealed that the experimental group was marked with notable progress (F (1.32) 2 = 42.26, p = 0.00, ?p = 0.56). Average entrepreneurial competence assessment results for this group were slightly higher than those for control – they constituted 4.5 points against 4.0. Research findings are believed to be universal and interesting to educators and administrative staff of educational institutions or those involved in creating and conducting entrepreneurship training courses. © 202

Rutas educativas individuales como factor de mejora de la calidad de la formacion de futuros docentes

The relevance of the issue under study is conditioned by the importance of enhancing the pedagogical education quality and by the following necessity of implementation of an individual approach and individual educational paths of learning. The article is aimed at studying issues of implementing individual educational paths in the framework of the teaching of pedagogical specialty students for making the quality of their training higher. Ten students of the RSVPU took part in the study. As a result of the analysis, the most effective methods and forms of using individual learning paths in teacher training have been identified. © 2019, Universidad del Zulia. All rights reserved

Study of plasma incineration processes in ecological waste recycling technologies

The processes of high temperature material heating for plasma recycling are investigated. The gas-dynamic parameters of the air-plasma flow in the plasma torch mixing chamber for ecology technologies are determined by methods of mathematical modeling. The characteristic temperatures, velocities and heating times of the utilized gas in different areas of the mixing chamber are determined. The directions of further research and development necessary to create a technology of plasma recycling with maximum efficiency are outlined. The issues of plasma recycling introduction at certain stages of high-temperature technologies are also considered. © 2019 Anakhov et al.Russian Foundation for Basic Research, RFBR: 19-08-00190The work is executed at support of RFBR grant 19-08-00190

Study of plasma incineration processes in ecological waste recycling technologies

The processes of high temperature material heating for plasma recycling are investigated. The gas-dynamic parameters of the air-plasma flow in the plasma torch mixing chamber for ecology technologies are determined by methods of mathematical modeling. The characteristic temperatures, velocities and heating times of the utilized gas in different areas of the mixing chamber are determined. The directions of further research and development necessary to create a technology of plasma recycling with maximum efficiency are outlined. The issues of plasma recycling introduction at certain stages of high-temperature technologies are also considered. © 2019 Anakhov et al