Prognostic value of the Metabolic Score for Insulin Resistance in the development of myocardial infarction in patients with coronary artery disease and obesity after coronary stenting

Aim. To assess the predictive value of anthropometric indices in relation to the risk of myocardial infarction in patients with coronary artery disease (CAD) and obesity after coronary stenting.Material and methods. The study included 229 patients with class II-IV angina pectoris, hospitalized for elective percutaneous coronary intervention with stenting. The median age was 55±7,5 years. Depending on the presence of obesity according to the World Health Organization criteria (1999), patients were divided into 2 groups. Group 1 included 107 obese patients, while group 2 — 122 non-obese patients. Patients were measured waist circumference (WC) and hip circumference (HC). In addition, waist-to-hip ratio was assessed. Lipid spectrum parameters were determined (total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C). The following indices were calculated: body mass index, visceral adiposity index, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), Metabolic Score for Insulin Resistance (METS-IR), TG-glucose index, lipid accumulation product, TG/HDL-C ratio, and metabolic index.Results. In the group of patients with obesity, higher values of cholesterol (p<0,001), TG (p<0,001), LDL-C (p=0,006), and lower HDL-C (p<0,001) levels were established. Comparative analysis of metabolic indices showed that all indices significantly differed in both groups. In order to determine the critical values for quantitative predictors, ROC curves were constructed with the determination of threshold values that increase the likelihood of myocardial infarction after revascularization. It has been shown that only the METS-IR has prognostic significance. It was found that the METS-IR >48,16 is a predictor of myocardial infarction in patients with CAD and obesity (area under the ROC curve, 0,653, sensitivity — 75%, specificity — 64,39%; 95% confidence interval: 0,587-0,716; p=0,045).Conclusion. In our study, we demonstrated the significance of the novel METS-IR. We found that the value of METS-IR >48,16 is a predictor of myocardial infarction in patients with CAD and obesity after coronary revascularization (area under the ROC curve, 0,653, sensitivity — 75%, specificity — 64,39%)

РАЗВИТИЕ ИНФОРМАЦИОННЫХ КОМПЕТЕНЦИЙ СТУДЕНТОВ ВРАЧЕБНЫХ СПЕЦИАЛЬНОСТЕЙ

The goal of this paper is the analysis of information communication technologies using for professional competencies development for medical students. There are described two informational learning technologies: standard and developed in Tomsk.Virtual learning environment Moodle is open source software which is developed for on-line education and installed in more than a dozen thousands educational institutions around the world including Russia. The Moodle provides students with rapid access to professional-oriented learning information via Internet any time and through any gadget. Using the Moodle a teacher can present different types of digital information, organize learning course, student’s knowledge and skills evaluation after structuring teacher’s knowledge. Rating approach is implemented in the Moodle very easy. Developed and develo­ping resources for the Moodle are located at the server http://simcenter.ssmu.ru.Learning electronic health record (LEHR) is developing by Tomsk professional team and it is the integration of an electronic health record and a program for clinical subject. There are additional functions besides usual for paper medical record, for example: learning about specialized software, electronic re­ference books, and medical standard documents. Information and clinical competences are forming in LEHR at the same time what is the undoubted advantage for students. Now LEHR on pediatrics and neurology are testing before trial exploitation in the learning. Software for LEHR and information about virtual patients are located at the server http://students.umssoft.com.The analysis and our experience have shown the possibilities of effective using the information communication technologies for development of informational and professional competencies of medical students in different subjects of educational program.Целью данной работы является анализ возможностей и описание опыта использования информационно-коммуникационных технологий для развития профессиональных компетенций студентов врачебных специальностей.Виртуальная обучающая среда Moodle является программным продуктом с открытым исходным кодом, специально разработанным для создания онлайн-курсов преподавателями и установленным в десятке тысяч образовательных организаций по всему миру, в том числе в Российской Федерации. Обучающая среда Moodle обеспечивает студентам оперативное получение профессионально значимой образовательной информации через Интернет в любое время и через любые устройства. Преподавателю Moodle дает возможности представления цифровой информации разного типа, организации самих занятий и системы контроля при условии четкого структурирования им своих знаний. Рейтинговый подход к оцениванию знаний студентов легко реализуется в данной системе. Реализованные и находящиеся в разработке ресурсы Moodle размещены на сервере симуляционного центра СибГМУ http://simcenter.ssmu.ru.Учебная электронная медицинская карта (УЭМК) разработана творческим коллективом в г. Томске и является результатом интеграции электронной истории болезни и программ клинических дисциплин. К обычным функциям истории болезни добавляется обучение студентов навыкам работы с программным обеспечением, электронными справочниками и ознакомление со стандартной медицинской документацией. Параллельное формирование информационных и клинических компетенций студентов является несомненным достоинством УЭМК. Учебная электронная медицинская карта по педиатрии и неврологии проходит окончательное тестирование перед опытной эксплуатацией в образовательном процессе. Деперсонифицированная информация о пациентах («база виртуальных пациентов») хранится на сервере http://students.umssoft.com.Проведенный анализ и опыт работы показали возможность эффективного использования информационно-коммуникационных технологий для развития информационных и профессиональных компетенций студентов врачебных специальностей в рамках различных дисциплин образовательных программ

CENP-F couples cargo to growing and shortening microtubule ends

Dynamic microtubule ends exert pulling and pushing forces on intracellular membranes and organelles. However, the mechanical linkage of microtubule tips to their cargoes is poorly understood. CENP-F is a nonmotor microtubule-binding protein that participates in microtubule binding at kinetochores and in the mitotic redistribution of the mitochondrial network. CENP-F-driven mitochondrial transport is linked to growing microtubule tips, but the underlying molecular mechanisms are unknown. Here we show that CENP-F tracks growing microtubule ends in living cells. In vitro reconstitution demonstrates that microtubule tips can transport mitochondria and CENP-F-coated artificial cargoes over micrometer-long distances during both growing and shrinking phases. Based on these and previous observations, we suggest that CENP-F might act as a transporter of mitochondria and other cellular cargoes by attaching them to dynamic microtubule ends during both polymerization and depolymerization of tubulin

Distance learning in cardiology: the use of multimedia clinical diagnostic tasks

Aim. To create a methodological base for distance learning of cardiology healthcare professionals — multimedia clinical diagnostic tasks.Material and methods. The interdisciplinary team used text and multimedia formats for clinical diagnostic data. Web technologies provided remote access to information located on the server.Results. The report presents the experience of the practical implementation of multimedia clinical diagnostic tasks in cardiology, including the augmented reality. The variability of presenting information to students is implemented in the multimedia clinical diagnostic tasks, which is integrated with the rating system for evaluating decisions. The solution paths are determined by the actions of the students in the trigger interactive blocks and is evaluated by the rating system. Personal rating is a numerical value that integrally characterizes the decisionmaking competence of students. The conversion of the quantitative rating into the conventional form (‘pass/fail’, ‘excellent’, ‘good’, ‘passing grade’) will be provided after the trial period of the software.Conclusion. The created Web service and computer simulations can become a methodological basis for the distance learning in cardiology. This technology can be in demand in the continuing medical education

CENP-F couples cargo to growing and shortening microtubule ends

Dynamic microtubule ends exert pulling and pushing forces on intracellular membranes and organelles. However, the mechanical linkage of microtubule tips to their cargoes is poorly understood. CENP-F is a nonmotor microtubule-binding protein that participates in microtubule binding at kinetochores and in the mitotic redistribution of the mitochondrial network. CENP-F-driven mitochondrial transport is linked to growing microtubule tips, but the underlying molecular mechanisms are unknown. Here we show that CENP-F tracks growing microtubule ends in living cells. In vitro reconstitution demonstrates that microtubule tips can transport mitochondria and CENP-F-coated artificial cargoes over micrometer-long distances during both growing and shrinking phases. Based on these and previous observations, we suggest that CENP-F might act as a transporter of mitochondria and other cellular cargoes by attaching them to dynamic microtubule ends during both polymerization and depolymerization of tubulin

Methodology in cardiologists’ postgraduate education

Aim. To develop the methodological ware for distance cardiologists’ postgraduate education by virtual patients’ simulations. The article describes the first stage of the project to create a database of virtual patients. It includes the integration of text and multimedia clinical and diagnostic information about patients and software for its presentation. A virtual patient is considered as an informational model of the diagnostic and treatment processes.Material and methods. To create a database of virtual patients, a description of completed clinical cases in specially designed patterns was used. To provide distance access to information about virtual patients, the JavaScript was used. Results. When forming the database of virtual patients, two categories of case histories were used — the most common cases and rare disease variants. From archival case histories and examination data, information has been selected that plays a significant role in the diagnosis and treatment. It was decided to present the information in the form of separate portions-visits. Each visit includes the results of tests and specialty consultations necessary to make a decision on further treatment. In the template developed by doctors and analysts, patient information is broken down into blocks that included complaints; anamnesis; physical examination; provisional diagnosis; diagnostic and treatment plan; tests’ results; administrations; final diagnosis; clinical report. These blocks served as the basis for the development of relational database tables. To visualize information about the virtual patient, prototypes of screen forms were implemented. Information about different visits was placed on different marks, and the user is able to see previously available information.Conclusion. After testing, this software will be used in education to demonstrate complete clinical cases to students. In addition, by each virtual case, tasks that require students to make medical decisions can be formed. The technology of virtual patients can be used both for postgraduates (doctors) and medical students

Neurocognitive deficits in clinical polymorphism of schizophrenia: typology, expression and syndromal overlaps

Objective. The authors tried to identify the typology, severity and overlap of neurocognitive deficits with positive/negative symptoms in patients with schizophrenia. Materials and methods. Fifty patients aged 22–55 years (25 women (50%) and 25 men (50%)) with schizophrenia diagnosed according to ICD-10 were examined. The average age was 38.0 ± 4.8 years, the average age of onset was 23 ± 3.2 years, the average disease duration was 15 ± 3.7 years. The patients were examined using battery tests to quantify their cognitive functions: Trail Making Test A&B; Stroop Color Word Interference Test; Verbal Fluency; Benton Visual Retention Test; 10 words learning; WAIS Digit Symbol Test; and WAIS Trail Making Test. The evaluation of cognitive deficits was carried out using z-scales. Association of neurocognitive deficits with other schizophrenia symptoms was also estimated using PANSS. The control group that was formed on the basis of the cognitive sphere parameters included 50 healthy volunteers. Statistical processing was carried out using the Mann–Whitney U test, k-means clustering, and the Kruskal-Wallis one-way analysis of variance. Results. The patients with schizophrenia and healthy individuals had significant differences in the second part of the Stroop Color Word Interference Test, both parts of the Verbal Fluency, average score of Benton Visual Retention Test, 10 words learning basedon 5 reiterations, WAIS Digit Symbol Test and WAIS Trail Making Test with p < 0.05; in the Trail Making Test B with p < 0.01. The cognitive sampling profile was determined and compared with the PANSS scores. The significant predominance (p < 0.05) of the symptoms across all scales was found with impaired attention, visual memory, performance function, and/or orientation/coordination, as opposed to the other manifestations of cognitive deficits. Conclusion. Neurocognitive deficits form syndromal overlaps with positive and negative schizophrenia syndromes, and the presence of attention, visual memory, performance and orientation / coordination disturbances is associated with the severity of schizophrenia in general